Floor Statements

Mr. President, 30 years ago, Caribou, ME, served as the proving ground upon which America has built a nationwide system of community-based outpatient clinics that delivers much improved access to medical services for America's rural veterans. The anniversary celebration on September 7 recognizes the determined commitment of Cary Medical Center, the Department of Veterans Affairs, local veterans, and an entire community that transformed healthcare for the men and women who defend our Nation and our freedom.

Our Nation's first CBOC held its formal opening in Caribou, my hometown, on June 13, 1987. The impact was immediate--no longer would the veterans of Aroostook County have to endure an up-to 10-hour round trip to the nearest VA hospital for medical exams or to meet with a VA physician. Today the Caribou CBOC treats a veteran population of 3,500 men and women who served our country, with more than 9,000 care visits annually. The pioneering work done in Caribou led to benefits for America's 3.5 million rural veterans who now receive care closer to home at more than 950 CBOCs throughout the country.

The story of the great advancement in healthcare began 8 years before that formal opening, when seven Aroostook County veterans devoted themselves to the mission of improving access to critical healthcare services in this region. The original members of Aroostook County Veterans Medical Facility Research and Development, Inc.--Percy Thibeault, Meo Bosse, John Rowe, Ray Guerrette, Wesley Adams, Walter Corey, and Leonard Woods, Jr.--faced many obstacles along the way and overcame them all. These patriots exemplified a special quality of the American veteran: they continued to contribute long after their service in uniform was done.

That great mission would not have been accomplished without the dedication and expertise of Cary Medical Center and the involvement of Bill Flagg. As the American Hospital Association noted in its Award of Honor presentation in 2011, Cary Medical Center has made exemplary contributions in the critical area of veterans' healthcare and has established a national model. In addition to playing a vital role in establishing the VA's first CBOC in Caribou, Cary Medical Center was one of five pilot sites for the highly successful Access Received Closer to Home, or ARCH, program. Maine's program, led by Kris Doody and a tremendous team of professionals, has been called a standard bearer for how to provide

rural veterans access to the care they need in their communities. Before he became VA Secretary, I had the opportunity to join Dr. David Shulkin on a visit to both the Caribou CBOC and Cary Medical Center, where he praised the innovative work being done being done to provide veterans with top quality healthcare close to where they live. Veterans in Aroostook County and throughout America are grateful for Cary's leadership.

Our State has long history as a leader in working to expand and improve veterans' access to quality healthcare. One year ago, we celebrated the 150th anniversary of the very first national hospital for veterans: Togus, in Maine, which opened its doors in November of 1866. In 2014, we celebrated the opening of the women's clinic at Togus in recognition of the fact that more and more women serve our country in uniform.

I am determined to continue those early efforts on behalf of our rural veterans. The recent enactment of the VA Choice and Quality Employment Act of 2017, which I cosponsored with my Maine colleague Senator Angus King, is an important step toward keeping this obligation to our veterans, both urban and rural. As well as providing additional funding for healthcare access in the community, the legislation authorizes 28 leases for VA facilities across the country, including a much-needed CBOC in Portland. The result of this crucial legislation is increased access to quality care for all who have defended our freedom.

Maine is home to more than 125,000 veterans. To put that in perspective, Maine has more veterans per capita than all but two of the other States in the country. We are proud of our State's contributions to protecting our Nation and of Maine's impressive record in caring for our veterans.

President Abraham Lincoln signed the legislation establishing a national network of hospitals for Civil War veterans on March 3, 1865. The very next day, he concluded his second inaugural address with a commitment ``to bind up our nation's wounds, to care for him who shall have borne the battle. . . .''

We must uphold that commitment. Our veterans have sacrificed so much for our country. We owe them all that we can do to ensure they receive the best care possible. The veterans and grateful citizens who fought for the Caribou CBOC knew that, and, on this 30th anniversary, we honor their dedication by carrying on their work.

Thank you, Mr. President.

I rise in support of the Food and Drug Administration Reauthorization Act that we are now considering. Let me begin by commending Chairman Alexander and Ranking Member Murray of the Senate Health, Education, Labor, and Pensions Committee for their leadership in bringing this important legislation to the Senate floor. This bill is the product of bipartisan, bicameral work and is proof that we can make progress when we work together on the areas where we can find agreement.

FDA user fees, which are reauthorized under this bill, are critical to moving the most advanced research from a promise to a cure and ensuring that new treatments reach patients in need. User fees, where companies fund a portion of the premarket review of their products, account for more than one-quarter of all FDA funding. Yet the FDA's authority to collect these fees will expire at the end of next month unless Congress acts, thus the urgency of getting this bill across the finish line.

That is why it is imperative that we advance this bill now and ensure that work on these promising new pharmaceuticals continues uninterrupted.

In May, the HELP Committee, on which I am pleased to serve, overwhelmingly approved bipartisan legislation to extend and reauthorize the FDA fees in order to support the public health of our Nation. The bill before us also incorporates many provisions that were advanced by individual Committee Members. It is a great example of how a committee process should work. It was collaborative. We each brought ideas to the table, and during our markup, those ideas were offered as amendments and in many cases incorporated into the legislation.

I thank the chairman and the ranking member for including in this important legislation provisions that I authored with Senator Claire McCaskill. Those provisions seek to accelerate the review process for prescription drugs in cases where there is limited or no competition. Our purpose is to lower or at least moderate the escalating prescription drug prices that are one of the key cost drivers in our healthcare system today.

During the last Congress, our Senate Aging Committee, which I chair-- and at that time Senator McCaskill was the ranking member--had a bipartisan investigation into the causes, impacts, and potential solutions to the egregious price spikes for certain off-patent drugs for which there were no generic competitors.

Now, let me explain this situation a little more.

