Debbie Stabenow

Ms. STABENOW

Ms. STABENOW. Mr. President, today I wish to pay special tribute to the Michigan Parent Teacher Association, which this year is celebrating 100 years of advocacy on behalf of Michigan's children and families. A lot has changed since the Michigan PTA was first established in Battle Creek on May 19, 1918. Parents today are as likely to learn school news via Facebook or text messages as they are from notes sent home, and students are as likely to learn their lessons on laptops and tablets as they are on the chalkboard. However, one thing hasn't changed at all: Michigan PTA members are still working together every day to provide a quality education and nurturing environment for every Michigan child. They do that in the best way possible, by bringing together families, educators, school boards, nonprofit organizations, businesses, community leaders, and elected officials around a common cause: promoting the welfare of Michigan children in school, at home, and in the community. It has been said that it takes a village to raise a child, and the PTA is building that village. They are building that village by offering parents resources on important topics like teen driving, bullying prevention, online safety, and career planning. They are building that village by presenting the Fran Anderson Michigan PTA Scholarship to high school seniors who have demonstrated leadership and advocacy skills through their involvement in PTA. They are building that village through Advocacy Day and advocacy training that gives members the tools they need to speak up for policies that benefit students, families, and schools. They are building that village by ensuring that parents remain strong partners in the education of their children. For a century, the Michigan PTA has made sure that the voices of our parents are heard and that the needs of our children are not forgotten. I have been honored to join them in this effort and look forward to continuing our work together. Michigan's future is found in our children. Thanks to the Michigan PTA for 100 years of making that future a bright one. Thank you.

Ms. STABENOW

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Ms. STABENOW. Mr. President, we have so many issues in front of us that are critically important to families. I want to speak about an issue today that is extremely important to so many Michigan families and to families across the Nation. It is estimated that 5.5 million Americans are living with Alzheimer's disease, including 1 out of 10 people over the age of 65. That number is growing. To put that in perspective, that is about the same number of people who live in Wisconsin or Minnesota or Colorado. By 2050, it is estimated that as many as 16 million Americans may be living with Alzheimer's. That is more people than live in Pennsylvania or Illinois. From Alaska to Alabama, to New Mexico, to Maine, no State is immune, as we know. In my own State of Michigan, the number of people living with Alzheimer's disease is expected to rise from about 180,000 today to 220,000 in the year 2025, which is not very far away. That is an increase of about 22 percent in less than 7 years. The cost of providing healthcare and long-term care for people affected by Alzheimer's is astronomical and growing. In fact, one out of every five Medicare dollars goes to Alzheimer's disease. It is estimated that last year, for the first time, the United States spent more than a quarter of a trillion dollars on Alzheimer's-related care. Without better treatments or a cure, those costs could surpass $1.1 trillion by 2050. Of course, much higher than the dollar cost is the human cost. As anyone who has lived with the disease or anyone who has had a family member live with the disease can tell you--and this really is the ultimate family disease--Alzheimer's and related dementias are thieves. They steal everything--memories, personalities, even lives. No price tag could ever be put on the suffering they cause patients and their families and the strain they place on caregivers. There are 15 million people in the United States caring for a family member with Alzheimer's. While many of them consider caring for a loved one a sacred duty, this duty still exacts a physical and mental toll on them. Caregivers suffer higher rates of heart disease, cancer, and depression than those in the broader population, and many are forced to quit their jobs or reduce the hours they work, creating additional personal and financial stresses. Lauren Kovach of Brighton, MI, learned what that is like when her grandma--she calls her Chupe--was diagnosed with Alzheimer's. Lauren's mom was a caregiver. She and Lauren made a pact that they would never put Chupe in a nursing home because she, in Lauren's words, ``lived her life for her family and to take care of us--of course we were going to do the same for her.'' That required a lot of sacrifices. Lauren's mom retired early. Lauren withdrew from college and moved in with her mom to provide a ``loving home full of laughter,'' as she said. They received no help with caregiving or living expenses. Lauren wrote: My mom is single-handedly the best person I know. She needs help. We need help. Many hundreds of families like mine need help. Lauren's beloved grandma passed away last June, but Lauren is still fighting, and I am proud to be fighting alongside her. She wrote: I go to Lansing each year for Advocacy Day--I will talk to anyone and everyone about this disease that is ruining millions of lives, including mine. Alzheimer's unfortunately isn't going anywhere anytime soon, but neither am I. This fighting spirit is what keeps caregivers like Lauren going, and they deserve to know that we are, in fact, fighting alongside them. That is why Senator Capito and I have introduced legislation that will help give families in West Virginia, Michigan, and all across the country new tools to cope with an Alzheimer's diagnosis and the life that follows. I would like to thank my friend from West Virginia for partnering with me on this important bill. The CHANGE Act builds on my HOPE for Alzheimer's Act, which was implemented beginning last year and supports parents and their families by requiring Medicare to pay for an individual care plan when a family member is diagnosed. This encourages more doctors to feel there is a reason to have early diagnosis because there is something they can do for people. It is certainly something that families need in order to have a plan, an action plan, once they receive that diagnosis. The CHANGE Act approaches this disease from a number of different directions and builds on the HOPE for Alzheimer's Act. First, it encourages early assessment and diagnosis. This is not happening as much as we would like. The Alzheimer's Association polling has indicated that a very high number--35 percent to 40 percent--of physicians are not doing early diagnosis. Oftentimes, they have said it is because they don't know what to do about it. There is no cure. There is not something to offer families other than fear. We want to make sure there is early diagnosis because there is a lot going on right now with medications that actually will help early. We want to make sure that patients have more time to make their own healthcare decisions, to access community-based support services for their family truly to be able to plan. Through HOPE for Alzheimer's, we now have a caregiving plan that the physician will be reimbursed for coordinating and bringing together. But there is much more that we need to do. Early diagnosis also gives patients and their families additional opportunities to participate in clinical trials. There is great research going on in Michigan and across the country that really does provide hope. I am encouraged and hopeful about the additional dollars we just agreed to in the budget agreement last week. I was proud to be one of those pushing for additional research dollars for the National Institutes of Health. Hopefully, those opportunities and cures will come even faster. Second, the CHANGE Act would improve care by testing what types of programs most help patients, their families, and caregivers. We know that case management, coordination of care, and caregiver support services can make a big difference both in the quality of life for patients and caregivers and in participation in clinical trials. In addition, the CHANGE Act would offer States the opportunity to test programs that help Alzheimer's patients to remain in the community--which is so important--by reducing the financial burden on family caregivers. Finally, the CHANGE Act would help uncover regulatory and legislative changes that would help accelerate Alzheimer's disease research, which is so critical right now. Families in Michigan and across the country have been waiting long enough. They have been waiting too long. They need a cure. Until that day comes, they need better treatments and more support. Just ask Nora Ann Reid-LeZotte of Kalamazoo. Only a few months after her father's death, her mom started to show signs of Alzheimer's. Nora Ann was determined to care for her mom at home. Given that she is a nurse practitioner, Nora Ann figured she was perfectly prepared to assume the role of caregiver--and then, she says, she wasn't. ``My days, then weeks, then years became more overwhelming than I could have imagined,'' Nora Ann said of the 6 years she spent caregiving. Nora Ann and her husband moved in with her mom to care for her and rented out their own house to make ends meet. Caregiver support would have made a huge difference, Nora Ann said, yet none was available until her mom's condition deteriorated enough that she needed IV infusions to stay hydrated. Nora Ann said: I was exhausted. I lost my own identity, my friends, and my life for that timeframe. My family suffered and sacrificed so I could care for my mom with dignity and safety. She added: I would do it all again because she was my mom. I can certainly identify with that, as I know all of us can. Nora Ann put her own life on hold to make her mom's final years as comfortable as possible. People like Nora Ann deserve our praise. Even more than that, they deserve our support and action on their behalf. It is time for a change. Let's pass this legislation as quickly as possible to help patients, support caregivers, and find better treatments and a cure. Families across Michigan and the country are waiting. I yield the floor. I suggest the absence of a quorum.

