Floor Statements

Madam President, New Hampshire takes pride in its many firsts among the States, including our first in the Nation Presidential primary. This year, Granite Staters have been celebrating the 300th anniversary of the New Hampshire State Library, the first State library in America. It all began in Portsmouth on January 25, 1717, when the 27th General Assembly directed ``ye Law books be distributed among ye severall towns of this Province in proportion according to their last Prov. tax, except two books which shall be for ye use of ye Govr & Councile and house of representatives.'' Three centuries later, the original books are surrounded by a modern collection of more than 600,000 items, housed across from the State house in Concord. The State Library is one of our most handsome public buildings, built in 1896 of New Hampshire granite, American steel, and Italian marble.

We Granite Staters love our libraries, and we have led the Nation in making books available to all citizens. As State librarian Michael York told New Hampshire Public Radio: ``We often use the term `anchor institutions.' There are 234 communities in New Hampshire and there are 234 public libraries. Nobody else can make that claim. Not McDonald's, not 7-11, not Dunkin' Donuts.''

In 1833, Peterborough established the first tax-supported public library in the world, a central collection of books owned by the people and free to all residents of the town. In the early 1800s, so-called social or parlor libraries sprang up across our State--places where dues-paying members came together to share books. A century later, wealthy philanthropists built free public libraries all across our State, including nine impressive Carnegie libraries. Phillips Exeter Academy, a private school in Exeter, NH, is home to the largest secondary school library in the world. Today every city and town in New Hampshire has a public library, and a key mission of the State library is to provide professional development for local librarians to keep them abreast of the latest developments in library science and technologies.

The State library serves as a centralized location for State and government documents, and its collection specializes in New Hampshire newspapers, authors, and books on New Hampshire history and culture. It includes an archive of Granite State political history, including posters, buttons, and bumper stickers from New Hampshire Presidential primaries dating back to 1952. One of its most prized possessions is a 20-foot, floor-to-ceiling ``Hitchcock map'' of New Hampshire, with the State's mountains, valleys, and lakes carved in relief by Dartmouth College--students in 1877.

During my years as Governor, I had the daily pleasure of looking out on our beautiful State library from my office windows in the State capitol. Both the building and its collection are among our State's most prized cultural treasures. I am grateful to State librarian Michael York and his professional staff for their dedicated service to our State and for their loving stewardship of this special building. I join with people across the Granite State in celebrating the first 300 years of America's first State library.

Mr. President, I was interested to hear my colleague and friend from North Dakota talking about this tax bill because, sadly, there has not been a lot of bipartisan work on the bill.

I really agree there is a consensus that tax reform is it long overdue, but we need tax reform that simplifies the Tax Code, bolsters the middle class, and helps small businesses create jobs. I think those principles could have been the basis for really good bipartisan work here in the Senate, and in Congress, generally, to come up with a bill that would have done all of those things, but, unfortunately, the legislation in front of us does none.

The result is a partisan tax bill, written in secret and without public hearings, adds to the national debt, punishes the middle class and small businesses, and gives massive tax cuts to corporations and the wealthy.

Last week, I came to the floor to share the concerns of Granite Staters about this legislation. They were amplified at a forum I had on Monday at Southern New Hampshire University, where I heard from students, graduate students, and higher education leaders in the State about the damage this bill would do to our State and to our national economy.

I have heard some reports today that there will be changes that come out of the conference committee that may address some of the concerns about the bill's impact on education. I hope that is true. Unfortunately, I haven't heard what those changes are. I don't know if any Democrats here have heard what those changes are. Unfortunately, these negotiations, like the bill, are being done in secret, and the future of students and so many people in New Hampshire and the country hang in the balance.

In particular, what I heard at the forum with the students and educators was that the bill as it passed the House would raise taxes on New Hampshire students and would make it financially impossible for many of them to continue their educations.

As passed, the House tax bill would eliminate the ability of individuals to deduct the interest they pay on their student loan debt. Nationwide, student loan debt has roughly tripled since 2004 and now totals a staggering $1.3 trillion--more than the total credit card debt in the country. It is particularly burdensome for those of us in New Hampshire because New Hampshire's 2016 graduating class had the highest per capita student loan debt in the country--an average of $36,367.

The Republican leader's tax bill would make this crisis far worse not only for current students but for those who graduated many years ago but are still burdened by student loan debt. It would prevent nearly 80,000 Granite Staters from deducting interest on their student loans.

The House legislation would also make it far more expensive to get an advanced degree because it eliminates tax-free waivers for tuition assistance. I am hearing recent reports that this provision may be taken out of the final bill. I certainly hope that is the case because as currently written, it would put graduate school financially out of reach for many students.

A Dartmouth College student pursuing a Ph.D. in biomedical sciences wrote that counting tuition waivers as earned income would raise his yearly taxes by more than $10,000. He said he

would no longer be able to afford rent and groceries and would have to consider dropping out of school.

Ken Ferreira, the associate vice president for student financial services at Franklin Pierce University, told me, in no uncertain terms, that tuition waivers are not income, and it is wrong to tax them. I could not agree more.

Tyler Kane is pursuing a master's degree in environmental engineering at the University of New Hampshire. He told me he already owes close to $40,000 in student loans and works nearly 60 hours a week. After paying rent and other expenses, his stipend leaves him with less than $200 a month. If his tuition waiver becomes taxable, that would be a tax increase of $2,500, and it would wreck his budget, leaving him in a $33-a-month hole. Along with many of his graduate student colleagues, he would have to consider dropping out of school.

It makes no sense to increase the burden of student debt and to impose new taxes on graduate students struggling to get by so we can give the biggest corporations in this country and the wealthiest a tax cut.

It is estimated that by 2020, two-thirds of all jobs in the United States will require some form of higher education. Yet today less than 45 percent of Americans have at least a 2-year degree. As I talk with small business owners across New Hampshire, one of their biggest challenges is finding skilled workers. The last thing we need to do is make education more expensive and unaffordable for millions of young Americans. As one New Hampshire businessman told me, it is like eating our own seed corn. For the United States to stay competitive in the global economy, we can't afford to discourage talented young people from going to college or pursuing a graduate degree.

I also had the opportunity to talk with Nate Stafford. He is pursuing a Ph.D. at the University of Hampshire. Because he serves as a teaching assistant, the university provides a tuition waiver of nearly $27,000, which would be taxed under the provision of the House bill. If his tuition waiver were taxed, that would force him to consider opting out of graduate school entirely.

I also heard from university administrators, who shared their concerns.

Sister Paula Marie Buley, president of Rivier University, pointed out that the proposed new taxes on students is ``a tax on our future.''

Jan Nesbit, the senior vice provost for research at the University of New Hampshire, warned that taxing graduate students' tuition waivers would have a cascading impact that would raise undergraduate tuition across the board because losing graduate students would affect both teaching assistants and research and drive up costs.

I heard from Cari Moorhead, the interim dean of the graduate school at the University of New Hampshire. She pointed out that many international students at UNH would be lost and noted that Canada has recently seen more than a 40-percent increase in international students. They are very pleased to be benefiting from the brain drain from the United States because of the financial barriers that we are putting up for graduate students.

The other damaging aspect of this legislation, which I think many people are not aware of, is that the tuition assistance that many companies provide to their employees would count as taxable income. Forty years ago, Congress provided employers with the flexibility to offer up to $5,250 in annual tax-free educational benefits to employees. This was designed to advance competitiveness and fill the need for more skilled workers. If we eliminate those benefits, how many of those employees who are looking to advance themselves through education will not be able to do that?

In so many ways, this tax overhaul legislation would take America backward, not forward. Tax reform should be about helping Americans prepare for the jobs of the 21st century; it shouldn't make it harder to afford college or graduate school. Tax reform should be about strengthening the middle class, not burdening it with higher taxes. Tax reform should be about growing the economy, not growing the deficits and the debt.

Like my colleagues on this side of the aisle, I am eager to work to genuinely reform the Tax Code. Reform is long overdue, but the bill we have before us is not reform. We need a bipartisan bill that puts the middle class first, puts small businesses first, and doesn't leave a massive debt for our children and grandchildren.

