Heidi Heitkamp

Ms. HEITKAMP

Ms. HEITKAMP. Thank you. I was going to say ``Mr. Chairman,'' but I guess at this point he is just Senator Crapo. Mr. President, I want to take a moment and personally thank Senator Crapo from Idaho for his incredible leadership. Frequently we are asked: What is wrong in the U.S. Senate? Why can't you seem to get anything done, even though there is common purpose; that is, to protect the American public, defend the American public, and help the American public be prosperous? Frequently my response is that many times it is a lack of leadership. It is a lack of willingness to sit down, listen, and prepare a product that can get results. That hasn't been our problem with Senator Crapo. He has been there personally every step along the way, not delegating to staff but working with us one on one--sometimes, maybe, four on one. He may feel a little bit ganged up on, but I think it was fair odds for him, I might say. I also know that this would not be here without the leadership of Senator Crapo and the Banking Committee, a committee that historically has a reputation for being notoriously bipartisan. I want to extend my great appreciation for his work and for his willingness to listen and to work with all of us. What are we celebrating today? We haven't quite gotten it over the finish line, but certainly the vote we just had a couple of hours ago, which was broad bipartisan support on a cloture vote, is not something we see very often in this body. I think what we have to say is that this bill is a piece of almost old-fashioned legislating. It is a prime example of how Senators can work together to effectively achieve a result and do it in a bipartisan way. Despite the Washington gridlock of partisanship, a group of us on Banking wrote and introduced this bipartisan bill through a good-faith negotiation, which lasted literally years. I have been working on this since coming to the U.S. Senate and being assigned to the Banking Committee. In fact, I have been working on these reforms since 2013. The bill didn't come together overnight. It was carefully crafted. It was done not just with these regulators in discussion but also the Obama-era regulators as well. We know that we have an opportunity to do something that no one thought was possible--take a piece of legislation that didn't come through in rule XIV, didn't come through in reconciliation. It came through in the traditional way, through a Banking Committee process where we sat--and I will again applaud the Chairman. No amendment was told it was out of order. No amendment wasn't given an opportunity to be heard or voted on. In fact, we sat for 7 hours and voted on amendments and listened to debate on this bill. Those people who think it came quickly are wrong. This did not come quickly. It came over a long period of time, through extensive discussions. I want to talk about why I care so much about this bill. When I was going around the State in 2012, talking to folks who had opinions about the Federal Government, one of the things I frequently heard from my small credit unions and my independent community bankers and my bankers--in North Dakota, independent community bankers frequently tend to be members of the North Dakota Bankers Association. They said one thing to me that really resonated, and that was: How is it that Dodd- Frank, which was supposed to deal with the largest lenders in this country, the largest institutions in this country--how is it that you have this Dodd-Frank bill that was supposed to stop too big to fail, and it has become too small to succeed? The compliance burdens are overwhelming. The confusion that we have about this--we wonder why all of this is on us when we weren't part of the problem. We are getting punished for being a financial institution and for no good reason, other than we are in a class that includes much bigger actors. One of the things I would tell you is that this bill is critical to rural America. When you look at the challenges that rural America faces, access to capital has to be on top of the list. Plus, I think all of those who have been to a Class B basketball tournament or a Class B basketball game can look at the program, turn it over, and what they will see is sponsorship from their local lending institution; they will see a part of the community. Whether it is helping host fundraisers, whether it is being involved in cancer drives, that Main Street institution of the community bank is there every step of the way. We are seeing more and more those institutions being challenged by things such as overregulation. I want to talk a little bit about my hometown bank, the first bank in which I had a checking account and a savings account. It is a little bit of a funny story. The statute of limitations has probably run, but back in the day, in every small town, there was illegal gambling. I know, people might be shocked. My dad put my name in a raffle they were having. That night at the stag party, I won the raffle. It was $30, which years ago was a lot of money. The first thing my dad did was take me to Lincoln State Bank to open a savings account. I put that $30 into a savings account. That institution was there, and from there, we had our first checking account. From there, I knew that my dad had a relationship with his banker that would help him through some tough times when he needed a little bit of extra cash and help him through times when he needed a car loan. When we lose those local lenders, when we lose the ability of those local lenders to do business, that means the opportunity for relationship banking is gone. What do I mean by that? I have told this story many times in committee. You are the small town banker. A guy comes in, and maybe he has a shoebox full of receipts. He doesn't have a fancy cash flow statement. He doesn't have a fancy work plan. But you know that this guy has never not paid a bill. He owes nobody any money. That is part of his character--who he is. He never cheats anyone. He fixes the plumbing. He fixes the furnace, and it stays fixed. He doesn't ask for a lot in return, but maybe he needs a new piece of equipment. Maybe he needs a new car. He goes to the local lender. That may not pencil out. It may not be the best loan they are going to make, but it is who they are, and it is what they contribute to that institution. They give that guy the loan, not based on any paperwork in that shoebox. They give that guy the loan based on who they know he is. Then, there is the other guy in the small town who comes in. He may have a fancy cash flow statement, and he may have a wonderful statement of net worth that he can present to the bank. Yet one thing the banker knows about him is that there may be some unpaid bills and that he may be the guy who takes out a loan but then wants to negotiate 80 cents on the dollar. In America, we have to bring back relationship lending. You can say: Well, none of these regulations really apply to them. Why don't you talk to these folks who are in the banking world and realize that they have retracted from mortgage lending because they are fearful that they will do something wrong and will not be able to afford the fines that they may be assessed. They are fearful that they will not be able to contribute and be part of the community effort because we have overregulated the smallest institutions to the point at which they wonder if their children, who could inherit their institutions, really want to stay in business. There will be a lot of discussion about this bill. There has been a lot of discussion already. The one thing I want to say is that we stand ready to defend any of these provisions. Before I close and turn this over to the Senator from Georgia, I want to just say that one of the things we need to be very careful of here when we debate this bill is that we do not in any way misstate the effects of this bill, because that misstatement will become part of the public record. I am going to be very aggressive in making sure that we push back against statements that I believe are false, statements that characterize this bill in a way that was not intended and that, in fact, is not part of the legislative language.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, on February 2, 2018, Tillie Fay Walker, 88, passed away in Bismarck, ND. Tillie was an enrolled member of the Mandan, Hidatsa, and Arikara Nation, born on the Fort Berthold Indian Reservation on July 11, 1928, and was a member of the Alkali Lodge Clan. Tillie was a fierce champion for the rights of her tribe and a passionate advocate for the dignity of all American Indians, particularly women. Her energy and intellect were used to progress positive change, mentor future Native leaders, and push government institutions to acknowledge and address the serious problems facing Indian Country. During a period when many thought a Native woman attending college was a foolish idea, she was that much more driven to receive her degree. At times when Tribes and Federal officials were at odds, Tillie brought elders and officials together to improve Federal policy positions on tribal sovereignty and land rights. Her work on the national level caught the attention of Dr. Martin Luther King, Jr., as he began to organize for the Poor People's Campaign. Tillie served as one of the key Native organizers for the campaign and recruited Tribal members and leaders from across the country to participate in the marches, sit-ins, and testimonies. She also gave fiery and memorable testimony to the Interior Secretary and the Commissioner of Indian Affairs during the campaign. Through these decades of work on the national scene, Tillie influenced the very direction of activism and Federal Indian policy. She considered the implementation of Indian preference hiring for the Indian Health Service and the Bureau of Indian Affairs to be her biggest professional accomplishment. Above all, Tillie was a lifelong keeper of cherished Mandan and Hidatsa history, practices, and language, and many tribal traditions now live on in younger generations due to Tillie's careful stewardship. Her legacy of Native pride and community activism survives on Fort Berthold and in those who work to improve the lives of Native Americans across the country. My deepest sympathies are with her family and many friends.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I wish to congratulate President Robert Badal of the University of Jamestown, formerly known as Jamestown College, in Jamestown, ND, on his outstanding tenure. Since 2002, Dr. Badal's leadership has brought strengthened academic programs, increased enrollment, greater financial strength, and significant expansion and renovation of the campus. These efforts and new offerings of graduate programs led to the change of status from college to university under Dr. Badal, who will be retiring on February 28, 2018. In addition to jumpstarting graduate programs, Dr. Badal has also more than doubled the endowment of the university and expanded academic offerings and extracurricular offering, and it currently celebrates a multi-year high enrollment of 1,136 students. Additionally, the university has reached to other parts of North Dakota by establishing a campus in Fargo with three graduate programs. To quote Dr. Badal, he has taken ``a small, but historic institution to a higher level.'' The University of Jamestown was truly fortunate to have a president whose unwavering passion and dedication to student success led to extraordinary growth and advancement. While his departure marks a new era for the university, he has left it in a very strong position for the future and for his successor. I thank Dr. Badal for his time and leadership at the University of Jamestown and wish him a very enjoyable retirement.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I rise today to talk about paid family leave. I want to introduce this topic by saying that politicians across America, whether they are local, whether they are in State offices, or whether they are in very important bodies like the U.S. Senate, make one pledge; that is, to support American families. They promise to try to make life just a little easier for people who are raising the next generation, to do what it takes to encourage people to have families and to have children, so our future is secured not only with a workforce but also the vibrancy that is America. It has been 25 years since we adopted the Family Medical Leave Act. That was a great step forward, and I actually remember when it happened. I was North Dakota's attorney general cheering from the sidelines, thinking: We have solved this problem. We are now protecting parents from losing their jobs and enabling them to care for their newborns. Unfortunately, it wasn't enough. It wasn't enough because how many people, even if they have the protection, can afford to exercise their rights under the Family Medical Leave Act? The answer is very, very few in my State. It is absolutely essential that we take this to the next step. It is essential that we make sure we are not forcing our citizens to choose between working--as they have to when families live paycheck to paycheck--and caring for their newborn. Many daycare facilities will not even take an infant until they are 10 or 12 weeks old. So what choice have we really given people under the Family Medical Leave Act? Just 15 percent of the workforce in the United States has access to paid family leave through their employer. That leaves millions of people without access to paid leave for time away from their job to care for a new child or a seriously sick relative. It is well past the time that the United States of America--the greatest country in the world--has a Federal paid family and medical leave policy to truly support working families. I will tell my colleagues that I find this issue particularly vexing because North Dakota competes with the rest of the country for workforce. If you go to California, this benefit is extended through a State system. If you go to Rhode Island, this benefit is extended through a State system. New York is pursuing a State system. Certainly States with large populations, like New York and California, have the economies of scale to offer this benefit in a State-based system. Guess what happens to a State that only has just over 700,000 people in population. Think about the percentages that we would need to run a State-based program. We need a national solution to this problem. I know a lot of people are saying: Well, the States are doing it; they are the laboratories of experimentation in this great democracy. But the fundamental problem is that for States like mine that don't enjoy economies of scale, this will not be a reality for the women, for the families in my State who want to have children. Also, daycare is the second issue that makes this so difficult. We need to make sure that people know they are going to have a guaranteed income for those first three months of child-raising. Why is that important? It is important because we know that as a matter of physiological development, that bonding period of time with your parents during those early months is so critical. When children get detached from their parents during those early months, they can suffer psychological effects that will last forever. So we need to get this done. Let's talk about what proposals are on the table. I don't want to be critical because I think it is wonderful that this issue has come to this body, not only on this side of the aisle, to talk about the need for paid family leave. But, once again, where we applauded the Family Medical Leave Act, we left too many people behind. We can't do that again. That is why it is really important that we analyze the proposals that are out there. I know that along with my good friend, the Senator from New York, we have been having long and extensive conversations with many Republicans about this issue, as well as with many folks in the White House, about the need for Federal paid leave. Over the past few days, details have come out about a Republican plan that would have new parents do something