Thomas Carper

Mr. CARPER

Mr. CARPER. Mr. President, I ask unanimous consent that my remarks not be counted against my postcloture time.

Mr. CARPER. Mr. President, my hope is that during President Trump's visit to Japan, he asked the leader of Japan why it is that when Japan only spends 8 percent of its GDP on healthcare, it gets better results than we do, and it covers everyone. Yet, when we spend 18 percent, we don't cover everybody, and we don't get better results. That is a good question, and I hope the President and Prime Minister Abe got into that. Yet that is something I need to turn away from now. Mr. President, I rise in opposition to the nomination of Bill Wehrum to be EPA's Assistant Administrator for Air and Radiation. We have seen this movie before, but like many sequels, this one may actually be worse than the original. My opposition to this nominee should not come as a surprise to my colleagues or to Mr. Wehrum because, in 2005, President George W. Bush nominated him for the exact same position, Assistant Administrator for Air and Radiation at the EPA. I opposed his nomination at that time, as did many of my colleagues, and he was not confirmed. Prior to his nomination in 2005, Mr. Wehrum was an industry lawyer and later a political employee at the EPA. He served as chief counsel to Jeff Holmstead, then the Acting Assistant Administrator for Air and Radiation, from 2001 through 2005. While serving at the EPA during this time, Mr. Wehrum had a concerning track record of suppressing scientific information and the work of the EPA's career staff, deferring to industry on issues of public health, and not responding to my colleagues and to me when we were then serving on the Environment and Public Works Committee. President Bush eventually nominated Mr. Wehrum to fill Jeff Holmstead's seat and to serve in an acting capacity as Assistant Administrator for Air and Radiation at the EPA, something Mr. Wehrum would not be able to lawfully do today. Behind me, to my left, is an excerpt from an editorial from April 2006. The New York Times published an editorial opposing Mr. Wehrum's nomination that mirrored my concerns at the time: [The Holmstead era at EPA] will be remembered chiefly for its efforts to weaken the Clean Air Act (particularly with respect to rules governing mercury emissions and older power plants), to manipulate science and to elevate corporate interests above those of the public. Mr. Wehrum, who served as Mr. Holmstead's deputy and doctrinal hit man, could make things worse. That is a direct quote from this editorial. This is the New York Times editorial from 2006 opposing Mr. Wehrum's nomination for the very same position he seeks today. During the Environment and Public Works Committee's consideration of Mr. Wehrum's nomination in 2005, I voted against him because I feared he would continue to fail to clean our air and protect public health. Despite the fact that Mr. Wehrum was not confirmed due to his inability to secure the 60 votes needed for cloture on his nomination, he was able to serve as Acting Assistant Administrator for EPA's air office for 2 years. Since leaving the EPA, Mr. Wehrum has returned to industry and served as an industry lawyer in litigation against the EPA. Since returning to the private sector, Mr. Wehrum has reflected on his time spent at EPA. In doing so, he didn't point to the good work he did at the Agency to advance its public health mission or the lasting protections he put in place that made a difference in the lives of ordinary citizens; instead, he noted that his tenure at EPA was really good for business, saying: I'm a much better lawyer now than when I first joined the agency. To really get to know how the agency works and how it ticks, I think that is very valuable. I have expanded my capabilities which will hopefully allow me to be effective in generating business and clients. In generating business and clients. Sadly, my fears of 2005 were well-founded, and only one thing has changed--the Senate rule with respect to the number of votes we need to consider and confirm a nominee. If Mr. Wehrum is confirmed this week, it will be because he is the beneficiary of the Senate's elimination of the requirement with respect to needing 60 votes to consider nominees. It will not be because he is better suited for this important job. I will walk through some telling numbers for my colleagues this evening. The first number is 31. That is the number of times Mr. Wehrum has represented industry against the EPA in Federal court since 2009. Let me be clear on this. After serving in an unconfirmed capacity at the EPA because he was too far outside the mainstream to be confirmed by this body, Mr. Wehrum then left the Agency and has spent the years since suing that very same Agency and attempting to weaken environmental and public health protections on behalf of his industry clients. Many of these lawsuits are still ongoing and, in the majority of the pending lawsuits, Mr. Wehrum has represented the interests of Big Oil. Look at another poster. The number 27. What does 27 refer to? It refers to the number of times public health groups prevailed in court when challenging Bush-era clean air regulations that Mr. Wehrum helped to craft because they did not follow the law or sufficiently protect public health. Failing to follow the Clean Air Act meant delays in public health protections and uncertainty for businesses across America. I don't doubt that Mr. Wehrum is a fine lawyer--so why were so many of the rules he helped to write found to be unlawful? The confirmation process is essentially a job interview. It is not a job interview with EPA, in a sense, and it is not really a job interview with us, but it is a job interview with the American people. In this case, Mr. Wehrum is essentially applying for the job he already had at EPA, and you would think that would be easy, but Mr. Wehrum's resume shows that a great deal of the work he did in his last job as Acting Assistant Administrator for Air and Radiation was not up to par. In this job, subpar work impacts millions of Americans, especially children and the most vulnerable among us. The next number is 10. Ten is the number of additional years that children were exposed to toxic air emissions from powerplants because of delays Mr. Wehrum helped put into place while at the EPA. The next number is eight. The number eight refers to the number of days before Mr. Wehrum's latest confirmation hearing when he was in a courtroom arguing against rules that would protect 2.3 million miners, construction workers, and bricklayers. According to Mr. Wehrum, ``People are designed to deal with dust. . . . People are in dusty environments all the time and it doesn't kill them.'' The next number is two, which is the number of times the DC Circuit Court cited ``Alice In Wonderland'' in its decisions to reject EPA rules that Mr. Wehrum helped craft because, in the court's view, the regulations were based on fantasy rather than following ``the rule of law.'' The next number is one. One is the number of times that language from a law firm that represented industry--and also happened to be Mr. Wehrum's former employer--made it verbatim into a clean air regulation that Mr. Wehrum stated he was ``extensively involved'' in preparing. Think about that. Zero. Zero is the number of times Mr. Wehrum advocated in court for stronger clean air regulations since leaving the EPA. It is an especially troubling number for those of us living in downwind States like Delaware. We live at the end of America's tailpipe, along with our neighbors in Maryland, New Jersey, Pennsylvania, New York, and folks all the way up to Maine. Zero is also the number of times Mr. Wehrum expressed a desire to protect public health when I met with him prior to his confirmation hearing. Mr. Wehrum sits before us again today nominated for the very same position he was nominated for 12 years ago. After reviewing Mr. Wehrum's record, talking to him in person, and listening and reading his answers during the hearing process, my position has not changed since 2005, primarily because his views do not appear to have changed. Like other EPA nominees, Mr. Wehrum was evasive on many of the questions asked of him, even convincingly forgetting a case that he worked on against the renewable fuel standard in National Chicken Council, et al v. EPA. However, what was clear in the answer that he did give, and in his conversation with me, is that public health simply is not Mr. Wehrum's main concern. In fact, when asked what Clean Air Act regulation he does support, he answered as follows: I represent clients in private practice. It is my legal ethical duty to zealously represent their interests. Well, in this job interview with the American people to be Assistant Administrator for the Office of Air and Radiation, the American people are his clients, and the fact that he cannot--or has refused to name--a single regulation that helps to ensure that they and their families have clean air to breathe is almost disqualifying in and of itself. Whether it is carbon, mercury, silica, or other toxic air pollution, Mr. Wehrum continues to show that he sides with polluters over science and doctors every time. Mr. Wehrum's extreme views will not be good for public health, and quite frankly the legal uncertainty that has resulted from his past work will not be good for American businesses. Businesses need certainty and predictability, and they don't get it with the kind of work he has done. Let me close by reminding our colleagues that next week we celebrate the 27th anniversary of the signing of the Clean Air Act Amendments of 1990. Twenty-seven years ago, we weren't debating how to weaken or delay our clean air laws. Instead, we passed bipartisan legislation that would improve and strengthen our clean air laws based on the very best science. In the process, we strengthened our economy too. Back then, 89 Senators, including some who still serve in this Chamber, voted to approve the Clean Air Act Amendments of 1990. As a Congressman over at the other body at that time, I voted along with them. A Republican President, George Herbert Walker Bush, signed the bill into law 27 years ago today. It was commonsense legislation, it was bipartisan, and we are all better for it. When the Clean Air Act Amendments of 1990 passed Congress, I was a Congressman in the House, and I voted in favor of that bill. I was proud of helping to pass that monumental law because I believed then, and I still believe today, that we can protect our environment and grow our economy at the same time--and we have the job numbers to prove it. We have had some delays in implementation, but, by and large, the law has been a huge success and has benefited just about every American. For every dollar we spend in installing new pollution controls in cleaning up our air, we have seen $30 returned in reduced healthcare costs, better workplace productivity, and saved lives. We have a return of $30 for every dollar we spend installing new pollution control. The bottom line is, fewer people are getting sick and missing work because of the Clean Air Act and the Clean Air Act Amendments of 1990. When it comes to the rhetoric surrounding air regulations, there is a lot of fake news that people like to peddle, but as the saying goes: Everyone is entitled to his or her own opinions but not to his or her own facts. Here are the facts. Our economy did not take a slide because of clean air protection. Quite the opposite is true. The Obama administration implemented the Clean Air Act based on the best science to date. Now our air is cleaner. We have seen 8 years of economic growth. I will say that again. We have seen 8 years of economic growth, the longest stretch in our history. Energy prices at the pump and the meter are lower than when President Obama took office--lower, not higher. The beauty of our clean air laws is that they are not static. Our clean air protections keep up with the latest oversight science and the latest technology. As we learn more about what makes us sick, about what is impacting our environment, and about what can be done to clean it up, the EPA has the authority, under the Clean Air Act, to make adjustments to make it better, to ensure that it protects more people, not fewer. That has been the trajectory to date. As technology and science develop, so do our clean air regulations. That is also the story of our country. Through innovative and creative solutions, we strive for progress in order to have a better life here at home and to lead the world in tackling the environmental challenges of our time. Mr. Wehrum's policies have been tried and have been proven not only unsuccessful but even dangerous. We don't need to continue to move backward. We need to move forward. Mr. President, I will leave you and our colleagues with this. I am sorry to say that Mr. Wehrum has worked deliberately to halt that progress, to delay that progress and to roll back clean air laws that have been protecting America and Americans for decades. Unlike many of the nominees who have come before us this year, unfortunately, we don't have to speculate about how Mr. Wehrum would do in this position. We have already seen it. We have already seen it, and the results were not good for the rest of us. As his clients at this time, we deserve better representation. Today Americans deserve leaders at EPA who will be impartial and will look out for the interests of all Americans, not just Big Oil and the kind of clients who can afford Mr. Wehrum's legal bills. We have seen this movie before, and there is no need for a sequel. I regret having to say that, but I do believe Mr. Wehrum is not the right fit for this position today, any more than he was a dozen years ago. I encourage my colleagues to vote no on his nomination to serve as EPA's Assistant Administrator for air. I yield the floor. I suggest the absence of a quorum.

Mr. CARPER. Mr. President, while Senators Alexander and Rounds are on the floor--Senator King has just left--I find it ironic that the four of us who are gathered here are former Governors and are interested in getting things done and are interested in working across the aisle. We want to be able to achieve better results for less money. I applaud Senators Alexander and Murray for their efforts in trying to ensure that we begin to do that. I think my friend from South Dakota gives much credit to President Obama in his attacking what was originally bipartisan legislation that had been introduced here in 1993 by Senator Orrin Hatch, with 22 Republican cosponsors, and that later became RomneyCare. The idea behind their proposal was that there ought to be exchanges in every State and that the people could join if they did not have healthcare coverage; No. 2, that there would be a sliding scale tax credit to help buy down the cost of coverage for people who got their care in the exchanges; No. 3, that there would be an individual mandate that said you don't have to get coverage but that, if you don't, you have to pay a fine; No. 4, that there would be an employer mandate that said employers of a certain size would have to cover their people; No. 5, that insurance companies could not refuse to cover people with preexisting conditions. Barack Obama had nothing to do with that. We continue to hear folks deride the idea of the exchanges and the five points I just mentioned as ObamaCare. He had nothing to do with it. When we marked up the Affordable Care Act, we took, really, those ideas from the 1993 legislation here, with 23 Republican cosponsors--RomneyCare--and proposed and implemented it, I think, in 2006. It worked. When we were marking up the Affordable Care Act, we were actually looking for something that worked in order to give coverage to people in a cost- effective way. In 1993, the Republicans used, I think, what was originally a Heritage idea--Romney in 2006. They had a good idea, and it used market forces. What we have never done since the Affordable Care Act went into place is actually enable a good Republican idea to work. I think what Senator Alexander has put together with Senator Murray can help move us closer to that step. Some other things that I think we ought to do include a reinsurance plan along the lines that Senator Kaine and I have introduced, and that, I think, has a fair amount of support in a lot of corners. If we are not going to have an individual mandate--and I think we ought to, but if we are going to take it away--the other thing is to make sure that we put in its place the exchanges having young, healthy people so you have a group of folks in each State in the exchanges who are insurable without the insurance companies losing their shirts. I think one of the great things about what Senator Alexander and Senator Murray are trying to do here is to take the small step of ensuring that the cost-sharing reductions really help lower income people with their copays and help them with their deductible costs. If we can do that, along with the 1332 waiver, which I support, this can be a confidence builder. Maybe we can do some other things like the reinsurance ideas we have and others have. If there is a better idea than the individual mandate, by golly, let's do that, but we need healthy, young people in the exchanges. My hope is, we can find common ground and make it on a little broader range of ideas to bring us good healthcare coverage at an affordable price and then turn--kind of pivot--to the Affordable Care Act itself. As for the stuff in the Affordable Care Act that ought to be changed or dropped, let's do that. As for the portions of it that ought to be preserved, let's do that as well. Again, I commend my friends for coming up with this very good step. My hope is that we can get a vote for it. I met with a lot of insurance company folks earlier today. We do not agree on everything, but one of the things I heard from them is, if we were to do what Senator Alexander and Senator Murray have called for with respect to cost-sharing reductions and if we were to do some kind of reinsurance plan along the lines of what Tim Kaine and I have suggested--but not necessarily that--and if we were to do something to make it clear that the individual mandate or some other mechanism were going to be in place and stay in place so we could get young people into the exchanges, if we were to do those three things, they told us, we could bring down premiums anywhere from 30 to 35 percent in the exchanges. Who benefits the most? As it turns out, it is not just the people who are getting their coverage in the exchanges. Who else benefits the most is Uncle Sam because, if we reduce premiums by 30 to 35 percent, Uncle Sam, which pays all of these tax credits to help buy down the cost of coverage in the exchanges, reaps a big benefit as well, and that helps to bring down the size of the deficit, which is good. I was just inspired by your words, of both of you, and wanted to say that and to applaud your efforts. It is a pleasure and an honor to work with you, and I look forward to doing more of that. Thank you.

