[Congressional Record Volume 155, Number 134 (Tuesday, September 22, 2009)]
[Senate]
[Pages S9631-S9634]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. DURBIN. Mr. President, I come to the floor to speak about an 
issue that looms over the Senate and the Capitol like no other. In the 
ebb and flow of the history of the Senate, many issues come and go, but 
few come before us with the importance of the issue of health care 
reform.
  Earlier this month, the U.S. Census Bureau released data on the 
income, poverty, and health coverage of Americans. The number of 
Americans living without health insurance is staggering: 46.3 million 
people were uninsured last year. The issue of the uninsured is not a 
question of us versus them. The uninsured are everywhere in America. 
Most of the people without health insurance today are working or are in 
a family with someone who works.
  Who are these people? They are not the poorest in America; we care 
for the poorest. We provide them health insurance known as Medicaid. 
They are not the fortunate ones such as myself or many others who have 
health insurance. They are folks who get up and go to work every day 
without the peace of mind of knowing that they have health insurance 
protection for themselves and their families. These are the people who 
made your bed and cleaned your hotel room this morning, the ones who 
fixed your breakfast and cleared the dishes off the table in the 
restaurant. They are watching your children and your grandchildren even 
as you go to work. They are taking care of your mom in an assisted 
living center and changing her bed linens. They include the realtor who 
helped you find your new home or sell the home. They include many 
veterans who served our country with pride and now find themselves in 
an unfortunate circumstance. In fact, 8 in 10 of the nonelderly 
uninsured live in families where the head of the family goes to work 
every single day. Not everyone who works for a large employer is lucky 
enough to have health coverage. Twenty-two percent of people in America 
working for firms with 500 or more employees are uninsured.
  Here is another important part to understand. Many people without 
health insurance are not among the poorest. One-third of the families 
without health insurance are making more than $44,000 a year. Despite 
making a moderate income, these individuals either work for an employer 
who doesn't offer health coverage or they can't find coverage they can 
afford. For the average U.S. family who has coverage, the worker and 
employer together paid an extra $1,017 last year in health care 
premiums to compensate for the uninsured.
  When the uninsured people reach a stage in life where they 
desperately need health care, they go to an emergency room. Hospitals 
don't turn them away; they treat them. Their expenses are not paid for. 
They are passed along to those with health insurance. It means those of 
us who pay health insurance premiums pay about $90 a month more to 
cover uncompensated care for the uninsured. That is a reality.
  The lack of insurance is not only about dollars though; it is also 
about lives. A study released last week by the American Journal of 
Public Health revealed that nearly 45,000 annual deaths in America are 
associated with lack of health insurance. In other words, the myth that 
people without insurance ultimately get the same care as everyone else 
is not true. The uninsured in America are more likely to die. I will 
give two examples. Things are getting worse for these families. This 
figure linking ``uninsurance'' or lack of insurance with premature 
death is 2.5 times higher than an estimate from the Institute of 
Medicine for just 5 years ago. Deaths associated with lack of health 
insurance now exceed those caused by many common killers. The increase 
in the number of uninsured and our Nation's eroding medical safety net 
for the disadvantaged help explain the substantial increase we have 
seen in the number of deaths associated with the lack of health 
insurance. The simple fact is that the uninsured are more likely to go 
