Susan Collins

Ms. COLLINS

Ms. COLLINS. Mr. President, earlier today I voted in support of the resolution offered by Senator Baldwin to roll back rules adopted in August by the Trump administration that would allow individuals to purchase so-called short-term, limited duration health insurance plans for up to 1 year. The Obama administration had previously limited the duration of such plans to 3 months. I rise now to explain why I chose to support the resolution and, beyond that, to note the critical need to take action to protect individuals who have no other affordable health insurance option. First, as proponents of the resolution have noted, short-term limited duration plans do not provide protections for enrollees who suffer from preexisting conditions. As I have often emphasized, it is essential that individuals who suffer from preexisting conditions are covered. In June of this year, I wrote to Attorney General Sessions urging him to reconsider his decision not to defend provisions protecting individuals with preexisting conditions in ongoing litigation challenging the Affordable Care Act in Federal court in Texas. As I noted in my letter, striking down these protections is no small matter: ``In 2016, the Kaiser Family Foundation estimated that 27 percent of American adults under age 65 have pre-existing conditions that would leave them uninsurable in the individual market. More recently, 57 percent of Americans responding to a poll said that they, or someone in their household, suffers from a pre-existing condition. These numbers include 590,000 Mainers, roughly 45 percent of the state's population.'' Mr. President, I ask unanimous consent that my letter be printed in the Record immediately following my remarks. At the same time, we cannot ignore the fact that many individuals lack an affordable health insurance option. For example, individuals who earn more than 400 percent of the Federal poverty level--about $49,000--are not entitled to the ACA's premium tax credits and must shoulder the full cost of plans they purchase in the exchange. For a 64-year-old male living in Caribou, ME, this amounts to about $9,500 for the cheapest bronze plan--or nearly 20 percent of his income--far too expensive. Based on the statistics I have already cited, there is a better than even chance that this individual suffers from a preexisting condition. Individuals who lose their jobs and their healthcare coverage along with it may also benefit from these plans. If someone is struggling to pay rent or a mortgage and trying to keep up with other bills, a short- term plan can help them achieve some measure of coverage without compounding their financial worries. There is a role for these plans, and I believe that we should work together to address these real-world situations. The underlying flaw in the Affordable Care Act is that it does not provide affordable coverage, but I believe this flaw can be addressed without jeopardizing protections for individuals with preexisting conditions. In fact, earlier this year, I offered legislation with my good friend Lamar Alexander that would have done exactly that. Our bill, would have funded cost-sharing reductions, reformed the section 1332 waiver program, and provided $30 billion over 3 years to support State reinsurance or invisible high-risk pools--methods proven to reduce rates without discriminating against those with preexisting conditions. Furthermore, healthcare experts at Oliver Wyman projected that our bill would have lowered individual health insurance premiums in the individual market by as much as 40 percent compared to what people would otherwise pay, while also expanding coverage to an additional 3.2 million individuals. Unfortunately--and incredibly--when we tried to advance this legislation, the Democratic leaders blocked it. I remain deeply disappointed that members on the other side of the aisle chose to derail legislation that could have lowered rates for the 18 million Americans who get their health insurance coverage from the individual market. I am also disappointed that we again find ourselves in an ``all or nothing, take it or leave it'' situation. I can only hope that some of the energy now stoking partisan animosity will be redirected soon toward finding healthcare solutions that work for all Americans.

