Of the aisle who have stood up to this effort because no matter how many changes have been made in support by senators, this would be devastating. The senators are trying to hide the impact of the bill attempting to keep from a vote before there is a full score and analysis of the bill including estimates for how many people would lose coverage and how Health Care Costs would be affected. We received a preliminary estimate from c. B. O. , saying that previous to the trumpcare this would leave millions of Americans Without Health Insurance because of massive cuts to medicare. We wont see a more detailed score for weeks. The Republican Party is trying to rush this through because of rules that will expire on saturday. Fortunately a number of nonpartisan organizations are publishing data on the latest bill and agreed this would have similar impacts as the previous Trumpcare Bills. Tens of millions of americans would lose health care, states would be devastated, and costs would increase. According to one of the organizations, rhode island is slated to lose 3 billion by 2027 and the cuts only get worse from there. Medicaid would be cut drastically, leaving our most vulnerable citizens with no access to health care. Over 60 of nursing home residents in rhode island access care through medicaid and half of medicaid spending is on these longterm care services. It would become impossible to track these programs with the cuts projected under this bill. In fact, states would be forced to cut not only health care, but also education and infrastructure to try to make up i think try to make up is a better word to use the difference. This would be nothing short of a crisis. We have already spent so much time this year having this fight. The time we could have spent working across the aisle to improve health care and end sequestration and ensure a better budget. After the efforts to pass Trumpcare Failed two months ago, republicans and democrats on the senate health, education, labor and pension joined together in a bipartisan fashion to come up with a bill that would improve our Health Care System and lower costs for everyone. Significant progress on this effort has been made. However, by resurrecting this trumpcare debate, we are again on the brink of voting on whether or not to kick millions of americans off of their Health Care System. We are taking people hostage. Health care experts has said that the instability in washington has caused rates to increase. Whats especially egregious is in addition we also need to extend funding for other Critical Health care priorities like the childrens Insurance Programs whose federal funding expires. The chairman and Ranking Member came to a bipartisan agreement to extend funding for five years to provide assurances for states and families across the country. However, that work is now on hold like the critical a. C. A. Stabilization effort. We must show the majority that this is not what the American People want. They want us to Work Together, strengthen health care, increase access, and keep costs down. The enormous outpouring of Health Care Experts criticizing trumpcare over the summer was a really powerful statement about what the American People, my constituents, and people across the country believe should be the path forward on health care. As my colleagues work to make lastminute changes to the bill and refuse to hold substantive hearings and rush through the bill with little or no warnings, my constituents are not fooled. They continue to write to me to keep up the opposition to trumpcare. Just a week or two ago i heard from barbara from littleton, rhode island, her mother has alzheimers and relies on medicaid for longterm care and her sister has Downs Syndrome and relies on medicaid for her health care. This new proposal, like the previous proposals, would be devastating to barbara and her family. I urge my colleagues to think about who colleagues to think about who would be impacted by this legislation. Whether or not you like obamacare or voted for it seven years ago, this latest Trumpcare Bill is not the solution. I will continue to oppose this efforts and hope to work with my colleagues to improve our Health Care System and lower costs to everyone. With that, mr. President , i would yield the floor. The presiding officer the senator from vermont. Mr. Leahy six years ago when Tropical Storm irene tore through my home state of vermont, i remember it like yesterday, there was a helicopter from the National Guard reviewing the damage many were still trying to recover from it. Days after the storm i came here to this chamber. I asked for the support for vermont to recover and rebuild. I remember, with gratitude, republicans and democrats alike in the senate from across the country stood with the people of vermont. I announced in vermont and elsewhere how much the calls of support from republican and democratic colleagues meant to me. But todayty think we have to do but today i think we have to do the same for the people of puerto rico and the u. S. Virgin islands. More than 3 and a half million americans, remember these are americans, have seen their homes destroyed by a double blow of hurricanes irma and maria. If you look at Satellite Photos of puerto rico at night before the hurricane with lights all over the island, afterward very few lights showing. The vast part of puerto rico remains in the dark. At least 44 almost half of its people are without water. Some estimates put it even higher. The vast majority of hospitals are without power. The food supply is dwindling. There is crippling communication on the island. People cant find out what happened to their families. Were on the jernlg verge of a humanitarian crisis. President trump, fema, and department of defense have to has to act quickly. We have to put the full force of the United States behind these efforts as we would in any state where this might happen. Earlier this Month Congress approved 15 billion emergency funding for Disaster Relief following hurricanes harvey and irma. As vice chairman of the appropriations committee, i was happy to support that. These resources should be put to puerto rico and the u. S. Virgin islands as well. It will not last long. This money will run out in a couple of weeks. We have to sustain our commitments for the long haul to rebuild and recover from all of these hurricanes, not just on the continental United States, but in all parts of the United States which includes puerto rico and the Virgin Islands. I would ask the administration to prepare the emergency aid requested as soon as possible and to and that the house and senate should act very quickly. We have to stand by each other in times of disaster. One of when theres a storm, one of us braces for it, the others have to help pick up the pieces. Thats what we are. Thats why we act. Thats why were americans. Were the United States of america, all of us, and now we must make sure that we respond, not just in texas, as we should, not just in florida, as we should, but in puerto rico and the u. S. Virgin islands. They are part of our country. Mr. President , i yield the floor. The presiding officer the senator from new mexico. Mr. Henrich i hope to move forward in a bipartisan fashion to find Real Solutions to our nations remaining health care challenges. I still believe most of us here in this senate, including senators alexander and murray in the help committee, are willing to Work Across Party Lines to find consensus on pragmatic improvements. That is why i was so appalled that President Trump and Republican Leadership are reviving a lastditch effort to pass a disastrous bill that would up end our Health Care System and take away Insurance Coverage for millions of americans. Worst yet, and even harder to believe, the bill that Republican Leadership is rushing to the floor for a vote this week potentially is actually worse than any previous versions of this legislation. The socalled grahamcassidy bill that they are hoping to vote on would mean higher premiums for worse coverage and millions of americans losing their Health Insurance. It will permanently gut medicaid. Let me say that again. It will permanently gut medicaid. And despite promises to the contrary that republicans have long made, it would end key protections for people with preexisting conditions like diabetes and heart disease. In short, it would throw our entire Health Care System into chaos. That is just awful policy any way you look at it. How did we get here . For over seven years republicans in washington have cheered shortcomings in our Health Care System and blamed the Affordable Care act for every single problem under the premise that they would do better if we only put them in charge. The trouble has been that their opposition to the a. C. A. Has been more rooted in Bumper Sticker politics than it ever was about actual policy or plans to do better for the American People. The longlasting effort on display throughout this year in the senate is only further evidence that President Trump and republicans in congress dont have any Real Solutions to improve our nations Health Care System. After months of negotiations behind closed doors, when the Senate Republicans released their secret Trumpcare Bill in july its contents proved too harmful for passage even in their own caucus. Now they are hoping for one more lastditch vote before the end of september to pass something, anything, to follow through on their reckless mission. One consequence of this legislation that