Floor Statements

Mr. President, on Friday, July 11, 2008, I regrettably missed a vote on H.R. 3221 due to a prior commitment in Michigan. If I had been present, I would have voted for Record vote No. 173, the motion to disagree to the amendments of the House adding a new title and inserting a new section to the amendment of the Senate to H.R. 3221. This represented the final hurdle in passing the much-needed Housing and Economic Recovery Act of 2008. I strongly support this bipartisan, comprehensive bill to address the root of our economic problems--the housing crisis. This bill would strengthen the regulatory oversight of government sponsored enterprises, GSEs, and provide FHA modernization reforms to help stabilize the housing finance system and begin to restore confidence to the market. The bill's Hope for Homeowners FHA refinancing program would help as many as 400,000 homeowners at risk of losing their homes to foreclosure. It also includes foreclosure counseling for families in desperate need of help, assistance for communities hit by foreclosures, an affordable housing trust fund, provisions to help returning soldiers avoid foreclosure and important tax benefits targeted to help the recovery of the housing market. I am especially pleased that the package includes my provision to allow struggling American businesses to invest in the economy and create jobs here at home. This bill is an important first step in helping struggling families in Michigan and throughout the country. I look forward to the swift enactment of this legislation to provide relief to homeowners and to uphold the American dream for all.

Mr. President, I wish to share with my colleagues a disturbing report about the challenges

home health professionals are facing while delivering service to our Nation's seniors. Too many home health providers have seen not only declining reimbursement but also increasing fuel costs.

Last week, the New York Times highlighted how these challenges are affecting several Michigan families and home health providers. Sadly, this is a problem facing the entire Nation. The National Association for Home Care & Hospice's, NAHC, Foundation for Hospice and Homecare released a study finding that nurses, therapists, and home care aides who serve chronically ill elderly and disabled patients drive nearly 5 billion miles each year. But escalating gasoline prices threaten their ability to reach their patients, particularly in rural areas. NAHC reported that, in Michigan, home health providers drove over 161 million miles to make nearly 12 million visits to seniors and other patients in need of homebound services.

As a short-term solution, I urge my colleagues to join with me in calling for the Medicare rural home-health add-on, which expired in 2006, to be reinstated. The rural add-on bonus will have a huge impact on the ability of home health providers to serve seniors, particularly in remote, rural locations.

I ask that a copy of the New York Times article be printed in the Record.

The material follows:

[From the New York Times, July 5, 2008]

As Gas Prices Soar, Elderly Face Cuts in Aid

(By John Leland)

South Haven, Mich.--Early last month, Jeanne Fair, 62, got

her first hot meals delivered to her home in this lake town

in the sparsely populated southwestern part of the state.

Then after two deliveries the meals stopped because gas

prices had made the delivery too expensive.

``They called and said I was outside of the delivery

area,'' said Mrs. Fair, who is homebound and has not been

able to use her left arm since a stroke in 1997.

Faced with soaring gasoline prices, agencies around the

country that provide services to the elderly say they are

having to cut back on programs like Meals on Wheels,

transportation assistance and home care, especially in rural

areas that depend on volunteers who provide their own gas. In

a recent survey by the National Association of Area Agencies

on Aging, more than half said they had already cut back on

programs because of gas costs, and 90 percent said they

expected to make cuts in the 2009 fiscal year.

``I've never seen the increase in need at this level,''

said Robert McFalls, chief executive of the Area Agency on

Aging in Palm Beach, Fla., whose office has a waiting list of

1,500 people. Volunteers who deliver meals or drive the

elderly to medical appointments have cut back their miles,

Mr. McFalls said.

Public agencies of all kinds are struggling with the new

math of higher gas prices, lower property and sales tax

revenues and increases in the minimum wage. Some communities

have cut school bus routes, police patrols, traveling

libraries and lawn maintenance. The St. Paul Police

Department is encouraging officers to use horses and bikes. A

number of state agencies, including those in Utah, are going

to four-day workweeks to save energy costs and reduce

commuting expenses for their employees.

But older poor people and those who are homebound are

doubly squeezed by rising gas and food prices, because they

rely not just on social service agencies, but also on

volunteers.

In the survey of agencies, more than 70 percent said it was

more difficult to recruit and keep volunteers.

Mrs. Fair, who has limited mobility because of diabetes,

lives on $642 per month in Social Security widow's benefits,

and relies on care from her son, who often works odd hours,

especially during blueberry season. ``He says, `You belong in

a nursing home; I can't take care of you,' '' Mrs. Fair said.

The delivered meals allowed her to eat at regular hours,

which helped her control her blood sugar levels, she said.

Last year she lost her balance during a change in blood sugar

and spent a month in a nursing home.

With no meal delivery in her area, Mrs. Fair said her home

aide, who comes three times a week, must pick up frozen meals

from a center in the next town.

``If my aide can't get the meals, maybe I can get my pastor

to pick them up,'' Mrs. Fair said. ``I can't travel even to

the drop-off center.''

Val J. Halamandaris, president of the National Association

for Home Care and Hospice, said that rising fuel prices had

become a significant burden for the 7,000 agencies

represented by his group, with some forced to close and

others compelled to shrink their service areas or reduce

face-to-face visits with patients.

A recent survey by the group concluded that home health and

hospice workers drove 4.8 billion miles in 2006 to serve 12

million clients. ``If we lose these agencies in rural areas,

we'll never get them back,'' Mr. Halamandaris said.

The agencies, which have suffered from Medicare cuts in

recent years, are lobbying Congress to account for fuel

inflation in reimbursement rates and to reinstate special

increases for providers in rural areas, a program that

expired in 2006.

In Union, Mich., a town among flat corn and soybean farms

near the Indiana border, Bill Harman, 77, relies on a home

aide to take care of his wife, Evelyn, who is 85 and has

Alzheimer's disease. Mr. Harman has had to use a wheelchair

since 2000 because of hip problems.

But the aide, Katie Clark, 26, may have to give up the job.

She lives 25 miles away and drives 700 miles a week to

provide twice-daily visits, helping Mrs. Harman dress in the

morning and get to bed at night, feeding her, doing chores

around the house. ``And putting up with a grumpy old man,''

she said jokingly to Mr. Harman. Her weekly income of $250 is

being eaten up by gas expenses, which come to $100 a week.

``Some weeks I have to borrow money to get here,'' said Ms.

Clark, a single mother of two, adding, ``They're just like

family to me.''

Agencies say they are facing a shortage of home aides,

because the jobs have low pay and often require long drives

for a few hours of work. ``They can't make any money,'' said

Laurence Schmidt, administrator for the Oswego County Office

for the Aging, in rural northwest New York. ``So they'll get

jobs in nursing homes, where they can drive to one place and

work a full shift. That is a statewide problem.''

Mr. Harman said that he thought a previous aide might have

abused his wife, but that Mrs. Harman was comfortable with

Ms. Clark. On a recent afternoon, Mrs. Harman called Ms.

Clark ``honey''; Ms. Clark, walking Mrs. Harman to the

bathroom, kissed her nose. Mrs. Harman said she was going

home. Ms. Clark said, ``You are home, silly.''

For her work, Ms. Clark receives $9 an hour. If she leaves,

Mr. Harman said, he could not care for his wife.

He said that when they married, she raised his five

children as if they were her own. When Mrs. Harman started to

develop Alzheimer's 8 or 10 years ago, he said, ``I promised

her, `Don't worry, I'll take care of you as long as I can.'

''

Without an aide, he said, he would have to put his wife in

a nursing home, and probably need to live in one himself.

