Bill Cassidy

Mr. CASSIDY

Mr. CASSIDY. I ask unanimous consent that the order for the quorum call be dispensed with.

Mr. CASSIDY

Mr. CASSIDY. Madam President, I am going to speak about the drug affordability act, what people in Washington call the Grassley-Wyden bill. I am renaming that bill. I am going to rename that bill to what I call the ``Making Coronavirus Medicines Affordable Act,'' and I want to address drug affordability from the perspective of coronavirus and address it from the perspective of a physician. First, people ask: How is this different than regular flu? Ten thousand people die a year from flu. Why is this so different from that? Well, again, as a physician, let me speak to that. Each of us, however old we are, have been exposed to flu, either by the flu vaccine or a flu infection, as many years as we have been alive. So when someone is exposed to the flu, they have a whole kind of armamentarium of antibodies. When the flu virus comes into your body, those antibodies mobilize, and it is not an exact fit to block the effects of the flu virus, but it is a pretty good fit. So for an infection which otherwise might cause problems, the effect is blunted and the symptoms are either absent or minimized. As it turns out, the flu virus kills the very young, who have never before been exposed to the flu virus before, or the very old, whose immune systems are no longer working as well. Even though they have been previously exposed, their body is more vulnerable. Now, as for coronavirus, nobody's body has ever seen that before. For everyone, this is a brand-new infection, and there is not a library book of immunologic responses that enable us to fight back against this virus. For all of us, if you will, it is a sucker punch to our health. We turn around, and, boom, it hits us. Now, in terms of who it can kill, again, it seems to cause problems in newborns--the very young--but it also causes problems not just in the very old but in the older but not so very old. In China we have learned that if someone is over 50 and they have an underlying medical condition, they are at increased risk. If you are over 60, you are at even more risk. So unlike influenza, where typically the person who dies would be 75 or 85 and in a nursing home, in terms of coronavirus, it might be somebody with high blood pressure or diabetes, heart disease, cancer, or a lung disease, who is otherwise living life, walking around the streets. They get hit with this virus, and, all of a sudden, they have a problem. Now, we are going to find a cure. Sooner or later, we will come up with medicines that help somebody who is infected get well. The question is, Will those medicines be available to you? That is what we need to be concerned about. So what does it mean? Well, first there have been reports that both because of the infection raging through China and a decision by India, it is possible that some of these drugs will not be available. In China, they make the raw ingredients that are shipped to India, and they make the medicines. Well, China is not producing as many of the raw ingredients, and India has put an embargo on the export of some of those drugs to the United States. At least of the drugs they have embargoed that I saw a list of recently, none of those medicines are medicines that we think might ultimately help fight coronavirus. So even though we have a problem with supply chain, so far there is no evidence it will impact the ability of a medication, whenever it is discovered, to be available here in the United States. But there is another issue. Can the senior citizen who is most vulnerable afford the medicine? Let me put this up. Under the current structure of Medicare Part D, the senior citizen-- the personal Medicare Part D--pays a certain amount of money until they go into the so-called catastrophic coverage phase. Now, pharmaceutical manufacturers and pharmacy benefit managers manipulate that list price to more quickly move the senior citizen into her catastrophic phase, and when she is in her catastrophic phase of our Medicare Part D benefit, she must pay 5 percent of whatever is the price of that drug. Even--imagine this--if that drug costs $1 million a year, she would have to pay 5 percent of it under the current structure of the Medicare Part D benefit. I just posted a video on my Facebook page, and an oncology nurse, Kathy at East Jefferson General Hospital in New Orleans, was speaking about how this benefit design, where the senior has to pay 5 percent, no matter the cost, is so harmful in terms of her ability to get certain cancer drugs to cancer patients. Now, imagine it is a coronavirus drug--a cure for coronavirus that we know is going to eventually be here, and it can be priced. You name the price; we are going to pay it. Or can we? Can someone afford 5 percent of $100,000 or 5 percent of $50,000? Is it imaginable that such a medication would be priced as such? It is totally imaginable. We need to enact what the chairman of the committee calls the Grassley-Wyden bill but which I call the ``Making Coronavirus Drugs Affordable Act.'' What we would do with this bill is change the Part D benefit so that when a senior pays up to a certain amount, period, it is stopped. She or he pays no more. And no matter how much that coronavirus drug is priced, she or he will not pay above a certain amount. If they price it at $100,000, under current law you are paying 5 percent of that. Under this law, you would not. The out-of-pocket exposure, if you will, is capped. By the way, it also caps it for the taxpayer, which saves you and me as taxpayers--all of us as taxpayers-- a heck of a lot of money as we attempt to balance the Federal budget and as we attempt to preserve the life of the Medicare Program. So I will point out that we are going to have a cure for coronavirus sooner or later, but if a senior citizen or anyone cannot afford that cure, it is as if the cure had never been invented. We need both for the cure to be invented and we also need for it to be affordable. Otherwise, it would not be available. By the way, somebody may tell you they are supporting another bill either in the House of Representatives or here in the Senate. This is the only bill out there which is bipartisan. This is the only bill out there which has a chance to pass. This is the only bill that can protect senior citizens, not only by being good policy but by being signed into law by the President of the United States. The President of the United States has signaled that he, indeed, would sign this law. Now, the ``Making Coronavirus Drug Affordable Act'' does other things as well. It caps out-of-pocket expenses. It lets patients pay over time. If they know they are going to have a big amount in January, they don't have to pay it all in January. They can pay it a little bit in January, February, March, and all the way through the end of the year. It protects patients from price gouging, but it still preserves incentives for these cures to be invented. As we look for a holistic response to the coronavirus infection, we must keep in mind that drugs have to be affordable. So I am asking all my fellow Senators to support the ``Making Coronavirus Drugs Affordable Act,'' also known as the Grassley-Wyden bill, and for Senator McConnell to bring it to the floor. With that, I introduce my colleague from Montana, Steve Daines, to continue this discussion.

