Floor Statements

Mr. President, I am very pleased that Afghanistan's robotics team will be coming to Washington to compete with students from nearly 150 countries in the FIRST Global Challenge, which begins on Sunday, July 16. I extend a warm welcome to these brilliant young minds, Lida Azizi, Somayeh Faruqi, Faramarz Najafi, Rodaba Noori, Fatemah Qaderyan, Kawsar Roshan, and Alireza Mahraban. Of course, we extend a warm welcome to the team's creation, a robot that can sort balls, recognize blue and orange, and move objects to their proper places. People across Afghanistan are extremely proud of the robotics team's achievements. In recent days, Americans have become acquainted with the many challenges they have overcome in order to excel in their studies and come to the U.S., and we too, are very proud of them.

I have been impressed to learn about their passion for education and determination to pursue STEM studies. This team's indomitable spirit is a testament to what can be achieved through hard work, creativity, and perseverance. Each member of the Afghan robotics team has become a powerful symbol for young women across the globe, especially for those in developing regions who face barriers to education and opportunity.

The FIRST Robotics Competition should also be recognized for its ability to bring young people together in the name of science, mathematics, and technology. It is the creation of Granite Stater Dean Kamen, and had its beginnings in a New Hampshire high school gym a quarter century ago. Today, FIRST programs reach more than 400,000 young people across the world every year. Beginning this weekend in Washington, the FIRST Global Challenge will bring some of the best and brightest young people from around the world to compete, to demonstrate teamwork, and to forge new friendships.

It gives me great joy to know that Lida, Somayeh, Faramarz, Rodaba, Fatemah, Kawsar, and Alireze will be among them. The FIRST Global Challenge is a competition, and only one team will leave Washington with top honors, but the seven young women representing Afghanistan are already winners. They have had the courage to overcome barriers and the audacity to compete with some of the most talented young people from across the globe. I wish these young women great success. I thank them for inspiring us with their fierce determination to achieve.

Mr. President, I am expressing sentiments for myself and on behalf of Senators Wyden and Murray, as a fair reading of the Affordable Care Act, ACA, makes clear, S. 1462, the Marketplace Certainty Act, is not necessary to provide a permanent appropriation for the payment of cost-sharing reductions under the ACA. The ACA already prescribes that such payments are to be made from such a permanent appropriation pursuant to 31 U.S.C. 1324. This is because an essential component of the ACA's system for ensuring the availability of affordable health insurance coverage is its two-part package of subsidies: tax credits and cost-sharing reductions. Whereas the premium tax credits make it more affordable for an individual to purchase health insurance, the cost-sharing reductions make healthcare more affordable by reducing the often daunting costs, such as copayments and deductibles, that even those with health insurance must pay to obtain healthcare, ACA, sections 1401, 1402, 26 U.S.C. 36B, 42 U.S.C. 18071. The ACA directs the Secretary of the Treasury to ``establish'' a single, integrated ``program'' to ``make advance payment'' of both subsidies to insurance companies, who are accordingly mandated to reduce individuals' premium payments to insurers, and their cost- sharing obligations to healthcare providers. To assure insurers and covered individuals that these equally essential funds will both be available, the act provides that requisite payments are to be jointly made from a permanent appropriation, 31 U.S.C. 1324, rather than be subject to the year-to-year whims of the annual appropriations process.

Despite the fact that the current permanent appropriation in section 1324 plainly covers these cost-sharing reduction payments, pending litigation brought by the House Republican leadership--which is currently being held in abeyance in the D.C. Circuit Court of Appeals-- and the current administration's mixed signals as to whether it will continue to make these payments required by law, could generate instability in individual insurance markets. S. 1462 removes all basis for any further questions about what is already clear from a fair reading of the ACA as a whole: both subsidies are to be funded from the same permanent appropriation. In addition, the amendment includes provisions that will strengthen the existing subsidy provisions, and, in light of developments since the ACA was enacted in 2010, make insurance more affordable for beneficiaries and help stabilize State- level individual insurance markets.

Mr. President, after weeks of secrecy, after not engaging with the public, after an effort to prevent not only Democrats in this body but women in this body from participating in putting together a new healthcare bill, last week we saw Senate Republican leaders put forward their bill to repeal the Affordable Care Act.

Like its companion bill in the House, this legislation imposes draconian cuts to Medicaid, our Nation's principal program for insuring children, people with disabilities, and seniors in nursing homes. It drives up costs for middle- and low-income Americans while delivering huge new tax cuts to the wealthiest in this country.

I start with the premise that you can't take health insurance away from 22 million Americans and call it reform or better care. I think President Trump was accurate when he described this approach simply as mean. The fact is, this legislation is a direct threat to the health and well-being of millions of Americans, including tens of thousands in New Hampshire.

The opioid epidemic in the country and in New Hampshire is the worst public health crisis in modern history. In New Hampshire, thanks to the expansion of Medicaid, done by a Republican legislature and a Democratic Governor, my colleague from New Hampshire who is now in the Senate, who is here with me today--thanks to their bipartisan work, nearly 11,000 Granite Staters have been able to access lifesaving treatment under the Medicaid Program for substance use disorders. By completely reversing the Medicaid expansion, the Senate bill released last week would cost who knows how many lives and would be a crippling setback in our fight against the opioid crisis.

Medicaid covers one out of three children in New Hampshire, as well as people with disabilities and seniors in nursing homes.

In concert with the President's budget, this bill being proposed by the Senate would cut Medicaid funding in half by the year 2027. Cuts of that magnitude simply cannot be done without

having devastating effects on children and other vulnerable people across New Hampshire.

Then, of course, this legislation blocks all Federal funding for Planned Parenthood. We have more than 12,000 Granite State women and men who depend on Planned Parenthood for essential health services, including cancer screenings.

According to the nonpartisan Congressional Budget Office, nearly 45,500 Granite Staters would lose coverage under the Republican leader's bill. These are people who rely on that coverage for basic care, as well as for treatment of cancer, heart disease, diabetes, and other chronic illnesses, and they are deeply afraid that they will be among the 22 million Americans who will lose their health coverage if the Senate bill becomes law.

Last Friday, Senator Hassan and I convened an emergency public field hearing in Concord. We wanted to hear directly from Granite Staters who would be affected by the Senate bill. I have to say--and I am sure my colleague agrees with me--it was an extraordinary event, with over 200 attendees. They overflowed the overflow room. This is a picture of the room where we held the hearing, and we can see people lined up on either side of the room, waiting to take their turn to testify.

Senator Hassan and I heard firsthand from healthcare providers, from people in recovery from substance use disorders, from parents of children with chronic diseases and disabilities, and so many others who are concerned about this legislation. We listened to emotional, heartfelt statements about the uncertainty, anxiety, and anger this Senate bill has caused. I was especially moved by testimony from parents who are worried their children will lose access to the lifesaving treatment they need that for so many of these kids is the difference between life and death.

People like Paula Garvey, of Amherst, NH, who talked about her 19- year-old daughter Rosie, who was diagnosed with cystic fibrosis just 2 weeks after birth. Rosie also suffers from juvenile rheumatoid arthritis. Rosie must follow a strict regimen of medications to keep the cystic fibrosis under control. Paula fears that the repeal of the Affordable Care Act and cuts to Medicaid will leave her daughter without coverage for her preexisting condition and that insurance companies will once again impose a lifetime dollar limit on benefits.

For Paula, and for any parent, the prospect of not being able to access lifesaving care for a child is profoundly upsetting. Paula said: I don't know what I am going to do if the Affordable Care Act goes away. What will Rosie do when she is off of our insurance and she is not able to find insurance again?

Sarah Sadowski of Concord, NH, testified about her 9-year-old daughter who has cerebral palsy. She said:

The Affordable Care Act was a huge moment of hope. I cannot

face what life would look like with pre-existing conditions,

lifetime limits, and countless hours on the phone with

insurance companies.

At the field hearing, we also heard important testimony about others who rely on Medicaid. For example, Medicaid provides coverage for more than 10 million Americans with disabilities and nearly 6 million seniors in nursing homes. In fact, these two groups alone account for nearly two-thirds of all Medicaid expenditures. Yet the Republican leader's plan to cut Medicaid funding in half over the next decade would have dire consequences for these Americans.

Brendan Williams, CEO of the New Hampshire Health Care Association, told our hearing that 63 percent of nursing home residents in New Hampshire rely on Medicaid. As was reported on Sunday in the New York Times, the deep cuts to Medicaid included in the Senate bill would force many retirees out of nursing homes or lead States to require residents' families to help pay for care. For many families, this is just not an option. They don't have the finances to be able to do that. So what happens? Their loved ones get kicked out of their residential care.

We also heard compelling testimony from healthcare providers who treat people with substance use disorders. Melissa Fernald is a private clinician in Wolfeboro, NH. She told us:

For the majority of [Medicaid expansion] patients, it is

the first time they have had health insurance. It allowed me

to assist them in properly diagnosing their mental health

conditions . . . and securing primary care providers to treat

their medical needs. It has been a powerful experience to

watch them heal and grow as a result of receiving proper

care. . . . My clients are more motivated and capable of

getting a job and gaining financial independence.

Again, if your heart is not moved by the morality of these kinds of stories and by the values I think we should have in this country to help people who need help, we should be moved by the economics of this. It is going to cost a whole lot more when we kick people with substance use disorders off of their insurance, when they go to emergency rooms to get their care, or when they die than to make sure they get the help they need.