For many isolated older people, home delivery of meals

provides not just nutrition but also regular contact with the

outside world, said Elaine Eubank, president of CareLink, a

nonprofit agency that serves elderly people in six counties

in Arkansas, delivering 480,181 meals to 18,000 people last

year. Because of gas prices, Ms. Eubank said, one center in

Monroe County had closed its kitchen, and others were

delivering frozen meals two days a week.

Mary Margaret Cox, executive director of Meals on Wheels in

Greeley, Colo., which serves meals to 300 people a day, said

that her agency was trying to avoid shifting to frozen meals,

but that it was getting hard to recruit students and teachers

who volunteer during the summer.

``Most don't have anyone else checking up on them daily,''

Mrs. Cox said of her clients. ``If we do more frozen meals,

they'll lose that daily contact.''

Many agencies said their revenues--which come from state,

federal and private sources--were not keeping up with their

increased expenses. ``We've had one increase from Medicaid in

11 years,'' Ms. Eubank said. ``But home care and Meals on

Wheels keep people at home for a fraction of the cost of a

nursing home. The state pays for care once they're in a

nursing home. So our cuts may cost more than they save.''

Sandra Prediger, 70, who still drives a car, said higher

gas prices hit her every time she needed to go to the doctor.

From her senior apartment in South Haven, she was barely able

to pay her bills before gas prices rose.

``I try to help some of the ladies around here, driving

them to doctors or to the store,'' Miss Prediger said, but a

round trip to her doctor or the beauty shop now costs $26 in

gas. She has had to ask her friends to pay half. ``I hate to

ask,'' she said, ``because they have less than me.''

Her Social Security check arrives on the third of the

month. For the few days before, her local gas station lets

her write a postdated check to fill up.

On July 2, Miss Prediger had no money and owed money to the

gas station. ``In a few minutes,'' she said, ``my friend

Shirley will probably call and say, `Can you take me to Wal-

Mart to get needles for my diabetes?' What else can I do?''

Barbara Blumka, 67, of Buchanan, Mich., said she would

continue delivering 15 or 16 meals a week though she could

not afford it. She is driving a Dodge Caravan, a ``gas

guzzler,'' she said.

``I see these people's faces,'' said Ms. Blumka, who gets

her meals at a senior center. ``They're so appreciative. I

think of all the people who took care of my mother in the

nursing home. This is my way of giving thanks.''

Christine Vanlandingham, development officer for the three-

county Area Agency on Aging, said that in three to six

months, the agency would have to start cutting meal

deliveries to clients who get them now.

But Ms. Blumka will continue to help the homebound. Her

nieces and nephews were buying her an adult tricycle for

other travels. ``It's neon blue,'' she said. ``I'll ride it

to the senior center.''

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

Thank you, Madam President.

The Economy

Madam President, I come to the floor after reading something I find very shocking. This is evidently in an interview with the Washington Times, referred to today by Jonathan Weisman. It has this quote. Former Senator Phil Gramm, a top policy adviser of Senator John McCain's, said the Nation is in a ``mental recession,'' not an actual one, and suggested the United States has ``become a nation of whiners.''

Senator McCain is in my State of Michigan at this moment today. I certainly want to go on record here on the floor of the Senate to say that the people of Michigan are not whiners. The people of this country, who have seen their jobs slip away--over 325,000 jobs since January, good-paying American jobs--are not whiners. People have seen gas prices going up and up and oil prices doubling over the last 10 months. This is not a nation of whiners. We are seeing food costs go up, health care costs go up, gas prices go up, everything in people's lives going up. Every middle-class family, every family in America is struggling while they see their wages go down, if they have a job at all. This is not a nation of whiners; this is a nation of tough people trying to survive, Americans who believe in this country, who believe in the American dream, who are fighting to keep their way of life in this country today.

I will be happy to.

Yes. I would be happy to. He said the Nation is in a mental recession, not an actual one, and suggested that the United States has become a nation of whiners.

Right, absolutely.

Madam President, I thank my friend from California, who comes to the floor and fights every day on behalf of middle-class Americans and people struggling to make it. We in Michigan have the highest unemployment rate in the country--8.5 percent as of the last numbers. So people are losing their jobs.

The Senator from California is absolutely right. The fact is that folks who are losing their jobs or who are seeing their wages cut in half are seeing gas prices go up and up and up.

We have had two oilmen in the White House for 8 years, and we have had now the highest gas prices we have ever had to pay while they protect oil profits, oil company profits over and over again. This is not an accident, what has happened here. I think it is almost too obvious. We have two oilmen in the White House, and we are in the situation we are today, with families struggling to get to work, to get the children to childcare, maybe to go on a vacation, who can't hold things together, and they are looking around, saying: What in the world is happening? Now, we are hearing from a top adviser of someone who wants to be the next President that this is a mental recession and that we are whiners.

I am happy to.

I am aware of that. It is outrageous. It is so stunning that this would be happening and be so obvious in terms of allegiance.

Well, I know this: I know ExxonMobil has made the highest profits of any company ever in the entire world. I don't know the exact number, but my guess is that it is a lot more than people in Michigan are making.

Madam President, I so much appreciate my friend from California and her advocacy on a daily basis on this floor for people who are feeling the squeeze on all sides.

We are seeing a situation in this country where, frankly, most middle-class families, as well as small businesses and large businesses and those who want to do business in this country, just can't take any more. We are at the limit right now of what we can absorb in terms of higher and higher costs on people every day, with lower and lower wages, maybe losing a pension, maybe losing your health care.

What we have seen over the last 8 years is the creation of a race to the bottom in a global economy, a race to the bottom where the average American is told: If you only work for less, pay more in health care, and lose your pension, maybe we can be competitive. As Democrats, we believe in a race to the top. As Democrats, we believe it is critical that we address the squeeze middle-class families are feeling if we are going to have an economy.

What has made us strong among nations around the world is a strong, vibrant middle class, folks who can have the American dream, who know they can have that job. In Michigan, it is to have a home and maybe a little cottage up north or a boat to go around the beautiful Great Lakes and enjoy fishing and hunting and know they can send the kids to college--all of those things that have meant the great American dream for families in America. It is slipping away because of the policies of the last 8 years, not paying attention to what is happening to our global economy and making it worse by, in fact, protecting those whose profits are getting higher and higher at the expense of middle-class Americans.

So I would just say that to hear we are a nation of whiners from someone who is advising someone who wants to be the President of the United States--alarm bells should be going off to every single person who drives up to a pump today and has to pay somewhere between $4 and $5 a gallon for gasoline or goes to the store and sees the price of milk going up and bread and everything else they need to feed their family or sees their costs of health care going up, if they are fortunate enough to have health care alone.

So I certainly invite Senator McCain to come to my State of Michigan as many times as he would like, and I hope he listens very, very hard. I hope he doesn't hear it as whining. I hope he hears it as a sign of proud, patriotic, America-loving people who just expect decisions here in this Government to be made in their best interests, not in the best interests of oil companies or credit card companies or insurance companies that aren't willing to cover their health problems. People want to know that, in fact, their families will be put first for a change. That has not happened in the last 8 years. We certainly don't need more of that.

Frankly, when I look at the gas price situation alone, I must say, if I remember correctly--and I will check this for sure--if I remember right, the gentleman who now calls us a ``nation of whiners'' actually authored language that began to deregulate the energy markets back in 2000, which has actually created much of the situation we are in today, with lack of accountability and transparency and gas prices, oil prices, going up and up and up.

The people of this country have had enough, and they expect us to work together in their interests. They expect that we will put them and their families first, that we will do everything possible to create a climate where they can get a good-paying job and work hard every day and know that if they play by the rules in America, they are going to be able to have a better life for their children than they have had for themselves. That is all on the line right now in America because of what has been happening in the last 8 years.

