[Congressional Record Volume 155, Number 162 (Tuesday, November 3, 2009)]
[Senate]
[Pages S11023-S11045]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       VA HOSPITAL IN MARION, IL

  Mr. DURBIN. Mr. President, I will respond to the Senator from Arizona 
after I speak to an important issue in my home State.
  My first comment relates to an important VA hospital in Marion, IL. 
In the fall of 2007, there was an alarming number of deaths at the 
Marion VA hospital, causing a thorough investigation to be initiated in 
Washington. At the end of the investigation, they found that nine 
veterans who had gone into this hospital for surgery had died under 
what were considered extraordinary circumstances. The investigation 
went deeper. As it went deeper, they found clear evidence of 
malpractice on the part of doctors at this veterans hospital and 
mismanagement by those who brought these doctors to the hospital and by 
those responsible for supervising them in their activities.
  As a result of that startling and shameful disclosure in the 
treatment of the veterans, the surgical unit was basically closed--at 
least inpatient surgery and many other medical activities were 
restricted until the investigation was complete, changes were made, and 
new personnel were brought in so that veterans receive the kind of 
protection and care they deserve.
  That investigation resulted in several doctors being dismissed. After 
the most cursory examination, we found that doctors had been brought to 
this hospital--at least a particular doctor who had been the subject of 
malpractice complaints in another State had not been thoroughly 
reviewed in terms of his background before he was brought into this 
veterans hospital, and he, in fact, was performing surgeries at this 
hospital beyond his competency and beyond his authority. That was a 
fact.
  We started this thorough review with new people at the Marion VA 
Center.
  I might say to the Presiding Officer and those following this debate, 
southern Illinois is a long way from Chicago. It is 400-plus miles away 
from Chicago. It is an area I know well. It is where my family roots 
are. It is an area once represented in Congress by Paul Simon, when he 
was a Member of the House, and then, of course, he later served in the 
Senate. Paul Simon used to say southern Illinois is the land of grits 
and gospel music. There are parts of southern Illinois that are south 
of Richmond, VA, in terms of latitude, to give an idea. It is the 
South.
  I say that because I want to let people know, in following this 
particular development, that for many of the people who live in 
southern Illinois, in small towns in southern Illinois, in northern 
Kentucky, and in eastern Missouri, the Marion VA Medical Center is 
critically important. It is a long drive from where they live to St. 
Louis or to Indianapolis or some other place. They count on the Marion 
VA hospital. We told these veterans they could count on it, that it 
would be there to help them when they needed it. So this scandal which 
came out 2 years ago caught everyone's attention and focused all of us 
on solving this problem as quickly as possible.
  We responded in the Senate. I had a colleague in the Senate then, a 
fellow Senator by the name of Barack Obama. He and I introduced a bill 
that went after the systemic weaknesses at the VA medical center 
structure that allowed these deaths to occur. Our bill imposed an 
accountable quality management system on VA medical centers, 
on regional networks that monitor and manage the medical centers, and 
the VA health care system as a whole. We proposed designating a person 
at each level who would be directly responsible for quality management 
and only quality management of health care for veterans. The Veterans' 
Affairs Committee, under the leadership of Chairman Akaka of Hawaii and 
Senator Richard Burr, a Republican, approved the legislation last 
Congress and reported it out of committee and to the full Senate, where 
it died on the floor.

  Yesterday, I was shocked to learn that a new inspector general's 
investigation of the Marion VA Center in August of this year by a 
medical doctor and his team found that problems identified 2 years ago 
have not been addressed at the Marion VA Medical Center. Despite this 
national scandal and the concern we all had about the treatment of 
veterans, many of the concerns and many of the issues that led to the 
deaths of these innocent veterans have still gone unheeded. In 2 years' 
time, the medical center responsible for treating veterans living in 
southern Illinois has not been able to meet the required standards in 
facilities safety, patient safety, peer review treatments, and, yes, 
limiting surgeries to those surgeons who are only approved and licensed 
to perform them. These continued failures are shocking and inexcusable.
  I and my staff and my colleagues in the House have pressed the VA and 
the medical center itself repeatedly about bringing this center up to 
the highest standards. We have visited the facility, convened meetings 
with employees, administrators, and written letters. We have done all 
we can think of to make sure our veterans have access to the highest 
levels of medical care in Marion, IL. We have been told time and time 
again that Marion's quality of care is being closely monitored and all 
appropriate steps are being taken to rectify the problem. I don't know 
what went wrong here, but I know now that these efforts have failed.
  The inspector general's report of this August is an indictment of all 
of the efforts undertaken by the previous administration and this 
administration to remedy the problem. I am deeply disappointed that yet 
another report identifies entrenched and serious problems at Marion.
  In the report finally released yesterday, the inspector general 
details appalling failures of quality management and patient safety 
standards. I have read the report. Some failures they found are the 
same ones they found 2 years ago: physicians performing procedures 
without required privileges and authority; review of treatment records

[[Page S11024]]

that is not regular or systematic; where there were reviews of 
treatment records, no one followed up on questionable treatment 
decisions as they were made; and, in fact, substandard, unacceptable 
record keeping of the deaths after treatment.
  Other failures in patient care the inspector general found: not 
complying with guidelines for patients with a history of methicillin-
resistant staff infection, known as MRSA. It is a deadly infection that 
can claim lives. They found an example where an individual who had a 
history of this infection was left in an environment where he was 
exposed to other innocent patients. Totally unacceptable. Not grounding 
electrical equipment in bathrooms, raising the danger of patient 
electrocutions at one of our veterans hospitals. That is what the 
inspector general found.
  After 2 years to focus on bringing the Marion VA Center up to the 
basic standards we should expect of every VA facility, those in the 
direct line of command at Marion have violated the public trust and 
should be relieved of their duties until serious questions about this 
management have been answered and resolved.
  Secretary Shinseki called me on the phone last night, and we had a 
lengthy conversation about Marion. When I first met the general and 
told him I would support him because of his service to our country and 
his obvious leadership skills, I talked about the Marion center. I told 
him it had to be high on his priority list. He said he would take the 
initial step of removing the Marion director and naming a replacement 
with a long and respected record of leadership.
  I wish this new director the best and offer all the help I can to 
provide and assure veterans in southern Illinois they will receive the 
best possible care. However, since the problems at Marion have not been 
fixed, more comprehensive and immediate action is required.
  Yesterday's inspector general report is only one of several 
revelations of quality-of-care issues in VA facilities to gain notice 
this year. In June, the inspector general reported that several VA 
facilities were not properly cleaning endoscopy equipment, potentially 
exposing veterans to infection. In July, weak oversight led to errors 
in cancer treatments at the Philadelphia Veterans Affairs Medical 
Center, resulting in mistreatment of several veterans. Taken together, 
the series of problems raise serious questions about how quality of 
care in the veterans health system is monitored and enforced.

  Since that initial, awful discovery of these unnecessary, shameful 
deaths in Marion, IL, 2 years ago, we have asked a lot of questions 
about quality of care that have gone unanswered. We have learned some 
things. We have learned that VA health care quality assurance programs 
at every level--Federal, regional, and local--could be better. Where 
good policy is in place, not all health care officials and 
practitioners are following the guidance fully. The shortage of health 
care professionals means VA hospitals are not doing all they can to 
weed out mistake-prone doctors.
  I wish to go back to the legislation Senator Obama and I introduced 
in the last Congress. This bill would create a network of health 
quality assurance officers. The idea is we need one designated person 
at each VA facility, in their VISNs and in VA's headquarters, to pay 
attention, strictly, to quality and patient safety issues.
  So the bill establishes quality management officers at the national, 
VISN, and medical center levels. These officers would be responsible 
for peer-review mechanisms and for confidential reporting systems, so 
VA employees can literally blow the whistle when they see things happen 
that endanger the lives and treatment of our veterans.
  The bill also requires potential VA physicians to disclose their 
employment history--that is not too much to ask--including negative 
elements in their resume, before they are hired.
  It also mandates that directors of the regional Veterans Integrated 
Service Networks--or VISNs--investigate and personally approve the 
candidates.
  Again, this year, as it did in the previous Congress, the Senate 
Veterans' Affairs Committee has reported the bill. They agree with me. 
They know it is a bipartisan bill, and they support it on a bipartisan 
basis. This year it is part of the Caregiver and Veterans Omnibus 
Health Services Act of 2009.
  Where is this bill? Why wasn't it passed before this inspector 
general came and found the same problems at Marion VA today that led to 
the deaths of nine innocent veterans 2 years ago? What happened to the 
bill after it was reported to the Veterans' Committee?
  Well, I can tell you. The bill is sitting on the Senate calendar. It 
is being held by one Senator who opposes moving to the veterans bills. 
He says it costs too much money. Well, what is a veteran's life worth? 
We lost nine 2 years ago. The latest report is that there is another 
one whose death has not been investigated, which has not had the 
appropriate level of review we would expect in a veterans facility, and 
this Senator says it is too much to ask that we would put someone in 
place at that Marion VA, and every VA facility, who would focus on 
patient safety.
  I want to tell you, that is unacceptable. Putting a hold on a bill 
that, if it is not passed, could endanger the lives of veterans is 
absolutely unacceptable. I hope this Senator will have second thoughts 
now that this inspector general's report is out. We need this quality 
management network in the veterans health system. If this were in place 
and working properly, we could catch those who are taking shortcuts and 
compromising the quality of care our veterans deserve.
  But we also have to acknowledge that policies are only as effective 
as the people who implement them. Good practices depend on the 
professionals on the ground, so we have to educate and hold 
professionals accountable, as well as enacting appropriate quality 
control measures. We have to make veterans hospitals attractive 
employers so the scarcity of doctors does not create a perverse 
incentive to overlook potential shortcuts.
  In the overwhelming majority of cases, the Veterans' Administration 
of the United States of America provides veterans with care of the 
highest quality. VA personnel--and I have met hundreds of them--similar 
to all health care workers, enter their professions because of a 
genuine personal desire to heal the sick and mend the wounded, 
particularly those women and men who have served our country. They do 
outstanding work for our veterans every single day, and they deserve 
our gratitude for that effort. We want to help them provide the very 
best care for veterans everywhere in America.
  I wish to thank Chairman Akaka and Senator Burr for noting that 
quality management in the VA needs to be restructured to ensure 
accountability. I agree with them completely. But despite the good work 
of the VA, and the wonderful people involved in the VA, clearly, at the 
Marion VA Center our veterans deserve better.
  I hope we can pass this bill and put in place the kind of safeguards 
that are needed so we will never have to face another inspector 
general's report such as this. You would think after nine veterans have 
lost their lives, and all the effort that has gone in to understand 
why--and stop it from occurring--that we would not be facing an 
inspector general's report that says we are still harboring people who 
are not of the highest quality, in terms of their talents, and 
protecting procedures and approaches which jeopardize the lives of many 
of these veterans.
  This bill should be removed from the calendar, brought to the floor, 
and passed immediately. I hope it will pass in an overwhelming fashion 
with bipartisan support.
  Mr. President, as to the Unemployment Compensation Extension Act, I 
heard the Senator from Arizona come out and talk about the 
unwillingness of the Democratic majority to allow the Republicans to 
offer amendments. He used that as his reason to explain why, for 26 
days, the Republicans have held up the extension of unemployment 
benefits to thousands of people across this country.
  During that 26-day period of time the Republicans have stopped us 
from extending unemployment benefits, 180,000 Americans have seen their 
unemployment benefits end. We know because many of us have heard from 
them. They are people who have been out of work for a long time and 
looking for a job without luck. When the unemployment check ends, they 
know it because that is the check that puts bread on the table. That is 
the check that pays

[[Page S11025]]

the mortgage and the utility bills. It keeps their family together.
  So for almost one calendar month, the Republicans in the Senate have 
stopped the extension of unemployment benefits. Why? The Senator from 
Arizona said: Well, because we had some amendments we wanted to offer.
  Well, this is a legislative body. It is not unreasonable to offer an 
amendment. But what he did not say is that some of the amendments had 
nothing to do with unemployment or the state of the economy. Some 
people may have heard of this organization ACORN. They have been in a 
lot of news recently--videotapes of ACORN employees doing bad things. 
They were fired. Some are being investigated.
  We have had about four or five amendments on the floor about ACORN. 
Are we going to investigate them? I am for that. I put an amendment in 
to do that. Are we going to cut off all their government contracts? Are 
we going to limit the work they can do on this agency or that agency? 
Amendment after amendment after amendment. At a time when we are in the 
midst of a deep recession, with high unemployment, fighting two wars, 
debating health care, some Senator thinks this is all about ACORN.
  So one of the Senators from Louisiana said: I am going to hold up 
unemployment benefits for people across America until I can have 
another chance to have another debate on another ACORN amendment. Well, 
forgive me, but I think the majority leader was right. That does not 
relate to unemployment. It does not relate to the state of the economy. 
It is simply one Senator who is stuck on one theme that has nothing to 
do with the economy and that Senator was insisting on his amendment or 
unemployment benefits would not move forward.
  So when the Senator from Arizona talks about the decision of the 
majority not to allow every amendment to be offered and tie up the 
Senate for days or weeks at a time, it is understandable. I do have to 
take exception to remarks that were made by my minority whip and friend 
from Arizona when he said we are not offering amendments to the 
Republicans on the unemployment compensation benefits bill.
  I call his attention to the amendment he voted for yesterday. It was 
a cloture motion, which means ending debate on a substitute known as 
the Reid-Baucus substitute. The Reid-Baucus substitute, which is being 
added to this unemployment benefits bill, includes, within its pages, 
two Republican amendments, the major Republican amendments that have 
been offered; one by Senator Johnny Isakson of Georgia about the home 
buyers credit. It is in here. A Republican amendment is in here. He and 
Senator Dodd have worked out the details. It is included. The second is 
an amendment by the Senator from Kentucky, Mr. Bunning, and it relates 
to some net operating loss tax treatment, which we think may help some 
businesses hire people back. Senator Bunning is a Republican. The 
amendment was incorporated as a part of it.

  So for the Senator from Arizona to argue that we are not allowing any 
amendments is to ignore the very amendment we voted for yesterday. 
There are Republican amendments here, and they were worked out, as they 
should be.
  Does that explain why we have waited almost 4 weeks to extend 
unemployment benefits? The Senator from Arizona takes exception to the 
idea that we would use the insurance fund that is collected from 
employers and employees across America for unemployment to extend 
unemployment benefits. Well, this is an insurance fund we all pay into, 
in the unlikely event we lose our job, so we can get unemployment 
insurance.
  The Senator from Arizona says we should not do that. It is unfair to 
collect that tax--or FUTA tax, as they call it--to fund unemployment 
benefits. I think it is perfectly fair. I have never used it once in my 
life. I do not mind paying into it. I think it is reasonable. If the 
day comes when I need it, it is there. So to say we should stop funding 
this kind of unemployment insurance benefit is, in my mind, to 
jeopardize a safety net many people count on across America.
  I have received calls from people in my State telling their stories. 
I hope the Senator from Arizona can receive a few of those calls, too, 
from his State. I am sure there are people who would contact him on 
this issue.
  One lady wrote me and she said:

       I am a 57 year old professional woman [with a masters 
     degree] who was laid off in November 2007, before things got 
     really bad. My unemployment ran out in mid September.

  When this debate had not started, but it was beginning here in the 
Senate. She said:

       I have closed my 401K, my retirement accounts and have 
     spent all my savings to survive thus far--and without having 
     had the help of unemployment benefits, I would have lost 
     everything I have long ago.
       And don't get me started on my health insurance issues.
       As Congress debates, people lose everything. Good people 
     who worked their whole lives. Please help pass this bill. It 
     will be too late for me, I am totally tapped out next month, 
     but it will save others.

  A man writes me:

       I am 60 years old. My wife is 56. We were both laid off. Me 
     first, then her.
       We have worked all our lives. Our unemployment benefits 
     have expired.
       We were unable to continue paying for Cobra--

  Which is a health insurance option for those who are out of work--

       so we lost that. So now we have no health coverage for the 
     first time in our lives and no benefits.
       We try to stay optimistic, but the reality is things are 
     tough. We look for work, to no avail. What will happen?
       Benefits should be extended indefinitely until the job 
     situation improves to the point where people can get a job. 
     In the meantime we'll take what we can get, and hope 
     something good happens.

  This woman, who has never contacted a public official before, writes 
me and says:

       This is my first time writing to any political figure. I 
     will keep my thoughts and concerns short and sweet.
       I am currently unemployed, a mother of 3 and live in a 
     suburb in Illinois. I have been looking for work for over 1 
     year now to no avail.
       It is my hope that you will vote YES in the Senate this 
     week to pass the unemployment extension and hopefully there 
     will be no more delays.
       My husband and I have been struggling to make ends meet for 
     months now and with the money I would collect from 
     unemployment, my family would be able to stay afloat [until I 
     can get another job].
       My son has some major medical issues at this time and even 
     though we carry insurance, it's just not enough to pay the 
     bills.
       I pray the Senate makes a positive and quick decision about 
     extending unemployment benefits.
       I appreciate your time.

  How do you explain to this woman, and others who wrote to me, what we 
are doing right now on the floor of the Senate? Are we debating a bill 
on the floor of the Senate? No. We are burning 30 hours off the clock 
because the Republicans insist we delay this as long as the Senate 
rules will allow. They do not want us to extend unemployment benefits 1 
minute sooner than they can extend this debate. Under the Senate rules, 
they have extended it now for 26 days. So another 2, 3 or 4 days are 
necessary before the Republicans use up all the time they could 
possibly use.
  What happens in the meantime? Well, for the three people who wrote me 
from Illinois, I am not sure. I do not know how they will get by in the 
meantime. I hope they will. But for them, it must be hard to understand 
why they have to be held captive to the procedural rules of the Senate 
that I think, in this case, are being clearly abused.
  We have adopted now Republican amendments that they have asked for. 
At least we have cleared them to be adopted. The vote last night had 
only two dissenters. Two Republican Senators dissented. Everyone else 
voted for it. This is now, apparently, a wildly popular bill but not 
popular enough for us to vote on it and get it done. No, we are going 
to have to wait for another day or two or three under the scenario that 
has been created on the Republican side.
  Last week, one of my Republican colleagues was talking on the floor 
about how we should be in no rush to do anything on unemployment 
insurance. He said:

       The benefits haven't run out yet. We're going to pass this 
     before the benefits run out. That's not the question.

