quorum call:

a senator: madam president? the presiding officer: the senator from new jersey. mr. booker: i would like to request that the quorum call be ended. the presiding officer: without objection. mr. booker: thank you very much. madam president, i rise today to urge support for a successful

veterans' health care program that will be extended if we pass this bipartisan package of veterans' affairs reforms. my colleague across the aisle, senator heller, and i have joined together to introduce legislation to extend the assisted living program for veterans with traumatic brain injury, or altbi, and give it the kind of support veterans with these severe brain injuries deserve. i'm grateful for the leadership of senator heller, his partnership on this very important, critical issue. i'm proud to work with him and i am hopeful that all of our colleagues will join together to pass the bipartisan package of v.a. reforms which now includes our legislation. i want to thank senators sanders, ranking member burr, along with john mccain, senator mccain, senator pryor, senator murkowski, landrieu, johanns, and baldwin

for joining together with us in this important effort. this program places veterans suffering from moderate to severe traumatic brain injury or tbi, it places them into privately run facilities where they receive 24-hour team-based attention. these are our veterans who stood for us, who answered the call to service, who went into harm's way, and have suffered traumatic brain injury, and now get the kind of care and attention that they deserve. they are immersed in this they were -- therapy, it helps them with their memory, their speech, their gradual community integration. that last point actually is the key. this program doesn't just prepare veterans from transition into one health care setting into another health care setting , it is about giving them the practical skills they need to return to their

communities and live independently. that is what is so special about this program. this is the kind of innovative work that senator heller stands for in his community, i in new jersey, and we all -- all our veterans across the country should have. congress should support this kind of work more often. now, this past week i had the opportunity to visit a facility in plains borough, new jersey, one of several facilities using this program. while i was there i spoke with an incredible veteran named gary. gary first enlisted in the military, completed his tour for the navy after graduating from high school. and then 9/11 happened, and gary stood up, reenlisted, this time with the national guard, and served in iraq. during his time there he suffered a traumatic brain injury. upon return home, gary was confined to a wheelchair and the doctors told him that he would

never, ever walk again. but then he began treatments. through this program that senator heller, myself and others are trying to extend. now, because of this program, gary can now walk again. he himself and his family called it a miracle. now using a cane, when he's indoors he can walk without assistance. gary's sister told me that before receiving this unique care through the program, gary was very negative, often depressed, often angry, but now that he's made progress, gary's whole attitude has changed. he's more than upbeat, he's social and enjoys cooking. in fact, he offered to cook me a meal, which senator heller as a bachelor, i get -- take all the meals i can get. another veteran named dewayne sustained a traumatic brain injury in 2003 while serving our country in the navy.

unable to live independently or get around 2002 without the aid of a wheelchair, this gentleman, this honorable veteran who hasn't -- wasn't even 25 years old, found himself living in a nursing home alongside a pop players -- population many decades his senior. in 2011, through this program and our legislation his life was changed. he moved into a specialized facility in new jersey where he still lives today and receives a range of treatments, including physical, occupational, speech therapies as well as psychological counseling and residential assistance. he is making incredible progress. i saw it with my own eyes, heard it from his family, and his care workers. he's also traded his wheelchair for now a cane and manages a regime of his own chores adding more dignity to his life already exemplary life of courage.

he has an active social life. he's got friends and comrades. and he believes he has a country that has been there for him when he's in need. these are the heroes that stepped up to serve our country when we needed them most, and now it's our responsibility to serve them with the extension of this incredible program. this program means independence for these veterans with severe brain injuries. we cannot cut there or any -- their or any other veterans' care short. this is a cost of war. we should not just be there to spend resources when we're sending them off. we should be there with open arms and support when we're welcoming them home. the v.a. now offers no alternative program to the one that i've described, no alternative program that provides the same kind of comprehensive rehabilitative long-term care in a residential

setting. these brave men and women who are benefiting from this specialized care were willing to put their lives on the line for our country. it should not be an option, it should be our obligation to take care of them when they return home. i strongly urge my colleagues in the senate to do their duty, to pass this reform package and extend this life-changing program. and, madam president, i want to again thank senator heller if i may yield to him, he has been a stalwart partner, leader on this issue. i've been encouraged by this opportunity to work together with him. i'm only disappointed he would not shave his head as i have. that would have shown true bipartisan camaraderie relationship. despite that, i look forward to his continued leadership on issues for our veterans and now i look forward to his remarks. mr. heller: madam president? the presiding officer: the senator from nevada. mr. heller: let me begin, if i may, thanking my friend and

