“I want the Senate to pass this bill right now. It requires people to show a photo ID to vote in federal elections. People have to show an ID to fly or use a bank. They should have to show one to vote, too. Most Americans support this rule, and it will stop cheating in our elections.”

“Mr. President, American voters deserve to have an election system that they can trust. Fair, safe, secure elections are a key hallmark of any society’s ability to be able to claim the status of democratic self-rule. If you don’t have safe, secure, independent, reliable elections, you have a widespread set of problems that will cascade and ultimately constrain liberty. Americans intuitively understand this. But at the moment, our elections are far less secure than they should be. Why? Well, because so much of it operates on the honor system. Now, an honor system is great. It works well if you are dealing with a smaller group of people, a closed-loop system in which everyone knows everyone else. And the honor system works well also if you don’t have a real risk of somebody claiming to be someone they are not and if they don’t have the ability to inflict harm on those who play by the rules. It is one of many reasons why there are a whole host of activities that, in our common experience, necessarily require someone to prove that they are who they claim to be. You experience this anytime you go to the bank, when you go to the doctor, to the pharmacy, when you are picking up theater tickets at will call--all kinds of circumstances. And, you know, one of the more familiar ones for Americans who routinely travel by plane is that when going through TSA, you have to prove who you are as well. If you leave the country, whether by land or by sea or by air or some other means, you are likely going to need a passport when you leave the country and when you come back into the country. These are all just a few--many circumstances in which it matters whether you are who you claim to be, so much so that it is important that you do more than just say: Trust me. I am who I claim to be. In the context of voting, sometimes we will refer to this as self- attestation, which is just a fancy way of saying it is the honor system: Trust me. I am who I claim to be. But, look, with good reason, it is not sufficient, self-attestation. ``Trust me. I am who I claim to be’’ isn’t enough when you board a commercial flight, when you purchase alcohol, or even when you attend the Democratic National Convention. Those are just a few of the circumstances where they don’t allow you to operate on the honor system because they know that it matters whether you are who you claim to be. Now, even for something as simple and relatively low stakes as obtaining the coveted never-ending pasta pass from the Olive Garden-- even there, they don’t allow the honor system. Even there, you have got to produce ID to show that you are who you claim to be. It should not be any easier for someone to get away with voter fraud at a polling location on voting day than it is to cheat the Olive Garden through its never-ending pasta pass--and yet that is exactly where we are today. We allow the honor system. Even though we have laws that prohibit things like noncitizen voting, those laws have been rendered difficult--essentially impossible--to enforce, as against those who would abuse self-attestation in countless circumstances. Those are being revealed; those are becoming known. That thing that they claim never happens--voter fraud or noncitizen voting-- just keeps happening over and over and over again--especially for something that many like to claim never happens. Well, it does, and we need to take steps to prevent it from happening. That is why I introduced the SAVE America Act. The SAVE America Act has two fundamental objectives--two very basic unassailable objectives: Let’s make it easy to vote and let’s make it hard to cheat. We have got to have both of those. The SAVE America Act does that through two different mechanisms: One, it requires, at the time of a new voter registration, for you to establish that you are, in fact, a U.S. citizen. And, second, it requires that on election day, at the time of voting, you show up with a photo ID--with a photo identification--so that you can prove that you are who you claim to be. Both of these things would make it easy to vote and hard to cheat. You have to have both of them. If you just make it easy to vote and don’t make it hard to cheat, you are going to have that much more incentive and opportunity for someone to cheat, and we don’t want that in this country. Americans overwhelmingly support voter ID laws for that reason. We are talking 83 percent of Americans, give or take a percentage point or two, depending on the poll. But Americans, by a margin of more than 4 to 1, favor voter ID laws, and we need one here. Now, with the SAVE America Act, we have heard some objections; we have heard some arguments. Nearly all of those arguments focus on the first component of the SAVE America Act. And at times when the SAVE America Act has been the pending business before the Senate floor, as it was just a few months ago, the arguments that we heard--probably somewhere between 95 and 99 percent of the arguments--coming from Democrats against the SAVE America Act were focused on the voter registration component: having to establish proof of citizenship beyond self-attestation at the time of a new voter registration. Now, those