[Congressional Record Volume 155, Number 171 (Wednesday, November 18, 2009)]
[Senate]
[Pages S11446-S11450]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. WARNER. Mr. President, I rise today to once again join my 
colleagues in addressing the need for comprehensive health care reform. 
The Senator from New Hampshire, Mrs. Shaheen, earlier spoke on health 
care reform and its effect on small business. I know my colleague, 
Senator Udall from Colorado, is going to be speaking soon. And I know 
we are going to be joined, as well, a little bit later by Senator 
Landrieu, who takes a leadership role on the issues affecting small 
businesses, as chair of the Small Business Committee. I rise today to 
stress how important health care reform is to the small business 
community. Currently, there are small businesses across America that 
have been hit very hard by the effects of the recession. Small 
businesses are struggling as they try to keep their doors open, with 
the enormous constriction of credit that is taking place. Small 
businesses are struggling to have the finances to expand; even healthy 
small businesses, as we have seen. Banks continue to draw back in 
capital and try to build up their own balance sheets. The people who 
have taken the hardest hit by the restriction on capital and the 
restriction on lending have been small businesses across this country.

  So we have the enormous challenges small businesses have felt by the 
recession that has been exacerbated by the constriction of lending, and 
then we add on top of that the enormous challenges that small 
businesses face in the health care market. The only people who pay 
retail--who pay full price for their health care benefits in America 
today--are small businesses and those who purchase health care on the 
individual-based market. There is no group that will more benefit, or 
have more to gain from meaningful health care reform, than small 
businesses.
  Small businesses currently lack the bargaining power of large firms 
and pay as much as 18 percent more for the same health insurance as 
larger companies. If you work in a large company you get the benefit of 
the larger pool, and you are better able to bargain for your health 
insurance rates. If you are poor and cannot afford health insurance, 
you get access to Medicaid. If you are a senior, you get access to 
Medicare. Small businesses are the group that falls through the cracks. 
They don't have access to this purchasing power, and consequently pay, 
on average, about 18 percent more for health insurance than larger 
companies.
  As health insurance costs continue to rise, more and more small 
businesses can no longer even afford to offer health insurance to their 
employees. And if they do, their employees can't afford the co-payments 
to purchase health insurance. In fact, nearly one-quarter of the 
uninsured in our country works for small businesses. Between 2000 and 
2009, the percentage of firms with less than 10 employees--the heart of 
small businesses--offering insurance coverage fell from 57 percent to 
46 percent. Among people with employer-based coverage in January of 
2006, one-sixth lost their coverage by 2008. Nearly three-quarters of 
small businesses that do not offer coverage to their employees cite 
high premiums as the reason. Small businesses want to offer health 
benefits to their employees, but are priced out of the market and 
cannot afford it.
  Many small business employees are left uninsured and, in turn, rely 
on the health care system to pick up the costs when they get sick. It 
is these people who show up at emergency rooms and access the most 
inefficient part of our health care system. They are oftentimes not 
people who are unemployed, but employees of small businesses. Enacting 
market reforms such as creating

[[Page S11447]]

