[Congressional Record Volume 155, Number 164 (Thursday, November 5, 2009)]
[Senate]
[Pages S11191-S11196]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                           HEALTH CARE REFORM

  Mr. BROWN. Mr. President, I rise again this evening, as I have many 
days in the last couple of months, to share with my colleagues letters 
from people in Ohio--from Bucyrus, Lima, Springfield, and Zanesville--
people who are sharing their stories with us.
  As I have been in the Senate now for 3 years, it occurs to me that 
perhaps more often than not, we talk about policy up here, but we 
simply do not pay enough attention to individual problems and 
individual people. That is why a lot of people think their elected 
officials are out of touch with them. These letters really do share 
with us where we are, what we ought to do, and how we should respond as 
we move forward on the health issue.
  This letter comes from Ann from Montgomery County. She writes:

       Our insurance premiums have nearly tripled in the last 6 
     years, going from $500 per month to $1,500 per month. At the 
     same time, none of our benefits have increased. Since we 
     bought our policy, we have paid the insurance company $68,000 
     for the insurance. Anthem's total spending for my family's 
     claims since we bought the insurance: $4,064.24. Anthem's 
     profit from my family: $64,000. Anthem's CEO's total 
     compensation last year alone: $10 million.

  Ann from Montgomery County, Dayton, Huber Heights, Centerville, 
Oakwood--that area of the State, southwest Ohio. Obviously, Ann is 
angry and frustrated with what she has seen. She has paid so much for 
insurance, gotten so few benefits, and she sees Anthem's CEO taking 
down $10 million a year.
  What we see repeatedly in the insurance industry, the average CEO 
salary for the biggest 11 insurance companies is $11 million a year. 
Insurance company profits have gone up more than 400 percent in the 
last 7 years.
  The way they make this money is this kind of business model where 
they hire a huge bureaucracy, a bunch of bureaucrats to keep people 
from buying insurance if they are sick. They discriminate based on 
gender. They discriminate based on age. They discriminate based on 
disability. In some cases,

[[Page S11192]]

they use the excuse of preexisting condition to keep people from buying 
policies, including, believe it or not, women who have been victims of 
domestic violence. Some insurance companies consider that a preexisting 
condition. If their husband hit them once, they might hit them again, 
and that would be a cost to the insurance company. They cannot get 
insurance. Sometimes a woman who has had a C-section is a preexisting 
condition. She cannot get insurance because if a woman has had a C-
section, she might get pregnant again and need another one. That is too 
expensive. They don't give her insurance. That is how Anthem and these 
other companies make these kinds of profits, because they hire 
bureaucrats to keep you from buying insurance if you have a preexisting 
condition.
  On the other end, they hire more bureaucrats to reject your claims 
when you have been sick. Oftentimes the insurance company records show 
that about 30 percent of all claims are rejected initially. Sometimes 
they are appealed and then they pay these claims. But then you as the 
patient or you the family of a sick husband, wife, child have to spend 
your time on the phone fighting with the insurance company while at the 
same time you are trying to nurse your husband, wife, child, or mother. 
What kind of system is that, that we allow these insurance companies to 
do that.
  What I found in these letters, in the last 3 months I have been doing 
this on the Senate floor, is a couple of things. One is, consistently 
people were pretty happy with their insurance, if you asked them a year 
or two earlier, but then they got sick and they found out their 
insurance wasn't what they thought it was. That frustration and anger 
builds from that.
  Another thing I found is that people in their late fifties and 
sixties have lost their insurance, they have lost their jobs, their 
insurance is canceled or their employers cannot afford it because they 
are a small business, they don't have insurance, they are 58, 62 years 
old, and they just hope they can hang on until they are Medicare 
eligible or until they can get a stable public plan, such as a public 
option, such as Medicare.
  I will share two more letters.
  John from Richland County--that is my home county. I grew up in 
Mansfield. There is Shelby, Lexington, Butler--north central Ohio.

       Health care reform will not be achieved unless a public 
     option is in place to compete with insurance carriers. I 
     recently retired after 45 years as a family physician. If 
     government-run medicine is so bad, why should insurance 
     companies object to the competition? Cost and treatment is 
     already controlled by the insurance providers whose only 
     motive is profit.
       Allowing the insurance industry to dictate terms of cost 
     and treatment has not worked and will not work. Please fight 
     for a public option.

