S3020 CONGRESSIONAL RECORD — SENATE May 22, 2019 those who serve in our community hos- one-size-fits-all healthcare plan passes? want a one-size-fits-all healthcare sys- pitals. I actually know many of these Just ask , of all tem. Many doctors and many small healthcare providers because I am one people. Last month, the Times ran community hospitals cannot afford it, of them. For many years I practiced or- with this headline: ‘‘Hospitals Stand to and they will not survive it. Certainly, thopedic surgery in Casper, WY. I was Lose Billions Under ‘Medicare for many rural communities can’t survive a medical doctor, a physician, and All.’ ’’ Hospitals stand to lose billions. it. chief of staff at the Wyoming Medical The Times cites a study from George As the Presiding Officer knows better Center. Mason University that found Medicare than most, as he has traveled his State When practicing medicine in Casper, provider reimbursement rates are more and as I have traveled mine, if a small WY—or anywhere in the Presiding Offi- than 40 percent lower than private in- community loses a hospital, it is hard- cer’s home State of Nebraska—you surance rates—40 percent lower. At er to attract doctors, nurses, teachers, really treat patients from all over the these payment rates, the Times says, businesses—all of the things that are State. That is because many people in ‘‘[s]ome hospitals, especially strug- vital for a community to have. So the Wyoming live in small towns. I am gling rural centers,’’ like those in the threat is very real in terms of what the talking about patients in towns like Presiding Officer’s home State and Democrats and what my wife’s hometown of Thermopolis, mine ‘‘would close virtually over- and the one-size-fits-all healthcare WY. My wife’s parents are there. When night.’’ plan would bring to our country. they need specialty care, they go to There would be an overnight closure Let me just tell people who are Casper. For those who haven’t traveled of hospitals under BERNIE SANDERS’ watching the debate right now: Demo- in Wyoming, it is about a 2-hour drive and the Democrats’ one-size-fits-all crats’ one-size-fits-all healthcare— one way when the weather is good. scheme for medicine in America. what this will mean for you is that you My point is, when you work in the I am sure a lot of people listening out will pay more to wait longer for worse Casper hospital, you are actually cov- there are thinking, maybe it is all a care. That is what it means. That is ering a large area in our State, and mistake; maybe Democrats don’t really what it means to you. You will pay that is often the case in many States. mean to threaten hospitals. Well, the more to wait longer for worse care. So when I hear that Washington Demo- fact is, Democrats have long argued That is what is at stake. crats want to have a one-size-fits-all that hospitals need to close. That is We all need to make our voices heard healthcare plan, I wonder if they have what they have said. loud and clear: no to Democrats’ one- given any thought to people in the Na- Look at what Dr. Ezekiel Emanuel, size-fits-all healthcare scheme, yes to tion’s heartland, to people out west. who is an architect of ObamaCare and real reforms that improve healthcare Are they considering people in rural a professor in Philadelphia, said on the and bring down the costs for all Ameri- communities at all? subject. He actually wrote a book out- cans. I will state that I think about the lining all of this. It is titled, ‘‘Rein- I yield the floor. people of Wyoming every day. I am venting American Health Care.’’ I suggest the absence of a quorum. there every week. The staff at small He predicted that 1,000 U.S. hospitals The PRESIDING OFFICER. The hospitals who serve rural communities would close by 2020. Well, we are ap- clerk will call the roll. like Thermopolis, Rawlins, Lusk, proaching that year. We haven’t closed The bill clerk proceeded to call the Kemmerer, and at the Lovell hospital, 1,000 in this country, but over 80 have roll. where I attended a health fair this past closed, and those are rural hospitals. Mr. CORNYN. Mr. President, I ask Saturday, talking to all of the folks Last year he published an op-ed in unanimous consent that the order for there—their needs are things I am not the New York Times—the same Dr. the quorum call be rescinded. convinced Washington Democrats have Emanuel—ominously titled, ‘‘Are Hos- The PRESIDING OFFICER (Mr. any knowledge of or care for at all. The pitals Becoming Obsolete?’’ He writes: LANKFORD). Without objection, it is so people at these hospitals work hard Hospitals are disappearing. While they will ordered. just to keep the doors open so that never completely go away, they will con- ENERGY INNOVATION they can continue to care for patients tinue to shrink in number and importance. Mr. CORNYN. Mr. President, it seems right there. This is inevitable and good. a bit surreal but necessary, nonethe- So alarm bells go off when I see head- Well, not in rural America—‘‘good,’’ less, to come here to the Senate floor lines like the one from the Washington he says, that thousands of hospitals to talk about the perils of Post that said: and patients who rely on them are and its sudden resurgence within the ‘‘Who’s going to take care of these peo- forced to close their doors for good. I Democratic Party. ple?’’ As emergencies rise across rural Amer- disagree fundamentally with this prin- We have seen our Democratic friends ica, a hospital fights for its life. ciple and what he is saying. push for policies like Medicare for All, That is the headline in the Wash- Of course, all people who practice which would completely wreck the sys- ington Post, referring to a community medicine in small towns want to keep tem that provides healthcare for our hospital in Osage County, OK. The hos- the doors open because they know the seniors and force all Americans onto pital has a sign out front that reads: impact on the lives of the people who the same plan, regardless of the fact ‘‘A small community is only as healthy live in those communities. Just last that they never paid anything into it, as its hospital.’’ That is the truth. week I had a chance to visit with Dr. like our seniors have, and regardless of Hospitals across rural America are Mike Tracy, a family physician in Pow- the fact that they may indeed like struggling. Many are, in fact, fighting ell, WY. He is past president of the Wy- their private health insurance that for their lives. Still, Democrats are of- oming Medical Society. He is pas- they get from their employers. fering a plan that will destroy private sionate about caring for his patients, Do you remember when the Obama health insurance in America, which is and guess what. He doesn’t participate administration promised in 2013, ‘‘If the lifeblood of our Nation’s healthcare in Medicare at all. Instead, he provides you like your plan, you can keep it’’? system; 180 million Americans get his services privately by charging his Well, I don’t really think they meant their insurance this way. patients a set, transparent monthly it, but that is at least what they said. Democrats want to drastically reduce fee. He does what he does to keep his Democrats have gotten so much more provider payments which, of course, practice open. His focus is on his pa- radical today that their motto should would drive many doctors from prac- tients, not on Washington paperwork, be, ‘‘If you like your plan, you can’t tice and shutter many small hospitals. and his patients are very happy. His keep it under Medicare for All.’’ The Centers for Medicare & Medicaid practice is successful. The patients are They have also promised things like Services Administrator has said a one- happy with the time he is able to sit free college—and, believe me, ‘‘free’’ is size-fits-all system ‘‘would decimate and be with them and look at them and popular, especially if you don’t think physician networks, creating a perma- focus on them, instead of the mandates you are ever going to have to end up nent physician shortage.’’ of a Washington computer screen. paying for it—promising anyone and So how can rural hospitals survive So you see, there are doctors like everyone that they can go to college with no financial cushion if Democrats’ Mike all across the country who don’t for free.

