Bill Cassidy

Mr. CASSIDY

Mr. CASSIDY. Mr. President, as we continue to debate health care, there are some things that are kind of being debated that I call monkey dust. When two gorillas fight, they try to confuse each other by throwing dust up in the air. It has nothing to do with the substance of the fight but rather is only meant to distract the other side. That is part of what this kerfuffle, if you will--people raise per-beneficiary payments as if that is something pernicious, something that should be avoided, something which is bad. First, we are setting this kind of in the perspective of Medicaid. Let me speak about per-beneficiary payments. For those who are in the Federal Employees Health Benefits Plan, the Federal Government makes a per-beneficiary payment to the insurance company to cover that Federal employee. For those States which have a Medicaid managed care company contract, the State makes a per-beneficiary payment to the Medicaid managed care company. That is a per-beneficiary payment. The reason I like this is because, inherently, the dollar follows the patient. Now we are speaking about this in the context of a Medicaid reform program. Why should Medicaid be reformed? That is the question. Let's speak about our current Medicaid system. It is bankrupting States and the Federal Government. In 2009, for the first time, the amount of money spent by States on Medicaid exceeded what they spent on education. Ever since then, Medicaid's expenditures are going up, and education expenditures are going down. Despite all this money, we get poor outcomes. Medicaid typically pays physicians below their cost of seeing a patient. I pointed out in my speech yesterday that the week ObamaCare passed the House of Representatives, Robert Pear, the New York Times journalist, wrote an article in the New York Times following cancer patients on Medicaid in Michigan. What Mr. Pear found was an oncologist who had so many Medicaid patients she was going bankrupt. Indeed, she had to begin to discharge those patients from her practice because she could not pay her bills. We tracked down one of those patients who was featured, and she died 2 weeks after being discharged from the practice. Medicaid pays so poorly that physicians cannot afford to see large numbers. That said, it isn't just an anecdote from this New York Times article. There is a study out of MIT for the National Bureau of Economic Research, I believe it is, that found that with all the money spent on Medicaid, the beneficiary only receives 20 to 40 percent. The rest goes to institutions. If we speak about a per-beneficiary payment, substantially all of that money goes to the patient. Under the current scenario, out of an MIT study, only 20 to 40 percent does. Go back to the oncologist who couldn't afford to see the patients because her reimbursements were so low. What if the rest of that money, which was not being attributed to the patient, instead could go to pay her doctor, then the patient would have never been discharged. By the way, on average, States spend 17 percent of their State dollars on Medicaid. In my own State of Louisiana, it is 19 percent, and in my State this has increased, nearly doubling from the year 2000. Let's go back to the per-beneficiary payment, where the dollar follows the patient, as in, by the way, the insurance plans that people have under ObamaCare on the exchanges. There is a subsidy that goes to the insurance company that then provides for the patient. The dollar follows the patient. So the per-beneficiary continues to do that. Folks say: Well, there is not enough money in Medicaid; therefore, we have to somehow do things differently. The models we use in private insurance will not work in the Medicaid population. We looked up the SEC report for a Medicaid managed care company, and the Medicaid expansion population, they get $6,000 per enrollee. I just met today with an insurance company that was discussing the rates they are going to give on the exchanges next year. It is going to be roughly $5,500 per enrollee will be a year's premium. So think about this. Those in the Medicaid expansion population have more Federal dollars going to support them than those citizens, those fellow Americans who are receiving their insurance on the ObamaCare exchanges. Yet we continue to hear from the Medicaid patients that they have problems accessing specialists. There is more money in Medicaid than in the private insurance market, but the Medicaid patient can't see a specialist because the patient's specialist is being paid below cost and cannot afford to see the patient. There is something incredibly wrong here. By the way, I should also point out that in States in which Medicaid is expanded, another MIT study found that 60 percent of those who go on the Medicaid expansion dropped private insurance--dropped private insurance--which means they go from kind of paying their own way to the taxpayer paying for them. My own State of Louisiana recently expanded Medicaid. It might not have been 60 percent of those on the Medicaid expansion dropped their insurance, but I am told by the chief insurance company that I think about 70 to 80,000 people dropped private insurance to go on Medicaid; 60 or 70 or 80,000 people stopped paying for themselves and asked taxpayers to pay for them. That is OK if you are the person going on Medicaid. You no longer have a deductible or a copay. I understand ObamaCare exchanges have $6,000 deductibles, and maybe that is what they had to do, but if we are going to come up with a sustainable system, that is not an answer. What I do is encourage that there be a per-beneficiary payment, that the money follow the patient. Again, for those who say it is some terrible thing to have a per-beneficiary payment, they are ignoring all the evidence of how it is good. Think of the Federal Employees Health Benefits Program. Probably if somebody is watching on C-SPAN, their spouse or their own policy they get through their employer, the employer pays the insurance company a certain amount of money per employee and per employee family member. We could also do what Indiana has done. In their Healthy Indiana Plan 2.0, they made per-beneficiary payments, if you will, to Medicaid enrollees, giving them a health savings account and covering their catastrophic expenses. They found that the Hoosiers who enrolled in this used 40 percent less charity care than those with traditional insurance. These are all Medicaid patients. Folks say: Oh, my gosh. Health savings accounts per-beneficiary payments can never work for the poor. In this case, 70 percent of those enrolled in this program were below the Federal poverty level. Yet, nonetheless, they contributed to their own HSA. They continued making those contributions and altered their behavior to become more cost-conscious, better consumers of health care. I always say don't underestimate patients. In my own practice, for 30 years, I worked in a hospital caring for the uninsured, and although the uninsured don't have some of the advantages in life that others have, they can take care of themselves. They know what is right and what is wrong in terms of their own interests. So let's make those per-beneficiary payments. Let's not be distracted by those who somehow make this a bad thing. Let's believe in the American people, that they can handle their own health care and that they don't need a Washington bureaucrat to tell them how to live their health care lives. Mr. President, I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Madam President, I rise to address a very important issue in regard to the health care of our poorest Americans and discus my plan, the Medicaid Accountability and Care Act, or the MAC Act, which is also included in my ObamaCare replacement plan which would address the failings of our current Medicaid system. My colleague from Washington just extolled the virtues of ObamaCare. As she pointed out, Medicaid clearly is a major part of the ObamaCare kind of response so it is apropos I would follow. I wish to first tell you my perspective. I am a physician, and I had been working in a hospital for the uninsured for 25 to 30 years, until they blew it up. I saw prisoners, the uninsured, and Medicaid patients. You might say: Wait a second. Medicaid, it is insurance. Why would somebody with Medicaid insurance be seen at a hospital for the uninsured? It is because in my State, like in most others, Medicaid pays beneath the physician's cost of seeing a patient. To paraphrase Saint Paul, it is the illusion of coverage without the power of access. I will point out, the week ObamaCare passed, there was an article in the New York Times, written by a very respected journalist, Robert Pear, tracking a Medicaid patient in Michigan. The physician, the oncologist seeing her, had so many Medicaid patients, the oncologist was going bankrupt because she could not afford to pay her bills so she had to discharge the Medicaid patients from her practice. I followed up to find out what would happen, and 2 weeks after being discharged from this oncologist's practice, the patient died. This is Medicaid, which is so critical to the purported success of ObamaCare. Is it that we are not spending enough money; that maybe if we just spent a little bit more on Medicaid it would all be better. A study from MIT found that 60 percent--let me stop. The State of Oregon did an expansion of Medicaid so researchers from MIT and elsewhere went to study it. This study found that 60 percent of the dollars used for the Oregon Medicaid expansion went to institutions, not for patients--as little as, say, 20 percent to 40 percent--but as little as 20 percent of the money that was put toward the Medicaid Program actually was a benefit for the patient. Let me repeat this. As much as 60 percent went to benefit institutions, not patients. They also found that patients on Medicaid did not have improved outcomes. Think about this. We are giving everybody all of this coverage. It is supposedly wonderful. Yet when they went back 1 year later and 2 years and 3 years later and looked at the patients covered on Medicaid-- versus those who were not, those who continued to be uninsured--there were no better health outcomes among those who are on Medicaid. If we can't agree this is a program to reform, it is going to be hard to agree on anything. For those who are not familiar with Medicaid, let's talk a little bit about the program. Medicaid is a Federal-State program. The Federal Government provides a certain percentage--a different percentage for each State--but the State actually administers the program. In some States, the Federal Government pays 50 percent of the cost. It can go up as much as 75 percent of the cost. In Mississippi, they put up $25, they get $75. In a State such as New York, they would put up $50 and get back $50 so it is a 1-to-1. This open-ended financing structure is based solely on how much the State spends. I will agree with my colleague from Washington State. We should not reward States that spend incontinently. We should not reward States that just spend, but under Medicaid, the State is rewarded. The more it spends, the more it draws down from the Federal Government. I always smile when people speak about the economic development of Medicaid expansion. Medicaid expansion is not about economic development. It should be about taking care of patients, but I understand that perspective because they pull down at least $1 for every dollar the State spends, sometimes at the 75-percent ratio. Under the ObamaCare Medicaid expansion, States have been drawing down 100 percent of what they spend. If the State is going to draw down 100 percent of what it spends on the Medicaid expansion population-- surprise, surprise--they are actually spending at a higher rate on the expansion population than on those Medicaid patients for whom the State actually has to cover part of the cost. The Federal Government has very little ability to weed out the corruption of the inefficient programs. Again, this matching incentive disincentivizes States from looking for ways to be more efficient, but, still, States have to balance their budget every year and Medicaid is either the second largest or largest budget item in every State. Even though the Federal Government is paying 50 percent to 75 percent of the traditional Medicaid population and 100 percent of the expansion population, the State taxpayer is still on the hook for a lot. On average, States spend 17 cents of every State dollar on Medicaid. My State of Louisiana has the highest percentage. Nineteen percent of our budget goes to Medicaid. The percentage is steadily increasing, nearly doubling since 2000. Sooner or later, even though the Federal Government covers the majority of the cost, the budget crunch gets more difficult because the rate of Medicaid spending is climbing faster than the State tax base. Because of all the Federal requirements on what a State can change in the Medicaid Programs, in order to come up with the State match, States have two options. They can pay providers less or they can cut other programs such as education and move the money to the Medicaid Program. First, paying physicians less brings us back to the situation Robert Pear described in his New York Times article, where the oncologist was going bankrupt because she could not afford to see more Medicaid patients. Let's speak a little bit about education. I am just going to use my hands. In 1963, the State government used about that much for education and when Medicaid started in 1964 or 1965, about that much for Medicaid. In 2009, for the first time ever, on average, States spent more on Medicaid than on education. Now the percentage on Medicaid continues to climb, if you will, cannibalizing the State dollars that could be used to support higher education, primary and secondary education. Let's look at the effect of the ObamaCare Medicaid expansion. Let's look not at my own State but Kentucky, a State which has been at this for a little bit longer. The previous Governor, Governor Beshear, implemented the ObamaCare Medicaid expansion---just kind of traditional Medicaid--and expanded it. Again, my colleague from Washington State was extolling how much ObamaCare has lowered costs. When Kentucky originally implemented it, they expected the long-term cost of Medicaid expansion to be only a 4- percent increase in their current State spending on Medicaid. After only 1 year of the expansion, updated projections showed the expansion cost the Federal Government more than half a billion dollars more than Governor Beshear had projected for 2014, and this will double in the coming years, meaning that the Medicaid expansion will