is so important to my home state of new mexico is that if we pass this bill, it will spell the end to any progress that we have made in fighting our nations opioid and heroin epidemic. It is nothing are short of hypocrisy for President Trump to say they are taking this Major Public Health crisis seriously when they are supporting this bill. Ironically the bill before us actually does less to combat opioids than the bill that was too draconian to pass last time. It is not just the Behavioral Health system that will be upended if we end the Medicaid Program. Medicaid pays for seniors in nursing homes, for School Nurses who care for our kids, and for americans with disabilities. And medicaid has been a financial lifeline for hospitals and Health Clinics in Rural Communities across this nation. I know this because ive heard it directly from our Rural Health Providers in new mexico. If we pass these drastic cuts to medicaid some of our Rural Health Providers in new mexico may very well have to close up shop. This is not some partisan assessment. This is what will happen according to many experts and people in the Health Care Field who have nothing political at stake in this debate. The medicaid directors for all 50 states, republican and democratic governors alike, have come out against this bill. Look, i am not outraged about all of this because im a democrat or because of what i think of president donald trump. Im outraged about this bill because of what it will do to new mexico families and to the communities that i represent. If we can halt this mad rush, we could all, democrats and republicans, get to work on the problems with health care that we all agree need attention. And there is work to be done, no doubt about it. There is still time to do what is right for the American Families who elected us to Work Together to make their lives better. The grahamcassidy bill simply doesnt do that. There is still time to change course, to go through regular order, to hold hearings plural and to build a consensus on fixes and improvements to the Health Care System. As senator mccain told us all earlier this year. Weve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle. Well said. There is a better way forward. Im confident that most of us would welcome a bipartisan regular order approach. We need to remember that there are real peoples lives that hang in the balance of this debate. I have heard so many new mexicans talk about what Health Coverage means to them, means to their families. And i dont know about you, but thats whose interests im looking out for. Real Bipartisan Solutions to the challenges in our Health Care System are within reach if President Trump and Republican Leadership would just be willing to let us Work Together to find them. Thank you, mr. President. The presiding officer the senator from massachusetts. Mr. Markey thank you, mr. President. I would like to start my remarks today by offering my prayers and support to the people of puerto rico and to their family members and friends here in the United States, many of whom have still not been able to get information about their loved ones. Massachusetts is home to the fifthlargest Puerto Rican Community in the mainland United States. It is a vibrant community, an engaged community. And since Hurricane Irma and maria, it has been a mobilized community. They are horrified by the images emerging from the island, pictures and video of destroyed homes, massive flooding, widespread devastation. These images are difficult for any of us to see, and for those who have family there, these scenes beg for immediate action. Thousands of families are homeless. Infrastructure is almost beyond repair. And much of the population is without power for an indefinite period of time going into the future. We need to act now. We must treat puerto rico just like any other United States state experiencing a natural disaster. That means the United States should continue deploying our military and civilian assets to provide lifesaving search and rescue, food, shelter and power to residents of the island. And Congress Must act to immediately provide additional aid and funding so that the island can begin the long process of rebuilding. Puerto ricans, like texas, like louisianans and floridians are u. S. Citizens. They are our sisters and brothers, and it is our moral obligation to provide them help and relief in this time of their greatest need. As we Debate Health care, let us remember that in the wake of these devastating storms, puerto rico and the u. S. Virgin islands will have enormous Public Health needs. They will be subject to increased risk of disease, transmission from lack of clean Drinking Water to physical injury from the storm and to mental and behavioral trauma from the remarkable losses they are suffering. And for those who suffer from chronic conditions such as diabetes and cancer and heart disease, finding and accessing treatment will be a daily struggle. Puerto rico is a medical tragedy happening right before our eyes. History will judge us by how quickly we respond to this catastrophe. We should remember that this debate over health care is not confined to just this week, and it is certainly not confined to this building or even to this mainland. Yesterday i held an emergency round table with the leading Health Care Leaders in massachusetts. These are the Health Care Heroes who provide compassion and treatment each day to their patients. They all spoke poignantly about the devastation that would come from repealing and replacing the Affordable Care act. Dr. Peter slavin, the president of the massachusetts general hospital, said to repeal the Affordable Care act would be a horrible sin for this country. But thats exactly what the grahamcassidy bill is. Its a cruel and inhumane sin that would hurt millions of American Families. In some cases this recent trumpcare proposal is worse than the bill before it. The bill uses a totally subjective formula which was changed at the whim of the bills sponsors to vote in favor of it. The bill was nothing more than something that had political Plastic Surgery that had been performed but it was fundamentally the same bill. At the roundtable i held in boston yesterday or to henry dorkin, the president of the massachusetts medical society, said that i fear that if grahamcassidy were to pass we would go back to attending more funerals of children. There is simply no reason to go back to a time when people died of preventable or treatable conditions simply because they did not have access to insurance. Just moments ago we learned that the Republican Leadership will not hold a vote on this disastrous bill. They simply did not have the votes. And right now millions of americans are again breathing a sigh of relief. I applaud my colleagues, senator john mccain, senator Susan Collins of maine, and others in this chamber who are calling for a bipartisan process to strengthen and improve our Health Care System. We have done it before on the opioid crisis. We have done it on alzheimers and other medical research funding. And i still believe we can do it here. We need to do what we have done so many times before and focus on Bipartisan Solutions instead of partisan exercises. I hope that we can put grahamcassidy and other trumpcare proposals behind us and embrace bipartisan negotiations led by senators alexander and murray to stabilize the individual Health Insurance market. Senators wyden and hatch introduced Bipartisan Legislation to reauthorize the childrens Health Insurance program for five more years just last week. There are a number of Bipartisan Health care issues that need immediate attention this week, such as the funding for Community Health centers and extending the number of medicare policies. This bill was not our only option. It isnt really even an option, at least not for those americans with preexisting conditions or who are on medicaid or who need opioid treatment. We need to Work Together in this chamber to improve health in a way that works for all americans, regardless of where they live or who their governor is. That is the responsibility of those who serve here. And now let us have a new beginning where we begin to Work Together to solve those problems. Mr. President , i yield back the balance of my time. A senator mr. President. The presiding officer the senator from delaware. Mr. Carper while the senator from massachusetts is still with us i think i lost my mic. Here we go. While the senator from massachusetts is still with us, i just want to say a couple of things. One, good for you. You just said a mouth full. He said what needs to be said. And what he said is there is not just one or two courses somebody said to me yesterday there is a choice between either single payer or between grahamcassidy. Those are our choices. No, no. I think a far better choice is to, for us to thank you. For us to take the example of leadership set by senators alexander and murray and the committee on health, education, labor, and pensions. They held in the span of, the presiding officer knows, in the span of two weeks, four bipartisan round tables with governors from all over the country, Insurance Commissioners from all over the country, health care providers, insurance, Health Economists to say what should we do . What should we do right now faced with the challenge and maybe the possibility of repealing the Affordable Care act . What should we do . They all said the same thing. Stabilize the exchanges. Every state has a Health