Susan Collins

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise to introduce a bill that would prohibit the IRS from the targeting any U.S. citizens for exercising their constitutional rights under the First Amendment. The history of the IRS offers abundant examples of the Agency trampling on these rights. In the most recent controversy, which came to light in 2013, the IRS applied a heightened scrutiny to applications from conservative groups that were seeking tax-exempt status. Delaying these groups' applications suggests an attempt to chill the constitutional right of speech and association by groups that hold conservative views. No matter what your political views, the details that have emerged are truly alarming. The IRS admitted that it deliberately targeted conservative groups' applications for tax-exempt status for extra review if they included such words as ``tea party,'' ``patriots,'' or ``9/11'' in their names. It also acknowledged targeting applications from groups that criticized how this country is being run or whose purpose was to address government spending, government debt, taxes, or simply to make America a better place. These inappropriate criteria stayed in place for more than 18 months and resulted in substantial delays in processing the applications of many different groups. In some cases, the applications remained outstanding for more than 2 years. The IRS also sought to compel some of the targeted groups to divulge their membership lists. IRS officials have subsequently admitted there was absolutely no reason for Agency personnel to have sought that kind of information. Such behavior, unfortunately, is not a one-time aberration, and the targets have been on both sides of the aisle. A May 2013 Time magazine article noted that the IRS has been involved in scandals going back at least as far as the Kennedy administration, which used the service to investigate so-called rightwing groups. President Nixon employed a secret IRS operation to investigate and audit political opponents. During the Johnson administration, the IRS targeted some antiwar activists. In the decades since, a number of political activists from both the conservative and liberal ends of the spectrum, as well as whistleblowers, have been subjected to intimidating and discriminatory scrutiny by the IRS. The IRS's history of abuses demonstrates that Congress must be ever- vigilant in protecting taxpayers. The Agency's power allows it to pervade the most sensitive aspects of Americans' private lives. Irrespective of whether those singled out are liberal or conservative, Democrat or Republican, Independent or Green Party members, regardless of their personal views, the targeting of private citizens for exercising their First Amendment rights is out of bounds and cannot be tolerated. Seventeen years ago, when the IRS was accused of using abusive tactics towards taxpayers, Congress responded by passing the IRS Restructuring and Reform Act. That act created the Taxpayer Bill of Rights, strengthened taxpayer protections against unauthorized collection activities, and established an oversight board to ensure that taxpayers are properly treated by the IRS. The bill I am introducing today builds on the 1998 act, as well as an amendment I authored in 2013, which became law, that prohibited the IRS from using funds provided through the fiscal year 2014 IRS funding bill to target American citizens for exercising their First Amendment rights. That prohibition on the use of funds was continued in the fiscal year 2015 funding bill, and the legislation I am offering today would make that prohibition permanent. The First Amendment is one of our most cherished and sacred freedoms, and its free exercise must be vigorously protected. It has been said the power to tax is the power to destroy. The American people cannot and will not tolerate any abuse of that power. It is imperative that Congress act to make sure the power of the IRS is never again used to harass or abuse Americans for exercising their First Amendment rights. The bill I have introduced is tailored to that end. I urge my colleagues to support this bill.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent to set aside the pending amendment to call up my amendments Nos. 346, 425, 426, 427, 442, and 810 en bloc.

Ms. COLLINS. Mr. President, I offer this amendment on behalf of myself and Senator Hirono. Our amendment would create a deficit-neutral reserve fund to expand access to higher education for some of our neediest students through the Pell grant program. The amendment would allow for year-round Pell grants so students who want to accelerate their degrees by taking additional courses, including during the summer, can receive an additional Pell grant when they need it and complete their education more quickly without having to wait for the next academic year to begin. I urge my colleagues to support this bipartisan amendment.

Ms. COLLINS. I am happy to withhold the request.

Ms. COLLINS. Mr. President, there will be very little time later today when we start voting for there to be full explanations of any of these amendments, which I think is very unfortunate. I do want to let my colleagues know about some of these amendments, and I am proud to say that, for the most part, the amendments I have filed and have now called up are bipartisan amendments that enjoy support on both sides of the aisle. For example, my amendment No. 427 would create a deficit-neutral reserve fund to support sufficient investment in Alzheimer's disease research to achieve the goal set by the national plan to address Alzheimer's disease--of having the means to prevent and effectively treat that disease by the year 2025. This amendment is cosponsored by Senator Moran, Senator Warner, Senator McCaskill, Senator Toomey, and Senator Donnelly. It is modeled very much on a bill that Senator Klobuchar and I have introduced to increase funding for Alzheimer's research. Just yesterday the Special Committee on Aging, which I lead along with Senator McCaskill, held an extensive hearing on Alzheimer's disease. We listened to preeminent researchers and individuals such as B. Smith, who unfortunately has been afflicted with early onset Alzheimer's. We listened to a caregiver and to a geriatric physician from Portland, ME. We had testimony from the Mayo Clinic and testimony from the individual who heads the Institutes on Aging at the National Institutes of Health. To a person they pointed out that we are spending $226 billion a year caring for people with Alzheimer's, yet we are investing less than $600 million in this disease. The experts tell us that if our investment were at the level of $2 billion a year, we could explore the promising breakthroughs, the therapeutic targets that are needed to develop a means of prevention or better treatments or, ultimately, even a cure for Alzheimer's. Think of that. That $2 billion figure that is recommended by the expert advisory council, headed by Dr. Ron Peterson from the Mayo Clinic, is less than 1 percent of what we are spending caring for people with Alzheimer's. This disease is going to bankrupt the Medicare and the Medicaid Programs. We are currently spending $154 billion from those two programs for care of patients with Alzheimer's. That is one of the amendments I will be proposing. I see the Senator from Illinois is on the floor, and he has been another real leader in this area.

