[Congressional Record (Bound Edition), Volume 155 (2009), Part 14]
[Senate]
[Pages 19107-19111]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. CASEY. Mr. President, I rise this morning to speak on an issue 
that so many of us, not only here in Washington in the Senate and in 
the Congress, generally, but across the country have been concerned 
about, talking about, debating; and it is the issue, of course, of 
health care.
  We have a long way to go over the next couple weeks and months. I 
know there is a lot of coverage and debate about timing and what is 
going to happen this week or next week or by the August break. But I 
believe we are going to get this done, and I think it is important we 
have a good debate about it.
  I think too often in this debate we have focused on conflict and 
controversy as opposed to looking at some substantive parts of this 
legislation. I start this morning, as I have so many times when I have 
been discussing this issue over the last couple months, with a 
constituent, one person, but I think a person who speaks for many 
people across Pennsylvania and across the country. Her name is Trisha 
Urban.
  She sent me a letter back in February that I have noted before. This 
letter, I think, tells us an awful lot about all we need to know about 
what is wrong with our health care system right now. Despite all the 
positive features of it--great hospitals and medical personnel and 
people we can be justifiably proud of and boast about--there are 
problems with our health care system.
  Trisha Urban, when she sent this letter in February, was recounting 
what had happened in her life just a few weeks before. She talked about 
her husband Andrew, who had to change positions in life, change jobs 
because he was completing an internship. She said:

       Because of pre-existing conditions, neither my husband's 
     health issues nor my pregnancy--

  She referred earlier to the fact she was pregnant at the time of the 
letter--

     . . . neither my husband's health issues nor my pregnancy 
     would be covered under private insurance.

  She said:

       I worked 4 part-time jobs and was not eligible for any 
     health benefits.

  She says later in the letter that they lost their health insurance 
coverage, and they had close to $100,000 worth of medical bills. Then 
she says:

       Concerned with the upcoming financial responsibility of the 
     birth of our daughter and the burden of current medical 
     expenses, my husband missed his last doctor's appointment 
     less than one month ago.

  And this is how the story ends for this family. She talks about--just 
a few weeks before this letter--what happened to her. She says:

       My water had broke the night before, we were anxiously 
     awaiting the birth of our first child. A half-hour later, 2 
     ambulances were in my driveway. As the paramedics were 
     assessing the health of my baby and me, the paramedics from 
     the other ambulance told me that my husband could not be 
     revived.

  That is her story--a story of not having the kind of health care 
coverage that she and her husband and her new baby should have--the 
story of her husband missing his last doctor's appointment because of 
financial burdens and, of course, the tragic part of that story, which 
is the loss of her husband, the same day her daughter was born.
  I do not think every story we have told about our constituents ends 
the same way. But the blessing here of this story, of this letter, is 
this: Trisha Urban could have said: Do you know what? I have a terrible 
burden and I can't handle this, and I am not going to try to talk to 
anyone about it. I am going to carry this burden myself. And she could 
go off and not be heard from again.
  But she took the time to write to me. This is how she ends the 
letter. She does not just tell her tragic story and just say: Can you 
help me? And: I am in trouble. She thinks beyond herself. She thinks of 
an issue that is affecting so many Americans, and she says this:

       I am a working class American and do not have the money or 
     the insight to legally fight the health insurance company. We 
     had no life insurance. I will probably lose my home, my car 
     and everything we worked so hard to accumulate in our life 
     will be gone in an instant.
       If my story is heard, if legislation can be changed to help 
     other uninsured Americans in a similar situation, I am 
     willing to pay the price of losing everything.

  That is what Trisha Urban says to us. I would note that in this 
Senate Chamber, you can go to every single desk--100 Senators, 
including myself--every single desk, and if you were to ask a Member of 
the Senate: Do you have health care coverage? They would say: Of 
course. I am a Federal employee, and I get to choose a lot of options. 
You could say the same of people who work in the House and in the White 
House and in executive branch agencies. So individual Senators are 
taken care of pretty well.
  So when Trisha Urban says to us in a letter: ``I am willing to pay 
the price of losing everything,'' when she says that, I believe she is 
not just saying it to tell us what is on her mind, what is in her heart 
in the aftermath of the tragedy, I believe that line and her letter and 
her whole story are emblematic of the stories of Americans across the 
country. I believe all those sentiments and

