Jeanne Shaheen

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, as we all know, we are continuing to debate what amounts to repealing the Affordable Care Act without any indication of what is going to replace it--what is actually in the Republican leader's bill. I think this is worth repeating because we are talking about changing one-sixth of the U.S. economy, impacting every American family, and yet we still have no idea what the bill actually is. We do know this. A partisan bill to take away health insurance from tens of millions of Americans, written behind closed doors, opposed by every healthcare stakeholder group and by an overwhelming majority of the American people should not pass the Senate. As I have repeatedly said, the only constructive way forward is for Democrats and Republicans to come together in a good-faith, bipartisan effort to repair and strengthen the current law. Bipartisanship should not be our last resort, as Senator McConnell has suggested. It should be a starting point. It should be the foundation of what we do in this body. This is how the great majority of the American people want us to conduct the Senate's business. This is what I hear from my constituents in New Hampshire, and this is especially true with healthcare legislation which affects families all across this country. Make no mistake, every bill proposed by the Republican leadership has been designed as a bullet to the heart of the Affordable Care Act. Republican proposals will collapse the individual marketplaces, make it impossible to provide affordable coverage for people with preexisting conditions, and take healthcare coverage away from up to 32 million Americans, including the most vulnerable. I hope nobody is fooled by this latest partisan measure to roll back the Affordable Care Act and take healthcare coverage away from tens of millions of Americans. I hope every Senator will, at long last, heed Senator McCain's call for bipartisanship--as we have been hearing at townhalls and in countless messages from our constituents. The American people want us to make commonsense, bipartisan changes to the current law. We need to work together to build on the strengths of the Affordable Care Act, which has dramatically reduced the number of uninsured Americans and has given us valuable tools for fighting the opioid epidemic which is ravaging so many communities in America. This is the best way forward for both the Senate and our country. Republican leaders have spent the last 7 months pushing deeply unpopular bills to repeal the Affordable Care Act, including their effort to dramatically cut Medicaid--not just the expansion of Medicaid under the Affordable Care Act but the Medicaid Program that has done so much to protect and provide healthcare for children across this country, for pregnant women, for those with disabilities and older Americans, so many of whom are in nursing homes who would lose that care if we dramatically cut the Medicaid Program as the Republican proposals have tried to do. At the recent National Governors Association meeting, Democratic and Republican Governors alike urged Congress to reject the Republican leaders' healthcare bill--in particular, its harsh and unsustainable cuts to Medicaid. The Republican Governor, John Kasich, was especially forceful in urging Members of Congress to work together to find bipartisan solutions. He urged Congress to give first priority to stabilizing the healthcare marketplaces. We should listen to the Governors, but most importantly we should listen to our constituents--to the great majority of our constituents who want to preserve what is working in the Affordable Care Act and see us change what is not working. Instead of legislation to take healthcare away from people, it is time now for an inclusive, bipartisan approach to provide quality, affordable healthcare for every American. Thank you. I yield the floor.

Mrs. SHAHEEN. Madam President, I intend to offer the following five motions to commit to H.R. 1628, and I ask unanimous consent that they be printed in the Record. The first motion would send the reconciliation bill to the Health, Education, Labor and Pensions Committee with instructions to strike repeal of cost sharing reductions, CSRs, and advanced premium tax credits and replace this section with my legislation, the Marketplace Certainty Act, which would make CSRs permanent and extend them to those making up to 400 percent of the Federal poverty line. I want to reiterate what I previously said for the Record, that the Affordable Care Act, ACA, already prescribes that such payments are to be made from such a permanent appropriation pursuant to 31 U.S.C. 1324. The first motion is supported by Senators Carper, Reed, Murphy, Baldwin, Hirono, Klobuchar, Blumenthal, Heinrich, Coons, Heitkamp, Stabenow, Cardin, Markey, Warner, and Van Hollen. The second motion would send the reconciliation bill to the Finance Committee with instructions to strike repeal of cost sharing reductions, CSRs, and advanced premium tax credits and replace this section with my legislation, the Marketplace Certainty Act, which would make CSRs permanent and extend them to those making up to 400 percent of the Federal poverty line. Similar to the first motion, I want to reiterate what I previously said for the Record, that the ACA already prescribes that such payments are to be made from such a permanent appropriation pursuant to 31 U.S.C. 1324. The second motion is supported by Senators Carper, Reed, Murphy, Baldwin, Hirono, Klobuchar, Blumenthal, Heinrich, Coons, Heitkamp, Stabenow, Cardin, Markey, Warner, and Van Hollen. The third motion would send the reconciliation bill to the Finance Committee with instructions to strike provisions that would weaken or eliminate the small employer health insurance credit, prohibit the ability of entrepreneurs to purchase affordable health coverage through the individual marketplace, or allow discriminatory rating rules that prohibit small businesses from providing affordable, comprehensive benefits to their employees. The third motion is supported by Senators Blumenthal, Carper, Udall, Baldwin, Brown, Peters, and Stabenow. The fourth motion would send the reconciliation bill to the Health, Education, Labor and Pensions Committee with instructions to strike provisions that would allow insurers to establish diabetes as a preexisting condition or reduce funding for diabetes research, treatment, prevention and education. The fourth motion is supported by Senators Hirono, Klobuchar, Blumenthal, Menendez, and Van Hollen. The fifth motion would send the reconciliation bill to the Finance Committee with instructions to strike language that would remove mental healthcare services from the list of essential health benefits or prohibit States from providing Medicaid coverage for more than 30 consecutive days of inpatient psychiatric services. The fifth motion is supported by Senators Hirono and Blumenthal.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I wish to recognize June 24 as Cystinuria Awareness Day and to offer my support to the International Cystinuria Foundation as the organization continues its excellent work promoting knowledge of this disease within the research and medical communities, as well as providing resources for those affected by cystinuria. Cystinuria is an inherited disease characterized by high concentrations of the amino acid cysteine in the urine, leading to the formation of cysteine stones in the kidneys and urinary tract. It is a rare disease that affects roughly 1 in every 7,000 people, including an estimated 130 Granite Staters. Cystinuria is a painful and often debilitating condition. Those who suffer from it can experience kidney stones as frequently as daily, causing many to lose weeks of work each year. Many sufferers use prescription painkillers to cope with the disease, and tragically, some develop substance use disorders. Cystinuria does not discriminate, affecting people of all genders, races, ethnicities, and ages. There is not yet a cure, and the disease is frequently misdiagnosed. I sincerely hope that this day of awareness will help in advancing research into the causes of the disease as well as possible therapies and cures. Because cystinuria is a rare disease, there is an acute need for more aggressive research, including at the National Institutes of Health. In addition to supporting important funding for research, we can also do our part by also advocating for awareness for the disease. Fortunately, the Affordable Care Act protects those with cystinuria and other preexisting conditions from discrimination by health insurance companies. Cystinuria Awareness Day is a valuable opportunity for Americans to learn about this condition and offer support to those living with it. I am grateful to the International Cystinuria Foundation for its commitment to raising awareness of the disease, advocating for research, and providing support for those suffering from cystinuria.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I strongly agree with these New Hampshire groups. After spending 6 months trying to pass the deeply unpopular, deeply flawed bill to repeal the law, shouldn't we welcome a bipartisan effort to improve the law? I believe the answer to that is yes, and the place to begin is by taking urgent action on a matter where most of us agree, and that is providing certainty to health insurance markets in order to hold down premium increases. In their 2018 rate request filings, insurers say that large increases are necessary because of the uncertainty surrounding the repeal of the Affordable Care Act and because the Trump administration refuses to commit to making cost-sharing reduction payments--those payments that go to insurance companies so they can help their consumers with the cost of health insurance, making sure that more people can get health insurance. Well, we now have an opportunity to end this uncertainty by putting the repeal behind us and authorizing a simple bill to authorize regular appropriations for the cost-sharing reduction payments. The current instability in the ACA marketplaces is a manufactured crisis, and Congress can put a stop to it very quickly. That is why I have introduced the Marketplace Certainty Act, which is a bill to permanently appropriate funds to expand the funds for and to expand the cost-sharing repayments. It does two things: It guarantees that these payments are coming, and it is going to cover more people to help. I am pleased to be joined by 26 Senators who have already cosponsored this bill. We can end this artificial crisis. We can immediately restore certainty and stability to the insurance markets, and, in turn, we can get the time we need in order to come together in a bipartisan way to improve this law to build on what is working and to fix what is not. We have a number of these commonsense measures, and this is one that has been embraced, not just by Democrats but by key Republican leaders, including Chairman Lamar Alexander and House Ways and Means Chairman Kevin Brady, who have urged that these payments be continued. As Chairman Brady put it, the payments are needed ``to help stabilize the [health] insurance market and help lower premiums for Americans.'' He added: ``Insurers have made clear the lack of certainty is causing 2018 proposed premiums to rise significantly.'' We have heard from our constituents at home. We have heard from doctors, nurses, hospitals, particularly rural hospitals, nursing homes, patient advocates, insurers, and those constituents who were in the statement I asked to be printed in the Record. They are pleading with us to set aside our partisan differences and work together to repair the Affordable Care Act. Again, we know what we can do. It is not just the Marketplace Certainty Act; there are other bills that have been introduced that can fix the uncertainty in the markets and allow us to address other issues with the law. Bipartisanship should be the Senate's first resort, not the last resort. An excellent place to start is by coming together right now to permanently appropriate funds for the cost-sharing reduction payments that keep health coverage affordable and to look at some of the other commonsense measures that are going to be talked about by my colleagues, like Senator Klobuchar, who will be coming to the floor. She has legislation that would help us deal with the high cost of prescription drugs, which is one of the things that is driving the increasing costs of healthcare. We need to pass these commonsense measures, and we need to do it now. Thank you. I yield the floor.

