Lamar Alexander

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I have been working very hard with Senator Harkin, members of the HELP Committee, and members of the House Energy and Commerce Committee on legislation to provide options for patients and providers who want compounded drugs made in FDA-regulated facilities. As we debate this bill today, I want to make clear that all involved on this legislation have no intent of limiting patient or provider access to quality compounded drugs that fill a clinical need. The process in the HELP Committee began as soon as news of the outbreak broke in Tennessee, and I cannot thank enough the folks at the Tennessee Department of Health, including Dr. Kainer, for all their good work that prevented so many further cases and lives being destroyed. We have been working very hard to reach an agreement on how compounding should be regulated--and we have come a long way. Stakeholders including pharmacists, public health groups, and the FDA, have been sitting around a table to find a consensus solution. We have made good progress, and I want to talk about this legislation. For traditional pharmacy, currently regulated under 503A of the Food, Drug, and Cosmetic Act, we strike the provisions found unconstitutional by the Supreme Court related to marketing. In addition, and what will help prevent another New England Compounding Center, NECC, the Drug Quality and Security Act establishes a completely separate and distinct section 503B that authorizes FDA to regulate an optional category for larger compounding facilities. Sterile compounding facilities that do not want to comply with the patchwork of State laws and requirements can choose instead to have FDA regulate their compounding. 503B establishes rigorous quality standards, registration, adverse event reporting, inspections, and fees. If there are unintended consequences to this legislation, I stand ready to work with my colleagues and provide necessary oversight. It has been almost 10 years since the Supreme Court decision that left a great deal of uncertainty in the regulation of pharmacy compounding. We clarify that 503A applies nationwide, and create an FDA regulated source for sterile compounded drugs. Nothing in the legislation is intended to limit access to quality compounded drugs for providers and patients or alter the practice of medicine but, rather, create a whole new alternative for safe sources of sterile compounded drugs that are held to a nationwide quality standard. The legislation does not change current law on office use compounding or repackaging. Chairman Harkin will discuss the importance of this language, and I thank him for working with me so hard on this over the last year.

Mr. ALEXANDER. Mr. President, I thank my friend Dr. Coburn for his remarks, concern, and assistance with this legislation. I agree with him, and want to clarify that nothing in this legislation will constrain a doctor's options to practice medicine. The legislation tries to ensure that if a doctor or patient needs access to compounded drugs, that there is an FDA-regulated source for those drugs where the quality standards are uniform nationwide. Doctors know their patients best and should have access to accurate information on the safety and quality of the drugs they use. If there are unintended consequences to this legislation, I stand ready to work with my colleagues and provide necessary oversight.

Mr. ALEXANDER. Mr. President, I rise today to speak about the Drug Quality and Security Act and also to thank the members and staff who have worked with us to reach an agreement and pass this bill. The legislation addresses the current ambiguity around the regulation of compounding pharmacies, one of which is tied to more than 60 deaths. It also establishes a workable system to get to unit level tracing of the nearly 4 billion prescriptions filled a year in the U.S. within a decade. In addition to bipartisan support in Congress, the bill enjoys broad support from the biomedical industry, patient groups, consumer groups, and other stakeholders. Over a year ago, staff began to work on identifying the cause and possible solutions to help prevent another meningitis outbreak. A group of staff from Republican and Democratic offices on the Health, Education, Labor, and Pensions Committee began a series of standing meetings and proceeded to meet every week for several months. They met with stakeholders and discussed policy solutions that each member thought would solve the problem. After much discussion of the benefits, costs, and possible unintended consequences, members agreed to a list of policy concepts. That bill, S. 959, is a strong bill, and was voted out of committee unanimously. While I believe our Senate bill was a stronger solution, it would not have gotten through the Chamber on the other side of the Capitol. We held bipartisan and bicameral meetings throughout August to try to find a consensus that could pass both Chambers, and that legislation is what you see before you. Is it perfect? No, but I believe it is a good first step and a market-driven solution to this terrible tragedy. I would like to thank Senator Harkin for his tireless work on this bill, along with Chairman Upton and Ranking Member Waxman of the Energy and Commerce Committee. Senator Harkin's staff has also worked tirelessly on this bipartisan bill. They worked many late evenings, long weekends, and through countless discussions to get the bill to where it is today. Specifically, I want to recognize and thank Jenelle Krishnamoorthy, Elizabeth Jungman, and Nathan Brown. I also want to thank Pam Smith, Senator Harkin's staff director, for her leadership in getting this bill to the finish line. I also would like to thank Jennifer Boyer with Senator Roberts and Hannah Katch with Senator Franken for all their help as well. Senators Bennet and Burr were instrumental in the drug tracing title on which they have been working for almost 2 years. Rohini Kosoglu with Senator Bennet and Anna Abram and Margaret Coulter with Senator Burr worked very hard to craft this section, and I would like to thank them, too. I would also like to thank our Senate legislative counsels Stacy Kern Scherer and Kim Tamber, and from the Congressional Budget Office Julia Christensen, Jean Hearne and Ellen Werble. Finally, I would like to thank my staff--Grace Stuntz, and my Health Policy Director, Mary-Sumpter Lapiniski. I also want to thank my staff director, David Cleary, for his work on this bill. My staff has been working around the clock for many days and weeks, and I sincerely appreciate their dedication to getting this bill passed. I know Members are pulled in many different directions and there is always a lot of work to complete. We have a bipartisan bill that we believe will pass the Senate later today and passed the House on Saturday, September 28th, that takes a big step in addressing the regulation of compounded drugs and preventing counterfeit, stolen, and substandard drugs from reaching consumers. I urge my colleagues to support this compromise.

