Bob Casey

Mr. CASEY

Mr. CASEY. Thank you

Mr. CASEY

Mr. CASEY. Mr. President, I rise to speak about the nomination of Judge Amy Coney Barrett to be an Associate Justice on the U.S. Supreme Court. That has been the subject of, I know, a number of floor remarks tonight and this morning. We know that in terms of the history of the nomination at this time before an election, no person has ever been confirmed this close--just days away from a Presidential election--and no election, of course, has had so many votes cast this early. Fifty-nine million is the last number I saw a couple of hours ago. And this is all happening--this rushed confirmation process--while people are voting, all while Republicans here in the Senate are ramming a nomination through and not voting on a COVID-19 relief bill, which should be the subject of our work at this time, in my judgment, because of the nature of the pandemic, the threat that it still poses, and the relief that is needed all across the country. But as much as we focus, in this Supreme Court Justice nomination debate, on this judge from the Seventh Circuit Court of Appeals, ultimately, it is really, in the end, not about her nomination; in the end, it is about real people's lives, especially as to how the Supreme Court will impact those lives, those families, when it comes to the Patient Protection and Affordable Care Act. That will be the focus of my remarks this morning. This is a debate about people, and I will talk about a few people from Pennsylvania in my time here on the floor, people like Erin Gabriel, who is from Beaver County, PA, right on the Ohio border, way out in the western part of our State. It is about Erin and her 11-year- old daughter Abby, as well as Shannon Striner. Shannon is from Pittsburgh, just a little south of where Erin is from. I will be talking about Shannon and her 4-year-old daughter, but I will start with Erin Gabriel's daughter Abby. I will use this photograph to tell everyone who Abby is. Abby is this child in the middle. She is in this picture with her brother and sister. Here is what Erin Gabriel said about her daughter. She said: My youngest daughter Abby just celebrated her 11th birthday last Saturday. This is just in the month of October, this month. That was something that was never promised to us. Abby is growing up in her community with her family and friends. Normally, she enjoys shopping, going to the movies, Disney on Ice. She travels. She swims at a local lake, and she snuggles with her dog at home, and she rides all the rides at Idlewild-- Which is a local amusement park-- Abby is autistic, deaf, blind, nonverbal, and has a rare progressive neurological syndrome affecting multiple organ systems, with a long list of life-threatening symptoms that we are all still trying to learn more about. Medically, Abby has to go through a lot. She sees multiple specialists in Pittsburgh, Cleveland, and Boston. She is undergoing blood work to monitor her anemia and to watch for signs of leukemia. She has regular EEGs and MRIs to monitor the progress of her seizures. She uses hearing aids and glasses and a wheelchair and a speech-generating device. She relies on protections for people with preexisting conditions, and she relies on the ban on lifetime caps to access this care. Without the Affordable Care Act, Abby would be uninsurable. Then Erin goes on to talk about the benefit of living in Pennsylvania because of some extra protections that Abby has. Then she continues: Because she receives this care, Abby is right now healthy, happy, and thriving. As you might expect, Abby is considered very high risk should she contract COVID-19. Abby has not been inside any building that is not our home or a hospital since March 10 of this year. Summer vacations, play dates, outings, travel plans to visit grandparents--they have all been canceled. This fall, we pulled Abby out of her school--a place that had become community to her over the last 8 years--to homeschool her. She, like many children with disabilities, simply cannot access a virtual education, and it is not safe to send her back into a school building while this virus is spreading. But Abby misses her school and her friends. Normally, ongoing speech, occupational, and physical therapy help Abby to keep the progress she has made learning to walk, to eat, swallow, and to communicate. But with COVID- 19, they have all come to a halt. It is just not safe, and it has also provided us a window into what her world looks like without access to these therapies. So that is just part of Abby's story, as told to us by her mom. As I made reference to in the statement of her mom, Erin wrote that Abby would be ``uninsurable'' without the ACA. I have to ask: Are we really going to say, again, that children like Abby are uninsurable? Are we going to allow that to happen in America? Is that the intent of this whole exercise, the exercise that has played out over years now--years--of repeal efforts? All of them so far have failed, so the second strategy was to run cases up through the judicial system, to get to the Supreme Court, and then, ultimately, to stack the Court with rightwing justices who could then strike down the Affordable Care Act. That is what we are heading toward right now. Is that America? Is that the America we want--where we advance healthcare to make sure families like Erin's and her daughter Abby have all the protection, all the coverage that she needs--after all the progress that has been made, instead of coming together and saying that we are going to make improvements to our healthcare system but we are going to grow the number of people who are covered and we are going to ensure that any child like Abby has the protections that she needs, that her family should have a right to expect in the United States of America, the most powerful, the wealthiest country in the history of the world? Erin went on to say that, because she receives this care, the care she is getting now--largely because of the Affordable Care Act, not to mention Medicaid: ``Largely because she receives this care, Abby is healthy, happy, and thriving.'' So I have to ask: What does justice demand here? St. Augustine said hundreds of years ago: ``Without justice, what are kingdoms but great bands of robbers.'' So any government--certainly our government--that makes it possible for a child to have those protections, those programs, those services, the therapies--and I could go on--and then takes an action that could result--and if this law is struck down by the Supreme Court will result--in those benefits and protections either to have been taken away or to be threatened or undermined or compromised or limited--any government which does that is robbing that family of justice. I mentioned earlier that Shannon's daughter Sienna is another example of what we are talking about here. Here is what Shannon says about Sienna, her 4-year-old daughter with Down syndrome. She says: Sienna is a remarkable little girl that loves life. She is a smiley, energetic, empathetic ray of sunshine. Her favorite activity is spending time with her big sister, whom she adores. If we let her, she would watch Sesame Street all day. Elmo is a way of life in our house. She loves music, books, therapy, and playing outside. She is mischievous, funny, and beautiful. She has the ability to bring smiles to our family on the worst of days. We wouldn't change one thing about her. Sienna happens to have an extra copy of her 21st chromosome, also known as trisomy 21 or Down syndrome. Sienna's diagnosis came as a surprise to us. After enduring four miscarriages, she was our miracle baby. Our miracle baby surprised us on the day of her birth with her diagnosis and a heart condition. We were completely unprepared to raise a child with a disability. After I delivered her, a kind nurse explained to me how lucky we were to have Sienna here in Pennsylvania after passage of the Affordable Care Act. Then she went on to talk about how Pennsylvania had some benefits in Medicaid. And then Shannon continues: As I entered this new world of early intervention, therapies, and medical needs, I began to realize just how much of a financial toll this would take on all of us if it weren't for the protections of the ACA and Medicaid: custom orthotics, outpatient weekly therapies, overnight hospital stays, adaptive strollers, walkers, safety sleepers, echocardiograms, communication devices, blood work. The list goes on. Sienna receives seven weekly therapies. The cost of those alone are $3,400 per week. Without the ACA, her therapies and medical care would have quickly exceeded the lifetime cap, and Sienna would be uninsurable for the rest of her life and left without access to lifesaving care. Shannon goes on: I am proud to be Sienna's mom. The journey is full of wonder, joy, and unimaginable love. It changes life's most ordinary moments into the extraordinary. But with constant attacks on our healthcare, it is also agonizing work, hard decisions, and constant advocacy. It gets exhausting fighting for your child, having to prove their value to the world. Then she goes on at the very end: Once again, we as parents are forced to suit up for battle and prove that our children are worthy of healthcare. Her last line of this statement is: Everyone loses if our children are unable to reach their fullest potential. So that is Shannon talking about Sienna, her daughter. She used that same word that Erin used. Different stories, similar burdens, but she used that same word that Erin used--``uninsurable''--uninsurable if the Affordable Care Act is taken away. She talks about life with the Affordable Care Act and without it. That is what a lot of parents do when they write to us. They tell us what their life was like before the Affordable Care Act and what their life is like now--and what their life would return to, those dark days when an insurance company could make a determination about a child's insurance, their coverage, their treatment--frankly, their life Then, toward the end, she talks about what she and other parents feel under these constant attacks, having to prove their value, the value of their child: We as parents are forced to suit up for battle--suit up for battle--and prove that our children are worthy of healthcare. I am going to ask the same question again: In America? In America, that is what we want to do--have this constant battle? Parents have to come here, to the U.S. Senate and to the House? The organization that this mom is a part of is called Little Lobbyists. This is a group for and because of the battles on healthcare. Why the hell is this going on in America? Why should we be fighting about progress that has been made? Why aren't we talking about improvements, getting the cost of healthcare down, getting the cost of prescription drugs down? Let's make improvements. Why do these parents have to continually battle to ensure that their children have this kind of protection? Should mothers really have to suit up for battle in the United States of America, where the powerful get their way all the time in this place? They are different kinds of lobbyists that come in. They are not Little Lobbyists. They are not mothers and their sons and daughters. They are a different kind of lobbyist. Corporations did really well in the tax bill of 2017, a bill that was rammed through between Thanksgiving and Christmas. What did they get? Well, they got about a 14-point reduction in their corporate tax rate--permanent tax relief, jacked up the debt to do it-- because they have power. I thought that was--when you compare that action that the Senate took at the time to what some in the Senate want to do on healthcare, to roll back the protections, to rip away protections for these children-- and I am not even talking tonight about the adults who are impacted. But when you compare those two actions, it is really perverse and disgusting that the powerful get to come in here and get permanent tax relief and get a bonanza the likes of which we haven't seen in modern American history. And all these parents are asking us to do is preserve what we have. They are not asking for anything more. They are just saying: Please make sure my child doesn't lose their coverage. Please make sure that they have the therapies they need when they have these complex medical needs, multiple disabilities--not one, in many cases, but multiple. That is all they are asking us to do. That is why it is such an important matter in the Supreme Court fight because you have to ask: Why the rush to get this nominee through by election day? That has never happened before this close to an election. Well, I will tell you why. This nominee is being fast-tracked, first of all, because this nominee has been vetted by the two groups that matter--the Federalist Society and the Heritage Foundation--both groups totally committed to undoing, striking down the Affordable Care Act. So she has already passed that test, and she apparently passed with flying colors, as she moves very quickly to a likely confirmation. But why the fast-track to get there in a matter of days? What is coming up? Is it election day? No. There is a date after the election; it is November 10. That is the argument date. They know that, if she is not on the Supreme Court, if she is not confirmed as a member of the Court by the argument, November 10, she can't participate in the decision. What is the decision? The decision to strike down the Affordable Care Act. That is what it is--the decision that really is the proxy for what did not happen on the floor of the U.S. Senate in July of 2017. When the repeal effort failed and when it failed multiple times in the House over many years, this is the proxy for it. Litigate it, fund it, and run that case right up the chain to the Supreme Court. So that is what this is about. They want to make sure that she is on the Court and at the argument so she can be the deciding vote on the Affordable Care Act. That is why we are rushing. How about another healthcare issue? How about Medicare? I mentioned Medicaid. How about Medicare, the program that used to have bipartisan support all across the board? Now, Judge Barrett was asked a direct question about Medicare, and she didn't want to give an opinion on Medicare. She was asked it in the context of the constitutionality of Medicare. And a member of the Judiciary Committee, Senator Feinstein, asked her because she referenced a law review article questioning the constitutionality of Medicare. I think that is a loopy theory. I think that is a theory that most Americans--probably 90 percent of Americans--don't agree with, questioning the constitutionality of Medicare, passed more than 50 years ago. It has benefited tens and tens and tens of millions of Americans and still today benefits numbers like that--45 million, roughly, I think it is. I understand why the judge doesn't want to say: Well, in this case that is before the Court or this case that is unsettled, I might have a--I can't give you a determination. But on Medicare couldn't she have at least said--instead of mentioning, as she did in her answer, the law professor's name twice who has this loopy theory on Medicare constitutionality, couldn't she have said simply: Well, I can't tell you how I am going to rule on a Medicare case, but I can tell you that, just like Brown v. Board of Education is a superprecedent in a judicial sense, I think most people would agree that Medicare is a superprecedent in a legislative sense. She wouldn't have violated any principle of not telling how you are going to come down in a case. She could just tell us or relate to us the reality that most Americans believe about Medicare. Now, I know there has been some commentary about her law review article that--or I should say her writings about the 2012 Supreme Court case. We know that the case she was referring to was a 2012 case. So, in 2017, Judge Barrett wrote an article about what Chief Justice Roberts ruled in the case. She wrote: ``Chief Justice Roberts pushed the Affordable Care Act beyond its plausible meaning to save the statute.'' In light of her frequent criticism of the act, the Affordable Care Act, Senator Leahy of Vermont asked her during her confirmation hearing whether she had ever written or spoken in favor of the law. She has not. So that is what she was writing in 2017. I have to ask: If she felt so strongly about the 2012 decision by the Court and the position of Justice Roberts, she didn't seem to write much about it for a couple years--until 2017, when you had a new President. And what followed a few months later was she was nominated in the circuit court of appeals. So that is curious. But what we know is that the President who nominated her, President Trump, certainly wants to strike down the Affordable Care Act. In fact, in May he said he wanted to ``terminate healthcare'' under the Affordable Care Act. We know the impact of that. That destruction, the act of striking down the Affordable Care Act, would harm tens of millions of Americans. In Pennsylvania, 5\1/2\ million people with a preexisting condition would be affected. Over 840,000 Pennsylvanians who are enrolled in Medicaid expansion would be, of course, adversely impacted. So that is the reality of what we are talking about with regard to this nomination. I will make reference to one more family before I conclude my remarks. It is the Kovacs family from--also from Western Pennsylvania, Plum Borough, PA, in Allegheny County, not too far from Pittsburgh. The Kovacs' 11-year-old son Thomas is blind and has multiple disabilities. He has epilepsy, microencephaly, and intellectual disabilities. His mom, Jessica, says the Affordable Care Act has made all of their lives better: ``The ACA has made it possible for Thomas to receive therapy services at his school, Center Elementary School in Plum Borough.'' The ACA has given his parents the option to change jobs and advance in their careers without fear of not being able to obtain health coverage for him because of his preexisting conditions. And they don't need to worry about busting through lifetime expense caps and losing coverage for Thomas. The ACA has brought peace of mind and comfort to their family because they know that he is protected by the essential healthcare benefits the law provides. Striking down the ACA isn't only about the essential health benefits. It is about a lot more than that. There is so much more that I could talk about tonight, so many more examples, but I will conclude with that and just make one final comment. When I think about what could happen and what is likely to happen if Judge Barrett is confirmed and becomes a member of the Court, participates in the argument on November 10, and then because of that participation is allowed to, as a member of the Court, to rule on this ACA case, it is highly likely that the Affordable Care Act will be wiped out. I have to ask about the fate of Abby and Sienna and so many other children like them all across our Commonwealth and all across the country. I think often in government we must ask, here in the U.S. Senate or in the House or in the other branch of government--the judicial branch or in any branch of government, the executive, legislative, or judicial branches--we should all ask ourselves, Is this action I am taking or is this policy or program advancing the cause of justice or not? I would submit that striking down the Patient Protection and Affordable Care Act by virtue of a Supreme Court decision is not only the wrong policy, it is a giant step backwards in the interests of justice. Justice demands that these children have these protections; that these protections are not undermined, they are not compromised, and they are not taken away by judicial fiat. This nomination threatens the healthcare of children like Abby and Sienna right now--right now in the United States of America, where we advanced into the light of protection for those children. When you consider what is at stake right now, it is that case. I think it is potentially the most important case the Court will decide in the next quarter century. That is the impact of it. Very few Americans are not directly affected by this case, either because they are affected by way of loss of coverage or they are affected because of the scope of the protections that were brought about by the passage of the Affordable Care Act, the enactment of it. A lot is at stake, not to mention so many other issues and so many other matters that will come before the Court. For that reason and several others, I will be voting against the nomination of Judge Barrett to be on the Supreme Court. If I have an opportunity between now and the vote, I will outline some other reasons why. But for purposes of tonight, this morning, I wanted to talk about children like Abby and Sienna and their moms. The moms, Erin and Shannon, should have the peace of mind that has come with the protections of the Affordable Care Act. With that, I will yield the floor.

