Christopher Murphy

Mr. MURPHY

Mr. MURPHY. Mr. President, I ask unanimous consent that the Committee on Armed Services be authorized to meet during the sessions of the Senate on October 3, 2013, at 9:30 a.m.

Mr. MURPHY. Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on October 3, 2013, at 10 a.m., to hold a hearing entitled, ``Reversing Iran's Nuclear Program.''

Mr. MURPHY. Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on October 3, 2013, at 2:30 p.m., to hold a Western Hemisphere and Global Narcotics Affairs subcommittee nomination hearing.

Mr. MURPHY

Mr. MURPHY. Reserving the right to object, Madam President, my understanding is that the Senator is proposing to allow for appropriations to move forward for a portion of veterans funding. Let me just say a few things. It is clearly a hardship that the shutdown is going to result in a diminution of benefits to our veterans. I appreciate the Senator coming to the floor to try to address that today. But as my colleague from Connecticut just mentioned, it is also an unacceptable hardship that there is about to be 4,000 workers at Sikorsky Aircraft who are going to be furloughed on Friday because of this shutdown. It is also an unacceptable hardship that thousands of Head Start children are going to show up to their preschool being closed. It is an unacceptable hardship to millions of frail elderly who are going to have their nutritional benefits compromised. So I think we can all agree that the consequences of the shutdown are unacceptable to our veterans. They are unacceptable, though, to a panoply of other families and individuals across the country. I would note also that I believe the resolution the Senator is offering and suggested be passed provides only partial funding for the VA. There is no funding here to operate the national cemeteries. There is no funding for the Board of Veterans' Appeals. There is no funding for constructing VA hospitals and their clinics. There is no funding, actually, to operate the IT system that the entire VA needs in order to continue going forward. So I would actually offer and ask unanimous consent that the Senator's request be modified; that an amendment which is at the desk be agreed to, that the joint resolution, as amended, then be read a third time and passed, and the motions to reconsider be considered made and laid upon the table with no intervening action or debate. This amendment is the text that passed the Senate. It is a clean continuing resolution for the entire government and something that is already over in the House and reportedly has the majority support of the Members of the House of Representatives. This would solve the problems I am sure the Senator is going to talk about with respect to certain veterans but would also solve all of those other problems and would make sure we continue to have funding for the national cemeteries, continue to build hospitals that need to be built for veterans, continue to service the IT needs that underlay the foundation of our veterans systems, and also make sure Head Start kids do not get turned away from their classrooms, make sure Sikorsky Aircraft workers get to go back to work, make sure our food still gets inspected, we get meals to our frail elderly. The CR is in front of the Senate. If the Senator would agree, I propose we move forward with this modification to his request.

Mr. MURPHY

Mr. MURPHY. Mr. President, I ask unanimous consent the period of morning business for debate only be extended to 5 p.m., with Senators permitted to speak therein for up to 10 minutes each.

