Bob Casey

Mr. CASEY

Mr. CASEY. Mr. President, I rise to speak about the same issue my colleague from New York just spoke to, and I know others have preceded her on the floor. I am grateful to be a part of this discussion today. What I could do--but I know I don't have to because it is so well known now--is go through the three or four most recent mass shootings which are the ones that get most attention, but I don't have to do that because we know so well now what happened just in the last number of weeks. One way to remember them, of course, is by the names of the communities: El Paso, Dayton, Midland, Odessa--names like that where everyone in the country knows exactly what we are talking about because of what happened there. What we don't talk about enough, of course, are the places where there is daily gun violence and horror and tragedy and death and grievous injury because it doesn't get the same attention. Tragically, another way to go through a list of tragedies that are connected to this awful epidemic of gun violence--this uniquely American problem of gun violence--is to use numbers. These numbers are now emblazoned on the communities that were so tragically destroyed, in large measure, by these events. In El Paso it was 22, in Dayton it was 9, and in Midland and Odessa it was 7. So doing the math, that is 38. That is the number of people killed in just three places. Of course, there are a lot of other deaths between those tragic events which aren't getting the same attention. That is another way to measure--38 killed between August 3 and August 31. Another number is the number of injured. I think the number now is just about 76, just in those three tragedies. So there were 38 killed and 76 injured in three American communities. One of the most disturbing realities after the fact is what happened in Dayton in just such a short timeframe. I know that timeframe. We could probably cite the other tragedies as well, but we know that in about 32 seconds in Dayton, 9 people were killed and 27 were injured. Law enforcement, the folks we often call the good guys--good guys not just with guns but good guys with a lot of training and a heroic willingness and heroic commitment to get to a place of danger to try to apprehend a criminal and to try to save people. In Dayton, law enforcement officials got there faster than Superman could get there, and it wasn't fast enough because in 32 seconds 9 were gone and 27 were injured. We know that in Midland and Odessa, TX, the authorities reported that the gunman was prohibited from purchasing a firearm at one point, but he was able to avoid a background check because he purchased his assault-style weapon through a private sale. This is further evidence of why we need a background check bill that is rigorous--not just a background check bill that makes a nice headline but is rigorous enough to stop the guy in Texas who brought such horror to that community, including, as one of the wounded, a 17-month-old child. We also know that through the month of August, in that same time period I mentioned, the 3rd to the 31st--but if you include every day of that month, the United States has experienced 38 mass shootings. So there were 38 times when four or more people were involved, which is the definition of a mass shooting. When I think about it in terms of the scale of it--and I don't think there is anyone who would disagree with this--this is a public health epidemic, and it is plaguing our cities and our communities every single day. What we are talking about, in terms of the perpetrators of this violence, they are not just criminals, they are domestic terrorists, and we should call them that. That is what they are. We shouldn't try to remember their names or, frankly, even speak their names, but we should remember what they are: domestic terrorists who are, frankly, in terms of the whole scale of the problem, causing more problems in America than any other terrorists are causing. These domestic terrorists are using high-powered, military-style assault weapons to kill our children and to kill our families. We know that last October, the most deadly active violence against the Jewish community in American history occurred at the Tree of Life synagogue in the city of Pittsburgh. Eleven were killed there and six were injured, including four of the six being law enforcement officers who, again, got there very quickly--maybe not in seconds but in minutes. Of course, getting there that fast, with all of their training, all of their courage, and all of their commitment, was not fast enough because even though they got there in just minutes, that wasn't fast enough because of the nature of the weapon and because of the assailant. How about Philadelphia? The two biggest cities in my home State are Philadelphia and Pittsburgh, Philadelphia being the largest. Days before the horrible weekend of El Paso and Dayton, a mass shooting occurred in Southwest Philadelphia that left a 21-year-old dead and five others injured. Because only one person was killed, it is not ranked as a mass shooting. That happened in that same timeframe. On August 14, an individual in North Philadelphia barricaded himself in a house and shot six police officers with an assault-style weapon. The shootout lasted nearly 8 hours and prompted a local childcare center to shelter in place for hours. I was at that childcare center just a few days later. Watching it on the news, I had envisioned a geographic distance of a lot more than it was. When I walked just to the side of the building where the childcare center was and looked across the street, it was closer than the width of this room we are in today. When you go out the back door of the childcare center, it was within feet across a very narrow street from where the shooter was barricaded. In this instance, you have one shooter in a house with a high-powered weapon who is able to hold off a number of law enforcement officials for hours at a time. That is just one example of the power of the weapon. The issue of gun violence is a uniquely American problem. No country has the same problem on this scale. America has never had a problem like this in its history. It is uniquely American and unique in American history itself. Some in Congress want to surrender to this problem. The argument is that there is nothing we can do except better enforcement of existing law. I don't think most Americans believe that--nor should they-- because there is certainly more we can do. To have a position that I would say is a surrender to the problem, you would have to argue that the most powerful Nation in the history of the world can do absolutely nothing--except maybe tighten up a law by way of enforcement--that we can do absolutely nothing to confront this problem. No one is arguing that if we passed a background check bill here or an extreme risk protection order bill that somehow the problem would magically begin to decline. No one is arguing that. But there is certainly something we can do to reduce the likelihood and we would hope substantially reduce the likelihood of more mass shootings. If we passed two bills in the Senate that became law and 25 years from now, one mass shooting was prevented, it would be worth every minute of that effort and every degree of energy expended in furtherance of passing that legislation. We have been talking about this for a long time just in the recent past. We now know that it is more than 195 days since the House passed H.R. 8, the Bipartisan Background Checks Act of 2019. As I referred to earlier, in the Odessa-Midland shooting, we know that our Nation now needs a national background checks bill in order to make all Americans safer from the horrors of gun violence. Reports indicate that in 2018 alone, 1.2 million firearm classified ads were posted on armslist.com that did not require a background check before purchase. This is a big loophole that helps feed an illegal underground gun market in cities and communities across our country. If implemented, the universal background checks bill known as H.R. 8 would close this loophole, requiring background checks for all firearm sales between private parties. We also know that since 1994, background checks have prevented 3.5 million gun sales to dangerous criminals and others prohibited from owning a gun. I have to ask again, are we to surrender to this problem? I don't think so. I think most Americans don't want to surrender to it. What they want is for us to take action. They are a little bit tired of just speeches and debate. They may want a little more debate, but they want votes. They want us to be debating and voting several times at least, if not more so. This is a grave, difficult challenge to confront, but the commitment to confronting it is a mission that I think is worthy of a great country. I ask Majority Leader McConnell to give the Senate the opportunity to debate and vote on first the universal background checks bill, H.R. 8. And I am sure there will be other versions of that in the debate, and that is fine. We should debate all of them and vote on all of them and debate and vote on an extreme risk protection bill. I would argue we should do more than that. We should have a series of commonsense gun measures to be debated and voted on, even if we are likely to know the outcome, because the American people expect that this uniquely American problem and the scale of it are worthy of that debate and worthy of those votes. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, I wish to celebrate the Urban Affairs Coalition in recognition of their 50th anniversary. Founded in 1969 as the Philadelphia Urban Coalition, the Urban Affairs Coalition works tirelessly to tackle a number of diverse issues that immediately affect communities throughout the Greater Philadelphia Region. A robust group of organizations, the Philadelphia Urban Coalition was founded after the assassination of Reverend Dr. Martin Luther King, Jr., with the goal of solving their communities' social and economic problems. In 1991, the group merged with the Urban Affairs Partnership to create the Greater Philadelphia Urban Affairs Coalition and in 2010 shortened the name to the Urban Affairs Coalition. They have managed over $1 billion of social investment since their founding. Today, the Urban Affairs Coalition consists of over 75 organizations working to achieve unity among government, business, neighborhood, and individual initiatives to improve the quality of life in the region, build wealth in urban communities, and solve emerging issues. The coalition works towards this mission in three different ways: backing nonprofits through fiscal sponsorship, capacity building, and professional development; working to improve life chances for the youth and young adults; and providing economic opportunity to low-income households, working families, and disadvantaged businesses. Through their extensive work, the Urban Affairs Coalition helps children and young adults climb the economic ladder, educates the community on job opportunities and financial advice, and provides access to capital for minority entrepreneurs. The coalition is committed to supporting nonprofits by helping them run backroom operations, allowing nonprofits to focus on public service. In addition to helping their community, the Urban Affairs Coalition recognizes local leaders at their annual banquet. They present the Doer Award, the Living Legacy Award, and the Community Leadership Award to those who make efforts to improve and support their communities. The Urban Affairs Coalition consistently looks to form new partnerships and is working to raise $1 million in the 2020 fiscal year to create a UAC Legacy Fund, which will further support educational and charitable activities. Additionally, I wish to commend Ms. Sharmain Matlock-Turner, the president and chief executive officer of the Urban Affairs Coalition. This year marks Ms. Matlock-Turner's 20th anniversary in her role. She also serves as the cofounder and chair of the West Oak Lane Charter School, a school in Northwest Philadelphia where 92 percent of students are eligible for free or reduced-price lunches. West Oak Lane prides itself on strong ties with higher education organizations. These relationships begin by focusing on educating the next generation of innovators. Ms. Matlock-Turner was one of three Philadelphia leaders to win a scholarship to Harvard Business School's Nonprofit Leaders' Summer Program in 2005, and she has since won awards from CASA Philadelphia, the American Red Cross, and many other organizations. The work of the Urban Affairs Coalition and Ms. Matlock-Turner have been crucial to providing countless children and young adults a fighting chance at a brighter future. Community improvement is their continuing mission, and I thank them for their hard work on behalf of Pennsylvanians. I wish them the best of luck on their future efforts.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent to speak as in morning business.

Mr. CASEY. Mr. President, I rise to celebrate one of the seminal moments in American civil rights history. This week marks the 29th anniversary of the signing of the Americans with Disabilities Act. On July 26, 1990, President George H. W. Bush signed a sweeping, bipartisan bill that acknowledged and affirmed the rights of people with disabilities. The passage of the so-called ADA promised that people with disabilities would be included in the guarantee of fundamental rights-- just by way of examples, the right to petition the court when discriminated against; the right to apply for and be considered for a job; the right to have and having the access to vote; the right to economic security; the right to live where you want to live. Twenty-nine years later, our country is better because we agreed to make the opportunities of our country accessible to all. The ADA changed the lives of 61 million Americans with disabilities and has made our Nation more accessible. The ADA proclaimed that Americans with disabilities must have the right and the means to fully participate in their communities. The ADA offers a path toward a truly accessible nation and elevates the voices of millions of individuals. One of those voices belongs to Jean Searle from the Commonwealth of Pennsylvania. Jean works at Disability Rights Pennsylvania, where she protects the rights of people with disabilities so they may live the lives they choose--free from abuse, neglect, discrimination, and segregation. As a child and young adult, Jean was forced to live in an institution. In that institution, she faced many indignities, the worst of which may have been having had her infant child taken from her without her consent. Simply because Jean lived with a disability, it was often assumed that she was not capable of making her own decisions, but she worked hard to find a way out of that institution. When she finally succeeded, she chose to live independently in her community and has found a fulfilling career in Harrisburg. The rights affirmed by the ADA and the services and supports Medicaid and other programs have provided have made it possible for Jean to be a full citizen of the Commonwealth of Pennsylvania and, yes, even of the United States of America. Jean has dedicated her life to protecting the rights of people with disabilities. During this ADA anniversary week, it is also fitting that today is Jean's birthday. So, Jean, in looking at your picture on my left, I say happy birthday. I know many here would wish the same if you were here in person on the floor with us. I am honored to share your birthday. Let me pause here. Almost 30 years after her infant son, whom I referred to earlier, was taken from her, Jean had the opportunity recently to meet him for the first time. Jean often says that to make the world a better place, we need to spend our time listening to people with disabilities and learning from the disability community. Well said, Jean. When I listen, I hear about the greatness of the ADA and, at the same time, about much more that still needs to be done. One of those things is to protect what we have. That includes protecting access to healthcare, preventing the repeal of the Affordable Care Act, and ensuring that Medicaid remains intact. We also need to combat threats to people with disabilities. Over the past 2 years, we have seen a systemic and concerted effort to sabotage supports that are necessary for equality, opportunity, and the full participation of people with disabilities. What this administration has failed to do with legislation it is trying to accomplish through regulation and court cases. Cutting Medicaid is contrary to the ADA's goals, and it makes it difficult--or even potentially impossible--for people with disabilities to work, to go to school, or to be engaged in their communities. While we protect the hard-fought rights the disability community has earned, we can also build upon the ADA's promises. As we celebrate the ADA's 29th anniversary, we can do at least three things--honor the great advancements that have been made because of the ADA; remain vigilant to attacks on those civil rights; and work to ensure that the ADA's goals are realized for all people with disabilities. I believe Jean's own words make the point clearer than I can. We must never go back. We must never forget the struggle that people with disabilities have gone through and are still going through today. We must never go back, as Jean said. So, as we celebrate the ADA's 29th anniversary, I promise--and I know it is the promise of many Members of Congress--to never forget that struggle. I also promise to stand side by side with the disability community to fully accomplish the ADA's goals.

