Floor Statements

Mr. President, after careful consideration, I have decided to oppose the confirmation of Scott Pruitt, the nominee for Administrator of the Environmental Protection Agency, EPA. I have met at length with Mr. Pruitt, who is an accomplished attorney with considerable knowledge about environmental laws. We discussed many important environmental issues about which I care deeply--from EPA's enforcement of landmark environmental laws, including the Clean Air Act and the Clean Water Act, to climate change and the Clean Power Plan, to protections from harmful pollutants such as lead and mercury. I also have reviewed testimony from his confirmation hearing.

In keeping with my past practice, regardless of which party is in the White House, I will vote for cloture on his nomination so that every Senator can have a clear, up-or-down vote on this important nomination of a member of the President's Cabinet. But I will vote no on Mr. Pruitt's confirmation.

The fact is Mr. Pruitt and I have fundamentally different views of the role and mission of the EPA. That does not mean that I agree with every regulatory action that EPA has taken. At times, the Agency has been difficult to work with and unresponsive to bipartisan congressional concerns, but the EPA plays a vital role in implementing and enforcing landmark laws that protect not only our environment but also public health.

Specifically, I have significant concerns that Mr. Pruitt has actively opposed and sued EPA on numerous issues that are of great importance to the State of Maine, including mercury controls for coal- fired power plants and efforts to reduce cross-State air pollution and greenhouse gas emissions. His actions leave me with considerable doubts about whether his vision for the EPA is consistent with the Agency's critical mission to protect human health and the environment.

The State of Maine, located at the end of our Nation's ``air pollution tailpipe,'' is on the receiving end of pollution generated by coal-fired power plants in other States. Reducing harmful air pollutants is critical for public health, particularly for Maine, which has among the highest rates of asthma in the country. Controls for mercury, one of the most persistent and dangerous pollutants, are especially important for children and pregnant women. Moreover, there is no doubt that the greenhouse gas emissions driving climate change pose a significant threat to our State's economy and our natural resources, from our working forests, fishing, and agricultural industries, to tourism and recreation.

The opposition to the nominee expressed by Friends of Acadia is grounded in concerns about the importance of emissions reductions for lessening the impacts of climate change that affect this gem of a national park. The changes we are already seeing in the aquatic life in Casco Bay and the Gulf of Maine, for example, are cause for alarm. The incidence of Lyme disease in northern Maine and high asthma rates throughout the State are also linked to environmental changes that threaten the health and well-being of too many Maine people.

These are among the reasons why I have voted to uphold the EPA rule governing mercury and air toxics standards from coal-fired power plants and the cross-State air pollution rule, as well as the Clean Power Plan to limit carbon pollution from existing and new fossil fuel-fired power plants.

I reject the false choice of pitting the environment against the economy because, for much of the State of Maine, the economy and the environment are inextricably linked. A strong commitment to protecting the health of our Nation's environment is critical for protecting Maine's natural beauty, the State's economy, and the health of those of us fortunate enough to call Maine home.

Due to my concerns about Mr. Pruitt's commitment to the mission of the EPA, I will cast my vote in opposition to his confirmation.

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

Mr. President, I rise to express my strong support for the nomination of Dr. David Shulkin to be the next Secretary of Veterans Affairs. I believe his impressive record of service in both the public and private health care sectors as well as his firm grasp of VA health care issues make him extraordinarily well qualified to lead the Department through the coming period of major reforms and continuing transformation.

Dr. Shulkin has served in numerous executive roles at hospitals across the country, including Beth Israel Medical Center in New York City, the University of Pennsylvania Health System, and the Atlantic Rehabilitation Institute. In fact, he has been named one of the top 100 Physician Leaders of Hospitals and Health Systems and one of the 50 Most Influential Physician Executives in the country.

In 2015, Dr. Shulkin brought his extensive experience in the private sector to the Department of Veterans Affairs and served as the VA Under Secretary for Health. Last year, I had the opportunity to host Dr. Shulkin in my hometown of Caribou, ME, as he toured the community-based outpatient clinic and our local hospital, Cary Medical Center, to see the innovative work being done there to provide veterans with top- quality health care closer to where they live.

Cary Medical Center partners with the VA through the Access Received Closer to Home or ARCH Program to provide veterans in Northern Maine with high-quality care, including specialty care close to home and close to their families, rather than forcing them to drive 250 or more miles to receive their care at the Togus VA Medical Center in Augusta, the location of Maine's only VA hospital.

This partnership between Cary Medical Center and the VA has been a huge success, with an approval rating from our veterans exceeding 90 percent. Last spring, when we were faced with the potential expiration of the ARCH Program, Dr. Shulkin, at my invitation, came to Maine and announced his commitment to ensure that veterans using this innovative program in our State would maintain seamless community care. He has kept his word.

During his visit to Maine, Dr. Shulkin also toured the Togus VA Medical Center, the oldest VA facility in the Nation and the community- based outpatient clinic in Bangor. I would note that he drove the 4 hours from Augusta, where the VA hospital is located, to Caribou to get a better sense of the distances in our State. Right now, when we are in the midst of a fierce blizzard, you can imagine how important it is for veterans in need of care to be able to access that care close to home in an emergency.

I was truly impressed, and remain truly impressed, with Dr. Shulkin's understanding of the needs of rural veterans and the challenges of providing health care in rural settings. While in Maine, Dr. Shulkin listened to veterans health care providers, VSO advocates, and the VA staff alike to ensure that our veterans received the care they

have earned through their service to our Nation.

In fact, he remained in Caribou and had a town meeting in which he heard from people representing a variety of views but all of whom encouraged him to continue this wonderful program. Dr. Shulkin's nomination to be VA Secretary has drawn support from our veterans service organizations throughout the country, including the American Legion, the VFW, the Disabled American Veterans, the Paralyzed Veterans of America, AMVETS, and the Vietnam Veterans of America.

That does not surprise me because he has demonstrated, in very concrete ways, his commitment to the veterans we are serving. At a time when bipartisan consensus, unfortunately, has been all too rare in this Chamber, Dr. Shulkin's nomination has been one of the few areas where Republicans and Democrats have found common ground. His nomination was approved unanimously by the Senate Veterans' Affairs Committee.

During this time, when crucial reforms and organizational changes are necessary to ensure consistent, high-quality care for our Nation's veterans, it is critical that the VA have a talented, experienced, and committed leader to spearhead the Department's transformation as we seek to improve the quality and timeliness of health care for our veterans.

Dr. Shulkin is an excellent nominee and I urge all of my colleagues to support his confirmation.

Seeing no one seeking recognition, I suggest the absent of a quorum.

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

Madam President, I come to the floor to announce a very difficult decision that I have made; that is, to vote against the confirmation of Betsy DeVos to be our Nation's next Secretary of Education. This is not a decision that I have made lightly. I have a great deal of respect for Mrs. DeVos. I believe she is a good person. I know she cares deeply about the children of this Nation. But for the reasons that I will explain, I simply cannot support her confirmation.

Later today, the Senate will vote on a motion to proceed to the DeVos nomination. I will vote to proceed to the nomination because I believe that Presidents are entitled to considerable deference for the selection of Cabinet members, regardless of which political party is in power, and that each and every Senator should have the right to cast his or her vote on nominees for the Cabinet. That is why, during President Obama's administration, I voted for procedural motions, including cloture, to allow the President's nominees for Secretary of Defense and for Secretary of Labor to receive up-or-down votes by the full Senate, even though I ultimately voted against those two nominees on the Senate floor. At the time, I stated that it is appropriate for every Senator to have an opportunity to vote for or against an individual Cabinet member, and I still believe that is the right approach.

