Susan Collins

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce the Relief for Farmers Hit with PFAS Act. I thank my colleagues Senator King and Senator Shaheen for joining me in introducing this important legislation for farmers across America and particularly in Maine and New Hampshire. The Relief for Farmers Hit with PFAS Act would provide vital assistance to farmers affected by PFAS contamination. PFAS are man-made chemicals--sometimes referred to as ``forever chemicals''--that can bioaccumulate in humans over time. They may traditionally be found in certain nonstick pans, some furniture, and firefighting foam and have been linked to cancer, thyroid disease, liver damage, decreased fertility, and hormone disruption. PFAS contamination is a growing problem, and additional resources are needed to support affected communities. In Maine, PFAS contamination affecting many different sectors, including agriculture, has been discovered over the past several years. The presence of PFAS in wastewater sludge once spread as fertilizer has prevented some Maine farms from selling their products, thus leading to significant financial hardship for these family farmers. One such farmer is Fred Stone, a dairy farmer in Arundel, ME. In 2016, Fred discovered that the milk produced on his farm contained some of the highest levels ever reported for a PFAS contaminant at that time. More recently, a dairy farm in Fairfield, ME, found PFAS levels in its milk that were 153 times higher than the State's standard. Dairy is not the only agricultural sector affected by these harmful chemicals. Adam Nordell and his wife Johanna Davis, from Unity, ME, learned that PFAS contaminated the soil and water in their organic vegetable farm, the result of sludge spread on their land in the 1990s. Tests showed that Adam and Johanna had levels of PFAS in their blood that were even higher than chemical plant workers who had manufactured PFAS for decades. Currently, USDA Provides limited support through the Dairy Indemnity Payment Program, DIPP, to dairy farmers who have been directed to remove their milk from the commercial market. This program, however, falls far short in meeting the growing needs of all affected farmers in the State of Maine. Moreover, this program helps only dairy farmers, excluding the farmers of other agricultural products who have had their livelihoods disrupted by PFAS contamination. USDA should do more to assist all farmers harmed by these chemicals. That is what our legislation aims to do. Specifically, the funds authorized by the Relief for Farmers Hit with PFAS Act could be used for a variety of purposes at the State level, including financial assistance to affected farmers; capacity building for PFAS testing for soil or water sources; blood monitoring for individuals to make informed decisions about their health; equipment to ensure a farm remains profitable during or after known PFAS contamination; alternative production systems or remediation strategies; educational programs for farmers experiencing PFAS contamination; and research on soil and water remediation systems and the viability of those systems for farms. In addition to making new resources available, our bill would create a task force at USDA charged with identifying other USDA programs to which PFAS contamination remediation should be added as an eligible activity. This would help bring more resources to farmers through existing programs. Additionally, the task force would provide technical assistance to States to help them coordinate their responses effectively. USDA needs to step up and provide support to farmers, who through no fault of their own are at risk of losing their livelihoods because of PFAS contamination. The Relief for Farmers Hit with PFAS Act would direct the Department to help where it is needed most. I know Secretary of Agriculture Rollins cares about this problem due to our discussions on PFAS. I urge my colleagues to support this bill. As the members of the Senate Agriculture Committee begin work on the 2026 farm bill, I hope that we can work together to pass the Relief for Farmers Hit with PFAS Act into law.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent to waive the mandatory quorum call with respect to the Freeman nomination.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce the Improving Access to Workers' Compensation for Injured Federal Workers Act. I am pleased that my colleague from Connecticut Senator Blumenthal is my lead cosponsor on this bill. Our bipartisan bill would allow physician assistants and nurse practitioners to certify disabilities and oversee treatment for Federal workers with injuries or illnesses that occur on the job, when doing so is consistent with the scope of their practice under State law. Civil servants bring dedication, competence, and experience to their work, and this proposal affords them greater choice over their own healthcare in the event that they suffer a work-related injury or illness. Federal employees can already select a PA or NP as their primary healthcare provider within the Federal Employees Health Benefits Program. However, and inexplicably, the Federal Employees' Compensation Act permits only a physician to make the diagnosis, certify the injury and extent of the disability, and to oversee the patient's treatments and care when a Federal employee is injured on the job. This bill would allow the more than 2 million Federal employees in our country, including more than 12,000 Federal employees in the State of Maine, the ability to receive their healthcare from the practitioner of their choice after a work-related injury. When they can make their own choice, they have access to more timely care and continuity of care. They are also having the decisions about their healthcare and the extent of their disability or illness made by their primary care physician who knows them best, who understands their healthcare history. Mainers, especially in our very rural communities, are often cared for by nurse practitioners or physician assistants. They act as their primary care providers. Let me give you an example. Jackie Carter and Corinne Malenfant are two nurse practitioners with a primary care practice in Orland, ME. They have described the challenges they face when they treat Federal employees. Despite being the chosen healthcare provider of their federally employed patients, Jackie and Corinne are not authorized to certify their patients' injuries and illnesses and oversee the care for their work-related injuries under the Federal Employees' Compensation Act. As a result, their patients can experience lengthy delays in starting treatment due to the requirement that only a physician can certify the injury and oversee the Federal employee's care while in the Workers' Compensation Program. In some very rural communities, Mr. President--and I suspect this may be true in parts of your State as well--there simply aren't any physicians who are practicing, or they are unable to accommodate additional patients. So think about the situation that is created here. A Federal employee, who has a primary care provider who is, say, a nurse practitioner or a physician assistant, is injured on the job, but instead of immediately being able to go to this primary care provider, they have to wait until they can get in to see a physician--a physician who may be miles away and unable to see them quickly, a physician who does not know their history. They can't proceed with getting the Federal employee's benefits and healthcare treatments they need to get well and return to work. That just makes no sense in rural America today. It is important to emphasize that this bill defers to State law. It would not expand the scope of any practice. Instead, it would simply remove a barrier that prevents dedicated healthcare professionals from practicing as their State permits them to do. NPs and PAs already provide a significant amount of healthcare to injured Federal employees, but within the Federal Employees' Compensation Act, while they are not currently authorized to certify