What we found was happening is that in cases in which the patent on the

original brand name pharmaceutical had expired, there were these companies that were not traditional pharmaceutical companies--they were not firms that had invested hundreds of millions in R&D in order to develop a new prescription drug. That is not what we are talking about. We are talking about these pharma companies--I call them hedge fund pharmas--that wait until the patent has expired, then buy the pharmaceutical drug and virtually overnight impose egregious price increases. One of the executives of these companies, when asked why he did so, answered simply ``because I can.''

Obviously, that has a very detrimental impact on patients, on healthcare providers, on insurers, and on Federal programs such as Medicaid and Medicare.

So building on our investigation, Senator McCaskill and I sponsored legislation, called the Making Pharmaceutical Markets More Competitive Act, to foster a more competitive generic marketplace and to improve access for affordable medicines. That is key. If we can have more competition in the prescription drug marketplace, that is what drives down costs, and that is what drives down prices. We know that from our experience when generic drugs come on the market.

The bill that we are considering today that is based on our legislation includes key provisions which were adopted unanimously as an amendment that I sponsored during the committee markup.

First, our provisions would require the FDA to prioritize the review of certain generic applications. It would set a clear timeframe of no more than 8 months for the FDA to act on such applications where there is inadequate generic competition. This would help to resolve situations in which there are drug shortages, as well as circumstances in which there are not more than three approved competitors on the market.

The Aging Committee's investigation into sudden price spikes found that older drugs with only one manufacturer and no generic competitor are particularly vulnerable to dramatic and sudden price increases.

One company that we investigated, Turing Pharmaceuticals, increased the price of a drug called Daraprim, which is a lifesaving drug for serious parasitic infections, from $13.50 a pill to $750 a pill--an increase of more than 5,000 percent--and they did so literally overnight. Now, keep in mind that this company, Turing Pharmaceuticals, had nothing to do with the costly research and development that brought about this lifesaving drug, known as Daraprim, but after they bought the drug--after the patent had expired and they saw that there was no generic competitor--they increased the price overnight by 5,000 percent. This price hike for a drug that has remained unchanged since 1953 is unacceptable and underscores the urgent need for legislation to prevent bad actors from taking advantage of a noncompetitive marketplace.

Second, the bill would improve communications between the FDA and the eligible sponsors prior to the submission of an application for the approval of a generic drug. That would improve the quality of applications from the beginning, increasing the chances of successful approval by the FDA.

Third, new reporting requirements would provide increased transparency into the backlog of applications for drug approvals and pending generic and priority review applications.

Fourth, this bill would provide the public with accurate information about drugs with limited competition. Drug manufacturers would be required to notify and provide rationale when removing a drug from the market, and the FDA would publish a list of off-patent brand name drugs that lack generic competitors, so that if you were a generic drug company, you would know that this would be an opportunity to develop a competitor drug.

I give the new FDA Commissioner a great deal of credit for his incorporating some of our provisions. He cares deeply about this issue.

Finally, this bill would streamline the regulatory process to address incidents in which the delayed re-inspection of manufacturing facilities becomes a barrier to generics entering the marketplace.

By taking these steps, we will enhance regulatory certainty for generic drug companies, help to prevent shortages, increase competition to lower prices and prevent monopolies, and deter practices that can lead to unjustifiable, exorbitant price hikes.

I am pleased that the legislation also includes another bill that resulted from our Aging Committee's investigation. This provision will help to prevent bad actors from receiving unwarranted vouchers under the Tropical Disease Voucher Program.

This program was intended to incentivize the development of medicines for neglected diseases, yet was exploited by the notorious Martin Shkreli, the founder of Turing. After spiking the price of Daraprim, he purchased another decades-old drug--one, once again, without a competitor--that is used to treat a life-threatening infection that is rare in the United States. Mr. Shkreli sought to use the Tropical Disease Voucher Program to gain exclusivity and hike the price for a drug that is not, in fact, a new drug.

Our legislation revises the program to better ensure that it achieves its intent, which is to spur the development of therapies that are truly new in order to treat and cure neglected diseases.

Drug companies should not be able to increase their prices dramatically by thousands of a percent overnight without any justification--without the development of modifications in the drug that improve its effectiveness, for example.

Our legislation will help to foster a much healthier and more competitive generic marketplace as the best defense against such exploitation. I am pleased that our bipartisan plan will increase generic competition, which is so important for American families and our seniors, particularly, who take a disproportionate number of the prescription drugs that are prescribed in this country.

Before closing, let me briefly mention another important provision in the bill before us, the Over-the-Counter Hearing Aid Act of 2017. Approximately 30 million Americans experience age-related hearing loss. Yet only about 14 percent of those with hearing loss use assistive hearing technology, often because they simply cannot afford the price of costly hearing aids.

We know from a hearing that we recently held in the Aging Committee that social isolation among our seniors can be exacerbated by hearing loss that is left untreated. That, in turn, increases that social isolation and increases the risk of serious mental and physical health outcomes. By making some types of hearing aids available over the counter, just as people buy readers to see with, which are over-the- counter eyeglasses, this legislation will help increase access to and lower the cost of the products for the consumers who need them.

The legislation we are considering today will help to bring lifesaving drugs to the marketplace and will ensure that the FDA continues to operate smoothly and, most importantly, that promising therapies make it to the American people.

Again, I commend Chairman Alexander and Ranking Member Murray for their leadership, and I encourage all of our colleagues to join me in supporting this important legislation.

Thank you.

I yield the floor.

Mr. President, Richard Dudman, one of our Nation's most esteemed journalists, passed away at his Maine home last night. I rise today in tribute to a great American reporter and engaged citizen.

