Lamar Alexander

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, Ken Burns told me last year that his 8- part, 16-hour ``Country Music'' film, which concludes on PBS this week, could be more popular than his Civil War film. After watching the first episodes, I suspect he might be right. His new film plumbs the depths of the American soul, using the one tool--music--that is the most likely to touch the largest number of us. As a U.S. Senator from Tennessee, I will confess my bias. The first 2 hours of ``Country Music'' a week ago Sunday were about the recordings of hillbilly music in 1927 at the birthplace of country music in Bristol, where the Tennessee-Virginia State line runs down the middle of Main Street. Two years ago, the Senator from Virginia, Mr. Kaine, and I, played a little concert--I on the keyboard and he on the harmonica--at the end of that Main Street, at a fiddler's festival that they had. The rest of the Ken Burns episode winds through a community called Boogertown in Eastern Tennessee, in the Smoky Mountains, where Dolly Parton was born, to the Grand Ole Opry in Nashville and to Beale Street in Memphis. We like to say that the whole world sings with Tennessee, but country music is more than Tennessee music. It is more than Appalachian music. It is more than the music of poor white Americans. It comes from the heart. As Burns' and Duncan's storytelling reminds us, every one of us has a heart. There is no better evidence of this than paying less than $20 to sit at a table at the Bluebird Cafe in Nashville. There you listen to three songwriters tell the stories behind their songs and play them for a small audience who doesn't even whisper during their performances. I sat at the Bluebird on a Saturday in 2013, listening to a young songwriter, Jessi Alexander, sing her song, ``I Drive Your Truck.'' One of her cowriters, Connie Harrington, had heard the story on NPR. It was the story of Jared Monti, an American soldier killed in Afghanistan trying to save another soldier. He won a Congressional Medal of Honor for that. To remember his son, his father, Paul, drives Jared's Dodge Ram truck because, the father says, ``I am alone, in the truck, with him.'' When Jessi Alexander finished singing, everyone in the Bluebird was weeping. I said to the person next to me, ``That has to be the song of the year,'' and it was. Last week, I attended the Annual Nashville Songwriter Awards show. I looked through the program listing all of the previous songs of the year. In 2012, it was Dolly Parton's farewell song to Porter Wagoner, ``I Will Always Love You.'' Dolly Parton is a great songwriter too. In 2003, it was ``Three Wooden Crosses.'' In 1972, it was ``Old Dogs, Children, and Watermelon Wine,'' by Tom T. Hall. Then, in 1969, it was ``Okie from Muskogee,'' by Merle Haggard. ``Three chords and the truth'' is how songwriter Harlan Howard defines country music. Ken Burns has become America's storyteller, a skill much more difficult than it would seem. He tackles the subjects that divide us, like the Civil War and Vietnam, and he presents them in a form that allows us to travel through those wrenching experiences, gathering the information we need to form our own opinions. One could argue that Ken Burns is our most effective teacher of U.S. history, a subject woefully undertaught in our schools. The lowest scores on high school Advanced Placement tests are not in math and science. They are in American history. So I am glad to know that there is more of Ken Burns' work to come. According to a New Yorker article in 2017, during the next decade Burns plans to produce films about the Mayo Clinic, Muhammad Ali, Ernest Hemingway, the American Revolution, Lyndon B. Johnson, Barack Obama, Winston Churchill, the American criminal justice system, and African-American history from the Civil War to the Great Migration. Producing these films must cost a lot of money, but, in my view, every penny that the Public Broadcasting System and private contributors have spent has been worth it. If I had the money, I would ask Burns how much time he will spend raising funds to pay for these next films and I would give him the amount of money that it would take so that he could spend that time producing an extra three or four more films before he hangs it up. Since I don't have the money, maybe someone else will do that. Mr. President, I ask unanimous consent to be printed in the Record an op-ed that was in the New York Times, ``Country Music Is More Diverse Than You Think,'' by Ken Burns and Dayton Duncan.

