Floor Statements

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.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

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

Mr. President, I rise today to speak about a motion we will be voting on after the nomination that is currently before the Senate, and that is the motion to proceed to a very important bill for seniors on Medicare coverage, for the disabled, for those who are in our military and their families. It relates to the way we reimburse physicians under Medicare and under TRICARE. It is called the Medicare Physician Fairness Act.

This is an effort to eliminate what has become a very flawed formula for determining the payments for physicians under Medicare.

We, in fact, know it is flawed because in the last 7 years, the last seven times that proposals have come forward from this formula to cut physician pay under Medicare and TRICARE, this Congress has chosen to reject that recommendation, that cut.

We want to make sure seniors can have access to their doctors, that Medicare is a quality system that allows the kind of reimbursements so we can continue to have the quality of providers, physicians, and others we have today.

This bill, S. 1776, would allow us to do away with what has become a very flawed process. Every year we postpone the cuts that have been proposed because we know they are flawed. We know this time of year, if we do not take action, there would be a 21-percent cut in Medicare for physicians who serve our seniors and people with disabilities. Because Medicare and TRICARE are tied together, that cut would also affect our military men and women and their families and retirees from the military. So, of course, we do not want that to happen. We are not going to allow that to happen. But rather than every year--every year, every year--deciding at the last minute we are going to stop these devastating cuts, putting physicians in the situation where they are not sure how to plan, worrying our seniors, worrying those in our military and retired military personnel, now is the time to change the formula to stop it.

By doing that, by passing this legislation, we then set the stage for health care reform where, in fact, under health care reform, we have a different set of incentives. We focus on strengthening Medicare in a way that improves quality access for seniors. We focus on incentivizing prevention. We focus on incentivizing primary care doctors with a different system that will provide bonuses and payments for our primary care doctors.

So we have a new system. We have a new vision for strengthening Medicare, strengthening our health care system. But right at the moment, we also have this failed system in place that we are kind of stuck with unless we can say: We are done. We are going to start again. We are going to start from a different budget baseline, and then move forward on health care reform.

That is exactly what I have been wanting to do with this legislation. That is why I am so appreciative of the fact that our majority leader, Senator Reid, understands and is committed to making this change. His commitment to Medicare, his commitment to our seniors, our military personnel, and to our physicians is the reason we are here today. So I am so grateful to him for all of his commitment and all of his work. But this needs to be changed right now.

As I indicated, we have a system that supports our Medicare system, covers seniors, the disabled. We also tie it to our military health care system, members of the U.S. military, surviving spouses, families, military retirees, and their families. All of them are extremely supportive. In fact, it is not an exaggeration to say this is a top priority, if not the top priority, of the AARP and those who advocate for seniors right now to give seniors the peace of mind to know they are going to be

able to have access to their doctors and that their doctors are going to have the resources they need to be able to treat them.

This bill would make sure that happened by rejecting what has been a failed system. We can go right on down the list. We not only have strong support from the American Medical Association and other physician groups but those who represent our military. Military officers and their families and retirees are extremely supportive.

I am very proud of the work that over 20,000 physicians in Michigan do every day providing to more than 1.4 million seniors and people with disabilities in Michigan the quality care they need and deserve.

We have over 90,000 TRICARE beneficiaries, men and women in our military, retirees who are receiving high-quality medical services in conjunction with the Medicare system. We are very proud of that, and we want to make sure we are maintaining that as well.

Let me go through again what we are trying to make sure we can fix. One, this legislation would repeal the current broken system. It would stop a 21-percent cut to our physicians under Medicare and TRICARE, which would be devastating. It would stop what is a Band-aid approach every year. We know we are going to fix it. We fix it every year individually for that year, always at the last minute.

It is time to change that process. I believe this is honest budgeting because we know we are not going to allow these cuts to take place. So we should do away with this process that even proposes these cuts every year and lay the foundation for real physician payment reform, which is in the legislation.

Let me share with you a letter from a medical clinic in southwest Michigan where physicians wrote to me.

Every year we have to wait to the last minute to see if the

rates will get cut or fixed. This makes it impossible to

budget and project for the next year. Especially for

practices like ours, with nearly 50 percent of our patients

are Medicare patients. With the uncertainty and the increases

that we do get not keeping up with the cost of living, we

have to err on the side of caution, which leads us to job

cuts. Though we need the staff to provide the best patient

care between Medicare and Medicaid we can't afford to keep

them and stay in business. If the uncertainty continues we

will be forced to re-evaluate our patient population as well,

leaving the Medicare patients with no choices for the care

that they need.

