Susan Collins

Ms. COLLINS

Ms. COLLINS. I am now very pleased to yield to the coauthor of this important bill. Senator Cortez Masto has been an extraordinary member of the Senate Special Committee on Aging. She attends every single hearing, which is amazing, given our schedules, and she contributes so much to the debate and questioning in those hearings. I am delighted to join in this effort with her.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today with my colleague from Nevada, Senator Cortez Masto, to introduce the Building Our Largest Dementia Infrastructure for Alzheimer's--or BOLD--Act. I am pleased that Senator Capito and Senator Kaine are also joining us as original cosponsors. Our legislation would create a public health infrastructure aimed at combating Alzheimer's disease and preserving brain health. Alzheimer's disease is one of the greatest and most under-recognized public health threats of our time. Former Surgeon General David Satcher has said that it is the most under-recognized public health threat of the 21st century. Five and a half million Americans are living with the disease, and that number will soar as our population continues to grow older and lives longer. In addition to the human suffering it causes, Alzheimer's is our Nation's most costly disease. The United States spends more than $259 billion per year, including $175 billion in Medicare and Medicaid costs. The financial impact of this dreadful disease will only continue to grow. In fact, it is estimated that by the year 2050, Alzheimer's will cost our country $1 trillion and afflict 16 million Americans. While Alzheimer's is the only one of our Nation's most deadly diseases without an effective treatment or cure, tantalizing new research suggests that there are steps we can take to promote prevention and improve treatment. The first step we should take is to recognize Alzheimer's as a public health crisis. It is because of public health advancements that we have safe water to drink, vaccines to prevent deadly diseases, interventions to quit smoking, and emergency preparedness tools to save lives. The effort to combat Alzheimer's disease requires a similar unified, national public health effort. That effort is gaining steam. In 1999, when I founded the Bipartisan Congressional Task Force on Alzheimer's, there was virtually no focus in Washington on this devastating disease. In fact, people were afraid to even refer to the disease, just as years ago people did not talk about cancer. Seven years ago, I coauthored with then-Senator Evan Bayh the bipartisan National Alzheimer's Project Act, which set the primary goal of preventing and effectively treating the disease by the year 2025. That bill created an expert council, which has calculated that $2 billion in Federal funding per year is needed to achieve that goal. On the Appropriations Committee, I have worked hard with Senator Blunt and others to turn the words of that recommendation into action. The funding bill for this year provides another $2 billion increase for the National Institutes of Health, and that includes a $414 million increase for Alzheimer's research--the largest in history. That brings the total for Alzheimer's research to $1.8 billion--well within reach of the $2 billion goal, which the experts tell us is necessary for breakthroughs. While this research is moving forward, we must put into practice what we know and enhance the quality of care and support for those living with Alzheimer's and their families. In March, the Aging Committee, which I chair, held a hearing on the arc of Alzheimer's, from preventing cognitive decline to ensuring quality care for those living with dementia. The hearing shed light on the fact that although we do not yet know how to prevent Alzheimer's, we are advancing in our understanding of the disease. Its progression does not happen overnight; it is preceded by years and perhaps decades of changes in the brain and a continuum of changes in behavior, including cognitive decline. A growing body of evidence suggests that lifestyle factors, such as regular physical activity and attention to heart health, may reduce the risk of cognitive decline. There is so much we have yet to know. Alzheimer's is a public issue for those living with the disease, for those caring for their loved ones with the disease, for all of us as taxpayers, and for those who know that our brain is our most precious resource. Alzheimer's exacts a tremendous personal and economic toll on families and communities. More than 40 million Americans know all too well the compassion, commitment, and endurance that it takes to be a caregiver of a loved one facing a chronic disease like Alzheimer's. The legislation we are introducing today would apply a new public health approach to Alzheimer's disease. It would establish Centers of Excellence in Public Health Practice dedicated to promoting effective Alzheimer's disease management and caregiving interventions, as well as educating the public on the disease, cognitive decline, and brain health. The Centers for Disease Control and Prevention is already doing tremendous work to combat Alzheimer's within the Public Health Road Map of the Healthy Brain Initiative. This legislation would create centers of excellence across the country to implement the CDC's Public Health Road Map. The centers would take a number of key steps against Alzheimer's. They would work to support early detection and diagnosis, lessen the risk of avoidable hospitalizations, reduce the risk of cognitive decline, enhance support to meet the needs of caregivers, reduce health disparities, and support care planning and management for those with the disease. The Centers' activities would support health and social services professionals as well as families and communities. In addition to establishing the Centers of Excellence in Public Health Practice, this bill would spread the opportunity for communities across America to create the necessary core capacity to combat Alzheimer's and to enhance existing efforts in this regard. The legislation would establish and distribute cooperative agreements to public health departments to support systems change, communications, and programmatic interventions. These agreements would also support the actions in the CDC Healthy Brain Initiative's Public Health Roadmap. Finally, at the heart of public health is data. This legislation would direct the CDC to collect data on cognitive decline, cognitive impairment, caregiving, and health disparities within its current systems. The bill would also create cooperative agreements for the analysis and reporting of data to ensure that the results are disseminated to the public and are used, ultimately, to improve brain health. For far too long, we have viewed Alzheimer's disease as an aging issue that plagues our seniors today and threatens to affect many more tomorrow. In fact, the disease is far more than that. It is a public health issue with a course that we can change. If we do not take action, both in this new public health approach and by continuing to build on the research, this disease will bankrupt the Medicare and the Medicaid Programs. We cannot afford to spend over $1 trillion in the year 2050 on just this one disease. We cannot afford to lose 16 million Americans by that year to this devastating disease. We cannot afford to allow the heartache and devastation of this disease to affect more and more American families. There are steps that we can take today to prevent cognitive decline and to improve the lives of those who are living with Alzheimer's and the lives of their caregivers. This public health approach is not only empowering, but it is key to avoiding the terrible impacts that I have outlined. After decades of expanding much needed biomedical research in Alzheimer's, we are ready for the next step--to translate research into policy. The BOLD bill would create a new, enlightened public policy out of promising research by creating the first ever national public health infrastructure for Alzheimer's disease. I am pleased to say that the bipartisan bill that the Senator from Nevada and I have introduced, with our colleagues from Virginia and West Virginia, is endorsed by the Alzheimer's Association, the Alzheimer's Impact Movement, the National Association of Chronic Disease Directors, and the National Association of Counties. I ask unanimous consent that their letters of support be printed in the Record at the conclusion of my remarks. I urge my colleagues to support this critical and bipartisan legislation.

Ms. COLLINS. I am now very pleased to yield to the coauthor of this important bill. Senator Cortez Masto has been an extraordinary member of the Senate Special Committee on Aging. She attends every single hearing, which is amazing, given our schedules, and she contributes so much to the debate and questioning in those hearings. I am delighted to join in this effort with her.

