Susan Collins

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce legislation with my colleague from Wisconsin, Senator Baldwin, to reauthorize the Lifespan Respite Care Program. Respite care provides full-time caregivers with the much-needed opportunity to take a temporary break from their responsibilities caring for aging or disabled loved ones. Every day, an estimated 43 million family caregivers attend to loved ones who are experiencing chronic, disabling health conditions. While many of these individuals care for an older adult, almost one-third of caregivers attend to persons under the age of 50. Caregivers help their loved ones remain at home, often delaying the need for nursing home or foster care placements. The value of their efforts is tremendous, amounting to more than $470 billion in uncompensated care. This compassionate task, however, can take a toll. Caregivers experience higher mortality rates and are more likely to acquire acute and chronic health conditions. Respite care, which provides temporary relief to caregivers from their ongoing responsibilities, helps to reduce mental stress and physical health issues they may experience, keeping caregivers healthy and families intact. Yet, almost 80 percent of America's caregivers have never received any respite services. As a senator representing the State with the oldest median age in our Nation and as Chairman of the Senate Aging Committee, the well-being of our seniors and their caregivers is among my top priorities. Since the Lifespan Respite Care Act was enacted in 2006, 37 States and the District of Columbia have received grants to increase the availability and quality of respite services. Still, the need for respite care continues to increase and outpace available resources. When I ask family caregivers about their greatest needs, the number one that I hear is respite. The Maine Department of Health and Human Services recognized this urgent need in a report released in December 2018 on children's behavioral health services. The report recommended expanding access to respite care services for families. One Maine mother shared, ``Respite has helped our family because we have been able to take other children to doctors appointments without everyone having to go. My husband and I have been able to have a little time away. I have been able to attend to my own mental health needs.'' From families caring for children with disabilities to those caring for older adults, the need for respite care today continues to grow. Our legislation will help to close the resource gap experienced by our nation's caregivers. Specifically, the Lifespan Respite Care Act will authorize robust funding for this program over the five years, through 2024, to assist states in establishing or enhancing statewide Lifespan Respite systems. It would authorize $20 million for fiscal year 2020, with funding increasing by $10 million annually, in order to reach $60 million for fiscal year 2024. This bill is widely supported by leading caregiver and respite organizations, including the ARCH National Respite Network and Resource Center, the American Psychological Association, the Arc, and the Elizabeth Dole Foundation. Mr. President, I ask to include letters from these supporting organizations in the Record. Mr. President, there is a large gap between caregivers who need respite services and those who receive it. Our legislation would provide the necessary resources to state respite agencies to ensure that more caregivers have access to the respite services they need. I urge all of my colleagues to join in support of this important bipartisan legislation, the Lifespan Respite Care Reauthorization Act of 2019. April 1, 2019. Hon. Susan Collins, U.S. Senate, Washington, DC. Hon. Tammy Baldwin, U.S. Senate, Washington, DC. Hon. Jim Langevin, House of Representatives, Washington, DC. Hon. Cathy McMorris Rodgers, House of Representatives, Washington, DC. Dear Senator Collins, Senator Baldwin, Representative Langevin and Representative McMorris Rodgers: We, the undersigned national organizations representing all ages and disabilities, are writing to offer our fervent support for and endorsement of the Lifespan Respite Care Reauthorization Act to reauthorize the Lifespan Respite Care Program at $200 million over five years. We also want to thank you for your leadership in supporting the nation's family caregivers. Every day, millions of American families are faced with unexpected illness, disease, or disability. A soldier is injured in war, a spouse develops multiple sclerosis or Alzheimer's disease, or a child is diagnosed with a developmental or physical disability or chronic illness. These are but a few examples of events that can forever change an individual's and family's trajectory. While each situation is unique, the one thing that they often have in common is the incredible value of family caregivers. Forty-three million family caregivers provide a vast majority of our nation's long-term care, permitting individuals of all ages to remain in their communities and avoid or delay nursing home or foster care placements. AARP has estimated that in 2013, family caregivers provided $470 billion in uncompensated care to adults, a staggering statistic that exceeds federal and state spending on Medicaid health services and long-term services and supports that same year. While the benefits of family caregiving are plentiful, caregiving can take its toll--with older spousal family caregivers experiencing higher mortality rates, rates of acute and chronic conditions, and depression than noncaregivers. Respite--short-term care that offers individuals or family members temporary relief from the daily routine and stress of providing care--is a critical component to bolstering family stability and maintaining family caregiver health and well-being. Respite is a frequently requested support service among family caregivers, but 85% of family caregivers of adults receive no respite and the percentage is similar for parents caring for their children with special needs. Not surprisingly, high burden family caregivers (defined as those who assist their loved one with personal care such as getting dressed or bathing) cite lack of respite as one of their top three concerns. To help provide family caregivers the support they need, the Lifespan Respite Care Program was enacted in 2006 with strong bipartisan support. The program provides competitive grants to states to establish or enhance statewide Lifespan Respite systems that maximize existing resources and help ensure that quality respite is available and accessible to all family caregivers. With more than half of care recipients under age 75 and more than one-third under age 50, Lifespan Respite rightly recognizes caregiving as a lifespan issue and serves families regardless of age or disability. Though the program has been drastically underfunded since its inception, thirty-seven states and the District of Columbia have received grants and are engaged in impressive work such as identifying and coordinating respite services available through various state agencies, including veterans caregiver services; helping unserved families pay for respite through participant-directed voucher programs or mini-grants to community and faith-based agencies; building respite capacity by recruiting and training respite workers and volunteers; and raising awareness about respite through public education campaigns. Originally authorized through Fiscal Year 2011, enactment of the Lifespan Respite Care Reauthorization Act is necessary to continue this excellent momentum, better coordinate and supply respite care to our nation's 43 million family caregivers through statewide Lifespan Respite programs and ensure that states are able to sustain the great work they have begun and still allow new states to receive a grant. We thank you for your commitment to individuals living with disabilities, older individuals in need of assistance and support, and the loved ones who care for them and we look forward to continuing to work with you as the bill moves forward. If you would like more information, please contact Jill Kagan. Sincerely, AARP; Alzheimer's Association; Alzheimer's Foundation of America; Alzheimer's Impact Movement; American Association of Caregiving Youth; American Association on Intellectual and Developmental Disabilities (AAIDD); American Dance Therapy Association; American Music Therapy Association; The Arc of the United States; Association of University Centers on Disabilities (AUCD); Autism Society of America; Brain Injury Association of America; Caregiver Action Network; Caring Across Generations; Christopher & Dana Reeve Foundation; Easterseals. Elizabeth Dole Foundation; Epilepsy Foundation; Family Caregiver Alliance, National Center on Caregiving; Family Voices; Generations United; The Jewish Federations of North America; Justice in Aging; LeadingAge; Lupus Foundation of America; The Michael J. Fox Foundation for Parkinson's Research; National Alliance for Caregiving; National Alliance of Children's Trusts and Prevention Funds; National Association for Home Care and Hospice; National Association of Area Agencies on Aging (n4a); National Association of Councils on Developmental Disabilities; National Association of Social Workers (NASW). National Association of State Directors of Developmental Disabilities Services; National Association of State Head Injury Administrators; National Association of States United for Aging and Disabilities; National Down Syndrome Congress; National Down Syndrome Society; National Hospice and Palliative Care Organization; National Military Family Association; National Multiple Sclerosis Society; National Respite Coalition; Paralyzed Veterans of America; Program to Improve Eldercare, Altarum; Rosalynn Carter Institute for Caregiving; Sibling Leadership Network; TASH; United Spinal Association; Well Spouse Association.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce legislation with my colleague from Wisconsin, Senator Baldwin, to reauthorize the Lifespan Respite Care Program. Respite care provides full-time caregivers with the much-needed opportunity to take a temporary break from their responsibilities caring for aging or disabled loved ones. Every day, an estimated 43 million family caregivers attend to loved ones who are experiencing chronic, disabling health conditions. While many of these individuals care for an older adult, almost one-third of caregivers attend to persons under the age of 50. Caregivers help their loved ones remain at home, often delaying the need for nursing home or foster care placements. The value of their efforts is tremendous, amounting to more than $470 billion in uncompensated care. This compassionate task, however, can take a toll. Caregivers experience higher mortality rates and are more likely to acquire acute and chronic health conditions. Respite care, which provides temporary relief to caregivers from their ongoing responsibilities, helps to reduce mental stress and physical health issues they may experience, keeping caregivers healthy and families intact. Yet, almost 80 percent of America's caregivers have never received any respite services. As a senator representing the State with the oldest median age in our Nation and as Chairman of the Senate Aging Committee, the well-being of our seniors and their caregivers is among my top priorities. Since the Lifespan Respite Care Act was enacted in 2006, 37 States and the District of Columbia have received grants to increase the availability and quality of respite services. Still, the need for respite care continues to increase and outpace available resources. When I ask family caregivers about their greatest needs, the number one that I hear is respite. The Maine Department of Health and Human Services recognized this urgent need in a report released in December 2018 on children's behavioral health services. The report recommended expanding access to respite care services for families. One Maine mother shared, ``Respite has helped our family because we have been able to take other children to doctors appointments without everyone having to go. My husband and I have been able to have a little time away. I have been able to attend to my own mental health needs.'' From families caring for children with disabilities to those caring for older adults, the need for respite care today continues to grow. Our legislation will help to close the resource gap experienced by our nation's caregivers. Specifically, the