Mr. CASEY

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

Mr. CASEY

Mr. CASEY. Mr. President, I want to start tonight by just making a few remarks regarding what is ahead of us in the next few days, and that is the debate about a Supreme Court Justice. I won't be able to cover everything tonight that I want to cover, but I will just make some preliminary comments about healthcare, which has been the driving debate in this nomination or at least the issue that has dominated the debate so far. We made, in my judgment, great progress in 2010, when the Patient Protection and Affordable Care Act was passed. Some refer to that statute as ObamaCare, which isn't really the name of the statute and doesn't adequately describe what it is about. The patient protection part of the act--or the name of the statute--is the part that I think involves most Americans, all the coverages that are provided, all the protections, I should say, that are provided. One example of that, of course, is the protection for preexisting conditions. The state of the law prior to that was if an insurance company did not want to cover someone because of a preexisting condition, they had the authority to do that or they could cover the person but charge them more. That is no longer permitted, and in a State like Pennsylvania, that number--the number of people who are protected by that provision of the law because they have a preexisting condition--that number is 5.5 million people. Nationally, it is as high as 135 million. So we know what is at stake in the debate, and it just so happens in this context that it is part of the debate about the Supreme Court nominee, Judge Barrett. I have a threshold, initial concern that is even before we get to the debate about the Affordable Care Act and what might happen to it by virtue of the lawsuit filed that is now before the Court with an argument date of November 10. I think that is the primary reason for the rush of her nomination--so that she can be a member of the Court for that argument on November 10 and make that decision, which I think is highly likely to be a decision against upholding the constitutionality of the Patient Protection and Affordable Care Act. The threshold concern I have, though, is just the way this process has unfolded, not just more recently but over time. The President, when he was a candidate, said he would choose from a list that was developed basically by two groups: the Federalist Society and the Heritage Foundation. They came up with a list, and that is the list he said he would choose from. That list was expanded when he became President. Judge Barrett was on that list, Justice Kavanaugh, Justice Gorsuch-- you can see the pattern there. I don't want a Supreme Court that is chosen by those two groups, but, so far, that is what the President has decided to do. In this case, the rush is, I think, for that basic reason, that the majority party here and Republicans in the House and a Republican President want this statute struck down. They want to have that majority, a six-to-three majority, to do that. But I guess, as much as I can talk, as we all do, about some of the policy--and I will--and the numbers, I think the most compelling parts of this debate are the stories that come from people across Pennsylvania and across the country who have come to us. I met some of these families about 10 years ago when we were debating the act then. I met them again when we were trying to stop the repeal in 2017 and 2018, and now we are getting together again because of this new and, I think, mortal threat to the law. I will just mention two for tonight--Erin and Shannon. Erin, I know better; I have met her over the years--Erin Gabriel. She has been very public about the fight that she is waging on behalf of her three children with disabilities: Collin, Bridget, and Abby. I have heard a good bit about each of them and maybe the most about Abby. Erin is from Beaver County, PA, right on the Ohio border, just north of Pittsburgh, and she is very concerned about what happens to her children because of their disabilities. Of course, under the old law-- the old way of approaching these issues--a child with a disability could be denied coverage because of a preexisting condition, and, also, a corresponding or related concern is the threat to Medicaid itself, especially in budget debates here over time, and Medicaid expansion. Erin Gabriel is one of the people who has made very clear to us the adverse impact on the life of her children that could result if the statute is overturned and declared unconstitutional. A second person who has brought her story to our attention is Shannon Striner. Shannon is a mom to two daughters: Haley and Sienna. Haley is actually a second grader now, and Sienna is a young girl with Down syndrome. Obviously, Sienna is a child who is going to need a lot of care, and we have to make sure that our healthcare system is there to meet the needs of those families. We are going to be talking more about these challenges that these families face, but for the life of me, I will never be able to understand--if I lived 1,000 years, I will never be able to understand why we would ever go backward on healthcare. Why would we go back to a time when a child or an adult who has a preexisting condition would be denied coverage? Why would we go back and erase by virtue of, in this case, what would be a judicial fiat all the progress that has been made because of the Affordable Care Act? So many more people have the security of healthcare. In my home State, it is 1 million people who gained coverage. The number now nationally is about 23 million. That number keeps going up. Most of them are getting their healthcare through the expansion of Medicaid. The number on that keeps growing. Part of the reason it is growing is because people lost their insurance as a result of the adverse impact of COVID-19--people losing their jobs and turning to programs like Medicaid for coverage. So that number keeps going up. In the State of Pennsylvania, just by way of example, the latest number is 840,781 Pennsylvanians who have benefited from Medicaid expansion. The benefit of it is one of the reasons you have States that are not controlled by Democrats that are voting to expand coverage. So that number keeps going up. I want to make sure that we take every step necessary to protect coverage, not just to uphold a statute and to, frankly, grow the number of people with healthcare but to remember the impact it has on people's lives and ensure that the people who gain coverage don't lose it. We have a State--as the Presiding Officer knows because of his family's roots--we have a State of a few big cities, but mostly it is a State of a lot of small towns. We have 48 rural counties out of 67, and in those small towns or rural communities, we have a lot of people who have gained coverage because of the expansion of Medicaid. As I said, you can see the number: 840,000 out of about 1 million who gained coverage--gained coverage through Medicaid expansion, so that is a big number. And even in a small county like Cameron County, one of our smallest--it might be the smallest county in population--there are 350 people in that county who got Medicaid expansion. I want to make sure all 350 or more can benefit from Medicaid expansion. Big cities like Philadelphia have bigger numbers, obviously. When I look at my home county, Lackawanna County, and look at the next county next to it, the largest population county in the region, Luzerne County, these are huge numbers of people who have gained coverage on Medicaid expansion. In Lackawanna, it is more than 17,180 people and more than 26,000 in Luzerne County. Now, that is not accounting for the folks who got coverage because of the exchanges that were set up. So the balance of those folks in Pennsylvania who got coverage, between 840 and 1 million, got their coverage because of the exchanges that were set up by the Affordable Care Act. One last point before I move to a second topic: Here are some of the benefits of Medicaid expansion that don't get a lot of attention but should warrant attention. I will just give you one example in 1 year from one State. In 2019, in Pennsylvania, over 135,000 people were able to receive treatment for substance use disorder because they were covered through Medicaid expansion. Now, most people may not think of that longer category or that long phrase, ``substance use disorder,'' but a subcategory to that and one of the largest parts of that challenge for many families and many communities is the opioid crisis. So that means tens of thousands of Pennsylvanians were getting covered by Medicaid expansion and treatment therefrom just at the time the opioid crisis was on the rise and causing death and devastation to so many families and so many communities. So that is one benefit to the program that doesn't get a lot of attention. We know that on the larger question of the Affordable Care Act itself, beyond Medicaid expansion and the exchanges, is the so-called prescription drug doughnut hole, that coverage gap where the older Pennsylvanian, at some point in the availability of prescription medications, has to pay for a while before they get into a catastrophic category where the Federal Government and the Medicare Program can pick up the cost. But in that coverage gap--and ``doughnut hole'' is a very benign way of describing a very burdensome problem for a lot of seniors--if that were to go away, if the Affordable Care Act were declared unconstitutional and that doughnut hole coverage or the filling of the gap, so to speak, were not there the next year or the year after or 5 years or 10 years from now, that could adversely impact hundreds of thousands of Pennsylvanians. By one estimate, more than 293,000 people on Medicare would be forced to pay more for their prescription drugs. So that is a lot on the line when it comes to the Affordable Care Act, and that is why this nomination is of such great consequence for one big issue. I think the Affordable Care Act Supreme Court decision will be the most significant decision that this Court will decide maybe for 25 years because of the scope of the impact. Even someone who is not threatened directly by the loss of coverage, the loss of protection for a preexisting condition, or even someone who can buy because of their wealth or their circumstances--that person will also be affected because premiums will likely skyrocket. So there are very few, if any, Americans not affected by this lawsuit that will utterly destroy the Affordable Care Act.

