Floor Statements

Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 10:45 a.m., Tuesday, January 24; that following the prayer and pledge, the morning hour be deemed expired, the Journal of proceedings be approved to date, and the time for the two leaders be reserved for their use later in the day; further, that following leader remarks, the Senate be in a period of morning business, with Senators permitted to speak therein, and with Senator Alexander being recognized for up to 15 minutes, followed by 30 minutes for the Democrats; finally, that the Senate recess from 12:30 p.m. until 2:15 p.m. to allow for the weekly conference meetings.

Mr. President, if there is no further business to come before the Senate, I ask unanimous consent that it stand adjourned under the previous order.

Madam President, in 2010 the American people were promised a number of things, but among

those things was affordable, accessible, and quality health care. They were promised that if they liked their health care plans, if they liked their insurance, they could keep those insurance policies. They were promised a system that could get more folks covered at lower costs.

Instead, unfortunately, the Affordable Care Act has failed us and has failed to keep its promises. Canceled policies, elimination of certain plans, difficulties in identifying new plans, massive premium increases, sky-high deductibles, and limited options for doctors have really become a new standard for many American families.

At the end of last year, I completed another round of 105 townhall meetings in our State. There are 105 counties in Kansas. On occasion-- it is pretty rare but on occasion someone will say: The Affordable Care Act was helpful to me and my family. My response to that is: I am glad, but surely we can come up with a proposal--a plan--that isn't so damaging to so many other people for the benefits that you claim you have acquired under the Affordable Care Act. Surely, we can come up with a plan that doesn't increase premiums, increase deductibles, increase copayments, eliminate plans, reduce the choice of the physician you see, and reduce your ability to keep the health care plan that you like. Because I am opposed to the Affordable Care Act does not mean I am opposed to trying to make sure Americans have better options and more affordable care.

I have also visited all 127 hospitals in our State. I have had conversations with the chief financial officer, the CEO, the trustees, the doctors, the nurses, and almost without exception the conversation is about how bad debt expenses increase, the ability for their patients--people who are admitted to the hospital--to pay their bills is less, not more, and that is because they can't afford the copayments and deductibles.

Unfortunately, ObamaCare--the Affordable Care Act--has taken away the freedom to make health care decisions from Americans, from us as individuals, and given way too much authority to the Federal Government. Kansans continue to ask me to help them get back to their former health care plans, to find a better way to do this, a plan that is more affordable with better coverage.

Over the last 6 years, I have advocated for a number of changes to our health care plan to help American families. Even before President Obama was President, we were talking about what we ought to do.

I had ideas of what we could do to improve the chances that people across Kansas and around the country would have a better opportunity to provide health care insurance for themselves and their family members. I am proud of some of the successes we have had in recent time.

I am a member of the Senate Appropriations Committee and a supporter of funding for NIH, or the National Institutes of Health. This is research that is essential to saving and improving lives, growing our economy, and maintaining America's role as a global leader, but, most importantly, it saves lives and improves health care. In addition, it saves money--the cost of health care--if we can find the cure and treatment for cancer, for diabetes, for Alzheimer's. One of the ways we can help reduce the cost of health care and make it more affordable is to make certain that we make the necessary investments in finding those cures and treatments.

Last year, I supported, and this Senate and Congress passed, the 21st Century Cures Act. This takes us in additional directions in the way of finding those cures for life-altering diseases and, in the process, helps us to save our families' dollars. We have also worked hard to try to maintain the funding for Federal programs and agencies that work with universities and medical schools to train and recruit medical professionals who then go on to serve particularly in medically underserved areas. It is very typical of your State and mine, Madam President, in which we are experiencing the constant shortage of the necessary professionals to provide the necessary health care.

While this is progress, with a new Congress, a new year, and a new administration, we now have a tremendous opportunity to provide real substantive reform to our health care system. I mentioned the conversations I have had in townhall meetings. In addition to the health care side of the Affordable Care Act and the problems it has created for affordable and accessible health care, we have also had the challenges on the economic side--the job creation side--that the Affordable Care Act has unfortunately caused--the conversation about whether or not to expand a business, whether or not to exceed the 50- employee threshold. Those aspects of the Affordable Care Act are very damaging and need to be addressed and cured as well.

As we as a Senate, we as a Congress, and we as a country look for a replacement strategy, for something different--significantly different than the Affordable Care Act--we ought to focus on the practical reforms that embrace increased flexibility and allow American men and women to decide what is right for them and their individual family health care needs.

As we take this matter up in Congress, I wish to again put forth some specific ideas I have offered over the years as a blueprint for reform that we should try to put in place.

First, we should maintain preexisting condition protections for those with continuous coverage. Individuals with debilitating diseases and chronic conditions who have purchased health care should be reassured that their coverage will not be stripped in any future health care changes to our system.

Second, we can increase coverage by enabling Americans to shop for plans from coast to coast, no matter what State they live in. This will lower the premiums by spurring greater competition in the insurance market.

Third, we should extend tax savings to those who purchase health care coverage, regardless of their employment. To assist low-income Americans, we can offer tax credits to help them obtain the private insurance of their choice. We also can expand access to care by supporting community health centers and other primary care access points.

Fourth, instead of limiting the choice of plans, let's give small businesses and organizations the ability to pool together in order to offer health insurance at lower premiums, similar to corporations and labor unions. We also need to make it possible for health insurance to travel with workers when they move from one job to another job throughout their careers.

Fifth, we ought to increase the incentives available to individuals to save now for their future and for long-term care needs by empowering them to utilize health savings accounts and other incentive plans. Doing so enables individuals to take ownership in their health, and that is important as well.

Sixth, we need not accept the idea that costs for currently available medical treatments will inevitably rise. Instead, let's continue to support those things that bring down the cost of health care by finding cures and treatments, as I mentioned, with the National Institutes of Health. Advancing lifesaving medical research and spurring innovation can help us accomplish health care savings, reducing the financial burden for those with diseases and their family members who care for them.

Seventh, we need to address shortages in our medical workforce by promoting education and programs at our universities and our medical schools that train physicians, nurses, and other health care officials and encourage them to practice in underserved areas through scholarship and loan repayment programs. Kansas is an example, as is your State, Madam President, where those rural areas and, additionally, those core centers of our cities lack so often the necessary health care providers.

Eighth, in order to curb the preventable costs that often occur through unnecessary emergency room visits and untreated symptoms of disease, we should provide coverage to low-income Americans, despite their limited financial means, in a financially sustainable way that ends up saving money in the long run. For all of us, the best reduction in health care costs is wellness, fitness, diet, and nutrition. That also means early preventive care. It means early diagnosis, and we make certain that Americans have access to that diagnosis and that early treatment. Ensuring access to quality care with a focus on preventive health is an effective way to limit high-cost health visits that place burdens on hospitals,

physicians, our economy, and our health care system as a whole.

Lastly, we can reform our medical liability system and reduce frivolous lawsuits that result in inflated premiums and the practice of defensive medicine, where doctors order every possible test out of fear of potential lawsuit. Doing so can save tens of billions of dollars each year and make health care more affordable for more people.

The bureaucracy that goes with the providing of health care needs to be simplified. I have often looked behind the desk when I go see my family physician and wonder what all the people who are working there are doing. So much of it is not about patient care but navigating the system by which your health care bill, at least in part, gets paid. There is all the variety of insurance forms. I know this in my life-- the ability to understand that insurance document that arrives in the mail and sits on our kitchen table waiting for my wife or me to figure out what this means. I have seen this with my own parents when they were living--the amount of documents, paperwork, and forms and checks for $13.19 that arrived in my dad's mailbox and trying to figure out with my parents: What does that mean? Why am I getting this?

So much cost savings and so much anxiety and angst could be eliminated if we had a system that was much more uniform in its presentation, simplifying the way in which our health care bill gets paid by our insurance provider, by Medicare, by Medicaid, or out of our own pocket. I would defy most Americans to be able, unfortunately, to understand what is the stuff that comes in the mail and what it means to them.

As we move forward with trying to replace and improve access of Americans to health care--to affordable health care--I believe there are reforms that will provide us with a good blueprint for how to start helping Kansans and all Americans across the country who have suffered under the deficiencies and the costs and the damage that comes from ObamaCare.