Mr. CASEY. I yield to Senator Brown.

Mr. CASEY. I thank the senior Senator from Ohio, who makes the point broadly about the importance of Medicaid in the context of healthcare but especially with regard to Americans with disabilities. I thank him for his comments, and I thank him for his advocacy.

Mr. CASEY

Mr. CASEY. Mr. President, I rise to speak about an issue that, candidly, we don't talk enough about around here, and that is the threat to the Affordable Care Act and the lawsuit that was filed and is now in a Federal court. This time, it is in the Circuit Court of Appeals for the Fifth Circuit. Earlier this month, there were oral arguments. This case could be decided in a short timeframe, maybe even this fall. I guess, because it is not an issue that is being debated in the Halls of Congress by way of hearings or votes or otherwise, it doesn't get the attention it warrants. This lawsuit, which is now a direct challenge to the constitutionality of the Patient Protection and Affordable Care Act, would be every bit as devastating and harmful as the repeal efforts that were undertaken two summers ago, in 2017, and the consequences of the success in that lawsuit would put the country in the same place it would have been had the repeal effort been successful. If you want to simplify it, the Affordable Care Act has two parts to it. We know, for example, of the protections that were put in place in the Affordable Care Act, one was new protections, and the other was new coverage. So, roughly, 20 million people got coverage who didn't have coverage before. Most of those 20 million, at the time--or a higher number at least--were folks who had gained their healthcare coverage through Medicaid expansion. As we now know, Medicaid expansion has had a number of positive impacts on the American people. It really came into force--came into effect--right in the middle of or in one of the early stages of our broader awareness of the opioid crisis, of the addiction crisis. Were it not for the expansion of Medicaid, a lot of people in my home State of Pennsylvania and around the country would not have had treatment for opioid misuse or for the broader category of substance use disorder conditions. Medicaid expansion has helped a lot of people with treatment, which is essential to freeing yourself from the grip of an addiction we have seen so often. This lawsuit was successful in the district court. If it were to be affirmed, for example, in the Fifth Circuit, it would mean this court would declare the Affordable Care Act as unconstitutional. The effect of that would be that Medicaid expansion would go away--protections for a much larger number of Americans, not simply those who need opioid treatment or treatment for opioid addictions or for substance use disorder conditions and not just for those who have been newly enrolled--for the roughly 20 million who have gotten coverage. When you are talking about the protections, you are talking about a much larger number of Americans--maybe as high as 150 million Americans or more--who have protections not only in the circumstances in which they had preexisting conditions but also protections against capping the coverage one would get or the treatment one would get over a year or over a lifetime, which is just to mention two or three new protections. For example, it would go away for all of those young people who have been able to stay on their parents' health insurance plans until the age of 26. So you are talking about a tremendous coverage loss of at least millions of people--potentially as high as 20-plus million people--and the elimination of protections for tens and tens and tens of millions of Americans. You would think, in that circumstance, those who have been most determined to have the Affordable Care Act struck down--because they have had about 8 years now, give or take, to prepare something with which to replace it--would have a replacement ready to go, maybe a replacement enacted into law, but at least a replacement that is ready to go on day one that would have all of the details worked out. This would not be just any replacement--not just a replacement that has words like ``preexisting conditions'' in the title of the bill--but something real and substantial and credible on a complicated subject like healthcare, meaning that the replacement would cover at least 20 million people, would provide all of the protections for all of those Americans, whether it is on protections against a preexisting condition or otherwise, and would be comparable in its positive impact on Americans. You would think this bill would be ready to go and ready to be enacted into law, but that is not the case. I shouldn't say I was surprised, but I was somewhat concerned when--I guess it was last week, about a week ago--I picked up POLITICO and read that a number of Republican Senators were expressing the hope that the lawsuit would be successful, the hope that the Affordable Care Act would be declared unconstitutional. Yet what I didn't see in that article and didn't see in a lot of other places is a replacement that will provide a comparable, if not identical, measure of protection. That is what they told us all along--right?--that they have another way to do it and that all of the American people are going to be better off because of it. That is the basic promise that has been made by the Republicans in the Senate and in the House over many years. So you would think it would be ready, but it apparently is not ready. I hope that maybe in the month of August, the plan will be developed and be ready to go and not just any old plan that has a nice title on it and a surge of protections that can't be brought to fruition--or brought into effect--because, when you provide the kind of protections the Affordable Care Act provides, you have to make the math work. You have to make sure you can pay for it, and you have to make sure the policy will support what you promise in the details of the legislation. We will see what happens. If this lawsuit were to be affirmed at the circuit court level, I am assuming there would be an appeal by one side or the other. Yet, if we reach a point at which a court says the ACA is unconstitutional, I hope there is going to be a replacement that will provide all of the protections, all of the coverage, and all of the essential elements that were in the Affordable Care Act but that they will be done in a better way because that is what they have all promised on the other side. I don't think it is likely to happen. Something is going to give. Something will be cut. Something will be taken away or a lot more than that. By way of an example, I will use only one number for today--642,000. I think it is 642,700. That is the estimate of the number of children who live in Pennsylvania who have preexisting conditions. So any change in law by way of a court--a Federal court or the Supreme Court or otherwise--or any change in law pursuant to congressional action has to make sure, among many things, that every one of those 642,700 children in Pennsylvania has protections in place by law for preexisting conditions in addition to covering all of the other adults across Pennsylvania. Basically, it is almost one out of every two Americans who has a preexisting condition. That is the rough estimate. That is a lot of people across the country. Some people believe, as well as there being some credible, reliable estimates, that it is north of 130 million Americans. So those are the only two numbers I will give. The lawsuit is problematic. If that were all, that would be bad enough, but there are two things that are problematic when it comes to healthcare. One is that of the proposed cuts by the administration. Now, I realize House Republicans and Senate Republicans may not agree with the President's proposal, but he is in the same party, and his Budget Director is in the same party, and the Congress of the United States has to react to that budget proposal. The administration proposed a 10-year Medicaid cut of $1.5 trillion, and that is with a ``t''--trillion--not billion. The administration proposed a $1.5 trillion cut to Medicaid. It proposed a similar cut-- or, I should say, a comparable cut but actually a lower number--to Medicare over 10 years of $845 billion. You have to be able to say: OK, if it is the case that there is a credible replacement that provides the identical protections and coverage that the Affordable Care Act provided, what would happen to healthcare if you were to cut Medicaid by $1.5 trillion and Medicare by $845 billion? You have to answer those questions if you are serious about healthcare. Now, if you are just kind of moving things around and having a talking point for a campaign, maybe that is different, but if you are serious about healthcare and if you are serious about coverage and if you are serious about there being an adverse impact on kids, on people with disabilities, and on seniors, you can't cut Medicaid by $1.5 trillion. One way to describe Medicaid is in the nursing home program for the middle class, in many instances. Medicaid is not a program for someone distant out there who is not worthy of our support and our help. Medicaid is about us. Medicaid is who we are because we decided more than 50 years ago that we are the United States of America, and we are the strongest country in the world for lots of reasons. Thank goodness we have the strongest military, and thank goodness we have the strongest economy. Yet we are also the greatest country in the world because folks around the world have seen they can follow our example once in a while. They saw more than 50 years ago that we said, if you are a child in a low-income family or if you have a disability or if you are a senior who is trying to get into a nursing home, Medicaid is going to help you do that. We also passed Medicare at the same time. So if you are serious about healthcare, you have to be really concerned about these budget cut proposals by the administration. The third and last topic on this is the efforts undertaken by the administration, when in the midst of failing to repeal the Affordable Care Act and, thereafter, the efforts to sabotage the Affordable Care Act--and not in any way an overstatement--when you have an advertising budget to let people know that they can go to the exchanges--not the Medicaid expansion but the exchanges--to get healthcare coverage and to get a subsidy to help them purchase healthcare--maybe for the first time, millions of people got that opportunity, and millions still have it--in order for folks to know about that, to know about their eligibility, to know about the benefits of that, you have to advertise. We know that. The administration cut the advertising budget by only 90 percent--not quite 100 but a 90-percent cut in the advertising budget. There are also other ways they have undermined and sabotaged the system. If you are concerned about healthcare, you have to be concerned about that sabotage, you have to be concerned about Medicaid and Medicare cuts, and you have to be concerned about this lawsuit. We have a lot of work to do just to protect the gains--the coverage gains and the protection gains--that have been hard won over many years that benefit tens and tens of millions of Americans. I am not sure I can put a total number on them. So I hope those who are rooting for this lawsuit to be successful will have factored in all of that when that day comes, if it were to come, to change healthcare radically and dramatically for the American people. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent to speak as in morning business.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent to speak as in morning business.