Mr. CASEY

Mr. CASEY. Mr. President, I want to thank my colleague from Michigan for outlining the stakes for the American people. I will start tonight with the two principle reasons we gather tonight on the Senate floor. We gather on this floor tonight to reflect upon the life of Ruth Bader Ginsburg, to pay tribute to her life of public service and to outline, as so many of our colleagues have outlined tonight, what is at stake for American families in a debate about the next Supreme Court Justice. Let me start with the life of Ruth Bader Ginsburg. Nothing we could say tonight would do justice to her story, but her story is an American story. It is a story of hard work and struggle, a story of overcoming discrimination--discrimination that I and so many others have never faced. It is also a story of knocking down barriers for women, a story of defending workers fiercely, a story of defending voting rights, and so much more that we will talk about in the next number of days. It is also a very human story, as much as it is an American story. It is a human story about her heroic battles--plural--many battles with cancer, at least two kinds of cancer, over the course of 20 years. This struggle, this heroic struggle, this battle helped to transform Ruth Bader Ginsburg--then Justice Ruth Bader Ginsburg--into an American icon and an inspiration to millions of Americans. We mourn her passing, and we will, in the days ahead, continue to laud her extraordinary accomplishments, her achievements as a lawyer and a Federal appeals court judge and, of course, her 27 years as an Associate Justice on the U.S. Supreme Court. At the same time as we pay tribute to her, we have, I believe, an obligation to make it clear what is at stake, what is on the line for tens of millions of Americans. I will focus on one subject area tonight, healthcare. We know that after failing to repeal the Patient Protection and Affordable Care Act numerous times--and ``numerous'' is an understatement--after failing that many times, Senate Republicans, along with the President, will try now to ram through a Supreme Court nomination that could, and very likely will, be the deciding vote to destroy the Affordable Care Act and all of its protections. I will not dwell tonight on the blatant hypocrisy of this action. I will talk mostly about healthcare. But the hypocrisy, I think, is well known all these days, since Justice Ginsburg's passing, by so many Republicans who said just 4 years ago that it was the wrong thing to do, even within 10 months in a Presidential election year, to confirm a new Justice. But here we are, and that same party, those same Senators, on tape over and over saying that they would not do this, are here trying to ram through another nomination. By the way, when you consider the last number of months--the months of May, June, July, and August--this body, the U.S. Senate, did little else but nomination after nomination and a defense bill and little else. There was no action, no substantial action on a COVID-19 relief bill despite the challenges our Nation faces. I guess nominations is all we are supposed to do in the Senate. Here we go again on the most consequential nomination that a Senate could consider. We know that the U.S. Supreme Court has a case before it that will be argued in early November that could be the end of the Affordable Care Act. In May, President Trump laid out in no uncertain terms what he wants to do to this healthcare law: ``We want to terminate healthcare under ObamaCare.'' Terminate healthcare is his goal--in the middle of the worst public legal crisis in 100 years, a worldwide pandemic that we are still suffering the effects of. We just crossed the 200,000 death total just hours ago or a few days ago at the most, 8,000 of those in Pennsylvania. At a time when so many families have been devastated either by the virus and the suffering that comes with contracting the virus or a death in the family--family members, deaths of friends and people who folks have worked with--in the midst of an economic crisis, a jobs crisis, in the midst of all that, we are supposed to go along with a process to ram through a new Supreme Court Justice and take no substantial action on a COVID relief bill. So much is at stake in the Affordable Care Act. I will try to go through a long list as fast as I can. We know that more than 20 million could lose coverage who gained coverage as a result of that act. We know that 135 million would lose their protections for a preexisting condition. In Pennsylvania, those numbers translate into 1.1 and 5.5-- 1.1 million people gained coverage, although that number is down now because of Republican efforts over the last couple of years here in Washington. But 1.1 million gained coverage, and there are 5.5 million in the State with a preexisting condition. If you go down the list of counties, which I will not do all 67 tonight, but I just want to give you some sense of what it means by county. In terms of Pennsylvanians who gained coverage, you would expect that the big cities had a lot of coverage gains. That is true. At last count, Philadelphia had 225,000 people who gained coverage. But if you go from Philly to Fulton--Fulton County happens to be a small county of 14,000 people on the Pennsylvania-Maryland border. They have more than 1,000 people at last count, 1,028 people who got healthcare through the Affordable Care Act. From Pike County to Greene County, thousands of people gained healthcare. From Chester County to Crawford County--Chester is in the southeast, and Crawford is way up in the northwest, just south of Erie--29,000 people or almost 30,000 in Chester and in Crawford County, more than 6,200. In my home county of Lackawanna, almost 20,000 people got healthcare. In Luzerne County next door, almost 30,000. Just in those two counties, almost 50,000 people got healthcare. All of that is at risk in Pennsylvania and in countless numbers of counties all across our country. Medicaid expansion, which has enabled people to gain access to treatment for an opioid addiction or other substance use disorder issues, would be destroyed. Medicaid expansion would be gone. Medicaid expansion also ensured women can receive a full year of postpartum care and provided coverage for older Americans who are not yet eligible for Medicare. Prescription drug costs would skyrocket for 12 million seniors and people with disabilities. That is because the ACA closed Medicaid's dreaded prescription drug donut hole. The ACA closed the donut hole. As I indicated earlier, for 135 million Americans with preexisting conditions, their coverage is now in jeopardy if the Supreme Court decision went the wrong way. Insurers would be able to drop them. Insurers will be able to refuse to cover them or insurance companies will be able to charge them more because of common diagnoses like depression, anxiety, asthma, diabetes, sleep apnea, and the list goes on from there--all the things the insurance companies were able to do for at least a generation or more in the dark days before we had an Affordable Care Act. Insurers would also be able to charge you more because you are a woman, allowed prior to the ACA, or they could charge you more because of your age. That also will come back. Insurers will be able to reinstate the annual lifetime caps on coverage that they provide. If your healthcare is too expensive, the insurance companies could just stop paying for it, even if you are a preemie, a tiny little baby in the NICU, or an adult with a terminal diagnosis. The essential health benefits would also go away. Insurers will be able to carve out benefits you need, like maternity care or mental healthcare. As a woman, you might not be able to find a plan to provide care during your pregnancy, unless you have insurance through your employer. For people with disabilities, the ACA is obviously essential. A Court that would destroy the ACA would allow for discrimination against the 61 million Americans with disabilities--let me say that again--the 61 million Americans with disabilities that have preexisting conditions. Prior to the ACA, it was routine that people with disabilities could not get health insurance. Prior to the ACA, if you had epilepsy, autism, or spina bifida, or any disability, you could be denied coverage. You could be charged much higher costs. A Court that strikes down the ACA will be a Court that directly attacks the disability community. That is why so many members of that community came to Washington in 2017 and fought valiantly to uphold the Affordable Care Act. They knew that their life was on the line. It wasn't just an issue for them. Their life was on the line. Prior to the ACA, there are stories I heard from Pennsylvanians every day--and I am sure so many other Senators did, as well--stories about people who, in addition to living with disabilities or facing a serious illness or other medical needs, were worried about paying their bills. For so many families, this isn't an issue that we are going to be debating in Washington--some far-off, abstract issue. This is real life for people. Mothers and fathers will be worried that their children will not have the coverage they need, that their family will not be covered--worries that, if they have not been eliminated, have been greatly mitigated by the coverage and the protections of the Patient Protection and Affordable Care Act. We have to ask ourselves a question as the Court considers this case just a few days after election day. We have to ask ourselves a number of questions, but certainly we should ask ourselves: Will the United States of America turn the clock back on insurance, turn the clock back on healthcare for so many millions of Americans? Will we allow the Federal Government, either through the Congress, which so far we have prevented, or through the Supreme Court or any Federal court--will we allow a Federal Government entity to rob people of the protections that they received through the Affordable Care Act, like protections for a preexisting condition? Will we allow all of this in the middle of a pandemic, the worst public health crisis in a century here in America and around the world? Will we allow any agency or any official to turn back the clock on healthcare in the middle of a jobs crisis? We have had double-digit unemployment in Pennsylvania for months now. They are the highest unemployment rates we have seen since 1983, and for a period of time this summer, they had been the highest unemployment rates we had seen in more than 50 years. We have a jobs crisis in the middle of a pandemic, which has caused a lot of people to already lose their healthcare. That is not who we are if we say we are American. America at its best is the country that is already trying to make progress, trying to expand protections. We have done that for generations. We made an advancement in 2010 when we passed the Patient Protection and Affordable Care Act. We cannot allow this institution--the institution of Congress--or the Supreme Court to destroy that act and to undermine that American progress. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, today I rise to recognize and pay tribute to Thomas Kane Gilhool, who championed the rights of inclusion for children and adults with disabilities and changed public policy in our country for all people with disabilities. His work was pivotal in affirming the constitutional right of children with disabilities to a public education, increasing community-based services for people with developmental disabilities, and creating a pathway for people with autism and other developmental disabilities to leave institutions and live with neighbors, friends, and family. Tom Gilhool was an originating member of Philadelphia's Community Legal Services. At the start of his career, he helped to organize, train, and then represented the Philadelphia Welfare Rights Organization and the Residents Advisory Board, as well as other organizations representing residents in low-income neighborhoods. The recognition agreements he secured empowered those organizations to effectively represent welfare recipients and public housing tenants and served as models that were replicated throughout the country. Tom Gilhool's seminal accomplishment was his groundbreaking representation of plaintiffs in the Pennsylvania Association for Retarded Citizens (PARC) v. the Commonwealth of Pennsylvania, the Nation's first civil rights case brought on behalf of children with disabilities. Kate Fialkowski, sister of two boys represented in the case, remembers Tom as ``an intellectual giant, lawyer, and legal historian,'' someone ``who used his gifts not for self-aggrandizement, but instead to raise up the lives of others, including those with intellectual and developmental disabilities.'' Prior to this case, children with disabilities were all but excluded from attending public schools. The decree of the U.S. District Court for the Eastern District of Pennsylvania in 1972 paved the way for the 1975 passage of the Education for All Handicapped Children Act, now known as the Individuals with Disabilities Education Act--IDEA--which affirmed every child's right to a free and appropriate public education in the least restrictive environment. Tom Gilhool's work on PARC v. Pennsylvania led to another landmark case on behalf of people with disabilities. In Pennhurst State School and Hospital v. Halderman, 1981, Tom Gilhool was lead counsel for residents of Pennhurst State School and Hospital, the residential home to almost 3,000 people with intellectual and developmental disabilities. By 1968, Pennhurst was exposed as an overcrowded, violent, and abusive setting. Through Tom's work, the right to habilitation in non-segregated settings was established. The ruling in Pennhurst v. Halderman was the forerunner of the 1999 Olmstead v. LC Supreme Court decision, establishing the right to treatment and services in community-based settings. Since that case, nearly 200,000 people have moved from abusive, segregated settings where they had been deprived of dignity, respect, and their basic needs. Tom Gilhool's work made it possible for millions of children and adults with intellectual and developmental disabilities to avoid such places. The cases Tom Gilhool argued laid much of the foundation for the passage of the 1990 Americans with Disabilities Act. Judith Gran, a long-time colleague of Tom Gilhool at the Public Interest Law Center said, ``Tom was the most effective civil rights lawyer of his generation. Without his vision and strategic gifts, [people with disabilities] might not have the right to education and the right to live in the community.'' In 2012, Pennhurst v. Halderman was cited by Chief Justice John Roberts in upholding the constitutionality of key provisions of the Patient Protection and Affordable Care Act in the National Federation of Independent Business v. Sebelius. When my father was elected Governor of Pennsylvania in 1986, he asked Tom to serve as Secretary of Education. Tom worked hard for the children of Pennsylvania from 1987 to 1989. Thomas Gilhool's tremendous contributions to the lives and rights of people with disabilities and their families are immeasurable. His accomplishments will continue to benefit all people with disabilities and inspire all who continue to work to protect the rights and freedoms of people with disabilities.