Let me again make clear what I said at the beginning of my remarks, which explains why this has been a decision that I have not made lightly. I know that Mrs. DeVos cares deeply about children. I recognize that she has devoted much time and resources to try to improve the education of at-risk children in cities whose public schools have failed them. I commend her for those efforts.

I wrote to Mrs. DeVos, seeking her assurances in writing that she would not support any Federal legislation mandating that States adopt vouchers nor would she condition Federal funding on the presence of voucher programs in States. She has provided that commitment, and I ask unanimous consent that the exchange of correspondence with Mrs. DeVos be printed in the Record at the conclusion of my statement.

Nevertheless, like all of us, Mrs. DeVos is the product of her experience. She appears to view education through the lens of her experience in promoting alternatives to public education in Detroit and other cities where she has, no doubt, done valuable work. Her concentration on charter schools and vouchers, however, raises the question about whether she fully appreciates that the Secretary of Education's primary focus must be on helping States and communities, parents, teachers, school board members, and administrators strengthen our public schools.

While it is unrealistic and unfair to expect a nominee to know the details

of all the programs under the jurisdiction of the Department of Education, I am troubled and surprised by Mrs. DeVos's apparent lack of familiarity with the landmark 1975 law, the Individuals with Disabilities Education Act--known as the IDEA--that guarantees a free and appropriate education to children with special needs.

The mission of the Department of Education is broad, but supporting public education is at its core. I am concerned that Mrs. DeVos's lack of experience with public schools will make it difficult for her to fully understand, identify, and assist with those challenges, particularly for our rural schools in States like Maine.

In keeping with my past practice, I will vote today to proceed to debate on Mrs. DeVos's nomination. But I will not, I cannot, vote to confirm her as our Nation's next Secretary of Education.

Madam President, I yield the floor.

Mr. President, I ask unanimous consent that the Special Committee on Aging, having adopted rules governing its procedures for the 115th Congress, have a copy of their rules printed in the Record, pursuant to rule XXVI, paragraph 2, of the Standing Rules of the Senate.

Mr. President, as Chairman of the Senate Aging Committee, I am delighted to introduce, with my good friend and former ranking member, Senator Claire McCaskill, the Senior$afe Act of 2017, a bill that would help protect American seniors from financial fraud. I'm pleased that Senators Isakson, Casey, Tillis, Klobuchar, Wicker, Shaheen, Capito, Tester, Barrasso, Donnelly, Heller, and King have joined us in sponsoring this bill.

According to the GAO, financial fraud targeting older Americans is a growing epidemic that costs seniors an estimated $2.9 billion annually. Stopping this tsunami of fraud is one of the top priorities of the Aging Committee. Last Congress, we held several hearings examining an endless variety of financial abuses targeting our nation's seniors. These range from the notorious IRS phone scam that burst onto the scene in 2015, to the incredible ``drug mule'' scam, where trusting seniors have been tricked by international narcotics traffickers into unwittingly serving as drug couriers, and then find themselves arrested and locked-up in foreign jails. The common denominator in these schemes involves innocent seniors falling prey and being tricked out of their hard-earned savings.

Sadly, not all scammers are strangers to their victims, in too many cases, seniors are exploited by someone they know well. Sometimes, that abuse is perpetrated by ``friends'' or family members who are handling the victim's affairs informally. Other times, the abuse is committed under color of a fiduciary relationship, such as a Power of Attorney or guardianship.

No matter the scheme, one factor is common to all--the fraudsters need to gain the trust and active cooperation of their victims. Without this, their schemes would fail. That is why it is so important that seniors recognize as quickly as possible the red flags that signal potential fraud.

Unfortunately, many seniors do not see these red flags. Sometimes they are

too trusting or are suffering from diminished capacity, but, just as often, they miss the signs because the swindlers who prey on them are extremely crafty and know how to sound convincing. Whatever the reason, a warning sign that can slip by a victim might trigger a second look by fmancial service representatives trained to spot common scams, who know enough about a senior's habits to question a transaction that doesn't look right. In our work on the Aging Committee, we have heard of many instances where quick action by bank and credit union employees has stopped a fraud in progress, saving seniors untold thousands of dollars.

Let me give you an example. Last year, an attorney in the small coastal city of Belfast, ME, was sentenced to 30 months in prison for bilking two elderly female clients out of nearly a half a million dollars over the course of several years.

The lawyer's brazen theft was uncovered when a teller at a local bank noticed that he was writing large checks to himself on his clients' accounts. When confronted by authorities, he offered excuses that the prosecutor later described as ``breathtaking.'' For example, according to press reports, he put one of his clients into a nursing home to recover from a temporary medical condition, and then kept her there for four years until the theft of her funds came to light. Meanwhile, he submitted bills for ``services,'' sometimes totaling $20,000 a month, including charging her $250 per hour for 6 to 7 hours to check on her house, even though his office was just a one-minute drive down the road.

In another example, in 2015, a senior citizen in Vassalboro, Maine, was looking to wire funds from his account at Maine Savings Federal Credit Union to an out-of-state location, supposedly to bail out a relative who was in jail. Something about this transaction did not sound right to the credit union employee. She asked the customer, and he said he had received a call from an ``official'' at the jail--but that ``official'' had instructed him not to speak to anyone about this. The ``official,'' of course, turned out to be a con artist.

Fortunately, the credit union worker recognized this as a scam, and her quick thinking saved her customer from falling victim and losing his savings.

These stories demonstrate the critical nexus that financial institutions occupy between fraudsters and their victims. Their employees, if properly trained, can be the first line of defense protecting our seniors from these criminals. Regrettably, various state and federal laws can inadvertently impede efforts to protect seniors, because financial institutions that report suspected fraud can be exposed to litigation. The Senior$afe Act encourages financial institutions to train their employees, and shields them from lawsuits when they make good faith, reasonable reports of potential fraud to the proper authorities.

There is no doubt that financial fraud and scams targeting seniors is a growing problem that we must act on. Last November, the Aging Committee heard testimony from Jaye Martin, the Executive Director of Maine Legal Services for the Elderly, who told the Committee that her organization has seen a 24 percent increase in reports of elder abuse in just one year. Many of these cases involve financial fraud.

In a letter describing her support for the Senior$afe Act, Ms. Martin says that:

In a landscape that includes family members who often wish

to keep exploitation from coming to light because they are

perpetrating the exploitation, the risk of facing potential

nuisance or false complaints over privacy violations is all

too real. This is a barrier that must be removed so that

financial institutions will act immediately to report to the

proper authorities upon forming a reasonable belief that

exploitation is occurring. These professionals are on the

front lines in the fight against elder financial exploitation

and are often the only ones in a position to stop

exploitation before it is too late.

Our bill is based on Maine's innovative Senior$afe program, a collaborative effort by Maine's regulators, financial institutions, and legal organizations to educate bank and credit union employees on how to identify and help stop financial exploitation of older Mainers. This program, pioneered by Maine Securities Administrator Judith Shaw, also serves as the template for model legislation developed for adoption at the state level by the North American Securities Administrators Association, or NASAA. The Senior$afe Act and NASAA's model state legislation are complementary efforts, and I am pleased that NASAA has endorsed our bill.

I am pleased that our bill has received bipartisan support in both houses of Congress. Last year, the House Financial Services Committee approved a version of the Senior$afe Act by a vote of 59 to zero, and it passed the full House by voice vote in July. In the Senate, the Senior$afe Act was cosponsored by a quarter of the Members of this body, balanced nearly evenly on both sides of the aisle, and was discharged out of the Banking Committee. Unfortunately, just one member of this body blocked it and prevented it from becoming law.