Insurance exchange on the individual marketplace. Stabilize it. And they all basically said three or four things in order to stabilize them. Number one, make clear that these costsharing subsidies to help lowerincome people in the exchanges for copays or deductibles, make it clear theyre not going to go away, be around for at least a couple of years. Number two, they said make sure we have either, give the states the ability to create their own insurance plans or create one for the federal government, by the federal government, involving the federal government. The third thing they said is if were not going to enforce the individual mandate i personally think we should. But if were not going to, make sure theres something as effective as the individual mandate to make sure the young people, millennials like my sons are getting their health care. Theyre in the exchanges and helping them make sure there is a healthy mix of people to insure. Those were almost word by word, panel by panel what we heard in four different hearings by the help committee, four different roundtables that preceded those hearings. The all said fix they all said fix the exchanges. I have an old friend, now deceased, a methodist minister for many years in southern delaware. He used to give me this advice when i was governor. He said just remember this, tom. The main thing is to keep the main thing the main thing. Thats what he said. The first time he said it to me i didnt know what he was saying. But i finally figured it out. The main thing is to keep the main thing the main thing, and right now what we ought to be able to agree on is to stabilize the exchanges. Premiums dont have to go up in the exchanges by 30 , 40 . And if we would simply do one thing and make it clear that these costsharing subsidies arent going away, give that green light to the insurance companies, they will reduce significantly Insurance Commissioners across the country will reduce significantly the increases in the premiums. Ive been told by more than a few Health Insurance companies if we would do that and make sure theres some kind of Reinsurance Program in place in effect and also make it clear that if the individual mandate is, continues to be enforced, and if its not replace it with something that is just as good, if we do those three things we can see premiums go down anywhere from 30 to 35 in the exchanges across the country. Who benefits from that mostly . Who benefits from a 30 , 35 reduction in the premiums or exchanges . The folks getting their insurance in the exchange to some extent. You know who else probably benefits even more . Uncle sam. And the reason why is because most of the people that get their coverage in the exchanges benefit from a sliding scale tax credit that buys down the cost of the premiums. And if the premiums go down by 30 or 35 , that means uncle sam, out of the u. S. Treasury, pays less money in the form of those taxpayers. Thats not a bad deal. That is not a bad deal. Our republican friends like to talk about dynamic scoring. Im not sure i believe dynamic scoring is real, but i believe that if we actually do help drive down the cost of premium increases, uncle sam is a big beneficiary of that. The last thing i want to say maybe two things. One, i want to thank senator alexander, i want to thank senator murray for the great leadership, bipartisan leadership that they have shown. I had a chance to go to the bipartisan roundtables a couple of weeks ago. They welcomed people on the finance committee. We have shared jurisdiction, as he knows, with the help committee. But we we had the opportunity in our committee to sort of follow the lead, if you will, of what they are doing on the help committee and do bipartisan hearings and maybe some bipartisan roundtables of our own. But why dont we sort of pick up where we were about a week and a half ago when the prospect of debating and voting on grahamcassidy came out almost for some people out of nowhere and led to yesterdays fivehour hearing in the finance committee, why dont we pick up where we left a week and a half ago and get to work again, get to work again. This is not something we ought to take weeks or months to do. Lets just do the main thing, and that is stabilize the exchange. If you do nothing else, maybe next week or so, lets make it clear that these costsharing subsidies are not going to go away. Not going to go away. We help the people in the exchanges, the premium increases come down, we actually help the treasury. Its not a bad deal. The last thing, mr. President , i want to say is for those people who some people say well, democrats believe the Affordable Care act is perfect, nothing needs to be changed. Its just nonsense. The presiding officer and i, we could sit down and address a number of things that need to be fixed. We arent smart enough to figure out all of them. We need to have hearings and good conversation among ourselves and a broad section of stakeholders across the country. As a recovering governor, former chairman of the National Governors association, i want to hear the voices of governors. I want to hear the voices of the Insurance Commissioners and a whole lot of other people who are affected by this. A whole lot of other people who are affected by this. Every president i think since harry truman has called for a providing Health Care Coverage for just about everybody in our country. Every president. And along the way we have made some advances to medicaid and medicare. Lyndon johnson. We made some advances in the Clinton Administration of orrin hatch and ted kennedys legislation, creating the chip program, the childrens Health Insurance program. But were still a long ways from where we ought to be with Health Care Coverage in this country. Here is the trifecta for where we would like to go, where president s and leaders have said forever we ought to go. Number one, provide Quality Health care for the people in this country. Number two, do it in a costeffective way. And number three, cover everybody, cover everybody. Were doing a lot better job of covering everybody. We still have 20 Million People who dont have Health Care Coverage. Thats down from maybe 50 million a couple of years ago. We still have people who dont have coverage. We still spend more money as g. D. P. For health care than most other advanced nations. We have to continue to figure out ways to get better results for less money and have a real focus on value. Have a real focus on value. There is actually a lot of encouraging work going on in my state, i know in ohio. Places like the cleveland clinic, places like christiania care in my state. A lot of encouraging work going on. We ought to find out what works and do more of that. The last thing, mr. President , i want to give a shout out to senator gary peters and senator duckworth and stabenow and a couple of others who have been focused on a Veterans Health motion to commit, and i just want to say a few words about health care as it pertains to veterans. Sometimes this is lost in the shuffle. The Medicaid Program in our country covers about 20 , 25 of the people who get health care in this coverage, medicaid. Medicare is about 15 . Most, the majority of people who get Health Care Coverage in this country get it through their large group plan. We have maybe 6 or 7 who get their coverage through the exchanges. As a veteran, a navy veteran, ohio state and navy guy all those years ago, retired navy captain, i know that not every veteran actually gets their Health Care Coverage from the v. A. Numbers of them arent eligible for doing that. As it turns out, among the people who receive coverage under medicaid today, a lot of them are old. A lot of them are like our parents, our grandparents, aunts, uncles. The reason why they are eligible for medicaid is because they spent down their resources, their assets, theyre old. A bunch of them have dementia. Maybe their family is unable or unwilling to take care of them. They end up in a nursing home. Medicare picks up the tab. This is like i described it yesterday in our finance committee. Like a tsunami. The baby boomers are moving toward their retirement in retirement, moving into their 70s, 80s, 90s in some cases. A lot of them were old and they have dementia. A couple million of them are veterans who get their Health Care Coverage through medicaid. And you have in ohio and other places like that and certainly in delaware we have huge problems with opioid and heroin. And the biggest form of treatment the presiding officer knows for people with drug addiction in this country is medicaid. There are some reasons why we think its important not to never touch one hair on the head of medicaid, if you will, but to try to figure the changes that we make, we make them in a smart way. Let me say a word about Veterans Health care. My understanding is the last version of the Republican Health care proposal that was not that was pulled today, not to be voted on, im told it cut several hundreds of billions of dollars from medicaid. I believe most everybody says that is true. Not every veteran, as i said, has access to the v. A. For health care. Nearly two million veterans, as i mentioned earlier, about one in ten veterans in this country rely on medicaid for their health care. That includes some 6,000 veterans that are living in my own state of delaware. The Affordable Care act provided Health Care Coverage to some 340,000 veterans in the states that expanded medicaid, 340,000 veterans just in the states that expanded