We are not a nation of whiners. America is going through tough times. Even though times are tough, so are we. We are tough, resilient, hard- working people. I am proud of the people of my State who are working hard to keep their heads above water, to keep their families and their houses, to be able to keep some kind of an income coming in in the midst of all of this. I am proud to fight for them every day, along with a caucus that understands what is happening and which is going to do everything we can to turn this around.

I ask unanimous consent that following my remarks, Senator Grassley be recognized to speak, to be followed by Senator Pryor.

Madam President, I suggest the absence of a quorum.

Reserving the right to object.

Mr. President, reserving the right to object, I would first indicate to my friend, the Senator from Mississippi, that, in fact, we have a bill in front of us that had 355 votes--a huge bipartisan majority--that addresses strengthening Medicare for our seniors. We are only 1 vote--1 Republican vote--shy of passing it here in the Senate.

My colleague also raises the concern about cutting Medicare Advantage. There are no Medicare Advantage cuts in the rates in this bill at all. There is a small change that doesn't even start until 2011.

So as a result of the fact that we have in front of us a bill to immediately address the concerns about access that my colleague has raised, I would object to his unanimous consent request.

Mr. President, I ask unanimous consent that following the remarks of Senator Cornyn, who I understand will be speaking after myself, Senator Levin be recognized as under the previous order, and Senator Chambliss be recognized to speak for up to 10 minutes.

Mr. President, it is important to understand what the choices in front of us are. Always we have a choice in terms of priorities, of how to proceed. As the person who has coauthored the bill in the last several sessions that would change completely the way we provide physician payments, I certainly support long-term

solutions, something called the SGR, sustainable growth rate. I believe the way it is set up, it is wrong, and we need to fundamentally change and stop this process of trying to make sure we don't see cuts happen in Medicare every single year. I certainly agree with that position.

What we have in front of us is a choice--a choice between a bill that has 355 votes in the House on a bipartisan basis--there are not a whole lot of times we see 355 people coming together on an issue such as this in the House, and 59 Members of the Senate. We had a majority. We had 59 votes. We have seen an effort to continue to filibuster the process from moving forward, and we are tomorrow going to see whether we will have one more additional Republican who stands with us, stands with the AARP, the American Medical Association, who stands with, most importantly, our seniors, who stands with the disability community, who stands with those who are concerned about access to Medicare in this country. We only need one vote. That is where we are right now.

I find it interesting, when we look at the motion that was made before about the bill my Republican colleagues wish to bring to the floor, in that bill, we see cuts in oxygen services, in speciality wheelchairs, large cuts in graduate medical education in order to pay for the bill. That is one choice. Or we have the choice in front of us that passed with 355 votes in the House and has 59 votes right now in the Senate which would take some smaller cuts out of graduate medical education and would do something very small and in the future to Medicare Advantage.

What is Medicare Advantage? In my mind, Medicare Advantage is part of the effort to privatize Medicare. We all remember former Speaker Newt Gingrich saying we cannot directly stop Medicare, so we are going to make sure it withers on the vine. Part of that withering has been to divert more and more dollars away from physicians and away from community care into private for-profit companies, private fee-for- service companies.

The argument was in the beginning that competition from the private sector, more choice will bring down costs and that they would be able to take 97 percent of the normal Medicare rate because it would cost less to bring down prices because of competition.

What has happened? What have we heard from the Congressional Budget Office? What have we heard from those who only analyze this issue? In fact, the exact opposite is happening. More and more rate increases have occurred. We now have a group that was getting 97 percent of the full rates, supposedly lowering costs, now on average getting 113 percent, and the Congressional Budget Office told us if we cap the rate to these private businesses at 150 percent of regular Medicare, we would still save money.

Because of the strong feeling of the Republicans and the President indicating he wants to protect them at all costs, in this particular bill we are not addressing the rates. There is no inability for people to get a choice through private care. There is none of that. There is no rate reduction, even though, in my mind, we ought to be doing that.

All that is done in this bill is a process that does not even take effect until 2011--not next year, not the year after, but the year after that--which is a process called deeming. I will not go into all of it now except to say it addresses how the private companies interact with those that are not part of their group or part of their network. That is all this addresses in Medicare Advantage. One would think the sky is falling based on what we have heard.

The reality is, AARP--a pretty good barometer of what seniors are thinking in this country--and a wide variety of organizations have come together very strongly in support of the bill in front of us that only needs one vote. Why? Because that is the bill that will strengthen Medicare for the future.

We need to act now. We are past time to act on this issue because, in fact, there are consequences already, even though the physician cut has not taken effect.

I received a letter this week and I wish to read it. I received a letter recently from a constituent named Kay about her father. Her father needs his physical therapy as part of his treatment for Parkinson's. I know what that is like. My grandmother died of Parkinson's. It is a very tough disease. He lives at home confined to a wheelchair most of the time due to Parkinson's. Despite rising gas prices, Kay and her sister drive her father three times a week--about 80 miles round trip--for his therapy. But last week, they were informed that Medicare would not pay for his therapy because the Medicare exemption process for physical therapy had expired.

We only need one more vote. If we had one more vote, Kay would not be worried about whether her father with Parkinson's can get the physical therapy he needs.

Kay wrote me:

I will go down swinging to help my dad. Can you go back in

and fight for us? We need these services extended. Please

fight for us . . . go back onto the floor and reopen this.

And vote again.

Our leader, I am proud to say, understands all of the stories, not only of Kay but of all the seniors across the country who are so desperately worried about what is going to happen with Medicare. Our leader has come to the floor and said we are going to vote ``yes'' again. We are only one vote short, only one vote.

The practical reality is, in my home State alone, it affects 1.4 million seniors and people with disabilities and over 90,000 veterans who are TRICARE beneficiaries, people who have served in our military. Military health care, TRICARE, is tied to Medicare. So if the Medicare cuts take effect, our veterans also will be affected and there will be a cut.

This is serious. We are past time, at this point, to be debating this issue. We need to vote, we need to pass it, and we need to send it to the President.

There are so many positive provisions in this bill for the future. It addresses assets for low-income seniors; preventive services; rural services which are so important to so many parts of Michigan; also the effort to move ahead and modernize the system with e-prescribing, so we can actually read the physician's handwriting, so we can actually have an electronic system that speaks to the future; and also telehealth which in so many parts of our country--again, Michigan is a real example of focusing on telehealth and the way to expand services to rural communities; expanding mental health services. There are so many important pieces to this bill.

Fundamentally, the difference between what was suggested by my Republican friend from Mississippi and from what is in front of us is whether we are going to have any kind of accountability at all for this effort that has begun to privatize Medicare.

We know from the testimony we received from the Congressional Budget Office that for 85 percent of the seniors in traditional Medicare, they actually pay more in premiums because of the overpayments on Medicare Advantage. Again, that is not even in this bill. That is not even in this bill. We still need to address that point. There is a small change that does not take effect until 2011, but because of that, colleagues on the other side of the aisle are willing to let this whole bill go down and a dramatic cut in physicians' services take effect. They are willing to let us lose the help for rural America, the effort to modernize Medicare with electronic e-prescribing, with telehealth, to focus on seniors who need mental health services. They are willing to let the whole thing go down and, in fact, have proposed, as I said earlier, an alternative plan, that rather than touch the for-profit folks in the health care system right now that are, in my mind, too many times undermining what is happening in traditional Medicare--not always; there are some positive aspects, but too many times. Instead of that, they bring forward an alternative that focuses on oxygen services and specialty wheelchairs and other areas in which to receive their cuts.

Mr. President, I ask unanimous consent for 2 additional minutes, as my colleague from Mississippi did prior to me.

I thank the Chair.

