Orrin Hatch

Mr. HATCH

Mr. HATCH. Mr. President, I ask unanimous consent that I be permitted to finish my remarks.

Mr. HATCH

Mr. HATCH. Mr. President, today I complete the series of floor speeches on religious freedom that I began in September. My purpose in this series is to present the full story of religious freedom in the hope that we may better understand and appreciate it and draw guidance for the future. Charting a path forward requires understanding where we have been and taking stock of where we are right now. The story of religious freedom, as I have laid it out, shows that we must choose between two starkly different paths. The story begins with religious freedom itself and why it is uniquely important and requires special protection. I said in September: No decision is more fundamental to human existence than the decision we make regarding our relationship to the Divine. No act of government can be more intrusive or more invasive of individual autonomy and free will than the act of compelling a person to violate his or her sincerely chosen religious beliefs. The story continues with the central place of religious freedom in America's identity. At no time in world history has religious freedom been such an integral part of a nation's origin and character. The seeds were planted centuries before the actual founding of this country with one religious community after another coming to these shores to freely practice their faith. When Congress enacted the International Religious Freedom Act less than two decades ago, we declared that religious freedom ``undergirds the very origin and existence of the United States.'' The story of religious freedom in America includes understanding both its status and its substance. In October, I explained how the status of religious freedom can be summarized as both inalienable and preeminent. Religious freedom is inalienable because, as the Declaration of Independence asserts, it comes from God, not from government. And because it is endowed, that is part of our very humanity. Religious freedom is preeminent or, as James Madison put it, ``precedent, both in order of time and in degree of obligation to the claims of civil society.'' I also explained that the substance of religious freedom can be understood in terms of its depth, or what it includes, and its breadth, or to whom it applies. Religious freedom, for example, includes much more than religious belief or speech. In fact, protecting in law both religious belief and the exercise of that belief preceded the First Amendment by 150 years. Madison again gives us guidance to finding the exercise of religion as the freely chosen manner of discharging the duty an individual believes he or she owes to God. This includes both belief and behavior in public and in private, individually and collectively. The substance of religious freedom also includes its breadth of application to all human beings. The First Amendment protects not certain exercises of religion or the exercise of religion by certain persons, but the free exercise of religion itself. As I mentioned, Congress unanimously enacted the International Religious Freedom Act. The vote in this body was 98 to 0, and 21 Senators serving today--12 Republicans and 9 Democrats--voted for this legislation, as did Vice President Biden and Secretary of State John Kerry, who were serving here at that time. That law declares our religious freedom to be a universal human right, a pillar of our Nation, and a fundamental freedom. This is the path of religious freedom on which we have traveled for three centuries, before a very different path emerged. In November, I outlined how the courts have begun to distort the First Amendment's protection for religious freedom. America's Founders included a narrow prohibition on government establishment of religion as a support for the broad individual freedom to exercise religion. Since the mid-20th century, however, courts have instead expanded the establishment clause into a virtual ban on religion in public life and narrowed the free exercise clause so that government may more easily restrict the practice of religion itself. I also examined how the courts, the Obama administration, and State legislatures are contributing to attacks on religious freedom right here in America. The common theme in these attacks is that far from being special, religious freedom must yield to other values or political objectives. Even worse, some are arguing that religious freedom is actually something negative that should be limited or even suppressed. These attacks not only target particular exercises of religion but undermine religious freedom itself. Rather than inalienable, these attacks would turn religious freedom into something granted or restricted by the government at its whim. Instead of preeminent, these attacks would reduce religious freedom to something optional and subservient. Rather than something deep and broad, these attacks would turn religious freedom into something shallow and narrow. State courts, for example, have imposed heavy fines on business owners who decline, based on their religious beliefs, to provide services such as photography, flowers or catering for same-sex marriages. The decision by these business owners did not prevent anyone from getting married or from having the wedding they chose. Other photographers, florists, and bakers gladly stepped up to do business. The only real effect of these fines was to punish these individuals for exercising their religious beliefs. By punishing the exercise of religion itself, these courts are saying that religious freedom must necessarily yield to other political priorities. ObamaCare made the same two-part attack on religious freedom but on a much larger scale. First, far from trying to accommodate religious freedom in developing ObamaCare or its implementing regulations, neither Congress nor the Obama administration gave religious freedom any consideration whatsoever. This is appalling in several different ways. Not only does it reflect a callous attitude toward this fundamental right, but it ignores the Religious Freedom Restoration Act's command that Federal law properly accommodate religious freedom. The only way to avoid that requirement is for Congress explicitly to exempt a statute from RFRA's standards. Congress did not do so. But consider this. On January 15, 2010, President Obama issued his first Religious Freedom Day proclamation. He reaffirmed ``our nation's enduring commitment to the universal human right of religious freedom.'' Just 2 months later, he signed into law the statute that so blatantly ignored and would be used to undermine that very universal human right. The second way that ObamaCare undermines religious freedom is by imposing significant burdens on the actual exercise of religion. The Department of Health and Human Services, for example, tried to force business owners to provide insurance coverage for methods of birth control that violate their religious beliefs. Thankfully, last year the Supreme Court said the Obama administration should have more properly accommodated religious freedom. Another case is now before the Supreme Court in which the Obama administration is demanding that a religious organization be forced to participate in providing insurance coverage for practices that violate their religious beliefs. The Obama administration, with its army of smart lawyers and deep well of taxpayer dollars, is fighting tooth and nail to make sure its political objectives quash religious freedom. Last week, I outlined the benefits that religion and religious freedom provide. It is essential to forming and securing our basic rights. Religion was the engine driving great social movements, such as abolition and civil rights. It motivates significantly greater contributions by individuals to charities of all kinds and inspires many of the largest charitable organizations in the country. But religion is not simply beneficial to society; it is an indispensable feature of any free government. Without religion and the moral instruction it provides, freedom falters and democracy all too easily dissolves into tyranny. In the 18th Century, the Massachusetts Constitution of 1780 declared that ``the happiness of a people and the good order and preservation of civil government essentially depend upon piety, religion, and morality.'' In the 21st Century, Harvard professor Mary Ann Glendon argues persuasively that religious freedom reduces societal violence and correlates with democratic longevity. The story of religious freedom that I have offered over the last few months presents a choice that we must make as we consider the way forward. On one path, religious freedom is an inalienable and preeminent right of all people; on the other path, it is an uncertain and optional possibility for some people. On one path the government must accommodate religious freedom; on the other path religious freedom must accommodate the government. One path is consistent with our history, founding, character, commitments, and an example to the rest of the world. The other path rejects that history, turns its back on our commitments, and abandons human rights in favor of shifting political agendas. Here is how I put it in one of my speeches last month: Subjugating religious freedom beliefs to government decrees is not the price of citizenship. To the contrary, respecting and honoring the fundamental rights of all Americans is the price our government pays to enjoy the continued consent of the American people. We must decide whether we still believe what our Nation, our people, and our leaders have said and done. James Madison wrote that religious freedom is an inalienable right that takes precedence over the claims of civil society. Thomas Jefferson said that religious freedom is ``the most inalienable and sacred of all human rights.'' Franklin Roosevelt said that religious freedom is a fundamental and essential human freedom. The United States voted for the Universal Declaration of Human Rights in 1948, signed the Helsinki Accords in 1975, and ratified the International Covenant on Civil and Political Rights in 1992. Each of these identifies religious freedom as a fundamental human right that includes both belief and behavior in public and in private, individually and collectively. Congress enacted the Religious Freedom Restoration Act almost unanimously in 1994. I should know; I was the principal advocate for it. It sets a tough standard for allowing government interference with religious freedom and offers this protection for all exercises of religion by all people. Democrats and Republicans, liberals and conservatives, adherents of different faiths--everyone joined hands on these basic principles. And I might add that Hatch and Kennedy joined hands as well. In the 2013 Religious Freedom Day proclamation, President Obama said that religious freedom is an essential part of human dignity. This is the path on which America began, the path America's Founders embraced, the path that all three branches of government have recognized, and the path we have reaffirmed countless times. The burden is on those who believe that we should now leave this path. Those who no longer believe that religious freedom is an inalienable right and an essential human freedom should say so. Those who no longer believe that, as our statutes and treaties assert, religious freedom is a fundamental right and a pillar of our Nation should be honest and up front about it. Those who believe that the shifting political priorities of the day trump religious freedom should candidly make their case. In the last week, since the terrorist attack in San Bernardino, we have glimpsed some of the ugliness that is down the path where politics trumps religious freedom. Many of our leaders expressed support and offered thoughts and prayers for the victims and their families. Those expressions were met by some with disdain, ridicule, and scoffing. Reporters, bloggers, activists, and even Members of Congress sent the message that thoughts and prayers are really not much of anything and in any event are legitimate only if they come from those who want more gun control. Finally, I want to highlight for my colleagues another source of guidance in choosing the future path for religious freedom. In June 1988, the most diverse group of leaders in American history presented the Williamsburg Charter to the Nation. Its purpose was to reaffirm religious freedom for all citizens, to set out the place of religious freedom in American public life, and to offer guiding principles for the future. Former Presidents Jimmy Carter and Gerald Ford and the chairmen of the two political parties signed it. The president of the AFL-CIO and the chairman of the U.S. Chamber of Commerce signed it. Presidents of universities and bar associations signed it. Leaders of faith communities, including the National Council of Churches and National Association of Evangelicals, Seventh-day Adventists, the Synagogue Council of America, and the Church of Jesus Christ of Latter- day Saints signed it. What could possibly unite such a disparate group? It would have to be something too general to be useful--perhaps something like sunshine or friendship--or something so profound that we simply must sit up and pay attention. The first principles of religious freedom affirmed by the Williamsburg Charter are these: First, religious freedom is an inalienable right that is ``premised upon the inviolable dignity of the human person. It is the foundation of, and is integrally related to, all other rights and freedoms secured by the Constitution.'' Second, the ``chief menace to religious liberty today is the expanding power of government control over personal behavior and the institutions of society, when the government acts not so much in deliberate hostility to, but in reckless disregard of, communal belief and personal conscience.'' Third, limiting religious liberty ``is allowable only where the State has borne a heavy burden of proof that the limitation is justified--not by any ordinary public interest, but by a supreme public necessity--and that no less restrictive alternative to limitation exists.'' These are the principles that should guide our way forward. Religious freedom is inalienable. Religious freedom is threatened when government either directly burdens or fails to accommodate it. Government burdens on religious freedom must be the least restrictive means of achieving a compelling government purpose or supreme public necessity. These principles inform proper resolution of the challenges that religious freedom will certainly face ahead. Some are calling for government to revoke or deny such things as tax- exempt status, certifications, or licenses for religious organizations with certain beliefs. I already mentioned how some courts are using anti-discrimination statutes to trump religious freedom. Applying the principles I have discussed would require the government to make the case that such impositions are the least restrictive way to further a supreme public necessity. Another challenge will be in the development, rather than the implementation, of anti-discrimination laws. Applying the appropriate principles requires that such legislation properly accommodate religious freedom. Title VII of the Civil Rights Act of 1964, for example, includes a religious exemption. I supported the Employment Non-Discrimination Act in the 113th Congress because, in addition to incorporating that exemption, it also prohibited retaliation against those who qualify for the exemption. My State of Utah this year enacted an anti- discrimination statute that similarly included a robust exemption for religious organizations. Earlier this year, however, Senators introduced the Equality Act, which would prohibit discrimination on the basis of sexual orientation and gender identity across several areas such as employment, housing, and education. It not only fails to incorporate the existing title VII religious exemption, it contains no accommodation for religious freedom at all. This is an example of the path that rejects religious freedom as even worthy of consideration. Such legislation should not become law unless it properly accommodates religious freedom. This is a time for choosing. The story of religious freedom is both an inspiring narrative and a cautionary tale. It brings to mind the inscription on a statue fronting the National Archives that ``eternal vigilance is the price of liberty.'' The heritage of religious freedom that took centuries to build could be dismantled in a fraction of that time. The right path means balance of accommodation; the wrong path means exclusion and suppression. The way forward requires us to choose the right path to make sure our actions speak louder than our words. Mr. President, I apologize for going over by 5 minutes. I yield the floor.

Mr. HATCH

Mr. HATCH. Mr. President, reserving the right to object, I want to say first that I appreciate what my colleague is trying to do with regard to Puerto Rico. I think it is fair to say that we all share his concerns, and I don't know of anyone in this Chamber who is indifferent to the issues facing our fellow American citizens in Puerto Rico. I agree with the senior Senator from New York that Congress should act to address these problems and we need to act very quickly. However, a number of Senators, myself included, have some concerns about the specific policy in the bill he has brought up today on the floor. Setting aside those concerns, there are a number of questions about whether this approach would effectively address Puerto Rico's problems. I want to work with my colleagues and especially my colleague from New York to find a path forward on this issue. Once again, there is bipartisan agreement that something needs to be done. I have been working closely with the ranking member of the Senate Finance Committee on this issue. He has been a great help. I have also been in some pretty involved discussions with the chairs of the Judiciary and Energy and Natural Resources Committees, which also have jurisdiction in this matter, as we have been working to draft a legislative proposal to address a number of these concerns. In fact, we are planning to introduce our bill later today. I am sure I will have more to say on that piece of particular legislation in the coming days. For now I will say I would be happy to engage the senior Senator from New York on this matter as well and would hope that he would be willing to do the same with me. Going forward, I hope we can work together to make sure we have all the information we need about the situation in Puerto Rico in order to craft informed policies and effective solutions and do so in short order, in the interest of helping the people of Puerto Rico. As of right now, I think we need additional deliberation on this matter rather than simply deeming any piece of legislation to be the correct approach. For these reasons I must object to the good Senator's request at this time, but once again I will commit to working with him and others to address these important issues. I do object.