I look forward to working with my colleagues--Republicans and Democrats--to find solutions to take advantage of this opportunity that we have. The American people--many American people, most American people--are hurting under this law, and they have spoken clearly numerous times. It is time for us to bring to them the changes that improve their lives by improving their health care, by improving their health, and by making sure that no American is worried about whether or not the necessary health care that they need or their family member needs is outside of their reach.

I yield.

I thank the Senator from Delaware, and I appreciate his comments. He did walk in just as I was talking about that particular issue of a series of things that I believe would improve the cost and affordability of health care. I thank the Senator for sharing his experience in Delaware and elsewhere and use that as an opportunity to indicate that the cost savings that comes from that kind of reform is a positive, but we also want to make sure those who, through no fault of their own, are actually harmed are made whole to the best of our ability that this can be accomplished.

Finally, I would use this as an opportunity to point out that this Senate ought to work in a way in which the ideas of all 100 Members are considered in a respectful way as we try to find solutions to the access and affordability of health care.

Again, I thank you for the time on the floor.

Madam President, I would welcome a membership on the Finance Committee, but I don't have one at this stage or with my time in the Senate. Under either circumstance--membership on the Finance Committee or here in the entire Senate--I look forward to working with my friend and colleague, the diligent Senator from Delaware.

I yield my time.

Mr. President, I want to comment on an interview that was published yesterday, quoting the President. In an interview published yesterday, the President spoke about a number of issues facing the United States. During that interview he had commentary on terrorism and he referenced the January attacks in Paris, France, in what I would describe as a very concerning way. The President addressed the attacks in Paris as ``randomly shooting a bunch of folks in a deli.''

The President's stated perception of the hostage taking and murder of four Jews in a kosher supermarket in that way--we ought to all be concerned. When asked to clarify the President's comments today, the White House stated that the Jewish victims of this attack were ``killed not because of who they were, but because of where they randomly happened to be.''

The White House today suggested that because there were non-Jews in the kosher supermarket named Super Kosher, the attack did not specifically target Jews.

The State Department restated this explanation today, refusing to say that an attack on a kosher supermarket that killed four Jews could be Jewish. The absurdity of this logic is apparent. Let me give you a hypothetical. If an attack occurs in a synagogue or in a church or in the American Embassy, are we really to accept the idea that on the chance that there were diverse people there, that that somehow disqualifies the possibility that members of the group who would predominantly frequent that place might be targeted? In other words, if somebody who happened to work in an American embassy but is not an American is killed in an attack, would we reach the conclusion that the attack on the embassy is not an attack on America?

The Obama administration's logic doesn't make sense and it is difficult to understand what they are trying to convey. It is also contrary to the open source media reports about the attack. Reuters reported that the perpetrator of the attack called a French television station to declare his allegiance to the Islamic State and stated his intentions to target Jews. Given this information, the Obama administration's now repeated comments that chalked this up to randomness--that is just amazing to me, that it is just random, this attack

in Paris. The fact that four Jews were killed at a kosher supermarket, it is just random.

It is dangerous for our government leaders to reach such a conclusion and for us to be operating as we make a determination of how to proceed next in the war on terror to reach the kind of conclusions the President, his spokespersons, and the State Department are reaching.

The Islamic State, the organization the perpetrators of the Paris attack claim allegiance to, has made a point to persecute various ethnic and religious minorities. The denial of anti-minority or anti- Semitic motivations in this case gives me hesitation about whether the President understands the true nature of the threat we now face. This comes in the context of a report that the administration is soon to present to Congress for approval an authorization for the use of military force against Islamic State fighters.

Authorizing a war is a decision that should be made with the fullest of information and the most complete understanding possible. The Obama administration should be doing everything it can to clearly describe the threat our country faces--in fact, that people around the globe face--and a strategy that will be employed under this potential authorization to use force. If we don't know who we are fighting, how can we have a strategy to prevent the death and destruction those enemies will cause? The stakes are way too high to operate under anything but a clear understanding of the significant challenges our country faces. It makes no sense to describe something different than reality.

Mr. President, I yield the floor.

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

Mr. President, I ask unanimous consent to address the Senate in morning business for such time as I may consume.

Mr. President, I am on the floor today to speak about an issue that I spoke about just a few days ago, the Choice Act.

Let me take my colleagues back in history just a few months, just to last year. I don't imagine any of us don't remember the scandal the Department of Veterans Affairs was facing--the stories across the country of fake waiting lists, of services not provided, of the potential death of veterans while waiting for those services to occur. I also would think that at least many of my colleagues would agree that for much of the past few years the Senate hasn't done much of the business it was designed to do and that needed to be done in our country.

But I remember a day in August of 2014 in which the Senate and the House of Representatives were successful in passing a bill. It is somewhat embarrassing to me to be on the floor praising the accomplishment of a bill passage. It is a significant part of what should be the normal course of business of the Senate.

But those of us--and I would put all of my colleagues in this category who care about the service men and women who sacrificed for the benefit of their fellow countrymen and came home to a Department of Veterans Affairs that failed to meet their needs. I have indicated that since I came to Congress, both in the House and the Senate, I have served on the Veterans' Affairs Committee. This is an issue that we need to make certain we get right.

Just this week, in fact this morning, we passed a piece of legislation, the Clay Hunt Suicide Prevention for American Veterans Act. That is an accomplishment. I remember the testimony of the two mothers in the Veterans' Affairs Committee who came to talk to us about the importance of this legislation, their experience as mothers, and the death of their sons by suicide.

In the time that I have been in Congress, it is among the most compelling testimony I have ever heard. The part that sticks with me the most is the belief by these two mothers that had the Department of Veterans Affairs done their work, their sons would be alive. What that tells me is the decisions we make and those decisions as implemented by the Department of Veterans Affairs in some cases--in fact in many cases--are a matter of life and death.

We saw the scandal that came about last year. We know the decisions we make have huge consequences on veterans and their families. We rejoiced--at least I did--in the passage of the Choice Act, which gave veterans the opportunity to choose VA services, to choose health care to be provided in their hometowns by their hometown physicians and doctors.

The criteria that is set out in the Choice Act for that to occur is pretty straightforward. It says if you live more than 40 miles from a VA facility, you are entitled to have the VA provide the services at home, if that is what you want. It says that if those services can't be provided within 30 days of the time you need those services, then the VA shall provide those services at home if you choose. You can see the hospital, you can be admitted to the hospital of your choice, and you can be seen by the doctor of your choice.

That was actually something to rejoice about, to be excited about-- that this Congress and this Senate came together and passed what I know to be a very significant and important piece of legislation. It is important for the reasons that common sense tells us it is important-- that a veteran who lives a long way from a VA hospital or a VA facility can now get services at home. A veteran who had to wait in line for too long could now get those services at home.

The other aspect of that is that the Department of Veterans Affairs has told us time and again about the inability to attract and retain the necessary health care providers, the doctors and others who provide services to our veterans.

So one way to improve that circumstance is to allow other health care providers, those in your hometown, to provide that service.

The Choice Act was a good measure for the Department of Veterans Affairs to meet its mandate to care for our veterans, and the Choice Act was a good measure for veterans who live long distances from a VA facility, especially in States such as mine and the Presiding Officer's, where it is a long way to a VA facility.

So I remember the moment in which that bill passed and was sent to the President. Finally something good has come. A bill has been passed. Something important to our veterans is occurring.

But the reality is the implementation of the Choice Act has created many problems and, in my view, the Department of Veterans Affairs is finding ways to make that implementation not advantageous to the veteran but self-serving to the Department.

This is what catches my attention today. We are reviewing the President's budget, and within that budget is this language:

In the coming months, the Administration will submit

legislation to reallocate a portion of Veterans Choice

Program funding to support essential investments in VA system

priorities in a fiscally responsible, budget-neutral manner.

What the President's budget is telling us is that there is excess money within the Choice Act. We allocated money--emergency spending--to fund the Choice Act, and the President's budget is telling us: Well, we think there is too much money in there. We are going to submit legislation to reallocate that money to something we think is a higher priority.

I don't expect many of my colleagues to remember, but I was on the Senate floor last week talking about a specific problem in the implementation of the Choice Act, and it was this: The Department of Veterans Affairs shall provide services at home to a veteran who lives more than 40 miles from a facility.