Mr. CASSIDY

Mr. CASSIDY. Madam President, today, I would like to recognize Capt. Joseph Victor Sheldon III, command chaplain, 4th Marine Division, for his 32 years of service in the U.S. Navy as he approaches his retirement ceremony. Captain Sheldon will be dearly missed by those who served with him, and our country thanks him for his dedicated service. Captain Sheldon served in a unique and critically important role as a chaplain in the U.S. Navy. His recognition of the importance of this role allowed him to effectively serve the soldiers he served with, as well as their families and civilian military workers. Military chaplains are also charged with forging relationships with their counterparts around the world when they serve abroad. Captain Sheldon took this responsibility in stride and provided a blueprint on how military chaplains should build relationships with their religious counterparts. His service included time in the Middle East following 9/11, Germany, the Pentagon, as well as serving as the Director of Religious Affairs of the Combined Joint Task Force in the Horn of Africa, CJTF-HOA. Louisiana and the entire Nation are grateful for Captain Sheldon's life of service to our great country.

Mr. CASSIDY

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

Mr. CASSIDY. Mr. President, one thing that is on everybody's mind right now is this: How do we prepare to address the coronavirus? I speak not just as a Senator but, perhaps even more particularly, as a physician who has done public health in my previous practice, working with immunizations, looking at all those issues as to who is vulnerable and who needs to be protected. There are a couple of things that are quite apparent from what we have already learned from this epidemic. Let me compliment the Chinese. They have come in for some criticism that was well deserved, but in other things they have helped determine a lot of things that will benefit the rest of the world in terms of the natural history of coronavirus. By the way, the theme of this talk is that we have to make sure that coronavirus medications are going to be available and affordable for senior citizens. Why do I emphasize senior citizens? One thing we have learned from the Chinese is that those who are 50 and above--and 65 and above, in particular--are the ones who are most likely to die from being exposed to and infected with coronavirus. That is our Medicare Part D population. If you have a chronic illness--and chronic illness can be hypertension, high blood pressure--again, you are particularly susceptible. If we know that our Medicare population is most vulnerable, let us focus particularly upon them. First, science is working. There are at least six vaccines that are being developed to attempt to address the coronavirus. Hopefully, one of them will work. There are other therapies being developed. Some of them are medications. Four different medicines are now being tested to see if they are the ones that absolutely prevent coronavirus. We know whatever drug that is could end up being quite expensive. For the Medicare Part D beneficiary, that leads into this discussion: How do we make sure those drugs are effective? Let me show you the current situation. This is the Medicare Part D standard benefit parameter under current law. In the orange is that which the beneficiary pays, the Medicare Part D beneficiary. The blue is what the insurance plan pays. The green is what the manufacturer pays. The dark blue is what the taxpayer pays, the Medicare system. What you see is, initially, beneath the deductible, the Part D beneficiary--the senior citizen on Medicare Part D--pays 100 percent. Then, you go into what is called the initial coverage phase, 25 percent; the coverage gap phase, 25 percent; and then above the catastrophic coverage, the senior citizen pays 5 percent, no matter how much that drug costs. That drug could cost $1 million, and they are going to pay 5 percent under current law. By the way, that is the list price. Even if the manufacturer and the pharmacy benefit manager have a deal where the drug might be priced at $100,000 but the rebate is $50,000 that goes back to the manufacturer-- so your net price is $50,000--the beneficiary is paying 5 percent of the list price. She is paying 5 percent of $100,000. She does not benefit from any rebates. This is current law. We can imagine if a drug that is quickly developed, expensive to develop, and expensive to produce--and it is the only one that works against the coronavirus--it is going to be an expensive drug. We can also imagine if it is an old drug that happens to work, there might be somebody who buys it, closes down all the competition, and then charges an arm and a leg for this one old medicine--off patent for decades-- that happens to be the one medicine that actually works to prevent the progression of coronavirus infection. How do we protect the senior citizen? Right now, one more time, she is exposed to 5 percent of the cost, no matter how expensive it is, under current law. There are a couple of proposals out there right now. One of them is on the House side, called H.R. 3, and the other principal bill on the Senate side is called Grassley-Wyden. I am going to rename it in a second. But let me just say those are the two bills. Mr. President, you know this, but for the folks watching, I will explain the tension. Whatever we do to control the cost of medication has to preserve the incentive for industry--for pharmaceutical companies and vaccine manufacturers--to continue to innovate. If you take away all their profits, they will just go home. Why invest billions of dollars if you don't make a profit? On the other hand, if they are able to charge so much that no one can afford it, no matter how innovative they are, it is as if the innovation never occurred. If the theme of this discussion is ``How do we make sure that coronavirus medications are available and affordable for the senior citizen?'' we have to strike that balance. It has to be the balance between encouraging innovation by allowing a profit but not so much profit that the senior citizen cannot afford it, and it is as if the innovation never occurred. So far there are two options. There is a bill on the House side called H.R. 3. A lot of what they have is very similar to that which was passed in the Senate, which I personally think is a very good bill. But they have one provision that says the Federal Government can dictate to the pharmaceutical company: This is how much you charge. And if you don't accept our price, ultimately, we will take 95 percent of your profits. If we are going to try to incentivize companies to come up with new medications to fight cancer, to fight coronavirus, to fight Alzheimer's disease, we can't go to them at the get-go and say: If you don't accept the price we dictate, we are going to take 95 percent of your profit. That is the way you end up with no innovation whatsoever. Even though there is a fair part of that