Mr. President, I yield the floor.

Mr. President, I agree with my colleagues that we need tax reform, but we need tax reform that simplifies the Tax Code, bolsters the middle class, and helps small businesses to create jobs. I think we can do that, and we can do that in a fiscally responsible way, but we need to work together, Republicans and Democrats, as we did the last time we did tax reform.

Unfortunately, these priorities are not reflected in the bill that is before us. Instead, it is a partisan, fiscally irresponsible giveaway to the wealthy and the largest corporations in this country, and it comes at the expense of the middle class and small businesses.

We know that the wealthiest Americans will see massive tax breaks from this bill, including President Trump himself. In fact, the New York Times has estimated that President Trump and his family would save more than $1 billion from this tax bill.

How does this legislation pay for these tax cuts? Well, it asks today's middle class and future generations to foot the bill. The nonpartisan analysis from the Joint Committee on Taxation has found that the bill will raise taxes on millions of middle-class families making less than $75,000 a year. The bill sunsets any middle-class tax breaks in 2026, and at the same time it makes tax breaks for large corporations permanent. It increases the national debt by $1.5 trillion.

I think the headline in the current Forbes Magazine says it all. It says

``The GOP Tax Bill Is The End Of All Economic Sanity In Washington.'' As more people look at this bill, they are beginning to see how it will hurt middle-class families across the country.

Over the past few weeks, I have heard more and more concerns from people throughout New Hampshire, and I just want to take a minute to highlight some of these concerns. I met recently with the New Hampshire Realtors and homebuilders. They are major advocates for home ownership in New Hampshire. They told me that this bill is nothing short of an attack on home ownership. In particular, they are concerned about the impact of repealing the State and local tax deduction, which would be a huge hit to middle-class families in New Hampshire. Right now, more than 200,000 Granite State homeowners use the State and local tax deductions so that they are not double-taxed. That is about one-third of taxpayers in New Hampshire. It is particularly important to us where property taxes account for 66 percent of all State and local taxes. That is a higher share than any other State in the country.

Homeowners are also concerned about proposals to limit the mortgage interest deduction, including on home equity lines of credit, where homeowners in New Hampshire are going to get hurt more than others because we have approximately 14 percent of homeowners who have a home equity line of credit, compared to 3.8 percent nationally. The result is, according to the Realtors and the homebuilders, that home values will decline significantly.

According to the Association of Realtors, this bill will put downward pressure on home values by as much as 18 percent in New Hampshire and 10 percent nationally. If we look at this chart for New Hampshire, we can extrapolate this across the rest of the economy.

If we look at this tax bill, this is the impact on homeowners in New Hampshire. Values are going to be reduced by about 18 percent. That is equivalent to what we saw after the financial meltdown in 2008, where, again, we had about that same reduction in property values--about 18 percent. That is a huge hit for us in New Hampshire and for people across the country.

I thought the Realtors put it very well when they said: It is simply unfair to ask homeowners, who pay 83 percent of all Federal income taxes, to take a greater tax burden so that the biggest corporations in this country can have steep tax cuts. It doesn't make sense.

I also heard significant concern from students, colleges, and businesses that this bill will raise taxes on students trying to get the skills they need to get ahead. That is really crazy because when we do that, we don't create the workforce we need for the future. The House bill, for example, would eliminate the ability of individuals to deduct the interest on their student loans, and it would tax graduate students on tuition assistance. I heard from a graduate student who, right now, is making $20,000 a year on a stipend. That is what he is trying to live on. If this bill goes into effect, he will pay $5,000 of that in taxes. It doesn't make sense. We need to be encouraging our students to get graduate and higher education degrees so that they can take on the jobs of the future.

Again, in New Hampshire, it is a particular problem, where student loan debt is higher than the national average. For the graduating class of 2016, New Hampshire had the highest per capita student loan debt in the country. The average debt for New Hampshire graduates was $36,367. We know, nationally, student loan debt has roughly tripled since 2004 to a staggering $1.3 trillion. That is higher than the total credit card debt. What this legislation is likely to do is to make that worse for young people who are trying to get out of college, have their student loans paid, get married, start families, buy a house. If they continue to have this impact, they are not going to be able to do any of those things.

The top challenge that faces New Hampshire businesses and so many businesses across this country is finding skilled workers. The last thing we should be doing is making education more expensive.

I also serve as the ranking member on the Senate Small Business Committee. Small businesses employ more than half of our workforce. They make up more than 99 percent of all employers. We need to work in a bipartisan way to enact tax reform that supports our small businesses. Again, this bill, unfortunately, doesn't provide meaningful reform for small businesses and the problems they are facing with the Tax Code. First of all, this bill doesn't address the top issue that we have heard from small businesses--tax simplification and the cutting of redtape in our Tax Code.

For entrepreneurs, time is one of their most valuable resources. Every wasted hour spent filling out forms or navigating confusing tax rules is an hour they can't spend innovating, marketing, and growing their businesses. The tax system is so difficult to navigate that 89 percent of small businesses turn to outside tax preparers to fill out their forms and file their returns. The compliance burden for small businesses is 67 percent higher than it is for large businesses, and it costs about $18 billion annually.

Tax reform should be an opportunity to help us help small businesses focus on what they do best, and that is running their business. Instead, this bill will result in even more redtape and complexity.

According to a former Joint Committee on Taxation economist, if this bill becomes law:

Treasury will be writing regulations and Congress will be

enacting technical corrections for years. There are more

ticking time bombs in this bill than in a Roadrunner cartoon.

A recent poll of small business owners from Businesses for Responsible Tax Reform found that a majority of them oppose the plan. This is polling that has just been done in the last week or so; 61 percent oppose, and only 28 percent support.

Small businesses are even more concerned about the impact this tax bill will have on our debt and deficit. In fact, 61 percent of small business owners oppose raising the debt by $1.5 trillion to pay for tax cuts.

Increasing the debt will inhibit our ability to address the real challenges facing small businesses, such as educating a skilled workforce, building out broadband in rural areas, and fixing our broken infrastructure.

Then there is the repeal of the individual mandate, which is a part of this tax proposal. According to CBO, repealing the individual mandate, as this bill does, would cause 13 million Americans to become uninsured by 2027. It would sharply raise premiums for those who purchase insurance on the individual market.

Now, we have heard from our colleagues that they think that including the Alexander-Murray legislation would help address that, but that is not designed to address the underlying healthcare bill that we have in this country. All that will do is address the uncertainty in the marketplace.

Repealing the individual mandate is going to deny health insurance to millions of Americans. It is going to cost middle-income families more, and, ultimately, it is going to have an impact on people's abilities to provide for their families and the long-term health of this Nation. That is not the kind of investment we should be making in the future of this country.

There are many more issues with this tax bill, but my time is limited. If we look at who is opposed to this bill, there are so many organizations: the Realtors, the homebuilders, the AARP, and the Fraternal Order of Police. They have all come out in opposition, and that is just to name a few.

I have heard from nearly 3,000 Granite Staters who have expressed their opposition to the impact of this bill, and as more and more people have a chance to read it, that number is going to continue to grow.

You know I want to work with my colleagues here. I think Republicans and Democrats should genuinely reform the Tax Code. It is long overdue. But we need to do it in a way that is transparent, that looks at where we want to go in the future and what we need to be investing in in this country. We need to work in a bipartisan way that puts the middle class and small businesses first and that doesn't leave a massive debt for our children and grandchildren. If we pass this legislation, that is exactly what we are going to be doing--leaving future generations to deal with a massive debt without

the benefits of the investment that we should be making in this country.

So it is a sad day for America.

I yield the floor.

Mr. President, it is hard to read or to listen to the news these days without hearing about Russia's interference in our American democracy, its influence peddling, and about the misinformation that has

been spreading on social media. I have bipartisan legislation that would address an aspect of this. This legislation is cosponsored by Senator Todd Young, and it is legislation that would give law enforcement the tools they need to create greater transparency about foreign individuals and entities that are operating in the United States in the interest of other governments. It would make it easier for the public to better track information they are receiving, particularly from governments that are hostile to the United States.

