Floor Statements

Mr. President, I ask unanimous consent that the Committee on Commerce, Science, and Transportation be authorized to meet during the session of the Senate on October 15, 2009, at 2:30 p.m. in room 253 of the Russell Senate Office Building.

Mr. President, I ask unanimous consent that the Committee on Finance be authorized to meet during the session of the Senate on October 15, 2009, at 10 a.m., in room 215 of the Dirksen Senate Office Building.

Mr. President, I ask unanimous that the Committee on Health, Education, Labor, and Pensions be authorized to meet, during the session of the Senate, to conduct a hearing entitled ``What Women Want: Equal Benefits for Equal Premiums'' on October 15, 2009. The hearing will commence at 10:30 a.m. in room 430 of the Dirksen Senate Office Building.

Mr. President, I ask unanimous consent that the Committee on Homeland Security and Governmental Affairs be authorized to meet during the session of the Senate on October 15, 2009, at 10 a.m. to conduct a hearing entitled ``Domestic Partner Benefits: Fair Policy and Good Business for the Federal Government.''

Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet during the session of the Senate, on October 15, 2009, at 10 a.m., in the SD-226 of the Dirksen Senate Office Building, to conduct an executive business meeting.

Mr. President, I ask unanimous consent that the Select Committee on Intelligence be authorized to meet during the session of the Senate, on October 15, 2009, at 2:30 p.m.

Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on October 15, 2009, at 10 a.m., to hold a subcommittee hearing entitled ``Drought, Flooding, and Refugees: Addressing the Impacts of Climate Change in the World's Most Vulnerable Nations.''

Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on October 15, 2009, at 2:30 p.m., to hold a subcommittee hearing entitled ``U.S. International Broadcasting into the War Zones: Iraq and Afghanistan.''

Mr. President, I rise today to introduce two health care bills that will help control health care costs and provide patients with better care. I believe these bills are easy to understand and reflect commonsense approaches to controlling health care costs.

The first bill, the Reducing Emergency Department Utilization through Coordination and Empowerment, or REDUCE Act, S. 1281, would reduce costly and excessive emergency room visits by providing patients with more consistent and coordinated care.

Emergency room overutilization is a source of wasteful spending in our health care system. Estimates show that $14 billion are wasted each year in unnecessary emergency room visits. It drives up the cost of health care and leads to overcrowding of our emergency rooms.

Frequent users of emergency room services make up a small, but very costly portion of the population. These individuals tend to have multiple chronic illnesses and severe mental illness. They often live in poverty or are homeless. Many times they use the emergency room because they have nowhere else to go.

In the most extreme cases, these individuals can cost the system millions of dollars. You heard right, one person can put a multi- million dollar strain on our health care system. For example in Camden, NJ, one person cost taxpayers $3.5 million over 5 years in Medicaid and Medicare payments.

We need to fix this problem, and I believe we can. The REDUCE Act is modeled after successful pilot programs across the country. It provides beneficiaries with a care management team consisting of a medical provider, a social worker and a community health worker that can provide medical care and support in any setting. The care management team also helps to ensure that these individuals are going to their primary care doctors and mental health providers on a regular basis.

Research shows it works. In fact, after two years of enrollment in one pilot program, on average, individual emergency room visits were reduced by 61 percent and emergency room charges were reduced by 59 percent for those that participated.

There is a lot we need to do to reform our health care system, but as we work on reform broadly, we also need to focus attention on individuals, especially these high cost patients. Doing so will improve care for this vulnerable population and reduce costs.

The second bill, the Access to Affordable Medicines Act, S. 1778, will increase access to lower cost generic drugs by closing a loophole some brand name drug companies exploit that needlessly and unfairly delays the entry of safe, lower-cost generic drugs to the consumer market.

As the law currently stands, when brand name manufacturers make labeling changes, generic drug labeling must reflect this change prior to the drug being approved and introduced in the market.

Too often, big pharmaceutical companies make last minute changes to the label. Many times the labeling changes are insignificant and do not deal with safety or warnings. In fact, these last minute changes are often used by brand name pharmaceutical companies to purposefully delay the introduction of cost-saving generic drugs by weeks or months. This can cost consumers and the federal government millions of dollars.

My bill would stop these costly practices by providing a 60-day grace period for the generic drug company to submit the new labeling for approval and marketplace distribution, while preserving safeguards if the new labeling truly presents a safety issue.

As we work to pass comprehensive health care reform in Congress, we do it with families and small businesses who struggle everyday with the high cost of health care in mind. These bills are the types of sensible reforms that we need to make so that the health care system is more affordable and more efficient. I look forward to working with my Senate colleagues on this legislation.

