Susan Collins

Ms. COLLINS

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 Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Ms. COLLINS

Ms. COLLINS. Mr. President, as Chairman of the Senate Aging Committee, I am delighted to introduce, with my good friend and former ranking member, Senator Claire McCaskill, the Senior$afe Act of 2017, a bill that would help protect American seniors from financial fraud. I'm pleased that Senators Isakson, Casey, Tillis, Klobuchar, Wicker, Shaheen, Capito, Tester, Barrasso, Donnelly, Heller, and King have joined us in sponsoring this bill. According to the GAO, financial fraud targeting older Americans is a growing epidemic that costs seniors an estimated $2.9 billion annually. Stopping this tsunami of fraud is one of the top priorities of the Aging Committee. Last Congress, we held several hearings examining an endless variety of financial abuses targeting our nation's seniors. These range from the notorious IRS phone scam that burst onto the scene in 2015, to the incredible ``drug mule'' scam, where trusting seniors have been tricked by international narcotics traffickers into unwittingly serving as drug couriers, and then find themselves arrested and locked-up in foreign jails. The common denominator in these schemes involves innocent seniors falling prey and being tricked out of their hard-earned savings. Sadly, not all scammers are strangers to their victims, in too many cases, seniors are exploited by someone they know well. Sometimes, that abuse is perpetrated by ``friends'' or family members who are handling the victim's affairs informally. Other times, the abuse is committed under color of a fiduciary relationship, such as a Power of Attorney or guardianship. No matter the scheme, one factor is common to all--the fraudsters need to gain the trust and active cooperation of their victims. Without this, their schemes would fail. That is why it is so important that seniors recognize as quickly as possible the red flags that signal potential fraud. Unfortunately, many seniors do not see these red flags. Sometimes they are too trusting or are suffering from diminished capacity, but, just as often, they miss the signs because the swindlers who prey on them are extremely crafty and know how to sound convincing. Whatever the reason, a warning sign that can slip by a victim might trigger a second look by fmancial service representatives trained to spot common scams, who know enough about a senior's habits to question a transaction that doesn't look right. In our work on the Aging Committee, we have heard of many instances where quick action by bank and credit union employees has stopped a fraud in progress, saving seniors untold thousands of dollars. Let me give you an example. Last year, an attorney in the small coastal city of Belfast, ME, was sentenced to 30 months in prison for bilking two elderly female clients out of nearly a half a million dollars over the course of several years. The lawyer's brazen theft was uncovered when a teller at a local bank noticed that he was writing large checks to himself on his clients' accounts. When confronted by authorities, he offered excuses that the prosecutor later described as ``breathtaking.'' For example, according to press reports, he put one of his clients into a nursing home to recover from a temporary medical condition, and then kept her there for four years until the theft of her funds came to light. Meanwhile, he submitted bills for ``services,'' sometimes totaling $20,000 a month, including charging her $250 per hour for 6 to 7 hours to check on her house, even though his office was just a one-minute drive down the road. In another example, in 2015, a senior citizen in Vassalboro, Maine, was looking to wire funds from his account at Maine Savings Federal Credit Union to an out-of-state location, supposedly to bail out a relative who was in jail. Something about this transaction did not sound right to the credit union employee. She asked the customer, and he said he had received a call from an ``official'' at the jail--but that ``official'' had instructed him not to speak to anyone about this. The ``official,'' of course, turned out to be a con artist. Fortunately, the credit union worker recognized this as a scam, and her quick thinking saved her customer from falling victim and losing his savings. These stories demonstrate the critical nexus that financial institutions occupy between fraudsters and their victims. Their employees, if properly trained, can be the first line of defense protecting our seniors from these criminals. Regrettably, various state and federal laws can inadvertently impede efforts to protect seniors, because financial institutions that report suspected fraud can be exposed to litigation. The Senior$afe Act encourages financial institutions to train their employees, and shields them from lawsuits when they make good faith, reasonable reports of potential fraud to the proper authorities. There is no doubt that financial fraud and scams targeting seniors is a growing problem that we must act on. Last November, the Aging Committee heard testimony from Jaye Martin, the Executive Director of Maine Legal Services for the Elderly, who told the Committee that her organization has seen a 24 percent increase in reports of elder abuse in just one year. Many of these cases involve financial fraud. In a letter describing her support for the Senior$afe Act, Ms. Martin says that: In a landscape that includes family members who often wish to keep exploitation from coming to light because they are perpetrating the exploitation, the risk of facing potential nuisance or false complaints over privacy violations is all too real. This is a barrier that must be removed so that financial institutions will act immediately to report to the proper authorities upon forming a reasonable belief that exploitation is occurring. These professionals are on the front lines in the fight against elder financial exploitation and are often the only ones in a position to stop exploitation before it is too late. Our bill is based on Maine's innovative Senior$afe program, a collaborative effort by Maine's regulators, financial institutions, and legal organizations to educate bank and credit union employees on how to identify and help stop financial exploitation of older Mainers. This program, pioneered by Maine Securities Administrator Judith Shaw, also serves as the template for model legislation developed for adoption at the state level by the North American Securities Administrators Association, or NASAA. The Senior$afe Act and NASAA's model state legislation are complementary efforts, and I am pleased that NASAA has endorsed our bill. I am pleased that our bill has received bipartisan support in both houses of Congress. Last year, the House Financial Services Committee approved a version of the Senior$afe Act by a vote of 59 to zero, and it passed the full House by voice vote in July. In the Senate, the Senior$afe Act was cosponsored by a quarter of the Members of this body, balanced nearly evenly on both sides of the aisle, and was discharged out of the Banking Committee. Unfortunately, just one member of this body blocked it and prevented it from becoming law. Besides receiving broad support in Congress, our bill has the support of a wide range of stakeholders, ranging from the State securities administrators and insurance commissioners to advocates for seniors. Combating financial abuse of seniors requires regulators, law enforcement and social service agencies at all levels of government to work collaboratively with the private sector. The Senior$afe Act encourages financial institutions to train their employees, and shields them from lawsuits when they make good faith, reasonable reports of potential fraud to the proper authorities. Mr. President, I ask unanimous consent that letters of support be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Mr. President, as Chairman of the Senate Aging Committee, I am delighted to introduce, with my good friend and former ranking member, Senator Claire McCaskill, the Senior$afe Act of 2017, a bill that would help protect American seniors from financial fraud. I'm pleased that Senators Isakson, Casey, Tillis, Klobuchar, Wicker, Shaheen, Capito, Tester, Barrasso, Donnelly, Heller, and King have joined us in sponsoring this bill. According to the GAO, financial fraud targeting older Americans is a growing epidemic that costs seniors an estimated $2.9 billion annually. Stopping this tsunami of fraud is one of the top priorities of the Aging Committee. Last Congress, we held several hearings examining an endless variety of financial abuses targeting our nation's seniors. These range from the notorious IRS phone scam that burst onto the scene in 2015, to the incredible ``drug mule'' scam, where trusting seniors have been tricked by international narcotics traffickers into unwittingly serving as drug couriers, and then find themselves arrested and locked-up in foreign jails. The common denominator in these schemes involves innocent seniors falling prey and being tricked out of their hard-earned savings. Sadly, not all scammers are strangers to their victims, in too many cases, seniors are exploited by someone they know well. Sometimes, that abuse is perpetrated by ``friends'' or family members who are handling the victim's affairs informally. Other times, the abuse is committed under color of a fiduciary relationship, such as a Power of Attorney or guardianship. No matter the scheme, one factor is common to all--the fraudsters need to gain the trust and active cooperation of their victims. Without this, their schemes would fail. That is why it is so important that seniors recognize as quickly as possible the red flags that signal potential fraud. Unfortunately, many seniors do not see these red flags. Sometimes they are too trusting or are suffering from diminished capacity, but, just as often, they miss the signs because the swindlers who prey on them are extremely crafty and know how to sound convincing. Whatever the reason, a warning sign that can slip by a victim might trigger a second look by fmancial service representatives trained to spot common scams, who know enough about a senior's habits to question a transaction that doesn't look right. In our work on the Aging Committee, we have heard of many instances where quick action by bank and credit union employees has stopped a fraud in progress, saving seniors untold thousands of dollars. Let me give you an example. Last year, an attorney in the small coastal city of Belfast, ME, was sentenced to 30 months in prison for bilking two elderly female clients out of nearly a half a million dollars over the course of several years. The lawyer's brazen theft was uncovered when a teller at a local bank noticed that he was writing large checks to himself on his clients' accounts. When confronted by authorities, he offered excuses that the prosecutor later described as ``breathtaking.'' For example, according to press reports, he put one of his clients into a nursing home to recover from a temporary medical condition, and then kept her there for four years until the theft of her funds came to light. Meanwhile, he submitted bills for ``services,'' sometimes totaling $20,000 a month, including charging her $250 per hour for 6 to 7 hours to check on her house, even though his office was just a one-minute drive down the road. In another example, in 2015, a senior citizen in Vassalboro, Maine, was looking to wire funds from his account at Maine Savings Federal Credit Union to an out-of-state location, supposedly to bail out a relative who was in jail. Something about this transaction did not sound right to the credit union employee. She asked the customer, and he said he had received a call from an ``official'' at the jail--but that ``official'' had instructed him not to speak to anyone about this. The ``official,'' of course, turned out to be a con artist. Fortunately, the credit union worker recognized this as a scam, and her quick thinking saved her customer from falling victim and losing his savings. These stories demonstrate the critical nexus that financial institutions occupy between fraudsters and their victims. Their employees, if properly trained, can be the first line of defense protecting our seniors from these criminals. Regrettably, various state and federal laws can inadvertently impede efforts to protect seniors, because financial institutions that report suspected fraud can be exposed to litigation. The Senior$afe Act encourages financial institutions to train their employees, and shields them from lawsuits when they make good faith, reasonable reports of potential fraud to the proper authorities. There is no doubt that financial fraud and scams targeting seniors is a growing problem that we must act on. Last November, the Aging Committee heard testimony from Jaye Martin, the Executive Director of Maine Legal Services for the Elderly, who told the Committee that her organization has seen a 24 percent increase in reports of elder abuse in just one year. Many of these cases involve financial fraud. In a letter describing her support for the Senior$afe Act, Ms. Martin says that: In a landscape that includes family members who often wish to keep exploitation from coming to light because they are perpetrating the exploitation, the risk of facing potential nuisance or false complaints over privacy violations is all too real. This is a barrier that must be removed so that financial institutions will act immediately to report to the proper authorities upon forming a reasonable belief that exploitation is occurring. These professionals are on the front lines in the fight against elder financial exploitation and are often the only ones in a position to stop exploitation before it is too late. Our bill is based on Maine's innovative Senior$afe program, a collaborative effort by Maine's regulators, financial institutions, and legal organizations to educate bank and credit union employees on how to identify and help stop financial exploitation of older Mainers. This program, pioneered by Maine Securities Administrator Judith Shaw, also serves as the template for model legislation developed for adoption at the state level by the North American Securities Administrators Association, or NASAA. The Senior$afe Act and NASAA's model state legislation are complementary efforts, and I am pleased that NASAA has endorsed our bill. I am pleased that our bill has received bipartisan support in both houses of Congress. Last year, the House Financial Services Committee approved a version of the Senior$afe Act by a vote of 59 to zero, and it passed the full House by voice vote in July. In the Senate, the Senior$afe Act was cosponsored by a quarter of the Members of this body, balanced nearly evenly on both sides of the aisle, and was discharged out of the Banking Committee. Unfortunately, just one member of this body blocked it and prevented it from becoming law. Besides receiving broad support in Congress, our bill has the support of a wide range of stakeholders, ranging from the State securities administrators and insurance