Besides receiving broad support in Congress, our bill has the support of a wide range of stakeholders, ranging from the State securities administrators and insurance commissioners to advocates for seniors.

Combating financial abuse of seniors requires regulators, law enforcement and social service agencies at all levels of government to work collaboratively with the private sector. The Senior$afe Act encourages financial institutions to train their employees, and shields them from lawsuits when they make good faith, reasonable reports of potential fraud to the proper authorities.

Mr. President, I ask unanimous consent that letters of support be printed in the Record.

Mr. President, as Chairman of the Senate Aging Committee, I am delighted to introduce, with my good friend and former ranking member, Senator Claire McCaskill, the Senior$afe Act of 2017, a bill that would help protect American seniors from financial fraud. I'm pleased that Senators Isakson, Casey, Tillis, Klobuchar, Wicker, Shaheen, Capito, Tester, Barrasso, Donnelly, Heller, and King have joined us in sponsoring this bill.

According to the GAO, financial fraud targeting older Americans is a growing epidemic that costs seniors an estimated $2.9 billion annually. Stopping this tsunami of fraud is one of the top priorities of the Aging Committee. Last Congress, we held several hearings examining an endless variety of financial abuses targeting our nation's seniors. These range from the notorious IRS phone scam that burst onto the scene in 2015, to the incredible ``drug mule'' scam, where trusting seniors have been tricked by international narcotics traffickers into unwittingly serving as drug couriers, and then find themselves arrested and locked-up in foreign jails. The common denominator in these schemes involves innocent seniors falling prey and being tricked out of their hard-earned savings.

Sadly, not all scammers are strangers to their victims, in too many cases, seniors are exploited by someone they know well. Sometimes, that abuse is perpetrated by ``friends'' or family members who are handling the victim's affairs informally. Other times, the abuse is committed under color of a fiduciary relationship, such as a Power of Attorney or guardianship.

No matter the scheme, one factor is common to all--the fraudsters need to gain the trust and active cooperation of their victims. Without this, their schemes would fail. That is why it is so important that seniors recognize as quickly as possible the red flags that signal potential fraud.

Unfortunately, many seniors do not see these red flags. Sometimes they are

too trusting or are suffering from diminished capacity, but, just as often, they miss the signs because the swindlers who prey on them are extremely crafty and know how to sound convincing. Whatever the reason, a warning sign that can slip by a victim might trigger a second look by fmancial service representatives trained to spot common scams, who know enough about a senior's habits to question a transaction that doesn't look right. In our work on the Aging Committee, we have heard of many instances where quick action by bank and credit union employees has stopped a fraud in progress, saving seniors untold thousands of dollars.

Let me give you an example. Last year, an attorney in the small coastal city of Belfast, ME, was sentenced to 30 months in prison for bilking two elderly female clients out of nearly a half a million dollars over the course of several years.

The lawyer's brazen theft was uncovered when a teller at a local bank noticed that he was writing large checks to himself on his clients' accounts. When confronted by authorities, he offered excuses that the prosecutor later described as ``breathtaking.'' For example, according to press reports, he put one of his clients into a nursing home to recover from a temporary medical condition, and then kept her there for four years until the theft of her funds came to light. Meanwhile, he submitted bills for ``services,'' sometimes totaling $20,000 a month, including charging her $250 per hour for 6 to 7 hours to check on her house, even though his office was just a one-minute drive down the road.

In another example, in 2015, a senior citizen in Vassalboro, Maine, was looking to wire funds from his account at Maine Savings Federal Credit Union to an out-of-state location, supposedly to bail out a relative who was in jail. Something about this transaction did not sound right to the credit union employee. She asked the customer, and he said he had received a call from an ``official'' at the jail--but that ``official'' had instructed him not to speak to anyone about this. The ``official,'' of course, turned out to be a con artist.

Fortunately, the credit union worker recognized this as a scam, and her quick thinking saved her customer from falling victim and losing his savings.

These stories demonstrate the critical nexus that financial institutions occupy between fraudsters and their victims. Their employees, if properly trained, can be the first line of defense protecting our seniors from these criminals. Regrettably, various state and federal laws can inadvertently impede efforts to protect seniors, because financial institutions that report suspected fraud can be exposed to litigation. The Senior$afe Act encourages financial institutions to train their employees, and shields them from lawsuits when they make good faith, reasonable reports of potential fraud to the proper authorities.

There is no doubt that financial fraud and scams targeting seniors is a growing problem that we must act on. Last November, the Aging Committee heard testimony from Jaye Martin, the Executive Director of Maine Legal Services for the Elderly, who told the Committee that her organization has seen a 24 percent increase in reports of elder abuse in just one year. Many of these cases involve financial fraud.

In a letter describing her support for the Senior$afe Act, Ms. Martin says that:

In a landscape that includes family members who often wish

to keep exploitation from coming to light because they are

perpetrating the exploitation, the risk of facing potential

nuisance or false complaints over privacy violations is all

too real. This is a barrier that must be removed so that

financial institutions will act immediately to report to the

proper authorities upon forming a reasonable belief that

exploitation is occurring. These professionals are on the

front lines in the fight against elder financial exploitation

and are often the only ones in a position to stop

exploitation before it is too late.

Our bill is based on Maine's innovative Senior$afe program, a collaborative effort by Maine's regulators, financial institutions, and legal organizations to educate bank and credit union employees on how to identify and help stop financial exploitation of older Mainers. This program, pioneered by Maine Securities Administrator Judith Shaw, also serves as the template for model legislation developed for adoption at the state level by the North American Securities Administrators Association, or NASAA. The Senior$afe Act and NASAA's model state legislation are complementary efforts, and I am pleased that NASAA has endorsed our bill.

I am pleased that our bill has received bipartisan support in both houses of Congress. Last year, the House Financial Services Committee approved a version of the Senior$afe Act by a vote of 59 to zero, and it passed the full House by voice vote in July. In the Senate, the Senior$afe Act was cosponsored by a quarter of the Members of this body, balanced nearly evenly on both sides of the aisle, and was discharged out of the Banking Committee. Unfortunately, just one member of this body blocked it and prevented it from becoming law.

Besides receiving broad support in Congress, our bill has the support of a wide range of stakeholders, ranging from the State securities administrators and insurance commissioners to advocates for seniors.

Combating financial abuse of seniors requires regulators, law enforcement and social service agencies at all levels of government to work collaboratively with the private sector. The Senior$afe Act encourages financial institutions to train their employees, and shields them from lawsuits when they make good faith, reasonable reports of potential fraud to the proper authorities.

Mr. President, I ask unanimous consent that letters of support be printed in the Record.

Mr. President, first, let me commend the Senator from Louisiana for his extraordinary work on this bill. It has been a great pleasure to work so closely with him as we have made a genuine effort to put together a bill that would be a reasonable replacement for ObamaCare that would help to bring people together.

I wish to commend the Senator from Louisiana for his expertise. As a physician, Senator Cassidy brings an important perspective to this debate, particularly since he has practiced for so many years in hospitals in Louisiana that serve the uninsured. So I wish to personally thank him for the privilege of working together to craft this bill.

There has been much debate recently on the best approach to replacing and reforming the Affordable Care Act. Considerable confusion and anxiety exists about the current status of the law and about the future of health care in our country. However, what is often overlooked in this discussion is that while the ACA provides valuable assistance for some people who were previously uninsured, the system created by the law is under tremendous financial strain.

