Jerry Moran

Mr. MORAN

Mr. MORAN. I ask unanimous consent that the pending amendment be set aside to call up amendment No. 73.

Mr. MORAN. Mr. President, thank you very much for recognizing me to take the opportunity to address something I hope can readily and easily be solved. If common sense prevails--and we know it doesn't often enough here in our Nation's Capital--one, the Department of Veterans Affairs certainly, in my view, can solve this problem. If common sense doesn't prevail there, then surely the Senate, the House of Representatives, and the President could agree upon a legislative fix that is really nothing more than common sense. I am talking about a veterans issue--one that is certainly prevalent in a rural State such as mine. My guess is it is a problem that occurs in a State such as the Presiding Officer's as well. I was very pleased. I came to the Senate floor and talked about the importance of passing and approving the CHOICE Act. We remember the scandal of last year in which it became clear the Department of Veterans Affairs had significant problems across the country. The VA hospital in Phoenix was a poster child for bad behavior that resulted in potentially the death of veterans. One of the things we did to try to help the Department of Veterans Affairs better take care of America's veterans was to pass the CHOICE Act. We did that in August of last year. It was signed into law, and it is now being implemented by the Department of Veterans Affairs. There are many issues that are associated with the implementation of this bill, but let me raise one. The crux of that legislation is this. If you are a veteran and you live more than 40 miles from a VA facility or if you can't get the Department of Veterans Affairs to provide the services within 30 days or the timeframe in which you need those services, then the Department of Veterans Affairs is required by law to provide those services, if you choose, at a place of your choice, presumably your hometown. This is about service to our veterans in their hometowns across Kansas and across States around the country. The theory is that the Department of Veterans Affairs is incapable of providing those services perhaps for a number of reasons, including lack of the necessary professionals. Therefore, let's take advantage of the professionals we have at home in our hometowns. Let the veterans see his or her hometown physician. Let the veteran be admitted to his or her hometown hospital. It is a pretty commonsense kind of reaction to the inability of the Department of Veterans Affairs to meet the needs of veterans across our country--provide another option. If that is the choice of the veteran, that veteran wants to have care at home, give them that option. As a Senator from a State such as Kansas, this makes sense to me even in the circumstance in which the Department of Veterans Affairs can provide the service. For 14 years I represented a congressional district in Kansas, the western three-fourths of our State. The congressional district is larger than the State of Illinois and has no VA hospital. We pushed for a number of years and were successful in opening outpatient clinics so veterans could get that care closer to home than the VA hospital, and those outpatient clinics provide--or at least intended to provide--routine care. Here is the problem today. The law says if you live more than 40 miles from a VA facility, then the VA must provide the services at home if you choose. The Department of Veterans Affairs is defining facility as any facility, including the hospital or the outpatient clinic. That doesn't seem too troublesome to me until you take it to the next step, which is, even if the VA hospital or the outpatient clinic doesn't provide the service that the veteran needs, they still consider it a facility within 40 miles. In my hometown, where I grew up, we have had an ongoing dialogue with one of our honored veterans. He needs a colonoscopy. My hometown is nearly 300 miles--250 miles from the VA hospital in Wichita. There is an outpatient clinic, a CBOC, in Hays, 25 miles away. But guess what. The outpatient clinic in Hays doesn't provide the service of colonoscopies. One would think the veteran in my hometown could go to the local physician or the local hospital and have the colonoscopy performed and the Department of Veterans Affairs provide and pay for the services. But no, because there is an outpatient clinic within 40 miles, even though it doesn't provide the colonoscopy, our veteran is directed to drive to Wichita. Incidentally, we have calculated the mileage expense of the veteran doing it. It does not make sense economically, either. But regardless of that, it certainly doesn't make sense for that veteran. I have said this many times over the years as we have tried to bring services closer to home to veterans. If you are a 92-year-old World War II veteran and you live in Atwood, KS, up on the Nebraska border, how do you get to the VA hospital in Wichita or in Denver? Our initial attempt was to put an outpatient clinic closer. The problem with that--we now have an outpatient clinic in Burlington, CO, and an outpatient clinic in Hays, KS. But that is still 2\1/2\ hours from Atwood, KS. If you are a 92-year-old World War II veteran in Atwood, KS, how do you get to Hays or Burlington, CO? The answer is you probably don't. Our veterans are not being served. We attempted to address this issue. Let me say it differently. We addressed this issue in the CHOICE Act and said that if you are 40 miles from a facility, then the VA provides the services at home. The VA is interpreting that facility-- the word facility--just to mean any facility there regardless of what service it provides. In many instances--I take Liberal, KS, where there is a CBOC. They haven't had a permanent physician in their CBOC in almost 4 years. But yet Liberal--the CBOC in Liberal--counts as a facility even though there is no physician who is regularly in attendance at the clinic. These issues ought to be resolved in favor of whom? The veteran. Whom, of all people, would we expect to provide the best service to? In any capable way we can, whom would we expect to get the best health care in our Nation? I would put at the top of the list those who served our country. The committee that passed this legislation, the CHOICE Act--it says in the language--the conferees recognized the issues I just described and added report language that allows veterans to secure health care services that are either unavailable or not cost-effective to provide at a VA facility, which was intentionally included to give the VA flexibility to provide veterans access to non-VA care when a VA facility, no matter what size or location, cannot provide the care the veteran is seeking. Yesterday I introduced S. 207. I would ask my colleagues to join me. Again, I guess my first request is, Could the Department of Veterans Affairs fix this problem on their own? If not, I would ask that my colleagues join me in fixing this legislatively with one more directive to the Department of Veterans Affairs saying, if they cannot provide the service at the CBOC, then it does not count as a facility within the 40 miles. This is a problem across our States. I had my staff at a meeting in the VISN in which they were describing how they were going to implement the CHOICE Act. They put up a chart in which they show how they are going to have a mobile van work its way through the area of our State and Missouri and talked about how that will then satisfy the 40-mile requirement. Why is the VA bending over backward to avoid--let my say it differently. Why is the VA not bending over backward to take care of the veteran, instead of bending over backward to make sure it is the most difficult circumstance for a veteran to get the health care they need at home? We ought to always err on the side of what is best for veterans, not what is best for the Department of Veterans Affairs--if you could ever make the case that providing services someplace far away from the veteran is good for the VA. I thank the Presiding Officer for the opportunity to speak to this issue. It is an important one. I have mentioned it to a number of my colleagues. They have described similar circumstances in their State. I have met with the Department of Veterans Affairs personnel. I serve on the veterans' committee, have since I came to Congress. We will work in every way with the veterans' committee, Republicans and Democrats, to make certain there is a fix to this issue. But I want to highlight the manner in which the Department is implementing the CHOICE Act is not the way Congress intended, and it is not the way that benefits the veteran. Finally, let me say that even if there was some circumstance in which the Department does not have the authority to do what we are asking them to do in the CHOICE Act, they have the ability today to provide non-VA care whenever they deem it necessary. There is also the opportunity for them to use a pilot program that many of us have in our States. I see the Senator from Maine is on the floor. They have a pilot program, the ARCH Program, in which we are trying to provide services to veterans at home. There are a variety of ways the Department can solve this problem. I ask them to do that. In the absence of their solution, I ask my colleagues to join me in sponsoring, in debating, in potentially amending but most importantly in passing and sending this bill to the President so we can resolve once and for all that the Department of Veterans Affairs is created for the benefit of the veteran, not the Department. I yield the floor.

Mr. MORAN. I also ask unanimous consent that I be allowed to speak as in morning business.