This bill would give the Department of Justice necessary authority to investigate potential violations of the Foreign Agents Registration Act, which is also known as FARA. We have heard a lot about that. This was legislation that was passed during the thirties, as there was fear about the rise of Nazism and Hitler in Germany and the effort to spread propaganda in the United States.

This would allow the American public to clearly trace where information is coming from and who is paying for it. I think, in this age of misinformation, that is especially important to the public.

At a time when our law enforcement officials, foreign policy experts, and leaders continue to grapple with the extent of Russia's intrusion into our democratic elections, this legislation is more urgent than ever. The need for this legislation is perhaps most clearly demonstrated by the case of Russian propaganda networks like RT America and Sputnik International. Both networks continually propagate and share content and programming that are designed to very subtly confuse and influence audiences worldwide. If you have ever listened to either of those channels, you will know there is just this subtle difference in how they present information.

In the United States, RT America is available on cable TVs across the country. It is considered to be one of the most high-profile assets in Vladimir Putin's vast $1.4 billion propaganda machine.

According to an assessment made public by the U.S. intelligence community in January, RT is the Kremlin's ``principal international outlet,'' and it is integral to Russia's information warfare operations across the globe. The Kremlin selects the staff for RT and closely supervises RT's coverage, including disinformation and false news stories designed to undermine our democracy. If you have any question about that, watch RT here. It is on the cable network here in the DC area.

RT News has publicly boasted that it can dodge our laws by claiming to be financed by a nonprofit organization and not by the Russian Government. Recently, the Department of Justice asked RT America to, in fact, register as a foreign agent. RT rejected an entirely reasonable request from the Justice Department to respect our laws. They refused to register.

How did we respond? Well, we continued to allow RT America to spread its disinformation and false narratives. This is unacceptable. We responded that way because we don't have the teeth we need in the law to be able to enforce it. That is what my legislation with Senator Young will do. That is why it is so important. It would strengthen FARA by giving the Department of Justice authority to compel foreign organizations to produce documentation to confirm funding sources and foreign connections. This new investigative authority was requested by the Department of Justice, and it is supported by the Government Accountability Office, the Sunlight Foundation, and the Project on Government Oversight. This is a good government piece of legislation.

In fact, if this authority that we have in our legislation were in place today, the Justice Department could immediately investigate RT America and publicly expose its ties to the Kremlin. In the absence of such authority, all the Justice Department can do is ask RT to voluntarily adhere to FARA regulations and hope the propaganda outlet complies. What are the odds of that? Pretty slim. Clearly, based on RT's refusal to comply with FARA, the Kremlin is well aware of the limitations that are inherent in our law.

As we wait for this commonsense legislation to move forward, the Kremlin, RT America, and Sputnik continue to wield their harmful propaganda and attempt to influence the American public.

Since the publication of the intelligence community's January report on Russia's interference in our 2016 Presidential election, we have learned that Moscow spent millions of dollars buying ads on social media sites and search engines, often using the very clips that had been aired by RT on its YouTube channel.

Last week, representatives of American social media companies testified before Congress and illustrated the lengths the Kremlin went in order to deceptively spread divisive propaganda, all seemingly without a trace or any clear indication about the origins of these ads and RT's news blasts.

The misinformation included numerous reports run by RT News on supposed U.S. election fraud and voting. So they spread, and they clearly intended to spread confusion about our elections in 2016 to try and encourage people to believe our elections don't work, to undermine our election process. They talked about machine vulnerabilities. They claimed the results of U.S. elections could not be trusted and did not reflect the people's will. Sadly, too many people saw those stories and believed they were real.

These are not just random examples of fake news. These stories are part and parcel of a broader influence campaign designed and directed by the Kremlin's leadership and pedaled by government-funded trolls in St. Petersburg and other front organizations. So in the same way that Russia is building up its military force, its navy, its ability to operate in space, and its missile program, it has also built up its propaganda campaign in ways that are designed to undermine Western democracies. If we don't pay attention to this, then shame on us.

We are, of course, a resilient democracy. We are confident that our values and institutions will prevail in the free marketplace of ideas. Our Constitution, unlike Russia's, protects the right of individuals and organizations to spread Russian viewpoints, disinformation, and, even, outright lies. But no organization, including RT America or any other front outlet for a country that is hostile to the United States, has the right to conceal a foreign funding source and thumb its nose at requests from our Department of Justice.

The American people have a right to know if RT America is a Russian propaganda organization that takes its direction from the Kremlin. They have a right to know who is funding those programs and what kind of misinformation they are spreading.

To that end, I urge my colleagues to put an end to the Kremlin's charade by supporting the Foreign Agents Registration Modernization and Enforcement Act. Let's give the Department of Justice the tools it needs to investigate and expose RT America and to fight back against the Kremlin's interference in our democracy.

Thank you, Mr. President.

I yield the floor.

I suggest the absence of a quorum.

Mr. President, I am pleased to join my colleague from Washington, Senator Murray, and congratulate her and Senator Alexander on being able to reach agreement to move forward to address the uncertainty in the marketplace.

Like Senator Murray, I also want to begin with what we are seeing going on in this open enrollment period. Despite all of the efforts to undermine the Affordable Care Act, to shorten the time

period in which people can sign up, to make it more difficult by having the site closed for part of Sundays, we are seeing a record number of people enroll in the initial days of open enrollment.

According to news reports, on the first day alone, about 1 million people visited healthcare.gov and more than 200,000 people selected a plan for 2018. That is almost double the number who signed up last year on the first day.

For anybody who is still thinking about it, you have until December 15, so sign up early. As my colleague from New Hampshire, Senator Hassan, says, it is the best Christmas shopping you can do--take care of your healthcare. Go to healthcare.gov and shop around, get the best deal, and enroll during this open enrollment period.

This surge in signups is especially remarkable in light of the widely publicized efforts by the Trump administration to depress enrollment. The administration has slashed the advertising and outreach budget by 90 percent, cut the open onrollment period by half, and shut down the marketplace website for 12 hours on Sundays, taking away valuable weekend hours when people have free time to explore plans.

I think the healthy volume of enrollments sends two very important messages.

First, it shows again that ordinary citizens, faith groups, insurance navigators, and other private organizations have done an amazing job of filling the outreach void that has been created by this effort by the administration to cut back on letting people know about the website and how to enroll. Those folks have spent countless hours getting out the word that the Affordable Care Act remains the law of the land and that those who qualify for financial assistance can purchase high-quality, affordable coverage.

The second message that I think is important from this strong enrollment is a message that has been echoed in recent public opinion polls. It is one that we saw in the turnout in the Virginia elections last night. It is that a clear majority of the American people support the Affordable Care Act, that they reject efforts to sabotage it and they want Members of Congress to work together to strengthen it, just as Senator Murray said.

I am very pleased that we have come together in the Senate to do just that. We have come together in support of bipartisan efforts led by Senator Murray and Senator Lamar Alexander, the chair and ranking member of the HELP Committee. They have come together to stabilize the Affordable Care Act and the marketplaces and bring down premiums. I am proud to be one of the 12 Democrats who were original cosponsors with 12 Republicans of this legislation. This balanced agreement, which was negotiated by Senators Alexander and Murray over many months, is our best bet for restoring stability to the marketplaces in the short run and giving us the time we need to negotiate longer term to deal with other changes to the health law to make it work better.

I am especially pleased that the Alexander-Murray agreement provides for the continuation of cost-sharing reduction payments, or CSRs, which are payments that are necessary to keep premiums, deductibles, and copayments affordable for working families. They are extended for 2 years in this bill. Without these payments, the cost of coverage will skyrocket, insurers will leave the marketplaces--as we have already seen, as the Trump administration has said they are going to discontinue those payments--and millions of people will lose their health coverage. This is an opportunity for us to keep that from happening. Both Democrats and Republicans have recognized that these cost-sharing reduction payments, these CSRs, are an orderly, necessary subsidy that keeps down the cost of health coverage for everyday Americans.

