Richard Durbin

Mr. DURBIN

Mr. DURBIN. Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senators Blumenthal and Carper. Medicaid covers one in two births in Illinois. It helps pay for two out of every three seniors in nursing homes, and it is the largest payor of opioid and substance abuse treatment. But guess what else Medicaid does? It helps 45 percent of school districts provide medical and therapy services for lower-income kids and those with special needs. That is right, Illinois schools currently receive about $144 million in Medicaid funding each year. They use this money to provide dental screenings, therapy services for kids with disabilities, to purchase handicap equipment, and employing trained staff. What would happen to kids nationwide if the $4 billion in Medicaid funding for schools went away? My motion would to commit would instruct the Finance Committee to report out a bill--within 3 days--that would protect funding for schools and students and says, if you want to slash Medicaid, it won't be on the backs of our kids.

Mr. DURBIN. Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senators Blumenthal and Carper. When thinking about Medicaid, we often talk about low-income children or pregnant women. But do you know the most expensive part of Medicaid? It is providing long-term care for your grandmother, your grandfather--at home or in the nursing home. When Social Security and Medicare aren't enough, Medicaid steps in to care for millions of seniors over age 65. Medicaid helps pay for two out of three seniors currently in nursing homes. These Republican proposals to slash Medicaid are so devastating that the American Association of Retired Persons, AARP, has come out in loud opposition to all the repeal bills. My motion to commit would instruct the Finance Committee to report out a bill--within 3 days--that protects the millions of seniors who rely on Medicaid for their care and says, if you want to slash Medicaid, it will not be on the backs of our vulnerable seniors.

Mr. DURBIN. Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senator Blumenthal. Over the past few months, I have met with many heroes in the disability community, including a woman in Illinois who has a 23-year- old son with autism. She told me that Medicaid allows her son to be at home and function independently. She told me that, without Medicaid, her son would have to be in a facility she couldn't afford. You know what else all of these advocates and fighters tell me? They tell me that the Republican healthcare repeal proposals--all of which decimate the Medicaid Program in order to give tax breaks to the wealthy--would be devastating for people with disabilities. Medicaid is a lifeline for 11 million people with disabilities. It is the core of our commitment to care for them, and it helps us meet our basic obligations as a society. That is why my motion to commit would instruct the Finance Committee to report out a bill--within 3 days--that protects children and adults on Medicaid with disabilities from increased costs and fewer benefits.

Mr. DURBIN. Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senator Blumenthal. Under the ACA, our Nation has seen the largest decline in the child uninsured rate, and in Illinois, we have seen a 40 percent drop. Today more than 95 percent of kids in our country are insured. Half of all children born in Illinois are covered by Medicaid. That means they are guaranteed quality, comprehensive health coverage, from vaccinations and vision checks, to dental health, mental health, and lead poisoning screenings. Medicaid serves low-income children in schools, and -I have visited many school-based health clinics that provide critical access and services for our kids. But every single Republican healthcare repeal proposal would slash Medicaid for our most vulnerable kids, jeopardizing the services they receive and their ability to access care. That is why my motion to commit would instruct the Finance Committee to report out a bill--within 3 days--that protects our kids and tells Republicans they will not be a bargaining chip in this cruel repeal effort.

Mr. DURBIN. Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senators Blumenthal and Carper. Thanks to the Affordable Care Act, Medicare is now financially stable for an additional 11 years. Because of the healthcare reforms that improve the delivery of healthcare, seniors are now paying $700 less annually in premiums and cost-sharing. The ACA is also closing the dreaded Medicare ``donut hole''--the gap where seniors were faced with high costs for their drugs--saving 11 million seniors an average for $2,127 each year on their medications. But Republicans want to jeopardize this progress. Instead of strengthening Medicare for the long run, many of the Republican repeal bills would give a huge tax giveaway to wealthy Americans--cutting years off Medicare's solvency. That is why my motion to commit would instruct the Finance Committee to report out a bill--within 3 days--that does not shorten Medicare's solvency.

Mr. DURBIN. Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed the Record. When Republicans talk about the challenges facing Obamacare, they tend to be a bit misleading. Let's set the record straight. What they are really talking about is within the individual market, where 6 percent of Americans get their coverage and more than 70 percent of those people get subsidies to help cover their costs. One problem Republicans like to cite is lack of competition, that private, for-profit insurers are pulling out, leaving few choices. We call these ``bare counties,'' and they are more common in rural areas and in States that did not expand Medicaid. I agree that we need more competition in the individual market. As a solution, my motion to commit instructs the Finance Committee-- within 3 days--to report out a bill that requires insurers offering Medicare Advantage plans in a particular county, to also offer an individual market plan in that county. Medicare Advantage insurance plans make huge profits off the Federal Government, yet many of those same insurers are refusing to participate in the individual exchange. To address bare counties, my motion says that, if you have a provider network and you are making money off the Federal Government, then you should also help improve choice by offering a plan in the exchange.

Mr. DURBIN. Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senator Blumenthal. All of these Republican repeal bills shift costs onto consumers, patients, hospitals, and State budgets. None of them do anything to actually address what is driving the increase in healthcare costs. And one of those biggest drivers? Pharmaceutical costs--Blue Cross of Illinois tells me they spend more on prescription drugs than inpatient hospital care. So what can we do to address prescription drugs? Listen to the American Medical Association, which called for a ban on direct-to- consumer pharmaceutical advertising. According to the AMA, these ads are, ``driving demand for expensive treatments despite the clinical effectiveness of less costly alternatives.'' In short, pharma advertises their drugs because they know you will tell your doctor you need it--driving up the cost-- regardless of whether it's right for you. That is why they spend billions on it. But the moment of truth on when patients find out about the cost is when they are checking out at the pharmacy. That is wrong. So my motion to commit would instruct the Finance Committee--within 3 days--to report out a bill that helps lower the cost of healthcare by tackling the driving cost of prescription drugs, requiring pharmaceutical companies to disclose the price of their drug in their ads.

Mr. DURBIN. Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senator Blumenthal.- All of these Republican repeal bills shift costs onto consumers, patients, hospitals, and state budgets. None of them do anything to actually address what is driving the increase in healthcare costs. And one of those biggest drivers? Pharmaceutical costs--Blue Cross of Illinois tells me they spend more on prescription drugs than inpatient hospital care. So what can we do to address prescription drugs? Have Medicare negotiate drug prices on behalf of seniors. Even the President says he supports this policy. Medicaid can negotiate drug costs, the Veterans Administration can negotiate drug costs, why shouldn't Medicare be able to leverage its 50 million beneficiaries to get a better deal? This motion is simple; it is something the President has talked about, something the American people support. This motion to commit would instruct the Finance Committee--within 3 days--to report out a bill that would require the Secretary of Health and Human Services to begin negotiating drug prices on behalf of seniors in Medicare.

Mr. DURBIN. Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The motion is supported by Senator Duckworth. The process Republicans have undertaken to repeal our healthcare law has been secretive, wrong, and undemocratic. At first, it was 13 chosen apostles--all men--meeting in secret to craft their repeal measure. At this moment, I don't know who is hiding in the shadows writing their repeal measure. But what I do know is that there have been no hearings, no opportunity for public input, and no opportunity for myself and Senator Duckworth--as representatives of Illinois--to offer input. If myself and Senator Duckworth have been locked out of the process from the beginning, why then should our constituents have to pay the price for this partisan Republican effort? So our motion is simple. It says that this Republican repeal bill cannot unfairly impose hardships on our Illinois constituents. It cannot increase costs on my constituents, cut services or benefits or eligibility for my constituents, eliminate essential health benefits for my constituents, or impose lifetime limits or discriminate against my constituents with preexisting conditions. If Senator Cruz who has been allowed to have input on this repeal bill--wants to rip away health insurance ``root and branch''from his constituents, that is fine. But this motion protects my constituents in Illinois.

