[Congressional Record Volume 154, Number 152 (Wednesday, September 24, 2008)]
[Senate]
[Pages S9373-S9378]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           COSPONSORSHIP OF S. 334, THE HEALTHY AMERICANS ACT

  Mr. SPECTER. Mr. President, I have sought recognition for the purpose 
of

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introducing or cosponsoring the Healthy Americans Act, S. 334, 
legislation which is directed to cover the some 47 million Americans 
who are not covered by health insurance. It is a bipartisan bill which 
has 16 cosponsors, half Republicans and half Democrats. It has been 
sponsored principally by Senator Wyden, Democrat of Oregon, and Senator 
Bennett, Republican of Utah. I believe it provides the basis for moving 
ahead on this very important subject.
  We have long struggled to cover all Americans with health insurance. 
In a detailed statement, which I am about to submit, I have recounted 
the efforts which this Senator has made over the course of my tenure in 
the Senate; beyond the bill's own coverage, the work which has been 
done on the Appropriations Labor, Health and Human Services 
Subcommittee; and legislation in which Senator Harkin and I, on a 
bipartisan basis, have taken the lead in increasing funding for the NIH 
from $12 to $30 billion.
  This proposal, S. 334, has a number of issues which I think need 
further analysis and further study and modification, as noted in the 
text of the statement. But I believe it is an excellent starting point 
and, having some 16 cosponsors, the most I have seen on a bipartisan 
piece of legislation to address this very important subject, I think it 
has an excellent opportunity in the next Congress to provide the basis 
for moving ahead for the appropriate coverage of all Americans.
  We are facing a grave situation in America where millions of 
Americans do not have health insurance coverage. As the cost of health 
care is increasingly prohibitive and access to insurance is reduced, 
the number of uninsured will continue to climb.
  It is estimated that nearly 47 million Americans are without health 
insurance. This includes the nearly 38 million individuals who have 
full or part time employment and still are without health care 
coverage. Of significant concern is the number of young adults lacking 
insurance: with an estimated 28 percent of those young people without 
insurance.
  Individuals without insurance suffer from both acute and far reaching 
consequences. It ultimately compromises a person's health because he or 
she is less likely to receive preventive care, more likely to be 
hospitalized for avoidable health problems, and more likely to be 
diagnosed in the late stages of diseases. Additionally, lack of 
insurance coverage leaves individuals and their families financially 
vulnerable to higher out-of-pocket costs for their medical bills.
  It is my belief that we can and should fix the problems felt by 
uninsured Americans with a system that does not resort to a single 
payer system and one that involves the private insurance industry. We 
must enact reforms that enhance our current market-based health care 
system.
  The legislation I want to discuss today is S. 334, The Healthy 
Americans Act, which would provide access to health insurance for all 
Americans. Senator Wyden introduced this legislation on January 18, 
2007, and since then, it has gained support from an impressive group of 
bipartisan Senators, including Bennett, Alexander, Nelson from Florida, 
Gregg, Coleman, Grassley, Landrieu, Stabenow, Crapo, Lieberman, Carper, 
Inouye, Corker, Smith and Cantwell. Today I am pleased to add my name 
to the list of cosponsors of S.334.
  The Healthy Americans Act uses the private health insurance market to 
ensure that all Americans have access to a quality plan they can 
afford. This legislation has a number of components that will address 
the problems that plague our current health insurance system.
  To begin, S. 334 provides so-called ``portability,'' which allows 
individuals to retain their health insurance regardless of the job they 
hold. In today's changing society, many Americans no longer stay with 
the same employer for long periods of time. Moving from job to job may 
mean the loss of health insurance, a new insurance carrier, or a gap in 
health care. The Healthy Americans Act seeks to provide consistent 
insurance coverage in a fluid job market.
  Additionally, the Healthy Americans Act offers assistance for those 
who need it most by providing premium assistance for individuals and 
families with incomes below 400 percent of the poverty level--or 
$41,600 and $84,800 respectively. This provision aids those individuals 
that are employed but their income is insufficient to afford insurance. 
The assistance is based on a sliding scale with those with lower 
incomes receiving the greatest help. Individuals below 100 percent of 
the poverty level--$10,400 for an individual or $21,200 for a family--
receive full assistance with their insurance premiums.