injuries and oversee patient treatment, they are authorized to treat injured Federal employees and be reimbursed for their services but only in cases where a physician has first certified the injury and continues to oversee the treatment. That is redundant, it causes delays, and it does not make sense. Federal programs have long recognized the importance of nurse practitioners and physician assistants. Yet the Federal Employees' Compensation Act is an outlier in the restrictive nature of the program when it comes to NPs and PAs and their patients. Modernizing the Federal Employees' Compensation Act through the reforms contained in this legislation would be consistent with the practices of numerous other Federal Agencies and programs, including Medicare, the Veterans' Administration, the Federal Motor Carrier Safety Administration, the Indian Health Service, and the Social Security Administration. They don't create this additional barrier. In rural communities, NPs and PAs may well be the only provider within a reasonable distance. Delaying the certification of injuries or illnesses for Federal workers means delays in their care. The longer those delays take, the longer before they can get the treatment they need to return to their jobs. I also want to note that this bill would not increase Federal spending. The Congressional Budget Office has found that this bill would have an insignificant net effect on direct spending, reasoning that while it may increase access to care for injured Federal employees, it would be offset by enabling them to return to work more quickly and to continue to serve the American people. Passage of the Improving Access to Workers' Compensation for Injured Federal Workers Act is a winner across the board. It simply makes common sense. It provides our dedicated Federal employees with additional healthcare options when they need it most. It allows NPs and PAs to share the knowledge they already have about their patients and treat their illnesses and injuries that are work-related in a timely fashion. I urge all of my colleagues to join Senator Blumenthal and me in supporting our bill.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce the Improving Access to Workers' Compensation for Injured Federal Workers Act. I am pleased that my colleague from Connecticut Senator Blumenthal is my lead cosponsor on this bill. Our bipartisan bill would allow physician assistants and nurse practitioners to certify disabilities and oversee treatment for Federal workers with injuries or illnesses that occur on the job, when doing so is consistent with the scope of their practice under State law. Civil servants bring dedication, competence, and experience to their work, and this proposal affords them greater choice over their own healthcare in the event that they suffer a work-related injury or illness. Federal employees can already select a PA or NP as their primary healthcare provider within the Federal Employees Health Benefits Program. However, and inexplicably, the Federal Employees' Compensation Act permits only a physician to make the diagnosis, certify the injury and extent of the disability, and to oversee the patient's treatments and care when a Federal employee is injured on the job. This bill would allow the more than 2 million Federal employees in our country, including more than 12,000 Federal employees in the State of Maine, the ability to receive their healthcare from the practitioner of their choice after a work-related injury. When they can make their own choice, they have access to more timely care and continuity of care. They are also having the decisions about their healthcare and the extent of their disability or illness made by their primary care physician who knows them best, who understands their healthcare history. Mainers, especially in our very rural communities, are often cared for by nurse practitioners or physician assistants. They act as their primary care providers. Let me give you an example. Jackie Carter and Corinne Malenfant are two nurse practitioners with a primary care practice in Orland, ME. They have described the challenges they face when they treat Federal employees. Despite being the chosen healthcare provider of their federally employed patients, Jackie and Corinne are not authorized to certify their patients' injuries and illnesses and oversee the care for their work-related injuries under the Federal Employees' Compensation Act. As a result, their patients can experience lengthy delays in starting treatment due to the requirement that only a physician can certify the injury and oversee the Federal employee's care while in the Workers' Compensation Program. In some very rural communities, Mr. President--and I suspect this may be true in parts of your State as well--there simply aren't any physicians who are practicing, or they are unable to accommodate additional patients. So think about the situation that is created here. A Federal employee, who has a primary care provider who is, say, a nurse practitioner or a physician assistant, is injured on the job, but instead of immediately being able to go to this primary care provider, they have to wait until they can get in to see a physician--a physician who may be miles away and unable to see them quickly, a physician who does not know their history. They can't proceed with getting the Federal employee's benefits and healthcare treatments they need to get well and return to work. That just makes no sense in rural America today. It is important to emphasize that this bill defers to State law. It would not expand the scope of any practice. Instead, it would simply remove a barrier that prevents dedicated healthcare professionals from practicing as their State permits them to do. NPs and PAs already provide a significant amount of healthcare to injured Federal employees, but within the Federal Employees' Compensation Act, while they are not currently authorized to certify injuries and oversee patient treatment, they are authorized to treat injured Federal employees and be reimbursed for their services but only in cases where a physician has first certified the injury and continues to oversee the treatment. That is redundant, it causes delays, and it does not make sense. Federal programs have long recognized the importance of nurse practitioners and physician assistants. Yet the Federal Employees' Compensation Act is an outlier in the restrictive nature of the program when it comes to NPs and PAs and their patients. Modernizing the Federal Employees' Compensation Act through the reforms contained in this legislation would be consistent with the practices of numerous other Federal Agencies and programs, including Medicare, the Veterans' Administration, the Federal Motor Carrier Safety Administration, the Indian Health Service, and the Social Security Administration. They don't create this additional barrier. In rural communities, NPs and PAs may well be the only provider within a reasonable distance. Delaying the certification of injuries or illnesses for Federal workers means delays in their care. The longer those delays take, the longer before they can get the treatment they need to return to their jobs. I also want to note that this bill would not increase Federal spending. The Congressional Budget Office has found that this bill would have an insignificant net effect on direct spending, reasoning that while it may increase access to care for injured Federal employees, it would be offset by enabling them to return to work more quickly and to continue to serve the American people. Passage of the Improving Access to Workers' Compensation for Injured Federal Workers Act is a winner across the board. It simply makes common sense. It provides our dedicated Federal employees with additional healthcare options when they need it most. It allows NPs and PAs to share the knowledge they already have about their patients and treat their illnesses and injuries that are work-related in a timely fashion. I urge all of my colleagues to join Senator Blumenthal and me in supporting our bill.