Mr. ALEXANDER. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I am reserving the right to object. The Senator from Alabama is a valued member of the Health, Education, Labor, and Pensions Committee. Ensuring that historically Black colleges and universities have continued funding is something we all want to do. However, instead of the short-term patch, I favor a long- term solution. I am ready to do this, along with a few other bipartisan higher education proposals that also have bipartisan support. Such a package could include permanent mandatory funding of $255 million for historically Black colleges and universities and reduction of the number of questions on the FAFSA that 20 million families fill out every year for their Federal aid, as Senators Bennet and Jones have proposed. I would like to see the Senate pass again the legislation Senator Murray and I persuaded the Senate to pass that reduces the current FAFSA to 22 questions. Senators Schatz, Lee, and Durbin have proposed Pell grants for prisoners. There is a proposal by Senators Portman and Kaine and many other bipartisan Senators on short-term Pell grants for job training. We could expand Pell grant eligibility. We could increase the maximum Pell grant award. These are all things we should be able to agree on, including funding for historically Black colleges and universities. I have been talking with Senator Murray now for several years about reauthorizing the Higher Education Act. I intend to discuss this all with her and with our committee members next week. We have the time to do it because, while the legislation expires at the end of this month, the money doesn't for several more months. So, in the meantime, I hope we can work together, as we often do in our committee, to pass a smaller package of higher education proposals, including a long-term proposal for historically Black colleges and universities, while we continue to work on the reauthorization of the Higher Education Act.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, today I wish to recognize the 150th anniversary of the University of Tennessee ``Pride of the Southland'' marching band and congratulate this esteemed band on 150 years of success. The ``Pride of the Southland'' marching band was founded in 1869 by Gustavus Robert Knabe, from Germany. During the 150 years of the marching band, there have been 10 directors, including the current director, Dr. Donald Ryder, who was proceeded by both Dr. Gary Sousa and Dr. W.J. Julian. It was Dr. Julian who created the now famous ``Circle Drill.'' Since the band was formed after the close of the Civil War, it had a military style with both uniforms and music. The marching band maintained a military look until 1951, when the then-band director, Walter M. Ryba, changed the look of the uniform and created a new look on the field. When Dr. W.J. Julian became the director in 1961, the marching band was moved from the military department and placed in the music education curriculum. With this change, they received new uniforms consisting of navy blue trousers and jackets with an orange and white military-style vest overlay with braided shoulder straps and a white plume with an orange and white shako. This is the uniform currently still in use today. Over the last 150 years, the marching band has grown dramatically from 13 members to over 350 members. With such a deep and rich history, it is no surprise that several families have had multiple generations who have participated in the ``Pride.'' The ``Pride of the Southland'' marching band has been recognized internationally for their unique marching style and music, including the innovative ``Circle Drill,'' which has become a strong tradition each fall, and ``Rocky Top,'' which started as the band's halftime show in October 1972, during the Vols annual football game versus Alabama. In 1982, the marching band opened the World's Fair in Knoxville and has performed in 15 Presidential inauguration--a record unmatched by any civilian organization--with the first being President Dwight Eisenhower in 1953 and, most recently, President Donald Trump. The band has appeared in over 50 bowl games, including the Rose Bowl, Cotton Bowl, Sugar Bowl, Orange Bowl, Citrus Bowl, Peach Bowl, Sun Bowl, Hall of Fame Bowl and the 1998 National Championship Fiesta Bowl. They have also performed on the field with stars such as Charlie Daniels Band, Kenny Rogers, Kenny Chesney, Lee Greenwood, Roy Acuff, the Osborne Brothers, and many others. At home in Neyland Stadium, the ``Pride of the Southland'' band has impressed Vol fans with its pre-game show, which is considered one of the finest ever performed. The band created the ``V-O-L-S'' chant, the opening of the ``Power T,'' ``USA,'' and more. I would like to recognize the ``Pride of the Southland'' marching band for its 150 years of rich history and commend the University of Tennessee and all band members, past and present, for the part they have played to make the program such a storied success. When I was 14, I sold programs at Neyland Stadium. There is nothing more exciting than watching a football game in Neyland Stadium, and if your seats are by the band, that is even better. There are no other traditions in the University of Tennessee's history that can surpass the astounding accomplishments and success that the ``Pride of the Southland'' marching band has in its 150 years of service to a great university.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, as a fellow Commodore and former Vanderbilt athlete, I would like to congratulate the Vanderbilt University baseball team on winning the 2019 National Collegiate Athletic Association Men's College World Series, the second championship title for the baseball program and the fifth national championship in Commodore athletic history. Tim Corbin, in his 17th season as head baseball coach, has built a program that not only contends each year for college baseball's top prize, but has developed a culture of excellence among his athletes, both on the field and off. En route to their second national title, Coach Corbin's team, also referred to as the Vandy Boys, broke the Southeastern Conference record with 59 total victories, while also winning both the regular season and tournament titles. Without Vanderbilt's seven-member senior class, the Commodores' success could not have been possible. These seniors provided leadership and stability to a program that had a target on its back throughout the season. This achievement is due to the hard work, talent, and teamwork of the following outstanding student-athletes: Harrison Ray, Cooper Davis, Philip Clarke, Tate Kolywck, Isaiah Thomas, Ethan Paul, Matt Hogan, Dominic Keegan, Kiambu Fentress, Austin Martin, Walker Grisanti, Pat DeMarco, Stephen Scott, Ty Duvall, Tyler Brown, Julian Infante, Ethan Smith, Patrick Raby, Sterling Hayes, Hugh Fisher, Erik Kaiser, Zach King, Jackson Gillis, John Malcom, Jake Eder, Justyn-Henry Malloy, Austin Becker, Mason Hickman, Chance Huff, AJ Franklin, JJ Bleday, Joe Gobillot, Drake Fellows, Kumar Rocker, and Jayson Gonzalez. These student-athletes were coached and mentored by a dedicated team of coaches and athletic department staff, including: Head Coach Tim Corbin, Associate Head Coach Scott Brown, Assistant Coach Mike Baxter, Volunteer Coach David Macias, Athletic Trainer Tracy Campbell, Strength and Conditioning Coach Chris Ham, Director of Baseball Operations Brooks Webb, Director of Player Development Brandon Barak, Video Coordinator Josh Ruchotzke, Equipment Manager Kevin Collins, and Student Managers Jack Goodrum, Chase Casali, Jackson Kelley, and Ethan Stem. I would also like to acknowledge Chancellor Nicholas S. Zeppos, Vice Chancellor for Athletics and University Affairs and Athletics Director Malcolm Turner, Deputy Athletics Director Candice Storey Lee, and Associate Athletic Director Phillip Brown for their leadership. Anchor Down, Commodores. We are proud of you.

Mr. ALEXANDER

Mr. ALEXANDER. I ask for the yeas and nays.

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, I ask unanimous consent to speak for as much time as I may require.