After serving in the Merchant Marine and U.S. Navy Reserve during World War II, Mr. Dudman began his journalism career at the Denver Post in 1945 and joined the St. Louis Post-Dispatch 4 years later. In his more than three decades at the Post-Dispatch, he covered Fidel Castro's Cuban revolution, the assassination of President John F. Kennedy, the Bay of Pigs invasion, the Watergate and Iran-Contra scandals, as well as armed conflicts from the Middle East and Asia to Central and South America.

In 1970, while covering the Vietnam war, Mr. Dudman was captured by the Viet Cong and held prisoner in Cambodia, a harrowing experience he wrote about in his acclaimed book, ``Forty Days With the Enemy.'' In 1981, on his last day as Washington bureau chief for

the Post-Dispatch, he ran up Connecticut Avenue to cover the attempted assassination of President Ronald Reagan. For some of the most momentous events of the second half of the 20th Century, Richard Dudman wrote the first draft of history.

After retiring and moving to Ellsworth and Little Cranberry Island in Maine, Mr. Dudman continued to contribute to the Post-Dispatch and wrote more than 1,000 editorials for the Bangor Daily News. Among his many accolades are the prestigious George Polk Career Award in Journalism and induction into the Maine Press Association Hall of Fame.

Mr. Dudman combined his journalistic professionalism with a spirit of serving others. In 2014, he and his wife, Helen, were presented with the Golden Eagle Award from the Boy Scouts of America for their commitment to community service, a quality that ran through their remarkable 69 years of marriage.

In this time of sorrow, I offer my deep condolences to Helen and their family. I hope they will find comfort in Richard's inspiring legacy and in a life well-lived. It has been said that we all have a birth date and a death date, with a dash in between. It is what we do with our dash that counts. Richard Dudman's dash was extraordinarily long, and he made it count. He filled it with passion, professionalism, and dedication. May his memory inspire us all to do the same.

Madam President, I rise today to introduce legislation with my colleague from Montana, Senator Tester, that would extend an important program to fund Teaching Health Centers, which support the health and well-being of families in rural and medically underserved communities. I am pleased that Senators Cochran, Manchin, Daines, Harris, and Boozman, have joined us as cosponsors.

In the background of the health care debate, there is another crisis that looms. We are facing a severe shortage of doctors. By 2025, we will need more than 100,000 new primary care doctors to meet the growing demand for health care services across the Country. The shortage is especially critical in rural and underserved communities, which are often those that have been hit hardest by the opioid epidemic. The most significant shortages are in family medicine, general internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and dentistry.

These shortages have reached crisis levels in many places. In clinics and health centers in Aroostook County, Maine's northernmost county where I grew up, I hear stories about vacancies forcing Mainers to travel many miles simply to see a primary care doctor or dentist.

For the past six years, one program, the Teaching Health Centers Graduate Medical Education Program, has worked to fill these gaps. This program helps to train medical residents in community-based settings, including low-income, underserved rural and urban neighborhoods. For example, since 2011, the Penobscot Community Health Care Center has trained 31 residents and served more than 15,000 dental patients in Bangor, Maine.

We need to meet people in the communities in which they live and work. This program is training the next generation of physicians, and has produced real results. When compared with traditional Medicare graduate medical education residents, those who train at teaching health centers are significantly more likely to practice primary care and remain in underserved or rural communities. The numbers speak for themselves: 82 percent of Teaching Health Center, or THC, residents choose to practice primary care, compared to 23 percent of traditional Medicare Graduate Medical Education residents; and 55 percent of THC residents choose to remain in underserved communities, compared to 26 percent of traditional Medicare GME residents.

Teaching health centers are serving Americans from coast to coast. A total of 742 THC residents are serving in 27 states and the District of Columbia. The program is competitive, and trains the best of the best. For each residency position, THC programs receive more than 100 applications. In 2017, THC residents and faculty will provide more than one million primary care medical visits to underserved communities.

Teaching Health Centers have demonstrated a record of success, and it is imperative that we support them. Our legislation would reauthorize the Teaching Health Centers Graduate Medical Education Program for three years. It would also allow new programs to expand within existing centers and the creation of entirely new teaching health centers.

This bill is widely supported by leading community health and physician organizations, including the American Association of Teaching Health Centers, National Association of Community Health Centers, American Academy of Family Physicians, American Association of Colleges of Osteopathic Medicine, American Osteopathic Association, American Council of OB/GYNs, Society of Teachers of Family Medicine, and Council of Academic Family Medicine. We have also received letters of support from teaching health centers in Maine, Montana, Tennessee, Iowa, Oklahoma, North Carolina, California, Mississippi, Pennsylvania, Washington, Texas, Connecticut, New York, Illinois, Massachusetts, and Idaho.

In the face of nationwide physician shortages, our legislation would provide a solution for communities today and a path forward to train the physicians of tomorrow. I urge all of my colleagues to join in support of this important legislation, the Training the Next Generation of Primary Care Doctors Act of 2017.

Madam President, I ask unanimous consent that the letters be printed in the Record.

Madam President, I rise today to introduce legislation with my colleague from Montana, Senator Tester, that would extend an important program to fund Teaching Health Centers, which support the health and well-being of families in rural and medically underserved communities. I am pleased that Senators Cochran, Manchin, Daines, Harris, and Boozman, have joined us as cosponsors.

In the background of the health care debate, there is another crisis that looms. We are facing a severe shortage of doctors. By 2025, we will need more than 100,000 new primary care doctors to meet the growing demand for health care services across the Country. The shortage is especially critical in rural and underserved communities, which are often those that have been hit hardest by the opioid epidemic. The most significant shortages are in family medicine, general internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and dentistry.

These shortages have reached crisis levels in many places. In clinics and health centers in Aroostook County, Maine's northernmost county where I grew up, I hear stories about vacancies forcing Mainers to travel many miles simply to see a primary care doctor or dentist.