arguments were ill-founded. In every single circumstance, they were founded in something that resulted from a mischaracterization of law, a mischaracterization of fact, or, in many circumstances, both. They were not well founded, but they were often and strongly expressed. It is one of the reasons why my friend and colleague, the Senator from Ohio, Senator Jon Husted and I were talking one day, a few months ago, and decided: Let’s try an experiment. Let’s see what would happen. Given that nearly every one of their arguments coming from the other side of the aisle against the SAVE America Act is focused not on the voter ID component but, rather, on the voter-registration proof-of- citizenship component, let’s run with something. Let’s introduce something that would just contain the voter ID component of the SAVE America Act--this, after all, would help us figure out where the weaknesses are, what can pass and what can’t pass--given that they almost never have argued against voter ID while opposing the SAVE America Act. And, in fact, many, if not most, of my Democrat colleagues in the U.S. Senate, at one point or another, in the very recent past-- many of them this year, in fact--have said that they support voter ID laws. So let’s introduce something that just focuses on the voter ID component of the SAVE America Act. Now, this bill--and, again, this overall approach--is one that Americans overwhelmingly support. We are talking 83, 84 percent of all Americans--Democrat, Republican, Independent, everybody mixed in. They support this. Why? Well, because it is good common sense. Everybody understands it. There are myriad circumstances in which it matters whether you are who you claim to be, and nowhere is that more important to the proper functioning of our constitutional Republic than it is in the context of voting and having secure elections. We have also seen that the need for these things has been enhanced dramatically in recent years, not only with the flood of noncitizens entering this country--we have now got, I think, between 30 and 35 million noncitizens residing in this country. It is now easier than ever for them, especially in light of the Supreme Court’s botched interpretation of the National Voter Registration Act. Over the strong dissent of Justice Alito, the Supreme Court essentially told the States that absent new Federal legislation--legislation in the form of the SAVE America Act--self-attestation is essentially sufficient in that circumstance. So Americans overwhelmingly accept this. This is a rare issue. Now, bipartisanship is not itself all that rare, but bipartisanship to this degree--we are talking 83, 84 percent of all Americans agreeing with something like this--is significant. That doesn’t happen every day. What is even more unusual, though, is when you have an issue where 83, 84 percent of all Americans strongly support a position, as they do in the case of voter ID laws, but then that overwhelming support doesn’t match what elected Federal lawmakers believe. So it is not 83 or 84 percent that Members of this body support that. No, it is much closer to 50-50, and it breaks down almost perfectly along partisan lines. So there is a real disparity here. Americans overwhelmingly support voter ID, but in this body, it is a different matchup. But, look, what we have done is we have taken the least controversial part of the SAVE America Act, put it into this legislation sponsored by Senator Jon Husted, drawn from my bill, the SAVE America Act, just the voter ID component, the most popular form of it--the argument that very, very few Democrats have focused on when opposing the SAVE America Act--and let’s push this forward. It is also significant that my friend and colleague Senator Husted was himself a former top elections official in the State of Ohio. He understands the importance of voter ID and wants to move that forward, and I applaud and congratulate him for his many efforts in support of the SAVE America Act and this narrower subset of this, which he has introduced. It is unthinkable, really, that any lawmaker--Democrat, Republican, or otherwise--would oppose something like this. And you have to wonder why--why oppose it? Why oppose it any more than you would claim that it would be unfair that you can’t withdraw money from a bank account without ID or you can’t board an aircraft without a photo ID? This approach, the self-attestation approach--the ``trust me, bro’’ approach--does not, should not, must not be allowed to work in the context of our sacred elections. It is not good for America to not have these laws in place. It is especially bad for America when, in some States--including and especially the State of California--not only do they not require voter ID, but, as I understand it, they have a law in place that imposes a penalty--I believe it is a criminal penalty--if you even ask someone about an ID on election day at a voting place. This is crazy. It is upside down. It is backward. So we need a Federal voter ID law, and we can pass one right now. We can pass one right now, and we must. To that end, Mr. President, notwithstanding rule XXII, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 547, S. 5271; further, that the bill be considered read a third time and passed and that the motion to reconsider be considered made and laid upon the table. The PRESIDING OFFICER (Mr. Ricketts). Is there objection? The Senator from California.”