commissioners to advocates for seniors. Combating financial abuse of seniors requires regulators, law enforcement and social service agencies at all levels of government to work collaboratively with the private sector. The Senior$afe Act encourages financial institutions to train their employees, and shields them from lawsuits when they make good faith, reasonable reports of potential fraud to the proper authorities. Mr. President, I ask unanimous consent that letters of support be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Mr. President, first, let me commend the Senator from Louisiana for his extraordinary work on this bill. It has been a great pleasure to work so closely with him as we have made a genuine effort to put together a bill that would be a reasonable replacement for ObamaCare that would help to bring people together. I wish to commend the Senator from Louisiana for his expertise. As a physician, Senator Cassidy brings an important perspective to this debate, particularly since he has practiced for so many years in hospitals in Louisiana that serve the uninsured. So I wish to personally thank him for the privilege of working together to craft this bill. There has been much debate recently on the best approach to replacing and reforming the Affordable Care Act. Considerable confusion and anxiety exists about the current status of the law and about the future of health care in our country. However, what is often overlooked in this discussion is that while the ACA provides valuable assistance for some people who were previously uninsured, the system created by the law is under tremendous financial strain. ObamaCare exchanges are on the verge of collapse in many States. The reality is that significant changes must be made. Doing nothing is not an option. I am, therefore, both surprised and disappointed by the remarks of the Democratic leader to the press and on the floor today about the genuine effort that Senator Cassidy and I have put forward in introducing the Patient Freedom Act. First of all, let me point out that the Democratic leader could not possibly have read our bill since we haven't introduced it yet, and it is evident that he has misunderstood many of its provisions. For example, in a press statement, he said we gutted the preexisting condition protections that we strongly support and that are codified in our bill in section 101(b). Again, that is section 101(b). It ensures that insurers cannot discriminate against individuals with preexisting conditions who pay their premiums. I guess what disappoints me most is that the Democratic leader's response really represents what is wrong with Washington, DC. The American people want us to come together. They want Democrats and Republicans to work as a team to solve the problems facing our Nation. If we are going to have a leader on the other side of the aisle denounce to the press and come to the Senate floor to criticize a bill that has not even been introduced yet, where are we? I really hope this is an aberration and that we can work together and that the compromises we put in the bill are recognized as a good-faith effort to bring both sides of the aisle together in the interests of the American people and in providing access to affordable health care. That is our goal. We are not saying our bill is perfect. We are open to refinements. We have made a good-faith effort, and to hear it described inaccurately and as other than a genuine effort to solve a problem truly disappoints me. The fact is, the ACA has been in effect for years. Yet nearly 30 million Americans still do not have health insurance coverage. Many of those who do have coverage through the ACA exchanges are experiencing large spikes in premiums, deductibles, and copays, increasing costs to consumers and taxpayers alike. Contrary to the predictions made by the early supporters of the ACA, premiums are increasing in nearly every State, with an average increase of 25 percent nationally. In New York State, the average increase on the exchange is 16.6 percent. I don't know, but perhaps the Democratic leader thinks that is an acceptable rate of increase. It strikes me as pretty high, and even though it is below the national average, it is still in double digits. The situation is even more dire in some States like Arizona, where premiums have increased by 116 percent. In many counties throughout our country, there are only one or two health insurers offering plans on the exchanges, severely limiting consumer choice. In my State of Maine, premiums for the individual market for 2017 have soared by 22 percent, on average, and plan options have become more limited. Now, while subsidies do cushion the blow for those consumers who are eligible for them, others have had to shoulder the full increase, and of course taxpayers have borne a greater burden. Moreover, individuals and families with incomes exceeding 250 percent of the poverty rate are not shielded from the dramatic increases in deductibles and copays. That is important to remember. The premium subsidy applies to incomes up to 400 percent of the poverty rate. It then drops off the cliff, and you are eligible for no subsidy whatsoever--there is no orderly phaseout. For help with copays and deductibles under the Affordable Care Act, the threshold is 250 percent of the poverty rate. These huge premium spikes and increases in deductibles and larger copays are having an effect on families and individuals--who are by no means wealthy--all over this Nation. Millions with coverage under the ACA are also facing increasingly narrow networks, which means they may find their preferred doctors are not in their networks. This can be particularly difficult for rural States that may have few specialists and whose citizens rely on major medical centers in nearby States. If patients want to continue to see these doctors, they can be faced with enormous costs that are not covered by their ACA insurance. As one Mainer put it, ``[President] Obama said I could keep my doctor, and the insurance company says I can't.'' The co-ops created under the ACA to help provide health insurance coverage have been failing at an alarming rate. In fact, only 5 of the 23 remain operational. It is also important to carefully consider the effects that ObamaCare's Medicare cuts have had on providers like rural hospitals and home health agencies, many of whom are struggling. In sum, prices are skyrocketing, coverage is narrowing, and the individual market is likely in a death spiral if Congress fails to act. I know many Members of this Chamber share the goal of expanding access to affordable health care. Over the years, I have collaborated with colleagues on both sides of the aisle on a number of initiatives. Today I am pleased to join my colleague, Senator and Doctor Bill Cassidy, in introducing the Patient Freedom Act of 2017 to help ensure that Americans have access to affordable health care that improves choices and helps to restrain costs. Let me emphasize again that our bill is a work in progress. It is not perfect. However, what it does--and it is virtually unique in this regard, in this Chamber--is it puts specific proposals on the table as we seek to craft bills to repair and improve the Affordable Care Act. Other legislation being discussed, such as those designed to help small businesses pool risks so they can better afford to provide insurance to their employees, also deserves consideration. Let's get a lot of ideas on the table. We have to start, and we have been willing to step forward and propose a specific bill. To be criticized for that by the Democratic leader is just so disappointing, particularly since the leader is well aware that I work across the aisle all the time to try to find solutions for our country. The Patient Freedom Act is built on the premise that giving people more choices is superior to the one-size-fits-all approach that defined the Affordable Care Act. We recognize that what works best for people in Maine or New Hampshire may not be right for people in New York or California. Our bill respects those differences by giving States options to choose the path that works best for their citizens. Now, option one would allow a State to choose to continue operating its insurance markets pursuant to all the rules of the Affordable Care Act. So if New York State wants to keep with the status quo, despite the 16.6-percent increase, on average, in the premiums for the individual market, New York State can make that choice. If a State chooses to remain covered by the ACA, exchange policies will continue to be eligible for cost-sharing subsidies and advanced premium tax credits, and the insurance markets will still be subject to ACA requirements. The individual mandate and the employer mandate will also remain in place for that State. Medicaid expansion States will continue to receive Federal funding. So if a State is happy with the status quo--with spiraling costs, with limited choices, with a market that is broken--fine, keep the ACA. In some States, maybe it is working well. States should have that option, and they would under the Cassidy- Collins bill. More appealing to many States, however, would be what we call the better choice option in the Patient Freedom Act that would allow a State to waive many of the requirements of the ACA, except for vital consumer protections, and still receive Federal funding to help its residents purchase affordable health insurance. Senator Cassidy has explained how it would work so I will not go through that all again. Let me just say that eligible individuals in States selecting this option would receive Federal funding deposited into their Roth health savings accounts. The aggregate funding for these per-beneficiary deposits would be determined based on the total amount of funding that the Federal Government would have provided in the form of ACA subsidies in each State, plus any funding each State would have received had it chosen to expand its Medicaid Program--even if, like my State, it has chosen not to do so. These deposits in the Roth health savings accounts would be phased out for higher income beneficiaries. States selecting this option for every resident who does not have health insurance coverage through his or her employer or through public programs like Medicare or the VA or the Federal Employees Health Benefits Program--in those States, the option would be a standard health insurance plan that would include first-dollar coverage through the Roth health savings account, basic prescription drug coverage, and a high-deductible health plan. States could automatically enroll their residents who are uninsured in this standard plan, unless an individual opted to use his or her health savings account to purchase more comprehensive coverage or opted out of coverage altogether. I can't imagine someone making the choice of opting out altogether when they would receive this generous subsidy. In addition to Federal funds, individuals and employers could make contributions to these health savings accounts, and the balances would grow tax-free. The bill also provides for a partial tax credit for very low-income individuals who do receive employer-based coverage to help these workers pay for their deductibles and their copays. Here is another important provision of our bill: Health care providers receiving payments from the Roth health savings accounts would be required to publish cash prices for their services. That would add transparency that is sorely lacking in our current system and that we need to move toward a more patient-directed health care future. For example, if your physician has suggested that you have a colonoscopy, you would know whether one hospital or one clinic would charge more than another so you can make the right decision for you. Health care reform should be about expanding affordable choices, and that is what our legislation aims to do by allowing States to structure their individual health insurance markets and to do so without the burdensome individual mandate, the employer mandate, or many of the other restrictive requirements in the ACA that have substantially driven up costs and forced millions of Americans to buy coverage that is more than they want, need, or can afford. Americans should have the choice to purchase more affordable coverage, if that is what works best for them. Let me again emphasize, since misinformation was given to the press about the consumer protections in our bill, the Patient Freedom Act would retain several important consumer protections, contrary to what was said earlier today by a colleague who hadn't read our bill. Dependents will be able to remain on their parents' health insurance policies until age 26. Insurance companies will still not be able to exclude coverage for preexisting conditions or discriminate based on health status. In fact, there is no medical underwriting for the standard plan offered under the better choice option. Insurance companies cannot cap benefits by including lifetime or annual limits in their policies, and they must offer to renew policies as long as enrollees continue to pay premiums. Insurance companies must also continue to cover mental health and substance use disorder benefits for individuals, a particularly important benefit given the nationwide scope of the opioid crisis that has seriously affected my State of Maine and so many other States throughout our country, ruining the lives of individuals, their families, and their communities. Provisions like these vital consumer protections should be retained. However, the Washington centric approach of the ACA must be changed if we are ever to truly reform our broken health care system. I am pleased to see a growing consensus among Members of both the Senate and the House that we must fix the Affordable Care Act and provide reforms at nearly the same time as we repeal the law. This will help protect the families who rely on the program and give insurers time to transition to a new marketplace that is based on more choices for consumers. That is what we are trying to do here. Reforms in the way we provide health insurance must ensure that individuals relying on the current system do not experience a needless and avoidable gap in coverage. If we are going to reform the system, we must begin to put specific proposals on the table for our colleagues to debate, refine, amend, and enact. That is why the criticism is so disappointing. This is an attempt to put forth a possible solution that would appeal to Members on both sides of the aisle. As we continue our work to find a responsible path to repealing and repairing the ACA, we should give the States the freedom to choose what they believe works best for their citizens, whether that means staying with the Affordable Care Act or selecting a different path--in my view, a better path--that will lead to patient-directed reforms that contain costs and provide more choice. The Patient Freedom Act does exactly that, and I commend my colleague Senator Cassidy for his leadership on this legislation. I also want to thank our cosponsors, including Senator Isakson and Senator Capito for their support as well.

