patients and folks can still keep getting emergency services. it may be a temporary solution, and one we've reached for far too many times, but it's a necessary solution to keep our health care system working. and i appreciate leader reid for bringing it to the floor. but this bill could be stronger, especially for folks in rural america. i have pushed to include two provisions in the bill to strengthen rural health care, but despite my best efforts, they are not going to be part of the measure we vote on tonight. the first provision which i introduced with senator roberts removes a requirement that physicians at critical access hospitals certify that a patient will be discharged or transferred in less than 96 hours in order for that hospital to be reimbursed for services. now, critical access hospitals are treatment centers in rural areas that have no more than 25 in-patient beds. they play a vital role in

providing quality, affordable health care in rural and frontier communities across this country. without them, folks would have to travel long distances to get care and many would not get treatment at all. but imagine being a rural physician and having to determine exactly how long a patient will stay as they are admitted. what if the patient develops a secondary condition? like pneumonia? you would have to decide whether to discharge the patient, keep them in and risk losing reimbursement or transfer them to another facility at cost. now, how is that good health care? how is that fair to rural america? hospitals should not have to choose between caring for their patients and getting paid. this is a choice that no one should have to make. it is certainly not one that the government should be forcing on rural physicians who already have their hands full.

the second provision which senator moran and i introduced prevents senators for medicare and medicaid services from enforcing a new rule that requires direct physicians supervision of outpatient therapeutic services such as drug infusions at critical access hospitals and other small hospitals. if this rule is enforced, it will severely limit the ability of rural americans to get much-needed care at their local communities where the community's one physician may be out of town when the call comes in. should a patient be denied basic blood work because the doctor isn't available? when folks in small towns get sick, the last thing they need is an added burden of traveling to another town to get the care that they need. that's why senator moran and i introduced this bill because washington's one-size-fits-all solution, sometimes they just simply don't work for rural

america. our bill passed the senate, but there is no companion bill in the house of representatives. so we sought to include it in tonight's fix. despite the fact that there is no stated opposition, that both of these bills will not cost the american taxpayer one dime, we were unsuccessful in our efforts. mr. president, i'm not asking for much. these two bills are widely supported. they are bipartisan and they won't add to the deficit, and they offer much-needed flexibility for rural hospitals seeking to provide high-quality health care to make ends meet. i know that senator wyden supports them, so does senator hatch, and i appreciate their support, but the house of representatives, for whatever reason, chose to leave these important proposals out. they are exactly the kind of bills we should be approving, bills that offer support for the thousands of hospitals that

provide critical care across rural america, hospitals that shouldn't have to have their hands tied by regulations, those regulations that work better in urban communities. we should be making sure they have the flexibility they need to meet the needs of their communities. mr. president, if you or i need emergency care here in the senate, there are multiple large hospitals nearby where we can get the treatment that we need. but that's not the case in rural america. distances in rural america are measured not in city blocks but in miles. we need to make sure the regulations coming out of the department of health and human services reflect that. montana has elected me to bring a little more common sense to washington. often this is not an easy job, but these with two straightforward commonsense provisions to move to montana ms and politicians in washington, get it and they get their concerns. and we hope that all americans get a fair shot at the opportunities promised to us

regardless of their zip code. i will keep fighting for these provisions and other measures that strengthen and support rural america. mr. president, with that, i yield the floor. mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: mr. president, as the new chairman of the senate finance committee, 16 working days on the job, it is humbling to be parachuteed late into the issue of reimbursing doctors for medicare services, and i intend to be brief here at the outset of this debate. mr. president, all sides agree that the current system for paying doctors known as the s.g.r. doesn't work well for seniors, the many gifted physicians who serve them or taxpayers. devised in 1997, the grr sets an

annual cost target for medicare physician payments, and it is honored more in the breach than in the observance. when the s.g.r. isn't met, the congress says that's okay, we'll just apply a patch and we'll punt. patch it up and let that s.g.r. limp along just as it has year after year after year. mr. president and colleagues, there have now been 16 of these patches, 16, and every senator that i talked to says that that just deifies common sense, and it seems bizarre even by beltway standards.

the cost of the patches now resembles the cost of the full repeal. now, to his great credit, the majority leader, senator reid, has repeatedly said that his first choice for dealing with this issue is to finally repeal the s.g.r. mr. president, now is the ideal time for repealing s.g.r. the cost of full repeal is far less than anticipated. thoughtful bipartisan work has been done in the house and the senate on repeal and replace and leading advocates for seniors and their doctors want to replace the status quo with real reform. so as an alternative to the flawed status quo an s.g.r.

patch number 17, this afternoon i will make two unanimous consent requests so that the senate is allowed to have a choice. specifically, a vote on a proposal to permanently repeal and replace the s.g.r. and also to fund the health care extenders. now, i will wrap up by briefly describing this proposal. its essence, mr. president, is to close two chapters of federal budget fiction. since the s.g.r. is just pretending that congress will hold the line on medicare spending, i believe it's time to end this fiction and wipe s.g.r. off the books. and for balance, i'm going to propose ending another piece of budget fiction. specifically, the overseas contingency operations known as

o.c.o. and the spending on wars that are winding down. this, too, mr. president is fiction. as former republican senator jon kyl said, a conservative by anybody's calculation, senator kyl said during a previous s.g.r. debate let's use war savings for one last time to wipe out the debt congress has built up by overriding reductions in payment to doctors, and from that point on, war savings would only be used for defense. so there you have my proposal, mr. president. truth in budgeting all around. wipe the slate clean on medicare so you can support seniors and their doctors and move forward with real reforms along the bipartisan lines the house and senate has already agreed to. i would add that if the congress took the action i just proposed, mr. president, it could go

further and address the health extenders. unlike the s.g.r., these are real programs, helping, for example, vulnerable low-income seniors, rural communities and seniors who need a variety of their -- therapies. each one of those has strong bipartisan support. this, too, can be addressed in a fiscally responsible manner, a big chunk of the cost of ten years' worth of these extenders could be addressed with savings of the one-year patch. so, mr. president, here's my closing. a lot of good work has gone into a bipartisan, bicameral reform plan that finally repeals and replaces the s.g.r. i would just say to my colleagues, doesn't that deserve a vote? if my unanimous consent is accepted, we would have that vote. and at this time, mr. president, i ask unanimous consent that notwithstanding the previous

order with respect to h.r. 4302, following disposition of the owens nomination, when the senate resumes legislative session, the senate proceed to the consideration of calendar 336, s. 2157, that following the reporting of the bill, the bill be read a third time and the senate proceed to vote on passage of the bill with no intervening action or debate, and that upon disposition of the bill, the senate resume consideration of h.r. 4302, as would -- as provided under the previous order. the presiding officer: is there objection? mr. sessions: mr. president? the presiding officer: the senator from alabama. mr. sessions: reserving the right to object, i want to express my appreciation for senator wyden for his leadership. he is doing a great job as chairman of the very important finance committee. he is active in all the issues before our senate. but regretfully, a number of members on this side object to

proceeding with his legislation at this point, and i would note that budget experts tell us that paying for this through o.c.o. is a mother of gimmicks. i guess i just spoke about the passing of senator jeremiah denton who was a prisoner of war in vietnam, we could use the savings from the vietnam war that we're not spending today to pay for this bill. so i would object, mr. president, and hopefully we can figure out another way to make this happen because you are correct, senator wyden, it's time to get this matter a permanent fix. i would ask consent that the s. 2122, calendar number 330, be proceeded to for immediate consideration. it would repeal the medicare

sustainable growth rate offset by repealing the obamacare individual mandate. i ask consent that the bill be read a third time and passed, the motion to reconsider be laid upon the table. the presiding officer: the unanimous consent request from the senator from oregon is on the table. is there an objection? mr. sessions: i did object, yes. the presiding officer: objection is heard. mr. sessions: and i would ask that -- that -- consent that the senate proceed to the immediate consideration of calendar number 330, s. 2122, a bill to repeal medicare sustainable growth rate offset by repealing the obamacare individual mandate. this is proposed by senators hatch and mcconnell and cornyn. i ask unanimous consent that the bill be read a third time and passed, the motion to reconsider be considered made and laid upon the table. the presiding officer: is there objection? mr. wyden: i would object,

mr. president. the presiding officer: objection is heard. mr. sessions: mr. president, i thank the senator from oregon for his leadership and hopefully something can work on this because it is important, but it is frustrateing that there is no intension it appears to -- frustrating that there is no intention it appears to allow this provision, this to be brought up, and without that kind of concept, i think it is unlikely that we'll get a unanimous consent to move forward with senator wyden's fix. mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: mr. president, before my friend from alabama leaves the floor, just to highlight where we are, i think he knows how strongly i feel about always trying to tackle these issues in a bipartisan fashion. and i would just assure the senator from alabama the reason that we took as our underlying repeal and replace bill the good work that was done by senator

hatch and chairman camp and champ upton is that i felt that extended the olive branch in terms of trying to bring the parties together, and i intend to do that consistently on the finance committee, pretty much just the way i did when i supported george w. bush on part d of medicare. the challenge, of course, here is that this would be the 51st attempt to essentially try to make changes in the a.c.a. that would end up particularly shifting costs to so many vulnerable people. and it seems to me particularly today, as we have thousands and thousands of people still trying to sign up -- i note the "wall street journal" saturday stated

that the c.b.o. said the original target for the affordable care act had been met, i think it would be particularly unfortunate to go forward with what would be the 51st effort to try the same kind of approach that particularly would cause so much cost shifting in american health care on to the backs of a lot of folks who are already walking in economic tightrope. i know a number of my colleagues, mr. president, want to speak. as the manager of the time, it is my intention to try to alternate with colleagues at various points of view with respect to this issue. i'm sure that will be done as well on the other side. i note my friend from virginia here on the floor. he is going to be the new chairman of the senate finance subcommittee on cisco responsibility. and i think he brings

extraordinarily important credentials to this job, and his support of the kind of approach that i have advocated this afternoon highlights that this will have support in both political parties from members who have strong credentials in terms of promoting fiscal responsibility and i would yield and look forward to my colleague's remarks. mr. warner: mr. president? the presiding officer: the senator from virginia. mr. warner: mr. president, i want to, first of all, thank the chairman of the finance committee for his efforts in this endeavor. i'm disappointed that there was an unwillingness to at least have a vote on this important issue. mr. president, i've had -- very lucky individual. i've had the opportunity to have a career in business. i've had a career as a governor. in each of those cases, i had to learn business practices and

accounting practice, business accounting practices are different than government accounting practices. state accounting practices are somewhat different as well. what i have to tell you, mr. president, what takes the cake is what passes for rational accounting and scoring practices in the federal government and how we maintain these fictions about what are costs, what are expenses in a way the vast majority of americans don't have the slightest idea what we're talking about. s.g.r., o.c.o., terms that we throw around in this body that have no relationship to the bottom line but prevent us from taking action to at least start the process of getting our balance sheet right, a balance sheet that is $17 trillion in debt that goes up $4 billion a night. now the chairman of the finance

committee outlined very well how this process came to be. the sustainable growth rate, where congress now 17 years ago said they saw at that point the cost of medicare will rise, the cost of our entitlement programs were rising. they put in place at that point what they thought was a rational solution to slowly, slow the rate of growth. the challenge was congress immediately punted and as opposed to resolving at that point, we maintain this legal fiction and this accounting fiction that no one under any kinds of traditional standards of accounting would accept where we've built in this cost increase and each year we come back and so-called patch it. and each year we go through a

fire drill where lobbyists across town harangue and harass members of both parties on a universal basis and say oh my gosh, we can't allow this to happen. doctors and hospitals, which should be off spending time providing health care or finding cheaper and better ways to deliver health care, storm the halls of the capitol to make sure that we don't provide what would now be an unsustainable cut in their reimbursement rates. but it appears to me that we are about to now go for the 17th time one more year on a short-term patch and one more time kick this can down the road. what we are avoiding if we take this vote this afternoon and simply patch over an effort that was brought over from the house,

an effort from the house that i would remind my colleagues never came to a roll call vote, we will once again avoid the opportunity to really start to in effect clear our balance sheet, to make the size of our debt and deficit, and for those of us who have been involved in this issue to go ahead and get rid of some of the budgetary fakery that quite honestly makes so many of our other efforts that may be legitimate seem illegitimate because we can't even clean up our books. now, the chairman of the finance committee went through how this s.g.r. was created in 1997 and how we've gone through annual patches. the remarkable thing right now is that the total cost of these patches actually exceeds that we've already spent exceeds the cost of repeal, repeal of s.g.r.

at this point is roughly $135 billion. based upon previous budget estimates, this is the year to take this action. and what has been the challenge in the past is that while there's been agreement -- we've heard the senator from alabama, and others are coming -- bemoan the fact that tkpw-r is a fakery -- s.g.r. is a fakery, s.g.r. is budget gimmickry, we have this action taken on every years where others storm and say please don't do this and at the 11th hour we extend. what is avoided opportunities in the past to get rid of this issue is that there's not been a solution, not been a bipartisan solution. but this year, do due to the god work of the chairman and ranking member of the finance committee and their equivalents in the

house, there really is agreement on what a replacement to s.g.r. would look like. we would move to a system that would actually fix the problem but also improve the quality of service covered under medicare. we would move to a payment system which would reward doctors for focusing on providing high-quality care. doctors would actually be rewarded for talking to each other to make sure tests and services are unnecessarily duplicated. doctors would be rewarded for ensuring patients have access to care when they need it, like same-day appointments. doctors would be rewarded for spending more time with patients and genuinely talking about the patient's priorities and concerns rather than running off to their next appointment. these are all goals, regardless of what some of our colleagues may feel about the affordable

care act these are all goals that i think almost all of us would agree would actually improve the quality of health care in america, and for medicare start to help drive that cost curve back in the right direction. and if we would act on this bipartisan solution, we could make a real demonstration even in an election year that congress is actually working together to solve a problem. as the chairman of the finance committee noted, in the five years i've had the honor of representing virginia, there's no issue that i've been more passionate about, involved with than trying to find that common ground around our debt and deficit, sometimes to the chagrin of my own colleagues on this side of the aisle. i believe getting our fiscal house in order is absolutely the top priority that this congress faces and our nation faces. i believe failure to do that

will squeeze out any development in education, infrastructure, military, whatever our other priorities are. and part of that is getting our entitlement costs under control. if we're going to get ouren -- get our entitlement costs under control we've got to eliminate the budget gimmicks and fakery that now are part of the process, and the primary one on the entitlement side is the s.g.r. we have a remarkable opportunity to get rid of this budget fakery, clear the books and get rid of the system. i know there's been questions about the cost and i know the chairman of the finance committee will soon put up a chart which will quote a periodical that doesn't often say good things about those of us on this side of the aisle and that is the "wall street journal" which is called the budget gimmickry hides medicare true costs by moving off future

spending off the balance sheet. again, we have a chance to get rid of that today. and what i think the chairman of the finance committee has offered is we could actually get a two-fer here. we could get rid of replacing and -- repealing and replacing the s.g.r. and at the same time eliminate another budget gimmickry tool, the o.c.o. accounts. i just can't understand why we wouldn't take advantage of this opportunity to start down the path of cleaning up our balance shoot. into today, with the actions we take today won't get rid of that $17 trillion in debt, won't bring down our deficit itself. but it will allow future actions to be dealing with an accounting system and a budget that is much truer to reality. so, mr. president, the chairman of the finance committee has called this the medicare

migraine. i think it's time for this congress, this senate to actually take two aspirin, pass this replace and repeal, get rid of this migraine and at the same time show the american people that we can act in a bipartisan fashion even in election year. mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: before he yields the floor, through the chair could i pose a question to the distinguished senator from virginia? the presiding officer: the senator may proceed. mr. wyden: the senator from virginia, as usual, has gotten right to the heart of the long-term challenge with respect to entitlements. and i've always tried to describe it as the challenge of protecting the medicare guarantee. because what seniors have is a guarantee. it's not something that is kind of up for grabs. it is a guarantee. it is inviolate, and protecting their guarantee means that in the days ahead we're going to have to figure out new ways to hold down costs.