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“I support this bill requiring photo ID to vote in federal elections, and I object to replacing it with a bill about tariffs. Almost all Americans support voter ID, and people use photo IDs every day. Democrats keep making excuses to stop it, and now they say it is too close to the election. I want to know if they would vote for this bill if it took effect after this November.”

“Mr. President, reserving the right to object, I appreciate the insight offered by my friend and colleague, the distinguished senior Senator of the State of California. He is someone I enjoy working with on multiple committees. He is a brilliant scholar and statesman, and I appreciate his arguments today. Now, I want to point out what we didn’t hear in his argument. At no point do we have any effort to address the merits of this legislation, the merits of voter ID laws. Instead, what we have heard from Senate Democrats so far this year on this issue has been: This isn’t necessary. We don’t need it. It is needless as voter fraud doesn’t happen. That has, of course, been proven very much false in recent months. Then they moved on to arguments like: Well, requiring voter ID laws would harm rural Americans or urban Americans. And then one day it is: It will harm older Americans. Another day, it is younger Americans. At times, they called them racist or sexist, which is odd because arguing that women are less likely to have and be able to produce a photo ID or that members of this or that race are able to do that doesn’t make any sense. It doesn’t comport with our common experience, with our common understanding. People of all races, people of both sexes, people in rural America and urban America and suburban America and everything in between, they have photo IDs because in this day and age, you have to have photo IDs. That is what they have been arguing so far this year. Now, today, what we did hear, most of what we just heard from my friend and colleague, one of the U.S. Senate’s most gifted minds, was: Well, it is too late--too late. You can’t change the rules midstream because early voting has already happened. Well, this is convenient after they have argued over and over and over again: We don’t need this and it is wrong and it is racist and it is sexist. Now, the argument has shifted to: Well, it is too late. Sorry. You lose. So they have secured the delay and gotten us now to the point where we are just weeks before the election. Early voting is already commencing in certain parts of the country. And now the argument is: Sorry. Too late. So I would love to find out from my colleague from California, does this mean he would be willing to accept this legislation, to pass it, to pass it today, right now, if only we included a delayed implementation clause such that the effective date would occur at some point after this November’s midterm election? I would love to know that, and I am hoping, at the conclusion of my brief remarks now, that he will tell us that. Then he moves on and asks the question: What is really going on, having never made any argument against the merits of this legislation. He makes it about time, and then he moves on and tries to attribute ill motives to me, to Senator Husted, to Senate Republicans, and to the Trump administration for supporting this; ill motives founded on sowing fear, uncertainty, and doubt, creating chaos in the elections, dogs and cats living out in the streets, a scene right out of the Book of Revelation. This doesn’t make any sense, especially given that we could remedy that if only he would agree to just a simple delayed implementation measure. And even if we didn’t, what is the worst case scenario if we passed this right now and the House of Representatives passed it tomorrow with an immediate effective date? The worst thing that can happen is that people show up on election day and they are asked to pull out a document that they produce several times a month; in many cases, several times a week; or, in some cases, several times each day every day. It is not that big of a deal; in fact, our election security depends on it and, frankly, should require it. Finally, then my friend and colleague the distinguished Senator from California tries yet again to distract attention away from this knowing, understanding perhaps, that this is supported by 83-84 percent of all Americans--Democrat, Independent, and everything in between. And it seems it is almost right out of ``Bill & Ted’s Excellent Adventure,’’ where they are confronting an enemy, and not knowing what else to do, they say: Look, it is the Goodyear Blimp. And while the guy they are arguing with turns to look for the Goodyear Blimp, which is not, in fact, there, they run in the other direction. He then tries to make it about tariffs and asks that instead of this, we consider and we pass this bill S. 5390, which I saw for the first time only minutes ago, that has absolutely nothing to do with anything addressed by this legislation I am trying to pass here today, nothing to do with election security. Fine, let’s talk about tariffs on another occasion, but that is not what we are talking about here. This is a distraction. It is a distraction away from something that the American people expect and demand us to do something about. So for these reasons, I cannot, I will not, I must not agree to those terms that we are just going to set this aside and move on to and pass this tariff bill that has nothing to do with election security. On that basis, I object and hope that my friend and colleague will tell us whether he is willing to agree to this legislation with delayed implementation mechanisms.”