Mr. HATCH

Mr. HATCH. Mr. President, today Senator Wyden and I have officially introduced the Audit and Appeal Fairness, Integrity, and Reforms in Medicare, or AFIRM, Act of 2015, a bipartisan bill developed earlier this year in the Senate Finance Committee. The AFIRM Act was actually ordered reported out of the committee in June, passing by voice vote with no recorded opposition. This legislation, comes mainly in response to the concerns many have expressed with regard to program integrity and the overall solvency of the Medicare Trust Fund. A recent report from the Government Accountability Office found that, in fiscal year 2014 alone, Medicare covered health services for approximately 54 million elderly and disabled beneficiaries at a cost of $603 billion in Federal funds. And, according to GAO, of that figure, approximately 10 percent of the funds were improperly paid. That is nearly $60 billion in improper payments--either errors or fraud--in a single fiscal year. That is an astronomical figure, and about 33 percent higher than the number we saw the year before. This unacceptably high level of improper Medicare payments has led to an increased number of audits to identify and recapture those funds. While officials at the Centers for Medicare & Medicaid Services have been reasonably successful in their mission to conduct audits on the more than one billion claims submitted to Medicare every year, they face an uphill battle in their efforts to recover improper payments. In 2014, for example, CMS recovery audit contractors recovered over $2.57 billion. While this may sound like a large number, that is less than of the 2014 Medicare improper payments estimate of $45.8 billion, hardly a figure anyone should be proud of. Coming on the heels of this massive loss in taxpayer funds and our Government's utter failure to retrieve them is an equally massive unintended consequence. Due to the increasing number of audits, there has been a predictable, yet dramatic, increase in the number of Medicare appeals. Currently, there are so many appeals being filed in response to these audits that the Office of Medicare Hearings and Appeals can't even docket them for 20 to 24 weeks after they are filed. In fact, within the last month, the total backlog of Medicare appeals eclipsed 900,000. You heard that right: There are more than 900,000 appeals currently pending at the Office of Medicare Hearings and Appeals. In fiscal year 2009, the majority of Medicare appeals were processed within 94 days. Now, 6 years later, it takes, on average, 547 days--or roughly a year and a half--to process an appeal. This is an incredibly frustrating amount of time, not only for physicians and other health care providers, but for Medicare beneficiaries as well. Think about that for a second. It takes, on average, a year and a half for Medicare beneficiaries--many of whom live on fixed incomes-- filing an appeal to find out whether their services will be covered in the end. It takes a year and a half for doctors--an increasing number of whom are already opting to not accept Medicare patients--to find out if they will be paid. Contributing to this problem is the fact that large portions of the initial payment determinations are reversed on appeal. The Department of Health and Human Services Office of Inspector General reported that, of the 41,000 appeals made to Administrative Law Judges, or ALJs, in fiscal year 2012, over 60 percent were partially or fully favorable to the defendant. Such a high rate of reversals raises questions about the quality of initial determinations and whether providers and beneficiaries are facing undue burdens up front. In order to protect beneficiaries, provide certainty for doctors, and take steps to at least partially shore up the Medicare Trust Fund, we need to address these issues now. That is why Senator Wyden and I introduced the AFIRM Act. If enacted, our bill will improve oversight of the Medicare audits and appeals process, effectively addressing the staggering Medicare appeals backlog. It will make the most fundamental changes to the appeals process since Medicare began. It will lay the groundwork for a more level playing field, reducing the burden on providers and suppliers, while giving auditors the tools necessary to better protect the Medicare Trust Fund. The AFIRM Act will address these issues in five ways. First, it will improve the audit programs by coordinating efforts between auditors and CMS to ensure that all parties receive adequate training on current policy, increasing transparency in the audit process, and requiring that CMS create new incentives to improve auditor accuracy. Second, the bill will make reforms to the Medicare appeals process to address the appeals backlog without sacrificing quality. Part of this will be done by raising the amount in controversy for review by an ALJ to match the amount for review required by a District Court. For cases with lower costs, a new Medicare Magistrate program will be created to allow senior attorneys with expertise in Medicare law and policies to decide cases in the same way as ALJs. This will allow more cases to be heard more quickly, while still providing ALJs full focus on the more complex cases. Third, the bill will allow for the use of sampling and extrapolation of Medicare claims, with the appellant's consent, to expedite the appeals process. Fourth, the bill will establish voluntary alternate dispute resolution processes for multiple pending claims with similar issues to be settled as a unit, rather than as individual appeals. This will reduce administrative costs while still providing reasonable consideration to pending claims. Finally, the bill will also require that CMS create an independent Ombudsman for Medicare Reviews and Appeals to help resolve complaints made by appellants and those considering appeal. As with any federal program, continuing oversight and good leadership are required to have any measure of success. These are thoughtful, bipartisan improvements, agreed on by the entire Finance Committee that will address the appeals backlog while still allowing us to improve program integrity going forward. I believe it is the best approach we can take to continue our efforts to recover lost taxpayer funds without creating undue burdens for health care providers and suppliers. Oftentimes in Congress we find ourselves shying away from bipartisan compromises like this. Some may feel that they have more to gain, politically, if they thumb their noses at the other party. Or, inversely, they have something to lose if they actually agree on an issue with members on the other side. Let me clearly state, for the record, that we have neither the time, nor the money to play partisan games with this issue. The average amount of time for an appeal to get processed has gone up by more than 550 percent in just 6 years. You heard me correctly--that increase is just in the time it takes to get the appeal processed, not even ruled on. If this trend continues, and absent congressional action, I think we can assume that it will continue, imagine how much more strained, expensive, and ineffective the Medicare appeals system could become. Truly, there is no time better than now to actually do our job and stem this rising tide. Before I finish I want to thank Senator Wyden for working with me on this effort and for making this a truly bipartisan endeavor. I hope all of my colleagues--on both sides of the aisle--will support the AFIRM Act.

Mr. HATCH

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

Mr. HATCH. Mr. President, I am grateful for this opportunity to offer a few remarks on the Every Student Succeeds Act. To be honest, I wasn't sure we would ever reach this point, given the often contentious and sensitive nature of the educational debate, but it is only fitting that we have spent so much time and energy trying to get the best bill we can. After all, the future of our Nation depends on it, our States depend on it, our schools depend on it, and our families and children depend on it. I credit the success of this bill to the diligent work of the chairman and ranking member of the Senate HELP Committee, as well as the chairman and ranking member of the House Education and the Workforce Committee. As a former chairman of this committee myself, I know how difficult it can be to strike a deal that is agreeable to both sides, but our committee leaders have done an outstanding job. I wish to thank them for helping us to reach out and reach a compromise. That is exactly what this bill is, a compromise. While neither side considers it perfect, both parties can agree that this bipartisan legislation will significantly improve the quality of education in our country. I have met with a wide variety of local education leaders in Utah, and each one I have spoken to supports this bill. This legislation helps fix a broken system that is failing our students. Once we have passed this reauthorization, our work will be far from over, but we will once again be moving in the right direction. For the past several years, my home State of Utah has sought relief from unworkable provisions in No Child Left Behind through the waiver process, but the waiver process is dysfunctional. It forces States to appeal to the Federal Government to fix a problem created by the Federal Government. As our State superintendent in Utah said, ``Results of the waiver process have not been salutary for education, for developments in administrative law, or for the health of our republic. Reforming and revising this deeply flawed statute has and must be the primary work of our federal delegates with respect to education.'' Today we are answering his plea and the plea of many State and local leaders throughout the country. I am grateful for the opportunity I have had to work on this bill. I am also grateful for the opportunity I have had to help write many of its provisions, including the Education Innovation and Research Program, which will allow schools, districts, nonprofits, and small businesses to develop proposals based on specific local needs. Funding for this program will be awarded based on demonstrated, successful outcomes flowing from the project. This initiative will help us find other incubators of success. It will also remove limitations on flexibility in exchange for demonstrated outcomes. Money should not be tied to what the Senate or the Federal Department of Energy thinks are good, prescriptive ideas. It should be tied to local innovation and tangible results. Through this bill, I have also worked to expand technology usage in the classrooms and to equip our teachers with the professional development they need to use technology successfully. Too many of our schools are using outdated or ineffective technological methods and models that are missing critical components of teacher participation and support. Educational technology allows us to personalize learning for students, target where students are struggling, and provide real- time, valuable feedback to teachers so they may adapt their instruction most effectively. I hope we can provide every child access to the same tools and resources and create the individualized learning experiences that we know are critical to success. This bill equips both educators and students with resources they need to succeed. As the president and CEO of the Salt Lake Chamber of Commerce said, ``This bill empowers willing states to achieve [through] improved early learning and high quality preschool experiences. It also invests in our hardworking teachers with more preparation programs, including those designed to improve literacy, civics education, and STEM education.'' This legislation is a victory both for Utah and for our Nation. The sooner we send this bill to the President and the sooner we can empower our States to help our students achieve their full potential, the better off we are all going to be. I have to say that I think this would be a major watershed bill. Hopefully, we will pass it tomorrow and our elementary and secondary education will greatly benefit from it. Again, I particularly compliment the distinguished chairman and ranking member for the work they have done on this bill--the hard and effective work they have done on this bill. I am grateful to have the privilege of working with them on the Health, Education, Labor, and Pensions Committee. I wish to thank everybody who has played a role on this difficult bill. It is difficult for me to see why anybody would vote against this bill because it repairs what has been a very pitiful system under No Child Left Behind. Mr. President, I suggest the absence of a quorum.

Mr. HATCH. Mr. President, I wish to engage in a colloquy with the chairman of the Health, Education, Labor, and Pensions Committee, Senator Alexander, to clarify questions that have arisen since S. 1177 was introduced. Under the Every Student Succeeds Act, pursuant to section 1201, we authorized Federal funding to provide grant opportunities for States to administer academic assessments and to carry out activities that ensure ``the continued validity and reliability of state assessments.'' Furthermore, under the same provision, we authorized funds to allow States to collaborate with organizations to provide services that will ``improve the quality, reliability, validity, and reliability of State academic assessments.'' I ask the chairman, is it your understanding that the references in section 1201 to activities and services that ensure and improve the ``validity and reliability of state assessments'' were intended to allow funds to be used for test security activities and services designed and utilized to prevent, detect, and respond to testing irregularities and incidents that threaten the validity of assessment results?

Mr. HATCH

Mr. HATCH. Mr. President, today Senator Wyden and I have officially introduced the Audit and Appeal Fairness, Integrity, and Reforms in Medicare, or AFIRM, Act of 2015, a bipartisan bill developed earlier this year in the Senate Finance Committee. The AFIRM Act was actually ordered reported out of the committee in June, passing by voice vote with no recorded opposition. This legislation, comes mainly in response to the concerns many have expressed with regard to program integrity and the overall solvency of the Medicare Trust Fund. A recent report from the Government Accountability Office found that, in fiscal year 2014 alone, Medicare covered health services for approximately 54 million elderly and disabled beneficiaries at a cost of $603 billion in Federal funds. And, according to GAO, of that figure, approximately 10 percent of the funds were improperly paid. That is nearly $60 billion in improper payments--either errors or fraud--in a single fiscal year. That is an astronomical figure, and about 33 percent higher than the number we saw the year before. This unacceptably high level of improper Medicare payments has led to an increased number of audits to identify and recapture those funds. While officials at the Centers for Medicare & Medicaid Services have been reasonably successful in their mission to conduct audits on the more than one billion claims submitted to Medicare every year, they face an uphill battle in their efforts to recover improper payments. In 2014, for example, CMS recovery audit contractors recovered over $2.57 billion. While this may sound like a large number, that is less than of the 2014 Medicare improper payments estimate of $45.8 billion, hardly a figure anyone should be proud of. Coming on the heels of this massive loss in taxpayer funds and our Government's utter failure to retrieve them is an equally massive unintended consequence. Due to the increasing number of audits, there has been a predictable, yet dramatic, increase in the number of Medicare appeals. Currently, there are so many appeals being filed in response to these audits that the Office of Medicare Hearings and Appeals can't even docket them for 20 to 24 weeks after they are filed. In fact, within the last month, the total backlog of Medicare appeals eclipsed 900,000. You heard that right: There are more than 900,000 appeals currently pending at the Office of Medicare Hearings and Appeals. In fiscal year 2009, the majority of Medicare appeals were processed within 94 days. Now, 6 years later, it takes, on average, 547 days--or roughly a year and a half--to process an appeal. This is an incredibly frustrating amount of time, not only for physicians and other health care providers, but for Medicare beneficiaries as well. Think about that for a second. It takes, on average, a year and a half for Medicare beneficiaries--many of whom live on fixed incomes-- filing an appeal to find out whether their services will be covered in the end. It takes a year and a half for doctors--an increasing number of whom are already opting to not accept Medicare patients--to find out if they will be paid. Contributing to this problem is the fact that large portions of the initial payment determinations are reversed on appeal. The Department of Health and Human Services Office of Inspector General reported that, of the 41,000 appeals made to Administrative Law Judges, or ALJs, in fiscal year 2012, over 60 percent were partially or fully favorable to the defendant. Such a high rate of reversals raises questions about the quality of initial determinations and whether providers and beneficiaries are facing undue burdens up front. In order to protect beneficiaries, provide certainty for doctors, and take steps to at least partially shore up the Medicare Trust Fund, we need to address these issues now. That is why Senator Wyden and I introduced the AFIRM Act. If enacted, our bill will improve oversight of the Medicare audits and appeals process, effectively addressing the staggering Medicare appeals backlog. It will make the most fundamental changes to the appeals process since Medicare began. It will lay the groundwork for a more level playing field, reducing the burden on providers and suppliers, while giving auditors the tools necessary to better protect the Medicare Trust Fund. The AFIRM Act will address these issues in five ways. First, it will improve the audit programs by coordinating efforts between auditors and CMS to ensure that all parties receive adequate training on current policy, increasing transparency in the audit process, and requiring that CMS create new incentives to improve auditor accuracy. Second, the bill will make reforms to the Medicare appeals process to address the appeals backlog without sacrificing quality. Part of this will be done by raising the amount in controversy for review by an ALJ to match the amount for review required by a District Court. For cases with lower costs, a new Medicare Magistrate program will be created to allow senior attorneys with expertise in Medicare law and policies to decide cases in the same way as ALJs. This will allow more cases to be heard more quickly, while still providing ALJs full focus on the more complex cases. Third, the bill will allow for the use of sampling and extrapolation of Medicare claims, with the appellant's consent, to expedite the appeals process. Fourth, the bill will establish voluntary alternate dispute resolution processes for multiple pending claims with similar issues to be settled as a unit, rather than as individual appeals. This will reduce administrative costs while still providing reasonable consideration to pending claims. Finally, the bill will also require that CMS create an independent Ombudsman for Medicare Reviews and Appeals to help resolve complaints made by appellants and those considering appeal. As with any federal program, continuing oversight and good leadership are required to have any measure of success. These are thoughtful, bipartisan improvements, agreed on by the entire Finance Committee that will address the appeals backlog while still allowing us to improve program integrity going forward. I believe it is the best approach we can take to continue our efforts to recover lost taxpayer funds without creating undue burdens for health care providers and suppliers. Oftentimes in Congress we find ourselves shying away from bipartisan compromises like this. Some may feel that they have more to gain, politically, if they thumb their noses at the other party. Or, inversely, they have something to lose if they actually agree on an issue with members on the other side. Let me clearly state, for the record, that we have neither the time, nor the money to play partisan games with this issue. The average amount of time for an appeal to get processed has gone up by more than 550 percent in just 6 years. You heard me correctly--that increase is just in the time it takes to get the appeal processed, not even ruled on. If this trend continues, and absent congressional action, I think we can assume that it will continue, imagine how much more strained, expensive, and ineffective the Medicare appeals system could become. Truly, there is no time better than now to actually do our job and stem this rising tide. Before I finish I want to thank Senator Wyden for working with me on this effort and for making this a truly bipartisan endeavor. I hope all of my colleagues--on both sides of the aisle--will support the AFIRM Act.

