[Congressional Record (Bound Edition), Volume 153 (2007), Part 2]
[Senate]
[Pages 2447-2452]
[From the U.S. Government Publishing Office, www.gpo.gov]




                         MINIMUM WAGE AMENDMENT

  Mr. BURR. Mr. President, on this brisk day in Washington, 
weatherwise, we have had a refreshing debate about minimum wage. I have 
listened to the majority leader say that those who have minimum wage 
amendments and would like to have votes are, in fact, against raising 
the minimum wage. I introduced my amendment yesterday. I highlighted 
the wonderful work of Senator Kennedy and Senator Enzi, the managers of 
the bill, the fact that we were long overdue for a minimum wage 
increase, and that, as a Member of the Senate, I thought it was 
important we explore, as we do this, if we can make some changes that 
allow us to address other areas.
  Now, I happen to be the Senator who offered the amendment--and I 
thank my colleagues Senator Coburn and Senator DeMint who are 
cosponsors--who suggested this--that with the $2.10 increase we make in 
minimum wage, we allow an employer to determine if they want to provide 
that increase in wages or in health care benefits.
  We have had a debate in this country for years, over the 13 years I 
have been here, about the uninsured population and what we need to do. 
Here is an opportunity to do something. Here is a real opportunity to 
give employers the incentive to provide to the most at-risk minimum 
wage workers a health care benefit that can be covered under the 
umbrella of health coverage that we, as Members of the Senate and those 
of us who work for the Federal Government, actually have that protects 
us.
  All Americans should have access to quality and affordable health 
care. Under our current system, many get health care from their 
employer. Let's increase the number of Americans under that umbrella of 
coverage and take the opportunity, as we increase the minimum wage 
rate, to allow employers to be the ones to do it.
  The majority leader has filed a cloture motion on S. 2. Let me 
explain exactly what that means. We are going to cut off the ability to 
offer amendments on anything non-germane. Anyone listening to the 
description of my amendment would have to say, clearly, that is 
germane. You will use the $2.10 increase in the minimum wage to allow 
employers to offer health care with that $2.10. Now, this is not a shot 
at the Parliamentarian of the Senate, but this amendment is not 
germane. In filing cloture without an agreement, we won't be allowed in 
the Senate to have a vote on my amendment. I can come here and sell the 
merits of my amendment to those across the country who listen to this 
and they will say--that makes a tremendous amount of sense. We want to 
extend health care to the uninsured. An excellent way to do that is to 
use the power of the employer. As an employer negotiated for the rest 
of his employees who may not be at the lower end of his pay scale, he 
can use the minimum wage workers in the group rate and access health 
insurance cheaper than they could as individuals.
  But no, filing cloture means without an agreement the Senate is never 
going to have a vote on this. We will be denied the vote because this 
is non-germane.
  I am not sure where this fits in that open process I heard described. 
As a matter of fact, we have actually filed cloture for a bill we have 
not even called up, a resolution on Iraq. I guess that means we will 
limit our debate on the war, too. Gee, that is a strange one to limit 
debate on.
  Let me take the time I have today to talk about my amendment. Mr. 
President, $2.10; what is that on an annual basis for an individual at 
the lowest end of the income scale in America? It is $4,368. Some 
people will be opposed to the amendment even though they will not get 
an opportunity to vote on it because they will say that is not enough 
money. Let me show what it can buy.
  Mr. President, $4,300 a year can buy health insurance, 100 percent 
for an individual. It can buy almost 50 percent of family coverage. 
This is the average as followed by the Kaiser Family Foundation of fee-
for-service insurance:

[[Page 2448]]

$3,782. I might say that regionally, where you live in the United 
States dictates the cost of health insurance, but this is an average 
for the United States, fee-for-service, traditional health care 
coverage, $3,782; a preferred provider plan, $4,150; a POS plan, 
$3,914; and a health maintenance organization, $3,767.
  The argument that you cannot provide health care with the $4,368 
increase we are giving to a minimum wage worker clearly has been 
demonstrated by the Kaiser Foundation to be wrong. You cannot only 
provide it as an employer, you can pay 100 percent of it. A minimum 
wage worker would not have to put a dime out of their pocket to have 
health care coverage that is equal to what a Member of the Senate has. 