Mrs. SHAHEEN. Mr. President, the majority leader says that he will move forward this week with a vote on a straight repeal of the Affordable Care Act in its entirety. I don't believe that a majority of Senators are willing to support a reckless leap in the dark, which that vote would mean. It is a vote that would end protections for people with preexisting conditions. It would take healthcare coverage away from tens of millions of Americans and tens of thousands in New Hampshire. It would terminate the Medicaid expansion that has been critical to fighting the opioid epidemic in my State and so many States across this country. According to the nonpartisan Congressional Budget Office, a straight repeal of the Affordable Care Act would result in more than 32 million people losing their insurance coverage by 2026. Premiums would roughly double in the individual marketplaces. I urge my Republican friends not to go forward with this misguided approach. The idea that they can repeal the healthcare bill now and give us a new bill in 2 years or whatever period of time is in the bill just doesn't pass the smell test. If we haven't seen an alternative to the Affordable Care Act in the last 7 years, there is no reason to believe that our Republican colleagues are going to be able to produce a bill in 2 years when there is chaos in the marketplaces. There is a better way forward for the Senate and for our country. During the Fourth of July recess, Majority Leader McConnell said that if he can't secure the votes to repeal the Affordable Care Act, he is prepared to work in a bipartisan way with Democrats on legislation to repair and strengthen the law. I believe that bipartisanship is the best way to get something done. That is what I tried to do when I was Governor of New Hampshire. I worked closely with our Republican legislature, and we got things done. It should not be a last resort for what we are doing; it should be the first resort. It should be what we do to build a foundation for policy in this country. I am hopeful that following the floor consideration of whatever the majority leader decides to do on healthcare--and, hopefully, it is going to get defeated--we will move forward with the majority leader's fallback plan, which I believe should be the starting position. We need to start fresh with regular order to craft bipartisan legislation that builds on the strengths of the Affordable Care Act, that builds on what is working and fixes what is not working. As we have been hearing at townhalls and in countless messages from our constituents, this is exactly what the American people want us to do. There is remarkable consensus in this country that the Republican leaders' bill is the wrong approach. An ABC/Washington Post poll on Sunday found that by a more than 2-to-1 margin, Americans prefer the Affordable Care Act to the Republican leaders' bill. Their bill is strongly opposed by hospital associations, by healthcare providers, by the health insurance industry, and by nearly every patient advocacy group, including the American Cancer Society and the American Heart Association. There is no reason to think that just repealing the Affordable Care Act is going to make that any better. On Saturday, the New Hampshire Hospital Association, the New Hampshire Medical Society--our physicians--and the New Hampshire AARP joined together in opposition to the bill. They noted that more than 118,000 Granite Staters--nearly 1 in 10 people in New Hampshire--would lose healthcare coverage under the Republican bill, and that number is even greater if we just repeal the Affordable Care Act. Their joint statement urges Senators ``to start over and create a new version of legislation that protects coverage for those who have it and provides coverage for those who need it most.'' Mr. President, I ask unanimous consent that the joint statement by these groups be printed in the Record.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I am disappointed but not surprised that my colleague has objected. I don't believe he objected because of the effort to help pay these subsidies, which are passthroughs to insurance companies. Reforming how we do those, I am certainly happy to sit down and talk about that, but the fact is, that is not the issue right now. The issue is, this is a way we could address the current uncertainty in the marketplaces in a way that will be good for maintaining stability of healthcare for all Americans. I am disappointed there isn't a willingness to work together to do that. I hope, as this debate continues, we will finally see people come together to get something done to address, not just healthcare for Americans but to address the one-sixth of the economy that depends on the healthcare industry. I yield the floor.

