[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[Senate]
[Pages 25860-25866]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. BEGICH. Mr. President, for the next hour, I will be joined on 
this floor by my freshman colleagues as we talk with the American 
people about the importance of health reform. We are committed to 
ending the status quo. We have had enough of constituents being denied 
coverage because of existing conditions. We are tired of skyrocketing 
health insurance premiums hurting small business. We have had it up to 
here with the lack of choices and affordability in our States. So today 
my colleagues and I will be talking about why health reform will work 
and how it is working already.
  There are many pilot programs, State initiatives, and private 
programs showing results right now. There are other very good ideas 
pending in the health reform bills. Our general theme this morning is 
innovation that works.
  First, we will hear from the Senator from New Mexico, Tom Udall, who 
will discuss how we must address the very real health care challenges 
facing rural Americans. Senator Udall will share with us rural health 
innovation that works.
  I yield time to Senator Udall.
  Mr. UDALL of New Mexico. Mr. President, I seek recognition.
  The ACTING PRESIDENT pro tempore. The Senator from New Mexico is 
recognized.
  Mr. UDALL of New Mexico. Mr. President, let me thank the Senator from 
Alaska for being down here and helping all of the freshman Senators 
work through these health care issues we have been discussing. We have 
had Senator Warner play that role, I think, and several others. I think 
Senator Shaheen from New Hampshire has also done that. It is important 
to realize that all of us in the freshman class believe we need health 
care reform. We have to have health care reform.
  Last week, during our gathering of freshman Senators in this Chamber, 
I talked about how health care reform must benefit rural America.
  As I explained then, rural Americans face unique challenges in 
finding quality, affordable health care. And rural health care systems 
face increased strain due to doctor shortages and inefficient and 
insufficient funding.
  Successful reform hinges, in large part, on how we meet the 
challenges of health care in rural America. But what many may not 
realize is that rural America, precisely because of these challenges, 
has become an incubator for the very innovation that will help us 
achieve our goal.
  Rural America is trying to meet these health care challenges head-on 
with innovative programs in communities across the country. In the 
process, they are offering a blueprint for the Nation as we work to 
enact reform that will benefit all Americans, no matter where they call 
home.
  In my home State, several innovative programs are already paying 
dividends. The two I wish to talk about today are the result of 
partnerships between our rural communities and one of our key

[[Page 25861]]

academic institutions, the University of New Mexico, our big teaching 
hospital in New Mexico.
  Academic health centers, such as the one at UNM, have the potential 
to be hubs of knowledge and expertise, not just for the communities 
where they are physically based but for the entire State.
  UNM recognized this potential and reached out to partners in rural 
areas throughout New Mexico. They asked two basic but often overlooked 
questions: What do you need? How can we help?
  What emerged from these conversations was the development of a 
statewide Health Extension Rural Office program. Through this program, 
which we call HERO for short, agents live and work in communities they 
serve, and they act as liaisons and resources to health partners in the 
area. We know this extension model for agriculture, and we are proving 
it can work for health services too.
  Here is one example. In the frontier county of Hidalgo, in southwest 
New Mexico, HERO agents discovered the community needed help recruiting 
local health professionals.
  To meet that need, HERO helped establish a partnership between UNM 
and community providers to offer free local housing for UNM medical 
residents during their regular rural rotation.
  It was a win-win for everybody. Hidalgo County got increased access 
to doctors and other specialists. The doctors got free housing during 
their rural rotations. UNM increased its profile and reputation in 
Hidalgo County. The communities got the opportunity to persuade these 
young doctors to continue their medical careers in that area.
  That is just one example of HERO's work.
  In addition to increasing the number of doctors in a community, HERO 
also helps develop plans for addressing health issues such as diabetes 
and teen pregnancy, for retaining pharmacy services after a community 
loses its only pharmacist or for establishing a one-stop-shopping model 
for medical, dental, behavioral health, and social services.
  In addition to its work with the HERO project, UNM also is achieving 
breakthroughs in the delivery of medical care through a project founded 
by one of its physicians, Dr. Sanjeev Arora. It is called Project ECHO, 
which is short for Extension for Community Healthcare Outcomes.
  Back in 2002, Dr. Arora was a physician specializing in hepatitis C. 
He had become increasingly frustrated with the lack of treatment 
options for the thousands of New Mexicans suffering from the disease.
  Many of these patients lived in the States' rural and frontier areas. 
There weren't enough specialists to treat them, and local providers 
often didn't have the expertise to provide treatment themselves.
  What Dr. Arora did was establish what he calls a one-to-many 
knowledge network, which includes a specialist and up to 40 rural 
providers. The doctors meet by videoconference to co-manage patients 
and to eventually teach these rural medical professionals to be 
minispecialists themselves.
  Over the years, what began as a program designed to treat hepatitis C 
patients has grown and expanded. Today, it includes more than a dozen 
knowledge networks and telehealth clinics on a wide variety of 
specialties, including HIV, diabetes, pediatric obesity, and 
psychotherapy.
