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Department of Defense, Military Construction and Veterans Affairs, and Full-Year Continuing Appropriations Act, 2013

Floor Speech

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Date:
Location: Washington, DC

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Ms. MIKULSKI. Madam President, we will be alternating on both sides of the aisle. I regret Senator Lee had to leave, and we welcome those who support the Cruz amendment to speak before we have to take a break.

I have to go to a meeting with Senator Reid and other members of the committee at 12:30 p.m. We ask those who have views on this to come forward and speak. I do have some comments on the Cruz amendment.

First of all, we welcome Senator Cruz. He is the new Senator from Texas. He replaced a very dear friend, Senator Kay Bailey Hutchison. Senator Hutchison and I were close friends and we usually agreed on goals, but there were times we didn't agree on methods. With Senator Cruz we agree that we do need a job-creating strategy. We know we need to promote economic growth in whatever we do and even follow the physician's adage of ``do no harm.'' That is why I absolutely disagree with the Senator's amendment. The very things he wants to accomplish and his underlying premise--though obviously well argued from his view in a persuasive way--I totally disagree with.

First of all, let's talk about what the Cruz amendment does. It prohibits discretionary funds from being used for the Affordable Care Act. It is affectionately known by some of us as ObamaCare, because Obama does care. So the Cruz amendment would prevent the Department of Health and Human Services from implementing the Affordable Care Act. This would mean the staff, for example, CMS, could not issue or enforce regulations on insurance abuse practices, such as gender discrimination. Quality reforms that improve the care that everybody does and actually lowers cost would also be affected. For example, Johns Hopkins lung transplants were cited as one study--Madam President, I could go on, but if the Senator from Utah is ready to speak, I will yield the floor. We were alternating, so it is actually the Senator's turn.

Madam President, as robust as my remarks would be, I will yield to give the Senator from Utah his rightful chance to speak.

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Ms. MIKULSKI. Madam President, I rise to speak on the Cruz amendment. I am glad Senator Lee had a chance to speak.

As I said, the Cruz amendment would prevent the Department of Health and Human Services from implementing funding for the discretionary spending aspects of the Affordable Care Act. Since the Presiding Officer knows the Affordable Care Act so well and played a major part in it when she was a Member of the House of Representatives, she knows this amendment would have disastrous consequences. It would essentially defund the Affordable Care Act. They call it ObamaCare. I call it ObamaCare. As I said earlier, Obama does care, and that is why we passed the legislation in the first place.

The Cruz amendment means that CMS couldn't do their job to, for example, issue regulations on ending gender discrimination. It has been said that there are all these pages of regulation. But why should we pay more for health insurance than men of comparable age and health status--as much as 50 percent more?

The Affordable Care Act also ends discrimination on the basis of preexisting conditions. As the Presiding Officer knows, in eight States women were denied health insurance because domestic violence was deemed a preexisting condition. They were battered in their own home, and then they were battered by their insurance agency. What are we doing here? This is not where we are going.

Excuse me. I promised I wouldn't try to incite; I would try more to inspire. But I feel very strongly and passionately that the Cruz amendment should not pass. It should not pass.

I wish to speak to what the Senator said about economic growth. He said he is for economic growth. I want to be on that list. He is a progrowth Senator. I want to be on that list too. I think it is a committee of 100. What I want him to know is that without a form of health care that provides universal access but insisting on delivery models of reform, we will have a catastrophe and not only in an earned benefit program such as Medicare. What happens is if people don't have health insurance, it gets shifted onto other people who do have health insurance and the employers who have the generosity and wherewithal to pay for it.

So if we want to be for economic growth, the first thing we need to do is clean up our own act here. This is what we need to do here. The politics of brinkmanship, ultimatum politicians, shut down, show down, and slam down must end. That is what we are trying to do here. What we are trying to do is move legislation so there is no government shutdown.

Businesses don't invest in creating jobs because they don't have certainty. They don't have reliability. Where is the Federal Government going? What is it going to do? How is it going to get its act together so businesses can invest, whether it is in their own employees or perhaps bringing money back home from overseas, legally earned profits, to put into infrastructure? So if a person is progrowth, they want to have health insurance.