Mrs. SHAHEEN. Mr. President, I am really pleased to have been joined by my colleagues to talk about the importance of addressing healthcare for all Americans, especially my colleague from New Hampshire. She and I have been touring the State for months now, talking with people in hospitals, with patients, with physicians, with providers, with people with substance use disorders, with providers who are providing treatment for people with substance use disorders, with people all over New Hampshire about what we can do to make sure people get healthcare when they need it. That should be the goal of this body. It should not be throwing people off their healthcare, which a repeal of the Affordable Care Act would do. It would throw 32 million people off their healthcare. We can address the instability in the marketplaces. We can do that pretty quickly. Senators Kaine and Carper talked about reinsurance, something which has worked very well for the first 3 years of the Affordable Care Act, and the reason it doesn't work now is because they have stopped. That is why we are seeing some of these rate increases. We can address the uncertainty by being clear that we are not going to repeal the Affordable Care Act, by addressing those cost-sharing reduction payments. The ACA already stipulates that CSR--those payments which reduce the costs of copays and deductibles--are to be made pursuant to 31 U.S.C. 1324. My bill provides for payments to be made jointly from a permanent appropriation rather than subject to the year-to-year whims of the annual appropriations process. The Marketplace Certainty Act removes all bases for any further questions about what is already clear from a fair reading of the Affordable Care Act as a whole; that both those CSR payments and the advanced premium tax credit subsidies are to be funded from the same permanent appropriation. I see my colleague from Texas on the floor, and I am sure he is going to object to the unanimous consent request I am going to be proposing in a couple of minutes. He objected last Thursday when I asked for unanimous consent to pass the Marketplace Certainty Act, and he justified the objection by asserting that the cost-sharing reduction payments are--I think he called it a bailout of the insurance companies. That is an inflammatory term, and I think we ought to be careful with how we use it because the truth is, the cost-sharing reduction payments are in no way, shape, or form a bailout. They are orderly payments built into the law to go directly to keep premiums, copays, and deductibles affordable for lower income Americans. In fact, those same payments were included in the bill Majority Leader McConnell just said he is not going to go forward with, the Republican bill. It included those very same cost-sharing reduction payments. I think they were included because there was a recognition that these are important to help address the cost of healthcare for all Americans. As I said earlier, we have had statements by the chairman of the Health, Education, Labor, and Pensions Committee, Lamar Alexander, talking about that these payments should be continued. We have heard from House Ways and Means Chairman Kevin Brady, who said we need to continue these payments to help stabilize the insurance market. It is the uncertainty that is causing the current problem, and we could address that today--this week--if people were willing to work together. As Democrats, we have come to the floor to say we want to work together. We think we can address the challenges we face with the Affordable Care Act. We can do it in a bipartisan way. I know we can because Tim Scott and I have done it. We passed a bill several years ago by unanimous consent, which basically gave States the ability to control group size for people and for companies in the marketplaces so I know it can be done, and I know we could do it today if there were a willingness on the part of all of our colleagues to work together. That is what the American people want. They don't want 32 million people thrown off their health insurance. We don't want rural hospitals to close in New Hampshire. We don't want nursing homes to close. We don't want people to be thrown out of their nursing homes. I was up in northern New Hampshire at a nursing home over the weekend, where I talked to a group of women in their eighties and older. One woman said to me: You know, I worked my whole life. I paid my taxes. I did everything I was supposed to do. I sold my house so I could get into this nursing home so I could qualify under Medicaid. I got rid of all my assets. Now they are telling me I am going to get thrown out? She said: What would I do? I have no place to go. I have no family to help me. People don't want that. What they want is for us to work together, to help fix healthcare so people can get what they need when they need it. Mr. President, I ask unanimous consent that the Committee on Health, Education, Labor, and Pensions be discharged from further consideration of S. 1462; that the Senate proceed to its immediate consideration; that the bill be considered read a third time and passed, and the motion to reconsider be considered made and laid upon the table with no intervening action or debate.

Mrs. SHAHEEN

Mrs. SHAHEEN. I want to be clear that what we need to do is to provide certainty in the marketplace right now. What is happening because of the effort by our Republican colleagues to repeal the Affordable Care Act--which is providing coverage for literally tens of millions of people--what is happening because of this administration's refusal to guarantee those payments that would help people with the cost of their health insurance is that we are seeing instability in the marketplace. But the answer is not the proposal that was released this morning, the second or maybe it is the third draft of healthcare legislation that was done behind closed doors by our colleagues. Earlier today, I had the opportunity to meet with two children from New Hampshire: Parker, who is 8, and Sadie, who is 10. These kids were here advocating for the children's hospitals that have meant that they can continue to live. They are kids who were born with serious health challenges. They continue to have those serious health challenges, but thanks to Children's Hospital at Dartmouth and Boston Children's Hospital, Parker and Sadie are alive today. They are smart, they are beautiful, and they are the delight of their families. They have been able to get the healthcare they need through CHaD and through Boston Children's because they are able to get covered for their healthcare under Medicaid. What our colleagues' healthcare legislation would do is dramatically cut the Medicaid funding that Parker and Sadie and so many children and old people and disabled in this country depend on in order to stay alive. That is a mean-spirited bill. That is not the answer to the serious healthcare challenges we have in this country, and that is not what we should be doing to fix what needs to be fixed in the Affordable Care Act. What we need to do is work together. I am disappointed that my colleagues on the other side of the aisle continue to work behind closed doors instead of having an open process. If this legislation that was introduced this morning is such a great piece of legislation, then let's go through regular order. Let's have a hearing. Let's let the people of this country weigh in and then see whether this is a healthcare bill we should pass. Thank you, Mr. President. I yield the floor.

Mrs. SHAHEEN. What is true about the Marketplace Certainty Act is that it would guarantee the payments that were promised under the Affordable Care Act--not to insurance companies but to families who need help affording health insurance. That is one of the goals as we think about what our challenge is to address the healthcare needs of the people of this country, and that, in fact, is what the Marketplace Certainty Act would do.

Mrs. SHAHEEN. Absolutely.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I am pleased to be here with my colleagues--Senator Klobuchar, from Minnesota, and Senator Heitkamp, from North Dakota--to talk about the most prominent issue facing us right now; that is, what happens to healthcare for millions of Americans. At a town hall in Kentucky last week, Majority Leader McConnell said that if he can't secure the votes to repeal the Affordable Care Act, he will have no choice but to work in a bipartisan way with Democrats on legislation to repair and strengthen the law. Well, I was encouraged to hear the majority leader say that because I don't think bipartisanship should be a last resort. I think it should be the starting point. It should be the beginning of the work we do in this Chamber because that is what the American people want and that is the best way to make lasting public policy. This is especially true with healthcare legislation, which impacts families all across America. As we have been hearing--and I have had a chance to hear it directly from my constituents in New Hampshire--the American people have wanted all along for to take a bipartisan approach. It is unfortunate that our colleagues on the other side of the aisle have spent months trying to pass a partisan, deeply unpopular bill. Now, I think we would all agree that there are changes we need to make in the Affordable Care Act, something for which I have advocated since we passed the law. I have had the opportunity to work with our colleague Tim Scott from South Carolina. In 2015, we worked together to make modest changes to the law to protect small businesses from excessive premium increases. I think that bipartisan approach is something with which, if we started today, we could make changes in the Affordable Care Act to improve it and to make sure that Americans could get better access to healthcare. We all understand that there are problems currently in the market in terms of premium increases, and we know why these premium increases are happening. In their 2018 rate request filings, insurers justified the increases because of the uncertainty surrounding the repeal of the ACA and because this administration refuses to commit to making what are called cost-sharing reduction payments. These payments were included as part of the Affordable Care Act to address premiums, deductibles, and copayments and to make them more affordable for working families, basically, to be able to help people afford insurance. The payments have been built into the rates that insurers are charging for 2017. But as we look ahead to 2018, there is a big problem because, if there is uncertainty around those payments, it means premiums will skyrockets, insurers will leave marketplaces, and people will lose their health coverage. Now, we could fix this today if we were willing to work together, because we know what we need to do. I think New Hampshire offers a vivid example of what we are seeing across the country. Last year, insurance markets were stable, health insurance premiums increased an average of just 2 percent in New Hampshire--the lowest annual increase in the country and in our State's history. Unfortunately, today, because of the uncertainty in the market, it is a very different story. Insurers in New Hampshire are raising premiums for 2018. The same thing is happening across the country. In some cases, insurers are filing two different sets of rates--one premised on the administration's continuing to make those cost-sharing payments that I talked about earlier, and the second set with higher premiums to account for continuing uncertainty and the possibility that the Trump administration, which is legally charged with implementing the Affordable Care Act, is going to renege on making the payments that have been promised to insurers and, ultimately, to families so that they can get healthcare. This uncertainty is completely unnecessary. The instability in the ACA marketplaces is a manufactured crisis, and we could put a stop to it today. That is why I have introduced the Marketplace Certainty Act, a bill to permanently appropriate funds that would expand the cost- sharing reduction payments and ensure that we can count on those payments being made. I am pleased to be joined by 25 other Senators who have already cosponsored this bill, and we can pass this right now if we had agreement with our colleagues on the other side of the aisle. The Marketplace Certainty Act is also supported by a broad spectrum of provider and patient advocate groups--including the American Cancer Society, the American Heart Association, the American Diabetes Association, and the National Association of Community Health Centers, just to name a few. We can end the artificial crisis. We could immediately restore certainty and stability to the health insurance markets. In turn, this would give us the space we need to come together on a bipartisan basis to improve the Affordable Care Act, to strengthen what is working, and to fix what is not working. That is what we were sent to Washington to do. Bipartisanship should be our first choice, not a last resort. The American people want us to stop bickering over healthcare, to work together, and to make the commonsense improvements to the law that we should be making. I yield the floor.