I feel so strongly about this, Mr. President. We spent a lot of time and effort and a lot of goodwill. A lot of people have worked together on both sides of the aisle, with good decisions

and good ideas that have come together on how to strengthen Medicare through this bill. It is obviously something that has wide bipartisan support because, again, we are talking about a huge overwhelming vote in the House of Representatives--355 people. Now we have the opportunity in front of us tomorrow, with all of our physician community, health care providers, senior organizations, AARP, disability groups, those who serve the Parkinson's patients and other patients who are suffering from particular diseases, consumer groups all across America coming together and saying this makes sense.

We need to make sure Medicare is available for our seniors. These are Draconian cuts and we want to stop them and we are willing to do it in a very balanced way. I thank our chairman of the Finance Committee for his leadership on something that is reasonable and balanced. We know him to be a reasonable person who does things in a balanced way. This doesn't gut Medicare or Medicare Advantage. It doesn't even touch the rates. It doesn't touch the companies, other than to address one part of the way they deal with those who are out of State or out of service through the process called ``deeming,'' that doesn't take effect until 2011.

Frankly, if that is the only part people disagree with, these cuts are now. These physical therapy cuts started last week. I would urge my colleagues, step up and be the one vote. We have until 2011 to change that part of the bill they do not like. But the therapy cuts started last week, and the physician cuts are going to start in a couple of weeks. That is the sense of urgency we should feel if we are concerned about the seniors in this country--about Medicare beneficiaries. Now is the time. It is real simple. It is real simple.

Tomorrow afternoon we will have the opportunity to vote yes on something overwhelmingly supported by the people of this country, and I urge my colleagues to step up. We only need, Mr. President, one more vote.

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

Thank you, Mr. President.

Medicare Improvements for Patients and Providers Act

We are at a critical point today for 44 million Medicare beneficiaries--seniors, people with disabilities--and the physicians, the health care providers, who serve them. We are at a critical point.

I am very hopeful we are not going to see this number go up--the number of filibusters that have been done on the other side of the aisle. I am very hopeful this number is not going to go from 78 to 79 over the Medicare legislation that is in front of us.

We have already seen a filibuster in a successful effort to stop the Medicare bill that would make sure that the 10-percent cut for physicians does not take place and that other preventative and other access issues are addressed. That is already part of these 78 filibusters. We have already seen the Medicare bill filibustered.

But today we are hopeful, based on the wonderful bipartisan vote of 355 Members of the House of Representatives, that as we come back with their bill that was passed--and I should mention, based on the bill that was crafted by Senator Baucus; and I wish to give him tremendous credit for all the hard work he has done; and I am proud to be a member of the Finance Committee, as the distinguished Presiding Officer is-- but the House, based on the work of the Senate, as well, has passed, with 355 votes, on a bipartisan basis, a bill to make sure 44 million seniors and people with disabilities do not find themselves worse off as it relates to being able to get a doctor or being able to get the care they need.

So we are at a crossroads right now. The time is up. As of next Tuesday, July 1, a cut will take effect if we do not act. On top of that, we will not see the other beneficial parts of this bill take effect for our seniors, for people with disabilities, for their families. So we are now at a point where it is decisionmaking time. The House has acted. It is my understanding they will, in fact, be adjourning at the end of today, and we will be in a situation to either act, based on a strong bipartisan vote and a tremendous amount of work that has been done in the Senate, or we will see devastating consequences in the Medicare system.

I do not want to see this number go from 78 to 79 because of a filibuster on a critically important Medicare bill. That is what we are talking about. This legislation itself is good public policy. That is why it received the 355 votes that it did, because it not only stops the cut, the 10-percent cut that is scheduled to take place next Tuesday, July 1--which, by the way, is the result of a fatally flawed sustainable growth rate formula, which I have talked about many times on this floor--we have to change the way what is called

the SGR is set up in terms of physician payments--this would not only stop a major cut for physicians that translates into cuts in service for Medicare beneficiaries, but it also does some other very important things that relate to increasing service.

First, let me say that if the cut were to take effect, we are talking about in Michigan alone losing $540 million--$540 million--for the care of seniors and people with disabilities over the next 18 months--only 18 months, $540 million, if we do not act before next Tuesday.

Right now, as to the 20,000 M.D.s and D.O.s in Michigan who provide high-quality care to 1.4 million seniors and people with disabilities and the over 90,000 TRICARE beneficiaries--our men and women in the military--we would see cutbacks in their staffing, in their ability to provide service.

I have heard so many stories from physicians' practices about what all of this means. At a time when more and more people are going into Medicare, as our country is aging, we do not need to see cutbacks that mean there are fewer physicians available to treat our senior citizens and people with disabilities. That is what that means. That is what this will mean if we do not act.

Additionally, the bill provides important and meaningful protections. We are looking at increasing help for low-income seniors, low-income individuals on Medicare who will be able to get additional assistance. It also improves coordination in a number of areas and addresses what we call mental health parity--being able to make sure that mental health services are treated in the same way as public health services. This is something we have gone on record to address in this body in a bipartisan basis on more than one occasion. In this Medicare bill, we address discrepancies between mental health services and physical health services, all of which are the same thing, in my mind. This is a continuum of care in terms of health care. But that is addressed in this bill and has very strong support.

The bill also addresses very important investments in technology for the future--investments that won't take place, such as electronic medical records that will not be developed if, in fact, we see huge cuts in Medicare, rather than investing in the future and investing in technology.

The legislation in front of us would do two things in the area of technology. We would provide additional opportunities for telehealth-- more providers, more facilities that would be able to use and be reimbursed for telehealth--and we focus on e-prescribing, which is the first stage of health information technology, bringing it into the 21st century in terms of our health care system and technology.

I am very proud of Michigan. We have been one of the leaders in both of these areas. In telehealth, in the upper peninsula of Michigan, we have had 15 counties that have been connected through the health care system. We have had the opportunity to see how well telemedicine works for all of our seniors, for people with disabilities, for families in general in the UP, as well as in northern Michigan and all around Michigan, including our rural communities, as well as in many of our urban communities. Telehealth is very important and it is expanded in this Medicare bill with more access to care.

We also address the first building block of health information technology, and that is e-prescribing. There are incentives for physicians to use e-prescribing and there is accountability in that arena. This is another area I have to say that I am proud of my State of Michigan for, because we have spent a lot of time and effort, and we have gotten real results for people, in terms of saving lives and saving money as it relates to e-prescribing. We have a group called the Southeastern Michigan E-prescribing Initiative, our auto industry, the United Auto Workers, BlueCross and BlueShield, and many of our businesses and providers have come together and found extraordinary results.

One of the things that I think is so important about e-prescribing is when you have an e-prescribing system, an electronic system where your current medicines can then be compared with any new prescription that the physician wishes to write, they are finding very important safety and quality results. For instance, 423,000 prescriptions that were originally written by physicians were changed or canceled by the doctor once they received very important information about potential allergic reactions or some other interaction with the other medicines their patient was on. So this is very important information that is available. We also know that 39 percent of the time, the physician, given more information, changed the prescription to save the patient and the employer money; being able to offer the option of more generic drugs. So there are huge benefits to e-prescribing. On top of that, you can read the physician's handwriting, and I say that lovingly to all of my physician friends.

But we are in a situation now where we have a bill in front of us that not only stops cuts that would be devastating but looks to the future in terms of electronic e-prescribing, in terms of telehealth, preventive services, helping low-income seniors and people with disabilities, being able to provide mental health parity; a number of areas that while they overall are low in cost are huge in benefit in terms of savings lives. In fact, there are many places in this bill where we are talking about saving dollars at the same time we are saving lives.

I am also very pleased with the fact that the bill addresses a number of health disparities that face those who receive Medicare based on the legislation I have introduced with, in fact, all of the women Members of the Senate--all 16 women Members. We have cosponsored the HEART for Women Act, which begins to gather gender and race data to determine gaps in coverage around heart disease. We are now using similar language in the Medicare bill to collect more data for researchers about disparities around health treatments and so on.