cost $1 billion more per year than expected. Again, this was the projected cost. This is the actual cost. If this is saving money--oh, my gosh. What would happen if we actually lost money? By anybody's calculation, this is losing money. This has been the situation across the country. States that have expanded Medicaid have turned out to be far more expensive for the Federal taxpayer than originally anticipated. Again, it just isn't a Federal program. Like many other States across the Nation, Kentucky is facing serious fiscal issues. They do not have $1 billion lying around. On its current path, Kentucky's own projections suggest the State will start losing $45 million in perpetuity beginning in 2021. This is a 10-percent increase. The Federal Government is putting up most, but Kentucky itself will have to put up an extra $45 million per year. Also, given that the Federal taxpayer--you and me, us, the people watching on TV and in the Gallery--given that we, the Federal taxpayer, put up 90 percent of Kentucky's costs--well, every State's costs, we just happen to be speaking about Kentucky--but every State's costs are 90 percent of the costs in perpetuity. As this cost grows, taxpayers are on the hook for 90 percent of it. Such a deal. It doesn't have to be this way. Let me compliment Indiana. When Vice President-Elect Mike Pence was Governor of Indiana, rather than adopting kind of ObamaCare's let's do the traditional Medicaid and watch the cost explosion--he took an innovative approach and created the Healthy Indiana Plan or HIP as an alternative to simply doling out the dollars. The plan gave each beneficiary a high-deductible plan in combination with a health savings account. It was capitated. Again, my colleague from Washington who just spoke kind of criticized these capitated plans, which means there is a set amount, and the person is, if you will, engaged in managing her dollars. The State will put up a certain amount on a sliding scale based upon the income of the Hoosier who enrolled. The plan empowered low-income enrollees to become better consumers of health care. Hoosiers who participated--for those not from Indiana, I have learned you don't say Indianans, you say Hoosiers. So Hoosiers who participated changed behaviors. They use 40-percent less charity care than traditional Medicaid patients. Seventy percent contributed to their own HSA. Once they started contributing, virtually all continued to do so regularly. That is despite 83 percent of those participants in the Healthy Indiana Plan earning less than the Federal poverty level. Those Healthy Indiana Plan patients also saw clear improvements in care over traditional Medicaid. They decreased their emergency room utilization by 40 percent relative to Medicaid's average. Thousands more physicians chose to take Medicaid patients. Remember, at the beginning, I discussed how physicians often can't see Medicaid patients. It pays them below the cost of their seeing patients. In Indiana, thousands more chose to take Medicaid patients, improving access to quality care. Clearly, the Healthy Indiana Plan was able to work for Indiana patients. This is the sort of quality innovation that States can devise if we give them the power. Now, revising the current funding structure would also encourage States to follow Indiana's example and develop innovative Medicaid programs to increase the efficiency in which the program spends money. Again, that is Federal taxpayer money. That is our money. For those watching right now, it is our money. We want to encourage States to be efficient with how they spend it. There should be greater flexibility to design the Medicaid program to better meet the needs of State residents. States will be given the latitude and the freedom to develop various coverage options and specialized delivery systems for different Medicaid patient populations. This is why I developed the Medicaid Accountability and Care Act, which we call the MAC Act. It reforms the flawed financing of Medicaid by giving each State a set amount according to how many people each State has enrolled in the different categories that each State's Medicaid program treats. That is a mouthful, but it is basically exactly like the Federal Employees Health Benefits Program or like any employer who goes to an insurance company and says: I want to give you a set amount of money per employee who enrolls in your plan. For that matter, it is like Medicaid managed care, where the State will go to a managed care company and give the managed care company a set amount per enrollee in that plan. Now, I hear people say: Oh, my gosh, it is a set amount. That is all we do in health care, except in Medicaid, where we reward inefficient spending. So if it is good enough for the State to do it to the Medicaid managed care program, why isn't it good enough for the Federal taxpayers to do it to the State? I am not quite sure I understand the critics of this approach. But, again, under the Medicaid Accountability and Care Act, or the MAC Act, each State would tell the Federal Government how many beneficiaries it has in different categories of Medicaid and the Federal Government would give each State the amount of money appropriate for that number of enrollees in each category. The advantage of this is it is a set amount. It allows the Federal Government to do that, which it does not do now; and that is, to say to the State government: If you recover fraud, you can keep that money. Now, let's go back. Under the current situation, the Federal taxpayer pays 50 to 75 percent of the State's Medicaid costs. If there is fraud--and there is lots of fraud in Medicaid--and the State government recovers it, it has to give back to the Federal taxpayers whatever the percent was the Federal Government put up. So if the State goes out and recovers $1 million--spends money on the attorneys, spends money on the investigation, on the court case, and it recovers $1 million--it has to give half a million to $750 million back to the Federal taxpayers. It is responsible for the prosecution, the investigation, but it gives most of the money back to the Feds. So the States don't investigate because it is a disincentive to go after fraud. Under the MAC Act, if the State goes out and gets $1 million worth of fraud, the State keeps the money. That is good for the State. It encourages the State to root out that fraud and to keep the money and to make sure that fly-by-night scam artists never get to become Medicaid providers in the first place. The MAC Act's reforms will result in improved health care for Medicaid patients. I will go back to where I started. I am a physician who worked in a hospital for the uninsured and Medicaid patients. These are my patients. If this proposal was not about improving patient care, I would not advance it. But recall that Oregon, with their Medicaid program, upon review by MIT, found no improvement in patient outcomes. Then let's go to Indiana, which actually set up health savings accounts and engaged the patient in managing their own health, and there, we do see better outcomes. We should all be about patients having better outcomes. Along the way, we do other things, such as equalizing the amount of money the Federal Government gives to each State per beneficiary. Again, my colleague from Washington State pointed out that folks in Washington get less money from the Federal Government than do other States. I would attempt to equalize that with the MAC Act. So let me finish. The American people have been voting against ObamaCare for the last 8 years. Whatever its proponents may say, the American people have found it wanting. One aspect of it that has been wanting is Medicaid. We have a proposal before us based upon my experience of treating patients in the hospital for the uninsured and Medicaid but also taking States like Indiana and elsewhere in which we attempt to give States the initiative to create specialized programs that focus on patient-centered care. In that way, we will see better outcomes. The current Medicaid funding system under ObamaCare works against States, penalizing them for addressing fraud, abuse, and waste. This must change. We need to change this broken framework with a system that will work with States to get their Medicaid programs back on track, benefiting their patients as much as possible. With that, I yield the floor. Madam President, I suggest the absence of a quorum.

Mr. CASSIDY

Mr. CASSIDY. Madam President, I hear my Democratic colleagues praising ObamaCare. I had to smile yesterday. I heard a colleague talking about how ObamaCare was addressing high pharmaceutical costs. I had to start laughing--and kind of a bitter laugh. Tell that to a senior who is paying $6,000 for her medicine, which before ObamaCare passed was a fraction of that. We hear how great it is that ObamaCare has given so many people coverage. Say how great that coverage is to someone who has a $6,000 deductible--a $6,000 deductible--who does not have $400 in her checking account. There is a friend of mine--people don't believe it so I put it on my Facebook page. He got his quote for him and his wife. They are 60 and 61 years of age. Their premium for 1 year was $39,000, each of them with $6,000 deductibles. Again, it is on my Facebook page because otherwise no one would have believed me. So when people speak about the affordable health care act, I have to laugh. If this is affordable, what would be unaffordable? We can clearly do better than this. I begin this speech by calling into question my Democratic colleague's defense of ObamaCare, but we can have common ground. I applauded and still applaud the goals of those who support the Affordable Care Act. They wish to have coverage for all. Now, that is important. For over 30 years, I have worked as a physician in a hospital for the uninsured. My medical practice has been geared toward bringing coverage, to bringing care to those who otherwise would not have it. As I look at this issue, I have to thank them for their motivation but have to recognize that the Affordable Care Act has not achieved that in a way which most Americans find affordable. The other thing about ObamaCare is that it coerces Americans. It takes power from patients and States and gives it to Washington, DC, coercing the individual with mandates and penalties, taking away her right to choose. That is not where the American people wish to be. I would like to believe Republicans and Democrats can find common ground. I have introduced a replacement plan that would give States the power. I am willing to concede, the minority leader believes that ObamaCare is working just fine in his State of New York. In my plan, we repeal ObamaCare on a Federal level, but if a State like California or New York thinks ObamaCare is working for them, God bless them. Under my plan, a State legislature would have the right to stay on ObamaCare. So here Congress would pass the legislation giving States the choice, and the State would either have the option we advance, which I think is superior--but when Republicans say that you can keep your health insurance if you wish, and we mean it, we mean it. If a State decided they wished to stay on ObamaCare, they could or if a State truly decides they want to have nothing at all to do with any of this, they can totally opt away from the Medicaid expansion, from any help for others in their State to purchase insurance, period. I think this recognizes that if the minority leader wants to claim it is working in New York, they can keep it, but clearly ObamaCare is not working in some other States. We can talk about Arizona, where briefly a county did not have a single insurance company providing insurance and where premiums increased by as much as 100 percent. We can look at Louisiana, my State, where that quote I gave earlier--a fellow and his wife, $39,000 for 1 year's premium. Clearly, ObamaCare markets are failing there. So let's repeal ObamaCare, give the States the power, allowing them to choose the system that will work for them. Now, health care cost is important. Under our bill, we make health care more affordable by giving the patient the choice, the power, if you will, of price transparency. Under ObamaCare, we have seen prices rise out of control. A lack of price transparency keeps providers from having to compete which takes away the consumer's power of choice. You can see this power of choice price transparency. Fifteen years ago, LASIK surgery cost $1,000 an eye or $875 an eye, with more for astigmatism. Now you can drive down the street and you see a billboard--a billboard--that says: LASIK surgery $275 an eye. So over a period of time, when everything has increased, LASIK surgery has come down--the power of price transparency. Another example I like to use is of a woman, a physician, went for her mammogram. She wanted to pay cash. They talked her out of it. No. No. No. We don't even know what to charge you. OK. I won't pay cash. They billed her insurance company. She later found that if she had paid cash for her mammogram, it would have cost her $90. As it turns out, they billed the insurance company $500. Her deductible was $100. She was actually out $10 because they billed her insurance company. She should have known that price going into it. One more example. If a doctor orders a CT scan, the cash price, according to an LA Times article a few years ago in the Los Angeles Basin, varied from $250 to $2,500. Unless you are an investigative reporter for the LA Times, able to call up and get that cash price, you otherwise would not know. I guess maybe it sometimes helps to have another example. Would anyone buy a car if they did not know the price of the car beforehand? Yet that is routinely done with health care. Under the legislation I and Senator Collins have introduced in the Senate, and I and Pete Sessions have introduced in the House of Representatives, people will know what the cash price is. I have found, working in a hospital for the uninsured, that when you the give the patient the information and power they need to know to make the better decisions, you get better outcomes. By the way, we have been told that Republicans don't have a plan. The plans I am speaking of now are drafted in legislative language-- legislative language, again, that would repeal ObamaCare, put in price transparency, and return decisionmaking power to the patient. We should repeal the individual mandate, repeal the employer mandate, prevent the Federal Government, the long arm of the Federal Government from reaching into someone's household, forcing them to do something they don't wish to do. There should be an alternative. Under both the World's Greatest Health Care Plan--the bill