Susan Collins

Ms. COLLINS

Ms. COLLINS. Mr. President, located on U.S. Route 1 near the 45th parallel and nestled among the forests and rivers of eastern Maine sits the town of East Machias, now celebrating its bicentennial year. Taking its name from the swift-flowing river the Passamaquoddy called ``bad little falls,'' East Machias is known for its beautiful scenery, abundant wildlife, Colonial history, and warm, small-town community. East Machias was originally part of the town of Machias that was established as a British Colony. Records of trading posts in East Machias can be found as early as 1633, while the Colony wasn't officially settled until more than a century later, in 1763. In 1765, East Machias' first sawmill was built, launching a rich lumbering and shipbuilding industry which would remain the backbone of the economy for centuries. This industry was driven both by the forests of eastern Maine and the proximity to the Machias River system. These rivers also helped East Machias become a hub for trade and commerce and proved critical to the development of the region following the American Revolutionary War. A key landmark in East Machias is Washington Academy, a private school founded in 1792. The Academy's classes were originally conducted in Machias, taking place in the legendary Burnham Tavern--the headquarters of the patriots that fought and won the first naval battle of the American Revolution at Machias Bay--and then the Masonic Hall until the first school building was opened in East Machias in 1823. Today, Washington Academy is a high-achieving school that serves the local communities as well as international students from more than 20 countries. Along with the Washington Academy, East Machias is home to a beautiful historic district, which was officially recognized by the National Park Service in 1973. The area encompasses the centers of the lumber and shipping industries, numerous houses built between 1760 and 1880, and several churches, including the First Congregational Church and the Former Church of the Disciples of Christ. The district also houses the archeological remains of four separate river-powered lumber and grain mills. Due to its scenic location among the rivers, forests, and coast of eastern Maine, East Machias is a popular destination for outdoors enthusiasts in all seasons. The appeal of East Machias to travelers and Mainers alike are the characteristics of quintessential Maine. It is a pleasure to congratulate the people of East Machias on this 200th anniversary and to wish them all the best in the years to come.

Ms. COLLINS

Ms. COLLINS. Mr. President, on 9/11, hundreds of firefighters and EMS providers made the ultimate sacrifice while carrying out their duty. Their courage became a defining symbol of American heroism, reminding us that the measure of service is found not in words, but in selfless action. The courage displayed by these first responders inspired millions and reminded us that hope is strongest when we stand together. In those moments of profound uncertainty, neighbors helped neighbors, communities rallied together, and Americans from every walk of life stood united in compassion and resilience. We also honor the thousands of first responders who labored tirelessly in the days, weeks, and months that followed. Amid smoke, debris, and uncertainty, they searched for survivors, recovered the fallen, comforted grieving families, and helped a wounded nation begin the long process of healing. Many have since faced life-threatening illnesses and chronic health conditions resulting from their service. Their sacrifices did not end when the recovery efforts concluded, and our Nation's obligation to care for them remains as enduring as their commitment to us.

Ms. COLLINS

Ms. COLLINS. Mr. President, I urge my colleagues to pass the continuing resolution in order to prevent a government shutdown. I yield back all time. Vote on H.R. 6500, As Amended

Ms. COLLINS

Ms. COLLINS. Mr. President, later tonight, my colleagues will be asked to pass the continuing resolution before us to prevent a government shutdown. As chair of the Senate Appropriations Committee, I worked with colleagues on both sides of the aisle to craft this stopgap funding measure. The continuing resolution that we produced is bipartisan and is supported by the administration. After three unnecessary lapses in funding during the fiscal year 2026 cycle, putting the possibility of yet another harmful shutdown off the table should be a priority for each and every one of us. This continuing resolution is straightforward. It continues current government funding levels until December 11, with limited anomalies aimed at avoiding disruptions in crucial government activities and programs. For example, our legislation includes necessary adjustments for programs like the Special Supplemental Nutrition Program for Women, Infants, and Children--better known as the WIC Program--to address program costs and participation levels. It allows the USDA loan programs to operate uninterrupted for our Nation's farmers. It gives the Department of Housing and Urban Development the resources it needs to maintain housing assistance for thousands of families, and we all know how absolutely critical that is. This continuing resolution also includes anomalies to prevent construction delays for several classes of U.S. Navy vessels, including the DDG-51s. It includes language to counter emergent cyber security threats, and it would help Federal law enforcement handle and plan for national security events. The resolution allows the administration immediate access to the full funding amounts for FEMA's Disaster Relief Fund and for the Forest Service and Department of the Interior's wildfire suppression efforts. We have only to look at the news to know just how critical those efforts and programs are. This bipartisan agreement also prevents the Office of Management and Budget from implementing a proposed rule regarding Federal financial assistance--from taking effect for the coming months. I advocated for significant changes to the proposed rule in a July 6 letter to the Agency, citing its potential to politicize the grant-making process and harm small, rural communities; our university, college, and nonprofit laboratories; our hospitals; our families; and biomedical research in general. There have been nearly 500,000 comments on this proposed rule, the vast majority of them against the changes that are proposed. I don't think that in the time I have been privileged to serve in the Senate, I have ever seen a proposed rule generate that many negative comments. This CR also gives Congress the time that it needs to continue our work on bipartisan appropriations bills. Last cycle, we were successful in getting 11 out of the 12 bills passed and signed into law. I hope we can do that this time as well, and the additional time the continuing resolution will give us should help bring that about. It is so important that Congress not abrogate its power of the purse--our constitutional responsibility. Senate passage of this continuing resolution would be a major step toward averting a damaging shutdown that could harm vital programs and throw the lives of Federal workers into disarray. We saw what happened in the shutdowns that occurred during the last cycle that were both unwarranted and unfair to so many of our Federal employees, particularly those who are forced to work without knowing when they would be paid. We cannot allow that to happen again. I very much appreciate the overwhelming bipartisan vote earlier today of 91 to 6, with 1 person voting ``present,'' to move forward with this legislation. I urge another ``aye'' vote tonight so that we can keep our government open and working for the American people.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am very pleased that we could pass these two very important bills this afternoon. I would be remiss if I did not mention that the University of Maine has an excellent lab that specializes in testing ticks for pathogens, and it has worked very closely with our game wardens, with foresters, with the others who are routinely in the woods of Maine and are exposed to tick bites. It actually has developed a little tick kit where you can send the tick into the lab, and it will be tested for pathogens. So I would be remiss if I did not salute the University of Maine for its excellent work on tick-borne illnesses. This legislation is going to make a big difference in helping to advance their work, as well as the research at the MaineHealth research institute. I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that the motion to reconsider be considered made and laid upon the table.