  Well, unfortunately, that is not true. When you hear statements such 
as that, the Republican delays start to make a little more sense. 
Americans need help right now, but some Republican Senators do not 
understand that.

[[Page S11026]]

Some Republicans, apparently, do not know that 600,000 Americans have 
already lost their unemployment insurance benefits--Americans who would 
be benefited if this bill passed--extending the coverage for an 
additional 14 weeks across the country and for 20 weeks in areas of 
higher unemployment.
  These 600,000 families have no place to turn. Their benefits are 
exhausted. The job market is still weak and the Senate talks and talks 
and talks and, even worse, goes into these quorum calls, where people 
do not even talk.
  We sit in our offices waiting to reach a point where we can take the 
next vote the Republicans will allow. We finally managed to make a 
little progress last night to move the bill forward. Now Republicans 
have said let's wait another 30 hours before we consider what we even 
passed last night. We have to wait so the Republicans can talk more 
about whatever it is they think is more important than helping the 
victims of this recession and dealing with the safety net we 
desperately need. So America waits and waits some more.
  I hope the Senate can finally provide the assistance that hundreds of 
thousands of Americans are waiting for. There is no excuse for us not 
to do it right now--today.


                 Major Opposition to Health Care Reform

  Mr. President, the Senator from Tennessee was here earlier. It 
appears now that the major Republican opposition to health care reform 
comes down to something very basic, which I never would have guessed.
  It turns out the Republicans object to the length of the bill. It 
turns out they are offended, and are carrying that offense to an 
extreme, because they believe the Senate bill for health care reform is 
over 1,000 pages long. I don't know if the Republicans can help me 
understand this. Maybe there are a number of pages that they think 
would be appropriate. I don't know if it is 900 or 500. But, 
apparently, in their mind there is an appropriate number of pages for a 
bill. When the bill goes beyond a certain number of pages, whatever it 
says is unacceptable. That, apparently, is the new approach being taken 
by the Republicans.
  Last week, I asked one of the Republican Senators how many pages the 
Senate Republican health care reform bill comprised. He didn't answer 
me, because he knows, and I know, that no such bill exists. There is no 
Senate Republican health care reform bill. Maybe some day there will 
be. I hope so.
  We have taken two major committees of the Senate and put them to work 
for weeks to devise health care reform bills. Now we are trying to 
blend those bills into a final product, which is in the works. Yet they 
come to the floor and complain it is too long. It turns out that one of 
the committee bills they are objecting to for being too long contained 
150 Republican amendments. Guess what. Those amendments comprised 300 
pages.
  Am I supposed to be outraged that we would have 300 pages of 
Republican amendments and say they should not be considered because I 
have in my mind a number I cannot quite disclose to you as to what a 
maximum number of pages might be for a bill? In a debate as serious as 
health care reform, have we reached these depths, where the only 
complaint we can find from the Republican side is that the bill has too 
many pages in it? I think that is a sad state of affairs.
  People across this country, and family after family, know the cost of 
health care is out of control for businesses, families, individuals, 
and governments. We cannot sustain it. Health insurance companies will 
keep piling on premiums and raising costs beyond the reach of families 
every single day. We have to do something about it now. If it takes 100 
pages, good. If it takes 1,000 pages, that is fine, too. Let's get it 
done.
  I keep waiting for the first Republican Senator to stand up and say 
we are going to join with Democrats in fighting the abuses of health 
insurance companies, which deny people coverage because of preexisting 
conditions, which bail out on those who are insured once they get sick, 
which won't allow you to take your insurance from one job to another, 
which say that your son or daughter at age 23 is cut off from the 
family plan.
  When will Republicans join us in pushing for real health insurance 
reform, which gives peace of mind to families across this country? I 
don't care if that takes 1,000 pages to do it. Let's do it and get it 
done.
  Finally, let's make sure that we push prevention and wellness, so 
people will have better health outcomes at lower costs, so that more 
people can qualify for health insurance, so that fewer people turn up 
in the emergency room without health insurance, or with poor health 
insurance, desperate for care.
  Again, how many pages are acceptable to the Republican side of the 
aisle? I am waiting to hear.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mrs. HUTCHISON. Mr. President, I am very pleased to be able to speak 
this afternoon about the health care bill that we all in this country 
are concerned is coming through Congress at a very rapid pace.
  I heard the distinguished Senator from Illinois saying the Republican 
complaint is how long the bill is. Well, of course, he acknowledged 
that there is no bill, that we actually don't have a bill that has been 
introduced yet in the Senate. So I think what we are talking about is 
the length of the bills that have been put forward by the two 
committees and will be put together, and it could be 3,000 pages long, 
if that is what it takes to cover this issue.
  The concern Republicans have is, are we going to have time to read 
it? Are we going to have time for the public to read it, so that we 
understand fully, before we start debating, before we start amending, 
what is in every line of the bill?
  The American people expect that we will know what we are voting on 
when we are talking about taking over one-sixth of our economy in this 
country. We are talking about the health care industry jobs--doctors, 
nurses, nurses' aides, hospital personnel, and the doctors' office 
personnel. We are talking about a lot of the economy of our country. 
Most importantly, we are talking about the relationship between a 
patient and a doctor, which is the most personal, most important health 
care relationship you can possibly have in every family.
  I think maybe the distinguished deputy leader on the Democratic side 
has mistaken the complaints about how big the bill is with how long we 
have to read the big bill. That is the issue. That is why we want to 
see the bill in the writing that is going to become law before we are 
asked to debate it, before we are asked to offer amendments. And we 
want the public to see it, too.
  In fact, there was an amendment offered in the Senate Finance 
Committee by Senator Bunning to reassure the American people that there 
would be 72 hours for this bill to be in the public domain before it 
would come to the floor. That amendment was defeated.
  It is very important to us that we have ample time to determine every 
part of this bill and how it will affect every American, every American 
family, and for all of the many people in the health care industry--the 
doctors, nurses, and all the people who provide health care in our 
country--to know how it will affect them, too. That is the complaint, 
for sure.
  Today I want to talk about the rising health care costs. We know that 
today, without any new bill, premiums are going up and Americans are 
being squeezed. Rising premiums are causing them to be very concerned 
about how much this health care coverage they have is costing. It is 
also squeezing small businesses, because their premiums are rising, and 
it is beginning to be a choice in some American businesses whether they 
can offer health care coverage anymore.
  We do need health care reform because of these rising premiums. You 
would think that, with the premiums going up and costs going up, and 
Americans being squeezed in a tough economic time, and employers being 
squeezed, that the position we would be taking in the Senate regarding 
health care reform would be to bring down costs. That would be what you 
would think we would be addressing. You would think we would be talking 
about offering more affordable coverage to more people.
  Texas, unfortunately, has the highest percentage of people today 
without health insurance coverage in the Nation. So I am very concerned 
about this issue. Unfortunately, 5.8 million uninsured Texans is the 
number we have

[[Page S11027]]

reached. So this is a huge issue for my State.
  Let's look at the health care reform and how it is going to affect 
the rising premium costs. Inflation causes the premiums to go up every 
year. So what we should be looking for is a way to cut back on those 
costs that are hurting people so much.
  Here is an example: Individuals and families buying their own 
insurance could see premiums increase as much as 73 percent under the 
new Democratic proposals that are being written right now. One study 
projects premium increases of roughly $1,500 a year for individuals, 
and $3,300 a year for family coverage, in addition to the natural rise 
in inflation and premiums that would be ongoing anyway. This was from a 
study delivered by Oliver Wyman. Think about it. All of the taxes on 
insurance companies, the taxes on an American individual or a family 
that decides not to take the coverage would add to the cost as well. 
Then you have the cuts in Medicare that are proposed and the increase 
in Medicaid that is proposed, which will cost every State and every 
taxpayer. So you have all these increases in costs, mandates, and 
taxes.

  More alarming is, if you do have insurance today, you may not even be 
able to keep what you have. The President said if you like what you 
have, you can keep it. But under the Democrats' proposal that is going 
through, all plans include a long list of benefits that are required to 
be in every plan. Some of these may be benefits your family doesn't 
need or you would not choose as a priority, but they are there. So that 
will have a cost impact. Millions of Americans will be forced to buy 
more expensive plans in order to comply with these new Federal laws 
that are going to reform health care.
  When it comes to a small business, you might think: What is this 
going to do to a small business? Small businesses are now having a hard 
time because they don't have the big risk pool. So their costs are 
higher anyway. A small business with 20 employees is going to have 
higher premiums anyway, and their margins are generally less because 
they don't have the advantage of having big risk pools and the things 
that can bring down costs in a bigger business. Small businesses are 
going to look at these rising costs and probably say, you know, I now 
have to decide, do I continue to offer health care coverage to my 
employees or do I back off? And if I back off, of course, people will 
have to buy their own insurance or pay a fine if they don't.
  That is what is going through Congress right now. The Joint Committee 
on Taxation stated that ``the imposition of the excise tax on insurers 
can be expected to lead health insurance providers and consumers to 
take measures to minimize their burden from the tax. As insurers pass 
along the cost to the consumer by increasing prices, the cost of 
employer-provided insurance will increase.''
  In the House bill, employers will be penalized if they don't pay for 
a specific percentage of employee premiums. So even if you are offering 
health insurance to your employees, you may still be penalized if the 
House bill prevails, if you don't pay the right percentage of coverage 
for employees. The Kaiser Family Foundation did a research study and 
said three out of five businesses in America that offer insurance would 
still have to pay the 8-percent payroll tax, because their percentages 
would not meet the Federal standard that would be in the House 
bill. That is just counterintuitive. It is counterintuitive to say if 
you are doing the right thing and you are offering health insurance to 
your employees--you are struggling to do it, but you are doing it--but 
if it is not the right percentage, if it is not 72.5 percent or 65 
percent, then you are not going to qualify anyway, so you are going to 
have to pay an 8-percent fine of the entire payroll of your company.

  This is not the reform we should be going after. What we should be 
doing is trying to have more affordable health care access for 
individuals and small businesses. That should be our primary objective.
  Here are the principles the Republicans would put forward for health 
care reform.
  Small business pooling: We have offered time and time again on the 
floor of this Senate the small business health plan that would allow 
small businesses to pool, to be able to offer their employees a bigger 
risk pool and, therefore, lower premiums for the employee and the 
employer. We have offered plans that would allow a State organization 
or a national organization--the U.S. Chamber of Commerce, the NFIB, the 
American Institute of Architects, whatever association that you might 
join as a small business person--to offer all of their members 
insurance plans that would have a big risk pool so that if you work for 
a small business, a small architecture firm, you would be able to offer 
this in the same basic amounts that if you worked for a big 
architecture firm or big corporation. But that would not cost the 
government anything, and it would not change anyone's coverage if they 
like what they have. It would offer more affordable access to more 
people.
  If the Republicans had the ability to offer amendments to the health 
care bill or to offer a substitute, we would reduce frivolous lawsuits. 
In States where there are limits on noneconomic damages or you have an 
arbitration requirement before you go to a lawsuit, we have lowered the 
cost of medical malpractice insurance to the doctors by as much as 25 
percent. Doctors have come back to practicing medicine again because 
these premiums have been lowered just by reducing frivolous lawsuits. 
This has been done in my State of Texas, California, and other States 
have followed suit and, no pun intended, have lowered the number of 
lawsuits. It has lowered the cost of the medical malpractice insurance 
premiums, and doctors have been able to do their work with their 
patients with much more freedom, knowing they do not need to order 
unnecessary tests just to cover themselves in case they get sued.
  No. 3, why not offer tax incentives? I am a cosponsor of a bill with 
Senator Jim DeMint that would offer tax incentives for individuals. 
There are small businesses and individuals who have no access to 
affordable coverage. It is just way too expensive. Why not give every 
individual who purchases their own insurance the same tax break that a 
corporation gets for offering health insurance to the employees? It is 
a nontaxable benefit to the employee. Why shouldn't the individual get 
that same break? Why don't we have a $5,0000-per-family tax credit if 
you buy your own health insurance for your family, or $2,000-per-person 
tax credit so that everyone is on a level playing field? That would be 
a huge incentive. It is a tax credit, so it would be much less 
expensive than what we are talking about in this government takeover of 
health care.
  How about creating a transparent, online marketplace for consumers to 
compare and purchase plans? That is something on which I think we could 
all agree. I think we could agree that if you had a health exchange 
where you could go online and companies would offer different kinds of 
plans, any company that wanted to come in with a credible plan for 
insurance coverage--again, a bigger risk pool so the company would have 
to be competitive, and it would have that lower cost--that would be a 
great boon for consumers and it would not cost the government anything 
to do that. It would just be a marketplace, a transparent place where 
people could shop for their plans and get a better deal because there 
would be more competition.
  We should allow the purchase of insurance across State lines. Why 
don't we allow the insurance companies the ability to pool States and 
offer individuals better prices for health care coverage? We have 
options that would be good options for American consumers and would 
give more access to affordable health care. The more people who have 
affordable health care, the lower cost to everyone who has health care 
because when people are covered, they don't go to the emergency room 
for a fever or a common cold. They go to a doctor's office. They have 
checkups so they have ongoing care to detect something before its gets 
so bad that it is more serious, more expensive to treat, and certainly 
more life-threatening.
  Those are the principles the Republicans would put forward. But to 
have a government takeover that is going to increase costs to everyone 
who has insurance and cause many people to lose their insurance because 
the employers back out is not the answer. It is not

[[Page S11028]]

the answer. We can do something that would give affordable access to 
more individuals and their families. That should be the goal of this 
health care reform. We need health care reform. We do. We don't need a 
government takeover of our health care system. That is the debate we 
ought to be having right now.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Kaufman). The Senator from Washington.
  Mrs. MURRAY. Mr. President, last week families and businesses across 
our country finally got some good news. We found out that initial 
estimates show that our GDP grew at a 3.5-percent rate last quarter and 
that the Recovery Act created or saved over 1 million jobs across the 
country, including over 30,000 in my home State of Washington, making 
us third in the country for job creation.
  Those are hopeful signs. But I know many families and many businesses 
and communities still need help. We have a long way to go before we 
have fully recovered from the worst economic condition since the Great 
Depression.
  I came out on the floor and spoke twice last week about the urgent 
need to pass an extension of unemployment insurance that would help 
over 18,000 people in my home State and millions of Americans across 
the country. I told the stories about five individuals who had lost 
their jobs and whose families are now in desperate need of support that 
the extension would give them to help them stay on their feet--families 
who right now, as we sit out here and debate this bill, wait for hours 
and hours for us to get to a final vote, even though we know we have 
the votes, families who are sitting at the kitchen tables across this 
country having a very agonizing debate about how to make next month's 
rent or how to get next week's groceries if their unemployment benefits 
run out.
  Those families do not understand why some of our colleagues are 
delaying and obstructing our efforts to offer this small measure of 
financial stability to those families who need it most. These families 
have been coming to me with their stories, and I am committed to 
fighting to make sure they have every opportunity to get back on their 
feet. That is why I am here today to urge my colleagues to support and 
pass the Worker, Homeownership, and Business Assistance Act of 2009.
  I am very proud to be a cosponsor of this bill because it will give 
our families and businesses in Washington State and across the country 
the support they need today. This bill will be a lifeline to millions 
of families, and it will provide tax relief to help our businesses 
create and save jobs. And it will help extend and expand the homeowners 
tax credit to continue a badly needed boost to help stabilizing the 
housing market.
  This legislation will help families who need it most by providing 
every single unemployed worker who has exhausted his or her benefits an 
additional 14 weeks of support, regardless of what State they live in, 
and it would extend unemployment to laid-off workers in States that 
have been hardest hit by the job losses, including Washington State, by 
6 weeks.
  Last week I told some of the stories that are pouring into my office 
from unemployed workers. These are workers who are not asking for a 
handout. They just need a small measure of support as they work to get 
back on their feet. These stories have continued to come in this week, 
and I wish to share a couple excerpts from letters people sent me 
urging me to do everything I can to make sure this bill finally passes.
  Bill and Patricia Profitt from Littlerock, WA, e-mailed me saying:

       Please act quickly to pass another extension 
     of unemployment benefits. My wife and I are in danger of 
     losing our house and have run out of unemployment. Please 
     help us.

  Donna Dettling from Olympia, WA, said:

       My extended benefits will run out in 7 weeks. I am a single 
     mother with three boys and I have been trying for months to 
     get work but have been unsuccessful. If the Senate does not 
     come to an agreement soon, we may end up homeless. Can you 
     please do what you can to push this forward?

  Then there is Barbara Headrick from Monroe, WA. She wrote to me and 
said:

       Dear Patty, I am desperate for the Senate to pass the 
     emergency unemployment benefits legislation. I cannot find a 
     job, have no income, and am in danger of losing my house as 
     well as my utilities. Please, please, please urge all the 
     Senators to pass this emergency legislation as soon as 
     possible.

