Floor Statements

Mr. President, I would also like to say a word about the World Trade Organization's announcement that was just made yesterday, one in which the World Trade Organization said that the Boeing 777X Program did not receive prohibited subsidies. This is a huge win for 80,000 Boeing employees in the State of Washington as well as for the 1,700 suppliers and individual businesses across our State who support our strong aerospace economy.

It is also a loss to the European Union in its efforts to retaliate against the United States for our challenge to illegal launch aid to Airbus that began more than 10 years ago. This shows it was right to raise these concerns by the United States and that the retaliation by Airbus was wrong.

Last year, the WTO ruled that the EU had not taken steps to comply with its previous ruling regarding $17 billion in illegal launch aid to Airbus, and that it had given another $5 billion in illegal launch aid to the A350 Program even after these kinds of subsidies had been declared illegal.

We need an aerospace market that is truly competitive, one that is not distorted by illegal subsidies. So these cases matter because the outcome impacts jobs here in the United States, and aerospace is one of the biggest manufacturers in the United States.

We know in our State that there are lots of challenges and there is lots of competition, but we want that competition to be on a level playing field. We want to make sure that, in the aerospace industry, people are playing by the rules. This is the third time the WTO has said that the massive illegal subsidies the EU has provided to Airbus are wrong, that they have failed to take the steps to comply, and that they need to change their behavior.

If the EU will not play by the rules, then we should take the necessary steps to force an end to these anti-competitive schemes. I say this because the WTO's ruling today--while I know many of my colleagues think this process played out all too long--did resolve the issue as it related to the EU gave Airbus.

Enforcement of these trade rules is important to U.S. competitiveness. I want to continue to strengthen our ability to enforce these kinds of rules and continue to make sure that the U.S. Government has all the resources and personnel it needs to make sure our trading partners meet their commitments, and our aerospace workforce in the United States is second to none. I want to continue to fight every battle to make sure they can be competitive.

I thank everyone at the Office of the U.S. Trade Representative for working so hard on this case for more than a decade. It is finally time to move on and to make sure that the EU is in line with these past WTO rulings and that we continue to fight for a fair and competitive aerospace market.

I yield the floor.

Mr. President, I saw the remarks of the President of the United States in Youngstown, OH, and it has brought me to the floor this morning because the focus of some of his speech was on the economy and job creation. Well, I can tell the President right now that we need his urgent attention to making sure that we create jobs right now. It is not about something in the future; it is about right now.

There are over 40 projects worth $30 billion being held up because the Export-Import Bank does not have a quorum. It is incredibly important to get a functioning bank and to get a board that supports having the support of a credit agency to work with the private sector to finance the sale of U.S.-made products.

The President seems to embrace the notion that we should make things in America. I think we should make things in America, but I don't think that we sell them only in America. I actually want to sell the great manufactured products of the United States of America to overseas markets, to the 95 percent of consumers who are outside the United States. But because this administration has not shown the leadership to get a functioning Export-Import Bank, we continue to struggle. Those $30 billion in projects are being held up because we don't have a functioning quorum.

GE Aviation in Ohio--I wish he would have visited them because they decided to move part of their operations to Canada and Brazil, instead of expanding in Ohio, to take advantage of countries that actually have a credit agency. GE Aircraft Engines decided to open a turbine prop engine facility in Europe for the same reason. We are losing jobs simply because we don't have a tool to work with private-sector banking to make sure that the sale of U.S.-manufactured products actually gets done to countries and organizations in those countries that don't have the proper financing. GE supposedly said that they weren't going to move their corporate headquarters to Ohio because they did not support the reauthorization of the Export-Import Bank.

Between 2012 and 2016, the Export-Import Bank supported more than 255 export deals in Ohio from all sizes of companies, such as Haltec, which exports auto parts, and Anglo American Hardwoods, which exports wood products to the GE Aviation that I mentioned and GE Aircraft Engines. These deals were worth more than $2 billion.

What I am so frustrated about is that this administration has not kept its word in support of the Export-Import Bank. We continue today with the folly of having our Trade Ambassador show up before the Finance Committee and say that the Export-Import Bank is controversial. I reminded him that it was actually supported by a majority of Democrats and a majority of Republicans in the U.S. Senate. It was also supported by a majority of Republicans in the House of Representatives and the Democrats in the House of Representatives. So how could it be so controversial if we reauthorized it?

But the White House has continued to have a double-edged strategy, pretend that they support the Export-Import Bank, and yet send up the name of a nominee to chair the bank who wants to destroy the bank and has made that intention clear.

If we want jobs in Ohio, we need to get the Export-Import Bank approving deals from manufacturers that are ready to close sales and create more jobs, so let's focus on the task at hand. I hope the President will stand up and clearly articulate the need and support for an Export-Import Bank and stop sending us the name of someone who just wants to destroy it.

I thank the Presiding Officer.

I yield the floor.

Thank you, Madam President.

I come to the floor--I know my colleague from Indiana, Senator Donnelly, is going to be down here to talk a little bit about his motion, and I want to support him in that, along with the Senator from Pennsylvania, Mr. Casey, because we are here to say we need to stop this war on Medicaid.

Throughout this healthcare process, it has been very clear that there are many on the other side of the aisle who just want to cut or gut Medicaid. What we are saying is, if you are serious about protecting Medicaid and stopping the war on Medicaid, then you should support the Donnelly-Cantwell-Casey amendment, which would recommit the bill to the Finance Committee with instructions to strike the language about Medicaid. It would make sure a state can expand Medicaid Program, and it would say: Don't cost-shift to the States.

With this motion, we are saying to our Republican colleagues: We don't want to cut people off of Medicaid. We want the committee to do exactly what the Republican Governors are saying, which is, quit beating up on Medicaid and focus instead on fixing the individual market. The individual market is 7 percent of the overall market for health insurance.

What we have found with the expansion of Medicaid that has been done by both Democratic and Republican Governors is great success.

I hope my Republican colleagues will heed the warnings of our Nation's Republican Governors and Democratic Governors. In June, a letter from seven bipartisan Governors was sent to Senate leaders. This is a letter by the Governors of Ohio, Montana, Nevada, Louisiana, Colorado, Massachusetts, and Pennsylvania. It shows the diversity of both our Nation and political parties. It says:

We believe that, first and foremost, Congress should focus

on improving our nation's private health insurance system.

Then they say:

Medicaid provisions included in this bill [that has been

proposed by the House] are particularly problematic. Instead,

we recommend Congress address factors we can all agree need

fixing.

So the message was clear from these Governors, including Republican Governors, and I hope my colleagues will listen to them. The Nation's Governors know because they have had to provide and be a partner on Medicaid for their citizens. They know how it affects their economy, and they know what it does when families in their States get access to healthcare. It reduces the bankruptcy rate. It helps people stay employed. It boosts GDP. All of these things are benefits of Medicaid expansion that we have seen in Washington State. It cut the uncompensated care cost in half. It also resulted in the creation of new jobs.

A nonpartisan study found that if the current bill we are debating, the House bill, is passed, state economies will shrink by $93 billion. So pulling the rug out from under Medicaid recipients would hurt jobs and hurt economies in Nevada, Alaska, and West Virginia. West Virginia would lose more than 10,000 jobs, more than $1 billion in gross State product, and more than $1.7 billion in business output. Nevada would lose 3,300 healthcare jobs and Alaska would lose 2,600.

So all of these things are ways for us to say: If you are serious now--before you go home for the August recess--about protecting Medicaid and stopping this ridiculous war on Medicaid, vote for our motion. Stand up and say you understand that we may have challenges in the individual market, but it doesn't mean that we should cut people off of access to healthcare through Medicaid.

I thank the Presiding Officer.

I yield the floor.

Mr. President, I thank the Senator from Pennsylvania for being here. We have been out here many a night, talking about the importance of Medicaid. I so appreciate his leadership in the Senate on this very important issue. He has been a champion of the Children's Health Insurance Program and has been a voice amongst all Senators in making sure that people have access to healthcare. I so appreciate being out here with him tonight.

I don't really appreciate being here right at this moment. I am really flabbergasted. Why are we here at this moment? Why are we here? I am pretty sure that President Trump, when he was candidate Trump, put in a tweet that he would not cut Medicaid. Yet that is the proposal we are talking about.

No matter what the proposal is--repeal, the House bill, the proposal scored by CBO or some Senate alternative on junk insurance--they all are a cut to Medicaid, so I am not sure how we are here. I am not sure how we are here when the Vice President at the time campaigned, I am sure, against the Affordable Care Act and then became Governor of Indiana and implemented Medicaid expansion in his own State. After saying that he was against the Affordable Care Act, he implemented Medicaid expansion. I am sure people in his home State said: If you want to take care of people, if you want to raise our standard of living, if you want to keep down the costs of healthcare delivery and private insurance, put people on coverage so that they aren't driving up the cost of uncompensated care.

So how are we here? How are we here when our House colleagues came up with a proposal that basically cuts 23 million people off of healthcare--including 15 million people on Medicaid--after working with the President, who said that he didn't want to cut Medicaid, and the Vice President, who basically campaigned against it and then went ahead and expanded it?