Mr. CASEY

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

Mr. CASEY

Mr. CASEY. Mr. President, I rise tonight to talk about a couple of issues I know that will be considered--at least I hope will be considered--in the negotiations that are under way. Later in this hour, we will be joined by three of my colleagues: Senator Whitehouse, Senator Blumenthal, and Senator Duckworth. Each of us will be talking about these issues from different perspectives, but all focused on those in our society who are most at risk in the midst of this worldwide pandemic and in the midst of this economic and jobs crisis that we are confronting right now. We know that this is the most difficult public health crisis in a century, and one of largest, if not in the top two, job crises we have ever faced. When we talk about Americans who are most at risk, among them are, of course, older Americans. Tonight, I will spend some time talking about older Americans in nursing homes who are at risk if we don't take action, and people with disabilities who need the benefit of--as do many older Americans need the benefit of--home and community-based services; and, third, Americans who are in communities of color who need the benefit of Medicaid, among other programs that we should be focused on. Let me start with nursing homes. We know that in the context of nursing homes, the skilled care that is provided there is the highest level of care for an older American or sometimes a person with a disability. We also know that is care that is provided to men and women who have done so much for the country--Americans who have fought our wars, worked in our factories, built the middle class, built America in so many ways and gave us life and love. All that they ask and all their families ask is when they are in a long-term care facility, especially a nursing home, that they are receiving skilled care that is quality care, and in the midst of this crisis, that we are taking every step possible to protect them from the virus and to keep them safe. Unfortunately, that hasn't happened in America today. As we speak tonight, more than just a couple of days ago, the number was lower than this, but now it is more than 62,000 Americans who have died in long-term care settings. Most of those are in nursing homes. When you add up the number of residents who contracted the virus and died with the workers who have died, the number is more than 62,000 Americans. That is about 40 percent of all the deaths in America. We have to take steps to get those numbers down--both the death number as well as the case number. Of course, the two are directly related. A number of months ago, Senator Whitehouse, who joins us on the floor tonight, and I introduced S. 3768, which was the Nursing Home Protection and Prevention Act. It was a proposed $20 billion investment in best practices. The tragedy here is that we know what works to get the death number down in nursing homes. We know exactly what works. Those nursing homes that were implementing these best practices months ago--way back, sometime in early March or even in February--are the ones that had lower numbers, fortunately, of deaths and case numbers. We know that you have to invest in a series of best practices, which means having enough personal protective equipment for everyone in a nursing home, but especially the residents and workers. We know that is essential to keeping people safe. We know that testing is part of that, of course, and having the capacity to test frequently and to have results transmitted very quickly. Cohorting is not a term that we hear a lot about, but it is a very simple concept. Cohorting means you separate the residents with COVID- 19 from those who don't have it. As easy as that is to say, it is more difficult to institute in a nursing home. Sometimes you have to retrofit. Sometimes you have to take other steps that funding is needed for. Cohorting works, which stands to reason, but we know it works now that we have some experience with the virus. We know that surge teams are critically important, as well, as part of these best practices. If you have an outbreak in a nursing home--and we have had so many examples of that in my home State of Pennsylvania and in so many other States--when the virus is spreading and there is a crisis in that nursing home because of the virus, you might need more help. You may need more doctors or nurses or certified nurse's assistants or so many other critical personnel in that nursing home. So $20 billion is a good down payment on protecting Americans in nursing homes. Our bill would do that. I am grateful for the help of Senator Whitehouse, as well as so many other Members of the Senate who joined in that bill. Unfortunately, the bill proposed--I guess it was July 27 or one of the last days of July. Unfortunately, the bill proposed by the majority has no meaningful investment in these best practices. We have to ask ourselves: Is this what America is going to settle for, that the greatest country in the history of the world is going to throw up our hands and say: There is really nothing we can do. It is a pernicious virus and the virus is spreading in congregate care settings like nursing homes, where you have individuals who are particularly vulnerable. So there is not much we can do. That is a defeatist, anti-American attitude. We know we can get these numbers down if we make the investment. The America that we claim to be would have a full-court press, a pull-out-all-the-stops effort to make sure that we get these numbers down. I don't think most Americans believe that we should throw up our hands and surrender to another 62,000-plus deaths a couple of months from now, which is where we could be headed if we don't take these steps. No one would assert that we can get these numbers down to zero or that there is some magic wand that will allow us to remove this threat from those we love so much in these nursing homes. But, my God, in America we are not going to take steps we know will work to get the case number down and the death number down? I think America is ready for an action plan that has been developed here in the United States by smart people who know how to attack this problem. So issue No. 1 is the most at-risk Americans. The second issue in terms of at-risk Americans is older Americans and people with disabilities who need the benefit of home and community- based services. Again, the Republican bill proposed by the majority here in the Senate doesn't mention Medicaid. In order to attack the nursing home issue--the nursing home death problem--or to invest in home and community-based services, we need to invest in Medicaid. We must stabilize and strengthen home and community-based services to keep older adults and people with disabilities both safe and healthy. To do that, you have to pay the workers more. The workers should be paid a living wage. When those workers are going into a home to provide that critical care, they should be provided the personal protective equipment that they need to keep themselves safe and also that person with a disability or a senior, if someone is coming into their home. Without sufficient dollars, human service organizations cannot recruit and retain the direct support professionals and personal care attendants who provide essential healthcare and community inclusion services for seniors and people with disabilities. This is just one example, among many. This is a picture of Marisa. She is from Allegheny County, PA. You can see by the picture--you may not see it from a distance--that the T-shirt says: ``Proud to Be Your Neighbor.'' You can barely read the words: ``Giant Eagle.'' That is one of the great supermarket chains in Southeastern Pennsylvania. Marisa uses home and community-based services to live independently. She is a volunteer at a food pantry and works at one of the Giant Eagle grocery stores and has done that work for 19 years. All these years later, she is one of the beneficiaries of this program. She can get services in the home and in her community. The key to this is that without dedicated dollars, agencies like Achieva, one of the many agencies that does this work and provides such services--these agencies will not be able to provide services that people with disabilities like Marisa and families like hers need. Pennsylvania, like many States, has so-called centers for independent living. They told me just last week on a phone call that as for helping people move from a nursing home or a congregate care setting, where often the risk is higher with the virus, often their ability to move people from that setting who want to go into a home or an apartment is fully dependent on the dollars from the funding they have. They have been able to move some people, but very few because they don't have the funding to move them. Another implication of this concern we have is that the direct service providers have scaled back these services. Most don't have enough cash reserve for longer than a month because of the lack of funding. Just imagine that. I introduced a bill 4 months ago, S. 3544, which provided dedicated dollars to respond to this crisis. But it wasn't until the HEROES Act passed by the House--not yet passed by the Senate, but passed by the House 10 weeks ago--included provisions of my bill, which was supported here in the Senate by 28 Senators. I have just two more issues. One is Medicaid and the other issue I will address is on the liability debate. Of course, we know what the Medicaid program is. It has been around since 1965. Medicaid is the program that helps 75 million Americans. If you add up the children on Medicaid, which is about 31 million children, and people with disabilities, which is another 9 million, you have roughly 40 of the 75 million. Medicaid is not just a program. It is a program that saves lives, maybe even more so in the middle of a public health emergency that we have been in all these months. Medicaid is also, I believe, a reflection of who we are as a nation. I think it also reflects whom we value. That is why Medicaid is so critical to seniors living in nursing homes who are sometimes from relatively middle-class families who could not afford long-term care. Many Americans with disabilities--as I mentioned, 9 million at last count, and of course, 31 million children--many of them live in rural Pennsylvania, in rural America. In fact, if you look at it by percentage, it is often the case that in rural counties, there is a higher percentage of children on Medicaid and the Children's Health Insurance Program. There is a higher percentage in a rural county than children in a county that has a lot of urban communities in it. So rural and small town America depend heavily upon Medicaid. They depend upon Medicaid in another way when you consider rural hospitals. Often the largest employer in a rural county in Pennsylvania--or the second or third largest employer at least--is a rural hospital. We have 48 of our 67 counties that are rural, and in those 48 rural counties, more than half of the top employers in the county are hospitals--or I should say the top or the second or third highest employers. So, of the top three employers in the most rural counties, you have a hospital--and Medicaid is so vital to those rural hospitals--operating on a thin margin and is evermore stressed in a pandemic. Medicaid expansion, of course, made it possible for millions of Americans to get healthcare through the Affordable Care Act, and we just saw yesterday, in the State of Missouri, the vote there to expand Medicaid. It has been happening in a lot of States that may not have embraced Medicaid expansion a number of years ago but that are now embracing it. Medicaid is a safety net in this time of crisis, in terms of the economic and jobs crisis we are living through. It, of course, impacts State budgets. One of the biggest expenditures in State budgets is Medicaid. For example, in our State of Pennsylvania, our unemployment rate in June was 13 percent, and there were 821,000 people out of work. In some counties, the unemployment rate is 14 percent or 15 percent or 16 percent or 17 percent. So, when 821,000 people are out of work in a State, a lot of them have lost their healthcare, and they have turned to Medicaid. Now, in the Families First bill, way back in the early part of March, the matching dollars--the so-called FMAP, which means the Federal matching dollars for Medicaid--were increased by 6.2 percent. That was a good step in the right direction, but Governors in blue and red States will tell you now, as a lot of other people will tell you now, they need an additional increase in Medicaid. I think the 14 percent FMAP, or matching dollar percentage, in the Heroes Act in the House made a lot of sense. I hope we can get to that number in the bill we are considering or we hope to be considering soon. The Republican bill does not have additional dollars for Medicaid, matching dollars, despite the fact that many of the Republican Governors around the country have asked for this kind of help. So I hope that will change as the negotiations move forward. I want to end on time if I can, maybe in the next 10 minutes. That is the goal. Finally, I want to talk about the liability shield issue. There are a lot of different perspectives on this. Let me talk about it in the context of those we are discussing tonight--seniors in nursing homes, people with disabilities who need home- and community-based services, folks who are in communities of color, and others who need the benefit of Medicaid. In my judgment, the Republicans' proposal, when you look at the liability proposal, would slam the doors of justice on those who want to bring an action. We have had a lot of commentary lately about our criminal justice system and its defects, its shortcomings, and even about the racism that, I believe, permeates that system. In this context, we are talking about the civil justice system. What do we do about that part of our justice system--the ability for a citizen to bring an action in a court of law to deal with an injury of some kind either by way of negligence or intentional conduct? In this context, we have a proposal by the majority to short-circuit, to undermine, that system of justice. It will affect those we are here to talk about tonight in very real ways whether they are low-income workers or people with disabilities or older adults or even, more broadly, essential workers. Why do I say that? If you are going to use a crisis like we are in now to try to achieve gains that some in this Chamber have tried to achieve for years in the so-called tort system--really, the civil justice system--and you paint with a very broad brush, you are going to slam those doors of justice pretty tightly. Just by way of comment from a Georgetown law professor, David Vladeck, in reference to this proposal, he recently explained the ``extreme reach'' of the proposal vastly exceeds ``any prior `tort reform' bills that have been introduced in Congress.'' He went on to call this corporate liability shield provision ``essentially impenetrable.'' That is how he described the strength of this shield. He warned that such proposals would give ``license for irresponsible and reckless conduct.'' When it comes to liability, it would also preempt all State laws requiring businesses to act reasonably. It would impose a heightened-- so-called--clear and convincing burden of proof on plaintiffs instead of the typical preponderance-of-the-evidence standard We know that in our system, in a civil case, the preponderance-of- the-evidence standard is the lowest standard. Just a little more than 50 percent of the jury would have to make the determination in terms of liability. We know that, in the criminal system, in order to find guilt, it has to be found beyond a reasonable doubt. That is the highest standard. There are some cases that are given the middle standard of--so-called--clear and convincing. That burden of proof is right in the middle. In a civil lawsuit, this bill would elevate it from a preponderance to clear and convincing, which would be, I think, a step in the wrong direction. The proposal would also force a worker, a consumer, a resident of a nursing home, or even a patient to show that a business failed to make ``reasonable efforts'' to comply with any applicable government standard. The issue here is that the Federal Government hasn't issued any mandatory standards. So these entities--many of them employers of one kind or another, sometimes very large employers--would be able to follow any standard they would choose. They could choose a local standard or a State standard or a Federal standard even if the one they were to choose would be the weakest standard as it relates to the protection of the worker. What the administration could have done, which I called for and many Members of the Senate called for, would have been to have promulgated a standard against which the actions of an employer could be measured. One idea was to promulgate an emergency temporary standard. I don't know why the Department of Labor wouldn't do that in the middle of the worst public health crisis in a century--why the Department of Labor would not simply take that step. That would give clarity to employers. That would give clarity to so many Americans about what the standard would be in a workplace to keep people safe from a raging virus, but they chose not to do that. Without any mandatory standards, it is wide open. Then we are supposed to believe that taking away the right to bring an action is somehow going to be just fine for a period of time. An emergency temporary standard by the Department of Labor should have been promulgated months ago, and it could still do it and remove the uncertainty--the lack of