For the past six years, one program, the Teaching Health Centers Graduate Medical Education Program, has worked to fill these gaps. This program helps to train medical residents in community-based settings, including low-income, underserved rural and urban neighborhoods. For example, since 2011, the Penobscot Community Health Care Center has trained 31 residents and served more than 15,000 dental patients in Bangor, Maine.

We need to meet people in the communities in which they live and work. This program is training the next generation of physicians, and has produced real results. When compared with traditional Medicare graduate medical education residents, those who train at teaching health centers are significantly more likely to practice primary care and remain in underserved or rural communities. The numbers speak for themselves: 82 percent of Teaching Health Center, or THC, residents choose to practice primary care, compared to 23 percent of traditional Medicare Graduate Medical Education residents; and 55 percent of THC residents choose to remain in underserved communities, compared to 26 percent of traditional Medicare GME residents.

Teaching health centers are serving Americans from coast to coast. A total of 742 THC residents are serving in 27 states and the District of Columbia. The program is competitive, and trains the best of the best. For each residency position, THC programs receive more than 100 applications. In 2017, THC residents and faculty will provide more than one million primary care medical visits to underserved communities.

Teaching Health Centers have demonstrated a record of success, and it is imperative that we support them. Our legislation would reauthorize the Teaching Health Centers Graduate Medical Education Program for three years. It would also allow new programs to expand within existing centers and the creation of entirely new teaching health centers.

This bill is widely supported by leading community health and physician organizations, including the American Association of Teaching Health Centers, National Association of Community Health Centers, American Academy of Family Physicians, American Association of Colleges of Osteopathic Medicine, American Osteopathic Association, American Council of OB/GYNs, Society of Teachers of Family Medicine, and Council of Academic Family Medicine. We have also received letters of support from teaching health centers in Maine, Montana, Tennessee, Iowa, Oklahoma, North Carolina, California, Mississippi, Pennsylvania, Washington, Texas, Connecticut, New York, Illinois, Massachusetts, and Idaho.

In the face of nationwide physician shortages, our legislation would provide a solution for communities today and a path forward to train the physicians of tomorrow. I urge all of my colleagues to join in support of this important legislation, the Training the Next Generation of Primary Care Doctors Act of 2017.

Madam President, I ask unanimous consent that the letters be printed in the Record.

Mr. President, in 2001, Maine's legendary Ellsworth American newspaper celebrated its 150th year by launching a new enterprise, the Mount Desert Islander, dedicated to covering every aspect of life in a place of extraordinary beauty. It is a pleasure to congratulate the two outstanding journalists who have guided the Islander since its inception, publisher Alan Baker and editor Earl Brechlin, for being recognized with the 2017 Sunbeam Award from the Maine Seacoast Mission.

The recipient of numerous State and national awards for excellence, the Mount Desert Islander is a great example of the value provided by community newspapers. From Acadia National Park, local government, and businesses, to education, sports, and the arts, the Islander's dedicated staff writes the history of their communities as it occurs. They keep people informed and help them be more involved as citizens. They follow State and national issues, always with an eye on how they affect their neighbors.

This dedication starts with committed leadership. After achieving success in journalism and publishing in Philadelphia and New York City, Alan Baker returned home to Maine and, in 1986, joined the Ellsworth American's management team, eventually purchasing the newspaper. In this age of media consolidation, Mr. Baker strongly believes that newspapers should be owned by individuals who are in touch daily with the readers they serve. As a former member of the Maine State Legislature, he is an effective voice for accountability and transparency in all levels of government.

A former ``Maine Journalist of the Year,'' Earl Brechlin has covered Mount Desert Island for more than 35 years, and he has been recognized with more than 100 awards for news, feature writing, and photography. His commitment to journalism is evident in his election as president of both the Maine and New England press associations. A Registered Maine Guide, Mr. Brechlin is the author of nine books that reflect his love for our State's natural beauty, history, and character.

The Maine Seacoast Mission is a nondenominational, nonprofit organization founded in 1905 to support island and coastal communities in Downeast Maine, and its boat, the Sunbeam V, helps to connect people in those communities with essential services and with each other. Through their dedication to the craft of journalism, Alan Baker and Earl Brechlin have strengthened that support and those community connections, and the Sunbeam Award is a fitting recognition of their many contributions.

Mr. President, today I am pleased to be joined by my friend and colleague from Delaware, Senator Chris Coons, in introducing the Reach Every Mother and Child Act of 2017. Our legislation would make it the policy of the United States to lead an effort to end preventable deaths of mothers, newborns, and young children in the developing world by 2030.

Due in part to American leadership and generosity, many lives have already been saved. Since 1990, the annual number of deaths of children under the age of five has been cut in half. Nevertheless, far too many mothers, newborns, and young children under the age of five still succumb to disease and malnutrition that could easily be prevented, if only we could reach the mothers and children with simple, proven, cost- effective interventions that we know will help them survive.

Every day approximately 800 women will die from preventable causes related to pregnancy and childbirth. In addition, more than 16,000 children under the age of five will die each day of treatable conditions such as prematurity, pneumonia, and diarrhea--with malnutrition being the underlying cause in nearly half those deaths.

According to USAID, a concentrated effort could end preventable maternal and child deaths worldwide by the year 2030; however, U.S. leadership and support of the international community are critical to success.

To achieve this ambitious goal, our bill would require the implementation of a strategy to scale up the most effective interventions to save as many lives as possible. This idea is central to our bill. We do not have to guess at what interventions will work-- the reality is that more than 16,000 children under 5 years old die each day of conditions we know today how to treat.

These life-saving interventions include clean birthing practices, vaccines, nutritional supplements, hand-washing with soap, and other basic needs that remain elusive for far too many women and children in developing countries. This must change.

In addition, our bill would establish a Maternal and Child Survival Coordinator at USAID who would focus on implementing the ten-year strategy and verifying that the most effective interventions are being scaled up in target countries.