Mr. HATCH

Mr. HATCH. Mr. President, I wish to join my friend and Finance Committee colleague, Ranking Member Wyden, in offering appreciation to a dedicated public servant, Mr. Kenneth E. Mannella, who has worked steadily for the American people at the Social Security Administration and will soon pursue activities in retirement. Ken Mannella joined the Social Security Administration in 1996 as a legislative analyst with the Office of Legislation for Congressional Affairs. Currently, he serves as an associate commissioner for the Office of Congressional Affairs. Before joining the Social Security Administration, Ken worked for 8 years for Governor William Donald Schaefer of Maryland. In Governor Schaefer's final terms, Ken Mannella was director of the Maryland National Relations Office, where he worked with Congress to obtain Federal assistance to help Maryland pursue its priorities. Prior to his work in Maryland, Ken worked for the U.S. Senate for 10 years on the staff of Senator Richard Schweiker and for Senator Charles Mathias as counsel on the Patents, Copyrights, and Trademarks Subcommittee of the Senate Judiciary Committee. You don't have a career working with the Senate and in congressional relations for as long has Ken has been at it unless you are really good at what you do. And that has been our experience with Ken; he has excelled at developing relations that facilitate useful flows of information and ideas between whom he represents and Congress. It would be hard to find anyone who would not agree that Ken is always an honest broker and always there to help if you need it. I appreciate Ken's work with Congress, and I know that my good friend Senator Wyden does as well. We wish him all the very best as he moves on to pursue what lies ahead for him and genuinely appreciate the work he has done with Congress, for the Social Security Administration, and--of most importance--for beneficiaries of the Social Security programs.

Mr. HATCH

Mr. HATCH. Mr. President, I wish to pay tribute today to Governor Olene Walker, a woman beloved in my home State of Utah and regarded across the Nation as a model of civility and selfless service. Governor Walker passed away last Saturday from causes incident to age. In her 85 years of life, she led with compassion and humility, earning the respect and admiration of everyone she served. Governor Walker's life was one of humble service, and her modest background made her rise in politics all the more impressive. Raised in rural Utah, she developed her trademark work ethic on the family farm and spent much of her childhood milking cows, hauling hay, and harvesting sugar beets. Both as a young woman working in her family's fields and as a Governor serving the people of Utah, no task was ever below Olene--she was always willing to do whatever was necessary to get the job done and to help those in need. As a State legislator, a Lieutenant Governor, and a Governor, Olene was steadfast in her commitment to help society's most vulnerable, especially small children. Her work in the area of health care reform precipitated the establishment of our State's Children Health Insurance Program, which helps provide medical insurance for Utah's underprivileged youth. After becoming Utah's first female Governor, she continued her advocacy for children by championing education reform. Governor Walker's Read With a Child Early Literacy Initiative was essential to her reform efforts. This program sought to improve childhood literacy by encouraging parents to read with their kids for at least 20 minutes every day. The initiative's focus on the family speaks to a simple truth: meaningful societal change doesn't begin in the bustling chambers of Congress but in the quiet solitude of the home, through the daily interactions between parent and child. As a former homemaker and as a mother of seven, Olene understood that healthy homes lead to a healthy society. This belief influenced many of her pro-family policies as Governor. Perhaps more than anyone I know, Governor Walker exemplified the teaching that the greatest among us is the servant of all. She often eschewed the trappings of public office and even refused to use a driver. After leaving the Governorship, Olene volunteered to serve as the primary president for her local church congregation. This humble position was a significant departure from her role as Utah's chief executive. Instead of negotiating with legislators and managing State agencies, Olene led dozens of little children in song and prayer, teaching them about the words of Christ and his early apostles. Anyone preoccupied with prestige or positions of power would surely consider this new responsibility a demotion, but Olene wasn't one of those people. She never concerned herself with titles, standing, or prominence; she cared only about serving others in whatever capacity she could. And she served until the very end. Even after retiring from office, Olene remained in the public sphere and continued to advocate for education reform. She was also active in ecclesiastical service and would eventually serve a 2-year mission in New York City for the Church of Jesus Christ of Latter-day Saints. She was equally engaged in academia and was instrumental in establishing the Olene S. Walker Institute of Politics and Public Service at Weber State University. In addition to hosting public forums, the institute helps students find jobs and internships in government and encourages women to become involved in politics. Through her trailblazing example, Governor Walker leaves a legacy of leadership that is sure to inspire generations of young Americans. With her passing, we have lost not only an exemplary stateswoman but also a loving mother and a friend. I am deeply grateful for my association with Olene Walker. I consider myself lucky to have known Olene and even luckier to have served alongside her. Elaine and I send our deepest condolences to the Walker family. May God comfort them, and may He comfort all of us as we mourn the loss of an exceptional woman.

Mr. HATCH

Mr. HATCH. Mr. President, I ask unanimous consent that I be allowed to finish my remarks.

Mr. HATCH. Mr. President, this week marks another milestone in the long, sordid history of the so-called Affordable Care Act. It has been roughly 5\1/2\ years since this law, cobbled together with spit and baling wire, went into effect. In a few weeks, we will reach the 6-year anniversary of the initial Senate passage of the legislation that would eventually become ObamaCare. Many of us remember those days well because we were here when it happened. Others who were here back then are no longer serving in Congress, and, in many cases, as a direct result of how they voted at the time. Still, for those of us who remain, I expect that this week--as we debate and hope to pass legislation to repeal the most harmful elements of ObamaCare--will bring back a flood of memories. It already has for me. We all remember the absurd promises that were made by the President and his allies to try to win over the American public: If you like your health insurance, you can keep it; the bill will bring health care costs down; only rich people and evil corporations will see their taxes go up--and so on and so forth. We all remember the deals cut behind closed doors to bring reluctant Democratic Senators on board. A number of those deals ended being so notorious that they even got nicknames: the ``Cornhusker kickback,'' the ``Louisiana purchase,'' the ``Bay State boondoggle,'' and ``Gatorade.'' We all remember a sitting Speaker of the House arguing with a straight face that Congress would have to pass the health care law before the American people could know what was in it. More than anything, we all remember a Senate majority--a super majority, as some called it at the time--that was so committed to giving their President a political win that they forced a massive, poorly drafted bill through the Senate without a single Republican vote. They didn't need any Republican votes to pass it, and they sure weren't looking for any. Instead, they threw together a massive overhaul of a huge portion of the U.S. economy and forced it on the American people on a strictly partisan basis--not only here but also in the House. I will tell you something else that I personally remember from that time. I remember sitting here on the floor shortly before the final cloture vote during the Senate's consideration of the bill and listening to our distinguished majority leader, who was at the time the minority leader. It was December 21, 2009. It was late, nearly 1 o'clock in the morning, and the good Senator stood up and offered some dire warnings for those who supported the bill. After detailing many of the problems the bill would cause--predictions that have all come true, by the way--Senator McConnell said: I understand the pressure our friends on the other side are feeling, and I don't doubt for a moment their sincerity. But my message tonight is this: The impact of this vote will long outlive this one frantic snowy weekend in Washington. Mark my words: This legislation will reshape our Nation. . . . And he was right. That legislation--now a law--has in many ways reshaped our Nation, including some ways that I am not even sure Senator McConnell could have predicted that night. Yes, it has had a disastrous impact on our health care system. I will have more to say about that in a moment. But, in my view, it has also eroded the public's confidence in our institutions and undermined the ability of our government to function well. By passing this law-- forcing it through Congress on a purely partisan basis--its proponents sent a clear message that partisanship trumped good judgment and the will of the voters. After running a masterful election campaign, President Obama came into office in 2009 riding a wave of goodwill and promises to usher in an era of ``post-partisanship''--whatever that was supposed to mean-- and allow us to transcend ideology to focus on good government and pragmatic solutions. Yet his biggest campaign promise, the top priority of his first term and his signature domestic achievement, ObamaCare, was the result of the largest exercise in naked partisanship in our Nation's history. By any estimation, the debate and passage of ObamaCare deepened our Nation's partisan divide and drove more voters--on both ends of the spectrum--into deeper and more entrenched partisan and ideological positions. It made people more cynical and less trusting of our government and its leaders. It gave additional credence to the perception that politics and governing in America are more about tribalism and conflict than about providing real solutions to the problems plaguing our citizens. Can anyone seriously argue that our Nation is less partisan or less divided now than it was prior to the passage of ObamaCare? I would like to see anyone try to make that claim with a straight face. Sadly, that is not all. The damage wrought by ObamaCare extends well beyond our Nation's political discourse and into our governing institutions themselves. Most notably, we have had an administration so committed to ObamaCare that it has, on numerous occasions, exceeded its constitutional authority in order to preserve it. The examples of overreach and abuse of power have been well documented. The Obama administration has unilaterally moved deadlines set by the statute that they found to be inconvenient. They have rewritten provisions in the law to give favors and carve-outs to political supporters. They have selectively enforced other provisions in order to give more teeth to their regulations. And that is just the tip of the iceberg. Make no mistake. President Obama's penchant for Executive overreach extends well beyond the implementation of the Affordable Care Act. But clearly, many of the most egregious examples of abuse on the part of this administration were undertaken to preserve a poorly constructed health system that simply could not work the way the law was drafted. Simply put, ObamaCare has led directly to a weakening of our constitutional order and an erosion of the separation of powers. Given all of these negative consequences, the question ultimately becomes this: Has it been worth it? Don't get me wrong. In my opinion, all these terrible aftereffects would, by themselves, be enough justification to undo what was done in this Chamber nearly 6 years ago. Still, if the law was working--if it was having a positive overall impact on our health care system-- proponents might have something to hang their hat on when it comes to this law. Indeed, if the American people now had better, more affordable health care, supporters of ObamaCare could at least try to argue that all of these other problems have been in service of some noble cause. Of course, we know the law is not working. The American people do not have better, more affordable health care under ObamaCare. Instead, the parade of horribles that began the day the law was enacted has extended beyond our politics, beyond our institutions, and into the lives and livelihoods of everyday Americans. The system created by the Affordable Care Act--so-called Affordable Care Act--was based largely on the premise that the government could impose drastic new regulations on the individual health insurance market without dramatically increasing the cost of insurance because younger, healthier consumers would be drawn into the market, bringing down costs for everyone else. This claim was obviously fiction. Republicans argued at the time that without serious effort to reduce costs overall, this prized demographic group would stay out of the market, and premiums would skyrocket due to the various mandates and regulations. We now know that we were right. Younger and healthier patients are, by the millions, choosing to forego health insurance and pay fines rather than enter into the individual insurance market. According to most surveys, many of these individuals are choosing to go uninsured because, even with the benefit of ObamaCare premium subsidies, they cannot afford the cost of insurance. As a result, premiums are going up all over the country. Premium spikes in the double digits have been increasingly common in the current enrollment period. My own home State of Utah has seen premiums go up in this enrollment period by an average 22 percent, which will undoubtedly wreak havoc on family budgets and local businesses. Other States have it even worse, with premiums spiking as much as 25 percent, 30 percent or, in the case of a State such as South Dakota, 63 percent. Even with increased premiums, insurers are having a harder time doing business in a number of markets, leading providers to exit the various exchanges where patients buy insurance with the aid of ObamaCare subsidies. Just a few weeks ago, in fact, we saw reports that the largest health insurance company in the Nation--UnitedHealth Group--was considering withdrawing from the exchanges entirely. The result will inevitably mean fewer insurers, which means fewer choices and even higher premiums for consumers. It is no wonder, therefore, that next year's enrollment estimates for the exchanges are down dramatically. And, as enrollment drops, all of this--the costs, the reduced options, and the overall state of care--will get even worse in the individual health insurance market. This downward spiral is all the more maddening when we consider that the President promised the American people that his law would actually reduce the cost of health insurance in the United States. I am not done yet. There are other problems worth discussing here today. There is, for example, ObamaCare's massive Medicaid expansion. In virtually every case, when the proponents of ObamaCare cite numbers of newly insured individuals under the law, most of the increase can be attributed to the Medicaid expansion. Let's be clear. Medicaid is one of the most poorly constructed programs in all of government. It is extremely costly at the Federal level and even more so at the State level, where it is not uncommon for the program to take up as much as one-fourth to one-third of a State's financial resources. Even with all that cost, it is, in terms of available providers and services, one of the worst, if not the worst health insurance options in the country. Some of us in Congress have been working for years to reform the structure of the Medicaid Program in order to reduce costs, improve the program, and preserve it for those who are in need. The Affordable Care Act did not fix these problems; it made them worse. Under ObamaCare, Medicaid is more expensive to taxpayers and an even larger burden on the States. With dramatically increased enrollment, Medicaid reform is likely to be even more difficult in the future. Why anyone would brag about adding enrollees to an insolvent government health program that provides the lowest standard of service in the country with the fewest provider options is beyond me. I suppose those tasked with claiming ObamaCare is a success have to cite positive figures wherever they can dig them up. The Affordable Care Act also increased taxes dramatically. It raised taxes on drug companies and medical device manufacturers, which have been passed directly to middle-income and lower income consumers because that is what happens when you increase taxes on businesses that produce goods and services. It includes a tax on the so-called Cadillac insurance plans, which proponents claim would only impact rich employees of very large corporations. Of course, the tax was structured in a way that guarantees that in the not too distant future, millions of middle-class Americans will be hit by the tax and see their insurance costs go up even further. All told, there have been about $1 trillion in new taxes under ObamaCare. While the President and his allies may claim these taxes hold the middle class harmless, the facts tell a different story. That story, of course, isn't just now coming to light. Many of us on the Republican side have been talking about these issues from the very beginning. I can go on and on. For example, the Affordable Care Act, with its various mandates, also increased costs to employers around the country, resulting in fewer new hires and reduced opportunities for many existing employees. Many small businesses now choose not to expand in order to avoid reaching the number of employees that will trigger new requirements. At the same time, because the law perversely defines a full-time employee as one working a minimum of 30 hours, other companies are avoiding the triggers by cutting back on workers' hours. All of these developments--every single one of them--were predicted way back in 2009 when the law was being debated. The President told us we were wrong. His supporters in Congress did the same. They ignored the obvious warnings, and now the American people, as well as small businesses and job creators, are paying the price. These issues and many others are why Republicans have spent more than 5 years fighting against ObamaCare. We have introduced bills to repeal the whole law, others to repeal just the most harmful elements. I personally have introduced bills to repeal the individual mandate, the employer mandate, and the medical device tax. On the Senate Finance Committee, we have conducted rigorous oversight on numerous aspects of the law and the implementation of various programs. Other committees have done the same within their jurisdictions. Virtually all of us have supported efforts to challenge elements of the law in court. While we have differed on tactics from time to time, Republicans have been united in our desire to repeal and replace this misguided attempt at health care reform. Some of us have even come up with specific ideas on how to replace ObamaCare. For example, earlier this year, Senator Burr, Chairman Fred Upton from the House, and I released the latest draft of the Patient CARE Act, a legislative proposal that would fix many of the things the authors of ObamaCare got horribly wrong. Most notably, as a number of health care experts have concluded, our proposal would actually reduce health care costs. As we all know, rising costs are the single biggest problem plaguing our health care system. Yet the President's health law did virtually nothing to address this issue. Unlike the poorly named Affordable Care Act, the Patient CARE Act would actually make health care more affordable throughout the United States. At the beginning of this year, Republicans assumed the majority in the Senate, having committed--even promised in some cases--to work to repeal this so-called Affordable Care Act. This week, with the bill now before us, we will take a major step toward delivering on those promises. The legislation we are now debating would send the broadest possible ObamaCare repeal to the President's desk. As the chairman of the Senate Finance Committee, I am pleased to have joined with my colleagues--the distinguished chairman of the Budget and HELP Committees, as well as the Senate Republican leadership--to lead this latest fight against ObamaCare. This bill would repeal many of the worst parts of ObamaCare. Among other things, it would repeal the individual mandate, the employer mandate, the medical device tax, and the Cadillac tax. All of these different parts of ObamaCare have contributed in one way or another to the long, slow death march we have witnessed over the past 5 years. All of them would be dealt with under this legislation. The legislation would address another contentious debate: the one dealing with Planned Parenthood. The debate over Planned Parenthood has perplexed Congress and divided our country for years as many people have expressed ever more opposition to providing such a controversial organization--and I am being generous with that label--with taxpayer funds. As we all know, this debate reached a boiling point earlier this year. The reconciliation package before us would prohibit Federal payments to Planned Parenthood and direct more funds to the Federal community health center program, putting an end to the Federal Government's entanglements with Planned Parenthood while alleviating legitimate concerns about funding for women's health. This is yet another reason to support this legislation. As I said, the debate we are having this week is an important milestone in the history of ObamaCare, maybe even the most important milestone yet. But we need to be realistic. While this bill is an important step, it stands no real chance of becoming law. For that to happen, we are going to have to see even more changes. But that doesn't mean our efforts here are for nothing. This bill may not result in new law, but it will give the American people a fresh accounting of where each of us stands when it comes to ObamaCare. It is funny, Republicans have taken some flack--not a lot but some-- for referring to the Affordable Care Act as ``ObamaCare'' or ``the President's health care law.'' The President, for his part, hasn't shied away from these labels, but I have read a few pundits who think these terms are specifically intended to undermine the legitimacy of a statute duly passed by Congress. In some respects, I suppose that might be true. After all, even though we constantly refer to the law as ``ObamaCare,'' it is not as though President Obama passed it himself. He was aided and abetted by his allies in Congress. While it may be useful shorthand to attach the President's name to it, I don't think the American people have forgotten the others who helped bring this terrible law to pass. President Obama will forever own the Affordable Care Act, that is for sure. People will likely always refer to it as ``ObamaCare.'' But those in Congress who drafted and voted for the law will own it too. When President Obama vetoes this legislation, as we all expect he will, he will take ownership of the Affordable Care Act--not that he hasn't in the past--along with its many failures and gross inadequacies all over again. I think the same can be said for any of our colleagues who vote against repealing the worst elements of the law this week. I hope my colleagues on the other side of the aisle will think about that as this debate moves forward and that they will consider voting with us to send this repeal to the President's desk. I think it would be a very wise move on their part. This isn't going away even if the President does veto this bill. I hope he doesn't, but if he intends to do it, it would be a breath of fresh air for our colleagues on the other side of the aisle to help us to have a veto-proof majority to tell the President once and for all that this bill is not what we want in America. Mr. President, I yield the floor.