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, this afternoon the Senate passed and sent to the President legislation that Tennesseans and Americans will welcome because it deals with the terrifying fungal meningitis outbreak that occurred more than a year ago that killed 16 Tennesseans and made many others sick. The problem at that time was sterile compounded drugs that turned out not to be sterile. So when they were injected into patients for back pain or neck pain, those tainted drugs caused fungal meningitis and caused a number of Tennesseans to die and many others to become sick. Had it not been for the heroic efforts of the Tennessee State Department of Public Health, many others across the country may have been injected with that tainted medicine and become sick. This is a very important piece of legislation which Senators and House Members have been working on for a year. I am glad it passed. I am sure the President will sign it. In our State, we know how personal this was. There is the story of Diana Reed from Brentwood, TN, who was the caregiver for her husband, who has Lou Gehrig's disease. She had neck pain--maybe because of helping him in and out of a wheelchair-- went to the doctor, and got an injection for her neck pain. The next thing she knew, she had fungal meningitis and she died. Still, her husband with Lou Gehrig's disease lives on. That story has been told in many States. We have been told by the Commissioner of the Food and Drug Administration that if we do not act, it will happen again. If we do not act, Commissioner Hamburg said, the question is not if but when there will be another tragedy. We have acted. No one should believe we can guarantee such a tragedy will never happen again, but for two reasons, it is much less likely we will have another tragedy like fungal meningitis as the result of contaminated drugs. No. 1, we have cleared up the question of accountability. After this happened, and it was discovered that the tainted drugs came from the Massachusetts compounding pharmacy, there was a lot of finger pointing back and forth between the FDA and the State board about who should have been regulating this pharmacy, because there were other trouble signs. This never should have happened and would not have happened if they had been either properly regulated either by the State or the Federal agency, the FDA. That often happens when there is not accountability, when it is not clear who is on the flagpole, as I like to say--when it is not clear who is in charge. We have used the example of Admiral Hyman Rickover, who was a Navy officer. In the 1950s, when he was assigned the job of the nuclear Navy, he told his captains two things: No. 1, you are in charge of the ship; and, No. 2, you are in charge of the reactor. If anything goes wrong with the nuclear reactor, your career is over. As a result of that level of clear accountability, since the 1950s there has never been a death as a result of a reactor accident on one of our nuclear ships. This legislation creates that kind of accountability for compounded drugs. It preserves the traditional role of States to regulate drugstores. Compounding is something almost every drugstore does. We have 60,000 of those, and that is an important job to the States. Most States do an excellent job. It preserves the role of the Food and Drug Administration for manufacturers, those who manufacture large amounts of drugs which are prepared without an individual prescription. But it creates a new sort of facility which we call outsourcing facility. This facility is regulated by the FDA. Two things have happened. One is either the FDA or the State is in charge of a compounding pharmacy. It will be one or the other. The second is there is a new outsourcing facility. A doctor or a hospital in Virginia or Tennessee may choose to buy all of its sterile drugs, for example, from a compounding pharmacy that is regulated by the FDA. It doesn't have to, but it may choose to do that. We believe many will choose to do that, particularly with the sterile drugs that are sent across State lines without a prescription. This legislation affects the health and safety of millions of Americans. There was a second part this legislation that was passed this afternoon that is equally as important and in some ways more far- reaching. We call it track and trace. That is the shorthand name for it. Four billion prescriptions are written every year. What this legislation does is attach a serial number to each drug that is manufactured and follows it all the way from the drug manufacturer to the individual pharmacy. Why is that important. It is important so that one will know, if given a prescribed drug, that it works, is not counterfeit, and that it is safe. It will take several years to implement this, but the drugs that make the 4 billion prescriptions will now be able to be tracked and traced from the manufacturer to the pharmacy. Many of our disputes are well advertised around the Senate. In fact, one could argue that is what we are for--the resolution of disputes. If there weren't a dispute, we probably wouldn't be here. We would work everything out at the city council, the Governor's office or somewhere else. The big issues of the day stand here. Some of those are hard to resolve. ObamaCare is hard to resolve, fixing the debt is hard to resolve. We have very different points of view. On this issue, which was difficult to do, we worked for more than 1 year on the compounding pharmacy bill and more than 2 years on the track-and-trace bill. It was very difficult to do. We were able to do it. I commend Senator Harkin, who is chairman of our committee, Senator Franken, Senator Roberts, Senator Burr, Senator Bennet, and many other Members of the committee. We were able to involve many people in it and come out with the unanimous recommendation of our committee, and it was unanimous today. Just because it was unanimous, I don't want anyone to think it was easy. It was hard work. Because it was unanimous, I don't want anyone to think it is not important. It is important in Tennessee to those 16 families who had a family member die. It is important to the dozens of families with a member of their family who is sick because of those injections. It is important to those families who may still become sick in our State and other States. No. 1, it is important to know after this who is on the flagpole. It is either the FDA or the State agencies, and there will be no more finger pointing. No. 2, any doctor or hospital that chooses to buy its sterile compounded drugs that are shipped interstate in large amounts without prescription from an FDA-related facility may do that. This is a day of results in the Senate, which I am pleased to see. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, The Tennessean reported on Tuesday morning in its headline that the State's largest underwriter is notifying 66,000 clients that their policies don't meet ACA coverage requirements. In other words, they are losing those policies. I have a letter from a woman, Emilie, who lives in Middle Tennessee who was 1 of 16,000 Tennesseans who are part of another plan called CoverTN. She is losing her policy. She says: I am a 39 year old single woman with a chronic illness, Lupus. I worked my way through college. As a person with a chronic illness that was deemed ``uninsurable,'' the only way I was able to obtain health insurance was through an employer based program called CoverTN . . . Although some call it a minimal coverage plan, it has been stellar AND affordable . . . I was excited to hear about the Affordable Health Care Act. I was glad to hear that ``uninsurables'' could no longer be denied coverage . . . unfortunately [that] is NOT TRUE. I cannot keep my current plan because it does not meet the standards of coverage. This alone is a travesty. CoverTN has been a lifeline. With the discontinuation of CoverTN, I am being forced to purchase a plan . . . that will increase [my costs] by a staggering 410%. My out of pocket expense will increase by more than $6,000.00 a year. Please help me understand how this is ``affordable.'' I beg of you to continue the fight for those, like me, who would only ask to be allowed to continue to have what we already enjoy. A fair health insurance plan at a fair price. That is from Emilie, who is a 39-year-old woman from Tennessee. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. On behalf of the people of Tennessee, whom I represent, and the American people, as well, I wish to thank the Senator from Iowa for his leadership on these two bills, but particularly on the compounding pharmacy bill. Our differences of opinion in the Senate are well advertised on ObamaCare, on debt, on Syria, and on a whole variety of matters. In fact, one would say the reason we exist is to debate the big issues that haven't been resolved somewhere else. There is another aspect of the Senate that is rarely well advertised, and that is when we get a result. Sometimes the results take a long time, involve a lot of people, and are very difficult to reach, and that is the case with this bill. Had not Senator Harkin been patient, as well as aggressive at the same time, in working with Republicans and Democrats and with Members of the House, we would not have reached this point today. It is important to call the attention of the American people to this result, these two pieces of legislation. One makes it clear who is in charge, as Senator Harkin said, who is on the flagpole when it comes to making sure the sterile drugs that are injected into your back--because a person has back pain--are safe so that they don't end up with a horrible death from fungal meningitis. Who is responsible for preventing that? The second bill is how are we going to make sure the 4 billion prescriptions we have every year in this country are safe, that they are not stolen, and that they do what they are supposed to do. How are we to make sure we can track them all the way from the manufacturer to the pharmacy who dispenses them? We have been working on these bills for 2 years. Lest anyone think that because it was a voice vote in the House and because we are close to unanimous consent in the Senate that it was easy to do, it is not that easy to do. In fact, it is worth going through how this happened before I say just a word to add to what the Senator said about the importance of bills. The FDA became involved in the fungal meningitis issue in September of 2012, 1 year ago, after reports from Tennessee that fungal meningitis was tied to a sterile compounded drug. This hits home to many Americans because a great many Americans have been injected in their necks, their backs, or their feet with a drug that is supposed to be sterile. If it is not, it could have terrible consequences. Immediately, Senator Harkin called a hearing. November 15, 1 year ago, we had our first hearing. Within 6 months we released draft legislation to address the compounding pharmacy issue. We then had a hearing on that legislation. Then we passed the legislation after a lot of comment, all in the open. Everyone had a chance to weigh in. We passed it unanimously. This committee on which we serve, Health, Education, Labor and Pensions, probably reflects the widest span of ideological differences we have in the Senate. The Republicans can be very conservative and the Democrats can be very progressive or very liberal, so one would think it would be hard to get a unanimous agreement, but we did. The House went to work and came up with their own version of the bill, taking our work into account. We then worked with them through the summer to reach an agreement on how to reconcile the two. The House passed it by a voice vote and sent it to us. Today we have a piece of legislation that has been hot-lined. That means that both sides have sent it around to every single office. All but one Senator have agreed we can pass it by unanimous consent. The Senator has that right, as I have that right, the Senator from West Virginia, and the Senator from Iowa has that right, and sometimes we exercise that right. Later this afternoon we will be having a cloture vote, a vote to move to this bill. That cloture vote is going to succeed. There will be a sufficient number of Republican votes and a sufficient number of Democratic votes to say we are ready to deal with this. Why are we ready to deal with this? Because Commissioner Hamburg of the Food and Drug Administration told us at our hearing what would happen if we don't. She said: We have a collective opportunity and responsibility to help prevent further tragedies. If we fail to act, this type of incident will happen again. It is a matter of when, not if, I'm afraid. If we fail to act now, it will only be a matter of time until we're all back in this room asking why more people have died and what could have been done to prevent it. No one is saying this legislation is going to guarantee that there will never ever be a tragedy again, but it will help prevent future tragedies. It will take up the responsibility she challenged us to do. We have spent 1 year on it, so many people have been involved, and it is time we move to do it. My hope is that after the cloture vote tonight, very soon thereafter, after everyone has had a chance to speak and say what they have to say, that we can pass this by unanimous consent, send it to the President, and say to the American people that our differences are well advertised, but our results can be equally important. We can pass a piece of legislation which, when taken with the track-and-trace legislation which accompanies it, affects the health and safety of every single American, period. I know the people of Tennessee would welcome a prompt solution to this, and this is what I hope we have. Senator Harkin, as he often does, spoke in very personal terms about this legislation. I want to tell one story from Tennessee so we know what we are talking about. Diana Reed, 56, of Tennessee, had tried massage and acupuncture, but neither eased her neck pain. One of the potential causes for her pain was an injury sustained while helping her husband, who has Lou Gehrig's disease, in and out of the wheelchair. Diana Reed was healthy, either ran or swam every day, in addition to becoming Wayne's arms, legs, and voice, according to her brother, Bob. She decided to try a series of epidural steroid injections for her neck problems before her health insurance ran out after losing her job at a nonprofit group. This decision ended her life on October 3 of last year. She began receiving injections August 21, with a total of three scheduled, one every 2 weeks. She felt pain and nausea for a full day after the first two injections. After the third