But when you file cloture, when you limit debate, when you deny a vote, 
you have now denied every minimum wage worker in the country of having 
an opportunity for their employer to work on behalf of their group to 
extend the health care benefit to minimum wage workers: a 100-percent 
benefit.
  The President and myself--I think we pay 25 percent of our insurance 
premium for health care, and that percentage certainly changes, 
depending on who you work for. But an employer assumes some percentage. 
Some employers pay 100 percent, but it is rare today. Here is an 
opportunity to give employers an incentive to provide 100 percent of 
the premium cost and still have money left over to provide to their 
employees.
  I am sure there are people listening to this debate who are saying 
this is crazy. If we have 47 million uninsured in this country, how 
many of those might fall into this category? The reality is, it is 
almost 15 million Americans whose income is $25,000 or less.
  The average minimum wage worker today makes a little over $10,000. 
The actual national poverty level is a little over $9,000. They are 
very close to it for a full 40 hours worth of work.
  When we look at 47 million Americans, I am beginning to think we like 
that number more for the purposes of debate than as a target or a goal 
to solve.
  I said at the beginning, I believe all Americans should have access 
to quality, affordable health care. My opposition only wants that 
access if the Government provides it instead of the private sector. 
That was the debate in Part D Medicare when we created the first ever 
drug benefit for seniors in this country. And there were two sides, 
those who said only the Federal Government can provide this and those 
who believed that the private sector could, in fact, negotiate prices--
not just for the price of the drugs but through that, the premiums--
where seniors could be afforded choices.
  Today, the majority of Medicare-eligible individuals are signed up 
with the Part D prescription drug plan. Much to my amazement, for those 
who are incredibly pleased with their plan, the percentage is close to 
100 percent because of their choices and those who want to assume more 
financial risk out of their pocket and pay a smaller premium can do it. 
Those who do not want to pay out of their pocket but want to pay a 
higher premium can do that. For every milestone we have seen in Part D, 
drug prices have reduced because we have injected competition, premium 
prices have reduced because we are now providing drugs to seniors who 
are actually taking them.
  What does that do to our overall health care system? It means the 
more they are taking their medications, the less likely they are to 
visit the hospitals. Gee, I wonder if that is applicable to what we are 
talking about here? Why are health care costs going so high? Yes, we 
have a lot of new technology. That technology allows us to do things in 
a noninvasive way. Instead of cracking a chest open and doing a bypass 
on somebody's heart because maybe they ate the wrong things for 60 
years, now we can go in through their leg, we can go up through their 
vein structure, we can put in a stent and we can open and eliminate the 
risk of a heart attack. The quality of life is better for them because 
the recovery is shorter. In some cases it can be done as an outpatient 
procedure. That $70,000 average cost of a heart bypass is reduced 
significantly and, consequently, with that, the overall health care 
system sees savings.
  Imagine if we had not been doing that what the rise in health care 
costs would be. Part of health care inflation today--and I suggest it 
is a large part--is the cost shift that goes on. What is cost shift? 
The Presiding Officer and I have health insurance.
  When we go in and access health care, the hospital, the doctor, the 
lab, and the pharmacist know they are going to get paid because we give 
them an insurance card. There is no question in their mind. They know 
exactly what their reimbursement is going to be. If a Medicare 
beneficiary at any point accesses health care, that doctor, that 
hospital, that lab knows exactly what the reimbursement is they are 
going to get from Medicare for the procedure they offer.
  But when somebody goes into an emergency room who is uninsured and 
they do not pay: What happens to the cost of the procedure they got? It 
is real simple. It gets shifted to us. It gets shifted to everybody who 
has insurance. And to recover that, everybody's premium in the country 
goes up.
  So as I stand here and talk about a very specific group, minimum wage 
workers in America, what everybody has to understand is what we do on 
this issue affects everybody's health care in America. It affects 
everybody's premium amount in America. It affects 25 percent of all 
Federal employees costs. If you want to drive some costs down in the 
Federal Government, it is easy: Let's do this because we will eliminate 
a significant part of the cost shifting that is going on in our health 
care system in this country.
  Studies have shown in order to get individuals to purchase their own 
health insurance, tax incentives to individuals need to cover half or 
more of their health insurance premium. We are covering 100 percent of 
it. Many tax-based health care proposals to help the uninsured are 
criticized because they do not meet the threshold of covering half or 
more of an individual's health insurance premium. This is the first 
time I have ever been criticized because we offered 100 percent of the 
premium.