This is really the bottom line. We want to make sure physicians are fully participating in caring for our senior citizens, for people with disabilities in this country. We want to make sure Medicare is strong. We want to make sure we are protecting it going forward. In order to do that, we have to start from the premise that we will not be allowing these cuts or the possibility of these cuts to go forward year after year after year.

The vote we are going to have in front of us is a vote to proceed to the bill. I know there are those with amendments they would like to offer. I would hope that we would see a strong bipartisan vote to simply go to this bill. I think the seniors of this country deserve that.

I think all of those who care about health care for our senior citizens and the disabled, our families, our military personnel deserve that; to have the opportunity to go to this bill, to be able to work on it together, and to be able to pass this bill and permanently solve this problem.

I am very grateful for the fact that the President of the United States not only supports this effort, his administration's budget, the budget he gave us at the beginning of this year, his very first budget, he put forward a budget that did not include going forward with the cuts in this flawed formula.

His budget baseline started from a premise that we would not be making these cuts going forward. I believe that is where we should be. We should be making sure we stop the Band-aid approach. Stop this effort that has gone on year after year and create an honest budgeting process so that we can make sure our seniors have confidence in the future; that they are going to be able to see their doctor under Medicare, and that physicians have the confidence of knowing they are supported by a strengthened Medicare system.

So I am very hopeful we will see a strong bipartisan vote to allow us to move to this very important measure to strengthen and protect Medicare of the future.

I yield the floor.

Mr. President, if I might just add to what our distinguished leader has said and thank him for bringing this vote to us. This is about strengthening and protecting Medicare.

The distinguished Republican leader is right: Enough is enough-- enough of running physicians up to the brink every year, not knowing what is going to happen; enough for seniors not knowing whether they will be able to continue to see their doctors. Seven different times we have brought them up to the brink and then not made the cut and have many times not paid for it. This legislation will wipe the slate clean and will for the first time bring honest budgeting to Medicare.

Mr. President, it is my great pleasure today to congratulate the Union Missionary Baptist Church on its 100th anniversary. This wonderful church was the first African-American Baptist church in Lansing, established by a small group of worshippers meeting in a living room. In 2001, the congregation built a Family Life Center, which ministers to the community with classrooms, a computer lab, a chapel, a prayer garden, and a commercial kitchen. The congregation today consists of over 700 members.

The church has been blessed by excellent leadership over the years. The first pastor was Rev. H.C. Randolph, who was succeeded by many other distinguished pastors over the years, including Rev. G.W. Carr, Rev. J.G. Bruce, Rev. S.L. Johnson, Rev. Norris Jackson, Rev. Joel L. King (uncle of Dr. Martin Luther King), Rev. Charles J. Patterson, and the current pastor, a wonderful leader and a dear friend, Rev. Melvin T. Jones.

Throughout its great history, Union Missionary Baptist Church has enriched the lives of thousands of people who have come through its doors to worship. It has been my privilege to work with Reverend Jones over the years. He and his church truly reflect what Paul urged of the Galatians: ``Whenever we have an opportunity, let us work for the good of all.'' I congratulate Reverend Jones and the congregation, and I look forward to participating in the church's centennial celebrations.

Mr. President, I rise this afternoon to discuss our efforts to extend unemployment benefits to over 15 million people who are looking for work today. That is only the number of people we know are out there based on the unemployment statistics, not those who have tried for a long time and been unsuccessful and are currently neither in the workforce nor are working two or three or four part-time jobs trying to hold things together for themselves and their families. We do know this. Over 15 million people today who are trying to support their families in this very tough economic time need our help immediately to stay afloat.

Two nights ago I asked for agreement to move to the unemployment insurance bill. Our leader had asked for agreement to do that before. This has already passed the House and is awaiting Senate action. Unfortunately, Republican colleagues objected. They have objected several times and continue to object to our bringing forward an effort to help families who, through no fault of their own, find themselves in an extraordinarily difficult situation, relying on unemployment in order to be able to keep their families afloat.