The Senate bill to repeal the Affordable Care Act and radically cut Medicaid is a threat to healthcare coverage for people in New Hampshire and in every other State in this country. I am so grateful to all of those Granite Staters who attended our field hearing on Friday. I know that in other States across this country, large numbers of people are turning out to express overwhelming opposition to the Republican leader's bill. I heard this morning that polling shows that just 17 percent of Americans support this legislation. We need to listen. We need to stop this headlong rush to pass a cruel and heartless bill.

For ordinary people in New Hampshire--the people whom Senator Hassan and I heard from on Friday--repealing the Affordable Care Act and gutting the Medicaid Program isn't about politics. It is a matter of life and death. We need to listen to the voices of ordinary people whose lives and finances would be turned upside down by this bill.

There is a better way forward for both the Senate and our country. It is time for Republicans and Democrats to put ideology and partisanship aside and come together to do what is right for ordinary working people in this country.

The majority leader's decision to delay a vote on the bill is an opportunity for all of us in the Senate. When we come back after next week's July 4th recess, let's come together in an open and inclusive process. The right way forward is for Republicans and Democrats to work together to strengthen the parts of the Affordable Care Act that are working, including Medicaid expansion, and to fix what is not working.

According to poll after poll, this is what the majority of the American people want us to do. It is time now to respect their wishes and to strengthen the Affordable Care Act so it works for all Americans.

I yield the floor.

Mr. President, I am very pleased to join my colleague from North Dakota, Senator Heitkamp, and appreciate all of the efforts she is making to try to address the challenges we are facing in the healthcare markets across this country. Like her and like so many of my colleagues who are going to be here, I have come to the floor this afternoon because we want to take urgent steps and we can take steps today to address the uncertainty in our health insurance markets. We can take steps today that can hold down premiums.

I have heard Senators on both sides of the aisle who have expressed concern about looming premium increases in the Affordable Care Act marketplaces. We all need to understand, as Senator Heitkamp pointed out, what some of the causes of these premium increases are.

Insurers regularly cite the Trump administration's refusal to commit to making cost-sharing reduction payments, also known as CSRs. These CSR payments were included in the Affordable Care Act in order to help Americans afford insurance once they had it. The ACA requires insurers to reduce deductibles and copayments for working families who are buying insurance in the marketplace. Because of the cost-sharing reduction payments, the CSRs, patients pay less for their care and the government reimburses the insurers.

These reductions and payments are built into the rates insurers are charging for 2017. Yet the Trump administration has refused to commit to paying these reimbursements because of a partisan lawsuit that has been brought by House Republican leaders.

Because of the radically uncertain landscape insurers are facing right now, many of them are doing one of

two things: Some are pulling out of the ACA marketplaces altogether, and others are dramatically increasing premiums. The end result is fewer choices and higher costs for American families.

Last year in my State of New Hampshire--and Senator Hassan is here. We represent New Hampshire, and we have been very concerned about what is happening right now. Last year, the insurance markets were stable, and health insurance premiums increased an average of just 2 percent-- the lowest annual increase in history. Today is a radically different story, in large part because of the uncertainty this administration is causing by refusing to guarantee insurers cost-sharing reduction payments. What we are seeing is that those insurance companies are protecting themselves by raising premiums on patients.

The same thing is happening in other States. In some cases, insurers are filing two different sets of rates--a set that is premised on the administration continuing to make cost-sharing reduction payments and an alternative set with higher premiums to account for continuing uncertainty and the possibility that this administration will stop making those payments.

Unfortunately, the Trump administration continues to send mixed signals to insurers, and of course it has threatened to stop paying cost-sharing reduction payments altogether. If this were to happen, insurers could immediately exit the markets for breach of contract.

So we are kind of in this perverse limbo situation. The administration creates uncertainty by refusing to commit to continuing the CSR payments, and the insurers protect themselves by exiting the markets or raising rates. And it is the premium holders, the families out there, who are hurt by this political football that the administration seems to be intent on continuing.

That is why I have introduced the Marketplace Certainty Act, which is a bill to appropriate funding for the cost-sharing reduction payments in order to make good on our commitment to help working families with their deductibles and cost sharing.

I believe that the House Republican leaders' lawsuit has no merit but that the chaos it has caused by allowing the Trump administration to waver on these promised payments requires that we act now.

I am pleased to be joined in this legislation by Senators Baldwin, Blumenthal, Cardin, Carper, Coons, Kaine, Hassan, Heitkamp, Cortez Masto, King, Leahy, Markey, Wyden, Stabenow, and I am sure that by tomorrow, we will have even more Senators on this bill.

We could pass it right now. Right now, we could end this manufactured crisis. We could immediately restore certainty and stability to the health insurance markets for all of our constituents. That would be good for the Republicans, and it would be good for the Democrats. Mostly, it would be good for the families out there who are experiencing this uncertainty.

We could do this. It would give us the breathing space we need to come together on a bipartisan basis to improve the law, to strengthen what is working and to fix what is not. In poll after poll, that is what the American people want us to do. They want us to stop the partisan bickering. They want us to work together. They want us to make commonsense improvements so that this law works for every American.

Mr. President, at this point, I ask unanimous consent that the Senate proceed to the immediate consideration of S. 1462, the Marketplace Certainty Act; that the bill be considered read a third time and passed; and that the motion to reconsider be considered made and laid upon the table with no intervening action or debate.

Mr. President, while I am disappointed, I am not surprised that my colleague from Wyoming has objected to our effort to move forward. He is objecting to ending the uncertainty we have experienced, which is forcing insurers to raise rates because of the uncertainty with which this administration is administering the Affordable Care Act. They have been very clear that they want marketplaces to implode so that the act does not work for people. Senator Barrasso is objecting to a commonsense step to stabilize the insurance marketplaces.

This is not going to be the last word because this is a commitment we made to American families. The instability here in Washington is what is causing the instability not only in insurance markets but in the country at large.

We are approaching the Fourth of July, which is next week. When our Founders declared independence on July 4, 1776, Benjamin Franklin warned that we must all hang together or we will all hang separately. It is no different today. We all need to come together. We need to work across the aisle. We need to improve the healthcare system so that it works for all Americans. That is our goal. That is why we are here on the floor today, and we need to start by making sure the insurers have some certainty so that they can keep rates low for American families. We will be back, have no doubts about that.

Mr. President, last month, Republicans in the House of Representatives passed a healthcare bill. They call it the American Health Care Act. It has been widely described as cruel and poorly crafted. Last week, President Trump described it as ``mean.''

The House bill, by design, would take health coverage away from tens of millions of Americans. It ends the guarantee of affordable coverage for people with preexisting conditions. It cuts Medicaid, which is the principal program for ensuring children, people with disabilities, and seniors in nursing homes. It cuts Medicaid by more than $800 billion, and to compound that cruelty, the same legislation gives an enormous tax cut--over $30 billion--to those at the top of the income scale.

We just heard this morning some of what is in the Senate bill, the Senate version of the American Health Care Act. In fact, not only does it not do what President Trump claims the Senate was working on--it doesn't address the mean aspect of it--but it actually makes it worse. In a State like New Hampshire, it provides for even deeper cuts to our expanded Medicaid Program, a bipartisan program that provides for treatment for substance use disorders for people dealing with the heroin and opioid epidemic. It would tax older Americans more than younger Americans for their health insurance and defund Planned Parenthood. There are all kinds of reasons. It would eliminate the requirement that people with preexisting conditions are able to have healthcare coverage. And all of this was done in secret behind closed doors.

My office has been deluged with messages from constituents who oppose the Republican leader's bill. This shows whom we have heard from in recent weeks. I have received more than 5,400 messages opposing the bill and 108 in support, so 5,461 are in opposition, and 108 are in support.

I am sure my colleagues on the other side of the aisle must be receiving similar volumes of mail and phone calls from their constituents, and they are hearing what I am hearing from my constituents: that if we go forward with this legislation that the House passed and that the Senate is considering, we are going to have people lose their access to healthcare and many people will have to pay more.

So I appeal to Republican leaders. I urge you to stop and reconsider what you are doing. I want you to listen to some of the people we have heard from in New Hampshire, everyday Americans whose lives would be devastated by this legislation.

Several months ago, I asked people across the State of New Hampshire to tell me their stories about the Affordable Care Act, to tell me their concerns, to let me know how it has made a difference for them.

Here we see one of the people I heard from. This is Deodonne Bhattarai and her son Bodhi. They live in Concord, NH. As you see, Bodhi is in a special chair. Deodonne writes:

Our three-year-old son is a bright, curious, funny little

boy who also has Spinal Muscular Atrophy.

That is a degenerative neuromuscular disease that causes his muscles to be very weak.

Our insurance initially denied coverage for his wheelchair,

but because of the Affordable Care Act--

The ban on discrimination against those with preexisting conditions--

my son is now able to explore his world independently.

She goes on to say:

I have [read news reports about the Republican

legislation], and I fear for our ability to maintain not just

insurance coverage but the type of quality coverage my son's

life depends upon.

Next we have a picture of the McCabe family. They are from Kingston, NH, and this is their story:

Our daughter, Ellie, was born with a rare and serious heart

defect called Hypoplastic Left Heart Syndrome.

You can see Ellie there. She looks like a healthy, inquisitive little girl, and she is looking healthy because she underwent her first surgery when she was just 3 days old.