  Now, why might other people object to this? Well, quite honestly, 
they might say the employees should get wages, not health care. Well, 
let me restate what I said at the beginning, so it is clear.
  All Americans should have health coverage. Mr. President, 14.6 
million Americans make less than $25,000 a year and are uninsured. So 
if we are wondering in that pot of 47 million what makes up some of 
them, here is 14.6 million of them right here. They make less than 
$25,000 a year, and we know for a fact they are uninsured.
  Mr. President, $2.10 a day can buy basic health insurance for a 
minimum wage worker. On this chart is a breakdown of millions of 
uninsured by household income. You notice that close to the largest 
group is shown right here: $25,000 and below.
  This amendment is like a laser beam on exactly where we can make a 
difference. You see, we are at a real crossroads in America. We have 
gotten used to the best health care delivery the world has ever seen. 
As a matter of fact, if we tried to import from another country--and I 
will not name one because I do not want to offend them--their health 
care system into our country, the American people would rebel. They 
would not wait. They would not accept half a loaf when they thought 
they deserved a whole loaf. That is how our system is.
  So if we want to get a handle on this incredible cost of health care, 
we have to do two things. We have to provide coverage and we have to 
promote prevention and wellness.
  You see, if we can teach people how to control disease, then the 
number of times they access health care is going to be less. That is 
pretty much common sense. The problem is if we cannot create a 
relationship between an individual and a health care professional, how 
in the world are we ever going to complete the educational process of 
what disease management is? How can

[[Page 2449]]

we teach a diabetic that it is just as important to get exercise and to 
have a diet as it is to take their medication and check their blood 
sugar?
  As a matter of fact, in Asheville, NC, we are in the 10th year of a 
project called the Asheville Project, where it has focused specifically 
on diabetes. This idea was clearly out of the box because the community 
decided, with a grant, they were going to reimburse pharmacists to 
counsel diabetes patients.
  Think about that: A diabetes patient goes in. They are getting their 
medications filled. Now in Asheville, NC, and 10 other locations in the 
United States, that diabetes patient will sit down with the pharmacist, 
and the pharmacist will look through their drug regimen and make sure 
it is correct. They will make sure there is no interaction of different 
medications that they are currently taking. They will talk to them 
about exercise. They will give them suggestions if they are not getting 
exercise. They will check their progress if they are. They will talk to 
them about diet. They will actually weigh them. Maybe that is what we 
are scared of: If we do this, they will start weighing all of us.
  The reality is in Asheville, NC, and these 10 other cities across the 
country, there is now data. It is not me. It is the data that proves 
they save $2,000 a year per diabetic because we now provide for every 
diabetic this intense relationship with a health care professional.
  Now, what you have to understand is that in Asheville's case, and 
these other areas around the country, this is not the traditional entry 
point where we would choose to educate. This is quite creative. As a 
matter of fact, we have talked about it, and it has been rejected in 
this institution before, that we actually pay pharmacists to do part of 
the health care education. I hope it is something we will reexamine 
because I think there is tremendous merit to it. It has proven to be 
successful.
  But what does it prove? It proves that if prevention and wellness are 
promoted, there are savings that are derived across the system, and 
those savings will drive down premium costs for every American.
  Well, how do you get there? You get there by making sure every 
American is covered. Mr. President, 14.6 million--that is a real chunk 
of people whom we have an opportunity to affect whether they actually 
have health care coverage, whether they will actually have the 
education they need with a health care professional on disease 
management. It could be diabetes; it could be HIV/AIDS. There are a 
number of things that fall into the category.
  But the reality is, if we miss this opportunity, we will continue to 
have 14 million people who will access health care in the emergency 
room on an as-needed basis, and the likelihood is, there will be an in-
hospital patient with an average stay of over 3 days. And at the end of 
that stay, they probably will not have the money to pay for it, and, in 
fact, that will get cost shifted to everybody's insurance across the 
country. They do not want to do that; they just do not have the money 
to pay for it.
  Well, here is an opportunity for them not to be put in a difficult 
situation. Here is an opportunity for an individual to have 100 percent 
of their insurance--let me go back to that. For an individual, $4,386, 
under a traditional PPO, POS, or HMO, pays 100 percent of their premium 
costs--better than we get as Senators--and for a family, $9,900, 
$11,000, $10,000--$10,000 is the average across the country, based upon 
the type of plan you choose. We could pay 50 percent of a family's 
health care premium if we allowed employers to use the $2.10 and to 
apply it to health care benefits versus wages.
