Bill Cassidy

Mr. CASSIDY

Mr. CASSIDY. I yield back.

Mr. CASSIDY. Mr. President, today I wish to discuss the historic rehabilitation tax credit. During the Finance Committee markup of the Tax Cuts and Jobs Act, the committee adopted my amendment to return the historic rehabilitation tax credit to the 20 percent level, with the credit now claimed over 5 years, as well as a transition rule to grandfather approved and underway projects under the prior law and regulations. The historic rehabilitation tax credit program provides jobs and investment in communities across the country. More than 40 percent of projects over the past 15 years have been located in communities with populations less than 25,000 people. Since 2002, the historic rehabilitation tax credit has facilitated 782 projects in Louisiana, bringing more than $2.2 billion of investment into cities and towns across the State. I am pleased this important provision will be preserved in tax reform. For purposes of the transition rule in my amendment, ``taxpayer'' refers to the person who undertakes the rehabilitation of a building. In the case where a person makes an election under section 48(d), the term ``taxpayer'' means the lessor, since the lessor is the person who undertook the rehabilitation. It is intended that the historic rehabilitation tax credits be available during the transition period only to the extent such credits would have been available under the prior law and regulations. Mr. President, I am proud of the work we have done in the Senate to develop a bill that delivers tax cuts to working families and significantly improves the competitiveness of our Tax Code. This will lead to greater investment, more jobs and opportunity, and an increase in economic growth. I would like to take a moment to highlight an important, unresolved issue that we should consider as we work toward putting a bill on the President's desk. Families in Louisiana are particularly prone to the negative impacts of natural disasters. From Hurricane Katrina in 2005 to historic flooding in multiple parts of the state during 2016, we have unfortunately seen some significant losses in our State; yet as we saw once again with the recent Hurricanes Harvey and Irma, Louisianans are resilient and watchful of neighbors through the tragedy and the recovery. One aspect of recovery that many people don't see is the enormous amount of capital that flows into the storm zone from the reinsurance industry. In simple terms, reinsurance is insurance for insurance companies, and it helps Louisianans rebuild their homes, their businesses, and their lives. Reinsurance transfers risk from the balance sheets of property and casualty insurance carriers so those companies can provide cost- effective solutions to consumers and businesses. A robust reinsurance market helps ensure that policyholders are getting the best rates possible on insurance for their homes and businesses. Many of the largest reinsurers in the world were founded in Europe 100 years ago or more, and a number of them do business in the United States through U.S. subsidiaries. My concern is the potential impact of the bill's base erosion provision on the reinsurance market and policyholders along the gulf coast. The base erosion provision has the rightful intent of targeting bad actors who implement strategies to avoid U.S. taxes; yet the provision may have an unintended consequence of negatively impacting cross-border reinsurers conducting normal transactions, which could affect the market and premiums. Reinsurance is critical to families and businesses in Louisiana, particularly after a natural disaster, and I hope to work with my Senate and House colleagues on this matter as we work to get the bill to the President's desk.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I would like to take a short break from talking about the tax bill to talking about something equally as important and much more poignant. I will first recognize and honor fellow Americans serving overseas in our military--men and women dedicating their time and effort to keep our country safe. Working far from home and often in danger, every day they risk their lives to defend our freedoms. Today, I will talk about one in particular, U.S. Naval Airman Matthew Chialastri, who not only risked his life but gave his life. Matthew was born and raised in Louisiana. He graduated as the valedictorian from Woodlawn High School in Baton Rouge, class of 2013. There, he was a member of the JROTC Program, and after graduating, he chose to enlist in the Navy. After completing his training, he began his Active-Duty service with Patrol Squadron 30, a P-8 training squadron. Then he served aboard the aircraft carrier USS America, from December 2015 to October of this year. He was then sent to Commander Fleet Activities in Japan to begin preparing to join the USS Ronald Reagan. During the course of his service, he earned the National Defense Ribbon and the Navy Battle ``E'' Ribbon. Sadly, on November 22, during a transport flight to the USS Ronald Reagan, Matthew's cargo plane was forced to make an emergency landing in the Philippine Sea. Eight survived. Three did not. Matthew and two of his fellow Navy servicemen lost their lives in service to our country. This is a terrible tragedy. Our hearts go out to Matthew's family-- his mother, Marty, and father, Phillip, his fellow sailors, and his friends in Louisiana. We grieve with them. As one of his former high school classmates said, Matthew could have had any scholarship he ever wanted to any school. He could have gone anywhere he wanted. He just believed that serving our country was first. That was his everything. Others who knew him described Matthew as smart, dedicated, and a strong leader. They said he could always make those around him laugh with his dry sense of humor and smile. As Americans, we mourn the loss of Naval Airman Matthew Chialastri. As folks from Louisiana, we mourn the loss of one of our own, but we honor his memory and the example he set for those of us who benefited from his willingness to sacrifice. We thank him for choosing to serve, for his sacrifice. We are forever grateful. I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, the last 8 years were really hard for a lot of families. They have seen their wages stagnate and their benefits not go up. Indeed, what they have been paying for health insurance and flood insurance and many other things has risen even though their wages have not. So the goal of this bill is to decrease taxes on those middle-income, working families in order to give them the opportunity to have better wages, better benefits, and to bring relief to situations that are peculiar. Are they peculiar to Louisiana? No, they are not peculiar to Louisiana, and I will elaborate on that in just a second. What could middle-class families in Louisiana do with better wages? They could pay off debt. They could provide more for their children. They could just live life a little bit more robustly and not have to, perhaps, move out of one home and into another because they can no longer afford the mortgage on the first. The goal of this is, first, to bring tax relief to working families and middle-class families. It is all part of an effort to cut taxes particularly for them. Now let's talk about raising their wages. Folks want to have more money in their take-home pay after taxes, but they also want to have higher wages and better benefits. This bill definitely creates that. Our current Tax Code encourages companies to move overseas. When they earn money overseas, they keep it there and build