  Those are just three quick e-mails from thousands of letters I have 
received from across my home State of Washington. We owe it to these 
workers, to their families, and to millions more like them to pass this 
legislation and not continue to delay it so that they can get the 
support they need.
  These men and women who are writing me and stopping me when I am home 
did not expect to have to ask for help. They had jobs. They felt 
secure. But now they are spending their days desperately looking for 
work that is not available. They are worrying about what will happen to 
them, and they are worrying about their families when their savings are 
exhausted and their credit cards are maxed out and the bank will not 
wait any longer for a mortgage payment.
  We cannot continue to go hour after hour after hour delaying this 
when our working families are pushed to the brink by a financial crisis 
that they did not create but for which they are paying. We need to pass 
this legislation.
  By the way, this bill is going to do a lot more for our families, 
businesses, and communities. It will expand and extend the successful 
home buyers tax credit that will allow our families the opportunity to 
move into homes and make sure that our weakened housing market 
continues on the road to recovery.
  This is a program that has already helped many families purchase 
their first homes. This bill will extend the $8,000 credit to first-
time homebuyers through the end of April 2010 and expand the program 
providing a $6,500 credit to new purchasers who have lived in their 
current home for 5 years or more.
  These programs will not only help families move into new homes; they 
will also increase liquidity and provide a shot in the arm to housing 
markets that still need a lot of support.
  I have heard from real estate agents, from homebuilders, from 
families from every corner of Washington State, and they all tell me 
they have to have this extension. I received letters from families 
telling me they want to buy a new home but they cannot close in time to 
get this credit and they would not be able to afford a new home without 
it.
  Thousands of homebuilders, construction workers, and real estate 
agents have contacted me telling me how successful this credit has been 
and how an extension and expansion would create jobs and give the 
housing market another strong push forward.
  This bill will also provide a critical boost to businesses in 
Washington State by extending their ability to carry back losses they 
suffered in 2008 or 2009. That is a tax provision that will provide 
badly needed capital to help our companies avoid layoffs, expand their 
operations, and create jobs.
  We have heard a lot today about this concept of too big to fail. 
Well, in this time of nationwide economic uncertainty, I believe the 
millions of families and Main Street businesses that are on the brink 
are certainly too important to fail, and they deserve every bit of 
support we can give them to allow them to get back on their feet. So 
the Worker, Homeownership, and Business Assistance Act of 2009 will 
help bring these families, businesses, and communities back from the 
precipice.
  I urge our colleagues to support and pass this critical legislation. 
It is surprising to me that we have to wait hour after hour after hour 
after hour, when we know the votes are there, simply because somehow 
delaying this bill is some kind of win for whoever is delaying it. It 
is not a win for Washington families who have to stay awake one more 
night worrying about how they are going to buy food or pay their 
mortgages or keep their families intact.
  I urge my colleagues to stop the delaying tactics and allow this bill 
to come to a vote.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. Mr. President, I would echo the words of Senator Murray, 
who has worked perhaps harder than anyone in this institution to extend 
unemployment benefits.
  I don't get it. Sometimes around here politics has a role. Certainly 
we have

[[Page S11029]]

two political parties, and we have a couple of Independents. In both 
the House of Representatives and in the Senate that happens. But on 
this one, on extending unemployment benefits, 90 percent of the country 
agrees on that. It is not a welfare program, it is unemployment 
insurance. People pay into it. It is to help people who want to work, 
who have lost their jobs, and would like to get back into the 
workplace.
  We have been trying to get this passed for 3 weeks, and the fact that 
this has not passed, I guess, indicates there are some Republicans who, 
frankly, don't much like unemployment insurance. It is a government 
program, so they do not like it--just as some number of Republicans 
don't like minimum wage or they don't like workers compensation or 
Medicare. They don't believe government has a role in some of these 
things. That is particularly difficult to swallow when it comes to 
unemployment insurance.
  Senator Murray mentioned the number of e-mails she has received from 
people in her State. I get e-mails and letters from Ohioans--from Lima, 
Xenia, Springfield, Zanesville, Bellaire, and Ravenna--all the time, 
from people who didn't know they were going to be unemployed. They have 
worked hard, played by the rules, paid their taxes, kept their houses 
nice, kept their neighborhoods strong, and they lost their jobs. They 
are looking and looking and looking and can't find a job.
  With an unemployment rate that is more than 10 percent in my State, 
all we are saying is give them an extension of unemployment so they can 
keep looking and keep putting food on the table. Unfortunately, some 
Republicans--not a majority of Republicans but some number of 
Republicans--think there is no role for government. They don't like 
Medicare, they don't like minimum wage or workers compensation, and 
they don't like unemployment compensation. It is a tragedy because, 
frankly, I don't think they are representing the people in their States 
very well.
  Almost nobody--almost no real people except for a bunch of people who 
dress like this and hang around this Chamber and down the hall in the 
House of Representatives--thinks that way. There are not many people 
who think unemployment shouldn't be extended.
  An hour or so ago, Senator Harkin had a hearing in the HELP Committee 
about the increasing health costs facing small businesses. We had a 
panel of five people who spoke, a couple of them small business owners 
who have been victimized by these huge health care costs.
  I want to start with this--the business model of an insurance company 
and a health insurance company. Not all of our problems with health 
insurance in this country--but a big part of our problems--are due to 
the behavior of the insurance industry. Think of it this way. The 
bottom line for the insurance companies is money. They need to make 
money. They want to make money. They should make money. But their 
business model is this: Hire a bunch of bureaucrats to figure out how 
to refuse to sell insurance to people who have preexisting conditions; 
and on the other end, hire a bunch of bureaucrats to stop from paying 
claims for people they are insuring when they get sick. That is how 
they make their money. They do not insure people with preexisting 
conditions, and then they sometimes do not pay up on claims when people 
get sick.
  Something like 30 percent of health insurance claims on the first 
round are denied--30 percent. That is almost one in three. Sometimes 
people fight with their insurance companies and end up getting their 
claims paid, but why should they have to do that? They pay for 
insurance year after year after year, and the insurance company makes 
money on them year after year after year. Then, after they get sick, 
sometimes their claims aren't paid. Sometimes when they get really 
sick, the insurance companies do something called rescission--they cut 
them out and take their insurance away from them.
  So when we start with that business model, it is obvious what 
happens. The CEO of Aetna made $24 million last year. Insurance company 
profits over the last 7 years have gone up 400 percent. The salaries of 
the executives, the CEOs, of the top 10 largest insurance companies in 
this country average $11 million. So in order to make that kind of 
profit, in order to make that kind of CEO salary--not to mention the 
salaries of other vice presidents and top executives--I guess that is 
the business model they need. They need to deny people with a 
preexisting condition from even getting insurance; then, on the other 
end, hire a bunch of bureaucrats to keep people from getting their 
claims paid for. That is why insurance reform is so very important. 
That is why this legislation is so very important.
  So today, in our committee--the committee on which Senator Sanders 
also sits, who joins me now on the Senate floor--we had this hearing on 
the increasing health care costs facing small businesses because this 
whole insurance company model of denying coverage because of 
preexisting conditions and then denying claims when people file them 
particularly hurts small businesses. When the insurance companies do 
that, small businesses in particular are victimized by it. Small 
businesses pay more for their insurance. If they have 10 employees and 
one gets very sick, the prices for the whole insurance plan for that 
small business get so out of whack they often have to cancel coverage 
or they simply can't afford it.
  So what is coming out of this health care hearing and what we are 
doing in our legislation that is so important. We have worked on 
creating this health insurance exchange which will allow small 
businesses to pool their risks and leverage better deals from insurers. 
So instead of a small business of 12 people trying to buy insurance, 
they get to join a health insurance exchange with millions of 
customers, millions of individuals, tens of thousands of small 
businesses. Then, if a few people get sick in one small business, their 
rates don't spike up; they have a much larger pool to keep prices in 
check.
  Small businesses pay about 18 percent more than large companies per 
capita for their insurance. They pay higher broker fees, higher 
administrative costs. They have the high cost of medical underwriting. 
So the result is an unfair competitive disadvantage for small 
businesses.
  One of the other things we do for small businesses in this 
legislation is to give tax breaks so a small business can take its 20 
employees and they can go into the insurance exchange and, if they 
choose to, they can go into the public option. The public option is 
there for several good reasons. The public option is just an option. It 
doesn't mean they can't go into Cigna, Aetna, Blue Cross, or Wellpoint. 
They can choose Medical Mutual, a not-for-profit in Ohio, or they can 
choose the public option. The public option will mean competition for 
insurance companies in southwest Ohio, where two companies have 85 
percent of the insurance in that part of Ohio--the Cincinnati area.

  When two companies have 85 percent, you can bet they are getting 
lower quality and they are paying higher cost. If we put the public 
option in there to compete with them, it will help to drive down cost, 
stabilize cost, and it will mean better quality insurance. They don't 
have to choose the public option, but the fact it exists helps.
  The other thing the public option will do is to keep these insurance 
companies much more honest. We are going to outlaw denying coverage due 
to preexisting conditions. No more discrimination based on disability, 
on geography, on gender, or any of that.
  The pages sitting in front of us--these young men and young women who 
aren't paying for their insurance yet--if we don't change anything, 
when the young women finish school and go out into the insurance 
market, they will pay higher rates than the young men will. So there 
are all kinds of discrimination that we are going to outlaw in this 
bill, but we need the public option to make sure these insurance 
consumer protection reforms are actually in force.
  Let me close. Attending today's committee hearing was a businesswoman 
from Ohio whom I met. Her name is Liz Coriell. She owns a business in 
Cleves, OH, outside Cincinnati, in the southwestern part of the State. 
She owns a medical gas servicing company, but she

[[Page S11030]]

can't afford health insurance for her workers. Her sons were going to 
come and work in the business, as her husband does--her husband is 65 
and has Medicare, so not a problem for him. She is not 65. Her sons 
would like to join the business, but they can't get insurance because 
she can't afford it for this small business.
  Why do we have a health insurance system that says to her sons: You 
can't come and work in your parents' family business because you can't 
get insurance, so it is not going to work out? Why do we allow that? 
Why don't we encourage these families to stick together--you know, 
family values--to help them go into the family business, if they want 
to, and not be denied.
  I come to the floor of the Senate many times--I will not today 
because Senator Sanders is waiting to speak--and I share letters I 
receive from people in Ohio. This one is from Cleveland. This one is 
from Mansfield where I grew up. Others are from Springfield, Dayton, 
and all over.
  Two things come through in these letters. One is that people thought 
they had good insurance until they got sick. Then they found out, well, 
maybe they lost their insurance because they got really sick or maybe 
they had a baby born with a preexisting condition, and then their 
insurance was canceled.
  The other thing I find is that it is affecting people like Liz from 
Cleves, OH, in southwestern Ohio. Liz is several years away from 
Medicare, but she is thinking about several years from now being 
eligible for Medicare, when she wouldn't have to worry about this. I 
get letters from people in their early sixties and late fifties who are 
just anxious and thinking: I am only 2 or 3 or 6 years away from 
Medicare, and then I will not have these problems with insurance. Then 
it will be predictable, and it will be stable.
  Why can't we do that for everybody now? So whether they are 26 or 46 
or 64--not quite eligible--why can't we take away that anxiety and 
build peace of mind for people so they don't have to worry about 
whether they can get insurance or whether they are going to be denied 
or going to have to fight insurance companies to get doctor bills paid? 
Let's take that anxiety off the table so Americans can concentrate on 
their small businesses and raising their kids and fixing up their 
neighborhoods. Let's let them concentrate on giving something back to 
this society and not always worrying about their health insurance.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, let me begin by congratulating my friend, 
Senator Brown of Ohio, for his leadership in this struggle for 
fundamental reform of the American health care system. He understands, 
as I do, that there is something absurd about a situation in which we 
as a nation end up spending almost twice as much per person on health 
care as any other nation on Earth; yet we end up with tens of millions 
of people who are uninsured, people who are underinsured, and we have 
almost 1 million Americans this year who are facing bankruptcy because 
of medically related illnesses.
  As Senator Brown just talked about, understanding that small 
businesses are the economic engine of this country, there is something 
absurd when we have small businesses desperately trying to provide 
health insurance for their employees but are finding it harder and 
harder to do so. So I want to congratulate Senator Brown for the work 
he is doing on health care.
  As I think every American understands, we are in the midst of the 
worst economic crisis since the Great Depression. I find it interesting 
that there are some people out there, some economists, including the 
Chairman of the Federal Reserve, Mr. Bernanke, who have told us ``the 
recession is very likely over.'' I suggest to Mr. Bernanke, come to the 
State of Vermont, go to California, go to Nevada, go to Ohio, go to any 
State in the country and go out on the street and ask people whether 
they think this recession is over. They will say it may be over for the 
large banks that were bailed out by taxpayers but it is not over for 
working families. In fact, according to the latest Washington Post/ABC 
News poll, 82 percent of Americans disagree with Mr. Bernanke. The 
overwhelming majority of the American people do not believe the 
recession is over. Of course, they are right. The recession may be over 
for banks that are now starting to be profitable, for Goldman Sachs, 
which is paying out huge bonuses to its top executives, but trust me, 
on Main Street, on family farms all over this country, in factories all 
over this country, this recession most certainly is not over.

  Since the beginning of this recession in December of 2007, 7.6 
million Americans have lost their jobs. The official unemployment rate 
has doubled, going from 4.9 percent to 9.8 percent. But what is 
extremely important to understand when we look at the economy today is 
that the official unemployment statistics do not reflect the reality of 
what is going on in our economy. Official statistics do not include 
people who have given up looking for work. If you are in a community 
where 15 or 20 percent of the people are unemployed, you have given up 
looking for work, but you are not part of the official unemployment 
statistics. What happens if you want to work 40 hours a week but you 
can only find a job for 20 hours a week or 25 hours a week? You are 
also not in the statistics.
  The reality is, if you add all those factors together, people who are 
officially unemployed, people who have given up looking for work, 
people who are working part time when they want to work full time, what 
you are looking at is 17 percent of working-age Americans today are in 
that category, which adds up to 27 million Americans--an astronomical 
number. That is an indication of a real catastrophe in our economy.
  Mr. Bernanke, I am sorry to disagree with you, but in my view and in 
the view of the vast majority of the American people, this recession is 
not over. In fact, in terms of unemployment numbers, it may, in fact, 
even be getting worse.
  On the issue we are dealing with right now, we have to address long-
term unemployment. It is one thing to lose your job and get another job 
a few weeks later. It is another thing not to be able to find a job 
month after month, and there are millions of Americans in that 
category.
  Today, 5.4 million Americans have been unemployed for over 6 months--
the highest on record. Long-term unemployment is a major crisis in this 
country. It is one we have to address. It is one we have to deal with 
in terms of extending unemployment benefits. The average length of 
unemployment is now 27 weeks. That is over 6 months. That is over half 
a year. That is the longest since the end of World War II.
  There are fewer jobs in America today than there were in the year 
2000, even though the workforce has grown by 12 million since then. 
This is a shrinking workforce. We now have the fewest manufacturing 
jobs than at any time since April of 1941, 8 months before the start of 
World War II. The importance of that is that manufacturing was the 
mechanism by which working families were able to carve out a middle-
class existence. They had decent wages, decent benefits. They had a 
union. They may have had a pension program. But today we have the 
fewest manufacturing jobs since April of 1941.
  Home foreclosures are the highest on record, turning the American 
dream of home ownership into an American nightmare for millions of 
people.
  There is nothing we should be proud of in saying this: Today, in the 
industrialized world, the United States has the highest rate of 
childhood poverty. We have the highest infant mortality rate. We have 
the highest overall poverty rate. At the same time, we have the largest 
gap between the wealthy and everybody else. What we have seen for a 
number of years is a collapse in the middle class. It has certainly 
gone on a lot longer than since the financial collapse. But we have 
also seen an increase in wealth amongst the top 1 percent. That gap 
between the very rich and everybody else is growing wider and wider. 
From a moral perspective, not to mention an economic perspective, we 
have to address the reality that the top 1 percent today earns more 
income than the bottom 50 percent. The top 1 percent owns more wealth 
than the bottom 90 percent. We are becoming two very different 
countries: people on top with incredible wealth--CEOs on Wall Street 
making hundreds and hundreds of millions of dollars, billions of 
dollars in a hedge

[[Page S11031]]

fund--yet working people seeing their incomes decline, working longer 
hours for low wages. Actually, today a two-income family has less 
disposable income than a one-income family did 30 years ago. That is 
what is going on in America--poverty increasing, middle-class 
shrinking, the gap between the very richest and everybody else growing 
wider.
  This is an important point to make. We know what happened on Wall 
Street a little over a year ago. We know what that collapse has done. 
We know that the outrageous behavior on Wall Street has precipitated us 
into this very severe recession. But we should not kid ourselves. If by 
some miracle tomorrow we manage to go back to where we were before the 
financial collapse on Wall Street, we would still be in very bad shape. 
It isn't a question of, weren't things great before the collapse on 
Wall Street and the development of this major recession--no, things 
were not great back then.
  Let me just mention what happened during the Presidency of George 
Bush. Let me talk a little bit about what happened during that 8-year 
period.
  When President Bush was in office from the year 2000 to 2008, 8.2 
million more Americans slipped out of the middle class and into 
poverty. That is what happened during that period. I might mention, you 
may recall--it is really frightening to think about it--how during much 
of that period the Secretary of Treasury and the President were saying 
the economy is robust, the gross national product is expanding. But 
that was the reality for working families--people slipping out of the 
middle class and into poverty.
  During that same period--we are dealing with health care right now. 
One of the reasons we need a national health care program guaranteeing 
health care to all people is during that same period, 7.8 million more 
Americans were uninsured; they lost their health insurance. We are now 
up to about 46 million people without any health insurance. That number 
is going up every single day. During the Bush era, close to 8 million 
Americans lost their health insurance.
  During the years 2000 to 2008, 4.5 million manufacturing jobs 
disappeared. I talked a moment ago about the importance of 
manufacturing. I know it is not a sexy job, but it was a means by which 
millions of Americans went to work every day, they produced real 
products, they had real income. It was a vehicle--manufacturing was and 
is a vehicle by which working Americans could make it into the middle 
class.
  During the Bush tenure, 3.2 million workers lost their pensions, with 
the result that about half of American workers in the private sector 
today have no pension whatsoever. There was a time--I know it is a 
radical idea to even think about--there was a time when millions of 
Americans who worked had a defined pension plan, a defined benefit 
pension plan. They actually knew they were going to have a pension. 
Boy, what a radical idea. That does not exist anymore.
  During the Bush era, median household income declined by over $2,100, 
from $52,500 to $50,303. According to an article that appeared a couple 
of months ago in USA TODAY, from 2000 to 2008 middle-class men 
experienced an 11.2-percent drop in their incomes, a reduction of 
$7,700 adjusting for inflation. That is unbelievable. During that 
period, middle-class men saw an 11-percent drop in their income. 
Middle-class women in this age group saw a 4.8-percent decline in their 
incomes as well.