colleague, senator booker for partnering for me on this critical piece of legislation that helps our nation's veterans. i would urge him to partnership in that meal from that veteran. i assure you that in this city where the pood is so rich -- food is so rich, that you probably will find a meal much healthier, and i know that's important to you. having said that, madam president, i know that senator booker and myself have always viewed veterans' issues to be truly a bipartisan issue. i'm pleased that we were able to work together and were able to accomplish this work as a partner. i'd also like to applaud my other colleagues, senators sanders, mccain and burr for their work not to conference report, also the house veterans' affairs committee chairman miller, and the rest of the conference members for reaching agreement to ensure that congress keeps its promise to our nation's veterans. the conference committee's bill is a good start to address

problems with appointment wait times, v.a. scheduling practices, accountability, and overall quality of care provided at v.a. medical facilities. as my colleague senator booker discussed, there's a very critical provision in the conference report's legislation that he and i took a lead on addressing and that's the extension of the assisted living program for veterans with traumatic brain injury. i applaud my friend. i applaud my colleague for the ability and the opportunity to work together with you. thank you for that. as a member of the senate veterans' affairs committee, i was eager to resolve this issue because of its impact on nevada and our nation's veterans, and together we were a proud partner. this program operates in two locations in nevada and serves wounded warriors who are trying to restore their quality of life. as the battlefield has changed over the years so have the injuries that service members and the veterans sustain. including traumatic brain injuries. t.b.i. is a complicated injury

to treat because the effects can be both mental and physical, and from headaches, dizziness and irritation all the way to speech difficulties, visual impairment, loss of memory and severe depression. every traumatic brain injury is different which is why some veterans need more care to rehabilitate and regain full independence. that is why congress created the assisted living t.b.i. program in 2008. under that program veterans can access a full range of rehabilitation services in a residential setting including physical therapy, speech therapy, occupational therapy and other activities to prepare veterans to return home and live a productive life. when i found out the program would be expiring and the v.a. was prepared to start kicking veterans out, i teamed up with senator booker to introduce legislation to extend authorization of this program for another three years. at a time when the v.a. is

facing a health care crisis and access to timely care it would have been unacceptable to let this critical program expire leaving veterans in nevada without a comparable alternative to treating this serious injury. i'd like to thank the conference committee for listening to us when we expressed the urgency of extending this program so veterans could continue receiving residential rehabilitation. i'm pleased the conference committee provided a three year extension so veterans can have a certainty that this program will remain in place for the next few years. i'd also like to thank representative cassidy from louisiana for his work in pushing this issue in the house of representatives as well as the veterans service organizations who fought alongside with us for this extension. and it is our responsibility in congress to ensure veterans across this nation receive timely and quality care from the veterans administration. senator booker and i share this commitment, and i am pleased

we're able to work together to get our legislation into the final compromise. as the senate prepares to vote on final passage of this critical v.a. foreman bill, madam president -- v.a. reform bill, i hope my colleagues recognize the importance of this compromise bill at a time when veterans are losing faith in the v.a. system and the certainty that congress will be there to provide oversight, accountability and legislative action to improve the care they receive from the nation that they sacrificed and served. so, thank you, madam president, and i yield the floor. and i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

mr. reed: madam president? the presiding officer: the senator from rhode island. mr. reed: thank you, madam president. i would ask that the calling of the quorum be dispensed with. the presiding officer: without objection. mr. reed: thank you, madam president. i come to the floor today to once again press for action on my bipartisan legislation to restore emergency unemployment benefits. over 3.5 million americans have

lost benefits since the program expired last december. and the need to help these individuals, their families and the economy remains compelling to all of us. in april senator heller and i were able to craft a bipartisan bill, and with the help of many of our colleagues the senate acted to restore these benefits. unfortunately, house republican leadership has refused to take up the senate-passed bill or consider their own. and while the president has occasionally talked a good game about the need to extend this aid to job seekers, it has never been made a must have by the administration. indeed, it is hard to understand why an extension of these benefits wasn't included in the president's supplemental appropriations request. so as we consider this supplemental appropriations bill this week, which includes critically important emergency funding measures, it is somewhat disheartening that extending unemployment insurance, another

