Lisa Murkowski

Ms. MURKOWSKI

Ms. MURKOWSKI. Madam President, there are 2 days every year when this Nation focuses special attention on those who served--Memorial Day and Veterans Day. I plan to approach this Memorial Day by expressing gratitude to those who have served and honoring the memory of those who sacrificed their lives for our freedom. When you serve in the military, supporting your buddy is everything. So as we honor the memory of those lost in action, we know they would want us also to care for their buddies who came home. Advances in military medicine since the Vietnam war have made it possible for many to survive the wounds of war that they would not have otherwise been able to do in earlier conflicts. But these veterans still do not return as they left, and many more return to the scourge of post-traumatic stress disorders. I will see a lot of veterans this Memorial Day weekend. I would like to be able to tell the veterans of Alaska that their Federal Government is doing right by them, but when it comes to the matter of health care, and particularly the failings we see with the Choice Program, I can't in good conscience tell them things are better in Alaska. It has been a while since I have been to the floor to speak in relatively bleak terms about the care our veterans receive in Alaska because for some while things had been improving. They had been improving for much of the last 8 years, but now it seems as if this pendulum is swinging the other way. When I came to the Senate 13 years ago, Alaska veterans who lived someplace other than the metropolitan area of Anchorage or Fairbanks or the Kenai Peninsula really didn't think about the VA health care. Those who lived in those three communities were able to gain their care at the local VA clinic, and it worked for them. But if they didn't live in a community where the VA was located and if they weren't eligible for beneficiary travel, the VA just didn't mean much to them. That was the status quo, and it really didn't show much sign of changing. Alaskans really began to challenge the status quo during the second gulf war. Operation Iraqi Freedom resulted in a large-scale deployment of Alaska National Guard members from throughout the State. At one point, 89 different Alaska communities were represented in the Middle East, and it was fully apparent that when these heroes returned home and were released from Active Duty, the VA was not prepared to meet their needs. When then-VA Secretary Nicholson visited Anchorage in 2006, he heard the message loud and clear from Alaska's veterans service organization, and that created a groundswell to turn the Alaska VA in a more veteran- centric direction. It wasn't easy. The familiar slogan that ``it doesn't matter who wins an election; the bureaucracy always wins'' was a way of life in the Alaska VA health care system, but we developed a pretty strong ally when Secretary Shinseki came on board. During his tenure as Secretary, we saw three significant changes from the status quo. The first thing that happened was that the VA began contracting with Alaska's tribal health care providers to care for both our Native and non-Native veterans who lived outside the reach of any VA facilities. If you are a veteran living in Bethel, it didn't make any difference if you were Native or non-Native--you could receive care through the tribal health care provider, and they were compensated by the VA at the same encounter rate the Indian Health Service paid them. The second thing we saw with Secretary Shinseki--I had commissioned an inspector general's inquiry into allegations that the VA was sending our Alaska vets to Seattle and other points even farther than Seattle for care that could be purchased from community providers in Alaska. There were situations where a veteran dealing with cancer and needing radiation or chemotherapy treatment would be sent to Seattle for a series of treatments when that same treatment could be provided in Anchorage or Fairbanks. Secretary Shinseki brought an end to that practice. Third, the VA hired a creative executive with deep experience in the Alaska health care market to lead the Alaska VA health care system. Even better, the VA senior leadership actually empowered her to do the right things for Alaskan veterans. So when that director began to see waiting lists forming for primary care and behavioral health services in Anchorage, she took the initiative and she enlisted non-VA providers to come in and work with them to solve the problems. We were in a pretty unique situation. We didn't suffer the wait list that veterans in the lower 48 saw because we had somebody who was at the helm, saw the problem, and said: We can be creative; we just need a little bit of flexibility so we can address our veterans' needs. The model was pretty simple. If a veteran needed to see someone outside the VA, they were placed with that outside provider by VA staff. And those VA staffers who matched the veteran with a local provider actually lived in Alaska. They knew Alaska's geography. They knew it wasn't possible to drive from Bethel to Anchorage. They knew the breadth and limitations on services available within our State. Also, the bills for services were sent to the VA; they were not sent to the veteran. If for some reason a provider wasn't paid on time, the veterans were insulated. They