bill that is constructed, that one is a deal breaker, and I can tell you that this doctor, who has seen a tremendous amount of innovation that has saved so many lives, will not agree to a provision that kills innovation. But then we go to the other side. What about the bill that we have here in Senate Finance? It came out of the Senate Finance Committee on a bipartisan basis, and on that bipartisan basis, it saves taxpayers $80 to $100 billion over 10 years. Drug companies still make their profit. They still have the incentive to innovate, but taxpayers also save. Most importantly, for the sake of this talk--which is how we make coronavirus medications affordable to the senior citizen when they become available--we cap the amount of money the senior citizen has to pay for her drugs. They no longer pay 5 percent of this price, even if the list price is $1 million. We are going to cap that so the senior citizen can afford it. One thing we also do is protect the taxpayer from having to pay so much and, instead, ask the manufacturers and the pharmacy benefit managers to pay their fair share. But for the purposes of this talk, instead of current law where it is 5 percent no matter how much it is, what the senior citizen has to pay is capped, so however much that coronavirus drug costs, the senior can afford it. She will not die because she can't afford to pay 5 percent of a list price no matter how high that list price is. This so-called Grassley-Wyden bill has passed out of the Senate Finance Committee. It needs to come to the floor of the Senate. We need to have a vote on it because as we prepare to fight the coronavirus--to literally put in policies that will save lives of our senior citizens-- one of those has to be this: How do we make sure the drug is affordable? I am renaming Grassley-Wyden. I am now calling Grassley-Wyden the ``Making Coronavirus Drugs Affordable.'' It caps out-of-pocket expenses; it lets patients pay over time, not all at once in January and February; it protects patients from price gouging; it preserves the innovation that does bring us these new drugs. We have lots of stuff coming through this Congress to address our Nation's vulnerability to coronavirus. We need to focus on those who are most vulnerable, those who are 65 and above. We applaud industry, pharmaceutical companies, researchers, and vaccine manufacturers for the effort they are putting in to find those drugs. We thank the Chinese for running many of these clinical trials that will hopefully establish that one of these drugs is actually effective. Yet what we must do is continue to allow innovation and, at the same time, make sure that coronavirus drugs are affordable. This bill will pass the Senate if it comes to the floor. I ask that it be brought to the floor. I yield the floor. I suggest the absence of a quorum.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I rise today to congratulate Professor George Pugh for his distinguished legal career and outstanding tenure as an educator at the Paul M. Hebert Law Center at Louisiana State University LSU. His dedication to the law, along with his many accomplishments and military career, is exceptionally impressive and displays his commitment to his community and fellow American. Pugh was born on Bayou Lafourche in 1925 and in 1942 began his studies at LSU. In the midst of World War II, he volunteered for military service and was deployed to France. After the war, he returned to LSU after three semesters, he enrolled in LSU Law School. He earned his juris doctor in 1950 and went on to Yale Law School to earn his doctorate of juridical science in 1952. Later that year, he joined the LSU Law School faculty as an assistant professor. Pugh served 2 years on the Judicial Council as the State's first judicial administrator for the Louisiana Supreme Court. He is known as the ``intellectual father'' of the Louisiana Code of Evidence, as he and his fellow co-reporters confected the Code of Evidence for the Louisiana State Law Institute, using the Federal Rules of Evidence as its model. It would be enacted into state law in 1998 and serve as an invaluable resource for judges, district attorneys, and other legal professionals. In all, he has provided 43 years of instruction to almost three generations of students. Pugh also served as a member of the Baton Rouge, LA, and American Bar Associations, chairing several committees. He was a member of the American Law Institute and received several invitations to teach at law schools in America and around the globe. At LSU, he received the ``Hub'' Cotton Faculty Excellence Award and an honorary doctorate of law from the University of Aix-Marseille III in France, was named a Sterling Fellow at Yale Law School, and was listed in ``Who's Who in America.'' Upon retiring in 1994, the Louisiana Law Review dedicated its January publication to Professor Pugh, as he had been its longtime editor and associate editor. I cannot congratulate Professor George Pugh without mentioning his late wife of 60 years, Jean Hemphill. Together, they founded the George W. and Jean H. Pugh Institute for Justice in 1998, working to promote justice for individuals in the administration of criminal and civil justice systems in Louisiana and around the world. Professor Pugh's compilation of the Louisiana Code of Evidence, distinguished teaching career, and contributions to the legal system of Louisiana show the extent to which he has used his God-given talents to make the world a better place. His incredible legal career and many awards speak volumes to who he is as a Louisianan and an American. Professor Pugh, you have made our State and our Nation proud.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I rise today to congratulate the CEO and president of One Acadiana, 1A, Troy Wayman, and the entire 1A organization for the distinguished honor of becoming an accredited economic development organization, AEDO. 1A has joined the ranks of only 66 economic groups in the world to earn the AEDO standing. In 2015, the Greater Lafayette Chamber of Commerce's board of directors ventured out to create an organization that would embody its longstanding mission--to be the leading force in the improvement of the business environment as well as the economic health and development of the region. Over the last 5 years, 1A has grown to more than 800 investors, members, and partners while serving the 9-parish Acadiana region. After a yearlong process, 1A was recognized and was awarded as an AEDO, cementing its place among the best of the best in the industry. Being honored and recognized by the International Economic Development Council, IEDC, as an AEDO speaks volumes to who they are as an organization. The dedication and passion that drives these members is a testament to their organization and speaks volumes to all of Louisiana. Congratulations, One Acadiana, on becoming an AEDO. I look forward to witnessing what the future holds for 1A and the entire Acadiana region.