Mr. COLLINS

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

Mr. COLLINS

Mr. COLLINS. Mr. President, today I rise with my colleague from New Mexico, Senator Heinrich, to discuss the Securing America's Voting Equipment Act of 2017, or the SAVE Act, which we introduced earlier this week. I know that you are well aware that the Senate Intelligence Committee has been conducting an in-depth investigation into attempts by the Russians to interfere with our elections last fall. What we have found is that the Russians' active measures preceded last fall, and they continue to this very day. We have an election coming up in November of this year and a major election next year, and both Senator Heinrich and I believe that it is so important that we act to assist States in protecting the integrity of their voting systems. Our bill seeks to facilitate information sharing on the threats posed to State election systems by foreign adversaries, to provide guidance to States on how to protect their systems against nefarious activity, and, for States that choose to do so, to allow them to access some Federal grant money to implement best practices to protect their systems. Let me be clear that I know of no evidence to date that actual vote tabulations were manipulated in any State in the elections last fall. Nevertheless, as early as the summer of 2016, the FBI discovered that foreign-based hackers had gained access to voter registration databases in two States. The Department of Homeland Security confirmed that Russia-linked actors attempted to access voter rolls and registration data in those two States. More alarming is that further investigation revealed that many more States than just two were ultimately found to have had their voting systems probed by the Russians. The Department of Homeland Security notified election officials in a total of 21 States that their election systems had been targeted by Russian Government-linked hackers. If voter rolls were altered or voting equipment tampered with, a compromise of these systems could open the door to voter disenfranchisement and would undermine public confidence and the integrity of our free and fair elections--a bedrock principle of our democracy. In response to these alarming threats, the SAVE Act would assist States in hardening their systems. It does not aim to tell States how to conduct their elections. The responsibility for conducting elections would remain with each State, as has been our country's tradition since its founding. State and local election officials alone, however, cannot be expected to defend against cyber attacks from foreign adversaries. That is why our bill seeks to bring to bear the unique authorities, capabilities, and resources that the Federal Government can offer to State and local election officials. Let me briefly describe the Heinrich-Collins bill. First, our bill would codify a decision made by both Secretaries of Homeland Security, Jeh Johnson and John Kelly, to designate election systems as ``critical infrastructure.'' This designation allows DHS to prioritize providing assistance to election jurisdictions and to establish formal mechanisms to enhance information sharing and collaboration within the electoral sector. More than 30 States took advantage of DHS's offer of assistance last year. Our bill also addresses a shortcoming that I raised during a hearing before the Senate Intelligence Committee in June regarding foreign efforts to compromise American voting systems. During this hearing, we learned that not a single secretary of state had been cleared to receive classified information before the 2016 election or in the 6 months since voting systems had been declared as critical infrastructure. This delay is truly inexplicable. We have to be able to share this critical information in order for State election officials to take the necessary steps to safeguard their systems. Our bill addresses this limitation on information sharing by authorizing the Director of National Intelligence to provide security clearances to designated chief election officials in each State. That way, the intelligence community can share appropriate classified information with States regarding foreign threats targeting election systems. Our bill also mandates that DHS conduct a threat assessment on physical and electronic risks to voting systems. Then, in collaboration with stakeholders, the Department will develop best practices to address those risks. A few simple measures can make a big difference. Best practices like relying upon paper ballots, as the State of Maine currently does, and conducting postelection audits to ensure that the tabulation by vote- counting machines matches the results of the paper ballots can bolster both resilience and public confidence in the integrity of the voting process. Finally, our bill creates a Federal grant program available for States to upgrade and safeguard the integrity of their systems by implementing the best practices that have been identified. Last year, the Russian Government sought to disrupt our democracy by threatening the integrity of our elections. It is incumbent upon Congress to assist the States and those charged with conducting elections at the local, State, and Federal level to protect them from foreign interference. Our bill would do just that. I am very pleased to work with the leader on this effort, Senator Heinrich, and I would urge all of our colleagues to join Senator Heinrich and me in sponsoring this bill. Thank you, Mr. President.

Ms. COLLINS

Ms. COLLINS. Mr. President, throughout our Nation's history, young Americans have left the comfort and security of home in order to preserve our freedom and to extend the blessings of freedom to others. We set aside Veterans Day to express our gratitude. One such veteran is Mr. Richard Lincoln of Wayne, ME. Although the story of his service in Italy during World War II is extraordinary, the virtues of courage, sacrifice, and devotion to duty it demonstrates describe the character of American patriots in all places and at all times. Now 91 years of age, Mr. Lincoln entered the U.S. Army in 1943 when he was just 17. He served with the legendary 88th Infantry Division, the first all-draftee division to serve in combat during the war. The 88th, known as the Fighting Blue Devils, proved that with rigorous training, able leadership, and unflagging determination, peace-loving Americans could stand up to a battle-hardened, militaristic enemy. The 88th played a key role at the Battle of Anzio, the long, costly, and critically important amphibious landing on the Italian coast in January of 1944 that eventually led to the liberation of Rome. Mr. Lincoln served as a first scout, an extremely dangerous assignment in a forward position under constant fire, to locate enemy artillery positions. When the Allies liberated Rome on June 4, 1944, the all- draftee 88th was the first division to enter the city. It was Mr. Lincoln's 18th birthday. He later was awarded the Bronze Star for his heroism during that grueling campaign. Victory came at a steep price. Between the Battle of Anzio and the German surrender in May of 1945, the Fighting Blue Devils spent 344 days in combat, with nearly 3,000 killed and more than 9,200 wounded. After returning home, Mr. Lincoln raised a family, served his community, and never forgot his comrades. Until he suffered a stroke that hampered his mobility, he marched in 58 consecutive Memorial Day parades in his hometown. He never rode in a ceremonial car; he always marched. In a speech to the Association of the U.S. Army on October 9, Defense Secretary James Mattis discussed the serious current threats to peace and security facing our Nation and the world. He told the story of Richard Lincoln to underscore his point that Americans are always willing and able to meet any challenge. On October 14, family and friends gathered around Mr. Lincoln at the Maine Veterans' Home in Augusta, where he was presented with a personal letter from Secretary Mattis and a book on the Battle of Anzio, inscribed by both Secretary Mattis and former Defense Secretary William Cohen, Maine's former Senator. Secretary Mattis's handwritten note to Mr. Lincoln includes these words: ``You have the respect and affection of today's military. You and your brothers-in-arms are the pride of our country.'' I am honored to join Secretary Mattis and all grateful Americans in thanking Mr. Richard Lincoln and all of the men and women who serve our country.

Ms. COLLINS

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

Ms. COLLINS. Mr. President, I am pleased to join with my colleague and friend Senator Cantwell to discuss a new GAO report on the cost of climate change. As our Nation begins to recover and rebuild from the devastation of Hurricanes Harvey, Irma, Maria, and Nate, as well as from the wildfires that are sweeping across the West, we cannot ignore the impact of climate change on our public health, our environment, and our economy. Most of the past focus of the impact of climate change has been on public health and the environment--important to be sure--but there has not been nearly enough analysis of the consequences for our economy and for the Federal budget, in particular. In 2007, I first became interested in the cost of climate change when Senator Joe Lieberman and I headed the Homeland Security and Governmental Affairs Committee. We commissioned a report by the GAO to look at the fiscal risk of climate change for both the Flood Insurance Program and the Federal Crop Insurance Program. Our request was an attempt to sound the alarm that there were very significant fiscal consequences to the Federal Government for failing to take action. The report found that the Department of Agriculture and the Department of Homeland Security can and should do better jobs of assessing the fiscal impacts that unchecked global warming will have on the taxpayer-funded Federal Crop Insurance Corporation and the National Flood Insurance Program. In addition, the report revealed that insurance programs had not developed a long-term strategy to deal with the effects of global climate change, putting them far behind private insurers that have incorporated these risks into their overall assessments. According to a 2014 GAO report, the Federal Emergency Management Agency, FEMA, and the Risk Management Agency commissioned some climate change studies in order to better prepare for potential climate effects. To build upon this important work, 2 years ago, Senator Cantwell and I asked the GAO to conduct a comprehensive study on the costs and risks to the U.S. Government from climate change and to evaluate policy actions that could be taken by the Federal Government to address these financial consequences. After 2 years of indepth, nonpartisan analysis, the GAO publicly released the results of its findings this morning, and they are astonishing. The GAO estimates that, by the year 2039, climate change will cost U.S. taxpayers more than $1 trillion. In just this past year alone, the economic losses will, almost certainly, exceed $300 billion. In Maine, our economy is inextricably linked to the environment. We are experiencing a real change in sea life, which has serious implications for the livelihoods of many people in our State, including those who work in our iconic lobster industry. With warming waters, lobsters are migrating into deeper waters, which poses more risks to our lobstermen and lobersterwomen. Additionally, Casco Bay, which is where Portland is located, has experienced an invasion of green crabs, which are not native to Maine and are devastating some of our other sea life population. This change in the Maine waters could be detrimental to our State's economy. I am also very concerned about the excessively high rate of asthma in my State. According to public health physicians, this is due to air pollution that comes into our State. Now, Maine is not a coal-burning State, but the emissions from other States are causing the changes in sea life and are also contributing to the public health epidemic of a very high rate of asthma. The fact is, Maine is located at the end of our Nation's tailpipe, and we get emissions blown in from other States, which affects our economy and the health of our citizens. The Federal Government cannot afford the billions of dollars in additional funding that is going to be needed if we do not take into account and start acting on the serious consequences of climate change. Spending more than $300 billion each year, in response to severe weather events that are connected to warming waters and producing stronger hurricanes, is simply not a solution. I hope the release of this new GAO analysis will encourage all of us to think more broadly about this issue, take a harder look at the economic consequences of climate change, and then use this analysis to inform Federal policy. We need to support practices and policies that promote resilience and reduce risk and exposure to weather-related losses for the Federal Government, for States, and for local communities. I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, there has been a great deal of discussion about what the appropriate tax rate should be for large corporations. That is important because we want them to create jobs right here in America and not overseas. Let us not forget the true engine of our economy, and that is our small businesses. We need to provide true tax relief to our small businesses, the job creators in our economy. I rise to discuss my amendment, which is No. 1151, which would create a deficit neutral reserve fund to support small business tax relief while preventing wealthy taxpayers from sheltering income from taxation at the appropriate rate. It would send the message that through tax reform, we can help our small businesses thrive and be the engine of job creation and economic growth in communities all across our great country. Small businesses make an out-sized contribution to our economy. According to the Small Business Administration, small businesses employ nearly half of all workers and generate two out of three net new jobs each year. Nationwide, they generate nearly half of our private, nonfarm GDP and one-third of our Nation's export value. The State of Maine is truly a small business State, with nearly 300,000 of our residents employed by our more than 141,000 small businesses. That is nearly 60 percent of our workforce. Most small businesses are organized as so-called passthrough entities, which means that their profits are passed on to their owners and reported on individual income tax returns. Under current law, this income is taxed at individual rates, which can reach nearly 40 percent at the Federal level and can be significantly higher than the corporate tax rates that larger firms face. Given the administrative costs and these high tax rates, small businesses are forced to devote more resources to compliance and tax payments and fewer resources to creating good jobs and investing in their local communities. It is no wonder that a recent survey by the National Federation of Independent Business found that concerns about Federal taxes on small businesses ranked third on the list of the top 10 concerns. With tax reform, we have the opportunity to fix this problem. Of course, we should aim to do so in a way that prevents people from abusing rates intended for small business passthrough income. My amendment would allow for changes to Federal tax laws and to provide relief to small businesses, while not allowing wealthy individuals to shelter their income from taxation at the appropriate rate. I urge my colleagues to support it.