Mr. DURBIN. Madam President, I intend to offer the following motion to H.R. 1628, and I ask unanimous consent that it be printed in the Record. The Commonwealth of Kentucky has benefitted immensely from the Affordable Care Act. Its uninsured rate has fallen 61 percent, one of the sharpest declines of any State. Kentucky chose to expand Medicaid, allowing 150,000 people to gain coverage. More than 1.4 million Kentuckians are no longer subjected to lifetime or annual caps on their benefits. Kentucky, sadly, has been one of the States hardest hit by the opioid epidemic. Thanks to the ACA, substance abuse treatment has increased 740 percent among Kentucky residents on Medicaid. Today, 881,000 Kentuckians--33 percent of adults--have a preexisting condition that, before Obamacare, could have left them uninsurable. So to ensure the health cand well-being of the residents of my neighboring State, Kentucky, this amendment says you cannot increase costs; cut services, benefits, or eligibility; eliminate essential health benefits; or impose lifetime limits or discriminate against Kentuckians with preexisting conditions. If the Senators representing the Commonwealth want to rip away health insurance from their constituents, undermine protections for Kentuckians with preexisting conditions, and raise costs on older Kentuckians, well, count this neighboring Senator in to fight on their behalf.

Mr. DURBIN

Mr. DURBIN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DURBIN

Mr. DURBIN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DURBIN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DURBIN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DURBIN

Mr. DURBIN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DURBIN

Mr. DURBIN. Four-and-a-half years. He is a newbie, and he has not seen the Senate I am describing. Can you believe there was a time in the Senate when we would bring an important measure to the floor on many different issues, and Members would come to the floor--I am not making this up--and actually hand an amendment to the clerk and say: I would like to offer an amendment to the bill. Then we would debate it, and then we would vote on it. Sometimes you won, sometimes you lost, and you moved on to the next amendment. That actually happened on the Senate floor. For the people who are new to the Senate, I am sure they do not believe me, but it did happen over and over and over. We had a healthy respect for one another. The amendments went back and forth, and we ended up seeing bills passed that made a difference in America. What we are doing now is a disgrace to this institution, and it does not honor the Senate, its Members, or our Constitution when what is at stake is so important. In looking at some of the provisions that have been brought before us in the Senate's Republican repeal bills to repeal the Affordable Care Act, I do not know how they can do it. I do not know how Senators could go home and say in their home States: A million of you are going to lose your health insurance because of something I just voted for. Health insurance means a lot to me personally. I have said it on the floor. There was a time in my life when I was a brandnew law student and was married. God sent me and my wife this beautiful little baby. She had some health issues, and we had no health insurance, as I was a law student. We ended up sitting in the charity ward of a local hospital here in Washington, hoping our baby girl would have a good, talented, capable doctor walk through the door and see her. I was not sure because I did not have health insurance. I will never forget that as long as I live, and I thought to myself that it will never happen to me again. I am going to have health insurance no matter what it takes. It meant that much to me, and it means that much to everybody. There is not a single one of us who does not want the peace of mind of knowing that if we get sick or if someone we love gets sick, he will have access to good hospitals and good doctors. That is what health insurance is all about. As the Republican proposals eliminate health insurance for 60 million, 20 million, 30 million Americans, you ask yourself: How can you do that to this country? The cuts they make in Medicaid have really educated America about Medicaid. People know about Social Security. They know what that is all about. We all pay into it and wait to receive our Social Security checks when we reach that age. They also know about Medicare. You have to be 65 years of age. It is pretty good coverage, isn't it? The ones who receive it think it is a pretty good deal to have Medicare coverage when they reach the age of 65, but Medicaid was one of those mystery programs. People were not sure. What does it do? The Medicaid Program in America does the following: In Illinois, that program takes care of half of the new mothers and their babies. Half of them are paid for by Medicaid--prenatal care to make sure the baby is healthy, the delivery of the baby. Afterward, the mom and baby are taken care of, paid for by Medicaid. This is one out of every two births in Illinois. Medicaid also sends provisions--money--to your local school districts. I will bet you did not know that. If your local school district has a special education program--and virtually all of them do--they receive Medicaid to pay for some basics. It pays for counselors for special ed students. Sometimes transportation in a local school district in downstate Illinois or feeding tubes for some severely disabled students are paid for by Medicaid. You may not know that for disabled people, Medicaid is their health insurance. Many of them have no place else to turn. I mentioned on the floor before that a mother in Champaign, IL, with an autistic child, said: Senator, if it were not for Medicaid, my son would have to go into an institution. I couldn't afford it. Medicaid is his health insurance. I have not touched the most expensive part of Medicaid of which you may not know, which is that two out of three people in nursing homes depend on Medicaid to get basic medical care. Medicare is not enough. They need the help of Medicaid. So if it is Mom or Dad or Grandma or Grandpa who is in a nursing home, two out of three of them depend on Medicaid. The Republican bill to replace the Affordable Care Act says we are going to cut the spending on Medicaid, that 25 to 35 percent will be cut. That is why Governors of both political parties have screamed bloody murder: You cannot do that. You are cutting the Federal contribution to Medicaid in our States. Who is going to pay for that baby? Who is going to pay for the mom? Who is going to pay the school district? Who is going to pay for the disabled? Who will take care of the folks in nursing homes? Why did they make that deep of a cut in Medicaid--a program that is so important to so many people? There is the tough part. That deep of a cut was made in Medicaid so Republicans, in their healthcare proposal, could include a tax break for the wealthiest people in America, for health insurance companies, and--get this--for pharmaceutical companies. To give them tax breaks, they had to cut Medicaid coverage for all of the people whom I just described. Is it any wonder that many Republicans backed away from this? Senator Heller, of Nevada, talked to Governor Sandoval--both Republicans--and said he could not support an early version of the bill because of the deep cuts in Medicaid. If this is supposed to be an improvement over the Affordable Care Act, which part of it is an improvement? Is it in cutting Medicaid coverage for all of those people, saying that your health insurance policy does not have to cover people with preexisting conditions, raising the cost of healthcare premiums, particularly for people between the ages of 50 and 64, eliminating health insurance for millions? Is that an improvement over the current system? It is not. It is a disaster. The question is, By the end of this debate, after we have gone through this crazy process of voting up and down quickly and with very little debate, will one more Republican Senator stand up and say unacceptable? Two of them have. If one more will join them, then we can get down to the real business we should face. The real business is being the Senate again with regular order, which means taking the measure to the HELP Committee. Senator Murray, of Washington, is the ranking Democrat. Senator Lamar Alexander is the chairman from Tennessee. I respect him and like him a lot. The two of them ought to have hearings on a bill to change the affordable care system and make it work better, bring down the cost of premiums, and expand health insurance coverage. I think that is what we should be all about. Now, there is a basic difference in philosophy here. I will close with this, but this is what drives us. Answer the following question, and I can tell you how you are going to vote on this bill: Do you believe healthcare is a right for every American or do you believe it is a privilege; that if you have enough money and you are lucky enough, you can get it, and if you don't, you go without. If you answer the question that it is a right, that it should be a right in America, then you have to reject this approach. You cannot take helpless people, some of whom are working hard in two and three jobs at a time and who have no healthcare benefits, and say to them: Sorry. Our system will not take care of you. One last point. The irony of that is that if you do not give people health insurance, if you do not give them protection, they still get sick, they still go to the hospital, and they still get care. What happens to the bills they cannot pay? Everybody else pays them. Before the Affordable Care Act, each of us paid $1,000 a year in premiums just to cover for the people who could not afford health insurance. We think there is a better way. We think Americans should have access to affordable health insurance across the board, and we think we can achieve that if we work together on a bipartisan basis. So I hope one more Republican Senator will join Senators Collins and Murkowski and bring us back to what John McCain described on the floor today to the Senate--of having a real debate about real issues and really caring about the American people. I yield the floor.