I can't believe how many times I have been on the Senate floor, and I haven't seen one of my colleagues come down here and talk about solutions that they are proposing. I just hear them come and talk about the repeal of the Affordable Care Act and kicking millions of people off of the healthcare they currently have.

Tonight, I can imagine there are many people across the United States of America who are like me, thinking, how could this be happening? How could we be sitting here tonight, not knowing what the Senate is going to vote on, not knowing whether they are going to repeal their health insurance, not knowing where their Senators stand or even if the Senator knows what proposal they are voting on? Yet I can tell you this: More than 70 percent of the American people think the ideas that have now been put forth by the House and the Senate Republicans and the President do not work. They are not the way to increase access to healthcare and drive down the cost of private insurance in the insurance market.

You don't have to take my word for it. I am looking at a statement by Ohio's Republican Governor, John Kasich. I worked with John Kasich in the House of Representatives. He was a budget hawk. He wanted to figure out how to make things work. So I trust that, as Governor, he is a fiscal steward about how to get things done when he says: ``Until Congress can step back from political gamesmanship and come together with a workable, bipartisan plan, it is a mistake for the Senate to proceed with a vote on Tuesday and force a one-sided deal that the American people are clearly against.''

So why are we here? Why are we here when a President promised that he wasn't going to cut Medicaid, a Vice President said that he was against the bill but then went and did Medicaid expansion? The people in the United States responded very clearly that they are not interested in cutting millions of people off of health insurance because they know that, even if it doesn't affect their family, it doesn't make common sense for keeping down the costs of healthcare.

So I ask my colleagues to stop and think about the people in the United States of America who are clearly scared to death about what is going to happen tomorrow. They are scared that someone in their family or that they, the provider for their family, are not going to be able to provide insurance.

If you are so brave, come down here and volunteer, as an amendment, to cut all of us--cut the Senate off of our access to health insurance until we come up with some idea that you think is so terrific. I doubt you will come and propose that. You wouldn't want your family cut off of healthcare.

I meet people like Emily Talbot, who came to visit me from Seattle Children's Hospital, who at age 6 was diagnosed with a condition that affected her brain tissues and spinal canal. She was from Idaho, and she was referred to Seattle Children's because it is the pediatric referral center for our region. Thanks to Medicaid, she saw 11 different pediatric subspecialists and had 13 brain surgeries and 7 back surgeries. Her mom told me that without Medicaid and without the prohibition on lifetime caps, she wouldn't have access to healthcare today.

Is that what my Republican colleagues want to say tomorrow, that ``we don't really know for sure how we are going to do this, we don't really know what works, but even though we said we weren't going to cut Medicaid, we are going to cut people off of health insurance who currently have coverage?''

I think the reason why people like these Governors from Republican States have been willing to speak out against this proposal and raise their concerns is because they have to be a steward of Medicaid, and they have to be fiscally responsible. So they know there are better ways.

When I talk to the regional hospitals in my State, they tell me that covering more people under Medicaid has created downward pressure on price in the individual market. It has helped us.

So our solution cannot be decimating the Medicaid market. Our solution has to look at those in the individual market who don't have as much clout as a big employer or somebody who can buy in bulk and drive down their price. There are ways to address that issue.

I look forward to working with my colleagues on those solutions, but that is not what is being recommended tomorrow. Those solutions haven't been put forth, nor are they part of any of these proposals. So I ask my colleagues to not proceed.

The President promised he was not going to cut Medicaid, and now it is like you want somebody to jump off the cliff tomorrow, and you are saying: Oh, by the way, I will throw you a parachute on the way down. It doesn't work.

As my colleagues have said here tonight, it is time to give certainty to this population that we have a proposal that will help continue to give them access to care. I would say to my colleagues that taking a vote on politics when it is the lives and the healthcare access that so many millions of Americans seek--don't play politics with healthcare. Let's get a solution that works and works on both sides of the aisle.

I thank the Presiding Officer, and I yield the floor.

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

What is the pending business?

I thank the Chair.

Madam President, I rise today to speak about the Bernhardt nomination to be Deputy Secretary of the Interior.

The Deputy Secretary plays an important role in forming and carrying out the administration's policy on a broad range of issues. These issues include our Nation's public lands, our national parks, our national wildlife refuges, our water resources, mineral and energy development on public lands and Federal waters, carrying out our trust responsibilities to our Tribal nations, and working with our territories and Freely Associated States.

The Deputy Secretary also performs very important functions as it relates

to the Secretary or in the Secretary's absence. In virtually all matters, the Deputy Secretary has the authority of the Secretary. That is why I look at this position with such an important critique, because we know in past positions there have been conflicts, and we know we have important policies to discuss, and we need to make sure we have no conflicts of interest.

I have made no secret that I have concerns about this nomination. Mr. Bernhardt is no stranger to this body and he is no stranger to the Department of the Interior. He held a number of senior political positions in the Department during the Bush administration beginning in 2006.

After leaving the Department in 2009, he returned to a successful private practice. For 8 years, he has represented a wide range of clients, including oil and gas companies, mining companies, and water supply interests in California, just to name a few. If he is confirmed, he will oversee the same companies at the Department of the Interior; that is, he will be making decisions on the same things that he lobbied for at the agency, and now he will be on the other side of the table and be able, after a short period of time, to make decisions in those areas.

So, as I said at his confirmation hearing--I'm not suggesting that just working for the private sector disqualifies someone, but when you have a wide range of issues that you have worked on in the private sector and now you are going to be on the other side of the table, it brings up concerns.

The President of the United States traveled the country when he was campaigning and said he wanted to drain the swamp from special interests, and he has repeated that many times over the last few years. But with Mr. Bernhardt's nomination, I am afraid he is not draining the swamp, he is actually helping to fill it.

The nominee's private sector experience as a registered lobbyist for companies whose main public policy focuses are in the Department of Interior creates an appearance of a conflict of interest. Also, the nominee wants to lead the Department that he sued four times.

It is true that Mr. Bernhardt has considerable experience. We saw another nominee come to this same post in a past administration on the same basis. People thought he had a lot of experience in a lot of these cases, but he obviously didn't follow the law and ended up going to jail because of his overreaching within the agency and organization.

So these are very important public policy issues, public lands issues--interests that the American people need to make sure are aboveboard and no conflicts of interest.

Mr. Bernhardt served in the highest levels of the Department of the Interior at a time when the inspector general called it ``a culture of ethical failure.'' I know that at the hearing he told us he tried to help change that failure of culture within the agency. The Inspector General also testified that ``ethics failures on the part of senior department officials--taking the form of appearances of impropriety, favoritism and bias--have been routinely dismissed with a promise `not to do it again.' ''

While Mr. Bernhardt has given testimony about the fact that he tried to help change and get away from that culture, I still have concerns that his private sector client base poses a significant problem. The nominee's extensive client base in the area, which falls under the jurisdiction of the Department of the Interior, creates at least an inherent appearance of conflict. He and his clients have lobbied extensively on such matters as the Cadiz pipeline in California, opening up the Arctic National Wildlife Refuge to oil exploration, and weakening the Endangered Species Act. He has advocated in favor of expanding offshore drilling and lifting the moratorium in the Gulf after the Deepwater Horizon disaster. He also represented Westlands Water District, the Nation's largest irrigation district, as a registered lobbyist. His law firm represented Westlands in four different lawsuits against the Department of the Interior.

In November 2016, he joined the Trump transition team, and Mr. Bernhardt deregistered as a lobbyist for Westlands yet continued to work for them in some capacity.

As the ranking member of the Energy and Natural Resources Committee, I raised concerns about these issues with the nominee during his confirmation hearing. He has submitted required financial disclosure and ethics forms, but there are specific questions we want to make sure are addressed.

He has declined to comment on recusing himself beyond just the 1-year minimum that is required by the ethics rules. I know Mr. Bernhardt says he will comply with whatever the organization and agency requires, but we don't have the time, given the long list of conflicts of interest and given that past case representation, to constantly know every issue and every meeting and every oversight to make sure that undue influence is not being pressured at the Department of Interior.

The President of the United States, who nominated Mr. Bernhardt, told the Times just yesterday in a conversation about the Attorney General: ``If he was going to recuse himself, he should have told me before he took the job and I would have picked someone else.'' Well, I hope that is not the issue here. I hope the agency isn't running fast toward somebody who just won't recuse themselves in hopes that they will get someone who will do the bidding of these interests and not take into consideration the complexity, the legal structure, and the challenges that dealing with these issues takes.

In fact, as late as March of this year, Mr. Bernhardt's firm was submitting invoices to Westlands for lobbying charges with itemized expenses. Documents show he was engaged in regular contact with congressional offices and working on legislation and efforts to inform administration policy at the same time he was serving on the Trump transition team.

Even the appearance that Mr. Bernhardt was still lobbying on behalf of clients that do business with the Department of the Interior at the same time he wants to help lead it validates some of the concerns we have been expressing.

I remain concerned about his record on behalf of these corporations at the expense of the environment and his tenure at the Department of the Interior and many other challenges. The Department's responsibilities and jurisdictions are just too vast. They are too important to the American people to just green-light someone who I believe will be very challenged in doing this job. So I urge my colleagues to oppose this nomination.