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“I want the Senate to pass the Patients Deserve Price Tags Act today. Right now, doctors and hospitals hide their prices, so people and employers end up paying far too much. If patients know what care costs ahead of time, they can pick cheaper options. That will force hospitals to lower their prices and bring down the cost of health insurance.”

“Mr. President, I rise in support of the Patients Deserve Price Tags Act. Free markets empower people to live freely. When there is information held by a monopoly which cannot--and I, the consumer, can’t figure out what that information is, it takes away my freedom of choice; it takes away my economic freedom because I am going to end up paying a price perhaps far higher than what I should. Right now, that is happening. People providing healthcare don’t have to provide the pricetag to the employer paying for the insurance or the employee who may be accessing that care in their deductible or outside the policy. It is impacting people. Mortgage and health insurance--the price of being insured can be $29,000 a year for a family of four--$29,000 a year if you include the deductible with the cost of the premium, including the employer’s share. So what we are trying to do is do something about that by giving the patient the power, giving her economic freedom by saying: This is how much it costs at this place, and this is how much it costs at that place. Let’s put a point on it. A pediatrician orders an x ray for a child, a chest x ray. If you go down the hall, it may cost $500, and if you go across the street, it may cost $75. Right now, it is incredibly difficult for that mother to know. What we imagine is that with this information being made available, it would be made available not just to those who would pull the information together, but they, in turn, would make it available for the mom with the baby, and she could say: Oh, chest x ray for my child--$500 here and $75 across the street. I am going across the street. I can promise you, when you do that, the place charging $500 is going to begin lowering the rate. This is about doing something positive for patients. Senators Marshall and Hickenlooper and the HELP Committee majority and minority staff put together the Patients Deserve Price Tags Act, and, again, it gives the patient power. As Roger pointed out, it passed 21 to 1 out of the HELP Committee--bipartisan support to give patients power. I will give you one more example. Ten years ago, a friend of mine told me--this was 10 years ago--that if he converted atrial fibrillation in his office, it cost $130. If you went to the hospital and had the same procedure done, it was $13,000. Now, shouldn’t the patient know? Because even if she is only paying a 20-percent copay, 20 percent of $130 is a lot better than 20 percent of $13,000. This could be the difference between a family able to pay their other bills. Ultimately, this will lower premiums because obviously if the cost of healthcare goes down, the cost of premiums should go down. It gives employers access to deidentified health claims data so that if, by the way, the insurance--if the doctor is charging $30,000 but is only paid $3,000 but the insurer bills the business $10,000, the business should know that. They paid a lot more than what the doctor charged. The business owner should know that, and right now, the business owner cannot know that. The Patients Deserve Price Tags Act is the first step to delivering what Americans asked for: healthcare they can afford, control in their hands, economic freedom. If Congress is serious about decreasing healthcare costs, we should pass this by unanimous consent today and send it to the President’s desk. I yield the floor.”

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“I want the Senate to pass this bill. Medical costs change wildly from place to place, like an MRI costing $300 at one clinic and $3,000 at another. Patients deserve to know the price of their care.”