she began having headaches. September 23, she finally agreed to go to a doctor and was quickly diagnosed with meningitis. While she remained stable for a few days and was mostly concerned about her husband's well-being--remember, he has Lou Gehrig's disease--and getting home to him as soon as possible, she took a turn for the worse. Her speech began to slur, she had trouble seeing, and eventually she had a stroke. One day later she was in a coma. One thousand people packed Otter Creek Church for her funeral, among them the alumni of a childcare learning center for inner-city preschoolers that she and her husband had founded. The autopsy found fungal meningitis at the injection site and in Mrs. Reed's brain. Mr. Reed has a rare form of ALS that worsens more slowly, and his mind has not been affected. Diana Reed would help him get in and out of bed, the shower, and his wheelchair. She became more instrumental in his accounting business as his speech worsened. After her death, members of their church brought meals, did laundry, and the church accepted donations to hire help to assist Mr. Reed with his personal care. This is only one story of the tragedy that the Commissioner of the FDA says will happen again if we don't act. We believe this bill will help to prevent such a tragedy. Steroid injections last year were meant to ease the pain of hundreds of Americans, and for many Tennesseans, instead, it became their worst nightmare. These vials of compounded medicine were contaminated. Sixty-four Americans, including sixteen from my State, died from the outbreak. It is a horrible way to die. When the HELP Committee held its first hearings on this tragic outbreak in November of last year, we looked at how could this possibly happen. It became clear that these contaminated vials were produced in a facility that was nothing like a traditional pharmacy, a corner drugstore, if you will. It operated more like a manufacturer, but it was unclear which regulator was in charge. Was the State in charge or was the FDA in charge? I made it clear at the beginning of the hearing that my priority was to find a way to clarify who is accountable for large-scale drug compounding facilities, who is on the flagpole for overseeing the safety of drugs made in these facilities. I used the example of Hyman Rickover and the nuclear Navy in the 1950s. Admiral Rickover was doing something new. He was doing something dangerous, potentially dangerous. He was putting reactors on submarines and ships, and no one knew quite how that was going to work. What did he do about it? Admiral Rickover hired the captain. He interviewed the captain and said: First, you are responsible for your ship; and, second, you are responsible for the reactor. If there is ever a problem with the reactor, your career is over. The U.S. Navy has never had a death on a nuclear ship as a result of a reactor problem because everyone knew, after Admiral Rickover made those decisions, who was on the flagpole. There should be no confusion, after this bill is passed and signed by the President, who is on the flagpole for a particular facility that makes sterile drugs. We should be able to walk into any one of our 60,000 drugstores, pharmacies, our doctors' offices, or pain clinics, and not have to worry about whether the medicines we get there are safe. The bill we are voting on represents that year of work we talked about to find a solution. Today we have drug manufacturers on the one hand and traditional pharmacies, the corner drugstore, on the other. This legislation creates a new, voluntary third category which we call an outsourcing facility. If a drugstore chooses to be in this category, they follow one nationwide quality standard, and the FDA is responsible for all the drugs made in that facility. FDA is on the flagpole. What is the advantage of this? First, it eliminates the confusion, it eliminates the finger pointing. If, Heaven forbid, this should happen again, it will be clear whose fault it was, who didn't do their job of regulating. Second, it provides an option available to doctors and hospitals who, if they wish, can choose to buy all their sterile drugs from a facility regulated by the FDA. Outsourcing facilities are subject to regular FDA inspections. The New England compounding center that caused these problems was not inspected by the State or the FDA from 2006 to 2011. Outsourcing facilities must report the products made at the facility to the FDA. The New England center that caused the problems was making copies of commercially available drugs, which is illegal. Outsourcing facilities must report to FDA when things go wrong with a product. Currently, large-scale compounders don't have any required reporting to FDA if they know about a problem with a product. Finally, outsourcing facilities, this new category, must clearly label their products so patients know it is compounded rather than FDA approved. Traditional pharmacy compounders will continue to be primarily regulated by the States, but for outsourcing facilities, the FDA is in charge. During our discussions we heard a lot about drug shortages. The Senator from Iowa and I worked especially to deal with that. We tried to address it where appropriate in this legislation. We know that compounded products aren't the answer to drug shortages. We don't want compounded products to be the backup solution to drug shortages; we want a better answer than that. We recognized the problem and tried to address it. Because of heroic reactions of State officials with the Tennessee Department of Health, more people didn't become sick from the outbreak last fall. I don't intend to sit through another hearing where FDA can point the finger at someone else instead of taking responsibility or claim it doesn't have enough authority, and if we pass this legislation, FDA won't be able to. This legislation also establishes clear rules for outsourcing facilities and puts FDA on the flagpole for drugs made in those facilities. I hope my colleagues will vote this afternoon to move to the bill, and then shortly after that we will be able to move to approve it, as the House did. Just one other comment, Mr. President. The chairman, the Senator from Iowa, and Senator Burr, Senator Bennett, and others have been working for at least 2 years on this form of legislation we call track and trace. It has been through vetting. I think everybody has had a chance to read it and to make a suggestion about it. There have been many changes and adjustments to make sure it works. Here is the problem. In the United States today, we have about 4 billion prescriptions written every year. We don't have a uniform system to track and trace these drugs once they leave the manufacturer, which makes it easier for counterfeits and substandard products to enter the market and puts patients at risk. The laws governing the tracking of drugs haven't been updated since 1988. In the last 2 years alone there have been three cases of counterfeit Avastin--a cancer drug being distributed in the United States to physicians and patients-- where the counterfeit did not contain any of the active ingredient. We have seen an increase in drug theft. We have no way of knowing if and when these drugs are resold in the U.S. supply chain. In 2009 insulin stolen from a truck much earlier was sold by pharmacies, and the insulin was ineffective due to improper storage. Stealing drugs has turned into a big business, and without assurance that drugs are stored under certain conditions and handled correctly throughout the supply chain, the drugs may not work. This legislation would set up a system over time--10 years--where products that are stolen could be flagged as such, preventing distribution to patients. It represents a consensus on establishing a national system for all prescription drugs to have a specific serial number on the bottles. That means wholesalers, repackagers, and pharmacies will be able to check the serial number on the bottle with the manufacturer to see whether that number was assigned by the manufacturer. The serial number will not only help prove it is not counterfeit, but the information can also be used to determine whether anything else has been reported about that bottle, including whether the product was stolen. This won't happen overnight. Creating a system that traces 4 billion prescriptions, made by over 80 manufacturers on over 3,600 manufacturing lines, that are dispensed to patients through a variety of ways will take some time. But the path laid out for us over a number of years will ensure that the U.S. drug supply chain is secure and that consumers receive drugs that work. I want to thank the Senator from Iowa, as I have already, for his leadership on these two extraordinary pieces of legislation; Senator Burr and Senator Bennet on the track-and-trace legislation; and Senator Roberts and Senator Franken worked hard on compounding legislation. Let me end where I began. The FDA Commissioner challenged us. She said that if we don't act, this tragedy will happen again. We have an opportunity to act tonight. I hope we do. The families who were devastated by this tragedy because of contaminated sterile injections that caused fungal meningitis in many of our States, especially in Tennessee, expect us to act. If we do, it will not be as well advertised as the differences of opinion we can have in the Senate, but it will demonstrate how, when we work together over a period of a couple of years, we can take a very big piece of complex legislation-- in fact, two--that affects the health and safety of every American and come to a consensus that takes a large step forward. I thank the Chair, and I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. I thank the Senator from Alaska for her excellent remarks. I was pleased I was able to hear them. The Senator from Alaska and the Senator from Massachusetts were at the hearing this morning when the head of the Centers for Medicare and Medicaid Services talked about the health care law. I thought the Senator from Alaska was especially cogent in pointing out the difficulties and the differences between those who live in Alaska and their inability to connect to the services in the new health care law. If I remember correctly, she said only three had been able to enroll and she pointed out the differences in time. I wish to spend a few minutes reflecting on what happened this morning and what I said to Ms. Tavenner, the administration's witness. I began by telling her a story, a story about 16,000 Tennesseans who have insurance through something called CoverTN, a low-cost, narrow coverage State program. ObamaCare is canceling their policies, those 16,000 policies. CoverTN apparently is an example of what the President has called ``bad apples,'' an insurance plan that Washington has decided isn't good enough for you. I recently heard from one of those Tennesseans whose policy will be cancelled on January 1. Her name is Emilie, and she is 39 years of age. She has lupus and lives in Middle Tennessee. She told me: I cannot keep my current plan because it does not meet the standards of coverage. This alone is a travesty. CoverTN has been a lifeline. . . . With the discontinuation of CoverTN, I am being forced to purchase a plan through the Exchange. . . . My insurance premiums alone will increase a staggering 410%. My out of pocket expense will increase by more than $6,000.00 a year [including subsidies]. Please help me understand how this is ``affordable.'' Our health care system makes up nearly 20 percent of our economy, touching the lives of every American. Today ObamaCare is pushing that 20 percent of our economy in the wrong direction. As the President has said, this law is more than a Web site that will not work. It is a law transforming our health care system in the wrong direction by increasing premiums, canceling insurance plans, destroying patient relationships with doctors, raising taxes, forcing people into Medicaid, spending $500 billion Medicare dollars on a new program instead of using the money to make Medicare more solvent, encouraging employers to reduce their employees to a 30-hour work week, and having the IRS fine Americans for failing to sign up for insurance on a Web site that doesn't work. The President has promised--at this morning's hearing I read from an iPad on the White House Web site. The President's Web site says: ``If you like your plan you can keep it and you don't have to change a thing due to the health care law.'' It says, ``If you like your plan, you can keep it, and you don't have to change a thing due to the health care law.'' In fact, the law cancels millions of individual policies. For millions of others, employers are dropping insurance programs as they discover the added costs of ObamaCare. For these Americans, the new promise is if you want health care, go find it on a Web site that the administration says will not be working properly until the end of November. That is an unwelcome Christmas present, to have only 2 weeks to shop for and buy a new insurance policy by December 15 so people are covered next year when ObamaCare outlaws their policies. This administration had 3\1/2\ years to set up the Web site. Millions of Americans will have 2 weeks to buy their insurance. The President put Secretary Sebelius in charge of implementing this law. I have called on her to resign because this has hurt so many Americans. Before the Internet, RCA could tell us every day how many records Elvis was selling. Ford could tell us every day how many cars they were selling. McDonald's would tell us every day how many hamburgers it sold. Congressman Issa has put on his committee's Web site notes from meetings at an Obama administration war room where apparently they are telling each other how many people are enrolling in health care. I asked Ms. Tavenner this morning if she knew how many people are enrolling, how many have tried, what level of insurance they are buying, and in what ZIP Code they live. Why don't you tell us? Why don't you tell Congress? Why don't you tell the American people? She said she would tell us by the end of the month--but we need to know every day. We need to know every week at least. Governors need to know. As they make decisions about expanding Medicaid, wouldn't it help to know how many of these new enrollees are going into Medicaid? Members of Congress need to know. We have appropriated at least $400 million for this Web site that doesn't work. The American people need to know. They might gain confidence in the system if they could see that every day more people were signing up for this or that. I can't get over the fact that we are not being told how many are enrolled, how many trying, what kind of insurance they