Lifespan Respite Care Act will authorize robust funding for this program over the five years, through 2024, to assist states in establishing or enhancing statewide Lifespan Respite systems. It would authorize $20 million for fiscal year 2020, with funding increasing by $10 million annually, in order to reach $60 million for fiscal year 2024. This bill is widely supported by leading caregiver and respite organizations, including the ARCH National Respite Network and Resource Center, the American Psychological Association, the Arc, and the Elizabeth Dole Foundation. Mr. President, I ask to include letters from these supporting organizations in the Record. Mr. President, there is a large gap between caregivers who need respite services and those who receive it. Our legislation would provide the necessary resources to state respite agencies to ensure that more caregivers have access to the respite services they need. I urge all of my colleagues to join in support of this important bipartisan legislation, the Lifespan Respite Care Reauthorization Act of 2019. April 1, 2019. Hon. Susan Collins, U.S. Senate, Washington, DC. Hon. Tammy Baldwin, U.S. Senate, Washington, DC. Hon. Jim Langevin, House of Representatives, Washington, DC. Hon. Cathy McMorris Rodgers, House of Representatives, Washington, DC. Dear Senator Collins, Senator Baldwin, Representative Langevin and Representative McMorris Rodgers: We, the undersigned national organizations representing all ages and disabilities, are writing to offer our fervent support for and endorsement of the Lifespan Respite Care Reauthorization Act to reauthorize the Lifespan Respite Care Program at $200 million over five years. We also want to thank you for your leadership in supporting the nation's family caregivers. Every day, millions of American families are faced with unexpected illness, disease, or disability. A soldier is injured in war, a spouse develops multiple sclerosis or Alzheimer's disease, or a child is diagnosed with a developmental or physical disability or chronic illness. These are but a few examples of events that can forever change an individual's and family's trajectory. While each situation is unique, the one thing that they often have in common is the incredible value of family caregivers. Forty-three million family caregivers provide a vast majority of our nation's long-term care, permitting individuals of all ages to remain in their communities and avoid or delay nursing home or foster care placements. AARP has estimated that in 2013, family caregivers provided $470 billion in uncompensated care to adults, a staggering statistic that exceeds federal and state spending on Medicaid health services and long-term services and supports that same year. While the benefits of family caregiving are plentiful, caregiving can take its toll--with older spousal family caregivers experiencing higher mortality rates, rates of acute and chronic conditions, and depression than noncaregivers. Respite--short-term care that offers individuals or family members temporary relief from the daily routine and stress of providing care--is a critical component to bolstering family stability and maintaining family caregiver health and well-being. Respite is a frequently requested support service among family caregivers, but 85% of family caregivers of adults receive no respite and the percentage is similar for parents caring for their children with special needs. Not surprisingly, high burden family caregivers (defined as those who assist their loved one with personal care such as getting dressed or bathing) cite lack of respite as one of their top three concerns. To help provide family caregivers the support they need, the Lifespan Respite Care Program was enacted in 2006 with strong bipartisan support. The program provides competitive grants to states to establish or enhance statewide Lifespan Respite systems that maximize existing resources and help ensure that quality respite is available and accessible to all family caregivers. With more than half of care recipients under age 75 and more than one-third under age 50, Lifespan Respite rightly recognizes caregiving as a lifespan issue and serves families regardless of age or disability. Though the program has been drastically underfunded since its inception, thirty-seven states and the District of Columbia have received grants and are engaged in impressive work such as identifying and coordinating respite services available through various state agencies, including veterans caregiver services; helping unserved families pay for respite through participant-directed voucher programs or mini-grants to community and faith-based agencies; building respite capacity by recruiting and training respite workers and volunteers; and raising awareness about respite through public education campaigns. Originally authorized through Fiscal Year 2011, enactment of the Lifespan Respite Care Reauthorization Act is necessary to continue this excellent momentum, better coordinate and supply respite care to our nation's 43 million family caregivers through statewide Lifespan Respite programs and ensure that states are able to sustain the great work they have begun and still allow new states to receive a grant. We thank you for your commitment to individuals living with disabilities, older individuals in need of assistance and support, and the loved ones who care for them and we look forward to continuing to work with you as the bill moves forward. If you would like more information, please contact Jill Kagan. Sincerely, AARP; Alzheimer's Association; Alzheimer's Foundation of America; Alzheimer's Impact Movement; American Association of Caregiving Youth; American Association on Intellectual and Developmental Disabilities (AAIDD); American Dance Therapy Association; American Music Therapy Association; The Arc of the United States; Association of University Centers on Disabilities (AUCD); Autism Society of America; Brain Injury Association of America; Caregiver Action Network; Caring Across Generations; Christopher & Dana Reeve Foundation; Easterseals. Elizabeth Dole Foundation; Epilepsy Foundation; Family Caregiver Alliance, National Center on Caregiving; Family Voices; Generations United; The Jewish Federations of North America; Justice in Aging; LeadingAge; Lupus Foundation of America; The Michael J. Fox Foundation for Parkinson's Research; National Alliance for Caregiving; National Alliance of Children's Trusts and Prevention Funds; National Association for Home Care and Hospice; National Association of Area Agencies on Aging (n4a); National Association of Councils on Developmental Disabilities; National Association of Social Workers (NASW). National Association of State Directors of Developmental Disabilities Services; National Association of State Head Injury Administrators; National Association of States United for Aging and Disabilities; National Down Syndrome Congress; National Down Syndrome Society; National Hospice and Palliative Care Organization; National Military Family Association; National Multiple Sclerosis Society; National Respite Coalition; Paralyzed Veterans of America; Program to Improve Eldercare, Altarum; Rosalynn Carter Institute for Caregiving; Sibling Leadership Network; TASH; United Spinal Association; Well Spouse Association.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to introduce, along with the senior Senator from California, Mrs. Feinstein, the Smithsonian American Women's History Museum Act. This bill would establish an American women's history museum in our Nation's Capital. American women have made invaluable contributions to our country in every field, such as government, business, medicine, law, literature, sports, entertainment, the arts, and the military. Telling the history of American women matters, and a museum recognizing these achievements and experiences is long overdue. In 1999, a Presidential commission on commemorating women in American history concluded that an ``appropriate celebration of women's history in the next millennium should include the designation of a focal point for women's history in our Nation's capital.'' In 2014, Congress took an important step toward realizing this goal when it passed legislation creating an independent, bipartisan commission to study the potential for establishing such a museum in Washington, DC. Following 18 months of study, the bipartisan commission unanimously concluded, ``America needs and deserves a physical national museum dedicated to showcasing the historical experiences and impact of women in the country.'' I could not agree more. The bill we are introducing takes the next step toward creating this national museum. Incorporating the recommendations of the bipartisan Commission, the bill would establish a national museum to collect, study, and create programs incorporating and exhibiting a wide spectrum of American women's experiences, contributions, and history. The Smithsonian Institution would be the governing body, ensuring that this museum is free and open to all who visit Washington, DC. Following the Commission's recommendation, the Smithsonian has begun an American Women's History Initiative to increase its research and programming related to American women, past and present. Mr. President, this year we commemorate the 100th anniversary of American women's suffrage and the decades-long fight for women's equality at the ballot box. The story, leaders, and lessons of women's suffrage are among the most powerful in our nation's history. Amid celebrations of that historic moment, I can think of few better ways to honor those women and that momentous achievement than by passing this legislation. A museum dedicated to women's history would help ensure that future generations understand what we owe to those American women who have helped build, sustain, and advance our society. I urge my colleagues to support this legislation.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to introduce, along with the senior Senator from California, Mrs. Feinstein, the Smithsonian American Women's History Museum Act. This bill would establish an American women's history museum in our Nation's Capital. American women have made invaluable contributions to our country in every field, such as government, business, medicine, law, literature, sports, entertainment, the arts, and the military. Telling the history of American women matters, and a museum recognizing these achievements and experiences is long overdue. In 1999, a Presidential commission on commemorating women in American history concluded that an ``appropriate celebration of women's history in the next millennium should include the designation of a focal point for women's history in our Nation's capital.'' In 2014, Congress took an important step toward realizing this goal when it passed legislation creating an independent, bipartisan commission to study the potential for establishing such a museum in Washington, DC. Following 18 months of study, the bipartisan commission unanimously concluded, ``America needs and deserves a physical national museum dedicated to showcasing the historical experiences and impact of women in the country.'' I could not agree more. The bill we are introducing takes the next step toward creating this national museum. Incorporating the recommendations of the bipartisan Commission, the bill would establish a national museum to collect, study, and create programs incorporating and exhibiting a wide spectrum of American women's experiences, contributions, and history. The Smithsonian Institution would be the governing body, ensuring that this museum is free and open to all who visit Washington, DC. Following the Commission's recommendation, the Smithsonian has begun an American Women's History Initiative to increase its research and programming related to American women, past and present. Mr. President, this year we commemorate the 100th anniversary of American women's suffrage and the decades-long fight for women's equality at the ballot box. The story, leaders, and lessons of women's suffrage are among the most powerful in our nation's history. Amid celebrations of that historic moment, I can think of few better ways to honor those women and that momentous achievement than by passing this legislation. A museum dedicated to women's history would help ensure that future generations understand what we owe to those American women who have helped build, sustain, and advance our society. I urge my colleagues to support this legislation.