without needed care, and that lack of health care coverage takes its 
toll.
  Is this what America has come to? We have too many people who are 
unable to get health care when they need it. My constituents know the 
story well. Let me cite a story about a woman from Chicago. To protect 
her identity, I will call her Monica. Monica came to the State of 
Illinois after Hurricane Katrina destroyed her home and took her 
sister's life. Today she has a small tatoo of her sister's name on her 
arm with a hurricane over it. She came to Chicago, lived in FEMA-funded 
emergency housing but became homeless when the FEMA funds ran out. She 
stayed in overnight emergency shelters for 2 years. She found herself 
in desperate need of help. But when she thought things couldn't get 
worse, she was stabbed outside one of these overnight shelters and 
admitted to Sinai Hospital in Chicago. Sinai is one of the great 
hospitals that serves some of the poorest people in that great city. I 
commend all of the people who keep that hospital's doors open and work 
to keep quality services available for even the poorest in the city.
  As it turned out, that stabbing saved her life. In the hospital, the 
medical team discovered she had hypertension and hepatitis C. The 
social worker enrolled Monica in a local program for the homeless and 
uninsured with chronic medical conditions. With help from this program 
and the hospital's social worker, she learned where to go for medical 
care and how to find help to rebuild her life. That was last summer. 
Today Monica has her own apartment and is managing her health. She is 
one of thousands of people who walk around with life-threatening 
chronic conditions such as hypertension and hepatitis C, conditions 
that go undiagnosed and untreated because these people can't seek care 
without health insurance.
  She is trying. Monica is doing her best. She wants to be self-
sufficient. She wants to be a contributing member of society, a giver 
not a taker. But she still lives in fear of being one accident, one 
illness, one diagnosis away from losing everything she has been able to 
accumulate in her life.
  That is the fear people face when they don't have insurance. Let me 
tell you of another fear. It is a fear that many families face every 
day, and Verta Wells' children know this fear.
  Verta is a constituent of mine from the downstate area--right near my 
home in Springfield. She and her sister were adopted by loving parents, 
and she has grown up in the town I call home since she was 5 years old. 
Verta is a veteran of the U.S. Army. She raised two sons in Springfield 
and had a steady job. Health insurance was not a problem, and she was 
working.
  As the parent of two boys, Verta's medical care was covered by 
Illinois Children's Health Insurance Program. It covers just not the 
kids but also a single mom such as Verta. She was a young and healthy 
mother. She worked at the local Steak n' Shake, which in my part of the 
world is the local restaurant to go for a hamburger and a milkshake. It 
is a great restaurant. It is clean and the help is always very good.
  Working at that restaurant, she enrolled in school part time to 
become a medical assistant. She wanted to do better in her life. 
Without a pressing illness, she took the insurance card for granted 
because she did not need it. As time went on, though, she learned how 
valuable that insurance card could be.
  One night, Verta, doing a self-examination, found a lump in her 
breast. Her youngest son was then 17 years old, which meant Verta had 1 
more year of health insurance under the Children's Health Insurance 
Program. Thankfully, she was able to go to a doctor for a mammogram. 
Three days later, the doctors told her the sad news that the lump was 
malignant.
  The All Kids Program--the version of CHIP in our State of Illinois--
paid for her treatment, and Verta was happy to come out the other side 
as a healthy breast cancer survivor. Her son graduated from high school 
and life looked good. Unfortunately, this is not where the story ended.