Mr. MORAN. Mr. President, earlier this evening an amendment of mine was made pending to the legislation that we now have before us, amendment No. 73. I thank my colleagues for allowing that amendment to become pending, and I look forward to the opportunity now, while we are determining the remainder of the evening's schedule, to describe the nature of amendment No. 73. I have a copy of the amendment in front of me. It is a short paragraph, but it is one that has significant consequences to the people of Kansas. But in addition to the people of Kansas, it has significant consequence to the people of Colorado, New Mexico, Oklahoma, and Texas. The story we are talking about is the lesser prairie-chicken. In March of 2014, the lesser prairie-chicken was listed not as an endangered species but a threatened species under the Endangered Species Act. It is true the numbers of birds declined in 2012 and 2013. The U.S. Fish and Wildlife Service had their explanation for why there was the decline in the population of those birds, both those who live on the land but as well a number of wildlife experts--people who are very interested in conservation practices in our State--believe and agree that the primary reason behind the bird's decline in population was the historic and prolonged drought that our area of the country has experienced in the past several years. There is less habitat for birds generally in our State and across this region of the country, but the reality is that it is because we have had so little rainfall. We have been in a drought in a significant part of the Nation, in our part of the country, for a number of years, and as a result there is less habitat and a decline in the bird population. What many believe is that with the return of rainfall, with the return of snow this winter and the moisture it will provide, we will have increasing wildlife habitat for the lesser prairie-chicken and a large number of birds and other wildlife in our State and in the surrounding States where this is a significant issue. There are some exceptions that have been written into the designation, but the reality is that there are huge, ongoing, significant economic consequences to the listing as a threatened species of the lesser prairie-chicken in Kansas, Colorado, Oklahoma, New Mexico, and Texas. Front and center of that, of course, are the consequences to agriculture. It is how we earn a significant portion of our living in our State. Land values, for example, have dropped as a result of this issue. Oil and gas exploration has been disrupted. Wind energy projects that have been an important component of our State economy and particularly a benefit to the economy of rural Kansas have been harmed as a result of this listing. These disruptions have driven down county tax revenues that are used for essential services in some of the most challenging and difficult parts economically of our State, from damage to Main Street, and certainly harmed a portion of Kansas that always struggles to be economically viable. The listing, in my view, was based on an artificially low population estimate due to the drought I described. I guess I failed to mention that 1 year ago this was a bird which could be hunted in Kansas. So, again, it was prevalent enough to be able to be pursued by those who hunt, but because of the drought the population declined. In fact, every Kansas county that is included in the habitat area was experiencing a D3-Extreme or a D4-Exceptional drought, according to the U.S. Drought Monitor, again highlighting that what we need here is rainfall and moisture that comes from snow and rain and that listing this as a threatened species doesn't create the moisture necessary to create the habitat for the return of the population of the bird. What we really have asked for is an opportunity which has been offered and suggested by conservation groups in Kansas, by the Kansas Department of Wildlife and Parks, and by the Kansas Farm Bureau and others to work together to find a solution short of this listing to increase bird population in Kansas. And I assume that is true in the other States as well. We are looking for a cooperative effort to improve habitat, and the fact is that the listing as a threatened species has been so disruptive that we have been unable to get what we would say is a more commonsense, less broad-brush approach to solving this problem in place as compared to the heavy hand of this listing. We stand ready, willing, and able to provide that kind of local effort to improve habitat and bird population. This amendment would not mean the lesser prairie-chicken would never be listed again, but it gives Kansans and others the opportunity to go back and make certain that efforts at the local level are given a chance to work before the very dramatic and devastating implementation of this decision to list the bird as threatened. So this is a relatively straightforward and simple amendment that will take the lesser prairie-chicken off the list as a threatened species, give Kansans and others the opportunity to improve the habitat, reduce the economic damage that is being done in our State and the States that surround us as a result of this listing, and then give us the opportunity to again work with the U.S. Fish and Wildlife Service to find a better solution and one that, I might add, may be more easily found once the rainfalls return to the State of Kansas. I thank the Presiding Officer for the opportunity to describe this amendment, and it is certainly my request and I look forward to it being an amendment that would be considered tonight, later this evening. Mr. President, I suggest the absence of a quorum.

Mr. MORAN

Mr. MORAN. Mr. President, Mr. Clay Hunt is a marine veteran who committed suicide in March of 2011 at the age of 28. Clay enlisted in the Marine Corps in May of 2005 and deployed to the Al Anbar Province near Fallujah in January of 2007. He was shot in the wrist by a sniper's bullet that barely missed his head, and it earned him the Purple Heart. Clay recuperated at Twentynine Palms, CA, and then graduated from Marine Corps scout sniper school in March of 2008, and he was redeployed in southern Afghanistan a few weeks later. His unit returned to the United States in late October 2008 and he was honorably discharged from the marines in April 2009. After he returned home, Clay suffered from post-traumatic stress disorder, PTSD. He struggled for many years and he struggled with inadequate care from his local VA hospital before taking his own life. The Clay Hunt Suicide Prevention Act passed the House of Representatives a little while ago this week. I believe this is an important piece of legislation. I serve on the Senate Veterans' Affairs Committee and we had testimony related to suicide prevention, suicide among our veterans, a few weeks back, and it is so clear in Kansas and across the country that many veterans and their families deserve something much more than we are able to provide--than we are providing now--and this legislation which will help in that regard deserves swift passage by the U.S. Senate. This bill, the Clay Hunt Suicide Prevention Act, would be instrumental in developing a VA system capable of offering first-class, first-rate mental health care services as well as utilizing the expertise of outside organizations to provide support for those struggling with the invisible wounds of service. The legislation would require third parties to conduct an annual evaluation of suicide prevention programs within the Department of Veterans Affairs and within the Department of Defense. It would also provide for a new Web site that would offer veterans information regarding available mental health care services, and it would create a joint pilot loan repayment program for VA psychiatrists. There is a tremendous shortage of VA professionals that this would help alleviate, and it will improve the exchange of training, best practices, and other resources among the VA veterans service organizations and not-for- profit mental health organizations to enhance the cooperation of their efforts in suicide prevention. During that Veterans' Affairs Committee hearing on November 19, last month, we were honored to hear Clay's story from his mom, Susan Selke. Susan shared her son's story of reliving the traumatic experiences of war and his disappointment when the VA failed to offer him the care he needed to treat his stress disorder. In fact, it was one of the most compelling--again, I have served on the Veterans' Affairs Committee since I came to Congress, and this mother's testimony was one of the most important pieces of information I have heard from a witness during the committee hearing. What she indicated was that in her belief--and she indicated that she believed her son thought this as well--that it was the VA bureaucracy, the inability, the unwillingness, the falling through the cracks, the culture that we have heard described in the Department of Veterans Affairs that was the straw that broke the camel's back and that caused her son to commit suicide. We have ranted, we have raved, we highlighted, we pointed out, we have discussed the VA and its problems, its bureaucracy, its culture, its failure of leadership, its service to the VA as compared to its service to veterans many times over many years. We often bemoan bureaucracy among all Federal agencies, but it is especially important at the Department of Veterans Affairs, because while it is easy to talk about the bureaucracy, the paperwork, the shuffling, the falling through the cracks, this mother's testimony about the death of her son indicated that it is not just about bureaucracy, it is not just about paperwork, it is not just about a culture. Those circumstances contributed to the death of a human being. In this case it contributed to the death of one who served our country nobly. So we can bemoan the bureaucracy, but we need to remember that it is that circumstance that causes the loss of life. Suicide is something that needs to be addressed. We need to have a concerted effort, and legislation that is now pending before the Senate that needs to be passed before this Senate concludes is one step we can take to make certain there are less circumstances in which a soldier or a veteran commits suicide. I cannot imagine the heartache, the difficulty, the challenge, that comes from a mom who comes to DC to testify about the suicide death of her son. I don't know how to put myself in that position, but I know it has to be a tremendously difficult, traumatic experience. The reason she must do that is because she wants to make certain that other sons of other parents of other mothers have a different experience than the one she, her family, and her son, experienced. It is clear we have a problem. It is critical that the VA follow through on its commitment and its responsibilities to our Nation's veterans. It is critical that they must follow through to those veterans who are just returning home, those who have been home a long time, and to their families who need to have the love and support and care of the VA and the American people. We have to keep working to find solutions to the issues of mental health our service men and women and veterans now face, and we must hold the VA accountable for their responsibilities when it comes to providing for the needs of those veterans. And that care and treatment must be provided in a timely, high quality, and in a specialized way that meets the needs of each individual veteran and their family. My presence on the Senate floor this evening is to highlight the importance of the message of the Clay Hunt Suicide Prevention Act, to pay honor and tribute to Clay Hunt and to his family, and to the hundreds of individuals and families across the country who have faced similar circumstances, and call us to the point that we recognize that steps taken today can make certain there are no more Clay Hunts, no more mothers who face the circumstance of the loss of their son, and that America lives up to its commitment to those we have called to duty. I urge my colleagues to make certain that this legislation passes the U.S. Senate before we recess for this holiday period. Mr. President, thank you for the opportunity to speak this evening. I yield the floor, and I suggest the absence of a quorum.

