[Congressional Record (Bound Edition), Volume 155 (2009), Part 20]
[Senate]
[Pages 26675-26683]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. LAUTENBERG. Mr. President, I thank my colleagues for giving me an 
opportunity to talk for a few minutes about health care as we try to 
understand what brings us to this point with a shred of rage, trying to 
maintain the dignity of our society.
  We are on the verge of fixing our health care system once and for 
all, but there is one major obstacle in our way. The obstacle I talk 
about is the health insurance companies, their lobbyists, CEOs, and 
their friends on the other side of the aisle. We can call this group 
the status quo caucus. They are spending unlimited funds on TV 
commercials and bogus studies to kill health reform. That is their 
mission. Think about it. They define their goal, their objective, as 
articulated by our colleague from South Carolina, as saying: If we can 
stop this health care reform from continuing, it can be the end of the 
Obama Presidency, it can be his Waterloo.
  What kind of an objective is that, that we put politics at the top 
end as we ignore millions of people, over 40 million people who do not 
have any insurance, and many of the others who do have insurance do not 
have a complete picture about what their policies permit or what they 
might lose by way of restrictions.
  This is an outrage. The public is manifesting their concern. They are 
not sure about what they hear, the derogatory material they see--don't 
do this, don't do that, no public option, and let's take our country 
back. I don't know whom they are talking about. Whose country? It is 
our country. It is everybody's country. There is no monopoly here for 
participation in American society.
  We hear the worst kinds of assertions about what we are trying to 
do--turning this country into a Socialist country. What has happened 
would be almost humorous if it were not so tragic; that is, for people 
who are on Medicare to be concerned about government interfering with 
their lives. Medicare is a government program, one of the most 
successful ever put into the structure of our country.
  While this group of obstructionists goes about their business, 
``don't let it happen'' is their mission. I just told you how it is 
demonstrated in the words of the Senator from South Carolina.
  The insurance companies are spending millions on TV commercials and 
bogus studies to kill health care reform. Quenching their thirst for 
profits has led to some of the worst predatory practices imaginable. 
This is an industry that will knowingly strip children of their health 
care coverage when a parent loses a job. This is an industry that 
demeans women by treating pregnancy and domestic violence as 
preexisting conditions--anything to escape their obligations under 
their insurance policies, for which they charge a lot of money. This is 
an industry that squeezes small businesses by charging them 18 percent 
more than they do large firms for the same health insurance policies.
  The priority of the health industry is not patients, it is profits. 
In the richest Nation in the world, decent health care should be a 
basic tenet of life for everyone in our society. But that is not the 
way it is going and that is not the way the health insurance companies 
look at it. Their single-minded drive for profits is at the expense of 
their policyholders--policyholders who depend on them for care when 
they are sick or injured and when they need medical or health 
professional assistance.
  We have a chart that demonstrates the massive profit increases at 
some of our largest health insurance companies for the years 2000 to 
2008. These are the profit increases at health insurance companies. 
This is 2000 and this is 2008. How can we forget 2008, when our country 
was coming apart at the seams, deep in recession and terrible 
expectations in front of us, with people losing their jobs and losing 
their homes by the millions. Yes, 2008 was that kind of a year. It was 
a disaster year, except for the guys who were in the health insurance 
business.
  In 2000, the profit for WellPoint, one of the best-known companies, 
was $226 million. Eight years later, their profit was $2.5 billion. 
Note this: $226 million and $2.5 billion, for a 1000-percent increase. 
For Aetna, $127 million in 2000;

[[Page 26676]]