we should never do, which is take money out of our retirement system. The plan suggests that new parents take money out of their Social Security benefits. Think about that. We have a retirement crisis in this country. Too few people have anything other than Social Security to live on in their older years, and now we are saying: Guess what. Borrow against that. Get your Social Security to help you pay for what happens today, and then hope upon hope that you will have enough money to retire in the future. It is, quite honestly, the wrong direction. This plan does not, in my opinion, support families. It would not help most working families and those who could use it. It would force them to choose between caring for a newborn or a family member or their retirement savings. I think it is likely that people would take that option, but jeopardizing their future retirement is not a choice they should have to make. Additionally, just think about this: Women already get, on average, 20 percent less in Social Security benefits than men. Why is that? It is that way because of the pay gap we have in this country--another issue we could discuss, but we are not going to do that today. Social Security is a critical retirement security plan in this country, and for far too many families, it is the only thing they can rely on in retirement--something we need to fix--and we don't need to exacerbate it by complicating the Social Security retirement crisis with the problem of paid family leave. So I am here to advocate for a bill that Senator Gillibrand has introduced and I have proudly cosponsored called the FAMILY Act. It is a real Federal paid leave policy that I think we desperately need. We need to support working families, and this bill does, because it would make that promise of family paid leave possible. Our bill provides 12 weeks of partially paid leave for workers dealing with serious health issues of their own, including birth and adoption of children, or for family members. Our bill would create an affordable, effective earned benefit that both employers and employees could and would contribute to. For employees, the paid leave benefit would always apply to them no matter where they live. It is transportable, which is so important in this new gig economy. Almost half of North Dakota workers do not qualify for a single--now, I want my colleagues to remember this--work day where they could get sick, and only about one-third of North Dakota's workers are eligible for and can afford unpaid leave. For them, the FAMILY Act would make all the difference. No family should have to choose between a loved one and their job. No family should have to make the choices that they have to make today, frequently delaying raising a family because they simply can't afford it when they put pen to paper. Our bill also levels the playing field for businesses. I think this is an important part. I want people to understand this. If you are a small firm in North Dakota that does coding--let's say you are a software firm and you get an exciting new product and you want to generate excitement within your business. You want to recruit the best and the brightest coming out of our universities, coming out of our tech schools, but you are competing against Microsoft and you are competing against Google and you are competing against all of those companies that can afford to provide that benefit. Many, many of the small businesses in my State have said: Help us compete; help us compete for the best and brightest. When those benefits are offered to workers, where are they going to go if they want to raise a family? They are going to go not just to where the pay is better, but they are also going to go where they can get the benefit of paid family leave. It is critically important that small businesses be enable to enjoy the economies of scale. If you work in retail and you say ``I want to exercise my right to paid family leave or my right to family leave, and I am going to go,'' the employer is going to protect the job, but they can't afford to pay that person when they are paying another person in a small business. If my colleagues can think about this the way I think about it--we have unemployment insurance for a reason. We have unemployment insurance because temporarily people have to get out of the workforce because maybe their job no longer exists or they have lost their job for some reason. We give unemployment benefits to help bridge them to the next job and to keep them in the workforce. As a condition of that, we ask them to continue to look for a job, and, hopefully, we provide some services in their search for a job. Think about the unemployment system. Who here would repeal unemployment insurance? It is temporary. This is an extension. Think about it like we would think about unemployment insurance. If something happens in your family--you have a baby, your mother gets cancer, your husband gets cancer--you can't afford to take time off, but you can't afford to leave them alone. So what do you do? You exit the workforce, potentially qualifying for food stamps, potentially qualifying for government benefits. This benefit keeps people in the workforce. When I talked about this benefit in Dickinson, ND--not exactly a hotbed of liberalism--and explained why I thought it was important, a woman came up afterward and said: Do you know what I really like about your plan? I said: That we are going to help families? She said: Well, that is important. But I really like that it keeps people in the workforce, that they have a job when they come back, and that they are able to bridge that and not leave employment. Think about the economic disruption when somebody can't keep an employee because of these challenges. Retraining costs are high. When this started in California, this was not yet again another big government program. People would talk about it that way. Satisfaction levels with this program from every end of the spectrum in California are off the charts--with employers and employees, with small business and with large business--because they know that the retraining and retooling they would have to do for employees is expensive, and they want to keep the good employees that they have. Let's do something for families. Let's actually do something. Let's not just promise it. Let's not mortgage our retirement for it. Let's do something for families and actually take this burden and say: We are going to help you. If you want to have a child, it is 3 months of paid family leave. It is not at your total salary. It will not be the full amount, but we are going to help you if your mom gets sick with cancer so you don't have to leave your job to take care of her. We are going to work with families to make this happen. I guarantee that this will be a program that will be remembered the way we remember other great programs, such as Social Security, Medicare, and unemployment insurance. I urge my colleagues to take a look at the FAMILY Act. Take a look at all of the good economic arguments that go with it--not the heartwarming arguments, which I think we can make, but the economic arguments about why this makes sense for American business and for the American economy. I yield the floor.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I want to congratulate the students, faculty, and parents of Longfellow Elementary School, located in Fargo, ND, on being awarded the 2017 National Blue Ribbon School Award. Founded in 1982, the National Blue Ribbon Schools Program recognizes public and private elementary, middle, and high schools where students perform at very high levels or where significant improvements are being made in students' academic achievement. A National Blue Ribbon Schools flag overhead has become a mark of excellence in education recognized by everyone from parents to policymakers in thousands of communities. Since the program's founding, the U.S. Department of Education has bestowed this coveted award to more than 8,500 of America's best schools. Longfellow Elementary School serves nearly 370 students and was one of three schools in North Dakota to be designated as an Exemplary High Performing School under this award. Receiving recognition as a National Blue Ribbon School signifies the hard work and dedication of the educators, students, and parents involved, and I have no doubt students at Longfellow are on a path to success. At Longfellow Elementary, every educator serves multiple roles in their students' day-to-day activities. To best support its students, families are heavily involved in the school and its functions. Unlike many schools in the Nation, Longfellow Elementary enjoys strong engagement and support from their students' parents, making them a shining example of how our public schools can thrive through robust community support. Longfellow is one of two elementary schools in the Fargo Public School District that provides an educational setting for students with a wide range of impairments that require extra attention. The multiple impairments magnet program provides speech, occupational, and physical therapy services to students. Cass County Public Health supports the program with regular visits by a nurse, and a music therapist visits with the class two times a week. It is through the Longfellow community that the school has been able tailor the teaching to their students' needs. The Longfellow's vision includes, ``Equitable opportunities will ensure a quality educational experience to stimulate and support all students in their intellectual, social, and personal growth.'' This vision statement embodies all that Longfellow Elementary is working to accomplish by including parents and family in their discussions. I wish the very best to the community of Fargo and congratulations to all engaged at Longfellow Elementary for achieving this high honor. Thank you for your commitment to our children and leaders of tomorrow.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I want to congratulate the students, faculty, and parents of Legacy Elementary School, located in West Fargo, ND, on being awarded the 2017 National Blue Ribbon School Award. Founded in 1982, the National Blue Ribbon Schools Program recognizes public and private elementary, middle, and high schools where students perform at very high levels or where significant improvements are being made in students' academic achievement. A National Blue Ribbon Schools flag overhead has become a mark of excellence in education recognized by everyone from parents to policymakers in thousands of communities. Since the program's founding, the U.S. Department of Education has bestowed this coveted award to more than 8,500 of America's best schools. Legacy Elementary School serves nearly 540 students and was one of three schools in North Dakota to be designated as an Exemplary High Performing School under this award. Receiving recognition as a National Blue Ribbon School signifies the hard work and dedication of the educators, students, and parents involved, and I have no doubt the students at Legacy are on a path to success. The school has received the Let's Move Active Schools National Award and the Star Award from their local Dakota Medical Foundation. These awards show Legacy's dedication towards promoting health and wellness among students and staff. Such health strategies include building wide flexible seating and personalized learning spaces, movement built into their curriculum, along with multiple health snack and food options and initiatives, which work to build both short- and long-term healthy habits for students. As school leadership states, ``At Legacy, our school Mission is: Educate. Our school Vision is: Everyone Learns.'' It is through this dedication that Legacy helps students excel academically, physically, emotionally, socially, and culturally. The school does so by often writing their own curricula to ensure they teach what fits students' needs and implementing programs that grow skills such as critical thinking, perseverance, problem solving, and sportsmanship. The innovation shown by the faculty at Legacy serves as a model that all schools can look towards when finding new ways to promote student growth and development. The West Fargo Public Schools' mission statement reads, ``Educating today's learners for tomorrow's world.'' This mission embodies all that Legacy Elementary is working to accomplish by looking at the needs of each individual student, as well as providing a healthy and respectful learning environment that breeds success. I wish the very best to the community of West Fargo and congratulations to all engaged at Legacy Elementary for achieving this high honor. Thank you for your commitment to our children and leaders of tomorrow.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I want to congratulate the students, faculty, and parents of Kindred Elementary School, located in Kindred, ND, on being awarded the 2017 National Blue Ribbon School Award. Founded in 1982, the National Blue Ribbon Schools Program recognizes public and private elementary, middle, and high schools where students perform at very high levels or where significant improvements are being made in students' academic achievement. A National Blue Ribbon Schools flag overhead has become a mark of excellence in education recognized by everyone from parents to policymakers in thousands of communities. Since the program's founding, the U.S. Department of Education has bestowed this coveted award to more than 8,500 of America's best schools. Kindred Elementary School serves nearly 460 students and was one of three schools in North Dakota to be designated as an Exemplary High Performing School under this award. Receiving recognition as a National Blue Ribbon School signifies the hard work and dedication of the educators, students, and parents involved, and I have no doubt the students at Kindred Elementary are on a path to success. Kindred Elementary hires and retains highly effective teachers that operate using professional learning communities. This allows school staff to collaborate on a daily basis and develop methods for continuous improvement based on student data and progress. To support its students, the school uses a multitiered approach called response-to- intervention, RtI, that offers timely support to students' academic and behavioral needs. The RtI team consists of classroom teachers, special education teachers, speech and occupational therapy staff, and other key staff. Kindred's innovative approach and commitment to developing student potential has resulted in high student outcomes that we can all be proud of. School leadership states the ``school district thrives because of the strong relationship between students, their families, community members, and the school district staff.'' To further the communal relationship, the school offers enrichment opportunities through lyceums, field trips, and guest presenters and performers. It is through this dedication that the school provides a tailored education that allows student, staff, and faculty to succeed. The Kindred Public School District's mission statement reads, ``Improving tomorrow, by learning today.'' This mission embodies all that Kindred Elementary is working to accomplish by looking at the needs of each individual student, as well as providing a safe and respectful learning environment that breeds success. I wish the very best to the community of Kindred and congratulations to all engaged at Kindred Elementary for achieving this high honor. Thank you for your commitment to our children and leaders of tomorrow.