clarity--that prevails right now. With regard to the liability provisions, this bill would immunize healthcare providers and facilities from any claims arising from ``coronavirus-related healthcare services.'' That is pretty broad. How does the bill define that? The bill defines that as follows: the treatment of patients ``for any purpose,'' not merely the treatment of COVID-19 patients during this public health emergency. That is about as broad as it gets, and that impenetrable liability shield would be in place for several years. It gets worse when it comes to people with disabilities. To add insult to injury, just consider what we did last week. Our Nation celebrated the 30th anniversary of the Americans with Disabilities Act--a law that extends civil rights protections to people with disabilities in every State. President George H. W. Bush signed the bill into law, and Republicans and Democrats and Independents all over the country celebrated its 30th anniversary. Literally, the next day, the majority proposed this corporate liability shield, which would blow a hole in the protections provided by the so-called ADA after the celebration of 30 years. That bill, the Americans with Disabilities Act, makes it possible for people with disabilities to be full participants in American society, but this corporate liability shield would undermine those very protections. It would decimate Federal protections granted under other landmark employment and civil rights laws, including the Age Discrimination in Employment Act, the so-called ADEA; the Genetic Information Nondiscrimination Act; and OSHA, the Occupational Safety and Health Act, which is one of the seminal actions, or pieces of legislation, to protect workers. It would also adversely impact the Fair Labor Standards Act as well as title VII of the Civil Rights Act of 1964. I don't know how you could have more of a wrecking ball in place for these landmark pieces of legislation in the middle of a pandemic. I will wrap up by saying that we have a lot of work to do, obviously, in these negotiations. In the midst of the negotiations, we ought to be thinking about the most vulnerable, whether they be older Americans, children, people with disabilities, or folks in communities of color, who have been adversely impacted in so many ways and evermore so in this time of crisis. I will not enter into it the Record, because it will be in the Record anyway, but I am holding in my hand a letter that we sent to Leader McConnell that outlines all of these concerns. It is a letter, led by Senator Duckworth from Illinois, Senator Warren from Massachusetts, and me, as well as now more than 40 of our colleagues, which goes through these concerns that we have for investments in strategies to get the nursing home death number down and for investments in home- and community-based services. It goes through the concerns we raised about the corporate liability shield, as well as about an overdue investment in Medicaid, which is the program that takes care of the most vulnerable among us. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, I rise this morning to cover a couple of topics. One is on some comments on the legislation that I hope we are going to complete to provide relief to the Nation with regard to both the public health crisis and the jobs crisis, and then I will have two other sets of remarks in different parts of the Record, but let me start with what we are facing right now. We know that it has been 4 months since the CARES Act, way back at the end of March, and we all expected, I think at that time, that that piece of legislation and the legislation prior thereto and subsequently would have an impact on Americans, we hoped, in a positive way. I think there is some evidence to indicate that the CARES Act had a positive impact. Obviously, it was not perfect legislation, but I don't think any of us thought that was the end of the road. And then we saw, just 10 weeks ago, the Heroes Act pass the House of Representatives. So you have the CARES Act enacted into law and operative--and thank goodness for that--as well as several other pieces of legislation. But the Heroes Act only passed by the House and no action by the Senate in those intervening 10 weeks. If you were on the majority side of the aisle, the Republican side, as Leader McConnell has outlined, and you wanted to delay--wait to see the full impact of the CARES Act--there is an argument that some would make in that direction. I don't agree with it. But what I don't understand is why, even if you believe that you should wait, why would you not be preparing for the worst? Why would you not be preparing for the kind of outbreaks we have seen across the country when the virus moved away from the Northeast, generally, to the South and Southwest, and then to the West even more so? Why would you not prepare at least an outline of legislation? Why would you not begin negotiations many, many weeks ago, as opposed to waiting until the last minute not just to respond to the overall problem--the worst public health challenge in a century--but also, in a particular way, why would you wait, as the majority did, until the very last minute on the issue of unemployment insurance when we know benefits are running out in a matter of hours, really, not even a few days now? So if that is your perspective that we should have waited, why wouldn't you prepare for the worst so that when the worst was hitting, or something comparable to that, you would have legislation ready to go? The majority chose to delay, and I think, in a real sense, seemed to adopt the President's kind of virus denial that if you just don't talk about it or if you try to change the subject or, in the case of the majority, if you don't legislate about it or prepare--just prepare to legislate about it, it will somehow recede into the background, and we don't have to worry about it. Well, that delay and that denial has proved to be, I think, misguided, and I think that is being charitable. So we are faced with a number of challenges at the same time as we face a public health and jobs crisis. I will start with nursing homes and long-term care and the very related issue of home- and community- based services. We know that in long-term care settings, most of those settings being nursing homes, the Nation has endured more than 59,000 deaths. That number may have hit 60,000, but we know that it is more than 59,000 deaths. So more than 40 percent of all the deaths in the United States of America, which is now about to reach 151,000, I think, from what we saw this morning--more than 40 percent of those are in long-term care settings and most of them in nursing homes. This isn't theoretical to people out there. This isn't theoretical to families across my home State of Pennsylvania or a lot of other States where, in many States, 60 percent or more of all the deaths were in long-term care settings. The deaths are, of course, residents of those nursing homes, in addition to workers. So when you combine resident deaths and worker deaths, you get more than 59,000. We have to ask ourselves as Americans: Is that just going to be acceptable? Are we going to stand here 3 months from now or 4 months or 6 months from now and say: Wow, it is really tragic, all these deaths, and another 59,000 people died in long-term care settings, mostly nursing homes? Is that the America we want? Is that the America we are going to settle for? And, oh, I know, I can hear the argument: Oh, you know, it is a terrible virus. It is. It is a virus that hits the very old in disproportionately higher numbers, and if you happen to be an older citizen and you have all kinds of chronic conditions or other health issues that might compromise your immune system or otherwise, you are especially susceptible. So some would argue: Well, this is just going to happen. But we know exactly how to get the numbers down--the case numbers down and the death numbers. Is it perfect? No. Can we get the 59,000 to zero? Of course not. No one would argue that. But the idea that the United States of America, in addition to not responding effectively to the onset of the virus itself--I am just talking about a subset or a part of the tragedy, and that is the tragedy in our nursing homes, both for residents and their families and for workers and their families. We know exactly what works, and I have a bill that would substantially reduce the deaths and the cases. What is it? Well, first of all, it is important to know the number--3768. That is the bill. I hope that my bill will be included wholly, or in substantial fashion, in the next bill. S. 3768, what does it do? It allocates $20 billion. Now, we have heard numbers that this next piece of legislation might hit $1 trillion or more, and I think that is likely. We should ask ourselves: Can't we set aside $20 billion of that, a fraction of that trillion dollar-plus or more bill that we will pass, we hope? Can't we set aside a fraction of that for older citizens and their families and the workers who take care of them? These are Americans who fought our wars. They worked in our factories. They built the strongest middle class the world has ever seen over the course of the last 75 or so years. These are people who were inventors and innovators. These are people who made America what it is today. They are our fathers and our mothers, our grandmothers and grandfathers. They gave us life and love. The least we could do is make an American effort to get the death numbers down and the case numbers down. Anyone who says we can't do that is defeatist and I think invoking an anti-American spirit. We know how to do this. What will the $20 billion go for? It is simple but could be profound in its impact. No. 1, we know that one practice in a nursing home that reduces the number of cases of people contracting the virus and the death number is cohorting. What does that mean? Separating--separating those with the virus in the nursing home from those who don't have it. Nursing homes that did that were successful in getting their numbers down. They did it early, way back in early March--maybe even earlier in some cases-- and it worked. It has been implemented in a number of States. But that has a cost to it. You might have to build out, and you might have to retrofit. You also need extra dollars for personal protective equipment. There should be no question that in the United States of America, every nursing home has every piece of personal protective equipment it needs. PPE is lifesaving--lifesaving for the resident to be guarded from contracting the virus and essential for the workers as well. What else do we need the money for? If you have a problem in a nursing home with an outbreak, we ought to be able to surge expertise from other settings. That nursing home might need more doctors in that crisis or that outbreak. It might need more nurses or certified nurses assistants or other personnel. We should have the dollars at the State level to serve those professions. We also need more money for testing in nursing homes--vitally important. I think families across the country expect us to directly address this. Unfortunately, the Republican bill proposed the other day does not do that, does not invest, as my bill would. Here is a headline from just this week, July 24, in the New York Times. I will not read the story, but the headline is ``FEMA Sends Faulty Protective Gear to Nursing Homes Battling Virus''--faulty protective gear. We are months into this, and we have FEMA sending faulty protective gear. Here are the first lines of the story: Expired surgical masks. Isolation gowns that resemble oversize trash bags. Extra-small gloves that are all but useless for the typical health worker's hands. It goes on and on. I don't have time to read it all today. But that article and so many other documented reports indicate that these facilities don't have the protective gear they need The second issue is unemployment insurance. We are told that the majority, in their proposal, wants to cut the $600 per week down to $200. Do the math--cutting it by $400 a week. This is at a time when we are told that since February, the United States has lost 15 million jobs. My recollection is that in the great recession of around a decade ago--between the fall of 2008 and sometime in the spring of 2009, roughly--about half a million jobs were lost. We have already lost, basically, double that--15 million jobs. We were told: Oh, don't worry. April is going to be a bad month, and May and June are going to be a lot better. That unemployment rate is just going to roll down from there. I was hoping that would be the case, but in Pennsylvania, in April, 1 million were unemployed. What was May? Fortunately, it went down-- 849,000. I expected June in our State to be a lot lower than 849,000. Maybe it would go down by 100,000 or 150,000; I hoped even more. But, unfortunately, it went from 849,000 to about 821,000--821,000 people out of work in Pennsylvania in the month of June. We still have a jobs crisis that will endure for a good while yet and, therefore, an unemployment crisis. The worst time to cut those benefits, those extra benefits, would be right now. I know we have heard the argument that if you continue this, you are creating a disincentive to work. That is what we are told. According to the Washington Center for Equitable Growth, in a report this month-- just a couple of days ago--they found: ``Lack of opportunities to work, not a disincentive to work, are keeping unemployment elevated.'' That is what they found. They documented more than that statement would entail, but that is what they found in their research. They also found 23 percent fewer job openings in July of 2020 versus July of 2019. So there were fewer job openings. The Bureau of Labor Statistics in the Department of Labor said that there are almost four unemployed in the United States for every job opening. The third issue, State and local funding: The Republican proposal has nothing to help States and local governments. We know that State and local governments have to balance their budgets, so extra dollars can come only from one source--the Federal Government. State and local governments have had to spend more to protect their citizens with the onset of the virus, the COVID-19 disease, and the impact of the virus and the pandemic blew a hole in their budgets. So what is going to happen? A State, whether it is a red State or blue State or whatever the political conditions--they are all the same when it comes to revenue loss. Here is what is going to happen, as sure as night follows day: They are going to have to cut education. So I would say to school districts: Get ready for cuts because if your State cannot balance its budget, there are going to be education cuts. There will be cuts to healthcare, probably Medicaid in most instances, and there will be other cuts. Public transit--we were on a call last night with transit advocates from around Pennsylvania, and our side is asking for more help for transit. But you can go down a long list, whether it is education or healthcare or even public safety itself at the local level. So we should do a lot more. We should be replicating or at least approximating what the House did when they allocated $875 billion for State and local governments combined. How about the Supplement Nutrition and Assistance Program? The majority has refused over and over again--categorically refused--to increase SNAP by the percentage that our side has argued for. I know it is a little easy in Washington to talk about hunger and food insecurity as some kind of distant issue because those of us who serve in this Chamber are not food insure. We don't have to suffer the pain of hunger that many families are suffering. Many suffered food insecurity long before the pandemic, but many others--even middle-class families or people trying to get to the middle class--are suffering from food insecurity because of the virus and the economic downturn. Families, we know, are literally choosing between the food they need for their families or paying the mortgage, choosing between the food they need-- groceries--versus paying for their kids' medications. The last issue in this part of my remarks is on Medicaid. We know that the Senate did the right thing in the Families First legislation way back in early March when it increased the matching dollars for Medicaid by 6.2 percent. Those matching dollars are vital for States to be able to pay for Medicaid and to be able to balance their budgets. The House bill, the Heroes Act, passed 10 weeks ago, I believe, set forth another increase of a higher amount--14 percent--for those matching dollars. I think that makes a lot of sense, especially when people are losing their jobs every day. We just read a story in the New York Times last week, I think it was. More than 5 million people in the country have lost their health insurance because they lost their jobs or for other reasons. So a lot of those folks who are out of luck when it comes to healthcare itself are turning to Medicaid. We should increase the matching rate to 14 percent. The Republican proposal has no additional dollars for Medicaid. I guess we should not be surprised because the White House budget proposals in the last several years--and I think supported in large measure by the Republican majority here in the Senate--have not only not wanted to increase dollars for Medicaid, but, in fact, the White House has proposed cuts of several hundred billion dollars to Medicaid over a 10-year timeframe several years in a row. Republicans in the Senate have said very little, if anything, against those kinds of proposals. Let me just move to a separate set of remarks

Mr. CASEY

Mr. CASEY. I know of no further debate.