Well, the problem I described last week is that the VA has determined that if there is an outpatient clinic within that 40 miles, even though it doesn't provide the services that the veteran needs, that veteran, he or she, must drive to the VA, wherever that is

located, and does not qualify for the at-home services.

Does this make any sense to any of us, that the VA says: Oh, there is an outpatient clinic within 40 miles of you, Mr. Veteran? Even though it doesn't provide the service that you need, we are still going to require you to drive to a VA hospital to receive those services and you don't qualify to go see your hometown doctor or be admitted to your hometown hospital.

Who would think--in fact, I admired Secretary McDonald in his early days at the Department in which he talked about how the VA is going to serve the veteran: The decisions we make at the VA will be directed at how do we best care for our veterans.

I respect Secretary McDonald for that attitude and approach, and I want the Department to follow his lead in accomplishing that mission.

But clearly deciding that a facility, even though it can't provide the service you need, precludes you from getting services at home makes no sense, and it certainly doesn't put the veteran at the forefront of what is in the best interest of a veteran.

So why would the Department of Veterans Affairs make that decision? We have a facility within 40 miles, but you don't qualify. So drive 3 or 4 hours to the VA hospital.

Well, one might think they have made the decision that we are going to enforce that aspect of the Choice Act. We are going to enforce the idea that you don't qualify because they don't have enough money to pay for those services. But, lo and behold, the President's budget says there is excess money that we now want to transfer to other priorities.

So, clearly, it is not funding issues. The Department is making decisions for some reason that makes absolutely no sense, defies common sense, and certainly doesn't put the veteran ahead of the Department of Veterans Affairs.

I don't know what the story is that these kinds of decisions would be made, but it certainly is worthy of the Senate to make certain the Department implements its moment of triumph, the Choice Act, in a way that benefits those we intended for the legislation to serve.

I will ask some questions of the Department, and I wonder about the attitude. I have been on task trying to get services provided closer to home for veterans for as long as I have been in Congress.

One of the other programs, aside from the Choice Act, is a program called ARCH for accessing services closer to home. There are pilot programs across the country to do that. One of them is in Kansas.

In an internal memo from Washington, DC, to a VA hospital in Kansas, the Department of Veterans Affairs indicated to the VA hospital in Kansas they could not promote, encourage or market the idea of a veteran seeking services at home.

So already I bring skepticism about the attitude at the Department of Veterans Affairs. For a long time they have been told not to encourage veterans to find health care outside the VA hospital, outside the VA outpatient clinic.

Here are a few questions. How do you reach the conclusion that there is excess money when the program is just now being implemented and, in fact, there has been a significant delay in getting the choice cards out to veterans so they could determine whether they were interested and qualified?

I also have learned that the Department of Veterans Affairs has intentionally narrowed the veteran population that is eligible for the choice program by rule, narrowing the number of medical procedures for which they will consider whether it can be performed outside the VA on the 30-day rule.

I didn't say that quite right. I didn't say it quite as well as I would like. But the VA already narrowed, by regulation, the services that might qualify for hometown services if it takes longer than 30 days to get those services.

The VA added an unnecessary reimbursement requirement. I am told now that if there is a third-party provider and you have some insurance, the VA is going to require that the veteran pay the copayment up front and then seek reimbursement from the Department of Veterans Affairs.

Of course, the fourth one is how can you reach the conclusion that a veteran, who needs colonoscopy--in my hometown, as I talked about last week, one must drive 3 or 4 hours to Wichita to the VA to get the colonoscopy because there is an outpatient clinic within 40 miles of my hometown, but the outpatient clinic doesn't provide colonoscopies.

Now we learn that it is not a matter of money. It has to be a matter of attitude, approach, and culture.

Just today, a few minutes before I came to the Senate floor to talk about this issue, I received an inquiry from a constituent who is a health care provider. What they indicated to me is their interest in providing services under the Choice Act. They have contacted the VA, pursued the opportunity to be a provider for that veteran population in rural Kansas, and they were told the rate of reimbursement would be something significantly less than Medicare.

The Choice Act says the Department of Veterans Affairs shall provide these services up to paying Medicare rates. The VA says if you are going to provide services to our veterans, we are only going to reimburse you at something significantly less. That is something this health care provider didn't believe they could make any money doing, but ultimately they concluded it was their responsibility to try to help veterans who lived in rural Kansas, and so they went back to the VA and said we are willing to take less rates. Certainly let's negotiate and see if we can find something mutually agreeable between the VA and us to provide those services. They have yet to receive a return to their inquiry to the VA--again, trying to preclude a willing provider who is willing to provide services at less than cost. How can that be common sense? How can that be putting veterans ahead of the VA?

I look forward to working with my colleagues. I look forward to our Committee on Veterans' Affairs--a committee the Presiding Officer serves on--trying to make sure we get this right. I want to return to the day in August when the Senate passed the Choice Act and there was this feeling of accomplishment of something beneficial and useful.

If the VA continues to implement this bill--if it doesn't reverse course, if it doesn't put the veteran first, we will have missed another opportunity to care for the needs of those who served our country. What American would we expect to receive the best health care possible in this country? Well, of course, I want all Americans to receive quality health care at an affordable cost. But I would say there is no group of people for whom it is more important that they receive what is their due, what was committed to them, than those who served in our military and are now our Nation's veterans.

I represent a very rural State. The congressional district that I represented as a House Member is larger than the size of the State of Illinois. It has no VA hospital. How do you get to a VA hospital when you are a 92-year-old World War II veteran and the hospital is 4, 5, 6 hours away?

I thought we had finally come to a solution. I thought that earlier with the passage of legislation I introduced in the House that ultimately became the ARCH pilot program. While it gets rave reviews from veterans who are in those pilot program areas, it has not been expanded. It doesn't solve the country's rural needs.

Then I thought, well, a great day has occurred; we passed the Choice Act. But as I look at the implementation, as I look at the decisions being made today at the Department of Veterans Affairs, I have to wonder if one more time we are providing false hope, false promises to those who served our country. We owe them something different than what is occurring today.

I reaffirm my commitment to my colleagues, but also to the leadership of the Department of Veterans Affairs, to work closely, side-by-side, to make sure the choices made fit the reality of those who served our country in the circumstances they find themselves in today. Help those veterans who can't get the service because they can't get there. Help those veterans who need the services more quickly than the Department of Veterans Affairs can provide them.

This seems straightforward to me, but I raise this concern today to make

sure my colleagues and I are united in the effort to see that good things happen as a result of the passage of the Choice Act in 2014.

Mr. President, I yield the floor.

I suggest the absence of a quorum.

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

Mr. President, we have had a lot of talk--certainly in the last year or so and certainly as this new session of Congress begins-- on the importance of tax reform. Our country is at a point in time where we certainly are no longer competitive globally. The economy now is one that works against us because of our Tax Code. I think there is general consensus in the Senate that reforming the Tax Code is of significant importance, something that must be done.

I am often asked not only when I am back in Kansas but here in Washington, DC: Do you expect there to be broad-based tax reform? And we keep guessing about the likelihood of that happening.

I think it is typical of elected officials, politicians, to always talk about the need for comprehensive tax reform. We talk about lowering rates, making the tax system more fair, less bureaucratic, less paperwork. I certainly join in those sentiments and believe that the current circumstance we have in regard to our Tax Code is such that it limits the freedom of Americans--American business men and women, individuals, and their families. We make way too many decisions based upon the consequences of those decisions and how they are affected by the Tax Code.

So I am all on board on tax reform, but I wish to talk about what I believe is the best solution toward tax reform. And it is not tinkering with the current system; it is an overhaul of the current Tax Code.

I have joined my colleague from Georgia, Senator Perdue, in once again introducing the fair tax plan. I started a long time ago in Congress, knowing that we needed to make significant changes in our Tax Code, with

the belief that most Americans ought to be able to file a tax return without the need of professional help, that we ought to be able to make decisions that are in the best interests of ourselves, our families, and our businesses without always going to the Tax Code to see what the consequences of those decisions were. I looked at a variety of proposals that were being considered at the time and continue to be considered today and ultimately reached the conclusion that the Fair Tax is the best option for significant reform. I wish to speak for just a minute about why I think that is the case.