what i've heard the senator from virginia talk about very eloquently is one of the key ways to do that is what the senator from virginia and i have sought to do, which is to start having medicare pay for value rather than just stay with this volume-driven fee-for-service system which largely rewards inefficiency. i think it's my sense that the senator from virginia believes that it is very hard to start the kind of real entitlement reform we need, where you protect the medicare guarantee and hold down costs, unless you make the kind of approach that we're advocating in this repeal and replace strategy with s.g.r. and, boy, we better get to it, because until we have those changes, we can't begin to get

on with another area the senator from virginia feels very strongly about, and that's chronic disease. diabetes and cancer and heart disease and strokes, which consume more than 80% of the medicare budget. we can't get on with that or any of the structural entitlement challenge until we do what the senator from virginia is talking about, by my calculation. is that pretty much the way the senator from virginia sees it? mr. warner: mr. president? the presiding officer: the senator from virginia. mr. warner: i would agree with the comments made by the chairman of the finance committee. in the replace -- repeal and replace proposal, we've laid out ideas that i think, again, cross the aisle there's going to be common agreement in. i know we've been joined by my good friend, the senator from oklahoma. no one knows more about health care and has been a stronger voice on entitlement and reform

than the senator from oklahoma. and we've spent an awful lot of time wrestling with how we get to that common cause. these commonsense reforms that move us closer to quality rather than quantity are a first step but also a first step is trying to relieve the annual or sometime every six-month fire drill we go through where health care providers across the country have to rush to congress to try to get a patch in place which at the end of the day they know we will put the patch in place and the way we put the patch in place month often than not is simply passing on -- more on which than not is simply passing on more costs to the providers in an outyear. this is the kind of budget gimmickry that, quite honestly, we tried to address in our so-called gang of six that would have put more constraints. we didn't get it done.

we've got another opportunity today not to solve the whole problem but by getting rid of s.g.r., by getting rid of o.c.o., removing two of the accounting and gimmickry obstacles that would help clear the decks towards the ultimate debate we're going to hav to hao have around tax reform and about entitlement reform. but the value here as well is that we would also by repealing s.g.r., put in place reforms that would move us towards a better quality health care system for our seniors. so, mr. president, i know that consensus here and kind of conventional wisdom is at moments like these, we'll always punt. we're going to have a chance to see this afternoon whether we're going to punt one more time or whether we will actually -- and if it takes a few more days --

could wrestle this to the ground and come up with a common cause where we could replace s.g.r., replace it with a better system and perhaps at the end of the day get rid of not one but two gimmicks that that have made our budgeting so much more difficult. with that, mr. president, i yield the floor. mr. coburn: mr. president? the presiding officer: the senator from oklahoma. mr. coburn: i wanted to spend some time today talking about the bill that's on the floor. i want to thank my colleagues from both oregon and from virginia. i've enjoyed working with them. the bill we have on the floor is one of the reasons why i'm leaving congress at the end of this year. because here's -- and here's why the american people are disgusted with us. we're going to put off to tomorrow what the we should be g

today. we should be fix this go probl problem -- we should be fixing this problem instead of delaying the problem. i concur a lot with what my colleague from virginia said. but the fact is, is there's no courage, there's no guts, there's no intention to actions to do what is the best thing in the long term for this country in this body anymore. so we have a bill that comes to us. i appreciate the fact the chairman wants to try to fix it. but if you vote for this bill that's on the floor today, you're part of the problem, you're not part of the solution. you are part of the problem. there's four budget points of order that lie against this bi bill. why in the world where there be four points of order lying against this bill? we're only going to vote on one of them. it's because it's a sham. it's a lie. the pay-fors aren't true. it's nothing but gimmicks. it's corruptible.

there's no integrity in what we're getting ready to vote on in terms of being truthful with the american public, in terms of being truthful with the people that are providing the care for medicare patients. i have a little bit of experience, 25 years, of practicing medicine, and i can tell you what's wrong with the payment system. we have a payment system from the insurance industry and from medicare and medicaid that says, see as many patients as you can if you want to pay your overhead because we're going to pay you based on a code rather than how much time you spend with a patient. and the first thing a doctor's taught in medical school is sit down and listen to the patient. if you'll spend time with the patient, the patient will tell you what's wrong with them. and we know that's true because we have two sets of data now, both on the consequenc in the cs and what we have seen in one of the great h.m.o.'s on the west

coast, that they order 62% fewer tests when they're listening to the patient. one of the biggest costs for medicare, one of the biggest wastes for medicare is tests. why do doctors order tests? because they didn't spend the time figuring out what's really wrong with you so they order a bunch of tests to try to help them where. as if they would have spent another 15 or 30 minutes with you, most of those tests, which are most -- most are not without risk -- would have never been performed. so here we have the senate doing what we usually do -- we're putting off to tomorrow when we can actually fix the real problem now. and it comes to another principle of medicine. the principle of medicine is that you don't treat symptoms, you treat disease. when you treat the disease, the symptoms go away. if you just treat symptoms, you'll never find the disease. you'll cover up the disease. that's exactly what we're doing.

now, the s.g.r. was a great id idea. it started in 1995 in the ways and means committee in the house under former chairman bill archer. and had we followed it, we would have seen some significant reining in of the costs of medicaid and medicare. but what happened? we cut spending, we cut reimbursement rates one time, and instead of responding to the political clamor of the provider group, we fixed it, a short-term fix. and we've been doing that ever since 1999. short-term fixes. so we're not fixing this problem today. what we're doing is taking a big old can and kicking it down the road. and worse than that, we're not even being truthful about what we're doing.

one of the little gimmicks -- one of the little gimmicks is shift $5 billion of sequester from $25 billion to $24 billion, and say you save money. but we all know that this little red area here will go right back over here and we'll spend that money. nobody believes it. it's kind of the wink and the nod to the american public, "oh, look at us." that's why they're disgusted. there's no truth. there's no honesty about what we're doing. and that's just one. here's the other offsets. the sequester was the one i just showed. savings from future medicare cuts, $2.3 billion. they will never occur. if you think they'll occur, you obviously think if they will

occur, then we should have fixed the real problem, the real disease of medicare today. but we didn't. and so the actions will continue to be exactly the same. that $2.3 billion will never be materialized whatsoever. it's a falsehood. $4.4 billion to medicaid. it won't ever come about. that's in future. but we'll take the money now to pay for it. so we -- in this bill of approximately $20 billion, half of the savings that we say are there aren't there. and every member of this body knows that. so when they vote for this today and vote against the budget point of order, what they're saying is i'm dishonest, i'm playing the game, i will not

stand up for truth so the american people actually know what we're doing. i do not believe in transparen transparency. i do not believe that we ought to have to live within our mea means, that we ought to make hard choices, just like every american family out there does today. finally, some of this is very unfair to the very people that worked on this with the committees because they made some commitments for real cuts to them to get a long-term fix. guess what? the real cuts come, that portion that's actually paid for, comes to just pay for it for one year. so not only are we dishonest with the american people, we are dishonest with the stakeholders who negotiated this for a 10-year elimination. the budget points of order

against this bill. just so we know what we're talking about, it violates paygo. plain and simple, violates paygo. it increases the on-budget deficit, this bill does. i dare somebody to come down to the floor and tell me it does not. it does. it violates the ryan-murray 2014 of the congressional budget act because it violates the top li line. nobody's going to come down here and say it doesn't. you won't hear one speaker come down here and say it doesn't violate that. it does. they know it does. but they won't speak the truth. this bill also spends money in excess of finance committee's allocation, another point of

order against the budget act. everybody knows that's true but they won't come down and say it doesn't. but they'll just vote for it. and it also has language in it within the budget committee's jurisdiction that has not been reported or discharged. so we're totally ignoring the process, like the chairman of the finance committee would like to have, so we can do the expedient political thing to take some pressure away. just like we did on the flood insurance bill. it got a little hot in the kitchen. instead of actually cooking the omelet, we threw the eggs in the trash can and ran out of the room. and that's exactly what's going to happen here. so we're putting off again the

hard choices. let me tell you why this is important. the senator from virginia outlined this a little bit. when i came to the senate, which was nine years ago, the individual debt each one of us held on the national debt was under $32,000. it today sits at $54,80 $54,800-and-some-odd. you can kind of get lost in that. what you have to think is, what's my family's obligation for what we haven't paid for within the federal government? let me tell you what it is. for every family in this america -- in this country whose average income is $53,000 per year -- as same as it was in 1988 now in terms of real dollars; we're gone backwards -- your obligations now are

$1.1 million per family. and we're going to play this game again and we're going to add another $10 billion to $12 billion between now and april? we're going to say -- claim it doesn't add anything but we're going to add another $10 billion so we can get away from the he heat, so we can get out of the kitchen, so we won't be responsible. which is more responsible: to tell the truth about where we really are? or to actually profess an untruth to your constituents? i-- in this vote this sneeng becausis.mark my words. every senator that votes for this bill that came out of the house will be telling an untruth to the american people. because they know it's not paid for. they know it violates all sorts of rules around here. they even violated the house

rules as they passed it. all to meet a deadline. let me give you a little history. we've missed the deadline before on s.g.r. fixes. does it cause additional work in providers, hospitals, doctor's offices? yes. does it provide additional work for c.m.s.? yeah. do we eventually catch up on it? yes. so what's the hurry? why not really treat the real disease? and the real disease is we have a payment system that is not good for patients and is not good for providers. and you can't fix it over a weekend but you can fix it and if we don't fix it, as the chairman would like to see a long-term fix -- i don't

necessarily agree with everything he wants to do but i applaud his effort to get a long-term fix -- if we don't fix it, we don't deserve to be here. there's no credibility left. there's no legitimacy left, if we pass this bill. it's all a pack of untruths. untruths to the stakeholders, untruths to the american public, and, most importantly, untruth to that generation that's coming up that's going to pay the bill for our untruth. this isn't an unfixable problem. it's a problem that hadn't gotten the attention at that time it needs, and it reflects par leadership on the congress and -- poor leadership on the congress and the committees. we knew this was coming up a year ago.

the senator from oregon can totally be forgiven, because he wasn't in charge of the finance committee until a month ago. but there's no denying the fact that this problem was there. and doing a patch and even doing some of what senator wyden wants to do won't fix the ultimate problem. think about the interaction of you with your caregiver. the average time in a doctor's office when you go in, before you're interrupted by your physician, is now six seconds. you go in, sit down, why are you here today? you start to say it and the first thing you get it is interrupted? why? because that physician knows needs to get to the next patient to pay the bill because we're paying bills based on c.p.t. codes. rather than paying that physician based on the amount of time they spend with a patient and including outcome measures.

we got a system that's designed to be defrauded and create overutilization. we designed it. we can fix it. voting for this bill doesn't fix anything except a little heat in the kitchen. and when we come back the next time, the heat is going to be hotter. and hotter and hotter. this bill is a cowardly response to the problem -- the real problem that we have. it's time we quit being cowards. i yield the floor. mr. wyden: before he leaves the floor, i just want to -- the presiding officer: the senator from oregon. wide i would thanoregon. mr. wyden: thank you, mr. president. before he leaves the floor, i just want to say to the senator from oklahoma who says -- and always with a smile -- that he and i certainly don't agree on

everything in this debate. but i think the concept of what the senator from oklahoma is talking about, that physicians spend time with their patients, is certainly a concept that out to be incorporated into how we proceed in the days ahead, and i think that the other aspect of this that people ought to focus on with respect to what the senator from oklahoma is talking about is that time that the physician spends with the patient in the office, a pretty good chance some of those discussions that they have there in the office are going to help keep that patient out of the hospital. and i think all sides ought to see that as a ask unanimous aska constructive goal. so i want my colleague from oklahoma know that in the discussions he and i have had -- and i appreciated the way my colleague said with a smile we don't agree on everything -- i

think the concept he is talking about with respect to doctors and time in the office is something that ought to be incorporated into this. it is my intention to work with the chairman. mr. coburn: thank you. mr. wyden: i want to pick up on another aspect of what i think both the senator from virginia and the senator from oklahoma have talked about, and that is that at this rate, you have to be concerned that after page 17, there wilpatch 17, theh 18, and after patch 18, there will be patch 19. and i'm sure there are some young people up in the galleries who are light years away from medicare. in fact, the distinguished president of the senate is a number of years away from the program, and i don't want to see him looking at patch 30 or 31 or 32. the reality is, if all you do is

take what you got and extend it, we're not going to turn this situation around. and my colleague from virginia and i started talking about one of the key concepts in our repearepeal-and-replace strateg. that's making sure we have a hard date -- really for the first time -- to start paying for value in health care, and repeal-and-replace has that hard date. it's long, long overdue. and until then, i think in much of our country we will still have volume-driven, fee-for-service medicine still driving health care in those communities from one end of the country to another. and i saw one observer say in connection with this that what they hope is that somebody in

washington would take a machete to fee-for-service. at a minimum, we ought to do what repeal-and-replace does, which is to reward for the first time quality and ensure that the message goes out to every corner of the country -- and i've heard the distinguished president of the senate say this in connection with his important health care reform efforts; that instead of just paying for volume, we actually pay for results, and what results hurricane katrinresults meanis r quality of results and what we know is that kind of care often costs less because you don't have people needing more services and possibly institutional care. while i wait for additional colleagues to come, i want to take a few minutes to describe some of the other opportunities we're missing out on by not