Mr. MURPHY

Mr. MURPHY. Mr. President, after 5 years of being a parent, I have gotten used to temper tantrums. It is an unavoidable part of having kids. They demand something--they want a second dessert, they want another 10 minutes before bedtime--and if they don't get it, they storm out of the room. That aspect of early human nature--the inability to deal with defeat and the unwillingness to compromise--luckily goes away over time as we get older and wiser and more thoughtful--everywhere except for Washington, DC. By now everybody gets what is going on. As Senator Durbin said, we are only a handful of hours away from a government shutdown--another manufactured, made-up, totally avoidable crisis. This one is just because we can't pass a 6-month continuing resolution. We are having a problem just keeping the government open under the exact same rules that it has been open because a small set of tea party Senators and Congressmen are basically throwing a temper tantrum because they haven't gotten their way. It is not news to anybody that Republicans oppose the health care law. They opposed it back when it was passed by both Chambers and signed by the President. They opposed it when the Supreme Court upheld the legislation. Their Presidential candidate opposed it when he got roundly defeated in the 2012 election. My opponent and the opponent of every single Senator who stood for election who voted for the law opposed it as well, and every single time they lost. Over and over Republicans have made it clear that they don't like the Affordable Care Act. They voted 40 times to repeal it or defund it or postpone it in the House of Representatives. This is despite the fact that today the Affordable Care Act is saving millions of seniors millions of dollars because they don't have to pay for drugs in the doughnut hole. This is despite the fact that starting in January it is going to save millions of people across the country from having to go into bankruptcy because they can't afford their health care. But Republicans are refusing to vote for a budget that will keep the government operating unless this health care bill is stopped. For too many of those urging a government shutdown, government has just become an abstraction. They have sold themselves on the idea that government is so twisted and malignant that shutting it down just wouldn't really do anything. After all, if the goal is to starve the beast, then what better way than putting the beast into a coma for a couple of days or a week. But that is not how this works. Government does real things for real people. It provides paychecks for 9,000 people in Connecticut. It pays Social Security benefits and processes claims for disabled veterans. It inspects our food. At the NIH, it comes up with cures for diseases. The markets watch whether the government operates because they actually know that the private sector works better when the public sector is working better. So that is why today the market once again has been falling through the floor, as it will if we move forward with this madness. Just as we don't give in to our kids when they threaten us if we don't give them what they want, America cannot reward this ``my way or the highway'' approach from the tea party. I have strong beliefs, just as my tea party Republican friends do, but I also get that I am part of a majoritarian deliberative body. Senator McCaskill and Senator Durbin made the point, as did the Presiding Officer. We all would love to attach things to this continuing resolution. There are 20 grieving families in Newtown, CT, who do not understand why 90 percent of the American public wants background checks on weapons and we can't pass that in the Senate. I bet some of them would think it might make sense for us to condition our support of the continuing resolution on getting background checks on gun purchases. Ninety percent of the American public supports that. But we are not doing that. That is not how we govern--hold the entire Federal Government hostage to get what we want. Ultimately, though, this just can't be how this place works. This is a 6-week continuing resolution. As the Presiding Officer said, it is just going to happen 6 weeks from now and 6 weeks after that. I heard that a long time ago this place used to actually be involved in the business of running the country. It doesn't feel like that anymore. As I sat there on the dais a week ago now watching the middle act of Senator Cruz's long, long, long speech, it didn't feel a lot different than it has for most days that I have watched the tea party over the last several years. It felt as if I were a theater goer. What is happening this week really isn't exceptional. It is just the latest and worst example of a long trendline away from legislating and toward playacting. With rare exceptions usually prompted only by deadlines and cliffs and fake crises, we don't do anything here any longer. We just dig trenches and we make arguments. We pass fake bills. We playact. Occasionally, when the stacks of all the things around us are about to come teetering down we stop and we push them back up again instead of thinking for a couple of seconds that if we just stopped, sat back, and actually restacked those sets of things so they didn't come crashing down, we would probably be better off. We just play parts. There is nobody better at playing their part than the tea party Republicans. Their character is recalcitrant, uncompromising, and destructive, and we have seen all of that on display this week. If we get beyond this crisis, we will just see it once again. But there is no curtain call here in Congress after which we can pull back our masks and share a good laugh. We are still all going to be left on stage tasked with picking up the pieces. I think I am past believing that these folks are just going to start playing a different role. It is time for the American public to start asking some questions about people before they send them here: Are you willing to compromise? Are you interested in actually running the government? Are you going to score your term based on whether you deliver for the American people rather than how many Twitter followers you have or how many times you showed up on the TV news that week? If this government shuts down tonight, it is just because of a temper tantrum or, put another way, a really, really bad play, the third act of which has gone on way, way too long. Mr. President, I yield the floor, and I suggest the absence of a quorum.

Mr. MURPHY. Mr. President, I ask to speak in morning business for 10 minutes.

Mr. MURPHY

Mr. MURPHY. Mr. President, I again wish to thank the Chairman and the Ranking Member for their tireless efforts and their willingness to work with us on these important issues. I yield the Floor to the Senator from Kansas, Mr. Moran.

Mr. MURPHY. Madam President, I rise today to engage my colleagues Senator Wyden, Senator Murkowski, and Senator Moran in a colloquy regarding legislation the Senate adopted yesterday for the modernization of the Federal helium reserve. I first would like to commend the leadership of the Senate Energy and Natural Resources Committee for their commitment to this effort and to thank my friend from Kansas for his partnership in this process. I know how long and hard the Chairman and Ranking Member and their staffs have worked on this complex piece of legislation, and they deserve our appreciation. I think it is important that we discuss one of the aspects of the proposed new auction program. The text before us today creates an auction and Section 6(b)(5)(A) allows the Secretary to auction less than the statutorily mandated amount if the Secretary determines the adjustment necessary to minimize market disruptions. The Secretary may make such adjustments only after only after submitting a written justification to the congressional committees of jurisdiction. I wish to ask Chairman Wyden whether he believes this provision will be exercised?