  While I am cosponsoring this legislation, I have some concerns that 
need to be addressed as the debate on this important issue moves 
forward. For instance, the potential new tax obligations associated 
with the Healthy Americans Act on both individuals and on businesses 
warrant further consideration. Concerns have been raised that this bill 
is not tax-neutral, meaning that new tax obligations created by this 
legislation are not completely matched by new or increased tax 
benefits. This resulting imbalance, or lack of tax neutrality, is 
argued by some to be a tax increase. Specifically, individuals would be 
required to pay their insurance premiums through the Federal tax 
withholding system, as opposed to the current model where premiums are 
paid to insurers through their employer. Payments would pass through 
the IRS on the way to newly created regional purchasing organizations 
called health help agencies--HHAs--and ultimately to the private 
insurer. The payment system, or collection, is technically a tax 
because it is being collected by the IRS. However, it is important to 
note that the Government will not keep those dollars and will not have 
discretion over how they are spent. Nevertheless, this payment system 
deserves further analysis on the issue of tax-neutrality.
  S. 334 would require all businesses to pay an assessment of between 2 
percent and 25 percent of average per worker premiums. The rate paid 
depends on the number of people it employs. I have concerns that this 
provision is structured as a tax. However, it is important to note that 
businesses would see some benefits as a result of the bill. They would 
be freed from the administrative burden of providing health care for 
employees because the individual would carry the responsibility of 
obtaining a private plan.
  Because employers would be required to pay increased wages--in lieu 
of providing a health plan, they would also be subject to additional 
payroll tax obligations--i.e. Social Security and Medicare. An 
employee's increased payroll tax obligation is offset by a tax 
deduction provided in the bill. There is no corresponding deduction for 
the employer to offset their additional payroll tax obligations, and 
one should also be considered, because the bill's purpose is not to 
increase payments to Social Security and Medicare. The sponsor's 
intention of maintaining a budget-neutral bill is also worth 
consideration.
  The mandate of paying increased wages only lasts for 2 years under 
the bill, after which time market forces would determine total 
compensation. Consideration should be given to retaining the employer 
payroll increase indefinitely to defray the cost of health insurance. 
Market forces may not sufficiently compensate employees when an 
employer decides to cut wages beyond the 2-year time frame. This would 
harm an employee's ability to purchase health insurance.
  I am also concerned with the elimination of specific tax benefits for 
corporations that do business abroad, though it is my understanding 
that the sponsors are not wedded to elimination of these specific 
items. The argument has been made by proponents that the Wyden bill 
makes U.S. firms more competitive internationally because it removes 
the burden on employers to administer health care plans for their 
employees. Often foreign firms do not have that burden. To that end, 
the sponsor has chosen to eliminate certain tax preferences to 
multinational corporations as a way to raise revenue. I believe that 
greater consideration should be given to whether the benefit to 
employers of not having to administer a health care plan outweighs the 
elimination of these provisions.
  First, the elimination of the section 199 manufacturing deduction 
raises concerns for our exporters. The section 199 deduction allows 
manufacturing

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firms of all kinds to take a tax deduction for their U.S.-based 
business activities. The deduction was 3 percent in tax years 2005 and 
2006, 6 percent in tax year 2007, and is scheduled to be 9 percent by 
2010. This tax benefit was enacted as part of the so-called FSC/ETI 
legislation in 2004 to replace an export tax incentive that was ruled 
to be in violation of our international trade commitments. At the same 
time, it sought to boost the ability of manufacturers to compete in the 
global marketplace.
  Second, the bill would eliminate deferral of income from foreign 
corporations that are owned by a U.S. parent company. Under current 
law, U.S. taxes do not apply to the foreign income of U.S.-owned 
corporations chartered abroad. As a result, a U.S. firm can 
indefinitely defer U.S. tax on its foreign income as long as the 
foreign subsidiary's income is reinvested overseas. U.S. taxes apply 
when the income is repatriated back to the U.S. Ending this deferral 
strategy could have the negative impact of encouraging the U.S. parent 
firm to relocate abroad or to limit the size of their operations in the 
U.S.
  S. 334 also requires all Americans to obtain health insurance. 
Eligible insurance plans include not only those purchased through this 
program, but health care coverage through Medicare, the Department of 
Defense, the Department of Veterans Affairs, Indian Health Service, or 
a retiree health plan. I am concerned that this mandate will put a 
burden on individuals and families that may not be able to afford the 
program despite assistance.