Ms. COLLINS

Ms. COLLINS. Mr. President, first, let me commend the Senator from Louisiana for his extraordinary work on this bill. It has been a great pleasure to work so closely with him as we have made a genuine effort to put together a bill that would be a reasonable replacement for ObamaCare that would help to bring people together. I wish to commend the Senator from Louisiana for his expertise. As a physician, Senator Cassidy brings an important perspective to this debate, particularly since he has practiced for so many years in hospitals in Louisiana that serve the uninsured. So I wish to personally thank him for the privilege of working together to craft this bill. There has been much debate recently on the best approach to replacing and reforming the Affordable Care Act. Considerable confusion and anxiety exists about the current status of the law and about the future of health care in our country. However, what is often overlooked in this discussion is that while the ACA provides valuable assistance for some people who were previously uninsured, the system created by the law is under tremendous financial strain. ObamaCare exchanges are on the verge of collapse in many States. The reality is that significant changes must be made. Doing nothing is not an option. I am, therefore, both surprised and disappointed by the remarks of the Democratic leader to the press and on the floor today about the genuine effort that Senator Cassidy and I have put forward in introducing the Patient Freedom Act. First of all, let me point out that the Democratic leader could not possibly have read our bill since we haven't introduced it yet, and it is evident that he has misunderstood many of its provisions. For example, in a press statement, he said we gutted the preexisting condition protections that we strongly support and that are codified in our bill in section 101(b). Again, that is section 101(b). It ensures that insurers cannot discriminate against individuals with preexisting conditions who pay their premiums. I guess what disappoints me most is that the Democratic leader's response really represents what is wrong with Washington, DC. The American people want us to come together. They want Democrats and Republicans to work as a team to solve the problems facing our Nation. If we are going to have a leader on the other side of the aisle denounce to the press and come to the Senate floor to criticize a bill that has not even been introduced yet, where are we? I really hope this is an aberration and that we can work together and that the compromises we put in the bill are recognized as a good-faith effort to bring both sides of the aisle together in the interests of the American people and in providing access to affordable health care. That is our goal. We are not saying our bill is perfect. We are open to refinements. We have made a good-faith effort, and to hear it described inaccurately and as other than a genuine effort to solve a problem truly disappoints me. The fact is, the ACA has been in effect for years. Yet nearly 30 million Americans still do not have health insurance coverage. Many of those who do have coverage through the ACA exchanges are experiencing large spikes in premiums, deductibles, and copays, increasing costs to consumers and taxpayers alike. Contrary to the predictions made by the early supporters of the ACA, premiums are increasing in nearly every State, with an average increase of 25 percent nationally. In New York State, the average increase on the exchange is 16.6 percent. I don't know, but perhaps the Democratic leader thinks that is an acceptable rate of increase. It strikes me as pretty high, and even though it is below the national average, it is still in double digits. The situation is even more dire in some States like Arizona, where premiums have increased by 116 percent. In many counties throughout our country, there are only one or two health insurers offering plans on the exchanges, severely limiting consumer choice. In my State of Maine, premiums for the individual market for 2017 have soared by 22 percent, on average, and plan options have become more limited. Now, while subsidies do cushion the blow for those consumers who are eligible for them, others have had to shoulder the full increase, and of course taxpayers have borne a greater burden. Moreover, individuals and families with incomes exceeding 250 percent of the poverty rate are not shielded from the dramatic increases in deductibles and copays. That is important to remember. The premium subsidy applies to incomes up to 400 percent of the poverty rate. It then drops off the cliff, and you are eligible for no subsidy whatsoever--there is no orderly phaseout. For help with copays and deductibles under the Affordable Care Act, the threshold is 250 percent of the poverty rate. These huge premium spikes and increases in deductibles and larger copays are having an effect on families and individuals--who are by no means wealthy--all over this Nation. Millions with coverage under the ACA are also facing increasingly narrow networks, which means they may find their preferred doctors are not in their networks. This can be particularly difficult for rural States that may have few specialists and whose citizens rely on major medical centers in nearby States. If patients want to continue to see these doctors, they can be faced with enormous costs that are not covered by their ACA insurance. As one Mainer put it, ``[President] Obama said I could keep my doctor, and the insurance company says I can't.'' The co-ops created under the ACA to help provide health insurance coverage have been failing at an alarming rate. In fact, only 5 of the 23 remain operational. It is also important to carefully consider the effects that ObamaCare's Medicare cuts have had on providers like rural hospitals and home health agencies, many of whom are struggling. In sum, prices are skyrocketing, coverage is narrowing, and the individual market is likely in a death spiral if Congress fails to act. I know many Members of this Chamber share the goal of expanding access to affordable health care. Over the years, I have collaborated with colleagues on both sides of the aisle on a number of initiatives. Today I am pleased to join my colleague, Senator and Doctor Bill Cassidy, in introducing the Patient Freedom Act of 2017 to help ensure that Americans have access to affordable health care that improves choices and helps to restrain costs. Let me emphasize again that our bill is a work in progress. It is not perfect. However, what it does--and it is virtually unique in this regard, in this Chamber--is it puts specific proposals on the table as we seek to craft bills to repair and improve the Affordable Care Act. Other legislation being discussed, such as those designed to help small businesses pool risks so they can better afford to provide insurance to their employees, also deserves consideration. Let's get a lot of ideas on the table. We have to start, and we have been willing to step forward and propose a specific bill. To be criticized for that by the Democratic leader is just so disappointing, particularly since the leader is well aware that I work across the aisle all the time to try to find solutions for our country. The Patient Freedom Act is built on the premise that giving people more choices is superior to the one-size-fits-all approach that defined the Affordable Care Act. We recognize that what works best for people in Maine or New Hampshire may not be right for people in New York or California. Our bill respects those differences by giving States options to choose the path that works best for their citizens. Now, option one would allow a State to choose to continue operating its insurance markets pursuant to all the rules of the Affordable Care Act. So if New York State wants to keep with the status quo, despite the 16.6-percent increase, on average, in the premiums for the individual market, New York State can make that choice. If a State chooses to remain covered by the ACA, exchange policies will continue to be eligible for cost-sharing subsidies and advanced premium tax credits, and the insurance markets will still be subject to ACA requirements. The individual mandate and the employer mandate will also remain in place for that State. Medicaid expansion States will continue to receive Federal funding. So if a State is happy with the status quo--with spiraling costs, with limited choices, with a market that is broken--fine, keep the ACA. In some States, maybe it is working well. States should have that option, and they would under the Cassidy- Collins bill. More appealing to many States, however, would be what we call the better choice option in the Patient Freedom Act that would allow a State to waive many of the requirements of the ACA, except for vital consumer protections, and still receive Federal funding to help its residents purchase affordable health insurance. Senator Cassidy has explained how it would work so I will not go through that all again. Let me just say that eligible individuals in States selecting this option would receive Federal funding deposited into their Roth health savings accounts. The aggregate funding for these per-beneficiary deposits would be determined based on the total amount of funding that the Federal Government would have provided in the form of ACA subsidies in each State, plus any funding each State would have received had it chosen to expand its Medicaid Program--even if, like my State, it has chosen not to do so. These deposits in the Roth health savings accounts would be phased out for higher income beneficiaries. States selecting this option for every resident who does not have health insurance coverage through his or her employer or through public programs like Medicare or the VA or the Federal Employees Health Benefits Program--in those States, the option would be a standard health insurance plan that would include first-dollar coverage through the Roth health savings account, basic prescription drug coverage, and a high-deductible health plan. States could automatically enroll their residents who are uninsured in this standard plan, unless an individual opted to use his or her health savings account to purchase more comprehensive coverage or opted out of coverage altogether. I can't imagine someone making the choice of opting out altogether when they would receive this generous subsidy. In addition to Federal funds, individuals and employers could make contributions to these health savings accounts, and the balances would grow tax-free. The bill also provides for a partial tax credit for very low-income individuals who do receive employer-based coverage to help these workers pay for their deductibles and their copays. Here is another important provision of our bill: Health care providers receiving payments from the Roth health savings accounts would be required to publish cash prices for their services. That would add transparency that is sorely lacking in our current system and that we need to move toward a more patient-directed health care future. For example, if your physician has suggested that you have a colonoscopy, you would know whether one hospital or one clinic would charge more than another so you can make the right decision for you. Health care reform should be about expanding affordable choices, and that is what our legislation aims to do by allowing States to structure their individual health insurance markets and to do so without the burdensome individual mandate, the employer mandate, or many of the other restrictive requirements in the ACA that have substantially driven up costs and forced millions of Americans to buy coverage that is more than they want, need, or can afford. Americans should have the choice to purchase more affordable coverage, if that is what works best for them. Let me again emphasize, since misinformation was given to the press about the consumer protections in our bill, the Patient Freedom Act would retain several important consumer protections, contrary to what was said earlier today by a colleague who hadn't read our bill. Dependents will be able to remain on their parents' health insurance policies until age 26. Insurance companies will still not be able to exclude coverage for preexisting conditions or discriminate based on health status. In fact, there is no medical underwriting for the standard plan offered under the better choice option. Insurance companies cannot cap benefits by including lifetime or annual limits in their policies, and they must offer to renew policies as long as enrollees continue to pay premiums. Insurance companies must also continue to cover mental health and substance use disorder benefits for individuals, a particularly important benefit given the nationwide scope of the opioid crisis that has seriously affected my State of Maine and so many other States throughout our country, ruining the lives of individuals, their families, and their communities. Provisions like these vital consumer protections should be retained. However, the Washington centric approach of the ACA must be changed if we are ever to truly reform our broken health care system. I am pleased to see a growing consensus among Members of both the Senate and the House that we must fix the Affordable Care Act and provide reforms at nearly the same time as we repeal the law. This will help protect the families who rely on the program and give insurers time to transition to a new marketplace that is based on more choices for consumers. That is what we are trying to do here. Reforms in the way we provide health insurance must ensure that individuals relying on the current system do not experience a needless and avoidable gap in coverage. If we are going to reform the system, we must begin to put specific proposals on the table for our colleagues to debate, refine, amend, and enact. That is why the criticism is so disappointing. This is an attempt to put forth a possible solution that would appeal to Members on both sides of the aisle. As we continue our work to find a responsible path to repealing and repairing the ACA, we should give the States the freedom to choose what they believe works best for their citizens, whether that means staying with the Affordable Care Act or selecting a different path--in my view, a better path--that will lead to patient-directed reforms that contain costs and provide more choice. The Patient Freedom Act does exactly that, and I commend my colleague Senator Cassidy for his leadership on this legislation. I also want to thank our cosponsors, including Senator Isakson and Senator Capito for their support as well.