Mr. CASSIDY

Mr. CASSIDY. Madam President, the Senate must determine whether to remove a President duly elected by the people. A decision of such magnitude deserves, first, full consideration of the procedures; second, the merits of the charges; and third, the ramifications removal would have on our Republic. The Framers of the Constitution granted the House of Representatives impeachment powers yet cautioned against using that power unless absolutely necessary. Impeachment negates an election in which Americans choose their leader. If substantial numbers of Americans disagree with removing the President, removal damages civic society. It follows that the House should conduct thorough and complete investigations, even if time-consuming, before impeaching. A thorough investigation educates Americans that a President should be impeached and removed. Failing to convince the people invites anger towards, disdain for, and abandonment of the democratic process. The Framers also required a two-thirds Senate majority for removal to prevent partisanship, so that removal only occurs after the House convinces its own Members, the Senate, and the American people. The Watergate investigation, for example, convinced Americans that President Nixon committed crimes, forcing his resignation with overwhelming support for removal in the House and the Senate. In the case against President Trump, the House declined to call witnesses it felt relevant, arguing that the courts would take too long and the President was an imminent threat to our Republic. House managers blamed legal resistance from the administration and witnesses. For example, Dr. Charles Kupperman threatened to sue. A congressional committee afraid of being sued while claiming to be fearlessly pursuing truth for the good of the country rings hollow. It also rang hollow when Adam Schiff said that we could not wait for the next election for voters to decide President Trump's fate after Speaker Nancy Pelosi held the articles for 37 days. That decision smacks of partisan political motivations. The partisanship the Founders warned against was reflected in the House vote with the only bipartisan votes being against impeachment. House Managers Schiff, Nadler, and Lofgren once said that party-line impeachment would divide the Nation. They never explained why their opinions changed. The role of the Senate, though, is to judge the House's evidence. House managers stated their case was ``overwhelming'' and ``compelling.'' Having not pursued further witness testimony in building their case, the House managers demanded the Senate call witnesses the House did not call. Additional witnesses, however, would not have changed material facts, but allowing the House to poorly develop a case, sacrificing thoroughness for political timing, would have forever changed the dynamic of the Chambers respective to the role of each in the impeachment process. Should the Senate acquiesce in this manipulation of the process, it would welcome the House to use impeachment as a political weapon, whatever the merits of its case. I have been speaking of procedure. I want to emphasize that procedure matters. Justice Frankfurter once wrote: ``The history of liberty has largely been the history of the observance of procedural safeguards.'' If the appropriate use of impeachment is to be preserved, procedural safeguards must be observed. Moving now to charges, in article II, House managers argued the President obstructed Congress by acting on the advice of legal counsel to resist subpoenas. The judiciary resolves disputes between the executive and legislative branches. The House should have exhausted judicial remedies before bringing this charge. I shall vote against article II. On article I, abuse of power, three issues must be addressed: one, the legal standard of guilt by which to judge the President; two, whether the President committed a crime; and if so, three, whether that crime warrants removal from office. First, the standard of guilt was never established. Legal standards for conviction vary from the lower--more probable than not--threshold to the higher, which is beyond a reasonable doubt, which is used in criminal cases. Since House managers charged ``something akin'' to a crime, ``beyond a reasonable doubt'' seems most appropriate, the higher threshold. As Senator Jay Rockefeller stated during President Clinton's impeachment, beyond a reasonable doubt ``means that it is proven to a moral certainty, that the case is clear, that the case is concise.'' Second, House managers allege that the President held military aid to Ukraine to leverage an investigation into former Vice President Biden as a quid pro quo, although they did not charge President Trump with the crime of requiring a quid pro quo or bribery. The President's defense team cast reasonable doubt on this allegation. For example, regarding the July 25 phone call, which was reported by the whistleblower and which triggered the House impeachment proceedings, the President raised the issue of corruption in Ukraine. President Trump has always been skeptical of foreign aid and especially when he thinks it is wasted. Hunter Biden was mentioned, but no connection was made with the release of aid to Ukraine. Other defense arguments included that Ambassador Kurt Volker denied a connection between aid and corruption investigations; President Zelensky and Ukrainian officials denied feeling pressure; and President Trump denied a quid pro quo to Ambassador Sondland and told Senator Ron Johnson, when asked if there was some sort of arrangement, ``No way. I would never do that.'' Both aid to Ukraine was released before the statutory deadline and a meeting between Presidents Trump and Zelensky occurred without an announced investigation. It is also important to note that the release of aid on September 11 followed new Ukrainian anti-corruption measures, which included swearing in a reformed Parliament and installing a new prosecutor general--August 29--and the newly established High Anti-Corruption Court meeting for the first time--September 5. The third issue regarding article I, abuse of power, is that the term is a nebulous one which does not define a specific crime. Contrast this with the impeachment of President Nixon when the House drafted an Article of Impeachment alleging abuse of power which enumerated five specific criminal and noncriminal offenses against President Nixon. The Constitution speaks of treason, bribery, or other high crimes and misdemeanors. Because high crimes and misdemeanors are not specifically defined, it is reasonable to assume that the Framers meant for impeachment to occur only if a crime approached levels as severe as treason and bribery. Since the House managers allege President Trump committed something ``akin to a crime,'' in deciding whether abuse of power is a high crime or misdemeanor, the prudent decision is to apply the principle of lenity. This principle, relied upon by Supreme Court Justice Marshall and Justice Frankfurter, says that if a law is ambiguous, it is better to narrowly interpret the words of a law in favor of the defendant. Although the preceding discussion finds that the House managers failed to prove their case beyond a shadow of a doubt, failed to define the crime, thereby invoking the principle of lenity, it is still a question that if a crime was committed, was it an impeachable crime? In 1998, then-Democratic Congressman Ed Markey argued that even though President Clinton, as chief law enforcement officer of the land, lied under oath, the crime was not impeachable. The Senate agreed, establishing the precedent that to remove a President, the crime must reach a high threshold of severity. The allegation against President Trump was not proven beyond a reasonable doubt, and it does not meet that high threshold. I shall vote against article I. I end by speaking of the ramifications for our Republic. In 1998, then-Congressman Chuck Schumer said of the Clinton impeachment: I suspect history will show that we have lowered the bar on impeachment so much, we have broken the seal on this extreme penalty so cavalierly that it will be used as a routine tool to fight political battles. My fear is that when a Republican wins the White House, Democrats will demand payback. Mr. Schumer was a prophet. This must stop. With that, I yield.

Mr. CASSIDY

Mr. CASSIDY. Mr. Chief Justice, I send a question to the desk on behalf of myself and Senator Risch to both the House managers and the White House counsel. And although I cannot pick, ideally, it would be Manager Lofgren.