Mrs. SHAHEEN. Mr. President, I thank my colleagues who are here this afternoon for their eloquence, their remarks, their passion for making sure the people in this country can get healthcare when they need it, and for their hard work and legislation to try and make that happen.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I am very pleased that Afghanistan's robotics team will be coming to Washington to compete with students from nearly 150 countries in the FIRST Global Challenge, which begins on Sunday, July 16. I extend a warm welcome to these brilliant young minds, Lida Azizi, Somayeh Faruqi, Faramarz Najafi, Rodaba Noori, Fatemah Qaderyan, Kawsar Roshan, and Alireza Mahraban. Of course, we extend a warm welcome to the team's creation, a robot that can sort balls, recognize blue and orange, and move objects to their proper places. People across Afghanistan are extremely proud of the robotics team's achievements. In recent days, Americans have become acquainted with the many challenges they have overcome in order to excel in their studies and come to the U.S., and we too, are very proud of them. I have been impressed to learn about their passion for education and determination to pursue STEM studies. This team's indomitable spirit is a testament to what can be achieved through hard work, creativity, and perseverance. Each member of the Afghan robotics team has become a powerful symbol for young women across the globe, especially for those in developing regions who face barriers to education and opportunity. The FIRST Robotics Competition should also be recognized for its ability to bring young people together in the name of science, mathematics, and technology. It is the creation of Granite Stater Dean Kamen, and had its beginnings in a New Hampshire high school gym a quarter century ago. Today, FIRST programs reach more than 400,000 young people across the world every year. Beginning this weekend in Washington, the FIRST Global Challenge will bring some of the best and brightest young people from around the world to compete, to demonstrate teamwork, and to forge new friendships. It gives me great joy to know that Lida, Somayeh, Faramarz, Rodaba, Fatemah, Kawsar, and Alireze will be among them. The FIRST Global Challenge is a competition, and only one team will leave Washington with top honors, but the seven young women representing Afghanistan are already winners. They have had the courage to overcome barriers and the audacity to compete with some of the most talented young people from across the globe. I wish these young women great success. I thank them for inspiring us with their fierce determination to achieve.

Mrs. SHAHEEN

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

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I am expressing sentiments for myself and on behalf of Senators Wyden and Murray, as a fair reading of the Affordable Care Act, ACA, makes clear, S. 1462, the Marketplace Certainty Act, is not necessary to provide a permanent appropriation for the payment of cost-sharing reductions under the ACA. The ACA already prescribes that such payments are to be made from such a permanent appropriation pursuant to 31 U.S.C. 1324. This is because an essential component of the ACA's system for ensuring the availability of affordable health insurance coverage is its two-part package of subsidies: tax credits and cost-sharing reductions. Whereas the premium tax credits make it more affordable for an individual to purchase health insurance, the cost-sharing reductions make healthcare more affordable by reducing the often daunting costs, such as copayments and deductibles, that even those with health insurance must pay to obtain healthcare, ACA, sections 1401, 1402, 26 U.S.C. 36B, 42 U.S.C. 18071. The ACA directs the Secretary of the Treasury to ``establish'' a single, integrated ``program'' to ``make advance payment'' of both subsidies to insurance companies, who are accordingly mandated to reduce individuals' premium payments to insurers, and their cost- sharing obligations to healthcare providers. To assure insurers and covered individuals that these equally essential funds will both be available, the act provides that requisite payments are to be jointly made from a permanent appropriation, 31 U.S.C. 1324, rather than be subject to the year-to-year whims of the annual appropriations process. Despite the fact that the current permanent appropriation in section 1324 plainly covers these cost-sharing reduction payments, pending litigation brought by the House Republican leadership--which is currently being held in abeyance in the D.C. Circuit Court of Appeals-- and the current administration's mixed signals as to whether it will continue to make these payments required by law, could generate instability in individual insurance markets. S. 1462 removes all basis for any further questions about what is already clear from a fair reading of the ACA as a whole: both subsidies are to be funded from the same permanent appropriation. In addition, the amendment includes provisions that will strengthen the existing subsidy provisions, and, in light of developments since the ACA was enacted in 2010, make insurance more affordable for beneficiaries and help stabilize State- level individual insurance markets.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, while I am disappointed, I am not surprised that my colleague from Wyoming has objected to our effort to move forward. He is objecting to ending the uncertainty we have experienced, which is forcing insurers to raise rates because of the uncertainty with which this administration is administering the Affordable Care Act. They have been very clear that they want marketplaces to implode so that the act does not work for people. Senator Barrasso is objecting to a commonsense step to stabilize the insurance marketplaces. This is not going to be the last word because this is a commitment we made to American families. The instability here in Washington is what is causing the instability not only in insurance markets but in the country at large. We are approaching the Fourth of July, which is next week. When our Founders declared independence on July 4, 1776, Benjamin Franklin warned that we must all hang together or we will all hang separately. It is no different today. We all need to come together. We need to work across the aisle. We need to improve the healthcare system so that it works for all Americans. That is our goal. That is why we are here on the floor today, and we need to start by making sure the insurers have some certainty so that they can keep rates low for American families. We will be back, have no doubts about that.