  In closing, I believe these two programs, along with the other 
initiatives discussed by my freshman colleagues today, are strong 
reminders that American innovation doesn't always begin in the Halls of 
Congress or down the street on Pennsylvania Avenue.
  Historically, the greatest American innovation is a grassroots 
phenomenon, bubbling up from individuals and communities across 
America, from enterprising folks who recognize a problem and work 
together to develop a solution that best meets their needs.
  This health care reform remains a work in progress. It is our job as 
legislators to seek out programs such as HERO or Project ECHO, to seek 
out these best practices, to find programs that work, and to expand 
that knowledge and ingenuity for the benefit of all Americans.
  I thank the Chair and yield the floor.
  Mr. BEGICH. Mr. President, I thank Senator Udall for his comments 
about ECHO and HERO. It shows what is happening at the grassroots 
level. We are for innovation that works and brings quality of care, 
lowers the cost, and getting better delivery of the services out there. 
I thank the Senator for bringing those examples of what is working in 
his own State to the American people and stating what we are for in 
this process.
  Next, my colleague from Illinois will join us, Senator Burris, who 
will discuss the important competition in the health care reform debate 
and how it can improve innovation.
  The ACTING PRESIDENT pro tempore. The Senator from Illinois is 
recognized.
  Mr. BURRIS. Mr. President, I thank my colleagues. I join my 
colleagues this morning to speak out on this very important issue.
  I am proud to join my freshman colleagues on the floor once again. 
And I am glad to be talking about the innovation that will come with 
meaningful health care reform.
  I agree with the points my colleagues have raised on this issue. 
Health reform will certainly spark employer innovation, to the great 
benefit of the American consumer. And that is a good reason to support 
reform. But few people are talking about the kind of innovation that 
will come about only if we include a public option in our reform 
package.
  So that is what I would like to discuss today.
  A public option means competition in the private market. As any 
businessman will tell you, competition breeds innovation. But this is 
especially true of the competition we can expect with a public option. 
That is because a public plan will not only encourage reform and 
innovation in private companies--it will actually step up and take the 
lead, just as Medicare has done in the past.
  In fact, a recent study shows that many private companies have 
adopted the innovations, such as improved payment methods and rigorous 
reviews of technology and treatment, that were developed under the 
Medicare system.
  That speaks volumes about the potential for innovation under a new 
plan that has the broad base, accountability, and transparency that 
only a public option could provide.
  The public option would be in a position to test and implement 
meaningful changes to the way health coverage works. These innovations 
will help to streamline the health care system, save money, and reduce 
the administrative costs that have run rampant among private insurance 
providers.
  The public sector will lead the way, and private companies will adopt 
their innovations. We have already seen this with Medicare--and with a 
broader public option, this trend is bound to increase. That is 
because, without competition, private corporations simply don't have 
any incentive to innovate.
  There is no reason to spend money on research when you have a virtual 
monopoly over the insurance market. There is no reason to develop new 
ways to improve coverage when you can increase premiums at will without 
incurring much risk.
  Certainly, private companies specialize in finding innovative ways to 
deny people's coverage--but that is the only kind of innovation we're 
likely to see from them. And I think America has had enough of that.
  A public plan would be entirely different. The recent study indicates 
that a public option would be at the forefront of improving coverage, 
through innovations such as:

     pioneering technologies and inventive treatments, improving 
     efficiency, expanding access, lowering costs, evaluating the 
     quality of care to help payers and purchasers get maximum 
     value, coordinating care for those with chronic illnesses, 
     and finding better ways to reward high-quality primary care 
     providers.

  These are only a few of the innovations we could hope to see with a 
public option. And all of these developments would be shared with the 
private

[[Page 25862]]

sector. This would help reduce costs, restore accountability, and 
improve health outcomes for every American.
  Mr. President, that is why we need the competition and innovation 
that only a public option can provide. It is time to lower the cost of 
health coverage. It is time to restore accountability to the system. It 
is time to make sure every American has access to quality, affordable 
health care.
  A public option will spur new innovations that will help us get 
there.
  That is why I will not back any insurance plan that does not carry 
with it this major issue of a public option.
  I yield the floor.
  Mr. BEGICH. Mr. President, I thank Senator Burris for his comments. 
The words he uses--``rewards quality, innovation, reduced costs, 
accountability, and competition''--are what we stand for. The other 
side does not. By the comments the Senator has laid out, he has 
detailed his views and what competition can do in controlling the 
costs.
  Next is Senator Shaheen, who will join us to discuss three health 
care innovations in her State of New Hampshire. She will share the 
success of the Center for Informed Choice, the medical home pilot and 
community partnership for improved public health.
  I yield to Senator Shaheen.
  The ACTING PRESIDENT pro tempore. The Senator from New Hampshire is 
recognized.
  Mrs. SHAHEEN. Mr. President, I am pleased to, once again, join my 
freshman Democratic colleagues to make the case for health care reform. 
I wish to recognize and thank Senator Begich for his leadership and 
coordination of this effort this morning.
