Jack Reed

Mr. REED

Mr. REED. Mr. President, today, the Senate passed the Food and Drug Administration Reauthorization Act of 2017, FDARA, to reauthorize user fees and other programs at the FDA to ensure that new, safe, and effective treatments get to patients in need as quickly as possible to save lives and greatly increase quality of life. While I have long preferred that Congress appropriate funding to the FDA for this purpose to avoid any conflicts of interest, I have supported user fee bills and will do so again today, as it represents a bipartisan pathway for timely drug approvals. I am pleased that this legislation increases the amount of funding that drug and device companies will contribute to the approval process. However, I am disappointed that this legislation does not address drug pricing in a comprehensive way, as I have long advocated. I will continue to work with my colleagues to press for Senate action on this critical issue. FDARA includes a number of key provisions I worked on to improve the pipeline for new pediatric drugs and devices. In particular, this legislation will reauthorize funding for critical pediatric programs such as pediatric clinical trials at the National Institutes of Health and the Pediatric Device Consortia grants under the FDA. In addition, this legislation will spur more pediatric drug development because of critical reforms to require drug companies to begin consideration of pediatric studies earlier in the drug development process. FDARA also takes important steps to spur drug development for and better consideration of the needs of neonates, recognizing that treatments for infants must be considered differently than for teenagers. Having worked for many years to improve access to care for children with cancer and childhood cancer survivors, I am also pleased to support the bill's new requirements for more pediatric studies on treatments for cancer. These provisions are designed to spur new and better treatments for children suffering from cancer. However, I believe that we should be making these changes to support new treatments for all diseases impacting children, not just those with cancer. While we were unable to go that far in this bill, we were able to add a study of this issue. I look forward to seeing the results and working with my colleagues to expand these requirements in subsequent legislation. I am also concerned that this legislation does nothing to limit the ability of drug companies to benefit from exemptions from current pediatric study requirements. I filed an amendment to FDARA to close the most egregious of these loopholes in which a drug company can technically be exempted from pediatric study requirements because the treatment would only be used for a rare pediatric condition. I would hope that my colleagues on both sides of the aisle could agree that this loophole must be closed. FDARA is an important step forward and an example of strong bipartisan health legislation in this Congress. I hope that we can continue this work, and not return to the partisan efforts to repeal the Affordable Care Act that occupied this body for much of the year.

Mr. REED

Mr. REED. Mr. President, we know that the quality of teachers and principals are two of the most important in-school factors related to student achievement. Yet the pipeline into the profession has been neglected. If we want to improve our schools, it is essential that we invest in the professional preparation of teachers, principals, and other educators. As such, today, I am reintroducing the Educator Preparation Reform Act with my colleagues Senators Casey and Coons to ensure that the Federal government continues to be a partner in addressing this critical national need. Today, we are facing a crisis in education. According to a research brief from the Learning Policy Institute, we have seen dramatic declines in enrollment in teacher preparation programs--an estimated 35 percent decline between 2009 and 2014. We also continue to see high rates of attrition among educators. If these trends continue, there will be an estimated gap of more than 100,000 between the number of teaching positions open and the number of teachers available to be hired annually through 2025. The impact of these shortages falls the hardest on our most vulnerable students in our highest need communities. Rhode Island is no exception. Providence, our largest school district, is facing an acute shortage of teachers certified to teach English language learners. My home State has also reported shortages in special education, science, math, and school nurses. We cannot solve this problem without improving both teacher and principal preparation. We need to make sure that our educator preparation programs are worthy of the professionals entering the field and the students they will serve. That is why it is more urgent than ever that we enact the Educator Preparation Reform Act. Our legislation builds on the success of the Teacher Quality Partnership Program, which I helped author in the 1998 reauthorization of the Higher Education Act. It continues the partnership between high need school districts, institutions of higher education, and educator preparation programs to reform pre-service programs based on the unique needs of the partners. Among the key changes are specific attention and emphasis on principals and the addition of a residency program for new principals. Improving instruction is a team effort, with principals at the helm. This bill better connects teacher preparation with principal preparation. The Educator Preparation Reform Act will also allow partnerships to develop preparation programs for other areas of instructional need, such as for school librarians, counselors, or other academic support professionals. The bill streamlines the accountability and reporting requirements for teacher preparation programs to provide greater transparency on key quality measures such as admissions standards, requirements for clinical practice, placement of graduates, retention in the field of teaching, and teacher performance, including student-learning outcomes. All programs--whether traditional or alternative routes to certification--will report on the same measures. Under our legislation, States will be required to identify at-risk and low-performing programs and provide them with technical assistance and a timeline for improvement. States would be encouraged to close programs that do not improve. We have been fortunate to work with many stakeholders on this legislation. Organizations that have endorsed the Educator Preparation Reform Act include: the American Association of Colleges for Teacher Education, American Association of State Colleges and Universities, Association of Jesuit Colleges and Universities, Council for Christian Colleges and Universities, Higher Education Consortium for Special Education, Hispanic Association of Colleges and Universities, National Association of Elementary School Principals, National Association of Secondary School Principals, National Association of State Directors of Special Education, National Disability Rights Network, National Network of State Teachers of the Year, Public Advocacy for Kids, Rural School and Community Trust, and the Teacher Education Division of the Council for Exceptional Children. I look forward to working to incorporate this legislation into the upcoming reauthorization of the Higher Education Act. I urge my colleagues to join us in this effort and support this legislation.

Mr. REED

Mr. REED. Mr. President, we know that the quality of teachers and principals are two of the most important in-school factors related to student achievement. Yet the pipeline into the profession has been neglected. If we want to improve our schools, it is essential that we invest in the professional preparation of teachers, principals, and other educators. As such, today, I am reintroducing the Educator Preparation Reform Act with my colleagues Senators Casey and Coons to ensure that the Federal government continues to be a partner in addressing this critical national need. Today, we are facing a crisis in education. According to a research brief from the Learning Policy Institute, we have seen dramatic declines in enrollment in teacher preparation programs--an estimated 35 percent decline between 2009 and 2014. We also continue to see high rates of attrition among educators. If these trends continue, there will be an estimated gap of more than 100,000 between the number of teaching positions open and the number of teachers available to be hired annually through 2025. The impact of these shortages falls the hardest on our most vulnerable students in our highest need communities. Rhode Island is no exception. Providence, our largest school district, is facing an acute shortage of teachers certified to teach English language learners. My home State has also reported shortages in special education, science, math, and school nurses. We cannot solve this problem without improving both teacher and principal preparation. We need to make sure that our educator preparation programs are worthy of the professionals entering the field and the students they will serve. That is why it is more urgent than ever that we enact the Educator Preparation Reform Act. Our legislation builds on the success of the Teacher Quality Partnership Program, which I helped author in the 1998 reauthorization of the Higher Education Act. It continues the partnership between high need school districts, institutions of higher education, and educator preparation programs to reform pre-service programs based on the unique needs of the partners. Among the key changes are specific attention and emphasis on principals and the addition of a residency program for new principals. Improving instruction is a team effort, with principals at the helm. This bill better connects teacher preparation with principal preparation. The Educator Preparation Reform Act will also allow partnerships to develop preparation programs for other areas of instructional need, such as for school librarians, counselors, or other academic support professionals. The bill streamlines the accountability and reporting requirements for teacher preparation programs to provide greater transparency on key quality measures such as admissions standards, requirements for clinical practice, placement of graduates, retention in the field of teaching, and teacher performance, including student-learning outcomes. All programs--whether traditional or alternative routes to certification--will report on the same measures. Under our legislation, States will be required to identify at-risk and low-performing programs and provide them with technical assistance and a timeline for improvement. States would be encouraged to close programs that do not improve. We have been fortunate to work with many stakeholders on this legislation. Organizations that have endorsed the Educator Preparation Reform Act include: the American Association of Colleges for Teacher Education, American Association of State Colleges and Universities, Association of Jesuit Colleges and Universities, Council for Christian Colleges and Universities, Higher Education Consortium for Special Education, Hispanic Association of Colleges and Universities, National Association of Elementary School Principals, National Association of Secondary School Principals, National Association of State Directors of Special Education, National Disability Rights Network, National Network of State Teachers of the Year, Public Advocacy for Kids, Rural School and Community Trust, and the Teacher Education Division of the Council for Exceptional Children. I look forward to working to incorporate this legislation into the upcoming reauthorization of the Higher Education Act. I urge my colleagues to join us in this effort and support this legislation.

Mr. REED

Mr. REED. Mr. President, our public schools are critical National infrastructure. They play a central role in our Democracy--educating the next generation, serving as polling places for our elections, hosting community meetings and events, and so much more. As we consider the components of a new major Federal investment in infrastructure, we cannot afford to leave our public schools behind. That is why I am proud to be introducing the School Building Improvement Act with my colleagues Senators Brown, Cortez Masto, Hassan, Warren, Whitehouse, Hirono, and Cardin. Safe, healthy, modern, well-equipped schools are essential for advancing student achievement and ensuring that the next generation is prepared to meet the economic, social, environmental, and global challenges our Nation faces. Yet, too many of the over 50 million students and six million staff who learn and work in our public schools, spend their days in facilities that fail to make the grade. A 2014 Department of Education study estimated that it would cost $197 billion to bring all public schools into ``good'' condition. Nationally, there is also a $38 billion funding gap in annual capital construction and new facility funding, as reported in the 2016 State of Our Schools report. Despite the benefits and need, however, Federal funding accounts for 0.2% of the total current capital investment in our schools. Addressing this need is the right thing to do for our students and our communities. Moreover, it will give a needed boost to our economy, putting people to work in family sustaining jobs. According to an analysis by the Economic Policy Institute, every $1 billion spent on construction generates 17,785 jobs. There are plenty of examples in Rhode Island of the urgent need for additional investment in school facilities. My hometown of Cranston recently reported $190 million in school facility deficiencies--a startling figure. In the weeks ahead, the Rhode Island Department of Education will publish a report detailing the infrastructure shortfalls in school districts across the state. Our students and community members do not have to be convinced about the need for investing in school facilities. This spring, students, educators, and community leaders gathered in Providence to talk about our schools. One participant said, ``The condition of the buildings is a value statement about how we feel about our students. We must have buildings that are warm, safe, and dry.'' The Federal government needs to be a partner in helping Rhode Island and other States in closing school infrastructure funding gaps. The School Building Improvement Act of 2017 will create a Federal- State partnership for school infrastructure. It will provide, over ten years, a total of $100 billion in direct grants and school construction bonds to help fill the annual gap in school facility capital needs, while creating nearly two million jobs. Specifically, the School Building Improvement Act will provide $7 billion per year in formula funds to States for local competitive grants for school repair, renovation, and construction. States will focus assistance on communities with the greatest financial need, encourage green construction practices, and ensure equitable access for public charter schools. Our legislation would also provide $30 billion for qualified school infrastructure bonds (QSIBs), $10 billion each year from FY 2018 through FY 2020 and expand the bond authority of and eligible purposes for Qualified Zone Academy Bonds (QZABS) to allow local education agencies to construct, rehabilitate, retrofit, or repair school facilities. The School Building Improvement Act also supports American workers by ensuring that projects use American-made iron, steel, and manufactured products. I would like to thank the broad coalition of educators, community organizations, and unions that have provided feedback and support for this legislation, including Rebuild America's Schools, American Federation of Teachers, Californians for School Facilities, Council of the Great City Schools, International Union of Operating Engineers, National Association of Elementary School Principals., National Association of Federally Impacted Schools, National Association of Secondary School Principals, National Education Association, National Parent Teacher Association, and North America's Building Trades Unions. We look forward to expanding this coalition in the weeks and months ahead. We have no time to waste in fixing our deteriorating school infrastructure. In the words of a student activist in Providence, ``Students cannot learn in a crumbling building, a school that isn't fit to uplift our minds.'' We need to listen to our students, strengthen our communities, and improve our school buildings. I urge all of my colleagues to cosponsor the School Building Improvement Act.