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

Mr. MORAN

Mr. MORAN. Mr. President, I have visited hospitals many times in our State. In fact, there are 128 community hospitals in Kansas, and I have visited each and every one of them once and, in many instances, two or three times. In fact, last weekend while I was home in Kansas, I visited my hometown hospital, Mercy, in Manhattan, KS. It is a very useful exercise. I would encourage my colleagues to spend time with health care providers. In the case of hospitals, it gives you the opportunity to visit with hospital administrators, the CEOs, the opportunity to visit with the nurses, patients, with physicians, and get a feel for what is going on in the delivery of health care in your State. I certainly know how valuable that is to me. One of the interests I have in serving in Congress is a belief that the way we live our lives at home in Kansas is something very special, and it is something that is worth trying to make certain is around for many years to come--in fact, for generations to come. One of my early conclusions, in looking at public policy and looking at the future of the communities of Kansas and the people who live there, is the access to health care, to affordable health care, is critical. It is a component in which many communities will not continue to exist if there is not access to hospital care, a physician, a hometown pharmacy--all the things that make up the opportunity for someone to be cared for in every aspect of their lives related to their health. I know this from my own circumstance, my hometown of Plainville with a population of about 2,000. My parents called Plainville home into their nineties. My parents are no longer living, but I know well before the time in which they passed, my sister and I would have had a conversation with my parents talking about: Mom, Dad, I am sorry, but you need to move, and you need to move where you can have adequate health care. You need to move where there is a good hospital and a set of physicians who will care for you. But because that exists in my hometown and continues to exist in my hometown, those kinds of conversations are not necessary. Wherever the place that you are telling your parents they have to move to access health care--wherever that place is--and it may be a very desirable place, but it is not home. My parents would have lived someplace in which they had not lived all of their lives, would not have been surrounded by the people they know and who knew them--particularly as they lived, my dad, until the age of 98. They would not have had the people who checked in on them, made sure they were doing OK each and every day, gave them the opportunity to continue to live at home, the people who would have given them a hug and a pat, and the pharmacist who said to my dad: Ray, you probably need to have your blood pressure taken. Those are very special things about many places many of us come from. In the absence of those kinds of opportunities for health care, our communities--certainly across my State and across the country-- especially in rural America begin to disappear, the point being that in the absence of access to health care, the ability to keep a community together to encourage senior citizens to remain at home in their hometowns and for us to be able to recruit and encourage young families to move to our communities is not going to happen, is not going to be available, unless we have access to health care. In the discussions I have with those health care providers, the doctors, the nurses, the CEOs, the administrators of the hospital-- including the patients--they continued to remind me that what is going on in our Nation's Capitol, in Congress, and certainly in the administration, are barriers, are burdens to the chances of that hospital and those health care providers continuing to be in business. Every visit involves the raising of concerns to me. Often it is: What you are doing about this, Senator Moran? What are you doing to reduce the Federal regulatory burden that our hospital faces? Are you working to make certain we are able to provide the health care our local residents need? Last month I introduced legislation that was bipartisan, a resolution that unanimously passed the Senate. It recognized the importance of access to hospitals and other health care providers, particularly in rural areas of our country. It indicated how special they were and how important they were to the success and survival of the communities in our country. The point I would make about that resolution is it passed unanimously. While the importance of rural providers is overwhelmingly acknowledged, as evidenced by the unanimous passage of that resolution, the Affordable Care Act and unnecessarily burdensome Federal regulations fail to demonstrate that we follow through on that understanding of the importance of hometown health care. Among the regulatory concerns I hear about in those hospital visits, serious flaws with what is called RAC, the Medicare Recovery Audit Contractor Program, is it is causing many problems for hospitals and providers across Kansas. Our hospitals and health care providers have been required to divert significant resources away from caring for patients, their mission to appeal incorrect audit decisions that are almost always ultimately overturned through an appeals process. This broken RAC Program places a tremendous burden on the providers, and it has created a 2-year appeal in backlogs within the Department of Health and Human Services. This program diverts the resources hospitals are devoting to caring for patients, to going through the process of trying to get their money back. That is certainly a problem and increasing the expense of providing health care. But the other aspect of that is often the hospital's money is tied up for 2 years, held by CMS, the Centers for Medicare and Medicaid Services, while it is adjudicated. Again, the overwhelming number of cases is decided ultimately in favor of the hospital, but it is certainly diverting resources and increasing costs. I met with Secretary Burwell at Health and Human Services to discuss what is an urgent need to improve the Medicare RAC Program. I have requested from HHS a timeline and objectives, measurable objectives, to address the RAC problems and the appeals backlog that is in existence now. Another concern in addition to the RAC audits is the Federal Government's inflexible supervision rules. CMS passed a rule that was delayed but now ultimately put in place. It requires that many pretty routine services that occur in a hospital--that includes things such as a drug infusion or blood infusions, cardiac and pulmonary rehabilitation--that they require supervision. That is just not an option in many rural hospital health care settings. There is a lack of understanding and a lack of common sense as to what a small hospital in a small town faces when CMS puts this regulation in place. They make it difficult for those hospitals to continue to provide those necessary services. Fortunately, we have had some success in addressing this issue. Congress passed legislation that prevents the Federal Government from enforcing that regulation through the near future. I have introduced original legislation to make that change, that regulatory prohibition, permanent. I will reintroduce that legislation in January in the new Congress as we try to capitalize upon the temporary success we have had in fighting back this regulation from CMS to make it permanent so that when the temporary prohibition expires that we will have the opportunity to keep them from reintroducing that provision. I will say that hospital administrators and employees, when I have a conversation with them, the discussion typically involves serious and strong opposition to a number of proposals that come from the Obama administration each year. One of those is to change the number of miles that you must be apart from another hospital in order to qualify to be a critical access hospital. It is a program under Medicare and Medicaid Services that allows for a reimbursement that is more based upon cost than otherwise would be the case. Also the administration has continued to propose a 1-percent reduction in the funding for those critical access hospitals. Those are pretty much life-and-blood issues for community hospitals across Kansas and around the country. That critical access hospital designation in receiving that cost-based reimbursement means that a hospital with few patients, one that doesn't have hundreds of patients each day, can still be reimbursed at a rate in which they can almost make ends meet, that they can cover their costs but still rarely is there any profit or extra revenue generated from that so-called cost- based reimbursement. Cutting reimbursements to the hospitals, removing them from the critical access program, I have little doubt but that it would eliminate many, if not most, of those hospitals currently in that critical access hospital program. There would be no place else for them to go, no other category within Medicare that would allow them to survive. I believe the number now is 88 of Kansas's 128 hospitals are those critical access hospitals. The other topics of conversation that arise in those conversations in visiting with health care providers at a hospital--the physician, the nurses, the physical therapists, the CEO of the hospital, the trustees, the board of directors of the hospital--is the Affordable Care Act. Again, we symbolically say we care a lot about rural health care providers, but the reality is the Affordable Care Act is creating significant problems, challenges, for the survival of hospitals, particularly the smallest hospitals in my State and across the country. The Kansas Hospital Association projects that the Affordable Care Act will cost Kansas health care providers approximately $1.3 billion in Medicare funding over the next 10 years. These Affordable Care Act cuts include reductions to hospitals' Medicare reimbursements and a payment called disproportionate share that the hospital receives in order to cover the high level of uninsured patients. These cuts are taking place on top of what Congress and the President agreed to under sequestration--a 2-percent across-the-board cut--that many, if not all, of our providers are now receiving. So what was supposed to be cost-based reimbursement, which nearly never covered