  One in five adults age 18 to 64 were uninsured in 2004--one in five 
adults. More than 54 percent of the uninsured are in families making 
200 percent or less of the Federal poverty guideline. Again, that is 
$9,800 a year. Americans living in households with annual incomes below 
$25,000 have a higher incidence of no insurance. Mr. President, 24 
percent were uninsured in 2004, compared to 15.7 percent of the total 
population. You see, this is not just the norm percentage who do not 
have insurance; this is almost double the national norm.
  Now, why this bill? Why the way we chose to do it? Well, employers 
are the centerpiece of health care delivery in the United States today. 
They may not be in the future. I am anxious to have that debate. 
Personally, I believe a health policy should be like a 401(k) plan. You 
should be able to take that health policy with you regardless of where 
you go, that when you change employers, you should not have to lose 
insurance coverage with a given company and the structure of your plan. 
You should have the option to take that with you. So I am sure at some 
point this year we will have that debate.
  Mr. President, 174 million workers and their dependents received 
health coverage through the workplace in 2004. So if you ask yourself, 
why am I offering this on the minimum wage bill? it is because 174 
million Americans receive their health care coverage via their 
employer. We have this excellent opportunity right now, as we talk 
about increasing minimum wage, where we can provide the incentive.
  I might add, I said the ``option,'' that an employer have the option. 
I am not mandating that an employer has to offer health care. There is 
a lot of work that goes into a company providing health care for their 
employees. They have to meet with plans. They have to negotiate rates. 
They have to keep records. There are going to be some employers who do 
not provide health care as a benefit, and they may not provide it for 
their employees afterwards. But you also have a segment of America that 
is minimum wage workers where companies would like to find a way for 
those folks to stay with them versus to leave for a nickel-an-hour or a 
dime-an-hour increase by somebody else.
  I can tell you, if you offer them 100 percent of their health care, 
then somebody is going to have to bid very high if, in fact, they are 
not providing health care, too.
  Workers, and especially low-income workers, feel more comfortable 
with their employers negotiating health care benefits than going into 
the individual market and purchasing it themselves. Why? It is real 
simple. It is because an employer negotiates volume. When I walk in, 
they see one individual, and they know I must be uninsured, if I am in 
there to buy health care, and the likelihood is they are never going to 
pull that sheet out of the middle drawer that says ``discounts.'' I 
will never receive a discount as an individual.
  And oddly enough, in this country, I have to say--and this is wrong--
the lower your income, the more the actuaries look at you and determine 
you are going to cost more. It is 100-percent wrong. And part of it is 
the structure of our model in this country: that we seldom promote 
wellness and prevention. I do not care where your income level is, if 
you provide those individuals with the tools they need, they are as 
healthy as the person next to them. What these folks do not have, 
because they do not have coverage, is they have no relationship with a 
health care professional. And that health care professional could be a 
primary care doctor; it could be a nurse; it could be a hospital; it 
could be a community health center; it could be a rural health clinic. 
And in the case of Asheville, NC, it could be a pharmacist in a very 
targeted program.
  More than 8 out of 10 of the uninsured are in working families. I am 
not talking about isolated individuals. I am picking these folks and 
not suggesting that we are doing something that just affects 
individuals. These are families. That is why when I talk about the 
family piece, think about a family that has never had health insurance 
for their children. Think about when they go in and their employer 
says: You know, we have this new requirement that we have to raise the 
minimum wage $2.10. But I will offer you 50 percent of your health care 
premium for your entire family, your wife and your children. It is 
going to be in place until your children get out of college. Maybe

[[Page 2450]]

that will give them an incentive to encourage those kids to graduate 
from high school and to consider higher education as part of their 
future.
  Six out of ten uninsured individuals have at least one family member 
working full time year-round. This is a huge population we are talking 
about affecting with this amendment. In 2002, 42 percent of wage and 
salary workers, age 18 to 64, were not offered health coverage through 
their employers. Here is a tremendous opportunity, as we do something 
that I have said I will support, and I doubt it will receive very many 
votes in opposition--here is an opportunity for the Congress to 
significantly affect the uninsured. But I remind everybody, we are not 
going to have an opportunity to vote on this amendment. It is so timely 
that I would come to the floor, I would wait my turn to talk about an 
amendment that I couldn't talk about the other day because the 
leadership was in a hurry. So I called up my amendment so it would be 
pending--pending means that it should get a vote before cloture would 
be filed--only to find out from the majority leader when he stood, I 
think he referred to my amendment as ``silly.''