Ms. COLLINS

Ms. COLLINS. Mr. President, first, let me start by commending the Senator from Louisiana for all of the thought and the work he has put into coming up with an alternative plan that would fix ObamaCare and result in more Americans having affordable health insurance. As a physician, Senator Cassidy cares deeply about his patients and about patients in general. His goal, which I share, is to make sure every American has access to affordable health care. I commend him for his hard work and leadership. There has been much debate lately on the best approach to replacing and reforming the Affordable Care Act, also known as ObamaCare. Some of my colleagues have argued for immediate repeal without any replacement, an option I reject, for it risks leaving millions of vulnerable Americans without affordable health insurance and would undo important consumer protections provided by current law. Others have proposed repeal with a delayed effective date of 2 or 3 years to allow time for the Senate to devise legislation that would provide a better approach to health insurance. My concern with the repeal-and-delay plan is that the ObamaCare exchanges, already on very shaky financial ground, would go into a death spiral as consumers would face uncertainty and insurers would have no basis for pricing their policies. Already we have seen insurers fleeing the marketplaces in many States, reducing choices for consumers. In some States, only one or two insurers remain on the exchanges, leaving individuals and families with few, if any, choice of insurance carriers. Every single one of the 23 State cooperatives whose startup costs were financed by ObamaCare has experienced severe financial problems and only five remain operational today. Many States, including Maine, are experiencing double-digit increases in premiums, causing increased costs for consumers and for taxpayers. So repeal and delay would only exacerbate this problem. I am pleased to see a growing consensus among Members of both the Senate and the House that we must fix ObamaCare, provide reforms at nearly the same time that we repeal the law, in order to protect families who rely on the program and to give insurers time to transition to a new marketplace that is based on more choices for consumers. Many of us have been working for years on proposals to reform our health care system, to expand coverage, and to encourage new delivery systems that would help restrain the growth in health care costs. That is what the legislation that I am going to be pleased to be joining my colleague from Louisiana on, would do. It is focused on giving more choices while ensuring that consumers have access to affordable health insurance. We have advanced bipartisan proposals in the past to deal with provisions of the law that have increased costs and discouraged employers from hiring full-time workers. Regrettably, every such reform has been met with a veto threat. That is why we continued to work. In 2015, I joined Senator Cassidy in introducing a more comprehensive and creative approach, the Patient Freedom Act, which is the basis for the legislation we are going to be introducing soon. It would allow States to have more choices. If they like the Affordable Care Act, they can keep the Affordable Care Act. If they want to go an alternative route that is more patient-centered, that would provide more choices and help to restrain costs, they can do that, too, and the Federal Government would bundle the funding that would otherwise be used for ACA subsidies and the expansion of Medicaid in their State and allow them to proceed along a more creative route. We recognize how different the needs of our States are, but our citizens should have access to affordable health care and be able to choose the path that works best for them. We will be talking more about the specifics of our bill when we introduce it, but I am excited about this approach. I am not saying it is perfect, but it is important that we put specific proposals on the table that our colleagues can coalesce around, debate, and refine so that we can move ahead and remove the fear and uncertainty of families who are relying on coverage through the exchanges without putting an undue burden on the employers who create jobs in this country. Mr. President, let me again commend the Senator from Louisiana. He has worked so hard to come up with a fresh approach. He has been very open to suggestions that I and others have made. We all understand the importance of maintaining the consumer protections that help individuals with preexisting conditions, that ensure that young people can remain on their parents' insurance policies until age 26, and that prohibit lifetime caps. Those provisions would remain. But what we want to do is to allow our States the option of selecting a different path that will lead to patient- directed reforms that contain costs and provide citizens with more health care choices. The Patient Freedom Act does just that. Again, I want to commend my colleague Senator Cassidy for his leadership. Mr. President, I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, today I wish to support the legislative waiver required for retired General James Mattis to become the next Secretary of Defense. The principle of civilian control of the military has been fundamental to the concept of American Government since the inception of our Republic. It was the Continental Congress that granted General George Washington his commission, and General Washington reported to that legislative body throughout the entire war. At the conclusion of the war, General Washington was the most popular and important figure in America. He easily could have positioned himself as the leader of the American government and, in fact, was urged to do so by many. Instead, General Washington famously resigned his commission on December 23, 1783, thus firmly establishing the principle that, in this new country, ultimate authority over the Armed Forces would rest with democratically elected civilians. General Washington's noble act was the foundation of such an important tenet of our democracy that the scene is depicted in a magnificent painting by John Trumbull, which occupies a prominent position in the rotunda of the United States Capitol. The principle of civilian control of the military was at the center of the debate when the structure of our Armed Forces was dramatically reorganized after World War II. A congressional consensus emerged from the military readiness failures of Pearl Harbor that the modern world required a more significant standing military force with a more centralized command structure. But harkening back to the precedent established by George Washington, it was imperative that this new structure have civilian leadership. This was especially concerning at the time, given the number of remarkable generals who had deservedly attained heroic status in the eyes of the American public and the free world. Thus, in 1947, Congress passed section 202 of the National Security Act, which provided that the Secretary of Defense needed to have at least a 10-year gap, later reduced to 7, from any military service. Since that time, 16 of the past 24 Defense Secretaries have had some prior military service. If approved, however, Gen. Mattis would only be the second Defense Secretary to receive a congressional waiver of the law--the other being General George Marshall in 1950. In order to examine this important history and review the wisdom of granting a waiver for Gen. Mattis, the Senate Armed Services Committee held a hearing exploring the issue of civilian control of the Armed Forces. After carefully reviewing the testimony from those hearings, I do support making an additional, one-time exception to the law in the specific case of James Mattis. In 1950, the world was a tumultuous place, with a hot war in Korea coupled with the extraordinary risks associated with a growing cold war in the nuclear age. President Truman turned to General Marshall to serve as Secretary of Defense because his noted character and competence, combined with his experience and ability, made him an ideal fit for the unique challenges presented at that time. Today the world is again a tumultuous place. The combination of the threat from terrorist organizations like ISIS and al Qaeda, as well as the threats emanating from countries such as Iran, North Korea, Russia, and China, has heightened tensions around the globe. And all our international challenges today take place against the backdrop of the knowledge that the world has a large and aging nuclear arsenal that could quickly create chaos in the wrong hands. As was the case with Gen. Marshall, Gen. Mattis, with his exceptional character and competence and his remarkable skills and ability, is a fit for these dangerous times. Over the course of his 44-year career in the Marine Corps, Gen. Mattis has earned a reputation as a warrior and commander who is beloved by soldiers and veterans alike. The ``warrior monk,'' as he is known in military circles, is a voracious reader and a student of history. He has served as a military commander at all levels and all over the world. His assignments have included a combat deployment during the Persian Gulf Wars and difficult leadership posts in both Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom, where Mattis commanded the 1St Marine Division in the city of Fallujah. His work over the past decade has demonstrated a deep appreciation for the challenges our country faces today. In 2006, Mattis coauthored the military's counterinsurgency manual with then-Army General David Petraeus. As an expert in counterinsurgency, Mattis understands the crucial role military power plays in conjunction with other civil instruments of national power, including diplomatic and economic efforts. Between 2007 and 2010, while serving as commander of the now disestablished U.S. Joint Forces Command, Mattis gained experience in broad DOD policy and management at an organization focused on the transformation of U.S. military capabilities. In 2010, I supported Gen. Mattis's nomination to serve as commander of U.S. Central Command, where he oversaw the wars in Iraq and Afghanistan and was responsible for an area which includes Syria, Iran, and Yemen. His experience at CENTCOM is a tremendous asset in developing a coherent strategy to address the threats posed by state actors and terrorist networks in the region and elsewhere around the world. In 2015, he testified before the Senate Armed Services Committee on the United States' global challenges and offered insight to the committee on crafting a coherent, bipartisan national security strategy with an eye towards international diplomacy and alliances, defense budgeting, and military force size and capabilities. Last year, he coedited a book on civil-military relations that explored the growing cultural gap between civilian society and the military, as well as the impact this lack of understanding may have on the civilian-military relationship. Finally,I would note that Gen. Mattis has the support of three very capable and successful former Secretaries of Defense whose careers were either largely or entirely in the civilian workforce. Secretaries Cohen, Panetta, and Gates know as well as anyone what it takes to succeed in that position and the importance of civilian leadership of the military. Their unqualified support of Gen. Mattis carries considerable weight with me and further convinces me that, in this particular circumstance, a waiver is warranted.

Ms. COLLINS

Ms. COLLINS. Mr. President, one of my top priorities as a Senator has been to expand access to affordable health care for all Americans. I have always believed that the key to achieving this goal is to bring down the cost of health care, so more Americans can afford to purchase the health insurance that they need. During debate over the Affordable Care Act, I raised the concern that the bill's cumbersome ``one size fits all'' approach would do more harm than good and would result in an even more expensive, broken, and unsustainable health care system. Unfortunately, my fears are now reality. According to the Kaiser Family Foundation, premiums for employer-sponsored family health plans now top $18,000 per year, up nearly $5000 since 2009. Deductibles have also been rising: in 2009, only one in five workers enrolled in single- coverage employer plans faced a deductible over $1000. Today more than half do. In Maine, premiums on the Exchange will rise an average of 22 percent this year, and many States are seeing even higher premium hikes. Meanwhile, fewer insurers are willing to write policies, leaving few choices for consumers who are looking for insurance. Some of the ACA's provisions--especially its consumer protections-- enjoy bipartisan support and should be retained; however, its Washington-centric approach must be changed if we are ever to truly reform our broken health care system. Nevertheless, this task must be undertaken with care. There is growing understanding that we cannot simply repeal the Affordable Care Act now and then wait 2 or 3 years to put reforms in place. Doing that would risk harming consumers who rely upon the current system for their insurance and would exacerbate the turmoil in the insurance markets. If we want a smooth transition from a broken and unaffordable system to a system that finally delivers on the promise of reform, we must carefully plan how we intend to get from where we are today, to where we need to be tomorrow. Thus, we are called to act quickly, but not in haste. That is why I joined Senators Corker, Portman, Cassidy, and Murkowski in offering an amendment that would change the reporting date for the bill reported pursuant to the budget resolution's reconciliation instructions from January 27 to March 3. While I continue to much prefer the later date, I have received assurances from Senate leaders that the January 27th date is not binding and that there is a shared commitment that we will take the time necessary to proceed thoughtfully with legislative reforms to replace and reform Obamacare. Few issues are as important to the American people as fixing our broken health care system. As we move to repair the ACA, I look forward to continuing to work with my colleagues on responsible alternatives that can put us on a path to a health care system that is truly sustainable and affordable.

Ms. COLLINS

Ms. COLLINS. Mr. President, today I wish to congratulate Secretary Ray Mabus on his retirement as the 75th Secretary of the Navy. It has been a great pleasure to work with Secretary Mabus during his impressive and storied tenure as the longest serving Secretary of the Navy since World War I. Since his confirmation in 2009, Secretary Mabus has continually reaffirmed his commitment to ensuring America's naval forces are second to none. During his more than 7 years of service, Secretary Mabus has also demonstrated an unwavering commitment to building our naval fleet and supporting America's shipbuilding industrial base. He has put 84 ships under contract across the country, more than the last three Navy secretaries combined, and invested significantly in our aging shipbuilding infrastructure. Secretary Mabus's focus on increasing shipbuilding has allowed the men and women at Bath Iron Works, BIW, to continue building high- quality destroyers, which are the workhorses of our Navy. To allow the Navy to operate these ships to their fullest potential while remaining mindful of the budget constraints faced by our military, Secretary Mabus supported energy initiatives to reduce dependence on fossil fuels. His focus on power-saving technologies, like diesel-electric plants in new ships, has reduced the Navy and Marine Corps' fuel expenses by 30 percent. In Maine, Portsmouth Naval Shipyard, PNSY, has received approximately $100 million in modernization funds since 2009, enabling it to maintain its status as the gold standard for public naval shipyards and further hone its efficiency and effectiveness in submarine repair. While advancing these reforms, Secretary Mabus visited Navy and Marine Corps installations across the globe, traveling over 1.3 million miles to over 150 countries and territories and all 50 States. When measured in distance, Secretary Mabus has travelled to the moon and back almost three times. In 2009, he and I visited the hard-working men and women at BIW and PNSY together. Since that first visit, Secretary Mabus has worked tirelessly to support our shipbuilding industrial base and ensure our Navy and Marine Corps have the tools they need to succeed. In addition, Secretary Mabus's leadership in 2010 on the Gulf Coast's long-term recovery plan following the Deepwater Horizon oil spill was exemplary. His work securing the future of the Gulf Coast made Americans and certainly his home State of Mississippi proud. Finally, his emphasis on platforms, power, and partnerships allowed our Navy to grow in strength, but Secretary Mabus never forgot those who make the system work: the people. Secretary Mabus was instrumental in advancing the repeal of don't ask, don't tell in 2011, a harmful policy that barred Americans from serving their country simply because of their sexual orientation. His efforts helped to ensure that all patriots who willingly answer the call to arms may proudly serve their Nation. Similarly, as discussions on military integration have evolved with a new focus on women in combat, Secretary Mabus again stepped up to become a leader on gender equality in the military. His support for integration of women into the Navy and Marine Corps, in all occupations and specialties, and his expansion of maternity leave have ensured that women can serve in the military jobs they love. Secretary Mabus has also taken steps to support career flexibility, continuing education, and family well-being for all members of the Navy and Marine Corps. He worked to ensure that all those who serve in uniform are provided the mental health care they need and deserve. By supporting and empowering a dedicated, intelligent, and committed personnel base, Secretary Mabus has enabled our Navy to remain the powerful fighting force that it is today. With his retirement, we lose a true patriot who served his country as a civilian, as well as in uniform, and we lose a visionary leader who saw how our Armed Forces could be better--and did everything in his power to make it happen. It has been a personal and professional pleasure to work with Secretary Mabus, and I wish him fair winds and following seas.

