Executive Calendar

Floor Speech

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Mr. President, often late at night when the Senate passes a piece of legislation by unanimous consent, people often don't get a chance to understand what it really means, and usually there is a sense of, well, this maybe won't be the most important thing coming down the road, and everybody just said OK, and so it passed the Senate.

Last night, the Senate took action on Medicare. At a time when 10,000 people will turn 65 every day for years and years to come, Medicare is something millions of older people rely on, and their kids and grandkids make plans to make sure their grandparents are taken care of, but also they want to know what their future is going to be all about.
What the Senate did last night--Democrats and Republicans coming together--is, in my view, transformational for seniors today and the beginning of an effort that is going to evolve in the days ahead for kids and their parents and their grandparents to, in effect, benefit from an updated Medicare guarantee that will stand the test of time for many years to come. The reason I say ``updated Medicare guarantee'' is that Medicare is not a voucher. It is not a piece of paper. It is not something you get and then, well, maybe it will do you some good, but if your healthcare costs go above your vouchers, you are going to get buried in costs. Medicare is a guarantee that vital services are going to be available to those over 65.

Last night, all Senators voted to send to the House of Representatives a bipartisan effort that was years in the making to update the Medicare guarantee to start focusing on chronic illnesses, such as cancer, diabetes, heart disease, and Alzheimer's.

Mr. President, I am going to make this a little bit personal. I am so grateful to Chairman Hatch, Senator Isakson, Senator Warner--the bipartisan group in the Senate that has been working on this.

What I can tell the Senate tonight is that back when I was director of the Gray Panthers and ran the legal aid services for older people, Medicare was a very different program. Back in the 1970s when we were getting the Gray Panthers off the ground, it was a very different program than it is in 2017. Medicare really consisted of two parts.
There was Part A. If a senior broke their ankle or needed surgery for a broken hip, they went to the hospital, and Medicare Part A would be there to cover a senior's surgery. If a senior had an awful bout of the flu, he or she visited the doctor and they used Part B. That is not Medicare in 2017. Medicare in 2017 is not primarily about treating the flu or a broken ankle. It is there for those conditions, and we are very glad that it is, but more than 90 percent of the Medicare dollars go to treat older people with two or more chronic conditions. I will tell you, until the Senate Finance Committee, on a bipartisan basis, began to deal with this problem--and fortunately, we had a couple of colleagues in the House who picked up on it as well--my sense is that, basically, both political parties had missed it. They really missed the fact that most of the Medicare dollars--90 percent--go to seniors who have two or more of these chronic conditions. They might, for example, deal with diabetes and heart problems.

But today's seniors really face the kinds of conditions that didn't dominate the program back in the days when the Gray Panthers were getting off the ground. Today, seniors get their care in a variety of different ways. It is not just fee-for-service medicine. We have the Medicare Advantage Plan, Accountable Care Organizations, and other new systems under development.

So keeping up with those changes--updating the Medicare guarantee-- ought to be a real priority for policymakers. That is why the Finance Committee has put so much effort over several years to get the bill that passed late last night across the finish line. There are still more steps before the policies reach the President's desk with strong bipartisan backing of the entire Senate. I am confident the job will get done.

The CHRONIC Care Act means more care at home and less in institutions. It will expand the use of lifesaving technology. It places a stronger focus on primary care. It gives older people--however they get their Medicare--more tools and options to receive care specifically targeted to address chronic illnesses and to keep them healthy. These, in my view, are a whole set of building blocks that you have to set in place to update the Medicare guarantee. Still to come is ensuring that every older person with multiple chronic conditions has an advocate to help them navigate through the Byzantine healthcare system in America.

I just want to highlight that point. If you have two or more of these chronic conditions--I guess the physicians call them comorbidities--you can be drowning, especially if you are not part of a coordinated Medicare program or Medicare Advantage or something like that. You can just be drowning in forms and processes and procedures. Lots of times, over the years, I have gotten calls from a child who is a lawyer or an engineer and they said: Ron, help me out in trying to get through all of this maze of bureaucracy to try to get help for my parents. So I want it understood that what the Senate has done as of last night is an extraordinarily important beginning, but there is a lot more to do.