Just today, a complaint was filed with a U.S. Attorney about this nominee's alleged lobbying activities based on new records available pursuant to California public records law. I want answers from the nominee. We are going to continue to ask questions.

In the meantime, I ask my colleagues to oppose this nomination. Make sure we get the answers we need before the nomination of David Bernhardt can continue.

I thank the Presiding Officer.

I yield the floor.

Madam President, I suggest the absence of a quorum.

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

Thank you, Mr. President.

I know my Republican colleagues are working on versions of the healthcare bill they have been talking about today, and I know my colleagues are going to try to say they are protecting the sickest of Americans, and they are saying they do want to ensure that people with preexisting conditions don't have to pay through the nose when they need care. I think the President called the House version of this attempt a mean bill, and I think the original Senate bill was just as mean, if not meaner, with the number of people who would be cut off of Medicaid over a period of time and left without access to care.

Today's bill also includes an amendment or a package of ideas by my colleagues from Texas and Utah--a provision that allows insurers to sell junk insurance on the individual health insurance market. As long as they offer at least one plan that is real insurance, insurers could offer a bunch of plans that, as CBO has said, are not really insurance; that is, they just cover one or two things. Yes, they would be cheaper, but if CBO doesn't consider these types of plans insurance, how are they insurance?

I think the whole notion of junk insurance being invested into this bill is very problematic. Under junk insurance plans, they can limit or deny coverage of essential benefits, including hospitalization, maternity care, preventive care, prescription drugs, laboratory care, and substance abuse treatment. That is what they can limit. We wouldn't want those limited. This is why CBO says that if you can't go to the hospital and get care, then it is not really insurance. I have to agree with them on that.

These plans could charge people more or simply deny them based on preexisting conditions, and these plans could pay out less than 60 percent of the healthcare expenses, leaving the beneficiary with unbelievable, insurmountable deductibles that would be hard to pay. These plans could also impose an annual or lifetime cap on insurance.

I had a young woman come to my office today who was treated at Seattle Children's Hospital in our State. This family actually lives in a neighboring State, but Seattle Children's Hospital is such a regional entity in the State of Washington, in Seattle, and we are so proud of that. They told me about the debilitating disease this young child was born with and how many surgeries she has had. Literally, with the brain treatments she has had to receive, she and her mother told me that if there had ever been any lifetime caps, they would have exhausted them in the first few years. I am so proud that she came to see us today and is continuing to talk about why capping healthcare plans would be so devastating to somebody like her.

We don't want to create two markets of insurance. We don't want the one that is the real plan, real insurance, and the one where everybody goes and buys insurance that even CBO says is not real insurance.

I know that probably in the last few days of discussion, people have said: Ok, we will put a bunch of money in to help the real, or regulated market. I talked to my insurance commissioner in the State of Washington, and he said: Listen, when you don't spread out risk, you are not going to have a market and you are going to create problems.

So the notion that you think that catastrophic out-of-pocket costs won't be borne by these individual patients, I think, is wrong or that these higher premiums and deductibles could be paid by these individuals. It turns out that these junk plans, as I said, do not even count as insurance, and everybody who is in the real insurance market would then end up having to pay more.

The bill explicitly states that non-compliant plans will not count as creditable coverage for the purpose of individuals demonstrating that they have insurance.

I am checking with my staff.

Is that right? Is that what is in the proposal?

Yes. The bill explicitly states that noncompliance plans will not count as credible coverage for the purpose of individuals demonstrating that they have insurance.

Under this bill, if someone gets one of those junk plans--if somehow you see that marketed and you buy into it because you think it is cheap and you think it is the greatest thing ever--and then you try to enroll in a comprehensive plan, there is a good chance that you will get a lockout period of 6 months before you can get coverage.

Why am I here talking about this? Because the State of Washington tried this. We tried this approach in the 1990s. After our State had passed a major healthcare reform bill in the 1990s, a group of State legislators allowed these junk plans to be sold along with compliant plans. Guess what happened? Nearly all of the insurers in our State pulled out of the individual insurance market, and a death spiral ensued. Why? Because the cost then of that individual market was so high and so great that they could not service it.

They said: Oh my gosh, if I have to offer a compliant plan along with this junk insurance, I cannot make the compliant plan work because it costs so much. We are not staying.

This very important experience taught us that that is not the way for us to spread risk.

I am concerned--and I have heard from a number of patient advocacy groups, not just the young woman from Seattle Children's Hospital who came to see me today but consumer groups and health insurers themselves, like America's Health Insurance Plans, Blue Cross Blue Shield Association, AARP, American Cancer Society's Cancer Action Network, American Diabetes Association, American Heart and Lung Association, Cystic Fibrosis Foundation, March of Dimes, National MS Society, National Health Council, and the National Coalition for Women

with Heart Disease. All of these organizations do not like this idea of junk insurance, of saying you can have a compliant plan that is real insurance and a marketplace in which there are things that are not really insurance, because then people are going to go buy a bunch of things that are not really insurance and then not have the ability to get cost and care and run up uncompensated care. Then you are going to make the real market unsustainable and unsupportive, and the rates are going to go so high that people are just going to pull out.

A group of 10 of those leading patient advocacy groups wrote:

Under the amendment, insurance companies would be allowed

to charge higher premiums to people based on their health

status--in addition to opting out of other patient

protections in current law, such as the guarantee of

essential health benefits--

Those are the things I was going over a few minutes ago--

and the prohibition on annual and lifetime coverage caps.

They go on to write:

Separating healthy enrollees from those with preexisting

conditions will also lead to severe instability of the

insurance market. This is unacceptable for our patients.

Yesterday, America's Health Insurance Plans wrote:

Allowing health insurance products governed by different

rules and standards would further destabilize the individual

market and increase costs for those with preexisting

conditions.

That is the largest health insurance group in the country, and they are writing this.

If they are telling us in advance that this is going to really destabilize the market and cause problems, we should listen because right now what we have had is an expansion of Medicaid and covering more people, raising the GDP and helping areas of our States and country and creating more stability.

We have had some challenges in the individual market. We should fix that. We should definitely drive down the cost of the delivery system by continuing to improve it. But the notion that this is the fix for the individual market when the providers are telling us it is going to destabilize the market and drive us out--we should understand what the result of that is going to be.

Yesterday, the Blue Cross Blue Shield Association wrote:

The result (of Cruz/Lee) would be higher premiums,

increased Federal tax credit costs for coverage available on

the exchanges, and insurers exiting the market or pricing

coverage out of reach of consumers.

I believe our goals should be trying to drive down the cost of insurance. We have lots of ideas about that, and I want to work with our colleagues on that, but I am very concerned that this approach to try to get people supporting a Senate proposal is the wrong approach and will drive people out of the market.

I think the bill is still a war on Medicaid. The bill still permanently cuts and caps the Medicaid Program. I have said numerous times that we saved $2 billion in the State of Washington by rebalancing people off of nursing home care and on to community-based care. It is a great concept. Look, we have a lot of people who are going to live longer. We have baby boomers who are reaching retirement. The number of people who are going to demand services, whether from Medicaid or Medicare, is going to be increased just because of the population bubble. We should be doing things to drive down the costs of care.

There are great ideas, and I was able to get some of those in the bill. We ended up passing those things, and some States are actually working on that. More than 15 States are actually working on that concept of rebalancing to community-based care and making long-term care more affordable under this provision. I guarantee you that we have to do that, but if you permanently cap or cut Medicaid, you are going to have veterans who use access to Medicaid for care who are not going to get care. You are going to get people who need opioid treatment.

I find it interesting that we would have this program over here. I see that my colleague from Michigan is on the floor. We call it the Saginaw Health Clinic.

One would say: OK, Saginaw Health Clinic, there is a bunch of money in this bill. Apply for opioid help.

They would say: OK. We are going to get $10 million.

When you walk in the door of the opioid Saginaw Health Clinic, the first thing they will ask is if you are on Medicaid. If you are not on Medicaid, you are not going to get any opioid help.

So the notion that we would cut people off of Medicaid but put more money in the opioid problem is not what we need to do to solve our challenge. What we need to do is make sure we are delivering the most cost-effective care as possible and make sure people are getting access to care.

That is why I have been all over the State of Washington. I have met so many people. I have met people at healthcare facilities who have told me that some of their highest costs were from a patient who continually came to see them in the emergency room, maybe 30 times a year, because he did not have coverage, so he drove up the cost for everybody. They said they finally got this person on the Medicaid expansion. Guess what. They do not have those costs anymore in their hospitals and facilities. It has driven down the costs.

I do not want to see people kicked off of Medicaid. I do not want to see it cut in a declining budget. I want us to improve Medicaid and make it more cost-effective and more utilized and supported.

Estimates by the CBO of the original Senate bill are that the Medicaid cut would be $772 billion over the next decade and that the Federal investment would be cut by 35 percent within the next two decades, relative to current law projections. That is a lot of consequence for the Medicaid population. I think that is why we have so many groups and organizations here that are anxious about this proposal and where we go. We definitely want to talk to our colleagues.