Ms. COLLINS. Mr. President, there has been a great deal of discussion about what the appropriate tax rate should be for large corporations-- so-called C corps. That certainly is important because we want to make sure that those large businesses are creating jobs here in the United States and not overseas in order to take advantage of lower tax rates. But let us not forget the importance of providing tax relief for our small businesses. It is our small businesses that create the majority of new jobs in this country and that are really the economic engines for so many of our communities. Small businesses make an outsized contribution to our Nation's economy. According to the Small Business Administration, they employ nearly half of all workers and generate two out of three net new jobs each year. Nationwide, small businesses generate nearly half of our private nonfarm GDP and one-third of our Nation's export value. My State of Maine is truly a State of small businesses. Sixty percent of our workforce--that is, nearly 300,000 of our residents--are employed by more than 141,000 small businesses. I spoke at length earlier about the amendment, and I know that the chairman of the Budget Committee has a lot of work to do tonight. So I won't repeat the comments I made earlier. Let me just say that my amendment would create a deficit-neutral reserve fund to support small business tax relief while preventing wealthy taxpayers from sheltering income from taxation at the appropriate rate. We want to have some guide rails. But it is important that we recognize that it is the small businesses of America that are the true job creators in so many of our communities. I urge our colleagues to support the amendment. Mr. President, I request a voice vote.

Ms. COLLINS. Thank you, Mr. President. I thank the chairman of the Budget Committee for his cooperation and support as well.

Ms. COLLINS

Ms. COLLINS. Mr. President, I wish to express my strong support for the confirmation of Halsey Frank to serve as the U.S. Attorney for the District of Maine. Mr. Frank has 30 years of experience working for the U.S. Department of Justice in Washington, DC, and in Maine, and he is highly qualified to assume this crucial law enforcement position. I thank the Senate for swiftly confirming him. Mr. Frank is an intelligent, highly competent, experienced law enforcement professional. Mr. Frank has served as an Assistant U.S. Attorney for Maine for the past 17 years, during which he has shown an indepth knowledge of our country's criminal justice system and significant experience in both criminal and civil law. In this role, he has prosecuted Federal crimes related to fraud, drugs, white-collar offense, violence, civil rights, and environmental violations. He has defended the United States in civil cases and handled numerous appeals. Prior to his current post, Mr. Frank was an Assistant U.S. Attorney for the District of Columbia, one of the country's largest offices, where he worked on a wide range of civil and criminal matters. He is presently a resident of Portland, ME, and a graduate of Wesleyan University and Boston University School of Law. Based on his demonstrated proficiency and character, I have every confidence that Mr. Frank will successfully lead and coordinate local and Federal law enforcement activities in Maine to faithfully uphold our Nation's laws and ensure public safety and order. Throughout his long and distinguished career, Mr. Frank has shown a strong commitment to public service, and I am confident that he will serve the State of Maine and our Nation very well.