The McCabes go on to say:

It terrifies us to think about what would have happened to

our family if Ellie hadn't been protected by the pre-existing

conditions protections in place thanks to the Affordable Care

Act. Without those protections, either we would be in serious

debt for the rest of our lives or Ellie would not have had

her life-saving surgeries.

Next, this is Dr. Marie Ramas. She serves at the Lamprey Health Care Center in Nashua, NH. That is a clinic I recently visited. She wrote to me:

I have a 24-year-old patient who was born with a congenital

condition that did not allow his leg bones to grow

completely. This patient was unable to afford proper care and

had been walking with an old prosthetic for the last 3 years.

Imagine not being able to get your prosthetic replaced for 3 years.

Thanks to expanded Medicaid and to the ACA protections for

those with pre-existing conditions, he's now getting quality

care and can afford a new prosthetic.

So his life has been changed by the Affordable Care Act.

I have also heard stories from scores of entrepreneurs and small business owners who have benefited from the Affordable Care Act.

This is Steve Roll of Keene, NH, and he wrote:

In late 2015, I left my job to start my own business. I've

built a profitable business and expect to hire employees

within a year or two. Before the ACA, I wouldn't have taken

the risk to start a business because I have a pre-existing

condition and I wouldn't have been able to get an individual

health insurance policy. If the ACA is repealed, I'm

concerned that I'll need to put my business on hold in order

to go back to a corporate job just to get the healthcare

benefits.

Well, the healthcare legislation that has been produced by the Republican leadership in the Senate would take away the requirement that people with preexisting conditions have to have access to healthcare.

We have another businessperson here, Dave Lucier. He is the owner of Claremont Spice & Dry Goods in western New Hampshire. Dave wrote this:

Before the Affordable Care Act, insurance costs were more

than a third of my business expenses. Now they're less than

an eighth. The ACA made it possible for me to go out on my

own and realize my dream of starting a small business here in

Claremont.

And his business is doing well.

Many women have written to me about how the Affordable Care Act has

ended discrimination against them by the health insurance industry-- discrimination because of their gender. In particular, they are grateful that the Affordable Care Act includes maternity care and contraception among the law's essential health benefits.

This is Maura Fay of Exeter, NH. I talked about her last night when I was talking about the impact of this Republican bill on women's health. Maura wrote:

My husband and I are self-employed. Before the ACA, we were

paying rates that were simply unsustainable for a middle-

class family like ours. When I was pregnant in 2013, we were

forced to pay a maternity rider of an additional $822 a

month. I'm worried about the rollbacks in regulations around

essential health benefits, especially since so many of them

impact women. Maternity coverage shouldn't come with an

additional $800 a month price tag.

Here in Washington, some folks seem to think that repealing the Affordable Care Act is all about politics, that it is about winning this debate. But for ordinary people in New Hampshire--people like Maura, like the McCabe family, like all the people I have shown pictures of this afternoon--for ordinary people in New Hampshire and across America, repealing the Affordable Care Act isn't about politics. For so many of them, it is about life-and-death. It is about the kind of lives they are going to lead. It is about whether they are going to be able to continue to afford healthcare, whether they are going to continue to pay their mortgage and buy prescription drugs. We need to listen to these ordinary people in each of our States whose lives and financial situations will be turned upside down if the Affordable Care Act is repealed.

This process has really not been in keeping with our democratic process in America. For the Republican leadership here in the Senate and before that in the House to pursue a partisan approach to healthcare, to deny Democrats and even deny many of my Republican colleagues the ability to engage in the writing of this bill--it is deeply misguided to deny the public access, to deny a hearing on this bill, legislation that we know is going to hurt tens of millions of Americans.

There really is a better way forward for both the Senate and for our country. If we put ideology and partisanship aside, if we work together, we can strengthen the parts of the Affordable Care Act that aren't working. We can continue Medicaid expansion so it can help people with substance use disorders, so it can help kids with disabilities, so it can help elderly people in nursing homes. We can fix what is not working, and we can improve on this law and make it better, but we can't do that if we continue to be divided up on our partisan sides, if we are not willing to talk about the issue, not willing to work together.

The American people want us to work together here in Washington to address their concerns. Well, it is time to respect their wishes. Let's strengthen the Affordable Care Act so that it works even better for all Americans.

I yield the floor.

Mr. President, I am joining my colleagues on the floor this afternoon because I share their concerns about what will happen to women's healthcare. I am concerned about what will happen to everyone's healthcare, but particularly this afternoon we are talking about our concerns with respect to healthcare for women.

If the Senate passes legislation like the House passed recently--the American Health Care Act--that legislation has been widely described as cruel and poorly crafted. Just last week, President Trump described it simply as mean. Republican leaders in the Senate are now writing a companion bill that reportedly makes mostly cosmetic changes to the House bill. By some accounts, it would make the House bill even more extreme.

Obviously, any legislation that, by design, takes health insurance away from tens of millions of Americans, I believe, is deeply misguided. I am particularly concerned about the harmful effects this legislation would have on women's health. Indeed, I received countless emails and letters from women who are offended that, once again, powerful men are meeting behind closed doors to make critical decisions regarding women's health, and we have been excluded from the room.

This Republican bill would take us back to the days before the Affordable Care Act, when insurers could charge women more just for being women, with no other reason needed. It would take away the Federal protections against discrimination based on preexisting conditions. Bear in mind, some of these conditions apply mostly or exclusively to women.

In the days before the Affordable Care Act, insurance companies treated pregnancies, sexual assault, domestic violence, and cesarean sections as preexisting conditions. Insurers routinely charged higher premiums to women with these ``preexisting conditions'' or they denied coverage all together. For example, more than 30 percent of mothers have a cesarean section. Once again, if this House-passed bill passes, and if we see something out of the Senate that does the same, women would face discrimination, mothers would face discrimination from insurance companies.

The American Health Care Act would also harm women by allowing insurers to opt out of the 10 essential health benefits that all insurance plans must cover under the Affordable Care Act. These benefits are called essential because that is exactly what they are. They are essential, not only to good health but, in some cases, to actually staying alive. A number of these essential health benefits apply exclusively to women, including contraception, maternity and newborn care, mammograms, and cervical cancer screenings.

Several months ago on Facebook, I asked people across New Hampshire to tell me their stories--stories about how the Affordable Care Act has made lifesaving difference or otherwise improved their lives. I heard from many women across New Hampshire who have written about how the Affordable Care Act has ended discrimination against them by the health insurance industry because of their gender. In particular, they are grateful that the Affordable Care Act includes maternity care and contraception.

This is a picture of Maura Fay, of Exeter, NH. She writes:

My husband and I are self-employed. Before the ACA we were

paying rates that were simply unsustainable for a middle-

class family like ours. When I was pregnant in 2013, we were

forced to pay a maternity rider of an additional $822 a

month.

That is in addition to her premium. She says:

I'm worried about the rollbacks in regulations around

Essential Health Benefits, especially since so many of them

impact women. Maternity coverage shouldn't come with an

additional $800 a month price tag.

Well, I appreciate that letter from Maura, but I am worried she may actually be underestimating the cost of maternity care coverage if the Affordable Care Act is repealed. According to one analysis, women who seek maternity care under the American Health Care Act--the legislation passed by the House--could pay up to $17,000 in surcharges to their insurance company.

The American Health Care Act that the House passed also makes draconian cuts to Medicaid, and this will disproportionately harm women--nearly 40 million women--who make up the majority of Medicaid beneficiaries. Medicaid provides healthcare for nearly half of all pregnant women in the United States, supporting them through their pregnancies and ensuring that their babies get a healthy start in life. This coverage is directly threatened by the Republican legislation.

The American Health Care Act the House passed, if we combine that with the administration's budget proposal, it would cut Medicaid by a staggering $1.4 trillion by the year 2027--so, in 10 years, a $1.4 trillion cut. This would reduce Medicaid funding by nearly half and mean that tens of millions of people would lose coverage, including many women of reproductive age.

Let me also point out that both the American Health Care Act passed by the House and the President's budget terminate all Federal funding for Planned Parenthood, and we just heard Senator Blumenthal speak eloquently about the importance of Planned Parenthood. This would leave millions of

women and families with fewer healthcare options. In New Hampshire, it would mean that between 12,000 and 13,000 women and men would lose access to basic primary and preventive health services, including lifesaving cancer screenings and HIV testing.

According to poll after poll, the American people all across the political spectrum strongly support Planned Parenthood and oppose efforts to defund it. Despite efforts by Republican leaders in the House and Senate to misrepresent the facts, Planned Parenthood does not use taxpayer dollars to fund abortions. Indeed, Federal law expressly forbids the use of Federal funds to pay for abortions except under extremely narrow circumstances that have been agreed to by Congress, so the real issue here is not abortion. This is about ensuring that American women have access to the basic healthcare they need where they want to receive it. Remember that Planned Parenthood plays an especially important role in delivering essential health services to low-income, uninsured, and vulnerable individuals, including in rural areas.

Earlier this year I received a letter from Samantha Fox of Bow, NH, and she writes:

In 2007, I was a 19-year-old just barely starting out when

I was denied health insurance due to a preexisting condition.

Had I been able to access affordable coverage, my preexisting

condition, a reproductive system disorder, would have been

easily manageable. . . . [A]t that time, I was able to access

care through Planned Parenthood which likely preserved my

ability to conceive in the future. Flash forward 10 years: I

am expecting my first child and I have coverage which, thanks

to the Affordable Care Act, includes prenatal care.