medicaid. For our veterans who rely on medicaid, the most recent trumpcare proposal would significantly scale back benefits or cause them to lose their benefits altogether. And veterans rely on those benefits would see higher Health Care Costs and lower quality care if they can access it all. All the while, we know that veterans are at high risk for serious and complex Health Care Issues because of our service. I just want to close by saying heartfelt, we all know veterans. We have an obligation to those who served us to make sure that we take care of them later on in their lives. We do that in a variety of ways. The v. A. Is much ma lined in my state. They are not perfect, but they do a darned good job. In northern delaware, we have two Community Outpatient clinics, one in dover, central delaware, another one in the southern part of my state. They do a very good job. Were about to open a brandnew 10,000squarefoot communitybased Outpatient Clinic in southern delaware. Having said that, not every veteran in delaware can access those facilities. For them, medicaid is useful, in some cases its critical to having any life at all. Just keep that in mind. As the challenges of our focus that were created by the possible vote here on this floor now averted on the cassidygraham proposal, lets keep in mind as we go forward and in a bipartisan way Work Together to fix the things in the Affordable Care act that ought to be fixed, to preserve those which should be preserved and lets figure out how to do that in a smart and humane way. Also keep in mind the couple Million People who use medicaid are veterans themselves. With that, mr. President , i would note the absence of a quorum. The presiding officer the clerk will call the roll. Quorum call a senator mr. President. The presiding officer the senator from new york. Mrs. Gillibrand i ask to suspend the quorum. The presiding officer without objection. Mrs. Gillibrand i rise to speak about the humanitarian crisis in puerto rico and the u. S. Virgin islands. This is one of the worst disasters our country has ever seen. The men and women and children who live on these islands are american citizens. Do not forget that. They are suffering, and they need our help. They have no food to eat, no water to drink, no power, no refrigeration. If we dont give them help now, then many more people there will die. Far more than those who were killed during the hurricane itself. I urge my colleagues here to think about our fellow american citizens in puerto rico and the u. S. Virgin islands and what they are suffering through right now. Listen to their cries for help. Listen to what one of my constituents said to me. Quote, we need help getting my grandparents to come to new york. Their house is damaged and not safe. My grandfather is 93 with alzheimers. He is bedbound. Hes not been able to walk for over 18 months. My grandmother is 92, diabetic with a heart problem. My aunt who takes care of her is 68, and we think had a brain aneurysm and needs medical care. Please help them. Help to get them to new york. We can pay for the plane ticket. We need help getting them to the airport and putting them on the plane. And this is what another new yorker told me. She said her father is a veteran of vietnam and is a retired new York Police Department lieutenant who now lives in puerto rico. This veteran of the United States military told his daughter that he had suffered from head trauma because he slipped and fell while clearing water that was entering his house. He told his daughter that puerto rico is devastated and looks like an atom bomb has struck the island. Hes without power, cell phone use, water. He told her that Mother Nature had unleashed a monster on them. He said god have mercy on us, and then told his daughter he loved her. This man is a veteran. He served in our military alongside so many other americans from puerto rico, and he protected our country when we needed him, so we need to protect him now. Mr. President , how would you respond if this humanitarian crisis happened in your state or in my state or any other state around the country . Can you imagine what this would be like if it was ohio . Can you imagine what this would be like if it was new york . We would act as quickly as we could. We would give people there every resource they needed to recover. And we wouldnt hesitate, even for a moment. This is urgent and serious, and we have to help our fellow citizens now. Congress must provide the funding necessary to send down every resource available, help them clean up, help them recover without further delay. That includes providing Disaster Community Development Block grant funding, just as we did for the people of texas and florida. We cannot turn our backs on our fellow citizens. I yield the floor. The presiding officer the clerk will call the roll. Quorum call quorum call mr. Udall mr. President . The presiding officer the senator from new mexico. Mr. Udall thank you, mr. President. I would ask to vitiate the quorum call. The presiding officer without objection. Mr. Udall thank you, mr. President. I rise today with my colleagues from the Senate Committee on Indian Affairs, senators heitkamp and senator cortez masto to talk about how the republicans latest and most Heartless Health care bill hurts American Indians and alaska natives. As ive just heard some good news that this bill might not be brought up for a vote this week. But republicans insist that they will continue their efforts to repeal the Affordable Care act and raid the Medicaid Expansion program, which will devastate Indian Country. So this latest withdrawal is great, but theyre saying its not going away, and so we have to maintain vigilance on the one hand this issue. We came together in july when republicans Better Care Reconciliation Act threatened to roll back health care for native American Communities. With that bills defeat, we hoped the jeopardize health care for native americans was behind us and we hoped to begin to Work Together to address the Real Health Care problems that americans face. Given this new threat, my Indian Affairs Committee Colleagues and i must remind this chamber once again that the federal government bears a solemn trust and treaty responsibility and obligation to ensure that native americans receive Quality Health care. Each version of republican repeal we have seen so far violates that trust responsibility. By taking Health Care Away from hundreds of thousands of native americans and abdicating the federal governments native health care responsibilities. If any of these proposals pass, native Americans Health and lives will be endangered. These efforts must be stopped. Everyone familiar with Indian Country knows that the Indian Health service is severely underfunded. Dont get sick after june, was a familiar refrain on many reservations, pueblos, and villages. Limited funding meant medical services were often rationed to only Emergency Care or life and limb. I. H. S. Patients were not guaranteed access to comprehensive medical services, specialized services, or preventive care. The Affordable Care act and the Medicaid Expansion changed this equation and changed it dramatically. The a. C. A. Alone has increased thirdparty billing revenues to i. H. S. More understand that 25 . And medicaid funding for i. H. S. Has increased nearly 50 . Tribal and urban Health Facilities have been able to move away from health care rationing. Medicaid expansion has provided Health Insurance to an additional 290,000 native americans from 492 tribes, almost 90 of all tribes. This includes 45,600 tribal members from my home state of new mexico. Uninsured rates in Indian Country have decreased from 53 for 39 . And many tribal communities uninsured rates are even lower. At the Santa Domingo pueblo in new mexico, 22 of kiwah pueblo Health Insurance patients were uninsured . 2013. In 2016 the uninsured rate was down to 7 . At that santa fe i. H. S. Unit in new mexico, 84 of our patients now have some sort of insurance. On the Turtle Mountain reservation in north dakota, theyve seen a 14 reduction in uninsured tribal members. At the portland urban Indian Health center, the rate of uninsured has gone from 56 to 8 , solely due to Medicaid Expansion. This is impressive. Let me just say that again. Gone from 56 uninsured to 8 . Medicaid expansion has helped make up for this historic underfunding in i. H. S. Services. Thirdparty billing revenue through medicaid now paychecks makes up to now makes up to 35 of the kiwah pueblos total health care budget. Fofor a tribe in new mexico, medicaid makes up more than 75 of their thirdparty billing revenue. And at navajo crown point i. H. S. Hospital, 50 of their budget comes from medicaid thirdparty billing revenue. For seattles indian urban health clinic, medicaid and medicare expansion have resulted in a revenue increase of 146 since 2012. And Medicaid Expansion has allowed i. H. S. To expand services and build new facilities. Kiawah Pueblo Health corporation has used some of its thirdparty billing to offer new specialt specialtycare Services Like obstetrics and podiatry and to build new clinic space. Santa fe i. H. S. Used its additional funds to build new examination rooms for santa clara pueblo, establish a mobile health unit and update outpatient rooms at the main clinic in santa fe. The seattle urban indian clinic uses its additional revenue to expand Patient Services to include a pilot opioid addiction program. In the words of the National Council on urban Indian