Floor Statements

Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Madam President, I come to the floor of the Senate to say to my colleague from Kentucky: Let the unemployment bill go. Let's free the unemployment compensation bill, the bill that will fund COBRA health insurance benefits and put people back to work building highways, and let's pay doctors the fees they deserve for saving lives and improving lives. Of all of the bills in the United States of America, why are we holding up this one? I think it is outrageous, and I think it is egregious.

My Lord, look at this. Right now in the United States of America, 400,000 American citizens are not receiving their unemployment benefits. They have been laid off. They have been pushed around. They have been pushed out. And now the Senate will not act to extend their benefits.

Then there are the health insurance benefits called COBRA, and 500,000 Americans are not getting that. Who gets COBRA benefits? No, it is not a snake--although there are a lot of snakes around. It means that if you were laid off from a company, you have the opportunity to, with your own money out of your own pocket, be able to buy insurance and get a modest subsidy to help you through this. My gosh, why can't we do this?

Then there are the thousands of doctors who are not being paid. There are the highway people who are not being paid.

I gave you national statistics, but I am a Senator from Maryland. I want you to know that tonight there are 4,700 unemployed workers in my State who are not going to get their unemployment benefits--4,700 unemployed workers. That is money they could use to provide their families with a safety net for food, housing, heat, and for the expenses and activities of daily living.

This isn't just a number. It is not a statistic. We are talking about 4,700 families who won't have a source of income to get them through this very difficult time.

Then there is COBRA. Again, COBRA pays 65 percent of the cost of health insurance for people who have lost their jobs. In Maryland, there are 9,282 people--close to 10,000--who have lost their benefits. COBRA makes sure they have health care. We are talking about someone, for example, who worked for a company all of his life, and then he was laid off because it was part of the great layoff that is going on in my State. He went to buy health insurance, and he is buying it through COBRA. It costs almost four times what it cost where he worked. At the same time, he has health problems. He is a diabetic. He is a father. He wants to work and, most of all, he wants to have health insurance for himself and his family. But, oh, no, we are holding it up because of something called pay-go.

Then what else are we doing? We are not paying our doctors. Regardless of how one feels about health insurance reform, you can't have health reform without doctors.

The opposition to health care reform, like Mr. Boehner, says we have the best health care system in the world. If we have the best health care system, why aren't we paying our doctors what they deserve? These are highly skilled people who work sometimes day and night to be able to save lives or improve lives. They assume the risks of medical management of highly complex cases. Why are we cutting their pay by 21 percent? I don't see those guys over there cutting their pay 21 percent until we figure out how to pay for our salaries. Why are we cutting doctors 21 percent?

I am so frustrated about this. Whether it is job reform, health care reform, mortgage reform, in this body, when all is said and done, more gets said than gets done.

The American people are as mad as they can be, and they don't want to take it anymore. I feel the same way. I am sick and tired of all these obstruction tactics that prevent people from getting the benefits they need to take care of their families or fund the programs that create jobs.

If we are going to have job reform and health reform, I think we need Senate reform. I am old-fashioned. I believe the majority rules. I think 51 ought to be a magic number. I am so tired of the tyranny of the 60. Oh, we need 60 votes--60 votes, a supermajority every time, except for the Pledge of Allegiance. I come back to wanting the majority rule. This is why I stand four square for filibuster reform.

I am heart and soul a reformer, sometimes a little too mouthy. Some people say I am a little too feisty. But I want to get the job done. I am ready to duke it out in the arena of ideas, present our best arguments, present our best cases, take a vote, and see how it turns out.

I hope when I offer amendments I win, but if I lose because I get less than 51, I feel I have gotten a square deal. But if I have to go after 60, I feel I am inhibited by the tyranny of 60.

I believe the filibuster is a dated, arcane tactic that belongs to another century and another Senate. I wish to see the filibuster rule either ended or modified.

There are those on our side of the aisle who say: Don't do that. What happens if we lose control, we might need it. Maybe if majority ruled, we would not lose control. Most of all, maybe the American people would see us actually debating, discussing, amending, and voting on ideas. Right now, the other side hides behind procedure. It hides behind process, it muddies the water, and the people are starting to catch on.

I am calling on our institution to seriously consider Tom Harkin's legislation. I think Senator Harkin is on to something. Senator Harkin and I are great respecters of the Senate and its traditions. We understand the filibuster and when it was used for great and grand debates on, for example, the expansion of civil rights in our country.

Under the Harkin proposal, you would get four shots at it. I think my colleague from Kentucky would like it. He is a baseball icon. You get three strikes and you are out. Maybe we would get four bites at the apple. The first time you vote if you don't get 60, it would fail. The second time you would need 59 votes or it would fail. The third time you would need 57 votes or it would fail. The fourth time, 53 votes and then we would come back to 51.

We are not for throwing away the filibuster, but we are for modifying it. Hopefully, it will bring us to a Senate that wants more function as the greatest deliberative body in the world. Now we are the greatest delayed body in the world. We don't deliberate; we delay. We don't do constructive things; we do obstructive things. This is not the Senate the American people want. They want us to debate ideas. They want us to do due diligence on those ideas, to make sure they are sensible, that they are affordable, that we are doing something that accomplishes the great missions of our country. I want, again, majority to rule.

I call upon the Senator from Kentucky and the other party: Let this bill go. Bring it out. Please, let us have a vote on it so tonight, when the families in Maryland go to bed, they can be sure that tomorrow when they awaken, their safety net of unemployment compensation is there; that they can buy their health insurance through COBRA, that gifted and talented doctors will know they will be paid and reimbursed and acknowledged for the great services they are performing. That is what the United States should be doing. There is plenty of money for other things.

When they talk about how they want this to be pay as you go--I voted for pay-go. I did. But we are in an emergency situation, and I believe this calls us to act now, and I hope we act tonight.

I hope we can all work together, and when more is said, the less gets said and more gets done.

I yield the floor.

Madam President, today I wish to commend and congratulate the League of Women Voters, in honor of the league's 90th anniversary. This nonpartisan political organization encourages informed and active participation in government, works to increase understanding of major public policy issues, and influences public policy through education and advocacy.

The League of Women Voters was founded by Carrie Chapman Catt in 1920--just 6 months before the 19th amendment to the U.S. Constitution was ratified, giving women the right to vote after a 72-year struggle. It was designed to help 20 million women carry out their new responsibilities as voters. It encouraged them to use their new power to participate in shaping public policy. Today, there are 900 State and local Leagues in all 50 States.

While the league neither supports nor opposes candidates for office at any level of government, it works to influence policy through advocacy on issues such as voting rights, health care reform, global climate change, and election administration. This grassroots citizen network is directed by the consensus of its members nationwide.

In honoring the league, we commemorate the past achievements of women and highlight the successes of women today. From the suffragists who founded the league 90 years ago to the incredible women who work today to improve our communities and our country as elected officials and as volunteers, the league's women are making a profound and lasting civic impact. I wish the League of Women Voters continued success as they bring more women into the political arena as candidates, informed voters and advocates.

Mr. President, I ask unanimous consent to speak as in morning business.

Mr. President, I rise to speak about the current state of affairs in the Washington Metro and why we need to bring about change. The Washington Metro, America's subway, is in trouble. I fear for its safety. I fear for its operational reliance. I fear for the well-being of both the passengers and the workers who ride Metro.

Every morning, I am afraid to wake up and find out that there has been another accident or death on the Washington Metro. Most recently, a Metro

train carrying 345 passengers derailed underground in the heart of downtown. It was Friday when the Federal Government reopened after our big No. 2 blizzard. The train somehow managed to get on the wrong track as it was leaving the station. Thank God a safety device actually worked and pushed the train off of the wrong track to prevent it from crashing into another train. Thankfully, a near miss.

In June, there was a terrible crash of the Metro, cars upon cars upon cars. Since that time, 13 people have died on the Metro, and there have been countless injuries. That is why that terrible day after our No. 2 blizzard, many sat in the dark, scared to death. They were afraid of being crashed into, which had happened before. They were afraid of fire. They were afraid of smoke. They were afraid of being trapped and, most of all, they were afraid that Congress would fail to act.

I wish to salute the Subcommittee on Housing, Transportation, and Community Development chaired by my good colleague Senator Bob Menendez, for taking a great interest in this and introducing legislation that the administration sanctions to begin to get Metro on the right track. We need to do this.

Last year, after the nine people were killed, I introduced legislation to give the Transportation Secretary the authority to establish Federal safety standards for Metro systems around the country. There had been none. It would require the Transportation Secretary to implement the National Transportation Safety Board's most wanted safety recommendations.

After accidents on subways, after accidents on our Metro, the NTSB comes in and investigates. Gee, are we glad to see them. They are the CSI meets Metro. At the end, they not only tell us what went wrong, but what we have to do to get it right. Well, guess what. We don't listen to them. After every accident, there is press--we are going to make changes--but nothing happens. So, for example, the issues they have recommended relating to crashworthiness standards for cars, emergency entry and evacuation standards, data event recorders, often go unheeded. We have to make those changes, and we need to take another step.

Today, I take another step by joining Senator Menendez, Senator Dodd, and Senator Cardin on the Public Transportation Safety Program Act. This is an idea that we have worked on, along with the administration, to give the Transportation Secretary the authority to establish Federal safety standards. It also strengthens State oversight programs that inspect and regulate the Metro systems. Because Washington Metro is in two States and in the District of Columbia--Maryland, Virginia, and DC--it has the Tri-State Oversight Committee. But you know what. The Metro board doesn't have to pay any attention. In fact, we had to raise cane and pound the table to allow them to work with the safety inspectors and actually walk the tracks to try to get some action. We had to muscle our way in, just trying to get the Tri-State folks involved in safety.

Well, for me, right now, the spotlight is the Washington Metro. My obligation is here. There are other Metro systems around the country that this bill will also deal with, but right now, myself and Senator Cardin, John Warner--Mark Warner--John Warner in his time--Jim Webb, and Congresswoman Eleanor Holmes Norton want to work together. We want to work with the Banking Committee to pass legislation that would bring about change. We want to make sure that when we make recommendations, the FTA--the Federal Transit Authority--has the authority to implement the changes and to make sure that Metros both here and around the country implement them.

We also want to require that the implementation of the NTSB's most wanted list is absolutely done so when we say let's have crashworthy standards for our cars, it is actually implemented. Did you know we have standards for everything that is involved in transportation but not standards for the safety or the crashworthiness of these cars? These two bills are important because there are no Federal safety standards for Metro systems. Rail transit is the only transportation mode without safety standards oversight or enforcement. As I said, we have safety standards for airplanes, commuter rail systems, even buses, but Metro systems do not have standards, even though the rail transit has 14 million daily riders. Up until now, safety has been left to the States. Each State has its own safety enforcement practices, but in our case of the Washington Metro, which travels in two States and the District of Columbia, we need to make sure we have a system that is appropriately regulated.

The bill that was introduced by the Banking Committee and Senator Menendez yesterday, which I support, does two things. It gives the Transportation Secretary authority to establish safety standards for Metro, light rail, and bus systems nationwide. It provides a framework for developing and enforcing those safety standards, and it will look at existing industry standards and best practices. It would also have to consider the NTSB's recommendations.

I think about those 13 people a lot. I think about the people who ride the Metro. I think about the people who work on the Metro. So when we talk about this legislation, we have to think of it not in terms of rail cars and money but in terms of people and in terms of safety.

That is why I introduced the National Metro Safety Act in July after the accident, joined by my colleague Senator Cardin. It enables the Transportation Secretary to develop, implement, and enforce those national safety standards, and it requires DOT to implement the NTSB, the National Transportation Safety Board's, most wanted safety recommendations. They have what they call their top 10. It would have standards for the crashworthiness of cars. It would mandate evacuation standards so that people could get out of these cars in the event of an accident. It would have the black box data recording device so we could trace what happens on a car and have the lessons learned. It would also deal with the hour of service regulations for train operators. It requires that we do these actions.

So for these issues--the crashworthiness, the train cars, the emergency entry and evacuation, data--all of this has been recommended in the past by the NTSB. In 2002 they recommended data event recorders. Nothing happened. They recommended emergency evacuation standards in 2006. Nothing happened. They recommended hours of service to make sure our people were fresh and fit for duty. Nothing happened. We know what happens: accidents in which people die, are maimed, burned, or injured.

It is time we listened to the experts who advise us. It is time that we ensure the safety of the people who ride the Metro here. It is time that we take action and be able to bring this under the Federal Transit Authority. The people who count on us when they get on a subway should be able to count on us to do all we can to ensure their safety.

Mr. President, people are angry and they are anxious. They are worried their middle class way of life is slipping by. They are worried about their jobs. They are worried about their pensions. They are worried about the cost of everything from health care to housing to higher education. They have to make tough decisions. They are sitting at their kitchen tables balancing their checkbooks and being careful about spending. They want to know we are being careful too. They want an administration and a Congress that do two things: create jobs and spend money frugally and wisely.

I am angry too. I was told that TARP was needed to get money to Main Street. I didn't care if every firm on Wall Street went bankrupt. But I did care about jobs, small businesses, and families' mortgages. That's what I was told TARP was about. Instead--ungrateful bankers got an astonishing amount of money from taxpayers who used it to pay themselves bonuses.

Chairman Bernanke made four big mistakes: he let banks take on too many risks, he ignored the housing bubble, he failed to protect homeowners, and he gave too much taxpayer money away for too little in return. It is not just Mr. Bernanke though. The entire economic policy team for the last two administrations deserves blame

So I had questions about this nomination. I spoke with Maryland business leaders, looked into Mr. Bernanke's record, and I met with him at the end of last year.

I let Mr. Bernanke know that I am focused on three things to get our economy going again: creating jobs, getting more lending to the middle economy and small businesses, and helping people get out from under the threat of foreclosure.

I know that people's top priority is jobs. Mr. Bernanke needs to realize that too. When Bernanke thought Wall Street was on the verge of a crisis, he acted dramatically. He used new powers for new programs. Well, the job market is in a crisis now. But the Fed's response has just been tame and tepid. We need the same urgency from Mr. Bernanke to jump-start the job market as he gave to Wall Street to jump-start the financial markets.

The Fed has pumped trillions of dollars into the financial system. Congress has approved billions more. Money went to the banks and because we thought they'd lend it out to help small businesses and help community banks, and community pillars. But what I have heard since then is that companies' credit is being withdrawn and responsible applicants are being rejected for reasonable loans. We need to try something different to make sure money goes where we want it to--and doesn't get used by banks to pay bonuses.

I am also angry that economic policy-makers went all out to help Wall Street and only halfway to help homeowners. In his second term Mr. Bernanke needs to do much more to

help them, and help communities ravaged by too many foreclosures.

Mr. Bernanke needs to realize that ``Crisis Averted'' doesn't mean ``Mission Accomplished.'' There have been too many missed signals-- misplaced priorities. But I am voting to confirm Mr. Bernanke because he is not a man of ideology and when we needed him most his expertise and level head probably helped stop a catastrophe. He didn't panic, and learned from history, which he has studied closer than anyone else. No one understands the risks the economy faces better than he does. That does not mean we shouldn't rock the boat. We need bold new approaches-- and I'll fight for them.

I was advised that rejecting his nomination would cause markets to nose-dive--which would hurt retirees and families saving for their future. I am not enthusiastic in my support. But I think Mr. Bernanke understands the job that he still has to do. And that in his second term he will focus better on jobs, getting lending going to the middle economy, and mortgages. So I will vote to confirm him for a second term.

Mr. President, people are angry and they are anxious. They are worried their middle class way of life is slipping by. During the last several months as I listened to people they had very clear messages.

First, ensure the solvency and stability of Medicare and, they said, no Medicare rationing.

Second, they said to get the government's fiscal house in order. They said to be as frugal as they have to be in their own homes.

I absolutely agree the government has to get its fiscal house in order. And I am unrelenting in making sure that Medicare is there when people need it, and is there in the way their doctor says they need to have it.

I fear this commission is a back door to rationing Medicare. I pledged during health care reform, and I pledge now, I will not ration Medicare.

I agree that Congress needs a gut check on spending, but we don't need a gutless vote. I worry that this commission will be a fast track process to ration Medicare run by a group with limited accountability selected by the very same politicians who were incapable of making the tough decisions. I will not vote for a commission to ration Medicare.

Social Security is not the real cause of the debt crisis. It has never added to the debt. It can be fixed through regular order with small tweaks that don't cut benefits.

I believe tough decisions on the budget and revenue should be made in the full light of day and through regular order with full accountability, and without subcontracting responsibility to a commission.

I support the goal of fiscal responsibility. We need urgent action. We must clean up the mess of many years of failed economic policies while ensuring the long-term health and economic security of Americans through the protection of Medicare and Social Security and at the same time, be aware that we must deal with job creation and the wrenching problem of home foreclosures.

I have made tough budget decisions in the past. I opposed tax cuts that went to the lavishly wealthy and cuts that let hedge fund managers pay lower taxes than their secretaries. I opposed tax cuts for corporations that shipped jobs overseas. I have used the powers of both my office and of other institutions to fight waste, fraud and abuse.

In the late 1990s, I was one of nine votes against repealing the Glass-Steagall Act which allowed banks to make risky bets with families' checking accounts with little regulation and no accountability, leaving taxpayers to clean up the mess with TARP. And it created the go-go permissiveness that got our economy into a ditch with a big recession that is part of the debt problem.

During the prescription drug debate I voted against the bill because Bush and the Republican Congress refused to allow the government to negotiate with drug companies for lower prices. It was just one more give away for drug and insurance companies so they could charge seniors and the government more for prescription drugs.

I have stood for strong and independent inspectors general at Federal agencies so they have power to ensure fairness and accountability. I asked the Department of Justice IG to investigate when political appointees were awarding grants to their friends. And IG made recommendations to reform the grant process.

I asked the Government Accountability Office to recommend reforms for the Chesapeake Bay Program to focus the bay program on results because the bay program was fudging its data to overstate progress in cleaning up the bay.

I have fought on my own committee against botched government boondoggles--lavish conferences with $4 meatballs at the Department of Justice, satellite construction contracts that have run billions over budget and years behind schedule, and Enron-like accounting in the AmeriCorps Program.

And I have supported strong protections for whistleblowers, so talented civil servants can come forward about wrongdoing without fear of retribution

when they uncovered corrupt practices. I believe some commissions can work, like the Bipartisan Policy Center's Debt Reduction Task Force headed by Pete Domenici and Alice Rivlin that will issue tough recommendations on revenue and spending.

I look forward to their findings and I want to hear recommendations from others. I would support a commission like the one proposed by Senator Baucus where there could be amendments and full debate so we could vote to stop the rationing of Medicare and raising taxes on the middle class.

I support the goal of fiscal responsibility. I don't support this process with its fast-tracking, muffling of amendments and limited debate. This is not the way to address programs touching every American family. I don't support shifting the burden and risks to seniors and their families.

I will not support this commission or rationing Medicare, raiding Social Security or any backdoor way of raising taxes on the middle class.

Mr. President, today is a historic day. After decades of discussions and promises, we have taken a giant step forward in providing universal access to health care. I was proud to vote for the Patient Protection and Affordable Care Act. It extends coverage to 31 million Americans who don't have health insurance now.

Our bill is a step forward in achieving my four principles of health care reform: saving and strengthening Medicare; ending punitive insurance company practices that deny coverage based on preexisting health conditions, age and gender; providing universal access; and emphasizing quality, prevention and integrative health to save lives and save money.

I like the Patient Protection and Affordable Care Act because it saves and strengthens Medicare. The bill extends Medicare solvency; promotes care based on value not volume; closes the prescription drug coverage gap with a 50-percent discount on brand-name medications for seniors who fall into the gap; stops insurance companies from charging seniors four or five times more for insurance than young people; and removes the cost barrier to preventive care by eliminating deductibles, copayments and other cost sharing for seniors.

This bill helps the good guy businesses that want to provide insurance, but can't because it costs too much. I come from a small business family. My father was a grocer and my grandmother ran a small bakery. So I grew up in a family that knew what it was to face a weekly payroll.

The Patient Protection and Affordable Care Act protects small businesses with fewer than 50 employees. It gives them tax credits to be able to afford insurance for their employees. The Senate bill creates new insurance exchanges for small businesses and individuals who don't get insurance through work. It is like an online shopping mall for insurance. It provides individuals and businesses the same bargaining power as if they were a large group. It gives them the choice and the opportunity to select the best plan they can afford with the care that best meets their needs.

The Senate bill promotes cost savings and greater doctor-patient satisfaction through administrative simplification. The bill creates single standards for electronic transactions that will mean less paperwork and more doctor-patient time.

The Patient Protection and Affordable Care Act will control costs through a new emphasis on integrative health, prevention, and quality. New funding for wellness and prevention programs will support innovative approaches. That includes local initiatives using grassroots strategies to create healthier communities.

The Patient Protection and Affordable Care Act also improves the quality of care. As a member of the Senate Health, Education, Labor, and Pensions Committee, I was charged with establishing our bill's section on improving quality and delivery systems in health care. This section creates a national strategy to improve lives, save lives and reduce costs. This is achieved by promoting best practices like simplifying drug labels, and promoting discharge planning and medication management. These practices save money and improve patient outcomes through reduced hospital readmissions, improved patient safety, and better care coordination.

For example, the Senate bill creates grants to identify, disseminate, and implement innovative best practices to local providers and patients. One such practice is the Pronovost Checklist from Dr. Peter Pronovost at Johns Hopkins University. He developed simple steps to properly insert a catheter and eliminate line infections. When used in Michigan for 1 year, it saved 2,000 lives and $200 million. We make his checklist--and others like it--available to hospitals across the country

We also expand the use of medical homes by establishing community health teams. These teams include providers from the primary care physician to specialists and nutritionists. In North Carolina, medical homes save $175 million each year. Our bill makes medical homes available across the country. These provisions--and more like them--not only save lives, they save money.

I am particularly proud of my women's preventive health amendment included in this bill. Right now, women pay more and get less in health care. For far too long, many insurance companies have treated simply being a woman as a pre-existing condition. They have used every trick in the book to deny coverage to women.

The Mikulski amendment guarantees access to preventive tests that save money and save women's lives. It requires insurance companies to cover preventive care and screenings at no added cost to women.

Without my amendment, there would be no guarantee that women under 50 would be covered for mammograms, no guarantee of an annual women's health exam that would include screenings for heart disease, and no guarantee that women would have access to this preventive care at no cost.

In the Patient Protection and Affordable Care Act I stood up for Maryland. I preserved the Maryland Medicare waiver, which I authored more than 30 years ago. This Maryland waiver is crucial in allowing hospitals to provide uncompensated care without jeopardizing their own financial stability.

What else does this health care reform bill mean for Maryland? It means that more than 1 million Marylanders who aren't covered now will have access to affordable insurance. It gives a helping hand to 50,000 small businesses in Maryland. It means lower costs for the 130,000 Marylanders who fall into Medicare's prescription drug coverage gap. It means that young adults in Maryland can stay on their parents' policies until they are 26 and that they'll have access to affordable coverage after that.

It means that families who are just a layoff, a job switch or an illness away

from losing coverage will have health care stability and security. It means that if you like the insurance you have now, you can keep it. Or if you don't have it, you can get it.

And it means that health care reform will be affordable to families and to the nation. We can't let health care bankrupt our families or the government. The non-partisan Congressional Budget Office says the Senate bill will reduce the deficit by $132 billion over the next 10 years.

And while I support the Patient Protection and Affordable Care Act, I have some serious yellow flashing lights. I hope these issues will be resolved in a more favorable way in conference.

I am for a more robust and transparent public framework to ensure competition and choice in the marketplace. I like public options. Two of my favorite public options are Social Security and Medicare. The Senate bill creates a lot of new customers for insurance companies by mandating insurance coverage. But like big banks, insurance companies don't show remorse for past transgressions. We can't simply trust them to do the right thing. The Senate bill relies heavily on regulation to achieve what could be done with a public framework. I prefer the House public option.

I also continue to oppose the excise tax included in the Senate bill. I am not for taxing the health care benefits of retired public employees and union members to pay for health reform. Some call them Cadillac plans. I call it a ``Clunker Idea.'' The excise tax will just shift costs onto workers through higher deductibles, copayments, and less generous coverage. I am against this back-door tax on middle America & retirees. Again, I prefer the House version on this.

So we have some work to do.

I will keep fighting for health care reform. Because it is absolutely terrible when you hear--I am sorry your insurance doesn't cover that. It is horrifying when you have no insurance at all because you lost your job or your benefits and you face losing your life savings to pay for the care you need.

I can assure you I will be fighting on the side of Maryland and the American people to complete health care reform in early 2010.

Mr. President, my top priority is jobs--to help those who have one, keep it and to help those who don't have one, find one. That is why I have always supported the automobile dealers in Maryland and across the country, which each employ on average about 50 people and are also economic pillars in large and small communities throughout the United States. Dealers don't just provide jobs for people who sell cars they also provide them to people who service the cars and for managers and office workers who make dealerships run smoothly.

I have fought for the auto dealers in several ways over the past year, first on the Recovery Act, where we passed tax incentives to help consumers purchase new cars, and then again this summer when I worked with my colleagues to pass cash for clunkers, which saved jobs in the auto industry, promoted energy efficiency, and helped the middle-class afford a car, which is most families' second largest purchase behind their home.

Dealers are not only critical to their local economies; they also make the auto industry work by distributing, selling, and servicing the cars at practically no cost to the manufacturers. That is why I cosponsored S. 1304--to give car dealers a chance to contribute to our economic recovery and to provide jobs as the domestic auto industry restructures and retools.

Today, I am proud to support a provision in section 747 of the Financial Services appropriations conference report that shows dealers that Congress is on their side and on the side of creating and protecting jobs as our economy struggles toward recovery.

This provision will give automobile dealers around the Nation a fair shot at getting back into business by setting up a neutral and fair arbitration process. First, it requires that manufacturers make all pertinent information available to dealers. I expect all parties to fully comply with this requirement and for all relevant information to be made available in a transparent and easily understandable form to dealers and to the arbitrators.

Also, I support section 747 because it requires arbitrators to consider all the relevant factors that affect whether a dealer is and can be successful, and that demonstrate how dealers contribute to the viability of the manufacturing companies whose cars they sell. I also expect and encourage arbitrators to consider the rights that dealers are guaranteed under all applicable Federal and State laws when making their decisions.

Our economy is struggling to recover because there aren't enough jobs. Auto dealers are a major employer across the country, and they also are essential to reviving a healthy American auto industry. As the American auto industry looks to the future, we can't forget the essential role that dealers play, providing both thousands of jobs and also the affordable cars and auto related services that American families need.

Mr. President, I rise to pay tribute to the life and legacy of my friend Abe Pollin. He was a businessman, community leader, philanthropist, familyman. He was someone who simply made our community and our Nation a better place.

Abe was a great man who did great things. But he did it without a lot of fanfare. He was a team owner who thought first about the community that supported his teams. He was an employer who didn't treat his athletes or his employees as commodities--but as members of his team.

Abe Pollin was also a developer. But he didn't just invest in buildings, he invested in communities. He built one of the first big apartment buildings in Bethesda, named after his beloved wife Irene, long before Bethesda became the vibrant downtown that it is today. He never lost faith in Washington--building the MCI Center, now the Verizon Center, in the mid 1990s--which led to the revival of downtown Washington.

Here in the DC Metro area, there are few community organizations that did not benefit from his advice, his philanthropy or his leadership. Abe made our region a better place, and will be greatly missed.

My thoughts and prayers are with the Pollin family--his wife Irene, who is a founding mother of the effort to empower women to fight heart disease, and his children and grandchildren. I will be forever grateful for the Pollin family's early support of a young city council woman from Baltimore who wanted to run for Congress. Abe Pollin was one of my earliest supporters, and his faith in me meant a great deal.

Last night, thousands of people gathered at the Verizon Center to celebrate Abe Pollin's life. His legacy is a community that is stronger, more vibrant--and simply a better place to live.

Madam President, I rise to speak on the bill as well as in opposition to the Nelson of Nebraska amendment on the subject of abortion.

First of all, I truly believe health care reform is the most important social justice vote we will cast in this decade. Why? Because we are talking about providing universal access to health care, which I believe is a basic human right and should be a fundamental American right. That is why health care reform is so important: To provide universal access to health care and, in this bill, ending the punitive practices of insurance companies against women, particularly in the area of gender discrimination, where we pay more and get less in our benefit package, as well as where simply being a woman is often treated as a preexisting condition.

Eight States consider domestic violence a preexisting condition and you can't get insurance. One woman who had a medically mandated C- section was told she couldn't get insurance again unless she had a sterilization--coerced sterilization in the United States of America. I thought that is what they did in Nazi Germany or in old Communist China.

The other thing this bill does is strengthen and stabilize Medicare to make sure seniors have access to health care at all ages and all stages.

I consider these principles to be pro-life. I think the health care bill we are debating is as pro-life as can be because what other thing helps maintain, protect, save, or deal with impaired life better than providing universal access to health care? A famous pastor by the name of Rick Warren, who has written the great book that has inspired so many, ``The Purpose Driven Life,'' talks not about pro-life but whole- life principles. I think being able to see a doctor or an appropriate health care professional saves lives, and I view this vote on health care reform as the most important pro-life or whole-life vote anyone can cast.

I agree with Pastor Rick Warren when he uses that principle. I believe in seeing a doctor when you need one, in saving a life, or in getting the health care you need so you don't lose an eye from diabetes, you don't lose your kidney, you don't lose your foot or, if you are pregnant and diabetic, you don't lose your child. We want to make sure women have access to mammograms, that the men we love and who love us have access if they have high blood pressure--and sometimes they have it because they don't have health care for their family--or prostate cancer. I believe that is what whole life is.

So with this bill, I believe supporting screening for diabetes is pro-life, cervical cancer screening is pro-life, but, most of all, if you want people to have healthy pregnancies, healthy childbirth, healthy babies, they need access to health care. So that is why I say voting for universal access to health care is as pro-life as you can be.

Making this debate about abortion, I believe, is misguided and wrong. First of all, in the bill, we already deal with this topic. In the interest of passing health care reform, I believe we deal with this sensitive topic in a sensitive way. We rejected shrill and strident amendments on both sides. For example, we did not seek to change the settled language regarding abortion that is the Hyde amendment.

There were those in the exuberance of last year's election who said: Oh, let's get rid of Hyde. Many of us took that position, trying to find that sensible center. We are principled and whole-life people as well. We said: Let's keep the Hyde amendment. It is settled language. I don't use the term ``settled law'' because that is a precise legal term, and I know my colleague from Pennsylvania and others can argue that, but Hyde is settled language.

What does the Hyde amendment that has been around for almost 30 years do? It prohibits any Federal funds to be

used directly for abortions, except in the case of rape, incest, or when the life of the mother is at risk. It has additional provisions that provide a conscious clause to protect providers who do not want to provide abortions. This bill does not seek to change the underlying premise of the Hyde amendment which, as I said, I regard as settled language of 30 years ago.

The pending Senate bill goes even further than Hyde. It was legislation that came out of the Finance Committee, and I salute them for, once again, trying to find a sensible center, engaging in civil and rational dialogue. I wish to compliment them on their efforts. However, the other side keeps changing the midpoint. By seeking a greater good, many of us agreed to what was in the Finance bill. Quite frankly, it went further than I would have liked if I were writing the bill, but, again, in the interest of comity we would keep this debate on the issue of providing health care and not turn it into an abortion debate.

What does what came out of the Finance Committee and what is in the merged bill do? It says loudly, clearly, and consistently: No Federal funds can be used to pay for the coverage of abortion, and it does it by separating out funds so no public money from Federal credits or subsidies would be used for abortions. What more can we ask anyone to do? Under the pending bill, health care plans cannot be required to cover abortion. Health care plans can choose to cover or not cover it, and State laws regarding abortion are not preempted. It, again, includes the longstanding practice of a strong conscience clause for either individual providers or institutions--for example, Catholic hospitals--from performing abortions if it is against their conscience.

I believe what we have done is found the sensible center, and it leaves the decision in the hands of patients and doctors, not politicians or insurance executives. So the question is not what is decided but who decides. I believe it should be in the hands of patients and doctors, not politicians or insurance executives.

Let's go to Nelson, which is a Senate version of Stupak. I reject the Ben Nelson amendment. I believe it is unnecessary. I believe it is unneeded. I believe it is uncalled for. It goes further than Hyde because it prohibits the public option from covering abortions and it prohibits individuals receiving Federal insurance subsidies from purchasing a plan that covers abortion and, even if you use your own money, it cannot be used for abortion.

It also allows women to purchase an abortion rider. Oh, boy. Is this supposed to be a big deal? Is this supposed to be the kind of thing that is supposed to make us happy? What an insulting, humiliating thing to say: If you want an abortion, go buy a rider. I think it demonizes women. Why don't you go into the workplace and paint a scarlet letter on your head. Hawthorne still lives in the Nelson amendment. Lets paint the ``A word'' on your forehead. Can you believe this? I don't know of any individual woman or any woman in consultation with the man she loves and who loves her saying: Yes, you know, we might have an abortion. Why don't we buy that rider. Nobody plans to have an abortion. It is not the subject of intimate conversations that families talk about as they plan their lives together. Do you realize the intense discrimination a woman would face? How about: Why don't we have men buy an abortion rider for the women they get pregnant? Let them buy the abortion rider. Maybe we can even give them a discount.

We are hot about this, and we are cranky about it because there is no need to do it like this. We have tried, at every step of the way, to handle this topic with great respect because there are people with principles. We are all people of principle. Some use the term ``pro- life.'' I use the term ``whole life.'' What are the rest of us? Do you think I am anti-life?

All my life as a social worker, I have fought for social justice. I fought for access to health care. And to say I am going to support a bill that denies access to services for most women in the exchange-- anyway, I think this thing goes further than Hyde, and we should be debating health care, not abortion. This legislation on the Senate floor should be about women's health, like the debate we had last week about prenatal health care, how to improve delivery systems for greater survival and how to minimize birth defects. That is what it should be.

Women's health care decisions should be made by the women, in consultation with their doctor. The Patient Protection and Affordable Care Act is what we believe is a wonderful compromise, and it rejects these strident viewpoints. The most pro-life thing we can do is pass universal access to health care. The most pro-life thing we can do is stabilize Medicare so people have health care at all ages and all stages.

So reject the Nelson amendment, and if you are pro-life, vote for the Senate merged bill.

I yield the floor.

Madam President, I yield myself a firm 10 minutes.

Madam President, health care is a woman's issue. Health care reform is a must-do woman's issue, and health insurance reform is a must-change issue.

So many of the women and men of the Senate are here today to fight for change and to make sure we have universal access to health care. When we have universal access, it makes a difference in our lives, which means we have to have universal access to preventive and screening services.

My amendment--and, by the way, it is a bipartisan amendment--makes universal access to preventive and screening services for women available.

There is much discussion about whether women should get a particular service at a particular age. We don't mandate that women get a service; we leave that up to a decision made with the woman and her doctor. But, first of all, they need to be able to have a doctor. So we are for universal access, and this is why the underlying bill is so important.

Then, when you have that, there should also be universal access to preventive and screening services, particularly to the top killers of women, those things that are unique to women. We think about cancer: breast cancer, ovarian cancer, and cervical cancer. Also, women are dying at an increased rate of lung cancer. Then there are these other silent killers that have had a lethal effect on women, and that is cardio and vascular disease. So we want to guarantee universal access to medically appropriate or medically necessary screening and preventive services.

Many women don't get these services because, first of all, they don't have health insurance; and, No. 2, when they do have it, it means these services are either not available unless they are mandated by States or the copayments are so high that they avoid getting them in the first place.

The second important point about my amendment is it eliminates deductibles and copayments. So we eliminate two big hurdles: having insurance in the first place, which is the underlying bill, as well as copayments and deductibles. I know of no one in this room who would not want to be on our side on this issue.

I wish to acknowledge the role the Senator from Alaska has played, Ms. Murkowski, as well as Senator Kay Bailey Hutchison, Senator Snowe, and Senator Collins. We, the women of the Senate, have worked on a bipartisan basis for years making sure we were included in the protocols at NIH, increasing funding for important research areas to find that cure, to race for that cure and, at the same time, to be able to have mammogram standards. What the Murkowski amendment--and by the way, she is Murkowski, I am Mikulski. We sound alike, and the amendments might sound alike, but, boy, are they different.

The Murkowski amendment offers information. I think that is important. That is a threshold matter. You have to have information to make an informed decision. But it does not guarantee universal access to these services, and, of course, it does not eliminate the high payments and deductibles. So her amendment is flawed. My amendment is terrific. My amendment offers key preventive services, including an annual women's health screening that would go to a comprehensive assessment of the dangers to women, including heart disease and diabetes.

We hope when the Senate makes its decision today, it deals with the fact that for we women, the insurance companies take simply being a woman as a preexisting condition. We face so many issues and hurdles. We can't get health care. We can't get health insurance because of preexisting conditions called a C-section.

I am going to be meeting with an insurance company executive later where his company denied health insurance to a woman who had a medically mandated C-section, and a letter from this insurance company said: We are not going to give you insurance unless you have a sterilization--a coerced sterilization in the United States of America. That is going to be an amendment for another day. But I just wish to give the flavor and the power of what women face when we have to cope with the insurance companies or where there are barriers to our getting these health care screening services.

So we want to be able to save lives, and we want to be able to save money. We believe in universal access, and if you utilize the service it is because you have had the consultation with your doctor. We do know early screening and detection does save lives, and, at the same time, it saves money.

I will conclude with this: When we look at heart disease and diabetes, not only cancer but early detection of diabetes means, in a well-managed program, under appropriate medical supervision you very likely will not lose that eye, you will not lose that kidney, you will not lose that leg and, most of all, you will not lose your life.

So let's not lose the Mikulski amendment. Let's go with Mikulski and thank Murkowski for her information, but hers is too tepid and too limited.

Madam President, I ask my colleague, one of the great guys who supports us, Senator Cardin, how much time he needs.

I yield 5 minutes to Senator Cardin.

Madam President, I yield 3\1/2\ minutes to the junior Senator from Minnesota, Mr. Franken.

Madam President, how much time does our side have?

I yield 5 minutes to the Senator from Michigan.

Madam President, I yield 4 minutes to the Senator from the State of Washington, who has been a real leader on these issues.

By the way, Madam President, before the Senator speaks, I want to thank Senator Stabenow for a unique courtesy. This is her desk, and as many of my colleagues know, I broke my ankle and I can't get up to where my desk is at this point. I will, however, in a matter of another few weeks. But she has given me this desk on loan so that I could stand on my own two feet to debate this amendment, and I wanted to thank her for the courtesy.

Madam President, I also want to note something while the senior Senator from the Republican leadership is here, and the author of the amendment. We, the women of the Senate, on a bipartisan basis, have worked for women's health. Today, we disagree on what is the best way to achieve it by these two amendments. I want to thank my colleagues for setting a tone of civility. I think this has been one of the most rational, civilized conversations we have had over this, and I would like to thank them.

As the leader on this side of the aisle, in terms of seniority, I would like to extend my hand in friendship and suggest when this bill is done, and this amendment is done, we continue to focus on this wonderful work that we have done together. We have done things that have saved millions of lives, and so I look forward to continuing that.

Madam President, I now yield 4 minutes to the Senator from the State of Washington, Mrs. Murray.

Of course.

I thank the Senator.

That is correct.

Yes, that is correct. This amendment does not cover abortion. Abortion has never been defined as a preventive service. This amendment is strictly concerned with ensuring that women get the kind of preventive screenings and treatments they may need to prevent diseases particular to women such as breast cancer and cervical cancer. There is neither legislative intent nor legislative language that would cover abortion under this amendment, nor would abortion coverage be mandated in any way by the Secretary of Health and Human Services.

Mr. President, we are waiting for Senator Boxer to come to the floor, so if the other side of the aisle has another speaker, I know at the end we hope that Senator Lisa and Senator Barb--I say that because our last names sound so much the same--could wrap it up.

How would the Senator from Wyoming like to proceed? We are waiting for Senator Boxer or for Senator Baucus.

Then I will wrap up.

Whatever way it will work and accommodate you while we are waiting to see who our speakers are.

Mr. President, I fear the microphone of the Senator from Alaska is not working.

That is so much better. I want to hear about the amendment and continue our conversation.

I ask unanimous consent she be extended an additional 2 minutes. No, I withdraw that request.

Mr. President, how much time is there on our side?

Mr. President, I yield myself 3 minutes.

As we get ready to conclude the debate on both the Mikulski as in Barbara Mikulski and Murkowski as in Lisa Murkowski amendments, I want to first say a word about the Senator from Alaska. We have worked together on the Health, Education, Labor and Pensions Committee. We have worked together as women of the Senate, to provide access to women's health services. Not too long ago, when I had my awful fall, she gave me much wisdom and counsel and practical tips because she herself had broken her ankle. To us, when you say to Senator Lisa or Senator Barb, ``Break a leg,'' it has a whole different meaning. I again thank her for all her work. I have great respect for her. I look forward to our continued working together.

But I do sincerely disagree with her amendment because what her amendment does is, it guarantees, really, only information. It does not guarantee universal access to preventive and screening services.

It also does not remove the cost barriers by eliminating the high deductibles for the copayments when you go to get a preventative or screening service. It tells insurance companies to give information on recommended preventative care. That is a good thing, but it is a threshold thing. You need to have universal access to the service.

In addition, we do not mandate that you have the service; we mandate that you have access to the service. The decision as to whether you should get it will be a private one, unique to you. We leave it to personalized medicine. So in the poignant case of the wife of the Senator from Wyoming, it would have been up to the doctor, the physician, to get her the service she needed.

It is not only I or one side of the aisle that is opposing the Murkowski amendment. The American Cancer Society, the American Heart Association, and the American academy of GYN services oppose it.

My amendment is a superior amendment because it guarantees universal access to preventative and screening services. It also eliminates one of the major barriers to accessing care by getting rid of high payments and deductibles. It doesn't say you will have a mammogram at 40 because, again, we are substituting ourselves for the task force; it says you will have universal access to that mammogram if you and your doctor decide it is medically necessary or medically appropriate.

Vote for Mikulski. Don't vote for Murkowski. And please, on this one, get it straight.

I ask for the yeas and nays.

Mr. President, I rise in opposition to the Lisa Murkowski amendment. Though well-intentioned, it does not guarantee universal access to preventive and screening services for women. It does not remove the cost barriers of high payments and codeductibles. It is opposed by the American Cancer Society and the American Heart Association. It primarily provides information on those matters.

We salute her intention, but we think her amendment is too limited, and, to quote the American Heart Association, it would be an actual ``step backwards'' in the area of making preventive services available, particularly not only in the matter of cancer but in heart and vascular disease--the emerging No. 1 killer for women.

I urge defeat of the Murkowski amendment.

Mr. President, as we debate health care reform, we need to recognize in the United States of America that health care is a women's issue. Health care reform is a must-do women's issue, and health insurance reform must be a must-change women's issue.

Too often when we look at when health care is even available to us, we face discrimination. We face continually the punitive practices of insurance companies that charge women more and give us less in a benefit. A 25-year-old woman pays more for health insurance than her male counterpart of the same health status. A 40-year-old woman pays almost 35 percent more for her insurance than a male of the same age, same health status. We want to change that in health care reform. We want to end the punitive practices of the private insurance companies in their gender discrimination.

We, the women of the Senate, are concerned that even being a woman is being viewed by the insurance companies as a preexisting condition.

Now we have the opportunity to change the law and change the direction of health care. I have offered an amendment to expand the screening and preventive services available to women in order to save our lives, make sure our lives are not impaired as we get older and, at the same time, be able to save money. We know early detection saves lives, curtails the expansion of disease, and, in the long run, saves money.

There are certain killers of women, the dread ``c'' word, cancer-- breast cancer, ovarian cancer, cervical cancer that are unique to we women. Then there is the dread disease of lung cancer that affects men and women but is emerging as a main killer of women. Then there is the other issue of heart disease and vascular disease. We know for years women were often left out of the research on heart disease. For years women's heart disease went undetected and unrecognized because our symptoms are different. We can change this law.

In my amendment we expand the key preventive services for women, and we do it in a way that is based on recommendations from the Centers for Disease Control and from HRSA. It will be based on the benefit package available to Federal employees. It means if our amendment passes, the women of America will have the same access to preventive and screening services as the women of Congress. What is good enough for a United States Senator should be good enough for any woman in the United States of America.

That is why we ask not only the women to join us but the good men of quality who support us. We know people such as Senator Dodd, Senator Reid, Senator Baucus, men of quality, never fear we women who seek equality. They have raced for the cure as long and as hard as we have and have fought for mammogram standards. This is why we are wearing pink today. Pink is the universal color that says while we race for the cure, we want to have access to it when we find it. But to have access to the cure, we are going to need to have access to mammograms to be able to get that diagnosis, and then we are going to have to have health insurance to be able to pay for the treatment we have.

This is the Titanic battle we have today: Are we going to have access to health insurance and are we going to have access to these preventive services?

We do know in the area of heart disease and cancer and silent, undetected killers such as diabetes, it is often undetected. What happens is, for many women they do not get that early detection and screening, No. 1, because they can't afford it. They can't afford it because they either don't have health insurance and there are other demands on their family or, No. 2, when they go, if they do have insurance, they find their benefit might not be covered. So many of these benefits are based on State mandates, but worse than that it is the copayments and high deductibles.

Many women say: Well, my insurance company provides for it, but this copayment and deductible, I have to choose between my children's shoes or my deductible. We want to either

eliminate or shrink those deductibles and eliminate that high barrier, that overwhelming hurdle that prevents women from having access to these early detection and screening programs.

Much is being debated about mammograms. We believe access to mammograms should be universal, universal access. But the decision on whether to get one should be made with your doctor. Well, that is great to say, but you need to have access to your doctor. You need to not have to overcome the high hurdle of deductions or copayments to be able to do it.

We know mammogram screenings decrease breast cancer by over 40 percent. Regular pap smears reduce cervical cancer by 40 percent. This year, 4,000 women will die of cervical cancer. Then let's take the dread, but often overlooked, diabetic screening. Diabetes is the underlying cause of two-thirds of chronic illness in both younger and older women. If we find it early and get everybody in the right program, they are going to be able to get the treatment they need so they don't lose an eye, they don't lose a kidney, they don't lose a leg.

We can't lose any more time. We need to provide universal access to health care to the American people and we need to make sure they have access to the screening and early preventive actions that will save lives.

Mr. President, I urge the adoption of the Mikulski amendment, and I thank you for your leadership on this issue.

I ask unanimous consent that the remaining time be equally divided between Governor Shaheen, Senator Hagan, Senator Murray, and Senator Gillibrand.

Madam President, that concludes our discussion and our responses to this portion of the health care reform bill.

I must say: Alert, alert, alert. We have just been informed that a shrill advocacy group is spreading lies about this amendment. They are saying that because it is prevention, it includes abortion services. There are no abortion services included in the Mikulski amendment. It is screening for diseases that are the biggest killers for women--the silent killers of women. It also provides family planning--but family planning as recognized by other acts. Please, no more lies. Let's get off of it and save lives.

Mr. President, I have an amendment at the desk.

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

Mr. President, before I go into the contents of my amendment, I thank the Senator from Wyoming for his unfailing courtesy to allow me to proceed to offer my amendment. I have worked with the Senator from Wyoming on the Health, Education, Labor and Pensions Committee, and have often valued his sound counsel and steady hand as we have moved complex legislation. His considerable experience as an accountant and his commitment to the stewardship of Federal funds have often added to the consideration of legislation. As we move forward on both debating and refining the health care reform bill before us, I look forward to working with him. Again, I thank him for his courtesy.

I also want to acknowledge the Democratic leader and wish to support him for bringing something called the ``merged'' bill to the floor, which took the best elements of both the Finance Committee and the HELP Committee and brought them forth.

I believe the overriding bill before us is an excellent bill. No. 1, it expands universal access to health care that will now cover over 90 percent more Americans. It will end the punitive practices of insurance companies, particularly in the area of gender, age discrimination, and preexisting conditions. It also stabilizes and makes Medicare secure and, at the same time, it begins to bend the cost curve by following innovative practices related to quality control and prevention.

I think the overriding bill is an excellent one. I congratulate the manager of the bill on the floor, the Senator from Montana, Mr. Baucus, chairman of the Finance Committee, for the excellent work his committee did, for bringing in a great bill that establishes new ideas, such as medical homes, emphasizing primary care and prevention, and at the same time accomplishing the objectives I have mentioned.

However, as I reviewed the bill, I felt we could do more to be able to enhance and improve women's health care. That is what my amendment does. The essential aspect of my amendment is that it guarantees women access to lifesaving preventive services and screenings.

This amendment eliminates one of the major barriers to accessing care in the area of cost and preventive services. It does it by getting rid of, or minimizing, high copays and high deductibles that are often overwhelming hurdles for women to access screening programs. We know that screening is important and early detection is important because it saves lives. But it also saves money. It does it by reducing the top diseases that are killing women today, or certainly impairing their lives.

Today, according to the CDC, the top killers of women are cancer-- breast cancer, cervical cancer, colorectal cancer, ovarian cancer. Also upfront and high on the list is lung cancer which, if identified early, can be treated with less invasive procedures and with lower costs. Another top killer of women is heart and vascular disease. And then there are the silent killers that often go undetected, such as diabetes, which can result in terrible consequences, such as the loss of an eye, the loss of a limb, or the loss of a kidney.

We now have screenings that are proven to detect these diseases early. Guaranteed access to these screenings, as I said, will save money and lives.

If we look at where women are today, we find women often forgo those critical preventive screenings because they simply cannot afford it, or their insurance company won't pay for it unless it is mandated by State law. Many women right now don't have insurance at all--seventeen million women in the United States of America are uninsured--or when they are insured, they have to pay large out-of-pocket expenses.

Three in five women have significant problems paying their medical bills. Women are more likely than men to neglect care or treatment because of cost. Fourteen percent of women report they delay or go without needed health care. Women of childbearing age incur 68 percent more out-of-pocket health care costs than men, simply because of the maternity aspect.

Women are often faced with the punitive practices of insurance companies. No. 1 is gender discrimination. Women often pay more and get less. For many insurance companies, simply being a woman is a preexisting condition. Let me repeat that. For many insurance companies, simply being a woman is a preexisting condition. We pay more because of our gender, anywhere from 2 percent to over 100 percent. A 25-year-old woman is charged up to 45 percent more than a 25-year-old male in the same identified health status. A 40-year-old woman is charged anywhere from 2 percent to 140 percent more than a 40-year-old man with the same health status for the same insurance policy.

What does my amendment do? It guarantees access to those critical preventive services for women to combat their No. 1 killers. We will provide these services at minimal cost.

The overall cost of my amendment has been scored by CBO. It says the cost is $1 billion. The majority leader, the Democratic leader, has provided opportunities to meet this cost. This amendment eliminates this big barrier of copayments and deductibles.

Let's talk about the benefit package. This benefit package is based on HRSA recommendations. It is based also on the recommendations of CDC. If this amendment passes, women will have access to the same preventive health services as the women in Congress have. If this passes, again, the women of America will have access to the same preventive services that we women in Congress have.

What does that mean? It means a mammogram, if your doctor says you need it; screening for cervical cancer, if your doctor says you need it; that check on diabetes, if your doctor is worried about you; and along with the symptoms related to menopause, there are other things, such as a loss of weight; and they may want to know at this juncture if you have diabetes. If you know that at 40, you are less likely to need kidney dialysis when you are 60.

The pending bill doesn't cover key preventive services, such as annual screenings for women of all ages to focus on our unique health needs. We know that for many people--for example, there are 15 million people in America with diabetes, and half are women. Often pregnant women with diabetes don't get the proper prenatal care. Heart disease is one of the top two leading causes of death in women--cancer and heart disease. Every year, over 267,000 women die from heart attacks. Women are generally unaware of their heart risks.

My amendment would, again, ensure heart disease screening for women. Remember that famous study that said ``take an aspirin a day to keep a heart attack away.'' It was done on 10,000 male medical residents, and not one woman was included. Thanks to a bipartisan effort, Bernadine Healy, NIH, and the women of the Senate, supported by the good guys of the Senate, were able to get that screening for women, get that evaluation. We know we manifest things differently than guys do. Now we are on our way to detection--if you can afford to have a doctor and if you can afford to have the screening.

My amendment also guarantees screenings for breast cancer--yes, for

mammograms. We don't mandate that you have a mammogram at age 40. What we say is discuss this with your doctor. But if your doctor says you need one, you are going to get one.

Studies have found mammogram screening decreases breast cancer among women by over 40 percent. Regular Pap smears reduce cervical cancer by 40 percent. This year, over 4,000 women will die of cervical cancer.

My amendment does focus on women's health needs. Keeping a woman healthy not only impacts her own life but that of her family. It impacts her ability to care for her child or an aging parent.

Early detection saves money by treating diseases early. Screening tests for breast and cervical cancer cost about $150, but the treating of advanced breast cancer is over $10,000 and can even go much higher. The treating of early stages of cervical cancer is $13,000 and can go much higher.

My amendment also leaves the decision of which preventive services a patient will use between the doctor and the patient. The health reform debate is focused on what you should have when. We agree. Decisions should be made in doctors' offices, not in the office of a Member of Congress or the office of an insurance executive. The decision about what is medically appropriate and medically necessary is between a woman and her doctor.

The authors of the bill have done a very good job in protecting women in many areas. This actually refines and improves this particular issue. That is why I support the overall health reform bill providing universal access to health care for over 90 percent of the American people, ending those punitive practices of the insurance companies, stabilizing and strengthening Medicare, and improving quality in public health by using innovation and preventive services and quality. We can pass a health reform bill.

I conclude by saying that we will end the confusion about what is needed in the area of preventive health services for women when our coverage is often skimpy and spartan. We want to make sure what we do enables us to have access to these comprehensive services.

I hope this amendment is adopted unanimously. I believe good people on both sides of the aisle will believe in its underlying premise: that early detection and screening save lives and save money.

Often those things unique to women have not been included in health care reform. Today we guarantee it and we assure it and we make it affordable by dealing with copayments and deductibles in a way CBO believes is fiscally achievable. In the long run, I think by doing this it will mean a lot to families, and it will mean a lot to the Federal budget.

Mr. President, I yield the floor.

Madam President, I wish to pay to tribute the life and legacy of Malcolm Sherman.

Malcolm Sherman was part of that extraordinary generation that fought for America during World War II, and then fought for what America stands for during the rest of his life.

He joined the Marines after the Japanese attack on Pearl Harbor and served during the Guadalcanal campaign. When he returned home, he built a family with his beloved wife Mimi, and he built a career in real estate.

He truly lived his life according to the Jewish principle of ``tikkun olam''--the repair of the world through the pursuit of social justice. He worked for peace and civil rights throughout his life. He also was a leader in the effort to ending segregation and discrimination in housing. Perhaps his greatest legacies are his children and grandchildren, who live by his principles of service.

I ask that an obituary of Mr. Sherman written by Frederick Rasmussen of the Baltimore Sun be printed in the Record.

The information follows.

Madam President, I rise today to pay tribute to my friend and colleague, Senator Robert C. Byrd from West Virginia. Today, Senator Byrd becomes the longest serving Member of the U.S. Senate, the longest serving Member of the U.S. Congress, and the longest serving Member in Congressional history. Today, Senator Byrd marks his 20,744th day in the Congress. This is an extraordinary milestone for a man who has played such an important role in the Senate.

Senator Byrd has a compelling personal story. He lost his parents as a young child and was raised by his aunt and uncle in a coal mining community. He became the first in his family to attend college and law school, working a series of jobs to support himself and his family. He was blessed with a wonderful wife, Erma Ora Byrd, who was beloved in the Senate family.

Senator Byrd never forgot where he came from. His work on behalf of the people of West Virginia is legendary. He never forgot the coal mining community he came from. He always worked to strengthen the opportunity ladder that he used to put himself through college and law school. He never forgot the people and communities that too often are left out and left behind.

When I first came to the U.S. Senate in 1987, Senator Byrd was the majority leader. He helped me get on some of the best committees, including the Appropriations Committee. Senator Byrd helped me learn the arcane Senate procedure. He helped me learn the ropes on the Appropriations Committee and how the appropriations process could be used to help communities and people in Maryland--and to create jobs.

As majority leader and as chairman, Senator Byrd set a tone of bipartisanship. He worked across the aisle to meet the day-to-day needs of his constituents and the long-range needs of our Nation.

I join my colleagues in celebrating Senator Byrd's many accomplishments--and in thanking him for his friendship.