are buying, where they live. We have a right to know that. Why doesn't the administration tell us that? One Senator has described the new health care law as an approaching train wreck. I know something about trains. My grandfather was a railroad engineer in Newton, KS, when I was a little boy. I was sure he was probably the most important person in the world sitting in that big locomotive. His job was to drive a steam engine locomotive onto what they called a round table, turn the train around and head it in the right direction. That was the only way you could turn something that big that fast. That is what our country needs to do. We need to turn this train around. We need to turn this law around and head it in the right direction. ObamaCare is the wrong direction because it expands a health care delivery system that we already knew cost too much. What is the right direction? The right direction is more choices and more competition that lowers costs so more Americans can afford to buy insurance. Don't expect Republicans to show up on this Senate floor with our 3,000-page plan to move the health care delivery system in the way we think it ought to go. We don't believe in that approach. We are policy skeptics, one might say. We don't believe these big comprehensive plans are wise enough to do what needs to be done. Instead, we believe we should change our health care delivery system step-by-step. I remember during the health care debate in 2010 I counted the number of times Republicans spoke on the floor about our step-by-step plan to take the health care delivery system in a different direction--173 times just during 2010. These are some of the steps we suggested and still do suggest that we should take to turn the train around and head it in the right direction: Make Medicare solvent. The trustees have said that in 13 years it will not have enough money to pay hospital bills. I know plenty of Tennesseans who are counting on Medicare to pay their hospital bills. Reform Traditional Medicare to compete on a level playing field with Medicare Advantage. That would provide competition and more choices for seniors. The Congressional Budget Office says it would save taxpayers money. Make Medicaid flexible. When I was Governor of Tennessee in the 1980s, Medicaid was 8 percent of the State budget. Today it is 26 percent. As a result, Democratic and Republican Governors of Tennessee have been told by Washington to spend money on Medicaid that they instead would rather spend on higher education. Make Medicaid more flexible. Perhaps we can cover more people and set our own priorities. Encourage employee wellness incentives. We talk a good game in the Senate about that, but the administration's regulation actually limits the ability of employers to say to employees if you have a healthy lifestyle, your insurance will be cheaper. We should repeal that regulation and make it easier for employers to encourage that kind of behavior, and offer cheaper insurance. Allow small businesses to pool their resources and offer insurance together. We call that small business health plans. All of these steps, by the way, are in legislative form. They are bills we have introduced. They are steps we could take today if we had enough votes to pass them, turning the train around and heading it in a different direction. Buy insurance across State lines. If Americans could look on the Internet and buy insurance across State lines that suited their needs, perhaps more Americans could afford insurance. Isn't that what we want to do? Change the 30-hour workweek to 40 hours. Both Democrats and Republicans support this idea. I am not sure where it ever came from, but it is one of the worst features of ObamaCare. It creates a big incentive to cause businesses to reduce the number of working hours from 40 to 30 so their employees will be part-time and the business won't be affected by the ObamaCare rule. That creates consternation within business, and it doesn't create good relations between the employer and the employee. Think about the employee. Think about the pay cut from 40 hours to 30 hours. Think about the employee going out to find another part-time job at, say, another restaurant. Why not give these employees a 33 percent pay increase? That would be a pretty good way to get up above the so-called minimum wage and give businesses a chance to have full-time employees again. So these are all steps that would change the health care delivery system by changing its direction away from expanding a health care system that we know already costs too much and sending it in the direction of choice and competition and finding ways to lower the cost of health care plans so more Americans can afford to buy insurance. The 39-year-old Tennessee woman whom I talked about this morning to Ms. Tavenner, the woman named Emilie who is losing insurance because ObamaCare has decided that her plan isn't good enough for her, finished her story with these words: This is one of the biggest betrayals our government has ever been committed on its citizens. I beg of you to continue to fight for those, like me, who would only ask to be allowed to continue to have what we already enjoy. A fair health insurance plan at a fair price. Please find a way to return to affordable health care. One good way to do that is to put the President's words into law: ``If you like your health plan, you can keep it.'' Senator Johnson of Wisconsin has offered that legislation. I have cosponsored it, as have others. My message to Emilie is that I am going to do my best to turn this train around and head our health care delivery system in the right direction so that she can buy and keep health care insurance that she can afford. I thank the Chair, I yield the floor, and I suggest the absence of a quorum.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, the majority leader says it is time to cut off debate and vote on the President's nominees to fill three vacancies on the District of Columbia Court of Appeals. I will not vote to end debate now because I think such a vote would be premature. Before the Senate has an up-or-down vote on the three judges, there is something else we ought to do first. We should first consider the bipartisan proposal that was made 10 years ago to have the right number of judges on this Federal appellate court. For more than a decade, Senators of both parties have argued that this court has more judges than it needs and that other Federal appellate courts have too few. In 2003, 2005, and 2007, with a Republican President in the White House, Republican Senators Sessions and Grassley introduced legislation to reduce the number of seats on the DC Circuit. In 2006, they were joined by a distinguished group of eight Judiciary Committee Democrats who made the same argument. These included the chairman, Senator Leahy, Senator Schumer, Senator Feingold, Senator Kennedy, Senator Feinstein, Senator Durbin, Senator Kohl, and Senator Biden. When President Bush nominated Peter Keisler to the DC Circuit, the Democrats wrote Senator Specter, the committee chairman, a strong letter. The letter says: We believe that Mr. Keisler should under no circumstances be considered--much less confirmed--by this Committee before we first address the very need for that judgeship . . . and deal with the genuine judicial emergencies identified by the Judicial Conference. The Democratic Senators argued, first, the committee should--before turning to the nomination itself--hold a hearing on the necessity of filling the 11th seat on the DC Circuit, to which Mr. Keisler has been nominated. They cited a number of objections by Senators to the need for more judges on that circuit. They then argued 6 years ago: [That] since these emphatic objections were raised in 1997, by every relevant benchmark, the caseload for that circuit has dropped further. Only after we reassess the need to fill this seat and tend to judicial emergencies should we hold a hearing on Mr. Keisler's nomination. That was the Democratic Senators' position in 2007. These distinguished Democratic Senators were not only forceful in 2006 and 2007, they were persuasive. They worked with President Bush and Congress agreed to reduce the DC Circuit by one seat and add it to the Ninth Circuit, where the caseload was 526 filings per judge--well above the caseload average for all the judicial circuits. In 2007, Senator Feinstein, a Democrat, and Senator Kyl, a Republican wrote: It makes sense to take a judgeship from where it is needed the least and transfer it to where it is needed the most. Mr. Keisler, by the way, was never confirmed. For 2\1/2\ years his nomination was held in the Judiciary Committee, from June 2006 until January 2009. The same arguments made in 2006 and 2007 should be persuasive today. Today, the average caseload for the DC Circuit--even if it were reduced by three judgeships to the eight seats currently occupied-- would be less than one-half the national average for circuit courts. The national average is 344 cases filed per judge this year in Federal appellate courts. The DC Circuit average, if it were reduced to the 8 current judges, would be 149 per year. The national average is 344 cases per year. The DC Circuit average--even if it is reduced to 8-- would be 149 per year, less than half. Since 2005, there has been a decrease of 27 percent in the number of written decisions by an active judge on the DC Circuit. Since 2005, the number of appeals filed in the DC Circuit has fallen by 17\1/2\ percent. Before it considers any of the President's nominees for the DC Circuit, the Senate should do in 2013, today, what Republican President Bush and the Democratic Senate did in 2007; first, consider the appropriate number of judges for the DC Circuit, and then, as Senator Kyl and Senator Feinstein wrote, ``take a judgeship from where it is needed least and transfer it to where it is needed most.'' I heard the argument that the cases in the DC Circuit are more complex than in another circuit, and therefore the caseload ought to be lighter. With eight judges, it will be a lot lighter--half the national average for circuit courts. That ought to allow plenty of time to write decisions in complex cases. Other circuits have complex cases as well. For example, the Second Circuit, including New York, regularly handles many of the most complex cases that come to the Federal courts. Finally, there are a number of senior judges who are active in the DC Circuit--that is true in almost all the circuits, and that is part of the way our system works today. They can carry some of the workload when that becomes necessary. I think it is striking that even if this court only has eight seats, that the average caseload is less than half of the national average. So why does it need three additional judges? That is the question Democratic Senators asked in 2007, and that is what the Senate and President Bush addressed. That is the question we should be asking today before we fill any more seats for an underworked circuit court. So I will not vote to end the debate on the President's nominees until the Senate does in 2013 what Democratic Senators suggested and what the Senate did in 2007: Assess the need for judges on the DC Circuit and transfer judges from where they are needed least to where they are needed most. That means that before we act on the President's three nominees, the Judiciary Committee and the full Senate should consider Senator Grassley's legislation that would transfer one judge to each of the overworked Second and Eleventh Circuits and eliminate one judge, leaving the DC Circuit with a caseload that still is less than half the national average for the eight remaining judgeships. Then, if there are still vacancies to be filled in the DC Circuit, the Senate can consider them one by one. The Senate has treated President Obama very well in considering his nominations. According to the Congressional Research Service, as of August of this year President Obama's Cabinet members were, on average, 54 days--moving from announcement to confirmation at about the same pace as those of President Bush and President Clinton. As far as President Obama's judicial nominees, President Obama has had 38 article III judges confirmed at this point in his second term, including 9 circuit judges, 25 district judges, and 4 judges to other article III courts. By comparison to those 38, President George Bush had 16 article III judges confirmed, 7 circuit judges, 7 district judges, and 2 judges to other article III courts. What about a waiting list of judges who are waiting to be confirmed by the Senate? Is there a big backlog? The answer is no. As of today, only two circuit judges have been reported by the committee and await floor action. Remember, the committee is controlled by Democrats and they can report whomever they want. Both of these are for the DC Circuit and are not judicial emergencies. Only seven district court nominations await floor action. None have been waiting long. Three were reported in August, and four were reported in September. So while there are always a few nominations that provoke controversy and take a while to consider, one of the Senate's most important and best known powers is the constitutional authority to advise and consent on Presidential nominations. That is a part of the checks and balances our Founders set up so we didn't have a king, we didn't have a tyranny. We made it slower. We gave the President the right to nominate, but the Senate has the right to advise and consent. Sometimes that takes a while. Sometimes those nominees are rejected. I believe and have argued consistently that with rare exceptions, Presidential nominations deserve an up-or-down vote after an appropriate time for consideration. President Obama's nominations have been receiving timely up-or-down votes. But first, as Senators of both political parties have argued for 10 years, we should make certain we have the right number of judges on the court. We don't have money to waste in this country with the debt we have today. We should transfer judges from where they are needed the least to where they are needed the most. That is the sensible thing to do. The President's nominees for the DC Circuit will receive up-or-down votes insofar as I am concerned unless there are exceptional circumstances. I ask unanimous consent to have printed in the Record the letter of July 27, 2006, from eight Democratic Senators to Chairman Arlen Specter suggesting that the hearing on Mr. Keisler be postponed until the Senate had considered the number of judges on the DC Circuit. I ask unanimous consent to have printed in the Record as well ``Additional Views of Senators Feinstein and Kyl'' which were written at that time.