Health, Medicaid Expansion has been an unqualified success. The a. C. A. Brought new hope to native families and communities. But this latest republican plan will undo this success. Thank goodness its been withdrawn. And that in that plan, they preserve that they will Medicaid Expansion for tribes. This offers a false hope. Like most people on medicaid, tribal members go on and off the roles as their income rolls as their income fluctuates. Proposals like grahamcassidy would continue that they be continue usually enrolled in Medicaid Expansion and work to receive benefits. If not, they will be dropped permanently from the program. Section 128 of grahamcassidy is also being pushed as helpful to Indian Country. This section expands i. H. S. s federally imbursement rate to nonnative providers but real lay it is a veil attempt to buy off state leaders concerned about massive cuts to the Medicaid Program. It will not improve health care tribal facilities. It will undercut the i. H. S. And it will undermine the tribal selfdetermination by bypassing tribal input in the federal medicaid reimbursement process. And there are 30,000 native americans who now have private, individual Health Insurance thanks to the a. C. A. Every republican plan so far strips away the a. C. A. s costsharing subsidies and tax credits that help make private insurance affordable for many of these tribal members and for millions of working americans. The republican bill does nothing to help these native americans keep their Health Insurance. The sponsors can try to dress this bill up, but the glaring reality is is that trumpcare 2 would be terrible for Indian Country. It is worse for tribes than any other proposed repeal plan so far. Its no surprise that prominent native organizations the national Indian Health, the National Counsel congress of American Indians, and the National Council on urban Indian Health oppose grahamcassidy and proposals like it. They join virtually all major patient advocate and you medical organizations in their opposition, including the american heart association, american cancer society, American Lung association, and the american medical association. 80 of the American People disapprove of the republicans attempts to undermine health care. Grahamcassidy is woefully out of touch with the American People and especially with Indian Country. Im glad this bill wont receive a vote this week. Mr. President , just like tens of millions of our fellow americans, tribes, tribal organizations, and individual native americans all around the country are worried what republicans will do to their health care. Ive received a record 15,000 calls, emails, and letters from constituents about health care this year. Almost all of them have been opposed to the republicans relentless attacks on health care. And not a single tribe has reached out to my office in support of this bill. These attacks are happening behind closed doors. There was only one rushed hearing, and it was yesterday. There was no formal Congressional Budget Office analysis, and there has been no meaningful consultation with tribes, although many of us have called for that. There has been no consultation. It is difficult to adequately describe the reckless liness, recklessness and cynicism and cruelty in the republicans rush to tear down the a. C. A. The senate health, education, labor, and Pensions Committee started a bipartisan effort to address the Real Health Care needs in this country. But republicans froze it once grahamcassidy was introduced. And im really hoping now that chairman Lamar Alexander and vicechairman patty murray can get back to the bipartisan work that needs to be done. Other timeessentialive legislation with broad bipartisan support like reauthorization of the childre childrens Health Insurance program and the special Diabetes Program for indians, which need to be enacted before the end of september, were pushed aside. Congress needs to change focus. We need to work across the aisle to meet the needs of the American People. And we need to improve native American Health care. We have come a long way under the Affordable Care act and the Medicaid Expansion, but we are far from being able to declare victory. I echo our colleague from arizona, senator mccain. Given the enormous impact of health care on the lives of americans and our economy, we need to find Bipartisan Solutions through the regular order. Partisan repeal of the a. C. A. Is not right for Indian Country or for america. And now, mr. President , i would yield the floor to my colleague from north dakota, senator heitkamp. I worked many years as attorney general with senator heitkamp. She was a great champion during those years for native americans and specifically for native american children, and shes been an incredible advocate on the Affordable Care act and the good that it has done for native americans. So, senator heitkamp. Ms. Heitkamp mr. President . The presiding officer the senator from north dakota is recognized. Ms. Heitkamp thank you, mr. President. And to my great colleague, one of the nicest people here, senator udall, who always leads with his brain, but we know that his heart isnt far behind. And hes been a tremendous leader and a tremendous advocate and a tremendous collaborate on this collaborator on this allimportant issue. I think we have to acknowledge how grateful we are that the republican bill known as grahamcassidy will not be advanced this week. I dont think its the last that weve heard of it, but it is critically important that now that we have time to talk about the impacts and have time to talk about why it is that we found this bill so objectionable, that we have an opportunity to raise the issues that may have been forgotten. And i think one of those issues is the unique challenges that native American People have in receiving and affording Quality Health care in america. Many of the tribes in my in fact all of the tribes in my state have a treaty right to health care. Its kind of like when they say under the Affordable Care act, you have access to care, but if the care is lowquality, if the care is unavailable, if the care is not something you can afford or that will actually provide the kind of services that you need, its really its really not fulfillment of the treaty obligation. So one of the things that we know is that many of the programs within the Affordable Care act have gone a long way towards meeting the federal governments treaty responsibility to provide health care to native American People. And so when we talk about how grahamcassidy would hurt seniors, children with disabilities, individuals with preexisting conditions, like asthma or cancer, those receiving treatment for opioid abuse and many, many more, but too often in those statistics which would encompass very many native American People who unfortunately have high rates of chronic conditions, the specific and unique needs of native populations are forgotten during debates in the congress. It happened when republicans tried to pass their initial Health Care Bill over the summer, and it nearly happened again. And here we are on the senate floor to make sure native communities are not left behind during these discussions. In the future we will be watching to make sure that communities in our state, unique and discrete and in fact treaty tribes that are entitled by contract, by treaty with the United States government to health care, that their interests are heard and that their voices are heard. In july when the senate was discussing the last Republican Health care bill that would have taken Health Care Away from north dakota families, i worked with senator udall, vice chairman of the senate Indian Affairs committee to hold a discussion on Tribal Health care. The purpose was to hear directly from tribal leaders, including the chairman of the Turtle Mountain band of chi chippewa indians on how bad that bill would have been for Indian Country. During that discussion in july, we lamented i think those of us on the committee, especially the minority members that what happens in the Indian Affairs committee all too often stays in the Indian Affairs community. What do i mean by that . I think the stories that we hear and the challenges that we hear for native people, that we respond to many times with great empathy are never taken out of that committee room. Theyre never understood broadly by senators in this chamber. And so we vowed that day that we are never going to leave those challenges in that committee room. We are going to take those challenges to this form and to this floor. So we want to share our concern about the lack of tribal consultation in the health care debates so far. Unfortunately, the grahamcassidy Health Care Bill still does not remotely or adequately protect native people. Just look at the opposition of the bill from the National Congress of American Indians, the national Indian Health board, and the National Council of urban Indian Health care. This bill is just as bad if not worse than the previous bill. And to push it through without adequate consultation in ways that would fundamentally change our Health Care System is in no way putting the Health Care Needs of people first. It is putting politics first. And it is irresponsible and unconscionable. Those of us on the Indian Affairs committee know undoubtedly that the Indian Health service is severely underfunded and some of us would argue inappropriately managed. Its been that way since ive been here. We have experienced those