  Today, as you have heard, I will discuss three exciting initiatives 
in New Hampshire that are transforming our health care system. These 
innovative ideas are shaping the debate and are changing the way we 
think about health care. They are revolutionizing how we deliver 
necessary health care services, and they are transforming our payment 
mechanisms. Most importantly, these initiatives go to the heart of this 
debate. They focus on the needs of patients, they make the system more 
efficient, and they use our dollars more wisely.
  The Center for Informed Choice at the Dartmouth Institute for Health 
Policy and Clinical Practice is dedicated to one simple idea: that 
patients deserve to be equal partners in making choices about their 
health care.
  We know when patients and their families have good information about 
procedures, treatments, and therapies, they make good decisions. The 
researchers at Dartmouth found that 40 percent of the time, patients 
who are fully involved in the decisionmaking process during the course 
of their medical care choose the less invasive and lower cost medical 
procedures. Forty percent of the time, patients choose the less 
invasive, lower cost procedures.
  More importantly, their research shows these patients have better 
clinical outcomes and higher rates of satisfaction as the result of 
their treatment. The providers at Dartmouth put this research into 
practice. They recognized it can be hard to decide whether to have 
surgery, to have a test, or to continue with a treatment. So they offer 
patients a variety of resources to help. Patients can talk to a 
counselor. They can do research in the library or talk to medical 
professionals. They can find out all their treatment options. They can 
learn what other people have done and fully understand recovery time 
and the impact on their quality of life. And they can do all of this 
online.
  I have been to the center. It is very impressive what they do. Soon 
this information is going to be available to the public online.
  Armed with information, these patients become empowered and equal 
partners in their health care. This is the direction that health care 
reform must take.
  Another exciting initiative in New Hampshire is our medical home 
pilot program. With close to 40,000 patients involved, the medical home 
is changing the way health care is delivered in New Hampshire. You see, 
a medical home is about collaboration. It is about a team of health 
professionals who are working together to provide individualized care 
for each patient.
  In New Hampshire, our medical home pilot has integrated the use of 
electronic medical records that import hospital, radiology, and 
laboratory tests directly into the patient's record. New Hampshire 
medical home model offers two important services to patients, including 
same-day scheduling and secure e-mail communications with their 
doctors. Unquestionably, the pilot is changing the way health care is 
delivered in New Hampshire.
  My third initiative I wish to talk about deals with changes that are 
happening at the local level to improve health in New Hampshire. In the 
western part of New Hampshire is a small city called Keene that has set 
its goal on becoming the healthiest community in America by 2020. So 
for all my freshman colleagues, they have to share this with the cities 
in their States and let them know we plan to be first in Keene, NH.
  The citizens of Keene took a look at the data and found out that our 
State's leading cause of death is heart disease related to tobacco use, 
poor diet, and physical inactivity. The folks in Keene realized that we 
spend a disproportionately high amount of money on our medical costs 
instead of focusing on prevention and wellness.
  The citizens of Keene took action. Led by a local hospital, Keene 
established a coalition of partners from all sectors of the community, 
including education, private business, nonprofit organizations, and 
municipal and State government. This coalition, which is called Keene 
Vision 2020, has made it a priority to engage citizens in healthy 
lifestyles. They have sponsored educational briefings, screenings, 
health clinics, health fairs, and Keene's Vision 2020 promotes the 
local farmer's market, and it has established a local walking group. 
All of this is done with one goal in mind: to be healthy.
  I have no doubt that Keene will be a healthier community in 2020, and 
I have no doubt that the preventive measures in which citizens have 
become engaged will lower our health care costs well into the future. 
We should all applaud and encourage this sort of community-wide 
commitment to prevention and wellness and to public health.
  This is an exciting time. Congress is closer than ever before to 
passing comprehensive health reform. Time and time again we have heard 
we cannot continue on the present trajectory. I am pleased to point out 
these exciting initiatives underway in New Hampshire that demonstrate 
we can improve the quality of care and lower our health care costs.
  I yield back to Senator Begich.
  The ACTING PRESIDENT pro tempore. The Senator from Alaska.
  Mr. BEGICH. Mr. President, I thank the Senator from New Hampshire 
again for addressing innovative health care, to reward quality, create 
innovation, reduce costs and making sure we are accountable for our 
actions in regard to health care. This is what this side of the aisle 
is for--innovation and new ideas to bring some competitiveness to the 
process and lowering the cost of health care.
  Next, we will hear from Senator Merkley of Oregon. My fellow freshman 
joins us to discuss how critical it is for the Senate to act now on 
health care reform because the cost of inaction is too great.
  I yield time to Senator Merkley.
  Mr. MERKLEY. Mr. President, I thank Senator Begich.
  My colleagues have been pointing out the importance of innovation. 
Senator Burris addressed how competition and the public option would 
increase innovation. Senator Shaheen just noted some of the models and 
efforts in her State. We need to share the insights of that throughout 
this Nation so we can take the best practices to produce the best 
quality results in every corner of our Nation.