  This concern is shared by fellow cosponsor Senator Chuck Grassley who 
stated that:

     . . . the act would require all individuals to buy health 
     insurance. I support accessibility to private insurance and 
     differ with my colleagues on this point.

  This is an issue that must be more closely examined.
  This bill also holds the Blue Cross/Blue Shield Standard Plan 
provided under the Federal Employees Health Benefit Program as the 
standard for the program. While I believe that everyone should have 
access to this level of coverage, it does not allow for variety in the 
types of insurance plans that would be available under the program. The 
current market allows for different types of plans, which should be 
available under the Healthy Americans plan. When Senator Norm Coleman 
signed on as a cosponsor of S. 334, he similarly noted:

       While I certainly believe people should have access to this 
     level of coverage, I don't think it should be the only 
     option. My vision of health reform does not include this one-
     size-fits-all approach. Instead, I support giving people 
     access to a variety of health insurance options and the 
     ability to make informed choices.

  The vetting of this bill is already underway. Senators Wyden, 
Bennett, Grassley, and Stabenow have taken steps to provide flexibility 
in the program by allowing businesses and employees to choose the best 
health insurance program for employees. An amendment has been filed to 
allow businesses to continue to offer health insurance to employees 
under the current system, yet employees would still have the option to 
enter the Health Help Agency and obtain a health americans private 
insurance plan.
  While these concerns are important and should be addressed, this 
bipartisan effort makes an important step forward in the ongoing quest 
to provide health insurance to all Americans. I believe the Healthy 
Americans Act contains excellent ideas and should be the basis for 
future discussions on health insurance reform. This sentiment is shared 
by Senator Judd Gregg, who when he joined this bill, stated:

       that by joining forces with colleagues on both sides of the 
     aisle on a private market approach, we can begin a bipartisan 
     dialogue, work through our differences, and find workable 
     solutions that will result in a better health care system for 
     all.

  I look forward to working with my colleagues to provide a health 
insurance system that can provide quality healthcare to all Americans.
  I have advocated health care reform in one form or another throughout 
my 28 years in the Senate. My strong interest in health care dates back 
to my first term, when I sponsored S. 811, the Health Care for 
Displaced Workers Act of 1983, and S. 2051, the Health Care Cost 
Containment Act of 1983, which would have granted a limited antitrust 
exemption to health insurers, permitting them to engage in certain 
joint activities such as acquiring or processing information and 
collecting and distributing insurance claims for health care services 
aimed at curtailing then-escalating health care costs. In 1985, I 
introduced the Community-based Disease Prevention and Health Promotion 
Projects Act of 1985, S. 1873, directed at reducing the human tragedy 
of low birth weight babies and infant mortality. Since 1983, I have 
introduced and cosponsored numerous other bills concerning health care 
in our country.
  During the 102nd Congress, I pressed the Senate to take action on the 
health care market issue. On July 29, 1992, I offered an amendment to 
legislation then pending on the Senate floor, which included a change 
from 25 percent to 100 percent deductibility for health insurance 
purchased by self-employed individuals, and small business insurance 
market reforms to make health coverage more affordable for small 
businesses. Included in this amendment were provisions from a bill 
introduced by the late Senator John Chafee, legislation which I 
cosponsored and which was previously proposed by Senators Bentsen and 
Durenberger. When then-majority leader Mitchell argued that the health 
care amendment I was proposing did not belong on that bill, I offered 
to withdraw the amendment if he would set a date certain to take up 
health care, similar to an arrangement made on product liability 
legislation, which had been placed on the calendar for September 8, 
1992. The majority leader rejected that suggestion, and the Senate did 
not consider comprehensive health care legislation during the balance 
of the 102nd Congress. My July 29, 1992, amendment was defeated on a 
procedural motion by a vote of 35 to 60, along party lines.
  The substance of that amendment, however, was adopted later by the 
Senate on September 23, 1992, when it was included in a Bentsen/
Durenberger amendment which I cosponsored to broaden tax legislation, 
H.R. 11. This amendment, which included essentially the same self-
employed tax deductibility and small group reforms I had proposed on 
July 29 of that year, passed the Senate by voice vote. Unfortunately, 
these provisions were later dropped from H.R. 11 in the House-Senate 
conference.