  John, a physician of 45 years, absolutely gets it. He says something 
interesting. I hear opponents of the public option, a lot of 
conservatives say government cannot do anything right, they mess 
everything up, and then they say that if we have a public option, they 
will be so efficient that they will run private insurance out of 
business. So which is it--the government cannot do anything right or 
the government is so efficient, it is going to run private insurance 
out of business?
  The point is, insurance executives' average salary is $11 million. 
Insurance companies' profits are up 400 percent in the last 7 or 8 
years. Insurance companies don't want the public option because you 
know what will happen--their profits won't be quite as high. They won't 
go up 400 percent. Salaries won't be as high because they have 
competition from the public option. They know they will be in a 
situation where life is not going to be quite as good for insurance 
companies and insurance executives. That is why they don't like the 
public option. That is why they fight the public option. And we know 
that is why the public option will work. It will mean more choice for 
consumers.
  In southwest Ohio, two companies have 85 percent of the insurance 
policies. A public option will provide competition, will stabilize 
prices, which means prices will come down and quality will be better. 
If you have two companies controlling 85 percent of the business in 
Cincinnati, Batavia, Lebanon, Hamilton, Littleton, Fairfield, or any of 
those counties, you have two companies controlling 85 percent of the 
business, you know the quality is lower and prices are too high.
  Let me conclude--Senator Casey is here. He more than any single 
Senator has spoken out strongly and fought successfully to make sure 
this health care bill works for our Nation's children, from when we 
passed the SCHIP back months ago to the health care bill on which my 
colleague from Pennsylvania has done remarkable work. Let me read one 
more letter and turn to him.
  Cheryl from Cuyahoga County in northern Ohio, the Cleveland area, 
writes:

       My daughter is paying costly health care out of her own 
     pocket to treat her depression. Despite getting a new job, 
     she was told her condition is preexisting and would not be 
     covered.
       After struggling for a year to find a good job, she doesn't 
     need this preexisting condition to shadow her.
       I, too, have a preexisting condition of breast cancer. 
     Please stop insurance companies from denying insurance due to 
     preexisting conditions.

  This letter again shows this insurance reform--our health care bill 
makes so much sense. I am hearing from hundreds and hundreds of them 
from Gallipolis, Pomeroy, along the Ohio River to Lake Erie, Lake 
County, to the Indiana border, Troy, Preble County--all over--that too 
many people are denied coverage because of a preexisting condition.
  Why does it make sense that people who are sick or maybe are going to 
get sick cannot get insurance? Why does it make sense that they would 
have to pay so much, they simply cannot qualify or literally cannot get 
it no matter how much they pay?
  One of the important things about our bill is that it will outlaw--
there will be no more exclusions for preexisting conditions. Nobody 
will be prohibited from getting insurance because of a preexisting 
condition, including women who have been victims of domestic violence, 
women who have had C-sections, men who have had colon cancer, whatever, 
No. 1.

  No. 2, nobody will be denied care because of discrimination, because 
of their disability, because of their age or their gender or their 
geography.
  No. 3, nobody will have their insurance policy rescinded. That is 
what the insurance companies say when they take away your insurance. 
Nobody will have their policy rescinded because they got sick and it 
was a very expensive illness they had and the insurance companies want 
to cut them off.
  In addition to these changes in the law that we are going to do with 
insurance reform, the public option will make sure these rules are 
enforced, that people simply can't game the system. The insurance 
companies will not be able to game the system the way they have.
  It makes so much sense to pass this bill. It is going to mean people 
who have insurance and are happy with it will be able to keep their 
insurance and have consumer protections. Small businesses will get help 
with tax incentives and other things to insure their employees. And it 
will mean those without insurance can get insurance and have the option 
of going to Medical Mutual, CIGNA, BlueCross, Aetna, WellPoint, or the 
public option and have that choice.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Bennet). The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I rise tonight to speak about the health 
insurance reform bill that will eventually come before the Congress. We 
have a process underway in the Senate that is still playing out. We 
don't have a bill, but I think we are cognizant of the fact that we 
need to talk about the challenge we face with regard to health care, as 
well as talk about some good ideas to confront this challenge.
  I commend my colleague from Ohio, Senator Brown, who has led the 
fight on making sure the public option is a priority. From day one, he 
not only has led this fight, but also from day one, way back in the 
summer when we were actually working on language in the Health, 
Education, Labor,and Pensions Committee, he and others sat down to 
actually rewrite that section. We are grateful for his leadership and 
for his ability to relate to us what a public option means to real 
people--not the concept, not only the policy of it, but what