  The important point to be made here is when you hear economists 
talking about the economy in abstract ways--we have 3 percent growth in 
this quarter; isn't that great? Yes, that is an important fact, but it 
is not the most important fact. The most important fact is what happens 
to ordinary people. This is what happens to ordinary people. People who 
were 45 to 54 years of age lost $7,700 in the Bush economy. That is 
true today, it was true then. Focus on what is happening to ordinary 
people.
  With all of that, with the long-term trends in which the middle class 
has declined, with the fact that since the greed and illegal behavior 
of Wall Street has gotten us into the deep recession we are in right 
now, working families all over this country are desperately in need of 
help, and they are looking to their Federal Government to provide that 
help. That is why it is so important that we pass an extension in 
unemployment benefits. I find it hard to understand, why my Republican 
colleagues continue to delay this legislation being implemented.
  We have to do more than that. We have to extend unemployment--that 
goes without saying--but we have to do more than that. We have to ask 
ourselves why our economy is in the shape it is right now. That will 
precipitate a major debate and major discussion, something we as a 
nation have to have. We have to ask ourselves not just the causation of 
the recession we are in right now, the role Wall Street has played, 
but, long term, why since the early 1970s has the middle class 
continued to shrink? What are the causes of that? Why do we have the 
highest rate of poverty of any major nation on Earth? Why is it today 
that people are losing their homes and their pensions and their life 
savings and their ability to send their kids to college?
  Clearly, short term it is imperative that we investigate thoroughly 
and that we hold accountable those crooks on Wall Street who have done 
so much damage to the American people. It is simply not acceptable that 
they be allowed to continue the behavior that drove this country into 
the severe recession. We need to understand how it happened, we need to 
hold accountable those people who caused this crisis, and where there 
is illegal behavior, those people should learn what the penal system of 
this country is about.
  One of the things that really amazes me is that I have yet to see, 
nor have the American people yet seen, one of those folks on Wall 
Street whose greed and recklessness has caused this recession, has 
caused this intense suffering all over this country--have you seen one 
of those guys go before television, get on TV and say to the American 
people: I apologize. I am sorry for our greed. I am sorry for the fact 
that we cost millions of people their jobs and their health care and 
their savings and their pensions. We are sorry.
  I have not seen that. In fact, what we are seeing is these guys on 
Wall Street spending millions of dollars every day, every week, every 
month on lobbying in order to make sure we do not bring about the 
reforms to prevent them from continuing to do what they did, which 
caused this recession. These guys live in a world of their own, a world 
of entitlement. They do not seem to understand their actions have 
widespread consequences in terms of destroying the economic well-being 
of millions of people. All they seem to think about is, I only made 
$100 million last year. I can't get by on that. I need my 18th home or 
16th car and 18th country club membership. For them, enough is never 
enough--more and more greed and more and more selfishness. That is an 
issue we have to deal with.
  It only took a couple of weeks for Congress to give Wall Street the 
largest bailout in history, some $700 billion. But the truth is, up 
until this point we have done very little to make sure this financial 
crisis does not occur again. These guys want to go right back to where 
they were. They want the freedom to speculate, the freedom to convert 
their financial institutions into large gambling casinos. The Federal 
Government has provided $182 billion to AIG, $50 billion to Citigroup, 
$50 billion to Bank of America, a $25 billion bailout to Wells Fargo, a 
$25 billion bailout to JPMorgan Chase, and on and on it goes. Yet we 
have asked them for nothing in return. Here are tens of billions of 
dollars. What are you going to do? What are you going to do for the 
American people who have bailed you out?
  I know reforming the banking sector is not going to be easy. After 
all, the banking and insurance lobbyists have spent over $5 billion on 
campaign contributions and lobbying activity over the past decade in 
support of deregulation. They were all over this place telling us, 
telling the Congress: Just trust us. Deregulate us. Let us do what we 
want to do. We are going to create wealth for all the American people.
  There were some of my colleagues who actually believed that. I 
happened not to be one of them, but some of them did, and we 
deregulated and we let them do whatever they wanted to do and we are 
where we are today.

[[Page S11032]]

  In 2007 alone, if you can believe this--this is what goes on--the 
financial sector employed nearly 3,000 separate lobbyists to influence 
Federal policymakers. Got that. There are 100 Members of the Senate, 
435 in the House--that equals 535 Members of Congress--and they had 
nearly 3,000 individual lobbyists to influence Federal policymaking. 
Over a 10-year period, they spent $5 billion.
  And that, my friends, is why the rich get richer and almost everybody 
else gets poorer. We have to address the issue of Wall Street. Let me 
make some suggestions as to what we have to do.
  We need, in fact, a thorough investigation as to how this happened 
and we need to hold those people accountable. I hope we can do that. I 
think the American people are asking questions, and they are right to 
demand answers. But what we also have to do is to deal with this issue 
of ``too big to fail.'' What I have said ever since this financial 
crisis began is: If a financial institution is too big to fail, that 
financial institution is too big to exist.
  We need to do exactly what Teddy Roosevelt did back in the trust-
busting days, and we need to start to break up these huge financial 
institutions. We cannot continue to be held hostage by them such that 
if they fail, they take down the entire system with them so we have to 
prop them up and bail them out.
  I would mention, interestingly enough, that is exactly what they are 
doing right now in the United Kingdom. Let me quote from the Washington 
Post:

       The British government announced Tuesday that it will break 
     up parts of major financial institutions bailed out by 
     taxpayers. The British government, spurred on by European 
     regulators, is set to force the Royal Bank of Scotland, 
     Lloyds Banking Group and Northern Rock to sell off parts of 
     their operations. The Europeans are calling for more and 
     smaller banks to increase competition and eliminate the 
     threat posed by banks so large that they must be rescued by 
     taxpayers no matter how they conducted their business, in 
     order to avoid damaging the global financial system.

  And you know what. Our friends in the U.K. are doing exactly the 
right thing. That is what we should be doing. But that is not just my 
opinion. A growing number of experts, both on the left and on the 
right, are coming to the same conclusion.
  On October 15, Alan Greenspan, probably the man more than any other 
individual responsible for the deregulatory efforts which led to this 
financial crisis, admitted last year that his views on deregulation 
were wrong. He was quoted in Bloomberg News as saying:

       If they are too big to fail, they are too big. In 1911 we 
     broke up Standard Oil--so what happened? The individual parts 
     became more valuable than the whole. Maybe that's what we 
     need to do.

  Alan Greenspan, the man whose deregulatory leadership helped create 
this disaster, now perhaps understands that that whole philosophy of 
deregulation, letting big banks do whatever they want, letting them 
merge with insurance companies, maybe was not quite right.
  Former Fed Chairman Paul Volcker, who has advised the Obama 
administration, supports breaking up big banks so that they no longer 
pose systemic risks to the entire economy. During a recent article in 
the New York Times, Volcker says:

       People say I'm old fashioned and banks can no longer be 
     separated from nonbank activity. That argument brought us to 
     where we are today.

  Absolutely right. The New York Times said that under Volcker's plan:

       JPMorgan Chase would have to give up the trading operations 
     acquired from Bear Stearns. Bank of America and Merrill Lynch 
     would go back to being separate companies. Goldman Sachs 
     could no longer be a bank holding company.

  In my view, that is exactly what needs to happen. What insanity that 
when individuals lose their health insurance, tough luck; small 
businesses go bankrupt, tough luck; but if you are a large financial 
institution and you acted in a legal greedy way, we say: Hey, no 
problem. Taxpayers of this country are here to bail you out, because if 
we don't bail you out, you are going to bring down the entire economy. 
That is absurd. We have got to end that.
  Robert Reich, President Clinton's former Labor Secretary, said:

       No important public interest is served by allowing giant 
     banks to grow too big to fail. Wall Street giants should be 
     split up--and soon.

  I agree with former Secretary Reich.
  Let me touch on a few other issues we have to have the courage to 
deal with. I get calls all the time. I do a national radio show--get it 
on the radio show, get it from Vermont. People are saying, We bailed 
out these large financial institutions and what they then do is say 
``thank you'' and they raised my interest rates on my credit card to 25 
or 30 percent.
  That is outrageous. That is usury. We need to pass national usury 
laws. The truth is, today one out of four credit card holders in this 
country is paying interest rates above 20 percent, as high as 41 
percent, more than double what they paid in interest in 1990.
  What we need to do is pass national usury legislation. I have 
introduced legislation that would mandate that the maximum interest 
rates that could be charged would be 15 percent. The reason I came up 
with that number is that is exactly what credit unions are doing today, 
15 percent, except under unusual circumstances.
  I am proud that on that bill we have as cosponsors Senators Durbin, 
Leahy, Levin, Harkin, and Whitehouse. That is what we have to do. It is 
immoral. It is wrong for these large companies to be charging 25 or 30 
percent interest rates.
  It goes without saying that as we take a look at Wall Street, we have 
to reregulate those institutions. We have to take a hard look at 
bringing back Glass-Steagall in one form or another.
  Lastly, we also need more transparency at the Federal Reserve. Last 
year when Secretary Bernanke came before the Budget Committee, I asked 
him a very simple question. I said: Mr. Chairman, my understanding is 
that you have lent out over $2 trillion at zero interest to some of the 
largest financial institutions in America. Can you tell me who got the 
money? I mean, you are putting taxpayer money at risk. Who received 
this $2 trillion-plus dollars? And, amazingly enough, what Mr. Bernanke 
said is: No, I am not going to tell you. It is a big secret. I cannot 
tell you.
  Well, on that day we introduced legislation that would mandate that 
he tell us, and also we would bring about a GAO audit of the Fed. The 
Fed, especially since the financial collapse, has assumed an enormous 
amount of power, and the American people have a right to have more 
transparency there.
  Let me conclude by saying that anybody who thinks this recession is 
over has obviously not talked to real people. Millions of people are 
hurting. Millions of people are frightened. They are looking to us for 
some help in terms of extending unemployment benefits, but they are 
also looking to us to understand the causation of this problem, and to 
work on economic ideas which will prevent a continued collapse of the 
middle class in this country.
  We have got a lot of work on our hands, and I look forward to working 
with you.
  I yield the floor.


                        Employment Disincentives

  Mr. LIEBERMAN. Mr. President, first, let me take this opportunity to 
commend the chairman and the other members of the Finance Committee on 
their collective efforts to extend benefits to those unemployed 
Americans who still face a tough job market in this difficult 
recession. Second, I would like to engage my good friend and colleague, 
the Senator from Montana and the chairman of the Committee on Finance, 
in a colloquy on a subject of utmost importance to the men and women 
who are currently unemployed. Specifically, I am concerned that under 
the current unemployment insurance, UI, extensions there may be 
disincentives for unemployed Americans to seek reemployment.
  Mr. Chairman, I believe we can agree that unemployed adults who want 
to return to work should be given every incentive to return to work 
even if they accept part-time jobs or lower wages. This benefits not 
only those individuals and their families but also strengthens our 
national economy. However, it has come to my attention that many 
Americans who knew they were doing the right thing by accepting a job, 
even at greatly reduced wages from their previous employment, would

[[Page S11033]]

have been better off turning down meaningful work.
  Mr. BAUCUS. I thank the Senator from Connecticut, Mr. Lieberman, for 
bringing this matter to my attention. We certainly want to avoid a 
policy that inadvertently discourages Americans from returning to work.
  Mr. LIEBERMAN. Mr. President, I became aware earlier this year that 
some of my constituents in Connecticut are being penalized for working 
either part time or temporarily after first receiving emergency 
benefits. Further investigation shows that this problem is becoming 
more prevalent to varying degrees in many States and possibly all 50 
States. Under current EUC extensions, if one receives emergency 
compensation and a year passes with no recorded work history, those 
benefits can continue uninterrupted while that person seeks employment. 
The problem often occurs, however, when a person takes a job, either 
part-time or short-term work, at much reduced wages compared to their 
previous employment. Because this lower wage work automatically 
qualifies them for reduced State benefits, Federal law now requires 
that they can no longer receive the much needed emergency extended 
compensation.
  In a particular case, one of my constituents, a woman who worked on 
behalf of Connecticut children for 28 years before losing her job, was 
receiving the Federal benefits she was entitled to. But when this 
woman, who is the sole caregiver of her 88-year-old father, took a 
minimum-wage job 2 days a week, her benefits dropped from $483 per week 
to $38 per week. She would have been better off financially had she not 
returned to work and instead stayed home to care for her ailing father.
  I am also advised by my State's labor department that many other 
constituents are becoming aware that taking employment at this time may 
disadvantage them, and some are therefore less inclined to accept 
employment. I also am told that more and more States are facing this 
problem and that the problem will grow as this recession continues. I 
hope the Finance Committee will look into this issue and consider 
legislative language which I have suggested to address this problem.
  Mr. BAUCUS. Again, I thank my colleague for bringing this matter to 
my attention. You raise a serious concern, and I can assure you my 
committee will take a look at the issues you raise.
  Mr. LIEBERMAN. Thank you, Mr. Chairman.


                            vote explanation

  Mr. ISAKSON. Mr. President, I was unavoidably detained during 
rollcall vote No. 332 on the motion to invoke cloture on the Reid/
Baucus substitute amendment No. 2712 to the unemployment insurance 
extension bill H.R. 3548.
  Had I been present I would have voted yea for rollcall vote No. 332 
and ask that the Record reflect that.
  Mr. CONRAD. Mr. President, section 306(f) of S. Con. Res. 13, the 
2010 budget resolution, permits the chairman of the Senate Budget 
Committee to adjust the allocations of a committee or committees, 
aggregates, and other appropriate levels in the resolution for 
legislation that reduces the unemployment rate or provides assistance 
to the unemployed, particularly in the States and localities with the 
highest rates of unemployment, or improves the implementation of the 
unemployment compensation program. In addition, section 306(b) permits 
the chairman to adjust the allocations of a committee or committees, 
aggregates, and other appropriate levels for legislation providing tax 
relief or refundable tax relief. These adjustments to S. Con. Res. 13 
are contingent on the legislation not increasing the deficit over 
either the period of the total of fiscal years 2009 through 2014 or the 
period of the total of fiscal years 2009 through 2019.
  I find that S.A. 2712, an amendment in the nature of a substitute to 
H.R. 3548, the Unemployment Compensation Extension Act of 2009, 
fulfills the conditions of the deficit-neutral reserve fund for 
unemployment mitigation. Therefore, pursuant to sections 306(f) and 
306(b), I am adjusting the aggregates in the 2010 budget resolution, as 
well as the allocation to the Senate Finance Committee.
  I ask unanimous consent that the following revisions to S. Con. Res. 
13 be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2010--S. CON. RES. 
 13; REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION 306(f) 
 DEFICIT-NEUTRAL RESERVE FUND FOR UNEMPLOYMENT MITIGATION AND SECTION 
           306(b) DEFICIT-NEUTRAL RESERVE FUND FOR TAX RELIEF

                        [In billions of dollars]

        Section 101
(1)(A) Federal Revenues:
    FY 2009...................................................1,532.579
    FY 2010...................................................1,614.788
    FY 2011...................................................1,935.431
    FY 2012...................................................2,137.235
    FY 2013...................................................2,298.817
    FY 2014...................................................2,520.688
(1)(B) Change in Federal Revenues:
    FY 2009.......................................................0.008
    FY 2010.....................................................-51.198
    FY 2011....................................................-153.200
    FY 2012....................................................-223.158
    FY 2013....................................................-216.520
    FY 2014....................................................-112.970
(2) New Budget Authority:
    FY 2009...................................................3,675.736
    FY 2010...................................................2,898.207
    FY 2011...................................................2,845.866
    FY 2012...................................................2,848.108
    FY 2013...................................................3,012.328
    FY 2014...................................................3,188.867
(3) Budget Outlays:
    FY 2009...................................................3,358.952
    FY 2010...................................................3,010.241
    FY 2011...................................................2,971.521
    FY 2012...................................................2,883.055
    FY 2013...................................................3,019.952
3,175.217............................................................
                                  ____



CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2010--S. CON. RES. 
 13; REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION 306(f) 
 DEFICIT-NEUTRAL RESERVE FUND FOR UNEMPLOYMENT MITIGATION AND SECTION 
           306(b) DEFICIT-NEUTRAL RESERVE FUND FOR TAX RELIEF

                        [In millions of dollars]

Current Allocation to Senate Finance Committee:
    FY 2009 Budget Authority..................................1,178,757
    FY 2009 Outlays...........................................1,166,970
    FY 2010 Budget Authority..................................1,231,628
    FY 2010 Outlays...........................................1,232,134
    FY 2010-2014 Budget Authority.............................6,851,258
    FY 2010-2014 Outlays......................................6,850,666
Adjustments:
    FY 2009 Budget Authority..........................................0
    FY 2009 Outlays...................................................0
    FY 2010 Budget Authority......................................5,708
    FY 2010 Outlays...............................................5,708
    FY 2010-2014 Budget Authority.................................6,639
    FY 2010-2014 Outlays..........................................6,639
Revised Allocation to Senate Finance Committee:
    FY 2009 Budget Authority..................................1,178,757
    FY 2009 Outlays...........................................1,166,970
    FY 2010 Budget Authority..................................1,237,336
    FY 2010 Outlays...........................................1,237,842
    FY 2010-2014 Budget Authority.............................6,857,897
    FY 2010-2014 Outlays......................................6,857,305

  Mr. BUNNING. Mr. President, I support the substitute amendment before 
us.
  The national unemployment rate is now 9.8 percent. In Kentucky, the 
unemployment rate is 10.9 percent. Millions of Americans are searching 
for work, and too many families are struggling and uncertain about 
their future. This is unacceptable.
  When Congress passed the so-called stimulus bill earlier this year 
that cost $787 billion, not counting increased interest payments on the 
national debt, our national unemployment rate was 8.1 percent. Clearly, 
this costly legislation has failed to stop the bleeding of jobs from 
the American economy.
  The bleak job picture makes it necessary to consider another 
extension of unemployment benefits. But if you talk to Americans who 
are searching for work, the best unemployment benefit we could extend 
to them is a high-quality job.
  That is why I believe it is so important to include provisions in 
this bill that will actually create jobs and reduce unemployment. Over 
2 weeks ago, I proposed an amendment that would provide net operating 
loss relief to businesses so they can hire and retain workers.
  I also strongly supported Senator Isakson's efforts to extend the 
home buyer tax credit, which is critical for the millions of jobs that 
depend on the housing industry.