  On August 12, 1992, I introduced legislation entitled the Health Care 
Affordability and Quality Improvement Act of 1992, S. 3176, that would 
have enhanced informed individual choice regarding health care services 
by providing certain information to health care recipients, would have 
lowered the cost of health care through use of the most appropriate 
provider, and would have improved the quality of health care.
  On January 21, 1993, the first day of the 103rd Congress, I 
introduced the Comprehensive Health Care Act of 1993, S. 18. This 
legislation consisted of reforms that our health care system could have 
adopted immediately. These initiatives would have both improved access 
and affordability of insurance coverage and would have implemented 
systemic changes to lower the escalating cost of care in this country.
  On March 23, 1993, I introduced the Comprehensive Access and 
Affordability Health Care Act of 1993, S. 631, which was a composite of 
health care legislation introduced by Senators Cohen, Kassebaum, Bond, 
and McCain, and included pieces of my bill, S. 18. I introduced this 
legislation in an attempt to move ahead on the consideration of health 
care legislation and provide a starting point for debate. As I noted 
earlier, I was precluded by Majority Leader Mitchell from obtaining 
Senate consideration of my legislation as a floor amendment on several 
occasions. Finally, on April 28, 1993, I offered the text of S. 631 as 
an amendment to the pending Department of the Environment Act, S. 171, 
in an attempt to urge the Senate to act on health care reform. My 
amendment was defeated 65 to 33 on a procedural motion, but the Senate 
had finally been forced to contemplate action on health care reform.
  On the first day of the 104th Congress, January 4, 1995, I introduced 
a slightly modified version of S. 18, the Health Care Assurance Act of 
1995, which contained provisions similar to

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those ultimately enacted in the Kassebaum-Kennedy legislation, 
including insurance market reforms, an extension of the tax 
deductibility of health insurance for the self employed, and tax 
deductibility of long term care insurance.
  I continued these efforts in the 105th Congress, with the 
introduction of Health Care Assurance Act of 1997, S. 24, which 
included market reforms similar to my previous proposals with the 
addition of a new title I, an innovative program to provide vouchers to 
States to cover children who lack health insurance coverage. I also 
introduced title I of this legislation as a standalone bill, the 
Healthy Children's Pilot Program of 1997, S. 435, on March 13, 1997. 
This proposal targeted the approximately 4.2 million children of the 
working poor who lacked health insurance at that time. These are 
children whose parents earn too much to be eligible for Medicaid, but 
do not earn enough to afford private health care coverage for their 
families.
  This legislation would have established a $10 billion/5-year 
discretionary pilot program to cover these uninsured children by 
providing grants to States. Modeled after Pennsylvania's 
extraordinarily successful Caring and BlueCHIP programs, this 
legislation was the first Republican-sponsored children's health 
insurance bill during the 105th Congress.
  I was encouraged that the Balanced Budget Act of 1997, signed into 
law on August 5, 1997, included a combination of the best provisions 
from many of the children's health insurance proposals throughout that 
Congress. The new legislation allocated $24 billion over 5 years to 
establish State Child Health Insurance Program, funded in part by a 
slight increase in the cigarette tax.
  During the 106th, 107th, 108th Congresses, I again introduced the 
Health Care Assurance Act. These bills contained similar insurance 
market reforms, as well as new provisions to augment the new State 
Child Health Insurance Program, to assist individuals with disabilities 
in maintaining quality health care coverage, and to establish a 
national fund for health research to supplement the funding of the 
National Institutes of Health. All these new initiatives, as well as 
the market reforms that I supported previously, work toward the goals 
of covering more individuals and stemming the tide of rising health 
costs.
  My commitment to the issue of health care reform across all 
populations has been consistently evident during my tenure in the 
Senate, as I have come to the floor and offered health care reform 
bills and amendments on countless occasions. I will continue to stress 
the importance of the Federal Government's investment in and attention 
to the system's future.
  As my colleagues are aware, I can personally report on the miracles 
of modern medicine. In 1993, an MRI detected a benign tumor, 
meningioma, at the outer edge of my brain. It was removed by 
conventional surgery, with 5 days of hospitalization and 5 more weeks 
of recuperation. When a small regrowth was detected by a follow-up MRI 
in June 1996, it was treated with high powered radiation using a 
remarkable device called the ``Gamma Knife.'' I entered the hospital on 
the morning of October 11, 1996, and left the same afternoon, ready to 
resume my regular schedule.