I want to wrap up my comments on this subject and, then, turn briefly to one other, by handing out some very appropriate thank-yous. I think the Finance Committee has handled this bill, in my view, as a model to work on a bipartisan basis. I want to thank Chairman Hatch. He and I put together the bipartisan chronic care working group two years ago, and Senators Warner and Isakson did a first-rate job of leading it.

There is an awful lot of sweat equity put in by staff. A lot of staff worked on these issues while they were dealing with weddings. We had three children born in the process, and there were job changes. Big thanks go to Karen Fisher, Hannah Hawkins, Kelsey Avery, Leigh Stuckhardt, Liz Jurinka, Beth Vrabel, and Matt Kazan on our team.
Chairman Hatch and his team really stepped up to work with us and all the Senators: Jay Khosla, Brett Baker, Jen Kuskowski, Katie Meyer- Simeon, and the chronic care lead, Erin Dempsey. Big thanks also go to Senators Warner and Isakson for lending us Marvin Figueroa and Jordan Bartolomeo.

I close this portion of my remarks by saying that I think what happened last night--while certainly not something everybody is talking about this evening--is something that is going to be extraordinarily important in the years ahead. It is an issue that I know the President of the Senate and I have talked about--this whole question of healthcare and Medicare and the like. This was an important step to take and an important step we can build on. I hope the other body in the House will take action quickly.

Puerto Rico and U.S. Virgin Islands Recovery Effort

Mr. President, let me turn now to this question of the Puerto Rico disaster. It has now been a week since Hurricane Maria made landfall in Puerto Rico, and 3.5 million American citizens are living amidst a horrifying state of devastation. When I was chairman of the Energy and Natural Resources Committee, which has jurisdiction over the affairs of Puerto Rico, the U.S. Virgin Islands, and America's other territorial possessions, I got very involved in the economic issues on the island.

But I come today to make a humanitarian plea to my friends and colleagues in the Senate. It is a plea not about economics. It is about people--fathers and mothers, children, grandparents, teachers, nurses, and thousands of veterans who served their communities and their country proudly. They are dealing with something that is almost unimaginable--this horrifying set of circumstances that they now find dominating their lives. The press accounts describe Puerto Rico as looking like a war zone. Millions of people on the island are without power, running water, and fuel. The few hospitals that are open--only 20 for the entire island--struggle to care for the injured and the sick. Many doctors and first responders are unable to get to their workplaces because their lives, too, are thrown into chaos, and 911 still doesn't work. Cell service and power are down. The airport in San Juan barely functions now, after days of being completely off the grid.

It is almost impossible for us here in this city to imagine this. We have the basic infrastructure and health and safety that we take for granted every day. Only one word sums up the state of the islands-- demolished. It is almost impossible to gauge the full extent of the devastation. Nobody knows how many lives have been lost or how many homes and businesses have been damaged beyond repair, and how many lives have been shattered.

What is known is that this disaster has affected the lives of every single one of the 3.5 million individuals living on the island and the millions more on U.S. mainland, who have had sleepless nights worrying about loved ones. This is a humanitarian crisis on American soil. It is past time to step up and provide immediate aid to help these Americans--not only for Puerto Rico but also for the U.S. Virgin Islands, which has also been clobbered by these storms. It is not just the right thing to do. It is the only thing to do.

A few hours ago, I joined 35 of my colleagues in sending a letter to the President, and we requested a number of concrete actions. There are other additional steps in my view that are vital. So I want to just tick through some of them on the floor.

First, the President has to issue a full disaster declaration for all of Puerto Rico, not just parts of it. Currently, 24 municipalities in Puerto Rico have yet to receive individual disaster assistance. This means that people who have lost their homes in these areas are ineligible for Federal assistance. This is unacceptable.