Ms. COLLINS. I know of no further debate on the bill.

Ms. COLLINS. Mr. President, I ask unanimous consent that the committee-reported substitute amendment be considered and agreed to and that the bill, as amended, be considered read a third time.

Ms. COLLINS. Mr. President, I will soon ask that the Senate pass S. 2398, the Kay Hagan Tick Reauthorization Act. The Tick Act was approved by the Senate HELP Committee more than a year ago with strong bipartisan support. I am proud to have authorized the original Tick Act in 2019 with my colleague Senator Tina Smith. Our bipartisan legislation strengthens Federal efforts to confront the alarming public health threat posed by Lyme disease and other tick-borne illnesses. The Tick Act essentially has three parts: First, it reauthorizes funding for the CDC's four Centers of Excellence in Vector-Borne Diseases; second, it extends grants to State and local public health departments to help them treat, test for, and conduct public education campaigns about ticks and other vector-borne diseases; and, third, it requires HHS to implement its national strategy to combat vector-borne diseases. Our bill is named after our former colleague Senator Kay Hagan. Kay, with whom I had the pleasure of serving, passed away in October of 2019 at the age of 66 from complications of a deadly tick-borne illness known as the Powassan virus. It is my hope that reauthorizing the Tick Act will help prevent future tragedies such as this one. Tick-borne diseases are a major public health concern, and the incidents have exploded over the past 20 years. Each year, the State of Maine has hit a new record high in the number of cases of Lyme disease. Last year, Maine reported 4,257 cases. Undoubtedly, that understates the number of cases because many are not reported. But that amount alone is more than double the number of cases reported in my home State just 6 years ago. Current projections show that 2026 will yet again be a record-setting year. This is a record that we do not want to set. The Lewiston Sun Journal reported just last week that every community in Maine's Franklin County faces a high risk of tick encounters for this season. Nevertheless, I am encouraged that we are making progress, and we have made progress in the 6 years since this law was first enacted. For example, a clinical trial for a Lyme disease vaccine is underway right now at the MaineHealth Institute for Research. It has always struck me, as I run, that every year my beloved Labrador retriever can get a vaccine for tick diseases and yet we cannot--we humans cannot-- and I am hoping this clinical trial will be successful, and it will make a real difference. Reauthorizing the Kay Hagan Tick Act would allow crucial projects, such as that research and others across the United States and public education campaigns--which are so important in teaching people what to do if they have a tick bite--that will all be allowed to continue. I want to thank Senator Smith for partnering with me on this reauthorization, and I would note that we have 21 bipartisan cosponsors. I urge all of my colleagues to support this lifesaving legislation. Mr. President, as if in legislative session and notwithstanding rule XXII, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 154, S. 2398.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce the Medicare Home Health Payment Integrity and Protection Act. This legislation would strengthen the Medicare home health program by advancing two complementary goals: protecting the home health program from fraud and strengthening access to these important services for the Americans who need them. I have long been a strong supporter of home healthcare. In a home visit I made in one of my first years as a Senator, I saw firsthand the extraordinary difference that skilled nurses, therapists, and other home health professionals make in the lives of patients and their families. Every day, these dedicated caregivers enable millions of our Nation's most frail and vulnerable individuals to remain in the comfort, security, and privacy of their home, which is where they most want to be. Home healthcare not only improves patients' quality of life but also helps avoid unnecessary hospitalizations and nursing home admissions, producing substantial savings for Medicare, Medicaid, and families alike. For these reasons, we should be strengthening, not weakening, the Medicare home health program. Yet recent trends present a troubling paradox. Despite the rapid aging of our population, the number of traditional Medicare beneficiaries receiving home health services has declined in recent years, from approximately 3.3 million beneficiaries in 2019 to 2.7 million just 5 years later. At the same time, nearly everywhere in our country, the number of Medicare-certified home health agencies has also been dropping. According to the most recent report of MedPAC, which is the independent agency analyzing and advising Congress on Medicare, excluding California, more than 500 home health agencies closed between 2019 and 2024, a decline of 5 percent. The picture is dramatically different in California, however, where the number of Medicare home health agencies has doubled over the same time period. Nearly all of that growth has occurred in Los Angeles County. If that strikes you as strange, you are in good company. As MedPAC observed, many stakeholders, including the California State Auditor, have concluded that the unusual pattern of home health agency growth and use in Los Angeles County raises ``significant program integrity concerns.'' In plain language, that means fraud. MedPAC further noted that Los Angeles County has already been identified as a major hotspot for waste, fraud, and abuse in Medicare hospice services and that the dramatic increase in home health agencies in the same area raises further flags. The California State auditor reported that one office building housed the corporate offices of more than 100 hospice agencies and dozens of home health agencies--a striking example of how organized fraud can exploit weaknesses in Medicare hospice enrollment and oversight. The concentration of Medicare home health spending in Los Angeles County is its own issue. This can be seen by the lopsided spending generated there. Even though only 2 percent of the Nation's Medicare fee-for-service beneficiaries live in Los Angeles County, that 2 percent generates 9 percent of all Medicare fee-for-service home health expenditures in the entire Nation--roughly 4\1/2\ times the expected share. CMS is fully aware of the fraud problem in Los Angeles County and has responded aggressively. I commend the Agency for doing so. My legislation builds on those efforts by strengthening CMS's ability to stop fraudulent providers before they enter the Medicare Program, ending the ``pay and chase'' model. The bill accomplishes this goal by enhancing enrollment screening for owners and managers of agencies operating in objectively high-risk markets, requiring more rigorous oversight of new and high-risk providers through targeted surveys, strengthening oversight of accrediting organizations, and improving verification that Medicare beneficiaries actually received the services billed to the program. Further, the bill requires agencies in high-risk areas to provide documentation showing that they are legitimate businesses, such as proof of liability insurance. The bill also requires more frequent unannounced site visits for agencies that are new, have changed ownership, or are reactivating their billing privileges. Funding to support these efforts is also authorized. These reforms are designed to identify fraudulent providers early while allowing legitimate agencies to focus on delivering quality patient care. The consequences of fraud extend well beyond the communities in which it occurs. When billions of dollars are improperly siphoned from the Medicare home health program, the result can undermine the integrity of the payment system used to reimburse legitimate providers. Honest home health agencies--particularly those serving rural communities--already face rising labor costs, workforce shortages, and the challenges of providing care across large geographic areas. Inadequate reimbursement threatens their ability to continue serving the seniors who depend upon them. Protecting the integrity of the Medicare home health program therefore requires more than identifying and prosecuting fraud; it also requires ensuring that legitimate providers are reimbursed fairly for the medically necessary care they provide. This is the bill's second key objective. To accomplish this, my bill directs CMS to reset the home health base payment amount using 2020 rates, adjusted for inflation, before applying future payment updates. Resetting to 2020 is appropriate because it reflects the first year of the current payment methodology under the Patient-Driven Groupings Model and predates the fraud patterns that later emerged. The bill also addresses a calculation distortion in the current payment methodology and directs CMS to implement appropriate corrections going forward. This legislation strikes the right balance. It strengthens CMS's ability to prevent fraud before taxpayer dollars are lost, while ensuring that honest providers have the resources necessary to continue delivering high-quality care. It advances both program integrity and payment integrity, protects Medicare beneficiaries, safeguards taxpayer dollars, and helps preserve access to the home health services that allow millions of Americans to receive care safely and independently in their own homes. I want to note that these program integrity provisions align with those outlined in the Protecting Seniors and Stopping Fraudsters Act, introduced by Rep. Van Duyne in May. I look forward to working with her to move our bills forward as quickly as possible. I urge my colleagues to join me in supporting this important legislation.