were protected from collection agency calls. It wasn't a perfect system and it wasn't without complaints, but on balance this was the best Alaskan veterans were ever treated. Then came the Phoenix scandal. We hoped that what had happened there--the spotlight that was shown on the VA as a result of a horrible scandal--would not affect the good things we were doing in Alaska. Two years later, I can tell you that things have changed profoundly and unfortunately, not for the better. The Choice Act seems to have been the catalyst for unraveling the VA reforms in our little corner of the world. Let me explain why. When we were presented with the Choice Act, I looked at it as having another tool that the VA could use to help expedite care to veterans who couldn't get their care in a timely fashion. If this is another tool in the toolbox, this is going to be good for our vets. But the VA didn't view the Choice Act simply as another tool; they viewed the Choice Act as the single right answer to care outside the VA. To this day, the VA seems to almost resent the fact that a variety of other purchase care programs coexist with the Choice Act, and they worked to undermine them through a hierarchy of care policies that make it impossible for our local VA officials to use community providers with whom they have built these relationships. That whole unraveling was enough to send our creative, innovative Alaska VA director into retirement, and unfortunately that position has been vacant ever since. By the way, when veterans asked ``What happened here? We had a good system. It was working. What has happened?'' the VA talking points said ``Blame the Congress. They gave us the Choice Act, and there is nothing we can do about it.'' That is an entirely disingenuous response given that all of the purchased care authorities that were on the books before the Choice Act remained on the books after the Choice Act became law. The VA had the flexibility before the Choice Act to craft local solutions, and they had the same flexibility to do so after the Choice Act. The decision not to support local flexibility was a deliberate choice, and it was a choice of the bureaucracy, not a choice that was mandated by the Congress. How has the Choice Act been working out in the State of Alaska? I spend a lot of time back home. I spend a lot of time visiting with our veterans, and I am listening hard. Every now and again, I do hear a veteran say: Yeah, I think things are OK. I think I am getting the care I want. But more often than not, what I am hearing from our vets is that instead of calling it the Choice Act, it is called the ``bad Choice Act'' or ``no choice at all.'' For a while, it seemed that the Native partnerships would be subsumed in Choice, and we pushed back on that and we won. But for the veterans who needed specialty care, the Choice Act has been a tough road to hoe, and I have a couple of examples. There was an elderly Tlingit Indian gentleman from southeast Alaska. He was sent to Seattle for a form of cancer therapy that was not available in Alaska. In the middle of his episode of care, he was told: You will have to return to Alaska. It was only after days on the phone with the VA and the Choice contractor--each whom was pointing the finger at the other--and then my office that the problem was resolved. Meanwhile, this veteran was telling his family to prepare for a funeral. It was that dire. Then there was the veteran who was scheduled for neurosurgery. This veteran was told that her referral from the Anchorage VA was rescinded and she would need to go to the Choice Program for another one. She called the Choice contractor's hotline and was referred not to neurosurgeons but to behavioral health providers. Evidently, the individual on the other end of the line didn't know what neurosurgery was. When the particular problem was resolved, the neurosurgeon was no longer available and the veteran was stuck on painkillers until her surgery could be rescheduled. That is not a good outcome. Another example is when a veteran living in Juneau, our capital city, was under the ongoing care of an ophthalmologist, but that doctor didn't take Choice. The veteran called the 800 number for Choice to get another referral. He was told that he could drive to Sitka and see someone there. If you lived in Alaska, you would be laughing because you would know there is no road from Juneau to Sitka. They are both islands. Another reason you might raise an eyebrow is because not only can you not drive there, but the Choice participant was an optometrist. Think about how this veteran feels after calling the 800 number and then being told to just drive down to the next town. You can't drive there, and oh, by the way, that specialist doesn't exist there. The VA and the Choice contractor claim to have fixed these problems, but for every problem that is fixed, there is still a veteran with a new one, a veteran who has lost faith with the Choice Program or a provider who no longer wants the hassle of taking Choice. One provider told me that the amount of time his staff has to spend on the phone with the Choice Program is disruptive to his practice. He said it is unfair to the other patients who aren't getting the attention they need from the office staff. I don't want to stand here and complain without offering solutions. There is a solution