Ms. COLLINS

Ms. COLLINS. Thank you, Mr. President. Mr. President, the five previous times that I have come to the floor to explain my vote on the nomination of a Justice to the U.S. Supreme Court, I have begun my floor remarks explaining my decision with a recognition of the solemn nature and the importance of the occasion. But today we have come to the conclusion of a confirmation process that has become so dysfunctional, it looks more like a caricature of a gutter-level political campaign than a solemn occasion. The President nominated Brett Kavanaugh on July 9. Within moments of that announcement, special interest groups raced to be the first to oppose him, including one organization that didn't even bother to fill in the judge's name on its prewritten press release--they simply wrote that they opposed ``Donald Trump's nomination of XX to the Supreme Court of the United States.'' A number of Senators joined the race to announce their opposition, but they were beaten to the punch by one of our colleagues who actually announced opposition before the nominee's identity was even known. Since that time, we have seen special interest groups whip their followers into a frenzy by spreading misrepresentations and outright falsehoods about Judge Kavanaugh's judicial record. Over-the-top rhetoric and distortions of his record and testimony at his first hearing produced short-lived headlines which, although debunked hours later, continued to live on and be spread through social media. Interest groups have also spent an unprecedented amount of dark money opposing this nomination. Our Supreme Court confirmation process has been in steady decline for more than 30 years. One can only hope that the Kavanaugh nomination is where the process has finally hit rock bottom. Against this backdrop, it is up to each individual Senator to decide what the Constitution's advice-and-consent duty means. Informed by Alexander Hamilton's Federalist 76, I have interpreted this to mean that the President has broad discretion to consider a nominee's philosophy, whereas my duty as a Senator is to focus on the nominee's qualifications as long as that nominee's philosophy is within the mainstream of judicial thought. I have always opposed litmus tests for judicial nominees with respect to their personal views or politics, but I fully expect them to be able to put aside any and all personal preferences in deciding the cases that come before them. I have never considered the President's identity or party when evaluating Supreme Court nominations. As a result, I voted in favor of Justices Roberts and Alito, who were nominated by President Bush; Justices Sotomayor and Kagan, who were nominated by President Obama; and Justice Gorsuch, who was nominated by President Trump. I began my evaluation of Judge Kavanaugh's nomination by reviewing his 12-year record on the DC Circuit Court of Appeals, including his more than 300 opinions and his many speeches and law review articles. Nineteen attorneys, including lawyers from the nonpartisan Congressional Research Service, briefed me many times each week and assisted me in evaluating the judge's extensive record. I met with Judge Kavanaugh for more than 2 hours in my office. I listened carefully to the testimony at the committee hearings. I spoke with people who knew him personally, such as Condoleezza Rice and many others. I talked with Judge Kavanaugh a second time by phone for another hour to ask him very specific additional questions. I also have met with thousands of my constituents, both advocates and many opponents, regarding Judge Kavanaugh. One concern that I frequently heard was that the judge would be likely to eliminate the Affordable Care Act's vital protections for people with preexisting conditions. I disagree with this contention. In a dissent in Seven-Sky v. Holder, Judge Kavanaugh rejected a challenge to the ACA on narrow procedural grounds, preserving the law in full. Many experts have said that his dissent informed Justice Roberts' opinion upholding the ACA at the Supreme Court. Furthermore, Judge Kavanaugh's approach toward the doctrine of severability is narrow. When a part of a statute is challenged on constitutional grounds, he has argued for severing the invalid clause as surgically as possible while allowing the overall law to remain intact. This was his approach in his dissent in a case that involved a challenge to the structure of the Consumer Financial Protection Bureau. In his dissent, Judge Kavanaugh argued for ``severing any problematic portions while leaving the remainder intact.'' Given the current challenges to the ACA, proponents, including myself, of protections for people with preexisting conditions should want a Justice who would take just this kind of approach. Another assertion I have heard often is that Judge Kavanaugh cannot be trusted if a case involving alleged wrongdoing by the President were to come before the Court. The basis for this argument seems to be twofold. First, Judge Kavanaugh has written he believes Congress should enact legislation to protect Presidents from criminal prosecution or civil liability while in office. I believe opponents miss the mark on this issue. The fact that Judge Kavanaugh offered this legislative proposal suggests he believes the President does not have such protection currently. Second, there are some who argue that given the current special counsel investigation, President Trump should not even be allowed to nominate a Justice. That argument ignores our recent history. President Clinton, in 1993, nominated Justice Ginsburg after the Whitewater investigation was already underway, and she was confirmed 96 to 3. The next year, just 3 months after Independent Counsel Robert Fiske was named to lead the Watergate investigation, President Clinton nominated Justice Breyer. He was confirmed 87 to 9. Supreme Court Justices have not hesitated to rule against the Presidents who have nominated them. Perhaps most notably in United States v. Nixon, the three Nixon appointees who heard the case joined the unanimous opinion against him. Judge Kavanaugh has been unequivocal in his belief that no President is above the law. He has stated that Marbury v. Madison, Youngstown Steel v. Sawyer, and United States v. Nixon are three of the four greatest Supreme Court cases in history. What do they have in common? Each of them is a case where Congress served as a check on Presidential power. I would note, the fourth case Judge Kavanaugh has pointed to as the greatest in history was Brown v. Board of Education. One Kavanaugh decision illustrates the point about the check on Presidential power directly. He wrote the opinion in Hamdan v. United States, a case that challenged the Bush administration's military commission prosecution of an associate of Osama Bin Laden. This conviction was very important to the Bush administration, but Judge Kavanaugh, who had been appointed to the DC Circuit by President Bush and had worked in President Bush's White House, ruled that the conviction was unlawful. As he explained during the hearing: ``We don't make decisions based on who people are, or their policy preferences, or the moment. We base decisions on the law. . . . '' Others I have met with have expressed concerns that Justice Kennedy's retirement threatens the right of same-sex couples to marry. Yet Judge Kavanaugh described the Obergefell decision, which legalized same- gender marriages, as an important landmark precedent. He also cited Justice Kennedy's recent Masterpiece Cakeshop opinion for the Court's majority stating that ``the days of treating gay and lesbian Americans or gay and lesbian couples as second class citizens who are inferior in dignity and worth are over in the Supreme Court.'' Others have suggested that the judge holds extreme views on birth control. In one case, Judge Kavanaugh incurred the disfavor of both sides of the political spectrum for seeking to ensure the availability of contraceptive services for women while minimizing the involvement of employers with religious objections. Although his critics frequently overlook this point, Judge Kavanaugh's dissent rejected arguments that the government did not have a compelling interest in facilitating access to contraception. In fact, he wrote that the Supreme Court precedent ``strongly suggested'' that there was a ``compelling interest'' in facilitating access to birth control. There has also been considerable focus on the future of abortion rights based on the concern that Judge Kavanaugh would seek to overturn Roe v. Wade. Protecting this right is important to me. To my knowledge, Judge Kavanaugh is the first Supreme Court nominee to express the view that precedent is not merely a practice and tradition but rooted in article III of our Constitution itself. He believes precedent ``is not just a judicial policy . . . it is constitutionally dictated to pay attention and pay heed to rules of precedent.'' In other words, precedent isn't a goal or an aspiration; it is a constitutional tenet that has to be followed except in the most extraordinary circumstances. The judge further explained that precedent provides stability, predictability, reliance, and fairness. There are, of course, rare and extraordinary times where the Supreme Court would rightly overturn a precedent. The most famous example was when the Supreme Court, in Brown v. Board of Education, overruled Plessy v. Ferguson, correcting a ``grievously wrong'' decision, to use the judge's term, allowing racial inequality. But someone who believes the importance of precedent has been rooted in the Constitution would follow long-established precedent except in those rare circumstances in which a decision is ``grievously wrong'' or ``deeply inconsistent with the law.'' Those are Judge Kavanaugh's phrases. As the judge asserted to me, a long-established precedent is not something to be trimmed, narrowed, discarded, or overlooked. Its roots in the Constitution give the concept of stare decisis greater weight such that the precedent can't be trimmed or narrowed simply because a judge might want to on a whim. In short, his views on honoring precedent would preclude attempts to do by stealth that which one has committed not to do overtly. Noting that Roe v. Wade was decided 45 years ago and reaffirmed 19 years later in Planned Parenthood v. Casey, I asked Judge Kavanaugh whether the passage of time is relevant to following precedent. He said decisions become part of our legal framework with the passage of time and that honoring precedent is essential to maintaining public confidence. Our discussion then turned to the right of privacy, on which the Supreme Court relied in Griswold v. Connecticut, a case that struck down a law banning the use and sale of contraceptives. Griswold established the legal foundation that led to Roe 8 years later. In describing Griswold as ``settled law,'' Judge Kavanaugh observed that it was the correct application of two famous cases from the 1920s, Meyer and Pierce, that are not seriously challenged by anyone today. Finally, in his testimony, he noted repeatedly that Roe had been upheld by Planned Parenthood v. Casey, describing it as precedent on precedent. When I asked him whether it would be sufficient to overturn a long-established precedent if five current Justices believed it was wrongly decided, he emphatically said no. Opponents frequently cite then-candidate Donald Trump's campaign pledge to nominate only judges who would overturn Roe. The Republican platform for all Presidential campaigns has included this pledge since at least 1980. During this time, Republican Presidents have appointed Justices O'Connor, Souter, and Kennedy to the Supreme Court. These are the very three Republican President-appointed Justices who authored the Casey decision which reaffirmed Roe. Furthermore, pro-choice groups vigorously opposed each of these Justices' nominations. Incredibly, they even circulated buttons with the slogan: ``Stop Souter or Women Will Die!'' Just 2 years later, Justice Souter coauthored that Casey opinion, reaffirming a woman's right to choose. Suffice it to say, prominent advocacy organizations have been wrong. These same interest groups have speculated that Judge Kavanaugh was selected to do the bidding of conservative ideologues, despite his record of judicial independence. I asked the judge point-blank whether he had made any commitments or pledges to anyone at the White House, to the Federalist Society, or to any outside group on how he would decide cases. He unequivocally assured me he had not. Judge Kavanaugh has received rave reviews for his 12-year track record as a judge, including for his judicial temperament. The American Bar Association gave him its highest possible rating. Its Standing Committee on the Federal Judiciary conducted an extraordinarily thorough assessment, soliciting input from almost 500 people, including his judicial colleagues. The ABA concluded that ``his integrity, judicial temperament, and professional confidence met the highest standard.'' Lisa Blatt, who has argued more cases before the Supreme Court than any other woman in history, testified: By any objective measure, Judge Kavanaugh is clearly qualified to serve on the Supreme Court. His opinions are invariably thoughtful and fair. Ms. Blatt, who clerked for and is an ardent admirer of Justice Ginsburg, and who is, in her own words, ``an unapologetic defender of a woman's right to choose,'' said Judge Kavanaugh ``fit[s] within the mainstream of legal thought.'' She also observed ``Judge Kavanaugh is remarkably committed to promoting women in the legal profession.'' That Judge Kavanaugh is more of a centrist than some of his critics maintain is reflected in the fact that he and Chief Judge Merrick Garland voted the same way in 93 percent of the cases they heard together. Indeed, Chief Judge Garland joined in more than 96 percent of the majority opinions authored by Judge Kavanaugh, dissenting only once. Despite all of this, after weeks of reviewing Judge Kavanaugh's record and in listening to 32 hours of his testimony, the Senate's advice and consent role was thrown into a tailspin following the allegation of sexual assault by Professor Christine Blasey Ford. The confirmation process now involves evaluating whether Judge Kavanaugh committed sexual assault and lied about it to the Judiciary Committee. Some argue that because this is a lifetime appointment to our highest Court, the public interest requires that doubts be resolved against the nominee. Others see the public interest as embodied in our long- established tradition of affording to those accused of misconduct a presumption of innocence. In cases in which the facts are unclear, they would argue the question should be resolved in favor of the nominee. I understand both viewpoints. This debate is complicated further by the fact that the Senate confirmation process is not a trial. But certain fundamental legal principles about due process, the presumption of innocence, and fairness do bear on my thinking, and I cannot abandon them. In evaluating any given claim of misconduct, we will be ill-served in the long run if we abandon the presumption of innocence and fairness, tempting though it may be. We must always remember it is when passions are most inflamed that fairness is most in jeopardy. The presumption of innocence is relevant to the advice and consent function when an accusation departs from a nominee's otherwise exemplary record. I worry that departing from this presumption could lead to a lack of public faith in the judiciary and would be hugely damaging to the confirmation process moving forward. Some of the allegations levied against Judge Kavanaugh illustrate why the presumption of innocence is so important. I am thinking, in particular, not of the allegations raised by Professor Ford but of the allegation that when he was a teenager, Judge Kavanaugh drugged multiple girls and used their weakened states to facilitate gang rape. This outlandish allegation was put forth without any credible supporting evidence and simply parroted the public statements of others. That such an allegation can find its way into the Supreme Court confirmation process is a stark reminder of why the presumption of innocence is so ingrained in our American consciousness. Mr. President, I listened carefully to Christine Blasey Ford's testimony before the Judiciary Committee. I found her testimony to be sincere, painful, and compelling. I believe she is a survivor of a sexual assault and that this trauma has upended her life. Nevertheless, the four witnesses she named could not corroborate any of the events of the evening gathering where she said the assault occurred. None of the individuals Professor Ford said were at the party has any recollection at all of that night. Judge Kavanaugh forcefully denied the allegations under penalty of perjury. Mark Judge denied, under penalty of felony, that he had witnessed an assault. PJ Smyth, another person allegedly at the party, denied, under penalty of felony, that he was there. Professor Ford's lifelong friend, Leland Keyser, indicated that under penalty of felony, she does not remember that party. Ms. Keyser went further. She indicated that not only does she not remember a night like that but also that she does not even know Brett Kavanaugh. In addition to the lack of corroborating evidence, we also learned some facts that raised more questions. For instance, since these allegations have become public, Professor Ford testified that not a single person has contacted her to say: ``I was at the party that night.'' Furthermore, the professor testified that although she does not remember how she got home that evening, she knew, because of the distance, she would have needed a ride. Yet not a single person has come forward to say that he or she was the one who drove her home or was in the car with her that night. Professor Ford also indicated that even though she left that small gathering of six or so people abruptly and without saying goodbye and was distraught, none of them called her the next day--or ever--to ask why she left or was she OK, not even her closest friend, Ms. Keyser. The Constitution does not provide guidance on how we are supposed to evaluate these competing claims. It leaves that decision up to each Senator. This is not a criminal trial, and I do not believe claims such as these need to be proven beyond a reasonable doubt. Nevertheless, fairness would dictate that the claims should at least meet a threshold of ``more likely than not'' as our standard. The facts presented do not mean Professor Ford was not sexually assaulted that night or at some other time, but they do lead me to conclude that the allegations fail to meet the ``more likely than not'' standard. Therefore, I do not believe these charges can fairly prevent Judge Kavanaugh from serving on the Court. Let me emphasize that my approach to this question should not be misconstrued as suggesting that unwanted sexual contact of any nature is not a serious problem in this country. To the contrary, if any good at all has come from this ugly confirmation process, it has been to create an awareness that we have underestimated the pervasiveness of this terrible problem. I have been alarmed and disturbed, however, by some who have suggested that unless Judge Kavanaugh's nomination is rejected, the Senate is somehow condoning sexual assault. Nothing could be further from the truth. Every person--man or woman--who makes a charge of sexual assault deserves to be heard and treated with respect. The #MeToo movement is real; it matters; it is needed; and it is long overdue. We know rape and sexual assault are less likely to be reported to the police than other forms of assault. On average, an estimated 211,000 rapes and sexual assaults go unreported every year. We must listen to survivors, and every day we must seek to stop the criminal behavior that has hurt so many. We owe this to ourselves, our children, and generations to come. Since the hearing, I have listened to many survivors of sexual assault. Many were total strangers who told me their heart-wrenching stories for the first times in their lives. Some were friends whom I have known for decades. Yet, with the exception of one woman who had confided in me years ago, I had no idea they had been the victims of sexual attacks. I am grateful for their courage and their willingness to come forward, and I hope that in heightening public awareness, they have also lightened the burden they have been quietly bearing for so many years. To them, I pledge to do all I can to ensure that their daughters and granddaughters never share their experiences. Over the past few weeks, I have been emphatic that the Senate has an obligation to investigate and evaluate the serious allegations of sexual assault. I called for and supported the additional hearing to hear from both Professor Ford and Judge Kavanaugh. I also pushed for and supported the FBI's supplemental background investigation. This was the right thing to do. Christine Ford never sought the spotlight. She indicated she was terrified to appear before the Senate Judiciary Committee, and she has shunned attention since then. She seemed completely unaware of Chairman Grassley's offer to allow her to testify confidentially in California. In watching her, I could not help but feel that some people who wanted to engineer the defeat of this nomination cared little, if at all, for her well-being. Professor Ford testified that a very limited number of people had access to her letter. Yet that letter found its way into the public domain. She testified she never gave permission for that very private letter to be released. Yet here we are. We are in the middle of a fight she never sought, arguing about claims she wanted to raise confidentially. One theory I have heard espoused repeatedly is that our colleague Senator Feinstein leaked Professor Ford's letter at the eleventh hour to derail this process. I want to state this very clearly: I know Senator Dianne Feinstein extremely well, and I believe she would never do that. I knew that to be the case before she even stated it at the hearing. She is a person of integrity, and I stand by her. I have also heard some argue that the chairman of the committee somehow treated Professor Ford unfairly. Nothing could be further from the truth. Chairman Grassley, along with his excellent staff, treated Professor Ford with compassion and respect throughout the entire process. That is the way the Senator from Iowa has conducted himself throughout a lifetime dedicated to public service. The fact remains that someone leaked this letter against Professor Ford's express wishes. I suspect, regrettably, that we will never know for certain who did it. To that leaker, who I hope is listening now, let me say that what you did was unconscionable. You have taken a survivor who was not only entitled to your respect but who also trusted you to protect her, and you have sacrificed her well-being in a misguided attempt to win whatever political crusade you think you are fighting. My only hope is that your callous act has turned this process into such a dysfunctional circus that it will cause the Senate--and, indeed, all Americans--to reconsider how we evaluate Supreme Court nominees. If that happens, then the appalling lack of compassion you afforded Professor Ford will at least have some unintended positive consequences. The politically charged atmosphere surrounding this nomination had reached a fever pitch even before these allegations were known, and it was challenging even then to separate fact from fiction. We live in a time of such great disunity, as the bitter fight over this nomination both in the Senate and among the public clearly demonstrates. It is not merely a case of differing groups having different opinions; it is a case of people bearing extreme ill will toward those who disagree with them. In our intense focus on our differences, we have forgotten the common values that bind us together as Americans. With some of our best minds seeking to develop ever more sophisticated algorithms designed to link us to websites that only reinforce and cater to our views, we can only expect our differences to intensify. This would have alarmed the drafters of our Constitution, who were acutely aware that different values and interests could prevent Americans from becoming and remaining a single people. Indeed, of the six objectives they invoked in the preamble to the Constitution, the one that they put first was the formation of ``a more perfect Union.'' Their vision of ``a more perfect Union'' does not exist today. If anything, we appear to be moving far away from it. It is particularly worrisome that the Supreme Court--the institution that most Americans see as the principal guardian of our shared constitutional heritage--is viewed as part of the problem through a political lens. Mr. President, we have heard a lot of charges and countercharges about Judge Kavanaugh, but, as those who have known him best have attested, he has been an exemplary public servant, judge, teacher, coach, husband, and father. Despite the turbulent and bitter fights surrounding his nomination, my fervent hope is that Brett Kavanaugh will work to lessen the divisions in the Supreme Court so that we have far fewer 5-4 decisions and that public confidence in our judiciary and our highest Court is restored. Mr. President, I will vote to confirm Judge Kavanaugh. Thank you. (Applause, Senators rising.)

