[Congressional Record (Bound Edition), Volume 155 (2009), Part 13]
[Senate]
[Pages 17957-17959]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. CASEY. Madam President, I rise to speak of two topics. The first 
is health care.
  We had a significant development yesterday in the Health, Education, 
Labor, and Pensions Committee, of which I am a member, where we 
actually voted the bill out of the committee. It is the first time in 
many years that a major piece of health care legislation, other than 
major initiatives such as children's health insurance, has been voted 
out of the Senate committee.
  We have a long way to go. We have the Senate Finance Committee 
working on this, the House is working on this, and President Obama has 
made this a major priority of his administration and I believe part of 
his economic recovery short-term and especially long-term. I commend 
two people for their work: Chairman Dodd, working in place of our 
chairman, Senator Kennedy. Between the two of them, they did a great 
job of leading this effort, not just in the course of some 60 hours of 
hearings and probably another 20 or more hours prior to the hearings--
prior to the markup when we were offering amendments--but many months 
and weeks and, in the case of both of these Senators, years working on 
health care. I also commend the staffs, and my staff, especially Morna 
Murray, who did great work.
  I say all that because it was a significant development. We know it 
is just one chapter in a long book. We have a long way to go. I think 
it is significant that a bill is out of a committee and moving through 
the Senate.
  I wish to focus in particular on a couple of aspects of the bill and 
then move to some reactions on the question of health care that we get 
from across Pennsylvania.
  The bill itself has as its foundation this principle: The status quo 
is not only unacceptable, it is, in fact, unsustainable. We cannot 
continue to ignore the issue of health care. We have to act on it this 
year--not next year or the year after but this year, 2009--at long last 
tackling a problem the American people have been debating for decades 
now across the country. Now we have a President who is leading, with 
the opportunity to finally make progress.
  The bill does a lot. First, as part of its foundation, it covers 97 
percent of the American people. It is critical that we make that part 
of the final bill. Secondly, in terms of the overall impact of the 
bill, it will reduce costs, it will preserve choices, and it will, in 
fact, enhance quality. All of the issues we have talked about for years 
are now going to be part of this bill.
  People have been frustrated by the unfairness of the failure of 
insurance companies to cover preexisting conditions. It is right there 
in the bill. Preexisting conditions, in the bill, will no longer be a 
bar to treatment and to the curing of disease and the treatment of 
individuals.
  It also has as a foundation to it the question of what to do to 
preserve choice? The American people have a right to not only keep the 
health care they like, but also they should have a choice--if they 
don't like what they have or if they have no insurance at all, they 
ought to be given a choice. I believe part of that choice isn't just 
within the framework of private insurance, the insurance companies, 
but, in fact, a public option, preserving not just choice for the 
American people but also enhancing competition and bringing down costs. 
That is essential. Even as we are concerned about the almost 50 million 
Americans, including 5 million children, who don't have coverage, we 
have to make sure we are preserving that choice.
  So reducing costs, preserving choice, and enhancing quality are very 
much a part of the bill that does change the status quo. At some point, 
people in Washington are going to have to join one team or the other--
the status quo team, the ``can't do it now, satisfied with the current 
system'' team, or the side of changing the status quo, the side of 
reform, the team that is working with President Obama to at long last 
address the question of quality, the question of access, and the 
question of bringing down the cost of care for our families and our 
businesses. So they have to choose their team. In my judgment, there 
are two teams: the status quo team and the reform change team with 
President Obama.
  I wish to highlight just two excerpts of letters I have received from 
constituents in Pennsylvania. I will read a sentence from each. Before 
I do that, I want to cite an element of one recent report. This is a 
recent report from Families USA. I will read one line to make this 
point:

       . . . 44,230 more people are losing health care coverage 
     each week.