Ms. STABENOW

Ms. STABENOW. Thank you very much for those kind words from the senior Senator from Iowa. We have partnered on many things together related to agriculture. I rise today to support Senator Grassley and Senator Ernst in this motion. We need to fill this position with an eminently qualified person, Bill Northey, right away. It is long overdue. As the ranking member of the Senate Agriculture Committee, I am in strong support of the nomination of Bill Northey to be Under Secretary of Agriculture for Farm and Foreign Agricultural Services. Despite historic delays in receiving nominations from the administration, our committee has worked swiftly on a bipartisan basis to put qualified leaders into place at the USDA. When we get qualified nominees, we move them, and Under Secretary nominee Bill Northey is no exception. In fact, I believe that he is a bright star in terms of the nominees and those that will be serving in the USDA. He was nominated in September of last year. Our committee quickly held a hearing and reported his nomination with unanimous bipartisan support to the floor on October 19. Mr. Northey is a highly qualified nominee. He is currently serving his third term as secretary of the Iowa Department of Agriculture and Land Stewardship. A farmer himself, he understands what American agriculture needs, and has pledged to be a strong leader for our producers. I have confidence in him. Unfortunately, instead of serving our farmers and ranchers at USDA, his nomination has languished in partisan limbo because of an unrelated issue raised by a Senate Republican colleague not on the Agriculture Committee. I appreciate Members have various kinds of concerns, but it is important to note that Mr. Northey's leadership is needed now on a number of issues, including the fact that he would be in charge of disaster recovery for our farmers in Texas, Florida, and Louisiana, and all across the country, who are serving in the aftermath of hurricanes, wildfires, and drought. It is also important for him to be at the USDA to support our farmers struggling with low prices. For the better part of a year, I have been working with the leaders of the Appropriations Committee, Senator Cochran and Senator Leahy, to fix a few pieces of the 2014 farm bill that didn't quite work as we intended them--the dairy and cotton safety net provisions. I do want to indicate, while I am on the floor, that the Senate budget agreement contains significant improvements for both commodities, including more than $1 billion in support for our struggling dairy farmers. These much needed improvements set us up to continue our bipartisan work to write the next farm bill that needs to be done this year. I look forward to working with our chairman, Senator Roberts, as well as our two distinguished Members from Iowa, on creating the kind of farm bill that we need for our farmers and ranchers and families. Unfortunately, though, when politics get in the way, our farmers and our ranchers lose. So I am hopeful that we can resolve whatever issues or at least move them to a different debate, rather than focusing them on this nominee who is very much needed. His leadership is needed right now at the USDA. He has strong bipartisan support. I think it is very unfortunate that his nomination has gotten caught up in another issue. I am hopeful that we could ask our Senate colleague to choose to address that in another way without getting in the way of critical leadership on disaster assistance and conservation and critical issues on which the USDA needs to have his leadership. Mr. Northey has strong, bipartisan support and should be advanced quickly. We need his leadership skills. I am going to continue to do everything I can to work with my colleagues to be able to make sure he has the opportunity to serve farmers and ranchers as part of the USDA leadership. Thank you, Mr. President.

Ms. STABENOW

Ms. STABENOW. Mr. President, I rise today to speak about why I, too, will be opposing Alex Azar to be the Secretary of Health and Human Services. I appreciate, as always, my great friend from Massachusetts and her advocacy for the people of her State and all of the country. Perhaps more than any other agency, the Department of Health and Human Services touches the lives of people in Michigan and across the country every single day. It provides families access to Head Start and other early childhood education programs that help our youngest learners get off to a strong start. It helps ensure that families have health insurance, whether through Medicare, Medicaid, children's health insurance, or private insurance. It administers the Food and Drug Administration, which makes sure that medications are safe and effective. It works to ensure that health insurance and prescription drugs are affordable because the best medication and health coverage in the world will not help anyone if they can't afford them. In short, this position is all about people. I expect our next Secretary of Health and Human Services to, above all, put people before politics or profits. Unfortunately, I do not have confidence that Mr. Azar will do that. Some of my biggest concerns come in the area of prescription drugs prices--an issue that is extremely important in Michigan. I have spent a tremendous amount of time focused on that over the years, on what needs to happen. Bringing down costs for families is a very, very critical issue for so many, if not every family in Michigan. Far too many of our families are struggling to keep up with the rising cost of prescription drugs. Take Patricia, who is 73 years old and a retired nurse. Patricia's doctor prescribed Humira for her severe rheumatoid arthritis. When she called the pharmacy, she learned the prescription would cost $1,405. Patricia told me: There is absolutely no way I can afford this amount on a monthly basis. Someone somewhere is getting extremely wealthy off of seniors. These companies should be called to task for their greed. I agree with Patricia. We know that Patricia is not alone in her struggling to afford her medication. Between 2008 and 2016, prices on the most popular brand name drugs rose over 208 percent--more than double in the United States. I can tell you that the average Michigan family's income didn't double during that same time. These outrageous price increases force people in Michigan and across the country to do things we have heard so much about--split pills in half, skip doses, and even go bankrupt--just to stay on the medications they need to stay healthy or to even stay alive. These folks are spending money on prescriptions that they could be using to save for their retirements or to pay for college for their kids. That is wrong, and it needs to change. I don't believe that Mr. Azar--a long-time pharmaceutical company executive with a track record of dramatically increasing drug prices-- is the person who can make that change. Here is an example: insulin. People who have diabetes, as we know, need it to stay alive--children, adults, seniors. Yet staying alive has become increasingly unaffordable, in part, thanks to Mr. Azar, the former president of Eli Lilly USA. The price of one vile of Eli Lilly's Humalog increased from $21 in 1996 to $123, when Mr. Azar became its President, to $255 in 2017, when Mr. Azar left. As we know, people need more than one vile. Mr. Azar says he agrees that prices are too high, but he does not seem ready or willing to do much about it. I want to know, if he thought they were too high, why he didn't lower them rather than raise them when he was in his position as president of Eli Lilly USA. I told him that the National Academies of Sciences, Engineering, and Medicine at our Finance hearing recommended allowing HHS to negotiate prices. He said they were wrong, that the Federal Government shouldn't negotiate prices for people to get the best deal. Common sense tells us that that is what should be happening and should have been happening for years. Mr. Azar also opposes the importation of safe and affordable prescription drugs from Canada. That is despite the fact that his former company, Eli Lilly, sells the identical insulin product in Canada and around the world for less than it sells it for here. Now, let's get this picture. One can go across a bridge from Detroit, into Windsor, which is 5 minutes, 10 minutes across the bridge, and dramatically drop the cost of one's insulin from the same company. Eli Lilly and other drug companies argue that the problem is it is not safe. So are they saying that Eli Lilly's insulin on one side of the bridge, in Windsor, is not safe to take across to the other side of the bridge? We open our bridges, and we export and import every single day most everything but prescription drugs. Why does Mr. Azar think people in Michigan should pay more for a decades-old drug than the people who are just a few miles away in Canada? By the way, insulin has been around for--what?--I don't know--100 years or something. I mean, at some point, you recoup your costs, but this particular brand of insulin is sold on one side of the bridge in one country, in Canada, for less than it sells it on the other side. People in Michigan need to know why they think that makes any sense. It sure doesn't make any sense to me, and it sure doesn't make any sense to Steven from Michigan. Steven is a 47-year-old veteran from Swartz Creek, who has type 2 diabetes. His doctor prescribed an Eli Lilly medication called Glyxambi, which has worked really well to control his blood sugar, but he cannot afford it. The medication costs more than $2,000 for a 90-day supply, and there is no generic equivalent. Hmm. I wonder what it costs in Canada. In Steven's words: The drug companies are holding us hostage! I now see why some seniors cut their meds in half. Something has to be done. I couldn't agree more. Something has to be done, as Steven has said. Unfortunately, I don't believe that Mr. Azar will do it. Drug prices aren't the only issue that concern me about this nomination. Last week, we learned that 3.2 million more Americans were uninsured at the end of last year, in December, than at the end of the year before. There were 3.2 million more people who didn't have insurance. It was the largest single year drop in the number of people who have insurance. It was the highest increase since 2008 of those who don't have insurance. This was a huge step backward from just a year earlier when the United States hit an all-time low of 10.9 percent of the number of people who didn't have insurance. Recently, we saw the passage of a tax bill that, among other things, will leave 13 million more Americans uninsured and will drive up the premiums--even higher-- by double digits. They are not done yet. Right now, the HHS and the Trump administration are considering rules that would expand the availability of insurance plans that don't cover essential health benefits. At another time, they were called junk plans. I can remember before we put in place the requirement for basic health benefits to be covered that someone would call me and say: I have had insurance for years and have never needed it. I got sick and discovered--oh, my gosh--it would only cover 1 day in the hospital. I didn't know. Those are called junk plans. You think you are OK until you actually need medical care, until you actually need coverage. Then you find out you were paying for something that was just a bunch of junk. We now have in place consumer protections. We have in place consumer requirements that are called essential benefits. Why? Because they are essential. Emergency room coverage is pretty essential as well as hospitalization. Everybody assumes, if one has insurance, one is covered in the hospital for the amount of time one needs to be in the hospital. Mental health and substance abuse treatment, prescription drugs, and maternity care are basic things that every person may need in one's lifetime as it relates to one's health. When I asked Mr. Azar if he believed plans should have to cover essential health benefits, he avoided really answering the question. He said that he would ``work to ensure the least disruptive approach to implementing these policies and to appropriately consider the concerns expressed by stakeholders''--called people who need healthcare-- ``during the rulemaking process.'' We don't need the least disruptive approach to implement bad rules. Instead, we need an approach that doesn't disrupt people's healthcare. This is a matter of life and death every day for someone in Michigan and across the country. I also asked Mr. Azar whether he believes that all health plans should be required to cover maternity care and newborn care at no additional cost. It is pretty basic. If you are a woman, it is pretty basic in terms of coverage. Once again, he ducked, saying, ``It is critical that every woman have access to high-quality prenatal care.'' We know what that means because, before the Affordable Care Act, only 12 percent of the plans in the individual market covered maternity and newborn care. You find yourself in a situation as a young woman--a very common situation that will happen--where you are newly married and struggling to get started. You don't plan to get sick, and you are not planning to have a baby, so you get the skimpiest health plan that you can have that you think will kind of cover you. Then something happens. Fifty percent of the time, we know that in young couples, there are unexpected pregnancies. Then whoops. It is prior to the Affordable Care Act. Oh, now you have a preexisting condition. You are going to have to pay more if you can get coverage at all. I cannot tell you how many times I have heard that from women I know, from people I represent in Michigan. It is pretty basic for women that maternity care and newborn care should be covered, and it is now without extra cost because it is basic care for women. Yet we have an HHS nominee who is not willing to say: Yes, maternity care is basic for women, and women shouldn't have to pay more to get basic healthcare, like maternity care and newborn care. Let me speak about another issue. If confirmed, Mr. Azar would also be in charge of Medicare and Medicaid, which raises additional concerns for me about the people whom I represent. Thanks to Michigan's Medicaid expansion--a bipartisan effort in Michigan--660,000 more people have insurance, and uncompensated care has been cut by 50 percent--cut in half--which means 50 percent more of the people who walk into the emergency room can actually pay for the care they are getting. It is not rolled over onto everybody else. It used to be, if somebody could not pay, everybody else would see his insurance rate go up, and taxpayers would pay more. Those costs have gone down 50 percent, and 30,000 jobs have been created as part of that process. Projections show that last year, the State of Michigan ended up saving money for the taxpayers; $432 million was saved because more people had insurance and could pay for the medical care they were getting. I thought that was what we wanted--for people to be able to pay for their medical care. Despite the President's promise not to cut Medicaid, every Republican health proposal that came before Congress last year had one thing in common--huge cuts to Medicaid. Then-Secretary Price pushed for the passage of these bills, and during that time, Mr. Azar said he supported those bills to gut Medicaid. In fact, the current budget resolution that we are under, which was passed by this Senate, has $1 trillion in Medicaid cuts, as well as almost one-half trillion dollars in Medicare cuts. It has not yet taken effect because they have to take another step to actually pass the bills in the Senate, but it is ready to go. It is in the budget resolution. Mr. Azar said he supported the bills, and it would put Medicaid on a more sustainable footing. Three out of five seniors in Michigan who are in nursing homes get their nursing home care through Medicaid health insurance--three out of five seniors. A more sustainable footing? Not for them and not for their families. I will tell you what is not sustainable--Michigan families trying to survive without health coverage, the medical care that they need. In conclusion, the people in Michigan know what the next Secretary of Health and Human Services needs to do. It is a pretty big job that affects part of everyone's life in some way. That person needs to, among other things, bring down the cost of prescription drugs immediately through the power of negotiation. He needs to take the shackles off in terms of exporting and importing prescription drugs. Just like any other product, we ought to have safe importation and competition across the border to bring down prices. We ought to have increased transparency, not the nominee's history of raising prices over and over. That person needs to protect and strengthen Medicaid and Medicare, not cut benefits, and that person needs to enforce patient protections, like the essential health benefits, like the ability for a woman to know that her basic healthcare--and, if she has a baby, prenatal care or postnatal care-- will be covered without her having to pay more because she is a woman. That is what should be happening--patient protections. We do not need someone who thinks it is OK to go backward and erode them. That is why I am voting no on Mr. Azar's confirmation. I hope my colleagues will take a serious look and do the same. The health of the people of Michigan and the people of this country depends on it. I thank the Presiding Officer. I yield the floor.