[[Page S9632]]

  For some time after her initial surgery for breast cancer, Verta 
experienced a pain in her chest. There was just one difference. With 
her kids now grown and over the age of 18, Verta did not have any 
health insurance anymore.
  The pain grew worse. Verta knew she had lost her insurance, but she 
was aware of a program called the Breast and Cervical Cancer Early 
Detection Program--a program that provides free care to uninsured women 
in our community.
  She enrolled in the program and went in for a mammogram. Despite the 
pain, the doctor did not find anything. Given her history, the doctor 
recommended, though, that she go see an oncologist at that point just 
in case, just to be absolutely sure.
  Verta might have gone, but it worried her that the visit was not 
covered by any health insurance. She was worried about the bills that 
were starting to pile up. After all, that earlier mammogram was clean, 
and the program covers women with breast cancer, so she felt somewhat 
confident she did not have to go any further.
  She loved working with her oncologist. The last thing she wanted to 
do was stick him with an unpaid bill. And she knew she could not pay a 
large medical bill on her waitress's salary. So she went on as if 
everything was OK.
  But several months later, she felt another lump in her chest. Still 
thinking her mammogram was fine, still worried about medical care she 
could not pay for, Verta did not check in with her specialist, her 
oncologist--until one day when she felt so dizzy she was forced to go 
to the emergency room. They diagnosed Verta with metastatic cancer. 
That was just a few months ago. Today, Verta is no longer with us.
  Is this what we have come to in America--a hard-working young mother 
without access to health insurance, afraid to go to the doctor, 
delaying care, and dying too soon? That is the reality.
  So when we talk about health care reform, we talk about several needs 
here. Earlier on the floor, the Republican leader came and talked about 
the fact that we are talking about changes--basic changes--in the 
system, he said, that involved taxes, and certainly we have to be 
honest about the cost of any reform. But, unfortunately, most on the 
other side of the aisle have not joined us in this debate. They are not 
sitting down with us and trying to work out a bipartisan bill. And, 
sadly, very few, if any, of them have any alternative to the current 
health care system in this country.
  Even if you are happy with your insurance today, most people have 
this lingering doubt about whether it will be there when they need it. 
Will that health insurance company turn you down when you absolutely 
need to have them pay for a serious surgery or important medical work? 
Are they going to fight you over how much money they will pay? Will 
they go through your application for insurance and say: Oh, you didn't 
disclose a preexisting condition and, therefore, we are not going to 
cover you? That happens way too often. As it happens, more and more 
people end up in debt--sometimes crippling debt.
  In the last few years, the number of individuals and families in 
America filing for personal bankruptcy because of medical bills has 
doubled. It went from 31 percent to 62 percent in just a few years. Of 
the 62 percent who filed for bankruptcy because they could not pay 
their medical bills, 78 percent of them had health insurance. It turned 
out to be health insurance that did not mean much. It was not worth 
much when they needed it.
  That is the reality today. It turns out that many people who go to 
bed at night rest easy believing they have health insurance but find--
because of that accident or that diagnosis--they are in a pitched 
battle with the health insurance companies, which they often lose. 
Losing it destroys their life savings and everything they have ever 
worked for.
  That kind of uncertainty, that kind of insecurity is why we are in 
the midst of this important debate. It is why we should have both sides 
of the aisle looking for practical, commonsense solutions, focused on 
keeping people healthy and well in America, and giving them security 
and stability when it comes to their health insurance. But, instead, 
there is not enough conversation and dialogue in the Senate. 
Unfortunately, at many town meetings across America, there was much 
more shoving and shouting than there was real conversation about how to 
solve this challenge that faces America.
  There are several things we need to do. We need to end insurance 
company discrimination. Insurance companies must be stopped from 
denying coverage to Americans with preexisting conditions, such as 
heart disease, cancer or diabetes. No longer should they be free to 
raise premiums or drop coverage when it turns out you are sick and need 
your health insurance.
  We also need to lower health care costs and reduce the Federal 
deficit because if we do not tackle health care, believe me, the cost 
of Medicaid and Medicare and the overall cost to governments at every 
level will continue to escalate, and those who are genuinely concerned 
about the debt facing our country have to acknowledge this could drive 
America's debt out of control, unless we do something about the cost of 
health care.
  The Congressional Budget Office estimates that one of the bills, 
being considered today in the Finance Committee, will lower premium 
costs for Americans purchasing coverage in the individual and small 
group markets. They say the bill effectively slows the growth of 
Federal health care spending over the long term and could save us up to 
$49 billion over the next 10 years.
  We need to also improve our focus on wellness and prevention. We need 
to work to change the focus of our health care from sickness to 
wellness, how we can avoid medical costs, keep people healthy, give 
them the independence of living at home with the peace of mind to know 
they are in good hands with a good doctor and good hospital, if they 
need it, but they are doing important things, making personal decisions 
to improve their own health. We do this in most of the bills before 
Congress, focusing on preventive care and wellness.
  We need to ensure quality health care coverage for millions of 
Americans who go without every single day. This is not just a matter of 
economics; it is a matter of justice. To think that we live in this 
great and prosperous nation--even struggling with this recession--that 
we turn and find 46 million Americans without health insurance coverage 
has to be unacceptable. I know what I am about to say some will 
disagree with, but I think peace of mind and health care coverage 
should be a right in America, not a privilege for those lucky enough to 
work in the right place or have enough money.