Mr. DURBIN. Thank you, Mr. President. History was made on the floor of the Senate Chamber today. I don't think it has ever happened before. Think about this: 50 out of 100 Senators came to the floor with the Vice President of the United States and voted to begin debate on a bill they have never seen--a bill they have never seen--because we don't know what the Republicans are going to offer as the alternative to the Affordable Care Act. There have been a lot of different versions. Technically, the one that is before us now is the version that passed the House of Representatives, but I think the Republican leader, Senator McConnell, has known from the beginning that has no chance whatsoever. So many Republicans have taken a look at what the House passed and said: We can't vote for that. You have to give us something different. The problem the Senate Republicans ran into is that they couldn't come up with anything better. They tried. They wrote several different versions, and every time they would write a version of the new Affordable Care Act, it got worse for the American people, and here is what I mean. Under one proposal for the Republicans--not the one before us, but the Senate Republicans--1 million people in my home State of Illinois would have lost their health insurance. There are 12.5 million people in Illinois, and 1 million would have lost their health insurance because of dramatic cutbacks in Medicaid and cutbacks in the premium support that is given to a lot of working families to buy regular health insurance in the health insurance market. It was so terrible that every time Republicans came up with a Senate proposal, two or two of them would announce: Can't buy it, won't vote for it--and ran away from it. So Senator McConnell came to the floor today and said: I am begging you, just vote to open debate on a bill that I haven't written yet, and 50 Republican Senators did, and the Vice President broke the tie, the 50-to-50 tie to move forward, and here we are. Let me start by tossing flowers--and this will probably get them in trouble--to two Republican Senators, Susan Collins of Maine and Lisa Murkowski of Alaska. They were the only two Republican Senators who had the courage to stand up and say: This is wrong. We shouldn't do this to the American people. They are the only two who are willing to say that we should have done this differently. There is an interesting thing that happened at the end of this. At the very last moment, the very last vote that was cast was cast by Senator John McCain. Everybody knows John has been diagnosed with a serious form of cancer. He made it back from Arizona here to cast his vote, and he asked for 15 minutes after the rollcall to make a speech. I don't think many, if any, Senators left the Chamber. Democrats and Republicans stuck around to hear his speech after the vote. Can I tell you that is unusual in the Senate? Most of us race for the doors and go up to our offices and watch on television and may catch a piece of this speech and a piece of the other speech, but we sat and listened because of our respect for John McCain. He is my friend. We came from the House of Representatives together many years ago. I served with him in the Senate when we put together a bipartisan group to rewrite the immigration laws for America--four Democrats, four Republicans. I sat across the table with John for months. We went back and forth through all the provisions on immigration. John even conceded today that he has an interesting temper. There were days when John McCain was Mount Vesuvius, just exploding in every direction, and you had to step back. And there were days when he smothered you with kindness. That is the way he is. We love him for it. He came today to give a speech that every American should read if you want to understand how a Democratic Senator can stand on the floor and give compliments and praise to a Republican Senator, which I am about to do. Senator McCain said that we have to do something about this country of ours--the political divisions. I will not get the words perfectly, but he said to us: Will you please start ignoring these radio and TV and internet talking heads who want us to fail and make a living by laughing at us? Will you ignore those people? Instead, look to what this institution, the U.S. Senate, is all about and what we should be doing to solve the problems for the people we represent. John McCain went on to say: Why don't we have debates on the floor of the Senate anymore? Do you know what? He is right. We are 7 months into this year's Senate session. We have not had one bill on the floor of the Senate that we have debated and amended--not one. This is a first, and it is in this kind of convoluted reconciliation process where you speed up the amendments. Think about this. We are amending your healthcare policy that affects you and your family. We are amending how you will buy health insurance as an individual and how your company will buy health insurance for you. We are amending, basically, whether your insurance policy is going to protect your family or not. Listen to how it works. People propose an amendment, and then we debate it. Do you know how long we debate it? We debate it for 1 minute on both sides. Disgraceful. John McCain called us on it today and asked: Why have we reached this point when an issue this important is going through a process that is totally partisan? You see, the Republicans decided early on that they were not going to invite us to the party; that they were going to write this healthcare bill by themselves, in secret. Senator McConnell picked 13 Republican Senators, and they sat for I don't know how long--months, weeks--and wrote a bill. One of them I mentioned earlier was ultimately rejected by the Republicans themselves. John McCain challenged us and said: For goodness' sake. He has been in the Senate--and I have too--during a time when it was much different. He really begged us, pleaded, and urged us to get back to that time when we worked together on a bipartisan basis to solve problems. John McCain was right. I did not agree with his vote to put us in this position we are in at this moment, but I was encouraged by the way he closed. He turned to Senator McConnell, who was sitting right there, and said to him: Do not count on my vote on final passage. I want to see what we do in this bill. I want to see how we debate this bill. One Republican Senator like John McCain can make the difference as to whether this process stops and a real bipartisan process starts. Isn't that what the American people expect of us? Seated in the Chair, the Presiding Officer, is a brandnew Senator from the State of Alabama. Welcome, Senator Strange. He comes here because Senator Sessions went on to become the Attorney General. He has seen the Senate for a couple of months or 3 months, maybe--5 months now--and I am sure he has his impressions of this body. They may be different than what he thought about it before he was elected. Yet I can tell him for sure that this is a much different Senate than the one Patty Murray was elected to, that it is much different than the one I was elected to. Even for Mike Enzi, my friend from Wyoming, it is much different than the one he saw. I see my colleague here, Senator Schatz, from Hawaii. How long have you been here now, Brian?