The bill would also establish an interagency working group to assist the Coordinator in promoting greater collaboration among all the federal agencies involved in this effort.

To promote transparency and greater accountability, our bill requires that detailed reporting be published on the Foreign Assistance Dashboard, where it can be assessed by the public, Congress, and non- governmental organizations to track the implementation of the strategy and the progress being made.

Finally, our bill would encourage USAID to pay for successful programs run by non-governmental entities. The message we want to send to all our partners in the private sector, the non-profit sector, the faith community, and in local and international civil society groups is this: if you can figure out a way to increase the likelihood that mothers and their children will survive childbirth and the first five years of life, we want to reward you for your contribution.

Improving the health and well-being of mothers and children around the world has far-reaching social and economic benefits as well. An independent group of economists and global health experts from around the world, known as the Lancet Commission, found that for every $1 invested in health initiatives in the developing world, there is a return of $9 to $20 in growing the gross domestic product of the country receiving the investment.

Other bipartisan initiatives, such as the successful President's Emergency Plan for AIDS Relief, or PEPFAR, which was started by President George W. Bush, demonstrate that results-driven interventions can turn the tide for global health challenges. Applying lessons learned from past initiatives, our bill would provide the focus and the tools necessary to accelerate progress toward ending preventable maternal and child deaths.

I urge my colleagues to join Senator Coons and me in supporting this bill to save the lives of mothers and children around the world.

Mr. President, today I am pleased to be joined by my friend and colleague from Delaware, Senator Chris Coons, in introducing the Reach Every Mother and Child Act of 2017. Our legislation would make it the policy of the United States to lead an effort to end preventable deaths of mothers, newborns, and young children in the developing world by 2030.

Due in part to American leadership and generosity, many lives have already been saved. Since 1990, the annual number of deaths of children under the age of five has been cut in half. Nevertheless, far too many mothers, newborns, and young children under the age of five still succumb to disease and malnutrition that could easily be prevented, if only we could reach the mothers and children with simple, proven, cost- effective interventions that we know will help them survive.

Every day approximately 800 women will die from preventable causes related to pregnancy and childbirth. In addition, more than 16,000 children under the age of five will die each day of treatable conditions such as prematurity, pneumonia, and diarrhea--with malnutrition being the underlying cause in nearly half those deaths.

According to USAID, a concentrated effort could end preventable maternal and child deaths worldwide by the year 2030; however, U.S. leadership and support of the international community are critical to success.

To achieve this ambitious goal, our bill would require the implementation of a strategy to scale up the most effective interventions to save as many lives as possible. This idea is central to our bill. We do not have to guess at what interventions will work-- the reality is that more than 16,000 children under 5 years old die each day of conditions we know today how to treat.

These life-saving interventions include clean birthing practices, vaccines, nutritional supplements, hand-washing with soap, and other basic needs that remain elusive for far too many women and children in developing countries. This must change.

In addition, our bill would establish a Maternal and Child Survival Coordinator at USAID who would focus on implementing the ten-year strategy and verifying that the most effective interventions are being scaled up in target countries.

The bill would also establish an interagency working group to assist the Coordinator in promoting greater collaboration among all the federal agencies involved in this effort.

To promote transparency and greater accountability, our bill requires that detailed reporting be published on the Foreign Assistance Dashboard, where it can be assessed by the public, Congress, and non- governmental organizations to track the implementation of the strategy and the progress being made.

Finally, our bill would encourage USAID to pay for successful programs run by non-governmental entities. The message we want to send to all our partners in the private sector, the non-profit sector, the faith community, and in local and international civil society groups is this: if you can figure out a way to increase the likelihood that mothers and their children will survive childbirth and the first five years of life, we want to reward you for your contribution.

Improving the health and well-being of mothers and children around the world has far-reaching social and economic benefits as well. An independent group of economists and global health experts from around the world, known as the Lancet Commission, found that for every $1 invested in health initiatives in the developing world, there is a return of $9 to $20 in growing the gross domestic product of the country receiving the investment.

Other bipartisan initiatives, such as the successful President's Emergency Plan for AIDS Relief, or PEPFAR, which was started by President George W. Bush, demonstrate that results-driven interventions can turn the tide for global health challenges. Applying lessons learned from past initiatives, our bill would provide the focus and the tools necessary to accelerate progress toward ending preventable maternal and child deaths.

I urge my colleagues to join Senator Coons and me in supporting this bill to save the lives of mothers and children around the world.

Mr. President, I rise to introduce a resolution supporting the goals and ideals of National Purple Heart Recognition Day. I am pleased to have been joined in sponsoring this resolution by the senior Senator from West Virginia, Senator Manchin, and 25 of our Senate colleagues.

The Purple Heart's history goes as far back as the founding of our Nation. General George Washington established what is now known as the Purple Heart Medal when he issued an order establishing the Military Badge of Merit on August 7, 1782. General Washington wished for the award to be used to recognize meritorious action performed by members of the Continental Army, and it took the form of a purple heart.

The Military Badge of Merit was discontinued after the Revolution and was not revived until 1932, when the Purple Heart medal was authorized as its official successor decoration. On February 22, 1932, the 200th Anniversary of the birth of George Washington, then-Army Chief of Staff General Douglas MacArthur resurrected the award, and it was redesignated as the Purple Heart. Quite appropriately, this reestablished Purple Heart Medal exhibits the bust and profile of George Washington.

It is around this time that the Purple Heart became synonymous with those unfortunate heroes who were killed or wounded in combat. Since 1932, the U.S. Military has awarded more than 1.8 million Purple Hearts.

Mr. President, just as the Purple Heart Medal has held a special meaning to its millions of recipients and their families, it also has special significance to my family. My father is a World War II veteran who was wounded twice during the Battle of the Bulge in Europe. He earned two Purple Hearts and the Bronze Star, and it was from him that I first learned to honor and respect our veterans.