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to urge my colleagues to support the Home Health Payment Innovation Act, which I have introduced with Senator Stabenow and Senator Nelson. Our legislation would help preserve access to existing home health services under the Medicare program while also providing a pathway for innovative approaches to utilizing these services moving forward. This bipartisan legislation is endorsed by the National Association of Homecare and Hospice as well as the Partnership for Quality Home Healthcare. I have been a strong supporter of home care since my very first home visit during my second year of Senate service. This experience gave me the opportunity to meet and visit with home health patients, where I saw first-hand what a difference highly skilled and caring visiting nurses make to the lives of patients and their families. I have been a passionate advocate for home care ever since. Last year, I was delighted to be recognized with the Ruby Slipper award from the Maine Home Care and Hospice Alliance--appropriately named because as Dorothy said in The Wizard of Oz, ``There's no place like home.'' The highly skilled and compassionate care that home health agencies provide in Maine and across the country has helped to keep families together and enabled millions of our most frail and vulnerable individuals to avoid hospitals and nursing homes and stay just where they want to be--in the comfort and security of their own homes. In fact, in 2014, AARP found that nearly 87 percent of of adults over 65 years old want to stay in their current home and community as they age. Furthermore, 85 percent of home health patients live with three or more chronic conditions. The legislation I am introducing today ensures the viability of home health services now and in the future. First, the Home Health Care Payment Innovation Act provides two key adjustments to the Bipartisan Budget Act of 2018 home health payment reform provisions. These changes would prevent premature payment rate cuts by basing any behavioral adjustment on observed evidence. It also provides a phase-in for any necessary rate increases or decreases to limit the risk of disruption in care. 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. Second, the legislation provides a pathway to expanded use of home health care in Medicare without increasing program spending by providing flexibility on waiving the ``homebound'' requirement for home health services when a plan or innovative care delivery models such as an ACO determines that providing care in the home would improve patient outcomes and reduce spending on patient care. By helping patients to avoid more costly hospital visits and nursing homes, we already know that home health saves Medicare, Medicaid and private insurers millions of dollars each year. Moving forward, 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 will help advance the goals of ensuring that care is delivered at the right time, at the right place, and at the right cost. The legislation I introduced today provides the pathway to do just that--promote innovation in home health. I urge my colleagues to support this legislation.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to urge my colleagues to support the Home Health Payment Innovation Act, which I have introduced with Senator Stabenow and Senator Nelson. Our legislation would help preserve access to existing home health services under the Medicare program while also providing a pathway for innovative approaches to utilizing these services moving forward. This bipartisan legislation is endorsed by the National Association of Homecare and Hospice as well as the Partnership for Quality Home Healthcare. I have been a strong supporter of home care since my very first home visit during my second year of Senate service. This experience gave me the opportunity to meet and visit with home health patients, where I saw first-hand what a difference highly skilled and caring visiting nurses make to the lives of patients and their families. I have been a passionate advocate for home care ever since. Last year, I was delighted to be recognized with the Ruby Slipper award from the Maine Home Care and Hospice Alliance--appropriately named because as Dorothy said in The Wizard of Oz, ``There's no place like home.'' The highly skilled and compassionate care that home health agencies provide in Maine and across the country has helped to keep families together and enabled millions of our most frail and vulnerable individuals to avoid hospitals and nursing homes and stay just where they want to be--in the comfort and security of their own homes. In fact, in 2014, AARP found that nearly 87 percent of of adults over 65 years old want to stay in their current home and community as they age. Furthermore, 85 percent of home health patients live with three or more chronic conditions. The legislation I am introducing today ensures the viability of home health services now and in the future. First, the Home Health Care Payment Innovation Act provides two key adjustments to the Bipartisan Budget Act of 2018 home health payment reform provisions. These changes would prevent premature payment rate cuts by basing any behavioral adjustment on observed evidence. It also provides a phase-in for any necessary rate increases or decreases to limit the risk of disruption in care. 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. Second, the legislation provides a pathway to expanded use of home health care in Medicare without increasing program spending by providing flexibility on waiving the ``homebound'' requirement for home health services when a plan or innovative care delivery models such as an ACO determines that providing care in the home would improve patient outcomes and reduce spending on patient care. By helping patients to avoid more costly hospital visits and nursing homes, we already know that home health saves Medicare, Medicaid and private insurers millions of dollars each year. Moving forward, 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 will help advance the goals of ensuring that care is delivered at the right time, at the right place, and at the right cost. The legislation I introduced today provides the pathway to do just that--promote innovation in home health. I urge my colleagues to support this legislation.