  In July 1998, I was pleased to return to the Senate after a 
relatively brief period of convalescence following heart bypass 
surgery. This experience again led me to marvel at our health care 
system and made me more determined than ever to support Federal funding 
for biomedical research and to support legislation which will 
incrementally make health care available to all Americans.
  In February 2005, I received tests at Thomas Jefferson University 
Hospital for persistent fevers and enlarged lymph nodes under my left 
arm and above my left clavicle. The testing involved a biopsy of a 
lymph node and biopsy of bone marrow. The biopsy of the lymph node was 
positive for Hodgkin's disease; however the bone marrow biopsy showed 
no cancer. A follow up PET scan and MRI at the University of 
Pennsylvania Abramson Cancer Center established that I had stage IVB 
Hodgkin's disease. After successful chemotherapy treatment I received a 
``clean bill of health.''
  Three years later, I received the test results from a routine PET 
scan, which showed a mild recurrence of Hodgkin's disease. I was once 
again undertook a chemotherapy regimen, which I have recently 
successfully completed.
  My concern about health care has long predated my own personal 
benefits from diagnostic and curative procedures. As I have previously 
discussed, my concern about health care began many years ago and has 
been intensified by my service on the Appropriations Subcommittee on 
Labor, Health and Human Services, and Education--LHHS.
  My own experience as a patient has given me deeper insights into the 
American health care system beyond my perspective from the U.S. Senate. 
I have learned: No. 1 patients sometimes have to press their own cases 
beyond doctors' standard advice; No. 2 greater flexibility must be 
provided on testing and treatment; No. 3 our system has the resources 
to treat the 47 million Americans currently uninsured; and No. 4 all 
Americans deserve the access to health care from which I and others 
with coverage have benefited.
  I believe we have learned a great deal about our health care system 
and what the American people are willing to accept in terms of health 
care coverage provided by the Federal Government. The message we heard 
loudest was that Americans do not want the Government to have a single 
payer Government operated system.
  While I would have been willing to cooperate with the Clinton 
administration in addressing this Nation's health care problems, I 
found many areas where I differed with President Clinton's approach to 
solutions. I believe that the proposals would have been deleterious to 
my fellow Pennsylvanians, to the American people, and to our health 
care system as a whole. Most importantly, as the President proposed in 
1993, I did not support creating an expansive new Government 
bureaucracy.
  On this latter issue, I first became concerned about the potential 
growth in bureaucracy in September 1993 after reading the President's 
239-page preliminary health care reform proposal. I was surprised by 
the number of new boards, agencies, and commissions, so I asked my 
legislative assistant, Sharon Helfant, to make me a list of all of 
them. Instead, she decided to make a chart. The initial chart depicted 
77 new entities and 54 existing entities with new or additional 
responsibilities.
  When the President's 1,342-page Health Security Act was transmitted 
to Congress on October 27, 1993, my staff reviewed it and found an 
increase to 105 new agencies, boards, and commissions and 47 existing 
departments, programs and agencies with new or expanded jobs. This 
chart received national attention after being used by Senator Bob Dole 
in his response to the President's State of the Union address on 
January 24, 1994.
  The response to the chart was tremendous, with more than 12,000 
people from across the country contacting my office for a copy; I still 
receive requests for the chart. Groups and associations, such as United 
We Stand America, the American Small Business Association, the National 
Federation of Republican Women, and the Christian Coalition, reprinted 
the chart in their publications--amounting to hundreds of thousands 
more in distribution. Bob Woodward of the Washington Post later stated 
that he thought the chart was the single biggest factor contributing to 
the demise of the Clinton health care plan. And during the November 
1996 election, my chart was used by Senator Dole in his presidential 
campaign to illustrate the need for incremental health care reform.
  The reforms we must enact need to encompass all areas of health. This 
must start with preventive health care and wellness programs. This 
starts at birth with prenatal care. We know that in most instances, 
prenatal care is effective in preventing low-birth-weight babies. 
Numerous studies have demonstrated that low birth weight does not have 
a genetic link but is instead most often associated with inadequate 
prenatal care or the lack of prenatal care. It is a human tragedy for a 
child to be born weighing 16 ounces with attendant problems which last 
a lifetime. I first saw one pound babies in 1984 and I was astounded to 
learn that Pittsburgh, PA, had the highest infant mortality rate of 
African-American babies

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of any city in the United States. I wondered how that could be true of 
Pittsburgh, which has such enormous medical resources. It was an 
amazing thing for me to see a 1-pound baby, about as big as my hand. 