[[Page S11034]]

  On October 27, I voted against cloture on the motion to proceed to 
this bill because there was no guarantee that a vote would be allowed 
on these two crucial provisions to improve the job situation for 
Americans.
  Today, this substitute amendment includes both of these job-creating 
provisions.
  Regarding net operating losses, businesses are generally allowed to 
offset their income with losses. Under current law, they can carry 
these losses back for 2 years and carry them forward for 20 years. In a 
difficult economy where businesses have experienced devastating losses, 
they may go out of business before they can recover their own money, or 
they may hang on and gradually recover their money when they return to 
profitability.
  During tough economic times, Congress has extended the net operating 
loss carryback from 2 to 5 years so businesses can apply for immediate 
refunds. The logic behind this is that businesses should have access to 
their own money when it can do the most good and prevent massive 
layoffs. In an economic crisis, it makes no sense to delay tax refunds 
until some uncertain, distant point in the future. Businesses may not 
survive in the future if they do not have access to their own money 
today.
  This relief is especially important in today's climate, where 
businesses find it increasingly difficult to get credit from banks.
  That is why I am pleased that this substitute amendment responded to 
my call for substantial net operating loss relief, which will allow 
businesses to create and keep jobs. It also includes Senator Isakson's 
extension and expansion of the home buyer credit, which will stimulate 
jobs in the housing industry. The crisis in the housing market was a 
root cause of our economic crisis and it is essential to extend this 
temporary tax credit to help stabilize the market.
  This amendment is not perfect. It is unfortunate that the 
unemployment benefit extension is financed by imposing taxes on 
businesses, and the net operating loss and home buyer provisions are 
offset by delaying tax relief that would make American businesses more 
competitive internationally. I had proposed an offset to my net 
operating loss amendment that would not have raised taxes or delayed 
tax relief, and my amendment would have provided more relief for job 
creation. However, legislation is rarely perfect, and on balance this 
amendment provides substantial tax relief and will spur job creation.
  I urge my colleagues to support this substitute amendment, which will 
both extend unemployment benefits and extend tax relief that will 
reduce the number of unemployed.
  The PRESIDING OFFICER. The Senator from Minnesota is recognized.
  Mr. FRANKEN. Mr. President, I ask unanimous consent to speak as in 
morning business for up to 45 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Health Care Reform

  Mr. FRANKEN. Mr. President, I rise today to talk about health reform. 
This is my first speech from the floor on this subject. I have a lot to 
say.
  By now, we have all heard the stories--at least those of us who have 
been listening--of those who have fallen through the cracks or, more 
accurately, the gaping holes. We know why those stories are important. 
They remind us that there are human beings behind these awful 
statistics.
  Since 2001, 6.6 million Americans have lost their health insurance, 
and many millions more are underinsured. They have seen their health 
coverage become more and more expensive and less and less adequate. 
People suffer because of this. They lose their homes. They go bankrupt. 
They do not get the health care they need. They get sicker. They 
experience pain, physical and emotional. And they cannot care for their 
children. They suffer because of this.
  During my campaign for the Senate, I did an event in Fergus Falls, 
the lovely town in Otter Tail County in west central Minnesota. A woman 
came up to me. She had a story to tell. She told me her father had 
gotten diabetes and died pretty quickly. But that was not the worst 
part of the story. She told me her dad received a lot of supplies from 
Medicare he had not used. She knew of a woman in town who had diabetes, 
so she decided to drive these supplies that her dad got for diabetes 
from Medicare to this woman's house. She did. She asked the woman if 
she could use any of the test strips and orthopedic shoes and other 
items. The woman said: Yes, I could use them.
  Then this woman, the woman with diabetes, told this other woman that 
her 24-year-old son had diabetes too. He had had juvenile diabetes as a 
kid, and now he could not afford insurance because he had a preexisting 
condition. So this woman from Fergus Falls, this woman with diabetes, 
shares her insulin with her son, a diabetic mother and a diabetic son 
sharing insulin because he cannot afford health insurance in our 
country. Is this the kind of country we want to be? Well, the answer 
depends on what we do right here right now.
  As we talk about reforming our health care system, I wanted to break 
that phrase ``health care system'' apart for a second, because we are 
talking about two things. The truth is we have some great health care 
in this country and a terrible system. We have dedicated, smart doctors 
and nurses and researchers and health professionals in this country. 
They do amazing things.
  If you are a member of the Saudi royal family, you can get on your 
private jet and come to my State for the best health care in the world. 
The Saudi royal family is willing to travel 7,500 miles to Rochester, 
MN, for great care from the Mayo Clinic. For a woman in Fergus Falls, 
MN, and her adult son, both with diabetes, the same great care is less 
than 300 miles away, but it is really a world away. That is because if 
you are an American, you can get great health care too, but only if you 
make it through the terrible system, and only if you can afford it.
  As I travel around Minnesota, when someone comes up to talk to me, I 
usually hear about three things. First, they say: Health insurance 
costs too much. What are we going to do about that? Second, they ask: 
What am I going to do if I get sick or my kid gets sick or my spouse 
gets sick? And then: Someone in our family has a preexisting condition. 
Then I lose my job or I want to change my job or I want to start a 
small business. How am I going to get health insurance then? And, 
third, if anything happens to me, something bad, am I going to lose 
everything? Am I going to go bankrupt?

  In my view, the answer to those three questions comes down to two 
major changes. First, we need to reform our health insurance system so 
it provides security for every American. Secondly, we need to reform 
our health care system by putting more focus on prevention and by 
changing the way health care providers deliver health care so they 
provide high quality at a lower cost. We can do this. We know we can do 
this.
  Let me take a moment to talk to the skeptics. One of the arguments I 
often hear from opponents of health care reform is that the majority of 
Americans are happy with the health care they have, and they are. 
Because the majority of Americans are healthy right now. The truth is, 
though, that even those who are happy with their coverage are not going 
to be happy for so long. Right now the average cost of family health 
insurance payments, including both the employer's and the family's 
share, is $13,375. That is double what it was 10 years ago. If we do 
nothing, those premiums will double again in the next 10 years, which 
means a family could be paying more than $30,000 per year for health 
insurance. As premiums rise, businesses are forced to drop employees, 
drop wages or drop coverage to keep up with cost. So even if you are 
happy with the coverage you have, it may suddenly be the coverage you 
no longer have because your employer can no longer provide it.
  That is exactly what has happened. As premiums go up, so do the 
number of uninsured Americans. In my State, 355,000 Minnesotans lost 
employer-based coverage between 2001 and 2008.
  There is another problem with the coverage you have. Often you can 
only find out what is actually covered when you get sick. You can only 
find out how hard it is to switch or get new coverage once you have 
been sick. That is why we need health insurance reform that provides 
true security. It is at those difficult times, when you are nervous and 
vulnerable and want to focus on dealing with your health

[[Page S11035]]

issues, that you realize how little security you have under this 
current system.
  Let me tell you about Liz MacCaskie, who lives in Minneapolis. Liz 
lost her job in September. She is 58 years old, my exact age. She has 
been living with diabetes and was just diagnosed with kidney failure. 
Liz was denied private coverage because of her preexisting condition. 
The only insurance she can get now comes with a $5,000 deductible and 
an $8 to $900 monthly charge to maintain coverage. How does paying 
close to $20,000 a year for insurance count as insurance? It doesn't. 
Especially when Liz is trying to live on $1,000 a month while she takes 
job training courses and does part-time domestic work. As a result, Liz 
and her husband have been borrowing money from Liz's brother-in-law to 
make payments on their house. This is unconscionable.
  Right now, if you have been sick, insurance companies can refuse to 
cover you--or charge you exorbitant premiums.
  As an older woman told me at the State fair this summer: At my age, 
everything is preexisting.
  Under our health care reform bill, we will stop insurance companies 
from denying you coverage or charging you more because of a preexisting 
condition. That is a very important, very good thing. Right now, if you 
are a woman who has had a C-section or you have been a survivor of 
domestic violence, health insurance companies can deny you coverage 
because having had a C-section or being the survivor of domestic 
violence is considered by some insurance companies to be a preexisting 
condition. Isn't that amazing? Is this the kind of country we want to 
be? The answer depends on what we do right here and right now.
  Under our health care reform bill, we will end discrimination against 
survivors of domestic violence and stop insurance companies from 
charging women more for their health coverage just because they happen 
to be women, which health insurance companies are allowed to do now. 
Right now, if you get sick, your insurance benefits can run out when 
you need them the most.
  Recently, I was contacted by a Minnesotan named Kathy. A few years 
ago, she was laid off and had to buy her own insurance. She was able to 
keep up with the cost until October of 2005, when she was diagnosed 
with Hodgkin's lymphoma. To pay her medical bills, Kathy exhausted her 
IRA and then had to file for bankruptcy. Kathy's cancer is under 
control, but her medical costs are over $10,000 each year. She makes 
$22,000 working part-time in a small CPA firm.
  This isn't just an individual tragedy, it is a national travesty. 
Fifty percent of personal bankruptcies in this country are the result 
of a health care crisis, and 80 percent of those health care 
bankruptcies are people who have health insurance. I know people are 
sometimes surprised to find out that Europe has been doing this better 
than we have. I have to ask: Do you know how many personal bankruptcies 
there have been in Germany and in France and in Switzerland because of 
health care? The answer is zero. Under our health care reform bill, we 
will eliminate annual and lifetime caps on benefits. Americans will be 
able to access affordable health care and avoid going bankrupt when 
they get very sick. That is important. It is very good.
  This bill guarantees secure coverage that will be there for all 
Americans and stay there when people need it. I know you might be 
thinking: Gee, covering every American, isn't that going to be 
expensive? Consider this: We already pay for the health care of 
Americans who don't have insurance. We just pay for it in the most 
inefficient way possible. Right now people without insurance go to the 
emergency room for health care, the most expensive possible way to 
deliver care. Those of us who do have insurance pay for it because it 
costs every insured family more than $1,100 a year in additional 
premiums. This cost shift occurs for two reasons. People are using the 
emergency room for primary care, meaning they are going whenever they 
get a cold or an ear infection, which is ridiculously inefficient, or, 
more likely, they are waiting until they get very sick, in which case 
it often means their health condition has progressed to a point that is 
very expensive to treat or maybe ultimately tragic.
  According to a Harvard study, nearly 45,000 Americans die because 
they don't have health insurance. Is this the kind of country we want 
to be? The answer depends on what we do right here, right now.
  The fact is, our irrational health insurance industry not only hurts 
our families, it also hurts our economy in so many different ways. I 
recently received a letter from James Solie from Moorhead, MN. He was 
an Air National Guard member for 32 years. During that time, his 
daughter was covered under TRICARE, the Department of Defense health 
care program for members of the uniformed services, their families, and 
survivors. Now that she is on her own, his daughter gets health care 
through her employer, one of the big-box stores. Her children were born 
with cystic fibrosis. Because of their significant health care needs, 
she can't leave her job.
  As James wrote to me:

       My daughter is presently a hostage of her family's health 
     insurance needs. She will keep working at that same store 
     until the law is changed.

  This is so common, there is actually a term for it. It is called job 
lock. If this woman had a brilliant idea for a new business or even 
just wanted to move to a better job, her need for health coverage would 
prevent her from doing so. That is not only bad for her, multiply it 
across millions of people and you see how bad it is for our economy.
  We are supposed to be the most entrepreneurial society in the world, 
but because of our health care system, innovators are prevented from 
starting their own business. Talented or ambitious workers are 
prevented from moving on to more satisfying, more challenging, more 
productive jobs. We put at risk the very entrepreneurial spirit that 
defines us.
  German Chancellor Angela Merkel spoke today for a joint session of 
Congress. She was born in East Germany. When she was a kid, people 
would smuggle American books and American films into East Germany. 
Today she spoke on what inspired her the most about it. She said: the 
American dream.

  We are denying millions of Americans their shot at the American dream 
because of our irrational health insurance system. This bill guarantees 
that you and your family always have access to stable, portable health 
insurance, even if you lose your job or get sick or both. It will end 
the job lock that handcuffs so many Americans.
  Of course, guarantees of coverage and portability are hollow promises 
if they are not accompanied by something else: affordability. Over the 
last decade, the average health insurance premium for American 
families, including both the employer's share and the worker's share, 
has risen from just under $5,800 to nearly $13,400. That is an increase 
of $7,600 or 131 percent over the last decade. That is more than three 
times faster than Americans' average wages rose in that same period. 
Even if you stay healthy, these trajectories are unsustainable. Even if 
you have coverage, you could still be just a diagnosis or an accident 
away from bankruptcy.
  This has to change right now. If your work-based health plan is 
expensive, you have no other option, unless you qualify for Medicaid. 
Under this bill, you will be able to get subsidized insurance if your 
coverage through work costs you more than a certain percentage of your 
income. Right now, if your employer doesn't offer you a health plan or 
you are unemployed, it is prohibitively expensive to buy it on your 
own. Under this bill, you will be able to access a range of affordable 
insurance options through a health insurance exchange. This exchange 
will be similar to a Travelocity for health insurance. All the plans 
have to meet basic standards, and you can match them up and compare 
them side by side so you can pick the one best for you and your family.
  This isn't going to only help individual Americans. It will help 
businesses, small businesses. Right now, if you are a business with, 
say, 11 employees and one of your employees gets sick or pregnant, your 
premiums are going to go up dramatically. That is because your risk 
pool is 11 people. But when you choose a policy from the exchange, your 
risk pool can be a million or two. That is the point of insurance,

[[Page S11036]]

to spread the risk over as many people as possible.
  In addition, small businesses will also be eligible to receive tax 
credits to help them purchase coverage for their workers. In Minnesota 
alone, over 72,000 businesses would be eligible for this assistance. 
That is what the subsidies and the exchange are all about: increasing 
the availability of insurance and making it affordable for families and 
small businesses.
  That is also what so much of the debate surrounding a public 
insurance option is about. A public option creates more choice for 
consumers and more competition in the marketplace. People who are happy 
with their current plans would not need to change them. But millions of 
people who did not have health care options before would finally have 
an affordable choice. This is what the overwhelming majority of 
Americans want. It is the right thing to do. I would say to anyone who 
is against the public option, do not choose it for yourself, but do not 
deny other Americans that choice.
  I remain steadfast in my support for a public option. But we should 
also recognize a public option is just one of several ways this bill 
seeks to control health care costs. All these changes, which will 
create security and promote affordability, will provide necessary and 
meaningful reforms to the health insurance system. But we need to 
remember the goal is not just a better insurance system; it is better, 
more affordable care. That requires not only changing the way insurers 
behave, it also involves the way we behave and the way our health care 
providers behave.
  Total spending on health care in the economy has doubled over the 
past 30 years and now is about 16 percent of our GDP. That is almost 
double the average for western industrialized nations, which are at 8.9 
percent. The CBO estimates that the percentage of our GDP spent on 
health care will double over the next 25 years to 31 percent of GDP if 
we do nothing.
  Fortunately, we have the opportunity right now to act, and we know 
how to do it. We need to look no further than Minnesota. If my 
colleagues will indulge me for a bit of some home State pride, 
Minnesota has taken a national lead in many areas, including cost 
containment and community health. Part of it is because 90 percent of 
Minnesotans are covered by nonprofit health plans. It is also because 
we have models such as the Mayo Clinic, Allina, and HealthPartners, 
where physicians are paid to be part of a team, providing integrated 
care, centered on the patient as a patient, not as a profit center.
  Patient-centered care is the key. The point is not just better, more 
efficient treatment for patients, it is that people do not want to be 
patients at all. The goal of health care is to prevent illness and 
then, if people get sick, to actually make people who are sick 
healthier, and then to keep them healthy.
  To those ends, we need to see reform in three areas: incentives for 
better care, more focus on prevention, and a real commitment to contain 
costs. Let's start with incentives.
  Right now, Minnesota providers are punished--punished--under Medicare 
for providing high-quality care at a low cost. According to the most 
recent data, Minnesota receives $6,600 per Medicare beneficiary per 
year and is second in the country for quality of care.
  Texas averages more than $9,300 per beneficiary, with some of the 
worst health outcomes in the country. So Minnesotans are effectively 
paying doctors in Texas for excessive treatments and lousy outcomes.
  Now, consider an innovative program I have seen in my home State: the 
Cardiac Care Program at Duluth St. Mary's Hospital. They aggressively 
manage patients with heart disease by helping people make lifestyle 
changes and making sure people get the followup attention they need. As 
a result, they have reduced hospitalizations by 80 percent and saved $1 
million in 1 year.
  But because the current system does not incentivize value, Duluth St. 
Mary's received no reward for these cost savings. In fact, a hospital 
that lets its cardiac care patients go unchecked until they need 
another procedure gets paid a lot for performing that procedure, even 
though their patients are less healthy.
  Under the current Medicare reimbursement system, the good care gets 
punished and the less effective, more expensive care gets rewarded. We 
are not providing health care in this country; we are providing sick 
care. We need incentives for providers to reduce hospitalizations and 
commit time and resources to prevention. That starts with Medicare 
payment reform.
  This is not an issue of State versus State. If we can get better 
outcomes at lower costs, it will be better for the entire country 
because it is the only way we will finally be getting a handle on the 
runaway cost of health care.
  That is why I am so thrilled this health reform bill includes a 
provision to fundamentally improve the way we pay doctors. Thanks to 
the efforts of Maria Cantwell and my colleague, Amy Klobuchar, and 
others, for the first time ever we will include what is called the 
value index in the Medicare payment structure. Doctors who provide 
high-quality care at a reasonable cost will no longer be punished. 
Instead, they will be rewarded for being effective partners in their 
patients' care.
  That brings me to lifestyle and prevention. One of the most 
disturbing trends, for our health and our health care system, is the 
massive increase in obesity in this country. We know this increase in 
obesity will lead to increased heart disease and diabetes and increased 
health care costs for our country. But that future is not inevitable.
  Today, Minnesota spends $1.7 billion per year on hospital costs for 
heart disease. But the residents of New Ulm, MN, have decided they are 
not going to contribute to those statistics anymore. New Ulm is a 
beautiful town in the heart of the Minnesota River Valley, about 90 
miles southwest of the Twin Cities. The town is partnering with Allina 
Hospitals & Clinics and has made a commitment to reduce heart attacks 
by 25 percent over the next 10 years. To do this, the residents of New 
Ulm are working to bring down their high blood pressure and 
cholesterol, manage their diabetes, stop smoking, and start exercising. 
They have community cooking classes, workplace wellness initiatives, 
and free health screenings.
  I visited New Ulm during the recess to see what these folks are doing 
and how determined they are to make changes in their lifestyles. This 
dedication to prevention and wellness will keep individuals in New Ulm 
living longer and living healthier. It will also save the health care 
system about $10 million over the next 10 years. When it comes to 
wellness, self-interest and the national interest are aligned.
  This bill we are debating right now guarantees that routine checkups 
and preventive care, such as colonoscopies and mammograms, are covered 
by all insurance plans at no cost. We need to invest in those things 
that sometimes seem peripheral to good health but are essential to it: 
access to healthy foods and a safe environment for physical and social 
activity to address the alarming rise of obesity and the epidemics of 
diabetes and heart disease.
  I thank my friend Tom Harkin for his leadership in making sure the 
Prevention and Public Health Investment Fund is in the health reform 
bill. This fund will help Americans make the lifestyle choices that 
lead to better health. These investments will help Americans stay 
healthier and save money in the long run.
  Another way to improve care and bring down its cost is to make sure a 
greater percentage of every health care dollar actually goes to health 
care, not wasteful administrative costs or advertising and profit.
  While national health care plans spend less than 87 cents of the 
health care premium dollar on health care, Minnesota's nonprofit plans 
lead the Nation in keeping administrative costs low, spending 91 
cents--91 cents--of every premium dollar on health care. Four cents may 
not seem like a lot until you remember that is 4 percent of $775 
billion in private health insurance premiums a year.
  This percentage--the 91 percent I was talking about--is called the 
medical loss ratio. It is a measure of how much of each health care 
dollar actually goes to health care. The medical loss ratio

[[Page S11037]]

for insurance plans in Minnesota is 91. Many individual and small 
health group plans across the country are closer to 60--meaning that 40 
cents of every health care dollar goes to administration, advertising, 
and profits--all things that do not make people healthier.
  That is why I have introduced legislation, the Fairness in Health 
Insurance Act, to mandate that 90 cents of every premium dollar must go 
to health services, not to unnecessary administrative costs or 
advertising or bloated executive salaries.