Mr. MURPHY

Mr. MURPHY. Mr. President, I read the papers down here and across the country. It makes it look as if the issue of whether we are going to move forward with the implementation of the health care bill passed a few years ago is just about politics. It is just a political football that is being tossed back and forth between the two sides. While the threats are empty, there is no way we are going to pass a continuing resolution that is not going to include funding of this vital health care law, it still gets an enormous amount of play out there. I think it is important for us to come down to the floor and explain to the American people that this issue is not political, that the health care law is not just a piece of paper. The health care law is a lifeline to millions of families out there across America who have been absolutely drowning in health care costs and an inability to access the system over the past several decades. We did not pass this law to score political points. We did not do it to make ourselves feel good. We did it because we saw almost immeasurable human suffering out on the streets of America to which this place needed to respond. It is not OK that in the most affluent, most powerful country in the world, about 15 percent of our society has the potential to go to bed sick every night simply because they cannot afford to see a doctor. It is certainly not OK that 50 percent of the bankruptcies in this country historically have been caused by the misfortune of an individual or a family member to get sick. So I think it is time that when we talk about the implementation of the health care law, ObamaCare, whatever you want to call it, we are talking about consequences that are not political. They are consequences related to life or death. That is not hyperbole. There are people out there every week dying because they do not have access to our Nation's health care system which, if you can find it, is and can be the best health care system in the world. The problem is there are far too many people who have no insurance and no way to access it or who are vastly underinsured and cannot get the right access to it. So I just want to talk for a minute about what this is going to mean to our constituents, to your neighbors, and what it would mean if, by some miracle of politics, the tea party gets its way and this bill was no longer the law of the land come next month. Let me tell you what it already means for a senior citizen who is living on $20,000 a year in New Britain, CT. Today, that senior citizen gets to walk in to their doctor to get a wellness visit. They do not have to pay anything out of pocket any longer. Previously they did. You would think that is not a lot of money. But for someone in Connecticut who is living on a fixed income or somebody in Delaware who is taking home a pretty meager Social Security check every month, the costs escalate when you are just trying to pay your rent or your mortgage, put food on the table, be able to put gas in your car to get back and forth to see your grandkids. That extra expense of having to pay for preventive costs can actually make a difference. For those seniors who have pretty high drug costs, one of the worst things this Congress did over the last 10 years was pass a prescription drug bill that had this doughnut hole sitting in the middle of it. If you paid for a bunch of drugs through the Medicare benefit, eventually you would have to start paying out of your own pocket. That could be thousands of dollars that senior citizens don't have. This health care bill closes the doughnut hole, eliminates half of it almost overnight and then essentially eliminates it over time. That is thousands of dollars in savings for seniors. That is medication that, frankly, a lot of seniors would never have been able to buy but they will now be able to access because of this law. Those things go away if Republicans get their way and ObamaCare is defunded. All of a sudden, if that happens, tomorrow senior citizens have to pay out of pocket for preventive costs. Seniors who have high drug costs all of a sudden have to go back to paying 100 percent of the cost of generics versus 50 percent, which is what they are paying now. What about the average family of four who today in Connecticut is paying about $605 a month for health care? Probably the health care plan is not that good to begin with. It probably has some significant holes in it in terms of what it will cover. If this health care bill is implemented, which it will be, that number goes down from $605 a month to $286 a month for the average family of four in Connecticut. Let me tell you, the average family of four in Connecticut living in Stamford, Bridgeport, Norwalk, or Norwich, could use that extra $300 in savings to help save for college, to help put a bit more nutritious meal on the table, maybe to pay some back credit card bills. Three hundred dollars is a big deal. That is the big difference this health care bill will make, $605 a month down to $286 in Connecticut. It is a big difference. It is an even bigger difference because the health care plan they are going to get for $286 a month is going to be a good one. We are going to finally have some standardization when it comes to the benefits you are getting. When you buy the health care plan in Connecticut or wherever you are, you are going to know what you are getting. There is going to be a minimum set of benefits that is going to be covered. You are going to be able to know that when you buy insurance you are getting ambulatory patient services, coverage for hospitalization, coverage for maternity and newborn care, your prescription drugs are covered, lab services, and rehab benefits. Every plan is going to be able to cover these things, but not if the health care law were magically repealed. All of a sudden people who were counting on that number going from $600 to $300 in Connecticut will be paying $600, probably $700, $800, and they will continue to have to deal with a dizzying array of benefit packages, many of which simply don't measure up to what families need. What about for Betty Berger? What does this mean for her? She is a constituent of mine in Meriden. She doesn't want anyone to ever have to go through what she went through. She and her husband had health care coverage for themselves and their kids through her husband's plan. Her husband switched jobs. In the week of time between when he was at his first job and his second job, their son was diagnosed with cancer. Her husband's second job identified it as a preexisting condition and effectively refused to cover the son. The Bergers lost everything. They lost their house, they lost their car, they lost their savings simply because their son was diagnosed with cancer during the 1 week in which the husband wasn't employed. That will never, ever happen again after this bill is implemented. No insurance plan regulated under this bill can deny a family access for health care simply because one of their family members is sick. It is unconscionable that ever happened in this country, and it will not happen again if this bill is implemented. But if the Republicans get what they want and this bill is defunded, if this bill is repealed in that magical fantasy world, the example of the Bergers happens hundreds of thousands of times over across the country. Lastly, what about the McCullough family, another family in Connecticut? Little Kyle McCullough, when I first met him, was 8. He is probably now 10 or 11 years old. He has a very complicated disease for which he has to take $3,000 injections. He will hit his lifetime limit in a matter of years and his family will be on the hook for every expense thereafter. The health care bill says no more annual, no more lifetime limits for health care coverage. You could have health care insurance that is going to take care of little Kyle McCullough for as long as he needs those injections, at whatever cost it is going to be. It is insurance. Because for people who have a bad lot in life and have a big, complicated, expensive, illness they are going to be covered. If the health care bill is repealed, defunded, or whatever Republicans want to do, Kyle McCullough's family has to pay for that out of pocket for the rest of their life, as will thousands of other families like them. That is what the stakes are. It is not a piece of paper. It is not a political football. It is life and death. It is hundreds, if not thousands, of dollars that hard-working families throughout this country desperately need and a health care system they need to be much more fair and much more compassionate. It is not going to happen. It is political fantasy that Republicans are going to be able to defund or repeal the health care law as a consequence of the budget debates we are going to have over the next few weeks. Let's be honest about what they are asking. They are asking for higher costs for seniors; they are asking for higher costs for middle- class families; they are asking for more bankruptcies; and they are asking for more misery for the thousands of families who are struggling to keep their heads above water when they deal with a complicated illness. That is the true reality of what is happening out there today in our health care system that is getting better by the day and will get even better if we move forward with the implementation of the health care law. I yield the floor, and I suggest the absence of a quorum.