Mr. CASEY. I further ask unanimous consent that the preamble be agreed to and that the motions to reconsider be considered made and laid upon the table with no intervening action or debate.

Mr. CASEY. Mr. President, I yield the floor.

Mr. CASEY. Mr. President, there is one more item to address before I relinquish the microphone. We know that yesterday was the 30th anniversary of the signing of the Americans with Disabilities Act, to which I just referred--the so- called ADA. This is legislation that Congress should be very proud of because of how much it has ensured that millions of Americans with disabilities have been able to exercise their rights as Americans. We still have some work to do on the goals of the ADA, but it is a good anniversary to remember and to celebrate. So, in honor of the anniversary, I offer this resolution to celebrate the 30th anniversary of the signing of the Americans with Disabilities Act. I ask unanimous consent that the Senate proceed to the immediate consideration of S. Res. 661, a resolution recognizing the importance of independent living for individuals with disabilities made possible by the Americans with Disabilities Act of 1990 and calling for further action to strengthen home and community living for individuals with disabilities, which was submitted earlier today.

Mr. CASEY

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

Mr. CASEY

Mr. CASEY. Mr. President, I rise this afternoon to talk about long- term care and a number of related challenges that confront our country, especially at this time. One of the most horrific numbers in all of the horror that we have seen in the aftermath of the onset of the virus and COVID-19 disease and the jobs and economic crisis that have followed it is the number of deaths in long-term care settings. When you combine the deaths of residents in nursing homes and other similar settings--sometimes called long-term care or even congregate settings--with the deaths of workers, we know that the number now exceeds 59,000 Americans. About 40 percent of all the deaths are either a resident of a long-term care facility or a worker in those facilities. So we are talking about those Americans today--those families--when we consider what we do next because no one here, I don't think--I don't care what side of the aisle, what point of view, who you are, what State you are from, no one in this body or in the House would want to accept the idea that, say, 4 months from today, or 5 months or 6 months, another 59,000 or 60,000 people will have died in those settings. We know a lot about how to get those numbers down. It is not one of those things where we can throw up our hands and say there is little that we can do. There is a lot we can do because Americans are smart, innovative, and caring, and a lot of smart people have figured out how to get those numbers down. So 59,000--more than 59,000--Americans is unacceptable. Also, 40 percent of all the deaths going forward is also unacceptable. About a month ago, I came to the floor with some of my colleagues, and we pressed for a vote on the solutions we need to save lives in nursing homes and also protect the workforce. The majority blocked the vote. Since then, the Senate has done nothing when it comes to this issue that has impacted so many families and so many communities. We have a chance now. I realize sometimes when a bill gets blocked that that isn't the end of the story and that the individual or the party blocking might have a different idea, a better idea, a different solution, a better approach. If that is the case with the majority, we need to hear it. I would hope that a solution, a remedy, a strategy to get the 59,000-death number down would include the resources to do it because this isn't a circumstance where you can just wish it away. This isn't a circumstance where you can just move a little bit of policy around. We need resources, and I will talk more about them. We know that yesterday Senate Republicans released their plan for the next piece of legislation relating to COVID-19 and the economy. This proposal is 2 months--a full 2 months--after the House passed the Heroes Act to bring relief to the millions of Americans who are suffering, families who are suffering, not only in the context of long- term care--having lost a loved one, a resident, or a worker in their family--but they are suffering for other reasons as well. We know the unemployment rate is intolerably too high. In my home State of Pennsylvania--just imagine this--the number was 1-plus million people out of work in April. Thankfully, that number went down in the month of May, but it only went down to 849,000 people out of work. I was hoping, as I know everyone was in the State, that the June number would fall precipitously and maybe by the same percentage, so 849,000 people would go well into the 700s and maybe even into the 600,000s and would keep going down from there. Unfortunately, in the month of June, it went from 849,000 to about 821,000 people out of work. I don't think I have seen unemployment numbers like that in my home State in my lifetime. The 13.4 percent unemployment in May dropped but only went down to 13 percent. Just by way of comparison, in the great recession of just roughly a decade ago, Pennsylvania's unemployment rate went way up, as it did in a lot of other States. It stopped at 10 percent. Some counties were above 10 percent, 11 percent, 12 percent or higher. Statewide, it never really went above 10 percent. We are now in our third month of unemployment rates well above 10 percent. It was 16 percent in April, almost 13.5 percent in May, and now 13 percent exactly now. We have a lot of work to do. For purposes of today's discussion, I wanted to talk about what we can do in the long-term care context. The Republican proposal of yesterday makes no meaningful investment to save lives in nursing homes. The policies that address long-term care in this proposal are insufficient. I think that is an understatement, but I will let that go for now. There is no investment in home and community-based services, and there is no funding to reward the heroes on the frontlines. Some people might say: What do you mean by home and community-based services? I don't understand that. I am not sure what you mean. We know that in the United States we have a number of settings where care is delivered--care for older citizens, older Americans, and care for people with disabilities. In the nursing home context, of course, that is skilled care in a facility, in a so-called congregate setting. Depending on which number you believe, in the United States we have between 1.3 and 1.5 million Americans there. We also have a lot of Americans who are getting their care--very important care for a senior or for someone with a disability--in a home setting or in a community- based setting, but the funding doesn't flow in that direction very often. So we are trying to change that because, obviously, if you are an older American, you might have certain conditions that make you even more susceptible, more vulnerable in the context of COVID-19. In many cases, it will be preferable to have you in a home setting or community-based setting. But if you are in those settings, we have to invest in the workers who do that heroic work in both nursing homes, in homes, and in community-based settings, because the care is not going to be what it needs to be if we are not helping the workforce. I think most people agree with that. Just as we cannot allow another 3 or 4 months to go by with 59,000 people dying, we also cannot allow the conflict here in the Senate to stop us from making progress in long-term care. We have to help nursing homes at the same time as we demand more of them. We need to invest in what we know works. I have a bill, S. 3768, introduced with Senator Whitehouse. The name of the bill is the Nursing Home COVID-19 Protection and Prevention Act. It would dedicate $20 billion in emergency funding for proven practices. We would spend $20 billion to get that death number down and also to get the case number down. We are concerned, as well, about the high number of cases. We need to invest in best practices that some long-term care settings were investing in way back in early March, and some long-term care facilities got much better results. They had fewer cases and lower numbers of deaths because they were investing in these best practices. But to invest $20 billion in emergency funding for these proven best practices, I think, is a bargain to get the death number down and get the case number down. This bill will help nursing homes become a lot better and become more proficient at a practice called cohorting. It is real simple. That just means separating people in the nursing home. You separate the residents with COVID-19 from the residents who don't have it. When that basic practice is in place and when it is operative, it is something that a lot of places need help with. There are, obviously, costs involved in that. There may be costs because you have to do retrofitting. There may be costs in terms of needing additional staff. But that is only part of it. The bill also allows nursing homes to provide for their workers, these heroes who are on the frontlines every day. Obviously, if you are on the frontlines every day, you are an essential worker. There are all these phrases and descriptions of these workers. Those who are at the front of the frontline are those in healthcare, because they are not only going out every day and providing an essential service, but they are closest to the risk. That includes folks who work in hospitals and other settings, of course. That is for certain. But it also includes people who work in nursing homes and at home and in community-based service settings. Those are folks whom we call heroes, and it is nice to call them heroes. It is nice to say they are doing great work. It is nice to pat them on the back, but what we should be doing is paying them more for the sacrifice they make for the country. The analogy, of course, is the GI bill. I have a bill that would add similar education benefits to those frontline workers, those heroes. But at a minimum, they should get premium pay and overtime pay. They should also have essential benefits, and we should help them with childcare. You can't say: You have got to be on the frontlines; you have got to be on the front of the front lines, and you have to go to work every day because we need your essential skilled work to care for the most vulnerable, but you are on your own with childcare. Good luck. We haven't done much to help them with that. My bill also includes strong resident protections--``resident'' meaning residents of nursing homes--to prevent evictions to homeless shelters and to provide an extra check on nursing home quality. All these things I just recited in the bill, the Republican proposal doesn't have. I think the time is long overdue for Congress to take action to deal with what can only be described as an American tragedy-- a preventable American tragedy. No one would argue--I certainly would not argue--that the 59,000-plus number could be zero. It is not what we are saying. What we are saying is you can bring the number down. If we bring the number down, even a little bit, it is worth it to save lives and to reduce the number of cases, but I think we can do a lot better than that. Last week, a coalition made up of representatives from the nursing home industry, direct service professionals, AARP, the Alzheimer's Association, Catholic Charities, The Arc, and the Service Employees International Union came together to write to Senate leadership to demand this action and more. Think about that group. That is not a group that is always on the same page. They have often direct conflicts on a lot of issues, but they have all come together to support the residents in nursing homes and those in other settings and the workers because that is how dire it is. Groups that are often in conflict on legislation are together on this. Here is part of what they wrote to the Senate leadership: ``The urgent need to save lives, prevent the spread of the virus, and address the services and support older adults and people with disabilities need cannot be overstated.'' In addition to nursing home supports, this coalition called for dedicated funds for home and community-based services under Medicaid that I described earlier. I have a bill to do that. The House-passed Heroes Act, in fact, does that. The Heroes Act passed 2 months ago, and here we are without a bill ready to vote on in the Senate. I sent a letter with 28 of my colleagues yesterday to urge Leader McConnell to move these policies forward. We know that over 2.5 million older adults and people with disabilities depend on these services to be able to continue living in their own homes. These 2.5 million seniors and people with disabilities are folks who are not in a nursing home or other congregate setting. They are, by definition, in their homes or in a community-based setting. They are receiving their supports and services in their homes, where they are less likely to be exposed to the virus and often are able to see their families. Just to give you one example, there is Michelle Mitchell of Allentown, PA--on the eastern side of our State, almost at the New Jersey border. Michelle is a person who benefits from the services. She has a lifelong disability--cerebral palsy--which affects the use of her arms and legs. She holds multiple degrees and is a full-time faculty member at a local college. Every single day, Michelle Mitchell has the benefit of a personal care attendant who helps Michelle get out of bed, helps her to bathe, helps her to dress, and helps her to eat. Without Medicaid home and community-based services, thousands of people with similar needs to Michelle would not be able to live at home and work and interact with neighbors and friends. Home and community-based services keep Michelle safe, they keep her healthy, and they keep her engaged. But the agencies that provide these vital services are facing barriers. A survey of home and community-based services providers conducted by the group ANCOR found that 68 percent of providers have had to close some of their services to people with intellectual or developmental disabilities. This same survey found that over half of the agencies had faced significant additional expenses because of pandemic expense. We know that life has changed for so many Americans and so many institutions. This is one of these agencies that do such good work. Some of the expenses they face include increased levels of overtime, purchases of personal protective equipment, and additional training for workers. Perhaps most unsettling is that the agencies that provide essential services to older adults and people with disabilities don't have sufficient funding to keep offering services for more than 1 month if payments stop. This lack of cash on hand illustrates how fragile the home and community-based services system is. Yesterday morning, administrators in Pennsylvania said that if home and community-based services were not available, thousands of additional people would need to enter nursing homes, which again, is a congregate setting, where the likelihood of contracting the virus is higher than a lot of other settings. That, of course, would put them at greater risk of contracting the virus and much greater risk of dying because of this horrible pandemic. When we talk about investing in home and community-based services, that is tied to the goal of getting not just the case number down but the death number down. The proposal by Republicans yesterday makes clear that they are not focused on this crisis. There is no investment in home and community- based services at all. The response to nursing homes is wholly insufficient. The level of funding provided in the proposal, in my judgment, is an insult to older Americans. It is an insult to people with disabilities and their families, and it is an insult to the workers who support them. Claiming that people with disabilities and seniors are supported in this legislation is just not true. On top of the lack of funding, the bill blows a hole in the protections provided by the ADA, or the Americans with Disabilities Act, for people with disabilities. To ensure that seniors and people with disabilities are kept safe and healthy during this public health crisis, we need to ensure that strong policies are in place to keep nursing homes safe, and we need to ensure that there is dedicated funding for home and community-based services. I am calling for an investment in both settings--home and community- based services--for seniors and people with disabilities, as well as investments in proven strategies that we know will help nursing homes and also get the death numbers down. To meet our responsibilities to those who are most at risk--the most vulnerable among us--the Senate should include these provisions that I have described in the next COVID-19 legislation.