Mr. CASEY

Mr. CASEY. Mr. President, I start this afternoon with a topic we are all talking about--the horror that we saw and heard last night at a rally when there was a chant over and over again--we have seen the footage of it--of ``send her back.'' I condemn this--as I did earlier today--in the strongest possible terms, and I want to reiterate my condemnation of that chant. I know that condemnation is widely shared on both sides of the aisle. I hope folks in both Chambers and both parties will condemn and reiterate the condemnation of that kind of chant but also what is underneath it. It is racist, for sure, and it is not who we are. That is not America. I am glad the President said that if it happens again, he will try to stop it. I wish he had done that in real time last night, but let's see what happens at the next rally. There is no excuse for any public official to do anything other than condemn that kind of language. Representative Omar is a Representative in the Congress of the United States who came here as a child, and for anyone to utter those kinds of words against her or anyone else, of course, should be condemned. Fortunately, I think most Americans agree with me, and we have to be very clear when we have that kind of sentiment expressed, especially when it is repeated across the country, as we saw last night. I want to talk about our asylum system, a legal asylum system that was established in the wake of the horrors of World War II. We as a Nation--the United States of America--vowed after that conflict to do better, to be better, to serve as a refuge for those fleeing violence and persecution in their home countries. Today, families from Central America are arriving at our southern border, hoping to avail themselves of this system because of the violence in their home countries. The three we have heard so much about--Honduras, Guatemala, and El Salvador--rank in the top 10 countries in the world for homicide--homicide. According to a report issued by Doctors Without Borders in 2017, Northern Triangle countries, these three countries, are experiencing--and this is a direct quote from the Doctors Without Borders report, 2017--``violent displacement, persecution, sexual violence, and forced repatriation akin to the conditions found in the deadliest armed conflicts in the world today.'' So said Doctors Without Borders. In the face of violence and other such circumstances, the choice to move in search of opportunity and safety is one that the vast majority of families would make, even when that journey can further subject them to violence and danger. Late last month, the Nation was horrified--indeed, the world was horrified--by a photograph of a 2-year-old girl and her father, her small arm clinging to her father as they lay facedown in a river, dead. That is not the picture I am showing here. We all know that picture. I don't need to show it again. So many Americans, so many people around the world remember that picture. But the picture I put up is a picture of that little girl and her father as they lived, a picture of the two of them that appeared in the Washington Post in an article dated Thursday, June 27, 2019, on page 3. Here is the article that the picture was taken from. The headline reads, ``Pair who died at border were desperate for a better life''-- desperate for a better life. That is the story of so many of these families--desperate for a better life, free from violence or the threat of violence, free from or at least distant from death threats, and free from poverty, grinding poverty, the likes of which so many of us have never had to experience. That is what they are desperate for when they say ``desperate for a better life.'' Rather than simply focus on this father and his daughter and how they died and the picture of them facedown in a river, I wanted to make sure we saw their faces, to celebrate their lives but to remind us of our obligation, our enduring obligation, to make sure that we at least--at least--take steps to reduce the likelihood that we will ever see again a horrific picture like the one of the two of them dead in a river, facedown. Here is what part of the story is of this little girl and her father. The little girl's name was Valeria. Quoting from the Washington Post story: Valeria was a cheery child. Not even 2 years old, she loved to dance, play with her stuffed animals and brush her family members' hair. Her father, Oscar Alberto Martinez Ramirez, was stalwart. Nearly always working, he sold his motorcycle and borrowed money to move his family from El Salvador to the United States. Martinez and his wife, Tania Vanessa Avalos, wanted to save up for a home there. They wanted safety, opportunity. ``They wanted a better future for their girl,'' Maria Estela Avalos, Vanessa's mother, told The Washington Post. They traveled more than 1,000 miles seeking it. Once in the United States, they planned to ask for asylum, for refuge from the violence that drives many Central American migrants from their home countries every day. But the farthest the family got was an international bridge. . . . On Sunday-- This would be the Sunday before June 27. On Sunday, they were told that the bridge was closed and that they should return Monday. Aid workers told The Post the line to get across the bridge was hundreds long. Then we know what happened next to this father and his daughter. There was also another story in the New York Times the day before, June 26. The headline read ``Girl was Safe but Tried to Follow Father Back.'' I will not go through all of it, but here is what they were facing in terms of their own economic circumstances. At the end of the New York Times story it reads as follows: Mr. Martinez quit his job at Papa Johns, where he had earned about $350 a month. By then, his wife had already left her job as a cashier at a Chinese restaurant to take care of their daughter. The couple lived with Mr. Martinez's mother in the community of Altavista, a massive housing complex of tiny concrete houses east of San Salvador, according to [someone referred to earlier in the story]. Though Altavista is under the control of gangs, the couple was not fleeing from violence, [Ms. Ramirez] told him. Rather, the grind of surviving as a family on $10 a day had become unmanageable. So we have a lot of families fleeing for reasons based on violence and death threats and that horror, and then we also have families fleeing because they, in this case, had $10 a day to live on. So these families risk danger as they cross through--what could only be said by way of understatement--treacherous terrain. They risk that danger because the graver risk is not to make that journey. The administration has not sought, in my judgment, to address the root causes of migration, such as what we just talked about: violence, poverty, and corruption. Rather, the administration has repeatedly attempted to walk back our Nation's solemn vow and close the door on refugees and asylum seekers. Over the past couple of weeks, reports have surfaced of children held in squalid conditions without adequate medical attention, sanitation, or even food and water. A law professor who spoke with children at a Texas CBP facility was quoted in the Washington Post as saying, ``It's the worst conditions I have ever witnessed in several years of doing these inspections.'' That is a law professor, not a casual observer but someone who has experience and training, recognizing what is happening in these facilities. In May, the Department of Homeland Security Office of Inspector General issued a report stating that the El Paso Del Norte Processing Center, a facility with a maximum of 125 detainees, was holding 900-- capacity 125, holding 900 detainees. Some migrants were held in standing-room-only conditions for days and weeks with limited access to showers and clean clothing. These conditions were dangerous and posed an immediate risk to both migrants and personnel. The administration has sought to use inhumane policies like separating families, just one example, as a deterrent--as a deterrent. They recently canceled English classes, recreational programs, and legal aid for unaccompanied minors at shelters across the country, and an attorney for the Department of Justice argued that the government should not be required to give detained migrant children toothbrushes, soap, towels, or showers. Does that make any sense at all? Is that consistent with our values? The administration is seeking to relax standards for holding children, when, according to the American Academy of Pediatrics--also not casual observers but a set of experts on what a child needs to survive and thrive--Department of Homeland Security facilities already do not meet the basic standards for the care of children in residential settings. Earlier this week, the administration issued an interim final rule that essentially bars Central American migrants from claiming asylum by making them ineligible for asylum, including unaccompanied children who enter the United States at the southern border after passing through another country. This is just the latest in many attempts to restrict our asylum system and bar those fleeing violence, persecution--and for other reasons--from exercising their legal right, a legal right that is not just grounded in United States law but international law, the right to petition the U.S. Government for protection consistent with what we did after World War II because of the horrors we saw in World War II. This wasn't just some concept that was dreamed up. It was meant to deal with the horrors that World War II brought, to say to the world that we are going to make sure that if someone is fleeing violence and persecution, they will at least have a shot to make their case, to have due process to make their case. Most don't make the case; we know that. Most end up not being successful. But we should let them make the case because we are, on our best days, a nation of laws. We are also, of course, a nation of immigrants, and both of these principles are intertwined and undergird our values. President Kennedy said it pretty well: Immigration policy should be generous; it should be fair; it should be flexible. With such a policy, we can turn to the world and to our own past with clean hands and a clear conscience. It is entirely possible to create an immigration system that reflects not just President Kennedy's vision but our values as Americans--a system that respects the rule of law, that treats all individuals with human dignity, and reflects our values as a Nation. When we think of not just what our immigration system must be about but what our asylum system must be about, let us think of those families who put their lives at risk because of what they are fleeing, who simply want to make their case. Let's also remember two people whose faces we didn't see much of except in this one picture--a father and a daughter, little Valeria and her father, Oscar Martinez Ramirez--and remember what they were trying to do. I realize some will debate this: What happens when someone presents themselves at our border based upon poverty? I understand that will be the argument against it, but we are a big enough country and a great enough country to be able to develop a system to make sure that child and that father have a shot to come here. One of the problems we are having now at the border is that when you tell the world that you want to push people away, by way of rhetoric or by way of extreme policies at the border--inhumane policies, which might be an understatement--and by telling the world, or at least sending the message to the world, that you want to greatly restrict immigration, you are going to have people choosing a different system to try to make their case. We need to fix both. We have a broken immigration system which this body dealt with in 2013--68 votes in the Senate--to fix the system and to deal with all the tough issues. We can't get 68 votes around here to adjourn for lunch or to move on to the next part of the day sometimes. That is only a slight exaggeration--but 68 votes. What happened? Because there are extreme voices in this town that told the House of Representatives, ``Don't even vote on it; just end it right here,'' the best attempt in maybe decades to secure the border, to deal with citizenship, to deal with the guest worker program, to deal with all the difficult issues with immigration, and with 68 votes here, died in the House. It didn't even get a vote in the House, and this Chamber and the House have done basically nothing since then, at least the way I see it--nothing in terms of dealing with this system, trying to fix this broken system so you have rules and order and certainty, but also based upon and founded upon our values. Some people say: You can't do it. It is just too hard. Congress isn't equipped for that. We are the greatest country in the world for a lot of reasons. One of them is because of our values. Another reason is when we are at our best, we tackle tough problems. Fixing this broken immigration system is a tough problem. Many Presidents and many Congresses have wrestled with it, but we got as close to getting to a fix as anytime in recent American history when that bill passed. The faster we get back to something that comprehensive, that bipartisan, and that grounded in fact and law, the better off we will be. While we are doing that on immigration, we should have a conversation about asylum--how to do it right and how to make sure that system is working so well that it will be an example to the world. We have a long way to go. We have work to do, but I think these difficult issues are indeed a great mission--a difficult mission, but I think they are a mission worthy of a great country. I yield the floor. I suggest the absence of a quorum.

Mr. CASEY

Mr. CASEY. Madam President, I rise to discuss this urgent issue of pensions and our legislative proposal to address this looming crisis. I commend and salute the work of Senator Manchin, my colleague from West Virginia, for his indefatigable work on this. There are probably a few other words I could use for his determination over time, and not just over months but literally now over years, as well as Senator Kaine's, from Virginia, and Senator Brown's, who will follow me. We are grateful for this combination of States coming together to stand up for workers. We know this discussion on the floor of the Senate takes place at a significant time. The House Ways and Means Committee just passed the bipartisan Butch Lewis Act, H.R. 397, on the 10th of July. The House is taking much needed action, and it is long past time that the U.S. Senate does the same. In my home State, there is a whole group of workers. Obviously, miners are a big part of this, the Teamsters, Bakery and Confectionery Workers, all of whom, through no fault of their own, are seeing their hard-earned pensions threatened. Failure to act could result in devastating economic consequences to communities across both the Commonwealth of Pennsylvania as well as throughout the Nation. Tens of thousands of pensions of Pennsylvanians could be at risk, including-- and these are just some of the numbers--11,831 coal miners and 21,460 Teamsters. Despite the challenges ahead, the good news is, we have bipartisan legislation to deal with this pension crisis through the legislation known as the Butch Lewis Act. The bill creates a loan program for troubled pensions. It is a commonsense solution that brings the public and private sectors together to address this crisis. We must also pass legislation so we can address coal miner health and pension benefits. Senator Manchin, as I referred to earlier, has shown great leadership throughout this process. We want to thank all the Senators who are with us today and others who are not with us on the floor, necessarily, but are with us by way of supporting this legislation. We have a long way to go and a mountain to climb for several reasons. There are a number of Senators around this Chamber who, on a regular basis, when a multinational corporation needs help, will pull out all the stops. They will overturn any stone. They will surmount any barrier. They will fight through any wall of opposition or resistance. That is the same kind of persistence and determination and resolve we need for workers--in my case, whether it is a coal miner or a teamster or a bakery and confectionery worker. It is long past due that we bring the same sense of urgency to the issues that involve workers as some here brought to corporate taxes. Just by way of one example, we were debating the 2017--November 2017 and December 2017 tax bill. My God, there were lobbyists all over town and people scurrying back and forth to make sure the corporate tax rate came down, to make sure the rate a corporation was paying was lowered substantially. In the end, they got more than they asked for, in my judgment. What was supposed to flow from that was an abundance of jobs, a rushing current of jobs, and wage growth was supposed to come from that legislation. Of course, it didn't. Some of us are right about our prediction--a prediction that we would not want to be right about, but we were. So if that kind of determination and concerted action and then the legislative result that flowed from that can be undertaken to help huge, multinational corporations, I think the same effort should be undertaken on behalf of workers who earned these pension benefits. This isn't something extra. This isn't something new. This isn't something other than an earned benefit, and for some of them, they earned it in the most difficult way possible, by going underneath the ground to mine coal year after year and, in some cases, decade after decade. Stephen Crane, the great novelist, wrote an essay in the early 1900s or just around the turn of the century, I should say, about a coal mine in my hometown of Scranton. He described all of the horrors, all of the darkness. He described the ways a miner could die. He referred to it as the ``hundred perils''--life-threatening. He described the mine in a very moving way. He talked about the mine being a place of inscrutable darkness, a soundless place of tangible loneliness--loneliness because you can't see your hand in front of your face and loneliness, of course, if you were injured on the job, or if you had an injury that debilitated you, or if you, in fact, lost your life. Tens of thousands of people lost their lives in mines. I know that is a long time ago. I know we have made advancements, but it is still hard work just as it is to do the other jobs I mentioned, whether you are a teamster or a bakery and confectionery worker. Just pick your particular work area or union. So we have some work to do here, and we are going to have to fight through a lot, but we are grateful we have some momentum and some sense of urgency that may not have been there only weeks ago. With that, I will yield the floor to my colleague from the State of Ohio.