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I rise today to discuss a couple of pressing issues regarding our healthcare system and to ensure that Americans are aware of some critical deadlines for their health options in the marketplace. It is that time of year. Healthcare open enrollment has started, and Americans across the country can sign up or change their healthcare plans to make sure they are getting a plan that works best for them and their families. I have long said that the health reform law, otherwise known as ObamaCare, is not perfect, and I have been pushing since I have been here to make it work better for North Dakota families and small businesses. But there are many pieces in that healthcare law that are helpful, and I wish to make sure that Americans and North Dakotans take advantage during this open enrollment period. Every individual and family should be able to get access to affordable, quality healthcare, and no one should have to go bankrupt to pay for healthcare for a child with a disability, a sick family member, or just an emergency that you never thought could happen. That is why I am encouraging everyone to please make sure you explore your options and sign up for healthcare coverage. It is more important than ever that folks take advantage of this open enrollment period early because there are many changes this year that, unfortunately, make it more difficult for individuals and their families to sign up for health insurance. Even if you already have a plan, it is worth checking out healthcare plans, as these prices change from year to year. First, open enrollment today is a month and a half shorter this year than it has been in the past. Open enrollment is from November 2--right now--until December 15. That is just 45 days. Do not wait to check this out. It is best if you go today to find out if there is a better plan for you or if you need to secure health insurance on the marketplace. Second, the administration has significantly reduced funding for in- person assistance, called navigators, who help individuals and families sign up for healthcare coverage. This action is leaving millions of Americans and thousands of North Dakotans without the critical help they need to understand their options and enroll in meaningful healthcare coverage. I want to make a point here. For those of us who in the past have always had the option of getting healthcare coverage through an employer, there is always someone in that employment office, in the payroll office, or in human resources who helps you through. This is not unique in needing this assistance. It is not unique to the marketplace. It is access and information that you have through your employer, if you are getting your insurance through your employer. The idea was that the same opportunity for information should be made available in person on the marketplace, but it is not. So we have to try and fill in those gaps. Because we have these gaps, we are in many ways seeing a number of cutbacks and a number of folks not getting access to the information they need. In fact, the Great Plains Tribal Chairmen's Health Board does not have enough funds to operate as a navigator, and they will not be able to help North Dakotans sign up for coverage as they have done in previous years. Another navigator in my State, Minot State University, has had its Federal funds cut by over 96 percent. Since 2013 the uninsured rate in North Dakota has been reduced from 11 percent to 8 percent, in large part because of the work of these navigators. The navigator grantees in my State have provided an invaluable service by guiding families through the process of determining the best private health insurance coverage for them, as well as through traditional Medicaid and Medicaid expansion application processes. Many North Dakotans who sign up for coverage qualify for Federal assistance to help afford that coverage. So it is vitally important that they understand Medicaid, that they understand Medicaid expansion, and that they understand the tax implications of the plans they are selecting. But even those numbers that show the decrease in uninsured in North Dakota don't tell the full story. Not only have navigators responded to daily inquiries both during and outside of the open enrollment period, but they have identified and responded to the challenges of increasing enrollment, particularly in rural and hard-to-reach areas of the State that are less likely to have access to coverage through an employer. Slashing funding for navigators also has implications for Indian Country. The Indian Health Service has had challenges delivering quality care to Native Americans in my State and certainly in our region. But those issues have lessened as more Native Americans have enrolled in traditional Medicaid, Medicaid expansion, and private health insurance, enabling these families to access quality, affordable healthcare to stay healthy. Thanks to the increase of third-party payments, we are no longer limited to life-or-limb care at Tribal IHS facilities in the Great Plains service area. Adding to the turmoil of the enrollment process, the administration also announced that it is cutting off Federal funding that helps make healthcare affordable for families, known as cost sharing reduction payments. As a result, many individuals and families will see their premiums skyrocket by double digits. Due directly to this decision and the uncertainty it has injected into our healthcare system, one insurer has exited the healthcare marketplace in North Dakota and another has reduced its health insurance plan offerings, leaving many counties in my State with only one insurer for consumers to choose from. Ironically, North Dakota was one of the best covered States in terms of options and choices. That option and that source of pride has been diminished as a result of the lack of consistency with cost sharing reduction payments. A recent report from the nonpartisan Congressional Budget Office said that if the administration stopped paying the cost sharing reduction payments, as it has now done, there would be serious consequences for individuals and families across the country. The report said families' premiums would jump about 20 percent, many families would be left without health insurance options as the lack of payment would force many insurers to leave the market, and it would also add $194 billion to the deficit over a decade. Despite these efforts to sabotage the marketplaces and jeopardize access to coverage for families, we have fortunately seen a surge of encouraging enrollment numbers in the first week of enrollment. But the American public deserves better, and I will do everything I can to ensure that consumers know their options, that consumers are connected with opportunities for meaningful coverage, and that they are provided certainty in the future about healthcare costs. On November 1, I had launched a new page on my website, heitkamp.senate.gov, to help provide resources and enrollment information to North Dakotans. I sincerely hope folks who are looking to buy health insurance on the marketplace in North Dakota take advantage of that website. Access to affordable quality healthcare is a must, and I am proud to have worked with a group of Republican and Democratic Senators, led by Senators Alexander and Murray, to reach a deal to offer some immediate fixes to make healthcare more affordable and accessible in North Dakota and across the country. Our bill would specifically address many of the new challenges that face folks during open enrollment. The deal we unveiled last month would provide certainty for insurers and customers by restoring the cost sharing reduction payments for 2 years and restoring Federal funding for outreach and enrollment efforts in States, including the navigator services that I talked about earlier. It incorporates an idea that I have been championing for many years, which is to create a lower cost copper plan with lower premiums and higher deductibles to increase coverage options for young, healthy families, where they aren't so much worried about the day-to-day costs of healthcare but that catastrophic event that could throw them into a lifetime of poverty. The agreement would also provide flexibility for States to continue to explore their options to deliver the best healthcare options to their citizens. This recognizes that one size does not fit all and that we need to have more flexibility for States to experiment and to provide the kind of quality of care and the kind of care options that work best for their State. On top of having significant bipartisan support, there is a bonus. The bonus is that CBO and the Joint Committee on Taxation estimate that enacting the legislation would reduce the deficit by $3.8 billion without substantially changing the number of people with health insurance coverage. Now Congress needs to pass our bill. I have long said there are good parts of the healthcare reform act and parts that need to be fixed. Our bipartisan deal is an important step to help families afford healthcare coverage so the health reform law works better for North Dakotans. How rare is it in this body to have this many people come together to propose one piece of legislation? I know that if you put this bill on to the floor tomorrow, it would easily pass with over 60 percent of the Senate. We need to get this done. We need to get it done to ensure the American public that we are serious about responding to their concerns about healthcare but that we are also serious legislators who can, in fact, fix the problems that we have in this country. This isn't everything that we have been working on, but it certainly is the most important and the highest priority to pass the Murray- Alexander bill. But there are other proposals to improve healthcare that I am working on. I recently introduced a bill to delay the health insurance tax for 2 years and make coverage more affordable for the 156 million consumers across the country impacted by the fee. It would also make the tax deductible moving forward, providing more certainty for families to plan into the future. Reducing the impact of the health insurance tax--a fee that directly impacts the healthcare affordability for families and small businesses--has had broad, bipartisan support. In 2015 Congress passed a 1-year delay of the fee. This delay benefited consumers, seniors, employers, State employees, and Tribes. The average premium reduction from that delay of the fee was 3 percent. If we think about the health insurance tax and we think about the sales taxes that many States enact, many States will tell you we don't enact sales tax on the necessities of life, whether it is food or whether it is electricity. Clearly, this is a necessity of life, having this health insurance. This health insurance tax is nothing more than a regressive sales tax on premium costs, and I believe we need to find a better and more commonsense alternative. Another commonsense bill that I have introduced to help make healthcare more affordable for middle-income families is a bill that would address what I call the current cliff problem on premium assistance that many middle-class families and seniors face when they earn above 400 percent of the Federal poverty level, putting affordable care out of reach. Right now, those earning just a nominal sum over--$1 over 400 percent of the Federal poverty level, which is $47,550 for an individual and $97,200 for a family of four--are no longer eligible for any premium support to make health insurance more affordable. This perhaps is one of those issues that I have heard more about than almost any other issue in the Affordable Care Act. What my bill would do is to get rid of the cliff and instead insert a slope. The bill would enable more young, healthy families to be able to obtain affordable healthcare coverage while diversifying the insurance pools, and it would make sure seniors with high medical costs aren't forced to lose those hard-earned retirement savings or go without care. Smoothing out that cliff will make health insurance more affordable, will make this bill more responsive to our middle-class taxpayers and middle-class families, and will provide some certainty for these families as they look at the high cost of healthcare and insurance premiums into the future. I also cosponsored a bill to provide stability in the insurance marketplace by making the current reinsurance program for individual health insurance market permanent. It would be similar to the successful programs used to lower premiums and spur competition in the Medicare Part D Program. This reinsurance program would provide funding to offset larger than expected insurance claims for health insurance companies participating in State and Federal insurance marketplaces, and it would encourage them to offer more plans in a greater number of markets, improving competition and driving down costs for patients and families. It is that catastrophic cost, which is unpredictable for the actuaries, that drives up high cost. If they know that catastrophic cost above a certain amount is subject to a reinsurance plan and those costs are shared more broadly than just within that system, the healthcare that they can provide and the insurance commissioners can secure with a reasonable rate would be greatly reduced. Lastly, another critical program that ensures access to coverage throughout the country and in North Dakota is the Children's Health Insurance Program, or CHIP. I have to tell you, I know many, many families who, without CHIP and without their ability to find that temporary opportunity to use CHIP to insure their children, would be bankrupt today. They would have incurred healthcare bills just from a simple fall off a swing set, and they would be spending a lifetime trying to figure out how they are going to pay or they would be finding their way into the bankruptcy court. CHIP is a program that has been used since the late 1990s, and more than 2,000 North Dakota children currently rely on it for affordable healthcare. It provides a critical bridge between Medicaid and private insurance coverage for children. We have to act fast to reauthorize CHIP and let thousands of children across the country who are on CHIP and their families know that we care about them, that we are standing up for them, and that we are not going to leave them behind. Unfortunately, the authorization for this critical and lifesaving program expired at the end of September. Without action from Congress, some States will already run out of Federal funding before the end of the year. Some already have and require emergency funding from the Centers for Medicare and Medicaid Services to shore up their programs so that they can still provide that continuous coverage while we fail to act here in the Congress. While my State of North Dakota is not scheduled to run out of funding until April of next year, this is not a way to administer an ongoing and critical healthcare program. We need to get this program reauthorized now before it is too late and we have unnecessarily hurt American children and have created unnecessary unpredictability for families who need and have found some incredible benefit in covering their children with this program. The Senate Finance Committee has marked up bipartisan legislation, the Keep Kids' Insurance Dependable and Secure Act, to extend authorization for the program for 5 years. Congress needs to act now to make sure these families know their children have dependable and secure coverage. No parent and no family member should have to wonder if their children will get critical care. Put yourself in their shoes. Since I came to the Senate in 2013, I have said there are parts of the healthcare law and the healthcare system that need improvement to make sure it is working for hard-working North Dakotans and hard-working Americans. As I have outlined, these are some tangible, commonsense policy proposals that have strong bipartisan support, and we can, in fact, make this system better. We can, in fact, tackle this challenge of healthcare, and then we can roll up our sleeves and reduce costs and make healthcare more affordable and less costly in this country. We can do all of that. We have a country and a group of American citizens who are counting on us to do our job to make sure that, into the future, they will have the certainty that they need, the predictability that they need, to get their healthcare coverage and to make sure that their families will never have to worry about having to file bankruptcy because a child has fallen off of a swing set. I yield the floor. I suggest the absence of a quorum.