In recent months, I have heard from hundreds of people across New Hampshire about the enormous difference that healthcare reform has made in their lives. We are a small State--we have just over 1.3 million people--but nearly 94,000 Granite Staters have gotten individual health coverage through the Obama marketplace, and nearly 50,000 have gotten coverage thanks to the Medicaid expansion, which had bipartisan support in New Hampshire. So that is about a tenth of New Hampshire that is covered either through the Affordable Care Act or through the expansion of Medicaid. And for us in New Hampshire, it has been particularly critical in responding and providing treatment to those people with substance use disorders.

Patricia Tucker has written to me. She is a substance use disorder counselor in Northfield, NH, and she talks about how grateful she is for the Medicaid expansion. She writes:

I am seeing people come for help that were not able to get

help in the past because they couldn't afford it. They are

getting help and remaining abstinent. If one mother gets

clean, this affects so many others.

She goes on to say:

[I treat] one mother who has two children. She now cares

for these children and has a full-time job. In the past, she

lived off the state and did not care for anyone, including

herself. Multiply this by thousands, just in New Hampshire,

and this makes such a big difference.

And think about how across the country we have affected people with substance use disorders because they can now get treatment.

I agree with Patricia Tucker and so many others who have contacted me about the Affordable Care Act. We are grateful for the progress, and we refuse to be taken backward. That is why the bipartisan agreement hammered out by Senator Alexander and Senator Murray is such an important breakthrough. This agreement stands on its merits as a good- faith, win-win compromise. But just as important and maybe even more important, these two Senators have given us a template for bipartisan negotiations on other critical matters that lie ahead, including tax reform, reauthorizing the community health centers and the Children's Health Insurance Program, and reaching an agreement on the 2018 budget.

The Senate is at its best when we observe regular order, when we honor the committee process, and when we work across the aisle and make principled compromises and get big things done for the American people.

In a Senate that is nearly evenly divided between Republicans and Democrats, bipartisanship is the only productive way forward. This is how the great majority of Americans want us to conduct the Senate's business, and this is especially true on matters such as healthcare and tax reform that impact families in New Hampshire and all across America.

I am grateful to people across our country who have gotten out the word about the health insurance open enrollment period that began on November 1 and continues through December 15. I am heartened by the surge in enrollments. I am encouraged by bipartisan progress in the Senate to stabilize the health insurance marketplaces. I certainly hope the leadership in the Senate allows this bill to come to the floor because we know we have the votes to pass it.

Instead of partisan efforts to undermine the law and take health insurance away from people, let's embrace the spirit of the Alexander- Murray agreement. Let's work together in a good-faith, bipartisan fashion to build a healthcare system that leaves no American behind.

Thank you, Mr. President.

I yield the floor.

Mr. President, my understanding is that Senator Cornyn was about to come to the floor, but I would be happy to have the Senator give the CBO report on this legislation, which I very enthusiastically support.

Mr. President, I am delighted to follow Senator Alexander and was very pleased to hear the news from the CBO that this Alexander-Murray proposal not only doesn't bail out insurance companies, as we all agree we should not do--we want to make sure savings go to consumers--but it also will save taxpayers $3.8 billion.

This is a bipartisan agreement. I applaud the work of Senator Alexander and Senator Patty Murray to craft this bipartisan agreement to address the challenges we have in the short term with healthcare. Senators Alexander and Murray have given us a template for bipartisan negotiations not just on healthcare but on other critical matters that are going to come before this Senate--tax reform, reauthorizing community health centers and the Children's Health Insurance

Program, reaching an agreement on the 2018 budget. These are all major issues facing this country and issues we should be working on in a bipartisan way. The Senate is at its best when we observe regular order and we follow the committee process, when we work across the aisle and make principled compromises to get things done for the American people. I believe that is exactly what this health insurance bill does.

In a Senate that is nearly equally divided between Republicans and Democrats, this is the only productive way forward for us to address the challenges that face this country. Too often we have seen people use bipartisan negotiations as a last resort, but bipartisanship should be the Senate's first resort, not the last resort. It should be the foundation of our work in this body. This is how the great majority of Americans want us to conduct the Senate's business.

When I travel around New Hampshire, this is the consistent comment I hear everywhere I go: Why can't you all work together to get things done for this country? This is especially true on matters like healthcare and tax reform, which affect families throughout the country.

I am encouraged that the Alexander-Murray bill has earned strong bipartisan support and, as Senator Alexander said, has 24 original cosponsors. That number is equally divided between Republicans and Democrats. This is a balanced agreement that has been negotiated by both parties over many months, and I think it is our best bet for stabilizing marketplaces in the short run so we can continue to work on long-term issues around healthcare.

I am especially pleased this agreement provides for the continuation of cost-sharing reduction payments for 2 years. These payments are necessary to keep premiums, deductibles, and copayments affordable for working people. Without these payments, the cost of coverage will skyrocket, insurers will leave the marketplaces, and millions of people will lose their healthcare coverage. I have been working on this issue of cost-saving reduction payments since earlier this year, when I introduced a bill that would permanently appropriate funds for the CSRs.

As the CBO said, the language in the Alexander-Murray bill ensures that these CSRs are not a bailout to insurance companies, but they are a way to help people with the cost of insurance. They are orderly payments that are built into the law that will go directly to keeping premiums, copays, and deductibles affordable for lower income Americans. Both Democrats and Republicans recognize that these payments are an orderly, necessary subsidy that keeps down the cost of health coverage for everyday Americans. As Senator Alexander said, we saw that these payments were in the bill the House voted for around healthcare, and they were also in the Senate bill earlier this year.

In recent months, I have heard from hundreds of people across New Hampshire about the enormous difference healthcare reform has made in their lives. We are a small State; we have just about 1.3 million people. Nearly 94,000 Granite Staters have gotten individual healthcare coverage through the marketplaces. Nearly 50,000 have gotten coverage thanks to the Medicaid expansion program in New Hampshire. That has been a bipartisan effort, with a Republican legislature and a Democratic Governor, to get that program in place, and it continues to enjoy the support of the Republican legislature and the Republican Governor.

Because of the Affordable Care Act's increased access to care, we also have 11,000 Granite Staters who have substance use disorders and who have been able to get treatment for the first time. New Hampshire has the second highest rate of overdose deaths from the heroin and opioid epidemic. Having treatment available through the expanded Medicaid Program has made a difference for thousands of people in New Hampshire and their families. Hundreds of thousands of Granite Staters with preexisting conditions no longer face discrimination resulting in denial or sky-high premiums. These are important achievements, and this legislation will allow us to continue down that road to make sure people have healthcare coverage they can afford.

For people across New Hampshire and across this country, healthcare coverage is often a matter of life or death. It is about being able to take a sick family member to a doctor. It is about knowing that a serious illness will not leave a mountain of debt.

I am very pleased to be able to join in the bipartisan efforts led by Senators Alexander and Murray to strengthen the parts of the healthcare law that are working and to fix what is not working. The other provisions in this legislation will allow States more flexibility through the 1332 waiver process. The Alexander-Murray agreement expedites waiver approval so States can implement smart fixes to stabilize their marketplaces, for instance, by establishing a State- based reinsurance program. The agreement also includes a restoration of funding for open enrollment outreach in educational activities, and it protects four protections related to insurance affordability, coverage, and plan comprehensiveness. All of these changes are positive steps forward, steps that I hope will set us on a bipartisan path, strengthening elements of the Affordable Care Act that are working well and fixing elements that need to be changed.

I am hopeful the Alexander-Murray agreement can gain the bipartisan support it needs to pass in Congress, that it can gain the President's signature, and I am encouraged by Senator Alexander's comments about the President's comments yesterday because we need to restore certainty and stability to the marketplaces. Instead of partisan efforts to undermine the law and take health insurance away from people, we should embrace the spirit of the Alexander-Murray agreement. Let's work together in a good-faith, bipartisan effort to build a healthcare system that leaves no American behind.