Mr. REED

Mr. REED. Mr. President, our public schools are critical National infrastructure. They play a central role in our Democracy--educating the next generation, serving as polling places for our elections, hosting community meetings and events, and so much more. As we consider the components of a new major Federal investment in infrastructure, we cannot afford to leave our public schools behind. That is why I am proud to be introducing the School Building Improvement Act with my colleagues Senators Brown, Cortez Masto, Hassan, Warren, Whitehouse, Hirono, and Cardin. Safe, healthy, modern, well-equipped schools are essential for advancing student achievement and ensuring that the next generation is prepared to meet the economic, social, environmental, and global challenges our Nation faces. Yet, too many of the over 50 million students and six million staff who learn and work in our public schools, spend their days in facilities that fail to make the grade. A 2014 Department of Education study estimated that it would cost $197 billion to bring all public schools into ``good'' condition. Nationally, there is also a $38 billion funding gap in annual capital construction and new facility funding, as reported in the 2016 State of Our Schools report. Despite the benefits and need, however, Federal funding accounts for 0.2% of the total current capital investment in our schools. Addressing this need is the right thing to do for our students and our communities. Moreover, it will give a needed boost to our economy, putting people to work in family sustaining jobs. According to an analysis by the Economic Policy Institute, every $1 billion spent on construction generates 17,785 jobs. There are plenty of examples in Rhode Island of the urgent need for additional investment in school facilities. My hometown of Cranston recently reported $190 million in school facility deficiencies--a startling figure. In the weeks ahead, the Rhode Island Department of Education will publish a report detailing the infrastructure shortfalls in school districts across the state. Our students and community members do not have to be convinced about the need for investing in school facilities. This spring, students, educators, and community leaders gathered in Providence to talk about our schools. One participant said, ``The condition of the buildings is a value statement about how we feel about our students. We must have buildings that are warm, safe, and dry.'' The Federal government needs to be a partner in helping Rhode Island and other States in closing school infrastructure funding gaps. The School Building Improvement Act of 2017 will create a Federal- State partnership for school infrastructure. It will provide, over ten years, a total of $100 billion in direct grants and school construction bonds to help fill the annual gap in school facility capital needs, while creating nearly two million jobs. Specifically, the School Building Improvement Act will provide $7 billion per year in formula funds to States for local competitive grants for school repair, renovation, and construction. States will focus assistance on communities with the greatest financial need, encourage green construction practices, and ensure equitable access for public charter schools. Our legislation would also provide $30 billion for qualified school infrastructure bonds (QSIBs), $10 billion each year from FY 2018 through FY 2020 and expand the bond authority of and eligible purposes for Qualified Zone Academy Bonds (QZABS) to allow local education agencies to construct, rehabilitate, retrofit, or repair school facilities. The School Building Improvement Act also supports American workers by ensuring that projects use American-made iron, steel, and manufactured products. I would like to thank the broad coalition of educators, community organizations, and unions that have provided feedback and support for this legislation, including Rebuild America's Schools, American Federation of Teachers, Californians for School Facilities, Council of the Great City Schools, International Union of Operating Engineers, National Association of Elementary School Principals., National Association of Federally Impacted Schools, National Association of Secondary School Principals, National Education Association, National Parent Teacher Association, and North America's Building Trades Unions. We look forward to expanding this coalition in the weeks and months ahead. We have no time to waste in fixing our deteriorating school infrastructure. In the words of a student activist in Providence, ``Students cannot learn in a crumbling building, a school that isn't fit to uplift our minds.'' We need to listen to our students, strengthen our communities, and improve our school buildings. I urge all of my colleagues to cosponsor the School Building Improvement Act.

Mr. REED

Mr. REED. Mr. President, today I am joined by Senators Casey, Gillibrand, Hassan, and Whitehouse to introduce the Layoff Prevention Act of 2017. This bill renews and extends Federal support for State short-time compensation--or work sharing--programs, which help avert layoffs and the economic effects of long-term unemployment. Work sharing is a proven concept that is endorsed by economists across the political spectrum. When business slows down, employers feel pressure to lay off employees. Under work sharing, employers may instead opt to reduce hours across-the-board, and employees may then collect a pro-rata unemployment compensation check for the hours they lost. This prevents layoffs, lowers employers' rehiring and training expenses, and costs States only a fraction of what they would pay if workers went on full unemployment. The Middle Class Tax Relief and Job Creation Act of 2012 included my Layoff Prevention Act, which modernized Federal work sharing laws. Partly as a result of this increased Federal support for work sharing, State work sharing programs helped to save over 130,000 jobs between 2012 and the expiration of Federal incentives in 2015. The legislation I am introducing today would renew incentives so that States with existing work sharing programs, and those considering enacting a program, can qualify for Federal support. Our economy has come a long way in recent years, and we should invest in proven programs like work sharing to ensure we do not experience again the same scale of job loss that we endured during the Great Recession. I urge my colleagues to join me in supporting passage of this bill to keep American workers on the job, save taxpayers money, and provide employers with a practical, positive, and cost-effective alternative to layoffs.

Mr. REED

Mr. REED. Mr. President, today I am joined by Senators Casey, Gillibrand, Hassan, and Whitehouse to introduce the Layoff Prevention Act of 2017. This bill renews and extends Federal support for State short-time compensation--or work sharing--programs, which help avert layoffs and the economic effects of long-term unemployment. Work sharing is a proven concept that is endorsed by economists across the political spectrum. When business slows down, employers feel pressure to lay off employees. Under work sharing, employers may instead opt to reduce hours across-the-board, and employees may then collect a pro-rata unemployment compensation check for the hours they lost. This prevents layoffs, lowers employers' rehiring and training expenses, and costs States only a fraction of what they would pay if workers went on full unemployment. The Middle Class Tax Relief and Job Creation Act of 2012 included my Layoff Prevention Act, which modernized Federal work sharing laws. Partly as a result of this increased Federal support for work sharing, State work sharing programs helped to save over 130,000 jobs between 2012 and the expiration of Federal incentives in 2015. The legislation I am introducing today would renew incentives so that States with existing work sharing programs, and those considering enacting a program, can qualify for Federal support. Our economy has come a long way in recent years, and we should invest in proven programs like work sharing to ensure we do not experience again the same scale of job loss that we endured during the Great Recession. I urge my colleagues to join me in supporting passage of this bill to keep American workers on the job, save taxpayers money, and provide employers with a practical, positive, and cost-effective alternative to layoffs.

Mr. REED

Mr. REED. Madam President, I have a motion to commit the bill, H.R. 1628, to the Committee on Finance with instructions to report the same back to the Senate in 3 days, not counting any day on which the Senate is not in session, with changes that, No. 1, are within the jurisdiction of such committee; and No. 2, ensure that any cuts to Medicaid shall cease to apply in States with fewer than 26 weeks of unemployment insurance under State law and shall be reversed in States with increased unemployment in a quarter and include a study on available job opportunities for those most likely to lose health insurance coverage in the next 10 years as a result of the bill. Like most of the country, Rhode Island was hit hard by the recession, and Medicaid provided a critical safety net. Medicaid can adapt to cover those who have lost their jobs or are facing other economic hardships, saving families from having to choose whether to take their kids to the doctor or put food on the table. Under this bill, States will be unable to expand coverage during a recession to those in need and will likely be forced to make devastating across the board cuts. I ask unanimous consent that the motion be printed in the Record.

Mr. REED. Madam President, I intend to offer the following motion to H.R. 1628 and ask unanimous consent that it be printed in the Record. I move to commit the bill, H.R. 1628, to the Committee on Finance with instructions to report the same back to the Senate in 3 days, not counting any day on which the Senate is not in session, with changes that, No. 1, are within the jurisdiction of such committee; and No. 2, ensure that no senior will lose access to long-term care service including nursing home care and home and community-based care under the Medicaid Program. Medicaid is the largest payer of nursing home care, with 900,000 individuals across the country and 4,756 individuals in Rhode Island who reside in nursing homes having their care paid for by Medicaid. This bill would decimate Medicaid, harming seniors and their families. This motion is supported by Senators Blumenthal and Shaheen.