As I said, Senator Perdue and I introduced S. 25, the Fair Tax Act of 2015. I have been a cosponsor of that legislation. It was originally introduced in the Senate by the former Senator from Georgia, Mr. Saxby Chambliss, and I am pleased to now succeed him in his efforts to see that not only is this topic discussed in Congress but ultimately that the Fair Tax Act becomes law. It is a significant step in the direction of individual freedom.

I would highlight for my colleagues--and I have said this on the Senate floor before--I think the greatest responsibility we have as American citizens is to pass on to the next generation of Americans the freedoms and liberties guaranteed by our Constitution and the opportunity for every American to live the American dream. The Fair Tax, in my view, brings both of those goals front and center. Greater freedom and protection of individual liberties is certainly a component of the Fair Tax, and the opportunity for every American to pursue the American dream is a result that comes from the Fair Tax. It is that Fair Tax direction and individual freedom that caught my attention. It is the concept our Founding Fathers knew so well.

I ask unanimous consent for additional time.

Mr. President, the Fair Tax repeals all Federal, corporate, and individual taxes, payroll taxes, capital gains taxes, and estate and gift taxes and replaces them with a revenue-neutral personal consumption tax. The Fair Tax allows Americans to keep the entirety of their income, putting individuals in charge of their own finances, not the government--or, more specifically, not the Internal Revenue Service.

All Americans should be able to trust the IRS, which exercises great authority over the lives of Americans in this country, but we know from past experiences that expectation is no longer founded. So getting rid of the Internal Revenue Service is a significant benefit that comes from the passage of the Fair Tax.

I recognize that consumption taxes can be regressive, meaning they are harmful to those at lower income levels. So the Fair Tax takes that into account by providing a pre-rebate for those who fall below certain poverty income levels so that the basics--the things we by necessity need to by in our individual daily lives--are not covered by a tax, therefore creating greater progressivity to what otherwise would be a more regressive tax and something that I think is still important in this country to make certain we don't overtax those at the lowest income levels in the United States.

Certainly, our current Tax Code has significant complexities with all the paperwork. By some estimates, U.S. companies are currently holding over $20 trillion overseas. With the passage of the Fair Tax, foreign investments would no longer continue to sit on the sidelines when they could be brought back to America to drive economic growth and create jobs. For international businesses looking to relocate to the United States, the Fair Tax would be a welcomed sign. But the Fair Tax also benefits the consumer. It also benefits the everyday citizen, as I said, because of the pre-rebate.

With my time being short, I look forward to having a dialogue on the Senate floor and in the committees over the next few months, and I ask my colleagues to seriously take a look at S. 25 and to join the Senator from Georgia, Mr. Perdue, and me and others in promotion of a program that reduces the complexity of the Tax Code in our lives, rids us of the Internal Revenue Service, protects the progressivity of the tax circumstance we find today, and most importantly, allows us to continue to pursue the American dream and promotes our individual freedoms and liberties.

The Fair Tax is worthy of people's consideration. It ought to be more than just a talking point. It deserves a debate, a discussion, a vote, and consideration by the Senate.

Mr. President, I yield back the remainder of my time, and I suggest the absence of a quorum.

Mr. President, the U.S. Fish and Wildlife Service has determined that the lesser prairie chicken should be listed in a number of States, including Kansas, as a threatened species. The lesser prairie chicken has had a significant history in our State and a significant population of birds, but as a result of a drought, the habitat for the lesser prairie chicken and other wildlife has been diminished and the number of birds has decreased.

The consequences of listing the lesser prairie chicken that results from a drought is so dramatic and so damaging to the Kansas economy and to the farmers and ranchers and the use of their lands, to the oil and gas industry and the exploration of oil and gas, and to the utility industry in regard to the production and transmission of electricity that this amendment is necessary to set aside that listing as a threatened species and to allow interest holders in Kansas to come together and find a commonsense solution based upon sound science to protect the habitat of this bird.

This is not just a Kansas issue, and in fact, this species is only the precursor to problems others will have in their States.

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

I also ask unanimous consent that I be allowed to speak as in morning business.

Mr. President, thank you very much for recognizing me to take the opportunity to address something I hope can readily and easily be solved. If common sense prevails--and we know it doesn't often enough here in our Nation's Capital--one, the Department of Veterans Affairs certainly, in my view, can solve this problem. If common sense doesn't prevail there, then surely the Senate, the House of Representatives, and the President could agree upon a legislative fix that is really nothing more than common sense. I am talking about a veterans issue--one that is certainly prevalent in a rural State such as mine. My guess is it is a problem that occurs in a State such as the Presiding Officer's as well.

I was very pleased. I came to the Senate floor and talked about the importance of passing and approving the CHOICE Act. We remember the scandal of last year in which it became clear the Department of Veterans Affairs had significant problems across the country. The VA hospital in Phoenix was a poster child for bad behavior that resulted in potentially the death of veterans. One of the things we did to try to help the Department of Veterans Affairs better take care of America's veterans was to pass the CHOICE Act. We did that in August of last year. It was signed into law, and it is now being implemented by the Department of Veterans Affairs.

There are many issues that are associated with the implementation of this bill, but let me raise one. The crux of that legislation is this. If you are a veteran and you live more than 40 miles from a VA facility or if you can't get the Department of Veterans Affairs to provide the services within 30 days or the timeframe in which you need those services, then the Department of Veterans Affairs is required by law to provide those services, if you choose, at a place of your choice, presumably your hometown.

This is about service to our veterans in their hometowns across Kansas and across States around the country. The theory is that the Department of Veterans Affairs is incapable of providing those services perhaps for a number of reasons, including lack of the necessary professionals. Therefore, let's take advantage of the professionals we have at home in our hometowns. Let the veterans see his or her hometown physician. Let the veteran be admitted to his or her hometown hospital. It is a pretty commonsense kind of reaction to the inability of the Department of Veterans Affairs to meet the needs of veterans across our country--provide another option. If that is the choice of the veteran, that veteran wants to have care at home, give them that option.

As a Senator from a State such as Kansas, this makes sense to me even in the circumstance in which the Department of Veterans Affairs can provide the service. For 14 years I represented a congressional district in Kansas, the western three-fourths of our State. The congressional district is larger than the State of Illinois and has no VA hospital.

We pushed for a number of years and were successful in opening outpatient clinics so veterans could get that care closer to home than the VA hospital, and those outpatient clinics provide--or at least intended to provide--routine care.

Here is the problem today. The law says if you live more than 40 miles from a VA facility, then the VA must provide the services at home if you choose. The Department of Veterans Affairs is defining facility as any facility, including the hospital or the outpatient clinic. That doesn't seem too troublesome to me until you take it to the next step, which is, even if the VA hospital or the outpatient clinic doesn't provide the service that the veteran needs, they still consider it a facility within 40 miles.

In my hometown, where I grew up, we have had an ongoing dialogue with one of our honored veterans. He needs a colonoscopy. My hometown is nearly 300 miles--250 miles from the VA hospital in Wichita. There is an outpatient clinic, a CBOC, in Hays, 25 miles away. But guess what. The outpatient clinic in Hays doesn't provide the service of colonoscopies.

One would think the veteran in my hometown could go to the local physician or the local hospital and have the colonoscopy performed and the Department of Veterans Affairs provide and pay for the services. But no, because there is an outpatient clinic within 40 miles, even though it doesn't provide the colonoscopy, our veteran is directed to drive to Wichita. Incidentally, we have calculated the mileage expense of the veteran doing it. It does not make sense economically, either. But regardless of that, it certainly doesn't make sense for that veteran.

I have said this many times over the years as we have tried to bring services closer to home to veterans. If you are a 92-year-old World War II veteran and you live in Atwood, KS, up on the Nebraska border, how do you get to the VA hospital in Wichita or in Denver?

Our initial attempt was to put an outpatient clinic closer. The problem with that--we now have an outpatient clinic in Burlington, CO, and an outpatient clinic in Hays, KS. But that is still 2\1/2\ hours from Atwood, KS. If you are a 92-year-old World War II veteran in Atwood, KS, how do you get to Hays or Burlington, CO? The answer is you probably don't.

Our veterans are not being served. We attempted to address this issue. Let me say it differently. We addressed this issue in the CHOICE Act and said that if you are 40 miles from a facility, then the VA provides the services at home. The VA is interpreting that facility-- the word facility--just to mean any facility there regardless of what service it provides.