Unemployment is not a partisan issue. Right now, 14 States and the District of Columbia, blue States and red States, have unemployment rates over 10 percent: Illinois, Georgia, Alabama, Florida, North Carolina, Ohio, Tennessee, Kentucky, South Carolina, California, Oregon, Rhode Island, Nevada and, of course, my great State of Michigan, where we are now seeing over a 15.3-percent unemployment rate, the highest in the country.

Our people are hurting and they have been hurting for a long time. I was very proud of our President as he came into office for understanding that and joining with us in a recovery package to make sure we were extending unemployment at the beginning of the year. But unfortunately the recession continues and people are still hurting. Democrats are unemployed and Republicans are unemployed. The people getting unemployment insurance are looking for work, they are pounding the pavement and they are putting in applications every day. This is not their fault.

The economic situation in this country is not their fault. The bank failures are not their fault. The foreclosure crisis is not their fault. But they are the ones paying the price every single day. Every single day, every single time the other side objects to bringing up this bill, people across the country are hurting. They are exhausting their unemployment insurance and are being left with no way to pay the mortgage, to take the kids to the doctor, to pay their heating bills, to be able to hold it together, waiting for this economy to turn around and jobs to be available, jobs they so desperately want.

It is getting cold outside. Winter is coming and families across the country are turning on their heaters for the first time in months. They need us to extend unemployment insurance so they can keep the heat on for their kids. Pulling the rug out from under these hard-working men and women doesn't just hurt them and their families, it hurts every community and it hurts our economy in America. When they can afford to pay their bills, that money goes back into the economy, as we know. We know that for every $1 spent on unemployment benefits, $2.15 goes back into the economy. That is exactly what we need at this point--immediate stimulus.

This is an incredibly difficult time for families, certainly in my State and all across the country. Blocking this legislation, saying no to everything, delaying everything--that is not going to pull us out of this recession and it is not going to help American families.

The time to act is now, right now. I urge my colleagues to stop blocking an important effort to help working men and women in this country, people who have followed the rules all their lives, have done nothing but find themselves at this place and this time, with the economy where it is, as we rebuild it--and we are and we will. We need to support them so they can do the right thing for their families and keep a roof over their heads and food on the table and the lights on and the heat on and know that their country has got their back.

That is what this is about. We need to pass the extension of unemployment insurance now. I hope we will.

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

First, Madam President, I thank my friend from Utah for his graciousness. It is a pleasure to serve with him on the Finance Committee.

(The remarks of Ms. Stabenow pertaining to the introduction of S. 1776 are printed in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Madam President, I appreciate very much my friend from Utah allowing me to step in for a moment. I will be happy to talk more about this at a later point, but it is important to get this introduced this evening so it can become a part of the debate.

Madam President, I ask unanimous consent that the Senate proceed to the immediate consideration of H.R. 3548, which was received from the House; further, that a Reid substitute amendment, which is at the desk, be agreed to; the bill, as amended, be read a third time and passed; the motions to reconsider be laid upon the table with no intervening action or debate; and any statements related to the bill be printed in the Record.

Mr. President, I rise for just a moment because I am introducing a bill today that I will speak more about at another time, but it is a very important bill for the physicians of this country.

We have had a failed, flawed payment system in place for many years as it relates to physicians, and we come back

every year, in fact, and stop the cuts that are proposed under that flawed system to make sure we are not putting our physicians in harm's way as it relates to their Medicare reimbursements.

This has gone on year after year after year after year. We all know that the sustainable growth rate process is flawed and yet we have not fixed it permanently. So the legislation I have would, in fact, fix this permanently and guarantee we are stopping this cycle that we put our physicians and hospitals through every year, where there may be a cut, there may not be a cut, and in the end we have to come in and fix it.

So this is a bill that would permanently change the payment system for physicians to a fairer system. It does have a cost to it. It is less than it was prior to the very positive action the Secretary of Health and Human Services took a few weeks ago, removing the costs of medicine from the formula. It should never have been there in the first place. But by removing that, that means the overall costs are less than they otherwise would be.

But it is important we get this right, we fix what has been a very flawed system. As we go into the health care reform debate, I think it is important we get this done right first so every physician understands we are not going to put them in this position year after year after year.

Mr. President, I rise for just a moment because I am introducing a bill today that I will speak more about at another time, but it is a very important bill for the physicians of this country.

We have had a failed, flawed payment system in place for many years as it relates to physicians, and we come back

every year, in fact, and stop the cuts that are proposed under that flawed system to make sure we are not putting our physicians in harm's way as it relates to their Medicare reimbursements.