ObamaCare exchanges are on the verge of collapse in many States. The reality is that significant changes must be made. Doing nothing is not an option.

I am, therefore, both surprised and disappointed by the remarks of the Democratic leader to the press and on the floor today about the genuine effort that Senator Cassidy and I have put forward in introducing the Patient Freedom Act.

First of all, let me point out that the Democratic leader could not possibly have read our bill since we haven't introduced it yet, and it is evident that he has misunderstood many of its provisions.

For example, in a press statement, he said we gutted the preexisting condition protections that we strongly support and that are codified in our bill in section 101(b). Again, that is section 101(b). It ensures that insurers cannot discriminate against individuals with preexisting conditions who pay their premiums.

I guess what disappoints me most is that the Democratic leader's response really represents what is wrong with Washington, DC. The American people want us to come together. They want Democrats and Republicans to work as a team to solve the problems facing our Nation. If we are going to have a leader on the other side of the aisle denounce to the press and come to the Senate floor to criticize a bill that has not even been introduced yet, where are we? I really hope this is an aberration and that we can work together and that the compromises we put in the bill are recognized as a good-faith effort to bring both sides of the aisle together in the interests of the American people and in providing access to affordable health care. That is our goal.

We are not saying our bill is perfect. We are open to refinements. We have made a good-faith effort, and to hear it described inaccurately and as other than a genuine effort to solve a problem truly disappoints me.

The fact is, the ACA has been in effect for years. Yet nearly 30 million Americans still do not have health insurance coverage. Many of those who do have coverage through the ACA exchanges are experiencing large spikes in premiums, deductibles, and copays, increasing costs to consumers and taxpayers alike. Contrary to the predictions made by the early supporters of the ACA, premiums are increasing in nearly every State, with an average increase of 25 percent nationally.

In New York State, the average increase on the exchange is 16.6 percent. I don't know, but perhaps the Democratic leader thinks that is an acceptable rate of increase. It strikes me as pretty high, and even though it is below the national average, it is still in double digits. The situation is even more dire in some States like Arizona, where premiums have increased by 116 percent. In many counties throughout our country, there are only one or two health insurers offering plans on the exchanges, severely limiting consumer choice.

In my State of Maine, premiums for the individual market for 2017 have soared by 22 percent, on average, and plan options have become more limited. Now, while subsidies do cushion the blow for those consumers who are eligible for them, others have had to shoulder the full increase, and of course taxpayers have borne a greater burden. Moreover, individuals and families with incomes exceeding 250 percent of the poverty rate are not shielded from the dramatic increases in deductibles and copays. That is important to remember. The premium subsidy applies to incomes up to 400 percent of the poverty rate. It then drops off the cliff, and you are eligible for no subsidy whatsoever--there is no orderly phaseout. For help with copays and deductibles under the Affordable Care Act, the threshold is 250 percent of the poverty rate. These huge premium spikes and increases in deductibles and larger copays are having an effect on families and individuals--who are by no means wealthy--all over this Nation.

Millions with coverage under the ACA are also facing increasingly narrow networks, which means they may find their preferred doctors are not in their networks. This can be particularly difficult for rural States that may have few specialists and whose citizens rely on major medical centers in nearby States. If patients want to continue to see these doctors, they can be faced with enormous costs that are not covered by their ACA insurance. As one Mainer put it, ``[President] Obama said I could keep my doctor, and the insurance company says I can't.''

The co-ops created under the ACA to help provide health insurance coverage have been failing at an alarming rate. In fact, only 5 of the 23 remain operational. It is also important to carefully consider the effects that ObamaCare's Medicare cuts have had on providers like rural hospitals and home health agencies, many of whom are struggling.

In sum, prices are skyrocketing, coverage is narrowing, and the individual market is likely in a death spiral if Congress fails to act.

I know many Members of this Chamber share the goal of expanding access to affordable health care. Over the years, I have collaborated with colleagues on both sides of the aisle on a number of initiatives. Today I am pleased to join my colleague, Senator and Doctor Bill Cassidy, in introducing the Patient Freedom Act of 2017 to help ensure that Americans have access to affordable health care that improves choices and helps to restrain costs.

Let me emphasize again that our bill is a work in progress. It is not perfect. However, what it does--and it is virtually unique in this regard, in this Chamber--is it puts specific proposals on the table as we seek to craft bills to repair and improve the Affordable Care Act. Other legislation being discussed,

such as those designed to help small businesses pool risks so they can better afford to provide insurance to their employees, also deserves consideration. Let's get a lot of ideas on the table.

We have to start, and we have been willing to step forward and propose a specific bill. To be criticized for that by the Democratic leader is just so disappointing, particularly since the leader is well aware that I work across the aisle all the time to try to find solutions for our country.

The Patient Freedom Act is built on the premise that giving people more choices is superior to the one-size-fits-all approach that defined the Affordable Care Act. We recognize that what works best for people in Maine or New Hampshire may not be right for people in New York or California. Our bill respects those differences by giving States options to choose the path that works best for their citizens.

Now, option one would allow a State to choose to continue operating its insurance markets pursuant to all the rules of the Affordable Care Act. So if New York State wants to keep with the status quo, despite the 16.6-percent increase, on average, in the premiums for the individual market, New York State can make that choice. If a State chooses to remain covered by the ACA, exchange policies will continue to be eligible for cost-sharing subsidies and advanced premium tax credits, and the insurance markets will still be subject to ACA requirements. The individual mandate and the employer mandate will also remain in place for that State. Medicaid expansion States will continue to receive Federal funding. So if a State is happy with the status quo--with spiraling costs, with limited choices, with a market that is broken--fine, keep the ACA. In some States, maybe it is working well. States should have that option, and they would under the Cassidy- Collins bill.

More appealing to many States, however, would be what we call the better choice option in the Patient Freedom Act that would allow a State to waive many of the requirements of the ACA, except for vital consumer protections, and still receive Federal funding to help its residents purchase affordable health insurance. Senator Cassidy has explained how it would work so I will not go through that all again.

Let me just say that eligible individuals in States selecting this option would receive Federal funding deposited into their Roth health savings accounts. The aggregate funding for these per-beneficiary deposits would be determined based on the total amount of funding that the Federal Government would have provided in the form of ACA subsidies in each State, plus any funding each State would have received had it chosen to expand its Medicaid Program--even if, like my State, it has chosen not to do so. These deposits in the Roth health savings accounts would be phased out for higher income beneficiaries.

States selecting this option for every resident who does not have health insurance coverage through his or her employer or through public programs like Medicare or the VA or the Federal Employees Health Benefits Program--in those States, the option would be a standard health insurance plan that would include first-dollar coverage through the Roth health savings account, basic prescription drug coverage, and a high-deductible health plan. States could automatically enroll their residents who are uninsured in this standard plan, unless an individual opted to use his or her health savings account to purchase more comprehensive coverage or opted out of coverage altogether. I can't imagine someone making the choice of opting out altogether when they would receive this generous subsidy.

In addition to Federal funds, individuals and employers could make contributions to these health savings accounts, and the balances would grow tax-free. The bill also provides for a partial tax credit for very low-income individuals who do receive employer-based coverage to help these workers pay for their deductibles and their copays.

Here is another important provision of our bill: Health care providers receiving payments from the Roth health savings accounts would be required to publish cash prices for their services. That would add transparency that is sorely lacking in our current system and that we need to move toward a more patient-directed health care future. For example, if your physician has suggested that you have a colonoscopy, you would know whether one hospital or one clinic would charge more than another so you can make the right decision for you.