Ms. STABENOW

Ms. STABENOW. Mr. President, before I make a unanimous consent request--and we will do that as soon as it is appropriate--I just want to stress again why we have been on the floor this afternoon. It is because we know we have bipartisan support not only for the Children's Health Insurance Program but for the health centers where they get their healthcare, and we can address this without pitting children against children through the unanimous consent request I have and the amendment I am offering along with Senator Brown and Senator Casey. In addition to that, there are critical issues that normally get done before the end of the year but did not. Those issues relate to rural hospitals, ambulances, pregnant moms, children, and so on that normally have bipartisan support. So we put these together in a bipartisan effort that really addresses not just one piece of the Children's Health Insurance Program but the places where they go to get their healthcare. They are going to small hospitals like in the town where I grew up or where my mom was director of nursing, and they are going to community health centers. We need to address these together. These are things we have done together. Therefore, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 36, H.R. 1301; that the Stabenow-Brown- Casey amendment, providing for a permanent extension of the Children's Health Insurance Program, a 5-year extension of the Community Health Center Program, and extensions of other expired Medicaid, Medicare, and health extenders, which is at the desk, be considered and agreed to; that the bill, as amended, be considered read a third time and passed; and that the motion to reconsider be considered made and laid upon the table with no intervening action or debate.

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

Ms. STABENOW. Mr. President, before offering a motion, I first want to thank our ranking member from Oregon, who is so dedicated, so passionate, so smart. He works tirelessly every day. It is such a pleasure to serve with him. He is someone who has a distinguished career of fighting for middle-class families, for working people, for the right kinds of things. He came from working with the Gray Panthers and senior citizens, and he brings that to work every single day, and I thank him for that. I want to stress before offering a motion that he and other colleagues--Senator Casey, Senator Brown, Senator Carper, whom we had hoped would be joining us, and I know is trying to as well--have all stressed the fact, first of all, that we are at the 1-year anniversary of this President. For the first time in a number of years, we have the House, the Senate, and the White House all controlled by Republicans, and over and over again, what has gotten the priority? What has gotten done? Things for the wealthiest Americans and people with really big lobbyists, special interest lobbyists. That is what gets done over and over again. So when, in fact, the funding ran out, not only for children's healthcare but also for community health centers and other important priorities that needed to get done for rural hospitals, ambulances, special diabetes programs, and other things, those have been shoved aside over and over and over again with people waiting and waiting and waiting. Why? Because the needs of the wealthiest Americans, the needs of the special interests, the folks with the big lobbyists have been the ones who have taken priority this last year over and over again. So now we get to a point where we are talking about children's health insurance. I am glad we are doing that, but it is in the context of pitting one group of children against another group of children and not recognizing that the majority of families who have children's health insurance need to use community health centers. That is where their doctor is, that is where they get their care, and that is cynically not included in this. We have an opportunity now. I am offering a unanimous consent request on a set of policies that have bipartisan support that we could get done today, not in a divisive way, not pitting children and families against each other but actually doing something together that would be in the best interests of the majority of Americans--middle-class families and folks trying really hard to stay in the middle class or get into the middle class. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration--I am being asked to hold off. I will be happy to do that while we have a moment where details are being worked out. Mr. President, I suggest the absence of a quorum.

