Floor Statements

I thank my colleague from Rhode Island because I couldn't agree more with what he just said in terms of who is standing between, in this case, a woman and her doctor or any patient and their doctor.

Right now, I assume the Senator would agree with me that the first person, unfortunately, the doctor may have to call is the insurance company to see whether he can treat somebody, to see what it is going to cost, is it covered. Right now, we know that half the women in this country, in fact, postpone, delay getting the preventive care they need because they can't afford it. So the amendment from the distinguished Senator from Maryland is all about making sure women can get the preventive care we need, whether it is the mammogram, whether it is the cervical cancer screenings, whether it is focused on pregnancy.

Would the Senator from Rhode Island agree that right now in the marketplace, I understand that about 60 percent of the insurance companies in the individual market don't cover maternity care?

They don't cover prenatal care. They don't cover maternity care, labor and delivery, and health care through the first year of a child's life. That is standing between a woman, her child, and her doctor. That is the ultimate standing between a woman and her doctor, since they were not going to cover that.

I think one of the most important things we are doing in this legislation is to have as basic coverage--something as basic as maternity care. When we are 29th in the world in the number of babies that make it through the first year of life, that live through the first year of life, that is something we should all be extremely outraged about, concerned about.

This legislation is about expanding health care coverage, preventive care, making sure babies and moms can get prenatal care, that babies have every chance in the world to make it through the first year of life because we have adequate care there. Yet the ultimate standing between a woman and her doctor is the insurance company saying: We don't think maternity coverage is basic care.

Yes.

Will the Senator repeat that to me? That is astounding. He said 50 percent?

As the Senator has said eloquently, we have all had situations like this happen in our families. Everybody listening and everybody involved in the Senate family has certainly had that happen to us. I have found it very interesting; every Tuesday morning we invite people from Michigan who are in town, to come by and we do something called ``Good Morning, Michigan.''

Not long ago, a woman came in and said:

I'm finally excited. I am 65 and now I can choose my own

doctor because I am going to be on Medicare.

Medicare is a single-payer, government-run health care system. I could not get my mother's Medicare card away from her if I had to wrestle her to the ground because, in fact, it has worked. It is focused on providing health care. That is their mission.

One of the things I think is indicative of the whole for-profit health care system--by the way, we are the only ones in the world who have a for-profit health care system--is when they talk as an industry, they talk about the ``medical loss ratio.'' The medical loss ratio is how much they have to pay out on your health care. So the language of the insurance industry--now, it is different if there is a car accident or if your home is on fire. We understand you don't want to pay out for a car accident or for a home fire. But in this case, we have an institution set up, through which most of us--we have over 82 percent of us in the private for-profit insurance market through our employers. We are in a system where the provider, the insurance company, calls it a ``medical loss'' if they have to pay out on your insurance. I think that alone is something that, to me, sends a very big red flag, if they are trying to keep their medical loss ratio down.

We have in this legislation been doing things to keep that up. We want them to be paying out for most of the dollars paid on a premium in health care so the people are getting the health care they are paying for. That is what this legislation is all about. But as my friend from Rhode Island has indicated, point by point, when we look at every amendment in the Finance Committee--I would say virtually every amendment from our colleagues on the Republican side--and when we look at the amendments so far on the floor of the Senate, the first two being offered are about protecting the for-profit insurance companies, making sure excessive payments that are currently going out for for- profit companies under Medicare continue; making sure we are protecting the industry's ability--not the doctor's ability to decide what care you need, when you need it, and so on, but the insurance company's ability to decide what they will pay for, what is covered, when you will get it--and, by the way, if you get too sick, they will find a technicality and they will drop you.

All of those things we are addressing are to protect patients, protect taxpayers, consumers, in this legislation. Would the Senator not agree?

The sign behind the Senator is right. It is about saving lives, money, and Medicare.

I totally agree with the Senator. I thank him for his comments. What I find even more perplexing is that what we have on the floor is not a single-payer system, even though some of us would support that. It is not. It is, in fact, building on the private system but creating more accountability. We are not saying there would not be a private insurance industry. What we are doing is saying that small businesses and individuals who cannot find affordable insurance today should be able to pool together in a larger risk pool. That has been, in fact, a Republican and Democratic idea going back years.

We are saying if they want to be able to ask us to cover these folks, we are saying to the insurance companies they have to stop the insurance abuses. We are not saying they can't offer insurance. In fact, this is a model like the Federal employee health care model, where people who don't have insurance today can get a better deal in a group pool, like a big business and a small business and individuals will purchase from private insurance companies. Many of us believe there ought to be a public option in there as well. But we are talking about private insurance companies participating.

All we are saying is, wait a minute. If you are going to have access to the individuals that now will have the opportunity to buy insurance, we want those rates to be down, and we want them to be affordable. We want to make sure there are no preexisting conditions. We want to know that if somebody pays a premium every month, and then somebody gets sick, that they don't get dropped on some technicality. We want to make sure that women aren't charged twice as much as men, which in many cases is happening today. Sometimes there is less coverage. We want to make sure maternity care is considered basic, that women's health is considered a basic part of a health insurance policy. We are not saying we are eliminating the private sector. We are not going to the VA model or even the Medicare model.

This is reasonable, modest, and should be widely supported on a bipartisan basis. These ideas have come from both Democrats and Republicans over the years, and yet we still get arguments that are wholly and completely protecting the interests of an industry that we are, in fact, trying to engage and provide affordable health care insurance.

I say to our colleague that I believe that is the case. In my State, we have 60 percent in the private market through employers.

Absolutely. In fact, I think it invites the private sector to participate in a new marketplace.

If I may add, I think one of the most telling ways to approach that is the fact that the American Medical Association, the physicians in this country, support what we are doing. They are the last ones who would support putting somebody--somebody else, I should say, because I believe we have insurance company bureaucrats frequently between our doctors and patients--but they would not be supporting us if it were doing what we have been hearing it is doing.

As a member of the Finance Committee with the distinguished chairman, we have heard nothing. We have written nothing that would in any way interfere with procedures. In fact, I believe through the fact we are making insurance more affordable, we are going to make more procedures available because more people will be able to afford to get the care they need.

If I may add to that--and I thank the chairman for putting in language on the Keystone initiative in the bill--in this bill, we are, in fact, expanding what has been learned about saving lives and saving money by focusing on cutting down on infections in the intensive care units, by focusing on surgical procedures, things that actually will save dollars, don't cost a lot, and save lives. But they involve thinking a little differently, working a little bit differently as a team. Our physicians, hospitals, and nurses have found that if they made quality a priority, it became a priority.

There are so many things in this legislation that will save money, save lives, increase quality, and that is what this is all about, which is why so broadly we see the health care community, all the providers, nurses, doctors, and so on, supporting what we are doing.

Mr. President, I, first, thank our distinguished leader on the Finance Committee. It is my pleasure to serve on the Senate Finance Committee. We have been working on this issue for well over a year--2 years now. I very much thank the Senator from Montana and appreciate his leadership in getting us to this point because I don't think we would have been here without his leadership. I very much appreciate that, as well as our leader, Senator Reid, who has worked tirelessly, and, of course, the Senator from Connecticut, Mr. Dodd, and Senator Harkin from Iowa as well. We certainly appreciate their leadership.

The bottom line of the legislation in front of us is very simple. On behalf of the American people, we have put forward a health care reform bill that will save lives, it will save money, and it will save Medicare. It does that in multiple ways.

I wish to spend just a few moments this evening talking about Medicare because there is a very significant amendment in front of us that would undercut what we are trying to do to save Medicare. As we go through this next debate, as I have done many times, I am going to continue to talk about the ways in which we are saving lives and saving money.

The reality is, Medicare is a sacred trust with America's seniors, with people with disabilities. Our health care reform efforts, both in the House and the Senate, will help ensure that trust is never broken. That is what this is all about. In fact, I don't think I could look my 83-year-old mother in the eye, knowing how much she has benefited from Medicare, and be doing anything that would weaken Medicare--now or on into the future.

We are going to extend Medicare solvency while providing better, more affordable care for America's seniors and people with disabilities. In fact, we are going to add 5 years to the Medicare trust fund solvency, which is extremely important. In the long run, I expect, as we go forward, as we bring down costs, as we save money, we will, in fact, be adding years to the trust fund by what we are doing.

We are going to crack down on waste, fraud, and abuse in the Medicare Program and wasteful overpayments to insurance companies through a Medicare Advantage effort that essentially was set up to privatize Medicare--turn it over to primarily for-profit insurance companies.

Reform is going to make sure we have more affordable services for seniors. We are going to begin to close that doughnut hole, a gap in prescription drug coverage, right now. It was passed a number of years ago--and I might indicate not paid for--and our effort is entirely paid for. It does not add a dime to the national debt. In fact, it brings down the deficit. But we are closing a gap in coverage on prescription drugs by 50 percent. We are going to phase that in. We are going to keep going until we get that completely closed.

We are going to make sure preventive services do not have a cost connected with them--no deductible, no copay. We want people to be getting the cancer screenings, the mammograms, the wonderful colonoscopies, the other preventive services people need, as well as being able to have a yearly physical with their physician, without deductibles and copays. We are going to aggressively attack fraud and abuse that raises Medicare costs for seniors and for taxpayers.

Reform is also about improving quality of care. It will move Medicare toward a system of rewarding high-quality care, investing in innovations, more efforts in primary care, family doctors, better coordination of care, cutting down on duplication of tests and bureaucracy and all those things we so frequently complain about in the Senate--as we should.

It is going to make long-term care services more affordable. There is such a growing demand and need for long-term services.

It is going to eliminate the imminent physician payment cut that threatens to stop seniors from having full choice of seeing their own doctor. As my colleagues know, I am deeply committed to permanently fixing a flawed physician payment system, but in this bill we make sure the 21-percent cut that is scheduled to take place next year does not take effect, and we will continue. We are committed to working until we completely solve this problem.