Thank you.

I yield the floor.

Mr. President, it feels like Groundhog Day again because, once more, we are seeing Republican leadership in the Senate advancing another bill to repeal the Affordable Care Act and to make radical cuts to the Medicaid Program.

As with previous efforts, this new bill--they call it Graham-Cassidy, but it really is TrumpCare 3.0, the third version, and it is strictly partisan legislation, crafted in secret outside of regular order, without hearings or consultation with most Senators or stakeholders. But here is what is different: This bill is even more reckless and more destructive than previous bills to repeal the Affordable Care Act.

It would take away healthcare coverage from an estimated 30 million Americans. It would effectively end protections for people with preexisting conditions by allowing insurers to charge exorbitant rates. It would make profound cuts to the Medicaid Program, which is a lifeline for 33 million children, 10 million people with disabilities, and 6 million seniors in nursing homes. It would be a tragic setback in the fight against the opioid epidemic because it would end access to lifesaving treatment for an estimated 1.3 million people with substance use disorders. In New Hampshire, where we are at the epicenter of the heroin and opioid epidemic, it would have a huge and tragic impact.

President Trump said that the previous Republican bill to repeal the Affordable Care Act was ``mean,'' and make no mistake, this bill is far worse. As I have said repeatedly, the only constructive way forward is for Democrats and Republicans to come together in a good-faith, bipartisan effort to repair and strengthen the current law.

As Senator McCain said to this Chamber in July: ``Let's return to regular order. We've been spinning our wheels on too many important issues because we keep trying to find a way to win without help from the other side.''

When Senator McCain said that, we gave him a standing ovation on the floor of this Chamber. In the weeks since the vote on the last attempt to repeal the Affordable Care Act, the Senate has actually been acting on his advice. We have been working under the leadership of Senators Alexander and Murray, the chair and ranking member of the Health, Education, Labor, and Pensions Committee, on bipartisan legislation to restore certainty to the health insurance markets, to fix problems with the Affordable Care Act that we all acknowledge. This effort includes a version of legislation that I have been working on to make regular appropriations for cost-sharing reduction payments. Those are payments that keep copays and deductibles affordable for low- and middle-income Americans.

I have participated, as have so many Senators, in the bipartisan meetings they have held with Governors, providers, stakeholders, insurers, and State insurance commissioners to craft a positive way forward. It is very disappointing that we are here today with another attempt to blow up all of these bipartisan efforts by bringing to the floor yet another divisive, partisan bill.

To understand why people are upset and fearful about this latest attempt to repeal the Affordable Care Act, I would call our attention to the many positive impacts the Affordable Care Act has had across the country--and in my home State of New Hampshire--and the consequences of repealing that law.

Thanks to the Affordable Care Act, more than 49,000 Granite Staters have been able to get health insurance coverage through the marketplace. Thanks to the Medicaid expansion, more than 11,000 people in New Hampshire have gotten lifesaving treatments. The Medicaid expansion, which has been a bipartisan effort between then-Democratic Governor Maggie Hassan and a Republican legislature, has been a critical tool in our fight against the opioid epidemic, and hundreds of thousands of Granite Staters with preexisting conditions at one time or another no longer face discrimination by health insurance companies. In one fell swoop, this Graham-Cassidy TrumpCare legislation would put all of these gains in jeopardy.

I would appeal to my colleagues in the Senate to stop and reconsider what is going on. Listen to the stories. Look at the faces of everyday Americans whose lives would be devastated by this legislation--from children, to seniors, to veterans.

Several months ago on Facebook and other social media platforms, I asked people across New Hampshire to tell me their stories--stories about how the Affordable Care Act has made a lifesaving difference or has improved their lives and the well-being of their families. I was overwhelmed by the response.

Here in Washington, some seem to think that repealing the Affordable Care Act, no matter how destructive the consequences, is just about politics; it is about notching a win for their team. But for the people in New Hampshire and across the country, repealing the Affordable Care Act and slashing Medicaid isn't about politics. It is about life and death. It is about people being cut off from vital, lifesaving treatment for substance use disorders. It is about families losing affordable health coverage, about seniors being unable to pay for nursing home care, and about millions of vulnerable people with preexisting conditions who would effectively be denied health coverage. It is about returning to the pre-ACA days when simply being a woman was considered a preexisting condition, justifying much higher rates.

I urge Republican leaders to stop this latest effort of destructive partisanship. There should be no retreat from the progress we have made in recent years, including the progress against the opioid epidemic. I encourage Senators who support this ill-conceived legislation to listen to the Governors, listen to the insurance commissioners, listen to patient and provider groups, and, most importantly, listen to their constituents.

Let's fix what is not working about the Affordable Care Act, and let's not pass legislation to take healthcare away from people. Let's support bipartisan efforts now under way in the Senate to stabilize the marketplaces and to provide access to quality, affordable healthcare for every American.

Thank you.

I yield the floor.

I suggest the absence of a quorum

Mr. President, today I wish to recognize the achievements of the Alliance to Save Energy over its 40-year history of working with Presidents of both political parties and Members of Congress on both sides of the aisle to advance Federal energy efficiency policy.

In 1977, Senators Charles Percy and Hubert Humphrey--a Republican from Illinois and a Democrat from Minnesota--founded the alliance as the leading energy efficiency coalition of businesses, governments, environmental groups, and consumer advocates. The goal of the alliance from the start has been simple: ``Use less and do more.'' In the wake of the oil embargoes and energy shortages of the 1970s, that message resonated loud and clear, and it still does.

Energy efficiency is America's largest energy resource, contributing more to our Nation's energy needs over the last 40 years than any other fuel source. Without the economy-wide improvements in energy efficiency made since 1973, it is estimated that today's economy would require 60 percent more energy than we consume now. In fact, savings from energy efficiency improvements over the last 40 years have reduced our national energy bill by an estimated $800 billion, all while growing and expanding our economy. Energy efficiency saves money, improves national security, reduces pollution, encourages innovation, boosts U.S. competitiveness, and creates jobs.

For 40 years, the alliance has taken great care to cultivate and maintain bipartisan support for policies supporting energy efficiency. Maybe the best example--certainly for me the most personal example--is the alliance's steadfast support and continued advocacy for the Energy Savings and Industrial Competitiveness Act, bipartisan energy efficiency legislation I have introduced along with my friend and partner, Senator Rob Portman. They recognize, as I do, that to accomplish anything in Washington, you must have friends and supporters across the entire political spectrum. The alliance's commitment to bipartisanship is not simply rooted in their history, but is also as a matter of practicality. In a Congress that is divided along partisan lines on so many issues, energy efficiency is one priority that can bring us together on a bipartisan, bicameral basis to get big things done.

The alliance also prides itself on its ability to bring businesses together alongside public and consumer advocates. The business case for energy efficiency is unimpeachable. Energy efficiency is the largest sector within the U.S. clean energy economy, employing nearly 2.2 million Americans nationwide--the majority of whom work for small businesses. American companies are leading the way in innovation and technological advancements in lighting, appliances, and building materials, to name a few. By working collaboratively with businesses and consumer leaders, the alliance is helping to improve energy efficiency across all sectors of the economy and develop new ways to bring new products and services to market.

Today the alliance is led by President Kateri Callahan, and the fiduciary board is chaired by Gil Quiniones, who is president and chief executive officer of the New York Power Authority. It is my privilege to serve as the honorary cochair of the alliance. I am joined by Honorary Vice Chairs Senators Rob Portman and Chris Coons, as well as Senators Lamar Alexander, Susan Collins, Ed Markey, Lisa Murkowski, Mark Warner, and Ron Wyden, as well as Representatives Michael Burgess, Adam Kinzinger, David McKinley, Dave Reichert, Paul Tonko, and Peter Welch. The alliance is rightfully proud of their storied bipartisan traditions, and this ideologically diverse and talented roster is a testament to the possibilities to make positive change when we listen to one another and work together.