Mrs. SHAHEEN. Mr. President, I am very pleased to join my colleague from North Dakota, Senator Heitkamp, and appreciate all of the efforts she is making to try to address the challenges we are facing in the healthcare markets across this country. Like her and like so many of my colleagues who are going to be here, I have come to the floor this afternoon because we want to take urgent steps and we can take steps today to address the uncertainty in our health insurance markets. We can take steps today that can hold down premiums. I have heard Senators on both sides of the aisle who have expressed concern about looming premium increases in the Affordable Care Act marketplaces. We all need to understand, as Senator Heitkamp pointed out, what some of the causes of these premium increases are. Insurers regularly cite the Trump administration's refusal to commit to making cost-sharing reduction payments, also known as CSRs. These CSR payments were included in the Affordable Care Act in order to help Americans afford insurance once they had it. The ACA requires insurers to reduce deductibles and copayments for working families who are buying insurance in the marketplace. Because of the cost-sharing reduction payments, the CSRs, patients pay less for their care and the government reimburses the insurers. These reductions and payments are built into the rates insurers are charging for 2017. Yet the Trump administration has refused to commit to paying these reimbursements because of a partisan lawsuit that has been brought by House Republican leaders. Because of the radically uncertain landscape insurers are facing right now, many of them are doing one of two things: Some are pulling out of the ACA marketplaces altogether, and others are dramatically increasing premiums. The end result is fewer choices and higher costs for American families. Last year in my State of New Hampshire--and Senator Hassan is here. We represent New Hampshire, and we have been very concerned about what is happening right now. Last year, the insurance markets were stable, and health insurance premiums increased an average of just 2 percent-- the lowest annual increase in history. Today is a radically different story, in large part because of the uncertainty this administration is causing by refusing to guarantee insurers cost-sharing reduction payments. What we are seeing is that those insurance companies are protecting themselves by raising premiums on patients. The same thing is happening in other States. In some cases, insurers are filing two different sets of rates--a set that is premised on the administration continuing to make cost-sharing reduction payments and an alternative set with higher premiums to account for continuing uncertainty and the possibility that this administration will stop making those payments. Unfortunately, the Trump administration continues to send mixed signals to insurers, and of course it has threatened to stop paying cost-sharing reduction payments altogether. If this were to happen, insurers could immediately exit the markets for breach of contract. So we are kind of in this perverse limbo situation. The administration creates uncertainty by refusing to commit to continuing the CSR payments, and the insurers protect themselves by exiting the markets or raising rates. And it is the premium holders, the families out there, who are hurt by this political football that the administration seems to be intent on continuing. That is why I have introduced the Marketplace Certainty Act, which is a bill to appropriate funding for the cost-sharing reduction payments in order to make good on our commitment to help working families with their deductibles and cost sharing. I believe that the House Republican leaders' lawsuit has no merit but that the chaos it has caused by allowing the Trump administration to waver on these promised payments requires that we act now. I am pleased to be joined in this legislation by Senators Baldwin, Blumenthal, Cardin, Carper, Coons, Kaine, Hassan, Heitkamp, Cortez Masto, King, Leahy, Markey, Wyden, Stabenow, and I am sure that by tomorrow, we will have even more Senators on this bill. We could pass it right now. Right now, we could end this manufactured crisis. We could immediately restore certainty and stability to the health insurance markets for all of our constituents. That would be good for the Republicans, and it would be good for the Democrats. Mostly, it would be good for the families out there who are experiencing this uncertainty. We could do this. It would give us the breathing space we need to come together on a bipartisan basis to improve the law, to strengthen what is working and to fix what is not. In poll after poll, that is what the American people want us to do. They want us to stop the partisan bickering. They want us to work together. They want us to make commonsense improvements so that this law works for every American. Mr. President, at this point, I ask unanimous consent that the Senate proceed to the immediate consideration of S. 1462, the Marketplace Certainty Act; that the bill 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.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, after weeks of secrecy, after not engaging with the public, after an effort to prevent not only Democrats in this body but women in this body from participating in putting together a new healthcare bill, last week we saw Senate Republican leaders put forward their bill to repeal the Affordable Care Act. Like its companion bill in the House, this legislation imposes draconian cuts to Medicaid, our Nation's principal program for insuring children, people with disabilities, and seniors in nursing homes. It drives up costs for middle- and low-income Americans while delivering huge new tax cuts to the wealthiest in this country. I start with the premise that you can't take health insurance away from 22 million Americans and call it reform or better care. I think President Trump was accurate when he described this approach simply as mean. The fact is, this legislation is a direct threat to the health and well-being of millions of Americans, including tens of thousands in New Hampshire. The opioid epidemic in the country and in New Hampshire is the worst public health crisis in modern history. In New Hampshire, thanks to the expansion of Medicaid, done by a Republican legislature and a Democratic Governor, my colleague from New Hampshire who is now in the Senate, who is here with me today--thanks to their bipartisan work, nearly 11,000 Granite Staters have been able to access lifesaving treatment under the Medicaid Program for substance use disorders. By completely reversing the Medicaid expansion, the Senate bill released last week would cost who knows how many lives and would be a crippling setback in our fight against the opioid crisis. Medicaid covers one out of three children in New Hampshire, as well as people with disabilities and seniors in nursing homes. In concert with the President's budget, this bill being proposed by the Senate would cut Medicaid funding in half by the year 2027. Cuts of that magnitude simply cannot be done without having devastating effects on children and other vulnerable people across New Hampshire. Then, of course, this legislation blocks all Federal funding for Planned Parenthood. We have more than 12,000 Granite State women and men who depend on Planned Parenthood for essential health services, including cancer screenings. According to the nonpartisan Congressional Budget Office, nearly 45,500 Granite Staters would lose coverage under the Republican leader's bill. These are people who rely on that coverage for basic care, as well as for treatment of cancer, heart disease, diabetes, and other chronic illnesses, and they are deeply afraid that they will be among the 22 million Americans who will lose their health coverage if the Senate bill becomes law. Last Friday, Senator Hassan and I convened an emergency public field hearing in Concord. We wanted to hear directly from Granite Staters who would be affected by the Senate bill. I have to say--and I am sure my colleague agrees with me--it was an extraordinary event, with over 200 attendees. They overflowed the overflow room. This is a picture of the room where we held the hearing, and we can see people lined up on either side of the room, waiting to take their turn to testify. Senator Hassan and I heard firsthand from healthcare providers, from people in recovery from substance use disorders, from parents of children with chronic diseases and disabilities, and so many others who are concerned about this legislation. We listened to emotional, heartfelt statements about the uncertainty, anxiety, and anger this Senate bill has caused. I was especially moved by testimony from parents who are worried their children will lose access to the lifesaving treatment they need that for so many of these kids is the difference between life and death. People like Paula Garvey, of Amherst, NH, who talked about her 19- year-old daughter Rosie, who was diagnosed with cystic fibrosis just 2 weeks after birth. Rosie also suffers from juvenile rheumatoid arthritis. Rosie must follow a strict regimen of medications to keep the cystic fibrosis under control. Paula fears that the repeal of the Affordable Care Act and cuts to Medicaid will leave her daughter without coverage for her preexisting condition and that insurance companies will once again impose a lifetime dollar limit on benefits. For Paula, and for any parent, the prospect of not being able to access lifesaving care for a child is profoundly upsetting. Paula said: I don't know what I am going to do if the Affordable Care Act goes away. What will Rosie do when she is off of our insurance and she is not able to find insurance again? Sarah Sadowski of Concord, NH, testified about her 9-year-old daughter who has cerebral palsy. She said: The Affordable Care Act was a huge moment of hope. I cannot face what life would look like with pre-existing conditions, lifetime limits, and countless hours on the phone with insurance companies. At the field hearing, we also heard important testimony about others who rely on Medicaid. For example, Medicaid provides coverage for more than 10 million Americans with disabilities and nearly 6 million seniors in nursing homes. In fact, these two groups alone account for nearly two-thirds of all Medicaid expenditures. Yet the Republican leader's plan to cut Medicaid funding in half over the next decade would have dire consequences for these Americans. Brendan Williams, CEO of the New Hampshire Health Care Association, told our hearing that 63 percent of nursing home residents in New Hampshire rely on Medicaid. As was reported on Sunday in the New York Times, the deep cuts to Medicaid included in the Senate bill would force many retirees out of nursing homes or lead States to require residents' families to help pay for care. For many families, this is just not an option. They don't have the finances to be able to do that. So what happens? Their loved ones get kicked out of their residential care. We also heard compelling testimony from healthcare providers who treat people with substance use disorders. Melissa Fernald is a private clinician in Wolfeboro, NH. She told us: For the majority of [Medicaid expansion] patients, it is the first time they have had health insurance. It allowed me to assist them in properly diagnosing their mental health conditions . . . and securing primary care providers to treat their medical needs. It has been a powerful experience to watch them heal and grow as a result of receiving proper care. . . . My clients are more motivated and capable of getting a job and gaining financial independence. Again, if your heart is not moved by the morality of these kinds of stories and by the values I think we should have in this country to help people who need help, we should be moved by the economics of this. It is going to cost a whole lot more when we kick people with substance use disorders off of their insurance, when they go to emergency rooms to get their care, or when they die than to make sure they get the help they need. The Senate bill to repeal the Affordable Care Act and radically cut Medicaid is a threat to healthcare coverage for people in New Hampshire and in every other State in this country. I am so grateful to all of those Granite Staters who attended our field hearing on Friday. I know that in other States across this country, large numbers of people are turning out to express overwhelming opposition to the Republican leader's bill. I heard this morning that polling shows that just 17 percent of Americans support this legislation. We need to listen. We need to stop this headlong rush to pass a cruel and heartless bill. For ordinary people in New Hampshire--the people whom Senator Hassan and I heard from on Friday--repealing the Affordable Care Act and gutting the Medicaid Program isn't about politics. It is a matter of life and death. We need to listen to the voices of ordinary people whose lives and finances would be turned upside down by this bill. There is a better way forward for both the Senate and our country. It is time for Republicans and Democrats to put ideology and partisanship aside and come together to do what is right for ordinary working people in this country. The majority leader's decision to delay a vote on the bill is an opportunity for all of us in the Senate. When we come back after next week's July 4th recess, let's come together in an open and inclusive process. The right way forward is for Republicans and Democrats to work together to strengthen the parts of the Affordable Care Act that are working, including Medicaid expansion, and to fix what is not working. According to poll after poll, this is what the majority of the American people want us to do. It is time now to respect their wishes and to strengthen the Affordable Care Act so it works for all Americans. I yield the floor.