plants and factories in other countries. They employ folks in other countries but do not bring that money home, employ Americans, or raise wages or give better benefits to those Americans. This changes that. Not only do we have tax cuts for the middle class, for working families, but we also encourage businesses to invest here, to create better paying jobs here. I have heard some say: Well, wait a second. Unemployment is low now. Why does it matter? Now is the time when workers most benefit if there is investment that creates more opportunity for those here in the United States. If there is a worker who is a welder and if he can either work here or there, businesses are going to bid for his services. They are going to pay more to get him to work. As they do that, just from supply and demand, wages will go up for the average American worker, for the average American family. Benefits will rise for those families, and the children of those families will have more opportunity. This is what that is about. There is another way in which we bring relief to those middle-income families. Part of what we are doing here is repealing the mandate of the Affordable Care Act. Americans hate the government's telling them what to do. Yet, as part of the ObamaCare mandate, it tells someone: Even if you cannot afford that insurance, even if you don't buy it, we are going to make you pay a fine. In 2015, more than 100,000 folks in Louisiana paid a fine for not having health insurance, and 37 percent--almost 40 percent--of those folks had an adjusted gross income of less than $25,000; 78 percent had less than $50,000. Think about this. The families who report incomes of $50,000 or less cannot afford insurance, and they are having to pay a fine because they have not. They are not millionaires or billionaires. These are families who are trying to make ends meet, who make a decision because the exchange policies are too expensive for them to buy, and now they are getting fined. This is part of the relief we are bringing to those working families by getting rid of that mandate. Lastly, there is another form of relief. Louisiana had its great flood of 2016, which was similar to Maria, Irma, and Harvey, but this was an unnamed storm that affected tens of thousands of people. Through this bill, we bring disaster relief to the folks in Louisiana. They will be able to deduct their losses from their incomes, which will allow them to rebuild their homes and allow them to rebuild their businesses. As they rebuild those businesses, it will allow them to employ those who need jobs so that they may rebuild their homes and their lives. This bill will cut taxes for those families. It will increase their wages and bring relief not only from economic stagnation but also from a natural disaster that was one of the most expensive storms in our Nation's history. I am very pleased that this bill is advancing, and I look forward to it being passed. I look forward, most of all, to the increased wages, lower taxes, and the relief that it will bring to those families in Louisiana. I now yield the floor to the Senator from South Dakota.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I wish to add my words to those that have been said. Let me begin by saying that the achievement of this tax proposal is not about anyone in this Chamber; it is about the working families who for the last 8 years have not done so well. They have either lost their jobs or their wages have been flat and their benefits have not improved or, indeed, the cost of those benefits have risen dramatically. I can say, with the Tax Cut and Jobs Act that is being introduced today, they will increase their take-home pay, they will have higher wages, and they will have a better life. Now let's talk about how that would be. How will these working families improve? The Presiding Officer, the Senator from Ohio, mentioned in his remarks that businesses will have money to invest. There will be competition for workers. And if there is competition for workers, then workers are paid more. They are given better benefits. What do those better benefits and better wages mean? It means they can invest more in their family, in their children's future, and that, in turn, will change their family's life for generations to come. So on behalf of those working families, I echo Chairman Hatch, that if there is a suggestion by anyone that can make this better, I ask them to bring that suggestion forward because this is not about Republicans, this is not about Democrats, this is not about anybody in this Chamber; it is about those working families who, for the last 8 years, have not done as well as the American dream would say they should. On behalf of those working families, I congratulate Chairman Hatch for this job. I look forward to the passage of this bill, and I look forward to all of the benefits of this bill coming to help the families of this country and in my State of Louisiana. Thank you. I yield the floor. I suggest the absence of a quorum.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, this is not about the budget, but it is about something that all of us can, unfortunately, understand the importance of. On Sunday, October 1, U.S. naval aviation instructor, LT Patrick L. Ruth, and student naval aviator, LTJG Wallace Burch, were both killed when their Goshawk training jet crashed in Tellico Plains, TN. Lieutenant Ruth was a native of Louisiana, growing up in Metairie. Lieutenant Ruth served in the Navy for 9 years, beginning his career in the Naval Reserve Officer Training Corps at Tulane University. He was commissioned in May of 2008. After flight training, he joined Carrier Airborne Early Warning Squadron 126, based in Norfolk, VA, in 2012. Lieutenant Ruth flew the E-2C Hawkeye as part of the tactical air forces of the U.S. Navy. His primary mission was early warning defense of the carrier battle group, as well as air strike control, ocean surveillance, and search and rescue coordination. In April 2015, he moved to Naval Training Squadron 7, based in Meridian, MS. As an instructor, Lieutenant Ruth trained the next generation of naval aviators in strike aviation, basic aircraft maneuvering, and landing skills. Lieutenant Ruth was a dedicated naval aviator. As evidence, he earned two Navy and Marine Corps Achievement Medals during his distinguished career. Our brave men and women in uniform take extreme risks every day to defend our Nation. The risks are necessary, made to ensure that our military is fully prepared to face any threat. We are forever grateful for Lieutenant Ruth and those who answer the call of duty to keep us safe. We must also think of the incredible sacrifices of Lieutenant Ruth's family and all military families. They may not be wearing uniforms, but they, too, serve our country. I had the privilege of speaking with Lieutenant Ruth's family. I learned that his younger brother Shane is Active Duty Navy. His older brother is retired Navy. His sisters were, and are, so supportive. Lieutenant Ruth's parents, David and Mary Ann Ruth, still grieve. How could any parent not? But to borrow from President Lincoln's letter to a grieving mother: I pray that our Heavenly Father may assuage the anguish of your bereavement, and leave you only the cherished memory of the loved and lost, and the solemn pride that must be yours to have laid so costly a sacrifice upon the alter of freedom. Lieutenant Ruth is survived by his parents, David and Mary; his fiance, Jessica; and his four siblings. We grieve with you. You are in our prayers. Lieutenant Patrick Ruth will not be forgotten. I yield the floor.