  I rise to speak about a different aspect of innovation; specifically, 
that in order for our citizens to benefit from this innovation, health 
care needs to be affordable. Currently, health care is on a road to 
unaffordability and inaccessibility. If we do not pass health care

[[Page 25863]]

reform, costs will eat up a bigger and bigger share of the gross 
domestic product and our families' budgets.
  More families will lose their insurance because they simply cannot 
afford it. Many other families will be forced into personal bankruptcy 
as medical bills spiral out of control. And, much worse, some Americans 
will die because of inadequate or delayed care. We cannot continue on 
this path.
  First, health care has become increasingly unaffordable and will only 
get worse. This is true whether we look at it through a macroeconomic 
perspective, the family perspective, or the small business perspective. 
Looking at the economy as a whole, in 2008, health care spending in the 
United States reached $2.4 trillion. It is projected to reach $3.1 
trillion by 2012, and if it continues in that fashion, it will reach 
$4.3 trillion by 2016. Add up those 10 years and what we find is we 
will be spending $30 trillion to $40 trillion for health care in just a 
10-year period.
  If we frame this through the family perspective, the cost increases 
are felt all over the Nation through double-digit annual increases in 
premiums. Workers are paying $1,600 more in premiums annually for 
family coverage now than they did 10 years ago. To put it differently, 
for many families, the cost has doubled over the last 8 years, and the 
cost will double again over the next 8 or 10 years. The result is that 
families who could afford health care a few years ago cannot afford it 
today, and many who can barely afford it today will not be able to 
afford it tomorrow.
  Our small businesses feel the pain as well. At the Hawthorne Auto 
Clinic in Portland, the cost of premiums has gone from 9 percent of the 
payroll to 18 percent of the payroll in the last 5 years. That is a 
huge amount of money diverted from hiring more staff or increasing 
wages for the staff or from investing in more capital equipment. These 
costs are hurting our families and damaging our small businesses.
  Second, as costs go up, more and more Americans will lose coverage. 
We are used to hearing there are 45 million Americans uninsured. But a 
recent study from the University of North Carolina estimates that 6 
million Americans have been added to the ranks of the uninsured since 
2007--6 million more uninsured since 2007--putting the number of 
Americans uninsured at 51 million to 52 million.
  According to the Kaiser Family Foundation, more than 80 percent of 
the uninsured are from working families. Members of the family have 
jobs.
  Take Karen Jeffrey from Ashland, OR. When she moved to Oregon from 
Hawaii, she tried to buy new insurance. Because she had suffered from a 
broken hip and a bout of cancer 15 years earlier, she could not find 
affordable coverage. So Karen is simply waiting until she can qualify 
for Medicare at age 65. If a medical emergency strikes before that 
arrives, that medical incident will be devastating. If we do not act 
now, rising health care costs will cause financial ruin for millions of 
families.
  A recent study in the American Journal of Medicine found that 62 
percent of all bankruptcies filed in 2007 were from medical expenses. 
Of those who filed for bankruptcy due to medical problems, about three-
fourths had health insurance. Even with insurance, many Americans are 
underinsured and devastated by a medical emergency. The impact of these 
bankruptcies reverberates throughout our families, throughout our 
economy. Every year 1.5 million families lose their home to foreclosure 
as a result of unaffordable medical costs.
  We also know families pay with their lives. In September, a Harvard 
Medical School study showed that 45,000 people die in the United States 
each year, 1 every 12 minutes, because of a lack of health insurance 
and cannot get good care--45,000 Americans each year. That is more than 
the number of Americans who died in the Revolutionary War. It is 
roughly equal to the number of our soldiers who died in combat in 
Vietnam over a 16-year period. It is the equivalent of 30 Titanics 
sinking every year--Americans dying because of unaffordable health 
care.
  We need health care reform that drives innovation. We have a 
tremendous number of models around the States to promote and improve, 
but we need to make health care affordable in order to get that 
innovation into the hands and benefits of our citizens. That is why we 
must proceed with health care reform now. There is no time to waste.
  Mr. President, I thank Senator Begich for moderating this discussion 
and putting in the spotlight the role and importance of innovation.
  The ACTING PRESIDENT pro tempore. The Senator from Alaska.
  Mr. BEGICH. Mr. President, I was here at the opening of the session, 
and I heard the Republican leader say--and I agree with his actual 
comment--that the American people have been taken for a ride. The 
Senator from Oregon just described the ride--the ride right over the 
cliff of cost of insurance that is no longer affordable, with 45,000 
people who die every year because of their inability to access 
affordable health care. The Republican leader is right, the American 
people have been taken for a ride--a ride over the cliff.
  What we are showing today is innovation, new ideas, new approaches 
that bring quality, affordable health care to millions of Americans and 
the 45,000 Senator Merkley talked about who die each year because of 
lack of health care.
  I thank the Senator from Oregon for reminding us of those statistics 
and making sure we do not forget what we are here to do.