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, last month, Republicans in the House of Representatives passed a healthcare bill. They call it the American Health Care Act. It has been widely described as cruel and poorly crafted. Last week, President Trump described it as ``mean.'' The House bill, by design, would take health coverage away from tens of millions of Americans. It ends the guarantee of affordable coverage for people with preexisting conditions. It cuts Medicaid, which is the principal program for ensuring children, people with disabilities, and seniors in nursing homes. It cuts Medicaid by more than $800 billion, and to compound that cruelty, the same legislation gives an enormous tax cut--over $30 billion--to those at the top of the income scale. We just heard this morning some of what is in the Senate bill, the Senate version of the American Health Care Act. In fact, not only does it not do what President Trump claims the Senate was working on--it doesn't address the mean aspect of it--but it actually makes it worse. In a State like New Hampshire, it provides for even deeper cuts to our expanded Medicaid Program, a bipartisan program that provides for treatment for substance use disorders for people dealing with the heroin and opioid epidemic. It would tax older Americans more than younger Americans for their health insurance and defund Planned Parenthood. There are all kinds of reasons. It would eliminate the requirement that people with preexisting conditions are able to have healthcare coverage. And all of this was done in secret behind closed doors. My office has been deluged with messages from constituents who oppose the Republican leader's bill. This shows whom we have heard from in recent weeks. I have received more than 5,400 messages opposing the bill and 108 in support, so 5,461 are in opposition, and 108 are in support. I am sure my colleagues on the other side of the aisle must be receiving similar volumes of mail and phone calls from their constituents, and they are hearing what I am hearing from my constituents: that if we go forward with this legislation that the House passed and that the Senate is considering, we are going to have people lose their access to healthcare and many people will have to pay more. So I appeal to Republican leaders. I urge you to stop and reconsider what you are doing. I want you to listen to some of the people we have heard from in New Hampshire, everyday Americans whose lives would be devastated by this legislation. Several months ago, I asked people across the State of New Hampshire to tell me their stories about the Affordable Care Act, to tell me their concerns, to let me know how it has made a difference for them. Here we see one of the people I heard from. This is Deodonne Bhattarai and her son Bodhi. They live in Concord, NH. As you see, Bodhi is in a special chair. Deodonne writes: Our three-year-old son is a bright, curious, funny little boy who also has Spinal Muscular Atrophy. That is a degenerative neuromuscular disease that causes his muscles to be very weak. Our insurance initially denied coverage for his wheelchair, but because of the Affordable Care Act-- The ban on discrimination against those with preexisting conditions-- my son is now able to explore his world independently. She goes on to say: I have [read news reports about the Republican legislation], and I fear for our ability to maintain not just insurance coverage but the type of quality coverage my son's life depends upon. Next we have a picture of the McCabe family. They are from Kingston, NH, and this is their story: Our daughter, Ellie, was born with a rare and serious heart defect called Hypoplastic Left Heart Syndrome. You can see Ellie there. She looks like a healthy, inquisitive little girl, and she is looking healthy because she underwent her first surgery when she was just 3 days old. The McCabes go on to say: It terrifies us to think about what would have happened to our family if Ellie hadn't been protected by the pre-existing conditions protections in place thanks to the Affordable Care Act. Without those protections, either we would be in serious debt for the rest of our lives or Ellie would not have had her life-saving surgeries. Next, this is Dr. Marie Ramas. She serves at the Lamprey Health Care Center in Nashua, NH. That is a clinic I recently visited. She wrote to me: I have a 24-year-old patient who was born with a congenital condition that did not allow his leg bones to grow completely. This patient was unable to afford proper care and had been walking with an old prosthetic for the last 3 years. Imagine not being able to get your prosthetic replaced for 3 years. Thanks to expanded Medicaid and to the ACA protections for those with pre-existing conditions, he's now getting quality care and can afford a new prosthetic. So his life has been changed by the Affordable Care Act. I have also heard stories from scores of entrepreneurs and small business owners who have benefited from the Affordable Care Act. This is Steve Roll of Keene, NH, and he wrote: In late 2015, I left my job to start my own business. I've built a profitable business and expect to hire employees within a year or two. Before the ACA, I wouldn't have taken the risk to start a business because I have a pre-existing condition and I wouldn't have been able to get an individual health insurance policy. If the ACA is repealed, I'm concerned that I'll need to put my business on hold in order to go back to a corporate job just to get the healthcare benefits. Well, the healthcare legislation that has been produced by the Republican leadership in the Senate would take away the requirement that people with preexisting conditions have to have access to healthcare. We have another businessperson here, Dave Lucier. He is the owner of Claremont Spice & Dry Goods in western New Hampshire. Dave wrote this: Before the Affordable Care Act, insurance costs were more than a third of my business expenses. Now they're less than an eighth. The ACA made it possible for me to go out on my own and realize my dream of starting a small business here in Claremont. And his business is doing well. Many women have written to me about how the Affordable Care Act has ended discrimination against them by the health insurance industry-- discrimination because of their gender. In particular, they are grateful that the Affordable Care Act includes maternity care and contraception among the law's essential health benefits. This is Maura Fay of Exeter, NH. I talked about her last night when I was talking about the impact of this Republican bill on women's health. Maura wrote: My husband and I are self-employed. Before the ACA, we were paying rates that were simply unsustainable for a middle- class family like ours. When I was pregnant in 2013, we were forced to pay a maternity rider of an additional $822 a month. I'm worried about the rollbacks in regulations around essential health benefits, especially since so many of them impact women. Maternity coverage shouldn't come with an additional $800 a month price tag. Here in Washington, some folks seem to think that repealing the Affordable Care Act is all about politics, that it is about winning this debate. But for ordinary people in New Hampshire--people like Maura, like the McCabe family, like all the people I have shown pictures of this afternoon--for ordinary people in New Hampshire and across America, repealing the Affordable Care Act isn't about politics. For so many of them, it is about life-and-death. It is about the kind of lives they are going to lead. It is about whether they are going to be able to continue to afford healthcare, whether they are going to continue to pay their mortgage and buy prescription drugs. We need to listen to these ordinary people in each of our States whose lives and financial situations will be turned upside down if the Affordable Care Act is repealed. This process has really not been in keeping with our democratic process in America. For the Republican leadership here in the Senate and before that in the House to pursue a partisan approach to healthcare, to deny Democrats and even deny many of my Republican colleagues the ability to engage in the writing of this bill--it is deeply misguided to deny the public access, to deny a hearing on this bill, legislation that we know is going to hurt tens of millions of Americans. There really is a better way forward for both the Senate and for our country. If we put ideology and partisanship aside, if we work together, we can strengthen the parts of the Affordable Care Act that aren't working. We can continue Medicaid expansion so it can help people with substance use disorders, so it can help kids with disabilities, so it can help elderly people in nursing homes. We can fix what is not working, and we can improve on this law and make it better, but we can't do that if we continue to be divided up on our partisan sides, if we are not willing to talk about the issue, not willing to work together. The American people want us to work together here in Washington to address their concerns. Well, it is time to respect their wishes. Let's strengthen the Affordable Care Act so that it works even better for all Americans. I yield the floor.