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

Mr. CASSIDY

Mr. CASSIDY. Mr. President, the Presiding Officer has been presiding on many occasions when I have risen to speak about the need to repeal and replace ObamaCare, and although we did not succeed in our last effort in the beginning of August, I, personally, along with Senators Graham, Johnson and Heller, am making one more try, and folks ask why. The simple answer I can give is, there is a fellow back home by the name of Moon Griffon. He is a conservative talk show host who speaks with passion about the Affordable Care Act. Why does he speak with passion? Moon Griffon is very open. He has a special needs child, and he has to buy insurance. His premium per year is over $40,000--$40,000, with a $5,000 deductible and an additional deductible for his pharmaceutical costs. He has to pay $50,000 a year for insurance, deductible, and pharmaceutical deductible. The mortgage payment for a $500,000 home is what he puts up because he has to buy insurance. He has a child with special needs. Now, there are many Moon Griffons across our Nation. Someone said, kind of as a wag, but I think there is a ring of truth to it, that ObamaCare, the individual exchange, only works if you don't because if you do work and you don't qualify for a subsidy, then you cannot afford it. By the way, I think there is bipartisan agreement on this. Senator Bernie Sanders is now putting forward what we would call BernieCare, a single-payer proposal. He would not be putting that forward if he thought the status quo is working. He is putting it forward because he realizes it is not. He has 16 cosponsors, if you will. Cosponsors are a testament to the fact that the status quo is not working. Well, I can tell you, since Medicare is going bankrupt in 17 years, the seniors who are on it will have their benefits threatened by adding another 150 million more Americans to the program. Those who have employer-sponsored insurance, I don't think they will want to give up their employer-sponsored insurance and trust in BernieCare. So our last hope, we think, is relieving folks from the burdens of the Affordable Care Act in a way that preserves President Trump's goals of caring for all, taking care of those with preexisting conditions, covering all, lowering premiums, and eliminating mandates. We have the basis of an approach. This past week, the HELP Committee has been having hearings, as well as the Finance Committee. Both Democratic and Republican Governors, insurance commissioners, stakeholders of other sorts, Medicaid directors, and all, whether Democratic or Republican, Governor or Medicaid director or insurance Commissioner, have said that if we give the States the flexibility to come up with their own solutions, they will find solutions that work better for their State than the Affordable Care Act--and it makes total sense. Clearly, Alaska is different than Rhode Island. Louisiana is different than Missouri. If we can come up with solutions specific for each State, as opposed to a one-size-fits-all that comes out of Washington, DC, these Governors, Medicaid directors, and insurance commissioners of both parties think we can do a better job. We have a model of this. The Children's Health Insurance Program, also known as the CHIP program, has been very successful. It works on a block grant that comes down to States. States pull down the dollars. They can roll over money for 2 years, and they provide a policy for the children in their State. There are certain criteria and safeguards regarding what that policy must look like. In fact, Senator Ron Wyden, last night, finished up his remarks praising the CHIP program, that it was reauthorized and what a victory for the health of children because this is a program that will work. There is a little irony there, as Senator Wyden had just finished criticizing the Graham-Cassidy-Heller amendment, which is patterned after the CHIP program. The irony, of course, is that he says our amendment will not work, and then he goes on to praise the program through which the money will flow and after which it is patterned. What we do through the program is take the dollars going to States currently through the Affordable Care Act, and we pool them together and deliver them to States in a block grant, very similar and, indeed, through the CHIP program. Along that way, we equalize how much each American receives toward her care, irrespective of where she lives. Why do I say that? Right now, 37 percent of the revenue from the Affordable Care Act goes to Americans in four States--37 percent of the revenue goes to those who live within four States. That is frankly not fair. I have nothing against those four States, but I don't see why a lower income American in Mississippi should receive so much less than a lower income American in Massachusetts or why someone in Arizona should be treated differently than someone in New York. I think we should equalize that treatment. Americans think that is fair. We do that with Medicare and Social Security and other popular programs. It is something we should do, as well, as we attempt to provide insurance for all to achieve President Trump's goals. One example of this, by the way--Pennsylvania has twice the population of Massachusetts. Both of those States expanded Medicaid. Massachusetts gets 58 percent more money than does Pennsylvania. Again, Pennsylvania has twice the population of Massachusetts, but Massachusetts gets 58 percent more money. Both Northeastern States have cities with a high cost of living, but somehow Massachusetts does that much better. Our goal, though, is through this grant that goes through the CHIP program--which Senators like Senator Wyden have praised, and rightfully so, as being an effective program for improving health, with safeguards needed to make sure the money is used wisely and that all States and all residents within those States will receive about the same amount of money toward their healthcare. This would be, if you will, not a Democratic plan, not a Republican plan but an American plan, in which Senators vote to trust the people in their State over a Washington bureaucrat. We have critics who don't understand our bill. It is a partisan bill, we are told. No. If you look at the residents of the States who do better under our plan, it includes States represented by Democratic Senators. Virginia does far better because they will get the dollars they currently do not--as do Floridians, represented by a Democratic Senator; Missouri does, represented by the Presiding Officer now but also by a Democratic Senator; and others that are represented by Democratic Senators, but the lower income Americans in those States actually have resources they currently do not have. Indeed, I implore those Senators not to vote a party line but rather to vote for those lower income Americans in their States so they can have the resources needed for their better health. I will conclude by saying one more time: We have one more chance. On the Democratic and Republican sides, we recognize that the Affordable Care Act is unsustainable. On the Republican side, we want to give power back to the patients, back to the States, fulfilling the wish of those Democratic and Republican Governors, insurance commissioners, and Medicaid directors to give them the flexibility to do what they wish to do. The Democratic vision, BernieCare, if you will, of which he has 16 cosponsors, is to consolidate every decision in Washington, DC. As for me, I will vote with the States, I will vote with the people, and I will vote with the wisdom of the average American as opposed to the benign ``we know better than you'' attitude of Washington, DC. Thank you. I yield the floor.