Ms. STABENOW. Mr. President, we are here on a Saturday on the 1-year anniversary of President Trump's inauguration. After a year of our colleagues on the other side of the aisle being in the majority in the House and the Senate and the White House, we are finding that rather than working together across the aisle to get things done, we have seen either nothing getting done, dysfunction, or partisanship at its worst. That really is not good enough. People in Michigan want us to work together to get things done. They don't want to see a situation where there is a cynical ploy of pitting children against each other--one group of children against another group of children--for some political purpose, some divisive purpose. There are a number of us who are here this afternoon to offer an amendment, which will be coming up, to address needs of children and families around healthcare. It is something which I care deeply about and which my colleagues care deeply about. It is something I have been coming to the floor to speak about since September 30, when we saw two very, very important programs for children and families in Michigan have their Federal funding expire--the Children's Health Insurance Program and community health centers. We have hospitals and ambulances and communities around the country that also need us to take action to make sure healthcare is available in their communities. That is what our amendment addresses as a whole. It is deeply concerning to me that when we look at the Children's Health Insurance Program--it covers 9 million children across the country and 100,000 children in Michigan, where many of them get their healthcare at health centers. If we really care about these children and their families and about the families of many people in Michigan--680,000-plus families who go to quality health centers in their community to see a doctor or a nurse to get the care they need--it is deeply concerning that those two pieces of healthcare for families would somehow be divided and pitted against each other. We have strong bipartisan support. It came out of committee. I see our distinguished ranking member from Oregon on the floor. He and the chairman, myself, others--all of us, working together, brought a bill out of committee months ago--I assumed it was going to happen immediately--that would extend children's health insurance. Senator Blunt, the senior Senator from Missouri, and I have bipartisan legislation, which 70 Members of the Senate have signed a letter supporting, extending community health center funding. We assumed that we would bring children's health insurance to the floor right away, that we would combine it with community health centers, which are the way children and families get their healthcare--you have to have both--and we assumed that we would be on our way, that we would pass this and that it would pass the House and go to the President for his signature, and we would ease the minds of millions of families, of parents who are concerned about taking their children to the doctor, dealing with their juvenile diabetes, their asthma attacks, addressing very serious chronic illnesses and the regular things that happen to kids all the time, such as broken bones, bruises, the flu, and so on. We are here today to stand up for those families and for an approach that is bipartisan. All of the items in our amendment have bipartisan support and can get done together, rather than the divisive underlying issue in front of us--the question of dividing groups of children, using children as pawns in some political game. We have the opportunity to come together and extend children's health insurance. We want to permanently extend it. That is what this amendment does. We know that, according to the budget office, because of a number of different things that have happened on healthcare, we can extend it for not 6 years, as has been proposed, but for 10 years, and it can actually save billions of dollars. The families across the country-- certainly the families in Michigan--deserve to know that this particular program will be extended permanently so it is not used as a political pawn in the future or some game, so that parents and children aren't used in some game because of other agendas. We can address that today as we look at the broader issues of how we give certainty to our military, certainty to our veterans for their healthcare, border security--we are a top border security State--and medical research and the other things that need long-term certainty that have not been able to get done in a very dysfunctional place now, as we look at what is happening here with one party in control. We need to be looking and working together. Let me say again, before turning to my other colleagues, that the Children's Health Insurance Program covers 9 million children at risk. We want to make sure this is a permanent healthcare program for the children of this country and for working families. We are talking about families whose moms and dads work but may not have health insurance at their work but still want to make sure the kids can go to the doctor and get covered. We provide a way for them to do that with children's health insurance. Secondly, they go to health centers. Thousands and thousands of parents use their children's health insurance to go to health centers in Michigan, 260 across the State. Nationally, we have 25 million patients, and 300,000 veterans are included in that. Some 7\1/2\ million children are served by health centers, which is the other piece of this that needs to happen. In addition to that, we have a number of other serious healthcare issues that need to be addressed in what has been dubbed in the past the health extenders package. Funding the Maternal, Infant, and Early Childhood Home Visiting Program, which is critical to families and children, is part of the commitment. On the floor, we have heard a lot about caring about children. I am happy to hear that. I appreciate, for some, a newfound commitment to children's healthcare. Others have been committed for a long time. Let's come together and fund the Maternal, Infant, and Early Childhood Home Visiting Program for new babies and moms. This would permanently repeal the therapy caps. That would help make sure that seniors and people with disabilities on Medicare receive the services they need to get healthy. This would provide adequate funding for ambulance providers in rural communities. This is a big issue in Michigan. I am proud to be leading this effort to make sure that the small town where I grew up, Clare, and other small towns all across Michigan have ambulance services so that in an emergency, somebody will show up and show up quickly to take care of people and get them to the hospital. Funding for small rural hospitals, like the one where my mom was the director of nursing when I was growing up in Clare--they need to keep their doors open. This would make sure that happens. All of these things are incredibly important--funding our safety net hospitals, continuing the Special Diabetes Program, leading to new research and therapies and ultimately leading to a cure. In conclusion, let me just say what I have said so many times. Healthcare is not political. Whether it is for children, whether it is for seniors, whether it is for veterans, whether it is for families, healthcare is not political, it is personal. That is what the fight for a long-term budget commitment to our veterans' healthcare is about, a long-term commitment to tackle opioids is about, a long-term commitment for children and families is about, and, frankly, mental health and all of the issues that deal with healthcare above the neck, which needs to be treated the same as healthcare below the neck. It is time to get this done. While other issues are being sorted out, we should not be pitting children against children. Families are counting on us to do the right thing. I hope colleagues will join us in supporting this effort. I now yield. I believe this is Senator Casey, Senator Brown, and I who are offering this amendment. Senator Casey--a passionate, long- term, devoted, committed supporter and champion for children--is right where he ought to be right now: on the floor of the U.S. Senate fighting for our children and families.

Ms. STABENOW

Ms. STABENOW. Mr. President, first of all, I wish to thank my friend from Ohio. Senator Brown has been a real champion. It is wonderful to partner with him and with the senior Senator from Indiana, Mr. Donnelly. All of us believe strongly--and the Democratic caucus together believes strongly--that a pension is a promise, period. A pension is a promise. Too many people right now are finding themselves in a situation where they are being told that promise is not going to be kept. For generations, millions of working men and women have built better lives for themselves in Michigan and across the country, and better lives for their families, with jobs that provided more than a paycheck. That is part of the American dream. These folks have worked hard, and we know that the people of Michigan can outbuild and outwork and outimagine anyone. I will take on my friends from Indiana and Ohio on that one because we know that in Michigan we have bright, hard-working folks. In exchange for a job well done, workers knew that they could count on basic benefits, including quality healthcare and a secure retirement, a pension. Jobs like these didn't just build families. We know that those jobs have built the middle class of our country--making things, growing things, creating things, and building things. That is what has created our middle class and our way of life. Unfortunately, though, we know that jobs that provide this kind of security and stability are becoming increasingly hard to find. Even worse, some workers have discovered that the benefits they earned over years of hard work have proven to be less than dependable. That is why we are here, because we believe a pension is a promise, and too many people are being told that promise isn't going to be kept. That is wrong. Imagine what it is like to be one of these workers. Perhaps you spent your career behind the wheel of a truck, hauling freight. The work is dangerous. The hours are long. You are separated from your family, but you keep on driving because the pay and the benefits are good, you are taking care of your family, and you are planning for the future. You know that after driving literally millions of safe miles, you will be able to retire with dignity. You will be able to have that cottage up north in Michigan, the snowmobile, and the boat, and to send your kids to college, thanks to the pension you worked so hard and so long for. After decades of work, you decide it is time to park the truck one last time. You say goodbye to your coworkers and hello to a new stage in your life. You plan in your retirement to spend more time at the lake, maybe even teach your grandkids to fish. You can make these plans because you know you have the security of that pension you have worked all your life for. Then, one day, everything changes. You learn that for a variety of reasons, the fund providing your pension is running out of money--not because of your fault. In fact, you might receive little, if any, of the benefits you were counting on. What do you do? What do you do? Do you swallow your pride, sell your home, and move in with one of your kids? Would you go back to work? Would you be able to get a job? A lot of Michigan workers don't have to imagine what they would do because they are living it right now. This is very serious. Again, I have always believed that a pension is a promise. Shame on our country, shame on our government if we don't make sure that promise is kept. People who worked hard to earn their retirement benefits should not have to worry about paying the power bill or putting food on the table or keeping their homes. Unfortunately, we know that a number of multi- employer pension funds, including ones in Michigan that Michigan workers depend on, face serious challenges due to the financial crisis and other factors. I remember back in 2008 and 2009, when there was a bailout that was passed for Wall Street banks, but what about the pensions that were invested? What happened to the middle-class families depending on that? We know what happened in terms of people losing their homes, and what about the other piece, which is the pensions, that lost money? This isn't the fault of the workers, like Kenneth of Sterling Heights, MI. He is a retired teamster. He wrote to me about his fears of being able to pay his bills and cover the basics, including food, medicine, and everyday expenses. He worked hard all of his life. He doesn't want to end his life in poverty, nor should he have to. He told me: ``We are not the people who made the bad investments of our hard-earned money and lost billions of dollars.'' Kenneth is absolutely right. This isn't the fault of the workers, and they shouldn't pay the price. They should know that the promise made to them after a lifetime of hard work will be kept. That is why I am so pleased to be cosponsoring the Butch Lewis Act of 2017 with my colleagues who are here this evening. The bill would create a new office within Treasury called the Pension Rehabilitation Administration. The new office would give troubled pension plans the opportunity to become solid again through loans and assistance from the Pension Benefit Guaranty Corporation. With this bill, these plans would be able to pay workers all of the promised benefits with no cuts--no cuts. The plans would be required to demonstrate the ability to repay the loans at the end of the term. Think about how Wall Street banks got loans. Shouldn't middle-class, working men and women--retirees who worked all of their lives and believed in our country, and believed that, in fact, our country would have their back--also have the same kind of opportunity to be able to protect their pensions? Let me just say again that this is an incredibly important piece of legislation that affects millions of middle-class Americans who have worked their entire lives--people who are retired now or are near retirement or are still working hard and paying in and trust that, in fact, their pension will be there, and it is incredibly important that our country keep its promise to them. Let me also say in conclusion that I will be reintroducing legislation that I introduced last session to address something else that I think is a matter of fairness: to prevent raises and reduce salaries of top pension fund executives if retiree benefits are cut. I understand how devastating pension cuts would be to retirees and their families, and the people making decisions--the people in power making decisions about funds--should actually be able to know that by feeling the same pain of cuts. There is no question we need long-term solutions to the pension crisis facing our country. People who are retired right now and face losing that pension and going into poverty or people who are about to retire don't have time to wait. There is a tremendous sense of urgency about this. Cutting benefits would place a terrible burden on retirees who have worked hard all of their lives to earn some dignity, some comfort, some security. It is people like Keith and Mary. They are both in their seventies and depend on Keith's pension and Social Security to meet their basic needs. They told me: We try to save, but it is difficult. We are hoping that the pension will last more than 10 years, but who knows. Keith and Mary have the right to know. They have the right to know that their country has their backs and that they can count on their pension being there. I urge my colleagues to help keep that promise for Ken and Keith and Mary and hard-working people all across Michigan and America. I see our leader on the floor. I want to thank him for making this a top priority as we are negotiating the priorities of this country, the priorities of the budget for next year. Making sure hard-working Americans have the promise kept of their pension is something that I know is at the top of his list, and I am proud to join him in this effort.