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, I often recommend to Tennesseans that they look at the U.S. Congress as if it were a split-screen television set. Here is what I mean by that. During the last month, on one side of the screen you saw the usual Washington, DC, turmoil--Trump versus the squad, Mueller testifying, impeachment votes, battle over the border, Presidential candidates posturing, and of course the daily tweets. On the other side of the screen was the President and congressional leaders agreeing to a 2-year budget that will strengthen our military, help our veterans, fund research for medical miracles, fund research for our National Laboratories, support our national parks, and save taxpayers a boatload of money by providing stability in funding. I might add that this part of the budget--31 percent of the budget-- is not the part of the budget that is creating the budget deficit. This part of the budget that we will be voting on tomorrow has gone up at about the rate of inflation for the last 10 years and is projected by the Congressional Budget Office to go up at about the rate of inflation for the next 10 years. It is the entitlement part of the budget that is the problem, which is why I am voting for what the President and the congressional leaders have recommended, but then also on that side of the screen, away from the Washington, DC, turmoil, there was another story, which is the story I want to talk about today. During that last same month, three Senate committees, by my count, made more than 80 bipartisan proposals, sponsored by at least 75 U.S. Senators of both political parties, to reduce the cost of healthcare that Americans pay for out of their own pockets. On June 26, after 17 hearings, 6 months of work, recommendations from 400 experts, our Health Committee, which I chair and of which Senator Patty Murray, the Democrat from Washington State, is the ranking member, voted 20 to 3 to recommend to the full Senate 55 proposals from 65 Senators that would end surprise medical billing, increase transparency so you can know the cost of your medical care--you can't lower your healthcare costs if you don't know your healthcare actually costs--and increase competition to reduce the cost of prescription drugs. The next day after our Health Committee reported that legislation, the Judiciary Committee, headed by Senator Graham and Senator Feinstein, reported out 4 proposals from 19 Senators that would reduce prescription drug costs by banning anticompetitive behaviors by drug manufacturers and helping the Federal Trade Commission to block those who game the citizen petition process to delay generic drugs and biosimiliars. Then, last Thursday, the Finance Committee--this one headed by Senator Grassley and Senator Wyden--by a vote of 19 to 9, reported more than two dozen additional bipartisan proposals also aimed at reducing the cost of prescription drugs. That is not all. The House Energy and Commerce Committee has passed its own solution to surprise billing. Last Thursday, Senator Murray's staff and I met with Representatives Frank Pallone and Greg Walden, the leaders of the House Energy and Commerce Committee. The four of us agreed to work together to lower healthcare costs. All of this work is consistent with what Secretary Azar and the President have been saying and doing to lower prescription drug costs and increase transparency. For example, last week, after the Finance Committee released its legislation, the White House said it ``is encouraged by the bipartisan work of Chairman Grassley and Senator Wyden to craft a comprehensive package to lower outrageously high drug prices, and today we are engaging with coalitions to help build support.'' That is from the White House. Here is why this amount of activity is, in so many ways, such a good sign for the American people. In our committee, what we have seen before with fixing No Child Left Behind, 21st Century Cures Act, last year's response to the opioid crisis--the last of which occurred, by the way, while on the other side of the split-screen television was the acrimonious Kavanaugh confirmation hearing--what we have seen with these recent new laws I just mentioned is that when that many Senators and that many Congressmen of both political parties go to work together on a big issue that affects millions of American people, there is likely to be a result that affects the American people. In other words, I believe legislation to end surprise medical billing, increase transparency, and lower prescription drug costs is looking like a train that will get to the station when Congress reconvenes in September, and well it should. The cost of healthcare is Americans' No. 1 financial concern, according to Gallup, and at one hearing before our Health Committee, experts from the National Academy of Medicine testified that up to half of what our country spends on healthcare is unnecessary. That is such a startling fact that I sat down then with Senator Murray and with Senators Grassley and Wyden and with Senators Graham and Feinstein, and I said to the leaders of those committees: Surely, if the experts say that half of what we are spending is unnecessary, Democrats and Republicans can find some things we can agree on that reduce the cost of what we pay for healthcare out of our own pocket, and we have. The work of these three committees, more than 80 proposals from 75 Senators, is the result of that work over the last 6 months. Let me say a word about perhaps the most visible proposal in the Health Committee's bill. Surprise medical billing is one of the most urgent problems that the House, the Senate, and the President are trying to fix. After about 20 percent of all emergency room visits, patients are surprised a few months later to receive an unexpected bill. It could range from $300 to $3,000 to $30,000. This happens because patients see a doctor they didn't choose, either because of emergency care at an out-of-network hospital or because an out-of-network doctor, not chosen by the patient, treats them at an in-network hospital. In his State of the Union Address and again at a White House event in May, President Trump called for an end to surprise billing. At the event, he gave me a copy of this medical bill, which we have enlarged on this chart. It was a bill sent to Liz Moreno, a Texas college student who had back surgery, and during a postsurgery followup visit, her doctor ordered a urine test. A year later, this bill showed up: $17,850 for a urine test. That is about the price of a new Nissan Sentra. The bill was sky high because the lab that ran the test--a lab Liz did not choose--was considered out of network by her insurer. Take Drew Calver, a Texan who told the President his story about getting $110,000 in bills--the emergency room he was rushed to during his heart attack was out of network and so were the doctors who treated him. That day, the President said: ``For too long, surprise billings . . . have left some patients with thousands of dollars of unexpected and unjustified charges. . . . So this must end.'' The Lower Health Care Costs Act the Senate Health Committee passed last month by a vote of 20 to 3 would have protected Liz and Drew from receiving those surprise bills. Here is how it works: Insurance companies would pay out-of-network doctors a local, market-driven benchmark rate, which would be the same local, market-based rate that insurers negotiated with doctors who agreed to be in network. Obviously, this would have saved Liz and Drew because they wouldn't have gotten a surprise medical bill. The Congressional Budget Office says that by ending surprise medical billing, this approach would generally lower health insurance premiums. CBO also estimates that the approach would save taxpayers $25 billion over the next 10 years. Based on data from Kaiser, only about 5 percent of doctors at 10 percent of hospitals send most of these surprise medical bills. So our solution primarily affects those doctors whom patients have little control over choosing--anesthesiologists, radiologists, pathologists, emergency room doctors, and neonatologists. It does not affect doctors whom a patient can choose, such as cardiologists or primary care doctors or pediatricians. In fact, the American Academy of Family Physicians, representing primary care doctors, supports our Lower Health Care Costs Act that ends surprise medical billing. Over the 17 hearings our Health Committee conducted in developing our legislation, we heard many stories about surprise billing. Here are a few. Todd, a Knoxville father who wrote me, took his son to the emergency room after