Mr. DURBIN

Mr. DURBIN. Mr. President, this week--perhaps as early as tomorrow-- Majority Leader McConnell, who just left the floor, will ask the Senate to vote on a bill we have not seen. That is right. We will be voting this week on a bill we haven't seen. I think it is a first. I am going to do a little research to see if this has ever happened before in the Senate, where Members of the Senate were brought together to vote on a bill that has not been made public or printed for us to review. This isn't an inconsequential bill. This is a bill about the healthcare system of the United States of America. There is not a single American living in our Nation today who will not be affected by our vote this week because we are in the process of deciding whether we will change healthcare in America, health insurance in America, and there is not a single one of us who doesn't have a health insurance plan, either private or public, or not affected by the health insurance industry in healthcare across the United States. In fact, healthcare itself represents one-sixth of the American economy. So we are being asked to vote on a bill this week which has not been printed and given to us and which will change healthcare for every single American and affect one-sixth of the American economy. We do know that some of the previous provisions that have been brought before us on the Republican side have an impact--a negative impact--and in my State of Illinois, a very personal negative impact. We know that their effort to repeal ObamaCare, which has been a political slogan that has been used for 6 or 7 years, ran into a wall when the American people said: Well, if you repeal it, what is left? What will be there? What will replace it? At that point, the Republican effort disassembled. They didn't have an alternative. They spent the last 6 years under ObamaCare--the Affordable Care Act--saying ``No, repeal it'' without spending the time to think about what would follow, what is next. The Congressional Budget Office--this is an interesting thing--the Congressional Budget Office is a nonpartisan agency that we turn to that evaluates our work. They take a look at the bills we write, and they take a look at the laws that will pass, and they say: Well, this is the impact it will have on the deficit, on future generations, on entitlement programs. Sometimes the Congressional Budget Office is maddening. They take forever. I don't know what is going on over there, but what you think is a simple question can take weeks and sometimes longer to result in an analysis, and there are times when I just flat out disagree with their analysis. Let me give an example. When we debated the Affordable Care Act, we said that one of the things we need to do is make sure there is plenty of preventive medicine. For example, we make sure under the Affordable Care Act that every senior gets a free annual physical. Our belief is, if you detect a problem a person has early enough, you might be able to lessen its impact or actually cure it. We said that to the Congressional Budget Office, and they replied to us: You cannot put a dollar value on preventive medicine. Well, it is common sense; isn't it? If you find something early, it is more likely to be cured. It is cheaper. No, you can't put a dollar on it. So the Congressional Budget Office sometimes can frustrate us, but we rely on them, and I would say, for the most part, they do give us good advice. I don't agree completely with them, but they give us good advice. Do you know what they say about the Republican repeal plans that have been passed in the House of Representatives and the various versions that have been suggested? They believe those repeal efforts will take health insurance away from 22 million to 32 million Americans. Think about that. We passed the Affordable Care Act because so many people in America had no health insurance, and we wanted to make sure they had it--for their own peace of mind, for their own good health, to make sure there was fairness in our system so sick people without health insurance who are cared for don't have their bills passed on to everybody else. Well, the Congressional Budget Office took a look at the Republican plan, which passed the U.S. House of Representatives by four votes--all Republican votes--four votes, and they looked at the plans proposed by Senator McConnell and the Republicans, and they said: At the end of the day, 22 to 32 million Americans will lose their health insurance. They said, in my State of Illinois, 1 million out of 12\1/2\ million will lose their health insurance. I cannot understand how any Senator of either political party could, in good conscience, come here and say: Boy, we had a great week. We just passed a healthcare reform bill, and 1 million people in Illinois will lose their health insurance. Really? That is why you ran for the U.S. Senate, to take health insurance coverage away from people? I would have thought common decency, common sense would suggest we want to do just the opposite. We want more and more people to fall under the protection of health insurance. We also know some of the reforms we built into the Affordable Care Act are going to be changed by at least the early versions of the Republican repeal bill. Like what? One out of three Americans has a preexisting medical condition. A few weeks ago, I went through a heart procedure that worked out just fine--thank you--but now I have a preexisting condition. I am in pretty big company: one out of three people across the United States. Remember the day before we passed the Affordable Care Act? Before we passed the Affordable Care Act, if you had a preexisting condition, if you could get health insurance, it was darned expensive. A good friend of mine had a trucking company. He had some problems with his ankle. He went to the doctor. The next year, when they wrote the health insurance plan for his trucking company, they excluded anything on the health insurance policy affecting his legs and his feet. Each year, he said, I was afraid to turn in any claim because the next year they wouldn't cover him. It is a preexisting condition. We changed that. We changed the law. We said, in America, when you sell health insurance, you cannot discriminate because of preexisting conditions. You can't discriminate with higher premiums because you have a child with diabetes. You can't discriminate with higher premiums if your wife has survived breast cancer. Now, to me, that is common sense, and it is humane. The Republican approach allows the States to waive that--back to the bad old days, when preexisting conditions could run your premiums through the roof, where you have haves and have-nots when it comes to health insurance, and Republicans said the other protections we put in the Affordable Care Act are also on the chopping block. For example, my wife and I raised three kids, put them through college. They had their health insurance when they were students. They came out of college looking for jobs--thank you--and it took a little while to find the right job, and we worried: Now that they are not in school, whose health insurance is going to protect them while they are looking for a job with benefits? We put in the Affordable Care Act that your kids--young adults--can stay under your family health insurance plan until they reach the age of 26. It is just common sense. Keep them under the family plan until they have a chance to get that job with benefits. We put other provisions in there--lifetime limits. It used to be, you would buy health insurance in this country and to keep the costs down, they would say: We have you covered. Up to $150,000, you are covered. Now, $150,000 sounds like a huge amount of money to people of modest means and working families, but we all know you are one accident or one diagnosis away from having medical bills that go through the roof. So $150,000? Get real. That could be 2 days in a hospital with a doctor and a surgery or radiation. That is the reality. So we took lifetime limits off the policies. They can't do that to you in America anymore. When you buy health insurance, you have health insurance, and if, God forbid, your condition takes your bills to sky heaven, they are going to be covered. Now the Republicans say: Well, that is another thing we will take out. We will make that optional. Can I tell you one other one that really gets me because it was a big debate here for years. Back where my friend Senator Sheldon Whitehouse is standing used to be the desk of Paul Wellstone, a liberal Senator from the State of Minnesota. What a good guy--terrific guy--short, feisty. Boy, when he got into a fight, you wanted to be on his side. Paul Wellstone teamed up with a man who sat right there named Pete Domenici. Pete Domenici was exactly the opposite politically: from New Mexico, conservative, Republican, disagreed with Wellstone on virtually everything, except for one thing. Each of them had in their families someone suffering from mental illness. They decided they were going to do something about the fact that most health insurance plans did not cover mental illness. It was a battle that went on for years to require health insurance to include mental illness and they won the battle and we put it in the Affordable Care Act. Now, the Republicans say: Let's make that optional. This is something you can buy if you want to buy it. At the end of the day, I think we all know we need a health insurance plan which is there when we need it, that covers things we can't even imagine when we buy the health insurance, and it makes sure people don't end up broke and bankrupt because of healthcare bills. That was the driving cause, the driving reason for people filing bankruptcy in America--medical bills. They couldn't pay them. Since we passed the Affordable Care Act, the number of bankruptcies filed because of medical bills has been cut in half. So good health insurance that covers you when you need it and covers a member of your family when you need it is essential. That is why this debate and this vote tomorrow are so essential. One thing I forgot to mention. Wellstone and Domenici didn't just cover mental illness. They put another provision in there, and most of us paid no attention to it: substance abuse treatment. That has to be covered in health insurance too. Is that important? Have you heard of the opioid epidemic, the heroin epidemic? I recently asked one of the best providers in Chicago about this, and they said: Luckily, people who have a child who ends up being addicted and needs treatment, if they have private health insurance, there