the cost, is being reduced by another 2 percent as a result of sequestration. Again, this is something this Congress--and if not this Congress, the new Congress that begins in January--needs to deal with, the issue of sequestration. For this and for other reasons sequestration is a significant problem. While I certainly support the reduced spending aspects--what the goal was of sequestration--the idea that we would do across-the- board cuts is irresponsible. We ought to be establishing the priorities--the things Congress, on behalf of the American people, thinks are the most important and beneficial to the American people, the things that are allowed for under our Constitution. Those are the things we ought to be funding, as compared to taking a step back and just having automatic cuts because we don't have the ability to decide in a responsible way what we can afford and what we cannot afford. Further, I would say the Affordable Care Act forced States to adopt-- the original act as passed by Congress--an expansion of Medicaid. The U.S. Supreme Court, in its 2012 ruling, indicated that Medicaid expansion was optional, not mandatory under the Constitution. So that portion of the Affordable Care Act was determined to be unconstitutional. States are now faced with the difficult decision that involves Medicaid and long-term costs associated with potential expansions, and hospitals face tremendous uncertainty about how they will care for an increased number of patients while they are already absorbing the Affordable Care Act's Medicare cuts. So States are struggling to figure out what to do about expansion of Medicaid. Hospitals are suffering from the consequence of not having additional Medicaid dollars. That is on top of the cuts that occur as a result of changes in Medicare. Really, in most hospitals across my State, two components are so important: Medicaid and Medicare cover a significant portion of the number of patients that are admitted to a hospital, and in many instances there are not many private pay patients who have their own health insurance to add additional revenue to the hospital's revenue stream. This scenario of Medicare and Medicaid both creating problems, being squeezed from both programs, presents significant problems for rural hospitals. Again, those reimbursements--Medicare and Medicaid--make up about 60 percent of those hospitals' revenues. The Affordable Care Act also put hospitals in the difficult position of having to balance increasing regulatory burden with reduced revenues. So in addition to the Medicare-Medicaid pressure, there is also the problem of increasing costs associated with more and more regulations emanating from the Department of Health and Human Services and other places across the Federal Government at the same time the reimbursement rates are declining. So increased cost, reduced revenue-- again, a significant problem. In 2011, the average Medicare margin for hospitals in Kansas was a negative--not enough to cover the cost--4.9 percent. These losses have to be offset somewhere, and that often results in a reduction in staffing. It sometimes means a reduction of services. The end result is a hospital that is not always able to meet the needs of their citizens--their patients. In many instances it is the hospital that may be among the largest employer in a county or community in our State. In addition to reduced staffing, an inability to buy equipment, and reducing certain specialty programs offered at the hospital, we are also seeing a significant depletion in their cash reserves and a freeze on capital expenditures. This circumstance is just not sustainable, and so we are seeing hospitals close. Since about 1990, the number of rural hospitals across the country has remained stable at around 2,000, but last year 15 rural hospitals closed. We have to be concerned there are more to follow. This is an alarming trend. These hospitals play a vital role in health care to those rural communities. It can determine whether a community has a future--whether individuals and families will decide to live there. The loss of a hospital has huge ripple effects and it harms patients. Their primary purpose is to save lives and improve health care, but it is also a tremendous loss to the community itself. I outlined problems that I believed would occur for hospitals with the passage of ObamaCare long before the law became law. I also would say it doesn't mean I don't believe there aren't significant improvements to be made to our health care delivery system, but I think the reality is that the Affordable Care Act causes more problems-- significantly more problems--than those it solves. Many Kansas hospitals struggle to meet the needs of the aging population in their States and the Affordable Care Act cuts are an exacerbation of their circumstance. Again, the Affordable Care Act had the promise of: If you like your plan, you can keep it. If you like your health insurance plan, you can keep it. If you like your physician, you can keep him or her. That didn't turn out to be true. In fact, if you liked your policy, you were probably not able to keep it, and that something else now--that replacement policy--often involves increased copayments and deductibles. That certainly is a problem for the policyholder and his or her family. It is a problem for the business and their employees. But we may have forgotten it is a huge problem for the health care provider. Almost every hospital I have visited, now that the Affordable Care Act is being implemented, will tell me about the increasing amount of unpaid hospital bills--the amount of money that is owed that is attempting to be recovered. The reason that occurs is because the copayments and deductibles are so significantly higher that patients don't have the ability to pay a $5,000 copayment or even a $1,000 copayment. So the hospital's bad debt is increasing because patients don't have the necessary amount of money to pay for their portion of what their health care insurance policy now requires of them. Again, this comes from a law that was described to us as going to increase the affordability and the availability of health care. I guess what I would point out is, in the circumstance we are now in, the policies are so expensive, so much more costly both in premiums and copayments and deductibles, that the affordability is a problem again and not just for the patient, not for the policyholder but for the hospital that is now left holding the bag because so many of their patients can't pay the copayments or the deductibles. When the Affordable Care Act passed, the President's own Medicare Chief Actuary noted that the cuts would cause as many as 15 percent of hospitals, skilled nursing facilities, and home health agencies to be unprofitable by 2019. While that point in time may have seemed a long time away, 2019 is now just about 5 years away. If ObamaCare remains in place, the estimated percentage of unprofitable providers is projected to increase, reaching roughly 25 percent in 2030 and 40 percent in 2050. So by 2030 25 percent of the hospitals, health care providers, will be unprofitable, and by 2050 40 percent--nearly half--of the health care providers will be unprofitable. Again, in particularly rural communities, if you can't make it on the revenues that come from patients, from providing health care to individuals, often the option is to increase taxes--property taxes, sales tax--or something to keep your hospital doors open. That ought not be the consequence of legislation passed by Congress--to require taxes to be raised for a Federal program called Medicare because it is failing to meet the needs of American citizens, our patients. These providers, our hospitals, just simply can't sustain in the circumstance they find themselves in. The Affordable Care Act has put us on a path that I think is dangerous for individuals, for businesses, and now for the health care providers themselves. In addition to the bad debt experience, many of the new health care plans have limited or restrictive provider networks, so that a local hospital may be eliminated from their network. This means that while under their previous insurance policy they could see a hometown physician or be admitted to their hometown hospital, because of these network restrictions they must go someplace out of town to access health care. This again is a terrible consequence for the individual, for the patient, but also something that drives revenues away from the hometown provider, much to the detriment of everybody who would want to make certain that provider, that doctor, remains in the community and that the hospital doors remain open. There is lots of evidence that the problems we are facing are real. They demand attention. Access to affordable health care is something that still deserves our attention. I look forward to trying to make certain we have that opportunity. Again, that is nothing that is going to happen in the next few days, but we have a responsibility to see that the things that are reducing the access to affordable health care are addressed. The efforts that resulted from the Affordable Care Act are exacerbating the problem, not solving the problem. I look at elections as like a new year. There is this optimism that maybe something good can come from a new Congress; that we can establish our New Year's resolutions and we can begin working, and I certainly make the offer to my colleagues throughout the Senate--all 99 of my colleagues--to be someone who wants to be problem solving, oriented toward finding solutions, and working together to make sure those health care providers that are so important to our lives, our safety, to our health, are around for a long time to come and that the communities that depend upon those hospitals--those 128 hospitals in my home State--have a viable future. We have to get the regulatory environment under control, we have to resolve the problems created by the Affordable Care Act, and we need to make certain that health care is an opportunity for people who live in places across my State to still have the opportunity to see the hometown physician, to have a prescription filled by the hometown pharmacist, and to make certain those hometown hospital doors remain open for today and for future generations of communities across my State. I appreciate the opportunity to address the Senate this afternoon, and I suggest the absence of a quorum.