insurance exchanges will finally give small businesses affordable 
options. Their employees will have a place to purchase insurance at 
large pool rates and, by insuring more people, reform will help drive 
down the cost of health insurance for all Americans. Insurance 
exchanges will also significantly reduce administrative costs for small 
businesses by enabling them to easily and simply compare the prices, 
benefits, and performance of health care plans.
  I know a number of us are working on a series of amendments for when 
the health care bill gets to the Senate floor to try to make sure we 
add further disclosure requirements and more transparency to our health 
care system. Right now we don't have a free market in our health care 
system because nobody knows what the providers actually pay, and what 
the doctors and hospitals actually charge. Small businesses will 
benefit by trying to bring transparency to these health insurance 
exchanges.
  Additionally, reform will enact consumer protections such as 
prohibiting insurance companies from denying coverage based on 
preexisting conditions and dropping people when they are sick. This is 
particularly a challenge to small businesses. If you only have a small 
group of employees and a few have preexisting conditions, those 
preexisting conditions drive up the cost of providing insurance for 
this smaller pool. Oftentimes this results in pricing small businesses 
out of the market. Reforms such as eliminating preexisting conditions 
will dramatically help small businesses and their employees obtain 
affordable health insurance.
  These protections are vital for small business employees because they 
help level the playing field in the small group market. They guarantee 
the option of large pool rates, lower costs, and prohibit insurance 
companies from arbitrarily penalizing small businesses when one of 
their employees becomes seriously ill.
  Lowering health care costs for employers is also key to our ability 
to compete in the global economy. If American business is going to come 
out of this recession and we can compete with countries around the 
world, we have to take on the cost of health insurance. American 
workers are more productive than any other workers in the world. But 
even with that increased productivity, if American businesses have to 
pay $3,000 to $4,000 more per employee because of higher health 
insurance costs than our competitors that puts American businesses at a 
dramatic disadvantage.
  As health care costs continue to rise, other business investments are 
sacrificed. Forty percent of businesses say health care costs have a 
negative impact on other parts of their business. As I mentioned, with 
the great reduction of credit availability to small businesses and in 
this challenging economic climate, American businesses cannot afford to 
be at such a disadvantage. With health care reform, more of our 
Nation's dollars will go toward investments in our economy.
  Health care costs also stifle productivity. Too many Americans end up 
staying in jobs simply because the employer provides health insurance. 
They aren't able to move around, or move into entrepreneurial startup 
firms where innovation and real growth potential takes place. Startup 
firms and, again, small businesses are often not able to offer health 
insurance. Consequently, we have good workers who are not able to move 
into these firms and help spur job growth because they are caught in 
dead-end jobs. They are constrained by the security of health insurance 
offered at their old jobs or perhaps because they have a preexisting 
condition and can't move to a new situation.
  Again, if we do health insurance reform right, it will put in place 
reforms such as the elimination of preexisting conditions requirements 
that will allow more freedom of movement within the job workforce.
  So, once again, I join my colleagues in making this case. We have 
made it time and again. Health care reform is necessary to make sure 
American businesses remain competitive. Health care reform is necessary 
because health care costs are the single largest driver of our Federal 
deficit. Health care reform is necessary because if we don't address 
rising costs, Medicare will be insolvent by 2017. If we don't reform 
the system, costs will also rise for families; an average Virginia 
family, for example, within the next decade, will be paying nearly 40 
percent of their disposable income to meet their health insurance 
premiums.
  I will close my comments with where I started. Small businesses are 
the only players in our market who still pay retail for their health 
care costs and are increasingly being priced out of the market. Reform 
is imperative for the small business community.
  I know my friend, the Senator from Colorado, is about to speak, and 
our leader on small business issues, the Senator from Louisiana, who 
has been so diligent on leading these efforts and making sure that 
small businesses are protected in health care. We must get this right. 
We must get this bill to the floor. And we must provide needed relief 
to the small businesses that will generate the economic recovery that 
we're all hoping for.
  Thank you, Mr. President. I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Colorado is 
recognized.
  Mr. UDALL of Colorado. Good morning. I, too, before I speak on health 
care, wish to join my colleagues in congratulating Senator Byrd. I, 
too, am in awe of all of his accomplishments, and I, too, admire his 
affection for the Senate and will endeavor in my service here to model 
his example.
  I join my colleagues this morning to discuss an issue of great 
importance to Colorado and to me. These past few weeks, as the 
Presiding Officer has, along with many of us on this side of the aisle, 
I have spoken about comprehensive health insurance reform as a key to 
strengthening and securing the lives of middle-class Americans. One of 
the most important components of that goal is ensuring that we do 
everything we can to help small business owners and their employees get 
affordable health coverage.
  As the Senator from Virginia mentioned, over the last 15 years, small 
businesses have created over 65 percent of the new jobs in our country. 
Yet the power of this job creation machine is being threatened by the 
exploding costs of health care. It will only get worse if we don't act.
  If we do not pass health insurance reform, small business owners will 
continue to see the costs of providing benefits eat away at their 
bottom line. In my home State of Colorado, premium costs for small 
businesses are projected to more than double over the next decade. 
These unsustainable cost increases not only harm current businesses, 
but they prevent the growth of new ones. More and more would-be 
entrepreneurs across the country are deciding not to start their own 
companies due to the fear that they would not have access to affordable 
insurance for their families or for their employees.
  Unfortunately, this fear is too often justified. In the insurance 
market today, small businesses lack the bargaining power to get 
affordable rates that many large employers enjoy. They find themselves 
subject to unpredictable and massive spikes in premiums. That is why it 
is so important that we pass a health care reform bill that takes 
proactive steps to address the rising costs of health care. I have to 
tell my colleagues I have been encouraged by the proposals I have seen 
thus far.
  For example, a recent analysis of the nonpartisan CBO, the 
Congressional Budget Office, score of the Senate Finance Committee bill 
estimates that the reforms therein would save small businesses $65 
billion every year for the next decade. The proposal would do this, in 
part, by taking steps to transform our health care delivery system to 
one that produces higher quality care at lower costs. It would also 
include tax credits specifically designed to help cash-strapped small 
businesses provide coverage to their employees.
  Additionally, new reinsurance programs would reimburse employers 
struggling with particularly high catastrophic costs. In addition to 
these probusiness proposals, we also need to make sure the market 
offers new and affordable options for those employers who want to offer 
coverage but currently cannot afford to do so. The new health insurance 
exchanges envisioned under the reform packages before us would permit 
small employers to purchase policies that spread risk across a