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce the Medicare Home Health Payment Integrity and Protection Act. This legislation would strengthen the Medicare home health program by advancing two complementary goals: protecting the home health program from fraud and strengthening access to these important services for the Americans who need them. I have long been a strong supporter of home healthcare. In a home visit I made in one of my first years as a Senator, I saw firsthand the extraordinary difference that skilled nurses, therapists, and other home health professionals make in the lives of patients and their families. Every day, these dedicated caregivers enable millions of our Nation's most frail and vulnerable individuals to remain in the comfort, security, and privacy of their home, which is where they most want to be. Home healthcare not only improves patients' quality of life but also helps avoid unnecessary hospitalizations and nursing home admissions, producing substantial savings for Medicare, Medicaid, and families alike. For these reasons, we should be strengthening, not weakening, the Medicare home health program. Yet recent trends present a troubling paradox. Despite the rapid aging of our population, the number of traditional Medicare beneficiaries receiving home health services has declined in recent years, from approximately 3.3 million beneficiaries in 2019 to 2.7 million just 5 years later. At the same time, nearly everywhere in our country, the number of Medicare-certified home health agencies has also been dropping. According to the most recent report of MedPAC, which is the independent agency analyzing and advising Congress on Medicare, excluding California, more than 500 home health agencies closed between 2019 and 2024, a decline of 5 percent. The picture is dramatically different in California, however, where the number of Medicare home health agencies has doubled over the same time period. Nearly all of that growth has occurred in Los Angeles County. If that strikes you as strange, you are in good company. As MedPAC observed, many stakeholders, including the California State Auditor, have concluded that the unusual pattern of home health agency growth and use in Los Angeles County raises ``significant program integrity concerns.'' In plain language, that means fraud. MedPAC further noted that Los Angeles County has already been identified as a major hotspot for waste, fraud, and abuse in Medicare hospice services and that the dramatic increase in home health agencies in the same area raises further flags. The California State auditor reported that one office building housed the corporate offices of more than 100 hospice agencies and dozens of home health agencies--a striking example of how organized fraud can exploit weaknesses in Medicare hospice enrollment and oversight. The concentration of Medicare home health spending in Los Angeles County is its own issue. This can be seen by the lopsided spending generated there. Even though only 2 percent of the Nation's Medicare fee-for-service beneficiaries live in Los Angeles County, that 2 percent generates 9 percent of all Medicare fee-for-service home health expenditures in the entire Nation--roughly 4\1/2\ times the expected share. CMS is fully aware of the fraud problem in Los Angeles County and has responded aggressively. I commend the Agency for doing so. My legislation builds on those efforts by strengthening CMS's ability to stop fraudulent providers before they enter the Medicare Program, ending the ``pay and chase'' model. The bill accomplishes this goal by enhancing enrollment screening for owners and managers of agencies operating in objectively high-risk markets, requiring more rigorous oversight of new and high-risk providers through targeted surveys, strengthening oversight of accrediting organizations, and improving verification that Medicare beneficiaries actually received the services billed to the program. Further, the bill requires agencies in high-risk areas to provide documentation showing that they are legitimate businesses, such as proof of liability insurance. The bill also requires more frequent unannounced site visits for agencies that are new, have changed ownership, or are reactivating their billing privileges. Funding to support these efforts is also authorized. These reforms are designed to identify fraudulent providers early while allowing legitimate agencies to focus on delivering quality patient care. The consequences of fraud extend well beyond the communities in which it occurs. When billions of dollars are improperly siphoned from the Medicare home health program, the result can undermine the integrity of the payment system used to reimburse legitimate providers. Honest home health agencies--particularly those serving rural communities--already face rising labor costs, workforce shortages, and the challenges of providing care across large geographic areas. Inadequate reimbursement threatens their ability to continue serving the seniors who depend upon them. Protecting the integrity of the Medicare home health program therefore requires more than identifying and prosecuting fraud; it also requires ensuring that legitimate providers are reimbursed fairly for the medically necessary care they provide. This is the bill's second key objective. To accomplish this, my bill directs CMS to reset the home health base payment amount using 2020 rates, adjusted for inflation, before applying future payment updates. Resetting to 2020 is appropriate because it reflects the first year of the current payment methodology under the Patient-Driven Groupings Model and predates the fraud patterns that later emerged. The bill also addresses a calculation distortion in the current payment methodology and directs CMS to implement appropriate corrections going forward. This legislation strikes the right balance. It strengthens CMS's ability to prevent fraud before taxpayer dollars are lost, while ensuring that honest providers have the resources necessary to continue delivering high-quality care. It advances both program integrity and payment integrity, protects Medicare beneficiaries, safeguards taxpayer dollars, and helps preserve access to the home health services that allow millions of Americans to receive care safely and independently in their own homes. I want to note that these program integrity provisions align with those outlined in the Protecting Seniors and Stopping Fraudsters Act, introduced by Rep. Van Duyne in May. I look forward to working with her to move our bills forward as quickly as possible. I urge my colleagues to join me in supporting this important legislation.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise this afternoon to pay tribute to an outstanding U.S. Senator and a dear friend, Senator Lindsey Graham. When my husband first woke me with the news that Lindsey had died the night before, I couldn't believe it. I said to him: That can't possibly be true. I thought it was some tasteless internet hoax or a false report. Not Lindsey. Not our Lindsey. But sadly, it was true, although I still find it so hard to accept. I can only imagine how difficult this unexpected loss must be for his beloved sister Darline and the other members of his family. Often when we think of a Senator, we ask: Did he or she make a difference? Did he or she have an impact on events here at home or abroad? Was the person a consequential Senator? With Lindsey, the answer clearly was the resounding yes. Lindsey was a leader not only in national policy but also in shaping international events. How telling it is that the Prime Minister of Israel and the President of Ukraine both made the long voyage to attend his memorial service yesterday at the National Cathedral. Whether he was leading a congressional trip to Israel in the wake of the October 7 massacre to demonstrate America's solidarity with Israel or his many trips to Ukraine to show the Senate's unwavering opposition to Russia's unprovoked invasion, Lindsey time and again demonstrated strong, effective leadership. He was truly a player on the world stage. And for me, Lindsey was also a close friend. Along with Senators John McCain and Joe Lieberman, I traveled four times with Lindsey to Afghanistan and Iraq. Believe me, on those long military trips, you get to know your colleagues very well. Lindsey's unsurpassed sense of humor, his self-deprecating wit, and his storytelling ability made serving with him delightful, and I always learned so much when I traveled with him as well. I keep thinking that John McCain and Joe Lieberman--both treasured friends and colleagues of mine--were there waiting to greet what they called the third amigo when Lindsey Graham entered the heavenly gates, and I tried to take some comfort in knowing that the three of them are now reunited. Yesterday, we celebrated the life of this extraordinary Senator. Lindsey's life on Earth ended far too soon, but his legacy will endure forever. I suggest the absence of a quorum.