Mr. CARPER

Mr. CARPER. Mr. President, I rise in opposition to the nomination of William Wehrum to be EPA's Assistant Administrator for Air and Radiation. President George W. Bush nominated Mr. Wehrum for the very same job in 2005. He was not confirmed then but was able to serve in that role on an acting basis--something he could not lawfully do today. At the time, I voted against Mr. Wehrum's nomination because I feared he would impede efforts to clean our air and protect the health of Americans. Sadly, my fears have been proved well-founded. Twenty times, the courts found that clean air regulations that Mr. Wehrum helped craft did not follow the law or protect public health. Since leaving EPA in 2007, Mr. Wehrum has spent his time suing the Agency. Mr. Wehrum was elusive in answering our questions. When asked which clean air regulations he supports, he could not name a single one--not one. Mr. Wehrum's extreme views are not good for public health and, quite frankly, the legal uncertainty that stems from his judgment would not be good for American businesses. That is why I call on all of my colleagues to join me in opposition to this nomination. Thank you.

Mr. CARPER

Mr. CARPER. Mr. President, last week, people across this country celebrated National Wildlife Refuge Week--and rightfully so. National Wildlife Refuges are one of the crown jewels of our Federal public lands network. These refuges provide essential habitat for some of our most imperiled species, including many impacted by climate change. Millions of refuge visitors also fuel local and regional economies by generating billions of dollars in sales. This week, the Senate is considering a budget resolution that would open one of our refuges, the Arctic National Wildlife Refuge, to oil and gas drilling. Despite tremendous public support for our refuge system and the economic benefits that the refuges bring to our local economies, efforts to develop these special wild areas are ongoing and have been championed by the current administration. The budget resolution is another such effort to promote development in a refuge, an effort that should be rejected. In some cases, refuges are compatible with development and increased human activity. In others, development decisions, such as the siting of oil and gas drilling, could negatively impact the future of both human and animal inhabitants. The Arctic National Wildlife Refuge, one of the largest remaining intact ecosystems in the world, is an example of the latter. The Refuge has been home to the Gwich'in people for more than 20,000 years. These Native people subsist primarily on caribou. Research shows that oil and gas development in the Refuge, even with a small footprint, could significantly alter Porcupine Caribou migration patterns and calving behavior. These changes would threaten the Gwich'in people's way of life. The U.S. 30-year-old treaty with Canada to conserve the Porcupine Caribou Herd could also be at risk. According to the U.S. Fish and Wildlife Service, the Arctic Refuge is the only national conservation area where polar bears regularly den. It is the most consistently used polar bear land denning area in Alaska. These iconic bears are increasingly vulnerable due to climate change, so the undisturbed Refuge land denning area is especially critical for their survival. The Refuge also hosts nearly 200 species of migratory birds, musk oxen, and wolves. As the Senate contemplates the future of this spectacular natural area, I want to remind my colleagues that this body has said no to opening the Arctic National Wildlife Refuge dozens of times. With oil prices significantly lower than they were earlier this decade and oil supplies at historic highs, it is hard to understand why we would change course now. The risks far outweigh any benefits, and the American public has consistently opposed drilling in the Arctic Refuge. I also want to express my strong concerns with possible pending administrative action in the Santa Ana National Wildlife Refuge, another national treasure. This Refuge is located on the U.S.-Mexico border, along the southernmost stretch of the Rio Grande River at the confluence of the Central and Mississippi flyways. It is home to more than 400 bird species, more than 300 species of butterflies, and more than 450 varieties of plants. The Santa Ana Refuge supports rare wildlife species, some found only deep in south Texas. The Refuge also provides habitat for at least eight species protected under the Endangered Species Act, including the ocelot. There are less than 50 ocelots left in the United States, so this Refuge is essential to the species' recovery. The Santa Ana Refuge is also a popular destination for birders and hosts more than 165,000 visitors each year. The booming ecotourism industry in the area is critical for local economies, which is another key reason why we need to ensure this Refuge and its inhabitants can thrive. U.S Customs and Border Protection and U.S. Army Corps of Engineers planning actions earlier this year suggest that the Trump administration may shift existing Federal Homeland Security funds to construct a segment of-border wall through the Santa Ana Refuge. As I have said before, we already have 650 miles of fencing along our southern border with Mexico in the areas where it is most effective. I am not unequivocally opposed to physical barriers where they are needed and where they can be shown to be the most effective method of border security, but the Santa Ana Refuge is not a known problem area for border crossing. Furthermore, a wall through the Refuge would permanently damage critical habitat, block wildlife migration routes, and would likely trap wildlife during floods. Again, a wall through the refuge would not yield intended outcomes and would harm both wildlife and communities. I urge my colleagues on both sides of the aisle to question and oppose construction of this wall segment. From Alaska to Texas to Delaware, our National Wildlife Refuge System is well worth protecting and preserving for future generations. I look forward to continued work with my colleagues and constituents to this end. Thank you.

Mr. CARPER. Mr. President, I rise in opposition to the amendment offered by the Senator from Utah. Why is this an important amendment vote? Just listen to this. More than 1,000 listed species, 77 percent of all listed species, including the polar bear, the Florida panther are found in one State--one State. Seventy-seven percent of all listed species, including the polar bear, the Florida panther, and many more are found only in one State, and for an island State like Hawaii, all of its species would lose protection. I urge you to join me in opposing this amendment.

Mr. CARPER

Mr. CARPER. Mr. President, in celebration of National Wildlife Refuge Week, Senator Barrasso and I introduced legislation just prior to the recent recess to reauthorize the National Wildlife Refuge System's volunteer and partnerships program. I want to share with our colleagues some information about S. 1940, the Keep America's Refuges Operational Act, and ask for their support. The Keep America's Refuges Operational Act reauthorizes the volunteer and partnerships program, with no increase, at $2 million per year. The U.S. Fish and Wildlife Service will use this authorization of Federal funding to provide volunteer uniforms, training, equipment, and necessary travel. The bill also allows volunteer groups to use this modest funding for administrative expenses directly related to the program. For example, these groups will now be able to use funding to complete administrative requirements of cooperative agreements with the U.S. Fish and Wildlife Service. Cooperative agreements enable volunteers to assist the agency in technical activities, such as bird banding, other wildlife tagging, and research. Our National Wildlife Refuge System is an exceptional network of public lands and waters dedicated to fish and wildlife conservation. More than 40 million people visit our refuges each year to explore, fish, hunt, and view and study wildlife. This ecotourism industry strongly supports local economies. Volunteers are critical to refuge operations, making up 20 percent of the refuge system's workforce. Volunteers assist with fish and wildlife surveys, restoring habitat, and supporting refuge office functions. Without volunteers and partner groups, refuges may have to cut back on public programs and reduce hours of operation. In my home State of Delaware, we have two beautiful refuges: the Prime Hook National Wildlife Refuge and the Bombay Hook National Wildlife Refuge. The two refuges employ only 10 full time staff, and both refuges are highly dependent upon volunteers. Each year, people come to our refuges to observe the federally threatened Red Knot shorebird, which stops along the Delaware Bay to refuel on horseshoe crab eggs along its migration journey. Volunteers make sure these visitors have memorable experiences. When people can see these pristine habitats and the many species that call them home, they are inspired to be good stewards of our planet for the enjoyment and benefit of future generations. I want to ensure that these opportunities abound, in Delaware and around the country. A small annual investment in the refuge system volunteer and partnerships program goes a long way. Every $1 appropriated to coordinate these volunteers translates to $10 worth of volunteer services. These appropriations also help cut government costs. In fiscal year 2016, 40,000 volunteers donated 1.4 million hours, with donated time equaling that of 649 full-time employees. I want to thank Senator Barrasso for cosponsoring this commonsense legislation. I look forward to working with him and our colleagues in the House to pass the Keep America's Refuges Operational Act and enact it into law. Thank you.