  That is 44,230 people, every single week, who are losing their health 
insurance. With that data staring us in the face--and you can point to 
other data in Pennsylvania and across the

[[Page 17958]]

country--can anyone really make the argument that we should slow down 
and maybe not get this done this year, wait a little longer, a year, 
another 2 years? In fact, if you do that, you are talking about waiting 
10 or 20 years. We cannot do that. We have to act with a sense of 
urgency and a sense of common purpose.
  I will read two lines from two letters. One is from a gentleman in 
Pennsylvania and, secondly, a letter from another constituent of mine. 
They put this into sharp focus. This letter says, in part:

       I, for one, find it impossible to understand how the Nation 
     that sent men to the moon, invented atomic energy, and won 
     the largest conflict in history [a reference to World War II] 
     cannot provide the basic right to medical care to all, and 
     most importantly, its neediest citizens.

  That is a pretty wise summation of why we have to get this done this 
year.
  Here is a brief line from another letter I received from a 
constituent in Pennsylvania. She speaks of the economic pressure she 
and so many families feel with the status quo, the current health care 
system:

       I am only trying to keep my family from becoming another 
     statistic.

  Another statistic like 44,230 families losing their health care 
coverage every single week, a statistic like the number of families 
going into bankruptcy every week and every month because of one issue 
principally for many families--not all but many--the issue of health 
care.
  I think we have to remember the wisdom and also the real-life 
experiences of the people who write to me, representing Pennsylvania, 
or any other State.
  I have two more points.
  The question is of premiums. There was a recent report that indicates 
that if we don't take action on the issue of health care reform, if we 
don't act now and finally, at long last deal with quality, cost, 
access, and preserving choice--this is a report by the New America 
Foundation, issued at the end of last year. It said:

       In Pennsylvania, family health insurance with a price tag 
     of $26,879 in 2016 would consume 51.7 percent of the 
     projected Pennsylvania median family income.

  The national number is very similar to that. So if you look at it 
over a 10-year period or an 8-year period, what we are looking at here, 
if we don't tackle this issue, is families in Pennsylvania and across 
the country will be paying half or more than half of their income for 
health care. That is the reality. That is why there is a sense of 
urgency and purpose and a resolute focus on this issue this year. We 
cannot sustain this. Our economy cannot continue to go in this 
direction. We have to begin to tackle it this year.
  Finally, before I move to my second topic, is the issue of children. 
I have made, along with Senator Dodd and so many others--this a central 
priority when we are doing health care reform. We are very happy this 
bill is moving forward, that health care is in sharp focus. One of the 
things we have to make sure of as we move through the process is that 
no children, especially poor children and those with special needs, 
come out of this worse off than they have been. One of my themes is 
``No child worse off.'' Just four words: ``No child worse off.'' I add 
as a corollary: especially poor and special needs children.
  Unfortunately, we have some ideas in Washington floating around that 
run contrary to that. I urge those who are ignoring the question of 
children, who are forgetting about the impact of this bill on 
children--and it is a very positive impact--to remember that line from 
Scripture where it says that ``a faithful friend is a sturdy shelter.'' 
We have a lot of people in Washington who do a lot of talking about 
being a friend of children, being advocates for children, and standing 
up for children. It is wonderful that they say that. But if we are 
going to prove ourselves to be a faithful friend to children by being 
that sturdy shelter that protects them, not only from the ravages of a 
bad economy, not only from the other horrors so many children face, but 
even protecting them from unintended consequences of health care 
legislation, if that is what we say we are going to do, we should prove 
it through the work we do in the bill.
  I have a couple of points about that. One of the things I worked very 
hard on in the bill, working with Senator Dodd, was to make sure that 
enrollment in care, either through the so-called gateway, which is part 
of the health care bill, or through Medicaid or CHIP, is done in a way 
that we are actively assisting--actively assisting--families to get 
them enrolled and not just saying: You are on your own and try to 
figure it out--actively seeking to help families, especially poor 
families, get enrolled.
  I have worked with Senator Dodd on a requirement that pediatric 
preventive care be included in the list of mandatory preventive 
services that insurance plans offer, with minimum cost-sharing 
requirements for families.
  I have also worked with Senator Dodd on ensuring that medical homes--
which, as we know, is not a place but an approach to care, patient- and 
family-centered care that is comprehensive and coordinated; that is 
what I mean by ``medical home''--that there is a medical home as well 
for children. Pediatric medical homes for children are part of the 
bill.
  Finally, we ensure the establishment of an oral health care 
prevention education campaign at the Centers for Disease Control 
focusing on preventive measures targeted toward children and pregnant 
women.
  For all these reasons and more, we have to continue to focus on 
getting health care legislation passed at long last.
  I was honored to be with the Presiding Officer yesterday at a 
discussion about preventive health care. That is a central part of this 
bill. I commend her work in this area. It is a central feature of this 
health care bill.