In many instances--I take Liberal, KS, where there is a CBOC. They haven't had a permanent physician in their CBOC in almost 4 years. But yet Liberal--the CBOC in Liberal--counts as a facility even though there is no physician who is regularly in attendance at the clinic. These issues ought

to be resolved in favor of whom? The veteran. Whom, of all people, would we expect to provide the best service to? In any capable way we can, whom would we expect to get the best health care in our Nation? I would put at the top of the list those who served our country.

The committee that passed this legislation, the CHOICE Act--it says in the language--the conferees recognized the issues I just described and added report language that allows veterans to secure health care services that are either unavailable or not cost-effective to provide at a VA facility, which was intentionally included to give the VA flexibility to provide veterans access to non-VA care when a VA facility, no matter what size or location, cannot provide the care the veteran is seeking.

Yesterday I introduced S. 207. I would ask my colleagues to join me. Again, I guess my first request is, Could the Department of Veterans Affairs fix this problem on their own? If not, I would ask that my colleagues join me in fixing this legislatively with one more directive to the Department of Veterans Affairs saying, if they cannot provide the service at the CBOC, then it does not count as a facility within the 40 miles.

This is a problem across our States. I had my staff at a meeting in the VISN in which they were describing how they were going to implement the CHOICE Act. They put up a chart in which they show how they are going to have a mobile van work its way through the area of our State and Missouri and talked about how that will then satisfy the 40-mile requirement.

Why is the VA bending over backward to avoid--let my say it differently. Why is the VA not bending over backward to take care of the veteran, instead of bending over backward to make sure it is the most difficult circumstance for a veteran to get the health care they need at home?

We ought to always err on the side of what is best for veterans, not what is best for the Department of Veterans Affairs--if you could ever make the case that providing services someplace far away from the veteran is good for the VA.

I thank the Presiding Officer for the opportunity to speak to this issue. It is an important one. I have mentioned it to a number of my colleagues. They have described similar circumstances in their State. I have met with the Department of Veterans Affairs personnel. I serve on the veterans' committee, have since I came to Congress. We will work in every way with the veterans' committee, Republicans and Democrats, to make certain there is a fix to this issue.

But I want to highlight the manner in which the Department is implementing the CHOICE Act is not the way Congress intended, and it is not the way that benefits the veteran. Finally, let me say that even if there was some circumstance in which the Department does not have the authority to do what we are asking them to do in the CHOICE Act, they have the ability today to provide non-VA care whenever they deem it necessary.

There is also the opportunity for them to use a pilot program that many of us have in our States. I see the Senator from Maine is on the floor. They have a pilot program, the ARCH Program, in which we are trying to provide services to veterans at home. There are a variety of ways the Department can solve this problem. I ask them to do that.

In the absence of their solution, I ask my colleagues to join me in sponsoring, in debating, in potentially amending but most importantly in passing and sending this bill to the President so we can resolve once and for all that the Department of Veterans Affairs is created for the benefit of the veteran, not the Department.

I yield the floor.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

The Senator from Alaska.

I ask unanimous consent that the pending amendment be set aside to call up amendment No. 73.

I ask unanimous consent that reading of the amendment be dispensed with.

Mr. President, this is an amendment that sets aside the endangered threatened species listing of the lesser prairie chicken. It is an important issue to the citizens of Kansas but also to Texas, Oklahoma, New Mexico, and Colorado.

I look forward to having this conversation and debate on the Senate floor at the appropriate time.

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

Mr. President, earlier this evening an amendment of mine was made pending to the legislation that we now have before us, amendment No. 73.

I thank my colleagues for allowing that amendment to become pending, and I look forward to the opportunity now, while we are determining the remainder of the evening's schedule, to describe the nature of amendment No. 73.

I have a copy of the amendment in front of me. It is a short paragraph, but it is one that has significant consequences to the people of Kansas. But in addition to the people of Kansas, it has significant consequence to the people of Colorado, New Mexico, Oklahoma, and Texas.

The story we are talking about is the lesser prairie-chicken. In March of 2014, the lesser prairie-chicken was listed not as an endangered species but a threatened species under the Endangered Species Act.

It is true the numbers of birds declined in 2012 and 2013. The U.S. Fish and Wildlife Service had their explanation for why there was the decline in the population of those birds, both those who live on the land but as well a number of wildlife experts--people who are very interested in conservation practices in our State--believe and agree that the primary reason behind the bird's decline in population was the historic and prolonged drought that our area of the country has experienced in the past several years.

There is less habitat for birds generally in our State and across this region of the country, but the reality is that it is because we have had so little rainfall. We have been in a drought in a significant part of the Nation, in our part of the country, for a number of years, and as a result there is less habitat and a decline in the bird population. What many believe is that with the return of rainfall, with the return of snow this winter and the moisture it will provide, we will have increasing wildlife habitat for the lesser prairie-chicken and a large number of birds and other wildlife in our State and in the surrounding States where this is a significant issue.

There are some exceptions that have been written into the designation, but the reality is that there are huge, ongoing, significant economic consequences to the listing as a threatened species of the lesser prairie-chicken in Kansas, Colorado, Oklahoma, New Mexico, and Texas. Front and center of that, of course, are the consequences to agriculture. It is how we earn a significant portion of our living in our State. Land values, for example, have dropped as a result of this issue. Oil and gas exploration has been disrupted. Wind energy projects that have been an important component of our State economy and particularly a benefit to the economy of rural Kansas have been harmed as a result of this listing. These disruptions have driven down county tax revenues that are used for essential services in some of the most challenging and difficult parts economically of our State, from damage to Main Street,

and certainly harmed a portion of Kansas that always struggles to be economically viable.

The listing, in my view, was based on an artificially low population estimate due to the drought I described. I guess I failed to mention that 1 year ago this was a bird which could be hunted in Kansas. So, again, it was prevalent enough to be able to be pursued by those who hunt, but because of the drought the population declined. In fact, every Kansas county that is included in the habitat area was experiencing a D3-Extreme or a D4-Exceptional drought, according to the U.S. Drought Monitor, again highlighting that what we need here is rainfall and moisture that comes from snow and rain and that listing this as a threatened species doesn't create the moisture necessary to create the habitat for the return of the population of the bird.

What we really have asked for is an opportunity which has been offered and suggested by conservation groups in Kansas, by the Kansas Department of Wildlife and Parks, and by the Kansas Farm Bureau and others to work together to find a solution short of this listing to increase bird population in Kansas. And I assume that is true in the other States as well. We are looking for a cooperative effort to improve habitat, and the fact is that the listing as a threatened species has been so disruptive that we have been unable to get what we would say is a more commonsense, less broad-brush approach to solving this problem in place as compared to the heavy hand of this listing. We stand ready, willing, and able to provide that kind of local effort to improve habitat and bird population.

This amendment would not mean the lesser prairie-chicken would never be listed again, but it gives Kansans and others the opportunity to go back and make certain that efforts at the local level are given a chance to work before the very dramatic and devastating implementation of this decision to list the bird as threatened.

So this is a relatively straightforward and simple amendment that will take the lesser prairie-chicken off the list as a threatened species, give Kansans and others the opportunity to improve the habitat, reduce the economic damage that is being done in our State and the States that surround us as a result of this listing, and then give us the opportunity to again work with the U.S. Fish and Wildlife Service to find a better solution and one that, I might add, may be more easily found once the rainfalls return to the State of Kansas.

I thank the Presiding Officer for the opportunity to describe this amendment, and it is certainly my request and I look forward to it being an amendment that would be considered tonight, later this evening.

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

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

Mr. President, I have visited hospitals many times in our State. In fact, there are 128 community hospitals in Kansas, and I have visited each and every one of them once and, in many instances, two or three times. In fact, last weekend while I was home in Kansas, I visited my hometown hospital, Mercy, in Manhattan, KS.

It is a very useful exercise. I would encourage my colleagues to spend time with health care providers. In the case of hospitals, it gives you the opportunity to visit with hospital administrators, the CEOs, the opportunity to visit with the nurses, patients, with physicians, and get a feel for what is going on in the delivery of health care in your State. I certainly know how valuable that is to me.