Ms. COLLINS. Yes, I will be happy to yield.

Ms. COLLINS. Mr. President, I want to thank my colleague and friend from Illinois for his comments. I happened to catch his speech yesterday. There was a sea of purple at our hearing--purple representing the Alzheimer's cause. I hope one day purple will represent Alzheimer's survivors. Wouldn't that be wonderful. This is a high priority for me. And I agree with the Senator from Illinois, I believe we should be increasing our investment in biomedical research, particularly for Alzheimer's, but in many other areas as well. The irony is that, ultimately, it will reduce not only human suffering but the cost of health care. The trajectory of Alzheimer's is such that if we do not develop better treatments, a means of prevention, or a cure, by the year 2050 the estimate is we are going to be spending more than $1 trillion taking care of people with Alzheimer's. For all of us in the baby boomer generation, the estimates are that by age 85, nearly 1 out of 2 of us will be afflicted with Alzheimer's, if the current trajectory is unchanged. Frankly, we are going to be spending our golden years either with Alzheimer's or taking care of someone with Alzheimer's. So this is a crisis, and it deserves our attention. I know Senator Moran also has a broader amendment on biomedical research, which I am proud to be a sponsor of, and this is an area where I hope we can come together in a bipartisan way, as my colleague has suggested. Mr. President, there are other amendments I would like to briefly discuss, seeing no one seeking the floor immediately, I don't believe. I will have my staff check on that. I am also going to offer an amendment to create a deficit-neutral reserve fund to increase access to higher education for low-income Americans through the Federal Pell grant program, including an innovative idea that I am very interested in, and that the chairman of the Committee on Health, Education, Labor and Pensions, Senator Lamar Alexander, is very interested in, which would allow for year-round Pell grants so that individuals could complete their education more quickly. Before I was elected to the Senate, I worked at a college in Maine-- Hudson University in Bangor, ME--and I saw firsthand the difference that Pell grants made in the lives of these students. Indeed, on my staff today there are highly talented individuals who were able to go to college solely because of the existence of Pell grants. Their families did not have experience with higher education and could not afford higher education. Pell grants made possible a bright future for these two women on my staff. This is the kind of opportunity that should unite us and that all of us should rally behind. Allowing year-round Pell grants would allow students to complete their education more quickly and join the workforce more quickly, which would help them financially as well. So I hope this is something we can pursue and that will be adopted as well. Another of my bipartisan amendments, No. 442, would establish a deficit-neutral reserve fund to change the definition of full-time employee under ObamaCare so a worker could work for more than 30 hours per week before the employer mandate penalty would be triggered. This, too, is bipartisan. Senator Donnelly, Senator Murkowski, Senator Manchin, and I have all been working on this. I hear from workers who are telling me their hours have been cut to 29 hours a week because of these penalties their employers simply cannot afford. It is not just in the for-profit hospitality industry, it is also in school systems, community colleges. So that is yet another of my amendments that I hope will enjoy support later today. Mr. President, I see a number of my colleagues on the floor, so I yield the floor. I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today with my colleague from Washington to introduce the Preserve Access to Rural Home Health Services Act of 2015 to extend the modest increase in payments for home health services in rural areas that otherwise will expire on January 1 of next year. Home health has become an increasingly important part of our health care system. The kinds of highly skilled--and often technically complex--services that our Nation's home health caregivers provide have enabled millions of our most frail and vulnerable older and disabled citizens to avoid hospitals and nursing homes and stay just where they want to be--in the comfort, privacy, and security of their own homes. I have accompanied several of Maine's caring home health nurses on their visits to patients and have seen first hand the difference that they are making for patients and their families. Surveys have shown that the delivery of home health services in rural areas can be as much as 12 to 15 percent more costly because of the extra travel time required to cover long distances between patients, higher transportation expenses, and other factors. Because of the longer travel times, rural caregivers are unable to make as many visits in a day as their urban counterparts. For example, home health care agencies in Aroostook County in Northern Maine, where I am from, cover almost 6,700 square miles, with an average population of less than 11 persons per square mile. These agencies' costs are understandably much higher than other agencies located in more urban areas due to the long distances the staff must drive to see clients. Moreover, the staff is not able to see as many patients due to time on the road. Agencies serving rural areas are also frequently smaller than their urban counterparts, which means that their relative costs are higher. Smaller agencies with fewer patients and fewer visits mean that fixed costs, particularly those associated with meeting regulatory requirements, are spread over a much smaller number of patients and visits, increasing overall per-patient and per-visit costs. Moreover, in many rural areas, home health agencies are the primary caregivers for homebound beneficiaries with limited access to transportation. These rural patients often require more time and care than their urban counterparts and are understandably more expensive for agencies to serve. If the extra three per cent rural payment is not extended, agencies may be forced to make decisions not to accept rural patients with greater care needs. That could translate into less access to health care for ill, homebound seniors. The result would likely be that these seniors would be hospitalized more frequently and would have to seek care in nursing homes, adding considerable cost to the system. Failure to extend the rural add-on payment would only put more pressure on rural home health agencies that are already operating on very narrow margins and could force some of the agencies to close their doors altogether. If any of these agencies were forced to close, the Medicare patients in that region could lose all of their access to home care. The legislation we are introducing today will extend the rural add-on for 5 years and help to ensure that Medicare patients in rural areas continue to have access to the home health services they need. Moreover, we would offset costs of the bill by reducing the home health outlier fund by .25 percent over the same 5 years. I urge our colleagues to join us as cosponsors.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today with my colleague from Washington to introduce the Preserve Access to Rural Home Health Services Act of 2015 to extend the modest increase in payments for home health services in rural areas that otherwise will expire on January 1 of next year. Home health has become an increasingly important part of our health care system. The kinds of highly skilled--and often technically complex--services that our Nation's home health caregivers provide have enabled millions of our most frail and vulnerable older and disabled citizens to avoid hospitals and nursing homes and stay just where they want to be--in the comfort, privacy, and security of their own homes. I have accompanied several of Maine's caring home health nurses on their visits to patients and have seen first hand the difference that they are making for patients and their families. Surveys have shown that the delivery of home health services in rural areas can be as much as 12 to 15 percent more costly because of the extra travel time required to cover long distances between patients, higher transportation expenses, and other factors. Because of the longer travel times, rural caregivers are unable to make as many visits in a day as their urban counterparts. For example, home health care agencies in Aroostook County in Northern Maine, where I am from, cover almost 6,700 square miles, with an average population of less than 11 persons per square mile. These agencies' costs are understandably much higher than other agencies located in more urban areas due to the long distances the staff must drive to see clients. Moreover, the staff is not able to see as many patients due to time on the road. Agencies serving rural areas are also frequently smaller than their urban counterparts, which means that their relative costs are higher. Smaller agencies with fewer patients and fewer visits mean that fixed costs, particularly those associated with meeting regulatory requirements, are spread over a much smaller number of patients and visits, increasing overall per-patient and per-visit costs. Moreover, in many rural areas, home health agencies are the primary caregivers for homebound beneficiaries with limited access to transportation. These rural patients often require more time and care than their urban counterparts and are understandably more expensive for agencies to serve. If the extra three per cent rural payment is not extended, agencies may be forced to make decisions not to accept rural patients with greater care needs. That could translate into less access to health care for ill, homebound seniors. The result would likely be that these seniors would be hospitalized more frequently and would have to seek care in nursing homes, adding considerable cost to the system. Failure to extend the rural add-on payment would only put more pressure on rural home health agencies that are already operating on very narrow margins and could force some of the agencies to close their doors altogether. If any of these agencies were forced to close, the Medicare patients in that region could lose all of their access to home care. The legislation we are introducing today will extend the rural add-on for 5 years and help to ensure that Medicare patients in rural areas continue to have access to the home health services they need. Moreover, we would offset costs of the bill by reducing the home health outlier fund by .25 percent over the same 5 years. I urge our colleagues to join us as cosponsors.