  I don't think it is silly. It may be non-germane, but the health 
insurance of minimum wage workers is not silly. As a matter of fact, it 
is crucial to the health care change that we have to accomplish in this 
country if, in fact, we are going to keep health care affordable for 
all Americans, not just some Americans.
  Let me talk about employers and employees. I believe my amendment is 
a win-win. I challenge any Member of the Senate to tell me who loses. 
Think about it. An employer is able to negotiate for minimum wage 
workers at the group rate which means he might be able to negotiate, 
because he is putting more people in the pool, an even lower cost for 
his overall workforce than he had before. He is able to offer his 
employees health care which his competitor might not. His employees 
have a tendency, then, to stay with him longer because we all know that 
there is a cost that is incurred by an employer, an investment to train 
them, an investment to have them in the business. And the last thing 
they want to do is see minimum wage workers that work a month or 2 or 6 
months and keep moving from employer to employer. And by the way, the 
one thing they don't have control over as an employer is the days that 
employees call in because they are sick. Those are days that the 
employer is planning on getting something done. That minimum wage 
worker, because they are now sick, picks up the phone and says: I can't 
be there.
  Maybe if we get them covered by insurance, maybe if they actually go 
for prevention and wellness education, maybe if they learn through that 
health relationship the things they should do and should not do, maybe 
they are not going to be picking up the phone and calling in and 
saying: I will not be there.
  The employers lose on those days, but the employees lose on those 
days, too, because this is a minimum wage worker. They are paid by the 
hour. They are only paid when they are there. Provide them health care, 
enable them not to make that phone call, the employer doesn't have a 
disruption in his business, and the employee doesn't have a subtraction 
in his paycheck. This is truly a win-win for employees and employers.
  Employers will spend less time and less money overall by providing 
the $2.10 increase in health benefits. Let me restate that. Employers 
will spend less money overall by providing it in health benefits. Why? 
Because they buy in bulk. What does that mean? It is more bang for the 
buck. They are able to get more benefit for a smaller amount of 
dollars. That means that when they go and negotiate the structure of a 
plan, they could negotiate something that had an even richer benefit, 
maybe no out-of-pocket cost, maybe no copayment for drugs because they 
have another $500 there with which they can negotiate. Employers get 
the same deduction in calculating taxable income, if they provide 
compensation in the form of health benefits or compensation in the form 
of wages and salaries.
  We all know because we have gone through part of the debate that when 
employers and employees are covered by health insurance, that is done 
with pretax wages.
  My point is, the tax implication on the minimum wage worker does not 
go up. They get the same advantage that we have, that their health 
benefits are not only deductible for the employer, but they can access 
some pretax dollars to do it.
  To deny a vote on this amendment is to not give minimum wage workers 
the same thing we have. Sure, there is a discrepancy in the difference 
that you make and I make and they make, but now we are talking about 
fairness from the standpoint of benefits. We have an opportunity to 
change that. And because we are in such a hurry in the Senate and 
because the majority leader is tired of people offering amendments--I 
think all of them have merit. I haven't seen any that I thought were 
for the purposes of delay. As a matter of fact, I would be for moving 
to wrap up this bill tomorrow if the majority leader would say I could 
have a vote on this amendment. He is not going to give me a vote. You 
can use the Senate rules to make sure that votes don't happen. And 
maybe I could have designed this in a way that it was germane. But 
sometimes the best things are simple. Sometimes when you lay it out in 
a way that people across the country, especially minimum wage workers, 
understand, it is better for them. We could hide it and make it 
confusing and make it to where employers possibly couldn't provide 
everything that they could. But we decided to leave it simple.
  What might be another objection to this bill? Well, can employers 
truly implement this process. Let me go to another chart. I think you 
have heard me say most of this except for the last one: Some coverage 
is better than no coverage. Will every employer get it right? Probably 
not. Will every employer get as much bang for the buck as they possibly 
can? Maybe not. Some coverage is better than no coverage. You have 
heard the percentages about the population that are at the income 
levels that minimum wage workers are. If you only believed that this 
amendment would provide some coverage, then you have to agree with me 
that is better than no coverage.