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

Mr. CASSIDY

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

Mr. CASSIDY. Mr. President, I ask for the yeas and nays.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, today I would like to recognize and honor the president-elect of the Louisiana REALTORS, Mrs. Pam Foreman Testroet. Pam is a distinguished realtor in Louisiana whose career has been defined by her devotion to ethics and her ability to make people comfortable while making important life decisions. The Louisiana REALTORS, LR, is a trade association tasked with helping its members in the business of real estate in Louisiana. LR represents its members on real estate issues before the State and Federal governments while also providing legal assistance and professional development opportunities. As president, Pam will ensure LR achieves its mission of ``providing optimum member resources while serving as the advocate for REALTORS and consumers.'' Pam began her career in Baton Rouge working for the Louisiana State Legislature and the constitutional convention. She held various jobs in New Orleans and Houma, LA, before pursuing her dream of a career in real estate in 2003. After receiving her real estate license, Pam became actively involved in REALTOR organizations, serving as a director on boards at the local, State, and national levels. Pam's top career priorities include client satisfaction, ethics, communication, technology, and education. As evidenced by her numerous awards, Pam has excelled at those priorities. Pam's awards include: 2005 Rookie of the Year, 2007 REALTOR of the Year, 2008 Congeniality Award, 2010 RE/MAX Cooperative Spirit Award, Louisiana REALTORS 2013 REALTOR of the Year, 2016 Louisiana REALTORS secretary/treasurer, and, finally, 2017 president-elect of Louisiana REALTORS. I would like to congratulate Pam on her astounding career and her ascension to the position of president of the Louisiana REALTORS. Her election as president is a testament of her work ethic and the positive impact she has had on those with which she has come in contact. I know Pam will excel in this position, and I am proud to have her in the great State of Louisiana.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, we are struggling right now to find a replacement for the Affordable Care Act. The American people have voted in four successive elections for such a replacement, culminating in the election of Donald Trump to be President of the United States. Now, one can ask oneself, if the Affordable Care Act is so great, why would the American people continue to want to have a different program? I think the wisdom of the American people is that they do not want the government so intrusive in their lives, and secondly, there is a sense that somehow the Affordable Care Act is not entirely fair, that perhaps there are some who do better under the Affordable Care Act than others. Our country is about equity. By the way, I am a physician, and for 25 years I have worked in the public hospital system of Louisiana trying to get healthcare for those who otherwise did not have it. I am all about those who do not have insurance or those who are fully insured getting better care. Ultimately, to have better care, there has to be adequate financing for that care. So we begin to look at the numbers that underlie how the Affordable Care Act--ObamaCare, if you will--finances healthcare across the Nation. It is very interesting. If you look at the numbers from Health and Human Services, three States--Massachusetts, California, and New York--get 37 percent of the money that ObamaCare spends on Medicaid expansion and health insurance access. Three States get 37 percent. And although I don't have an accurate depiction of what the demography is, I estimate their population to be roughly 18 percent, if that much, of our Nation's total population. So they get twice as much, if you will, on a per- beneficiary basis than the rest of the Nation put together. That is not fair. And if we are going to provide access for patients--our fellow Americans--to healthcare, ultimately we have to have adequate financial resources to do so. My colleague Senator Graham will speak in more detail about the inequities between the States, but let me just say as a guideline, how do we create equity? How do we create fairness so it is not just three States that benefit, but wherever you live, if the Federal taxpayers are contributing to your access to insurance, you get about the same amount whether you are in Louisiana, Colorado, South Carolina, Mississippi, or in California, Massachusetts, or New York? That is about equity. What we attempt to do--and we are going to submit this as part of the Graham-Cassidy amendment--is we attempt to establish fairness for all Americans in terms of the support they receive from the Federal taxpayer. What we will do, beginning in 2020, is begin to equalize the payments between those States receiving very little, those States receiving a lot more, and those States that are kind of right where they should be. We do this by beginning with a formula that acknowledges that the poorer the people, the more support they need; the older the person, the higher their medical expenses. So between poverty and age, it is a good starting point about how to divide those dollars. Between 2020 and 2026, we will actually gradually move those high-cost States down, those lower cost States up, and keep those just- about-right States just about right, until at the end, wherever that American lives, she or he is getting about the same amount as every other patient receiving support across the country. When we say this--I am a physician. I know that if you have more disease burden in one State, that is a costlier population. If your average age is greater in one State, that is another aspect of a costlier population. We can go through those sorts of factors. So we do put wiggle room at the end, so that if a State is higher cost because they have more disease, they would get a little bit more money. But on the whole, if you net it out, wherever that American lives, she or he would get about the same amount of money. Senator Graham will go over this in more detail, but it turns out that the average American receiving benefits under the Affordable Care Act--if you combine Medicaid expansion and the tax credits people receive, the average credit is somewhere in the mid-$6,000 range; call it $6,400, $6,500. But if you look at what some States receive, in Massachusetts, it is about $18,000 per person. Now, that is a lot of money. So if the average is $6,600 and in one State it is $18,000, that is not fair. Now, I would submit that if we equalize that treatment; if we just treat people fairly; if no matter where you live, the amount you get is not dependent upon the State in which you live but upon your need, then we can actually provide access. We can fulfill President Trump's campaign pledges of continuing coverage, caring for those with preexisting conditions, lowering premiums--lowering premiums--and eliminating mandates. By the way, it isn't just Republican-represented States that would benefit. We can look at West Virginia. These are some preliminary numbers. West Virginia would receive in 2020 about 43 percent more than they would based upon current trajectories. Indiana would receive about 48 percent more. Let's look at Montana. Montana would receive about--my gosh--Montana would receive over 100 percent more than they are currently scheduled to receive. This takes the money that has already been allocated, and instead of focusing it on three States--there are a few more; call it seven, but those are the States that really bring it home--if, instead of all of this Federal largess going to three States, we distribute it fairly, all Americans can do better. All Americans can do better. Ultimately, we should be about fairness in this Chamber, not about partisan politics. I thank the Chair for the privilege of addressing this issue, and I now defer to my colleague from South Carolina.