Ms. COLLINS

Ms. COLLINS. Mr. President, let me first commend the senior Senator from Texas for his efforts to work out a compromise that I hope will allow this bill to go forward. Senator Heitkamp and I also have been working with the senior Senator from Texas to try to come up with a solution that is similar to what he has outlined, and we will have more to say about that after the vote. Mr. President, I ask unanimous consent that I be permitted to proceed as in morning business for the purpose of a bill introduction, unless someone else is seeking the floor to speak on this bill.

Ms. COLLINS. Thank you, Mr. President. (The remarks of Ms. Collins pertaining to the introduction of S. 804 are printed in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

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

Ms. COLLINS. Mr. President, on behalf of myself and Senator Heitkamp, I send an amendment to the desk.

Ms. COLLINS. Mr. President, for the past 10 days this body has been engaged in an important debate on a bill that has had widespread, bipartisan support, that was reported unanimously by the Senate Judiciary Committee, and that would help to end the scourge of human trafficking. I am a cosponsor of this bill because I believe it will help equip law enforcement and prosecutors with the tools they need to combat these horrific sex trafficking crimes. I, along with my colleague, Senator Leahy, have also introduced a bill--that we have filed as an amendment--that would reauthorize the Runaway and Homeless Youth Act programs so we can also have a prevention piece in this legislation. Many Members of this body have worked very hard on this legislation. Senator Cornyn, whose bill we are considering, has been a real leader in the area of human trafficking. Senator Klobuchar also has a bill I have been proud to cosponsor. Senator Grassley and Senator Leahy, at the request of all 20 of the women Senators, held a hearing on this issue at which I was privileged to testify, along with Senator Ayotte, Senator Mikulski, and Senator Gillibrand. I applaud the Judiciary Committee for its work in shining a light on some of the darkest stories imaginable. No State is immune from the evils of human trafficking. Just recently in Maine, a couple was arrested for allegedly trafficking a girl who was only 13 years old. They used the Internet to sell her for sex. The Runaway and Homeless Youth and Trafficking Prevention Act that Senator Leahy and I have cosponsored seeks to prevent young people from ever getting trapped in these situations in the first place, and I hope we can move on to that bill, which we have filed as an amendment. But, regrettably, we find ourselves at an impasse--imagine that--an impasse on a bill that would help curb human trafficking. How can that be? Senator Heitkamp and I have joined forces to try to move this bill forward. That is our goal, and the goal of the amendment we have filed. What our amendment would do, and it is very straightforward, is it would subject the fund that Senator Cornyn has created, and which I strongly support, to the annual appropriations process and to all of the usual restrictions that the Appropriations Committee can and does add to appropriations bills. There is precedent for taking a fund that is not financed by tax dollars and sending it through the appropriations process. It, frankly, happens all the time. We have seen it with the oil and gas revenues that go to the Land and Water Conservation Fund. Those are not tax dollars. We have seen it with a number of fees and restitution programs that are not tax dollars but go through the appropriations process, where the Appropriations Committee can work its will. Under out amendment, all of the money collected from special assessments imposed on certain trafficking criminals and deposited into the fund would still be made available to anti-trafficking and victims' services grant programs, but only through the direction of the annual appropriations process. By placing the fund squarely within the jurisdiction of appropriators, each and every penny collected would be subject to the limitations in those appropriations bills. Our amendment would strike the reference that has been the sources of this controversy from this authorizing bill, but does not alter that restriction on federal funds that has existed for 39 years. Our amendment makes clear that money in the fund, or transferred from the fund, is subject to the limitations provided in appropriations acts. I believe our amendment, by allowing the Appropriations Committee to put whatever restrictions are appropriate on this fund--and I have no doubt the usual restrictions will be put on by the Appropriations Committee--could get this bill to move forward, and those such as Senator Cornyn, Senator Klobuchar, and others who have worked so hard to bring this bill to the Senate floor, will see there is a path forward. We owe it to the victims of human trafficking. We owe it to the victims of human trafficking. We owe it to them. We cannot fail in this task. If we cannot approve a bill to deal with human trafficking, then what will we be able to deal with? We have to get past the tendency to score partisan, political points that have affected too many bills on both sides of the aisle. In this case, it is simply too important. I thank my dear friend and colleague from North Dakota, Senator Heitkamp, who has been an attorney general, who has dealt with the victims of this terrible crime, for coming forward and joining with me as we attempt to put forth--for our colleagues' sincere consideration-- a path forward that will end this impasse.

Ms. COLLINS. If I could respond through the Chair, Mr. President, I do have the privilege of serving on the Committee on Appropriations, and I have seen the restrictions we have put on funds over the years. One of those restrictions which is at issue here goes back 39 years. So it is not unusual for the Committee on Appropriations to put certain limitations on the use of funds. As I explained earlier, the Committee on Appropriations also deals with nontax dollars. It is not unusual for us to appropriate money that comes from the collection of fines, of fees, of penalties, from leases. This is common. So what we are proposing in this bill is not anything new, unusual, or unique. It would be part of the standard appropriations process. Indeed, Senator Cornyn actually raised the idea on the floor today of having the victims fund go through the appropriations process. We differ in language, so I don't want to imply there is any endorsement, but the concept is one the author of the bill has raised. So in response to my colleague from North Dakota, who has spoken so eloquently of her experience in dealing with the victims of human trafficking, I would assure her that as a member of the Committee on Appropriations, I know full well that we put restrictions and limitations on funding as a standard course.