However, I am pleased to report that as a result of successful 
prevention initiatives like the Federal Healthy Start program, 
Pittsburgh's infant mortality has decreased 24 percent.
  To improve pregnancy outcomes for women at risk of delivering babies 
of low birth weight and to reduce infant mortality and the incidence of 
low-birth-weight births, as well as improving the health and well-being 
of mothers and their families, I initiated action that led to the 
creation of the Healthy Start program in 1991. Working with the first 
Bush administration and Senator Harkin, as chairman of the 
Appropriations Subcommittee, we allocated $25 million in 1991 for the 
development of 15 demonstration projects. This number grew to 75 in 
1998, to 96 projects in 2008. For fiscal year 2008, we secured $99.7 
million for this vital program.
  To help children and their families to truly get a healthy start 
requires that we continue to expand access to Head Start. This 
important program provides comprehensive services to low income 
children and families, including health, nutritional, and social 
services that children need to achieve the school readiness goal of 
Head Start. I have strongly supported expanding this program to cover 
more children and families. Since fiscal year 2000, funding for Head 
Start has increased from $5.3 billion to the 2008 level of $6.9 
billion. Additional funding has extended the reach of this important 
program to over 1 million children.
  The LHHS Appropriations bill also has made great strides in 
increasing funding for a variety of public health programs, such as 
breast and cervical cancer prevention, childhood immunizations, family 
planning, and community health centers. These programs are designed to 
improve public health and prevent disease through primary and secondary 
prevention initiatives. It is essential that we invest more resources 
in these programs now if we are to make any substantial progress in 
reducing the costs of acute care in this country.
  As ranking member and chairman of the LHHS Appropriations 
Subcommittee, I have greatly encouraged the development of prevention 
programs which are essential to keeping people healthy and lowering the 
cost of health care in this country. In my view, no aspect of health 
care policy is more important. Accordingly, my prevention efforts have 
been widespread.
  I joined my colleagues in efforts to ensure that funding for the 
Centers for Disease Control and Prevention, CDC, increased from $2.3 
billion in 1997 to $6.375 billion in fiscal year 2008. We have also 
worked to increase funding for CDC's breast and cervical cancer early 
detection program to $200.8 million in fiscal year 2008.
  I have also supported programs at CDC which help children. CDC's 
childhood immunization program seeks to eliminate preventable diseases 
through immunization and to ensure that at least 90 percent of 2-year-
olds are vaccinated. The CDC also continues to educate parents and 
caregivers on the importance of immunization for children under 2 years 
old. Along with my colleagues on the Appropriations Committee, I have 
helped ensure that funding for this important program together with the 
complementary Vaccines for Children Program has grown from $914 million 
in 1999 to $3.2 billion in fiscal year 2008.
  While vaccines are critical for prevention we must be prepared for an 
influenza pandemic. To ensure that America is properly prepared for 
such a pandemic the LHHS Appropriations bills have provided $6 billion 
since 2005. This funding provides development and purchase of vaccines, 
antivirals, necessary medical supplies, diagnostics, and other 
surveillance tools.
  We have also strengthened funding for Community Health Centers, which 
provide immunizations, health advice, and health professions training. 
These centers, administered by the Health Resources and Services 
Administration, provide a critical primary care safety net to rural and 
medically underserved communities, as well as uninsured individuals, 
migrant workers, the homeless, residents of public housing, and 
Medicaid recipients. Funding for Community Health Centers has increased 
from $1 billion in fiscal year 2000 to $3.2 billion in fiscal year 
2008.
  Increases in research, education and treatment in women's health have 
been of particular importance to me. In 1998, I cosponsored the Women's 
Health Research and Prevention Amendments, which were signed into law 
later that year. This bill revised and extended certain programs with 
respect to women's health research and prevention activities at the 
National Institutes of Health and the Centers for Disease Control and 
Prevention.
  In 1996, I also cosponsored an amendment to the fiscal year 1997 VA-
HUD Appropriations bill, which required that health plans provide 
coverage for a minimum hospital stay for a mother and child following 
the birth of the child. This bill became law in 1996.
  In 2005, I introduced the Gynecologic Cancer Education and Awareness 
Act to increase education of gynecological cancer so that women would 
be able to recognize cancer warning signs and seek treatment. This 
legislation became law in 2007.