[[Page 19108]]

all those details of her life present a challenge to us.
  I am willing to pay the price of losing everything, she says to us.
  The question is--or I should say one of the important questions is--
over the next couple of weeks and months, as we debate this issue, what 
are we willing to lose? What are individual Members of the Senate 
willing to do and willing to lose to get this done? I believe part of 
that is having a constructive and thorough and far-reaching debate 
about not just the issues but what is in the legislation. I will spend 
some time on that this morning and I will for the next couple of weeks.
  As a member of the Health, Education, Labor and Pensions Committee, 
we have a bill. Sometimes the fact that there is a bill and there is a 
lot of positive features to it gets lost in Washington. There is a lot 
of talk about conflict between Democrats and Republicans; there is a 
lot of talk about controversy or issues that are sometimes easy to 
debate or cover, but what has been lost in a lot of this debate over 
the last couple of weeks is what is in the bill. We are going to get to 
that. We won't get to all of it today, of course.
  I believe the bill does a couple of things. First, it ensures that 
over time we are going to have stable costs. That is one thing American 
families are looking for, some kind of stability or peace of mind with 
regard to costs and with regard to other issues as well. So stable 
costs.
  I also believe this legislation and the bill we are going to send to 
President Obama this fall will also have secure choices. If you like 
what you have, you like the plan you have, you can keep it. It is not 
going to change. If you want to make a change, you are going to have 
options.
  Thirdly, it is about the quality of care. I believe the American 
people have a right to expect that we are going to control costs, that 
we are going to provide them with secure choices, but that we are also 
going to provide quality care. Any old health care, in my judgment, 
isn't good enough.
  I believe the bill does all three things: stable costs, secure 
choices, and quality of care.
  One of the threshold questions we have to answer in this debate is--
because it is going to be a choice. We are not going to have a choice 
between 10 options on health care in a general sense or 5 options; we 
are going to have a basic, fundamental choice, as we do on a lot of 
issues. It is going to be one or the other, A or B, or A versus B, 
maybe, and here is the choice. The first question we have to answer is 
do we want to keep the status quo, do we want to keep perpetuating a 
system which has costs out of control for families and for businesses, 
for government, which doesn't offer the kind of quality care across the 
board--some get it, we know that, and it is good care--but is there 
enough quality care across the board? I would argue there isn't. Are we 
going to offer that and say it got too tough and we weren't willing to 
take some risks with an important bill, we decided to not do anything? 
That is the status quo. That is what we have now.
  The other choice is change and reform. President Obama, fortunately, 
as a new President of the United States, has chosen to be about the 
business of reform and change. He has said to us, and I believe the 
American people have said to us: We cannot stay where we are. We cannot 
allow a system to perpetuate the problems we have right now. So that is 
the fundamental choice: the status quo, do nothing; or change and 
reform, working with President Obama and listening to the voices of the 
American people, people such as Trisha Urban and so many others.
  So when we debate this--the status quo, stay where we are, versus 
change and reform--we have to begin to examine some of the questions 
the American people are worried about. They are worried about costs. 
They are worried about change and legislation not leading to a control 
of costs, the kind of stability we want.
  One of the questions we are not spending much time in Washington 
debating is: What is the cost of doing nothing? What is the cost of 
doing nothing? What is the cost of the status quo? Well, fortunately, 
some people have begun to examine that. One of the examinations of that 
is a report by Families USA, and the report is entitled ``The Clock Is 
Ticking.'' It says: ``More Americans Losing Health Coverage.'' One of 
the points it has made--and of course I won't read the whole report--
but one of the points it has made in the report is this: Here is what 
the status quo means, here is what no change means: 44,230 more people 
losing health coverage every week. The report also goes on to talk 
about what it means in individual States; a State such as Pennsylvania 
where they are projecting over the next couple of years tens and tens 
and tens of thousands of people losing their coverage. By one estimate 
in this report, 178,000 more people just in Pennsylvania--just in 
Pennsylvania--losing their coverage.
  I ask unanimous consent that this report, ``The Clock Is Ticking,'' 
by Families USA be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                          [From Families USA]