Mr. CASSIDY

Mr. CASSIDY. Mr. Chief Justice, I send a question to the desk on behalf of myself and Senator Risch, both to the White House counsel and the House managers.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I rise to discuss the spending bill, which we are about to vote on, which is going to increase our deficit by almost a fourth of a trillion dollars over 10 years and of which I think I might be the first speaker. We are going to vote on this. We got it yesterday--Monday, maybe--and we are going to vote on it tomorrow. I smile because this is supposed to be the world's greatest deliberative body, and we have not deliberated one bit on far-ranging policies. Now, by the why, the mess is kind of bipartisan. We can spread the blame around. Let me bring up the heart of it. When ObamaCare passed, President Obama famously said it would not increase the deficit by one dime. That is gone. I think that replaces ``you can keep your doctor if you want to'' as the greatest lie. What we did today is to repeal about $400 billion in payments to pay for all the healthcare that is going out. It is kind of a joke on Republicans. We are getting ObamaCare, but we are not paying for it. On the other hand, as I will explain in a second, it may ultimately be a joke on Democrats. Now, this concerns me because we didn't have a committee hearing on it, and we haven't had a floor debate, but we just committed that for almost $400 billion that have been used to fund Medicaid expansion, people getting subsidies for their health insurance, and many other things, we just went poof, and it is gone. Now, some of it, like the health insurance tax, was a tax that the insurance industry agreed to so that the Obama administration would force ObamaCare upon the rest of us. But now that it has been agreed to and ObamaCare is stuck, they don't want to pay the tax. They would rather that go poof. Now, people say: Wait a second. If we get rid of that tax, maybe insurance premiums go down. One, they don't guarantee it, but, secondly, what we could have done is we could have taken that money, created reinsurance pools across the Nation, and that is estimated to lower premiums by 10 to 20 percent. In that case, not only would the insurance industry be fulfilling their bargain--hey, you stick the Nation with ObamaCare, but we will help pay for it--you would actually be able to use the money to lower premiums. That would be something good. One, they would have kept their word, and, two, it would have been good for the American patient, if you will. The other tax that has gone just poof--$300 billion just gone without debate, without deliberation, without a committee hearing, which is still there on Friday, and today we walk in on Monday, and it is poof, and we vote on it tomorrow, and I am the first person to speak on it-- is the so-called Cadillac tax. Now, on the Cadillac tax, that is a provision under ObamaCare in which for high-cost policies, if they go too high, you get taxed on them. The whole idea is to encourage wiser purchasing of health insurance. Now, frankly, I didn't care for the Cadillac tax. I get the reason it was there. But 100 different economists have said that it serves a purpose across the political spectrum. My preference is that if we had replaced the Cadillac tax, one, we would have paid for it. We shouldn't be getting ObamaCare without paying for it. Secondly, we would have gotten some reforms. They are reforms that actually would have been--if we were not going to use the Cadillac tax to hold down the cost of premiums--another mechanism by which we could hold down the cost of premiums. Why is this important? Because not only did we just go poof to almost $400 billion, but because healthcare expenditures are driving our debt and deficit. It is not just that we lost this $400 billion. We lost any restraint upon policies going higher and higher. Now, that is bad for the American patient. It is bad for the American household because our country will continue its indebtedness. I am a doctor. I know if you put more money into the furnace, it will burn that much higher, and now there is just no excuse to try and rein in those expensive policies. It is not just that. One thing that my Republicans apparently have agreed with Democrats on is to stop the Trump administration from taking on something called ``silver loading.'' It is a little technical here, but just hang with me. For the middle-class family in your State who buys their insurance on the exchange and does not get a subsidy, pop, there goes their premium. How does this happen? When the Trump administration ended the payments from the Federal Government to insurance companies, insurance companies figured out a way around it. They are