in 2008, $1.4 billion. Think about it--$127 million to $1.4 billion, 
for a 990-percent increase. Humana, in 2000, had a $90 million profit 
year, but by 2008 they were up to $647 million, for a 619-percent 
increase. United Health had $736 million worth of profit in the year 
2000, and in 2008 these guys made $3 billion, for a 340-percent 
increase. That is $736 million compared to $3 billion, for a 304-
percent increase.
  In assure you working people were not looking at these kinds of 
increased percentages in their incomes. As a matter of fact, their 
purchasing power declined. Even though salaries may have stayed the 
same or have been increased by some factor, their purchasing power 
decreased.
  Humana, we recently learned, achieved these profits largely by 
cheating taxpayers, by taking funds that were supposed to be subsidies 
for lower rates for their policyholders but, in fact, they went into 
the company's profits.
  Just like the industry's profits have risen, so has CEO compensation. 
Over the last 20 years, compensation for health insurance company CEOs 
has grown steadily while workers' pay has barely moved. The average 
compensation package for each of the top five health insurance company 
executives between 2006 and 2008 was almost $15 million a year.
  I ran a fairly large company before I came to the Senate, and I think 
earning a profit is good. I think it is appropriate to keep your books 
honestly, tell the company to be transparent, tell the country exactly 
what your profits are, how it was earned, what your expenses were, what 
your revenues were. The company I ran is a company called ADP. I 
started it with two other fellows. They, like I, came from poor, 
working-class families who worked in the mills in Paterson, NJ. We 
worked very hard. That company today has 46,000 employees in 26 
countries across the world. We started in Paterson, NJ, in a dumpy 
hotel building where we could rent space. So I know something about 
balance sheets, financial statements, and profitability. I think that 
profit is a good thing.
  But it is one thing if you are manufacturing lawnmowers and another 
thing if you are providing health care and the squeeze on the profit 
side comes out of people's lives; comes out of creating suffering and 
fear of loss of coverage.
  The average salary for these insurance company executives was almost 
$15 million each year--each CEO--while a year's pay for the average 
worker during that same time was about $44,000. Imagine, these people 
are working in the shops, moving things along, doing their clerical 
work, doing what they have to do, and the top guy is earning $15 
million a year, while the average person working there is earning 
$44,000, and $44,000 today doesn't carry a family very far.
  A single health insurance CEO earns approximately 335 times the 
average worker. It is scandalous. But it doesn't end there. At the same 
time health insurers and CEOs have made out like bandits, the industry 
has increased its premiums relentlessly. According to a new report from 
the Kaiser Family Foundation, insurance premiums for families more than 
doubled since 1999. Ten years ago, premiums averaged less than $6,000 a 
year. Today, they have grown to an average of more than $13,000 a 
year--the highest amount on record. These are for middle-class people 
earning very modest incomes trying to get along and watch their health 
insurance.
  I have had people walk up to me, people I see in positions of labor, 
saying: Mr. Senator, please, my rent is going up, my taxes for real 
estate are going up, I can't afford more. My health care is the one 
thing that worries me so much. I can't afford to pay the premium, Mr. 
Senator. Please, help us.
  As the following chart shows, over the past 10 years, insurance 
premiums have gone up three times faster than wage increases--in a 
period of just 10 years. So we see what is happening to a family's 
ability to afford to cover their needs. If today's CEOs cared as much 
about the public health as their financial wealth, our system wouldn't 
look this way. What happens is we are trading the well-being of the 
needy for unconscionable gains by the greedy.
  It is so funny, the times we live in. I read there was a boat show 
that just took place in Miami, FL, and the most active part of the 
sales of boats was for boats that were 100 feet or longer. We are 
talking about millions of dollars for these boats. I don't begrudge 
those people. I don't, really. But look at basic America and see what 
it is that keeps our country going.
  The health care field is one of the great abominations. We have to 
end this poisonous prescription for management of health care companies 
and change the way these health insurance companies operate. There is 
one way to do it and that is to make sure there is competition within 
the industry that is serious. The legislation we are putting forward 
will reshape health insurance and end the industry's choke hold on 
ordinary Americans.
  Under our proposal, it will be against the law for insurance 
companies to discriminate against women. It will be against the law for 
them to deny coverage because of a preexisting condition. It will be 
against the law for them to end insurance coverage just because 
policyholders become sick. That is what they are supposed to take care 
of. On top of that, we are going to stop insurance companies from 
charging immense amounts of out-of-pocket expenses.
  We will also make it so insurance providers have to cover routine 
checkups and preventive care, so lifesaving mammograms will no longer 
be out of reach for millions of women. I know a world-renowned research 
clinician in New York who says mammograms are the gold standard for 
dealing with anticipation of breast cancer.
  These changes will make health insurance companies more honest, more 
transparent and more accountable and they will still make enough money 
to take care of the wages and the profits they seek. They may not be as 
great as they are, but they shouldn't be as great as they are.
  Our Republican colleagues are chasing a different goal. They are 
looking for political victories on the backs of the working people of 
our country. They are fixated on stopping the Congress and President 
Obama no matter what the consequences are for our country and for the 
people who work hard to keep their families together. But I want to 
remind these obstructionists that health insurance companies have shown 
their utter disregard for the well-being of all Americans from all 
walks of life. They do not care if the policyholder is a Democrat, a 
Republican or an Independent. I remind anybody who hears what we are 
saying or looks at what we are doing that fixing health care is not a 
choice; it is a necessity.
  I know this on a personal basis, though I am fortunate. I have a 
grandson who is 16 years old. He has asthma. When my daughter takes him 
to play sports--he is a good athlete--she first checks to see where the 
nearest emergency clinic is in case he starts to wheeze. I have a 
granddaughter, 11 years old, and she has diabetes. When she was here in 
Washington on a visit, I looked at her, and I didn't like the way she 
looked. I said to my daughter--they live in Florida--you have to find 
out what is wrong with Maddie. There is something there. It worried me. 
She was pale, she didn't have any energy, and she looked terribly slim. 
When I went down to Florida 3 days later, after they left Washington, I 
went to the hospital where she had entered and I saw her. She looked 
like a new person because the diabetes was treated and she had insulin. 
She looked like a new person.
  Those things mean so much. There is nothing more important to any of 
us--and I say this about my Republican friends as well--nothing more 
important than our children, our grandchildren. That is what we all 
live for. They have a right to live and be healthy. For the future of 
our children and grandchildren, every American--we have to meet our 
obligations. I plead with my friends on the other side, get out of the 
way. Don't stand there unless you are willing to come in here and say: 
I don't want people to

[[Page 26677]]