                          The Clock Is Ticking


                 more americans losing health coverage

                              Introduction

       In this turbulent economy, Americans are not only losing 
     their jobs and their homes they are also losing their health 
     coverage at an alarming rate. The latest data from the Census 
     Bureau indicate that some 45.7 million Americans lacked 
     health coverage in 2007, and economists believe that the 
     situation has only worsened in the intervening months as the 
     economic downturn has taken its toll.\1\
       Health reform is needed now more than ever. As health care 
     costs rise, more and more families are priced out of health 
     coverage. Increasing numbers of employers, especially small 
     businesses, are no longer able to offer their employees 
     affordable coverage, or in some cases, any coverage at all. 
     If current economic trends continue, more and more Americans 
     will lose the health coverage they currently have. National 
     experts have predicted that at least 6.9 million more 
     Americans will lose their health coverage by the end of 
     2010.\2\
       In this report, Families USA provides the first ever state-
     by-state illustration of the number of people who may lose 
     health coverage between the beginning of 2008 (the period 
     immediately after the last Census Bureau report on the number 
     of uninsured) and the end of 2010 (the close of the current 
     111th Congress).

                              Key Findings

       With each passing week that meaningful health care reform 
     is not enacted, more families in every state are losing 
     health coverage (see table on page 2):
       44,230 more people are losing health coverage each week.
       191,670 more people are losing health coverage each month.
       2.3 million more people are losing health coverage each 
     year.
       Families USA based its state numbers on national estimates 
     published in the peer-reviewed policy journal Health Affairs 
     in May 2009. These estimates project that 6.9 million more 
     Americans, primarily people in working families, will lose 
     health coverage by the end of 2010.\3\ The Health Affairs 
     analysis, which focused on the time period between 2008 and 
     2010, is based on a model that assumes that, during this time 
     period, there will be no policy changes with respect to the 
     health care system. It further assumes that personal income 
     growth and per capita health spending among insured adults 
     will follow the latest projections from the Congressional 
     Budget Office and the Office of the Actuary at the Centers 
     for Medicare and Medicaid Services (CMS), respectively.
       This time period is appropriate for Families USA's analysis 
     because it captures potential losses of coverage between the 
     most recent Census Bureau calculations of the number of 
     uninsured Americans (which reflect calendar year 2007) and 
     the end of the 111th Congress (December 2010), which has 
     taken up health reform as one of its major legislative goals.
       In order to generate state-level numbers, Families USA 
     calculated the share of uninsured, nonelderly individuals 
     residing in each state using the most recent data reported in 
     the Census Bureau's Current Population Survey for 2006-2007. 
     We assumed that state losses in health coverage would 
     parallel this distribution, and we apportioned the national 
     estimate accordingly. The data suggest that the health care 
     crisis is continuing to deepen across the nation, and that 
     the longer Americans are forced to wait for health reform, 
     the more people will lose coverage.

                               Discussion


                  Health Insurance Premiums Are Rising

       Over the last decade, health insurance premiums have risen 
     at rates that far outpace

[[Page 19109]]

     inflation. Between 1999 and 2008, the average annual family 
     premium more than doubled, soaring from $5,791 to $12,680, an 
     increase of 119 percent.\4\ During the same time period, the 
     Consumer Price Index, which measures inflation, rose by only 
     29.2 percent.\5\ In the current economic downturn, working 
     families are already struggling to afford basic necessities 
     like groceries, car payments, gas, and housing costs.\6\ 
     Paying for skyrocketing health care premiums is putting 
     additional strain on families that are already financially 
     strapped.