Mr. CASSIDY

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

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I rise to speak to the repeal and replace effort that is before us, and the challenge has been how to do so. Senator McConnell has recently introduced a bill, and as we pore over it, there is much to like, but quite likely, there will be some Senators who will still express reservations as to whether this amendment adequately fulfills President Trump's campaign pledges--those pledges specifically to continue coverage, care for those with preexisting conditions, eliminate mandates, and lower premiums. If more is required, Senator Lindsey Graham and I have actually come up with an amendment that we will add to the bill being offered. It doesn't replace it but, rather, it adds to it. In it, we return to conservative solutions that devolve power back to States and rely upon the States to, in turn, devolve power to the patient. So what does this bill do? What we do basically is take the dollars that the Federal Government would give to a State under ObamaCare and we give those same dollars in the form of a block grant. We allow the State to then administer the money in its best way to, one, give patients the power, and two, fulfill President Trump's pledges. We think this works. It is a 10th Amendment solution in which that which is not specifically given to the Federal Government is, in turn, given to the State. Let the States decide what they want to do. Some object. They say: Oh my gosh. A conservative State may do something that we don't think--whoever is speaking--it should be allowed to do. Another might say: Well, I don't think a liberal State should be allowed to do that. Under our bill, we devolve to the State, so a blue State can do a blue thing and a red State can do a red thing. Let's let our States be the laboratories of democracy that teach each other the best way in which to insure others. But we say it will be the State that has the power and not the Federal Government. If you oppose this approach, it means you would trust a Washington bureaucrat more to address the needs of your State than you would trust the people of your own State. We would still have those protections which would allow folks to get the adequate coverage they need. There would still be--for example, preexisting conditions will be covered, fulfilling President Trump's pledge to that end. We would fulfill what I call the Jimmy Kimmel test--that everybody who is ill or has a loved one who is ill would have adequate resources to have that person's illness addressed. We have a precedent as to how this is done. Congress, I am told, when it addressed the Temporary Assistance for Needy Families Program, gave the dollars necessary, with flexibility to the States. Although at the time the solution was criticized as giving too much money to the States, since, the Federal Government has not had to put in more money. Because of the flexibility, the States have been able to use the dollars allocated in such a way as to meet the needs of the population. So what could a State do with these dollars? It could help those patients who are at higher risk or higher cost purchase the coverage they need, perhaps in a reinsurance or in an invisible high-risk pool that would allow premiums to be lowered for those individuals and for all. It could maintain status quo. Those folks getting tax credits instead could have these dollars fund their purchase of insurance. It could be used together with Senator Cruz's amendment, which would allow a health savings account to be used to purchase health insurance. The individual could set up such an account, the State could fund it, and then these dollars could then be used to purchase insurance. I like that, personally. That particular provision was in the Cassidy-Collins bill, the Patient Freedom Act, and it dovetails very nicely with block- granting these dollars back to the States to care for someone. It could directly contract with providers to provide assistance to a specific population. So imagine you have an Indian reservation--or if not an Indian reservation, which might be covered under another source of funding, another fairly isolated population that does not have access to healthcare, the State could say: OK, we are going to come in and provide providers specifically for that population. Alaska may adopt this because they have 700,000 people stretched over a land mass almost as big as the lower 48, and that might be a solution Alaska comes up with, but the point being, the solution would be specific for that State. Unlike ObamaCare, in which, out of Washington, DC, Washington bureaucrats dictate that the same approach be taken across the Nation no matter how different the States are, in this, the money is given to the State, and the State is asked to provide for their citizens in a way specific for the needs of that State. We think the Graham-Cassidy amendment returning power to States and to patients is a conservative solution which ultimately gives the patient more power. I will repeat. This does not replace that bill which is being offered by Senator McConnell. It would be an amendment to that. And if it turns out that some Senators feel as if that particular bill is not adequate to fulfill President Trump's campaign promises, we think this amendment could take the bill the rest of the way. Mr. President, I yield the floor. I suggest the absence of a quorum.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, today I would like to acknowledge and honor Camp Beauregard on its 100th year of service. Named after famed Louisiana General Pierre Gustav Toutant Beauregard, Camp Beauregard is a U.S. Army installation operated by the Louisiana National Guard. For the past century, Camp Beauregard has hosted hundreds of thousands of soldiers training for combat missions all across the world and has served the State and local communities. The site that eventually became Camp Beauregard was constructed in the late 1850s as a military academy. Following the Civil War, the school was relocated to Baton Rouge and renamed Louisiana State University. In the early 1900s, the site became the permanent camp for the Louisiana State National Guard's annual training exercises. The site officially became Camp Beauregard in 1917 as the United States entered World War I. Over 44,000 soldiers trained at Camp Beauregard before the end of the First World War, and hundreds of thousands of men trained at Camp Beauregard during the Second World War. Camp Beauregard is currently the largest National Guard post in Louisiana and is essential to the Louisiana National Guard's efforts to serve the United States, Louisiana, and local communities. Not only does Camp Beauregard serve as a training ground for soldiers preparing for overseas combat operations, the camp also plays a vital role during major weather events and hosts competitions and family events. For 100 years, Camp Beauregard has served Louisianans and Americans alike. I and my fellow Louisianans are proud of Camp Beauregard's accomplishments and the positive impact the training there has had on our State, our Nation, and across the world. I would like to thank those currently at Camp Beauregards as well as all those who have served our country there, and congratulate them for 100 years of service and patriotism.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I am also here to comment, as Senator Cornyn has, on the state of play, if you will, and the repeal and replacement of ObamaCare. I think sometimes the American people feel like collateral damage as Republicans and Democrats go back and forth as to what is the best policy. I am a physician, a doctor who worked in a public hospital for the uninsured for decades before I went into politics. I guess from my perspective, the primary thing is not Republican versus Democrat, but that patient who is struggling to pay her bills, her premiums, or the fellow who can't afford medicine. What are we doing for them? There is a gentleman who went on my Facebook page--again, cutting through this kind of political noise. This is Brian from Covington, LA: My family plan is $1,700 a month, me, my wife and 2 children. The ACA has brought me to my knees. I hope we can get something done. The middle class is dwindling away. Can everyone just come together and figure this out? If that is not a plaintive plea of someone who is drowning under the cost of premiums for insurance, which he knows he has and, as a responsible father and husband, he will work to pay for--nonetheless, he says that he is being crushed by these high premiums. The American people need relief. We have to lower those premiums. I have always said, though, that whatever we do must pass the Jimmy Kimmel test; that is, to say that if Brian's wife or children or he himself has a terrible illness, there will be adequate coverage to pay for the care their family would need for that member of their family with that terrible disease. It kind of brings us to where we are now-- two aspects to what we are considering. By the way, when folks say that we are redoing one-sixth of the economy, that is not true. The Affordable Care Act, ObamaCare, again, attempted to address one-sixth of the economy that is healthcare. We are focused on the individual market, which is about 4 percent of those insured, and Medicaid. We are not touching Medicare. We are not touching the employer-sponsored insurance market. It is important to realize that this is not as comprehensive as the Affordable Care Act. It is something far more focused. Let's first talk about Medicaid. I am very concerned about what has been proposed for Medicaid, but also concerned about current law regarding Medicaid. Under the Medicaid expansion in the Affordable Care Act, States got 100 percent of all the cost of the patients enrolled for the first 4 to 5 years. As you might expect, States were quite generous in their payments for these patients as they contracted with Medicaid-managed care companies to care for them, so much so that those folks enrolled in Medicaid expansion. Taxpayers are paying 50 percent more than taxpayers are paying for those in traditional Medicaid. And States enrolled roughly 20 million people in the Medicaid expansion program. The combination of enrolling so many people in the Medicaid expansion program and paying 50 percent more than for traditional Medicaid means that when States finally have to foot 10 percent of the bill, which they will by 2020--when States have to finally foot that 10 percent of the bill, they cannot afford that 10 percent. Unfortunately, under the Affordable Care Act, State taxpayers will not be able to pay what in California is $2.2 billion extra per year as the State's 10-percent share. Similarly in Louisiana, my State, our taxpayers--me, my colleagues, my friends, my neighbors--would be on the hook for $310 million per year. Our State is having a budget crisis because we can't afford $300 million. Now it is a $310 million recurring bill every year. One thing that is not said is that Medicaid expansion in its current format is not sustainable. We have to do something--again, to preserve benefits for that patient. We have to take care of that patient, but we have to make it sustainable, both for the Federal taxpayer and the State taxpayer. By the way, whoever is watching this is both a Federal and State taxpayer. You are getting caught both ways. Let me speak a little bit about the process. If you want to speak about Medicaid, we just laid it out. Let's speak a little about the process, as much has been said about it. I don't care for how the process transpired, but I certainly understand Leader McConnell's concerns that Democrats would not collaborate. I find that a sorry state of affairs. What do I mean by that? Susan Collins and I, and four other Republican Senators, put forward a bill that would allow Democratic States to continue in the status quo--to get the money they would have ordinarily received under the Affordable Care Act and to continue a system--as much as they desire to have--for the whole Nation. The minority leader, Chuck Schumer, condemned our bill before we filed it, meaning before he had a chance to read it. Without reading our bill, he condemned it, even though his State of New York would have been allowed to continue in the program that they are currently in and receive the dollars to support that program. He condemned the