Mr. HATCH

Mr. HATCH. Mr. President, I ask unanimous consent that I be permitted to complete my remarks.

Mr. HATCH

Mr. HATCH. Mr. President, last week families across the Nation gathered in gratitude to celebrate Thanksgiving--the holiday we commemorate in remembrance of our Pilgrim ancestors. With humble appreciation, we venerate the sacrifice of America's early settlers. We remember their fortitude in leaving family and home to colonize a new wilderness. Facing disease, starvation, and even death, these brave men and women endured tremendous hardships to secure the blessings of religious liberty. Freedom of religion--so precious and so prized by our Pilgrim forebears--is the legacy we enjoy as a result of their sacrifice. Today, I wish to honor the Pilgrims' legacy by speaking once again on the topic of religious liberty. Over the past several weeks, I have addressed this subject at length. In so doing, I have explained the critical importance of religious freedom and its centrality to our Nation's founding. I have also debunked the erroneous notion that religious liberty is primarily a private matter that has little place in the public domain. More recently, I have detailed the many ways freedom of conscience is under attack--both at home and abroad. You might wonder why I devote so much time and attention to this vital subject. After all, this is the seventh in a series of speeches I have given on the topic of religious liberty. When there are myriad other issues facing our country, why do I feel so compelled to speak out about religious freedom? Because, Mr. President, no other freedom is so essential to human flourishing and to the future of our Nation. Indeed, religion is not only beneficial to society but also indispensable to democracy. I begin by discussing the most tangible benefits religion brings to society. History provides many examples. Indeed, many of our Nation's most significant moral and political achievements are grounded in religious teachings and influences. First, consider the role of religion in the formation of our most basic rights. America's Framers were well versed in both religion and philosophy, and in drafting our Founding documents, they drew inspiration from both sources. Take for example, the unalienable rights identified in the Declaration of Independence: life, liberty and the pursuit of happiness. These rights are a synthesis of both religious and philosophic teachings. The rights themselves stem from the theories of the philosopher John Locke, but the concept of inalienability--the idea that these rights are inviolable because they are ``endowed [to men] by their Creator''--is religious in nature. By invoking the divine and linking our rights to a moral authority that lies above and beyond the state, America's Founders insulated our freedoms from government abuse. Philosophy helped articulate our fundamental rights, but religion made them unassailable. Thanks to the moral grounding provided by religion, we exercise these rights free of state control. In addition to undergirding the establishment of our God-given rights, religion directly benefitted American society by catalyzing the two greatest social movements in our Nation's history: abolition and civil rights. Abolition traces its roots to the Second Great Awakening, when preachers such as Charles Grandison Finney and Lyman Beecher rose to prominence with their revivalist teachings on social justice and equality. Many of the earliest pro-abolition organizations coalesced around Christian evangelical communities in the North. Emancipation was a religious cause first and a political movement second. Most abolitionists were deeply religious themselves, including two of the movement's most vocal leaders, William Lloyd Garrison and John Greenleaf Whittier. The Christian doctrine of moral equality was especially crucial in generating the grassroots support that eventually made emancipation possible. Religion was equally influential in guiding the civil rights movement. We speak today of Dr. Martin Luther King, but we sometimes forget that before he was a doctor he was a reverend. In 1967, the year before his death, Reverend King proclaimed: Before I was a civil rights leader, I was a preacher of the Gospel. This was my first calling and it still remains my greatest commitment. . . . [A]ll that I do in civil rights I do because I consider it a part of my ministry. Reverend King recruited other religious leaders to his cause when he convened a meeting of more than 60 black ministers in what would eventually become the Southern Christian Leadership Conference. This coalition of evangelical leaders was instrumental in organizing both the Birmingham campaign and the March on Washington. For these ministers and many other men and women who participated in the civil rights movement, religion provided the initial impetus for their advocacy. Today, religion continues to benefit society by contributing to our Nation's robust philanthropic sector. The importance of charity and helping the poor is nearly universal across all faiths. Every year, religious organizations throughout the United States feed the hungry, clothe the naked, give shelter to the homeless, and care for the sick and afflicted. Without these religious groups, our government welfare system would be overwhelmed. Charitable organizations are irreplaceable because they often step in where the state cannot. Consider some of the largest, most well- respected religious charities in operation today, such as the Salvation Army, Catholic Charities, World Vision, or LDS Humanitarian Services. These organizations are motivated by more than a mere humanitarian impulse; they are driven by a sense of duty both to God and to man. Every year, they lift millions from despair, offering not only material assistance but also spiritual direction to help individuals lead more prosperous lives. This is a critical service that no government program could ever provide. It is clear that religion has benefitted our society in several meaningful ways. First, as a result of religious teachings, we have unfettered claim to the natural rights delineated in our Nation's founding documents. Second, thanks to religious leaders from John Rankin to Martin Luther King, we freely exercise civil rights today that were once denied millions of Americans. Third, by virtue of religious teaching on charity, we have a humanitarian sector that is unparalleled in its ability to respond to crisis, bless the poor, and lift the needy. But my purpose in speaking today is not merely to recite a list of blessings brought about by religious liberty. Religion is not simply beneficial to society; it is an indispensable feature of any free government. Without religion, liberty itself would be in danger and democracy would devolve into despotism. The nexus between religion and democracy involves the relationship between morality and freedom. Freedom is a double-edged sword; it can be used for good or for evil. Statesmen may use freedom to defend justice, but tyrants can abuse it for their own corrupt ends. Morality is necessary to ensure that individuals exercise their freedom responsibly. Religion provides free individuals with the moral education necessary to exercise freedom responsibly. It instills the very virtues that lead to an engaged citizenry, including a concern for others, the ability to discern between right and wrong, and the capacity to look beyond the mere pursuit of present pleasures to the good of society. President George Washington identified the link between morality and religion. According to Washington, ``Reason and experience both forbid us to expect that national morality can prevail in exclusion of religious principle.'' For Washington, morality presupposed religion, and both virtues cultivated a healthy society. Perhaps this why he said that ``[o]f all the dispositions and habits which lead to political prosperity, religion and morality are indispensable supports.'' That was George Washington. John Adams was of the same mind. He argued that without religion and morality, our government could not stand because, ``[a]varice, ambition, revenge and gallantry would break the strongest cords of our Constitution, as a whale goes through a net''; hence, his most famous observation that the Constitution ``was made only for a moral and religious people.'' For Washington, Adams, and many others who helped to establish our constitutional system of self-government, religion, morality, freedom, and democracy are necessarily interlinked. Without the moral sensibilities that religion that can provide, freedom is all too easily corrupted, endangering the very foundation of democracy. Our Founding Fathers were not alone in calling attention to the inextricable connection between religion and a healthy democracy. The renowned political philosopher Alexis de Tocqueville offered his own analysis on the subject. After spending several months observing American Government and society, Tocqueville wrote his famed ``Democracy in America'' in an attempt to explain American political culture to his French counterparts. When Tocqueville published his work in the early 19th century, the United States was a burgeoning democracy and unique as one of the only countries in the world that guaranteed religious liberties to its citizens. At this intersection of democracy and religion, Tocqueville made his most compelling observations. Like Washington and Adams, Tocqueville believed that religion was essential to the success of the American political experiment. Without the moral strictures of religion, the Nation's democracy would collapse on itself. In Tocqueville's own words: Despotism may be able to do without faith, but freedom cannot. . . . How could society escape destruction if, when political ties are relaxed, moral ties are not tightened? And what can be done with a people master of itself if it is not subject to God? In other words, Tocqueville asked how the experiment of self- government could succeed if individuals refused to submit to any moral authority beyond themselves. By posing this question, Tocqueville argued that democracy needs religion and morality to ensure that citizens exercise their freedom responsibly. Democracy needs religion to help refine the people's moral responsibility and instill the virtues of good citizenship that make democracy possible in the first place. Tocqueville also taught that democracy needs religion to temper the materialistic impulses of a free-market society. By setting our hopes and desires beyond imminent, temporal concerns and turning our hearts instead toward those in need, religion engenders charitable behavior and saves democracy from its own excesses. In Tocqueville's view, the free exercise of religion is not just a condition of liberal society; it is a precondition for a healthy democracy. Without religion and the moral instruction it provides, freedom falters, and democracy all too easily dissolves into tyranny. In this regard, religion is not merely a boon to democracy, but a bulwark against despotism. Laws alone are incapable of instilling order and regulating moral behavior across society. As LDS Apostle Dallin H. Oaks has observed, ``Our society is not held together just by law and its enforcement, but most importantly by voluntary obedience to the unenforceable and by widespread adherence to unwritten norms of right . . . behavior.'' Of course, religion and a basic sense of morality help induce such voluntary obedience to the unenforceable that Elder Oaks describes. George Washington conceded that individuals may find morality without religion, but political society needs the spiritual grounding that only religion can provide. In this regard, religion complements law in cultivating a moral citizenry. Both law and religion are necessary to engender good citizenship. As the influence of religion diminishes, governments must enact more laws to fill the void to maintain a moral citizenry. So the consequences of less religious activity are not greater human freedom but greater state control. Religion, then, acts as a check on state power. It cultivates morality so governments don't have to through the cold, impersonal machinery of law. By acting as a shield against state overreach, religion is a friend to both democracy and freedom. Expanding religious freedom empowers democracy, but limiting religious freedom weakens our democratic institutions. In the most extreme case, eliminating religious freedom altogether results in tyranny and human suffering on a massive scale. Consider the catastrophic state of affairs in countries that have explicitly outlawed religion. The Soviet Union, Communist China under Mao, the Khmer Rouge in Cambodia, and North Korea are prominent examples. In each of these countries, leaders committed unspeakable atrocities to enforce their own godless morality. In the absence of faith, there was no religious horizon to keep political ambitions within limits. Unencumbered by the moral restraint of religion, dictators systematically killed millions of their own people to establish their own secular vision of Heaven on Earth. These illustrations of totalitarianism, torture, and genocide demonstrate that a society without religion is a society without freedom. I raise these grievous examples to reiterate my initial point: Religion is central to human prosperity. Society needs religion to keep political ambitions in check, and democracy needs religion to maintain morality so that freedom can flourish. I had the privilege of serving for 2 years in three States--Ohio, Indiana, and Michigan--as a missionary for the Church of Jesus Christ of Latter-day Saints. We served without pay, without compensation. I lived on $55 to $65 a month, and I traveled all over those three States, helping other missionaries be able to teach the Gospel of Jesus Christ. I am glad I had the freedom to be able to serve that mission in three States in this beautiful, wonderful country, where religious freedom is a revered right and a heralded concept. Those 2 years were the most important years of my life because they led to a wonderful marriage with Elaine, 6 children, 23 grandchildren, and 16 great grandchildren, and those are all I know about at this time. I have to say that they led to a better life in every way, even though my life has been hard. I was raised in Pittsburgh, PA. My father was a building tradesman. Sometimes there wasn't work. We lost our home shortly after my birth. It was a little band-box frame home in Homestead Park, PA. My dad borrowed $100 to purchase an acre and then tore down a burned-out building to build us a home that was black on three sides, and the fourth side had a Meadow Gold Dairy sign that he had apparently torn down and put up just exactly the way it was. We didn't have indoor facilities. It was an acre of ground, and we raised quite a bit of our food. We actually raised chickens. I was in charge of the chickens, taking care of the chicken coop, feeding them, cleaning up after them, collecting the eggs every day, selling the eggs, and delivering the eggs, from 6 years old on. I am glad I had that experience. I am glad that my family went to church and was religious. The Mormon Church at that time in Pittsburgh was very small, but the people were all patriotic and loved America. Why did they? Many of them were from other countries. They loved America because they were free. I didn't know any better, but I knew I was free, and that was important--not just to me but to my parents and to many others as well. Elaine and I are so grateful that we have been able to raise our six children, all of whom are married now, all of whom have children, and many of whom have our great-grandchildren. The thing that tied us together more than anything else was religion in this freest of all nations. I am so grateful for this country. I am so grateful for the freedoms that we all take for granted. I am so grateful for my parents, who were just humble people, neither of whom had received any education beyond the eighth grade, but both were brilliant in his or her own way. The thing they taught us was religion and doing good to our fellow men and women. I am so grateful for this great country. I am so grateful for all of the many blessings we have from religious freedom, and I don't want to see us lose that in the realm of political correctness. In closing, I urge all of my colleagues to consider the state of religious liberty in the United States today. Only by strengthening this fundamental freedom can we secure the future of our own democracy and keep the rest of our freedoms alive and viable. I suggest the absence of a quorum.