Ms. COLLINS

Ms. COLLINS. Thank you. Mr. President, later today, the Senate will make a significant decision with implications for our constitutional system of government. We will vote on a resolution to reverse the President's ill-advised national emergency declaration that funds the construction of a border wall using money that Congress has appropriated and the President has signed into law for other purposes, such as military construction. I want to thank Senator Udall, the Senator from New Mexico, for working together with me. We introduced a companion resolution to overturn the President's declaration, and I commend Senator Udall for his leadership. By declaring a national emergency, the President's action comes into direct conflict with Congress's authority to determine the appropriation of funds, a power vested in Congress by the Framers of our Constitution in article I, section 9. That is why this issue is not about strengthening our border security, a goal that I support and have voted to advance. Rather, it is a solemn occasion involving whether this body will stand up for its institutional prerogatives and will support the separation of powers enshrined in our Constitution. Throughout our history the courts have consistently held that ``only Congress is empowered by the Constitution to adopt laws directing monies to be spent from the U.S. treasury.'' For the past 65 years, the courts have determined the boundary of Presidential authority vis-a-vis Congress under the doctrine of Youngstown Sheet & Tube, the 1952 Supreme Court case that reversed President Truman's seizure of U.S. steel companies during the Korean war. As Justice Robert Jackson explained in his profoundly influential concurrence in that case, the question of whether a President's actions are constitutionally valid should be determined by examining the source of the President's authority. In this concurrence, the Justice goes through three scenarios in which he assesses the President's power. According to Justice Jackson, when acts taken by the President are against the express or implied will of Congress, the President's power is at its lowest ebb. President Trump's declaration clearly falls in that category. The President rests his declaration on the National Emergencies Act, and that act fails to define precisely what constitutes an emergency. There is a commonsense rule we can apply. It is a five-part test that was used by the Office of Management and Budget under former President George Herbert Walker Bush to determine whether requested funding merited an emergency designation under our budget rules. Under that test, a spending request was designated as an emergency only if the need for spending met a five-part test. It had to be necessary, sudden, urgent, unforeseen, and not permanent. Whether one agrees with President Trump that more should be done to secure our southern border--and I do agree with him on that goal--his decision to fund a border wall through a national emergency declaration would never pass all of this five-part test. Another concern I have with the President's declaration is, it shifts funding away from critical military construction projects. We don't know which ones. We have not been able to get a list, but this could have very real national security implications. Again, I would note that the Military Construction appropriations bill incorporated projects recommended by the President and his Department of Defense, was passed by both bodies, and signed into law by the President. Let me emphasize, once again, that the question presented by this resolution is not whether you are for a border wall or against a border wall; it is not whether you believe that border security should be strengthened or whether it is sufficient; it is not whether we support or oppose President Trump; rather, the question is a far more fundamental and significant one. The question is this: Do we want the executive branch, now or in the future, to hold the power of the purse, a power the Framers deliberately entrusted to Congress? We must stand up and defend Congress's institutional powers as the Framers intended we would, even when doing so is inconvenient or goes against the outcome we might prefer. I urge my colleagues to support the rulings of disapproval and our Constitution. Thank you.