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

Mr. MORAN

Mr. MORAN. Mr. President, I am on the floor this afternoon to speak briefly about the American Savings Promotion Act, H.R. 3374. My understanding is that this bill may soon pass the Senate--it was passed by the House of Representatives in September--and I wish to speak briefly about its value to our country, to its citizens, and to our country's future. I believe this is a fairly narrow circumstance with broad consequences. I believe if there is a primary responsibility we have in being a citizen of this country, it is to make sure, among other things, that we pass on to future generations of Americans the opportunity to pursue the American dream--to be able to have an idea to pursue a business plan, to save for your family's and children's education, to save for your own retirement, to prepare yourself for a bright financial future. Unfortunately, many Americans struggle to do that. Certainly, one of the aspects of that circumstance is there is very little savings that goes on in our country today. People are unable or unwilling, or perhaps undisciplined, in a way that allows them to prepare for their financial security and their financial future. The problem is--and statistics bear this out--people aren't saving. The reality is, according to a recent survey, 44 percent of American households lack the savings to cover basic expenses for 3 months if unemployment or medical emergency or another crisis leads to a loss of stable income. Many Americans have the inability--almost the majority of Americans have the inability to care for themselves and their families if there is an emergency or a problem for more than 3 months. That is something we ought to try to resolve. I also think there has been over a period of time a disparity of incomes. We want to make certain those at the lowest income levels have an opportunity to increase their income and to increase their financial stability. In fact, the Senator from Oregon, Senator Wyden, and I created sometime ago the Senate Economic Mobility Caucus, trying to make certain that people have a chance to move up the ladder of economic success and security in our economy and in our country. Senator Wyden and I came together to bring some of the best minds from conservative to more liberal thought-provoking organizations and policy organizations to visit with Republican and Democratic Senators and their staffs about what ideas are out there that might increase the chances that a person or a family has the chance to improve their financial circumstances. One of the ideas that arose from that caucus's discussions was this legislation called the American Savings Promotion Act, again, with the realization that people are not saving for their own financial security, that they lack stability in times of emergency and difficult economic challenges to care for themselves, how can we encourage Americans to save more? One of the ideas that came forth in this regard is the opportunity to link savings to prizes. When I first heard this, I thought it sounded a little bit odd, a little bit like a gimmick. But the reality is with little savings, people still believe--in fact, 20 percent of Americans believe that winning the lottery is a meaningful strategy to build wealth. Americans spend more than $60 billion every year on lottery tickets and families earning the least spend the highest percentage of their earnings on lottery tickets despite the long odds of winning. This legislation is not about a lottery, but about allowing financial institutions the opportunity to provide prizes for those who save, who open a savings account and deposit money into that account. In our country, because of the way financial institutions are regulated, that has been an opportunity in a number of States in credit union financial institutions for a period of time. In fact, the statistics and the facts that arise from that experiment or that experience indicate that savings increases when there is a prize associated with the savings behavior. So it is one of the reasons this makes sense. Prize-linked savings is an innovation, a tool to encourage savings while offering the chance to win a larger prize. We know these programs work because of the evidence in the States that I mentioned in which credit unions have been offering these prizes associated with savings, and that has occurred in Nebraska and North Carolina and Washington. Since 2009, over 50,000 accountholders have collectively saved more than $94 million, and it only is available in the credit union setting and not available in a bank setting because of Federal barriers that prevent banks and thrifts from offering these prize-linked savings products. With the passage of this legislation--again, which is a pretty straightforward, commonsense kind of opportunity--this legislation will update Federal laws to allow States to expand prize-linked savings to other financial institutions beyond credit unions. Increasing savings is a win-win for individuals. It is certainly valuable to boost the financial institutions' accounts and an improvement to the American economy. This legislation was introduced by me, with the cosponsorship efforts of Senator Sherrod Brown, the Senator from Ohio, in an effort to create one more opportunity, one more piece of encouragement for people to save for their own financial well-being, to care for themselves and their families, and to increase the savings rate in this country for the benefit of the entire economy, but most importantly for the benefit of low-income individuals who need a boost of encouragement to save. I wish to thank my colleagues in the House. As I say, this legislation passed in the House where Congressman Kilmer and Congressman Cotton led the effort in the House, and my colleague, the Senator from Ohio, Senator Brown, for his efforts in supporting this legislation here in the Senate. It is an opportunity for us to do something modest but useful, something based upon common sense, and something that accomplishes a goal we all should have of making certain the American dream is alive and well, that individuals and families take personal responsibility for themselves and their family members. We all know that increased savings, preparing for any kind of circumstance or emergency that comes our way, is something that ought to be encouraged. I appreciate that it is likely that later today or tomorrow H.R. 3374 will pass, again, an example of where we have been able to work together and bring new ideas to the cause of making certain that everybody has the opportunity to increase their economic value, to increase the economic worth for their family available for the future, to pay their bills, and to make certain their future is bright, again, in my mind making sure the American dream is more alive and all American families are better off. Mr. President, I thank you for the opportunity to address the Senate, and I suggest the absence of a quorum.

Mr. MORAN

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

Mr. MORAN

Mr. MORAN. Madam President, agriculture is the lifeblood of my home State of Kansas. It drives our economy, but more importantly, it offers our citizens a way of life that is unique in today's world. Within that industry I often encounter thoughtful, committed men and women who work every day to raise their families, run their businesses, serve their neighbors, and provide a better future for the next generation. Those qualities are found in Steve Baccus, who for the past 17 years has served on the Kansas Farm Bureau Board of Directors and for the last 12 served as its president. Kansas Farm Bureau is our State's largest general farm organization, with nearly 105,000 members. Under Steve's leadership, the organization has influenced policy and politics, promoted rural values, and worked to show an increasingly urban population how food is produced and why technology is indispensable to feeding a hungry world. Steve is a native Kansan, a veteran, a husband, a father of five, and a grandfather. His fourth-generation family farm in Ottawa County produces wheat, corn, soybeans, and occasionally a sunflower or a bit of sorghum. I met Steve now many years ago when he was on his local farm bureau board, and we grew to be friends over the years. He was always someone I could count on to give trustworthy advice and counsel. As agricultural issues repeatedly come to the forefront of debate in Washington, DC--from trade and energy, to the economy, overregulation, and the farm bill--Steve has worked to make certain the voices of Kansas farmers and ranchers are heard in the Nation's Capital. Steve's passion for improving the lives of Kansans and advocating for the future of our rural State has always impressed me. His service on the Kansas Farm Bureau board was inspired by Steve's deeply held belief that there is a better future ahead for Kansas agriculture and for our State. He has always been selfless in his service, often taking time to drive across all 105 Kansas counties over the years to update members of the farm bureau on issues that impact their lives and the lives of their family members in rural Kansas and across our State. KFB members always knew where to find Steve and felt comfortable seeking his help. In addition to his service as president of the Kansas Farm Bureau, Steve has led multiple boards and organizations, including the Board of the American Farm Bureau Federation and the Farm Bureau Mutual Insurance Company, whose board he currently chairs. He has led trade missions, presented testimony before Congress and State legislative committees, and has championed the cause of agriculture for much of his adult life. Steve embodies many traits we can all admire, including a deep love for the great State of Kansas and gratitude for the many hard-working families who provide food, fuel, and fiber on which Americans and the world rely. These traits have earned Steve the respect of his peers across the country. Steve has been a true public servant to agriculture, and he did it for all the right reasons. Not often do you find someone who has such good and clear intentions of service. Kansas farmers and ranchers found that in Steve Baccus in spades. He is a tremendous role model for all of us who want to make a difference in the lives of others. Steve, we congratulate you for your service and wish you and your wife Patricia well in the next chapter of your life as you retire as president of Kansas Farm Bureau.

Mr. MORAN

Mr. MORAN. Madam President, I ask unanimous consent to address the Senate for up to 15 minutes.

Mr. MORAN

Mr. MORAN. Madam President, last Sunday I was at a funeral service in Manhattan, KS, because Kansas lost one of its greatest philanthropists and education advocates when Marianna Kistler Beach passed away on November 1, 2014. Marianna and her late husband Ross Beach--who passed away in 2010-- were residents of my hometown of Hay, KS, for more than 60 years before moving to Lawrence. This devoted couple was well known and well loved for their acts of service and kindness to others. Because of Marianna and Ross Beach, numerous Kansans have been inspired through the arts, and individuals with disabilities and their families have lived healthier, more productive lives. Marianna was born on November 24, 1919, in Lincoln, KS, and Marianna learned the importance of empowerment through education at a young age from her parents. Elmer and Myrtle Kistler moved their family from Lincoln--including their 15-year-old daughter Marianna--to Manhattan, KS, in 1934 in order to give their children the opportunity for a college education during the Great Depression. Marianna graduated from Manhattan High School and Kansas State University, where she was a member of Pi Beta Phi, Sigma Phi Journalism Honorary, and Mortar Board. Marianna married Ross--whom she always called Rossie--in 1941, and they were devoted to each other for 69 years until his death in 2010. Ross Beach was a pioneer in banking, radio and television, and oil and gas, and Marianna was a support system behind all that success. Ross was the president of Kansas National Gas Company and chairman of the board of the Douglas County Bank, and with Marianna by his side Ross created economic opportunities for many Kansans. But the Beaches' business success was overshadowed by Ross and Marianna's generosity. Marianna Beach worked hard to make certain education and the arts would be a priority of Kansans. She and her husband assisted with the formation of the Beach-Schmidt Performing Arts Center and the Sternberg Museum of Natural History at Fort Hays State University. Marianna was a member of the Mid-America Arts Alliance, president of the Hays Arts Council, and wrote a column on art and city beautification for the Hays Daily News for more than 20 years. For the Beaches' 50th wedding anniversary, Marianna convinced her husband to establish the Marianna Kistler Beach Museum of Art on the campus of Kansas State University to ensure that art is accessible to all Kansans. My wife Robba and I have had the honor to serve on the board of visitors of this museum that bears their name. We are able to witness firsthand the positive consequences of the passion and commitment Ross and Marianna had for culture and for the arts in our State. Marianna's priorities were guided by a belief in the value of each individual, which was illustrated by her lifelong commitment to supporting and uplifting individuals with special needs. Supported by her husband, Marianna worked tirelessly to maximize the potential of handicapped individuals, serving on the President's Committee on Mental Retardation from 1969 to 1975. She was also actively involved at the local level. She did everything personally. In fact, the Beach Center on Disability at the University of Kansas is named in her honor. The research done there focuses on disability policy, employment, family support, and early childhood services. The Beaches' level of generosity will truly live on for generations to come. Despite their stature in our community and State, Marianna and Ross Beach always treated every person they encountered with respect and dignity. As a young newlywed couple starting a new life in Hays, the first invitation Robba and I received was to come to Ross and Marianna's home for dinner. There was never a more gracious, caring couple than the Beaches, who wanted to make sure everyone was included. For a large portion of my life, I joined Ross and other businessmen and professionals for lunch at The Roundtable. While there was a lot of talk about sports and politics, I learned a lot about life by listening to Mr. Beach. My friendship with Ross Beach certainly opened doors for me in business and politics, but more importantly, it gave me the confidence to realize that this smalltown Kansas kid could one day be able to serve here with my colleagues in the Senate. While my family and I are saddened by the death of Marianna Beach, we take comfort knowing that the legacy of the Beach family will endure far beyond our generation. While Marianna and Ross Beach donated their talents and treasure, it is their character and generous souls that I and many others will miss the most. Marianna was loved by all who knew her but especially by her family. I extend my heartfelt sympathies to her daughters Mary, Terry, and Jane, as well as her brother Lee, sister Janet, and eight grandchildren and six great-grandchildren. I know you loved your mother, grandmother, and sister dearly, and she will be greatly missed. I hope you find comfort in knowing that she and Ross are united in their Heavenly home. We are told that to whom much is given, much is expected. Ross and Marianna Beach more than fulfilled any expectations. I am thankful for having the good fortune of knowing them for more than 40 years. God bless Marianna and Ross Beach for their life together and let them be a role model for all of us. Thank you, Madam President, and I yield the floor.