bill before he read it, even though it would have allowed his State to continue in the status quo. Similarly, we approached other Senators--10, at least, on my part. None would help us with our bill, even though their State could have continued in its current status quo, receiving the income it currently receives. That tells me that even a good faith effort to reach across the aisle was not going to get cooperation. That is too bad, and that is why, I think, there is kind of a political back-and-forth in which the patient--the American like Brian, struggling to support and cover his family--gets lost in the crossfire. A goodwill bill, designed for States to do that which they wish to do, would not even be considered by the other side. I have always pointed out that if even two Democrats had walked into Mitch McConnell's office and said ``We will work with you to pass a bill,'' they could have gotten far many more things for their State than saying ``No, we have not been invited to the party; therefore, we will not participate.'' I say that as an observation, not as a criticism, but also as an explanation to the American people of how we have ended up in this position. Now, as to the bill that will be before us, I have not seen the written language. I reserve judgment until I have seen that, but I will say that there are some things I like. If our desire, again, is to take that patient, the American citizen, and make sure his needs or her needs are met--a family such as Brian described here who cannot afford their current premiums--there are things in this bill which will lower those premiums. There is the so-called cost-sharing reduction payments for the next couple of years that would continue to provide certainty to the insurance companies so that when they market insurance on the individual market, there would be certainty. They would be able to know those dollars are coming from the Federal taxpayer to support folks for the next couple of years, and they could lower their premiums accordingly. There will be a so-called State Stability Fund that going forward, States could use to create what was called the invisible high-risk pool--a reinsurance program, if you will--so that if you are a patient on dialysis, a patient with cancer, very expensive to care for, you would continue to get the care you require, but everyone else in that insurance market has their premiums lowered because there is a little bit of help for those folks with those higher cost conditions. By that, we lower premiums. President Trump, when he was running for President, said he wanted to continue coverage, care for those with preexisting conditions, eliminate the ObamaCare mandates, and lower premiums. What I have seen or, at least, heard is we are on the path to fulfilling President Trump's pledge. Now, again, reserving judgment until I have seen written language, I will say that what I have seen so far keeps the patient as the focus, would address someone like Brian, the needs of his family, the needs of their pocketbook as well as their health, and build a basis so that going forward, States would have the ability to innovate, to find a system that works best for them. On behalf of those patients, I hope that we as a Senate--whatever our party--are successful. I hope going forward we, as a Senate, no matter what our party, put the patient as the focal point, hoping that our combined efforts--again, no matter what our party--will address her needs or his needs, both financially and particularly for their health. I yield the floor. I suggest the absence of a quorum.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, one of the things we are debating right now is, What is the future of the Affordable Care Act or, I should say, healthcare in the United States? One thing we can all agree to is that the individual market under the Affordable Care Act--or ObamaCare, as it is commonly called--is not doing well. I will put up this Facebook post from a constituent in Louisiana named Brian. He wrote in to say: My family plan is $1,700 a month. Me, my wife, and 2 children. The ACA has brought me to my knees. He doesn't say this, but we know that, most likely, his family deductible is $13,000. I hope we can get something done. . . . The middle class is dwindling away. Can everyone just come together and figure this out? So his family is putting out $20,000 a year for insurance. They most likely have a $13,000 family deductible. They have two children, a young family, $33,000 of out-of-pocket expenses before they would see significant benefit from their policy. Clearly, we have a problem. When he was campaigning, Candidate Trump recognized this, and he said over and over that his contract with the voters was to maintain coverage, lower premiums, address and care for those with preexisting conditions, and to eliminate the ObamaCare mandates. This, if you will, was his contract with the voters--a pretty good contract. I think it is something both parties can get behind. Candidate Trump and then President-elect Trump doubled down on this just before taking the oath of office, saying: ``People covered under the law''--meaning the law that he would support to replace the Affordable Care Act--``can expect to have great healthcare. It will be in a much simplified form. Much less expensive and much better.'' Indeed, the President of the United States seemed, again, to renew this commitment this past week at a lunch with 15 Senators at the White House, once more saying how we have to have a law that lowers premiums and cares for those with preexisting conditions. That is the baseline. Some would argue, has President Trump committed himself to some right that previously did not exist that all Americans would have healthcare? I am a physician, a doctor. I worked in a public hospital for the uninsured for so long. I can tell you, Congress created a right to healthcare when it passed the Emergency Medical Treatment and Labor Act. I think President Clinton was the one who signed it into law. This said that anyone--whether they were a U.S. citizen or not--could come to an emergency room and receive all the care they needed, and if they could not pay, they would still receive care. Whenever somebody says ``My gosh, folks don't have a right to healthcare,'' I note that when I was in the emergency room at 2 o'clock in the morning, as long as those emergency door rooms were open, there were people coming through. They would have congestive heart failure, COPD, diabetes out of control, gunshot wounds, or vomiting blood. They could be schizophrenic or a drug overdose. As long as that patient or those patients came through the door, we treated them, and someone paid. I would say that it is the fiscally conservative way that if Congress is going to say ``My gosh, everybody has a right to healthcare,'' then we should come up with a considered way to pay for it, as opposed to forcing the hospital to shift the cost of this care to other sources-- principally, by the way, small businesses paying higher premiums for their employees, higher rates to pay for the uninsured. The fiscally conservative way is ``Let's address these needs.'' As a physician, I will also say that the best business practice ways to address somebody with chronic health conditions is to actually manage the disease. If you have a diabetic who doesn't have insurance, she may come to the hospital once a month with diabetes out of control. You have to start an IV and put her in the hospital, perhaps overnight, sometimes in the hospital for longer. This can cost thousands of dollars. Contrast this with having that patient with a primary care physician so that you can manage her disease. Not only is her health better, but you spend a lot less money. In fact, the wisest corporations in our country now consider the health of their employees as a cost center. What can we do to have the best outcomes at the lowest price? This is the most fiscally conservative way. I think that is the approach we should take as a country. This brings us to the next point. How do we achieve that which President Trump suggested, which was that we would maintain coverage, lower premiums, care for those with preexisting conditions, and eliminate mandates in a way that we could achieve it? Some folks say that you cannot achieve this. I disagree with this. The way to achieve it is to embrace each of President Trump's goals. Susan Collins and four other Senators and I have put forward a bill called the Patient Freedom Act. In the Patient Freedom Act, the approach we take is to first maintain the coverage President Trump spoke of, but we do it by eliminating mandates. We give the States the options of doing something called automatic enrollment. It means it is easy to be enrolled. On our income taxes, for example, Republicans have always said: We want to make it easy to pay your taxes--not 16 pages of forms that you have to fill out with a CPA and an attorney but, rather, something you can do on one page. We need to make enrollment in insurance easy. The second thing--if you can expand the enrollment, we can take from what we know works, which is on Medicare. When someone turns 65, he or she is automatically on Medicare. They don't have to fill out a bunch of forms online. Rather, they are just on Medicare. They get a card. Here is your Medicare card. You are in unless you don't want to be. If you don't want to be, we make it easy to get out. You just call up and say: I don't want to be on Medicare. And you are not. It turns out that 99 percent of Americans like this simple approach, and they stay on Medicare. We could expand coverage and make it simple, still eliminating mandates by giving States the option to say to their residents, you are in unless you are out. We are going to make it simple. If you are eligible for this credit, you would get the credit. And unless you call us up and say that you don't want it, you would be enrolled in an insurance program. In this way, we care for those with preexisting conditions. How is that the case? If you have a few sick people in the insurance pool, then the only people whom you can spread that risk among are the few and the sick in the pool. Every year they pay higher and higher premiums. On the other hand, if you can expand the risk pool to include all the young ``healthies''--the folks who think themselves immortal, who on an average year may only have $500 or $800 worth of healthcare expenses-- if you can incorporate all of them in your risk pool, then the expense of the few and the sick is spread out over the many and the healthy. Instead of premiums rising because of one person's illness, premiums hardly budge because the cost of that care is spread over so many. We call it a risk pool for a reason. If you take a cup of water and you pour it in a large swimming pool, the level of that swimming pool does not change because that big pool absorbs the water. If you take a cup of water and you pour it in a smaller cup of water, it overflows. We need to make it where it is the former situation--where we have a big risk pool with lots of young, healthy people with whom we can share that risk over the many and not the few. In this way, we can lower premiums. It was modeled that if we did automatic enrollment in my State, still maintain the enrollment of the older and the sicker who are already in, we would lower premiums by 20 percent. That is the power of giving the States the option to make it simpler for people to be enrolled in their insurance. The conservative way to approach our healthcare reform is to recognize that President Trump's contract with the voter on the campaign trail is the pathway to achieving his goals. As we do that in a fiscally conservative way, we recognize that we should not move this cost of care off to small businesses. We should go ahead and pay for it. It is fiscally conservative to manage these patients' illnesses, as opposed to have them going to an emergency room every so often for emergency room care. Lastly, we have to say that if we embrace Republican ideas of making it simpler to be in a plan, as opposed to more complicated, we are more likely to have that risk pool that is inclusive of many who are healthy, not just a few who are sick. I look forward to replacing the Affordable Care Act--the un- Affordable Care Act as it has become--with something that embraces conservative principles and fulfills President Trump's campaign pledges. I yield the floor.