  This builds upon the important work of my colleague, Jack Reed, who 
pushed for disclosure of this information in the HELP Committee bill.
  My house colleague, Keith Ellison, from Minnesota's Fifth District, 
has introduced similar legislation. The House has made progress on this 
issue by requiring a medical loss ratio of at least 85 percent for the 
small and large group insurance markets. And because administrative 
costs constitute such a high percentage of health costs, I want to go 
even further. Right now, there are hundreds of different private 
insurers that have hundreds of different claim forms and codes. Why so 
many different forms? Because the more complicated it is, the more 
different each form is, the more likely it will be filled out with an 
error.
  Remember, a form filled out with an error allows the insurer to deny 
the claim. That is why I have called for every insurer to use a 
standard form for claims. Minnesota has done this on the State level 
and is saving money and preventing the headaches that providers have in 
trying to navigate these hundreds of different forms. Nationally, this 
is a great way to save a lot of money and a lot of paperwork.
  You know who will like this? Doctors. Physicians reported spending 
the equivalent of 3 work weeks each year dealing with health care plans 
and having to devote additional resources to hire extra staff, not to 
provide care for patients but to do extra, endless paperwork.
  When time is converted to dollars, the national cost to physician 
practices of dealing with health plans is between $23 billion and $31 
billion each year. If we had a uniform billing and claims system, we 
could save up to $70 billion per year. Wow.
  By moving to electronic medical records, we will reduce the number of 
duplicated tests. We would make it cheaper and easier for people to 
stay healthy and out of the emergency room. We would be on a path to 
lower costs for everyone by making health care patient-centered, not 
profit-centered.
  I am proud of what we are doing in Minnesota--with institutions that 
are delivering care efficiently and effectively. But I recognize the 
truth of something one health care economist said to me at a health 
care roundtable I held in Minneapolis a couple months ago. He said:

       Minnesota gets an ``A'' . . . but only because we're 
     grading on a curve.

  There is huge room for improvement all across America. That is why 
this is an incredible moment of opportunity for those of us in this 
Chamber and for the entire Nation.
  As I said when I rose, we have great health care in this country but 
a lousy system. If we do not fix the system, millions more Americans 
will lose the care. Yes, this is complex stuff. That is why it is 
particularly important that nobody here injects into this debate 
misinformation that engenders fear. There has been too much of that 
already, and it has not resulted in anybody getting better care or 
moving us closer to a consensus.
  So let's remember that behind the numbers we talk about are real 
people--real people who urgently need our help. As the saying goes: 
Statistics are people with the tears wiped off.

  This is our chance to confront the biggest single threat to America's 
future and the greatest unmet moral obligation in our history all 
rolled up into one. That is what health care is. This is our chance to 
answer those questions Americans are asking, our chance to make life 
better for Liz MacCaskie and James Solie's daughter and Kathy and a 
mother and her son from Fergus Fall, MN. We have a chance to keep costs 
down for people who have insurance and finally provide coverage for 
those who don't. This is our moment to meet this great moral and 
economic challenge. So let's finish our work and overcome whatever 
legislative challenges remain.
  We all want to look back on this day from an America in which 
everyone has stable, secure, affordable health care and say it wasn't 
the easiest thing, but it was the right thing, and together we were 
able to get it done.
  There is so much more to say on health disparities, on fraud, abuse 
in the system, on mental health parity, on chemical dependency 
treatment, on chronic care, on rural health, on workforce issues such 
as the need for more primary care physicians, and so many other 
important topics. This is just a start, and I will certainly be back to 
say more.
  I yield the floor, and I note the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. KAUFMAN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Cardin). Without objection, it is so 
ordered.
  Mr. KAUFMAN. Mr. President, I ask unanimous consent to speak as in 
morning business for up to 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.


            Tribute to Federal Employee Dr. Stephen Andersen

  Mr. KAUFMAN. Mr. President, I rise once again to honor the service of 
one of our country's great Federal employees. Today, during these 
uncertain times, the American people face many challenges--one of them 
we share in common with all people throughout the world. What I speak 
of is the threat posed by climate change.
  Just this morning, in a special joint session, we heard German 
Chancellor Angela Merkel on the importance of working together 
internationally to address climate change. We have come so far in the 
past three decades but much more needs to be done. So much depends on 
our ability to address this problem, including the long-term stability 
of our economy and our national security.
  Since its creation in 1970, the Environmental Protection Agency has 
been at the forefront of reversing climate change. This week's great 
Federal employee not only spent over 20 years at the Agency, he is also 
someone we can thank for his leadership in implementing a landmark 
agreement that has already helped slow down climate change.
  When Dr. Stephen Andersen first came to the EPA in 1986, he already 
had over a decade of experience in the field of climate and ozone 
protection. During his first year as part of the EPA's Stratospheric 
Protection Team, he worked with Soviet scientists to negotiate a joint 
effort to map the ozone by satellite. This was the first-ever United 
States-Soviet joint mission in space.
  The following year saw the adoption of the Montreal Protocol in 1987. 
This crucial international agreement led to dramatic reductions in the 
chemicals that contribute to ozone depletion.
  Stephen began serving as cochair of the Montreal Protocol Technology 
and Economic Assessment Panel in 1988. He worked tirelessly to convince 
hundreds of military and industrial experts to phase out the use of 
ozone-depleting chemicals on a voluntary basis. Over the course of 20 
years, the Montreal Protocol was so successful that it helped prevent 
annual emissions of 11 billion metric tons of carbon dioxide. According 
to a crucial study by a team of environmental scientists Stephen 
himself led, the Montreal Protocol may have delayed the impact of 
climate change by 7 to 12 years. That doesn't even count the effects of 
other reductions made as a result of the treaty's influence.
  Stephen led an effort a few years ago to encourage several of the 
world's highest emitting nations to strengthen the original treaty. His 
leadership led to nine countries agreeing to speed up the elimination 
of hydrofluorocarbons.
  Today, Stephen continues to work on the science of combating climate 
change. He has focused much of his energy on helping to create 
voluntary partnerships between the EPA and the business community in 
order to promote green practices.
  Stephen won a Service to America Medal last year for his long and 
distinguished career as an outstanding public

[[Page S11038]]

servant. I hope my colleagues will join me in honoring Dr. Stephen 
Andersen's service and that of all the dedicated employees of the 
Environmental Protection Agency. I know that as we continue making 
progress on this front, they will play an important role in America's 
global environmental leadership.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland is recognized.


                           Health Care Reform

  Mr. CARDIN. Mr. President, I take this time--and will share it with 
the Senator from Minnesota, Ms. Klobuchar, and the Senator from 
Delaware, Mr. Kaufman--to talk a little bit about health care reform, 
health insurance reform, and the need for us to act.
  Quite frankly, on behalf of middle-income families of America, the 
very worst option we could do is allow the status quo to continue.
  During this time, I am going to be quoting from some letters I 
received from Maryland families who are hurting today. These are 
families, some of whom have health insurance but they cannot afford it 
or they are not certain they are going to have adequate coverage to 
deal with the needs of their families. They are looking to us to help 
them deal with the problem of health insurance today.
  The first problem, quite frankly, is the fact that it is too 
expensive. Health insurance in America is too expensive for so many 
families. As the Senator from Minnesota knows, I use the numbers 6, 12, 
23 frequently: $6,000 is what it cost a family in Maryland 10 years ago 
for a family health insurance policy. Maybe their employer paid part of 
it. Maybe they paid part of it. Then, it was $6,000 for adequate 
coverage. Today, that number is $12,000 a family. Many families in 
Maryland have a hard time affording $12,000 of their compensation going 
to pay for their health insurance. By 2016, it is going to be $23,000 
for a family, if we don't do anything about health insurance reform.
  Today, of that money families are spending, $1,100 represents what 
insured families are paying for people who don't have health insurance. 
I am frequently asked: What about these 46 million or 47 million 
Americans who have no health insurance, shouldn't they take care of 
themselves? I say: Yes, we should have personal responsibility, but 
today those who have insurance are paying extra costs for those who 
don't have insurance.
  One of the most important points of health insurance reform is to 
make sure everybody pays their fair load to reduce the cost of those 
who currently have health insurance.
  (Mr. TESTER assumed the chair.)
  Ms. KLOBUCHAR. Will the Senator yield for a question?
  Mr. CARDIN. Yes.
  Ms. KLOBUCHAR. That is a very important point about the hidden tax. 
When I was county attorney in Minnesota, representing one of our 
biggest hospitals in the State, a lot of people came in who didn't have 
a doctor. Their doctor was the emergency room. Their doctor still is 
the emergency room, and it is incredibly expensive. If you could 
explain that a little more because many people don't understand that 
when people don't have insurance, we are still paying for them. They 
call it the hidden tax.
  Mr. CARDIN. I thank my colleague for the question. The Senator is 
right. People who have no health insurance do what they can do. They 
use the emergency room as their doctor. They use the emergency room 
when they should not be using it. It is very expensive; it costs a lot 
of money. By the way, they don't pay their bills. It becomes part of 
what is known as uncompensated care in our hospitals. What is more 
serious is, they don't get the preventive health care they need. They 
get the more intense services than if they had access to our health 
care system from the beginning. They use the emergency room, as the 
Senator from Minnesota is referring to, and they don't pay their bills, 
and that becomes uncompensated care. All of us who pay the hospital 
bills and pay for our services also pay for what the uninsured are 
using in the emergency rooms, which adds to the cost of hospital care 
and adds to the cost of our insurance premiums that we pay for family 
policies. In Maryland, that amounts to $1,100 a year. That is what you 
and I are paying for those who don't have health insurance because they 
are using the health care system and not paying their bills.
  Part of health care reform is that everyone should have access to 
affordable, quality health care and health insurance.
  Mr. KAUFMAN. Will the Senator yield for a question?
  Mr. CARDIN. Yes.
  Mr. KAUFMAN. Isn't it true that when these people don't get 
prevention, don't have a doctor, don't get the vaccines and the shots 
they need and they don't go to the emergency room until they are very 
sick, what happens is they go to intensive care or something or they 
have a much more serious illness that can go on for weeks and months 
under intensive care and the price goes up and up?
  Mr. CARDIN. The Senator from Delaware is absolutely right. There have 
been studies done comparing two individuals with the same health care 
condition, one with insurance and one without insurance. The person who 
doesn't have insurance uses more health care services than the one who 
has health insurance, and it is for the reason the Senator said. The 
person with health insurance will have a much earlier intervention or 
gets preventive health care, will take blood pressure medicine or 
cholesterol medicine or will have tests that discover illness at an 
early stage or prevents an illness; for example, with colon cancer, a 
polyp can be discovered before it becomes cancerous. A person without 
insurance doesn't get those services. They enter the system in a much 
more costly way, which may lead to hospitalization that wouldn't have 
been necessary if they entered the system at an earlier stage, but they 
cannot because they have no health insurance. So the Senator is right.
  One of the things we do is try to help the families who have health 
insurance. We can end insurance company abuses. That is a very 
important point. The health insurance reform package we are looking at 
will end health insurance company abuses. All the bills reported out of 
the committees do that. You cannot be denied coverage due to 
preexisting conditions. There will be no more annual or lifetime caps 
on benefits. They cannot charge more or drop your coverage if you get 
sick. It requires them to fully cover preventive care and checkups.
  I have received--and my colleagues have, I am sure--letters from 
people in my State. I wish to tell you how important these health 
insurance reforms will be in helping middle-income families. I have one 
example, and I am sure my colleagues can cite others. Here is a letter 
I received last month from Kevin, who lives in Kensington, Montgomery 
County.
  Kevin is a healthy, nonsmoking, 54-year-old father who was laid off 
and has recently started his own company. He has two high school-aged 
children. He recently completed the Marine Corps marathon and has been 
an avid runner and swimmer all his life. I daresay most of us could not 
do that.
  After Kevin was laid off, all four family members applied for 
coverage in the individual market. However, Kevin and his two children 
were denied access to comprehensive coverage because of preexisting 
conditions. Listen to this. Kevin was denied coverage because the 
insurance company said he had a history of upper respiratory symptoms. 
Actually, he has only had two chest colds in the last 6 years. Five 
years ago, tests showed a very small amount of scar tissue in his 
lungs, but doctors have concluded this is not a health issue or risk. 
Yet he was denied coverage because of a preexisting condition. It is 
important to get health insurance reform passed because insurance 
companies will not be able to discriminate based on preexisting 
conditions--that don't even exist, in Kevin's case.
  Kevin's daughter's coverage excludes benefits related to any injury 
to any part of her back. This is because she once had a minor slipped 
disc, which has not caused her pain in more than 2\1/2\ years. This is 
a common condition among teenage girls, but the insurance company is 
refusing to cover back injury. Her doctor has written to the insurance 
company stating that she ``has no more likelihood of needing medical 
services than any other patient her age.'' Yet today, Kevin is denied 
full coverage for his daughter.

[[Page S11039]]

  It gets even worse. Kevin's son was also refused coverage for his 
knee because he was diagnosed with growing pains that required no 
treatment. This means Kevin's son will not be covered for any injury to 
his knees at any time in the future.

  Kevin writes:

       We have a healthy, physically active family. No doubt 
     healthier and in better shape than 98 percent of the families 
     in this country. And we're told that 3 of the 4 of us are too 
     great a risk to be fully covered. . . .
       We are victims of a health care system that is horribly 
     broken, and our experience in trying to get health insurance 
     for our family--a family that has no chronic health 
     conditions requiring medical treatment--has turned us into 
     strong supporters of health care reform.

  Mr. KAUFMAN. Will the Senator yield?
  Mr. CARDIN. Yes, I am glad to yield.
  Mr. KAUFMAN. This thing with preexisting conditions is incredible. 
You hear this everywhere you go. In Dover, DE, we have Angela Austin, a 
recent mother. She works as a bartender. Most of her earnings come from 
tips. She doesn't get health insurance from her employer.
  When Angela became pregnant, she tried to find private health 
insurance, but she was repeatedly denied coverage because her pregnancy 
was considered a preexisting condition. She applied for Medicaid--to 
find prenatal care for her and the baby--but was denied coverage 
because she earned $200 more than the monthly limit allowed.
  She called organizations and clinics and was unable to find a payment 
plan she could afford. Midway through her pregnancy, Angela decided to 
cut back her work hours so she could qualify for Medicaid. She worked 
all 9 months of the pregnancy and delivered the baby on May 27.
  The Medicaid coverage she got was especially crucial because she had 
complications from hyperthyroidism and was able to get the necessary 
prescriptions to control the condition.
  The story gets even worse. Angela was so anxious that everything 
possible be done to ensure a healthy baby, the system threw up 
roadblocks.
  Pregnancy should not be considered a preexisting condition. What is 
more, no one should be denied coverage because of a preexisting 
condition. There are many cases where people are totally healthy, and 
they have been denied coverage because of preexisting conditions. We 
are going to pass a bill that eliminates not being acceptable for 
preexisting conditions.
  Mr. CARDIN. I think people in this Nation would be shocked to hear 
about that situation and for someone who is totally healthy being 
denied full coverage because the insurance company just wants to deny 
coverage, just wants to pay less claims in the future, so it finds 
reasons to restrict coverage, even though that person is as healthy as 
anybody in the general public but is being denied coverage today.
  Ms. KLOBUCHAR. Will the Senator yield?
  Mr. CARDIN. Yes.
  Ms. KLOBUCHAR. I also was listening to this and thinking, about a 
week ago, I was at an event that Mrs. Obama, the First Lady, put on for 
breast cancer in honor of Breast Cancer Awareness Month. There were 
three women there who all had breast cancer. They were all survivors, 
and they had incredibly low rates of possibly getting breast cancer 
again because of advances in science. I was stunned to hear of their 
difficulty. Even though their possibilities of getting breast cancer 
again were so low, it was still considered a preexisting condition for 
an insurance policy. A recent example, when you think about it hitting 
middle-class families--and some of the people watching this on C-SPAN 
may have seen this on television--a little boy named Alex was denied 
coverage by his family's health plan. Alex's parents have coverage 
through their employers, similar to so many middle-class Americans. But 
their 4-month-old son Alex, who weighed 17 pounds--and my daughter was 
one of those low percentages when she was born. He weighed 17 pounds at 
4 months old, so he was denied coverage. The insurance company claims 
this was a preexisting condition for the otherwise healthy baby because 
of his weight.
  Here is the interesting part--and I know the Presiding Officer from 
Montana will appreciate this. After his family went on TV with the 
little boy, then the insurance company changed its mind and, suddenly, 
decided to cover him. I guess the lesson is that middle-class families 
have to go on TV to make their case in order to get coverage or when a 
woman who has been a victim of domestic abuse is denied coverage--which 
is considered to be a preexisting condition in eight States--maybe if 
she was willing to talk about her domestic abuse on TV, there would be 
a change of heart. That is not good enough--coverage by cable TV--for 
the majority of Americans. They need stability in the system. They need 
a guarantee that they are going to have coverage. I thank the Senator 
from Maryland for raising this important issue.
  Mr. CARDIN. If I might mention another family in Maryland, a typical 
family--Marvin and Lillian, who live in Chevy Chase, who are 
grandparents. I can relate to that, having two wonderful 
granddaughters. Marvin is a retired Federal Government employee. Both 
he and his wife Lillian have Medicare. They are in pretty good shape. 
However, they are worried about their grandchildren.
  They have a grandson who is 14 years old. He has Crohn's disease and 
dwarfism. He currently has coverage through his parents, but his family 
is petrified that he will be denied coverage when he is no longer able 
to receive insurance through his parents. Because of his preexisting 
conditions, it will be extremely hard for him to find individual 
coverage while job hunting or adequate coverage while at school. 
Without reform, high health care costs will preclude him from starting 
his own business or working for a small business owner.
  Marvin writes:

       My grandson's future employment prospects will be limited 
     because he will need an employer with a large group plan to 
     ensure good coverage. If he gets sick without coverage, or 
     very limited coverage, it would be a disaster.