“Mr. President, I certainly want to echo my gratitude to my colleague Senator Hickenlooper for his help with this bill and his staff and my staff and the HELP Committee staff as well, all of the work they have done on this bill--bill that will bring immediate relief to everybody across the country. Real examples: An MRI of your knee might be, in one place, $300, and in another one, it might be $3,000. A hip replacement in one facility might be $15,000 but $150,000 in another location. We are not making those numbers up; that is the discrepancy you are going to hear about. Look, patients deserve pricetags. Mr. President, notwithstanding rule XXII, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 522, S. 2355; further, that the committee-reported substitute amendment be agreed to, the bill as amended, be considered read a third time and passed, and that the motion to reconsider be considered made and laid upon the table.”

“I object to this bill. Forcing hospitals to show their prices will not make healthcare cheaper. Most people use insurance or the government to pay their medical bills, and those prices are already fixed ahead of time. Patients cannot shop around to change them. Instead of adding new government rules, Congress should let people band together into large buying groups to negotiate better health insurance rates.”

“Reserving the right to object, this legislation is well- intended but also misguided. It doesn’t address the root problem and, in all likelihood, will not lower any healthcare prices. Congress has spent almost a decade pondering price transparency, regulations, and implementing them to some extent. Even with all this effort, current price transparency tools are only used by less than 20 percent of patients. Patients in general ignore prices. Why? Because they are disconnected from the price. They don’t pay. Someone else pays the bill. Prices are opaque because the patient is separated from the direct payment by a third party. For almost all patients, prices are fixed by a third party--either insurance or government, Medicare, Medicaid. Mandated transparency, when an insurance company is in the middle, has actually no effect on prices. Imagine it this way: About half of the country has Medicare, the other 10 or 20 percent has Medicaid, and then there is private insurance. There are about 5 percent of Americans who have no insurance. Now, transparency might make a difference there, but it actually already does. If you have to pay cash, everybody knows the price. Nobody will go in anywhere. If you are paying for something out of pocket, the prices are completely transparent and everywhere. An example is LASIK surgery. LASIK surgery is done to correct vision so you don’t have to wear glasses. The prices are on billboards all around town. If you call the receptionist or anybody where you have to pay cash for an elective procedure, the receptionist will tell you on the phone what the price is. The one they won’t tell you the price on is the gallbladder, if you have your gallbladder removed, because that has been negotiated with a third party, the insurance company. There is a price, and you are not going to, if you know the price, go get a better price. If they tell you at the hospital that the price is $500 but your insurance pays for the gallbladder, that is what it pays at the other hospital. If it pays $600 and you know the price and you go one versus the other--you don’t get to negotiate the price. The price is already fixed. The government sets the prices, too, so if you know what the price is that Medicare is going to pay, it doesn’t do anything. Nobody can change the price; it is actually mandated by law. So the problem really is that prices are fixed almost all the time. It is not lack of transparency; it is that prices are fixed. Now, there is a part of the market that actually does work. It is called elective, which means not covered by insurance. It also works to a certain extent if you are willing to pay at that time. I go to a local HCA hospital on occasion, and when I pay, they say: If you will pay now, we will give you a 25-percent discount by immediate pay. So there are parts of the system that do work. But the opaqueness is because you are not paying. The opaqueness is because a third party is paying, and that really is where the system is broken. So there is almost nobody choosing any healthcare based on price other than the 5 percent or those who are in the elective market, the 5 percent who don’t have insurance or in the elective market. Even if you have a high deductible but you still have insurance, all your prices under the deductible have already been negotiated. You may not know what it is going to cost, that it is going to be $500 for the gallbladder or whatever the surgery is going to cost you--you don’t know those prices, but they have already been negotiated. If we tell you, if we mandate that they tell you and then they tell you, you aren’t going to be able to go to another hospital and get a cheaper price because it has already been negotiated. The insurance company has already negotiated this with the hospitals. So this is well-intended, but it is just not going to work, and it just adds one more government mandate and is not a good idea. I would argue that the mandated transparency regulations will actually have limited effect even in the best-case scenario because over 95 percent of the healthcare market involves insurance or government middlemen already. Healthcare prices have continued to rise 5 to 10 percent annually because of the root cause of the problem: insurance and third-party payments. We also don’t seem to have enough leverage as patients to get a better price. There is something that we could do, and it is a bill that I have had out there for years and that I would be happy to get behind a unanimous consent effort, and this is something called association healthcare or health association. The way they would work is this: Instead of an accountant and three employees trying to get insurance for four people, you join a buying group--this would be like Amazon, Sam’s Club, Costco--and then a large group would negotiate, not for individual policies but for a group policy. It takes a change in our labor laws. We change the ERISA law to let you do this. Then you would be able to dial up Amazon, get on Amazon, and if Amazon had 40 million members that wanted to buy insurance, 1 person at Amazon would call up probably the CEO of UnitedHealthcare and negotiate a rate. So what we would do is grant you leverage. It doesn’t cost anything, doesn’t mandate anything, and lets you do what you want. It gets rid of aspects of our labor law that prevent this. It would let anybody join a buying group or co-op to buy their insurance. Now, understandably, the insurance companies are opposed to this. We haven’t been able to get it out of committee. And one of the reasons is the Democrats largely oppose this because they say: Well, we are kind of for it, but we have to mandate what the insurance is. This has been the thing going all the way back to ObamaCare. When you mandate what is in insurance, you elevate the cost of it. So if we let the market take care of it, let people come together in co-ops to buy insurance, you could drive prices down. This window dressing won’t work because the prices are already fixed, and knowing what the prices are won’t bring the prices down. Employers already do some of this negotiation for you. There are examples. Lowe’s Home Improvement has negotiated a $325 MRI at facilities in the highest tier. There are websites that will help you out if you don’t have insurance. The only people who really benefit by some of these price transparencies would be people without insurance, but there are some. For example, there is a website you can go to where you can get an MRI on Sundays. If you live in a big city and you will drive an hour outside the big city and you want to get your MRI and you will spend an hour driving and do it on Sunday afternoon at 3 o’clock when the volume is really low, you can get a discount. There are websites that will direct you there. But until Congress is serious about reducing the Federal Government’s role in healthcare, reducing the subsidization, allowing people to join co-ops--that is when we will actually get the price down. But this bill actually won’t do it. I think it adds mandates, and it ultimately actually might increase the price of healthcare as we add one more cost to the insurance companies and those who have to provide healthcare. So, therefore, I object.”