The two costs business cannot control are the cost of health care and the cost of energy. We can control the impact on reforming the cost of health care through ObamaCare. Why do I say that? First of all, if a person doesn't have health insurance, they get sick and go to the emergency room. Do my colleagues know what the average cost of an emergency room visit is? It is $1,000. Do my colleagues know what a primary care doctor gets? He gets $40. Now, what is wrong with that picture? He gets $40, not $400, by the time all of it is taken out.

I wish to bring to the attention of my colleagues a fantastic documentary that was on CNN on Sunday night. It was called ``Escape Fire.'' It was a complete 2-hour documentary from CNN, not some lefty think tank or nothing like the Institute of Medicine. This was a CNN documentary on the cost of health care and how the system we have now increases costs but does not increase or improve health outcomes.

I am not going to argue all those dynamics here today, but if we really want to lower the cost of health care, we want to have President Obama and our Affordable Care Act. This is what businesses want. What they don't want is cost-shifting. Because some people don't have it or because they got it too late in their own situation, the cost is actually greater.

The other side has talked about small business. Senator Cruz just told this wonderful story about his father--a Cuban refugee, essentially--who came to this country. Because he couldn't speak English, he took a job where it wasn't required, washing dishes. And then here we go, one generation later, Senator Cruz is a Senator. I think that is a wonderful personal story. He then went on to talk about business.

His story is a lot like my own family's story. We came from Poland. When we came from Poland, it was not because we were rich; we came because we thought that Lady Liberty and her shining light really meant something. My family started small businesses. My grandmother ran one of the best Polish bakeries in Baltimore. My father had a small grocery store. Because of a large family, he left school in the eighth grade, but through his own grit and determination, with my mother at his side, he served a community. Over 700 people came to my father's funeral because they loved him as much, in their own way, as we did. My father, through his grit, determination, and working--the same as Senator Cruz's father--my father worked 6 days a week, 12 hours a day. He sent his three daughters to college to be sure they had an education in post-high school.

He wanted to have health care. My father was crazy about Social Security and BlueCross and BlueShield. My father couldn't get on Social Security until the 1950s because small business was excluded. The reason he liked Social Security was that he worried about my mother and he worried about his girls. He was worried that if he died, would his own insurance--my father had insurance. My father was a planner and a provider--a planner and a provider--but he worried about whether that would be enough to take care of us. So when he was eligible for Social Security, he said: I will pay my fair share so if anything happens, fine, and if nothing happens, I am glad to pay my fair share.

As a small businessman, he didn't have access to big markets, but through the Maryland Grocers Association--again, in the 1950s--he could come in on BlueCross and BlueShield. He wanted health insurance for himself, for my mother, for his daughters, and, if he could, for the few people who worked for him because he knew that people were one financial bankruptcy away if a big illness happened.

What my father faced in the 1950s America is facing now in 2013.

So what does ObamaCare do? It improves access for 35 million Americans who are without health insurance. It ends the punitive practices of insurance companies, one of which is gender discrimination. The other is the preexisting condition denials. It also strengthens Medicare in a way that actually reduces health costs. Data has been released in the last several days that actually shows health care costs are going down, and it is not because of the recession. It is because our reforms are going into effect, such as the famous Pronovost checklist developed at Johns Hopkins University that was quoted in another study: If we wash our hands and take care of certain things in the OR, we won't get an infection. And if we don't get infections, we don't stay in the hospital longer than necessary.

I chaired the quality initiatives committee that examined how we could, through improvements in quality, not only save lives but would it save money, and the answer was a resounding yes. I didn't make that up.

They said: MIKULSKI, you are a social worker. What do you know about delivering health care?

It wasn't my idea. I went to learned societies, such as the Institute of Medicine, that said to err is human, but it is also costly. I am not talking about the medical malpractice stuff--infections, returning admissions to hospitals within 10 days or 30 days because of the way people are often discharged, the issue of prevention.

I am the author of the so-called preventive amendment that went into the health care bill.

What was that all about? It meant that early detection and screenings save lives--early detection and screenings save lives. That means if you get your mammogram, if you get your PSA test for a man, you are more likely to find it.

But it is not only for that dread, awful ``C'' word. Let's take a ``D'' word: diabetes. A lot of people walk around and do not know they have diabetes or high blood pressure. Both are silent killers. They can result in strokes or death. If you have undetected diabetes, it can kill you through a coma and other things, but it can also kill you slowly. The consequences of prolonged diabetes can result in the loss of eyesight, the loss of a kidney, diabetic myopathy, where you cannot walk. And if you come in so late, you are often--rather than facing an amputation, wouldn't it have been better to find it 10 years before and get you into the right program, with the right diabetic educator, to make sure we not only control your diabetes but we are not paying for amputations, which is a heartbreak for the family and the person and a budget buster to us?