  It is truly unacceptable that in America today, because of the way 
our health insurance system operates, that a person's future and what 
type of job that person can seek is limited because of a preexisting 
condition. That does not make this Nation as competitive as we need to 
be. We can certainly do a much better job on that now.
  There are two good points here. One is that we eliminate preexisting 
conditions. That would be taken care of. We also provide coverage 
through the age of 26 so that you can keep a child on your family plan 
coverage through the age of 26. I think this is going to be a very 
popular issue. This is one area that does not cost a lot of money. 
Children in their early twenties are not at high risk. It is unlikely 
this will add greatly to the insurance premium cost--in fact, it will 
not--but it does give greater assurances for those children who are not 
yet fully in the workplace--so they do not have the opportunity to get 
an affordable health insurance product--that they can stay on their 
parents' policy until age 26. That is another way we are going to help 
families.
  Lastly, the other area we want to be sure is done is when people 
change jobs. We know this is a very mobile workforce; people change 
jobs much more frequently today than they did 10 years ago. This bill 
will make sure you always have health insurance, even if you lose or 
change your job. You are not going to be locked into a company because 
you don't want to lose your health benefits. I must tell you, I hear 
that frequently from people in Maryland. I am sure my colleagues hear 
it in Minnesota and Delaware. People say: I want to change jobs, but I 
can't because I don't want to lose my health benefits. That should not 
be a reason someone shouldn't be able to look for other opportunities. 
When we get health insurance done, people will be able to get insurance 
regardless of where they work. There will be affordable coverage for 
all Americans. That will help middle-income families. That is our 
objective. That is what we are trying to do.
  Another area I want to mention briefly is small businesses. We hear 
frequently that small business owners have a hard time finding 
affordable insurance. I will give a couple examples of people from 
Maryland.
  Steven from Annapolis is a self-employed small business owner. 
Steven's health care premiums have increased by unmanageable amounts. 
Steven is currently paying 55 percent more for

[[Page S11040]]

his family health insurance than he was 14 months ago--a 55-percent 
increase in 14 months. The premiums for Steven and his family, all of 
whom are healthy, are approaching $10,000 annually. In August, his 
premiums increased 24 percent, after having increased 25 percent in 
2008. He wakes up in cold sweats worried about how he can afford such 
high costs. Steven sent me his most recent health insurance bill, which 
showed the 24.1-percent increase.
  Steven writes:

       We are worrying about these problems 24 hours a day. That 
     is no exaggeration.
       Small business people wake up in a cold sweat, as I have 
     done many times through the course of this difficult 
     recession, wondering how we are going to meet our client 
     deadlines, pay our bills, and be a good father and husband 
     all at the same time.

  For small businesses, if you have one bad experience with health care 
during the year, you can expect a large premium increase the next year. 
It is one thing about health insurance being expensive as it is, but if 
you are a business owner, how can you plan your company budget when you 
don't know what your health premiums are going to be the next year?
  Ms. KLOBUCHAR. Will the Senator yield?
  Mr. CARDIN. I will be glad to yield to my friend from Minnesota.
  Ms. KLOBUCHAR. One of the things I have learned in the past year 
meeting with small business owners is this huge disparity. Small 
businesses pay 20 percent more. The ones that are the bedrock of our 
entrepreneurial system in this country pay 20 percent more than big 
businesses for health care. Their employees are in a small business, 
but the ones who need it the most, the ones who probably make less 
income, pay 20 percent more for health insurance.
  I was up in Two Harbors, MN, visiting a little backpack company that 
has done such a good job. They now make backpacks for our troops 
because they are lighter weight and better for their backs. This little 
company started with a few employees; it now has 15, 20 employees.
  When the owner of that company started it, he didn't have kids. He 
now has two kids--four in their family. He is paying $24,000 a year for 
his health insurance. This is a little tiny backpack company in Two 
Harbors, MN. When the Senator from Maryland was telling us about people 
having to adjust, they cannot plan, he told me if he had known when he 
started that much of his profits were going to go into his health 
insurance, he would not even have started the company to begin with.
  This not only hurts our employees, it actually stops small businesses 
from starting--the incubator of so many of our great ideas in this 
country and jobs in this country. This is truly something that needs to 
be solved because it is hurting jobs in this country, the fact that it 
is so difficult for small business owners to afford health care.
  Mr. KAUFMAN. Will the Senator yield for a minute?
  Mr. CARDIN. I yield to the Senator from Delaware.
  Mr. KAUFMAN. This is another example. It is not just Delaware, 
Maryland, Minnesota, California, or New York. On the same subject, Ian 
Kaufman--no relation--moved to Delaware right out of college in 1990. 
Unfortunately, like far too many Americans today, he got laid off from 
his job. To get back on his feet, he wanted to start his own business. 
In the process, Ian picked up COBRA coverage to ensure his family 
maintained health care insurance. When he first signed up for COBRA 
coverage, his monthly premium was $1,800--a lot of money each month. 
Thanks to the COBRA provisions, however, in the stimulus bill, Ian saw 
his payments reduced by 66 percent, which made his monthly premiums 
much more manageable. However, this premium assistance will soon run 
out, and then he will be back once more to paying $1,800 a month. In 
anticipation of higher COBRA payments, Ian applied for coverage at 
BlueCross BlueShield but was turned down. They never gave him a reason. 
He suspects--what we were talking about earlier--that there was a 
preexisting condition of one of his daughters.
  Ian worries, like so many Americans, that the high cost of providing 
health care to his family, in addition to the difficulty of finding a 
willing policy provider, will affect his ability to stick with his 
startup business--the point my colleagues were making of starting up a 
business and being worried about health care.
  Unfortunately, Ian's health insurance predicament as a self-employed 
businessman is not uncommon. There are entirely too many sole 
proprietors and small businesses that cannot afford health policies for 
themselves, their families, and any employees they might have, thereby 
killing the innovators of our system, the people who create the jobs, 
the people who made America great, the small businesspeople. They 
cannot go into business because they are worried about health care not 
just for their employees, but they have to worry about health care for 
themselves and their families. We have to change that if we are going 
to get innovation back in the country and small businesses up and 
running.
  Mr. CARDIN. Small businesses are clearly the driving force behind job 
creation in America. The Senator from Delaware is absolutely right. 
Innovation comes from small business. They are so discriminated against 
under our current health care system. Middle-income families, in large 
measure, work for small businesses, and they are absolutely 
disadvantaged today because of the system.
  The status quo is unacceptable. We need to enact insurance reforms 
under what we have here. Small companies can benefit the same as large 
companies, with much larger pools, much more affordable plans, more 
choices.
  There are really no options for small businesses today. They do not 
have a lot of companies willing to write the policies. It is 
interesting, in my State of Maryland, two insurance companies write 71 
percent of the private insurance business. If you are a small business 
owner, you are either going to be with one of those companies or you 
are not going to be able to find insurance. They can pretty much 
dictate.
  One more example. Robert, who lives in Baltimore, is a married 
architect who has health insurance with one of our large insurance 
companies. His insurance for himself and his wife is $20,000 a year--
$20,000 a year. As a small businessperson--listen to this--not only 
does he have to pay these high premiums, but if he needs to find a 
gastroenterologist in order to do a test, there are plenty of 
gastroenterologists in his neighborhood, but the insurance company will 
not cover a doctor in that area. He has to travel all the way across 
town. He says he spends more time finding out who will treat him 
because he doesn't have a choice of plan. He has to be in this plan. So 
there is a lot of wasted money in the system he has to go through.
  By the way, if you are in a small business, running a small business, 
you have to spend time on your business. If you don't spend time on 
your business, you are not going to make it. If you have to spend time 
to figure out what doctor you can see under the small print in your 
insurance plan, you are not going to succeed as a businessperson.
  There are a lot of good reasons why we need health insurance reform 
in America. There are a lot of good reasons we need to act, a lot of 
good reasons middle-income families are depending on us to fix this 
broken system--it is too expensive, not enough choice. The health 
insurance reforms coming out of our committees all provide much more 
choice and option and protection to the people in our communities.
  Mr. KAUFMAN. One of the great ironies in this whole health care 
debate, which is full of ironies, is I talk to so many small 
businesspeople, and they are scared of the public option. They have 
been scared by the ads and things on television. As you say, for a 
small businessperson, the public option is going to be their choice to 
get the health care they need, simple health care that is laid out for 
them that makes a lot of sense.
  One of the big things we have to get through to people is exactly 
what the story is here and what really will help them get their health 
insurance so we can have small businesses built up, get more employees, 
create more jobs, and create the jobs we need for the country.
  Mr. CARDIN. The public insurance option is another choice. There is 
more competition. It brings down costs. That

[[Page S11041]]

is why we support a public option. It is a reliable product you know is 
going to be there.
  If you are living in western Maryland--and there are not a lot of 
insurance companies there--you know there is a public option, that plan 
will be there for you. You know it is going to be affordable. You know 
it is not going to leave town, as some of the private insurance 
companies did that used to insure Medicare. These plans will be there.
  It is also going to act as strong competition for the private 
insurance companies so they know they have to be competitive. Today, 
again, it is not competitive. There are not enough companies there.
  The private insurance option will offer people, such as Robert whom I 
mentioned, another option, another choice, an affordable plan. That is 
what he is looking for. He cannot afford $20,000 a year. He is looking 
for a premium much more affordable than $20,000 a year, and the public 
insurance option gives him that choice.
  One other thing about the public option that needs to be clarified. 
There are those who say: This is a government takeover. Is Medicare a 
government takeover? The answer is no. There has not been one Senator 
come to this floor to say we should repeal Medicare. Medicare has been 
a very successful program.
  By the way, health insurance reform will strengthen Medicare. Why? 
Because the way to bring down Medicare costs is to bring down health 
care costs. What we have been doing year after year is picking on 
Medicare, saying we are going to control health care costs by reducing 
Medicare. We cannot do it. You have to bring down health care costs to 
bring down Medicare costs. And what we do is strengthen the Medicare 
benefits by giving additional benefits, starting to fill that doughnut 
hole under the prescription drug plan, offering preventive care to our 
seniors. So we are strengthening the Medicare Program. The doctors and 
the hospitals are all private, as they would be under a public option. 
This is a way of providing more competition, quite frankly, keeping the 
private insurance companies a little bit more competitive and honest as 
they do their marketing, to make sure we get value for the dollars we 
are paying for our health insurance premiums.
  Mr. KAUFMAN. Again, once more, the irony. Isn't it an incredible 
irony that people come to the floor and talk about reducing the 
deficits, reducing the deficits, reducing the deficits, but they don't 
have health care reform. We know the major cause for the increase in 
deficits is Medicare and Medicaid, not because they are bad programs 
but because health care costs explode. There is no way they cannot get 
greater. That is our biggest challenge in terms of deficit reduction. 
We have to do something about Medicare and Medicaid costs.
  People talk about deficits and then say we don't need health care 
reform, why don't we slow down, we don't need it now, this is not 
important. We cannot deal with our deficits if we don't deal with 
health care costs because without dealing with health care costs, we 
cannot deal with Medicare and Medicaid. The Senator is absolutely 
right.
  Mr. CARDIN. Health care costs are growing about three times what 
wages are growing in America today. That means a government that pays 
for Medicaid and Medicare will continue to pay a larger amount of the 
budget for health care unless we can get health care costs under 
control. It also means American families are going to be paying more of 
their income for health care unless we get health costs under control.
  So how do we get health care costs under control? We do it by 
prevention and we do it by wellness and by streamlining the 
bureaucratic system, by using health information technology more 
effectively and by managing diseases. We do it in a way that brings 
down health care costs and improves access and quality, and that is 
what we are doing.
  The Senator from Delaware is absolutely right. Our goal is quite 
simple: bring down the escalating cost of health care, provide access 
to affordable quality health care for every American family, and do it 
in a fiscally responsible way.
  The Senator from Minnesota, Ms. Klobuchar.
  Ms. KLOBUCHAR. Well, I thank Senator Cardin. As I was listening, I 
was thinking about how I first got involved in this whole debate. My 
story is like so many moms and middle-class parents. It involved rules, 
rules that made no sense when it is your family's health at stake.
  When my daughter was born, she was very sick. She couldn't swallow. 
They thought she had a tumor. She was in intensive care overnight. Back 
then, the insurance companies had a rule that you could only stay in 
the hospital 24 hours--new moms and their babies. For some people, when 
you have been in labor for 24 hours and you think your daughter might 
die for 24 hours, it doesn't make sense. So 24 hours after giving 
birth, I was kicked out of the hospital. I was wheeled out of the 
hospital while my daughter was there in intensive care.
  I thought to myself: This is never going to happen to anyone again. I 
went to the legislature with a number of other moms and got one of the 
first bills passed in the country guaranteeing new moms and babies a 
48-hour hospital stay. I still remember the conference committee where 
we had a number of lobbyists who couldn't say they were against the 
bill, but they were trying to delay the implementation. They were 
trying to make it so that it wouldn't take effect for years and years 
and years.
  I finally decided to bring my pregnant friends to that conference 
committee so they outnumbered the insurance company lobbyists 2 to 1. 
When the legislators said: When should this bill take effect, all the 
pregnant moms raised their hands and said: Now. And that is what was 
happening.
  I can tell Senator Cardin, this is what the American people are 
saying. They are saying: Now. They need reform now because of what you 
have just talked about--the fact that costs have been escalating and 
escalating, and it is becoming more and more unaffordable for so many 
middle-class Americans.
  In 2008, employer health insurance premiums increased by 5 percent, 
two times the rate of inflation. Everyone feels it. Everyone knows what 
I am talking about.
  When people throw out all these numbers--and we hear all these 
numbers from the other side--I believe you only have to know three 
numbers. Senator Cardin brought them up before, three simple numbers. 
They are easy to remember: 6, 12, and 24.
  What do the numbers 6, 12, and 24 represent? Well, $6,000 was the 
cost of insurance for the average American family 10 years ago. They 
were paying that in their premiums. They are now paying $12,000. Some 
people are paying a lot more, such as the small business owner I talked 
about in Two Harbors, MN. But the average is $12,000.
  What do the studies show? They show that in 10 years people in 
Billings, MT, people in Delaware, people in Baltimore, people in the 
tiniest towns in this country will be paying an average of $24,000 a 
year. Do you think they are going to be able to afford that, the 
average middle-class family, $24,000 a year? I think every family can 
look at their own checkbook and figure out that answer. That is why we 
need health care reform now.
  I think of the people I have heard from in my State, such as Jan in 
Plymouth who wrote the other day about her 20-year-old daughter 
Jennifer. Jennifer was diagnosed almost a year ago with Hodgkin's 
lymphoma. She made it through chemotherapy but is still being 
monitored. She had to continue going to college to keep her health care 
coverage. Despite having good health care insurance, Jan and her 
husband had to use their retirement fund to cover the out-of-pocket 
expenses of Jennifer's chemotherapy. Jennifer has since taken some time 
off from school to recover and is going to be transferring to a new 
school soon. Her parents don't know how they are going to keep her 
insured.
  That is why the point was made about this plan allowing parents to 
keep their kids on their insurance until they are 26 years old. I can't 
tell you what good news that is to the parents of America who are 
struggling and who are thinking: Once my kid goes to college, what is 
going to happen because they would not have a job? How are they going 
to get insurance?
  Now, until they are 26 years old, they are going to get insurance. 
That would

[[Page S11042]]

help this family in Minnesota tremendously.
  The preexisting conditions--I talked about three women with breast 
cancer who were there with the First Lady--unbelievable stories of 
people who, through no fault of their own, get a disease, they are not 
sick anymore but they get thrown off their insurance policies; kids who 
are a little overweight or a little underweight--the only way they can 
get rid of this thing off their backs and get health insurance is by 
going on TV? I think we would have to have permanent TV stations going 
around the clock to cover all these families who want to get their 
preexisting conditions off their backs. That is not going to work in 
this country. The better way is to pass health care reform.
  The Senator from Maryland brought up the cost, and I can tell you 
that for a lot of people in Minnesota, that is the No. 1 issue I hear: 
How can we afford this? What can we do about it? Well, I can tell the 
Senator from Delaware--and I see the Senator from Illinois, Mr. Durbin, 
is here, and he has been working hard on the Medicare fraud issue on 
the Judiciary Committee, as well as the Senator from Maryland--that 3 
to 10 percent of our health care dollars go down the tube to crooks, to 
con men, and we are not doing anything about this. There is money in 
the system, and it is just going to the wrong places.
  Another way to solve this is with trying to put more quality measures 
into our system, trying to have high quality care at the lowest cost. 
People understand if you go to a hotel and you spend more money on a 
room, you tend to get a better room, a bigger room, with a nicer view. 
With health care, it is not the case. With health care, some of the 
highest cost places have the lowest quality care. So one of the things 
that health reform allows us to do is to put in those high-quality 
measures.
  So we start having incentives. We say to hospitals: If you have less 
infections in your hospital, which means more people live, you will be 
treated better in the system. So we will put in incentives so that 
doctors treat their patients better and, believe it or not, that is the 
way we are going to save money.
  Why is that? So many times the way the system operates, it is about 
reimbursing for every little test, every little thing you do, instead 
of looking at the rules or looking at the quality of care that you can 
get at the end of the road. And that is what we want to do with this 
legislation. There is a value index in this legislation.
  The bill that came out of the Finance Committee, which Senator 
Cantwell and I have worked hard on, let's us look at the value to the 
patient. Let's put patients in the driver's seat so they can get the 
value, so middle-class families can get the same kind of health care 
that Members of Congress get, so they can get the kind of value they 
want out of their health care.
  So when we look at how we can pay for this, there are so many ways. 
We can not only save some money, such as plug that doughnut hole so 
that seniors can get better deals on their prescription drugs, but we 
can do it so we can give people higher quality care. We are going to 
link rewards to outcomes to create the incentives for doctors and 
hospitals to work together to improve quality and efficiency. That is 
what we are trying to do.
  So I thank Senator Cardin for bringing up this issue of cost because 
for so many middle-class families in my State, they understand we want 
to have not only more affordable care but also high-quality care. They 
do not like these kinds of mistakes that go on, and there are some 
things we can do by creating incentives for safer procedures and for 
better standards for hospitals and for doctors that I think could go a 
long way toward paying for a lot of what we need to do.