a bicycle accident. Todd was surprised when a few months later he received a bill for $1,800--because, even though the emergency room was in network, the doctor who treated his son was not. Ahead of the birth of their first child, Danny and his wife Linda, from Georgia, chose an in-network doctor and hospital. Of course, they thought their insurance would cover their bills. When Luke was born 3 weeks premature, he had to spend 11 days at the in-network hospital's neonatal care center. In the weeks after Luke went home, $4,279 in bills were sent to Danny and Linda because the neonatal care center, located in their in-network hospital, was out of network. Carrie Wallinger, from Phoenix, AZ, received a $9,000 surprise medical bill after going to an in-network emergency room after her dog bit her finger. The doctor who came to stitch up her finger was from an out-of-network facility, and so she got an unexpected $9,000 surprise bill. A South Carolina woman who had to have an emergency C-section received a $15,000 bill from an out-of-network anesthesiologist. Usually when you are being wheeled into an emergency room for an emergency operation, you are not thinking about choosing a doctor, and you are not interviewing them about whether they are in network or out of network. In Texas, after an ATV crushed his arm, Dr. Naveed Khan, a radiologist, needed advanced medical care. The cost of a 108-mile trip in an out-of-network helicopter cost $44,631. Nicole Briggs, from Colorado, had emergency surgery to remove her appendix at an in-network hospital. She owed $4,727 because the surgeon was out of network. In Mississippi, Stacy White took her husband to the emergency room at an in-network hospital. The emergency physician who saw her husband was out of network, and to her surprise, they received a bill for $2,700. West Coz, a 3-year-old with a 107-degree fever, was airlifted from a small community in West Virginia to a more advanced hospital 75 miles away. His parents were left with a $45,000 bill for the helicopter. In Maine, the State representative who sponsored a bill to protect patients against surprise bills received a several-hundred-dollar bill himself because the radiologist who read his daughter's x-ray was out of network even though he took his daughter to an in-network hospital. There are many more stories I could tell, but the bottom line is, in each case, this happened because the patient almost always had little choice. If you don't have choice, then you really don't have a functioning market. It is a market failure. One reason for the uptick in surprise bills is that this market failure is now being exploited by private equity firms. Oftentimes, hospitals will contract with a company to staff their emergency rooms and hospitals. These companies will handle billing, manage schedules, and hire doctors to staff the hospital emergency room. Here is some research done by Yale economist Zack Cooper. He found that two of the leading staffing companies--both backed by private equity firms--significantly increase the rate of out-of-network billing in a hospital once the firms are hired. In the case of one of the physician staffing companies that Cooper studied, a large insurer's data showed that the cases of surprise billing increased by 100 percent at six different hospitals once this physician staffing firm took over those hospitals' emergency rooms. In a New York Times article, Cooper described the 100-percent jump in surprise bills once these private equity-backed staffing companies entered by saying it was ``almost . . . like a light switch was being flipped on.'' In Axios, Cooper said: ``If you're willing to engage in some fairly unsavory billing practices, (these services) could be quite lucrative. . . . That's just discouraging, and it makes people want to go to single payer.'' These surprise bill abuses make Americans want to go to single payer. Our goal is to protect patients, not private equity firms and companies that are taking advantage of patients. Surprise medical bills are one of the most visible problems for the 180 million Americans who get their health insurance on the job. When growing numbers of patients are receiving surprise medical bills that could bankrupt their families, it is time for Congress to act. If Congress can't fix such an obvious market failure in healthcare, pressure will only grow for a radical Federal takeover of healthcare that will take away private insurance from the 180 million Americans who get insurance on the job and leave patients with less choice, fewer doctors, and worse healthcare. Avik Roy wrote in Forbes that ``if we do nothing [to address surprise medical bills], the problem will get far worse. If we do something that is too incremental, we'll pat ourselves on the back and then be forced to revisit the problem in a few years. Americans deserve market-based alternatives to single-payer health care. Without reform of exploitive hospital prices, we'll never get there.'' Americans want to be mindful consumers of healthcare. When Todd, the Knoxville father, wrote me, he said: ``If I'm expected to be a conscientious consumer of my own health care needs, I need a little more help.'' In other words, he needs for Congress to end surprise medical bills. It is unacceptable to say to patients that, even by paying their premiums every month, even by researching and choosing in-network hospitals and doctors, they may be on the hook for thousands of unexpected dollars because of a surprise bill over which they had no control. At least 75 Senators and the President of the United States have made it clear that our intent is to end surprise billing and to reduce what Americans pay out of pocket for their healthcare. When Congress reconvenes in September, I would encourage all of my colleagues to support these efforts to reduce healthcare costs. Mr. President, I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, I have one message for my colleagues in the Senate and those who might be watching. It is about this chart, which is very simple. This is the line of what we call discretionary spending. This is about 31 percent of the budget. That is the budget agreement you have read about in the newspapers the last couple of days. That is what we are talking about. It is a blue line. It has to do with paying for our national defense, so it is about half of the dollars; then for our national parks, America's best idea; then for the National Institutes of Health, the source of medical miracles ranging from restoring your heart to curing Zika to the National Laboratories, which are the sources of our competition with the rest of the world. That is what this money is for. What the blue line recognizes is that for the last 10 years, the growth in spending for national defense, national parks, the National Institutes of Health, and National Labs has gone up at about the rate of inflation, and for the next 10 years, including the budget agreement that the President and the congressional leaders recommended this week, it will go at about the rate of inflation. The point is, for 20 years--2008 to 2029--the increase in spending for the amount of money we are talking about and for the type of spending in the budget agreement is not the source of the Federal deficit. What is? Medicare, Medicaid, Social Security, and interest-- that is the red line that 10 years ago was $1.8 trillion. At the rate we are going, it will be $5.4 trillion in 10 years. That is not the type of spending we are talking about in the budget agreement. My message today is in support of properly funding national defense, national parks, National Institutes of Health, and National Labs and not beating our chest and pretending that we are balancing the budget on the backs of our soldiers, our medical miracles, and our national parks when, in fact, it is the entitlements that the President and the Democrats and the Republicans in Congress need to address. I will talk about the blue line today. I have talked about the red line plenty before. Former Senator Corker and I introduced legislation a few years ago that would have reduced the growth of this red line by $1 trillion over 10 years. The only problem was, we were the only two cosponsors of the legislation. The budget deficit is vitally damaging to our country, but the budget agreement that President Trump recommended is not the source of the budget deficit. That part of the budget is under control. That is 31 percent of all the dollars we spend in the United States. Just add to that, if this continues for another 10 years, this blue line--national defense, national parks, National Institutes