Mr. CASEY

Mr. CASEY. Mr. President, before we close tonight, I want to talk about a story that is troubling a lot of Americans--one that we have just learned about in the last couple of days--and that is the recent events regarding the U.S. presence in Afghanistan and some of the reporting. Like many of my colleagues--and I am sure this is a feeling shared by tens and tens of millions of Americans--I am alarmed, as I know they are, by reports of the intelligence community's discovery that the Russian Government offered to pay Taliban and Haqqani Network militants to target American troops in Afghanistan. The New York Times broke the story on June 26. Since then, several questions have emerged regarding how the intelligence has been handled, how long decisionmakers within the U.S. Government have known about this, and thirdly, what measures the administration is taking to hold Russia accountable. Obviously, there are a number of stories by other news outlets in addition to that by the New York Times. I will just refer to one excerpt from the New York Times' June 26 report. It reads: ``An operation to incentivize the killing of American and other NATO troops would be a significant and provocative escalation of what American and Afghan officials have said is Russian support for the Taliban.'' The story later goes on to read: ``Any involvement with the Taliban that resulted in the deaths of American troops would also be a huge escalation of Russia's so-called hybrid war against the United States, a strategy of destabilizing adversaries through a combination of such tactics as cyberattacks . . . and covert and deniable military operations.'' We have learned in recent days that these reports have been circulating through the U.S. intelligence community since early 2019, but there was little to no action taken. The timeline regarding these events is of particular concern to me and, I know, to many Americans but especially to those who represent a State in which there is a direct connection. In April of 2019, three U.S. marines were killed in a car bomb near Bagram Airfield in Afghanistan. There was speculation that this may have been a bounty attack that had been carried out by the Taliban for the Russians. There has been further reporting on this--tracking the dollars--by the New York Times and maybe by a few other outlets, but I know the New York Times did. One of the marines killed in that April 2019 attack was a Pennsylvanian. If there had been credible intelligence regarding the Russian plot and if that intelligence had been acted upon, one question I have is--and it is only a question; I don't know the answer to this question, but I ask it--could the death of this young Pennsylvania marine and his brothers in arms have been averted? That is a question. I don't know the answer to it. I hope, in the coming days and weeks--and I hope not longer than weeks--we will have an answer to that question, among many, as it troubles so many Americans. As of the close of last year, December of 2019, 294 servicemembers from Pennsylvania had been killed in the wars in Iraq and Afghanistan-- the third highest toll of any State. Our State has sacrificed a lot. If Russia had had any hand in contributing to these losses, to say that it is offensive, enraging, and deeply problematic is an understatement and warrants a close look not only at the U.S. engagement in Afghanistan but also at how we respond--how the United States of America responds-- to Vladimir Putin's efforts to disrupt U.S. efforts overseas and take American lives while doing it. Accordingly, I have several questions about how the intelligence has been handled and what measures have been taken to hold Russia accountable for these horrific, incendiary, unlawful actions contrary to international law. The administration must brief all Members of Congress immediately. I think Americans are offended when the administration briefs one side of the aisle. All Members of Congress should be briefed. Those briefings should occur immediately and in close proximity to the reporting. The briefings should include when they received the intelligence--when the administration received it--when the President was briefed, and what actions were considered in response. I also call on the administration to report to Congress on a process for protecting our troops in moving forward. You could be justifiably offended by inaction by the administration or for the knowledge that preceded that inaction, that they did nothing in response to it. It is especially offensive now to a lot of Americans that this information now is in the public record and there seems to be no evidence of any kind of a response, any kind of an action. So I think the administration should report to Congress not just on who knew what when, but also on what we do going forward. The families of these fallen soldiers deserve answers. The American people, obviously, deserve answers as well. We cannot let Russia and Vladimir Putin get away with this. I yield the floor. I suggest the absence of a quorum.

Mr. CASEY. Mr. President, I want to thank the senior Senator from Michigan for her leadership. I will say more about her work in a moment. We would not be here tonight talking about this program that we know by the acronym, but the words are all important, Supplemental Nutrition Assistance Program--SNAP--what we used to call food stamps. We wouldn't be here without her leadership and those who made food insecurity and anti-hunger initiatives a priority. This is a program that I believe is core to our responsibility to support American families during this national crisis--the public health crisis and the jobs crisis. This program, the Supplemental Nutrition Assistance Program, is a lifeline for millions of Americans to access the food they need to survive. I think that is an understatement. As the junior Senator from Oregon, Mr. Merkley, just said, this is about life itself. This is about being able to live and being able to survive. No human being can survive without food, and so many go without food on a regular basis. So many others are food insecure, but that doesn't mean they have not felt the pain we are talking about. I wanted to say just a couple of words about Senator Stabenow because this has been not just an issue for her, not just a program, the SNAP program, and not just a cause of food insecurity, but it has really been a passion for her. Some people are mission-driven in their work. She has been one of those Senators who has been mission-driven to make sure we are doing everything we can with every opportunity, every budget, every season of the Senate; that we do everything we can to help the most vulnerable. Someday, many years from now when many of us may not be around, there may be folks who are chronicling or summarizing the history of the Senate on particular issues. I am sure, just as we make reference to work that has preceded us or Senators who have preceded us--I have no doubt when a Senator stands up on this floor years from now, maybe even decades from now, and they talk about the Supplemental Nutrition Assistance Program, if they start to itemize or catalog or list the Senators who had the most profound impact on this program, Senator Stabenow will be one of very few who will be listed in such a chronicle of the advocacy done for the SNAP program. William Jennings Bryan said a long time ago, in a different context, but he said it well about a cause, about how one person can make such a difference on one issue or one cause. We have seen some of that lately with Americans demanding action on a range of issues--marching and protesting for criminal justice reform or changes to policing or advocates for healthcare or whatever issue, whatever cause. William Jennings Bryan said it well. I think he said it in 1896: ``The humblest citizen in all the land, when clad . . . in a righteous cause, is stronger than all the hosts of error.'' ``When clad . . . in a righteous cause, is stronger than all the hosts of error.'' I think what he meant by that is that one citizen can have a huge impact. What we have even with Senator Stabenow's work is one Senator who can have an impact. This has been for her, I know, her righteous cause, and the country is better for her service and better for her work on this issue. What are we talking about here? When we say food insecurity, that may not sound too threatening to a lot of people. That means you are hungry. The person we are talking about might be an adult, but all too many times it is a child. When a child is hungry, it is hard as an adult to really fully understand what that means. I never lived a day of my life when I was hungry the whole day or the second day or the third day, so I really can't explain it. I never experienced it. I think that is probably true of most Members of Congress. Maybe growing up for some, they were, but many, of course, now don't feel that sense of food insecurity. It is a devastating reality for tens of millions of Americans. That was the case before the jobs crisis, before the COVID-19 public health crisis. It is ever more so now in the aftermath of the onset of the virus and while we are still in the grip of this COVID-19 disease--what we know and are describing worldwide as a pandemic. The pandemic has only made this crisis worse. Even more urgent is the crisis of food insecurity and economic insecurity. The unemployment numbers that we see now are further exacerbating what were already the undeniable realities of hunger, poverty, and food insecurity in this country. I know, for example, in my home State of Pennsylvania--I haven't seen the May numbers yet, but April numbers were high: 15 percent unemployment, 975,000 people out of work, heading toward a million people out of work in one State. I am certain that number will be lower in May, and thank God for that, and I hope lower in June again. When you are saying in one State there are hundreds of thousands more on top of the unemployed numbers from March, you can understand the terrible impact. When we talk about unemployment, that often leads to food insecurity, and that may lead to the kind of desperation that hunger can bring. You are talking about real pain in the lives of people--physical pain in an adult but especially in a child who may not be able to articulate the pain they are feeling. They may not be able to function, literally. They may not be able to function in any way. They certainly can't learn in school. No human being can learn and grow if they are hungry all the time--no one, not the strongest person we know. I come from a heritage of people who left Ireland because of hunger. They called it the Great Hunger at the time. When policies were put in place or actions were not taken and hundreds of thousands of people starved, millions left Ireland, just like people leave their homelands today to escape hunger, to escape poverty, and even famine itself--the most extreme version of hunger around the world. We are talking about real physical pain. We are not just talking about a casual missing of a meal or being a little bit hungry, as so many of us have never experienced. It is pain, but it is also fear. Imagine the fear of a parent. I can't even begin to imagine as a parent knowing that, for a lot of different reasons--job loss or other adverse circumstances in your life--you cannot afford to feed your children. That one person might have both the pain of hunger and the total fear of not being able to feed your children. If we are not doing something about that in the Senate, we are just not doing our job. We say: Oh, the CARES Act did this and the CARES Act did that. Well, do you know what? We have been trying for months now, on the Democratic side of the aisle in the Senate, to get a couple of things done. What are they? No. 1, increase in SNAP benefits by 15 percent. Why can't that be done in the Senate when we know the pain and the reality of hunger? Increase the minimum benefit level. Why can't we do that in the Senate? We passed, what, five bills for $3 trillion, and we can't add more money to the SNAP program? I know, we did it in an earlier bill. Let's stop patting ourselves on the back for that. Let's do something transformative or at least do something substantial. Let's not even get to transformative. Let's get to substantial help for Americans who are hungry right now, folks who are low income and are hungry; folks who had a job and lost their job are hungry. They may benefit from a food pantry or a food bank. We are not doing enough for them either. We are certainly not doing enough for the Supplemental Nutrition Assistance Program, the most vulnerable among us. Thirdly, in addition, increase the benefits overall by 15--the minimum benefit level. We should put a stop to the rules the administration has been cramming down the throats of Americans so that less people will get the benefit of the SNAP program. The administration is dead wrong about that. They haven't just doubled down on pushing these draconian changes to the program, but they recently appealed a court ruling that put a temporary pause on one of the rules. I don't know the words for that--heartless, callous--but it is not good for any of us. It is a stain on the moral fabric of America when any administration does that. I know Senator Stabenow and her colleagues on the Agriculture, Nutrition, and Forestry Committee--we should use the middle word more often than we do. It is not simply the Ag Committee. It is the Agriculture, Nutrition, and Forestry Committee. The nutrition part of it has been the subject of some good working relationships on the committee. I want to thank Senator Stabenow for her work again. I appreciate the work she has done with Senator Roberts. We have to do more than we have done on this program. I was proud a couple of years ago to finally--after attempt after attempt, year after year--finally, to get the Global Food Security Act passed. People have been waiting for that from the time Dick Lugar served in the Senate all the way through the time I teamed up with former Senator Johnny Isakson. We got the Global Food Security Act done, which meant that the Feed the Future Program--that great program the Bush administration started and the Obama administration brought to fruition--was codified in law. That was a good day for world food security. That was a good day for the world when America showed that we know how to do this, that we know how to help countries grow their own food and provide food security. Yet we haven't done enough here. We never can say we have done enough here if we are not funding at an adequate level in the middle of a pandemic, in the middle of a public health emergency, and in a jobs and economic emergency. We can't say we are doing enough if we are not going to invest in SNAP. I have a lot more to say, but I know I am over my time. Let me make one final point. The moral case is unassailable here. There is no disputing the benefit of this program, especially now. So I think the moral question is settled. I just hope folks will consider it. How about the economic case? Say that you are a Member of Congress and that you don't like this program. There are not many people who would admit to that, but you don't like it, and you don't want to add more funding to it. That is your position. That is a morally objectionable position, but let's say that is your position. You could also be for an increase to the SNAP program because it is a good bang for the buck, OK? So if all you are interested in is going back home and saying ``Do you know what I did today? I voted for a program that will more than pay for itself, and it will help everybody''--if that is what your game is and if that is what makes you happy, your going back to your community, to your State, then fine. This program, the SNAP program, is a great bang for the buck. If you spend a buck on SNAP benefits in an economic downturn--and I will make sure I cite the source here. It is the U.S. Department of Agriculture's Economic Research Service. Guess what. You will get $1.50 in return, maybe even as high as $1.80. Let's go with the current number of $1.50. That is a pretty good ROI, return on investment. If that is all you care about, is a return on investment, and you don't care about the program--you are not really troubled by food insecurity, and you are not really persuaded by the pain of hunger-- then support it because it is a good bang for the buck. That would make sense. That is the American way to consider what we should be doing here. Consider the moral case, which should be enough, but you can also consider the efficacy of the program--the effect, the value--in an economic sense. We are all better off when SNAP is funded at an adequate level--all of us--because of that bang for the buck and because when people get SNAP dollars, they spend them. Guess what. That is good for all of us. It is good for our local economies, and it is good for our State economies. It is good for producers, for the people transporting the food, and for the people marketing the food. That is why farmers and people in the ag sector of our economy are sometimes the biggest proponents of the SNAP program. This is the right thing to do to try to ease some of that pain--that awful pain--that children feel in the middle of the night, in the morning when they wake up, at lunchtime when other kids are eating something and they may not be eating, especially now that they are away from school, at night, and when they go to bed at night. So let's come together and get something done. There is some good news in that we might be considering another bill, but let's meet our obligation on the Supplemental Nutrition Assistance Program. If others who have been reluctant to do that vote for this and support this, then you can do all the pats on the back that you want, but let's do the right thing for America, especially for those suffering from the pain of hunger. I yield the floor to the senior Senator from Michigan.