Mr. REED. Madam President, let me join the Democratic leader in expressing my dismay in what has been going on on the Senate floor with respect to healthcare. For over 7 years, my colleagues on the other side of the aisle have been talking about how they intended to repeal the Affordable Care Act in order to replace it with something better and improve our healthcare system. President Trump has said time and again that he would provide better healthcare at a lower cost. He said that everyone would be covered. Yet we have seen no solutions from the other side that would accomplish these goals. We have been trying to work with Republicans, not just this year but for the last several years to improve our healthcare system. In fact, we worked with them to craft the Affordable Care Act in the first place, holding public hearings and meetings with both Democrats and Republicans around the table. The Affordable Care Act included well over 150 Republican amendments. Yet they refused to work with us on our final passage of the law and refused to work with us on the current law and healthcare ever since. However, today we have seen a couple of glimpses of bipartisanship. First, the Senate voted last night, both Democrats and Republicans, to reject the TrumpCare bill that would have provided tax breaks to special interests while decimating Medicaid. I am glad the Senate has spoken on that issue and said that we do not support this effort. This afternoon, Democrats and Republicans voted to reject a bill that would have repealed the Affordable Care Act with no replacement. A majority of Senators voted to say that effort was unacceptable. Now that we have taken those votes, Senators have had their say on what they think is the best path forward, and to me, these votes show that most Senators want to work in a bipartisan fashion to improve our healthcare system. I have heard many of my colleagues on the other side of the aisle say just that, as Senator McCain said so eloquently yesterday. I think, if my colleagues are willing to sit down and negotiate in good faith on legislation to improve our healthcare system and bring down costs, we could come up with a bill that would get the support of the majority of this body. My colleague Senator Shaheen, for example, introduced legislation to help stabilize the individual market, something I think most of us would agree is an important step forward in improving the Affordable Care Act. However, we are now hurdling toward a vote with absolutely no plan to improve the healthcare system. My Republican colleagues are scrambling to get enough votes just to pass anything at all. Right now we are debating the bill, but what does that mean when we have not yet seen the bill we are eventually going to vote on? This is not a meaningful exercise with opportunities to amend and improve legislation. We are simply killing time so that the Republican leadership can unveil a new bill, if they are able to come up with one, that they can convince enough of their Members to support. Hours or minutes before final passage this could be sprung upon us, and we would then be forced to take a vote. That is not the way the legislative process should work. What kind of message does this send to our constituents? This is an example of legislating at its worst. This is why many Americans don't trust Washington to have their backs. We don't know what Republicans intend to pass at the end of this debate, but we do know that they intend to pass something that is harmful. The CBO score, which the Democratic leader suggested, based upon the reports of what is pending, suggests significant losses in coverage across the country and significant increases in the cost of healthcare insurance for Americans. Based on what we have seen so far, each proposal would send the healthcare market into a death spiral, impacting all of our constituents--not just the Medicaid recipients, not just those who are in the exchanges--and even private employers who provide insurance coverage for their workers would see increases. As I mentioned earlier, the bill we voted on this afternoon would repeal the Affordable Care Act with no replacement. In that case, the nonpartisan Congressional Budget Office said this would cause 32 million Americans to lose health insurance over the next decade, including 17 million next year alone, and health insurance markets would collapse. As I indicated, fortunately, that failed, with both Democrats and Republicans voting against it, but it looks like Senate Republican leadership is still trying to cobble together yet another version, taking some of the worst elements of the repeal act. What is worse, there will be no opportunity to review the bill, no chance for CBO to analyze the bill and provide feedback, no opportunities for stakeholders, patients, and States to weigh in. It is telling that the only path forward they have for their repeal effort is to pass a bill no one has literally read. The only chance they have to get support for their effort is to hide, essentially, the impact of the bill because on the merits it appears devastating to our constituents. Nevertheless, as much as they try to hide this bill, the American people will find out. They will find out when they get the bill for their health insurance. They will find out when they go to their doctor and discover the treatment they had last year that was covered under the Affordable Care Act is no longer covered. They will find out when the only insurance company in their State decides to leave. They will find out when their employer says: We are no longer providing healthcare to our employees. They will find out when they start a family and discover that maternity care is no longer covered and, if the child needs medical care early in life, the insurance company can say: No, thank you; we don't have to cover the child. There is a preexisting condition. Just last night I got a call from a woman in Charlestown, RI--Amy. She urged me to continue fighting to preserve the Affordable Care Act. She is a hairdresser and her husband is a commercial fisherman. Because they are both self-employed, they are not able to get coverage through work. They have been able to access care through our State's health insurance marketplace, HealthSource RI. As Amy said, she and her husband are hard-working, middle-income taxpayers, but they never have been able to afford coverage without the help of the Affordable Care Act. They would not have been able to do that. Amy recently got sick and had to be hospitalized. She has coverage because of ObamaCare. She was able to get the treatment she needed. Without coverage, she would have been left to pay a bill of $78,000. Amy told me that she and her husband would have had to sell their house to afford that, and, probably even with that, they would have been left impoverished. Is that really what my colleagues want for their constituents? My constituents know what is at stake. I have heard from thousands and thousands of them throughout the year, urging me to keep fighting for healthcare, asking me to put an end to this repeal effort. However, Democrats cannot do this alone. We need more Republicans like some of my colleagues, Senator Collins and Senator Murkowski, to come forward and say: Enough is enough. Even if you have problems with the current system, let's try to work together to solve the problems. We might not always agree, but we will try our best to come to a consensus. There is no harm in trying to come up with a bipartisan solution. It is not too late to reverse course and return to regular order, to start again, to start right, and to do it, as my colleague on the Armed Services Committee, Chairman McCain, said, the good old fashioned way, with Senator Alexander and Senator Murray on the HELP Committee and my colleagues on the Finance Committee working their way through, carefully and deliberately, listening, amending, moving forward legislation so that we can come to this body not with a few minutes' notice but fully prepared to vote on something that is critical to every family in the country. With that, Madam President, I yield the floor.

Mr. REED

Mr. REED. Mr. President, today I am introducing the DEPSCoR Reauthorization Act of 2017 along with Senators Rounds, Brown, Collins, Carper, Coons, Whitehouse, Shaheen, Cortez Masto, and Hirono. The purpose of this bill is to ensure that we have universities in all 50 States capable of working with the Department of Defense on advanced research topics. A truly National network of university researchers who understand the needs of the Department of Defense puts us in the best possible position to respond to the ever-changing threats our armed forces face. This network will also meet the workforce needs of our defense laboratories by training graduate students in defense-relevant research. This bill reauthorizes the DEPSCoR program, which is modeled on the NSF's successful EPSCoR program for States that receive relatively low amounts of Federal science funding. The bill will focus the DEPSCoR program on defense research, while allowing the scientists and engineers of our defense laboratories to work directly with university researchers from DEPSCoR- eligible States. Seven years ago, Congress asked the National Academy of Sciences to study the EPSCoR programs. The study concluded that it was in the National interest to engage scientific talent in all 50 States, and that EPSCoR programs were a valuable part of a National strategy to maintain global scientific leadership. The report emphasized that successfully engaging all 50 States required the involvement of technology-driven agencies, including the Department of Defense, to complement the basic science focus of the NSF. Until 2009, the Department of Defense managed an EPSCoR-like program, known as DEPSCoR. An independent evaluation of DEPSCoR, conducted by the Institute for Defense Analyses, showed that DEPSCoR research contributed to the DoD mission, producing high-quality research and new technologies that were operationally deployed in areas such as missile guidance and communications. DEPSCoR also successfully developed defense research capabilities in States historically underserved by Federal research and development (R&D) funding. Since DEPSCoR stopped receiving Congressional support, defense research in DEPSCoR-eligible States has plummeted, with the decreases far larger than the relatively modest amounts going to DEPSCoR awards. This shows that DEPSCoR was doing what Congress intended the program to do: develop competitive defense researchers in all 50 States. The impact of cancelling DEPSCoR went far beyond research grants. Developing university research capabilities in all 50 States is critical to meeting DoD workforce needs. The Defense Laboratory Enterprise is more national in scope than NASA or the Department of Energy's National Laboratory system, with facilities in 24 States, including DEPSCoR-eligible States. The 2016 review of DoD laboratories by the Defense Science Board reported that these laboratories depend on locally trained scientists and engineers. Without relevant training provided through DoD-supported research projects at nearby universities, these facilities may struggle to find highly qualified scientists and engineers. Because of these concerns, I have been working with my colleague on the Armed Services Committee, Senator Rounds of South Dakota, to revive this program. This reauthorization uses the lessons learned from the previous iteration of DEPSCoR to improve the program, making it more responsive to Department of Defense needs. I invite our colleagues to join us in supporting this legislation.

Mr. REED

Mr. REED. Mr. President, today I am introducing the DEPSCoR Reauthorization Act of 2017 along with Senators Rounds, Brown, Collins, Carper, Coons, Whitehouse, Shaheen, Cortez Masto, and Hirono. The purpose of this bill is to ensure that we have universities in all 50 States capable of working with the Department of Defense on advanced research topics. A truly National network of university researchers who understand the needs of the Department of Defense puts us in the best possible position to respond to the ever-changing threats our armed forces face. This network will also meet the workforce needs of our defense laboratories by training graduate students in defense-relevant research. This bill reauthorizes the DEPSCoR program, which is modeled on the NSF's successful EPSCoR program for States that receive relatively low amounts of Federal science funding. The bill will focus the DEPSCoR program on defense research, while allowing the scientists and engineers of our defense laboratories to work directly with university researchers from DEPSCoR- eligible States. Seven years ago, Congress asked the National Academy of Sciences to study the EPSCoR programs. The study concluded that it was in the National interest to engage scientific talent in all 50 States, and that EPSCoR programs were a valuable part of a National strategy to maintain global scientific leadership. The report emphasized that successfully engaging all 50 States required the involvement of technology-driven agencies, including the Department of Defense, to complement the basic science focus of the NSF. Until 2009, the Department of Defense managed an EPSCoR-like program, known as DEPSCoR. An independent evaluation of DEPSCoR, conducted by the Institute for Defense Analyses, showed that DEPSCoR research contributed to the DoD mission, producing high-quality research and new technologies that were operationally deployed in areas such as missile guidance and communications. DEPSCoR also successfully developed defense research capabilities in States historically underserved by Federal research and development (R&D) funding. Since DEPSCoR stopped receiving Congressional support, defense research in DEPSCoR-eligible States has plummeted, with the decreases far larger than the relatively modest amounts going to DEPSCoR awards. This shows that DEPSCoR was doing what Congress intended the program to do: develop competitive defense researchers in all 50 States. The impact of cancelling DEPSCoR went far beyond research grants. Developing university research capabilities in all 50 States is critical to meeting DoD workforce needs. The Defense Laboratory Enterprise is more national in scope than NASA or the Department of Energy's National Laboratory system, with facilities in 24 States, including DEPSCoR-eligible States. The 2016 review of DoD laboratories by the Defense Science Board reported that these laboratories depend on locally trained scientists and engineers. Without relevant training provided through DoD-supported research projects at nearby universities, these facilities may struggle to find highly qualified scientists and engineers. Because of these concerns, I have been working with my colleague on the Armed Services Committee, Senator Rounds of South Dakota, to revive this program. This reauthorization uses the lessons learned from the previous iteration of DEPSCoR to improve the program, making it more responsive to Department of Defense needs. I invite our colleagues to join us in supporting this legislation.