The bottom line is this is a must-pass bill, and we need to pass it now. Time is running out. In fact, in my mind, time has run out. It is now time to act today. When our leader, Senator Reid, who is very committed to this legislation, committed to Medicare, came to the floor and asked for unanimous consent to be able to take up the Medicare bill, there were objections again. I am very concerned that those objections are going to be leading to another filibuster, another filibuster vote coming in the next day or few days.

I hope colleagues are aware that the American Medical Association strongly supports this bill and has been actively involved in promoting the bill and urging all of us to support the bill. The AARP, a leading seniors' organization, has endorsed the House bill as well. I will read a portion of their letter. AARP's letter notes:

Our members have also stressed strong interest in knowing

how their elected officials vote on key issues that affect

older Americans. Given the importance of the Medicare

legislation, we will be informing them how their Senators

vote on this legislation when it comes to the Senate floor.

There is great concern among people around the country watching and waiting. People are asking what is taking us so long and why haven't we acted. We have legislation that we worked through on a bipartisan basis here in the Senate, and it has now passed by 355 votes in the House of Representatives. You can't get much better than that vote. This bill has now come over to us and it is time for us to act.

I thank again Chairman Baucus for his leadership and his hard work. I also thank my good friends in the House, Chairman Rangel and Chairman Dingell, for their work on behalf of Medicare beneficiaries and physicians. I stand squarely behind this bill. I was proud to introduce legislation a number of months back to address the question of physician payment and the need to change the process and the way this is done fundamentally. I am so pleased that the bill in front of us mirrors the 18-month bill I introduced and adds to it some critically important changes, critically important incentives to modernize the system with telehealth and more access to health care, modernize the system as it relates to electronic prescribing, and does more to make sure our low-income seniors receive the help they need, and makes sure that we are, in fact, providing a more equitable system where mental health and physical health payments and services are looked at in the same kind of way. This is very important. Focusing more on prevention is very important.

The bottom line is we have 44 million Americans who rely on Medicare every day. Medicare is a great American success story. It passed in 1965. It is a great American success story that has brought healthier lives through better medical care as well as opportunities for longer lives for millions and millions of Americans. Access to those services is jeopardized seriously if we do not pass this bill. The ability to expand on services and prevention is also in jeopardy if we do not pass this bill.

I am hopeful we will come together, as our House colleagues have done, and stand on a bipartisan basis in support of our providers, our health care providers and, most importantly, those men and women who are counting on us to keep the Medicare system strong for the future. I am hopeful we will not see another filibuster stopping us from addressing the important issues of Medicare. This needs to be done today.

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

Mr. President, the effects of the housing crisis have rippled through our economy, affecting every state in the country. There are currently 1 million homes in foreclosure and in the next 2 to 3 years it is estimated that 2 million Americans may lose their homes to foreclosure. Few States have felt these effects more than in my State of Michigan. Michigan has one of the highest foreclosure rates in the country at 3.6 percent with 1 in every 353 households receiving a foreclosure filing during the month of May. The high levels of foreclosures, coupled with growing inventories of houses, significant declines in house prices, and a decline in building activity have made efforts for recovery even more difficult. Americans are being squeezed from the grocery store to the gas pump and they desperately need relief. That is why I am pleased to support this bipartisan housing legislation. This bill is a significant step to provide relief to struggling homeowners throughout the country and to stabilize our economy.

It would strengthen the regulatory oversight of government sponsored enterprises, GSEs, and provide FHA modernization reforms to help stabilize the housing finance system and begin to restore confidence to the market. The bill also contains the HOPE for Homeowners FHA refinancing program for at-risk homeowners. The Congressional Budget Office estimates that the program is expected to help 400,000 homeowners at risk of losing their homes to foreclosure. The bill also seeks to keep people in their home by providing $150 million in additional funding for housing counseling. These funds will help as many as 250,000 additional families connect with their mortgage lender to explore options that will keep them in their homes.

Foreclosures not only affect individual homeowners, but

have community-wide ramifications. These properties attract

crime and vandalism, which drag down local property values

and create losses in wealth built up through home equity.

Estimates show that more than 40 million households will see

their property values decline as a result of a foreclosed

home in their neighborhood. To help communities mitigate

these impacts, this bill would provide almost $4 billion for

State and local governments to purchase and rehabilitate

foreclosed properties. In Michigan, this would provide $345

million in additional economic activity and 3,220 new jobs.

It would help restore 5,695 properties and raise $11 million

in taxes for the state.

The bill also includes important tax benefits targeted to help the recovery of the housing market. It includes a simplification and temporary increase of the low-income housing tax credit to promote the construction of affordable rental housing. To reduce the growing inventory of unoccupied housing, the bill includes a one-time homebuyer tax credit of $8,000 to stimulate buyer demand. I am also pleased that the package includes my provision to allow struggling American businesses to invest in the economy and create jobs here at home. It would allow those companies hurting the most to utilize already accumulated tax credits to make critical investments in their businesses and create jobs.

As the housing market continues to deteriorate, I applaud the work of our leadership in crafting this much-needed housing package. I would especially like to thank Chairman Dodd and Ranking Member Shelby for their leadership and work on this important issue. However, I am concerned with two provisions of the legislation that, if enacted, could have far reaching implications for our Nation's housing policy.

The bill as currently drafted provides for an effective date upon enactment, immediately granting the new GSE regulator power over three very diverse and complex entities. The new oversight system must allow for a transition to ensure there are no lapses in regulatory authority or unnecessary market disruptions. The House-passed version of the bill establishes an effective date of 6 months after enactment, which allows all stakeholders in the housing finance system adequate time to adjust to the new system.

I am also concerned with the language that would restrict the use of the GSEs mortgage portfolios as a source of liquidity for the housing market. The current language includes a bias in favor of the GSEs securitizing loans, which predisposes the regulator from being open to all available options. The portfolios are a critical tool to help struggling borrowers refinance risky mortgages and meet the needs of underserved communities. It is imperative that GSEs have flexibility over their portfolio authority. Without this flexibility, subprime, multi-family and other affordable lending could be hindered during a time when GSE investment is needed most for families and our economy. I look forward to a timely and appropriate resolution to both of these concerns.

This housing package is an important first step to address the crisis facing our Nation and it cannot wait another day. In Michigan, we have been in a recession for too long. Our American dream is turning into an American nightmare for too many families. Working together today, we must save the American dream for the future.

Mr. President, first, I commend Senator Dodd and Senator Shelby for working so hard to bring this bill to the floor-- Senator Chris

Dodd for his wonderful leadership on the House bill.

I ask unanimous consent to speak as in morning business for 10 minutes and the time be charged postcloture.

Mr. President, I have to say that I was quite amazed and shocked yesterday to hear the proposal that certainly flies in the face of what I believe needs to be happening for Michigan and other States that have been the backbone of the manufacturing economy in our country, the backbone of the middle class. It was a proposal to turn our way of handling American jobs and the economy into a game show. We do not need a game show. We do not need prizes down at the end of some long line for doing what needs to be done in order to create innovation and be able to focus us on the next generation of advanced battery technology or any other technologies. What we need is something thoughtful and sustained, ongoing investments to create jobs in the United States.

The last 8 years we have not seen that. We have not seen a willingness to step up and aggressively invest in advanced battery technology research or any other areas where we would be able to get the kind of jobs and production we need in the United States. I remind the Chair that, as he knows so well, just since January we have lost 325,000 good-paying jobs in America. As the distinguished Presiding Officer and I have both come to the floor to speak about good-paying American jobs, middle-class jobs for middle-class families, we continue to lose jobs.