Mr. COLLINS

Mr. COLLINS. Mr. President, the information required by rule XLIV of the Standing Rules of the Senate related to congressionally directed spending items is included in the committee reports (Senate Reports 119-44, 119-46, 119-47, and 119-55) that are referenced in Senate amendment No. 3951 to H.R. 4016. I hereby incorporate that information into this disclosure by reference.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise to introduce the Alzheimer's Screening and Prevention ASAP Act. This bill would require the Centers for Medicare & Medicaid Services to cover FDA-approved blood-based biomarker tests for Alzheimer's disease, expanding access to earlier and more accurate diagnoses for millions of Americans. Alzheimer's disease is one of the greatest public health challenges of our time. It currently affects more than 7 million Americans, including an estimated 29,000 individuals in Maine. That number is expected to increase in the coming years as our population ages. Alzheimer's is also the most expensive disease in America. The cost of caring for people with Alzheimer's and other dementia was an estimated $360 billion in 2024. Total costs are expected to exceed $1 trillion by 2050 unless we take meaningful action. Early diagnosis of this disease is critical. It allows patients and their families to better plan for the future, access care and support services, and take advantage of available treatments that are most effective in the early stages. Yet far too many individuals remain undiagnosed until their symptoms become severe. I have had the privilege of meeting with Mainers from the Alzheimer's Association year after year when they come to Washington. One story stands out to me as an example of the importance of early diagnosis. Ten years ago, Ralph Carmona was diagnosed with mild cognitive impairment resulting from Alzheimer's disease. Because he was diagnosed in the very early stages of disease, Ralph was able to participate in a clinical trial for Leqembi. Leqembi is one of the first disease- modifying therapies approved by the FDA for early treatment of Alzheimer's. Ralph credits this drug with significantly slowing his symptoms. He has even run a marathon since his initial diagnosis. Recent scientific advances have led to the development of blood-based biomarker tests that can detect Alzheimer's with increasing accuracy. These tests are far less invasive and significantly more affordable than current diagnostic methods, such as PET scans or spinal taps. Earlier this year, FDA approved the first blood test for clinical use. This approval will greatly increase the ability of primary care physicians to diagnose the disease in its very early stages while symptoms are still mild and potentially treatable. The only current treatments available for Alzheimer's disease are approved for patients in the early stages of disease. An important next step is for CMS to cover this breakthrough. I pushed CMS to cover Leqembi and other early-stage disease-modifying therapies. If the FDA approves a treatment an innovative blood test such as this one, there is no reason why CMS should refuse to cover it. The ASAP Act would address this gap by requiring CMS to cover FDA- approved blood tests for Alzheimer's once they are deemed safe and effective. The bill also supports the continued development and evaluation of screening practices that reflect the latest in medical science. As the founder and cochair of the Congressional Alzheimer's Task Force, I have long believed that we must do more to detect Alzheimer's early and expand access to innovations in diagnosis and treatment. I want to thank the Alzheimer's Association for its continued advocacy and for developing this important legislation. Their partnership and dedication to improving the lives of those affected by Alzheimer's have been invaluable. I look forward to working with my colleagues to ensure swift passage of this bill.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise to introduce the Alzheimer's Screening and Prevention ASAP Act. This bill would require the Centers for Medicare & Medicaid Services to cover FDA-approved blood-based biomarker tests for Alzheimer's disease, expanding access to earlier and more accurate diagnoses for millions of Americans. Alzheimer's disease is one of the greatest public health challenges of our time. It currently affects more than 7 million Americans, including an estimated 29,000 individuals in Maine. That number is expected to increase in the coming years as our population ages. Alzheimer's is also the most expensive disease in America. The cost of caring for people with Alzheimer's and other dementia was an estimated $360 billion in 2024. Total costs are expected to exceed $1 trillion by 2050 unless we take meaningful action. Early diagnosis of this disease is critical. It allows patients and their families to better plan for the future, access care and support services, and take advantage of available treatments that are most effective in the early stages. Yet far too many individuals remain undiagnosed until their symptoms become severe. I have had the privilege of meeting with Mainers from the Alzheimer's Association year after year when they come to Washington. One story stands out to me as an example of the importance of early diagnosis. Ten years ago, Ralph Carmona was diagnosed with mild cognitive impairment resulting from Alzheimer's disease. Because he was diagnosed in the very early stages of disease, Ralph was able to participate in a clinical trial for Leqembi. Leqembi is one of the first disease- modifying therapies approved by the FDA for early treatment of Alzheimer's. Ralph credits this drug with significantly slowing his symptoms. He has even run a marathon since his initial diagnosis. Recent scientific advances have led to the development of blood-based biomarker tests that can detect Alzheimer's with increasing accuracy. These tests are far less invasive and significantly more affordable than current diagnostic methods, such as PET scans or spinal taps. Earlier this year, FDA approved the first blood test for clinical use. This approval will greatly increase the ability of primary care physicians to diagnose the disease in its very early stages while symptoms are still mild and potentially treatable. The only current treatments available for Alzheimer's disease are approved for patients in the early stages of disease. An important next step is for CMS to cover this breakthrough. I pushed CMS to cover Leqembi and other early-stage disease-modifying therapies. If the FDA approves a treatment an innovative blood test such as this one, there is no reason why CMS should refuse to cover it. The ASAP Act would address this gap by requiring CMS to cover FDA- approved blood tests for Alzheimer's once they are deemed safe and effective. The bill also supports the continued development and evaluation of screening practices that reflect the latest in medical science. As the founder and cochair of the Congressional Alzheimer's Task Force, I have long believed that we must do more to detect Alzheimer's early and expand access to innovations in diagnosis and treatment. I want to thank the Alzheimer's Association for its continued advocacy and for developing this important legislation. Their partnership and dedication to improving the lives of those affected by Alzheimer's have been invaluable. I look forward to working with my colleagues to ensure swift passage of this bill.