to Choice's problems in the State of Alaska, and that solution is to go back to the way we had it, with the local VA partnering local providers with local patients. The Senate Appropriations Committee has urged the VA to reinstate this model in Alaska through language that is included in the fiscal year 2017 report, but I am really not sure where it is going, given the current VA leadership. The rapport, unfortunately, is just not there. Toward the end of Secretary Shinseki's tenure, members of the Veterans' Affairs Committee in the other body berated the VA for its poor congressional relations. I will say that when I needed to talk to the Assistant Secretary for Congressional and Legislative Affairs or, for that matter, Secretary Shinseki, they were right there. And even if the results didn't come as quickly as I would have liked them to, that team was clearly delivering for our folks in Alaska, but I cannot say the same for the current team. Through the fiscal year 2016 VA appropriations bill, I demanded a report on how the VA would serve Alaskan vets under the consolidated Choice Program that told the VA to formulate last summer, and we still haven't seen that report. During the recent appropriations hearings, I raised concerns about how personnel vacancies and management issues in the Alaska VA were affecting performance, and Dr. Shulkin took issue with that characterization. He offered to show me some metrics. We are still waiting. Last week he sent a young doctor from Philadelphia, whom he has charged with running purchased care, up to Alaska. The report back is that he was tone-deaf to criticisms of Choice lodged by our veterans and providers, and he suggested that the rate being paid to the Native health system to do work that the VA should be doing themselves was unjustifiably high. This is very troubling. So we learn that VA is hiring a bunch of new executives to help this individual manage a nationwide community care program out of the VA central office. I remain very concerned. Long before the Phoenix scandal, the VA was purchasing community care using a decentralized model. Now it seems to be moving abruptly to a centralized model. I don't know how well centralized models work in other parts of the West or rural communities in other regions, but I can state that they just do not work in a place such as Alaska. One-size-fits-all is not the model that best serves our veterans, but this seems to be the direction we are moving toward. To make matters worse, we are not even debating what we want community care in the VA to look like. We have 100 Members who have a stake in the outcome, but only a few seem to be involved in that discussion. The votes always seem to be pretty much straight up or down, with no opportunity for amendments. We have done that now twice-- in the first instance with the Choice Act itself and then again last year when we had to bail the VA out because its health care programs would have gone insolvent during the August break if we hadn't done so. We need to address this. We can't keep writing a blank check to the VA. We have to have reform, and that reform needs to work. Last week the Senator from Arizona proposed a 3-year extension of the Choice Program, but the amendment included some changes in the way the VA pays providers in the purchased care arena. There was some problematic language, so I wasn't able to support his amendment at that time. Since then, he has worked with us, which I greatly appreciate, and the leaders of the Senate Veterans Affairs Committee worked with us to resolve those problems. So I can now support the 3-year extension in the Choice Program that he proposes which I expect will include the language changes we discussed. But even if we approve that 3 year extension that's not the end of our interest in the Choice program or VA purchased care. I think it is important to take the time; let's get this right. I think we need to come to terms with what we want care outside of the VA to look like. I think there are still some huge problems in the implementation of the Choice Program that we need to address, and, unfortunately, these problems are profound in the smaller and harder to get places like Alaska. I think it is high time that we give the VA clear direction about the value we place on access to veterans' health care in those smaller and hard to get places. In many cases we know the dynamics of the local health care markets better than the folks in a central VA office. Fixing purchased care begins with directing the VA to collaborate with Members of this body to get it right--not allowing the VA to play members off one another so that, once again, the bureaucracy wins. We can't sit quietly by while the VA blames us for failings that they need to own--failures that might have been avoided through collaboration with those who know their localities best. I appreciate the opportunity to spend a few minutes on the floor this evening talking about how we make things right for who have served us. Memorial Day is but once a year. Veterans Day is but once a year. But every day--every day we need to be honoring and thanking those who serve us, and when we say thank you for their service, let's show them that we mean it. Holding the VA's feet to the fire on results is one way to do that. I yield the floor. I suggest the absence of a quorum.