Mr. MORAN

Mr. MORAN. Mr. President, October--next month--is Domestic Violence Awareness Month. It is not expected that the Senate will be in session next month and I would like to use this opportunity to visit just a moment about domestic violence in an effort to create a greater awareness and to work to eliminate this plight among many families and many individuals across the country. Domestic violence is an issue that impacts way too many Americans. In fact, it affects so many homes, and yet it is something that is rarely spoken about publicly. Right now, because of actions of professional athletes, domestic violence is in the news and it is on our minds. But this attention needs to continue when the sports writers quit writing and when the news reporters and camera crews quit covering and they move on to the next story. Many Americans assume domestic violence doesn't occur in their neighborhood, it doesn't occur among their friends, but unfortunately that is not the case. Domestic violence does not discriminate by race, gender, age group, education or social status. We can't stereotype, the way we often do, about domestic violence. In fact, it is not just a problem for women; it is also a problem for children and men who are often victims. In large communities, in small communities across the country and across, unfortunately, my State of Kansas, too many Americans, too many Kansans find themselves placed in danger by the very people who are supposed to love and care for and protect them. Each year, more than 2 million women are victims of domestic violence across the country. In Kansas alone, it is estimated that 1 in 10 adult women will suffer from domestic abuse this year. These are damning statistics that make clear, whether we realize it, someone we know is enduring physical and psychological abuse today, tomorrow, this week. We have a responsibility to help the hopeless--those who are often too afraid to speak out for themselves. I rise tonight to try to give voice to those who are victims and to acknowledge professionals and volunteers who provide care and the services those victims need. On a single day last year, shelters and organizations in Kansas served more than 720 victims, and similar organizations around the country served more than 66,000 victims each day. I visited one of those organizations last year, the Kansas SAFEHOME. It is a tremendous organization that serves the greater Kansas City area. SAFEHOME provides more than just a shelter for those needing a place to live or to escape from abuse. They provide no-cost advocacy, counseling, an inhouse attorney, and assistance in finding employment. The agency also provides education in the community to prevent abuse. Each year SAFEHOME helps thousands of women and children reestablish their lives without violence. The employees and volunteers there are making huge differences in the lives of many. I have often said on the Senate floor that what happens in Washington, DC, matters, but I know we change the world one person, one soul at a time, and in this setting and in settings similar to it across Kansas and around the country, lives are being changed and improved. Despite the important and the honorable and noble work that organizations such as SAFEHOME are performing, they are often faced with uncertainty regarding the Federal support they will receive. The good news is that last year Congress was able to move past politics and pass legislation to reauthorize the Violence Against Women Act. I sponsored and voted for that legislation and in my view it provides crucial, critical resources for victims of domestic violence and empowers our justice system to act on their behalf. Just as crucial, it works to prevent abuse from occurring in the first place. This legislation is having a real impact on the lives of Kansans because survivors now have access, for example, to legal services, through the Legal Assistance to Victims grant project, established in 2012 by the Kansas Coalition Against Sexual and Domestic Violence. One survivor expressed how grateful she was for the program because, as she said, ``I didn't know what I would have done without it.'' Without the assistance of this program, she may have had to go to court without legal representation, knowing that her perpetrator already had an attorney representing him. With that legal representation, her perpetrator was held accountable for his actions. Throughout our country, more than one in three women still suffer from abuse during their lifetime, and domestic violence brings fear and hopelessness and depression into the lives of every victim. We should work not only to end this violent crime, but we must also care for those who are victims. By volunteering at a local shelter, speaking out when we become aware of domestic violence or making a donation to an organization that helps in those circumstances, every citizen--as I said, we could change the world one person at a time, and every citizen can find a way to get involved and make a difference. Now and throughout the year--not just now, not just next month, October is Domestic Violence Month--let us be mindful of the victims of domestic violence and each of us do our part to break the cycle and bring hope to those who suffer and are in despair. Let us also use the conversations taking place now in the print in the papers and on the view of the television as an opportunity to speak out against any and all types of domestic abuse. Let's raise the awareness of this silent and devastating crime and bring about an end to all domestic violence. I yield the floor, and I suggest the absence of a quorum.

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

Mr. MORAN. I ask unanimous consent to speak as in morning business.

Mr. MORAN

Mr. MORAN. I wish to engage in a colloquy with the chairman of the Finance Committee, Senator Wyden, and with Senator Heitkamp, to clarify several questions that have arisen since H.R. 3043 and S. 1507 were introduced. I say to the chairman, the term general welfare is found in the Preamble to the Constitution, and the power and duty of governments to promote the general welfare is at the core of our service to the people. Indian Tribes, through treaties, agreements, and statutes, reserved their original, inherent right to self-government, and Tribal governments are in the best position to determine the general welfare interests of the Indian people. H.R. 3043 and S. 1507 are intended to respect the right of Indian Tribes to provide for the general welfare of Tribal members. I ask the chairman, is it your understanding that in interpreting the meaning of the requirement under the bill that Indian Tribal government programs be ``for the promotion of the general welfare,'' it is intended that the IRS will apply this requirement in a manner no less favorable than the safe harbor approach provided for in Revenue Procedure 2014-35, and in no event will the IRS require an individualized determination of financial need where a Tribal program meets all other requirements of new section 139E as added by the bill?

Mr. MORAN

Mr. MORAN. Mr. President, effective immediately, I hereby resign my position as Commissioner to the Eisenhower Memorial Commission.

Mr. MORAN

Mr. MORAN. Mr. President, I ask to speak as in morning business.