  We also need to cut down on fraud, waste, and abuse. There is a 
program called Medicare Advantage. The private health insurance 
companies came to us several years ago and said: Government, you are 
not running this government program well. Let us offer Medicare 
benefits, and we are going to show you something. We could offer more 
coverage, better care, at a lower cost than the government.
  So Congress said: Be our guest. Today, the Medicare Advantage 
Program, which is supposed to be the private health insurance answer to 
Medicare, costs 14 percent more than the Medicare Program. We are 
paying a subsidy to private health insurance companies that set out to 
prove they could do it more cheaply than Medicare, when, in fact, they 
are charging us more.
  Should we continue to subsidize these private health insurance 
companies to give them more profit or should we go back to the basic 
model, Medicare, that provides more cost-efficient care for most 
Americans who have reached the age of 65 and face disability? There are 
other examples of fraud and abuse, too, in this system. We can clean it 
up, and with those savings we can start to do more to help America.
  We need to improve choice and competition. The five largest health 
insurance carriers in America have 82 percent of the business. In some 
communities, you do not have a choice. There is one dominant or two 
dominant health insurance companies, and if you do not like the way 
they do business, you do not have any choice. That is what it comes 
down to. Those of us in the Federal Employees Health Benefit Program--
Members of Congress and 8

[[Page S9633]]

million Federal employees and their families--have real choice: open 
enrollment every year to choose from private insurance companies, to 
pick the one right for our family and right for our pocketbook. That is 
what every American should have. That is not a luxury or something over 
the rainbow.
  For 8 million of us, Federal employees and Members of Congress, it is 
a reality. Why can't we offer that to every American, to say: You can 
keep the insurance you have if you want to. But if you want to look and 
shop, you should have some choices--some real choices--because of real 
competition. So we need reform that creates a competitive and 
transparent market that allows consumers to compare plans and choose 
what is best for them.
  Finally, we need to modernize our health care system, to bring 
computers and the electronics of our modern age into hospitals and 
doctors' offices, so they have a complete record on each patient, so 
they understand if there is something in your background that should be 
noted and taken into consideration before they make a diagnosis and 
order a prescription or a test, to make certain in a hospital you are 
not given drugs you are allergic to that could take your life, to avoid 
medical accidents and death that is associated with them.
  All these move us in a more efficient situation, a more competitive 
situation, and one which will bring better care to America and improve 
patient safety.
  Let me conclude by saying health care is too often a luxury. In Cook 
County, we struggle to provide patients with timely access to care. In 
the area around Chicago, at the local public hospital, the waiting time 
for some specialty services can range from 6 months to 1 or 2 years 
right now--too long to wait for critical services.
  Those who criticize this health care reform debate and say it is 
going to lead to lines and waiting and rationing are not accepting the 
reality of the current system. There are many waits that are 
unnecessary and some of them dangerous today. The stories I gave 
earlier about Monica and Verta demonstrate the need to reform our 
system. But there are millions more like them.
  Too many individuals and families bypass health care because they 
cannot afford it. The high cost of health care and the lack of 
insurance for millions of people are more than a financial problem, 
they are life threatening.
  Today, about 11,000 Americans will lose their health insurance. Can 
you imagine at the end of the day coming home and facing your children 
or your family saying: I have bad news. Because I lost my job or 
because my employer no longer can provide it or because we cannot 
afford it, we don't have health insurance anymore. Keep your fingers 
crossed, folks, because this family is now living on the edge, just one 
accident or one diagnosis away from facing the grim reality of the cost 
of health care.
  Every day in America, families are forced to choose a different 
doctor when their health care plan is changed because their employer 
cannot afford to provide health insurance. Every day in America, 
families see their health plan benefits erode because they cannot keep 
up with higher premiums, copays, and deductibles. Every day in America, 
people decide to skip a doctor's visit, medication, and treatment 
because they cannot afford it.
  Families are confronted with losing their health insurance altogether 
because their employers cannot afford it, and year after year health 
care costs keep going up and up and up. Are we going to stand by and 
watch this happen? Are the people who have been elected to this Senate 
and the House of Representatives going to accept their responsibility 
to those who sent us here to tackle one of the toughest, most 
complicated, most controversial issues of our time but one we cannot 
afford to ignore?
  I hope my friends on the other side of the aisle will join us in that 
effort. It is time to tell our constituents across America: It does not 
matter where you live, what you do or how much money you make, in the 
United States of America every American should have the opportunity to 
access health care they can afford, to give them the peace of mind they 
deserve.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Gillibrand). The Senator from Illinois.
  Mr. BURRIS. Madam President, I ask unanimous consent to speak for 5 
minutes in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BURRIS. Madam President, I thank the Senator from California for 
the time yielded to me.
  In the halls of power and in living rooms across America, on cable 
news and around the dinner table, everyone seems to be talking about 
health care reform. From coast to coast--and on both sides of the 
aisle--there seems to be broad consensus. The American people and their 
elected leaders see the clear need for reform. But we often disagree 
about how to meet such a challenge.
  As we consider health care reform, and as we try to seek consensus, I 
believe we can find common ground on the need to address disparities in 
the health care system. I say we need to address the disparities in the 
health care system.