Mr. HATCH

Mr. HATCH. Madam President, throughout my time as ranking member and now chairman of the Senate Finance Committee, finding money for surface transportation infrastructure has been a persistent and seemingly intractable problem. Even as we went into this year with a new Republican majority in the Senate, none of us could have imagined that we could find a way to provide 5 years of solvency and stability for the highway trust fund. Yet, with today's announcement of the completed conference report, that is precisely where we are right now. The conference report for the Fixing America's Surface Transportation Act will hopefully be enacted within a few days' time. As the very first member of the conference committee to sign the report, I want to briefly talk about the process by which the legislation came about and how we got to where we are now. Immediately before the Memorial Day recess, there was an unsuccessful attempt to put together a package to possibly get the highway trust fund through the rest of 2016. The agonizing difficulty we faced at that time in dragging ourselves through another 18 months gave us a desire to think bigger than we had before. This is why I was determined to help find a way out of the cycle of short-term infrastructure bills and why I believed it was necessary for us to think outside of the proverbial box and look everywhere for potential offsets. Generally, the Finance Committee is responsible for the financing title of any highway bill that goes through the Senate. Usually, we do our best to work within our committee's jurisdiction to identify offsets. However, because those resources have been quickly drying up, we had to look elsewhere for this package. After the committee spent weeks examining numerous options and alternatives, I was able to present our distinguished majority leader with a list of offsets that, while not necessarily ideal, would allow us to put together a long-term highway bill without raising taxes or increasing the deficit. I am very pleased with the work we were able to do there as that list of offsets formed the basis of the funding for the long-term deal we will likely be voting on in short order. As we continued on, by the end of July, the Senate had managed to pass a bipartisan infrastructure bill with 3 years of solvency, funding, and certainty for the highway trust fund. Though we were required to enact another short-term extension before the August recess, momentum had begun to build in both Chambers for a long-term highway bill. Common practice on highways over the past few years has been to enact short-term extensions and then go and complain about the dysfunction in Congress before moving on to the next order of business. The offset package produced by the Senate showed that we could do things differently and, for the first time in almost two decades, a long-term transportation bill was actually possible. After the August recess, the House began working off of the Senate bill as a template for their own legislation. After they passed a remarkably similar bill in November, the conference committee came together to produce the legislation announced today. While I am not one who likes to count chickens before they have been hatched--no pun intended--I am optimistic that the bill will pass with a strong bipartisan vote. Putting these offsets for this long-term bill together has truly been a group effort. As I mentioned, we searched far and wide for offsets that required a number of chairmen and committees to work together. I commend my colleagues for their efforts and their willingness to do so and their willingness to do what it took to make the endeavor successful. I especially want to thank Senator Thune and the commerce committee, who assisted these efforts by providing for the transfer of certain motor vehicle safety penalties to the highway trust fund. I also appreciate the work done by the House Financial Services Committee and Congressman Randy Neugebauer, chairman of the Subcommittee on Financial Institutions and Consumer Credit. He was able to identify a new and important offset for the infrastructure bill, a feat which few have been capable of. While, as is often the case around here, some are very quick to throw out criticisms of individual offsets and were less willing to offer suggestions for suitable alternatives, Congressman Neugebauer, in response to concerns about an item in the original offset package, came forward to produce a viable and scorable alternative that was able to garner bipartisan support and ultimately broaden the overall support for this long-term deal. Back in July, when the Senate first proposed a long-term bill, many said we couldn't do it without raising taxes. When we passed our first bill, these same people claimed that it stood no chance of passage in the House. Now, just a few months later, both Chambers are a few days away from considering the conference report built upon the foundation laid by that same Senate bill. This legislation provides a longer extension than the vaunted SAFETEA-LU extension, which many had long viewed as a model for a multiyear highway bill. In fact, you would need to go back at least to the late 1990s--actually, to the early 1990s--to find a highway reauthorization of comparable duration. As I said, this major bicameral success was unthinkable a few months ago. While I do acknowledge that we still face the problem of outlays from the highway trust fund outpacing the dedicated revenues, this bill will give us a much needed 5-year break from the deadlines and cliffs that all too often dictate how we deal with the highway trust fund. It is, quite simply, a great example of what we can do when we work together. I would like to briefly note that these types of victories for good government have been piling up all year under the current Senate majority. We do need to start thinking now about more permanent solutions on highways, but once we pass this bill, we will be in a better position than at any time in nearly two decades to do so. That, as they say, is nothing to sneeze at. Before I conclude, I wish to pay tribute to Chairman Inhofe, Chairman Shuster, and Barbara Boxer and her Democratic counterpart in the House, who led a conference committee that was able to sift through various issues and put together a very complex piece of legislation in a matter of just a few weeks. These two chairmen deserve a lot of credit for their efforts, as do all the Members who took part in the conference. Today Congress is making headway to implementing the longest highway reauthorization bill in more than 15 years. We have heard time and again that a long-term highway bill would only be possible if we included a big tax increase. Yet we have been able to defy the odds and provide much needed funding for America's bridges, highways, and roads for the next 5 years. This marks a watershed moment for our transportation community, which will now have the security and stability they need to plan, implement, and complete critical infrastructure projects. Of course, while we have crossed a major hurdle today, our job is not yet over. There is still one more vote to go, and I am confident we will get there. I look forward to continuing to work with my colleagues on both sides of the aisle to complete our work and ensure that a strong multiyear highway bill is signed into law this year. I look forward to working with all of my colleagues for whatever challenges lie ahead. With that, I yield the floor.

Mr. HATCH

Mr. HATCH. Madam President, I ask unanimous consent that I be permitted to finish my remarks.

Mr. HATCH

Mr. HATCH. Madam President, I rise to speak on Puerto Rico's financial and economic challenges. The Government of Puerto Rico tells us the territory has more than $73 billion in debt that is, to use their words, ``not payable.'' On top of that, Puerto Rico has tens of billions of dollars in unfunded pension liabilities and very few assets to back up its pension promises. The economy in Puerto Rico has persistently registered double-digit unemployment rates, staggeringly low labor force participation rates and a bloated public sector and there are growing strains on Puerto Rico's health care system, some of which reflected the way the so-called Affordable Care Act was written to treat Puerto Rico and other territories, some of which reflects differing treatment between Puerto Rico, where residents do not pay Federal personal income taxes, and States where residents are included in the Federal personal income tax system. In short, there is very little good economic news coming from Puerto Rico these days. As a result, we are seeing an ongoing debate about what the Federal Government can or should do in order to help the American citizens residing in Puerto Rico. To me, this debate boils down to four relatively simple questions: Question No. 1, should the Federal Government allow Puerto Rico access to chapter 9 of the Bankruptcy Code or to even broader debt resolution tools; question No. 2, will providing fresh tax incentives to Puerto Rico help boost the island's economy by creating jobs and stimulating growth; question No. 3, should Congress increase Federal resources to help ease Puerto Rico's strained health care system; and question No. 4, should we take steps to exempt Puerto Rico from burdensome Federal regulations--including labor, transportation, and energy regulations-- that may be contributing to the territory's ongoing economic struggles? Today we have seen a number of proposals that attempt to address these and other questions, although, in my opinion, many of them do so in very awkward ways. I want to take time today to address each of these four major questions in turn and hopefully shed some light on what we have to consider as we try to address the growing crisis in Puerto Rico. So far, the majority of these discussions among policymakers with regard to Puerto Rico have focused on question No. 1, allowing access to chapter 9 bankruptcy relief. As we all know, chapter 9 applies specifically to financially distressed municipalities that are seeking protection from creditors as they develop and negotiate plans to adjust their debts. Puerto Rico is not currently eligible for chapter 9 bankruptcy, meaning that granting them access to this type of relief will require a legislative change to the Bankruptcy Code, which may come with its own set of problems. Some proponents of the bankruptcy solutions for Puerto Rico have argued that the clear language preventing the island from accessing chapter 9 reflects some sort of drafting error. They argue further that once Puerto Rico is eligible for chapter 9 protections, it should apply to debts already incurred. Now, whether the exclusion for Puerto Rico from chapter 9 was intentional--and I don't believe it was--we should keep in mind that there are potential rule-of-law issues at stake when we talk about legislative action to retroactively alter the terms of debt contracts. Puerto Rico's creditors entered into their contracts with the various existing risks priced into the agreements in the form of interest rates and other terms. If the island had been eligible for chapter 9 bankruptcy prior to entering into those agreements, creditors would have formed different expectations, likely leading to different terms, including differing interest rates that could have reshaped the demand for Puerto Rico bonds. This is not rocket science. This is finance 101. We should be cautious about any legislative action that would alter the terms of existing contracts. At the very least, we should consider what impact extending chapter 9 to existing Puerto Rico obligations would have on credit transactions moving forward, given that parties set credit agreements based upon the laws they expect to apply. If parties believe there is a real possibility that Congress might retroactively change those laws in the future, they are likely to seek different terms or reevaluate a contract's potential worth. Even so, it is not at all clear that our amending chapter 9 to allow access for Puerto Rico will solve the debt problems of Puerto Rico. Officials from the Obama administration have argued that chapter 9 would only cover about 30 percent of Puerto Rico's outstanding obligations and, as a result, even broader debt restructuring authority is necessary. Therefore, those in Congress with proposed solutions that center only on chapter 9 bankruptcy are apparently not aware of the administration's position. However, the other nonbankruptcy proposals we have seen--which would allow Puerto Rico to handle its debt on its own--are also lacking. For example, we have seen proposals to allow the Federal Reserve to purchase debt issued by Puerto Rico and to authorize the Treasury to guarantee bonds issued by the Government of Puerto Rico or any of its instrumentalities. Of course, this approach would run the risk of setting very bad precedents for future insolvent entities and is fraught with moral hazard. Ultimately, those pushing to restructure Puerto Rico's debt as the sole solution tend to want to simply blame the problems on the creditors, using loose terms like ``hedge funds'' or ``vulture funds.'' For these people, punishing the creditors is their desired focus, not because it is a viable solution but because, at the end of the day, an opportunity for populist rhetoric is itself a valuable commodity heading into a contentious election cycle. While that approach may help some around here appeal to their political base, it does precious little to help the people of Puerto Rico and ignores the fact that a number of the creditors are middle- class investors and retirees from virtually every U.S. State and territory--from Utah to New York, to Puerto Rico itself. Ultimately, whatever case can be made for restructuring authority for Puerto Rico's debt, there may not be an urgent need for that authority to be granted right away. This is evidenced by the fact that despite several months of debate surrounding the issues, Puerto Rico has only recently begun negotiating with some of its creditors. I would hope that if the need for relief is in fact dire, the Government of Puerto Rico will waste no time in negotiating and working toward private solutions. If there is no urgency on that front, it would be hard to argue that there is an urgent need for Congress to consider proposals relating to chapter 9 bankruptcy or broader restructuring authority. That is question No. 1. Let's talk about question No. 2, which deals with tax incentives to boost Puerto Rico's economy. On the tax front we have seen proposals in Congress to allow residents in Puerto Rico to claim the earned-income tax credit and the refundable portion of the child tax credit on the same basis as other U.S. taxpayers. Likewise, the Obama administration has indicated support for a similar approach, although they have not provided any real details as to what their proposal would look like. Proposals such as these are problematic for a number of reasons. As I mentioned, the residents of Puerto Rico are exempt from the Federal personal income tax system, meaning that they do not pay any personal Federal income tax. Therefore, offering these refundable tax credits would not reduce their tax burden because you can't reduce a tax burden that is already zero. In other words, these tax credits would ultimately be cash payments offered directly to lower income residents of Puerto Rico. On top of that, the earned-income tax credit and the child tax credit are already rife with fraud and overpayments when they are offered to taxpayers who are required to file a return and can at least theoretically incur a tax burden at some future date if their income goes up. Extending these same credits to Puerto Rico could very well introduce a number of threats to the integrity and administration of our tax system. Those who issue these types of proposals rarely have a solution to these inherent concerns. Moreover, we haven't seen any public information from congressional scorekeepers as to how much these proposals would cost. I also haven't heard any proponents of this approach offer so much as a hint about how they would plan to offset the costs or if they intend to offer any offset at all. Long story short, most of the tax-related proposals to the Puerto Rico situation leave much to be desired. That is not to say we should not do anything in this area. There are quite likely tax incentives we could offer to better incentivize growth and labor force participation and perhaps investment in the Puerto Rican economy. I think it would be safe to say Republicans would be open to such a discussion. But to date, I haven't seen anything that resembles a serious solution that focuses on the Tax Code. This brings us to question No. 3, dealing with health care policy, which has been the primary focus of a number of our colleagues when it comes to these issues. Here in Congress, we have seen some poorly constructed proposals that, when boiled down to their essence, would allocate more than $30 billion from the general fund directly to Puerto Rico. Of course, that is not how the proponents describe their ideas. Typically, these proposals are couched as changes to the way Puerto Rico's share of Federal health dollars is determined under existing programs. However, while the issues are admittedly complex, the result is fairly simple: Fiscal irresponsibility would be rewarded to the tune of tens of billions of dollars. Now, don't get me wrong--we will very likely have to consider these ideas to alter the means by which we allocate Federal health funds to Puerto Rico. However, if we decide to go that route, it is essential that we move forward in a fiscally appropriate and responsible manner. To date, I have yet to hear any concrete thoughts from proponents in Congress or from our Federal health agencies about how this can be done. I have heard, however, that the so-called Affordable Care Act is the source of some of the health care-related problems faced by Puerto Rico. I will leave it to those who wrote that law and forced it through Congress on a partisan basis to explain why that is the case. We now come to question No. 4, the possibility of providing Puerto Rico with relief from various Federal regulations. We have heard a number of ideas in this area, including reforms or exemptions from regulations governing labor markets, shipping, energy costs, and others. While I am inherently sympathetic to proposals to scale back Federal regulations, the issues here are very complex and would become very political in a hurry. For example, while I haven't taken any straw polls, I think it is safe to say that many of my friends on the other side of the aisle would reflexively oppose any attempt to mitigate the application of Federal minimum wage regulations to Puerto Rico. This would be puzzling given that Congress has offered similar relief to other ailing U.S. territories in the relatively recent past. On top of that, the Krueger Report, which was commissioned by the Government of Puerto Rico along with a host of economic analysts across the political spectrum, argued that allowing Puerto Rico the flexibility to set minimum wages that differ from the Federal levels would have a positive economic impact and that the current minimum wage levels do not fit productivity conditions on the island. Still, even in the face of all this evidence and precedent, my guess is that many of my colleagues would take issue with this idea. I would expect they would similarly reject out of hand any proposals to scale back environmental regulations and rules governing transportation even if it could be shown that their regulations were having a negative impact and contributing directly to Puerto Rico's fiscal and economic predicament. Unfortunately, Madam President, for a number of our colleagues here in Congress, commitment to ideology too often does not allow room to admit when your policies are not working. While the situation in Puerto Rico isn't the first time we have seen that come up, I expect we will see that happening a lot if we get a chance to consider regulatory relief as a potential solution. Those are the four main questions we face with regard to Puerto Rico. While they each come with their own sets of difficulties, those are the basic categories of solutions we have seen come to light so far. Of those four categories, two of them--the tax and the health care categories--are interrelated insomuch as Members of Congress and administration officials have made them the focus of various ideas to help Puerto Rico improve its fiscal situation and perhaps its economy. While those putting the tax and health proposals forward have largely been silent about what our official scorekeepers--the CBO and the Joint Committee on Taxation--will say about the costs of their CTC ideas, I have done some of my colleagues' homework for them. Adding up the refundable tax credits, including the EITC and the CTC, and health-related resource flows, including changes to Medicaid allocations, the overall cost looks to be well north of $30 billion and likely around $40 billion over the next 10 years. Those are hardly insignificant figures. Questions of funding and resource allocation are always difficult, and they implicate a number of issues. It isn't as simple as just deciding to give more health funds to Puerto Rico or access to refundable tax credits because doing so would necessarily mean reduced funding for other Federal priorities or increased taxes or yet more Federal debt. True enough, Puerto Rico's problems are multidimensional and complex, and I don't know anyone in Congress who is indifferent to the plight of these American citizens. Sadly, these facts don't make our unpleasant budget arithmetic any easier. If anything, they make it all the more complicated. In short, there are no easy answers. That said, regardless of how we move forward, we need to have a clearer picture of what is going on in Puerto Rico. We need to have the fiscal facts regarding the island's indebtedness, funding levels, and needs. Yet, to date, we have not seen any recent audited financial statements from Puerto Rico, although we have asked for them. Instead, we are being asked to rely on statements and cash flow analysis commissioned by the Government of Puerto Rico. As of right now, finances in Puerto Rico remain extremely opaque and difficult to monitor. Congress should demand independent verification of the territory's finances before moving forward on any kind of relief package. Moreover, while we are hearing horror stories of inadequate cash flow and a liquidity freeze in Puerto Rico, it is difficult to ascribe much urgency to the situation when we are still seeing and reading about relatively large outlays for questionable expenses. Indeed, it is hard to believe an entity is in danger of running out of cash when it is paying for a broad public relations and lobbying campaign and when officials are talking about protecting hundreds of millions of dollars in year-end bonuses for government employees. This brings us to yet another difficult question. I suppose you could call this question No. 5. What can we do to ensure that Puerto Rico changes its clearly unsustainable fiscal course? No matter what we do with regard to debt restructuring, tax policy, health care policy, or regulatory relief, the solution will ultimately be meaningless if we don't take steps to ensure that Puerto Rico doesn't simply continue on the fiscally irresponsible path that brought them to this mess in the first place. Even if every creditor gets a massive haircut and all the requested resources are channeled directly to the island, steps need to be taken to avoid getting into this situation again in the future. For some time Puerto Rico has spent more than it takes in from revenues and receipts and has covered the difference with debt. The debt that has been issued has tapped out virtually every possible future receipt of the government, and basic budget arithmetic has caught up with this unsustainable fiscal recipe and has effectively shut Puerto Rico out of funding markets. In short, Puerto Rico must move to policies that are fiscally sustainable. Madam President, that is not me trying to impose on Puerto Rico's sovereignty. That is not an agenda of ``austerity'' at work. It is just the simple budget arithmetic of the situation. Before we undertake any efforts to provide relief or assistance to Puerto Rico, we need to give this simple math its proper consideration and demand a workable plan for the future. I would like to see Puerto Rico submit such a plan, and that plan is going to have to include how they resolve the overwhelming burden of government down there when they have allowed it to grow out of control and become the employer of last resort. For its part, the Obama administration has chosen to remain relatively vague on this somehow. In October, we saw a joint statement from Treasury, the Department of Health and Human Services, and the National Economic Council outlining a general plan which they called a ``Roadmap for Congressional Action.'' This roadmap contained many of the same general proposals I have discussed today with regard to bankruptcy relief, tax credits, and health spending. Conspicuously absent were any proposals for regulatory relief for Puerto Rico. Also absent were any real cost estimates or proposed offsets, just some lipservice to the need to undertake these changes in a ``fiscally responsible'' way. I have made inquiries to various agencies, including Treasury and HHS, with little in the way of detailed response to many of these issues at stake here. It remains puzzling to me that in the midst of what some in the administration are calling a ``humanitarian crisis,'' we are seeing very little engagement from our health agencies, particularly when so many have been arguing that the crisis stems in large part from the lack of health care funding in Puerto Rico. It also seems that provisions of taxpayer-funded technical assistance--which I would think would be considered in any package aimed at Puerto Rico--may be rendered moot given that, as I understand it, Treasury officials are working to wedge such a system on the sidelines into appropriations vehicles. Needless to say, before Congress can even begin to consider a significant legislative package to address the situation in Puerto Rico, we need more information from the administration about what it is now doing and what it plans to do in the near future. Put simply, it would not be productive for Congress to move forward on a legislative vehicle costing billions of dollars, if not tens of billions of dollars, without knowing beforehand if that legislation contradicts or conforms to the plans of Federal agencies. Long story short, Madam President, this will likely be a significant undertaking. There are a lot of ideas floating around. Some may work; others clearly will not. As the chairman of the Senate committee with jurisdiction over our Tax Code and most of the relevant health programs, I am more than willing to work with my colleagues on both sides of the aisle to find a bipartisan path forward. To accomplish that goal, we need everyone involved to be upfront and willing to work together. That goes for Members of Congress, the administration, and the Government of Puerto Rico. Everyone needs to come clean about the current state of affairs, the specific needs and amounts requested, the actual costs of any legislative or administrative proposal, and whether they want to offset costs or simply incur more Federal debt. Right now, too many people are willing to throw out demands and vague proposals-- with the price tag as high as $30 billion to $40 billion--accompanied by a lot of political rhetoric. That is precisely what we do not need. It would be very easy to play politics with this issue. My hope is that enough of us will be able to set that aside to allow Congress to do right by our fellow citizens in Puerto Rico. There are some who believe that crass politics may be playing a role here and that some would throw Puerto Rico to the dogs so that more and more people will immigrate to Florida for political purposes. I hope that is not true. I can't believe that is true, but it has been stated. I hope we can come together as Democrats and Republicans to solve this problem. Puerto Rico is going to have to help us to know what to do. I suspect the creditors are going to have to help us, too, or we are going to have to help them as well. I stand ready, willing, and able as chairman of the Finance Committee to solve these problems. But so far we haven't even received the right financial statements from Puerto Rico, and we can't move ahead without having clear-cut information that shows us what is going on, what the problems are, what we have to do, and how to do it. I want to do whatever it takes to help Puerto Rico resolve these problems, and I would like to see Puerto Rico itself resolve them. It may take some help from us; it may take some help from creditors. I would like to see them sit down with creditors before we come up with some colossal Federal program that is going to basically hurt everybody. But I am open, and I sure as heck want to get this problem solved. I like the people of Puerto Rico. I think they deserve better treatment than this. But they also got themselves into this problem by requiring too much of the central government and spending more and more all the time, with more and more central government employees that they don't need. That is a large part of this problem. I yield the floor.

Mr. HATCH. Will the Senator yield?

Mr. HATCH. I appreciate my friend and colleague from Florida. I too understand that he understands a lot about this. Look, bankruptcy laws do not apply. That doesn't mean we can't change that. I am not sure that is the way to do it. We are going to have to have some real information before we can move in that direction--which may be dangerous. I do think it is incumbent upon the Puerto Rican leadership to provide us with audited financial statements, so we really know what the problems are, so we can then approach this in an intelligent, reasonable, healthy, loving way. I am for getting this problem solved, but I am not for just throwing money at it when we know their central government is completely bloated and that is what is causing some, if not most, of the problems. At least that is what we have been told. I am happy to look at financials. I am happy to look at whatever suggestions are made. Not that I am that important, but we can move if we know what we are talking about. I am not about to move on the backs of the rest of the American taxpayers until they clean up the mess that is there, and they sit down with their creditors and see what they can work out. We ought to be encouraging them. I think their creditors want us to encourage them because they think it can be worked out--at least the one that I have spoken with. So I commit to the distinguished Senator. He knows I don't make commitments unless I mean them. I am going to try to solve this problem. When I say ``I,'' I mean our committee and our Congress is going to try to solve this problem. But let's do it in an intelligent way. Let's get all the facts, let's get some cooperation from Puerto Rico, and let's get the right financials so we know exactly what we can work with. If we can get all that, hopefully we can find some solutions here that will bring these folks into balance and give them a shot for the future. Last, but not least, I agree with the distinguished Senator that they have not been treated fairly, and it is time for us to start treating them fairly. I disagree with him that there are not people in Congress who would love to see more and more coming to Florida as Democrats. I am pretty sure that is the case, but that shouldn't be the case. We should be working on these problems and solving them. I commit to the distinguished Senator from Florida who is a great Member of our committee that I will work with him, and we will see what we can do to solve these problems. But let's get some financials we can rely on before we go off on some deep end and miss the boat here.