Ms. COLLINS

Ms. COLLINS. Madam President, I rise in support of the Patient Right to Know Drug Prices Act, which is legislation that I have introduced with Senators McCaskill, Barrasso, Stabenow, and Cassidy. Our bill has also been cosponsored by Chairman Lamar Alexander and 19 other Senators from both sides of the aisle. This is one of those rare occasions on which we are taking up a bill that has widespread bipartisan support and that is going to really make a difference. This commonsense bill would ban the use of pharmacy gag clauses--an egregious practice that prevents pharmacists from telling their consumers when they can purchase those prescriptions for less money by paying out-of-pocket rather than by using their insurance. This legislation is action that we can take right now to help lower the costs of prescription drugs for some consumers. More than half of Americans, as well as more than 90 percent of seniors who are, say, 65 or older, take at least one prescription drug each month. Americans have been estimated to spend nearly $45 billion out-of-pocket each year for prescription drugs. According to a recent poll by the Kaiser Family Foundation, as many as one out of five Americans does not fill a needed prescription because they are unable to afford it. I witnessed this struggle firsthand recently at a pharmacy in Bangor, ME. When a couple ahead of me in line received their prescription, they were told by the pharmacist that the copay would be $111. The husband looked to his wife and said: Honey, we just can't afford that. They turned around and walked away, leaving the prescription behind. I was so upset when I saw that that I asked the pharmacist: How often does this happen? His reply: Every day. Our bill would ensure that pharmacists could volunteer information to customers on how to lower their costs for prescription drugs. A recent study that was published in the Journal of the American Medical Association found that 23 percent--nearly one-quarter of prescriptions filled through insurance--ended up costing consumers more money than if they had purchased the drugs without using their insurance. Who would think that using your debit card rather than your insurance card to purchase a prescription drug would be less expensive? It is, of course, so counterintuitive that consumers do not think to ask this question of the pharmacists, and gag clauses in contracts prohibit pharmacists from volunteering this information to patients. They prohibit them from telling patients how to obtain the lowest prescription drug prices. Thus, consumers are paying more than they should unless they ask for specific guidance. Americans have the right to know which payment method provides the most savings when purchasing their medications. By prohibiting gag clauses, our legislation takes concrete action to lower the cost of prescription drugs, saving consumers money and improving healthcare. More than 40 organizations support our bill that will ban this unfair restriction, including the National Community Pharmacists Association, the American Medical Association, the Alliance for Transparent & Affordable Prescriptions, the ERISA Industry Committee, the Pharmaceutical Care Management Association, and America's Health Insurance Plans. Our bipartisan bill was approved by the HELP Committee, with unanimous support, on July 25. The administration has also condemned gag clauses and is on record as supporting our bill. Despite this widespread support for banning this egregious practice that restricts the free speech of pharmacists, Senator Lee has filed an amendment that would eviscerate our bill. The Lee amendment would limit the gag clause prohibition to only self-insured employer plans. That would exclude all other employer group and individual market plans. Under the Lee amendment, approximately 85 million Americans would be excluded from protection. Think about that. There are 85 million Americans who are receiving coverage under employer-sponsored plans or in the individual market who would be excluded from this protection. The gag clauses that would be banned in our bill are unconscionable regardless of the type of insurance plan. We know that patients who do not take their medications experience greater complications. One study has estimated that medication nonadherence costs the healthcare system some $337 billion, not to mention there being poorer health outcomes for the individuals affected. The Patient Right to Know Drug Prices Act prohibits gag clauses from being used by health plans that are sponsored by employers or offered in the individual market. The Federal Government's role in regulating these plans and protecting consumers who are served by these markets is already well established. The Employee Retirement Income Security Act--better known as ERISA--was enacted in 1974. Employers who sponsor insurance plans for their employees, as defined by ERISA, are able to deduct the expenses associated with these plans. These expenses are also not subject to the payroll tax. In 2017, the value of the Federal tax benefit for employer-sponsored health insurance was estimated at $260 billion. I strongly support our State-based system of insurance regulation. Indeed, I spent 5 years overseeing the Maine Bureau of Insurance as Maine's commissioner of professional and financial regulation. Our bill does not change the longstanding deference to States on this issue. Yet I would note that even though ERISA preserves the authority of the States to impose insurance regulations on fully insured plans, these plans must still comply with a multitude of provisions that have been set by the Federal Government, and it has been that way for many, many years. For example, regardless of State law, a fully insured health plan must comply with COBRA and must cover minimum hospital stays after childbirth, reconstruction after a mastectomy, and students who take medically necessary leaves of absence. Also, these plans are prohibited from discriminating based on genetic information. Unlike Senator Lee's amendment, our legislation would prohibit gag clauses in all group health plans so that no matter how the employer decides to provide insurance coverage, the employees are able to get the best prices for their medications by consulting freely with their pharmacists. Our bill will also prohibit the use of gag clauses in individual health insurance plans, protecting consumers who don't have employer- provided insurance and who are, rather, purchasing insurance on their own. Americans who purchase insurance in the individual market may qualify for tax credits to help cover the cost of their policies or they may be eligible for tax-preferred savings accounts, such as health savings accounts established by the Medicare Modernization Act of 2003. Senator Lee's amendment will eliminate the protections our bill provides for these individuals, many of whom already face growing out-of-pocket costs. We need this bill as a complement to another bill we passed just recently that prohibits these gag clauses for the Medicare Part D prescription plans. This is a companion bill to that legislation. The bottom line is this: Pharmacists should not be restricted from telling customers if there are other ways for them to purchase needed prescription drugs less expensively. The administration has made banning these clauses a top priority, and this important consumer protection should be written into law. I urge my colleagues on both sides of the aisle to oppose Senator Lee's amendment and to support passage of S. 2554. Today the Senate can go on record taking a concrete step to help reduce prescription drug prices for some consumers. It makes no sense to exclude 85 million Americans from this protection, as Senator Lee's amendment would do. Reducing prescription drug prices must be a national priority. I am pleased to yield to the leading cosponsor of this bill, Senator McCaskill.