have health insurance. I don't care whether a child has health 
insurance. Say it out loud instead of skulking behind the walls and 
hiding the truth about what your mission is.
  It is my hope that history will record a moment of success, success 
for the people of our country. We have never quite been this close to 
achieving fundamental health care reform. We may never have this 
opportunity again.
  Once more, step forward, colleagues, Senators, sent here by people 
who trust you, who have confidence in you. Take care of them. Be honest 
with them. If you don't want to give them health care insurance, say 
so. Say: I don't want to give you health insurance. Or say: We don't 
want your condition to determine whether we cover you, we want to 
decide. This is an opportunity we have to seize.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon is recognized.
  Mr. LEVIN. Will the Senator yield for a unanimous consent request?
  Mr. MERKLEY. I will.
  Mr. LEVIN. I ask unanimous consent that after the Senator from Oregon 
is recognized and the Senator from Michigan is recognized, under the 
existing unanimous consent agreement I then be recognized.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MERKLEY. Mr. President, I thank the senior Senator from New 
Jersey for his remarks, for his reminder that health care is not about 
profits, it is not about salaries of the CEOs, it is about health care 
for Americans so that all citizens have access to affordable and 
quality health care. That is what this debate is about.
  One component of that debate is extending the opportunity for health 
care to those who do not have that opportunity right now. Another part 
of this debate is about improving the way insurance works for those who 
already have insurance. That is what I want to address tonight.
  There are common practices in our insurance industry, our health care 
system, and that includes exclusion of preexisting conditions, gender 
discrimination, arbitrary annual spending limits or lifetime spending 
limits, and dumping--the practice of kicking people off policies when 
they get sick. They go against the very idea of insurance. What people 
expect is that their health insurance will be there if they need it. 
What they often find is it is not there.
  For example, many people do not realize their insurer has placed an 
arbitrary limit on how much care they can get in a single year or over 
the course of their lifetime. A person may be paying monthly premiums, 
perhaps $500 a month in premiums, every month for years, adding up to 
tens of thousands of dollars. That person may be going forth in that 
fashion, needing not so much as a checkup, but then they are struck by 
a serious illness or a serious accident and they need regular and 
sometimes expensive care. Suddenly they find out that the thousands of 
dollars in premiums they have paid do not actually guarantee they will 
get the care they need.
  I will give an example from my home State of Oregon. Alaya Wyndham-
Price is a healthy 27-year-old from Lake Oswego, OR. She had insurance 
but had no reason to think she would actually need it, given that she 
was healthy and she was young. Imagine her surprise when she was 
diagnosed with a tumor the size of a golf ball just below her brain. 
Then imagine her further shock when she found out that her insurance 
policy caps treatment at $20,000 a year.
  It took $30,000 of tests--and it doesn't take a whole lot of testing 
to run up that kind of bill--to determine the best treatment for her 
tumor. The surgery to remove that tumor is going to cost $50,000, but 
because of Alaya's limit, she has to put off the surgery until next 
year. That means further hardship on her, for her family--emotionally, 
physically, and financially.
  As she told me this story a couple of weeks ago, I kept pondering, 
what will that delay do to her ultimate health outcome? How much 
opportunity is that delay affording to a tumor that doesn't have her 
health in mind as it grows?
  These caps are not right. It is not right to tell someone who is 
gravely ill that they can only have so much health care in a given 
year. It is not right to ration treatments on the ability to pay. It is 
not right to collect premiums year after year and then in the fine 
print put in an annual cap that denies care when it is desperately 
needed. Alaya has insurance but she has already amassed a massive 
amount of debt. Hopefully, she will be able to continue paying her 
bills and not have this critical health care issue also drive her into 
a critical financial situation, into bankruptcy. Indeed, that is what 
happens to many Americans who have health insurance. Half the people 
who declare bankruptcy do so because of medical bills, and three-
fourths of those who declare bankruptcy because of medical bills had 
insurance.
  Insurance at the least is supposed to be the way to keep yourself 
financially solvent in the case of a disaster, but that is not what is 
happening for millions of Americans. It is not working for many 
Americans.
  Insurance failed Kathryn Peper of Tigard, OR. Katherine had trouble 
getting any insurance because she had high cholesterol, a common 
condition but enough to allow the insurers to deny her application 
because of this preexisting condition. She did finally find a policy--
$550 a month. She paid that premium and one would think insurance at 
that price would pay some of her medical expenses, but she found out it 
did not. Her insurer routinely refused to pay for even simple doctor 
appointments. So she was paying a huge amount for insurance and getting 
no coverage as a result, when she needed it to go to the doctor. She 
finally canceled her policy, and she now pays out of pocket for each 
visit, and she hopes she does not have a debilitating condition come up 
or an accident.
  There are other practices. I mentioned dumping. This is egregious. 
Imagine you pay your premium year after year, month after month, 
stretching over 10, 15 years, and then you have that accident or that 
disease that lands you in the hospital and you need a lot of care. You 
get a letter from your insurance company saying: We don't think you are 
a good insurance risk anymore so we are canceling your insurance.
  At the end of that year you are suddenly stuck with massive bills and 
no insurance coverage to pay for the ongoing treatments you need. That 
is not right.
  We have built our health care system around private insurance and 
private insurance remains an integral part of health care reform. But 
things have to change. We can't continue to have our citizens pay 
millions to insurers and see so little in return. It is not good for 
the health of the American people or our Nation. We need an insurance 
policyholder bill of rights. It needs to have guaranteed issue, no 
blocks as a result of preexisting conditions, no rejection because of 
preexisting conditions. It needs to have no arbitrary annual or 
lifetime limits. It needs to say no dumping, and it needs to say no 
gender discrimination.
  Each and every one of these concepts was debated in the Health, 
Education, Labor and Pensions Committee and incorporated into the bill 
that came out of that committee. These are principles I want to see 
carried straight through until we put this health care reform on the 
President's desk.
  It is time to act for the citizens of this Nation. It is time to have 
a health care system that works for working Americans.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.
  Ms. STABENOW. Mr. President, first I thank my friend and colleague 
from Oregon, Senator Merkley, for those wonderful comments and his 
passion and commitment on this issue; also, Senator Lautenberg from New 
Jersey and my friend and partner from Michigan, Senator Levin, who will 
be speaking, and the great Senator from Rhode Island, as well, who has 
been a wonderful leader on this issue and so many other issues as well. 
We all come today because we are committed. We are absolutely committed 
to seeing reforms in our insurance system so families get

[[Page 26678]]