Mr. REED

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

Mr. REED. Mr. President, I am truly dismayed by what we have seen in this Chamber over the last couple of months with respect to the Senate TrumpCare bill. We are expecting to take a vote tomorrow on the motion to proceed, but at this point, our Republican colleagues have not shared with us exactly what we are proceeding to. We do not know if our Republican colleagues will attempt to replace the ACA with their flawed TrumpCare bill or if they will just vote to repeal the ACA and immediately upend health insurance markets across the country. Not one of these options is acceptable, and I am skeptical that my colleagues will be able to come up with a better solution in the next 24 hours. For an issue of this magnitude, we should be holding hearings, meetings, and discussions in the committees of jurisdiction, with experts from around the country, much like we did when we worked to pass the Affordable Care Act. In that way, we could have worked together across the aisle to develop ideas that would improve the system in place, not gut it. There have long been misconceptions about how the Affordable Care Act came to be. For over a year, we held hearings, meetings, and roundtable discussions with Members from both parties and had a robust amendment process in our committees, both in the Senate Finance Committee and in the Health, Education, Labor, and Pensions Committee. I served on the HELP Committee at that time and went through numerous hearings, open discussions, and numerous amendments, and I listened to my colleagues. In fact, the HELP Committee's draft of the ACA included over 160 amendments that were offered by my Republican colleagues. It was truly a bipartisan effort at the committee level to try to at least discuss the critical issues that both sides had identified. This stands in stark contrast to the bill our colleagues have written in secret this year. Even some Republican Senators were kept in the dark, excluded from the process. There were no opportunities for experts, doctors, patients, and others to weigh in and offer comments. As a result, they have written a bill that is bad for patients, bad for healthcare providers, bad for States, and bad for the system as a whole. My colleagues even rejected the chance to hear from States in public hearings about their healthcare systems in terms of what has worked well and what has not. There are examples of States that have done some very innovative things and some examples of States that have had difficulties. We always say that the States are the great incubators for new ideas. Yet the process that was adopted did not incorporate the views in both of the cases--those in which States have done remarkably well and, frankly, when they could have done much better. We should look to the States to see how we can improve our healthcare system and let them be partners with us in this process. That is what we did in the consideration of the Affordable Care Act. In fact, some States had already worked to expand access to care before the ACA, most notably Massachusetts, with RomneyCare, and we looked carefully at those examples and tried to incorporate those successful ideas in a national model. By contrast, across the country, Governors and Senators and State legislators--both Democrats and Republicans--are largely opposed to the Senate Republicans' TrumpCare bill because they know it would be a bad idea for their States. State and local officials have crossed party lines and joined together to get the word out about how bad this bill would be for Americans in all States and from all walks of life. My Republican colleagues must heed their advice and abandon this harmful approach. It is no secret as to why my Republican colleagues have struggled to come up with the votes within their caucus for their repeal efforts. Their proposals are bad for my State of Rhode Island and bad for the country as a whole. In fact, many States with Republican legislatures and Republican Governors have done very well in incorporating the ACA and understand the impact this will have almost immediately on their healthcare systems. While we do not know exactly what we will be voting on tomorrow, we have some guesses based on some of what Republicans have publicly shared over the last couple of weeks, and each proposal seems to be worse than the next. First, my colleagues tried to vote on their TrumpCare bill, which would have provided massive tax giveaways to the very wealthiest Americans at the expense of hard-working Americans across the country. This bill would have decimated Medicaid, cutting State budgets and eliminating access to care for seniors, children, and people with disabilities. Fifty percent of the funds in my State go to seniors, and it is roughly equivalent across the country. Typically, it is through Medicaid for seniors who are in nursing homes. If they were to lose that funding, the States could not make it up. I think every State in this country is struggling with its own fiscal issues--education, transportation and infrastructure--a host of issues. When this money is pulled out, they will not be able to replace it. They will make difficult decisions about cutting back eligibility so that, ironically, middle-class seniors will be the first to feel the brunt of these cuts. That is exactly one of the areas in which we are trying to improve our system, not only of healthcare but of government. Even after doing that, I think they will still come up short, and that is when they will go into the education funding formulas. There are many States across the country now that are already in crisis, and this will just add to the crisis. None of these fixes, I don't think, will overcome the damage that would be inflicted by the bill. The nonpartisan Congressional Budget Office confirmed that last week when it released an updated score of the bill to reflect some of the changes that had been made. The CBO said that under this revised bill--the latest one that has been evaluated--22 million Americans would lose coverage, just like in the previous version of the bill. It said that 22 million Americans--a significant number of our neighbors--would lose their coverage. Many of them are working families, and many of them have children with special needs, and they need this coverage. They would be thrown out. I was at a Lowe's store in Rhode Island when a young man came up to me--probably in his mid-thirties--and said: Please, Senator, you have to stop this bill. I have a son who has a serious problem. I believe he told me it was MS. He said: If, eventually, they remove the lifetime limits on healthcare insurance, as they are talking about, I will be done. I have employer healthcare insurance. I have a good job, and I have benefits, but if they put those lifetime limits back again, I will be bankrupt. My son will not have the care, or he will only get the care through some type of--something--some extraordinary method. That is the reality. These are our neighbors. Similarly, the CBO said that out-of-pocket costs would increase across the board and that care would be prohibitively expensive for the sickest and poorest amongst us. That is one of the great ironies here-- that the sickest would be paying more and more and more. The CBO was not misled by these so-called fixes that have come into the bill. In fact, we know that the reality would be even worse, I believe, than the CBO has predicted because it has not taken into account a provision that was added too late to be scored--a provision that would bifurcate insurance markets and separate the sick from the healthy, which would lead to a death spiral in the market that would all but certainly collapse the market. They are plans that are not really insurance. They are kind of--I don't know what they are. In fact, the CBO could not even call them insurance. But that would qualify as a plan. The healthiest, youngest people would buy it because it would be cheap, and they would have some kind of sense of protection, driving the sickest and older people into other plans, which would increase their costs and, in fact, create this bifurcated system in which either young, healthy people would not have insurance or they would have this insurance, which would not be insurance when they need it. Then you would have more and more people with chronic conditions and illnesses and just the accumulated health issues of age flocking to what is left and bringing down that system. It would be a death spiral. If that were not bad enough, some of my colleagues on the other side of the aisle decided that the backup plan would be to vote on a bill to repeal the ACA in its entirety on a 2-year delay. They claim that it will give them an opportunity to work out a replacement plan. This is not sound policy. First, they have had more than 7 years to come up with a replacement but have not had any success. At this moment, there is this ad hoc ``What do we put in? What do we take out?'' The 7 years of supposed study and analysis has produced, apparently, nothing, and they have spent all of this year behind closed doors, coming up with something they think will work, but they have come up with the same results--the same CBO scores, basically. The real end game is not to repeal and replace; it just seems to be to repeal. My other concern is that even if this repeal is delayed by 2 years, markets will not wait 2 years to react and insurance companies will not wait 2 years to react. They have to provide for decades in terms of actuarial values, in terms of their shareholders. Hospitals will not wait 2 years. They will see this coming to an end. They will start scaling back their programs, their outreach, all of the things they do, and the effects will be imminent. This effort would leave 17 million more Americans uninsured next year and 32 million more Americans uninsured over the next decade. That is the repeal-and-wait approach. And once again the CBO said this bill will lead to skyrocketing healthcare costs, for the reasons that I suggest: markets will not wait. Markets will move very quickly once they know this is gone. And since in the last 7 years we couldn't get a replacement, the idea that we are getting it in 2 more years is something they won't believe, and it will be immediate and devastating--again, another death spiral for the marketplace. But here we are on the precipice of voting on whether to upend our entire healthcare system so that, in some respects, this President can claim a victory over former President Obama--not because it is sound healthcare policy but just because of that very complicated relationship. And it is not the right thing to do. It is long past time for us to leave the campaign rhetoric behind, to get together in a bipartisan fashion, and to work out ways to improve our healthcare system. That is what we attempted to do with the ACA. We sat in meeting after meeting, hearing after hearing--the longest markup, I believe, in the HELP Committee--accepting and voting on Republican amendments and Democratic amendments. That is how we get things done--I hope that is how we get things done. Healthcare makes up one-sixth of our economy. And when you walk into an ER or a doctor's office, they don't ask you whether you are a Republican or a Democrat, but whether you have insurance. That is the only question they ask: How are you paying for this? If you don't have insurance, then you are in an awfully difficult position, and we know that. Everybody is going to use the healthcare system in their life. This is not an optional thing. This is not something that is designed for a special group of people. We all will use the healthcare system. And if you can't access it because you have no money or no insurance, maybe you will find a way through the emergency room or some other way, but it won't be the best healthcare and it won't be the most efficient and economical for our country. In fact, one of the ironies of our healthcare system before the ACA is that we could have large portions of our population with no health insurance, not getting treatment for illnesses that could have been readily fixed while they were in their forties and fifties, and then suddenly at 65, with Medicare, which we all support, they can get treatment they need. I had an ophthalmologist in my office one day, and they kind of looked around and commented: Well, you are right, because I see people right now coming into Medicare--65, 66 years old--because they had early onset diabetes, which could have been treated by a modest drug regime in their forties and fifties. They are now so sick that they have to have expensive surgery. That is not effective for the country. With the Affordable Care Act, we were putting our whole Nation, we hoped--from young people, children, all the way through--on a path to good healthcare, so that by the time they get to Medicare, those issues would not be so important. So I would urge my colleagues to abandon this effort, to begin tomorrow not with a vote on their proposal, but sitting down with both sides, doing the same process that we did. Again, one of the tests of life is, do you allow your colleagues and friends to do what you did, or do you insist they do something else? We are just asking them to do the same thing we did with the Affordable Care Act over many months of hearings and debate, and then at the end there was a vote. We are going to see this for the first time tomorrow--the details. We still don't know what is going to be in it. There will be a vote, but it won't be an informed vote. It won't be a result of careful deliberation. It won't be a result of a bipartisan effort. It won't be a result of all the equity holders, including doctors, patients, public health officials, and governors, coming together and saying: We can do this better. That, to me, is a shame. With that, I yield the floor. I suggest the absence of a quorum.