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

Ms. COLLINS. Mr. President, I ask unanimous consent that I have one minute to respond to my friend and colleague.

Ms. COLLINS. Mr. President, it seems very arbitrary to me to exclude potentially 85 million Americans from the protections this bill would provide when there is such a clear Federal nexus to act in this area. According to the Kaiser Family Foundation, 58 percent of workers insured in self-insured plans are actually in ``partially insured'' plans. The reason this matters is that some States may attempt to regulate these plans, believing they can, and then have their State laws challenged in the courts and preempted. Why not take the commonsense approach our bill does and simply ban the use of pharmacy gag clauses--an egregious practice that prevents pharmacists from telling their customers they could purchase their prescriptions with less money by paying out of pocket rather than using their insurance. We have the support of 40 medical and consumer groups for this bill, and this legislation is action we can take right now to help lower the cost of prescription drugs for some consumers. It has widespread bipartisan support. It came out of the HELP Committee unanimously, and it is supported by the administration. I urge a ``no'' vote on the amendment offered by the Senator from Utah and a ``yes'' vote on the underlying bill.

Ms. COLLINS

Ms. COLLINS. Mr. President, today along with Senator Carper, I am introducing the Comprehensive National Mercury Monitoring Act. This bill would ensure that we have accurate information about the extent of mercury pollution in the United States. A comprehensive national mercury monitoring network is needed to protect human health, safeguard fisheries, and track the effect of emissions reductions. This tracking is particularly important in light of increasing mercury emissions from other countries, including a substantial amount of mercury emissions from China. Mercury can be transported around the globe, meaning emissions and releases can affect human health and environment even in remote locations. The issue of mercury emissions is growing in importance around the world. In 2013, the United States was the first Nation to join and sign the Minamata Convention on Mercury, a global agreement to reduce mercury pollution. The Minamata Convention has been signed by more than 125 countries and raises the issue that mercury poses a global threat to human health. At present, scientists must rely on limited information to understand the critical linkages between mercury emissions and environmental response and human health. Successful design, implementation, and assessment of solutions to the mercury pollution problem require comprehensive long-term information. A system for collecting such information, such as we have for acid rain and other pollution, does not currently exist for mercury--a much more toxic pollutant. Mercury is a potent neurotoxin of significant ecological and public health concern, especially for children and pregnant women. It is estimated that approximately 200,000 children born in the U.S. per year are exposed to levels of mercury in the womb that are high enough to impair neurological development. Mercury exposure has gone down as U.S. mercury emissions have declined; however, levels remain far too high. By accurately quantifying regional and national changes in atmospheric deposition, ecosystem contamination, and bioaccumulation of mercury in fish and wildlife in response to changes in mercury emissions, a monitoring network would help policy makers, scientists, and the public to better understand the sources, consequences, and trends in mercury pollution in the United States. We must have more comprehensive information and we must have it soon; otherwise, we risk making misguided policy decisions. Specifically, the Comprehensive National Mercury Monitoring Act would: Direct EPA, in conjunction with the Fish and Wildlife Service, U.S. Geological Survey, National Park Service, the National Oceanic and Atmospheric Association, and other appropriate Federal agencies, to establish a national mercury monitoring program to measure and monitor mercury levels in the air and watersheds, water and soil chemistry, and in marine, freshwater, and terrestrial organisms across the nation; Establish a scientific advisory committee to advise on the establishment, site selection, measurement, recording protocols, and operations of the monitoring program; Establish a centralized database for existing and newly collected environmental mercury data that can be freely accessed on the Internet and is comprised of data that is compatible with similar international efforts; Require a report to Congress every two years on the program, including trends, and an assessment of the reduction in mercury deposition rates that need to be achieved in order to prevent adverse human and ecological effects every four-years; and Authorize $95 million over three years to carry out the Act. We must establish a comprehensive, robust national monitoring network for mercury to provide the data needed to help make decisions to protect the people and environment of Maine and the United States.

Ms. COLLINS

Ms. COLLINS. Mr. President, today along with Senator Carper, I am introducing the Comprehensive National Mercury Monitoring Act. This bill would ensure that we have accurate information about the extent of mercury pollution in the United States. A comprehensive national mercury monitoring network is needed to protect human health, safeguard fisheries, and track the effect of emissions reductions. This tracking is particularly important in light of increasing mercury emissions from other countries, including a substantial amount of mercury emissions from China. Mercury can be transported around the globe, meaning emissions and releases can affect human health and environment even in remote locations. The issue of mercury emissions is growing in importance around the world. In 2013, the United States was the first Nation to join and sign the Minamata Convention on Mercury, a global agreement to reduce mercury pollution. The Minamata Convention has been signed by more than 125 countries and raises the issue that mercury poses a global threat to human health. At present, scientists must rely on limited information to understand the critical linkages between mercury emissions and environmental response and human health. Successful design, implementation, and assessment of solutions to the mercury pollution problem require comprehensive long-term information. A system for collecting such information, such as we have for acid rain and other pollution, does not currently exist for mercury--a much more toxic pollutant. Mercury is a potent neurotoxin of significant ecological and public health concern, especially for children and pregnant women. It is estimated that approximately 200,000 children born in the U.S. per year are exposed to levels of mercury in the womb that are high enough to impair neurological development. Mercury exposure has gone down as U.S. mercury emissions have declined; however, levels remain far too high. By accurately quantifying regional and national changes in atmospheric deposition, ecosystem contamination, and bioaccumulation of mercury in fish and wildlife in response to changes in mercury emissions, a monitoring network would help policy makers, scientists, and the public to better understand the sources, consequences, and trends in mercury pollution in the United States. We must have more comprehensive information and we must have it soon; otherwise, we risk making misguided policy decisions. Specifically, the Comprehensive National Mercury Monitoring Act would: Direct EPA, in conjunction with the Fish and Wildlife Service, U.S. Geological Survey, National Park Service, the National Oceanic and Atmospheric Association, and other appropriate Federal agencies, to establish a national mercury monitoring program to measure and monitor mercury levels in the air and watersheds, water and soil chemistry, and in marine, freshwater, and terrestrial organisms across the nation; Establish a scientific advisory committee to advise on the establishment, site selection, measurement, recording protocols, and operations of the monitoring program; Establish a centralized database for existing and newly collected environmental mercury data that can be freely accessed on the Internet and is comprised of data that is compatible with similar international efforts; Require a report to Congress every two years on the program, including trends, and an assessment of the reduction in mercury deposition rates that need to be achieved in order to prevent adverse human and ecological effects every four-years; and Authorize $95 million over three years to carry out the Act. We must establish a comprehensive, robust national monitoring network for mercury to provide the data needed to help make decisions to protect the people and environment of Maine and the United States.

Ms. COLLINS

Ms. COLLINS. Madam President, I ask unanimous consent to speak as if in morning business.