of Health, National Laboratories--is going to go from 31 percent of the budget to 22 percent of the budget, and mandatory spending is going up to 78 percent. This is the budget deficit. This is the budget agreement we are going to be voting on next week. That part of the budget is under control. Here is what the budget agreement, which the President recommended and our Democratic and Republican leaders in the House and Senate have recommended and which I strongly support, does. The first thing it does is suspend the debt limit--the amount we can borrow. If we don't do that, we have a global fiscal crisis. We all know that, so we need to do it. Second, it raises the defense and nondefense discretionary budget caps. That is this blue line down here. That is the amount of money we can spend, as I said, on national defense. That is about half of the spending--and then our veterans, National Labs, biomedical research, and national parks. Let's talk about the military for just a minute. Former Secretary of Defense James Mattis, who had enormous respect here in Congress, said that ``no enemy in the field has done as much harm to the readiness of the U.S. military than the combined impact of the Budget Control Act's defense spending caps, worsened by operating for 10 of the last 11 years under continuing resolutions of varied and unpredictable duration.'' In plain English, what that means is that because of the President's leadership and the recommendations of our bipartisan leaders, we will avoid what Secretary Mattis said has been so damaging to our military. Here is what happened. Back in 2011, we passed the Budget Control Act to try to limit this part of the budget. That came after a special committee was appointed, which everyone hoped would deal with this part of the budget--the problem part, the part that is causing the deficit. The Budget Control Act came up with a formula that everybody thought would work. They said: Well, if we put in there that we will have dramatic reductions in military spending, Congress will never do that, so they will be forced to finally do something we all should have had the courage to do a long time ago, and that is deal with entitlements. What happened? We didn't deal with the red line, and we cut the military. We cut the military badly over the last 10 years, and we are just now beginning to catch up. Last year, Congress avoided sequestration and increased discretionary spending for fiscal years 2018 and 2019. Let me say it again, because I am going to repeat it over and over and over: We increased spending last year at about the rate of inflation. That is not the cause of the Federal deficit. Reaching that agreement, though, meant that for the first time in nearly a decade the Department of Defense received its budget on time, and it received a record funding level for research and development. This new 2-year budget agreement that the President has recommended will rebuild our military by providing $738 billion for defense discretionary spending for 2020 and $740 billion for 2021. It will also allow us to fulfill the commitment we made as a part of the New START Treaty in 2010 in December. I voted for that, and part of the deal with President Obama was that if we passed the treaty limiting nuclear weapons, we would make sure that ours worked. President Trump said the other day that Russia has 1,111 nuclear weapons, and they all work. We don't want them to use them, and the best way to keep them from using them is to make sure ours work. We have reached a budget agreement so that we can get to work on the appropriations bills and hopefully get many of them done before the end of the fiscal year, which is the 30th of September. That is important to the military especially. When I met with Secretary of the Army Mark Esper, who was approved by a big vote yesterday as Secretary of Defense, we talked about what it meant to have an appropriations bill passed into law on time, instead of a so-called continuing resolution, which is just a lazy way to go. It just says to spend next year what you spent last year, which means we don't spend for the things we need to spend, and we don't stop spending on the things we shouldn't spend. Here are some of the benefits of passing the appropriations bill on time, which would mean October 1. It keeps large projects on time and on budget. That is true in the Defense Department, and it is also true other places. We have a big project called the Uranium Processing Facility at Oak Ridge, TN, which comes through the Energy and Water Appropriations Committee, which I chair, and Senator Feinstein is the ranking member. We made sure that is on time and on budget--$6.5 billion by 2025. But if we don't appropriate the money on time and on budget, we can't finish the project on time and on budget, and who is hurt by that? Our national defense and our taxpayers or the Chickamauga Lock in Tennessee. All of the Army Corps of Engineers leaders have told me: Don't start these projects and then stop them. Don't stop and start and stop and start. That wastes money and slows things down. So, for the last several years, we have continued steady reconstruction. We need to pass these on time and on budget. Also, it keeps equipment maintenance at the Department of Defense on schedule. That saves money. There is more research and development for new technologies. It speeds up modernization of current equipment and keeps military training on schedule. That means soldiers, sailors, airmen, and marines are properly prepared for prompt combat, and it prevents accidents. This new 2-year agreement also helps our veterans. In 2018, President Trump signed the VA MISSION Act, which the Senate passed by a vote of 92 to 5. The MISSION Act gave veterans the ability to seek medical care outside the Department of Veterans Affairs and see a private doctor closer to home. So if you are 60 miles away in the State of Nebraska or Kansas or Tennessee and you need medical care and you can't be seen at a VA facility, you can see a private doctor close to home. This budget agreement makes sure we have enough money to support that, and I will ask the staff here how much that is. Senator Perdue said yesterday that 40 percent of the increase in the spending in this budget agreement, on the discretionary side, is to help veterans with the Choice Program. So it is not even in the national defense part of the budget; it is in the nondefense part of the budget. It helps veterans. So 40 percent of this increase is helping veterans on top of what we spend for defense, and we still keep the spending at about the rate of inflation. That is not the source of our budget deficit. It is important for the American people to know that the Republican majority in Congress has worked together with Democrats to provide record levels of funding for science, research, and technology. In the Senate, Senator Blunt from Missouri and Senator Murray from Washington State have provided the leadership for that in the Appropriations Committee. In April 2016, Francis Collins, Director of the National Institutes of Health, told our Appropriations Committee--I am a member of that, as are Senator Durbin and others; we worked on this together--that with adequate and consistent funding, he can make 10 bold predictions about some of the medical miracles he expects over the next several years. He talked about regenerative medicine that would replace heart transplants by restoring your heart from your own cells. He talked about vaccines for Zika, for HIV/AIDS, and for the universal flu, which kills tens of thousands. He talked about an artificial pancreas. He talked about cures for Alzheimer's or at least medicines that would identify the symptoms--that would identify Alzheimer's before the symptoms and do something about it. Since fiscal year 2015, the Appropriations Committee has increased funding for the National Institutes of Health by $9 billion, or 30 percent. From $30.3 billion in 2015 to $39.34 billion in fiscal year 2019, Senator Blunt and Senator Murray did that by cutting some programs and increasing the National Institutes of Health. They did it all down here in the blue line that stays within the rate of inflation--not up here in the red line. That is called good government. I can't tell you the number of leaders of academic and research institutions I meet who say that the young investigators in our country are so encouraged by this new funding for biomedical research, and they are busy working on the next miracles. That is what consistent funding will do. Dr. Collins came back to the committee this year, and I asked him if he was