I introduced with Pete Sessions--or the Patient Freedom Act that I have Susan Collins as a cosponsor, we take all of the money a State would receive had they done the Medicaid expansion and those eligible to be signed up for the ObamaCare exchanges, and we give that money to the State to allow them to give tax credits to those who are eligible. These tax credits could only be used for health insurance. If the patient did nothing, she would have a health savings account, catastrophic policy with a pharmacy benefit. She could use the health savings account as first-dollar coverage. Now, under ObamaCare, $6,000 deductible. Under our plan, the patient has first-dollar coverage, so if her daughter has an earache and she takes her daughter to the urgent care center, she can cover that visit with a health savings account that would be funded with this credit. They also have catastrophic major medical coverage, so if they get in that car wreck, take them to the emergency room, sky-high pricing, they are protected from medical bankruptcy. Under our replacement plan, we also give States the option to say that if someone in our State is eligible, they are automatically enrolled. I smile when I say that covers two populations, the person who may live under a park bench and does not have his life together to otherwise do it, and the other population would be my 22-year-old son and those like him, those young folks who never think they are going to get ill so they never sign up for insurance. Without them being in the pool, we end up with a sicker pool. That is what has happened with ObamaCare. By the way, it would be easy to imagine you could end up with 95 percent enrollment of those eligible should the State decide to go this way. The timeframe for our replacement would be simple. In year one, say 2017 Congress passes the enabling legislation, which in year 2018 allows the State to choose between these three options; in 2019, the State would implement the option it chooses; and by the end of 2019, we have made the transition from repeal to replace, to implementation. Folks ask: Would I lose my coverage? I am a physician. I am going to give my perspective: a patient I might see who has breast cancer. She does not like ObamaCare. She voted for Donald Trump, but she is on the bubble financially. She is not sure she can afford coverage, but she has breast cancer. As bad as ObamaCare is, at least she is getting some care. Now she is having to put out all this money first, but still she is getting some care. If we keep her in the prism through which we look at this problem so that in the transition from ObamaCare to better coverage she continues to have her therapy, so at the end of this, not only does she have better coverage, but she has health and recovery from breast cancer, we have done our job. That is our Republican goal, to keep our prism as that woman who is vulnerable from a sickness she has now. In our transition, she does not lose coverage; she merely moves to better coverage. I introduced the Patient Freedom Act with 12 Senate cosponsors in 2015 and then again teamed up with Representative Pete Sessions in 2016 to introduce the World's Greatest Health Care Plan. That is truly its name. Tom Price, our soon-to-be HHS Secretary, first introduced his Empowering Patients First Act to the House of Representatives in 2014. Speaker Paul Ryan, Representative Fred Upton, Senators Richard Burr, and Orrin Hatch have also outlined plans for comprehensive health care reform. All of these plans create a new system that returns power of choice to patients and to States. Simple provisions as I have described such as health savings accounts, instituting free market values, if we put them into a replacement plan now, we will quickly have an effect upon millions. Republicans have worked hard to lay the groundwork to repeal and replace ObamaCare. President-elect Trump has said he wants repeal and replace to happen at the same time. He promised both. We should fulfill both promises. Our majority leader has said we can do a better job as Republicans covering more people. We have the principles, the ideas, and the plans ready to go so let's put them to use. We owe it to the American people to carry out that replacement now with a smooth transition so the insured population can grow without anyone losing coverage in the process. Republicans are committed to creating and passing effective health care legislation to replace ObamaCare and to bring real coverage to all Americans. Now is the time to do so. Madam President, I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, may I briefly acknowledge and thank Pastor and Bishop Tenney for being here. Today is his 83rd birthday. As he told me, he has been pushing 80, but now he pulls it. He has blessed many people. He is an anointed man of God whom many others have looked toward for guidance, as a man who by his life and by his words guides them to a deeper relationship with God. On behalf of our entire Senate, I extend our thanks to Bishop Tenney for being here today. Thank you. I yield back.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I suggest the absence of a quorum.

Mr. CASSIDY. Mr. President, I have the honor to recognize and thank my colleague and friend, the Honorable Senator David Vitter, for his 25 years of service to Louisiana. Our State has been fortunate to have him as its voice and advocate in this Chamber for the past 12 years. On a personal note, when I arrived at the Senate, David worked with me, sharing with me some of the privileges that normally he, as a senior Senator, could have kept all to himself. With great graciousness, he worked with me and said: Listen, this is how I think the process should be set up. I would like you to have some of this privilege as well. I will do the same with whoever replaces David. He has set a pattern that, again, by his graciousness and magnanimity, deserves repetition. As a new Senator, I was fortunate to have him as a resource for advice and knowledge that comes from time and experience in this body. There are some things that happen here that you have to kind of have experience to follow. David had both the experience, the sharpness, and the insight to recognize. I again look forward to sharing what he has taught me with whoever takes his place. I will note, as David did, he helped lead our State through some of our worst times. From Hurricane Katrina in 2005 to the great flood of 2016, all of the way in between, David has worked hard to make sure Louisiana and the people of Louisiana have what they need to recover. The hallmark of Senator Vitter's tenure is that he has always cared deeply about our State, constantly looking for what he could do that would benefit our State, not just in the short term but doing that which is consistent with his principles to help Louisiana and the United States thrive in the long term. He has been on the side of that family whose father goes for 2 weeks, works on an oil rig in the middle of the Gulf of Mexico, working hard so his family has a better future. David has been on the side of that mom juggling two jobs to earn enough to make sure her children's needs are met. A recent example--again for the short-term and long-term perspective David handled so well--he stayed persistent for years working across the aisle, first with Senator Frank Lautenberg, then Senator Udall, to pass the much needed reform of the Toxic Substances Control Act, the first reform of its kind in 40 years. This reform protects both the workers--those people on that rig, perhaps, at least the people who would be processing the products of that rig--but also gives the manufacturers of Louisiana and across the country the certainty they need to expand their businesses and create more jobs. On a lighter note, David is a great Saints fan. We in Louisiana kind of liked the fact that when the slogan ``Who Dat'' came up spontaneously, and people started to put it on their shirts and the NFL was going to go court to stop this from happening, David wrote a letter to Roger Goddell. The letter started off by saying: ``Who Dat.'' So speaking truth to power on behalf of the ``Who Dat Nation'' is one credit of his. Similarly, David was tweeting before our President-elect made it perhaps as high profile. I remember during the 2013 Super Bowl in New Orleans--and again the context of this is, the Saints had just been punished--of course Saints fans think unfairly--by Roger Goddell. So during the 2013 Super Bowl in New Orleans, when the power went out, David's tweet, without missing a beat said: ``Like most Saints fans, I am immediately assuming Roger Goddell is the chief suspect for the power outage.'' The quick-witted quip cut to the emotion of the ``Who Dat Nation.'' As the 114th Congress comes to a close, the Senate will be losing an important Member. David brings a sound, strategic mind to this Chamber that will be missed. I wish him, Wendy, their children, Lise, Sophie, Airey, and Jack, the best of luck in their journey forward. On behalf of all Louisiana, I say thank you. I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I thank Senator Alexander for yielding and for his leadership, and I thank Senator Murray for her leadership. I thank Senator Murphy for his cooperation and collaboration in passing this legislation. I will speak to mental health as Senator, a doctor, a family member, and as a friend of those with mental illness. Because of these different hats, passing comprehensive mental health reform has been a priority since day one. Senator Chris Murphy and I introduced the Mental Health Reform Act in 2015, shortly after arriving in the Senate. Since then, Senators Alexander and ranking member Murray have made mental health reform a priority, and I thank them once more for their vital work to include the provisions the four of us introduced in the Mental Health Reform Act of 2016 in the 21st Century Cures Act. In some way, everyone is affected by serious mental illness. This is not a partisan issue. It crosses any division of age, gender, demographics, and certainly political party. If I go to a townhall meeting in Louisiana in an area that is not so wealthy and speak of the need to address mental health, heads nod yes. If I go to another townhall meeting in another area that is very wealthy and mention the need to address mental health, all heads nod yes. Everyone nods their head yes because mental health is an issue in the back of everyone's mind. Earlier I mentioned that everyone has a family member or friend who has a serious mental illness--maybe not, but it might be that person whom you went to high school with and her life turned out far differently. Perhaps her marriage broke up, perhaps her children are in foster care, or perhaps she is homeless. If you think--not even hard-- that person will come to your mind. The largest problem affecting Americans with serious mental illness is lack of access to care. Just a few weeks ago, I spoke to a neuropsychologist in Baton Rouge, Dr. Paul Dammers. He said he sees 15 to 20 patients a day and is booked up to 6 months in advance. If your loved one is having a mental health crisis, they should not have to wait 6 months to receive treatment. He stressed the significance of the barrier to treatment posed by the shortage of mental health professionals. Thank God for Dr. Dammers and for all the work he and the other mental health specialists do to help those with mental illness return to wholeness, but they need help. Access delayed is access denied, and access is hampered by a shortage of mental health providers and too few beds for those with serious mental illness who need to be hospitalized. Too often patients cannot get the care they need, and too often they have a long delay between diagnosis and treatment. Without appropriate treatment options, prisons, jails, and emergency rooms become the de facto mental facility. Sheriff Greg Champagne from St. Charles Parish, LA, and past President of the National Sheriffs' Association quotes a statistic that sheriffs are the No. 1 providers of mental health services in any parish or county in the country. Incarceration has become our top mental health treatment strategy. More than three times as many mentally ill are housed at any one time in prisons and jails than being treated in hospitals. Now, it is clear it is time to fix our broken mental health care system. The 21st Century Cures Act provides incentives to build an adequate and skilled mental health workforce to expand access to mental health care, providing quick and effective diagnosis and treatment. Our goal is that the person who has her first psychotic episode when she is 18 will be restored to wholeness so that when she is 50, she looks back upon that as a distant memory but not as a life-defining event. This bill also addresses privacy issues that keep some patients from receiving the best treatment possible. As an effect of the government regulation HIPAA--an important law protecting patient privacy-- nonetheless, when it comes to a patient with mental illness as an adult, the doctor feels as if she or he is not allowed to share vital information for their care with a third party, even if that third party is their caregiver. A woman I went to high school with has an adult son with serious mental illness, and she relates that she is the one who brings him to the hospital and she is the one who gives him his medicines. Yet, when he is discharged, she is not told what medicines he takes. She is not told when he takes them, and she is not told when to bring him for follow up. Privacy is important, but when government regulation gets in the way of a doctor and a patient and a family trying to make sure their loved one is cared for, something needs to change. This legislation also provides incentives to build an adequate and skilled mental health workforce but also to train that workforce to better understand these rules of disclosing patient information. This allows doctors to better serve their patients and ensure they are getting the proper care they need. It also--again, as a physician, this next provision just matters so much to me--promotes access to services through the integration of primary and behavioral health. Right now, if someone with a serious mental illness goes to see their psychiatrist and the psychiatrist notes that their hypertension is out of control and she wants to send the patient down the hallway to see her colleague, the family practitioner, the Federal program won't pay for that. She refers the patient to the emergency room instead. Conversely, the family practitioner treating the hypertension knows that the patient is psychotic. They are not allowed to send the