is some coverage. Now, there is a battle about how many bills will be paid and how much is paid, but it is covered under the health insurance plan. Republicans want to make that optional. They call it freedom of choice. The junior Senator from Texas, Ted Cruz, talks about policies you could buy that are really cheap policies. We call it junk insurance. You are insured in name only. If you need it, it isn't going to be there. That has been in the Republican plans that have come before us. We don't know whether that will be in the plan we have to vote on tomorrow. We don't know. It is a mystery. How many hearings have been held on the bill we will vote for tomorrow on proceeding to change healthcare in America? None. Not one. How many amendments have been offered? Of course, none. We haven't seen it. We don't know. We also know something else. The Republican plan on healthcare will slash the Medicaid Program. Most people--myself included--a few years ago, would have been stumped to describe the Medicaid Program and what it covered. Now, I will tell you what it covers, and think about cutting what I am about to describe by 25 to 35 percent. No. 1, half of the children born in the State of Illinois are paid for by Medicaid. Their mother's prenatal care, the birth of the child, and postnatal care of mom and the kid is covered by Medicaid--one-half. In addition to that, every school district in my State--probably in Rhode Island, probably in Oklahoma--receives Medicaid payments--school districts. Why? For the kids with special education needs. Medicaid helps pay for counselors so these kids can be mainstreamed in education. Medicaid in my State even pays for feeding tubes for those severely disabled children who are in school--but a 25- to 35-percent cut in the Republicans' proposals for Medicaid. The most expensive thing in Medicaid, the thing that costs the most money, I haven't mentioned. Is your mother in a nursing home? Is your father? Your grandfather? Sixty percent of the people in nursing homes rely on Medicaid to stay in that nursing home and get the basic care they need. So when you cut that by 25 to 35 percent, what happens to Mom? What happens to your grandfather? Does that mean the family now has a bill to pick up? Does that mean they have to leave the nursing home and go somewhere else? Where will that be? Yet that is one of the proposals. The disabled community, they stepped up as well. Medicaid is health insurance for disabled people in America. A woman in Champagne came to me and said: I have a 23-year-old son with autism. He is pretty good. He is kind of on his own. He is doing some things. Senator, if he didn't have Medicaid health insurance, I would have to put him in an institution. I don't want to do that. How important is Medicaid? How important is it that the Republicans will slash this Medicaid? It gets to the heart of healthcare for tens of millions of people in the United States of America. Why do Republicans want to cut Medicaid? It is simple. It is linear. It is direct. They have to cut $700 billion out of Medicaid to provide a tax cut for the wealthiest people in America. Oh, Durbin, you are making that up. This must be a press release from the Democratic National Committee. No, that is exactly what it is all about. In order to pay for the tax cuts to the highest income individuals, to pharmaceutical companies, and to health insurance companies, they cut Medicaid payments to the States. They think that is simple justice, a tax cut. They are always for tax cuts, but look who pays for that tax cut. So who lines up for and against the Republican approach we are going to get to vote on tomorrow? That is easy. There is not a single medical advocacy group in America today supporting the Republican position. That is a pretty broad statement. You had better be ready to back it up, Senator. I am ready. Hospitals, doctors, nurses, pediatricians, every medical advocacy group, and community clinics all oppose what the Republicans are setting out to do--and they are not alone. Remember the preexisting conditions? I mentioned diabetes and cancer. The American Diabetes Association, the American Cancer Association, the American Heart, Lung, you name it, all of those groups oppose what the Republicans are setting out to do. They realize it is a dramatic step backward in terms of healthcare in America. Every healthcare repeal bill Congressional Republicans have devised to date has represented a massive step backward for healthcare. None of the bills proposed by Senate or House Republicans would increase the number of Americans with health insurance coverage. It does just the opposite. None of them reduce costs or improve care. You say: Well, if you tell me you don't know what the bill is going to be, how are you describing it? I am giving the composite of all the bills that have been offered by the Republicans in the House and Senate. So far, we think--one in the House for sure--four different bills in the Senate, which I have just described, you will find this in all the bills. They don't get better, they get worse. None of them will strengthen our healthcare system or improve people's lives. One of my Republican colleagues really put it in a few words very directly and said recently: I didn't come to Washington to hurt people. I trust that none of us--not a single Republican or Democrat--came for that purpose. We want to help people, don't we? Isn't that why we are here? That is why we need to reject this approach. It is why we need to sit down together and make our healthcare system better. I voted for the Affordable Care Act. I believe in it. It cut the number of uninsured people in my State in half, and I think that is a worthy goal. It made many other changes which I have described here this evening. Is it perfect? By no means. I used this example before: The only perfect law that I know of was carried down the side of a mountain on clay tablets by Senator Moses. Everybody else does their best, and sometimes we need a little help. Our current healthcare system needs some help. Let me tell you where I think we ought to change it. No. 1, we know that the one market where the premiums are going through the roof is the individual marketplace, where small business people and others are facing skyrocketing premiums. What percentage of America fits into that group? Six percent. They are not being treated fairly under the current system. We have to change it. We have to make healthcare premiums affordable. Every Republican plan brought before us raises those premium costs. No. 2, we don't address the costs of prescription drugs in the Affordable Care Act. Health insurance companies tell us that is driving premium costs more than any single item. Blue Cross Blue Shield in Illinois pays more for pharmaceuticals--prescription drugs--each year than they pay for inpatient hospital care. There is nothing that is controlling these costs. We should; shouldn't we? Shouldn't we agree that, if you happen to live in some part of the country where you don't have health insurance available in the marketplace, at a very minimum you will have a public option? What do I mean by that? A plan that looks like Medicare, a plan that isn't driven by profit, but a plan that provides the basic services. We can do that. We have Medicare Advantage programs. We have other options. We want to make sure that is available to every American. You choose it, if you wish. Those three things right off the top I would include as part of what we can do on a bipartisan basis--Democrats and Republicans. Take the tax cut off the table. Take slashing Medicaid off the table. Take rewards to health insurance companies off the table. Focus on helping the families, businesses, and individuals in America who need this basic protection. We are going to go into this mystery vote tomorrow. We have been elected to the U.S. Senate. There aren't many people in history who have had this honor. What we are doing tomorrow does not bring honor to the Senate. Considering a bill that has not been written, published, and disclosed to the American people is just wrong. Considering a bill that has never had a committee hearing is unfair. Considering a bill that I am sure will have many flaws and weaknesses is reckless. That is what we face this week. How important is it? It may be the most important vote we cast this year as far as I am concerned. There is nothing more important in life than the peace of mind in knowing you have health insurance at that critical moment when you or somebody in your family desperately needs help. There is not going to be a minor amendment offered on the floor that will straighten out the situation. I know my colleagues are here to speak. I will close by saying this. If you come to watch this bill, whatever it is, brought before the Senate in the next few days, it will not be a moment when you think better of this place. It is a process called vote-arama. Here is what it means. You put an amendment on the floor and file it with the clerk. They read the amendment. Then you have 2 minutes--1 minute for and 1 minute against--and you vote. Really? We are going to take the healthcare system of America and put it through that kind of a process, where we don't even have time to sit and measure the impact of one amendment over the other? The Congressional Budget Office will not have its analysis. So it is really going to be a free skate. We will be up here trying our best to vote yes or no on these amendments if we proceed to the bill. Here is the good news. If 3 Republicans--3 out of 52--will step up and say: Stop, we can do better as a Senate, that will be the end of this terrible endeavor. We will send the measure back to committee. We will have Democrats and Republicans sit down. They will go through the regular process. They will produce a bill. The public will get to read it. They will go through expert testimony. Then we will have an amendment process. Then they will bring it to the floor, and we will do the same. We will consider it carefully. We will use our best judgment and try to come up with something on a bipartisan basis that is a credit to America. Instead, what we are going to face, if the majority leader has his way tomorrow, is a process that does not serve this country well and does not bring honor to the Senate. I urge my Republican colleagues, three of them at least, to step up. They aren't just saving a lot of people across America from the worry of whether they have good health insurance when they desperately need it. They are saving the reputation of the Senate. I yield the floor.