It is not a surprise our Republican colleagues are opposing a plan that actually protects Medicare, it actually protects Medicare benefits for seniors, people with disabilities, and keeps Medicare finances in the black for 5 additional years. Just months, 7 months ago, nearly 80 percent of the Republican House Members voted to end Medicare as we know it by turning it into a voucher program that provides a fixed sum of money to pay to private insurance companies, which, by the way, has led--we are now trying to fix overpayments to private for- profit insurance companies at the expense of Medicare and services for seniors.

A top AARP policy official called this scheme that was supported by 80 percent of the House Republicans, just 7 months ago--called this scheme ``a very dangerous idea,'' saying it would raise costs for all beneficiaries and lower the quality of care for less-affluent seniors, lower income seniors.

Now faced with a plan that actually strengthens Medicare, actually saves Medicare for the future and makes sure money goes to Medicare beneficiaries rather than to insurance companies in high payments, some colleagues are pulling out all the stops to defend the health care status quo that sends hundreds of billions of dollars in overpayments to private insurance companies. That is, unfortunately, the result of the McCain amendment, which I strongly oppose.

Many Republicans are resorting to traditional scare tactics and falsehoods, myths. We have heard this over and over. You can go to the AARP Web site and see the fact that, time after time, they have put up falsehoods to try to scare seniors, which I think is outrageous. For proof of how politically motivated these attacks are on the President's proposal and our proposals to eliminate waste and insurance company overpayments in Medicare Advantage, you have to look no further than the fact that a group of Republican Senators actually introduced a similar proposal as recently as this past May.

These kinds of distortions, the fear tactics that have been used, would be offensive under any circumstance, but they are especially disingenuous coming from a group of people who have a long history--a party that has a long history of opposing Medicare and that very recently tried to kill the program as we know it. Their most recent assault was just the latest in a war that Republicans have been waging on the program since the beginning when a majority of them voted no on even establishing Medicare. The overwhelming majority of Republican colleagues voted no.

Last time we had a Democratic President, leading Republicans across the country launched a vicious attack on Medicare. They bragged about opposing the creation of the program in the first place. They called for huge cuts to Medicare and even the ``elimination'' of entitlement programs such as Medicare, as we know them. One even blamed seniors' greed for Medicare's budget problems.

As we now debate this issue, I find it so interesting that colleagues on the other side of the aisle are indicating that, after years of history of trying to cut, eliminate, change Medicare, Republicans having voted against even establishing Medicare, that somehow they are now the protectors of Medicare. As AARP has said, there is nothing in this proposal that is going to cut benefits or increase out-of-pocket costs for seniors. They would not be supporting the efforts we have been involved with if, in fact, it did. I think we all know that.

President Obama and the Democratic majority in this Congress are committed to protecting and strengthening Medicare, a program we created--I should say my predecessors. I was not here. I was not fortunate enough to be here, but it was Democrats who created that program. I am very proud of it because it is one of the great American success stories, Medicare and Social Security. It is a sacred trust with our seniors, and our health insurers reform plan will ensure that trust is never broken.

Health care reform is about saving lives, saving money, and saving Medicare.

I yield the floor.

Mr. President, it is my pleasure and honor this evening to be here to strongly support this motion, this historic motion to proceed to a historic debate about whether we, as America, the greatest country in the world, are going to make sure all Americans have access to affordable health care insurance. This is something that has been debated for 100 years. Now we have the opportunity, with the House having passed their version, to move forward to this debate where we will have lots of opportunity to offer amendments and to debate honest differences in policy. But in the end, I believe confidently that we will come together to move forward to pass legislation that will save lives, that will save money for the American people, that will protect Medicare, and that will stop insurance abuses happening for families every single day.

I have come to the floor so many times to talk about health insurance reform, as has the distinguished Presiding Officer from Rhode Island. I wish to take just a moment to say thank you to a few people because, as the Presiding Officer knows, we would literally not have this opportunity today if it were not for Senator Harry Reid,

our distinguished majority leader. He is a quiet, smart, determined, focused leader who has listened to everyone, who has looked at the work products from the Finance Committee and the HELP Committee and brought together a combined bill that is the best of both. He is going to give us the opportunity to continue to debate and improve it on the floor before final passage. So I thank Senator Reid. I know he is passionate about his State of Nevada, and that is his No. 1 love after family, but I think No. 2 is the Senate and the ability to lead and get things done, and I thank him.

I thank Senator Baucus for his incredible leadership on the Finance Committee; Senator Dodd for his leadership and stewardship in bringing the HELP Committee through with their legislation; Senator Harkin, Senator Wyden, and Senator Bennett, who is on the floor. We are not agreeing on the movement forward on this bill, but there have been 2 years of working on health care that I appreciate, and their efforts together to work on health care.

I thank Senator Snowe. I don't know if she is going to be with us this evening, but her courageous vote on the Finance Committee is something we desperately appreciate. I know she is going to continue to provide input, and I am hopeful she will be with us on the final vote because her input and her knowledge have been extremely important in this process.

I also thank the memory of a very important Senator named Ted Kennedy, who I know is here in spirit, for 40 years of dedication to this cause.

Finally, I thank President Obama. If not for his vision, we would not be here today. For 8 years under a former President, we did not have the opportunity to get here to this place. We did not have the opportunity to be able to end insurance abuses and truly protect Medicare for the future, to put forward health care reform, to save lives, and to save money. I also thank President Obama for understanding that health care is also about jobs and that we have too many people in this country today who are losing their job, and with that they are losing their health insurance. So it is impossible to talk about health care reform without also talking about jobs because for most families they are connected and one and the same.

I have spoken on the floor so many times on health care cost and access. Frankly, health care is something that brought me to public service 30 years ago; when I was 5, I just want to say that for the record. I led an effort in our community to keep a nursing home open in Okemos, MI, and ever since then have been fighting to get to this debate, to get to this point in terms of affordable health insurance for all Americans.

So tonight, after this vote, we start the real debate. This bill provides a framework for every American to find affordable insurance. Is it everything I would do if I was writing it by myself? Of course not. Every Member can say the same thing. But the Democratic process is coming together with the best ideas and negotiating and doing the best we can to be able to solve as much as we can in the best way possible. I am going to continue to work to make health care truly affordable and will be sponsoring and cosponsoring amendments as we move forward to improve on what I believe is a very good bill. I am confident that at the end, again, we will pass legislation that saves lives, that saves money, that protects Medicare, and that stops insurance abuses.

When we first started this effort, I set up the Health Care People's Lobby on my Web site so that people could share their stories, how they felt about what we should be doing. Should we move forward and act? What should happen? What were their experiences with their health insurance and the companies that cover them now? I have heard so many stories. I wish to thank everyone--thousands of people--who has shared their story. I want to put a face on this debate and vote tonight by sharing just a couple with you.

When we say saving lives, this is not just a slogan. We are talking about saving lives. Forty-five thousand people have the ultimate rationing every year because they can't find affordable insurance. As a consequence, they lose their lives--45,000 people in the greatest country in the world. We can do better than that, and that is what this bill is about.

I wish to share just one story of a young man, Joe, from Okemos, MI. He is a recent graduate of dental school. He worked very hard, was very bright. He was just between jobs after completing his residency, and we know how long and hard that is, to get to that point. He suddenly fell ill. This was only a few months ago. He called his mom. She urged him to go to the doctor, but because Joe didn't have insurance, he was worried about going to the doctor, so he didn't. He continued to feel worse. His family finally got him to agree to go to the hospital, but by then it was too late. Joe died at age 27 of an aneurism--27 years old--because in America, he didn't have insurance and was afraid he couldn't afford it if he went to a doctor.

This is about saving lives. This is about saving money for businesses that are trying to keep the doors open, that may provide insurance now but are at a point where either the jobs go or they have to stop providing insurance. So people come in, and the owner says: I want to keep you working, but we are not going to be able to have health care for you anymore.

This is about the fact that our country is spending twice as much as any other country on health care and yet sometimes having outcomes that are far worse than we would like to see as it relates to other countries. We are 29th in the world in the number of babies who make it through the first year of life. Of all of the insurance companies a woman can choose from if she goes into the private individual insurance market--59 percent don't provide maternity care, basic care, prenatal care, care for mom and baby during the first year. So that is going to change because of the values we bring to this.

We are going to protect Medicare. Folks don't have to believe us. There is a lot of debate about what is happening in Medicare. I am very proud to say we have received a very strong letter from the AARP supporting a ``yes'' vote this evening to move forward on this debate, and that is critically important for us.

Let me share from the Web site of AARP what they say--the champions for seniors in this country; what they say, not what we say--about what is being done in health care reform.

On their Web site:

Myth: Health care reform will hurt Medicare.

Fact: None of the health care reform proposals being

considered by Congress would cut Medicare benefits or

increase your out-of-pocket costs for Medicare services.

Fact: Health care reform will lower prescription drug costs

for people in the Medicare Part D coverage gap or doughnut

hole so they can better afford the drugs they need.

Fact: Rather than weaken Medicare, health care reform will

strengthen the financial status of the Medicare program.

That is why AARP has written a letter urging us all to vote yes on the motion this evening we will be voting on, because we are strengthening Medicare for the future.

Then let me speak to the question of insurance reforms because the reality is that the majority of people have insurance. The majority of us so far have insurance through our employer, and we hope that as we bring down the costs and save money, that, in fact, we will be able to make sure people are going to be able to continue to have the coverage they are paying for today. So we are talking about insurance abuses and stopping those insurance abuses.

I wish to share a couple of stories from individuals who have found themselves in a very difficult situation. I realize my time has come to an end, so I will be brief, but I do want to share just a couple of stories in conclusion.