Ms. STABENOW

Ms. STABENOW. Mr. President, today marks a sad and, frankly, shocking day for too many of America's children and hard-working families because it has now been 100 days since funding for the Children's Health Insurance Program and community health centers expired. History has shown us that there is a whole lot that can get done in 100 days. It took Thomas Jefferson only 17 days to write the Declaration of Independence; the brave allied forces who landed on D- day advanced through France and liberated Paris in only 80 days; and Congress managed to pass 15 major pieces of legislation during President Franklin Delano Roosevelt's first 100 days in office. Yet, here we are, 100 days past the deadline of September 30, and Congress still hasn't managed to pass long-term legislation to reauthorize what we call CHIP--the Children's Health Insurance Program--and to fund our community health centers. We have a strong bipartisan bill funding CHIP, which was passed out of committee. I give our chairman and ranking member kudos for working together. I was proud to work with them. It came out of committee with only one ``no'' vote and has waited and waited and waited on the floor of the Senate. Senator Blunt and I have a bipartisan bill to continue funding community health centers, and 70 Members of the Senate have signed a letter supporting long-term funding for community health centers, which expired September 30--100 days ago. Right now, we are in a situation where 9 million children and their parents don't know what is going to happen long term. As soon as this month, 100,000 children and their families in Michigan have begun to get letters saying that their children will lose coverage, and they are trying to figure out what is going on. Imagine being a parent who is working hard. A lot of folks I know are working two jobs, trying to hold it together. You don't have health insurance; you earn too much for your children to be able to get Medicaid health insurance, so the Children's Health Insurance Program is your lifeline. It is your lifeline. It gives you peace of mind to know that if your daughter falls and breaks her arm or your son gets a cough that won't go away, you can take them to the doctor. What if those children have something worse than a broken arm or a cough? What if they are diagnosed with type 1 diabetes or asthma or cancer? Just imagine being that parent and getting a letter which says that your child may no longer have health insurance. It is not necessary. This is not necessary. We could do this tomorrow. If we thought it was important enough to bring it to the floor, we could get a vote--and I believe it would be overwhelmingly bipartisan--tomorrow if there were a sense of urgency, an understanding, about how these parents feel and how these children feel. So what would you do if you got that letter? Would you tell your kids? You don't want them to worry about it. What would you do? I believe hard-working families--and we are talking about working families, people with jobs, working--deserve better. Then we have community health centers that serve 25 million people across the country, including 300,000 veterans and 7.5 million children. Our health centers are doing a phenomenal job. At more than 260 sites across Michigan, our health centers are serving 681,000 people, including about 13,000 Michigan veterans. This month, health centers that were supposed to receive a new 12- month grant are only getting a small amount of funding to get them through the next few weeks, not knowing what is going to happen again. By June, Michigan's community health centers will lose over $80 million in funding, and over 99,000 patients will lose care. Last month, I had the opportunity to visit two of our great Michigan community health centers, each of their networks operating more than one site--Hamilton Community Health Network in Flint and Western Wayne Family Health Centers in Inkster. Like clinics across Michigan, these centers are serving literally thousands of Michigan families every day--people of Michigan who don't have medical care for one reason or another. Now those thousands of people are at risk of having no place to go if they get sick or if they need preventative care so that they don't get sick. Hamilton Community Health Network will run out of funding in April, and Western Wayne Family Health Centers will not get their full funding this month. They were asking me: Should they lay people off? How should they be planning for their centers? What should they be doing? That means 15,500 people are wondering what will happen to them if they or their children get sick or slip on the ice--which there is a lot of in Michigan--and sprain an ankle. Felicia knows what it is like to live under that cloud of fear. She wrote me a letter indicating that in 2011 she was an AmeriCorps volunteer serving in Lansing and didn't have health insurance. When she started feeling tired all the time and losing weight, she went to the Center for Family Health in Jackson, MI, another great center. The Center for Family Health, which served 29,000 patients in 2016, will run out of funding in March if we don't act. Felicia was diagnosed with stage 4 Hodgkin's lymphoma--pretty scary stuff. The Center for Family Health helped her get her health coverage through Medicaid and care from the University of Michigan, including chemotherapy and later a stem cell transplant. Felicia wrote me: Now I am feeling awesome, I am cancer-free, and I am working part time while I am finishing up college. I feel that I owe my life to the Center for Family Health. Felicia knows the importance of community health centers; one in Michigan saved her life. People like Felicia and children who are covered by the Children's Health Insurance Program, which we call MIChild in Michigan, shouldn't have to wait a day longer. They are counting on us to get this done. It has been 100 days of uncertainty that did not have to happen. Let me say that again. We have a bipartisan bill reported out of the Finance Committee. The House has reported their version. There is no reason we can't immediately put a 5-year extension on the floor of the Senate. Senator Blunt and I and our cosponsors of our bill have always assumed that once CHIP came to the floor, we would be adding in community health centers, for which there is strong support, and we would be able to get this done. People would know that their neighborhood health center is there. Their children can go to the doctor instead of sitting for hours in the emergency room. They would be able to see their doctor if they got sick. It has been 100 days since funding has expired for community health centers and children's health insurance. That is 100 days too many. I have been coming to the floor every week to say: Let's do it today. Let's do it tomorrow. We don't have to wait and hold them as bargaining chips in some bigger appropriations negotiation. These are families. These are kids. These are people who want to have confidence in us that we will do our jobs. This one can get done. It could have gotten done before the holidays. What a great Christmas present that would have been. It can get done now. On behalf of the 25 million people who use those community health centers, the 9 million children and their parents who use the Children's Health Insurance Program, I call on all of us to have the sense of urgency and the leadership--the leader--to bring this up. We can get it done in a day. We would all feel good about it because it would be something we would be doing together instead of having these families wait and wait. Mr. President, before yielding, I want to acknowledge our newest Senator, Mr. Jones, who is here, and thank him. Even as he was in his happiness, and rightly so, on the evening he found out he was going to be the next Senator, he mentioned CHIP. In listening to that acceptance speech, it did my heart good to know that children's health insurance was at the top of our newest Senator's mind at that important time, and it is a pleasure to see him on the floor this evening. I believe the Senator from Arizona is here.

Ms. STABENOW

Ms. STABENOW. Mr. President, I am proud to pay special tribute today to the people of Macomb County, MI, who are celebrating their county's bicentennial this year. The people of Macomb County symbolize the history, sacrifices, and character of people all across our country who have helped create the American middle class. They represent America's diverse history of immigrants coming to this country to find the American dream. When it comes to hard work, the people of Macomb County are second to none. The county's rich history has created a resilient people who put family, faith, and community first in their lives. Macomb County was founded on January 15, 1818. Located on the shores of Lake St. Clair, the county is named in honor of General Alexander Macomb, a veteran of the War of 1812. The county was the third county founded in Michigan and, today, is Michigan's third most populous county. Macomb County is known for its innovation and impressive manufacturing might. It is a backbone of the American automotive industry. Fiat Chrysler, Ford Motor, and General Motors employ more than 35,000 people and operate 10 facilities in Macomb County. There are more than 1,600 manufacturers in Macomb County employing more than 69,000 individuals. I am so proud to represent these hard-working Michigan workers. The county is also an important defense hub for both Michigan and the United States. It is home to Selfridge Air National Guard Base, which was established in 1917 and, today, is home to operations of all branches of the U.S. military, as well as several Department of Homeland Security agencies. In the 10 years immediately following September 11, 2001, approximately 3,816 Michigan Air National Guard airmen from Selfridge deployed to locations around the world. Macomb County is also home to the Detroit Arsenal, the first ever mass- production tank plant in the United States and a vital part of our Nation's ``Arsenal of Democracy'' during World War II. The Detroit Arsenal now hosts the headquarters of the U.S. Army Tank Automotive Research, Development and Engineering Center, called TARDEC, and the U.S. Army Tank-automotive and Armaments Command, or TACOM, Life Cycle Management Command. Numerous events and celebrations are planned in the county throughout this year to mark this special historical milestone. Congratulations to the people of Macomb County on 200 years of distinguished history. We all look forward to many years of prosperity and success in the years ahead.