Ms. COLLINS

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

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to discuss Senate bill, S. 659, the Biologic Patent Transparency Act. This bill would help encourage competition in the prescription drug marketplace and begin to put an end to the harmful patent strategies that block new drugs from coming to market. I am pleased to be sponsoring this legislation with my friend and colleague from Virginia, Senator Tim Kaine, as well as with Senators Portman, Shaheen, Braun, and Stabenow, all of whom have joined us as original cosponsors. Prescription drugs are vital to the health and well-being of Americans, especially our Nation's seniors, 90 percent of whom take at least one prescription drug in any given month. Developing these medicines is a lengthy, expensive, and uncertain process. It often takes more than a decade and can cost billions of dollars to bring a new drug from the laboratory to the patient. Most drugs fail during the clinical trials. If we want new medicines to reach consumers who need them, the companies that invest in this research and development and take the risks necessary must see a fair return on their investment. To encourage such investments, Congress grants inventors limited periods of patent protection during which their products are legally shielded from competition. Rewarding these investments has proven to be beneficial to many Americans. The past century could be termed the ``Age of Miracle Drugs,'' with discoveries such as insulin and penicillin, and treatments for cancer, heart disease, HIV, and other serious medical conditions. Today, however, we might well define a ``miracle drug'' as one that has not doubled in price since the last refill. Although our country leads the world in prescription drug innovation, we also lead the world in drug spending. According to one estimate, U.S. spending on prescription drugs will reach between $580 billion and $610 billion by the year 2021. In 2017, Americans spent more than $330 billion on retail prescription drugs, and nearly one-quarter of individuals surveyed reported difficulties paying for the cost of their prescription medications. How well I remember standing in the pharmacy line several months ago behind a couple who were informed by the pharmacist that their copay would be $111. The husband turned to his wife and said: ``Honey, we just can't afford that.'' They then turned around, left their prescription on the counter, and left the pharmacy. I asked the pharmacist how often that happens, and he told me, ``Every day.'' That is the kind of onerous burden too many Americans are facing, and it's causing them to forgo fulfilling a prescription, to stretch out doses, or simply to choose to buy the medicine and short themselves on food or be late in paying their rent or mortgage. Among the most expensive drugs on the market today are biologics. These are incredibly promising drugs for the health and well-being of many Americans. They have revolutionized treatment for many serious and life-threatening conditions, from diabetes and rheumatoid arthritis to cancer and multiple sclerosis. Today, fewer than 2 percent of Americans use biologics, yet biologics account for nearly 40 percent of total spending on prescription drugs. Last year, the Senate Aging Committee, which I chair and which the Presiding Officer is a member of, held a hearing to examine the price increases for one of these groundbreaking treatments. HUMIRA, the world's best-selling prescription drug, is a biologic that was first approved for the treatment of rheumatoid arthritis by the Food and Drug Administration, the FDA, in 2002. In 2017, U.S. sales of this product generated an astonishing $12.3 billion in revenue for the drug's manufacturer. Now, HUMIRA is truly a miracle drug for many patients. It is used to treat a variety of conditions, ranging from rheumatoid arthritis to Crohn's disease to ulcerative colitis and plaque psoriasis. So a wide range of diseases and conditions are responsive to HUMIRA. According to various reports, more than 200 patent applications have been filed for HUMIRA, with nearly 90 percent of those filed after HUMIRA was first approved by the FDA in 2002. According to the manufacturer's CEO, more than 130 patents are included in HUMIRA's patent portfolio today. Protections provided by these patents can block competition and extend the drug's market monopoly until the year 2034. Keep in mind that this is for a drug that was first approved in 2002. We're talking about extending the patents until 2034. HUMIRA has increased in price yet again this year, and although biosimilars have been approved by the FDA, patent litigation is blamed for keeping these lower cost alternatives from reaching the market. And HUMIRA is not the only biologic to be protected by such an extensive portfolio of patents--what we call a ``patent thicket.'' Enabling the creation, approval, and marketing of competitive biological products must be among our top priorities when we consider ways to reduce the healthcare costs of Americans. The Biologic Patent Transparency Act is an important step Congress can take to shine light on the patent thickets that protect these biologics and to stop some of the gaming that has prevented consumers from accessing lower cost, FDA-approved products. So what will our bill do? It has three major components. First, our bill would require manufacturers to disclose to the FDA the web of patents that protect their approved biologics from competition by biosimilar manufacturers--a process that we already know works. It has worked remarkably well for the small molecule drugs that are governed by the Hatch-Waxman Act of 1984. Although generics accounted for only 13 percent of U.S. prescriptions immediately before the Hatch-Waxman Act was passed, today they make up 90 percent. These generics often cost 70 to 90 percent less than the branded product. They have significantly reduced costs and expanded access to necessary treatments for Americans. According to one estimate, generics have saved consumers more than $1.6 trillion in drug costs over the last decade. Second, our bill would tackle the patent strategies that are intentionally designed to block competition by limiting the enforceability of late-filed patents against biosimilar manufacturers that have already filed applications with the FDA. According to one estimate, over 70 of the patents covering HUMIRA were applied for and granted within three years prior to the expiration of the initial patents. So here's what is happening. A manufacturer of a wildly successful drug sees that its patents are about to expire and that a competitor--a biosimilar manufacturer--is on the way to getting approval by the FDA for its product. So what that original brand manufacturer does is make small alterations, frequently, in the product. It doesn't change the product in a dramatic way. It doesn't come up with a brand new medicine, but it changes it ever so slightly or decides to patent an aspect of it that was not previously patented. The whole purpose is to prevent that biosimilar manufacturer from bringing to market a more affordable product that consumers could access. That is just wrong. That is not what patents are intended for. And as I made clear earlier in my statement, I support a limited period of exclusivity for the innovator manufacturer. I think we should reward that investment in research and development and clinical trials, which is often very expensive. But it is not right for the patent system to be gamed this way, for it to be exploited and for last-minute patents to be filed for the sole purpose of precluding a competitor from coming to market with a less expensive, equivalent drug. Restricting the enforcement of these late-filed patents that are filed after the application by the biosimilar manufacturer has been filed with the FDA will still protect the important investments made by the manufacturers, while encouraging the biosimilar manufacturers to bring important innovations to consumers sooner and at a lower cost. Finally, the third part of our bill would require the FDA to regularly publish specific information related to approved biologic products, making it easier for prospective competitors to evaluate and plan for the development and introduction of biosimilars. In addition to the name and patent information for all approved biological products, our bill would require the FDA to publish information including the drug's marketing status, applicable reference products, periods of exclusivity, biosimilar or interchangeable products, and approved indications for usage. The FDA will be required to regularly update this information as well, so that it is readily available and up-to-date. So what this will do is allow the biosimilar manufacturer to go to what is known as the ``Purple Book'' at the FDA, take a look at the drug it wishes to compete with, and learn what existing patents are there, how long they are going to be in effect, and plan accordingly. America's system of protecting innovation has provided our citizens with tremendous benefits, especially in the area of pharmaceuticals. Of that there can be no doubt. We must provide pharmaceutical manufacturers with the ability to recoup their investments, but at the same time, we cannot be blind to the costs of these drugs, nor to cases where patent laws are manipulated to preserve monopolies and prevent lower cost, equivalent drugs from coming to market. Passing the Biologic Patent Transparency Act is a major step we can take to put a stop to the patent-gaming that blocks consumers from accessing lower cost drugs. I encourage my colleagues to support this crucial legislation. Thank you. I yield the floor. Seeing no one seeking recognition, I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise to announce my opposition to the nomination of Chad Readler to be a Judge on the Sixth Circuit Court of Appeals. As the Acting Assistant Attorney General of the Justice Department's Civil Division, Mr. Readler was both a lead attorney and policy adviser in the Department's decision not to defend the Affordable Care Act, including its provisions protecting individuals with preexisting conditions. Rather than defend the law and its protections for individuals with preexisting conditions, such as asthma, arthritis, cancer, diabetes, and heart disease, Mr. Readler's brief in Texas v. United States argued that they should be invalidated. I strongly objected to DOJ's position to not defend the law, and it is telling that this position also concerned some other career attorneys in the Department. In fact, three career attorneys withdrew from the case rather than support this position, and one of those attorneys eventually resigned. In my view, the Justice Department's severability argument is wrong and implausible. On June 27, 2018, I wrote to Attorney General Sessions and urged the Justice Department to reverse course and to defend the law's critical protections for individuals with preexisting conditions. Even the Justice Department acknowledged that it was ``rare'' for the government to refuse to defend the laws of the United States against constitutional challenges. I have continuously stressed the importance of protecting Americans who suffer from preexisting conditions, including 45 percent of Maine's population: 590,000 Mainers. In July 2017, I voted to block several proposals to repeal the ACA, which I feared would reduce protections for individuals with preexisting conditions. In October 2018, I voted to overturn a Trump administration rule that expands the duration of short-term health insurance plans, which could deny coverage to people with preexisting conditions.