Mr. CARPER

Mr. CARPER. Mr. President, while the Senator from Massachusetts is still with us on the floor and in other ways as well, I just want to say a couple of things. One, good for the Senator. He just said a mouthful, and he said what needs to be said. What he said is that there is not just one or two choices. Somebody said to me yesterday: Well, it is a choice between either a single-payer or Graham-Cassidy. Those are our choices. Uh-uh. No. No. I think a far better choice for us to take is in the example of leadership set by Senators Alexander and Murray on the Committee of Health, Education, Labor, and Pensions. As the Presiding Officer knows, in a span of 2 weeks, they held four bipartisan roundtables with Governors from all over the country, insurance commissioners from all over the country, healthcare providers, insurance, and health economists to ask: What should we do? What should we do right now in our being faced with the challenge and maybe the possibility of repealing the Affordable Care Act? What should we do? They all said the same thing--stabilize the exchanges. Every State has a health insurance exchange, an individual marketplace. Stabilize them. They all basically said to do mainly three or four things to stabilize them: No. 1, make clear that these cost-sharing subsidies, which help lower income people in the exchanges with their copays and deductibles, are not going away. Make it clear that they are going to be around for at least a couple of years. No. 2, either give the States the ability to create their own reinsurance plans or create one for the Federal Government, by the Federal Government, involving the Federal Government. The third thing they said is, if we are not going to enforce the individual mandate--I, personally, think we should--then make sure there is something that is just as effective as the individual mandate in order to make sure that young people--millennials like my sons--are getting their healthcare. They are in the exchanges, and they are helping to make sure there is a healthy mix of people to insure. Those were almost word by word, panel by panel, what we heard in four different hearings by the HELP Committee during four different bipartisan roundtables that preceded those hearings. They all said to fix the exchanges. I have an old friend who is now deceased. He was a Methodist minister for many years in southern Delaware. He used to give me this advice when I was Governor: Just remember this, Tom--the main thing is to keep the main thing the main thing. That is what he said. The first time he said it, I didn't know what he was saying. It took me a while, but I finally figured it out. The main thing is to keep the main thing the main thing. Right now, the thing that we can do and ought to be able to agree on is to stabilize the exchanges. Premiums do not have to go up in the exchanges by 30, 40 percent. If we would simply do one thing and make it clear that these cost-sharing subsidies are not going away and give that green light to the insurance companies, insurance commissioners across the country will reduce significantly the increases in the premiums. I have been told by more than a few health insurance companies that if we would do that and make sure there is some kind of reinsurance program in place, in effect, and also make it clear that the individual mandate must continue to be enforced--and if it is not, then replace it with something that is just as good--if we would do those three things, we would see premiums go down anywhere from 30 to 35 percent in the exchanges across the country. Who mostly benefits from that? Who benefits from a 30- or 35-percent reduction in premiums in the exchanges? The folks who are getting their insurance in the exchanges benefit, but do you know who else probably benefits even more? Uncle Sam. The reason is that most of the people who get their coverage in the exchanges benefit from a sliding scale tax credit that buys down the cost of the premiums. If the premiums go down by 30 or 35 percent, that means that Uncle Sam, out of the U.S. Treasury, pays less money in the form of those tax credits. That is not a bad deal. Our Republican friends like to talk about dynamic scoring. I am not sure I believe dynamic scoring is real, but I believe if we actually do help drive down the cost of premium increases, Uncle Sam is a big beneficiary of that. The last two things I want to say are, No. 1, I thank Senator Alexander and Senator Murray for the great bipartisan leadership they have shown. I had a chance to go to four bipartisan roundtables a couple of weeks ago. They welcomed people not on the HELP Committee. I am on the Finance Committee, as is the Presiding Officer. We have shared jurisdiction with the HELP Committee. But we have the opportunity in our committee to sort of follow the lead, if you will, of what they are doing on the HELP Committee and do bipartisan hearings and bipartisan roundtables of our own. Why don't we sort of pick up where we were about a week and a half ago when the prospect of debating and voting on Graham-Cassidy came out of nowhere and led to yesterday's 5-hour hearing in the Finance Committee? Why don't we pick up where we left a week and a half ago and get to work again? This is not something we ought to take weeks or months to do. Let's just do the main things; that is, stabilize the exchanges, and if we do nothing else in the next week or so, let's make it clear that these cost-sharing subsidies are not going to go away. We help people on the exchanges, the premium increases go down, and we actually help the Treasury. That is not a bad deal. The last thing I want to say is for those people who say that Democrats believe the Affordable Care Act is perfect and nothing needs to be changed. That is just nonsense. The Presiding Officer and I can sit down and tick off a number of things that ought to be addressed and fixed. He and I probably, as smart as we are, are not smart enough to figure out all of them. We need to have a good hearing and good conversation amongst ourselves and with a broad section of shareholders and stakeholders across the country. As a recovering Governor and former chair of the National Governors Association, I want to hear the voices of the Governors. I want to hear the voices of the insurance commissioners and a whole lot of other people who are affected by this. Every President, I think, since Harry Truman has called for providing healthcare coverage for just about everyone in our country--every President. Along the way we made some advances with Medicaid and Medicare with Lyndon Johnson. We made some advances in the Clinton administration with Orrin Hatch and Ted Kennedy's legislation creating the CHIP Program, the Children's Health Insurance Program. We are still a long way from where we ought to be for health insurance in this country. Here is the trifecta of where we would like to go and where Presidents and leaders have said forever that we ought to go. No. 1, provide quality healthcare for people in this country; No. 2, do it in a cost-effective way; and No. 3, cover everybody. We are doing a lot better job of covering everyone. We have 20-some million people who don't have coverage. That is down from 50 million people years ago. We still have people without coverage. We spend a lot more money in percentage of GDP in this country than most other advanced nations. We have to continue to get better results for less money and have a real focus on value. There is a lot of encouraging work going on in my State. I know in Ohio there are places like the Cleveland Clinic. There are places like Christiana Care in my State. There is a lot of encouraging work going on, and we ought to build on it and find out what works and do that. Lastly, I want to give a shout out to Senator Gary Peters and Senators Duckworth, Stabenow, myself, and a couple of others who have been focused on a veterans' health motion to commit. I want to say a few words about healthcare as it pertains to veterans. This has been lost sometimes in the shuffle. The Medicaid Program in our country covers about 25 percent of the people who get healthcare in this country. Medicare is about 15 percent. The majority of people who get healthcare coverage in this country get it through their large group plan. We have 6 percent or 7 percent who get coverage through the exchanges. As a navy veteran, an ROTC guy, retired Navy Captain, we know that not every veteran actually gets their healthcare coverage from the VA. A number of them aren't eligible for that. As it turns out, among the people who receive coverage under Medicaid today, a lot of them are old, a lot of them are like our parents, grandparents, aunts, and uncles. The reason they are eligible for Medicaid is they have spent down their resources and assets, and they are old. A bunch of them have dementia. Maybe the family is unable or unwilling to take care of them, and they end up in a nursing home, and Medicare picks up the tab. I described it yesterday in our Finance Committee hearing. It is like a tsunami. My generation, the baby boomers, are moving into their retirement and moving into their seventies, eighties, and nineties, in some cases. A lot of them are old, and they have dementia. A couple million of them are veterans who get their healthcare coverage through Medicaid. In Ohio and other places, and certainly in Delaware, we have huge problems with opioids and heroin. The biggest form of treatment, as the Presiding Officer knows, for people with drug addiction in this country is Medicaid. Those are some reasons we think it is important not to touch one hair on the head of Medicaid, if you will, but to try to figure out how to make changes in a smart and humane way. Let me say a word or two about veterans' healthcare. My understanding is that the last version of the Republican healthcare proposal was pulled today, not to be voted on. It totally cut several hundreds of billions of dollars from Medicaid. I believe most everyone says that is true. Not every veteran has access to the VA for healthcare. Nearly 2 million veterans, as I mentioned earlier--that is 1 in 10 veterans in this country--rely on Medicaid for their healthcare, and that includes some 6,000 veterans who are living in my own State of Delaware. The Affordable Care Act provided healthcare coverage to some 340,000 veterans in the States that expanded Medicaid. For our veterans who rely on Medicaid, the most recent TrumpCare proposal would significantly scale back benefits or cause them to lose their benefits altogether. Veterans who rely on those benefits would see higher healthcare costs and lower quality care if they could access it at all. All the while, we know veterans are at high risk for serious and complex issues because of their service. I want to close by saying in a heartfelt way that we all know veterans. We have an obligation to those who have served us to make sure we take care of them later in their lives. We do that in a variety of ways. The VA system is much maligned in my State. It is not perfect, but I think they do a darn good job. We have one big hospital in Northern Delaware and two community-based outpatient clinics--one in Dover and Centerville and another one in the southern part of our State. They do a very good job. We are about to open a brandnew, 10,000-square foot community outpatient clinic in Georgetown, DE, the county seat of our southernmost county. Having said that, not every veteran in Delaware can access those facilities. For them, Medicaid is useful, and in some cases it is critical to having any care at all. We should keep that in mind. The challenges of the focus that were created by the possible vote here on this floor are now averted on the Graham-Cassidy proposal. As we go forward in a bipartisan way, let's work together to fix the things in the Affordable Care Act that need to be fixed and preserve those that need to be preserved, and for the aspects that need to be dealt with or dropped, let's figure out how to do that in a smart and humane way. We need to also keep in mind that a couple million people who use Medicaid are veterans themselves. With that, I suggest the absence of a quorum.

Mr. CARPER

Mr. CARPER. Mr. President, the Senator from Massachusetts has delivered a powerful message, obviously, one from the heart and a compelling message. I want to thank her for that. We have a bunch of new pages here. They showed up for duty earlier this week, and they are generally, I think, rising juniors, probably 16 years old or so. Most of the 800,000 people who we are talking about here as Dreamers came here before they were old enough to be a page, and many of them were not even old enough to go to kindergarten or first grade. They didn't come here by their own volition. They were, for the most part, brought here by their parents. They were brought here to flee horrific conditions in countries such as Honduras, Guatemala, and El Salvador, where there is violence, murder, and mayhem that is largely created because of our addiction to drugs in this country. They send us drugs trafficked through those countries from South America, and we send guns and money to places such as Honduras, Guatemala, and El Salvador. When we take into custody bad guys, people who are here illegally and who are also criminals, where do we send them? We send them back to Honduras, Guatemala, and El Salvador. We send them criminals, and we send guns and money to those three countries. The conditions that this toxic mix creates are ones that I wouldn't want to submit my children or my family to, and, frankly, a lot of the people in those three countries feel the same way. We are complicit in their misery. We are complicit in their misery, and that is why so many folks in those three countries, which are called the Northern Triangle, try to escape. These kids didn't come here on their own. They came here with their parents. Many of them, frankly, don't have any memories of where they were born. We are not looking for them to become American citizens. What DACA attempts to do is to give them some time--to give us some time--to be able to make their stays here legal--something short of citizenship. If your hearts aren't touched by the stories that Senator Warren just told us about these three young people, I want to take a little different approach and express why we should care. I came here to the Senate some years ago as a recovering Governor. I was privileged to be Governor of Delaware from 1993 to 2001, and people say that I am still a recovering Governor. I have focused much of my life on public service and on creating a nurturing environment for job creation and job preservation. Presidents, Governors, Senators, and mayors like to talk about the jobs they created and, in truth, we don't create jobs. People in our positions try to create a more nurturing environment for job creation, and that includes a quality workforce with the skills that are needed by employers. It includes transportation infrastructure that works. It includes public safety. It includes access to capital to finance the projects. It includes a lot of things: energy, a reasonable tax burden, and commonsense regulations. Those are some of the elements that create a nurturing environment. One of the top items on that list is always workforce--people who have the skills that employers are looking for, people who have the willingness to come to work and to work hard, to be trained, and to be promoted, in many cases, and people who are honest. I have not met 800 Dreamers. But at Delaware State University, which is a historically Black college and university in Dover, DE--they have been around for 125 years--there are about 40 Dreamers who are undergraduates there, either freshmen or sophomores, and I have met most of them. They are some of the most remarkable college students I have ever met. These are students who aren't just getting by with a 2.0 average or 3.0 average. These are students who are on the dean's list, who come to school on time, who don't cut classes, who make excellent grades, who work in many cases part-time jobs to help support their time in school, and who are anxious to be able to make real contributions to our community, to our State, and to our country. One young man, who was from El Salvador, at a public event we had 2 days ago on Tuesday at Delaware State University, said this to us--to the president of the university, Harry Williams, and their new provost, Tony Allen. He stood up, he held his hand over his heart, and he said: Every day since I was the age of 5 in kindergarten, in the school I held my hand over my heart and pledged allegiance to that flag. He said: I don't have any other flag. I don't have any other country. This is my country. We need young men and young women like him. I learned early this month, from the Department of Labor jobs report for the month of August, that one of the things it shared with us was that there are millions of jobs in this country that are going unfilled. There are millions of jobs in this country that are going unfilled. We have thousands of them in Delaware. Michigan probably has tens of thousands. I was told by one of the Ohio Senators that there are jobs in Ohio that are not being filled because the people who are applying for them don't have the skills, the work ethic, or the record. In some cases, they can't pass a drug test. Yet these employers in all of our States need workers. In a day and age when we need workers with the academic skills and the work skills--we need them probably more than ever--we are ready to pack up 800,000 of them and send them back to where their parents came from, where they were born. It is in America's naked self-interest to ensure that these young people are given a shot to make the kind of contributions that they are capable of to meet the needs of hundreds of thousands of employers in this country. Given that opportunity, they will make their parents proud, and they will make us proud. They will make our Nation stronger and more economically vibrant. It is in our interest to let them stay and to welcome them here. I will close with the words of Matthew 25: When I was a stranger in your land, did you welcome me? Think about that. When I was a stranger in your land, did you welcome me? Let's welcome these young people. Let's put them to work.