[[Page S11193]]

it means to real people and real families. I commend him for that great 
work.
  One of the areas I have tried to spend as much time as possible on is 
the question of what happens with regard to our children. Will children 
at the end of this process be better off or worse off, especially in 
the context of children who happen to be vulnerable because of income? 
We are concerned about poor children and children with special needs in 
particular.
  I believe one of the principles--or maybe the better word is a goal--
that we must meet at the end of the road, when we have a bill that gets 
through both Houses of Congress and goes to the President, when a bill 
gets to the President of the United States, President Obama, for his 
signature--and I believe we will get there; it is going to take some 
time and we are going to be continuing to work very hard in the next 
couple of weeks to get that done. But when that bill gets to President 
Obama, I believe we have to make sure in this process over these many 
months of work--and for some people, many years--we have to make sure 
that bill ensures that no child, especially those who are vulnerable, 
is worse off. I believe we can get there. I believe we must get there. 
I believe we have an obligation, especially when it comes to vulnerable 
children, poor children, and those with special needs.
  To set forth a foundation for that, I submitted a resolution several 
months ago, resolution 170. I won't read it or review it tonight, but 
it was a resolution that focused on that basic goal of making sure no 
child was worse off. I was joined in that resolution by Senator Dodd, 
then-chairman of our health care reform hearings, this summer. Senator 
Rockefeller also was a cosponsor of this resolution, someone who has 
led on not just health care issues in the Finance Committee but also in 
a very particular way he stood up for children, as has Senator Dodd--
both Senators in their many years in the Senate.
  We just heard from Senator Brown. He was a cosponsor of this joint 
resolution for children, as well as Senator Sanders from the State of 
Vermont and Senator Whitehouse from Rhode Island. Those five Senators 
joined with me in this resolution which I believe is the foundation for 
what we have to do with regard to children.

  The chart on my left is a summation of some of the things we just 
talked about. First of all, this first point with regard to our 
children, children are not small adults. It seems like a simple 
statement. It seems very much self-evident, but, unfortunately, we 
forget that. I think we forget it once we become adults. But even in 
the context of health care reform, we cannot just say this is a health 
care strategy or program or manner of delivering care or a treatment 
option or a way to cover more Americans with regard to health care, so 
if it applies to an adult it will work for children. Unfortunately, 
because they are not simply small adults, we have to have different 
strategies for children that differ from the way we approach the 
challenge in providing health care for adults.
  The second bullet: Children have different health care needs than do 
adults. I think that is a basic fundamental principle; that children 
have to be approached in a different way. The treatment is different, 
the prevention strategies are different, and sometimes the outcome of a 
health care treatment or strategy is different.
  It is also critical that all children, particularly those who are 
most disadvantaged, get the highest quality care throughout childhood. 
And that is the foundation of that resolution.
  When it comes to health care reform generally, but in particular with 
regard to our children, we have to get this right. We can't just say: 
Well, we tried, and we tinkered with some details or some programs, and 
we did our best. When it comes to health care for children, not only 
for that child or his or her family or the community they live in--and 
we tend to forget this--but also our long-term economic strength is 
predicated in large measure, in my judgment, on how we care for our 
children, and especially the kind of health care our children will 
receive. So we have to get this right for our kids, for their families, 
and for our economy long term.
  Fortunately, we have made great strides over the last 15 years. 
Really even less, maybe the last 12 years we have made great strides on 
children's health insurance. President Clinton signed a law passed by 
Congress in 1997 creating a nationwide Children's Health Insurance 
Program--the so-called CHIP program. In that case, we had something 
that had its origin in the States.
  My home State of Pennsylvania started one of the largest, if not the 
largest, children's health insurance efforts in the Nation, and that 
was built upon by way of Federal legislation so that we now have had a 
program in existence since about 1997 nationally where millions of 
children have health care because we made them a priority.
  In Pennsylvania, for example, we have had, fortunately, a diminution, 
a decreasing number of children who are uninsured, to the point where 
last year, when there was a survey done for the State of Pennsylvania, 
the uninsured rate for children was 5 percent. That is still too high, 
but it is lower than it used to be. We want to bring that, obviously, 
to zero, but we have a 5-percent rate of uninsured children in 
Pennsylvania and 12 percent uninsured for people between the ages of 19 
and 64.
  For children and for citizens over the age of 64--65 and up--we have 
had strategies for both those age groups; children more recently, with 
regard to children's health insurance, as well as Medicaid for low-
income children, and also, we have had Medicare for our older citizens. 
But the problem is that age category in the middle, that vast middle 
age group of 19 to 64. We haven't had a strategy recently, or over many 
decades, and that is one of the many reasons we are talking about 
health insurance reform for everyone but especially for those who are 
in that age category.
  With regard to children, we have to make sure what we know works 
stays in place. We have plenty of data to show that children with 
health care coverage do better than children without health care 
coverage. That is irrefutable. It is absolutely indisputable now. I 
don't think anyone would dispute that as a matter of public policy. 
Children with insurance are more likely to have access to preventive 
care.
  A major part of our reform effort--and the major part of the HELP 
bill we passed this summer--is all about prevention. Children in public 
programs are 1\1/2\ times more likely to obtain well-child care than 
uninsured children. What does that mean? Well, it is simple. The 
experts tell us children enrolled in the CHIP program--or SCHIP, as we 
sometimes call it--in their first year of life have six well-child 
visits to the doctor. That is fundamentally important. It can alter in 
a positive sense that child's destiny. Their future can be determined 
in the first couple of weeks and months, and certainly the first year 
of life. It is good for that child in the first year of life to go to 
the doctor at least six times for a well-child visit, as they do in the 
CHIP program. It is important that we have prevention strategies in 
place for that child in the very early months of that child's life, but 
certainly in the first year.
  Here is another chilling statistic. Uninsured children are 10 times 
more likely to have an unmet health care need than insured children--
not double or triple but 10 times more likely to have an unmet health 
care need.
  We hear some people in this debate say: Well, that is about someone 
else. That is about some other family, someone else's child. That is 
not our problem.
  Well, it actually is your problem. Even if you have no compassion, 
even if someone out there says: Well, that is not my problem; that is 
someone else's problem.
  It is your problem because for every child who has no insurance, and 
as a result has no well-child visits to the doctor or does not get to 
the dentist or does not get preventive care, there is, in some way, an 
adverse impact on our economy. Think about it long term. If you are 
running a company, who do you think will be a stronger employee for you 
or a more productive employee, someone who got good health care in the 
dawn of their life--as Hubert Humphrey used to say--or someone who 
didn't get that kind of health care or nutrition or early learning?