smart. They know how to get out of taxes that they have agreed to pay for, as an example. So they did what is called ``silver loading.'' They increased the cost of so-called silver policies on the ObamaCare exchange. So if you are not getting a subsidy, you are paying a lot more. But because if you are not getting a subsidy and you are paying a lot more, that increased the amount of subsidies for people who were. So if you are, you know, getting a subsidy, you are probably pleased with it. If you are the middle-class person making 400 percent of Federal poverty level and you are paying your taxes and you are trying to do it right, you just got stuck with a higher premium. The administration was trying to take it on. This deal, which we have not discussed, which was not heard in committee, which we have not deliberated on at all, says to the administration: You can't take that on. Yes, that middle class family not getting a subsidy is paying far more, but you can't take it on. Stand down, administration, we are going to stick it to that family, as well as saying poof to $400 billion. Now, there are some other issues that are important to me in my State. The National Flood Insurance Program is an important program. We advanced some reforms that would make it more affordable for the homeowner, more sustainable for society, and more accountable to the taxpayer. We haven't had anything in there. We renewed it. I am pleased that we renewed it. We renewed it without reforms. You have had flooding in your State, and I have had flooding in my State. You have had yours in yours, and I have had it in mine. We need that program to be sustainable, accountable, and affordable. We have lost the opportunity. I forget how many short-term extensions we have had without reform. I think it is like 10, 12, 14, or 16. You lose count after a while. We have missed that opportunity. So we started on Friday. Everybody goes home except for a few people. They work on it over the weekend, they come in on Monday, and we get a 2,000-page bill on Monday. We will vote on it tomorrow, and I am the first person to speak on it. Now, I understand that impeachment is taking a lot of energy and oxygen out of the Chambers. I understand that a lot of attention is addressed elsewhere, but all I can say is that you have just imperiled your country's fiscal health. On one more thing before I wrap up, there is a little bit of an irony here. Republicans are getting ObamaCare, but it is unpaid for. There is another irony here as well. The courts today ruled that the individual mandate in ObamaCare is unconstitutional. Now, I am not an attorney, but I gather they did not rule that this was so-called severable. If this is not constitutional, then the rest can stand because we just sever it off. Imagine this. Imagine that the courts decide that that portion of ObamaCare--which is related to Medicaid expansion and is related to the exchanges in which people get subsidies to buy these policies--is unconstitutional but would have allowed the mechanism by which to pay for it to stand, because that is another part of the law. We have just repealed that. Why is that important? Because if this falls, we have to have the money to pay for a replacement. Democrats have so long screamed that we need to have universal access. By the way, I am a doc. I would like everybody to have insurance. I fought for it, and I worked for it. But the other party, which has said this is such a high priority, has just eliminated the funding that could be used for replacement in Texas v. Azar, the court decision that may strike down that portion of ObamaCare. So, Republicans, we got ObamaCare that is not paid for. Democrats, they may end up with no ObamaCare at all. Patients, whether they are on Medicaid, getting a subsidy, or not getting a subsidy, will lose. I hope that we can return to being the world's greatest deliberative body, but as regards that, this has to be considered a low point. I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Madam President, the Rotary Club of Lafayette will turn 100 years old in 2020. I would like to share with you some of the accomplishments of the club since its founding in 1920. Early in their history, they underwrote the election to fund the first public library, they helped to establish One Acadiana and started the first Lafayette Boy Scout troop. In addition to establishing Rotary Park in the 1980s, they currently fund annual scholarships for local students, coordinate food drives for FoodNet, and support Rotary's mission to eradicate polio worldwide, in addition to supporting other local charities. Congratulations to the Rotary Club of Lafayette on this historic achievement. I wish you all the best of luck in years to come.