Ms. COLLINS

Ms. COLLINS. Mr. President, at the end of a Congress, we all know how easy it is for just one Senator to block a bill. I rise today to express my great disappointment that we have been unable to overcome objections from just one Senator from the other side of the aisle who is blocking the passage of legislation called the Senior$afe Act that is designed to help protect our seniors from financial fraud and exploitation. This is a bill I introduced with my colleague, Senator Claire McCaskill, as a result of extensive hearings and investigations that we have conducted in the Senate Aging Committee. A companion bill passed the House on a voice vote. Nationally, as many as 5 million seniors may be victims of financial abuse annually. Stopping this tsunami of fraud has been one of the top priorities of the Senate Aging Committee. In the many hearings we have held on this issue, what we found is that scammers seek to gain the trust and active cooperation of their victims, who are usually older Americans. Without that trust and cooperation, their schemes would fail. Unfortunately, seniors often do not see the red flags that signal that fraud is likely involved in these sophisticated schemes. Sometimes seniors are simply too nice, too trusting. In other sad cases, they may suffer from diminished capacity. But just as often, they miss these flags because the swindlers who prey upon them are extremely crafty and they know how to sound convincing. Any of us who have received these calls at home know how persuasive and persistent these con artists can be. Whatever the reason, a warning sign that can slip by a victim might trigger a second look by a financial services representative who is trained to spot common scams and who knows enough about a senior's habits to question a transaction that just doesn't look right. In our work on the Senate Aging Committee, we have heard of so many cases where an alert bank teller or credit union employee on the frontlines has stopped a financial fraud in its tracks, saving seniors untold thousands of dollars. In fact, the Government Accountability Office estimates that our seniors lose an astonishing $2.9 billion a year to this kind of fraud, and that is probably the tip of the iceberg because many times this fraud is never reported. I will give an example. Earlier this year, an attorney in the small coastal city of Belfast, ME, was sentenced to 30 months in prison for bilking two older female clients out of nearly half a million dollars over the course of several years. The lawyer's brazen theft was uncovered when a local bank teller noticed that he was writing large checks to himself from his clients' accounts. When confronted by authorities, he offered excuses that the prosecutor later described as ``breathtaking.'' For example, he put one of his clients into a nursing home to recover from a temporary medical condition and then managed to keep her there for 4 years until the theft of her funds came to light. In the meantime, he submitted bills for services, sometimes totaling $20,000 a month, including charging her $250 per hour for 6 to 7 hours to check on her house, which was a 1-minute drive from his office. Financial institutions are in a critical position to check these fraudsters. If properly trained, employees can be the first line of defense. Regrettably, certain laws can inadvertently impede efforts to protect seniors because financial institutions that report suspected fraud can be exposed to lawsuits. Our bill, the Senior$afe Act, encourages financial institutions to train their employees and shields them from lawsuits for making good-faith, reasonable reports of potential fraud to the proper authorities. As Jaye Martin, the head of Maine Legal Services for the Elderly, put it in a letter describing her support for the Collins-McCaskill bill, ``In a landscape that includes family members who often wish to keep exploitation from coming to light because they are perpetrating the exploitation, the risk of facing potential nuisance or false complaints over privacy violations is all too real.'' This is a barrier that must be removed so that financial institutions will act immediately to make a report to the proper authorities upon forming a reasonable belief that exploitation is occurring. These professionals are on the frontlines in the fight against elder financial exploitation and are often the only ones in a position to stop the exploitation before it is too late. Mr. President, I ask unanimous consent to have printed in the Record the full letter from Ms. Martin immediately following my remarks. Our bipartisan bill is based on the State of Maine's innovative Senior$afe Program. It has been a collaborative effort by my State's regulators, financial institutions, and legal organizations to educate bank and credit union employees on how to identify and help stop the exploitation of older Mainers. It was pioneered by Maine's securities administrator, Judith Shaw, and it has led to a significant increase in reports of suspected senior financial exploitation and fraud. The Maine program also serves as a template for model legislation developed for adoption by the North American Securities Administrators Administration, which is known as NASAA. The Senior$afe Act and this model State legislation are complementary efforts, and I am very pleased that the association of securities administrators has endorsed our bill. As I mentioned, the House Financial Services Committee approved our companion bill by a vote of 59 to 0 in June, and it passed the House by a voice vote in July. The Senate bill is sponsored by a quarter of the Members of this body, balanced nearly evenly on both sides of the aisle, and has the support of a wide range of stakeholders looking out for the interests of consumers, including the securities administrators whom I have already mentioned, the Conference of State Bank Supervisors, and the National Association of Insurance Commissioners. These are all regulators who are looking out for our consumers. Mr. President, I ask unanimous consent to have printed in the Record these letters of endorsement immediately following my remarks. Under our bill, liability protections are only provided for good- faith, reasonable reports of suspected fraud. The legal obstacles facing financial institutions that report this kind of suspected fraud and abuse are not limited to just privacy laws because these institutions have also been threatened with claims such as breach of contract, bad faith, slander, unfair practices, and even harassment. As one compliance officer for one of my community banks put it, without this kind of immunity for good-faith reporting, small community banks will face the ``freeze effect'' and won't make reports that could help to protect our seniors; thus, ``the effectiveness of Senior$afe will be undercut.'' I just cannot believe we cannot clear this commonsense bill for the President's signature when it would help so many seniors avoid becoming the victims of financial fraud and abuse, when it is supported by groups like Maine Legal Services for the Elderly, when it has won the support of national organizations of State securities administrators, State insurance commissioners, State bank regulators, when it would make such a difference. Sadly, because of the objections of just one Senator on the other side of the aisle, we are stymied. That means we will have to start all over again next year. Much needed help for our seniors--that could help them avoid being swindled out of what GAO estimates is almost $3 billion a year--will have to wait for another day. I just don't understand it. I have made many good-faith efforts in this regard, but regretfully, because we are at the end of the session, we don't have the time to go through all of the procedural steps that would be needed to pass this bill, which I am sure, given its broad bipartisan support, would pass overwhelmingly. I hope the Senator in question will reconsider and allow us to send this important bill to the President for his signature.

Ms. COLLINS. I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, on January 3, 2013, Senator Mark Kirk climbed the 45 steps to the U.S. Capitol, triumphantly returning to work after a year of intensive recovery from a stroke. To the cheers of colleagues and friends, he called it one of the greatest moments of his life. It was a moment of courage and determination that defined a life dedicated to serving the people of Illinois and of our Nation. From his service in the Navy Reserve as an intelligence officer, to the World Bank, the State Department, the House International Relations Committee, and five terms representing the 10th Congressional District of Illinois, Senator Kirk brought to this chamber a wealth of experience, wisdom, and commitment. I had the pleasure of working alongside Senator Kirk on the Appropriations, Health, Education, Labor, and Pensions, and Aging Committees. His approach to legislating has been in the highest traditions of the Senate: Informed, passionate, and always civil. He looked at the issues before the Senate not through the lens of a political partisan, but rather through the lens of a pragmatic problem solver and consensus builder. Senator Kirk has been a valued ally on many fronts. We introduced the REGROW Act to accelerate the development of new therapies for patients living with such diseases as Alzheimer's disease and diabetes and to achieve breakthroughs in stroke recovery. I was proud to be named with him to serve on the Women's and Family Global Health Task Force so that the United States will continue to be a leader in preventing maternal and childhood deaths from treatable causes. We joined together on vital legislation to keep firearms out of the hands of terrorists and in addressing our Nation's opioid addiction crisis. He has always had a deep commitment to good government and was a strong voice for accountability through independent, effective inspectors general. As chairman and former ranking member of the Appropriations Subcommittee on Military Construction and Veterans Affairs, Senator Kirk has worked tirelessly on behalf of the men and women who serve our country. Following in the tradition of Illinois Senator Everett Dirksen, who helped pass the Civil Rights Act a half-century ago, Senator Kirk has been a leader in ensuring the rights of America's LGBT community. The past election brought disappointment, but it also revealed character. Senator Kirk ran a vigorous but honorable campaign and never compromised his principles. When the decision went against him, he conceded graciously, reminding Americans that what unites us is far stronger than what divides us. It has been an honor to serve with Senator Kirk in the U.S. Senate. It has been a joy to develop our friendship, one I will cherish always. I wish him all the best in the years to come, and I know that he will meet any challenges that lie ahead with the strength and fortitude he brought to those 45 steps of the U.S. Capitol.

Ms. COLLINS

Ms. COLLINS. Mr. President, as a young man growing up in Searchlight, Nevada, Harry Reid was an accomplished amateur boxer. During his 30 years of service in this Chamber, Senator Reid has demonstrated time and again the qualities of skill, hard work, and determination that he learned in the ring all those years ago. Prior to joining the Senate in 1987, Senator Reid established a deep commitment to public service in the House of Representatives and in State and local offices. And before that, he served Congress and supported his young family working nights as a Capitol police officer while attending law school at George Washington University. As a Senate leader, serving as Democratic whip, majority leader, and, currently, Democratic leader, he has been a formidable advocate for his caucus. In the Senate, Senator Reid has been a passionate voice for education, environmental protection, health care, and renewable energy. His commitment to those who serve our Nation in uniform is evident through his support for military readiness and for our veterans. The great Jack Dempsey defined a champion as ``someone who gets up when he can't.'' In his many years of service to the people of Nevada and to our nation, Senator Harry Reid has proven himself to be a fighter who always answers the bell. I wish him and his wife, Landra, health and happiness for many more years to come.