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

Mr. CASEY

Mr. CASEY. Mr. President, in reserving the right to object, I don't have a problem--nor do, I am sure, a number of Senators--with Senator Johnson's bill. I am objecting on behalf of the Democratic Senators so we can start a conversation about helping all of the air traffic controllers in this country receive 12 weeks of paid parental leave, starting on September 30, 2020. We did a great thing here in the Senate for other Federal employees last year in the National Defense Authorization Act that the President signed, but these air traffic controllers were accidentally left out. I think--and I am sure this is true of many who agree with me--that if the chairman would take a look at Senator Schatz's bill to fix that, these hard-working moms and dads would be very appreciative. Therefore, I object.

Mr. CASEY. Mr. President, I think the reference was to Senator Schatz's bill, and I am just asking, on behalf of the Democratic Senator, if the chairman would take a look at that bill.

Mr. CASEY. Mr. President, as we conclude the hour in the next 10 or 15 minutes, let me start my remarks by thanking my colleagues who joined us tonight. I thank Senator Whitehouse, who has worked with us on this legislation from the very beginning, on introduction, and so many who are cosponsors on the legislation--Senator Hassan from New Hampshire and Senator Shaheen, the senior Senator from New Hampshire. I thank her for being here and for her comments about this legislation. I also thank Senator Blumenthal. I wanted to start just for a few minutes before we conclude with this chart. This is a chart depicting a map of the United States that is dated June 27 from the New York Times. The summary reads: ``In at least 24 states, a majority of deaths are linked to nursing homes.'' Of course, I mentioned at the outset the deaths, as of a few hours ago, of more than 54,000 people, when you add up the residents and the workers, comprising 40 percent of the deaths nationwide. You can see when you break it down by State, my home State of Pennsylvania is at 68 percent--a majority of the deaths--linked to nursing homes. States just to the south, where there is Virginia at 61, Maryland at 61, Ohio at 57, but even further south, North Carolina is at 57. Then you go out into the middle of the country, and in North Dakota, 64 percent of the deaths were linked to nursing homes; Minnesota, 77 percent. There are not many that are below 30 percent-- only a few. Those are the numbers, but of course the numbers don't tell the story. We need a plan for this. This is not the America we should accept. This isn't America, where we just throw up our hands and say this virus is so terrible, so aggressive, and the COVID-19 disease is so destructive--the results from the virus--that we are going to accept another 54,000-plus deaths in the United States of America and not have an action plan There is no action plan right now. The Centers for Medicare and Medicaid Services and other parts of the Federal Government have only recently started to speak to this issue, but there is no plan. Unless we have legislation that the majority not too long ago in this hour just objected to--a big part of the solution is to invest in proven strategies, best practices like cohorting, where you separate COVID-19 residents in nursing homes from residents who do not have the disease-- that works; we know that works because it has worked in real time in lots of places in the country--as well as the other investments we can make in surge capacity to add professional help in the form of more doctors, more nurses, and more certified nursing assistants when a nursing home is being overrun. No one here is saying that the Federal Government is the only entity responsible for this. Nursing homes have to do more, and governments at all levels have to do more. But the Federal Government is the payer and the level of government that comes up with rules and regulations and law that governs what happens in a long-term care setting. So this bill, S. 3768, which has now been objected to by the majority--and I am still waiting all these weeks and months now for the majority to come up with their nursing home strategy to get the death and case numbers down. We are still waiting for that. This bill, S. 3768, would provide $20 billion in emergency funding. When you consider all that has been invested in so many other priorities, the least we can do is to invest in proven strategies for our nursing homes. It would provide support for personal protective equipment for nursing home workers who are doing that heroic work every day. Some of the funding would go for testing, as I mentioned, cohorting, surge teams, and so much else. The bill is supported by the AARP, the Alzheimer's Association, and 25 other organizations representing seniors, people with disabilities, nursing homes, and other providers. This is what we need to pass now to have a strategy in place because we cannot wait for the administration because they seem to have no sense of urgency with regard to this problem. This is an American problem that was created here in response to a virus. No one would argue that the American people cannot come up with a strategy to get the death numbers and case numbers down. Who are we talking about here? We are talking about two groups of Americans, right? The residents and the workers. The residents--we are talking about those residents in nursing homes. These are Americans who fought our wars. These are Americans who worked in our factories and Americans who raised families year after year, decade after decade. These are Americans who built the great American middle class. These are the Americans who built this country, and they gave each of us life and love and a strong foundation personally but also in terms of the strength of our country. The least we can do--the very least this Senate can do is to make sure we at least have a strategy. Are we just going to throw up our hands and just say there is nothing the most powerful institutions in the world can do to reduce the number of nursing home deaths? As I said before, we don't want to be standing here 3 months from now, 6 months from now, talking about another 54,000 or 55,000 nursing home deaths. Is that really America? We are still waiting for the administration. We are told that by one estimate, 12 to 18 nursing home residents have died per hour, every hour over the last several months--12 to 18 nursing home residents dying every hour. So we can't and should never allow another hour to pass without action. The majority has allocated a lot of time for nominations the last 2 months or more, a lot of time for other issues, but not time for COVID- 19 strategies to reduce long-term care deaths in nursing homes. So the time now is not for debating nominations for agencies; the time is long overdue for us to take action to deal with this American tragedy of deaths of residents in nursing homes and deaths of workers. While we are talking about those workers, they do heroic work every day. They go in to do this work, expose themselves to the virus, expose their families to the virus, and they do back-breaking work, often for pay that isn't commensurate with the nature and sacrifice and the dignity of their work. So they are heroic. If there were ever a group of front-of-the-frontline workers--these are not just frontline workers; they are at the very front of the line. We should make sure they have protections in the nursing homes to do their work but also pandemic premium pay, as we call it, and so much else. I ask a parliamentary inquiry: How much time is remaining?

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

Mr. CASEY. Mr. President, we are going to be talking tonight about nursing homes in the context of the COVID-19 disease. I will start with the numbers, which I think most Americans, unfortunately, know by now. Every day we see the number of cases and the number of deaths. I don't know exactly the number today, but it was somewhere around 127,000 deaths. Yet a number they may not know are the numbers when it comes to nursing homes. More than 54,000 residents of nursing homes or workers have died--more than 54,000. They account for more than 40 percent of all the deaths in the USA. To say this is unacceptable in no way begins to describe the gravity of this, the tragedy, and the failure by the administration to deal with it and to have a strategy to get that number down. I hope the administration and I hope Members of Congress would commit themselves today to say that when we come back here 3 months from now, 4 months from now, 5 months from now, that we are not again saying 54,000 more people died in nursing homes. I hope there will be an effort made by the majority in the Senate to make sure we are working together with the administration to get that number down. I don't sense that the administration has any kind of a strategy here at all because if there were a strategy, that number would never be as high as it is. I will have more to say later, but there is something we can do in the Senate and that is to pass legislation to do a couple of things. No. 1 is to focus dollars on the problem. In this case, we have nursing homes across the country that never implemented the kind of practices that would help them to reduce the number of deaths in nursing homes. We know there are best practices that work. We know that when a nursing home is given the resources to separate those with COVID-19 from those who don't have it, so-called cohorting--it is a phrase we should become familiar with, ``cohorting''--if that happens in a long-term care setting, the death number will go down for sure, and the case number will go down, but not enough places are doing that. We should help them do that. I have legislation to do just that. We also know there are best practices with regard to investing in strategies that will surge medical support for nursing homes to get more professionals to be brought to bear on a problem in a nursing home. There is a lot we can do. I will have more to say about it in a moment, but I know we want to get to a unanimous consent request. This is not going to be good enough for us to just curse the darkness and say how bad this is and how unacceptable it is. We have to act. That means the Senate has to pass legislation which includes dollars-- funding--so we can have better practices in our nursing homes. I hope those who will say that is not what we should do have a good plan, a good strategy. Let me start with a unanimous consent because I know we have to get that done here. Mr. President, I ask unanimous consent that the Health, Education, Labor, and Pensions Committee be discharged from further consideration and the Senate proceed to the immediate consideration of S. 3768, the Nursing Home COVID-19 Protection and Prevention Act of 2020. I ask unanimous consent that the bill be considered read a third time and passed and that the motion to reconsider be considered made and laid upon the table.

Mr. CASEY. Mr. President, I have just a few more minutes, and I will be done. I won't go through the details of this report, but I want to note for the Senate two things. No. 1, we will be introducing--I will, and Senator Peters, the ranking member of the Homeland Security and Governmental Affairs Committee, and Senator Wyden, the ranking member of the Finance Committee--the three of us and our offices will be releasing a report about nursing homes. The report is entitled ``COVID- 19 and Nursing Homes: How the Trump Administration Failed Residents and Workers.'' This is a chronicle of deadly delay and a chronicle of a lack of real urgency on behalf of the administration. I hope the administration is reaching that point of urgency and is going to deliver to the American people a plan to get the death numbers down, to get the case numbers down in nursing homes. We haven't seen that sense of urgency. This report includes nine findings and nine recommendations, so no one can ever accuse us of just cursing the darkness of this tragedy without bringing the light of solutions to this issue. There is more that I could say, but just for the record, as I conclude, I ask unanimous consent that the written comments that my office received from two constituents with concern about their loved ones in nursing homes be entered into the Record. Just for the record, I will read the names of the family members: Thomas and Barbara Taylor of Coatsville, PA. The Presiding Officer is a native of Redding and knows what I am talking about when I mention these names. Joette Peters of Manheim, PA, is also a part of this, as well as Amy Lowenthal, who had a relative. Her dad, David, was a geriatrician in Philadelphia. Her comments are about that. I ask unanimous consent that these written comments from constituents be printed in the Record

Mr. CASEY. Mr. President, I yield the floor.