ready to update those bold predictions. He said: We are close to a cure for sickle cell anemia--sickle cell disease--and a new, nonaddictive painkiller which in my view would be the holy grail in our fight against opioids. With this new budget agreement, Congress could increase funding for the National Institutes of Health for the sixth consecutive year to continue this lifesaving research and do it all within the blue line, which is not the cause of the Federal budget deficit. Let's go to the Office of Science. Last year, the Energy and Water Development Appropriations Subcommittee that I chair with the Senator from California, Mrs. Feinstein, the ranking Democrat, agreed, along with Congress, for the fourth consecutive year--and President Trump signed it--to provide record funding for the Department of Energy's Office of Science. With this new budget, we can do it for 5 years. What does this mean? This means funding for the 17 National Laboratories, including the Oak Ridge National Laboratory, which are America's secret weapon. No other country has anything like our National Laboratories. Many Americans worry about competition from China and other parts of the world. How do we meet that competition? Through innovation. Where does that innovation come from? It is hard to think of a major initiative that has not come since World War II without some federally sponsored research funding. Funding our Labs is important and helps keep us first in the world in supercomputing. Why is supercomputing important? Because it keeps our standard of living high and keeps our national defense on its toes. China knows that. Two years ago, China had the two top supercomputers, but today the United States has the two fastest supercomputers in the world and the Exascale computing project will deliver the next generation system starting in 2021. This accomplishment is not the result of 1 year of funding or one political party but 10 years of bipartisan effort through the Bush, Obama, and Trump administrations, Democratic and Republican, to try to make sure America is first in the world of supercomputing. We did it all under the blue line over the last 10 years. The funding went up at the rate of inflation, not through the Moon like in entitlements which is the source of the Federal budget deficit, not the money we spend to keep ahead of China and Japan in supercomputing. On national parks, Ken Burns and others say America's national parks are our best idea. There are 417 of them. They have a badly deferred maintenance backlog. Senators Portman, Warner, King, myself, and others are working with President Trump, who supports our legislation, to try to cut half of the deferred maintenance in the national park backlogs in the next 5 years. We are going to use money from energy on Federal lands to do that. Americans are often shocked to find when they go to Federal parks that bathrooms don't work, roofs leak, and campgrounds are closed because there is not enough money for maintenance. This budget helps make sure our national parks are something Americans can continue to enjoy--all 418 of those parks--and we do that under the blue line that goes up at the rate of inflation, not at the budget-busting rate of the entitlements line. I have said this over and over, and it needs to be said over and over. The red line is mandatory spending. The blue line is discretionary spending. The blue line will be $1.6 trillion at the end of 10 more years. The red line will be $5.4 trillion at the end of 10 more years. Ten years ago, the blue line was 1.1 and the red line was 1.8. What do you think the problem is for the source of the Federal budget? You don't need a Ph.D. in mathematics to figure this out. It is not this line. It is not national defense; it is not biomedical research; it is not supercomputing; it is not the Army Corps of Engineers. It is this one line--entitlements. It is our fault for not having dealt with it, but we shouldn't beat our chest and pretend to balance the budget by decimating the work on that blue line. Discretionary spending is only 31 percent of the money. Mandatory spending is the rest of the funding. It will increase from 69 percent of total spending to 78 percent in 2029. The spending on national parks, national defense, National Institutes of Health, and National Labs will be reduced to 22 percent. I don't believe we can properly defend our country, properly keep up our parks, stay first in the world in supercomputing, and expect to continue biomedical research that produces lifesaving miracles if we squeeze all the money out of the blue line and let it go up in the air on the red line. The United States is experiencing robust economic growth, and there is a lot of political talk in this Chamber but no one really disputes that. Our economy is growing and growing. We have not seen anything like it in a long time. There have been 6 million new jobs created just since President Trump was elected, with the lowest unemployment rate in 50 years, at 3.7 percent. Before Congress passed the major tax reform in 31 years, our gross domestic product was projected to be a little less than 2 percent over the next 10 years. For the first quarter of 2019 this year, actual gross domestic product was a little over 3 percent. Higher GDP and lower unemployment leads to higher family incomes and more revenue for the Federal Government. More revenue for the Federal Government reduces the debt. I urge my colleagues to support this 2-year budget agreement. To those who are worried about the Federal debt, I am worried about it too. That is why Senator Corker and I put our bill in to reduce by a growth of $1 trillion over 10 years what is happening with this red line. If we want to talk about the Federal budget deficit, let's talk about where it really is. Let's talk about the red line, which has gone from $1.8 trillion 10 years ago and is projected by the Congressional Budget Office to go to $5.4 trillion 10 years from now. Let's not pretend we are balancing the Federal budget by focusing on the part of the Federal budget that is under control, the part that funds our military, national parks, biomedical research, and National Labs. For the last 10 years, it has gone up at about the rate of inflation, and for the next 10 years, according to the Congressional Budget Office--including this 2-year budget agreement which only affects the blue line, not the red line--it goes up at the rate of inflation. So I am proud to support it. I believe it is the right thing to do, and when the House sends us a chance to vote for it next week, I hope it gets a big vote from the U.S. Senate. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I have 8 requests for committees to meet during today's session of the Senate. They have the approval of the Majority and Minority leaders. Pursuant to rule XXVI, paragraph 5(a), of the Standing Rules of the Senate, the following committees are authorized to meet during today's session of the Senate: Committee on Agriculture, Nutrition, and Forestry The Committee on Agriculture, Nutrition, and Forestry is authorized to meet during the session of the Senate on Thursday, July 25, 2019, at 9:30 a.m., to conduct a hearing. Committee on Armed Services The Committee on Armed Services is authorized to meet during the session of the Senate on Wednesday, July 24, 2019, at 10 a.m., to conduct a hearing pending military nominations. Committee on Energy and Natural Resources The Committee on Energy and Natural Resources is authorized to meet during the session of the Senate on Thursday, July 25, 2019, at 10 a.m., to conduct a hearing. Committee on Finance The Committee on Finance is authorized to meet during the session of the Senate on Thursday, July 25, 2019, at 10 a.m., to conduct a hearing. Committee on Foreign Relations The Committee on Foreign Relations is authorized to meet during the session of the Senate on Thursday, July 25, 2019, at 10:30 a.m., to conduct a hearing. Committee on Homeland Security and Governmental Affairs The Committee on Homeland Security and Governmental Affairs is authorized to meet during the session of the Senate on Thursday, July 25, 2019, at 9:30 a.m., to conduct a hearing. Committee on the Judiciary The Committee on the Judiciary is authorized to meet during the session of the Senate on Thursday, July 25, 2019, at 10 a.m., to conduct a hearing. Select Committee on Intelligence The Select Committee on Intelligence is authorized to meet during the session of the Senate on Thursday, July 25, 2019, at 2 p.m., to conduct a closed hearing.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I ask for the yeas and nays.