Ms. MURKOWSKI

Ms. MURKOWSKI. Senator Collins and every member of this body know that I support fair housing. It is so important for my State, where there is a lack of affordable housing, and the Anchorage School District is one of the most diverse in the Nation. However, I have heard concerns from people in Alaska. They worry not so much about the rule itself but about how HUD could implement it. Many communities in Alaska are overwhelmingly Alaska Native, 90 percent or more of the population. Will this affirmatively furthering fair housing rule result in Federal grants being withheld from communities that are currently and have long been populated almost entirely by Alaska Natives because those communities are now considered to be segregated?

Ms. MURKOWSKI. Will Senator Collins yield briefly for a question?

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, in compliance with paragraph 11(a) of rule XXVI of the Standing Rules of the Senate, the Committee on Energy and Natural Resources has obtained from the Congressional Budget Office an estimate of the costs of S. 329, Lower Farmington River and Salmon Brook Wild and Scenic River Act, as reported from the committee. The full estimate is available on CBO's Web site, www.cbo.gov. Mr. President, I ask unanimous consent that the summary of the estimate be printed in the Record.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, in compliance with paragraph 11(a) of rule XXVI of the Standing Rules of the Senate, the Committee on Energy and Natural Resources has obtained from the Congressional Budget Office an estimate of the costs of S. 2069, Mount Hood Cooper Spur Land Exchange Clarification Act, as reported from the committee. The full estimate is available on CBO's Web site, www.cbo.gov. Mr. President, I ask unanimous consent that the summary of the estimate be printed in the Record.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, in compliance with paragraph 11(a) of rule XXVI of the Standing Rules of the Senate, the Committee on Energy and Natural Resources has obtained from the Congressional Budget Office an estimate of the costs of S. 556, Sportsmen's Act of 2015, as reported from the committee. The full estimate is available on CBO's Web site, www.cbo.gov. Mr. President, I ask unanimous consent that the summary of the cost estimate be printed in the Record.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, in compliance with paragraph 11(a) of rule XXVI of the Standing Rules of the Senate, the Committee on Energy and Natural Resources has obtained from the Congressional Budget Office an estimate of the costs of S. 1592, a bill to clarify the description of certain Federal land under the Northern Arizona Land Exchange and Verde River Basin Partnership Act of 2005 to include additional land in the Kaibab National Forest, as reported from the committee. The full estimate is available on CBO's Web site, www.cbo.gov. Mr. President, I ask unanimous consent that the summary of the cost estimate be printed in the Record.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I would like to recognize the work of the chairman and ranking member on the Transportation, Housing and Urban Development Appropriations Subcommittee for their good work on this very important appropriations bill. I recognize that, while we haven't had a multiple series of votes on amendments on this bill, I know the floor managers have been working aggressively to process amendments and make this appropriations bill-- not only the T-HUD bill but also the MILCON bill--a good appropriations measure. So I thank my colleagues for their respective efforts, and I am pleased to see us processing appropriations bills here on the Senate floor. Affordable Care Act Mr. President, I wish to take a few minutes this evening to talk about the Affordable Care Act and some of the impacts that we are seeing in my State of Alaska. We referred to this as the ACA, the Affordable Care Act, but most of the folks, when I talk to them back home, call it the ``un-Affordable Care Act'' because we are not seeing how it is making health care insurance--any kind of care--more affordable. Last year, nationally, we saw a dozen co-ops fail that were created by the ACA, which literally threw people into turmoil, leaving in question if they had any insurance at all. UnitedHealth, one of the largest providers in the country, has been forced off the exchanges in numerous States. Just last week we had the news back home that Moda Health was going to be withdrawing from the Alaska market in 2017. What that means is that we will be a State with only one option in the individual market next year. So what that means for the some 14,000 Alaskans who are currently on a Moda plan is that they are going to be forced to change insurers next year. But I guess it is an easy choice when you only have a choice of one on the individual market there. Then, of course, just last week we saw signs that the administration's payments of the cost-share reduction were unconstitutional. So we can only assume that is going to further exacerbate problems. This week in the Wall Street Journal, there was an article about the ever-shrinking market for rural areas. The article mentioned a small business owner in Kodiak, AK, a bookkeeper, who is worrying about what the price of premiums will be when you are left with only one option. She made this statement: It's going to be a monopoly, basically; ``here's the price, take it or leave it.'' That is what happens when you have just one. As the market continues to fail in other States, we are seeing other States lose their options as well. Alabama and Wyoming are also now left with only one choice. More States may be facing this in the near future. The Wall Street Journal article goes on to point out that the ``patchwork of coverage reflects continued instability in the individual market as companies shift their geographic footprints to avoid areas that have turned out to generate steep losses and focus on places that they believe that they can get their ACA business into the black.'' So what that means for States like Alaska that are very rural and that have some of the highest health care costs in the Nation: We are just not attractive enough to foster competition. At the end of the day, who suffers? It is the Alaskans. It is those who are seeking the care. The administration says the market just needs to ``stabilize and evolve,'' but what about this bookkeeper in Kodiak? What about the educators out there? What about parents who are left wondering: What do we do in the meantime? It used to be that the Federal Government broke up monopolies and worked to foster competition in order to benefit consumers, but now what we are seeing at least playing out in my State is, through bad law and failed policies, we see that same government creating de facto monopolies in the individual marketplace. I find it deeply troubling that as these health insurance options continue to shrink, any hope of curbing the rapid increase of premium rates also disappears. We are constantly asked by our constituents: Are my premiums going to continue to increase? We are talking