From the newspaper recently: Benjamin French, a young boy in Michigan, was born with his right arm missing below the elbow. In his 12 years, he has been fitted with seven prostheses. His most recent replacement will cost nearly $30,000, and his doctor says he will soon grow out of it. He is a 12-year-old who is growing up, so as he gets an artificial arm, it has to be replaced periodically to be able to grow with him. But according to his insurance company, the boy is ineligible for future coverage of prosthetic devices because he has already spent his lifetime maximum benefit. That is going

to stop. We are going to eliminate those lifetime caps that get in the way of a 12-year-old being able to have the artificial arm he needs as he grows up so he can lead a normal life.

I wish to share one other story, and that is from Glen from Sterling Heights. He is 62 years old. He got laid off in December. It doesn't look as if he will be called back. He writes:

I am too young for Medicare. I have preexisting conditions,

so nobody wants to insure me. If I get sick before I can get

Medicare, my savings and everything else will be wiped out.

This is not the way I pictured retirement was going to be. I

raised four children, got them through school, and married;

paid taxes and did what I thought was the right and moral

thing to do. I didn't create this mess, but I am sure paying

for it.

He did the right and moral thing, and that is what we are being asked to do on behalf of the American people.

Vote to move forward tonight. Vote for the debate. Doing nothing is not an option when we are losing jobs, people are losing lives; when we are losing the capacity of the country to be able to provide the health care for our families that we need to provide. It is our turn tonight to vote yes on proceeding to a debate that I believe, working together, will result in legislation on health care that will save lives, save money, protect Medicare, and stop insurance abuses.

Thank you, Mr. President. I yield the floor.

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

Mr. President, I am very proud to be here with colleagues of mine who have today joined me on the floor. Senator Merkley from Oregon and Senator Mark Begich from Alaska are such strong, passionate voices for people in this health care debate, for what we need to do to stop the insurance abuses and to save lives and save money. I am so pleased they are both here with me. Let me take a moment before turning it over to them to talk about what this is really all about for us.

Right now, the bill in front of us basically saves lives and saves money. We save lives through making sure that the 47,000 people who lost their lives last year because they couldn't find affordable health insurance to be able to see a doctor--making sure we change that; by focusing on prevention, also, so people have early detection and people can find out earlier when they have cancer and get the treatments they need to save their lives. There are so many ways in which this bill in front of us literally will save lives.

We save money. We save money for individuals and small businesses that are currently having a difficult time finding affordable insurance. If you have your insurance through an employer, as do about 60 percent of the people in my State, and if you are a large employer, then you can get a better rate because you have a large group plan. If you are a small business, you don't get that same treatment today. If you are an individual, if you are, like many people today, operating out of your home as a businessperson, a single entrepreneur, or maybe you are creating that next great invention in your garage and you are trying to find health insurance as a single individual for yourself and your family, you can't do that right now in a very affordable way.

So we want to fill in the gaps in a system that has worked well for many people with employer insurance and certainly for people in Medicare and our veterans with the VA and our military personnel and others. But we have a little less than 20 percent of the public right now that is left out there without a way to get affordable insurance, so we want to bring down their costs. We want to bring down the costs for our bigger businesses as well.

We want to make sure we are stopping people from using emergency rooms inappropriately and raising the cost on everybody with insurance and instead give everyone the opportunity to see their own doctor, their family doctor, and make sure their children and their families get the care they deserve.

We know this also saves money for the Federal Government, for States, for our economy as a whole, and we know what the numbers are in terms of inaction, the fact that we need to bring down costs across the board.

This bill protects Medicare. We know we would not have the AARP endorsing the House plan and hopefully supporting ours as well--I know they are still looking through the specifics, but they certainly support health care reform, and we welcome their support. They want health care reform. They have said certain things that I think are very important that debunk what we have heard from the other side of the aisle.

We have heard over and over that health care reform will hurt Medicare. The AARP Web site has up on its site: Myth: Health care reform will hurt Medicare. And then it says--not from us but from the AARP, a champion for senior citizens in this country--Fact: None of the health care reform proposals being considered by Congress would cut Medicare benefits or increase your out-of-pocket costs for Medicare services. None of the proposals we have introduced as the Democratic majority, supported by President Obama, would do that.

Fact: Health care reform will lower prescription drug costs for people in the Medicare Part D coverage gap, or what has now been dubbed the ``doughnut hole,'' so that they can get the better, affordable drugs they need.

Fact: Rather than weaken Medicare, health care reform will strengthen the financial status of the Medicare Program--strengthen it for the future.

We know Medicare has been a great American success story, and we want to make sure it is on strong financial footing to go forward for all of us who are baby boomers and beyond, to our children. This comes from the AARP Web site. So we strengthen Medicare. We protect Medicare.

Then we focus like a laser on stopping insurance abuses. We have heard so many times, unfortunately, story after story about families who cannot find insurance because someone in the family has a preexisting condition of some kind--a child who has leukemia, someone who is a diabetic. Even for women, pregnancy has been used as a preexisting condition. We want to make sure all Americans have the opportunity to find affordable insurance. We want to make sure that if you have insurance you have paid for your whole life, you have paid the premiums, you feel confident that because you have health insurance, when somebody in the family gets sick, the companies can't drop you on a technicality.

So we have a number of areas in which we want to stop abuses and, frankly, strengthen the system. We want your children to be able to stay on your policy until age 26 if they need that. That is something I have often said that I wish had been in place a couple of years ago because I know what it is like to have a son or daughter come out of college and that first job doesn't have health insurance.

We want to make sure early retirees get the health care they need and are able to afford their health insurance with the Federal reinsurance plan, to help businesses keep costs down for people who--frankly, many have been forced to retire at age 55 or age 60 and don't yet qualify for Medicare.

So this is the bottom line: We are saving lives, we are saving money, we protect Medicare, and we stop insurance abuses.

I wish to focus for a moment on something else we are doing that is absolutely critical to me and, I know, to colleagues across the country, because this plan will also save jobs. Folks have said to us: Well, don't talk about health care; let's talk about jobs. Lowering the cost of health care is about jobs. It is about jobs. We lose jobs overseas to other countries that have lower health care costs than we do. We have seen plants--in fact, in Michigan--go across a river that you could swim across, the Detroit River, from Michigan into Canada, everything else being equal--a unionized labor force, environmental standards--everything else equal but one thing: the health care costs are less. So this is about jobs, and it is about keeping jobs in America.

We know our plan will allow big employers to save $9 billion over the next 10 years--$9 billion. What will they do with that? They will put that back in,

reinvesting in equipment, building other plants, hiring more people.

Health care reform is about jobs.

Small businesses are estimated to save 25 percent in their costs over the next 10 years with the tax credits we have in the bill--the ways we create the ability to buy through a large pool, to be able to lower costs, and with the tax cuts in the bill to small business. There are tax credits to help all the companies that don't have insurance to be able to find affordable insurance.

The bottom line is, it is estimated that if we do nothing, the costs to businesses will double, and we will lose 3.5 million jobs. We can turn this ship around and begin to bring down costs. It is estimated we can save 3.5 million jobs.

People in America understand we have to focus on jobs and the economy. They also know the one-two punch is that when you lose your job, you lose your health care. So in our bill, we specifically create policies that make sure that if you lose your job, you don't lose your health care.

We want businesses, large and small, to be able to redirect the spending on ballooning health care costs and premiums, to be able to redirect that on hiring people and doing what we know how to do best, which is making things in America and putting people to work.

This is about jobs. It is saving lives and saving money and saving jobs in this country. I will conclude by saying that what are we hearing from our colleagues on the other side is the same kind of tactics that were argued in the 1960s before Medicare. You can take some of the same arguments and lift them right from the pages of the Congressional Record and you would think it was today's debate, but it was actually back in 1964, 1965, with Medicare. We know the arguments they used then about destroying the economy, about costs going up, about people losing access to doctors, and about how this would hurt businesses--it didn't happen then. We know it will not happen now. But what we are hearing is: Just wait, wait, wait, wait--that is all we heard in the Finance Committee. Don't do it now. What is the rush?

Well, if you are not getting those premium increases in the mail, maybe you don't feel the rush. If you are not losing your job and health care, maybe you don't feel the rush. But we have been talking about this for 100 years. We are tired of waiting. The American people are tired of waiting. They are saying business as usual for insurance companies: Let the insurance companies decide whether we are going to have maternity care covered under basic insurance. That is not necessary. It is an option. Let them decide whether we are going to focus on prenatal care.

We are 29th in the world in the number of babies who live through the first year of life--below Third World countries. Right now, 70 percent of the insurance companies in the individual market don't offer maternity care as basic health care. They say let the insurance companies decide. Let them be the ones between you and your doctor. When a doctor says what he wants to do when you are sick, what is the first call they make? To the insurance company. They say that is OK, let the insurance companies be the ones deciding what you are going to pay or get, whether you are going to be able to find coverage. Let them stand between you and your doctor. We say: No, we have had enough of that.

Finally, they say higher costs for middle-class families and small businesses are OK. Higher costs are OK because they are willing to allow this craziness to continue. Mr. President, we are not.

Let me emphasize, again, the bottom line: This is about saving lives, about saving money, and it is about protecting Medicare and stopping insurance abuses. We are committed to doing those things, getting through all the misinformation. All those who make so much money off the current system are just flailing and saying anything right now to try to stop us from getting control of the system and bringing costs down and making health care available. We are committed to getting this done for the American people.

I yield the floor.

Mr. President, I wish to take a few moments and continue this discussion and then turn it over to the distinguished Senator from New Mexico, Mr. Udall. We are so pleased to have him. We served together in the House. We are pleased to have him as a colleague in the Senate. They are a terrific team of people who are so smart, who care so much and have such great experience. Our previous speaker, coming from Oregon as the leader in the State legislature, and Senator Begich, as a leader, as a mayor--we bring a wealth of experience of people who have been serving, problem-solving, trying to make government work, make the right decisions at various levels of government. It is wonderful to be working with them today.

I wish to take a moment because I understand that the Republican leadership, our colleagues, are currently holding a press conference talking about what we are doing is somehow rationing care. This is the same argument, by the way, used back in the sixties with Medicare. Somehow seniors would not be able to get care, it would be rationed, which, of course, is the exact opposite of what happened.