  Next, I am pleased to hear from Senator Kirk. The Senator from 
Massachusetts joins us to discuss the Community Living Assistance 
Services and Support Act, or the CLASS Act. Yesterday, the Senator made 
his first speech on the floor of the Senate. It was enjoyable, 
exciting, and very to the point when it came to health care.
  Today I look forward again to his comments regarding health care, 
especially the CLASS Act. I yield time to Senator Kirk.
  The ACTING PRESIDENT pro tempore. The Senator from Massachusetts is 
recognized.
  Mr. KIRK. Mr. President, I thank Senator Begich for his leadership 
this morning on important issues that are concerning the American 
people. I thank the Senator from Alaska and my other colleagues in the 
freshman class for advancing the important measures that the American 
people are anxious to see enacted to improve their health security 
future and their economic future as well. I also thank my colleagues 
for their kindness and courtesies in welcoming me to the Senate and to 
be a part of this impressive and distinguished team as we do what is 
our responsibility for the American people.
  This morning I wish to address a legislative initiative that will 
assist our senior or infirm citizens as part of our health care reform 
initiative.
  Today in the United States, there are approximately 200 million 
people who are elderly or disabled. These individuals are some of our 
most vulnerable and often they are forgotten. But they always had a 
friend and advocate in Senator Ted Kennedy. He was the premier 
legislative innovator.
  Senator Kennedy understood the current system is not working; that it 
cried out for innovation. He knew it was wrong that in order for 
individuals with disabilities and the elderly to receive the services 
and support they needed, they had to stop working, spend down their 
savings, abandon their dreams, abandon their homes, and possibly go 
into a permanent facility--all the wrong incentives for individuals who 
deserve dignity in those fragile years. All this, he felt, was directly 
contrary to our idea of living the American dream.
  Senator Kennedy was not one to sit idly by. He acted. He acted to try 
to help as many of these men and women as possible. The Community 
Living Assistance Services and Supports Act--known as the CLASS Act--
was at the heart of his efforts to help people with functional 
limitations and their families obtain the services and support they 
needed in order to keep their independence and continue as active 
members of their communities. I am honored to take up that worthy 
cause.

[[Page 25864]]

  Here is how the CLASS Act will help the middle class. Under the act, 
a worker in Massachusetts or any other State can choose to pay into a 
voluntary insurance program through affordable payroll deductions. 
After 5 years of those deductions, they would be eligible for a daily 
cash benefit of $50 if they became disabled. That money can make a huge 
difference in allowing a disabled person to live with independence and 
with dignity. For example, it can pay for having a ramp installed in 
their home or pay for needed transportation or purchase a computer to 
work from home and remain self-sufficient.
  Some have said this innovation is unsustainable; that it is just 
another government benefit that will become unaffordable in the years 
to come. But the Congressional Budget Office and other independent 
auditing agencies estimate the CLASS Act will be able to maintain its 
solvency for 75 years. The plan is self-funded and is a cost saver for 
Medicaid since fewer people would need to push themselves into poverty 
in order to enroll in Medicaid and receive the care they need. The 
CLASS Act will correct that disincentive.
  The CLASS Act is a realistic answer to the serious problems of our 
current system and it is important to the lives of millions of 
Americans. Disability could suddenly strike any of us in the years 
ahead. As we work to provide health insurance to the tens of millions 
of Americans who do not have it, it is hard to understand why we should 
not meet the needs of millions of people with disabilities and the 
elderly who desperately need our help.
  I hope very much that our colleagues will support the CLASS Act as an 
innovative and necessary part of the current health reform bill, and I 
look forward to further opportunities to advance this measure, and 
ultimately as a part of the needed health reform bill that is coming to 
the floor that will help and serve the American people through its 
ultimate enactment.
  I thank the Chair, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. BEGICH. Mr. President, I thank Senator Kirk for describing the 
CLASS Act, an important program for long-term care, and the legacy of 
Senator Kennedy and his work regarding that innovation.
  At this time, we will hear from my colleague from North Carolina, 
Senator Hagan, who will discuss how wellness programs are a key 
component of comprehensive health care reform and how they have an 
impact on long-term outcomes for American citizens.
  Senator Hagan.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mrs. HAGAN. Mr. President, I am joining my colleagues on the floor 
today to discuss how health care reform will support innovative private 
sector programs that will save taxpayers money and make our Nation 
healthier in the long run. I wish to take this opportunity to discuss 
groundbreaking work at SAS, a software company based in Cary, NC.
  Since 1985, SAS has established itself as a global leader in 
employer-sponsored wellness programs. Although SAS provides health 
insurance for its employees, almost 90 percent of their families use 
the company's on-site health care center, and more than 50 percent, 
including the company's CEO, use the health care center as their 
primary care provider.
  SAS started providing wellness programs to its employees because the 
company realized the value of having healthy employees--they are more 
productive, they are more loyal--which translates into low employee 
turnover and reduced recruitment and retention costs. Disease 
prevention and wellness also translate into lower health care costs for 
the company as employees take better care of themselves.