Mr. CASSIDY

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

Mr. CASSIDY. Mr. President, this morning, an unbalanced individual carried out a cowardly attack, not only against Members and staff of this Congress but against democratic institutions. This terrorist--and he is a terrorist--desired to destroy our democratic institutions. We as a country cannot allow this to happen. If anything, this must strengthen our resolve to do what is right for our country and for each other. We cannot let this shooter defeat good. I have known Steve Scalise for decades. I served with Steve in the Louisiana Senate, then in the U.S. House of Representatives. I called his wife Jennifer and will be available to help his family in any way I can. Steve is a man of good character. He loves the United States and Louisiana, loves the LSU Tigers, which, of course, is our mutual affection as well. It is a privilege to serve with someone who cares so deeply about the people whom we are both honored to represent. My prayers are with Steve, Jennifer, and their children. We also think of Zack Barth, Matt Mika, Agent David Bailey, and Agent Crystal Griner. We think of them, are gratified that they were able to receive medical treatment quickly, and ask that everyone join in keeping them and their families in our prayers as well. To all of them--we want them to know that we in the United States and in Louisiana support them. I specifically commend the Capitol Police for all they do, and, again, Agents Bailey and Griner for their bravery and quick actions to protect those in danger. We are blessed by the service of the Capitol Police and fortunate they were there to prevent this attack from being even more tragic. Where do we go from here? Frankly, we as a country need to come together to try and reinject civility into our political rhetoric. We can disagree on policy. It is that disagreement and our ability to discuss and debate these differences that makes democracies successful. The key word here is ``debate.'' There is a difference between debate and attacking the motives and good faith of another. Debates are healthy, productive, and you respect those in opposition. You discuss ideas, not perceived intentions. When respect and good faith in the intentions of the other are lost, though, perhaps it does more to hurt than to heal. We as individuals need to look at how we use rhetoric--rhetoric that can cause someone who is unbalanced to commit an act of violence, as we saw this morning. Anyone saying things to vilify another or portray them as evil, we have to recognize that can drive some, again, to acts of violence. Let's do what we can to move this country to the era of respectful debate. Now let me end where I began. We cannot let political terrorism win. We must stand firm in support of our democracy and democratic institutions. We must carry on, not letting evil triumph. We do that by recognizing that we are all, first, children of God, then all Americans. We come together, stand united, doing that which is best for our country and for each other. I yield the floor. I suggest the absence of a quorum.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I thank my colleague from New York for yielding, as well as for the tremendous work she and our staffs have done together on the Flood Insurance Affordability and Sustainability Act of 2017. There is a capriciousness of flooding which makes the National Flood Insurance Program so important. You can have a mountaintop village next to a dry gulch. If there is a sudden flash flood, folks who have lived there 100 years suddenly find their 100-year-old homes destroyed. The NFIP helps rebuild the lives of those who are so affected. The Flood Insurance Program is critical, not just to that mountaintop village but, by extension, our entire country. The economic impact of flooding extends far beyond real estate transactions to the fundamental vitality of communities and the workforce that operates our ports, develops and refines our domestic energy, and produces our seafood and agriculture for global consumption. It just makes sense. Most towns started on the coast and on riverways because that is how goods were transported, and the history of these waterside communities is what makes them, one, economically vital, but, two, also makes them susceptible to flooding. I will note that the Presiding Officer's State of Pennsylvania, I believe, has among the most incidents of flooding in our country--principally because there are so many riverine systems. There is a valley with a river. If the water rises quickly, that riverside community is flooded. Look at my State of Louisiana. It relies on an accessible and affordable flood insurance program, but that benefits the country. Louisiana is the No. 1 producer of offshore oil and gas, producing over 15 percent of our Nation's domestic energy supply. That is 15 percent of our Nation's domestic energy supply. It is home to the second largest refining capacity in petrochemical industry. The Gulf of Mexico is home to 11 of the top 20 U.S. ports by cargo volume, and we have one of the largest seafood industries in the world. After Hurricane Katrina, when our port facilities were affected and the farmers in the Upper Missouri suddenly could not get their crop to international markets, it shows the importance of our ports for our entire economy. The National Flood Insurance Program allows folks in my State to participate in a working coast that gets that energy inland and gets those products in the international market, and this is what provides the value-added contribution to our domestic economy. Since the creation of the National Flood Insurance Program, people in Louisiana paid over $5 billion in flood insurance premiums, but, unfortunately, we have suffered some of the greatest losses after Hurricanes Katrina, Rita, Gustov, Isaac, and the flooding of the great Louisiana floods of last March and August. While the NFIP has a deficit of $24 billion--according to FEMA's premium and payout data--the NFIP would have had a surplus if we remove the 2005 loss year, including the losses incurred after Superstorm Sandy. I will also note that New Orleans flooded because federally built floodwalls designed to protect those businesses and families were constructed in a faulty way. This has been recognized, and their failure is what led to the expense. I am not here to say that NFIP doesn't need reforms--it needs reforms--but to underscore the fact that the program has worked for many years despite its failings. We need to reauthorize the NFIP and use the opportunity to improve the program, make it more affordable, transferring more risk to the private sector at a lower cost, increase investment mitigation, modernizing flood mapping to produce greater accuracy, and improve the transparency and accountability of all the participants that operate and administer the program. There are a number of constituencies interested in long-term reauthorization of NFIP. Senator Gillibrand and I know that the issue of flooding crosses party and geographical lines. We wanted to set the right bipartisan tone as Congress begins to debate the issue by introducing our bill, the Flood Insurance Affordability and Sustainability Act. We hope the legislation will contribute to the ongoing discussion and work the committees of jurisdiction are conducting as we move toward reauthorization of the NFIP and with the needed reforms that enhance affordability and sustainability of the program. Senator Gillibrand and her staff are passionate advocates for an affordable and sustainable flood insurance program. I am glad to work with her on this issue. We have listened to many stakeholders: bankers, realtors, homebuilders, flood plain managers, insurers, reinsurers, mapping experts, local government officials, financial experts and, most importantly, homeowners who work on our working coast and who have so much invested in making sure they can live and raise their families in a way which has protection from the capriciousness of flooding. I thank my colleague from New York, as well as Senator Capito, for her contribution to this legislation and process.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I thank my colleague from New York for yielding, as well as for the tremendous work she and our staffs have done together on the Flood Insurance Affordability and Sustainability Act of 2017. There is a capriciousness of flooding which makes the National Flood Insurance Program so important. You can have a mountaintop village next to a dry gulch. If there is a sudden flash flood, folks who have lived there 100 years suddenly find their 100-year-old homes destroyed. The NFIP helps rebuild the lives of those who are so affected. The Flood Insurance Program is critical, not just to that mountaintop village but, by extension, our entire country. The economic impact of flooding extends far beyond real estate transactions to the fundamental vitality of communities and the workforce that operates our ports, develops and refines our domestic energy, and produces our seafood and agriculture for global consumption. It just makes sense. Most towns started on the coast and on riverways because that is how goods were transported, and the history of these waterside communities is what makes them, one, economically vital, but, two, also makes them susceptible to flooding. I will note that the Presiding Officer's State of Pennsylvania, I believe, has among the most incidents of flooding in our country--principally because there are so many riverine systems. There is a valley with a river. If the water rises quickly, that riverside community is flooded. Look at my State of Louisiana. It relies on an accessible and affordable flood insurance program, but that benefits the country. Louisiana is the No. 1 producer of offshore oil and gas, producing over 15 percent of our Nation's domestic energy supply. That is 15 percent of our Nation's domestic energy supply. It is home to the second largest refining capacity in petrochemical industry. The Gulf of Mexico is home to 11 of the top 20 U.S. ports by cargo volume, and we have one of the largest seafood industries in the world. After Hurricane Katrina, when our port facilities were affected and the farmers in the Upper Missouri suddenly could not get their crop to international markets, it shows the importance of our ports for our entire economy. The National Flood Insurance Program allows folks in my State to participate in a working coast that gets that energy inland and gets those products in the international market, and this is what provides the value-added contribution to our domestic economy. Since the creation of the National Flood Insurance Program, people in Louisiana paid over $5 billion in flood insurance premiums, but, unfortunately, we have suffered some of the greatest losses after Hurricanes Katrina, Rita, Gustov, Isaac, and the flooding of the great Louisiana floods of last March and August. While the NFIP has a deficit of $24 billion--according to FEMA's premium and payout data--the NFIP would have had a surplus if we remove the 2005 loss year, including the losses incurred after Superstorm Sandy. I will also note that New Orleans flooded because federally built floodwalls designed to protect those businesses and families were constructed in a faulty way. This has been recognized, and their failure is what led to the expense. I am not here to say that NFIP doesn't need reforms--it needs reforms--but to underscore the fact that the program has worked for many years despite its failings. We need to reauthorize the NFIP and use the opportunity to improve the program, make it more affordable, transferring more risk to the private sector at a lower cost, increase investment mitigation, modernizing flood mapping to produce greater accuracy, and improve the transparency and accountability of all the participants that operate and administer the program. There are a number of constituencies interested in long-term reauthorization of NFIP. Senator Gillibrand and I know that the issue of flooding crosses party and geographical lines. We wanted to set the right bipartisan tone as Congress begins to debate the issue by introducing our bill, the Flood Insurance Affordability and Sustainability Act. We hope the legislation will contribute to the ongoing discussion and work the committees of jurisdiction are conducting as we move toward reauthorization of the NFIP and with the needed reforms that enhance affordability and sustainability of the program. Senator Gillibrand and her staff are passionate advocates for an affordable and sustainable flood insurance program. I am glad to work with her on this issue. We have listened to many stakeholders: bankers, realtors, homebuilders, flood plain managers, insurers, reinsurers, mapping experts, local government officials, financial experts and, most importantly, homeowners who work on our working coast and who have so much invested in making sure they can live and raise their families in a way which has protection from the capriciousness of flooding. I thank my colleague from New York, as well as Senator Capito, for her contribution to this legislation and process.