[[Page S11194]]

  All these things we talk about have ramifications for our long-term 
economy because of our workforce. To have a high-skilled workforce, you 
have to have access to health care. So that number of 10 times more 
likely to have an unmet health care need for the uninsured child versus 
the child with insurance is chilling. It is one of those numbers that 
alone should compel us, should motivate us to pass this bill.
  Insured children are better equipped to do well in school. Uninsured 
children, with poorly controlled chronic diseases, such as asthma, can 
suffer poor academic performance if their health care condition causes 
them to miss many days of school. We know that. This is not news, but, 
unfortunately, we have allowed conditions to persist in our system 
where a child doesn't get the kind of care they need, and that allows 
their asthma or other condition to be made worse. Insurance improves 
children's access to the medications and treatments they need to 
control chronic diseases, allowing them to miss fewer days of school. 
We know that is the case.
  The chart on my left gives a brief overview of a Johns Hopkins 
University study published in the New York Times on October 30, just a 
few days ago, which states that hospitalized children without insurance 
are more likely to die. So this isn't just about a child getting a 
slower start in life because they didn't have health care or a child 
not having a B average in school because they didn't get health care or 
missing days from school. All of that is terrible for that child and 
for that family, but this is a lot worse than that. This is literally 
about the life and death of a child, according to this study and others 
as well.
  Mr. President, I ask unanimous consent to have printed in the Record 
an article dated October 30, 2009, in the New York Times with the 
headline: ``Hospitalized Children Without Insurance Are More Likely to 
Die, a Study Finds.''
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See Exhibit 1.)
  Mr. CASEY. This is what the article says:

       Researchers at Johns Hopkins Children's Center analyzed 
     data from more than 23 million children's hospitalizations in 
     37 states from 1988 to 2005.

  This wasn't a quick survey, Mr. President. This was a detailed study 
of millions of records over that long a time period. Continuing the 
quote:

       Compared with insured children, uninsured children faced a 
     60 percent increased risk of dying, the researchers found.