This has gone on year after year after year after year. We all know that the sustainable growth rate process is flawed and yet we have not fixed it permanently. So the legislation I have would, in fact, fix this permanently and guarantee we are stopping this cycle that we put our physicians and hospitals through every year, where there may be a cut, there may not be a cut, and in the end we have to come in and fix it.

So this is a bill that would permanently change the payment system for physicians to a fairer system. It does have a cost to it. It is less than it was prior to the very positive action the Secretary of Health and Human Services took a few weeks ago, removing the costs of medicine from the formula. It should never have been there in the first place. But by removing that, that means the overall costs are less than they otherwise would be.

But it is important we get this right, we fix what has been a very flawed system. As we go into the health care reform debate, I think it is important we get this done right first so every physician understands we are not going to put them in this position year after year after year.

Mr. President, I thank the dean of the women in this Senate, Senator Mikulski, for bringing us all together on the Senate floor, and I join with my great colleagues from California and North Carolina and other colleagues who will be joining us

as well, to talk about the importance of health care reform for women.

Women are the majority of the population. We have the ability to benefit from this reform that holds insurance companies accountable and creates more opportunity for coverage. We will see a great benefit to come from all of this, and I want to speak to just one piece of it. We know the majority of people today--men and women, families--have insurance, and there are a multitude of bad insurance company practices that are occurring today stopping people from getting coverage because they have a preexisting condition.

By the way, we found out just last week, from an article in the Washington Post, that some insurance companies treat pregnancy, or the intention to adopt, as a reason to reject someone for a preexisting condition. I mean that is pretty shocking to me. In fact, the same report said that being pregnant or being an expectant father, with some companies, was grounds for automatic rejection--automatic rejection-- when it comes to being able to get a health insurance policy.

So this reform is about making sure everyone benefits; that women who have insurance, as well as women who don't currently have access to health insurance, can see protections and changes that stop the discrimination and create better access to health care because that is what this is all about, being able to find affordable health care and health care that meets our needs. All women across the country certainly are desperately concerned about that. We have 62 million American women right now who are in their childbearing years, and I was quite shocked to learn that right now, according to the Women's Law Center, nearly 60 percent of the individual insurance plans that are out there in the marketplace--if you are not getting insurance through your employer, but you are going out yourself to find an insurance policy for you and for your family--nearly 60 percent don't provide any coverage for maternity care or even an option of supplemental insurance for an additional cost.

So for the women in these plans who are attempting to get insurance, no amount of money can buy the maternity care that they need. So this bill is about changing that and making sure the women of this country have the care they need.

I thank the Chair.

Madam President, I thank Senator Brown.

I want to thank my friend from Ohio--and before he leaves, my friend from Oregon as well. We are so proud and happy to have the Senator from Oregon with us as one of our terrific Members, coming from being the speaker of the house in Oregon, and leading on energy and being passionate on health care and jobs. It is just wonderful having the Senator with us. So we appreciate his advocacy on this important issue.

I want to thank my friend from Ohio. I think we have States that are more alike than any two States I can think of in the Senate because of the challenges that have undergone the auto industry and manufacturing--the extent to which we understand that fair trade is important, that health care and jobs are critical. We also fight to protect our Great Lakes. So we have many ways in which we are team partners in the Senate, and I want to thank the Senator from Ohio for his leadership in bringing us together again to speak about a critical part of this health care reform effort.

I also want to recognize the Senator from New Mexico, whom I see on the floor, whom we are very proud to have with us, as well, coming from the House of Representatives, who has done such a wonderful job in transitioning, hitting the ground running. And with the Presiding Officer, the Senator from New Hampshire, who is presiding, we have a fantastic group

of Members who have joined us who are going to help us get health care reform done, as well as tackle energy and a number of different issues. So it is a pleasure and honor to work with you.

As I speak about health care and the importance of having a public insurance option, I first want to take just a moment to note another issue that is very much tied to health care but an action that was taken a while ago--a very concerning action, again, where the Senate Republican leadership chose to block us moving forward on the extension of unemployment insurance.

As our Presiding Officer from New Hampshire knows, having been a leader in bringing us together and putting forth a plan to be voted on, it was incredibly concerning to me that, in fact, the effort and the proposal to extend 14 weeks of benefits for all of the people in all of our States who are currently unemployed or who will soon be unemployed, with an additional 6 weeks for States such as mine with the very highest of unemployment levels, was blocked one more time on the Senate floor. This is not what we ought to be doing.