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I am joining my colleagues on the floor this afternoon because I share their concerns about what will happen to women's healthcare. I am concerned about what will happen to everyone's healthcare, but particularly this afternoon we are talking about our concerns with respect to healthcare for women. If the Senate passes legislation like the House passed recently--the American Health Care Act--that legislation has been widely described as cruel and poorly crafted. Just last week, President Trump described it simply as mean. Republican leaders in the Senate are now writing a companion bill that reportedly makes mostly cosmetic changes to the House bill. By some accounts, it would make the House bill even more extreme. Obviously, any legislation that, by design, takes health insurance away from tens of millions of Americans, I believe, is deeply misguided. I am particularly concerned about the harmful effects this legislation would have on women's health. Indeed, I received countless emails and letters from women who are offended that, once again, powerful men are meeting behind closed doors to make critical decisions regarding women's health, and we have been excluded from the room. This Republican bill would take us back to the days before the Affordable Care Act, when insurers could charge women more just for being women, with no other reason needed. It would take away the Federal protections against discrimination based on preexisting conditions. Bear in mind, some of these conditions apply mostly or exclusively to women. In the days before the Affordable Care Act, insurance companies treated pregnancies, sexual assault, domestic violence, and cesarean sections as preexisting conditions. Insurers routinely charged higher premiums to women with these ``preexisting conditions'' or they denied coverage all together. For example, more than 30 percent of mothers have a cesarean section. Once again, if this House-passed bill passes, and if we see something out of the Senate that does the same, women would face discrimination, mothers would face discrimination from insurance companies. The American Health Care Act would also harm women by allowing insurers to opt out of the 10 essential health benefits that all insurance plans must cover under the Affordable Care Act. These benefits are called essential because that is exactly what they are. They are essential, not only to good health but, in some cases, to actually staying alive. A number of these essential health benefits apply exclusively to women, including contraception, maternity and newborn care, mammograms, and cervical cancer screenings. Several months ago on Facebook, I asked people across New Hampshire to tell me their stories--stories about how the Affordable Care Act has made lifesaving difference or otherwise improved their lives. I heard from many women across New Hampshire who have written about how the Affordable Care Act has ended discrimination against them by the health insurance industry because of their gender. In particular, they are grateful that the Affordable Care Act includes maternity care and contraception. This is a picture of Maura Fay, of Exeter, NH. She writes: My husband and I are self-employed. Before the ACA we were paying rates that were simply unsustainable for a middle- class family like ours. When I was pregnant in 2013, we were forced to pay a maternity rider of an additional $822 a month. That is in addition to her premium. She says: I'm worried about the rollbacks in regulations around Essential Health Benefits, especially since so many of them impact women. Maternity coverage shouldn't come with an additional $800 a month price tag. Well, I appreciate that letter from Maura, but I am worried she may actually be underestimating the cost of maternity care coverage if the Affordable Care Act is repealed. According to one analysis, women who seek maternity care under the American Health Care Act--the legislation passed by the House--could pay up to $17,000 in surcharges to their insurance company. The American Health Care Act that the House passed also makes draconian cuts to Medicaid, and this will disproportionately harm women--nearly 40 million women--who make up the majority of Medicaid beneficiaries. Medicaid provides healthcare for nearly half of all pregnant women in the United States, supporting them through their pregnancies and ensuring that their babies get a healthy start in life. This coverage is directly threatened by the Republican legislation. The American Health Care Act the House passed, if we combine that with the administration's budget proposal, it would cut Medicaid by a staggering $1.4 trillion by the year 2027--so, in 10 years, a $1.4 trillion cut. This would reduce Medicaid funding by nearly half and mean that tens of millions of people would lose coverage, including many women of reproductive age. Let me also point out that both the American Health Care Act passed by the House and the President's budget terminate all Federal funding for Planned Parenthood, and we just heard Senator Blumenthal speak eloquently about the importance of Planned Parenthood. This would leave millions of women and families with fewer healthcare options. In New Hampshire, it would mean that between 12,000 and 13,000 women and men would lose access to basic primary and preventive health services, including lifesaving cancer screenings and HIV testing. According to poll after poll, the American people all across the political spectrum strongly support Planned Parenthood and oppose efforts to defund it. Despite efforts by Republican leaders in the House and Senate to misrepresent the facts, Planned Parenthood does not use taxpayer dollars to fund abortions. Indeed, Federal law expressly forbids the use of Federal funds to pay for abortions except under extremely narrow circumstances that have been agreed to by Congress, so the real issue here is not abortion. This is about ensuring that American women have access to the basic healthcare they need where they want to receive it. Remember that Planned Parenthood plays an especially important role in delivering essential health services to low-income, uninsured, and vulnerable individuals, including in rural areas. Earlier this year I received a letter from Samantha Fox of Bow, NH, and she writes: In 2007, I was a 19-year-old just barely starting out when I was denied health insurance due to a preexisting condition. Had I been able to access affordable coverage, my preexisting condition, a reproductive system disorder, would have been easily manageable. . . . [A]t that time, I was able to access care through Planned Parenthood which likely preserved my ability to conceive in the future. Flash forward 10 years: I am expecting my first child and I have coverage which, thanks to the Affordable Care Act, includes prenatal care. Now, here in Washington, some people think that repealing the Affordable Care Act is all about politics and notching a win on their scoreboard. But for ordinary people in New Hampshire and across the country, including millions of women, repealing the Affordable Care Act isn't about politics, it is about life and death. We need to listen to the women and men in each of our States whose lives and finances would be turned upside down if the Affordable Care Act is repealed. Furthermore, it is just wrong to exclude women, to exclude their colleagues, to exclude Democrats, to exclude the public and to pursue a strictly partisan approach to healthcare--the same approach that produced a terrible bill in the House. And it is deeply misguided to bring legislation to the floor that we all know would hurt tens of millions of Americans and do particular harm to women. There is a better way forward in the Senate. Let's put ideology and partisanship aside. Let's work together. Let's strengthen the elements of the Affordable Care Act that are working in the real world, including Medicaid expansion, and let's fix what is not working. It doesn't matter what we call this. It doesn't have to be called ObamaCare. We can call it whatever we want. The important thing is to have legislation that would provide access to healthcare for Americans, healthcare they can afford, that is quality, that is there when people need it. This is what the great majority of the American people want us to do. It is time now to respect their wishes. Let's strengthen the Affordable Care Act so that it works even better for all Americans. I yield the floor.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I am here this afternoon to speak about the amendment to address sanctions on Russia, but I want to preface my remarks by saying, like all of us here in the Capitol today, that my thoughts are with Congressman Scalise and with the staff member, the two Capitol police officers, and others who were part of the terrible tragedy this morning. In particular, I want to salute the officers involved, whose courage and professionalism undoubtedly saved many lives, and I join with the entire Senate family in hoping for a full recovery for everyone involved. Amendment No. 232, as Modified Mr. President, in a few minutes, we will vote on a bipartisan amendment to strengthen sanctions on Russia and to mandate rigorous congressional review of any effort to loosen the sanctions regime. I am pleased to cosponsor this amendment, which has real teeth, including provisions that I advocated for to prevent sanctioned individuals from using family members to circumvent sanctions. I am also pleased that the amendment includes congressional review of any decision to restore Russia's access to non-Embassy compounds that were seized at the end of last year in the United States. I think this is not the time to grant Russia such privileges, especially given that it would bolster their intelligence-gathering capabilities. I am pleased that this is a bipartisan amendment, thanks to the leadership of the chair and ranking member of the Foreign Relations Committee, on which I serve, Chair Corker and Ranking Member Cardin, as well as the chair and ranking member of the Banking Committee, Senator Crapo, who is here, and Ranking Member Brown. They worked very hard to come up with a bipartisan agreement. I also want to recognize Senators McCain and Graham, whose work on the underlying bill gave us a foundation to come up with this amendment. Again, on a personal level, I want to especially thank the chair and ranking member of the Foreign Relations Committee. Senator Corker had made a commitment to get this bill done after we got back from the break. He has been good on his word, and we have a bipartisan agreement. I think these measures are necessary because the United States has been attacked by a hostile foreign power. As a result, we have a responsibility to respond in a way that punishes the attacker and that strives to prevent a recurrence in the future. In January, the Director of National Intelligence released a declassified report on Russia's interference in our election. I think it is important to reiterate what that report said. It states: We assess Russian President Vladimir Putin ordered an influence campaign in 2016 aimed at the US presidential election. Russia's goals were to undermine faith in the US democratic process. While recently we have learned more about the scope of their interference, a classified National Security Agency report, prepared prior to the November election, concluded that Russian military intelligence executed a cyber attack on at least one U.S. voting software supplier and sent spear-fishing emails to more than 100 local election officials. Yesterday, Bloomberg reported that Russia's cyber attack on the U.S. electoral system included incursions into voter databases and software systems in as many as 39 States. We are learning more and more about the extent to which Russia attacked our voting system and tried to undermine our elections. That is exactly why the Senate stands united behind this bipartisan amendment to stiffen sanctions. We must not allow this kind of interference in our elections to become a normal process. What we have heard from experts in the intelligence community--they have warned us that if Russia gets a pass on this, that it will interfere in future U.S. elections. We have seen it in Europe and other Western democracies. In testimony last month before the Judiciary Committee, the former Director of National Intelligence, James Clapper, said: I believe [the Russians] are now emboldened to continue such activities in the future both here and around the world, and to do so even more intensely. He goes on to say: I hope the American people recognize the severity of this threat and that we collectively counter it before it further erodes the fabric of our democracy. Russia's interference in our electoral process should outrage every patriotic American. We need a bolder, more aggressive strategy for deterring Russia. This bipartisan agreement to stiffen sanctions is a critical step forward. In concert with this legislation, we need to be focused on bolstering NATO and our European allies, and we need to demonstrate more vigorous support for Ukraine's efforts to strengthen its democracy and independence. We need to be more aggressive in countering the Russia propaganda and disinformation campaign, including the Russia Today empire. Finally, I want to again applaud the leadership of all of our committees who were involved in coming up with this bipartisan agreement. Also, I applaud the bipartisan leadership of Majority Leader McConnell and Minority Leader Schumer because without their negotiations, we would not be here today. I certainly urge all of my colleagues in both Houses of Congress to promptly approve this legislation, and I hope the President will sign it.