I would like to close today by recognizing the past contributions of members who previously served on the alliance honorary board: Senators Jeff Bingaman, Larry Craig, Alan Cranston, Byron Dorgan, John Heinz, Jim Jeffords, Bennett Johnston, Richard Lugar, Mark Pryor, Mark Udall, and Timothy Wirth, along with Representatives Ralph Hall, Steve Israel, John Edward Porter, and Zach Wamp. I had the good fortune of working alongside many of these distinguished public servants. I am proud to be part of the shared legacy of this collection of energy-efficiency champions.

I congratulate the alliance on all they have accomplished since it was founded in 1977. Now, the alliance stands at the precipice of the next 40 years, which will undoubtedly usher in unforeseeable challenges and opportunities in the energy sector. I stand with them today, energized by their success so far, and ready for the next set of energy efficiency policies we need to succeed.

Thank you.

Mr. President, as we all know, we are continuing to debate what amounts to repealing the Affordable Care Act without any indication of what is going to replace it--what is actually in the Republican leader's bill. I think this is worth repeating because we are talking about changing one-sixth of the U.S. economy, impacting every American family, and yet we still have no idea what the bill actually is.

We do know this. A partisan bill to take away health insurance from tens of millions of Americans, written behind closed doors, opposed by every healthcare stakeholder group and by an overwhelming majority of the American people should not pass the Senate.

As I have repeatedly said, the only constructive way forward is for Democrats and Republicans to come together in a good-faith, bipartisan effort to repair and strengthen the current law. Bipartisanship should not be our last resort, as Senator McConnell has suggested. It should be a starting point. It should be the foundation of what we do in this body. This is how the great majority of the American people want us to conduct the Senate's business. This is what I hear from my constituents in New Hampshire, and this is especially true with healthcare legislation which affects families all across this country.

Make no mistake, every bill proposed by the Republican leadership has been designed as a bullet to the heart of the Affordable Care Act. Republican proposals will collapse the individual marketplaces, make it impossible to provide affordable coverage for people with preexisting conditions, and take healthcare coverage away from up to 32 million Americans, including the most vulnerable.

I hope nobody is fooled by this latest partisan measure to roll back the Affordable Care Act and take healthcare coverage away from tens of millions of Americans. I hope every Senator will, at long last, heed Senator McCain's call for bipartisanship--as we have been hearing at townhalls and in countless messages from our constituents. The American people want us to make commonsense, bipartisan changes to the current law. We need to work together to build on the strengths of the Affordable Care Act, which has dramatically reduced the number of uninsured Americans and has given us valuable tools for fighting the opioid epidemic which is ravaging so many communities in America. This is the best way forward for both the Senate and our country.

Republican leaders have spent the last 7 months pushing deeply unpopular bills to repeal the Affordable Care Act, including their effort to dramatically cut Medicaid--not just the expansion of Medicaid under the Affordable Care Act but the Medicaid Program that has done so much to protect and provide healthcare for children across this country, for pregnant women, for those with disabilities and older Americans, so many of whom are in nursing homes who would lose that care if we dramatically cut the Medicaid Program as the Republican proposals have tried to do.

At the recent National Governors Association meeting, Democratic and Republican Governors alike urged Congress to reject the Republican leaders' healthcare bill--in particular, its harsh and unsustainable cuts to Medicaid. The Republican Governor, John Kasich, was especially forceful in urging Members of Congress to work together to find bipartisan solutions. He urged Congress to give first priority to stabilizing the healthcare marketplaces.

We should listen to the Governors, but most importantly we should listen to our constituents--to the great majority of our constituents who want to preserve what is working in the Affordable Care Act and see us change what is not working. Instead of legislation to take healthcare away from people, it is time now for an inclusive, bipartisan approach to provide quality, affordable healthcare for every American.

Thank you.

I yield the floor.

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

The first motion would send the reconciliation bill to the Health, Education, Labor and Pensions Committee with instructions to strike repeal of cost sharing reductions, CSRs, and advanced premium tax credits and replace this section with my legislation, the Marketplace Certainty Act, which would make CSRs permanent and extend them to those making up to 400 percent of the Federal poverty line. I want to reiterate what I previously said for the Record, that the Affordable Care Act, ACA, already prescribes that such payments are to be made from such a permanent appropriation pursuant to 31 U.S.C. 1324.

The first motion is supported by Senators Carper, Reed, Murphy, Baldwin, Hirono, Klobuchar, Blumenthal, Heinrich, Coons, Heitkamp, Stabenow, Cardin, Markey, Warner, and Van Hollen.

The second motion would send the reconciliation bill to the Finance Committee with instructions to strike repeal of cost sharing reductions, CSRs, and advanced premium tax credits and replace this section with my legislation, the Marketplace Certainty Act, which would make CSRs permanent and extend them to those making up to 400 percent of the Federal poverty line. Similar to the first motion, I want to reiterate what I previously said for the Record, that the ACA already prescribes that such payments are to be made from such a permanent appropriation pursuant to 31 U.S.C. 1324.

The second motion is supported by Senators Carper, Reed, Murphy, Baldwin, Hirono, Klobuchar, Blumenthal, Heinrich, Coons, Heitkamp, Stabenow, Cardin, Markey, Warner, and Van Hollen.

The third motion would send the reconciliation bill to the Finance Committee with instructions to strike provisions that would weaken or eliminate the small employer health insurance credit, prohibit the ability of entrepreneurs to purchase affordable health coverage through the individual marketplace, or allow discriminatory rating rules that prohibit small businesses from providing affordable, comprehensive benefits to their employees.

The third motion is supported by Senators Blumenthal, Carper, Udall, Baldwin, Brown, Peters, and Stabenow.

The fourth motion would send the reconciliation bill to the Health, Education, Labor and Pensions Committee with instructions to strike provisions that would allow insurers to establish diabetes as a preexisting condition or reduce funding for diabetes research, treatment, prevention and education.

The fourth motion is supported by Senators Hirono, Klobuchar, Blumenthal, Menendez, and Van Hollen.

The fifth motion would send the reconciliation bill to the Finance Committee with instructions to strike language that would remove mental healthcare services from the list of essential health benefits or prohibit States from providing Medicaid coverage for more than 30 consecutive days of inpatient psychiatric services.

The fifth motion is supported by Senators Hirono and Blumenthal.

Mr. President, I wish to recognize June 24 as Cystinuria Awareness Day and to offer my support to the International Cystinuria Foundation as the organization continues its excellent work promoting knowledge of this disease within the research and medical communities, as well as providing resources for those affected by cystinuria.

Cystinuria is an inherited disease characterized by high concentrations of the amino acid cysteine in the urine, leading to the formation of cysteine stones in the kidneys and urinary tract. It is a rare disease that affects roughly 1 in every 7,000 people, including an estimated 130 Granite Staters. Cystinuria is a painful and often debilitating condition. Those who suffer from it can experience kidney stones as frequently as daily, causing many to lose weeks of work each year. Many sufferers use prescription painkillers to cope with the disease, and tragically, some develop substance use disorders.

Cystinuria does not discriminate, affecting people of all genders, races, ethnicities, and ages. There is not yet a cure, and the disease is frequently misdiagnosed. I sincerely hope that this day of awareness will help in advancing research into the causes of the disease as well as possible therapies and cures. Because cystinuria is a rare disease, there is an acute need for more aggressive research, including at the National Institutes of Health. In addition to supporting important funding for research, we can also do our part by also advocating for awareness for the disease. Fortunately, the Affordable Care Act protects those with cystinuria and other preexisting conditions from discrimination by health insurance companies.

Cystinuria Awareness Day is a valuable opportunity for Americans to learn about this condition and offer support to those living with it. I am grateful to the International Cystinuria Foundation for its commitment to raising awareness of the disease, advocating for research, and providing support for those suffering from cystinuria.

Mr. President, the majority leader says that he will move forward this week with a vote on a straight repeal of the Affordable Care Act in its entirety. I don't believe that a majority of Senators are willing to support a reckless leap in the dark, which that vote would mean. It is a vote that would end protections for people with preexisting conditions. It would take healthcare coverage away from tens of millions of Americans and tens of thousands in New Hampshire. It would terminate the Medicaid expansion that has been critical to fighting the opioid epidemic in my State and so many States across this country.