I am very proud to be a part of a majority that is tackling that, focusing on investments, on jobs rebuilding America, on investments in the future. We passed a budget resolution a little earlier this year that included a green-collar jobs initiatives, which I was proud to offer. It had strong support from our Presiding Officer. Among things that we listed and we put into the budget resolution was advanced battery funding. This is something I know our appropriators are taking seriously. I also know my colleague, Senator Levin, is focusing on this in the Department of Defense authorization. I know we are serious about investing in the future now, today--putting dollars in to partner with the private sector to get us to that next generation of vehicle that is so critical.

One of the things about which I am extremely concerned is that other countries have been investing for years, and we have not seen the same kind of investments proposed year after year in the President's budget or supported by our colleagues on the other side of the aisle.

When Toyota first made the Prius, we heard a lot about it. They made this with advanced batteries made in Japan. What is more concerning is when Ford Motor Company first made the Ford Escape Hybrid--and I am very proud they did--they looked around and couldn't find the advanced battery in America. They got it in Japan.

We cannot afford to be on a road to dependency on foreign technology as we are trying to get off of dependence on foreign oil. This needs more than proposals that feel like game show prizes down at the end of a road, a road we may not be able to get to if we are not serious as a country about what we need to do in making investments right now.

Germany has announced a great battery alliance which will invest over $650 million in advanced lithium-ion batteries. It is specifically aimed at helping German auto companies.

South Korea, by 2010, will have spent $700 million on advanced batteries and developing hybrid vehicles.

China has invested over $100 million in advanced battery research and development.

Over the next 5 years, Japan will spend $230 million on advanced battery research. It is spending $278 million a year on hydrogen research for zero emission fuel cell vehicles.

These countries understand they need to step up to compete in a global economy and partnering with their automobile industry. We need to do no less.

We have picked one segment of the economy, the automobile industry, in which we have placed a major new mandate--an $80 billion mandate on fuel efficiency. We need to do everything we can to help them achieve that. But they will not get there unless now--this year, next year, the year after--we are supporting and partnering on efforts for advanced battery technology research and development. Not the basic research, the basic research is being done. Now we are at a point where we need to have the technology developed to deal with issues around the size and the weight of the vehicle and the reliability of the batteries and all of the issues that bring it to the point for marketing and sales. We are very close. But our country needs to be taking this very seriously right now if we are going to have good-paying manufacturing jobs, high-tech manufacturing jobs in this country, particularly in the automobile industry.

I thank our majority leader and our chairman of the Budget Committee who placed dollars into the budget. I thank all of those who will be involved as we move forward to implement our efforts to invest in advanced battery technology research. I only wish the passion that was shown yesterday would be shown on the Senate floor, would be shown in votes for the budget resolution, would be shown in votes for appropriations, would be shown in votes and leadership speaking up as the President, year after year, has woefully underfunded his requests for advanced battery technology research.

We are past time to get this done. It should not be treated as something that is trite but as something that is very serious and very doable if we are willing to step up and partner and make the investments that need to be made, as every other country is doing.

Our companies today are not competing with other companies around the world. They are competing with other countries around the world, other countries that understand that whoever gets to advanced battery technology first will have the edge. Whoever is getting the hydrogen fuel cell technology first will have the edge. Whoever gets to that next technology will find themselves in the position to be the leaders in a global economy. We need to understand that and take that seriously. I am proud to be part of a majority that does, and we are working very hard.

We have moved the ball down the road and have more to do, but I am amazed to hear the kinds of discussions that have gone on in the last 24 hours as it relates to jobs and the economy and prizes. The prize for us is a good-paying job and a strong middle class and keeping advanced manufacturing in this country. We do that by being serious and sustained and thoughtful, by providing dollars on the front end, by making sure we understand the seriousness of the competition around the world, and having a sense of urgency about American jobs.

I suggest the absence of a quorum.

Mr. President, I rise today to join my friend and distinguished colleague in supporting the nominations of Judge Helene White, Mr. Raymond Kethledge to the Sixth Circuit Court of Appeals, and Mr. Stephen Murphy III to the District Court for the Eastern District of Michigan. I also want to remember those whom Senator Levin spoke of as well.

I thank, particularly, Chairman Leahy for working with us in a very diligent manner, for his patience, and for his commitment and his willingness to work with us to move the President's nominations forward. It has been a very long process--one that started more than 11 years ago for Judge Helene White. In fact, I have been here for 8 years, and she has been waiting more than 11 years for this vote--4\1/ 2\ years, originally, to have the hearing. I find that because of the length of time she has been waiting, it is difficult to say that somehow this was a short-circuited process or a process that happened too quickly. It has, in fact, been more than 11 years. I hope this serves as an example of how we can come together when both sides, with the administration, are willing to work together in a bipartisan manner. I am very pleased we have been able to come to this agreement together. That is what we have done here.

Senator Levin and I have worked with the Bush administration, and as a result, we have the three nominees for the Federal bench who are in front of us. In fact, all three of them were rated ``well-qualified'' by the American Bar Association. I urge my colleagues to support them.

First, let me say a few words about Judge Helene White, who brings 30 years of legal experience to the Sixth Circuit Court of Appeals. She is a graduate of the University of Pennsylvania Law School and the Barnard College at Columbia University. Judge White has been a State judge since 1981. She has served on both the 36th District Court for the city of Detroit and the Wayne County Circuit Court. Since 1992, she has served, with distinguished service, on the Michigan Court of Appeals. She has participated in more than 4,400 cases in her time as a judge on the Michigan Court of Appeals. All told, Judge White will bring more than 25 years of bench experience to the Sixth Circuit. While I support all of our nominees, Judge White is the only person who brings that judicial experience, having served on the bench with distinguished service, someone who is respected by all sides for her intellect, her fairness, and her balance. I am so very pleased that we are finally at this point to be able to vote on this important nomination.

Secondly, Mr. Raymond Kethledge, who is also nominated for the Sixth Circuit Court of Appeals, graduated magna cum laude from the University of Michigan and the University of Michigan Law School. I told him that even though I went to a rival school--Michigan State University--I will support his nomination. In fact, my son is a graduate of U of M. I was pleased to see another Wolverine being nominated for this distinguished position. Following law school, he served as Senator Spence Abraham's judiciary counsel. He then went on to clerk for both Judge Ralph Guy, on the Sixth Circuit Court of Appeals, and Justice Kennedy, on the Supreme Court, before eventually becoming a partner at Bush Seyferth Kethledge & Paige in Troy, MI. I am certainly pleased to support his nomination to this position.

Finally, Mr. Stephen Murphy has been nominated for a seat on the District Court for the Eastern District of Michigan. He will bring both academic and Federal law experience to the bench. He has taught at the University of Detroit Mercy School of Law and the Ave Maria School of Law in Ann Arbor. He has practiced as both a Federal prosecutor and a defense counsel. He also practiced business litigation as an attorney for General Motors. Since 2005, he has served as the U.S. attorney for the Eastern District of Michigan.

I urge my colleagues on both sides of the aisle to support the President's nominees. We have worked hard in a bipartisan manner. It has taken a long time to get to this point, but I am very pleased we are here together supporting these nominees for the Sixth Circuit Court of Appeals and the Eastern District of Michigan. I am hopeful that, very shortly, we will confirm each of these nominees.

I yield the floor.

Madam President, I wish to thank our dean of the Democratic women, Senator Barbara Mikulski, for once again being right on point and Senator Barbara Boxer for her leadership as it relates to protecting our environment and energy security. She and Senator Maria Cantwell have been our leaders as it relates to cutting gas prices and at the same time doing those things that allow us to protect our beautiful land and water and air. So I wish to thank my colleagues.