Mr. MURPHY

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

Mr. MURPHY

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

Mr. MURPHY. Mr. President, almost all of this week on the floor of the Senate will be dedicated to one of the most serious, if not the most serious, matters this body ever considers--that of war and peace and the question of whether we engage American military assets in conflicts across the globe. I am sure I will be back to the floor later this week to speak on that weighty matter. I appreciate the very passionate remarks of the Senator from Illinois on this subject. Almost every week over the last several months when the Senate has been in session, I have come to the floor to talk about another subject of life-and-death consequence; that is, the growing number of individuals across this country who have been killed by guns. We are going to debate life and death on the Senate floor this week as we try to figure out what the course of American intervention may or may not be in a place on the other side of the Earth in which far too many innocent people, little babies and adults alike, are being killed. We also need to debate what we are going to do to prevent the fact that babies and teenagers and adults right here in the United States of America are being killed. So I have brought this poster down--or a variant of it--a couple of times a month every single month since about April of this year, and it shows a number. The number is a pretty simple number. It represents the number of people in the United States who have been killed by guns since December 14. As we get further away from that date, maybe people forget what it is, but in Connecticut we will never, ever forget what that date means. December 14 is the date on which 20 little 6- and 7-year-old boys and girls were killed inside Sandy Hook Elementary School, along with 6 teachers and professionals who protected them, as well as the gunman and his mother. Twenty-eight people in all were killed that day. It has lit a spark under the American consciousness about this issue, which has frankly been lingering for far too long. Twenty-eight people died in Newtown on December 14, but every day across this country, on average, 30 people die due to homicide from guns. So I am back here today to try to tell the stories of just a handful of the 7,907 people who have been killed at the hands of gun violence since December 14. When I started back in April, I think this number was somewhere around 4,000. It has marched upward and almost doubled since then. This has been a really bad summer in Connecticut. For instance, in places such as New Haven and Hartford and Bridgeport, we thought we were making some real progress when it came to the number of homicides by guns. This summer, unfortunately, we saw far too many, people such as Devaante Jackson, 18 years old, who was killed on August 15 of this year in New Haven. He was killed in a driveby shooting while simply standing on a sidewalk just after 8 o'clock on the evening of August 15. A friend of Devaante's said: I don't understand why somebody would do this to him. He's real good. I never knew he had any problems with anybody because he always (got) along with everybody. Another friend said: He wasn't a bad kid; he was just in the wrong spot at the wrong time . . . everybody should know . . . stop the violence, put the guns down. A few days later in Hartford, at the same nightclub, in two separate incidents, two young men--Miguel Delgado, age 21, and Brian Simpe, age 19--were killed. Disputes started in the nightclub and spilled out onto the streets of Hartford--two different disputes, two different incidents, and both of these boys were killed. Brian was 19 years old. He graduated from Manchester High School and attended Manchester Community College. He worked at ShopRite in order to make enough money to go to community college. He wanted to start his own business. He was a kid who wanted to do something great with his life. Before he headed out that night, he tweeted, ``Just another summer night out.'' Unfortunately, in places such as Hartford and New Haven and Bridgeport and Baltimore and Chicago and Los Angeles, this is just another summer night out. Too many people are being killed simply as a result of common disputes, this time happening in a nightclub in Hartford. Domestic violence, as we know, unfortunately, often leads to tragic homicidal incidents. Janice Lesco, from Coventry, CT, died on August 24--just a few weeks ago--from a gunshot wound to the chest. Her husband, who shot her, then committed suicide. Her husband had a well- documented and decade-long history of threats and abuse. Ms. Lesco was a mother and a grandmother. She had lived in Coventry for most of her life. Luckily, in Connecticut we have an agreement that people who have a history of domestic violence shouldn't get their hands on a gun, but they can if they walk into a gun show or if they buy their gun on the Internet. We can't simply make the decision here that if a person buys a gun online or a person buys a gun at a gun show, they should be stopped from doing so if they have a history of domestic violence. Frankly, I was struck by this one newspaper article describing one night in New Haven. This is even earlier--on August 11, 2013. It starts by talking about Torrance Dawkins, a 22-year-old Waterbury man who was celebrating his birthday in a New Haven nightclub when he was shot and killed at about 1:30 on August 11. The article goes on and sort of casually says that later that day New Haven police responded to more gun violence. A local rapper was putting up sheets on an upcoming concert he was going to be holding in town, and he suffered a single gunshot wound to his neck. Davon Goodwin, who was 18 years old, was later that day shot in the thigh on Hamilton Street. And just before 5 p.m. that day, police were called to an area near Dixwell Avenue and found out that Jermaine Adams, 41, had received a gunshot wound to his face. Those last three people miraculously survived. But we can see how casual gun violence can be on a summer Sunday in New Haven, CT. One young man died as a consequence of a dispute at a nightclub, and three other people luckily survived who were shot later in the day. Every single day in this country--in the United States of America--30 people are dying due to gun violence. Almost 8,000 people have died since the tragedy in Sandy Hook, and this body has done nothing to stop it. We have had commonsense legislation before this Senate that would just say: You know what. If you have a criminal history, you should not be able to buy a gun, no matter where you buy it--at a gun show, from a gun dealer, online. We have had commonsense bipartisan legislation on the floor saying: You know what. It should be a crime to buy a whole mess-load of guns from a gun store and then go out and intentionally sell them to criminals. We cannot get that passed either. We even tried to just say: Let's beef up our mental health system to make sure people who have serious mental illnesses get the treatment they need so they do not resort to violence--the very few who do. That was part of the bill we could not get passed. So I am going to continue to come down to the floor to give voices to these victims, to talk about the real people, the stories behind the dozens of people who are killed every day by guns and the 8,000 people who have been killed since Sandy Hook. We are going to make an important decision this week about whether we are going to commit military assets to the Middle East, and maybe that debate will stretch into next week and the week after. But we should not forget that while people are dying overseas, people are dying due to gun violence right here in the United States, and before it is too late--before another 8,000 people die from guns in this country--we should do something about it. I yield the floor. I suggest the absence of a quorum.

