National Commission on Health Care Act

Mr. President, while Republicans proclaim this week as Health Week on the Senate floor, it is quite the contrary in the homes of millions of American families. Today, 46 million Americans have no health insurance at all. And 1.3 million New Jerseyans have no health insurance. Another 16 million or more Americans are underinsured, meaning that they have insurance, but still do not have access to the care they need. Complicating matters even more is the fact that the average cost of family health coverage--$10,880--now exceeds annual earnings for a minimum-wage earner.

So what does the Senate majority propose to do to solve the problem? Nothing more than dust off the old playbook and make another run at the same old play. They propose a medical malpractice bill that has been defeated over and over again, that does not even really reduce costs for providers or patients, and in the process actually reduces remedies for patients. They propose a bill claiming to help small businesses, but it actually hurts patients by removing existing coverage and protections and exacerbates the problem of the underinsured.

So at the end of Health Week in the Senate, all we have to show the American people is more of the same--the same 46 million with no insurance, the same 16 million people with inadequate insurance, and the same families working 40 hours a week to earn a living for their family but still unable to afford quality health care for them.

Instead of leading us down a dead-end road, as Republicans have done this week, we should be on the expressway to real health care solutions--legislation such as the Stem Cell Research Enhancement Act, legislation to extend the enrollment deadline for the new Medicare Part D drug benefit, legislation to provide real solutions to the large and growing number of uninsured Americans, and legislation to address long- term care needs that will only become more pressing as the baby boom generation ages.

The Republican proposals being considered this week never even received a hearing or a vote in their committees of jurisdiction and were destined to fail from the beginning. Is this really all the majority party plans to address regarding the endless needs of our health care system? I believe we can and must do better.

First, Alzheimer's disease does not boast a party affiliation. Neither does cancer or diabetes or Parkinson's disease. Yet, potential cures to these debilitating and fatal diseases are being ensnared in political wrangling, posturing, and obstruction.

Today, almost 35 years after President Nixon declared war on cancer, the Federal Government and Washington Republicans remain AWOL in the fight against this fatal illness and a host of other debilitating diseases. While we have made great strides in researching potential vaccines and cures, our colleagues on the other side of the aisle choose to tie our researchers hands.

The bottom line is this: When your life--or the life of a loved one-- is on the line, you never give up and you never limit your options-- never. You never lose faith, and you pursue every option, every sliver of hope, of finding a cure.

This issue is about more than statistics, it is about more than numbers on a fact sheet. These are real people. These are families. These are mothers and fathers, sons and daughters, aunts and uncles. These diseases cut through race, age, religion, country, and political affiliation. We all suffer, which is why we must move beyond the usual partisan posturing and fight for expanding research.

I had the opportunity to vote on this stem cell legislation in the House of Representatives, where we had broad, bipartisan support. And I believe that same bipartisan support exists in the Senate, which makes it even more difficult to understand why we cannot come together and do something meaningful for those who are suffering.

We have an opportunity to do what is right, and the majority has again let that opportunity pass them by. This bill means so much more than ending restrictions placed on stem cell research. This bill means hope for the individuals challenged and fighting to live a life with dignity.

Stem cell research has vast potential for curing diseases, alleviating suffering, and saving lives. I know my colleagues recognize the enormous potential of this research too, and it is time to clear the way for discovering new cures and therapies and bring this bill to a vote.

Another thing we cannot ignore is the fast approaching deadline for seniors to enroll in a Medicare prescription drug benefit without being penalized. We need to stand up for our seniors and extend the deadline so that our seniors have time to choose the plan that is right for them.

When the Federal Government rolled out the new benefit, and it did not go as planned, States such as New Jersey stepped up to the plate and provided emergency drug coverage to seniors and people with disabilities in need. Now the Federal Government has a responsibility to recognize its shortcomings and give our seniors a chance to enroll without having to pay the price for the Federal Government's mistakes.

And the concerns go beyond just seniors' drug benefits. There is also a grave concern that seniors and people with disabilities may lose access to their local neighborhood pharmacies. Almost any senior will tell you that they rely on their local pharmacist to help them when they have complications with their drugs--whether it is interactions between drugs or problems getting their medications.

I recently heard from Adolph Gonzalez and Alan Garcia who run the North Bergen Pharmacy, which has been open and serving its customers for the past 21 years. Unfortunately, since prescription drug plans are not paying their claims in a timely fashion, pharmacies such as this one are dipping into their line of credit, taking out loans and scrambling to stay afloat. Unless things change, pharmacies such as the one in North Bergen, NJ, are going to be forced to close their doors.