              Higher Premiums Lead to Less Health Coverage

       These high and continually rising premiums affect families 
     as well as employers, and the combined result is that more 
     and more Americans are losing health coverage. Employers that 
     do continue to offer health coverage are being forced to pass 
     on the rising costs to their employees by imposing higher 
     premiums or copayments or by offering plans that cover fewer 
     benefits. Other employers are choosing not to offer coverage 
     at all because it is simply too expensive. Between 2000 and 
     2008, the share of firms offering health coverage declined by 
     6 percentage points, with small businesses being the most 
     likely to drop coverage.\7\ Among firms with fewer than 200 
     employees that do not offer their employees health coverage, 
     a total of 70 percent cited high premiums as either the most 
     important reason (48 percent) or the second most important 
     reason (22 percent) that they do not offer coverage.\8\
       Even if families are fortunate enough to have access to 
     health coverage, either through job-based plans or through 
     the individual market, they are still at great financial 
     risk. In 2009, nearly one in four non-elderly Americans with 
     insurance--53.2 million people--will spend more than 10 
     percent of their pre-tax income on health care.\9\ The 
     problem is even worse for an estimated 14.3 million non-
     elderly Americans with insurance who will spend more than a 
     quarter of their pre-tax income on health care in 2009. This 
     financial burden means that some Americans are literally 
     becoming impoverished in order to pay for health care 
     costs.\10\
       When families are pushed to the brink by the current health 
     care crisis, some must make tough choices between paying for 
     health coverage and paying for other necessities, while 
     others have no choice at all--they are simply forced to go 
     without coverage. A previous Families USA report found that 
     during the two-year period from 2007-2008, an estimated 86.7 
     million Americans under the age of 65--one in three non-
     elderly Americans--were uninsured.\11\ The majority of these 
     individuals (79.2 percent) were from working families where 
     at least one family member was employed full- or part-time. 
     These individuals either work for an employer that does not 
     offer health coverage, or they cannot afford the coverage 
     that is offered. The data presented in this report show that 
     the number of people who find themselves in this situation is 
     growing in every state (see table on page 2).


      Growing Unemployment Contributes to Further Coverage Losses

       Since the data presented in this report are based primarily 
     on working Americans, they do not account directly for the 
     effect that growing unemployment is having on losses of 
     health coverage. Nonetheless, with the economy in recession, 
     rising unemployment is almost certainly fueling additional 
     increases in the number of people who are losing coverage. 
     The Urban Institute estimates that every 1 percent increase 
     in the unemployment rate leads to a 0.59 percent increase in 
     the number of adults under the age of 65 without health 
     coverage.\12\ Between January 2008 and June 2009, 
     unemployment swelled by 4.6 percent, so it is safe to assume 
     that states will experience even greater losses of coverage 
     between 2008 and 2010 than can be captured by our Key 
     Findings.\13\

                               Conclusion

       With each passing week, more Americans are losing their 
     health coverage, and they will continue doing so if current 
     economic patterns hold. Recent polling data show that 
     Americans fear that instability in the availability and 
     affordability of their health coverage will continue if 
     health reform is not enacted.\14\ In order to stem the rising 
     tide of uninsured in this country and to provide American 
     families with stable health coverage that they can depend on, 
     Congress should act expeditiously to pass health reform 
     legislation. As this report suggests, the longer Congress 
     waits to enact meaningful health reform, the more American 
     families will lose coverage in each and every state.


                                Endnotes

       \1\Paul Fronstin, Sources of Health Insurance and 
     Characteristics of the Uninsured: Analysis of the March 2008 
     CPS Survey (Washington: Employee Benefit Research Institute, 
     September 2008).
       \2\Todd P. Gilmer and Richard G. Kronick, ``Hard Times and 
     Health Insurance: How Many Americans Will Be Uninsured by 
     2010?'' Health Affairs Web Exclusive (May 28, 2009): w573-
     w577.
       \3\Ibid.
       \4\Kaiser Family Foundation and Health Research and 
     Educational Trust, Employer Health Benefits: 2008 Annual 
     Survey (Washington: Kaiser Family Foundation, September 
     2008).
       \5\Consumer Price Index data from the Department of Labor, 
     Bureau of Labor Statistics.
       \6\Michael Perry, Julia Cummings, Julia Paradise, and Tanya 
     Schwartz, Snapshots from the Kitchen Tbble: Family Budgets 
     and Health Care (Washington: Kaiser Commission on Medicaid 
     and the Uninsured, February 2009).
       \7\Kaiser Family Foundation and Health Research and 
     Educational Trust, op. cit.
       \8\Ibid.
       \9\Kim Bailey, Too Great a Burden: Americans Face Rising 
     Health Care Costs (Washington: Families USA, April 2009).
       \10\Michelle M. Doty, Sara R. Collins, Sheila Rustgi, and 
     Jennifer L. Kriss, Seeing Red: The Growing Burden of Medical 
     Debt Faced by U.S. Families (New York: The Commonwealth Fund, 
     August 2008).
       \11\Kim Bailey, Americans at Risk: One in Three Uninsured 
     (Washington: Families USA, March 2009).
       \12\John Holahan and A. Bowen Garrett, Rising Unemployment, 
     Medicaid, and the Uninsured (Washington: Kaiser Commission on 
     Medicaid and the Uninsured, January 2009).
       \13\Unemployment data from the Department of Labor, Bureau 
     of Labor Statistics, available online at http://data.bls.gov/
PDQ/servlet/ SurveyOutput Servlet?data_tool = 
     latest_numbers&seriesid=LNS14000000, accessed on July 8, 
     2009.
       \14\Memo from Jim Kessler and Anne Kim to Interested 
     Parties, Offering Stability to Harry and Louise--A Strategy 
     to Get to Yes on Health Care Reform (Washington: Third Way, 
     July 6, 2009), available online at http://www.third way.org/
     data/product/file/224/Getting_to_Yes_with_Harry_and 
     _Louise.pdf.