Mr. President, I rise today to introduce two health care bills that will help control health care costs and provide patients with better care. I believe these bills are easy to understand and reflect commonsense approaches to controlling health care costs.

The first bill, the Reducing Emergency Department Utilization through Coordination and Empowerment, or REDUCE Act, S. 1281, would reduce costly and excessive emergency room visits by providing patients with more consistent and coordinated care.

Emergency room overutilization is a source of wasteful spending in our health care system. Estimates show that $14 billion are wasted each year in unnecessary emergency room visits. It drives up the cost of health care and leads to overcrowding of our emergency rooms.

Frequent users of emergency room services make up a small, but very costly portion of the population. These individuals tend to have multiple chronic illnesses and severe mental illness. They often live in poverty or are homeless. Many times they use the emergency room because they have nowhere else to go.

In the most extreme cases, these individuals can cost the system millions of dollars. You heard right, one person can put a multi- million dollar strain on our health care system. For example in Camden, NJ, one person cost taxpayers $3.5 million over 5 years in Medicaid and Medicare payments.

We need to fix this problem, and I believe we can. The REDUCE Act is modeled after successful pilot programs across the country. It provides beneficiaries with a care management team consisting of a medical provider, a social worker and a community health worker that can provide medical care and support in any setting. The care management team also helps to ensure that these individuals are going to their primary care doctors and mental health providers on a regular basis.

Research shows it works. In fact, after two years of enrollment in one pilot program, on average, individual emergency room visits were reduced by 61 percent and emergency room charges were reduced by 59 percent for those that participated.

There is a lot we need to do to reform our health care system, but as we work on reform broadly, we also need to focus attention on individuals, especially these high cost patients. Doing so will improve care for this vulnerable population and reduce costs.

The second bill, the Access to Affordable Medicines Act, S. 1778, will increase access to lower cost generic drugs by closing a loophole some brand name drug companies exploit that needlessly and unfairly delays the entry of safe, lower-cost generic drugs to the consumer market.

As the law currently stands, when brand name manufacturers make labeling changes, generic drug labeling must reflect this change prior to the drug being approved and introduced in the market.

Too often, big pharmaceutical companies make last minute changes to the label. Many times the labeling changes are insignificant and do not deal with safety or warnings. In fact, these last minute changes are often used by brand name pharmaceutical companies to purposefully delay the introduction of cost-saving generic drugs by weeks or months. This can cost consumers and the federal government millions of dollars.

My bill would stop these costly practices by providing a 60-day grace period for the generic drug company to submit the new labeling for approval and marketplace distribution, while preserving safeguards if the new labeling truly presents a safety issue.

As we work to pass comprehensive health care reform in Congress, we do it with families and small businesses who struggle everyday with the high cost of health care in mind. These bills are the types of sensible reforms that we need to make so that the health care system is more affordable and more efficient. I look forward to working with my Senate colleagues on this legislation.

Mr. President, I am very pleased to join my women colleagues in the Senate today to talk about the importance of passing health

care reform for all the women in this country, and I want to thank Senator Mikulski for her leadership on this issue.

Plainly and simply, the status quo is not working. Today's health system is simply not meeting the needs of women. For too many women and their families today, quality, affordable health care is out of their reach.

It should surprise no one that women and men have different health care needs. Despite this difference, it is unacceptable that women are not treated fairly by the system and do not always receive the care they require and deserve. In cases where women can find coverage that is affordable, often it is woefully inadequate.

A recent survey by the National Women's Law Center found that the vast majority of individual market health insurance policies did not cover maternity care, and only a few insurers sell a separate maternity rider. That isn't that surprising when you consider, as we have heard, that only 14 States require maternity coverage and insurance companies are all about their bottom line. Defending the practice, one insurance spokesman called pregnancy ``a matter of choice.'' To make matters worse, many insurance companies consider C-sections a ``preexisting condition.'' One insurer simply rejects women who have had C-sections. This is unbelievable.

What is most shocking to me is that insurance companies can deny coverage to a woman for having been a victim of domestic violence. Domestic violence--something no woman plans for or wishes upon herself or anyone else--can be used to deny insurance coverage. Mr. President, this cannot be allowed to continue.

Without a doubt, the current private health insurance framework leaves too many women uncovered. For those who are covered, care often falls short. It is time to end the insurance discrimination that women face. I am pleased that both Senate bills which have come out of committee ban discrimination based on preexisting conditions, and I also applaud the Finance and the HELP Committees for putting an end to gender discrimination in pricing insurance and ensuring that women and men pay the same price for the same coverage.