  Under our current health care system, employees will be better off 
with health care coverage through their employers because employers get 
better pricing. If they don't or they can't, then I know what is going 
to happen. They are going to offer it in wages. But should we deny them 
the opportunity to try to help us solve part of the health care problem 
that we have in America, and that is the uninsured that are here?
  I said earlier that I thought all Americans had a stake in this 
amendment because it is their health care premium that is affected by 
every health care policy we take up. When we add additional mandates 
for coverage, we drive up premium costs. When the American people 
exercise, watch what they eat, they help us to moderate health care 
costs and premium costs. Health insurance, even the most basic health 
insurance, gives people access to a system of health care, that 
relationship with a health care professional, that primary care doctor, 
the prevention and wellness programs, routine testing for chronic 
diseases that keep them out of a hospital.
  I want to relate a story. I won't mention the company. Well, I will 
mention the company: Dell computers. I think it is important that you 
understand that they are in one of the most competitive industries in 
the world. I daresay I don't think anybody is going to wake up tomorrow 
and say: I think I will get into computer manufacturing because there 
is so much money to be made. Everybody globally is in computer assembly 
and manufacturing. Dell does it the best. I don't say that just because 
they have a plant in North Carolina. I say it because the experts say 
that.
  I might also say, since Lenovo has a plant in North Carolina, they do 
a pretty good job, too. But Dell recognized

[[Page 2451]]

one day that if they wanted to be competitive in this highly 
competitive industry of computers, they had to do something about 
health care. They were self-insured. They had already taken the first 
step. They assumed a lot of the risk as a company to drive down the 
cost of their health care for employees and, consequently, for the 
company. What did Dell find out?
  Dell tried to make available prevention tools for their employees. If 
they were overweight, they would give them a dietician to work with 
them. If they had diabetes, they would give them somebody who could 
counsel them about diabetes. If they smoked, they paid for a cessation 
program. What happened? Less than 10 percent of the Dell employees who 
were affected by these things took advantage of the program. Less than 
10 percent of them signed up to receive the help.
  Any other corporation in America might have said: I will just accept 
the fact that we are going to have this high health insurance. But Dell 
realized: We are still making computers. And if we can't fix this, we 
are not going to be competitive.
  What did they do? Dell offered employees up to $250 cash if they 
would sign up for the program. I will tell my colleagues, the American 
people respond to money. They do respond to money. All of a sudden, the 
enrollment in these plans went sky high. Today, some 5 or 6 years later 
Dell computers can prove that they save about $1,700 for every employee 
who goes into that program. Those numbers may have changed since the 
last time I met with them.
  My point is this: Everywhere we looked--private sector, public, 
individual, group--where we have been brave enough to go out and do it 
differently, where we have been brave enough to force prevention and 
wellness into the system, it works. It works for the employee and for 
the employer. It is job security because they are more competitive. And 
every American receives the benefit of it because there is less cost 
shift in the system.
  Let me bring it back to where we are. All Americans should have 
health coverage. We have this unique opportunity, as we debate the 
opportunity for minimum wage workers to receive a $2.10 raise over a 
period of time, to give the option to every employer to provide that 
$2.10 increase in health care benefits versus in wages. And the Kaiser 
Foundation's health research proves that, for an individual, regardless 
of whether it is traditional fee-for-service insurance, point-of-
service, or health maintenance organization, that $4,368 a year pays 
100 percent of the premium cost for that minimum wage worker, which is 
a higher percentage than a Member of the Senate is paid for by the 
Federal Government. That means a minimum wage worker is not required, 
such as I am, to pay 25 percent of their health care cost, but they 
would get 100 percent. If, in fact, their family is uninsured, which 
the majority of them are, the Kaiser Family Foundation says the average 
for family coverage--wife, kids, unlimited--that an employer for a 
minimum wage worker can provide is almost 50 percent of the premium 
cost.
  This is a tremendous opportunity, from a standpoint of health care 
policy, that I so hope we are not going to miss the opportunity to do. 
But if my colleagues on both sides of the aisle allow debate to be shut 
down without an agreement from the majority leader that he is going to 
allow a vote--the only reason I can see not to have a vote is because 
nobody has figured out how to put a second-degree amendment on it. It 
is too simple. Procedurally, if they can kill it, they would.