Mr. CARPER

Mr. CARPER. Good afternoon, Mr. President. It is good to see the Presiding Officer and to hear my colleague Senator Perdue, as he prepares to probably head for home for the next several weeks. A number of our Senators are heading for their home States this afternoon and tomorrow to begin what is traditionally called the August recess. I am fortunate to live in Delaware, and I can go home every night. Some people see it as a blessing, others as a curse. I see it as a blessing to go home and stay a while. I am looking forward to that. We have three Senate office buildings here on Capitol Hill that Senators share and where they have their office space. The oldest is Russell. The next oldest is Dirksen. The newest is a building they call the Hart Senate Office Building. For 16 or 17 years, my staff and I have been in the Hart Building--and by choice. Every 2 years we can change offices, but we always want to stay in the same office, which is sort of unusual when you have been here for 16 or 17 years. Sometimes a lot of people say the names Russell or Dirksen or Hart. Russell and Dirksen are pretty famous folks, even now. Hart is less well known. I will not take a lot of time to give a deep history of who Philip Hart was, but he was a Senator from Michigan and he was a Democrat. His time here preceded my time. I was elected State treasurer for Delaware in 1976, a Congressman in 1982, and Governor in 1992. Then, I came to the Senate in 2001. But for Philip Hart and me, as far as I know, our service never crossed. If we did, I am not aware. I don't know a lot of the things he was famous for. There are some of his famous quotes, but one of my all-time favorite quotations are the words I believe he said when he left this place. He left the Senate and retired. Some say he left too soon, but when he retired, he said these words: ``I leave as I arrived, understanding clearly the complexity of the world into which we were born and optimistic that if we give it our best shot, we will come close to achieving the goals set for us 200 years ago.'' That is what he said. Aren't those wonderful words? At a time when we could actually use a little bit of encouragement, I hope that, maybe, his words provide at least a small measure. For me, they always provided a large measure. If you go back to the beginning of this Congress, January 3, and the inauguration of the President on January 20 of this year, there were high hopes on both sides to immediately get to work on comprehensive tax reform; on transportation and infrastructure policy for roads, highways, bridges, rails, ports, broadband, and maybe our electric grid. There was the idea of doing something for our Republican friends to repeal the Affordable Care Act. As it turns out, we have in some cases disappointed, and in other cases we probably have pleased the folks who elected us to serve them, in developing and creating some of the policy for our country. I spent a fair amount of time on healthcare. I know the Presiding Officer, the Senator from Wisconsin, has as well. I spent a fair amount of time thinking and working on healthcare before, as a Governor and even as a Congressman. I am not a doctor. I have never pretended to be and have never wanted to be, but I think one of the credos for the folks in the medical field and physicians is ``do no harm.'' I hope that, at least on the healthcare front, in these 7 months here of this legislative session, we have not done a great deal of harm. I don't think we have. We had a robust debate on whether the Affordable Care Act should be repealed, with a special focus on the section called ObamaCare, and not much of a debate on how we get better healthcare results for less money, although it is a goal we all share, as Democrats and Republicans, in the executive branch and in the legislative branch. I think that we all share the goal of trying to figure out how to provide better healthcare for less money to everybody so everybody has coverage. I think that is a shared goal. Lamar Alexander, my Senate colleague from Tennessee, likes to say: A pilot wouldn't take off in an airplane without knowing what his or her destination is. Think about that. With respect to our destination on healthcare, I think we know what the destination is; that is, as I said earlier, to make sure we provide better coverage for less money and cover everybody. That is the destination. Just as a guy who spent a lot of time as a naval flight officer in airplanes for about 23 years, I know there are different ways to get to places. Sometimes it is a straight line; sometimes it is not. Sometimes you have to go around turbulence, around storms, or under them. You may run short on fuel, and there may be mechanical malfunctions. It is not always a straight line to get to where we want to go in an airplane. It turns out that it is not a straight line--that destination that we want to get to with respect to healthcare, for better results, less money, and covering everyone. One of the efforts to reach that destination has its roots in 1993. In fact, here in Washington there were two ideas for reaching that destination in terms of healthcare. Our shared goals go back to 1993, where you had here in Washington two different ideas that were put on the table. One idea was from our First Lady, Hillary Rodham Clinton. She worked with really smart people to come up with a healthcare plan called HillaryCare, to essentially try to achieve those three goals I mentioned. Our friends in the Republican Party were not always kind in characterizing her proposal. I think, when they called it ``HillaryCare,'' it was not meant to be a compliment. Even now, in television commercials, I remember seeing them kind of denigrating her efforts. One of the responses from the folks who supported it--at least, something that First Lady Hillary Clinton proposed--or one of the things that the Democratic side said to the Republicans was this: What is your idea? At least we have an idea. Then, some really smart people over at the Heritage Foundation went to work and they came up with what turns out to be a good idea--several very good ideas--to draw on market forces in order to try to meet those three goals I stated earlier on healthcare. The first great idea of the five ideas was to create exchanges in every State for people who don't have coverage under Medicaid or Medicare or they don't work for an employer that provides healthcare for them. These are large purchasing pools in every State where people can get healthcare coverage and be part of a large group plan and realize the benefits of being a part of that large group plan. The second aspect or pillar of their five ideas was the idea of a sliding-scale tax credit for people whose income was low. They would get a tax credit to lower the cost of a premium in the exchange in their State. As that person came up and up, at least to a certain level, the tax credit would go away. It is a sliding-scale tax credit. That was a Heritage Foundation idea. Their third idea was something called an individual mandate, which said that, if you don't have coverage, you have to get it. Particularly, you have to sign up for it in the exchange. If you don't want to sign up, you are going to be fined. You can't actually make people sign up and get coverage, but the idea behind Heritage was that we would incentivize people to get coverage, because, eventually, people who don't have coverage will have to get care. Unfortunately, it is really expensive if they go to the emergency room. A lot of times they are so sick that they end up getting admitted. That costs a bundle, and the rest of us end up paying for it. So the third pillar was the individual mandate. The fourth pillar was the employer mandate, because we want employers to cover their employees. That may not be absolute full coverage or Cadillac coverage. You don't have to necessarily cover their family, but we want you to offer coverage to your employees--hopefully, decent coverage. The last part dealt with preexisting conditions. The Heritage folks said that there should be a prohibition against insurance companies being able to say to people who are sick or have some kind of preexisting conditions: We are not going to insure you because you have a preexisting condition. Heritage said that should be verboten. You shouldn't get away with that if you are an insurance company. Those were the five ideas. Our friends here on the Republican side of the aisle said: We want to take those ideas. They did. The lead sponsor was John Chafee. I think he had 22 Republican sponsors in 1993, including Senator Hatch, who was the senior Republican on the Finance Committee and chaired the Finance Committee, and Chuck Grassley, a senior Republican on Finance who was also the chairman of the Judiciary Committee. They were some of the 22 cosponsors of the Republican bill, which really reflected the Heritage Foundation's ideas. Neither HillaryCare nor the Chafee legislation went forward and was adopted. But about 13 years later, in 2006, a fellow Governor of Massachusetts was thinking about what were some things he could do to really differentiate himself in the field for running for President in 2008. His advisers came up with this idea: Why don't we try to cover everybody in Massachusetts and be the first State with everyone having healthcare coverage? They dusted off the Heritage Foundation's five ideas and introduced the legislation in Massachusetts. They amended it and changed it a little bit, but, in the end, they passed the legislation. They implemented legislation in 2006, I believe, that reflected Heritage's ideas from 1993 and reflected the legislation that was written in this Chamber by John Chafee in 1993. It worked. It worked in Massachusetts. They fairly quickly were able to cover a lot of extra people in their State who hadn't been covered before. One of the things they wrestled with early on was portability. As it turns out, the folks who are young and invincible, like our pages here with us--I think this may be the last day or two before they head back for home. The Presiding Officer may not know this, but the pages are here on overtime. Most of the pages returned to their home States across the country, but there are a half dozen or so volunteers that are still sticking with us to the bitter end. Hopefully, it is not too bitter an end. We hope that someday you will come back here as interns or maybe staff Members, and, who knows, maybe even as Presiding Officers or just mortals--mere mortals like me. Thank you again for your service. Anyway, the Romney folks found out that they had this fine setup. So if people didn't get coverage in Massachusetts, they would have to pay a fine. It went up over time. It was later that they decided that if they had to do this over again, they would have had the fine start higher and escalate faster in order to send a clear message to the young invincibles and others who didn't have coverage that you have to get serious about getting coverage. They wanted a mix of people in their exchanges so that insurance companies would be able to insure them and not lose their shirts--to make money off of it. Anyway, when we were working on the Affordable Care Act in 2009, my first year on the Finance Committee, we were trying to figure out what to do. We proposed a lot of ideas to sort of keep our eye on the ACA. The Affordable Care Act was a way to just sort of pivot away from sick care, where we just spend money on people when they are sick, and do more to invest on how we help people stay healthy through prevention and wellness, by doing screenings for colorectal cancer, breast cancer, and prostate cancer, in ways that, if you take away the copays for people and they can go ahead and get the screenings, they save themselves a lot of money and a lot of pain and maybe from dying, which otherwise wouldn't be the case. There are a lot of aspects of the Affordable Care Act. We raised the eligibility for folks for Medicaid. When I came back from Southeast Asia in 1993, I went to business school in Delaware and got an MBA. The next year, I became State treasurer. I was 29. At that time, I thought of Medicaid as healthcare coverage for poor women with children. At the time, that was pretty much what it was, but not today. Almost two-thirds of the money we spend on Medicaid is for people who are in nursing homes--our parents, our grandparents, our aunts, our uncles. A lot of them are veterans. I think 2 million are veterans. We spend a lot of money on Medicaid today to treat addiction for heroin and opioids, and we spend money on poor families, including women and children, but the nature of the coverage has changed a whole lot. For many years, it has been a 50-50 yield. Largely, States pay 50 percent, and the Federal Government pays 50 percent. We changed that in the Affordable Care Act because we wanted the States to cover more than just the people up to 100 percent of poverty. The Federal Government stepped in and said to the States: If you would go along with this, we would like to cover people from 100 percent to 135 percent of poverty. The Federal Government, at least for a while, would pay for that marginal increase in coverage up to 135 percent of poverty. It is a pretty good deal for the States, and about 31 States have signed up to do that. So a lot of people have coverage today who did not have it before through Medicaid. The other thing we did in writing the Affordable Care Act was to take the idea that they have sort of glommed onto in Massachusetts with RomneyCare--which has its roots back to the 1993 proposal from Heritage and that was proposed here in the Senate by Senator Chafee--and put that into the Affordable Care Act. I know that there are some people who wanted to have a single-payer system in that their idea of healthcare reform was to cover everyone under Medicare who did not have coverage. We were just not ready to go there, so we said: Let's try something that has been put in place in one of our States, maybe with the idea that Massachusetts could be the laboratory of democracy--to find out what works and do more of that--and that was what we did. We passed legislation that created exchanges in all 50 States, and we had an individual mandate to encourage people to get coverage and incentivize them but fine them if they did not. A lot of people say that we started too slowly, as Massachusetts did not implement it fast enough to get people signed up in the exchanges, but we learned, maybe, from our mistakes. We had the employer mandate, and we had the sliding sales tax credit in the Affordable Care Act. Then we had the prohibitions against insurance companies that refused to cover people because they had some kind of preexisting condition. That was the part of the Affordable Care Act that had its roots, really, in Heritage and Republican Senators--really good ones. Some of them are still here. Somehow, this has turned out to be that part of the Affordable Care Act with the exchanges and so forth. It ended up being called ObamaCare, which is really ironic because he did not have anything to do with creating it. It was not his idea, but, somehow, it has been deemed to be ObamaCare. It is the part of the Affordable Care Act that has been most attacked by our Republican friends. It was their creation, their suggestion, and now they want to get rid of it. We have had some tough debate here in recent weeks, and the Senate has decided not to repeal that part of the Affordable Care Act. I think that we are smart not to repeal it, but the idea is to help make it work. One of the best ways is to sort of calm down the exchanges--quit disrupting and destabilizing the exchanges. When the President says that we do not know if we are going to enforce the individual mandate or the subsidies that we provide for low-income people, who get their coverage in the exchanges, to help cover their co-pays or deductibles-- they do not know if they are going to keep doing that. They are basically saying of the ObamaCare exchanges to just put them in a death spiral. Let them just die. Then, maybe, the Democrats will come to the table. I think all of that would be a huge mistake. Most of the people would suffer. As a matter of fact, a lot of the folks who voted for them are in rural States, and a lot of them are in red States around the country. I think it is cruel, and I do not think it is very smart. Last Friday morning at 2 a.m., three Republicans--Lisa Murkowski, of Alaska; Susan Collins, of Maine; and John McCain, of Arizona--joined 48 Democrats in saying: Let's hit the pause button on degrading, further bringing down, the Affordable Care Act. Let's hit the pause button. It is not because the Affordable Care Act is perfect, because we know there are things in it that need to be fixed, but there are portions that need to be preserved as well. We said: Let's see if we can't hit the pause button--kind of pivot-- and stabilize the exchanges, first of all, then do the fix, and do the repair that needs done in the ACA. We would keep the stuff that is really good and that everyone says is good and move on. Let's not just do it as Republicans by themselves or Democrats by themselves. We have tried that. Let's try working together. Now we have a chance to do that, and people, like the Presiding Officer, who have very good ideas will have a chance to present those ideas in hearings that will be held by Senators Lamar Alexander and Patty Murray right after we come back here, just after the Labor Day holiday. I learned in our Finance Committee today that Chairman Orrin Hatch and Senator Ron Wyden, who is the senior Democrat on the committee, will also be holding a hearing or hearings on how do we stabilize the exchanges and how do we, maybe, find some ways to improve on what we have done in the Affordable Care Act. I can think of any number. I am sure that the Presiding Officer can as well. I do not leave here discouraged. This is a country about which people say: You must be miserable serving in the U.S. Senate. I say: Oh, no, not at all. I am sort of energized by what has been going on, not discouraged. A long time ago, we fought the Civil War. One hundred fifty years ago, we fought the Civil War. My friend here from Mississippi remembers that. I grew up in the last capital of the Confederacy--Danville, VA. I remember that. One hundred fifty years ago, hundreds of thousands of people were killed, maimed, or wounded. When it was over, our President was assassinated, and his successor was impeached. Somehow, we got through that and made it to the 20th century and fought, not one, but two World Wars. We won them both and led them both. We fought the Cold War--won it, led it. We led the world out of the Great Depression and into the 21st century. The 21st century emerged, and the Sun came up that January day in 2001. America had the strongest economy on Earth and the most productive workforce on Earth. We are a nation of peace. We had four balanced budgets in a row. We had not balanced a budget since 1968. Then we figured out how to do that four times in a row during the last 4 years of the Clinton administration. In 2001, we were the most admired Nation on Earth and the most admired force for justice on Earth. I like to remind people that if we can get through the 150 years after the Civil War and end up where we were on January 1, 2001, we will get through this as well. The last thing I would say is this: When we come back, there is plenty to do. One of the things we have to do is deal with our financial plan, our budget, and figure out what to do with respect to the debt ceiling. We will be coming back and holding the hearings that I described on the Affordable Care Act and trying to stabilize the exchanges. We will begin to figure out what we ought to do beyond stabilizing the exchanges and do it as Democrats and Republicans working together. When we passed Social Security, Medicare, the Civil Rights Act, and the GI bill, those were not all Democratic ideas or all Republican ideas. Some of the best work we do is when we work together. We will also have the opportunity to tackle our Tax Code. We have a tax code that, in some cases, discourages companies, especially larger companies, from staying in the United States and continuing to do business here and employing people here. In some cases, we encourage them to look for other places around the world in which to locate their businesses. We need to make sure we have a tax code that encourages innovation and that encourages companies to expand and grow here. My hope is that we can, especially on the Finance Committee, really focus on that and work with our colleagues, work with the House, and work with the administration. I am a really optimistic person about most things, but the last time we did comprehensive tax reform in this country was in 1986. At that time, we had Republican President Reagan, who was for it. He had a great Treasury Secretary, Jim Baker, who was for it. Dan Rostenkowski, the chairman of the Ways and Means Committee in the House, was for it. Tip O'Neill, the Democratic Speaker of the House, was for it. We had Bob Packwood and Bill Bradley, a Democrat and a Republican--brilliant people on the Finance Committee. They were for it, and it still took 5 years to do it--really hard stuff. We need to get serious about it, and we need to get going. My hope is that we will end up being revenue-neutral. We could use some revenues, but I hope it will be revenue-neutral. At the end of the day, I hope that what we do will answer these four questions: Is it fair? Does it foster economic growth? Does it make the Tax Code less complex or more complex? Finally, how does it affect our fiscal situation--our budget situation? My hope is that we can keep those questions in our minds as we formulate tax reform and answer them in an appropriate way. I see my colleague here with whom I serve on the Finance Committee and on the Environment and Public Works Committee. He is waiting his turn, and I have talked long enough. I will close where I started, with the words of the late Senator Philip Hart, of Michigan, who was admired by a lot of people here in this body before we came here. He said these words: I leave as I arrived, understanding clearly the complexity of the world into which we were born and optimistic that if we give it our best shot, we will come close to achieving the goals set for us 200 years ago. Boy, those words ring true today, don't they? As we are about to leave, unlike our friend Philip Hart, who left the Senate, those who serve today in the Senate are going to come back in 4 weeks. My hope is that when we come back, we will come back determined to work together. That is what people want us to do. They want us to work together because, if we do, we will get a lot more things done. My wife and I went to Africa and actually met up there with one of our sons and a friend of his two summers ago in August--2 years ago this August. I learned more about Africa in, actually, a week to 10 days than I had learned in all of my life. One of the things I learned was an African proverb that some of you already know. It goes something like this: If you want to go fast, travel alone. If you want to go far, travel together. Think about that: If you want to go fast, travel alone. If you want to go far, travel together. We have tried going it alone, and we have not gotten that far. My hope is that when we come back, we will travel together, and we will go a long, long way and make everyone proud of us. I say again to my colleagues and the pages and our staffs, thank you for the good work that you have done. It is a pleasure serving with all of you. I bid you adieu. Thank you. I yield the floor.