Mrs. SHAHEEN

Mrs. SHAHEEN. Actually, the New Hampshire Hospital Association also opposes the bill for the very same reason. We have hospitals at risk if this bill is passed.

Mrs. SHAHEEN. Mr. President, if my colleague will yield once more, last year we passed the 21st Century Cures Act, which appropriated $1 billion--$500 million this year and $500 million next year--to address the heroin and opioid epidemic we are having, and in the recent passage of the omnibus bill, we got $700-plus million to help us fight this epidemic. So on the one hand, we are putting money in to address it, and on the other hand, we are taking away the treatment people need by passing a healthcare bill that is going to throw people off their treatment and give them no other option to address their substance use disorders.

Mrs. SHAHEEN. If I could just add one more group of folks who are going to be affected by this bill that passed the House several weeks ago. That is our veterans. We have millions of veterans in this country who get their healthcare through Medicaid. We have asked these folks to put their lives on the line for this country, and now we are talking about taking away the healthcare they depend on. I was at one of our community mental health centers in New Hampshire last week and met with a number of veterans who get their care through the expansion of Medicaid. They talked about what it means to be able to get care, to be able to go into that community mental health center and work with the veterans outreach coordinator who works with veterans, trying to make sure they get the help they need. If this bill goes forward, PTSD, which affects so many veterans, would be considered a preexisting condition and they wouldn't be able to get health insurance going forward. This is bill is nothing but mean-spirited. As the Senator said, all of the efforts to save money in the bill are so money can be used to give huge tax breaks to the wealthiest among us. I don't think that is what Americans want. As the Senator says, we need to work with our colleagues. We need to get a good bill that improves the Affordable Care Act, fixes what is not working, and makes it better.

Mrs. SHAHEEN. Those numbers came out while I was speaking on the floor, because I was talking about the first House-passed bill to repeal the Affordable Care Act. What the Senator from Illinois is telling me is that the numbers for the bill they passed to fix the first bill they couldn't pass are just as bad and in some ways even worse than the original bill.