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

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that the revised memberships on the 12 subcommittees of the Committee on Appropriations for the 119th Congress be printed in the Record. The new assignments reflect the service on the committee of Senator Darline Graham, who was selected to fill the vacancy created by the passing of former Senator Lindsey Graham, as well as other revisions related to the change in committee membership.

Ms. COLLINS

Ms. COLLINS. Mr. President, on March 21, 1901, a town in Aroostook County was incorporated and named after the region's pristine clear waters. Today, it is a great joy to join the people of Crystal, ME, in celebrating the 125th anniversary of a town that epitomizes rural life in the northern parts of our country and people who have shown the power of resiliency. Crystal's founding was just one piece of an already illustrious history. First established by William Young of Searsmont in 1839 as Township No. 4, Fifth Range West of the Easterly Line of the State, Crystal quickly classified itself as a plantation--and not just in name. Drawn by the fertile land, settlers determined that potato cultivation could be successful, and they started shipping their products southward on railroads that exist to this day. By the mid-1900s, the town of Crystal began facing the challenges that afflict many rural communities, leading to population decline that rendered Crystal one of the smallest and most rural communities in the entire State. Yet the people of Crystal persevered. Their farming and logging industries remain strong, creating an economic model for formerly industrialized towns. Throughout its history, Crystal has been recognized as having outstanding natural resources. Crystal Bog, also known as the 1000 Acre Bog, encompasses an extensive area of wetlands found south of Fish Stream. This area represents one of Maine's best examples of a Domed Bog Ecosystem and is classified as a National Natural Landmark. It also supports some of the State's most diverse fens, plants, and animals, including circumneutral fen, Clayton's copper butterfly, and swamp-fly honeysuckle. Crystal's 125th anniversary is more than just a celebration. It is recognition of a people who have thrived in the face of adversity. While every town has its unique challenges, I am sure that Crystal's best days lie ahead. I congratulate the town of Crystal, ME, on this wonderful achievement, and I look forward to witnessing its bright future.

Ms. COLLINS

Ms. COLLINS. Madam President, I just want to thank my colleagues for their kind comments and for being on the floor on an occasion which means so much to me. Growing up in northern Maine in Aroostook County, I learned the values of hard work, perseverance, and keeping your commitments. Mainers are known for their work ethic, and I have strived to bring those values here to my work representing them in the U.S. Senate. It is such an honor, and I am so grateful for the support of my colleagues. Thank you so much. (Applause, Senators rising.)