Ms. COLLINS

Ms. COLLINS. Mr. President, I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, the cost of health insurance has been a major problem with the Affordable Care Act and with many of the bills which have been advanced to repeal and replace this law. I rise to introduce the Lower Premiums Through Reinsurance Act of 2017. This bill would provide States with the flexibility and support they need to create State-based reinsurance programs for their individual health insurance markets in order to lower premiums while ensuring continued coverage for people with preexisting conditions. I am very pleased to be joined by my colleague and friend Senator Bill Nelson in introducing this bill. Senator Nelson is a former insurance commissioner who comes to this issue with a wealth of knowledge dating to his experience with Florida's innovative homeowners' reinsurance program, developed in the 1990s in the wake of Hurricane Andrew. For my own part, I spent 5 years in State government overseeing a department which included the Bureau of Insurance. Over the past 2 weeks, the Senate HELP Committee, on which I am privileged to serve, completed a round of hearings under the able leadership of Chairman Lamar Alexander and Ranking Member Patty Murray. They looked at the steps we could take in the near term to stabilize the individual market and help to bring down rates. Reinsurance was frequently mentioned as an option Congress should consider and adopt. Insurance commissioners from Alaska, Pennsylvania, South Carolina, Tennessee, and Washington State all spoke positively of its benefits, as did the five Governors who testified before the committee--three Republicans and two Democrats. Although the witnesses presented different views on how a reinsurance mechanism might be structured, they were in broad agreement that reinsurance funding would help stabilize the markets and lower premiums. The National Association of Insurance Commissioners has recommended that Congress provide reinsurance funding of $15 billion annually to help cover high-cost claims in the individual market. We realize, however, we are living in very tight budget times, and there is an understandable reluctance among many Members to provide that level of Federal funding. We believe the ACA's section 1332's flowthrough mechanism can effectively leverage that level of funding with a much smaller contribution of Federal dollars. Our bill, therefore, would appropriate $2.25 billion per year in 2018 and 2019, which should be sufficient to leverage $15 billion in total reinsurance funding annually, based on the ratios in Alaska's recently approved 1332 waiver. As Alaska's insurance commissioner told the HELP Committee, next year her State will be able to fund its $55 million reinsurance program with just $6.6 million of its own money--15 percent of the total. The remaining $48.4 million will be provided in Federal flowthrough funding that matches the savings to the Federal Government resulting from the reinsurance program. Let me explain why there would be savings for the Federal Government. If we are able to reduce the cost of premiums, then the Federal Government will be paying less by way of subsidies to individuals who qualify for those subsidies because they make 400 percent or less of the Federal poverty level. The bill we are introducing today would allow States to quickly stand up their own reinsurance programs through the Affordable Care Act's section 1332 waiver process. Broadly speaking, the bill would create a menu of options States could use to design reinsurance programs, which in turn would be eligible for Federal seed money grants. States may also obviously add funds from other sources to the mix. States that want to set up their own reinsurance pools quickly could do so under our bill by using one of three options designed for expedited review: first, by demonstrating that their program is an ``invisible high-risk pool'' along the lines of the Maine and Alaska models, which I will describe in more detail in a moment; second, by showing that their program fits within the parameters of ObamaCare's ``transitional insurance program,'' which expired at the end of last year; and third, by submitting what I would call a ``me too'' application based on another State's program that has already received approval. I wish to take a moment to explain why our legislation provides expedited review for different reinsurance pool designs. First, many of the witnesses who testified before the HELP Committee made the point that States would have difficulty quickly coming up with their own design. We acknowledge that, and that is why we provided expedited review for a pool based on the transitional ACA reinsurance program previously in effect and with which States are already familiar. Second, we know from the experience of the States of Maine and Alaska how effective invisible reinsurance pools can be. Alaska's invisible pool reduced a projected 40-percent rate increase to just 7 percent this year and is expected to contribute to a 20-percent decline in premiums next year. Maine saw similar results in its program, the Maine Guaranteed Access Reinsurance Association. The Maine program, which was in operation from 2012 until the end of 2013, covered approximately 3,600 insured individuals, at a cost of approximately $12,500 per person, per year, and reduced rates in the individual market by about 20 percent on average. It is important for us to keep in mind that the individual market is where people who do not have employer-sponsored insurance have to go to buy their insurance. If they make 400 percent or less of the Federal poverty level, they get premium tax credits--subsidies, in other words--from the Federal Government to assist them with the cost. But if they make a dollar over 400 percent of the Federal poverty level, they lose that assistance altogether. Another problem that is in the ACA is those cliffs, which make no sense whatsoever and really penalize individuals who may work in the trades, such as electricians and plumbers, who don't know for certain what their income is going to be and can face an unexpected bill where they have to pay back the entire subsidy. But there are others who make above 400 percent who knew it and didn't qualify for the subsidy, but they still have to purchase in the individual market. I think that should be revisited, but that is a speech for another day. My point is that they would benefit greatly from a 20-percent reduction in the premiums they pay. That was our experience in Maine. On average there was a 20-percent reduction in premiums when the reinsurance pool was in effect. The reinsurance pool even generated a surplus of $5 billion during its 18 months of operation. The Maine pool was successful for several reasons. First, risks were ceded up front so insurers could not wait until a policyholder developed an unexpected serious health condition to decide who was going to be in the high-risk pool and who was not. The rules also required policies for individuals who suffered from certain high-risk conditions to be automatically ceded to the pool on enrollment. I note that when an insurer made the decision to cede to the pool the risk for a particular policyholder, or if it was an automatic ceding, 90 percent of the premiums from that policyholder went to the reinsurance pool to help finance it. Second--and this is important--the program was invisible to both individuals who were insured through it and to healthcare providers. Individuals were covered seamlessly and enjoyed the same benefits as nonpool enrollees. Likewise, healthcare providers did not know whose policy had been ceded to the pool. Third--and also very important--Maine's program operated with the full set of consumer protection guardrails set by the ACA, including guaranteed issue, guaranteed renewability, and prohibitions against taking preexisting conditions or health status into account in issuing policies or setting rates. Fourth, the Maine program was designed to provide true reinsurance. Insurers paid the first $7,500 in costs, plus 10 percent of the next $25,000. After that threshold, the pool picked up the rest of the costs. Finally, Maine's program was backed by a stable funding source. In addition to receiving 90 percent of the premiums for ceded policies, it also received funding that was assessed at a rate of $4 per person, per month, on all healthcare policies. While Alaska's reinsurance program differs from Maine's in some respects, the success of both models shows the promise and proves the promise of invisible reinsurance pools, and that is why our bill includes invisible reinsurance pools as an option for expedited review and approval. Open enrollment in the ACA exchanges begins November 1, just about 6 weeks from now. In just days, CMS is expected to finalize the premiums insurers will charge in the ACA exchanges next year. While I personally remain ever hopeful that a bipartisan agreement on a targeted, consensus approach to stabilizing the markets and reducing premiums can still be reached, clearly, we have very little time. Beyond providing cost-sharing reduction funding, there is no step that would be more powerful in stabilizing markets and reducing premiums than providing reinsurance. This Chamber is deeply divided on what to do on healthcare policy, but surely we ought to be able to come together and build on the good work that the leaders of the HELP Committee have done--work that more than 60 Senators have witnessed and participated in by attending coffees that Senator Lamar Alexander and Senator Patty Murray have sponsored with our witnesses and by participating in the HELP Committee hearings. They have worked hard to produce a bill that would really make a difference. The bill Senator Nelson and I are introducing today helps to fill out the reinsurance provisions that I know from attending each of those hearings have been widely supported by virtually every witness who testified before us. It would enable States to stand up their own reinsurance program simply and quickly, and it would reduce the costs of the Federal Government if we used the section 1332 flow-through mechanism far below what would otherwise be required. Most important of all, it is something that we could do right off, along with the cost- saving reductions, which help low-income people with their copays and their deductibles--their out-of-pocket costs. Those two steps are actions that we could take right now to help moderate premium increases that would otherwise occur and that would be of real benefit to anyone who is in the individual market.