One former CBO Director said, the junk insurance idea is ``a recipe for a meltdown.'' This is someone who served in past Republican administrations, and I take his word seriously.

I think what we need to do is work together to make sure we get a program that addresses our most fundamental issues--the challenges in the individual market, keep addressing how we keep and stabilize a population on the most affordable rates there are, and keep the things we know have worked very well, like the Medicaid expansion. It has worked. It has supported people, and it has helped us stabilize the market.

I will remind my colleagues, too, that the State of New York took one provision of the Affordable Care Act and has 650,000 people in New York on a very, very affordable insurance plan. We think that if you are an individual in the individual market, you should be able to get the same clout as somebody who works for a large employer. You should be able to go in and buy in bulk as a class, as a group of people, and when you buy in bulk, you should get a discount. That is what we think will help us in the individual market to drive down these costs for what is about 7 percent of the marketplace.

I urge my colleagues to reject this latest proposal. Let's get serious about fixing the things that we know we can fix and improve upon, but for the over 22 million Americans who are very nervous about this proposal because they know they are going to get cut off of care, let's not do that to them. Let's improve where we need to go in affordability in the healthcare arena and not think that a junk insurance program or cutting people off is the solution for the future.

Thank you, Mr. President.

I yield the floor.

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

Mr. President, I come to the floor this afternoon with my colleague, the Senator from Hawaii, who has been leading our efforts on coordinating a very loud and resounding voice on trying to stop the FCC from running over an open internet, and I thank him for his organization for today. I know we will be joined by our colleague, Senator Wyden from Oregon--and perhaps the other Senator from Oregon and several others--to talk about this important issue.

We are here today to try to draw attention to one of those important economic issues before us: the need to preserve an open internet with strong net neutrality laws.

We are facing a pivotal moment in the fight to preserve an open and fair internet. A strong and open internet is, without question, one of the great innovations of our time and one of the great job creators of our time. Yet the Trump administration stands poised to undo the bedrock principle of net neutrality in the face of evidence it would undermine our economy and undermine future job growth.

The FCC has announced its intention to go against the demands of 5 million American consumers and reverse what is an existing rule so that big cable companies and telecom providers can erect toll lanes; that is, if you want fast internet speed, you have to pay more. This would threaten the fundamental nature of our internet and the innovation economy.

Last week, FCC Commissioner Clyburn and I held a townhall meeting on net neutrality in Seattle. More than 300 people attended, and not one was in favor of paying higher prices to their cable company for worse or inhibited internet services.

Many people shared their personal stories about how an internet with toll lanes would affect them negatively. We heard from many small businesses and startups that they were afraid of losing business because they might have to charge higher prices to their customers if these important protections were reversed.

I heard from people with health problems and their concerns about health emergencies while away from home. The absence of net neutrality rules would mean that a doctor in their small hometown could not get critical information to the medical practitioners who are dealing with a patient in an emergency so that they could get important lifesaving treatments. Whether you are a doctor examining a patient via telemedicine or in an emergency room in Seattle or a student in a rural community trying to access the

internet to get information, take a test or do research, a fast connection is necessary. Your ability to have a fast connection is something you are more than just a little concerned about. Being artificially slowed down in favor of big companies that buy faster lanes would turn our economy in the wrong direction.

Our economy is in the midst of a massive technological transformation. As technology advances, incredible opportunities and new jobs are created. Every business plan of every startup relies on the ability to get content to consumers.

Largely as a result of innovation and the proliferation of hundreds of startups in the United States, the internet economy today is now worth $966 billion and accounts for almost 6 percent of our U.S. GDP. This is a higher percentage of the U.S. economy than many other industry sectors, including construction, mining, utilities, agriculture, and education.

Net neutrality--meaning you have an open internet that is not artificially slowed down unless you pay a ransom--is important for small businesses and startups and entrepreneurs who rely so much now on an integrated business model where internet access, marketing, and advertising their products and services to reach customers is critical. We need an open internet. We need it to foster job creation, competition, and innovation for the almost 3 million Americans workers who already rely on the internet economy today.

When net neutrality was implemented a year-plus ago, we were protecting and making sure there was no uneven playing field. Basically, because of the regulations, we were able to help small businesses and entrepreneurs thrive. But our internet providers are internet gatekeepers, and without net neutrality, they would seize upon the opportunity to change that.

One slice of the internet economy--the app economy, which is growing every single day--consists of everyone who makes money and has a job, thanks to mobile apps powered by an open internet. Today, 1.7 million Americans have jobs because of this economy. Nearly 92,000 of those jobs are in my State of Washington.

Over the past 5 years, the app economy jobs have grown at an annual rate of 30 percent. I don't know of another sector that is growing that fast. The average growth rate for all other jobs is about 1.6 percent. By 2020, the app economy could grow to over $100 billion. Why is this so important? Because we all know that these various applications and apps make our lives better. They make it easier. In a busy world, they are helping us do the things that are so important to us with more ease and more certainty.

The internet economy is dynamic and supercharged in creating job growth. This phenomenon of economic growth trajectory would not be possible without the internet as a platform for economic activity. This is why it is so important that the FCC not, in the dark of night, put down a rule without public comment to try to stop and change this direction that has already been protected by past FCC Commissioners. This is why my colleagues and I are here today on a date when everybody is trying to raise awareness--because the FCC could act as early as August 18 to try to change these rules.

It is important that we oppose any new FCC actions trying to dismantle an open internet. We need to make sure we are talking about the harm to consumers, the harm to innovation, and the fact that internet speeds for American consumers are important and consumers shouldn't be burdened by a cable company holding you at ransom to pay more just to get faster speeds.

Consumers are already struggling with high prices. Cable bills rose 39 percent from 2011 to 2015, eight times the rate of inflation. In 2015, the average consumer cable TV bill was $99 a month; just a year later, the average consumer cable bill had risen by 4 percent to over $103. My guess is a lot of people listening to this now are probably thinking, boy, where are we today?

One of the most popular arguments by the enemies of an open internet is that it suppresses investment and leaves consumers with poor broadband infrastructure. That is a false claim. Data shows that investment by publicly traded cable companies and big telephone companies was 5 percent higher during the 2-year period following our protection of an open internet. Clearly, people are continuing to make investment.

I want to make sure people understand that we do not want to see a change in this policy. We do not want to see American consumers run over by large cable companies that are demanding higher rates. We want to make sure that we don't end up with a two-tiered internet system-- one for big companies who will pay and pay and pay for faster rates, and consumers who are left with a very slowed-down, challenging to use internet, which makes it hard for us to continue to innovate.

I encourage the American consumer to go out and contact the FCC. Yes, your voice can be heard. The FCC has already received 5 million comments, and they have until August 17 to hear more. Today, we are asking everybody in America to say: Please don't slow down my internet connection. Don't hurt our economy; don't hurt American business. Invest in innovation, and keep an open internet for the future.

I yield the floor.

Mr. President, I have joined my colleague in coming to the floor to talk about how we need to make progress on healthcare and make sure that we don't pull healthcare out from millions of Americans. I thank the Senator from Illinois for talking about his constituents. Like the Senator from Illinois, I was at home this past July recess talking to my constituents, and I heard many of them talk about their individual healthcare needs and their concerns about what is happening in Washington.

I met a young woman who told me about her daughter who was born prematurely and weighed less than 2 pounds. Her daughter required specialized, expensive treatment as a newborn. She was concerned that if we keep moving ahead with the repeal of the Affordable Care Act, she and her husband would be overwhelmed with crushing hospital debt if, in fact, we hadn't covered preexisting conditions. She is one of millions of Americans who are scared that they are going to lose their health insurance under the proposal that is being talked about, that has been talked about for the last several weeks, and from what we can tell-- because, obviously, there is a lot of secrecy--may still include details about reducing coverage for those who have access to care through Medicaid.

I have come to the floor tonight to talk about the latest idea because I think one of the things that is clear--and probably why the Senate majority leader said that he wanted, basically, to cancel the first 2 weeks of the August recess--is that my colleagues don't want to go home and talk about the proposal that was brought before them. In fact, they are now trying to bring up a new proposal, thinking that, again, with a very limited time period, without floor discussion, without committee debate, without an amendment process, somehow our colleagues on the other side of the aisle will fall prey to the notion that there is a silver bullet, a magic solution. I have come to the floor knowing that an amendment or a discussion piece or the new behind-closed-doors discussion proposal being advanced by my colleagues from Texas and Utah is basically to allow junk insurance into the marketplace.

What do I mean by junk insurance? I mean a proposal that basically offers less than the essential benefits, such as hospitalization, prescription drug benefits, lab costs, and all of those things; that, basically, by offering a market where you can get junk insurance, you can say: Oh, well, you have to have one offering of insurance that does cover all the basics and essentials, but then you can have junk insurance.

I say ``junk insurance'' because this is the wrong idea for the marketplace. It is basically mixing good and bad and not having adequate risk spread across--so basically it means that you don't have to have compliant plans for the market. I know this firsthand because we had this in Washington. We had this same experiment in Washington in the 1990s, and people tried to do the exact same thing--basically, have a compliant plan, and then say that you have a bunch of less-than- adequate proposals for insurance in the market that really aren't giving individuals coverage. What happened? It drove up the cost of the compliant plans that covered most of healthcare and basically drove the insurers out of the market. That was the experience in Washington State. This same idea was tried, and it failed because basically it ran up the price, and insurers didn't stay around to offer options. They

couldn't make the mandate of the required plan work because it basically took the risk out of the system.