Mr. REED

Mr. REED. Mr. President, I rise to discuss the nomination of Mr. Patrick Shanahan to serve as the 33rd Deputy Secretary of Defense. The Senate Armed Services Committee held a hearing on his nomination on June 20, and he was voted out of committee by voice vote. Mr. Shanahan was born and raised in the State of Washington. He received his undergraduate degree from the University of Washington and then a master's degree and MBA from the Massachusetts Institute of Technology. Mr. Shanahan then embarked on a 30-year career at the Boeing Company, where he rose to the most senior echelons of management, working on both the company's defense and commercial programs. Most recently, Mr. Shanahan served as the senior vice president for supply chain & operations. The Deputy Secretary of Defense is one of the most important positions within the entire national security system. The Deputy serves as the number 2 official at the Department of Defense, as well as the Department's Chief Management Officer. As the second in command to the Secretary of Defense, the Deputy oftentimes is assigned a broad spectrum of responsibilities which require strong management skills. The Department currently faces challenges on multiple fronts. For more than 16 years, our military has been consumed by two prolonged wars against violent extremist groups like ISIS. As a result, the military has faced a generational fight which has sapped readiness and precluded our military personnel from training for full spectrum operations. However, violent extremist groups are only one of the many challenges facing our country. The past several years have seen the rise of near-peer competitors, most notably Russia and China. Russia has been a resurgent force bent on disrupting Europe and undercutting our own Nation and our Presidential election process. China continues its saber-rattling in the Asia-Pacific region by undermining the freedom of navigation and using economic coercion of its smaller, more vulnerable neighbors. When we factor in the destabilizing actions of North Korea and the long shadow of Iran, it becomes urgently clear that we need strong leadership at the Department of Defense. If Mr. Shanahan is confirmed, he will need to contend with all these challenges. It will not be easy and hard decisions on policy and strategy will need to be made. Perhaps one of the hardest decisions facing the Deputy Secretary of Defense is the allocation of budget resources within the Department. In an ideal world, a cogent defense strategy that takes into consideration the multitude of concerns facing our Nation would inform how the Department invests resources in weapons platforms and advanced technologies to confront these challenges. However, the reality is that the spending caps imposed by the Budget Control Act determine the level of funding for most of these budget decisions. The current budgetary crisis is compounded by the fact that the President's most recent budget request adds much needed funding to defense activities, but it shortchanges nondefense spending accounts in order to increase spending for our military. Furthermore, the budget request fails to recognize that the BCA budget caps are law. If these spending levels are enacted, the President's budget request would trigger sequestration, effectively wiping out increased defense spending with mandatory across-the-board cuts. This would be the worst of all worlds. Not only would we be giving the money on the one hand and taking it back with the other hand, but it would not be in any systematic way. We would be making cuts to readiness. We would be making cuts to personnel. We would make cuts to all sorts of things which are much more valuable than some programs which would receive an additional cut. Unless we resolve ourselves to act--which is going to take a bipartisan effort to repeal the BCA--we can't effectively fund not only the Department of Defense but every other Federal department. That is one of the great challenges Mr. Shanahan will face. Indeed, these multiple challenges will require strong leadership and the ability to make tough decisions. Mr. Shanahan has developed a strong reputation during his tenure at Boeing as someone capable of taking on challenging programs, fixing problems, and turning them into successes. When I met with Mr. Shanahan to discuss his nomination, he emphasized that the public sector needed to work closer with the private sector to get more cost-effective results while ensuring our warfighters have the best equipment at their disposal. It is that kind of leadership that the Department of Defense needs as our Nation faces as diverse an array of threats and challenges to our national security as at any point in our history. Based on Mr. Shanahan's qualifications and experience, as well as his testimony before the Senate Armed Services Committee, I believe he is fully qualified for the job. Therefore, I will vote in favor of his nomination to be the next Deputy Secretary of Defense, and I trust he will do his best to lead the men and women who ably and courageously serve this Nation. On a final note, if confirmed, Mr. Shanahan will be relieving Bob Work, who has served this Nation ably and selflessly for most of his life. Bob Work served in the U.S. Marine Corps for 27 years, rising to the rank of colonel. In 2009, he was confirmed as Undersecretary of the Navy, where he shepherded the service through many challenges for the next 4 years. He tried to return to the private sector, but in 2014 he was then nominated and confirmed as Deputy Secretary of Defense. Bob Work was the continuity in the Defense Department through three Secretaries of Defense. He stayed more than 6 months into the new administration in order to aid Secretary Mattis. There is no task, no matter how difficult or how big or small, that Bob Work would not devote all of his energy to until it was resolved. Bob Work personifies his name. He works, tirelessly. Our Nation owes him a great debt of gratitude, and I hope he takes some well-deserved vacation time and enjoys the company of his wife and daughter. I yield the floor. I suggest the absence of a quorum.

Mr. REED

Mr. REED. Mr. President, I would like to take a moment today to talk about the ongoing efforts by the Senate Republicans to take away health insurance from millions of Americans by repealing the Affordable Care Act. I was here on the floor just a couple of weeks ago reading letters from my constituents about how they have benefited from the ACA and what TrumpCare would mean for them based on what we had seen of their bill so far. Since then, my colleagues on the other side of the aisle have continued forging ahead in their effort to repeal the ACA, in spite of overwhelming opposition. Indeed, nearly every major healthcare organization representing patients, doctors, nurses, and hospitals, among others, is opposed to this misguided effort, and that is on top of the millions of Americans who know firsthand how devastating TrumpCare would be for them and their families. Senate Republicans are working on tweaks to convince their colleagues to vote for this disastrous bill. Unfortunately, their so-called ``fixes'' are not improvements. That is because, in my view, TrumpCare is fatally flawed and cannot be fixed. My constituents know better and have continued to write and call--even stopping me in stores and on the streets--to express their opposition and fear, quite frankly, of all versions of the Senate TrumpCare bill. For example, my Republican colleagues are looking to add a provision that would bring us back to the days when insurance companies could deny coverage or charge exorbitant amounts for those with preexisting conditions. The Affordable Care Act ended this practice once and for all, we hope, and I can't imagine why my colleagues want to bring back those discriminatory policies. However, the amendments that several Senators have proposed would do just that. They would allow insurance companies to sell plans on the marketplace with no protections for those with preexisting conditions, which would create a death spiral in the marketplace, so that the very people who need health insurance the most would be priced out entirely. Just last week, I heard from Anne in North Smithfield, RI, about this very issue. Anne said: I am the parent of a childhood cancer survivor. The last 11 months of my life have been fighting alongside my warrior, my hero, my 9-year-old osteosarcoma survivor, Julia. She loves unicorns, horses, the beach, and going for walks. Due to no fault of her own, she hasn't been able to walk for the past 11 months. I am writing to ask for your support to ensure that all children fighting cancer have access to affordable, quality healthcare. If enacted into law, the current proposal for the healthcare bill will have devastating impacts on the hundreds of thousands affected by childhood cancer. Without quality health insurance and access to treatment, my child would not have survived. Anne went on to explain that the Republican efforts to undermine preexisting conditions protections would be devastating for childhood cancer survivors. Even parents who get their insurance through their employer would be at risk. Anne pointed out that nearly half of families of children with cancer will experience gaps in coverage because one or both parents often need to stop working or reduce their hours to care for the child. Further, TrumpCare erodes other critical consumer protections by allowing annual and lifetime limits on care. Anne continues her message: Additionally, childhood cancer patients must be assured of access to essential health benefits without the threat of lifetime or annual caps that would effectively price patients out of lifesaving treatments. Two-thirds of childhood cancer survivors will develop serious health conditions from the toxicity of treatment. My child's future is already uncertain enough. We should not have to worry about annual or lifetime caps on coverage. I agree with Anne. What use is healthcare coverage that expires just when you need it the most? Why would anyone think it makes sense to sell a health insurance policy for thousands of dollars that doesn't actually cover anything--or nothing--when you need it? This is a step in the wrong direction, and I continue to urge my Republican colleagues to reverse course. I would also like to talk about what this bill would do to those suffering from opioid addiction, a public health crisis that has taken a tremendous toll on our country and particularly on my home State of Rhode Island. I, along with many of my Democratic colleagues, have been talking about how the Senate TrumpCare bill would pull the rug out from many of those who are suffering from substance use disorders, like opioid addiction, by decimating Medicaid, which is how many people suffering from the opioid crisis access treatment. News reports suggest that Republicans are considering adding a fund for opioid addiction treatment as another so-called fix to the TrumpCare bill. While we absolutely need more Federal funding to expand access to drug treatment--in fact, I have been urging Republican leaders to do just that for years--what they are proposing cannot make up for the bill's nearly $800 billion in cuts to Medicaid with a $45 billion opioid fund. The math simply doesn't work. Second, short-term drug treatment programs do not provide a full spectrum of healthcare coverage over the long term, like Medicaid or other health insurance coverage. The Medicaid expansion under the ACA has provided the security of reliable healthcare coverage and long-term stability to help people with chronic conditions such as substance use disorders seek treatment and turn their lives around. TrumpCare takes that away. In addition, people with opioid addiction suffer from other mental health conditions at twice the rate of the general population and higher rates of physical health conditions as well, which would still go unaddressed in this so-called fix. We will be setting people up for failure if we provide immediate drug treatment services but cut access to the other mental and physical healthcare services they need. An opioid fund alone will not solve this public health crisis and, in fact, would be a drop in the bucket compared to how the rest of this bill would worsen the crisis. The cuts to Medicaid under the Senate TrumpCare bill are beyond repair. The Senate TrumpCare bill fundamentally changes the structure of the Medicaid Program, making massive cuts, representing a 35-percent cut over the next two decades. Simply put, this will end the Medicaid Program as we know it, which will hurt not only those suffering from the opioid crisis but also seniors, children, and people with disabilities. We may see Republicans try to spread out this harm over more years to hide the damage, but do not be fooled. Whether they make massive cuts to Medicaid in 2021 or 2022 or even 2026, for that matter, the cuts will be devastating. In short, no fix can undo the damage this bill will cause. This bill is a massive tax break for the wealthiest Americans at the expense of everyone else. No amendment or tweak to the bill will change that. Sharon from Wakefield, RI, wrote to me just a couple of days ago and summed this up very well. She said: I do not support the so-called American Health Care Act because it is not a health care plan, it is a tax cut for the rich. I am 67 years old, and I have a mild version of muscular dystrophy, and I have Medicaid. Since the GOP wants to end Medicaid, I am asking you to vote NO on the bill. Republicans must abandon this effort and come to the table to work with Democrats on a new path forward. Let's have productive conversations about how we can improve access to care and bring down costs. Let's harness this interest in improving access to drug treatment and work together on those efforts. But, coupled with the TrumpCare bill, those efforts will not mitigate the damage this bill will inflict on my constituents and those across the country. I hope those on the other side of the aisle who have expressed misgivings will oppose TrumpCare in all of its forms so that we can work together on a bipartisan solution and attempt to do something positive for our constituents. With that, Mr. President, I suggest the absence of a quorum.