emergency need has once again been ignored. in the past six months the national unemployment rate dropped from 6.7% to 6.1%. long-term unemployment rate has dropped just below 2%. it is great to see these positive strides in our economy, but i strongly disagree with those who would argue that these signs of improvement suggest that emergency benefits are no longer needed. let me underscore a few reasons why emergency unemployment benefits are still necessary. first, while the long-term unemployment rate has dropped from 2.3% in january to just under 2% in june, the current level is still significantly higher than in any other point when emergency benefits were allowed to expire. in june 2008, under president george w. bush, when the long-term unemployment rate was just 1%, a supermajority of members in both chambers voted to create emergency unemployment

insurance benefits for the long-term unemployed. that was at 1%. and now we're twice that. today a long-term unemployment rate of 2% means over three million americans who are out of work through no fault of their own have been searching for work for more than six months. these individuals are struggling, and with each passing month their financial situation becomes increasingly dire. they shouldn't be held to a different standard than those who are searching for work in 2008. second, the long-term unemployed are still struggling mightily to find work. according to a recent report by economists at the federal reserve when you look at the likelihood that someone will find a job in a given month, the rate for long-term unemployed is roughly the same as it was at the height of the great recession several years ago. in fact, someone who is long-term unemployed is almost twice as likely to stop looking for work altogether and fall out

of the labor force as they are to get a job. these difficulties in finding work are persistent across educational levels around age groups although they are much more pronounced among the african-american and latino communities. we're seeing people trying very hard to find work, but they're facing the same obstacles that they were facing at the height of the great recession. and again, i think this underscores the need to help these people. some have argued that the improvement in the labor market is driven by congress's failure to extend emergency benefits. according to this argument, taking away unemployment benefits and insurance pushes people to step up the job search. i find this argument very difficult when you face people back in my home state of rhode island who have been looking desperately, in a situation where there are usually three,

four, five, six applications in some case for every job, and they're looking and looking and looking. in rhode island our unemployment rate is tied for highest in the nation, not the position we want to be in, and to suggest these people aren't desperately searching for work really sort of, i think, demeans them unnecessarily. we all know because we go home. there are people who have been looking. they're skilled, they're talented, they've worked for 20 years. they want to get. getting the $300 a week perhaps in benefits is nothing like the salary they commanded. it won't in the long term pay for their mortgage, pay for their children's education, pay for the necessities of life. they know that and they're in a desperate situation. and this assistance helps a little bit. but not only the contact that we have with our constituents, but recent research also

demonstrates that this argument is flawed, that cut off the benefits and everyone goes right bag to work. we can use north carolina to test the impact of cutting benefits. that state took steps in july 2013 to terminate unemployment benefits for anyone who has been out of work for 20 weeks or more. if opponents to extending unemployment insurance are correct, north carolina's policy change should have led to significantly sharper declines in its unemployment rate. a recent article in "the new york times" by justin walforz explores evidence from north carolina to assess this claim. according to his rf, when north carolina -- his research when north carolina is compared to states that did not cut their program, north carolina's economic growth -- quote -- "looks quite similar to its peers and certainly not better." the level of job growth in north carolina are similar to neighboring states like south carolina that did not change their program. dr. wolforz concludes that --

quote -- "there is no evidence that cutting benefits cuts unemployment." others have argued that cutting u.i. at the state level will save money and help the economy at the state in indirect benefits. in response eight states dereeced -- decreased that an individual could receive state unemployment benefits however a study suggests these states did not save significant amounts of money or boost employment. this is further evidence that cutting u.i. benefits is simply not a good idea. the refusal by house republicans to renew unemployment insurance benefits doesn't just hurt individuals and their families by each week they don't get this amount of support. the effects are more far-reaching with research that suggests the unemployed will be hurt for decades to come. according to research by a senior economist at the federal reserve bank of boston, workers

unemployed for 26 weeks experience a much larger negative income effect and have a lower earning even after 10 or 15 years than those workers that experience shorter duration of unemployment spells. many are forced to rack up debt on their credit cards just to meet basic living needs. in a recent gallup poll shows 20% of individuals who were unemployed for 12 months have been treated for depression. this is a serious blow, not just to your economic well-being, but to your identity, to your sense of worth, to your sense of being able to help your family and provide for your family. and these effects are long term and very, very serious. and this rate of depression is twice as high as those who have been unemployed for just a few weeks. so there is apparently a correlation. the impact is far-reaching.