Ms. COLLINS

Ms. COLLINS. Madam President, the U.S. Senate, indeed, our entire Nation, is mourning the loss of a great leader, an American patriot, our colleague and friend, Senator John McCain. I first met John McCain when I was a young staffer in Senator Bill Cohen's office and John was serving as the Navy's liaison officer. As a fellow Senator for the past 21 years, I knew him as a trusted colleague, a courageous legislator, and a close friend. John was a true American hero who devoted his life to serving his country. Courage and character were the hallmarks of his military service as well as his work in Congress. In the Senate, he was a consequential leader on the most critical issues facing our country. John McCain was one of our Congress's most respected voices for a strong national defense and for good government. His word was as much his bond in Washington as it was to his brothers in arms in Vietnam. I would like to share with my colleagues a story, I believe, that demonstrates the essential character of John McCain. In November of 2010, John was part of a congressional delegation on its way to a security conference in Nova Scotia. Bad weather caused their flight to be diverted to Bangor, ME, where I live. I shortly received a phone call to come to the airport, and I went and welcomed John and my colleagues on their unplanned visit. As it happened, the Troop Greeters of Maine were at the airport at the same time. This legendary group of citizens has greeted more than 1.5 million servicemembers either leaving to go overseas or returning home since 2003; never missing a single flight, even in bad weather or the middle of the night. The Presiding Officer, I believe--who also has served her country so well, Senator Ernst--was one of those who was greeted by the Troop Greeters in Bangor, ME. Rather than fly out when the weather cleared, John and the others in the delegation agreed to stay and join me with the long line of these patriotic Troop Greeters to await the arrival of the airplanes. I remember when I told John that there was a plane that would be arriving shortly and then there was another one in a couple of hours, he said: Of course, we will stay. Well, you can imagine, having gone through the gauntlet of Mainers greeting and welcoming the troops back home, hugging them, cheering them, giving them cell phones, thanking them for their service, that all of a sudden the troops realized they had just shaken hands with John McCain; the legendary John McCain, who was so popular with servicemembers. I saw them literally do a double take when the first group went by, shook his hand, and then turned around and said to each other: Wasn't that John McCain who just shook our hands? They then came back and of course posed for pictures and chatted with him and held up the rest of the line, who were very eager to see John. I will never forget how thrilled these troops were to be greeted, when they were first setting foot back on American soil, by a true American hero, John McCain; someone who had served our country with such courage and character. By the end of the day, John had spent 3 hours greeting two planeloads of soldiers. He loved greeting them and posing for pictures. It was such a heartwarming, unexpected event and a very special moment. It not only gladdened the hearts of the troops but also of the Troop Greeters, who were thrilled to have their hero with them. It was vintage John McCain that he stayed even after the weather had cleared and greeted each and every one of those troops. John McCain did what he thought was right, regardless of the political consequences. He had absolutely no interest in scoring partisan political points on the Senate floor. He welcomed and would listen to good ideas, whether they came from the Democratic or the Republican side of the aisle. While he was always open to new evidence, good ideas, and was capable of changing his mind, he was unshakeable when he was convinced of the appropriateness of a course of action. John was impatient. He wanted to get on with solving the problems facing our country. He had no use for the political games that, sadly, far too often are played in the Senate. One often overlooked aspect of John was his love for the environment. I once visited him at his beloved ranch in Sedona, and I was surprised when he took me all over the property, pointing out birds, naming them, and clearly taking such delight in the wildlife. Until that moment, I did not know of his interest and love for nature. Later on, I accompanied John on a trip he organized to the Arctic to see the permafrost melting and to meet with Native Alaskans. We also traveled to Antarctica, where we spent 4 days meeting with scientists who told us of the impact of global warming. He took me on so many trips and broadened my horizons. Four times we went to Afghanistan, four times to Iraq. We went to Yemen. We went to Libya and met with Colonel Qadhafi before he was overthrown and killed. John taught me so much on these trips. The principles that guided John's life are best summed up by his own words from his beautiful autobiography, ``Faith of My Fathers.'' He said: ``Glory belongs to the act of being constant to something greater than yourself, to a cause, to your principles, to the people on whom you rely, and who rely on you in return.'' John McCain was a statesman and a dear friend who was devoted to a cause greater than himself, and that cause was the United States of America. It has been an honor to serve alongside him for nearly 21 years in the U.S. Senate. Although he will be deeply missed by all of us, he leaves behind an extraordinary legacy that will inspire Americans for generations to come. I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, what a pleasure it is to be here on the Senate floor with such determined advocates on behalf of the families all across our Nation who are dealing with this devastating disease of Alzheimer's. I spoke earlier in the week about the many terrific provisions in this bill on the Defense appropriations side and on the Labor, Health, and Human Services part of the appropriations package, but I am delighted to be here today to shine a spotlight on the additional funding for Alzheimer's disease. As a member of the Appropriations Committee, it has been such a pleasure to work with my colleagues, including Senator Moran, Senator Capito, and our leader, Chairman Blunt, on this shared priority year after year. I particularly want to recognize the extraordinary leadership of Chairman Blunt in making sure that adequate funding is provided for this devastating disease. Alzheimer's is the sixth leading cause of death in the Nation, and it is increasing at unprecedented rates. Like many families, mine too has known the pain of its devastating consequences. Today, an estimated 5.7 million Americans are living with Alzheimer's. In addition to the human suffering it causes, Alzheimer's is our most costly disease at $277 billion a year, with Medicare and Medicaid covering $186 billion. Without a change in the current trajectory, the number of Americans with Alzheimer's is expected to triple to as many as 14 million by 2050, costing more than $1.1 trillion per year and bankrupting the Medicaid system. Fortunately, Congress has taken significant actions and in this bill recognizes the urgent need to continue our investment full speed ahead. Since the 2011 signing of the National Alzheimer's Project Act, known as NAPA, which I coauthored with former Senator Evan Bayh, we have increased funding for Alzheimer's by $1.36 billion. Seven years ago, NIH received only $440 million for this research, compared to more than $5 billion for another very serious disease--cancer. Since that time, we have steadily boosted Federal research dollars for Alzheimer's--to $936 million in 2016, $1.4 billion in 2017, and $1.8 billion last year--but this bill before us achieves a milestone because by adding another $425 million for this research, the total funding for the first time will exceed the $2 billion mark. This is the largest increase in history, and it allows us to reach the level that experts have advised us is necessary to find a means of prevention, effective treatments, or ultimately a cure by the year 2025. This has been a bipartisan commitment. Alzheimer's doesn't care whether you are a Democrat, a Republican, an Independent, or a Green. It does not discriminate. This robust commitment promises returns such as we have seen for cancer, diabetes, and other chronic illnesses. Fueled by Federal support, researchers are beginning to understand more clearly the complex biology of Alzheimer's with sophisticated new tools that are leading to better imaging agents and therapies. NIH research is laying the foundation for precision medicine through the Accelerating Medicines Partnership for Alzheimer's Disease, which will produce more targeted therapies that I believe will lead to a means of either preventing or at least delaying the onset of this disease. With NIH funds, scientists are also exploring possible risk factors, including diet, heart health, diabetes, and exposure to environmental toxins. Results from the Systolic Blood Pressure Intervention Trial released last month found that lowering blood pressure is associated with reducing the risk of mild cognitive impairment and dementia. Through a $25 million NIA grant, the Jackson Laboratory in Maine is co-leading the Alzheimer's Disease Precision Models Center with Indiana University--the first of its kind--to accelerate the most promising research into therapies from the bench to the bedside. This is exactly the kind of collaboration and sharing we need to make a difference. As chairman of the Senate Aging Committee and founder and co-chair of the Senate Alzheimer's Task Force and as a Senator representing the oldest State in the Nation by median age, I am committed to making 2020 the dawn of light for Alzheimer's to alter the path for generations to come. The robust support in this bill represents a historic step forward that will promise dividends in the future. As glimmers of light seep through this door that has been shut tight for far too long, we must continue to push forward. We cannot let up on the accelerator of funding. We need to improve the lives of those living with Alzheimer's and their caregivers. How many of us have seen an elderly parent caring for a beloved spouse with severe dementia? It takes a toll not just on the victim of the disease but on the entire family and particularly on the caregivers. That is one reason I have introduced the BOLD Infrastructure for Alzheimer's Act with Senator Cortez Masto. This bipartisan bill would promote public health knowledge and awareness of Alzheimer's disease, cognitive decline, and brain health by supporting implementation of the CDC's Healthy Brain Initiative: Public Health Road Map. BOLD now has 48 cosponsors, I am delighted to report, and we are on track to consider the bill soon in the HELP Committee, led by Senator Alexander and Senator Murray. BOLD follows our previous efforts, such as NAPA, and, together with the extraordinary increase in NIH funding that we are providing today, these congressional actions are poised to usher in a whole new era in our battle against this devastating disease. I have visited research laboratories all across the United States-- the Mayo Clinic, NIH here in the Washington area, Jackson Laboratory in the great State of Maine, the University of Pennsylvania, Harvard--and I have seen what is going on in the labs due to the increases in NIH funding we have provided. It is so exciting. I am convinced that if we sustain this commitment, we will be able to avoid such tragedy for so many American families, as well as avoid the tremendous burden of our Nation's most costly disease. Again, I salute Chairman Blunt's efforts to continue to press forward and thank him for his leadership and strong support of biomedical research. I yield the floor to the chairman of the subcommittee, Senator Blunt.