Now people hold their breath if they retire early and don't have insurance, just waiting to turn 65 so they can get Medicare and they can see whatever doctor they want, not the one the insurance company says they can see but the doctor they believe they need to see, the specialist they believe they need to see.

We know that for too many people in this country, there is the ultimate in rationing. Over 45,000 people lost their lives last year because of the ultimate rationing. They couldn't find affordable health insurance. They couldn't see a doctor. They couldn't get the care they needed. Mr. President, 45,000 people in the greatest country in the world paid the ultimate price. Shame on us. We want to stop that. This legislation will head us in the direction to stop that, to say as a matter of principle in this country that it is not acceptable that any American would lose their life, any mom or dad would lose their child because they could not find affordable insurance in this great country.

We also know that every year we push as hard as we can to increase the amount of money going to the National Institutes of Health to gather information, to do research to save lives--to save lives through research, through information. In this legislation we want to make sure as the NIH is doing more research, as we are looking at better prescription drugs or new cures, that we are giving physicians and patients the very best information.

I am not scared of information. I want information for my family, for myself. I have been in a situation--I am sure that we all have--talking to

my physicians, where they said according to the latest data we now think a little bit differently about a particular procedure or a particular medicine. And they make a different recommendation. I want my doctor to have that information. That is not rationing. In fact, we specifically say in this bill, we specifically prohibit the Secretary of Health and Human Services from denying coverage of treatment solely based on research, solely based on information. But we certainly want the information.

I think it is kind of silly to even argue about whether we want medical research and information so our doctors have the very best information to be able to treat us. Right now, less than 1 percent of our health care spending goes to examining what treatments are most effective. We want to make sure the information is there for physicians. Physicians support that, by the way. This is something in the House bill, endorsed by the AMA, endorsed by medical professionals all across the country. We want our doctors to have more information to do a better job for us, not less.

We are hearing, over and over, scare tactics. We know we are going to continue to hear that until we get to the end and pass this bill. But none of the groups--doctors, nurses, family groups, consumer groups, business groups--none of those who currently support this legislation would be doing so if they thought it was in fact doing the things the other side is claiming it is doing, and certainly not if it was rationing care. The ultimate rationing right now occurs when people arbitrarily get dropped because the insurance company doesn't want to pay the bill; when people cannot get the coverage they need because of a preexisting condition; or when they lose their life because they can't find affordable insurance. Our legislation is about saving lives and saving money.

I wish now to turn the floor to my colleague from New Mexico.

Mr. President, I ask unanimous consent that the Committee on Armed Services be authorized to meet during the session of the Senate on November 20, 2009, at 2 p.m.

Mr. President, I ask unanimous consent that the Committee on Finance be authorized to meet during the session of the Senate on November 20, 2009, at 10 a.m., in 215 Dirksen Senate Office Building.

Mr. President, I ask unanimous consent to speak for up to 20 minutes in morning business.

Mr. President, first, it is a good thing our health care reform doesn't do the kinds of things the Senator is talking about. I wouldn't support it either. I don't think the Chair would either. It is a good thing that is not what we are doing. With respect to my friend from South Dakota, we have a different view of this bill.

Let me first start by saying, as the Chair knows and has said, this bill saves lives and saves money, and particularly protects Medicare and stops insurance abuses. That is what we are about.

Before going through the specifics of the bill, I wish to read from a very interesting column today in the New York Times. We can have competing newspapers, dueling newspapers on the floor. Nicholas Kristof did a column called ``The Wrong Side of History.'' I quote:

Critics storm that health care reform is ``a cruel hoax and

delusion.'' Ads in 100 newspapers thunder that reform would

mean ``the beginning of socialized medicine.''

The Wall Street Journal's editorial page predicts that the

legislation will lead to ``deteriorating service.'' Business

groups warn

that Washington bureaucrats will invade ``the privacy of the

examination room,'' that we are on the road to rationed care

and that patients will lose the ``freedom to choose their own

doctor.''

All dire--but also wrong. Those forecasts date not from

this year, but from the battle over Medicare in the early

1960s. The heirs of those who opposed Medicare, [who

protected the insurance industry at that time] are conjuring

the same bogymen [today].

Indeed, these same arguments we hear today against health

reform were used even earlier, to attack President Franklin

Roosevelt's call for Social Security.

I appreciate the concerns that have been raised, but this is a replay of a time in the sixties when there was a debate about whether seniors who couldn't find affordable insurance in America should have access to the health care they need and the insurance they need.

Thank goodness, Democrats at that time, the President, and the Democratic majorities in the House and the Senate, chose to stand up for seniors and to override the objections coming from the insurance companies and the insurance lobby and those making money off the system at that time.

Let me talk a little bit about what is at stake if we do nothing, because that is the first question. Why should we be doing something? Every single day--in fact, today--14,000 Americans got up with health insurance and by the time they go to bed tonight they will not have it because they have lost their job, because their business had to drop them because the costs went up too much, because they couldn't afford the explosion in premiums and copays.

Insurance rates will almost double by 2016 for families, up to $24,000 for a family of four. Businesses will see their costs double in the next 10 years. What is extremely concerning to me as a Senator of the great State of Michigan, where we have a lot of employer-based care, employers doing the right thing, working hard to try to continue to provide health care coverage, those increased costs, doubling the costs over the next 10 years will, in fact, cost us 3.5 million jobs. Health care reform is about saving jobs.

Family incomes will be reduced by $10,000. Every single day--right now--5,000 homes are foreclosed. About half the homes that are foreclosed every day are foreclosed because of a medical crisis, and most of those families had insurance but it did not cover the cost of their medical expense. And we know that 62 percent of the bankruptcies today are because of a health care crisis and health care bills.

The status quo is not acceptable. Doing nothing means costs will go up, the insurance industry will still stand between you and your doctor deciding the kind of care you should get and the doctors you should see. In many cases, most plans require a certain set of doctors, a certain set of parameters.

We will lose jobs if we do not act. We cannot afford to lose more jobs. We are committed to turning the economy around and putting people back to work.

What do we hear from our Republican colleagues? Wait, wait, wait. We heard that in committee. Wait, slow down, we are going to have a lot of efforts on the floor to slow things down, take hours and hours and hours, don't act. Wait, wait, wait. And while we wait, those who make a lot of money off the current system will continue to make a lot of money off the current system while people see their health care costs go up and too many families struggle every day to figure out how they are going to provide health care for their children and themselves.

Business as usual from insurance companies--that is what we hear from the other side. Let the insurance companies do it. Let the insurance companies make the decisions about when you will be covered, how you will be covered, what you are going to pay, whether your doctor is in network or out of network, and whether you will be able to see the specialist you want to see. Business as usual is OK. Higher costs for middle-class families and small businesses are OK.

We believe these things are not OK, that doing nothing is only going to explode the deficit, hurt businesses, hurt families. We are prepared to act.

What does this mean in saving lives and saving money? First, it strengthens and protects Medicare. I will talk a little bit more about that. Lowering costs for small businesses and families. We know right now the majority of those who are uninsured are working. They are working in a small business or they are working out of their home as a single entrepreneur. They are in their garage, frequently working on that next invention, or they are out as a realtor in the community.

For years we have been saying we should pool small businesses and entrepreneurs into a larger group so they could get a better rate, such as a big business. That is what this is about. Amazingly, this big government takeover we hear so much about is for less than 20 percent of the people in the country right now. Eighty percent of the people in the country get their insurance through their employer--about 60 percent. The rest through a public program of some kind--Medicare, VA for veterans, our military, Medicaid. We are talking about filling in the gaps for small businesses and individuals, providing them tax cuts so that health insurance is more affordable and pooling them together. That is what this is about.

We are going to stop the insurance company bad practices as I talked about before. We are going to focus on prevention and quality which saves us money over time. In fact, one of the biggest ways we will save money is by focusing on keeping people healthy, focusing on ways that we change a system so we are not paying for individual procedures, but paying for those things the doctor needs to do and wants to do in total to help you recover from an operation or have the treatment you need.

We are going to, importantly, reduce long-term costs, lower the deficit and reduce long-term spending. If we do nothing, costs will continue to go up and up and, unfortunately, because of family costs and business costs, we are likely to see care go down and down as they struggle to keep their heads above water.

Let me talk a little bit more about Medicare. This is so important, as we know. We are going to strengthen Medicare. We know, again, if we do nothing, it is predicted the Medicare trust fund will be insolvent in 2017. We have to act.

We are doing a number of things both to bring down costs by focusing on prevention, saying to seniors and people with disabilities that if you go in for that annual checkup, if you go in for preventive work and, yes, mammograms, or the dread colonoscopy, that you will be able to do that without costs. There will be no deductible and no copay.

We are going to lower the gap in the prescription drug program under Medicare. Right now we know there is a gap in coverage, and we are going to begin to close that and hopefully close that all the way over time.

We are going to prevent payment cuts to doctors. This is something about which I care very deeply. We are going to make sure the cut for next year of 21 percent does not take place for doctors. But we need to solve long term the formula problems that are putting at risk doctors' and patients' ability to see their doctor. We are committed to doing that, to working with physicians.

It is incredibly important that seniors right now who can, in fact, see the doctor they want--because under Medicare you can choose your own doctor--we want to make sure they can continue to do that.

We are going to reduce the deficit and protect Medicare for the future. This is very important. In fact, the payroll tax that was talked about by the Senator from South Dakota would go into the Medicare trust fund to help make sure we are doing that.

It is important we recognize that the AARP, which has endorsed the House bill and supports health care reform moving forward--they have not specifically at this point endorsed what Senator Reid has brought before us today, but we are hopeful they will. We know they are supporting health care reform.

There is no question that AARP, a champion for seniors in this country, would not be supporting moving forward on health care reform, they wouldn't be supporting what the House did if, in fact, it did what our colleagues are saying on the other side of the aisle. They would not.