  I have also been a strong supporter of funding for AIDS research, 
education, and prevention programs.
  During the 101st and 104th Congresses, I cosponsored the Ryan White 
CARE Reauthorization Act, which provided Federal funds to metropolitan 
areas and States to assist in health care costs and support services 
for individuals and families affected by acquired immune deficiency 
syndrome, AIDS, or infection with the human immunodeficiency virus, 
HIV. Those bills became law in 1990 and 1996 respectively.
  Funding for Ryan White AIDS programs has increased from $757.4 
million in 1996 to $2.14 billion for fiscal year 2008. That includes 
$794 million for the AIDS Drug Assistance Program, ADAP, to help low-
income individuals afford life saving drugs. AIDS research at the NIH 
totaled $742.4 million in 1989 and has increased to an estimated $2.91 
billion in fiscal year 2008.
  Veterans provide an incredible service in defending our country, and 
providing them with quality health care is critical. During the 102d 
Congress, I cosponsored an amendment to the Veterans' Medical Programs 
Amendments of 1992, which included improvements to health and mental 
health care and other services to veterans by the Department of 
Veterans Affairs. This bill became law in 1992.
  During the 106th Congress, I sponsored the Veterans Benefits and 
Health Care Improvement Act of 2000, which increased amounts of 
educational assistance for veterans under the Montgomery GI Bill and 
enhanced health programs. This bill became law in 2000.
  I also sponsored the Department of Veterans Affairs Long-Term Care 
and Personnel Authorities Enhancement Act, which improved and enhanced 
the provision of health for veterans. This bill became law in 2003.
  In the 108th Congress, I introduced the Veterans Health Care, Capital 
Asset and Business Improvement Act of 2003, which upon becoming law in 
December 2003 enhanced the provision of health care for veterans by 
improving authorities relating to the administration of personnel at 
the VA.
  In June 2004, I introduced the Department of Veterans Affairs Health 
Care Personnel Enhancement Act, which simplified pay provisions for 
physicians and dentists and authorized alternate work schedules and pay 
scales for nurses to improve recruitment and retention of top talent. 
The bill was signed into law in December 2004.
  To increase the portability of insurance, in 1996, I cosponsored the 
Health Coverage Availability and Affordability Act, which improved the 
portability and continuity of health insurance coverage in the group 
and individual markets, combated waste, fraud, and abuse in health 
insurance and health care delivery, promoted the use of medical savings 
accounts, improved access to long-term care services and coverage, and 
simplified the administration of health insurance. This bill became law 
in 1996.
  Statistics show that 27 percent of Medicare expenditures occur during 
a person's last year of life and beyond the last year of life, a 
tremendous percentage of medical costs occur in the last month, in the 
last few weeks, in the last week, or in the last few days.

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  The issue of end of life treatment is such a sensitive subject and no 
one should decide for anybody else what that person should have by way 
of end-of-life medical care. What care ought to be available is a very 
personal decision. However, living wills give an individual an 
opportunity to make that judgment, to make a decision as to how much 
care he or she wanted near the end of his or her life and that is, to 
repeat, a matter highly personalized for the individual.
  Individuals should have access to information about advanced 
directives. As part of a public education program, I included an 
amendment to the Medicare Prescription Drug and Modernization Act of 
2003 which directed the Secretary of Health and Human Services to 
include in its annual ``Medicare and You'' handbook, a section that 
specifies information on advance directives and details on living wills 
and durable powers of attorney regarding a person's health care 
decisions.
  As ranking member and chairman of the Labor, Health and Human 
Services, and Education Appropriations Subcommittee, I have worked to 
provide much-needed resources for hospitals, physicians, nurses, and 
other health care professionals.
  An adequate number of health professionals, including doctors, 
nurses, dentists, psychologists, laboratory technicians, and 
chiropractors is critical to the provision of health care in the United 
States. I have worked to provide much needed funding for health 
professional training and recruitment programs. In fiscal year 2008, 
these vital programs received $334 million. Nurse education and 
recruitment alone has been increased from $58 million in fiscal year 
1996 to $149 million in fiscal year 2008.