  Mr. CASEY. Mr. President, the cost of doing nothing also has been 
examined, using those words, by the New America Foundation. This 
particular report is dated November 2008 and is written by Sarah Axeen 
and Elizabeth Carpenter. The name of this report is exactly those 
words: ``The Cost of Doing Nothing.'' The subtitle of the report is 
``Why the Cost of Failing to Fix Our Health Care System is Greater than 
the Cost of Reform.'' The cost of failing to fix is greater than any 
other cost.
  Mr. President, I ask unanimous consent to have this report printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

              [From the New America Foundation, Nov. 2008]

                       The Cost of Doing Nothing


 why the cost of failing to fix our health system is greater than the 
                             cost of reform

                (By Sarah Axeen and Elizabeth Carpenter)

                              Pennsylvania

       Pennsylvania's economy lost as much as $5 billion because 
     of the poor health and shorter lifespan of the uninsured in 
     2007. This equates to more than $4,200 per uninsured 
     Pennsylvania resident.

                                    TABLE 1.--ECONOMIC COST OF FAILURE, 2007
                                    [Ranked by high bound and per uninsured]
----------------------------------------------------------------------------------------------------------------
                                                                                            Per
                 Low Bound                            High Bound            Rank (High   Uninsured    Rank (Per
                                                                              Bound)        Cost      Uninsured)
----------------------------------------------------------------------------------------------------------------
$2.68 Billion.............................  $4.96 Billion................           41       $4,219           24
----------------------------------------------------------------------------------------------------------------

       By 2016, Pennsylvania residents will have to spend nearly 
     $27,000 or close to 52 percent of median household income to 
     buy health insurance for themselves and their families. This 
     represents a 93 percent increase over 2008 levels and the 
     sixth highest premium cost in the country.

[[Page 19110]]



                                       TABLE 2.--AFFORDABILITY OF PREMIUMS
                                  [Ranked by level in 2016 and percent change]
----------------------------------------------------------------------------------------------------------------
                                                                                          Percent
                                               2008               2016     Rank (2016)     Change      Rank (%)
----------------------------------------------------------------------------------------------------------------
Full Cost of Family ESI.............  $13,906...............      $26,879           46        93.3%           41
Full Cost of Family ESI as a Share    28.1%.................        51.7%           38          n/a          n/a
 of Median Household Income
----------------------------------------------------------------------------------------------------------------

       People seeking family health insurance through their 
     employer in Pennsylvania will have to contribute more towards 
     premiums than residents of all but one state. They will also 
     experience the second greatest percent change in their 
     premium contributions nationwide. By 2016, people in 
     Pennsylvania seeking family coverage through their employer 
     will have to contribute almost $9,000 to the cost of the 
     premium.

                           TABLE 3.--AFFORDABILITY OF PREMIUMS: EMPLOYEE CONTRIBUTIONS
                                           [Ranked by percent change]
----------------------------------------------------------------------------------------------------------------
                                                                                          Percent
                                                         2008                  2016        Change        Rank
----------------------------------------------------------------------------------------------------------------
Family ESI................................  $3,510.......................       $8,830      151.56%           50
----------------------------------------------------------------------------------------------------------------

       The amount Pennsylvania residents will have to pay to see a 
     doctor will grow to $29 by 2016.