about monthly premiums in the State of Alaska amounting to $3,000 a month for a family. Think about that. That is not affordable in anybody's book. It is not beyond the realm of possibility given what we have already seen. Last year in Alaska, between Moda and Premera, the two that are covering on the individual market, the increases were over 30 percent, somewhere between 32 and 35 percent increases over the previous year. I have been on the floor, and I have shared stories of hard-working Alaskans who are paying a couple of thousand dollars a month for the cheapest bronze plan that is available on the exchange. I have spoken about how the ACA has been called the single greatest threat to quality public education. The reason for that is our school districts are being faced with hundreds of thousands of dollars in fines under the Cadillac test when it is imposed. I have relayed stories from employers who are saying: I can't afford to expand my business. I won't expand my business because of the employer mandate--harming not only the businesses but the workers themselves. The bottom line, and I hear it from all corners of the State, is that the ACA is not working for us in Alaska. I had a group of Realtors from around the State visit me in my office here last week. One woman in the group said that she was paying $2,500 a month. She has a family of four. She has a $6,000 deductible for her coverage. She said: You know, it is really hard for us to keep making these payments every month. They don't qualify for the subsidy. I talked to another young family from Eagle River who was forced to switch from Premera to Moda after the ACA passed because the premium increases were not sustainable, and even then, when they switched, they were paying $1,200 a month with a $10,000 deductible. So what happens when you have a deductible like that? You put off that health care. But think about it. It just makes it so hard to run a business. It makes it so hard to pay for your day-to-day experiences. Worse yet, for that family from Eagle River, they went from Premera to Moda because their premiums were too high. Now Moda is leaving, so they have to go back to the insurer that was too high before. This family is scrambling. What are they going do? How are they going to be able to afford insurance in the future? As the costs continue to rise, these small businesses are wondering: How long do we keep our doors open if these costs continue at these rates? In Anchorage, a couple who has Moda has been paying $2,500 a month, with a $10,000 deductible--an increase of $1,000 a month over their premiums for last year. Now they are going to be switching to the only company on the individual market in 2017. They are going to see yet another increase. A woman in Anchorage whom we talked to has watched year after year as her rates increased from $500 a month to nearly $2,000 a month. She is basically holding her breath for what the 2017 premiums rates will hold. We don't know yet in Alaska. Because of the announcement from Moda, we are not sure what the increase will be coming from the other insurer. More and more, I am hearing from folks who say that they feel it is just cheaper to simply not buy insurance, to pay the tax penalty and then hope and pray that nobody in the family gets sick. Hoping to not get sick is not a health plan. As more and more Alaskans are dropping out, costs for those who stay in go up, driving more to drop out, and you have this death spiral within the system. The deeper we get into life under the ACA, the deeper Alaskans fall into a hole. The ACA has failed the people of our State. This one-size- fits-all approach rarely works for a State as diverse as Alaska. It certainly has not worked in the realm of health insurance. This is not the only place where we are seeing the law failing. There is more that needs to be done to make the Affordable Care Act work for rural parts of the country that have specialized needs thanks to higher medical costs, lack of access, and now fewer insurance options. We in Congress need to take a serious look at the trends we have seen and work on solutions that will provide the flexibility that is needed for the States to make a difference when it comes to access to affordable care. I have consistently supported full repeal of the ACA. I voted to do so on several occasions now. But I have also recognized that it was going to be difficult, if not impossible, in this administration to do so. But I have supported steps that will reduce the burdens of the ACA and I think work to address some of the most harmful provisions in the law. One example is full repeal of the Cadillac tax I just mentioned. The Cadillac tax will only worsen conditions in Alaska, with nearly 62 percent of customers who will be facing that tax if the Cadillac tax were to be implemented. Again, I repeat, in our State, not only are our health care costs so high, but our insurance costs are so high. Whether you are in what would be considered a Cadillac plan because of the benefits or it is just because you are paying so much for it, it is assumed that those benefits are good. Sixty-two percent of the folks in Alaska would be impacted by this tax. It is a prime example of the ACA hurting small, rural States, because so many of us have more expensive health care due to the remoteness and due to our lower population size. Then those States are forced to take money away from things, like our school districts, where they are trying to put the money into public education, into other services, to pay for the cost. So our State suffers, boroughs suffer, our schools suffer, and our Alaskan families suffer. As we look to the end of this administration and looking to next year, I would hope that we can seriously address the problem that the ACA has created for so many areas of our country. For rural States like Alaska, the approach to health care needs to focus on more than forcing people to just buy insurance and, unfortunately, buy expensive insurance. We need to work to find solutions to these issues, whether it be through the creation of a nationwide insurance pool so that policies are not limited to one State, as they are currently. Right now, as I say, Alaska is not a very attractive market. We have small numbers. We have high costs. Who is going to come? How are we going to get a greater pool? We need to look more critically at how we improve the cost of transparency of medical procedures. We need to look critically at these special enrollment periods and see if people are finding loopholes that allow them to game the system. Expanding both health savings and flexible spending accounts will allow people to save what they think they should and make the choices for themselves instead of the government forcing things on individuals. When we think about those areas where we can save money through not spending it in the first place--an ounce of prevention is worth a pound of cure--we should be incentivizing people to live healthier lifestyles in order to prevent and bring down the incidence of chronic disease. Type 2 diabetes--largely preventible through lifestyle changes--costs an estimated $176 billion a year. Obesity-related illnesses cost an estimated $190 billion a year. A recent study found that a 10-percent drop in smokers could save $63 billion in health care costs per year. It makes zero sense to be paying providers to treat these problems after they have arisen rather than trying to focus on the front end, paying for lifestyle changes and case management that would significantly reduce the cost of treating these diseases. I have been working to find solutions that will help support Alaska's rural needs, especially those related to access and workforce development because if we can improve the overall access to treatment and options to medical providers, we then take steps to reduce the cost of medical procedures. I have supported the Family Health Care Accessibility Act that will improve the care provided by community health centers by enabling them to utilize volunteer primary care providers. Community health centers-- I think so many of us recognize the benefits and the crucial role they serve in meeting the needs of rural and underserved communities, allowing patients to receive local treatment instead of being forced to travel far from home for treatment. Steps like these that help to improve access are just some of the ways I think we should be rethinking our approach to health care in the broader sense as we seek to alleviate the burdens that have been imposed by the ACA. I have continued over several Congresses now to introduce the Medicare Patient Empowerment Act. This is legislation that would give patients the option to negotiate with their provider. Medicare would pay the typical fee the patient negotiates for the difference there, but we face a very unique situation in our State. Again, a one-size-fits-all prescription doesn't work for us. We have incredibly low reimbursement rates for Medicare in Alaska, so you have very few providers that will accept Medicare. When you are newly Medicare eligible or you come into the State, it is tough to find anybody who will see you. If there is some flexibility to negotiate prices, what we are trying to do with this bill is cut through the redtape, allow Medicare beneficiaries to benefit from increased access, and enable patients to have the relationships they have built with their physicians. We have a very fast-rising senior population in the State, and it is going to be increasingly important to make sure they have the option to seek the care they need. I do not support compulsory health insurance but do believe individuals with preexisting conditions should receive care. As we discuss these important issues in the Senate, I continue to work to address--again--these issues that have presented themselves with implementation of the ACA. So working to a place where we fully repeal and replace the ACA is where we need to be. There have been several Republican proposals that would not only replace this unworkable law but replace it with consumer-based reforms. Senator Burr of North Carolina, Senator Hatch of Utah, and Senator Cassidy of Louisiana all have been working on important measures that take steps to get us to a place where what we are talking about is affordable health care, a reality that works for all Americans, whether you are in Alaska or you are in North Carolina. Obviously, there is much work in front of us. Again, it is important to recognize the frustration so many are feeling as they are seeing their costs increase, their access going nowhere, and let them know we continue to work on these very difficult issues. Alaskans deserve it. Americans deserve it. With that, I yield the floor.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, in compliance with paragraph 11(a) of rule XXVI of the Standing Rules of the Senate, the Committee on Energy and Natural Resources has obtained from the Congressional Budget Office an estimate of the costs of S. 782, Grand Canyon Bison Management Act, as reported from the committee. The full estimate is available on CBO's Web site, www.cbo.gov. Mr. President, I ask unanimous consent that the summary of the cost estimate be printed in the Record.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, the people of Kodiak, AK, will gather on Saturday, May 7, to celebrate the life of Thomas ``Tom'' Cornelius Sweeney. Tom passed away on March 29 at the age of 84. Tom was born on February 9, 1932, in Helena, MT. He first came to Kodiak as a member of the U.S. Navy, then returned to work construction and married Nancy Ann Norman. Nancy's family owned the gift and photo shop, Norman's. Tom first pursued a career in law enforcement, serving as a territorial policeman, detective, State trooper, and private investigator. That took Tom and Nancy to various cities in Alaska. Following the 1964 Good Friday earthquake and tsunami, they returned to Kodiak for good. Tom and Nancy helped Nancy's family restore Norman's following the disaster. Tom pursued his entrepreneurial interests in oil sales, automobile sales and service, and finally insurance brokerage before retiring in 1996--a well-rounded career. He was equally committed to the Kodiak community, serving as president of the Kodiak Chamber of Commerce, the Kodiak Rotary Club, and Pioneers of Alaska Igloo #18, which Tom helped reactivate in 1983. His statewide leadership roles included service as state commander of the Veterans of Foreign Wars and chairman of the Alaska Committee for Employer Support of the Guard and Reserve. Tom leaves behind his beloved wife of 60 years, Nancy, two sons, grandchildren, great-grandchildren, and a large extended family. I join with the people of Kodiak in celebrating the life of this great Alaska pioneer.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, in the very short time we have before the vote is called, I have just a few comments this morning. We have completed our work on a bill that includes more than 350 amendments that were filed to this broad, bipartisan bill. We have accepted a total now of 65 of those amendments. This bill contains priorities from over 80 Members of this body. Not everything has been smooth. I think we recognize that. I think this bill has shown that the Senate does work, the Senate can work cooperatively, that they can work toward a bipartisan product that will produce long-lasting benefits for the people who have sent us here to serve them. Our next step, our last step, is obtaining final passage. I would strongly encourage all of our colleagues to vote aye this morning. There are plenty of reasons to do that. I will repeat what I said yesterday: Our bill will help America produce more energy. It will help Americans save more energy. It will protect our mineral security and our manufacturers. It will boost innovation, leading to new technologies and new jobs. It will increase America's influence on the world stage, allowing us to finally become that global energy superpower and enjoy the benefits that come with it. This is a good bill. This is an important bill for our country. I thank our colleagues who have worked with us to get to this point. I urge my colleagues to support the Energy Policy Modernization Act and vote for this bill.