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

Mr. REED

Mr. REED. Mr. President, today I am introducing the State Flood Mitigation Revolving Fund Act of 2017 along with Senators Kennedy and Menendez. The purpose of this bill is to reduce flood risk and the costs associated with flooding by establishing a State revolving loan program to fund mitigation projects for homeowners, businesses, and communities. This includes activities such as home elevations, flood proofing, acquisitions, and environmental restoration. By funding projects that reduce risk, the bill also provides an avenue to help middle-income and low-income property owners reduce their flood insurance premiums. Mr. President, flooding is the most common and costly hazard facing American property owners. Every year, we are reminded of this when we see catastrophic flooding in communities across the country. Since 2010, my home State of Rhode Island has experienced two Presidentially- declared flooding disasters, which have cost the Federal government over $86 million in payments from the National Flood Insurance Program. Nationally, disasters like these have caused FEMA to pay out an average of nearly $3 billion a year in flood insurance claims over the last five years--not to mention the billions in disaster payments for uninsured damage. Almost universally, experts remind us that the best way to reduce the cost of flooding is to engage in proactive, not reactive, flood mitigation. This is what the State Flood Mitigation Revolving Fund Act seeks to do. Modeled on the successful Clean Water and Drinking Water State Revolving Funds, this bill creates a straightforward and easily accessible program through which States can offer low-interest loans to homeowners, businesses, and communities who want to mitigate their flood risk. By creating a revolving fund, the bill will allow States to design and more efficiently implement their own flood mitigation strategies provided that they help achieve Federal objectives such as reducing disaster payments. Within this construct, the bill gives States the flexibility to undertake flood mitigation projects without the red tape associated with other Federal disaster mitigation programs. The bill requires state to provide a match of 20 percent, but they would have an incentive to further leverage Federal dollars, as many already do under the drinking water and clean water SRFs. Additionally, the bill ensures mitigation assistance is focused on where the flood risk is greatest and where people are most vulnerable. The bill requires States to prioritize mitigation assistance for low- income homeowners and geographic areas, pre-FIRM buildings, and severe repetitive loss and repetitive loss buildings. Finally, it gives States the option of providing additional subsidization for low-income property-owners and-communities that simply do not have the wherewithal to assume additional debt. Mr. President, as we talk about appropriate investments in infrastructure, mitigation is one place where we should be putting our money. FEMA reports that every $1 we spend on mitigation generates $4 in future savings. Not only will this legislation lead to a healthy return on investment, it will also create jobs through the work it funds I invite my colleagues to join me, Senator Kennedy, and Senator Menendez in supporting this legislation.

Mr. REED

Mr. REED. Mr. President, today I am introducing the State Flood Mitigation Revolving Fund Act of 2017 along with Senators Kennedy and Menendez. The purpose of this bill is to reduce flood risk and the costs associated with flooding by establishing a State revolving loan program to fund mitigation projects for homeowners, businesses, and communities. This includes activities such as home elevations, flood proofing, acquisitions, and environmental restoration. By funding projects that reduce risk, the bill also provides an avenue to help middle-income and low-income property owners reduce their flood insurance premiums. Mr. President, flooding is the most common and costly hazard facing American property owners. Every year, we are reminded of this when we see catastrophic flooding in communities across the country. Since 2010, my home State of Rhode Island has experienced two Presidentially- declared flooding disasters, which have cost the Federal government over $86 million in payments from the National Flood Insurance Program. Nationally, disasters like these have caused FEMA to pay out an average of nearly $3 billion a year in flood insurance claims over the last five years--not to mention the billions in disaster payments for uninsured damage. Almost universally, experts remind us that the best way to reduce the cost of flooding is to engage in proactive, not reactive, flood mitigation. This is what the State Flood Mitigation Revolving Fund Act seeks to do. Modeled on the successful Clean Water and Drinking Water State Revolving Funds, this bill creates a straightforward and easily accessible program through which States can offer low-interest loans to homeowners, businesses, and communities who want to mitigate their flood risk. By creating a revolving fund, the bill will allow States to design and more efficiently implement their own flood mitigation strategies provided that they help achieve Federal objectives such as reducing disaster payments. Within this construct, the bill gives States the flexibility to undertake flood mitigation projects without the red tape associated with other Federal disaster mitigation programs. The bill requires state to provide a match of 20 percent, but they would have an incentive to further leverage Federal dollars, as many already do under the drinking water and clean water SRFs. Additionally, the bill ensures mitigation assistance is focused on where the flood risk is greatest and where people are most vulnerable. The bill requires States to prioritize mitigation assistance for low- income homeowners and geographic areas, pre-FIRM buildings, and severe repetitive loss and repetitive loss buildings. Finally, it gives States the option of providing additional subsidization for low-income property-owners and-communities that simply do not have the wherewithal to assume additional debt. Mr. President, as we talk about appropriate investments in infrastructure, mitigation is one place where we should be putting our money. FEMA reports that every $1 we spend on mitigation generates $4 in future savings. Not only will this legislation lead to a healthy return on investment, it will also create jobs through the work it funds I invite my colleagues to join me, Senator Kennedy, and Senator Menendez in supporting this legislation.

Mr. REED

Mr. REED. Mr. President, I come to the Senate floor, once again, to urge my colleagues to work in a bipartisan, transparent fashion to improve our healthcare system and help bring down costs. Over the weekend, members of the American Medical Association--the Nation's largest organization of doctors--had a chance to finally read the proposed Republican bill and found it violates their ``do no harm'' principle. According to a letter they wrote to Leaders McConnell and Schumer, ``Medicine has long operated under the precept of Primum non nocere, or, `first do no harm.' The draft legislation violates that standard on many levels.'' That is the conclusion of the American Medical Association, and they are correct. This bill will not lower costs, and it will not improve our healthcare system. Instead, it will remove health insurance coverage for millions of Americans. Indeed, the CBO has just released their estimate that 22 million Americans will lose their health insurance coverage. It will increase costs for everyone and decimate State budgets, creating a ripple effect throughout our economy. The bill my colleagues worked in secret to craft is, in a sense, a sham. It will not lower costs, and it will not improve our healthcare system, as they insist. Instead, it will remove health insurance coverage for millions of Americans--22 million, according to the CBO-- increase costs for everyone, as I said, and decimate State budgets. In fact, their bill essentially is a huge tax cut for the wealthiest 2 percent of Americans at the expense of everyone else. If you need any further proof of the real driver of this bill, one of its biggest giveaways is a retroactive tax break on investment income for people making at least a quarter of a million dollars. Dozens of leading economists, including six Nobel laureates, have criticized this plan as, in their words, a ``giant step in the wrong direction'' that prioritizes tax breaks averaging $200,000 annually per household in the top 0.1 percent of Americans over the well-being of working families. In fact, President Trump himself will get an estimated $2 million tax break each year from the giveaways in this bill. Let's call this bill what it is: a massive giveaway to the wealthiest Americans. Meanwhile, the rest of the country--all of our constituents--will be the ones paying the price for these tax breaks for those well-off. So much for the President's claim that he would end a rigged system. Now, how do Republicans pay for these tax breaks? For starters, they are proposing to end the Medicaid expansion under the Affordable Care Act, which is providing health insurance to nearly 15 million Americans, but then they go even further by effectively block-granting Medicaid, cutting hundreds of billions of dollars from the program over the next decade. These are not reforms designed to lower costs. This is a cut, pure and simple, which will sharply curtail and eliminate needed healthcare services to many across this country. In fact, the Center on Budget Policies and Priorities published data that shows a stark contrast of who gains and who loses under this bill. The 400 households in the country with the highest incomes will get tax breaks totaling $33 billion because of the Senate TrumpCare bill. As a result, over 725,000 Americans will lose Medicaid coverage in just four States to equate to that $33 billion: Alaska, Arkansas, Nevada, and West Virginia. That doesn't even scratch the surface as to who will lose access to care in the remaining 46 States. Medicaid has played a critical role in ensuring access to care for millions of Americans, including children, seniors, and people with disabilities. In fact, across the country, and in my home State of Rhode Island, about half of all Medicaid funding is spent on nursing home care. Over 60 percent of nursing home residents access care through Medicaid. If you think nursing home care will be protected, you are in for a rude awakening because the math just doesn't work. It will be impossible to cut Federal funding for State Medicaid programs by hundreds of billions of dollars and not impact the most significant Medicaid expenditures, which are nursing homes. I would also like to talk about the role Medicaid plays in emergencies like a recession or public health crisis. We know all too well how an economic downturn impacts communities. With job loss, comes loss of health insurance, pensions, and other benefits. The tax base shrinks, and State budgets suffer. Medicaid, as currently structured, is able to adapt to this. As the need increases, the program grows to cover everyone who is eligible, including those who have just lost jobs. This saves families from having to choose whether to take their kids to the doctor or put food on the table. Under the Senate TrumpCare bill, States will be hamstrung by arbitrary caps and limits on Medicaid. In fact, States will be unable to expand coverage during a recession to those in need, and they will likely have to make cuts across the board, from healthcare and education to transportation infrastructure, to make up for the lost tax revenues. This is not strictly going to be an issue of healthcare policy in States. The cuts are so dramatic that after they have taken all they can from other healthcare programs, they will inevitably go to education funding--the biggest expense most States have--and then to transportation and then to public safety. Even then, I don't think they can keep up with these cuts. Like most of the country, Rhode Island was hard hit by the recession. It took many years for the economy to even begin to turn around in the right direction. It seemed my colleagues are forgetting how Medicaid has been a critical safety net through tough economic times. I am also concerned that my colleagues are not aware of the impact Medicaid has on our Nation's veterans. The uninsured rate among veterans has dropped by 40 percent since implementation of the Affordable Care Act. Nationwide, nearly 1 in 10 veterans is covered by Medicaid, including approximately 8,000 veterans in my home State of Rhode Island. The cuts to Medicaid that have been proposed by my Republican colleagues put the care of our veterans at risk. We have all promised to provide the best care possible to our brave men and women when they leave the service, but the Senate TrumpCare bill would do the opposite. That is not the only way this bill would damage veterans' care. Many veterans seek help for mental health care by going outside of the VA system. TrumpCare puts mental health and substance abuse treatment at risk by saying insurance companies no longer need to cover these services. For the over 15,000 veterans in Rhode Island who access mental and behavioral healthcare outside of the VA, they would be out of luck. For all the bipartisan work in this Chamber to increase veterans' access to these services, it would all be for naught if Senate Republicans pass their TrumpCare bill. These are just some of the things Republicans are sacrificing in the name of tax breaks for the wealthy. It is, frankly, unconscionable. More importantly, this will not be lost on the American people. I have heard from thousands of my constituents since the beginning of this year, and if Senate Republicans press forward with this legislation, I think we will all hear from many more of these constituents for many years to come. TrumpCare is fundamentally flawed and cannot be fixed. We would welcome the opportunity to work across the aisle on improvements to the Affordable Care Act, like those to lower costs, especially prescription drug costs, any time. I, once again, urge my colleagues to drop their efforts and to work with us to instead make improvements to the ACA. I yield the floor.