Mr. HATCH

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

Mr. HATCH

Mr. HATCH. Madam President, I rise to speak once again on the topic of religious liberty. This is the sixth in a series of addresses I have given on this critical subject. In my previous remarks, I have discussed why religious liberty matters and why it deserves special protection from government interference. I have also detailed the history of religious liberty in the United States and its centrality to our Nation's founding. Likewise, I have debunked the erroneous notion that religion is a purely private matter that has no place in the public domain. Last week, I discussed the status of religious liberty in contemporary American life. I argued that, in ways that are both alarming and unprecedented, religious liberty is under attack here in the United States. Today, I turn my attention beyond our borders to examine the status of religious liberty abroad. Again, my argument is straightforward: across the world, religious liberty is under serious attack. My observations are particularly relevant as we approach Thanksgiving. Our Nation commemorates this special holiday in remembrance of our pilgrim ancestors who fled persecution in search of religious freedom. These brave men and women sailed unchartered waters and settled strange lands in order to build a society where they could practice their religion free from state interference. Their earnest efforts precipitated not only the establishment of a new colony, but the birth of a nation committed to the principles of religious pluralism. For America's earliest settlers, this land stood as a symbol of refuge--a haven from the storm of religious oppression that lingered over Europe. Centuries later, victims of religious persecution across the world still look to our shores for sanctuary. They see America as John Winthrop once described it: ``As a city upon a hill''--a light that reaches across the oceans, giving hope to those still living in the shadows of religious intolerance. Today our world needs that light more than ever. Nearly four centuries after the Pilgrims made landfall at Plymouth Rock, the state of religious liberty across the world is increasingly precarious. From brutal crackdowns on religious minorities in Central Asia to a growing wave of anti-Semitism in Europe; from the violent campaigns of Boko Haram in Africa to the nefarious specter of ISIS in the Middle East-- religious liberty is under attack like never before. Despite the rapid advance of democracy over the last century, the blessings of religious freedom are still inaccessible to a majority of the world's population. In fact, a recent Pew study finds that three- quarters of the global population ``lives in countries with high- government restrictions and significant hostilities surrounding religion.'' Think about that. In spite of the substantial progress our own society has made in securing individual rights and enshrining religious liberty in law, there are still billions of people across the world who are unable to exercise their religion freely and fully. There are still billions of individuals living under despotic regimes that not only fail to protect people from persecution, but that actively constrain the conscience of citizens through law. There are still billions of people who understand religious liberty as little more than a philosophical concept, much less a reality. I wish I could offer these people hope. I wish I could say that the gradual march of progress will part the waters of religious intolerance, paving a clear path forward for religious liberty, but reality restrains my optimism. Around the world, hostility to religion is increasing. Religious liberty abroad faces opposition from two sources: states and nonstate actors. While I would like to relate an exhaustive account of the war being waged on both fronts, time permits me to highlight only the most grievous examples of persecution. I begin with state-sponsored acts of religious oppression. Far from being a relic of the past, government persecution of religious minorities is alive and well. First, consider the state of religious liberty in Asia. China is perhaps the world's leading instigator of religious persecution. Last year, in a nearly unprecedented crackdown on religious expression, the Chinese Government bulldozed or removed crosses from more than 400 Protestant and Catholic Churches. According to the United States Commission on International Religious Freedom, many experts have characterized this growing tide of oppression against Christians in China as ``the most egregious and persistent since the Cultural Revolution.'' And Christian denominations are not the only groups facing oppression. Members of all faiths, including Muslims and Tibetan Buddhists, ``face arrests, fines, denials of justice, [and] lengthy prison sentences'' because of their religious beliefs. Practitioners of Falun Gong experience the most intense persecution. Sixteen years ago, the Chinese Government imposed an outright ban on the practice of Falun Gong. Since that time, the government has imprisoned believers in forced labor camps, subjecting them to psychiatric experiments and other heinous forms of torture. The government has even executed practitioners of Falun Gong, mutilating their bodies and harvesting their organs for profit. Our Nation can no longer turn a blind eye to these atrocities. Nor can we ignore the plight of religious prisoners in North Korea, where Kim Jong-un has incarcerated thousands of his own citizens for their religious beliefs. These men and women are separated from their families and forced to work in concentration camps. While the government punishes followers of any faith, the country's Christians face the greatest persecution. If caught practicing their religion, Christians face imprisonment without trial. Many face execution. In Southeast Asia, Myanmar is responsible for propagating religious bigotry, not so much by what it does but by what it doesn't do. Across the country, religious and ethnic minorities face increasing persecution at the hands of the Buddhist majority. Rather than intervene to protect these vulnerable groups from mistreatment, the Myanmar Government has stood idly by as an observer to the violence. As a result of the government's inaction, 140,000 Muslims and at least 100,000 Christians have been internally displaced. In Africa and the Middle East, the situation is just as bleak. In Iran, despite President Rouhani's promise to extend greater protections to religious minorities, the number of individuals detained because of their religious beliefs has actually increased during his term. Baha'is, Christians, Jews, and Sunni Muslims throughout the country face perpetual persecution, arrest, beating, and imprisonment. Some are even executed for their beliefs. And of course, there is perhaps no government on earth more vocal in its anti-Semitism than Iran. Meanwhile, in Saudi Arabia, the state prohibits all non-Muslim public places of worship. Any citizen who dares question the government's repressive policies is likely to face charges of apostasy, blasphemy, and even sorcery--a crime punishable by death. In Syria, Bashar al Assad has abandoned all appearances of religious liberty by deliberately targeting Sunni Muslim civilians in a bloody civil war. As he massacres his own people, he does so on the basis of their religious affiliation. Madam President, I ask unanimous consent that I be permitted to finish my remarks.

Mr. HATCH. In Pakistan the government consistently fails to protect its own citizens from religiously motivated violence, and the courts exploit repressive anti-blasphemy laws to prosecute religious minorities. Egypt's courts convict and imprison citizens under the same pretext. In Sudan the government harasses its minority Christian population and subjects Muslims and non-Muslims alike to the punishments of Sharia law. The state even executes citizens who convert from Islam to another religion. Even in Europe, religious liberty is under attack, albeit in more subtle ways; take, for example, Switzerland, where a constitutional amendment placed a countrywide ban on the construction of minarets--a widely recognized symbol of Muslim prayer and devotion. In another blow to Europe's Islamic population, France recently outlawed the wearing of burqas and niqabs in public. When a Muslim woman appealed the ban to the European Court of Human Rights, the court upheld the law. What I have related here is only a small sampling of the manifold abuses taking place around the world. If I were to relate every instance of state-sponsored religious bigotry abroad, I would be speaking here for days. And none of this is to mention the war against freedom being waged by non-state actors. In the past decade, we have witnessed an unprecedented rise of terrorist groups and other criminal organizations seeking to eradicate religious liberty altogether. Take, for example, the rise of Boko Haram in the Lake Chad region of Africa. This Islamic terrorist organization made headlines last year after kidnapping over 276 Nigerian schoolgirls. According to the Human Rights Watch, Boko Haram has since forced these young girls to convert to Islam and undergo severe physical and psychological torture. Many of these young women have been subject to forced labor, and others have been raped while in captivity. Boko Haram's central mission is to annihilate all Western social and political activities, including any religion that isn't Islam. In its fight against religious freedom and other Western values, the group has conducted indiscriminate attacks on civilians and has even used children as suicide bombers. The brutality of Boko Haram is only surpassed by the barbarism of ISIS. Far from being the ``jayvee team'' President Obama once described, ISIS has proven to be perhaps the most formidable terrorist network in operation today. I fear that too many underestimate the threat ISIS poses to religious freedom. This is an organization whose very raison d'etre is to establish a global Islamic caliphate and usher in the apocalypse. As Islamic State militants carry out their mission, religious liberty is often the first casualty. In the barren world ISIS envisions, there is no room for dissent: either convert or be killed. Yazidis, Christians, and Shia Muslims throughout the Middle East have been confronted with this impossible ultimatum. Refusal to give in to the Islamic State's demands has resulted in mass executions, extrajudicial killings, kidnapping of civilians, forced displacement, the killing and maiming of children, rape, and other forms of sexual violence. The savagery of ISIS has even gone viral as the group posts videos of grisly beheadings on the Internet. In almost every case, captors target their victims on the basis of religion. As we are all too aware, the cruelty of ISIS is not confined to the Middle East. Just last week, three teams of ISIS militants carried out terrorist assaults throughout Paris, detonating suicide bombs at a soccer stadium and opening fire on innocent civilians at a concert hall. The violence injured more than 350 innocent bystanders and claimed at least 129 lives in what is considered the worst terrorist attack on French soil in the nation's history. We could call these attacks ``senseless acts of violence'' because that is exactly what they appear to be, both in the scope of their brutality and in the scale of their indiscrimination. But I fear that dismissing these attacks as ``senseless'' too often hides from our view the radical rationale that motivates such violence. ISIS does not kill merely to feed an insatiable bloodlust; it kills because it wants to terrorize, shock, and intimidate other civilizations into submission. It kills because it wants to impose on all people a narrow-minded, medieval ideology of Islam--one that would rob us of our religious freedom and other fundamental rights. Sadly, ISIS is not alone in its animus toward religious freedom. Nearly every terrorist organization that has vowed our destruction--be it Al Qaeda, Hamas or Hezbollah--seeks to strip us not only of our sense of security but also of the fundamental freedoms that make religious pluralism possible. If we are committed to defending religious liberty overseas, we must confront the growing menace of Islamic extremism, and we must challenge those nations that engender religious intolerance through law. Today, by calling attention to the suffering of religious peoples throughout the world, I have demonstrated clearly and without question that religious liberty faces growing hostility abroad from both state and non-state actors alike. From the heavy hand of government to the violent campaigns of terrorist organizations around the globe, the right to worship according to the dictates of one's own conscience is under relentless attack. With a fuller understanding of the threats facing religious liberty, the question now becomes: What is to be done? If religious liberty is under attack abroad, what can our Nation do to protect this precious freedom now and in the future? First, we must recognize that protecting religious freedom abroad is not just a question of moral principle; it is a matter of national security. Often, violations of religious liberty abroad threaten our own safety at home. As a case in point, consider the role of religious intolerance in the Syrian civil war. Bashar al-Assad quickly disposed of religious freedom when he began deliberately targeting Sunni Muslims, murdering thousands of citizens on the basis of their religion. His brutal actions precipitated the formation of ISIS--an organization hell-bent on destroying other religions and entire civilizations in the name of Islam. As ISIS gained in strength, it began to export its extreme ideology abroad, triggering several attacks throughout the world, including last week's coordinated assaults in Paris. Now, ISIS poses a formidable threat to the United States and all of our allies. Assad's blatant disregard for religious liberty not only escalated violence in the region but also catalyzed the formation of ISIS. As a result, the world is less safe. Given the obvious nexus between protecting religious liberty and strengthening global security, I agree with the following assessment from the U.S. Commission on International Freedom: In the long run, there is only one permanent guarantor of the safety, security, and survival of the persecuted and the vulnerable. It is the full recognition of religious freedom as a sacred human right which every nation, government, and individual must fully support and no nation, government, or individual must ever violate. If we are committed to bolstering the security of other nations, then we must be equally devoted to strengthening religious liberty abroad. At the forefront of foreign policy should be a commitment to defend and advance religious liberty in countries where it is under attack. We should also be prepared to reevaluate our relationship with governments that fail to make religious liberty protections a priority. Congress took concrete steps to prioritize religious freedom as a foreign policy objective when it passed the International Religious Freedom Act of 1998. This law established the Ambassador-at-Large for International Religious Freedom. The Ambassador oversees the State Department's Office of International Religious Freedom, which monitors discrimination against people of faith and publishes an annual country- by-country report on the status of religious freedom abroad. This historic legislation also created the U.S. Commission on International Freedom--an independent, bipartisan organization that closely follows religious persecution in other countries and offers recommendations to the executive branch and Congress on how best to promote religious freedom overseas. As one of the only countries in the world to make religious liberty an explicit foreign policy objective, our nation is unique in its commitment to this preeminent freedom. As a legislative body, Congress can renew that commitment by continuing to support the provisions of the International Religious Freedom Act. The future of religious liberty overseas depends on our willingness to strengthen it here in Congress. Lastly, if we are committed to protecting religious liberty abroad, we must be ready to defend it here at home. At the beginning of my remarks, I recalled the imagery of John Winthrop's ``City on a Hill.'' Throughout our Nation's history, several public figures have invoked Winthrop's allusion to capture a simple truth: America's special freedoms make her a light to other nations. Through our robust exercise of religious liberty, we offer hope to people beyond our borders--men and women suffering under the yoke of oppression who look to our country for sanctuary. As our nation strives to be an example of religious freedom, we can offer greater hope to those persecuted for their religious beliefs, and by addressing threats to freedom of conscience here at home--including the attacks on religious liberty that I detailed in previous remarks--we can strengthen and beautify our City on a Hill, building upon the foundation laid for us by our Pilgrim forbears, so that the light of our Nation might shine before all mankind. With this call to action, I yield the floor.