  Recently, one SAS employee--a man in his 30s--was told he had early 
signs of Type 2 diabetes. Through their diabetes self-management 
program and other onsite SAS resources, this man was able to make real 
changes in his lifestyle, eating habits, weight and exercise, and now 
he no longer meets the diagnostic parameters for diabetes.
  I also recently visited Lenoir Memorial Hospital in Kinston, NC, 
where this hospital provides their employees and members of this 
community with access to a gym and a wellness program. More than 40 
percent of the hospital's employees participate because of incentives 
the hospital provides for basic preventive screenings. People who don't 
work at the hospital--people in the community--can pay a low monthly 
fee to use the gym, including its indoor and outdoor track, weights, 
and yoga classes. Many of the people who use the facility are middle-
aged and older. Health care staff monitor the facility and help create 
a comfortable and safe environment for everyone who comes to exercise. 
This opportunity is a benefit to the entire community.
  Two weeks ago, I visited the showroom of the North Carolina furniture 
manufacturers Mitchell Gold and Bob Williams. This company currently 
employs 550 North Carolinians, and for the past 10 years the company 
has provided their employees with a free annual health fair, where 
employees can receive preventive exams at no cost. This spring, more 
than 200 women received free mammograms from a mobile unit that came to 
the plant. The company recently started a part-time, onsite medical 
clinic to address their employees' medical needs.
  Companies such as SAS, Lenoir Memorial Hospital, and Mitchell Gold 
and Bob Williams reap tremendous economic benefits from their 
investments in these wellness programs. In 2008 alone, SAS saved more 
than $5 million in productivity and insurance costs as a result of its 
onsite health care center.
  Businesses across our country can improve worker productivity and 
save money by encouraging their employees to adopt healthier 
lifestyles. Obesity, chronic heart disease, and diabetes continue to 
rise in America at a significant cost to our health care system. The 
time to be innovative is now.
  In the health care reform bill, we are building on these successful 
wellness programs and encouraging all employers to invest in the health 
and well-being of their employees. Specifically, in the Health, 
Education, Labor and Pensions Committee bill, employers can offer their 
employees who participate in a wellness program a discount of up to 30 
percent in their health insurance premiums. Currently, the average 
employee insurance premium is $250 a month, or $3,000 a year. This 30-
percent discount would mean a savings of $900 per year to that 
employee.
  Expanding employer wellness programs will bring the cost of health 
care down and will make America a healthier nation.
  I thank the Chair.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. BEGICH. I thank Senator Hagan for once again showing this morning 
another innovative approach to reducing health care costs for Americans 
today and into the future; and how wellness and prevention are critical 
for the long-term benefits of the American people in reducing health 
care costs--not by just a small amount but significant amounts, as she 
laid out.
  Next we will hear from our colleague from Colorado, Senator Bennet, 
who joins us to discuss how innovation and patient-centered care can 
improve our health care system.
  I yield time to Senator Bennet.
  The PRESIDING OFFICER. The Senator from Colorado is recognized.
  Mr. BENNET. Mr. President, I thank the Senator from Alaska for 
organizing this presentation this morning. It is a pleasure to be here 
with my freshman colleagues to talk about health care reform in this 
country, something that is long overdue if we are going to end the 
double-digit cost increases our working families face every year and if 
we are to see small businesses continue to grow and thrive in this 
country and lead us out of the recession we are in.
  As the Presiding Officer knows, in our State we have suffered a lot 
from a health care system that doesn't work. We see more and more of 
our families losing their insurance and fewer and fewer of our 
employers able to offer insurance, which is something they want to do 
for their employees. So it is high

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time for us to get these costs under control, and that will take 
innovation. In our State, we haven't waited on Washington. There are 
great examples of Coloradans who have pulled together to deliver high-
quality health care at a lower cost.
  A great example of what I am talking about is in Mesa County where 
Grand Junction is located. They have instituted what they call 
transitional care, where they have reduced the readmission rates at the 
hospital to about 2 percent. The national average is roughly 20 
percent. One out of every five Medicare patients who is released from 
the hospital winds up in the hospital in the same month they were 
released. There are a lot of reasons for that. Those of us who have 
small children or are caring for parents know how many times we have to 
tell the same story over and over as we make our way from one doctor's 
office to the next. Many people forget to fill out their prescriptions 
or they do not have the kind of instructions they need to be able to 
take responsibility for their own care. In Mesa County they have solved 
that problem by creating a transitional model that makes sure when 
patients leave the hospital they do so with a coach--a coach who helps 
them go from the emergency room to their primary care physician and 
their mental health provider to get the care they need over a period of 
time.
  I was very pleased that Chairman Baucus included in the Finance 
Committee version of this health care reform legislation the piece I 
wrote based on the work in Grand Junction that will compensate--
reimburse--providers who set up a model such as the one in Mesa County 
that actually saves money. That is truly what this is all about--this 
tortuous path we have been on to try to get health care reform done--to 
have a very excellent end point which makes sure we are reducing the 
cost to our working families and, at the same time, increasing quality; 
that we are making sure we are not devoting a fifth of our gross 
domestic product to health care when every other industrialized country 
in the world, with whom we are competing, is devoting less than half 
that to health care.