We must come together to pass comprehensive health reform to help all the women of our Nation who are facing high insurance costs just because they are women. I applaud the women on the HELP and the Finance Committees for the work they have done and reiterate that any legislation we consider must level the playing field and make health care accessible and affordable for all.

I thank the Chair, and I yield the floor.

Madam President, I rise today to add my voice to Senator Baucus in strong support of the Unemployment Compensation Extension Act. This bill, as the Senator said, is designed to help those families who are struggling in all 50 States by extending at least 14 weeks of unemployment benefits to workers across the country who are going to exhaust their benefits by the end of this year.

I thank Majority Leader Reid and Chairman Baucus for bringing this bill to the floor, and the many Senators and staff who have worked so hard to get this done, particularly Senator Jack Reed, who is going to be speaking, Senators Chris Dodd and Amy Klobuchar.

Through no fault of their own, many of those who lost their jobs months ago still cannot find work. Five million workers have been unemployed for more than 6 months. That is an all-time high, and it is why extending unemployment benefits in all 50 States is so important.

When I am back in New Hampshire and meeting families trying to get by, one thing is very clear: People want to go back to work, but they face one of the weakest job markets since the Great Depression. Until that job market improves, we have a responsibility to help those workers pay their mortgages and keep food on the table.

Another very important reason why we should support this, and why I am disappointed that our colleagues on the other side of the aisle have refused to come forward in support of this, is that extending unemployment benefits is a proven boost to our economy. Unemployment compensation is money that

gets spent immediately on necessities. People who are out of work need this money to help pay the rent, pay their mortgages, buy food, pay for gas. Extending unemployment benefits is one of the most effective actions we can take to help get this economy moving again, and I urge my colleagues to support this important extension and to quickly pass this critical legislation.

Madam President, I yield the floor.

Mr. President, I wish to express my sympathy over the loss of U.S. Army SPC Justin Pellerin, a 21-year-old resident of Concord, NH. Specialist Pellerin was killed while conducting combat operations in Wardak Province, Afghanistan, on August 20, 2009.

Specialist Pellerin was a 2006 graduate of Concord High School. It was there that he met Chelsea, his high school sweetheart, whom he would later marry. The two had just celebrated their 1-year anniversary and were looking forward to Justin returning home in December. His family and friends remember him for his sharp sense of humor, his selflessness, and his love of American muscle cars.

Justin joined the Army because he wanted to make a difference in the world. For his distinguished service, he has been awarded the Bronze Star, the Purple Heart, the Good Conduct Medal and the National Defense Service Medal. He, and the thousands of brave men and women of the U.S. Armed Forces, represent the best in America's long tradition of duty, sacrifice, and service.

In addition to his wife Chelsea, Specialist Pellerin is survived by his mother Melissa; stepfather Dale Farmer; and two younger sisters Molly and Hannah. He will be missed dearly by all those who knew him.

I ask my colleagues to join me and all Americans in honoring the life of SPC Justin Pellerin.

Madam President, I wish to begin by thanking Senator Merkley for coordinating this effort today. I am pleased to be able to, once again, join my fellow freshmen Senators discussing how critical it is for the Senate to act on health care reform.

As the Senate moves to reform our broken health care system, we must address the skyrocketing cost of health care. We must ensure quality in our health care system. Over the past several months, I have heard from many individuals and families from New Hampshire who are dealing with the rising costs of health care. The stories they tell me are the most poignant reminders of why we must reform our health care system.

Recently, I heard from a man named Jeff, who is from Loudon, a small community close to the capital city of Concord. Jeff had recently lost his job and with it his health insurance. So when he experienced swelling of his right leg and shortness of breath, he was afraid to go to the doctor because he was afraid he could not afford the cost.

So he ignored the symptoms until they got so bad he had to call 911. He was taken to a local hospital. Doctors realized he had a blood clot in his leg which had migrated to his lung. This was a life-threatening condition called a pulmonary embolism. Since treatment, his condition has improved dramatically.

However, the final bill from the hospital was over $200,000. To this day, Jeff remains in debt. Think how much we could have saved if he could have gone to the doctor when he first felt those symptoms. Stories such as these are unacceptable. They can happen to anybody. The truth is, similar to Jeff, we may all be one medical condition away from financial disasters because of the high cost of health care. So we must work to protect hard-working individuals and families as we put forward a bill.