for individuals, for families, for the economy as a whole. and it undercuts, again, this notion that there is no cost, in fact there is a benefit to cutting these benefits. there is a long-term cost. one of the aspects too is in order to qualify for these benefits you have to be actively searching for work. without these benefits, the incentives to look for work is in some respects diminished. and indeed these other phenomena take place. the lack of resources to increasing desperation and depression. yet again, it's encourage to go see that there are signs of economic improvement. and it's encourage to go see that some of the long-term unemployed have found jobs and dip below that 2% level. but that does not mean we should turn our backs on those that are still looking. that does not mean we should treat them differently than we

did people in 2008 in the same position in a difficult economy looking for work. and those of us who continue to fight for the long-term unemployed, i must say that senator heller in this effort has been a stalwart. we've heard lots of excuses and a lot discussed in my view, forward arguments about how we should abandon the program and more point lid abandon these people -- pointedly abandon these people. i don't think we should. what is certain in terms of the analysis that the nonpartisan congressional budget office estimates, that our failure to remove this program last december will cost us over the course of this year 200,000 jobs and that this emerging aid helps families make ends meet until they find work. one of the great ironies here is that in refusing to extend these benefits, we've basically shut

down 200,000 jobs in this country. it's almost absurd. it's a catch-22 where we're shutting the doors on the unemployed so we can get them to work. but yet the analysts will tell you had we extended benefits, we would have gain 2-d 00,000 jobs. why? because these payments go right back into the economy. if you're unemployed, you're going to take that modest check, about $300, $350, you're going to pay your phone bill, you're going to get the car repaired so you can get over to the job interview, you're going to dot things you have to do to help your children get through the day. you're not going to save it. you're not going to buy a french impressionist painting. you're going to go right into the local economy and spend the money. so for many reasons, i think that is why we have to do this.

that's why senator heller and i have filed an amendment to this emergency appropriations bill on a bipartisan basis, and the amendment will be the same as we proposed previously but except for offsets. that's because for the second time offsets that we have identified to pay for an extension of benefits have been used for another ar measure. i guess we must take some satisfaction in that we've developed offsets on unemployment and then another program grabs them and it gets passed here. but i'd rather have the extension of the benefits. and so we're moving forward. i hope we can. i'm committed to fighting for these american workers so they won't be left behind now and for years and years to come. and with that, madam president, i would encourage my colleagues to join us, and i would yield the floor.

madam president, i would note the absence of a quorum. the presiding officer: the clerk will call the roll quorum call:

quorum call:

quorum call: the presiding officer: the senator from louisiana. mr. vitter: madam president, i ask unanimous consent to end the quorum call. the presiding officer: without objection. mr. vitter: thank you, madam president. madam president, i rise again to talk about the crisis at our southern border and the need for strong, unified action to deal with it, the need to come together around a commonsense enforcement approach that undoubtedly will need some

additional resources, but also clearly demands some changes to the law, changes to current law so that we may quickly deal with the need to deport folks coming over our mexican border illegally, quickly deport them to their home country. in the case of alien children quickly reunite them with their families, take them out of the hands of criminal gangs and reunite them with their families in their home countries. that is an obvious need in the eyes of the american people. i think the vast majority of americans realize that we need that sort of approach that starts with enforcement, much better enforcement of our southern border, and, yes, if people do get across, quickly deal with their situations and quickly and effectively deport them. that's the approach we need. sadly, madam president, that's

not what the president has proposed. that's not what harry reid is even allowing us to vote on on the senate floor. you know, for a couple of weeks at least after this crisis hit the first page of the newspaper, president obama constantly pointed to those parts of the law that he said tie his hands in terms of quickly, effectively deporting some of these individuals. he pointed to the 2008 changes of the law over and over and over again. the problem is a couple weeks after that when he actually sent up a proposal to congress to deal with the crisis, that talk was gone. mention of that was gone. there was no suggestion of any change in the law in that regard or any other regard. the only request he made was money. $3.7 billion, a huge amount of additional money, the great