The notion that somehow this new idea by my colleagues is going to be the silver bullet is, in my opinion, not an answer at all. People who would be the ones who could get that kind of coverage for a short period of time would then end up leaving the rest of the people without adequate coverage. As I said, what happens is, the costs then just go up, and then the market has to adjust. I would say that in our State-- because a lot of people are talking about leaving the individual markets over the proposals that we are talking about today because they are concerned about the costs and who is going to be covered--you would see a very rapid collapse of the individual market exacerbated by what my colleagues from Texas and Utah are proposing.

There are numerous nonpartisan health experts who seem to be saying the same thing. There is the American Academy of Actuaries, where one individual said:

People who are healthy now would tend to choose

noncompliant plans with really basic benefits. People who

want or need more comprehensive coverage could find it out of

their reach, because it could become unaffordable.

Another individual from the American Enterprise Institute wrote that ``the main effect of the Cruz-Lee amendment would be to shift costs from healthy consumers to less healthy consumers and households with lower incomes.''

Douglas Holtz-Eakin, a Republican and former Director of the Congressional Budget Office called the amendment by my colleagues from Texas and Utah ``a recipe for a meltdown.''

Larry Levitt, senior vice president at the Kaiser Family Foundation, summed it up best when he called the amendment ``a recipe for instability and discrimination.''

So you can see that many people already understand the idea of junk insurance is not a market solution at all. It is not really even healthcare coverage. In its May 24 score of the House proposal, the CBO provided a definition of health insurance, saying that they would ``broadly define health insurance coverage as consisting of a comprehensive major medical policy that, at a minimum, covers high-cost medical events and various services, including those provided by physicians and hospitals.''

To me it seems pretty clear that the types of plans that could be sold under this proposal don't meet that definition.

What are essential benefits that we expect to be covered in a plan? Obviously, hospitalization, emergency services, ambulatory services, mental health, prescription drugs, rehabilitation, if needed, laboratory services, like lab tests, and we have moved toward some preventive, health, and wellness measures. Those are the essential benefits that are supposed to be in a plan, and I want my colleagues to know that this experiment was tried. It failed. It drove insurers out of the marketplace because it just made the plans that were covering essential benefits so costly by distorting--really tearing the market apart.

The second point about the proposal we are hearing about is that it is still a war on Medicaid. In my opinion there are cost-effective ways for us to continue access to healthcare. I have brought them up on the Senate floor. One would be looking at rebalancing from nursing home care to community-based care or, as I have mentioned, a basic health plan that bundles up a population and serves them up to get a discount so that individuals would have as much clout as a large employer would have in the marketplace.

I hope that my colleagues will stop the focus on capping, cutting Medicare--because it would throw so many people off of the system--and focus on rebalancing people to the type of healthcare that will help us save costs, keep people in their homes, and give consumers the ability to compete cost effectively in the individual market.

These are the problems I still see with this proposal. To think, basically, that junk insurance will be the way for us to get a proposal and to see that Medicaid is still the target in a war on Medicaid, to me, is not the proposal to move forward on. I hope our colleagues will realize that both of these have severe faults and will sit down and talk about the proposals that will help us in establishing a more robust individual market.

I thank the Presiding Officer.

I yield the floor.

Mr. President, I join my colleague Senator Murray in commemorating the Ballard Locks' 100th anniversary. As our constituents in Washington State know, these locks are an integral part of our regional economy. The safe and efficient operation of the Ballard Locks supports $1.2 billion in total lock-related economic activity, more than 3,000 full-time jobs, and more than 1 million tons of freight. With over 1.3 million visitors a year to see the locks and the fish ladder and visit the Carl S. English Jr. Botanical Gardens, the Ballard Locks are one of the region's top tourist attractions generating another $40 million in economic activity per year.

The Ballard Locks provide critical public safety and environmental functions, maintaining the water level of Lake Washington and Lake Union and preventing salt water intrusion from Puget Sound into these freshwater lakes. The locks support two floating highway bridges-- Interstate-90 and

State Route-520--the water and sewer systems that serve Mercer Island residents, and approximately 75 miles of developed commercial, municipal, and residential shoreline. It also allows for emergency response by the Seattle Fire Department, Seattle Harbor Patrol, King County Sheriff, and U.S. Coast Guard. The facilities spillway and fish ladder serve as a link for salmon and steelhead migrating from the ocean upstream to freshwater spawning grounds, which is important to fulfilling Federal Tribal treaty responsibilities.

Mr. President, together Senator Murray and I will continue to advocate for this critical infrastructure, working to ensure our colleagues and the administration understand the importance of the waterways and navigation systems in the Pacific Northwest. Investing in our water infrastructure supports jobs, economic security, and healthy communities. Senator Murray and I are proud to fight for the investments the Army Corps needs to operate, maintain, and restore the Ballard Locks.

Mr. President, I join my colleagues here from the Finance Committee. Although I don't want to admit it, it was 10 years ago that we had this discussion in the Finance Committee--my colleagues from Maryland, from Delaware, and from Oregon. What people don't realize--even the Presiding Officer knows we spent a lot of time talking about healthcare. This was not ``let's have a few meetings and roll out a bill.'' There was a very long period. In fact, the Chair knows that, in fact, our side got a lot of heat for a lot of dialogue that happened with him and our colleague from Maine at the time--a lot of heat for dialogue with her. I think there was a period of time, about 6 or 7 months, where every single day I went to at least one thing in the discussion of the healthcare policy--at least one thing every day for like 6 months. That wasn't even the markup. Those weren't even the meetings. That was just the time period where the committee had designated various subgroups so we would talk about policy.

I don't know if the two of you remember that period, but my recollection is every single day I was going to something regarding the healthcare policy and listening to experts and recommendations, and then, of course, we had these--I call them more roundtables than hearings. We had a lot of roundtable discussions, and we obviously went through a very formal bill process.

There is a little bit of irony that we are the ones out here today still talking about this healthcare bill. I think it is because we knew what the challenges were, and we tried to address them and were not afraid to keep addressing them. We are not afraid to be out here today talking about solutions we want to see as well.

I thank my colleague from Delaware and my colleague from Oregon for both being part of that effort because it really was an unbelievable amount of time and energy and discussion and formulation. The notion that somehow now we would take something that is one-sixth of the economy and draft something up in a dark process, then throw it out here--I am not surprised today that there aren't the votes. The thing to do now is not try to just rack up some votes in the next few days and come back in July. The thing to do is to sit down and have a serious discussion.

I notice a couple of my colleagues are down at the White House. They are positioned right there next to the President. Maybe they are trying to put them on the hot seat. He is sitting there talking about the individual market. He is talking about the individual market in Alaska. All I am thinking is that the individual market in Alaska--we are sitting here, and the other side is proposing to cut 15 million people off of Medicaid. What does that have to do with the individual market? Nothing.

I don't know if people are ready to focus on this the way we focused on it in that time period for more than a year--more than a year, day after day, meeting after meeting, hearing after hearing. I hope what they will do is stop this proposal and sit down and have an open process and have a discussion on these policies because they are so important.

We have been having all this discussion, and a lot of the frustration people have talked about is the individual market, where 7 percent of Americans

get health insurance. There are ways to fix and improve the individual market. I feel like I was fortunate enough to put forward one of the better ideas that worked successfully, at least it is working successfully in the State of New York, the Basic Health Program. So 650,000 people are on the Basic Health Program as a proposal. I think they call it, in that State, the Essential Plan. Two adults in a family of four can buy a policy for about $500 in premiums, on an annual basis, instead of about $1,500 on the exchange for that population that is above the Medicaid rate that needed to have a solution in the marketplace. There are 13 different companies offering insurance to those 650,000 people, so that is obviously working.

Now, it got implemented late. New York did it in 2016 because they were off to the races, but other States should now consider this. What is so great about this and helping to address the individual market is because, where we are on this side, we are willing to allow individuals who don't work for a large company to get the same clout as if they worked for a large company. When you buy in bulk, you get a discount. Americans know that. That is why they shop at Costco. If you go there and buy in bulk, you get a discount. That is what they are doing in New York. So 650,000 people have been bundled up like they are a big company and saying to the marketplace: Who wants to bid on selling us insurance? The end result has been more affordable insurance in the individual market. That is what they should be discussing down at the White House today. That is what they should be discussing, not cutting 15 million people off Medicaid. That is not a smart idea.

I am sure my colleagues here have already gone over this notion that once you cut people off of care, they end up in the emergency rooms or have exacerbated healthcare needs. So there are longer periods of time to get access to healthcare, more complicated healthcare costs, rising premiums.

We have gone around our State and heard loud and clear from the provider community and the hospitals that they have seen downward pressure on the price of private insurance because we expanded Medicaid, and the economic numbers are out there now to show the same thing. Cutting people off of Medicaid is not the solution to the individual market. I hope somebody down there at the White House brings that up.