Mr. CASEY

Mr. CASEY. Madam President, I rise this evening to talk about judicial nominations and, in my view, the state of play, where we are. I want to highlight some of the very real impacts these nominations have on Americans across the board. We have had a number of opportunities this year to come together and have agreement on some judicial nominations, but, frankly, this year-- the last several years--this issue has been the subject of conflict and sometimes rancor and division on the Senate floor and in the committee, the committee of jurisdiction, the Judiciary Committee. I have raised concerns about the willingness of Senate Republicans to dismantle longstanding Senate rules but also Senate norms, all in a rush to pack the bench with nominees who are often both ideological and also, in some cases--not in all but in some cases--both too ideological and often unqualified. Early this afternoon, the Senate voted to confirm Daniel Aaron Bress to a Ninth Circuit seat in California. I will talk about his nomination just by way of example, not by way of argument before a confirmation vote because that has passed. I think his nomination and confirmation are another example of the decline of the Senate's once-proud traditions relating to judicial nominations. He was opposed by both of his home State Senators. Both Senator Feinstein and Senator Harris did not return a blue slip for Daniel Aaron Bress. The blue slip, as many people know, is literally a single piece of paper where Senators sign their name and then check off whether they support or oppose, as a way to have consensus between Senators from their home State, and it has always been accorded respect and deference in this Chamber, but that has all changed now. In this case, you had a California nomination--I will get to that part of it in a moment--where, as I said, both Senators did not return blue slips. In this case, in particular, I think it is particularly offensive because Senator Feinstein is the ranking member of the committee. For those who don't pay attention to all this terminology, ``ranking member'' is the top person in one party who is not the chairman or chairwoman, as the case may be. So as the top Democrat, the ranking member of the Senate Judiciary Committee, her opposition to Judge Bress should be an important factor in his nomination and confirmation. Prior to this administration, the Judiciary Committee had never held a hearing for a nominee from the ranking member's home State without his or her support. Again, that has all changed just recently. Prior rules and norms have not stopped Republicans in the Senate from pushing extreme and sometimes corporate nominees through this process, especially at the circuit court level. In a recent press release, Senator Feinstein and Senator Harris explained that they opposed Judge Bress in part because he had so few connections to California. He lived in California for only 1 year since graduating from high school, he has not voted in California in an election for over a decade, and the California bar lists him as a Washington, DC, attorney. I mention that because that should be relevant. When a home State Senator--in this case, two home State Senators, one of whom is the top Democrat on the Judiciary Committee--I think in that case there should be deference paid to that kind of concern that is raised. After all, they both represent their State. As I mentioned earlier, the blue slip process is predicated on the idea that home State Senators are more familiar than anyone else with their State's legal community. I think that goes without saying. They serve an important role in nominating individuals to serve and represent the State. Judge Bress is an example of why the blue slip process is so important. He is not part of the California legal community. Despite objections of the Senators, he will now sit on the Ninth Circuit Court of Appeals and decide cases for a State with over 39 million residents at last count. Without blue slips, what would prevent a California judge from being nominated to a court in another State? What would happen if you had someone from a different State, who had very little ties to a State, be nominated and confirmed, for example, to serve in a State like Pennsylvania? It doesn't make a lot of sense to most people. It is a norm that should not be violated. His nomination illustrates how the blue slip process has been eviscerated, especially for the circuit courts, which is something that I had some firsthand experience with. I did not return a blue slip on one nominee who was confirmed, and in the second case, there was a hearing scheduled over my objections by way of not returning a blue slip. That experience that I had as a Senator whose blue slip and the deference that should be paid as part of that blue slip process--that circumstance in my case is at variance with my experience for district court judges. Senator Toomey and I--my colleague from Pennsylvania--have worked together to jointly recommend experienced, consensus nominees for the Federal district courts in Pennsylvania. We have three districts--the Eastern District, the Middle District, and the Western District. Unfortunately, this bipartisan district court process has become the exception, not the rule. It used to pertain here in the Senate, where every State had some kind of process by which nominees were presented for confirmation by their home State Senators, and the White House--the administration--in every case would pay deference to that. That is exceedingly rare today. I am thankful we have maintained it so far in Pennsylvania with regard to the work Senator Toomey and I do together and our staffs do together to reach consensus. It doesn't always work, by the way, but usually no one hears about the ones who don't work out because we keep that to ourselves and move on to the next person and see if we can't reach consensus. I appreciate that. I think we are either at 19 or 20 judges confirmed since 2011, working together, and I hope we can maintain that so that at least--at least-- the blue slip process can be respected for district court nominees. I think people who elect us in our home States expect that. They expect us to work together and to try to reach consensus where we can. Sometimes it is not possible, but they do expect us to do that. If there is an expectation of consensus and bipartisan cooperation that adheres to or is expected of Senators, then there ought to be institutional support for that here in the Senate and by the administration. As I mentioned, that is not the case today, at least as it relates to the appeals court, the circuit courts around the country. This has relevance, of course, not just to process and norms and traditions; that is in and of itself important. It is of even greater significance when you consider the issues these courts will deal with. Just today, for example, there was oral argument before the Fifth Circuit Court of Appeals in the Texas v. United States case--a monumental case that has the potential to cause millions of Americans to lose coverage. We know that because we know that since the Affordable Care Act was passed, more than 20 million people have gained coverage, the larger share of that being people who gained coverage through the expansion of Medicaid. If that case were to be successful--a case brought by Republican attorneys general from around the country and then later opposed by Democratic attorneys general--if that case is successful, as it was at the district court level, 20 million people stand to lose their coverage, and a much larger number--depending on which number is on the record currently, but at least 150 million-plus Americans have protections today because of the Affordable Care Act, like the protection if you have a preexisting condition protection. Under the old system, the old rules, the old law, you could be denied treatment or coverage because you have a preexisting condition. That was happening routinely. That is no longer the law today. The law today is that if you have a preexisting condition, you can still get coverage. As I said, that would be at risk for something north of 150 million Americans. Some of the data tells us the numbers are equally substantial when it comes to different parts of the law and those who are adversely or potentially adversely affected. If you had to step back and summarize where we have been in the last more than--just about 2\1/2\ years now since the Trump administration came into office, working with House Republicans and Senate Republicans, you have had a campaign--really a constant campaign of what I would argue is about three things, and maybe not only three but at least three: ripping away coverage; decimating the Medicaid Program or at least attempting to over and over again; and thirdly, sabotage-- sabotage mostly by the administration itself but also supported by Republicans here in the Congress. That sabotage has been, unfortunately, successful. As of January, for example, the Gallup organization released data that said the number of Americans--I am reading from the first line of a news story from the publication Vox. The headline is ``Under Trump, the number of uninsured Americans has gone up by 7 million.'' The sub- headline is ``Even in a strong economy, Americans are losing their health coverage.'' This is an article written by Sarah Kliff--someone who spends a lot of time writing about and analyzing healthcare as an issue. It is dated January 23, 2019. I will read just the first two sentences: ``The number of Americans without health insurance has increased by 7 million since President Donald Trump took office, new Gallup data released Wednesday shows.'' Again, this is a January 2019 story. It goes on from there to say: ``The country's uninsured rate has steadily ticked upward since 2016, rising from a low of 10.9 percent in late 2016 to 13.7 percent--a four-year high.'' So at the end of 2016, at the beginning of the Trump administration, the uninsured rate was 10.9. At the end or the latter part of 2018, going into 2019, it stood at 13.7. So Gallup tells us that 7 million more people do not have healthcare who had it when the President started his administration. A number of organizations have catalogued recent analyses of the potential threats that could impact communities if this Texas v. United States case were successful. I will mention again for the record that the litigants--the ones who were bringing the case, these Republican attorneys general--prevailed at the district court level. Now it is on appeal at the circuit court, and, in my judgment, it is probably more likely than not that they will prevail at that level too. Then, of course, the only option would be the Supreme Court, and I don't have a lot of confidence that this Supreme Court would rule against that case, which would result in chaos. That is a terrible understatement for what would happen when 20 million people potentially lose their coverage and tens and tens of millions more lose the protections they enjoy now, especially those against the denial of treatment or coverage because that individual has a preexisting condition. Here are the numbers, just to remind folks. Everyone has heard the number nationally. One hundred thirty-three million Americans, roughly, have a preexisting condition. In my home State of Pennsylvania, that number is a little more than 5.3 million people. Those numbers are terribly high, but I think the one really making an impression on me and I hope on others--especially those in Pennsylvania--is the number of children in the Commonwealth of Pennsylvania who have a preexisting condition. Six hundred forty-two thousand seven hundred Pennsylvania children have a preexisting condition--642,700. No action by the U.S. Congress, by the administration, or by a court should ever result in any child being denied coverage or treatment because of a preexisting condition--any child but let alone numbers that are so high and so offensive to even consider that number of children or any portion of that number could be denied coverage. The only number I will emphasize tonight is 642,700 Pennsylvania children with a preexisting condition. I won't go through all the numbers because I know we are here late tonight, but another number that jumps out at me--and this number comes from a document published by Protect Our Care telling us in a publication today that when you consider the doughnut hole coverage, meaning that the Affordable Care Act began to fill the coverage gap when older Americans were paying for prescription drugs and often paying exorbitant prices for prescription drugs--the Affordable Care Act began to chip away at that number, so much and in such a substantial fashion that the average senior, since the Affordable Care Act was passed--and this is the period of time between 2010 and 2016--that seniors gained $2,272 on average, almost $2,300 per senior to help them with their prescription drug costs by helping to fill that so-called doughnut hole, which is a very benign way to talk about a terrible coverage gap that burdens a lot of older Americans. In Pennsylvania, that number is lower, but it was still more than $1,100 per person. All of that will be at risk if this case is successful. Just like the protections for preexisting conditions are at risk, the support that has been available up until the recent past for prescription drug coverage for seniors--that support potentially could go away completely. So seniors will again potentially be footing the bill if this lawsuit is successful. Two more, just for the record. Access to treatment would be in jeopardy for some 800,000 people with opioid use disorder issues. We know there are a huge number of Americans who have a substance use disorder issue, often an addiction. A subcategory of that--probably the biggest subcategory--are those with an opioid addiction. That has hurt families of all kinds--rich and poor, north and south, no matter where you live--east, west, rural, urban, suburban. It knows no bounds. A lot of that support has come from the support for quality treatment that folks need to lift themselves out of the grip of an addiction. A lot of that support comes from Medicaid expansion. Whether it is the repeal bills that were promoted on the Senate floor over and over again or whether it is the lawsuit that could have as devastating of an impact on healthcare as any repeal bill would, no matter where you turn, in terms of Republican healthcare bills and this lawsuit, you can see the adverse impact on Medicaid expansion. Virtually every one of them not only wants to cut Medicaid expansion, in most of the Republican bills, they want to eliminate it over time-- completely eliminate Medicaid expansion. Somehow it was wrong. I have to ask why. Why was it wrong that millions of people got their healthcare through an expansion of Medicaid? Why would anyone ever doubt that someone next to you who doesn't have coverage, first and foremost, and might have an opioid addiction problem is getting coverage, and because they have insurance coverage, they can get treatment for that terrible scourge our country is going to be dealing with for decades--why is that the wrong thing to do? How would taking that coverage away from someone with an opioid problem advance the interests of the American people? The answer is, it wouldn't. The answer is, it would set back the efforts to deal with a whole host of folks out there who are getting treatment today solely, completely, because of Medicaid expansion. The last thing I will mention is our rural areas. I represent a State that has 67 counties, and 48 of them are rural. A lot of the rural hospitals in those communities are already teetering on the edge of collapse and have been for years--not just the last several years but for many years. One of the fastest ways to ensure that more rural hospitals would close and collapse is to cut Medicaid or to take away Medicaid expansion. That has an adverse impact, the likes of which we can't even begin to calculate because folks in rural Pennsylvania will lose coverage if you decimate Medicaid or you take away Medicaid expansion, but that doesn't end there. A lot of folks in those communities are getting treatment for an addiction issue or something related. They will be adversely impacted; their families will; their communities will, but it doesn't stop there in a rural area. In a lot of these rural areas in my home State--and it is true all across the country--the biggest employer, or at least the second or third biggest employer, is often a hospital. In my State, there are probably 25 counties where the top employer in those 48 rural counties--about half of them, roughly--the No. 1 and No. 2 employer is a hospital. So cutting Medicaid or eliminating Medicaid expansion or sabotaging the health insurance markets or taking away the coverage of the Affordable Care Act has healthcare consequences, has opioid addiction treatment consequences, and of course has a job consequence as well. If you cut Medicaid in a lot of rural areas, you are going to lose a lot of jobs. It is as simple as that, as devastating as it is. So we have a long way to go to make progress on healthcare. I hope--I hope--my Republican friends will come together with us and work on lowering the cost of healthcare and lowering the cost of prescription drugs, but they don't seem to be that interested in that. Some are, intermittently, once in a while, but they don't seem to be interested because there is an obsession in the Senate, on the Republican side, with decimating the Medicaid Program, ending Medicaid expansion, and completely wiping out all the gains of the Affordable Care Act. That would be bad enough, but it is doubly worse or it is doubly insulting, I should say, when there is no plan for replacement. So what if a court of law, what if a Federal court in the Fifth Circuit, in the next couple of months, says the moving party here, the party that wants to declare the Affordable Care Act unconstitutional--declares the moving party is the prevailing party, that they win? Let's say it doesn't go to the Supreme Court, but even if it does, let's say it loses there. What happens then to those 20 million people who got coverage? What happens to the 150 million-plus who have coverage today, protections today, who did not have it before the Affordable Care Act? They were paying their premiums for years, if not decades. They had coverage for years, if not decades. Their children were maybe covered in their employer-sponsored plan, but in many cases--maybe not in every case--they didn't have much protection from preexisting conditions. They didn't have protections against lifetime limits or caps on the treatment you can get in a year or over a lifetime. We had the bizarre and insulting and degrading experience, where women were discriminated against by the insurance companies because they were women. Being a woman was actually, in a sense, a preexisting condition. That made no sense. Are we going to go back to those days because a group of attorneys general wanted to change the law, and they couldn't prevail on the Senate floor, or they couldn't prevail over time in the House, or by way of what the administration would do, so they went into court, and they are going to wipe out coverage for tens and tens of millions of Americans? Is that a good thing for America? I don't think so. I think that sends everything in the wrong direction. Unfortunately, that is not just theory. Some of it is already happening. As I said before, Gallup tells us that 7 million fewer people have healthcare today, or at least as of January, than did two Januarys before that. So we have a long way to go to make progress on healthcare, but we are not going to make much progress around here if we have a continual fight. I hope some will agree to set aside the fight about repeal and lawsuits taking away coverage. Let's work together to lower costs, and let's work together to lower the costs of prescription drugs, in particular, because I have to answer to a lot of families. One of them is Matt Stefanelli, a young man we just spoke to today talking about his children. Matt's son has type 1 diabetes. We are from the same home county. He is worried not only about his own healthcare, but he is worried about his son's healthcare. We have an answer, and the answer is to respond to families like Matt's. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent to speak as in morning business.