Mr. CARPER

Mr. CARPER. Mr. President, I spent many years of my life in Navy airplanes. I am a retired Navy captain. Senator Alexander said something the other day about the fact that a pilot doesn't start up and take off in an airplane unless he or she knows what the destination is. I thought that was pretty interesting. It is true. With respect to healthcare in this country, we have actually known for a long time what the destination is, and the destination is a combination of three things: better healthcare coverage for less money--and cover everyone. That is really our destination. It is not just the destination this year in this Congress; it has been our destination really since Harry Truman was President. For some years, we have argued and disagreed about how to get to the destination. I don't think anyone would argue about the need to get to that destination, but the question is how. In 1993--I mentioned yesterday in my remarks on the floor--Hillary Clinton was a brandnew First Lady and worked on something called HillaryCare. In response, Republicans came up with something that really has its roots and origin from the Heritage Foundation. They had more of a market-based approach, which called for every State having their own exchange, where people without coverage could get healthcare coverage. There would be a sliding scale tax credit that would help buy down the cost of premiums for folks who got the coverage in their State's exchange. Low-income people got a bigger tax credit. Higher income people had a smaller tax credit that would eventually fade away. The third piece of the Republican alternative to HillaryCare was the idea of an individual mandate, which basically said that everybody has to get coverage. If you don't, we can't make you, but you have to pay a fine. Over time the fine would go up. The fourth piece of the Republican proposal in 1993 was that employers of a certain size with a certain number of employees would have to make sure they provided coverage for their employees. I don't remember a lot of specificity of what that coverage would include, but if they had quite a few employees, they would have to provide coverage for them, make it available. The last piece was the idea that health insurance companies would say at that time: If you have a preexisting condition, sorry, we are just not going to cover you. The Republican proposal said: That is verboten. You can't do that, insurance companies. So that was their idea that was introduced here. There were, I think, about 23 cosponsors, led by John Chafee, who was a former marine, former Governor of Rhode Island, U.S. Senator, and highly regarded. The legislation he introduced in 1993 had 20, 22 cosponsors, I think, including some people who are still here--Senator Hatch, Senator Grassley, and a number of others. That idea became RomneyCare. In 2006, Governor Romney sought to cover everybody in the State of Massachusetts before running for President. It was a pretty good idea. It was such a good idea that when we worked on the Affordable Care Act, that idea was one of the major principles, one of the major pillars of the Affordable Care Act. Now--I said this yesterday--Barack Obama gets credit for coming up with that approach to provide healthcare. He is a smart guy, but that wasn't his deal. He didn't come up with that. I didn't come up with that. Governor Romney didn't come up with that. I don't think Senator John Chafee, beloved Senator from Rhode Island--neither he nor Senator Hatch nor Senator Grassley came up with that. I think it was an idea from the Heritage Foundation. It is probably heresy, as a Democrat, to say this, but it was a good idea. It was a good idea in 1993. It was a good idea in 2006 in Massachusetts, and it was a good idea when we folded it into the Affordable Care Act as one of the major pillars. I want to go back and revisit 2009 just for a little bit. There are those who believe that there was no bipartisan involvement and the ACA was just hustled through without a lot of thought or debate. As it turns out, I think we spent 80 days all total in the U.S. Senate in that Congress in 2009, debating the bill in committees--the two committees of jurisdiction. I served then and I serve now on the Finance Committee. We spent a heck of a lot of time in debates and markups where people had a chance to offer amendments, debate them. The Health, Education, Labor, and Pensions Committee spent a lot of time that year, 2009, similarly in bipartisan hearings, with bipartisan amendments, debate. All totaled, I believe, over 300 amendments were offered in Senate committees of jurisdiction, and I am told that 160 amendments offered by Republican Senators were adopted and made part of the legislation. I know our Republican colleagues believe that they were shut out of the process, but I think a closer review of that process in history would suggest that just wasn't so. Was it a perfect process? No. Could it have been better? Sure. You can always do things better. But it was a process that we went through in order to address this concern. In 2008, during that year's election, one of the things I learned was that we were spending in this country, as a percentage of GDP for healthcare, 18 percent of GDP. I have a friend who, when I ask him how he is doing, says: Compared to what? I would just say: Well, what were the Japanese spending in 2008 as a percentage of GDP for healthcare? It was 8 percent. Think about that. Well, maybe we got better results; maybe people live longer in this country or we have lower rates of infant mortality than the Japanese. No, it is not true. They got better results. They spent half as much, and they got better results. Well, maybe a lot of people in that country didn't have coverage and we covered everyone. Actually, just the opposite is true. They covered everyone. We had 40 million people who went to bed in 2008 without any healthcare coverage, and for a lot of them, access to healthcare coverage was the emergency room of a hospital. As you all know, as we know, when people get sick enough, they will get care in this country. It may not be cost-effective care. It may be expensive care because it is not just an emergency room visit. In many instances, it is the admission to the hospital and a stay that could last for days or even weeks. We do have some idea how much it costs to stay in the hospital. It is hugely expensive. Eventually, people would get healthcare coverage or healthcare attention, but a lot of times it costs an arm and a leg, literally and figuratively. So the question was, could we do better than that? What we came up with is a multifaceted approach, which includes that Heritage Foundation idea of the exchanges where people didn't have access to coverage. And the focus would be not just on spending money on people when they were sick, but to save us--not to have so much a sick care system, but to have a healthcare delivery system that focuses more on helping people to stay healthy and well, with a much bigger focus on prevention and wellness and frankly a focus on, for example, making sure people, when they reach the age of 50, get a colonoscopy and they don't have to pay a whole lot of money to get it because it would be part of their health insurance coverage. I have a friend whose mom died several years ago. My friend and I work out at the YMCA in Wilmington from time to time. She just turned 50, and I said: Well, how old are your parents? My friend is really fit, and I said: How old are your parents now? She said: They are both deceased. I said: Really? What happened? She said: My mom died of colon cancer a number of years ago. I said: Didn't she get the colon screening--the colorectal screening and all? She said: No, no, no. She didn't like that, didn't want to do that. It costs a lot of money, and so she just didn't do it. We have other people who, over the years, have not had prostate screenings for prostate cancer, and we have had people who didn't have breast cancer screenings because, in some cases, it is unpleasant and, in some cases, just because it can cost a lot of money, and a lot of that was out of pocket, so people would forego that. We have changed that. We want people to get the screenings and to be able to get those screenings and find out and make sure that they are not going to get sick and cost a lot of money. My friend's mother was sick for many months. I can't imagine how much it cost--and all that for maybe a $1,000 colorectal screening that was not taken. We don't do that stuff in this country much anymore. We actually offer the screenings. They are free. With our focus on wellness and prevention and things like annual physicals, we want to catch problems when they are small. One of the reasons healthcare coverage in Japan--as a Naval flight officer, I flew a lot of missions in and out of Japan during the Vietnam war, and one of the things I learned about Japan is that, one, the people are very slender. In this country, about one-third of our people now are obese or on their way to being obese. Obesity is a great precursor, which says that this person is going to have healthcare problems and costly healthcare problems. There are a lot of people in this country who still smoke--not as many as before--but that is another predictor of people on whom we are going to have to spend a whole lot of money. The other thing that caught my eye in Japan was the access to primary healthcare close to where people live. In almost every neighborhood of any consequence, people had access to a clinic where they could go for a checkup, for a physical to catch problems when they are small and to address them when they are small. As we looked around the world at things that were working, that would seem to be something that worked, we tried to make sure that was part of our approach in the Affordable Care Act. Another thing we found that worked is, in some countries and literally here in this country--the Mayo Clinic, the Cleveland Clinic, and places like that--one of the secrets of their success, better results for less money, is the idea of coordinating the delivery of healthcare--coordinating the delivery of healthcare. My mom, now deceased, lived until she was 82. She had dementia. She had arthritis. She had congestive heart failure. She had any number of ailments. My dad had passed away several years earlier. She lived near Clearwater, FL. We had people--my sister had people living with her to take care of her until later in her life. At one time, my mom was seeing five or six doctors. They were prescribing a total of 15 medicines for her. I remember we had in her home something that looked like a fishing tackle box--my dad's fishing tackle box. You may have seen one of these. If you open it up, it has all these medicines in it to take before breakfast, with breakfast, after breakfast, before lunch, all the way to bedtime, and they are all set up and arranged. Fifteen different medicines she was taking from five or six doctors who never talked to each other. Nobody had any idea what was being prescribed for my mom. Nobody was coordinating that care. That is foolish. I know a lot of those medicines probably interacted badly with each other and hastened my mom's decline and death. The focus we had on the Affordable Care Act, with coordinated delivery of healthcare among different doctors and different specialties and with hospitals, nursing homes, federally qualified community health centers, and the VA, we do a much better job at coordinating delivery of healthcare. In Delaware, we just don't have electronic health records for healthcare--we have those all over the country now. One thing that came out of the Affordable Care Act was we put the pedal to the metal and said we want a whole lot more electronic health records being used that talk to each other for coordinated delivery of healthcare--better care. Delaware took it a step further. In Delaware, we have something called the Delaware Information Network, which I signed into law, authorizing it in my last term as Governor. I had no idea really what the potential was of what we were doing, but with some help from the Federal Government, we have now just a terrific utility, a terrific mechanism to help us take this idea of coordinating delivery of healthcare and put it on steroids and further improve the quality of healthcare. I have been approaching this day with real concern. I am an optimistic guy. I am a glass half-full guy, but I have been troubled a lot more than not. I went home last night and my wife met me at the door and she said: You don't seem yourself. I said: I am troubled, and she said she was too. She had been watching too much TV. There are a lot of concerning things going on in this city, at the White House, and even in this building. We are at our best when we work together. We Democrats didn't create Social Security by ourselves. The GI bill--I was a beneficiary of the GI bill at the end of the Vietnam war, and so was my father at the end of World War II. There have been good ideas like Medicare. Democrats didn't create them by themselves, Republicans didn't create them by themselves. We worked together to create those landmark pieces of legislation and programs that all of us would agree are good for this Nation and good for our people. When you are dealing with a subject that involves maybe everybody in the country and perhaps one-sixth of our population, this is one we ought to do together. We ought to do this together. John McCain and I served during the Vietnam war. We came to the House of Representatives together, and we worked on normalizing relations with Vietnam. He was a Senator with John Kerry, and I was a House Member with a bunch of my colleagues over there. John McCain stood right over here a couple days ago. We were all happy to see him back. We welcomed him back because we need him and his leadership. He said a number of times during his remarks that what we need is regular order. I guess people who might have been watching on C-SPAN are wondering what is regular order. We have a new crop of pages here. Let me just say to our pages who are rising juniors and coming from States all over America and actually do a great job of helping make sure this place doesn't get too messed up in more ways than one, regular order is when people have a good idea, whether it is in healthcare, defense, or agriculture, and actually take their good idea and introduce legislation. I try to introduce legislation most times with bipartisan support. I have learned you get better results in the end if you do that. The idea of regular order is introducing legislation that reflects and addresses a need or an issue. That bill is introduced here in this Chamber. It is assigned by the Parliamentarian to the committee of jurisdiction. The sponsor or sponsors of the bill go see the chair of the committee where the bill is assigned and ask for a hearing. If they convince the chair of the committee it is a good bill, with a good idea, then there is a good chance they will have a hearing. At that hearing will be witnesses--expert witnesses, stakeholders. Those witnesses will say: I like this about that bill or I see a problem with that bill, and there are changes that should be made to the bill. In some cases, we invite the Congressional Budget Office, sometimes Senators or House Members to come in and testify as well. On an issue that is this important, we need regular order because whatever the Republican ideas are--and hopefully we will find out what their ideas are today--we need to check the tires, take the time to find out what is good about it and what is not and fix it in committee, where Democrats and Republicans can offer amendments, debate them. That would be done in the Finance Committee and also in the Health, Education, Labor, and Pensions Committee. That is what we ought to do. If we take that approach, we will end up with a better final result; rather than being a country that looks at other countries around the world, asking: Why does Japan get better results than we do, spending half as much money and they can cover everybody--why is that? I am proud of much of what we do in this country with respect to healthcare; in many ways, we are on the right track, but as I said, in everything I do, I know I can do better. We can sure do a better job on healthcare. Last thought. I see we have been joined by the Democratic leader, and I will say a few words before yielding the floor. I was fortunate enough to visit Tanzania with my wife. We met our sons over there two summers ago. After going to a seminar, we went out across the country, had a chance to just see an amazing--for those who have never been there, and I never spent much time in Africa, it was an incredible experience, all the life and animals and nature and it was beautiful and incredibly exciting. One of the many things I learned there was this proverb, and it goes something like this: African proverb: If you want to go fast, go alone. If you want to go far, go together. If you want to go fast, go alone. If you want to go far, go together. We need to hit the pause button. We need to fix the exchanges in every State to stabilize the exchanges. There are three easy ways to do it: make clear that the individual mandate is going to be maintained or replaced by something that is at least as effective; a doctor reinsurance program that will help stabilize the program, much as reinsurance was used as a mechanism to stabilize and make successful the Medicare Part D Program; and, finally, we should make clear that the cost-sharing arrangements we have, the subsidies that help reduce the costs, the copays and deductibles for people getting their coverage in the exchanges, just make it clear they are not going to go away. The insurance companies tell us, if we would do those three things--secure the individual mandate or something as good as the individual mandate, reinsurance, and address the cost-sharing arrangements, that they are not going away--if we do those three things, they tell us the cost of premiums across the country would drop by as much as 25 percent to 35 percent. Think about that. What you would have is the insurance companies not fearing they are going to lose their shirts because of not having a pool of people they can insure. They are fearful of having a pool of people to insure in the exchanges that are sick, crippled, and there are not a lot of young, healthy people who create a mix that can actually, effectively and predictably, be insured by insurance companies. The great thing about reducing premiums by 25 to 35 percent in the exchanges is this. People who get the coverage in the exchanges benefit. They save money. Do you know who else saves money? Uncle Sam, because we are paying a significant amount of support to help make sure the exchanges envisioned all those years ago by the Heritage Foundation--to make sure they work. That sounds like a pretty good step: hit the pause button; stabilize the exchanges; make sure we have coverage for people in every State through the exchanges in every county and bring down the premiums by 25 percent to 35 percent; provide certainty and predictability for the insurance companies. With that predictability and certainty, we have more competition. The insurance companies get into the game, and they say we are going to offer policies as well. After we have done that, let's pivot and address, as Democrats and Republicans working together, fixing those parts of the Affordable Care Act that need to be fixed and preserve the parts that need to be preserved. Let's do that together. With that, I yield the floor. Recognition of the Minority Leader