Listening to the discussion about what is happening in terms of gas prices just brings me back to what is an essential part of our checklist for change; that is, making sure Americans have jobs. We are going to pay those high gas prices which are absolutely outrageous. Senator Mikulski is right, it takes a change in policy. Senator Boxer is right when she talks about the fact that there are a lot of places the oil companies could be drilling right now. That is the problem. Right now, instead of buying more corporate jets and putting more money into bonuses for themselves, if they were to reinvest in the land that is already there, that would address their concern about supply. We know what is really happening. Unfortunately, for the last 8 years, we have literally had two oilmen in the White House, and we have watched the price of gasoline go beyond our wildest expectations. I know people in Michigan never would have thought we would be at over $4 a gallon.

To add insult to injury, during this same time when we are looking at foreclosure rates at the highest level in my lifetime, certainly, and gas prices at the highest levels, food prices going up, the cost of health care going up, what is going down--and what is frightening for families across America--is their incomes, their jobs, and their standard of living. Just since January, 324,000 good-paying American jobs have been lost--just since January of this year, 324,000 families without a job, yet paying those high gas prices, paying those high food prices, trying to figure out how to send the kids to college or to pay tuition if they are in college. How do I make ends meet? How do I have my piece of the American dream when I am losing my job or my income is going down?

Our checklist for change is about the things Americans want to have happening in this country. It is frightening to see that since 2001, we have lost 3 million--3 million--think about this number--3 million manufacturing jobs in this country. Certainly, the people in Michigan have taken a big hit of that 3 million. But overall now, considering all of the policies and the lack of

action, including the dollars being sent to a war in Iraq rather than being invested here at home, we now are in a situation where 8.5 million Americans are unemployed--8.5 million Americans.

Our Republican colleagues would say: They should just go find a job. We don't want to extend unemployment benefits because that encourages people to stay home. That makes no sense if you are somebody who has been out of work trying to keep your house, trying to pay the food bill and the gas bill and everything else. But the reality is that we have about 4 million jobs in this country right now and 8.5 million people out of work--roughly 4 million available jobs and 8.5 million people unemployed.

We also have what I call a race to the bottom in general economically where Americans are being told: In a global economy, if you will only work for less, we can be competitive. If you will only lose your pension, lose your health care, we can be competitive.

We reject that. Our checklist for change rejects the notion of a race to the bottom and the loss of our American way of life.

What we embrace are strategies that create good-paying jobs, middle- class jobs at home in America. What we embrace is a race to the top. We want to export our products--not our jobs--in a global economy. To do so means a level playing field on trade, enforcing our trade laws, as well as creating new trade agreements. We want to make sure people are not losing jobs because of the high cost of health care, the burdens on small and large businesses today. So we believe the race to the top means a change in the way we fund health care in this country.

Finally, we understand it means investing like crazy in education, in innovation. That is the race to the top. That is what we embrace in our checklist for change. I am very proud of the fact that the Democratic Senate and House have put together a budget resolution for the next year that focuses on three major areas of job development--jobs and innovation through our green-collar jobs initiative: investing in the new advanced battery technology for the new vehicles; investing in conservation and energy efficiency through buildings and other kinds of efficiencies that are so important; job training in the new green- collar economy, investing not only in biofuels but making sure the pump is actually there, so when you drive your vehicle, you can get biofuel or biodiesel--you can actually find a pump. So green-collar jobs are an important piece of what we have put in place.

Secondly, jobs in America. When we are rebuilding highways, bridges, and water and sewer systems, those are jobs that will not be exported overseas. Those are good-paying jobs in America. Our checklist for change, as well as our budget, believes change should be done, and we can invest in good-paying jobs at home.

Finally, in our budget resolution we invest in job training and make a major investment in opportunity through education, from preschool all the way up to college.

We know that serious changes need to be made in the priorities of this country. I had the opportunity a while ago to be on a television show following a Republican colleague--a woman in the House--who looked at our checklist and said: We Republicans can support all those things.

In looking at that, I am scratching my head and going: We have had 6 years with President Bush and an entire Republican Congress, and they had control of every piece of the Government. They were not focusing on jobs, energy alternatives, fiscal accountability--as the occupant of the chair has talked about--or education or equal pay for equal work. They didn't fix that. They didn't address these issues that American families and businesses are asking us to do.

In the last 2 years, instead of working with us on the changes we have initiated, we have been blocked over and over again on the floor of the Senate. All we get is filibuster, filibuster, filibuster. So we come to the floor and to the American people as Democratic women who have been fighting, along with our Democratic male colleagues, for real change that will send gas prices down, not up, and that will send health care costs down, not up, and make it more available, to bring food prices down and, most important, bring wages up.

In the greatest country in the world, we can do better than losing 324,000 good-paying jobs just since this past January.

I am proud to join my wonderful colleagues in putting together a checklist that speaks to the things we know American families want to see happening. We are going to do everything possible, both this year, and as we go to the changes that we hope will happen next year, to embrace and actually get results on our checklist for change.

I yield the floor.

Madam President, I rise today in support of S. 3101, the bipartisan effort introduced by our Senate Finance chairman, Senator Baucus, and the distinguished Senator from Maine, Senator Snowe, that will strengthen Medicare. This is a critically important bill that I hope we will have the support of the Senate on tomorrow to be able to proceed to and to pass.

This important legislation not only prevents harmful cuts from jeopardizing patient care, but it also sets the stage for modernizing our health care system through information technology. This is a very exciting part of this bill for me, with Senator Snowe having worked on this issue, with many other colleagues now for some time, and it is a very important step forward.

First and foremost, though, this legislation protects patients' access to their trusted physicians. If Congress does not act soon, Medicare payments to physicians and health care professionals will be cut by 10 percent--10 percent--as a result of the fatally flawed sustainable growth rate formula or, as we call it, the SGR. It is sad that we are once again going through this exercise. If I could, I would reform the flawed SGR formula once and for all. Personally, I wish to stop this process and create a new one that makes much more sense for physicians and for patients and the Medicare system. It makes no sense for us to go through this ordeal every 6 months or so and risk jeopardizing seniors' access to care when we know the kind of cuts facing physicians under Medicare would be devastating and would, in fact, directly impact access to care for those who rely on Medicare.

Physicians are the foundation of the Medicare system and our Nation's health care system, and patients of all ages depend upon our physicians for their health care services, which they provide in an outstanding way every single day. Every aspect of our health care system, from hospitals to rural health clinics, relies upon the skills and services of physicians.

When I introduced my bill, S. 2785, earlier this year on stopping the SGR cuts, I heard from countless seniors and physicians, medical group practices, and hospitals in my State, all expressing support for the effort to stop these cuts. For example, one orthopedic practice in southwest Michigan wrote me and said:

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

the rates will be cut or fixed. It makes it impossible to

budget and project for the next year. Especially for a

practice like ours, with nearly 50 percent of our patients

receiving Medicare. 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 to job cuts.

That is certainly an ongoing issue all across my State. We certainly don't want to be seeing cuts as they relate to jobs or access under health care, compounding what is already happening in the health care system.

A radiologist in southwest Michigan reported having to close three outpatient x-ray offices over the past 5 years, and they are looking to close another one this year. A surgery center told me it had to put off investing in an EMR and was forced to freeze any wage increases and possibly lay off staff. A medical group in mid-Michigan that staffs two emergency room departments determined that the scheduled reduction would reduce its Medicare payments by nearly $175,000 a year--$175,000 a year.

If the reduction were to go into effect and this legislation is not passed, or similar legislation is not passed, the group wrote me it would be forced to reduce the workforce by either one full-time physician or two full-time physician assistants--cutting back on the availability of health care services for seniors and the disabled in my community. That is truly frightening when our emergency rooms are losing staff.