Mr. CASSIDY

Mr. CASSIDY. Madam President, I ask unanimous consent that the Judiciary Committee be discharged from further consideration and the Senate now proceed to S. Res. 367.

Mr. CASSIDY

Mr. CASSIDY. Madam President was presiding before and I heard several speeches by my colleagues on the Democratic side of the aisle speaking about the 1332 waiver process that the Trump administration is using to lower insurance premiums, and the kind of common refrain is: This is a terrible thing. We are eroding protections in the Affordable Care Act, and we should preserve the Affordable Care Act as it is. This is so ironic because the people who want to get rid of Obamacare right now are running for President on the Democratic side of the ticket. If you ask Bernie Sanders if he wants to get replace Obamacare, he raises his hand. If you ask Elizabeth Warren if she wants to replace Obamacare and force people to give up their employer-provided insurance, she raises her hand. Now, why do the Presidential candidates--Democratic Presidential candidates sit there and say: Hey, let's get rid of Obamacare? And when the administration does something to lower premiums, my Democratic colleagues stand up and decry this kind of assault upon whatever value they are speaking to. What I think is the Democratic candidates running for President are so aware that healthcare costs under Obama have skyrocketed. Let me see if I can find my figures here, but it's quite remarkable. Let's just speak a little bit about what has happened. Since 2013, the deductible for someone with single coverage has increased by 53 percent. And despite deductibles going up, say, $10,000, premiums have increased 20 percent. So the patient's out-of-pocket exposure is increasing both in the deductible and with their premium. For a family of four in Louisiana--we looked on healthcare.gov just walking here-- $25,000 for the policy with an over $10,000 deductible. Now, this is not affordable. So clearly there is a concern about affordability. That is what the Trump administration has been trying to address. And frankly, that is what Bernie Sanders and Elizabeth Warren wish to have Americans sacrifice their employer-sponsored insurance to address. But my Democratic Senate colleagues don't want to do this. They would rather have all the protections of Obamacare, even if you cannot afford the policy. And truly, that is what we are doing now. And now, we get to speaking about the waivers that the Trump administration is giving, somehow they are saying these are terrible things. Let me point out that, in the seven States with 1332 waivers granted under the Trump administration, health insurance premiums have decreased by 7.5 percent. Some States have had a double-digit reduction. Maryland, for example--and I will come back to Maryland--has had a 30-percent reduction in their health insurance premiums under the 1332 waiver given by the Trump administration. North Dakota had a 20- percent reduction. And what about if you didn't get a waiver? In my State, which didn't apply for a waiver, premiums are expected to rise 10 percent this coming year--10 percent. So the family of four paying $25,000 a year with a $10,000 deductible will pay $27,500 next year, with a $12,500 deductible, meaning they will be out almost $40,000--$40,000 for their health insurance. I suspect there is a lot of families in my State that wouldn't have minded if we applied for a waiver if we could just lower premiums, instead of seeing out-of-pocket expense continue to rise. Now, there is a little bit of an irony here. Maryland has a legislature dominated by Democrats, and they actually got a 1332 waiver. So my Democratic colleagues who are speaking about how terrible these waivers are, they should look back to States which Democrats control who are applying for these waivers. I am told that Montana has a waiver, Montana with a Democratic Governor who is running for President on the Democratic side of the ticket. Apparently, that person felt it was something that he would sign into law and otherwise approve because it would be beneficial to the people in the State. I don't know why, in the Senate, my Democratic Senate colleagues want Americans to pay more for insurance. Why do they insist on continuing to advocate for policies which make healthcare, health insurance, so unaffordable? This is personal for me. Besides being an American wanting all to have coverage, for 25 years, I worked in a hospital for