Mr. DURBIN

Mr. DURBIN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DURBIN

Mr. DURBIN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DURBIN

Mr. DURBIN. I announce that the Senator from Michigan (Ms. Stabenow) is necessarily absent.

Mr. DURBIN

Mr. DURBIN. I announce that the Senator from Vermont (Mr. Leahy) and the Senator from Michigan (Ms. Stabenow) are necessarily absent.

Mr. DURBIN

Mr. DURBIN. Mr. President, I rise in open opposition to the nomination of John Bush, nominated to serve a lifetime appointment on the Sixth Circuit Court of Appeals. The Federal courts of appeal have a significant impact on the lives of many Americans. Because the Supreme Court only reviews a limited number of cases each year, decisions by the circuit courts represent the final word on thousands of legal matters that involve a host of important issues. The Senate has to take very seriously its obligation to consider candidates for these important courts. We have to make sure they have the qualifications, the temperament, and the judgment to serve for the rest of their lives. Based on Mr. Bush's record and his testimony before the Judiciary Committee, I believe he falls short of this standard. Over the course of his legal career, Mr. Bush has made dozens of provocative comments, casting serious doubt on his temperament, his judgment, his impartiality, and his ability to serve as a fair and impartial judge. Consider the following things that this nominee has said or done: In 2008, Mr. Bush compared abortion to slavery, writing in an anonymous blog, I might add, that ``the two greatest tragedies in our country--slavery and abortion--relied on similar reasoning and activist justices at the U.S. Supreme Court, first in the Dred Scott decision and later in Roe.'' Senator Feinstein and I decided to ask Mr. Bush to explain this statement at his hearing. He did not disavow the comparison he made in this anonymous blog. Here is what he said instead. He claimed that he had referred to Roe v. Wade as a tragedy ``in the sense that it divided our country.'' I asked Mr. Bush to explain his logic, asking whether he would characterize Brown v. Board of Education as a case that divided our country. He answered: ``I wasn't alive at the time of Brown, but I don't think it did.'' That is an incredible statement made by a man who seeks to serve on a Federal circuit court for the rest of his life. His logic and his historical analogy have fallen apart. There is no dispute that Brown v. Board of Education, which ended up in the official desegregation of public schools across America, was a landmark Supreme Court decision that deemed racial segregation unconstitutional and, as a result, led to controversy and division across the United States. I can't believe a man from Kentucky, a border State--a neighboring state of my State of Illinois--could not measure the impact of Brown v. Board of Education and whether it divided our country. That, to me, is incredible. The reason, of course, he didn't is because he didn't want to concede, quite obviously, that he was just opposed to a woman's right to choose, and this was a rationalization for this position. There were many other instances in which Mr. Bush expressed provocative and troubling views. He wrote that public financing of election campaigns is ``constitutionally dubious'' and ``runs afoul of constitutional guarantees by forcing taxpayers to subsidize candidates' political speech and contravention of those taxpayers' First Amendment rights.'' This is a view which is hard to understand because it contradicts decades of Supreme Court precedent. Mr. Bush, seeking this opportunity to serve for the rest of his life on a Federal court, has now questioned a Supreme Court precedent which has been on the books for years. He gave a speech where, sadly, he made an anti-gay slur about the town of Louisville, KY. He wrote blog posts supporting the nomination of a voter suppression advocate Hans von Spakovsky to the Federal Election Commission. In response to a written question I sent to him, he refused to disavow President Trump's claim that 3 to 5 million people voted illegally in 2016. He said it was ``the subject of political debate.'' That assertion by the President has been rejected and discredited by every objective person who has been challenged but not by Mr. Bush, who seeks this lifetime appointment to the court. Mr. Bush wrote blog posts that repeatedly placed the terms global warming and climate change in quotes, insinuating they did not exist. He described then-House Speaker Pelosi as ``Mama Pelosi'' and wrote that someone should ``gag the House speaker.'' He posted articles from right wing websites, speculating that former President Barack Obama was born in Kenya. He wrote in a blog post during the 2016 Republican National Convention, ``Time to roll with Trump.'' The list of comments goes on and on. On a range of policies and legal issues, Mr. Bush has already made crystal clear where he stands. At his hearing, Mr. Bush asked the Judiciary Committee to trust that he could completely set aside everything I have read into the Record this morning; that he can walk away from his personal views if he is confirmed to serve on the circuit court. Unfortunately, he has given us little reason to trust that assurance. He has no judicial experience demonstrating that he could be impartial. He spent his entire career in private practice. At his hearing before the Judiciary Committee, Mr. Bush was asked by Senator Tillis, a Republican Senator: ``Do you think that impartiality is an aspiration or an absolute expectation?'' Mr. Bush responded: ``It is an aspiration. I will do my best to be impartial.'' In other words, Mr. Bush claims that he will try to be impartial but that the Senate shouldn't expect that he will be completely successful. Here is what Senator Tillis, my Republican colleague, then said in reply: ``I actually have a concern with someone who thinks impartiality is an aspiration. I think it is an expectation.'' I agree with Senator Tillis. I believe Mr. Bush's failure to commit to impartiality disqualifies him from this lifetime position. Mr. Bush's views are far outside the judicial mainstream. He provided no evidence that he could set aside his views if confirmed. I understand that Mr. Bush does check many of the boxes we have seen for recent nominees from this administration. Most important and absolutely essential to his nomination is the fact that he is a longtime member of the Federalist Society. The Federalist Society describes itself as ``a group of conservatives and libertarians dedicated to reforming the current legal order.'' The Federalist Society is funded by big money, rightwing interests like the Koch brothers, the Chamber of Commerce, and the Ed Uihlein Family Foundation. This is the group President Trump personally thanked for selecting his list of Supreme Court nominee finalists. So far this year, every Trump judicial nominee who has had a hearing before our Senate Judiciary Committee has been a Federalist Society member. Coincidence? I don't think so. I urge my Republican colleagues not to let the Federalist Society serve as the selection committee--the secret handshake--to become a Federal judge for life in the United States of America. We want a Federal bench that welcomes independent and impartial thinkers. Mr. Bush's Federalist Society membership shouldn't be his ticket to the Federal bench. In conclusion, this vote, when it comes to his nomination, is really not a close call. It is clear that Mr. Bush has friends in high places, but he has demonstrated a temperament and a judgment which we should not put in a lifetime position on the Federal court of appeals. I urge my colleagues to oppose his nomination. Mr. President, I yield the floor. I suggest the absence of a quorum.

Mr. DURBIN

Mr. DURBIN. Mr. President, for the second time this year, Illinois communities are assessing damage and cleaning up after flooding. My thoughts and prayers are with the families and first responders in northern Illinois who are working to recover after heavy rain caused severe flooding in Lake, McHenry, Kane, and Cook Counties last week. The water has started to recede in some communities, but in some areas, water levels will likely continue rising this week. Thousands of buildings--including homes, businesses, and schools--have been damaged by floodwaters. Lake County has been one of the areas most impacted by this flooding. Last weekend, I visited two towns in this area--Libertyville and Gurnee--and I saw street after street of flood damage to homes and businesses. What I saw was heartbreaking. I spoke with residents who were concerned about being able to recover from the flood and resulting damages and who voiced the need to find long-term solutions that will mitigate the impact of future flood events. I am extremely grateful for the hard work of local first responders and county officials. Thankfully, there have been no reports of injuries or fatalities as a result of this historic flooding. I want to acknowledge the dedication of both the State and local employees and volunteers who have come out to help at every level, from the Illinois Emergency Management Agency and the American Red Cross, to county emergency management agencies. Many volunteers have helped with sandbagging. County board chairman Aaron Lawlor has also been helpful in securing resources and making sure residents have information about where to find shelter and access cleanup supplies. People from all around the area are pitching in to help their neighbors and even strangers protect property and get back on their feet. I would also like to thank James Joseph, director of the Illinois Emergency Management Agency, for his hard work. He has been there during a time when Illinois constituents and communities need him the most. The State has provided 850,000 sandbags and deployed an emergency management assistance team for flood mitigation and response efforts. Representatives from the Illinois Emergency Management Agency are working closely with local officials to make sure communities have the resources needed to protect critical infrastructure and clean up when water begins to recede. The Governor has declared four counties State disaster areas. In the coming days, the State will work with FEMA and local officials to begin conducting preliminary damage assessments. Once we have an idea of the scope of the damage, the Governor has the ability to request a Presidential disaster declaration. In the past, it has been challenging for Illinois to receive Federal aid after a disaster occurs, but the Illinois delegation and I stand ready to do whatever we can to help get any Federal assistance needed so that these communities can clean up and recover. There is more work to be done, and cleanup may be difficult and dangerous, but I have no doubt the people who live and work in the impacted communities will make incredible progress rebuilding with the help and support of volunteers, local officials, and State agencies. I want to thank everyone who has been engaged in the response and mitigation efforts and all those who will be engaged in recovery efforts in the weeks to come. We will rebuild, as Illinoisans always do, and we will be stronger for it.

Mr. DURBIN

Mr. DURBIN. Mr. President, let me thank my colleagues for coming to the floor and speaking on behalf of Native Americans and the Indian Health Service, its shortcomings and challenges that it creates for us. I don't have an Indian reservation in my State, but I certainly have visited these Indian reservations in other States and believe we have an ongoing responsibility--social and moral responsibility--to those who were in this country long before many of our ancestors and who have not been treated fairly many, many times when it comes to the poverty they face in this country and the challenges they face. It is as bad as or worse than any other group in America. We can do better, and we need to start with the Indian Health Service and health services. I thank my colleagues for raising that issue. Mr. President, it is interesting, this is a historic week in the Senate because we have been engaged in a debate for weeks about what to do about healthcare in America. The Senate, of course, is under the majority control of the Republicans, as the House of Representatives is, and, of course, with a Republican President. They all came to Washington at the beginning of this year and said: The first thing we want to do is to repeal ObamaCare. We have said it for 6 years. We are finally going to do it. We are going to get rid of ObamaCare, the Affordable Care Act, once and for all. They set out to do it in a variety of ways. President Trump's first Executive order to the agencies of the Federal Government said: Do everything you can to discourage ObamaCare. He turned around and did just that. His agency stopped advertising for people to sign up for ObamaCare. They were determined to put an end to it. In the House of Representatives, they took a step beyond that. They introduced legislation to repeal it and replace it. What they replaced it with was a disaster. The Congressional Budget Office took a look at the Republican repeal plan in the House and said 24 million people will lose their health insurance. Beyond that, they talked about the changes that would take place in health insurance policies with the Republican repeal plan. It passed the House by four votes, which meant that if two Republican Members-- and only Republicans voted for it--had voted the other way, it wouldn't have passed. It was that close. Then it was sent to the Senate, and it was up to the Senate Republicans to decide what they would do with this bill and what they would do with the repeal of ObamaCare. They spent many weeks in conversation and discussion about what they might do. Thirteen Members, Republican Senators, sat in private rooms and talked about what they would do to replace ObamaCare. Finally, they reported a bill. It turns out their bill was an improvement over the House bill. The House bill eliminated health insurance for 24 million Americans. The Senate bill eliminated health insurance for 23 million Americans. Still, when you look at it, it is a horrible thing. In my State of Illinois, a million people in my State would have lost health insurance with either the House or Senate Republican bills. It is the reason there has been resistance in my State to this Republican effort from the start. You would expect it on a political basis. Sure, the Democrats will oppose the Republicans on issues, but this went beyond it. There wasn't a single medical advocacy group in the United States that supported what the Republicans were doing, not one. The hospital associations across America, the medical society of doctors, the nurses, the pediatricians, they all opposed what the Republicans set out to do. When it looked like there were problems in passing one version of the Senate Republican repeal bill, they sat down to rewrite it. As they sat down to rewrite it, they got into deeper water and bigger problems. Senator Cruz, the junior Senator from Texas, said: Well, one way to bring down the cost of health insurance is to take out some of the protections of a health insurance policy. We can get premiums down pretty low if we take away the protections of a health insurance policy that are in the Affordable Care Act. That was his proposal. Just this weekend, Blue Cross Blue Shield and the major health insurance industry said that this will be a disaster. If you have some people buying real insurance and real protection and others paying rock-bottom premiums for little or no coverage, you are going to create two classes of Americans, and you are going to see premiums going through the roof for those who are buying full-coverage policies. They came out against the Cruz proposal. This week, we returned to face the votes. We were supposed to be voting today, a vote on whether to repeal ObamaCare. As of last night, things started changing. Two Republican Senators joined two others and said they were opposing the effort, and so the Republican majority did not have the votes it needed to go forward. They said: Well, at least we will vote on repealing ObamaCare. Three Republican Senators have announced, as of today, that voting for simple repeal is something they will not do. Many of them make the argument that just repealing ObamaCare without replacing it is irresponsible. They are right. If you don't like the current system, I believe you are duty-bound, as a Senator or Congressman, to come up with a better idea, something that serves America better. They have been unable to reach that point. Where are we? At this moment, we are at a standstill. The Republican efforts to repeal and replace have stopped as of this moment. There may be a vote, an official vote this week. I don't know. That is up to Senator McConnell as the Republican leader, but it appears there is no plan coming out of the Republican side to replace the Affordable Care Act. I am proud to have voted for it. I voted for it for very simple reasons. When it comes to health insurance, I believe that is one of the basics in life. I am one of those politicians who believes healthcare is a right, just like police and fire protection. It should be part of who we are in America. I don't believe it is a question of how rich you are or how lucky you are as to whether you have health insurance in this country. We can do better as a nation. The Affordable Care Act set out to do that. We reduced the number of uninsured Americans with ObamaCare when we passed it 6 years ago by 50 percent. We reduced by half the uninsured people living in my State of Illinois. Many of them went to the insurance exchanges, bought private health insurance. If they had lower incomes, they got subsidies to help pay the premiums. Others picked up Medicaid coverage as their health insurance. It was significant. I ran into people all across my State, from Chicago to downstate, who had never had health insurance 1 day in their lives. These are not lazy people. These are hard-working people who happen to have the kind of jobs that didn't offer health insurance. Ray Romanowski, big Polish fellow, guitarist and musician in Chicago said: Senator, I have never had health insurance. I am a musician. Nobody was ever going to provide me with health insurance. He said: Lucky I have it now because I have been diagnosed with diabetes. I am in my sixties, and I have, through the Affordable Care Act, health insurance through Medicaid. Similar story, almost identical story in deep Southern Illinois. Judy, who works as a hospitality hostess in a local motel--she is the one who greets you with a smile when you come in for that free breakfast. Judy is 62 years of age. She never had health insurance 1 day in her life. She holds down two and three jobs at a time. The only health insurance she ever had is what she has now under Medicaid. What is going to happen to those people if we eliminate Medicaid coverage--which the proposals before us suggested--if Medicaid coverage is cut back dramatically? Those two people, Ray and Judy, are still going to face health challenges. They are still going to get sick and go to the hospital, but if they don't have health insurance, will the hospital treat them? Yes. What will happen to their bills? Their costs will be passed on to everyone else. That is the way it used to be done. What we have learned this week in Washington, in this national healthcare debate, is there are of course concerns about whether the current healthcare system is what it should be, and I think it can be improved, but we have learned one basic thing. We are not going back. We are not going back to the days when health insurance companies could deny coverage to you or your family because of a preexisting condition. We are not going back to the days where they put a limit on how much they would pay on your health insurance plan. Remember when you first realized that a $100,000 limit was not worth that much if you had a serious diagnosis or a serious accident? We are not going back to the days when that health insurance plan literally expired in coverage, forcing you and your family into bankruptcy over medical bills. We are not going back to the day when families couldn't cover their kids coming out of college. The Affordable Care Act said you can keep your child on your health insurance plan as a family until they reach the age of 26. Those of us who have had kids who have graduated college realize they don't always get a great job right off the bat. Some of them start as interns or part-time workers, and they don't have health insurance. They now know they have the peace of mind of the family health insurance plan. We want to make sure we protect that. We are not