Unfortunately, we have had too many seniors who have been scared. I, frankly, think that is shameful, the

kind of misinformation that is being given out to seniors. I know my mom, at 83, was initially concerned about what she was hearing until I walked through what we are doing. By the way, I think you would have to wrestle my mother to the ground to take away her Medicare card.

The reality is, this is a great American success story, and we want to keep it that way.

The reality is also that the AARP Web site talks about the myth that health care reform will hurt Medicare. This is from them, from their Web site. I welcome anyone to check it out. The myth is that we would be hurting Medicare.

Fact: None of the health care reform proposals being

considered by Congress would cut Medicare benefits or

increase your out-of-pocket costs for Medicare services.

None of them would cut Medicare benefits or increase your out-of- pocket costs.

Fact: Health care reform will lower prescription drug costs

for people in the Medicare part D coverage gap or ``donut

hole'' so they can better afford the drugs they need.

Fact: Rather than weaken Medicare, health care reform will

strengthen the financial status of the Medicare program.

This is from AARP, not from the Senate, not from Democrats. This is from a group whose job, whose mission it is to analyze what we are doing here and call it as they see it on behalf of those who receive Medicare benefits.

It would be terrific if that stopped being a talking point.

Let me talk a little more about insurance reform.

Whether you have insurance now or whether you are in the less than 20 percent who are without insurance today, affordable insurance, who will be going into this new pool we have, the insurance exchange--we see broad changes that will benefit patients. We really are talking about patients, consumers, families benefiting from insurance reform.

We are going to end discrimination for preexisting conditions, whether your child has leukemia and you are worried about whether at some point they are going to be able to find insurance on their own as they get older, a child with disabilities, or someone with juvenile diabetes. Unfortunately, we have also seen this used to discriminate against women. We have seen insurance companies say pregnancy is a preexisting condition and use it not only against women but against men who are expectant fathers. We want to make it very clear that you cannot be discriminated against if you have either a temporary or a permanent health condition.

We are going to stop the practice of dropping you if you become seriously ill. I don't know how many times I have heard from people in Michigan who said: You know, I am doing fine, I am paying my insurance premiums, I have insurance coverage, I am doing fine. But they have never really had to use the insurance. They have been fortunate that no one in their family has gotten seriously ill. Then something happens--a cancer, serious car accident, some other diagnosis that is very serious--and then in too many cases we have seen the insurance company come back and look for a technicality in order to be able to drop them because they are now having to pay out money for health care. That is wrong. This process of rescissions needs to stop, and under health reform it will.

We also, again, are saying that as a matter of policy under insurance, preventive care should be free. You are paying a premium but no copays and deductibles. We want people to be able to go to the doctor to get the annual visit, to be able to get the screenings, to be able to get the other preventive services they need. We want to save lives. This saves lives and saves money. We want to make sure that happens.

Then we are eliminating the annual and lifetime caps, to be able to address the caps as well.

Also, I am very pleased about two other provisions I think are so important for families. One is to allow young people to be able to stay on their parents' insurance through age 26. I wish that had been in place a couple of years ago, actually. I know from experience that the first job a young person may get out of college may not have health insurance or they may come out of college and work one or two or three part-time jobs in order to put things together while looking for work. This is very important for young people, to give them the opportunity to stay on their parents' insurance until age 26. This is one of the provisions that will start immediately when the bill is enacted. I believe it is very important.

Another provision that will happen immediately that is particularly important for many people in my wonderful State is a provision that will help hold down costs for early retirees. I was proud to be the author, with Senator Kerry, of this provision. We have many people who are retiring at age 55. It may not be voluntary. To many people, it is not voluntary. If the company continues the insurance, it is expensive. A person is not eligible for Medicare yet, and when they are retired early, someone 55 to 64 is usually using more medical care, more health care services. So it tends to be higher cost.

We also now have situations such as the United Auto Workers have decided, in order to help their industry and their companies, that they would assume the costs of retiree insurance, and early retirees are finding it extremely difficult, as they put together the numbers, to pay for care. Going forward, when this bill passes we will be a partner with those businesses or entities providing early retiree insurance by providing coverage for catastrophic care. It is called reinsurance, but basically above a certain amount we will cover it as the Federal Government. Above a $15,000 amount of a particular health care cost or treatment, the company will know that the Federal Government will reinsure or cover that. That means the exposure for the company is capped, which means their costs will not go up. In fact, they should go down significantly for early retirees. It also means other entities as well should be able to more accurately plan based on this partnership between businesses, employer-based care, and the Federal Government. This is very significant.

Again, as I close, it is very important to stress what this is all about. There are many pieces to this. I invite anyone from Michigan, as we have done all year, to go to my Web site. We have the entire bill posted. We have done this at every step of the way. We will continue to do that as the debate moves forward, with amendments and so on. We welcome people to get engaged.

I have a Health Care People's Lobby that folks can sign up for e- mail, and we will keep you posted on what is happening, and you can share your thoughts, your feelings, and your stories about what health care reform would mean to you or what has happened to you as someone needing health care or not getting the health care help from your insurance company that you believe you should as someone who has been paying for health care.

We are in a position now, we are poised to do something that I believe should have been done years ago. Many have tried to do it.

I commend this President for making health care, health insurance reform, a top priority; for understanding that we are losing jobs overseas because we are not competitive internationally with other countries, that health insurance reform is about jobs. It is about saving jobs. It is about the cost of losing your insurance. It is about businesses seeing their costs go up. It is also about a moral imperative that says, if you loose your job, you should not loose your health insurance in the greatest country in the world.

This is about saving lives at every level. It is about saving money at every level--for families, individuals, small businesses, larger businesses, States, the Federal Government. This is about tackling what has become a huge cost to our economy and beginning to turn that. It will take time, but we have to begin to turn this ship so we can get these costs under control. Saving lives, saving money, protecting Medicare for the future, and stopping the insurance abuses that occur every day for too many families--that is what health insurance reform is all about.

I am so pleased and proud of our leader, Senator Reid, and grateful for his leadership and amazing skill in bringing us to this point. I am so grateful for the leadership of Senator Baucus in Finance and Senator Dodd and Senator Harkin on the HELP Committee and everyone who has been involved in this effort.

It is worth the time, whatever it takes, to do this and get it right. Saving lives and saving money for American families and businesses, protecting Medicare, stopping insurance abuses--this is worth fighting for. I am very proud to be part of a group of people who have placed this as a top priority.

I yield the floor.

Madam President, how lucky we are to have the great Senator from West Virginia--20,744 days spent in this ``sanctuary,'' this Senate Chamber, which I have heard him call, on more than one occasion, ``the very temple of constitutional liberty.''

Within just a few days of my arriving here in 2001, I was instructed in no uncertain terms to go and see Senator Byrd, to listen to him, and to learn from him. And so I went and I listened and I learned. I learned about the history of this great body. I learned about the importance of the rules and decorum of the Senate.

It is such an honor to be a Member of this body but also an awesome responsibility. For 20,744 days, Senator Byrd has been fighting for the people who sent him here, for the great men and women of West Virginia, and for all the people of this country.

He is an inspiration.

I was proud to be 1 of the 22 Senators who stood with him against the Iraq war. I was proud to stand with him on so many occasions to fight for the working men and women of this country--whether they be coal miners in West Virginia or autoworkers in Detroit. And I am proud to stand here today, with so many of my colleagues, to honor Senator Byrd's remarkable service.

Right outside my office, I proudly display a print of a painting made by the Senator from West Virginia, a very beautiful scene of West Virginia tranquility. Whenever I see it, which is every day, I am reminded of my colleague, of his extraordinary service, of his fierce dedication to liberty, and of his humble respect for the Constitution of our great country.

Madam President, I thank the Senator from West Virginia for his friendship, for his wisdom, and for his great service to our country.

Mr. President, yesterday I introduced S. 2729, the Clean Energy Partnerships Act. I am proud to have as cosponsors for this bill Senator Max Baucus, Senator Amy Klobuchar, Senator Sherrod Brown, Senator Tom Harkin, Senator Mark Begich, and Senator Jeanne Shaheen, who has been working with me on the carbon conservation program after she introduced S. 1576, the Forest Carbon Incentives Program Act.

As we work toward creating a clean energy economy in America, we need a strategy that protects our environment while protecting and creating jobs and revitalizing our economy.

The bill I introduced yesterday is an important part of that strategy. By creating partnerships among manufacturing, utilities, agriculture, and forestry, we can reduce costs now to help transition to a clean energy economy tomorrow.

As we work to develop new technologies to reduce emissions in the future, we also need to find cost-effective ways to limit emissions in the short-term that do not cost us jobs. This bill is about creating a lower cost strategy to help us reach our emission reduction goals while protecting and strengthening our economy.

We can counteract, or offset, our current carbon emissions by investing in practices like sustainable agriculture and forestry projects that capture and store carbon. A ton of carbon is a ton of carbon. That is what this offset bill is all about.

For example, we can change farming practices through more efficient application of fertilizer, the use of cover crops, or by utilizing tillage practices, called ``no till farming.'' No-till farming reduces carbon emissions by leaving old plant matter buried underground. In contrast, conventional tilling moves old plant matter from last

year's crop from under the soil to the top of the soil, where it decomposes and releases carbon into the atmosphere.

Improved forestry practices are another example of effective and scientifically-proven methods to help reduce carbon emissions. These practices must be a central component of any clean energy legislation. It is estimated that forests store up to 80 percent of above-ground carbon and nearly 70 percent of the carbon stored in the soil. Reducing deforestation, restoring forests, and better land management can all help reduce atmospheric carbon levels, not just in our country but around the world.

This bill also creates incentives to develop new technologies for reducing other greenhouse gas emissions. For example, methane is more than 20 times more potent than carbon dioxide and can be produced from landfills, coal mines, farms, natural gas systems and oil pipelines.