Mr. ALEXANDER. Mr. President, I come to the floor today to give thanks and show respect to World War II and Cold War heroes who served in our Nation's nuclear weapons programs on this fifth National Day of Remembrance. They weren't serving in the heat of battle but in the laboratory, handling materials on a daily basis that ranged from benign to toxic and highly radioactive. These materials posed risks that many scientists did not understand at the time. Today in Oak Ridge, TN, the American Museum of Science and Energy, and Cold War Patriots are gathering to celebrate former workers and view a quilt that honors nuclear workers for their contribution to America's safety. This one-of-a-kind remembrance quilt has 1,250 commemorative handwritten quilt squares that form an American flag that measures 17 feet by 11 feet. I want to specifically remember Bill Wilcox for his service to our country and passion for preserving Oak Ridge history. Bill passed this September. Bill was a former manager of the K-25 operations, a Manhattan Project veteran, and the official historian for the city of Oak Ridge. In 1943, Bill was hired by Tennessee Eastman on a ``Secret, secret, secret!'' project in an unknown location. When he started at Eastman he was told: As chemists you'll have to know that you'll be working [on] this project with a substance called uranium. That is the last time that you will hear that word or you will speak it until after the war. And if you are ever heard speaking the word you will be subject to discharge from our employment immediately, and very likely prosecuted by the United States government, and may end up in jail. Is that clear? In Oak Ridge ground was broken for the Y-12 plant in February of 1943, and by the end of the summer they started installing complex physics machines, called calutrons. About 1,000 calutrons were installed at Y-12. How were these calutrons operated? Tennessee Eastman said that the calutrons couldn't be run as an experiment but should be run like an industrial plant. Rather than manuals, there should be a simple red line on meter A. The operator would turn knob A until the needle is on the red line on meter A. However, General Leslie Groves, head of the Manhattan Project, along with physicists disagreed. So they took five calutrons and ran them for a week with the best physicists and then another week with girls right out of high school that kept the needle on the red line of the meters. ``After a week the girls had won hands down in terms of productivity.'' These women were called the ``calutron girls.'' One calutron girl first learned of the war effort in Oak Ridge when she was at a cafe in Sweetwater, TN. She was working in a hardware store at the time. The store had a big window where people from the surrounding counties put photos of their sons who went away to war. She had the job of straightening up the photos when the heat from the window caused the cardboard frames to buckle. With great dignity, the families would take down the pictures of their fallen soldiers. Wanting to help the war effort, she went to Oak Ridge, where there was ``mud everywhere, and green Army trucks, and vehicles, and soldiers, and that was just inside the gate.'' As a calutron girl, she wore a blue uniform. The chemical workers wore white. She said: You weren't allowed to go in the other room . . . you'd stick out like a sore thumb, a blue something in a white- uniformed place . . . But they let us go over--towards the end . . . they told us to take all the bobby pins out of your hair before you go out there because it would yank your bobby pins out. She remembers: You couldn't talk. You couldn't say anything to anybody about where you worked, what building, when you left the plant. In fact, there were huge banners up all over the plant: `When you leave here what you see here stays here.' And you weren't allowed to tell even . . . somebody [that] worked on the same thing you did. There were signs everywhere: ``Keep your mouth shut!'' ``Loose lips sink ships!'' ``See no evil; hear no evil; speak no evil'' with posted fines of $10,000 and warnings of jail time. One of the things that was curious about Oak Ridge was that these rail cars came in every week, but nobody ever saw any product going out. The reason was that the product went out in a standard-sized briefcase every week chained to the wrist of a military officer, in plainclothes. He would get on the train and go to Chicago to exchange the briefcase. During 1945, a different process at the K-25 building was surprisingly successful and cost less than 10 percent of the cost of the Y-12 process. The K-25 building was a mile-long U-shape--once the world's largest buildings under one roof. The operators had to use bicycles just to get around their building. The successful K-25 process ran full blast for another 20 years, while the Y-12 plant received a new mission. These efforts along with others by our nuclear weapons workers across the country won World War II and the cold war. At the peak of the Cold War, nearly 600,000 workers across the country were involved in the research and production of nuclear weapons. Today, many former nuclear weapons workers are retired. Many of them are sick. Some are dying. The government is helping these sick nuclear workers through the Energy Employees Occupational Illness Compensation Program created by Congress in 2001. This program provides compensation to those who were exposed to radiation and toxic materials while building our nuclear weapons, especially those that were instrumental in our winning the cold war. This program receives claims from all 50 States nearly 100,000 individual workers. This program is especially important to Tennessee. Tennessee has the highest number of claims than any other State--over 14,000 workers. Tennesseans, mostly former workers at Oak Ridge National Laboratory, Y- 12 and K-25, have received over $1.7 billion in compensation and paid medical bills, according to the Department of Labor. Today, the nuclear workers across the country continue this heroic legacy to advance nuclear power, nuclear medicine and other technology that continues to make our lives better and keep our country safe. So I am privileged to work with Senator Mark Udall in honoring these patriots who worked countless hours with little-understood hazardous materials to build our country's nuclear deterrent. Mr. President, I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I thank the Senator from Utah. If that suits his convenience, I appreciate that courtesy very much. I will not take more than 8 or 10 minutes. The President should ask the Secretary of Health and Human Services, Kathleen Sebelius, to resign her position because of the disastrous rollout of ObamaCare. Taxpayers have spent $400 million to create exchanges that--after 3\1/2\ years--still don't work. As a result, the White House had to announce last night that the key enforcement mechanism to their individual mandate--a $95 fine that increases every year--will be waived until the end of March of next year. That may be fine for those currently without insurance, but for the millions being forced into the exchanges and losing their current insurance, there is no relief, just higher prices, a likely lapse in insurance coverage, a broken Web site, and broken promises. We already know of 1.5 million Americans who are losing their policies because starting January 1, many insurance policies they now have will not be legal under ObamaCare, and because the exchange will not be working, they will not be able to choose another policy. This chart gives an example of what is going on. Just in three States-- California, Florida, and New Jersey--there are 1.4 million insurance policies that will not be valid after January 1 because they are not legal under ObamaCare. Compare that number, 1.4 million, to the number of Americans in those three States who have reportedly applied or enrolled on the Web site for insurance, 7 or 8 percent of all the people who will lose their current policy have applied for a different policy through the exchange. That is what is going on with families across this country as people worry about health care. These are policies in the individual market. There are 19 million Americans in the individual market. We also heard on NBC News over the last couple of days that the Obama administration knew that 47 to 60 percent of the policies in the individual market would not be legally offered under ObamaCare. Yet they still said to people: ``If you like your insurance, you can keep it.'' At some point there has to be accountability. Expecting this Secretary to be able to fix what she has not been able to fix during the last 3\1/2\ years is unrealistic. It is throwing good money after bad. It is time for her to resign and for someone else to take charge. No private sector chief executive would escape accountability after such a poor performance. The principle of accountability is not and should not be foreign to the public sector. Admiral Hyman Rickover, father of the nuclear navy, told his submarine captains they were not only accountable for their ships, they were also accountable for the nuclear reactors on their ships. If anything went wrong with the reactor, their career in the Navy was over, the Admiral said. As a result of that dose of accountability, since the 1950s, there has never been a death as a result of a problem with a nuclear naval submarine reactor. Americans deserve that kind of accountability in the implementation of the new health care law. Instead, the Secretary appears not even to have told the President about known problems with the ObamaCare Web site in the months and days leading up to the launch. Despite repeated requests, she has refused to tell Congress or the public the reasons the ObamaCare Web site continues to fail, while insisting on more time and an undisclosed amount of money to fix it. Before the Internet, RCA knew how many records Elvis was selling every day, Ford knew how many cars they were selling every day, and McDonald's could tell us how many hamburgers they were selling each day. Yet, here we are in the advanced stages of the Internet age and, under Secretary Sebelius's leadership, the Obama administration will not tell us how many Americans have tried to sign up for ObamaCare, or how many have actually signed up, or what level of insurance they have purchased, or in what ZIP Code they live. Not only will they not tell us, they have done their best to keep us from finding out. With WikiLeaks and Edward Snowden spilling our beans every day, what is happening on the ObamaCare exchanges is the best kept secret left in Washington, DC. The National Security Agency could learn some lessons from Secretary Sebelius. Later today I will ask unanimous consent to approve a six-page bill I introduced yesterday to require the administration to answer these questions every week. Secretary Sebelius is not responsible for enacting ObamaCare, but she has been responsible for 3\1/2\ years for implementing it. Now many Americans have only a few weeks to purchase new insurance or be without health insurance. To expect the Secretary to correct in a few weeks what she has not been able to do in 3\1/2\ years is unrealistic. It is time for the President to ask the Secretary of Health and Human Services to resign. I thank the Chair and yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, before the Internet, RCA knew how many records Elvis was selling every day. Before the Internet, Ford knew how many cars they were selling every day. Before the Internet, McDonald's could tell you how many hamburgers it sold each day. Yet the Obama administration cannot tell us how many Americans have tried to sign up for ObamaCare. They can't tell us how many people have tried to sign up for ObamaCare. They haven't told us what level of insurance they bought or in what ZIP Code they live. Not only can they not tell us, they have done their best to keep us from finding out. With WikiLeaks and Edward Snowden spilling our beans every day, what's happening on the ObamaCare exchanges is the only secret left in Washington. The National Security Agency should learn some lessons from Secretary Sebelius. We shouldn't have to rely on anonymous sources to get basic information about what's happening with the ObamaCare exchanges. Yesterday I introduced legislation to require the administration to tell Congress and the American people how many people have tried to sign up, how many did sign up, what level of insurance did they buy, in what ZIP Code do they live, and what the administration is doing to fix the problems. This isn't complicated information. In the Internet age, the administration ought to be able to provide this information every day. They should be able to provide it really every minute. We shouldn't have to pass a law to find these things out. So I hope every Senator will support my legislation. It is a six-page bill. It has been available to the public now for 24 hours. It is easy to read. The stakes are high for every American. So I ask unanimous consent that the Committee on Health, Education, Labor, and Pensions be discharged from further consideration of S. 1590, a bill to require transparency in the operation of the American health benefit exchanges, and that the Senate proceed to its immediate consideration. I further ask unanimous consent that the bill be read a third time and passed, and the motion to reconsider be considered made and laid upon the table.