In 2020, when the Medicaid cap--if it did go into effect--the analysis is it would cost shift $324 million per year to my State. They would be cutting people off of Medicaid, and then basically the cost would be $324 million a year to our State. You can imagine that our State doesn't have that money and isn't interested in picking up that tab. By 2028, when the Medicaid cuts start to kick in, we would be cost-shifting $4.2 billion per year to the state of Washington. That is not smart economics for us.

Over the weekend, I visited Virginia Mason Hospital in the northwest--again, a great success in delivery system reform. They implemented the Toyota model of production. There is, literally, faster turnaround time on lab reports and better expedience of nursing care. I think there was something like a 72-percent reduction in insurance liability costs. I mean, there are huge successes by changing and improving the delivery system that helps put pressure down on price. This is what we need to be talking about.

There is much innovation that was in the Affordable Care Act. We need to now ask the question: What further things do we need to do to make sure we drive down costs in the individual market as well? But with this Senate bill, you are not going to drive down price. There are reports now out by the Center on Budget and Policy Priorities last Friday that show the price will actually go up in the individual market if you cut people off of Medicaid. Basically, it will just increase by several thousand dollars the actual amount of money the people in the individual market will have to pay for insurance, so that clearly is not the solution.

I urge my colleagues on the other side of the aisle--I hope they come back and say that it is time to work in a discussion about these ideas in a broad way, not just another Hail Mary pass. Just get rid of this notion that cutting poor people off of Medicaid is somehow going to magically fix the individual market. It is not. I thank my colleagues from the Finance Committee who went through all of that.

Believe me; I am telling you, these discussions went on for weeks and weeks and weeks. Some people here are trying to come up with a score and get an answer in a week on this entire package. I think we debated, I would say, probably 2 or 3 weeks just on the notion of reforming-- getting off of fee-for-service and focusing on a value index and getting the priorities of the delivery system focused on better outcomes at lower costs. This is something that really should be a big priority in healthcare.

I remember we had private meetings. We had the head of CBO come down and talk to us. We had hearings. We probably spent 3 weeks just on one concept of how effective that would be in the healthcare delivery system.

I see we are still here. We are still talking. We are still willing to improve this delivery system and make sure people have better access to care, and I thank my colleagues for including me in this discussion today.

I want to again thank the Senator from Oregon, the ranking Democrat on the Finance Committee. I know he knows exactly what I am talking about when we talk about innovation. There is so much innovation he put into the Affordable Care Act, giving states discretion. They already have all the discretion they need; they have all the discretion they need to keep innovating.

Hopefully we will get our colleagues to follow suit because this is where we are going to deliver better care at lower costs and help improve the access for everybody in America.

I thank the Senator from Oregon.

Mr. President, I come to the floor to join my colleagues. We can see there are numerous colleagues on this side of the aisle who are speaking, just as my colleague from Vermont just did with great passion or my colleague from Massachusetts did with great passion and as I am sure my colleague from Minnesota will. We have all been home for the weekend talking to our constituents. We are all back here now with the CBO news, and we are here because we are very concerned about the next steps the Senate might take in this healthcare debate.

When I was at home, I heard some unbelievably positive stories about healthcare. I was at a hospital in our State, Virginia Mason, which has been one of the leaders in reducing healthcare costs by utilizing new efficiencies. They have improved the return time of getting lab results to patients by 85 percent; they have increased productivity in some areas by 90 percent; they have reduced liability insurance premiums by 76 percent. They have innovated. They have innovated. They have innovated. They talked about the direction healthcare should go, and not once did they mention cutting or capping Medicaid as a solution.

I also talked to a community health center which, under the Affordable Care Act, was actually able to expand in a community. They literally cut in half the uninsured, and they are delivering great adult dental access to thousands of people in a county that didn't have good access to dental care. They are making great progress.

I talked to a veteran who served our country, who literally got out and is now going to school but without the help of Medicaid would not have been able to cover her healthcare expenses.

I met a woman on the street who told me her husband had lost his job. She never thought they would be on Medicaid, but when he lost his job, they went on Medicaid, and they depended on that to provide healthcare for themselves and their children.

I met a gentleman who also said he, too, lost his job, and after that came down with a serious, life-threatening illness, and it was only Medicaid that saved him.

So what do we know today that is different than last Friday? We now have some CBO numbers. We know the numbers. We know the numbers: that 22 more million Americans, as a result of this bill, if it is passed, would be uninsured; 15 million of them on Medicaid; and $772 billion in Medicaid cuts. We know we thought it was heartless. Now we see the numbers that say cutting that many people off of Medicaid is, in my opinion, as my colleagues have also said, not something we should be pursuing as a nation. It leaves us to ask about not just the impact of this on individuals, as I just mentioned--because I believe there is a much better way to go with innovation--but what it also does for the individual market. A lot of this debate started because people thought the individual market hadn't seen some of the benefits of the employer- sponsored system. Well, why not talk about the individual market?

If 7 percent of the way people access health insurance, the individual market, was having a problem, why not talk about ideas to improve the individual market? Instead, we have a bill from the House and the Senate that beats up on the Medicaid population as if they are the culprit. If you want to improve Medicaid and delivery services and help decrease costs, let's do that. There are so many innovative ideas, but just cutting people off Medicaid to solve the individual market problem doesn't even make sense to me.

We now have, as of last Friday, too, the Center on Budget Policy and Priorities' assessment, talking about how this would raise individual premiums in the individual market. They gave some examples. For example, in West Virginia and Nevada, a 60-year-old with an income of $36,000 would pay respectively, $5,000 and $4,000 more than what

they are paying now. In Alaska, a 60-year-old making $45,000 would pay $5,777 more than what they are paying now for premiums. So the notion that this bill is driving down costs is just a fallacy.

We have heard from Republican and Democratic Governors talking about this. They sent us a letter saying the first thing we should do is focus on improving our Nation's private health insurance system. Where did the Governors ask that you come and beat up on Medicaid? They didn't say that. They didn't say: Please beat up on Medicaid, have a big party covering people on Medicaid as a partner with us for 65 years and then leave us stuck with the bill. They didn't say that. They say:

Medicaid provisions included in this bill are problematic.

Instead, we recommend Congress address factors we can all

agree need fixing.

That is a pretty clear message, I believe, from Republican Governors who are saying this is not the way to fix healthcare.

Also, last week, a nonpartisan study by the George Washington University found that the House-passed bill would have a huge economic impact on our country. States' economies would shrink by $93 billion, compared to what they would be without the bill. Business output would be cut $148 billion. The study notes that the bill, combined with normal economic cycles ``could contribute to a period of economic and medical hardship in the U.S.''

That report also talks about job loss throughout the country, saying that individual states would see more than $1 billion in lost gross State product, just because of the number of people who wouldn't be covered, the number of healthcare providers who would no longer be there, the loss of healthcare infrastructure and then the impact on the healthcare system overall for uncompensated care. These are costs we can't afford.

As my colleague Senator Sanders mentioned, there are all these healthcare organizations that have now come out saying they don't support this Senate-drafted bill. The Academy of Family Physicians knows about caring for the Medicaid population. They are seeing so many patients, and they know what this challenge is. The American Psychological Association doesn't support this bill. Other healthcare associations, such as the Catholic Health Association, do not support this bill. I have a long list.

Mr. President, I ask unanimous consent to have printed in the Record the list of healthcare-related organizations and others that don't support this legislation.

Mr. President, I hope my colleagues understand that there are those here who are very willing to talk about how we can improve our healthcare system, but we are not going to make poor Americans the scapegoat of our healthcare challenges.

A gentleman named Joe Baker, president of the Medicare Rights Center, I think, said it best. He said:

You or someone you love is going to need Medicaid. You may

not need the nursing home care . . . but you may rely on

community-based services, like home care, that will allow you

to stay in your home and out of a nursing facility. Medicaid

is the lifeline that covers many of the benefits that

Medicare does not provide.

Now why did I read that? Why did I pick a guy who is the head of a Medicare organization? Because he knows what his individual organization participants need in a healthcare delivery system. Everybody knows--everybody knows the people of America are living longer and as they age they need more healthcare. To our colleagues who want to reduce those costs, we are ready to come and talk about how we are going to reduce those costs.

I have talked about how I authored a community-based ``rebalancing'' program--the kind of rebalancing that helped our State save more than $2 billion. If we did that in every State, we would be saving billions of dollars, but the notion that we are going to proceed in the next 24 hours or so on a motion, after we have a CBO report that says this would have a devastating impact on millions of people with Medicaid, is not the right way to go.

Taking this out on the poor people of America who need Medicaid will make it worse for us as well. It will raise our rates, return the costs to where they were, and not help us solve this problem for the future. I hope our colleagues will understand that so many people are raising so many concerns about this. Yes, it is about economics, but there are also personal stories of people, such as our colleague from Hawaii who said: You never know. You never know when an individual situation is going to affect you, and you want to make sure there is healthcare to help you get through that crisis.

Thank you. I yield the floor.

Madam President, I thank my colleague from Maryland for articulating the issues in this discussion draft that has been released this morning.