                                 TABLE 4.--BENEFITS: COPAYMENTS AND DEDUCTIBLES
                                  [Ranked by level in 2016 and percent change]
----------------------------------------------------------------------------------------------------------------
                                                                                          Percent
                                               2008               2016     Rank (2016)     Change      Rank (%)
----------------------------------------------------------------------------------------------------------------
Average Copayment...................  $19...................          $29           17        53.6%           38
Average Deductible..................  $1,223................       $1,889           10        54.5%           21
----------------------------------------------------------------------------------------------------------------

  Mr. CASEY. I will submit for the Record only two pages of this; it is 
a long report. It includes the cover page and then a page on 
Pennsylvania which I will briefly refer to, and then I wish to talk 
about how the report implicates and examines the information on the 
chart I have on my left.
  Here is what the report says on page 86 for Pennsylvania. It is true 
of a lot of States, but unfortunately for Pennsylvania, it is a higher 
number. I am quoting from part of page 86:

       By 2016----

  Just 7 years away----

     Pennsylvania residents will have to spend nearly $27,000, or 
     close to 52 percent of median household income to buy health 
     insurance for themselves and their families. This represents 
     a 93 percent increase over 2008 levels and the sixth highest 
     premium cost in the country.

  So in Pennsylvania, if we do nothing, if we stay on that road to the 
status quo, which I believe is the road to ruin when it comes to the 
budgets of our families and our businesses--if we stay on that road, 
for Pennsylvania, it means that by 2016, the people of Pennsylvania 
will be paying 52 percent of their median household income to buy 
health insurance for themselves and their families. That is what it 
means. That is what the status quo is. That is where we are headed if 
we say, Well, we couldn't get the job done here in Washington.
  The chart on my left is also a chart that reflects the work of the 
New America Foundation, ``The Cost of Doing Nothing.'' These are U.S. 
numbers between 2008 and 2016. The cost of premiums now, as of 2008, is 
$13,244, going up to $24,291; in just 8 years, an 83.4 percent 
increase. That is the status quo. That is where we are headed. That is 
where we are going if we listen to the voices in Washington that say it 
is too tough to do this. People are not ready for this yet. There are 
too many powerful special interests telling us not to do it. It might 
be insurance interests, it might be business interests, or it might be 
very partisan politicians telling us we shouldn't do this. That is the 
cost of doing nothing. That is the status quo.
  I will go to the next chart which again is from this report, ``The 
Cost of Doing Nothing,'' and this is a U.S. number as well: Share of 
household income spent on premiums climbing. As I said, in 
Pennsylvania, where the share of median household income would go up to 
52 percent, in those few short years, 7 or 8 years--the U.S. number 
fortunately for the rest of the country is a little less, but it is 
still very high. So if we do nothing, if we stay where we are and do 
the same old thing--runaway costs, lower quality, no prevention, all of 
the things we are not doing now--we will go from a median family 
income, them paying 26 percent of their income for health care, which 
is high in and of itself, to paying over 45 percent of their income for 
health care. Again, this chart depicts the status quo, the cost of 
doing nothing.
  When we talk about costs here, we have to talk about the cost of 
doing nothing. What people are paying now is in my judgment too high. 
We ought to try to bring that number down, but we should certainly 
avoid at all costs that number going up for the American people.
  I don't know too many families out there--maybe there are a few--but 
I don't know too many families in America and I don't know any in 
Pennsylvania who have come up to me and said, You know what. Don't 
worry about getting health care done because in 7 or 8 years I will be 
able to afford 52 percent of my income to go to health care. I haven't 
heard that from anybody in my State. I doubt there is anybody in 
America who will say, You know what. Let's not do anything. Let's stay 
on the road we are on. I can afford and my family can afford to pay 45 
percent of our income to health care in a couple of years. Don't worry 
about it. We are going to be fine. So that is what the status quo is, 
and that is where we are headed.
  Finally, I would conclude with this. When we listen to the voices of 
the American people, people such as Trisha Urban, as I mentioned 
before, who in her letter to me of February, right in the middle of the 
letter said this: She talked about her husband having to make a change, 
that he had to leave his job for 1 year to complete an internship 
requirement to complete his doctorate in psychology. So as he is trying 
to advance his education, he pays a health care price. That is another 
whole part of this story, before he died. She said the internship was 
unpaid and they could not afford COBRA.
  Why should a change in someone's life to improve their education to 
complete a doctorate affect their health care? That is the system we 
have. That is the status quo.
  But then she says:

       Because of preexisting conditions, neither my husband's 
     health issues nor my pregnancy would be covered under private 
     insurance.