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce the Improving Access to Medicare Coverage Act, to help protect American seniors from high medical costs when they need skilled nursing care after hospitalization. I am pleased to be joined on this bill by my colleague from Vermont Senator Welch. Our bill corrects a problem arising from current Medicare policy, which requires beneficiaries to have an ``inpatient'' hospital stay of at least 3 days before Medicare will cover posthospitalization skilled nursing care. Patients who receive hospital care under ``observation status'' do not qualify for this benefit, even if their hospital stay lasts longer than 3 days. Many patients on observation stays may not even realize that they have never been admitted as inpatients. They just know that they are in the hospital. If they are admitted later to a skilled nursing facility for follow-up care, they may be shocked to learn that they will be liable for out-of-pocket costs totaling thousands of dollars. Some Medicare beneficiaries may be foregoing skilled nursing or rehabilitation care altogether because they simply cannot afford to pay the out-of-pocket costs. The financial consequences of the distinction between an observation stay and inpatient admittance can be severe for seniors. One example is a Maine Medicare enrollee who was admitted in ``observation status'' at a hospital in Maine, but who needed and received acute care at that hospital. She was discharged to a skilled nursing care facility, which was also appropriate for her condition, but because of Medicare's 3-day rule and its treatment of ``observation status,'' Medicare refused to pay for her skilled nursing care. She was stuck with a bill of more than $56,000.00 for care she needed. That is unfair. In another example, shared with me by Dr. Claudia Geyer, the chief medical officer at Central Maine Medical Center in Lewiston, ME, a 90- year-old man with a fractured pelvis was denied Medicare coverage for skilled nursing care because he was admitted to the hospital under observation status. This gentleman had no way of paying for skilled nursing care on his own, so he had to remain in the hospital, costing Medicare more--and more important--not getting the physical therapy he needed to regain his strength and recover. As a result, he slowly weakened, suffered cognitive declines, and deteriorated to the point where he needed extensive care that may have been avoidable. Dr. Geyer also cared for a 99-year-old patient who was living independently with the support of her family and had never before required hospitalization. This patient used a walker in her home but suffered a fall and broke her wrist. She was stabilized in the hospital and was expected to make a full recovery, but first she needed high quality skilled rehab, and she could not use her walker while her wrist healed. Despite almost a century of good health and almost no cost to Medicare in her lifetime, she and her family were horrified when they were told that CMS would not cover her skilled nursing expenses due to the hospitalization being deemed an ``observation stay.'' During Covid, this 3-day rule was waived to make sure seniors could be discharged from the hospital to skilled nursing homes as soon as it was medically appropriate. That waiver ensured that patients weren't hospitalized longer than truly necessary and also protected seniors from unexpected and unfair bills. But as soon as the waiver ended in 2023, patients started staying in the hospital longer for no medical reason. In fact, a study published in January by the Brown University School of Public Health showed that Medicare paid for 2,000 more inpatient days in the month following the end of the waiver just because of this rule. If our aim is to improve the quality of care our seniors receive while avoiding unnecessary expenses, allowing this waiver to expire has taken us in the wrong direction. The bipartisan bill we are reintroducing today effectively codifies the waiver by deeming time spent in observation status as inpatient care for the purpose of Medicare's 3-day prior hospital stay requirement for skilled nursing care. I am pleased this bill has the support of the Society of Hospital Medicine, the American Health Care Association, and more than 30 other organizations that represent seniors and their health care needs. Mr. President, I ask unanimous consent that letters from these organizations be printed in the Record immediately following my remarks. When seniors require hospitalization, their focus should be on their health and getting well, not on how they were admitted. The bill we are reintroducing advances that goal by helping insulate older Americans from undue out-of-pocket costs while ensuring that they get the care they need. I urge my colleagues to support it.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to congratulate Sargent Corporation on 100 years of exceptional business growth and development. From a humble beginning in Alton, ME, the general contracting company has grown significantly, continuing to work with and for Mainers to better our State, one project at a time. In 1926, Herbert E. Sargent set out to make a living, purchasing a used dumptruck for hauling in the summer and plowing in the winter. Through honest, hard work, Herb offered high-quality services for his community, and demand quickly grew. Just 4 years later, he ambitiously acquired a fleet of trucks and a bulldozer, taking on many more projects. Herb's son Jim took over the family's business in 1957, aiding his father and building on his reputation as an honest, reliable contractor. Two decades later, Jim became company president. In the 1990s, after some very successful projects near Baltimore, Sargent expanded beyond New England to the Mid-Atlantic region. In 2013, the company's employees acquired 100 percent of the stock from Herb R. Sargent, the founder's grandson. Since then, the company has been entirely employee-owned. Today, more than 500 employee-owners throughout New England and the Mid-Atlantic remain invested in and supportive of the success of Sargent. Sargent Corporation has bettered communities across the State through various projects, such as recent work at Eastport Airport, the Downeast Wind Farm, the Maine Turnpike, and many more. Through these public and private projects, Sargent's work has improved environmental health, energy production, and transportation infrastructure across the State. Due to the high quality of performance and record of safety at Sargent, the company has won a plethora of awards in my home State, including the Build Maine Award 16 times since 2010. These rewards affirm what I know firsthand about Sargent: The company has maintained their priorities in performance and safety. Sargent Corporation was built on integrity, reliability, and hard work 100 years ago, and as they adapt with the times, these values hold true. Today, I thank Sargent for its tremendous impact on our communities and congratulate it on its milestone anniversary.