patient down to the psychiatrist on the same day. Now, in private insurance programs, this is not an issue. It has only been an issue in Medicaid. This law begins to change that. I will note that patients with psychiatric illness die 20 years younger than do patients who have a physical illness but do not have a psychiatric illness. We must do better by those with serious mental illness. Another thing this bill does is to establish a grant program focused on intensive early intervention for children who demonstrate the first signs that may evolve into serious mental illness later in life. Drs. Howard Osofsky and Joy Osofsky of the Health Science Center in New Orleans did research after Hurricane Katrina and found that you can detect from ages 0 to 3 evidence of a child who may have a problem with mental illness later in life. This bill provides grants for early intervention for the infants and children, which will address the effects of trauma and the adverse experiences that up to 10 to 15 percent of children under the age of 5 have. A second grant program supports pediatricians consulting with mental health teams. This is modeled after successful programs in Massachusetts and Connecticut. This legislation does many important things to change how we treat mental illness. By expanding access to mental health resources, clarifying the rules on disclosure of patient information with family caretakers, and integrating primary and behavioral health, the 21st Century Cures Act will begin to fix our broken mental health system and prevent more people affected by mental illness from being denied the care they need. Thank you, and I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I am here to speak about the American Energy and Conservation Act, which we will be voting on today. I thank once more my colleagues on both sides of the aisle for their hard work on this American Energy and Conservation Act of 2016. Yesterday, the senior Senator from Florida made some statements, and I would like to address some of those. The senior Senator from Florida suggested that developing America's energy resources off our coast is incompatible or somehow conflicts with Department of Defense activities. Let's be honest. Let's just be honest. There have been oil and gas operations in the Gulf of Mexico for almost 80 years. Through all of this activity, industry and the United States military have been able to coexist. As for future production off the Atlantic, I personally sat with representatives from the Department of Defense to discuss this issue. Their analysis showed that in President Obama's original Atlantic Draft Proposed Program, less than 2 percent of the acreage was recommended to not have oil and gas development because of operation conflicts. Now, here sometimes it is ``he said, she said'' or ``she said, he said.'' This is objective. This is the DOD Mission Compatibility Planning Assessment regarding the Outer Continental Shelf Oil and Gas Leasing Program from October 30, 2015. That is where that 2 percent number comes from. The American people deserve honesty. We should not mislead them. The senior Senator from Florida can vote as he wishes, but, again, Department of Defense operations are not an excuse. Secondly, the senior Senator from Florida suggested that he is looking forward to working with the new administration. Although he did not support President Trump, he is looking forward to working with the new administration on behalf of the American people. Again, let's be honest. If there is one thing that came out of this last election, it is that Americans want better jobs with better benefits. The last 8 years have been hard on working families. That is why they are desperate for these better paying jobs. It is fitting in that regard that we are voting on the American Energy and Conservation Act. This has been studied and is said to incentivize the creation of 280,000 new jobs by 2035. This legislation is expected to trigger $194 billion in new capital investment in our economy, creating $51 billion in cumulative government revenue for our Federal Government and for States. Now, let's be honest. If you are going to work with the new President, let's work on programs that will create hundreds of thousands of good-paying jobs for Americans who need those jobs, as well as revenue to address debt, deficit, and other issues in our State and Federal Government. Now, let's also be honest. If America does not develop our natural resources, the vacuum will be filled with the likes of Iran, Venezuela, Russia, and Cuba--Cuba, which would like to drill off their coastline. Now, the choice is either to create good-paying jobs in the United States--off States like Virginia and North Carolina--or to forfeit these jobs abroad. By the way, the senior Senator from Florida gave the reason why Senators from mid-Atlantic States should vote for this. He spoke specifically about the billions of dollars in revenue that would come to States. He complains about it. If I were from Virginia and North Carolina or a Middle Atlantic State, I would say: My gosh, I get hundreds of thousands of new high-paying jobs and billions of dollars to address our States' needs? I would be all about this. Now, there are different ideas about the future of energy in the United States, and this legislation does not discriminate. It includes language introduced by two Democrats and two Republicans--Senators Heller, Heinrich, Risch, and Tester--that streamlines the process for developing renewable energy on public lands and establishes the first- ever revenue-sharing paradigm for renewables. For those who say we need to do something for carbon-free energy as well, this bill does so. The change would incentivize the production of 27,000 megawatts of carbon-free energy that the Bureau of Land Management estimates could be provided for these projects. Additionally, we bring offshore wind into the mix, by creating the first-ever revenue sharing for offshore wind, incentivizing the development of 4,233 gigawatts of carbon-free generation that, again, the Bureau of Land Management estimates will be available for development off our coast. Now, some say they don't want to look at development off their coastline. This would be 50 miles out--at least in the case of the oil rigs, 50 miles out. Your sight line stops somewhere around 25 miles, at most. So this would not be seen by anyone who is otherwise enjoying the beach. This legislation makes investment and conservation projects across the country. We included another bipartisan provision that provides an estimated $807 million for projects that increase access to public lands for hunting, fishing, and other outdoor recreational activities. This provision was included in Senator Murkowski's Bipartisan Sportsmen's Act of 2015, which 24 Senators have cosponsored. The legislation makes investments in a variety of important programs-- important to Western States--including the Payment in Lieu of Taxes Program. The bill also restores the traditional 50-percent onshore oil and gas State and Federal share for production on public lands, which the Obama administration had reduced since 2010 to pay for spending elsewhere. Again, all of this is of particular importance to Western States. The American Energy and Conservation Act of 2016 is supported by over 50 important stakeholder groups, including the National Association of Manufacturers, the U.S. Chamber of Commerce, the American Chemistry Council, the American Petroleum Institute, the Western Energy Alliance, and the Consumer Energy Alliance. There is one more thing. It has been suggested by implication by the senior Senator from Florida that we are trying to open up acreage off the coast of Florida--that we are trying to open up acreage in general. We don't open up any acreage at all offshore in this bill. All this does is say that if a new President--President Trump--decides to have Outer Continental Shelf drilling, there would be a certain model of revenue sharing. But we absolutely do not open up new acreage. Again, that sometimes seems to be implied. We need to be honest with the American people. All energy-producing States deserve to share the revenue derived from energy developed both onshore and offshore. Responsible revenue sharing allows States hosting energy production to mitigate for the historic and prospective infrastructure demands of energy production. It just makes sense. They need more roads. It helps those States build the roads and allows States to make the strategic investment needed to ensure for future generations the resiliency of the infrastructure and for vital natural resources. I urge my colleagues to support proceeding to the legislation so the Senate's voice can be heard on this important topic. Let's be honest with the American people. This is about creating great jobs. It is about sharing revenue with States. It is not about opening up new acreage. It is thoroughly compatible with the Department of Defense's mission to protect our country. I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I wish to thank Senator Vitter for his support, his kind words, and his tireless effort over his senatorial career to highlight the fact that Louisiana is losing so much land and there is something we need to do about it. I also thank Majority Leader McConnell for following through on his commitment to allow a vote on the American Energy and Conservation Act of 2016. This was introduced earlier this year by Senators Murkowski, Scott, Vitter, Tillis, Sullivan, and me. I thank each of them for their hard work. I also thank Senators Kaine and Warner for helping draft the Atlantic portion of the legislation and for cosponsoring an earlier version. As I just said, this is a bipartisan piece of legislation that uses an ``all of the above'' strategy to pursue true American energy independence. More than anything else, though, this legislation is about creating better jobs with better benefits. If there was one message we heard from this past election--if we actually listened to the American people, if we heard what they were saying, what we heard is that they want jobs that work for them, better jobs with better benefits. This helps accomplish that. For example, a study conducted by Quest Offshore Resources, Inc., projects that this legislation would incentivize the creation of 280,000 new jobs by 2035. That same study estimates $195 billion in new investments and an additional $51 billion in cumulative government revenue. That is $51 billion in new Federal revenue that this bill helps unlock. It goes a long way to addressing our debt, deficit, and obligation to future generations. The American Energy and Conservation Act will benefit American families and small businesses by expanding opportunities for States-- not just gulf coast but elsewhere--to support energy development. For years, energy activities in coastal Gulf States and adjacent offshore waters have produced billions of barrels of oil and trillions of cubic feet of natural gas for American families. These States support offshore energy development for the rest of the country and provide the support and pay for the infrastructure needed to bring this energy to market. As with all development, there are increased costs associated with supporting increased traffic, additional use of local and State resources, as well as transportation corridors such as pipelines, vessels, and trucks to get this energy delivered to consumers across the United States. This bill is truly an ``all of the above'' energy jobs bill. This legislation includes language introduced by Senators Heller, Heinrich, Risch, and Tester that streamlines the process for developing the renewable energy on public lands while establishing the first-ever revenue sharing paradigm for renewables. This legislation incentivizes tapping into the 27,000 megawatts of carbon-free energy that the Bureau of Land Management estimates could be provided by these projects. Furthermore, if offshore revenue exists for oil and gas development, the same should be true for offshore wind development. That is why we are using the same model established in GOMESA to extend revenue sharing to States that support offshore wind projects. This legislation thus incentivizes developing some of the 4,233 gigawatts of carbon-free generation that the Bureau of Land Management estimates is available for development off our coasts. This is the American Energy and Conservation Act of 2016. This legislation makes significant investments in conservation projects all over the United States. This legislation provides an additional $807 million for projects that increase access to public lands for hunting, fishing, and other outdoor recreational activities. This particular provision was included in Senator Murkowski's Bipartisan Sportsmen's Act of 2015, which 24 Senators have cosponsored. The legislation makes investments in a variety of important programs, including the Payment in Lieu of Taxes Program. This legislation is supported by over 50 important stakeholder groups, including the National Association of Manufacturers, the U.S. Chamber of Commerce, the American Chemistry Council, the American Petroleum Institute, and the Consumer Energy Alliance. These organizations understand that this legislation is a jobs builder and good policy for American workers. Mr. President, I urge my colleagues to support this legislation, the American Energy and Conservation Act of 2016. I yield back.