challenges of lack of leadership, lack of funding, and really an attitude that this is the way weve always done it. And its resulted in very many of our institutions losing their c. M. S. Certification. That is unacceptable. The stories are unacceptable. But we also cannot just pin it on Indian Health. We have to recognize and understand that this is also a funding problem. So it is essential that we find resources to fill those gaps. And enter the Affordable Care act where we not only have traditional medicaid eligibility, but we also have expanded medicaid which now has given that extra hope to Indian Health care providers that that resource can be made available without constantly having to beg for Additional Resources to Indian Health. And so it is particularly because of these severe challenges that at independentian health Indian Health service that traditional medicaid, Medicaid Expansion and private Health Insurance access have been critical for Indian Country. Making sure native americans can access quality, Affordable Care to keep them and their families healthy. Thanks to the increase of thirdparty payment, we are no longer limited to life and limb care at tribal and i. H. S. Facilities in the great plains i. H. S. Service area. But grahamcassidy Health Care Bill would undo all that progress. It would slash Medicaid Expansion and cap the federal contributions to traditional medicaid pushing those remaining costs on to states and counties that can ilafford it. Medicaid expansion has Significant Impact on i. H. S. Services at Turtle Mountain. Increasing the funding and Resources Available to its Patient Population by increasing Health Care Services, increasing purchase reference care, p. R. C. Service, and increasing revenue generation. Here are just some of the statistics that show how Turtle Mountain i. H. S. Hospital has been impacted by the Medicaid Expansion. A 13 decrease in uninsured. A 30 increase in medicaid coverage. A 13 increase in traditional medicaid coverage. A 57 increase in private Insurance Coverage. A 9 increase in the number of individuals served. A 43 increase in revenue generation, i. E. , collections. And a 32 increase in purchase reference care referrals. Now, that may sound like its good for the institution, but when its good for the institution, the health care provider, it is good for the families that get their services there. So thirdparty billing revenue has also allowed the hospital to make renovations to Emergency Rooms and clinics, purchase new medical equipment, including neonatal monitors, recruit and hire additional staff, including licensed professionals, increase staff training and education, provide wifi throughout the hospital and expand its allimportant Behavioral Health care facility to serve more patients. But the Republican Health care bill would have eliminated these costsharing payments that make private Health Insurance affordable and accessible to American Indian families and north dakota indian families. For the first time all through the country, you hear this over and over and over again, in pockets of poverty in this country. For the first time in peoples lives, they have an insurance card. And that is a ticket to a future. Without an insurance card, many times people are left behind. So this is an issue ive spoken about multiple times because it is so important. In north dakota the republican bill would have caused an estimated almost a thousand native americans to lose their costsharing reduction payments. The Republican Health care bill would also jeopardize Mental Health services, all important Mental Health services for native youth and remove a traumainformed approach to students education. The nation from my state is working to set up a Mental Health pilate program in their schools next year. In this this partnership that will bring social workers and a satellite clinic to school campus, this Pilot Program will be paid for by medicaid. In the grahamcassidy Health Care Bill, that cut 1. 5 billion from traditional medicaid in north dakota by 2036 affecting 36 ill say that again 36,000 low income not people but low income children. The tribe and the north Dakota Department of public instruction are relying on those medicaid dollars to keep this Mental Health program possible, which will keep kids in the classroom and their communities while they are provided services. Quite honestly, keeping children with their families, which is a longstanding challenge as we see the history of trauma, childhood trauma beginning at the time of not only the westward movement of families like my ancestors but the trauma that was experienced when children were ripped out of their home and taken to boarding schools, a trauma that many native American Communities have not yet recovered from. So sadly this plan would take a significant step backwards in health care for all americans. And it certainly falls short on our promises and our treaty obligations to native americans. With so much at stake in our Health Care System, its critical that we talk take a thoughtful and inclusive approach to health care. And in fact, Health Care Reform that considers the needs of all americans, including in my case the first americans, native americans. Republicans need to work with democrats. Ive been saddened when i hear last night during the debate a discussion about how there isnt any opportunity for bipartisanship. I like the 30 of my other colleagues attended meetings held by the help committee before their hearings, 30. Think about this. 30 United States senators at 8 00 in the morning without a mandate, no obligation to be there, completely voluntary, came together in three mornings to talk about how we can Work Together, bipartisan on health care, a bipartisan group. When people say its not happening, it clearly is happening. It is clearly happening that we can, in fact, get to yes on many of the challenges that we have in health care, but we cant get to a lasting system if it is something thats done in a back room in the dead of night without consultation, not just with other members of this body but with consultation for groups like native american, tribes and native American People. So over the past four and a half years, ive offered reasonable reforms that should be bipartisan to make the current Health Care System work better for North Dakotans and better for those citizens and my constituents in Indian Country. Over the past few months and years, ive met with a group of republican and Democratic Senators to talk about reasonable reforms that would make Health Care Work better. You know, if we just focus for a minute on what unites us and what we can do, if we just set aside partisanship, if we simply believe that we can in fact bury partisan hatchets and begin the work of working together. I want to say one last one last kind of discussion. Many times when you hear people talk about treaty obligations for health care or education, its usually people on this side of the aisle who are talking about tribal sovereignty, tribal treaty rights. Well, i was in i was gladdened to hear my colleague from south dakota talk about a treaty right that tribes in his state have to health care. Now, the solution there was to ask the federal government if in fact that citizen of that state, was a native american enrolled, to say that really was a treaty right. So the federal government should pay a hundred percent of that even though your state match would be 5050. That makes sense. I can buy that. But you know what . That does nothing to expand health care to native people, nothing. What that does is said that 50 that youre currently paying because these are citizens of your state, not some, you know, kind of nonresident, these are residents of your state, citizens of your state that you pay that additional 50 for. You know, if the argument had been were going to take that additional 50 . The federal government is going to pay it and were going to augment what we do in health care for this population, then were actually getting somewhere. Then were actually accomplishing something for native American People and native american children. And i want you to understand that this is a population that suffers diabetes at record rates, hyper tension, behavior and Mental Health, including serious, serious addictions, record and epidemic suicides among young people all through Indian Country. Prord and epic record and epic amounts of opioid and meth addiction, children being born addicted. We need interventions now. We do not need to see a reduction in support to health care, both behavior and Mental Health care right now. It is now, it is crisis. We need to do everything we can to consult with the tribes, to consult with indian Health Care Leaders, to consult with the people who do this work for a living and fashion a system that will expand and grow access to health care. It is critically important and make no mistake. These are the first americans. Way too often the asterisk americans. What do i mean by that . Theyre large enough to have a demographic category. So their challenges are not tracked, whether its human trafficking, whether it is addiction. And if we do not begin to focus on this, we will fail in our treaty obligations. The United States of america signed a treaty with indian people. Lets keep our word. Lets Work Together. Lets work in collaboration with many, many of the people in my state who are struggling to make ends meet. Lets not reduce services and resources. Lets not take a