VerDate Sep 11 2014 01:18 May 23, 2019 Jkt 089060 PO 00000 Frm 00004 Fmt 0624 Sfmt 0634 E:\CR\FM\G22MY6.006 S22MYPT1 May 22, 2019 CONGRESSIONAL RECORD — SENATE S3021 Now, there are some smart things we The only estimate I have seen is a $93 parison—China’s annual carbon dioxide can do to help prepare high school stu- trillion price tag, but that is an impor- emissions have increased roughly by dents and college students to hold tant piece of information that you double—twice what they were during down their debt and to make sure that would think the public would have a the same time period. they get the sort of advice and coun- right to know, and that is not some- So I would say that we can blame seling they need to make sure they are thing the advocates of the Green New America first for all sorts of problems. studying something that is going to be Deal have been particularly proud of. I don’t think that is fair, nor is it accu- able to provide them an income with Even if this is something a majority rate, and, particularly, when you start which they can repay the loans that of Americans want, we don’t currently talking about the environment and they take out, and there is some work have the technology or the resources to controlling ozone-depleting CO2 emis- we need to do in that area. make it happen. Our Democratic sions. I think there is a better way to Across Texas, I have had a chance re- friends know that. So they are, in es- approach it, and we need to start with cently to go to a number of middle sence, making a promise for something the facts. schools and high schools, and in that they can’t deliver because of the I think the facts are that we need to Texas—and I am sure we are not price and because the technology has form partnerships to leverage the capa- alone—there are many high schools not yet been invented. bilities of the private sector and where students can get dual credit, col- So what was really bizarre here on achieve cost-effective solutions. None lege and high school credit, and some the Senate floor was that when the ma- of the people advocating the Green New of them graduate from high school jority leader provided our Democratic Deal can really tell you how much you with essentially 2 years of college be- colleagues a chance to vote on this res- would be paying for electricity if we hind them, and it costs them nothing. olution on the Senate floor, not a sin- were able to implement the Green New It is free. I guess that is free. Actually, gle Democratic colleague voted for it. Deal, how much you would have to pay it is not free, either, but they don’t They voted ‘‘present.’’ for your transportation costs, or how have to pay anything more for it, and Well, that is a new one on me. I much you would have to pay to heat or their parents don’t have to pay any- thought when we came here to the Sen- cool your house. We need policies that thing more for their property or sales ate, our job was to represent our con- make sense, that are affordable and tax for it. stituents and vote yes or no on legisla- achievable, and that will actually bring So that is a smarter way to approach tion. To show up and vote ‘‘present’’ down the cost of each of those items this, rather than this radical idea that seems to me like an abdication of that for the American people. things like college can somehow be responsibility, but it also is some evi- The solution isn’t a $100 trillion free, knowing that, actually, there will dence of how really cynical and insin- Green New Deal; it is good old-fash- be somebody that pays for it, whether cere this proposal really is. ioned, all-American innovation. By it is our children, when they grow up That is not to say that it isn’t pop- incentivizing research into the devel- and they have to pay back the money ular when you start offering free things opment of new technologies, we can that we have recklessly borrowed in and you start promising things that keep costs low for taxpayers, while se- our deficits and debt, or by raising are unaffordable or unattainable. curing our place as a global leader in taxes, and you can’t raise taxes enough Instead of talking about these poli- energy innovation. One great example on the rich people in order to pay for cies that are unwanted, unachievable, of the type of solution I am suggesting this. So, inevitably, that burden will and unaffordable, let’s talk about some you could learn about by taking a trip fall on the middle class. real solutions. I think that is the re- To put the icing on the cake on these to the NET Power plant in La Porte, sponsibility of people like me who say radical policies, you have to look at TX, right outside of Houston, which I the Green New Deal will not cut it, to this Green New Deal proposal that the did recently. NET Power has developed Democrats have rolled out and really which people might ask: Well, what are a first-of-its-kind power system that call this the icing on the cake in their your suggestions? And I think that is generates affordable, zero-emissions socialist proposals. an important and fair question. electricity using their unique carbon They want to take over the entire en- No matter what your perspective on capture technology. They have taken ergy sector of the economy, and they energy issues and the environment, I natural gas—one of the most prevalent want to regulate it, and they want to think every single one of us can agree and affordable energy sources that tax it in such a way as to promise on at least one point: We need smart there is—and they have made it emis- somehow something that is never going energy policies that will strengthen sion-free. This is a shining example of to be realized. our economy without bankrupting the