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I have spoken on the floor twice now to tell the stories of the devastation caused by the great flood of 2016 and the depth of need the families of Louisiana have. Since I last spoke, about 10,000 more people have applied for individual assistance through FEMA, and now about 150,000 folks in Louisiana have applied for individual assistance. This is a serious, immediate issue, and we need help for those who are in great need. In all of the debate back and forth, some people have forgotten or never realized how massive this disaster was--an unprecedented event. The National Weather Service deemed this as a once-in-a-thousand-years event. Twenty parishes have been declared disaster areas. In the city of Denham Springs, 90 percent of homes flooded, and in about half of the structures flooded, it will cost owners over 50 percent of the value of the building to repair. Ninety percent of the housing stock in this town has been flooded. According to the estimates by the Advocate newspaper--the paper in the Baton Rouge area--as many as 12,000 Baton Rouge area businesses flooded. The National Flood Insurance Program has found that when businesses floods, as much as 40 percent of them never reopen. For a small business to reopen their doors, there is great cost, and this can prove too great to rebuild. The consequence of this is to the owner of the business, but it is perhaps felt more greatly by the employees--and their families--who lose their jobs. This flooding caused $8.7 billion in damage. If you take out hurricanes, this has been the most expensive natural disaster to happen in the United States in the last 100 years. Let me repeat that. Take out Sandy and Katrina, and we have the most expensive natural disaster in the last 100 years--$8.7 billion. No one was prepared, and it is not their fault. Less than a quarter of the population had flood insurance because the flood occurred in areas more than 50 feet above sea level. One fellow who called me lives 7 miles from the river, and he got 4 feet of water. He did not expect to have a flood and was not required to have flood insurance. Why would you when you are 7 miles away from the river? Thousands of families were completely caught off guard by a thousand- year flood and are now struggling to pick up the pieces. They need our help. They are trying to make a decision whether to rebuild or just move on: We can't afford to repair our house. We owe more than it is worth. Let's just walk away from our mortgage, buy a trailer, and hopefully be able to do something different in the future. Here are a couple of examples of families affected. This is a street. This is not a lake; this is a street. This is a family being evacuated by volunteers. The water was too deep for them to get out. You can imagine, if this is on the street, it is also in the house. And that which most people keep--wedding dresses, picture albums, toys, clothes--is flooded too. When the water recedes and the water goes out of the house, also what goes out are these heirlooms, picture albums, clothes, and piles of debris on the side of the road. Let me also remind you of Dorothy Brooks. She is 78 years old. In this picture, she was being rescued out of 3 feet of water. You can see the water here next to the deputy's leggings. This is in Tangipahoa Parish, and this is Sergeant Thomas Wheeler. Dorothy relies on a wheelchair. As you might guess, she could not evacuate, nor could she prepare for the flooding. Dorothy is not the only person who is handicapped or who is a senior citizen who was affected. At their age, they have been unable to evacuate but also unable to carry out the repairs once the floodwaters recede. One example of this is Roy and Vera Rodney--both in their eighties--who had 4 inches of water in their house. It was not a whole lot, but 4 inches. The FEMA inspector told them their home was habitable, so they were denied repairs and rental assistance. Being in their eighties and having no family in town, they couldn't gut and repair their home on their own. The water sat, and there was damage to the carpet. Their belongings sat. Mold came in, mold spread, and now their house is too unhealthy to live in. They have evacuated to family who live far away, and while there, they are not available to let volunteers come in to gut their house. In the weeks that they have been forced to wait, the house has remained ungutted and mold has continued to spread. Because they could not get their aid in time, the cost of recovery has grown. The Rodney story is the story of the whole region. Dollars to help that come sooner will have a greater impact than the same amount of money that comes later. Again, if the Rodneys had been able to take out 4 inches of wet baseboard, furniture, carpet, wood flooring, their home would have dried and they would have rebuilt. Because they could not, mold spread, the damage increased, and now the whole house has to be remediated. The same amount of money sooner has a greater impact than later. That is the story of us seeking funding for Louisiana in the CR. Helping each other is a fundamental American value. I ask all my colleagues to support this continuing resolution with the money for disaster relief for families--not just in Louisiana but also in Louisiana--who have been faced with natural disasters, to help families like these who have lost everything put their lives back together. Let's do what is right and pass this legislation so we can help relieve these flood victims. I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I rise again today to bring attention to the devastating floods in my State of Louisiana, which are now being called the Great Flood of 2016. In a matter of a few days, 7.1 million gallons of rain fell on Louisiana--more than fell during Hurricane Katrina. The flooding that resulted caused $8.7 billion in damages to homes and businesses. A flood event of this magnitude is such a low probability that it is called a thousand-year flood. To put this in perspective--just statistically--the last time a flood of this magnitude would have occurred in this area would have been 500 years before Christopher Columbus discovered the Americas. It is hard to comprehend, but this chart may help. We all know of the devastation caused by Hurricane Sandy and of Katrina, Rita, and Wilma in 2005. This is from the 1871 Chicago fire. This is the fifth largest disaster after the 1906 San Francisco earthquake. In the last 100 years, the 2016 Louisiana flood is the third largest disaster in American history. The National Hurricane Center was not able to warn us for this. They said that rain is going to start. It started to rain, and the next day there was flooding. Most folks who were flooded had never been flooded before. They were living in areas that they were told were not at risk for flooding. The first parishes did not have time to evacuate or to prepare. Here you can see a family being helped out by volunteers. In the back, you see what is called a high-water vehicle. It doesn't flood out, but it is a single vehicle. There were as many as 30,000 folks evacuated from their homes by what was called the ``Cajun Navy''--Americans helping Americans get out. By the way, this is a residential street. This is a neighborhood in which you can see the street itself flooded. This family's belongings are now piled up on the side of a road. They escaped with the bags they hold. This is one family. So far, 144,000 people have applied for individual assistance through FEMA. I suggest that these people need to know their fellow Americans care about them. Just as important for communities, small businesses were hit too. According to the local newspaper, 12,000 small businesses in the area flooded have been out of commission because of the flood. This is from Denham Springs. It is a town right across the Amite River from East Baton Rouge Parish. You see everything they are selling piled up on the side of the road. Of course, this is tragic for the business, but think about the community. The National Flood Insurance Program estimates that 40 percent of small businesses that flood never recover and never go back into business. This is tragic not just for the business owner but also for the people whom she employees because you have just destroyed the job and the opportunity for everyone whom she does employ. It is one thing to look at statistics and to look at the huge scope of this disaster, but I return to the fact that it is a disaster affecting individuals and affecting families--people who have lost everything. When I say ``everything''--they still have their life, but the floodwaters have now receded. You would say: Wait, how can floodwaters have receded if we still have a home under which there is obviously a lot of water? This flood was so devastating. There is a community called Cypress Point in the French Settlement. The homes were built far above the base flood elevation. They were told they were not at risk of flooding. The floodwaters rose, though, to 46 feet above flood level, and they ripped out the ground beneath the homes. What you are looking at used to be ground beneath the home. Now the river has taken away the bank, and these homes are sitting in a river. Ten of these homes are being condemned, and there is a certain kind of bitterness these folks must feel. First, they didn't think they were going to flood. If they want to come back and put supports under their home, they will have to get an Army Corps of Engineers permit to do that. If their home falls into the river--and it looks like that could happen--they have to pay to remove their home from that river. They are going to be caught coming and going. Again, these homes are built above the base flood elevation. This is Dorothy Brooks. Dorothy is 78. She is being rescued. She is wheelchair-bound. Here is Sergeant Thomas Wheeler of the Tangipahoa Parish Sheriff's Office carrying her out. Dorothy did not have time to get out on her own. You can still see rain falling, even though water is up to about 3 or 4 feet. Many seniors like Dorothy were able to return to their home, but due to their age, they could not rip it out. If your home is flooded to 4 feet, you have to go around and physically take the sheetrock and the insulation out that is behind the carpet and the wood floors. If not, mold comes in. Here is a tragic example of it. Roy and Vera Rodney are both in their eighties. They had 4 inches of water in their home. The FEMA inspector told them that it was habitable. So they were denied repairs and rental assistance, but they didn't have any family nearby. They couldn't gut their house. They couldn't repair it. So the water-damaged carpet, furniture, and belongings stayed, and, predictably, mold appeared. They could no longer live there. They evacuated. They weren't there to let volunteers in to rip it out. Now they have mold throughout their home, and it is uninhabitable. Because they couldn't get the aid they needed, cost of recovery grew with time. If there is a metaphor here, it is this. If you are unable to get the aid when needed, the cost of recovery grows with time. Roy and Vera were not required to purchase flood insurance. They lived in zone X. Zone X is thought to be at such low risk of flooding that flood insurance is not required. By the way, that is a huge factor in flooding. About 80 percent of the homes that were flooded did not have flood insurance--not because they didn't purchase it on purpose when they were told to but because they were told they lived in low-risk areas for flooding where flood insurance was not required. I will say that is why Federal aid is so critical. We have thousands of families completely caught off guard, unprepared--through no fault of their own--by a freak of nature, a thousand-year flood. They are now struggling to pick up the pieces. They are trying to make the decision: Do I stay and rebuild, or do I just move on? Families, businesses, Louisiana need help. I ask that we pass this funding bill quickly. People are hurting; people need help. Some look at this picture and just see debris. This may be Youngsville, a community I visited, but it could be any community. I would say that is not debris. That is a wedding dress that was saved for 20 years. It is picture albums, children's toys, clothes to go to work, textbooks, and memorabilia. It is their life, piled up the road. I am thankful that Senate leadership has put what they are calling a down payment on the continuing resolution. This reassures families that their fellow Americans care and that they can rebuild and prosper, but we are not through yet. Helping each other is a fundamental American value. I urge my colleagues on the other side of the aisle to support this legislation--to help families faced with losing their homes and losing everything, to help folks pick up the pieces and put their lives back together. To Americans across the country, call your Senator and ask them to support Dorothy, Ray, and Vera. I yield back.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I rise today to honor three brave men: Corporal Montrell Jackson, Deputy Brad Garafola, and Officer Matthew Gerald. It has been a tough summer in Louisiana. Not only did we have the floods of which I spoke yesterday, but we had the Alton Sterling shooting, the civil unrest afterwards, and then these three officers killed and several others shot. I will speak today to these officers. On July 17, the three men I just mentioned gave their lives while protecting our community when ambushed while reporting to a 9-1-1 call. Deputy Nick Tullier, Deputy Bruce Simmons, and Officer Chad Montgomery were injured during this attack. Thankfully, Deputy Simmons and Officer Montgomery have returned home to their families, but Deputy Tullier remains in the hospital. Please keep him in your thoughts and prayers. Speaking of those who died, Corporal Jackson was a 10-year veteran of the Baton Rouge Police Department, a loving husband to his wife Trenisha, and a father to his 4-month-old child, Mason. Following the shooting of Mr. Alton Sterling, Montrell wrote on his Facebook page: I personally want to send prayers out to everyone affected by this tragedy. These are trying times. Please don't let hate infect your heart. This city must and will get better. Deputy Garafola served the East Baton Rouge Sheriff's Office for over 24 years. He was a beloved son, husband to his wife Tonja, and father to their four children: Garrett, Braley, Brad, and Samantha. He was remembered for always selflessly trying to help others. At the time of his death, he again acted selflessly, giving his life when he saw another officer down, running to that officer who was injured during the attack and by doing so exposing himself to fatal gunfire. Officer Matthew Gerald joined the Baton Rouge Police Department just last year. Before this, he had bravely served our country in both the Army and Marine Corps. Between 2002 and 2009, Matt completed three tours of duty in Iraq as a crew chief on a helicopter crew and received numerous awards and medals. Prior to his service in the Army, he had enlisted in the Marine Corps in New Orleans and served 4 years from 1994 to 1998. Matt was a loving son, husband to his wife Dechia, and father to Dawelyn and Fynleigh. His wife recently announced she is pregnant with their third child. Each of those men shared common core values that guided them: service, stewardship, and sacrifice. They put the needs and well-being of others before their own. Scripture says, ``Greater love hath no man than this, that a man lay down his life for his friends.'' In protecting their community, these men paid the ultimate sacrifice. I honor their lives and thank their families for their selfless service to the city of Baton Rouge, to the State of Louisiana, and to the United States of America. I yield the floor. I suggest the absence of a quorum.