majority of it to feed and house and relocate these illegal aliens, including unaccompanied alien children within our own country. now, madam president, the problem with that is that's going to encourage this flow. that's going to encourage this problem to grow. it's not going to discourage it. it's not going to end it. so we need that comprehensive approach including necessary changes to the law and enforcement to quickly deport these folks to their home countries and reunite them with their families. in the absence of the president leading in that regard, i developed my own legislation. i introduced it in the senate and i've now introduced it as a floor amendment to the spending bill which senator reid is bringing to the senate floor. it would change those aspects of the law we need to change to

streamline the process and allow us to quickly deport individuals within 72 hours back to be safely reunited with their families in their home country. that's the only thing that will stem this increasing tide, this increasing flow and this increasing problem. now there's also been a lot of debate about resources necessary, increased spending necessary. and clearly that is necessary. but before we pass the president's proposal, we need to marry it with these enforcement measures, marry it with these changes to the law. and we need to be paying for that enforcement and deportation, not simply paying to feed and house these illegal aliens within the country, to actually relocate them to other places within our country with no forseeable end in sight.

we can't do that. if we get it right with the right enforcement measures, i also have suggestions about how we can help pay for whatever increase enforcement border security and quick deportations are going on. and i have two suggestions in particular. these are two specific bills i've introduced some time ago in the u.s. senate. and this week i've introduced each of these bills as amendments to the spending bill harry reid is bringing to the senate floor. one is s. 1176. that's the free standing bill, but i've also introduced it as a senate floor amendment. the remitant status verification act of 2013. what is this about? this is about remittances by illegal aliens in this country,

sending money back to family in their home country. the g.a.o., respected nonpartisan entity, the g.a.o. has previously noted that the united states was the largest remittance-sending country in the world with a majority of funds sent to latin america and the caribbean and substantial amounts also sent to asia and africa. in the past ten years the total number of international remittances have increased by about 8% in 2013 alone are expected to grow 10.1% in 2014. 10.7% in 2015. so it's reaching an astronomical number. in 2015 it will be over $500 billion. now, if folks are working in this country legally, they're here legally, that's fine. we don't want to hassle them. we don't want to make any problems with that. but clearly a significant

portion of the folks we're talking about are here illegally and working illegally. that's wrong, and we need legislation i'm proposing to fix that situation with four important goals in mind. first of all, we need to see if folks are sending these -- folks who are sending these remittances are here legally. second, we need to ensure u.s. taxpayer fairness. third, we need to address inaccurate u.s. data on remittances and get and collect all the full facts. and, fourth, we need to make sure that illegals receiving u.s. benefits -- see if they're remitting higher amounts abroad. my legislation would address all of these goals and fundamentally it would get a handle on the situation and make sure that those who are not in this country illegally pay a

substantial fee and that was used on border security and other immigration enforcement. that could grow a significant amount of revenue, a significant amount of revenue specifically dedicated to border and other enforcement. the second proposal i have is in the form of s. 2632 -- excuse me. wrong number. it's in the form of other legislation, free-standing legislation which i've also introduced this week as a senate floor amendment for the supplemental appropriations bill. it's about child tax credits. this amendment addresses a clear loophole in the i.r.s. code that allows illegal aliens to access income tax-based benefits such as the child tax credit and the additional child tax credit.

according to the treasury department inspector general -- again, this is not some partisan republican source. it's the obama administration treasury inspector general. they issued a report recently that said $4.2 billion, with a b, each year is sent to folks probably here illegally who do not qualify under these programs. but we send them a check, a refundable tax credit, nonetheless. $4.2 billion. now, as the inspector general himself has said, there's a pretty simple way to fix this by requiring a valid social security number or other appropriate identification number. this approach is straightforward. it is simple, and it will fix the problem. and it would cut down $4.2

billion -- with a "b" -- of spending that we're sending improperly, illegally to largely illegal aliens and illegal alien feels. we could use those resources instead on enforcement. those are simply two specific adjustments that i have filed this week in the form of senate floor amendments that could help raise the additional resources we need to address this issue. but again, i want to emphasize we need to do a number of things, and it's not all throw money at the situation. particularly, when most of that money under president obama's proposal is simply to house and feed these folks illegally in the country and actually distribute them throughout the country for an indefinite period of time. fundamentally we need to marry that up with real enforcement measures, including those addressed and listed in my bill. i hope we take that approach.