Ms. STABENOW

Ms. STABENOW. Mr. President, on a different subject, talking about keeping promises; that is, other people who are counting on us to be able to act in order to get their healthcare. We have had 81 days since the funding ended for the Children's Health Insurance Program and community health centers. Each State is a little different because of the various combinations of funding and so on, which meant not everyone lost care immediately right after. There are three States this month, others in the first of the year, and so on. I literally received just a few moments ago a notice from our State saying it is very likely that if we don't act, in January, families in Michigan are going to get a notice that what we call MIChild, which provides healthcare for 100,000 children in Michigan of working families who don't qualify for help through Medicaid or other assistance--they are working and maybe at work they are getting healthcare, but it doesn't cover their children, or maybe they are not getting healthcare, and they want to at least be able to cover their children, that is what MIChild is all about. It has been 81 days since the deadline of September 30, which stopped the Federal funding from going forward. This affects 9 million children nationwide and 100,000 children in Michigan. In addition to that, community health centers across the country serve 25 million patients every year; 300,000 of them are veterans, and 7.5 million of them are children. I had the opportunity last Friday to visit two wonderful facilities-- one in Flint, which is in Genesee County, and one in western Wayne County--and see the great work they do and talk to some of the people who were there to get care. People are counting on community health centers and they are counting on the Children's Health Insurance Program in order to make sure they have the care they need for themselves and their families. It is important that we act. We could act right now. This is bipartisan. We passed a bipartisan bill out of the Finance Committee in September, before the deadline. I want to thank the chairman, Senator Hatch, and the ranking member, Senator Wyden. I was pleased to join with them. We passed it out of committee with only one ``no'' vote. We have bipartisan support to get this done. Senator Blunt and I offered a bill that is bipartisan and has had the support of 70 Members of this body in signing a letter saying to continue funding for community health centers. Our plan all along was to pass the children's health insurance bill out of committee in September and add health centers and then pass it before the deadline so that it would take away the anxiety, worry, and fear that families now have about what is going to happen. Every day that goes by, people are worried about what is going to happen. Are they going to be able to take their child to the doctor, be able to get their asthma treatments, handle their juvenile diabetes, cancer treatments, or the normal things that happen to kids every day? I am not sure if there will be any votes today. We could, today, pass the Children's Health Insurance Program and community health centers and let families across America know they are going to be able to have the medical care they need for themselves and their children coming into the new year. I yield the floor. I suggest the absence of a quorum.

Ms. STABENOW

Ms. STABENOW. Mr. President, I first thank our distinguished leader from Illinois, not only for his eloquence and passion but his unfettered commitment to the young people who were brought here as children, who maybe had never set foot in the country their parents came from and may not know the language. They are here, and a promise was made to them in our country. I spoke yesterday on the floor about two young people from Michigan. We have 10,000 young people in Michigan--some serving in the military, some in jobs, some in school--who don't know any other country. They love our country, and they just want our country to keep its promise to them. That is what I view it as, keeping our promises. So I thank the Senator.

Ms. STABENOW

Ms. STABENOW. Mr. President, I want to speak about keeping promises to a very important group of Americans as well; that is, our men and women who are serving us as veterans and serving us in the military. Representing Michigan in the U.S. Senate is a great honor. I know it is for all of us. One of the best parts of the job is being able to work on behalf of Michigan's veterans. From the Civil War to the World Wars, to the Korean war, to Vietnam, the Cold War, the Gulf war, and our fight against terrorism, Michigan's veterans have given us their all. Our veterans have always been the first in line to defend our democracy. That is why they should never be at the back of any line--for a job, healthcare, housing, or a world- class education. Unfortunately, there are times when our veterans aren't getting the benefits they deserve, have earned, and have been promised. When that happens, it is our duty to fight for those who fought for us. That is why, in 2014, Congress passed something called the Veterans Access, Choice, and Accountability Act, called the Veterans Choice Program. This legislation aimed to reduce wait times and provide medical services to veterans in their communities after we heard of very serious issues and horrible situations that had occurred for veterans in some parts of our country. The Veterans Choice Act was created to meet a real need--getting our veterans prompt healthcare in locations that are convenient for them. This program is especially critical for veterans in rural communities throughout Michigan as well as throughout the country--people in rural areas who were previously required to travel long distances, hours and hours, for services. However, since it was enacted, providers across my State and in many parts of the country have not been getting paid, rural hospitals have pulled out, and this program in Michigan has not been working. Worst of all, too many Michigan veterans and veterans across the country are struggling to get the appointments and the healthcare they need. That is why, last week, I introduced a bill I am calling the Veterans Deserve Better Act. This bill will help our veterans in three ways to be able to correct what is occurring right now in Michigan with a private contractor--a private provider who has not been doing the job. I have talked to the Secretary of Veterans Affairs who understands the problem and agrees this has to be fixed. My bill will improve the scheduling process for veterans seeking healthcare. They shouldn't have to wait weeks or months to be able to get an appointment with a doctor. Our military operates under the simple creed, ``Leave no person behind,'' but far too many of our veterans in need of healthcare are languishing in a system that simply isn't accountable to them. Through this private contracting process, that certainly has been the case. My bill would require the VA, and any outside contractors who are setting up healthcare appointments through the Veterans Choice Program, to provide veterans with more and better information, and if veterans are still struggling to get appointments, they will be told exactly how to file a complaint so it can get fixed. Second, my legislation will hold third-party contractors accountable. We have excellent service through our VA medical facilities, but this new system--which is supposed to make it better, quicker, and faster-- has not been working, and third-party contractors, at least in Michigan, have not been held accountable. The VA will track all appointments made through outside contractors who must schedule appointments within 5 days. Any appointments not scheduled within 5 days will be sent to the VA for followup. Within 30 days of this legislation being signed, third-party contractors will be required to submit a list of the veterans who have been waiting for more than 15 days for their appointments. I know of many waiting much longer. We don't leave soldiers on the battlefield. We shouldn't leave veterans to fight alone to get their healthcare needs met. Third, this legislation ensures that Veterans Choice Program providers receive prompt payment or denial of payment. If payment is denied, the healthcare provider will need to be told why and what information they need to submit in order to get the claim processed. The VA will also be required to submit a report to Congress on the number of unpaid claims to Veterans Choice Program providers and to take action on those claims within 45 days. What do I mean by providers? I am talking about our hospitals in northern Michigan, in the Upper Peninsula, in the northwest side of the State, and the northeast side of the State signed up under this program to be able to provide the care for someone who is more than 40 miles away from a VA medical center; then, they find they are not getting paid for their services to the tune of millions and millions of dollars. Veterans who have served their country and the medical providers who treat them deserve nothing less than getting this system right. Appointments should be made quickly, payments should be made for service, and there has to be continual accountability. Unfortunately, we know they aren't always getting what they need. One of those veterans is Jerry, a former National Guardsman who was stationed in Greenville, MI, on the west side of the State. He now lives in Sumner Township in Gratiot County. Last January, Jerry received a scary diagnosis. He had a lesion on his brain. He needed to see a specialist right away. Veterans Choice was supposed to make an appointment for Jerry to see an endocrinologist, but when he showed up for the appointment, unbelievably, he discovered he was mistakenly sent to a urologist. After that, Veterans Choice sent Jerry to a family practitioner who had no record that he even had an appointment. It was 2 days off of work and travel to visit doctors that Jerry should have never been sent to in the first place. By this time, Jerry was understandably very upset. He reached out to my office, and I am glad he did, so we could help. We were able to contact Veterans Choice on his behalf and get him the appointment he needed with the right specialist. Now, this is after his spending 5 months--5 months--trying to get to the right doctor. There is no excuse for this. However, Jerry's issues weren't over. When he saw the same specialist a second time, Jerry learned the doctor had never been reimbursed for his previous visit. As Jerry said, ``It shouldn't take five months to see a specialist, especially with something this scary and serious. And I shouldn't have to worry about whether or not Veterans Choice will pay for my care that I have earned.'' Yes, Jerry, you have earned and been promised that care. Jerry is exactly right. Unfortunately, he is not alone in Michigan--I know this from talking to colleagues in other areas--particularly with this same provider. I have heard from many other Michigan veterans who can't get appointments, are getting the wrong appointments, are having to travel long distances to appointments--which, this was supposed to stop veterans from having to drive long distances for appointments--or whose healthcare providers aren't being paid for their services and then deciding they don't want to participate in the Veterans Choice Program. My colleagues on the Veterans' Affairs Committee are working on comprehensive reforms to the Veterans Choice Program, and we are staring down another funding deadline. It is important this gets done, and we need to do it right away. We need to fix the problems veterans are having to deal with on a daily basis. I am looking forward to working with colleagues to fix this as quickly as possible. Our veterans deserve better. It is time we pass this legislation and make sure they get it. I would like to end with the words of a man who knew something about service and sacrifice on behalf of our country. Before he was President, before he was a member of this very Chamber, John F. Kennedy was a veteran who served in the U.S. Navy during World War II. On August 2, 1943, the PT boat he commanded was struck by a Japanese destroyer in the South Pacific. The entire crew ended up in the water, and two of his men died. Although Lieutenant Kennedy badly injured his back in the collision, he helped his men find safety on an island several miles away, where they were rescued a week later. Kennedy later was awarded the Navy and Marine Corps Medal for his leadership. He once said: ``As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.'' I believe that is our responsibility. It is not enough to praise our veterans on special days, although they have certainly earned every word of praise. Instead, we must work together to uphold each and every promise we have made to them. Veterans like Jerry and so many others have always been first in line to defend us. It is time to make sure they are not at the back of the line when it comes to getting the healthcare they need.