When we look at what is happening in our State with about 15 percent unemployment, everyone understands the challenges we are going through. We have people who want to work. They want to work. They are looking for work. They may be piecing together income in a variety of ways. The difference between their being able to keep a roof over their heads for their families and food on their tables right now has been the efforts of extending unemployment that we did with our great new President, President Obama, coming into office and making that a priority. We made it a priority in the Recovery Act. Now we are at a point where we need to extend that.

We expect in Michigan alone that 99,000 people will exhaust their unemployment benefits by the end of this year; tens of thousands of people coming to the unemployment offices. So this is critical for us. We are not going to go away. We are going to keep right back at it until we get this done.

The same thing is true with health care reform because there is a direct relationship. As I start to speak about health care, I wish to say one of the very positive things of the many positive things about the legislation we will be voting on is that we want to strengthen it with a strong public option. One of the very important pieces of this legislation we worked on in the Finance Committee, and supported by the HELP Committee as well, creates a real safety net so if you lose your job, you don't lose your insurance. This is absolutely critical.

We are talking about extending unemployment benefits for people who have been trying to find work and can't find work. Well, what we all know is that when you lose that job, too many people also lose their insurance. Then they lose the house. Then they lose whatever comes next--the car or the kids can't go back to school. So it is all related. In our health care bill, we make sure there is a real safety net and that people who lose their jobs know they will be able to have insurance, and that is very important.

It is also critical, for people who are looking to purchase insurance, that they can get the very best price. It is important that people who have insurance can keep it; that they know what they are paying for they actually get, by the way, which is why the insurance reforms are so important; so you are not dropped right when you get sick or blocked from getting coverage. We know in order to create this new pool for individuals and small businesses that can't find or afford insurance that it is absolutely critical, if we are going to say everybody in the United States of America needs to have insurance, that it be affordable, that it be competitive in the marketplace, and that people be able to have every choice possible available to them. That is what we are talking about tonight because, ultimately, this is about providing real stability and security for American families.

I received a letter from a constituent of mine, Lynn, in Marshall, MI. She wrote:

In the space of two months, my husband's income was cut 25

percent because of the economic downturn. At the same time,

our oldest son, 21 years old, was diagnosed with leukemia.

Every parent's worst nightmare.

To date his bills have totaled about $450,000 for

treatment. While we currently have insurance, I worry about

my son and how his ability to obtain adequate health care

will forever be affected by his illness. His leukemia has an

exceptionally high cure rate, but how will he afford his own

health insurance which will likely affect his ability to stay

healthy for the rest of his life. He is only 21 and on the

verge of graduating from college. Once he graduates, he will

lose his coverage under my husband's plan. His treatment

won't even be finished by the time he graduates. I lay awake

at night and worry how we will finish his treatment.

Lynn, everybody who has ever had a child worries about this kind of scenario and what could happen for their children. That is why we are here tonight. In the richest country in the world, no parent should have to lay awake at night worrying about how their son or daughter would be able to find the health care they need.

In our reform in the Finance Committee, there is great news from part of what Lynn talked about, and that is we have extended health insurance for young people on their parents' policies until age 26. That is incredibly important and very positive. But when he then goes into the marketplace to find insurance, will he be able to find affordable insurance in this new exchange we set up? The way to guarantee that happens is through a strong public option, a public choice. You don't have to choose it. That is the great thing about America. We are all about choices.

So we make sure there is a real competitor in the marketplace that is pegged to the real costs of health care and that doesn't have to worry about making a profit, that doesn't have to worry about marketing, that doesn't have to worry about other costs, but strictly providing health care and the costs of providing health care in the marketplace. Having that kind of competitor will make sure everybody is honest about the real costs associated with providing health care.

We know there are very powerful interest groups that have lined up to slow down or to stop this bill from passing, and they are bitterly opposed to a public insurance option. They know it will bring down costs, it will hold insurance companies accountable, and will bring down the overall costs for taxpayers because of what we are doing in health care reform, now and on into the future. We don't need to hear from more of those voices. We need to hear from our own constituents who are struggling every day with the rising costs of health insurance.