Ms. HEITKAMP

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

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, pursuant to section 904 of the Congressional Budget Act of 1974, I move to waive section 305(b)(2) of that act for purposes of the pending amendment, and I ask for the yeas and nays.

Ms. HEITKAMP. Mr. President, as we move forward on tax reform, I think the one great potential for absolute agreement is that we should lower the burden for middle-income taxpayers, and as we move forward, the one thing we absolutely should not do is in any way increase the tax burden for middle-income taxpayers. This amendment is about guaranteeing that no one who makes under $250,000 sees his taxes increase in any kind of legislation, including in any tax reform proposal. I have heard from teachers, nurses, and veterans. They all want to know what this means for them. To guarantee people an absolute bright line that their taxes will not go up is absolutely essential as we move forward. I urge a ``yes'' vote on this amendment.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I rise today to discuss and bring awareness to the obligation that we have to never forget what is happening to way too many Native American women in this country. For too long, the disproportionate incidents of violence against Native American women have gone unnoticed, unreported, or underreported, and it is time to address this issue head-on. That is what I intend to do today and in the remaining days of my time in the Senate, until we actually get a bill passed. There is no official database or requirement for information collection regarding the number of missing and murdered Native women. In most cases, the only records of them are records that have been provided to us by the families and friends of the victims. It is critical that Congress push the U.S. Department of Justice and the FBI to work with Tribal communities to come up with culturally appropriate protocols for responding to cases of missing and murdered Native women. I would like to take this time to honor Savanna LaFontaine-Greywind, whose story has been told on the news in North Dakota and nationally and who has been on the forefront of my mind since introducing this bill. On August 19, Savanna, a 22-year-old member of the Spirit Lake Tribe, who was 8 months pregnant, went upstairs to her neighbor's apartment in Fargo, ND, after being invited to try on a dress for alterations. While she was there, what awaited her in that apartment were truly horrific acts of violence. Although Savanna's baby daughter survived and is now safe with her father and grandparents, that was the last time anyone who loved Savanna saw her alive. After 8 days of searching for Savanna by the family and the community, her body was finally found by chance by kayakers in a nearby river. Her body was wrapped in plastic and duct taped. Her death was an incredible tragedy and, unfortunately, one that happens way too often to Native women. While the news of Savanna's death was heard around the world, thousands of indigenous women are murdered and disappear each year, with many of those cases being ignored or forgotten. Over my decades in public service, I have worked with Tribal communities on issues that involve violence against Native women. In response to those talks and to this latest tragedy, today I am introducing legislation that would help tackle the barriers to bringing justice for missing and murdered Native women across the country. My bill, which is named after Savanna, would work to improve Tribal access to Federal databases for missing persons. It would promote interjurisdictional collaboration by establishing protocols for responding to cases of missing and murdered Native Americans, and it would require the collection of data related to missing and murdered Native women. Native women are an inherently vulnerable population whose voices are still not heard by most people in power. Across rural North Dakota, women living on reservations face unique challenges when dealing with violence. Lack of access to emergency services, lack of access to law enforcement officers, lack of access to an AMBER Alert system, and confidential victim services that are not provided--these all act as barriers to women getting the help that they desperately need. Unfortunately, there is no official database or mandated database collection on the total number of missing and murdered Native women in our country. This has added to not knowing what the actual magnitude of this epidemic really is and has resulted in several Tribal members sending me stories and handwritten lists of the names of missing and murdered women that people have gathered just from their collective memory. I would like to share some of the stories that I have been so honored to receive from family members. Telling these stories--and giving me the ability to tell these stories--is not easy because every time you tell the story, you relive the story. These tragedies still hurt deeply. Even years after the murder, they still absolutely relive that experience. I know they have given me these stories to tell for one simple reason: because they pray and they hope and they dream that giving me these stories may change the outcome for some other family. I am going to start by talking about these wonderful women--these beautiful women. Up at the far right-hand corner with her beautiful baby is Stella Marie Trottier-Graves. Stella Marie was born and grew up in Belcourt, ND, and was a member of the Turtle Mountain Band of Chippewa. She spent many years traveling the world with her husband, who served in the U.S. Air Force, and their three children. The family lived in Florida, Germany, Japan, and Arizona. Everywhere they went, Stella quickly made friends and proudly shared her Chippewa culture. She was loved and adored by all who met her for living an adventurous and fearless life. In July 2009, Stella and her family moved back to Belcourt, ND, and she started to attend Turtle Mountain Community College. On September 16, 2010, Stella and her cousin were at the local bar when she decided to stay behind with other people they knew. According to witnesses, Stella left with another couple to continue the evening out. Stella's body was later found in a male Tribal member's pickup in an open field on the reservation. It wasn't until 13 days later that the family was officially notified by law enforcement of Stella's death. Throughout the investigation, there were a lot of rumors and misinformation, which made it difficult to find the murderer or the murderers. People who were with Stella the night of her death said that they were never questioned, and information provided was never followed up on. No one has ever been charged or convicted for this murder, and the last hours of Stella's life remain unknown. Stella was an incredible woman who was loved by all who knew her. Her family, her children, and her Tribe deserve justice. Monica Wickre is pictured here with those beautiful earrings and the red shirt. Monica was a 42-year-old mother of three who was born and raised in Belcourt on the Turtle Mountain Band of Chippewa reservation and lived near Aberdeen, SD. After a night out with friends on April 7, 1993, Monica never returned home. Her relatives grew concerned when they had not heard from or seen Monica for several days. Eventually, the family filed a missing persons report and started to talk to friends and neighbors. The detective assigned to the case worked closely with the community and the family and assured them he was working diligently on this case. In June of that year, a canoeist found Monica's badly decomposed body in the James River outside Aberdeen. Throughout the next several years, new detectives were assigned to the case, each having to basically start over and work with limited notes, interviews, and evidence from the previous investigators. A couple of times, the police told the family that they had a suspect or were close to arresting someone for Monica's murder, but there was never enough information to charge the suspect. This has resulted in nearly 25 years of heartache for Monica's family and her friends. Monica's family wants justice for their daughter, sister, and mother, and they all want closure. Although the case is no longer active, the family continues to bring awareness about Monica's case in the hope that someone will come forward with information that will, in fact, help solve it. Monica Lisa Two Eagle is the woman with the dark hair in the floral print shirt. She was a member of the Rosebud Sioux Tribe and one of 14 children. She was kind, caring, and athletic. In the winter of 1979, Phil Two Eagle saw his sister Mona Lisa, who was in her early twenties, leave the siblings' house and get into a red-and-white pickup with a couple of men. Mona Lisa never returned. In the following days, the family and local law enforcement searched for her on horseback. Taking it upon themselves, they searched for her on horseback. About 2 weeks after she went missing, Mona Lisa's father and brother found her frozen in a pasture near their home. She had been beaten, possibly raped, and left alone in a blizzard. Rumors ran wild that family and law enforcement tried to solve the crime, but, even to this day, no one was ever convicted or even charged. The two men who were last seen with Mona Lisa all those years ago are still running free, while the family lives every day with the lack of justice. Lakota Rae Renville, the woman in the black-and-white photo, is the last victim I want to talk about. I want to thank her family, who are here today and who have honored me and trusted me with her memory. I want to help them understand how grateful I am, but I also want them to know that sharing her story will help raise awareness about the crimes of missing and murdered indigenous people. Lakota was a member of the Sisseton-Wahpeton Dakota Bands of North and South Dakota, who, despite being shy and reserved, had a solid group of friends who supported her and even helped her excel in school. After graduation, Lakota spent time taking care of her family, especially her nieces and nephews. In 2005 Lakota met a man online and unexpectedly relocated to Missouri, unbeknownst to her family. With most details still unknown 12 years later, the family is left with more questions than answers. What they do know is that she was forced into sex trafficking and manipulated against her will. In October of 2005, Lakota's family was called and told that her body was found badly beaten, wrapped in carpet padding and a blanket in an open gravel pit in Missouri. Local investigators brought in and subsequently let go dozens of suspects and, to this day, have not brought her murderer to justice. Lakota was never given a chance to become a mother or pursue that bright future that surely lay ahead of her. She was robbed of a life she had yet to experience, a life that was certain to be filled with love from her family and deep appreciation from her family. These are not isolated cases. This goes on every day in America. I want to make a point of how discouraging it, so many times, when you see events unfolding where it may be that a young girl goes missing in a Caribbean island and the world is turned upside down looking for her or when we hear a story of someone who comes from maybe a more affluent and wealthy family who goes missing and we turn over every stone to find them. Yet that is not the story for very many indigenous women. When you look at the importance of what we do today, probably the most important thing we can do is to tell these stories, and from telling these stories we have an opportunity to really change. We can't ignore that frequently for Native people, they are not wrong to believe that they are the forgotten people of this country. Way too often, the first Americans become the last Americans. Under the Savanna's Act, the Attorney General, in cooperation with the Secretary of the Interior, must consult with the Tribes on how to improve Tribal access to Federal criminal information databases, such as the National Crime Information Center and the National Missing and Unidentified Persons System. We need to ensure that Tribal law enforcement has up-to-date information on missing Native women and better communication--in fact, essential--with Federal, State, and local law enforcement agencies and Tribal law enforcement agencies so cases like the ones you have heard of today don't go unnoticed or uninvestigated. Jurisdictional issues are a huge barrier in Indian Country to responding to and prosecuting crimes committed on Tribal lands. Standardized protocols must be established in order to give a quicker response to Native women going missing. The complexity of jurisdiction on Tribal lands can slow down an investigation, but it is not an excuse. It can waste crucial time at the beginning of an investigation or a case, but it is not an excuse. If we do not act rapidly, we know we lose precious time to prevent homicides and to bring a woman safely home and help apprehend the perpetrators. In one case study alone done by the National Institute of Justice, 97 percent of Native women experience violence by a non-Native perpetrator. This number emphasizes what I have long said, that historical trauma is a major factor of violence against Native women, and perpetrators feel that Tribal lands give them a free pass from the law. This can no longer be tolerated, and jurisdictional issues must be addressed. It cannot be the excuse for inaction. Although we don't know the total number of missing and murdered Native women, it is clear, from all of the stories and from the statistics that we do have, that the rates at which Native American women experience violence is intrinsically related to the likelihood of their going missing, being murdered, and forced into sex trafficking. Here are just some of the statistics collected by the National Institute of Justice, the Government Accountability Office, and the Centers for Disease Control and Prevention regarding violence against Native women. In 2016, 5,712 cases of missing Native women were reported to the National Crime Information Center, and 125 of those cases were in my State of Dakota alone. On some reservations, Native women are murdered at more than 10 times the national average. I want to repeat that. On some reservations, Native women are murdered at more than 10 times the national average. American Indians and Alaskan Natives are two times more likely to experience rape or sexual assault compared to all other races. In 2010, we found that the U.S. attorneys declined to prosecute nearly 52 percent of violent crime that occurred in Indian Country. Homicide is the third leading cause of death among American Indians and Alaskan Native women between 10 and 24 years old. These high rates of violence, including domestic violence, sex assault, and human trafficking, must stop. We must work together to combat domestic violence and human trafficking in Indian Country. Just last week, the Indian Affairs Committee held a hearing to discuss the lack of services provided for Indian Country regarding the horrific acts of violence and human trafficking of Native women. Just yesterday, while questioning one of the officials at the Department of the Interior about the need to do training in human trafficking at our casinos, he simply said: I thought you were going to ask me about Indian gaming. I quickly said: I am asking you about Indian gaming because all of this works together. If we do not work together in every institution of the Federal Government, in every institution of the State government, and in every institution of Tribal government, we will never make progress in providing the security that we have in this building, and the security that we enjoy as White women will never be realized for women living on the reservation in Indian Country. We cannot let this continue. There are countless more stories like Savanna's, Stella's, Mona Lisa's, Monica's, and Lakota's that we will never know. It is time for Congress to recognize this epidemic and take action to prevent these stories and find out just how many stories there really are. It is time to give voice to these voiceless women. It is time to bring their perpetrators to justice and give a voice to the families who are struggling even today--sometimes decades later--to understand how this can happen in America. They seem to be second-class citizens. I think that is what we know. I am working with very many of my colleagues on the other side. This isn't a partisan issue. I have been joined by my wonderful colleague from the great State of Alaska. I think the first time we ever met, this was the topic of conversation: What is the security for Indian children, security for Indian women, and Alaskan Native women? We knew because both of us have traveled extensively in our States and spent a lot of time in the indigenous populations. When family members ask us why this is happening, we frequently don't have an answer. I know that in my State jurisdictional issues provide some barriers to actually getting this done, but that is an excuse. We need to do better. With that, I want to yield the floor to my wonderful colleague from the great State of Alaska, who once again is joining me and leading her side of the aisle to bring attention to these issues.