Mr. CASEY. Mr. President, I rise this evening to speak about the horrific humanitarian crisis at our southern border--the inhumane and truly despicable conditions under which migrants, including children, are being held by the U.S. Government. Children are being held for prolonged periods of time in facilities that are woefully inadequate, and that is an understatement. On my left is a chart with some pictures. I want to walk through each of these pictures to talk about these children by name. Since September of 2018, these children have died while in United States Government custody. I will start at the lower right-hand corner of the chart as you are facing the chart: Carlos Hernandez Vasquez, 16 years old; up here on the left top of the chart, Wilmer Josue Ramirez Vasquez, 2 years old; Darlyn Cristabel Cordova-Valle, age 10; Juan de Leon Gutierrez, right here on the other side of the chart, just 16 years old; Jakelin Caal Maquin--many know her name from the time when she passed away--just 7 years old; and finally, Felipe Gomez Alonzo, just 8 years old. These six deaths occurred in the span of less than 1 year and are the first deaths in at least a decade. Mourning their deaths is not enough. I think we can at least agree on that. As much as anyone can mourn their deaths, that is not enough. We must act in light of this terrible darkness that these children experienced and that their families are living with and that our country is experiencing as well. In recent weeks we have heard some of the reporting. There have been reports of children held without adequate medical attention, without food or water or sanitation. Just by way of one searing example, Warren Binford, a law professor at Willamette University, who spoke with children at the Texas facility, said: Basically, what we saw are dirty children who are malnourished, who are severely neglected. They are being kept in inhumane conditions. They are essentially being warehoused, as many as 300 children in a cell, with almost no adult supervision. This is a lawyer who is trained to understand and to explain these kinds of conditions. This isn't some casual observer. This is an expert in her field who is telling us this. She is not a Member of Congress. She is not an employee of the U.S. Government. She is a lawyer who saw this with her own eyes--children who are malnourished, neglected, living in inhumane conditions, warehoused, with 300 children in a cell with no adult supervision. This same law professor reported witnessing a 14-year-old--a 14-year- old--caring for a 2-year-old without a diaper, lack of medical care, with flu outbreaks and lice infestation. Law Professor Binford said: It's the worst conditions I have ever witnessed in several years of doing these inspections. That is what a trained professional is telling us about what is happening in these conditions. A Senate colleague of mine talked about going into a facility where children were housed. This is a Senator with a lot of experience in the Senate. He said, usually when you walk through any kind of facility or any kind of environment in the United States of America where children are, you can hear them laughing and playing and having fun--that beautiful noise of children playing. He said you couldn't hear any of it. He talked about the eerie and disturbing quiet in that place. There was no noise, no laughing, no happiness, I guess, is probably the best way he described it. Then this one Senator talked about making eye contact with a child. As soon as he or she made eye contact, the child would turn away. I am sure we have other examples from colleagues here and in the House and within our government, but when a law professor who has been in a lot of these circumstances tells us this, we should listen, and we should act. Another lawyer reported speaking with young mothers and children--all of whom were claiming asylum at a Texas facility. The mother reported a lack of proper medical care, or clean clothes, or sufficient cups or baby bottles, forcing reuse and sharing of those same cups and bottles, as well as mothers wiping their children's runny noses or vomit with their own clothes because they have nothing else--not even a paper towel--to clean with when they are experiencing these conditions. This particular lawyer was quoted in the Texas Tribune, just in case anyone wants a source. These reports of overcrowding and lack of medical care, sanitation problems, and lack of food or water are an abomination. This is not America. It is not the America we grew up with. It is not the America we tell the world we are. We have told the world for generations that we care about each other; that we welcome people to our shores and try to treat them fairly. We can't say that when we have these kinds of insults. Just imagine the fear a child experiences in these circumstances--the fear that comes from being alone, the fear of not having their mother or their father or some loved one nearby, in many circumstances. Some, I guess, might have an older sibling with them, but just imagine how frightened they are. Then, to compound that, they don't have basic necessities. I can't even imagine the fear. There is a great hymn in my faith that talks about being a servant. I will not go through all the lyrics. The song is named ``The Servant Song.'' I will take the sacredness out of it for purposes of where we are speaking today. One of the lines of ``The Servant Song'' says: ``I will hold the . . . light for you in the night time of your fear.'' I can't imagine any other circumstance that anyone here could describe to better fit that description--in the night time of the fear of children who may have survived, but others, as this chart depicts, lost their lives because of failures of our government. A 2-year-old, a 10-year-old, a 7-year-old, a 16-year-old, an 8-year-old, and another 16-year-old who were in government custody of the United States of America lost their lives. I can't even begin to imagine that fear. We all have to ask ourselves a lot of questions, but one question we have to ask ourselves in both Houses of Congress and the administration is, Will this government be there in the night time of the fear experienced by these children or not? It is readily apparent, from all the reporting month after month, that we are in no way meeting that test for too many children. Maybe some are in better conditions, but there are a lot of children--I don't even know the number. I hope it is only in the hundreds, but many people believe it is a lot more than that. There may be thousands or more who are in the night time of their fear. Our government is not only part of creating the fear, we are doing next to nothing to alleviate it. We should ask ourselves, will we be there for them in the night time of their fear? The administration's response to all of the reporting of this horror has been an insult to the United States of America. It is an insult to the taxpayers who send money to the government and say: Make sure that when a child comes to our borders, we treat them humanely; make sure the system works. It is an insult to our values, of course. It is an insult to the proclamations we make as Americans to the world that we are a beacon of light for the world in so many ways. Thank goodness we are in some other facets of our government and of course the lives of our people. On this issue, we are bringing darkness not only to the lives of those children, but we are bringing darkness to the world. We are less safe as a country when this happens. We empower people around the world--very bad actors around the world--who have been perpetuating this narrative for generations that America allows this to happen. When you do that, you empower the bad guys to recruit and to marshal their forces against you. When you treat children this way, who then lose their lives in government custody, we are less safe. It hurts our national security. It doesn't just undermine our values. It is not just immoral. It makes us less safe. It is a national security threat as much as it is an insult to our values or at least the values we claim to have as a government in the executive and legislative branches. This administration has sought to increase family detention. They sought to relax the standards under which children are held. The administration recently canceled English classes, recreational programs, and legal aid for unaccompanied minors at shelters across the country. Recently, an attorney for the Department of Justice argued that the government should not be required to give a detained migrant child--or in this case children--toothbrushes, or soap, or towels, or showers, and probably goes on from there. It is hard to comprehend how insulting that is to our values; how cruel and inhumane that is. If our government can't provide that to a child, how can we call ourselves a government? How can we say we have the values that we claim to have as a government? This person was a lawyer for the U.S. Government from the U.S. Department of Justice. A lawyer said that, not some low-level employee of some department in the Federal Government. A lawyer in a courtroom said our government shouldn't have to provide toothbrushes or soap or towels. We should not be relaxing standards when, according to the American Academy of Pediatrics, the Department of Homeland Security facilities already don't meet the basic standards for care of children in residential settings. Moreover, the Academy of Pediatrics stated that detention itself, even for short periods of time, can cause psychological trauma and induce long-term mental health risks for children. I made this point to the administration months ago; that when you are setting up your protocols about how to deal with a child, please consult with the American Academy of Pediatrics--which is probably the leading organization in the whole country--about how best to care for a child and what not to do. I think we should listen to them, and I hope the administration would not only be listening to the American Academy of Pediatrics but would be incorporating their expertise and protocols. Conditions for migrant adults are also completely unacceptable and an insult to our values. Last month, the Department of Homeland Security Office of the Inspector General issued a report. This isn't just a routine report. I will read the headline: ``Management Alert--DHS Needs to Address Dangerous Overcrowding Among Single Adults at El Paso Del Norte Processing Center.'' This is a management alert sent by one part of the government--not just the executive branch but one department to the other--the inspector general to the management of the Department of Homeland Security. That is how bad it is. I will read just one line on page 9 of the report: Recommendations. We recommend the Acting Secretary of DHS: 1. Take immediate steps to alleviate the overcrowding at the El Paso Del Norte Bridge Processing Center. They didn't say work on it for a couple of months and try to get something done. Their own inspector general is saying take immediate steps. Mr. President, I ask unanimous consent to have at least the body of this report, if not the attachment, printed in the Record.