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much larger population. New consumer protections would also keep costs 
down by prohibiting insurers from charging higher premiums on the basis 
of health status or gender.
  Right now, being a woman is a preexisting condition under the terms 
of many insurance policies. That is just not acceptable. Employers 
would also be able to keep expenses down by promoting personal 
responsibility--offering wellness premium discounts to employees who 
make healthy choices.
  Enacting meaningful health care reform is necessary for ensuring 
productive small businesses, new American jobs, and a strong economy. 
Independent and unbiased analyses estimate that in the next 10 years, 
reform can save upward of 80,000 small business jobs and raise wages by 
more than $30 billion annually. Those are very promising numbers.
  As the Senate begins its historic floor debate on health insurance 
reform, you can expect that I and my colleagues will continue reminding 
the other side of the aisle just how critical reform is to the small 
business community. No amount of misleading rhetoric or misdirection by 
the defenders of the status quo will be enough to convince the American 
people we should continue forward on our current unsustainable path.
  I say to all my colleagues: Let's work together over the coming weeks 
to strengthen this legislation, empower small businesses, and put 
America's health care system on the road to recovery.
  Thank you, Mr. President. As I yield the floor, I wish to acknowledge 
the great leadership of the chairman of the Small Business Committee, 
the Senator from Louisiana.
  Thank you.
  The PRESIDING OFFICER (Mr. Kirk). The Senator from Louisiana is 
recognized.
  Ms. LANDRIEU. Mr. President, I thank the Senator from Colorado and 
the Senator from Virginia for their remarks earlier this morning on the 
subject I am also going to speak on, which is the urgency for us to 
provide important help to millions of small businesses out there that 
are depending on us to get this reform done right.
  I wish to speak for a minute about reforms for small business in 
America. There were many different reasons expressed by Members of 
Congress about why they began engaging in this very tough debate on 
health care. Many different issues brought us to the table. One of the 
issues that brought me to this table of reform and negotiation was the 
desperate plight of small businesses in America that have nowhere to 
turn.
  As my colleagues have said in their very excellent statements this 
morning, the unpredictable and unsustainable and skyrocketing costs of 
health care to small business in America is damaging their ability to 
grow, is participating in an uptick of bankruptcies, is diminishing 
their ability to hire people and create jobs at a time when our country 
needs those jobs created, perhaps more than ever in the last 25 or 30 
years. Until we get health care right for small business, they cannot 
get job creation right for America. It is as simple as that.
  So as difficult as this debate has been--and it has been very long, 
very arduous, with lots of different views--one thing we must do, in 
the final weeks and months of the debate, is get it right for small 
business. I have heard from hundreds of small business owners as 
chairman of the Small Business Committee. My members have heard from 
hundreds. We have heard from thousands, through their representative 
associations, from conservative associations, to moderate, to more 
liberal associations representing a broad stretch of small businesses 
in this country, saying this is their No. 1 issue.
  Just this week, Barbara Biersmith, who owns Sylvan Learning Center in 
Monroe, LA, a small business owner--1 out of the 27 million that exist 
in the United States of America--and 27 million is a lot of people, a 
lot of businesses and employees. She is one. She is quoted in the 
Monroe News Star this week:

       As a business owner, I have struggled in vain for more than 
     22 years to find a way to provide health insurance for my 
     employees.
       Health insurance providers tell me I have too few employees 
     to make a group. Or they tell me that some of my employees 
     have preexisting conditions that excludes them from a group 
     and that would make the group too small.
       The kind of highly educated, experienced people I prefer to 
     hire nearly always have preexisting conditions. Who doesn't 
     have a preexisting condition by the age 30?

  Considering that being a woman of childbearing age is considered a 
preexisting condition, I think she is right. Who doesn't have one these 
days based on the interpretation of these policies? She goes on to say:

       Because my business can't provide good health benefits 
     effectively, I am restricted to hiring people who are covered 
     by their spouse's medical insurance.

  This is something that is not talked about often. I know my colleague 
from Washington is waiting to speak. I will go through this as quickly 
as I can. I hear this over and over again when I am on the streets and 
in towns and communities back home and I don't hear it here. Let me say 
it. I have any number of people who come up to me and say: Senator, 
thank you for working hard on health care. I am a little concerned or 
confused about what you all are doing but try to get it right because 
my health care is through my spouse who works for the government or my 
health care is through my spouse who works for a big company, and if I 
didn't have that health care, I wouldn't have any.
  I was in a restaurant last week, and the gentlemen who owns it told 
me this: I couldn't be a small business owner but for my health care 
that is covered through my spouse.
  It is right to get the policy right so everybody can have access to 
affordable health care coverage.
  She goes on to say:

       I hope and pray our representatives and Senators soon pass 
     Federal legislation to help the really small businesses of 
     America.

  Let me say I hope that help is on the way. If we can negotiate this 
bill, in terms of robust exchanges, subsidies for small businesses, 
particularly these very small businesses of under 10 employees or 25 
employees, it would help. The situation Barbara is facing is not 
acceptable and must be corrected. But her situation is not unique, as I 
said. According to a report by the Small Business Majority, the health 
care costs for small businesses are expected to increase from $156 
billion in 2009 to $2.4 trillion by 2018.
  Before I put up the next chart, I need to repeat these numbers 
because they are dramatic. These are numbers published by the Small 
Business Majority's report, based on actual data. This is a bill that 
small business cannot pay. This is a bill they cannot pay. We must get 
the costs moving in a different direction. It will take some time, but 
we must get this chart going from up to down. That is why I have pushed 
every day of this debate to focus on cost containment. Not only is it 
important for taxpayers and government, it is absolutely critical for 
small businesses to have more choices at lower costs.
  This chart shows the graph in a different way. This shows the 
cumulative cost of health care benefits--the first one. This is 
indicating job loss, and 178,000 small business jobs will be lost in 
2018 due to the high cost of health care. That is up from 39,000. 
Companies can't continue to hire if they have to pay higher premiums 
for the employees they still have working for them.
  Costs are high because of a broken insurance market where insurers, 
in order to satisfy their stockholders, put a greater focus on their 
bottom line. I understand that when you are in business, you need to 
make a profit. I understand that is why you are in business. I have no 
problem with people making profits--and significant ones--as long as 
the rules are fair and as long as there is opportunity to keep our 
values in order. One of the values we have in America is people going 
into business making a profit but making sure, if you are in the 
business of insurance and delivering benefits, that is what you are 
delivering to the people you are trying to serve. So we need some 
adjustments in those rules and regulations. That is what I think we are 
doing in our reform bill.
  More alarmingly, getting back to the statistics, according to some 
reports, including a recent New York Times article, the insurance 
companies are planning to raise rates even higher today in anticipation 
of our reform effort. This is very unsettling, and the