what they are paying for and we can bring costs down and we can save 
lives.
  We are here because we want to share the voices and stories from 
people in our States who have paid into a system and too often not 
gotten what they have paid for, not been able to benefit from the 
health care system that we have in this country.
  It is important that insurance industry reforms be a part of health 
care reform. We know we are still in the process of bringing a bill to 
the floor. At this point we are talking about our goals and our 
commitment to the common shared values and goals that we have going 
forward because we know we need to make sure this is addressed.
  When we started this debate earlier this year, I set up an online 
health care people's lobby for the people of Michigan to be able to 
share with me their thoughts, concerns, and stories as they relate to 
health care, not having health insurance, what is happening to their 
families. My sense was we can step outside this Chamber and meet at any 
moment with insurance company lobbyists and prescription drug lobbyists 
and others who are here representing special interests. It is very 
important that voices be heard from people who just want health care 
for their families and either cannot find it, cannot afford it, or they 
have it and the costs are going through the roof and then they find 
that what they have paid for or what they thought they were paying for 
is not what they are actually getting for their families.
  That is specifically what we want to talk about today, the fact that 
there are abuses, bad practices occurring right now. People who have 
insurance have a stake in health care reform. We are not changing their 
ability to have insurance. Everyone can keep what they have. But we 
want to make sure they are getting what they are paying for.
  That is a very important part of health care reform. It is important 
as we look at the fact that since 2000, insurance company profits have 
gone up 428 percent. People in my State would take a quarter of that. 
We are seeing insurance premiums during that same period go up 120 
percent. Even though profits have gone up 428 percent, we still have 
seen premiums going up 120 percent, and now even higher. We are seeing 
more and more announcements of premiums going up despite the high 
profits in the industry.
  What is most concerning is, for average people wages are either going 
down, they are losing their job, or if they have a job their wages 
certainly are growing much more slowly. In fact, over the 8-year period 
we have seen wages going up about 29 percent at best, if you are 
fortunate enough to have a job in this bad economy. That means every 
day insurance companies are taking a bigger chunk out of budgets of our 
families and businesses, and it is not fair.
  The status quo is not working anymore for anybody other than those 
who are making profits off the system. It is hurting families, it is 
hurting businesses, and it is costing us jobs. In fact, health care 
reform is about jobs. It is about saving jobs, it is about making sure 
if you lose your job you do not loose your health care. It is about 
making sure that small businesses that want to provide insurance for 
employees can do that or not have to lay off people because premiums 
are going up. So it is very much about jobs.
  It is very much about jobs, and that is why we need a health care 
reform bill now. It is time to put an end to the insurance company 
abuses. The goals we share in this process are to stop the process of 
denying coverage because of preexisting conditions; to stop the process 
of annual and lifetime caps on benefits; to stop the process where 
someone can get charged more or dropped from coverage if they get sick.
  I have seen too many situations where somebody pays in, pays in, and 
pays the higher premiums and so on, and then somebody in the family 
gets sick and, based on technicalities, they are dropped or they are 
not covered. That is wrong. We are committed to fixing that.
  We also want to make sure on the positive end that we are focusing on 
prevention and on checkups and making sure you can do that without the 
cost of copays and deductibles. We are encouraging people to get 
healthy, to get those early checkups, to be able to get the care on the 
front end that they need.
  It is also extremely important as we move forward we crack down on 
discrimination by insurance companies. Right now women can pay twice as 
much for insurance as men and, in fact, get less coverage. In eight 
States and the District of Columbia, being a victim of domestic 
violence can count as a preexisting condition. I was stunned when I 
first heard that, and then said, well, that cannot be. We doubled back 
and, yes, in fact, that is true for men and women who need help for 
getting the insurance care they need right when they need it.
  In many places, being pregnant, having ever been pregnant, even 
wanting to be pregnant, can be qualified as a preexisting condition. We 
had a report in the Washington Post about insurance companies that even 
denied coverage to men who were expectant fathers. I am not sure what 
kind of family values those are. But we need insurance reform that 
addresses some pretty basic things.
  Right now 60 percent of the plans in the individual and small 
business markets do not cover vital maternity and prenatal care for 
pregnant women. That needs to change with health care reform. It is not 
an accident that we have an infant mortality rate of 29th in the world, 
below some Third World countries, children and babies who do not make 
it through their first year of life.
  We look at the fact that too many insurance plans do not cover 
prenatal care and care for mom and baby during the first year of the 
baby's life. We are committed to changing that.
  I wish to share a story I received that goes right to the heart of 
why insurance reform is so important to families in Michigan and all 
across the country. It comes from a constituent of mine in Michigan, 
Lynn, from Marshall, MI.
  A few years ago she got the kind of news that every parent fears. Her 
son Justin was diagnosed with leukemia. To date, his medical bills have 
totalled over $450,000. Thankfully they have insurance and his leukemia 
has a very high cure rate.
  Justin is 21 now and a senior in college. He is doing fine, 
thankfully, but Lynn worries about what is going to happen when he 
graduates from college and can no longer stay on her insurance. With 
leukemia as a preexisting condition, his insurance premiums will go 
through the roof. And for a young man who is just starting his career, 
those kinds of costs would simply be unaffordable.
  If Justin wants to start his own business, which is so central to the 
American dream, he would never be able to afford to pay for his own 
insurance with that kind of preexisting condition. How many other 
Justins are out there, who would be the innovators and the 
entrepreneurs we need to revitalize our economy in America? Who would 
make the difference if only they could afford to go out on their own 
and start their own company and know they could get affordable 
insurance without preexisting conditions and other barriers that have 
been in their way from insurance companies?
  That is why we need health care reform. We need health insurance 
reform as a part of health care reform. We are committed to that. We 
are committed to stop abuses in the health insurance industry. Those 
who have insurance now who will be able to keep their insurance need to 
know they are getting what they are paying for in the health care 
system today for their families. That is why we need reform now, and we 
are committed to getting it done.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.
  Mr. LEVIN. Mr. President, it should be crystal clear to all of us why 
the health insurance industry opposes reform so strenuously: because 
the status quo is so profitable.
  As my colleagues have pointed out, the massive profit announced this 
week by Humana, Inc. illustrates this vividly. Humana's third-quarter 
profit of

[[Page 26679]]

$301 million was a 65-percent increase over the same period a year ago. 
And Humana executives made no secret of the reason for this ballooning 
profit. The company's president and CEO said, ``Our government segment 
continued to perform well in the third quarter particularly in our 
Medicare business.''
  It is no coincidence that Humana is one of the biggest providers of 
Medicare Advantage plans. These plans, in which private insurers 
contract with the government to provide coverage to Medicare 
beneficiaries, were supposed to unleash the power of private-sector 
competition, lowering costs, improving service, and increasing benefits 
to our seniors.
  It has not often worked out that way. While some Medicare Advantage 
plans have performed well, Medicare pays, on average, 14 percent more 
for Medicare Advantage beneficiaries than for those in traditional 
Medicare, and despite this increase in payments to Medicare Advantage 
plans, the Government Accountability Office has found that seniors 
often face higher out-of-pocket costs in Medicare Advantage plans.
  In fact, when the GAO studied the costs and performance of these 
plans, it found that in 2005, those plans spent significantly less for 
health care for seniors than they projected to pay. That lower spending 
on medical care for seniors led directly to windfall profits, $1.1 
billion more in profits than the insurance companies had told the 
government they expected to earn. That $1.1 billion is taxpayer money 
that should be providing treatment to our seniors, and instead is 
boosting insurance company profits.
  Indeed, health insurance companies need no taxpayer help in reaping 
big profits. From 2002 to 2006, profits at publicly traded insurance 
providers increased more than tenfold. At the same time these companies 
are making massive profits, working Americans and their employers have 
endured year after year of much higher premiums, reduced benefits, and 
denials of treatment.
  Our citizens need a sensible health care system. We can not afford a 
system in which our people are denied treatment because their benefits 
are capped. We can not afford a system in which they are denied 
coverage because they have a preexisting condition. Our Nation can not 
afford a system in which the loss of a job means the loss of coverage 
and debilitating health costs. Our Nation can not afford a system in 
which even those with jobs and insurance face rapidly increasing 
premiums and out-of-pocket costs. Our nation certainly can not afford a 
system in which our tax dollars boost the ever-higher profits at 
insurance companies, or in which premiums and out-of-pocket costs 
constantly go up, while coverage constantly shrinks or disappears 
entirely.
  The Senate needs to put the interests of the American people ahead of 
the interests of insurers. We need to take up a health reform plan that 
makes comprehensive, affordable health coverage available to every 
American, and helps keep insurance companies honest.
  I yield the floor, and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WHITEHOUSE. I ask unanimous consent that the period for speakers 
be extended for an additional 20 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WHITEHOUSE. Mr. President, I have joined my colleagues on the 
floor this evening to discuss the need for health insurance reform, 
which is a critical component of the health care reform package that 
the Senate will soon consider.
  Our colleagues on the other side of the aisle are fond of suggesting 
to the American people that our current health care system is 
fundamentally fine, fundamentally sound, and all it needs is some minor 
tweaks. But Rhode Islanders who have faced down their insurance 
companies over the denial of benefits they paid for will tell you that 
idea is dead wrong. As they and many other Americans have found to be 
painfully true, our current system of health care is all too often a 
mirage concocted by health insurance companies to extract premiums from 
consumers while denying coverage when it is actually needed.
  Reform of this system of delusion is needed and it is needed now. As 
someone said the other day: Americans have all the health care they 
need until they need it. Then the insurance company comes and 
interferes.
  Those profit-driven companies focus on share price and quarterly 
earnings and other telltales of the business world and are only too 
happy to diligently mail those premium notices and collect those 
payments when you are feeling well. But when illness strikes, they 
vanish, they disappear, hiding behind stacks of forms, automated 800 
numbers, with no human to be found, and weeks and weeks of delay and 
denial.
  The insurance company Humana pulled just such a stunt a few years 
ago. In May of 2006, a Humana policyholder was diagnosed with a rare 
and advanced form of liver cancer. Without treatment, he was not 
expected to live more than 4 years. But in September of that year, his 
doctor, a board-certified interventional radiologist, recommended a 
course of treatment for the cancer involving a new technology, 
expensive but proven to be effective.
  The insurance company policy explicitly covered such radiological 
treatment. At this point, it is an inspirational story, a terminally 
ill patient whose persistent and caring doctor found a technological 
advance that could extend his life. But when the insurer Humana became 
involved, this patient's bureaucratic nightmare began. The treatment 
recommended by the doctor is widely accepted. It is FDA approved. It is 
reimbursed by Medicare and Medicaid, and it is covered by several large 
insurance plans. But Humana's medical director denied coverage. He 
denied it on the basis that it was ``experimental/investigational, not 
identified as widely used or generally accepted.''
  Humana decided to deny this lifesaving treatment in spite of the fact 
that the insurance company medical director, the same fellow who made 
that determination, later admitted in court that:

       He has never performed [the] treatment, consulted with 
     another physician about the treatment, or even read any 
     literature on the topic.

  Without ever having performed this treatment, without ever having 
consulted with another physician about this treatment, without ever 
having read any literature on the topic, he reached the decision that 
this treatment was ``experimental/investigational . . . not identified 
as widely used [or] generally accepted,'' leaving this man with liver 
cancer and a doctor telling him how to cure it hanging in bureaucratic 
limbo.
  Since this policyholder could not pay out of pocket--it was an 
expensive treatment--the hospital treating him said it could not 
proceed with the treatment. With time running out and nowhere to turn, 
he hired an attorney to force Humana to stick to the terms of its 
health insurance policy. Thank goodness, he won.
  In a blistering opinion, the trial judge found that the company could 
not have possibly made a well-informed decision under the provisions of 
the plan. Rather, the judge found, the company relied on the flimsy 
pretext of an internal company guideline deeming the treatment 
``experimental.'' How good is that? You are the insurance company that 
has the decision on whether to pay. You have a rule that says you don't 
pay if it is experimental, and you create your own internal, 
independent guideline that decides, contrary to all the rest of the 
evidence, that it is experimental. It is like being able to grade your 
own exams, except that lives hang in the balance.
  The basis for that conclusion was two written summaries of medical 
articles by a private health insurance industry consultant. That is 
what they based

[[Page 26680]]

that internal guideline on. They said it was based on written summaries 
of medical articles by a private health insurance industry consultant. 
It makes you feel pretty good as a customer of the insurance company to 
think that they are getting recommendations from their own private 
health insurance industry consultants, right? The real problem was 
this: The summaries were wrong. Neither of the articles actually 
concluded that the treatment was experimental. The whole thing was a 
big, complex, bureaucratic chase founded in falsehood.
  The court found that Humana inappropriately denied the treatment and 
ordered that it immediately pay for this patient's cancer treatment. 
What a waste--a waste of money, a waste of time, and a waste of 
resources. Worse than all of that, what a thing for this man to have to 
go through. Not enough that he has been diagnosed with a rare and fatal 
form of liver cancer, not enough that a doctor has told him that with 
the right treatment, he could extend his life, maybe long enough to see 
a daughter graduate, maybe long enough to see a son get married, maybe 
long enough to arrange his affairs for his family to do well after he 
has left them, on top of all that, he now had two battles to fight--one 
with his illness, one with his insurance company.
  We have heard a lot of hysterical propaganda lately about how health 
reform will put the government between you and your doctor. Indeed, the 
recent GOP health care bill on the House side has in its opening 
passages that it will not intervene in the doctor-patient relationship, 
suggesting that other proposals would intervene in the doctor-patient 
relationship.
  I submit that our colleagues on the other side are a lot less 
concerned about intervening in the doctor-patient relationship than 
they are about the Congress of the United States intervening in the 
insurer-to-insured relationship. I submit they are more concerned about 
leaving American insureds at the mercy of these insurance companies--
the place where they actually intervene between the patient and the 
doctor. The worry for the real American isn't that the government is 
interfering between them and their doctor; the worry is that when they 
get sick, that insurance company intervenes between them and their 
doctor.
  We hear it in Rhode Island, in Colorado, the State of the Presiding 
Officer. We hear it over and over. Indeed, one of the things they do is 
called rescission. Rescission is when you have paid your premiums, you 
have been a good customer, you think you are a customer in good 
standing, and something awful happens--an unexpected diagnosis, a 
terrible accident. Suddenly, you need to call on that insurance policy 
that you have paid for month after month, year after year, to see you 
through your time of illness or injury. Then what do they do? The first 
thing they do is send somebody in their administrative offices 
squirreling off through your file to look for something you did wrong 
when you filled out your form. If they can find a mistake, they yank 
the coverage you paid for all those years.
  During a recent study by House colleagues, committee investigators 
found a total of 19,776 rescissions from just three large insurance 
companies over 5 years; 19,776 families who thought they had coverage, 
who paid for coverage, who were good customers, but when they got sick, 
the insurance company turned on them, and, once again, they had to 
fight two battles--one against the illness or injury and one against 
the insurance company. The rescissions saved those three insurance 
companies $300 million, a third of a billion dollars. As a prosecutor 
would say, there is motive.
  When you look for real examples of bureaucratic interference, when 
you look for real examples that resemble death panels, you need look no 
further than the kind of story about this gentleman Humana turned on 
when he got his diagnosis. We are here not to encourage that, not to 
have the government do it, but to stop it, to put an end to it.
  In stark contrast to this patient's humiliation, having to pay 
attorney's fees out of pocket to fight the insurance company, having to 
try to cope with all this nonsense while suffering from a terminal 
illness, Humana executives and shareholders have done quite well. The 
company reported this week that its third-quarter profits are up 65 
percent. Its CEO, Michael McCallister, was paid $5.2 million in 2008. 
Nice pay. Too bad the work is so mean-spirited.
  You might think the Humana story is extreme, an outlier, a rare, 
tragic case, but you would be wrong. The private health insurance 
industry torments Americans like that patient day-in and day-out, 
17,000 of them just with the rescissions.
  Another example: In 2005, BlueCross of California denied a patient's 
claim for bone marrow treatment, writing only that its decision was 
``based upon the member's specific circumstances and upon peer reviewed 
criteria including Medical Policy.'' What is that? What does that mean? 
``Based upon the member's specific circumstances and upon peer reviewed 
criteria including Medical Policy''--what a lot of rigmarole. The State 
insurance commissioner stepped in and penalized the company because it 
didn't describe any reasons for its denial, nor did it cite provisions 
of the insurance policy upon which it relied, just ``based upon the 
member's specific circumstances and upon peer reviewed criteria 
including Medical Policy.'' You could make that up about anything. In 
essence, the insurance company denied that claim for no reason.
  That same year, the company denied another patient's claim for 
nutritional counseling to treat anorexia. In its notice of 
cancellation, the company wrote to its insured that ``nutritional 
counseling is only covered when the diagnosis is diabetes. Since the 
claim was not submitted with a diabetes diagnosis, the claim was 
denied.'' California's insurance regulator found that the company's 
reasoning directly contradicted the benefits listed under the policy 
which said that dietary counseling ``is covered if it is for the 
treatment of anorexia.'' Why do you make somebody who needs this health 
care go chasing through the policy to find the place where it actually 
says it is covered? Why make up a lie that it is not covered? There is 
an obvious reason: If you do that to enough people, some won't take the 
trouble. Some will fight back. Some will figure out that it is 
inaccurate. Some will go to the regulators. But some will give up. Of 
those who give up, you make money.
  BlueCross of California is owned by WellPoint, whose CEO, Angela 
Braly, made $9.8 million last year.
  Many years ago, Charles Dickens wrote a book called ``Bleak House.'' 
In ``Bleak House,'' there are a lot of story lines, but one of them is 
about two young people who are pursuing a case in the British courts. 
Jarndyce v. Jarndyce was the name of the litigation. It is described in 
``Bleak House'' as a monster extending through the courts, through 
writs and clerks and judges. And the storyline through ``Bleak House'' 
is that eventually, through all this bureaucracy, through all this 
static, through all this nightmare, through all this hassle, the couple 
finally gets to the point where they achieve the inheritance that was 
theirs, and that was the subject of the litigation they needed to claim 
through this arduous ordeal. The problem: By the time they got the 
inheritance, it had all been eaten up, every penny and farthing, by all 
that process and all that delay.
  Our current system of private health insurance too often leaves 
policyholders feeling like that poor young couple in ``Bleak House,'' 
surrounded by bureaucracy; surrounded by people who are out to gouge 
you, not to help you; surrounded by people who turn their backs on you 
in your hour of need; surrounded by people who sold you all the health 
coverage you need until you really need it. Then they are looking for 
loopholes and trying to deny you coverage.
  We owe Americans better than that. We can build a system of health 
insurance about which Dickens would not be tempted to write or Franz 
Kafka for that matter. Let's build a system that prevents insurers from 
evading their

[[Page 26681]]

promises--in which people can't be denied coverage for a preexisting 
condition; in which surprise annual or lifetime caps don't pitch you 
into bankruptcy; in which insurers compete on customer service, not on 
how to figure out ways to deny you coverage. That is the system we in 
Congress are striving to enact into law this year.
  One of the ways we will do this is by adding to the bill a public 
option. You can chase these insurance companies around until you are 
blue in the face. You can sic the regulators on them all day long. But 
they have been doing this for years. It is a habit. It is a pattern and 
practice. It is a business model. It is not going to change without 
competition forcing it. That is yet another one of the reasons a public 
option is so important in this debate.
  One of my fellow Rhode Islanders, Karen Ignagni, is actually the 
chief lobbyist for the health insurance industry. She said something 
the other day about the public option. She said that it would reduce 
payments ``to doctors and hospitals rather than driving real reforms 
that bring down costs and improve quality.'' I submit she has it 
exactly wrong, exactly backward.
  First, as we have crafted a public option, it would have to compete 
and negotiate for price, just like the private insurance industry does, 
no different than the insurance companies Ms. Ignagni represents.
  But more to the point, this idea that it will compete by reducing 
payments to doctors and not drive real reforms, I submit the exact 
opposite is true. It is the public option that will drive the real 
reforms. It is the public option that will pursue cost-effective 
quality improvements; that will pursue wellness and prevention for 
customers; that will find better ways to pay doctors for value, not for 
volume; that will take advantage of President Obama's investment in 
health information technology to transform American health care for the 
better.
  So I will close with that observation, and I will add one more thing. 
I have used examples from public records, but many of us here have had 
this experience personally.
  Someone in my family, whom I love very much--I would describe him as 
my best friend--got a terrible diagnosis some time ago, and his family 
and everybody who loves him gathered around to help him. One of the 
things that was recommended was that he go to the National Institutes 
of Health, where the best specialists for this terrible diagnosis he 
had can be found.
  So he went to the National Institutes of Health. Actually, I went 
with him because it is just up the road in Maryland--he had to come 
down from New York--and I wanted to be a good friend and a good family 
member and show support and be there with him. So I know firsthand he 
went up to NIH, and I know he spoke to that doctor, that world's best 
expert on this terrible diagnosis, and I know firsthand what he was 
told. I know exactly what he was told to do by that doctor.
  He went back home to New York with this course of treatment for his 
condition that had been given to him by the top specialist in the field 
in the country, the man recognized by the National Institutes of 
Health, and when he began that course of treatment, guess what his 
insurance company told him. ``I'm sorry, that's not the indicated 
treatment.'' Oh, really? Not indicated? By whom? By some person on the 
other end of the phone who has never even examined him? By some person 
on the other end of the phone who might not even have a medical degree?
  Why is it that every single time the insurance companies get involved 
and say something is not the ``indicated treatment,'' the indicated 
treatment is less expensive, the treatment they want is less expensive 
than what the doctor wants? You would think that maybe once in a while, 
just to throw us off, they might say: No, no, no, wait a minute, the 
indicated treatment is actually more expensive and better than what 
your doctor said, and we want you to have that. Has that ever happened? 
I do not think so. Every time the private health insurance industry 
steps in between you and your doctor and says: No, we are not covering 
that treatment, we don't care that your doctor has prescribed it--in 
this case, we don't even care that the top specialist in the country 
prescribed it--it is always to push you to a cheaper treatment.
  The terrible thing is that for every American like the man I love, 
for every American like him who fought back, who said: Nuts to that, I 
have been to the NIH, this is what they told me to do, this is what I 
am doing, some number will give up, some number will be defeated, 
already scared by a terrible diagnosis, already bombarded at home with 
forms and bills and things they do not know how to cope with, already 
trying to cope with issues like preparing their family for horrible 
news. Dealing with the difficulties of treatment, some number of them 
will give up, and they will let the insurance companies get away with 
it. For every one of them who dies a little earlier because they did 
not get the treatment they should have--for every one of them--we in 
this Congress need to get to work to make sure this kind of behavior is 
never permitted again.
  This is not a small matter. This hits home in every one of our States 
every day. So I am proud to support our health care reform. I think we 
are going to see this legislation through to the end, and we are going 
to get it right, and after all the scare mongering and all the stories 
about death panels and all the phony defense about the government 
getting between you and your doctor--when what they are really 
protecting is the right of the insurance company to step in and get 
between you and your doctor; that is what they are about--after all of 
that, what people are going to find, coming out, when they actually see 
the real results, is that, in fact, the world has changed for them. 
What Americans will see is that we will have changed the world for the 
better for people who are now in the grip of these greed-driven 
insurance companies.
  Mr. President, I thank the distinguished Presiding Officer very much, 
and I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Burris). The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. CASEY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CASEY. Mr. President, I also ask unanimous consent that after the 
next, I believe, 10 minutes expires on our time, that I be permitted to 
speak in morning business beyond that time by, oh, say 10 minutes at 
the most.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CASEY. Mr. President, I rise tonight to also speak about health 
care, as we have heard from some of my colleagues. I was coming in as 
Senator Whitehouse was concluding his remarks on the floor and am 
grateful for his leadership and the leadership demonstrated by so many 
of our colleagues here on this critically important issue.
  We have heard a great deal in the last couple of weeks about some of 
the fundamentals of health care reform. I was speaking last week about 
children and some of the progress we need to make in the final bill to 
protect our children, to make sure that especially poor children are 
not only not worse off at the end of this debate but also that they 
are, in fact, better off because of the reforms we make. We have great 
programs to work with. The Children's Health Insurance Program, for 
example, has been tremendously successful in insuring the children of 
working parents. We know the kinds of early, periodic screening and 
diagnostic testing done in Medicaid is very important to poor children 
and their families. So there is much we have to do just with regard to 
children.
  Our older citizens, of course, are a huge focus of this health care 
reform. We want to control costs. We want to provide better quality, 
ensure prevention strategies that will not only save lives but also 
save us a lot of money. We want to wrestle, as we have been trying to 
do, with the cost issue, and we will continue to do that, and I think 
successfully.

[[Page 26682]]

  But one area I think we often, unfortunately, overlook is what 
happens to our small businesses. We know that most of the jobs in 
America--the foundation of our economy--are created by small 
businesses. These are the very businesses in States such as 
Pennsylvania and the Presiding Officer's home State of Illinois and 
States across the country--big States and small State--where businesses 
have been devastated by health care costs. Over and over again, we hear 
it.
  Just in the last couple of days, we saw this headline in the New York 
Times: ``Small Business Faces Sharp Rise in Health Costs.'' And the 
subheadline or the reference to the story says: ``Up 15%, On the 
Average.'' ``Insurers Increase Rates as Congress Weighs Major 
Overhaul.'' So there are a lot of small businesses in Pennsylvania and 
across America that are waiting to see what the House and the Senate 
will do. What kind of bill will we send to President Obama for his 
signature?
  If we do nothing, there is one thing we are sure of. If we do 
nothing, if we do not pass legislation this year--as I think we will--
but if the Congress did nothing, we know those costs are going up all 
the time. The New York Times reminds us of that: ``Up 15 percent, On 
the Average.'' There is an increase in costs, if we do nothing, that 
has been escalating for years now. We have had people in the Congress, 
here in this Chamber, and other places saying: We have to help small 
businesses. We have to be conscious of what their needs are, the 
difficulties they have had in this recession.
  Families have had a lot of difficulties, obviously. In addition to 
that, small businesses have. But we cannot say we really are concerned 
about what happens to small businesses--small business owners--in 
America if we do not help them on health care, if we allow this to 
persist, this spiraling, ever-increasing cost of health care for small 
businesses.
  If you look at it just in terms of Pennsylvania--one way to look at 
this is just in terms of State numbers. These numbers, we will not have 
to go through. I know some of them are small. But here is the basic 
point: cost of health benefits to small businesses per year if there is 
no reform. This is just for Pennsylvania, as shown on this chart. If 
you look at the year 2009: 7.43--the annual spending in billions of 
dollars in the State of Pennsylvania. Almost $7.5 billion spent by 
small businesses on health care. You do not need to read every number 
here because a lot of them are small, but you can see the trajectory of 
that graph, that blue line going up and up and up. So by the time 2018 
rolls around, not even a decade away--9 years away--if we do nothing, 
Pennsylvania's small businesses will pay more than $16 billion for 
health care--just in less than a decade, more than a doubling of health 
care costs for small businesses in one State. One can just imagine. One 
doesn't have to be an expert with numbers to extrapolate from that what 
that means for the United States of America. Small businesses already 
crushed in many instances by health care costs, being crushed even 
further. That is the cost of doing nothing. There are a lot of ways to 
measure that, but the cost to small business is one of them.
  According to an August 2009 Small Business Majority survey of 200 
Pennsylvania small businesses, the top three concerns for small 
businesses in Pennsylvania--and I have no doubt this is similar to the 
rest of the country--here are the three top concerns: No. 1, 
controlling costs; No. 2, having insurance that covers everyone; and, 
No. 3, ensuring at least high-quality standard benefits. So small 
businesses have the same concerns that many people here have: 
controlling costs, enhancing quality, and making sure we have broad 
coverage.
  Ninety percent of small businesses in Pennsylvania want to eliminate 
preexisting condition rules, and 75 percent see these rules as a 
barrier to starting a business. So someone is making a decision, making 
a determination about whether they will start a small business, and 
they think to themselves: I may not be able to get this business off 
the ground because of health care costs or because of preexisting 
conditions.
  Why have we allowed this problem--not just the cost problem but the 
problem that we point to all the time of preexisting conditions--why 
have we allowed insurance companies to do that? Well, we have allowed 
it over many years because we haven't taken them on and defeated them 
when it comes to passing legislation.
  This is the year when at long last we are going to say to insurance 
companies: You cannot have this kind of power over people's lives, over 
people's business decisions by, for example--one of many examples, but 
the most prominent, the most egregious example--denying someone 
coverage because of a preexisting condition.
  I know this summer, way back in the middle of July, as a member of 
the Health, Education, Labor and Pensions Committee, we passed our bill 
out of that committee and the first section of that bill dealt with the 
preexisting condition problem. In one sentence in that bill we set 
forth a determined effort to make it illegal to prevent someone from 
coverage because of a preexisting condition. So this is about 
individuals and families, as well as about small businesses. They, too, 
suffer from the preexisting condition problem in our health care 
system.
  There are a lot of other numbers I could point to in a survey. I will 
not go through all of those, but I do wish to highlight tonight as well 
what we heard just yesterday, or part of what we heard yesterday in the 
Health, Education, Labor and Pensions Committee where we had a number 
of witnesses. One of those witnesses was Jonathan Gruber who is an MIT 
economist. He testified that small businesses--and I am paraphrasing 
his testimony; it is all in the record--small businesses are 
disproportionately hurt by the health care status quo and that health 
insurance reform will lower--lower--premiums and save jobs in the small 
business sector.
  I am quoting from Dr. Gruber from MIT:

       Small business has little to fear and much to gain from 
     health reform.

  Not my words, the words of an MIT economist who has spent time not 
just analyzing health care reform over many years, he played a role in 
helping Massachusetts develop their strategy. But he is talking about 
reform generally on health care as it relates to small businesses.
  Professor Gruber also talked about health insurance reform breaking 
down many of the barriers that currently are faced by small business 
owners or prospective small businesses. For example, unpredictable 
premium jumps, as we see on the chart. Whether they are predictable or 
not, they occur all the time. But they are especially problematic when 
a small business owner doesn't have any warning. Fear of starting new 
businesses for lack of affordable health insurance options is an 
impediment to starting a small business. An impediment to creating jobs 
is another way of saying it, in my judgment.
  Professor Gruber talks about other barriers to small businesses under 
our current system: higher costs and limited choices due to 
administrative expenses and lack of bargaining power. Just imagine what 
it is like for a small business owner in a huge environment where they 
don't have the kind of bargaining power a big company has or they don't 
have the kind of bargaining power the Federal Government has to go into 
the marketplace to keep costs down. So they go in virtually unarmed or 
alone into that marketplace, a small business owner, who might have 4 
or 5 or 7 or 8 or 10 or 20 employees.
  Tax credits would help small businesses who need it the most to help 
them pay for insurance. Dr. Gruber unveiled a new analysis in his 
testimony showing that health insurance reform will save small 
businesses 25 percent over the next decade. One thinks: Well, 25 
percent, what does that mean? By his estimate, this 25 percent savings 
to small business as a result of health care reform, in his judgment, 
would be a $65 billion-per-year savings for small business. That is Dr. 
Gruber at MIT, not my words, not the words or the analysis of some 
Senator or House

[[Page 26683]]

Member on one side of the debate or the other.
  So the consequences of those savings would be enormous to small 
businesses in America. I know we need this kind of reform in 
Pennsylvania.
  Workers in small businesses would see an increase in their take-home 
pay, according to Dr. Gruber, of almost $30 billion a year. That 
affects all of our lives in a very positive way. If a small business in 
our community can hire more people, can make an investment in the 
development of that small business because of health care savings as a 
result of a health care reform bill, our communities will be stronger. 
We will have more people working. We will have a much stronger economy 
right at the community level, not just in a macro or larger scale way.
  Finally, on this analysis of what health care reform could mean to 
small businesses in terms of savings, that reform could save almost 
80,000 jobs, according to Dr. Gruber--80,000 jobs in the small business 
sector by 2019. Dr. Gruber also dispelled the myth that health 
insurance reform will raise costs for small businesses. He said:

       Objective CBO analysis shows that these claims are clearly 
     wrong. Reform will lower, not increase, nongroup insurance 
     costs.

  So says MIT economist Dr. Gruber, who has lots of experience in this 
area and is lending the benefit of his experience and his insight into 
these analyses on health insurance reform, but in particular as it 
relates to small businesses.
  So what we want to try to do with health care reform when it comes to 
a State such as Pennsylvania is take this blue line of an exponential 
increase in health care costs for small businesses in one State--and I 
think this is true of the country as well, in my judgment--we want to 
make sure this line and this exponential increase is turned the other 
way or at least begin to flatten out so that the $7 billion that small 
businesses are paying in Pennsylvania for health insurance reform by 
the year 2018 might be only something a little less or a little more 
than $7 billion.
  We cannot say with a straight face or with any degree of integrity, 
in my judgment, that we want to lower costs for small businesses, that 
we want small businesses to hire more people, and then in the next 
breath say: But I don't think we should pass any health care reform. It 
is too complicated or it is too something to get it done this year. We 
cannot do that.
  We cannot continue to say: Oh, isn't it too bad that health care 
costs are so high? Isn't it too bad we couldn't do something about the 
health care costs of small businesses? This, in the end, is not simply 
about the small business owner, it is not simply about what we are 
going to do for small businesses to help them get through this 
recession. This, in the end, is about our economy. We are either going 
to change course, get control of costs, reform health care and be able 
to move our economy forward or we won't meet that challenge.
  We are going to make the changes and institute reforms that will lead 
to lower costs, better health care outcomes, and a better bottom line 
for small businesses and, therefore, control long-term health care 
costs and long-term national debt. All of that comes from a good health 
care bill in the end.
  We cannot fail. We cannot at long last say we didn't get the job 
done. We have to for our families, for children, for older citizens, as 
well as for small business owners. I think we can. I think we have the 
strategy that the American people understand fundamentally, and I think 
we can do it this year.
  Mr. President, with that I yield the floor and note the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. CASEY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________