Mr. CASEY. This report details dangerous overcrowding for a prolonged basis at this detention center and the dangers it creates. According to the report, a facility with maximum capacity of 125 detainees is holding approximately 900. Some migrants were held in standing-room- only-conditions for days or weeks with limited access to showers or clean clothing. Migrants, many of whom are asylum seekers, were observed standing on toilets themselves to make room and gain breathing space. These conditions not only violate Custom and Border Patrol's transport, escort, detention, and search standards but are an affront to our values as a nation. Asylum seekers who have fled violence and suffered through an arduous journey should not be subjected to unhealthy, unsanitary, unsafe conditions under any circumstances. Asylum seekers are coming to our shores because of violence in their home countries. Everyone knows this. This isn't a theory; it is fact. Honduras, Guatemala, and El Salvador rank in the top 10 countries in the world for homicide. Why do we think they are coming? Would any one of us journey hundreds or thousands of miles? I don't think so. According to a report issued from Doctors Without Borders in 2017, Northern Triangle countries--the countries I just mentioned--are experiencing ``violent displacement, persecution, sexual violence, and forced repatriation akin to the conditions found in the deadliest armed conflicts in the world today.'' That is not some Member of Congress just talking. For asylum seekers, the decision to move is not a choice; it is a necessity. The journey can further subject them to violence, danger, and other abuses along the way. Once they arrive at our shores, it is critical that they are treated with compassion and human dignity and receive a fair opportunity to present their claims. That is the America that we believe in. That is the America we were taught to believe that we are--a nation that respects human life, human values, and gives people a fair chance when they present themselves for asylum. The only good news that we can report tonight is that the Senate passed a bill to provide nearly $4.6 billion in humanitarian aid, including $2.88 billion to the Office of Refugee Resettlement to care for migrant children and to help minimize the time they are held in Federal facilities, in Federal custody. The House also passed a bill, which I support. We must quickly conference these bills to provide the needed resources while we also ensure there are protections for migrants and greater accountability and transparency from DHS to ensure the funds are appropriately spent. The faster we get this done, the better, and maybe we can reduce the likelihood that six more children will die in the next couple of months in the custody of the U.S. Government. I end with this note: I talked about what we are as a nation and what we believe that we should be and the standard we are not meeting now. We must be a nation that respects people who come to our shores and treats them with a measure of human dignity and compassion and fairness. What we must not be is a nation that refuses asylum seekers who flee persecution and violence from the murder capitals of the world. We must not be a nation that separates children from their families. We must not be a nation that gives migrants, including children, who are in squalid and inhumane conditions, no hope of getting out of that circumstance. We are, indeed, when we are at our best, a nation of opportunity, a nation of immigrants, and, of course, a nation of laws. It is imperative that we fix our broken immigration system more broadly so that it, once again, reflects these American values. As we work on a broad response to a broken immigration system, let us at least be there for those children in the nighttime of their fear-- No. 1, not to create that fear and, No. 2, not to perpetuate it for these children. At a minimum, we should make a pledge in our government to never have six deaths of children who are in the custody of the U.S. Government. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, I want to thank my colleague from Connecticut for leading this discussion today on gun violence. We want to focus on one bill in particular, one piece of legislation, but I want to step back for a moment and talk about this issue more broadly in terms of what it means for the American people. We are talking about a problem, the problem of gun violence, which is a uniquely American problem. No other country has this problem. No other country has the amount of mass shootings. I don't know the exact number, but we have had so many that we know them by the name of the community. When we say Newtown, CT, or Sandy Hook Elementary School, when we talk about places like Columbine, or Parkland, you know what happened at those places because they have become so common. So this is a uniquely American problem that Americans have to solve. Some of those Americans, obviously, have to be Members of Congress. You would never know there was this problem based upon the inaction by Congress, by the Senate, and, until recently, the House over many years. The one question I have to ask is, are we going to surrender to this uniquely American problem--because the inaction by Congress over many years now would indicate to me that the answer to that question is yes; that a lot of Members of Congress, House and Senate, have concluded that there is absolutely nothing we can do to reduce even the likelihood of another mass shooting or reduce the likelihood of more and more gun violence. So here we are. The House has passed background check legislation that, as Senator Murphy just outlined, is overwhelmingly popular with more than 90 percent of Americans who support it, and we are in day 113. It has been 113 days since the House passed it, and there is no action on the Senate floor. There hasn't even really been a debate of any kind here in the Senate on gun violence or what to do about it. So consider that time frame and all the time that has gone by since. The one bill that dealt with this issue of gun violence that passed either House in probably 25 years is now 113 days from having any action in the Senate. So with no action on something as popular and as well-supported as that bill and on such an important issue as gun violence, I have to conclude that without any action here in the Senate, in this particular legislative graveyard, the Senate is surrendering to this problem. It is just letting this bill die in the Senate over time. Among the many examples we could talk about, I will give you two examples from both ends of our State of Pennsylvania. In the city of Pittsburgh, we witnessed the deadly act of violence against the Jewish community. The worst act of violence against a Jewish community in American history was at the Tree of Life synagogue back in October, when a shooter opened fire on three congregations worshipping during Shabbat services. Three different congregations were worshipping at the same place. This deadly mass shooting--a targeted, cowardly, hateful attack on the Jewish community--resulted in the deaths of 11 innocent Pennsylvanians and injured 6 more, including 4 members of law enforcement. Eleven people were gone in a matter of minutes, and in this case they range in age from the ages of low fifties, I guess, to the oldest being 97 years old, if memory serves me. While this attack was horrific for so many reasons, it is just one example of the ongoing and systemic problem of gun violence across our country. It is an epidemic. I will say it. It is a uniquely American problem, and we are acting as if there is no problem at all here in the Senate. Just consider this. Through the month of April, nearly 400 individuals have been shot in the city of Philadelphia. In many cases, if that doesn't lead to death itself, it leads to grievous permanent injury. Just this past weekend in Philadelphia, there were 19 shootings in one city--19 shootings in one weekend with 5 deaths and 28 others wounded. One of the shootings occurred in a public park during a graduation party. Six people were shot and one was killed. They were all under the age of 25. Here is what the toll so far is this year. This year the gun-related death toll in Philadelphia is 152--in one city. Needless to say, the national statistics on this--the national numbers--are staggering, in addition to the numbers I cited from Philadelphia. Gun violence affects more than 100,000 people every year, impacting their lives year after year in numbers like that. On February 27, as I mentioned, the House passed H.R. 8, the Bipartisan Background Checks Act of 2019--113 days ago--but the majority leader has refused to call this bipartisan bill to the floor of the Senate. Shouldn't we even debate it? Is that really where we are--that this uniquely American problem of gun violence is not even worthy of a debate? We are looking for a vote, obviously, but is it not even worthy of a debate and then a vote? We know that there may not be the votes in the Senate to pass this, but we are not even going to debate something on such an important issue? This is a piece of legislation supported by more than 90 percent of the American people. If you don't want to be for it, just tell us in the debate and register your vote. At least we will have debated the one bill that passed the House in 25 years. We have this one opportunity on one bill, and it is not even worthy of a debate here in the Senate. I am a proud original cosponsor of the Senate version of the bill, the Background Check Expansion Act, because it is a type of commonsense legislation that makes Americans safe from the horrors of gun violence. In fact, expanding background checks is supported by more than 90 percent of Americans because they know--we all know--that background checks make our community safer. Since 1994, background checks have prevented more than 3.5 million gun sales to dangerous criminals and others prohibited from owning guns. Yet these background check bills haven't seen the light of day since H.R. 8 was passed in the House. I will say it again: 113 days ago. They were sent to this legislative graveyard. I have to ask my Republican colleagues: Why don't you ask the majority leader to schedule just one debate? It could be a limited debate. Then, let's have a vote up or down. I hope there may be a vote on some other measures, but at least let's debate and vote on a background check bill that passed the House of Representatives. The time for talk about this issue and the time for lamenting the problem has long passed. We have to do something about it. That means debating and voting. That is what we are supposed to do here--debate big issues and vote. Vote how you want, but at least debate and vote on this issue, which will reduce the likelihood that we will see more and more tragedies like we have seen. We are told that 100 people are shot and killed every day in the United States of America. One hundred people are shot and killed every day. We go not just days but weeks and months and now years without a single bill getting the kind of debate and vote that it should get and without a single bill passing. At least let's get a start with this piece of legislation. Let's debate it and vote on it. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, I would ask unanimous consent to speak as in morning business.

Mr. CASEY. Mr. President, I rise today to discuss one of the judicial nominations we are considering. We are on the floor this afternoon to discuss the nomination of Matthew J. Kacsmaryk to be a U.S. district judge for the Northern District of Texas. We know that under the Senate rules we are now operating under, judicial nominees are receiving just 2 hours of what is called postcloture consideration, and for that time on the floor, we are considering a lifetime appointment to be on the Federal district court bench or to be a judge on one of the circuit courts. These are lifetime appointments, and to have just 2 hours on any nomination I don't think is enough time--I think a lot of Americans agree with me--but maybe even more so when you have a nominee whose views are, to be understated for a moment, troubling, views about judicial philosophy or a judicial philosophy and--a philosophy that I think a lot of Americans would find extreme. In this case, the nomination of Mr. Kacsmaryk is a prime example of why these nominees for lifetime appointments warrant a longer time for review. Again, I think that is an understatement. Even at a time when we are on a regular basis considering nominees who fall outside of the mainstream and who tend to fall in a place, in terms of legal philosophy, that a lot of Americans would find very concerning--even at a time when we have considered a lot of nominees I would consider outside the mainstream, Mr. Kacsmaryk's nomination is particularly troubling. I will use just two examples, briefly. The first example is his hostility to women's access to safe, affordable, and FDA-approved contraception. So many Americans--I think long before the Affordable Care Act but certainly in light of the Affordable Care Act--consider access to contraception that is safe, affordable, and FDA-approved--well, I think most Americans would consider and should consider that part of a basic healthcare package. That is the way it ought to be. But I would hope that a judge would at least recognize that it is fundamental to women's healthcare. Unfortunately, I don't think this nominee does, and that in and of itself is troubling. The second example--and these are only brief overviews in the interest of time--is Mr. Kacsmaryk has repeatedly disparaged and attacked the LGBTQ community. In a public comment in 2016 to the Centers for Medicare & Medicaid Services, which is part of the Department of Health and Human Services and is known as CMS, Mr. Kacsmaryk argued that transgender individuals suffer from a ``psychological condition in need of care'' and suggested that being transgender was a ``delusion.'' I have to ask--a delusion? Where does he come up with that? I don't know where one comes up with that kind of analysis. It doesn't make sense to most Americans. Prior to that, Mr. Kacsmaryk wrote an article about the Equality Act, which is bipartisan legislation that is before the Senate. The Equality Act would have the effect of--these are my words; this is not a full description of it--have the effect of catching up, in terms of the legal protections provided to Americans who happen to be gay or lesbian, bisexual, transgender--have the protections afforded to them catch up to those provided to other Americans. We finally made progress. More than 50 years ago now, we had the Civil Rights Act and other legislation over time that provided more and more protection over time to more Americans. Unfortunately, we don't have a similar measure of protections for Americans who happen to be LGBTQ. It is literally the case today that in some States, if you are gay or lesbian, you could be married in one hour of the day or on one day and the next day or the next hour be fired, and that would be permissible under law. So there are protections for employment and for access to education and housing--the full measure of American life. The Equality Act would ensure those protections. That is not law yet, and that is why we have to pass it by way of Federal law. With that background, I want to go back to what I previously stated. Mr. Kacsmaryk wrote an article that suggested that the Equality Act, which I described, would ``weaponize'' the Obergefell decision. That was the landmark decision that allowed same-sex couples to marry. He said the Equality Act would weaponize that decision, while in this particular writing making reference to a ``long war ahead'' when discussing LGBTQ rights in a post-Obergefell America. So in America after the Obergefell decision, which allowed marriage equality and which made that part of our Federal law, thank goodness, after a long time--he believed that the Equality Act would be part of a ``long war ahead,'' when discussing that future in America. That doesn't make sense to me. I don't think it makes sense to a lot of Americans. I think most Americans believe that decision for marriage equality was an advancement where the circle of protection is growing, as it ought to. For too long, that circle was very small--until we had some breakthroughs over the last 50 years. Fortunately, marriage equality-- the right to marry, the right to spend the rest of your life with someone you love of the same sex--was finally enshrined into law by a Supreme Court decision. But this nominee seems to believe that the Equality Act would ``weaponize.'' I don't know where you come up with words like that--``weaponize,'' ``war.'' It just doesn't seem to fit in the America I think most people believe in. As this is playing out, it just so happens--and this is offensive. I hope it wasn't intentional. I don't have any reason to believe it was intentional. But it just so happens that the majority has this particular nomination on the floor when we are talking about these concerns about LGBTQ Americans and a particular nominee or maybe more than one nominee--I am here to talk about just one. But this is all playing out this month in the midst of celebrating LGBTQ Pride Month. So that is particularly offensive. Again, I will state for the record that I don't have evidence that it was intentional to consider someone with those views at this particular time, but it is nonetheless offensive because of the timing. The LGBTQ community had to sacrifice so much for so long in their fight for equality and civil rights in the United States of America, and we have a lot more work to do. As I indicated, the Equality Act is not yet law. Even though it is slightly bipartisan so far, we need to grow that bipartisanship so we can get it passed here in the Senate. I think LGBTQ Americans--frankly, all Americans--deserve better than a nominee who suggested that the Equality Act ``weaponizes'' the right to marry the ones they love. I think our country deserves a judge better than that, even if it is just for one particular Federal district court. I also believe that Americans deserve a better nominee than Mr. Kacsmaryk--maybe especially on these issues that I have raised but generally, as well. They deserve a nominee who respects and will protect the rights of all Americans, especially those Americans who have been the subject of ongoing, continuous discrimination--in this case, LGBTQ Americans. That discrimination has not abated or been ripped out by the roots because we have advancements like the right to marry or advancements in law. That discrimination continues. In fact, it is protected in some ways by the laws of some States, where you can fire someone simply because they are gay and do that with impunity. The discrimination continues by way of hateful acts that people undertake, but also the discrimination continues by way of law, as well. We should have judges in every district court, in every circuit court, in every court in the country--no matter what level of judicial office we are talking about--who will respect and protect every single American. In this case, I think you have a nominee who is not just outside of the mainstream but way outside of the mainstream, and I think that is why--so far, at least--he has been the subject of bipartisan opposition, and that is pretty rare around here, as many know. He is too extreme for this appointment. I would hope that my colleagues would vote against him. I know we had one vote already. I say all this as someone who has worked for a long time in a very bipartisan, collaborative way to appoint district court judges in Pennsylvania over and over. Those judges have had the support of Senator Toomey, as well as my support. A Democratic Senator and a Republican Senator have worked together on a number of appointments. We are getting close to 20 now, I think, since we have served together since 2011. I think we are at 19, if I haven't lost count. That means that we both have worked together to review, to scrutinize, and to decide whether to support a judge who might come from a Democratic nomination and might be supported by me and by my office, as well as a nominee supported by my colleague Senator Toomey. Over time, that means that Democratic judges, or someone nominated by a Democratic Senator and a Democratic White House a couple of years ago, and Republican nominees, nominated by a Republican Senator and a Republican White House, have been given consideration, review, and then confirmation. I am someone who takes his responsibility seriously. I have a long and distinguished record of working in this process to make sure that we get Federal district court judges from different points of view nominated by both Senators of both parties who meet that test, not judges who just meet the test of competence but also meet the test of being within the mainstream. Again, this means a judge who will respect and protect every single American. I think that is not asking too much of any nominee, no matter what district court. I yield the floor. I suggest the absence of a quorum.

Mr. CASEY

Mr. CASEY. Mr. President, it gives me great pleasure to celebrate 100 years and four generations of McGregor Industries, an outstanding metal fabrication firm based in Dunmore, PA. Since its establishment 1919, McGregor Industries has been renowned for its production of quality railings, staircases, and iron and steel works. The company's roots in Scranton's South Side neighborhood firmly placed McGregor Industries at the center of the highly competitive iron and steel trade market of the Northeast. Their many high-profile projects have built our businesses, our churches, our schools, and even our airports in northeastern Pennsylvania and across the Commonwealth. When the company faced hardship in a changing market of the early 2000s and again in the 2008 financial crisis, Robert R. ``Bob'' McGregor readily took on the challenge to save his grandfather's enterprise. Bob's engineering background encouraged McGregor Industries to evolve and thrive in changing times through innovations in engineering and development, eventually resulting in the McGregor Stair Tower and Stair Systems. McGregor Stair Systems soon became prominent features of many Philadelphia area building projects. Under the leadership of a fourth generation McGregor and Wharton graduate, Grace McGregor Kramer, the company's high-rise stair towers have expanded to the Boston area. Contracts with MIT and the Encore Boston Harbor casino are among the largest construction projects in Massachusetts history, with McGregor Industries securing contracts for over 4,000 workers. This family-led operation upholds its reputation as a reliable and innovative leader in its industry that architects, engineers, contractors, and construction managers can depend upon. McGregor Industries and its devoted employees possess the focus and innovation required of steel industries in the 21st century, while maintaining the spirit of a family business committed to its community. McGregor should take great pride in its decades of growth and tradition of excellence passed from generation to generation. McGregor Industries remains a testament to American-made ingenuity. Their commitment to service and the betterment of communities across the Commonwealth of Pennsylvania and beyond is inspirational. I wish their leadership and employees success for many years to come.