Mr. MORAN. Mr. President, I thank the Chair for the opportunity to speak this afternoon. I am also pleased to see on the floor my colleague from North Dakota, Senator Heitkamp. She and I have a legislative interest in a matter now pending before the House of Representatives, and it is at least my desire to see the Senate utilize this opportunity of a bill passing the House to also be considered by the Senate and hopefully be approved. While it has been a challenge throughout this year and throughout this session to get legislation to the floor and voted on, I would not want us to pass up the chance for this legislation to be approved and sent to the President for signature. The legislation we are speaking about is the Tribal General Welfare Exclusion Act. The House of Representatives, as I said, is considering H.R. 3043 this week. This is legislation I am absolutely certain will enhance the economic opportunities and the quality of life for our Native Americans in this country. The Constitution states that a core responsibility of the Federal Government is to promote the general welfare of the people. The Federal Government has a trust responsibility to protect tribal interests. These two objectives come together in this legislation. It certainly would be an understatement to say that the Federal Government over the years has fulfilled its trust responsibility. We know that to not be the case. In an effort to fill that void, tribal governments have taken actions to meet their tribal members' needs with initiatives such as cultural programs and education and social services and health care. Unfortunately, over a period of time, those benefits have been treated as income and those benefits have been subject to the Internal Revenue Service Code. We need to make certain we don't add to the burden that tribes too often have encountered from the Federal Government and that these benefits would not be subject to income taxes and these benefits and the tribes will not be subject to IRS audits because of them. The Tribal General Welfare Exclusion Act extends to Native Americans the same tax privileges that are provided by our States; namely, that the value of government services provided by the tribes to their members, just like the services provided by a State to its citizens, would be excluded for tax purposes. Federal and State governments have enjoyed the privilege of having such services as education, social welfare, health care programs, housing, as well as cultural programs exempt from that taxation. Native Americans have not been as fortunate. The House is close to correcting this problem, and it is my plea and hope that the Senate will follow suit this week. The IRS recently issued a notice that establishes the tribal gender welfare exclusion. It is a matter of treasury policy, and this is appreciated. It is a step in the right direction, but we want to make certain that this policy is extended and codified. The general welfare issue should be put into law to protect against future policy changes, and among other provisions this legislation establishes a tribal advisory committee within the Department of the Treasury to advise the Secretary on Indian tax policy and also declares that any ambiguities of the act will be resolved in favor of tribal governments. It directs the IRS field agents to be educated and trained in matters of Federal Indian law and government trust responsibilities. This is a reasonable commonsense, constitutional piece of legislation. It fosters fairness within our Tax Code and promotes better understanding of the Federal Government's trust relationships. Four years ago similar exclusion rules for Native Americans' health benefits were passed. We have before us now the opportunity to clarify the exclusion as it should be. This legislation makes a lot of sense. It adheres to the Constitution which recognizes tribes as sovereign nations with the authority to provide for their peoples. This has been affirmed many times by Congress in the past. It is clearly part of our U.S. Constitution. The economic benefits are obvious. Our tribal territories, reservations, our Native Americans need not be worrying about the onerous IRS audits and should not be paying taxes when no one else is required to pay taxes on similar benefits. This legislation is revenue neutral, something that is very pleasing. The Joint Committee on Taxation has deemed any impact on the revenue of our Federal Government to be negligible. As a person who cares a lot about the fiscal condition of our country, we ought to be reducing our deficit and boosting our economy. This piece of legislation does not increase the deficit, and it does boost the economy, particularly of tribes across the Nation. Here in the Senate, Senator Heitkamp and I introduced S. 1507. It is a companion bill to the one the House is considering. This piece of legislation has broad bipartisan support, and more than 20 Senators from Alaska to Georgia have joined us in this effort. I am grateful for the members of the Finance Committee and the Indian Affairs Committee who lent their support to this legislation. I am not a member of either one of those committees, but there are four tribes in Kansas and I have an interest in their well-being as well as that of all Native Americans. Native Americans are not seeking to play here by different rules. In fact, it is quite the opposite. They simply want to enjoy the same benefits accorded any other government in our country. They emphasize to me the principle of tribal sovereignty and self-government. This legislation reinforces those principles. More than 40 tribes in 24 states, nearly a dozen Indian organizations and a number of regional tribal organizations representing tens of thousands of Native Americans supported this legislation. It is not just Native Americans. In fact, the U.S. Chamber of Commerce has recognized this legislation as one that will foster economic development and supports its passage. As we are preparing to depart Washington, DC, and take time away from the Nation's Capital, it would be a terrible mistake on our part and a missed opportunity if we don't take advantage of House action this week while the Senate is here in session this week to see that this legislation is approved. My hope is that this could be accomplished by unanimous consent, and I know Senator Heitkamp and others and I have been talking to members of the committees as well as the leadership of the Senate to see that we accomplish this. It is a wrong that can be righted. It is a wrong that should be righted quickly and not at a later date. This certainly is one of those pieces of legislation that is a win-win for all. If we see the House pass the Tribal General Welfare Exclusion Act, I urge my colleagues to join with me, Senator Heitkamp, and Republican and Democrat Senators who are supportive of this legislation, to see that this legislation arrives on the President's desk in the most expedient manner possible. I yield the floor.

Mr. MORAN

Mr. MORAN. Thank you, Madam President. I wish to speak for a few moments this afternoon on the topic of veterans and veterans affairs, knowing, or at least expecting a vote later today on a piece of legislation that has now been compromised between the House and Senate versions of the bill, and something that I look forward to supporting. Honoring Herb Schwartzkopf First of all, though, I wish to take a moment to honor a Kansas veteran, a veteran who dedicated much of his life to serving our country, whether that was on active duty in the Navy or advocating on behalf of other veterans, Mr. Herb Schwartzkopf from Ransom, KS. Mr. Schwartzkopf's many selfless acts began when he served in the Navy in Vietnam. After separating from the service, he returned to Kansas and joined the Veterans of Foreign Wars, the VFW, which he has been a member of now for more than 35 years. He is considered a life member of the VFW. Last year the Hutchinson News asked Herb about his life and dedication to serving his fellow veterans. His response was, ``I will talk about the `V,' but I am not going to talk about me.'' The V is Herb's beloved VFW Post, because he is a humble man who has accomplished much and his priorities in life have been taking care of his country and taking care of the veterans who have served his country. The countless contributions Herb Schwartzkopf has made over 35 years of advocacy for veterans has earned him the highest honor bestowed by the VFW, the All-American Commander of Post 7972 in Ransom, KS. Herb's VFW post serves as a meeting place and a community service hub for the Lions Club meetings and Thanksgiving feasts for the 296 residents of his hometown. It is also a place for raising funds for local cancer patients and victims, helping fund annual Honor Flights to come see the World War II Memorial by Kansas veterans. The 160 members of Post 7972 complete more than 250 service projects and volunteer more than 4,000 hours a year. His leadership at the VFW post has deservedly won the National Community Service Post of the Year award five times, including 3 years in a row for 2009, 2010, and 2011. The Ransom VFW's success is a result of true selflessness. As Herb put it: ``If something comes up and somebody needs help, we just try to rise to the occasion.'' It seems only fitting that he has earned this prestigious award as All-American Post Commander. I pay tribute to him, to his post, his service to our country, and his service to other Kansans, and thank him for that care and concern for other veterans across the country. So I say thank you for your selfless dedication. On behalf of all Kansans, we wish you well and we are fortunate to have you as a citizen of our State and a citizen of our Nation. Toxic Exposure Research I also want to speak about legislation today that has been introduced by Senator Blumenthal and me. It is an issue that Senator Blumenthal brought to my attention and today we have introduced the Toxic Exposure Research Act of 2014. We unfortunately live in a nation where men and women volunteer their services to sacrifice and support us to have the strongest, freest, greatest Nation in the world. When servicemembers raise their right hand and take the oath of enlistment or commissioning, they commit their lives to support and defend the Constitution of the United States and to protect the freedoms we hold dear. Standing by their side through combat tours and multiple duty stations around the world is their family. We should and we must acknowledge that their family members are being called to sacrifice for our Nation as well. The Toxic Exposure Research Act is about addressing the wounds of war that might impact a servicemember's family--wounds that may not be evident for decades later when it is passed on to the next person of their family or the next generation. This legislation would provide for the research on health conditions of dependents of veterans who were exposed to toxins during their service to our Nation such as Agent Orange in Vietnam, gulf war neurotoxins, burn pits in Iraq, or other chemicals from recent conflicts overseas. I am not a veteran, but my life has been shaped by the fact that the Vietnam war took place during my high school years. Many of my conversations in high school were spent talking to those who were a few years older than I who were volunteering or being drafted, and for those who returned home to my hometown after their service in Vietnam. During Vietnam, many of our veterans were exposed to Agent Orange and years later many veterans and their families are still struggling with the side effects of that exposure. Agent Orange specifically has been shown to cause birth defects in children of military members who came in contact with the toxin during the Vietnam war. There are other poisons from wars since Vietnam that have led to life-altering health problems and painful tragedies among veterans and their families. A story of Herb Worthington and his daughter Karen is compelling. Mr. Worthington was drafted to serve in Vietnam and was exposed to Agent Orange. Years after his service came to an end he suffered from many conditions as a proven result of his exposure to Agent Orange. His daughter has battled MS for more than 19 years and has been treated for other conditions such as melanoma and an extremely painful nerve condition. Her life has been handicapped by health problems and various kinds of illnesses which must be studied in connection with the exposure of her father and what he experienced with Agent Orange. Stories like Mr. Worthington's and his daughter Karen's have been shared all across the country in townhall meetings. I have heard them in stories at home in Kansas and they have been collected by the Vietnam Veterans of America. This is an issue that is important to all veterans. It is important to all Americans that we live up to our commitment to those who serve, and it is time we take necessary steps to help and protect their families now and for generations to come. Many people we will never know may be affected by the consequences of their mother, father, grandmother, or grandfather's service to their country. Clear evidence of unsettling conditions and those personal stories warrant the need to collect data to research and study the consequences of these toxins. I invite my colleagues to learn more about these conditions and the impact they are having on family members of veterans by checking out a social media page, Faces of Agent Orange, through the Vietnam Veterans Association, VVA. The fact is many symptoms from toxic exposure are misdiagnosed in descendants of veterans because of lack of understanding and lack of scientific proof. I would ask my colleagues to join us in giving the authority to the Secretary--the new Secretary we confirmed earlier this week--a tool he needs so he can designate a VA medical center as a national center for research on the diagnosis and treatment of health conditions of descendants of individuals or soldiers exposed to toxic substances during their service to our country, during their time as military members. This legislation would establish an advisory board of experts to advise the national center and the VA Secretary with determining the health conditions studied and those that are a result of toxic exposure. The Department of Defense has a role to play here in this research, sharing incidents of military members who were exposed to substances, to enhance the studies and outcomes conducted by the Department of Veterans Affairs. Ultimately our hope is this medical research would determine those conditions that are the result of debilitating toxins and lead to appropriate support and benefits, cures and treatments for family members. Military families support our Nation in their love and commitment to those who served in the Armed Forces, and they should not inherit the painful residual wounds of war that put their lives at risk long after the military operation is over. Toxic exposure research is a necessary step toward making certain our military men and women and their descendants will be properly cared for. It is also a step toward making certain that those toxins are not used in a way that causes this to be repeated again in any future war. We must keep our promises to our veterans and to their families who have made the greatest sacrifice for the sake of our country, our security, our freedom, and our country's future. Madam President, I yield the floor.