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to congratulate Sappi North America, Inc., on 50 years of operations at the Somerset Mill in Skowhegan, ME. Since opening in 1976 on the banks of the Kennebec River, the Somerset Mill has grown into one of the most technologically advanced paper mills in North America. Today, the mill manufactures high-quality paper products from trees harvested in Maine and is known for its longstanding commitment to its employees and the surrounding community. The Somerset Mill employs approximately 780 skilled workers, making it one of the largest employers in Maine. The facility operates three state-of-the-art paper machines, with a total annual production capacity of 1.25 million tons. The mill produces coated freesheet paper commonly used for magazines, brochures, and direct mail advertising. It is also a leading producer of paper and paperboard used in packaging, labels, graphic papers, and grease-proof paper for food packaging. Project Elevate, a $500 million modernization investment completed last year, doubled the production capacity of Paper Machine No. 2. These recent investments in the Somerset Mill reflect the steadfast devotion Sappi holds to producing quality products and responding to market demands, further strengthening Sappi's position as a leader in sustainably manufactured paperboard. Sappi North America has undertaken significant efforts to reduce greenhouse gas emissions. The Somerset Mill generates much of its energy on-site using biomass from papermaking byproducts, namely bark and wood chips. Sappi also has an approved Science Based Targets Initiative goal to reduce its carbon emissions by 41 percent by 2030. Additionally, the Somerset Mill holds triple certification from the Forest Stewardship Council, Sustainable Forestry Initiative, and Programme for the Endorsement of Forest Certification. These accolades reflect Sappi's continued effort to maintain the long-term well-being of Maine's invaluable natural environment. Sappi's Somerset Mill has been recognized for its attention to the safety of its employees. In 2023, for the first time in its 50-year history, the pulp mill completed the fiscal year without a recordable injury. The mill also achieved 1 million hours without a Lost Time Injury and received a Gold Award through Sappi's global Safety Recognition Awards program. The mill's impact extends beyond its operations and into the surrounding community. In 2026, Sappi's Somerset Mill leadership was named Large Business of the Year by both the Mid-Maine Chamber of Commerce and the Skowhegan Area Chamber of Commerce. In 2025, Sappi North America CEO Mike Haws was recognized as the MaineBiz Leader of the Year. In 2023, the Somerset Mill received the Somerset County Champions Award at the Heart of Maine United Way campaign kickoff event after raising 30 percent of the county's total United Way workplace campaign contributions. I congratulate Sappi North America and all the employees of the Somerset Mill on this milestone anniversary and thank them for their continued contributions to Maine's economy, paper industry, and communities.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to speak about a bill that Senator Shaheen and I introduced recently. It is called the Improving Needed Safeguards for Users of Lifesaving Insulin Now Act, or the INSULIN Act. This bill would make insulin more affordable for Americans with diabetes. I would like to also recognize the work of Senators Warnock and Kennedy who joined us in introducing this important bill. In 1997, I founded the Senate Diabetes Caucus after meeting with a family from Maine who had a 10-year-old son with type 1 diabetes. I will never forget this young boy looking up at me and saying to me that he wished that he could just take 1 day off from having type 1 diabetes--his birthday or Christmas--just 1 day. But, of course, he could not. It was then that I knew that I had to dedicate my efforts toward earlier diagnosis, better treatments and technology, and one day a cure. Since 2009, Senator Shaheen and I have cochaired the Diabetes Caucus in the Senate and worked together to fund vital research and advance policies that will improve the lives of those who are living with diabetes. One of our top priorities has been to make insulin more affordable. Now, insulin was first isolated more than 100 years ago in Canada, and the scientist who did discover it gave away, essentially, the patent rights because they wanted insulin to be available and affordable to everyone who needed it. Tens of millions of Americans rely on insulin as part of their daily treatment for their diabetes. For children, teens, and adults with type 1 diabetes, insulin is not optional; it is literally a matter of life or death. About 20 percent of those with type 2 diabetes are also insulin- dependent. While there are some exciting and extraordinary scientific breakthroughs in cell and gene therapy that may change this--and the sooner the better--the fact is that, today, people who are dependent on insulin still face great anxiety about its affordability. I have heard from far too many people across Maine and across this country who, because of the escalating costs of insulin, feel they have to ration their insulin and do not take the full dose that their physician has prescribed and that they need to be healthy. Let me tell you of one example. Bek Hoskins, of Chelsea, ME, is a young adult. Bek was forced to skip her doses of insulin to try to make it last longer, to stretch it out, because she simply could not afford the cost. In one profoundly memorable instance, Bek pushed her body's limit too far, and she ended up in the emergency room. Her husband Barrett rushed her, through a snowstorm, to the hospital, and she nearly died because she tried to go without insulin for 2 days. Such a dangerous, preventable crisis should never occur. We must address this life-threatening problem. Senator Shaheen and I have introduced legislation to reduce the price of insulin in the past two Congresses, and we have made some progress. For example, three of the biggest insulin manufacturers--Eli Lilly, Novo Nordisk, and Sanofi--voluntarily chose to cut their list prices. This is encouraging, but there is more work to be done. We also joined together for reforms in the pharmacy benefit manager system, which encouraged PBMs to choose the highest priced insulin for insurance formularies. That was because their compensation was frequently a percentage of the list price. Much of that we are fixing, and some of it was fixed last year. But we need more legislation to fix the fundamental problems in the insulin market, including limited biosimilar competition, as well as barriers to patients' access. The INSULIN Act would do just that. Our bill would limit cost sharing for insulin to no more than $35 a month, or 25 percent of the list price per month, for at least one type of insulin for each type that is needed and dosage form, for patients who have commercial insurance. Our bill would also prohibit insurers and pharmacy benefit managers from placing utilization obstacles such as prior authorization and step therapy on products that have capped costs. These important patient protections will deliver immediate out-of-pocket relief. The INSULIN Act of 2026 will also promote generic and biosimilar competition in the insurance market to further drive down prices through more competition. The bill would create a new, expedited FDA pathway to promote biosimilar competition. It would take similar steps to enhance regulatory certainty for biosimilar drug companies, such as by requiring the FDA to prioritize actions such as inspections and communications with manufacturers. We can't have a situation where a biosimilar, which is like a generic for insulin, is launched at a low price but faces obstacles to its approval even if it is absolutely identical to a brand-name insulin, and we can't allow--and we have seen this before--pharmacy benefit managers to refuse to choose that lower priced biosimilar product for the insurance company's formulary simply because they will make less on the deal. Finally, this bill helps address the insulin needs of uninsured Americans by creating a pilot