As I hear him talk about these complex kids, how the cap is going to work, and when people are going to be affected, it reminds me of the book, ``The Smartest Guys in the Room.'' Right? Basically, people cook up schemes they think other people can't understand or the broader public will not catch on to in the hopes they can pass something. That is exactly what is going on here, a hoax and a scheme that is not cost- effective for the American taxpayer and will literally cut people off of access to healthcare, and literally, if the House bill was mean, this is doubling down on mean.

So I thank my colleague from Maryland for articulating the complex kids issue because these are concepts. If this is a discussion draft, I would hope my colleagues would come to the floor and discuss it-- discuss the concepts that are in this bill and debate them, but that is not what is happening. In fact, we know very little detail at this point in time because people are assessing the information and trying to read and assess in between the lines.

I can state what I know and have gleaned so far by the accounts, and that this is a continuation on the war on Medicaid. I say that because with regard to this war on Medicaid, we didn't know where the Senate would go in their proposal. We know what the House decided to do. The premise and structure of the House bill is to cut Medicaid by capping it and continually driving down the amount of Federal obligation to this program.

I will tell you, it is not even a smart idea. If you want to reform and deliver

better healthcare at a lower cost, there are many ways to do that and save dollars and give better patient care, but that is not what the House proposal is. It was a budget mechanism. I am not just saying that. I am talking to my healthcare providers at home, I am talking to university professors, people who know and understand healthcare and have studied it for a long time. What the House did and now the Senate is doubling down on is nothing but a budget mechanism to cut people off of healthcare--as my colleague said, the most vulnerable of our population.

It is a wrong-headed idea. It is not going to help us control costs. Medicaid reduces bankruptcy rates, helps people stay employed, and boosts our GDP. Why would we want a draconian idea like cutting Medicaid as the centerpiece of a budget proposal by our colleagues on the other side of the aisle? As people have said, because they want to take that revenue and give it away in tax breaks for the wealthy. I guarantee you that is not what we should be doing.

The access to Medicaid is so important. Our veterans access the healthcare system through Medicaid. Many of them receive care through the VA, but also they receive services through Medicaid. Veterans would be impacted and would lose care. Our children who are seen at hospitals, such as the Children's Hospital in Seattle, are Medicaid populations, and they would not have the resources to get access to care. Our institutions that are covering individuals at Medicaid rates would take a hit.

All the Senate proposal does is basically move that cap, but it is a steeper cap at a point in time that makes and exacerbates this problem of cutting people off of access to care. So if the House bill is mean, this is just doubling down on mean.

There is nothing about destructing this safety net that is so important to Americans that goes hand-in-hand with the philosophy about how to drive down costs to healthcare. If you think about it, if we came out here and had a discussion with 100 U.S. Senators and said a great way to drive down the cost of healthcare would be to cut people off of healthcare, most people would say that is not a smart idea because when people are cut off of healthcare, we know that uncompensated care exacerbates healthcare needs, challenges other parts of our system, and delivering care to them makes it more expensive. When we have had discussions and roundtables about the proposal that the House had put out, providers in my State told me point-blank, covering the Medicaid population has helped drive down and control the rate of insurance in the private markets. By saying we are going to cut Medicaid at a more drastic rate, we are going to just send a signal to the market that rates for the private insurers should go up.

I don't think that is what my constituents want. They want us to innovate. They want us to drive quality care and managed care into parts of the United States where it doesn't exist. They want us to take care of our most vulnerable population, and they want to make sure we are not delivering that off people who are going into the emergency room 50 times in a year because they don't have insurance.

We know the Medicaid rate is critically important. Medicaid costs up to one-quarter less than private insurance. It is a way to deliver care. We know measures we put into the Affordable Care Act, such as moving people off of nursing home care to community-based care, has saved Medicaid dollars. More States should do it.

We know plans such as bundling up the individual market into larger programs so they can have clout like others who work for a larger employer has also driven down costs. So those are the things we should be accelerating, not this notion that we move forward as a country by cutting the most vulnerable off of healthcare.

I ask my colleagues to come out and discuss this concept, discuss this idea, how it will affect the healthcare providers in their States. I plan to do that with my State. I hope they will come out here and tell us why it is a smart strategy to cut people off from Medicaid. I know no State that has the money to make up for the Federal share of Medicaid that is going to be doubled down in this bill.

I do not want to see a war on Medicaid. What I want to see is innovation. What I want to see is that covering people with some level of insurance basically helps save everybody on their insurance bills as well. I hope my colleagues will take this discussion draft and be proud to come out here and discuss it, but we have heard very little of that thus far.

Let's look at the real numbers, and I guarantee that we will hear from Governors, we will hear from States, we will hear from providers, we will hear from businesses, and we will hear from people who do not think this is a good idea.

Already there are comments from the National Association of Area Agencies on Aging: ``This strategy will also put . . . Medicaid [and] states [and consumers] on a fiscally precarious path.''

We have heard from other people that the Medicaid cap is up to twice as bad for States, will cause problems, and also from children's healthcare groups: ``Converting Medicaid into a per capita cap . . . would dismantle critical protections . . . to care for all enrollees.''

These aren't just partisan comments. These are the facts. What my colleagues don't realize is that by taking a huge chunk out of Medicaid, you are taking a huge chunk out of the safety net so many Americans depend on. It will not help us lower costs. It will exacerbate an escalation of rates for everyone in the market.

I thank the Presiding Officer, and I yield the floor.

Mr. President, I come to the floor tonight to join my colleagues to raise concern about a proposed Senate healthcare bill that might move through the U.S. Senate, as my colleagues are pointing out, without a hearing, without attention to details, actually almost in secret. I guess it would be secret--if we didn't know exactly what was in the House bill, it would be even more secret. People have said it is probably going to be 80 percent of what is in the House bill.

I can tell you, I agree with President Trump. That was a mean bill. So if it is just 80 percent mean, I guarantee it is still going to be mean.

I say that because I have been at home listening to my constituents, and they do not appreciate it one bit. If you are Harborview Medical Center and you are a public hospital and you are going to cut $627 million out of their budget because of your cap on Medicaid and you are going to leave a regional hospital without resources, they are mad.

If you are talking about children's hospitals and they see children who are on Medicaid and they are not going to be able to see those children or get coverage, they are mad.

Just Saturday I was with veterans in Vancouver, WA. People don't understand, but veterans of the United States of America do not get all of their healthcare coverage through the VA. They get it with Medicaid at individual clinics for services. I have met several of these people in my State, and they have told me point-blank, without access to Medicaid, they would not get the benefits they need as veterans of our country.

I think it is mean to break our promise to veterans and not give them access to Medicaid. I think this whole discussion is basically the fact that we are trying to box with these guys on a proposal. If their proposal is so great, they should come to the Senate floor and just-- don't even talk about the bill, talk about the principles.

I want to know, in the Republican proposal, what ideas do you have to lower costs, increase the quality of care, or improve access. Those are the milestones by which you should be debating healthcare.

Now, if your goal is to just cut Medicaid and cut people off Medicaid and cut their benefits so you can give tax breaks to the rich, OK, you might convince me that, yes, you have a proposal--because I think that is exactly what their proposal is--but if your proposal is about reducing costs, then come out here and debate it. Don't even tell me what is in the bill; just show up on the Senate floor and debate us and say: Here is our idea for reducing costs.

I will tell you what my idea of reducing costs is because I wrote it into the Affordable Care Act and some States are doing it and it was a good idea. It was called give the individual who doesn't work for a big employer the ability to negotiate with clout and be bundled up with other people. That is what they did for the working poor in New York. So 650,000 people in New York are now on something called the Basic Health Program. Why? Because they didn't work for an employer that could negotiate a big discount for them.

We asked, on our side of the aisle: Why would we let poor people just get thrown around in the market and not be able to drive a decent price? I call it the Costco model. So we said to them: We are going to let you be bundled up like the big employer is and you are going to be able to drive a decent price in the marketplace. That plan is giving a family, with $40,000 a year of income and four individuals in the family, a yearly annual premium of about $500 instead of $1,500 on the exchange.

So that is an idea. So come out here and discuss that or, if you want to tell me you have figured out a way to give better quality of care, I would love to hear that idea. I would love for you to come out and tell me how you are going to deliver better quality of care because I can tell you there are things in this bill that are about quality of care. They are about improving the way that organizations deliver care so they are rewarded for achieving better outcomes for patients.

The whole idea of accountable care organizations are that you put the patient at the center of the delivery system, and you reward them for doing a good job of delivering better outcomes. We have innovated. We have innovated in the Affordable Care Act. If you are talking about access, come out and tell us what proposal you have that is about increasing the access to healthcare. I would love to hear it because in the Affordable Care Act, we already did that too. We said: You know what. It is kind of crazy and expensive to think that everybody who ages, particularly in Medicaid, should spend time in a nursing home. Why? It is more expensive, and I don't think I have met one Washingtonian who told me they really wanted to go to a nursing home. They want to stay at home.

So we wrote into the Affordable Care Act incentives for States to change the delivery system, as we have done in the State of Washington, and deliver affordable care to people at home in their communities. By gosh, actually some States--Texas, Arizona, Indiana, other States--took us up on it. They said: What a great idea. We want to reduce costs.