Now, here in Washington, some people think that repealing the Affordable Care Act is all about politics and notching a win on their scoreboard. But for ordinary people in New Hampshire and across the country, including millions of women, repealing the Affordable Care Act isn't about politics, it is about life and death. We need to listen to the women and men in each of our States whose lives and finances would be turned upside down if the Affordable Care Act is repealed.

Furthermore, it is just wrong to exclude women, to exclude their colleagues, to exclude Democrats, to exclude the public and to pursue a strictly partisan approach to healthcare--the same approach that produced a terrible bill in the House. And it is deeply misguided to bring legislation to the floor that we all know would hurt tens of millions of Americans and do particular harm to women.

There is a better way forward in the Senate. Let's put ideology and partisanship aside. Let's work together. Let's strengthen the elements of the Affordable Care Act that are working in the real world, including Medicaid expansion, and let's fix what is not working. It doesn't matter what we call this. It doesn't have to be called ObamaCare. We can call it whatever we want. The important thing is to have legislation that would provide access to healthcare for Americans, healthcare they can afford, that is quality, that is there when people need it. This is what the great majority of the American people want us to do. It is time now to respect their wishes. Let's strengthen the Affordable Care Act so that it works even better for all Americans.

I yield the floor.

Mr. President, I am here this afternoon to speak about the amendment to address sanctions on Russia, but I want to preface my remarks by saying, like all of us here in the Capitol today, that my thoughts are with Congressman Scalise and with the staff member, the two Capitol police officers, and others who were part of the terrible tragedy this morning. In particular, I want to salute the officers involved, whose courage and professionalism undoubtedly saved many lives, and I join with the entire Senate family in hoping for a full recovery for everyone involved.

Amendment No. 232, as Modified

Mr. President, in a few minutes, we will vote on a bipartisan amendment to strengthen sanctions on Russia and to mandate rigorous congressional review of any effort to loosen the sanctions regime. I am pleased to cosponsor this amendment, which has real teeth, including provisions that I advocated for to prevent sanctioned individuals from using family members to circumvent sanctions.

I am also pleased that the amendment includes congressional review of any decision to restore Russia's access to non-Embassy compounds that were seized at the end of last year in the United States. I think this is not the time to grant Russia such privileges, especially given that it would bolster their intelligence-gathering capabilities.

I am pleased that this is a bipartisan amendment, thanks to the leadership of the chair and ranking member of the Foreign Relations Committee, on which I serve, Chair Corker and Ranking Member Cardin, as well as the chair and ranking member of the Banking Committee, Senator Crapo, who is here, and Ranking Member Brown. They worked very hard to come up with a bipartisan agreement.

I also want to recognize Senators McCain and Graham, whose work on the underlying bill gave us a foundation to come up with this amendment.

Again, on a personal level, I want to especially thank the chair and ranking member of the Foreign Relations Committee. Senator Corker had made a commitment to get this bill done after we got back from the break. He has been good on his word, and we have a bipartisan agreement.

I think these measures are necessary because the United States has been attacked by a hostile foreign power. As a result, we have a responsibility to respond in a way that punishes the attacker and that strives to prevent a recurrence in the future.

In January, the Director of National Intelligence released a declassified report on Russia's interference in our election. I think it is important to reiterate what that report said. It states:

We assess Russian President Vladimir Putin ordered an

influence campaign in 2016 aimed at the US presidential

election. Russia's goals were to undermine faith in the US

democratic process.

While recently we have learned more about the scope of their interference, a classified National Security Agency report, prepared prior to the November election, concluded that Russian military intelligence executed a cyber attack on at least one U.S. voting software supplier and sent spear-fishing emails to more than 100 local election officials. Yesterday, Bloomberg reported that Russia's cyber attack on the U.S. electoral system included incursions into voter databases and software systems in as many as 39 States.

We are learning more and more about the extent to which Russia attacked our voting system and tried to undermine our elections. That is exactly why the Senate stands united behind this bipartisan amendment to stiffen sanctions. We must not allow this kind of interference in our elections to become a normal process.

What we have heard from experts in the intelligence community--they have warned us that if Russia gets a pass on this, that it will interfere in future U.S. elections. We have seen it in Europe and other Western democracies.

In testimony last month before the Judiciary Committee, the former Director of National Intelligence, James Clapper, said:

I believe [the Russians] are now emboldened to continue

such activities in the future both here and around the world,

and to do so even more intensely.

He goes on to say:

I hope the American people recognize the severity of this

threat and that we collectively counter it before it further

erodes the fabric of our democracy.

Russia's interference in our electoral process should outrage every patriotic American. We need a bolder, more aggressive strategy for deterring Russia. This bipartisan agreement to stiffen sanctions is a critical step forward.

In concert with this legislation, we need to be focused on bolstering NATO and our European allies, and we need to demonstrate more vigorous support for Ukraine's efforts to strengthen its democracy and independence.

We need to be more aggressive in countering the Russia propaganda and disinformation campaign, including the Russia Today empire.

Finally, I want to again applaud the leadership of all of our committees who were involved in coming up with this bipartisan agreement. Also, I applaud the bipartisan leadership of Majority Leader McConnell and Minority Leader Schumer because without their negotiations, we would not be here today.

I certainly urge all of my colleagues in both Houses of Congress to promptly approve this legislation, and I hope the President will sign it.

Mr. President, I am deeply concerned by warnings from leading health insurance companies and State insurance commissioners that the Trump administration is now deliberately undermining the Affordable Care Act, leaving insurance plans no choice but to sharply raise premiums or exit the marketplaces.

I understand--I think we all do--that the Affordable Care Act continues to experience stresses and that it needs to be strengthened. There is no doubt about that. I have been saying from the beginning that we need to correct what is not working, that we need to keep what is working, and that we need to work together to change it. Yet, in 2016, there were abundant signs that the law was working and that insurance markets were stabilizing.

For instance, in my State of New Hampshire, health insurance premium increases last year averaged just 2 percent. That is the lowest annual increase in history. Today, it is a very different picture. Because of the efforts of the Trump administration to undermine the Affordable Care Act, insurance companies in New Hampshire and across the country face widespread uncertainty. Many of them are deciding that they have no choice but to protect themselves by drastically increasing premiums.

This week, there was a report in the New Hampshire Union Leader, which is our State's largest newspaper, that premiums in New Hampshire could increase by as much as 44 percent. Now, President Trump says that the Affordable Care Act is ``exploding,'' but let's be clear. If ObamaCare is exploding, as President Trump says, it is because this administration lit the fuse and has been working aggressively to undermine the law.

We can see on this poster what is being reported in other parts of the country. In the LA Times, we see that health insurers and State officials say that Trump is undermining ObamaCare and pushing up rates and that health insurers plan big ObamaCare rate hikes, and they blame Trump.

Perhaps the greatest damage has been done by the administration's refusal to commit to funding cost-sharing subsidies, which are the Federal subsidies that help millions of people pay for coverage. To protect themselves, many insurance companies are preparing two sets of premiums for next year--one premium level if the administration agrees to fund the cost-sharing subsidies and a second, dramatically higher premium level if the administration says no to cost-sharing subsidies.

More broadly, the administration's mixed signals and erratic management of the Affordable Care Act are causing uncertainty in the marketplace. Paul Markovich, the CEO of Blue Shield of

California, has said that health plans are being forced to raise premiums to compensate for all of the turmoil.

It gets worse.

Last week, the Los Angeles Times reported that Seema Verma, the Administrator of the Centers for Medicare and Medicaid Services, shocked a meeting of insurance industry executives by threatening to cut off funding for cost-sharing reductions unless insurers agreed to support the House Republicans' bill to repeal the Affordable Care Act-- the bill that was passed several weeks ago.

Washington State Insurance Commissioner Mike Kreidler criticized the administration's actions as playing Russian roulette with Americans' health insurance coverage. He said: ``This has real impact on people's lives.''

One insurance company executive said this about the administration's actions: ``There's a sense that there are no hands on the wheel, and they are just letting the bus careen down the road.''

Physicians and other healthcare professionals live by a time-honored pledge to do no harm, but the Trump administration is pursuing a course that will do tremendous harm to millions of Americans who have gained health coverage for the first time because of the Affordable Care Act. Unless and until Congress repeals the Affordable Care Act, it is the law of the land, and this administration has a responsibility to administer this law with fairness, with rigor, and with competence. The administration certainly does not have the right to take active steps to undermine or even sabotage the law or to threaten insurance companies with such steps if they do not support the repeal of ObamaCare.

It is time for the administration to reconsider its approach to healthcare reform. To date, regrettably, the administration's approach has been highly partisan, with no outreach to Democrats. Instead of a ``do no harm'' approach, instead of taking steps to fill President Trump's pledge that we are going to have insurance for everybody--and he came through New Hampshire on multiple occasions during his primary campaign and during the general election campaign. What he said about health insurance was that we were going to make sure that everybody has it; we are going to make sure that they pay less and that they get quality coverage. The administration now seems determined to take health coverage away from tens of millions of Americans.

The Congressional Budget Office estimated that the House Republicans' bill--the first one--to repeal the Affordable Care Act would take coverage away from 24 million Americans. Yesterday, the administration proposed a budget that would cut Medicaid by as much as $1.3 trillion over the next decade. That would end coverage for millions of low- income Americans, people with disabilities, and so many of our elderly in nursing homes. In New Hampshire, where we are really on the frontlines of the heroin and opioid epidemic, it would end treatment for many people who are getting treatment for their substance use disorders because of the expansion of Medicaid.