  So this research showed a 60-percent increased risk of dying. That is 
what we are talking about. This isn't theoretical. This isn't some 
public policy argument we have pulled down from a public policy report. 
This is about life and death for children. We are either going to stay 
on the course we have been on with regard to children, making 
improvements, strengthening a program like CHIP, or we are not. I think 
it is vitally important that we continue to make progress as it relates 
to children's health insurance.
  So this is fundamental to this discussion about health care reform, 
and sometimes a study or a chart or a public policy report doesn't tell 
us nearly enough. Sometimes the life of a person says it best.
  Senator Brown has been highlighting letters that he has received from 
people in the State of Ohio, and people in Pennsylvania have written to 
me or sent an e-mail or appeared in my office and relayed their own 
stories. In this case, when it comes to real families and real 
children, it is especially important to highlight them.
  I just have one example to share tonight. I received a letter from a 
Pennsylvania resident named Denise Lewis. Denise has four children who 
are now older, but when she contacted us, she was recalling what she 
went through with her four children in terms of health care. All 
through their childhood, Denise and her husband struggled with being 
either uninsured or underinsured. What health insurance they have had 
has always been employer-based but often was limited and only covered 
hospitalizations. Her family couldn't afford the premiums on more 
expensive coverage, and much of this, unfortunately, was before the 
Children's Health Insurance Program was in effect. Her family never 
qualified for any other kind of assistance.
  She said she would work a second job part time as a waitress so they 
could afford food and to pay off medical bills. Today, even though her 
youngest is 19 years old--her youngest child of the four is 19 years 
old today--she is still sending monthly checks to her pediatrician to 
pay for all the care her children received.
  Imagine that, all these years later, because of the system we have. 
Goodness knows there are great parts to our system that we should 
celebrate and be proud of, but there are a lot of parts of our health 
care system which simply don't work for too many Americans and is 
hurting families, hurting businesses, and killing our ability to grow 
our economy long term, and this is one example.
  Why should Denise Lewis or anyone have to worry like this, have to 
choose between food and getting medical care or paying for a hospital 
visit? Why should anyone have to pay off medical bills years and years 
later for children who are already grown?
  At times, Denise said the medical care her children needed would 
actually determine what food the family ate that week. They managed to 
make ends meet but never had any money for extras of any kind.
  Listen to this in terms of what Denise said, and these are her words:

       Wondering whether you should go to the doctor is completely 
     different from wondering whether your kids should go to the 
     doctor.

  That is the nightmare that too many families are living through. 
There are those who say: Well, let's just think about it for another 6 
months. Some are saying: Let's not pass a bill. Let's slow it down. 
It's too complicated. We can't do this.
  For those who are saying that, I would ask them if they have ever had 
to face that decision--the question of what kind of care their child 
would get. Had they ever faced the dilemma of how much your family can 
eat in a particular week or can you pay for a doctor's visit?

  Denise Lewis, one of her children had frequent ear infections as a 
baby, and more than once she would call the pediatrician and ask if she 
could get a prescription without coming to the office so she wouldn't 
have to pay for the office visit.
  Why have we tolerated this, year after year and decade after decade, 
of people telling stories such as this? The Congress of the United 
States, year after year, has said we will get to that later; it is too 
complicated. Why should any parent, mother or father, single parent--
why should any parent have to make those choices or say to a 
pediatrician can I get a prescription without coming to the office 
because I can't afford the office visit?
  We are the greatest country in the world. We have all the benefits of 
the wonders of technology and great doctors and dedicated and skilled 
nurses, great hospitals and hospital systems, all this brainpower and 
talent and ability--ability to cure disease. Yet on the other side of 
our system we tell people you have to pay more for a doctor visit for 
your child. Why did we allow this to happen? Year after year, we have 
just allowed the problem to persist.
  Our system has said to women, you should engage in some preventive 
strategy. With regard to breast cancer, you should get a mammogram. 
Then we say you have to pay for all or most of it. Why do we do that? 
Why should we allow that to continue?
  I want to move to two more charts. I know I am over my time a little 
bit. Let me go to the next chart. I really believe, when we describe 
some of these challenges, we are talking about, really, a national 
tragedy, that the children in our country should be reduced to having 
the emergency room as their primary care physician or their doctor's 
office.
  When we were growing up, we knew what it was like to go to the 
doctor, but for too many children the emergency room is the doctor's 
office. That is not good for the child because that usually means they 
are further down the road for a condition or problem; they are sicker 
and have more complications. It is also bad for how we pay for health 
care.
  We also know the emergency room care by uninsured Americans with no 
place to go but an emergency room is one of the biggest drivers of the 
out-of-