environmentally and fiscally re- For example, they say they want to American families. sponsible policies we should be advo- achieve net zero emissions in 10 years. I would just note, parenthetically, cating and supporting. Well, Texas, Oklahoma, and other that we have actually made some pret- Last year, renewables accounted for States generate a lot of electricity ty good progress when it comes to only 17 percent of our total energy from renewable sources, particularly emissions control. Between 1970 and sources. That includes hydropower, wind-generated energy, but there is no 2017, combined U.S. emissions of six wind, solar, biomass, and various other way in the world you are going to be criteria air pollutants have gone down sources. Seventeen percent. Natural able to eliminate things like natural 73 percent. During that same period of gas already accounts for more than gas and other sources of energy be- time, the American economy grew by double that. So if we could take this cause the wind doesn’t always blow and 262 percent, the number of vehicle incredibly common and affordable en- the Sun doesn’t always shine. So you miles traveled grew 189 percent, and ergy source and make it more environ- are going to need something to provide our population grew 59 percent. We mentally friendly, why wouldn’t we do the baseload when the wind is not were able to reduce pollutants by 73 that? Why wouldn’t that be a more sen- blowing and the Sun is not shining. percent at a time when the population sible, fiscally responsible way of ad- This pie-in-the-sky idea of net zero was growing, people were driving more, dressing this? emissions in 10 years by going entirely and our economy was growing. These policies are important for con- to renewables is simply fantasy. More recently, between 1990 and 2017, servation but also for securing our They also want to overhaul our the United States reduced sulfur diox- competitiveness on the world stage. If transportation system. They want to ide concentrations by 88 percent, lead American companies don’t produce rebuild and retrofit every single build- by 80 percent, nitrogen dioxide by 50 these technologies first, well, you bet ing in the country, but they offer no percent, particulate matter by 40 per- somebody else will. real details, and, in fact, I think there cent, ground-level ozone by 22 percent, The heavyhanded government ap- is a reason for that, because they don’t and carbon monoxide by 77 percent. proaches we are seeing from our Demo- even talk about the details of what From 2005 to 2017, carbon dioxide cratic colleagues are not the answer. needs to be accomplished or the cost emissions declined nearly 15 percent in Instead, we have to harness the power there would be associated with trying the United States. During that same of the private sector and build partner- to accomplish it. period of time—and this is a fair com- ships to drive real solutions.

VerDate Sep 11 2014 01:18 May 23, 2019 Jkt 089060 PO 00000 Frm 00005 Fmt 0624 Sfmt 0634 E:\CR\FM\G22MY6.007 S22MYPT1 S3022 CONGRESSIONAL RECORD — SENATE May 22, 2019 Yes, we need to invest in innovative House Democrats recklessly blocked I applaud President Trump for turn- solutions and encourage the private this reauthorization of VAWA because ing up the volume on this issue last sector to continue prioritizing reliable, they were seeking to add controversial summer. That is when the President affordable, and environmentally sound provisions that should never be a part announced his administration’s blue- energy sources. of a consensus bill—certainly not one print to lower drug costs for all Ameri- When you implement government that enjoys broad bipartisan support. cans. He found out—and we all found policies that get government out of the In the face of this political jockeying out—that is a goal that has widespread way and let the experts do their jobs, by House Democrats, I am proud to say support that includes Republicans and you can be pro-energy, pro-innovation, that the Appropriations Committee did Democrats, as well as urban and rural pro-growth, and pro-environment. I the right thing: It continued to fully Americans. will soon be introducing some legisla- fund all Violence Against Women Act Of course, the President can only do tion that I think will help us move programs through the remainder of so much—whatever law passed by Con- down that road. We know the United this fiscal year. So this means that gress allows the President to do and States leads the world in emissions re- House Democrats, when they tried to that doesn’t solve all the issues. So duction, and this bill will build on that kill VAWA by refusing to reauthorize even though I applaud the President, success without a one-size-fits-all man- it, actually failed to accomplish their that doesn’t mean I exclude in any way date that would bankrupt our country. goal if their goal was to deny women the responsibility of Congress to take DEBBIE SMITH ACT and other victims of violence the crit- action. Mr. President, on another topic, as I ical funding needed for these programs. There are many good ideas to build highlighted earlier this week, the Sen- Despite the efforts they undertook to upon that share broad, bipartisan, bi- ate has unanimously passed the Debbie let VAWA expire, critical domestic vio- cameral support. There is one policy, Smith Act of 2019, which would provide lence and sexual assault prevention however, that some Members are talk- critical resources for law enforcement programs will continue to receive full ing about that I don’t agree with, and to test rape kits, prosecute criminals, Federal funding until we can reach a that is repealing what is the noninter- and deliver justice for victims. This bipartisan consensus agreement and ference clause in Medicare Part D. I was a major bipartisan achievement, update the law. So good for the Appro- would like to explain why Congress and I look forward to working with our priations Committee for making that kept the government out of the busi- House colleagues to get this legislation happen, but my point is that VAWA ness of negotiating drug prices in the to the President’s desk as soon as pos- should never be used as a political Medicare program. Some 16 years ago, sible. plaything or pawn. when I was formerly chairman of the But there is more we need to do to I am somewhat encouraged by ongo- Finance Committee, I was a principal assist victims of violence and sexual ing, bipartisan negotiations here in the architect of the Medicare Part D pro- assault. For example, today I am filing Senate, and I commend Senator ERNST gram. the Help End Abusive Living Situa- for her commitment to this effort and For the first time ever, Congress, in tions—or HEALS—Act, which will pro- look forward to supporting a long-term 2003, added an outpatient prescription vide domestic violence survivors with extension of VAWA that is done in the drug benefit to the Medicare program. expanded access to transitional hous- right way—through negotiation and Maybe I ought to explain for my col- ing. This will help these victims per- agreement, not political gamesman- leagues why it took between 1965 and manently leave their abusers, rebuild ship. That is the wrong way to do 2003 to include drug benefits in the their lives, and begin a long-term heal- things. We know better—if people will Medicare program. Remember, in 1965, ing process. simply stop the political posturing and prescription drugs or drugs generally Even more pressing, folks on both political games and do the work the didn’t play a very big role in the deliv- sides of the aisle agree that we need to American people sent us here to do. ery of medicine like they do today, but reauthorize and strengthen the Vio- Mr. President, I yield the floor. over time, they have become more im- lence Against Women Act, also known I suggest the absence of a quorum. portant. as VAWA. It is something I strongly The PRESIDING OFFICER. The That is why great support at the support and an issue our friend and col- clerk will call the roll. grassroots, both bipartisan and bi- league Senator ERNST continues to The senior assistant legislative clerk cameral, evolved into what we call the champion here in the Senate. proceeded to call the roll. Medicare Part D program, adopted in Republicans and Democrats say we Mr. GRASSLEY. Mr. President, I ask that year, 2003. So we came to the con- must do more to provide services for unanimous consent that the order for clusion that adding the prescription victims of domestic violence and sex- the quorum call be rescinded. drug benefits for seniors was the right ual assault, and while we certainly had The PRESIDING OFFICER. Without thing to do, but it needed to be done in some disagreements on the way to do objection, it is so ordered. the right way—right for seniors and that, there is no question that VAWA PRESCRIPTION DRUG COSTS right for the American taxpayers. By has traditionally been a bipartisan Mr. GRASSLEY. Mr. President, I am that, I mean allowing the forces of free commitment. That is why I was so here to discuss with my colleagues enterprise and competition to drive shocked earlier this year when House issues dealing with the work of the costs down and drive value up. Democrats blocked the Republican ef- Senate Finance Committee and pos- For the first time ever, Medicare re- fort to reauthorize this critical law be- sible legislation that hopefully will cipients in every State had the vol- fore it lapsed last February. come up this summer to keep untary decision to choose a prescrip- The current violence against women healthcare costs down, particularly tion drug plan that fit their pocket- law lapsed in February because House prescription drugs. books and their healthcare needs. Democrats refused to allow us to ex- In the process of doing that, I want The Part D program has worked. tend it. Why would they do that? If to set the record straight on an issue Beneficiary enrollment and satisfac- they claim to be supportive of efforts that affects every American who is eli- tion are robust. The Part D market- to protect women and others from vio- gible for Medicare. More specifically, I place offers consumers better choice, lence and assault, why would they let am here to talk about efforts to reduce better coverage, and better value; yet the very law that authorizes the var- the rising cost of prescription medi- here we are again. It has been 13 years ious programs Congress has paid for in cine. since Part D was implemented, and the past—why would they let that Prescription drugs save lives. Mil- once again, I am hearing the same calls lapse? Well, sadly, this is where poli- lions of Americans like myself wake up to put the government back into the tics rears its ugly head. every morning and take their daily driver’s seat of making decisions on We were seeking a short-term reau- medication, but there is something what you can take in the way of pills thorization of the existing Violence that has become a very tough pill to or what your doctor might be able to Against Women Act so bipartisan nego- swallow for an increasing number of prescribe to you based upon what a for- tiations could continue on a long-term Americans, and that is paying for the mulary might be. We want the private update and extension of the law, but rising cost of prescription drugs. sector to decide the formulary, not the

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