According to the nonpartisan Congressional Budget Office, a straight repeal of the Affordable Care Act would result in more than 32 million people losing their insurance coverage by 2026. Premiums would roughly double in the individual marketplaces. I urge my Republican friends not to go forward with this misguided approach.

The idea that they can repeal the healthcare bill now and give us a new bill in 2 years or whatever period of time is in the bill just doesn't pass the smell test. If we haven't seen an alternative to the Affordable Care Act in the last 7 years, there is no reason to believe that our Republican colleagues are going to be able to produce a bill in 2 years when there is chaos in the marketplaces.

There is a better way forward for the Senate and for our country. During the Fourth of July recess, Majority Leader McConnell said that if he can't secure the votes to repeal the Affordable Care Act, he is prepared to work in a bipartisan way with Democrats on legislation to repair and strengthen the law.

I believe that bipartisanship is the best way to get something done. That is what I tried to do when I was Governor of New Hampshire. I worked closely with our Republican legislature, and we got things done. It should not be a last resort for what we are doing; it should be the first resort. It should be what we do to build a foundation for policy in this country.

I am hopeful that following the floor consideration of whatever the majority leader decides to do on healthcare--and, hopefully, it is going to get defeated--we will move forward with the majority leader's fallback plan, which I believe should be the starting position. We need to start fresh with regular order to craft bipartisan legislation that builds on the strengths of the Affordable Care Act, that builds on what is working and fixes what is not working. As we have been hearing at townhalls and in countless messages from our constituents, this is exactly what the American people want us to do.

There is remarkable consensus in this country that the Republican leaders' bill is the wrong approach. An ABC/Washington Post poll on Sunday found that by a more than 2-to-1 margin, Americans prefer the Affordable Care Act to the Republican leaders' bill. Their bill is strongly opposed by hospital associations, by healthcare providers, by the health insurance industry, and by nearly every patient advocacy group, including the American Cancer Society and the American Heart Association. There is no reason to think that just repealing the Affordable Care Act is going to make that any better.

On Saturday, the New Hampshire Hospital Association, the New Hampshire Medical Society--our physicians--and the New Hampshire AARP joined together in opposition to the bill. They noted that more than 118,000 Granite Staters--nearly 1 in 10 people in New Hampshire--would lose healthcare coverage under the Republican bill, and that number is even greater if we just repeal the Affordable Care Act. Their joint statement urges Senators ``to start over and create a new version of legislation that protects coverage for those who have it and provides coverage for those who need it most.''

Mr. President, I ask unanimous consent that the joint statement by these groups be printed in the Record.

Mr. President, I strongly agree with these New Hampshire groups. After spending 6 months trying to pass the deeply unpopular, deeply flawed bill to repeal the law, shouldn't we welcome a bipartisan effort to improve the law? I believe the answer to that is yes, and the place to begin is by taking urgent action on a matter where most of us agree, and that is providing certainty to health insurance markets in order to hold down premium increases. In their 2018 rate request filings, insurers say that large increases are necessary because of the uncertainty surrounding the repeal of the Affordable Care Act and because the Trump administration refuses to commit to making cost-sharing reduction payments--those payments that go to insurance companies so they can help their consumers with

the cost of health insurance, making sure that more people can get health insurance. Well, we now have an opportunity to end this uncertainty by putting the repeal behind us and authorizing a simple bill to authorize regular appropriations for the cost-sharing reduction payments.

The current instability in the ACA marketplaces is a manufactured crisis, and Congress can put a stop to it very quickly. That is why I have introduced the Marketplace Certainty Act, which is a bill to permanently appropriate funds to expand the funds for and to expand the cost-sharing repayments. It does two things: It guarantees that these payments are coming, and it is going to cover more people to help. I am pleased to be joined by 26 Senators who have already cosponsored this bill. We can end this artificial crisis. We can immediately restore certainty and stability to the insurance markets, and, in turn, we can get the time we need in order to come together in a bipartisan way to improve this law to build on what is working and to fix what is not.

We have a number of these commonsense measures, and this is one that has been embraced, not just by Democrats but by key Republican leaders, including Chairman Lamar Alexander and House Ways and Means Chairman Kevin Brady, who have urged that these payments be continued. As Chairman Brady put it, the payments are needed ``to help stabilize the [health] insurance market and help lower premiums for Americans.'' He added: ``Insurers have made clear the lack of certainty is causing 2018 proposed premiums to rise significantly.''

We have heard from our constituents at home. We have heard from doctors, nurses, hospitals, particularly rural hospitals, nursing homes, patient advocates, insurers, and those constituents who were in the statement I asked to be printed in the Record. They are pleading with us to set aside our partisan differences and work together to repair the Affordable Care Act.

Again, we know what we can do. It is not just the Marketplace Certainty Act; there are other bills that have been introduced that can fix the uncertainty in the markets and allow us to address other issues with the law.

Bipartisanship should be the Senate's first resort, not the last resort. An excellent place to start is by coming together right now to permanently appropriate funds for the cost-sharing reduction payments that keep health coverage affordable and to look at some of the other commonsense measures that are going to be talked about by my colleagues, like Senator Klobuchar, who will be coming to the floor. She has legislation that would help us deal with the high cost of prescription drugs, which is one of the things that is driving the increasing costs of healthcare. We need to pass these commonsense measures, and we need to do it now.

Thank you.

I yield the floor.

Mr. President, I am really pleased to have been joined by my colleagues to talk about the importance of addressing healthcare for all Americans, especially my colleague from New Hampshire. She and I have been touring the State for months now, talking with people in hospitals, with patients, with physicians, with providers, with people with substance use disorders, with providers who are providing treatment for people with substance use disorders, with people all over New Hampshire about what we can do to make sure people get healthcare when they need it.

That should be the goal of this body. It should not be throwing people off their healthcare, which a repeal of the Affordable Care Act would do. It would throw 32 million people off their healthcare.

We can address the instability in the marketplaces. We can do that pretty quickly. Senators Kaine and Carper talked about reinsurance, something which has worked very well for the first 3 years of the Affordable Care Act, and the reason it doesn't work now is because they have stopped. That is why we are seeing some of these rate increases.

We can address the uncertainty by being clear that we are not going to repeal the Affordable Care Act, by addressing those cost-sharing reduction payments. The ACA already stipulates that CSR--those payments which reduce the costs of copays and deductibles--are to be made pursuant to 31 U.S.C. 1324.

My bill provides for payments to be made jointly from a permanent appropriation rather than subject to the year-to-year whims of the annual appropriations process. The Marketplace Certainty Act removes all bases for any further questions about what is already clear from a fair reading of the Affordable Care Act as a whole; that both those CSR payments and the advanced premium tax credit subsidies are to be funded from the same permanent appropriation.

I see my colleague from Texas on the floor, and I am sure he is going to object to the unanimous consent request I am going to be proposing in a couple of minutes. He objected last Thursday when I asked for unanimous consent to pass the Marketplace Certainty Act, and he justified the objection by asserting that the cost-sharing reduction payments are--I think he called it a bailout of the insurance companies. That is an inflammatory term, and I think we ought to be careful with how we use it because the truth is, the cost-sharing reduction payments are in no way, shape, or form a bailout. They are orderly payments built into the law to go directly to keep premiums, copays, and deductibles affordable for lower income Americans. In fact, those same payments were included in the bill Majority Leader McConnell just said he is not going to go forward with, the Republican bill. It included those very same cost-sharing reduction payments. I think they were included because there was a recognition that these are important to help address the cost of healthcare for all Americans.

As I said earlier, we have had statements by the chairman of the Health, Education, Labor, and Pensions Committee, Lamar Alexander, talking about that these payments should be continued. We have heard from House Ways and Means Chairman Kevin Brady, who said we need to continue these payments to help stabilize the insurance market. It is the uncertainty that is causing the current problem, and we could address that today--this week--if people were willing to work together.