Ms. COLLINS. Mr. President, I again want to thank my colleague from North Dakota for her very eloquent plea to our colleagues. I know we can do this. I know we can find a path forward. I know we can get a sufficient number of votes so that we can proceed and debate the many amendments that have been filed on this bill. I know we can do it. The victims of this horrific crime deserve no less from the United States Senate, so let's not fail them. Let's not fail them. Mr. President, I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, as the founder and the cochair of the Senate Diabetes Caucus, I have learned much about this devastating disease affecting nearly 29 million Americans. Fortunately, due to the Special Diabetes Program and to increased investments in diabetes research, we have seen some exciting breakthroughs and we are on the threshold of a number of important new discoveries. This is particularly true for the estimated 1.2 million Americans living with type 1 diabetes. Advances in technology such as continuous glucose monitors are helping patients control their blood glucose levels, which is key to preventing costly and sometimes deadly diabetes complications. We are moving closer and closer to our goal of an artificial pancreas. The National Institutes of Health and the Food and Drug Administration have been extremely supportive of these innovations in diabetes care. I was, therefore, shocked and troubled to learn that insulin-dependent Medicare beneficiaries are being denied coverage for continuous glucose monitors because the Centers for Medicare and Medicaid Services has determined that they do not meet the definition for durable medical equipment and do not fall under any other Medicare category. As a consequence, we are seeing situations similar to what we saw with insulin pumps in the late 1990s, where individuals with type 1 diabetes have had coverage for their continuous glucose monitors on their private insurance, only to lose that coverage when they get old enough to become eligible for Medicare. Let me give some brief background. A continuous glucose monitor is a physician-prescribed, FDA-approved medical device that can provide real-time readings and data about trends in glucose levels every 5 minutes, thus enabling someone with insulin-dependent diabetes to eat or take insulin and prevent dangerously high or low glucose levels. There has been essential and extensive clinical evidence that shows that individuals using this device have improved overall glucose control and, thus, reduced rates of hypoglycemia or low blood glucose levels. That is why professional medical societies have recognized the clinical evidence and have published guidelines recommending that these monitors be used in appropriate patients with type 1 diabetes. Now, here is the fact that is astonishing to me. About 95 percent of commercial insurers provide coverage for continuous glucose monitors, but Medicare is refusing to provide coverage for those devices. I recently heard about this problem from one of my constituents, 74-year- old Prudence Barry of Portland, ME. Diabetes treatments have changed dramatically since Pru was diagnosed with type 1 diabetes back in 1954. Back then, it was very difficult for her to control her insulin levels and to get her glucose levels properly read. Well, Pru has led an active and fulfilling life. Living with type 1 diabetes for more than 60 years has taken its toll. Today, Pru no longer feels it when her blood glucose levels drop to dangerous levels, causing her to lose consciousness and suffer seizures more frequently. Nighttime low sugars are particularly troubling. She fears the possibility of her blood sugar developing so low during the night that she never wakes up. The continuous glucose monitor is a potential lifesaver for Pru because it prevents these dangerously high or low blood glucose levels by alarming the wearer when the glucose levels fall outside of the safe range. So even though 95 percent of private insurers cover this technology, Medicare does not. As a consequence, Pru does not have access to the potentially lifesaving device because she cannot afford to pay for it out of pocket. Pru is not alone. There are thousands of seniors with type 1 diabetes who like my constituent are denied access to this technology that would help keep them healthy and safe. The ironic thing is it is only because of advances in diabetes care, such as continuous glucose monitors, that people with type 1 diabetes can expect to live long enough to become Medicare beneficiaries. So I am very concerned about this decision by CMS. It makes absolutely no sense. It contradicts all the work NIH and the FDA are doing to get new innovative treatments and technologies to patients. I brought this up in a recent hearing of the HELP Committee and asked the outgoing FDA Commissioner what she thought. She expressed her regret about the lack of consultation between her agency and CMS about payments for FDA-approved devices and drugs. I am particularly concerned given the implications that this coverage decision will have for future decisions regarding artificial pancreas systems, which will combine a continuous glucose monitor, insulin pump, and sophisticated algorithm to control high and low blood sugar around the clock. This coverage decision on the part of CMS--which, after all, is also part of the Department of Health and Human Services--directly counteracts all of the work that the NIH and the FDA are doing to get new innovative treatments and technologies to patients. As I said, I recently had the opportunity at a HELP Committee hearing to ask outgoing FDA Commissioner Hamburg whether CMS consults with her agency when making these kinds of coverage decisions. In response to my question, Commissioner Hamburg expressed regret that her agency does not routinely consult with CMS about payments for FDA-approved drugs and devices, saying that the FDA should ``look at the whole ecosystem of biomedical product development