So if that is such a great working aspect of the Affordable Care Act and you think it works and it increases access to care by giving people community-based care and reduces Medicaid costs, come out here and talk about it. Talk about what you want to do to put that program on steroids so more people in America can benefit from better access to care and not think they are going to spend their last days in a nursing home. That is what we should be debating. But we can't even see or hear or have a hearing about what this proposal is. Yet my colleagues can't even come out here and throw a concept on the table.

But the fact that you want to affect over 1 million veterans who have fought for our country and you are going to cut many of them off of the Medicaid care they deserve to have access to--that is a broken promise. It is just as broken a promise as what President Trump said. President Trump tweeted: I was the first and only GOP candidate to state that there will be no cuts to Social Security, Medicare, and Medicaid. So I am not surprised that he calls it a mean bill. But he should also own up that it cuts Medicaid.

We all have an office budget. I see my colleague from Virginia here. If we took our office budget and said: We are going to cut it and cap it, and next year it is going to be lower, and next year it is going to be lower, and next year--in perpetuity--that is what their idea is, it is to put a cap on Medicaid and cut it in perpetuity and basically cut it out of existence.

I don't know why they are beating up on Medicaid, because Medicaid has provided great stability to so many people in our country. It has lifted people out of poverty, provided healthcare, stabilized communities, and raised the economic standard of living in many communities in our country.

I received a letter from a superintendent from the Vancouver School District. He wrote to me about the devastating impacts that capping Medicaid would have on his students. He wrote:

Our school-based Medicaid programs serve as a lifeline to

children who can't access critical healthcare and services

outside of their school.

He goes on to say:

Restructuring Medicaid to a per capita cap system would

undermine Vancouver Public Schools' ability to provide

America's neediest children access to vital healthcare

[insurance].

So why would we do this?

I met a veteran, Kristina, who is 46 years old and a full-time student. She suffers from chronic and disabling injuries and needs a high level of care. The care she gets from Medicaid helps her access the medication that manages her chronic care and keeps her going,

and she is working toward that degree. Why would we cut somebody like that--a veteran--off of Medicaid just because someone's idea over here is to cap and reduce Medicaid?

These stories are from all over the country, and people are wondering: Why would you take this level of investment in Medicaid out of our entire economic system? Why would you impact our school districts, our regional hospitals, our veterans, our Medicaid population? Why would you affect a community that has a large Medicaid base?

And that is the way they serve them. Our hospitals have told us: We have stabilized private insurance premiums because more of the population is covered and has access to Medicaid.

You rip that back, and we will be back to skyrocketing costs, with people in the emergency room, no access to care other than that facility, with impacts on everybody on private insurance and on Medicaid. It is just not a good idea.

So I ask my colleagues, come out here. Don't say you want a patient- centered healthcare delivery system, because we are all for that, and we actually put things in the Affordable Care Act that did that and are working. If you want to make that claim, come out here and say what it is that you don't like about the patient-centered delivery system that we are working on promoting, and how you want to change it. If you say your proposal increases access to Americans, let's hear it, if it is about better quality. But I don't hear any of that. I just hear a drumbeat by some people who want to be heartless and cut people who have access to healthcare, people who are less fortunate in our society, because they want to cut Medicaid.

The President promised he wasn't going to do that. I ask my colleagues to live up to that, and let's start talking about the substance that truly will increase access, lower costs, and give better care to our constituents and the people of the United States of America.

Mr. President, I yield the floor.

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

Mr. President, this side of the Capitol is obviously sending our thoughts and prayers to colleagues in the House of Representatives--particularly, to Congressman Scalise--and to the other wounded law enforcement individuals and staff. Certainly, our hearts and prayers go out to those individuals too.

These men and women who protect us every day here in the Capitol do an outstanding job. We really want to make sure they understand how important it is and how much we appreciate their protection of us and the security they provide to everyone here in the Capitol.

(The remarks of Ms. Cantwell and Ms. Collins pertaining to the introduction of S. 1352 are printed in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Mr. President, I come to the floor this afternoon with my colleague from Maine to talk about an important issue, as well, something we had long planned to introduce today and did so this morning--the reintroduction of a Senate bill focusing on apprentice programs.

My colleague Senator Collins and I, in the past Congress, wanted to make sure people understood how important we thought the apprentice program was, and we introduced legislation then to create a Federal incentive for apprentice programs. We are coming back now in this Congress and reintroducing this legislation.

I know there has been a lot of talk about apprentices this week. We just had a roundtable discussion this morning with some of our business and labor leaders talking about the skills gap and the need for more apprentice investing as it relates to manufacturing. I know the President is doing some discussion of the apprentice program too. Obviously, it is no surprise to anybody in America that the President knows--or at least has used--the word ``apprentice'' in a pretty aggressive way throughout his career. So I hope he will tune in and listen to what my colleague from Maine and I have to say about this.

We are saying that it is time in America to have a Federal priority on apprentices; that is, the first-ever tax incentive for hiring an apprentice. Why do we want a Federal priority? Because we know that in America we need to skill and train a workforce for tomorrow, and so many people in America aren't training and aren't skilling for those jobs.

In the downturn of our economy, a lot of people lost faith. What should they invest their time and money in? There was so much transition in the economy that people weren't sure where they should skill themselves. As we see a transitioning economy now in various sectors, as they continue to modernize, and as technology continues to change, people also say to themselves: What should I skill myself in? What should I get trained in? Because they are not sure that, at the end of that period, they will be right there with what the job market wants. That is why apprenticeship is so important today.

By giving a Federal incentive for the apprentice program, we are saying: Hire and train. We are actually saying: The apprentice program is earning while you learn, and it will help so many Americans take that issue off the table where they weren't sure whether or how they should skill themselves. They actually are hired and trained on the job.

This is something we have known as a country for a long time. We know the apprentice program has worked. We have seen it across many sectors, in building trades and construction. We have seen it in other areas. In aviation, for example, in the Pacific Northwest, the Boeing Company has taken great advantage of the apprentice program. There are so many other sectors. The maritime sector has taken advantage of the apprentice programs. What we are saying today is that we need to make this a national priority in a more aggressive way. The Department of Labor and registered apprentice programs are part of what we make an investment in here in the Federal budget. But what we are not doing is putting it on steroids, and that is what we need to do now.

Our legislation would create enough incentives for 500,000 new apprentice program individuals over the next 10 years. We think this is critically important because we know how much the U.S. economy needs these skilled workers. According to the National Skills Coalition, 53 percent of U.S. jobs are middle-skilled, meaning that they require some postsecondary education. Yet only 43 percent of U.S. workers are trained at that level. According to the National Association of Manufacturers, 67 percent of their members report a shortage of available, qualified workers. We are going to need 3.5 million manufacturing jobs over the next decade, and this leaves us with a shortage of about 2 million.

So we need to give our businesses the skill levels they are looking for so they can be competitive, so they can meet their market needs, and so they can make profits and help grow our economy. We can't let them be deterred by the fact that they have the opening and they have the jobs, but they just don't have the skill level. By doing an incentive program, we can help get a national message out: The apprentice program is a key part of our economic strategy, and skilling a workforce for the jobs of today and tomorrow is the best recipe for growing our economy.

There has been an overall decline in employer-provided training over the last two decades. By making this investment now, we are going to help U.S. businesses with the investment that should be made and, further, as I said, expedite getting people into the programs we need to get them into. If we are going to be competitive and our businesses are going to compete in this global economy and they are going to continue to innovate, they need the workforce to do it.

I think about the chip fabrication industry. Before Intel came along, probably no one knew how to do chip fabrication. But there was a sector of our economy that taught and educated people on chip manufacturing. That will not be the last innovation our economy sees. In aerospace, we have been able to, with composite manufacturing, make lighter weight planes. That composite was a huge shift from the aluminum that dominated aerospace. But composite manufacturing is a whole new skill level in which we are still training and educating the workforce. We need to compete in that sector, which is so important to manufacturing jobs.

I would say that every aspect of our economy needs apprentices. But what does the apprentice get out of it? Not only do they get a job and they get to be skilled on the job, but they also earn more. Over the course of their career, a registered apprentice earns about $300,000 more than a non-apprentice working in the same field. A study done by our State Workforce Training and Education Coordinating Board found that completing apprentices earned $13,000 more per year just as they started.

So apprentices are a win-win for us and our economy. They give the employer the skills they are seeking to make their companies successful, and the individual worker gets trained and hired in a field that takes away this uncertainty about our economy, which has so plagued us over the last decade or two, and the community gets a more successful employment base and successful companies that add to the economy of a region and to our country.

I am so glad to be here with my colleague Senator Collins, who has

known that this apprentice program has been a success, and that is why she and I have partnered for years on this program. We hope now that by reintroducing it and getting more of our colleagues to join in, they, too, will talk about why apprentices are so important today.

We hope there is a guy down the street in the White House, who had a program called ``Apprentice,'' who takes seriously the bipartisan effort of two Senators who have been at this for a few years, and says: This is where we should be spending our money and making an investment to skill, educate, and employ Americans right now, for today.

I yield to my colleague from Maine.