As Democrats, we have come to the floor to say we want to work together. We think we can address the challenges we face with the Affordable Care Act. We can do it in a bipartisan way. I know we can because Tim Scott and I have done it. We passed a bill several years ago by unanimous consent, which basically gave States the ability to control group size for people and for companies in the marketplaces so I know it can be done, and I know we could do it today if there were a willingness on the part of all of our colleagues to work together. That is what the American people want. They don't want 32 million people thrown off their health insurance. We don't want rural hospitals to close in New Hampshire. We don't want nursing homes to close. We don't want people to be thrown out of their nursing homes.

I was up in northern New Hampshire at a nursing home over the weekend, where I talked to a group of women in their eighties and older. One woman said to me: You know, I worked my whole life. I paid my taxes. I did everything I was supposed to do. I sold my house so I could get into this nursing home so I could qualify under Medicaid. I got rid of all my assets. Now they are telling me I am going to get thrown out? She said: What would I do? I have no place to go. I have no family to help me.

People don't want that. What they want is for us to work together, to help fix healthcare so people can get what they need when they need it.

Mr. President, I ask unanimous consent that the Committee on Health, Education, Labor, and Pensions be discharged from further consideration of S. 1462; that the Senate proceed to its immediate consideration; that the bill be considered read a third time and passed, and the motion to reconsider be considered made and laid upon the table with no intervening action or debate.

Mr. President, I am disappointed but not surprised that my colleague has objected. I don't believe he objected because of the effort to help pay these subsidies, which are passthroughs to insurance companies.

Reforming how we do those, I am certainly happy to sit down and talk about that, but the fact is, that is not the issue right now. The issue is, this is a way we could address the current uncertainty in the marketplaces in a way that will be good for maintaining stability of healthcare for all Americans. I am disappointed there isn't a willingness to work together to do that.

I hope, as this debate continues, we will finally see people come together to get something done to address, not just healthcare for Americans but to address the one-sixth of the economy that depends on the healthcare industry.

I yield the floor.

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

Mr. President, I am pleased to be here with my colleagues--Senator Klobuchar, from Minnesota, and Senator Heitkamp, from North Dakota--to talk about the most prominent issue facing us right now; that is, what happens to healthcare for millions of Americans.

At a town hall in Kentucky last week, Majority Leader McConnell said that if he can't secure the votes to repeal the Affordable Care Act, he will have no choice but to work in a bipartisan way with Democrats on legislation to repair and strengthen the law. Well, I was encouraged to hear the majority leader say that because I don't think bipartisanship should be a last resort. I think it should be the starting point. It should be the beginning of the work we do in this Chamber because that is what the American people want and that is the best way to make lasting public policy.

This is especially true with healthcare legislation, which impacts families all across America. As we have been hearing--and I have had a chance to hear it directly from my constituents in New Hampshire--the American people have wanted all along for to take a bipartisan approach. It is unfortunate that our colleagues on the other side of the aisle have spent months trying to pass a partisan, deeply unpopular bill.

Now, I think we would all agree that there are changes we need to make in the Affordable Care Act, something for which I have advocated since we passed the law. I have had the opportunity to work with our colleague Tim Scott from South Carolina. In 2015, we worked together to make modest changes to the law to protect small businesses from excessive premium increases. I think that bipartisan approach is something with which, if we started today, we could make changes in the Affordable Care Act to improve it and to make sure that Americans could get better access to healthcare.

We all understand that there are problems currently in the market in terms of premium increases, and we know why these premium increases are happening. In their 2018 rate request filings, insurers justified the increases because of the uncertainty surrounding the repeal of the ACA and because this administration refuses to commit to making what are called cost-sharing reduction payments.

These payments were included as part of the Affordable Care Act to address premiums, deductibles, and copayments and to make them more affordable for working families, basically, to be able to help people afford insurance. The payments have been built into the rates that insurers are charging for 2017. But as we look ahead to 2018, there is a big problem because, if there is uncertainty around those payments, it means premiums will skyrockets, insurers will leave marketplaces, and people will lose their health coverage. Now, we could fix this today if we were willing to work together, because we know what we need to do.

I think New Hampshire offers a vivid example of what we are seeing across the country. Last year, insurance markets were stable, health insurance premiums increased an average of just 2 percent in New Hampshire--the lowest annual increase in the country and in our State's history. Unfortunately, today, because of the uncertainty in the market, it is a very different story.

Insurers in New Hampshire are raising premiums for 2018. The same thing is happening across the country. In some cases, insurers are filing two different sets of rates--one premised on the administration's continuing to make those cost-sharing payments that I talked about earlier, and the second set with higher premiums to account for continuing uncertainty and the possibility that the Trump administration, which is legally charged with implementing the Affordable Care Act, is going to renege on making the payments that have been promised to insurers and, ultimately, to families so that they can get healthcare.

This uncertainty is completely unnecessary. The instability in the ACA marketplaces is a manufactured crisis, and we could put a stop to it today. That is why I have introduced the Marketplace Certainty Act, a bill to permanently appropriate funds that would expand the cost- sharing reduction payments and ensure that we can count on those payments being made.

I am pleased to be joined by 25 other Senators who have already cosponsored this bill, and we can pass this right now if we had agreement with our colleagues on the other side of the aisle.

The Marketplace Certainty Act is also supported by a broad spectrum of provider and patient advocate groups--including the American Cancer Society, the American Heart Association, the American Diabetes Association, and the National Association of Community Health Centers, just to name a few.

We can end the artificial crisis. We could immediately restore certainty and stability to the health insurance markets. In turn, this would give us the space we need to come together on a bipartisan basis to improve the Affordable Care Act, to strengthen what is working, and to fix what is not working. That is what we were sent to Washington to do.

Bipartisanship should be our first choice, not a last resort. The American people want us to stop bickering over healthcare, to work together, and to make the commonsense improvements to the law that we should be making.

I yield the floor.

Mr. President, I thank my colleagues who are here this afternoon for their eloquence, their remarks, their passion for making sure the people in this country can get healthcare when they need it, and for their hard work and legislation to try and make that happen.

Absolutely.

What is true about the Marketplace Certainty Act is that it would guarantee the payments that were promised under the Affordable Care Act--not to insurance companies but to families who need help affording health insurance. That is one of the goals as we think about what our challenge is to address the healthcare needs of the people of this country, and that, in fact, is what the Marketplace Certainty Act would do.

I want to be clear that what we need to do is to provide certainty in the marketplace right now. What is happening because of the effort by our Republican colleagues to repeal the Affordable Care Act--which is providing coverage for literally tens of millions of people--what is happening because of this administration's refusal to guarantee those payments that would help people with the cost of their health insurance is that we are seeing instability in the marketplace. But the answer is not the proposal that was released this morning, the second or maybe it is the third draft of healthcare legislation that was done behind closed doors by our colleagues.

Earlier today, I had the opportunity to meet with two children from New Hampshire: Parker, who is 8, and Sadie, who is 10. These kids were here advocating for the children's hospitals that have meant that they can continue to live. They are kids who were born with serious health challenges. They continue to have those serious health challenges, but thanks to Children's Hospital at Dartmouth and Boston Children's Hospital, Parker and Sadie are alive today. They are smart, they are beautiful, and they are the delight of their families. They have been able to get the healthcare they need through CHaD and through Boston Children's because they are able to get covered for their healthcare under Medicaid. What our colleagues' healthcare legislation would do is dramatically cut the Medicaid funding that Parker and Sadie and so many children and old people and disabled in this country depend on in order to stay alive.

That is a mean-spirited bill. That is not the answer to the serious healthcare challenges we have in this country, and that is not what we should be doing to fix what needs to be fixed in the Affordable Care Act. What we need to do is work together.

I am disappointed that my colleagues on the other side of the aisle continue to work behind closed doors instead of having an open process. If this legislation that was introduced this morning is such a great piece of legislation, then let's go through regular order. Let's have a hearing. Let's let the people of this country weigh in and then see whether this is a healthcare bill we should pass.

Thank you, Mr. President.

I yield the floor.