This is what prevention is all about. It is not some gooshy-pooh thing. It is not like a slogan on a cereal box. This is the real deal. If you find certain of these chronic conditions sooner, you can manage their escalation. That helps the family and the patient. It also helps control our costs.

This is what we are talking about. This is why we care so much. And for women, we were helped through this bill, dealing with gender discrimination, preexisting conditions. Children were helped. And now, right now--because ObamaCare is not fully implemented--it stops insurance companies from denying families health insurance or charging sky-high premiums because their child has a preexisting condition.

What are we talking about here? We are talking about autism. We are talking about type 1 diabetes. We are talking about even children who have arthritis.

The other day I had such a poignant thing happen. I was dashing to the elevator, and there was a family with a young lady, a young girl about my height, but about--well, she was 13 and a tween. When they showed me their picture of the last time we met, that tween, that young lady, was in a wheelchair. We do not think of someone around 11 or 9 having arthritis, but she does. This is going to be a chronic condition with this young lady. But through the work of NIH, other great research, and working with a biologic that was used for other medical issues but allowed under FDA to work with her, under very strictly controlled conditions, with parental consent, of course, this young lady stood next to me. We laughed and we joked, back to back, because the little girl that was in the wheelchair is now a tween, and she is a lot taller than I am. We had a good laugh. But I will tell you, when I got on that elevator I had a good cry, and I was so emotional about it, I even feel it today.

What are we doing here? Don't we want to give this little girl a break? When her mother and father applied for health insurance, do we want the schoolmarmish no--the nos of the insurance company saying: No, that kid has arthritis. We cannot insure you.

That kid does have arthritis, but she is walking today. She is standing proud with her mother and father, joking with a U.S. Senator, doing well in school. Isn't that what we want for our country and for our young people? Why would we want to repeal legislation that does that?

I could talk a lot about this bill. I feel so strongly about the incredible infrastructure we have in our United States--NIH, academic centers of excellence, learned societies from IOM to the American Academy of Pediatrics that have advised us along the way--all of us working together. The biologic was developed by the private sector--the private sector--working with doctors, working with FDA, to say: Can we try an off-label that meets all the ethical things where children are involved?

We did it, and look at the story. That is just one story. We are a country of 300 million people. That story is being acted out every single day, and it is being acted out right now in the ER. If you came to the ER with me at Johns Hopkins, the University of Maryland, at Mercy Hospital, are there people who are there from trauma? Yes. Are there people there who were in an automobile accident? Yes. I was there 3 years ago myself with a fall coming out of church. Yes. But over 70 percent who are there are there because they do not have health insurance. And they are using a thousand dollars a visit being in there. What kind of system is that?

So if we repeal the President's Affordable Care Act, the consequences on families, the consequences on business, will be horrific. We are simply shifting the cost rather than solving the problem.

Are there reforms necessary? Yes. Do the Senators from Texas and Utah, who spoke, offer suggestions? Yes. But let's let ObamaCare go forward. Let's evaluate, let's do due diligence, and let's do oversight and make sure health reforms we have instituted are working, but do not repeal it. We will endanger lives, and we will endanger our economy.

I yield the floor.

I suggest the absence of a quorum.

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Ms. MIKULSKI. The Senator is correct. If I might comment back, we sound like two war horses at the VFW Hall. The next thing, if it wasn't prohibited, we would be doing shooters on the Senate floor.

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Ms. MIKULSKI. We could exchange a lot of things about diamonds, but that would be quite a benchmark.

This is what I am going to say: What we would like to do is return to regular order where the Senator could have brought his bill to the floor all by itself--not in the midst of a threat of a showdown, shutdown, lockdown. He could have brought it up with his ranking member. Now you have the Senator from Kansas, Mr. Moran, and we have open, public debate, transparent, going through category after category: education, special education, funding for the National Institutes of Health, the Department of Labor, all of those things.

The Senator's subcommittee is one of the most robust, other than defense, and second in size in expenditure. It funds the entire Department of Labor, the entire Department of Education, and the entire Department of Health and Human Services. Under that, there are spectacular agencies and independent agencies, such as the Social Security Administration, which is literally headquartered in my hometown of Baltimore.