Health care reform should be about expanding affordable choices, and that is what our legislation aims to do by allowing States to structure their individual health insurance markets and to do so without the burdensome individual mandate, the employer mandate, or many of the other restrictive requirements in the ACA that have substantially driven up costs and forced millions of Americans to buy coverage that is more than they want, need, or can afford. Americans should have the choice to purchase more affordable coverage, if that is what works best for them.

Let me again emphasize, since misinformation was given to the press about the consumer protections in our bill, the Patient Freedom Act would retain several important consumer protections, contrary to what was said earlier today by a colleague who hadn't read our bill. Dependents will be able to remain on their parents' health insurance policies until age 26. Insurance companies will still not be able to exclude coverage for preexisting conditions or discriminate based on health status. In fact, there is no medical underwriting for the standard plan offered under the better choice option. Insurance companies cannot cap benefits by including lifetime or annual limits in their policies, and they must offer to renew policies as long as enrollees continue to pay premiums. Insurance companies must also continue to cover mental health and substance use disorder benefits for individuals, a particularly important benefit given the nationwide scope of the opioid crisis that has seriously affected my State of Maine and so many other States throughout our country, ruining the lives of individuals, their families, and their communities.

Provisions like these vital consumer protections should be retained. However, the Washington centric approach of the ACA must be changed if we are ever to truly reform our broken health care system.

I am pleased to see a growing consensus among Members of both the Senate and the House that we must fix the Affordable Care Act and provide reforms at nearly the same time as we repeal the law. This will help protect the families who rely on the program and give insurers time to transition to a new marketplace that is based on more choices for consumers. That is what we are trying to do here. Reforms in the way we provide health insurance must ensure that individuals relying on the current system do not experience a needless and avoidable gap in coverage.

If we are going to reform the system, we must begin to put specific proposals on the table for our colleagues to debate, refine, amend, and enact. That is why the criticism is so disappointing. This is an attempt to put forth a possible solution that would appeal to Members on both sides of the aisle.

As we continue our work to find a responsible path to repealing and repairing the ACA, we should give the States the freedom to choose what they believe works best for their citizens, whether that means staying with the Affordable Care Act or selecting a different path--in my view, a better path--that will lead to patient-directed reforms that contain costs and provide more choice. The Patient Freedom Act does exactly that, and I commend my colleague Senator Cassidy for his leadership on this legislation. I also want to thank our cosponsors, including Senator Isakson and Senator Capito for their support as well.

Mr. President, first, let me commend the Senator from Louisiana for his extraordinary work on this bill. It has been a great pleasure to work so closely with him as we have made a genuine effort to put together a bill that would be a reasonable replacement for ObamaCare that would help to bring people together.

I wish to commend the Senator from Louisiana for his expertise. As a physician, Senator Cassidy brings an important perspective to this debate, particularly since he has practiced for so many years in hospitals in Louisiana that serve the uninsured. So I wish to personally thank him for the privilege of working together to craft this bill.

There has been much debate recently on the best approach to replacing and reforming the Affordable Care Act. Considerable confusion and anxiety exists about the current status of the law and about the future of health care in our country. However, what is often overlooked in this discussion is that while the ACA provides valuable assistance for some people who were previously uninsured, the system created by the law is under tremendous financial strain.

ObamaCare exchanges are on the verge of collapse in many States. The reality is that significant changes must be made. Doing nothing is not an option.

I am, therefore, both surprised and disappointed by the remarks of the Democratic leader to the press and on the floor today about the genuine effort that Senator Cassidy and I have put forward in introducing the Patient Freedom Act.

First of all, let me point out that the Democratic leader could not possibly have read our bill since we haven't introduced it yet, and it is evident that he has misunderstood many of its provisions.

For example, in a press statement, he said we gutted the preexisting condition protections that we strongly support and that are codified in our bill in section 101(b). Again, that is section 101(b). It ensures that insurers cannot discriminate against individuals with preexisting conditions who pay their premiums.

I guess what disappoints me most is that the Democratic leader's response really represents what is wrong with Washington, DC. The American people want us to come together. They want Democrats and Republicans to work as a team to solve the problems facing our Nation. If we are going to have a leader on the other side of the aisle denounce to the press and come to the Senate floor to criticize a bill that has not even been introduced yet, where are we? I really hope this is an aberration and that we can work together and that the compromises we put in the bill are recognized as a good-faith effort to bring both sides of the aisle together in the interests of the American people and in providing access to affordable health care. That is our goal.

We are not saying our bill is perfect. We are open to refinements. We have made a good-faith effort, and to hear it described inaccurately and as other than a genuine effort to solve a problem truly disappoints me.

The fact is, the ACA has been in effect for years. Yet nearly 30 million Americans still do not have health insurance coverage. Many of those who do have coverage through the ACA exchanges are experiencing large spikes in premiums, deductibles, and copays, increasing costs to consumers and taxpayers alike. Contrary to the predictions made by the early supporters of the ACA, premiums are increasing in nearly every State, with an average increase of 25 percent nationally.

In New York State, the average increase on the exchange is 16.6 percent. I don't know, but perhaps the Democratic leader thinks that is an acceptable rate of increase. It strikes me as pretty high, and even though it is below the national average, it is still in double digits. The situation is even more dire in some States like Arizona, where premiums have increased by 116 percent. In many counties throughout our country, there are only one or two health insurers offering plans on the exchanges, severely limiting consumer choice.

In my State of Maine, premiums for the individual market for 2017 have soared by 22 percent, on average, and plan options have become more limited. Now, while subsidies do cushion the blow for those consumers who are eligible for them, others have had to shoulder the full increase, and of course taxpayers have borne a greater burden. Moreover, individuals and families with incomes exceeding 250 percent of the poverty rate are not shielded from the dramatic increases in deductibles and copays. That is important to remember. The premium subsidy applies to incomes up to 400 percent of the poverty rate. It then drops off the cliff, and you are eligible for no subsidy whatsoever--there is no orderly phaseout. For help with copays and deductibles under the Affordable Care Act, the threshold is 250 percent of the poverty rate. These huge premium spikes and increases in deductibles and larger copays are having an effect on families and individuals--who are by no means wealthy--all over this Nation.

Millions with coverage under the ACA are also facing increasingly narrow networks, which means they may find their preferred doctors are not in their networks. This can be particularly difficult for rural States that may have few specialists and whose citizens rely on major medical centers in nearby States. If patients want to continue to see these doctors, they can be faced with enormous costs that are not covered by their ACA insurance. As one Mainer put it, ``[President] Obama said I could keep my doctor, and the insurance company says I can't.''

The co-ops created under the ACA to help provide health insurance coverage have been failing at an alarming rate. In fact, only 5 of the 23 remain operational. It is also important to carefully consider the effects that ObamaCare's Medicare cuts have had on providers like rural hospitals and home health agencies, many of whom are struggling.

In sum, prices are skyrocketing, coverage is narrowing, and the individual market is likely in a death spiral if Congress fails to act.

I know many Members of this Chamber share the goal of expanding access to affordable health care. Over the years, I have collaborated with colleagues on both sides of the aisle on a number of initiatives. Today I am pleased to join my colleague, Senator and Doctor Bill Cassidy, in introducing the Patient Freedom Act of 2017 to help ensure that Americans have access to affordable health care that improves choices and helps to restrain costs.