Ms. MURKOWSKI. Mr. President, I ask for the yeas and nays.

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

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I ask unanimous consent that the Senate be in a period of morning business, with Senators permitted to speak therein for up to 10 minutes each.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I thank my colleagues for their support of the Energy Policy Modernization Act. I think the vote we have just concluded is indicative of what I have been saying for years now. I have a relatively lengthy policy manual or handbook, if you will, of how I view the energy space and how we can work to advance our energy policies, but, as with so much nowadays, if you put down a 115-page book or if you have a multipage white paper, it kind of goes by the way. So I have framed my energy policy into three simple words. I don't have it on a chart this afternoon, but it is basically pretty simple: ``Energy is good.'' I think that is what we have concluded with passage of the Energy Policy Modernization Act of 2016, with 85 Members supporting us in this effort. I thank my ranking member, Senator Cantwell, for working with me throughout this very collaborative process. The way we built this bill was not just the two of us as colleagues on the Energy Committee but working with Members on the committee across the aisle, working with other Members of this body in a very open and transparent manner. And it was not just colleagues here within the Senate; it was the outreach we did with numerous listening sessions and the administration. I thank Secretary of Energy Moniz for his assistance in what we built. What we have in front of us and what we are recognizing today is truly a strong, committed process that yielded a strong product. I wish to acknowledge the very, very hard work of our staffs. We all know we cannot do what we need to do as Senators without good people backing us at every turn. I am extraordinarily fortunate as chairman of the Energy and Natural Resources Committee to have a team on the majority's side that is not only extraordinarily hard-working, but they are all amazing experts when it comes to the energy space. I wish to particularly recognize my staff director, Colin Hayes. Colin came into this Energy bill midway. He came on as my staff director at the first of the year after my previous staff director, Karen Billups, who had served on the Energy Committee for close to 25 years, retires. So we had that experience and expertise leaving--and Karen worked so hard to help craft so much of this bill, but then we needed the technician to move it through this process, and Colin Hayes stepped up in an extraordinary and remarkable way, and I thank him for all he did to guide us here. I wish to recognize the others on my Energy Committee staff: Pat McCormick, Brian Hughes, Kellie Donnelly, and Lucy Murfitt. I want to give a special shout-out to Lucy because she was able to help navigate some of the issues that perhaps were not seen upfront and in person, but behind the scenes were very important, not the least of which was the amendment we took a voice vote on yesterday relating to the wild horses in North Carolina. Managing interesting issues and doing it deftly was Lucy's strong suit. I thank Severin Randall. I also thank Annie Hoefler, who made sure anything I needed in my book was there, Michael Tadeo, Tristan Abbey, Chester Carson, Isaac Edwards, Heidi Hansen, Chris Kearney, Chuck Kleeschulte, Kip Knudson, Brianne Miller, Jason Huffnagle, Ben Reinke, Krystal Edens, Melissa Enriquez, Deanna Mitchell, and Karen Dildei. They are all members of our team on the Republican side who have been working day and night for weeks and months now. But we can't work a bill as successfully as we have today without working hand-in-glove with your counterparts on the other side. Just as Senator Cantwell and I worked together, our staffs worked together, and they were led very ably by Angela Becker-Dippmann. Angela came to the committee after being pulled out of another place at the request of Senator Cantwell, and her guidance has been extraordinary. I greatly appreciate her work. I wish to