One of the interests I have in serving in Congress is a belief that the way we live our lives at home in Kansas is something very special, and it is something that is worth trying to make certain is around for many years to come--in fact, for generations to come.

One of my early conclusions, in looking at public policy and looking at the future of the communities of Kansas and the people who live there, is the access to health care, to affordable health care, is critical. It is a component in which many communities will not continue to exist if there is not access to hospital care, a physician, a hometown pharmacy--all the things that make up the opportunity for someone to be cared for in every aspect of their lives related to their health. I know this from my own circumstance, my hometown of Plainville with a population of about 2,000.

My parents called Plainville home into their nineties. My parents are no longer living, but I know well before the time in which they passed, my sister and I would have had a conversation with my parents talking about: Mom, Dad, I am sorry, but you need to move, and you need to move where you can have adequate health care. You need to move where there is a good hospital and a set of physicians who will care for you.

But because that exists in my hometown and continues to exist in my hometown, those kinds of conversations are not necessary. Wherever the place that you are telling your parents they have to move to access health care--wherever that place is--and it may be a very desirable place, but it is not home. My parents would have lived someplace in which they had not lived all of their lives, would not have been surrounded by the people they know and who knew them--particularly as they lived, my dad, until the age of 98. They would not have had the people who checked in on them, made sure they were doing OK each and every day, gave them the opportunity to continue to live at home, the people who would have given them a hug and a pat, and the pharmacist who said to my dad: Ray, you probably need to have your blood pressure taken. Those are very special things about many places many of us come from.

In the absence of those kinds of opportunities for health care, our communities--certainly across my State and across the country-- especially in rural America begin to disappear, the point being that in the absence of access to health care, the ability to keep a community together to encourage senior citizens to remain at home in their hometowns and for us to be able to recruit and encourage young families to move to our communities is not going to happen, is not going to be available, unless we have access to health care.

In the discussions I have with those health care providers, the doctors, the nurses, the CEOs, the administrators of the hospital-- including the patients--they continued to remind me that what is going on in our Nation's Capitol, in Congress, and certainly in the administration, are barriers, are burdens to the chances of that hospital and those health care providers continuing to be in business.

Every visit involves the raising of concerns to me. Often it is: What you are doing about this, Senator Moran? What are you doing to reduce the Federal regulatory burden that our hospital faces? Are you working to make certain we are able to provide the health care our local residents need?

Last month I introduced legislation that was bipartisan, a resolution that unanimously passed the Senate. It recognized the importance of access to hospitals and other health care providers, particularly in rural areas of our country. It indicated how special they were and how important they were to the success and survival of the communities in our country.

The point I would make about that resolution is it passed unanimously. While the importance of rural providers is overwhelmingly acknowledged, as evidenced by the unanimous passage of that resolution, the Affordable Care Act and unnecessarily burdensome Federal regulations fail to demonstrate that we follow through on that understanding of the importance of hometown health care.

Among the regulatory concerns I hear about in those hospital visits, serious flaws with what is called RAC, the Medicare Recovery Audit Contractor Program, is it is causing many problems for hospitals and providers across Kansas.

Our hospitals and health care providers have been required to divert significant resources away from caring for patients, their mission to appeal incorrect audit decisions that are almost always ultimately overturned through an appeals process. This broken RAC Program places a tremendous burden on the providers, and it has created a 2-year appeal in backlogs within the Department of Health and Human Services. This program diverts the resources hospitals are devoting to caring for patients, to going through the

process of trying to get their money back. That is certainly a problem and increasing the expense of providing health care. But the other aspect of that is often the hospital's money is tied up for 2 years, held by CMS, the Centers for Medicare and Medicaid Services, while it is adjudicated. Again, the overwhelming number of cases is decided ultimately in favor of the hospital, but it is certainly diverting resources and increasing costs.

I met with Secretary Burwell at Health and Human Services to discuss what is an urgent need to improve the Medicare RAC Program. I have requested from HHS a timeline and objectives, measurable objectives, to address the RAC problems and the appeals backlog that is in existence now.

Another concern in addition to the RAC audits is the Federal Government's inflexible supervision rules. CMS passed a rule that was delayed but now ultimately put in place. It requires that many pretty routine services that occur in a hospital--that includes things such as a drug infusion or blood infusions, cardiac and pulmonary rehabilitation--that they require supervision. That is just not an option in many rural hospital health care settings. There is a lack of understanding and a lack of common sense as to what a small hospital in a small town faces when CMS puts this regulation in place. They make it difficult for those hospitals to continue to provide those necessary services.

Fortunately, we have had some success in addressing this issue. Congress passed legislation that prevents the Federal Government from enforcing that regulation through the near future. I have introduced original legislation to make that change, that regulatory prohibition, permanent. I will reintroduce that legislation in January in the new Congress as we try to capitalize upon the temporary success we have had in fighting back this regulation from CMS to make it permanent so that when the temporary prohibition expires that we will have the opportunity to keep them from reintroducing that provision.

I will say that hospital administrators and employees, when I have a conversation with them, the discussion typically involves serious and strong opposition to a number of proposals that come from the Obama administration each year.

One of those is to change the number of miles that you must be apart from another hospital in order to qualify to be a critical access hospital. It is a program under Medicare and Medicaid Services that allows for a reimbursement that is more based upon cost than otherwise would be the case.

Also the administration has continued to propose a 1-percent reduction in the funding for those critical access hospitals.

Those are pretty much life-and-blood issues for community hospitals across Kansas and around the country. That critical access hospital designation in receiving that cost-based reimbursement means that a hospital with few patients, one that doesn't have hundreds of patients each day, can still be reimbursed at a rate in which they can almost make ends meet, that they can cover their costs but still rarely is there any profit or extra revenue generated from that so-called cost- based reimbursement.

Cutting reimbursements to the hospitals, removing them from the critical access program, I have little doubt but that it would eliminate many, if not most, of those hospitals currently in that critical access hospital program. There would be no place else for them to go, no other category within Medicare that would allow them to survive. I believe the number now is 88 of Kansas's 128 hospitals are those critical access hospitals.

The other topics of conversation that arise in those conversations in visiting with health care providers at a hospital--the physician, the nurses, the physical therapists, the CEO of the hospital, the trustees, the board of directors of the hospital--is the Affordable Care Act.

Again, we symbolically say we care a lot about rural health care providers, but the reality is the Affordable Care Act is creating significant problems, challenges, for the survival of hospitals, particularly the smallest hospitals in my State and across the country.

The Kansas Hospital Association projects that the Affordable Care Act will cost Kansas health care providers approximately $1.3 billion in Medicare funding over the next 10 years. These Affordable Care Act cuts include reductions to hospitals' Medicare reimbursements and a payment called disproportionate share that the hospital receives in order to cover the high level of uninsured patients.

These cuts are taking place on top of what Congress and the President agreed to under sequestration--a 2-percent across-the-board cut--that many, if not all, of our providers are now receiving. So what was supposed to be cost-based reimbursement, which nearly never covered the cost, is being reduced by another 2 percent as a result of sequestration. Again, this is something this Congress--and if not this Congress, the new Congress that begins in January--needs to deal with, the issue of sequestration.

For this and for other reasons sequestration is a significant problem. While I certainly support the reduced spending aspects--what the goal was of sequestration--the idea that we would do across-the- board cuts is irresponsible. We ought to be establishing the priorities--the things Congress, on behalf of the American people, thinks are the most important and beneficial to the American people, the things that are allowed for under our Constitution. Those are the things we ought to be funding, as compared to taking a step back and just having automatic cuts because we don't have the ability to decide in a responsible way what we can afford and what we cannot afford.

Further, I would say the Affordable Care Act forced States to adopt-- the original act as passed by Congress--an expansion of Medicaid. The U.S. Supreme Court, in its 2012 ruling, indicated that Medicaid expansion was optional, not mandatory under the Constitution. So that portion of the Affordable Care Act was determined to be unconstitutional.

States are now faced with the difficult decision that involves Medicaid and long-term costs associated with potential expansions, and hospitals face tremendous uncertainty about how they will care for an increased number of patients while they are already absorbing the Affordable Care Act's Medicare cuts. So States are struggling to figure out what to do about expansion of Medicaid.