It has, I would say, 40 percent of the domestic expenditures which meet compelling human need. It also funds the kinds of programs we need for the workforce of the future and our research of the future.

The Senator deserves to have his day. Anyone who wishes to analyze it, scrutinize it, amend it, improve it from both sides of the aisle should do this.

I say to my colleague, what I want to do is get this bill through this Senate, working with my colleague Senator Shelby, who has been my ranking member over the years and who is so well versed on the agreement. Essentially, the ideal situation would have been regular order where we would have passed our bills before October 1. You could have been on the Senate floor.

Now we are in something called a continuing resolution where the entire Federal Government is in one package. Everybody is trying to parse it, understand it, and they should. This is not the way to govern. We shouldn't be threatened with these deadlines and kind of an ultimatum-type situation.

We are going to try to do the best we can. The Senator has made his point and done it robustly. He produced a great bill, along with Senator Shelby, in terms of coming out of the subcommittee, and then fashioned it. It is not only great on content, policy, but it has the sense of receiving value for the dollar as well and keeps an eye on that.

At the same time, we were able to fashion a bipartisan agreement, but you couldn't move the bill. Here we are now into this larger issue. My job is to get this bill through the Senate, working with Senator Shelby. This is our job.

I am going to say to Senator Harkin and to all Members on both sides of the aisle, we need to get back to regular order. We can't be doing big bills nobody understands, that everybody is suspicious of. We need to be able to do this the way the founders of the Appropriations Committee wanted us to, committee by committee, out in the open, with full and open debate where we could focus on the content. When we bring Commerce-Justice-Science, we can focus on the Justice Department, focus on Federal law enforcement, and focus on science programs.

We can look at Labor-HHS, which has such an enormous labor impact on our economy and an impact on the future of our economy. Remember, research and development, the workforce of the future, through education, Pell Grants, are all of the great things on this bill.

As the Senator proposes this amendment and the Senate works its will on this amendment, I want to say get the job done. Let's get the bill passed and then let's solve the sequester problem, which has a Draconian shield hold over us. Let's get rid of brinkmanship, shutdown, showdown politics.

Let's return to our regular order where we may produce bills, debate them in the full sunshine of the Senate--and not only do a good job, but the American people can understand what we are doing. There aren't just views on policy. This is America. That is what a democracy is and what a parliamentary body is. We should be able to bring process and procedure. This means following a regular order with our legislation.

I thank the subcommittee chairman, Senator Harkin, for his advocacy in the last 2 years. He and Senator Shelby worked together to produce a great bill. We are where we are, and I hope we do all we can to pass the bill and return to regular order.

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Ms. MIKULSKI. Mr. President, I wish to say the Senator who currently now chairs the Subcommittee on Defense will speak on the amendment of the Senator from Arizona. I wish to speak about the process and about sequester.

First, the Appropriations Subcommittee on Defense finished its work before the August recess. The authorizers didn't get it done until December 20. There is a gap here because Senator Inouye--a very happy, blessed, and beloved memory--moved his committee in an expeditious way, which appropriators are supposed to do.

Remember, appropriations are supposed to be done before October 1. Senator Inouye chaired the committee, chaired the full committee and then chaired this Appropriations Subcommittee on Defense. Senator Inouye did his job under the authorization that was present before him.

The authorizers didn't pass their bill until December 20. We want to respect the authorizers not only on defense but on every committee. They need to pass their bills before we pass ours. We work on our bills by holding our hearings under regular order beginning when we get the President's budget, which we wish would be up-tempo a bit. Then we start our hearings, mark up our bills in May and June, and begin to move them through the process.

Before we attack the Appropriations Committee, we should attack the process and get back to regular order, where authorizing and appropriating are in sync.

The second thing I wish to comment on is sequester. I want to acknowledge what the Senator from Arizona said about the impact of sequester. Sequester is an awful, awful, awful thing. That is not on this bill. When the Budget Committee comes up, along with the negotiations by the President with the leadership of the House, I absolutely agree with him, we must cancel sequester and ensure that not only our Defense Department but others who defend America, such as our Border Patrol guards, are not unduly harmed. And we are hollowing out, to use the quote from General Amos, an extraordinary Commandant.