[[Page S11195]]

control costs we often see in our system. That is why we need health 
care reform now.
  We now cover about 7 million children in CHIP. Thankfully, 
fortunately, we reauthorized it in 2009. It kind of went by people 
pretty quickly, but that was a major achievement. That bill went 
through and the President, President Obama, signed it into law. By 
virtue of that one signature and the work that led up to that, those 7 
million who are covered now by CHIP will double by 2013 to 14 million 
children who will be covered by that program.
  But even with that reauthorization, there are still things that will 
challenge us with regard to the Children's Health Insurance Program. 
One of them is a failure that could take place over time where we do 
not strengthen the Children's Health Insurance Program.
  I meant to highlight this chart as well: ``Uninsured low-income 
children are four times as likely to rely on an emergency department or 
have no regular source of care.'' That is the point I wanted to make 
about emergency room visits.
  Finally, let me move to the fourth chart. Not only is this program, 
the Children's Health Insurance Program, a major success across the 
country, but it has reduced the rate of uninsured children by more than 
one-third. As we can see by this chart on my left, insuring children is 
something people across America strongly support. Prior to the 
amendments and the markup process in the Finance Committee this fall, 
there was a proposal to move the Children's Health Insurance Program 
into the health insurance exchange as part of the Finance Committee 
bill. Many members of that committee, and others like me and others, 
didn't think that was a good idea. Senator Jay Rockefeller was another 
and, fortunately, he was on the Finance Committee. His amendment in 
that committee fortunately removed the Children's Health Insurance 
Program from the exchange.
  Why was that important? The data is overwhelming that placing 
families that are covered by the Children's Health Insurance Program 
into that newly created insurance exchange would, in fact, increase 
their costs and decrease their benefits. There was a debate about it, 
but I think the Finance Committee did the right thing. By keeping the 
Children's Health Insurance Program as a stand-alone program that we 
know works--all the data shows it. It is not an experiment. It is not a 
new program. We have had more than a decade of evidence that shows that 
it works. We have to keep that in the final bill. We have to keep that 
as a stand-alone program, and we have some work to do to make sure that 
happens.
  When you see the numbers here, an overwhelming three to one majority, 
62 percent to 21 percent of Americans, would oppose the elimination of 
the Children's Health Insurance Program if they learned that a new 
health insurance exchange ``may be more costly for families and provide 
fewer benefits for children.'' We have to make sure when we get to the 
point of having a final bill worked out that we keep that in mind.
  We know for now that we have a stand-alone program. Thank goodness 
that change was made. We know it works. But we have to do everything we 
can to strengthen the Children's Health Insurance Program, because in 
the coming years there will be recommendations to change it. There will 
be others who will make suggestions about how the Children's Health 
Insurance Program fits into our health care system, and we have to be 
very careful about how we do that.
  But for now I want to emphasize two points and I will conclude. A 
commitment to that basic goal that no child at the end of this is worse 
off, especially vulnerable children who happen to be poor or have one 
or more special needs--we have to make sure that happens. We also have 
to reaffirm what I think is self-evident and irrefutable. The 
Children's Health Insurance Program works. We have to keep it as a 
stand-alone program, and we have to continue to strengthen it because 
there are some changes we can make to strengthen it.
  I look forward to working with our colleagues in the Senate to meet 
those goals. I know the Presiding Officer has a concern about this as 
well. He has been a great leader on health care in his first year in 
the Senate. I thank him for his work.
  I will conclude with this. In the Scriptures it tells us ``A faithful 
friend is a sturdy shelter.'' We have heard that line from Scripture. 
We have heard it other places as well. We think of a friendship as a 
kind of shelter when things get difficult, when life gets difficult. 
One of the questions we have to ask ourselves in this debate is, Will 
the Congress of the United States really be a friend to children? Will 
we be that faithful friend who acts as a sturdy shelter? Because 
children can't do it on their own; we have to help them. I believe by 
getting this right we can be that faithful friend and we can be that 
sturdy shelter for our children.
  Let it be said of us many years from now, when people reflect upon 
how this debate took place and what we passed, in terms of health care 
reform--let it be said of us, when our work is done, that we, all of us 
as Members of the Senate and Members of the Congress overall, that we 
created at this time, at this place, a sturdy shelter for our children 
and that we can say that with confidence and with integrity.