I introduced legislation to address problems with the Medicare Part D drug benefit and so have many of my colleagues. All of us recognize that unless we start making important changes to improve the program, seniors are going to see lapses in their care. We must be committed to making sure that all Americans have a comprehensive drug benefit that allows them to take the medication prescribed by their doctors, provides them the information and flexibility to pick a plan that works best for them without being penalized, and allows them to continue visiting their local pharmacy.

Unfortunately, the majority party is not going to allow us the opportunity to improve the Medicare Part D prescription drug benefit this week. Our fight for seniors is one we are going to continue, but one that has been overlooked this week in the U.S. Senate.

Second, the unproductive nature of this week is most insulting to the 46 million people across the country who have no health insurance at all--1.3 million in New Jersey alone. No American family should be forced to skip a trip to the doctor because they fear it will also mean an unfortunate trip to the bank.

That is why I strongly support initiatives that will help small businesses afford meaningful health insurance for themselves and their employees; increase coverage for uninsured parents by extending the State Children's Health Insurance Program, SCHIP; and help Americans nearing retirement buy into Medicare--programs that have proven successful in reducing the uninsured and providing access to quality coverage.

In addition, I introduced the Health Care COSTS Act, which will help hard-working Americans afford their health insurance when they are between jobs by providing an ``advanceable'' tax credit for half the cost of COBRA premiums. As I mentioned earlier, the average cost of a family health plan exceeds a full year's earnings for a minimum-wage worker, so there is no way most families can afford to continue to purchase coverage if they lose their job and have to find another.

Instead of debating a bill that will preempt the important New Jersey

State coverage protections--including coverage of cervical cancer screening, contraceptives, home health care, mammography screening, mental health parity, and prostate cancer screening, to name a few--and protection against age discrimination in setting premiums, the Enzi bill takes the high bar of health insurance for New Jersey, and lowers it to a dangerously low level that strips away the coverage our State fought so hard to get.

The choice before us this week--the Enzi bill or nothing--is a false choice. This policy will result in reduced access to important health benefits and substantially increase premiums for people who need coverage most. It will allow insurance companies to cherry-pick the most profitable patients and punish those who need coverage most. It will allow companies to discriminate against older, sicker patients by charging them 3 exhorbitant premiums for the care they get. It will pit young versus old, the healthy versus the sick. These are false choices, and we should not allow the majority to force us into making them.

What we should be doing is considering a bill that preserves State benefits and prevents such cherry-picking. By offering small businesses access to the Federal Employees Health Benefits Program, which has provided extensive benefit choices at affordable prices to me, my colleagues, and all Federal employees for decades, we can do just that.

By pooling small businesses across America into one risk and purchasing pool like the Federal Employees Health Benefits Plan, the new Small Employees Health Benefit Plan will allow employers to reap the benefits of group purchasing power and streamlined administrative costs, as well as access to more plan choices. That is why I support the Lincoln-Durbin alternative. Unfortunately, the Republican leadership has refused to let us have a full debate and up-or-down vote on this proposal.

Finally, the challenge of caring for our aging population will only increase as the baby boom generation grows older and our life expectancy increases. We need to work now to address the challenges of providing affordable long-term care, encourage future retirees to plan for their own long-term care, and strengthen our existing programs to address this growing need.

I have introduced legislation to do just that. This week we should be supporting legislation that helps all families afford to care for the ones they love while also preparing for their own long-term care needs.

While I am disappointed in the partisan nature of this week's debate, it makes my commitment to fighting for the health and well-being of all Americans that much stronger. I call on my colleagues to finally make the health care priorities of the America people the health care priorities of the Senate.

No longer should we avoid a vote on stem cell research, a vote on improving the Medicare Part D prescription drug benefit, a vote for a real solution to solve the issue of the uninsured, and a vote to help our growing senior population age with dignity. At the end of so-called Health Week in the Senate, we will have accomplished nothing for the millions of Amerians who are uninsured or underinsured and struggling every day to provide health care for their families.

Mr. President, I would like to comment on the legislation the majority has brought forward during what it has dubbed Health Week and on health care more broadly.

While I do not support this legislation as drafted, I commend Senator Enzi for attempting to address the important issue of health insurance for small businesses.

As of 2004, over 45 million Americans were uninsured. Unfortunately, these numbers continue to rise with each passing year as more and more employers cease offering coverage to their employees. In Rhode Island, the percentage of companies offering health insurance coverage declined from 80 percent in 1999 to 68 percent in 2005. In my State, a small business is more likely to drop coverage because of the prohibitive cost.

While some employers have stopped offering coverage altogether, others have struggled to keep up with escalating costs. Since 2000, premiums for family coverage have increased by 73 percent compared to an inflation growth of 14 percent and a wage growth of 15 percent over the same period.

Health insurance affordability not only affects employee satisfaction, it also has a direct impact on a company's competitiveness.

We need to address these issues, but S. 1955 is not the answer. It decreases cost by changing rating structures, allowing cherry-picking of healthy individuals, and offering plans with very few benefits.

S. 1955 would amend the Employee Retirement Income Security Act of 1974 (ERISA) to allow for the creation of small business health plans, SBHPs, sponsored by business or trade associations that would, like self-insured plans, be exempt from State laws. As was the case with legislation proposing the creation of association health plans, AHPs, a considerable number of health care experts have expressed concerns that this legislation would exempt SBHPs from important State regulations that protect consumers, guarantee access to coverage and treatment, and ensure financial solvency. Millions of Americans could lose coverage for such important care as screening for breast, cervical, colorectal, and prostate cancer; well-child care and immunizations; emergency services; mental health; and diabetes supplies and education.

I have serious concerns that this legislation could weaken the already fragile insurance market we currently have in the United States. States have worked diligently to craft insurance regulations that reflect their individual needs. They have developed rating systems and mandated benefits to best protect their citizens.

This bill will affect not only health insurance for small businesses but also health insurance for all markets. In a letter to the chairman and ranking member of the Health, Education, Labor, and Pensions HELP Committee, the Rhode Island health insurance commissioner expressed his strong concerns about how S. 1955 would affect the State's health insurance regulatory system, its ability to hold health plans accountable, and develop solutions particular to our Sate. I will ask that the text of this letter be printed in the Record.

I have serious concerns about the health insurance that would be offered under this legislation. If insurance does not offer adequate coverage, it is insurance in name only. It is of little use if you can't afford it or access it when you need it.

A recent program on PBS' NOW focused on what it termed ``junk insurance plans'' and profiled two particular cases where the insurance was really no insurance at all, leaving couples who had faithfully paid premiums with astronomical medical bills. In one case, the insurance plan sold was marketed through an association for the self-employed.

It is important to try to address the problem of the uninsured, but we need to be sure that it is being done in a sensible and thoughtful manner.

While Senator Enzi has taken a great deal of time to meet with a variety of stakeholders in drafting this legislation, there have been no hearings on the bill, even though my colleagues and I on the HELP Committee requested such hearings. Moreover, 41 attorneys general have signed a letter in opposition to S. 1955; 19 State insurance commissioners and State departments responsible for insurance regulation have written letters opposing this legislation.

There are better options. The Lincoln-Durbin proposal would be more effective in curbing health care costs and expanding coverage, as well as help small businesses and their employees. It would create the Small Employers Health Benefits Program SEHBP and provide tax breaks for employers that offer financial assistance for insurance premiums to low-income employees. SEHBP is based on the Federal Employee Health Benefits Program and would extend the purchasing power of the Federal Government to small businesses that choose to participate. In addition, SEHBP enrollees in local plans would enjoy an array of coverage options, while at the same time benefiting from State consumer protections.

I filed three straightforward, commonsense amendments to guarantee more comprehensive coverage, to preserve State authority, and to make sure SBHPs actually reduce costs. I first proposed these amendments during the HELP Committee consideration of this bill. The first amendment would create a commission to establish a Federal floor of benefit mandates in accordance with the laws adopted in a plurality of the States, which would preserve some of the critical benefits currently mandated by Rhode Island and other States. The second amendment would limit the preemption of State laws by clarifying that unless specifically provided for, nothing in S. 1955 would override any State or local law related to health insurance. The third amendment requires the Government Accountability Office GAO to evaluate the program 24 months after its implementation, and if there is no evidence of a decrease in cost or increase in access to health care, the program would be terminated.

I am disappointed that the majority is not allowing us to engage in a full and fair debate on these and other amendments in the absence of a broad agreement on the bill.

Earlier this year, we saw the implementation of another program that was not well thought out and was fraught with problems as a result. Many of the problems with the Medicare Part D prescription drug benefit could have been averted. This crisis was anticipated for some time by independent researchers and advocates for Medicare beneficiaries, yet the Republican-controlled Congress repeatedly blocked remedies and continues to do so. Working to improve the Medicare drug plan is not even on the agenda for Health Week.

I did not support the Medicare Modernization Act because I felt the benefit was insufficient and the emphasis on a privately administered program made it excessively complex for beneficiaries. This plan imposes penalties for those enrolled to change plans but allows the plans to change the prescriptions they cover at will. Millions of retirees faced with choosing among a large number of private drug plans struggled with different rules, lists of covered drugs, and premiums. Many who are eligible to sign up have avoided doing so all together.

The problems have been so widespread that more than 20 States, including Rhode Island, had to step in to pay drug claims that should have been paid by the Federal Medicare Program. At least two dozen States have taken emergency action to help low-income individuals who could not get their medications under the program, and States spent many millions of dollars on this assistance.

Since its launch on January 1, doctors and pharmacists have complained that many drugs theoretically covered by the new Medicare drug benefit are not readily available due to the insurers' restrictions and requirements. Many pharmacists can't keep track of

the plans' myriad policies and procedures and doctors say the diverse requirements are onerous and can delay or deny access to needed medications.

The May 15 deadline for enrollment in Part D is looming. We should be taking action to extend the deadline and improve Part D during this sole week the majority has dedicated to so-called health care reform. Let's put America's Medicare beneficiaries first.

Another issue that is imperative for us to address is stem cell research. Last May, the House passed the Stem Cell Research Enhancement Act, H.R. 810, by a wide margin. We heard Senator Frist last summer announce that he agrees with lifting the stem cell ban, but we have not seen any movement on this issue.

President Bush's policy limits Federal funding of embryonic stem cell research in practice to 22 stem cell lines that have been in existence since 2001, and these lines are unsuitable for research. In recent years, we have seen amazing medical breakthroughs thanks to a dedication to research. HIV disease, which was a virtual death sentence just over a decade ago, has become for many a chronic disease. The 5- year survival rate for childhood acute lymphoblastic leukemia is approximately 85 percent, a dramatic increase because of new lifesaving treatments.

I hope to be able to stand on this Senate floor a few years from now asking for support for new research and highlighting the advancements that have been made in the treatment of spinal cord victims, children with diabetes, and those with Parkinson's because of embryonic stem cell research. The Senate should be marking the 1-year anniversary of the House passage of H.R. 810 by having a vote on the bill. We have an obligation not only to those stricken with these devastating conditions but to the family and friends who care for them. H.R. 810 opens the door to medical research that could unlock the mystery behind many of these devastating diseases while ensuring strong ethical and scientific oversight.

I share Senator Enzi's desire to stem the rising costs of health insurance, which pose a challenge to many, including our Nation's small businesses and self-employed individuals. While Congress should certainly do more to address this matter and expand coverage to those who currently lack it, S. 1955 would have little impact on these crucial needs.

There are other equally critical health issues facing millions of Americans. In addition to Medicare and stem cell research, we should be considering legislation to expand health insurance coverage to every child in this country, legislation to strengthen our public health system, and legislation to ensure an adequate number of nurses and other health professionals to care for our aging Nation. While the majority is stunting this week's debate, it is my hope that the Senate will actually take the time and find a way to work together to have a serious debate on important health care issues this year.

I ask unanimous consent that the before-mentioned letter be printed in the Record.

Mr. President, access to affordable, quality health care is on the minds of virtually every American. As I travel across my State of Colorado and this nation, people urge me and my colleagues in Congress to solve our health care crisis. I rise today to again add my voice to the millions calling for meaningful, comprehensive health care reform--reform that allows Americans to get the health care that they need; reform that will stop the crippling effect that the rising costs of health care has on our citizens, businesses and economy.

Last year, Senator McCain and I introduced the National Commission on Health Care Act, S. 2007. Its purpose is simple and bold--to fix our broken health care system.

The need to reform our health care system could not be more compelling. An astounding 46 million Americans lack health insurance. They come from every community, every walk of life, and every race and ethnic group. But the most telling part about them is that they come from working families who struggle to put food on their tables and pay their bills. They live in constant fear of getting sick. When they get sick, they often go without medical care and get sicker.

For those fortunate enough to have health insurance, the picture is also grim. Health insurance premiums for family coverage have risen by over 59 percent since 2000, with the average annual premiums for employer-sponsored family coverage costing nearly $11,000. Rising premiums place working families at risk of joining the ranks of the uninsured.

Rising health care coverage has also threatened the ability of American businesses to maintain insurance coverage for their employees and compete on a global level.

Congress must act now to reform our system. We need much more than a

week of gimmicks or piecemeal bills. We need comprehensive reform. S. 2007 reflects that need. The act creates a bipartisan commission of 10 elder states men and women. I want to stress that this is a bipartisan commission. Our health care crisis is not a Democratic or Republican problem. It is a national problem that we must solve together.

The members will conduct a thorough investigation into our health care system, building on the work of others to comprehensively look at availability, affordability, quality and costs relating to our health care system. It will look at the uninsured, the small business insurance market, the increases in premiums and health care costs, and the problems that businesses face in maintaining insurance coverage.

The commission will study our government programs and the private health insurance industry. And, most importantly, the commission will develop comprehensive proposals and recommendations to actually solve problems associated with our Nation's health care system. It is not enough to chip away at the problem by enacting policies related to one aspect of our health care system. We need a comprehensive study and comprehensive solutions.

The National Commission on Health Care will not duplicate the very important work that has already been done by other commissions and think tanks. What it will do is study the proposals from a comprehensive perspective, engage business, labor, health care, consumer, insurance and other groups to develop workable policies that if enacted will solve the crisis we face today.

I look forward to working with my colleagues on both sides of the aisle to pass the Commission Act to reform our broken health care system.

Mr. President, I want to take a few minutes to talk about the Medicare prescription drug program. I want to talk about the need to extend the deadline for seniors and people with disabilities and I want to talk about the rural, independent pharmacies that have suffered because of implementation problems with the drug program.

I was not a member of this esteemed body when the Medicare Modernization Act creating this program was enacted. I therefore have no political stake in defending or criticizing the drug program. I have every interest, however, in making sure that the program is properly implemented and that our seniors and people with disabilities have adequate time and accurate resources with which to make decisions about what plans best meet their health care needs. I strongly support Senator Bill Nelson's legislation extending the deadline for seniors and people with disabilities to enroll in the program. I want to thank Senator Bill Nelson for his commitment to ensure that seniors and people with disabilities have adequate time and accurate information to make wise decisions about their prescription drug insurance.

In less than 1 week, seniors will face the deadline for enrollment in the prescription drug program. For many seniors and their family members, selecting an appropriate prescription plan is a difficult and challenging endeavor. I know firsthand how time-consuming and difficult it is to navigate through the various plans to select the plan that meets the needs of an individual senior.

Several weeks ago, I helped my 82-year-old mother select a prescription drug program. In Colorado, there are over 42 plans to choose from--each covering different drugs or formularies as they are known, each with different monthly premiums; each with different copayments, each with different drug prices, and each with different participating pharmacies. I speak from experience--the process is daunting.

My offices have been helping many Coloradans with questions on Medicare prescription drug program. Often, individuals have called my office in exasperation, trying to find a friendly voice to help them through this process. My staff has assisted these individuals. However, many seniors continue to put off signing up for the program because they are confused and nervous. In Colorado, there are still over 100,000 individuals who are eligible to enroll in the plans who have not. Coloradans consistently tell me that they need more time to make sure they review reliable accurate information to select the right plan. They should have that time.

The complexity of the plans and the importance of the choice that seniors and the disabled must make dictate that we allow them more time to make these important decisions regarding their health. Beyond the complexity of the program, seniors and people with disabilities need more time because of the government's own inability to provide reliable information and available help to navigate the choices they are being asked to make.

Just this month the Government Accountability Office released a report that highlighted the government's own shortcomings with respect to the implementation of the drug benefit. The report highlighted that the Medicare help-lines were not providing accurate information for beneficiaries with questions about enrollment. Posing as seniors and senior advocates, the GAO made calls to the Medicare help-line with questions about how the program works. Astonishingly, the GAO often could not get through to an operator!

When the GAO staff did finally get through to an operator, the information specialists often could not answer their questions about the drug benefit, could not help them with questions about specific plans, and could not provide the detailed information that seniors need to enroll. If the government that administers this program could not provide timely, adequate information to beneficiaries, how can we hold them to an artificial deadline? Our seniors and people with disabilities deserve better. They certainly do not deserve to be penalized.

Individuals who miss the approaching deadline will not have an opportunity to enroll until November. In turn, they will face increased premiums and co-pays. And these costs increase the longer the individual waits. Seniors should not be punished for the government's inability to provide them with information with which to make a choice regarding their health. We need to help our seniors in this process, by giving them the time and resources needed to make the best decision for them.

I also want to speak in support of Senator Lautenberg's Pharmacists Medicare Relief Act of 2006 to modify the Medicare drug benefit to allow pharmacies to get timely payment from prescription drug plans. As we all know, pharmacies operating in rural towns and communities, like my hometown in Colorado, are important components of the community's already fragile health care delivery system. Because rural residents tend to be older and have more chronic conditions, pharmacy services to rural residents are particularly important.

The Medicare drug program has threatened the very survival of some rural pharmacies because of the manner in which the plans pay the pharmacies. These pharmacies must pay their wholesalers on a weekly or biweekly basis. Unfortunately, the prescription drug plans reimburse the pharmacies every 6 weeks. The discrepancy in payment has seriously affected the business of many pharmacies, and particularly pharmacies in rural communities.

Fortunately, there is a simple fix: require the plans to reimburse the pharmacies every 14 days. That is exactly what Senator Lautenberg's legislation will do. This legislation would require the plans to pay pharmacists within 14 days if the claims are submitted electronically, and 30 days if the claims are submitted by paper. The legislation also prohibits plans from cobranding Medicare beneficiaries eligibility cards--which means that it bans brands or names of pharmacies from being printed on the prescription drug cards, so that large pharmacies cannot use this advertising advantage at the expense of small operations.

These simple fixes will enable pharmacies in rural areas to continue to serve beneficiaries. Our rural pharmacies and the seniors and disabled people they serve deserve our best efforts to correct problems with the drug benefit plan to enhance health care delivery. I urge my colleagues to support this small but very important fix.

One thing that we can all agree on is that our health care system is in crisis, and that crisis is harming health care providers and patients who need health care services. It is clear that we need

real reform. The time for enacting piecemeal legislation that chips away at the massive health care problems is over. Our healthcare crisis will persist long after this healthcare week in the Senate is over. I pledge to put partisanship aside and work with all of my colleagues toward real health care solutions.

Mr. President, I rise today to speak about my concern for the 6.6 million uninsured individuals in California and the impact the Enzi Small Business Health Insurance bill, S. 1955, will have on both the uninsured and the insured in my State.

While the goal of this legislation is one I agree with--finding a solution to lower health insurance costs and greater access to health insurance for small business owners and their employees--I have serious concerns about the fundamental shift toward insurance deregulation and bare bones insurance coverage under the Enzi bill.

It is my understanding that some changes have been made in the substitute amendment to the Enzi bill but that those changes do very little to change the fact that this bill will result in a loss of covered benefits and an increase in costs for older, sicker workers.

While I respect the position of small businesses that support this legislation, I simply cannot support a proposal that I believe would result in higher costs for older, sicker workers and would result in a loss of covered benefits my State fought hard to guarantee.

My concerns are shared by a wide range of people.

It was also the conclusion of the nonpartisan Congressional Budget Office, 41 State attorneys general including the attorney general of California, 13 Governors, the California State insurance commissioner, the California Public Employees' Retirement System and countless national organizations such as the AARP, the American Medical Association, the American Cancer Society, and many more.

California has one of the most comprehensive set of required insurance benefits in the country. A partial list includes: Coverage of routine patient care costs of cancer clinical trials; coverage of breast, prostate, cervical,

colorectal and other cancer screening; coverage of breast cancer screening, diagnosis and treatment, including prosthetic devices and reconstructive surgery; the right to a second opinion when requested by insured individual or health professional treating an insured individual; minimum maternity hospital stay; coverage of equipment, supplies, including prescriptions, and management of diabetes; coverage of alcoholism and drug abuse treatment; coverage of blood lead screening; coverage of contraceptives approved by the FDA; coverage of services related to diagnosis, treatment and appropriate management of osteoporosis; coverage of domestic partners and coverage of infertility treatment.

The legislation before us sets a ceiling, not a floor for insurance coverage of vital services. Amendments that have been discussed such as creating a 26-State benefit mandate threshold are a ceiling, not a floor.

The reality is that any attempt to ``harmonize'' State benefit mandates will likely result in harm to Californians.

Just like legislation passed by the House last March called the National Uniformity for Food Act which I strongly oppose, this legislation preempts States rights.

California voters and elected officials have determined what they think is best for the State and this legislation override the will of Californians whether they work for a small business or large one.

I am also concerned about the impact this bill will have on premiums for small business employees. California has rules to protect premium adjustments from increasing year to year beyond 10 percent.

And in California, insurance companies may set premium rates for employees based on only three risk factors: age, family composition, and geographic region.

Under this bill, not only will employees be subject to rating based on additional factors such as the size of business, gender and type of business, but California's age and geographic region limitations are preempted.

The new rating factors in the bill disadvantage certain small businesses and they disadvantage businesses with a high proportion of women of child-bearing age.

I find it deeply troubling that Senators on both sides of the aisle have been denied the opportunity to vote on amendments to address the problems with this legislation.

I would like to address another healthcare issue that I have been deeply concerned about and that is stem cells.

The Senate has spent a week dedicated to health care and yet, the majority leader has not scheduled a vote on embryonic stem cell legislation.

It has been 8 years--1998--since I introduced one of the first bills dealing with the ethical issues around stem cell research.

It is almost one year--May 24--since the House passed the Castle- DeGette bill.

It has been 9 months--July 29--since the majority leader shocked the Senate and announced his support for stem cell legislation.

But no bill has been passed by the Senate.

What we have learned over that period is that the more than seventy lines the President said were available when he set his policy in August 2001 are down to just over twenty.

Those approximately twenty lines are contaminated with mouse feeder lines and they are old. They are of no therapeutic value.

We need more lines if we are going to untie the hands of researchers so they can do the research needed to learn about the biology of diseases, the restoration and repair of damaged tissue, and the development of treatment therapies.

Time and time again researchers say they need more embryonic stem cell lines.

But, the leadership of the Senate and White House won't listen. They would rather obstruct the work of scientists who want to work with embryonic stem cells. The result is scientists moving to other countries to do their work.

The time to act is now. The price of inaction goes up every day.

Since this fight began, we have lost Christopher Reeve on October 10, 2004, Dana Reeve on March 6, 2006, 4 million Americans to cancer, 1.8 million Americans to diabetes, and 144,000 Americans to Parkinson's.

I have heard opponents of embryonic stem cell research talk about the promise of adult stem cell research. No one I know is arguing that we shouldn't pursue adult stem cell research. That's why the Senate passed the cord blood bill unanimously last year.

But, we must not fund this research to the exclusion of embryonic stem cells.

There is no question that this country needs an effective stem cell policy--both to provide Federal funding for viable stem cell lines and to provide Federal ethical guidelines.

It is simply appalling that here we have a week dedicated to a debate on health care and the leadership of the Senate has not scheduled a vote on the Castle-DeGette, embryonic stem cell bill.

I personally believe this week should be renamed the ``week of missed opportunities'' instead of ``health week''.

Instead of addressing problems associated with the Medicare drug benefit such as the amendment I filed to the pending legislation to protect seniors from insurance plans who may decide to end coverage of drugs they said they'd cover when the senior enrolled in the plan, we are doing nothing.

Instead of allowing the Federal Government to use its bulk purchasing power to negotiate with drug companies to provide lower prices for seniors, we are doing nothing.

Instead of addressing the fact that millions of confused seniors will face a penalty in Medicare forever if they are eligible and don't sign up for the drug program by this Monday, we are doing nothing.

And yet we will have a cloture vote on a bill that will leave millions of Californians without a guaranteed access to cancer screenings and treatment, diabetes coverage, the right to a second medical opinion if they request it, among many others.

All of those protections will be lost, and Senators will have been denied without the opportunity to vote on any amendments to address the problems associated with this legislation.

It is a shame that the leadership of the Senate has allowed this week to become one of missed opportunities when we have bills such as the Castle-DeGette embryonic stem cell bill that have passed the House and are sitting at the President's desk waiting to be taken up and passed by the Senate.

Mr. President, the Senate has spent much of this week debating S. 1955, the Health Insurance Marketplace Modernization and Affordability Act of 2006. I commend my good friend and colleague from Wyoming for all of his hard work on this legislation, which is intended to make health insurance more affordable for small businesses by allowing them to join together to purchase association-based small business health plans. Despite my support for the goal of this bill, I think its approach is fundamentally flawed. Let me explain my concerns.

One of my top priorities in the Senate has been to expand access to affordable health care for all Americans. There are still far too many Americans without health insurance or with woefully inadequate coverage. As many as 46 million Americans are uninsured, and millions more are underinsured.

Since most Americans get their health insurance through the workplace, it is a common assumption that people without health insurance are unemployed. The fact is, however, that as many as 83 percent of Americans who do not have health insurance are in a family with a worker.

Uninsured working Americans are most often employees of small businesses. In fact, some 63 percent of uninsured workers either work for a small firm or are self-employed. Taking a look at the problems faced by small businesses is, therefore, a good place to start as we attempt to reduce the numbers of uninsured.

Small businesses want to provide quality health insurance for their employees, but the cost is often just too high. So I am totally in agreement with the underlying goal of this legislation, which is to make health insurance more affordable for small businesses and their employees. To that end, I have introduced bipartisan legislation to help employers cope with rising costs by creating new tax credits for small businesses to make health insurance more affordable and by providing grants to States to assist with the development and operation of small employer purchasing cooperatives to increase the clout of small businesses in their negotiations with insurers.

I do, however, have a number of very real concerns about S. 1955, as it was reported out of the Senate HELP Committee.

First, the legislation preempts the States' traditional authority to regulate insurance and allows not just small business health plans but all health insurers to exclude important benefits like cancer screenings, mental health coverage, and diabetes care that currently are guaranteed under many State laws.

States have had the primary responsibility for the regulation of health insurance since the 1940s, and based on my experience in overseeing the Maine Bureau of Insurance for five years, I believe that States have generally done a good job of responding to the needs and concerns of their citizens.

As the founder and cochair of the Senate Diabetes Caucus, I also am all too aware of the tremendous emotional and economic toll that this devastating disease takes on an estimated 21 million Americans and their families. I am particularly concerned that the bill would preempt as many as 46 State laws guaranteeing coverage for the medications, equipment, services, and supplies that people with diabetes need to manage their disease and prevent costly and potentially deadly complications.

This simply is penny wise and pound foolish. Diabetes currently costs our Nation more than $132 billion annually. Eighty percent of those costs are due to the complications associated with diabetes-- complications that, absent a cure, can only be prevented through prevention and proper management of the disease. If cloture is invoked, I will be offering an amendment with Senators Bingaman and Domenici to preserve State laws requiring coverage for comprehensive diabetes care. Both the American Diabetes Association and the Juvenile Diabetes Research Foundation have endorsed our amendment.

I am also concerned that the bill would preempt State rating rules and establish a new national standard. Proponents of the legislation contend that the application of this new national standard may not cause much disruption in many states. In Maine, however, which uses modified community rating, it could alter the market substantially.

In fact, the nonpartisan Congressional Budget Office, CBO, estimates that one-quarter of all small businesses will actually pay higher premiums if this bill is passed. It is therefore likely that many small employers in Maine--particularly those with an older workforce--will wind up paying more, and in some cases substantially more, under this bill.

This bill is no panacea, even for those small employers who will see savings. The CBO estimates that health care premiums will only average about 2 to 3 percent lower if S. 1955 is passed. Many small business owners have been told that the bill will cut their costs by from 12 to 20 percent. Even those employers who do see savings are likely to be disappointed that they are not as great as they had been led to believe.

Finally, I am concerned that the bill, as reported by the committee, could allow health plans to exclude a class of health care providers, solely on the basis of their license or certification, restricting patients' access to qualified health professionals. This is a particularly important issue in rural areas like Maine, where there may not be a sufficient supply of physicians to provide the care that the health plan has promised to cover.

For example, virtually all health plans cover medically necessary primary care services. Many rural Americans use a physician assistant or nurse practitioner as their primary care provider because there simply isn't an adequate supply of physicians where they live. In these areas, if a plan only covers primary care services offered by a physician, patients will either have to drive great distances to receive the care they need or pay out of pocket for services that are supposed to be covered benefits.

If cloture is invoked, I will be offering an amendment to maintain the application of all existing State laws prohibiting health insurers from discriminating against health providers who are acting within their scope of practice under State law, solely on the basis of their license or certification.

Mr. President, I do plan to vote for cloture. Congress should be taking action to make health insurance more affordable for small businesses, and I believe that this debate should go forward.

I do not, however, believe that we need to preempt the good work that States have done in the area of patient's rights and protections in order to help our small businesses. I would, therefore, oppose the current bill on final passage unless it is substantially changed.