Ms. COLLINS

Ms. COLLINS. Mr. President, this is the 41st day of an entirely unnecessary government shutdown; a shutdown that never should have occurred; a shutdown that has caused tremendous harm to the American people, to our national security, to our entire country; a shutdown that has resulted in Federal employees being furloughed, laid off, or forced to work without compensation; a shutdown that is causing enormous uncertainty and stress for families that rely upon the SNAP program for the nutrition that they need; a shutdown that is causing families to wonder: Are they going to be able to fly to see the grandparents on Thanksgiving? A shutdown that never should have occurred. We finally have the ability tonight to end this shutdown. We have put forth, the Appropriations Committee, working in a bipartisan way with Members on both sides of the aisle and in both Chambers, a package of bills that includes a continuing resolution that will reopen government immediately once it is passed by this Senate, the House, and signed into law by the President. It is legislation that due to incredibly good work by Senators Jeanne Shaheen, Tim Kaine, Katie Britt, the White House, and many of us, will ensure that those Federal employees who have been furloughed or laid off or forced to work without pay will receive their backpay, will be recalled to their jobs if they were laid off as a result of this shutdown. That will make a huge difference to these Federal employees who have worked so hard to serve the people of our Nation. This package of bills also includes three--three--yearlong appropriations bills that were passed by overwhelming margins, bipartisan margins, more than 80 votes in each case, by the Members of this Senate way back on August 1. These bills are the Agriculture bill, the Agriculture-FDA bill-- Senator Boozman chairs that subcommittee. It includes funding for the SNAP program; for the Women, Infants, and Children nutrition program, known as WIC; for our farmers; for rural development; for our rural communities throughout this country. It is a very important bill--a bill that will take away the worry that families who are low income and seniors who are low income and rely upon the SNAP program or the WIC Program are feeling today about whether the funding is going to be there. That concern goes away with the passage of this full-year appropriations bill that extends until the end of September of next year. A second bill in this package is the Military Construction and Veterans Affairs bill. That subcommittee is chaired--I have actually mixed up the two subcommittees. Agriculture is chaired by Senator Hoeven, and Military Construction-VA is chaired by Senator Boozman. They are both extraordinary chairmen who work in a bipartisan manner with their ranking minority members and with their House counterparts. Think about it. Tomorrow is Veterans Day. Wouldn't it be wonderful if tonight the Senate passes the bill that provides yearlong funding through the end of this fiscal year, to September 30 of next year, for our VA? What a way to tell our veterans how much we value their sacrifice and their service--a debt to them that we can never fully repay. It is so important to get that bill through. Military construction projects--what a difference that makes to our troops all over the world. There are two that matter a great deal to me in the State of Maine, one that will help the Portsmouth Naval Shipyard, which I worked on with my fellow Senator from Maine and our two Senators from New Hampshire, and one that will benefit the Air National Guard Base in Bangor, ME, where I live. I am so proud of that base. It does more refuelings than any base on the east coast during wartime, and it is extraordinarily skillful and filled with patriots. They will be taken care of. The third bill is the Legislative Branch bill. That bill answers concerns that a lot of our Members have about security in this increasingly polarized and difficult environment in which we live. But that is not all, and I want to correct any misimpression that has been given by some who have spoken today on the other side of the aisle. The Senate majority leader has given a public commitment that he will bring to the Senate floor bills that extend the Affordable Care Act, which, unfortunately, has turned out to be anything but affordable. But it will extend the premium tax credits that allow our lower income and middle-income families to afford their much needed health insurance. In many cases, these are individuals who are self-employed, so they do not get health insurance through the workplace, or they are the employees of small businesses that are unable to provide health insurance, particularly in this time when we are seeing skyrocketing premiums. So, as I have said from the beginning, I support an extension of the ACA tax credits, but they need reform. It is wrong that wealthy families qualify for taxpayer-subsidized tax credits for their health insurance when they can afford their own health insurance. That was the change in ObamaCare that was made during COVID. We should take a look at what the original income cap was under the Affordable Care Act. It was 400 percent of the poverty level. Now, we can decide what it should be, but surely we ought to be able to agree in a bipartisan way that there should be some cap on income so that very wealthy individuals are not able to receive taxpayer-funded tax credits. Let's limit that to those who are in middle-income and lower income families. There are other great ideas that have been raised by our colleagues on how we can reform the ACA to make health insurance more affordable. I know that the chair of the HELP Committee, Senator Cassidy, who is a medical doctor, as well as Chairman Mike Crapo of the Finance Committee have promised to have hearings to take a hard look at this, and we have the commitment of the majority leader to bring these bills to the floor. So it is just not true that we are ignoring this issue. We do need to act by the end of the year, and that is exactly what the majority leader has promised. In addition, he has pledged to bring additional, yearlong appropriations bills to the Senate floor. We will be doing that shortly, and that is the right thing to do. I want to thank the eight Democrats who yesterday stood up for the American people and did what was right: pledged to reopen government; to pass these three appropriations bills that Members of this Chamber passed by over 80 votes on August 1 and which will take away the threat of any kind of shut down for the programs in those three bills. As I mentioned, the last bill is the Leg Branch bill. I want to thank Senator Markwayne Mullin for his leadership on that bill as well. We have terrific members on the Appropriations Committee on both sides of the aisle who have worked so hard, and I must say that I think all of them ought to be voting for this package of bills tonight. I made most of my comments yesterday when I brought these bills to floor. There are others who are seeking recognition, so I will cease my remarks. But I just want to encourage everyone to cast their vote for this package of bills so that we can send it over to our House colleagues, where I hope they will do the same, and then send it to the President, who has already endorsed this package and pledged to sign the bill into law. Let's end this entirely unnecessary, shameful shutdown. Mr. President, I ask unanimous consent that there be 2 minutes of debate, equally divided, prior to each rollcall in relation to Calendar No. 168, H.R. 5371.

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

Ms. COLLINS

Ms. COLLINS. Mr. President, I yield back all remaining time.

Ms. COLLINS. Mr. President, I want to thank all of our colleagues for their hard work on this bill. I am excited about its impending passage. I hope that will mean that we will immediately reopen government as soon as the House acts and the President signs it into law. I am also very pleased that we were able to fully fund three appropriations bills that passed with overwhelming bipartisan support on August 1. I thank my colleagues. I know of no other requests for time. I yield back the remaining time. Vote on H.R. 5371, As Amended

Ms. COLLINS. Mr. President, I just want to reiterate my gratitude for my colleagues, our staff who report night and day, literally, and to all of those who have brought us to this point. We are going to reopen government. We are going to ensure that Federal employees, whether they were furloughed or laid off or forced to work without pay, will now receive compensation that they have earned and deserve. And we will also be able to celebrate on Veterans Day tomorrow the fact that we have passed the appropriations bill for the VA. This would not have come about without the work of so many people-- too numerous to mention. But I do want to thank my fellow appropriators, particularly the chairs of the three committees--Senator Boozman, Senator Hoeven, and Senator Mullin--for their hard work. I want to thank our House counterparts, particularly Chairman Cole, who worked night and day with us on getting conference agreements. And our Democratic colleagues who courageously realized that we could not let this shutdown continue to go on with the harmful consequences growing worse with each passing day. I also want to particularly thank my staff. They literally went without sleep and worked continuously to do all that needed to be done. I want to thank Leader Thune and Leader Barrasso for their hard work and the work of their staff as well. My list of gratitude could go on and on, but the hour is getting late, and I do want people to be able to go home for the night and home-home, finally. Again, I think this is a great victory for the American people. It shows that the Senate can work; that we can produce the results that are needed. I want to give a shout-out to Senator Katie Britt, who is here this evening-- she helped in so many ways with the negotiations-- and Senator Shaheen, Senator Kaine, Senator Angus King, my colleague, and the rest of the eight Democrats who were willing to cross party lines for the good of the people of this country. So thank you, Mr. President, for all that has been done and for your personal participation as well. I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, today, the Senate Appropriations Committee advanced legislation to reopen government immediately, funding vital programs and resuming pay for Federal workers who, for the last 40 days, have had to live with the stress of missed paychecks and not knowing when they would be paid. Under our legislation, all Federal employees, including members of our military and Coast Guard, the Capitol Police officers, Border Patrol agents, TSA screeners, air traffic controllers--all will receive their back wages. It is significant that this measure also includes three full-year fiscal year 2026 appropriations bills, including the annual Agriculture-FDA bill, the Military Construction and Veterans Affairs legislation--very timely, given that Veterans Day will soon be upon us--and the Legislative Branch funding. This three-bill package, which originally passed the Senate on August 1 with overwhelming bipartisan support--87 votes in 2 cases, 81 in another--will support our veterans, our troops, our farmers, and rural communities. Of note, this package will provide full-year funding for the Supplemental Nutrition Assistance Program, known as SNAP, and the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC. One of the most unfortunate and shameful consequences of the shutdown has been that these vital nutrition programs were in jeopardy for our most vulnerable families, including 170,000 Mainers who rely on the SNAP program. Other programs will be funded through January 30 while the Senate and House continue our work on the remainder of the yearlong appropriations bills. For example, funding for important programs like Head Start and such as the Low-Income Heating Assistance Program will now be restored. I look forward to voting for this legislation and ending the unnecessary harm to the security of our families and our Nation. We must begin to act tonight. We must not delay any longer. Finally, I want to thank the many members on both sides of the aisle of the Appropriations Committee and the Senate leadership who have worked especially hard to bring this package together. I would be remiss if I did not also thank our staff. My staff missed an entire night's sleep to get this package together and get the job done. Again, I want to particularly thank the members of the Appropriations Committee, including the three who served as the subcommittee chairs: Senator Boozman, Senator Hoeven, and Senator Mullin. I want to thank Katie Britt--Senator Britt--who did an extraordinary amount of work, Lisa Murkowski, Mike Rounds, Jerry Moran, Shelley Moore Capito, Cindy Hyde-Smith, Deb Fischer. There are so many who worked so hard on this package. I want to thank each and every one of them. Let's get the job done, and let's do it fast. Did I miss Senator Hoeven in my list? Senator Hoeven was a rock star.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent to have printed in the Congressional Record, at the appropriate place, the explanatory statement to accompany the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today with my colleague from Vermont, Senator Welch, to introduce the Comprehensive Alternative Response to Emergencies Act, or the CARE Act. Our bipartisan legislation would require the Centers for Medicare and Medicaid Services to test a 5 year treatment-in-place model for Medicare. This model, also known as TIP, is the practice of treating patients in their homes or where a medical emergency occurs. The pilot program in our bill would reimburse EMS for the care they administer to seniors in emergencies outside of the hospital, such as for minor medical incidents. This program would expand access to health services for seniors, especially in rural communities, while reducing unnecessary emergency room visits and expenses. Emergency room doctors throughout Maine often tell me about the frequent backlogs and long wait times that patients experience in waiting rooms. One way to address this problem is to reduce the number of nonessential emergency room visits. By creating a pathway to reimburse EMS for treating certain patients at home, the CARE Act will help decrease the number of emergency room visits and lengthy wait times. When EMS arrives after a 9-1-1 call, they usually transport patients to the emergency department immediately. Many patients, however, may not need emergency services from a hospital and could be better served by receiving treatment ``in place.'' EMS is capable of providing a host of interventions, such as treating hypoglycemia for a patient with a diabetic emergency or responding to routine, chronic seizures. Most insurance plans, including Medicare, do not reimburse emergency medical services unless the patient is transported to the hospital. The current payment model can thus incentivize transportation to the hospital even when a less expensive level of care is appropriate. The CARE Act will also help support EMS providers' long-term financial viability. According to the Maine Ambulance Association, approximately 35 percent of EMS calls conclude without transport. Without reimbursement, EMS providers must absorb the costs of these calls, further challenging the sustainability of their operations. The treatment-in-place pilot program proposed by our legislation offers a solution to this financial burden by reimbursing EMS for this kind of care. This model also saves Medicare money. When CMS implemented a trial version of TIP during the COVID-19 pandemic, the program demonstrated more than $500 net savings to Medicare per patient encounter. This commonsense bill builds on the past success of TIP. TIP increases communities at a time when EMS is facing historic staffing and financial challenges, by removing the need for time-consuming transport. The reimbursement of a TIP encounter is only a fraction of the cost of ambulance transport and a hospital emergency department visit. Reducing unnecessary emergency room visits, lowering costs, and easing the strain on our hospital and EMS workforce will help improve care overall. The CARE Act presents an opportunity to further test the TIP model and improve patient care, while supporting the brave first responders who save countless lives in our communities. Our bill is supported by the American Ambulance Association, the Maine Ambulance Association, the National Association of Emergency Medical Technicians, the National Rural Healthcare Association, the National EMS Quality Alliance, and many other local EMS organizations around the country. I urge all my colleagues to support this legislation.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today with my colleague from Vermont, Senator Welch, to introduce the Comprehensive Alternative Response to Emergencies Act, or the CARE Act. Our bipartisan legislation would require the Centers for Medicare and Medicaid Services to test a 5 year treatment-in-place model for Medicare. This model, also known as TIP, is the practice of treating patients in their homes or where a medical emergency occurs. The pilot program in our bill would reimburse EMS for the care they administer to seniors in emergencies outside of the hospital, such as for minor medical incidents. This program would expand access to health services for seniors, especially in rural communities, while reducing unnecessary emergency room visits and expenses. Emergency room doctors throughout Maine often tell me about the frequent backlogs and long wait times that patients experience in waiting rooms. One way to address this problem is to reduce the number of nonessential emergency room visits. By creating a pathway to reimburse EMS for treating certain patients at home, the CARE Act will help decrease the number of emergency room visits and lengthy wait times. When EMS arrives after a 9-1-1 call, they usually transport patients to the emergency department immediately. Many patients, however, may not need emergency services from a hospital and could be better served by receiving treatment ``in place.'' EMS is capable of providing a host of interventions, such as treating hypoglycemia for a patient with a diabetic emergency or responding to routine, chronic seizures. Most insurance plans, including Medicare, do not reimburse emergency medical services unless the patient is transported to the hospital. The current payment model can thus incentivize transportation to the hospital even when a less expensive level of care is appropriate. The CARE Act will also help support EMS providers' long-term financial viability. According to the Maine Ambulance Association, approximately 35 percent of EMS calls conclude without transport. Without reimbursement, EMS providers must absorb the costs of these calls, further challenging the sustainability of their operations. The treatment-in-place pilot program proposed by our legislation offers a solution to this financial burden by reimbursing EMS for this kind of care. This model also saves Medicare money. When CMS implemented a trial version of TIP during the COVID-19 pandemic, the program demonstrated more than $500 net savings to Medicare per patient encounter. This commonsense bill builds on the past success of TIP. TIP increases communities at a time when EMS is facing historic staffing and financial challenges, by removing the need for time-consuming transport. The reimbursement of a TIP encounter is only a fraction of the cost of ambulance transport and a hospital emergency department visit. Reducing unnecessary emergency room visits, lowering costs, and easing the strain on our hospital and EMS workforce will help improve care overall. The CARE Act presents an opportunity to further test the TIP model and improve patient care, while supporting the brave first responders who save countless lives in our communities. Our bill is supported by the American Ambulance Association, the Maine Ambulance Association, the National Association of Emergency Medical Technicians, the National Rural Healthcare Association, the National EMS Quality Alliance, and many other local EMS organizations around the country. I urge all my colleagues to support this legislation.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today in strong support of Joshua Dunlap to serve on the U.S. Court of Appeals for the First Circuit. Josh is an attorney of extraordinary intelligence, extensive experience, and demonstrated integrity. He is highly respected in the legal community throughout the State of Maine, and I urge my colleagues to support his nomination to the First Circuit. Josh grew up in Vassalboro, ME, and now lives in Scarborough with his wife Sydney and their three children. He graduated first in his class from Notre Dame Law School, where he received the law school's highest honor, awarded to the student with the most distinguished academic record. He then clerked for Judge Paul Kelly of the U.S. Court of Appeals for the Tenth Circuit. In 2009, Josh joined the very well respected law firm Pierce Atwood in Portland, ME. During his 16 years at the firm, he has specialized in complex civil litigation matters and currently serves as cochair of the firm's appellate team. Josh is admitted to practice in multiple U.S. courts of appeal and the U.S. Supreme Court. He has also assisted special masters in three original jurisdiction proceedings before the Supreme Court. Finally, Josh also chairs the Maine Appellate Rules Committee, to which he was appointed by the Maine Supreme Judicial Court. This impressive experience, coupled with his intelligence and integrity, makes Josh exceptionally well qualified to serve on the First Circuit. His substantial appellate litigation experience will also bring a practitioner's perspective to the court. The nonpartisan American Bar Association unanimously rated Josh as ``well qualified'' to serve on the First Circuit. I would note that that is the highest possible rating for a judicial nominee. It reflects the ABA's assessment of his integrity, experience, and temperament. There were several compelling letters of support submitted to the Senate Judiciary Committee in favor of Josh's nomination, and I would like to highlight a couple of them. A diverse group of faculty and alumni from his law school who taught Josh or studied alongside him praised him for his ``respect for differing views'' and ``deep appreciation for the rule of law.'' A letter signed by a group of leading Maine attorneys who describe themselves as representing a broad spectrum of political views and legal philosophies wrote that Josh has all the qualities the very finest judges exhibit: He is hard-working, courteous, and judicial in temperament, very smart, and of sterling character, with a commitment to fairness and the rule of law. At his confirmation hearing before the Senate Judiciary Committee, Josh testified that Mainers are famously independent and that he suspects that characterizes him as well. That is exactly what we want in a judge. Maine is proud of our history of supplying superb, well-qualified, independent-minded jurists to the Federal bench. I know that Josh will continue in that fine tradition. I urge all of my colleagues to vote in favor of his nomination, for he truly deserves bipartisan support. Mr. President, seeing that there are no other speakers, I would ask unanimous consent that the already scheduled vote begin immediately.