Ms. COLLINS

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

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to speak on the resolution that I am joining Senator Udall in introducing. It would reverse the President's ill-advised decision to declare a national emergency and commandeer funding provided for other purposes by Congress and instead redirect it to construct a wall on our southern border. I thank Senator Udall for his leadership and also recognize the support we have received from our cosponsors, Senator Murkowski and Senator Shaheen. Let me be clear. The question before us is not whether to support or oppose the wall. It is not whether to support or oppose President Trump. Rather, it is this: Do we want the executive branch now or in the future to hold a power that the Founders deliberately entrusted to Congress? It has been said that Congress's most precious power is the power of the purse set out in plain language in article I, section 9 of our Constitution. It reads as follows: ``No money shall be drawn from the Treasury but in consequence of Appropriations made by law.'' Alexander Hamilton, in Federalist 72, made clear the Founders' view that only the legislative branch commands this power, not the judiciary and not the executive. James Madison, in Federalist 58, called the power of the purse ``the most complete and effectual weapon with which any constitution can arm the [ . . . ] representatives of the people.'' Congress's power was jealously guarded in the early days of our Republic. No less an authority on our constitutional framework than Supreme Court Justice Joseph Story, in his famous ``Commentaries,'' explained that ``[i]f it were otherwise, the executive would possess an unbounded power over the public purse of the nation, and might apply all its monied resources at his pleasure.'' Throughout our history, the courts have consistently held that ``only Congress is empowered by the Constitution to adopt laws directing monies to be spent from the U.S. treasury.'' I strongly support protecting the institutional prerogatives of the U.S. Senate and the system of checks and balances that is central to the structure of our government. I support funding for better border security, including physical barriers where they make sense. I understand the President is disappointed that the funding he requested did not pass, but the failure of Congress to pass funding in the amount the President prefers cannot become an excuse for the President to usurp the powers of the legislative branch. This is not the first time I have made this argument against Executive overreach. In 2015, I authored the Immigration Rule of Law Act, legislation that would have provided a statutory basis for the Dreamer population, while rolling back President Obama's 2014 Executive orders expanding that program. As I explained at the time, even though I supported comprehensive immigration reform and was disappointed that it had not passed, I rejected the notion that its failure could serve as the justification for President Obama to implement by Executive fiat that which Congress had refused to pass, regardless of the wisdom of Congress's decision. I would now like to turn to a discussion of the National Emergencies Act. This act was passed in 1976 to standardize the process by which the President can invoke national emergency powers and Congress can terminate the declaration through a joint resolution such as the one we are introducing today. The act is procedural in nature. It lays out the process the President must follow to declare a national emergency but does not provide the President with any additional powers. Instead, it requires the President to specify where, in existing law, he has been granted the authority for the powers he intends to exercise. By itself, the National Emergencies Act does not give the President the power to repurpose billions of dollars to build a wall. The President must look elsewhere for that authority. In his declaration, the President cites the authority provided by title 10, section 2808 of the U.S. Code, which relates to ``Construction authority in the event of a declaration of war or national emergency.'' But that authorization applies only to ``military construction projects'' that are ``necessary to support [the] use of the armed forces.'' I do not believe this provision can be fairly read to bootstrap the presence of troops along the southern border into the authority to build a wall as a military construction project. The question isn't whether the President can act in an emergency but whether he can do so in a manner that would undermine the congressional power of the purse. Here, I think we need a better understanding of what should qualify as an emergency. One place we could turn is to a five-part test originally developed by the Office of Management and Budget in 1991, under former President George Herbert Walker Bush, to determine whether requested funding merited an ``emergency spending'' designation under our budget rules. Under that test, a spending request was designated as an ``emergency'' only if all five of the following conditions were met: First, expenditures had to be necessary; second, the need had to be sudden, coming into being quickly, not building up over time; third, the need had to be urgent; fourth, the need had to be unforeseen; and fifth, the need could not be permanent. I raise this test only by way of analogy, but it is fair to say that whether or not you agree with the President that more should be done to secure the southern border--and I do agree with the President's goal-- his decision to fund a border wall through a national emergency declaration would not pass this five-part test. The President's declaration also has practical implications for the military construction appropriations process, as my colleague has pointed out. Last year, in testimony before the Appropriations Committee, the Department of Defense said that the President's budget request for military construction funding was crucial to support our national defense, including construction projects to improve military readiness and increase the lethality of the force. This includes missile defense, improved facilities in Europe to deter Russian aggression, and infrastructure to operationalize the F-35 stealth fighter. This also included several important efforts at the Portsmouth Naval Shipyard in Maine that are vital to the Navy conducting timely maintenance and refueling of our Nation's submarines. Shifting funding away from these vital projects is shortsighted and could have very real national security implications. We must defend Congress's institutional powers, as the Founders hoped we would, even when doing so is inconvenient or goes against the outcome we might prefer. The gridlock we have experienced on difficult issues like border security and immigration reform is not simply a failure to get our work done but a reflection of the fact that we have yet to reach a consensus. The President's emergency declaration is ill-advised precisely because it attempts to shortcut the process of checks and balances by usurping Congress's authority. This resolution blocks that overreach, and I hope, regardless of our colleague's position on the construction of the border wall, that we will join together to assert Congress's constitutional authority in the appropriations process. I urge our colleagues to support this important resolution.

Ms. COLLINS. I would be happy to.

Ms. COLLINS. Mr. President, I would thank the Senator for his gracious comments. As always, it has been a great pleasure to work with him, and I know he cares deeply about the constitutional principle that brings us to the floor today. Let us defend the Constitution.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to speak on the resolution that I am joining Senator Udall in introducing. It would reverse the President's ill-advised decision to declare a national emergency and commandeer funding provided for other purposes by Congress and instead redirect it to construct a wall on our southern border. I thank Senator Udall for his leadership and also recognize the support we have received from our cosponsors, Senator Murkowski and Senator Shaheen. Let me be clear. The question before us is not whether to support or oppose the wall. It is not whether to support or oppose President Trump. Rather, it is this: Do we want the executive branch now or in the future to hold a power that the Founders deliberately entrusted to Congress? It has been said that Congress's most precious power is the power of the purse set out in plain language in article I, section 9 of our Constitution. It reads as follows: ``No money shall be drawn from the Treasury but in consequence of Appropriations made by law.'' Alexander Hamilton, in Federalist 72, made clear the Founders' view that only the legislative branch commands this power, not the judiciary and not the executive. James Madison, in Federalist 58, called the power of the purse ``the most complete and effectual weapon with which any constitution can arm the [ . . . ] representatives of the people.'' Congress's power was jealously guarded in the early days of our Republic. No less an authority on our constitutional framework than Supreme Court Justice Joseph Story, in his famous ``Commentaries,'' explained that ``[i]f it were otherwise, the executive would possess an unbounded power over the public purse of the nation, and might apply all its monied resources at his pleasure.'' Throughout our history, the courts have consistently held that ``only Congress is empowered by the Constitution to adopt laws directing monies to be spent from the U.S. treasury.'' I strongly support protecting the institutional prerogatives of the U.S. Senate and the system of checks and balances that is central to the structure of our government. I support funding for better border security, including physical barriers where they make sense. I understand the President is disappointed that the funding he requested did not pass, but the failure of Congress to pass funding in the amount the President prefers cannot become an excuse for the President to usurp the powers of the legislative branch. This is not the first time I have made this argument against Executive overreach. In 2015, I authored the Immigration Rule of Law Act, legislation that would have provided a statutory basis for the Dreamer population, while rolling back President Obama's 2014 Executive orders expanding that program. As I explained at the time, even though I supported comprehensive immigration reform and was disappointed that it had not passed, I rejected the notion that its failure could serve as the justification for President Obama to implement by Executive fiat that which Congress had refused to pass, regardless of the wisdom of Congress's decision. I would now like to turn to a discussion of the National Emergencies Act. This act was passed in 1976 to standardize the process by which the President can invoke national emergency powers and Congress can terminate the declaration through a joint resolution such as the one we are introducing today. The act is procedural in nature. It lays out the process the President must follow to declare a national emergency but does not provide the President with any additional powers. Instead, it requires the President to specify where, in existing law, he has been granted the authority for the powers he intends to exercise. By itself, the National Emergencies Act does not give the President the power to repurpose billions of dollars to build a wall. The President must look elsewhere for that authority. In his declaration, the President cites the authority provided by title 10, section 2808 of the U.S. Code, which relates to ``Construction authority in the event of a declaration of war or national emergency.'' But that authorization applies only to ``military construction projects'' that are ``necessary to support [the] use of the armed forces.'' I do not believe this provision can be fairly read to bootstrap the presence of troops along the southern border into the authority to build a wall as a military construction project. The question isn't whether the President can act in an emergency but whether he can do so in a manner that would undermine the congressional power of the purse. Here, I think we need a better understanding of what should qualify as an emergency. One place we could turn is to a five-part test originally developed by the Office of Management and Budget in 1991, under former President George Herbert Walker Bush, to determine whether requested funding merited an ``emergency spending'' designation under our budget rules. Under that test, a spending request was designated as an ``emergency'' only if all five of the following conditions were met: First, expenditures had to be necessary; second, the need had to be sudden, coming into being quickly, not building up over time; third, the need had to be urgent; fourth, the need had to be unforeseen; and fifth, the need could not be permanent. I raise this test only by way of analogy, but it is fair to say that whether or not you agree with the President that more should be done to secure the southern border--and I do agree with the President's goal-- his decision to fund a border wall through a national emergency declaration would not pass this five-part test. The President's declaration also has practical implications for the military construction appropriations process, as my colleague has pointed out. Last year, in testimony before the Appropriations Committee, the Department of Defense said that the President's budget request for military construction funding was crucial to support our national defense, including construction projects to improve military readiness and increase the lethality of the force. This includes missile defense, improved facilities in Europe to deter Russian aggression, and infrastructure to operationalize the F-35 stealth fighter. This also included several important efforts at the Portsmouth Naval Shipyard in Maine that are vital to the Navy conducting timely maintenance and refueling of our Nation's submarines. Shifting funding away from these vital projects is shortsighted and could have very real national security implications. We must defend Congress's institutional powers, as the Founders hoped we would, even when doing so is inconvenient or goes against the outcome we might prefer. The gridlock we have experienced on difficult issues like border security and immigration reform is not simply a failure to get our work done but a reflection of the fact that we have yet to reach a consensus. The President's emergency declaration is ill-advised precisely because it attempts to shortcut the process of checks and balances by usurping Congress's authority. This resolution blocks that overreach, and I hope, regardless of our colleague's position on the construction of the border wall, that we will join together to assert Congress's constitutional authority in the appropriations process. I urge our colleagues to support this important resolution.