Ms. COLLINS

Ms. COLLINS. Thank you, Mr. President. It has been 11 years since a Labor, Health and Human Services, and Education appropriations bill has been considered on the Senate floor, so let me begin my remarks this morning by commending the chairman and ranking member of the full Appropriations Committee, Senators Shelby and Leahy, for their determination to report each and every one of the appropriations bills so they can be considered, fully debated, and amended in the regular order. I also commend the subcommittee chairman, Senator Blunt, and the ranking member, Senator Murray, for their leadership in creating a bipartisan bill. This bill will make critical investments in medical research, opioid abuse prevention and treatment, the education of our students, and strengthening America's workforce. I appreciate so much that the subcommittee accommodated so many of my priorities in crafting this bill. It has my very strong support. I am particularly pleased that the bill includes another $2 billion increase for the National Institutes of Health. Robust investments in biomedical research will pay dividends for many American families struggling with disease and disability, just as such research has enabled us to prevent, treat, or cure other serious illnesses. Notably, this year, for the first time, the bill reaches the milestone of providing at least $2 billion a year for Alzheimer's disease research--the amount that the advisory council to the National Plan to Combat Alzheimer's Disease has calculated is needed to find an effective treatment for this disease by the year 2025. Tomorrow, I will join Senator Blunt and others of my colleagues delivering separate remarks dedicated to this milestone achievement, but I did want to briefly highlight that investment now. As founder and the cochair of the Senate Diabetes Caucus, I am also pleased this bill continues to recognize the importance of investing in diabetes research. Since founding the caucus in 1997, funding for diabetes has increased more than sixfold, from $319 million in 1997 to $2 billion in 2018, and that is only appropriate. We know treating and caring for older people with diabetes consumes approximately one out of three Medicare dollars, so this is a very expensive disease as well as one that causes a great deal of heartache and damage to those who are diagnosed with type 2 diabetes later in life. I have also worked very hard with the Juvenile Research Diabetes Foundation on type 1 diabetes, which is usually diagnosed in childhood and is a lifelong disease. The investments we have made have helped us make real breakthroughs in diabetes treatment. The bill provides a $60 million increase for the National Institute of Diabetes and Digestive and Kidney Disorders at NIH. As the NIH's lead agency for diabetes research, this continued investment is critical to preventing diabetes, improving the lives of more than 30 million Americans, including 12 million seniors already living with the disease, as well as providing the foundation to ultimately discover a cure for type 1 diabetes. This bill provides $3.7 billion in the fight against the opioid epidemic that is gripping our country. Sadly, in my State of Maine, the crisis has actually worsened with drug-related overdoses claiming the lives of 407 people in Maine last year, according to the new statistics from the Centers for Disease Prevention and Control. The crisis in Maine shows no signs of abating. Indeed, the contamination of heroin with fentanyl has made this crisis even worse, taking the lives of even more who are in the grips of addiction. While I am very hopeful the Senate will consider a comprehensive opioids package put together by the Senate HELP Committee, to which many of us contributed in the weeks ahead, it is imperative that the funds provided in this appropriations bill reach our communities without delay. This legislation also funds key priorities for vulnerable seniors, including the Low Income Home Energy Assistance Program, which I know is of interest to the Presiding Officer because he represents the State of Alaska, and that program is critical there, as it is in the State of Maine. It funds the State Health Insurance Program, Meals on Wheels, and other essential programs that make such a difference to our seniors. As chair of the Senate Committee on Aging, I am particularly delighted that this bill provides a $300,000 increase to the administration for community living for the establishment of the family caregivers advisory council. This council was created by a bipartisan bill that I introduced with Senator Baldwin, the RAISE Family Caregivers Act, and it will help develop a coordinated strategic plan to leverage our resources, promote best practices, and expand services and training for our Nation's caregivers. I am sure everyone here has had the experience of a parent who is already older taking care of a disabled spouse--perhaps someone with Alzheimer's disease, which is 24/7 for that caregiver. Caregivers need more support and assistance. They need to know where to go. We need to expand respite care, which is the No. 1 concern I hear from caregivers. Respite care in rural areas is extremely difficult to find. The hearings we have held in the Aging Committee have also put a spotlight on the mobility challenges that many seniors face as they age, such as difficulty climbing steep staircases that can lead to devastating falls, performing routine household chores, taking care of themselves, or being able to drive. This bill provides a $4 million increase for the creation of a new aging and technology program to support the development of assisted technology for seniors with disabilities in rural areas. The University of Maine Center on Aging is doing such interesting work in this area after collaborating with assisted living facilities and talking directly to older Americans to find out what they need. Sometimes it is merely a matter of renovating a bathroom or putting up grab bars, installing sensors to make sure the refrigerator door is being opened regularly so you know the older American is eating properly. Sometimes it is more complicated than that. This center will help us explore how technology can allow more of our seniors to age in place and stay in the comfort, security, and privacy of their own homes, where many of them long to be. Maintaining access to care in rural areas is essential, and, thus, I also support the inclusion of $71.5 million for the Rural Health Care Services Outreach Grant Program. This bill also calls on the Federal Government to remove arbitrary barriers around collaboration between rural and nonrural health providers that could inadvertently close off opportunities. We have seen that happen in my State, where a community health center that is located in Bangor, ME, is trying to help a very rural community, Jackman, ME, which unfortunately recently lost its nursing home and was using the local hospital for assistance. We need to have more collaboration and not let arbitrary bureaucratic rules prevent that kind of cooperation. It is paramount that we do not discourage innovative approaches in healthcare. On a related note, I also applaud the inclusion of increased funding to support community health centers, which serve approximately 27 million Americans, including upward of 186,000 individuals in the State of Maine. Community health centers will only continue to play a larger role in healthcare delivery as we seek to reduce overall healthcare costs, as well as provide greater access to behavioral health and substance use disorder prevention and treatment services. In addition to key health and aging priorities, this bill also supports essential programs at the Department of Education. Notably, this bill provides increased investments in title I, which helps our public schools serve low-income students. The student support in academic enrichment grants, which help to provide students with well- rounded education, is an important program that brings art, music, and technology to our rural community schools. I also strongly support the increased investment in the Individuals with Disabilities Education Act, IDEA, which has provided opportunities to children with disabilities and helped many of them reach their full potential. Across the State of Maine, superintendents, principals, and teachers tell me that one of the most effective ways we can support education overall is to better fund the Federal share of IDEA. That would help every single school district. When IDEA became law in 1975, Congress set a goal of providing 40 percent of the excess cost of serving students with disabilities. I regret to say, we are nowhere near reaching that goal, but this increase in funding for IDEA represents a step forward toward fulfilling that commitment, and I hope we can do more next year. This bill also funds teacher and school leader professional development, and the Rural Education Achievement Program, a law that I coauthored several years ago to bring additional resources to small and rural schools. Students in rural America should have the same access to Federal dollars and a good education as those living in urban and suburban communities. REAP has helped to provide equity for small rural schools in Maine and across the country. It has helped to support an array of activities, such as new technology in classrooms, distance learning opportunities, and professional development. Here is a great example. REAP funding has helped Maine's small island schools connect together to create an island reading program using video conference technology that this program made affordable. In other parts of Maine, REAP has helped schools acquire new technology hardware, software, and to expand teacher training. Having worked at a Maine college before I came to the Senate--Husson University--I know firsthand this bill's important investments in higher education, including Pell Grants and the TRIO Programs. The University of Maine is one of those institutions that has a great TRIO Program. It will help low-income and first-generation students access college education. TRIO often makes the difference in a student's ability to attend and complete a college education. Funding for apprenticeships and workforce development programs are also key priorities that will strengthen Maine's workforce, preparing people with the skills and experience they need to succeed. I could go on and on, but there are many others seeking recognition. Let me just end by urging my colleagues to support the fiscal year 2019 Labor, Health and Human Services, and Education appropriations bill. It is good and much needed legislation. Thank you.

Ms. COLLINS

Ms. COLLINS. Mr. President, in 2010, Bangor Daily News journalist Christopher Cousins wrote a touching essay on a fishing trip he had taken with his young son to the Maine lake where he and his father had fished throughout his childhood. It was his first trip back since his father's death 3 years earlier. That remarkable essay exploring the special bond between father and child and the powerful link between fond memories of the past and hopes for the future took on added poignancy on August 15 when Chris passed away at age 42. At this difficult time, I offer my deepest condolences to his wife, Jen, and his sons, Caleb and Jacob. As a husband and father, Chris was devoted to his family. As a consummate journalist who worked for several Maine newspapers, he was devoted to the best ideals of his profession. His work covered a wide range of subjects, but it consistently demonstrated a commitment to the truth and to providing his readers with the information that is the lifeblood of democracy. Chris joined the Bangor Daily News in 2009, covering local news in southern Penobscot and Somerset Counties with a keen understanding of the issues that concern the people of Maine. In 2010, he covered the Maine Gubernatorial race with extraordinary energy and insight. In 2013, Chris became State house bureau chief for his newspaper. Always tenacious and unfailingly fair, he earned the respect of politicians on both sides of the aisle and throughout the halls of government. His work ethic, skill as a writer, and belief in accountability led to a better understanding of the complex and often contentious issues that confront our State. Chris's passing is a great loss to the people of Maine, his many friends, and his colleagues at the Bangor Daily News. It is a heartbreaking loss to his wonderful family, and I hope they will find comfort in knowing that his contributions and accomplishments truly made a difference to people throughout Maine.