Ms. COLLINS

Ms. COLLINS. Mr. President, further, I ask unanimous consent to waive the mandatory quorum call with respect to cloture on the motion to proceed to Calendar No. 136, H.R. 4016.

Ms. COLLINS

Ms. COLLINS. Mr. President, today the Senate has the opportunity to begin consideration of an appropriations bill that is vital to our national defense and to the well-being of the brave men and women who serve in our Armed Forces. The fiscal year 2026 Defense appropriations bill would provide U.S. military services with the funding needed to deter China and Russia, to support our servicemembers and their families, and to strengthen the defense industrial base. The bill would remove the uncertainty that our American troops face about when they will be paid because of the needless and reckless government shutdown that Leader Schumer has directed. I would point out that passing a continuing resolution, as we have tried to do 10 times now, would also remove the cloud of uncertainty hanging over military paychecks. In July, as the Presiding Officer is well aware, the Appropriations Committee advanced the Senate version of the Defense appropriations bill by an overwhelming bipartisan vote of 26 to 3. The Senate version addresses major funding gaps across the board. It would invest in shipbuilding, including providing a critical downpayment toward an additional DDG 51, the workhorse of the U.S. service fleet, along with investments in additional Columbia- and Virginia-class submarines. It would expand critical munitions production, including air and missile defense interceptors, long-range missiles, and next-generation hypersonic weapons developed by our most innovative firms. It would fund drone and counterdrone technologies, which are increasingly changing the nature of the battlefield, as we have seen in both Ukraine and Israel. And it would sustain security cooperation with close allies and partners whose growing defense capabilities are force multipliers for the United States and contribute to the deterrence of shared adversaries. Finally, this bill would invest in our most precious asset: the courageous, dedicated, patriotic men and women of our Armed Forces. It shows our continuing commitment to their readiness, well-being, and mission success. Let me commend the leadership--the outstanding leadership--of subcommittee chairman Mitch McConnell and ranking member Chris Coons for their hard work on this bill. I also want to thank majority leader John Thune for his commitment to bringing fiscal year 2026 appropriations bills to the Senate floor. This is such a welcomed change compared to last year when then- majority leader Senator Schumer refused to bring a single one of the 12 annual appropriations bills to the Senate floor for consideration. I want to note for my colleagues that the Senate version of the Defense bill was put together with input from 94 of our Senate colleagues who submitted more than 5,800 requests to the committee for our careful consideration. For all of these reasons, I urge my colleagues to allow us to proceed to the consideration of the fiscal year 2026 Defense funding bill. We want this to be an open process, with an opportunity to add additional bipartisan bills that address vital domestic priorities, including biomedical and scientific research and infrastructure, and we want Members to have a voice in the funding decisions that affect all of our States and constituents back home. That is the approach that we took in committee. That is the approach that we want to take on the Senate floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent to speak for up to 5 minutes prior to the scheduled rollcall vote.