The Purple Heart is a reminder that freedom is a gift purchased at the greatest possible price, and it is for that reason that I introduce this resolution. It is vitally important for all Americans to learn the history of this important military award, and understand and honor the sacrifices of the many men and women in uniform who have earned the Purple Heart. I am grateful to all of my colleagues who joined me in supporting this resolution.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

There being no objection: the text of the bill was ordered to be

Mr. President, few issues are as important or personal to the American people as healthcare, which is why this debate has been so fervent and ignites such passion.

On the one hand, the Affordable Care Act, ACA, has allowed millions of individuals and families to obtain health insurance for the first time. It has also brought important patient protections like those for people with preexisting conditions and prohibitions on annual and lifetime limits on insurance payments for needed care.

On the other hand, too many Americans face skyrocketing premiums and unaffordable deductibles coupled with mandates that give them few, if any, choices. Some insurance plans have become so restrictive that families find they can no longer go to the doctor or hospital of their choice. In addition, the ACA's employer mandate discourages businesses from creating jobs or giving their workers more hours, while its tax credits and subsidies are designed so poorly as to cause ``wage lock''--``where working harder to get ahead can instead make some Americans fall further behind.''

Despite President Obama's campaign promise that his health plan ``would save the average family $2,500 on their premiums'' per year, the opposite has happened as premiums are increasing in nearly every State, with an average increase of 25 percent nationally last year. Today, despite the implementation of the ACA, 28 million Americans remain uninsured.

These problems require a bipartisan solution. The Democrats made a big mistake when they passed the ACA without a single Republican vote. I don't want to see Republicans make the same mistake.

Earlier this week, I voted against proceeding to healthcare reform legislation--the American Health Care Act of 2017--that passed the House of Representatives last May without a single Democratic vote. For many Americans, this bill could actually make the situation worse. Among other things, the bill would make sweeping changes to the Medicaid Program--an important safety net that for more than 50 years has helped poor and disabled individuals, including children and low- income seniors, receive health care. The nonpartisan Congressional Budget Office, CBO, projects that the number of uninsured Americans would climb by 23 million under this bill.

Senate leaders, recognizing that the House bill did not have sufficient support, advanced their own substitute proposal that would make similar structural changes to the Medicaid program, as well as many other changes. CBO estimates that this plan would reduce the number of people with insurance by 22 million, cause premiums and other out-of-pocket costs to soar for Americans nearing retirement, and shift billions of dollars of costs to State governments. It also would undermine the financial stability of rural hospitals and long-term care facilities and likely lead to the loss of important consumer protections for many Americans, while doing virtually nothing to address the underlying problem of escalating healthcare costs. Earlier this week, this body struck down that proposal by a vote of 43 to 57.

A separate proposal that would simply repeal the ACA without a replacement also failed, by a vote of 45 to 55. That legislation, according to CBO, would result in 32 million people losing their insurance, bringing the total number of uninsured Americans to 60 million a decade from now. Clearly, that is going in the wrong direction.

In a final effort to reach consensus, Republican leaders have pieced together a plan that would repeal key portions of the ACA while punting on many of the more difficult questions. While I support many of the components of this plan, this approach will not provide the market stability and premium relief that is needed. In fact, a bipartisan group of Governors wrote Senate leaders this week, urging rejection of this so-called skinny plan, which they say ``is expected to accelerate health plans leaving the individual market, increase premiums, and result in fewer Americans having access to coverage.''

I ask unanimous consent that the letter be printed in the Record following my remarks.

Also included in all of these plans is a misguided proposal that would block Federal funds, including Medicaid reimbursements, from going to Planned Parenthood. Millions of women across the country rely on Planned Parenthood for family planning, cancer screening, and basic preventive healthcare services. Denying women access to Planned Parenthood not only runs contrary to our goal of letting patients choose the healthcare provider who best fits their needs, but it also could impede timely access to care.

If Planned Parenthood were defunded, other family planning clinics in Maine, including community health centers, would see a 63 percent increase in their patient load. Some patients would need to drive greater distances to receive care, while others would have to wait longer for an appointment,

Let me be clear that this is not about abortion. Federal law already prohibits the use of Federal funds to pay for abortion except in cases of rape, incest, or when the life of the mother is at risk.

This is about interfering with the ability of a woman to choose the healthcare provider who is right for her. This harmful provision should have no place in legislation that purports to be about restoring patient choices and freedom.

We need to reconsider our approach. The ACA is flawed and in portions of the country is near collapse. Rather

than engaging in partisan exercises, Republicans and Democrats should work together to address these very serious problems. In their letter to Senate leaders, the bipartisan group of Governors correctly notes that, ``True, lasting reforms can only be achieved in an open, bipartisan fashion.''

Healthcare is extraordinarily complex, and we must work together systematically in order to ``do no harm'' and improve our healthcare system. In developing legislation, our focus should be on the impact on people, premiums, and providers.

We are dealing with an issue that affects millions of Americans and one sixth of our economy, and we need to approach reforms in a very careful way. That means going through the regular process of committee hearings; receiving input from expert witnesses such as actuaries, Governors, advocacy groups, and healthcare providers; and vetting proposals with our colleagues on both sides of the aisle. It needs to be a much more deliberative process, and I am pleased that Chairman Alexander has expressed a willingness to begin hearings in the Senate Health Committee.

Neither party has a monopoly on good ideas, and we must work together to put together a bipartisan bill that fixes the flaws in the ACA and works for all Americans.

Mr. President, I am pleased to introduce, along with the senior Senator from California, Senator Feinstein, the Smithsonian American Women's History Museum Act. This bill would establish an American women's history museum in our Nation's capital.

Mr. President, I am pleased to introduce, along with the senior Senator from California, Senator Feinstein, the Smithsonian American Women's History Museum Act. This bill would establish an American women's history museum in our Nation's capital.