Mr. MURPHY. Mr. President, I ask unanimous consent to speak as in morning business.

Mr. MURPHY

Mr. MURPHY. Madam President, today I wish to honor the service of Mr. Peter Sorbo, of Connecticut, whose family resides in Waterbury, CT. In January 1943, 18 year-old Peter Sorbo enlisted in the Army to serve his country during World War II. Deployed to the European theater and assigned to Bombardment Group 384, Squadron 545, he served as a waist gunner on a B-17 Flying Fortress and perished on August 12, 1943 after his plane was shot down above the Rhine. I would like to have printed in the Record an article from the Waterbury Republican American that outlines this fascinating story about one of Connecticut's brave soldiers. Many of Connecticut's sons, like Peter Sorbo, gave their lives defending our freedom and they deserve our perpetual gratitude. I ask that this body devote itself to remembering these courageous men and women by honoring their sacrifices and forever preserving their memories. The following article written by Mike Patrick appeared in the July 29, 2013 edition of the Waterbury Republican-American. Madam President, I ask unanimous consent that it be printed in the Record.

Mr. MURPHY

Mr. MURPHY. Mr. President, I thank very much Senator Baldwin and thank the State of Wisconsin for, in a lot of ways, leading the way and showing us what is possible when it comes to delivery system reform. It is pretty amazing some of those statistics Senator Baldwin used when she talked about how much waste there is in the system today. The estimates are from the Council of Economic Advisers, $700 billion; from the New England Healthcare Institute, $850 billion. To put that in context, even if the median of the two is right--somewhere in the high $700 billion range--that is $100 billion more than we spend every year on the military. That is enough money to provide coverage for 150 million more Americans. That is enough to pay the salaries of every single first responder personnel in the country, including firefighters, police officers, and EMTs for over a decade. It is an enormous amount of money that we are wasting today because we have a reimbursement system, as Senator Whitehouse said as well, that essentially rewards providers and hospitals and health care systems for providing volume rather than providing quality. We understand there is not a single health care provider in the country that does not get into this if not for their desire to provide quality health care. There is no malevolent motive involved here. But, ultimately, when you have to keep your doors open--as a medical practice, as a hospital, as a nursing home--and you get paid more the more medicine you practice and the more treatments you order and the more tests you have your patients undergo, then you are going to follow the money. It is time we reorient our reimbursement model under Medicare and Medicaid, and in partnership with our private insurers, so we are reimbursing based on the quality of medicine and the quality of the outcomes you provide rather than on how much stuff you order or prescribe. Let me talk about three examples of how we have succeeded already when it comes to changing the model of reimbursement. First, the issue of readmission rates. When you go into a hospital for a surgery, that hospital is going to get a set fee for the surgery and for the amount of time you spend in the hospital afterwards. It is called a bundle payment. Bundle payments are good because what it does is it encourages you to essentially use your resources wisely because you are not going to get paid more if you keep the person in the hospital for 10 days than if you keep the person in the hospital for 5 days. But here is the problem when it comes to the care people were getting after a particular surgery. Because the hospital got a set payment for that period of time, they had an incentive to push the person out of the hospital as quickly as possible. That was an incentive not only because the payment itself did not get bigger the more amount of time you were in the hospital, but it also was incented that way because if the person went home too early and then they came back again to the hospital, the hospital got a second bundle payment when they came back. And if they came back a third time and a fourth time, they got another payment. So what was happening is there was an incentive to send people home before they were ready because not only would that save you money on the first bundled payment, but it actually made the hospital or the health system money in the long run because the person came back a second or a third or a fourth time. I do not think there was a single hospital in the Nation that was deliberately misaligning their care so they would have people coming back to the hospital a second or a third or a fourth time. I am not suggesting people were trying to game the system in that way. But what certainly was happening was that without an incentive that pulls you the other way--get the care right the first time--there was, unfortunately, insufficient care being provided. So the health care bill says: Listen, we will pay you for maybe the first readmission, maybe for really complicated procedures we will pay you for a second readmission, but at some point there has to be an end to this model. At some point it has to be up to you as the hospital or as the health care provider to get the care right the first or the second time so we are not on the hook for readmissions occurring times three or times four. That is a pretty simple change, but it can save hundreds of millions of dollars. The second example is accountable care organizations. We set up a bunch of Pioneer accountable care organizations. These