Let me emphasize again that our bill is a work in progress. It is not perfect. However, what it does--and it is virtually unique in this regard, in this Chamber--is it puts specific proposals on the table as we seek to craft bills to repair and improve the Affordable Care Act. Other legislation being discussed,

such as those designed to help small businesses pool risks so they can better afford to provide insurance to their employees, also deserves consideration. Let's get a lot of ideas on the table.

We have to start, and we have been willing to step forward and propose a specific bill. To be criticized for that by the Democratic leader is just so disappointing, particularly since the leader is well aware that I work across the aisle all the time to try to find solutions for our country.

The Patient Freedom Act is built on the premise that giving people more choices is superior to the one-size-fits-all approach that defined the Affordable Care Act. We recognize that what works best for people in Maine or New Hampshire may not be right for people in New York or California. Our bill respects those differences by giving States options to choose the path that works best for their citizens.

Now, option one would allow a State to choose to continue operating its insurance markets pursuant to all the rules of the Affordable Care Act. So if New York State wants to keep with the status quo, despite the 16.6-percent increase, on average, in the premiums for the individual market, New York State can make that choice. If a State chooses to remain covered by the ACA, exchange policies will continue to be eligible for cost-sharing subsidies and advanced premium tax credits, and the insurance markets will still be subject to ACA requirements. The individual mandate and the employer mandate will also remain in place for that State. Medicaid expansion States will continue to receive Federal funding. So if a State is happy with the status quo--with spiraling costs, with limited choices, with a market that is broken--fine, keep the ACA. In some States, maybe it is working well. States should have that option, and they would under the Cassidy- Collins bill.

More appealing to many States, however, would be what we call the better choice option in the Patient Freedom Act that would allow a State to waive many of the requirements of the ACA, except for vital consumer protections, and still receive Federal funding to help its residents purchase affordable health insurance. Senator Cassidy has explained how it would work so I will not go through that all again.

Let me just say that eligible individuals in States selecting this option would receive Federal funding deposited into their Roth health savings accounts. The aggregate funding for these per-beneficiary deposits would be determined based on the total amount of funding that the Federal Government would have provided in the form of ACA subsidies in each State, plus any funding each State would have received had it chosen to expand its Medicaid Program--even if, like my State, it has chosen not to do so. These deposits in the Roth health savings accounts would be phased out for higher income beneficiaries.

States selecting this option for every resident who does not have health insurance coverage through his or her employer or through public programs like Medicare or the VA or the Federal Employees Health Benefits Program--in those States, the option would be a standard health insurance plan that would include first-dollar coverage through the Roth health savings account, basic prescription drug coverage, and a high-deductible health plan. States could automatically enroll their residents who are uninsured in this standard plan, unless an individual opted to use his or her health savings account to purchase more comprehensive coverage or opted out of coverage altogether. I can't imagine someone making the choice of opting out altogether when they would receive this generous subsidy.

In addition to Federal funds, individuals and employers could make contributions to these health savings accounts, and the balances would grow tax-free. The bill also provides for a partial tax credit for very low-income individuals who do receive employer-based coverage to help these workers pay for their deductibles and their copays.

Here is another important provision of our bill: Health care providers receiving payments from the Roth health savings accounts would be required to publish cash prices for their services. That would add transparency that is sorely lacking in our current system and that we need to move toward a more patient-directed health care future. For example, if your physician has suggested that you have a colonoscopy, you would know whether one hospital or one clinic would charge more than another so you can make the right decision for you.

Health care reform should be about expanding affordable choices, and that is what our legislation aims to do by allowing States to structure their individual health insurance markets and to do so without the burdensome individual mandate, the employer mandate, or many of the other restrictive requirements in the ACA that have substantially driven up costs and forced millions of Americans to buy coverage that is more than they want, need, or can afford. Americans should have the choice to purchase more affordable coverage, if that is what works best for them.

Let me again emphasize, since misinformation was given to the press about the consumer protections in our bill, the Patient Freedom Act would retain several important consumer protections, contrary to what was said earlier today by a colleague who hadn't read our bill. Dependents will be able to remain on their parents' health insurance policies until age 26. Insurance companies will still not be able to exclude coverage for preexisting conditions or discriminate based on health status. In fact, there is no medical underwriting for the standard plan offered under the better choice option. Insurance companies cannot cap benefits by including lifetime or annual limits in their policies, and they must offer to renew policies as long as enrollees continue to pay premiums. Insurance companies must also continue to cover mental health and substance use disorder benefits for individuals, a particularly important benefit given the nationwide scope of the opioid crisis that has seriously affected my State of Maine and so many other States throughout our country, ruining the lives of individuals, their families, and their communities.

Provisions like these vital consumer protections should be retained. However, the Washington centric approach of the ACA must be changed if we are ever to truly reform our broken health care system.

I am pleased to see a growing consensus among Members of both the Senate and the House that we must fix the Affordable Care Act and provide reforms at nearly the same time as we repeal the law. This will help protect the families who rely on the program and give insurers time to transition to a new marketplace that is based on more choices for consumers. That is what we are trying to do here. Reforms in the way we provide health insurance must ensure that individuals relying on the current system do not experience a needless and avoidable gap in coverage.

If we are going to reform the system, we must begin to put specific proposals on the table for our colleagues to debate, refine, amend, and enact. That is why the criticism is so disappointing. This is an attempt to put forth a possible solution that would appeal to Members on both sides of the aisle.

As we continue our work to find a responsible path to repealing and repairing the ACA, we should give the States the freedom to choose what they believe works best for their citizens, whether that means staying with the Affordable Care Act or selecting a different path--in my view, a better path--that will lead to patient-directed reforms that contain costs and provide more choice. The Patient Freedom Act does exactly that, and I commend my colleague Senator Cassidy for his leadership on this legislation. I also want to thank our cosponsors, including Senator Isakson and Senator Capito for their support as well.

Mr. President, first, let me start by commending the Senator from Louisiana for all of the thought and the work he has put into coming up with an alternative plan that would fix ObamaCare and result in more Americans having affordable health insurance. As a physician, Senator Cassidy cares deeply about his patients and about patients in general. His goal, which I share, is to make sure every American has access to affordable health care. I commend him for his hard work and leadership.

There has been much debate lately on the best approach to replacing and reforming the Affordable Care Act, also known as ObamaCare. Some of my colleagues have argued for immediate repeal without any replacement, an option I reject, for it risks leaving millions of vulnerable Americans without affordable health insurance and would undo important consumer protections provided by current law.

Others have proposed repeal with a delayed effective date of 2 or 3 years to allow time for the Senate to devise legislation that would provide a better approach to health insurance. My concern with the repeal-and-delay plan is that the ObamaCare exchanges, already on very shaky financial ground, would go into a death spiral as consumers would face uncertainty and insurers would have no basis for pricing their policies.

Already we have seen insurers fleeing the marketplaces in many States, reducing choices for consumers. In some States, only one or two insurers remain on the exchanges, leaving individuals and families with few, if any, choice of insurance carriers. Every single one of the 23 State cooperatives whose startup costs were financed by ObamaCare has experienced severe financial problems and only five remain operational today.

Many States, including Maine, are experiencing double-digit increases in premiums, causing increased costs for consumers and for taxpayers. So repeal and delay would only exacerbate this problem.

I am pleased to see a growing consensus among Members of both the Senate and the House that we must fix ObamaCare, provide reforms at nearly the same time that we repeal the law, in order to protect families who rely on the program and to give insurers time to transition to a new marketplace that is based on more choices for consumers.