Mr. CASEY

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

Mr. CASEY. I ask unanimous consent to speak as in morning business.

Mr. CASEY

Mr. CASEY. Madam President, we are on the floor, and I will be joined by colleagues to talk about the program we know as Medicaid--a program that I think we are beginning to appreciate more, especially in the last couple of years--and the impact it has on the American people. Unfortunately, the debates on healthcare have resulted in Medicaid becoming a target. Too often, both in the Senate and in the other body--the other body, the House--the Medicaid Program has been the subject of attempts to do at least one of three things, if not all three. One is attempts to decimate the program by way of funding cuts over the next 10 years. We know the President's budget has proposed cutting Medicaid by $1.5 trillion over 10 years--that is with a ``t''--roughly, $150 billion each and every year for 10 years. That is a bad idea, and we are going to fight that with all we have. Other attempts to slash Medicaid have been perpetuated over time, either to cut it over 10 years or to cut it in a particular year. The third thing we have seen is sabotage efforts by the administration when it comes to the exchanges resulting from the Affordable Care Act but also attempts to sabotage the Medicaid Program itself. I will develop that in a moment in terms of the attempts by the administration. Medicaid is a program that, I think, tells us who we are as a nation. We are a great nation for a number of reasons. We all know we have the strongest military and the strongest economy. When we are at our best, we are an example to the world. We are also the greatest country in the world because of the way we attempt--don't always do the right thing and don't always do as much as we should--but because of our attempts to take care of folks who need help and to give opportunity to folks who might need a door to be opened or an opportunity to be presented to them. Medicaid is one of those examples of American greatness when we get it right. Medicaid is the program that we know is responsible for making sure seniors can get into nursing homes. Absent Medicaid, millions of seniors wouldn't be able to have the benefit of skilled care in a nursing home. Something on the order of 60 percent of seniors have an opportunity to get skilled care because of Medicaid. Absent Medicaid, it is highly likely they wouldn't be able to get that care, especially when you consider the cost of care to just one family. It would cost tens and tens of thousands of dollars. Medicaid is the program that takes care of a huge share of the Nation's children, and a subset of that, of course, is children with disabilities. We are told, just in Pennsylvania alone--the most recent number I have seen--54 percent of children with disabilities have their healthcare provided to them by Medicaid. Thank goodness that is the case, and we have to make sure that continues. Just consider the birth of a child. We know, whether it is Pennsylvania or the Nation, the number exceeds 40 percent. Forty percent of all the births in the country--more than 40 percent, I should say--are paid for by the Medicaid Program. So the Medicaid Program affects the family in so many different ways: the family, when it comes to a birth, in very high numbers across the country; the family, when it comes to providing healthcare for children and to give children the opportunity not just to have coverage and insurance but to have early screening, early diagnosis, and testing--the kind of preventive care, in a sense, that we hope anyone would receive but especially a young child. Medicaid, of course, goes from, to use Senator Hubert Humphrey's line, ``the dawn of life to the twilight of life''--from children all the way through to older Americans and folks in between there who might have a disability. Probably every Member of the Senate has received a letter from a family who has a loved one with a disability, especially a child, expressing how Medicaid is important to them. We all know these debates are critically important to what happens to Medicaid. If we allow the majority in the Senate, and if we allow the administration to have its way, we would have substantial cuts to Medicaid--maybe not a trillion and a half, as the administration has proposed, but substantial cuts that would hurt the American family. I wanted to highlight some of the ways I mentioned earlier that the administration has tried to sabotage Medicaid. That is my view of it. Here are some examples: Starting in January of 2018, the administration undertook an effort to allow States, for the first time, to take away Medicaid coverage from people who are not working or who are not engaged in work-related activities for a specific number of hours each month. In Arkansas, for example--this was the first State to implement this new policy by the administration--over 18,000 Medicaid beneficiaries lost coverage in 2018 due to the new requirements. Almost one in four people were subject to the new rules. While a Federal district court recently struck down restrictive waivers in both Arkansas and Kentucky, the Centers for Medicare and Medicaid Services, the so-called CMS, continues to approve these policies in additional States. So that is one attempt to knock people off Medicaid in the calendar year 2018--18,000. Another attempt was in the State of Utah. HHS, Health and Human Services, a Federal agency, has also approved an unprecedented authority for States to deny coverage for people who otherwise would be eligible for Medicaid. This authority undermines Medicaid's guarantee of healthcare coverage to low-income people who meet the eligibility criteria set by Congress. Earlier this year, Health and Human Services approved a proposal to allow the State of Utah to cap enrollment based solely on State funding decisions. So, in other words, once the number of enrollees reaches the State's funding cap, other eligible people would be shut out of coverage. An arbitrary enrollment cap limits enrollment on a first- come, first-serve basis and would treat similarly situated people very differently, depending on when they apply for coverage, effectively holding low-income people's healthcare coverage hostage--hostage to State lawmakers' annual budget decisions on how many people should get coverage. So this is another way to limit Medicaid coverage. Now, Health and Human Services is reportedly working on a block grant guidance for States that could give States the latitude to cut coverage of services or provide payments in ways not allowed under Federal law. So here are just a couple of examples of what the administration is doing that I would argue is sabotage: cutting Medicaid by providing waivers that have not been provided before to the States. I don't think coverage of Medicaid should be determined by a purely budgetary decision at the State level. States have to balance their budget. They have constraints. The Federal Government should ensure that anyone who is eligible for Medicaid should receive it. There are those who say: Well, if you go down that path, the Federal Government will not be able to afford it. I have heard words used on this floor and other places around the Capitol that the cost of Medicaid is ``unsustainable.'' That is the word that is used over and over--unsustainable. I wonder if the same people, the same Members of Congress, use the word ``unsustainable'' for corporate tax cuts that went into effect starting in late 2017, where there was a corporate tax reduction voted on in the Senate where that reduction went from a 35-percent rate down to a 21-percent rate. The original idea was to go from 35 to 20, and it ended up at 21. So that is a 14-point reduction in the corporate tax rate. We were told, if we did that, if we all agreed to do that--I did not agree with it--but if we were to agree to do that and the bill went through and became law, which it did, that somehow wages would be increased for workers across the board. In fact, the White House, at that time, promised that wages would go up $4,000 per worker--$4,000. I haven't had a steady stream of workers coming to my office saying they got a $4,000 wage increase because of the December 2017 tax bill. In fact, they are telling me the opposite. Many of them are paying more than they were before that tax bill. I make that point and relate it to Medicaid very simply because the same folks who talked about and have advocated for and even voted repeatedly to cut Medicaid are the same folks who often supported a corporate tax cut that cost over a trillion dollars and was not paid for. Then the same people say: Oh, my goodness. We have a trillion-plus hole in the budget so we have to go and cut Medicaid or Medicare. So what results now is a little more than a year later--a year and a half later, after the tax bill passed, what do we have? We have the administration coming forward saying: We have to cut Medicaid by a trillion and a half over the next 10 years and Medicare by over $845 billion over the next 10 years. That is the tradeoff: cut Medicaid and Medicare, in essence, to pay for a corporate tax cut. Remember, every point they reduce that corporate tax cut--when they went from 35 to 34, the cost of that is $100 billion over 10 years. Then, when it went from 34 to 33, another $100 billion is implicated in that cut, and you can see the reduction. For every point of the corporate tax cut, it will cost the Nation, over 10 years, $100 billion. So when folks start talking about the cost of Medicaid being unsustainable, I just think that is a camouflage for what they really want to do, which is to cut Medicaid and reduce those who are eligible. I am going to try, with everything I have, to prevent them from doing that because last time I checked, Medicaid was a program about us. It is an ``us'' program, not a program for someone over there--someone who is distant from us. Medicaid, as we found out most recently in the debates about healthcare, is a program about us, about who we are. It is about babies being born. It is about kids with disabilities. It is about children who live in families who are very low income. The families are thereby eligible for Medicaid, and that child not only has coverage but has the kind of early preventive healthcare we would hope every child has. And Medicaid is also about the members of our family who are senior citizens trying to get skilled care. So we are going to have a long discussion today, at least for the better part of an hour, about Medicaid, and I am grateful that colleagues of mine are willing to come to the floor and talk about this critically important program and what is at stake for our families.

Mr. CASEY. Mr. President, I will at this time yield the floor to my distinguished colleague from the State of Washington, Senator Murray. We are honored by her presence here on the floor. I will come back a little later.