and use, and recognize that each of the different components that often operate in silos actually are very interdependent.'' I completely agree with her assessment. I am therefore joining my colleague from New Hampshire and the Co- Chair of the Senate Diabetes Caucus in introducing the Medicare CGM Access Act of 2014 to create a separate benefit category under Medicare for the continuous glucose monitor and require coverage of the device for individuals meeting specified medical criteria. Our legislation is strongly supported by a coalition of organizations, including the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the Endocrine Society and the JDRF. I encourage my colleagues to join us as cosponsors of this important legislation. I see Senator Leahy has come to the floor and undoubtedly wants to speak on the pending business. Let me conclude my remarks by saying I am very pleased the Senator from New Hampshire, Jeanne Shaheen, who is the cochair of the Senate Diabetes Caucus, is joining me in introducing the Medicare CGM Access Act to create a separate benefit category under Medicare for these monitors and to require coverage of the device for seniors who are meeting specified medical criteria. Mr. President, I ask unanimous consent that a letter of endorsement be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Mr. President, as the founder and the cochair of the Senate Diabetes Caucus, I have learned much about this devastating disease affecting nearly 29 million Americans. Fortunately, due to the Special Diabetes Program and to increased investments in diabetes research, we have seen some exciting breakthroughs and we are on the threshold of a number of important new discoveries. This is particularly true for the estimated 1.2 million Americans living with type 1 diabetes. Advances in technology such as continuous glucose monitors are helping patients control their blood glucose levels, which is key to preventing costly and sometimes deadly diabetes complications. We are moving closer and closer to our goal of an artificial pancreas. The National Institutes of Health and the Food and Drug Administration have been extremely supportive of these innovations in diabetes care. I was, therefore, shocked and troubled to learn that insulin-dependent Medicare beneficiaries are being denied coverage for continuous glucose monitors because the Centers for Medicare and Medicaid Services has determined that they do not meet the definition for durable medical equipment and do not fall under any other Medicare category. As a consequence, we are seeing situations similar to what we saw with insulin pumps in the late 1990s, where individuals with type 1 diabetes have had coverage for their continuous glucose monitors on their private insurance, only to lose that coverage when they get old enough to become eligible for Medicare. Let me give some brief background. A continuous glucose monitor is a physician-prescribed, FDA-approved medical device that can provide real-time readings and data about trends in glucose levels every 5 minutes, thus enabling someone with insulin-dependent diabetes to eat or take insulin and prevent dangerously high or low glucose levels. There has been essential and extensive clinical evidence that shows that individuals using this device have improved overall glucose control and, thus, reduced rates of hypoglycemia or low blood glucose levels. That is why professional medical societies have recognized the clinical evidence and have published guidelines recommending that these monitors be used in appropriate patients with type 1 diabetes. Now, here is the fact that is astonishing to me. About 95 percent of commercial insurers provide coverage for continuous glucose monitors, but Medicare is refusing to provide coverage for those devices. I recently heard about this problem from one of my constituents, 74-year- old Prudence Barry of Portland, ME. Diabetes treatments have changed dramatically since Pru was diagnosed with type 1 diabetes back in 1954. Back then, it was very difficult for her to control her insulin levels and to get her glucose levels properly read. Well, Pru has led an active and fulfilling life. Living with type 1 diabetes for more than 60 years has taken its toll. Today, Pru no longer feels it when her blood glucose levels drop to dangerous levels, causing her to lose consciousness and suffer seizures more frequently. Nighttime low sugars are particularly troubling. She fears the possibility of her blood sugar developing so low during the night that she never wakes up. The continuous glucose monitor is a potential lifesaver for Pru because it prevents these dangerously high or low blood glucose levels by alarming the wearer when the glucose levels fall outside of the safe range. So even though 95 percent of private insurers cover this technology, Medicare does not. As a consequence, Pru does not have access to the potentially lifesaving device because she cannot afford to pay for it out of pocket. Pru is not alone. There are thousands of seniors with type 1 diabetes who like my constituent are denied access to this technology that would help keep them healthy and safe. The ironic thing is it is only because of advances in diabetes care, such as continuous glucose monitors, that people with type 1 diabetes can expect to live long enough to become Medicare beneficiaries. So I am very concerned about this decision by CMS. It makes absolutely no sense. It contradicts all the work NIH and the FDA are doing to get new innovative treatments and technologies to patients. I brought this up in a recent hearing of the HELP Committee and asked the outgoing FDA Commissioner what she thought. She expressed her regret about the lack of consultation between her agency and CMS about payments for FDA-approved devices and drugs. I am particularly concerned given the implications that this coverage decision will have for future decisions regarding artificial pancreas systems, which will combine a continuous