  Mr. CARDIN. I thank my colleague from Minnesota. She has been a real 
fighter for middle-income families and working families in America and 
in Minnesota and has brought out these issues of how we can improve the 
standard of living.
  I think the point the Senator raises is one that needs to be 
underscored. Today, working families, middle-income families are seeing 
an erosion of their income. They are seeing more and more of their 
compensation going to pay for health benefits. If their employers are 
paying for it, it means less take-home money for them in their 
paychecks. If they have to pay the cost, they are seeing more and more 
of an increase. Again, health care costs are going up three times what 
wages are going up in America. So middle-income families are falling 
behind every year, and they are depending on us to speak up for them.
  They are also paying a hidden tax--a hidden tax. Middle-income 
families today are spending $1,100 a year paying for those who don't 
have health insurance. We talked about that earlier. That is a hidden 
tax. We have to get rid of that tax.
  One of the things we do in our health insurance reform is to get rid 
of that tax by saying that everyone has to be responsible for their own 
health care costs. Why should I pay for someone who today could have 
health insurance but chooses not to have health insurance?
  Ms. KLOBUCHAR. If the Senator will yield, I think it is unfair to 
middle-class families who are trying to save every penny so they can 
send their kids to college--and those costs are going up--and to put 
food on the table and fill their car with gas, to have this hidden tax 
where they are paying for people who aren't getting health insurance or 
can't afford health insurance. That is why I think one of the most 
important things for people to understand about this bill is that we 
are already paying for these people who don't have health insurance. So 
let's make it more efficient and work for everyone so you can get some 
benefit out of this yourself.
  Mr. CARDIN. It is interesting that one of the ways we can save money 
from the Medicare system is to get everybody to pay their health care 
bills. Our seniors are paying higher costs under the Medicare system 
because people use the system who are not Medicare beneficiaries and 
don't pay for it. So Medicare, every year, pays a premium to our 
hospitals called DIS--the disproportionate share--for the uncompensated 
care in the hospitals. The Medicare system is paying for that. Our 
seniors could be getting better benefits if everyone paid their own way 
rather than having our seniors subsidize those who have no health 
insurance.
  So these are ways in which we do help middle-income families in 
America.
  Ms. KLOBUCHAR. I was just with a group of seniors this past weekend 
in Richfield, MN, and they are worried because they hear about these 
numbers--that by 2017, if we don't do something, Medicare will go in 
the red. Those seniors are living longer and longer lives, which is a 
great thing. Hopefully, my mom is watching right now; she is 82 years 
old. But those who are 65 want to have Medicare when they are 95 years 
old, and those who are 65 want to make sure Medicare is there for them 
when they are 90 years old. That is why it is so important to look at 
this reform and make sure this is working for the seniors.
  The doughnut hole, I am so tired of worrying about that problem. 
These seniors have their health care coverage for their drugs, and then 
it vanishes and goes down the doughnut hole. One of the great things I 
like about this health care reform is that it will help them pay for 
the doughnut hole. I think 50 percent of those costs they will not have 
to worry about anymore.
  Mr. CARDIN. Not only will we be able to help them with the doughnut 
hole on prescription drugs, we will be able to provide them better 
health care services with lower copayments and deductibility, and we 
are providing a stronger system.
  Look, I think we all have a common interest. If you are a family that 
currently has health insurance, if you are a small business owner who 
is covering your employees, if you are covered under the Medicare 
system today, you all have an interest in making sure we pass the 
health insurance reform that is being debated now in the Congress.
  For those who have insurance, it will make your coverage more 
affordable in the future. It will eliminate this hidden tax, and it 
will enact significant health insurance reforms to protect you against 
the arbitrary practices of private insurance companies.
  If you are a small business owner, it will give you more competition, 
more reliable premiums without being increased radically on a yearly 
basis. It

[[Page S11043]]

will provide competition so that you can get the same benefits a large 
company can get with larger pools.
  If you are in the Medicare system, it takes some of the cost out of 
Medicare that you are currently subsidizing for people who are 
uninsured. It firms up our health care system, which is good for 
Medicare in the future as far as keeping it safe and sound, and it 
allows us to expand benefits, such as the prescription drug benefit, 
and get rid of that doughnut hole.
  So we are all in this together. But the only option that we cannot 
afford to have is the status quo. The letters we have read on the 
Senate floor from people who are literally being forced out of their 
current coverage, who are being discriminated against by insurance 
companies because of preexisting conditions that don't even exist, they 
are depending upon us to act.
  I see the assistant majority leader is here, and I mention that 
because Senator Durbin has been one of the real leaders in taking on 
some of the tough interests in our country--taking on the tobacco 
companies and dealing with tobacco and children, taking on prescription 
drugs to make sure we have affordable drugs in America. So I thank him 
for his leadership because I know he has been one of the real leaders 
on this issue in the Senate.
  I know all of us will do everything we can to help middle-income 
families. We have worked hard to strengthen Medicare over the years, 
fought the efforts by those who wanted to privatize Medicare, who 
wanted to weaken Medicare, and we are committed to making sure that 
these programs are strengthened, are continued, and that is why we are 
so passionate about the need for us to take up health insurance reform, 
for us to make sure we protect middle-income families.
  Mr. DURBIN. If the Senator will yield for a question?
  Mr. CARDIN. I am glad to yield.
  Mr. DURBIN. I thank the Senator from Minnesota, Ms. Klobuchar, and 
Senator Cardin from Maryland for their leadership coming to the floor. 
I have been following the floor all day.
  I heard from the other side of the aisle a litany of complaints that 
they have about health care reform. Leading off in the complaints about 
health care reform is the number of pages in the bill. The fact is, 
there is no Senate bill; it is in preparation at this moment. But the 
Republican side of the aisle, starting with Senator McConnell, the 
leader, through other Senators, continues to come to the floor and 
bemoan the fact that this bill may actually reach 2,000 pages in 
length. I don't know that it will. I don't know that it will not. I 
don't know that it makes any difference. I don't think people back home 
really care if this is a short bill or a long bill as long as it is a 
good bill, as long as it does what needs to be done.
  When you get down to the issues we are talking about, we want to make 
sure the language is precise. If we are going to fight the health 
insurance companies--and believe me, they are spending a fortune trying 
to stop us. But if we are going to fight the health insurance companies 
to make sure people have a fighting chance when they have a health 
insurance plan not to be canceled when they have a preexisting 
condition, so they have a health insurance plan that is there when they 
need it when they get sick, a health insurance plan that has enough 
money in it to pay for what they need, pay for preventive care, then 
let's take the time and write the pages that are necessary. Trust me, 
the attorneys for the insurance companies will be fighting us in court 
every step of the way as we try to make these changes.
  I was listening to the Senator from Maryland and the Senator from 
Minnesota. I recall a story I learned when I went home about a good 
friend of mine whose son has been battling cancer for years. He is a 
bright young man who developed a melanoma and has gone through 
extensive radiation and chemotherapy and also surgeries. It has been a 
valiant effort on his part. Two years ago, his oncologist found a drug 
that made a difference for him. He was cancer free. He was as happy as 
he has been for a long time because of this drug.
  I think you know how this story is going to end. Just 2 months ago, 
his health insurance company notified him that they would no longer pay 
for this drug that he needed. His oncologist sent a letter to the 
insurance company and said: This drug I am using off-label is working 
for him. It has arrested the spread of his cancer, saved his life, and 
you need to continue it.
  The insurance company said: No, we will no longer pay for this.
  The drug costs $13,000 a month. There is no way this young man and 
his young family can pay for this. Even if his dad, mom, and all the 
relatives mortgage their homes, they just can't pay for it.
  It shows you how average people who pay premiums all their lives are 
at the mercy of an insurance company executive or, worse, an insurance 
company clerk who decides to just say no. That happens every single 
day.
  I have been waiting for the first person on the Republican side of 
the aisle to stand up and say: We may disagree on a lot of things, but 
we sure do agree we have to do something about health insurance reform. 
The way they are treating Americans is unacceptable. But we never hear 
that from that side of the aisle.
  I hope at the end of the day we will be able to come together in a 
bipartisan way. We all want to. But there may come a point where we 
cannot. If standing up to the health insurance companies can only be 
done on this side of the aisle, so be it. Let's gather the votes, and 
let's do it. But at the end of the day for that family and many in 
Maryland and Minnesota, that is going to be the test of whether health 
care reform works. Will the costs start coming down? Will you have a 
fighting chance with the health insurance company when you really need 
protection? Will it pay for things that mean something to you, such as 
maintaining a person on diabetes prevention and wellness? Will it start 
bringing more people into the protection of health insurance so, as 
Senator Cardin said, we all are not paying for those who show up as 
charity cases at the hospital? Those are the bottom-line questions.
  I thank the Senator for raising this because I think this goes to the 
heart of this health care debate.
  Mr. CARDIN. A little earlier, I read into the record several letters 
I received from Marylanders. That was a sampling. I received a lot 
more. But it just points out--a letter from a Marylander who was denied 
full coverage, not only for himself but his two children, for 
preexisting conditions that didn't even exist, frankly--they didn't 
exist--but the insurance company was in a position where they could 
write a policy the way they wanted to write it, and this person in 
Maryland had no choice. There was no other insurance company that 
person could get. There was no competition there. We need to do 
something about that. We need to make it clear. I agree with the 
Senator, if it takes 10 pages or 100 pages or 1,000 pages, we have to 
make it clear that insurance companies cannot do those types of 
practices against people in this Nation. They cannot underwrite based 
upon preexisting conditions.
  It seems as though insurance companies want to write insurance 
policies where no one can make claims. We buy insurance to protect us. 
Insurance needs to be there. That is one of the reasons we eliminate 
caps. Insurance should be there to give you the coverage when you need 
it. If that family needs that medicine to keep that child alive, that 
is why you have insurance. Insurance should cover that. If it takes 
1,000 pages, let's make sure we get it right to protect the people in 
this Nation.
  Ms. KLOBUCHAR. If the Senator will yield, I was thinking, as the 
Senator from Illinois was talking about the number of pages in bills, 
when we were in the middle of this country's worst economic crisis 
since the Depression under the Bush administration and people were 
trying to figure out what to do, if you remember, the administration 
came forward with a bill that gave nearly $1 trillion out to banks, and 
it was something like 25 pages long, if I remember. I think the people 
in this country said: Hey, wait a minute, this is a major issue; 25 
pages or 10 pages or 3 pages or 100 pages is not enough.
  We are dealing with an incredibly complicated issue--with insurance 
companies that have been running this show for so long. The fact that 
we are going to spend some time on this bill, as the Senator from 
Illinois has pointed out--and the Senate bill is not even

[[Page S11044]]

done yet. We are still working on this, we are still bringing through 
these consumer reforms and that which is going to be good for the 
people of America.
  I really am a little tired of hearing about the number of pages. As I 
said, I think there are 3 numbers that matter here: 6, 12 and 24. Mr. 
President, $6,000 is what an average family paid 10 years ago--$6,000. 
Now an average family pays $12,000. What are you going to pay 10 years 
from now? What are you going to pay if nothing is done here--just keep 
going the way we are going, with the cost, the waste in the system, the 
Medicare fraud, and all these things that should not be going on? Mr. 
President, $24,000 is what the average family is going to pay. We need 
to start bringing those costs down, and the only way we take on these 
companies that have been putting in place these rules that say if a 
baby is 4 months old and happened to weigh 17 pounds, just a little 
underweight, you can't get insurance, and his family's insurance 
company--the only way we are going to help by taking them on, and I 
don't care how many pages it takes.
  Mr. CARDIN. I thank my colleagues, Senator Klobuchar from Minnesota, 
Senator Kaufman from Delaware, and Senator Durbin from Illinois, for 
their comments and for their passion on this issue. This is an issue we 
have to get right for middle-income families in America. They are the 
ones hurting. They are the ones who cannot afford this current system. 
They are the ones falling further and further behind every year. These 
are the ones--subject to the discriminatory practices of private 
insurance companies--we have a responsibility to protect. These are the 
ones paying the hidden tax for people who do not have health insurance, 
many of whom can afford health insurance but choose not to get it. It 
is our responsibility to act on behalf of middle-income families in 
America to make sure we have the health care system that is affordable 
and is available to every person in this country.
  What we are doing is to bring down the cost of health care, to make 
sure we have affordable care for every person, every American, and do 
it in a fiscally responsible way. I urge my colleagues to make sure we 
take advantage of this opportunity. Let's make sure we get health care 
reform done, and done as soon as possible.
  I yield the floor. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Ms. KLOBUCHAR. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. KLOBUCHAR. Mr. President, I rise today to talk about extended 
unemployment benefits. I just received a call this afternoon from one 
of my State legislators in Minnesota who represents the Iron Range of 
Minnesota where my grandpa grew up and worked 1,500 feet underground in 
the mines in Ely, MN, never graduated from college, and saved money in 
a coffee can in the basement of his and my grandma's house to send my 
dad to college, and my dad and brother also worked in the mines.
  It is tough times up in Ely, MN. Things go up and down, up and down 
in the iron ore business. Right now, they are in a downtime. There are 
some glimmers of hope out there. Some of the mines have started up 
again, but there is high unemployment up there, high unemployment in 
the double digits. That is why this is so important, as America has 
been trying to really pick itself up and get moving again after this 
economic crisis.
  Someone once said that when Wall Street gets a cold, Main Street gets 
pneumonia. That is what we are still seeing across this country despite 
the glimmers of hope we see with the GDP, the good numbers there and 
some of the other good numbers with house sales going up. There are 
some positives going on in this country, there is no doubt about that. 
But there are still so many people looking for jobs. I think for every 
job out there, there are six unemployed people trying to find that job. 
I have gotten letters from people saying they have applied for hundreds 
of jobs, sent in their resumes.
  That is why it is so important, while Wall Street is starting to do 
well again, to make sure we are protecting the people in this country 
who need their unemployment. In the past 125 days alone, over 185,000 
Americans lost their unemployment benefits. Each passing day without an 
extension, more and more Americans are losing the last lifeline they 
have to keep their heads above water in this difficult economy.
  One of the things I really like about the Senate bill--I see the 
Senator from Illinois is back. I thank him for his leadership, and 
Senator Reid and Senator Shaheen and others who have worked on this 
issue. The Senate bill doesn't say: OK, only certain States are going 
to be able to get this extension of unemployment benefits. The Senate 
bill says what the people of my State say: The unemployment rate in 
Minnesota might be 7.3 percent right now, but in my house it is 100 
percent, and I have been trying to find work over and over again.
  I don't know what I would have said to the people of my State if I 
had to come home and say to them: Look, the people of Wisconsin are 
going to get their unemployment benefits extended, right across the 
border there, but the people of Minnesota are not.
  We were glad to get Brett Favre from Wisconsin. That was a nice 
pickup. But it doesn't mean they get unemployment benefits and we 
don't. That is not a fair trade. So we are very glad the Senate bill 
takes care of States such as Minnesota and so many other States such as 
Montana and others across this country.
  I urge the Senate to pass this as quickly as possible in the name of 
all the people in my State and others who have been looking for work.
  I will end with a letter I got from a woman named Barbara, from 
Mahtomedi, MN. She wrote:

       My husband has been looking for a job since March and 
     without unemployment to help us out I don't know what will 
     happen. All of us [our kids] have been looking for steady 
     employment for months. We drive old cars, we bought a house 
     within our means that we have been fixing up slowly for 
     ourselves for the past 22 years. We buy everything used or on 
     sale. Please don't let [the people of our State] get left out 
     in the cold [because it is starting to get cold and we need 
     the unemployment until we find a job.]

  I thank you for allowing me a few minutes to talk about this 
important bill pending before the Senate, and I urge the Senate to 
quickly adopt our unemployment bill.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois is recognized.
  Mr. DURBIN. I thank the Senator from Minnesota because the story she 
tells are stories that are told in every State. How will we ever 
explain to people who are struggling from day to day to feed their 
families while they look for a job why it took us 26, 27, 28 days to 
extend unemployment benefits in the Senate? Because, on the other side 
of the aisle there was objection because Senators had ideas of 
amendments they wanted to offer.
  Well, there are plenty of bills for ideas. This was a bill that was 
providing necessities of life for a lot of people even in their own 
States. I am glad that it appears we are finally going to move to it 
tomorrow, 4 weeks after we started the extension of unemployment 
benefits.
  I do not understand how you can be for family values and not stand up 
for these families when they are facing the toughest challenges in 
life.
  I thank the Senator from Minnesota for her comments.
  I ask unanimous consent that on Wednesday, November 4, following a 
period of morning business, the Senate resume consideration of H.R. 
3548, and all postcloture time be considered expired, all amendments to 
the substitute and bill be withdrawn, no further amendments be in 
order, and the substitute amendment be agreed to, and the motion to 
reconsider be laid upon the table; that the Senate then have general 
debate until 12:15 p.m., with the time equally controlled between the 
leaders or their designees, the Senate proceed to vote on the motion to 
invoke cloture on H.R. 3548; and that if cloture is invoked, the 
postcloture time be considered to have begun running as if cloture had 
been invoked at 11:45 p.m., Tuesday, November 3.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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