i hope senator read allows that -- i hope senator reid allows that debate, allows those votes. right now he's laying across the tracks. the only thing he's allowing a vote on is this spending measure , just give the president largely a blank check. that won't solve the problem. that is not the correct response. we need to do all of the things broadly speaking i've laid out. i hope we do that. i hope we come together as in fact the american people have around that commonsense approach, that clear consensus. thank you, madam president. with that, i relinquish the floor and suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

mr. nelson: madam president? the presiding officer: the senator from florida. mr. nelson: i ask unanimous consent that the quorum call be lifted. the presiding officer: without objection. mr. nelson: madam president, i want to talk about health insurance.

you notice that nationally and back in our states that the angst over the affordable care act -- often de-rice civil referred to as obamacare -- that that angst has subsided and, in part, that has occurred because more people are being covered. as a matter of fact, in the first tranche of sign-ups of people who did not have insurance, over 8 million people, which exceeded the goal of 7 million by the time the cutoff came for signing earlier in year -- over 8 million people had signed up. and that was just narrow population of those who wanted

insurance but could not afford it. then they had it available through the state exchanges or the federal exchange in the states. another part of the population that did not have health care were people who actually were in a low-income situation and, therefore, there was no chance that they could afford it, and that's where we ex expanded medicaid in the affordable care act up to 138% of poverty, which is a very low level of income, and i believe, if i remember correctly, it's somewhere in a family of four $23,000 annual

income. well, you can imagine with a family of four, you can't even think about having the money to provide for health insurance with that kind of limited inco income, and that brings you up to 138% of poverty. but the only part of the affordable care act, since it was declared by the supreme court as constitutional -- the only part that was struck down as unconstitutional was the part of the law that was mandating upon the states to expand medicaid, which is a state and federal joint program funded up to 138%. so it made it voluntary. well, half of the states have expanded it and about half of the states have refused, such as my state of florida.

the republican goafn an governoe republican legislature, not wanting to have anything to do with what they were condemning as obamacare, refused to expand medicaid in florida, and that was refusing to give health care to a population, if you can believe this, of 1.2 million people in florida that would have had health care but do not get it because the state legislature and the governor refused to raise the level. by the way, that was taking floridians' federal taxpayer dollars of $51 billion over the next several years that was alloallocated to that, and refug to accept is that for the health care of poor floridians, over 1

million people. i mean, that seems unconscionable. this stuff is so complicated, people don't realize in large part that is, in fact, what happened over the course of the last two legislative sessions that they could have expanded health care in florida. and it's floridians' tax dhars that they are just -- tax dollars that they are just giving away instead of letting that apply to health care for floridians. so nationwide, if i recall correctly, it was something like another 9 million people were brought on with the expansion of medicaid, even though states like florida were refusing it, to expand it. and that's in addition to getting health care to those

that could afford it with subsidies or because of better rates could afford it in the first place, and that was a group of another 8 million. and so you see that you're starting to chip away at that group of people in the country that had no health care because they had no health insurance, and yet when they got sick, where did they end up? they ended up in the emergency room. they couldn't pay. of course now it was an emergency because they had no preventive health care. and since they couldn't pay, who do you think pays? all the rest of us do in our insurance premiums, and it's estimated in a state like

florida that the average family health insurance policy you're paying upwards of $800 to $1,000 of your premiums per year just to take care of the group who ended up in the emergency room because they didn't have any health care. that's part of what the affordable care act was intended to do. now, another part of the affordable care act was to save medicare from going into bankruptcy. back in the early part of the last decade, we had passed a nice-sounding law. it was called the prescription drug bill. as its name suggests, it was to

provide prescription drugs for senior citizens. omitted in the explanation of it was not only were you paying premium prices that the government had always gotten as a discount, now the government was paying a premium price with no discount for all the drugs on medicare. but a part of that was setting up medicare being delivered by an insurance company with a fancy name called medicare advantage. always before, if you were going to deliver medicare through a health maintenance organization, an h.m.o., which is an insurance company, you would expect that it would bring the cost down per person. that's how it started out. about 95% of the cost of a