[[Page 19111]]


  Because of preexisting conditions. So because her husband had a heart 
problem and because she was pregnant, that works against them. That is 
the system we have for too many families.
  So when people talk about: Oh, the HELP Committee passed a bill, the 
Affordable Health Choices Act, which I believe does stabilize costs and 
ensures quality and secures our choices, it is more than that, it is 
more than the headlines and the descriptions. We can go right to the 
bill language and show how this legislation, in a very specific way in 
a number of instances, responds to what Trisha Urban has told us in her 
letter, what she has challenged us with. She didn't write to me to say, 
Well, this preexisting thing is kind of a nuisance. It was a bar, an 
impediment to her and her family getting health care, basic health 
care. Why should this even be something we have to legislate about? One 
would think that in America today, with all of the wealth we have and 
all of the great power, we would have fixed this years ago, but we have 
families who are not getting health care because the insurance company 
says you have a preexisting condition. Sorry, you have to wait; or 
sorry, you get no treatment at all.
  That is the status quo, and that is one of the costs of doing 
nothing. How do you calculate a preexisting condition being a bar to 
you getting coverage? I don't know. I know one thing: Despite all the 
talk in Washington about what this might mean, who is arguing with 
whom, what the debate is about between Democrats and Republicans, in 
this bill we answer Trisha Urban's question on preexisting conditions. 
Here it is.
  This is bill language not some talking point or some general 
description. This is in the bill that sometimes people in Washington 
don't want to examine because the language is reform. The language is 
against the status quo. The language on this provision, especially, is 
a dramatic change in policy--something the insurance companies have not 
wanted to do on their own. The American people are finally saying, 
through their elected representatives and this bill, that we are going 
to make sure preexisting conditions don't bar treatment, that 
preexisting conditions don't prohibit Trisha Urban and her family from 
getting the kind of health care they deserve.
  Here is what section 2705 says:

       Prohibition of preexisting condition exclusions or other 
     discrimination based on health status.

  The American people want to know what is in the bill.

       A group health plan and a health insurance issuer offering 
     group or individual health insurance coverage may not impose 
     any preexisting condition exclusion with respect to such plan 
     or coverage.

  It is right in the bill. There are some people here who would not 
talk about that because they would rather debate no bill. They would 
rather debate, well, we have a suspicion that it is going to cost too 
much. But they don't show any evidence, and they don't have a competing 
argument or a bill. This is right in the bill--``may not impose any 
preexisting condition.''
  That is a dramatic change in health care policy in America in 2009. 
It is not part of the debate. For the next couple of weeks and months, 
what we are going to do is tell people a lot about what we have been 
working on in Washington. Day by day, we will tell them what is exactly 
in this bill, and we will keep talking about it so more people 
understand it.
  Unfortunately, some would not understand it because the special 
interests in Washington would rather talk about the perceived 
controversy.
  I suggest that people go to the Web site for the committee that 
worked on this bill. The HELP Committee Web site is help.senate.gov. Go 
to that Web site and review the language on preexisting conditions or 
anything else. I believe at the end of the day, it is going to be very 
clear who stands for the status quo and doing the same thing and no 
change versus what the President and a lot of us are trying to do, 
which is change, reform, and give people, such as Trisha Urban, some 
peace of mind, some stability to know that she and her family--which 
is, now that her husband is gone, she and her daughter would not have 
to worry about this ever again.
  Isn't that what we ought to be doing? I think we can do that together 
and in a bipartisan way. I believe we have no choice but to turn away 
from the status quo and go down the path of change and reform.
  Mr. President, with that, I yield the floor and suggest the absence 
of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. McCAIN. Mr. 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. McCAIN. Mr. President, what is the parliamentary situation?
  The ACTING PRESIDENT pro tempore. We are in morning business.
  Mr. McCAIN. Is the Senator from Delaware waiting to speak?
  Mr. KAUFMAN. Yes.
  Mr. McCAIN. I am glad to follow the Senator from Delaware.

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