Mr. CASSIDY

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

Mr. CASSIDY. Mr. President, I rise to speak about ObamaCare and the incredibly negative impact it is having on millions of Americans. Let's just speak about its impact upon the middle class. There was a recent article in the Wall Street Journal, dated August 26, which spoke about how ObamaCare is pushing the burden of health care costs to the middle class. It speaks about how deductibles have risen 256 percent, but wages have only increased 32 percent. It also goes on to say how folks are spending 32 percent more on health care, but they are having to cut back on groceries, restaurants, entertainment, and clothing. Everything else is being cut back as health care consumes more and more. ObamaCare was supposed to change health care. The President promised that premiums would fall $2,500 per family. The logical question is, Why didn't that happen? I have a good example. A physician friend I know who happens to be a neurologist in Baton Rouge texted me. She had a couple in her office who were paying $1,600 a month for insurance. They have a $10,000 family deductible. They are middle class and don't get a subsidy. Let's think about this. They are paying $1,600 a month and have a $10,000 family deductible. Let's do a little quick math. That is roughly $16,000 a year plus $3,200, which comes to $19,200 a year, if my math is correct. When we add $10,000 for a deductible--let's say they both get in a car wreck and they are taken to the emergency room at the same time--they will be out $29,000 before they see a benefit from their insurance. They will have to pay $29,000 before they see a benefit from ObamaCare which is supposed to hold down costs. These are statistics and anecdotes. Let's speak in a different sense. Let's speak about premium hikes. Premiums are up 31 percent this year in Louisiana, but premium increases are rising as high as 67 percent in Arizona. There is a 69-percent premium increase in Tennessee, and that is consistent across the Nation. As it turns out, there is one county now which doesn't have any insurance company providing coverage, but there are many other counties in our Nation in which there is only one insurance carrier. I can tell you, the less competition you have, the higher costs will go. As this continues, competition decreasing--and insurance companies like Aetna, Humana, and Blue Cross are pulling out of the exchanges in some States--we can expect these premiums to continue to rise. The situation we are in is that people are either going to be insurance poor or they will be forced to go without insurance. There is an incredible irony. The bill which passed, the Affordable Care Act, had the stated goal of making health care affordable. It is becoming so unaffordable that people are going without insurance. I think this will only worsen. Up to today, ObamaCare has received $10.5 billion in Federal tax dollars as subsidies, and there were a series of co-ops set up. The co- ops were going to foster competition. As it turns out, 16 out of the 23 co-ops have gone out of business, health expenditures are on an alltime rise, and the subsidies are going away--some of them have been ruled illegal by the Federal courts--and so only the beneficiary will be paying the premiums. Despite $10.5 billion in subsidies, insurance companies have lost $2.7 billion. Again, if these subsidies go away because they are illegal, we can expect premiums to rise even more. I am a big believer that if you are going to criticize something, you should offer an alternative. I would like to point out that this Republican and another Republican have offered an alternative. We call it the World's Greatest Healthcare Plan. We have kind of a cheeky title to draw attention to it, but it is serious legislation. Under the World's Greatest Healthcare Plan, we change the paradigm of ObamaCare. If under ObamaCare the presumption is that government knows best and folks in Washington can make better decisions for the folks in Baton Rouge, New Orleans, Lafayette, Shreveport, the Presiding Officer's hometown in Pennsylvania, or any other place in the Nation, and knows what to tell them and what they should buy--therefore how much they should spend--under the World's Greatest Healthcare Plan, we take the opposite approach. We assume that the woman in the household--usually it is a woman. I am a physician so I know this. Usually, the woman makes 95 percent of the decisions on health care for a family--let's use the feminine--so she knows what is best for her family. There is kind of a humorous anecdote. On the campaign trail 2 years ago, I had two different women speak to me in a very memorable way. One of them came up and said: You know, I am 58 and my husband is 57. Our two boys are 18 and 19. Unless my name is Sarah and my husband is Abraham, we are not having more children, we do not need pediatric dentistry, and I do not need obstetrical benefits, but that is included in my policy, which I am forced to pay for, and my husband and I are paying $28,000 a year for insurance. Another woman from Jefferson Parish walked up to me and said: My name is Tina. I am 56 years old, and I had a hysterectomy. My husband and I are paying $500 more a month for insurance--$6,000 more a year--and I am paying for pediatric dentistry and obstetrics. I do not need these benefits, but I sure as heck would like to have my money. Washington is making the decision that these two women in Louisiana, and women across the Nation should pay for benefits they don't need, therefore paying far more. By paying far more, they have less to spend on other things they might need to purchase, for example, flood insurance in my State, clothing, restaurants, entertainment, a night out in their own State, wherever that State might be, but they cannot make that decision. Under the World's Greatest Healthcare Plan, we take the power away from Washington and give it to the family. We allow them to choose the benefits they wish, those they need, making the decisions between pocketbook and health care that they are uniquely qualified to make. By the way, we also do away with the individual mandate. We know that individual mandate. It is the ObamaCare provision saying that you shall buy insurance or the Federal Government will fine you. Under the World's Greatest Healthcare Plan, we take all the money a State would receive from the Federal Government for health care and we allow the State to give a credit to each individual in that State who is eligible, and that would be most folks. The State legislature would have the option to say that everyone in the State who is eligible is enrolled unless they choose not to be--unlike ObamaCare, where you have a 16-page online form where you have to get on and have your W-2 and check it off. If you don't have a W-2 with you and are a poorer person and have to go to the library for your Internet access and you go home by public transportation to get the right form and have to take public transportation back, it is not going to happen. Under our plan, you are enrolled unless you choose not to be. We expect to have 95-plus percent enrollment. We don't provide the bells and whistles of ObamaCare, but what we do is give first-dollar coverage. Instead of a $6,000 deductible per individual or a $10,000 deductible per family, every family will have a health savings account with which they have first-dollar coverage. If they need to take their daughter to the urgent care center to have an earache treated, they have first-dollar coverage. There is not a $6,000 deductible to work through. They have a pharmacy benefit and a catastrophic coverage on top. If they are in a car wreck and admitted to the hospital, they will be protected from medical bankruptcy by that catastrophic coverage. Another thing we do by giving power to the patient is price transparency. Under ObamaCare we have seen prices rise and rise and rise even more. Part of the problem is the consumer has no power. She does not have the ability to know that if a doctor orders a CT scan for her child--if she goes to this place and pays cash, it is $250 or if she goes to that place, it is $2,500. I picked those numbers, by the way, because the Los Angeles Times had an article a few years ago and found that the cash price for a CT scan in the L.A. Basin varied from $250 to $2,500, and there would be no way someone would know. With the World's Greatest Healthcare Plan, the power of price transparency is given to that mom so she knows where she can take the child for the best cash price and the highest quality and balance that with her budget. If the family wishes to really take matters into their own hands, they can put their family credits all together in a pool and buy a group policy for their family or they can give it to their employer as the employee's contribution for an employer-sponsored plan and buying into the richer coverage that employers typically give. I could go on, but, if you will, the premise I learned as a physician is that if you give the patient the power, she will make the right decision for her family, both for their health and their pocketbook-- unlike ObamaCare, which says: Family, you are not as wise as folks in Washington. We are going to tell you what you have to buy, therefore what you have to pay, and if prices escalate even more and you decide you can no longer afford insurance, we are coming after you to make you pay a penalty. It is wrong, I think it is un-American, and it is certainly bad for families. The principle under the World's Greatest Healthcare Plan, which I like to say in a phrase is giving the patient the power, but the academic literature would call it the activated patient--someone who is now fully engaged in managing her and her family's health care. Not only does that result in lower costs, statistically it gives you better outcomes. There is a physician Congressman on the other side in the House of Representatives who tells a story of someone he worked with. They went through a health savings account, and the manager came up and said: Dr. Fleming, I don't particularly care for this plan because it doesn't pay for my inhaler. He said: Well, your health savings account can pay for your inhaler, I suppose, if it is not covered by your pharmacy benefit, but if you stop smoking, you don't need an inhaler, and he walked away not thinking about it. She later approached him and she said: Dr. Fleming, let me tell you. He said: Yes? She said: You are right. He is thinking: What was I right about? She said: I stopped smoking and no longer need an inhaler. That is a personal story, if you will, of that which statistically is demonstrated. If people become engaged in their health care, they are not only healthier, but they save money. Under the World's Greatest Healthcare Plan, we take that Republican principle of believing in the power of the individual to shape her life and her family's destiny in a much more positive way than you would expect from a bureaucrat telling you to be passive and to otherwise obey. I will return. Unfortunately, the President's health care law, the Affordable Care Act or ObamaCare, is crushing the middle class with ever-higher premiums, higher deductibles, higher copays, an inability to pay, and becoming insurance poor as they cut back on everything else to avoid paying the penalty for the needed health insurance. Republicans have offered an alternative. One alternative is the World's Greatest Healthcare Plan, and in our alternative we give the patient the power. I suggest that would be an important area of compromise; that we all see that giving the patient the power, the individual American the responsibility, is a better way to go. I yield the floor.