Mr. CARPER

Mr. CARPER. Mr. President, I intend to offer a motion to commit the reconciliation bill to the Health, Education, Labor and Pensions, HELP, Committee with instructions to ensure the bill does not harm or reduce the size of the individual health insurance market risk pool in any State. I am offering this motion to ensure that the healthcare bill does no harm to the States' individual and small business health insurance markets by fracturing or reducing insurance market risk pools in ways that would drive up health insurance premiums and deductibles for older Americans or Americans with preexisting conditions. The following Senators support my motion to commit: Senators Coons and Shaheen. I ask unanimous consent that the full text of my motion to commit be printed in the Record.

Mr. CARPER. Mr. President, I intend to offer a motion to commit the reconciliation bill to the Finance Committee with instructions to ensure the bill includes reforms to our healthcare system that lower healthcare costs and improve health outcomes. I am offering this motion because the healthcare bills before us make devastating changes to our country's healthcare system that endanger Americans' access to healthcare and raise healthcare costs for all Americans, but contains no commonsense reforms to our healthcare system that drive down underlying healthcare costs and improves health outcomes. Millions of Americans wrestle with unaffordable healthcare costs and our fee-for-service healthcare system remains inefficient and wasteful. Instead of passing the buck to States and reducing access to healthcare for low- and middle-income Americans, we should be focusing on reforms that can improve the healthcare system and lower healthcare costs for all Americans. The following Senators support my motion to commit: Senators Coons and Shaheen. I ask unanimous consent that the full text of my motion to commit be printed in the Record.

Mr. CARPER

Mr. CARPER. I am happy to yield.

Mr. CARPER. I was happy to yield. Good to see you. Mr. President, I want to say a few words about ObamaCare. If you ask most people in this country ``What is ObamaCare?'' my guess is, they probably wouldn't know. Those who do might think it has something to do with the exchanges that would allow people to have coverage who don't have coverage on their own. They are not in a large group plan and they are not insured by their employer. They are not covered by Medicaid. They are not covered by Medicare. Maybe they are not a veteran. And 5 or 6 or 7 percent of the people today get their coverage from something called the exchanges. We have large purchasing pools in each State that are insured by private health insurance. That was not invented by Barack Obama. People call it ObamaCare, but its roots go back well before he was a U.S. Senator, much less before he was President of the United States. The idea of these large purchasing pools in each State--called exchanges-- goes back to, as far as I can tell, 1993, when the new First Lady, Hillary Clinton, was offering to begin work to find a way to do what I think every President since Harry Truman has tried to do, and that is three things: provide better coverage for people in this country, do so at less cost, and cover everybody. I believe that has been the goal of every President since Harry Truman. When Lyndon Johnson was President, some notable progress was made with the introduction of Medicare and Medicaid. But there were still a lot of people who, in 1993--in fact, in 2003 and 2008 and 2009--who didn't have healthcare coverage in this country, tens of millions of people. In 1993, when Hillary Clinton worked on what was called--in some cases derisively--HillaryCare, she and others said to Republicans: Well, where is your idea? What is your idea? At least we have an idea. The Republicans apparently turned to the Heritage Foundation and said: Help us come up with an alternative. And Heritage did. The alternative they came up with was a market-based approach to providing coverage for people. The idea was that in every State across the country, something called an exchange or marketplace would be created, which is really a large purchasing pool for people who don't have coverage. So the idea of the exchanges originally suggested by Hillary were introduced in the U.S. Senate by a Republican Senator from Rhode Island named John Chafee, who was a very good man, a marine veteran, a former Governor, and a greatly admired U.S. Senator. He offered legislation to do five things. As far as I can tell, all ideas were suggested by the Heritage Foundation. No. 1, create purchasing pools in every State. People who didn't have coverage could buy their coverage as a member of a much larger purchasing pool, and by doing that, bring down the cost of coverage. The second thing in the Chafee legislation in 1993 was to allow folks who bought their coverage through the exchanges to be eligible for a slight tax credit--the lower their income, the bigger the tax credit. When their income reached a certain level, the tax credit would go away. The third component of the Chafee proposal--again, going back to Heritage--was the idea of individual mandates. You can't make people get coverage, but in the case of the Chafee legislation, provide for a monetary fine for people who failed to get coverage. Over time, the amount of that fine would go up. The idea was to make sure that younger, healthier people would get healthcare coverage, and they would sign up for coverage in the exchanges. That way, the insurance companies would have a healthy mix of people to insure. Otherwise, people would wait until they were really sick--they need to go see a doctor, go to the hospital, or have an operation--to get their coverage, and then the health insurance companies would be left with a tough mix of people to insure. Financially, that would be very challenging for health insurance companies. They said: We need something to ensure that young, healthy people get their coverage through the exchanges. The fourth piece of the 1993 legislation offered by Senator Chafee said that employers of a certain size, with a certain number of employees, have to cover their employees. You don't have to cover them 100 percent for their insurance and their family's insurance, but they have to be covered with insurance and have access to health insurance through their employer. The fifth and last piece of ObamaCare, which is really the Heritage Foundation's idea, was a prohibition against health insurance companies saying to people who have a preexisting condition--they had to cover people with preexisting conditions in these exchanges. That is what people think of and call ObamaCare. Barack Obama is a bright guy. I knew him before he was a U.S. Senator. I knew him when he was a State senator. He didn't invent it. It was not made up in his head. The source of those ideas was originally the Heritage Foundation. I actually think they are good ideas. I thought they were good ideas then, and I think they are good ideas now. Somewhere between 1993 and 2009, when we debated on this floor the Affordable Care Act--including exchanges, tax credits, the individual mandate, the employer mandate, a prohibition against insurance companies not covering people with preexisting conditions--somewhere between 1993 and the debate here in 2009 on the Affordable Care Act, a Governor of Massachusetts said: Why don't we try to be the first State to provide healthcare coverage for everybody? And they took that Chafee legislation--the Heritage Foundation idea--dusted it off, and turned it into RomneyCare. It actually worked pretty well. They sure covered a whole lot of people in that State who hadn't been covered before. They covered a lot of people who were not eligible for Medicaid, not eligible for Medicare, maybe not a veteran. They were not receiving coverage from a large group plan, so they now had an option to get coverage in the exchanges. For those who chose not to in Massachusetts, they had to pay a fine. As it turns out, it was not a very big fine, and it went up over time but not quickly and not very high. So did some people who were young and healthy get coverage in the exchanges in Massachusetts? Yes. If you asked some of the people who were involved with Governor Romney at that time, they would say that if they had to do it over again, the fine would have started a little bigger and gone up a little faster in order to make sure healthier, insurable people got into the exchanges for their coverage. Well, in 2009, we were here on this floor and debating what some people still call ObamaCare, but it is something else. It is really RomneyCare. It is really ChafeeCare. It is really HeritageCare. But it ain't ObamaCare. It is a market-based idea to get coverage for people. I think it happens to be a good idea. Right now, this administration has done their dead level best to destabilize the exchanges. They made it a question of whether the individual mandates will be enforced. If young, healthy people decline to sign up for coverage, will there be a fine they would have to pay? Will it go up over time? This administration has thrown big doubt on that. As a result, a lot of young people haven't signed up. They are not sure they really need to. We had something in place for a couple of years called CRAs, cost- sharing arrangements. Think, if you will, about people who are buying their healthcare coverage on the exchanges. Their income is under 250 percent of poverty. For several years now, they have been able to get help paying down their copays and their deductibles when they get their coverage on the exchanges. What this administration has sought to do is throw doubt on whether those cost-sharing arrangements will continue. What has happened as a result is the health insurance companies, which lost their shirts in 2014, raised premiums, deductibles, and copays. They lost money again in 2015, but less. They raised premiums, deductibles, and copays, and lost money in 2016, but less. Some of them even actually made some money. They were not in a death spiral. According to Standard and Poor's, they were actually coming to a stronger financial position. Enter into that this administration throwing doubt on whether the exchange are going to be around, the individual mandate is going to be enforced, these cost-sharing reductions are going to continue to be offered. That is why a lot of the health insurance companies in this country decided they are going to get out in different States. They are not going to offer coverage in a number of States, a number of counties. That is why. Businesses need certainty and they need predictability, and that includes health insurance costs. Frankly, they didn't have that certainty and predictability. If we are smart about it, we will hit the ``pause'' button and maybe, before we do anything else, provide the certainty and the stability in the exchanges that are needed. And for the health insurance companies, make sure they will offer coverage without having to fear that they will be back in 2014 and lose their shirts again. That is not why they are in business. There are three things that need to be done in order to stabilize the exchanges. The first thing that needs to be done is the individual mandate, which we have by law. It says: If you don't have healthcare coverage, get your coverage on the exchange. If you choose not to, you have to pay a fine. Over time, that fine goes up. We need to preserve something that works like the individual mandate--maybe, ideally, the individual mandate as it is, and if we can't get the votes for that, then something that works at least as well as the individual mandate in making sure people--healthy people too--get their coverage on the exchanges if they are eligible. The second thing we ought to do is reinsurance. Senator Kaine, myself, and others, including some recovering Governors who serve here in the Senate, have cosponsored legislation that we have described as reinsurance. I am told it has been around forever in the insurance business, and it is one of the reasons the Medicare Part D drug program is successful and works. The way it works, quite simply, is this: Say an individual who has serious medical problems gets their coverage in the exchanges. They first start in 2018. In 2018, 2019, and 2020, for a person who has significant health challenges and is expensive to insure, the first $50,000 of their cost to the insurer in a year would be borne by the insurer. Between $50,000 and $500,000 for one individual for one year, the Federal Government would pay 80 percent of that. It is reinsurance. For anything over that in those 3 years, 2018 through 2020, the first 3 years, anything between $50 and $500,000, the Federal Government would pay 80 percent. Starting in 2021 and beyond, the reinsurance program would continue, but it would be a little bit different. In 2021 and beyond, the first $100,000 of costs incurred by an individual covered by a policy in the exchange--the first $100,000 would be on the insurance company. They would have the liability. Anything between $100,000 and $500,000 in one year for that individual, 80 percent of that cost would be borne by the Federal Government. Anything above $500,000 from 2021 and beyond would be borne, again, by the insurance company. It is called reinsurance. The last piece of the three is to make it clear that these cost- sharing reductions are reduced and make sure that the copays and the deductibles will continue to be subsidized by the Federal Government. It will reduce the out-of-pocket costs for people whose income is below 250 percent of poverty. If we do those three things, the insurance companies tell us we will stabilize the exchanges. They will have a healthy group of people to insure. More insurance companies will come in to provide coverage in States and in counties. More insurance companies providing policies and coverage leads to competition. The competition leads to better quality coverage, and the competition leads to lower prices--lower prices for individuals who are getting their coverage in the exchanges and lower prices, we are told, for Uncle Sam. The Federal Government, the costs to the Treasury, will be reduced, as well, if we do these three things. Again, we are told by the health insurance companies that have been reluctant to stay in the exchanges, if we do those three things, we would reduce the cost of premiums in the exchanges by 25 to 35 percent. That helps individuals get their coverage, and it helps the government, too, in reducing our exposure. I think that makes a lot of sense. Unfortunately, what our colleagues here on the floor are talking about doing--and the rumors we hear about some kind of skinny repeal-- certainly, it doesn't stabilize the exchanges. It does more to destabilize the exchanges. That isn't where we need to go. We need to hit the pause button and say: Let's stabilize the exchanges, and then let's revert to regular order. People have ideas on health insurance. Let's introduce bills. Let's have hearings with witnesses who come in and say what is good or what is bad. The witnesses could include Governors, health insurance folks, providers, normal people. Let's have a debate. Let Members offer amendments in committee, have votes, report the bills out, and eventually bring them here and go through the same thing. We call that regular order. John McCain, in his return speech yesterday--thank God he is back--called again and again for return to regular order. We need to do that, and if we do, we will end up not with a Democratic victory or a Republican victory or a Trump victory, we might win a victory for democracy and actually doing what is right and what needs to be done. That, most of all, is what we need to do. I yield the floor.

Mr. CARPER

Mr. CARPER. I ask the Senator to withdraw that suggestion, please.

Mr. CARPER. Mr. President, good to see you and our friend from Utah. I feel compelled to go back in time, if I could. This is a question a lot of people ask me back home and around the country: Where did ObamaCare come from? The part where most people think of ObamaCare is when they think of the exchanges that have been established in all 50 States, where people who don't have healthcare can get coverage as part of a large-group plan. That was an idea that came from RomneyCare. In 2006 in Massachusetts, when Mitt Romney was the Governor and was running for President, they came up with a really smart idea: Governor Romney, you have a much better chance of being elected President if you have done what no other Governor has done; that is, to cover everybody in your State for healthcare. Well, that is an interesting idea. They looked around for ideas, and what did they come up with? They came up with an idea that was actually suggested by the Heritage Foundation. The Heritage Foundation found its way to this body in 1993 in legislation introduced by Republican Senator John Chafee of Rhode Island that called for doing five things: No. 1 was creating exchanges or marketplaces in every State, where people who didn't have coverage could be part of a large group and get coverage. No. 2, folks who bought coverage on the exchange might be eligible for a sliding-scale tax credit. Lower-income people would get a better tax credit, reducing their premiums, than people whose income was higher. No. 3 was the idea of an individual mandate. People had to get coverage. If they didn't, they would have to pay a fine. You can't force people to get coverage, but in Massachusetts they said: Well, at least we will fine them, and, eventually, maybe over time, the fine will go up and most people--including young, healthy people--will elect to get coverage and be part of a group that is actually insurable, as opposed to people who are just sick or who are anxious to get an operation or are needing to get an operation. The fourth principle, which was the idea underlying the Chafee legislation, which would later become RomneyCare, was the idea that employers of a certain magnitude, or with a certain number of employees, had to cover their employees. The fifth principle in that original idea was brought to us from the Heritage Foundation, by 23 Republican Senators in 1993--as an alternative, by the way, to HillaryCare--and later became RomneyCare. The fifth principle was the idea that if you are an insurance company and you want to deny coverage to people because they have a preexisting condition, you cannot do that. That was it. When a number of us in this body worked on the Affordable Care Act, we took the Heritage Foundation idea, the idea from those 23 Republican Senators who introduced it, cosponsored it-- including Senator Hatch, including Senator Grassley. Some of the folks who are complaining the most about ObamaCare or the exchanges are the people who supported the original legislation introducing the idea. I don't know if that seems ironic to other people. It certainly does to me. I spent part of Saturday--invited up to Providence, RI, to do something I used to do for 8 years--meeting with the National Governors Association. For 8 years, as Governor of Delaware, I was privileged to be a part of the National Governors Association, at one time vice chair and later on as the chairman of the group. They invited me to come back and talk about healthcare, healthcare reform, and what was going on here in the Senate. I was happy to do that, and we made it work on my schedule. There, to speak on behalf of the administration, was the Vice President of the country, the Secretary of Health and Human Services, the OMB Director, and the Administrator of the Center for Medicare and Medicaid Services, explaining to the Governors why they should support the administration's position and why they should support the Republican position here in the Senate. Today the Republicans sent out a strong letter--not just Republicans. Republican Governors and Democratic Governors sent out a joint letter, a bipartisan letter, saying to us, basically: Do these things. Their advice to us was this: Hit the pause button; stop what we are doing. No. 2, pivot and stabilize. Stop destabilizing the exchanges. This administration is trying to destabilize the exchanges, which were a Republican idea, and I think, actually, a good idea. But the administration has sought to destabilize the exchanges, through a variety of tricks that they are pulling. The third thing we should do is to stabilize the exchanges. It is not all that hard. Make it clear that the individual mandate, or something very much like the individual mandate, is going to continue to be the law of the land so that we end up with young, healthy people in the exchanges and not just a lot of sick people and older people. No. 2 is reinsurance. One of the keys to the success of Medicaid Part D, the drug insurance program for folks on Medicare, is reinsurance. A number of us, led by Senator Tim Kaine and myself and others, said: Why don't we take that tried-and-true idea and use it to help stabilize the exchanges? I spoke here earlier today on how that would actually work. It is not a Democratic or a Republican idea. It is just a good idea. The third thing we need to do to stabilize the exchanges--an idea actually suggested by a number of Senators, including Senator Jeanne Shaheen of New Hampshire--is to say that we are going to continue to fund and authorize something called CSRs, or cost-sharing reductions, which actually reduce the copays and the deductibles for lower income people who buy their coverage in the exchanges. Those three things, we are told by health insurance companies, would reduce the cost of premiums in all the States by anywhere from 25 percent to 35 percent. It would stabilize the exchanges, and it would get other insurance companies to say: I don't know if I want to insure in Ohio, Delaware, or Utah. Insurance companies would say: Well, I think I can offer insurance products there and not lose my shirt. Then, they would get back into the exchange. They would offer coverage. Then, when more than one or two offer coverage, guess what happens. You have competition. And do you know what flows from competition? Better diversity of products to choose from and lower costs. Those are three things we can do to stabilize the exchanges and, frankly, they are not all that hard. The fourth thing the Governors suggested we do is, basically, regular order. Around here, regular order means that if people have a good idea, they introduce it. We turn it in up here at the front desk, and the legislative idea goes to the committee of jurisdiction. There is a discussion of whether there should be hearings about that particular bill. If it is a good bill, there may well be hearings. You have sponsors. It could be bipartisan. But, eventually, the idea will have a hearing in committee, and those who like that idea or those who don't like that idea show up in daylight, in the light of day, and say: Here is why I like it; here is why I don't like it. They let their voices be heard. On issues as important as healthcare, why we are not fully involving the Governors is beyond me. I just don't get it. Who runs the Medicaid Programs? The Governors in their States. That is a big part of what we are debating in this battle. I will close with this. I said it before earlier today, and I want to say it again. As I travel around Delaware, talking to people in my little State--we have a lot of Democrats, we have a lot of Republicans, and we have a lot of Independents--they speak to me with one voice, and here is what they say: Work together. Solve some problems together. Democrats and Republicans, take off your hats and work together. That is what they want us to do. It is not just Delaware. A Kaiser Permanente national survey released last week said 71 percent of the people in this country surveyed said we ought to work together and get this done. If we are smart, before we leave for the August recess, we will stabilize the exchanges with the three things I talked about. The administration just needs to stand down and just be quiet on this point. If they don't like this Republican idea of the exchanges, just be quiet. But we come back here in September, and we go to work, with regular order, hearings--bipartisan hearings--bipartisan roundtables, and the chance for us to debate legislation in committees in the House and in the Senate, and on this floor, and to debate amendments. That is the way we ought to do this. Anytime in this country when we have done really big things--Social Security comes to mind, the GI bill comes to mind, and the 1986 tax reform comes to mind--we didn't do it with just Democratic votes or Republican votes. We did it together. If we do that, we will be stronger together. I will close with an old African proverb. It goes something like this: If you want to go fast, go alone. If you want to go far, go together. We need to go far. If we do, we and the American people will get a lot further along toward the three things we have sought ever since Harry Truman was President: No. 1, cover everybody; No. 2, quality healthcare; and No. 3, affordable price. That is the ``holy grail,'' and we should strive to get there together. I suggest the absence of a quorum.