Ms. COLLINS

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

Ms. COLLINS. Mr. President, as a member of the Defense Appropriations Subcommittee, let me begin my remarks by thanking Chairman Shelby and Ranking Member Durbin, as well as Vice Chairman Leahy, for their leadership on the committee and their advocacy for the men and women who defend our Nation. At a time when the threats to our Nation are increasing rather than decreasing, the work of the Defense Subcommittee is vitally important to ensure that our men and women in uniform, as well as our DOD civilian employees, have the training, ships, planes, vehicles, and other equipment they need to defend our country. The bipartisan bill reported out of the committee reaffirms the strategic importance of our Navy and our shipbuilding programs by including funding for three Arleigh Burke-class destroyers in fiscal year 2019, while also including $250 million in advance procurement funding for an additional destroyer in fiscal year 2020. This funding signals our strong belief that the Navy should sustain an aggressive rate of growth for large surface combatants in fiscal year 2020 and beyond in order to project strength in an increasingly dangerous and complex world. In recognition of national security imperatives, the Navy's own 2016 fleet structure assessment increased the target number for large surface combatants to 104 ships from the 88 ships called for under the previous 308-ship Navy requirement. Maintaining a steady and predictable production profile for large ships will not only protect the help of our shipbuilding industrial base but also ensure that the Navy maintains an adequate number of these ships into the future. In Maine, we are very proud of the vital role Bath Iron Works plays in contributing to our national security by building and maintaining ships for the fleet. BIW is known throughout the fleet for the high quality of its ships that are built there, with many Sailors using the motto ``Bath built is best built.'' BIW employs the finest shipbuilders, engineers, and designers in the world. This bill rightly recognizes the great value that these tried and tested warships bring to the Navy. I am also proud of the continued investment this bill makes at our Nation's public shipyards. The additional $350 million provided for facility sustainment, research, restoration, and modernization, as well as the $176 million for shipyard investment acceleration, will help the Portsmouth Naval Shipyard in Kittery, ME, and other public shipyards keep our Nation's submarines at sea for years to come. This bill also makes critical investments in research and development programs that are being carried out in partnership with research institutions such as the University of Maine. These programs include producing jet fuel from Maine's forest biomass, using structural thermoplastics for Army ground vehicles, conducting cellulose nanocomposite research for the Army, developing hybrid composite structures for the Navy, and participating in the Navy's advanced hull form development initiative, among many other essential research and development projects. Our legislation invests in cutting edge, fifth generation aircraft by funding 89 F-35 aircraft. These state-of-the-art planes are truly the future of aviation, and I am proud of Pratt & Whitney's contributions to this program through its construction of the F135 engine at its facility in North Berwick, ME. Additionally, our legislation procures eight heavy-lift helicopters for the Marine Corps. The rotating drive shafts are a critical component of this aircraft and are produced at Hunting Dearborn's facility in Fryeburg, ME. The National Guard, as the Presiding Officer is well aware, provides our country with both a strategic and operational reserve which has proven itself time and again. I applaud the bill's inclusion of providing $900 million to the National Guard and Reserve equipment account to modernize our Reserve Forces and ensure their full interoperability with the Active-Duty Force. Finally, the committee report ensures that Congress has sufficient oversight over any efforts to close or realign facilities of the Defense Finance and Accounting Service. DFAS, as it is called, maintains a highly efficient facility in Limestone, ME. It is responsible for payments to our servicemembers, DOD employees, vendors, and contractors. Given this critical responsibility, I applaud the work done by the hundreds of hard-working employees at Limestone, and I welcome their continued support of our Armed Forces. I am very pleased that we are proceeding the Defense appropriations bill, as well as the Labor-HHS appropriations legislation. I look forward to working with my colleagues to pass both bills in one package this week. I yield the floor. I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that my defense fellow, John-Paul Mantone, be granted floor privileges for the length of the current debate on the appropriations bills that are before us.

Ms. COLLINS

Ms. COLLINS. Mr. President, I call up the following amendments and ask unanimous consent that they be reported by number: No. 3464, No. 3522, No. 3524, and No. 3402.

Ms. COLLINS. Mr. President, I ask unanimous consent that I be permitted to proceed with a closing statement for up to 3 minutes.

Ms. COLLINS. Mr. President, as we near completion of the fiscal year 2019 appropriations bill for Transportation, Housing and Urban Development, and Related Agencies, which has been included in the appropriations package before this Chamber, I wish to thank all of my colleagues for working collaboratively with us. The managers' amendment incorporates 14 T-HUD amendments, which adds to the deliberations that produced the bill that we brought to the floor. In drafting this bill, the ranking member, Senator Jack Reed, to whom I am very grateful for his bipartisan collaboration, reviewed more than 800 requests and input from 70 Senators from both sides of the aisle. This truly is a bipartisan product. I also want to thank the staff for their diligence and commitment throughout this process. Our Transportation-HUD bill makes important investments in our infrastructure and housing programs that will benefit communities and vulnerable families, seniors, young people, homeless veterans, and so many others across the Nation. Improving our infrastructure is also essential for economic growth, personal mobility, and the creation of jobs. I am pleased that we were able to bring this spending bill to the floor so that Members have a full opportunity to analyze and debate this legislation rather than the past practice of moving all the appropriations bills in one enormous, 1,000-page omnibus. That is a great credit to the Senate, to the Appropriations Committee, and particularly its leaders, Senator Shelby and Senator Leahy, and to the majority and minority leaders as well. All of them worked together and made it a goal for us to report all 12 appropriations bills from the Appropriations Committee and bring them to the floor for full and open debate. That is how the process is meant to work. I want to thank my Members on both sides of the aisle and urge my colleagues to support the bill. Mr. President, I wish to also speak about clarifying FDA regulations on ``added sugar'' labeling requirements. It is very important to our pure maple syrup and honey producers in the State of Maine. I rise to thank my colleagues, including Chairman Shelby, for including in the managers' package an amendment that I offered with Senators King, Sanders, Hoeven, Shaheen, and Leahy to help protect our pure maple syrup and honey producers from labeling requirements that could create widespread consumer confusion and negatively affect these industries. Although FDA's ``added sugars'' labeling requirement is intended to help educate consumers about a product's contents, complications arise when it is applied to single-ingredient sweeteners like maple sugar or honey. The rule would require the label to state that all sugar in these products as ``added sugar.'' The Maine Maple Producers Association, along with the individual producers it represents, believes that the term ``added sugar,'' when used with a single ingredient sweetener, will confuse consumers and misrepresent the product's standard of identity. Consumers may assume that high fructose corn syrup or cane sugar has been added to the maple syrup, which directly conflicts with the pure and natural image of the product. Our amendment would ensure that no funds are used to enforce the ``added sugars'' requirement on any single ingredient sugar, honey, agave, or syrup that is packaged for sale as a single ingredient. I am grateful that FDA has acknowledged the serious concerns expressed in the public comments and by Members of Congress, by declaring its intent to ``swiftly formulate a revised approach.'' While we are committed to ultimately achieving an exemption for single- ingredient sweeteners, passage of this amendment is another signal of strong bipartisan, bicameral opposition to the requirement. This is a commonsense solution to avoid harmful unintended consequences of a well-meaning rule, and I thank my colleagues for their support.

Ms. COLLINS

Ms. COLLINS. Mr. President, I commend the Senators who are the authors of this amendment. The Senator from Kansas, Mr. Moran, has discussed this issue with me many times, as have the Senators from New Mexico who feel very strongly about it as well. I know the Senators from Colorado are also cosponsors. As chairman of the subcommittee with jurisdiction over the funding for Amtrak, I support this amendment. Amtrak's national network is vital for the hundreds of communities across the country it serves, particularly in the more rural areas of our country. At a hearing I chaired this past May with the ranking member, Senator Reed, Amtrak committed to not making service changes in advance of new authorizing legislation. It also committed to consulting with the communities it serves before making changes that would affect the residents of those communities. We fully expect Amtrak to stand by the commitments that were made at our May hearing. This amendment conveys our longstanding support for long-distance passenger rail service, and I encourage my colleagues to adopt it.

Ms. COLLINS. I ask for the yeas and nays.

Ms. COLLINS. Mr. President, we are continuing to make progress on this package of appropriations bills. Speaking for the managers on this side of the aisle--the Republican chairman of the subcommittee--I request that our colleagues file amendments at the desk by 1 p.m. tomorrow.

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