That is why I created my online Health Care People's Lobby, so people in Michigan can have their voices heard. We have had over 7,000 people respond. I am very grateful we have had hundreds of stories that have been shared with us. I am so grateful for all of those.

Lisa from Novi, MI, signed up for the People's Lobby, and she wrote:

I am one of the lucky ones. We have health insurance and

everyone is healthy. However, with just routine doctor

visits, the time spent deciphering bills and reconciling what

the insurance company paid and what we owe can be

overwhelming.

Haven't we all been through that?

Our insurance is a primary reason my husband has stayed

with his current employer at a lower salary, because most new

job opportunities don't offer coverage. I strongly believe

in a public option.

The reason we are here on health care reform and the reason we have a sense of urgency about it is because, as Lisa said, many new job opportunities don't provide health insurance, and we know we have to do better in this country. That is the point of creating a large pool for people who can't find insurance, don't have it through their job, to be able to pool people together and have an insurance exchange. But as I said before, to make sure that works, to make sure it is really affordable for families and for small businesses, we need real competition of a public insurance option.

Another constituent, Glenn from Sterling Heights, is 62 years old. He got laid off in December, and it doesn't look like he will be called back. He writes:

I am too young for Medicare. I have a preexisting

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

I can get Medicare, my savings and everything 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 right

and moral things to do. I didn't create this mess, but I am

sure paying for it.

There are many people in Michigan in that very same situation that I am fighting for every day. In our insurance bill, first we have positive responses to this issue. We are going to stop the banning of insurance because of preexisting conditions. That is extremely important. We have help in this bill for early retirees to make sure we can help with the costs. But to make sure this whole system works together, we need a public insurance choice for Glenn so that if the other options don't work for him at 62 years old, he has a choice where he can go to an option that is affordable and is focused totally on providing health care for him. A public health option would give Glenn some hope. It would give him security until he is able to get to Medicare, so that he wouldn't lose everything if he had a medical crisis.

Glenn is not alone. We know 62 percent of bankruptcies occur because of the medical crisis. We know 5,000 people every day lose their homes to foreclosure because of the medical crisis.

I have literally received thousands of e-mails and stories from people around Michigan, and I wish to thank everyone who has e-mailed me, who has shared their story. We have literally thousands of stories of people who have gone through so many different experiences of worrying about whether they are going to lose their insurance, trying to figure out how to pay for their insurance, not being able to find insurance because of a preexisting condition, not being able to find something affordable as an individual going out into the marketplace. We have heard thousands and thousands of stories from Michigan, and they all say act now. Give us choice, real choice and competition.

We know having a public insurance option is the way we guarantee all of this fits together. So for my constituents--for Lynn, for her son, for Lisa and Glenn, for the 11,000 others who have signed up for the People's Lobby--I urge all of my colleagues to join with us to make sure with all of the pieces we have put into these bills that are so important and so positive that we bring it all together by including a public health insurance choice for people so that if the private, for- profit companies in the exchange are not able to give people affordable insurance, they know ultimately they can find it.

I thank you very much, Mr. President. I wish to thank my friend from Ohio again for his passion and his time and efforts, and I yield the floor back to him.

Mr. President, I am here today in recognition of National Hunting and Fishing Day, which was recognized on September 26. Hunters and anglers contribute significantly to our Nation's economy. More than 1 million hunters and anglers add over $3 billion each year into Michigan's economy alone.

From the very beginning, hunting and fishing have been at the center of Michigan's history and culture. Our two great peninsulas, surrounded by the magnificent Great Lakes, are home to over 8 million acres of public hunting land, tens of thousands of rivers and streams, and some of the best hunting and fishing in the United States. Whether meandering along Hemingway's Fox or Two Hearted Rivers for brook trout and ruffed grouse, or making the annual trip to deer camp with friends and family, Michigan's proud heritage comes with a sense of profound responsibility to protect that legacy for future generations.

We have made some important progress. I have been pleased to spearhead a number of efforts including Federal funding to stop the invasive cormorant from destroying our fisheries. This project has already shown conclusive results in bringing back once-decimated fishing areas. Through my work on the Senate Agriculture Committee, we have invested over $4 billion in new conservation efforts that will protect wildlife habitats and increase access for hunters and anglers across the country. Most recently, the Senate passed $400 million in funding for the Great Lakes Restoration Initiative to clean up the Great Lakes.