Equipment that can reduce or eliminate methane emissions can have a drastic impact on our environment. We can even use technologies that not only capture the methane but use it to generate cleaner electricity. That equipment can be designed and built right here in America, building on our innovative and manufacturing expertise to create good-paying jobs.

Not only will an offsets program help store carbon, it will also result in cleaner water, more wildlife habitat, and reduced costs for business and agriculture. That is why this legislation has the broad support of organizations and leaders in agriculture, forestry, conservation, utilities and manufacturing, including National Milk Producers Federation; National Farmers Union; National Corn Growers Association; National Cattlemen's Beef Association; American Farmland Trust; National Alfalfa & Forage Association; Dow Chemical Company; Duke Energy; American Electric Power; PG&E Corporation; Dominion; John Deere; Business Council for Sustainable Development; Coalition for Emission Reduction Projects; Generators for Clean Air; National Association of Forest Owners; American Forest Foundation; Binational Softwood Lumber Council; Conservation Forestry; First Environment, Inc.; Forest Guild; Hardwood Federation; Lyme Timber Company; Maine Forest Service; National Alliance of Forest Owners; National Association of State Foresters; National Association of University Forest Resource Programs; National Hardwood Lumber Association; Society of American Foresters; Weyerhaeuser; The Nature Conservancy; Association of Fish and Wildlife Agencies; and Trust for Public Land.

The legislation I introduced yesterday creates partnerships between our agricultural and manufacturing industries, protecting jobs and revitalizing our economy. It is estimated that strong agriculture and forestry offsets could be worth up to $24 billion annually to our economy. If the right clean energy policies are put in place, we have the opportunity to make this work for manufacturing and agriculture and create jobs.

Manufacturing in America created the middle class and is the backbone of our economy. We cannot have an economy if we aren't making things in this country--so any energy bill we pass must protect our industries, protect jobs, and protect our American middle class.

By creating partnerships between manufacturers and agriculture, we can link up the people who ``bring home the bacon'' with the people who actually make the bacon.

By allowing our manufacturing industries to offset their carbon emissions with savings made by sustainable agriculture and forestry practices, we can create a real win-win situation for America's economy.

In my home State of Michigan, we know how to make things and grow things. We know that to reach the clean energy future, we must link our manufacturing expertise with our agricultural expertise. Supported by some of the finest research universities in the world, we are already making key investments in clean energy technology that will reinvigorate our economy, create jobs, and protect our environment for the next generation.

That is what this bill is all about. We still have a long way to go in creating a clean energy bill that makes sense for our manufacturing and agricultural industries. But this bill is an important step toward reaching a balanced approach to energy legislation that respects our environment while also respecting the men and women who build things and grow things in this country.

Mr. President, first I thank my friend and colleague from Oregon, Senator Merkley, for those wonderful comments and his passion and commitment on this issue; also, Senator Lautenberg from New Jersey and my friend and partner from Michigan, Senator Levin, who will be speaking, and the great Senator from Rhode Island, as well, who has been a wonderful leader on this issue and so many other issues as well. We all come today because we are committed. We are absolutely committed to seeing reforms in our insurance system so families get what they are paying for and we can bring costs down and we can save lives.

We are here because we want to share the voices and stories from people in our States who have paid into a system and too often not gotten what they have paid for, not been able to benefit from the health care system that we have in this country.

It is important that insurance industry reforms be a part of health care reform. We know we are still in the process of bringing a bill to the floor. At this point we are talking about our goals and our commitment to the common shared values and goals that we have going forward because we know we need to make sure this is addressed.

When we started this debate earlier this year, I set up an online health care people's lobby for the people of Michigan to be able to share with me their thoughts, concerns, and stories as they relate to health care, not having health insurance, what is happening to their families. My sense was we can step outside this Chamber and meet at any moment with insurance company lobbyists and prescription drug lobbyists and others who are here representing special interests. It is very important that voices be heard from people who just want health care for their families and either cannot find it, cannot afford it, or they have it and the costs are going through the roof and then they find that what they have paid for or what they thought they were paying for is not what they are actually getting for their families.

That is specifically what we want to talk about today, the fact that there are abuses, bad practices occurring right now. People who have insurance have a stake in health care reform. We are not changing their ability to have insurance. Everyone can keep what they have. But we want to make sure they are getting what they are paying for.

That is a very important part of health care reform. It is important as we look at the fact that since 2000, insurance company profits have gone up 428 percent. People in my State would take a quarter of that. We are seeing insurance premiums during that same period go up 120 percent. Even though profits have gone up 428 percent, we still have seen premiums going up 120 percent, and now even higher. We are seeing more and more announcements of premiums going up despite the high profits in the industry.

What is most concerning is, for average people wages are either going down, they are losing their job, or if they have a job their wages certainly are growing much more slowly. In fact, over the 8-year period we have seen wages going up about 29 percent at best, if you are fortunate enough to have a job in this bad economy. That means every day insurance companies are taking a bigger chunk out of budgets of our families and businesses, and it is not fair.

The status quo is not working anymore for anybody other than those who are making profits off the system. It is hurting families, it is hurting businesses, and it is costing us jobs. In fact, health care reform is about jobs. It is about saving jobs, it is about making sure if you lose your job you do not loose your health care. It is about making sure that small businesses that want to provide insurance for employees can do that or not have to lay off people because premiums are going up. So it is very much about jobs.

It is very much about jobs, and that is why we need a health care reform bill now. It is time to put an end to the insurance company abuses. The goals we share in this process are to stop the process of denying coverage because of preexisting conditions; to stop the process of annual and lifetime caps on benefits; to stop the process where someone can get charged more or dropped from coverage if they get sick.

I have seen too many situations where somebody pays in, pays in, and pays the higher premiums and so on, and then somebody in the family gets sick and, based on technicalities, they are dropped or they are not covered. That is wrong. We are committed to fixing that.

We also want to make sure on the positive end that we are focusing on prevention and on checkups and making sure you can do that without the cost of copays and deductibles. We are encouraging people to get healthy, to get those early checkups, to be able to get the care on the front end that they need.

It is also extremely important as we move forward we crack down on discrimination by insurance companies. Right now women can pay twice as much for insurance as men and, in fact, get less coverage. In eight States and the District of Columbia, being a victim of domestic violence can count as a preexisting condition. I was stunned when I first heard that, and then said, well, that cannot be. We doubled back and, yes, in fact, that is true for men and women who need help for getting the insurance care they need right when they need it.

In many places, being pregnant, having ever been pregnant, even wanting to be pregnant, can be qualified as a preexisting condition. We had a report in the Washington Post about insurance companies that even denied coverage to men who were expectant fathers. I am not sure what kind of family values those are. But we need insurance reform that addresses some pretty basic things.

Right now 60 percent of the plans in the individual and small business markets do not cover vital maternity and prenatal care for pregnant women. That needs to change with health care reform. It is not an accident that we have an infant mortality rate of 29th in the world, below some Third World countries, children and babies who do not make it through their first year of life.

We look at the fact that too many insurance plans do not cover prenatal care and care for mom and baby during the first year of the baby's life. We are committed to changing that.

I wish to share a story I received that goes right to the heart of why insurance reform is so important to families in Michigan and all across the country. It comes from a constituent of mine in Michigan, Lynn, from Marshall, MI.

A few years ago she got the kind of news that every parent fears. Her son

Justin was diagnosed with leukemia. To date, his medical bills have totalled over $450,000. Thankfully they have insurance and his leukemia has a very high cure rate.

Justin is 21 now and a senior in college. He is doing fine, thankfully, but Lynn worries about what is going to happen when he graduates from college and can no longer stay on her insurance. With leukemia as a preexisting condition, his insurance premiums will go through the roof. And for a young man who is just starting his career, those kinds of costs would simply be unaffordable.

If Justin wants to start his own business, which is so central to the American dream, he would never be able to afford to pay for his own insurance with that kind of preexisting condition. How many other Justins are out there, who would be the innovators and the entrepreneurs we need to revitalize our economy in America? Who would make the difference if only they could afford to go out on their own and start their own company and know they could get affordable insurance without preexisting conditions and other barriers that have been in their way from insurance companies?

That is why we need health care reform. We need health insurance reform as a part of health care reform. We are committed to that. We are committed to stop abuses in the health insurance industry. Those who have insurance now who will be able to keep their insurance need to know they are getting what they are paying for in the health care system today for their families. That is why we need reform now, and we are committed to getting it done.

I yield the floor.

Mr. President, I wish to speak both about the substance of the amendment in front of us that I understand Senator Reid and the distinguished chair of the Finance Committee, Senator Baucus, have put forward, the substance of it and supporting it, and also on the time it has taken us to get to this point, which is of tremendous concern to me. I know it is also to many other people, certainly people in the great State of Michigan, which I represent.

I believe we are on week 5 of trying to extend unemployment benefits for people who, through no fault of their own, have lost their jobs, are looking for work, trying to hold things together, trying to keep a roof over their families' heads and keep food on the table, and Michigan is getting cold, so the heat is coming on. They are trying to do that while looking for a job.

People want to work. People in Michigan work and they want to work. They are skilled and they are ready to work. We know that for every one job available, there are six people trying to get that job. So we are in an extremely difficult time. That is why we extended unemployment benefits in the Recovery Act. I thank our President. We had challenges under the previous President in being able to do that. President Obama put that forward, and I am grateful for his continual support and all of our colleagues who supported that.

But now we find that even as things very slowly begin to turn in the economy, every day we still have 70,000 people who are going off of their unemployment insurance benefits and they still cannot find a job. These are middle-class Americans who have played by the rules, and what is happening is not their fault. They are trying to keep things going until they can find a job.

We have now spent weeks and weeks trying to get to this bill. Since we started debating this on the Senate floor, as of today, 186,000 more people have lost their benefits and are trying to figure out what in the world they are going to do for their families. That is the situation we are in.