Mr. HATCH

Mr. HATCH. Mr. President, I rise today to introduce the Stem Cell Therapeutic and Research Reauthorization Act of 2015. I am glad to have Senators Reed, Burr, and Franken joining me as sponsors of this bipartisan bill that will reauthorize critical, innovative, and life- saving programs. We have been working on this legislation throughout the year and have met with stakeholders in blood cell transplantation to receive their input. We also included members of the Senate Health, Education, Labor and Pension Committee who are deeply committed to passing this legislation. In drafting this legislation, we also collaborated with our counterparts in the House of Representatives. I am grateful for the leadership of Congressman Chris Smith and Congresswoman Doris Matsui, who did so much to get this legislation through the House. I commend my colleagues and their staffs for their hard work. I appreciate the opportunity to provide some history and background that will explain why this reauthorization bill is so important. This legislation will reauthorize for another five years both the C.W. Bill Young Cell Transplantation Program and the National Cord Blood Inventory, which are administered by the Health Resources and Services Administration. These vital programs provide access to life-saving treatments for serious conditions and disease. Bone marrow contains blood-forming stem cells that develop into the three blood cell types that keep the body healthy. The body uses those red blood cells, white blood cells, and platelets as building blocks for blood, tissue, and organs. These blood cells die naturally, and the body must continuously make new ones. Serious health problems can develop in people whose bone marrow cannot make enough new blood cells to replace the cells that die. Cord blood is a newborn baby's blood that remains in the placenta or afterbirth. This blood can be collected after delivery at no risk to the mother and baby. Like bone marrow, cord blood is also rich with stem cells, and doctors can use it as an alternative to bone marrow transplant. In fact, research in the mid-1980s highlighted the promise of cord blood, demonstrating that it is more highly enriched with blood-forming stem cells than bone marrow. Cord blood transplantation has been used successfully to treat leukemia, lymphoma, immunodeficiency diseases, sickle cell anemia, and certain metabolic diseases. In addition to treating cancer and other blood diseases, researchers are currently testing stem cells for a host of disorders, including autoimmune and genetic disorders. Cord blood research is also showing potential for use in the innovative fields of cellular therapy and regenerative medicine. Vaccines derived from cord blood to use against viruses and certain types of cancers are currently in early trials. Research has also indicated that cord blood could be used to treat conditions for which few treatments are available, such as stroke, cerebral palsy, hearing loss, autism, and traumatic brain injury. Dr. Joanne Kurtzberg of the Carolinas Blood Bank is one of the world's leading stem cell researchers at Duke University in Durham, North Carolina. At the time of that groundbreaking scientific research in the 1980s, Dr. Kurtzberg was caring for a 5 year old boy named Matthew who had a rare, inherited blood disorder called Fanconi anemia--a disease that leads to bone marrow failure. In light of the new scientific findings, doctors planned a cord blood transplant for Matthew at a hospital in Paris, France, using fully matched cord blood that had been collected during the birth of his newly born baby sister. Matthew's transplant in 1988 was a success, laying the groundwork for cord blood transplantation. Matthew is now in his 30s. He is married, working, and living a healthy and productive life. He is living proof that cord blood contains stem cells that can replenish the bone marrow and immune system throughout a patient's life. In 1993, with the assistance of Dr. Pablo Rubenstein of the New York Blood Center, Dr. Kurtzberg performed the world's first unrelated donor cord blood transplant at Duke University. Over the following years, these amazing research doctors discovered more about the use of cord blood transplantation in patients who cannot find a fully matched donor. Dr. Kurtzberg is also the president of the Cord Blood Association, CBA. I am thankful for Dr. Kurtzberg and the CBA's support in helping us develop meaningful legislation that will help cord blood banks do their jobs. I also owe gratitude for the input and guidance on this reauthorization bill that my staff and I received from Mike Boo and Dr. Jeffrey Chell with the National Marrow Donor Program, NMDP. I am proud to have a long history of working on this issue. In early 2003, I met with Joanne Kurtzberg, Pablo Rubenstein, and Phil Coelho of Thermogenesis Corporation to discuss umbilical cord blood therapies as a promising alternative to bone marrow transplantation and how the Federal Government could help to increase collection efforts. That night, I called Health and Human Services Secretary Tommy Thompson to talk to him about this new science, and he agreed to meet with Joanne, Pablo, and Phil the very next day. Staff from the Health Resources and Services Administration, the Food and Drug Administration, and the National Institutes of Health joined us for that discussion. Secretary Thompson stressed that cord blood banks would need to be managed through HRSA and promised to support my legislation. In October 2003, I introduced a bill to amend the Public Health Service Act to establish a National Cord Blood Stem Cell Bank Network to prepare, store, and distribute human umbilical cord blood stems cells for the treatment of patients and to support peer-reviewed research using those cells. That bill, the Cord Blood Stem Cell Act of 2003, S. 1717, gained strong bipartisan support over the last few months of the 108th Congress. Although it did not pass the Senate, my 2003 bill helped to generate more interest in and support for blood stem cell transplantation. I kept working on legislation to help increase access to these life- saving transplants in the following Congress. In April 2005, the Institute of Medicine, IOM, issued recommendations to create a national cord blood network. Those of us in Congress who had been working on cord blood and bone marrow realized that combining our bipartisan, bicameral efforts would benefit patients by increasing treatment options and encouraging future research. We reviewed the IOM report and incorporated those important recommendations into one comprehensive bill. That legislation, the Stem Cell Therapeutic and Research Act of 2005, P.L. 109-129, that was signed into law on December 20, 2005, created the National Cord Blood Inventory and established an inventory goal of at least 150,000 new and diverse cord blood stem cell units. The 2005 law also combined the NCBI with the bone marrow donor program that had been created in 1986 by the late Congressman Bill Young to create a single point of access for blood stem cell transplants and research. This single point of access allows physicians the ability to search for any potential adult volunteer bone marrow donor or umbilical cord blood unit anywhere across the globe. Finally, our 2005 law also named the program the C.W. Bill Young Cell Transplantation Program, in honor of Bill's tireless efforts to promote bone marrow donation and transplantation. Five years later, I was the lead sponsor of the Stem Cell Therapeutic and Research Reauthorization Act of 2010, P.L. 111-264, which was signed into law on October 8, 2010, and reauthorized the Program and the NCBI for another 5 years. The 2010 law also placed new emphasis on exploring innovations in cord blood collection and increasing the number of collection sites across the nation. Great progress has been made toward achieving the NCBI's goal of at least 150,000 diverse cord blood units; however, data suggest that the number of available cord blood units in the United States is still insufficient to meet the estimated need for unrelated transplant, which has increased by 25 percent since 2005. The number of transplants for patients in minority populations has increased from 253 in 2000 to 990 in 2014. Much of this increase can be attributed to the increased potential for bone marrow or cord blood transplant. This is exciting, promising science. There are still challenges to the success of bone marrow and cord blood transplantation. Not all cord blood units contain enough cells to transplant into all patients. In many cases, more than one unit is preferred or necessary for larger children or adults. New science indicates the possibility that using larger, higher quality cord blood units will reduce the incidence of graft-versus-host disease, GVHD, a serious complication of blood cell transplantation in which the donor cells attack the recipient. GVHD is the biggest barrier to successful transplantation. I am glad to know that the Advisory Council and HRSA have been working with public cord blood banks to discuss ways to increase CBU quality and diversity. As the inventory continues to grow, the diverse units within the NCBI will serve an increasing number of patients that have difficulty obtaining cells from well-matched adult donors. Cell dose and degree of match between patient and CBU are both strongly associated with transplant outcomes. A larger inventory of publicly available CBUs also will contribute to improved patient survival after transplant because a growing inventory of high cell count CBUs will allow better tissue matches. Cord blood banks have told us that they cannot do this on their own. Without continued support from HRSA, this life-saving science would be financially unsustainable. We must reauthorize this important program. Today, I am introducing the Stem Cell Therapeutic and Research Reauthorization Act of 2015 to further advance the important work of the bone marrow and cord blood programs. Passage of this legislation will preserve the commitment that the Congress made three decades ago to help patients with blood cancers and other life-threatening diseases by helping to increase access to life- saving transplants. It will also open the doors to new discoveries within the fields of cellular therapy and regenerative medicine. I am proud to introduce the Stem Cell Therapeutic and Research Reauthorization Act of 2015, and I urge my colleagues to support it.

Mr. HATCH

Mr. HATCH. Mr. President, I rise today to introduce the Stem Cell Therapeutic and Research Reauthorization Act of 2015. I am glad to have Senators Reed, Burr, and Franken joining me as sponsors of this bipartisan bill that will reauthorize critical, innovative, and life- saving programs. We have been working on this legislation throughout the year and have met with stakeholders in blood cell transplantation to receive their input. We also included members of the Senate Health, Education, Labor and Pension Committee who are deeply committed to passing this legislation. In drafting this legislation, we also collaborated with our counterparts in the House of Representatives. I am grateful for the leadership of Congressman Chris Smith and Congresswoman Doris Matsui, who did so much to get this legislation through the House. I commend my colleagues and their staffs for their hard work. I appreciate the opportunity to provide some history and background that will explain why this reauthorization bill is so important. This legislation will reauthorize for another five years both the C.W. Bill Young Cell Transplantation Program and the National Cord Blood Inventory, which are administered by the Health Resources and Services Administration. These vital programs provide access to life-saving treatments for serious conditions and disease. Bone marrow contains blood-forming stem cells that develop into the three blood cell types that keep the body healthy. The body uses those red blood cells, white blood cells, and platelets as building blocks for blood, tissue, and organs. These blood cells die naturally, and the body must continuously make new ones. Serious health problems can develop in people whose bone marrow cannot make enough new blood cells to replace the cells that die. Cord blood is a newborn baby's blood that remains in the placenta or afterbirth. This blood can be collected after delivery at no risk to the mother and baby. Like bone marrow, cord blood is also rich with stem cells, and doctors can use it as an alternative to bone marrow transplant. In fact, research in the mid-1980s highlighted the promise of cord blood, demonstrating that it is more highly enriched with blood-forming stem cells than bone marrow. Cord blood transplantation has been used successfully to treat leukemia, lymphoma, immunodeficiency diseases, sickle cell anemia, and certain metabolic diseases. In addition to treating cancer and other blood diseases, researchers are currently testing stem cells for a host of disorders, including autoimmune and genetic disorders. Cord blood research is also showing potential for use in the innovative fields of cellular therapy and regenerative medicine. Vaccines derived from cord blood to use against viruses and certain types of cancers are currently in early trials. Research has also indicated that cord blood could be used to treat conditions for which few treatments are available, such as stroke, cerebral palsy, hearing loss, autism, and traumatic brain injury. Dr. Joanne Kurtzberg of the Carolinas Blood Bank is one of the world's leading stem cell researchers at Duke University in Durham, North Carolina. At the time of that groundbreaking scientific research in the 1980s, Dr. Kurtzberg was caring for a 5 year old boy named Matthew who had a rare, inherited blood disorder called Fanconi anemia--a disease that leads to bone marrow failure. In light of the new scientific findings, doctors planned a cord blood transplant for Matthew at a hospital in Paris, France, using fully matched cord blood that had been collected during the birth of his newly born baby sister. Matthew's transplant in 1988 was a success, laying the groundwork for cord blood transplantation. Matthew is now in his 30s. He is married, working, and living a healthy and productive life. He is living proof that cord blood contains stem cells that can replenish the bone marrow and immune system throughout a patient's life. In 1993, with the assistance of Dr. Pablo Rubenstein of the New York Blood Center, Dr. Kurtzberg performed the world's first unrelated donor cord blood transplant at Duke University. Over the following years, these amazing research doctors discovered more about the use of cord blood transplantation in patients who cannot find a fully matched donor. Dr. Kurtzberg is also the president of the Cord Blood Association, CBA. I am thankful for Dr. Kurtzberg and the CBA's support in helping us develop meaningful legislation that will help cord blood banks do their jobs. I also owe gratitude for the input and guidance on this reauthorization bill that my staff and I received from Mike Boo and Dr. Jeffrey Chell with the National Marrow Donor Program, NMDP. I am proud to have a long history of working on this issue. In early 2003, I met with Joanne Kurtzberg, Pablo Rubenstein, and Phil Coelho of Thermogenesis Corporation to discuss umbilical cord blood therapies as a promising alternative to bone marrow transplantation and how the Federal Government could help to increase collection efforts. That night, I called Health and Human Services Secretary Tommy Thompson to talk to him about this new science, and he agreed to meet with Joanne, Pablo, and Phil the very next day. Staff from the Health Resources and Services Administration, the Food and Drug Administration, and the National Institutes of Health joined us for that discussion. Secretary Thompson stressed that cord blood banks would need to be managed through HRSA and promised to support my legislation. In October 2003, I introduced a bill to amend the Public Health Service Act to establish a National Cord Blood Stem Cell Bank Network to prepare, store, and distribute human umbilical cord blood stems cells for the treatment of patients and to support peer-reviewed research using those cells. That bill, the Cord Blood Stem Cell Act of 2003, S. 1717, gained strong bipartisan support over the last few months of the 108th Congress. Although it did not pass the Senate, my 2003 bill helped to generate more interest in and support for blood stem cell transplantation. I kept working on legislation to help increase access to these life- saving transplants in the following Congress. In April 2005, the Institute of Medicine, IOM, issued recommendations to create a national cord blood network. Those of us in Congress who had been working on cord blood and bone marrow realized that combining our bipartisan, bicameral efforts would benefit patients by increasing treatment options and encouraging future research. We reviewed the IOM report and incorporated those important recommendations into one comprehensive bill. That legislation, the Stem Cell Therapeutic and Research Act of 2005, P.L. 109-129, that was signed into law on December 20, 2005, created the National Cord Blood Inventory and established an inventory goal of at least 150,000 new and diverse cord blood stem cell units. The 2005 law also combined the NCBI with the bone marrow donor program that had been created in 1986 by the late Congressman Bill Young to create a single point of access for blood stem cell transplants and research. This single point of access allows physicians the ability to search for any potential adult volunteer bone marrow donor or umbilical cord blood unit anywhere across the globe. Finally, our 2005 law also named the program the C.W. Bill Young Cell Transplantation Program, in honor of Bill's tireless efforts to promote bone marrow donation and transplantation. Five years later, I was the lead sponsor of the Stem Cell Therapeutic and Research Reauthorization Act of 2010, P.L. 111-264, which was signed into law on October 8, 2010, and reauthorized the Program and the NCBI for another 5 years. The 2010 law also placed new emphasis on exploring innovations in cord blood collection and increasing the number of collection sites across the nation. Great progress has been made toward achieving the NCBI's goal of at least 150,000 diverse cord blood units; however, data suggest that the number of available cord blood units in the United States is still insufficient to meet the estimated need for unrelated transplant, which has increased by 25 percent since 2005. The number of transplants for patients in minority populations has increased from 253 in 2000 to 990 in 2014. Much of this increase can be attributed to the increased potential for bone marrow or cord blood transplant. This is exciting, promising science. There are still challenges to the success of bone marrow and cord blood transplantation. Not all cord blood units contain enough cells to transplant into all patients. In many cases, more than one unit is preferred or necessary for larger children or adults. New science indicates the possibility that using larger, higher quality cord blood units will reduce the incidence of graft-versus-host disease, GVHD, a serious complication of blood cell transplantation in which the donor cells attack the recipient. GVHD is the biggest barrier to successful transplantation. I am glad to know that the Advisory Council and HRSA have been working with public cord blood banks to discuss ways to increase CBU quality and diversity. As the inventory continues to grow, the diverse units within the NCBI will serve an increasing number of patients that have difficulty obtaining cells from well-matched adult donors. Cell dose and degree of match between patient and CBU are both strongly associated with transplant outcomes. A larger inventory of publicly available CBUs also will contribute to improved patient survival after transplant because a growing inventory of high cell count CBUs will allow better tissue matches. Cord blood banks have told us that they cannot do this on their own. Without continued support from HRSA, this life-saving science would be financially unsustainable. We must reauthorize this important program. Today, I am introducing the Stem Cell Therapeutic and Research Reauthorization Act of 2015 to further advance the important work of the bone marrow and cord blood programs. Passage of this legislation will preserve the commitment that the Congress made three decades ago to help patients with blood cancers and other life-threatening diseases by helping to increase access to life- saving transplants. It will also open the doors to new discoveries within the fields of cellular therapy and regenerative medicine. I am proud to introduce the Stem Cell Therapeutic and Research Reauthorization Act of 2015, and I urge my colleagues to support it.

Mr. HATCH

Mr. HATCH. Mr. President, I ask unanimous consent that I be permitted to finish these remarks.