Many of us have been working for years on proposals to reform our health care system, to expand coverage, and to encourage new delivery systems that would help restrain the growth in health care costs. That is what the legislation that I am going to be pleased to be joining my colleague from Louisiana on, would do. It is focused on giving more choices while ensuring that consumers have access to affordable health insurance.

We have advanced bipartisan proposals in the past to deal with provisions of the law that have increased costs and discouraged employers from hiring full-time workers. Regrettably, every such reform has been met with a veto threat. That is why we continued to work.

In 2015, I joined Senator Cassidy in introducing a more comprehensive and creative approach, the Patient Freedom Act, which is the basis for the legislation we are going to be introducing soon. It would allow States to have more choices. If they like the Affordable Care Act, they can keep the Affordable Care Act. If they want to go an alternative route that is more patient-centered, that would provide more choices and help to restrain costs, they can do that, too, and the Federal Government would bundle the funding that would otherwise be used for ACA subsidies and the expansion of Medicaid in their State and allow them to proceed along a more creative route.

We recognize how different the needs of our States are, but our citizens should have access to affordable health care and be able to choose the path that works best for them.

We will be talking more about the specifics of our bill when we introduce it, but I am excited about this approach. I am not saying it is perfect, but it is important that we put specific proposals on the table that our colleagues can coalesce around, debate, and refine so that we can move ahead and remove the fear and uncertainty of families who are relying on coverage through the exchanges without putting an undue burden on the employers who create jobs in this country.

Mr. President, let me again commend the Senator from Louisiana. He has worked so hard to come up with a fresh approach. He has been very open to suggestions that I and others have made.

We all understand the importance of maintaining the consumer protections that help individuals with preexisting conditions, that ensure that young people can remain on their parents' insurance policies until age 26, and that prohibit lifetime caps. Those provisions would remain. But what we want to do is to allow our States the option of selecting a different path that will lead to patient- directed reforms that contain costs and provide citizens with more health care choices. The Patient Freedom Act does just that.

Again, I want to commend my colleague Senator Cassidy for his leadership.

Mr. President, I yield the floor.

Mr. President, today I wish to support the legislative waiver required for retired General James Mattis to become the next Secretary of Defense.

The principle of civilian control of the military has been fundamental to the concept of American Government since the inception of our Republic. It was the Continental Congress that granted General George Washington his commission, and General Washington reported to that legislative body throughout the entire war.

At the conclusion of the war, General Washington was the most popular and important figure in America. He easily could have positioned himself as the leader of the American government and, in fact, was urged to do so by many. Instead, General Washington famously resigned his commission on December 23, 1783, thus firmly establishing the principle that, in this new country, ultimate authority over the Armed Forces would rest with democratically elected civilians. General Washington's noble act was the foundation of such an important tenet of our democracy that the scene is depicted in a magnificent painting by John Trumbull, which occupies a prominent position in the rotunda of the United States Capitol.

The principle of civilian control of the military was at the center of the debate when the structure of our Armed Forces was dramatically reorganized after World War II. A congressional consensus emerged from the military readiness failures of Pearl Harbor that the modern world required a more significant standing military force with a more centralized command structure. But harkening back to the precedent established by George Washington, it was imperative that this new structure have civilian leadership. This was especially concerning at the time, given the number of remarkable generals who had deservedly attained heroic status in the eyes of the American public and the free world. Thus, in 1947, Congress passed section 202 of the National Security Act, which provided that the Secretary of Defense needed to have at least a 10-year gap, later reduced to 7, from any military service.

Since that time, 16 of the past 24 Defense Secretaries have had some prior military service. If approved, however, Gen. Mattis would only be the second Defense Secretary to receive a congressional waiver of the law--the other being General George Marshall in 1950.

In order to examine this important history and review the wisdom of granting a waiver for Gen. Mattis, the Senate Armed Services Committee held a hearing exploring the issue of civilian control of the Armed Forces. After carefully reviewing the testimony from those hearings, I do support making an additional, one-time exception to the law in the specific case of James Mattis.

In 1950, the world was a tumultuous place, with a hot war in Korea coupled with the extraordinary risks associated with a growing cold war in the nuclear age. President Truman turned to General Marshall to serve as Secretary of Defense because his noted character and competence, combined with his experience and ability, made him an ideal fit for the unique challenges presented at that time.

Today the world is again a tumultuous place. The combination of the threat from terrorist organizations like ISIS and al Qaeda, as well as the threats emanating from countries such as Iran, North Korea, Russia, and China, has heightened tensions around the globe. And all our international challenges today take place against the backdrop of the knowledge that the world has a large and aging nuclear arsenal that could quickly create chaos in the wrong hands.

As was the case with Gen. Marshall, Gen. Mattis, with his exceptional character and competence and his remarkable skills and ability, is a fit for these dangerous times.

Over the course of his 44-year career in the Marine Corps, Gen. Mattis has earned a reputation as a warrior and commander who is beloved by soldiers and veterans alike. The ``warrior monk,'' as he is known in military circles, is a voracious reader and a student of history. He has served as a military commander at all levels and all over the world. His assignments have included a combat deployment during the Persian Gulf Wars and difficult leadership posts in both Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom, where Mattis commanded the 1St Marine Division in the city of Fallujah.

His work over the past decade has demonstrated a deep appreciation for the challenges our country faces today. In 2006, Mattis coauthored the military's counterinsurgency manual with then-Army General David Petraeus. As an expert in counterinsurgency, Mattis understands the crucial role military power plays in conjunction with other civil instruments of national power, including diplomatic and economic efforts.

Between 2007 and 2010, while serving as commander of the now disestablished U.S. Joint Forces Command, Mattis gained experience in broad DOD policy and management at an organization focused on the transformation of U.S. military capabilities.

In 2010, I supported Gen. Mattis's nomination to serve as commander of U.S. Central Command, where he oversaw the wars in Iraq and Afghanistan and was responsible for an area which includes Syria, Iran, and Yemen. His experience at CENTCOM is a tremendous asset in developing a coherent strategy to address the threats posed by state actors and terrorist networks in the region and elsewhere around the world.

In 2015, he testified before the Senate Armed Services Committee on the United States' global challenges and offered insight to the committee on crafting a coherent, bipartisan national security strategy with an eye towards international diplomacy and alliances, defense budgeting, and military force size and capabilities.

Last year, he coedited a book on civil-military relations that explored the growing cultural gap between civilian society and the military, as well as the impact this lack of understanding may have on the civilian-military relationship.

Finally,I would note that Gen. Mattis has the support of three very capable and successful former Secretaries of Defense whose careers were either largely or entirely in the civilian workforce. Secretaries Cohen, Panetta, and Gates know as well as anyone what it takes to succeed in that position and the importance of civilian leadership of the military. Their unqualified support of Gen. Mattis carries considerable weight with me and further convinces me that, in this particular circumstance, a waiver is warranted.

Mr. President, one of my top priorities as a Senator has been to expand access to affordable health care for all Americans. I have always believed that the key to achieving this goal is to bring down the cost of health care, so more Americans can afford to purchase the health insurance that they need. During debate over the Affordable Care Act, I raised the concern that the bill's cumbersome ``one size fits all'' approach would do more harm than good and would result in an even more expensive, broken, and unsustainable health care system.

Unfortunately, my fears are now reality. According to the Kaiser Family Foundation, premiums for employer-sponsored family health plans now top $18,000 per year, up nearly $5000 since 2009. Deductibles have also been rising: in 2009, only one in five workers enrolled in single- coverage employer plans faced a deductible over $1000. Today more than half do.