Ms. COLLINS

Ms. COLLINS. Thank you, Mr. President. In 1974, a freshman Senator from Delaware named Joe Biden was identified as one of Time magazine's ``200 Faces for the Future.'' That prescient prediction anticipated the more than four decades of contributions and accomplishments that followed. Joe Biden served six terms in the U.S. Senate and became Vice President of the United States, but he is exactly the same person today as he was when more than 40 years ago he took that first train trip from Wilmington to Washington to be sworn in as a United States Senator. He is everybody's friend--but nobody's fool. And while Joe Biden changed Washington, Washington never changed him. It is an article of faith among those of us who know and love Joe Biden that nothing is more important to him than family. It is, therefore, a cruel irony that this good and decent man has faced so many family tragedies during his long and fruitful career in public service. Although he has been sorely tested by several wrenching losses, Vice President Biden's irrepressible spirit has never been broken. He is as optimistic about his country today as he was in 1972, when as a county councilman he defeated a long-serving Senate incumbent and began the journey that ultimately led him to the second highest office in the land. With his Cancer Moonshot Initiative, Joe Biden once again has turned personal tragedy into a public cause that undoubtedly will save lives. To know Joe Biden is to admire him, his warmth, his devotion to friends and family, his commitment to all things Delaware, and his fierce loyalty to his party that somehow never alienated those of us on the other side of the aisle. Perhaps that is due to the many thoughtful gestures the Vice President demonstrates every day. How well I remember bringing my younger brother to the White House holiday party one year and running into the Vice President just as he was leaving after a long day of work. He instantly stopped and asked if we would like for him to give us a personal tour of the West Wing of the White House. For the next 45 minutes, instead of being driven home, the Vice President of the United States took my brother and me on the best tour of the White House that anyone could ever have. I still remember the shocked look on the face of the marine at the situation room when we arrived there. Another wonderful memory that I have was of the time Joe Biden and I were named Irish Americans of the Year by the American Ireland Fund. I thought it was so telling that both of us brought our family members to the celebratory dinner, and both of us talked about our Irish mothers. Now, I do remember that Joe's speech was considerably better than mine, but mine was much, much shorter. In a time of almost suffocating partisanship, Joe Biden is a breath of bipartisan fresh air. People may disagree with Joe on 1 or 2 or even 10 issues, but nobody finds him disagreeable. It is often said that if you don't love Joe Biden, it is time for some serious introspection. You may have a serious problem. No one can say with certainty what lies ahead for Vice President Joe Biden, but this much is certain: He will face the future with unbridled enthusiasm, extraordinary energy, and an unwavering commitment to his family, his friends, and his country. I thank the Vice President for his outstanding service to our country, but most of all I thank him for his extraordinary friendship to me. I wish the Vice President and his wonderful family all the best. Thank you, Mr. President.

Ms. COLLINS

Ms. COLLINS. Madam President, it is with deep affection, admiration, and appreciation that I rise today to offer my heartfelt congratulations to our colleague and my dear friend, Senator Barbara Mikulski, as her service in the Senate comes to a close. As the longest serving woman in the history of the United States Congress--30 years in this Chamber, in addition to 10 years in the House--she has earned the gratitude of the people of her beloved Maryland and of the entire Nation. That gratitude is based on much more than simple arithmetic, much more than just how many years she has served here, impressive though that is. In reflecting on her service, it is difficult to decide where to begin--her accomplishments, her vision, or her complete dedication to the people she serves, the dedication that began in that neighborhood in Baltimore that she describes so passionately today. No matter where we begin, we end up in the same place--it is all about her character. Perhaps the best way to describe Senator Mikulski's character is by noting that she is not only officially the longest serving woman in the history of the Congress, but she is also unofficially the dean of the women in the Senate. That title perfectly demonstrates the trust and respect she has earned her from her colleagues. As a brandnew Senator in 1997, I was one of those tutored by this accomplished and experienced dean. At that time, Senator Mikulski had already been in the House and the Senate for a combined 20 years. She didn't know me from Adam--or perhaps I should say from Eve--yet, despite the difference in our seniority, our States, and our parties, she took me under her wing. She was one of the first people who called me after I was sworn in as a new Senator. I was so grateful for her kindness and her wisdom. She invited me to a power workshop in her office, along with Mary Landrieu, the other woman who was elected that year. She taught me the ropes of the appropriations process and instituted regular bipartisan dinners for the women of the Senate. In the years since then, I have come to know her as a fighter, a trailblazer, and a person of such integrity. Maybe it is all those years with the nuns that taught you that. It has been a privilege to work with her on such vital issues as home health care, maritime issues, higher education, pay equality, and an issue near and dear to both of us, Alzheimer's research. Serving with her on the Appropriations Committee, I have witnessed firsthand what an extraordinary leader she is--fair, openminded, yet with firm expectations and a clear sense of direction. Senator Mikulski is, above all, a hard worker. Growing up in East Baltimore, she learned the value of hard work in her family's grocery store, as we have heard today. Her commitment to making a difference in her neighborhood led her to become a social worker, helping at-risk children and our seniors. The statement she made sums up her approach to serving in Congress: ``I was a social worker for Baltimore families. Now I'm a social worker building opportunities for families throughout America.'' Two years ago, I was honored to stand alongside Senator Barb to accept Allegheny College Prize for Civility in Public Life. We were representing all of the women of the Senate for our leadership in bringing an end to the devastating government shutdown of 2013 and working together on so many other issues. With our dean setting the example, we have always rejected the idea of a women's caucus because we, like the men in the Senate, span the ideological spectrum. Who would expect otherwise? We have worked together across party lines to serve all Americans. As Senator Mikulski puts it ``It's not about gender, it's about the agenda.'' In fact, all of us have our favorite sayings that the Senator from Maryland has taught us, and we will miss her way with words so much. When Senator Mikulski reached her Senate longevity milestone 5 years ago, she surpassed my personal role model in public service, the legendary Senator from Maine, Margaret Chase Smith. Just as the great lady from Maine inspired me and countless other young women of my generation to serve, the great lady from Maryland inspires the young women of today, always encouraging them to go for it. Throughout her life in public service, she has lived by one guiding principle: to help our people meet the needs of today as she helps our Nation prepare for the challenges of tomorrow. What an honor it has been to serve alongside Senator Barbara Mikulski. I have learned so much from her. I will never forget the day she told me I had the soul of an appropriator, which I knew was the highest compliment she could give me. And she was right. We have worked on that committee to get so much done. I wish her many more years of health, happiness, and, most of all, that most important ``ship,'' friendship.

Ms. COLLINS

Ms. COLLINS. Mr. President, Maine and New Hampshire share a border, a history, and an invigorating climate. When Kelly Ayotte came to the Senate 6 years ago, I immediately saw in her those traits shared by the people of our two States: a strong work ethic, a respect for tradition balanced by a spirit of innovation, and fiscal prudence always tempered by compassion. During those years, I came to know Senator Ayotte as a diligent, energetic, and committed public servant. She brought with her to the Senate a remarkable record of public service. As her State's attorney general, she fought hard to protect the people of New Hampshire and the environment that is so crucial to their way of life. It has been rewarding to work with her on such bipartisan efforts as the Terrorist Firearms Prevention Act, the Runaway and Homeless Youth Act, and addressing the opioid addiction crisis confronting our States. From her support for land conservation to advancing biomass energy, she has been a strong leader in the wise use of natural resources and their role in growing the economy. Coming from a military family, she has demonstrated her respect for our men and women in uniform as a member of the Armed Services Committee and is recognized as a leading voice on national security issues and the well-being of our veterans. We have joined together on many occasions to advocate for the Portsmouth Naval Shipyard that is so important to our Nation's defense and to the dedicated men and women of our two States who work there. It has been an honor to serve with Kelly Ayotte in the United States Senate, and the American people are better off for her service. I wish Kelly and her wonderful family all the best in the years to come.

Ms. COLLINS

Ms. COLLINS. Mr. President, today I wish to pay tribute to Senator Barbara Boxer, who has served her State and country with boundless energy, enthusiasm, and exuberance. Senator Boxer's 24 years in the Senate are only part of her legacy of leadership and accomplishments. Previously, she served for 10 years in the House of Representatives for California's Sixth Congressional District and before that as the first woman president of the Marin County Board of Supervisors. That remarkable record of service includes another record. In her reelection in 2004, Senator Boxer received nearly 7 million votes, the most in Senate history until that time and a mark that stood for 8 years. During her service in the Senate, Senator Boxer has established herself as a champion of the environment, infrastructure, and medical research. Along with Senator Inhofe, she authored a 5-year transportation bill that many thought was an impossible task in a gridlocked Senate. But she worked across the aisle and did it. The United States-Israel Enhanced Security Cooperation Act she authored in 2012 reaffirmed the special relationship between our two countries and is another of Senator Boxer's accomplishments. It has been especially rewarding to work with her on legislation to better protect women from violence, in our country and around the world. In her first campaign for Congress in 1982, she ran under the slogan, ``Barbara Boxer Gives a Damn.'' She always has and always will. It is a pleasure to thank Senator Barbara Boxer for her years of service and to wish her and her husband, Stewart, many more years of good health and great happiness.

Ms. COLLINS

Ms. COLLINS. Madam President, as I have listened to the eloquent farewell remarks of my friend and colleague, Senator Dan Coats of Indiana, I could not help but think that he sounded happy, contented, serene, and at peace with the decision he has made. But he leaves the rest of us feeling bereft and sad and knowing that we will miss him as a friend and as an esteemed colleague. As the 114th Congress draws to a close, many words of affection and gratitude will be offered in tribute to our friend and colleague Dan Coats as he leaves this Chamber. But there is no word that better defines this outstanding leader than the one word that has guided his entire life, and that word is ``service.'' As we have heard from his colleague from Indiana, the junior Senator, in 1966, at the height of the Vietnam war, Dan Coats enlisted in the U.S. Army, achieving the rank of staff sergeant. In 1980, he was elected to the U.S. House of Representatives from Indiana's Fourth Congressional District, and he joined the Senate 8 years later. He quickly became widely known and deeply respected as a strong voice for fiscal discipline and national security and as an expert in our intelligence agencies and foreign affairs. Dan Coats left the Senate in 1999 and was named as U.S. Ambassador to Germany 2 years later. He arrived at his post in Berlin just 3 days before the terrorist attacks of September 11, 2001. I cannot help but think how fortunate our country was to have him in that key position at a time of such turmoil, anxiety, and fear for our country and all the world. He played a central role in strengthening the relationship between our Nation and Germany during that critical time. After his tenure as Ambassador had ended, Senator Coats continued his service. He became the president of Big Brothers and Big Sisters of America and offered his talents to many other civic and volunteer organizations, including the Center for Jewish and Christian Values, which he chaired with another dear friend of mine, Senator Joe Lieberman. With his wife Marsha, he founded the Foundation for American Renewal to advance faith-based solutions and initiatives to help resolve our Nation's many social problems. When Dan Coats returned to the Senate in 2012, he pledged to the people of Indiana and to our Nation that he would focus his tremendous energy and extraordinary intellect on cutting wasteful spending, reducing our national debt, promoting pro-growth, job-creating policies, and strengthening our national security in an era where we face numerous threats from every possible place. He has kept those promises. As a father and a grandfather--two roles that I know he cherishes--Senator Coats has taken to heart our obligation to ensure a sound economic future for the next generation. It has been a particular honor to work side by side with Dan Coats on the Intelligence Committee. His public service through that committee will never be fully known to the public, but I can share with you that Senator Coats has almost an instinctual ability to get to the heart of an issue, no matter how complex or difficult the topic. That, of course, is also a tribute to the fact that he has thought so deeply about the issues that confront our country and the threats posed by rogue states and terrorist groups. He was one of the first Members of the Senate to recognize the crisis that would emerge due to this administration's failed policy and incoherent strategy toward Syria. His strong and effective advocacy for improved cyber security, a passion that we share, is another example of his deep commitment to the safety and security of our Nation and its people. For years, Senator Coats has worked to protect our Nation's most critical infrastructure from devastating cyber attacks. Senator Coats has warned us that it is not a matter of if but of when such attacks occur right here in our country. He did so--he led the way--knowing of the political pressure that would be brought to bear to accept the status quo of cyber insecurity that exists within our country's most important infrastructure. Senator Dan Coats is an inspiring role model to all of us who seek to serve. He epitomizes dedication, effective service, and an untiring commitment to making America--already the greatest country in the world--an even better place to live. Our Nation is truly grateful to this great man, and I am so grateful for his friendship. I wish Senator Coats and his family all the best in the years to come. I suggest the absence of a quorum.