Mr. CASSIDY

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

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I am here to speak about a topic which, wherever I go, people speak about--the replacement of the Affordable Care Act or ObamaCare, as people call it. Clearly, we need action. I had a Facebook post maybe a week or two ago from Brian in Covington, LA. He said: My family plan is $1,700. The quote goes on to say how his family cannot afford that $1,700. Rates are going up, which I have said time and time again. My friend back in Baton Rouge, he and his wife are 60, 61. The quote for their insurance last year was $39,000--for 1 year. That is clearly not affordable. This is not just in Louisiana; it is in Washington, DC, it is in California, it is across our Nation where individual market quotes are going up that they cannot support. Most recently, Connecticut insurers--there are two--are proposing rate increases that are 15.2 percent and 33.8 percent, on average, respectively. They are quoting 22 percent over 2017. In Maryland, some insurers are going to raise rates as much as 59 percent for those individual plans. I am a physician. I learned a couple of things in my 20 or 30 years of practice. One, to lower costs, the patient must have the power; and, two, the insurance must be affordable; and, three, that the insurance they receive must be adequate. President Trump totally got this. On the campaign trail, President Trump said time and again--what I call his contract with the voter. He wanted folks to maintain coverage with lower premiums, care for those with preexisting conditions, and eliminating mandates. I think President Trump just knew it. I shorthand this, if you will, saying, if we focus on lowering premiums and making sure it passes the Jimmy Kimmel test. The late-night comedian, when his child was born with a terrible heart problem, immediately got the care that child needed. So if we can have insurance that passes the Jimmy Kimmel test--lowering premiums, taking care of the rest of President Trump's goals, then I think we can accomplish it. We need to talk to experts, actuaries, those who design insurance plans, to make sure we come up with something. There is something else the President said that I want to focus on. This is just before he took the oath of office. He said people covered under the law--meaning the Republican replacement--can expect to have great healthcare. ``It will be much simplified.'' One of the complaints about the Affordable Care Act is it is so complicated. Even online, 16 pages online, with your W-2, if you don't get it, you get booted out. The President said we must have a much simpler way of going about this--much less expensive and much better. What could this look like? Let me propose some conservative solutions that could be in a Republican plan that would achieve the President's goal. First, the patient has to have the power. In my 30 years of practice, I found that if the patient has the power, the system lines up to serve her. One example is price transparency. If we can put in that a provider has to publish the provider's price, so the patient getting the blood test knows the cost of the blood test at that moment and can compare it to someone down the street, we will lower cost. One example just came up in a newspaper out of New Orleans. Nola.com is their website. A woman went in and got blood tests. She received a bill weeks later and her bill was for $324. She found she could have gotten the same blood test for $34 right down the street. A woman from Texas came up. She said she heard me speak of price transparency--the power of negotiating, if you will. The doctor ordered an MRI on her son's shoulder. She called up the different places where she could have it done and she got a price of $667. On my Facebook page is a little video of her speaking: I got it for $667. Then I remembered what you said: If you pay cash, you get a discount. I called them back. I said, if I pay cash, will you give me a lower price? They said: Pay us cash, we will cut that $667 to $400. The patient had the power. So she ended up paying far less for the procedure the doctor ordered. That is one conservative solution, give the patient the power. Secondly, let States innovate. We need to take all of this power that ObamaCare brought to Washington, DC, and push it back out to the States. If we do that, we are going to accomplish something. Let's just acknowledge that there are 700,000 people or so in Alaska. If you took a map of the State of Alaska and put it over the lower 48, it would stretch from roughly Georgia to the Pacific Ocean. Washington, DC, has almost the same population as Alaska, and you can walk across the city in a morning. Clearly, you need different solutions for an area you can walk across and an area you cannot fly across in the same time that you would walk across Washington, DC. We have to return power back to the patients. We have to engage doctors and patients so those patients with complex conditions get their healthcare managed. I use the example of a diabetic. She perhaps developed childhood diabetes, and now she is 35 years old. If a doctor is managing her condition, she works, stays at home, her complications are minimal, and her life is much better. If her condition is not managed, she comes to the emergency room three times a month with diabetes out of control. That just shoots a hole in the bucket of fiscal responsibility and also in her health. Instead of working, keeping a family, she is coming to the hospital, getting care through the emergency room, which she cannot afford to pay for, and that cost is shifted to everyone else. That is not the way to manage that. We need to engage doctors with patients. Another conservative solution is we need more competition between insurers so there is not just one insurance company in the market that can therefore set prices but rather we have multiple. So if we give the patient the power by giving the patient a tax credit that she can use to purchase the insurance she wishes to have, that will create competition as more insurers enter the market. If we have that competition--those market forces--prices come down. When the President said we have to make things simpler, I think that also includes how we enroll people in insurance. We figured that out on Medicare. Under Medicare, if someone turns 65, they are on Medicare. It could not be simpler. They get a letter. They are on Medicare. If they don't want to, they can call: Hey, I don't want to be on Medicare. But as a rule, they are on Medicare. Fortune 500 companies have figured out the same thing. In order to enroll people into retirement plans they say: Listen, you are in the 401(k) plan unless you choose not to be. That makes it simpler to get a 95-percent enrollment in retirement plans. Now, you could say: Hey, listen, you have to fill out a bunch of forms. If you don't fill out these forms, you are not going to be enrolled. But that would not work for Medicare. It would not work for 401(k)s. It has not worked under ObamaCare. We need to take those same sort of solutions we have found for both Medicare and enrolling people in their retirement and do it for the Republican alternative. The Republican alternative would say: We make it easy to enroll. You are in unless you are out. So if you are eligible for a tax credit, you would receive it. You would then have the insurance. If you were passive about it, you would have a default policy. But if you are active, you could do more with it. But by doing so, you actually increase the number of people insured. Now, when you increase the pool of those insured, you lower premiums. We had Blue Cross look at our proposal to make it easy to enroll: You are in unless you are out. That would lower premiums by 20 percent, just by expanding the number of those who are insured--20 percent. So when President Trump says he wants to continue coverage, caring for those with preexisting conditions without mandates and lowering premiums, doing this feature where you are in unless you call us and tell us you don't want to be and making it simple achieves all four goals. We would increase coverage. By that, we would lower premiums, taking care of those with preexisting conditions. Now, again, it is using the mechanism that is already used in Medicare and in Fortune 500 companies, making it easy to enroll. There are some who don't want to give States the options. They don't want to give patients the options. They don't want to make it simple to enroll. They want to replace, if you will, the tyranny of ObamaCare--where all of this power is taken to Washington, DC, and States and people were told what they had to do-- with a different sort of tyranny, telling States what they can't do. I think we ought to give as much power to the States, as much latitude to the patients to come up with the solutions that work for them. That is the conservative way to go. But I will say, in speaking with conservatives, that I very much invite our Democratic colleagues to come to the table. There are some of my Democratic colleagues who have said they just want Republicans to work through this, thinking that it might be a political train wreck that would work to their advantage. But in those States there are Americans whose premiums are becoming unaffordable. I mentioned earlier that in Connecticut premiums are rising 15 and 34 percent this year. In Oregon, it is as high as 22 percent, and Maryland is as high as 60 percent. Now, who cares if the person is a Democrat or a Republican? If her premium is increasing 60 percent, she cannot afford it. So I challenge my Democratic colleagues to get off the sidelines and engage. Try to do something not for political purposes but for the purpose of that person who is at home struggling to pay the bills and deciding that she can no longer afford insurance, but, perhaps unbeknown to her, she has a cancer brewing inside her. Just when she decides she can no longer afford coverage because premiums have risen 60 percent, that is when her cancer is discovered. We have to address this. It will take us on either side of the aisle--both Democrats and Republicans--to work together. I will finish with a quote from a fellow from Covington, Brian, on my Facebook page. He said that his family plan is $1,700 a month, for him, his wife, and his two children. The ACA, the Affordable Care Act, or ObamaCare, has brought him to his knees. I hope we can get something done. The middle class is dwindling away. Can everyone just come together and figure this out? This is a cry for help. It is a challenge to Republicans and Democrats to come up with a plan that is not a red plan or a blue plan but an American plan to address his needs, his wife's needs, and those similar to him across the country.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I ask unanimous consent that Patrick Flanigan, an intern in Senator Kennedy's office, be granted floor privileges for the remainder of the day.