recognize the other members of the minority Energy Committee staff as well. Sam Fowler has been around since time immemorial guiding us. I thank Rebecca Bonner, David Brooks, John Davis, Benjamin Drake, David Gillers, Rich Glick, Spencer Gray, Sa'Rah Hamm, Aisha Johnson, Faye Matthews, Scott McKee, Casey Neal, Bryan Petit, David Poyer, Betsy Rosenblatt, Samantha Siegler, Bradley Sinkaus, Carolyn Sloan, Rory Stanley, Melanie Stansbury, Al Stayman, Nick Sutter, Stephanie Teich-McGoldrick, and Brie Van Cleve. This is kind of a list of Emmy Award winners in my book. But as good as our teams are, we need help here on the floor. The folks on the floor staff have been fabulous and extraordinary, and we thank them for their efforts. Laura Dove and Gary, thank you for what you have done. The other members of the Republican floor staff--Robert Duncan, Chris Tuck, Mary Elizabeth Taylor, Megan Mercer, Katherine Kilroy, Tony Hanagan, and Mike Smith--are great people to work with, and we appreciate their guidance. We had good, strong support from the leader's office. Neil Chatterjee was a kind of energy whisperer for many of us and was a great help, as well as Kate Sterne and Monica Popp with Senator Cornyn's office, Eric Ueland and Becky Cole on the Budget Committee, Heather Burnham and Christina Jacquet at Senate Legislative Counsel, and Megan Carroll and Kathy Gramp at the Congressional Budget Office. I am proud of the work so many have done in getting us here. We are looking forward to sitting down with our counterparts on the House side and getting to work to make sure the benefits we have achieved today in the Senate are replicated with our colleagues in the House so that we can see passage of an energy bill by both bodies and signed into law by the President. Mr. President, I yield the floor. I suggest the absence of a quorum.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I ask unanimous consent that the Senate now be in a period of morning business, with Senators permitted to speak therein for up to 10 minutes each.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I call up the following amendments en bloc and ask that they be reported by number and be considered en bloc, along with amendment No. 2963, offered by Senator Murkowski: Cantwell amendment No. 3276; Klobuchar amendment No. 3302, as modified; Flake amendment No. 3055; Flake amendment No. 3050; Hatch amendment No. 3237; Murkowski amendment No. 3308; Heller amendment No. 3286, as modified; Vitter amendment No. 3075; Portman amendment No. 3168; Shaheen amendment No. 3292, as modified; Heinrich amendment No. 3155; Manchin amendment No. 3270; Cantwell amendment No. 3313, as modified; Cantwell amendment No. 3214; Vitter amendment No. 3266; Sullivan amendment No. 3310; Heinrich amendment No. 3317; Vitter amendment No. 3265, as modified; Kaine amendment No. 3012; Alexander amendment No. 3290; Gillibrand amendment No. 3004; Warner amendment No. 3233, as modified; Thune amendment No. 3239; Udall amendment No. 3221; Coons amendment No. 3203; Portman amendment No. 3309, as modified; Flake amendment No. 3229; and Inhofe amendment No. 3251.

Ms. MURKOWSKI. Mr. President, I know of no further debate on these amendments.

Ms. MURKOWSKI. Mr. President, this brings us to the end of the agreed-to votes on the amendments that required a rollcall, as well as the 29 various amendments that were accepted by voice en bloc. We have made extraordinary progress on a good, strong, bipartisan energy modernization bill. I thank colleagues for the process we have all engaged in today as we have worked to wrap up the final measures to allow us to move to final passage tomorrow morning.

Ms. MURKOWSKI. Mr. President, I ask unanimous consent that the order with respect to the vote on the motion to invoke cloture on S. 2012, upon reconsideration, be vitiated.

Ms. MURKOWSKI. Mr. President, I ask unanimous consent that the motions to reconsider be considered made and laid upon the table en bloc.

Ms. MURKOWSKI. I ask for the yeas and nays.

Ms. MURKOWSKI. We yield all time back.

Ms. MURKOWSKI. I ask for the yeas and nays.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I suggest the absence of a quorum.