Ms. COLLINS

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

Ms. COLLINS. Mr. President, I rise in strong support of the 21st Century Cures Act, and I commend the chairman and ranking member of the Senate Health, Education, Labor, and Pensions Committee, Senator Lamar Alexander and Senator Patty Murray, for their unwavering commitment to this very significant bipartisan legislation. The Senate HELP Committee, on which I am privileged to serve, has devoted considerable time and effort to this comprehensive legislation. It includes many reforms and priorities that will benefit so many families across our great country. The 21st Century Cures Act will support the research and development of safe treatments and cures for millions of Americans and their families who are coping with devastating diseases. It will improve the process of moving new discoveries from laboratory benches to patient bedsides. I doubt that there is a family in America who will not be touched by this important legislation in some way. All of us have a family member, a coworker, or a friend who has courageously faced the struggles of living with a debilitating chronic illness or a rare disease or who has received a devastating diagnosis and has passed away far too soon, leaving a hole in our hearts. Imagine how this could change with the passage of the 21st Century Cures Act and strong support of the research and development that will lead to new treatments and therapies that can help us achieve our dream of conquering so many devastating diseases. Simply put, this legislation matters. It matters to the children who know firsthand the burden of living with type 1 diabetes and who beg their parents for just one day off--their birthday or Christmas--from having to deal with the consequences of their juvenile diabetes. It matters to the family members who know the agonizing experience of looking into the eyes of a loved one suffering from Alzheimer's disease, only to receive a confused look in return. It matters to the parents of young boys who have Duchenne muscular dystrophy, who know what it is like to give their all in an effort to help their sons achieve their dreams, whether it is finishing college or driving a car, even as every day their children battle the progression of this debilitating and ultimately terminal illness. The 21st Century Cures Act will drive progress in medical innovation so that we can prevail against these diseases and many more that cause so much pain and suffering, so much fear and uncertainty, and so much heartbreak. There simply is no investment that we can make that provides greater return for Americans than our investment in biomedical research. It not only leads to new discoveries and the development of better treatments and even cures but also can have a dramatic effect on the budgets of families, States, and the Federal Government. The bill before us will help direct $4.8 billion to the National Institutes of Health, including $1.6 billion for the BRAIN Initiative to improve our understanding of diseases such as ALS, Parkinson's, and Alzheimer's, our Nation's most costly disease. We spend $263 billion a year caring for people with Alzheimer's disease. Of that amount, approximately $160 billion comes from the Medicare and Medicaid Programs. If the current trajectory continues as our population grows older, this disease will bankrupt the Medicare and Medicaid Programs. That is why I am so pleased to see the BRAIN Initiative funded in this bill and also the work we are doing in the Appropriations Committee to boost funding for Alzheimer's disease and other dementias so that we can finally find effective treatments, a means of prevention, or perhaps even a cure for this disease that brings so much heartache not only to those suffering from it but to their families as well. Our bill will also help provide $1.8 billion for the Vice President's Cancer Moonshot. We all know that Vice President Biden has taken on this cause--a very personal one for him--because he lost his beloved son Beau to cancer. Another exciting field that will be funded by this bill is $30 million for regenerative medicine, using adult stem cells. How exciting it was to have an individual come before our policy lunch whose sight had been restored due to innovative stem cell surgery. This individual lives in Tennessee now but happens to be from Presque Isle, ME, just 13 miles from where I was born and grew up. How I wish so many older people in this country who are losing their vision to macular degeneration and glaucoma--in some cases, a combination of both--or injuries to their eyes could benefit from this exciting development with adult stem cells, which has restored the sight of someone who was legally blind. He now can drive. That is so exciting, and that is the promise of researching regenerative medicine. In addition to support for NIH, the 21st Century Cures Act will help direct $1 billion in much needed funding to address the horrendous heroin and opioid abuse problem in this country. Maine has been particularly hard hit by this epidemic. In just the first 9 months of this year, Maine experienced a record 286 overdose deaths. That is more than one a day. Tragically, that number already exceeds the 272 overdose deaths in Maine during all of 2015. I am distressed when I hear about the lack of treatment options for Mainers who are struggling with drug addiction, particularly in rural areas. As a result of the shortage of treatment alternatives, this epidemic is playing out in emergency rooms, county jails, and on the main streets of my State. I can't tell you how many sheriffs have come to me pleading for help, telling me that the intake area of their jail looks like a detox center or an emergency room of a hospital. They are overwhelmed by these cases. We can and must do more to support access to treatment and to alert people of all ages to the risks of opioid abuse and heroin use. The 21st Century Cures Act will provide a vital infusion of $1 billion over 2 years to support grants to States to supplement treatment and prevention efforts. I was talking with one of my colleagues earlier today. Both of us remember when we were in school hearing lectures from recovering heroin addicts who came into the schools, and I can state that it was highly effective. We would never have tried heroin. I can't even think of a proper analogy. We know, unfortunately, that many of the people who are using heroin started with prescription opioids, and that is why I am encouraged by movements across our country and by actions taken, at my request and the request of other Senators, by the Centers for Medicare & Medicaid Services to make sure we are not putting pressure on providers to overprescribe opioids. Surely they are appropriate in certain cases, but the number of prescriptions has soared in this country and is twice the number prescribed on a per capita basis as in our neighboring country of Canada. The 21st Century Cures Act also includes a bill that I introduced with several of my colleagues--Senators Warren, Kirk, Baldwin, Alexander, and Murray--that is called the Advancing NIH Strategic Planning and Improving Representation in Medical Research Act. Despite its extremely cumbersome name, it is an important bill that has been incorporated into this legislation. It will require the NIH to release periodically a strategic plan outlining how the agency will meet its mission statement, and it will provide us with important guidance and metrics as we continue to work together to increase this vital funding. It will also help to ensure that study populations in clinical research are more representative of the diverse population in our country. For example, women face many of the same health threats as men, such as heart disease and cancer, but they react differently to various treatments. I remember years ago an infamous study that was called MRFIT. It had only men enrolled in it. I believe, if memory serves me correctly, it was to look at heart disease. Well, women often have different symptoms of heart disease than do men, and they respond differently to different medications, therapies, and treatments. We also know that women are at higher risk for certain chronic health conditions, such as Alzheimer's disease and osteoporosis. They suffer from those diseases in far greater numbers than do men. With Alzheimer's disease, I am wondering whether it is simply a matter that the biggest risk factor is age and women live longer than men, but perhaps there are other factors at play. My point is that by helping to ensure that women, African Americans, Latinos, and other demographic groups are appropriately represented in clinical research, we can increase our scientific understanding of the causes, risk factors, prevention strategies, and effects of treatments for diseases that commonly or disproportionately affect these populations. The bill before us also includes legislation that I introduced with my colleague from Wisconsin, Senator Baldwin, to help address the educational debt burden that many young researchers face. This is so important to help ensure that America's finest, up-and-coming young researchers continue to help lead the world in biomedical discovery in this country. I don't want to lose these young talented people to other countries. I want them to stay right here. If they come to work for the NIH or the CDC or other federally funded institutions and agencies and we can get them help with their medical school, college, their advanced degrees, and their debt, that is a very good agreement for us to be making. It is also of tremendous importance that we were able to add mental health legislation to the 21st Century Cures Act. The reforms in this bill will enhance coordination, address a lack of resources, and develop real solutions to improve outcomes for individuals with serious mental illness and to help their families, who are often desperate to get them the help they need. I am pleased that the bill also includes the Mental Health on Campus Improvement Act, which I offered as an amendment when we considered the mental health legislation in committee. My colleague, Senator Dick Durbin, and I introduced this legislation for the first time in 2009. I commend him for his leadership. College students in Maine and across the country must have access to critical and often lifesaving mental health services. Despite growing demand for these critical services, far too many students still lack access. Without these services, students may experience detrimental effects that range from declining academic performance to drug dependence and to being at greater risk of suicide. While millions of Americans suffer from mental illness, only a statistical few engage in unspeakable acts of violence against themselves or others. Suicide, however, is the leading cause of death among Americans between the ages of 15 and 34. In addition, recent tragedies on college campuses, such as the shooting at a community college in Roseburg, OR, or at Northern Illinois University, highlight the dire need for mental health outreach and counseling services on college campuses. Perhaps some of the tragedies that we have witnessed might have been prevented had the resources been in place to support timely diagnosis, early intervention, and effective treatment for those struggling with severe mental illness. One of the saddest meetings I have had in the last year was with a group of families from Maine who had adult children who were suffering from severe mental illness, yet these families felt powerless in getting them the help they needed. These adult children were not compliant with the medication they had been prescribed, and in many cases their families felt powerless to be able to get them the help they needed. In one terrible case, a man's son was released from a hospital in the State of Maine--from a hospital for people with mental illness--and he killed his mother, thinking she was Al Qaeda. Only then could his father get his son the institutionalized help his son so desperately needed. It was just such a painful, painful story to hear from this anguished father and husband. I believe the language in this bill will help to change that. The 21st Century Cures Act passed the House last week by an overwhelming vote of 392 to 26. Think how few bills pass with that kind of strong, bipartisan support. It is supported by President Obama, who had an op-ed in Maine newspapers this weekend endorsing the bill. It is the product of years of bipartisan work on the Senate HELP Committee, and it has earned the support of more than 300 organizations. Frankly, I am surprised that we are having a rollcall vote--a cloture vote on this bill. I am surprised because, while this bill may not be perfect--and no bill is--there is so much that is worthwhile, good, and significant in it that will make such a difference to so many American families. I urge all of our colleagues to vote in support of this bill so that we can quickly send it to the President's desk, where he is eager to sign it into law. It may well be the most important, far-reaching legislation that we pass this year in terms of its benefits for families across this great Nation. Mr. President, I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am delighted to commend the Falmouth Middle School of Falmouth, ME, on being named a 2016 National Blue Ribbon School of Excellence. This outstanding middle school is one of only 329 schools across the country to receive this prestigious recognition from the U.S. Department of Education. Created in 1982, the Blue Ribbon Schools Program honors public and private schools that are either academically superior in their States or that demonstrate significant gains in student achievement. The schools singled out for this national recognition are models of high educational standards and accountability. Falmouth Middle School is among a select group of schools to achieve the Blue Ribbon designation not once, but twice. Since receiving its first award in 2008, the school has continued to excel as a community of collaborative and engaged learners who value diversity, kindness, creativity, excellence, responsibility for self, and service to others. This award recognizes the hard work and determination of Falmouth Middle School's pupils and staff. This is a top-performing school on State-required assessments, and staff at the school use assessments throughout the academic year as a tool for improving and customizing instruction. A strong commitment to professional development ensures that teachers and staff, as well as students, are lifelong learners. Falmouth Middle School is known for its extensive extracurricular activities in academics, athletics, and the arts, which help forge a strong school community where students are connected and encouraged to pursue their interests. Just this year, three new afterschool clubs were formed--in French, writing, and dance--driven by enthusiastic students and guided by involved teachers. This Blue Ribbon award is a tribute not only to the students, but also to the administrators, teachers, staff, and parents of Falmouth Middle School. Together, they are succeeding in their mission to generate excitement and momentum for learning. They are making a difference in the lives of their students, helping them reach their full potential as independent, responsible learners and citizens. I congratulate the entire community for this well-deserved recognition.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am delighted to commend Reeds Brook Middle School of Hampden, ME, on being named a 2016 National Blue Ribbon School of Excellence. This outstanding middle school is one of only 329 schools across the country to receive Blue Ribbon recognition from the U.S. Department of Education. Created in 1982, the Blue Ribbon Schools Program honors public and private schools that are either academically superior in their States or that demonstrate significant gains in student achievement. The schools singled out for this national recognition are models of high educational standards and accountability. The Blue Ribbon designation continues Reeds Brook's tradition of quality education. In 1997, just 2 years after it opened, the school became just one of five middle schools in Maine to be accredited by the New England Association of Schools and Colleges. Today, after earning reaccreditation in 2007, Reeds Brook Middle School is one of just three Maine middle schools to achieve that distinction. This award recognizes the hard work and determination of Reeds Brook Middle School's pupils, teachers, and staff. It is a top-performing school on State-required assessments, and educators at the school use assessments throughout the academic year as a tool for improving and customizing instruction. A strong commitment to professional development ensures that teachers and staff, as well as students, are lifelong learners. Reeds Brook excels as a school built on a foundation of responsibility, respect, honesty, and compassion. Through a unique weekly trading card program, teachers and staff recognize students who demonstrate those values, instilling a sense of individual and school pride. Reeds Brook Middle School is known for its extensive extracurricular activities in academics, athletics, and the arts, and students are encouraged to pursue their interests. An on-site garden and greenhouse promote volunteerism throughout the community. Students serve their community by working with the local food pantry and recycling center. Two projects underscore the values that guide Reeds Brook Middle School. Students avidly support the Special Olympics, championing and cheering not just their team, but also athletes from other schools. Through an ongoing project, students meet with and interview local veterans, preserving the veterans' living histories and honoring their service. This Blue Ribbon award is a tribute not only to the students, but also to the administrators, teachers, staff, and parents of Reeds Brook Middle School. Together, they are succeeding in their mission to generate excitement and momentum for learning. They are making a difference in the lives of their students, helping them reach their full potential as independent, responsible learners and citizens. I congratulate the entire Hampden community for this well-deserved recognition.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am delighted to commend the Sea Road School of Kennebunk, ME, on being named a 2016 National Blue Ribbon School of Excellence. This outstanding elementary school is one of only 329 schools across the country to receive this prestigious recognition from the U.S. Department of Education. Created in 1982, the Blue Ribbon Schools Program honors public and private schools that are either academically superior in their States or that demonstrate significant gains in student achievement. The schools singled out for this national recognition are models of high educational standards and accountability. This award recognizes the hard work and determination of the Sea Road School's pupils and staff. Sea Road School is a top-performing school on State-required assessments, and staff at the school use assessments throughout the academic year as a tool for improving and customizing instruction. Students also participate in extracurricular activities, which helps forge a strong school community where students are connected and encouraged to pursue their interests. Indeed, a successful vote on a town ordinance to ban single-use plastic bags in Kennebunk this spring started with research and advocacy by Sea Road School students. Sea Road School is a member of Regional School Unit 21. Six years ago, Kennebunkport Consolidated School, another member, was also named a Blue Ribbon School. RSU 21 is the first administrative unit in Maine to have two schools attain this distinction. This Blue Ribbon award is a tribute not only to the students, but also to the administrators, teachers, staff, and parents of Sea Road School. Together, they are succeeding in their mission to generate excitement and momentum for learning. They are making a difference in the lives of their students, helping them reach their full potential as independent, responsible learners and citizens. I congratulate the entire community for this well-deserved recognition.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today as the chairman of the Senate Aging Committee to speak about the bipartisan resolution I have introduced with Senator McCaskill designating September 22, 2016--the first day of the fall season--as National Falls Prevention Awareness Day. The purpose of this designation is to better educate seniors, families, and caregivers--as well as government and civic organizations--about the practices, programs, and policies that can be taken to reduce the risk of falls. Falls are the leading cause of both fatal and nonfatal injuries among older adults. Older adults are the fastest-growing segment of the U.S. population, and the number is projected to increase from 46.2 million in 2014 to 82.3 million in 2040. As more Americans age, falls will become even more numerous and costly than they are now. In 2014, approximately 2.8 million older Americans were treated in emergency rooms after falling, and more than 800,000 were subsequently hospitalized. Tragically, more than 27,000 of them died as a result of their injuries. The U.S. Centers for Disease Control and Prevention puts these staggering statistics in a context that really brings the problem home: one out of every three seniors falls each year; every 13 seconds, a senior is treated in an emergency room for a fall; every 20 seconds, a senior dies from a fall. In addition to the human toll, these falls generate enormous economic costs. The annual total direct medical cost of fall-related injuries for older adults is approximately $34 billion. As more members of the baby boomer generation reach retirement age, these costs could nearly double within the next 5 years. Beyond the pain, suffering, and expense, falls can affect a senior's ability to live independently and can lead to a compromised quality of life, and thus to isolation and depression. Many people who fall, even if they are not injured, can develop a fear of falling. This may cause them to limit their activities, resulting in reduced mobility and physical activity. As a Senator representing the state with the oldest median age, I am especially concerned that Maine is eighth in the Nation in the percentage of seniors who suffer falls. Seniors in Maine who fall experience an average medical cost of approximately $16,000, according to the most recent statistics available. Fortunately, there are many organizations throughout Maine, including several Area Agencies on Aging, which provide important fall awareness programs, such as risk assessments, and exercise and balance programs. Our resolution urges relevant Federal, State, and local organizations to work to help educate seniors about ways they can reduce the risks that may result from a fall, including injury and even death. The resolution also recognizes that evidence-based programs reduce falls by utilizing cost-effective strategies, such as exercise programs, medication management, vision improvement, reduction of home hazards, and fall prevention education. Family members and other caregivers can also help seniors evaluate their homes for fall-inducing hazards and modify their living space with adequate lighting and assistive devices, such as grab bars in the shower or tub, to help ensure a safe environment. There are more steps we can take. The costs of even minor modifications like grab bars and hand rails can add up quickly, while more expensive projects such as widening doorways or installing a ramp are financially unrealistic for far too many seniors. Several existing Federal programs can help seniors make these needed modifications to their homes, but few seniors are aware of them. To address this issue, I have joined Senators King and Ayotte in sponsoring S. 3230, the Senior Home Modification Assistance Initiative Act, which would improve awareness and better coordinate existing Federal programs. Falling is not an inevitable consequence of aging. Practical lifestyle adjustments, evidence-based prevention programs, community partnerships, and continued research are among the tools available to reduce falls. Fall-related injuries have a devastating impact on the lives of our seniors, their families, and their communities. Our goal is to unite professionals, older adults, caregivers, and family members so that they might all play a part in raising awareness and preventing falls.