glucose monitor, insulin pump, and sophisticated algorithm to control high and low blood sugar around the clock. This coverage decision on the part of CMS--which, after all, is also part of the Department of Health and Human Services--directly counteracts all of the work that the NIH and the FDA are doing to get new innovative treatments and technologies to patients. As I said, I recently had the opportunity at a HELP Committee hearing to ask outgoing FDA Commissioner Hamburg whether CMS consults with her agency when making these kinds of coverage decisions. In response to my question, Commissioner Hamburg expressed regret that her agency does not routinely consult with CMS about payments for FDA-approved drugs and devices, saying that the FDA should ``look at the whole ecosystem of biomedical product development and use, and recognize that each of the different components that often operate in silos actually are very interdependent.'' I completely agree with her assessment. I am therefore joining my colleague from New Hampshire and the Co- Chair of the Senate Diabetes Caucus in introducing the Medicare CGM Access Act of 2014 to create a separate benefit category under Medicare for the continuous glucose monitor and require coverage of the device for individuals meeting specified medical criteria. Our legislation is strongly supported by a coalition of organizations, including the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the Endocrine Society and the JDRF. I encourage my colleagues to join us as cosponsors of this important legislation. I see Senator Leahy has come to the floor and undoubtedly wants to speak on the pending business. Let me conclude my remarks by saying I am very pleased the Senator from New Hampshire, Jeanne Shaheen, who is the cochair of the Senate Diabetes Caucus, is joining me in introducing the Medicare CGM Access Act to create a separate benefit category under Medicare for these monitors and to require coverage of the device for seniors who are meeting specified medical criteria. Mr. President, I ask unanimous consent that a letter of endorsement be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Mr. President, I wish to recognize the inspiring accomplishments of Nancie Atwell from Southport, ME, who was awarded the first Global Teacher Prize by the Varkey Foundation. This international, nonprofit organization is committed to improving the quality of education worldwide. Nancie's selection as the foundation's first ever prize recipient is a testament to her outstanding contributions to the teaching profession and her effect on countless students and teachers. The $1 million prize was awarded at a ceremony in Dubai attended by former President Bill Clinton and Sheikh Mohammed bin Rashid Al Maktoum, Prime Minister of the United Arab Emirates. Heralded as the ``Nobel Prize of Teaching,'' the prestigious Global Teacher Prize shines a spotlight on the critical role that teachers play in our society. Nancie was selected from more than 5,000 nominations received from 120 countries. The candidates were evaluated based on their innovative teaching practices, including their ability to prepare students to be global citizens. The pool of thousands was narrowed down to a group of 10 remarkable nominees, including teachers from Afghanistan, India, Kenya, Haiti, Malaysia, Cambodia, and the United States. Within this elite group, Nancie Atwell rose above the rest. Nancie has been a teacher since 1973. In 1990, she used money from her own pocket to found the Center for Teaching & Learning, an independent demonstration school that educates students from kindergarten through eighth grade in the small town of Edgecomb. Her vision was to foster a more meaningful education for Maine students. The center serves a close-knit population of approximately 75 students who travel from several surrounding towns because they are attracted to the school's small class sizes, research- based curriculum, and teacher outreach programs. In a gesture that exemplifies her deep commitment to her students, Nancie announced that she intends to donate every last penny of the $1 million prize back to her school to support its resources, scholarships, library, and to replace its worn out furnace. Nancie, who has authored many books and articles about education and hosted 140 education workshops, embodies a teaching philosophy based on student engagement, not just assignments. She encourages her pupils to identify and pursue their passions. By enabling students to choose to read and write about what interests them, the center has created an environment where children are excited to learn and eager to demonstrate their knowledge. In addition to teaching students, the center does remarkable work teaching teachers. Educators from other schools regularly visit the center for professional development. Once there, they observe school- wide morning meetings, libraries in every classroom, and student-driven writing workshops. The center facilitates a teacher internship program that pairs visiting educators with teachers at the school. These intern-teachers observe and confer about instruction methods and leave equipped to make substantive changes back in their own schools. In her acceptance speech, Nancie said: When children are engaged, when learning is joyful, those are the lessons that stick. Those are the lessons that are worthwhile and meaningful and hang around. This philosophy has inspired teachers and students alike. In fact, it was one of Nancie's former students who nominated her for the prize. Under Nancie's leadership, the Center for Teaching & Learning has earned national praise. How wonderful it is that Nancie's work has now earned global recognition. The people of Maine--and especially its students--are fortunate to have such a pioneering and driven educator fighting for a brighter future. Nancie is a remarkable ambassador for both the State of Maine and our country, and I congratulate her on this outstanding accomplishment.