[[Page S11449]]

sooner we act the better I think we will be--to help reform this 
market, to bring some order to the framework. That would be extremely 
helpful.
  Lack of choice and competition is a problem, as I said. In Louisiana, 
our two top insurers maintain 74 percent of the market. In Alaska, I 
understand, there are two insurers maintaining 95 percent of the 
market. This is not real choice. It is not real competition. That is 
why the exchanges we have in most of the base bills, making them more 
robust, making subsidies as generous as we can to encourage individuals 
to assume responsibility for their health care, as well as subsidizing 
small businesses to encourage them to get into these large pools, I 
believe--and many of us believe--that will help to drive down costs, as 
we reform the private market.

  To level the playing field for small businesses and to provide 
working families with more choices at lower costs, the bill we will 
vote on in the Senate will have as robust an exchange system as 
possible. These exchanges will allow businesses and individuals to pool 
to give them the negotiating power and to spread risk.
  We estimate today that small businesses pay retail, as the Senator 
from Virginia. Mr. Warner said. Everybody else pays wholesale. Small 
business pays retail. The price of paying retail is a minimum of 18 
percent more on premiums that they are paying. So we want to get that 
savings. The exchanges will achieve that. The exchanges will also 
achieve lower administrative costs, so you don't have to hire a full-
time lawyer or accountant to navigate the wide variety--actually, there 
are limited choices today, but you will have more transparency, more 
robust exchanges.
  Finally, regardless of the level of benefit choices, there should be 
a limit on how much individuals must spend out of pocket and a minimum 
standard of care among all the plan levels. These are some of the 
protections we are working on for small businesses, which will benefit 
individuals as well.
  Again, I thank my colleagues for being on the floor this morning. I 
think Senator Cantwell, the Senator from Washington, who is here to 
give voice to this important part of the debate. Again, we have 
hundreds of Members of Congress. We all came to this debate carrying 
various issues and with greater concerns than others. One of my great 
concerns has been, as we try to find a way to dig ourselves out of this 
great recession--some say the worst economic situation since the Great 
Depression--the only way we are going to do that is for businesses to 
create jobs. Right now, there is a big burden that they have been 
carrying alone. They need help, support, and they need more tax 
credits, more robust subsidies, and a more orderly private market 
framework that allows the insurance companies to be in business and to 
make a profit but also allows small businesses to be able to afford 
quality coverage for American workers, so we can get back to being the 
most productive workforce in the world.
  I yield the floor for the Senator from Washington.
  The PRESIDING OFFICER. The Senator from Washington is recognized.
  Ms. CANTWELL. Mr. President, I come to the floor to join my 
colleagues to talk about the rising cost of health care on small 
businesses. I thank the chair of the Small Business Committee, Senator 
Landrieu, from Louisiana. She has been an outspoken and articulate 
advocate for small business. She is constantly focusing on what we are 
going to do to help small businesses in America, and she wants to make 
sure any health care legislation that is passed out of the Senate 
focuses on that. That is very important because we know that when we 
talk about small businesses in this current environment, they are at a 
disadvantage when it comes to our health care system. That is to say 
they have long been the backbone of the American economy. Small 
businesses employ about 40 percent of our workforce. Even in a 
downturn, the job creation we are going to see is going to come from 
small businesses. If we can address their concerns in health care 
reform about the rising cost of health care, then we are going to be 
doing ourselves a favor because they are going to be able to grow more 
jobs and grow the economy.