Mr. CARPER

Mr. CARPER. Mr. President, I want to preface my remarks today by asking that you convey to your wingman, Senator John McCain, our colleague, our best wishes and our hope that he is on his way to a speedy recovery and will be back here because we need him. We need his wisdom. I want to thank Tim Kaine for the leadership that he and Senator Shaheen are showing to help us try to stabilize the marketplaces. Senator Hassan and I have talked a lot about this. What do we do now? I think this is an opportunity. This is an opportunity here. I realize there is a fair amount of confusion as to which path to take and which way to go. I hope we don't waste this opportunity. I sent a message to the new chairman of the National Governors Association and to the new vice chairman of the National Governors Association. Brian Sandoval from Nevada is the new chair and the Governor from Nevada, previously the vice chair, and Steve Bullock from Montana is the vice chair. One is a Republican, and the other is a Democrat. I sent them a message this morning saying that it would be good to hear from the Governors. They have been working on a bipartisan letter--they have been working on it for a while--and this is really the time it could make a positive impact. We have three people sitting here--four of us--who used to be part of the National Governors Association. I loved it, and I am sure Senator Kaine, Senator Hassan, and Senator Shaheen loved it as well. Here is what I suggested that the Governors may want to consider in their message: No. 1, urge us to hit the pause button. Hit the pause button. Let's just stop in place for a moment. No. 2, pivot soon--not in September, not in August, but now, like this week, pivot to stabilizing the exchanges. No. 3, return to regular order. Senator Kaine has already mentioned this. When I talked with Senator McCain last week a couple of times briefly, we both talked about the need for regular order. People have good ideas on healthcare; introduce them. Committees with jurisdiction, hold hearings. Witnesses, including Governors, should come before the committees of jurisdiction--a couple of committees in the House and in the Senate--and let's hear from the experts, and let's certainly hear from the Governors, who have to run these Medicaid Programs and have a lot of expertise in this area to offer us. Then I would say, after the August recess, if we can actually do something real in stabilizing the exchanges, what a confidence builder that would be among us and, I think, around the country. It would be a great confidence builder. The other thing I would mention is that when we come back after the August recess, don't just muck around and wonder what we are going to do; we should pull together in a bipartisan way--something we talked about doing a lot, but we don't often do it--to really do maybe a couple of things. Let's figure out what we need to fix in the Affordable Care Act. Republicans believe that Democrats feel it is perfect and nothing should be changed. Well, I don't feel that way. My guess is that most of our Democrats don't, either. No bill I have ever worked on was perfect. It can always be done better. The same is true with big programs like Medicare and Social Security, veterans programs, and so on. They can all be done better, and this is certainly the case as well. Let's fix the parts of the ACA that need to be fixed, and let's preserve the parts that ought to be preserved. I would reiterate, speaking on behalf of some recovering Governors, including me, the Governors need to be heavily involved in this. I suspect that all of the former Governors who are on the floor with me today, when we were part of the NGA, we weren't on the floor--actually, I was on this floor any number of times because Governors had access to the floor--but we had many opportunities, many invitations to testify before Senate committees and House committees on a wide range of issues. I think we brought value, and we need to hear from them today. I want to go back and talk about how we go about stabilizing the exchanges. The first thing that would help would be for the administration to stop destabilizing them. That would be a big help. Senator Kaine has led on legislation--and he has mentioned it, and I want to drill down on it just a little bit--that would provide reinsurance, much as we do in other ways in terms of the Medicare Part D drug program. Using reinsurance is a very common tool, and we can use it to help stabilize the exchanges. How would it be used in our proposal? If this lady standing right in front of me were getting healthcare and her healthcare needs were expensive, under our reinsurance plan starting in 2018, 2019, 2020, the first $50,000 in her healthcare that she used in year one, 2018, the Federal Government--well, the insurance companies themselves actually would be on the hook for the first $50,000 of care she got. Between $50,000 and $500,000, under our proposal, the Federal Government would pay for 80 percent of that cost--80 percent of that cost. Between $50,000 and $500,000 would be on the Federal Government. Anything above $500,000 would be back on the insurance company. That is what we would do for the next 3 years. Starting in 2021 and going forward, the first $100,000 would be on the insurance company for the costs borne--created by an individual, and then between $100,000 and $500,000, 80 percent of that would be on the Federal Government, and after that, the rest of it is back again on the insurance company to pay for. That is our proposal. We have a bunch of cosponsors on it, and we need some Republican cosponsors as well. It is not a Democratic idea. It is not a Republican idea. It is just a good idea that deserves bipartisan support. Another thing we ought to do to stabilize the exchanges is what Senator Shaheen has proposed; that is, we have these CSRs, cost-sharing reductions. I think of them as subsidies to help subsidize people whose income is under a certain level; I think it is 250 percent of poverty. Folks who are in the exchanges getting healthcare coverage and whose income is under 250 percent of poverty currently receive some subsidies to help buy down and reduce the cost of their copays and their deductibles. It is not really clear whether that is authorized. It is not really clear whether that is being funded, but it has been done for a number of years. The current administration has been saying: Well, we don't know if we are going to continue to do that. There have been some States that want to go to court and say: You can't do that. We need to pass a law and say that we are going to have these cost- sharing reductions and that the subsidies will continue to be offered. The last thing we need to do is to make clear that the individual mandate or something as good as or at least as effective as the individual mandate is going to be around. For the administration to say: Well, we don't know if we are going to enforce the individual mandate--it just encourages young, healthy people not to get coverage. We have to make it clear that the individual mandate or something as good as--it could be a proxy for it or maybe several things that work together that could be as effective as the individual mandate. If they don't work, maybe we could just have a default position that would be the individual mandate again. We ought to have hearings on these kinds of things and discuss them and hear from all kinds of folks. The other thing I want to mention is just that when I go around my State, my Lord, I have never heard people so interested in encouraging us. I think I am regarded in my State--along with Senator Coons and our Congresswoman, Lisa Blunt Rochester--I think we are regarded as bipartisan people. We are Democrats and proud to be Democrats. We would like to work with Republicans, too, and I think that is part of being a recovering Governor. But on this subject, on healthcare reform, going forward, the people in my State don't want a Democratic victory. They don't want a Republican victory. Frankly, they don't want a Trump victory. They want a victory for our country. That is what they want. They want a victory for our country. And so do I, and I think so do most Democrats in this Chamber and most Republicans. So let me say again, if I could make this suggestion, let's hit the pause button. Let's stop in place for right now. Let's pivot and figure out how we can stabilize the exchanges. Let's return to regular order. Let's hold bipartisan hearings, have expert witnesses, including folks from all walks of life who know about healthcare coverage, who know a lot about healthcare. After the August recess, let's launch a real, bipartisan effort to fix the things in the ACA that need to be fixed and retain, preserve those aspects that should be retained. As I said before, we need Governors at the table, not just recovering Governors. We need Governors at the table and a bunch of other folks as well who have a lot to contribute. If we do those things, we will, in the words of--paraphrasing Mark Twain--Mark Twain used to say: When in doubt, tell the truth. You will confound your enemies and delight your friends. I think that is what he used to say. In this case, I would just say, paraphrasing Mark Twain, when in doubt, do what is right. When in doubt, do what is right. We will confound our enemies and delight our friends. With that, I yield the floor.

Mr. CARPER

Mr. CARPER. Mr. President, I want to welcome our new pages. They have been here all of 24 hours or so. I talked to some of them earlier today. They come from all over this country, and we welcome each of them. I understand they are with us for 3 weeks, and we wish it could be longer. Who knows? Maybe it will be. We will see.

Mr. CARPER

Mr. CARPER. Mr. President, I love what the Senator from Minnesota just said. I am a retired Navy captain. For years we had healthy competition among the different branches of our services. I salute the folks in the Army, the Marines, the Air Force, and Coast Guard. I always say: The Navy salutes you. Then I also say: a different uniform, the same team. To the extent that we wear different uniforms, we really are on the same team, and I think the American people are anxious for us to start acting that way. What I hope we will do is to hit the pause button right now on the legislation that the Republicans have pulled off the floor and that we will use this time as an opportunity not to go to our separate corners and figure out how to do the other team in when we return here in 10 days. I hope we will, as some of our colleagues have suggested, explore some ideas where we can work together. Some have talked about how to make the marketplaces work. It is not a Democratic idea. It is a Republican idea. There are the tax credits for the exchange, which is a Republican idea. The individual mandate and the idea that there cannot be prohibitions on insurers denying coverage are Republican ideas too. Those are all ideas from 1993, taken from Mitt Romney, who put them in RomneyCare in Massachusetts, and we put them in the Affordable Care Act. We didn't just do this and shut out the Republicans. We had 80 days where we worked on the legislation. I was on the Finance Committee with Senator Schumer and others, and we had, I think, a dozen or more hearings and dozens of amendments--over 300 amendments in all. Some 160 Republican amendments were included in the bill. To somehow say that they were being shut out is nonsense. That is a reinvention of history. Let's do it the right way. At the end of the day, we will do what President Trump has been calling for, for the last 5, 6, 7, 8 months, as I recall. He said: Why don't we cover everybody, why don't we provide better coverage, and why don't we do it in a more affordable way. Unfortunately, what Republicans have offered and what they pulled off the floor doesn't do that. It provides less coverage for more money. It says to people--the least well off in our society: We are going to provide you less coverage in order to give folks who make a lot of money, and really don't need a tax break, a tax break. That is not consistent with the Golden Rule. The Presiding Officer knows it well. We are supposed to treat other people the way we want to be treated. That is an example of a failure with respect to the Golden Rule. I didn't come here to waste my time and other people's time. I came here to get things done. We tried hard to involve the Republicans 8 years ago. They may not acknowledge that. The people in this country still want us to really bear down and work together, and we can do that. At the end of the day, we will be better as a party, we will be better as a body, and we will be better as a country. I want to thank Senator Warner for letting me speak before him. Thank you so much. I will say to Senator Kaine: Thank you for allowing me to be your partner on a great reinsurance plan that will help stabilize the exchanges. I am delighted to be your wingman. Thank you.

Mr. CARPER

Mr. CARPER. Mr. President, something the Senator from Washington said just reminded me--after we heard the news that Republicans are going to go back to the drawing board and see what they can come up with maybe during the Fourth of July recess, I did a radio interview with a station back in Delaware. One of the questions the interviewer asked me was: Well, the Republicans have a lot of money to play with; I hear a couple hundred billion dollars. Won't the Republican leaders just offer money to one Senator after the other after the other to find out what they need in order to get them to support this? I said: I hope not. I hope that is not what happens. This is a time when we need to hit that pause button and, rather than dole out money to try to draw this Republican or that Republican to come into the fold, if you will, why don't we just spend some time in the rooms the Senator from Washington was talking about. We spent all that time--a lot of time together, with Democrats and Republicans in hearings, public hearings, private meetings, roundtables, and so forth. That is the kind of thing we need to do over again. If we do that, we might be surprised. We might surprise the rest of the country about how well that would work out. Thank you.

Mr. CARPER. Senator Cardin and I serve together on the committee called Environment and Public Works in the Senate. One of the issues we deal with is clean air. This conversation about predictability and uncertainty that businesses seek is not just in health insurance, it is in all kinds of businesses across the country. I remember being in a conversation 8, 9 years ago with--I think Senator Alexander of Tennessee was with us. We met with the CEOs of a number of utilities across the country. Senator Alexander and I were pushing legislation in response to President George Bush's proposal called Clear Skies. It was designed to reduce the emission of sulfur dioxide, nitrogen oxide, mercury, and CO2, carbon dioxide. We talked with these CEOs from across the country for an hour in my office. We had been talking about reductions of X percent and Y percent and so forth in the emissions from these harmful pollutants from primarily coal-fired utilities. At the end of the conversation, this one older fellow who was representing a utility in the southern part of our country--he was sort of a curmudgeon-like person--he said: Senator, this is what you need to do with respect to the restraint on emissions, reduction in emissions. Here is what you need to do. You need to tell us what the rules are going to be. You need to provide us some certainty and predictability and give us a reasonable amount of time to comply and then get out of the way. I will never forget that conversation. Tell us what the rules are going to be, provide us with some certainty and predictability, a reasonable amount of time, and get out of the way. It is not just utilities that want certainty and predictability, so do others, and particularly, as utilities are a regulated industry, so is insurance. They do like to have predictability and certainty. We tend to focus just on the exchanges and the marketplaces in the 50 States, which provide health insurance for maybe 5, 6, 7 percent of Americans who get healthcare coverage. Most people get their healthcare coverage from employer-provided programs. Maybe 20, 25 percent get their coverage through Medicaid. I used to think Medicaid was healthcare for poor women and children. When I was elected State treasurer, I used to think Medicaid was healthcare for poor women and children and not much else, and it turns out, it is a lot more than that today. Twenty, twenty-five percent of folks get their coverage there, another 15 percent or so in Medicare, and the rest are in the exchanges. Every State has an exchange. That is for folks who can't get coverage anywhere else. The idea is to have some opportunity to participate in a purchasing pool. When we passed the Affordable Care Act, we made a promise that we would do the kinds of things that Senator Cardin is talking about to provide certainty and predictability for the health insurance companies when they insure in these exchanges. The health insurance companies were reluctant to provide coverage to the folks who were going to get coverage through the exchanges. As my friend will recall, some of these people hadn't had healthcare for months, years, maybe even decades, and maybe some never had healthcare in their lives, so nobody really knew how much healthcare they would need, except we knew and the insurance companies knew that these people would need a lot. As my friend said, we provided some ways of reducing that lack of predictability. It is like the comic strip ``Peanuts,'' with Lucy and Charlie Brown and the football. When she pulls the football away, she always fools him. He still kicks and misses every time. We sort of did that with the insurance companies. We assured them we would help provide stability, and we took away the very mechanisms designed to do that. I think what my friend is saying, we need to come back and provide maybe three ways to do it; one, with respect to reinsurance; two, cover the risk costs; and the third is to do something--if we don't continue with the individual mandate, we need to come up with something like the individual mandate, which is not as harmful as Republicans are suggesting. I don't think the a 6-month lockout is humane.

Mr. CARPER. I will be happy to.

Mr. CARPER. Mr. President, may I ask the Senator from Oregon to yield for about 30 seconds?

Mr. CARPER. I was Governor from 1993 to 2001. We started in a recession and ended up with 6, 7 really strong years, as you recall, during the Clinton administration. We were able to balance our budget 8 years in a row, cut taxes 7 out of 8, pay down some debts, and get good credit ratings across the board. The person who was my secretary of finance the last 4 years is now our Governor, John Carney. Ben knows him pretty well. He was a wonderful member of Congress and a wonderful Lieutenant Governor before that. He is looking at a budget of less than $4 billion. He is looking at a $400 million hole to fill. What is being proposed by our Republican colleagues on Medicaid would not make that $400 million hole any smaller. It would add anywhere from $100 to $200 million-- increasing it anywhere from 25 percent to 50 percent. It is a killer. Our Governor and our legislature are struggling enough to try to fill a $400 million hole rather than trying to figure out how to deal with something as vibrant as $600 million. It would be a backbreaker. That is what we are looking at. I share that with everybody. Going to my ``laboratory of democracy,'' some people would like to have Medicaid for all. Several of our colleagues are very much interested in a single-payer system. As an old Governor--someone who had the privilege leading the National Governors Association--I am a believer that States can be that laboratory of democracy. They can take ideas and show us it is a good idea for the country and other States or take ideas and prove they are bad ideas. We ought to enable them to do that.