                [From the New York Times, Oct. 30, 2009]

                               Exhibit 1.

Hospitalized Children Without Insurance Are More Likely To Die, a Study 
                                 Finds

                         (By Roni Caryn Rabin)

       Nicole Bengiveno/The New York Times Researchers analyzed 
     data from more than 23 million children's hospitalizations 
     from 1988 to 2005.
       Uninsured children who wind up in the hospital are much 
     more likely to die than children covered by either private or 
     government insurance plans, according to one of the first 
     studies to assess the impact of insurance coverage on 
     hospitalized children.
       Researchers at Johns Hopkins Children's Center analyzed 
     data from more than 23 million children's hospitalizations in 
     37 states from 1988 to 2005. Compared with insured children, 
     uninsured children faced a 60 percent increased risk of 
     dying, the researchers found.
       The authors estimated that at least 1,000 hospitalized 
     children died each year simply because they lacked insurance, 
     accounting for 16,787 of some 38,649 children's deaths 
     nationwide during the period analyzed.
       ``If you take two kids from the same demographic 
     background--the same race, same gender, same neighborhood 
     income level and same number of co-morbidities or other 
     illnesses--the kid without insurance is 60 percent more 
     likely to die in the hospital than the kid in the bed right 
     next to him or her who is insured,'' said David C. Chang, co-
     director of the pediatric surgery outcomes group at the 
     children's center and an author of the study, which appeared 
     today in The Journal of Public Health.
       Although the research was not set up to identify why 
     uninsured children were more likely to die, it found that 
     they were more likely to gain access to care through the 
     emergency room, suggesting they might have more advanced 
     disease by the time they were hospitalized.
       In addition, uninsured children were in the hospital, on 
     average, for less than a day when they died, compared with a 
     full day for insured children. Children without insurance 
     incurred lower hospital charges--$8,058 on average, compared 
     with $20,951 for insured children.
       In children who survived hospitalization, the length of 
     stay and charges did not vary with insurance status.
       The paper's lead author, Dr. Fizan Abdullah, assistant 
     professor of surgery at Johns Hopkins, dismissed the 
     possibility that providers gave less care or denied 
     procedures to the uninsured. ``The children who were 
     uninsured literally died before the hospital could provide 
     them more care,'' Dr. Abdullah said.
       Furthermore, Dr. Abdullah said, indications are that the 
     uninsured children ``are further along in their course of 
     illness.''
       The results are all the more striking because children's 
     deaths are so rare that they could be examined only by a very 
     large study, said Dr. Peter J. Pronovost, a professor of 
     surgery at Johns Hopkins and an author of the new study.
       ``The striking thing is that children don't often die,'' 
     Dr. Pronovost said. ``This study provides further evidence 
     that the need to insure everyone is a moral issue, not just 
     an economic one.''
       An estimated seven million children are uninsured in the 
     United States, despite recent efforts to extend coverage 
     under the federal Children's Health Insurance Program.
       Advocates for children said they were saddened by the 
     findings but not surprised.
       ``We know from studies of adults that lack of insurance 
     contributes to worse outcomes, and this study provides 
     evidence that there are similar consequences for children,'' 
     said Alison Buist, director of child health at the Children's 
     Defense Fund, a nonprofit advocacy organization. ``If you 
     wait until a child gets care at a hospital, you have missed 
     an opportunity to get them the types of screening and 
     preventive services that prevent them from getting to that 
     level of severity to begin with.''

[[Page S11196]]

       The most common reasons for children being hospitalized 
     were complications from birth, pneumonia and asthma. The 
     study found that the reasons did not differ depending on 
     insurance status.
       Earlier studies have found that uninsured children are more 
     likely than insured children to have unmet medical needs, 
     like untreated asthma or diabetes, and are more likely to go 
     for two years without seeing a doctor.
       Following a recent expansion, 14 million children will be 
     covered by the CHIP program by 2013, according to the 
     Congressional Budget Office. Advocates for children are 
     concerned that efforts to overhaul the health care system may 
     actually reverse the progress made toward covering more 
     children if CHIP is phased out and many families remain 
     unable to afford health insurance.
       ``You can't just dump 14 million vulnerable children into a 
     new system without evidence that the benefits and the 
     affordability provisions are better than they are now,'' Dr. 
     Buist said. ``That's not health reform.''

   Mr. CASEY. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. CASEY. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________