I am proud to come from New Hampshire for so many reasons but one of them is because of the great work that is done by the Dartmouth Institute of Health Policy. For more than 20 years, Dartmouth has been a leader in comparative effectiveness research and has revolutionized our understanding of our health care system. Because of the Dartmouth Atlas Project, we now know there are huge variations in the way health care resources are used and how money is spent depending on where we live.

This chart shows the difference in spending among different regions per

Medicare patient. It is amazing to me that Medicare costs can range from the lowest spending referral region, which as you can see is just over $5,000, to the highest spending referral region, where in some parts of the country Medicare pays over $14,000 to provide the same kind of treatment that in other parts of the country is provided for only a little over $5,000.

Unfortunately, the research also shows that just because someone is in a higher spending area, it does not mean they are going to live longer or have better health outcomes. Simply put, more costly care does not mean better care. There is a fundamental problem with our health care system, and this is something we have to work on.

Things do not have to be this way. We can find savings in our system and still provide high-quality care. As I mentioned last week, we can save significantly on Medicare costs by reducing hospital readmissions. I have introduced bipartisan legislation with Senator Collins to do that. We have the opportunity to fix a problem that has been around for generations. We need to work together to achieve this goal.

Mr. President, I wish to begin by recognizing and thanking Senator Warner for his efforts today to organize the freshmen to talk about why it is so critical that we get something done to reform health care in this country. He and I both belong to the former Governors caucus, and I come to this debate with the work, years of work that I did as Governor and the perspective we have to do something to improve the availability of health care for all Americans and certainly for the families in New Hampshire.

Over the past several months, my office has responded to thousands of letters and phone calls about health care. I have traveled all across New Hampshire, talking to small business owners and families who are desperate for help. I have talked to health care providers who are frustrated with the current system. Time and time again, what I have heard is that our health care system is not working. Costs are too high and access is too limited. The status quo is simply not sustainable. Now is the time to act.

Every day in New Hampshire and across our country, families are struggling with the rising costs of health care. It threatens their financial stability and leaves them exposed to higher premiums and deductibles and puts them at risk of losing their health insurance and, in too many cases, financial ruin. According to one study, 62 percent of bankruptcies in 2007 were caused by a medical condition. I have a chart that shows this very clearly. This is the 62 percent of those bankruptcies that were the result of the costs of medical care. What is probably even more concerning is that of those 62 percent, 78 percent of them were insured. So most of the people in this country who are going bankrupt as the result of their health care costs actually have health insurance.

Health care costs are a threat to our economy, to our small businesses, and to our working families. The current health care system is simply unsustainable for our economy. As Senator Warner pointed out, it is estimated that in 2009 our Nation will spend $2.5 trillion or 18 percent of our gross domestic product on health care. That means health care costs account for 18 percent of the value of all the goods and services produced in this country. If we continue on this current path, health care will make up over a third of our economy by 2040.

Senator Warner showed that in a chart. This is a graph that shows the same thing--what happens to health care costs if we do nothing, as a portion of the entire economy of this country.

In New Hampshire, our small businesses are feeling this burden firsthand. From 2002 to 2006, there was a more than 40-percent increase in the cost of health insurance premiums for New Hampshire businesses. For those of our smallest businesses, those with fewer than 10 employees, that increase was almost double, to more than 70 percent--a 70-percent increase in just 4 years for small businesses in New Hampshire. That means that, although our small business owners want to provide their employees with health insurance, many of them cannot afford it.

Ultimately, it is our hard-working families who suffer. Today, the average family living in New Hampshire pays about $14,600 for their insurance premium. In New Hampshire, we have the highest premiums in the country for those people who have group rates.

I wish to say that one more time because in New Hampshire we are paying the highest premiums in the country for group health insurance. If we continue on this current path, families will be paying almost $25,000 in the next 10 years, by 2019. Again, here is another graph that shows what is going to happen to New Hampshire families--$25,000 in 10 years. This is not affordable.

The good news is that we know how to bring down costs. At the Center for Informed Choice at Dartmouth, research shows that more spending does not translate into better outcomes. In fact, it shows that up to 40 percent of the time, patients who are engaged in the decisions related to their care will choose the less invasive and less costly procedures. These choices produce better outcomes with higher rates of patient satisfaction.

The health care industry can do better for less. We can find savings in our system. For example, experts have estimated that we can save $5,000 per Medicare beneficiary by reducing costly hospital readmissions. I have introduced legislation with Senator Susan Collins from Maine called the Medicare Transitional Care Act. This bipartisan legislation will reduce Medicare costs and offer better support and coordination of care to Medicare patients. This will not only improve the quality of health care for our seniors, but it will also save taxpayers money.