Ms. COLLINS. I would be happy to.

Ms. COLLINS. Mr. President, I would thank the Senator for his gracious comments. As always, it has been a great pleasure to work with him, and I know he cares deeply about the constitutional principle that brings us to the floor today. Let us defend the Constitution.

Ms. COLLINS

Ms. COLLINS. Mr. President, after careful consideration, I have decided to oppose the confirmation of Andrew Wheeler, the nominee for Administrator of the Environmental Protection Agency, EPA. While Mr. Wheeler is certainly qualified for this position, I have too many concerns with the actions he has taken during his tenure as Acting Administrator to be able to support his promotion. I believe that Mr. Wheeler, unlike Scott Pruitt, understands the mission of the EPA and acts in accordance with ethical standards; however, the policies he has supported as Acting Administrator are not in the best interest of our environment and public health, particularly given the threat of climate change to our Nation. I met at length with Mr. Wheeler, and we discussed many important environmental issues about which I care deeply, from EPA's enforcement of landmark environmental laws to greenhouse gas emissions and mercury pollution. Since last August, the EPA has proposed to roll back environmental protections, including determining it is no longer ``appropriate and necessary'' to regulate mercury emissions from power plants, halting efforts to reduce greenhouse gas emissions from cars and trucks, and replacing the Clean Power Plan. These efforts are of great importance to the State of Maine, which is located at the end of our Nation's ``air pollution tailpipe'' and is on the receiving end of pollution generated by coal-fired power plants in other States. Moreover, there is no doubt that the greenhouse gas emissions driving climate change pose a significant threat to our State's economy and our natural resources, from our working forests, fishing, and agricultural industries, to tourism, and recreation. Reducing harmful air pollutants is critical for public health, particularly for Maine, which has among the highest rates of asthma in the country. In Maine, cars, trucks, and other vehicles produce more than 50 percent of our State's greenhouse gas emissions. Controls for mercury, one of the most persistent and dangerous pollutants, are especially important for children and pregnant women. The Agency's recent efforts to halt progress in these critical areas takes us in the wrong direction. In keeping with my past practice, I will vote to allow the full Senate to consider Mr. Wheeler's nomination so that every Senator can have a clear up or down vote on this important nomination of a member of the President's Cabinet. However, due to the actions Mr. Wheeler has taken during his tenure at the EPA, I will vote against his confirmation.

Ms. COLLINS

Ms. COLLINS. Mr. President, as Chairman of the Senate Aging Committee, I rise today to introduce, with the Committee's Ranking Member, Senator Bob Casey, the ``Guardianship Accountability Act of 2019,'' a bill that would assist States in improving guardianship oversight and data collection. Protecting older Americans from financial fraud and exploitation has long been one of my top priorities as Chairman of the Aging Committee. According to the National Center for State Courts, an estimated 1.3 million adults are under the care of guardians--family members or professionals--who control approximately $50 billion of their assets. Guardianship is a legal relationship created by a court that is designed to protect those with diminished or lost capacity. We found, however, that in some cases, the system lacks basic protections against inappropriate use of guardianship and abuse by those in power, leaving the most vulnerable Americans at risk of exploitation. In November 2018, the Aging Committee released a bipartisan report following a year-long investigation into State guardianship programs. Titled, ``Ensuring Trust: Strengthening State Efforts to Overhaul the Guardianship Process and Protect Older Americans,'' the report included a number of recommendations intended to help stem the wave of guardianship abuse, encourage reforms to State systems and restore trust in guardianship arrangements. Throughout the course of our investigation, we heard harrowing tales from families around the Nation who have struggled with abusive guardians, unscrupulous individuals exploiting vulnerable Americans for their personal profit. Yet we also spoke with families who had heartening stories to share--of dedicated and faithful guardians stepping up to protect the assets of seniors with dementia and other conditions affecting their capacity. A good guardian can provide years of support for a protected individual, ensuring a full life directed, wherever possible, by the person's own choices and preferences. Once a guardianship is imposed, however, the individual's rights are removed, and oversight to protect the individual from abuse, neglect and exploitation becomes critical. Our Committee gathered information, analysis and recommendations from States, courts, and organizations representing older Americans and those with disabilities around the country. We found signs of progress in a number of jurisdictions. For example, in 2017, Maine was the first state to enact the Uniform Law Commission's Uniform Guardianship, Conservatorship, and Other Protective Arrangements Act. Among the reforms made to Maine's guardianship system, this legislation highlighted the importance of exploring all options to limit or preclude the need for guardianship when appropriate, including the use of supported decision making. Maine's law also mandates the regular review of reports filed by guardians to determine, among other things, whether the guardianship should continue and whether the guardian has complied with his or her duties. Yet stories in the news continue to call our attention to this important issue. Appalling stories, such as that of a guardian from Nevada who allegedly used the guardianship process to financially exploit more than 150 individuals, and that of another guardian from North Carolina who, along with an attorney, an advocate, and a professor, took advantage of two men under guardianship and allegedly stole hundreds of thousands of dollars, remind us of the vulnerabilities created by these relationships and the need for diligent oversight. In the course of the Committee's investigation, we received more than 100 comments identifying gaps in the system and, most important, offering solutions. The Committee found a pattern of barriers to proper oversight and a need for greater use of alternatives to guardianship. We found persistent and widespread challenges that require a nationwide focus in order to ensure the guardianship system works on behalf of the individuals it is intended to protect. The Committee's report outlines policy recommendations at local, state and federal levels that would improve outcomes for Americans subject to guardianship. The Guardianship Accountability Act, which we are introducing today, addresses many of the report's recommendations. The bill would direct the Elder Justice Coordinating Council to establish a National Online Resource Center on Guardianship to collect and publish information relevant to guardianship for use by guardians, individuals subject to guardianship, as well as courts, states, local governments, and community organizations. The resource center would also publish model legislation and best practices developed pursuant to the Elder Abuse Prevention and Prosecution Act, compile and publish training materials for guardians, share research related to guardianship, and maintain a database on state laws regarding guardianship and the use of less restrictive alternatives. In addition, our legislation would also expand the availability of federal demonstration grants established by the Elder Justice Act, so funds can be used for developing state guardianship databases, for training for court visitors, and for sharing information on guardian background checks. Combating financial abuse and exploitation of seniors requires law enforcement and social service agencies at all levels of government to work together, and the bipartisan Guardianship Accountability Act promotes this kind of collaboration. I urge my colleagues to support this bipartisan legislation.