Mr. President, I am pleased to join my colleague from North Dakota, Senator Heitkamp, in sponsoring the School Food Modernization Act to assist schools in providing healthier meals to students throughout the country.

School meals play a vital role in the lives of our young people. More than 30 million children participate in the National School Lunch Program every school day and more than 14 million eat school breakfasts, with participation rising steadily in Maine and nationwide. In Maine, 48 percent of children qualify for free or reduced-price meals based on household income.

Moreover, the food served at schools affects children's health and well-being. Many children consume up to half their daily caloric intake at school and some get their most nutritious meal of the day at school instead of at home. At the same time, too many of our children are at risk of serious disease, which may have a lifelong effect on their health as they grow to adulthood.

In response to these health concerns, our schools have stepped up. For example, in the New Sweden Consolidated School in Aroostook County, Maine, food service manager Melanie Lagasse prepares meals from scratch instead of opening cans or pushing a defrost button. The school's 64 students, aged preschool to 8th grade, have grown to relish the chicken stew, baked fish, and meatloaf that she makes fresh.

Many schools, however, lack the right tools for preparing meals rich in fresh ingredients. Schools built decades ago often lack the equipment and infrastructure necessary to do more than reheat and serve one or two meal options each day.

To serve healthier meals, 99 percent of Maine school districts need to acquire at least one piece of equipment and almost 50 percent of districts need kitchen infrastructure upgrades. The median equipment need per school alone is $45,000. Making the required changes to infrastructure is even more costly, with 41 percent of schools needing more physical space, 22 percent more electrical capacity, 21 percent more plumbing capacity, and 19 percent more ventilation.

It is estimated that $58.8 million would be necessary just in Maine for the equipment and infrastructure upgrades needed to serve healthy meals to all of our students. That far exceeds the $89,000 in grants that the U.S. Department of Agriculture awarded Maine last fiscal year. Maine is not alone. In a recent survey of school nutrition directors, the most frequently cited financial concern was equipment costs, ranking higher than even labor and food costs.

The School Food Modernization Act seeks to help food service personnel offer a wide variety of nutritious and appealing meals and snacks to all students. First, the bill would establish a loan guarantee assistance program within USDA to help schools acquire new equipment to prepare and serve healthier meals. Second, it would provide targeted grant assistance to provide the seed funding needed to upgrade kitchen infrastructure or to purchase high-quality equipment such as commercial ovens, steamers, and stoves. Finally, to aid school food service personnel in running successful, healthy programs, the legislation would authorize USDA to provide support on a competitive basis to highly qualified third-party trainers to develop and administer training and technical assistance, including online programs

Senator Heitkamp and I appreciate that provisions of this legislation were incorporated into the Child Nutrition Reauthorization legislation that was passed out of the Agriculture Committee last Congress. We encourage our colleagues to continue to support school kitchen equipment needs as the reauthorization process continues.

Mr. President, if our school children are going to be able to learn and compete, they need to be healthy and their minds and bodies fully nourished. This bill would help us achieve that goal.

Mr. President, I am pleased to join my colleague from North Dakota, Senator Heitkamp, in sponsoring the School Food Modernization Act to assist schools in providing healthier meals to students throughout the country.

School meals play a vital role in the lives of our young people. More than 30 million children participate in the National School Lunch Program every school day and more than 14 million eat school breakfasts, with participation rising steadily in Maine and nationwide. In Maine, 48 percent of children qualify for free or reduced-price meals based on household income.

Moreover, the food served at schools affects children's health and well-being. Many children consume up to half their daily caloric intake at school and some get their most nutritious meal of the day at school instead of at home. At the same time, too many of our children are at risk of serious disease, which may have a lifelong effect on their health as they grow to adulthood.

In response to these health concerns, our schools have stepped up. For example, in the New Sweden Consolidated School in Aroostook County, Maine, food service manager Melanie Lagasse prepares meals from scratch instead of opening cans or pushing a defrost button. The school's 64 students, aged preschool to 8th grade, have grown to relish the chicken stew, baked fish, and meatloaf that she makes fresh.

Many schools, however, lack the right tools for preparing meals rich in fresh ingredients. Schools built decades ago often lack the equipment and infrastructure necessary to do more than reheat and serve one or two meal options each day.

To serve healthier meals, 99 percent of Maine school districts need to acquire at least one piece of equipment and almost 50 percent of districts need kitchen infrastructure upgrades. The median equipment need per school alone is $45,000. Making the required changes to infrastructure is even more costly, with 41 percent of schools needing more physical space, 22 percent more electrical capacity, 21 percent more plumbing capacity, and 19 percent more ventilation.

It is estimated that $58.8 million would be necessary just in Maine for the equipment and infrastructure upgrades needed to serve healthy meals to all of our students. That far exceeds the $89,000 in grants that the U.S. Department of Agriculture awarded Maine last fiscal year. Maine is not alone. In a recent survey of school nutrition directors, the most frequently cited financial concern was equipment costs, ranking higher than even labor and food costs.

The School Food Modernization Act seeks to help food service personnel offer a wide variety of nutritious and appealing meals and snacks to all students. First, the bill would establish a loan guarantee assistance program within USDA to help schools acquire new equipment to prepare and serve healthier meals. Second, it would provide targeted grant assistance to provide the seed funding needed to upgrade kitchen infrastructure or to purchase high-quality equipment such as commercial ovens, steamers, and stoves. Finally, to aid school food service personnel in running successful, healthy programs, the legislation would authorize USDA to provide support on a competitive basis to highly qualified third-party trainers to develop and administer training and technical assistance, including online programs

Senator Heitkamp and I appreciate that provisions of this legislation were incorporated into the Child Nutrition Reauthorization legislation that was passed out of the Agriculture Committee last Congress. We encourage our colleagues to continue to support school kitchen equipment needs as the reauthorization process continues.