Mr. CASSIDY. On behalf of the leader, I object.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I rise today to discuss the thousand-year flood that hit my State of Louisiana a few weeks ago. It is not named, so we call it the Great Flood of 2016, in which 13 people lost their lives and $8.7 billion in damage occurred in just a few days. As an example of the enormity, here are the power outages that followed the flooding. This is baseline before the flood. The lights went out, and all of this reflects homes substantially flooded. There is no substitute for witnessing the aftermath of the disaster yourself, but I will try to paint a picture of the damage of this terrible event and the situation from which my constituents are currently trying to rebuild. Again, it was an unprecedented weather event. The National Weather Service deemed it a once-in-a-thousand-year event. There was no way to prepare. It was not as if there was a storm system off the coast of Africa that was proceeding across the Atlantic Ocean. Less than a quarter of the population had flood insurance and not because they were supposed to and didn't. Most weren't supposed to because it wasn't supposed to flood, and they were not required to have flood insurance. Again, the flooding occurred in areas more than 50 feet above sea level where folks were told they were not in a flood zone or were at low risk. That is one example. Thursday afternoon, residents were warned of a possible flash flood from a weather system moving into the area, but even the National Hurricane Center had no expectation of how devastating the storm would be. It was missing key cyclone characteristics, and these parishes, never having been hit by a flood such as this, felt all was well. The first parishes to be hit by flooding had no time to evacuate or prepare. In just the first 2 days, as much as 2 feet of rain fell in South Louisiana. This record rainfall statistically had a 0.1-percent chance of occurring; thus, it is described as a thousand-year weather event. Again, this is baseline--grass, trees, roads. This is the same street. All that brown is water. In parts of Livingston Parish, within 15 hours, 31 inches of rain fell. By the end of the third day, Baton Rouge, the capital city, had 19.14 inches of rain; Denham Springs, within Livingston Parish, had about 25 inches of rain; Watson, LA, saw over 31 inches of rain. We received more than three times the rain that Louisiana saw from Hurricane Katrina. The recordbreaking rainfall led to recordbreaking river crest. For example, the National Weather Service recorded the Amite River's height at 46.2 feet--5 feet higher than the previous record. Again, this is all pretty apparent. This is baseline where you have dry land with some lakes in between and now that is water. This would be the river, and the river bleeds out into the surrounding land. The Comite River was at 34 feet--4 feet higher than the previous record. As water poured out of these overflowing river systems, currents were so strong that 14 stream gauges, used to measure the height and current of the river, were broken. When the rain ended, 13 were dead: William Mayfield, Linda Bishop, Brett Broussard, William Borne, Richard James, Samuel Muse, Kenneth Slocum, Earrol Lewis, Stacy Ruffin, Alexandra Budde, Ordatha Hoggatt, and two others who have not been identified. Many were swept out into the current of the water. Most were caught completely off guard by the speed at which the flooding occurred. These parishes are more than 50 feet above sea level, and they were not prepared. The majority of the 20 parishes that were declared Federal disaster areas were considered low risk for flooding. In Louisiana, only about 12 percent of homeowners living in low-risk areas have flood insurance. FEMA has already documented over 60,000 homes that were significantly damaged. The number is expected to increase to more than 110,000 homes. Less than 20,000 of those families and individuals had flood insurance. This is debris piled up in front of homes. After 3 days of heavy rain, 20 parishes--one-third of the State--were declared Federal disaster areas. Among these, East Baton Rouge had 35 percent of its homes and businesses damaged. Ascension and Livingston Parishes had about 90 percent of their homes significantly damaged or declared a total loss. You walk the streets, and entire lives are lined up by the curb. Imagine almost 100,000 people having to start from scratch. Imagine right now owning only the clothes on your back and a waterlogged home, which may cost more to repair than you can hope to repay. It is fair to say that this region is in crisis. A significant portion of our State's population has lost everything. In many cities, thousands had to be rescued by boat or airlifted-- taking nothing with them and forced to leave everything behind. The good news is our community is strong. Neighbors are helping neighbors slowly put pieces back together, but there are challenges repairing infrastructure, sending kids to school, and disposing of large amounts of debris. Aside from that, we are still in hurricane season. We don't know what might come next, but another storm hitting Louisiana before recovery is complete would be devastating. Right now my office is working in tandem with the entire Louisiana congressional delegation and our Governor on securing expedited authorization and funding to build the Comite River Diversion and other mitigation projects to keep this from happening again. This is critical for rebuilding and preventing this level of damage from occurring with future storms. Remembering that our State has experienced severe flooding in 36 parishes in less than 6 months, our delegation is requesting a 90-percent to 10-percent cost share between FEMA and the State of Louisiana. We are also asking for supplemental appropriations of disaster recovery community development block grant funds to help with the long-term recovery. Louisianans will work tirelessly, as we have for weeks, to rebuild. We are so lucky that we have had volunteers from out of the State come to help. Hopefully today, by increasing the awareness of this disaster, more people are encouraged to volunteer and donate in order to help fellow Americans recover. Mr. President, I yield back. Mr. President, I suggest the absence of a quorum.

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 bill be read a third time and passed and the motion to reconsider be considered made and laid upon the table.

Mr. CASSIDY. I yield the floor.

Mr. CASSIDY. Mr. President, I rise today in support of H.R. 4904, the Making Electronic Government Accountable By Yielding Tangible Efficiencies Act of 2016, and that is an acronym for the MEGABYTE Act. H.R. 4904 is the House companion to a piece of legislation Senator Gary Peters and I introduced, S. 2340. I would like to thank Senator Peters for being the lead cosponsor of the Senate version of the MEGABYTE Act and thank Senator Thad Cochran for cosponsoring it. S. 2340 passed the Senate by voice vote last week. My friends in the House of Representatives--Representative Matt Cartwright, Representative Will Hurd, Representative Steve Russell, and Representative Elijah Cummings--are the lead sponsors of H.R. 4904. It passed the House on June 7, 2016, by a vote of 366 to 0. The MEGABYTE Act reforms the Federal Government's management of information technology software licensing. The nonpartisan Government Accountability Office, or the GAO, found that implementing oversight and management policies of Federal software licenses saved a single agency 181 million taxpayer dollars per year. If implemented, the MEGABYTE Act could yield billions in savings across the Federal Government. Now, the Federal Government spends $82 billion a year on information technology. In 2015, for example, for the second year in a row, GAO listed IT software license management as a top priority for its annual duplication report. The GAO stated that the executive branch ``does not have adequate policies for managing software licenses.'' Of the 24 major Federal agencies, only 2 have implemented comprehensive and clear management policies of Federal software licenses. Furthermore, none of the 24 major Federal agencies have fully implemented all 5 industry-best practices recommended by the GAO. The MEGABYTE Act saves taxpayer dollars and cuts government waste through the following actions: The Office of Management and Budget Director shall issue a directive requiring that the chief information officer of each executive agency is to identify clear roles, responsibilities, and central oversight authority within the agency for managing enterprise software license agreements and commercial software licenses. Agencies will also establish a comprehensive inventory, including 80 percent of software licensing spending and enterprise licenses in the agency. They shall regularly track and maintain software licenses to assist the executive agency in implementing decisions throughout the software license management lifecycle. They shall analyze software usage and other data to make cost- effective decisions. I notice that every now and then, someone has a database software package and they never use the database. We the taxpayer can save that money. They should provide training relevant to software license management and establish goals and objectives of the software license management program of the agency. Lastly, I will mention that they should consider the software license management lifecycle phases--including the requisition, reception, deployment, maintenance, retirement, and disposal phases--to implement effective decisionmaking and incorporate existing standards, processes, and metrics. Congress has the responsibility to ensure that taxpayer dollars are being used efficiently and effectively. For all the reasons stated above, I offer my strong support for the MEGABYTE Act and urge the Senate to pass H.R. 4904, sending it to the President's desk. With that said, I ask unanimous consent that the Committee on Homeland Security and Governmental Affairs be discharged from further consideration of H.R. 4904 and the Senate proceed to its immediate consideration.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I ask unanimous consent that Genevieve Gorman, a legislative aid in my office, be granted the privileges of the floor for the remainder of the 114th Congress.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I come as a Senator, but actually I come wearing two different hats right now--two more hats aside from being a Senator. One of them is a teacher. I still teach at the LSU Medical School and have for the last 30 years, so I decided to do a presentation on something wearing my next hat. In my life as a physician, I have done much work in public health and have learned, by the way, that if you head off illness early, you save a lot of money. You save a lot of money after that. I call it the balloon theory. If you put a balloon up to helium and you squeeze the nozzle, it inflates quickly, but if you pull it off the nozzle, it remains deflated. Right now, we have something at risk with Zika that will be like that helium balloon--inflating rapidly unless we do that initial thing that pulls the balloon off the helium so that it works. I am a teacher, so I decided to do something different. If anybody in the audience so chooses, they can put their phone and their QR code reader up to the television or the computer monitor and they can scan this barcode, and they will see the slides we are about to go over. So if you are watching at home and you wish to follow, then you can download these slides, and if you think them important, you can forward these slides to another person. Again, that is my effort as a teacher to try to speak about the spread of Zika. This is Jose Wesley, born to a Brazilian mother who contracted Zika probably in her first 3 months of pregnancy. When Zika went through the momma's blood when Jose was in her womb, into the amniotic fluid or through the placenta, it entered Jose's body and went to his brain. That virus stayed inside his brain and terribly affected his brain. Jose was born with microcephaly. You cannot really see from this angle what microcephaly is, but what ``microcephaly'' means is ``small brain.'' Here is a profile of a child with microcephaly. You can see that--unlike the big head babies normally have--this is a very small head. This is associated with severe neurologic deficits and early death. This is a tragedy and potentially a preventable tragedy. Again, the teacher in me wants to talk a little bit about Zika. The spread of Zika historically gives us insight as to what we must fear now. Zika was first discovered back in 1951 in Africa, Uganda. Then, at some point in the three decades that followed, it spread quickly to Asia, and then from Asia to Yap Island in 2007, which is in the Pacific. In 2013 and 2014, it went to more Pacific islands. In 2015 and 2016, it entered the Americas. At some point, it began to spread rapidly. This is important because it is now in the Americas threatening Americans. These are States which have cases of Zika. Here is the U.S. Virgin Islands. Here is Puerto Rico. They have the most, but almost every State is affected. Most folks have contracted it elsewhere and brought it back to their State, but there are some folks who received it sexually. So their partner contracted it, perhaps in Brazil, and came back to Texas or Florida or Louisiana, where I am from, and they contracted it sexually. Nonetheless, the virus is in the United States. It is particularly a problem in Puerto Rico and the U.S. Virgin Islands. These are American citizens. These Puerto Ricans, if they wish, can board a plane and travel anyplace they wish in the continental United States. That is their right as Americans. Similarly, these