Ms. COLLINS

Ms. COLLINS. Mr. President, as Chairman of the Senate Aging Committee, I rise today to introduce, with the Committee's Ranking Member, Senator Bob Casey, the ``Guardianship Accountability Act of 2019,'' a bill that would assist States in improving guardianship oversight and data collection. Protecting older Americans from financial fraud and exploitation has long been one of my top priorities as Chairman of the Aging Committee. According to the National Center for State Courts, an estimated 1.3 million adults are under the care of guardians--family members or professionals--who control approximately $50 billion of their assets. Guardianship is a legal relationship created by a court that is designed to protect those with diminished or lost capacity. We found, however, that in some cases, the system lacks basic protections against inappropriate use of guardianship and abuse by those in power, leaving the most vulnerable Americans at risk of exploitation. In November 2018, the Aging Committee released a bipartisan report following a year-long investigation into State guardianship programs. Titled, ``Ensuring Trust: Strengthening State Efforts to Overhaul the Guardianship Process and Protect Older Americans,'' the report included a number of recommendations intended to help stem the wave of guardianship abuse, encourage reforms to State systems and restore trust in guardianship arrangements. Throughout the course of our investigation, we heard harrowing tales from families around the Nation who have struggled with abusive guardians, unscrupulous individuals exploiting vulnerable Americans for their personal profit. Yet we also spoke with families who had heartening stories to share--of dedicated and faithful guardians stepping up to protect the assets of seniors with dementia and other conditions affecting their capacity. A good guardian can provide years of support for a protected individual, ensuring a full life directed, wherever possible, by the person's own choices and preferences. Once a guardianship is imposed, however, the individual's rights are removed, and oversight to protect the individual from abuse, neglect and exploitation becomes critical. Our Committee gathered information, analysis and recommendations from States, courts, and organizations representing older Americans and those with disabilities around the country. We found signs of progress in a number of jurisdictions. For example, in 2017, Maine was the first state to enact the Uniform Law Commission's Uniform Guardianship, Conservatorship, and Other Protective Arrangements Act. Among the reforms made to Maine's guardianship system, this legislation highlighted the importance of exploring all options to limit or preclude the need for guardianship when appropriate, including the use of supported decision making. Maine's law also mandates the regular review of reports filed by guardians to determine, among other things, whether the guardianship should continue and whether the guardian has complied with his or her duties. Yet stories in the news continue to call our attention to this important issue. Appalling stories, such as that of a guardian from Nevada who allegedly used the guardianship process to financially exploit more than 150 individuals, and that of another guardian from North Carolina who, along with an attorney, an advocate, and a professor, took advantage of two men under guardianship and allegedly stole hundreds of thousands of dollars, remind us of the vulnerabilities created by these relationships and the need for diligent oversight. In the course of the Committee's investigation, we received more than 100 comments identifying gaps in the system and, most important, offering solutions. The Committee found a pattern of barriers to proper oversight and a need for greater use of alternatives to guardianship. We found persistent and widespread challenges that require a nationwide focus in order to ensure the guardianship system works on behalf of the individuals it is intended to protect. The Committee's report outlines policy recommendations at local, state and federal levels that would improve outcomes for Americans subject to guardianship. The Guardianship Accountability Act, which we are introducing today, addresses many of the report's recommendations. The bill would direct the Elder Justice Coordinating Council to establish a National Online Resource Center on Guardianship to collect and publish information relevant to guardianship for use by guardians, individuals subject to guardianship, as well as courts, states, local governments, and community organizations. The resource center would also publish model legislation and best practices developed pursuant to the Elder Abuse Prevention and Prosecution Act, compile and publish training materials for guardians, share research related to guardianship, and maintain a database on state laws regarding guardianship and the use of less restrictive alternatives. In addition, our legislation would also expand the availability of federal demonstration grants established by the Elder Justice Act, so funds can be used for developing state guardianship databases, for training for court visitors, and for sharing information on guardian background checks. Combating financial abuse and exploitation of seniors requires law enforcement and social service agencies at all levels of government to work together, and the bipartisan Guardianship Accountability Act promotes this kind of collaboration. I urge my colleagues to support this bipartisan legislation.

Ms. COLLINS

Ms. COLLINS. Mr. President, William Barr is unquestionably qualified to serve as Attorney General, a position to which he was confirmed unanimously in 1991, in President George H.W. Bush's administration. Mr. Barr's record of public service and long career in the law are exemplary. I have carefully reviewed his record, listened to his testimony before the Judiciary Committee, and questioned him for an hour in my office. Given the significant issues before the Department of Justice and the fact that it is currently led by an unconfirmed, Acting Attorney General, I will vote to confirm Mr. Barr. It is imperative that the Senate confirm an Attorney General who is committed to allowing the Special Counsel to complete his investigation unimpeded. Mr. Barr gave this commitment under oath to the Judiciary Committee and again to me in our private meeting. He testified clearly that he will not permit any interference in Special Counsel Mueller's investigation into Russian attempts to influence the 2016 election. In fact, Mr. Barr told the committee that he believes ``the overarching public interest is to allow [Special Counsel Mueller] to finish.'' He also said he would resign if he were ordered by the President to fire the Special Counsel without good cause. Mr. Barr testified, ``The country needs a credible resolution to these issues, and if confirmed, I will not permit partisan politics, personal interests, or any other improper consideration to interfere with this or any other investigation. I will follow the Special Counsel regulations scrupulously and in good faith, and on my watch, Bob [Mueller] will be allowed to finish his work.'' Not only must the Special Counsel be allowed to finish his work, but also his conclusions must be as open and transparent to the public as possible. The Special Counsel regulations, put in place during the Clinton administration, have guided administrations from both parties for two decades. Those regulations instruct the Special Counsel to submit a confidential report to the Attorney General, and Mr. Barr testified that he will be as transparent as possible about the report, consistent with the law. He told me he will always err on the side of disclosure and believes transparency is critical to the public's confidence in the investigation. When asked whether he would allow the President or his attorneys to edit any report, Mr. Barr told the committee, ``That will not happen.'' Mr. Barr and I also discussed the memo he wrote in 2018 about obstruction of justice and his views on executive power. I asked him whether suborning perjury would be obstruction. He said yes. I asked him what he would do if the President asked him to stop an otherwise lawful investigation. He said he would resign. We discussed the political checks that exist to limit Executive power, and he described the Special Counsel as a ``super charged political check.'' Some have suggested, however, that Mr. Barr's memo means he believes the President cannot obstruct justice at all. In a letter to Chairman Graham, Mr. Barr responded: ``Quite the contrary, [the memo] expressed my belief that a President, just like anyone else, can obstruct justice if he or she engages in wrongful actions that impair the availability of evidence. Nor did the memorandum claim, as some have incorrectly suggested, that a President can never obstruct justice whenever he or she is exercising a constitutional function. If a President, acting with the requisite intent, engages in the kind of evidence impairment the statute prohibits--regardless whether it involves the exercise of his or her constitutional powers or not--then a President commits obstruction of justice under the statute. It is as simple as that.'' Deputy Attorney General Rod Rosenstein has said publicly that Mr. Barr's memo had no impact on the investigation. Mr. Rosenstein also noted, ``Lots of people offer opinions to the Department of Justice, but they don't influence our own decision making.'' Mr. Barr's views on executive power, while legitimate, differ from my own and do concern me as a member of the legislative branch. His opinions highlight the tension that sometimes emerges among the branches of government and which is rooted in the separation of powers. On any given matter, I would likely argue for a more limited approach to Executive power. Regardless of his philosophy, Mr. Barr has noted correctly that the President is not above the law. Mr. Barr brings considerable experience to bear on important legal policy matters at the DOJ. He testified that he supports efforts to protect the civil rights of LGBT individuals and that he is against discrimination against anyone on account of their gender identity or sexual orientation. He further stated that he is willing to support ``red flag laws'' as a step toward preventing gun violence. Mr. Barr offered his commitment to implementing the newly enacted FIRST STEP Act, a bill I supported and that he described as one that ``recognizes the progress we have made over the past three decades in fighting violent crime.'' Mr. Barr is also committed to combating scams and fraudulent schemes that target seniors, which, as chairman of the Senate Aging Committee, I have investigated and urged the Department to prioritize. Finally, Mr. Barr has served our country previously with distinction. One hundred and twenty former officials and employees from various administrations have praised Mr. Barr's ``character of unwavering commitment to the rule of law without regard to favor or politics.'' His nomination is supported by many leaders from the law enforcement community, including the Fraternal Order of Police and the Federal Law Enforcement Officers Association. In his testimony before the Judiciary Committee, Mr. Barr pledged to run the Department of Justice with professionalism and integrity. He noted that the President did not seek any promises from him and that he made none to the President. Mr. Barr has pledged his allegiance to the rule of law, the Constitution, and the American people. He has served our country honorably in the past, and I believe he will do so once again.