going back to the day when those young people had no coverage at a critical moment in their lives. We are not going back to the day when we allow these insurance companies to charge whatever premiums they wish. We put provisions in the law that limit the premiums that can be charged on Americans, that limit the profits that are taken out of health insurance companies. Those were moves that had to be made to protect innocent American families who, unfortunately, were struggling with medical bills before this law passed and now at least have some chance of paying for them. What we learned in the course of this national debate is significant. We learned that if you put up a proposal, as the Republicans did in the House and the Senate, that takes health insurance away from over 20 million Americans, you have a problem. People are going to push back and say that it isn't fair to take away health insurance and the protection and peace of mind that come with it. If you come up with a plan that ends up dramatically cutting back on Medicaid, you are going to get a lot of people who are concerned about it. Across America, the Medicaid Program as we know it does many significant things. One-half of the babies born in my State of Illinois are covered by Medicaid. Mom and her prenatal care, the delivery of the baby, and the caring for mom and the child afterward are covered by Medicaid. If you make a cut in the reimbursement for Medicaid, you will endanger the basic treatment needed to have a healthy baby. The second thing we know is that Medicaid is critical for people with disabilities. I met a mother in Champagne, IL, and she came up and told me she has a 23-year-old autistic son. It has been a struggle for her and her family, but now he has a somewhat independent life. She said: Senator, if you take away Medicaid insurance from him, I will have to put him in some institutional program that I cannot afford. There is nowhere to turn. I also want to remind people that Medicaid pays school districts to take care of kids with special education needs, transportation, counselors, even feeding tubes for the severely disabled. That is an important part of Medicaid. I haven't touched on the most expensive part of the Medicaid Program in America. The most expensive part is for those who are in nursing homes, those who are older Americans and need Medicaid to get by. They have Social Security and they have Medicare, but they need Medicaid. If you cut back on Medicaid as proposed by the Republicans in both the House and the Senate, who will take care of these elderly folks who are in a situation where they have exhausted their savings? Do they move back in with the family? Sometimes that is not even possible, but that is one of the prospects faced. What we need to do is to accept the obvious. We have reached an important political milestone here where the Republicans don't have the votes to move forward, but we still have the challenge of the current system. I was proud to vote for it, but it is far from perfect. The current healthcare system in America, the Affordable Care Act, needs help, needs changes. We need to do it. We ought to just surprise the heck out of America by working together, both political parties, to solve the problems. Let's identify a few of the most obvious problems. No. 1, the Affordable Care Act in America today does not address the cost of prescription drugs. You ask a health insurance company: What is driving the cost of premiums? Prescription drugs. Did you ever notice that when you turn on the television at certain times of the day, it is all about drugs? It is all about new drugs, things you can hardly pronounce. These new drugs are being advertised on television time and again. And then there is a 2- or 3-minute disclaimer: Be careful. If you take this drug, you might die. Be sure and tell your doctor if you have ever had a liver transplant. I listen to all these warnings, and I am thinking, this is being sold in advertising for the general population? Did you know that there are only three countries in the world that allow television advertising of prescription drugs--the United States, New Zealand, and Brazil? Why do the pharmaceutical companies advertise drugs on television? Certainly if you want to inform a doctor about a new drug, you wouldn't buy a television ad, would you? The reason they are on television is so that we, as individual consumers and patients, will walk into the doctor's office and say: Doctor, it took me five times, but I finally figured out how to spell ``Xarelto,'' and I want Xarelto as my blood thinner. The doctor has a choice: He or she can explain to you that you may not need Xarelto, that there is a cheaper version of blood thinner or that this isn't the one that really fits your needs in this circumstance. Doctors don't do that. Many of them just write out the prescription. That is why the television advertising is taking place-- to convince the consumer, who asks the doctor and who ends up with the high-priced drug being scripted for them. That is the reality of why the costs of healthcare keep going up. What does the Affordable Care Act do about that? Nothing. It does nothing when it comes to the cost of prescription drugs. I want these drug companies to make a profit, don't get me wrong. If they are profitable while looking for new cures, that is the way it should be. But when they charge through the roof and double and triple the cost of these pharmaceutical drugs, that is not fair. It is not fair to consumers, and it is not fair to taxpayers. Think about the fact that many of exactly the same drugs made in the United States are sold in other countries for a fraction of what they cost in the United States. Even in Canada, they charge about one-half or one-third for many of the most popular drugs because the Canadian Government said to the drug companies in America: We are drawing the line. We are not going to let you charge anything you want to charge. Why don't we do something in America to protect consumers? Why don't we at least inform people when pharmaceutical companies are overcharging so that we can put some pressure on them to stop? That is part of the change to the Affordable Care Act that I think will save us money and at the same time deal with an issue most Americans really are concerned about. We also should be concerned about the fact that when it comes to the individual health insurance market, that is where most of the problems are. Six percent of the American population buying health insurance through the exchanges--half of them have to pay the full premiums, and some of those premiums go through the roof. Why? Because the people who are buying this insurance are usually people with a medical history or they are older folks and they want to have the peace of mind of coverage. The healthy, younger folks aren't buying it. As a result, the insurance risk pool gets pretty expensive when it comes to premiums. We need to fix that, and we can fix that. That is another thing on which we should come together as Democrats and Republicans to try to achieve. For those who say: Well, I promised my entire political career that I couldn't wait for the day to come forward and vote to repeal ObamaCare, I just want to tell them that they should be aware that when the Congressional Budget Office looked at the impact of just repealing the Affordable Care Act and not replacing it, they said the following: This would force more insurance companies to leave the market immediately. It would increase premiums by 20 percent a year and double the price of premiums over 10 years, and it would take health insurance away from 32 million people. So taking that vote to repeal the Affordable Care Act may earn you a cheer at some political rally, but it is not responsible. It is not good. It will raise the cost of health insurance for families across our country if we just repeal and don't replace, and it will take health insurance away from over 30 million people, according to the Congressional Budget Office. It is better that we replace it with something responsible, better that we take the current system and make it stronger. This has been an interesting debate. I have learned a lot in the course of this debate because I went and visited the hospitals in Illinois. The Illinois Hospital Association opposed the Republican plan in the House and opposed the proposal in the Senate. They said it would cost us 60 to 80,000 jobs in Illinois and it would close down some hospitals we need in rural parts of our State, smalltown hospitals that are critically important. I don't want to see that happen, the people who live there don't want to see that happen, and you won't be able to keep and attract good employers and good jobs if that does happen. So I have worked with these hospital administrators and want to move forward with them on an alternative. I will close by saying this: It is interesting how many people say ``I can't wait until I reach age 65 because I will qualify for Medicare.'' Medicare doesn't discriminate based on preexisting conditions and provides good health insurance for millions of Americans. It is an illustration and a lesson for us that if you have something that isn't driven by the profit motive, that people trust, that has provided basic, good care for Americans, good hospitals and good doctors, that is what people are looking for. Why shouldn't they? That should be part of the American dream. It should be part of our right as Americans. Mr. President, I yield the floor. I suggest the absence of a quorum.