folks who are infected in these States can travel anyplace they wish. Why is that important? Well, theoretically, it is important because these are the areas where the mosquitos that carry the Zika virus live in the United States. So theoretically, wherever these mosquitos are-- and Hawaii should be on here someplace--the virus can enter and the virus can be transmitted by the mosquitos to many other Americans. By the way, though, it is not just that you have to live where the mosquitos are. The first person to die from Zika in the continental United States just died in Utah. She contracted it elsewhere but then died in Utah. So the risk to our country is at least this. I will be perfectly honest. It is particularly a risk for those on the gulf coast because we have the sort of subtropical climate in which Zika flourishes. That is why I am particularly concerned. But wearing my other hat as a public health doctor, I know we have this moment in time. Either we pull that balloon off so it does not inflate with Zika, damaging our country, creating more Joses here in the United States, or not. Some of you may have seen the barcode that I held up initially. You may have downloaded that. We will hold up that barcode again if you wish to download these slides, but all of these are on the PowerPoint presentation that you may download should you wish. Public health emergencies are inevitable. Let's talk about the response to this one. Mr. President, $600 million that was left over from the Ebola fund has been released to CDC and other agencies to mount a response against Zika. Now, $600 million was left over, and only one-fifth of it has been spent. So there are still substantial dollars available, but the CDC and other Federal agencies say they need more. Republicans have supported $1.2 billion in additional funding to fight Zika. My colleagues on the Democratic side--we have a difference over this. They are opposing this $1.2 billion to fight Zika because they say the Republican bill discriminates against Planned Parenthood. Planned Parenthood is not mentioned in the bill, and the way it discriminates--I have been in Washington--in the Senate, at least--for 2 years, and sometimes you have to kind of figure out why people are taking offense at something. Even though Planned Parenthood is not mentioned, the reason they object is because we specify that the money needs to go to a public agency, one that sees Medicaid patients, the State or territory Federal program that takes care of the uninsured. Planned Parenthood is not a Medicaid provider. So it is not that they are not mentioned; it is that they are a private entity that, in Puerto Rico, does not accept Medicaid. So we could carve in and say: If you are a private entity, you can also receive these Federal dollars to provide family planning. It just so happens that in Puerto Rico, Planned Parenthood does not. So Republicans are trying to release $1.2 billion to pull the balloon off the helium so it does not inflate with all kinds of cases, and one more case of a Jose would be one case too many. But we are caught up in this snafu about Planned Parenthood. It is the craziest thing in the world, but unfortunately it is how Washington, DC, sometimes works. As a public health physician, I find that incredibly offensive. As a doctor who understands the critical nature of this, I am asking folks on the other side of the aisle to accept that this bill may not be exactly what they want--it is not exactly what I want--but it is something that would give additional resources to the Centers for Disease Control and others to begin to fight the Zika virus before it comes more extensively to our Nation's shores. We can anticipate that public health emergencies in the future are inevitable. For example, we recently had Ebola. We had the West Nile virus. We have already spoken about Zika. So aside from hoping that my Democratic colleagues will agree to release the $1.2 billion to fight Zika now, there is also something else I am proposing, but I don't want to sound overly partisan because I am doing this particular bill with my Democrats--with Senator Brian Schatz from Hawaii. We are putting forward the Public Health Emergency Response and Accountability Act. I am from Louisiana. We have had hurricanes. Hurricane Katrina is the one that is the most famous. If there is a hurricane or another natural disaster that hits an American State, then FEMA has a budget that is automatically triggered. It does not have to go through this appropriations process. We don't tie it down in discussions of extraneous matters. It is something that immediately comes to bear to bring relief to those affected by natural disasters. The other thing that is done is that normal Federal contracting processes are waived. So instead of having to get 10 different signatures--which literally might be the case--for someone to travel from Washington, DC, to Louisiana or Kansas or Florida, it is waived and that emergency response coordinator may immediately go. There is oversight, so this is not carte blanche, but it is a more effective way to bring Federal resources, in partnership with local resources, to bring relief to those affected. We bring that flexibility in the use of funds while retaining accountability. We call this the Public Health Emergency Response and Accountability Act, and we anticipate entering this in very soon. Senator Schatz has been wonderful to work with in terms of this aspect of what we are doing. So there are two issues. The $1.2 billion that we should release now, that would immediately go--it is not a perfect bill, but we have to prevent more cases of these children who are tragically born with microcephaly, as well as more deaths, like the woman who recently died in Utah. Then, No. 2, we need to have the response and accountability act, which gets rid of this process we struggle through in order to release those funds to bring the relief we need. Let me summarize by saying this: This is a baby with microcephaly. I think there have been three children born in the United States already--not conceived here but born here--who have microcephaly. This child's life is limited. She will most likely die at an early age, with severe neurological deficits. If you just want to look at it in a dollars-and-cents approach, this child will be a ward of the State for the entirety of her life and will cost the Federal taxpayer millions of dollars. We have already had these babies born in Puerto Rico, New Jersey, and Hawaii. There are two pregnant women in Illinois who tested positive for Zika, and we had a death in Utah and Puerto Rico--not children but adults. The question is, Will the Senate work to stop this? And again, if you are watching and you wish, you can scan this barcode, you can download this presentation. Let me finish by saying this. I just said the Senate should work to stop the spread of Zika. You can do something. We are a representative democracy and we respond to you, the people, and if we don't, by golly, you should vote us out. So I am asking you, if you are watching at home and you think there needs to be a response quickly and efficiently and effectively to combat the spread of Zika, you can either barcode this or not, but whatever you do, call your Senator. Ask your Senator--ask her or him--to support efforts to stop the spread of Zika, to release the $1.2 billion, and to also support the bill Senator Schatz and I are putting forward, the Public Health Emergency Response and Accountability Fund. Ultimately, we answer to you, the people. That is a good thing. I ask you to perhaps use this tool to help us, to encourage us to answer to you, as we should. Mr. President, I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, yesterday, May 22, 2016, our Nation celebrated National Maritime Day. The United States has always been and will always be a great maritime nation. My home State of Louisiana ranks first in the Nation in economic impact from America's domestic maritime industry. The American Maritime Partnership shows Louisiana's 54,850 maritime jobs pump more than $11.3 billion annually into our economy. America's robust domestic maritime industry includes vessel operators, marine terminals, shipyards, and workers engaged in the movement of cargo exclusively within the United States. According to a study commissioned by the Transportation Institute and conducted by PricewaterhouseCoopers, PwC, Louisiana also ranks first in the country in maritime jobs per capita, with 1 in every 83 jobs connected to the State's domestic maritime industry, nearly twice that of any other State. Louisiana also ranks third in the Nation in shipbuilding. According to the U.S. Maritime Administration shipbuilding accounts for 29,250 jobs and more than $2.23 billion in annual economic impact for our State. However, Congress has the responsibility for ensuring that our Nation's maritime infrastructure is adequately maintained in order for this industry to flourish. There is no greater maritime asset in the United States then the Mississippi River and its tributaries. They connect over 350 million acres of farmland to world markets via international trade through the 12,500 miles of inland navigational channels. Much of the commodities and goods produced in the heartland brought to world markets via the Mississippi River to the Gulf of Mexico and beyond to foreign nations around the globe. The Mississippi River Basin includes 41 percent of the continental United States, and the value of the agricultural products and the large agribusiness industry in the Mississippi River Basin produces 92 percent of the Nation's agricultural exports and 78 percent of the world's exports in feed grains and soybeans, while 60 percent of all grain exported from the United States is shipped via the Mississippi River from ports throughout the region, including the Port of New Orleans, the Port of South Louisiana, and the Port of Greater Baton Rouge. Barge traffic and navigation on the Mississippi River also carries a vast array of coal, fertilizer, cement, chemicals, and petroleum products, so any significant disruption to this navigational channel has huge consequences for the entire U.S. economy. Unfortunately, the recent winter and spring floods in the Mississippi River Valley have severely impeded navigational traffic along significant stretches along the Mississippi River ship channel. For example, at Southwest Pass along the lower Mississippi River ship channel, the authorized draft is 47 feet, but due to the excess sand and silt washing downstream from the flooding, the ship channel had draft restrictions of 41 feet for a month earlier this year. Economically, for each foot of draft loss a vessel either on the inbound or outbound voyage must leave behind approximately $1 million, per foot, in cargo behind. This is particularly problematic because the last foot of draft is often where a vessel makes any profits. So during a month timeframe, each vessel traveling along the Mississippi River at Southwest Pass could potentially have had to leave behind $6 million in cargo, an average of 30 vessels per day moving through the channel. An unreliable ship channel threatens the viability of barge traffic along the entire Mississippi River system by raising the transportation costs to move cargo. Navigation along the Mississippi River system is just one example of many maritime infrastructure challenges our Nation faces. Congress has the responsibility for providing the resources necessary to keep America's infrastructure open for business. Inaction is not an option if we want to keep United States competitive in the global marketplace. Across America, the domestic maritime industry includes approximately 40,000 vessels, supports 478,440 jobs, and has an annual economic impact of $92.5 billion. The industry also generates approximately $92.5 billion in wages and $10 billion in tax revenues. In honor of this quintessentially American industry and National Maritime Day, I look forward to working with my colleagues to find solutions for America's maritime infrastructure challenges.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, today I wish to recognize seersucker manufacturers and enthusiasts across the United States. I wish everyone a Happy National Seersucker Day. This uniquely American fashion has a storied history dating back to 1909. Louisiana is proud to have played an important part in introducing the country to seersucker apparel. The first seersucker suit was designed by Joseph Haspel at his Broad Street facility in New Orleans, LA. This lightweight cotton fabric, known for its signature pucker, has been worn and enjoyed by Americans across the country during the hot summer months. Mr. Haspel said it best, ``hot is hot, no matter what you do for a living.'' In the 1990s, Seersucker Day was established by Members of this chamber to honor this unique American fashion. I proudly resumed this tradition in 2014 in the U.S. House of Representatives by designating Wednesday, June 11, as National Seersucker Day. I have continued this tradition in the U.S. Senate and wish to designate Thursday, June 9, as the third annual National Seersucker Day. I encourage everyone to wear seersucker on this day to commemorate this iconic American clothing.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, this amendment pertains to the sale from the Strategic Petroleum Reserve. It merely gives the government the authority to time that sale. We can buy oil high or buy oil low, but we should sell it higher. All this amendment does--a commonsense, bipartisan amendment--is to say that whenever the oil is sold from the Strategic Petroleum Reserve, it should be when the best price is fetched, if you will, for the taxpayers of the country. It is common sense. It protects taxpayers. It should be adopted. Thank you.