are bigger systems of care, where you have primary care doctors networked with specialty care providers, working under one umbrella to coordinate the care of the sickest patients. There are different numbers, but they all tell the same thing, which is that the sickest 5 or 10 percent of patients in the country are taking up about 50 percent of annual medical expenditures. So if you do a better job of coordinating the care of that small percentage of the medical population, you are going to save a lot of money. Accountable care organizations can do that. Instead of having siloed care, where a co-morbid patient goes to a primary care doctor over here, then a specialist here, then a specialist there, if they are all under one roof and they are talking to each other, then you can save a lot of money just by coordination. That is the theory. So the health care reform act put that theory into practice. It set up a pilot program by which Pioneer accountable care organizations--essentially, a beginning set of accountable care organizations--would be set up under a model through which Medicare would say: If you save money, we are going to deliver back to you some of those savings so that, in fact, there is not a disincentive to practice less medicine because if you practice less medicine, Medicare will take some of the savings and it will share with you some of the savings. Well, we have only had a year or so of returns from this model, but the results are pretty stunning. The average increase in costs per beneficiary has been--in the Pioneer ACOs--less than 50 percent of that for non-Pioneer ACO models. That is a pretty significant savings. In addition, go back to this question of readmissions. In 25 of the 32 Pioneer ACOs, there was a lower risk-adjusted readmission rate than in non-Pioneer ACOs. Coordinated care where you are reimbursing an organization as opposed to just the individual physicians actually saves you a lot of money. Then third, the issue of outliers. What you find when you look at the data--and it may be that Senator Whitehouse talked about this--is that sometimes 60, 70, 80 percent of the system is practicing good medicine at the right cost, and it is really only a small handful of providers that are way outside of the median and all you have to do, when it comes to some subsets of reimbursement, is bring those outliers back into the median. Home care was a great example. In the Accountable Care Act, we said that for home care providers that had utilization rates that were far outside the median, we were going to stop reimbursing for those episodes that were far outside the median. CBO was not sure how to score it because they did not really know that was going to change people's practice. But it did. And it is estimated that single change, in controlling for the handful of outliers when it comes to high utilization rates in the home care line item, is going to get us almost $1 billion in savings over a 10-year period of time. When you look at home care, actually it is only a handful of areas in which you have these outpaced utilization rates compared to the rest of the country. It is places in Texas, it is places in certain counties in Florida. Most of the country is right where you should be. So part of reforming our delivery system is also taking care of these outliers. We have seen savings, whether it be in controlling readmission rates, setting up accountable care organizations, or taking on outliers within our home care system. Now it is time to do more because, before I turn it over to my good friend Senator Blumenthal, here is where the rubber hits the road. In about 10 years, Medicare starts taking in less money than it sends out. It does not go bankrupt all of a sudden, but it starts to become fiscally insolvent. There are only a handful of ways to stop that reality from happening. You can either ask beneficiaries to pay more out of pocket; you can cut their benefits, give them less; you can ask people to pay more into the system while they are working or you can make the system more efficient. It may be that we have to do a mix of those. But clearly the first three are not that palatable: reducing benefits, increasing copays, or increasing taxes. This is not a partisan issue. Both sides agree that in 10 years we have an accounting problem in Medicare. Both sides agree that we have to make changes today in order to stop that crisis from occurring. It strikes me that if the most conservative Republican and the most liberal Democratic sat down at a table and looked at those four options--increased copays, reduced benefits, increased taxes, or increased efficiencies--we would all agree. The conservative Republican and the liberal Democrat would agree, along with probably every other Member of this body, that is the first place you should go is to reduce inefficiencies. That is what the delivery system provides. So we have set up a working group here in the Senate which is beginning its work this week, that Senator Baldwin, Senator Whitehouse, Senator Blumenthal, I, and others will be building over the course of the late summer and fall. We hope it will draw interest from both sides of the aisle so we can start to put some meat on the bones when it comes to the changes in our delivery system that can be made to increase efficiencies so as to forestall the need to balance the Medicare books on the backs of taxpayers, workers, or beneficiaries. With that, let me yield the floor to my great friend from Connecticut, someone who both as a Senator and our State's attorney general has been fighting for health care consumers for a long time, Senator Blumenthal.

Mr. MURPHY

Mr. MURPHY. Madam President, I ask unanimous consent to speak as in morning business.