Ms. STABENOW

Ms. STABENOW. Mr. President, first to my friend from Oklahoma, happy 58th anniversary. That is wonderful. You have a beautiful family. Every year, I enjoy getting the Christmas card with the picture of your beautiful family on it. It is a wonderful milestone to celebrate today.

Ms. STABENOW

Ms. STABENOW. Mr. President, I am rising today to join my voice with so many others to support young people whom we call Dreamers. These young people were brought to the United States as children, sometimes as babies. For many of them, this country is the only home they have ever known. I should say up front that we need comprehensive immigration reform for our security and our economy. Our Nation's immigration system is broken, and it hurts families, workers, businesses, and farmers each and every day. But targeting these young people who have come to our country through their parents-- their parents bringing them as children--does nothing to solve the larger issues that we need to address in the Senate and in the House. To remind everyone, to be eligible for the Deferred Action for Childhood Arrivals Program, which we call DACA, young people have to have entered the United States before their 16th birthday. They must be attending school, have graduated or earned their GED, or have been honorably discharged from the U.S. military, and they must not have been in trouble with the law. Those are pretty good principles for all of us--following the law and working hard. When anyone does that, they should know that our country has their back. Those who were approved for DACA were given a legal status to remain here and a work permit so that they could work and contribute to our country. We made these young people a promise, and we need to keep it. I feel very strongly that whether it is our veterans, our people in the military going to war who are protecting us every day, who are serving our country--we made them a promise that they would have healthcare, among other promises, to make sure that veterans are not at the back of any line. When someone works all their life--they work 30 years, they pay into a pension, and they assume that pension is going to be there--that is another kind of promise. This is also a promise that was made to young people. If they worked hard and followed the rules and stayed out of trouble and contributed to our country, either serving in the military or going to school and working, they would have the right to be here and be able to contribute to our country. Nationwide, we know there are about 800,000 young people who are covered by DACA. In Michigan alone, we have over 10,000 young people-- 10,000 young Dreamers--working hard and going to school, contributing to our economy and our quality of life in Michigan. Many of them have DACA status. Those are some of the numbers; however, we are not talking about numbers here. We are talking about people's lives. We are talking about 10,000 young people in Michigan who are attending colleges, starting businesses, creating jobs, buying homes, serving in the military, and raising American children of their own. They are proud to be here. These young people aren't numbers; they are our neighbors. In Michigan, we care about our neighbors. One of these young people is named Nara. She shared her story with me, both last week and again today. I am so pleased that she and other wonderful young people are in town today to share their stories. Nara was born in Poland. Her parents faced intense discrimination because of their different backgrounds; one was from Poland and the other was from Mongolia. In 2000, when Nara was only 4 years old, she and her mom were granted a visa to come to the United States. Nara excelled in school. She graduated from high school with honors and attended the University of Detroit Mercy. She also found ways to give back, leading service trips around the country and volunteering for organizations, including the Humanitarian Alliance of Michigan, World Medical Relief, and Children's Hospital of Michigan. Earlier this year, Nara graduated with a bachelor's degree in biology and a minor in leadership. She was awarded one of Detroit Mercy's highest honors, presented to the undergraduate student who best exemplifies the mission of the university--leadership and service. Another one of our wonderful young people is Juan. He was brought to the United States by his parents when he was a 1-year-old. He was just a baby. He has known no other country. When Juan was in high school, he tried to enlist in the Marines to serve his country. He longed to serve the country that had given him so many opportunities. His plans changed, however, when a recruiter told him that he would likely be deported after he had served his country. Instead, Juan got a job, hoping to save up money for college. The DACA Program allowed him to get a job permit and a better job. Today he is a prelaw student at Wayne State University. He hopes to one day become an immigration lawyer. Juan said this: I believe in America. . . . I was raised here. I love this country. . . . This is my home. Nara, Juan, and so many other young people are great examples of why we need to pass the Dream Act. We need to extend DACA as soon as possible. I would love to see it happen right now, today. Young people are waiting, have been waiting, and are in horrible situations because they don't know what is going to happen. These young people have done everything right, and they don't know whether they are going to be ripped away from their family and sent to a country they may never have been in. They want to be here, contributing to America. They want to earn their degrees, start businesses, raise families, and give back to their communities. We need comprehensive immigration reform. That is for sure. But first, we need to pass the bipartisan Dream Act as quickly as possible. These young Dreamers have done nothing wrong. They have done everything right. They have done everything they have been asked to do. It is time to make sure our country stands up and keeps its promises to them. That is what our neighbors would do. I yield the floor. I suggest the absence of a quorum.

Ms. STABENOW

Ms. STABENOW. Mr. President, I come to the floor to talk about the Children's Health Insurance Program and Community Health Centers, but I do want to take a moment to respond to my friend and colleague, the distinguished Senator on the Republican side. I can speak for myself and others, I know, on this side who very much want to see tax reform, very much want to close loopholes that take jobs overseas and support small businesses, but what is in front of us and what was voted on was a bill that, when fully implemented, would raise taxes on something like 87 million middle-class Americans. That doesn't make any sense at all. All of the rosy estimates on economic growth were not backed up in legislative language. As to the $4,000 wage increase that had been talked about as a minimum for people across the country to receive based on economic growth, I suggested we write that into law; that if, in fact, folks don't get their $4,000, the tax breaks would stop--and folks aren't willing to do that. I want to make sure folks in Michigan get their $4,000 wage increase, and we don't get another bunch of promises with trickle-down economics, where everything goes to the top 1 percent, and folks in Michigan are still waiting for it to trickle down.

Ms. STABENOW

Ms. STABENOW. Mr. President, I am making a motion to instruct the conferees with language at the desk to put in place a guarantee that middle-class families will receive the raises my Republican colleagues are promising them. In other words, for people watching all of this, the proof is in your paycheck. This motion would direct the conference committee for this bill to add a provision that would return the corporate tax rate to its current rate if wages do not increase by at least $4,000. The President has said they will. Our Republican colleagues--we saw posters all last week saying at least $4,000; in fact, we have heard as much as $9,000. This is important for families because corporate profits are already at record highs and wages are at record lows. If people are really going to get $4,000 more in their pocket in wage increases, colleagues across the aisle should be willing to vote for this guarantee. The proof is in their paycheck.

Ms. STABENOW. Thank you. The White House also promised the average American family would get a $4,000 raise in the tax plan. That is why I am here. What I am saying to the folks in Michigan is, the proof is in your paycheck. That is what this motion is all about. If my Republican colleagues are serious about putting more money in the pockets of the middle class, which I want to do, I urge them to support this motion. We need to make sure that if folks are going to be promised at least $4,000 more in their wages, they get it. This motion would say, these new tax cuts only go forward if people get their $4,000. The proof is in their paycheck. That is what this motion is about, and if my colleagues really believe what they are saying and what the President has said, they will support this motion to make sure that guarantee is there for middle-class families. I yield the floor.

Ms. STABENOW. Mr. President, I have a motion at the desk.