We have in front of us a very important amendment that has been worked on on a bipartisan basis. I congratulate everyone who worked on this together. I hope we will pass this quickly and move on and send the right message to people in this country that we get it, that we understand what is going on for families.

Let me speak about the amendment, and then I will speak about the process.

The amendment would allow an extension of 14 weeks for anyone who is currently unemployed in their State and qualifies for unemployment insurance and an additional 6 weeks, totaling 20 weeks, for people in my great State who have been hit too hard for too long. So we need to get this passed.

There are other provisions that have been combined with this. One of the other successes--in fact, I am proud, as the original author of cash for clunkers, to have Congress talk about that and the first-time home buyers tax credit. That has helped the economy. We know there is an expiration of the first-time home buyers $8,000 tax credit, so we extend that. There are other provisions in there as well.

There is another provision I am proud to have helped champion in the Finance Committee and now in this legislation, which is to allow companies that are struggling in this economy to keep themselves going, to keep people employed, to keep their lights on, and to be able to get immediate help with the net operating loss carryback--it is the way they calculate their losses--which will allow capital to immediately flow for small, medium, and large companies that are cash-strapped. That capital will help businesses be able to hire people, purchase equipment, or to turn their businesses around to be able to keep things going and keep their businesses going. That is in this provision as well. It is an important bipartisan effort.

According to a study by the National Bureau of Economic Research, the expansion we are talking about would inject $34 billion into businesses and our economy immediately.

This is about jobs. This is about supporting our small businesses that are having a very tough time getting capital. The CEO of the Home Builders Association claims that tax credits from the tax provisions would provide midsize and larger homebuilders enough funding to save 30,000 jobs that would have been lost without this change. So we have an important provision that has been worked on in a bipartisan way.

These items were something that we as a majority--our leader had come to the floor to support now for some time, to say let's get on with it; we need to support these provisions for homeowners, businesses, and help those who are currently unemployed. Let's get on with it. We are now at a point to vote on this amendment. What concerns me is the time it has taken us to be able to do that.

Over and over again, we have seen a pattern this year. In fact, we have seen 85 different times that the party of no has objected over and over to bringing up legislation--to even bringing up the unemployment legislation. It is a very simple thing for the leader to come to the floor to ask unanimous consent to go to a bill. But we are seeing objections over and over. Every time there is an objection, we are required to go through our own process. We find we have to file a motion called a cloture motion. You have to wait 2 days, and at the end of that 2 days, you vote. If there are 60 people who vote to proceed, you do that. We are finding over and over that we are getting overwhelming support to proceed.

At different times, we object to things with which we substantively disagree. That is our right as Senators. But we got to this cloture vote, and 87 people voted to go to the unemployment benefits legislation and to this amendment. So there is not an objection. This is about winding out the hours on the clock so we cannot get to health care, we cannot get to other jobs measures. And health care is about jobs, certainly in my State. When you lose your job, you lose your health care. We have seen that over and over.

Now we are in the process of this 30 hours. We voted to bring the debate to closure on this amendment we have, which is bipartisan, dealing with housing and support for businesses and the unemployed. Yet we have to go another 30 hours, which won't end until about midnight tonight, before we can actually vote. Then we will turn around and again there will be something else. The next move the leader tries to make, there will be an objection and we will have to wait 2 more days. We will vote on whether to proceed. Most of the time, everybody votes to proceed. Then we start a 30-hour clock, and then we vote on it. It goes over and over. Eighty-five different times, we have either had this process or an objection.

Mr. President, I just wanted to raise this for the American people as we move forward now. Everyone knows we have big problems. We can have honest differences about how to address those. That is our job. But we are seeing over and over a party of no, no, no stopping things. Heaven forbid that this President be successful or this Congress be successful. That is of great concern to me, in a State with the highest unemployment in the country, where every day we have people saying: Why in the world can't you act? Why can't you get things done?

The reason we are finding ourselves in this position now is an effort to slow-walk the entire year. It is amazing. We have actually gotten more done in this year than at any other time since FDR and the Great Depression despite all of this. Now we have come to a point where, by the end of the year, we want to have something extremely important accomplished on health care, and that relates to jobs and the economy. We are seeing objection after objection.

I am hopeful there will be a willingness to step up and debate our differences and have a vote. Let's just have a vote and work together to be able to solve problems. The American people are very tired of this. They want us to get something done. We want to get something done. We are committed to it whether it takes 30 hours and days and objections or whether we can just do this and come together. Either way, we are going to get this done. It is important to understand that real people are being impacted every single time there is an objection. Right now in this economy, the American people deserve better than what has been happening.

Mr. President, I have come to talk specifically about the urgency of passing the unemployment benefit extension.

I want to take a moment to respond to my friend from Oklahoma, who was essentially bashing the Government's ability to provide any kind of structure or opportunity for health care, saying that the Federal Government cannot be trusted to provide access to health care for people. I suggest that the 40 million people who receive their health care through Medicare--seniors over age 65 and people with disabilities--would probably disagree with that. I think my 83-year-old mother would wrestle me to the ground if I tried to take away her Medicare card. She has access to choose her own doctor and procedures.

This is a system that involves the public and private sectors, and it was in fact established in 1965 by the U.S. Government to make sure seniors and people with disability have health care. Also, those who are poor in this country and have lost their jobs and are fearful of losing their health care, families, and low-income seniors who need to go into nursing homes would probably disagree with my friends from Oklahoma about Medicaid, even though there are many challenges that we need to work on in terms of rates and so on.

Medicaid is a safety net for many Americans. That is the difference, in some cases, for seniors in nursing homes between life and death.

I am proud the Federal Government also stepped up on Medicaid. I also think the Children's Health Insurance Program, which was started in the nineties for low-income working families to make sure that if someone is working in a job and does not have health insurance, at least their children can be taken care of with a low-cost policy they pay for. But we established and created a way for families to get health insurance. I think those folks would probably disagree with the statement as well.

In many regards, the VA--and while there are certainly challenges and issues and we all push through to make sure our constituents are served--has been in the forefront of health information technology, electronic medical records, and so on. The VA is a system that works for our veterans as it should. When it is not well funded, as it has not been in the past with the previous administration, we stepped up to increase the funding repeatedly to make sure our veterans have what they need through a Federal Government health care system.

Finally, I will just say, there are our military and military retirees as well whom, I am proud to say, our country has supported through providing a health care system.

We can talk more about health care at another time. But I do think this ongoing effort to be critical of anything we do collectively as a country, through a democratic process of government, that somehow that is bad, I find that interesting, when we are saying to those around the world they should go to our system. We, together through our system, have made sure there are opportunities for many Americans, most Americans, if you count the employer-based health care system, the tax credits, the incentives for employers, the government policy. In some way, our government has been involved in incentivizing health care. The question now is, Do we complete the job? I am very hopeful we will complete the job for every American and tackle health care costs that are crippling our businesses, our government, and our families.

I wish to speak about something else that is of tremendous urgency for families. I was very pleased that last night, finally, after 3 weeks of blocking our ability to get to this bill to extend unemployment benefits, we have the opportunity to get to a vote. Eighty-seven Members voted to proceed to the bill. I don't understand, when 87 Members vote to proceed to the bill, why we could not have done this sooner.

Since we started to try to get to this bill, to this point today, 143,000-plus people have lost their unemployment insurance benefits-- just in the last 3 weeks, over 143,000 people, who have done nothing but work all their lives, play by the rules, the job goes away, they are trying to find another job and, in the meantime, keep a roof over the head for their family, food on the table, turn on that electric, turn on that heating system, which is going to cost

even more to the family budget--just keep things going.

We know 7,000 people today will lose their unemployment benefits; 7,000 people tomorrow will lose their unemployment benefits; 7,000 people the next day. We have been trying to build on what we did in the Recovery Act. I am so grateful our President immediately wanted to extend unemployment benefits. We did not have to struggle, as we did for 8 years, to try to make that happen. President Obama gets it, and it was in the recovery package.

Now we come to a position where we need to extend it. The House passes it, and we spend 3 weeks procedurally trying to get to this bill so we can consider it.

There are amendments that will be offered. There are amendments that are very good amendments that I support, such as extending the first- time home buyers tax credit, help for our businesses in this economy, adjusting tax issues of net operating loss, positive things, bipartisan things. But fundamentally, the question I have is why did it take us so long to get to the substantive discussion on this bill?

That leads me to the second matter about which I wish to talk.

Since the beginning of this year, we have seen 82--yesterday it was 81, now it is 82 times, as of this week, that we have seen Republican objections to moving America forward, forcing us to go to a vote, such as yesterday, where 87 people said yes. Why did it take a vote? Why did it take 3 weeks? If people were sincere about moving this country forward, about solving problems, all the talk of bipartisanship and all our efforts to create that, we would not get no, no, no; I object, I object, I object. That is all we hear as we try to move forward to solve some of the most critical issues facing the country, facing families, facing businesses--the economy, internationally with wars. Over and over again, things that should take 2 hours take 2 weeks.

It is time to say enough is enough. We have done this too long this year. Now is enough. It is time to get on with the business, the people's business, and to, frankly, call it like it is.

I wish to go through a few of the 82--not all of them--a few of the 82 objections because we started the year with efforts to block the President from getting his team in place.

We know there was an election. Somebody won. They have a right to have their team in place to govern. That is how this works. Yet right out of the box, the day after the swearing in, January 22, there was an objection to calling up the Jackson nomination, the Sutley nomination, the Solise nomination, the Rice nomination--objection, objection, objection. We can go on through point by point.

I will jump down to April 21, when there was an objection to scheduling a vote on Christopher Hill to be the Ambassador to Iraq. We are in the middle of a war, years of a war, and there was an objection to moving that nomination for most of April, but then he was confirmed with 73 votes.

This, obviously, was not about the fact that there was not a majority of people--overwhelmingly, over two-thirds of the Senate wanted to have this vote, wanted to confirm the Ambassador to Iraq, but yet there were objections and slow-walking and slow-walking and slow-walking, trying to slow down the business of governing and getting things done for this country.