Ms. COLLINS

Ms. COLLINS. Mr. President, in 1925, business and government leaders from throughout New England came together in Poland Springs, ME, to develop a strategy to reverse the decline in our traditional industries and our communities. Today, we celebrate a century of accomplishments by the New England Council to foster prosperity and opportunity. When Captain John Smith explored our rugged coast more than 400 years ago, he wrote in his journal that settling this untamed region would take, ``the best parts of art, judgment, courage, honesty, constancy, diligence, and industry.'' I know of no better description of the spirit that guides the New England Council. Congratulations and happy birthday.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise to urge passage of the funding bill that was approved by the House of Representatives earlier today. Now, let's be clear on what this bill is and what it is not. It is a stopgap measure, which is known as a continuing resolution or often called a CR. It is straightforward. It continues current funding levels for government until November 21. That gives Congress the time that we need to continue our work on the annual appropriations bills. It is not a yearlong CR. Republicans do not want a yearlong CR. The reason we are operating under a yearlong CR for the first time in history for the Department of Defense, which is causing tremendous difficulties, is because the then-majority leader Senator Schumer refused to bring a single appropriations bill to the Senate floor in the last Congress despite the hard and bipartisan work of the Senate Appropriations Committee. So let's be clear on that. Once again, the House and Senate Appropriations Committees have worked hard over the last several months to advance annual appropriations bills and carry out our constitutional responsibility of the power of the purse. Last month, the full Senate passed with overwhelming bipartisan support our first package of fiscal year 2026 annual appropriations bills. They included the bills funding agriculture and the FDA; military construction and veterans affairs; and the legislative branch. This marked the first time since 2018--7 years ago--that the Senate approved annual appropriations bills before the August home State work period. In the intervening weeks, the leaders of the relevant Senate subcommittees have been working very hard with their House counterparts on both sides of the aisle to reconcile the differences between the House and the Senate bills. We hope to have final versions of these three bills soon that can be considered in both Chambers, enacted, and sent to the President for his signature. In addition, Majority Leader Thune has already expressed a willingness, indeed a commitment, to bring another package of fiscal year 2026 appropriations bills to the Senate floor next month. This is a welcome change from the last year when then-majority leader Senator Schumer refused to bring a single one of the 12 annual appropriations bills to the Senate floor for consideration. Those are the facts. The result of that obstruction was a full-year continuing resolution for fiscal year 2025 and a delayed start to our current appropriations process. To my colleagues on both sides of the aisle who want to avoid a similar fate for fiscal year 2026, I say, work with us to complete the annual funding bills, just as we are doing in committee. Pass this clean CR, which has no poison pills, so that we can prevent disruptions to vital programs on which the American people rely while Congress completes its work on the annual funding bills. It should be that simple. Government shutdowns have negative consequences across government and across the Nation. They require certain government employees such as Border Patrol agents, members of our military and Coast Guard, TSA screeners, and air traffic controllers, among others, to report to work with no certainty on when they will next receive their paycheck. Shutdowns put critical investments in our national defense on hold, training exercises could be limited, which could hurt our Nation's readiness. New programs would be paused, delaying new capabilities from getting to our warfighters. Under a shutdown, Federal funding for important national priorities would be halted, including grants to State and local law enforcement and other first responders, new funding and support for the Head Start Program and child welfare services, as well as formula grants to States that support older Americans and individuals with disabilities. Most day-to-day operations at our national parks would cease. The first week of October is usually peak foliage in Downeast Maine. It is a time when visitors flock to Arcadia National Park in Maine--the crown jewel of Maine. In previous shutdowns, park personnel were kept to a minimum. Visitor service centers were closed. Restrooms were not maintained. Trails were not cleared. All of this affects the visitor experience and has a ripple effect, harming our local small businesses when tourists decide to cancel their reservations. Instead of supporting a clean CR to prevent a government shutdown, congressional Democrats, sadly, have put forth a partisan alternative that is full of poison pill riders and significant policy changes. This is not a clean CR just extending existing funding levels until, well, in their case, until the end of October, in the case of what I thought was an agreed-upon bipartisan date, November 21, as the House bill would do. Most appalling--and I want to make sure that all my colleagues on both sides of the aisle realize this--the Democratic version of the continuing resolution would repeal the $50 billion fund that I authored to help our rural hospitals that are on the brink of closure. I am sure that is a problem in the Presiding Officer's State as well. In Maine, we have already seen one hospital closure this year, and this fund is vital to other rural hospitals across the State and across the Nation that are struggling to stay afloat and provide essential healthcare to their communities. Now, I support extending the enhanced premium tax credit for health insurance, but unlike appropriations, that issue does not have a September 30 deadline. It should be a priority for us to take up before the end of the year because, as has been mentioned by the vice chair, insurance bureaus across this country have approved substantial rate increases--24 percent in the State of Maine--so we do need to act. But that is a significant policy change, and the deadline is not September 30. I urge my colleagues to abandon this brinksmanship that does not serve the American people well, that is unworthy of this Senate, and adopt this straightforward bill sent to us by the House, which the President is willing to sign into law without any further delay and which will avoid a completely unnecessary and harmful shutdown of government. This would allow us the time to complete the fiscal year 2026 appropriations process and continue our work to find a path forward on the enhanced premium tax credit. I yield the floor. 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. I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce legislation with my colleague from Virginia Senator Kaine that would reauthorize the only federally funded programs specifically designed to develop a healthcare workforce focused on the care of older Americans. The Geriatrics Workforce Improvement Act would reauthorize two programs important to training specialists who care for our older adults: the Geriatrics Workforce Enhancement Program and the Geriatrics Academic Career Awards Program. The number of Americans age 65 and older is growing. In 2020, there were just three States in which senior citizens outnumbered children: Maine, Vermont, and Florida. Today, there are 11 States that have more seniors than children, and Maine has the oldest population in the Nation. The percentage of the U.S. population over age 65 rose by 3 percent, to 18 percent, in just 1 year. The fact is, the United States is facing a shortage of geriatric health professionals and direct service workers to support our aging population. The American Geriatrics Society projects that we will be short some 1,700 geriatricians by the year 2036. Fewer than 7,000 of our Nation's nearly 1 million physicians are board-certified geriatricians. We need to train 1,600 geriatricians per year over the next 9 years to fill that gap. Complicating this shortfall is the fact that as many as 90 percent of our older adults either have or will develop one or more chronic health conditions. So you put together many chronic conditions, an aging population, multiple medications, and changes that naturally occur in aging, and you have a situation making caring for older adults ever more complex and challenging. In any given year, it is expected that 30 percent of older adults will require specialized geriatric care. Today, there are 42 Geriatrics Workforce Enhancement Programs in 37 States. I am pleased that since the last reauthorization in 2019, this list has expanded to include such a program in the State of Maine. It is located at the University of New England. For Maine, with an aging population of more than a quarter of a million Mainers over the age of 65 and only 36 geriatricians, there is an acute need to train more geriatric health professionals and direct service providers quickly to meet this growing demand. Maine's program, known as AgingME, has brought much needed support to communities and families throughout the State. For example, AgingME has worked with other training and geriatrics-serving partners to develop a postgraduate credentialing program in geriatrics. Students who participate in the program complete more than 2,000 hours of training in medically underserved communities and rural areas of Maine. AgingME has also worked to increase the number of community-based learning programs, such as falls prevention education programs in rural areas. It has also helped to connect family caregivers with resources for Alzheimer's and related dementias through its website and through partnerships with Maine's Area Agencies on Aging. Nationally, the geriatric workforce program has produced significant outcomes. In 2022, the most recent reported year, Geriatrics Workforce Enhancement Programs trained nearly 72,000 students, professionals, patients, caregivers, and faculty. These programs were also able to offer faculty development training programs and activities, provide outreach and education to families and caregivers on care delivery for older adults, and train patients in self-management of their conditions. More than 2.2 million individuals have been trained through these programs, of whom 57 percent were patients and their caregivers. And all of us know the vitally important role that family caregivers play in taking care of their older relatives, often their parents. But we also know that they need help in doing so, including training. Approximately a third of the courses offered focused on Alzheimer's disease and other dementias. Patients and caregivers also took courses on other topics related to the health needs of older adults, such as geriatric health, emergency response training, and community health. Our legislation would also reauthorize the geriatrics career advancement award program. Established in 1998, this program was created to increase the number of faculty engaged in geriatric education. Transitioning from clinical training and practice into an academic faculty role can be challenging. It requires gaining new skills as an educator, skills not typically taught in clinical training programs. Geriatrics Academic Career Awards support early career development for emerging leaders by providing funding that supports their efforts to develop skills as an educator in geriatrics. The Geriatrics Workforce Improvement Act would reauthorize these two vitally important programs at a combined amount of $48.2 million per year over the next 5 years. It really is a modest investment that will help ensure that our older Americans have the expert care that they need, that their caregivers are provided with training, that other support employees and healthcare providers receive the skills that they need as well. Together, these programs will continue to train the current workforce and family caregivers while developing a cadre of emerging leaders in geriatric education in a variety of disciplines. In doing both, we can help to ensure that our aging Americans will be cared for by a healthcare workforce specifically trained to meet their unique and often complex health needs for decades to come. This will lead to improved care for older Americans while saving valuable resources and reducing unnecessary costs. I urge my colleagues to support this bipartisan legislation to strengthen and extend these two important programs.