Ms. COLLINS

Ms. COLLINS. Mr. President, I join my colleagues to call for action to prevent the version of the overtime rule that the U.S. Department of Labor finalized this past May from going into effect on December 1. I want to commend Chairman Alexander, Senator Scott, and Senator Lankford for their leadership in this area. Federal regulations can impose unexpected and costly requirements on small businesses, educational institutions, and nonprofit organizations. The new U.S. Department of Labor rule on overtime pay is a prime example that could harm the very workers it intends to help, cause small businesses to curb hiring, and force universities and colleges to either raise tuition or cut programs. The new rule will double the annual salary threshold from $23,660 to $47,476 for mandatory overtime, effective December 1. While it is time for a reasonable update in the threshold, doubling the threshold overnight and with so little time for employers to prepare will have negative consequences. I have spoken with small businesses, educational institutions, and nonprofit organizations across Maine, and it is clear that this huge and sudden increase in the threshold is far too much and too fast. Rather than producing bigger paychecks, this new rule is likely to produce reduced hours, benefits, and flexibility for Maine workers. Many small employers in Maine have told me that they do not have the margins to pay overtime to salaried employees earning up to $47,476. Some will have to shift their employees to hourly positions. Formerly salaried employees used to flexibility in their work schedules will have to track closely each hour they work each week, instead of being able to leave work to pick up a child at school without worrying about the impact on their paycheck. The new rule is also a problem for those seasonal businesses in Maine that make an effort to keep their employees on the payroll all year round. In the summer and fall, these employees often work for more than 40 hours a week, but in the winter and spring, they usually work far fewer than 40 hours a week. The current system allows them to have a constant, consistent year-round salary that they can count on. The new overtime rule would upend that and result in many workers being moved from salaried to hourly positions or even being let go during winter months. This will make it harder for workers to make ends meet and harder for employers to retain high-quality employees. Although the regulation is touted as a means of boosting employees' pay, a study commissioned by the National Retail Federation found that most employees would see no change in net pay. Instead, many employees would see their hours reduced to avoid overtime, while others would see their base wages, benefits, or bonus pay decreased in order the offset the added payroll expense. Moreover, the National Federation of Independent Business, a leading voice for small business, has noted that the new overtime rule would particularly hurt small businesses in rural areas. The Maine Department of Labor believes that the rule would have a disproportionate economic effect on Maine businesses, where salaries and the cost of living are not as high as in other regions of the country. For instance, the cost of living in Bangor is roughly 37 percent lower than in Washington, DC. While $47,476 might seem like a reasonable threshold for an employee living in a high-cost area like Washington, DC, it is the equivalent of a salary of more than $74,000 in Bangor. Businesses are not alone in their concern. Nonprofit organizations are also struggling with the impact on their workers and those whom they serve. The executive director for Habitat for Humanity in greater Portland states that the ``new overtime rules will so drastically change our current compensation obligations that we may no longer be able to give our workers the benefits, schedules and other incentives that drew them to us in the first place.'' And he notes that ``services to those in need will be reduced and organizational funding will decline as resources are spent on overhead instead of programs.'' Indeed, nonprofit organizations would be among the hardest hit by this rule. Cutbacks in essential services are predicted by the Salvation Army, youth services providers, home health care services, and blood centers throughout the country. In addition, higher-education groups nationwide are urging the Department of Labor to take a more measured approach. When the final rule was published last spring, Molly Corbett Broad, the president of the American Council on Education, noted that ``requiring such a dramatic and costly change to be implemented so quickly will leave many colleges with no choice but to respond to this regulation with a combination of tuition increases, service reductions, and, possibly, layoffs.'' She went on to note that those harmed by the new rule will include ``a wide array of non-faculty employees--from athletics coaches and trainers to admissions recruiters and student affairs officers--whose work is not well suited to hourly wage status and who will face diminished workplace autonomy and fewer opportunities for flexible work arrangements and career development.'' This is not a theoretical concern. The University of Maine system would face an estimated $14 million increase in annual operating costs if it restructured employees' pay to maintain the exempt status of these workers. To avoid changes in its salary structure that could force tuition increases or threaten university services, Maine's University System is conducting an arduous and costly position realignment that could still result in an increase in annual labor costs. The overtime threshold has not been increased in a number of years and should be raised, but doubling virtually overnight and with so little time for employers to prepare will be extremely costly and damaging to small businesses, universities, nonprofit organizations, and so many other segments of our Nation's economy and our society. That is why I am a cosponsor of the resolution of disapproval of this rule introduced by Chairman Alexander and Senator Scott's Protecting Workplace Advancement and Opportunity Act, which would ensure a balanced approach to updating Federal overtime rules by requiring that any new regulation on overtime consider the impact on small business and nonprofits, differences in geographical regions, and impacts on lower-wage industries, startups, and workers. Today I am joining Chairman Alexander in introducing legislation that would phase in a more reasonable increase to the overtime threshold over five years. I am also cosponsoring another bill introduced today by Senator Lankford that would delay the effective date of the new rule by 6 months, from December 1, 2016, to June 1, 2017, to allow more time for Congress to work on this issue. The flurry of bills on this topic is indicative of just how much concern there is about the potential harm this rule could inflict on the very workers it intends to help, on small businesses, on students, on nonprofits, and on countless others. I urge my colleagues on both sides of the aisle to join me in rejecting this onerous and ill-advised rule.