Ms. COLLINS

Ms. COLLINS. Madam President, I support S. 178, the Justice for Victims of Trafficking Act. The bill supports law enforcement officers and prosecutors in their efforts to prevent, respond to, and combat human trafficking. Of particular importance, the domestic trafficking victims' fund created by this legislation would help States and localities develop training and services for survivors. In February, I was proud to join all the women in the Senate in requesting that the Judiciary Committee hold a hearing on human trafficking. I appreciate the work of Chairman Grassley and Ranking Member Leahy in quickly scheduling that hearing and thank them for inviting Senators Mikulski, Ayotte, Gillibrand, and me to testify before the committee on behalf of all of the women in the Senate. I applaud the committee's bipartisan work in shining a light on some of the darkest stories imaginable. No State is immune from the evils of sex trafficking. Traffickers lure vulnerable victims with the promises of a better life and use violence, threats, lies, money, drugs, and other forms of coercion to trap them in a life of commercial sex. Many criminals who once worked in drugs have now turned to sex trafficking because it is more profitable. The stories of victims are shocking. Just this past January, police in Bangor, ME, arrested a man and woman for allegedly forcing a 13- year-old girl into prostitution. This child, who was listed as a missing person, was being sold for sex through ads on the Internet. Unfortunately, there are many horrific cases like this occurring across the country. The policies and tools for law enforcement, prosecutors, and survivors included in S. 178 are important pieces of a strong Federal response to human trafficking, and I commend Senators Cornyn and Klobuchar for their work on this legislation. I also hope the Senate will adopt an amendment I have cosponsored with Senator Leahy that would reauthorize the Runaway and Homeless Youth Act programs, which provide critical preventive and treatment services that help homeless youth around the country. Runaway and homeless youth are especially vulnerable to becoming victims of trafficking and sexual exploitation. A meaningful response to the very serious problem of human trafficking must also ensure that those most vulnerable to human trafficking--including our Nation's homeless youth--have the resources they need. The preventive measures provided by the Runaway and Homeless Youth Act programs can help stem the tide of potential trafficking victims. The State of Maine is doing its part to end the scourge of human trafficking, where the Not Here Justice in Action Network and other partnerships between law enforcement and service providers are helping to raise awareness and help victims. Our health care workers in Maine are also tremendous partners. St. Joseph Hospital in Bangor, ME, for example, has focused its efforts on educating and training clinicians, nurses, and emergency medical providers to recognize the signs of human trafficking among their patients. With the proper tools and training, these nurses can intervene. They are learning how to identify victims and how to ask the right questions, which are critically important to keeping these atrocities from continuing. The Justice for Victims of Trafficking Act offers important supports for victims and enhanced tools for our law enforcement. I urge my colleagues to support the bill.

