Floor Statements

I thank the Senator. I need 3 minutes.

I will use it.

Mr. President, I rise today to ask unanimous consent to be added as a cosponsor to the amendment of Senator Coburn, amendment No. 2789, to require all Members of Congress to enroll in the public option. I am pleased to cosponsor this amendment because I strongly support the public option and I will have no qualms at all enrolling in this plan.

There is a lot of misinformation about the public option, so I want to be clear about why we need a public option and why I would be proud to enroll in a public health insurance plan.

We need a public option because health insurance premiums for Minnesota residents have risen 90 percent since 2000 and because 444,000 Minnesotans went without health insurance in 2008. We need a public option because, while millions of Americans struggle to pay for health care, insurance executives continue to make bloated, obscene salaries. From 2000 to 2007, American families saw their premiums almost double. During that same time, we saw more than 6 million more Americans become uninsured. During that same period, insurance companies' profits rose 428 percent--428 percent in 8 years. They are making outrageous profits by gouging American families. That is why we need a public option.

The public option will offer affordable premiums and a comprehensive benefits package for Americans struggling with their health care costs. It is going to provide the kind of coverage Americans need to be healthy. The public option will foster competition among private health insurance companies and lower long-term costs for Minnesotans and for families all across the country. There is no cost for the public option to the Treasury. In fact, CBO estimates it saves $3 billion. It is a win-win situation.

It is important to remember that a public option doesn't mean private health insurance goes away. In fact, after health reform, 188 million Americans will have coverage through a private insurer. Only 2 percent of the overall insured population is projected to enroll in the public option. This is just another option you will have. It is an option because that is what the bill is about.

Absolutely.

I talked to my wife Franni. We have been married 34 years now. I talked to her a couple of weeks ago. I said if this passes, we should do the public option. She said, absolutely. Yes, I am perfectly serious about this.

Madam President, I rise to express my support for Senator Mikulski's amendment for women's health.

This amendment is crucial because it is about prevention. Prevention is one of the key ways this bill will transform our system of sick care into true health care. It is common sense. You get the right screenings at the right time so you find diseases earlier. It saves lives and it saves money.

The Senate bill already has several provisions for preventive care, which I strongly support. For example, colonoscopies and screening for heart disease will be covered at no cost. It is a good start.

The current bill relies solely on the U.S. Preventive Services Task Force to determine which services will be covered at no cost. The problem is, several crucial women's health services are omitted. Senator Mikulski's amendment closes this gap. Under her amendment, the Health Resources and Services Administration will be able to include other important services at no cost, such as the well woman visit, prenatal care, and family planning.

These preventive services will truly improve women's health. For example, if all women got the recommended screening for cervical cancer, we could detect this disease earlier and prevent four out of every five cases of this invasive cancer. This will improve the health of our mothers, sisters, and our daughters. This bill and this amendment will make prevention a priority and not an afterthought.

Although I respect the efforts of my distinguished colleague from Alaska, the Murkowski alternative falls short. The Murkowski amendment does nothing to guarantee women will have improved access to coverage and cost-sharing protections for preventive services. Rather than establish objective, scientific standards about which preventive services should be covered, this alternative only requires insurers to consult with medical organizations when making coverage decisions.

While we know the U.S. Preventive Services Task Force recommendations do not cover all necessary services, the Murkowski amendment entirely removes even this basic coverage requirement from the bill, leaving women without any protections under health care reform for essential preventive care. This means that important preventive care for women, including screening for osteoporosis and sexually transmitted infections, may not be covered by insurance plans.

In the simplest terms, the Murkowski amendment maintains the status quo, and we know the status quo is not working for millions of women who are forgoing preventive care because they simply cannot afford it. The Murkowski amendment continues to leave prevention coverage decisions up to health insurance companies, and that means there would be no guarantee

that any health plan will cover basic preventive services at all.

Do we want to leave these important decisions up to the insurance companies? The health of American women is too important to leave in their hands. That is why I urge my colleagues to support Senator Mikulski's amendment and vote to make sure women can get the preventive screenings they need to stay healthy. Most important, this amendment will make sure women have access to these lifesaving screenings at no cost.

I request another 45 seconds.

Madam President, prevention is just one of the ways this bill will improve women's health. It also ends insurance companies' practice of charging women more because they happen to be women, or denying coverage based on a history of pregnancy, C-section, or domestic violence.

We need to pass this bill this year to ensure comprehensive, affordable care for women throughout the country. And we need to include this amendment because I want to be able to look my wife in the eye, I want to be able to look my daughter in the eye--my son, too--and my future grandchildren in the eye and say we did everything we could in this bill to improve women's health. We cannot wait any longer. I urge all my colleagues to stand with us and support this amendment.

I yield the floor.

Mr. President, I thank Senator Dodd for his leadership on this bill. I want to talk about Senator Mikulski's amendment.

First, a little bit about some of the claims that have been made on the floor today about Medicare. Senator Dodd pointed out that in the Bush budget--the last Bush budget--there was a bigger cut to Medicare, but not in the context of any kind of health care reform. Senator Baucus said it so well about what the cuts are. They are to hospitals, and the hospitals are fine with it. They are not jumping-up-and-down excited about it, but they are fine with it because it comes in the context of health care reform.

We are covering 30 million more people. What does that mean to hospitals? When people come into the emergency room, they have coverage. The hospitals get paid. That is the context in which we are doing this; whereas, when President Bush was proposing those kinds of cuts, they were not in the context of insuring 31 million more people. When the uninsured were going into emergency rooms for the most inefficient care possible--and won't be now--it was costing every American family $1,100 in additional insurance costs. So they are comparing apples and oranges. We are doing so many things, and Senator Dodd talked about some of the things this bill does. I want to talk about Senator Mikulski's amendment, because women are among the most severely disadvantaged in our current health care system. Right now, health insurance companies can and do discriminate against women solely on the basis of their gender.

Right now, it is legal in many States--again, not in all States, and this is why, when you are talking about getting health insurance from another State, you have to be careful. In Minnesota, we have stronger regulations. In other States, you don't. In many States, it is legal to charge women higher premiums, or deny them coverage at all, if they have had a C-section. It is a preexisting condition. If they have been the victim of domestic violence--in many States in this country an insurance company can deny a woman coverage because she has been the victim of domestic violence, because it is considered a preexisting condition. That is wrong.

I am immensely pleased that under this bill, for the first time, women will have access to comprehensive health

benefits, including maternity care, without having to pay more than their male counterparts. But we can do even more for women's health in this country.

Senator Mikulski's amendment improves the bill to make sure women can get the preventive screenings they need to stay healthy. Most important, the amendment will make sure that women have access to these lifesaving screenings at no cost. So it doesn't interfere with a woman and her doctor, as my distinguished colleague from Texas said a few minutes ago. It makes these screenings available at no cost. Why is this important? Because right now, women are delaying or skipping preventive health care because they cannot afford it. That is not just bad for women's health, it is bad for our system because it drives up costs unnecessarily. Even in Minnesota, where we generally do a good job at health care, there are women right now who are not getting the care they need. They are skipping their annual exam because they are uninsured. Women who are uninsured are twice as likely not to get the care they need.

Other women in Minnesota simply cannot afford the coverage they have now. Since 2007, the number of women who have delayed or avoided preventive care because of cost has doubled. The economic crisis has only made things worse. But the economic situation is no excuse. The reality is that women are forgoing preventive services that could save their lives because of the way insurance works now.

Make no mistake what that is about. From 2000 to 2007, the health insurance companies saw their profits increase 428 percent. Women are forgoing preventive measures that could save their lives. Is this the kind of country we want to live in?

There was some good news yesterday. The CBO confirmed what many of us already knew--that with the insurance market reforms and subsidies in our bill, women will be able to purchase better coverage at a lower cost than they would be paying without the bill. That is huge. With Senator Mikulski's amendment, we will go even further, guaranteeing that women receive preventive care when they need it, without barriers. These screenings catch potential problems such as cancer as early as possible. This saves lives and, by the way, it saves money.

For example, cervical cancer screenings every 3 to 5 years could prevent four out of every five cases of invasive cancer. Regular screenings could prevent more than half of the cases of infertility. Senator Mikulski's amendment will give women the care they need when they need it. This is a huge step forward for justice and equality in our country.

It is also a top priority for me that health reform includes another crucial women's health service, which is access to affordable family planning services. These services enable women and families to make informed decisions about when and how they become parents. Access to contraception is fundamental, a fundamental right of every adult American, and when we fulfill this right, we are able to accomplish a goal we all share--all of us on both sides of the aisle to reduce the number of unintended pregnancies. And so I believe that affordable family planning services must be accessible to all women in our reformed health care system.

We can't wait any longer, and I urge all of my colleagues to stand up with us and support this amendment.

My apologies to Senator Dodd. I guess I, as a freshman, am not necessarily familiar with all the rules. I think that means I must yield the floor, is that right?

I yield to my good friend from Texas.

Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Madam President, I ask unanimous consent that the next hour be equally divided between the following three Senators: Franken, Lincoln, and Levin.

Madam President, I rise today to express my strong support for the Patient Protection and Affordable Care Act.

I commend Leader Reid, Chairman Harkin, Chairman Baucus, and Senator Dodd for their leadership that has brought us to this critical point. We are on the verge of passing legislation that will do more than any bill in recent history to make our country healthier, our economy more stable, and our working families more secure.

Make no mistake, this bill will change. There will be amendments to it that will make it an even better bill. There may be amendments that make it less to my liking and, therefore, a less good bill, to my point of view. But the final bill will make health care available to more tens of millions of Americans. It will make health insurance more secure for all Americans who have it and will put an end to the unsustainable trajectory that we are now on with the cost of health care, and will avert an otherwise inevitable catastrophe to our health care system and our economy.

The reality right now is that we are denying millions of Americans their shot at the American dream because of our irrational health insurance system.

Right now, if you have been sick, insurance companies can refuse to cover you or charge you ridiculous premiums. If you get sick, your insurance benefits can run out when you need them the most.

Right now, people without insurance do not get preventive care. Instead, they go to the emergency room when they cannot hold out any longer. This is the least-efficient and most expensive way to deliver care, and those of us who do have insurance pay for it. It costs every insured family more than $1,100 a year in additional premiums to pay for those who don't have health insurance.

Right now, if you are a woman who has had a C-section or if you have been a survivor of domestic violence, health insurance companies can arbitrarily decide not to cover you. That is because having had a C- section or being a survivor of domestic violence is considered by many insurance companies to be a preexisting condition. That is wrong.

What is even more egregious is that while millions of Americans struggle to pay for health care, insurance executives continue to make obscene salaries. From 2000 to 2007, a period of 8 years, Americans saw their premiums almost double. During that same time, we saw more than 6 million more Americans become uninsured. During that same time, insurance company profits rose 428 percent--428 percent. That is all you need to know to understand why we have to pass this bill--428 percent in 8 years. No wonder the insurance companies are fighting this bill. Of course they don't want to be subject to antitrust laws. They are making outrageous profits by gouging American families. Make no mistake, that is what this is about.

This bill will change all that. It will fundamentally transform how health insurance works in this country. This bill guarantees secure coverage that will be there for Americans and stay there when they need it the most. This is not going to help just individual Americans; it is going to help small businesses too.

There are urgently needed changes that will go into effect the day the President signs this bill into law. Effective immediately, preventive services, such as colonoscopies and cholesterol tests, will be covered by all insurance plans at no cost. This will make prevention a priority, not an afterthought. We will detect cancers earlier and stop chronic diseases, such as diabetes, in their tracks. Not only will this save innumerable lives, it will lower the long-term cost of health care for all of us. This is one of the key

ways health care reform transforms our system of sick care into a true health care system.

Effective immediately, any new health insurance plan will let your children remain on the family policy until they are 26. That is big. Say you are a parent whose kid has been ill in the past, maybe she had asthma and she just graduated, say, from the University of Minnesota. Your daughter is just out of school, and she wants to find a job. We all know this is a big enough challenge in this economy. While she plans for her future, the last thing she should have to worry about is how she is going to get health insurance.

The good news is, after health care reform, she will have secure coverage until she gets on her feet. She can either stay on your plan until she is 26 or once the exchange is up and running, she can purchase an affordable plan through the exchange.

Also, effective immediately, we will hold health insurance companies accountable by making them give rebates if they spend more than 20 percent of premiums toward profits, marketing, or administration. I am proud to have championed this safeguard with my colleagues, Senator Rockefeller and Senator Whitehouse.

The current reality is, most of us do not know where our health insurance premiums go. It is challenging enough to understand a billing statement from your health insurer, much less track where your money is being spent. We are going to change that.

Thanks to Senator Jack Reed, the Senate bill also requires transparent reporting of how health insurance companies are spending your money. This transparency is especially important as we cover an additional 3l million Americans under this bill. We know from their profit margins that right now insurance companies are price gouging. But clear reporting will help us hold them accountable for every dollar we invest in health insurance.

Based on our experience in Minnesota, I know we can do even more to rein in marketing, wasteful administrative costs, and profits in health insurance. In the coming weeks, we will debate this bill, amend it, and make it even better. I will be pushing to require an even higher percentage of your premiums go toward actual health care.

The reason I believe we can provide higher quality care without excessive profits is because Minnesota already does it. We are distinguished by the fact that 90 percent of Minnesotans are served by a nonprofit health plan. These plans outperform their national peers and are able to put an average of 91 cents of every premium dollar toward actual health care services--91 cents out of every dollar.

In other plans throughout the Nation, you may find less than 60 percent of your premium is put toward health care. The rest is for overhead, marketing, and profits. By taking the profits out of the health insurance industry--not taking them out but lowering them to a reasonable level--Minnesota health plans do a better job of helping our residents live healthier, longer lives. As we begin debating this bill on the Senate floor, it is essential that health insurance companies get the message loudly and clearly that their top priority must be serving patients, not creating more and more profits, not a 428-percent increase in profits in 8 years.

Under the Senate bill, we will stop insurance companies from denying you coverage or charging you more because of preexisting conditions. This will end the egregious industry practice of discriminating against survivors of domestic violence. Insurance companies also will no longer be able to charge women more for their health coverage just because they happen to be a woman.

We will ban lifetime caps and end unreasonable annual limits on your benefits. These insurance market reforms will help Americans, but they will be particularly life changing for families such as the Battersons who live in Bloomington, MN. Linda Batterson has three daughters. She owns her own business, and her husband Bud is a realtor.

The Battersons have some relatively minor health problems--asthma, allergies, and back problems. But because health insurance companies can charge them more based on their health history, their only health care option in Minnesota is a high-risk pool. This year they are paying nearly $21,000 for health care--$21,000 for their insurance. This is not a Cadillac plan. Neither the Battersons' businesses nor their family can sustain these costs.

But the good news is, the Battersons will get relief under our bill. They will be able to go to the exchange and find an affordable plan. Health insurance companies will not be able to charge the family more because of their health history. If companies are going to raise rates, they will have to publicly disclose and justify any increase.

I think we can all agree that one group of Americans who suffer under our current system is small businesses. Across Minnesota--from Bemidji to Spring Valley--I have talked to small business owners who want to do the right thing. They want their workers to be healthy, but they cannot afford the current unpredictable and skyrocketing rates.

In Minnesota, we have 92 percent of our State covered, and we have invested resources to create the MinnesotaCare Program to make sure low-income residents are covered. But even with all this success, the uncontrolled cost of health insurance is forcing us to tighten our belts and make sacrifices that no American should have to make, such as small businesses having to choose between laying off workers or dropping health insurance for everyone.

I am pleased to tell you this bill will bring real relief to small businesses across our country. We will even the playing field so small businesses can do the right thing for workers without sacrificing their bottom line. This will make them competitive with large employers and with companies from overseas so they can attract the best and brightest workers.

Right now, small businesses are often priced out of the markets. They may be lucky to find just one or two carriers willing to cover their workers. So the first important change that health care reform can bring is choice of plans for small businesses. They will be able to participate in the exchange which will offer them a choice of reliable plans. This coverage will be less expensive and provide better coverage than what is available today.

Right now, if you are a business with, say, 15 employees and 1 of them gets sick or has a baby, your premiums are going to go up dramatically. That is because your risk pool is 15. But when you choose from policies on the exchange, your risk can be pooled with hundreds or even thousands of other businesses. That is the whole point of insurance, to spread the risk over the greatest number of people.

The second key benefit for small businesses is tax credits to help business owners purchase coverage. Effective immediately, these credits will ease the burden on small business owners who offer coverage but are being squeezed in the current market. For business owners who have not been able to offer insurance, the tax credits will provide a new incentive to begin covering their workers, keeping the workforce healthy and productive.

Today I have touched on just a few elements of the health care reform bill. I will be back. I have touched on insurance market reforms and provisions tailored to the needs of small businesses. But this just scratches the surface. The public option will bring much needed competition, and the incentives for high-quality care will make us all healthier. Taken together, these elements will bring our country into a new era in which high-quality and affordable health care is a reality in this country.

Passing national health care reform this year is my top priority because I have listened to Minnesotans across my State. They have told me loudly and clearly that the current health insurance system is not working for them, and they have told me they want access to care. I have heard them.

They want to know they can start a small business without worrying about the cost of health insurance because one of their kids has a preexisting condition. They want to know they will have health care when they need it the most. They want insurance companies to prioritize health services over profits. They are looking for us to fulfill our promise to pass comprehensive health care reform this year.

I look forward to working with all of you to make this a reality.

I yield the floor.

I suggest the absence of a quorum.

Madam President, I ask unanimous consent that I be allowed to speak in morning business for up to 5 minutes.

Madam President, I rise today to urge my colleagues to support S. 2730, the COBRA Subsidy Extension and Enhancement Act.

As you may know, COBRA allows jobless workers to keep their health care as they look for new work. The Recovery Act included a COBRA subsidy through the end of this year, but if we fail to act, millions of Americans currently looking for work will be faced with a further unbearable burden--the tripling of their COBRA payments.

I am very pleased with the Senate Patient Protection and Affordable Care Act that was released yesterday. This bill will help bring down health care costs for families and the Federal Government. We will invest in prevention and provide incentives to doctors to provide high- quality health care. I commend Leader Reid, Chairman Harkin, Chairman Baucus, and Chairman Dodd for moving us one critical step closer to secure, affordable health care for all Americans. But while health care reform will bring long-term relief, the proposed COBRA extension will help us bridge the gap before health care reform is fully implemented.

Take, for example, the situation of one of my constituents, Gregory, from Lakeville, MN, southeast of the Twin Cities. Gregory has built a professional career in the printing industry, the same industry my dad was in. He was a printing salesman for 30 years. The printing industry has been especially hard hit by our current recession. Gregory's wife depends on him for health insurance. She has rheumatoid arthritis. My mom had rheumatoid arthritis. Gregory also has two daughters in school.

Gregory was laid off this March and has been tirelessly looking for a job ever since. But there aren't any jobs to be found. Now he has accepted that he may have to change fields, but he is 57 years old. A career change at 57 isn't easy. Unless Congress passes a COBRA extension, his premiums will nearly triple, going from $350 a month to $940 a month. In today's dismal economy, who has $940 each month to spend on health care insurance, especially if you don't have a job?

Gregory has explored the option of a private insurance plan, but his wife's preexisting rheumatoid arthritis makes private plans an impossibility. Gregory is hopeful, as am I, that passing a health care reform bill will eliminate this problem of preexisting conditions. But in the meantime, what are families like Gregory's supposed to do?

Gregory's family is not alone in this plight. CBO estimates that 7 million workers and their families have used the COBRA subsidies in 2009. That includes thousands and thousands of Minnesotans. The expiration of the subsidy will make premiums so expensive that many families will be forced to drop their coverage, adding further to the number of uninsured Americans. Now is not the time to put another burden on struggling families.

The COBRA Subsidy Extension and Enhancement Act will provide relief to families by extending the COBRA subsidy another 6 months, through June of 2010. By that time, our economy will have made significant progress in job creation, and many Americans will be back on the job. The extension will also include an increase in the subsidy--from 65 percent to 75 percent--allowing more families to retain coverage. During this recession, the last thing Congress should do is pull the plug on benefits before folks have had a chance to get back on their feet.

I know my colleagues Senators Brown and Casey share the same goal of passing meaningful health care reform this year. But they also know the importance of providing a stopgap measure to deliver relief to families who are struggling in the current downturn. I thank them for their leadership on these critical issues.

I urge my colleagues to swiftly enact the COBRA Subsidy Extension and Enhancement Act and allow more families to maintain health care insurance coverage as they look for work.

I yield the floor.

Mr. President, a quality education can serve as a positive counterweight to the abuse, neglect, and instability that children in foster care have experienced. That is why Senator Murray and I are introducing the Fostering Success in Education Act. The act builds on previous Federal efforts to increase the school stability and success of foster children.

The very placement of children in foster care has deprived many children of their opportunity to obtain a decent education. The primary reason is that children in foster care frequently move between foster homes, and often change schools when they move. Research shows that students lose 4 to 6 months of educational progress each time they change schools. It therefore becomes nearly impossible for foster children--who change schools multiple times--to make significant educational progress.

Moreover, foster children often change schools in the middle of the school year. When this happens, it is hard for them to catch up with their classmates, since they didn't learn the material their classmates studied earlier in the year.

Because different schools offer different courses, it is also difficult for foster children to transfer their course credits from prior schools after they move. Many foster children therefore end up repeating courses and even grades.

But what is even more disturbing is that foster children are often segregated from other students, and inappropriately placed in separate schools at group foster homes and residential treatment facilities. At these separate schools, foster children typically receive a subpar education, making it difficult for them to transition smoothly to regular public schools later on.

As a result of all these challenges, many foster children fall behind their peers in school, lose hope, and ultimately drop out. Consider, for example, the school experience of Carrie, a 19 year-old young woman in Minnesota, who was placed in foster care in eighth grade. When Carrie moved to her first foster home, she had to transfer to a new school. Being uprooted from her family was difficult enough, but she also had to cope with the transition to her new school--just when she most needed the support of her friends and teachers at her old school. Moreover, because she changed schools in the middle of the school year, she found it difficult to keep up with her classmates in her new school.

There was no need to add further instability to Carrie's life by making her change schools. Her old school--the school that she had attended since kindergarten--was just 20 minutes away from her foster home. It would have been perfectly reasonable to transport Carrie back to that school.

Over her next 5 years in foster care, Carrie ended up 7 moving between 7 different foster care placements and schools. The schools where she spent most of her time in high school separated her from other children in her community, and offered her a low-quality education. For example, in ninth grade, Carrie attended a school at a residential treatment facility, where her education consisted of sitting in a classroom with children as young as ten, and filling out simple workbooks with little help from an instructor. Given the multiple educational disruptions Carrie experienced, it is not surprising that she believes she left high school with only a ninth grade education.

Unfortunately, Carrie's school experience is not unique. Many foster children in Minnesota, and across the

country, have experienced a similar pattern of moving between multiple schools, wasting time in segregated schools, and leaving school without much to show for all their years of education.

Last year, Congress decided that it was time to do something about this situation. Congress enacted the Fostering Connections to Success Act, a child welfare law that, among other things, requires child welfare agencies to collaborate with local education agencies to improve the school stability of foster children.

Child welfare agencies, however, can't go it alone. To fulfill the vision of the Fostering Connections Act, they need the full cooperation of State and local education agencies.

That is why Senator Murray and I have decided to place requirements on State and local education agencies that mirror those placed on child welfare agencies in the Fostering Connections Act. For example, our bill requires State and local education agencies to collaborate with child welfare agencies to provide foster children who move to new school districts with the right to attend their schools of origin--or, in other words, the right to attend their former schools or the schools they attended before they were placed in foster care.

If Carrie had this right when she was placed in foster care, she would have been able to remain in the school she had attended since kindergarten. When it's not in the best interest of particular foster children to remain in their schools of origin, our bill requires State and local education agencies to work with child welfare agencies to enroll foster children immediately in new schools. This is an important element of our bill because foster children often spend weeks out of school as a result of enrollment delays.

In addition, our bill provides funding to help school districts and child welfare agencies address the educational needs of foster children, such as funding to provide foster children with transportation back to schools in their former school districts.

Finally, our bill clarifies that foster children have a right to the same educational opportunities as other children in their community. This means, for example, that foster children cannot be placed in separate schools merely based on the misguided belief that foster children cannot fit in at a regular public school.

In addition to working with Senator Murray on the Fostering Success in Education Act, we have collaborated on a related bill--the Educational Success for Children and Youth Without Homes Act, which Senator Murray introduced earlier today. The Educational Success for Children and Youth Without Homes Act will improve the educational stability of homeless children, who, like foster children, face significant educational challenges because they often move between school districts. While there are many similarities between the protections provided to homeless and foster children in our bills, our bills also address the unique circumstances of each group.

I am grateful to Carrie, and the many other foster and homeless youth who have bravely spoken out about their difficult school experiences. Their efforts will help prevent other children entering foster care or experiencing homelessness in the future from suffering similar ordeals.

I believe it is time that we listen to these youth and take steps to ensure that we don't deprive homeless and foster children of their right to an equal education. Senator Murray and I therefore plan on working hard in the coming months to achieve the reforms we lay out in the bills we're introducing today, and I would urge my colleagues to support both of these important bills.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I ask unanimous consent to set aside the pending amendment and to call up my amendment No. 2745.

Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. President, the amendment I offer today would fund a vital new initiative within the Department of Veteran Affairs that was authorized by the recent National Defense Authorization Act. This initiative is a VA program and study for the provision of service dogs to disabled veterans, which began as an amendment I offered to the Defense authorization bill and is now a provision in the enacted law.

This 3-year program will study the benefit of using service dogs to help treat veterans with physical and mental injuries and disabilities. It is meant to provide the VA with one more tool to raise the quality of life for those who have given so much to our Nation.

Under this program, the VA will partner with nonprofit organizations that provide service dogs free of charge to veterans. The government will offset some of the costs of providing the dogs, which are currently funded largely through private donations. This will allow roughly 200 veterans to be paired with dogs and to participate in the study. In this way, the program will amount to a public-private partnership where donors to those nonprofits will know their money will go further, thanks to public matching funds.

The veterans who participate in the study will be veterans with physical disabilities and with mental disabilities such as PTSD. It was one such veteran, CPT Luis Montalvan, who initially sparked my interest in this effort. I met Luis, who had been injured while serving in Anbar in Iraq, along with his service dog Tuesday, at an inaugural event. Luis explained to me that he could not have been there if it weren't for Tuesday who eases his PTSD in numerous and very impressive ways.

After meeting Luis, I undertook research and learned about all of the benefits that service dogs can provide individuals with disabilities. I saw the wonderful work of the nonprofits which give their time and the donors who give their money to undertake the intensive training and the provision of these dogs. I learned there were more veterans out there who feel they could benefit from such a service dog if they had access to one.

I introduced my legislation shortly after coming to office. The VA program it establishes will study--scientifically--the benefits to veterans of the service dogs, so we are proceeding based on evidence. The VA will also provide funds to veterans who participate in the study to cover some of the costs of maintaining their service dogs.

Today I am offering this amendment to the Military Construction and Department of Veterans Affairs appropriations legislation so the fully authorized VA initiative may now be fully funded. The amendment is straightforward and reasonable. My amendment today would simply make $5 million available for this study that passed by unanimous consent. In this way, we can both provide more service dogs to the veterans who want them, and we can study the benefits they can provide to those veterans and the most effective ways to provide those benefits.

Our Nation owes a profound debt to those who have served in the military. For those veterans with disabilities, we need to make sure the VA has as many effective tools for raising their quality of life as possible. My amendment would make sure that one of those tools is funded.

I urge my colleagues to support this amendment.

I yield the floor, and I suggest the absence of a quorum.

I ask unanimous consent that the order for the quorum call be rescinded.

I ask unanimous consent to speak as in morning business for up to 5 minutes and that the time be charged postcloture.

Mr. President, I yield the floor.

I suggest the absence of a quorum.

Mr. President, right now many of us are engaged in a worthwhile discussion about health care and health insurance. These are immensely important topics, and I look forward to working with all colleagues to pass health reform this year. In these broader discussions, it is easy to forget that the best way to become a healthier country with lower health care costs is to prevent Americans from becoming sick in the first place. A great place to prioritize wellness over sickness comes in our prevention of diabetes.

Today 24 million Americans suffer from diabetes, and the epidemic is getting worse. If we do not make some changes soon, the prevalence of the disease will double over the next 30 years. The annual cost of diabetes in the country is expected to reach $338 billion by 2020. Right now 57 million Americans are what is considered prediabetic.

That means they are at risk of developing the full-blown disease because they have high blood pressure or high glucose levels. These statistics include over a million adults and 92,000 youth in my State alone. These are Minnesotans who may find out tomorrow they have become diabetic.

We know that diabetes may become debilitating and require costly medical interventions, from daily injections of insulin all the way to amputations. We know how devastating this disease is from the stories we hear when we are back home.

This week I was on the floor and shared the story of Liz MacCaskie from Minneapolis. She lost her job in September and is 58 years old, my exact age. She lives with diabetes and was just diagnosed with kidney failure. She is paying close to $20,000 a year for her insurance and trying to live on $1,000 a month.

If we could help people such as Liz avoid the pain and suffering that comes from diabetes, it would be a healthier, more prosperous country. The good news is that we can help Americans avoid this costly and debilitating disease. Research has shown that prediabetics can avoid full-blown diabetes if they receive access to community services such as nutrition counseling and gym memberships. These are proven to cut the risk of developing diabetes in half.

I am pleased to be offering legislation with Senator Lugar to ensure that prediabetics have access to services that will stop this disease in its tracks. The Diabetes Prevention Act is based on an NIH research study done in partnership with the YMCA in Indiana. The study showed that a 16-week intensive lifestyle program can prevent diabetes and cost less than $300 per person--less than $300 per person--per

year. Studies have shown us that this investment can save us money within 2 to 3 years.

The Minnesota Department of Health has been working with our local YMCAs in Willmar, Rochester, and Minneapolis to implement this program. We have a diverse group of instructors who speak Spanish, Hmong, Somali, and American Sign Language. They include parish nurses, dietitians, and community health educators. All these folks are helping community members to eat healthier and become more physically active. For the lucky people who get to participate in these programs, it is working. They are losing weight, getting healthier, and avoiding diabetes.

But right now, these efforts are a drop in the bucket because the epidemic is so great. With this bill, we will replicate this cost- effective program and improve the lives of millions of Americans. This bill will help communities across the country to set up diabetes prevention programs--on Indian reservations, in rural areas, and urban centers. Ultimately, health insurance companies will be reimbursing for these services because prevention saves money and it saves lives.

This is an investment in our Nation's future. I look forward to working with my colleagues to enact this important legislation.

Mr. President, sexual assault is a heinous crime. It is also a startlingly common one. Last year, 90,000 people were raped. We as a Nation have an obligation to help the survivors of sexual assault--by providing them prompt medical attention, and by bringing their assailants to justice.

Thanks to modern technology, we have an unparalleled tool to bring sexual predators to justice: forensic DNA analysis. Using the DNA evidence collected in a rape kit, a police department can conclusively identify an assailant--even when the survivor cannot visually identify her attacker. When DNA collected in rape kits matches existing DNA records, police can quickly capture habitual rapists before they strike again. Rape kit DNA evidence is survivors' best bet for justice. It is also communities' best bet for public safety.

Unfortunately, we have failed to make adequate use of DNA analysis. In 1999, a study commissioned by the National Institute of Justice estimated that there was a backlog of over 180,000 untested rape kits. In 2004, responding to studies like this one, then-Senator Biden, Chairman Leahy and others worked to pass the Debbie Smith Act, a law named after a rape survivor whose backlogged rape kit was tested six years after her assault. That act provided federal funding for the testing of backlogged DNA evidence. Unfortunately, it did not require those funds to test DNA evidence in rape kits.

Because of this loophole--and because many States and localities simply did not use the Debbie Smith funds they were allocated--the promise of the Debbie Smith Act remains unfulfilled. Since 2004, the federal government has distributed about $500 millions in Debbie Smith grants to law enforcement agencies around the country. Local figures suggest that these funds have not had their intended effect. In March 2009, Los Angeles County had 12,500 untested rape kits in police storage. L.A. County is not alone. This fall, the Houston Police Department found at least 4,000 untested rape kits in storage, and Detroit reported a backlog of possibly 10,000 kits.

Those are just three cities. This means that potentially hundreds of thousands of rape kits are sitting, untested, in police departments and crime labs around the country. That is hundreds of thousands of women who have not seen justice. That is countless assailants still free and countless new assaults that have occurred because of this. The New York Times recently highlighted a case which occurred years after the passage of The Debbie Smith Act where a rapist struck twice while the rape kit for one of his earlier victims sat unprocessed at a State crime lab. Sadly, that lab's four month processing delay was one of the shortest in the state.

When rape kits are not tested, rapists are not caught. When rape kits are not tested, more women are raped. Having a backlog of thousands of kits endangers our communities and sends a clear message to perpetrators and survivors of sexual violence: that cases of sexual assault are not a priority. Unfortunately, because our Nation lacks any mechanism to track rape kit backlogs, we have no way of knowing the full scope of this rape kit backlog and the national tragedy that it causes.

The Justice for Survivors of Sexual Assault Act of 2009, which I am introducing today with Senator Grassley, Senator Feinstein, and Senator Hatch, addresses the national rape kit backlog and several other problems that work to deny justice to survivors of sexual assault. These include the denial of free rape kits to survivors of sexual assault, and the shortage of trained health professionals capable of administering rape kit exams.

First, this bill will create strong financial incentives for states to clear their rape kit backlogs once and for all. This bill will reward states who make progress in clearing up their rape kit backlog and start processing their incoming rape kits in a timely manner. It will penalize those that don't, while allowing them the opportunity to regain any lost funds. Having a backlog is not an impossible situation to remedy. In just a few years, the city of New York cleaned up their rape kit backlog, and as a result, saw its arrest rate for rapes jump from 40 to 70 percent.

Second, this bill will put measures in place to track progress and hold States and localities accountable. Law enforcement agencies will be responsible for reporting their reductions of rape kit backlogs, and the Department of Justice will be responsible for analyzing that data and reporting back to Congress.

Third, this bill will guarantee that survivors of sexual assault don't ever pay for their rape kits. Right now, States must cover the full cost of a rape kit examination, either upfront or through reimbursement. But some states don't even cover half of the cost. Survivors who live in States who are in compliance with the law still mistakenly receive bills because of the confusing nature of the reimbursement process. We don't bill criminals for fingerprint processing. Survivors of sexual assault should never see the bill for their rape kit exam, let alone pay any upfront costs.

Fourth, this bill will train more health professionals to administer rape kit exams. If survivors of sexual assault are lucky enough to have their rape kit processed, it is important to ensure it is not declared inadmissible in court due to faulty evidence collection.

Lastly, this bill will provide funds for a study on the availability of trained health professionals to administer rape kit exams at Indian Health Services facilities. Recent studies have shown that Native American women suffer a disproportionately high amount of sexual violence, and we need to make sure that IHS has the proper resources it needs to serve survivors.

We have waited too long to address the rape kit backlog in the United States to the detriment of survivors and our communities. It is time to aggressively clear rape kit backlogs and put rapists where they belong: off our streets and behind bars. With the Federal Government beginning to collect more DNA samples from convicted, non-violent offenders and dozens of State governments following its lead inaction now would mean that rape kits wait longer on the shelf, rape survivors wait longer for justice, and rapists spend more time on the streets.

Survivors of sexual assault do not deserve this. They deserve justice. I want to continue Congress's work in trying to address this issue. In doing so, I follow in the footsteps of people like Vice President Biden and Chairman Leahy, who have consistently and powerfully championed sexual assault survivors within the Senate Judiciary Committee and on the floor of the Senate.

I ask that my colleagues join Senator Grassley, Senator Feinstein, Senator Hatch, and me in supporting the Justice for Survivors of Sexual Assault Act of 2009.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, right now many of us are engaged in a worthwhile discussion about health care and health insurance. These are immensely important topics, and I look forward to working with all colleagues to pass health reform this year. In these broader discussions, it is easy to forget that the best way to become a healthier country with lower health care costs is to prevent Americans from becoming sick in the first place. A great place to prioritize wellness over sickness comes in our prevention of diabetes.

Today 24 million Americans suffer from diabetes, and the epidemic is getting worse. If we do not make some changes soon, the prevalence of the disease will double over the next 30 years. The annual cost of diabetes in the country is expected to reach $338 billion by 2020. Right now 57 million Americans are what is considered prediabetic.

That means they are at risk of developing the full-blown disease because they have high blood pressure or high glucose levels. These statistics include over a million adults and 92,000 youth in my State alone. These are Minnesotans who may find out tomorrow they have become diabetic.

We know that diabetes may become debilitating and require costly medical interventions, from daily injections of insulin all the way to amputations. We know how devastating this disease is from the stories we hear when we are back home.

This week I was on the floor and shared the story of Liz MacCaskie from Minneapolis. She lost her job in September and is 58 years old, my exact age. She lives with diabetes and was just diagnosed with kidney failure. She is paying close to $20,000 a year for her insurance and trying to live on $1,000 a month.

If we could help people such as Liz avoid the pain and suffering that comes from diabetes, it would be a healthier, more prosperous country. The good news is that we can help Americans avoid this costly and debilitating disease. Research has shown that prediabetics can avoid full-blown diabetes if they receive access to community services such as nutrition counseling and gym memberships. These are proven to cut the risk of developing diabetes in half.

I am pleased to be offering legislation with Senator Lugar to ensure that prediabetics have access to services that will stop this disease in its tracks. The Diabetes Prevention Act is based on an NIH research study done in partnership with the YMCA in Indiana. The study showed that a 16-week intensive lifestyle program can prevent diabetes and cost less than $300 per person--less than $300 per person--per

year. Studies have shown us that this investment can save us money within 2 to 3 years.

The Minnesota Department of Health has been working with our local YMCAs in Willmar, Rochester, and Minneapolis to implement this program. We have a diverse group of instructors who speak Spanish, Hmong, Somali, and American Sign Language. They include parish nurses, dietitians, and community health educators. All these folks are helping community members to eat healthier and become more physically active. For the lucky people who get to participate in these programs, it is working. They are losing weight, getting healthier, and avoiding diabetes.

But right now, these efforts are a drop in the bucket because the epidemic is so great. With this bill, we will replicate this cost- effective program and improve the lives of millions of Americans. This bill will help communities across the country to set up diabetes prevention programs--on Indian reservations, in rural areas, and urban centers. Ultimately, health insurance companies will be reimbursing for these services because prevention saves money and it saves lives.

This is an investment in our Nation's future. I look forward to working with my colleagues to enact this important legislation.

Mr. President, sexual assault is a heinous crime. It is also a startlingly common one. Last year, 90,000 people were raped. We as a Nation have an obligation to help the survivors of sexual assault--by providing them prompt medical attention, and by bringing their assailants to justice.

Thanks to modern technology, we have an unparalleled tool to bring sexual predators to justice: forensic DNA analysis. Using the DNA evidence collected in a rape kit, a police department can conclusively identify an assailant--even when the survivor cannot visually identify her attacker. When DNA collected in rape kits matches existing DNA records, police can quickly capture habitual rapists before they strike again. Rape kit DNA evidence is survivors' best bet for justice. It is also communities' best bet for public safety.

Unfortunately, we have failed to make adequate use of DNA analysis. In 1999, a study commissioned by the National Institute of Justice estimated that there was a backlog of over 180,000 untested rape kits. In 2004, responding to studies like this one, then-Senator Biden, Chairman Leahy and others worked to pass the Debbie Smith Act, a law named after a rape survivor whose backlogged rape kit was tested six years after her assault. That act provided federal funding for the testing of backlogged DNA evidence. Unfortunately, it did not require those funds to test DNA evidence in rape kits.

Because of this loophole--and because many States and localities simply did not use the Debbie Smith funds they were allocated--the promise of the Debbie Smith Act remains unfulfilled. Since 2004, the federal government has distributed about $500 millions in Debbie Smith grants to law enforcement agencies around the country. Local figures suggest that these funds have not had their intended effect. In March 2009, Los Angeles County had 12,500 untested rape kits in police storage. L.A. County is not alone. This fall, the Houston Police Department found at least 4,000 untested rape kits in storage, and Detroit reported a backlog of possibly 10,000 kits.

Those are just three cities. This means that potentially hundreds of thousands of rape kits are sitting, untested, in police departments and crime labs around the country. That is hundreds of thousands of women who have not seen justice. That is countless assailants still free and countless new assaults that have occurred because of this. The New York Times recently highlighted a case which occurred years after the passage of The Debbie Smith Act where a rapist struck twice while the rape kit for one of his earlier victims sat unprocessed at a State crime lab. Sadly, that lab's four month processing delay was one of the shortest in the state.

When rape kits are not tested, rapists are not caught. When rape kits are not tested, more women are raped. Having a backlog of thousands of kits endangers our communities and sends a clear message to perpetrators and survivors of sexual violence: that cases of sexual assault are not a priority. Unfortunately, because our Nation lacks any mechanism to track rape kit backlogs, we have no way of knowing the full scope of this rape kit backlog and the national tragedy that it causes.

The Justice for Survivors of Sexual Assault Act of 2009, which I am introducing today with Senator Grassley, Senator Feinstein, and Senator Hatch, addresses the national rape kit backlog and several other problems that work to deny justice to survivors of sexual assault. These include the denial of free rape kits to survivors of sexual assault, and the shortage of trained health professionals capable of administering rape kit exams.

First, this bill will create strong financial incentives for states to clear their rape kit backlogs once and for all. This bill will reward states who make progress in clearing up their rape kit backlog and start processing their incoming rape kits in a timely manner. It will penalize those that don't, while allowing them the opportunity to regain any lost funds. Having a backlog is not an impossible situation to remedy. In just a few years, the city of New York cleaned up their rape kit backlog, and as a result, saw its arrest rate for rapes jump from 40 to 70 percent.

Second, this bill will put measures in place to track progress and hold States and localities accountable. Law enforcement agencies will be responsible for reporting their reductions of rape kit backlogs, and the Department of Justice will be responsible for analyzing that data and reporting back to Congress.

Third, this bill will guarantee that survivors of sexual assault don't ever pay for their rape kits. Right now, States must cover the full cost of a rape kit examination, either upfront or through reimbursement. But some states don't even cover half of the cost. Survivors who live in States who are in compliance with the law still mistakenly receive bills because of the confusing nature of the reimbursement process. We don't bill criminals for fingerprint processing. Survivors of sexual assault should never see the bill for their rape kit exam, let alone pay any upfront costs.

Fourth, this bill will train more health professionals to administer rape kit exams. If survivors of sexual assault are lucky enough to have their rape kit processed, it is important to ensure it is not declared inadmissible in court due to faulty evidence collection.

Lastly, this bill will provide funds for a study on the availability of trained health professionals to administer rape kit exams at Indian Health Services facilities. Recent studies have shown that Native American women suffer a disproportionately high amount of sexual violence, and we need to make sure that IHS has the proper resources it needs to serve survivors.

We have waited too long to address the rape kit backlog in the United States to the detriment of survivors and our communities. It is time to aggressively clear rape kit backlogs and put rapists where they belong: off our streets and behind bars. With the Federal Government beginning to collect more DNA samples from convicted, non-violent offenders and dozens of State governments following its lead inaction now would mean that rape kits wait longer on the shelf, rape survivors wait longer for justice, and rapists spend more time on the streets.

Survivors of sexual assault do not deserve this. They deserve justice. I want to continue Congress's work in trying to address this issue. In doing so, I follow in the footsteps of people like Vice President Biden and Chairman Leahy, who have consistently and powerfully championed sexual assault survivors within the Senate Judiciary Committee and on the floor of the Senate.

I ask that my colleagues join Senator Grassley, Senator Feinstein, Senator Hatch, and me in supporting the Justice for Survivors of Sexual Assault Act of 2009.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I ask unanimous consent to speak as in morning business for up to 45 minutes.

Mr. President, I rise today to talk about health reform. This is my first speech from the floor on this subject. I have a lot to say.

By now, we have all heard the stories--at least those of us who have been listening--of those who have fallen through the cracks or, more accurately, the gaping holes. We know why those stories are important. They remind us that there are human beings behind these awful statistics.

Since 2001, 6.6 million Americans have lost their health insurance, and many millions more are underinsured. They have seen their health coverage become more and more expensive and less and less adequate. People suffer because of this. They lose their homes. They go bankrupt. They do not get the health care they need. They get sicker. They experience pain, physical and emotional. And they cannot care for their children. They suffer because of this.

During my campaign for the Senate, I did an event in Fergus Falls, the lovely town in Otter Tail County in west central Minnesota. A woman came up to me. She had a story to tell. She told me her father had gotten diabetes and died pretty quickly. But that was not the worst part of the story. She told me her dad received a lot of supplies from Medicare he had not used. She knew of a woman in town who had diabetes, so she decided to drive these supplies that her dad got for diabetes from Medicare to this woman's house. She did. She asked the woman if she could use any of the test strips and orthopedic shoes and other items. The woman said: Yes, I could use them.

Then this woman, the woman with diabetes, told this other woman that her 24-year-old son had diabetes too. He had had juvenile diabetes as a kid, and now he could not afford insurance because he had a preexisting condition. So this woman from Fergus Falls, this woman with diabetes, shares her insulin with her son, a diabetic mother and a diabetic son sharing insulin because he cannot afford health insurance in our country. Is this the kind of country we want to be? Well, the answer depends on what we do right here right now.

As we talk about reforming our health care system, I wanted to break that phrase ``health care system'' apart for a second, because we are talking about two things. The truth is we have some great health care in this country and a terrible system. We have dedicated, smart doctors and nurses and researchers and health professionals in this country. They do amazing things.

If you are a member of the Saudi royal family, you can get on your private jet and come to my State for the best health care in the world. The Saudi royal family is willing to travel 7,500 miles to Rochester, MN, for great care from the Mayo Clinic. For a woman in Fergus Falls, MN, and her adult son, both with diabetes, the same great care is less than 300 miles away, but it is really a world away. That is because if you are an American, you can get great health care too, but only if you make it through the terrible system, and only if you can afford it.

As I travel around Minnesota, when someone comes up to talk to me, I usually hear about three things. First, they say: Health insurance costs too much. What are we going to do about that? Second, they ask: What am I going to do if I get sick or my kid gets sick or my spouse gets sick? And then: Someone in our family has a preexisting condition. Then I lose my job or I want to change my job or I want to start a small business. How am I going to get health insurance then? And, third, if anything happens to me, something bad, am I going to lose everything? Am I going to go bankrupt?

In my view, the answer to those three questions comes down to two major changes. First, we need to reform our health insurance system so it provides security for every American. Secondly, we need to reform our health care system by putting more focus on prevention and by changing the way health care providers deliver health care so they provide high quality at a lower cost. We can do this. We know we can do this.

Let me take a moment to talk to the skeptics. One of the arguments I often hear from opponents of health care reform is that the majority of Americans are happy with the health care they have, and they are. Because the majority of Americans are healthy right now. The truth is, though, that even those who are happy with their coverage are not going to be happy for so long. Right now the average cost of family health insurance payments, including both the employer's and the family's share, is $13,375. That is double what it was 10 years ago. If we do nothing, those premiums will double again in the next 10 years, which means a family could be paying more than $30,000 per year for health insurance. As premiums rise, businesses are forced to drop employees, drop wages or drop coverage to keep up with cost. So even if you are happy with the coverage you have, it may suddenly be the coverage you no longer have because your employer can no longer provide it.

That is exactly what has happened. As premiums go up, so do the number of uninsured Americans. In my State, 355,000 Minnesotans lost employer-based coverage between 2001 and 2008.

There is another problem with the coverage you have. Often you can only find out what is actually covered when you get sick. You can only find out how hard it is to switch or get new coverage once you have been sick. That is why we need health insurance reform that provides true security. It is at those difficult times, when you are nervous and vulnerable and want to focus on dealing with your health

issues, that you realize how little security you have under this current system.

Let me tell you about Liz MacCaskie, who lives in Minneapolis. Liz lost her job in September. She is 58 years old, my exact age. She has been living with diabetes and was just diagnosed with kidney failure. Liz was denied private coverage because of her preexisting condition. The only insurance she can get now comes with a $5,000 deductible and an $8 to $900 monthly charge to maintain coverage. How does paying close to $20,000 a year for insurance count as insurance? It doesn't. Especially when Liz is trying to live on $1,000 a month while she takes job training courses and does part-time domestic work. As a result, Liz and her husband have been borrowing money from Liz's brother-in-law to make payments on their house. This is unconscionable.

Right now, if you have been sick, insurance companies can refuse to cover you--or charge you exorbitant premiums.

As an older woman told me at the State fair this summer: At my age, everything is preexisting.

Under our health care reform bill, we will stop insurance companies from denying you coverage or charging you more because of a preexisting condition. That is a very important, very good thing. Right now, if you are a woman who has had a C-section or you have been a survivor of domestic violence, health insurance companies can deny you coverage because having had a C-section or being the survivor of domestic violence is considered by some insurance companies to be a preexisting condition. Isn't that amazing? Is this the kind of country we want to be? The answer depends on what we do right here and right now.

Under our health care reform bill, we will end discrimination against survivors of domestic violence and stop insurance companies from charging women more for their health coverage just because they happen to be women, which health insurance companies are allowed to do now. Right now, if you get sick, your insurance benefits can run out when you need them the most.

Recently, I was contacted by a Minnesotan named Kathy. A few years ago, she was laid off and had to buy her own insurance. She was able to keep up with the cost until October of 2005, when she was diagnosed with Hodgkin's lymphoma. To pay her medical bills, Kathy exhausted her IRA and then had to file for bankruptcy. Kathy's cancer is under control, but her medical costs are over $10,000 each year. She makes $22,000 working part-time in a small CPA firm.

This isn't just an individual tragedy, it is a national travesty. Fifty percent of personal bankruptcies in this country are the result of a health care crisis, and 80 percent of those health care bankruptcies are people who have health insurance. I know people are sometimes surprised to find out that Europe has been doing this better than we have. I have to ask: Do you know how many personal bankruptcies there have been in Germany and in France and in Switzerland because of health care? The answer is zero. Under our health care reform bill, we will eliminate annual and lifetime caps on benefits. Americans will be able to access affordable health care and avoid going bankrupt when they get very sick. That is important. It is very good.

This bill guarantees secure coverage that will be there for all Americans and stay there when people need it. I know you might be thinking: Gee, covering every American, isn't that going to be expensive? Consider this: We already pay for the health care of Americans who don't have insurance. We just pay for it in the most inefficient way possible. Right now people without insurance go to the emergency room for health care, the most expensive possible way to deliver care. Those of us who do have insurance pay for it because it costs every insured family more than $1,100 a year in additional premiums. This cost shift occurs for two reasons. People are using the emergency room for primary care, meaning they are going whenever they get a cold or an ear infection, which is ridiculously inefficient, or, more likely, they are waiting until they get very sick, in which case it often means their health condition has progressed to a point that is very expensive to treat or maybe ultimately tragic.

According to a Harvard study, nearly 45,000 Americans die because they don't have health insurance. Is this the kind of country we want to be? The answer depends on what we do right here, right now.

The fact is, our irrational health insurance industry not only hurts our families, it also hurts our economy in so many different ways. I recently received a letter from James Solie from Moorhead, MN. He was an Air National Guard member for 32 years. During that time, his daughter was covered under TRICARE, the Department of Defense health care program for members of the uniformed services, their families, and survivors. Now that she is on her own, his daughter gets health care through her employer, one of the big-box stores. Her children were born with cystic fibrosis. Because of their significant health care needs, she can't leave her job.

As James wrote to me:

My daughter is presently a hostage of her family's health

insurance needs. She will keep working at that same store

until the law is changed.

This is so common, there is actually a term for it. It is called job lock. If this woman had a brilliant idea for a new business or even just wanted to move to a better job, her need for health coverage would prevent her from doing so. That is not only bad for her, multiply it across millions of people and you see how bad it is for our economy.

We are supposed to be the most entrepreneurial society in the world, but because of our health care system, innovators are prevented from starting their own business. Talented or ambitious workers are prevented from moving on to more satisfying, more challenging, more productive jobs. We put at risk the very entrepreneurial spirit that defines us.

German Chancellor Angela Merkel spoke today for a joint session of Congress. She was born in East Germany. When she was a kid, people would smuggle American books and American films into East Germany. Today she spoke on what inspired her the most about it. She said: the American dream.

We are denying millions of Americans their shot at the American dream because of our irrational health insurance system. This bill guarantees that you and your family always have access to stable, portable health insurance, even if you lose your job or get sick or both. It will end the job lock that handcuffs so many Americans.

Of course, guarantees of coverage and portability are hollow promises if they are not accompanied by something else: affordability. Over the last decade, the average health insurance premium for American families, including both the employer's share and the worker's share, has risen from just under $5,800 to nearly $13,400. That is an increase of $7,600 or 131 percent over the last decade. That is more than three times faster than Americans' average wages rose in that same period. Even if you stay healthy, these trajectories are unsustainable. Even if you have coverage, you could still be just a diagnosis or an accident away from bankruptcy.

This has to change right now. If your work-based health plan is expensive, you have no other option, unless you qualify for Medicaid. Under this bill, you will be able to get subsidized insurance if your coverage through work costs you more than a certain percentage of your income. Right now, if your employer doesn't offer you a health plan or you are unemployed, it is prohibitively expensive to buy it on your own. Under this bill, you will be able to access a range of affordable insurance options through a health insurance exchange. This exchange will be similar to a Travelocity for health insurance. All the plans have to meet basic standards, and you can match them up and compare them side by side so you can pick the one best for you and your family.

This isn't going to only help individual Americans. It will help businesses, small businesses. Right now, if you are a business with, say, 11 employees and one of your employees gets sick or pregnant, your premiums are going to go up dramatically. That is because your risk pool is 11 people. But when you choose a policy from the exchange, your risk pool can be a million or two. That is the point of insurance,

to spread the risk over as many people as possible.

In addition, small businesses will also be eligible to receive tax credits to help them purchase coverage for their workers. In Minnesota alone, over 72,000 businesses would be eligible for this assistance. That is what the subsidies and the exchange are all about: increasing the availability of insurance and making it affordable for families and small businesses.

That is also what so much of the debate surrounding a public insurance option is about. A public option creates more choice for consumers and more competition in the marketplace. People who are happy with their current plans would not need to change them. But millions of people who did not have health care options before would finally have an affordable choice. This is what the overwhelming majority of Americans want. It is the right thing to do. I would say to anyone who is against the public option, do not choose it for yourself, but do not deny other Americans that choice.

I remain steadfast in my support for a public option. But we should also recognize a public option is just one of several ways this bill seeks to control health care costs. All these changes, which will create security and promote affordability, will provide necessary and meaningful reforms to the health insurance system. But we need to remember the goal is not just a better insurance system; it is better, more affordable care. That requires not only changing the way insurers behave, it also involves the way we behave and the way our health care providers behave.

Total spending on health care in the economy has doubled over the past 30 years and now is about 16 percent of our GDP. That is almost double the average for western industrialized nations, which are at 8.9 percent. The CBO estimates that the percentage of our GDP spent on health care will double over the next 25 years to 31 percent of GDP if we do nothing.

Fortunately, we have the opportunity right now to act, and we know how to do it. We need to look no further than Minnesota. If my colleagues will indulge me for a bit of some home State pride, Minnesota has taken a national lead in many areas, including cost containment and community health. Part of it is because 90 percent of Minnesotans are covered by nonprofit health plans. It is also because we have models such as the Mayo Clinic, Allina, and HealthPartners, where physicians are paid to be part of a team, providing integrated care, centered on the patient as a patient, not as a profit center.

Patient-centered care is the key. The point is not just better, more efficient treatment for patients, it is that people do not want to be patients at all. The goal of health care is to prevent illness and then, if people get sick, to actually make people who are sick healthier, and then to keep them healthy.

To those ends, we need to see reform in three areas: incentives for better care, more focus on prevention, and a real commitment to contain costs. Let's start with incentives.

Right now, Minnesota providers are punished--punished--under Medicare for providing high-quality care at a low cost. According to the most recent data, Minnesota receives $6,600 per Medicare beneficiary per year and is second in the country for quality of care.

Texas averages more than $9,300 per beneficiary, with some of the worst health outcomes in the country. So Minnesotans are effectively paying doctors in Texas for excessive treatments and lousy outcomes.

Now, consider an innovative program I have seen in my home State: the Cardiac Care Program at Duluth St. Mary's Hospital. They aggressively manage patients with heart disease by helping people make lifestyle changes and making sure people get the followup attention they need. As a result, they have reduced hospitalizations by 80 percent and saved $1 million in 1 year.

But because the current system does not incentivize value, Duluth St. Mary's received no reward for these cost savings. In fact, a hospital that lets its cardiac care patients go unchecked until they need another procedure gets paid a lot for performing that procedure, even though their patients are less healthy.

Under the current Medicare reimbursement system, the good care gets punished and the less effective, more expensive care gets rewarded. We are not providing health care in this country; we are providing sick care. We need incentives for providers to reduce hospitalizations and commit time and resources to prevention. That starts with Medicare payment reform.

This is not an issue of State versus State. If we can get better outcomes at lower costs, it will be better for the entire country because it is the only way we will finally be getting a handle on the runaway cost of health care.

That is why I am so thrilled this health reform bill includes a provision to fundamentally improve the way we pay doctors. Thanks to the efforts of Maria Cantwell and my colleague, Amy Klobuchar, and others, for the first time ever we will include what is called the value index in the Medicare payment structure. Doctors who provide high-quality care at a reasonable cost will no longer be punished. Instead, they will be rewarded for being effective partners in their patients' care.

That brings me to lifestyle and prevention. One of the most disturbing trends, for our health and our health care system, is the massive increase in obesity in this country. We know this increase in obesity will lead to increased heart disease and diabetes and increased health care costs for our country. But that future is not inevitable.

Today, Minnesota spends $1.7 billion per year on hospital costs for heart disease. But the residents of New Ulm, MN, have decided they are not going to contribute to those statistics anymore. New Ulm is a beautiful town in the heart of the Minnesota River Valley, about 90 miles southwest of the Twin Cities. The town is partnering with Allina Hospitals & Clinics and has made a commitment to reduce heart attacks by 25 percent over the next 10 years. To do this, the residents of New Ulm are working to bring down their high blood pressure and cholesterol, manage their diabetes, stop smoking, and start exercising. They have community cooking classes, workplace wellness initiatives, and free health screenings.

I visited New Ulm during the recess to see what these folks are doing and how determined they are to make changes in their lifestyles. This dedication to prevention and wellness will keep individuals in New Ulm living longer and living healthier. It will also save the health care system about $10 million over the next 10 years. When it comes to wellness, self-interest and the national interest are aligned.

This bill we are debating right now guarantees that routine checkups and preventive care, such as colonoscopies and mammograms, are covered by all insurance plans at no cost. We need to invest in those things that sometimes seem peripheral to good health but are essential to it: access to healthy foods and a safe environment for physical and social activity to address the alarming rise of obesity and the epidemics of diabetes and heart disease.

I thank my friend Tom Harkin for his leadership in making sure the Prevention and Public Health Investment Fund is in the health reform bill. This fund will help Americans make the lifestyle choices that lead to better health. These investments will help Americans stay healthier and save money in the long run.

Another way to improve care and bring down its cost is to make sure a greater percentage of every health care dollar actually goes to health care, not wasteful administrative costs or advertising and profit.

While national health care plans spend less than 87 cents of the health care premium dollar on health care, Minnesota's nonprofit plans lead the Nation in keeping administrative costs low, spending 91 cents--91 cents--of every premium dollar on health care. Four cents may not seem like a lot until you remember that is 4 percent of $775 billion in private health insurance premiums a year.

This percentage--the 91 percent I was talking about--is called the medical loss ratio. It is a measure of how much of each health care dollar actually goes to health care. The medical loss ratio

for insurance plans in Minnesota is 91. Many individual and small health group plans across the country are closer to 60--meaning that 40 cents of every health care dollar goes to administration, advertising, and profits--all things that do not make people healthier.

That is why I have introduced legislation, the Fairness in Health Insurance Act, to mandate that 90 cents of every premium dollar must go to health services, not to unnecessary administrative costs or advertising or bloated executive salaries.

This builds upon the important work of my colleague, Jack Reed, who pushed for disclosure of this information in the HELP Committee bill.

My house colleague, Keith Ellison, from Minnesota's Fifth District, has introduced similar legislation. The House has made progress on this issue by requiring a medical loss ratio of at least 85 percent for the small and large group insurance markets. And because administrative costs constitute such a high percentage of health costs, I want to go even further. Right now, there are hundreds of different private insurers that have hundreds of different claim forms and codes. Why so many different forms? Because the more complicated it is, the more different each form is, the more likely it will be filled out with an error.

Remember, a form filled out with an error allows the insurer to deny the claim. That is why I have called for every insurer to use a standard form for claims. Minnesota has done this on the State level and is saving money and preventing the headaches that providers have in trying to navigate these hundreds of different forms. Nationally, this is a great way to save a lot of money and a lot of paperwork.

You know who will like this? Doctors. Physicians reported spending the equivalent of 3 work weeks each year dealing with health care plans and having to devote additional resources to hire extra staff, not to provide care for patients but to do extra, endless paperwork.

When time is converted to dollars, the national cost to physician practices of dealing with health plans is between $23 billion and $31 billion each year. If we had a uniform billing and claims system, we could save up to $70 billion per year. Wow.

By moving to electronic medical records, we will reduce the number of duplicated tests. We would make it cheaper and easier for people to stay healthy and out of the emergency room. We would be on a path to lower costs for everyone by making health care patient-centered, not profit-centered.

I am proud of what we are doing in Minnesota--with institutions that are delivering care efficiently and effectively. But I recognize the truth of something one health care economist said to me at a health care roundtable I held in Minneapolis a couple months ago. He said:

Minnesota gets an ``A'' . . . but only because we're

grading on a curve.

There is huge room for improvement all across America. That is why this is an incredible moment of opportunity for those of us in this Chamber and for the entire Nation.

As I said when I rose, we have great health care in this country but a lousy system. If we do not fix the system, millions more Americans will lose the care. Yes, this is complex stuff. That is why it is particularly important that nobody here injects into this debate misinformation that engenders fear. There has been too much of that already, and it has not resulted in anybody getting better care or moving us closer to a consensus.

So let's remember that behind the numbers we talk about are real people--real people who urgently need our help. As the saying goes: Statistics are people with the tears wiped off.

This is our chance to confront the biggest single threat to America's future and the greatest unmet moral obligation in our history all rolled up into one. That is what health care is. This is our chance to answer those questions Americans are asking, our chance to make life better for Liz MacCaskie and James Solie's daughter and Kathy and a mother and her son from Fergus Fall, MN. We have a chance to keep costs down for people who have insurance and finally provide coverage for those who don't. This is our moment to meet this great moral and economic challenge. So let's finish our work and overcome whatever legislative challenges remain.

We all want to look back on this day from an America in which everyone has stable, secure, affordable health care and say it wasn't the easiest thing, but it was the right thing, and together we were able to get it done.

There is so much more to say on health disparities, on fraud, abuse in the system, on mental health parity, on chemical dependency treatment, on chronic care, on rural health, on workforce issues such as the need for more primary care physicians, and so many other important topics. This is just a start, and I will certainly be back to say more.

I yield the floor, and I note the absence of a quorum.

Mr. President, today I am introducing a bill to help keep our country's invaluable nurses and health care workers safe from debilitating injuries suffered on the job. This legislation will require workplace standards that eliminate the manual lifting of patients--the primary cause of musculoskeletal disorders in the health care profession. And I want to first thank my colleague in the House, Representative Conyers of Michigan's l4th District, for his leadership on this issue and for the impressive work he put into crafting this bill.

When we think of dangerous working conditions, mines or construction sites might come to mind. But in fact, work performed in hospitals and nursing homes contributes to thousands of cases of musculoskeletal disorders in nurses and health care workers each year. These injuries require time away from work, and unfortunately, many workers suffering from chronic back injury are forced to leave the profession permanently. Nurses and health care workers deserve better--they shouldn't have to sacrifice their safety and their livelihood to help others, especially when many of these injuries could be prevented.

The manual lifting of patients is the primary cause of musculoskeletal injuries, and can be eliminated with the use of lifting equipment. Many health care facilities already have this equipment available, and studies have shown that it reduces injuries to workers, increases safety for patients, and is a cost-effective investment over several years.

This legislation would require the Department of Labor to propose standards for safe patient handling to prevent musculoskeletal disorders for health care workers, and eliminate manual lifting of patients through the use of lift equipment. It would also require health care facilities to develop safe patient handling plans and provide training on safe patient handling techniques.

Under the bill, health care workers would have the right to refuse assignments that are not in compliance with safe patient handling standards and be protected from employer retaliation against workers who refuse these assignments or report violations.

To help health care facilities to make this transition, the bill creates a new grant program for needy health care facilities that require financial assistance to purchase safe patient handling equipment.

I urge my colleagues to support the Nurse and Health Care Worker Protection Act. All of us benefit from the services these professionals provide, and by passing this legislation, we can help ensure they are able to safely continue in their important careers.

Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.

Mr. President, today I am introducing a bill to help keep our country's invaluable nurses and health care workers safe from debilitating injuries suffered on the job. This legislation will require workplace standards that eliminate the manual lifting of patients--the primary cause of musculoskeletal disorders in the health care profession. And I want to first thank my colleague in the House, Representative Conyers of Michigan's l4th District, for his leadership on this issue and for the impressive work he put into crafting this bill.

When we think of dangerous working conditions, mines or construction sites might come to mind. But in fact, work performed in hospitals and nursing homes contributes to thousands of cases of musculoskeletal disorders in nurses and health care workers each year. These injuries require time away from work, and unfortunately, many workers suffering from chronic back injury are forced to leave the profession permanently. Nurses and health care workers deserve better--they shouldn't have to sacrifice their safety and their livelihood to help others, especially when many of these injuries could be prevented.

The manual lifting of patients is the primary cause of musculoskeletal injuries, and can be eliminated with the use of lifting equipment. Many health care facilities already have this equipment available, and studies have shown that it reduces injuries to workers, increases safety for patients, and is a cost-effective investment over several years.

This legislation would require the Department of Labor to propose standards for safe patient handling to prevent musculoskeletal disorders for health care workers, and eliminate manual lifting of patients through the use of lift equipment. It would also require health care facilities to develop safe patient handling plans and provide training on safe patient handling techniques.

Under the bill, health care workers would have the right to refuse assignments that are not in compliance with safe patient handling standards and be protected from employer retaliation against workers who refuse these assignments or report violations.

To help health care facilities to make this transition, the bill creates a new grant program for needy health care facilities that require financial assistance to purchase safe patient handling equipment.

I urge my colleagues to support the Nurse and Health Care Worker Protection Act. All of us benefit from the services these professionals provide, and by passing this legislation, we can help ensure they are able to safely continue in their important careers.

Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.