grant program for States to implement to identify people with diabetes who are uninsured and provide them with insulin at $35 a month. It will also create an insulin resource center and a hotline for people with diabetes who are uninsured to help connect them with programs so that they can secure the insulin that they need in order to be healthy. The INSULIN Act will help make insulin more affordable for Americans, both those with and without insurance, by capping the cost and addressing fundamental flaws in the insulin market and the FDA approval process. I thank the American Diabetes Association, Breakthrough T1D, and the Endocrine Society for endorsing this much needed legislation. Let me just add one final point. If individuals who are insulin- dependent are able to use their insulin, they not only are going to be healthier and avoid severe ramifications of not taking insulin; the healthcare system is going to save money. It is far less expensive to help people afford the insulin that they need for their diabetes than to have them hospitalized or at risk of losing a limb or becoming blind or having other severe consequences because they are not able to afford their insulin. So I would encourage my colleagues to join us in supporting this bipartisan and much needed legislation. I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, on May 2, 2026, Maine Maritime Academy bestows an honorary degree upon Dr. James S. C. Chao in recognition of his extraordinary contributions to global shipping, education, and public service. Dr. Chao's lifelong commitment to maritime commerce and leadership development has had a lasting impact on the industry and on generations of young professionals. It is fitting that the keynote speaker for the academy's 83rd commencement is Dr. Chao's daughter, the Honorable Elaine Chao, who served our Nation with distinction as both Secretary of Labor and Secretary of Transportation. In that latter role, Secretary Chao was a champion of America's maritime academies that prepare the next generation of leaders for our Navy, Coast Guard, and maritime industry. When the new training vessel State of Maine was delivered in March of this year, I was proud to stand with Secretary Chao as cosponsor of that magnificent ship. Appreciating the vital role the oceans play in commerce, security, and the environment is a family tradition. Dr. Chao was born 99 years ago in a small, rural farming community in China. Despite the danger and privations of World War II and the Chinese Civil War, he excelled in his educational pursuits and became one of the youngest captains in the Chinese Merchant Marines. After being separated by the war, Dr. Chao searched relentlessly for the love of his life Ruth Mulan Chu and finally found her by chance in Taiwan. They were wed in 1951, beginning a marriage that lasted for 57 years until her passing in 2007. In 1958, Dr. Chao achieved a record-high score on the Chinese Merchant Marine Master's Special Qualification Examination, which gave him the opportunity to continue his studies in the United States. Arriving in New York alone and with little money, he secured a low- paying job with a Chinese shipping company and, with persistence, eventually gained admission to graduate programs at Columbia University and St. John's University. Balancing his studies with three jobs, he finally was able to bring Ruth and their three children to America in 1961. After earning a master's degree in business administration in 1964, he founded his own company, Foremost Maritime Corporation. Among his early accomplishments was managing emergency food shipments during the wars in Vietnam and Bangladesh. Today, the company, now part of the Foremost Group, is global leader in international shipping, trading, and finance. Foremost Group is a leader in green technology in shipping, continuously upgrading its fleet with energy-saving devices, and building new ships with alternative fuel and carbon capture features. Foremost's fleet is ranked among the world's most eco-friendly bulk carriers. For his outstanding contributions to the maritime industry, Dr. Chao was inducted into the International Maritime Hall of Fame at the United Nations. Among his many other honors are the Ellis Island Medal of Honor, the Horatio Alger Award of Distinguished Americans at the U.S. Supreme Court, and an Outstanding American by Choice recognition by the U.S. Department of Homeland Security. Together, Dr. and Mrs. Chao devoted their business success to philanthropy, particularly in providing scholarships to deserving students. Since four of their daughters attended Harvard Business School, the couple endowed the Ruth Mulan Chu Chao Center as part of a $40 million gift to the university that also supports the Chao Family Fellowship Fund. Dr. Chao credits his remarkable accomplishments to courage, determination, confidence, and trust. As our Nation celebrates its 250th anniversary, we do well to heed his words, as one who achieved the American dream: ``I could not have had the same success anywhere else as I have in this country. In America, you don't need to have a connection or a certain background. All you need is to have a goal. After that, all you have to do is work hard and help others.'' America is so fortunate to have such an outstanding individual come to our shores and contribute so much. I congratulate Dr. James S.C. Chao on this recognition from Maine Maritime Academy and wish him all the best.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce two bills: the Improving Retirement Security for Family Caregiver Act and the Catching Up Family Caregivers Act. These bills, which I am introducing today with my colleague from Virginia Senator Warner, would enable family caregivers to better save for retirement. Family caregivers play an important role in American society, providing uncompensated care for millions who often need assistance 7 days a week. While they devote themselves to providing care for our Nation's children, seniors, and other loved ones, they often suffer economically. According to a study by the Edward Jones Grassroots Taskforce, 64 percent of American women say their caregiving duties have had a negative impact on their ability to save towards their long- term financial goals, and more than half have had to take on fewer professional responsibilities due to caregiving. While it is difficult to put a dollar amount to the value of the devotion, time, and services that these caregivers provide, the Alzheimer's Association has estimated that in 2023 family caregivers provided $350 billion in uncompensated dementia care. Our retirement system needs to accommodate this enormous commitment by helping ensure that family caregivers do not fall short of what they need for their own retirement. That is exactly what the two bills Senator Warner and I are introducing today would do. Our legislation would enable family caregivers to contribute to their retirement funds even if they are not making significant income. Under current law, contributions to Roth IRAs are capped at $7,000 or yearly income, whichever is less. This severely limits the amount a family caregiver earning less than $7,000 can contribute to a retirement account. The Improving Retirement Security for Family Caregivers Act would eliminate the yearly income cap for family caregivers, enabling them to contribute up to $7,000 annually to a Roth IRA. Our current retirement system allows those over the age of 50 to make ``catch-up'' contributions above the statutory limit, the idea being that those in their fifties have more discretionary income to put toward retirement than they