In Maine, premiums on the Exchange will rise an average of 22 percent this year, and many States are seeing even higher premium hikes. Meanwhile, fewer insurers are willing to write policies, leaving few choices for consumers who are looking for insurance.

Some of the ACA's provisions--especially its consumer protections-- enjoy bipartisan support and should be retained; however, its Washington-centric approach must be changed if we are ever to truly reform our broken health care system. Nevertheless, this task must be undertaken with care.

There is growing understanding that we cannot simply repeal the Affordable Care Act now and then wait 2 or 3 years to put reforms in place. Doing that would risk harming consumers who rely upon the current system for their insurance and would exacerbate the turmoil in the insurance markets. If we want a smooth transition from a broken and unaffordable system to a system that finally delivers on the promise of reform, we must carefully plan how we intend to get from where we are today, to where we need to be tomorrow.

Thus, we are called to act quickly, but not in haste. That is why I joined Senators Corker, Portman, Cassidy, and Murkowski in offering an amendment that would change the reporting date for the bill reported pursuant to the budget resolution's reconciliation instructions from January 27 to March 3. While I continue to much prefer the later date, I have received assurances from Senate leaders that the January 27th date is not binding and that there is a shared commitment that we will take the time necessary to proceed thoughtfully with legislative reforms to replace and reform Obamacare.

Few issues are as important to the American people as fixing our broken health care system. As we move to repair the ACA, I look forward to continuing to work with my colleagues on responsible alternatives that can put us on a path to a health care system that is truly sustainable and affordable.

Mr. President, today I wish to congratulate Secretary Ray Mabus on his retirement as the 75th Secretary of the Navy. It has been a great pleasure to work with Secretary Mabus during his impressive and storied tenure as the longest serving Secretary of the Navy since World War I.

Since his confirmation in 2009, Secretary Mabus has continually reaffirmed his commitment to ensuring America's naval forces are second to none. During his more than 7 years of service, Secretary Mabus has also demonstrated an unwavering commitment to building our naval fleet and supporting America's shipbuilding industrial base. He has put 84 ships under contract across the country, more than the last three Navy secretaries combined, and invested significantly in our aging shipbuilding infrastructure.

Secretary Mabus's focus on increasing shipbuilding has allowed the men and women at Bath Iron Works, BIW, to continue building high- quality destroyers, which are the workhorses of our Navy. To allow the Navy to operate these ships to their fullest potential while remaining mindful of the budget constraints faced by our military, Secretary Mabus supported energy initiatives to reduce dependence on fossil fuels. His focus on power-saving technologies, like diesel-electric plants in new ships, has reduced the Navy and Marine Corps' fuel expenses by 30 percent.

In Maine, Portsmouth Naval Shipyard, PNSY, has received approximately $100 million in modernization funds since 2009, enabling it to maintain its status as the gold standard for public naval shipyards and further

hone its efficiency and effectiveness in submarine repair.

While advancing these reforms, Secretary Mabus visited Navy and Marine Corps installations across the globe, traveling over 1.3 million miles to over 150 countries and territories and all 50 States. When measured in distance, Secretary Mabus has travelled to the moon and back almost three times. In 2009, he and I visited the hard-working men and women at BIW and PNSY together. Since that first visit, Secretary Mabus has worked tirelessly to support our shipbuilding industrial base and ensure our Navy and Marine Corps have the tools they need to succeed.

In addition, Secretary Mabus's leadership in 2010 on the Gulf Coast's long-term recovery plan following the Deepwater Horizon oil spill was exemplary. His work securing the future of the Gulf Coast made Americans and certainly his home State of Mississippi proud.

Finally, his emphasis on platforms, power, and partnerships allowed our Navy to grow in strength, but Secretary Mabus never forgot those who make the system work: the people.

Secretary Mabus was instrumental in advancing the repeal of don't ask, don't tell in 2011, a harmful policy that barred Americans from serving their country simply because of their sexual orientation. His efforts helped to ensure that all patriots who willingly answer the call to arms may proudly serve their Nation.

Similarly, as discussions on military integration have evolved with a new focus on women in combat, Secretary Mabus again stepped up to become a leader on gender equality in the military. His support for integration of women into the Navy and Marine Corps, in all occupations and specialties, and his expansion of maternity leave have ensured that women can serve in the military jobs they love.

Secretary Mabus has also taken steps to support career flexibility, continuing education, and family well-being for all members of the Navy and Marine Corps. He worked to ensure that all those who serve in uniform are provided the mental health care they need and deserve. By supporting and empowering a dedicated, intelligent, and committed personnel base, Secretary Mabus has enabled our Navy to remain the powerful fighting force that it is today.

With his retirement, we lose a true patriot who served his country as a civilian, as well as in uniform, and we lose a visionary leader who saw how our Armed Forces could be better--and did everything in his power to make it happen. It has been a personal and professional pleasure to work with Secretary Mabus, and I wish him fair winds and following seas.

Mr. President, I am pleased today to join my friend and colleague from North Dakota, Senator Heitkamp, in introducing 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. In Maine, 40 percent of children qualify for free or reduced-price meals based on household income.

The food served at schools to these children affects their health and well-being. Many children consume up to half their daily caloric intake at school. In fact, children often 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. One-third of the children in this country are overweight or obese, which increases their risk for heart disease, high blood pressure, Type 2 Diabetes and other chronic diseases. These conditions may have a lifelong effect on their health as they grow to adulthood.

In response to concerns about the health of our children, our schools have stepped up to the plate. Nationwide, schools are working diligently to meet the new U.S. Department of Agriculture standards and serve healthier meals. For example, in the New Sweden Consolidated School in Aroostook County, ME, food service manager Melanie Lagasse prepares meals from scratch instead of opening cans or pushing a defrost button. The school's 64 students, ranging from preschool to eighth 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 and must rely on workarounds that are expensive, inefficient, and unsustainable. Schools built decades ago lack the tools and the infrastructure necessary beyond reheating and holding food for meal service.

To serve healthier meals to their students, 99 percent of Maine school districts need at least one piece of equipment and almost half, 48 percent, of districts need kitchen infrastructure upgrades. The median equipment need per school is $45,000.

Even more costly would be making the required changes to infrastructure. Forty-eight percent of Maine schools need some kind of infrastructure change to serve healthy meals. For example, 41 percent of schools need more physical space, 22 percent need more electrical capacity, 21 percent need more plumbing capacity, and 19 percent need more ventilation.

Add the equipment costs together with the infrastructure costs and it is estimated that overall, $58.8 million would be needed just in Maine to serve healthy meals to all of our students. That far exceeds the $111,000 in grants that the USDA awarded Maine during the last two fiscal years for new equipment.

Our bill authorizes loan guarantee assistance and grants for school equipment and infrastructure improvements, thereby helping food service personnel meet nutrition standards. First, it would establish a loan guarantee assistance program within USDA to help schools acquire new equipment to prepare and serve healthier, more nutritious meals to students. School administrators and other eligible borrowers could obtain Federal guarantees for 80 percent of the loan value needed to construct, remodel, or expand their kitchens, dining, or food storage infrastructure.

Second, the bill would provide targeted grant assistance to give school administrators and food service directors the seed funding needed to upgrade kitchen infrastructure or to purchase high-quality, durable kitchen equipment such as commercial ovens, steamers, and stoves.

Finally, to aid school food service personnel in meeting the nutrition guidelines, the legislation would strengthen training and provide technical assistance by authorizing 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.

We need to start our school children off on the right food every day. If they are going to be able to learn and compete, they need to be healthy and their minds and bodies fully nourished. This bill will help us achieve that goal.