  I applaud the Senator from Louisiana for her efforts and join with my 
colleagues, Senators Warner, Udall, and Shaheen, in coming down here to 
describe why we think it is so important that we get health care reform 
and that we do something about this because we really do want to get 
our economy going, and we certainly want to control costs so that small 
businesses can grow jobs.
  Why is this so important? We have seen a 120-percent increase in 
premiums over the last 10 years. That is to say, from 1999 to 2009, 
insurance premiums have increased 120 percent--120 percent. What family 
in America can sustain the constant increase in insurance premiums 
every year? The fact is, they cannot.
  In my State, we have seen a sharp rise in those who are without 
health insurance because the premiums keep going up. More and more 
small businesses have to make choices between keeping employees on the 
rolls or cutting back on their health insurance. And they are making 
those choices. It puts all of us at a disadvantage.
  What should we be doing instead about the rising costs of premiums in 
health care? We should be doing something to bend the cost curve. You 
will hear many of my colleagues, as you did this morning, talk about 
bending the cost curve and why it is so important. Right now, if we 
look at what is happening with health insurance, as I said, it already 
increased 120 percent over 10 years. The next 10-year period, it is 
supposed to increase in the same way, double in cost, increase about 
7.9 to 8 percent a year. So that means if we do nothing, small 
businesses are going to continue to see this escalator of costs keep 
going up for, and that means they are going to employ fewer and fewer 
people because they cannot afford the health care coverage.
  We see that general inflation is about 2 percent, but this increase 
in premiums is about, as I said, 7 to 8 percent. Why are we seeing this 
huge increase in the cost of premiums if general inflation is only 
about 2 percent? This, in my opinion, is what the health care debate 
should be about. This difference between general inflation and health 
care cost increases should be the entire debate. What are we going to 
do to drive down the costs so that health care costs are kept more in 
pace with inflation?
  Why are these statistics so important? The issue is that, according 
to the National Small Business Association, only 38 percent of small 
businesses provided health insurance last year. That is down 61 percent 
from 1993. So we are continuing to see that shrinkage in people 
offering coverage. Of those who do offer coverage, 72 percent say they 
are struggling to continue to offer coverage to their employees.
  An MIT study shows that the cost of health care to small business 
will more than double in the next 10 years, just as it has in the last 
10 years, and that small businesses pay up to 18 percent more than the 
same coverage for larger firms. What that means is small businesses are 
being disadvantaged. They are being disadvantaged because they do not 
have the same clout in the marketplace as a large employer to negotiate 
benefits and drive down costs.
  What do we want to do about that? What we want to do is give small 
businesses the same kind of negotiating power large companies have to 
negotiate for benefits. In fact, health care reform and helping small 
businesses should be able to negotiate with insurance companies to 
drive down the costs of their plans.
  This is something that is already part of the underlying bill we 
passed out of the Finance Committee. I am sure that when we see 
legislation coming to the Senate floor this Friday, we will see the 
same kind of provision, at least with the basic health plan, a 
provision I helped coauthor in the legislation that would allow States 
to negotiate on behalf of the uninsured, allowing those who are 
employed in small businesses to help lower the costs. In our State, 
this plan has driven costs down 30 to 40 percent lower than what those 
individuals would be able to get in an individual market. That is 
amazing, the fact that they have been able to pool together 40,000 to 
60,000 people, go to the marketplace, and say to insurance providers: 
If you want access to our insurance business, you have to

[[Page S11450]]