going forward with full repeal-and-replace, as i and senator warner and others would like to see. in particular, it's very clear that medicare in 2014 is remarkably different than medicare back when it began in 1965. medicare in 2014 is now dominated by chronic disease, cancer, diabetes, heart disease, stroke. it's more than 80% of the medicare spent. and i think we've got some students for some very important breakthroughs. the senator from georgia, senator isakson, has joined me in a bipartisan bill here, the better care, lo lower cost act. it is bipartisan with a bill in the house. i think that would give both parties an opportunity for the

first time to provide the real financial incentives for the long-term to reward the kind of coordinated care that we're not getting in this country for seniors. for many seniors, after their free physical that they now get under medicare, their care is so fragmented, so poorly coordina coordinated, that until they land in a hospital emergency room -- perhaps an $1,100 deductible -- and can't figure out all the doctors they've seen during their odyssey through chronic-care treatment, we have virtually no system that responsibly manages and is accountable for that senior's care. so in repeal-and-replace, we took the first steps towards

building a chronic-care policy for our country. we took the chronic special-needs plans -- what are called the csnps -- that haven't worked out as had hoped, and initiated reforms for those particular plans to ensure that all the individuals who are part of that program would for the first time have an individual care plan, and that's something that many seniors -- certainly a majority of seniors -- lack, particularly if they are part of traditional fee-for-service medicine. they don't have an individual care plan. they might have two or more kind of chronic conditions. they might think that perhaps they can manage their own

medicines and manage their own, you know, nutrition. but there would be an alternative, and that would be what senator isakson and i have talked about for the long-term and what we would begin with a true repeal-and-replace program for s.g.r. with s.g.r., we would start finally looking at those chronic-care patients in a way that ensured that they got coordinated care, from the first time they saw a physician, who under our approach for the long term would have a pharmacist and a physician assistant and maybe a nurse. they would be able to have one person accountable for their care, and the irony, mr. president, is all over the country there are programs that

are now doing this and reaping dramatic savings. for example, in rural pennsylvania, there is a particularly promising program where the savings have exceeded more than 20% on some of the sickest patients with the kind of approach that senator isakson and i are advocating for the long term and which we would at least begin with these chronic special-needs patients under full repeal-and-replace of the s.g.r. now, i just want to close with one other point, mr. president, before i yield the floor to colleagues. the full repeal-and-replace of medicare would also -- the full repeal and replace of medicare would also contain an idea that senator grassley and i have worked on for over three years

to open up the medicare databa database. the medicare database is really a treasure-trove of the most useful information about medicare claims and payments around this country. it holds the record of all payments from taxpayers to physicians and other providers for seniors' health care. right now, access to this medicare database is very limited. if the public or seniors or others want to get access to this information, they have to raiwade through the bureaucracy, and there are simply very substantial obstacles when we know that this kind of information can often produce better quality for lower prices, because providers who do well when that information gets out

will see that they're rewarded for their work, and those that aren't measuring up to those standards will either have to change their practices or simply find it hard to keep their doors open. the markets work best when information is transparent for all parties. but today most patients lack any comparative information and usually don't find out the cost of their care until after the fact, if at all. so senator grassley and i have proposed that there be a free and searchable database, one that would allow seniors to find and choose doctors and other health care professionals enrolled in the medicare program, adding the actual services that are performed and what price medicare pays for those services. and americans would finally be able to compare what medicare

pays for particular services in different parts of the country. opening up the medicare claims database in this way would help us hold down health care costs but would also improve the quality of medicare services, be a tool in fighting fraud, and be useful in helping individuals with private health plans -- private plans, h.s.a.'s and employer-based insurance. because what's going to happen there, mr. president, is if you have an employer plan in hartford, connecticut, or an h.s.a. in connecticut, the first thing you're going to say is, this is what medicare, you know, pays for a particular service. why can't i, with my employer plan or my h.s.a., have the same price? and if i'm not getting it, that probably means i'm getting less pay, and i'd rather see health

care costs held down so i could get more in my paycheck. so so opening up the record from a quality standpoint of medicare paid services would be a very powerful tool for measuring hospital and doctor performance. the claims data with full protection of patient privacy would open into how doctors and hospitals are treating patients. it would also provide a full accounting of areas that lack access to doctors, specificsists, treatment, and procedures. so making that information readily available would also allow clab -- doctors to collaborate on improved care management and making sure that the highest-quality services were delivered to patients at lower cost.

and finally, the transparency that we would get from the effort senator grassley and i have teamed up on that was part of the full repeal and replace strategy, would help us have a powerful new tool against fraud and waste. we look at the medicare program, "the wall street journal," the center for public integrity have been able to -- even with limited access to medicare claims data, look at that information and expose through a series of articles how doctors and medical practitioners game medicare to increase their profits. if you made the system for transparent as senator grassley and i have sought to do and is in the full repeal and replace proposal, we would have a significant new tool to root out

those -- and there -- they're a relatively small number fortunately that truly fleece seniors and taxpayers and allow us to get more value for the medicare dollar. and, mr. president, because i know other colleagues would like time to speak on this, in 2012 the medicare program cost about $580 billion. in a few years, given the demographics and technology, that bill is going over a trillion dollars. often when i meet with young people i go to a high school, i'm sure the distinguished president of the senate does, meet with 16-, 17-, 18-year-olds, we talk about matters that concern them, student scholarships and parks and transportation, and towards the end of the meeting i often

say, so you all are 16, 17, and 18, my guess is you tweet your friends when you get up in the morning and probably given your age, you tweet your friends about medicare. and these 16, 17, and 18-year-olds smile and, well, they say there's another person from washington, d.c. who doesn't get it. and i kid with them a little bit and 24e7b finally i say i just want you to know i'm kidding but not really, because if we don't figure out how to protect the medicare guarantee and hold down the cost for all you students who care about scarps and parks -- scholarships and parks and the roads and the like, guess what, there's not going to be any money for the concerns that are first and foremost to you. and at that point, of course, the students jump right in and

they want to know about preventive medicine and how to root out waste and some of the things that we're talking about. but, mr. president, we can't get to a lot of those important medicare reform issues, which senator warner articulated so well when he began his remarks, if we can't get full repeal and replace of the badly flawed medicare s.g.r. program. in other words, i've spent a few more minutes talking about how senator isakson has an approach that's bipartisan in both the senate and the house and how to deal with chronic disease, i've talked about opening up the medicare database which is in full medicare repeal and replace. i've talked about some broad reforms, and, of course, at the center is paying for value. which is in full repeal and replace, start in 2018, and we

may not get for a while if the congress just keeps reupping from the 17th patch to the 18th patch to the 19th patch. so what we're going to have to do is here in this body and i know the distinguished president of the senate has a great interest in the question of the budget and the future, particularly of entitlement costs, which i would say puts the medicare guarantee and holding down costs front and center, and we're going to have to speed up, we're going to have to accelerate the drive to actually get full repeal and replace rather than patch 17, patch 18, patch 19, patch 20, and up and up and up. my view is that we ought to be doing it now. i've recognized the objection

from the other side, but i've talked to a lot of senators over the last three days of both political parties, and i think there's a growing awareness that simply extending what we already have and punting on the need to fix the urgent structural problems with what we have, which is what some senators and house members sought to do, it can't be ducked much longer. so, mr. president, with that i'd yield the floor and will reserve my time for closing and note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

a senator: mr. president, inquiry, are we in a quorum call? the presiding officer: the senator is correct. a senator: i would ask the quorum call be suspended. the presiding officer: without objection. a senator: mr. president, i have one unanimous consent request for a committee to meet during today's session of the senate. it has the approval of both the majority and minority leaders. i ask consent that this request be agreed to and that the request be printed in the record. the presiding officer: without objection. mr. kaine: mr. president, i rise today to voice my support for the -- i rise today to voice my support for the people of afghanistan who this week on saturday will be in the midst of a presidential election, pursuing the first democratic transfer of power in that nation's history. april 5 will be a momentous day, a presidential election where millions of afghans will head to the polls to determine their destiny by a peaceful means. as we know, much is going on in the world in ukraine and syria and iran.

it is easy to miss this milestone but it's a milestone that i think should have some significance to us as americans. americans should be proud of the role that we have played in bringing the afghan people to this point, given the significant sacrifice that members of our country have made. there have been nearly 2,300 service members who have given their lives in afghanistan, 2,299. the united states has spent $600 billion in afghanistan since september of 2011. while we can't gloss over the challenges that remain in afghanistan, today and tomorrow we should remember the progress that has been achieved in 13 years since the taliban fell in october of 2001. progress that has been made possible because of the sacrifices of american service men and women, our diplomats, the american people, and the grit and determination of the afghan people. on april 5, afghans will defy those who seek who intimidate them through violence and

terrorism because it's a fundamental choice. does afghanistan want to move forward or go backward to horrific days. the ink-stained finger of an afghan voter will send a far more powerful message than any terrorist's gun or bomb. i think afghan men and women will be thinking of their children as they vote on saturday, the promise of the next generation as they head to the ballot box. an afghan girl born in october, 2001, when the taliban fell is now 13 years old. she has no doubt faced hardship and will continue to, but she now has before her unprecedented opportunities. mr. president, sometimes we get into a little bit of a mode where we just say things haven't gone well in afghanistan or the u.s. investment of blood and treasure and energy hasn't made a difference, and i want to put on the record here today 13 very real indicators of a transformation in afghan's life in the last 13 years.

number one, two-thirds of afghans today have and are able to use cell phones compared to 5% before 2001. before 2001, taliban-controlled radio was the only news source in afghanistan. today afghans can choose from 75 television stations and 170 radio stations. the afghan national gross domestic product has grown nearly 10-fold since 2001. one in three afghans have access to electricity. kabul enjoys power supply 24 hours a day. in 2001 in afghanistan, there were only 30 miles of paved roads which had a a direct impact on their economy. today nearly 10,000 miles of paved roads, nearly 300 times the amount in 2001. over 50% of the population today now has safe drinking water, nearly double from 2004.

the number of teachers in afghanistan was only 20,000 in 2001. today it's 175,000, 30% of whom were women. three million afghan girls are enrolled in the schools, compared to only 5,000 in 2001 and -- a nearly 600-fold increase. overall school enrollment in afghanistan has increased to nearly eight million. there are 168 female judges across afghanistan and 68 women members of the national assembly. 85% of afghans now live in districts with health care providers. infant mortality has been reduced to 327 per 100,000 live births, which would still be high for the united states, but in 2002, that number was 1,600, so it's been reduced to about 1/4 or 1/5. but, mr. president, the number that i think is the most powerful was this -- afghan

women now have access to more health care before. female life expectancy has increased since 2001 from 44 years to 64 years. from 44 years to 64 years. so just think about what 20 extra years of life is like for a woman and then multiply that by every woman and girl in afghanistan and male life expectancy has improved as well because of improvements in infant mortality. this is a significant change, a real transformation in afghan life. we cannot discount remaining challenges, combat corruption, strengthen civil society and further advance women's rights. the recent attack by the taliban on the electoral process at a guest house in kabul at the serena hotel and over the weekend remind us that security is a problem. our condolence goes out to the

victims. the attacks show a cowardly desperation. the ballot box represents the largest threat to the taliban and any terrorist affiliate, and they resort and are resorting to indiscriminate attacks because they know that a ballot box and electoral democracy will be their demise. by engaging in violence and killing afghans on the threshold of an election, the taliban is only sewing the seeds of their own -- sewing the seeds of their own demise. they recognize the tide is against them. a word mr. president about the afghan national security forces who are working together and with other partners going forward especially on the elections this week. more than 350,000 afghan soldiers and policemen are the security lead now throughout the country. they bear the brunt of the casualties of these attacks. more than 13,000 afghan security force members have been killed in the line of duty, but they are determined, with the support of our country and the training we provided them and that others have provided them, they are determined to protect their

homeland and they have proven capable of securing their homeland. our service members and diplomats have for years trained and assisted, and that training is paying off, and it's showing every day, and we also have numerous examples of afghan interpreters who have assisted our service members in that training, and we can't forget them. the afghan forces will not face the challenges of this week, the electoral challenges. the future of afghanistan is not military challenge. it rests upon security throughout civil society, and these elections are a pivotal moment but not the only pivotal moment. the united states commitment to afghanistan continues. in 2011, we signed a strategic partnership agreement. we designated afghanistan a major non-nato ally of our country. there is the text that is complete of a bilateral security agreement, outlines our willingness to train, advise and assist in this mission beyond 2014, and i am confident that it

will be signed once the new government takes place. one of the reasons, mr. president, i'm confident is that all of the candidates for president of afghanistan are engaged in a civil debate, and they are being asked what they think about the role of the united states and they are all committed to the u.s. playing this new role as they transition their democracy with this peaceful transfer of power. finally, mr. president, a word about what is at stake because it's not just about the statistic. it's also and most importantly about individual lives. just three months ago, in january, certainly jamila biaz, a 50-year-old mother of five, became the first woman to be appointed a police chief in afghanistan. at her promotion ceremony, she said she would not have achieved her position but for the efforts of the united states and the international community. in a letter that same month through president obama, over three dozen civil society afghan leaders stated as follows -- quote -- "over the coming years, afghanistan will be

completing its political and security transitions as the foundation for the future that we seek. it is our sincere hope that the people of the united states who are with us during difficult years will remain with us as we complete the challenging transition period and become more self-reliant." pengama anwari is the current head of the afghan human rights commission. she stated ten years is only a drop in the ocean in the process of changing society, but ms. anwari is still hopeful about the future of her country and is relentless in her efforts to advance women's rights. when george washington stepped down as president during america's first democratic transition, it was a pivotal moment for our young republic. this transition, the first peaceful transition in afghanistan's history is equally pivotal. we stand showrt to shoulder with afghans, but this is an afghan moment. every candidate, every soldier, every election monitor, every citizen must do their part to ensure the success of this

transition. and finally, mr. president, as the afghans transition, so do we. so do we. the congressional action that authorized our military presence in afghanistan was passed in this body on september 14, 2001. nearly 13 years ago. with our combat mission in afghanistan coming to an end, with this election and a peaceful transition, with the transition of american military participation to a train, assist and advise role, this 13-year effort is now transitions, transitioning to something new that will be the subject of the bilateral security agreement. we haven't been able to have a welcome home party for all of our american service men and women who served in afghanistan because the operation was ongoing. it is my hope that this transition in afghanistan, which will also transition our role, will enable us to, mr. president, have one of those

pivotal expressions of american pride. we have all seen the pictures of v.e. day and v.j. day when the american public celebrated the end of a period of sacrifice of our service, men and women. this is a period of sacrifice that has been going on longer than any war in the history of our country, and it is my hope that while we will continue to work together with the afghans, we may now reach a moment where we can accelerate, we can acknowledge this transition and say welcome home and thank you to all the american service men and women who, along with their families, have given so much in the last 13 years. with that, mr. president, i yield the floor. mr. mcconnell: mr. president, are we in morning business? the presiding officer: the senate is considering h.r. 4302.

mr. mcconnell: mr. president, i am going to proceed on my leader time. the presiding officer: the senator has that right. the republican leader. mr. mcconnell: mr. president, we all know everybody -- a huge percentage of americans across the country are filling out their brackets a couple of weeks ago to get ready for march madness, and now it's down to the final four, and once again the university of kentucky is in the final four. it's become something we're quite accustomed to, having won the championship at u.k. in 2012. we kept the championship in our state in 2013 with the university of louisville, and now we intend to further underscore that the college basketball capital of the world is indeed in the commonwealth, and we look forward to watching in dallas the final four next weekend. mr. president, today is the normal deadline for most people

to sign up for obamacare, and while one senator on the other side of the aisle said yesterday there is no such thing as obamacare, that will come as news to millions of our constituents, the millions of americans facing higher premiums, canceled plans and the loss of doctors and hospitals they like as a result of this law. obamacare is definitely real to middle-class families that we represent, and if our friends on the other side want to make the pain of this law go away, then they can work with us to replace it with smart, bipartisan reforms, but trying to wish their own obamacare law away or simply pretending that it's not there, well, that's just not going to work. the american people deserve a lot better than that. now, on another matter, mr. president, we'll be having a vigorous debate this week in the senate about how to create jobs

and rebuild the middle class. on the one side, our good friends, the democrats, will be offering more of the same. they will propose treating the symptoms instead of meaningfully improving the prospects of people who are struggling out there. on the other side, republicans will be proposing concrete ways to break unemployment and hopelessness that pervades the obama economy, ideas aimed at helping people reach their true potential and build a better life for themselves. the republican message is all about innovation and opportunity and making it easier for more people to join the ranks of the middle class. it is about reforming the underlying causes of unemployment instead of just perpetually treating the symptoms, and it's about how we create jobs of the future that will allow americans to do a lot more than just simply pay their bills. republicans will offer a series of jobs amendments this week that underline our determination to reorient america's economic

trajectory. we want to lift our country from stagnation to growth, from hostility toward enterprise, to an embrace of innovation and from a system rigged by government elites for their own benefit to one that can actually work for the middle class once again. so americans will hear two competing agendas this week. on the one hand, a tired sort of government-centered democratic agenda designed by and for ideologues of the left. on the other, a modern enterprise-oriented republican agenda designed around the hopes and potential of the middle class. this is a debate republicans welcome. it's one we've been waiting to have for a very long time and we hope washington democrats will actually be serious this time when they say they want to focus on jobs. because every time they say that, they keep getting distracted and pivoting to other issues. here's something else we need to expect from the majority too,

and that's votes, actually votes on amendments for positive reform. the american people deserve at least that much after so many years of failure, the middle class deserves the chance for something better. remember there are nearly four million americans who have been unemployed for six months or longer. these americans deserve to have a congress that's committed to making it easier, not harder, to create jobs. so let's have this debate. let's vote on republican jobs amendments and let's give some hope again to the middle-class families who suffered for entirely too long. i yield the floor. mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: mr. president before he yields the tphraof, i just want -- yields the floor, i just want to in response to the senator from kentucky again making it clear that it's my

interest in working very closely with colleagues on the other side of the aisle on these health care issues, it's why we took the proposal that senator hatch had for repeal and replace on medicare as the base bill. it's why i've spent a lot of time working with colleagues on the other side of the aisle on medicare part-d and trying to make sure it could be implemented well. and what was striking is a a lot of the stories about medicare part-d in the first couple of months resemble the stories that we're now seeing about the affordable care act. and the kpwoefplt kpwoefplt -- and the congressional budget office has commented that part-d has come in more than 25% less in terms of its projected costs than what c.b.o. saw years ago. so we're going to work in a constructive way. i hope that we won't see a push,

for example, to repeal the affordable care act, because if you do that, you go back to the days when health care in america is for the healthy and the wealthy, because you would allow again discrimination against those with a preexisting condition. the affordable care act has air-tight protection for those who have a preexisting condition. and if you repeal the affordable care act, you would simply go back to those days. so working with colleagues in a bipartisan way on strengthening the health care system and our economy, absolutely. but turning back the clock, for example, on vital consumer protections, like protecting our people from discrimination against preexisting conditions, that's something that i think would be a huge, huge mistake. i would also ask unanimous

consent, mr. president, to put into the record an article from the "wall street journal" here over the weekend. it was entitled "signup surge" with respect to the affordable care act. the signup's topping the congressional budget office target ahead of the march 31 deadline. and i was particularly pleased by the comments from insurance executives in pennsylvania, raofplt -- rhode island and florida talking about how more younger people are signing up which of course is key to what we all want to do in terms of bipartisan approaches that strengthen the role of private health care in america. and i would just ask so that my colleagues can read the remarks of high mark, inc., a major health plan based in pittsburgh. bluecross and blew -- blue

shield of rhode island. the florida blue senior vice president who said younger people are signing up. and i think all of this indicates that as far as private-sector health care is concerned, which we all sought to promote in connection with this, we're seeing more younger people come to these plans. i also, in response to my friend from kentucky, who asked about the jobs agenda, senator hatch and i have been working very constructively together on efforts to go forward in the finance committee, which could even begin this week to deal with the tax extenders which are particularly important for the jobs that senator mcconnell seeks, as he did in his remarks for that agenda, to get some traction, would be talking about an extension for the research

and development tax credit, which is key for innovation. we would be talking about jobs in renewable energy, jobs for veterans. this is the kind of jobs agenda that we're pursuing in the finance committee. mr. president, with that, i would yield the floor. the presiding officer: the tempt time -- democratic time is expired. the senator from illinois. mr. durbin: i want to thank a long time member of my staff leaving the congress after 22 years of service to congress. alan bruce isn't technically from illinois but he's from indiana. he's served the people of illinois in an extraordinary way. for the last 22 years alan has been my systems administrator. he joined my staff in 1992 when i was a member of the house, moved with me to the senate in 1997. he's the person most responsible for keeping my office and offices in illinois and

washington connected electronically to each other and to the world outside the senate. he oversees our network of desktop, latop computers, blackberries, cell phones and all the rest. over the years he's taught me a lot of things, and there was a lot for me to learn. everything from how to make n.i.h. computer work, dealing -- how to make my computer work, dealing with e-mail and how to skype. he's been a good teacher, hard working loyal member of my staff. in an age when people change employers repeatedly alan is unusual. the united states congress is the only employer he had since he graduated from cumberlands college in williamsburg, kentucky in 1986. he didn't plan to work on capitol hill. six weeks after he graduated from college he was getting ready for an interview to become a manager of a radio shack in fort wayne, indiana. the morning of that interview his mom said you don't really want to do this, do you? alan said, no, i really don't.

my heart is not in it. that day happened to be a saturday. it was also the day of the annual circus cities day parade in alan's hometown of peru, indiana. alan canceled his interview at radio shack and he and his mom went to the parade. working the parade line was a new candidate for the house of representatives. his name was jim johns. jim introduced himself to alan and alan's mother and learned alan was looking for a job. radio shack's loss was congressman johnson's game and mine as well. a few days after that parade alan was working as a volunteer driver for jim's campaign. when jim won his election he hired alan to work in his kokomo, indiana office helping constituents to work on military and veterans affairs. it was a good fit. alan grew up in a military family. his dad phillip bud bruce was a career air force man. in 1989 alan moved to washington to work in congressman johns'

d.c. office as systems administrator managing a congressional computer network in those days was a lot different. the internet was still pretty obscure used mostly by elite researchers. people didn't have personal e-mails and back then high-tech communications meant fax machines. computers were used mainly for keeping lists, data entry. cell phones were a perk of just the wealthy few. almost no one had heard of a web site and smartphones, youtube, twitter, flicker, nobody imagine what had that meant. alan joined my staff as systems administrator in 1992. to give you a sense of how dramatically his world changed, consider this. in 1997, my first year in the senate, i received 30,000 pieces of mail. that's real mail through the u.s. postal service. last year my office received 600,000 pieces of mail. only about 2% to 3% went through the post office. the rest were e-mails. however constituents reach out, whether it's by the postal

service or e-mail, alan works with the rest of my staff to make sure their letters are answered. the technological revolution is only one of the big societal changes that alan has taken part of in the last 25 years on capitol hill. alan was an early leader in congress among staff to end workplace discrimination against lesbian and gay congressional staffers. in the early to mid-1990's he was an early board member of what was then called lesbian and gay congressional staffers association. the association held frequent brown bag lunches to brief other staffers on issues of importance to the lesbian-gay americans, including don't ask, don't tell policy and the federal defense of marriage act. today both don't ask, don't tell and doma are history, and federal employees who are legally married to the same-sex spouses receive the same federal privileges and responsibilities as other married federal workers. as alan prepares to start the

next phase of his life in sunny tampa, florida, i want to thank him again both for keeping my office connected to the larger world and, of course, to the state of illinois, and for keeping the united states congress as an employer, moving toward the american ideal of equality and justice for all. mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from missouri. mr. blunt: mr. president, according to the national institute of mental health, approximately one in four adults suffers from a diagnosable mental health disorder that could be treated if diagnosed properly and treated properly. the bill that the chairman brings to the floor today, the bill that those -- establishes the so-called doc fix, the

repair and reimbursement issue in it that allows to us look at those individuals that have these mental health behavioral illnesses and begin to treat them in eight pilot states like any other illness. when senator stabenow and i introduced the bill, the excellence in mental health act in february of 2013, our goal was to be sure that federally qualified centers, that behavioral clinics that met, mental health clinics that met the proper standards could offer mental health treatment like any other kind of health treatment. what this bill we'll vote on later today includes is a provision that takes that legislation and allows us to have, allows the country to have a two-year pilot in eight states. those eight states are designating the legislation, the states themselves would step forward and say they wanted to

be part of this. certainly when we introduced this legislation in february of 2013, supported from the very start by chairman wyden, who had just become chairman of this critically important finance committee, we did it looking at the reality that people's lives are changed and that people they impact are changed. one of the things that moved the senate toward talking about mental health was some of the violent tragedies we've had in the country in recent years. in fact, after the sandy hook tragedy in december of, a year ago, it was -- it had been -- we had a hearing, the committee that deals with these issues had a hearing on mental health in january of 2013. it was the first hearing on mental health since 2007. for whatever reason, these are issues that as a society we haven't wanted to deal with in

the way we could. as i mentioned, violent tragedies, i want to be sure and say that people with behavioral illness are much more likely to be the victims of the crime than they are to be the perpetrators of the crime. but even when saying that, we know that the one consistent thing in these tragedies over and over again in this country or other countries is somebody that has a behavioral illness that hasn't been dealt with, somebody has a clear need that no one has reached out to meet that need. pursuing the excellence in mental health act and now pursuing this pilot project for eight states, the law enforcement community has been widely supportive of dealing with these challenges where we can deal with these challenges, at locations that people want to go to create maximum accessibility and fully qualified locations. the veterans community, unbelievably responsive.

the iraq and afghanistan veterans community was in washington last week dealing with mental health challenges, was their number-one priority. and we just had a news conference here in the building, and somebody from that group was once again with us as they have been since february of 2013. the community that supports mental health and looking for mental health solutions has been widely supportive of what we're trying to do. the house passed this legislation. it's legislation that we worked on, house members, senate members, bipartisan. one of the house members, dr. tim murphy, a psychiatrist who understands these issues; we have a special -- not only is he supportive of what we were doing, but we became supportive of what he was doing when he was advocating that for people who have behavioral illness, people who have a mental illness who were involved in a nonviolent

crime, that dealing with their illness rather than incarcerating the individual is the better approach that should be available to law enforcement, to judges. that's an important part of what we're doing here. the excellence in mental health act was originally cosponsored by a bipartisan group of 25 senators. it's been supported by 50 mental health organizations, veterans' organizations, law enforcement organizations. it's a place where -- it creates a place where people's needs are met. the demonstration project would allow community mental health centers an opportunity to increase the kind of services they provide within and to their local communities by providing a similar rate under medicaid that federally qualified centers receive for primary care services. this is something we've been talking about for a long time and it allows government to

begin to treat these behavioral challenges exactly like we treat other challenges. to have a healthy body, a healthy mind all in one person, all in one spirit, all treatab treatable. but this provision in this bill that comes before us today i think is the beginning of a significant change in how we look at helping people change their lives. the beginning of a significant change in looking at mental illness like it's any other illness. i believe we're going to see a good response to this on the floor today as we vote. more importantly, i think we're going to see a number of states who are incredibly interested in being one of these eight pilot states that will allow that to happen. missouri i certainly hope turns out to be one of those states and i would say that clearly our state has been a leader in so

many things, mental health, first aid, many of our federally qualified clinics have added behavioral health. many of our community clinics have added a level of service that this law would anticipate you'd need to have to meet community needs. i've certainly worked closely with the missouri coalition of community mental health centers. they just celebrated their 35th anniversary and they're very excited about this legislation. senator stabenow and i were on the floor the last day of october, the 50th anniversary of president kennedy signing the community mental health act, and many of the goals of that act have not been achieved in the way that the country i believe 50 years ago would have hoped to see them achieved. but this legislation today includes a significant step toward that goal set half a century ago, still unrealized, that allows us to do things as a country that we wouldn't otherwise be able to do. i would say that senator

stabenow has been a great partner in this legislative effort, a great advocate for this effort. our bipartisan friends in the house have as well. and i look forward to a successful vote today so that we can see this important step forward. and i would yield the floor. mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: just to make two unanimous consent requests. mr. president, i would ask unanimous consent that anne dwyer, a staff on the finance committee, have floor privileges for the 113th congress. the presiding officer: without objection. mr. wyden: and, mr. president, i would ask unanimous consent that senator cardin have five minutes at this time to address the s.g.r. issue. the presiding officer: is there objection? hearing none, the senator from maryland. mr. cardin: mr. president, thank you very much. let me thank senator wyden for his leadership on fixing this physician reimbursement structure on medicare. and to senator blunt, i want to

thank him and senator stabenow for their leadership on the mental health demonstration program that's in this -- whatever bill we pass will be in it because it's absolutely essential that we address the growing problems in our community health networks. so i thank both of them for their bipartisan leadership. mr. president, the current way that we reimburse physicians under medicare is broken. the s.g.r. system has been broken since it was passed in 1997 as part of the balanced budget act. we have had 16 temporary patches to the s.g.r. system and it's created uncertainty, not just among the medical community as to what the reimbursement rate will be for medicare patients, but it's caused uncertainty among medicare patients as to whether they know that their doctor will be there to treat them for their illnesses. if we don't fix the problem, we let it go off the cliff, we would see a 24% cut in reimbursements to physicians

under medicare. that's not sustainable, as we know. it would affect access to our seniors and disabled to their doctors. we have to fix this problem. and it expires today, march 31. so we've got to take action. but we have to choices. one is that we could take advantage of the opportunity not just to make sure we don't go off the cliff but to actually fix the problem and that's what senator wyden has been able to put together with senator hatch and with our colleagues in the house, a replacement that will actually work, that will actual will reward physicians -- actually will reward physicians for taking good care of their patients, by managing their care, by bringing down the costs of health care, by managing our delivery system, taking high-cost patients, treating them so that their illnesses are treated but also done in a more cost-effective way. that's what the replacement would do if we could pass a permanent fix to the s.g.r.

physician reimbursement structure in medicare. we have a bipartisan proposal. that bipartisan proposal will reward proper delivery of care. it also takes care of the therapy caps and other of the health care extenders. i mention that because senator collins and i have been working a long time to try to get a permanent replacement to the arbitrary cap on therapy services. that was also put in the 1997 b.b.a. act, balanced budget act. and what that did, that 1997, it put an arbitrary cap on therapy services. so the more severe you're injured, the more severe your illness, the less services you'll be able to get that you need in order to take care of your illness or injury. and that makes absolutely no sense at all and we fix that. so why are we debating this? there's strong bipartisan support because there's two proposals that are out there. one that senator wyden has brought forward that fixes the problem, that constitutes -- that substitutes a rational

system, and it's paid for. i could argue it's been paid for many times over. it's been paid for because we have already passed patches that have been paid for $153 billion. that's more than what this patch costs, what this permanent fix costs. and who's paid that $153 billion? it's been clinical labs, it's been skilled nursing facilities, it's been community health. all those have paid for a problem they didn't create within the medicare system. this has been paid for already. it's been paid for already many -- it's current policy. no one expects us to go off the cliff. but senator wyden, in an effort to say, okay, we're going to try to deal with this in an upfront way, c.b.o. is now scoring this proposal to be a little over $118 billion. that's a bargain considering just a couple years ago it was $300 billion over a 10-year period. mr. president, i remember in 2005, i filed a fix of this -- of this bill with

then-congressman clay shaw, bipartisan bill. scored at $50 billion. this has been paid for many times over. but senator wyden -- could i ask consent to speak for two additional minutes. the presiding officer: is there objection? without objection. mr. cardin: thank you. but senator wyden, in an effort to try accommodate everyone here, said okay, we'll take the cost savings that's already in the house bill. i could argue thatall that reals nothing to do with the physician problem but it's ones i think we can agree on so we have real cost savings of over $20 billion that senator wyden has put in his bill. he said okay, we have the scores savings under the overseas contingency operations if people feel we have to have an offset, even though we've paid for it over and over again. so we have two options -- another temporary fix, continuing uncertainty, continuing this problem down the road, asking those who didn't cause it to pay for it even though it's already been paid

for before, or we could really take care of it and tell our medical community, let's work on other issues to improve our health care system rather than coming down here every year asking for a temporary extension of the medicare physician reimbursement structure and not allowing the s.g.r. system to take effect. that's the two options we have. so i just came down they're thank senator wyden for putting forward a proposal that would fix it, that would really do it, so that we wouldn't have to come back again next year. congress really get gets somethg done, and it's bipartisan, bicameral. fix has already been signed off by the house and the senate. and senator wyden's couple with a plan that -- come up with a plan that we can also be fiscally responsible. i would urge my colleagues to go down the path of fixing the physician reimbursement structure so we can take that uncertainty out of the medicare law, do what's right for our medicare beneficiaries so they have the certainty of their care under medicare and do it in a

fiscally responsible way. mr. president, i yield the floor. the presiding officer: the senator from alabama. mr. sessions: mr. president, i do appreciate senator wyden and others who've worked on this problem. it's a matter we need to fix. the senator from maryland said the fix is signed off by the house, too. so i guess we're supposed to know the fix is in. we're just going to take care of the doctors who need their money and we're not going to pay for it, we're not going to do it within the budget. again. so as ranking member on the budget committee, i feel i've got a responsibility to report to this body the plain financial truth about the legislation that comes before us. now, the bill has been offered

by our democratic colleagues is worse than this one and i guess this is the reid-boehner bill that is before us. it would claim to pay for it by an o.c.o., the overseas contingency operations, which is there isn't anything worse than this pay-for in this bill. the reid-boehner doc fix legislation that we're about to consider violates the spending limits that we passed in democrat, the ryan-murray raised spending limits by $6 billion, only three months after those limits were signed into law. think about that. the bloomberg news released an analysis today concluding that -- quote -- "since december of 2013, the republican house and a democratic senate have approved more than $40 billion worth of spending offsets in the

form of cuts that would take place in 2023 at the earliest, or timing shifts in policy to bring savings into the 10-year window. in other words, congress has gimmicked an additional $40 billion in new spending in just a few months since ryan-murray was passed. that's just what it is. the budget committee, chairman murray, our democratic majority chairman, is going to -- has already ruled it violates the budget, it spends money we don't have, it's not a legitimate pay-for. so here we are again proposing to bust the spending limits. this is the behavior of a profligate congress. how many of our members, colleagues, how many were running for office two years a ago, four years ago, six years ago and you were talking to your constituents and he said, "that congress is -- and you said,

"that congress is spending us into bankruptcy, they're irresponsible. they won't even wright a budget. they spend, spend, spend. they don't worry about the deficits. the country is going into too much debt" how much have said that in their campaigns. "and when i get there, i'm going to do something about it?" and what happens when you get here, some members say oh, we've got to take care of the doctors. we do need to do that. but there's waste, fraud, and abuse throughout this $4 trillion budget spending of ours that we could use to reduce those spendings legitimately to pay for what we need to do for our doctors. that's what we agreed to do when we passed the budget control act. that's what the budget control act did. the budget control act in 2011 said this: the president signinged it, it passed both houses of congress, had democrat and republican

support. the budget control act says, over the next ten years, we're projected to increase spending by $10 trillion. but we're going to be more frugl than that we're only going to increase spending by $8 trillion. so spending would increase $8 trillion. and what happens, as soon as it begins to bite a little bit and we're challenged to make some priorities and decide how we're going to help our doctor friends who do need some relief, what do we do? we just violate the agreement. we spend money that we don't have and say somehow it's paid for. but senator murray says it's not. it's not paid for. so last year we borrowed -- think about this -- $221 billion to just pay the interest on our

debt. $17 trillion debt we have. we have to pay interest on it, colleagues. surely we all know that. and it was $221 billion last year. federal aid to education is $100 billion. federal highway bill is $40 billion. we spent that much on interest last year alone. but the worst news is, the congressional budget office tells us that ten years from today our interest cost will surge to $880 billion a year annually. senator hatch, do you have a question there? all right. the way you looked at me ... and that's more than $5,000 in interest per person. per family in the united states, $880 billion. can you imagine that? that's almost $400 a month for

the average family that pays taxes in america. that's how much their share is going to have to be raised in taxes to pay the interest in one year. and what do i say about this? this assumes, colleagues -- this $880 billion in interest and the surge in our debt, this assumes that we will adhere to the budget control act, which this bill busts, it violates. and it's not the first time. and won't be the last. they're going to come back again and again and again with gimmicks and violations because people in our congress are unwilling to take the heat to find real offsets. so we should keep that in mind as we consider this or any other

legislation that will increase the amount of money we have to borrow. i would like to call attention to three specific ways the proposed legislation violates spending and deficit limits. each of these are points of order that lie against the bill, confirmed by the majority on the budget committee. what i'm saying is, each of these three points i'm raising now represent points of order. in other words, the budget committee has ascertained that they violate the budget. we spend more than we're allowed to spend. $17.6 billion increase in the on-budget deficit over the five-year period from fiscal year 2014 through 2018. and a $9.5 billion increase in the on-budget deficit over the ten-year period of 2014-2023.

spending in excess -- number two, the spending in excess of the topline total in the ryan-murray levels for 20146789 w--2014. the president signinged it in january and this is going to add $6 billion more than we just agreed to spend. oh, well ... nays not a problem. that's not a problem. i say it is a problem. i say it's the way a nation goes broke. how about this: spending in excess of the financial committee's allocati allocation. the committees are allocated so much money. they're not entitled to spend above the allocated amount. so this spends $6.1 billion in budget authority and outlays in fiscal year 2014, this year we're in, above the finance committee's allocation.

was there a time agreement, mr. president? the presiding officer: there is an order to go to executive session at 5:00. if the senator would like to ask unanimous consent -- mr. sessions: i would like to ask unanimous consent for two additional misseen minutes and l wrap up. the presiding officer: is there objection? hearing none ... mr. sessions: thank my courteous colleagues. so, mr. president, maya mcginn nighs, at the committee for a responsible budget, well-respected, was quoted as saying, "we're just heartened then in a 12-month doc fix, the legislationed under consideration would use a budget gimmick to offset a portion of its cost, specifically a portion of the bill's savings are achieved by simply shifting sequester savings set to occur in 2025 into 2024 within the congressional budget office scoring window, but this has

zero actual impact on the debt." congress should remove the phony savings in this bill and replace them with real cuts or shorten the duration of the doc fix." close quote. that's an objective analysis of it. so, mr. president, that's being the case, the pending measure -- h.r. 4302, the protecting access to medicare act -- would violate the senate paygo rule and increase the deficit. therefore, i raise a point of order against this measure pursuant to section 201-a of s. con. res. 21, the concurrent resolution on the budget for fiscal year 2008. mr. wyden: mr. president? mr. president? the presiding officer: the senator from oregon. mr. wyden: pursuant to section 904 of the congressional budget office of 1974, the waive sections of i move to waive all applicable sections of that act and applicable budget

resolutions for purposes of the pending bill and i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. hatch mr. president? the presiding officer: the yeas and nays are ored. mr. wyden: mr. president, i would now ask unanimous consent to make a unanimous consent request. ferraro is there objection? the presiding officer: is there objection? the. mr. wyden: with respect to thr 4302 following disposition of the owens nomination, when the senate resumes lilgive serks the senate proceed to the consideration of calendar 336, s. 2157. if the sthiewt amendment at the desk be agreed to, the bill ages amend be read a tired time and senate proceed to vote on passage of the bill with no intervening action or debate, and that upon disposition of the bill, the senate resume consideration of h.r. 4302, as provided under the previous order. the presiding officer: is there objection?

without objection. mr. hatch: i have to raise an objection, so i object. the presiding officer: oh, the senator from utah. mr. hatch: i have to raise an or, so i object. the presiding officer: objection is heard. mr. hatch: mr. president, i would ask unanimous consent that the senate proceed to the immediate consideration of calendar number 330, s. 2122, a bill to repeal the medicare sustainable growth rate offset by repealing the obamacare individual mandate. i ask unanimous consent that the bill be read a third time and passed, the motion to reconsider be laid on the table. the presiding officer: is there objection? a senator: i object. the presiding officer: objection is heard. the senator from utah. hatch mr. presidentmr. hatch: m, today the senate will vote on h.r. 4302. this is a bill that will extend for one year the so-called doc fix relating to the sustainable

growth rate or s.g.r. formula. patching the s.g.r. has become a regular item of business here in the congress. it's basically an annual ritual that we have to go through here. from the first day the s.g.r. went in effect in 2002, congress as acted to prevent is reimbursement cuts to physicians from going into effect mured to ensure the medicare beneficiaries continue to have access to quality care. the presiding officer: there is an order to proceed to regular session. mr. hatch: i would ask unanimous consent that we proceed to executive session and my remarks be placed thereafter. the presiding officer: without objection. the senate will proceed to executive session to consider the following nomination, which the clerk will report. the clerk: nomination, john b. owens of california to be united states circuit judge for the ninth circuit. the presiding officer: under the previous order, the time until 5:30 p.m. will be equally

divided and controlled between the two leaders or her designees. mr. hatch: mr. president? the presiding officer: the senator from utah. mr. hatch: if i can have the first part of this -- my remarks be placed in the record at this point, i would appreciate it. the presiding officer: without objection. hatch from the first day the s.g.r. went into effect in 2002, congress has acted to prevent its reimbursements from going into effect mured to aensure the medicare beneficiaries continue to have access to quality care. more often than not, s.g.r. patches have been cobbled together at the last minute between the leadership offices of both parties. mr. hatch: they are usually tacked onto larger pieces of legislation without the input of members and without the benefit of going through a committee. for years this process has bothered members of the congress who, like me, want to see transparency and regular order return to the legislative process. iit has also bothered seniors and physicians who are

constantly bothered whether the gridlock is going to final lay send them over the s.g.r. cliff. there is bipartisan support for repealing and replacing the s.g.r. or the sustainable growth rate. and to the surprise of many, progress has been made do-to-do just that. for more than a year, a bipartisan, bicamera group of members of congress worked to fully repeal the s.g.r. and replace it with more reasonable reforms that move medicare's antiquated system toward a system that rewards doctors for providing quality care based on health outcomes. it was part of -- i was part of that group, senior senator was former senator max baucus. chairman baucus and i worked for months to produce an s.g.r. repeal bill here in the senate. eventually that bill sailed through the finance committee with broad bipartisan support. at the same time, the two relevant house committees -- the ways and means committee and

energy and commerce committee -- also report add bill to repeal the s.g.r. that in and of itself would have been quite a feat. however, we weren't done yet. ment realizing that we were close to achieving our goal, the chairman and raiferging member of all three relevant committees -- three republicans and three democrats -- decided to come together to find a single, unified approach that both parties in both chambers could support. at the time there were a lot of naysayers. indeed, given congress's recent track record, there were reasons to be skeptical. however, by consulting with all the relevant stakeholders and hearing their recommendations and concerns, we were able to craft a policy that is nearly unanimous support across the health care community. that's right, mr. president. for the first time since the s.g.r. was enacted in 1997, republicans and democrats in the house and senate are united

behind a policy that et goes rid of this flawed system once and for all. however, we can't get a ahead of ourselves. from the outset of this process, chairman baucus and i, along with our house counterparts, agreed that any legislation to repeal and replace the s.g.r. must be fiscally responsible. without any offsets, this policy would add autographly $180 billion to the deficit if we don't have offsets. if it is going to pass in haj the senate and house of representatives, and if we're going to maintain the same level of bipartisan support for the package, we need to find offsets that both parties can support. it's kind of miraculous we've come together but both the bilateral and bipartisan people have worked on this and have agreed that we have to have solid offsets. and in the months since we reached and agreement on the underlying policy, all of the parties involved have been working to find suitable offsets.

i'm not going to disparage 234eug. this is a difficult process. but it has to be done. and despite the bipartisan good will this process has engendered, there have been some who were not satisfied with our progress. and with today's s.g.r. deadline looming, there was an effort to hijack this bipartisan process and turn it into yet another partisan sideshow. with an agreement in place and the parties still at the negotiating table some of my friends on the other side of the aisle thought it would be preferable to simply bring our bill to the floor and demand a vote either with offsets or with offsets they knew republicans would not be able to support. in other words, mr. president, they wanted to force our bipartisan policy through the senate on a partisan basis and then jam the house with it. this was to say the least disappointing to me. here we have an historic opportunity to do something that will help people throughout this country and do it with the type

of broad bipartisan consensus that is all too rare in washington these days. yet there were still some who would prefer to snatch defeat from the jaws of victory and set up yet another political showdown destined to end in partisan stalemate. needless to say, i'm glad eventually cooler heads prevailed which brings us to today's support. the s.g.r. patch that we will be voting on today is not perfect. however, i'm not going to make the perfect the enemy of the good. it's a good-faith effort to move the ball forward thanks to the good work of speaker boehner and majority leader reid. what we need now is time to get this done the right way and this bill will give us that. so for these reasons i plan to vote in favor of the s.g.r. bill before us today. i urge my senate colleagues to do the same. once this legislation is signed into law we need to get back to the negotiating table and i have

no doubt my friend, the distinguished senator from oregon will work with me as he always has, in order to resolve these problems that have re arisen. there are three committees with jurisdiction over the s.g.r. issue. we all need to work together to find a responsible path forward. hopefully the bill we'll vote on today will put an end to the unnecessary distractions and roadblocks thrown in our path. mr. president, is an important vote today and i'm very grateful to those who are willing to support what we're at least trying to do. and i want to thank all concerned. with that i yield the floor. mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: before he leaves the floor i want to thank my partner from utah for his exceptional work in terms of putting together a repeal and replace program, and say as i have in the course of the afternoon that essentially the proposal that i

have talked about here today could more appropriately be called the hatch-kyl plan because the underlying bill is essentially the outstanding work done by the senator from utah, chairman camp, chairman upton, a number of democrats, and essentially takes as the pay-for what our former colleague, senator kyl, a conservative by anybody's calculation, had in mind. so we are going to be doing a lot of bipartisan work in the senate finance committee, mr. president, senator hatch and i as i touched on earlier are their working on the tax extenders, and i simply thought that the ideas of senator hatch and senator kyl, two conservatives who i admire, fit quite well with the kind of bipartisan approach that you heard many senators on this side of the aisle talk about this

afternoon such as senator cardin and senator warner. so at the end of the day, i guess i'll put my final remarks in the context of what senator coburn, our friend from oklahoma said, and he essentially said don't put off until tomorrow what you can do today, and the good work that senator hatch has done on this -- i wasn't the point person for the democrats at that time, it was chairman baucus -- i think highlights what we could be moving on today, and the pay-for that our former colleague, senator kyl of arizona, put forward several years ago, is just as valid as it once was. so we will continue, as senator hatch as described this afternoon to work very closely together, and i'm hopeful that here in the next couple of days colleagues will also see it on a

vital matter relating to jobs because the two of us are working together on tax extenders, which is so important for promoting innovation in our economy, the research and development credit renewable energy, jobs for veterans and, mr. president, with that i yield the floor. mr. hatch: mr. president, i suggest 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 california. mrs. feinstein: mr. president, i ask that the quorum call be vitiated. the presiding officer: without objection. mrs. feinstein: thank you, mr. president. i wanted to come to the floor very briefly and i'd ask to speak for three minutes. the presiding officer: without objection. mrs. feinstein: thank you very much. to talk about john owens, who is the first vote, for a judgeship, particularly one to the united states court of appeals for the ninth circuit. no one questions his qualifications, i spoke on the floor about him before. was proud to nominate him to the president. he has a sterling background and would be an excellent circuit court judge. the question that arose was because the previous judge, a

man by the name of steven trott, he spent his entire legal career in california before joining the reagan administration, he was licensed to practice law in california, he was supported by the two republican senators from california, and blue slips for his nomination were sent to california. now, what am i trying to do? i'm trying to say this was a california judge for the ninth circuit. now, what has happened, since then, is because he moved his home to idaho once he was a judge, idaho or some of the representatives from idaho tend to believe that voila, this is now an idaho seat. it is not an idaho seat. i explained last week that california has less than its proportional share of ninth

circuit court judgeships, and idaho has its fair share. senator crapo, who came to the floor and spoke about this, said nothing about population or caseload to illustrate why this judgeship should move to california. this has been a long-standing attempt to take this seat away from california. when i came to the floor before, i outlined the whole process of how historically this is, in fact, a california seat. so i would like to urge my republican colleagues to consider the precedent they would be endorsing if they vote against this nominee because of this seat's history, and that is if a circuit court judge in your state decides to move to another state in the circuit, then your state has lost that judgeship. that's the precedent that not

approving this judge would set. so i urge my colleagues to continue to support this nominee, notwithstanding the opposition of the senators from idaho. i thank the chair, i yield the floor. i 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 nebraska. mr. johanns: i ask the quorum call be dispensed with. the presiding officer: without objection. under the previous order, all postcloture time is considered expired and the question occurs

on the nomination. mr. johanns: i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the yeas and nays are ordered. the clerk will call the roll. vote:

vote:

vote:

vote: the presiding officer: are there any senators wishing to vote or wishing to change their vote if not, the ayes are 56, the nays are 43. the nomination is confirmed. under the previous order, the senate will resume legislative session and resume consideration of h.r. 4302. mr. reid: mr. president? the presiding officer: under the previous order -- the majority leader. mr. reid: i ask unanimous consent that the votes tonigh tonight -- the presiding officer: the senate will be in order.

mr. reid: the next votes tonight be 10 minutes in duration. the presiding officer: is there objection? without objection. under the previous order, the question is on the motion to waive. the yeas and nays were previously ordered. the clerk will call the roll.

vote:

vote: the presiding officer: are there any senators in the chamber wishing to vote or wishing to change their vote? if not, the ayes are 64, the nays are 35. three-fifths of the senators duly chosen and sworn having voted in the affirmative, the motion is agreed to. under the previous order, the clerk will read the title of the bill for a third time. the clerk: h.r. 4302, an act to amend the social security act to amend medicare payments to physicians and other provisions of the medicare and medicaid programs and for other purposes. the presiding officer: under the previous order, -- the

majority leader. mr. reid: we're going to have a vote now on s.g.r. and if all things work out as anticipated, that will be the last vote tonight. the presiding officer: under the previous order, the question occurs on passage of h.r. 4302. is there a sufficient second? there is. the the yeas and nays are ordered. the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators in the chamber wishing to vote or wishing to change their vote? if not, on this vote, the yeas are 64, the nays are 35. the 60-vote threshold having been achieved, the bill is passed. under the previous order, the senate will resume consideration of the motion to proceed to h.r. 3979, which the clerk will

report. the clerk: motion to proceed to consideration of h.r. 3979, an act to amend the internal revenue code of 1986, and so forth and for other purposes. the presiding officer: under the previous order, all postcloture time is considered expired. the question occurs on the motion to proceed. the majority leader. mr. reid: i have a substitute amendment at the desk. the presiding officer: the question is on the motion. all in favor say aye. all opposed, no. the ayes appear to have it. the ayes do have it. the motion is agreed to. the clerk will report the bill. the clerk: calendar number 333, h.r. 3979, an act to amend the internal revenue code of 1986 and so forth and for other purposes. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: i have a substitute amendment at the desk. the presiding officer: the clerk

will report the amendment. the clerk: the senator from nevada, mr. reid, proposes an amendment numbered 2874. strike all after the first word and insert the following -- short title -- mr. reid: mr. president, i ask unanimous consent the reading of the amendment be waived. the presiding officer: without objection. mr. reid: i ask for the yeas and nays on that amendment. the presiding officer: is there a sufficient second? there appears to be. the yeas and nays are ordered. mr. reid: i have a first-degree amendment to the substitute that's already at the desk. the presiding officer: the clerk will report. the clerk: the senator from nevada, mr. reid, proposes an amendment numbered 2874 to amendment numbered 287 -- 2875 to amendment numbered 2874. at the end, add end, add the fo: -- reid i ask that further reading be waived. the presiding officer: without objection. mr. reid: ask for the yeas and

nays. the presiding officer: is there a sufficient second? there appears to be. the yeas and nays are ordered. reid i havmr. reid: i have a see amendment to the substitute which is at the desk. the presiding officer: the clerk will report. the clerk: the senator from nevada, mr. reid, proposes an amendment numbered 2876 to amendment numbered 2875. in the end, strike one day and insert two days. mr. reid: i have a cloture motion at the desk. the presiding officer: the clerk will report the cloture motion. the clerk: cloture motion, we, the undersigned senators, in accordance with the provisions of rule 22 of the standing rules of the senate, hereby move to to a close the debate on amendment of the substitute amendment to h.r. 3979, an act to amend the internal revenue code of 1986 to ensure that emergency services volunteers are not taken into account as employees under the shared responsibility requirements contained in the patient protection and affordable care act. is signed by 17 senators as follows.

mr. reid: i ask unanimous consent the reading of the names be waived. the presiding officer: without objection. mr. reid: i have an amendment to the bill. the presiding officer: the clerk will report. the clerk: the senator from nevada, mr. reid, proposes an amendment numbered 2877 to the language proposed to be stricken by amendment numbered 28746789 at th74.mr. reid: i ask unanimos consent the reading be terminated. the presiding officer: without objection. mr. reid: i ask for the yeas and nays on that amendment. the presiding officer: is there a sufficient second? there appears to be. the yeas and nays are ordered. mr. reid: i have a second-degree amendment. the presiding officer: the clerk will report. the clerk: the senator from nevada, mr. reid, proposes an amendment numbered 2878 to amendment numbered 2877. in the amendment, strike three days and insert four days. mr. reid: i have a motion to commit h.r. 3979 but it also has instructions and that is at the desk. the presiding officer: the clerk will report. the clerk: the senator from

nevada, mr. reid, moves to commit the bill to the committee on finance with instructions to report back forthwith with the following amendment numbered 2879. mr. reid: i ask for the yeas and nays on that motion. the presiding officer: is there a sufficient second? there appears to be. the yeas and nays are ordered. mr. reid: i have an amendment to the instructions. the presiding officer: the clerk will report the amendment. the clerk: the senator from never, mr. reid, proposes an -- from nevada, mr. reid, proposes an amendment numbered 2880 to the instructions of the motion to commit h.r. 3979. mr. reid: i ask for the yeas and nays on that amendment. the presiding officer: is there a sufficient second? there appears to be. the yeas and nays are ordered. mr. reid: i have a second-degree amendment. the presiding officer: the clerk will report. the clerk: the senator from nevada, mr. reid, proposes an amendment numbered 2881 to amendment numbered 2880. mr. reid: i have a cloture motion at the desk. i ask the chair report it. the presiding officer: the clerk

will report the cloture motion. the clerk: cloture motion, we, the undersigned senators, in accordance with the provisions of rule 22 of the standing rules of the senate, hereby move to bring to a close the debate on h.r. 3979, an act to amend the internal revenue code of 1986 to ensure that emergency services volunteers are not taken into account as employees under the shared responsibility requirements contained in the patient protection and affordable care act. signed by 17 senators as follows. mr. reid: i ask unanimous consent the reading of the names be waived. the presiding officer: without objection. mr. reid: note the absence of a quorum. the presiding officer: the clerk will call the roll. mr. reid: i ask unanimous consent the call of the quorum be terminated.

the presiding officer: without objection. mr. reid: on the matter before the body before the quorum call was ordered, i ask unanimous consent that the mandatory quorums required under rule 22 be waived. the presiding officer: is there objection? without objection, so ordered. mr. reid: i move to proceed to calendar number 250, the minimum wage fairness act. the presiding officer: the clerk will report the motion. the clerk: motion to proceed to the consideration of s. 1737, a bill to provide for an increase in the federal minimum wage and to amend the internal revenue code of 1986 and so forth and for other purposes. a senator: mr. president? the presiding officer: the senator from new jersey. mr. menendez: mr. president, i shortly am going to make a unanimous consent request on s.

res. 404, a resolution that i introduced honoring the life and legacy of cesar chavez. this resolution has been blocked by my colleagues on the other side of the aisle every time it has come up for the last seven consecutive years. every time. every time. now, today, on what would have been cesar chavez's 87th birthday, i ask my republican colleagues to find it in their hearts to honor a man who really made a difference in our country. frankly, i don't understand their reluctance. i don't understand their obstructionism. i don't understand how they can look back at that time in history, at the sacrifices cesar chavez made for our country, asking for nothing more than fair treatment and justice.

now, i realize it's uncommon to make a live unanimous consent request for a commemorative resolution, but if republicans are going to object yet again for an eighth year in a row to honoring a -- in my view, a great american hero, i really want it to be on the record. i think republicans need to answer to the american people as to why as a party they can agree to passing resolutions honoring world plumbing day or congratulating the penn state dance marathon -- both senate resolutions that were adopted this month by unanimous consen consent -- but insist on standing in the way of honoring a civil rights trail blazer who changed the course of our nation's history. cesar chavez was a man before his time and he deserves proper recognition. he dedicated his life to fighting for equality, justice

and dignity. not only for hispanic farm workers but for all workers in the united states. yet our friends on the other side cannot find it in their hearts to honor him, and i have to ask why. why can't they simply say "yes"? it was an extraordinary man who gave of himself for his cause and deserves to be remembered and honored by the united states senate. the president of the united states proclaimed today, march 31, 2014, as cesar chavez day. over ten states honor his life and legacy each year on this day. the secretary of the interior established a national monument in his honor. and across the country, you'll find schools and parks, streets, libraries and other public facilities named after cesar chavez as well. so i implore senate republicans to reconsider denying cesar chavez's legacy for an eighth year in a row. adopt this commemorative

resolution by unanimous consent. give cesar chavez the recognition he so deserves. that's all we ask. nothing more. this year, there is a new movie chronicling the life of cesar chavez, a life lived with honor and dignity and decency for the betterment of all of us. the film is long overdeuvment that life, that dedication, that spirit will always be missed. he was born near his family's farm in yuma, arizona. when he was 10 in the hard times of the depression, the family lost their farm, like millions of americans, and they became migrant farm workers, laboring in vineyards across the southwest, where he learned of the injustice and hardship of a farm worker's life. he never left those fields. he never left the land. he never turned his back on the people who worked it and the rest is history. robert kennedy called him one of the most heroic figures of our time. i think it's because cesar

chavez understood and believed in one fundamental truth. he always said -- quote -- "the fight is never about grapes or lettuce. it's always about people." he was right and that fight continues today. the struggle for fairness and dignity for every american goes on and cesar chavez was and is its inspiration. he certainly is an american hero but most definitely a hero to the hispanic community. he paved the way for the contributions of hispanic-americans, for innovative and social improvements. if there's one man that redefined leadership, it is cesar chavez. and i think my colleagues need to know that the community stands with me today and stands firmly behind my resolution honoring the life and legacy of cesar chavez. mr. president, i have a list and in the interest of time i won't read it but of over 29 national and actually 37 national

hispanic and labor organizations all which support the resolution that i'd ask unanimous consent to include in the record. the presiding officer: without objection. mr. menendez: we all eagerly aawait the day when politics will no longer preclude its passage. cesar chavez's profound legacy and lasting legacy can be reduced to three words -- they echo from the fields of delano, california, across america all the way to the without. ce se queda. these three words, while simple in nature, harbored the power of communities to move from darkness to a brighter light of hopes. these three words represented as the very core of spirit that breathes life into america's struggle for a better life. as the leader of the first successful farm worker's union in the united states, he fought to ensure those working tirelessly to provide americans

with food received the benefits they deserved. nonetheless, his service extends far beyond our agricultural fields and provides inspirations to those working to improve human rights, empowering workers, regardless of race or ethnicity. his countless efforts to ensure equality, justice and dignity for all people in the united states are a testament of his leadership and success, a success that can only be measured by the lasting impact he's made toward ending workplace discrimination, unsafe and unfair working conditions, low wages, and child labor. he was more than just a farmer with a vision. he was a civil rights leader that embodied the pursuit of justice that continues to inspire millions of americans today. so i come to the floor today to honor the life and achievements of cesar chavez, to ask my republican colleagues to put aside their politics and do what is right by a man whose life and legacy deserve the recognition of this nation, one nation, and one congress. let us stand together and

recognize the accomplishments of a great american hero, but most importantly, let us honor the values that make our country great, the values of tolerance, hope and freedom upon which this country was founded. let us always remember, as chavez said, the fight is always about the people. with that, mr. presiden mr. prek unanimous consent that the judiciary committee be discharged from further consideration of s. res. 404, the resolution be agreed to, the preamble be agreed to, and the motion to reconsider be laid upon the table with no intervening action or debate. the presiding officer: is there objection? mr. sessions: mr. president? the presiding officer: the senator from alabama. mr. sessions: reserving the right to object. i would note that the resolution has not come out of the judiciary committee and that senator vitter, who has filed an amendment to the resolution, asks that that amendment be

accepted or voted on, which has been not agreed to. the amendment would say a couple of things. one, whereas cesar estrada chavez strongly believed in enforcing immigration laws, thereby reducing the deleterious effects of inexpensive labor on the wages of farm workers in the united states and which was recognized by the congressional budget office in june of 2013 in their report entitled "economic impact of s. 744, the border security and economic opportunity and modernization act." and he offers this "whereas," a second one. "whereas, cesar estrada chavez recognized the importance of a secure southern border with mexico through citizen participation in the enforcement of immigration laws by encouraging members of the

united farm workers of america to contact the immigration and naturalization service to report instances of illegal labor." so those were -- that not having been accepted, i guess i would ask that that would be accepted. it's at the desk, be agreed to prior to the adoption of this resolution. well, mr. president -- the presiding officer: does the senator from new jersey so modified his request. mr. menendez: reserving the right to object, mr. president, this is not about cesar chavez. this is about immigration. now, i know that my distinguished colleague has a different view about immigration than i do. i know that he and senator vitter, on who he's offering this amendment by, also has a

different view. the senate has spoken on the question of immigration. 67 senators, two-thirds of the senate, has already sent an immigration reform bill to the house of representatives. so while we may have different views, that's not the issue of cesar chavez. and in my view, it is an injustice to his memory to offer such an amendment, and that's why i will have to object. mr. sessions: mr. president? the presiding officer: is there objection to the original request? mr. sessions: i would object and would just note that i do have a different view, and on these issues with regard to the impact of s. 744, had it passed, it would have been adverse to farm workers no who are in this country working hard, knees pay raises, and need better job opportunities, and i think these are important parts of mr. chaff he is's career $chavez's career. it seems to me that the senate

would be pleased to accept them. i understand we have a disagreement, and i would yield the floor and express my respect for senator menendez and his reaper oleadership on the forein relations committee, but we disagree on this subject. the presiding officer: objection is heard. mr. menendez: mr. president? the presiding officer: the senator from new jersey. mr. menendez: mr. president, you know, i have deep respect for senator sessions, but i'll just simply say, this is the eighth year -- the eighth year -- in which under some fig leaf -- before they could hide through their objection. this is really a fig leaf. the senate has expressed itself on immigration reform. this is not about immigration reform. this is about cesar chavez. this is about a man that led boycotts across the country to bring to justice the rights of farm workers and all workers across the land. and there is no bigger supporter by the way of immigration reform than the united farm workers, which he helped build, create,

and today is one of the strongest voices for that immigration reform. so it's really shameful that we can pass, you know, commemorative resolutions on some of the most insignificant issues, but on the life of someone who changed the course of this country for millions of latinos who understand that life and history and would want to see that life commemorated that there can be a continuing objection eight years, and i will keep coming each year to the floor, mr. president, to make this happen, because at some point it will. and with that, mr. president, i yield the floor. the presiding officer: the senator from michigan. ms. stabenow: thank you, mr. president. before the distinguished senator from new jersey, the senior senator, leaves, i just want to thank him for his diligence and advocacy on behalf of a distinguished american. i can say as a chair of the

agriculture committee, without the work of cesar chavez, without those who toil in the fields, picking the fruits and vegetables and providing the backbone of the agricultural workforce, we wouldn't have an agricultural economy in many places in this country. and to say on the date of his birth that we recognize cesar chavez i think is something that is straightforward and ought to be happening and should have happened eight years ago. mr. president, today marks the culmination of a long fight to improve community mental health care in our country. last thursday the house of representatives passed the protecting access to medicare act, which includes a demonstration project based on the excellence in mental health act that my friend and partner from missouri, roy blunt, and i authored, and i want to

recognize senator maria can't well, wh--maria cantwell, who ie floor for her wonderful passionate support. i want to thank our house sponsors. this is a house-senate democrat-republican initiative. congresswoman matsui, a democrat from hawaii, congressman lance, a republican from new jersey, were our sponsors. we also had significant partnership and advocacy from congressman tim murphy, a leader in mental health in the congre congress, a republican from pennsylvania. i want to thank susan collins, who, as the senator from maine, has been a passionate advocate as well; senator jack reed, who

has worked with me for years on this legislation, he and i partnering for a long time to get this done. i want to thank the chairman of the ways and means committee in the house, chairman camp, and chairman upton for working with us, both from my home state of michigan, for wor working and partnering for us. i want to thank the speaker and our majority leader, senator reid, who put together a proposal, not what most of us would have liked to have seen in terms of permanenting fixing this issue of the s.g.r. or medicare reimbursement for physicians, but even in looking at just a fix for a year, they came together and supported our vision for positively moving forward on a demonstration project to increase community mental health services. and certainly last but not least, i would i want to thankr

ron wyden, who has been there since day one, and who was unequivocal in his support for what we were doing. i want to thank chairman wyden for his leadership and support. our legislation is really a landmark step forward for community mental health funding. one of the most significant advances we have seen in decades. this bill will improve the lives of people all across the country by providing funding to create 24-hour emergency psychiatric services and higher standards and funding for community care. we authored this bill because mental illness touches all of our families in one way. one out of four americans. for me, it was my father, who suffered from bipolar disorder and was not diagnosed for at least ten years, when i was growing up. and i saw the impact on my dad,

the most loving, wonderful father someone could have, on my mom, my brothers, our whole family as we struggled to figure out what was going on and get him the help and support he needed. when he finally was accurately diagnosed and received the right treatment and support, got the right tools to manage this disease, he was able to go back to work and live a happy and rewarding life for the rest of his life. like my dad, too many people who need treatment don't get it, including one-third of all people living with mood disorders, and more than half of those with severe mental diseases. that's because in this country we treat mental health and physical health differently. if you have diabetes, you monitor your sugar levels, take insulin to manage your disease, you go on with your life as you

are manage your disease. if you are bipolar, meaning you have a chemical imbalance in the brain, you may receive zero treatment, maybe lose your job, or worse -- your family; maybe end up in jail or on the street. diabetes and bipolar disorders are both chemical imbalances in different parts of the body. both deserve treatment. and people deserve to be able to get effective treatment for both. both are treatable. both are treatable. the same is true for schizophrenia and many other behavioral diseases. there is hope when people get help. there is treatment available, and from that the ability to manage diseases just like we do for so many physical diseases.

this bill which we just passed in the senate will make it more likely to happen that people can get the treatment and support they need. this bill makes great improvements in the way we treat mental health care as well. it will expand access, make sure people get treatment of a higher quality level, because we just -- just as we do with federal qualified health centers, we are now creating federally qualified behavioral health clinics. so if you meet higher standards, you get higher reimbursement, and, therefore, more services available. this legislation authorizes eight states to be designated to receive enhanced funding for community mental health services, based on meeting high-quality standards for services. as i said before, the designation of federally qualified behavioral health clinic. it is voluntary. states will compete to be designated as one of the eight

demonstration states, and i would expect many states and communities across the country to be working together to do that. i fully expect this demonstration project to save lives and save money for communities in every state who are housing people in jails who should be getting the treatment they need and th in the communin order to mapping their diseases and live -- to manage their diseases and live productive lives. it has taken a long time to get here. the fight began 50 years ago when president john f. kennedy called on congress to create a new type of health facility that would improve the quality of mental health care in the community -- in the community -- and reduce stying i restying mad congress to take action because he had a vision to bring mental health treatment out of institutions and into

communities across america. following his lead, congress sent him the community mental health act. it was the last bill he signed before he was murdered in dall dallas. and it was one of the most important bills that he signed. senator blunt and i spoke on the senate floor last fall to commemorate the 50th anniversary of that bill signing, because it marked a major change in the way we treat mental health. unfortunately, over the past few decades, instead of increasing funding for mental services, we've seen cut after cut after cut, and we are seeing the consequences. in-patient facilities all across the country have closed their ambassadors, but thedoors, but n replaced in the community. worse, many are turned to jails

as their primary mental health facilities. as cook county sheriff testified in the house of representatives just last week, "the unfortunate and undeniable conclusion is that because of dramatic and sustained cuts in mental health fund, we have criminalized mental illness in this country." the e.r., the jail, are not the place to treat mental illness. mr. president, we can do better than that in this country, and we have now taken a major step to do that. our families deserve better. that's why our former colleague, senator pete domenici, and senator paul wellstone, a dear friend to so many of us who we miss dearly, and later another dear friend, senator ted kennedy, who we also miss dear dearly, a towering figure on so many issues, they joined together with senator kennedy's son, representative patrick

kennedy, and wrote the bipartisan mental health parity and addiction act. they wanted to make sure we had parity in how insurance companies treat mental and physical health. that bill became law finally in 2008. it was a huge step forward. i'm proud to be -- i was proud to author mental health parity in the affordable care act which was the next big step forward. today we voted on the final step in mental health parity in the community. the ability to get funding for quality mental health services, the same way we fund quality community health services. i met and heard from so many people who have personally felt the effects of mental illness and who want us to pass this bill so they and others can get the treatment they need. one of those people who joined us, in fact, today at a press

conference, flew in from michigan is melkia neumann who lived over 30 years with undiagnosed bipolar disorder. over 30 years. she finally got the treatment she needed through the oakland county health authority in the detroit suburbs and she recovered sand now managing her illness and is the board chair of the very same mental health authority she turned to for help. so that she can help others who need it. she said her message to congress is please pass this bill so that everyone can get the mental health help they need. not everyone is as lucky as melkia, though. there are many who still need our help which is why what we've done today is so important. today one in four returning veterans from iraq and afghanistan are in need of some form every mental health treatment, one in four. i recently heard from marsha in

dearborn about her friend. marsha writes my friend basically served two tours in iraq for this country. before he left for war he was so outgoing, and all he wanted was to put a smile on everyone's face. he had the biggest heart of everyone i know. but when he came home from war with ptsd, her friend was in trouble, marsha writes, "what is done for these men and women when they come home from war? they see things no one should ever see, do things no one should ever be asked to do and they're expected to come home and live normally." her friend killed himself after suffering from ptsd for eight years. marsha's friend is only one of the 22 veterans who take their lives every day. every day.

in america. so this is where our bill comes in. this bipartisan bill expands mental health care, working with outpatient v.a. clinics, working with community mental health centers, all working together and i want to thank so much the iraq and afghanistan veterans for being with us every step of the way, advocating, all the veterans' organizations who have been so supportive. this bill will create a broad range of mental health services like a 24-hour crisis psych are trick service in communities that are selected. integrated screenings, for illness and substance abuse, expanded peer support and counseling for families, for patients and families alike. and it allows community mental health centers to be finally be

reimbursed the same as physical health providers. we're finally saying that as a country we're going to treat illnesses from the neck up the same way we treat illnesses from the neck down. instead of merely talking about mental health in the wake of tragedies like the navy yard here in washington last fall that took 13 lives or the tragedy at sandy hook, we have taken action this evening. mental health isn't a partisan issue. senators domenici and wellstone understood it just like senator blunt and i do, just like senator cantwell, senator collins under. -- understand. senator wellstone shouldn't here to see the progress we've made but he once said politics is not about power, it's not about money, politics is not about winning for the sake of winning, politics is about the improvement of people's lives.

the improvement of people's lives. that's exactly what we are doing, improving people's lives and creating hope and opportunity for people to get the help they need to live long, successful lives. so i thank all of our colleagues for working together to get this done. it will be something as we move forward that we can all be proud of. thank you, mr. president. the presiding officer: the senator from kansas. mr. moran: i ask unanimous consent to address the senate as if in morning business for less than 15 minutes. the presiding officer: without objection. mr. moran: mr. president, thank you very much. first let me address legislation that passed the senate earlier this evening.

the sustainable growth rate is such an important issue to the people of kansas. i come from a state in which senior citizens are a very prevalent portion of our population, and access to health care is so dependent upon whether or not medicare reimburses a physician, a hospital, a home health care agency, a nursing home in an adequate amount. and i fear that in the absence of that adequate medicare reimbursement we will see a lot fewer doctors and hospital doors close. and so i've been an advocate,, in fact, i never voted to create the spheanl growth rate, i suppose i should explain a what that is. in the broadest of terms it means there's a formula that ultimately reduces the reimbursement that a physician receives under medicare, and it's become a very dramatic thing. this year i believe it's around 24% reduction that will occur april 1, tomorrow, if the sustainable growth rate formula is not altered.

the reality is that congress has altered that formula to avoid those reductions because we know when a health care provider is not compensated in a way that covers the cost of providing the service, most likely we're going to have fewer health care providers. hospitals will not be there, physicians will no longer be in practice, and particularly in areas of our country that are rural where a significant, portion of the population are senior citizens whose medical bills are paid in part through medicare. my discouragement, my dissatisfaction is once again i think the senate has demonstrated its dysfunction by passing a very short-term fix to this long-term problem. and if history is any indication we'll be back a year from now in the same predicament. we've made alterations 16 times previously, this is the 17th time in which we've done a short-term fix to a long-term problem. and to me it's one more symptom of our inability as a senate to

function in a way that benefits the american people and in this case patients that are served by physicians who will be harmed. in many instances across kansas our hospitals are now employers of physicians and so they've entered into a contract with a physician and when the reimbursement rate for the physician is reduced, it means less revenue to the hospital, a tighter squeeze on many hospitals that are barely hanging on by a thread. i wanted to express my appreciation to senator wyden, the chairman of the finance committee, for his efforts to find a long-term solution, a permanent repeal of the s.g.r. and again express my willingness to him and others to work with democrats in the senate,to, to work with republicans in the senate to find the necessary numbers of us who will come together to support legislation that would permanently end the s.g.r. and that we would not be then asked a few months from now to come back once again to solve the problem. we know the problem is there,

we know we'll have to find a solution. the consequences of failing are so great, but we are unwilling to take the necessary steps today to pass a permanent repeal , an elimination of the s.g.r. formula. again, to senator wyden, he and i have had conversations since last thursday about my willingness to have conversations with republican members of the senate to find the necessary votes to pass legislation for a permanent repeal. and i expressed that offer again to senator wyden that we're still interested in doing that, that the country, it's -- its health care providers and patients deserve winter what weiner able to do today. mr. president -- we were able to do today. let me turn to a story about a very special kansas family. unfortunately, it's a sad story. you know, i often describe to my friends and colleagues in washington, d.c. about how special kansas is and what -- in a special way how we live our

lives there. families are important. the values of family-run -- run deep in our communities and we have neighbors who care for each other and we all know each other one on one, name by name, family by family. we know where they go to church, we know what schools their kids are in, how their families are doing. when tragedy strikes, the entire community is shaken. i pay tribute today to a family from north central kansas, the malls. glen mall and his wife elaine, their daughter amy hearter and samantha hearter were traveling to the national cattleman's beef association show in nashville on february 3 when the plane they were in crashed during its second landing attempt. the jet went down about 10 miles from the airport in bellevue, tennessee. i saw on the internet a bellevue

resident who i don't know but she wrote this tribute to glen mall, the pilot. and she said glen had reached the most bustling section of our community at the busiest time of the day, and we have seen hundreds of homes with cars in the driveway, a kroger grocery store packed with shoppers, an assisted living center, an enormous ymca where hundreds were extreme streaming in and out to exercise and to take classes. again, this is the bellevue resident speaking. glen didn't know this but school was canceled for our kids so a larger number than usual of them were at the y with their parents. experts are saying now that a last-second sharp turn by glen made in the seconds before the plane crashed indicated he that he had made a heroic decision to hit the one spot in the vicinity where no one on the ground would be and glen managed to spare all

of the lives. the bellevue resident went on to describe her community as one which is filled with people who share glen's obvious affinity for family. she said bellevue drentsz -- quote -- "are talking about glen mall, the hero who we believe had the extraordinary courage and presence of mind to save our families even as he realized he couldn't save his own." glen was born in great bend and raised his family, raised on his family farm near there where his parents instilled a strong work ethic and sense of integrity. en went on to garage from kansas -- graduate from kansas state university and that's where he met his wife elaine. they moved back to north central kansas to grow the three-generation family farm and eventually to raise their three children. he promoted his life's work through representation of kansas farmers and ranchers in organizations like the kansas

livestock association and the national cattleman's beef association. glen and elaine were respected not only in the cattle industry but also in their community for their generous commitment to improving the lives of their neighbors. as a founding board member of pawnee valley health organization, their hospital was faced with passengers closure until efforts were made by community members like glen to solve the problem and to keep the hospital doors open. for rural communities like larnerd, access to facilities like pawnee valley is essential to their future. elaine was a hireless heart for service and volunteered in the historical society, the santa, h-4, girl scouts and was a k

state trustee. she played the piano and taught bible stawdy classes at grace community church in great bend. where the pastor said that they loved to talk, that he loafed to talk with glenn about the weather and that's a common kansas conversation and always used the farmer's expertise to analyze the day. the pastor said that glenn knew exactly how much moisture he had had and what was needed and whether this was good for the wheat versus the milo and how it might affect the feed yards. the pastor continued, he said there has been talk to glenn behaved in a very heroic way. i have no idea whether that is true but i will tell you he's the kind of guy who would absolutely have done the right thing. glenn and elaine's legacies of selflessness, philanthropy and leadership undoubtedly live on. i've met lots of people in my

life and i don't know if i've met more with people, and with a sense things will be better tomorrow and the idea that hard work and living your life in integrity and as a companion to your creator would mean that good things would happen for you and your family. amy harter, their daughter and her family lived in the house on the mulls' land and worked in the family business while her and her house doug raised their children, chase and samantha. 16-year-old samantha, the granddaughter, was killed in that plane crash. she was described by one of her classmates at larned high school as a silly girl, but a serious enough one to be a member of the honor choir. she would have the most energy in the honor choir practice at 7:00 in the morning, and she would be there tired but with caramel rolls that her mom had made and laughing and having

fun. kansans know what it means to persevere, and certainly the mull family has persevered through many difficulties. no farmer or rancher escapes that in our state. we embrace our state's motto, to the stars through difficulties, and during difficult times, we always see the very best in people, like glenn's decision to save lives in tennessee when he couldn't save himself or his family. amidst the loss of glenn and elaine, their daughter and granddaughter, this kansas community is suffering. what stands out is the outpouring in larned and great bend, at home in central kansas, by the care and compassion shown by their friends and neighbors, but also by the residents of bellview, nebraska, who were united in care and concern for

this family that they never knew. glenn, elaine, their daughter amy and granddaughter samantha will be greatly missed, and all we can do now is model our lives after the lives they led and ask that god comfort them, their families, be a source of support for all who knew them as we go through this continued time of grief. mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from washington. ms. cantwell: mr. president, i thank the senator from kansas for his remarks and sympathies to the family and thank you for that rendition of your state's fortitude. my state is working with fortitude right now, too, in the mudslides, and per veerens is a good word. thank you.

mr. president, we took an important step today to improve the lives of millions of americans who deal with mental illness. i'm talking about the excellence in the mental health act that was included in provisions of legislation we just passed this evening. i want to thank my colleagues, senator stabenow and senator blunt, for their leadership on this bill. senator stabenow just gave a very passionate history of why she has been so involved with this issue. people may not realize, she has been working on this since 2005. so i want to thank her for that leadership because around here it takes time to get things done, and she has never forgotten how important those with mental illness and their loved ones and families who care about them are to us in the united states of america. this legislation was bipartisan legislation, and i think that helped us get the bill passed. it was something i was happy to cosponsor with senator stabenow when we worked through the

committee and then when we tried to get this included in this latest package, and i'm proud to be here tonight to thank her and senator blunt for their leadership in getting it done. this legislation improves the access to community health centers and leads to better quality of care. it will give access to those participating states who are fortunate enough to be in this first phase of a pilot program and help local governments and health care systems who are all plagued by these challenges, but most importantly it will help save lives. community mental health treatment centers are struggling because they're trying to meet the demands and do so within the balance of their budgets, and according to a national alliance of mental illness, states have cut more than $1.6 billion in mental health funds since 2009.

so here we are with a very pervasive problem and budget tightening obviously causing big challenges. what are those challenges? basically, too many people falling through the cracks. nationally, more than half of those with serious mental disorders don't get the treatment they need to lead productive, healthy lives. in my state, the state of washington, 55% of those with mental illness are not getting treatment. that translates to 500,000 people who are not getting the help they need according to the substance abuse and mental health service administration. and when they reach a crisis point, it's not just a burden on them and their families but our communities, our hospitals, our criminal justice systems. and as a result, our jails and our emergency rooms have become the mental health clinic of last resort. as the tacoma news tribune wrote in a recent disoirl -- quote --

"jails and prisons have become our de facto mental institutions." unquote. not only is that approach ineffective, it's also extremely expensive. it means local governments spend more for housing and court services and medication and treatment of the mentally ill while in their custody, and it means for emergency rooms that they fill up with mentally ill patients that they are often ill-equipped to deal with. in washington, we have seen a dramatic rise in psychiatric boarding or warehousing. boarding happens when involuntarily committed patients must wait for hours in a hospital emergency room because psychiatric facilities have no open beds. in a recent investigation by "the seattle times," they found that boarding has become routine in our state. quote -- "traumatizing thousands

of mentally ill residents wreaking havoc on hospitals and wasting millions of taxpayer dollars." unquote. patients are frequently parked in the halls or bound to beds, usually given a medication, but otherwise no psychiatric care, and this report i think is the basis of why this legislation is so important. it also talked about financial costs. boarding costs washington state residents' health care system 45 million a year, according to the state. we can support proven models that improve efficiency and reduce spending. one such model is this legislation we just passed, community-based care that focuses on prevention, early intervention and coordination between providers. all of those things is why the

legislation is so important. it helps increase efficiency while bolstering the community health centers with increased medicaid support. it will enable the state to improve the quality and range of services. so it requires the state to certify community mental health standards and meet higher standards and some of the services would be things like 24-hour crisis management, screening assessments and diagnosis, outpatient mental health substance abuse services, outpatient primary care screenings to monitor the indicators of health conditions, peer support and counseling, better coordination with veterans' clinics, acute care hospitals and in-patient psychiatric and substance abuse services. all of these things are missing in our communities, and

oftentimes those individuals end up, as i just said, in either the emergency room of a hospital or in a jail. currently, there are no standards for mental health services in community health facilities, and preparing states who will participate in this program, they will be able to get a medicaid reimbursement that are equal to what federally qualified health centers receive for primary care services. this is something that is so important that senator stabenow mentioned, putting this on equal footing. more than 50 mental health medical law enforcement groups and organizations supported this important legislation because it is what they need to help do their job in these communities. those who supported this legislation, the national sheriffs association, the national association of police organizations, the american psychological association, the

american medical association and the american federation for suicide prevention. in washington, we have seen how some of these community-based services are paying off. in rural central washington, the counties of yakima, klititak invest in early intervention programs such as the treatment and meeting with patients in their homes. this region in my state now has the lowest per-capita psychiatric hospitalization, according to an editorial in the seattle times just last week. this demonstration project builds on what we already know can be successes. so clearly, we have a lot of work to do, but this important legislation will help us be smarter about community-based care that will keep people out of the emergency rooms and out of our jails and stop making them be the mental health clinics of last resort.

as chris imhofe, an official with washington state social and health services remarked, quote -- "it's exciting for a community when something like this happens. it helps us not strand people with psychiatric emergencies and emergencies, which is a good thing. that's why this legislation is taking us in the right direction." so, again, i want to thank the senators from michigan and missouri for their leadership on this legislation. i think it's so important that we got it passed and hopefully now it will move towards the president's desk and implementation. i ask unanimous consent that the senate proceed to a period of morning business with senators permitted to speak for up to ten minutes each. the presiding officer: without objection.

ms. cantwell: i ask unanimous consent the senate proceed to executive session to consider the following nominations -- calendar number 714, 715, 716, 717, 718, 719, 720, 721, 722, 723, 724, 725, 726, 727 and 728, and i ask that all nominations placed on the secretary's desk in the air force, army, marine corps and navy, that the nominations be confirmed en bloc, the motions to reconsider be considered made and laid upon the table with no intervening action or debate and that no further motions be made in order to any of these nominations, that the president shall be immediately notified of the senate's actions. the presiding officer: without objection. ms. cantwell: i ask unanimous consent that the commerce committee be discharged from further consideration of p.n. 1058, that the senate proceed to vote on the nomination, the

motion to reconsider be considered made and laid upon the table with no intervening action or debate, that no further motions be made in order to the nomination and that any related statements be printed in the record and that the president be immediately notified of the senate's action. the presiding officer: is there objection? without objection, the committee is discharged. the clerk will report the nomination. the clerk: nomination, carolyn r. welsh of illinois to be secretary of the department of commerce. the presiding officer: the question is on the nomination. all in favor say aye. all opposed no. the ayes appear to have it. the ayes do have it. the nomination is confirmed. ms. cantwell: mr. president, i ask unanimous consent that with respect to the owens nomination

confirmed today, the motion to reconsider be considered made and laid upon the table and the president be immediately notified of the senate's action and the senate then resume legislative session. the presiding officer: without objection. ms. cantwell: i ask unanimous consent that the senate proceed to the immediate consideration of s. res. 405 submitted earlier today. the presiding officer: the clerk will report. the clerk: senate resolution 405, expressing support for the designation of the week of march march 31 through april 4, 2014, as national assistant principals week. the presiding officer: is there objection to proceeding to the measure? without objection. ms. cantwell: i ask unanimous consent that the resolution be agreed to, the preamble be agreed to and the motion to reconsider be considered made and laid upon the table with no intervening action. the presiding officer: without objection.

ms. cantwell: i ask unanimous consent that the senate proceed to consideration of s. res. 406 submitted earlier today. the presiding officer: the clerk will report. the clerk: senate resolution 406, designating april 4, 2014, as national association of junior auxiliaries day. the presiding officer: is there objection to proceeding to the measure? without objection. a senator: i ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motion to reconsider is laid upon the table with no intervening action or debate. the presiding officer: without objection. ms. cantwell: i ask unanimous consent the senate proceed to the consideration of s. res. 407, submitted earlier today. the presiding officer: the clerk will report. the clerk: senate resolution 407, honoring former senator and rear admiral jeremiah andrew denton jr.