  Differences in reimbursement rates between rural and urban areas have 
led to significant problems in health professional retention. During 
the debate on the Balanced Budget Refinement Act, which passed as part 
of the fiscal year 2001 consolidated appropriations bill, I attempted 
to reclassify some northeastern hospitals in Pennsylvania to a 
Metropolitan Statistical Area with higher reimbursement rates. Due to 
the large volume of requests from other states, we were not able to 
accomplish these reclassifications for Pennsylvania. However, as part 
of the fiscal year 2004 Omnibus appropriations bill, I secured $7 
million for 20 northeastern Pennsylvania hospitals affected by area 
wage index shortfalls.
  As part of the Medicare Prescription Drug and Medicare Improvement 
Act of 2003, which passed the Senate on November 25, 2003, a $900 
million program was established to provide a one-time appeal process 
for hospital wage index reclassification. Thirteen Pennsylvania 
hospitals were approved for funding through this program in 
Pennsylvania. This program has been extended on several occasions and 
has provided a total of $164.1 million for Pennsylvania hospitals.
  The National Institutes of Health--NIH--are the crown jewels of the 
Federal Government and have been responsible for enormous strides in 
combating the major ailments of our society including heart disease, 
cancer, and Alzheimer's and Parkinson's diseases. The NIH provides 
funding for biomedical research at our Nation's universities, 
hospitals, and research institutions. I led the effort to double 
funding for the NIH from 1998 through 2003. Since I became chairman in 
1996, funding for the NIH has increased from $12 billion in fiscal year 
1996 to $30.2 billion in the fiscal year 2009 Senate LHHS 
Appropriations bill.
  Regrettably, Federal funding for NIH has steadily declined from the 
$3.8 billion increase provided in 2003, when the 5-year doubling of NIH 
was completed, to only $328 million in fiscal year 2008. The shortfall 
in the President's fiscal year 2009 budget due to inflationary costs 
alone is $5.2 billion. To provide that $5.2 billion in funding, I 
recently introduced with Senator Harkin, the NIH Emergency Supplemental 
Appropriations Act. This supplemental funding would improve the current 
research decline, which is disrupting progress, not just for today, but 
for years to come.
  In 1970, President Nixon declared war on cancer. Had that war been 
prosecuted with the same diligence as other wars, my former chief of 
staff, Carey Lackman, a beautiful young lady of 48, would not have died 
of breast cancer. One of my very best friends, a very distinguished 
Federal judge, Chief Judge Edward R. Becker, would not have died of 
prostate cancer. All of us know people who have been stricken by 
cancer, who have been incapacitated with Parkinson's or Alzheimer's, 
who have been victims of heart disease, or many other maladies.
  The future of medical research must include embryonic stem cell 
research. I first learned about embryonic stem cell research in 
November 1998 and held the first congressional hearing in December of 
that year. Since that time I have held 19 more hearings on this 
important subject. Embryonic stem cells have the greatest promise in 
research because they have the ability to become any type of cell in 
the human body.
  During the 109th Congress, the House companion bill to S. 471, the 
Stem Cell Research Enhancement Act, was passed by Congress but vetoed 
by President Bush. The vote to override the veto in the House failed. 
The legislation would expand the number of stem cell lines that are 
eligible for federally funded research, thereby accelerating scientific 
progress toward cures and treatments for a wide range of diseases and 
debilitating health conditions.
  In the 110th Congress, S. 5, the Stem Cell Research Enhancement Act, 
of which I am a lead cosponsor and is identical to the 109th Congress 
legislation, was passed by Congress, but a vote to override the veto in 
the House again failed.
  During the course of our stem cell hearings, we have learned that 
over 400,000 embryos are stored in fertility clinics around the 
country. If these frozen embryos were going to be used for in vitro 
fertilization, I would support that over research. In fact, I have 
provided $3.9 million in fiscal year 2008 to create an embryo adoption 
awareness campaign. Most of these embryos will be discarded and I 
believe that instead of just throwing these embryos away, they hold the 
key to curing and treating diseases that cause suffering for millions 
of people.
  The many research, training and education programs that are supported 
by the Federal Government all contribute to this Nation's efforts to 
provide the best prevention and treatment for all Americans. But 
without access to health care, these efforts will be lost. But with the 
plan outlined in the Health Americans Act, we can provide health care 
coverage for the 47 million uninsured Americans. This bipartisan bill 
is where the health insurance reform debate needs to begin--with a 
market based approach to reforming health insurance. The time has come 
for concerted action in this arena. I urge my colleagues to take action 
on this important issue.

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