give us a discount. I call it the Costco model. I don't know how many 
people here this morning understand the Costco model, but the Costco 
model is something where you buy in bulk and you make large purchases. 
You should get a discount. That is what we are saying. We want to give 
small businesses the same kind of purchasing power large businesses 
have so they can drive down costs. That is going to be a critical 
component of this legislation, and this Senator, along with my 
colleagues who are out on the floor today, is going to make sure that 
negotiating power exists in a final bill for small business.
  Second, we need to make sure we also have provider reform, that 
provider payments reward not just volume but value. Right now in our 
health care delivery system, there is a lot of focus given to what I 
would say is the quantity of health care that is delivered, the fee-
for-service system that basically ends up having insurers paying 
physicians for the number of patients they have seen or the number of 
tests they have ordered but is not generated or focused on payment to a 
physician based on the outcome of the patient. There are provider 
reforms in this legislation that will also help drive down the cost to 
small businesses because those providers will be focusing on what it 
takes to deliver health care to those individuals.
  Third, we need to have better transparency on drug pricing because 
transparency of cost is something that will help us in negotiating, as 
a government purchaser, better health care benefits. Right now, there 
is a lot of unknown about health care costs in drug pricing because 
middlemen basically negotiate discounts on behalf of their customers 
but end up pocketing some of those benefits.
  We want to make sure all three of these points are part of vital 
legislation to help drive down the cost for small businesses.
  I have many small businesses come into my office. I met with some in 
the State of Washington. We are very proud of the diverse array of 
companies that exist in our State. A lot of people look at some of the 
major employers such as Boeing or Microsoft or, as I mentioned, Costco, 
Starbucks. Washington State is home to many entrepreneurs. There are 
many great companies that may be the big companies of the future but 
are the small businesses today, and they need our help and assistance.
  Two of those, Kent and Linda Davis, run a technology consulting firm 
and pay $1,500 per month for health insurance--$1,500 per month. They 
just learned that in 2010 their premiums will increase by another $300 
per month. This is the third substantial increase they have had in a 
row. They want to hire more employees, but they cannot because of the 
cost of health care.
  Another successful entrepreneur who has come into my office, Gene 
Otto, is the owner of the San Francisco Street Bakery. You might think 
the San Francisco Street Bakery is in San Francisco, but it is actually 
in Olympia, WA, and it employs 20 people. Over the past decade, the 
increases in health insurance premiums have forced them to take 
dramatic reductions in the level of benefits and the number of 
employees they can cover. This is a company that wants to grow. They 
want to expand. They have great products and great services.
  It is people such as the Davises and Gene Otto who are the economic 
engine of our economy. They are going to continue to depend on us to 
make sure that in this legislation and in this legislative debate, we 
are going to do everything we can to help small businesses grow.
  Small businesses cannot grow if health care costs are going to rise 8 
to 10 percent a year. It will hamper the ability of those small 
businesses to meet the demands and challenges of their workforce and 
keep them healthy, facing an economy that has been certainly challenged 
by this big downturn we have seen but that needs to go back to growth 
in the future. They want to be part of that. They want to be part of 
that growth, and they want to be part of helping our economy recover. 
But to do that, we are going to have to do something to control health 
care costs.

  I applaud my colleagues who I know share these same issues and 
concerns: the Senator from Virginia, who has been very outspoken on the 
fact that we have to change our system to make sure we are bending the 
cost curve and focusing on driving down costs with provider reforms; my 
colleague from Louisiana, who is focused on making sure small 
businesses have clout and access to small business negotiations that 
large companies have; my colleague Senator Shaheen, who also has been a 
big supporter of making sure we have provider reform in the system; and 
Senator Udall, who comes from a State that knows health care costs are 
a key component. If we want our economy to grow, we have to drive down 
health care costs.
  Two of our former colleagues have been on the floor in the last few 
minutes--the Vice President of the United States and the Secretary of 
Interior. We are glad they have come up to Capitol Hill to continue 
discussions with us about how important this legislation is. I thank 
them for that. I thank them for their service to our country and for 
their willingness to serve in the administration. We certainly miss 
them in the Senate. But I think it emphasizes the urgency of the health 
care legislation, that our economy is struggling, that we want it to 
grow, that we think small businesses are going to be a key component of 
that, but we have to give them negotiating power. We have to give them 
the ability to negotiate with insurance plans to drive down the costs, 
and we have to do better at reforming the system so we can see that 
growth happen in America.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Tennessee.
  Mr. ALEXANDER. Mr. President, will you please let me know when 8 
minutes has elapsed?
  I, too, see the Secretary of Interior on the floor, who formerly was 
a Member of this body. We miss him. We are glad he is here. We are glad 
he is taking care of the treasured landscapes of America.

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