Mr. MORAN

Mr. MORAN. Madam President, I ask unanimous consent to address the Senate for approximately 4 minutes.

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

Mr. MORAN

Mr. MORAN. Madam President, I have been a Member of Congress in both the House and in the Senate, and in my entire time as a Member of Congress I have served on either the House or Senate Veterans' Affairs Committee. Over that time I have worked with nine Secretaries of the Department of Veterans Affairs. Today I am here to add my support and ask for the confirmation of someone who I believe will be the next Secretary of the Department of Veterans Affairs, Mr. Bob McDonald. I had believed--I do believe--that a change at the Department of Veterans Affairs was necessary. I made clear that we needed to change the leadership at the top, and I believe this change is a good thing for the Department--the management of the Department, but, most importantly, for the veterans whom the Department is to serve. I also know a change in the leadership of the Department of Veterans Affairs in and of itself is insufficient to solve the problems our veterans are facing in access to health care and in the long time our veterans are required to wait to receive their benefits. I have met with Mr. McDonald in my office. I also, as a member of the Senate Veterans' Affairs Committee, had the opportunity to listen to him testify and to ask him questions in the confirmation process, and I was completely impressed by his candor, his sincerity, and certainly his commitment to serving our Nation's veterans. He is a leader in the tradition of the 82nd Airborne Paratroopers who are well regarded as the first to be called when there is a military emergency. As they say, when the President calls, the 82nd Airborne will answer. In my view, that is exactly what we have in Mr. McDonald. When the President called, he answered that call. He answered the opportunity to serve the veterans of this country. When the President needed help, he found someone, in my view, who will dutifully fulfill the responsibilities of being a Cabinet Secretary and work on behalf of our Nation's veterans. It seems to me there is no certainty in this world in which we know people for brief amounts of time, but it certainly seems clear to me that Mr. McDonald is the right person to lead the VA. He is willing and capable of restoring hope in veterans so they can trust the agency and the Department that was created for their benefit. I asked the President--I don't know that he ever saw my request or certainly never probably listened to my request, but the plea was please nominate someone from outside the Department of Veterans Affairs. This gentleman, Mr. McDonald, while having military experience, has a significant background of being the CEO of Proctor & Gamble, and in that position he was well-known for his value- based leadership, believing that ``the best companies and leaders operate with a clear purpose and consistent set of principles or values.'' What the VA must do right now is to dismantle the bureaucracy, break down the culture of indifference, and review its commitment to the core values of the Department. There is no higher calling than to take care of the men and women who served our country. Mr. McDonald shares that dedication to making certain our veterans have access to quality care--the best our Nation can offer--and he is focused and ready to take on the challenges that lie ahead. At least he convinced me that is the case. There is now, fortunately, compromise legislation poised to pass both the House and Senate this week that will soon offer veterans more access to the quality care they deserve. Although this legislation is significant, it is impossible for Congress to mandate a change in attitude. Leaders can change attitudes at the Department. Congress does not have the power to control or develop a workforce that treats veterans like patriots, deserving care from a grateful nation, rather than to make them feel as though they are a burden. Leadership throughout the institution, starting with Bob McDonald at the top, must command the VA to head down a new path of redemption and hope. We must create an agency that is more cost-effective, more compassionate, and more caring toward the veterans it serves. The VA must become an agency that is worthy of the service and sacrifice of our Nation's veterans. Madam President, I yield the floor.

Mr. MORAN

Mr. MORAN. Mr. President, thank you very much. For 3 weeks we have seen fighting going on in Israel and the Gaza Strip carried on between the Israeli military and Hamas. In both Gaza and Israel lives, unfortunately, are being lost, homes are destroyed, families are devastated, security is threatened, and daily life is polluted by this war. Since the fighting began, Hamas has made it abundantly clear it is unwilling to behave in any responsible manner. The organization is using civilian areas such as schools and hospitals, mosques and playgrounds, as rocket-launching sites. Caches of rockets have been discovered inside two Gaza schools sponsored by the United Nations. A chance for peace emerged when Egypt put forward a cease-fire plan that Israel agreed to. Hamas refused to cease hostilities. Later Israel agreed to a temporary truce, the pause requested by Hamas to facilitate the delivery of humanitarian supplies to Gaza. Despite the Israeli cooperation, Hamas quickly violated the cease-fire, resuming rocket launches into Israeli territory. Hamas's actions seek to kill and terrorize those across the Israeli border while they also do great harm to the people of Gaza. Ending the rocket attacks would hasten an end to the current violence and bloodshed that has taken a disproportionate toll on Gazan lives. On July 17, the Senate unanimously passed a resolution to express American support for Israeli self-defense efforts and called for an immediate cessation of Hamas's attacks against Israel. S. Res. 498 also serves as a reminder to anyone ascribing legitimacy to Hamas's deadly aggression toward Israel; despite any governing agreement with Fatah and the Palestinian Authority, Hamas's violence is not legitimate in the eyes of the United States of America. Since 1997, Hamas has been included on the U.S. State Department's list of designated foreign terrorist organizations. The group's ongoing attack on civilian targets further justifies this designation. Hamas's participation in a unity government limits improvements to life in Gaza as American law restricts U.S. aid to Palestinian groups aligned with terrorist organizations such as Hamas. Gaza's poor economic state, which is cited by Hamas as justification for their attacks on Israel, is not at all improved by Hamas's belligerence. Instead, Hamas's strategy of violence only worsens Gaza's economic outlook. Hamas's actions compound the consequences of funding weapons and smuggling tunnels rather than investing in the future of Gaza and its people, the point being that what Hamas is doing is damaging to the people of not only Israel but to the folks who live in Gaza. This reality begs observers to question Hamas's commitment to the people it supposedly represents. Since the beginning of the current conflict, Hamas's commitment to violence against Israel appears to be their primary mission, not the care and well-being of their people. Unless cessation of hostilities becomes Hamas's priority, Israel will retain and must retain the right to defend its people and the welfare of those living in Gaza will regretfully continue to deteriorate. Americans would not tolerate this. We would not. Our constituents would be insistent that we not tolerate the threat of terrorism that Israel faces on a daily basis. Since 1947, attacks from its neighboring Arab States have repeatedly forced Israel to defend its people. This Senate has and will continue to demonstrate that the United States stands with Israel, especially during these turbulent times as Israel takes necessary action to reduce Hamas's means of terror, to disarm those who stand firmly in the way of a real and lasting peace. Mr. President, I yield the floor, and I suggest the absence of a quorum.