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I rise today to discuss and bring awareness to the obligation that we have to never forget what is happening to way too many Native American women in this country. For too long, the disproportionate incidents of violence against Native American women have gone unnoticed, unreported, or underreported, and it is time to address this issue head-on. That is what I intend to do today and in the remaining days of my time in the Senate, until we actually get a bill passed. There is no official database or requirement for information collection regarding the number of missing and murdered Native women. In most cases, the only records of them are records that have been provided to us by the families and friends of the victims. It is critical that Congress push the U.S. Department of Justice and the FBI to work with Tribal communities to come up with culturally appropriate protocols for responding to cases of missing and murdered Native women. I would like to take this time to honor Savanna LaFontaine-Greywind, whose story has been told on the news in North Dakota and nationally and who has been on the forefront of my mind since introducing this bill. On August 19, Savanna, a 22-year-old member of the Spirit Lake Tribe, who was 8 months pregnant, went upstairs to her neighbor's apartment in Fargo, ND, after being invited to try on a dress for alterations. While she was there, what awaited her in that apartment were truly horrific acts of violence. Although Savanna's baby daughter survived and is now safe with her father and grandparents, that was the last time anyone who loved Savanna saw her alive. After 8 days of searching for Savanna by the family and the community, her body was finally found by chance by kayakers in a nearby river. Her body was wrapped in plastic and duct taped. Her death was an incredible tragedy and, unfortunately, one that happens way too often to Native women. While the news of Savanna's death was heard around the world, thousands of indigenous women are murdered and disappear each year, with many of those cases being ignored or forgotten. Over my decades in public service, I have worked with Tribal communities on issues that involve violence against Native women. In response to those talks and to this latest tragedy, today I am introducing legislation that would help tackle the barriers to bringing justice for missing and murdered Native women across the country. My bill, which is named after Savanna, would work to improve Tribal access to Federal databases for missing persons. It would promote interjurisdictional collaboration by establishing protocols for responding to cases of missing and murdered Native Americans, and it would require the collection of data related to missing and murdered Native women. Native women are an inherently vulnerable population whose voices are still not heard by most people in power. Across rural North Dakota, women living on reservations face unique challenges when dealing with violence. Lack of access to emergency services, lack of access to law enforcement officers, lack of access to an AMBER Alert system, and confidential victim services that are not provided--these all act as barriers to women getting the help that they desperately need. Unfortunately, there is no official database or mandated database collection on the total number of missing and murdered Native women in our country. This has added to not knowing what the actual magnitude of this epidemic really is and has resulted in several Tribal members sending me stories and handwritten lists of the names of missing and murdered women that people have gathered just from their collective memory. I would like to share some of the stories that I have been so honored to receive from family members. Telling these stories--and giving me the ability to tell these stories--is not easy because every time you tell the story, you relive the story. These tragedies still hurt deeply. Even years after the murder, they still absolutely relive that experience. I know they have given me these stories to tell for one simple reason: because they pray and they hope and they dream that giving me these stories may change the outcome for some other family. I am going to start by talking about these wonderful women--these beautiful women. Up at the far right-hand corner with her beautiful baby is Stella Marie Trottier-Graves. Stella Marie was born and grew up in Belcourt, ND, and was a member of the Turtle Mountain Band of Chippewa. She spent many years traveling the world with her husband, who served in the U.S. Air Force, and their three children. The family lived in Florida, Germany, Japan, and Arizona. Everywhere they went, Stella quickly made friends and proudly shared her Chippewa culture. She was loved and adored by all who met her for living an adventurous and fearless life. In July 2009, Stella and her family moved back to Belcourt, ND, and she started to attend Turtle Mountain Community College. On September 16, 2010, Stella and her cousin were at the local bar when she decided to stay behind with other people they knew. According to witnesses, Stella left with another couple to continue the evening out. Stella's body was later found in a male Tribal member's pickup in an open field on the reservation. It wasn't until 13 days later that the family was officially notified by law enforcement of Stella's death. Throughout the investigation, there were a lot of rumors and misinformation, which made it difficult to find the murderer or the murderers. People who were with Stella the night of her death said that they were never questioned, and information provided was never followed up on. No one has ever been charged or convicted for this murder, and the last hours of Stella's life remain unknown. Stella was an incredible woman who was loved by all who knew her. Her family, her children, and her Tribe deserve justice. Monica Wickre is pictured here with those beautiful earrings and the red shirt. Monica was a 42-year-old mother of three who was born and raised in Belcourt on the Turtle Mountain Band of Chippewa reservation and lived near Aberdeen, SD. After a night out with friends on April 7, 1993, Monica never returned home. Her relatives grew concerned when they had not heard from or seen Monica for several days. Eventually, the family filed a missing persons report and started to talk to friends and neighbors. The detective assigned to the case worked closely with the community and the family and assured them he was working diligently on this case. In June of that year, a canoeist found Monica's badly decomposed body in the James River outside Aberdeen. Throughout the next several years, new detectives were assigned to the case, each having to basically start over and work with limited notes, interviews, and evidence from the previous investigators. A couple of times, the police told the family that they had a suspect or were close to arresting someone for Monica's murder, but there was never enough information to charge the suspect. This has resulted in nearly 25 years of heartache for Monica's family and her friends. Monica's family wants justice for their daughter, sister, and mother, and they all want closure. Although the case is no longer active, the family continues to bring awareness about Monica's case in the hope that someone will come forward with information that will, in fact, help solve it. Monica Lisa Two Eagle is the woman with the dark hair in the floral print shirt. She was a member of the Rosebud Sioux Tribe and one of 14 children. She was kind, caring, and athletic. In the winter of 1979, Phil Two Eagle saw his sister Mona Lisa, who was in her early twenties, leave the siblings' house and get into a red-and-white pickup with a couple of men. Mona Lisa never returned. In the following days, the family and local law enforcement searched for her on horseback. Taking it upon themselves, they searched for her on horseback. About 2 weeks after she went missing, Mona Lisa's father and brother found her frozen in a pasture near their home. She had been beaten, possibly raped, and left alone in a blizzard. Rumors ran wild that family and law enforcement tried to solve the crime, but, even to this day, no one was ever convicted or even charged. The two men who were last seen with Mona Lisa all those years ago are still running free, while the family lives every day with the lack of justice. Lakota Rae Renville, the woman in the black-and-white photo, is the last victim I want to talk about. I want to thank her family, who are here today and who have honored me and trusted me with her memory. I want to help them understand how grateful I am, but I also want them to know that sharing her story will help raise awareness about the crimes of missing and murdered indigenous people. Lakota was a member of the Sisseton-Wahpeton Dakota Bands of North and South Dakota, who, despite being shy and reserved, had a solid group of friends who supported her and even helped her excel in school. After graduation, Lakota spent time taking care of her family, especially her nieces and nephews. In 2005 Lakota met a man online and unexpectedly relocated to Missouri, unbeknownst to her family. With most details still unknown 12 years later, the family is left with more questions than answers. What they do know is that she was forced into sex trafficking and manipulated against her will. In October of 2005, Lakota's family was called and told that her body was found badly beaten, wrapped in carpet padding and a blanket in an open gravel pit in Missouri. Local investigators brought in and subsequently let go dozens of suspects and, to this day, have not brought her murderer to justice. Lakota was never given a chance to become a mother or pursue that bright future that surely lay ahead of her. She was robbed of a life she had yet to experience, a life that was certain to be filled with love from her family and deep appreciation from her family. These are not isolated cases. This goes on every day in America. I want to make a point of how discouraging it, so many times, when you see events unfolding where it may be that a young girl goes missing in a Caribbean island and the world is turned upside down looking for her or when we hear a story of someone who comes from maybe a more affluent and wealthy family who goes missing and we turn over every stone to find them. Yet that is not the story for very many indigenous women. When you look at the importance of what we do today, probably the most important thing we can do is to tell these stories, and from telling these stories we have an opportunity to really change. We can't ignore that frequently for Native people, they are not wrong to believe that they are the forgotten people of this country. Way too often, the first Americans become the last Americans. Under the Savanna's Act, the Attorney General, in cooperation with the Secretary of the Interior, must consult with the Tribes on how to improve Tribal access to Federal criminal information databases, such as the National Crime Information Center and the National Missing and Unidentified Persons System. We need to ensure that Tribal law enforcement has up-to-date information on missing Native women and better communication--in fact, essential--with Federal, State, and local law enforcement agencies and Tribal law enforcement agencies so cases like the ones you have heard of today don't go unnoticed or uninvestigated. Jurisdictional issues are a huge barrier in Indian Country to responding to and prosecuting crimes committed on Tribal lands. Standardized protocols must be established in order to give a quicker response to Native women going missing. The complexity of jurisdiction on Tribal lands can slow down an investigation, but it is not an excuse. It can waste crucial time at the beginning of an investigation or a case, but it is not an excuse. If we do not act rapidly, we know we lose precious time to prevent homicides and to bring a woman safely home and help apprehend the perpetrators. In one case study alone done by the National Institute of Justice, 97 percent of Native women experience violence by a non-Native perpetrator. This number emphasizes what I have long said, that historical trauma is a major factor of violence against Native women, and perpetrators feel that Tribal lands give them a free pass from the law. This can no longer be tolerated, and jurisdictional issues must be addressed. It cannot be the excuse for inaction. Although we don't know the total number of missing and murdered Native women, it is clear, from all of the stories and from the statistics that we do have, that the rates at which Native American women experience violence is intrinsically related to the likelihood of their going missing, being murdered, and forced into sex trafficking. Here are just some of the statistics collected by the National Institute of Justice, the Government Accountability Office, and the Centers for Disease Control and Prevention regarding violence against Native women. In 2016, 5,712 cases of missing Native women were reported to the National Crime Information Center, and 125 of those cases were in my State of Dakota alone. On some reservations, Native women are murdered at more than 10 times the national average. I want to repeat that. On some reservations, Native women are murdered at more than 10 times the national average. American Indians and Alaskan Natives are two times more likely to experience rape or sexual assault compared to all other races. In 2010, we found that the U.S. attorneys declined to prosecute nearly 52 percent of violent crime that occurred in Indian Country. Homicide is the third leading cause of death among American Indians and Alaskan Native women between 10 and 24 years old. These high rates of violence, including domestic violence, sex assault, and human trafficking, must stop. We must work together to combat domestic violence and human trafficking in Indian Country. Just last week, the Indian Affairs Committee held a hearing to discuss the lack of services provided for Indian Country regarding the horrific acts of violence and human trafficking of Native women. Just yesterday, while questioning one of the officials at the Department of the Interior about the need to do training in human trafficking at our casinos, he simply said: I thought you were going to ask me about Indian gaming. I quickly said: I am asking you about Indian gaming because all of this works together. If we do not work together in every institution of the Federal Government, in every institution of the State government, and in every institution of Tribal government, we will never make progress in providing the security that we have in this building, and the security that we enjoy as White women will never be realized for women living on the reservation in Indian Country. We cannot let this continue. There are countless more stories like Savanna's, Stella's, Mona Lisa's, Monica's, and Lakota's that we will never know. It is time for Congress to recognize this epidemic and take action to prevent these stories and find out just how many stories there really are. It is time to give voice to these voiceless women. It is time to bring their perpetrators to justice and give a voice to the families who are struggling even today--sometimes decades later--to understand how this can happen in America. They seem to be second-class citizens. I think that is what we know. I am working with very many of my colleagues on the other side. This isn't a partisan issue. I have been joined by my wonderful colleague from the great State of Alaska. I think the first time we ever met, this was the topic of conversation: What is the security for Indian children, security for Indian women, and Alaskan Native women? We knew because both of us have traveled extensively in our States and spent a lot of time in the indigenous populations. When family members ask us why this is happening, we frequently don't have an answer. I know that in my State jurisdictional issues provide some barriers to actually getting this done, but that is an excuse. We need to do better. With that, I want to yield the floor to my wonderful colleague from the great State of Alaska, who once again is joining me and leading her side of the aisle to bring attention to these issues.