Mr. MURPHY. Madam President, let me associate myself with the remarks of my colleague from Connecticut, Senator Blumenthal, as well as the majority leader, who was here earlier today, and Senator Klobuchar--all speaking on behalf of our nominee to head the ATF, as well as Senator Blumenthal's remarks on behalf of Fairfield, CT, resident James Comey to be the head of the FBI. Very few agencies, other than the ATF and the FBI, are more intricately involved in the preservation of the health and safety of the American public, and we deserve to have votes on those nominees tonight and this week. But I also want to associate myself with the other remarks Senator Klobuchar made. She talked about our obligation as a body to reverse these very damaging sequester cuts to NIH funding for medical research, and she listed some very compelling stories about men and women who have had their lives saved, preserved, lengthened because of discoveries made through medical research. It is a reminder to the Senate and to the House--to anyone who treads upon these two floors--that we hold life and death in our hands with the decisions we make. We decide when we choose to fund or not fund the NIH as to whether we are going to give life to people who are waiting on those kinds of cures and treatments. But, similarly, we make decisions about life and death when we choose not to act, when we choose to do nothing, to sit pat. In this case we make a decision to allow people to die in this country--specifically 6,633 people since December 14--when we make a choice to do nothing about the scourge of gun violence that continues to plague this Nation. I have tried to come down here every single week--as Senator Klobuchar did in speaking about the effects of funding medical research in very personal terms--to talk about the implications of doing nothing when it comes to the increasing levels of gun violence in this country, in similarly personal terms. December 14, of course, for most people is easily recognized as the date when 20 6- and 7-year-olds were killed in Sandy Hook, CT, along with 6 adults who cared for them, as well as the gunman and his mother. Since that day, 6,633 people have been killed by guns at a rate of about 30 a day--the highest of any civilized nation in the world, and we do nothing. One of those, on July 14, was Horsley Shorter, Jr. Horsley managed a Family Dollar store in Tampa, FL. Junior, as he was known, had some kids come in occasionally who would try to take things out of the store or try to steal. When he had to report them to the police, he would. But this was a very gentle man, and more often than not he would pull the kids aside and try to talk through things with them to try to help them understand what they were doing and what the implications were. He would never do anything to instigate a fight, his friend said. In fact, his last words to one of his coworkers was ``the pen is mightier than the sword.'' What happened that day was an armed robber came into the store and demanded money from the clerk. According to police, Shorter was inside the office, and he was shot when he ran out to try to help his coworker who was at the counter. The robber then forced the clerk at gunpoint into the parking lot, where he stole the clerk's car and used it to escape. According to one friend, Shorter was very close to that coworker, took him under his wing, which was the reason he ran out into harm's way to try to save him. This friend said: I believe that's why that young guy is alive [today]. Junior wasn't going to watch nobody die. He gave his life for him. About 2 weeks earlier, on July 2, Chanice Reed, 22, and Annette Reed, her mother, as well as Eddie McCuin, a 10-year-old, were shot in a triple murder in Fort Worth, TX. An hour after the shooter killed his pregnant girlfriend, her mother, and her little brother, he walked into the Forest Hill Police Department, telling officers to arrest him because he ``did something bad.'' He was 22 years old. He had a history of domestic violence. He was sentenced to 1 year of deferred adjudication probation because of assault. Because of a domestic dispute, and because of his easy access to guns, in order to resolve this disagreement, he shot his pregnant girlfriend, her mother, and her 10-year-old little brother. Just a couple days ago, in Bridgeport, CT, Pablo Aquino died. He was 27 years old. He was described as a ``humble man.'' He was always down at the baseball field helping kids because he had a son playing baseball there. He spent his days at the Fairfield County Hunting Club in Westport, where he tended to horses. He got into an argument--a simple argument--when the suspect decided that the best way to solve this argument was to turn a gun on Pablo, killing him. The next day, the community had a vigil for him. The vigil was to remember him but also because they did not have enough money for a funeral. So as the vigil was going on, one of his friends stood out on the corner with an empty tin can of iced-tea mix, asking passersby to contribute a couple cents for a funeral that was expected to cost $2,000. Over the July 4 period, there were three shootings in New Haven, CT. At around 10:30 on Wednesday night, police said somebody shot and killed 19-year-old Errol Marshal. His body was discovered on the front porch of a home, pronounced dead at the scene. At the same time, investigators found Courtney Jackson, a 26-year- old, suffering from a gunshot wound to the stomach. Brian Gibson, 23, of New Haven, was shot outside of a public housing complex shortly thereafter. All three shootings were connected. All three shootings are due to the fact that too many kids and too many young adults today do not know how to resolve their disputes any other way than getting a gun, and also because in a city such as New Haven guns are like water; they are all over the place. They are all over the place because this body does not pass legislation to keep guns out of the hands of criminals. We refuse to pass a bill making it a Federal crime to illegally traffic guns. All those seem very dissimilar from Newtown. But then there are ones you hear about that strike you as so similar to the reason why I am here today talking about this, because of the 26 people who died at the Sandy Hook Elementary School. Not much more than a month after Newtown, the Griego family was killed, all in one fell swoop, in Albuquerque, NM--Greg, 51; Sarah, 40; Zephania, 9; Jael, 5; and Angelina, 2. The parents were killed by their son, the little girls and boy killed by their brother. Nehemiah was 15 years old when he took a semiautomatic weapon to kill his family. Like Adam Lanza, the shooter in Newtown, Nehemiah was a troubled teen--more troubled than anyone around could have realized. Like Adam Lanza, he took out his rage on his family, first killing his mother while she lay sleeping in her bed. Like Adam Lanza, he had plans to continue his killing spree. He was going to go to the local Wal-Mart before he was stopped. He was anticipating getting into a firefight with the police. And like Adam Lanza, he used an assault weapon that was readily available to him in his own home. Greg, 51; Sarah, 40; Zephania, 9; Jael, 5; Angelina, 2--5 of the 6,633 people--30 or so a day--who have been killed by guns since December 14. We are not going to stop them all by passing a piece of legislation on the Senate floor. Background checks will not bring 6,600 people back, nor will a ban on human trafficking, nor will a ban on the sale of 30-round magazines or assault weapons. But they will absolutely bring some of those people back. They will absolutely lessen the rate below 30 a day. I am going to continue to come down to the floor week after week to tell the stories of victims of gun violence, to give them a voice on the floor of the Senate, so that someday, some time, hopefully soon, this place will wake up to the fact that we do have responsibility over life and death on the floor of the Senate, and it is about time, when it comes to the rising incidents of gun violence across this country, we do something about it. I yield back the floor. I suggest the absence of a quorum.