Hospitals are suffering from the consequence of not having additional Medicaid dollars. That is on top of the cuts that occur as a result of changes in Medicare. Really, in most hospitals across my State, two components are so important: Medicaid and Medicare cover a significant portion of the number of patients that are admitted to a hospital, and in many instances there are not many private pay patients who have their own health insurance to add additional revenue to the hospital's revenue stream.

This scenario of Medicare and Medicaid both creating problems, being squeezed from both programs, presents significant problems for rural hospitals. Again, those reimbursements--Medicare and Medicaid--make up about 60 percent of those hospitals' revenues.

The Affordable Care Act also put hospitals in the difficult position of having to balance increasing regulatory burden with reduced revenues. So in addition to the Medicare-Medicaid pressure, there is also the problem of increasing costs associated with more and more regulations emanating from the Department of Health and Human Services and other places across the Federal Government at the same time the reimbursement rates are declining. So increased cost, reduced revenue-- again, a significant problem.

In 2011, the average Medicare margin for hospitals in Kansas was a negative--not enough to cover the cost--4.9 percent. These losses have to be offset somewhere, and that often results in a reduction in staffing. It sometimes means a reduction of services. The end result is a hospital that is not always able to meet the needs of their citizens--their patients.

In many instances it is the hospital that may be among the largest employer in a county or community in our State. In addition to reduced staffing, an inability to buy equipment, and reducing certain specialty programs offered at the hospital, we are also seeing

a significant depletion in their cash reserves and a freeze on capital expenditures. This circumstance is just not sustainable, and so we are seeing hospitals close.

Since about 1990, the number of rural hospitals across the country has remained stable at around 2,000, but last year 15 rural hospitals closed. We have to be concerned there are more to follow. This is an alarming trend. These hospitals play a vital role in health care to those rural communities. It can determine whether a community has a future--whether individuals and families will decide to live there. The loss of a hospital has huge ripple effects and it harms patients. Their primary purpose is to save lives and improve health care, but it is also a tremendous loss to the community itself.

I outlined problems that I believed would occur for hospitals with the passage of ObamaCare long before the law became law. I also would say it doesn't mean I don't believe there aren't significant improvements to be made to our health care delivery system, but I think the reality is that the Affordable Care Act causes more problems-- significantly more problems--than those it solves.

Many Kansas hospitals struggle to meet the needs of the aging population in their States and the Affordable Care Act cuts are an exacerbation of their circumstance. Again, the Affordable Care Act had the promise of: If you like your plan, you can keep it. If you like your health insurance plan, you can keep it. If you like your physician, you can keep him or her. That didn't turn out to be true.

In fact, if you liked your policy, you were probably not able to keep it, and that something else now--that replacement policy--often involves increased copayments and deductibles. That certainly is a problem for the policyholder and his or her family. It is a problem for the business and their employees. But we may have forgotten it is a huge problem for the health care provider.

Almost every hospital I have visited, now that the Affordable Care Act is being implemented, will tell me about the increasing amount of unpaid hospital bills--the amount of money that is owed that is attempting to be recovered. The reason that occurs is because the copayments and deductibles are so significantly higher that patients don't have the ability to pay a $5,000 copayment or even a $1,000 copayment. So the hospital's bad debt is increasing because patients don't have the necessary amount of money to pay for their portion of what their health care insurance policy now requires of them.

Again, this comes from a law that was described to us as going to increase the affordability and the availability of health care. I guess what I would point out is, in the circumstance we are now in, the policies are so expensive, so much more costly both in premiums and copayments and deductibles, that the affordability is a problem again and not just for the patient, not for the policyholder but for the hospital that is now left holding the bag because so many of their patients can't pay the copayments or the deductibles.

When the Affordable Care Act passed, the President's own Medicare Chief Actuary noted that the cuts would cause as many as 15 percent of hospitals, skilled nursing facilities, and home health agencies to be unprofitable by 2019. While that point in time may have seemed a long time away, 2019 is now just about 5 years away. If ObamaCare remains in place, the estimated percentage of unprofitable providers is projected to increase, reaching roughly 25 percent in 2030 and 40 percent in 2050. So by 2030 25 percent of the hospitals, health care providers, will be unprofitable, and by 2050 40 percent--nearly half--of the health care providers will be unprofitable.

Again, in particularly rural communities, if you can't make it on the revenues that come from patients, from providing health care to individuals, often the option is to increase taxes--property taxes, sales tax--or something to keep your hospital doors open. That ought not be the consequence of legislation passed by Congress--to require taxes to be raised for a Federal program called Medicare because it is failing to meet the needs of American citizens, our patients. These providers, our hospitals, just simply can't sustain in the circumstance they find themselves in. The Affordable Care Act has put us on a path that I think is dangerous for individuals, for businesses, and now for the health care providers themselves.

In addition to the bad debt experience, many of the new health care plans have limited or restrictive provider networks, so that a local hospital may be eliminated from their network. This means that while under their previous insurance policy they could see a hometown physician or be admitted to their hometown hospital, because of these network restrictions they must go someplace out of town to access health care. This again is a terrible consequence for the individual, for the patient, but also something that drives revenues away from the hometown provider, much to the detriment of everybody who would want to make certain that provider, that doctor, remains in the community and that the hospital doors remain open.

There is lots of evidence that the problems we are facing are real. They demand attention. Access to affordable health care is something that still deserves our attention. I look forward to trying to make certain we have that opportunity. Again, that is nothing that is going to happen in the next few days, but we have a responsibility to see that the things that are reducing the access to affordable health care are addressed. The efforts that resulted from the Affordable Care Act are exacerbating the problem, not solving the problem.

I look at elections as like a new year. There is this optimism that maybe something good can come from a new Congress; that we can establish our New Year's resolutions and we can begin working, and I certainly make the offer to my colleagues throughout the Senate--all 99 of my colleagues--to be someone who wants to be problem solving, oriented toward finding solutions, and working together to make sure those health care providers that are so important to our lives, our safety, to our health, are around for a long time to come and that the communities that depend upon those hospitals--those 128 hospitals in my home State--have a viable future.

We have to get the regulatory environment under control, we have to resolve the problems created by the Affordable Care Act, and we need to make certain that health care is an opportunity for people who live in places across my State to still have the opportunity to see the hometown physician, to have a prescription filled by the hometown pharmacist, and to make certain those hometown hospital doors remain open for today and for future generations of communities across my State.

I appreciate the opportunity to address the Senate this afternoon, and I suggest the absence of a quorum.

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

Mr. President, Mr. Clay Hunt is a marine veteran who committed suicide in March of 2011 at the age of 28. Clay enlisted in the Marine Corps in May of 2005 and deployed to the Al Anbar Province near Fallujah in January of 2007. He was shot in the wrist by a sniper's bullet that barely missed his head, and it earned him the Purple Heart.

Clay recuperated at Twentynine Palms, CA, and then graduated from Marine Corps scout sniper school in March of 2008, and he was redeployed in southern Afghanistan a few weeks later. His unit returned to the United States in late October 2008 and he was honorably discharged from the marines in April 2009.

After he returned home, Clay suffered from post-traumatic stress disorder, PTSD. He struggled for many years and he struggled with inadequate care from his local VA hospital before taking his own life.

The Clay Hunt Suicide Prevention Act passed the House of Representatives a little while ago this week. I believe this is an important piece of legislation. I serve on the Senate Veterans' Affairs Committee and we had testimony related to suicide prevention, suicide among our veterans, a few weeks back, and it is so clear in Kansas and across the country that many veterans and their families deserve something much more than we are able to provide--than we are providing now--and this legislation which will help in that regard deserves swift passage by the U.S. Senate.

This bill, the Clay Hunt Suicide Prevention Act, would be instrumental in developing a VA system capable of offering first-class, first-rate mental health care services as well as utilizing the expertise of outside organizations to provide support for those struggling with the invisible wounds of service.

The legislation would require third parties to conduct an annual evaluation of suicide prevention programs within the Department of Veterans Affairs and within the Department of Defense. It would also provide for a new Web site that would offer veterans information regarding available mental health care services, and it would create a joint pilot loan repayment program for VA psychiatrists. There is a tremendous shortage of VA professionals that this would help alleviate, and it will improve the exchange of training, best practices, and other resources among the VA veterans service organizations and not-for- profit mental health organizations to enhance the cooperation of their efforts in suicide prevention.