Mr. President, if our school children are going to be able to learn and compete, they need to be healthy and their minds and bodies fully nourished. This bill would help us achieve that goal.

Mr. President, ensuring that more Americans are better prepared financially for their retirement is one of my top priorities.

That is why I rise to reintroduce with my colleague, Senator Nelson, the Retirement Security Act of 2017. Our bill would encourage more small employers to offer retirement plans, provide incentives for employees to save more for retirement, and make it easier for low- and middle-income taxpayers to claim tax benefits for retirement savings already authorized in law.

According to the non-partisan Center for Retirement Research, there is an estimated $7.7 trillion gap between the savings American households need to maintain their standard of living in retirement and what they actually have. A recent Gallup poll found that only 54 percent of working Americans believe that they will have enough money to live comfortably in retirement. We must continue to work to ensure that more Americans will have the resources they need to enjoy their ``golden years.''

The Social Security Administration's most recent report noted that 61 percent of all beneficiaries rely on Social Security for more than half of their income. Many seniors in my State rely almost entirely on Social Security to cover their monthly expenses, despite the fact that the average annual benefit is only about $16,000 per year. It is hard to imagine stretching those dollars far enough to pay the bills-- certainly a ``comfortable retirement'' is out of the question.

Sadly, they fare no better when it comes to savings: a survey by the Federal Reserve found that nearly half of individuals do not have enough savings to cover an emergency expense of $400. That is not even enough to buy new tires for a car. For this reason, among others, Americans need to increase their personal savings so that we can better weather financial emergencies without raiding our retirement accounts.

There are many reasons why Americans have struggled to save for retirement, including the shift away from employer-based ``defined benefit'' plans, or pensions; the severity of the recent financial crisis; rising health care costs; the need for expensive long-term care; and most of all, the fact that Americans are living far longer than they did in the past. Many Americans reaching retirement age also have more debt than retirees of previous generations.

Another contributing factor is that employees of small businesses are much less likely to participate in employer-based retirement plans. According to a study by the PEW Charitable Trusts, more than 30 million U.S. workers lack access to a work-based plan to save for retirement.

Making it easier for smaller businesses to offer retirement plans for their workers would make a significant difference in the financial security of many Americans. That is why the bill we are introducing today focuses on reducing the cost and complexity of retirement plans, especially for small businesses, and on encouraging individuals to save more for retirement. Let me describe the provisions of the bill:

First, our bill would make it easier for businesses to enter into multiple employer plans, known as MEPs, to offer retirement programs to their employees. MEPs permit small companies to share the administrative burden of a retirement plan, which helps lower costs. Current law discourages the use of MEPs because it requires a connection, or ``nexus,'' between unrelated businesses in order to join a MEP, such as membership in the same trade association. Our bill would waive the nexus requirement for businesses.

Second, our bill makes joining a MEP a more attractive option for small businesses. Under current law, if one employer in a MEP fails to meet the minimum criteria necessary for retirement plans to obtain tax benefits, all employers and their employees could lose these tax benefits--which are substantial. For employees, benefits include delaying the taxation of income contributed to a plan until funds are

withdrawn. For employers, plan disqualification could result in limited deductions and a higher tax burden. Our bill would address this uncertainty, and protect members of a MEP from the failure of one bad apple to meet its obligations.

Third, our bill would reduce the cost of maintaining a retirement plan. Current law requires that participants in a retirement plan receive a variety of notices. Our bill would direct Treasury to simplify, clarify, and consolidate these required notices to lessen costs.

Fourth, the Retirement Security Act would encourage those still in the workforce to save more for retirement. Retirement plans are often designed to comply with existing safe harbors to prevent the IRS from challenging the tax benefits that flow to employees and employers. The existing safe harbor for so-called ``automatic enrollment'' plans effectively caps employee contributions at ten percent of annual pay, with the employer contributing a ``matching'' amount of up to six percent. Our bill would create an additional safe harbor for these plans that would allow employees to receive an employer match on contributions of up to ten percent of their pay. Employees would be able to contribute more than ten percent, albeit without an employer match for contributions above ten percent.

I recognize that businesses that choose to adopt a plan with this new optional safe harbor may face additional costs due to the increased employer match. That is why our bill would also help the smallest businesses--those with fewer than 100 employees--offset this cost by providing a new tax credit equal to the increased match.

I should note that the new retirement plan options for businesses included in our bill are just that--options. No business, large or small, would be required to offer its employees a retirement plan under the Retirement Security Act.

Finally, our bill would ensure that current measures to encourage savings are functioning as they were intended. One such measure is the so-called ``saver's credit,'' which reduces the tax burden on low- and middle-income individuals who contribute to retirement plans, including IRAs and 401(k) plans. Yet the credit cannot be claimed on a Form 1040EZ, which is frequently used by these individuals. A 2013 Transamerica Center for Retirement Studies survey found that only 23 percent of people with household incomes of less than $50,000 per year, the group most likely to qualify, were aware of the saver's credit. To address this, our bill directs Treasury to make the credit available on Form 1040 EZ.

Mr. President, during my time as chairman of the Senate Aging Committee, I have heard countless stories of retirees whose savings did not go as far as they anticipated. Adequate savings reduce poverty among our seniors. As the HELP Committee noted in a July 2012 report, poverty among our seniors also increases Medicare and Medicaid costs and strains our social safety net. Giving those not yet at retirement age more opportunities to save, and to save more, would help ease this additional burden on entitlement programs that already are projected to be unsustainable.

In light of the positive effects this bill would have in strengthening retirement security for millions of Americans, I urge my colleagues to join Senator Nelson and me in supporting the Retirement Security Act of 2017.

Thank you, Mr. President.