  There are probably a lot of details in this legislation that still 
need to be worked out, and I am sure there is room for improvement--
there is always room for improvement--but the American people cannot go 
through one more decade like the last decade of having poorer and 
poorer coverage at a higher and higher cost. That is not the way our 
system should work. We can do better than that as Americans. We have 
shown we can do better than that in Colorado, in our State, and I am so 
pleased there are going to be communities all over the country that 
will have the opportunity to learn from each other and provide better 
transitional care for patients and more patient-centered care as we 
move through this health care debate.
  I thank the Senator from Alaska for organizing this, and I yield the 
floor to him.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. BEGICH. Mr. President, I thank the Senator from Colorado for 
talking about the importance of why we need to do this but also 
reminding us of the small business component of all this and how 
important it is not only for the individual policyholder but the small 
business that is struggling every single day.
  I thank him for reminding us, and I will now make my comments, and 
talk a little about what people have said today but also to hopefully 
blunt a few of the myths.
  I want to thank my freshman colleagues who have spoken this morning. 
It is truly wonderful to hear the many different ideas, innovative 
reforms that are already working, and about the new proposals that will 
help us achieve the overall goal of reform: Tens of millions more 
Americans covered, with access to more choices and premiums that 
individuals and small businesses can afford.
  In these final few moments of my time, I want to preempt what may 
come on the floor from the other side of the aisle later today, from 
those who will have listened to these presentations about innovation 
and excellence. They are likely to respond the way they have always 
responded to reform ideas--by just saying no.
  The bill is still being written, but we have already seen the tactics 
of the other side. They say this is a purely partisan exercise and that 
the Democrats are not listening to Republicans. They bring a big, 
thick, mock bill to the floor and say it is too big and we will never 
read it. They say the bills need to be on the Internet or democracy is 
somehow in jeopardy.
  With all due respect to my colleagues on the other side, the 
Republicans, I beg to differ. For starters, I brought my prop--actually 
it is not a prop; it is the real deal. What I am holding are the actual 
Republican amendments that were accepted to the HELP bill; 161 
amendments, 300 pages of the bill--almost a third came from them. This 
is the stack that doesn't even include the additional Republican 
amendments accepted in the Finance Committee. These are not proposed 
amendments; these are the Republican amendments that were accepted and 
reported out of the HELP Committee.
  I have two questions. First, are the critics of health reform saying 
that the size of the eventual bill really matters, that the Senate 
leadership somehow should be embarrassed because a major piece of 
legislation that will affect one-sixth of our entire economy is not 
offered in some big-type Cliff Notes? We are already hearing that. By 
the way, all the bills have already been on the Internet for weeks, in 
some cases for months. The merged Senate version will be on the 
Internet and so will the final bill from the conference committee after 
the House and Senate work out their differences.
  My second question is this: I wonder how many of my colleagues across 
the aisle have actually read these Republican amendments, because there 
are some very good ideas. I know the Republicans are quick to say the 
committee only accepted technical amendments, but that doesn't appear 
to be true for all cases.
  An amendment by Senator Burr says the HELP Committee's community 
health insurance option must follow State insurance regulation. This is 
not trivial. It refers to important matters such as solvency, consumer 
protection, and much more. The amendment helps to ensure a level 
playing field between the public option and all the other health plans 
in each State's insurance market. That is hardly technical.
  The bipartisan amendment supported by Senators Gregg and Enzi and 
Alexander allows employers to give bigger incentives to employees who 
participate in workplace wellness programs, which I think is a great 
idea. It is something I implemented when I was the mayor of Anchorage, 
AK.
  My own Alaska colleague, Senator Murkowski, had other good ideas to 
add to the HELP bill, including improving student loan repayments to 
help medical professionals who agree to work in medically underserved 
areas--another very good idea.
  I hope my point is clear. There is a lot to be done by all of us, and 
there has already been good work by Members on both sides of the aisle. 
So let's talk about the merits of health reform, let's debate the 
policy, and let's lay out our legitimate differences and then work 
together on solutions.
  My freshman colleagues have described it well over the past hour. 
When it comes to reform, there are many examples of excellence already 
underway. We need to support such innovation, expand it, and make it 
part of a nationwide effort to give all Americans access to health 
insurance and basic medical care. There is still time for all of us to 
work together. We need health reform now, and we know it will work.
  I yield time at this point to the Senator from Colorado, Mark Udall.
  The PRESIDING OFFICER (Mr. Bennet). The Senator from Colorado is 
recognized.
  Mr. UDALL of Colorado. Mr. President, I thank the Senator from Alaska 
for convening the important discussion we have had here this morning. 
As you have heard and we have all heard over

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the last hour, my colleagues and I agree that the point of health care 
reform is to bring affordable, quality health care to all Americans. 
The bill we will debate here on the floor in the coming weeks will 
include important insurance reforms to make that a reality.