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“I want this bill passed. It requires healthcare providers to show their prices upfront. Insurance companies already negotiate different prices at different hospitals, and patients deserve to see those prices before choosing care. Price transparency works in other businesses, and it will save people money on healthcare.”

“Mr. President, certainly I agree on many of the points my colleague made, and certainly I am in favor of expanding association healthcare plans. The goal of that is more competition, and that is all we are trying to create. My colleague says this won’t work, but transparency works in every other industry. I think it is well documented that our bill would save $1,000 per month. Here is the big fallacy in his argument. He is right that the insurance companies have negotiated these rates. So within one community, this insurance company has negotiated one rate with a surgery center, one rate with the hospital, one rate with an imaging center. So all I say is the patient deserves to see what that negotiated rate is, and then they can compare it. So it is like we agree, but he disagrees with the final step here: We want patients to know what that negotiated price is. A real example: Getting a hip replaced at a surgical hospital might cost $15,000 or $20,000, but at the hospital down the street, it might be $150,000. The same way with an x ray. Going to the hospital, you know, the x ray--the MRI might be $3,000 there but $300 down at the imaging center. So I agree that those prices have been negotiated, but I want to make sure it is in the hands of the consumers. Could you imagine driving down the street and gas stations--you didn’t know how much the gas was going to be? Of course you wouldn’t be able to make a good consumer choice. So that is all we are asking, is full transparency in healthcare just like in every other industry. I yield the floor.”

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