Ms. HEITKAMP

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

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I come to the floor today to give my strong support and ask my colleagues to support the confirmation of Judge Ralph Erickson to fill the North Dakota vacancy on the U.S. Court of Appeals for the Eighth Circuit. This is a seat that the U.S. Judicial Conference has deemed a judicial emergency, as it has been empty for almost 900 days. Being nominated to a seat on the U.S. circuit court of appeals is an honor and a privilege, virtually unmatched in the legal profession. After reviewing Judge Erickson's record and talking to his colleagues and the people who have worked with him and appeared before him back in North Dakota, I am very proud to come to the floor this morning and offer my strong support for his nomination to the Eighth Circuit. When Judge Erickson was nominated and confirmed to his current seat on the U.S. District Court for North Dakota, it was with the support of our two great former Senators and my good friends, Byron Dorgan and Kent Conrad. Judge Erickson has certainly upheld their faith and trust in his abilities as a district court judge, and I am confident he will uphold my faith and my trust in his ability as he moves to the Eighth Circuit. Judge Erickson has a long history of commitment to the legal profession and the State of North Dakota, first through his service on the State court and, since 2003, as a judge on the U.S. District Court for the District of North Dakota. Very few lawyers can make such a long-term commitment to public service, and his record certainly reflects his belief that when a lawyer is called to serve for the greater good, they should answer that call. I hope Judge Erickson is able to instill this sense of commitment to public service in aspiring young lawyers whom he will come to meet and whom he will be able to influence through his example. A nominee for the North Dakota seat on the Eighth Circuit must have experience in working with Indian Country, given the number of Tribes and the Indian land that are contained within the jurisdiction of the Eighth Circuit. During his career and at his hearing before the Judiciary Committee, Judge Erickson has shown an in-depth understanding of Tribal sovereignty issues and a recognition of the challenges and disparities in the treatment of Native Americans under the law when they are arrested and charged for crimes in Indian Country. Judge Erickson has been an advocate for equal treatment of Native Americans under the law. He also serves as the chair of the U.S. Sentencing Commission's Tribal Issues Advisory Group. I have no doubt that Judge Erickson will bring this knowledge and understanding of Tribal issues, sovereignty, and treaties with him to the Eighth Circuit. The best judges always have been people who can truly understand and bring to the bench a sense of empathy. Judge Erickson has used some of his own struggles and challenges during the course of his life to inform his own views and to give counsel to those who come before him as he uses his own personal struggles as an example. It takes a really big person to recognize and learn from their failings and to use them to help others. I admire him greatly for that. During his confirmation hearing before the Senate Judiciary Committee, Judge Erickson showed an openness and frankness in responding to questions and discussing his past struggles. That was refreshing, illuminating, and honestly all too rare here. I believe he impressed my colleagues on that committee greatly with his willingness to be so forthcoming and so honest. That is why they unanimously reported his nomination out of the committee. It is a tremendous honor to be on the floor of the U.S. Senate before Judge Erickson's confirmation vote. I am here today to give my highest recommendation in support of his nomination to the U.S. Circuit Court of Appeals for the Eighth Circuit. I, again, urge all of my colleagues' thoughtful consideration and evaluation and favorable endorsement of his confirmation. Thank you so much. I yield the floor.