While we have made progress, there is more work to be done. I will continue to work for passage of the National Fish Habitat Conservation Act and the Clean Water Restoration Act, which will help preserve Michigan's 36,000 miles of rivers and streams, including over 1,000 miles of blue-ribbon trout streams. I will also continue to work to ensure access to public lands and waterways.

Working together, we can preserve our natural resources so others can enjoy our rich hunting and fishing heritage for generations to come.

Mr. President, I appreciate the opportunity to be here with colleagues, and I so appreciate the words of the Senator from North Dakota and those of the Senator from New York and all of our other colleagues who have been here, talking about our friend and colleague, the great Senator from Massachusetts.

I think for me, being in my second term and still a relative newcomer here, one of the greatest honors of my life was the opportunity to work and become friends with Senator Ted Kennedy.

I often have been asked what was the most surprising or exciting thing about being in the Senate. I always referred to Ted Kennedy, not only knowing him and the larger-than-life way he has been described, which was also true, but for me the images are of sitting in a small room going over amendments on the Patients' Bill of Rights when I was in my first term and having the great Ted Kennedy--not his staff but Ted Kennedy--sitting in a room with advocates talking about how we needed to mobilize and get people involved and what we needed to do to get votes or how to write something--doing the work behind the scenes.

Ted Kennedy, because of who he was--his family, his certainly great leadership and knowledge, and his length of time here--could have simply stood on the floor and made eloquent speeches, which he always did--the booming voice in the back that would get louder and louder as he became more involved in what he was talking about--he could have just done that, and that would have been an incredible contribution to the Senate. But that is not what he did. He was as involved behind the scenes in getting things done, more so than in the public eye. He worked hard and showed all of us an example of someone who was dedicated to the details, to the advocacy as well as to what was happening on the floor of the Senate. It was a very important lesson for all of us.

As chair of the Steering and Outreach Committee for our Senate majority, one of my responsibilities is to bring people with various interests together, usually on a weekly basis, to meet with Members on issues from education to health care, clean energy, civil rights, veterans. People always wanted to have Ted Kennedy in the room. Again, as a very senior Member with tremendous responsibilities, chairing the HELP Committee and all of the other responsibilities he had, he could have easily said to me: You know, I am just not going to be able to do that. We will have more junior Members come and join in these meetings. But he came, over and over again.

One of the things we joked about all the time was that he would see me coming and say: I know, there is a meeting tomorrow. I will be there.

He was someone who gave his all at every moment. He also understood that people needed and wanted to see him, to hear him, and the important leadership role he had here. It was important to people. And he treated everyone the same.

He was committed to a vision of making America the best it could be, where every child would have the chance to grow up and be healthy, succeed in life, have a job, at the end of life a pension and retirement, and be able to live with dignity. His service

was great, but his legacy is even greater.

I believe his challenge to each of us is even greater. It is true that nearly every major bill that passed in the last 47 years bears some mark from Senator Ted Kennedy--the Civil Rights Act; the Voting Rights Act; Meals for the Elderly; the Women, Infants and Children Nutrition Program; the Violence Against Women Act; title IX, which is giving so many women and girls the opportunity to participate and move through education's highest levels, including the U.S. Supreme Court, as well as the wonderful athletic abilities we have seen; the Children's Health Insurance Act; AmeriCorps; the National Health Service; the American Health Parity Act; legislation to allow the FDA to regulate tobacco; the Ryan White Comprehensive AIDS Act; the Americans with Disabilities Act--it goes on and on. These are just a few of the hundreds of bills Senator Kennedy sponsored or cosponsored during his time in the Senate, and each and every one of those bills made America a little bit better.

His commitment to achieve the best for America, for every child, every family, every worker was unmatched. We have lost the lion of the Senate, and he will be sorely missed. Personally, I have lost a friend, someone for whom I had the highest personal respect and someone I cared deeply about as a person.

To Vicki, to the family, we give our love and affection and thanks for sharing him with us. In his maiden speech in the Senate, Senator Kennedy spoke of his brother's legacy. Today, the same words can be spoken about him. If his life and death had a meaning, it was that we should not hate but love one another. We should use our powers not to create the conditions of oppression that lead to violence but conditions of freedom that lead to peace.

Ted, we will miss you.

Mr. President, I suggest the absence of a quorum and ask that the time be charged equally to both sides.

Without objection, it is so ordered.

The clerk will call the roll.