I was very pleased to see that many of these provisions were in the markup that came out of the Finance Committee.

Although the numbers and statistics are compelling, it is really the stories I have heard from my constituents

which best illustrate why reform cannot wait. This is not just about politics, this is about real people.

A few weeks ago I received a letter from a young woman named Jennifer. Jennifer and her husband had recently decided they wanted to start a family. They both work for small businesses that do not offer health insurance, so they shopped around for an individual insurance plan. The policy they could afford did not cover standard maternity care, but they were told they would be covered in case of an emergency: if Jennifer needed a C-section or if she had other health problems during the pregnancy.

Unfortunately, Jennifer suffered a rare complication, a molar pregnancy, resulting in a loss of the pregnancy and requiring extensive followup. But the insurance company told them it would not cover ``that'' emergency. So during their time of grieving, Jennifer and her husband are not only facing piles of medical bills, they are wondering how they will ever be able to afford a baby in the future.

No young family should have to go through this. We have the opportunity to stabilize health care costs and reform our health care system for people such as Jennifer and her husband. We know this is not easy. It is one of the greatest challenges of our time. But the time has long passed for action. We need to act now to stabilize costs and provide coverage for Americans.

I look forward to working with my colleagues on both sides of the aisle to achieve this goal.

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

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. Res. 267 submitted earlier today.

I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid upon the table, with no intervening action or debate, and any statements be printed in the Record.

I ask unanimous consent the Senate proceed to the immediate consideration of S. Res. 268 submitted earlier today.

I ask unanimous consent the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid upon the table, with no intervening action or debate, and any statements be printed in the Record.

I ask unanimous consent that when the Senate completes its business today, it adjourn until 9:30 a.m. tomorrow, Wednesday, September 16; 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 reserved for their use later in the day, and the Senate then proceed to a period of morning business until 11 a.m., with Senators permitted to speak therein for up to 10 minutes each, with the Republicans controlling the first 30 minutes, the majority controlling the next 30 minutes, and the remaining time equally divided and controlled between the two leaders or their designees; that following morning business, the Senate resume consideration of H.R. 3288, the Transportation-HUD appropriations bill, as provided for under the previous order.

Senators should be prepared for a series of up to five rollcall votes to be begin at approximately 11:40 a.m. tomorrow. Additional votes are expected to occur throughout the day in an effort to complete action on the Transportation appropriations bill.

If there is no further business to come before the Senate, I ask unanimous consent that it stand adjourned under the previous order.

Mr. President, I am honored to be here to add my voice to so many of those who today have eloquently remembered Senator Ted Kennedy. Like so many who have spoken today, I was the beneficiary of so many personal kindnesses from Senator Kennedy.

I actually first met him on the campaign trail. In 1980, I was actually on the other side in New Hampshire when he was running against Jimmy Carter. Despite the fact that was a very hard-fought campaign and we won and he lost, when I ran a winning campaign 4 years later in the New Hampshire primary, Senator Kennedy was one of the first people to call and congratulate me.

After that, I had the opportunity to campaign over the years with Senator Kennedy. There was no one who could fire up a crowd as he could. In 2000, I remember he was there for Al Gore when times were tough in New Hampshire. He was there for John Kerry in 2004. And I had the opportunity to travel around the country with him in support of John Kerry, his very good friend.

But I really got to see the difference he made in so many lives when I worked with him at the Institute of Politics at the Kennedy School of Government at Harvard. I had the opportunity to be chosen to be the director there, and Senator Kennedy was one of those people who helped make that decision and make that happen for me. What was so impressive was that it did not matter how busy he was with the work in Washington, with what he was doing in Massachusetts, he never missed a meeting. His first concern was always: What are the students doing? What is going to excite them? What is going to get them involved in politics and public service, because that was the mission of the Institute of Politics. It was one of two memorials that were established by the Kennedy family to remember his brother, President John Kennedy. It was always amazing to me to see someone who was so busy, so prominent in national life, who never missed an opportunity to talk with the freshman student who was there who wasn't quite sure what they wanted to do, to talk with and encourage the young people who were involved at the institute to get involved in politics, in government, in public service.

I know Senator Kennedy will be remembered by so many of the kindnesses he provided to people. He will be remembered by the tens of thousands of people whose lives he touched. But I think one of his most significant legacies will be those young people who are encouraged to get involved in politics, who appreciate that public service in government is an honorable profession because of his leadership and the work he did.

I feel very honored and privileged to have worked with him and to have had the opportunity to serve with him, however briefly, in the Senate. I know we will all remember for future generations what Senator Kennedy has done.