Ms. STABENOW. Mr. President, first, I want to express strong support for Senator King's motion and for the argument that he is making about the debt. I couldn't agree more. I also rise to speak on my motion to instruct, which I will be offering in just a few moments, to direct the conference committee for this bill to add a provision that would return the corporate tax rate to its current levels if wages do not increase by at least $4,000. That is the promise that has been made over and over to working men and women--that these cuts that are being made and changes that are being made will result in at least $4,000 in increased wages, in people's pockets. I think they have the right to know that the majority means that when they say it and to make sure that that is written into the final bill. The reason for this motion is very clear. As I indicated, Republicans have promised American families an increase in incomes of $4,000, $7,000, even $9,000. I think that is great, and I would strongly support that. There is no evidence that this approach will do that, and, so far, there has not been a willingness to put language in to guarantee that that is what will happen for middle-class working men and women. President Trump has called this bill, in his words, a ``great, big, beautiful Christmas present'' for the American people. I would argue that, in reality, at this point, it is a great, big, beautiful Christmas present for the wealthiest 1 percent. As for middle-class families, not so much--it is more like a lump of coal. It keeps a loophole that let's corporations write off their expenses when they ship jobs overseas, but if you move from one end of the country to Michigan for a great new job, you cannot write off your moving expenses. Big businesses can keep deducting their State and local taxes, but, sorry, middle-class families: You can only deduct a small portion of your State and local taxes. When they talk about making it simpler and closing loopholes, none of that is in this bill. In fact, oil companies will enjoy a brand new $4 billion offshore tax loophole. Meanwhile, 87 million American households that earn less than $200,000 a year will get a tax increase. I will say that again: 87 million American households that earn less than $200,000 will get a tax increase. Health insurance premiums would go up 10 percent and keep going up, while 13 million fewer people will have health insurance coverage. If that is what is considered a great big beautiful Christmas present, I would imagine Michigan families would say: No, I will keep the gift receipt and take it back to the store. Treasury Secretary Steve Mnuchin said: ``On the personal side, middle-income families are getting cuts and rich people are getting very little cuts.'' Unfortunately, when added all up, he was very tricky. He said on the personal tax side, but when adding it all up together, all of these proposals together mean that folks like Secretary Mnuchin and others in the Cabinet in their income brackets will be the real winners. White House Budget Director Mick Mulvaney is making promises too. He said: ``The White House, the President, is not going to sign a bill that raises taxes on the middle class, period.'' I assume, then, that means he will not sign this bill. Mr. President, I ask unanimous consent for 1 minute more.

Ms. STABENOW

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

Ms. STABENOW

Ms. STABENOW. Mr. President, I am coming to the floor again to focus on the fact that the clock is ticking for families in Michigan and across the country--men and women, children, older people, younger people who use the community health centers, as well as those who have their children covered under the Children's Health Insurance Program. The Federal funding for those programs stopped September 30--67 days ago. We have had votes. We have had bills. We have had nominations come before us. There have been divisiveness and controversy. It would be wonderful if we could stop for 1 day and do something that has bipartisan support. The fact is that CHIP covers 9 million children, and 100,000 of those are in Michigan. We passed a bill out of the Finance Committee in September. I want to laud our chairman, Senator Hatch, and our ranking member, Senator Wyden. It was a bipartisan bill. There was only one ``no'' vote. We reported it out. I assumed we would want to get this done before September 30, when the funding ran out. Instead, here we wait, 67 days later. There are 9 million children at risk because of this inaction--100,000 children in Michigan. The truth is that today, thanks to CHIP and thanks to a variety of healthcare efforts across the country, 97 percent of the children in our country have access to a doctor. In Michigan, it is actually higher; it is 97 percent of our children. So if a child has juvenile diabetes, if they have a cancer or asthma or just fall out of a tree and break their arm or have bronchitis or the flu, whatever it is that is happening to children, parents have the peace of mind under the MIChild Program to know that they can take their child to a doctor whom they have a relationship with and who knows their children, instead of going to the emergency room. We also know that emergency rooms are the most expensive way to provide care. They are necessary. They are important for emergencies but not for the daily routines of life, when someone could be seeing a doctor. It costs more; uncompensated care costs more, and when someone uses the emergency room when they could be seeing a doctor, then everyone else pays for that with their insurance rates going up. So MIChild in Michigan and the Children's Health Insurance Program across the country work. They save money. They save lives. In fact, as soon as January, in Michigan, families are going to start to get notices that the funding will go away, that the medical care will go away. It is not a great way to start the new year: Merry Christmas. Happy New Year. Your child is not going to be able to go see their doctor anymore. We don't have to have that happen because we have strong bipartisan support for this. It is the same thing with community health centers. Twenty-five million people are able to see a doctor or a nurse and get the care they need through a community health center in their community. There are 300,000 veterans who are able to see a doctor through a community health center, and there are 7.5 million children as well. In Michigan, our health centers are all over the State. We have some 260 different clinics around Michigan that serve 681,000 people and, again, almost 13,000 veterans. Starting in January, they are going to begin to lose funding at different times--some in February, some in March, some in April--because of local funding streams. But starting in January, in Michigan, health centers are not going to have the funding they need. The majority of their funding--70 percent of their funding-- comes through the program that expired September 30, and we know that this also doesn't have to happen. My friend Senator Roy Blunt and I have put in legislation. We have a letter signed by 70 Members--not 7--70 Members of this body, over two- thirds of this body signing a letter supporting the continuation of community health centers. Yet we can't get that brought up either. We thought the original plan was to bring up CHIP, the Children's Health Insurance Program, and include community health centers with it, and get that done before September 30. The clock is ticking every single day, and it has not been done. Folks may be trying to hold it hostage politically for some reason or trying to work on some deal at the end of the year. In the meantime, families are worrying, men and women are worrying, and veterans are worrying about what is going to happen, whether or not they are going to continue to get their healthcare. Let me go back to where I started. Today is 67 days, and tomorrow it will be 68 days since the funding for two healthcare programs that have had broad bipartisan support over the years and broad bipartisan support today--67 days since that funding has stopped. I would like to close with a story from a gentleman named Darin, whose life was changed by one of Michigan's community health centers. He shared his story with me. Darin was an unemployed truckdriver when he moved to Jackson, MI, 4 years ago. He hadn't seen a doctor for a decade, and, in his words, he was ``a complete mess.'' He had diabetes, congestive heart failure, and he had no energy. He needed an oxygen tank to walk. He started seeing Dr. Roy at the Center for Family Health, which is a great health clinic in Jackson. He told her he didn't want to just be stable; he wanted to get better. So they went to work so that he could get back on his feet and get back to work. Darin got his diabetes under control. He improved his lung function, got rid of the oxygen tank, and quit his pain pills. Darin said: I went from being . . . hardly able to move to where I feel like I can do almost anything. Dr. Roy saw me at my lowest, and she has seen me improve so much that she celebrates with me. Dr. Roy kicked me in the seat of the pants, and I will always thank her for it. Darin got his kick in the seat of the pants, and, Mr. President, with all due respect, I believe Members of this body could use one too. There are 25 million people who count on community health centers for their care--their children's care, the care of their moms and dads. There are 9 million children who are covered under the Children's Health Insurance Program. They have been waiting and worrying for long enough; 67 days is long enough. I am hopeful that there will be a sense of urgency from colleagues to get this done. Thank you. I yield the floor.

Ms. STABENOW

Ms. STABENOW. Mr. President, today I wish to pay special tribute to my friend, Virgil Bernero, who will be ending his service as mayor of Lansing, MI, at the end of this year. This is a special opportunity for me to recognize Virg's outstanding service to the people of Lansing. I have represented Lansing throughout my years in public service, so I have had the opportunity to work closely with Virg. Virg and I share something in common: We both began our public service careers as an Ingham County commissioner, State representative, and State senator. He was first elected mayor of Lansing in 2005. He has served with a unique passion and energy for public service. He is devoted to his family and has worked on behalf of families he has represented with the same devotion and commitment. While mayor, Virg led Lansing through the recession and, despite facing major budget shortfalls, was able to maintain 12 consecutive balanced budgets and produce a budget surplus during each of the last 3 years. He led efforts to attract new business investments in the city, including a $182 million repurposing of a former electric powerplant into the headquarters of a major national insurance company. He worked to foster regional cooperation and economic development efforts and led the creation of the Lansing Economic Area Partnership, the Lansing area's first regional economic development public-private partnership. During the automotive crisis, Virg organized Michigan mayors and led a passionate and aggressive defense of the American auto industry, which is one of Lansing and mid-Michigan's backbone industries. He founded and led the Manufacturing Alliance of Communities, a national coalition of mayors that worked to secure Federal support for our automobile industry. Since that time, General Motors has invested more than $1 billion in their Lansing facilities and recently moved production of the Chevrolet Camaro from Canada to the Lansing Grand River assembly plant. I am grateful for Virg's friendship and congratulate him on his years of extraordinary service. I wish him and his family all the best as he begins this new chapter in his life.