When we think about the people who would be hurt by this, it is unconscionable to hear Office of Management and Budget Director Mick Mulvaney say: ``There is a certain philosophy wrapped up in the budget, and that is that we are no longer going to measure compassion by the number of programs or the number of people on those programs.'' I disagree with that view. By deliberately taking healthcare coverage from 24 million Americans, it shows the lack of compassion of this administration.

This is not about numbers. He is right about that. This should not be about numbers. This should be about people, about their families, and about what these proposals will do to everyday Americans who will no longer have access to affordable health coverage. Whether they have preexisting conditions or whether they need to get treatment for cancer, for substance use disorders, or for whatever their healthcare needs are, under this proposal, they are not going to be able to afford it. Millions of Americans will not be able to afford it.

I think there is a better way forward. Instead of tearing down the Affordable Care Act and taking health coverage away from people, we should be building on the gains and on the achievements of healthcare reform.

On that score, I want to share an extraordinary letter to the editor that was written by Carol Gulla, of Newmarket, NH.

I am reading her letter:

I was in good health; why bother with a physical?

That was my mentality for years before the Affordable Care

Act (aka Obamacare). I work for a small nonprofit business,

so we don't qualify for group health insurance plans. An

annual physical wasn't included in the high premium, high

deductible plans that were available to me on the individual

health insurance market so they were often a luxury. But it

was OK; I felt great! Why bother with doctors?

Because of the Affordable Care Act, last June I went for a

routine physical. During [the exam] a lump was discovered in

my breast. Ten days later, breast cancer was diagnosed. . . .

Fast forward to today. I've just completed my final

chemotherapy treatment and my prognosis is very positive.

That physical saved my life.

Let me restate that--Obamacare saved my life.

That crucial physical in June would not have happened had

it not been an essential preventive service included in all

health plans under the ACA. While not perfect, my insurance

through the ACA is far better than anything available to me

as an individual in the past.

Ms. Gulla's letter continues:

Up until this point I have been pretty quiet about my

diagnosis simply because I didn't want cancer to be the main

topic of every conversation I had. But, with the Republican

majority in Washington, including Secretary of Health & Human

Services Tom Price, promising to repeal the ACA, being quiet

is no longer an option. I am being asked to entrust my health

and well-being to hollow promises of it will ``be replaced by

something better; it will be great.'' Forgive me if I'm

skeptical!

This is my life we're talking about! Do not tell me to be

patient. Do not tell me to ``wait and see.'' Either outline a

. . . plan for improving the Affordable Care Act, or leave my

health insurance alone!

She signs it with her name, Carol Gulla, of Newmarket, NH.

I think we need to listen to Carol and to so many other people like her all across America.

Instead of allowing this administration to undermine and even sabotage the Affordable Care Act, we in the Senate need to work together, Democrats and Republicans, to strengthen the parts of the Affordable Care Act that are working in the real world, including Medicaid expansion, and to fix what is not working. According to multiple recent polls that I have seen on this issue, this is what the great majority of Americans want us to do. It is time for us to listen to the American people.

The Affordable Care Act has had a profoundly positive impact all across America, but it needs commonsense repairs and it needs strengthening. Mend it, don't end it, and certainly don't sabotage it. This should be a bipartisan focus in the Senate. I intend to do everything I can to encourage such a bipartisan effort. I know my colleagues on both sides of the aisle would be willing to do this important work if they understood how much the American people want to see us do this.

We know that the Affordable Care Act has had positive impacts in each of our States, including giving people peace of mind, knowing they can't be denied coverage based on preexisting conditions. So let's work together. Let's ensure that the Affordable Care Act works even better in the future for all Americans.

Thank you, Mr. President.

I yield the floor.

Mr. President, will my colleague yield for a question?

Those numbers came out while I was speaking on the floor, because I was talking about the first House-passed bill to repeal the Affordable Care Act. What the Senator from Illinois is telling me is that the numbers for the bill they passed to fix the first bill they couldn't pass are just as bad and in some ways even worse than the original bill.

Well, that was going to be my followup question. In New Hampshire, we have the second highest percentage of overdose deaths in the country. We lose more people in New Hampshire to deaths from overdoses of opioids and fentanyl and heroin than we do to car accidents. And an overwhelming percentage of people--over 90 percent-- are getting treatment for their substance abuse disorders through the expansion of Medicaid, which has been a bipartisan program in New Hampshire that has covered about 60,000 people, many of whom are getting treatment for substance abuse disorders.

So what the Senator from Illinois is telling me, from the CBO, is that based on the plan that passed the House that Republicans have supported, those people who are getting their treatment--lifesaving treatment for mental health issues and substance abuse disorders--they are going to be kicked off of their plan, and they are not going to have any other option for getting that care.

Mr. President, if my colleague will yield once more, last year we passed the 21st Century Cures Act, which appropriated $1 billion--$500 million this year and $500 million next year--to address the heroin and opioid epidemic we are having, and in the recent passage of the omnibus bill, we got $700-plus million to help us fight this epidemic. So on the one hand, we are putting money in to address it, and on the other hand, we are taking away the treatment people need by passing a healthcare bill that is going to throw people off their treatment and give them no other option to address their substance use disorders.

If I could just add one more group of folks who are going to be affected by this bill that passed the House several weeks ago. That is our veterans. We have millions of veterans in this country who get their healthcare through Medicaid. We have asked these folks to put their lives on the line for this country, and now we are talking about taking away the healthcare they depend on.

I was at one of our community mental health centers in New Hampshire last week and met with a number of veterans who get their care through the expansion of Medicaid. They talked about what it means to be able to get care, to be able to go into that community mental health center and work with the veterans outreach coordinator who works with veterans, trying to make sure they get the help they need. If this bill goes forward, PTSD, which affects so many veterans, would be considered a preexisting condition and they wouldn't be able to get health insurance going forward.

This is bill is nothing but mean-spirited. As the Senator said, all of the efforts to save money in the bill are so money can be used to give huge tax breaks to the wealthiest among us. I don't think that is what Americans want. As the Senator says, we need to work with our colleagues. We need to get a good bill that improves the Affordable Care Act, fixes what is not working, and makes it better.

Actually, the New Hampshire Hospital Association also opposes the bill for the very same reason. We have hospitals at risk if this bill is passed.

There will be. If I could ask one final question because not only is this effort in the Senate happening behind closed doors, but initially it excluded women.

Women are more than 50 percent of this country. We have particular needs when it comes to healthcare. Fortunately, the essential health benefits part of the Affordable Care Act provide requirements for preventive health for women, for mammograms. They cover maternity benefits when you have a baby. They are talking about writing this legislation without taking into consideration the women in the Senate, the women in the country, and what we need to do to make sure we have access to healthcare. That is just unconscionable, added to the fact that it is all being done behind closed doors.

Absolutely. They want to take us back to that.

Mr. President, I wish to speak in strong support of the U.N. Paris climate change agreement and in opposition to efforts to undermine this international agreement that is vital to the environmental and economic well-being of New Hampshire, the Nation, and the world.

In 2015, I joined nine of my Senate colleagues in Paris to attend the 21st U.N. Climate Change Conference, also known as COP 21, where the climate agreement was negotiated. What we witnessed at COP 21 was monumental: 195 countries representing more than 95 percent of global carbon emissions worked together to adopt the first universal climate agreement that calls for international cooperation on addressing the causes of global warming and helping poorer nations most affected by it. The following year, on Earth Day, the United States and more than 170 nations signed the international climate agreement in New York; and on November 4, 2016, the Paris Accord entered into force.

I am proud to say that the U.S. was a big part of that effort. That is why I am so disappointed to see that President Trump is currently considering whether to pull the United States from this historic agreement. This would be a huge mistake.

No country is insulated from the increasingly present and escalating effects of climate change. In the United States, we are seeing it throughout the country, and this is certainly true in New Hampshire. Rising temperatures are shortening our fall foliage season, which is so important to our State's tourism economy. Milder winters have led to increases of insect-borne diseases that endanger our wildlife. In New Hampshire, we have already seen a 40 percent decline in our moose population. The changing climate is also putting more stress on sugar maples, and this is already affecting syrup production.

The Paris Agreement establishes a long-term, durable global framework for countries to work together to reduce carbon emissions and keep the global temperature rise well below 2 degrees Celsius in order to avoid some of the worst consequences of climate change. For the first time, countries have committed to putting forward ambitious, nationally determined climate targets and reporting on their progress towards those targets using a standardized process of review. The Paris Agreement encourages transparency, accountability, and collaboration among nations not only to meet their climate targets, but to encourage innovation while doing so.

That is why American business leaders are strongly in favor of continued U.S. participation in the Paris accord. From oil giants to tech firms, corporate leaders understand that the transition to clean energy presents one of the biggest economic opportunities of this century to create jobs and build wealth in this country. In fact, the International Energy Agency projects that, over the coming decades, more than $60 trillion will be invested in energy efficiency and clean energy technologies as countries address the threat of climate change. The United States stands in a unique position to be the leader of the clean energy revolution. This would be jeopardized if the President decides to remove the United States from the international climate agreement.

Climate change represents an enormous challenge, but the solutions are within reach if we put into place policies that allow for swift action. The United States must help ensure that the goals of the Paris Agreement are realized. That is why I joined with my colleagues to introduce a resolution stating that the United States should work in cooperation with the international community and continue to exercise global leadership to address the causes and effects of climate change. We have a responsibility to help protect our children and grandchildren from the most severe consequences of global warming by reducing emissions now. This President must not remove the United States from this important agreement.