Mr. MURPHY

Mr. MURPHY. Mr. President, there is a broad consensus among the people of this country that when we spend dollars through the Federal Treasury, when we spend taxpayer dollars, they should be used to fund American jobs. In fact, that has been a law on the books since the early part of this century. For a long time the Buy American Act has required that when we buy things, whether it be through the military or through the Department of Transportation, we buy things from American contractors. That makes more sense today than ever before because as we struggle to try to get our economy back up and running, one of the sectors that is hurting more than others is the construction sector. Every time we violate the Buy American provisions of our law, we lose the opportunity to try to alleviate great stress that is currently upon our construction industry. Thankfully, the DOT has been one of the best agencies, actually, when it comes to making sure American-made material goes into construction projects. The $41 billion the Highway Administration receives in this bill to be spent on roads and bridges is an important engine of job growth throughout the country. I have to say they generally do a pretty good job, as opposed to some other agencies--the Department of Defense at the top of the list--in making sure those dollars go to American companies. There are circumstances in which the Buy American provisions are waived. There are a number of ways you can waive those provisions, but it is important for us to have full transparency and disclosure when the Department of Transportation and FHWA are considering awarding a major project funded by American taxpayers to a foreign company. When the Buy American statute is waived, the requirement that American-made material be used is null and void. What this bill says is that when the FHWA provides public notice that they are considering waiving the Buy American clause for a particular project, they include in that public notice a consideration of the impact on American jobs. It is worth knowing whether a waiver is simply going to result in the loss of 10 American jobs or the loss of 500 American jobs. This amendment very simply says that when a waiver to the Buy American law is pending, we should know from the Department of Transportation and from the FHWA how many American jobs are at risk. That gives us the opportunity to weigh in and try to make sure that waiver is not granted. This, frankly, gives American companies a little bit better information to use when they are trying to make the case that they can actually do the work that may be being considered for a foreign company. We all know what is happening to jobs in the building trades. In some parts of the country unemployment is hitting 20 percent when it comes to carpenters, operating engineers, plumbers, and sheet metal workers. I wish to applaud the DOT for being one of the models when it comes to trying to make sure taxpayer dollars are kept here at home. This amendment would make sure that in those limited cases where the DOT is sending work overseas, we get a chance to understand what the real impact will be. We have a lot of work to do when it comes to tightening our Buy American laws. We are talking about the DOT, but the real problem is another agency we will hopefully have a chance to talk about later on the Senate floor; that is, the Department of Defense. Seventy percent of Federal purchasing comes through the Department of Defense. They have been expediting the offshoring of defense work at a rate that should make every single Senator on this floor shudder. This is an important amendment that I hope will get bipartisan support. I thank Senator Collins for allowing it to become pending on the floor. I think it is just the beginning of a lot of work we have to do when it comes to enforcing a very simple principle. When our constituents send their hard-earned tax dollars to Washington, DC, and they are used to buy things or build things for the U.S. Government, we need to hire U.S. companies and American workers to do the job. I ask unanimous consent that there be a period for debate only until 2:15 p.m. today.

Mr. MURPHY. I yield the floor, and I suggest the absence of a quorum.

Mr. MURPHY. I would ask the Senator if the Senator from Maryland could speak for 5 minutes. I would notify all of my colleagues that we intend to go to the motion to table once that debate occurs.

Mr. MURPHY. Madam President, I ask unanimous consent to call up amendment No. 1783.

Mr. MURPHY. I call up amendment No. 1783 and ask that it be pending.

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

Mr. MURPHY. I ask unanimous consent that the reading of the amendment be dispensed with.