step backwards. Thank, mr. President. I yield the floor back to my colleague in new mexico. The presiding officer the senator from new mexico. Mr. Udall thank you. Let me thank senator heitkamp for her great advocacy for native americans. I have known her for a long time. Whether she was the state tax commissioner for north dakota or attorney general, she has always been a great advocate for the native american tribes. She is one of the hardest working members of the senate Indian Affairs committee and brings a great bipartisan approach to this and we look forward to doing more of that in the future. I also would say to the presiding officer here, he has shown bipartisanship on opioids, which we have an epidemic. We can show there is bipartisanship. With that, mr. President , i would ask consent for myself and senator Cortez Mastro to engage in a colloquy and yield to her. The presiding officer without objection. Ms. Cortez masto thank you, mre Ranking Member, senator udall of Indian Affairs. I am glad to be working with you in a bipartisan way and i am also proud to represent the great state of nevada. Nevadas tribal communities deal with many of the same challenges that plague many communities throughout the United States. Indigenous people suffer from higher rights of illness and Substance Abuse than the general population. I recently received this communication from the walker river chairman amber torez about the importance of the expansion for her community. She said i feel this would be detrimental for the people. With this coverage we have been able to obtain services for our male and childless adult population. Our people have been able to obtain services that do not qualify through the Indian Health services. She goes on to say, a large portion of our reservation is covered by the expansion and has seen their Health Ailments addressed in a timely manner due to alternative means of coverage. She says, we have seen our covered recipients per sentage go from per sentage going from 50 to 45 . If Medicaid Expansion is repealed, what is the alternative for these people . Historically Indian Health services has only been at a medical level priority one for our Service Delivery area, which means leading blind, broken or dying, is this what we look forward to going back to . This is a question a lot of native americans are asking now and a question i would like to pose to Ranking Member udall. The federal government has a responsibility to the native communities. Would rolling back expansion in nevada and other states like mine result in prea. C. A. Coverage and care as chairman torez discussed . Mr. Udall mr. President , and senator Cortez Mastro, thank you so much, and thank you for bringing the statements forward from chairwoman torres. She has every right to be concerned. The short answer is, yes, we dont want to go back. Tribal leaders across the country want to know how this bill would impact their members. But as senator heitkamp highlighted, Republican Leadership is not engaged in any meaningful tribal consultation. I knows that something that i know thats something that concerns you a lot. You always raise that issue, tribal consultation, how born how important that is and that did not occur. Repeal of the Medicaid Expansion would put millions of dollars out of critical and pull those dollars out of critical funding from the Indian Health service and return the entire system to life or limb. Medicaid funding at i. H. S. Has increased by over 42 million since the Affordable Care act, and that has been an increase of 43 . Under the a. C. A. Tribes and urban Indian Health facilities have offered a wider range of Health Care Services to native americans, things like obgyn, podiatry and Behavioral Health. I mentioned the old official i. H. S. Motto several times, dont get sick after june. This was a motto because the Indian Health service would run out of money after june. And so what people would say with regard to their health care in Indian Country, dont get sick after june. Prit pretty outrageous situation. In practical concerns, that led to the health care rationing. Imagine living in that sort of Health Care System where diabetics are told help is only available once their kidneys start to shut down, where expectant mothers cant access prenatal care. The reality is grahamcassidy, and we hope another proposal doesnt come forward like grahamcassidy, we know that they buried that today, would turn back the clock in Indian Country taking this back to the days of life and limb. I want to thank senator Cortez Mastro for her great advocacy for native americans. I know very well her work as state attorney general. I know she worked with tribes, wanted to work through problems rather than litigating them all the time. I just wanted to say to your chairwoman there in nevada that we really appreciate her hard work on behalf of her tribal members and other tribes around the country. I would yield to the senator from nevada. Ms. Cortez masto thank you, mr. It is true that Indian Country made significant gains under the Affordable Care act. Before the a. C. A. , Indian Health services regularly denied tribal members for claims for basic cares like mammograms, health screenings, or diabetes care. Because of the chaos that the Trump Administration has, this has gotten worse many insurers are pulling out of a. C. A. Exchanges thanks to the uncertainty these continued efforts to repeal the a. C. A. , like grahamcassidy, are creating in the health care market. Democrats are ready to work with republicans to fix the problems with the Affordable Care act. We want to provide certainty that brings insurers back into the Health Insurance marketplace, lower premiums, and Prescription Drug prices, and improves health care. We cant kick millions of people, including members of the walker river tribe and the hundreds of other tribes in the nature in the state of nevada off of their health care. No one in this country should be forced to choose between paying their medical bills and putting food on their table. All too often our tribal members are confronted with that very choice. I will not stop fighting to oppose these efforts to take away the health care of native communities in nevada and a million more americans throughout our country. It is time we worked together. Thank you, mr. Vice chair, and i will yield the floor back. Mr. Udall thank you very much, mr. President , and thank you senator Cortez Mastro. You can, at least today, tell your chairwoman, that this bill has been withdrawn. There is not going to be a further vote on it. I would urge her, and i know you know this well, we need to stay vigilant. It can be brought up any time, it can be attached to a major piece of legislation moving forward and so urge her to continue this great advocacy and we appreciate your great advocacy and i would yield the floor and note the absence of a quorum. The presiding officer the clerk will call the roll. Quorum call quorum call i quorum call mr. Nelson mr. President. The presiding officer the senator from florida. Mr. Nelson i ask consent to vacate the quorum call. The presiding officer without objection. Mr. Nelson mr. President , i am, want to express my appreciation to the fellow senators who have come up innumerable times to express their regrets for what has happened to florida, as we did with our colleagues from texas with regard to the hurricane in texas. And indeed, it was an unusual storm. The very almost Gold Standard storm of hurricane andrew 25 years ago, it crossed the state of florida in four hours, and it was small in diameter compared to this present hurricane that hit florida and traveled right up the peninsula and, therefore, covered up the entire state. And so for the past few weeks traveling all around, there was vast devastation either by the wind or by flooding. Its really hard to believe that a state as large as ours could be virtually covered up by a storm. There was limited access to critical supplies like gasoline gasoline, and some places sustained considerable damage. I remember down in the keys at the part that hit the northeastern quadrant of the eye wall of big pine key, i went to a trailer park, a place of mobile homes, and there was not one mobile home that was sitting upright. They were all turned on their side or turned over on their roof. It was something that you just cant believe the force of the wind. Now, the cost of rebuilding is going to be in the billions. We have done a temporary measure of 15 billion. Thats running out. Were going to have to do something in the immediate for the Virgin Islands and puerto rico, but there is going to be a continuing cost in texas and a huge cost in florida. Many people have been dislocated, and they are unable to move back into their homes. You take people in the florida keys. There is a tourism economy there, and to have a tourism economy, youve got to get the Service Personnel back in. Well, they dont have any homes. And so you have got to bring in temporary housing. And in the keys, theres one way in and one way out, and so thats going to take some time. And then sadly in the tragedy of all tragedies, 11 frail, elderly seniors died in a hotbox that was a nursing home that had lost power and the generators that were required under existing law, existing regulations of the state of florida, the generators were for putting back on the lights. They werent the generators sufficient in order to run the air conditioning systems. And 11 Senior Citizens perished. And