Mr. President, I came to the floor this afternoon to speak to the CRA legislation before us that would overturn the Department of Labor rule designed to help Americans save for retirement, but before I speak to that, I just want to join all of my colleagues on the floor in applauding what has happened to support the miners and to get them health benefits and to thank my colleague Joe Manchin for his leadership.

I know how personally he has fought for this, as so many people who spoke on the floor have. You know, we don't have any coal miners in New Hampshire, Joe, but we have hard workers. We have people who understand that when you make a promise to them, you need to keep that promise. Thank you for leading this fight and to everyone who made this happen because we need to reassure Americans that when we say we are going to do something, we actually follow through and we do that. So thank you for making that happen.

Now, Mr. President, it is disappointing that actually on the issue that is before the Senate right now, this effort to change the labor rule on retirement, that we are actually going to take something away from Americans. States across America have been developing and implementing innovative, low-cost retirement savings options to improve their citizens' retirement security.

That is really important at a time when we have so many people who have not been able to save for retirement, who are worried about what might happen if something happens to them and they can't work into the retirement age. Sadly, the misguided legislation that is before us would shut down these efforts and effectively take away from States the right to establish retirement options for workers.

Now, across the country we have had Republican and Democratic State treasurers join with groups, including the AARP and the Small Business Majority, to oppose this effort. I want to join them in asking two what I think are obvious questions.

First, why do the sponsors of this resolution want to deny Americans new, attractive retirement savings options?

Second, why in the world are they doing this at a time when the United States faces a growing retirement savings crisis--a crisis that threatens to strand millions of seniors without any personal savings and at risk of falling into poverty? And why do this when it doesn't include any mandates and there is no cost to taxpayers either at the Federal level or, in most States, at the State level? This is something that is paid for by people who are looking to get a pension.

Facts matter, and we shouldn't ignore them. Some 55 million Americans lack access to a workplace retirement plan, and 45 percent of households don't have any retirement account assets--zero savings. Polls show that more than three-quarters of private sector workers fear not having enough money to live comfortably in retirement.

To address this nationwide crisis, many States have stepped up to the plate, experimenting with public-private partnerships to help small businesses provide low-cost, turn-key payroll deduction options. The legislation being debated today would abruptly compromise the future of these State initiatives.

In my State of New Hampshire, nearly 99 percent of our employers are considered small businesses. That number is hard to believe. They employ over 50 percent of New Hampshire's workers.

Nearly 43 percent of Granite Staters work for an employer that does not offer a retirement plan.

As the ranking member of the Small Business Committee, I talk to small business owners regularly, and as a former small business owner myself, I understand the challenges they face. For many, it is a challenge just to meet payroll and to keep the doors of their businesses open. I know that many of them would like to offer a company retirement plan because they want to do right by their employees, but they just can't afford it.

A Pew Foundation survey found that three-quarters of owners of small and medium-sized businesses across the country support the idea of these State-run options because they offer a way for employees to save for retirement at little or no cost to the employer.

So these programs are sort of like starter plans for small businesses. A company that is still trying to gain its financial footing can offer this option to its employees. Then, once the company gets on more solid ground and it needs to attract and retain talent, it can transition to a more ambitious retirement plan that allows it to contribute to its employees' retirement savings.

It is especially troubling to me that the Senate is even considering whether to deny Americans this retirement option at the same time that we are seeing leaders on the House side trying to pass a healthcare bill that would make it more expensive for many preretirement seniors and for people with preexisting conditions to purchase health coverage.

Again, I would ask: Why would we want to deny this new, innovative retirement option to millions of employees who work for small businesses without retirement plans? Why would we want to deny small businesses the choice of offering these options? Why should the Federal Government stand in the way of States and small businesses that want to take positive steps to address the retirement crisis and help their citizens?

I think this legislation is misguided. It is legislation in search of a problem, and, worse than that, it would put a massive roadblock in the way of States and small businesses that are striving to solve the real and growing problem of inadequate retirement savings.

So I urge my colleagues to really take a look at what would happen in their home States. I urge them to stand up for America's small businesses, to vote no on this legislation. Let's ensure that Americans have more, not fewer, options to save for retirement.

I yield the floor.

Mr. President, I ask unanimous consent to engage in a colloquy with the Senator from Idaho.

Mr. President, I am pleased to come to the floor today to join my colleague, who is the chair of the Small Business Committee--and I am the ranking member--to celebrate National Small Business Week.

This is an opportunity for all Americans, regardless of party affiliation or geography, to come together and support the small businesses that drive

the American economy and make such an enormous contribution to our local communities and culture.

I am pleased to be able to work with Senator Risch. We have enjoyed a terrific working relationship. We are there, at this moment in the committee, to try to make a difference for the small businesses of not only our States of New Hampshire and Idaho but throughout the entire country.

I ask my chairman if he would like to start out and then turn it back to me, and we can talk a little bit about what we see happening on the Small Business Committee.

Mr. President, I thank Senator Risch.

As you point out, we were both Governors, so we had a chance to see small businesses from the perspective of the States and how States can be involved in supporting small businesses. But we also have been small business owners and operators ourselves. My husband and I had a family- owned seasonal retail business, and you operated a family-run ranch in Idaho. So I am sure you share with me the challenges of small business owners, the things that kept me awake at night and that I know keep other small business owners awake: meeting payroll, balancing budgets, attracting workers, finding customers, and complying with local, State, and Federal regulations.

As you pointed out, and I certainly agree, our committee works in a bipartisan way not only on supporting public policy to help small businesses but also supporting the Small Business Administration, which has programs that help nurture our small businesses and address their unique concerns.

On Monday, I visited one of those small businesses. I was kicking off Small Business Week in New Hampshire, and I visited a company in Dover, which is a neighboring community to where I live. The company is called Popzup, spelled just like it sounds. It is a family-owned business that created an innovative microwave popcorn box without harsh chemicals, plastic, or silicon. The company's popcorn that goes in that box is environmentally friendly. It comes from American farms that don't use GMO products. It is great. They also have all of these seasonings that go on the popcorn, everything from a seasoning called Everything Bagel to one that is maple syrup. So it is a unique company.

Its founders, Julie and Marty Lapham, launched the company in 2015. They have received a lot of support from the Small Business Development Center in New Hampshire. In fact, Julie told me about preparing for a ``Shark Tank''-style competition she was participating in and how she got tremendous help from the SBDC in her presentation. She said: Without that help, I wouldn't have been able to do it. She actually won first prize in the competition--$10,000--because the SBDC had helped her sort through financing options, and she and her husband continue to work with them as they grow the company.

As we look at Small Business Week this week, it is important to also recognize the great work SBA does with outstanding entrepreneurs from all 50 States and territories.

I know you have some similar examples of small businesses in Idaho.

Mr. President, I very much thank Senator Risch. I share his enthusiasm for the Office of Advocacy and all of the programs SBA administers and appreciate the good work of the new Administrator there, Linda McMahon.

You bragged a little bit on your Small Business of the Year in Idaho, and I would like to do the same. Our New Hampshire Small Business Person of the Year is Dr. Jake Reder, who is the cofounder and CEO of Celdara Medical in Lebanon, NH.

I think it is important to point out that small businesses create 16 times per employee the number of patents that large businesses do, and Celdara Medical is a great example of that. They were founded in 2008. They are a biotech startup that identifies early-stage medical technologies and provides financing and business guidance to move lifesaving products from university laboratories to high-potential medical companies. They really show that entrepreneurship can be a positive force to cure disease and save lives.

During their startup, Celdara secured funding through the SBA's SBIR Program, the Small Business Innovation Research Program, which was extended last year--thanks in large part to the work of the committee-- for 5 years because of its great track record, enabling entrepreneurs across the country to participate in R&D to keep us at the vanguard of innovation. They were also assisted by the SCORE counseling network, which provides mentors to small businesses.

There are so many things we can do to support our small businesses, and that is the goal of the Small Business Committee. We also want to continue to support a modern and flexible SBA that can respond quickly to economic conditions that confront small businesses in this global economy.

Like you, I thank all of our colleagues who are going to help us recognize small businesses throughout the country. I also thank the Appropriations Committee for its bipartisan work on the omnibus bill to fund the SBA and our critical rural development programs. We have heard about many of them at the rural hearing you talked about. Hopefully the spirit of cooperation we share on the committee will spread throughout the Congress.

So happy Small Business Week to all of our small businesses, and I thank all of the entrepreneurs in New Hampshire and Idaho and across the country for their hard work, for their innovation, and for their grit. They have our gratitude and our respect.

Thank you, Mr. Chairman. I look forward to the good work we will continue to do for small businesses in this country.

I yield the floor.

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

Mr. President, last month I introduced bipartisan legislation with Senator Todd Young of Indiana to create greater transparency about foreign individuals and organizations that are operating in the United States to advance the interests of foreign governments, including governments that are hostile to the United States.

In particular, our bill will give the Department of Justice new and necessary authority to investigate potential violations of the Foreign Agents Registration Act by RT America, the U.S. branch of RT News or Russia Today News.

The Foreign Agents Registration Act was passed back in the late 1930s in response to concerns about Nazi propaganda being disseminated in the United States without people knowing what it was. It is absolutely appropriate today for us to take a look at what Russia and other countries may be doing to our news.