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 today to join Senator Leahy, the ranking member of the Committee on the Judiciary, in explaining an amendment we have filed, amendment No. 290, to the Justice for Victims of Trafficking Act. I wish to take this opportunity to thank Senators Ayotte, Murkowski, Heitkamp, and Baldwin for also cosponsoring our amendment and for their strong support. Our amendment would reauthorize the Runaway and Homeless Youth Act programs which expired in 2013. These three programs--the Street Outreach Program, the Basic Center Program, and the Transitional Living Program--have helped thousands of our homeless youth meet their immediate needs and provide long-term residential services for those who, sadly, cannot be safely reunited with their families. The Street Outreach Program helps homeless and runaway youth find stable housing and connects them with the treatment, counseling, and crisis prevention they need. A central goal of this program is to prevent sexual exploitation and abuse. The Basic Center Program helps community-based providers meet the basic needs of shelter, food, and clothing for homeless youth. The Transitional Living Program supports long-term housing services that help our homeless youth enter stable living environments and develop critical life skills. The amendment Senator Leahy and I and our cosponsors are offering complements the underlying bill by addressing prevention, intervention, and recovery services for the victims of sex trafficking--particularly among one of the most vulnerable populations, and that is our homeless youth. According to the Institute of Medicine and the National Resource Council, homelessness is one of the most common risk factors for sex trafficking. Without access to food, shelter, and social supports, homeless youth too often turn to what is termed survival sex--a way to trade sex for a place to sleep and other basic necessities. Another recent report found that one in four homeless youth are victims of sex trafficking or engaged in survival sex. Approximately 48 percent of homeless youth have done so because they did not have a safe place to stay. Our amendment strengthens the existing programs by ensuring that service providers know how to identify trafficking victims and give these youth the support they need. In Maine, our homeless shelters are critical partners in the fight to end human trafficking. In Portland, the Preble Street Resource Center has used Runaway and Homeless Youth Act resources to connect young people who need food, safe shelter, health services, and educational support with those who can provide those services. The Preble Street Anti-Trafficking Coalition is currently helping approximately 50 trafficking victims--whose ages range from 15 to 42--start new lives. There are more than 1.6 million homeless teens in the United States, an astonishing number. A growing number of homeless youth identify as LGBT, and it is estimated that up to 40 percent of runaway and homeless youth are LGBT. Our amendment would also ensure that those seeking services through these Federal programs are not denied assistance based on their race, color, religion, national origin, sex, sexual orientation, gender identity, or disability. All homeless young people need access to safe beds at night and services during the day so they will never have to choose between selling their bodies and a safe place to sleep. The stand-alone bill on which our amendment is based was reported out of the Committee on the Judiciary during the last Congress with an overwhelmingly strong bipartisan vote of 15 to 3. It has the support of nearly 270 organizations, including service providers, anti-trafficking advocates, and many faith-based organizations that serve homeless youth each and every day. Covenant House, the largest service provider for runaway and homeless youth, strongly supports our reauthorization of these programs. Let me thank Senator Leahy for working so hard and for working to incorporate important feedback into our amendment, such as applying the nondiscrimination clause only to the runaway and homeless youth programs and clarifying the continued ability to provide sex-specific shelters and programming, such as all-girls shelters or all-male shelters. Let me take this opportunity to also commend Senator Cornyn and Senator Klobuchar for their work on the Justice for Victims of Trafficking Act, a bill I have proudly cosponsored. The policies and tools included in this bill are important pieces of the Federal response to the horrific crime of human trafficking. Congress must do more to provide law enforcement with the tools it needs to pursue to end sex trafficking and to also support preventive programs such as the runaway and homeless youth programs that help those who fall victim to traffickers. In many ways our bill is the bookend for the bill that is pending on the Senate floor because it focuses on the service end in helping those who are most vulnerable, our young people. By providing homeless young people with the support and services they need, we can help prevent them from ever being trafficked in the first place. The runaway and homeless youth programs have provided a lifeline and housing for America's homeless and for its human trafficked youth for 40 years. They are a vital tool in addressing these serious problems. I urge my colleagues to support our bipartisan amendment.

Ms. COLLINS

Ms. COLLINS. Madam President, this morning we have the opportunity to accomplish two important goals. First, we can pass legislation which will fully fund the Department of Homeland Security so it can perform its vital mission. Second, we have the opportunity to stand up for our constitutional system of separation of powers. I support and voted for comprehensive immigration reform. But the President's overreach usurps the role of Congress and undermines our constitutional system of checks and balances. The failure of Congress to pass a law to the President's liking cannot become an excuse for the President to usurp the powers of the legislative branch. The President knows he lacks the authority to write the law. He has said so 22 times, on 22 different occasions. Allow me to describe my bill very briefly. Specifically, it does four things. First, it bars the administration from using funds to implement the immigration orders issued by the President in November of last year. Second, it has absolutely no effect on the much more constrained and limited Executive orders the President issued in 2012, the so-called DACA Program that protects the DREAMers, to whom I am very sympathetic. Third, it directs the Department to give the highest enforcement priority to the deportation of foreign nationals in our country illegally who have been convicted of domestic violence, child abuse, exploitation, or a sex crime. Why would we want to keep in this country someone who is deportable who is a sex offender, who has been convicted of child molestation or domestic violence? It makes no sense. Ironically, just this week the Senate Judiciary Committee held an excellent hearing on sex trafficking. We heard heartbreaking stories of very young girls who had been abused by men. If there are foreign nationals in this country who have been convicted of these crimes, they should be deported. And, fourth, it includes a sense-of-the-Senate resolution that the executive branch should not act to give foreign nationals who are here illegally an edge in competing for jobs against American citizens or legal residents with green cards. The Founders gave us a system of separation of powers and checks and balances not to tear us apart but to pull us together. They gave us no shortcuts on purpose. The President's November 2014 Executive actions are ill-advised precisely because they attempt to shortcut the process by usurping Congress's authority to pass legislation. My legislation would block that effort without in any way altering or diminishing the more constrained and important 2012 DACA Program. I want to see the Department of Homeland Security fully funded. It has an absolutely vital mission at a time when our country faces numerous threats. I urge my colleagues this morning both to vote for the clean DHS bill and for my legislation to stand up for the role of Congress in our constitutional system.

Ms. COLLINS. We yield back our time.

Ms. COLLINS

Ms. COLLINS. Madam President, my bill would block the extraordinarily broad immigration actions issued by the President in November of last year. The President himself knows he lacks the authority to take such actions--he has said so publicly on 22 occasions. I support comprehensive immigration reform. But the President's 2014 Executive order overreach usurps the role of Congress, and undermines our system of checks and balances. We must stand tall for the separation of powers doctrine in our Constitution. We can do so while protecting the much more limited June 2012 Executive order that created the so-called DACA program that benefits DREAMers. Under my bill, the DACA program will continue just as it was designed by the President in 2012. Madam President, I yield back all time on this side.