Mr. CASEY. Mr. President I want to thank my colleague from the State of Washington for outlining the challenges presented now to Medicaid in terms of efforts by Republicans, which I have described with three words: decimate, slash, and sabotage. I think all three are an accurate description of what they have tried to do. But I am also grateful that Senator Murray was highlighting some of the great benefits of the program in her initial remarks on the floor. We just had a report yesterday from a great organization called Protect Our Care. I will not read the entire report, but I was struck by a few findings that they summarized in that report, quoting from various studies about the impact of Medicaid. Here are just a few. A number of these findings relate to Medicaid expansion, which was the expansion of Medicaid that became law when the Affordable Care Act was passed back in 2010, but it is only now, years after Medicaid expansion has gone into effect, that the impact is being felt in a very positive way. For just a couple of highlights here on Medicaid expansion, for example, expansion was associated with lower rates of maternal mortality. In this case, the research was done by the Georgetown University Center for Children and Families. The research also found that States that had expanded Medicaid experienced 1.6 fewer maternal deaths per 100,000 women than States that refused to expand Medicaid. As folks might remember, the law allowed States to expand Medicaid, but a number of States had not taken advantage of that. There is a clear advantage for States that expanded on this indicator for maternal mortality. A second finding, in addition to reducing maternal mortality, is that Medicaid expansion has also been associated with a significant reduction in infant mortality. A study published in the American Journal of Public Health in April of 2018 found that the decline in infant mortality was more than 50 percent greater in States that expanded Medicaid, compared to those that did not. So there is a second finding on infant mortality. Beyond improving health surrounding childbirth, Medicaid expansion improves access to family planning. A University of Michigan study found that one-third of women enrolled in the State of Michigan's expanded Medicaid Program reported that their coverage improved access to birth control and family planning services. Michelle Moniz, a doctor, the study's lead author, concluded that her team's findings ``suggest that the expansion provided an important service for populations with a high unmet need for family planning care.'' So there are just three examples and three different studies, with one validating the benefit of Medicaid expansion to reduce maternal mortality. So fewer pregnant mothers are dying, in the case of one study, because of Medicaid expansion. The second study is talking about reducing infant mortality because of Medicaid expansion, and the third says that, because of Medicaid expansion, there is improving access to family planning. So those are just three examples in three different studies about the benefit of Medicaid expansion. Unfortunately--and it is important to put this on the record--when you see the Republican bills to repeal the Affordable Care Act, every one of them seems to have one thing the common: They don't simply talk about limiting Medicaid expansion. They don't just talk about cutting it back. A number of these proposals that we have debated here--and I guess we only had a vote in the Senate on one--they all have in common that they want to eliminate Medicaid expansion--not just cut it but eliminate it. Somehow, for some reason, and I will never understand this, my Republican colleagues want to get rid of Medicaid expansion. They seem to think it was a bad thing, that it was a bad result for the American people that Medicaid expansion became law and States were able to take advantage of it, increasing the number of people covered by something on the order, at last count, of 12 million people. Why is it a bad thing that 12 million people got healthcare? I will never be able to understand that, as long as I live. Why is it wrong, why is it bad that 12 million more people got healthcare through Medicaid expansion? Is it also then, by extension, a bad thing to reduce maternal mortality? Is that a bad thing as well? Is that a bad result? Is it also a bad result of Medicaid expansion that we were able to show in States that expanded Medicaid that infant mortality goes down? Is that a bad result? Is it a bad result in States that expanded Medicaid, as opposed to States that did not, that in addition to the reduction in maternal mortality and infant mortality, that there was access to family planning? Is that a bad thing as well? I don't think many Americans would reach that conclusion. They would argue, I think, just upon the coverage question, that 12 million people or more getting healthcare is an advancement--that we are all better off when 12 million get healthcare coverage. There seems to be a prevailing point of view here among some that if the guy next to you gets healthcare, somehow that diminishes you. That is contrary to all the evidence, contrary to all the studies about coverage. But in the case of Medicaid expansion, it is not simply that 12 million more Americans got coverage, but now there is empirical data and empirical results that tell us that maternal mortality is likely to go down and infant mortality is likely to go down. That is a good result. That is why, when people talk about cutting Medicaid by a trillion and a half over the next 10 years, or eliminating Medicaid expansion, they have some explaining to do. Now, maybe if they have a study showing that in States that did not expand Medicaid they have a strategy to get infant mortality numbers down and maternal mortality numbers down, let's hear the competing argument. I haven't heard that, though. I am still waiting for it. Here is another good result of Medicaid expansion. It has also proven to be a potent tool for reducing--this is according to the Protect Our Care report from yesterday. Again, I am still quoting from it. Medicaid expansion has proven to be a potent tool for reducing racial disparities in healthcare. Black babies are twice as likely, according to this report, as White babies to be born at low birth weight, and are 1.5 times as likely to be born prematurely. One study published in the Journal of the American Medical Association in April 2019 found that when considering low birthweight babies and preterm birth outcomes overall, Medicaid expansion was associated with significant improvements in relative disparities for Black infants compared with White infants in States that expanded Medicaid versus those that did not--significant improvements in relative disparities. That is a good result we know about now--not a theory, a good result from Medicaid expansion. I will give you another one. This is about opioid use disorder. I have no doubt that the problems we have had all across the country--the epidemic of substance use disorder, a subset of that being the problems with opioid addiction--and all of the horror and misery and skyrocketing deaths from that scourge, that public health emergency--I have no doubt that the concern about that is bipartisan. We have done a lot of bipartisan work here in the Senate to dedicate new dollars-- billions and billions of dollars--to help on that. The only problem is, we need many billions more just to meet the treatment needs of those who are already in that awful grip of an opioid addiction. We have bipartisan concern and bipartisan action. That is good. I want to acknowledge that. But here is the problem: When it comes to Medicaid expansion's role, there seems to be a little disconnect between and among Members of the Senate on that. Here is what Protect Our Care tells us: Multiple studies suggest that Medicaid expansion plays a crucial role in improving access to treatment for opioid use disorder. A February 2018 Center on Budget and Policy Priorities analysis of data from the Federal Agency for Healthcare Research and Quality found that Medicaid expansion dramatically reduced--I will say it again-- dramatically reduced the share of opioid-related hospitalizations in which patients were uninsured, so making sure that more people in the grip of that addiction who present themselves for help actually have insurance coverage. Here is a quotation from the Center on Budget and Policy Priorities study: ``The share of hospitalizations in which the patient was uninsured fell dramatically in states that expanded Medicaid: from 13.4 percent in 2013 (the year before expansion took effect) to just 2.9 percent two years later.'' So it went from roughly 13 percent down to basically just 3 percent. So that is another result. I have to ask the question again. Why is it a bad thing that roughly 12 million people got health insurance through Medicaid expansion? Why is it a bad thing that Medicaid expansion now has a demonstrated track record on reducing infant mortality and maternal mortality and helping begin to bridge a racial disparity between a child who happens to be an African American child versus a child who is not? Why is that a bad thing? Why would you propose, with that track record--and I am only mentioning a few--why would you propose eliminating the program? That seems to be the prevailing point of view in virtually every healthcare bill that is offered on this side of the aisle--to take Medicaid expansion and eliminate it over time. Why would you do that? I could understand better the argument where they said: Well, look, we have a new idea. We have an idea that will reduce infant mortality, maternal mortality, bridge some of those racial gaps, and cover 12 million people with a new program, a new approach. I would listen a little then and maybe consider their ideas. But when you call for the elimination over and over again of a program with that track record in just a couple of years--and this isn't longitudinal data over decades; we know right away the benefits of more people getting coverage, more children getting treatment, and people in the grip of an opioid addiction having insurance and therefore having coverage. In Pennsylvania, there are tens of thousands of people--not thousands, tens of thousands--who are getting treatment for an opioid or substance use disorder condition solely because they happen to live in a State that expanded Medicaid. If they lived in a State that didn't expand it, they would be pretty much on their own when it comes to getting treatment or services for that kind of an addiction. I really have trouble understanding what my colleagues have presented. If you want to introduce a bill to change healthcare, I think it is incumbent upon you to have an alternative, have a better way of covering as many people, have coverage that is affordable, and have a strategy that will accomplish what we have already accomplished through the Affordable Care Act. That number is even bigger. It is the Medicaid expansion number plus folks who get their coverage through the exchanges. That number is above 20 million. So if you have a better proposal, you ought to present it. But they haven't. That is unfortunate because now we are facing the prospect of not just proposals that could pass and be signed into law by this President that would destroy the opportunity for 20 million people to have healthcare, but a big share of that would be cutting Medicaid expansion. The other part that is a direct threat to Medicaid itself is the lawsuit making its way through a Federal court. I have heard a number of my colleagues say: Oh, no, we want to preserve protections for preexisting conditions. We want to preserve most of Medicaid. We want to cut the costs, and we want to preserve it. Well, if you have those goals, if you say you are really for having all those consumer protections from the Affordable Care Act, and if you really care about seniors getting into nursing homes because of Medicaid and you care and you want to preserve that, and you care about kids with disabilities who have their healthcare through Medicaid and you want to preserve their healthcare, and you want to preserve healthcare for kids from low-income families through Medicaid--if you believe all that, you have to oppose the lawsuit. You can't make the argument that you care about those Americans and you care about healthcare and protections and all of that and then say you support the lawsuit. You have to come out against the lawsuit. Make a statement--you should if you are serious about it, if you are honest about it--or maybe file something with the Federal court, maybe a formal filing to say: Here is why I oppose the lawsuit. File a brief. Do something. But at least tell the American people the truth. If you are going to be for preserving these kinds of protections, you can't be for the lawsuit. In fact, you would have to be unalterably opposed to the lawsuit if you really care about those kinds of major healthcare issues, including Medicaid. If you were really concerned about Medicaid and you wanted to preserve most of it and you had ideas about how to change it for the better, you can't support the sabotage by the administration because the effect in a number of these States with these waivers is that people lose their Medicaid coverage--as I said, we now know that in 2018, 18,000 people in Arkansas lost coverage. That will be replicated in other States. Tennessee now is one of the States considering a block-grant proposal. Utah--I mentioned what they are doing--tying Medicaid to the State budget, instead of covering folks who are eligible as opposed to tying coverage and care to how much money is in the State budget. I think that if you are going to make an argument in favor of Medicaid, you have to oppose the lawsuit and you have to stop the sabotage. The third thing you can do to be honest about what you say you believe in--and constructive here--is to say we shouldn't cut Medicaid by $1.5 trillion over the next 10 years, as the administration proposed. Just say you are against what the administration proposed and you don't think we should cut it by $1.5 trillion. And you should add your opposition to the cuts to Medicare. The administration proposal is to cut Medicare by $845 billion over 10 years. You should oppose that as well. If you do that--if you oppose the sabotage, oppose the lawsuit, and oppose the budget cuts--then we can have a conversation about lowering the cost of healthcare, lowering the cost of prescription drugs, and preserving Medicaid as much as humanly possible even when costs go up. It is pretty apparent to me that a lot of Americans rely upon Medicaid. How about if you represent a State, for example, that has a substantial rural population? I represent the State of Pennsylvania, which has 67 counties, but 48 of them are considered rural. We have a lot of rural communities, a lot of counties where there may not be agriculture in every corner, but there are a lot of small towns and a lot of rural communities, and they tend to be one and the same. These are communities that are faced with several levels of challenges. They often have job loss because a substantial employer has left. They often have infrastructure problems because they have a lot of bridges that are structurally deficient. They have all kinds of other economic challenges that sometimes relate to the markets and agriculture and so many other problems. Many of these communities also have a so-called digital divide--they are living in a county where 40, 50, 60 percent of the people who live in that county don't have access to broadband, high-speed internet. In addition to all those problems in some rural areas, they also have a problem with healthcare access. The good news here is that there are a lot of kids in rural areas who get their healthcare through--guess what--Medicaid. Big numbers. In some places, the numbers of children covered by Medicaid and the Children's Health Insurance Program are much higher than in urban areas. In a rural area, if you start cutting Medicaid and eliminating Medicaid expansion, as many around here want to do, you are not only going to hurt a child in an urban community or in a small town, but you are also going to hurt a child in a rural community very badly. It gets worse from there. If you cut Medicaid, rural hospitals that are already on the brink of failure or bankruptcy or at least downturn in their ability to balance their budgets--a lot of those rural hospitals will fail. We know that. The data is pretty clear on that. If all of your focus is on a rural area and you think rural children should have the chance for good-quality healthcare, and if you think rural hospitals--sometimes the biggest employers in a community--should remain open, you should really care about Medicaid. You should really be worried about proposals to cut it by $1.5 trillion over a decade, as the administration proposes. You should be very concerned about proposals to eliminate Medicaid expansion because guess what is another challenge in a lot of these communities--the opioid substance use disorder crisis. My colleagues are here, and I want to make sure they have an opportunity to weigh in as well. We are privileged to be joined by two colleagues. I yield the floor to my colleague from the State of Oregon, the senior Senator from the State of Oregon.

Mr. CASEY

Mr. CASEY. Mr. President, this week marks the 10th anniversary of the end of Sri Lanka's decades-long civil war. On May 19, 2009, Sri Lanka's 26-year conflict between the Liberation Tigers of Tamil Eelam, LTTE, and the government of Sri Lanka came to a close with the LTTE's military defeat and surrender. This anniversary comes on the heels of the horrible Easter Sunday terrorist attacks on churches across Sri Lanka for which we are still seeking answers and accountability from ISIS and its affiliates on the island. While the end of the war was a counterterrorism victory, we have since learned the ugly cost of this effort. According to International Crisis Group, in the final months of Sri Lanka's civil war, Sri Lankan Government ``attacks on its own self-declared `no-fire zones' killed tens of thousands of [Tamil] civilians . . . claims range from 7,000 to 147,000 dead.'' For several years, I have been calling for an international, independent mechanism to investigate allegations of war crimes and crimes against humanity committed during the Sri Lankan conflict. I also remain concerned about recent violations of human rights and religious freedom in that country. Since the end of the war, there has yet to be real progress made on reconciliation and accountability for Tamils through domestic processes, as recommended by the UN High Commissioner for Human Rights 2015 Investigation on Sri Lanka, OISL. Human rights violations against Tamil, Christian, and Muslim minorities continue, and the Sri Lankan Government has failed to bring to justice the perpetrators of attacks against journalists, religious, and ethnic minorities and opposition politicians. Sri Lanka has a long way to go on its path to reconciliation. In addition to pursuing meaningful justice and accountability, the Sri Lankan Government must implement comprehensive security sector reform, fully operationalize the Office of Missing Persons to provide families with answers on what happened to their loved ones, repeal the controversial Prevention of Terrorism Act, PTA, release political prisoners as called for by our own State Department and required by fiscal year 2019 Appropriations bill and address the root causes of the civil war and the government's responsibility to protect citizens of all communities. Concerns over intercommunal strife are exacerbated by the horrific April 21 Easter attacks on churches and hotels across the island that killed over 200 civilians. We are learning that ISIS-affiliated entities were behind the attacks. As Sri Lanka deals with the very new threat of Islamic extremism, it is critical that its government not repeat its pattern of suppressing media, civil society, and religious freedom under the veil of counterterrorism. The government's abuse of emergency powers, recent ban on Muslim face-covers, coupled with retaliatory attacks against mosques and Muslim businesses with little response from Sri Lanka law enforcement is problematic and only serves to heighten tensions between religious and ethnic communities. I urge the Sri Lankan security forces to exercise restraint in their response to the Easter attacks. While horrific on their own, the Easter attacks were a stark reminder that, as we come upon the 10th anniversary of the end of Sri Lanka's civil war, intercommunal conflict remains a reality on the island. The Sri Lankan Government's response to the Easter attacks echoes of the country's history of conflict and oppression under cover of counterterrorism. As we remember and commemorate the tens of thousands of lives lost leading up to May 2009, I urge Sri Lanka, the United States and the international community to continue to pursue justice, accountability, and reconciliation for a war-torn nation.