RT America, which broadcasts from studios here in Washington and is available on cable TV across the United States and across the world, for that matter, is one of the most high-profile assets in Vladimir Putin's vast $1.4 billion propaganda machine. According to the U.S. intelligence community, the Kremlin selects the staff for RT and closely supervises RT's coverage, including disinformation and false news stories designed to undermine our democracy.

Here we have a photo that shows exactly what I believe seems to be happening with RT. This photo was taken from a declassified U.S. intelligence report, and it shows RT's editor-in-chief--and former Putin campaign staffer, by the way--Margarita Simonyan briefing Putin on RT's facilities. So clearly he is interested.

Well, I believe the American people have a right to know if a Russian Government entity is exploiting our first amendment freedoms to harm our country. It is galling that RT news has publicly--publicly--boasted that it can dodge our laws by claiming to be financed by a nonprofit organization and not the Russian Government.

Well, what my bill--our bill--would do is strengthen the Foreign Agents Registration Act by giving the Department of Justice authority to compel foreign organizations to produce documentation to confirm funding sources and foreign connections. This is investigative authority that has been recommended by the Department of Justice inspector general, the Government Accountability Office, and the Project on Government Oversight. Our bill would create transparency by giving Justice the authority it needs to investigate RT America and publicly expose its ties to the Kremlin.

The audacity of Russia's interference in Western democracies, including extensive meddling in our 2016 Presidential election, is deeply alarming, and we have learned that Russia's influence campaign reaches tens of millions of unsuspecting Americans. False news stories can end up on our Facebook timelines and our Twitter feeds. They shape the political conversations that we have with our friends at the supermarket and our colleagues at work.

These are just a few of the headlines from RT. This one is actually from Sputnik, which is another Russian news outlet. They show the extent to which these false news stories are being spread around. This one talks about how ``1,000s Turkish forces surround NATO's Incirlik air base for `inspection' amid rumors of coup attempt,'' which suggests that we were involved in that coup attempt.

``FBI wiretapped Trump Tower in search of `Russian mobster.' ''

``Spying on Trump: CIA Whistleblower Points Finger at Clapper, Brennan, Comey.''

``Ukrainian Su-25 fighter detected in close approach to MH17 before crash.'' You will remember that this was the plane crash over Ukraine-- that the Russians shot down.

During our Presidential campaign in 2016, dozens of narratives and false news stories originated in Russia--for instance, this one, the baseless story that the Obama administration launched a coup against the Turkish Government from the U.S. airbase in that country.

Earlier, RT News ran numerous reports on supposed U.S. election fraud and voting machine vulnerabilities, claiming that the results of the U.S. elections could not be trusted and did not reflect the people's will.

Well, researchers have traced these and other stories to a common source: the Kremlin's sophisticated, multifaceted propaganda empire, which reaches some 600 million people across 130 countries and in 30 languages.

If you watch RT News, you will agree that it is not clear whether you are watching a U.S. news station or a Russian station because it has slick production values. It is arguably the jewel in the crown of this propaganda empire.

According to the U.S. intelligence community report declassified in January:

The Kremlin has committed significant resources to

expanding the [RT News'] reach, particularly its social media

footprint. . . . RT America has positioned itself as a

domestic US channel and has deliberately sought to obscure

any legal ties to the Russian government.

A prime objective of this propaganda barrage is to influence U.S. and European public opinion, create confusion, and shape election outcomes.

The Associated Press has identified a building in Moscow where an estimated 400 internet trolls--fluent in English and well-versed in American politics--work 12-hour shifts, creating false narratives and fake news stories. These stories are then seeded on the internet, they get validated, and they get passed on by popular websites and eventually end up on our radios, TVs, and smartphone screens.

In an incident earlier this month, a discredited former CIA employee went on RT News to charge that President Obama had asked British intelligence to spy on Donald Trump. Well, this false news story was then spread by legal commentator Anthony Napolitano on the FOX News show ``Fox and Friends,'' which is regularly watched by the President. The claims were then cited by President Trump and White House Press Secretary Sean Spicer to defend the President's claims that his predecessor had wiretapped Trump Tower.

Well, we know that during testimony before Congress 2 weeks ago, the NSA Director, ADM Michael Rogers, agreed with our British allies that the original RT News story was utterly ridiculous.

At an Armed Services Committee hearing last month, Gen. Philip Breedlove, Retired, the former Supreme Allied Commander in Europe, told us that when Russian-backed forces shot down Malaysian Airlines Flight 17 over Ukraine in 2014, the Russians put out four stories within two news cycles placing the blame on the Ukrainian Government and others. This is the headline that we see from RT. The general said it took 2 years for

the West to finally debunk these false news stories.

We know that Russia interfered in our 2016 Presidential election. We know that a Russian influence campaign was one aspect of that interference. Our intelligence community has concluded that RT America is an arm of the Russian propaganda juggernaut, operating openly in our country and taking full advantage of our First Amendment freedoms.

I am sure we would all agree that everyone in the United States, in every organization, has a right to speak, write, and broadcast freely. That is what our First Amendment says. We are a resilient democracy. We are confident that our values and institutions will prevail in the free marketplace of ideas. Our Constitution protects the right of individuals and organizations to spread those Russian viewpoints, disinformation, and even outright lies, but the American people have a right to know if RT America is a Russian propaganda organ that takes its direction from the Kremlin. They have a right to know who is funding their operations.

RT has publicly boasted that it uses a shell nonprofit corporation to dodge U.S. laws. This legislation, the Foreign Agents Registration Modernization and Enforcement Act, would put an end to that charade. The legislation Senator Young and I recently introduced would give the Department of Justice the authority it needs to request documentation from RT News on funding sources and foreign connections.

As we see here, clearly the legislation has hit a nerve because Kremlin spokesman Dmitry Peskov defended RT News, and Russia's State Duma is considering measures to retaliate.

What RT says about our legislation is that ``US senator wants to probe RT as a `foreign agent' . . . What's next, public executions''? Well, that is ridiculous. The editor-in-chief at RT News has said that my legislation is a ``persecution of dissenting voices.'' As I said, that is just nonsense. I welcome dissenting voices. That is what our First Amendment and the United States are all about. But it is not reasonable or acceptable for an individual or organization working in the United States on behalf of a hostile foreign government to conceal funding and direction that it receives from that government.

Vladimir Putin is not going to stop us from enforcing our laws and protecting our country. We have a responsibility to expose RT News, RT America, and the entire panoply of tactics that Russia has used to interfere in our 2016 election and that they continue to currently use to sow confusion and distrust and spread around stories which pretend to be news but which are not accurate.

Make no mistake, the Kremlin's influence campaign is an ongoing enterprise, and to the extent that it is successful, that it can operate under the radar screen, it will become even more brazen and more aggressive in the future.

In testimony before the Senate Armed Services Committee last December, Dr. Robert Kagan of the Brookings Institution said that Russia's broader objective is to subvert Western democracies, and we see that going on now in Europe. He said: ``For the United States to ignore this Russian tactic, and particularly now that it has been deployed against the United States, is to cede to Moscow a powerful tool of modern geopolitical warfare.'' That was a direct quote.

This is a profound test for our country. Our democracy has been attacked and continues to be under attack from this kind of news that is being put out by a Kremlin-funded organization which is a hostile foreign power. We need to understand the Kremlin's tactics, and we need to expose this propaganda here in the United States, including RT America. To that end, I urge my colleagues to support 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.

Mr. President, I yield the floor.

Madam President, I come to the floor to join my colleagues in opposing this misguided measure, which would leave millions of women and families with fewer healthcare options, and it would drastically decrease women's access to basic primary and preventive health services, including lifesaving cancer screenings and HIV testing.

Make no mistake about it, as my colleagues have said, the primary target of this legislation is Planned Parenthood. For years now, we have seen Republican leaders in Congress attempt to defund this essential healthcare provider, which serves millions of women nationwide, including nearly 12,000 women in New Hampshire, most of them with incomes below or near the poverty line. The sad irony of these attacks is that study after study has shown that restricting access to birth control and other family planning methods actually increases the number of abortions.

The authoritative Guttmacher Institute estimates that in 2014 alone, contraceptive care provided under title X helped women avert more than 900,000 unintended pregnancies and 326,000 abortions. Without contraceptive care provided by title X funded centers, the U.S. rates of unintended pregnancy and preventable abortions would be an estimated 33 percent higher, and the teen pregnancy rate would be 30 percent higher.

At the end of the Obama administration, teen pregnancy in the United States was at its lowest point since we have been keeping track. As Senator Hirono said, these services don't provide abortions. Federal law expressly forbids the use of Federal funds to pay for abortion, except to save the life of the mother.

So the real issue here is not about abortion. This is about ensuring that American women have access to the basic healthcare they need, where they want to receive it. This is just a mean-spirited effort to keep women from seeing the provider they want to see and getting care at rates they can afford. For 40 percent of women, their visit to a family planning center is the only care they receive annually.

In 2015 alone, title X provided basic primary and preventive healthcare services such as Pap tests, breast exams, birth control, and HIV testing to more than 4 million women and men at nearly 4,000 health centers. Planned Parenthood plays an essentially important role in delivering health services to low-income, uninsured, and vulnerable individuals, including in rural areas.

I am sure that every person in this Chamber has received letters and emails and phone calls from constituents on this issue. They are pleading with us: Don't take away our access to healthcare from Planned Parenthood.