Ms. COLLINS

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

Ms. COLLINS. Madam President, I first want to commend the Senator from Iowa for suggesting that we take the occasion of Valentine's week to come to the Senate floor and talk a bit about our home States. Of course, each of us is convinced that we represent the best State in the Union, but in my case it happens to be true. Valentine's Day is celebrated around the world with flowers, candy, and romance. It is also a time to reflect upon the places and the people we love. To me, this is an occasion to celebrate the State in which I was born, raised, and live--the great State of Maine. People who know Maine share my love for its spectacular scenery--the rolling hills of Aroostook County, the rocky coast and the many harbors, the beautiful western mountains, the quiet forests, the beautiful rivers, and the pristine lakes. The boundless recreational opportunities our outdoors offer lifts our hearts, and the abundant wildlife inspires us. I love Maine's food. From our clean ocean comes the best lobster in the world, and from our fertile soil grows the potatoes and wild blueberries that are unmatched. From gourmet mustard from Eastport to craft beer throughout the State, Maine artisans are finding new ways to delight our taste buds. There simply is no better place to enjoy a wonderful meal than the great restaurants in the State of Maine. Add to that our wonderful museums, Acadia National Park, State parks, and art galleries, and it is easy to see why more than 1 million tourists come to our State each year. Most of all, I love the people of the State of Maine. They are hard- working, self-reliant, and compassionate. They revere tradition and yet are so innovative. In good times, they are grateful. In difficult times, they are resilient. They serve their communities and their country, caring for their neighbors and their neighborhoods. They are always ready to lend a helping hand. I love Maine's sense of community. Our annual town meetings each spring are evidence of the willingness of Mainers to come together to chart their own course. This community spirit will be on display next week with our high school basketball tournaments, where athletes from cities and towns all over the State gather in Bangor, Augusta, and Portland for spirited competition and sportsmanship. How well I remember the excitement of traveling from Caribou to Bangor 50 years ago, when I was a sophomore in high school, to watch our high school team win the coveted gold ball on a half-court buzzer shot--the shot that was heard around the State. It was the most exciting sports event I have ever attended. These tournaments are among the great traditions of our State, as are the many festivals and fairs that occur throughout the summer months and the fall. It is such an honor to represent the people of Maine in the U.S. Senate. Maine is a State of entrepreneurs, and I enjoy working for policies that enable our small businesses to start up, grow, and prosper. Most importantly, they create the majority of jobs in our State. Maine is a State of wise senior citizens--the oldest State in the Nation by average age. Developing the policies that will allow our seniors to age in their own communities and to live in security and health is among my top priorities. Maine is a State with one of the highest percentages of veterans per capita in the entire country. Mainers have always answered the call to serve our Nation. We must ensure that the brave men and women who defend our freedom receive the services and the respect they deserve. At Bath Iron Works, home to the world's best shipbuilders, Portsmouth Naval Shipyard in Kittery, Saco Defense, Pratt & Whitney, and other companies that contribute to our national defense, it is the skilled Maine workers who help to keep America strong, and I am so proud of their vital contributions. The poet Robert Frost wrote, ``We love the things we love for what they are.'' I love the State of Maine for what it is and its people for who they are, and I wish them all a very happy Valentine's Day. Thank you. I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Madam President, I ask unanimous consent that I be permitted to proceed as in morning business for up to 10 minutes.

Ms. COLLINS. Thank you. (The remarks of Ms. Collins pertaining to the introduction of S. 433 are printed in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Ms. COLLINS. Madam President, the second bill that I have introduced is the Home Health Care Planning Improvement Act. I have introduced this bill with my friend and colleague from Maryland, Senator Cardin. Our legislation will improve the access that Medicare beneficiaries have to home healthcare by allowing physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives to order home health services. All of these healthcare professionals are playing increasingly important roles in the delivery of healthcare, particularly in rural and underserved areas of our Nation, like those represented by the Presiding Officer and the State of Maine. I have learned of far too many cases of seniors experiencing unnecessary delays in accessing home healthcare because a physician was not available to order the care promptly. To avoid these needless delays, it is common sense that other medical professionals who are familiar with a patient's case should be able to order these services. Under current law, however, only physicians are allowed to certify or initiate home healthcare for Medicare patients, even though they may not be as familiar with the patient's case as the nonphysician provider. In some cases, the certifying physician may not even have a relationship with the patient and must rely on the recommendation of the nurse practitioner, physician assistant, clinical nurse specialist, or certified nurse midwife to order the medically necessary home healthcare. That makes no sense whatsoever. In too many cases, these requirements create obstacles, delays, and unnecessary paperwork before home healthcare can be provided. The result can be an unnecessary hospital readmission or other setback for the patient that would not have occurred had the home healthcare been provided promptly. The Home Health Care Planning Improvement Act removes the needless delays in getting Medicare patients the home healthcare they need simply because a physician is not available to sign the form required by law. Again, I would make the point that this physician may not even have a relationship with the senior or other patient who needs the home healthcare. That primary care relationship may be between the patient and a nurse practitioner or a physician assistant, and yet that qualified healthcare professional is unable to order the home care that the patient needs. These two bills will help to ensure the viability and accessibility of home health services now and in the future. By helping patients to avoid much more costly hospital stays and nursing homes, we know that home healthcare saves Medicare, Medicaid, and private insurers' programs millions of dollars each year. At a time when healthcare costs are among our most pressing policy challenges, we should embrace cost- effective solutions like home healthcare. Thank you, Madam President. I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to urge my colleagues to support two bills that I have introduced that will help to preserve and to expand access to home healthcare. I have been a strong supporter of home care since my very first home visit early in my Senate service. This experience gave me the opportunity to meet and to visit with home healthcare patients, where I saw firsthand what a difference highly skilled, caring visiting nurses and other healthcare professionals make in the lives of patients and their families. I have been a passionate advocate of home healthcare ever since. The highly skilled and compassionate care that home health agencies provide in the State of Maine and across the country have enabled millions of our most frail and vulnerable individuals to avoid hospitals and nursing homes and to stay just where they want to be--in the comfort, privacy, and security of their own homes. As we look to the future, home health services will continue to be in high demand. The Census projects that by the year 2030, the proportion of U.S. residents older than age 65 will have nearly doubled from 2010. The Home Health Payment Innovation Act, which I have introduced with Senator Stabenow, Senator Kennedy, Senator Jones, Senator Cassidy, and Senator Paul, preserves access to existing home health services under the Medicare Program, while also providing a pathway for innovative approaches to using these vital services. This bipartisan legislation is endorsed by the National Association of Home Care and Hospice, as well as by the Partnership for Quality Home Healthcare. Our bill would make two key adjustments in home health payment reform provisions that were passed last year. First, it would prevent unwarranted payment rate cuts by basing any behavioral adjustments on actual evidence. Second, it would limit the risk of disruption in care by providing a phase-in for any necessary rate increases or decreases. This phase-in is critical for home health providers, as CMS has already proposed cutting Medicare payment rates in 2020 by more than $1 billion in the first year alone, based purely on assumptions of changes in behavior. Our bill also provides the pathway to expanded use of home healthcare in the Medicare Program without increasing program spending It provides flexibility on waiving what is called the ``homebound requirement'' for home health services when a plan or innovative care delivery model, such as an accountable care organization, determines that providing care to the patient in the home would improve outcomes and reduce spending on patient care. As plans and providers continue to experiment with innovative ways to deliver care and improve value in Medicare spending, allowing them the flexibility to waive this limitation--the homebound limitation--will help to advance the goals of ensuring that care is delivered at the right time, in the right place, and at the right cost.