  I want to ask you though, Mr. President, and everybody watching, will 
we have succeeded in our mission if we merely put an insurance card in 
every American's pocket? Comprehensive health care reform needs to be 
about a lot more than that. We have heard about the difficult fiscal 
challenges that await us if we do nothing. Putting our economy on a 
sustainable path for the future means we have to address this 
unsustainable growth in health care spending that you so eloquently 
addressed earlier in your remarks.
  One of the best ways we can do that is by preventing illness in the 
first place. The good news is that many communities and providers all 
over the country are doing just that. We can recognize their innovative 
successes and incentivize others to follow in this reform package. If 
we do that, we will have a big impact on patient health as well as on 
the Nation's bottom line.
  I wish to talk about a program in Colorado that has been getting 
results. The Northwest Colorado Visiting Nurse Association, which has 
been working with the Department of Public Health, local physicians, 
and others, operates the Aging Well program. It focuses on prevention, 
and it connects rural Coloradans over age 50 with services and 
information to help them remain active, healthy, in their homes, and 
out of the hospital. Patients receive health screenings, exercise 
classes, and courses on managing conditions such as arthritis or 
chronic pain. Aging Well has been a great success. Listen to these 
numbers from a recent survey: 98 percent of participants reported 
improved fitness, 60 percent visited their doctor less often, and 18 
percent reduced their medication needs. This saves dollars and improves 
lives.
  Health insurance reform legislation includes funding to start similar 
programs aimed at keeping those just shy of their Medicare years--I 
have to confess, like me--active and healthy. The goal is to allow 
Americans to avoid spending their golden years worrying about illnesses 
that could have been prevented in the first place. To complement these 
programs, additional grants would give these organizations the tools to 
promote healthy living for all ages, reduce obesity, tobacco use, and 
mental illness.
  Health reform would also require insurers to provide full coverage 
for preventive services at no cost to enrollees. That is music to the 
ears of any American who has skipped a recommended mammogram or an 
annual physical exam because the cost was too great.
  Let me talk about children as well. There are grants in our health 
reform package for school-based health clinics so that children who 
lack easy access to a doctor can get preventive care right at school. 
These clinics have been shown to save $2 for every $1 they spend. This 
results in fewer emergency room visits and hospital visits, and we 
deliver health care before problems become more serious.
  Let me turn back to adults in the workplace. Reform would bring 
wellness programs to the workplace by providing grants for employers. 
Companies that have implemented wellness programs have already seen big 
savings. PepsiCo is one such company. They offer onsite screenings, 
programs to help employees lose weight, exercise incentives, and other 
measures. As a result, they have saved nearly $120 per participating 
employee per month, which has resulted in a 2-year savings of over $22 
million. Even better than the dollars involved here, participants 
demonstrated lower health risks and better health outcomes. This is one 
more way reform will pave the way and provide incentives for more 
companies to follow suit for their employees.
  Reform is also a great deal for seniors. For the first time, Medicare 
will pay for annual wellness visits. Reform would create incentives for 
Medicare patients who alter their behavior in order to lower their 
blood pressure and better control their diabetes. Medicare will cover 
recommended preventive services now, which is at no additional cost to 
seniors. In sum, contrary to what we have heard from some on the other 
side, Medicare benefits will be improved by the reform that is being 
proposed.
  Let me conclude by pointing out that this legislation makes the wise 
choice of building on our wellness efforts that are already working. We 
know preventive care enables doctors and other health care providers to 
detect diseases earlier, when treatment is the most effective, averting 
more serious and costly problems later on. But it also empowers each 
and every one of us to take charge of improving the quality of our 
lives, and when done correctly it is a crucial component of efficiently 
and responsibly addressing health care spending.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Alaska is recognized.
  Mr. BEGICH. Mr. President, I thank Senator Udall for once again 
pointing out how prevention and wellness works and how some real hard 
dollars make a difference in health care. As I close, I again thank my 
colleagues, the freshmen, for once again coming this week and making 
our point clear on innovation and the impact it will have on bringing 
accountability and a better product for the consumer, ensuring that we 
reduce costs through innovation.
  I heard this morning some one-liners from the other side that say 
``rationing, delay, deny'' is what we are all about over here. 
Absolutely wrong. What we are about is ensuring that the current 
rationing going on by insurance companies, the delay by insurance 
companies, and the denials by insurance companies stop so our consumers 
have good-quality, long-term health care.
  As I said earlier when the Senator from Oregon was talking, I heard 
again this morning that the American people were being taken for a 
ride. My comment was that I agree with the other side; they are--right 
over the cliff. It is time to take action and have health care reform.
  Is it a perfect bill when we are all here on the floor at some point 
discussing it? It may not be. But is it better than where we are today? 
Absolutely, because today is literally taking the American people right 
over the cliff. So it is in the best interests of the American people 
to move forward and create a better system that is more accountable 
with better quality.
  I appreciate my freshman colleagues for standing up today and laying 
out new, innovative approaches that are working across this country.
  I yield my time.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mr. GREGG. I ask to be recognized as in morning business for 10 
minutes.
  The PRESIDING OFFICER. The Senator is recognized.

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