  In a country founded on the principles of freedom and equality, we 
currently possess a health care system that is anything but free and 
equal. This is simply not right. We need to ensure that quality, 
affordable health care is available to all Americans. We need to cut 
down on the widening disparity between minority individuals and the 
wider population so no one is left behind because of their racial or 
ethnic identity.
  People of color make up about a third of the population in the United 
States, but they represent half the Nation's uninsured. In Illinois 
alone, more than 21 percent of minorities do not have health insurance 
compared with 12 percent of Whites. It is time to correct this inequity 
and move toward a sustainable system that serves every single American 
regardless of skin color or economic background.
  This begins before birth. Only 76 percent of Black mothers and 77 
percent of Hispanic mothers have access to prenatal care in the first 3 
months of pregnancy. For White mothers, the number stands at more than 
88 percent. This is unacceptable. It demonstrates that minority 
individuals are at a clear disadvantage even before they are born. This 
places them at a greater risk for problems down the road, problems 
ranging from higher infant mortality to increased rates of chronic 
diseases in later life. Combine these risks with a higher poverty rate 
and lower insurance coverage and we have a recipe for disaster.
  For no reason other than the color of their skin, millions of 
Americans are poor and uninsured. They have reduced access to health 
care and an elevated risk of illnesses such as high blood pressure and 
heart disease. This leads to a shortage of preventive care and forces 
some people to go to emergency rooms when they have nowhere else to 
turn. No wonder our health care system is strained to the limit. No 
wonder costs are through the roof, positive health outcomes are down, 
and we are unable to break this destructive cycle.
  We must address these disparities as part of our responsible health 
care reform package. We must work hard to make sure all Americans can 
benefit from health care reform. This means eliminating barriers to 
Federal health programs for American Indian tribes. It means increasing 
access to quality care for children, pregnant mothers, and every legal 
resident of this country--I say every legal resident. It means 
expanding preventive care and screening programs so we can stop 
diseases before they start. This is especially important for those who 
live below the poverty line.
  As we move forward, it is our responsibility to make sure we include 
every member of society in our reform proposals. We must not rest until 
everyone is a part of the solution.
  I urge my colleagues to join me in these efforts. If we work 
together, we can extend the promise of prosperity to every single 
American, regardless of race or ethic background. We can make sure this 
country is more free, more fair, and more equal.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mrs. FEINSTEIN. Madam President, I ask unanimous consent that the 
order for the quorum call be rescinded.

[[Page S9634]]

  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. FEINSTEIN. Madam President, I ask that the Interior bill be 
reported.

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