Mr. ALEXANDER

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

Mr. ALEXANDER

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

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, within a few minutes, the Senate will be voting on President Trump's nomination of Cliff Corker to be the U.S. Federal District Judge for the Eastern District of Tennessee. I am here to strongly urge my colleagues to support Cliff Corker. Cliff Corker has the respect of the people who know him best. He was selected to serve as a magistrate judge by the district court judges of the Eastern District of Tennessee--a very high testament to his qualifications. When Cliff Corker was appointed magistrate judge, this is what he said: It's a tougher job to be the decision maker rather than the advocate. There's so much more responsibility in making the decision than advocating for the client because you really want to see justice done. Prior to his nomination to be magistrate in 2015, Judge Corker had his own law firm in Johnston City, TN. He handled a wide range of cases, from civil litigation to capital murder. He graduated from James Madison University and received his J.D. from the William & Mary Law School. The American Bar Association rated Judge Corker as unanimously ``well qualified,'' the highest ranking a nominee can receive. I am sure that is because of his judicial and litigation experience. Judge Corker has big shoes to fill. He is taking over for Judge Ronnie Greer, a very well respected Tennessean, a friend of mine for many years, who has served as a judge in Tennessee's Eastern District for the last 15 years. Prior to that, he was a State senator in Tennessee. Cliff Corker demonstrates the qualities that I look for in a judge: good character, good temperament, high intelligence, respect for the law, and respect for those who come before the court. Tennessee is fortunate that President Trump chose to nominate such a well-qualified candidate. I urge my colleagues to support Judge Corker's nomination. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, last month, during National Nurses Week, Ballad Health, a healthcare system in East Tennessee, announced it would be giving several thousand nurses a raise. The head of Ballad Health announced a $10 million investment in pay increases for nurses. He said: ``Our nurses and those who work with them in the provision of direct patient care are heroes . . . however, it is also true that . . . we face significant national shortage of these critical health care providers.'' Alan, the head of Ballad Health, said that his investment was, in part, because of a new rule proposed by the Trump administration in April. This new rule will update the formula that determines how much Medicare will reimburse hospitals for patient care. The formula takes into account, among other things, the cost of labor in that geographic area called the area wage index. This new rule attempts to level the playing field between hospitals in areas that have higher wages, and therefore are reimbursed at a higher rate than hospitals in areas with lower wages. The Centers for Medicare and Medicaid Services Administrator, Seema Verma, wrote in a recent op-ed in The Tennessean in Nashville: Many stakeholders have raised concerns that the Medicare hospital payment system disadvantages many rural hospitals. Our proposed rule brings payments to rural and other low-wage hospitals closer to their urban neighbors. I say this standing in the Senate Chamber, where we have the chairman and the ranking Democrat on the Agriculture, Nutrition, and Forestry Committee--two experts on rural areas and rural hospitals in our country. In recent years, too many rural Americans have seen their local hospital close and their doctors leave town. Since 2010, 107 rural hospitals have closed across 28 States and another 637--about one-third of all rural hospitals--are at risk of closing. In Tennessee alone, 12 rural hospitals have closed since 2010. A recent survey by the Robert Wood Johnson Foundation and the Harvard School of Public Health found that one in four Americans in rural areas couldn't access healthcare when they need it. This new rule will help rural hospitals keep up with the cost of providing care and keep those hospitals open. Alan from Ballad Health said: ``This proposed change indicates that Washington finally understands that rural health systems, like ours, have been historically unable to keep up with the real cost growth of nursing and other direct care providers.'' Craig Becker, who leads the Tennessee Hospital Association, wrote in The Tennessean earlier this month that this rule ``is good news for our State's hospitals and will provide much-needed relief to many of them, especially those in rural areas'' and that the rule ``finally will address the significant inequities in the Medicare area wage index--the first meaningful effort by any administration to address this flawed system.'' This new rule from CMS will help ensure Americans can access healthcare close by to their homes by leveling the playing field between urban and rural hospitals that rely on the Medicare hospital payment system. Last month, the Senate Health, Education, Labor, and Pensions Committee, which I chair and Senator Murray of Washington State is the ranking Democrat, approved, by a vote of 20 to 3, a bipartisan package of 55 proposals from 65 Senators to lower healthcare costs that will help rural Americans. For example, the legislation would ban anticompetitive terms that large hospital chains sometimes use in contracts with employers, such as the so-called all-or-nothing clauses. These clauses increase prices for employers and patients and can block healthcare plans from choosing hospitals based on the care quality, the patient experience, or one hospital's competitive pricing. Banning all-or-nothing clauses will help level the playing field for smaller, independent hospitals who are not part of a large corporate chain. Another provision in the Lower Healthcare Cost Act of 2019 will expand technology-based healthcare to help Americans in rural areas have access to specialty care. I hope the Trump administration and CMS Administrator Verma will quickly finish this rule and give Americans better healthcare choices and outcomes at lower costs, especially in our rural areas. I yield the floor.