Next, while the President rightfully revised his original disaster declaration so that the island will not have to split the cost of disaster relief with the Federal Government for 180 days, the President should continue this assistance until the island is back on its feet.

The administration also needs to include funding and necessary emergency support for the Puerto Rico Medicaid Program in any emergency request. Medicaid in Puerto Rico doesn't work the way it does in the 50 states, where it is a guarantee of care for vulnerable, low-income people. Puerto Rico's Medicaid Program is built on a block grant, which means that in times of crisis, resources might not be there when it is needed most. Even before the disasters, Puerto Rico was close to depleting its Medicaid supplemental funding. When it does, it will have nowhere to turn to pay for medical care for many of its most vulnerable.

In my view, this is a perfect example of why block grants--as contemplated by the bill that we considered in the Finance Committee this week--Graham-Cassidy-Heller--and vital programs like Medicaid don't mix. It is a recipe for disaster.

In addition, there are expired tax provisions unique and vital to Puerto Rico's economy, and they ought to be extended with any disaster relief package in order to give workers and businesses certainty and predictability. This includes tax incentives for producing goods in Puerto Rico and rebates for taxes on exported rum. In my view, if this is done properly and laid out in a proactive way, it will give predictability for the future and make a difference--an important difference to a lot of people on the job.

It is also vital to get Puerto Rico's electric grid up and running and provide power generators in the meantime. This isn't simply a matter of recharging phones or turning televisions back on for news updates. Going without power is life-threatening. Perishable food goes bad. Those with diabetes can't refrigerate their insulin. Hospitals have a difficult time running essential medical equipment, like dialysis machines or heart monitors. Air conditioners are useless, which is especially dangerous for kids and seniors given the hot, humid temperatures and the limited supply of safe water.

Another necessary step is to help ensure that Puerto Rico and the U.S. Virgin Islands receive assistance as quickly as possible, and that would include a short-term waiver of the Jones Act. The Jones Act is an important policy for ensuring a vibrant U.S. maritime industry and for our national defense. But in times of disaster it is more important to get supplies to the impacted areas as quickly as possible. The government has granted such a waiver in Houston and Florida, and it is, in my view, beyond comprehension that they haven't done the same thing for Puerto Rico and the Virgin Islands.

Finally, the administration needs to mount a full-court press to rebuild the islands' roads, ports, and airports. Once aid arrives, it is useless if you can't get it out to those who need it most. As several of my colleagues and I wrote to the President today, our military is uniquely qualified to help Puerto Rico meet some of its critical recovery needs. That includes construction battalions that can repair power and surface transportation infrastructure.

I close by saying that the people of Puerto Rico and the Virgin Islands are desperate for our help. This situation is extreme. Congress and the administration need to act as soon as possible. The cleanup from Maria and Irma is just the beginning. The fact is that these megastorms, fueled by global warming, are going to keep coming, even after the power is restored and the storm damage from Maria and Irma is repaired. There is going to be a lot of work necessary to reverse years of struggle and build up Puerto Rico's economy and infrastructure.

Coming to the aid of our fellow Americans at a time of crisis, in my view, is at the very core of being Americans. At home, I call it ``the Oregon way.'' Our natural disaster this summer was wildfires. Recently, I was out visiting fire camps that stretched from our northern border with Washington State to our southern border with California and many points in between. I met people helping Oregon fight fire from all over the United States. I met Floridians who were there the weekend Irma hit Florida. They were there to help Oregonians deal with fire, when they and their families were worried about what Irma was going to do to Florida.

Colleagues, I close simply by way of saying that we should expect no less in our efforts here in the Senate to help our fellow Americans in Puerto Rico and the U.S. Virgin Islands. The American people now have to be part of a mobilization to bring together the enormous resources in the Federal Government to help when disaster strikes. It is a matter of basic fairness and humanity to help protect and restore these American citizens and lands.
I yield the floor.

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