Ms. COLLINS

Ms. COLLINS. Mr. President, the cost of health insurance has been a major problem with the Affordable Care Act and with many of the bills which have been advanced to repeal and replace this law. I rise to introduce the Lower Premiums Through Reinsurance Act of 2017. This bill would provide States with the flexibility and support they need to create State-based reinsurance programs for their individual health insurance markets in order to lower premiums while ensuring continued coverage for people with preexisting conditions. I am very pleased to be joined by my colleague and friend Senator Bill Nelson in introducing this bill. Senator Nelson is a former insurance commissioner who comes to this issue with a wealth of knowledge dating to his experience with Florida's innovative homeowners' reinsurance program, developed in the 1990s in the wake of Hurricane Andrew. For my own part, I spent 5 years in State government overseeing a department which included the Bureau of Insurance. Over the past 2 weeks, the Senate HELP Committee, on which I am privileged to serve, completed a round of hearings under the able leadership of Chairman Lamar Alexander and Ranking Member Patty Murray. They looked at the steps we could take in the near term to stabilize the individual market and help to bring down rates. Reinsurance was frequently mentioned as an option Congress should consider and adopt. Insurance commissioners from Alaska, Pennsylvania, South Carolina, Tennessee, and Washington State all spoke positively of its benefits, as did the five Governors who testified before the committee--three Republicans and two Democrats. Although the witnesses presented different views on how a reinsurance mechanism might be structured, they were in broad agreement that reinsurance funding would help stabilize the markets and lower premiums. The National Association of Insurance Commissioners has recommended that Congress provide reinsurance funding of $15 billion annually to help cover high-cost claims in the individual market. We realize, however, we are living in very tight budget times, and there is an understandable reluctance among many Members to provide that level of Federal funding. We believe the ACA's section 1332's flowthrough mechanism can effectively leverage that level of funding with a much smaller contribution of Federal dollars. Our bill, therefore, would appropriate $2.25 billion per year in 2018 and 2019, which should be sufficient to leverage $15 billion in total reinsurance funding annually, based on the ratios in Alaska's recently approved 1332 waiver. As Alaska's insurance commissioner told the HELP Committee, next year her State will be able to fund its $55 million reinsurance program with just $6.6 million of its own money--15 percent of the total. The remaining $48.4 million will be provided in Federal flowthrough funding that matches the savings to the Federal Government resulting from the reinsurance program. Let me explain why there would be savings for the Federal Government. If we are able to reduce the cost of premiums, then the Federal Government will be paying less by way of subsidies to individuals who qualify for those subsidies because they make 400 percent or less of the Federal poverty level. The bill we are introducing today would allow States to quickly stand up their own reinsurance programs through the Affordable Care Act's section 1332 waiver process. Broadly speaking, the bill would create a menu of options States could use to design reinsurance programs, which in turn would be eligible for Federal seed money grants. States may also obviously add funds from other sources to the mix. States that want to set up their own reinsurance pools quickly could do so under our bill by using one of three options designed for expedited review: first, by demonstrating that their program is an ``invisible high-risk pool'' along the lines of the Maine and Alaska models, which I will describe in more detail in a moment; second, by showing that their program fits within the parameters of ObamaCare's ``transitional insurance program,'' which expired at the end of last year; and third, by submitting what I would call a ``me too'' application based on another State's program that has already received approval. I wish to take a moment to explain why our legislation provides expedited review for different reinsurance pool designs. First, many of the witnesses who testified before the HELP Committee made the point that States would have difficulty quickly coming up with their own design. We acknowledge that, and that is why we provided expedited review for a pool based on the transitional ACA reinsurance program previously in effect and with which States are already familiar. Second, we know from the experience of the States of Maine and Alaska how effective invisible reinsurance pools can be. Alaska's invisible pool reduced a projected 40-percent rate increase to just 7 percent this year and is expected to contribute to a 20-percent decline in premiums next year. Maine saw similar results in its program, the Maine Guaranteed Access Reinsurance Association. The Maine program, which was in operation from 2012 until the end of 2013, covered approximately 3,600 insured individuals, at a cost of approximately $12,500 per person, per year, and reduced rates in the individual market by about 20 percent on average. It is important for us to keep in mind that the individual market is where people who do not have employer-sponsored insurance have to go to buy their insurance. If they make 400 percent or less of the Federal poverty level, they get premium tax credits--subsidies, in other words--from the Federal Government to assist them with the cost. But if they make a dollar over 400 percent of the Federal poverty level, they lose that assistance altogether. Another problem that is in the ACA is those cliffs, which make no sense whatsoever and really penalize individuals who may work in the trades, such as electricians and plumbers, who don't know for certain what their income is going to be and can face an unexpected bill where they have to pay back the entire subsidy. But there are others who make above 400 percent who knew it and didn't qualify for the subsidy, but they still have to purchase in the individual market. I think that should be revisited, but that is a speech for another day. My point is that they would benefit greatly from a 20-percent reduction in the premiums they pay. That was our experience in Maine. On average there was a 20-percent reduction in premiums when the reinsurance pool was in effect. The reinsurance pool even generated a surplus of $5 billion during its 18 months of operation. The Maine pool was successful for several reasons. First, risks were ceded up front so insurers could not wait until a policyholder developed an unexpected serious health condition to decide who was going to be in the high-risk pool and who was not. The rules also required policies for individuals who suffered from certain high-risk conditions to be automatically ceded to the pool on enrollment. I note that when an insurer made the decision to cede to the pool the risk for a particular policyholder, or if it was an automatic ceding, 90 percent of the premiums from that policyholder went to the reinsurance pool to help finance it. Second--and this is important--the program was invisible to both individuals who were insured through it and to healthcare providers. Individuals were covered seamlessly and enjoyed the same benefits as nonpool enrollees. Likewise, healthcare providers did not know whose policy had been ceded to the pool. Third--and also very important--Maine's program operated with the full set of consumer protection guardrails set by the ACA, including guaranteed issue, guaranteed renewability, and prohibitions against taking preexisting conditions or health status into account in issuing policies or setting rates. Fourth, the Maine program was designed to provide true reinsurance. Insurers paid the first $7,500 in costs, plus 10 percent of the next $25,000. After that threshold, the pool picked up the rest of the costs. Finally, Maine's program was backed by a stable funding source. In addition to receiving 90 percent of the premiums for ceded policies, it also received funding that was assessed at a rate of $4 per person, per month, on all healthcare policies. While Alaska's reinsurance program differs from Maine's in some respects, the success of both models shows the promise and proves the promise of invisible reinsurance pools, and that is why our bill includes invisible reinsurance pools as an option for expedited review and approval. Open enrollment in the ACA exchanges begins November 1, just about 6 weeks from now. In just days, CMS is expected to finalize the premiums insurers will charge in the ACA exchanges next year. While I personally remain ever hopeful that a bipartisan agreement on a targeted, consensus approach to stabilizing the markets and reducing premiums can still be reached, clearly, we have very little time. Beyond providing cost-sharing reduction funding, there is no step that would be more powerful in stabilizing markets and reducing premiums than providing reinsurance. This Chamber is deeply divided on what to do on healthcare policy, but surely we ought to be able to come together and build on the good work that the leaders of the HELP Committee have done--work that more than 60 Senators have witnessed and participated in by attending coffees that Senator Lamar Alexander and Senator Patty Murray have sponsored with our witnesses and by participating in the HELP Committee hearings. They have worked hard to produce a bill that would really make a difference. The bill Senator Nelson and I are introducing today helps to fill out the reinsurance provisions that I know from attending each of those hearings have been widely supported by virtually every witness who testified before us. It would enable States to stand up their own reinsurance program simply and quickly, and it would reduce the costs of the Federal Government if we used the section 1332 flow-through mechanism far below what would otherwise be required. Most important of all, it is something that we could do right off, along with the cost- saving reductions, which help low-income people with their copays and their deductibles--their out-of-pocket costs. Those two steps are actions that we could take right now to help moderate premium increases that would otherwise occur and that would be of real benefit to anyone who is in the individual market.

Ms. COLLINS

Ms. COLLINS. Mr. President, 30 years ago, Caribou, ME, served as the proving ground upon which America has built a nationwide system of community-based outpatient clinics that delivers much improved access to medical services for America's rural veterans. The anniversary celebration on September 7 recognizes the determined commitment of Cary Medical Center, the Department of Veterans Affairs, local veterans, and an entire community that transformed healthcare for the men and women who defend our Nation and our freedom. Our Nation's first CBOC held its formal opening in Caribou, my hometown, on June 13, 1987. The impact was immediate--no longer would the veterans of Aroostook County have to endure an up-to 10-hour round trip to the nearest VA hospital for medical exams or to meet with a VA physician. Today the Caribou CBOC treats a veteran population of 3,500 men and women who served our country, with more than 9,000 care visits annually. The pioneering work done in Caribou led to benefits for America's 3.5 million rural veterans who now receive care closer to home at more than 950 CBOCs throughout the country. The story of the great advancement in healthcare began 8 years before that formal opening, when seven Aroostook County veterans devoted themselves to the mission of improving access to critical healthcare services in this region. The original members of Aroostook County Veterans Medical Facility Research and Development, Inc.--Percy Thibeault, Meo Bosse, John Rowe, Ray Guerrette, Wesley Adams, Walter Corey, and Leonard Woods, Jr.--faced many obstacles along the way and overcame them all. These patriots exemplified a special quality of the American veteran: they continued to contribute long after their service in uniform was done. That great mission would not have been accomplished without the dedication and expertise of Cary Medical Center and the involvement of Bill Flagg. As the American Hospital Association noted in its Award of Honor presentation in 2011, Cary Medical Center has made exemplary contributions in the critical area of veterans' healthcare and has established a national model. In addition to playing a vital role in establishing the VA's first CBOC in Caribou, Cary Medical Center was one of five pilot sites for the highly successful Access Received Closer to Home, or ARCH, program. Maine's program, led by Kris Doody and a tremendous team of professionals, has been called a standard bearer for how to provide rural veterans access to the care they need in their communities. Before he became VA Secretary, I had the opportunity to join Dr. David Shulkin on a visit to both the Caribou CBOC and Cary Medical Center, where he praised the innovative work being done being done to provide veterans with top quality healthcare close to where they live. Veterans in Aroostook County and throughout America are grateful for Cary's leadership. Our State has long history as a leader in working to expand and improve veterans' access to quality healthcare. One year ago, we celebrated the 150th anniversary of the very first national hospital for veterans: Togus, in Maine, which opened its doors in November of 1866. In 2014, we celebrated the opening of the women's clinic at Togus in recognition of the fact that more and more women serve our country in uniform. I am determined to continue those early efforts on behalf of our rural veterans. The recent enactment of the VA Choice and Quality Employment Act of 2017, which I cosponsored with my Maine colleague Senator Angus King, is an important step toward keeping this obligation to our veterans, both urban and rural. As well as providing additional funding for healthcare access in the community, the legislation authorizes 28 leases for VA facilities across the country, including a much-needed CBOC in Portland. The result of this crucial legislation is increased access to quality care for all who have defended our freedom. Maine is home to more than 125,000 veterans. To put that in perspective, Maine has more veterans per capita than all but two of the other States in the country. We are proud of our State's contributions to protecting our Nation and of Maine's impressive record in caring for our veterans. President Abraham Lincoln signed the legislation establishing a national network of hospitals for Civil War veterans on March 3, 1865. The very next day, he concluded his second inaugural address with a commitment ``to bind up our nation's wounds, to care for him who shall have borne the battle. . . .'' We must uphold that commitment. Our veterans have sacrificed so much for our country. We owe them all that we can do to ensure they receive the best care possible. The veterans and grateful citizens who fought for the Caribou CBOC knew that, and, on this 30th anniversary, we honor their dedication by carrying on their work.

Ms. COLLINS

Ms. COLLINS. Thank you, Mr. President. I rise in support of the Food and Drug Administration Reauthorization Act that we are now considering. Let me begin by commending Chairman Alexander and Ranking Member Murray of the Senate Health, Education, Labor, and Pensions Committee for their leadership in bringing this important legislation to the Senate floor. This bill is the product of bipartisan, bicameral work and is proof that we can make progress when we work together on the areas where we can find agreement. FDA user fees, which are reauthorized under this bill, are critical to moving the most advanced research from a promise to a cure and ensuring that new treatments reach patients in need. User fees, where companies fund a portion of the premarket review of their products, account for more than one-quarter of all FDA funding. Yet the FDA's authority to collect these fees will expire at the end of next month unless Congress acts, thus the urgency of getting this bill across the finish line. That is why it is imperative that we advance this bill now and ensure that work on these promising new pharmaceuticals continues uninterrupted. In May, the HELP Committee, on which I am pleased to serve, overwhelmingly approved bipartisan legislation to extend and reauthorize the FDA fees in order to support the public health of our Nation. The bill before us also incorporates many provisions that were advanced by individual Committee Members. It is a great example of how a committee process should work. It was collaborative. We each brought ideas to the table, and during our markup, those ideas were offered as amendments and in many cases incorporated into the legislation. I thank the chairman and the ranking member for including in this important legislation provisions that I authored with Senator Claire McCaskill. Those provisions seek to accelerate the review process for prescription drugs in cases where there is limited or no competition. Our purpose is to lower or at least moderate the escalating prescription drug prices that are one of the key cost drivers in our healthcare system today. During the last Congress, our Senate Aging Committee, which I chair-- and at that time Senator McCaskill was the ranking member--had a bipartisan investigation into the causes, impacts, and potential solutions to the egregious price spikes for certain off-patent drugs for which there were no generic competitors. Now, let me explain this situation a little more. What we found was happening is that in cases in which the patent on the original brand name pharmaceutical had expired, there were these companies that were not traditional pharmaceutical companies--they were not firms that had invested hundreds of millions in R&D in order to develop a new prescription drug. That is not what we are talking about. We are talking about these pharma companies--I call them hedge fund pharmas--that wait until the patent has expired, then buy the pharmaceutical drug and virtually overnight impose egregious price increases. One of the executives of these companies, when asked why he did so, answered simply ``because I can.'' Obviously, that has a very detrimental impact on patients, on healthcare providers, on insurers, and on Federal programs such as Medicaid and Medicare. So building on our investigation, Senator McCaskill and I sponsored legislation, called the Making Pharmaceutical Markets More Competitive Act, to foster a more competitive generic marketplace and to improve access for affordable medicines. That is key. If we can have more competition in the prescription drug marketplace, that is what drives down costs, and that is what drives down prices. We know that from our experience when generic drugs come on the market. The bill that we are considering today that is based on our legislation includes key provisions which were adopted unanimously as an amendment that I sponsored during the committee markup. First, our provisions would require the FDA to prioritize the review of certain generic applications. It would set a clear timeframe of no more than 8 months for the FDA to act on such applications where there is inadequate generic competition. This would help to resolve situations in which there are drug shortages, as well as circumstances in which there are not more than three approved competitors on the market. The Aging Committee's investigation into sudden price spikes found that older drugs with only one manufacturer and no generic competitor are particularly vulnerable to dramatic and sudden price increases. One company that we investigated, Turing Pharmaceuticals, increased the price of a drug called Daraprim, which is a lifesaving drug for serious parasitic infections, from $13.50 a pill to $750 a pill--an increase of more than 5,000 percent--and they did so literally overnight. Now, keep in mind that this company, Turing Pharmaceuticals, had nothing to do with the costly research and development that brought about this lifesaving drug, known as Daraprim, but after they bought the drug--after the patent had expired and they saw that there was no generic competitor--they increased the price overnight by 5,000 percent. This price hike for a drug that has remained unchanged since 1953 is unacceptable and underscores the urgent need for legislation to prevent bad actors from taking advantage of a noncompetitive marketplace. Second, the bill would improve communications between the FDA and the eligible sponsors prior to the submission of an application for the approval of a generic drug. That would improve the quality of applications from the beginning, increasing the chances of successful approval by the FDA. Third, new reporting requirements would provide increased transparency into the backlog of applications for drug approvals and pending generic and priority review applications. Fourth, this bill would provide the public with accurate information about drugs with limited competition. Drug manufacturers would be required to notify and provide rationale when removing a drug from the market, and the FDA would publish a list of off-patent brand name drugs that lack generic competitors, so that if you were a generic drug company, you would know that this would be an opportunity to develop a competitor drug. I give the new FDA Commissioner a great deal of credit for his incorporating some of our provisions. He cares deeply about this issue. Finally, this bill would streamline the regulatory process to address incidents in which the delayed re-inspection of manufacturing facilities becomes a barrier to generics entering the marketplace. By taking these steps, we will enhance regulatory certainty for generic drug companies, help to prevent shortages, increase competition to lower prices and prevent monopolies, and deter practices that can lead to unjustifiable, exorbitant price hikes. I am pleased that the legislation also includes another bill that resulted from our Aging Committee's investigation. This provision will help to prevent bad actors from receiving unwarranted vouchers under the Tropical Disease Voucher Program. This program was intended to incentivize the development of medicines for neglected diseases, yet was exploited by the notorious Martin Shkreli, the founder of Turing. After spiking the price of Daraprim, he purchased another decades-old drug--one, once again, without a competitor--that is used to treat a life-threatening infection that is rare in the United States. Mr. Shkreli sought to use the Tropical Disease Voucher Program to gain exclusivity and hike the price for a drug that is not, in fact, a new drug. Our legislation revises the program to better ensure that it achieves its intent, which is to spur the development of therapies that are truly new in order to treat and cure neglected diseases. Drug companies should not be able to increase their prices dramatically by thousands of a percent overnight without any justification--without the development of modifications in the drug that improve its effectiveness, for example. Our legislation will help to foster a much healthier and more competitive generic marketplace as the best defense against such exploitation. I am pleased that our bipartisan plan will increase generic competition, which is so important for American families and our seniors, particularly, who take a disproportionate number of the prescription drugs that are prescribed in this country. Before closing, let me briefly mention another important provision in the bill before us, the Over-the-Counter Hearing Aid Act of 2017. Approximately 30 million Americans experience age-related hearing loss. Yet only about 14 percent of those with hearing loss use assistive hearing technology, often because they simply cannot afford the price of costly hearing aids. We know from a hearing that we recently held in the Aging Committee that social isolation among our seniors can be exacerbated by hearing loss that is left untreated. That, in turn, increases that social isolation and increases the risk of serious mental and physical health outcomes. By making some types of hearing aids available over the counter, just as people buy readers to see with, which are over-the- counter eyeglasses, this legislation will help increase access to and lower the cost of the products for the consumers who need them. The legislation we are considering today will help to bring lifesaving drugs to the marketplace and will ensure that the FDA continues to operate smoothly and, most importantly, that promising therapies make it to the American people. Again, I commend Chairman Alexander and Ranking Member Murray for their leadership, and I encourage all of our colleagues to join me in supporting this important legislation. Thank you. I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, Richard Dudman, one of our Nation's most esteemed journalists, passed away at his Maine home last night. I rise today in tribute to a great American reporter and engaged citizen. After serving in the Merchant Marine and U.S. Navy Reserve during World War II, Mr. Dudman began his journalism career at the Denver Post in 1945 and joined the St. Louis Post-Dispatch 4 years later. In his more than three decades at the Post-Dispatch, he covered Fidel Castro's Cuban revolution, the assassination of President John F. Kennedy, the Bay of Pigs invasion, the Watergate and Iran-Contra scandals, as well as armed conflicts from the Middle East and Asia to Central and South America. In 1970, while covering the Vietnam war, Mr. Dudman was captured by the Viet Cong and held prisoner in Cambodia, a harrowing experience he wrote about in his acclaimed book, ``Forty Days With the Enemy.'' In 1981, on his last day as Washington bureau chief for the Post-Dispatch, he ran up Connecticut Avenue to cover the attempted assassination of President Ronald Reagan. For some of the most momentous events of the second half of the 20th Century, Richard Dudman wrote the first draft of history. After retiring and moving to Ellsworth and Little Cranberry Island in Maine, Mr. Dudman continued to contribute to the Post-Dispatch and wrote more than 1,000 editorials for the Bangor Daily News. Among his many accolades are the prestigious George Polk Career Award in Journalism and induction into the Maine Press Association Hall of Fame. Mr. Dudman combined his journalistic professionalism with a spirit of serving others. In 2014, he and his wife, Helen, were presented with the Golden Eagle Award from the Boy Scouts of America for their commitment to community service, a quality that ran through their remarkable 69 years of marriage. In this time of sorrow, I offer my deep condolences to Helen and their family. I hope they will find comfort in Richard's inspiring legacy and in a life well-lived. It has been said that we all have a birth date and a death date, with a dash in between. It is what we do with our dash that counts. Richard Dudman's dash was extraordinarily long, and he made it count. He filled it with passion, professionalism, and dedication. May his memory inspire us all to do the same.

Ms. COLLINS

Ms. COLLINS. Madam President, I rise today to introduce legislation with my colleague from Montana, Senator Tester, that would extend an important program to fund Teaching Health Centers, which support the health and well-being of families in rural and medically underserved communities. I am pleased that Senators Cochran, Manchin, Daines, Harris, and Boozman, have joined us as cosponsors. In the background of the health care debate, there is another crisis that looms. We are facing a severe shortage of doctors. By 2025, we will need more than 100,000 new primary care doctors to meet the growing demand for health care services across the Country. The shortage is especially critical in rural and underserved communities, which are often those that have been hit hardest by the opioid epidemic. The most significant shortages are in family medicine, general internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and dentistry. These shortages have reached crisis levels in many places. In clinics and health centers in Aroostook County, Maine's northernmost county where I grew up, I hear stories about vacancies forcing Mainers to travel many miles simply to see a primary care doctor or dentist. For the past six years, one program, the Teaching Health Centers Graduate Medical Education Program, has worked to fill these gaps. This program helps to train medical residents in community-based settings, including low-income, underserved rural and urban neighborhoods. For example, since 2011, the Penobscot Community Health Care Center has trained 31 residents and served more than 15,000 dental patients in Bangor, Maine. We need to meet people in the communities in which they live and work. This program is training the next generation of physicians, and has produced real results. When compared with traditional Medicare graduate medical education residents, those who train at teaching health centers are significantly more likely to practice primary care and remain in underserved or rural communities. The numbers speak for themselves: 82 percent of Teaching Health Center, or THC, residents choose to practice primary care, compared to 23 percent of traditional Medicare Graduate Medical Education residents; and 55 percent of THC residents choose to remain in underserved communities, compared to 26 percent of traditional Medicare GME residents. Teaching health centers are serving Americans from coast to coast. A total of 742 THC residents are serving in 27 states and the District of Columbia. The program is competitive, and trains the best of the best. For each residency position, THC programs receive more than 100 applications. In 2017, THC residents and faculty will provide more than one million primary care medical visits to underserved communities. Teaching Health Centers have demonstrated a record of success, and it is imperative that we support them. Our legislation would reauthorize the Teaching Health Centers Graduate Medical Education Program for three years. It would also allow new programs to expand within existing centers and the creation of entirely new teaching health centers. This bill is widely supported by leading community health and physician organizations, including the American Association of Teaching Health Centers, National Association of Community Health Centers, American Academy of Family Physicians, American Association of Colleges of Osteopathic Medicine, American Osteopathic Association, American Council of OB/GYNs, Society of Teachers of Family Medicine, and Council of Academic Family Medicine. We have also received letters of support from teaching health centers in Maine, Montana, Tennessee, Iowa, Oklahoma, North Carolina, California, Mississippi, Pennsylvania, Washington, Texas, Connecticut, New York, Illinois, Massachusetts, and Idaho. In the face of nationwide physician shortages, our legislation would provide a solution for communities today and a path forward to train the physicians of tomorrow. I urge all of my colleagues to join in support of this important legislation, the Training the Next Generation of Primary Care Doctors Act of 2017.

Ms. COLLINS. Madam President, I ask unanimous consent that the letters be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Madam President, I rise today to introduce legislation with my colleague from Montana, Senator Tester, that would extend an important program to fund Teaching Health Centers, which support the health and well-being of families in rural and medically underserved communities. I am pleased that Senators Cochran, Manchin, Daines, Harris, and Boozman, have joined us as cosponsors. In the background of the health care debate, there is another crisis that looms. We are facing a severe shortage of doctors. By 2025, we will need more than 100,000 new primary care doctors to meet the growing demand for health care services across the Country. The shortage is especially critical in rural and underserved communities, which are often those that have been hit hardest by the opioid epidemic. The most significant shortages are in family medicine, general internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and dentistry. These shortages have reached crisis levels in many places. In clinics and health centers in Aroostook County, Maine's northernmost county where I grew up, I hear stories about vacancies forcing Mainers to travel many miles simply to see a primary care doctor or dentist. For the past six years, one program, the Teaching Health Centers Graduate Medical Education Program, has worked to fill these gaps. This program helps to train medical residents in community-based settings, including low-income, underserved rural and urban neighborhoods. For example, since 2011, the Penobscot Community Health Care Center has trained 31 residents and served more than 15,000 dental patients in Bangor, Maine. We need to meet people in the communities in which they live and work. This program is training the next generation of physicians, and has produced real results. When compared with traditional Medicare graduate medical education residents, those who train at teaching health centers are significantly more likely to practice primary care and remain in underserved or rural communities. The numbers speak for themselves: 82 percent of Teaching Health Center, or THC, residents choose to practice primary care, compared to 23 percent of traditional Medicare Graduate Medical Education residents; and 55 percent of THC residents choose to remain in underserved communities, compared to 26 percent of traditional Medicare GME residents. Teaching health centers are serving Americans from coast to coast. A total of 742 THC residents are serving in 27 states and the District of Columbia. The program is competitive, and trains the best of the best. For each residency position, THC programs receive more than 100 applications. In 2017, THC residents and faculty will provide more than one million primary care medical visits to underserved communities. Teaching Health Centers have demonstrated a record of success, and it is imperative that we support them. Our legislation would reauthorize the Teaching Health Centers Graduate Medical Education Program for three years. It would also allow new programs to expand within existing centers and the creation of entirely new teaching health centers. This bill is widely supported by leading community health and physician organizations, including the American Association of Teaching Health Centers, National Association of Community Health Centers, American Academy of Family Physicians, American Association of Colleges of Osteopathic Medicine, American Osteopathic Association, American Council of OB/GYNs, Society of Teachers of Family Medicine, and Council of Academic Family Medicine. We have also received letters of support from teaching health centers in Maine, Montana, Tennessee, Iowa, Oklahoma, North Carolina, California, Mississippi, Pennsylvania, Washington, Texas, Connecticut, New York, Illinois, Massachusetts, and Idaho. In the face of nationwide physician shortages, our legislation would provide a solution for communities today and a path forward to train the physicians of tomorrow. I urge all of my colleagues to join in support of this important legislation, the Training the Next Generation of Primary Care Doctors Act of 2017.