Ms. HEITKAMP

Ms. HEITKAMP. Thank you, Mr. President. To my great colleague and one of the nicest people here, Senator Udall, who always leads with his brain, we know that his heart isn't far behind, and he has been a tremendous leader, a tremendous advocate, and a tremendous collaborator on this all-important issue. I think first that we have to acknowledge how grateful and thankful we are that the Republican bill, known as Graham-Cassidy, will not be advanced this week. I don't think it is the last that we have heard of it, but it is critically important that now we have time to talk about the impacts and we have time to talk about why it is that we found this bill so objectionable, and we have an opportunity to raise the issues that may have been forgotten. I think one of those issues is the unique challenges that Native American people have in receiving and affording quality healthcare in America. All of the Tribes in my State have a treaty right to healthcare. It is kind of like when they say that, under the Affordable Care Act, you have access to care, but if the care is low quality, if the care is unavailable, if the care is not something you can afford or that will actually provide the kinds of services that you need, it is really not fulfillment of the treaty obligation. One of the things we know is that many of the programs within the Affordable Care Act have gone a long way toward meeting the Federal Government's treaty responsibility to provide healthcare to Native American people. We talk about how Graham-Cassidy would hurt seniors, children with disabilities, individuals with preexisting conditions like asthma or cancer, those receiving treatment for opioid abuse, and many more. But too often in those statistics, which would encompass many Native American people who unfortunately have high rates of chronic conditions, the specific and unique needs of Native populations are forgotten during debates in the Congress. It happened when Republicans tried to pass their initial healthcare bill over the summer, and it nearly happened again. Here we are on the Senate floor to make sure that Native communities are not left behind during these discussions in the future. We will be watching to make sure that communities in our State, unique and discreet, and, in fact, treaty Tribes, which are entitled to healthcare by contract, by treaty with the U.S. Government--that their interests are heard and that their voices are heard. In July, when the Senate was discussing the last Republican healthcare bill that would have taken healthcare away from North Dakota families, I worked with Senator Udall, vice chairman of the Senate Indian Affairs Committee, to hold a discussion on Tribal healthcare. The purpose was to hear directly from Tribal leaders, including the chairman of the Turtle Mountain Band of Chippewa Indians from North Dakota, about how bad that bill would have been for Indian Country. During that discussion in July, we lamented--those of us who are on the committee, especially the minority members--that what happens in the Indian Affairs Committee all too often stays in the Indian Affairs Committee. What do I mean by that? I think the stories we hear and the challenges we hear about Native people, which we respond to many times with great empathy, are never taken out of that committee room. They are never understood broadly by Senators in this Chamber. We vowed that day that we are never going to leave those challenges in that committee room. We are going to take those challenges to this forum and to this floor. We want to share our concern about the lack of Tribal consultation in the healthcare debates so far. Unfortunately, the Graham-Cassidy healthcare bill still does not remotely or adequately protect Native people. Just look at the opposition to the bill from the National Congress of American Indians, the National Indian Health Board, and the National Council of Urban Indian Health. This bill is just as bad as, if not worse than, the previous bill. To push it through without adequate consultation in ways that would fundamentally change our healthcare system is in no way putting the healthcare needs of people first; it is putting politics first. It is irresponsible and unconscionable. Those of us on the Indian Affairs Committee know undoubtedly that the Indian Health Service is severely underfunded and, some of us would argue, inappropriately managed. It has been that way since I have been here. We have experienced those challenges of lack of leadership, lack of funding, and, really, an attitude that this is the way we have always done it. It has resulted in very many of our institutions losing their CMS certification. That is unacceptable. The stories are unacceptable, but we also cannot just pin it on Indian health. We have to recognize and understand that this is also a funding problem. So it is essential that we find resources to fill those gaps and enter the Affordable Care Act, where we not only have traditional Medicaid eligibility, but we also have expanded Medicaid, which now has given extra hope to Indian healthcare providers that this resource can be made available without constantly having to beg for additional resources for Indian health. So it is particularly because of these severe challenges at the Indian Health Service that traditional Medicaid, Medicaid expansion, and private health insurance access have been critical for Indian Country, making sure Native Americans can access quality, affordable care to keep them and their families healthy. Thanks to the increase of third-party payments, we are no longer limited to life and limb care at Tribal and IHS facilities in the Great Plains IHS service area. But the Graham-Cassidy healthcare bill would undo all of that progress. It would slash Medicaid expansion and cap the Federal contributions to traditional Medicaid, pushing those remaining costs onto States and counties that can ill afford it. Medicaid expansion has significant impact on IHS services at Turtle Mountain, increasing the funding and resources available to its patient population by increasing healthcare services, increasing Purchased/Referred Care, or PRC, services, and increasing revenue generation. Here are just some of the statistics that show how Turtle Mountain's IHS hospital has been impacted by the Medicaid expansion: a 13-percent decrease in uninsured patients; a 30-percent increase in Medicaid coverage; a 13-percent increase in traditional Medicare coverage; a 57- percent increase in private insurance coverage; a 9-percent increase in the number of individuals served; a 43-percent increase in revenue generation, i.e., collections; and a 32-percent increase in Purchased/ Referred Care referrals. That may sound as if it is good for the institution, but when it is good for the institution--the healthcare provider--it is good for the families who get their services there. Third-party billing revenue has also allowed the hospital to make renovations to emergency rooms and clinics, purchase new medical equipment, including neonatal monitors, recruit and hire additional staff, including licensed professionals, increase staff training and education, provide Wi-Fi throughout the hospital, and expand its all- important behavioral healthcare facility to serve more patients. But the Republican healthcare bill would have eliminated these cost- sharing payments that make private health insurance affordable and accessible to American Indian families and North Dakota Indian families for the first time. All through the country you hear this over and over again, in pockets of poverty in this country. For the first time in people's lives, they have an insurance card, and that is a ticket to a future. Without an insurance card, many times people are left behind. This is an issue I have spoken about multiple times because it is so important. In North Dakota, the Republican bill would have caused an estimate of almost 1,000 Native Americans to lose their cost-sharing reduction payments. The Republican healthcare bill would also jeopardize all- important mental health services for Native youth and could remove a trauma-informed approach to students' education. The Mandan, Hidatsa, Arikara Nation from my State is working to set up a mental health pilot program in their schools by next year in this partnership with Nexus and PATH in North Dakota, which will bring social workers and a satellite clinic to school campus. This pilot program will be paid for by Medicaid. The Graham-Cassidy healthcare bill would cut $5.5 billion from traditional Medicaid in North Dakota by 2036, affecting 36,000 low- income--not people--but low-income children. The Tribe and the North Dakota Department of Public Instruction are relying on those Medicaid dollars to keep this mental health program possible, which will keep kids in the classroom and in the communities while they are provided services. Quite honestly, keeping children with their families is a longstanding challenge, as we see the history of childhood trauma beginning at the time of not only the westward movement of families, like my ancestors, but the trauma that was experienced when children were ripped out of their homes and taken to boarding schools--a trauma from which many Native American communities have not yet recovered. Sadly, this plan would take a significant step backward in healthcare for all Americans and certainly fall short on our promises and our treaty obligations to Native Americans. With so much at stake in our healthcare system, it is critical that we take a thoughtful and inclusive approach to healthcare--in fact, healthcare reform that considers the needs of all Americans, including, in my case, the first Americans, Native Americans. Republicans need to work with Democrats. I was saddened when I heard last night during the debate a discussion about how there isn't any opportunity for bipartisanship. I, like 30 of my other colleagues, attended meetings held by the HELP Committee before their hearings. Think about this. Thirty U.S. Senators, at 8 in the morning, without a mandate, with no obligation to be there, completely voluntary, came together during three mornings to talk about how we can work together as a bipartisan group on healthcare. So when people say it is not happening, it clearly is happening. It is happening, and we can, in fact, get to yes on many of the challenges that we have in healthcare. But we can't get to a lasting system if it is something that is done in a back room in the dead of night without consultation, not just with other Members of this body but without consultation for groups like Native American Tribes and Native American people. Over the past 4\1/2\ years, I have offered reasonable reforms that should be bipartisan to make the current healthcare system work better for Dakotans and better for those citizens and my constituents in Indian Country. Over the past few months and years, I have met with a group of Republican and Democratic Senators to talk about reasonable reforms that would make healthcare work better if we just focus for a minute on what unites us and what we can do if we just set aside partisanship, if we simply believe that we can, in fact, bury partisan hatchets and begin the work of working together. I want to mention one last discussion item. Many times, when you hear people talk about treaty obligations for healthcare or education, it is usually people on this side of the aisle who are talking about Tribal sovereignty, Tribal treaty rights. Well, I was gladdened to hear my colleague from South Dakota talk about a treaty right that Tribes in his State have to healthcare. The solution there was to ask the Federal Government--if, in fact, the citizen of that State were Native American enrolled--to say that really is a Federal treaty right. So the Federal Government should pay 100 percent of that, even though your State match would be 50-50. That makes sense. I can buy that. But do you know what? That does nothing to expand healthcare to Native people--nothing. What that does is say that 50 percent that you are currently paying is because these are citizens of your State, not some kind of nonresidents. These are residents of your State, citizens of your State, whom you pay that additional 50 percent for. If the argument had been that we are going to take that additional 50 percent, the Federal Government is going to pay it, and we are going to augment what we do in healthcare for this population, then we are actually getting somewhere. Then we are actually accomplishing something for Native American people and Native American children. I want you to understand that this is a population that suffers diabetes at record rates--hypertension, behavioral and mental health, including serious addictions, with record and epidemic suicides among young people all through Indian Country, record and epic amounts of opioid and meth addiction, children being born addicted. We need interventions now. We do not need to see a reduction in support to healthcare--both behavioral and mental healthcare--right now, at this time. It is a crisis, and we need to do everything we can to consult with the Tribes, to consult with Indian healthcare leaders, to consult with the people who do this work for a living, and fashion a system that will expand and grow access to healthcare. It is critically important. Make no mistake, these are the first Americans, and way too often, the ``asterisk Americans.'' What do I mean by that? They are not large enough to have a demographic category, so their challenges are not tracked, whether it is human trafficking, whether it is addiction. If we do not begin to focus on this, we will fail in our treaty obligations. The United States of America signed a treaty with Indian people. Let's keep our word. Let's work together. Let's work in collaboration with many of the people in my State who are struggling to make ends meet. Let's not reduce services and resources. Let's not take a step backward. Thank you. I yield the floor back to the Senator from New Mexico.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I intend to offer the following motion to H.R. 1628. I ask unanimous consent that it be printed in the Record and that the Record acknowledge the support of this motion by Senators Udall, Cantwell, Cortez Masto, Heinrich, Franken, Murray, Merkley, Schatz, Stabenow, and Tester.

Ms. HEITKAMP

Ms. HEITKAMP. Would the Senator yield for a question?