I have, for too many years, heard from hospitals and others across Michigan about the difficulty in finding physicians who are able to take Medicaid patients because the rates are so low. This is the first year I have been hearing such great concern from hospitals, from hospital emergency rooms, about Medicare, the Medicare rates being so low--without these cuts--and the inability to find physicians who are able to take those patients.

I am hopeful we can add language to S. 3101 similar to a bill I have introduced with Senator Specter to begin to address the crises facing our emergency rooms because we have a much broader issue we need to address there as well.

I am very proud of the work that over 20,000 MDs and DOs do in Michigan every single day, providing more than 1.4 million seniors and people with disabilities, and over 90,000 TRICARE beneficiaries in Michigan with high quality medical services under the Medicare Program.

If Senator Baucus's bipartisan legislation does not pass, physicians in Michigan will lose some $540 million for the care of seniors and people with disabilities over the next 18 months due to the 10-percent cut in payments for 2008 and the additional 5-percent cut for 2009. Madam President, $540 million of services, Medicare services, health care services that will not be rendered to the people in Michigan is not acceptable.

Michigan physicians are looking at cuts of more than $10 billion by 2016; $10 billion in the next 8 years as a result of this flawed formula, and 9 years of cuts. We certainly can't expect that physicians can continue to provide the same level of care if their payments are cut $540 million over the next 18 months alone. These cuts will be devastating to our seniors and access to care.

Second, the lack of a predictable and equitable Medicare payment system hinders our investment in information technology, which we all know we need to be investing in. We need physicians in hospitals and other providers to be investing in technology that not only allows people to communicate with one another--electronic medical records and e-prescribing--but allows the very latest technology so that we have the very highest quality, the ability to provide the most efficient processes of providing health care that is possibly available.

Health IT is very important to that. This bipartisan legislation recognizes the need for investing in information technology, something, as I indicated before, that I am pleased to have worked on for the last several years with Senator Snowe. This bipartisan legislation would increase the list of those sites under telehealth that would include skilled nursing facilities and dialysis centers and community mental health centers that would be able to receive reimbursement for telehealth, which is so important. I thank Senator Conrad for his leadership. I am pleased to be joining with him and others on the whole question of expanding this part of the technology of telemedicine, telehealth. In addition to improving access to care and facilities, we will see significant cost savings achieved by avoiding transporting medically fragile patients from one place to another. I am so proud, among many other advances in Michigan around health IT, telehealth is something that we have been using in rural parts of northern Michigan and the upper peninsula now for years. We have great leadership that has been developed. I am pleased to have had an opportunity to participate and see what is done that allows people in remote parts of Michigan to be able to communicate directly with physicians, with nursing staff, and so on, to receive care they need without traveling long distances. There are wonderful ways this can happen. This legislation expands the ability for people to receive telehealth services. This is important.

Additionally, this bipartisan bill moves us toward e-prescribing, a basic building block for greater adoption of health information technology. There are incentives for doctors who write prescriptions electronically, that improve both quality and efficiency. I thank Senator John Kerry and Senator John Ensign for working with me on the whole question of e-prescribing and being in a position to put this forward, and I thank Senator Baucus again for his leadership in strong support of this effort.

Again, we in Michigan have been recognized as one of the top five States in e-prescribing. We have had huge success in a regional collaborative in southeastern Michigan called SEMI, the Southeastern Michigan ePrescribing Initiative that has brought together General Motors, Ford,

Chrysler, the UAW, insurers, and providers to work with consumers to be able to electronically create e-prescribing so the physician can in fact communicate directly with the pharmacy in the most accurate way with the most accurate information. We have some 2,500 physicians in southeastern Michigan who are engaged in this.

Last October, a patient safety analysis found that SEMI alerted doctors of potentially incorrect drug prescriptions that resulted in nearly 423,000 prescriptions being changed or canceled because of the information the doctor was able to receive. Possibly the physician was looking at a particular medication that had an adverse drug relationship with something else the patient was on, or maybe there were concerns about allergic reactions or other information that was helpful and gained through this process in the program through e- prescribing. SEMI also sent out more than 100,000 medication allergy alerts. When a formulary alert was presented, so physicians were alerted as to a problem with a particular drug they were thinking of prescribing, 39 percent of the time the physician changed the prescription.

Madam President, I ask unanimous consent for an additional 3 minutes.

Madam President, 39 percent of the time when the physician had more information they changed the prescription and therefore addressed safety concerns or saving the patient or the employer dollars.

In February, a physician satisfaction survey found that 9 out of 10 physicians believed that e-prescribing met or exceeded expectations. This is only one region of Michigan where it has been extremely successful. We have incentives in this bill to be able to support physicians using e-prescribing and being able to have some assistance to be able to purchase the equipment they need. I believe there are a thousand reasons why that is a great idea and one of the reasons I enthusiastically support this bill.

Third, this bill reauthorizes important rural provisions to ensure that all Americans, regardless of where they live, have access to health care. We have, in Michigan, again, many small- and mid-sized providers serving vast rural areas around our State. This is very important, to approve the payments for community health centers and ambulances and other providers who are hit by declining Medicare reimbursement--as well as high gas prices, I might add.

Finally, let me say I am very pleased that an area of the bill addresses gathering more information on health disparities regarding gender or regarding race. It is taken from language in my HEART for Women Act, to be able to gather more information for providers as to gaps where we need to be focusing more on particular kinds of services.

Many organizations such as the American Medical Association and the AARP have endorsed this bill and endorsed it strongly. I again thank Senator Baucus, as Finance chairman, for his leadership. I support fully his goal of providing this 18-month fix for physician payments as well as providing other very important incentives for the future.

This bill is very much about the future with e-prescribing and with telehealth and other information gathering. I very much hope that we, on behalf of the 44 million people who rely on Medicare, will have a very strong vote to proceed to this bill and have a strong bipartisan vote to adopt it. I am very hopeful that with a strong vote the President will decide to support this bill and sign this initiative.

It is critically important that we get this done. The physician cut is going to take place very shortly if we do not act. This bill does the right thing and moves us in the right direction as it relates to health care reform.

Excuse me, Madam President, if I might ask my friend, who has already been patient, to suspend for a moment. I have been asked to read a unanimous consent request.

Thank you ever so much. I am here talking about physicians and ``the physician'' is on the floor. Certainly I would not presume to know more about medicine than my colleague from Oklahoma. I appreciate very much his allowing me to do this.

Madam President, I ask unanimous consent the Senate proceed to a period for morning business, with Senators permitted to speak for up to 10 minutes each.

I ask unanimous consent that the following calendar items be indefinitely postponed en bloc: Calendar Nos. 35, 37, 42, 46, 47, 48, 49, 50, 51, 52, 143, 224, 227, 228, 230, 231, 232, 233, 234, 235, 236, 245, 248, 250, 251, 252, 254, 255, 256, 267, 285, 354, 360, 361, 362, 364, 367, 372, 373, 375, 377, 378, 379, 385, 424, 425, 436, 437, 546, 572, 639, 640, 643, 655, 658, 662, 663, 664, 665, 666, 667, 668, 669, 670, 671, 672, 673, 674, 675, 676, and 724.

I understand that S. 3118, introduced earlier today by Senator Grassley, is at the desk. I ask for its first reading.

I ask for a second reading and object to my own request.

Madam President, I ask unanimous consent that when the Senate completes its business today, it stand adjourned until 9:30 a.m. tomorrow, Thursday, June 12; that following the prayer and pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day; that the Senate resume the motion to proceed to S. 3101, the Medicare Improvements for Patients and Providers Act, as under the previous order.

Madam President, also under the previous order, the cloture vote on the motion to proceed to the Medicare bill will occur at approximately 3 p.m. tomorrow afternoon.