I received a letter from Sandra Sonnichsen of Goshen, NH. She writes:

Planned Parenthood was my only affordable source of

gynecological healthcare for most of my life. I received

good, wise, and thoughtful care. I think it is not extreme to

say they saved my life. Abortions were not involved. They--

Meaning Planned Parenthood--

remain very important, especially for poor or uninsured

women. There are not enough alternate low cost women's

clinics available. Not providing birth control services to

women who want it is not a good economic or social solution.

Don't let it be defunded.

In a follow-up call, Sandra said that without Planned Parenthood, she would not have had any healthcare at all. Because her mother died of breast cancer, Sandra is deeply grateful that she has been able to receive mammograms, thanks to Planned Parenthood.

I also heard from Meredith Murray of Exeter, NH. She says:

Nine years ago I graduated from college and immediately

began my journey to become a medical provider. . . . During

this time in my life, I was surviving almost entirely on

student loans. And I knew that during this time, especially,

I needed to ensure that I was doing all I could to prevent

pregnancy. . . . With my insurance--an IUD would have cost

$900. That was not possible for me to afford. Then I

remembered--Planned Parenthood. . . . I was informed, due to

title X funding, my IUD would be completely covered. I

continued to use Planned Parenthood services for the next 5

years for my routine screenings while in medical school. The

care I received was phenomenal. As I proceeded through my

medical training, I strived to be as kind, compassionate, and

knowledgeable as those who work Planned Parenthood health

centers. I am now a practicing medical provider, married, and

still using an IUD because Planned Parenthood offered me that

opportunity.

I received this letter from Samantha Fox of Bow, NH. She writes:

In 2007, I was a 19-year-old just barely starting out when

I was denied health insurance due to a preexisting condition.

Had I been able to access affordable coverage, my preexisting

condition, a reproductive system disorder, would have been

easily manageable. . . . At that time, I was able to access

care through Planned Parenthood, which likely preserved my

ability to conceive in the future.

And finally, let me share this message from Robina Parise of Rye, NH. She says:

I started utilizing the services at Planned Parenthood for

birth control when I was about 17 years old. . . . Planned

Parenthood made sure I was protected and healthy. They gave

me access to vital protection and healthcare when I could not

get it anywhere else. They regularly called me with reminders

to have exams and to pick up my prescription. Planned

Parenthood is the reason my husband and I were able to

graduate from high school and college. . . . I'm not sure

what our lives would be like now without their support.

I don't know. Do the people who are voting for this CRA believe it would be better to have allowed the people whom I just talked about--to prohibit their access to these healthcare services so that their lives would have been disrupted, so they might not have finished college, so we wouldn't have another doctor in the world, so they wouldn't be able to afford healthcare? I hope we will listen to our constituents who have been speaking out in passionate support of Planned Parenthood and other family planning clinics.

This is about respecting women's access to healthcare services, including millions of vulnerable women who have nowhere else to turn for essential care. This is also about respecting women's constitutionally protected right to make our own reproductive choices. We must not allow Congress to strip away investments in family planning clinics by allowing States to discriminate.

Finally, I want to point out that we haven't heard from any of our colleagues on the other side of the aisle who are voting for this measure about why they think it is so critical. I don't know. Maybe they are not willing to come to the floor and tell my constituents why they should be denied access to healthcare from the provider they want. Well, I am disappointed that we haven't heard from anyone who is willing to stand up and defend this vote. I hope they are going to have to defend it to the American people.

Madam President, I yield the floor.

Mr. President, I come to the floor today to talk about the importance of the Senate's vote to ratify the accession of Montenegro into the North Atlantic Treaty Organization, or NATO. I am confident we will see an overwhelming, bipartisan majority of our colleagues here in the Senate support Montenegro's effort to join NATO. This is in Montenegro's interest, it is in Europe's interest, and it is in the national security interest of the United States.

NATO is the most successful security alliance in history, and it is essential to the stability, freedom, and prosperity that Europe enjoys and that the United States has enjoyed, and, really, to that stability that has existed since after World War II. NATO has provided the security and stability for the freedoms we enjoy and the prosperity. Montenegro's accession to NATO will help the alliance become more resilient, and it will deter Russian aggression on Europe's eastern flank, which is why the alliance invited Montenegro to become its 29th member last year.

I agree that Montenegro is a small country, but it is geopolitically important. Its membership in NATO will complete the alliance's control of the Adriatic coastline, and that will strengthen NATO's southern border.

Since its independence from Serbia 10 years ago, Montenegro has pursued inclusion in Euro-Atlantic institutions, and it has been a good partner to NATO. For example, Montenegro has contributed ably to the mission in Afghanistan, which is the only time article 5 of NATO has been invoked. It was after the attacks of 9/11 on the United States, and our response was to go into Afghanistan. Montenegro joined us, along with our other NATO allies in this effort. Montenegro also imposed sanctions on Russia for its aggression in Ukraine.

Montenegro's accession to NATO is also critically important for the wider Balkan region, which faces increasing Russian influence and interference. After all, remember that the two major wars of the last century, World Wars I and II, started in the Balkans. We need to do everything we can to maintain stability there. This is one of the things that I believe Montenegro's accession to NATO will help us do. We saw the increasing Russian influence and the increasing effort to destabilize the Balkans last year in Montenegro's fall elections.

Since those elections, Montenegrin authorities have arrested several people in connection with a coup attempt and a plot to assassinate Montenegro's Prime Minister. There is indisputable evidence that ties both violent plots back to Russia, which was trying to eliminate a high-profile supporter of Montenegro's accession to NATO and install, instead, a pro-Kremlin political party there. Montenegrin police are still working with international authorities to locate the suspected Russian masterminds of these efforts.

But when the bipartisan codel from the Senate and House, led by Senators McCain and Whitehouse, went to the Munich Security Conference in February, we had a chance to meet with Montenegro's Prime Minister Djukanovic. He told us in very vivid detail about the efforts to assassinate him and about Russia's efforts to install instead a pro- Russian government. Do we really think that Mr. Putin, who desires nothing more than to weaken the NATO alliance, would work so hard to disrupt Montenegro's inclusion in NATO if he didn't think it would strengthen the alliance?

Approving Montenegro's accession to NATO would signal support for Montenegro's independence and sovereignty and for their continued efforts to move towards the West and away from Russia. It would also demonstrate our solidarity with countries like Montenegro that Vladimir Putin is trying to bully, especially in light of our own recent experience with Russian meddling in our Presidential election. Now is a critically important time to send Russia the message that we will not tolerate this behavior. Last fall, a bipartisan group of diplomats, national security experts, and former administration officials sent a letter to Congress urging quick action on Montenegro's accession.

Earlier this month, Secretary of State Rex Tillerson wrote a letter to Senator McConnell and Senator Schumer detailing the reasons Montenegro's accession to NATO is in our interest and urging that we schedule a prompt floor vote on the accession. Virtually all NATO members have already formally blessed Montenegro's inclusion in the alliance. So it is just the United States that hasn't taken this important step forward.

The case for the Senate to support Montenegro's NATO accession is overwhelming. That is why it is so frustrating that it has taken so long. With Senator Johnson, I cochaired the Foreign Relations Committee hearing on this subject back in September of last year. In December and again in January, the Foreign Relations Committee approved Montenegro's accession protocol, and efforts were made to secure the necessary agreement for the full Senate to do the same. These efforts have been blocked by just a few Senators, despite the overwhelming bipartisan support for approval.

I am glad that Montenegro's accession is finally getting the vote in the Senate that it deserves. The United States has long stood for freedom and democracy in Europe, and I urge my Senate colleagues to stand strong for freedom and democracy now by voting to approve Montenegro's accession to NATO.

I yield the floor.

Mr. President, as ranking member of the U.S. Senate Committee on Small Business and Entrepreneurship, it is a privilege to join Chairman Risch as we celebrate the first ever Small Business Development Center Day, which will unite the more than 1,000 small business development centers, SBDCs, across the country with the hundreds of thousands of entrepreneurs they have assisted in their 37- year history.

Small businesses are the engine of our economy, creating two out of every three new jobs in the United States. As Chairman Risch stated, since 1980, America's SBDCs have provided these small businesses with high-quality, low- or no-cost consulting, and a variety of educational programs across the country. Together with SBA's other resource partners--women's business centers, veterans business outreach centers, and SCORE chapters--SBDCs have enhanced the ability of America's small businesses to grow and create jobs.

To provide some context for what this means to our economy, the association representing SBDCs estimates that SBDC clients start a new business every 30 minutes, create a new job every 5 minutes, generate $100,000 in

new sales every 7.5 minutes, and raise $100,000 in capital every 11 minutes. Job growth for SBDC clients is nearly 10 times greater than job growth for the average business.

Under the leadership of Dr. Richard Grogan, the New Hampshire SBDC State director, New Hampshire SBDCs have helped thousands of small business owners and entrepreneurs realize their dreams, start new businesses, and create jobs. Last year alone, New Hampshire SBDC counseled and trained more than 2,500 businesses and assisted in the formation of more than $39 million in capital for New Hampshire's small businesses.

For example, NH SBDC has been instrumental for Julie Lapham, the founder and chief sales officer of a startup in Dover, NH, called Popzup. Popzup is a family-owned business that provides a new popcorn product for health-conscious consumers. As Julie explained it, her local SBDC helped to prepare her for a Shark Tank-style pitch competition in which she took home a first-prize award of $10,000. They have helped her understand her financing options and continue to stay involved and support her company's growth.

I hope my colleagues will join me and Chairman Risch in celebrating SBDC Day and acknowledging their local SBDCs for their accomplishments and the role that they play in helping small businesses create jobs.