Susan Collins

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today with my colleague from Washington, Senator Cantwell, to introduce the Preserve Access to Medicare Rural Home Health Services Act of 2015. This legislation would extend the modest increase in payments for home health services in rural areas that otherwise will expire on January 1 of 2018. Home health has become an increasingly important part of our health care system. The kinds of highly skilled--and often technically complex--services that our nation's home health caregivers provide have enabled millions of our most frail and vulnerable older and disabled citizens to avoid hospitals and nursing homes and stay just where they want to be--in the comfort, privacy, and security of their own homes. I have accompanied several of Maine's caring home health nurses on their visits to patients and have seen first hand the difference that they are making for patients and their families. Surveys have shown that the delivery of home health services in rural areas can be as much as 12 to 15 percent more costly because of the extra travel time required to cover long distances between patients, higher transportation expenses, and other factors. Because of the longer travel times, rural caregivers are unable to make as many visits in a day as their urban counterparts. For example, home health care agencies in Aroostook County in Northern Maine, where I am from, cover almost 6,700 square miles, with an average population of fewer than 11 persons per square mile. These agencies' costs are understandably much higher than other agencies located in more urban areas due to the long distances the staff must drive to see clients. Moreover, the staff is not able to see as many patients due to time on the road. Agencies serving rural areas are also frequently smaller than their urban counterparts, which means that their relative costs are higher. Smaller agencies with fewer patients and fewer visits mean that fixed costs, particularly those associated with meeting regulatory requirements, are spread over a much smaller number of patients and visits, increasing overall per-patient and per-visit costs. Moreover, in many rural areas, home health agencies are the primary caregivers for homebound beneficiaries with limited access to transportation. These rural patients often require more time and care than their urban counterparts and are understandably more expensive for agencies to serve. If the extra three per cent rural payment is not extended, agencies may be forced to decide not to accept rural patients with greater care needs. That could translate into less access to health care for ill, homebound seniors. The result would likely be that these seniors would be hospitalized more frequently and would have to seek care in nursing homes, adding considerable cost to the system. Failure to extend the rural add-on payment would only put more pressure on rural home health agencies that are already operating on very narrow margins and could force some of the agencies to close their doors altogether. If any of these agencies were forced to close, the Medicare patients in that region could lose all of their access to home care. The legislation we are introducing today will extend the rural add-on for 5 years and help to ensure that Medicare patients in rural areas continue to have access to the home health services they need. Moreover, we would offset costs of the bill by reducing the home health outlier fund by .25 percent over the same 5 years. I urge our colleagues to join us as cosponsors.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today with my colleague from Washington, Senator Cantwell, to introduce the Preserve Access to Medicare Rural Home Health Services Act of 2015. This legislation would extend the modest increase in payments for home health services in rural areas that otherwise will expire on January 1 of 2018. Home health has become an increasingly important part of our health care system. The kinds of highly skilled--and often technically complex--services that our nation's home health caregivers provide have enabled millions of our most frail and vulnerable older and disabled citizens to avoid hospitals and nursing homes and stay just where they want to be--in the comfort, privacy, and security of their own homes. I have accompanied several of Maine's caring home health nurses on their visits to patients and have seen first hand the difference that they are making for patients and their families. Surveys have shown that the delivery of home health services in rural areas can be as much as 12 to 15 percent more costly because of the extra travel time required to cover long distances between patients, higher transportation expenses, and other factors. Because of the longer travel times, rural caregivers are unable to make as many visits in a day as their urban counterparts. For example, home health care agencies in Aroostook County in Northern Maine, where I am from, cover almost 6,700 square miles, with an average population of fewer than 11 persons per square mile. These agencies' costs are understandably much higher than other agencies located in more urban areas due to the long distances the staff must drive to see clients. Moreover, the staff is not able to see as many patients due to time on the road. Agencies serving rural areas are also frequently smaller than their urban counterparts, which means that their relative costs are higher. Smaller agencies with fewer patients and fewer visits mean that fixed costs, particularly those associated with meeting regulatory requirements, are spread over a much smaller number of patients and visits, increasing overall per-patient and per-visit costs. Moreover, in many rural areas, home health agencies are the primary caregivers for homebound beneficiaries with limited access to transportation. These rural patients often require more time and care than their urban counterparts and are understandably more expensive for agencies to serve. If the extra three per cent rural payment is not extended, agencies may be forced to decide not to accept rural patients with greater care needs. That could translate into less access to health care for ill, homebound seniors. The result would likely be that these seniors would be hospitalized more frequently and would have to seek care in nursing homes, adding considerable cost to the system. Failure to extend the rural add-on payment would only put more pressure on rural home health agencies that are already operating on very narrow margins and could force some of the agencies to close their doors altogether. If any of these agencies were forced to close, the Medicare patients in that region could lose all of their access to home care. The legislation we are introducing today will extend the rural add-on for 5 years and help to ensure that Medicare patients in rural areas continue to have access to the home health services they need. Moreover, we would offset costs of the bill by reducing the home health outlier fund by .25 percent over the same 5 years. I urge our colleagues to join us as cosponsors.

Mr. COLLINS

Mr. COLLINS. Mr. President, I am pleased to have joined with my colleague, Senator Angus King, in sponsoring this resolution to designate December 12, 2015, as Wreaths Across America Day. Since its inception, the Wreaths Across America project has become an annual tradition of donating, transporting, and placing Maine balsam fir remembrance wreaths on the graves of our fallen heroes buried at Arlington National Cemetery, as well as at veterans' cemeteries and memorials in every State and overseas. In the program's 24 years, more than 2.4 million wreaths have been placed in honor of those who have served our country. The origin of Wreaths Across America is an inspiring example of that generosity and gratitude. During the Christmas season in 1992, Morrill and Karen Worcester took time during their busiest season to donate and deliver wreaths from their company in Harrington, ME, to Arlington National Cemetery to honor the heroes who lie at rest there. At first, a small group of volunteers laid the wreaths with little notice. In recent years, however, the Arlington Wreath Project has grown to become a national phenomenon. The people of Maine are proud that this important and well-deserved tradition began in our State. This year, on December 12, thousands of volunteers in Arlington, throughout our Nation, and overseas will carry out the mission of Wreaths Across America to ``Remember, Honor, Teach.'' This will conclude a weeklong procession between Maine and Virginia, with stops along the way to pause and remember the men and women who have died to preserve our freedoms, spread the message about the importance of honoring those who serve, and remind the people of the United States about the sacrifices made by our veterans and their families. This procession helps to ensure that those sacrifices are never forgotten. The Patriot Guard Riders, along with other dedicated escort groups, will accompany tractor-trailers filled with donated wreaths from Maine to Arlington National Cemetery. America's trucking industry has long supported Wreaths Across America by providing drivers, equipment, fuel, and related services to assist in the transportation of wreaths across the country to more than 1,000 locations. Wreaths Across America not only honors our departed heroes, but also imparts the important message to veterans who are still with us that we honor their service. It tells our men and women in uniform today that we are grateful for their courage and devotion to duty. It tells the families of those serving our country that they are in our thoughts and prayers. And it tells the families of the fallen that we share their grief. Throughout human history, the evergreen wreath has been offered as a tribute to heroes. On December 12, 2015, we will again offer this enduring symbol of valor and sacrifice as part of our never-ending obligation to thank those who wore the uniform of our country. In this season of giving, we will pay tribute to those who have given us the most precious gift of all, our freedom.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise in support of the bipartisan Every Student Succeeds Act. This is landmark legislation that would reform and reauthorize the Elementary and Secondary Education Act, also known as No Child Left Behind. As a member of the Health, Education, Labor, and Pensions Committee, and as a member of the conference committee that resolved the differences between the two bodies' versions of their education reform bills, I want to particularly applaud the leadership of Chairman Alexander and Ranking Member Murray for doing a truly extraordinary job in putting together the bipartisan, bicameral reform bill that is before us today. Congressional action to fix the serious flaws with No Child Left Behind, while preserving the valuable parts of the law, is long overdue, but that day has finally arrived. NCLB was well-intentioned, and its focus on the education of every child and greater transparency in the performance of our schools were welcomed reforms, but some of the law's provisions were simply unachievable and thus discouraging to teachers, parents, administrators, and students alike. The current system of unattainable standards and a patchwork of State waivers has led to confusion about Federal requirements. High-stakes testing and unrealistic 100 percent proficiency goals do not raise aspirations; instead, they dispirit those who are committed to a high- quality education for our students. The Every Student Succeeds Act returns much needed flexibility to the State departments of education and to local school districts. The bill would remove the high-stakes accountability system that was simply proven to be unworkable under No Child Left Behind. Instead, the bill would empower States to set the goals for their schools and students and design ways to improve student achievement. The bill would also eliminate the burdensome, overly prescriptive parts of No Child Left Behind, such as the definition of a ``highly qualified teacher,'' which is a perfect example of something that sounds great but in fact proved unworkable in many of the small and rural schools in my State where teachers are called upon to teach a wide range of subjects. The Every Student Succeeds Act would also reauthorize the Rural Education Achievement Program, known as REAP. I coauthored this law with former Senator Kent Conrad back in 2002. Students in rural America should have the same access to Federal grant dollars as those who attend schools in larger urban and suburban communities. Most Federal competitive grant programs, however, favor larger school districts because they are the ones that have the ability to hire grant writers to apply for those grants, even though that extra money may be needed more by a small rural school. As a result, rural school districts often had to forgo funding because they simply lacked the capacity to apply for the grants. That is the problem the Rural Education Achievement Program Act was intended to solve, and it has provided financial assistance to both schools and districts to help them address their unique local needs. This program has helped to support new technology in classrooms, distance learning opportunities, and professional development programs, as well as an array of other activities that benefit students and teachers in rural schools. Since the law was enacted in 2002, at least 120 Maine school districts have collectively received more than $42 million from the REAP program. When I talk to those small Maine school districts, they have been enormously creative in using REAP money to improve the education of their students. They have told me that without the law that Senator Kent Conrad and I authored back in 2002, in many cases they would not have been able to introduce technology into the classroom, to further professional development for their teachers or to provide special enrichment activities for their students. That law has been a real success, and I am delighted that this bill reauthorizes it. I also want to highlight that the final version retains a Senate provision authorizing a pilot program that I worked on with several of my colleagues to require the Secretary of Education to allow seven States to designate alternative assessment systems based on student proficiency and not just on traditional tests. Such systems can give teachers, parents, and students a much fuller understanding of each student's abilities and better prepares them for the college or career path of their choice. The Federal Government should cooperate with States and school districts that are designing brand new assessment systems, and this pilot program is an important step in that direction. Providing a good education for every child must remain a national priority so each child fulfills his or her full potential, has a wide range of opportunities, and can succeed in an increasingly competitive economy. From having visited more than 200 schools in my State, I know this legislation will be welcomed indeed. The Every Student Succeeds Act honors these guiding principles while returning greater control and flexibility to States and local school districts, where it belongs. I urge all of my colleagues to support this landmark legislation. Mr. President, I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, I call up amendment No. 2885.

Ms. COLLINS. Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Ms. COLLINS. Mr. President, this amendment, which I offer with my colleagues Senator Murkowski and Senator Kirk, would strike the provisions that would eliminate Federal funding, including Medicaid reimbursements, for Planned Parenthood. Otherwise, the likely result would be the closure of several hundred clinics across the country, depriving millions of women of the health care provider of their choice. I want to make clear that our amendment does not include any new spending, it does not increase taxes, and it retains the current Hyde amendment language, which prohibits the use of Federal funds for abortions except in cases of rape, incest or where the life of the mother is at risk. I urge adoption of the amendment.

Ms. COLLINS

Ms. COLLINS. Madam President, I suggest the absence of a quorum.

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

Ms. COLLINS. I suggest the absence of a quorum.

Ms. COLLINS. Madam President, for the information of our colleagues, we are making good progress in clearing a number of amendments that have support on both sides of the aisle. I expect we will be able to proceed with an amendment offered by Senator Cornyn and Senator Reid shortly, and in the meantime I suggest the absence of a quorum.

Ms. COLLINS. Madam President, on behalf of myself and the ranking member of the subcommittee, Senator Reed, I object. We are in a process where we are trying to clear amendments, and we are making good progress on this bill. I understand Senator Paul has raised an issue that is issue, but it does not belong on this bill and indeed would result in this bill not progressing. We are trying to get back to regular order on the appropriations process. With cooperation, I am confident we could finish this important appropriations bill today. We could show the American people that we can govern and fund essential transportation and housing programs that are included in this bill. By and large, we have had excellent bipartisan cooperation. I was hoping we could move to the amendment offered by the Senator from Texas--a member of the Republican leadership--and cosponsored by the Senate Democratic leader. It is an amendment that I believe we could dispense with quickly, and we would then be able to continue to work through the amendments on this bill. Since the amendment from the Senator from Kentucky would grind this bill to a halt and does not belong on this bill--and there will be other opportunities to deal with this issue because the House is going to be passing legislation this week dealing with the issues raised by the Senator from Kentucky--I will object.

Ms. COLLINS. Madam President, I suggest the absence of a quorum.

Ms. COLLINS. Madam President, I would yield to the Senator from Oklahoma for the purpose of explaining an amendment that he has at the desk, and a modification--a very good amendment, I might add.

Ms. COLLINS. I want to thank the Senator from Oklahoma for his courtesy to one of our colleagues who is on his way to the floor to repeat an earlier ritual that we went through when one of our colleagues attempted to make an amendment pending. So in deference to that colleague, I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Madam President, for the information of our colleagues on both sides of the aisle, I would like to explain the situation we face. First, let me say that working very closely with the ranking member of the subcommittee, my friend and colleague Senator Jack Reed, we have been making very good progress on this bill. We have a number of amendments offered by Senators from both sides of the aisle that we have agreed to work out, to clear on both sides, with both managers of the bill. In some cases we have also gotten to the authorizing committees, the Budget Committee. In other words, a great deal of hard work has gone into clearing amendments that are ready to be considered, that could be accepted by voice vote or unanimous consent or in a managers' package. I am confident because of this bipartisan cooperation, because of the extraordinarily hard work of our staffs, that we could finish this appropriations bill today. Would that not be progress for the Senate, to be able to complete action on a bill that has vital funding for homeless veterans, for homeless youth, for disabled and low-income elderly who depend on the subsidized housing programs that are funded in this bill? This bill has important infrastructure spending. All of us are aware of the deteriorating infrastructure, the crumbling roads and structurally deficient bridges that we have in this country, the need for improvements in rail safety, in our transit system. There are so many issues that are important to the American people. This bill funds the Community Development Block Grant Program, possibly one of the most popular programs with State and local officials for spurring economic development and job creation in their communities, but, alas, we have encountered a roadblock. As we have seen this morning, even amendments that have been cleared on both sides of the aisle are not being allowed to proceed. I think that is so unfortunate because with cooperation I am confident we could have finished work on this bill and moved to final passage today. Regrettably, that is not going to occur unless there is a change of heart. I do want to say I recognize there are other very important issues for us to deal with. The House today is taking up a bill that would deal with the screening process for refugees who come into this country. All of us recognize that our first obligation is the security of the American people. That is not what the bill before us is dealing with, but there is action on the House side. A bill is expected to pass today with widespread bipartisan support and will be sent over for our consideration. So I think it is unfortunate that we apparently cannot complete action on the appropriations bill that is before us. However, I do want to assure my colleagues that we are going to continue to work on this bill. We are going to continue to review the amendments that have been filed. We are going to work with the sponsors. We are going to work with the floor managers. We are going to continue to make progress behind the scenes in the event that we find a way around this roadblock. In the meantime, I do want to express my appreciation to my ranking member, Senator Reed, for his close cooperation on this bill. He and I introduced the substitute amendment jointly when we began work on this bill. A special thanks to our staffs who have been working night and day to clear amendments that are ready go but unfortunately cannot be considered.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that the Committee on Armed Services be authorized to meet during the session of the Senate on November 19, 2015, at 9:30 a.m.

Ms. COLLINS. Mr. President, I ask unanimous consent that the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate on November 19, 2015, at 9:30 a.m., in room SD-366 of the Dirksen Senate Office Building.

Ms. COLLINS. Mr. President, I ask unanimous consent that the Committee on Homeland Security and Governmental Affairs be authorized to meet during the session of the Senate on November 19, 2015, at 2 p.m. to conduct a hearing entitled ``ISIS's Impacts on the Homeland and Refugee Resettlement.''

Ms. COLLINS. Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet during the session of the Senate on November 19, 2015, at 10 a.m., in room SD-226 of the Dirksen Senate Office Building.

Ms. COLLINS. Mr. President, I ask unanimous consent that the Permanent Subcommittee on Investigations of the Committee on Homeland Security and Governmental Affairs be authorized to meet during the session of the Senate on November 19, 2015, at 10 a.m., to conduct a hearing entitled, ``Human Trafficking Investigation.''

Ms. COLLINS. Mr. President, I ask unanimous consent that the Select Committee on Intelligence be authorized to meet during the session of the Senate on November 19, 2015, at 2:30 p.m.

Ms. COLLINS. Mr. President, I ask unanimous consent that the Committee on Foreign Relations Subcommittee on East Asia, the Pacific, and International Cybersecurity Policy be authorized to meet during the session of the Senate on November 19, 2015, at 10 a.m., to conduct a hearing entitled ``Democratic Transitions in Southeast Asia.''

Ms. COLLINS

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

Ms. COLLINS

Ms. COLLINS. Madam President, I ask unanimous consent that the Senate be in a period of morning business, with Senators permitted to speak therein for up to 10 minutes each, until 2 p.m. today.