  In North Carolina, Mr. President, there are 1.3 million uninsured 
individuals; 17 percent of my State's population is uninsured, compared 
to the national average of 16 percent. So, listen, I feel bad. I wish 
to see North Carolina do better. As a matter of fact, we have probably 
more waivers in health care than any State in the country right now, 
from Medicaid to the soon-to-be dual eligibles under Medicare because 
we are trying to lower the costs for everybody by being creative as to 
how we do it. I will tell you this: In North Carolina, the centerpiece 
of our success is two words: Prevention and wellness. When we are able 
to establish a relationship with a health care professional, we now 
have an opportunity to bring prevention and wellness into every 
person's health care regimen. I am convinced this is absolutely crucial 
to the future of health care in this country and to the affordability 
of health care for the future.
  Eight hundred and ninety eight thousand uninsured individuals and 
families are on their own with one full-time worker in North Carolina. 
So when I said 1.3 million uninsured, understand that almost 900,000 of 
them are in families--families who could get 50 percent of their 
premium paid for by their employer, if we gave the employer the option 
of providing health care versus being forced only to provide wages.
  In North Carolina, we have 204,360 uninsured part-time workers. That 
means they are not going to work 40 hours. So maybe they are only going 
to work 20 hours, and instead of getting $4,368, they are going to get 
a little over $2,000. Well, even those part-time workers--uninsured 
part-time workers--if they are earning minimum wage under this program, 
as much as 50 or 60 percent of the premium of their health care could 
be paid for. So it is not limited to full-time workers.
  It is too simple. It is way too simple. Everybody in the country gets 
it. Why doesn't the Senate get it? How can anybody look at this and say 
we should not do it? It is easy. The Senate rules allow you to not have 
a vote. I am not trying to delay; I am trying to make the bill better. 
I am trying to learn from what we are learning all across the country--
that there are smart people outside Washington who are in companies, in 
States, who are involved in the health care system, and we have a real 
opportunity to take what they have been telling us and apply it to the 
most at-risk group of Americans, which are the minimum wage workers.
  I have always shrugged it off when somebody came up to me and said: 
Gee, do you guys ever listen in Washington? Do you pay attention to 
what is going on? Because I thought we did. I do. But, you know, what I 
am learning today is that ``we'' don't. You cannot come on the floor of 
the Senate day after day and talk about the uninsured population and 
how we have an obligation to take care of it, and here is a real 
opportunity to do it--and what is the majority's answer? We are not 
going to let you vote because we think you are trying to delay.
  I am not trying to delay, I say to the majority leader; I am trying 
to provide health care for minimum wage workers--for maybe 14.6 million 
people in this country. You know, the sad part is, even if I get this 
done, there are still 30 million Americans who are uninsured. Maybe the 
fear is that it will work. Maybe they will find out that when these 
guys get insurance, they are no longer going to be sick. Maybe they are 
worried we are going to find out that if they are not sick, our 
insurance will go down and every American's insurance will go down.
  Health care continuously ranks as one of the top issues in this 
country. I have devoted 13 years now to understanding health care to 
the degree that I feel like I can walk into an operating room and do a 
procedure, even without staying at a Holiday Inn Express. But, you 
know, we are not listening to them. We are not listening to doctors, 
nurses, community health centers or rural health clinics. And I can 
tell you this: We are not listening to the American people. We are not 
doing what we can to provide the opportunity for health care coverage 
to be extended to them. Do you know what? People with high health care 
costs, in the absence of having to spend that on health care, are not 
going to spend it in other areas. It is those other areas that create 
jobs. It is the groceries, it is the gas, those things they pick up on 
the way home to eat that fuels our restaurants.
  If you want to have good balance and growth in the economy, if you 
want Americans to be at work, if you want this country to prosper, this 
is a piece of it. This is a piece to make sure Americans have health 
care coverage. I

[[Page 2452]]

am confident this is not the last time we are going to have this debate 
this year. We will have a debate, and it will actually be considered 
germane. I have wondered for the time I sat and listened to the 
majority leader, what will be the excuse then? Maybe it is because it 
wasn't their idea. Maybe it is because they would like to wrap it into 
something bigger.