Ms. HEITKAMP

Ms. HEITKAMP. Madam President, I intend to offer the following motions to H.R. 1628, and I ask unanimous consent that they be printed in the Record. Both motions are supported by Senators Franken and Udall.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I ask unanimous consent that Myles Odermann, an intern in my office, be granted floor privileges for the duration of today's session of the Senate.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I think that anyone who picked up the Wall Street Journal over the last couple of weeks and read the stories about Indian health and what is happening, especially in our region of the world in the Great Plains--it shocked the conscience. It should have resulted in a prolonged level of outrage that would bring us all together. Unfortunately, we have seen this movie one too many times. Things happen where we see national stories about challenges in Indian Country, about the failure to fulfill commitments under treaty rights. We see despair. We see the incredible rates of poverty, the incredible rates of unemployment, even in a State like ours where unemployment rates are never the issue. We wonder, why isn't something being done? Guess who wasn't shocked. Those of us who serve on the Indian Affairs Committee. We on the committee spent a lot of time looking at this last year, trying to figure out how we could engage the bureaucracy to be more responsive and more responsible and how we could look at sourcing the dollars we needed to make sure that Indian health was supplemented and that the level of care we expect when we walk into our hospitals--that that is the level of care Native American people who go to the Indian Health Service on their reservations and who might go to an Indian run, a Tribal run facility, would expect. That is what we expect, and I think that is what the American public might think is actually going on, but those of us on the committee know differently. We held a roundtable today to talk about what those challenges are, what Native American leaders believe are those challenges, and to ask them a simple question: What has Medicaid expansion meant to your Tribes? What does access to Medicare and Medicaid mean for delivery of healthcare services? I want to start off by saying that they have a lot of great ideas, and I will run through some of these. Chairman Keplin from Turtle Mountain said: We need local doctors. It is hard to get people to live on the reservation if they are not from the reservation, so we need to figure out how we are going to get local folks to be trained, and we are willing to do that in our Tribal colleges. We need to build relationships with other healthcare providers, like Sanford, that can bring specialists. We need our cancer infusion center to be there so that people can get cancer treatment right at home. And we need to make sure we are doing everything we can to make sure we can treat diabetes right there at home. So the healthcare challenges were amazing, but the cost challenges were also amazing. Duane from Pueblo in New Mexico had some very interesting perspectives. Eighty percent of his patient load comes to the clinic. They speak their Native language. They have had stability in their workforce, but they are looking at transitioning to a Tribal facility. But those people don't want to transition because of Federal retirement. So is there something we can do to keep these treasured healthcare providers working for the Tribe and working for their people--the people who know the language and who are familiar with the case studies? Lincoln from Alaska said: One of our biggest problems is year-to-year funding. The VA has 2-year funding. We don't know what the money is going to be and when it is going to come. We also need to train local people. Sam said: We have a huge need to continue to build out our cultural resources and our attention to culture and prevention. Ron from Washington talked a lot about the recruitment of workforce. The employer mandate came up because so much of the employment on the reservations is in fact Tribal members. They are talking about that they are mandated to buy this health insurance, but these same members have a treaty right to that healthcare. Is there a way to help those stretched Tribal resources go a little further by taking a look at some relief from the employer mandate? The definition of what constitutes an Indian came up over and over. From Massachusetts, Cheryl talked about permanent reauthorization of Indian healthcare and more resources in diabetes, because that is a pervasive problem, and Indian employment, again, talking about that issue of buying health insurance. As to marketplace access for Native American enrollees who are not living on the reservation, how do they make sure they are able to get their treaty rights? Talking about mental well-being and talking about culture is prevention. One of my favorite lines that came out of this was when we asked about prevention, and Ashley said: Culture is prevention. We need better access to 1115 waivers. Take a look at the Canadian model, she suggested. They do more with cultural sensitivity. The list goes on and on of great ideas. Not one of these ideas said: Repeal the Affordable Care Act. Not one of them said: Let's get rid of Medicaid expansion; let's not look at what we can do. Let's just all acknowledge what we who serve on this committee know: We have challenges that far exceed many other populations. We have come to the floor to talk about how the repeal of the Affordable Care Act and how the Republican healthcare bill would hurt different populations. We have talked about the elderly. We have talked about children with disabilities. We have talked about rural communities. We have talked about many, many more folks. I think we haven't done enough to talk about what this means for Indian people. We have a special relationship with Indian people in my State because every Tribe in my State is, in fact, a treaty Tribe with a treaty right to healthcare. Last night, it obviously became clear that the bill, as it stands, wouldn't get enough votes to move forward. But we need to keep talking about this bill, and we need to keep talking about what the questions are. Instead of talking about this bill or that bill or all of the acronyms, let's start with healthcare. Let's have a conversation about healthcare that starts with healthcare. Where are we doing it right? Where are we doing it wrong? How can we reduce costs? Who is being left behind? It is clear to me that in the healthcare world--never mind the Affordable Care Act or the Better Care Act, whatever the Republican bill was called. That is a discussion for politics. That is not a discussion for healthcare. So let's talk about what Native Americans need. Let's talk about how we have failed. As I said earlier today, Senator Udall led a really important discussion about how we need to preserve Medicaid. When we look at the Indian Health Service, I think anyone who really looks at the numbers has to admit that it is chronically underfunded. Last year, I brought the former IHS Director to North Dakota to press her on maintaining quality care in our Tribal communities. This was especially important because of the severe challenges Indian healthcare has. We know that the lack of funding for Indian healthcare can be critically augmented by three main sources: Medicaid, Medicare, and private insurance. If every person walking in has the ability to pay, we are going to improve access to care, and we are going to improve the opportunity to recruit a workforce. I think some people may roll their eyes when they say: Don't get sick in June. My husband is a family physician and practices about 60 miles north of the Standing Rock Sioux Tribe. He can tell you that there have been times when people from the reservation have come to the clinic to see him because the clinic in Fort Yates is shuttered--no money that day, no opportunity for healthcare. So people come to get the healthcare they need, but they have to drive a long way. It is wrong. You see a new doctor whom you have never seen before and who may not, in fact, understand your condition. So the Turtle Mountain Band of Chippewa, who are represented today, have over 33,000 enrolled members, of which approximately 14,500 actively receive treatment and benefits for services at the local IHS hospital. Thanks to Medicaid expansion and increased enrollment efforts by the Turtle Mountain Band of Chippewa in my State of North Dakota, their Indian Health Service hospital is now able to offer so much more in services to their people and increase their outreach and prevention. In June alone, Turtle Mountain's IHS clinic served nearly 13,000 clinical patients and provided over 1,000 emergency room services. Third-party billing revenue has now allowed the Tribes to make renovations to their emergency room and their clinic, to purchase new medical equipment, including neonatal monitors, to recruit and hire additional staff, including licensed professionals, to increase staff training and education, to provide Wi-Fi throughout the hospital, and to expand their behavioral healthcare facility to serve more patients. Since the Medicaid expansion, they have had a 9-percent increase in the number of individuals they have served. Their hospital is also experiencing a decrease in the number of uninsured patients--still too high, in my opinion, at 39 percent. We can get that lower if we get more people to take advantage of Medicaid expansion. But, unfortunately, a Republican healthcare plan that would eliminate cost-sharing subsidies is making that private health insurance less affordable and less successful. So let's be honest about how we are affecting our Native American population and talk about the multiple times this expansion has been so important to our Native families. In North Dakota, the Republican bill would cause an estimated 984 Native Americans to lose cost-sharing reduction subsidies. The Senate Republican healthcare bill would also get rid of the Medicaid expansion and cap the amount of Federal funding States can get to cover those on traditional Medicaid. As a result, it would drastically reduce the amount of Medicaid funding going to the States. This would push the remaining costs to the States and counties that can't afford it. The American Hospital Association estimates that North Dakota Medicaid would lose $1.2 billion. I will say that again. North Dakota Medicaid would lose $1.2 billion through 2026. Right now, 9,000 North Dakota children and individuals with disabilities--Native Americans, seniors, and low-income families--rely on Medicaid for affordable, quality care, but this bill would rip it away in so many wrong ways. The uninsured rate for Native Americans has fallen nationally from 24 percent to 15 percent, largely due to Medicaid expansion. We go on and on. Currently, Medicaid accounts for 24 percent of the Indian Health Service workforce. The Senate Republican bill would strip away $772 billion from Medicaid, and the White House proposes cutting an already underfunded Indian Health Service budget by 6 percent. We already know that the per-patient cost in the Indian healthcare system is greatly below that of Medicaid reimbursement cost, on average. So if we take away Medicaid reimbursement, we are hurting not only the providers, but we are once again making healthcare less affordable. This is a crisis. I can't begin to tell the Members of this body what a crisis Indian healthcare is in. We have known it on the committee for many, many years. In fact, Senator Dorgan was the first one to really sound the alarm of the crisis in the Great Plains area, thinking that a report that was so damaging would result in change. Guess what. It didn't. It didn't result in change. But the one thing we can point to that is a bright shining light has been access to Medicaid dollars. It has given them access to capital expenditure, and it has given them access to workforce. It has given a more consistent way for people who don't live on the reservations to get healthcare. I have said this many, many times: We need to not go backward; we need to go forward. When people say: We are going to take a step back, we are going to reduce actual appropriations by 6 percent for Indian health, and we are going to eliminate Medicaid expansion, I say: You had better look before you take a step backward because you might be off the cliff. That is how dire it is in Indian Country. The one thing I am going to conclude with is that for many, many years in healthcare we have not done what we need to do to consult with Tribal people: Here is the facility; this is what we are going to provide. Good luck. One size fits all. What we need to do and what Medicaid has allowed is that flexibility for Tribes to engage, for Tribal people to engage in what their needs are, and to take a look at those community health models that do dental care, eye care, and mental health and addiction counseling. All of this needs to be wrapped up. When people say there is no hope, there certainly is no hope without help. There is an old saying: When you have your health, you have everything. I can tell you from personal experience that it is absolutely true. You could be the richest man in the world, but if you don't have good health, your quality of life is not what it could be. When we look across the indicators of what has happened in Indian health with indigenous people throughout our country, when we know this is our obligation--this is that treaty obligation, the treaty right that has been bargained for--shame on us. Medicaid can be that bridge. It can be the bridge to better healthcare. That is why it is so critical, Mr. President and my vice chairman, that we be out here speaking for our communities, speaking for these unique groups of folks who depend so much on Medicaid expansion but who also depend on us to do a better job, to be better stewards of that relationship, to be better citizens as it relates to living up to the obligations that our ancestors negotiated. I ask everybody who hasn't really been exposed to this issue to read the articles in the Wall Street Journal. But don't just read them and wring your hands and say: This is horrible. Take a step to change the outcome. Don't just read them and say: Boy, that is horrible. Take responsibility for what you read. Every one of us in the Senate and in the Congress is responsible for fulfilling the obligations of these treaties. When we aren't doing it, it is a failure on every one of us, and it is a failure to protect some of the most vulnerable people in our country--and that is Native American children. I yield the floor and turn it back to my vice chairman, Senator Udall.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I ask unanimous consent that Felicia Lucci, an AAAS fellow in my office, be granted floor privileges for the duration of today's session of the Senate.

Ms. HEITKAMP

Ms. HEITKAMP. Madam President, one thing I want to talk about, as we are talking about carbon utilization--and Joe did a great job of talking about new technologies. Frequently when I talk about this topic people say: There is no such thing as clean coal. Coal cannot be a clean energy source. And I say: That is not true. I tell them about my personal experience with the largest carbon sequestration storage program in the country, up until some of the new developments, and that was Dakota Gas. I served on the board of directors of Dakota Gas, and, ironically, the carbon capture and transmission into an oil field was not done to respond to concerns globally about carbon; it was done to produce a salable and lucrative byproduct--CO2--which can be used in the oil fields. The one point I want to make is that a lot of the new development in exploration and in production of oil is done in tight formations, shale formations. This is not a technology, CO2 flooding isn't a technology that has been widely used in tight formations because we haven't figured out how to do it. I want to acknowledge one of those great American corporations, Occidental Petroleum, for doing something they call huff and puff, where they inject the CO2. They basically let that sit in the well and then eventually recharge the well. They are seeing excellent results in using this as an enhanced oil recovery method. We are very excited about the bipartisan group. We are very excited that we can take one of the most contentious issues--one of the most contentious issues here on the floor--an issue for which, time after time, no one could find a path forward, and we have met with great success in getting good people to come together. Finally, I want to say that it has been a joy to work with the junior Senator from West Virginia. I spend a lot of time with the senior Senator from West Virginia. The junior Senator from West Virginia, from my experience, is always looking for solutions to problems--not adding to the rancor, but looking for solutions to real problems. We have had a great partnership, and I look forward to our continued partnership in promoting and moving this issue forward. With that, I yield the floor.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, before the chair of the Permanent Subcommittee on Investigations leaves, I also would like to put into the Record that, recently, in a raid that was performed in the Philippines, some very interesting documentation was seized about backpage, according to news reports, and the FBI was immediately called. I think there is an opportunity to use that information to advance the investigation and to continue to expose the participation of backpage, not just as a billboard or as a want ad but as a knowing participant in the trafficking of children--not just in our country but globally. I thank the chairman.

Ms. HEITKAMP

Ms. HEITKAMP. Mr. President, I would like to associate myself with the comments from the former Governor and now Senator from the great State of New Hampshire. It is not enough to say the system is failing. It is not enough to come here and say: We can fix it if you just agree to vote the way we are voting. If you just agree, you can present any amendments you want. You can do whatever you want. We don't even have a CBO score on this legislation. We don't know what is in this legislation. There have been no hearings so that people on both sides of the aisle can ask questions and say: What does this mean for a family on traditional Medicaid who has to rely on this to keep custody of their kids? And by the way, what does it mean if, as a result of losing their Medicaid coverage, those children are no longer able to stay at home and they become foster children because it is the only way they can get healthcare? What does it mean for those families about whom we all think we ought to have a real discussion, young people, young families who have excellent health, how they might have been disadvantaged on the exchange? What do we need to do for them? Maybe they were doing better economically than a lot of folks until they hit the cliff. That is why I want to see my bill debated, because it can, in fact, offer opportunity. Every time we talk about this, what we hear about is how much it would cost. Well, the bottom line is that if all you do is shift the burden of these costs without any discussions with Governors, with private payers, with corporate America that is self-insured--if all we are doing is shifting costs and saying ``It is now your problem,'' we are not doing our job. If you look at the Rand Corporation study, 12 percent of the population of this country has five or more chronic diseases. As a result of those unmanaged--typically unmanaged chronic diseases, what you will see is they incur 40 percent of the cost. Is that a problem? The answer is yes, that is a problem. We need to figure out how we can better manage chronic disease. A great friend of mine, a guy named Richie Carmona, who once was the Surgeon General of this country, used to say--and I think it is true-- 70 percent of all healthcare costs are related to chronic disease, most of which is preventible. Where in any of these bills are we talking about prevention? Where are we talking about wellness? Where are we talking about bending the healthcare curve? We are only dumping and running with these bills. We are not doing our job, and as a result, we are frightening people in this country. We are frightening the elderly. We are frightening people who say: Right now, I can afford my health insurance; I am on an exchange. But when we change the ratio from 1-to- 3 to 1-to-5 and reduce the amount of subsidies, then 30, 40, 50 percent of their disposable income will be used to pay for health insurance. That is the thing you are not hearing here. So we have to come together. We have to come together with the fundamental questions of what is wrong with not just the Affordable Care Act but what is wrong with healthcare and how we fix it and how we change outcomes. We can't do that if we don't work together. This is a body that is divided 48 to 52. How do you come together if you don't come to the middle, if you don't come to the middle to compromise? You don't. At the end of the day, we have not met our deepest obligation, which is to speak for those who are the least fortunate among us. We have not met our obligation to govern this country in a way that would make our Founding Fathers proud, to make our citizens proud, and that can advance this idea that the U.S. Congress can get something done in the United States of America--instead of partisan rancor. We hold out the hope that we will at one point be able to debate these ideas that we presented. We hold out the hope that we will, in fact, meet somewhere to arrive at a better plan for the delivery of healthcare in this country. I just want to close with one thought. There is not one organized healthcare group or advocacy group in my State that supports the Republican healthcare plan, so as we are looking at judgment on that plan, don't take my word for it. Take the medical associations' word for it, take the hospital associations' word for it, take AARP's word for it, take the consortium of large hospitals in my State, which urged a ``no'' vote on this legislation, take the disabled children's advocacy groups' word for it. This is not a path forward, but we are big enough people and good enough leaders that we can forge a path forward if we just find the will to do it. I yield the floor. I suggest the absence of a quorum.