Ms. COLLINS. Madam President, I ask unanimous consent that the letters be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Mr. President, in 2001, Maine's legendary Ellsworth American newspaper celebrated its 150th year by launching a new enterprise, the Mount Desert Islander, dedicated to covering every aspect of life in a place of extraordinary beauty. It is a pleasure to congratulate the two outstanding journalists who have guided the Islander since its inception, publisher Alan Baker and editor Earl Brechlin, for being recognized with the 2017 Sunbeam Award from the Maine Seacoast Mission. The recipient of numerous State and national awards for excellence, the Mount Desert Islander is a great example of the value provided by community newspapers. From Acadia National Park, local government, and businesses, to education, sports, and the arts, the Islander's dedicated staff writes the history of their communities as it occurs. They keep people informed and help them be more involved as citizens. They follow State and national issues, always with an eye on how they affect their neighbors. This dedication starts with committed leadership. After achieving success in journalism and publishing in Philadelphia and New York City, Alan Baker returned home to Maine and, in 1986, joined the Ellsworth American's management team, eventually purchasing the newspaper. In this age of media consolidation, Mr. Baker strongly believes that newspapers should be owned by individuals who are in touch daily with the readers they serve. As a former member of the Maine State Legislature, he is an effective voice for accountability and transparency in all levels of government. A former ``Maine Journalist of the Year,'' Earl Brechlin has covered Mount Desert Island for more than 35 years, and he has been recognized with more than 100 awards for news, feature writing, and photography. His commitment to journalism is evident in his election as president of both the Maine and New England press associations. A Registered Maine Guide, Mr. Brechlin is the author of nine books that reflect his love for our State's natural beauty, history, and character. The Maine Seacoast Mission is a nondenominational, nonprofit organization founded in 1905 to support island and coastal communities in Downeast Maine, and its boat, the Sunbeam V, helps to connect people in those communities with essential services and with each other. Through their dedication to the craft of journalism, Alan Baker and Earl Brechlin have strengthened that support and those community connections, and the Sunbeam Award is a fitting recognition of their many contributions.

Ms. COLLINS

Ms. COLLINS. Mr. President, today I am pleased to be joined by my friend and colleague from Delaware, Senator Chris Coons, in introducing the Reach Every Mother and Child Act of 2017. Our legislation would make it the policy of the United States to lead an effort to end preventable deaths of mothers, newborns, and young children in the developing world by 2030. Due in part to American leadership and generosity, many lives have already been saved. Since 1990, the annual number of deaths of children under the age of five has been cut in half. Nevertheless, far too many mothers, newborns, and young children under the age of five still succumb to disease and malnutrition that could easily be prevented, if only we could reach the mothers and children with simple, proven, cost- effective interventions that we know will help them survive. Every day approximately 800 women will die from preventable causes related to pregnancy and childbirth. In addition, more than 16,000 children under the age of five will die each day of treatable conditions such as prematurity, pneumonia, and diarrhea--with malnutrition being the underlying cause in nearly half those deaths. According to USAID, a concentrated effort could end preventable maternal and child deaths worldwide by the year 2030; however, U.S. leadership and support of the international community are critical to success. To achieve this ambitious goal, our bill would require the implementation of a strategy to scale up the most effective interventions to save as many lives as possible. This idea is central to our bill. We do not have to guess at what interventions will work-- the reality is that more than 16,000 children under 5 years old die each day of conditions we know today how to treat. These life-saving interventions include clean birthing practices, vaccines, nutritional supplements, hand-washing with soap, and other basic needs that remain elusive for far too many women and children in developing countries. This must change. In addition, our bill would establish a Maternal and Child Survival Coordinator at USAID who would focus on implementing the ten-year strategy and verifying that the most effective interventions are being scaled up in target countries. The bill would also establish an interagency working group to assist the Coordinator in promoting greater collaboration among all the federal agencies involved in this effort. To promote transparency and greater accountability, our bill requires that detailed reporting be published on the Foreign Assistance Dashboard, where it can be assessed by the public, Congress, and non- governmental organizations to track the implementation of the strategy and the progress being made. Finally, our bill would encourage USAID to pay for successful programs run by non-governmental entities. The message we want to send to all our partners in the private sector, the non-profit sector, the faith community, and in local and international civil society groups is this: if you can figure out a way to increase the likelihood that mothers and their children will survive childbirth and the first five years of life, we want to reward you for your contribution. Improving the health and well-being of mothers and children around the world has far-reaching social and economic benefits as well. An independent group of economists and global health experts from around the world, known as the Lancet Commission, found that for every $1 invested in health initiatives in the developing world, there is a return of $9 to $20 in growing the gross domestic product of the country receiving the investment. Other bipartisan initiatives, such as the successful President's Emergency Plan for AIDS Relief, or PEPFAR, which was started by President George W. Bush, demonstrate that results-driven interventions can turn the tide for global health challenges. Applying lessons learned from past initiatives, our bill would provide the focus and the tools necessary to accelerate progress toward ending preventable maternal and child deaths. I urge my colleagues to join Senator Coons and me in supporting this bill to save the lives of mothers and children around the world.

Ms. COLLINS

Ms. COLLINS. Mr. President, today I am pleased to be joined by my friend and colleague from Delaware, Senator Chris Coons, in introducing the Reach Every Mother and Child Act of 2017. Our legislation would make it the policy of the United States to lead an effort to end preventable deaths of mothers, newborns, and young children in the developing world by 2030. Due in part to American leadership and generosity, many lives have already been saved. Since 1990, the annual number of deaths of children under the age of five has been cut in half. Nevertheless, far too many mothers, newborns, and young children under the age of five still succumb to disease and malnutrition that could easily be prevented, if only we could reach the mothers and children with simple, proven, cost- effective interventions that we know will help them survive. Every day approximately 800 women will die from preventable causes related to pregnancy and childbirth. In addition, more than 16,000 children under the age of five will die each day of treatable conditions such as prematurity, pneumonia, and diarrhea--with malnutrition being the underlying cause in nearly half those deaths. According to USAID, a concentrated effort could end preventable maternal and child deaths worldwide by the year 2030; however, U.S. leadership and support of the international community are critical to success. To achieve this ambitious goal, our bill would require the implementation of a strategy to scale up the most effective interventions to save as many lives as possible. This idea is central to our bill. We do not have to guess at what interventions will work-- the reality is that more than 16,000 children under 5 years old die each day of conditions we know today how to treat. These life-saving interventions include clean birthing practices, vaccines, nutritional supplements, hand-washing with soap, and other basic needs that remain elusive for far too many women and children in developing countries. This must change. In addition, our bill would establish a Maternal and Child Survival Coordinator at USAID who would focus on implementing the ten-year strategy and verifying that the most effective interventions are being scaled up in target countries. The bill would also establish an interagency working group to assist the Coordinator in promoting greater collaboration among all the federal agencies involved in this effort. To promote transparency and greater accountability, our bill requires that detailed reporting be published on the Foreign Assistance Dashboard, where it can be assessed by the public, Congress, and non- governmental organizations to track the implementation of the strategy and the progress being made. Finally, our bill would encourage USAID to pay for successful programs run by non-governmental entities. The message we want to send to all our partners in the private sector, the non-profit sector, the faith community, and in local and international civil society groups is this: if you can figure out a way to increase the likelihood that mothers and their children will survive childbirth and the first five years of life, we want to reward you for your contribution. Improving the health and well-being of mothers and children around the world has far-reaching social and economic benefits as well. An independent group of economists and global health experts from around the world, known as the Lancet Commission, found that for every $1 invested in health initiatives in the developing world, there is a return of $9 to $20 in growing the gross domestic product of the country receiving the investment. Other bipartisan initiatives, such as the successful President's Emergency Plan for AIDS Relief, or PEPFAR, which was started by President George W. Bush, demonstrate that results-driven interventions can turn the tide for global health challenges. Applying lessons learned from past initiatives, our bill would provide the focus and the tools necessary to accelerate progress toward ending preventable maternal and child deaths. I urge my colleagues to join Senator Coons and me in supporting this bill to save the lives of mothers and children around the world.