During that Veterans' Affairs Committee hearing on November 19, last month, we were honored to hear Clay's story from his mom, Susan Selke. Susan shared her son's story of reliving the traumatic experiences of war and his disappointment when the VA failed to offer him the care he needed to treat his stress disorder.

In fact, it was one of the most compelling--again, I have served on the Veterans' Affairs Committee since I came to Congress, and this mother's testimony was one of the most important pieces of information I have heard from a witness during the committee hearing. What she indicated was that in her belief--and she indicated that she believed her son thought this as well--that it was the VA bureaucracy, the inability, the unwillingness, the falling through the cracks, the culture that we have heard described in the Department of Veterans Affairs that was the straw that broke the camel's back and that caused her son to commit suicide.

We have ranted, we have raved, we highlighted, we pointed out, we have discussed the VA and its problems, its bureaucracy, its culture, its failure of leadership, its service to the VA as compared to its service to veterans many times over many years. We often bemoan bureaucracy among all Federal agencies, but it is especially important at the Department of Veterans Affairs, because while it is easy to talk about the bureaucracy, the paperwork, the shuffling, the falling through the cracks, this mother's testimony about the death of her son indicated that it is not just about bureaucracy, it is not just about paperwork, it is not just about a culture. Those circumstances contributed to the death of a human being. In this case it contributed to the death of one who served our country nobly.

So we can bemoan the bureaucracy, but we need to remember that it is that circumstance that causes the loss of life. Suicide is something that needs to be addressed. We need to have a concerted effort, and legislation that is now pending before the Senate that needs to be passed before this Senate concludes is one step we can take to make certain there are less circumstances in which a soldier or a veteran commits suicide.

I cannot imagine the heartache, the difficulty, the challenge, that comes from a mom who comes to DC to testify about the suicide death of her son. I don't know how to put myself in that position, but I know it has to be a tremendously difficult, traumatic experience. The reason she must do that is because she wants to make certain that other sons of other parents of other mothers have a different experience than the one she, her family, and her son, experienced.

It is clear we have a problem. It is critical that the VA follow through on its commitment and its responsibilities to our Nation's veterans. It is critical that they must follow through to those veterans who are just returning home, those who have been home a long time, and to their families who need to have the love and support and care of the VA and the American people. We have to keep working to find solutions to the issues of mental health our service men and women and veterans now face, and we must hold the VA accountable for their responsibilities when it comes to providing for the needs of those veterans. And that care and treatment must be provided in a timely, high quality, and in a specialized way that meets the needs of each individual veteran and their family.

My presence on the Senate floor this evening is to highlight the importance of the message of the Clay Hunt Suicide Prevention Act, to pay honor and tribute to Clay Hunt and to his family, and to the hundreds of individuals and families across the country who have faced similar circumstances, and call us to the point that we recognize that steps taken today can make certain there are no more Clay Hunts, no more mothers who face the circumstance of the loss of their son, and that America lives up to its commitment to those we have called to duty.

I urge my colleagues to make certain that this legislation passes the U.S. Senate before we recess for this holiday period.

Mr. President, thank you for the opportunity to speak this evening. I yield the floor, and I suggest the absence of a quorum.

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

Mr. President, I am on the floor this afternoon to speak briefly about the American Savings Promotion Act, H.R. 3374.

My understanding is that this bill may soon pass the Senate--it was passed by the House of Representatives in September--and I wish to speak briefly about its value to our country, to its citizens, and to our country's future.

I believe this is a fairly narrow circumstance with broad consequences. I believe if there is a primary responsibility we have in being a citizen of this country, it is to make sure, among other things, that we pass on to future generations of Americans the opportunity to pursue the American dream--to be able to have an idea to pursue a business plan, to save for your family's and children's education, to save for your own retirement, to prepare yourself for a bright financial future. Unfortunately, many Americans struggle to do that.

Certainly, one of the aspects of that circumstance is there is very little savings that goes on in our country today. People are unable or unwilling, or perhaps undisciplined, in a way that allows them to prepare for their financial security and their financial future. The problem is--and statistics bear this out--people aren't saving. The reality is, according to a recent survey, 44 percent of American households lack the savings to cover basic expenses for 3 months if unemployment or medical emergency or another crisis leads to a loss of stable income. Many Americans have the inability--almost the majority of Americans have the inability to care for themselves and their families if there is an emergency or a problem for more than 3 months. That is something we ought to try to resolve.

I also think there has been over a period of time a disparity of incomes. We want to make certain those at the lowest income levels have an opportunity to increase their income and to increase their financial stability. In fact, the Senator from Oregon, Senator Wyden, and I created sometime ago the Senate Economic Mobility Caucus, trying to make certain that people have a chance to move up the ladder of economic success and security in our economy and in our country. Senator Wyden and I came together to bring some of the best minds from conservative to more liberal thought-provoking organizations and policy organizations to visit with Republican and Democratic Senators and their staffs about what ideas are out there that might increase the chances that a person or a family has the chance to improve their financial circumstances.

One of the ideas that arose from that caucus's discussions was this legislation called the American Savings Promotion Act, again, with the realization that people are not saving for their own financial security, that they lack stability in times of emergency and difficult economic challenges to care for themselves, how can we encourage Americans to save more?

One of the ideas that came forth in this regard is the opportunity to link savings to prizes. When I first heard this, I thought it sounded a little bit odd, a little bit like a gimmick. But the reality is with little savings, people still believe--in fact, 20 percent of Americans believe that winning the lottery is a meaningful strategy to build wealth. Americans spend more than $60 billion every year on lottery

tickets and families earning the least spend the highest percentage of their earnings on lottery tickets despite the long odds of winning.

This legislation is not about a lottery, but about allowing financial institutions the opportunity to provide prizes for those who save, who open a savings account and deposit money into that account. In our country, because of the way financial institutions are regulated, that has been an opportunity in a number of States in credit union financial institutions for a period of time. In fact, the statistics and the facts that arise from that experiment or that experience indicate that savings increases when there is a prize associated with the savings behavior. So it is one of the reasons this makes sense. Prize-linked savings is an innovation, a tool to encourage savings while offering the chance to win a larger prize.

We know these programs work because of the evidence in the States that I mentioned in which credit unions have been offering these prizes associated with savings, and that has occurred in Nebraska and North Carolina and Washington. Since 2009, over 50,000 accountholders have collectively saved more than $94 million, and it only is available in the credit union setting and not available in a bank setting because of Federal barriers that prevent banks and thrifts from offering these prize-linked savings products.

With the passage of this legislation--again, which is a pretty straightforward, commonsense kind of opportunity--this legislation will update Federal laws to allow States to expand prize-linked savings to other financial institutions beyond credit unions.

Increasing savings is a win-win for individuals. It is certainly valuable to boost the financial institutions' accounts and an improvement to the American economy.

This legislation was introduced by me, with the cosponsorship efforts of Senator Sherrod Brown, the Senator from Ohio, in an effort to create one more opportunity, one more piece of encouragement for people to save for their own financial well-being, to care for themselves and their families, and to increase the savings rate in this country for the benefit of the entire economy, but most importantly for the benefit of low-income individuals who need a boost of encouragement to save.

I wish to thank my colleagues in the House. As I say, this legislation passed in the House where Congressman Kilmer and Congressman Cotton led the effort in the House, and my colleague, the Senator from Ohio, Senator Brown, for his efforts in supporting this legislation here in the Senate. It is an opportunity for us to do something modest but useful, something based upon common sense, and something that accomplishes a goal we all should have of making certain the American dream is alive and well, that individuals and families take personal responsibility for themselves and their family members. We all know that increased savings, preparing for any kind of circumstance or emergency that comes our way, is something that ought to be encouraged.

I appreciate that it is likely that later today or tomorrow H.R. 3374 will pass, again, an example of where we have been able to work together and bring new ideas to the cause of making certain that everybody has the opportunity to increase their economic value, to increase the economic worth for their family available for the future, to pay their bills, and to make certain their future is bright, again, in my mind making sure the American dream is more alive and all American families are better off.

Mr. President, I thank you for the opportunity to address the Senate, and I suggest the absence of a quorum.

Madam President, I ask unanimous consent to address the Senate for up to 15 minutes.