                          Global Food Security

  Mr. CASEY. Madam President, let me move to a second topic in the 
remaining time I have, in addition to health care, and that is actually 
a related issue, the issue of hunger and food security, but on the 
scale of the world, the international stage. I wish to speak briefly on 
the subject of a significant achievement from last week's G8 summit 
held in Italy.
  The G8 leaders agreed to commit $20 billion over the next 3 years to 
international agricultural development, of which the United States will 
pledge a minimum of $3.5 billion over this period.
  As the President, the White House, noted, that comprises more than 
doubling of current U.S. levels of agricultural development assistance 
and represents a dramatic shift in the way our government conceives of 
global food security.
  For too long, the United States has relied on the traditional 
emergency aid model, a testament, of course, to the charity and 
generosity of the American people, but also an inefficient and often 
delayed response to hunger overseas.
  A real investment in international agricultural development can help 
the developing world grow self-sufficient in agriculture and provide a 
livelihood for the significant share of the population that are small 
farmers across the world.
  Everyone is familiar with the old saying: Give a man a fish and you 
feed him for today. Teach a man to fish, and you have fed him for a 
lifetime. We should bear that in mind when we think about this policy 
of global food security. That is exactly what the international 
community, led by the G8 and President Obama, is seeking to do, with an 
emphasis on several key principles, at least three: strategic 
coordination of assistance to ensure that aid is provided in a fashion 
that maximizes effectiveness and efficiency; investment in country-
owned plans to provide genuine domestic ownership and inclusion of 
benchmarks and other standards of accountability; and a sustained 
commitment with followthrough at future summits to ensure that the 
leading States are carrying through on their pledges.
  This G8 initiative is a complement to the Global Food Security Act, 
introduced earlier this year by the ranking member of the Senate 
Foreign Relations Committee, Senator Lugar, and

[[Page 17959]]

myself. As of today, eight other Members have cosponsored the Global 
Food Security Act, and I was pleased that Secretary of State Clinton 
recently offered her general endorsement of this legislation.
  This bill would achieve three major objectives. No. 1, enhance 
coordination within the U.S. Government so that USAID, the Agriculture 
Department, and other entities are not working at cross-purposes. We do 
that by establishing a new position, a special coordinator for food 
security, in the White House who would report directly to the President 
and would forge a comprehensive U.S. food security strategy.
  No. 2, the bill expands U.S. investment in the agricultural 
productivity of developing nations so that nations facing escalating 
food prices can rely on emergency food assistance and instead take 
steps to expand their own crop production. A leading agricultural 
expert recently estimated that every dollar invested in agricultural 
R&D generates $9 worth of food in the developing world.
  I am grateful to Senator Lugar for his bold proposal by the acronym 
HECTARE to establish a network of universities around the world to 
cooperate on agricultural research.
  No. 3, the bill would modernize our system of emergency food 
assistance so that it is more flexible and can provide aid on short 
notice. We do this by authorizing a new $500 million fund for U.S. 
emergency food assistance.
  This bill has been worked on and marked up in the Foreign Relations 
Committee and reported out. I am working with Senator Lugar to bring 
this legislation to the floor so the full Senate can take it up and 
pass it.
  We should not wait--as I said about health care earlier--we should 
not wait for another massive food crisis such as the one that hit the 
world last summer, before taking action on this legislation. Global 
food security is not only a humanitarian issue, of course--and that is 
of immense proportions--but it is also a national and international 
security issue. Hunger breeds instability, and instability can set the 
stage for failed states.
  Madam President, I yield the floor and suggest the absence of a 
quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. DURBIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DURBIN. Madam President, I ask to speak in morning business.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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