per-person in medicare, regular medicare fee-for-service. but, no, no ... in the prescription drug bill, this thing was turned upside down. now they were going to offer medicare through an h.m.o., but the reimbursement from medicare was going to be 14% above medicare fee-for-service per person. -- reimbursed to the insurance company at 114% of medicare fee-for-service. as a result of that, medicare was going broke, and that was another reason for the a.c.a., to stop medicare going broke by winnowing down that 14% and

giving incentives to the insurance companies to do what ought to be the goal, which was a quality of care of stead of just paying -- instead of just paying a dollar percentage value per patient. and, thus, you have the recreated medicare advantage, and it is being raided on its -- rated on its quality so that seniors can vote with their feet by going to the better-rated insurance plans in medicare advantage. now, why am i retracing all of this? to get to this point: we're just getting to the point for this next round of medicare advantage to have the insurance companies announce what their rates are. some of them are going to go up,

some of them are going to go down, but i want the people of florida to know that two years ago in their state legislature, they took away the legal power of the insurance commissioner of florida to approve the rate hikes. they took that away. now, i happen to understand something about this. before i came to the senate, i was the elected insurance commissioner of florida, and i jealously guarded that ability to approve rate increases and decreases in order to protect the insurance consumer. the legislature of florida

stripped that ability of the insurance commissioner -- now appointed, not elected in florida -- and, therefore, if they see rate hikes for medicare advantage in this next round just about to be announced, they took away the ability of the state regulator to limit the rate hikes. that sounds unconscionable, it certainly does. every year insurance companies are going to try to raise their rates. it's the job of a state regulator to regulate what happens to those rates. and so the florida legislature last year passed senate bill 1842, and one of the things it

did, it stripped the office of insurance regulation of one of its chief responsibilities. regulating health insurance rates. and that's after florida had had some of the strongest laws governing insurance, and that was the case when i was insurance commissioner 15 years ago. of which i could not only approve rates, but i could reject rate increases. well, we saw this at the time a year ago. i contacted the governor and urged him to veto the bill.

but sadly, it is the law of florida. and therefore, that's why i come to the floor today because i'm disappointed in the news reports that are starting to say that these rate increases in florida are being blamed on the affordable care act. they're being blamed on obamacare. well, the insurance commissioner used to have an opportunity to look at those rates and say that they were not right and to stop those rate increases. or to give a rate increase that was actuarially sound. not anymore. there were a lot of other things that have been done in our state

of florida to stop the implementation of the affordable care act. first of all, our state refused to accept a planning grant in order to get ready for the affordable care act before it was ever starting to be implemented. i've already told you about refusing to expand medicaid to cover more than an additional million people in florida that otherwise would get health care. what was the purpose of the a.c.a. other than trying to save medicare, which it has done financially from disaster? it was to help make insurance coverage available and

affordable. there were provisions in there, technical terms like medical loss ratio, that said that an insurance company had to give 80% of the premium dollar back in health care instead of giving it off to c.e.o. salaries and executive perks, and if they did not, what the insurance company had to do if they did not get 80% of the premium dollar back in health care to the patient, they had to return that part in refunds, and i can tell you that happily, that law is working. one million floridians last year

received over $41 million in refunds. it was an average of $65 per family. why? because some insurance companies didn't spend enough on medical care for their policyholders. another part that we had talked about was making insurance -- private insurance -- remember how they said this was going to be government health care? private insurance companies selling insurance, people could afford it because there were subsidies up to the level of a family having 400% of poverty level of income. well, of the one million

floridians who enrolled -- and remember, i gave you the figure eight million nationally enrolled -- of that eight million, one million people needed and wanted insurance so much in our state alone that they enrolled, and 91% of them were able to receive a subsidy under the graduated subsidy level in order that they could purchase that private insurance. and the folks who bought a plan using subsidies, they reduced their premiums through the subsidies by an average of 80%. and so what we had in health insurance before the affordable care act was -- it was like the

wild west. plans could deny you coverage, an insurance plan if you had coverage and you were suddenly getting treatment, they could cancel your coverage, they could also deny you coverage by saying that you had a previous existing condition, and it could have been something as simple as a rash. you couldn't get health insurance. now all of those things they can't use as an excuse. so what i see is the last throes of this resistance to the affordable care act, and you're going to hear it again as insurance plans come out on medicare advantage and show that