Two days later, there was an objection to moving forward to the nomination of Thomas Strickland, the Assistant Secretary for Fish and Wildlife. Ultimately, he was confirmed with 89 votes. What took so long?

Seconds after that objection, there was an objection to Kathleen Sebelius as Secretary of Health and Human Services, right as we were first beginning to respond to the H1N1 virus, and we didn't even have a Secretary of Health and Human Services. Yet there was an objection.

Seconds after that, there was an objection to David Hayes to be Deputy Secretary of Interior. They filibustered this nomination. We had to go through all these procedural votes. In the end, he was confirmed unanimously. So even the person who objected to going to this nomination ultimately supported the nomination, which leads one to ask: What is the motivation of what is going on here?

In May, they objected to proceeding to the Family Smoking Prevention Tobacco Control Act. Ultimately, it passed with 79 votes in June. Twice we had to file procedural motions, cloture motions to get the credit card bill in front of the Senate. Ultimately, it passed with 90 votes.

In July, we had to file again. We had to go through the slow process, start the 30-hour clock, another 30-hour clock, waste time on the floor trying to get the Homeland Security bill up, which passed with 84 votes.

The Defense authorization bill, another absolutely critical bill that everyone agrees must move forward for our troops, for our security, was held up on the floor most of the month of July and ultimately passed with 87 votes.

In September, the Interior funding bill, the same thing. It ultimately passed with 77 votes. Finally, last week, Republicans objected to even going to the conference committee.

When we look at this, we have a bill that passes with 87 votes on Defense authorization, goes to conference committee, comes back, another objection, have to do a cloture vote, run the clock, and then the bill passes with 68 votes.

That leads us back to where we are today. Twice there were objections to bringing up the extension of unemployment compensation for millions of American families, middle-class families who are caught in the middle of an economic tsunami. They did not create it.

It is our job to create the economic framework to support the jobs that need to be created. We are focused on that, laser focused on that. Every piece we do relates to jobs, whether it is health care, energy policy or financial reform. Whatever it is, it all comes back to jobs. But we take 3 weeks to get in front of us a bill on which ultimately, last night, 87 people voted to proceed.

We have a new President of the United States this year. There was an election. There is a new Congress. We know there are differences on substance, and that is what a democracy is all about, honest differences. I have differences on specific policy issues. But what we see here is a conscious strategy that has to stop. It has gone on all too long. We have many challenges as a country that need to be addressed. We have families in crisis who need us to act, and this has to stop.

We can no longer continue to see this number go up from 82 to 85 to 90. Who knows where this will end, who knows, in terms of objecting to moving forward, objecting to taking up bills.

We have one of the most important issues that I know I will ever address or have worked on in my time in the House or Senate coming before us on health care reform. We have differences. We have people of good will who have differences. We will have a motion whether to even proceed to the bill and debate those differences. Yet my assumption is that almost all--hopefully not all--almost all the Republicans in the Senate will vote no to even proceeding to discuss it.

We are in one of the most important times in our country's history. We don't have time for this. We don't have time for these ongoing antics that just burn the time on the clock, stop us from taking votes, stopping us from getting the team in place so the administration can do their work, stopping us from solving problems, extending unemployment compensation, focusing on jobs, focusing on health care costs, tackling what we need to do for clean energy. We don't have time. The American people don't have time. Our country doesn't have time to waste on items that are blocked that eventually have overwhelming support.

We know there are times when we all feel passionately about something, when there are divisions in the Senate, when we choose to stop moving forward. We all have been in that position, and I respect that decision. I certainly hold that as a right of mine, as it is for each of us. But what we are seeing over and over are efforts to slow- walk the business of this country, of solving problems, and then when we get to the end, such as yesterday, there are 76 votes or 90 votes or it is unanimous. That is what I am objecting to--the strategy of stopping the people's business from getting done. I hope as we go forward on health care and go

into the new year, we will be able to focus on the substance of things, debate that vigorously--as we will--but stop what is the gratuitous objection over and over and over just for the purpose of saying no.

I strongly urge my colleagues to support the unemployment extension legislation that is in front of us. There is a sense of urgency. As I indicated before, we have a situation where we have over 148,000 people, just in the last 3 weeks, who have lost unemployment benefits-- 7,000 people, every day we debate this, every day it goes back to the House, every day before it goes to the President. It is time to get this done.

Mr. President, I suggest the absence of a quorum.

Mr. President, I ask unanimous consent that the Committee on Banking, Housing, and Urban Affairs be authorized to meet during the session of the Senate on October 28, 2009, at 9:30 a.m., to conduct a hearing entitled ``Dark Pools, Flash Orders, High Frequency Trading, and Other Market Structure Issues.''

Mr. President, I ask unanimous consent that the Committee on Commerce, Science, and Transportation be authorized to meet during the session of the Senate on October 28, 2009, at 2:30 p.m. in room 253 of the Russell Senate Office Building.

Mr. President, I ask unanimous consent that the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate on October 28, 2009, at 10 a.m., in room SD- 366 of the Dirksen Senate Office Building.

Mr. President, I ask unanimous consent that the Committee on Environment and Public Works be authorized to meet during the session of the Senate on October 28, 2009, at 9:30 a.m., in room 406 of the Dirksen Senate Office Building to hold a hearing entitled ``Legislative Hearing on S. 1733, Clean Energy Jobs and American Power Act.''

Mr. President, I ask unanimous consent that the Committee on Homeland Security and Governmental Affairs be authorized to meet during the session of the Senate on October 28, 2009.

Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet during the session of the Senate on October 28, 2009, at 10 a.m., in room SD-226 of the Dirksen Office Building, to conduct a hearing entitled ``Effective Strategies for Preventing Health Care Fraud.''

Mr. President, I ask unanimous consent that the Ad Hoc Subcommittee on Contracting Oversight of the Committee on Homeland Security and Governmental Affairs be authorized to meet during the session of the Senate on October 28, 2009, at 2:30 p.m. to conduct a hearing entitled, ``Achieving the President's Objectives: New OMB Guidance to Combat Waste, Inefficiency, and Misuse in Federal Government Contracting.''

Mr. President, I ask unanimous consent that the Special Committee on Aging be authorized to meet during the session of the Senate on October 28, 2009, from 2-4:30 p.m. in room 562 of the Dirksen Senate Office Building.

Mr. President, I ask unanimous consent that the Subcommittee on National Parks be authorized to meet during the session of the Senate on October 28, 2009, at 2 p.m. in room SD-366 of the Dirksen Senate Office Building.

Mr. President, on behalf of Senator Mark Udall, I ask unanimous consent that a fellow in his office, Matt Bowen, be granted floor privileges for the duration of the month of October.

Mr. President, today I introduced legislation to create a national strategy for treating two diseases that affect millions of Americans: depression and bipolar disorders. This bill, the Establishing a Network of Health-Advancing National Centers of Excellence for Depression, or the ENHANCED Act, will establish a network of national centers of excellence for the treatment of these disabling conditions. My bill would increase the number of people with depressive disorders who receive appropriate and evidence-based treatment; it would create a national resource to develop and disseminate evidence-based interventions, and provide public and professional education aimed at eradicating the stigma associated with depressive and bipolar disorders.

Depression and bipolar disorders affect one of every five people in the United States and are the leading cause of disability among individuals between the ages of 15 and 44. In fact, more Americans suffer from depression, bipolar illness and other mood disorders than from coronary heart disease and cancer combined.

Depression can affect anyone, at any age, at any time. It affects children, adolescents, and adults. It affects people of all racial, ethnic, religious, and socioeconomic levels as well as both sexes. Young adults, women of childbearing age, people with chronic medical conditions such as diabetes and heart disease, and adults over the age of 55 are at especially high risk of depression.

With medication, psychotherapy, or combined treatment, most people with depression and mood disorders can be effectively treated and resume productive lives. Yet one-third of those suffering from depression--nearly 5 million Americans--do not receive treatment because they cannot afford it, do not believe it is needed, are afraid of societal judgment, or do not know where to go.

My bill is based on work done informally by 16 academic research institutions across the nation. Led by my own State's University of Michigan Depression Center, these comprehensive research and treatment centers have joined together to create a network of depression centers positioned to take academic research and translate it into practice, standardize diagnoses, treat early and more effectively, and prevent recurrences of depression and bipolar disorders.

Currently, there is no direct federal support or coordination of this work. Clinicians lack universally accepted multi-disciplinary approaches and real-time clinical and care management guidelines. Nearly half of all diagnoses of depression and bipolar are missed. And tragically, one of the preventable costs of undiagnosed, untreated and undertreated depression is suicide. The World Health Organization recently reported that suicide causes more deaths around the world every year than homicide or war. Across all age groups nationwide, more than 90 percent of those who commit suicide have a diagnosable psychiatric illness at the time of death: usually depression, alcohol abuse or both. Clearly, we need better diagnostic approaches to depression in primary care, other medical settings, and mental health programs.

Finally, depression has a significant economic impact on society. The estimated total annual cost of depression in the U.S. is $83.1 billion, with the majority of costs in the form of reduced productivity, absenteeism, and mortality.

The ENHANCED Act offers us a viable response to a devastating and often debilitating disease: it would create a national network with a pathway for developing and expanding up to 30 depression centers of excellence with a goal of increasing access to the most appropriate and evidence-based depression care; it would develop and disseminate evidence-based treatment standards, clinical guidelines, and protocols to improve accurate and timely diagnosis of depression and bipolar disorders; it would expand multidisciplinary, translational, and patient-oriented research by fostering the collaboration of academic and community-based organizations; and, it would establish a sustainable national resource for public and professional education and training.

We need to act now to make effective and evidence-based treatment of depressive and bipolar disorders available to the millions of Americans suffering from depression.

I urge my colleagues to join me today to support the ENHANCED Act.

Mr. President, I ask unanimous consent that letters of support be printed in the Record.