Mr. REED

Mr. REED. Mr. President, today, along with Senators Brown, Tester, Blumenthal, Kaine, Duckworth, Warren, Baldwin, Franken, Klobuchar, Cortez Masto, Van Hollen, and Menendez, I am reintroducing the Military Consumer Enforcement Act to further strengthen consumer protections for service members. Our Nation has a strong tradition of working to protect our service members while they sacrifice to keep our Nation, safe. Building on these efforts, Congress passed the Soldiers' and Sailor's Civil Relief Act in 1940 to provide essential financial protections for service members to ``enable such persons to devote their entire energy to the defense needs of the Nation.'' Now called the Servicemembers Civil Relief Act (SCRA), this law provides such protections as prohibiting the eviction of service members and their dependents from rental or mortgaged properties and capping the interest at 6% on debts incurred prior to an individual entering active duty military service. Despite the importance of the SCRA's protections to our service members, enforcement of this critical law has been inconsistent and subject to the discretion of our financial regulators. For example, according to a July 2012 report from the Government Accountability Office, the estimated percentage of depository institutions that serviced mortgages that were examined for SCRA compliance varied by year between 2007 through 2011 at a rate of 4% in 2007, 17% in 2008, 18% in 2009, 26% in 2010, and 15% in 2011. Without a change in the law, SCRA enforcement will continue to be subject to the changing priorities of the financial regulators, which can also change with each newly elected President. Simply put, prioritizing the consumer protection of our service members should not be discretionary; it should be mandatory. Our legislation ensures that SCRA enforcement will be a permanent priority for the Consumer Financial Protection Bureau, CFPB, which Congress created to enforce Federal consumer financial protection laws. In 2010, as we debated the authorizing legislation for the CFPB, I led the bipartisan effort to ensure the CFPB would play a key role in protecting service members through the establishment of an Office of Servicemember Affairs, OSA. Since that time, the CFPB, through its enforcement actions, has helped service members recover approximately $130 million in relief from unscrupulous actors in the financial marketplace and through the OSA's monitoring of complaints, the CFPB has helped other regulators provide more than $60 million in relief for more than 78,000 service members harmed by SCRA violations. Imagine how much more the CFPB could do for our service members if it could do more than just refer potential SCRA violations to other regulators and educate service members about their SCRA rights. With this demonstrated record of success in protecting our service members, the CFPB should be empowered, as it would be under this legislation, to enforce certain key SCRA provisions, such as the protections against default judgments and being charged no more than the maximum rate of interest on debts incurred before military service. We should do all we can to make sure there is a strong watchdog on the beat that can enforce the protections we have put in place. When it comes to the SCRA, that strong watchdog should be the CFPB. Our legislation is supported by more than thirty groups, including the National Military Family Association, the Military Officers Association of America, Veterans Education Success, Student Veterans of America, Consumer Federation of America, Americans for Financial Reform, Public Citizen, the Sargent Shriver National Center on Poverty Law, U.S. PIRG, Consumers Union, National Association of Consumer Advocates, National Consumer Law Center (on behalf of its low income clients), National Community Reinvestment Coalition, Center for Popular Democracy, Alliance for Justice, American Association for Justice, and the Center for Responsible Lending. I urge our colleagues to help honor our commitment to our Nation's service members by joining us in this effort to improve the supervision and enforcement of the SCRA.

Mr. REED

Mr. REED. Mr. President, today, along with Senators Brown, Tester, Blumenthal, Kaine, Duckworth, Warren, Baldwin, Franken, Klobuchar, Cortez Masto, Van Hollen, and Menendez, I am reintroducing the Military Consumer Enforcement Act to further strengthen consumer protections for service members. Our Nation has a strong tradition of working to protect our service members while they sacrifice to keep our Nation, safe. Building on these efforts, Congress passed the Soldiers' and Sailor's Civil Relief Act in 1940 to provide essential financial protections for service members to ``enable such persons to devote their entire energy to the defense needs of the Nation.'' Now called the Servicemembers Civil Relief Act (SCRA), this law provides such protections as prohibiting the eviction of service members and their dependents from rental or mortgaged properties and capping the interest at 6% on debts incurred prior to an individual entering active duty military service. Despite the importance of the SCRA's protections to our service members, enforcement of this critical law has been inconsistent and subject to the discretion of our financial regulators. For example, according to a July 2012 report from the Government Accountability Office, the estimated percentage of depository institutions that serviced mortgages that were examined for SCRA compliance varied by year between 2007 through 2011 at a rate of 4% in 2007, 17% in 2008, 18% in 2009, 26% in 2010, and 15% in 2011. Without a change in the law, SCRA enforcement will continue to be subject to the changing priorities of the financial regulators, which can also change with each newly elected President. Simply put, prioritizing the consumer protection of our service members should not be discretionary; it should be mandatory. Our legislation ensures that SCRA enforcement will be a permanent priority for the Consumer Financial Protection Bureau, CFPB, which Congress created to enforce Federal consumer financial protection laws. In 2010, as we debated the authorizing legislation for the CFPB, I led the bipartisan effort to ensure the CFPB would play a key role in protecting service members through the establishment of an Office of Servicemember Affairs, OSA. Since that time, the CFPB, through its enforcement actions, has helped service members recover approximately $130 million in relief from unscrupulous actors in the financial marketplace and through the OSA's monitoring of complaints, the CFPB has helped other regulators provide more than $60 million in relief for more than 78,000 service members harmed by SCRA violations. Imagine how much more the CFPB could do for our service members if it could do more than just refer potential SCRA violations to other regulators and educate service members about their SCRA rights. With this demonstrated record of success in protecting our service members, the CFPB should be empowered, as it would be under this legislation, to enforce certain key SCRA provisions, such as the protections against default judgments and being charged no more than the maximum rate of interest on debts incurred before military service. We should do all we can to make sure there is a strong watchdog on the beat that can enforce the protections we have put in place. When it comes to the SCRA, that strong watchdog should be the CFPB. Our legislation is supported by more than thirty groups, including the National Military Family Association, the Military Officers Association of America, Veterans Education Success, Student Veterans of America, Consumer Federation of America, Americans for Financial Reform, Public Citizen, the Sargent Shriver National Center on Poverty Law, U.S. PIRG, Consumers Union, National Association of Consumer Advocates, National Consumer Law Center (on behalf of its low income clients), National Community Reinvestment Coalition, Center for Popular Democracy, Alliance for Justice, American Association for Justice, and the Center for Responsible Lending. I urge our colleagues to help honor our commitment to our Nation's service members by joining us in this effort to improve the supervision and enforcement of the SCRA.