the working poor, for the uninsured, trying to bring healthcare to those who could not otherwise afford it. It has been my life mission, if you will, as a physician, to try and get healthcare to those who cannot have it. And so when folks want to give them this great policy, but you can't afford it, but don't worry, it is a great policy if you can afford it, I have to smile. Like the Greek myth Tantalus--where we get the word ``tantalize'' from--where the prize is always just beyond the reach, just beyond the reach, always there to tempt, but you can never have. So you have a family making $120,000 a year having to pay $25,000 for insurance, with a $10,000 deductible. They are sacrificing so many things. It is tantalizing, but we are sure this is a better state of affairs. Now, what the administration has done, they have given States flexibility to craft affordable options for families that do not have subsidies. It respects the fact that some States are different than other States. Imagine that. Alaska is different than Rhode Island--Alaska, if you laid it across a map of the lower 48, would stretch from Georgia to California, but has fewer people than Rhode Island, and Rhode Island, which is a postage stamp compared to Alaska. Those States are different, so allow them to have different healthcare systems. By the way, when we do this, we are assured by the administration that they continue to enforce protections for those with preexisting conditions and all other things that we as Americans, that we as Republicans, that I as a physician who have spent my life caring for the uninsured, value--so that, if healthcare is not affordable, it is not available. And what we have seen by the folks on the left who are concerned about healthcare costs is a doubling down on government control. They want to go for Medicare for All. They want to take away your employer-sponsored insurance. But at least they acknowledge that cost is a problem. What my Senate colleagues are not doing, the ones who are speaking today, is acknowledging that cost is a problem, and you can have the greatest plan in the world and, if it is unaffordable, then that greatness is ironic. It is on a piece of paper, but it is not real in someone's life. What we have seen is that States, when they come to the Federal Government requesting permission to put in a program which is specific to the circumstances in their State, they are not only covering the citizens in their State, continuing to have protections for those with preexisting conditions, but they are also lowering premiums by as much as 30 percent. And that is a good thing, and I have no clue why my Democratic colleagues do not want to see premiums lowered by 30 percent. Madam President, thank you, and I yield the floor. (At the request of Mr. Schumer, the following statement was ordered to be printed in the Record.)

Mr. CASSIDY

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

Mr. CASSIDY. I know of no further debate on the measure.

Mr. CASSIDY. Madam President, I ask unanimous consent that the Senate proceed to the consideration of Calendar No. 234, S. Res. 236.

Mr. CASSIDY

Mr. CASSIDY. I now ask for a second reading, and in order to place the bill on the calendar under the provisions of rule XIV, I object to my own request.

Mr. CASSIDY. Madam President, I understand there is a bill at the desk, and I ask for its first reading.

Mr. CASSIDY

Mr. CASSIDY. Madam President, I ask unanimous consent that the committee-reported substitute amendment be agreed to, the bill, as amended, be considered read a third time and passed, and that the motion to reconsider be considered made and laid upon the table.

Mr. CASSIDY. Madam President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 237, S. 1678.

Mr. CASSIDY

Mr. CASSIDY. Madam President, I ask unanimous consent the resolution be agreed to, the committee-reported amendment to the preamble be agreed to, the preamble, as amended, be agreed to, and that the motions to reconsider be considered made and laid upon the table.

Mr. CASSIDY. Madam President, I ask unanimous consent that the Senate proceed to the consideration of Calendar No. 233, S. Res. 183.

Mr. CASSIDY

Mr. CASSIDY. Madam President, I ask unanimous consent that the Senate proceed to the consideration of Calendar No. 235, S. Res. 277.

Mr. CASSIDY. I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, and the motions to reconsider be considered made and laid upon the table.