  Well, as I said, 13 years after I have worked on health care--and I 
see my colleague from Iowa and I know he wants to speak, and I will 
wrap up, and I don't know anybody who has devoted much more to health 
care than he has. This is a real opportunity, Mr. President. It is an 
opportunity for the Senate to actually do something on health care 
versus sitting on the floor and talking about it. As it stands right 
now, this opportunity for minimum wage workers in America will not 
happen because the Senate will be denied the opportunity to vote as to 
whether they would like this to be part of the plan. Again, I am sure 
it is difficult for America to believe that this is not germane to the 
minimum wage bill, as it was to me. But I am not here to battle the 
interpretation of the Parliamentarian; I am here to suggest to you that 
one of the reasons we are here is we are supposed to do what is right. 
We are supposed to pay attention to what is going on across the 
country, and we are supposed to do what is right to fix it.
  I ask you to think that I am doing something right today. I could 
walk away having a vote where I didn't win. But not getting the 
opportunity to have a vote cheats America out of the opportunity to 
begin to turn around our health care system. I hope that between now 
and Tuesday with the cloture vote, Members on both sides of the aisle 
will have an opportunity to look at this vote and to encourage the 
majority leader to allow us to have a vote and, if not, to encourage 
him to vitiate the cloture vote and allow us to talk some more.
  This is important. We ought to spend time talking about major policy 
shifts. For the 10 years I spent in the House of Representatives, I 
dreamed of the fact that I could come to this floor, with the 
tremendous thought and debate that goes into the work here--I am not 
going to tell you I am disillusioned, but I can tell you this: To take 
something of this importance and to suggest we are not going to vote on 
it, or to suggest that when we are talking about ways we can improve a 
bill, we haven't got time to sit and debate this, that is not the 
Senate I envisioned before I got here.
  That is not the deliberative process, the open and balanced and 
thoughtful Senate I used to see from the other end of the Capitol. It 
is my hope that, as we move forward, we will be allowed the opportunity 
to debate this more. Hopefully, we will be allowed to vote up or down 
on it. As I said, if I lose, I will save the debate for another day and 
another bill. We are going to have an opportunity to debate health 
care, I know. We are going to find more things to agree on than we 
disagree on. I never envisioned the Senate saying that because this is 
a tough vote we are not going to take it.
  This vote is not near as tough as the fact that 14 million Americans, 
who are, in all likelihood, minimum wage workers, could have the option 
of health care if we did this and are not going to have health care if 
we don't vote. That is not silly, and it is not a delaying tactic; it 
is policy.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Webb). The Senator from Iowa.
  Mr. HARKIN. Mr. President, I thank my friend from North Carolina for 
his timely speech. He knows what I mean by that. I didn't hear all of 
his remarks, but I did catch the tail end of them, and I think I get 
the import of his remarks, which is basically that we need to do 
something about health care in America. We need to debate it, discuss 
it, vote on it. But to the extent somehow some kind of blame is being 
laid at the step of those of us on this side of the aisle--after all, 
we just took over the Senate about 3 weeks ago--I remind my friend from 
North Carolina that his party has been in charge for the last several 
years, and they have had the White House. We haven't seen anything come 
from the White House, nor have we seen anything come out of the 
Congress to deal with this over the last several years.
  Be that as it may, I say to my friend from North Carolina, the 
President put forward a proposal in his State of the Union Message. We 
will see what the budget looks like when it comes down next week. I 
join with him. I hope we will have a good debate and discussion. It is 
the most important issue we have confronting our society today. But it 
is not just, I say to my friend from North Carolina, the issue of how 
we pay the bills and how we pay for people who get sick. The issue is 
preventive medicine. How do we make prevention pay? How do we make 
prevention the incentive? How do we incentivize prevention?
  I noticed a full-page ad in the Washington Post this week and also in 
the New York Times talking about prevention is the answer. If we really 
want to get a handle on cutting down the cost of health care in 
America, just jiggling how you pay the bills is not going to be the 
answer. We have to get in front of this issue and make an incentive for 
people to live a healthier lifestyle, for businesses to provide 
workplace settings that are healthy, helping to make sure people get 
their physicals, annual checkups, mammogram screenings, cutting down on 
smoking, making sure that our schools also teach kids at the earliest 
age what it means to stay healthy. We are building elementary schools 
in America now without playgrounds. What kind of nonsense is that?
  So our whole thrust on this health care issue, I say to my friend 
from North Carolina, we always just keep focusing on how we are going 
to pay the bills. That is a problem, obviously, but if we want to get 
out ahead of it, we have to start focusing on preventive medicine. I 
look forward to that debate hopefully soon.

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