that was after a number of calls that had been made to the governors cell phone and calls that were made to Florida Power and light. And there is a criminal investigation that is under way that will answer some of the questions of why as they pled for help to come and to get back on the power, why were those never answered and as a result 11 people have died . Something like that just simply shouldnt happen in america, a country that has the resources and the compassion that our people have. Well, i want to say that if people cant get through in an emergency like this to a federal or state agency, i want them to call me at my office, 407 area code, 8727161, or the watts line 8886714091, or visit the website at billnelson billnelson. Senate. Gov. Well get to the bottom of it, because in an emergency situation like that, with peoples lives on the line, that should never happen again, and im so proud of the people that when in our office so diligently and we had many of the employees here in the Washington Office go to florida as eyes and ears out there in the community before fema could get in to register people for individual assistance because they couldnt get through if they had cell phones and the Cell Phone Service was spotty, they couldnt get through. We had people out there in the field, signing people up and getting it to fema for the individual assistance. And our folks in the florida and the florida staff as well as the washington staff that went down there, they did a wonderful job. And they worked their fingers to the bone, and they worked their hearts out, and i want them to know how much i appreciate that serving the people of florida in need. And its important that those of us in Public Service respond with urgency and purpose when somebody calls for help. And that applies to all of us in Public Service. I was really heartened by what i saw all over florida. I saw people helping people. I saw frail elderly that had no place to go, were taken in florida girls dormitory that had air conditioning, and they took care of them for four nights, eight frail, elderly women. I saw people helping people in belleglade. Senator rubio and i went together to belle glade and served food. We went to thank those students in that dorm near amokolee. We thanked them together for people helping people. Now what we need to do is to take that same effort that we saw in texas and that weve seen in florida of people helping people, and we have got to help the people of the Virgin Islands and puerto rico. Over the weekend, the fullscale devastation now of the third hurricane the first texas, the second florida, and on up into the southeast and now the third one. Not only hitting the Virgin Islands like the former one did, but just ripping up puerto rico. Ive talked to the governor, and he says the island faces a humanitarian crisis, and the devastation over this past week has become a lot clearer to us as we start to see all of the devastation on our tv screens. According to one report and i quote Hurricane Maria whipped puerto rico with irmalevel winds, drenching the island with harveylevel flooding, crippled communications, decimated buildings and damaged the dam that puts the downstream residents at risk of a catastrophe, end of quote. Thats what our fellow americans are facing right now down in the caribbean. We need to act with urgency and purpose to aid puerto rico in their time of need. I will have a chance to go down there on sunday. I want to see it firsthand, and i will continue to carry this message that the United States congress has got to come to the aid of our friends in the Virgin Islands, our fellow citizens in the Virgin Islands and puerto rico. So i have talked to the department of defense and said do everything that you can do to assist, and they are trying. And i have talked to the f. A. A. Administrator. Just the simple thing of being able to have instrument landings after so many of the radars got knocked out, and heres one example of just a practical problem facing the island as if they didnt have enough practical problems to begin with. Look at the financial crisis. Look at the medicaid funds which are going to run out. Thats before the hurricane. Look at the zika crisis in puerto rico. And thats before the hurricane. Think what its like now. So heres an example. So one of the resource on the top of a mountain gets taken out by the storm. All right. We need to get it back up there. We need a helicopter and can get a helicopter to take a radar up to place it there because the roads are impassable. But now theres a cloud cover up in the mountain. They cant fly up. And so one problem come bounds another so we can get instrument landings coming in to puerto rico instead of the visual flight rules where you have to keep so much more distance from the planes. And just think, if we end up having to have an airlift in order to get food and supplies into puerto rico to keep them alive. So nows not the time to talk about their former financial problems about the debt payments to bondholders. In a crisis, all that matters is saving the lives and giving people the resources they need to get back on their feet. Im hopeful that our colleagues will see the urgency of the situation in puerto rico and the u. S. Virgin islands in addition to the ongoing troubles in florida that will continue for some time, and i expect texas as well. And i hope that we can Work Together to get an aid package soon that helps all of those affected by the storms as soon as possible, because why . We are all americans. We need to act like it. We need to come together and get on the long road to recovery. Mr. President , i yield the floor. The presiding officer the senator from ohio. Mr. Portman mr. President , first to my colleague from florida, thank you for your report to your state and for the words about the devastation in puerto rico. Our hearts go out to those in florida, in texas, the Virgin Islands, in puerto rico. We do have a responsibility to respond quickly. We are responding from devastating storms, unprecedented, really, when you combine them. Our thanks also go to the First Responders and to the many volunteers, including some from my home state of ohio and my own town, and the neighbors who have stepped forward to help those people in need. It has been extraordinary. And again, i look forward to working with my colleagues on coming up with additional assistance as we have already for some of the initial damage in texas. There is so much more now that we must do. I rise today, mr. President , to talk about one of our colleagues here in the senate who has an inspiring story and is celebrating an important anniversary this week. I want to mention this week doorkeeper tim oneill, who works with us all here in the senate, celebrates 27 years of government service. He has been a doorkeeper since 2010, during which time i have had the pleasure of getting to know tim, as have many of my colleagues in the United States senate. His career has been a remarkable journey. It started here in the senate where he was a legislative director, later went on to work in the white house. Not just during one president ial administration but during four president ial administrations. Tim worked for president s ronald reagan, george h. W. Bush, george w. Bush, bill clinton. He worked in the department of the treasury and then at the federal Housing Finance board, eventually becoming chairman of that agency. After that, he wept to the house of representatives where he was senior legislative counsel for the Financial Services committee. Were happy to have tim back here on the senate side where he works today. Tim has had an impressive career, as i have outlined, but the most amazing thing about his career doesnt reside in what hes done but what he has overcome. One weekend in january of 1989, when tim was at the treasury department, his life was altered forever. It first changed on the friday morning of that weekend when he found out his wife jenny was pregnant with their first child. But later that weekend on a sunday, he was putting on his shoes to go jogging, 34 years old, and he suffered a major stroke that affected twothirds of his brain. The doctors didnt originally tell jenny how serious it was. Later she would find out that they did not believe that he would live through the night, and if he did, they believed that his lasting brain damage would mean that he would never walk again and never talk again. Despite this very grim prognosis, tim had a few things going for him. First his incredibly positive attitude that we all see every day here in the senate. Second, he was young and athletic, which improved his chances of recovery. He also talks about his irish determination which made him resilient, and he had the knowledge of knowing that jenny was pregnant and he was absolutely committed to being part of his daughters life. In fact, one of the few things he said he remembered in his initial stages of recovery was that jenny was pregnant and that he had a daughter coming. When he began regaining his speech, the first thing he told jenny was that he was going to r the path was not seescy. In those first few months, he worked eight hours a day. He worked with speech and physical therapists a understand with jenny at his side, he put in overtime every day. The extensive road to recovery was daunting. A harvard educated lawyer in the middle of a sophisticated career had to relearn how whod,
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