Mr. REED

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

Mr. REED. As a proud resident of Rhode Island and proud resident of Providence Plantations, I thank the Chair for the recognition. Mr. President, I want to join my colleagues in expressing strong opposition to the Republican efforts to repeal the Affordable Care Act and to ask my Republican colleagues to abandon these efforts. They are crafted behind closed doors, and they embrace a huge tax cut for the wealthy at the expense of the most vulnerable among us. Indeed, I implore Republicans to work with us on a bipartisan basis, in good faith, to make improvements to our healthcare system. We can make these improvements. I hope we can. Just a couple of weeks ago, the nonpartisan Congressional Budget Office told us that 23 million Americans would lose health insurance under TrumpCare. Let me say that again: 23 million Americans will lose health insurance under the Republican bill. That is more people than live in Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, New Mexico, Nebraska, North Dakota, South Dakota, Vermont, West Virginia, Wyoming, the District of Columbia, and my home State of Rhode Island and Providence Plantations combined--a huge portion of Americans. That is a shocking number. What is worse is that my colleagues on the other side of the aisle plan to dismantle our healthcare system--one-sixth of the country's economy--without so much as a hearing to get input on the bill. Their bill is being written in secret, and from what we can glean of the process the Republicans are employing, we likely will not even see the text in the near future, although I am encouraged that there is some discussion of releasing the text tomorrow. Regardless of whether it is released tomorrow, there has been no deliberate consideration in a hearing. There has been no thoughtful interaction between Republicans and Democrats. In sharp contrast, I was a member of the HELP Committee while we drafted the Affordable Care Act. The Senate spent 25 consecutive days in session on consideration of the Affordable Care Act, the second longest consecutive session in the history of the Senate. The Senate Health, Education, Labor and Pensions Committee, which I served on at the time, held more than 47 bipartisan hearings, roundtables, and walkthroughs on health reform. In fact, the HELP Committee considered over 300 amendments over the course of a month-long markup, one of the longest in the history of the Congress. Over half of the accepted amendments were from Republicans. This bipartisan input, along with testimony and consultation from healthcare organizations representing hospitals, doctors, nurses, and patients, among others, over the course of a year led to a better, more informed bill. We have a lengthy legislative process for a reason. Yet the Republican leadership--up until this moment at least--continues to write their bill in secret as they look for ways to convince their caucus to support a bill that nearly every major healthcare organization opposes, to say nothing of the 23 million Americans across all of our States who would lose their health coverage, and millions more would seek increased costs because of TrumpCare. I would like to remind everyone that these are real people who will be hurt if we go forward as my Republican colleagues intend to. These 23 million people are all our constituents, our family members, our friends and neighbors. In fact, since the beginning of this year, I have heard from thousands of my constituents from all walks of life, through phone calls, letters, emails, appearances at townhall events, and even those I see out and about shopping around the State or on the airplane to Washington and back to Rhode Island. They have all indicated how they have benefited from the ACA and how TrumpCare could have a devastating impact on their families. For example, David from Providence, RI, wrote to me to tell me how his life has been affected by the Affordable Care Act. He said: I don't usually write Senators, actually I've never written a Senator. I have great concerns about my healthcare. I have a preexisting condition, two heart attacks and open heart surgery, triple bypass. I had medical issues and needed to leave my position at a full-time job 3 years ago to get well. During that leave, the company went chapter 11. I lost my healthcare and had no income. I was able to acquire Medical Insurance through the Affordable Care Act. I started my own design business as a sole proprietor and worked a second job to make ends meet. My healthcare was subsidized for two years. I am now successful in my design business and will be paying back the subsidy for this year and no longer need the subsidy going forward. I am able to purchase affordable healthcare through the Health Connection in RI. Affordable healthcare and the subsidy were there when I needed it. This allowed me to start my business and become a successful business/sole proprietor in RI. It is critical for my continued success to have access to affordable healthcare and not be judged by preexisting conditions. As David describes, the Affordable Care Act gave individuals and families control over their healthcare for the first time. He was able to get the care he needed, regardless of preexisting conditions, and able to start a new business. This is something I have heard a number of times from my constituents. I have also heard from Andrew and his wife in Little Compton, RI, who decided to strike out on their own and open a dairy farm after the Affordable Care Act was implemented. Andrew said: ``We took this plunge and started a business knowing that the stability of health care was there--we have a four year old daughter--and if it goes away, we are not sure what we will do.'' Time and again, I hear from Rhode Islanders who are now free to take risks and start new businesses and other creative pursuits knowing that they will be able to access affordable healthcare. I ask my Republican colleagues: Do you want to go back to the days when people are locked into their jobs for health insurance? The only reason they are there is for health insurance. Their creativity, their ability to innovate and to invigorate our economy is stifled literally because they need the health insurance. Do you want to discourage your constituents from starting new businesses? Under TrumpCare, people like David, with preexisting conditions, would not have the option, and Andrew and his wife may not have been willing to take on the risk of leaving a job with health insurance to start a new business. However, as we speak, my Republican colleagues are meeting in secret planning to take away these opportunities. I encourage my Republican colleagues to meet with their constituents, to hear their stories about the ACA. They are not unique to Rhode Island. It is not enough to just ban insurance companies from denying coverage to people with preexisting conditions. The ACA eliminated annual and lifetime limits. In fact, yesterday I bumped into a family-- two families--one with an adorable little girl who had a tracheotomy and who was being pushed around in a stroller. She is about 2 or 3 years old. And I met some other children, another young boy named Tim with a tracheotomy. Today I found out that their problem is lifetime limits. These are very young children, 2 years, 3 years old. Most insurance policies, except for the ACA, would have a lifetime limit. Now, you might be able to go buy it, but before these youngsters are 10, 12, or 13 years old, they will not have health insurance for the rest of their life. So it is not just the preexisting conditions. The ACA eliminated annual and lifetime limits. When I saw those darling children yesterday, I just knew that has to be the law. Otherwise, it is just a matter of time. Maybe in 5 years, maybe in 6 years, but the kind of conditions they have, at some point, they will hit that limit and at some point the insurance company will say: No thanks. We made those changes in the ACA. They are going to be disposed of in the proposals I have seen. The ACA requires coverage of basic healthcare services like maternity care. That is not guaranteed. Before the ACA, insurance companies would cut off coverage just when it was needed most and priced people with health conditions out of the market. These are not abstract concepts. I hear from constituents each and every day about the importance of the critical consumer protections under the ACA, and TrumpCare would undermine all of these. Susan from Warwick wrote me to say: ObamaCare saved my life. Please keep fighting to make affordable healthcare available to all Americans. I was diagnosed with Acute Myeloid Leukemia in 2012. I have my own business and pay for my own health insurance. We always purchased what we thought was adequate, but I'd reached the limit on my policy within just a few weeks of cancer treatment. That left me with huge bills, a need for more expensive coverage in order to obtain lifesaving treatment . . . and technically with a ``preexisting condition--cancer.'' Susan knows that insurance doesn't mean much if you are sick and have limits on your care. She goes on to say: I am horrified by the Republican plan to replace Obamacare. Health care is not a luxury. It should be available to all. I never want anyone else to experience the fear I did when my insurance ran out and I realized the care that could save my life might not be available to me. Before we found additional insurance--and jumped through hoops to get it--we looked at selling the house, emptying our IRAs and savings account to pay for my care. It would not have been enough. Cynthia from Woonsocket, RI, wrote to me to tell me about how TrumpCare would undermine care for people like herself with Parkinson's disease. Specifically, Cynthia wrote about how patients with Parkinson's rely on the essential healthcare benefits required under the Affordable Care Act, including rehabilitative services, mental healthcare, and access to prescription drugs. TrumpCare would do away with these benefits. Cynthia also points out that the average age of diagnosis of Parkinson's is around 60 years old. However, TrumpCare creates an age tax, leading to skyrocketing costs for this very population. Cynthia also said in her letter that one-third of patients with Parkinson's access care through Medicaid. She says TrumpCare puts all of those patients at risk of losing care. As a patient, she knows better than most that without these existing protections, health insurance will not actually cover the care that is needed. To add more detail on how critical Medicaid can be, especially to seniors, a constituent living in a nursing home in Pascoag wrote to me to say: I am 101 years old and enjoy every day to the best of my ability. I am petrified that many of the programs that I rely on for my health and well-being, indeed my life, will be reduced or even eliminated. Please protect my access to Medicaid. DO NOT make Medicaid a block grant to the states. My daughter is helping me to send this communication to you. Please do not forsake me. So I ask my colleagues: How do you intend to protect her access to nursing home care while cutting Medicaid by over $800 billion? Block- granting Medicaid, as Republicans have proposed to do, will reduce Medicaid funding by at least 25 percent over the next decade and leave States unable to maintain current Medicaid programs, leaving behind our most vulnerable. Indeed, the most significant costs for Medicaid in my State and every other State is nursing home care. It is exactly those men and women, like my constituent from Pascoag, a vigorous 101-year-old, who will be forced to pay more, who will be forced because of cutbacks in service at the facility not to have two or three people on duty but just one. All of that we can foresee, and we only can prevent it if we reject this attempt to replace, to repeal, to undercut affordable care. Now, this Medicaid crisis is serious, and it is not just going to affect the healthcare sector because we know the pressure is on the States to make up some of this lost funding. It will not just be by transferring funds within healthcare efforts. They will have to go everywhere through their budgets: That is K through 12 education. That is infrastructure. That is law enforcement. That is all the things States and localities do but particularly States. They will try to plug the gap because they will have people, like I have described who have written me, coming and not just demanding but obviously in need of healthcare, and they will try to respond, but the response will affect our competitiveness, our education systems, our productivity, when you can't fix infrastructure, and it will be a profound impact. In fact, a significant number of jobs in my State and a significant number of jobs projected for the future are in the healthcare industry. When this significant reduction of resources to the healthcare sector comes about, the jobs will go, too, because without the resources, you will not employ people--you can't employ people. Let me share a letter from one of my constituents because it succinctly describes what TrumpCare will really mean for this country. Glenn and Paula from Wakefield, RI, shared a letter from their daughter, Gianna, who has type 1 diabetes, saying: Let me offer you a translation of what your votes mean: I will die younger and sicker. Probably much sicker. My kids will have a mother for less of their lives. Your votes are what will cause this. Because no matter how consciously I care for myself, no matter how responsible I am, it won't matter if my insurance refuses to cover me. And it won't matter for you either, if you are one of the vast majority of Americans who will end up with a pre-existing condition over the course of your life. If you think you can simply pay the costs yourself, you are in for a rude awakening. These are only a few examples of the letters, calls, and emails I have received from constituents. The response in opposition to TrumpCare has been overwhelming by the very people whom it will impact the most. I hope my colleagues will listen to these concerns, not just the Rhode Island stories I am sharing today but also from their own constituents. People's lives are at stake. I urge my colleagues on the other side of the aisle to abandon this effort to pass TrumpCare and start working with us on bipartisan solutions to improve our healthcare system. Mr. President, I yield the floor. I suggest the absence of a quorum.

Mr. REED

Mr. REED. Mr. President, today Senator Blunt and I are reintroducing the Family Self-Sufficiency Act, and we are pleased to be joined in this effort in this Congress by our colleagues, Senators Scott and Menendez. The Family Self Sufficient, FSS, Program is an existing Department of Housing and Urban Development, HUD, employment and savings incentive initiative for families that use section 8 vouchers or live in public housing. FSS provides participants access to the resources and training that enable them to pursue higher paying employment opportunities and meet financial goals, while putting FSS families in a better position to save by establishing an interest-bearing escrow account for them. Upon graduation from the FSS program, the family can use these savings to pay for job-related expenses, such as additional workforce training or the purchase or maintenance of a car needed for commuting purposes. In short, FSS is all about giving our constituents the incentives and the tools to move up the economic ladder. Our bipartisan legislation enhances the FSS Program by streamlining the administration of this program, broadening the supportive services that can be provided, and extending the reach of the FSS Program to tenants who live in privately owned properties with project-based assistance. In short, we make the FSS Program easier to administer and more effective. First, to streamline the FSS Program, our bill would permanently combine two separate but similar FSS Programs into one. Under the existing authorization, HUD is supposed to operate one FSS Program for those families served by the Housing Choice Voucher Program and another for those families served by the Public Housing Program. This is the case even though the purpose of each FSS Program--to increase economic independence and self-sufficiency--is identical. Unfortunately, without a permanent change in the authorization, public housing agencies, PHAs, may at some point in the future have to operate essentially two programs to achieve the same goal. With our bill, PHAs would be relieved of this unnecessary burden permanently. Second, our legislation broadens the scope of the supportive services that may be offered to include attainment of a high school equivalency certificate, education in pursuit of a postsecondary degree or certification, and financial literacy, such as training in financial management, financial coaching, and asset building. Providing families in need with affordable rental housing is critical, but combining this resource with the support and services to help families get ahead increases the effectiveness of this Federal investment. Our legislation makes it easier for FSS participants to obtain the training necessary to secure employment and the education to make prudent financial decisions to protect and grow their earnings. Lastly, our bill permanently extends the FSS Program to families who live in privately owned properties subsidized with project-based rental assistance. It shouldn't matter what kind of housing assistance a family gets. Families seeking to achieve self-sufficiency shouldn't be held back by this sort of technicality. I thank Center on Budget and Policy Priorities, Compass Working Capital, Housing Partnership Network, Preservation of Affordable Housing, National Housing Conference, Stewards of Affordable Housing for the Future, National NeighborWorks Association, National Association of Housing and Redevelopment Officials, Public Housing Authority Directors Association, Public Housing Association of Rhode Island, and Rhode Island Housing for their support. I also thank Senator Blunt, Senator Menendez, and Senator Scott for their partnership and I urge my colleagues to support this bipartisan bill, which will help give those receiving housing assistance a greater chance to build their skills and achieve economic independence.