did when they were younger. In the same way, the Catching Up Family Caregivers Act would allow family caregivers to take advantage of ``catch-up'' contributions for every year they were sidelined from the workforce as a family caregiver. These complimentary bills would allow family caregivers to invest more in their retirement funds now and later. The bills have earned the support of important stakeholder organizations that work with family caregivers, such as the Insured Retirement Institute. In a letter in support of the bills, the IRI wrote: ``While a noble and selfless decision, leaving the workforce is often the only option an individual has when seeking to provide the necessary care for a family member. Not only does this severely reduce or eliminate a caregiver's income, but their ability to participate in workplace retirement savings plans and save for retirement is also lost. The solutions offered by the Improving Retirement Security for Family Caregivers Act and the Catching Up Family Caregivers Act provide caregivers eligibility to contribute to Roth IRAs and enhance their ability to catch up once they return to the workforce.'' I note that both pieces of legislation are also endorsed by the Securities Industry and Financial Markets Association, SIFMA, the American Benefits Council, the Edward Jones Grassroots Task Force, the Insured Retirement Institute, and the Women's Institute for a Secure Retirement, WISER. The Alzheimer's Association and the Alzheimer's Impact Movement have also endorsed the Catching Up Family Caregivers Act. Mr. President, I ask unanimous consent that the letter from the Alzheimer's Association and the Alzheimer's Impact Movement be included in the Record immediately following my remarks, along with letters from Edward Jones Grassroots Taskforce, the American Benefits Council, the Insured Retirement Institute, IRI, and the Women's Institute for a Secure Retirement, WISER. I am grateful for the support of these groups who know how important these retirement reforms will be to the financial security of caregivers who sacrifice for their loved ones. I urge my colleagues to support our legislation.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise today to introduce two bills: the Improving Retirement Security for Family Caregiver Act and the Catching Up Family Caregivers Act. These bills, which I am introducing today with my colleague from Virginia Senator Warner, would enable family caregivers to better save for retirement. Family caregivers play an important role in American society, providing uncompensated care for millions who often need assistance 7 days a week. While they devote themselves to providing care for our Nation's children, seniors, and other loved ones, they often suffer economically. According to a study by the Edward Jones Grassroots Taskforce, 64 percent of American women say their caregiving duties have had a negative impact on their ability to save towards their long- term financial goals, and more than half have had to take on fewer professional responsibilities due to caregiving. While it is difficult to put a dollar amount to the value of the devotion, time, and services that these caregivers provide, the Alzheimer's Association has estimated that in 2023 family caregivers provided $350 billion in uncompensated dementia care. Our retirement system needs to accommodate this enormous commitment by helping ensure that family caregivers do not fall short of what they need for their own retirement. That is exactly what the two bills Senator Warner and I are introducing today would do. Our legislation would enable family caregivers to contribute to their retirement funds even if they are not making significant income. Under current law, contributions to Roth IRAs are capped at $7,000 or yearly income, whichever is less. This severely limits the amount a family caregiver earning less than $7,000 can contribute to a retirement account. The Improving Retirement Security for Family Caregivers Act would eliminate the yearly income cap for family caregivers, enabling them to contribute up to $7,000 annually to a Roth IRA. Our current retirement system allows those over the age of 50 to make ``catch-up'' contributions above the statutory limit, the idea being that those in their fifties have more discretionary income to put toward retirement than they did when they were younger. In the same way, the Catching Up Family Caregivers Act would allow family caregivers to take advantage of ``catch-up'' contributions for every year they were sidelined from the workforce as a family caregiver. These complimentary bills would allow family caregivers to invest more in their retirement funds now and later. The bills have earned the support of important stakeholder organizations that work with family caregivers, such as the Insured Retirement Institute. In a letter in support of the bills, the IRI wrote: ``While a noble and selfless decision, leaving the workforce is often the only option an individual has when seeking to provide the necessary care for a family member. Not only does this severely reduce or eliminate a caregiver's income, but their ability to participate in workplace retirement savings plans and save for retirement is also lost. The solutions offered by the Improving Retirement Security for Family Caregivers Act and the Catching Up Family Caregivers Act provide caregivers eligibility to contribute to Roth IRAs and enhance their ability to catch up once they return to the workforce.'' I note that both pieces of legislation are also endorsed by the Securities Industry and Financial Markets Association, SIFMA, the American Benefits Council, the Edward Jones Grassroots Task Force, the Insured Retirement Institute, and the Women's Institute for a Secure Retirement, WISER. The Alzheimer's Association and the Alzheimer's Impact Movement have also endorsed the Catching Up Family Caregivers Act. Mr. President, I ask unanimous consent that the letter from the Alzheimer's Association and the Alzheimer's Impact Movement be included in the Record immediately following my remarks, along with letters from Edward Jones Grassroots Taskforce, the American Benefits Council, the Insured Retirement Institute, IRI, and the Women's Institute for a Secure Retirement, WISER. I am grateful for the support of these groups who know how important these retirement reforms will be to the financial security of caregivers who sacrifice for their loved ones. I urge my colleagues to support our legislation.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that the revised memberships on the 12 subcommittees of the Committee on Appropriations for the 119th Congress be printed in the Record. The new assignments reflect Senator Deb Fischer's selection as chair of the Subcommittee on Legislative Branch and Senator Jon Husted's selection as a member of the Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies; Subcommittee on Financial Services and General Government; Subcommittee on Department of the Interior, Environment, and Related Agencies; Subcommittee on Departments of Labor, Health and Human Services, and Education, and Related Agencies; Subcommittee on Legislative Branch; and Subcommittee on State, Foreign Operations, and Related Programs, all for the remainder of this Congress.

Ms. COLLINS

Ms. COLLINS. Mr. President, I have five requests for committees to meet during today's session of the Senate. They have the approval of the Majority and Minority Leaders. Pursuant to rule XXVI, paragraph 5(a), of the Standing Rules of the Senate, the following committees are authorized to meet during today's session of the Senate: