with these issues is the way we did it last year. we worked with the president in a bipartisan way and reduced rates for students. what we need to do today is vote "no." no to the political stunt and that will lead us immediately to deal with veterans standing in line at clinics and hospitals across the country. i urge the senate to send this to the committee that's already working on it in a bipartisan way, and let's move to help the veterans in a bipartisan way. i thank the president and i yield the floor. the presiding officer: the clerk will report the motion to invoke cloture. 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 the motion to proceed to calendar number 409, s. 2432, a bill to amend the higher education act of 1965 to provide for the refinancing of certain federal student loans, signed by 17 senators. the presiding officer: by unanimous consent, the mandatory quorum call has been waived.

the question is, is it the sense of the senate that debate on the motion to proceed to s. 2432, a bill to amend the higher education act of 1965 to provide for the refinancing of certain federal student loans and for other purposes shall be brought to a close. the yeas and nays are mandatory under the rule. the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators in the chamber who wish to vote or wish to change their vote? hearing none, on this vote the yeas are 56, the nays are 38. three-fifths of the senators duly chosen and sworn not having voted in the affirmative, the motion is not agreed to. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: i enter a motion to reconsider the vote by which cloture was not invoked on s. 2432. the presiding officer: the motion is entered. mr. reid: mr. president, i see no one seeking the floor at this time. i would ask a quorum call be initiated. the presiding officer: the clerk will call the roll. quorum call:

vote:

mr. reid: madam president? the presiding officer: the majority leader. mr. reid: i ask unanimous consent the call of the quorum be vitiated. the presiding officer: without objection. mr. reid: i ask unanimous consent the senate proceed to s. con. res. 37. the presiding officer: the clerk will report. the clerk: senate concurrent resolution 37, authorizing the use of the rotunda of the united states capitol in commemoration of the shimon perez congressional gold medal ceremony. the presiding officer: is there objection to proceeding? without objection. mr. reid: madam president, i ask unanimous consent the concurrent resolution be agreed to, the motion to reconsider be laid on the table with no intervening action or debate. the presiding officer: without objection. mr. reid: madam president, this is a request to use the rotunda

of the united states to give to shimon perez a congressional medal. this is a -- this is really a fine human being, and i'm -- i feel so fortunate to have had conversations with him over the years. i have such respect for this man who's been a leader in israel for decade after decade after decade. a man who always stood for pea peace, a man who's so futuristic about what should be done in that part of the world. so i'm -- i look forward to this ceremony that will take place. he is now 90 years old and there's -- in just my estimation, there are very few people in the world that have dedicated such valiant service to their country as this man has to the state of israel.

i would suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

quorum call:

a senator: madam president? the presiding officer: the senator from wyoming. mr. barrasso: madam president, i ask unanimous consent that the quorum call be vitiated. the presiding officer: without objection. mr. barrasso: i ask unanimous consent to speak as if in morning business. the presiding officer: without objection. mr. barrasso: thank you, madam president. madam president, i come to the floor today to talk about some of the side effects we have been seeing from the health care law. when president obama and democrats in congress were selling their health care law, they made a lot of promises. one of the big ones was that the health care law would save money. they said it was going to save money because people would be going to see physicians in offices for routine care instead of going to the emergency room.

president obama said, and i will quote, he said if everybody's got coverage, then they are not going to the emergency room for treatment. well, just like promises about keeping your doctor if you like your doctor, if you -- about keeping your insurance if you like your insurance, promises that the president made, it turns out that the president's claims about the emergency room care weren't true either. that's, of course, what the louisville currier -- courier journal said that they have seen in the state of kentucky. that was the headline just monday, just a couple of days ago. the headline is -- quote -- more patients flocking to e.r.'s under obamacare. that's not what the president said but that's the headline. more patients flocking to e.r.'s under obamacare. the article says it wasn't supposed to work this way, but since the affordable care act took effect in january, norton hospital has seen its packed emergency room become even more prouded, with about 100 more patients a month.

a 12% spike in the number of patients at the emergency room at the hospital in louisville. like the article said, it wasn't supposed to happen that way. that's why i come to the floor to talk about the side effects of the president's health care law. there are many side effects. they are harmful. they are expensive. some are irreversible, but they are all related to promises made to the american people by a president who i believe didn't fully understand his law and i know there are many people in this body who voted for it. i understand they never read it in the first place. so those are the concerns i have. those are the concerns i hear at home in wyoming every week and i heard them this past weekend all around the cowboy state. and this emergency room situation may be just another if -- for the president, another surprising side effect of the health care law. and they are just not seeing this, madam president, in kentucky. according to a survey by the american college of emergency

physicians, it's happening all across the country. their survey found that 58% of emergency room doctors say they're seeing more patients since the beginning of the year. a doctor in virginia told "the wall street journal" that the health care law, he said, is going to stretch emergency doctors further, and that has implications on how quickly we can get people through. so when the emergency rooms have more patients, it involves longer wait times for those patients. it just seems, madam president, that the democrats who voted for this health care law, many without reading it, were so focused on getting people insurance coverage that they came up with a system that actually makes it harder for people to get care, and it was interesting listening to the president continuing to give these speeches about coverage and ignoring the fact that people were worried about actually getting health care. that's a very dangerous side effect, but it's not the only side effect of the law. there are also incredibly

expensive side effects of the health care law. an expensive side effect that a lot of people are starting to hear more about, as the states release information on insurance premiums for next year. late last friday, the state of maryland released their rates. you could tell it was going to be bad news for people in maryland because they snuck the numbers out late friday afternoon. it seems that's what happens when bad news comes out. they try to get it out late friday afternoon. according to "the washington post," the biggest insurance company in maryland is -- is care first, and this was then saturday's paper, "washington post," metro section, saturday, june 7. "carefirst seeks hefty premium increases." hefty premium increases. the article says maryland's dominant insurance company, carefirst, is proposing hefty premium increases of 23% to 30%.

23% to 30% for the consumers buying individual plans next year under the health care law. the president of the united states said that the health care law was going to save families $2,500 a year by the end of his first term, so what we're seeing here, metro section, "washington post" saturday, carefirst seeks hefty premium increases. maryland's dominant insurance company carefirst proposing hefty premium increases of 23% to 30% for consumers buying individual plans next year under the federal health care law. that's a very costly side effect, madam president, of the health care law. remember the health exchange where people are supposed to buy insurance, this insurance in maryland, remember it was so broken that they had to start over again. state officials spent $118 million to set up their own

exchange. now they're going to use software from connecticut's exchange. nobody got care for that money. that's wasted taxpayer dollars. nobody got care. now, connecticut may have gotten the software right, but people there are going to have to pay more for insurance, too. "the washington post" says that the two insurance carriers in connecticut have proposed rate increases averaging about 12%. that's the average. some people have smaller increases, but many people will pay much more. president obama said that democrats in congress would forcefully defend the law and be proud of it. that's what he said they should do, forcefully defend and be proud. are there any democrats who are ready to come down to the floor and forcefully defend these dangerous side effects of more people going to the emergency room, stretching overworked emergency room doctors even thinner, making for longer waiting times in emergency rooms? are democrats going to come to the floor and forcefully defend and be proud of the law when they see expensive side effects

like these hefty premium increases in maryland of 23% to 30%, 12% in connecticut? it didn't have to be this way, madam president. republicans offered ways to reform america's health care system back when we were debating the law, but president obama and democrats in congress didn't want to hear it. we warned about some of these brutal side effects in the health care law that were going to hurt people and we talked about bipartisan ideas that could have helped maintain the access that people had to the doctor they liked. that's what people they wanted. they wanted the doctor that they liked. at the same time they wanted care to be more affordable. they wanted access to care, quality care, affordable care. not empty coverage, which is what the president's provided. and also expensive coverage. we're going to keep talking about things like expanding access to health savings accounts to save money for families and their -- as well as for employers. i talked about that when some of us met with the president back in 2010.

the president didn't want to listen. it's too bad but it's not too late. republicans are going to keep talking about letting consumers -- letting consumers buy health insurance across state lines to increase competition, to let them shop for things they actually need and want and will work for their family. that could actually help bring down prices, not drive them up like the democrats' health care law is doing. these are ideas that republicans have offered from the beginning, ways to give the american people the care they need from a doctor they choose at lower costs. that's all people wanted in the beginning. instead, they got all these harmful, hurtful, expensive side effects. we know what the american people have asked for, we know what they wanted and that's what republicans are going to continue to try to give them, not the empty promises from president obama and democrats who told the american people that the president and the democrats knew better what they

needed or wanted, than what the american people knew worked best for them and their families. thank you, madam president. i yield the floor. a senator: madam president? the presiding officer: the senator from vermont. mr. sanders: i have eight unanimous consent questions for committees to meet during today's session of the senate. they have the approval of the majority and minority leaders. i ask unanimous consent that these requests be agreed and to have and that these requests be printed in the record. the presiding officer: without objection. mr. sanders: madam president, as chairman of the senate committee on veterans' affairs, i want to say a few words as to where we are right now and my strong hope that we can move forward as rapidly as we can, hopefully today, in addressing some of the very serious problems that exist

around the veterans administration. madam president, what i have learned since i have been chair of the veterans' committee for the last year and a half is that the cost of war does not end when the last shots are fired and the last missiles are launched. the cost of war continues until the last veteran receives the care and the benefits that he or she is entitled to and has earned on the battlefield. the cost of war is, in fact, extremely expensive in terms of human life and financially. and that is something that every american should know. it's very easy to vote to send

people to war but we have to understand what the costs of those wars in terms of what happens to people who come home from war and in some cases do not come home. the cost of wars in iraq and afghanistan is almost 7,000 dead. the cost of war from iraq and afghanistan alone is some 200,000 men and women coming home with post-traumatic stress disorder and traumatic brain injury. the cost of war is too many young men and women coming home without their legs or their arms or their hearing or their eyesight. the cost of war are tragic suicides that are taking place all across this country. the cost of war are veterans coming home and finding it difficult to get reintegrated

into their communities and get jobs and get their feet on the ground financially. the cost of war are high divorce rates and the impact that that has on children. the cost of war are widows suddenly having to begin their lives anew. those are some of the real costs of war. madam president, last week senator mccain and i hammered together a proposal to deal with the immediate crises facing the v.a. and i thank him very, very much for coming forward, for working with me and for understanding the need for us to move forward expeditiously. there are serious problems at the v.a. now and they must be addressed now. not next week, not next month

but now. and i want to at this point thank the 27 bipartisan cosponsors who have agreed to sign on to this bill. and they are senator -- and there are 21 democrats, six republicans and i think, in fact, the support is broader than that. and i want to thank senators begich, blumenthal, booker, burr, casey, collins, coons, hager, hirono, isakson, johanns, kaine, manchin, mccain, murphy, pryor, rubio, udall, schatz, and whitehouse for cosponsoring this legislation. clearly the bill that senator mccain and i introduced, which now has 27 cosponsors from both parties, is not the bill that he would have written alone and it

is certainly not the bill that i would have written alone. it is a compromise. what this bill does is address the immediate crisis facing the v.a. of veterans having to wait too long a period of time, long waiting lists in order for them to get the quality care that they need in a timely manner. what our veterans deserve is to be able to get into the system in a timely manner and get quality care. and what this legislation does is move us forward strongly in that direction. let me very briefly describe some of the major features in this legislation. there has been on the drawing boards for many years in some cases the need to build or

expand v.a. medical and research facilities. this bill provides for 26 major medical facility leases in 26 states and puerto rico. that is something i think that is supported in a bipartisan w way, something that has already passed the house in i think virtually a unanimous vote. this bill provides for the expedited hiring of v.a. doctors, nurses and other health care providers and $500 million targeted to hire those providers with unobligated funds. unobligated funds. madam president, the simple truth of the matter is that no medical program, not in the private sector, not in the v.a., not anywhere, can provide quality care in a timely manner

if that program does not have an adequate number of doctors, nurses, and other medical providers. while it is not clear as to exactly how many more providers are needed, there is no question that many, many -- or i have heard, and i won't swear to this, but i have heard estimates that in phoenix alone -- in phoenix alone -- there is a need for up to 500 new providers. just in phoenix. and while the phoenix situation may be worse than other parts of the country, there is no doubt in my mind that many, many, many hundreds, if not thousands of doctors and nurses are needed and we need to expedite the hiring process. what our legislation also doe does -- and this is an important point -- is to say to veterans around the country that if you

cannot get into a v.a. facility in a timely manner, you will be able to get the care you need outside of the v.a. and that means you'll be able to go to a private provider in your community, you'll be able to go to a federally qualified health center in your community. if there's an indian health service, if there's a department of defense military base and you can get care there, you will be able to do that. so this gives the veteran himself or herself the opportunity, if that person cannot get timely care within the v.a., to go outside of the v.a. what this bill also does is say to veterans who live 40 miles or more away from a v.a. facility that if they choose -- and it's clear there are some veterans who live hundreds of miles away in our rural areas, from a v.a.

facility -- they will also be able to get care outside of the v.a. and for those veterans in rural areas, this is an important provision. this legislation also addresses a major crisis that we have seen tragically in recent years within the d.o.d., within the military, and that is the issue of sexual assault. far too many women and men have been sexually assaulted and this legislation provides funding for the v.a. to improve care for those people who are suffering from sexual assault. this bill also deals with an issue where i believe there is widespread support among republicans and democrats and independents and that is the need to address in-state tuition for all veterans at public colleges and universities. this legislation also provides that surviving spouses of those

who die in the line of duty will be eligible for the pos post--91 g.i. bill. this also provides help to the v.a. in terms of improving scheduling capabilities and also their capital planning, two areas clearly where the v.a. needs to improve. lastly and very importantly, this bill gives the secretary of the v.a. the authority to immediately fire incompetent employees and, even worse, those who have falsified or manipulated data in terms of waiting periods or in other instances. so what we say is if somebody has lied, has manipulated data, they are out tomorrow, after the bill is signed.

but what we also do is provide a very expedited appeal process in order to allow some due process. i worry very much about the politicalization of the v.a. if a secretary comes in with a new president and says well, i'm going to get rid of 400 top people and four years later another secretary comes in and says, i'm going to get rid of 400 people. what we want in the v.a., which is the largest integrated health care system in america, taking care of 6.5 million veterans, one shouldn't care whether those folks are democrats or republicans, progressives or conservatives. what you want is competent and able supervisors and doctors. and i also want to make sure that if people get fired, it has nothing to do with the color of their skin or their sexual orientation. so we have an abbreviated appeal process. but within that process, somebody can be removed from their position immediately.

madam president, the house of representatives, as you know, passed legislation yesterday which covers a lot of the same ground that the sanders-mccain bill covers and i want to applaud the house for moving forward in a very rapid fashion. i am absolutely confident that working with house chairman miller and rankin the ranking m, we can, in fact, bridge the differences that exist in the two bills and send the president legislation that he can sign as soon as possible. finally, madam president, i want to say a word to the some 300,000 employees who work at the v.a.

the overwhelming majority of these people are hardworking, honest, serious employees. in fact, many of them are veterans. and, madam president, my experience is that for many of these employees, what they do is less of a "job" than a mission. they understand the sacrifices that veterans have made, and they in the vast, vast majority of cases are doing excellent work to support our veterans. madam president, let us never forget that today some 230,000 veterans, today and tomorrow and the next day, are going into the v.a. for health care

and that the vast majority of those people -- and that's 6.5 million people a year -- are receiving high-quality care. i talk to veterans all over the state of vermont, and what they tell me is they get very good care. i'm not going to say every veteran does, but that's true all over this country. but in vermont, and i expect in most areas of this country, veterans feel good about the health care they get. and a few weeks ago i held a hearing, and i asked point blank all of the major veterans' organizations their views about v.a. health care and what they said -- it's not bernie sanders, it's what they say -- is once people get into the system, the care is good. and that's not just their view. there are independent studies out there that rate v.a. health care with private sector care

and as often as not, v.a. care comes out better. our job right now is to address the crisis of long waiting periods and making sure that veterans all over this country can get the care that they need in a timely manner. in my state of vermont, according to information that just came out the other day, some 98% of veterans get appointments in the system within 30 days. and i suspect the numbers are similar in certain other parts of country. clearly not in all parts of the country and that is the issue that we are addressing right now. so, madam president, it seems to me that our job now is to defend the veterans of this country who have defended us. it is time to move the

sanders-mccain legislation as quickly as we can, hopefully today. and i know the majority leader, senator reid, feels strongly about this issue. he wants this legislation moved as quickly as possible. i do, and i believe senator mccain does as well. once we get that legislation passed, i'm confident that we can set up a quick conference committee, and we can resolve the differences between the house bill and the senate bill and get that bill to the president as early as next week. madam president, it is one thing to give great speeches on memorial day and veterans day about how much we love and respect veterans. it is another thing for us to act expeditiously and effectively on behalf of

veterans. now is the time for action, and i hope very much we will have virtually unanimous or unanimous support to move this important legislation forward. and with that, madam president, i would yield the floor and note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call: