Floor Statements

Mr. President, I rise in strong opposition to the Nelson- Hatch amendment. Let me start by saying that I support a woman's right of choice as a constitutionally affirmed right. I understand how difficult and divisive this issue is. That is why the underlying bill we have before us carries out the compromise that has already been reached between pro-choice and pro-life supporters. It represents maintaining the prohibition on Federal funds for abortion but allows a woman to pay for abortion coverage through use of her own funds. That is current law, and that is what the underlying bill makes sure we continue.

Many of us believe the health care debate is critically important. It is also controversial. Let's not bring the abortion issue into the bill. The Nelson-Hatch amendment would go beyond that. It would restrict a woman's ability to use her own funds for coverage to pay for abortions. It blocks a woman from using her personal funds to purchase insurance plans with abortion coverage. If enacted, for the first time in Federal law, this amendment would restrict what individual private dollars can pay for in the private insurance marketplace.

When you look at those who are supporting this amendment, you can't help but have some concern that this amendment is being offered as a way to derail and defeat the health care reform bill. Most of the people who are going to be supporting the amendment will vote in opposition to the bill. It is quite clear that the Senate health reform bill already includes language banning Federal funds for abortion services. So supporters of this bill are not satisfied with the current funding ban; they are trying to use this to move the equation further in an effort to defeat the bill. This is really wrong as it relates to women in America.

I am outraged at the suggestion that women who want an abortion should be able to purchase a separate rider to cover them. Why would we expect this overwhelmingly male Senate to expect women to shop for a supplemental plan

in anticipation of an unintended pregnancy or a pregnancy with health complications? Who plans for that? The whole point of health insurance is to protect against unexpected incidents.

Currently, there are five States--Idaho, Kentucky, Oklahoma, Missouri, and North Dakota--that only allow abortion coverage through riders. Guess what. The individual market does not accept this type of policy. It doesn't exist.

Abortion riders severely undermine patient privacy, as a woman would be placed in a position of having to tell her employer or insurer and, in many cases, their husband's employer that they anticipate terminating a pregnancy.

Also, requiring women to spend additional money to have comprehensive health care coverage is discriminatory. We don't do that for services that affect men's reproductive rights.

I hear frequently from my friends on the other side of the aisle that the statements we make; that is, those who support the underlying bill--that this allows individuals who currently have insurance to be able to maintain their insurance builds on what is good in our health care system. This amendment takes away rights people already have. So if you have insurance today as an individual that covers abortion services, if this amendment were adopted, you will not be able to get that. So we are denying people the ability to maintain their own current insurance, if this amendment were adopted.

It is the wrong amendment. The policy is wrong. But clearly, on this bill it is wrong.

I urge my colleagues to accept the compromise reached on this bill. Many of us who would like to see us be more progressive in dealing with this issue and remove some of the discriminatory provisions in existing law understand we will have to wait for another day to do that. Let's not confuse the issue of health care reform. Let's defeat this amendment that would be discriminatory against women. That is wrong.

I urge my colleagues to reject the Nelson-Hatch amendment.

I yield the floor.

First, let me thank my colleague, Senator Mikulski, for her leadership on this issue. I strongly support her amendment for the reasons she said. This is a very important point about providing preventive health services to the women of America, a critically important part of our strategy not only to bring down costs in health care, but to have a health care system that is fair in America.

I have been listening to my colleagues on the other side of the aisle talk about the underlying bill. They talk about it as if this is a static situation. Many of the criticisms I hear about the underlying bill are criticisms about our current health care system. I can tell my colleagues the people in Maryland, many of whom are finding it difficult to find affordable coverage today, are outraged with what is happening with private insurance companies and the attitudes they are taking.

As Senator Mikulski pointed out, they are denying coverage for preexisting conditions or imposing arbitrary caps. As has been indicated, if we are unable to get this bill passed, what is going to happen in the future? We know costs are going to become even greater, more people are going to lose their coverage, insurance companies are going to continue their arbitrary practices, and the health care of Americans is in jeopardy.

We are already spending so much of our economy on health care, and if we don't take action, it will be a greater part of our economy.

But we have some good news. The underlying bill has now been analyzed by the CBO; that is the independent scorekeeper. What they tell us is, if we pass the underlying bill, for the overwhelming majority of Americans, they are going to find that their health insurance premiums will either stay the same or go down. For the overwhelming majority of Americans, they will have a better insurance product that will cover the types of preventive services Senator Mikulski is talking about, which are in her amendment.

We are not only going to bring down the cost for the overwhelming majority of Americans as to what will happen if we don't pass a bill, we are going to provide better coverage for them. The underlying bill will also reduce dramatically the number of people who don't have health insurance in America by 31 million. That will make our system much more effective.

I have heard my colleagues talk about what is going to happen with Medicare. If we pass the underlying bill, we are going to strengthen Medicare. We already have a provision that there cannot be reductions in the guaranteed benefits. We pointed out that AARP endorses the bill. They understand there will be additional preventive health care for our seniors, and we will help fill the doughnut hole in prescription drugs.

When you reduce the number of uninsured, the amount of cost Medicare has to pay for health care in our hospitals is reduced. That is why we can reduce our payments to hospitals in America, because the amount of uncompensated care they currently have will be dramatically reduced. I have heard colleagues on the other side of the aisle talk about Medicare Advantage. I remember when we used to pay the private insurance companies in Medicare a little less than people in traditional Medicare. Then we paid them the same. Now we are paying them more. That is corporate welfare. Medicare Part B premiums are higher than they should be. Taxpayer support is higher than it used to be. We know these benefits that are being paid could be gone tomorrow. We saw the private insurance companies leave the Maryland market and so many other markets. These are reforms that save the taxpayers money and strengthen Medicare for the future.

Bottom line: The bill is good for middle-income families. It will provide the insurance reform so they have an insurance product that can cover their needs, including wellness and prevention programs. It is good for small business because it offers more choice. I can tell you chapter and verse of small companies in Maryland that, today, cannot get an affordable product and are seeing 20, 30 percent increases in their premiums. They need this bill in order to be able to preserve health care for their employees.

This bill, with the Mikulski amendment, will provide the preventive health care for all Americans that is so desperately needed, which will reduce costs, improve quality, and make our health care system more efficient and effective in the future, bringing down costs by investing in wellness and prevention.

I urge my colleagues to support the Mikulski amendment and to support the underlying bill.

I yield the floor.

Mr. President, for six decades the Voice of America's, VOA, Ukrainian-language service has been providing an invaluable service through its consistent broadcasting of factual and comprehensive news and information to the people of Ukraine.

During the first four decades of its existence, the Ukrainian service reached a Ukrainian population starving for information under an extremely strictly controlled, propagandistic Soviet media environment. Ukrainians went to great lengths and some risks to overcome Soviet censorship, which included the jamming of VOA and other shortwave international broadcasting.

During the Cold War VOA Ukrainian provided its listeners with uncensored news about such monumental events as the Hungarian Revolution, the Prague Spring, rise of Solidarity, and the fall of the Berlin Wall. A variety of shows worked to open the outside world to Ukrainian listeners, including a Popular Music Show, a Youth Show, and the long running series Democracy in Action, which was about how democracy works in the United States.

The Ukrainian service also focused on developments within Ukraine itself. VOA broadcasts about Soviet human rights violations in Ukraine, including its coverage of activities of the Helsinki process and the Helsinki Commission, gave sustenance to Helsinki Monitors and other Ukrainian human rights activists, especially those languishing in the gulag for daring to call upon the Soviet government to live up to its Helsinki Final Act obligations. They knew that they were not forgotten. Furthermore, the Ukrainian service also provided objective information about the Chornobyl nuclear disaster and the development of Ukraine's movement for democracy and independence, culminating in the December 1, 1991, referendum in Ukraine in which an overwhelming majority of Ukrainians voted for the restoration of their nation's independence.

For nearly two decades since, VOA's Ukrainian service has continued to fill an important role in Ukraine's evolving democracy. VOA reported on the challenges that Ukraine faced and on the U.S.'s considerable support and assistance for Ukraine, including in the dismantling of the nuclear arsenal it inherited from the Soviet Union. During the Orange Revolution, VOA Ukrainian helped to reassure millions of Ukrainians that the international community would not sanction electoral fraud.

As Ukraine has evolved, so has the Ukrainian Service. While no longer broadcasting on radio as it did for most of its 60 years, it reaches more Ukrainians than ever with daily broadcasts over Ukrainian television--something unthinkable during Soviet rule--and reporting on its website. It continues to report on what is happening in Ukraine, but also it continues to cover every aspect of American life and society. As Chairman of the Helsinki Commission, I commend the ongoing role of VOA's Ukrainian service in helping Ukraine fulfill its aspirations in becoming a more fully democratic, independent, and secure.

Mr. President, I rise today in recognition of World AIDS Day, an international commemoration held each year on December 1 to raise awareness of HIV and AIDS around the world. The theme for this year's World AIDS Day is ``universal access and human rights.''

Around the world, 33 million people were living with HIV in 2007, including 2.7 million new infections. In the U.S., more than 1.2 million people are infected with HIV. According to the Joint United Nations Program on HIV/AIDS, or UNAIDS, global reports indicated that 2 million people died from AIDS-related causes in 2007.

Globally, sub-Saharan Africa is the hardest-hit region when it comes to HIV infection, accounting for two-thirds of all people living with HIV and for three-quarters of AIDS deaths in 2007. Sadly, 75 percent of young people worldwide who are diagnosed with HIV are girls living in sub-Saharan Africa.

According to the results of a global youth survey conducted in 99 countries, 50 percent of young people have a dangerously low knowledge of how the disease is contracted and can be prevented. Another report by UNAIDS collected data from 64 countries and found that fewer than 40 percent of young people have basic information about HIV. This knowledge gap is particularly disturbing when taking into account a UNICEF report that indicates that 4.9 million young people, ages 15-24, are living with HIV worldwide.

Despite these statistics, recent advances in prevention and treatment of HIV give hope for the future. Globally, approximately 38 percent of the 730,000 children under 15 who needed antiretroviral drugs to treat HIV in 2008 were receiving the necessary therapy, according to UNAIDS. This is a huge increase from just a little over 10 percent in 2005.

The percentage of pregnant women living with HIV who received antiretroviral treatment to prevent mother-to-child transmission has increased from 9 percent in 2004 to 33 percent in 2007.

Despite recent improvements in treatment coverage and declining mother-to-child transmission of HIV, problems remain in preventing and treating the disease. In addition, the number of new HIV infections continues to outpace the advances made in treatment numbers for every two people put on antiretroviral drugs, another five become newly infected with the disease. Clearly, prevention measures are essential to continue the fight against HIV/AIDS.

No State in the U.S. is immune from the effects of HIV/AIDS, and the epidemic is deeply felt among Marylanders as well. At the end of 2007, Maryland had 28,270 people living with HIV and AIDS. That same year, Maryland ranked fourth in the U.S. for the number of AIDS cases per 100,000 people.

The Maryland Department of Health and Mental Hygiene has estimated that

there are between 6,000 and 9,000 Marylanders who are unaware that they are infected with HIV. Of the 1.2 million people in the United States who are estimated to be infected with HIV, as many as 21 percent are unaware that they have the virus.

To address this problem, it is crucial that HIV screening be readily available and accessible to everyone at little or no cost. This will increase the rate of diagnosis in individuals that have HIV and will accelerate their treatment.

The Patient Protection and Affordable Care Act will address this need and will help achieve the goals outlined by the theme of this year's World AIDS Day campaign of ``universal access and human rights.''

First and foremost, the bill eliminates discrimination based on pre- existing conditions. Individuals with HIV will no longer be rejected from insurance coverage because of their disease.

The bill also encourages outreach to enroll vulnerable and underserved populations in Medicare and CHIP, including adults and children with HIV/AIDS. It provides personal responsibility education grants to States to create HIV/AIDS education programs for adolescents.

The bill will also cover preventive services recommended by the U.S. Preventive Services Task Force, including HIV testing for all pregnant women. This testing will be provided at no individual cost, making it universally accessible to all women in the U.S. Testing pregnant women for HIV is vital for prevention efforts, allowing women who test positive to begin antiretroviral drugs to prevent transmission to their baby.

Furthermore, the Mikulski amendment, which I have cosponsored, would allow coverage for HIV testing for all women, regardless of risk, based on expert recommendations from the Health Resources and Services Administration.

The Patient Protection and Affordable Care Act also provides grants to encourage training health care workers to treat individuals with HIV/AIDS and other vulnerable populations.

Because of the numerous provisions in the bill that will help the prevention and treatment of HIV/AIDS, several groups have expressed their support for the Patient Protection and Affordable Care Act. Among the groups that I have heard from is the HIV Medicine Association, an organization representing 3,600 physicians, scientists, and health care professionals who work on the frontlines of the HIV/AIDS epidemic in communities across the country.

We must continue to fight HIV/AIDS, and I urge my colleagues to support the measures outlined in the Patient Protection and Affordable Care Act that will further our efforts to combat this disease.

Mr. President, first, let me thank the Senator from Montana, Mr. Baucus, for bringing forward a bill that has been long overdue on the Senate floor.

This is a historic moment as we debate health care reform. Many of us have been looking forward to this moment for many years. As to this bill, the Congressional Budget Office has now confirmed, for the overwhelming majority of Americans, it will bring down their health care insurance premiums.

This bill will bring down the growth rate of health care costs. It will provide affordable options for millions of Americans who today have been denied the opportunity to buy health insurance.

The Congressional Budget Office tells us that it will insure 31 million Americans who otherwise would not have insurance, bringing down the uninsured rate. And, most importantly, the Congressional Budget Office--that objective scorekeeper; that is not Democrats, not Republicans; this is the objective scorekeeper--tells us this bill will bring down the Federal deficit.

So it is a responsible bill, a bill that will provide affordable insurance options for millions of Americans who are denied insurance today. It will reduce our deficit, and will start to get a handle on the escalating cost of health care. It saves money. It saves lives through prevention and early detection of diseases, and by expanded coverage. And it saves Medicare.

Why does it save Medicare? Because many of us who have been here for a long time understand that the only way you can bring down the cost of Medicare is to bring down the cost of health care. That is exactly what this bill does, providing for the long-term safety of Medicare for our seniors.

It also expands benefits for our seniors in prevention and helps to start to fill the doughnut hole in prescription drug coverage. The underlying bill moves us toward what we need to do in health care reform. It brings down health care costs. How? By managing diseases and understanding the way we pay for diseases today is where most of the cost in health care is. This helps us manage diseases. It expands insurance coverage, which will bring down costs. It provides for investments in health information technology so we can bring down the administrative costs, and it invests in wellness and prevention.

Amendment No. 2791

Mr. President, I rise today to encourage my colleagues to support the Mikulski amendment, which will ensure women have access to essential preventive services. The leading causes of death for women are heart disease, cancer, and stroke. Early screening for risk factors could prevent many of these deaths and lead to improved health and quality of life for women. But despite the benefits of early screening, many insurers do not cover them, and too often women skip them because the costs are prohibitive. We know early detection of disease saves lives, and so we must ensure that needed preventive services are available to all Americans, regardless of gender.

I have long worked to improve access to preventive services. Knowing what we do now about the importance of prevention, it seems hard to believe that before 1998 Medicare did not cover cancer screenings or other preventive services. I am proud of a bill I authored in 1997 as a Member of the House of Representatives. It established the first package of preventive benefits in traditional Medicare. It was part of the 1997 Balanced Budget Act, and it would not have passed but for strong bipartisan support.

Medicare now covers screenings for breast, colon, and prostate cancer, bone mass measurement for osteoporosis, diabetes testing supplies, glaucoma, and more. Last year's bill, the Medicare Improvements for Patients and Providers Act, gave HHS the authority to expand the list of covered services so that as new, highly effective procedures are discovered, they can be made available to beneficiaries without having to wait the length of time for Congress to act. This bill wisely builds on the benefit package for seniors and expands it to cover all Americans as part of their insurance coverage. We are expanding prevention and making sure it is available so all Americans will have a better insurance product that will cover preventive services.

Basic screenings can have an enormous impact on health and save money in the long run. Chronic disease incurs a huge cost for our health care system. Today, more than half of Americans live with at least one chronic condition, accounting for 75 percent of all health care spending each year. To bend the cost curve, we need to reduce the onset of chronic diseases before they become much more expensive to treat.

The American Cancer Society reports that the incidence of cervical cancer and mortality rates have decreased by 67 percent over the past three decades. This is mainly attributable to the introduction of the Pap test. The average cost for normal cervical screening in 2004 was $31. In contrast, the treatment for early-stage cervical cancer averaged $20,255, and the treatment for late-stage cervical cancer was almost $37,000. Screening saves lives, saves money. The bill before us invests in prevention. It will save money. It will save lives.

Breast cancer screening has also been shown to reduce mortality. Early-stage diagnosis gives a 5-year survival rate of 98 percent, and statistics compiled by the American Cancer Society indicate that 61 percent of breast cancers are diagnosed at this stage, largely due to mammographies and other early screening methods.

The bill before us guarantees coverage for a number of services to promote public health and wellness and to prevent devastating chronic disease. Some of these measures include providing coverage for everyone for services that have an ``A'' or ``B'' rating by the U.S. Preventive Services Task Force. These tests and screenings are either recommended or strongly recommended and include screenings for osteoporosis, colon cancer, and would be covered with no cost sharing--a strong incentive for people taking advantage of these screenings.

Covering immunizations recommended for adults by the Advisory Committee on Immunization Practices of the CDC is also covered. Preventive care services and screenings for infants, children, and adolescents that are supported in comprehensive guidelines from the Health Resources and Services Administration--all that is in the underlying bill that will save us money and will save us lives.

In addition to these vital services, the women's preventive health services must also be covered, the Mikulski amendment. The Mikulski amendment extends the preventive services covered by the bill to those evidence-based services for women that are recommended by the Health Resources

and Services Administration. HRSA, a division of the Department of Health and Human Services, has as its goal to improve access to primary and preventive care services to uninsured and underinsured individuals.

It focuses on maternal and child health, HIV/AIDS care, recruiting doctors in underserved areas, health care in rural areas, and organ donation. HRSA strives to develop ``best practices'' and create uniform standards of care, including eliminating health disparities among minority populations.

Some of the additional services for women that will be covered under the Mikulski amendment include mammograms for women under 50. In 2000, breast cancer was the most common cancer affecting Maryland women, and nearly 800 women died from the disease, according to the Maryland Department of Health and Mental Hygiene. According to the Kaiser Family Foundation, 76.6 percent of women aged 40 and over had a mammography within the past 2 years. This amendment would ensure that all of these women would have access to mammography with no out-of-pocket cost.

Also covered under the Mikulski amendment are cervical cancer screenings for all women, regardless of whether they are sexually active, and ovarian cancer screenings--all those will be made available under the Mikulski amendment. Ovarian cancer is the fifth leading cause of cancer deaths among women in Maryland. General yearly well-women visits would be covered; pelvic examinations, family planning services, pregnancy, and post partum depression screenings, chlamydia screenings for all women over 25. Chlamydia is the most prevalent sexually transmitted disease diagnosed in the United States. Approximately 4 million new cases of this disease occur each year, and up to 40 percent of the women infected with this disease may be unaware of its existence. It is the leading cause of preventable infertility and ectopic pregnancy.

Also included are HIV screenings for all women regardless of exposure to risk. According to the Kaiser Foundation, among those women who are HIV positive, 33 percent of the women were tested for HIV late in their illness and were diagnosed with AIDS within 1 year of testing positive.

We need to do a better job here. This is International Aids Awareness Day. I think it is very appropriate we have the Mikulski amendment on the floor today.

Studies reported by the Kaiser Foundation indicate that women with HIV experience limited access to care and experience disparities in access, relative to men. Women are the fastest growing group of AIDS patients, accounting for 34 percent of all new AIDS cases in 2001, compared with 10 percent in 1985. So this amendment will help in regard to that issue for our women.

Also included is sexually transmitted infection counseling for all women. Women disproportionately bear the long-term consequences of STDs. Screenings for domestic violence are covered. The Maryland Network Against Domestic Violence reports that one out of every four American women--one out of every four American women--reports she has been physically abused by a husband or a boyfriend at some time in her life. Well, the Mikulski amendment provides screenings for domestic violence.

Also included are overweight screenings for teens, gestational diabetes screenings, thyroid screenings.

Much of the debate on health care reform has focused on quality--how do we make our health care system work better and produce better outcomes for the money we spend. Ensuring that women have access to preventive services that are recommended by experts on women's health is absolutely essential to providing quality care.

This amendment protects the rights of a woman to consult with a doctor to determine which services are best for her and guarantees access to these services at no additional cost. Preventive health care initiatives is one area I hoped we could all agree upon. The Senate has a long history of bipartisan support for women's preventive services. I hope the string remains unbroken with this amendment.

I strongly support the efforts spearheaded by Senator Mikulski to extend the services that are covered for women. I strongly urge my colleagues to support this very important amendment that makes a good bill better. This bill is desperately needed. Let's vote for those amendments that improve it, such as the Mikulski amendment, and let's move forward with this debate.

With that, I yield the floor.

Let me thank Senator Klobuchar for setting the record straight as it relates to the Mayo Clinic. It is interesting, I have had conversations with people at Johns Hopkins University, the University of Maryland Medical Center. I hear the same thing. They desperately want to see health care reform. The cost issues are beyond their ability to maintain the excellence of our health care system. We have to get health care costs under control.

If I might point out, I was listening to my colleagues on the other side give every reason why we should not move forward with the debate, saying: Don't worry, things will be OK. Those were the same arguments they made 15 years ago, which was the last opportunity we had to debate comprehensive health care reform. They blocked it from being on the floor of the Senate 15 years ago.

What has happened in the last 15 years, after they said: Don't worry about it. Everything will be OK. Just keep on with our current system of protecting the private insurance companies. They will do a great job.

In the last 15 years, we have seen health care costs go up, $912 billion, almost a three-time increase. We have seen the per capita cost of health care go from $3,400 to $8,100. We have seen that share of our economy in the last 15 years go from 13 percent of our economy to over 17 percent of our economy. We need to act.

One more number I want to give because it affects Mayo Clinic and affects Johns Hopkins because in many cases they are the provider of last resort, where no one else will give care. Also, the number of the uninsured has increased since 1993 from 39 million to 46 million.

The legislation that is being brought forward by our vote later today will reduce the number of uninsured by 31 million. Mr. President, 98 percent of Americans will be covered by health insurance with this bill. It reduces the growth rate of health care costs in America. It provides an affordable option for every American. This is a critically important bill.

The Senator mentioned small companies. I am glad the Senator did because small companies are the ones that are most discriminated against today in our health care system. They pay 20 percent more for the same coverage as a larger company. They do not have options. They do not have a lot of choices about who they can get to insure them. Not only is the cost so high, the annual increases are unpredictable. How do you run a business, if you are a small business owner, not knowing whether your health care cost is going to go up by 10 percent, 20 percent, or 40 percent in the following year? You cannot.

As the Senator knows, we have had small businesses come before us and tell us they are going to have to decide to eliminate their health care. In one case, we had a small business owner who said: Look, I am going to have to give up my business and start to work for a larger company because I can't afford the health care.

We are at a crisis. I do not understand my colleagues on the other side saying they do not even want to have a debate on this issue, they do not even want to vote so we can take up this issue. Instead, they want to protect the private insurance companies and let them continue to make these profits, continue to cause real problems for our consumers.

I have letter after letter from people who are confronting the problems of private insurance today, where they are denying coverage based on preexisting conditions or not covering a specific drug under their policies. There is no effective way to challenge private insurance companies today. This bill will give the consumers of America a chance against our private insurance companies.

Will my colleague yield?

On the Medicare issue, during the last hour we heard all these people, who for a long time have been trying to privatize Medicare and reduce the program, now saying that Medicare is going to be in jeopardy if this bill moves forward. It is very interesting. The AARP gets it right when it says:

The new Senate bill makes improvements to the Medicare

program by creating a new annual wellness benefit, providing

free preventive benefits, and--most notably for AARP

members--reducing drug costs for seniors who fall into the

dreaded Medicare doughnut hole, a costly gap in prescription

drug coverage.

This bill strengthens our health care system, strengthens Medicare for the future, and that is what is going to be critically important to our seniors.

I thank my colleague.

Mr. President, will the Senator yield for one moment?

I was going to comment, listening to the Senator, at the desk that was Senator Kennedy's desk, how proud he would be of the statements the Senator is making here this evening. Senator Kennedy was our champion for middle-income families in America. He understood they needed a voice in the Senate, and he was their strong, passionate voice.

This bill speaks to middle-income families. It is what Senator Kennedy fought his whole career for here in the Senate, to do something that would help middle-income families.

As the Senator points out, we need to bring down the cost of health care. Health care costs are rising three times faster than wages. Senator Kennedy understood better than any of us that Americans are falling farther and farther behind because of the health care issues, because of health care costs. Private insurance companies can make lots of money if health care costs go up. They are not losing. It is the middle-income families who are getting hurt by the system.

He understood that small businesses could not survive unless we figured out a way to deal with the health care issues. And as to people on Medicare--most people on Medicare are from middle-income families. We need to protect Medicare for the future. That is why, again, I get very concerned when I hear what we have heard over the last hour in the discussions, because one of the principal reasons we need to bring this bill forward on the floor of the Senate tonight is to strengthen Medicare, to make sure it is there for the future, to make sure it stays strong, and to make sure we expand benefits, as we do under this bill.

I thank the Senator because those of us who have heard Senator Kennedy speak on the floor of the Senate know how sorely missed he is here, and we are proud you are representing that vote here on the floor of the Senate tonight.

If the Senator will yield for a moment, as Senator Klobuchar pointed out, if you don't have competition--and Senator Kaufman said the same thing--if you don't have competition, what is your choice? You are going to have to pay the premium.

There was a Washington Post article written about a street in Gaithersburg. Gaithersburg is a growing suburban community not far from here, certainly middle-class families. They think they are doing fairly well. It talked about one street in Gaithersburg, and they gave half a dozen stories about people--real stories--about people having problems with our current system. They talk about Patty, who has private insurance and thought she was in good shape. She talks about having to search a book in order to find out what doctor she could go to to stay in the network because it is too expensive to go out of network, and then she hits her deductible and finds that her fees and copayments come in fast and strange, making it unaffordable for her with her current insurance coverage. She has no other choice. That is the only insurance she can get.

Two doors down the road is Chuck who needs oxygen, needs certain medicines. He had to fight with his insurance company to get the prescription drug covered. He got the prescription drug covered, only to find out the nurse who administered the drug was not covered, and it cost $400--another problem with a private insurance company.

Across the courtyard, Will and Sarah, they have insurance today. They are going to lose it because he

just lost his job, and he has no prospect for being able to afford insurance.

The last one is Martha. This is a very interesting one. Martha went to the emergency room for delivery of her child. She needed an epidural. She made sure she went to a hospital that was in-network because she wanted to make sure it was covered. Guess what. That anesthesiologist she had no control over was not in-network and she had to pay all that extra money. Again, no choice. She had no choice in the system. There is no competition.

I know we have Senator Kirk here who is our newest Member. Perhaps the Senator could tell us what he is hearing from Massachusetts. He is a new Member here. I don't know whether he is getting the same stories of what is happening in his State.

That is the interesting point. These are all real stories, people who are being denied health care today because of arbitrary practices from private insurance companies or the way our system is currently organized.

The vote tonight is a pretty simple vote. If you think the current system is what you want, OK, I understand why you are voting against cloture. I understand that you say the status quo is fine; we don't even want to debate the issue; we don't care about the people who have been affected by the arbitrary actions of private insurance companies and saying that pregnancy and childbirth is a ``preexisting condition'' or when you are using over-the-counter drugs to keep your cholesterol under control and the insurance company says that was a preexisting condition.

All we are saying tonight is: Is this worthy of debate on the floor of the Senate--a clear vote? Those who vote for cloture say this is worthy. The people who have written us these letters are entitled to have the Senate take up this issue. That is why we point out that there are numerous groups, including the American Medical Association, that say vote for cloture, let's have this debate before the American people.

We are running out of time, with only a few more minutes left. I want the people in Maryland and of the Nation to understand what this vote means. We are going to bring an amendment to the floor of the Senate for debate. Any Senator will be able to offer an amendment to how we should advance health care. The Senator from Massachusetts is absolutely correct. We are either going to continue to see our health care system with more people being denied coverage, with the costs escalating much faster than our economic growth, with businesses having to decide to terminate plans--that is what is going to happen--or we can take up health care reform and try to rein in the practices of private insurance companies and provide a way where every American can get access to affordable health care. That is why the American Cancer Society Cancer Action Network says:

The American Cancer Society Cancer Action Network urges all

Senators to vote in favor of allowing critical health care

legislation introduced by Senator Harry Reid this week to be

debated on the Senate floor. With thousands of cancer

patients being denied coverage, charged excessive premiums,

and facing exorbitant out-of-pocket costs, it is urgent that

the Senate take action now, not later, to protect and extend

health coverage to millions of Americans in need.

Last week, Cynthia and Eric Cathcart were here in the Senate. They are two people who are self-employed. They cannot even get an insurance policy to cover their family. They have to have two separate policies, with two deductibles and two premiums, and they cannot afford it. We must take up this issue for the Cathcarts and the millions of Americans who cannot make it under this current system. Middle-income families are depending upon us tonight.

AARP not only wants us to advance the bill; they support the bill. They believe this bill will improve the Medicare system, make it stronger, and provide additional benefits, particularly in reducing the dread Medicare doughnut hole. They want the Members of the Senate to vote to allow this bill to come to the floor.

Mr. President, shortly we will have an opportunity to vote on moving forward and considering health care reform in this country. I thank the majority leader, Senator Reid, for putting together the bill that came out of our two committees that accomplishes what I think are the three goals we need to accomplish in health care reform. I have been asked by the people of Maryland whether I would support a particular bill. I told them in order for me to vote for a bill, it has to do three things: First, it needs to bring down the cost of health care in America; second, it needs to provide an affordable quality insurance option to every American; and, third, it must be done in a fiscally responsible way.

The bill Senator Reid is bringing forward accomplishes those three goals. First, it brings down the cost of health care in America by about $1 trillion. It does it by investing in prevention and healthy lifestyles; by cracking down on fraud, waste, and abuse; and by eliminating unnecessary administrative costs in our health care system. That is the way we should bring down health care costs in America. That will improve quality but bring down costs.

Second, this bill allows every American to have access to affordable health insurance and health care. The Congressional Budget Office estimates the bill will reduce the number of uninsured in America by 31 million. We will be able to get 98 percent of Americans who are in this country legally, citizens, covered by health insurance as a result of this legislation.

Third, this bill moves forward in a fiscally responsible way by not only staying within our budget but by actually reducing our budget deficit by $127 billion with no new tax burdens on middle-income families.

I am particularly pleased this bill will help middle-income families in America. Mr. President, I know you have received letters from your constituents. I have received letters from my constituents that tell us the status quo is unacceptable for middle-income families in America.

Let me give two examples of people who wrote to me. I got hundreds of letters from Marylanders telling me they cannot make it under the status quo. This is from Meg, from Rock Hall, MD. Rock Hall, MD, is on the eastern shore. She is a healthy, active 62-year-old woman. She plays tennis four times a week. She is not on prescription medicines and has never had a major medical issue.

She wanted to change her insurance coverage. She has insurance, but she wanted to go to a more affordable insurance plan for her family. She was denied coverage. Why? Because she had received counseling 3 years earlier due to a stressful family situation and because she had a slightly elevated cholesterol level. Her cholesterol has been brought under control taking over-the-counter medication, and she has not had counseling in over a year.

She writes to me, and how do I answer that? It says:

If I am considered high-risk, where does that leave

Maryland residents who have serious health conditions, are on

medications, or require on-going care?

Meg is absolutely right. The bill the leader is bringing forward will deal with middle-income families such as Meg's by telling health insurance companies they cannot participate in such discriminatory practices, by restricting preexisting conditions. In fact, Meg doesn't have preexisting conditions, but they are using that to deny her full coverage.

Earlier this week, Cynthia and Eric Cathcart came to us, came to this Capitol to tell us their stories. I must tell you, I was shocked to hear of their circumstance.

Here are two individuals who are self-employed, trying to make it. They have two children. They are trying to get along. Eric told us he is basically giving up on his business and is going to have to work for a larger company because he can't afford health insurance. Cynthia, who is a piano instructor, tells us the same story. Listen to this.

Here are a husband and wife, two children, and they cannot get an insurance policy to cover their whole family because of the preexisting condition restrictions. These are small business owners who are going to have to literally give up their businesses.

Today they have two separate insurance plans: one for the husband and child, one for the wife and child, because that is the only way they can get it. They have to pay two separate deductibles because they couldn't get an insurance plan to cover the family. The amount of money they are paying for health insurance is prohibitively expensive.

The status quo is not acceptable for the Cathcarts and should not be acceptable for any of us. Under the health care bill the leader is bringing forward, though, discriminatory practices by private insurance companies would be prohibited, and the Cathcarts would have the option of a lot of different plans they could choose from to cover their entire family without separate deductibles for different members of their family.

That is the type of health care reform we need that will help middle- income families in America. It will help middle-income families by bringing down the cost of health care. The cost of health care in America is growing at way too fast a rate. Ten years ago in Maryland it cost an average family about $6,000 for health insurance. Maybe their employer paid part; maybe they paid part. Today that is $12,000 a family. By 2016 it will be $24,000 a family if we do not take action. We need to help middle-income families. We need to move forward with health care reform.

The average family in Maryland today is paying $1,100 per family for the cost of those who do not have health insurance. Those who have health insurance are paying for those who do not have health insurance.

That is why the bill the leader is bringing forward, that will cover 98 percent of Americans, is going to help middle-income families by eliminating that hidden tax of $1,100 per family in Maryland and around the country.

Health care costs are growing three times faster than wages are growing in America. Inaction should not be an option.

For small businesses the situation is very dire. They are spending 20 percent more than a comparable company that does the same business that is larger. Just as stressful, they cannot predict what the annual premium increase is going to be. How can you run a business without knowing what your costs are going to be from 1 year to another? For the sake of small businesses we need to move forward with health care reform.

A lot of families in Maryland depend upon Medicare; a lot of middle- income families in Maryland depend upon Medicare. This bill will strengthen Medicare by dealing with the underlying costs of health care, by getting that under control. At the same time we protect Medicare for the future, we provide additional benefits for our seniors by starting to close the doughnut hole, getting prescription drug costs under control, and providing preventive care for our seniors. This legislation will help middle-income families by dealing with insurance reform and eliminating preexisting conditions. It will provide larger pools to offer more choice for middle-income families.

This legislation will help workers who work for small companies. It will help those people in our community who have preexisting conditions. It will help those people in our community who are changing jobs. It will help those in our community who depend upon Medicare. This is legislation that is critically important for middle-income families in America.

The status quo is unacceptable. We need to act, and we are going to have a chance to do that when we vote Saturday on proceeding with health care reform. I urge my colleagues to move forward on this vital legislation for America.

I yield the floor.

The PRESIDING OFFICER . The distinguished Senator from Utah is recognized.

Will my colleague yield on that point?

Let me point out that much of the insurance reform takes effect immediately. The preexisting conditions are dealt with immediately. The larger pools for those who can't find health coverage, that is done and implemented immediately.

Mr. President, as we prepare to depart for the Thanksgiving break, I wish to thank those who work to combat hunger in this country and to commend the administration for its goal of eliminating child hunger by 2015. I encourage the administration to work with Congress to find solutions to achieve this goal and end hunger in America.

We must commit ourselves to solving this crisis. The U.S. Department of Agriculture has just released findings that 14.6 percent of Americans were ``food insecure,'' up from 11.1 percent in 2007. Food insecurity is measured by the number of persons who experience hunger at some point during the year because they could not afford enough food.

The Agriculture Department also found that one-third of these households had what the researchers called ``very low food security,'' which mans that they were forced to skip meals or cut portions. The other two-thirds of households got by only through reliance on food stamps, soup kitchens, and food pantries.

The nearly 4 percent increase in food insecurity between 2007 and 2008 is the largest since USDA began reporting hunger statistics in 1995. Even more disturbing, USDA reports that nearly 17 million children live in households where food was scarce at some point during the last year. This figure amounts to more than one out of every five children in the United States.

An astonishing 1.1 million children went to sleep hungry at some point in 2008--a 36-percent increase from 2007. In my State of Maryland, more than 135,000 children currently live in food insecure households. Sixty-three thousand of these children are under the age of 5.

No child should ever know what it means to be hungry. Childhood hunger hinders development in the long term, and children who are hungry have difficulty learning and are at much higher risk to be in poverty as adults. Hunger negatively affects children's behavior, school performance, and cognitive development.

As we celebrate this holiday season, it is important to reflect on how each of us can support our communities. In my home State, the employees and volunteers at the Maryland Food Bank provide 14 million pounds of food annually to those in need. Working with more than 1,000 partner organizations, including soup kitchens, senior centers, daycare centers and afterschool programs, the food bank works to fill unmet needs of Maryland families. In these difficult economic times, the services of the Maryland Food Bank are more important than ever.

During the past year, the staff at the food bank's facilities in Baltimore and Salisbury saw demand increase by 50 percent. Middle-class families who a year ago made donations to the food bank are now turning to the organization to put food on their own tables.

Americans with full-time jobs are the fastest growing cohort of those in need. As unemployment continues to rise, families are being forced to spend their savings and are too quickly moving from middle to low income. America's working poor are most at risk. They live from paycheck to paycheck and have no safety net if their company downsizes or their hours are cut. When money is short, Americans are forced to make excruciating choices.

It is estimated that one-third of Marylanders relying on food assistance must choose between buying food and paying utility bills. Fifty-three percent of those who receive food assistance have unpaid medical bills. The number of working poor families in Maryland is 70 percent higher than it was two decades ago.

In addition to the food bank, I also want to highlight the work of employees at the many social service agencies across our State. These dedicated workers devote their time and energy to helping their community and work side-by-side with the Maryland Food Bank and other organizations to provide meals and services to those in need.

For example, the Maryland Department of Education works closely with the Maryland Food Bank on several projects that provide students with nutritious meals. More than 303,000 Maryland children rely on free or reduced-price meals in schools. Through the Backpack Program, the food bank provides schools such as Baltimore Highlands Elementary with backpacks filled with food. Children receive the backpacks on Friday afternoons to ensure they are not hungry over the weekend.

Kids Cafe is an innovative partnership between the food bank, the Maryland Department of Education, and local afterschool programs that provides nutritious meals and teaches children how to make healthful food choices.

Our seniors are also at risk of food insecurity at much higher levels than the general population. I applaud efforts such as the SNAP Outreach Program in Maryland, which is a partnership between the USDA and local organizations to help register seniors for food assistance programs.

Despite these efforts, we need to do more. In my State alone, it would take 82 million pounds of food to support the more than 350,000 Marylanders in need every year.

We must recommit ourselves to serving our communities and work together to support those in need during these difficult times.

So as Senators and staff leave Washington for their home States and prepare to give thanks and enjoy the company of family and friends, I encourage us all to show our support for those who work daily to make mealtime possible for millions of Americans in need.

Mr. President, I was pleased to meet with the Ecumenical Patriarch, Bartholomew I, again last week during his visit to Washington. Together with the congressional leadership, we heard his impassioned call for support for the reopening of the Theological School of Halki, an institution that has come to symbolize many of the difficulties faced by the Patriarch, the remnant of the Greek community in Turkey and other religious and ethnic minorities in that country.

I had the pleasure to meet Bartholomew I during an official visit to modern-day Istanbul in 1998. He impressed me as a man of good will, anchored in his deep personal faith, seeking to promote understanding, justice and respect for the human rights and dignity of each individual, the very qualities that prompted the Congress a year earlier to award him the Congressional Gold Medal. Indeed, his leadership extends well beyond the borders of Turkey to the Orthodox community around the world.

The Ecumenical Patriarch repeatedly returned to the issue of the Halki Seminary in various meetings during his U.S. visit, including at this oval office meeting with President Obama. Earlier this year, several of my colleagues from the Commission on Security and Cooperation in Europe, which I chair, joined me in a letter to the President underscoring our longstanding concern over the continued closure of this unique institution.

Founded in 1844, the Theological School of Halki, located outside modern-day Istanbul, served as the principal seminary for the Ecumenical Patriarchate until its forcible closure by the Turkish authorities in 1971. Counted among alumni of this preeminent educational institution are numerous prominent Orthodox scholars, theologians, priests, and bishops as well as patriarchs, including Bartholomew I. Many of these scholars and theologians have served as faculty at other institutions serving Orthodox communities around the world.

While over the years there have been occasional indications by the Turkish authorities of pending action to reopen the seminary, to date all have failed to materialize. In a potentially promising development, Turkey's Prime Minister, Recep Tayyip Erdogan, met with the Ecumenical Patriarch in August. In an address to a wider gathering of minority religious leaders that day, Erdogan concluded by stating, ``We should not be of those who gather, talk and disperse. A result should come out of this.''

I urge Prime Minister Erdogan to follow through on the sentiment of those remarks by actions that will facilitate the reopening of the Halki Seminary without condition or further delay. As Chairman of the Helsinki Commission,

I am particularly mindful of the fact that the continued closure of the Theological School of Halki stands in clear violation of Turkey's obligations under the 1989 OSCE Vienna Concluding Document, which affirmed the right of religious communities to provide ``training of religious personnel in appropriate institutions.''

At a time when Turkey is seeking to chart a new course, the resolution of this longstanding issue would not only be a demonstration of Ankara's good will, but, as President Obama mentioned in his address to the Turkish Grand National Assembly in April, will send such an important signal inside Turkey and beyond. I remain hopeful and encourage Prime Minister Erdogan to act decisively and without condition on this matter before his upcoming visit to Washington in early December.

To underscore the importance attached to the reopening of the Theological School of Halki and our solidarity with the Ecumenical Patriarch, I am pleased to introduce a resolution on this issue together with Mr. Brownback, Mr. Reid, * * *

Madam President, I wish to pay special tribute to Senator Robert C. Byrd. Today, Senator Byrd becomes the longest-serving Member in the illustrious history of the U.S. Congress. What an amazing accomplishment! He already holds the distinction as the longest-serving Senator, and is the only Senator in U.S. history elected to nine full terms.

Considering that Senator Byrd won his first election, to the West Virginia House of Delegates, in 1946, it may be that he is the longest- serving elected official in history--period.

When Robert Byrd was elected to the Senate in 1958 after serving in the House for 6 years, he was part of a large, distinguished class that included such future giants as Hugh Scott, Gene McCarthy, Edmund Muskie, and Philip Hart (D-MI). He has surpassed them all.

According to the Senate Historical Office, Robert Byrd was the 1,579th person to become a U.S. Senator. Since he was elected to the Senate, another 334 individuals have become U.S. Senators. All in all, Robert Byrd has served with over 400 other Senators. And I am certain that all of them have held their colleague, as I do, in the highest esteem.

Senator Byrd's modest beginnings in the hard-scrabble coal fields of Appalachia are well known. Suffice it to say that his life is the quintessential American success story.

I think every young American should learn about Senator Byrd's life as an example of what hard work and persistence and devotion can accomplish in this country.

Senator Byrd married his high-school sweetheart, Erma Ora James, shortly after they both graduated from Mark Twain High School in 1937. He was too poor to afford college right away and wouldn't receive his degree from Marshall University until 60 years later when he was 77. In between, he did something no other Member of Congress has ever done: he enrolled in law school at American University and in 10 years of part- time study while serving as a Member of Congress, he completed his law degree.

Senator Byrd was married to his beloved Erma for nearly 69 years, and has been blessed with two daughters, six grandchildren, and seven great-grandchildren.

During his Senate tenure, Robert Byrd has been elected to more leadership positions than any other Senator in history. He has cast 18,585 rollcall votes. Only 28 other Senators in the history of the Republic have cast more than 10,000 votes; Strom Thurmond is the only other Senator to cast more than 16,000 votes. Senator Byrd's attendance record over the past five decades just under 98 percent is as impressive as the sheer number of votes cast he has cast.

Senator Byrd's legislative accomplishments, from economic development and transportation to education and health care, are legendary. It is no surprise that he has won 100 percent of the vote of West Virginians in a previous election, 1976, or carried all 55 of West Virginia's counties.

In the meantime, he has written five books, including the definitive history of the U.S. Senate.

Perhaps the highest tribute to Senator Byrd can be found in his biographical section of the ``Almanac of American Politics,'' which states: ``Robert Byrd may come closest to the kind of senator the Founding Fathers had in mind than any other.'' His fealty to the U.S. Senate and to the Constitution has served as an inspiration, a lesson, and a guiding light to all of us who have been privileged to follow him in this chamber.

Robert E. Lee said, ``Duty is the most sublime word in our language. Do your duty in all things. You cannot do more. You should never wish to do less.'' Senator Robert C. Byrd has done his duty in all things-- to himself, to his family, to his State, to his Nation, and to God.

I am honored to join his and my colleagues here in the Senate, West Virginians, and all Americans in paying tribute to this great Senator and this great man.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Amendment No. 2748, as Modified

I suggest the absence of a quorum.

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

Madam President, I ask unanimous consent to speak as in morning business for up to 10 minutes.

Madam President, this Congress has taken a giant step forward in our effort to reform the Nation's health care system. Saturday evening, the House of Representatives passed its bill, which is estimated by the Congressional Budget Office to provide affordable health coverage to 96 percent of Americans while reducing our deficit by $109 billion over the next 10 years.

On behalf of the 760,000 uninsured Marylanders and the countless more who are underinsured or facing huge premium increases next year, I am encouraged by my colleagues' success, and I look forward to debating this most important issue here in the Senate in the weeks ahead.

Today, I rise to discuss an issue that has received scant attention on the floor of the Senate, and that is health disparities. It is an issue directly affecting 1 out of every 3 Americans: the 45 million Latinos, 37 million African Americans, 13 million Asians, 2.3 million Native Americans and Alaskan Natives, and 400,000 Hawaiians and Pacific Islanders in our Nation. While they represent one-third of our Nation's population, they are fully one-half of the uninsured. So when we enact legislation that expands access to millions of uninsured Americans, it will make a difference in minority communities, in overall minority health, and in the health of our Nation.

But it is not enough to just get people health insurance coverage. Research tells us that even after accounting for those who lack health insurance, minority racial and ethnic groups face inequities in access and treatment, and they have adverse health care outcomes at higher rates than Caucasians.

That is right, even when insurance status, income, age, and severity of conditions are comparable, racial and ethnic minorities tend to receive lower quality health care, so coverage is not enough.

Despite many attempts over the years by health policymakers, providers, researchers, and others, wide disparities still persist in many facets of health care. When it comes to equitable care for minorities, low income, geographic, cultural and language barriers, and racial bias have been found to be common obstacles. These inequities carry a high cost in terms of life expectancy, quality of life, and efficiency.

And they cost our Nation billions of dollars each year. Researchers from Johns Hopkins University and the University of Maryland found that between 2003 and 2006, racial and ethnic disparities cost the Nation more than $229 billion in excess direct medical costs.

Adding in indirect costs reveals a staggering $1.24 trillion from lost wages and premature and preventable deaths and disabilities. By elevating the focus on health disparities, we can bring down these costs and improve the quality of care across the board. So health disparities should matter to us

all, in terms of improved value for our health care dollars, both public and private.

If we are to improve the health care status of America, we must focus on these inequities and make a concerted effort to eliminate them. There is no better place to commit ourselves to that effort than in the health reform legislation that we are about to consider. There is no better time to begin than right now.

Examples of grim health disparities are found in all racial and ethnic minority groups and across a broad range of diseases and conditions. The overall life expectancy for African Americans is 5.3 years less than Whites, but as the Kaiser Family Foundation has reported, health disparities begin even before birth.

The use of prenatal care varies widely by race, with 88 percent of White mothers receiving care in the first trimester of a pregnancy, but only 76 percent of Black mothers and 77 percent of Latino mothers.

This disparity is evident at birth, when Black women experience preterm births at a rate 50 percent higher than White women--18.5 percent compared to 11.7 percent, and the rates of low-birth weight babies are also higher among Black babies--14 percent, compared to the 8.3 percent national average.

In August of 1967, 8 months before his assassination, Martin Luther King addressed the Southern Christian Leadership Conference's Tenth Anniversary Convention in a speech entitled, ``Where Do We Go from Here?''

He said that to answer that question:

We must first honestly recognize where we are now. When the

Constitution was written, a strange formula to determine

taxes and representation declared that the Negro was sixty

percent of a person. Today another curious formula seems to

declare that he is fifty percent of a person. ``Of the good

things in life, the Negro has approximately half those of

whites. Of the bad things in life, he has twice those of

whites.

He goes on to discuss housing, income, and employment rates, before saying, ``the rate of infant mortality among Negroes is double that of whites.'' Today, in 2009, the Kaiser Family Foundation reports that the overall rate of infant mortality in the United States is 6.9 deaths per 1,000 live births, a white infant mortality rate is at 5.7 deaths, but African Americans have an infant mortality rate more than twice that of Whites at 13.6 infant deaths per 1,000 live births.

So 46 years after Dr. King's ``I Have a Dream'' speech, and 41 years after his death, we have not made progress in closing the gap in infant mortality.

There is no other way to put it: this is a crisis, it has been a crisis for decades, we have known it, and we have failed in our response.

Health disparities continue through life, and the data cut across diagnoses and conditions. These are just a few of the statistics:

African-American children have a 60 percent higher rate of asthma than White children and visited the emergency room for asthma related services 4.5 times more often than White children in 2004.

The incidence of diabetes is nearly twice as high in African Americans as in Whites. Complications from diabetes and death from the disease are also higher in African Americans, and the rate of hospital admissions for uncontrolled diabetes for African Americans and Latinos is nearly 5 and 3 times, respectively, the rate for Whites and Asians.

High blood pressure accounts for 18 percent of the Nation's overall death rate, but 41 percent of deaths in African-American women and 50 percent of deaths in African-American men are attributed to hypertension.

Regarding early detection of colon cancer, African Americans, Asians, Native Americans and Latinos over age 50 all have lower rates than Whites when it comes to receiving any form of colon cancer screening. This disparity increased between 1999 and 2006.

Incidence of, and death rates from, kidney cancer in Native Americans and Alaska Natives are higher than in any other racial or ethnic group.

Native Americans and Alaska Natives die from heart disease much earlier than the overall population--36 percent are under age 65 compared with only 17 percent for the U.S., according to the American Heart Association's data.

Perhaps the greatest disparities are in the rates of HIV and AIDS. African Americans experience an AIDS case rate nearly 10 times that of Whites: 60.1 per 100,000 adults and adolescents, compared to 6. per 100,000 for Whites. Latinos and Native Hawaiians and other Pacific islanders have an AID case rate nearly 3 times that of Whites, at 20.4 per 100,000.

Disparities also affect oral health care, which--as I have discussed on the floor before--is an integral part of overall health care--and without which, patients cannot have good overall health. Regardless of age, minorities are less likely than Whites to have visited a dentist in the past year. The percentage of people who had untreated dental disease is substantially higher for African Americans and Latinos than for Whites, and the prevalence of periodontal disease is 2.5 times greater for Native Americans and Alaskan Natives than for Whites. We know that periodontal disease leads to heart disease, brain infections, and other serious illnesses.

Last year, the American Journal of Public Health published research showing the vast disparities in mortality rates. Using data for the decade between 1991 and 2000 from the National Center for Health Statistics, the researchers, including Dr. David Satcher, the 16th Surgeon General of the United States, found that the mortality rate for African-American infants and adults aged 25 to 54 years was more than double that of Whites.

Had the mortality rates of the two races been comparable during that decade, the researchers calculate that 886,202 deaths could have been averted.

Let me repeat that--the lives of nearly 900,000 African Americans could have been lengthened and the quality of life improved for many more if we had been able to close the gaps in health disparities.

This chart illustrates the higher death rate observed among African Americans across Maryland and the United States, based on Centers for Disease Control and Prevention data, for the years 1999 to 2003. The striped bar shows that in the U.S., African Americans had a 31.5 percent higher death rate from all causes of disease than Whites.

Maryland has a comparable discrepancy at 30.8 percent, shown by the red bar. The number of excess deaths varies by county, with the lowest discrepancy in death rates in Charles County--4.1%--and the highest discrepancy in Talbot County--64.5%.

We cannot afford to wait. We need action at every level: local, State, and Federal, but the leadership must come from the Secretary of Health and Human Services. HHS will need a strengthened institutional capacity to achieve these goals.

Codifying the Office of Minority Health and elevating it to report directly to the Secretary will empower the agency to continue its important work--protecting and improving the health of racial and ethnic minority populations, advising the Secretary of HHS on the needs of minority communities, coordinating and supporting research and demonstration programs, and supporting the community organizations that enhance outreach and education efforts. These offices will be able to promote activities related to disease prevention, wellness, access to care, and research related to racial and ethnic minorities with the goal of reducing and eliminating disparities.

The offices will be authorized to administer grant programs and also help train health professionals to care for diverse populations. The bill passed by the House on Saturday includes a provision to codify the Office of Minority Health.

I will be working to expand that provision in the Senate bill so that it reflects concerns echoed by many health advocates and provider groups across the nation who know that we must marshal the resources necessary to eliminate disparities.

The bill reported by the HELP Committee contains many important provisions, including section 221, which would codify and increase the authority of the Office of Women's Health across several agencies in HHS. I believe strongly that the Office of Minority Health should receive the same prioritization that the Office of Women's Health is set to receive, particularly in light of the vast amount of data documenting racial and ethnic

disparities. This is really an issue of equality in the efforts to achieve health equity. As we champion efforts to achieve equity in women's health, let us also do the same for minority health.

I will also be working to ensure the codification of the Office of Minority Health at HHS and the network of minority health offices throughout the Department's various agencies.

I will close with another quote from Dr. King, who said that ``of all the forms of inequality, injustice in health care is the most shocking and inhuman.'' As with other forms of inequality in America, it is within our power to change it, and I ask my colleagues to join me in the quest to do so without further delay.

Madam President, I would like to address the concerns stated by the Senator from Oklahoma, Mr. Coburn, and the Senator from Alabama, Mr. Sessions, about Judge Davis's record when it comes to criminal cases. His concerns seem primarily rooted in six criminal case reversals that appear in Judge Davis's record. As a Federal judge over the past 14 years, Judge Davis has presided over approximately 5,300 cases. Of that number, Judge Davis has presided over approximately 4,300 cases that went to verdict or judgment based on a trial or decision he made. My colleagues are focusing on just a handful of cases to argue that Judge Davis should not be elevated to the Fourth Circuit.

While the number of reversals on criminal evidentiary matters appearing in Judge Davis's record that my colleague has mentioned is small, Judge Davis has directly addressed Senators' questions related to each of these reversals, expressing his commitment to applying the law to the facts impartially and fairly, while respecting the role of the appellate courts in our judicial system and their decisions in all cases. Following his confirmation hearing in the Judiciary Committee in April, which I chaired, our committee reported him out favorably with a strong bipartisan vote of 16 to 3. This overwhelming, bipartisan approval indicates that Judge Davis is well-qualified to be a U.S. Circuit Judge for the Fourth Circuit. Out of the 5,300 cases over which Judge Davis has presided, these six cases are hardly cause for the concern my colleagues have expressed. Later I want to also mention some criminal cases in which Judge Davis's stiff criminal sentences were upheld by the Fourth Circuit, along with convictions obtained after jury trials. However, to make the record clear, I will review in detail Judge Davis's responses to some of the half a dozen cases noted by my colleagues.

In US v. Bradley, Judge Davis accepted several plea agreements with the defendants, who ultimately pleaded guilty but later, on appeal, argued that their pleas were not voluntary because the court impermissibly participated in pleas negotiations. The Fourth Circuit did ``not suggest that [Judge Davis] improperly intended to coerce involuntary guilty pleas,'' but found plain error and remanded the case for assignment to a different district judge. Upon questioning by the committee, Judge Davis said that he became involved with--but did not interfere with the plea process--at the invitation and encouragement of defense counsel. He ultimately concluded that he shouldn't have gotten involved with the process at all. He said he believed, with the benefit of hindsight, that his involvement in facilitating the guilty pleas in this case was inappropriate and that the Fourth Circuit was correct to say so.

In US v. Custis, Judge Davis granted the defendant's motion to suppress evidence discovered in a residential search on the grounds that the warrant was defective and insufficient. The Fourth Circuit reversed, holding that probable cause supported the warrant. While Judge Davis told the committee he does believe he read the affidavit in a common sense manner, he fully accepts the appellate court's ruling in this case.

In US v. Kimbrough, Judge Davis said he accepts the appellate court's ruling rejecting his legal conclusion that the police permitted the defendant's mother to question him under circumstances which the police couldn't have done so without first administering customary warnings. He agrees that warnings are required only when official interrogation takes place, but not when private interrogation takes place.

In US v. McNeill, Judge Davis granted a motion to suppress the defendant's confession on the grounds of an unlawful arrest. Judge Davis explained to the committee that the principal issue before him was whether, for a warrantless misdemeanor arrest, the fourth amendment required that the misdemeanor be committed in the officer's presence. He concluded that the answer was ``yes'' in this case, and that no misdemeanor had been committed in the officer's presence as of the moment of arrest. While Judge Davis explained that the Fourth Circuit's holding presented an argument and precedent that had not been presented to him, he fully accepted the appellate court's ultimate ruling in this case.

In US v. Dickey-Bey, Judge Davis also suppressed evidence arising out of the interception of cocaine by police for lack of probable cause to arrest the defendant. He has told us that he fully accepts the appellate court's rejection of his legal conclusion that the evidence presented at the hearing on the motion to suppress was insufficient, and remains committed to adhering to the fourth amendment requirement to make commonsense assessments of objective facts, taking into account the totality of the circumstances.

I found Judge Davis's responses to the Judiciary Committee's questions

about these six criminal cases to be candid, honest, and forthright. Judging by the overwhelming bipartisan support for his approval in the Judiciary Committee, so did many of my colleagues, on both sides of the aisle. Judge Davis has told us that in every case that has ever come before him, and there have been over 5,300 of them, he has done his best to determine the facts and to apply the law to the facts impartially and fairly.

Indeed, among the 5,300 cases that Judge Davis has presided over, he has a clear record of using a moderate and fair approach to criminal cases. He has presided over numerous important criminal trials that have resulted in convictions affirmed by the Fourth Circuit, and he has also granted motions to suppress evidence obtained in violation of the rights of the accused. So let's look at his record more broadly to get a clearer picture of his many years on the bench.

For example, in US v. Ulrich, Judge Davis handed down convictions for four defendants for mail fraud in connection with a real estate flipping scheme, a ruling that was affirmed by the Fourth Circuit in June 2007. In 2001, in US v. Montgomery, the Fourth Circuit affirmed his convictions related to a 10-week, multidefendant trial in a narcotics conspiracy prosecution. In 1998, the Fourth Circuit affirmed his conviction handed down in a murder prosecution in US v. Gray.

As a Fourth Circuit Judge, Judge Davis has expressed that he will follow the precedents of the Supreme Court and the circuit, and will continue to apply the law to the facts of each case impartially and fairly. His record as a district judge clearly bears out this commitment.

I thank my colleagues for supporting this nomination.

Madam President, let me first compliment my colleague, Senator Mikulski, for her leadership in bringing forward the nomination of Judge Davis to the circuit court of appeals. I join her in her comments about the fall of the Berlin Wall, the importance that meant not just for Europe. The Berlin Wall represented not only a divided city, a divided country, but a divided continent. And the fall of that wall that we commemorate of 20 years

ago has significance well beyond that one city.

I was privileged to be in Berlin as the wall came down and will never forget those moments.

It is also nice to see my colleague on the Senate floor without the need of any aid. She has been a fighter all of her life. She has been a fighter during this episode. She never missed a beat as far as representing the people of Maryland.

But I particularly want to point out to my colleagues how proud I am of Senator Mikulski for the manner in which she has handled judicial appointments in our State. She is interested, as I am, in getting the very best on our Federal courts, and in the process that was set up for us to make recommendations to the President and make recommendations to our colleagues on the confirmation of judges from those who apply from Maryland. This represents an open process, a process that encourages our very interest to apply and become Federal judges, and one that is solely aimed at getting the very best talent onto our Federal courts.

That is certainly true with Judge Davis. It is certainly true with that nomination. Judge Davis had a hearing before the Judiciary Committee in April. In June, our committee reported him out favorably with a strong bipartisan vote of 16 to 3.

I am not going to go through all of the points that Senator Mikulski raised as far as his background. But I do want to underscore a few points I think are very important in the filling of this particular judicial position.

Judge Davis has strong roots in Maryland. This is a Maryland seat on the Fourth Circuit. He was born in and raised in Baltimore. He is still a resident of Baltimore. Judge Davis has an exceptional record of legal experience in our State, including working as an assistant U.S. attorney, as a State district court judge, as a State circuit court judge, and now as a U.S. district judge.

He received his bachelor's degree from the University of Pennsylvania and graduated cum laude with his J.D. degree from the University of Maryland School of Law where he still teaches classes as an adjunct faculty member.

He served as a district judge for the U.S. District of Maryland since his Senate confirmation in 1995. You see Judge Davis has deep roots in Maryland and deep roots in the judicial branch of government.

He has a longstanding record that he has demonstrated in protecting civil rights and liberties. I agree with my colleague, Senator Mikulski, that one of the principal standards we want to see in judges on our courts is an understanding of our Constitution and the protection it provides our citizens. That is particularly important on our circuit court of appeals.

To give you one example of Judge Davis's record in protecting the rights of our people, this was a landmark decision on civil rights, Reid v. Glendening, where Judge Davis ruled that the Baltimore City Courthouses were not wheelchair accessible, in violation of the Americans with Disabilities Act. He then ordered the city and State to create a plan to make the buildings accessible.

I think that is pretty gutsy when we realize that some of the support our judiciary needs comes from local government. Yet Judge Davis did what was required under our Constitution.

He has been praised by lawyers in Maryland as a smart, evenhanded, fair, and open-minded judge. He has served as a judge for 22 years. He has handled somewhere around 5,300 cases. Judge Davis received a ``well qualified'' rating from the American Bar Standing Committee on the Federal judiciary.

If confirmed, Judge Davis would be the third African-American judge to serve in the Fourth Circuit, which has one of the highest percentages of minority populations of any circuit in the country.

As my colleague pointed out, the Fourth Circuit has one of the highest vacancy rates of any court, any circuit in our Nation. Five out of the fifteen seats are vacant, which constitutes one-third of the appellate court. Indeed, Judge Davis is a replacement for Judge Francis Murnaghan, who died in August of 2000.

Judge Murnaghan also had a lifelong record as a Maryland resident who served on the Federal bench for 20 years and was one of the most respected lawyers and judges in our State. Judge Davis served as a law clerk for Judge Murnaghan on the Fourth Circuit from 1979 to 1980. So I think this is a very appropriate appointment.

I am proud to join the senior Senator from Maryland, Ms. Mikulski, in recommending to our colleagues the confirmation of Judge Davis. We believe he will continue the great tradition, the great record he has established as a Federal judge, as a State judge, and he will continue that when confirmed by this body to serve on the Circuit Court of Appeals for the Fourth Circuit.

We are proud to recommend his confirmation to our colleagues. With that, I see that the senior Republican on the Judiciary Committee, Senator Sessions, is on the Senate floor.

I yield the floor.