Mr. ALEXANDER

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

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I thank the Senator from West Virginia for working to reduce the cost of prescription drugs. That is the question I hear most often in Tennessee: How can I reduce what I pay for out of my own pocket for healthcare costs? The most obvious way to reduce what you pay out of your own pocket for healthcare costs is to reduce the cost of prescription drugs. Shirley, from Franklin, TN, is one of those Americans who asked me that question. This is what she said: As a 71 year old senior with arthritis, I rely on Enbrel to keep my symptoms in check. My copay has just been increased from $95.00 to $170.00 every ninety days. At this rate I will have to begin limiting my usage in order to balance the monthly budget. There has never been a more exciting time in biomedical research, but that progress is meaningless if patients can't afford these new lifesaving drugs. Last month, as Senator Capito mentioned, our Senate Health Committee passed legislation by a vote of 20 to 3 that included 14 bipartisan provisions to increase prescription drug competition as a way of lowering generic drug costs and biosimilar drugs that reach patients. Here is what that includes: The CREATES Act--the Senator from Iowa, Mr. Grassley, is on the floor. He, Senator Leahy, and many others have proposed the CREATES Act, which will help bring more lower cost generic drugs to patients by eliminating anticompetitive practices by brand drugmakers. That is in the bill we approved. It also includes helping biosimilar companies speed drug development through a transparent, modernized, and searchable patent database. That was proposed by Senators Collins, Kaine, Braun, Hawley, Murkowski, Paul, Portman, Shaheen, and Stabenow. This legislation we have was approved 20 to 3. There are 55 different proposals by 65 different U.S. Senators--about the same number of Republicans and Democrats--all to reduce healthcare costs. Here are some other examples. The bill improves the Food and Drug Administration's drug patent database by keeping it more up to date to help generic drug companies speed product development, a proposal offered by Senator Cassidy and Senator Durbin. Another provision is it prevents the abuse of citizens' petitions. These are used to unnecessarily delay drug approvals. This was proposed by Senators Gardner, Shaheen, Cassidy, Bennet, Cramer, and Braun. President Trump included that in his 2020 budget. Another provision is it clarifies that the makers of brand biological products, such as insulin, are not gaming the system to delay new, lower cost biosimilars. That came from Senators Smith, Cassidy, and Cramer. Another provision is it eliminates exclusivity loopholes. These allow drug companies to get exclusivity and delay patient access to less costly generic drugs by just making small tweaks to an old drug. That came from Senators Roberts, Cassidy, and Smith, which President Trump also proposed in his budget. Another provision prevents the blocking of generic drugs. This is done by eliminating a loophole that allows a first generic to submit an application to FDA and block other generics from the market. Again, the President included this in his budget. Another provision in our bill prevents delays of biosimilar drugs by excluding biological products from compliance with U.S. Pharmacopeia standards. That sounds pretty complicated, but what it means is that it could delay patient access and lower the cost of drugs. Again, that is another proposal by President Trump. Another provision is it increases transparency on price and quality information by banning the kind of gag clauses Senator Capito talked about. These are gag clauses in contracts between providers and health plans that prevent patients, plan sponsors, or referring physicians from seeing price and quality information. Another provision bans pharmacy benefit managers from charging more for a drug than it paid for the same drug. Instead of remaining stuck in a perpetual partisan argument over ObamaCare and health insurance--and I can guarantee you that is going to continue to go on for a while--we have Senators on that side of the aisle and Senators on this side of the aisle working together to lower the cost of what Americans pay for healthcare out of their own pockets. Since January, Senator Murray and I have been working in parallel with Senator Grassley and Senator Wyden of the Finance Committee. They are continuing to work on their own bipartisan bill. Last month, the Senate Judiciary Committee also voted to lower the cost of prescription drugs. In the House, the Energy and Commerce, Ways and Means, and Judiciary Committees have all reported out bipartisan bills on the cost of prescription drugs. As I have mentioned, President Trump and Secretary Azar have been focused on this. Last year, the administration released a blueprint on steps the President would take to lower prescription drugs. Last year, the Food and Drug Administration set a new record for generic drug approvals. Generic drugs can be up to 85 percent less expensive than brand drugs. So I believe the cost of prescription drugs is an area where Democrats and Republicans in Congress and the administration can find common ground to help Americans reduce the cost of healthcare that they pay for out of their own pockets. I am very hopeful that our bill, with 55 proposals from 65 Senators, which has been reported to the Senate floor, will be placed by the majority and minority leaders on the Senate floor before the end of the month. We can pass it, the House will do their job, and we can send it to the President to lower prescription drug costs. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I ask unanimous consent that a copy of my opening statement at the Senate Health Education, Labor and Pensions Committee be printed in the Record.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I ask for the yeas and nays.

Mr. ALEXANDER

Mr. ALEXANDER. Reserving the right to object, this is the latest Democratic attempt to raise the cost of healthcare paid for out of your own pocket by taking away an ability to provide lower cost health insurance that preserves preexisting condition protection and the essential health benefits. These short-term health benefits were available under President Clinton. They were available under President Bush. They were available under President Obama right until the last few months of his office, when he cut them down to 3 months long. President Trump has simply said that you may now have them up to a year and renew them for 3 years. If you live in Fulton County, GA, your insurance costs will be 30 percent less against the typical ObamaCare bronze plan and even more against the silver plan. This is the latest Democratic attempt to increase the cost of what you pay for healthcare out of your own pocket. Their next attempt will be Medicare for All, which, if you have health insurance on the job, will take that health insurance away. I object.

Mr. ALEXANDER. Mr. President, will the Senator yield for a question?

Mr. ALEXANDER. Mr. President, is the Senator of Wisconsin not aware that the short-term healthcare plans do not change the law of preexisting condition?

Mr. ALEXANDER. Mr. President, may I----

Mr. ALEXANDER. She gave the wrong answer, Mr. President.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, reserving my right to object, section 1332 is the innovation waiver that is part of the Affordable Care Act, passed by the Democratic majority. That act includes protection for preexisting conditions. Using the flexibility granted under section 1332 does not change anything about preexisting conditions. So it is misleading to the American people to suggest that it does. This is another Democratic attempt to make it more expensive, to cost more for what you pay for healthcare out of your own pocket by taking away flexibility from the States to find a less expensive way for you to afford healthcare and, at the same time, not changing the preexisting condition protection that is provided by the Affordable Care Act. This is the latest attempt to do it, but the boldest attempt to raise the cost of your healthcare is Medicare for All, which if you have insurance on the job, as 181 million Americans do, would take that insurance away from you. I object.