they're hiking their rates, and yet i want to the people of florida to know it was the state legislature who took away the ability of the insurance commissioner of florida to regulate those rates. madam president, i yield the floor and i would suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

a senator: madam president? the presiding officer: the senator from oklahoma. mr. coburn: i ask the quorum call be dispensed with. the presiding officer: without objection. mr. coburn: i wish to speak as if in morning business. the presiding officer: without objection. mr. coburn: this is my tenth year in the senate, and every time we come to a close of a session for a summer break or for a holiday break, all of a sudden you start hearing all these unanimous consent requests that come to the senate. for those of you listening to

this and for my colleagues, those are requests that bills be passed without a vote. and i'm fine with that as long as they meet certain characteristics and considerations. but what the american public doesn't know is about 70% of the work the senate does happens by unanimous consent with no recorded vote on the back of any one senator. and today's no different much i've heard five or six requests for unanimous consent requests, and they're fine with a couple of provisions. and the first provision is they ought to be within the powers of the congress as enumerated by the constitution and the enumerated powers. the tendency is, oh, we have to do this. it has to happen now. and in some cases it's really true. but the reason it has to happen now is because we haven't done it before now because we failed to do it. and we utilize the end of a

session to force people to give on positions that they would never give on otherwise because they don't want to take the heat for being responsible for stopping something from happening, even though it might not fit within the enumerated powers. it might not be under our constitutional authority. but the most egregious of all of this is the fact that we're going to be asked today probably seven or ten times to pass pieces of a legislation that the very cost for will fall on the backs of our children and our grandchildren. not us. and with over $400 billion in waste a year in the federal government, waste, fraud, duplication, to ask us to spend $200 million here or $2 billion here or in the case of the veterans bill, $17 billion of which $5 billion of it is actually paid for, without doing the hard work of not transferring more debt to our

children is not acceptable to me. and so my rights as an individual senator are going to be utilized today until we go home to make sure we don't transfer another penny, if i can stop it, on to the backs of our children. and it would be different if we were efficient, we didn't have any waste, we didn't have any fraud, we didn't have any duplication. but, you see, it's an excuse to not do the hard work that we were sent up here to do. so i'm putting my colleagues on notice that if you want to pass any bill that's going to go by unanimous consent, you better find some waste somewhere to offset it with or i will object. and i don't mind taking the heat no matter what the issue. i've done it before; i'll do it again. our children and our grandchildren are worth any amount of heat to create a future opportunity for them

that's at least as equal to what we've had. so i wanted to say that before i start talking about the veterans bill. i voted for the veterans bill that went out of the senate. and my background as a physician and businessman -- businessman first, physician second; regrettably, a politician third. but i voted for that because i thought in conference that we would actually fix it. what's wrong with the v.a.? leadership, a culture of corruption, a culture of noncaring. that doesn't apply to all the v.a. employees. that doesn't apply to all the v.a. hospitals. but it certainly does apply to a number of them. and how did we get there? i'd note for the record that v.a. spending is up 60% since 2009. 2010, 2011, 2012 and 2013 it's

up 60%. patient demand is up only 17% in that same period of time. the number of providers has increased by 40%. so it surely can't be a problem of money. and if you look at the increased utilization of those services over the next progressive ten years, it will be less than 20%. we did some good things in the bill in the senate, most of which are kept. but we didn't do enough. if you're going to manage the v.a., you have to give the head of that organization the ability to be able to manage it. senior executive service, the secretary of v.a. is going to have that capability to hire and fire. for a very limited number of

title 38 employees -- those are hospital managers, physicians, and for a very limited number he'll have that as well. but for where we've seen a lot of problems, he won't be able to fire people who have directly harmed our veterans. so we haven't given him the tools to create the environmental chapping tha thats to happen and the cultural chapping had a has to happen in the veterans organization. the other thing that i would note is if you look at the requirement for primary care physicians and physician extenders -- nurse practitioners and p.a.'s -- their patient load is about a fourth of what the private practitioners in this country are. that's not true clinic to clinic, but on average that's true. in oklahoma, we have had some great physicians that work every night until 10:00 taking care