Mr. ALEXANDER. Madam President, I thank my friend, the Senator from Iowa. I'm disappointed--this administration described itself as the most transparent in history. All we have asked for is how many people are signing up, how did they do, where do they live, and what level of insurance do they have. We ought to know that. Taxpayers ought to know it. So we'll keep trying other ways to get the information the American people deserve to have. I thank the President, yield the floor, and note the absence of a quorum.

Mr. ALEXANDER

Mr. ALEXANDER. I yield the floor.

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

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, tomorrow, according to the statement made by the majority leader, we will be voting on the nomination of Richard Griffin, Jr. for General Counsel of the National Labor Relations Board. I will be voting against Mr. Griffin's nomination for general counsel because I am concerned about the direction of the NLRB as an advocate more than an umpire, and I do not believe his presence as the general counsel will improve that situation. As the senior Republican on the Labor Committee, working with my friend, the chairman, Senator Harkin, and with others, what I hope we can do over the next several years is look for a long-term solution for the restructuring of the National Labor Relations Board--one that will ensure that it will operate more as an umpire than as an advocate, whether the President is a Democrat or a Republican. The Board has become far too politicized under recent administrations. This did not start with the Obama administration, but it has gotten worse with this administration, and it has moved more and more toward the side of union advocacy with such major shifts as ambush elections, micro-unions, and undermining State right-to-work laws. Swinging back and forth on important labor policy issues does the American working man and woman no good in this time of underemployment and unemployment. So, later this fall, I will join other Senators in introducing legislation that will restore balance to the National Labor Relations Board--a proposal that will retain the rights of workers and employees, but reduce the swing that occurs from administration to administration based upon who is in power. What we should be striving for is fairness and consistency. There are exceptions, of course, but as a general proposition, I believe a President should have an up-or-down vote on his nominee, so I intend to vote for cloture. But Mr. Griffin's nomination does not do enough for me to show the promise of moving the Board from advocacy toward umpire and, therefore, I do not intend to vote to confirm his nomination. I thank the Presiding Officer and I thank Senator Harkin for his courtesy in allowing me to go first. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, before the Internet, RCA knew how many records Elvis sold every day. Before the Internet, Ford knew how many cars they were selling every day. Before the Internet, McDonald's could tell you how many hamburgers it was selling every day. Yet the Obama administration cannot tell us how many Americans have tried to sign up for ObamaCare. They can't tell us how many Americans did sign up for ObamaCare. They can't tell us what level of insurance they bought, nor can they tell us in what zip code they live. They told us that 20 million Americans have visited the ObamaCare Web site. They have the basic information to shop, but how many have tried to sign up? How many did sign up? Where do they live? What kind of insurance did they buy? Not only have they not told us, they have done their best to keep us from finding out. With WikiLeaks and Edward Snowden spilling our beans every day, what is happening on the ObamaCare exchanges is the biggest secret left in Washington, DC. The National Security Agency could learn lessons from Secretary Sebelius. We should not have to rely on anonymous sources to get basic information about what is happening with ObamaCare. Therefore, I am introducing legislation today to require the administration answer the following questions every week: How many people tried to sign up? How many people did sign up? What level of insurance did they buy? In what ZIP code do they live? What are they doing to fix the problems? This is not complicated information. In the Internet age, the administration ought to be able to provide this information not every week but every day. In fact, they should be able to provide it every minute. We should not have to pass a law to find these things out. I hope that every Senator will support this simple request that this legislation makes. It is a six-page bill. I will put it in the Congressional Record today, and everyone will have a chance to read it tomorrow. After everyone has had a chance to read it, I intend to ask unanimous consent to pass it. This Congress--both sides of the aisle--is dedicated to transparency. This administration has described itself as the most transparent administration in American history. So why should we not unanimously pass legislation to ask for the most basic information about what is happening on the ObamaCare exchanges? Health insurance companies say that in order to guarantee that everyone has a chance to sign up for insurance before January 1, which is when the law says they must, the application has to be in by December 15. That is not very far away. The administration has been talking about giving a grace period of a few weeks before the IRS will fine them for not having bought insurance, as ObamaCare says most Americans must buy health insurance. Still, if the Web site is not fixed, millions of Americans will be required to sign up for health insurance on a Web site that does not work. As a consequence of not being able to sign up for health care, they will be fined by the Internal Revenue Service. There is a much bigger problem than the fine, and that is millions of Americans may be without any health insurance at all after January 1 because their insurance is being canceled because of ObamaCare. Remember when President Obama said: If you like your insurance, you can keep it? Well, like a lot of things that have been said about ObamaCare, that is turning out not to be the case. Our staff has counted the announcements by health insurance companies that are ceasing to offer policies on January 1 because they don't qualify under the ObamaCare law. For example, in Tennessee, the State provides 16,000 Tennesseans who have trouble getting insurance with a plan called CoverTN. Because it doesn't meet the exact requirements of ObamaCare, the State is having to cancel that insurance on January 1, and those 16,000 Tennesseans won't have health insurance. Other Americans--for example, Tennesseans I have talked to--have what we call catastrophic insurance. They have insurance that provides for a catastrophe. That kind of insurance is often not available under ObamaCare. It is not allowed by ObamaCare for most people. An insurance company that offers these policies will not be offering them after January 1, and as a result, millions of Americans will not be able to buy the insurance they now have. If individuals can't or won't sign up, that will mean that after January 1, many of the sickest people will go into the exchanges. The result will be that the price of insurance--for everyone who has insurance--will go through the roof. We are already seeing that in the insurance markets today. The bottom line: If the Web site is not fixed, millions of Americans will not only be fined by the IRS for not buying insurance on a Web site that doesn't work, more importantly, they will be without health care insurance on January 1, insurance that many of them have today. The President has said over the last few days that the Web site will be ready by November 30. You are supposed to have your application in by December 15 and have the insurance bought by January 1, which only gives 2 weeks for millions of Americans to make their way through this maze. We tried to obtain this simple information that I have asked for, yet repeatedly, the requests which I have directed to Secretary Sebelius have come back with no answer at all--no answers, nothing. Outside analysts tell us that only \1/2\ of 1 percent of the people who logged on to the ObamaCare Web site in the first week were able to enroll, but we really don't know. Two weeks ago I sent a letter with House Oversight Chairman Darrell Issa to Secretary Sebelius, asking for the information she and the President are not giving us Such as how many people have enrolled successfully in the exchanges, what the technical problems are, how much it already costs, and how much it will cost to address these problems. The deadline for a response to our request has passed. Chairman Issa has said--and I joined him in the letter--that he may consider a subpoena to get that information. The American people deserve an answer to these questions. Often when the debate comes up, someone will say, Well, the Republicans don't have any proposals of their own. I have often made those proposals. I remember on this floor of the Senate many times proposing steps we should take to change our health care system so more people could afford insurance. We went back and counted the number of times when, during the health care debate, various Republicans talked about our step-by-step proposals for what we should do about health care, and there were 173 mentions of our step-by-step proposals. The basic problem with what happened with the new health care law was that we--the Democratic Congress did, I didn't; I didn't vote for it-- expanded a health care delivery system that already costs too much. That was the wrong thing to do. That was an historic mistake. What we should have done is to make changes, step by step, in the health care delivery system that would reduce the cost of health care for the largest number of Americans so more people could have afforded it. Those were the steps we should have taken. We can still do that. Our health care delivery system is nearly 20 percent of our economy. ObamaCare is not our health care delivery system. Rather, ObamaCare includes some additions to our health care delivery system. ObamaCare is an expansion of a health care delivery system that already costs too much. The law is making some changes such as the ones I described earlier in my remarks. Those changes have been described as a train wreck, but we can turn the train around and head it in another direction--a direction of more competition, more choices, and lower costs for Americans buying health insurance. How can we do that? That is a subject for a long discussion, but here are a few of the ideas: Make Medicare solvent. The trustees have said that in 10 years there won't be enough money to pay hospital bills. We have a duty to make Medicare solvent. Reform Medicare Advantage to increase more choices and put it on a more level playing field with Traditional Medicare. That will provide seniors more options and it should save some money. Make Medicaid more flexible. I was Governor. I said on the floor that every Senator who voted for ObamaCare ought to be sentenced to go home and serve as Governor and try to implement the law. During my time as Governor, Medicaid was 8 percent of the State budget. I see it has grown to 26 percent today in Tennessee, soaking up money that otherwise would go for higher education or for other needed parts of State government. We should encourage workplace wellness. We had a lot of debate about that during the ObamaCare debate and we have ended up with a regulation that is too restrictive. We can change that. We can allow small businesses to pool their resources and offer a larger number of plans to a larger number of Americans at prices they can afford. We can allow Americans to purchase insurance across State lines. That would reduce the cost of health care, which should be our major goal. We could expand health care savings accounts. There is bipartisan legislation before the Senate that would define full-time employment for purposes of the health care law--this one or any one in the future--as 40 hours instead of 30 hours. That would be a great help to American business and an even bigger help to the employees who are being forced to go from 40 hours to 30 hours-- employees who most need that income, and who, by going to 30 hours, will have to go to a second part-time job, and in many cases, in doing so, lose whatever health care benefits that might be available to them. I don't know where the 30 hours came from. That sounds as though it was made in France. A made-in-America part-time job ought to be up to 40 hours. Those are just a few of the steps we could take to turn the train around and avoid the wreck and move us in the right direction. We will be making those arguments over time. But for now, we need information about what is happening on the ObamaCare exchanges. I intend to ask unanimous consent tomorrow to pass a simple, six-page bill. It is legislation which requires the administration to give us weekly reports about how many have tried to enroll, how many have succeeded, what ZIP Code they live in, and what level of insurance they have purchased. Congress needs to know that, if millions of Americans are going to lose insurance on January 1, before they have a way to buy it through a Web site that doesn't work. States need to know it because, as time goes on, these decisions are going to have an effect on the Medicaid Programs that States are a partner in and are operating. Americans need to know it because, in many cases--we have counted at least 1.5 million cases and we expect millions more policies that were available to Americans when the law passed will not be available after January 1. So these Americans--and this includes people working in the Congress and people who are in the Congress--these Americans are going to have to make decisions before January 1 about what insurance they will have, because the insurance they now have isn't going to be available under the new health care law. This is a six-page bill, and a pretty simple idea. If RCA knew how many records Elvis was selling every day, if Ford knew before the Internet age how many cars Ford was selling every day, if McDonald's before the Internet age knew how many hamburgers it was selling every day, surely the Obama administration can tell us every week how many are enrolling on ObamaCare's Web site, how many are successfully getting their insurance, where they live, and what kind of insurance they buy. The stakes are much higher than Elvis's records, than Ford's cars, and than McDonald's hamburgers. These are the stakes of health insurance that involve the lives of millions of Americans, and I hope my colleagues will join me tomorrow when I ask unanimous consent to approve legislation that will require these weekly reports.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, before the Internet, RCA knew how many records Elvis sold every day. Before the Internet, Ford knew how many cars they were selling every day. Before the Internet, McDonald's could tell you how many hamburgers it was selling every day. Yet the Obama administration cannot tell us how many Americans have tried to sign up for ObamaCare. They can't tell us how many Americans did sign up for ObamaCare. They can't tell us what level of insurance they bought, nor can they tell us in what zip code they live. They told us that 20 million Americans have visited the ObamaCare Web site. They have the basic information to shop, but how many have tried to sign up? How many did sign up? Where do they live? What kind of insurance did they buy? Not only have they not told us, they have done their best to keep us from finding out. With WikiLeaks and Edward Snowden spilling our beans every day, what is happening on the ObamaCare exchanges is the biggest secret left in Washington, DC. The National Security Agency could learn lessons from Secretary Sebelius. We should not have to rely on anonymous sources to get basic information about what is happening with ObamaCare. Therefore, I am introducing legislation today to require the administration answer the following questions every week: How many people tried to sign up? How many people did sign up? What level of insurance did they buy? In what ZIP code do they live? What are they doing to fix the problems? This is not complicated information. In the Internet age, the administration ought to be able to provide this information not every week but every day. In fact, they should be able to provide it every minute. We should not have to pass a law to find these things out. I hope that every Senator will support this simple request that this legislation makes. It is a six-page bill. I will put it in the Congressional Record today, and everyone will have a chance to read it tomorrow. After everyone has had a chance to read it, I intend to ask unanimous consent to pass it. This Congress--both sides of the aisle--is dedicated to transparency. This administration has described itself as the most transparent administration in American history. So why should we not unanimously pass legislation to ask for the most basic information about what is happening on the ObamaCare exchanges? Health insurance companies say that in order to guarantee that everyone has a chance to sign up for insurance before January 1, which is when the law says they must, the application has to be in by December 15. That is not very far away. The administration has been talking about giving a grace period of a few weeks before the IRS will fine them for not having bought insurance, as ObamaCare says most Americans must buy health insurance. Still, if the Web site is not fixed, millions of Americans will be required to sign up for health insurance on a Web site that does not work. As a consequence of not being able to sign up for health care, they will be fined by the Internal Revenue Service. There is a much bigger problem than the fine, and that is millions of Americans may be without any health insurance at all after January 1 because their insurance is being canceled because of ObamaCare. Remember when President Obama said: If you like your insurance, you can keep it? Well, like a lot of things that have been said about ObamaCare, that is turning out not to be the case. Our staff has counted the announcements by health insurance companies that are ceasing to offer policies on January 1 because they don't qualify under the ObamaCare law. For example, in Tennessee, the State provides 16,000 Tennesseans who have trouble getting insurance with a plan called CoverTN. Because it doesn't meet the exact requirements of ObamaCare, the State is having to cancel that insurance on January 1, and those 16,000 Tennesseans won't have health insurance. Other Americans--for example, Tennesseans I have talked to--have what we call catastrophic insurance. They have insurance that provides for a catastrophe. That kind of insurance is often not available under ObamaCare. It is not allowed by ObamaCare for most people. An insurance company that offers these policies will not be offering them after January 1, and as a result, millions of Americans will not be able to buy the insurance they now have. If individuals can't or won't sign up, that will mean that after January 1, many of the sickest people will go into the exchanges. The result will be that the price of insurance--for everyone who has insurance--will go through the roof. We are already seeing that in the insurance markets today. The bottom line: If the Web site is not fixed, millions of Americans will not only be fined by the IRS for not buying insurance on a Web site that doesn't work, more importantly, they will be without health care insurance on January 1, insurance that many of them have today. The President has said over the last few days that the Web site will be ready by November 30. You are supposed to have your application in by December 15 and have the insurance bought by January 1, which only gives 2 weeks for millions of Americans to make their way through this maze. We tried to obtain this simple information that I have asked for, yet repeatedly, the requests which I have directed to Secretary Sebelius have come back with no answer at all--no answers, nothing. Outside analysts tell us that only \1/2\ of 1 percent of the people who logged on to the ObamaCare Web site in the first week were able to enroll, but we really don't know. Two weeks ago I sent a letter with House Oversight Chairman Darrell Issa to Secretary Sebelius, asking for the information she and the President are not giving us Such as how many people have enrolled successfully in the exchanges, what the technical problems are, how much it already costs, and how much it will cost to address these problems. The deadline for a response to our request has passed. Chairman Issa has said--and I joined him in the letter--that he may consider a subpoena to get that information. The American people deserve an answer to these questions. Often when the debate comes up, someone will say, Well, the Republicans don't have any proposals of their own. I have often made those proposals. I remember on this floor of the Senate many times proposing steps we should take to change our health care system so more people could afford insurance. We went back and counted the number of times when, during the health care debate, various Republicans talked about our step-by-step proposals for what we should do about health care, and there were 173 mentions of our step-by-step proposals. The basic problem with what happened with the new health care law was that we--the Democratic Congress did, I didn't; I didn't vote for it-- expanded a health care delivery system that already costs too much. That was the wrong thing to do. That was an historic mistake. What we should have done is to make changes, step by step, in the health care delivery system that would reduce the cost of health care for the largest number of Americans so more people could have afforded it. Those were the steps we should have taken. We can still do that. Our health care delivery system is nearly 20 percent of our economy. ObamaCare is not our health care delivery system. Rather, ObamaCare includes some additions to our health care delivery system. ObamaCare is an expansion of a health care delivery system that already costs too much. The law is making some changes such as the ones I described earlier in my remarks. Those changes have been described as a train wreck, but we can turn the train around and head it in another direction--a direction of more competition, more choices, and lower costs for Americans buying health insurance. How can we do that? That is a subject for a long discussion, but here are a few of the ideas: Make Medicare solvent. The trustees have said that in 10 years there won't be enough money to pay hospital bills. We have a duty to make Medicare solvent. Reform Medicare Advantage to increase more choices and put it on a more level playing field with Traditional Medicare. That will provide seniors more options and it should save some money. Make Medicaid more flexible. I was Governor. I said on the floor that every Senator who voted for ObamaCare ought to be sentenced to go home and serve as Governor and try to implement the law. During my time as Governor, Medicaid was 8 percent of the State budget. I see it has grown to 26 percent today in Tennessee, soaking up money that otherwise would go for higher education or for other needed parts of State government. We should encourage workplace wellness. We had a lot of debate about that during the ObamaCare debate and we have ended up with a regulation that is too restrictive. We can change that. We can allow small businesses to pool their resources and offer a larger number of plans to a larger number of Americans at prices they can afford. We can allow Americans to purchase insurance across State lines. That would reduce the cost of health care, which should be our major goal. We could expand health care savings accounts. There is bipartisan legislation before the Senate that would define full-time employment for purposes of the health care law--this one or any one in the future--as 40 hours instead of 30 hours. That would be a great help to American business and an even bigger help to the employees who are being forced to go from 40 hours to 30 hours-- employees who most need that income, and who, by going to 30 hours, will have to go to a second part-time job, and in many cases, in doing so, lose whatever health care benefits that might be available to them. I don't know where the 30 hours came from. That sounds as though it was made in France. A made-in-America part-time job ought to be up to 40 hours. Those are just a few of the steps we could take to turn the train around and avoid the wreck and move us in the right direction. We will be making those arguments over time. But for now, we need information about what is happening on the ObamaCare exchanges. I intend to ask unanimous consent tomorrow to pass a simple, six-page bill. It is legislation which requires the administration to give us weekly reports about how many have tried to enroll, how many have succeeded, what ZIP Code they live in, and what level of insurance they have purchased. Congress needs to know that, if millions of Americans are going to lose insurance on January 1, before they have a way to buy it through a Web site that doesn't work. States need to know it because, as time goes on, these decisions are going to have an effect on the Medicaid Programs that States are a partner in and are operating. Americans need to know it because, in many cases--we have counted at least 1.5 million cases and we expect millions more policies that were available to Americans when the law passed will not be available after January 1. So these Americans--and this includes people working in the Congress and people who are in the Congress--these Americans are going to have to make decisions before January 1 about what insurance they will have, because the insurance they now have isn't going to be available under the new health care law. This is a six-page bill, and a pretty simple idea. If RCA knew how many records Elvis was selling every day, if Ford knew before the Internet age how many cars Ford was selling every day, if McDonald's before the Internet age knew how many hamburgers it was selling every day, surely the Obama administration can tell us every week how many are enrolling on ObamaCare's Web site, how many are successfully getting their insurance, where they live, and what kind of insurance they buy. The stakes are much higher than Elvis's records, than Ford's cars, and than McDonald's hamburgers. These are the stakes of health insurance that involve the lives of millions of Americans, and I hope my colleagues will join me tomorrow when I ask unanimous consent to approve legislation that will require these weekly reports.

Mr. ALEXANDER

Mr. ALEXANDER. I ask unanimous consent to speak as in morning business.

Mr. ALEXANDER. Madam President, this government shutdown is disappointing to me. It's disappointing to those who are affected by it, and I'm sure it's disappointing to the American people. Because they're seeing their government not function in such a visible way. What is especially disappointing to me is the unwillingness of the President and Senate Democrats to make a reasonable effort to resolve the real differences of opinion that exist here. It's not unusual, Madam President, that we have differences of opinion in Washington, DC. In fact, the Founders created a government here with the expectation that it would kick up to the Nation's Capitol the disputes we couldn't resolve in our own families, disputes we couldn't resolve in our city councils, in county commissions, and our State legislatures and State government. And the Founders intended that those disputes, which are in this body, not be resolved easily by creating a system of checks and balances: A Supreme Court, a Presidency, and a Congress. And by creating, in this body, the rules that make it very difficult to come to a result. The idea was that we didn't want a king. A king is efficient. Tyranny is efficient. Our Founders didn't want that. They didn't want a despot. They wanted a way to get, eventually, to a result. They sought to avoid the tyranny of the majority by creating these checks and balances and these rules in the Senate. They sought to create a situation where the majority couldn't ride roughshod over the minority. But I do not think the Founders envisioned a system of checks and balances that produced a permanent stalemate on issues that are important to the American people. Even in the most contentious of issues--and there have been many issues in our history much more contentious than anything we are dealing with today. They didn't envision that the government would simply shut down or stop operating or stop trying to come to a result. That is why I find the attitude of the President and the Senate Democrats so disappointing. By any fair measure, the proposals by the Republican House of Representatives to bring this to a solution are reasonable proposals. Let's look at what they've proposed. They proposed that we continue funding the government. Every single proposal the House has made to this body is that we continue funding the government. And they've proposed that we also, at the same time, No. 1, be fair to the middle class by delaying the individual mandate in the new health care law for a year. Now, the President has already himself delayed seven major provisions in the new health care law that is supposed to take effect today. These include the employer mandate, which is $12 billion over 10 years for corporations. Yet the President and Senate Democrats are saying we can give the employers a $12 billion break by a 1-year delay, but we're going to stick it to the middle class of America by fining them $95 if they do not buy health care and sending the IRS out to collect it next year if they fail to do it. What we suggested was, since the President himself has already delayed seven major provisions, since the regulations aren't written, let's also delay the individual mandate for a year. That would be fair to the middle class. No. 2, the House has suggested that we can continue funding the government and be fair to those who are ill by repealing the medical device tax. Seventy-nine senators have voted for the medical device tax repeal, including a large number of Democratic senators. No. 3, the House Republicans have said, let's continue to fund the government and be fair to the American people when it comes to health care. Treat the American people the same way Congress is treated. And finally, most recently, the House Republicans have said, let's continue to fund the government and can we not just sit down and talk about it? Have a conference? Which is the way, under our rules established by the Constitution, we're always supposed to resolve disputes. And the answer has been no from the Senate Democrats. No, to giving the same consideration to the middle class, the people who are required to buy health insurance; no, to giving fairness to those who are ill by repealing the medical device tax; no, to giving fairness to the American people by treating them the same way Congress is treated; and no, to giving fairness to the system in saying can we not just sit down and talk in a conference, which is our way of resolving disputes. And the answer by the President and the Senate Democrats is no, no, no. The President's role is to bring us together. He said that during his campaigns. He has a great capacity for persuading the American people that he is right. He seems to be able to talk with the Iranian rulers, but not to the congressional leaders. Our goal is fairness for the middle class, fairness for the taxpayer. Our latest offer from the House of Representatives was, let's keep the government running and let's sit down according to our rules and have a conference and talk about it. This stubbornness in the face of reasonableness will not be good for our country, will not be good for either political party, it will not help us to achieve the kind of result on this and other issues that the Founders intended by creating a system of checks and balances in our democratic form of government. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I appreciate being part of the colloquy with the Senator from Texas, and I was listening to his comments. I remember being asked by Senator McConnell and the House Speaker John Boehner to speak on behalf of Republicans at the President's health care summit 3 years ago about the new health care law. I was the first speaker there and since that time have done my best to try to void its passage and then to repeal and replace it. But I'm not in the shut down the government crowd. I'm in the let's- take-over-the-government crowd and elect a number of more Republicans and even a Republican President who agrees with us and who wants a different kind of health care law, one that introduces choice and competition and that actually reduces health care costs for most Americans. What bothers me so much about this impasse today is the effect it might have on our military men and women around the world. I'm trying to imagine what it must be like for someone fighting in Afghanistan whose check might be late, whose spouse is at Fort Campbell, and whose mortgage is due today or tomorrow or the next day, or what if the Department of Defense school closes there and that spouse has a job and no childcare? These are very practical problems we need to be thinking about. We need not be thinking about shutting down the government. We need to be thinking about a way to fund the government and change the health care law at the same time. Now, the House of Representatives has tried once and now is trying it again to make a reasonable offer. These discussions are all about compromise, about taking suggestions that come from one body to the other body and taking what you can. So if they have come back and said: Well, the United States Senate had 79 Senators, including many Democrats, who voted to repeal the medical device tax. And they said: Let's delay the individual mandate for a year. I'm surprised the President himself has not done that. The President himself has delayed seven provisions, major provisions in the health care law, including the employer mandate. The regulations aren't ready. The program is supposed to start tomorrow. It would seem to me it would actually be to the President's benefit, as well as the country's benefit, to say instead of just delaying parts and exempting these people, let's get it right. Let's delay it for 1 year. That is what the House of Representatives, the Republican House, has said to the Senate. They have said let's repeal the medical device tax, a particularly onerous 2.3% tax on top of revenues that increases the cost of medical devices for millions of Americans. We all agree we ought to get rid of it--79 of us do anyway, including about as many Democrats as Republicans. And the President himself has acknowledged this law isn't ready. The chairman of the Democratic Committee that wrote it says it is a coming train wreck. So it seems to me this is a reasonable suggestion from the House of Representatives to say let's work on getting rid of ObamaCare, that is what we would like to do, or changing it, that is what they would like to do to make it work, but let's fund the government. Let's not run the risk that one single soldier fighting in Afghanistan has a paycheck that is one day late because his spouse is home in Fort Campbell and the mortgage can't be paid or the Department of Defense School is closed and there is no childcare for the spouse who has a job while her husband or his wife is fighting overseas. Now, that's something we should not allow to happen, whether it's Republicans or Democrats. It may be that the majority leader agrees with that and he has brought that up and we have brought that up, but we should do more than bring up political points. People expect us to act like adults, work together, come to a result, so we can change the health care law and we can keep the government going. I've said for three years that instead of the historic mistake we passed which expanded health care delivery systems that already cost too much, we should go step by step to have a health care law that actually reduces health care costs: Make Medicare solvent instead of taking one-half trillion dollars out of it for other programs. Give Medicaid more flexibility so Governors can serve more people. Repeal the medical device tax. Make it easier for employers who want to help employees have a healthier lifestyle so they can have cheaper insurance. Allow people to buy insurance across state lines. Allow small businesses to pool their resources and offer insurance. I have listed a half dozen already, steps we could agree on that would reduce health care costs in the country. I'm not in the shut down the government crowd, and neither are most everybody I know around here. We are in the take-over-the-government crowd, and let's elect enough Republicans and a Republican President to change the health care law. But in the meantime, we should make absolutely sure that men and women, whether on Active Duty or in the National Guard, not on Active Duty at this time, we should make sure they are paid on the day they are supposed to be paid and their spouses are not waiting for the check. I thank the Senator from Texas for engaging in this colloquy, and I wish to join him in this effort.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, will the Chair please let me know when 15 minutes has expired. I have 20 minutes. I would like to know when 15 minutes has expired.

Mr. ALEXANDER. Mr. President, once after I made a speech my late friend Alex Haley, the author of ``Roots,'' came up to me and said: Lamar, may I make a suggestion. I said: Of course. He said: When you speak--instead of ``making a speech,'' would you say, ``let me tell you a story,'' and someone might actually listen to what you have to say. So I do have a little speech on the new health care law to make. But before I make a speech, let me tell a story that I think applies to the new health care law. It is a story about two famous and patriotic Tennesseans who went to Texas. The two men are Sam Houston and Davy Crockett. In the early part of the 19th century, Sam Houston was the Governor of Tennessee. He resigned that position because of a problem with his marriage. He went to Arkansas, lived with Indians, and he went to Texas. Congressman Davy Crockett went for a different reason. He got crossways with President Andrew Jackson, who recruited a one-legged veteran of the War of 1812 to run against him and he lost his race for Congress in 1834. He later went to the courthouse steps in Madison County, TN, and said what every defeated candidate has always wanted to say to such voters. He said: I am going to Texas and you can go to hell and he went to Texas. That is historic fact. I am not using bad words here. So we had these two famous Tennesseans, patriotic, brave men, both of whom went to Texas. They had the same goal in mind, the independence of Texas, but they had different tactics. Former Congressman Davy Crockett said: I think I will go to the Alamo. Some people said: Davy, if you go to the Alamo, you will get killed. He went to the Alamo anyway and he did get killed, but we remember him for his bravery and we remember the Alamo. Sam Houston took a different tack. He withdrew with his men to San Jacinto. He was heavily criticized by some people in Texas at that time for withdrawing. Some said it was a retreat, but he waited until the Mexican General Santa Anna was in a siesta with his troops, he attacked, defeated his troops, and he won the war. Today we celebrate both men. We think of them both as patriots, as great Americans, and we remember the Alamo. But we celebrate Texas Independence Day on March 2, 1836, when Sam Houston won the war. The moral of the story is that sometimes in a long battle, patience is a valuable tactic. That is why I am in Sam Houston's camp on this one. I am not in the shut down the government crowd, I am in the take over the government crowd. Americans should elect more Republican Senators and then ultimately a Republican President and then I am going to delay, dismantle, and replace the new health care law which we call ObamaCare with a law that actually reduces health care costs for Americans. My first reason for not shutting down the government is that it will not work. The problem is even if we were to vote to shut down the government, according to the way some people argue--and I understand their passion and I respect it--ObamaCare would just keep going like the Energizer bunny. The reason Senator Coburn, the Senator from Oklahoma, has pointed out is that 85 percent of the funding for ObamaCare is mandatory spending. Mandatory spending is the type of spending that just keeps going. So money for the exchanges, money for the subsidies, and the individual mandate would continue. What would we have achieved? We would have shut down the government, but most of ObamaCare would keep going. If that is not enough, the President has authority in the law to declare some services essential. I assume, since this is his signature issue and he is President for another 3 years, that he would declare most of ObamaCare essential services. So where would we be? As long as we have a Democratic majority in the Senate and President Obama in the White House, it takes 67 votes in the Senate to repeal ObamaCare and we have 46 on the Republican side. Every one of us has voted against ObamaCare repeatedly. Every one of us would do so again. Every one of us would vote to repeal it. But in my view, the right tactic is not to shut down the government. It won't work, ObamaCare would just keep going, and we would have shut down the government. What does that mean? What does a government shutdown mean? Not everything would shut down, but here are some of the things that would or could happen: The 3.4 million Active-Duty military who would have to report to work--whether at Fort Campbell in Kentucky and Tennessee or in Afghanistan--would not be paid for their service as long as the government is shut down. At home, their spouses could suddenly find the Department of Defense schools closed. What are they going to do for childcare, or with a check arriving too late to pay the mortgage? Social Security checks would continue to be paid, but the offices might be closed. Same for more than 20 million of our veterans who receive benefits; they might come late. Two million Americans fly everyday. There would likely be fewer TSA agents, fewer air traffic controllers, leading to long lines at the airports in Nashville and New York and Chicago. How do you think those 2 million people are going to feel about that? The national parks would close. Head Start might close and many of the 110,000 people at our National Laboratories could be furloughed. The last time the government shut down was nearly 20 years ago. Back then, 200,000 people applied for passports and couldn't get them during the shutdown. There are 200,000 Tennesseans going to college this fall who want or are in the process of getting a new student loan and they might not get it on time. Your gun permit might not come through, neither might your FHA loan. The last time we had a government shutdown, it cost the taxpayers $1.4 billion extra dollars, according to the Congressional Research Service. So I am in the Sam Houston camp on this issue in that I want to show a little patience in trying to win the war. If we shut down the government, ObamaCare keeps going, it costs the taxpayers a lot of money, and inconveniences a lot of Americans. Who do you suspect is going to get blamed for this? We will have suceeded in shifting the blame for passing ObamaCare from the Democrats, who did it unanimously, to the Republicans for shutting down the government. You would think the Democratic National Committee might have come up with that idea, not the Republican National Committee. That might not be a good public policy position, but it is a fact and people are observing it. Then there are people who say to be a good conservative, you have to vote to shut down the government. I have been listening to these people who define who is a good conservative and who is not a good conservative. It is a little bit like being in Sunday school and somebody new comes into class and says: I am a better Christian than you are and if you don't agree with me get out of the church. You might say: Grandma is a Quaker and Uncle Sam is a Baptist and we all try pretty hard in our faith. It is not up to us to judge which one of us on the Republican side is a better conservative than another. Everyone who looks around knows among Republicans, most of us are conservatives, but we have different kinds. We have neoconservatives, we have paleoconservatives, we have fiscal conservatives, we have social conservatives, we have cultural conservatives, we have Ross Perot conservatives--we have opened the door over the last 40 years to every kind of conservative, and it has made our party bigger and more successful because we have tolerated different points of view. So I am not for shutting down the government for all those reasons. It will not work. When the government has been shut down before the Congressmen could not buy their plane tickets back to Washington fast enough to open the government because the voters were absolutely outraged. It would shift the blame for ObamaCare, which ought to be the referendum in 2014, to should you shut down the government or not shut down the government? We should not be in this business of saying I am a better Christian than you are or I am a better Jew than you are or I am a better conservative than you are. We ought to respect each other's point of view. Instead, what should we do? First, we ought to delay implementation of the new health care law. My colleague from Tennessee, Representative Marsha Blackburn whose conservative credentials I've never heard anybody question, and Senator Jeff Flake from Arizona wrote an editorial the other day--I ask unanimous consent for it be printed in the Record following my remarks--saying the health care law must be delayed. There is good reason for that. It is coming too fast and the chairman of the Finance Committee said it is going to be a train wreck. The logical thing to do is delay it for 1 year. The President has already delayed many provisions of the health care law. The employer mandate has been delayed for 1 year. The requirement that insurance companies report to the IRS information about health insurance products has been delayed for 1 year. The ability for small employers to provide employees with multiple health insurance plan options in something we call the small business SHOP exchange has been delayed for 1 year. The ability for state Medicaid programs to send electronic notices to beneficiaries, that is delayed for 1 year. The start of the Basic Health Program, delayed for 1 year. Other provisions have been delayed for 1 year and there are regulations that the administration has simply not had time to issue. So why not delay the entire law for 1 year? That would give the administration time to at least get ready it would give the American people a chance to have a referendum on the law in 2014. So that is the first thing we could do. The second thing we could do is begin to dismantle the law. By that I mean we should repeal all of the job-killing, premium-hiking taxes, especially the medical device tax. This is a particularly onerous tax that is 2.3 percent on the revenues of those companies and it drives up the cost of medical devices that tens of millions of Americans use. We should also and repeal the mandates on individuals, families, and job creators that drive up premiums. But that is not all we should do. We have a responsibility to say what we would do as Republicans if the voters were to trust us with the government. If they were to give us more Senators who would vote to delay, dismantle, and repeal ObamaCare, what would we do with it? Or if in a couple of years they were to give us a Republican President, what would we propose? We can do a pretty good job of saying what we don't like in ObamaCare. Three years ago, I was asked by Senator McConnell and Speaker Boehner to lead off for the Republicans at the President's Health Care Summit. I took the opportunity to outline for the President some of the problems with his proposal that we saw at that time. It turned out that we were pretty prescient in what we were saying because most of the problems we predicted have happened: increased premiums, more spending, more taxes. We said a 2,700-page bill, more or less, probably has a lot of surprises in it. The bill cut Medicare by one- half trillion dollars, not to make Medicare solvent, but to spend on a new entitlement even though Medicare is going broke within several years according to the Medicare trustees. If Medicare goes broke, people will not be able to depend on it. We said the new law would mean there will be about one-half trillion dollars of new taxes, and millions of Americans' premiums would go up. Today, the newspapers are filled with stories of rising premiums. So that is what we said at the President's Health Care summit 3 years ago. Now we have an obligation to say what we would like to do instead. I said to the President at that time: Mr. President, the President's--your proposed health care law is an historic mistake because it expands a health care delivery system that already costs too much instead of taking steps to reduce its costs. The law is a mistake because it attempts to be comprehensive, and it is too big a bite to chew, too much to swallow, and too much to digest at one time. That is turning out to be right. That is why we have all these delays. So we suggested why don't we go step-by-step to begin to reduce health care costs? We suggested at the President's health care summit working with him in a bipartisan way to do that. We can still do that. We can delay it. We can dismantle the parts of it I talked about. Then what do we do? Step No. 1, make Medicare solvent so seniors can depend on it. Senator Corker and I have a proposal which will do that, offer seniors more choices and at the same time reduce the Federal debt by nearly one trillion dollars over the next 10 years. Medicare needs to be solvent because we have many Tennesseans who depend on it to pay their hospital bills, and it is going broke in a few years if we don't take steps to do that. No. 2, give Governors more flexibility with their state Medicaid programs. Medicaid has gone from 8 percent of the State budget when I was Governor in the 1980s to 26 percent today. It is soaking up money that ought to go to higher education. Governors would like to keep tuitions from going higher, but they cannot and the main reason is Federal Medicaid mandates get in the way so we need to make Medicaid more flexible. I said when the health care debate was going on that every Senator who votes for it ought to be sentenced to go home and serve as Governor for 2 years to implement it. That may be one reason we have so many Governors who are having a hard time balancing their budgets with all these federal mandates. No. 3, strengthen innovative workplace wellness programs. The administration has a regulation that needs to be repealed that restricts the ability of employers to say to employees: If you live a healthy lifestyle, you can have lower insurance premiums. No. 4, let small businesses pool their resources and offer a lower cost insurance plan for their employees. No. 5, provide families the opportunity to purchase insurance across State lines. No. 6, expand access to health savings accounts and catastrophic health insurance plans, which would give people an opportunity to buy cheaper insurance rather than more expensive insurance. No. 7, incentivize the growth of private health insurance exchanges. No. 8, make it easier for patients to compare prices and the qualities of doctors. No. 9, incentivize States to reform junk medical malpractice lawsuits. I have talked about one way to delay ObamaCare, two ways to dismantle it, and nine steps to move from expanding a health care delivery system that already costs too much. By introducing more choice and competition into our health care delivery system, we can acheive the goal of reducing costs for most Americans. That is a strategy, an agenda and a plan that will earn the confidence of enough independent voters in Tennessee and other States across this country to elect more Republican Senators, or Democratic Senators who agree with us, and that will give us a chance to dismantle, delay, and repeal the health care law, which was an historic mistake. This is nothing new. We counted it up. Republicans mentioned 173 times in the health care debate our step-by-step plan to reduce health care costs. We still stand ready to put it into place. The best way to repeal Obamacare is not to shut down the government. The best way to do it is to take over the government, elect some more Senators, and elect a President. Put it in a bill. That is our constitutional system. We all admire the Constitution. We carry it in our pockets, and we talk about it. We have a constitutional system, and we have to follow those rules if we want to make legislative changes. I greatly respect the passion and the endurance of those Senators who argue that we should shut down the government if we don't get our way immediately on the health care law. I respect that just as I remember the Alamo and respect our great Tennessean Davy Crockett who went to Texas. But on this one, when it comes to tactics, I am in General Sam Houston's camp. I think we will have to show patience to win the war. In the meantime, let's delay ObamaCare, let's dismantle it, and let's show the American people that we have a better plan with better steps to replace what is in the law now with a step-by-step plan to reduce the cost of Americans' health care. That is the plan I am voting for today and the rest of this week and the rest of this year and next year, until we get the job done. I thank the Presiding Officer.

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, I am pleased today to praise the service of Nick Geale, who was until July the director of oversight and investigations on the minority staff of the Senate Health, Education, Labor and Pensions--HELP--Committee, of which I am ranking member. In July, Nick was confirmed by this body as a member of the National Mediation Board, where he will surely continue his hard work, thoughtful deliberation, and fair application of the law on behalf of workers and employers in the railroad and airline industries. Nick joined the HELP Committee in 2009 under the previous ranking member, Senator Mike Enzi of Wyoming, for whom he first served as oversight and investigations counsel before becoming director of oversight and investigations. I was fortunate that he agreed to stay when I became the Ranking Member and appreciate his service. In his role here, Nick investigated waste, fraud, and abuse in government programs and agencies, often working with agency inspectors general and the Government Accountability Office in that capacity. He also led the HELP Committee's investigations into the implementation of Federal programs and to ensure proper enforcement of Federal laws. He thoroughly evaluated and advised the HELP Committee on the President's nominees and assisted the HELP Committee's staff in policy matters and hearings. Nick came to the HELP Committee from the U.S. Department of Labor, where he served as an attorney to the Solicitor and then as counsel to the Deputy Secretary under the leadership of Secretary Elaine L. Chao. In both those roles, he assisted the agency in implementing labor policies for the more than 180 laws under its jurisdiction and helped manage the Department's 15,000 employees. Nick also has a distinguished academic background. He graduated cum laude from Claremont McKenna College in 1996 and received a J.D. from Georgetown University Law Center in 1999. Maybe more important than noting his worthy accomplishments in public service is to note his character and his attitude toward his work, the taxpayers he served, and the colleagues he worked alongside. Nick worked hard to ensure that every taxpayer is treated fairly. With his practical experience in labor and employment matters, litigation, and alternative dispute resolution, Nick has been an eloquent and effective help to the committee. His dedication and friendship to those he worked with, on both sides of the aisle, is a testament to the character he has and will continue to have as he transitions to this next phase of his career. I thank him for the passionate service on behalf of the HELP Committee, the U.S. Senate, and the American taxpayer. I wish him the best in his service on the National Mediation Board.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I thank the majority leader and the Republican leader for what they expressed about David Schiappa. We rank-and-file Senators feel the same way on both sides of the aisle. I was reminded that the late Alex Haley, the author of ``Roots,'' once said: ``When an old person dies, it's like a library burning down.'' Dave is neither old nor dying, but there is some similarity in what is happening. With his leaving after 30 years, a number of volumes from the Senate library are going out the door. We won't have that wisdom, that experience, or that knowledge that has been so valuable to us, and that has been especially important to the Senate where nearly half the Members are in their first term. This is an institution that depends on precedent, understanding, and respect of its strengths over a long period of time. I had a chance to work with Dave at the request of Senator McConnell at the beginning of the last two Congresses to work on the Senate rules. In working with Dave and with Gary, what I found was they were representing our point of view, but they also had such a love of the institution, they wanted to make sure whatever we came up with enhanced it, strengthened it, and didn't destroy it. We wish Dave the best. We have admired his service and his friendship, and we hope that over the next few years he will allow us to bring those volumes of wisdom, knowledge, and experience back because occasionally we may need to read them. I yield the floor.