What we need to do is get a process in order to have the proper policy debates.

I note that the subcommittee chairman will now comment on the specifics.

I yield the floor.

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Ms. MIKULSKI. Mr. President, before the Senator leaves the floor, the chair of the Budget Committee--first of all, I want to compliment her on the work she has done on the Budget Committee. It is indeed impressive. I want to compliment her because she is headed for a balanced approach, really. Increased revenue. We are not talking about rates, we are talking about getting rid of tax break earmarks, earmarks that go on not for one group for 1 year but go on indefinitely, such as subsidies for corporate jets and sending jobs overseas.

But the other areas she is looking at are how we can be more frugal in our spending, and then a rigorous review of mandatory spending. We have to review it to see how we can get more value for our dollar.

The Senator has championed veteran's health care. She and I know we can get more value there. I compliment the Senator on that.

I am going to ask the Senator a question about timing and process. Does the Senator have a time mandate that has been assigned to her to complete her bill?

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Ms. MIKULSKI. Well, I want to share the Senator's sense of urgency to get her bill done. In order for her to get her bill done, I need to get my bill done. I want to pledge my cooperation, and I believe that of my vice chairman, Senator Shelby. We have a sense of urgency to move our bill because we must take it over to the House. There, we have a deadline that is a Draconian one: If we do not have a continuing funding resolution passed before the

Easter-Passover break, we will face a government shutdown. That is horrific in terms of our economy and the people who want the U.S. Government to govern itself. It is also one more sign that we have a problem governing. I say that because, while the Senator is marking up her bill tomorrow, we want to move through here so that we are done.

I would like to have this bill done tomorrow. There are those who have obligations in their States and even at an international conference. I would like to support that, but Senator Shelby and I need support too. So we do not doubt people offering amendments, we do not question their content or their policy, but we have timing and process.

Our bill is not meant to be ``pin the tail on the donkey.'' It is not meant to solve every problem the U.S. Government has. Our job is to keep the continuing resolution.

I want to say to the Senator, while, speaking to a much larger audience, I know there is pent frustration not to be able to offer amendments and debate. We are doing that. You win some, you lose some. That is called the Senate. I want the Senator to know we want to work with her so that we do not interfere in her work. But I believe one of the ways we can get to the budget, which is the real framework for how we can even vitiate sequester, is to get out our bill, meaning the continuing funding resolution.

So I want to compliment the Senator on her work. I pledge to support it, but I ask the support of all of the other 98 of our colleagues. Let's look at what we need to get done on the continuing funding resolution, not what we would like to get done.

Mrs. MURRAY. If the Senator from Maryland, the chairman of our Appropriations Committee, would yield for a minute, I want to back her up on that. I know there are probably 8,000 amendments that can be offered to this because nobody is happy with the fact that we are faced with a continuing resolution that does not reflect the needs of all of our communities. I know she did not come here to debate process or to be the mother of Senators and get them over here to offer amendments. I know where her passion is. It is fitting for her kids and families and communities in Maryland. That is what she wants to get back to.

If we can get past this and put the CR in place, swallow hard and then get our budget done and work toward a process of a bipartisan budget, we need to do that so we can then give the Senator the ability to put the Appropriations Committee bills together. They will come out here and we will be able to offer amendments and people will have their say about the spending of the future. We cannot get to that unless we get that work done.

Ms. MIKULSKI. That is right. An open and transparent process in that legislation that we put together over a weekend, 571 pages. Senators McCain and Coburn were right, but I could not do any more because I did not get it from the House until Thursday. So, again, I am not here to debate process, but I am the prodder of the process. So I am out here prodding and pleading: Please, let's get a simple, contained order of amendments. We thank the other side of the aisle. They are working with us.

In terms of the floor staff who is working on this, we need the cooperation of the Senators.

Mrs. MURRAY. I would back up the Senator and urge Senators to, please, finish this product, move on to our budget next week, and get that done. Then we can get to the point that America will respect the work of this body and not lurch from crisis to crisis as the Senator has outlined and get back to focusing on the policies those families she cares about and represents so well want her here for.

Ms. MIKULSKI. Absolutely. I see my colleague from Maryland, such an able and active Member, a member of the Finance Committee that is known to make a contribution. We want him to make a couple of trillion dollars' worth of contributions, as a matter of fact.

I yield the floor.

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