Floor Statements

I thank the Senator from Colorado for yielding.

I am joining my freshman colleagues on the floor to express my amazement at the difficulty this body is having conducting even the simplest legislative functions.

When I came to Washington last year from the North Carolina State Senate, I was certainly under no illusions that the process here would be lightening fast. In fact, I believe strongly we should take the time to make reasoned judgments about legislative and executive branch and judicial nominees. The American people are better served when we take the time to make the best decisions.

But there is a difference between taking time for reasoned judgment and impeding progress for the sole purpose of delay. There currently are 67 executive branch nominations awaiting action by the full Senate. Every one of these has been approved by the committee of jurisdiction, many having been approved unanimously. Thirty-one of those sixty-seven nominees were approved in committee last year and have been waiting for months for action by the full Senate.

One individual awaiting action by the Senate, Michael Punke, has been nominated to be our ambassador to the World Trade Organization. He was approved unanimously by the Senate Finance Committee in December.

As my colleagues know, the member countries of the WTO are currently engaged in a round of trade talks that could have enormous implications for American workers and industries. Would it not make sense to have the best possible American representation at those talks? Should we not want someone there who is advocating forcefully on behalf of our American workers, producers, and businesses?

It has been reported the delay in considering this particular nomination is connected to a concern one Senator has regarding a recent tobacco law passed in the Canadian Parliament. Well, I represent the largest tobacco State in the country. I will be honest, I understand the concerns of my fellow tobacco-State Senator regarding this legislation.

But I guess I have not been here long enough to understand how concerns with Canadian tobacco legislation lead you to the conclusion that you should prevent the United States from being represented in international trade negotiations. How are we supposed to address our issues with Canada and all trading partners when our seat at the table is empty? That is just one example. The calendar is full of nominees who deserve a vote.

In fact, there are two judicial nominees on the calendar from North Carolina who would be easily confirmed should they come up with for a vote, Jim Wynn and Al Diaz, nominees for the Fourth Circuit Court of Appeals. They were both approved by the Senate Judiciary Committee in January. But truth be told, we have not just been waiting since January, we have been waiting since 1994.

There has been an opening for a North Carolina judge on the Fourth Circuit since 1994. Partisan politics has gotten in the way of filling that vacancy time and again. Finally, we have not one but two qualified judges, supported by both myself and Senator Burr. Let's bring them up for a vote.

The government cannot function without qualified appointees in place. Let's stop the delays and bring these nominees up for a vote so they can get on with the business of the American people.

I yield the floor.

Mr. President, today, I am proud to recognize the contributions of our Nations' pharmacies to the American health care system. Over 200 members of the pharmacy community--including practicing pharmacists, pharmacy school faculty and students, state pharmacy leaders, and pharmacy company executives--will come together to highlight the importance of supporting policies that protect access to neighborhood pharmacies and utilizes pharmacists to improve quality and reduce health costs.

Currently, there are over 50,000 community pharmacies operating nationwide. Pharmacists are one of the Nation's most accessible health care providers, and nearly all Americans live within about 2 miles from a community retail pharmacy. Pharmacy has a long history of receiving, filling, billing, and dispensing prescriptions in tandem with counseling. But pharmacists, utilizing their specialized education, also play a major role in medication therapy management, disease state management, immunizations, health care screenings, and other health care services designed to improve patient health and reduce overall health care costs.

Pharmacists help patients adhere to their medications to improve health outcomes and reduce the risks of adverse events and unnecessary costly hospital readmissions and emergency room visits. Pharmacists are uniquely qualified to work with patients to help manage their medications and play an essential role in helping them take their medications as prescribed. Unfortunately, only 50 percent of Americans living with chronic diseases adhere to their drug regimens. Patient nonadherence costs the Nation's economy an estimated $290 billion each year, not to mention the avoidable loss of quality of life for patients and their loved ones. Congress recognized the important role of local pharmacists when it included a medication therapy management, MTM, benefit in Medicare Part D. As we have seen the increasing power of this benefit in improving patient health outcomes, I support community pharmacy's efforts to strengthen the MTM benefit so it is available for seniors and others struggling with chronic conditions and other illnesses.

As the face of neighborhood health care, pharmacies across the Nation offer these and other cost-saving programs and services to help patients take medicines they need to achieve positive results from appropriate use of their medications. For more than a century, pharmacies and pharmacists have made a difference in the lives of people in North Carolina and the rest of America. In order to ensure pharmacies continue to exist in our local communities, pharmacists deserve fair reimbursements for the cost effective medications that they dispense.

Today, I celebrate the value of pharmacy and support efforts to protect access to neighborhood pharmacies and utilize pharmacies to improve the quality and reduce the costs of health care. Finally, I would like to congratulate over 200 pharmacy leaders, pharmacists, students, and executives and the pharmacy community for their contributions to the good health of the American people.

Mr. President, I rise in support of Senate passage of H. Con. Res. 158, the House companion to a resolution I introduced last August to highlight greater awareness of breast and other cancers by designating an early cancer detection month. This House resolution is sponsored by my good friend and colleague from North Carolina, Congressman Bob Etheridge.

Almost every person has been touched by cancer, either personally or through a family member or friend who has suffered from some form of the disease. Sadly, every year, more than 2 million new cases of cancer are diagnosed in the United States.

The most common forms of cancer diagnosed in Americans are skin cancer, breast cancer in women, prostate cancer in men, lung cancer, and colorectal cancers. And it is estimated that in 2009, over half a million Americans died from all types of cancer.

Last year, in North Carolina, there were an estimated 42,270 new cases of cancer and more than 18,000 deaths due to cancer. Of those lost, 1,300 deaths were from breast cancer in women and 860 deaths from prostate cancer.

Current cancer treatments include surgery, radiation, chemotherapy, hormone therapy, biological therapy, and targeted therapy; however, there is no cure. Many oncologists and breast cancer researchers believe that a cure for breast cancer will not be discovered until well into the future.

However, we cannot sit idly by while we wait for a cure. Instead, we must continue to support organizations, health care providers, and even our friends who work so hard to raise awareness about cancer, particularly cancer prevention and early detection. Fortunately, many forms of cancer can be prevented altogether, such as skin cancer and lung cancer. In addition, at least half of all new cancer cases can be prevented or detected earlier by screening, and if detected early enough, more than 75 percent of all people could be saved when cancer is most treatable.

For breast cancer, early detection has been proven to reduce mortality. This is encouraging, due to the fact that 1 in 8 women in the United States will develop breast cancer in her lifetime.

In 2008 alone, the overall cost of cancer in the United States was estimated at $228.1 billion. Greater awareness and early detection of all cancers will not only save tens of thousands of lives, but also greatly reduce the financial strain on the government and private health care services by detecting cancer before it requires very expensive treatment.

Cancer has taken an enormous toll on our society's health and economy. But this disease, in all its forms, is often detectible at early stages. By designating a month to focus on early detection for breast cancer and all other forms of cancer, we will address some of the principle challenges that inhibit screening and prolong detection. Enhanced awareness and screening are the keys to reducing morbidity and mortality from cancer and reducing the financial and emotional stress that this disease places on Americans.

I want to thank Senator Richard Durbin for joining me in cosponsoring the Senate resolution. I also would like to thank Representative Etheridge for sponsoring the House companion, which passed on January 21. I am extremely pleased that both Chambers have been supportive of this issue and that the Senate is adopting this concurrent resolution today.

Mr. President, I rise today to speak about drug reimportation. With millions of seniors balancing drug regimens that entail taking several medicines per day on a fixed income, I believe we need to find a way to ensure that they have access to affordable drugs. If we could reduce the cost of drugs with reimportation and guarantee the safety of those drugs, I would be very supportive. However, I have serious doubts that we can adequately ensure the safety of our drug supply with the drug reimportation amendment proposed by my colleague from North Dakota.

Even without reimportation, the United States has had trouble with counterfeit drugs. At the height of the H1N1 epidemic this fall, the FDA was warning consumers to be wary of counterfeit H1N1 treatments. These counterfeits came from foreign online pharmacies. In one instance, the FDA seized so-called H1N1 treatment tablets from India and found them to contain talc and acetaminophen. Last month, the Washington Post reported on a coordinated global raid of counterfeit drugs from the United States to Europe to Singapore. The United States discovered about 800 alleged packages of fake or suspicious prescription drugs, including Viagra, Vicodin, and Claritin, and shut down 68 alleged rogue online pharmacies.

Counterfeit pharmaceutical drugs are appearing on the market at increasingly alarming rates. In 2007, drugs comprised 6 percent of the total counterfeit product seizures. In 1 year, they have now jumped to 10 percent of all counterfeit product seizures.

This growing problem is all about unscrupulous criminals preying on the sick and the elderly who are in desperate need of cheaper drugs. But the consequences are harmful and, in some cases, deadly.

Officials estimate that some of these counterfeit drugs contain either a dangerous amount of active ingredients or were placebos. Some counterfeits include toxic chemicals such as drywall material, antifreeze, and even yellow highway paint.

According to a recent Washington Post article, tracing the origins of drugs such as Cialis and Viagra took investigators across the globe and back again. Supposedly these drugs came from a warehouse in New Delhi, though the online company selling the drug was headquartered in Canada and was licensed to sell medicine in Minnesota. However, when Federal officials investigated the drug origins further, they actually found that the online Web site was registered in China, its server was hosted in Russia, and its headquarters had previously been listed in Louisiana.

On a local level near our capital, the Baltimore Sun yesterday reported on the death of a University of Maryland pharmacologist, Carrie John. Ms. John suffered an allergic reaction to a counterfeit version of a legal drug in the United States but purchased illegally from the Philippines. Apparently, the counterfeit drug so closely resembled the legal version that two pharmacologists conducting the analysis after Ms. John's death could not tell the difference. Local police have yet to identify the contents of the counterfeit drug.

A few of my colleagues have already mentioned the letter sent last week by FDA Commissioner Margaret Hamburg outlining the safety concerns the FDA has about reimportation. Specifically, the FDA stated that importing non-FDA-approved prescription drugs posed four potential risks to patients. Let me go over those four risks.

No. 1: The drug may not be safe and effective because it did not undergo the rigorous FDA regulatory review process.

No. 2: The drug may not be a consistently made, high quality product because the facility in which it was manufactured was not reviewed by the FDA.

No. 3: The drug may not be substitutable with the FDA-approved product because of differences in composition or manufacturing.

No. 4: The drug could be contaminated or counterfeit as a result of inadequate safeguards in the supply chain.

If the agency that oversees drug safety is saying it would have difficulty guaranteeing the safety of our Nation's drug supply with reimportation, I have grave concerns, particularly since the FDA is already underfunded and understaffed.

But let's take a moment to examine how Europe, which does allow reimportation, has fared in terms of safety.

British authorities say counterfeit drugs often exchange hands between middlemen and are repackaged multiple times before reaching a legitimate hospital or pharmacist. This creates opportunities for counterfeit products, often produced in China and shipped through the Middle East, to penetrate the European market.

Mr. President, I ask unanimous consent for 3 additional minutes.

In 2008, British authorities identified 40,000 doses of counterfeit Casodex, a hormone treatment for men with advanced prostate cancer, and Plavix, a blood thinner.

More recently, the European Union seized 34 million fake tablets at customs points in all member countries. In other countries around the world, the World Health Organization estimates that up to 30 percent of the medicines on sale may be counterfeit. As a result, numerous people have died.

Earlier this year, 80 infants in Nigeria died from teething medicine that contained a toxic coolant. In July, 24 children in Bangladesh died from the consumption of poisonous acetaminophen syrup.

The Dorgan amendment does not require imported drugs to be FDA approved or meet FDA misbranding standards. Furthermore, it does not prevent criminals in other countries from repackaging imported drugs.

Although our safety system is not perfect, we have a thorough FDA review system for drug safety that actively involves physicians, pharmacists, and patients. As a result, Americans can be generally confident that our medications are safe and contain the ingredients on the bottle.

Supporters of reimportation argue that the sick and elderly need an alternative way to obtain affordable drugs. However, a study by the London School of Economics found that in the European Union, middlemen reaped most of the profits with relatively little savings passed down to the consumer. Nothing in the Dorgan amendment requires the savings to be passed on to the consumer, leaving the door wide open for unscrupulous, profit-seeking third parties to get into the reimportation game.

In the United States, we are already trying to reduce the cost of prescription drugs through the use of generics. This is one of the most effective ways for customers to reap savings, and the generic dispensing rate at retail pharmacies is close to 65 percent. The FDA is already working with stakeholders to develop drug reimportation policy. With the FDA looking into this and significant outstanding safety concerns, I cannot in good conscience support the amendment offered by my colleague from North Dakota. Instead, I will support the amendment offered by my colleague from New Jersey. The Lautenberg amendment will allow the importation of drugs only if the Secretary of Health and Human Services certifies that doing so would save money for Americans and would not adversely affect the safety of our drug supply.

While it is critical that all Americans, especially our Nation's seniors, have access to affordable drugs, it is imperative that we not compromise the safety of U.S. drugs on the market. After all, what good are cheap drugs if they are toxic or ineffective?

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

Mr. President, I rise in support of the freshman value and innovation package, which builds on efforts to provide quality, affordable health care at a lower cost to families. I, too, applaud our colleague, Senator Mark Warner, for helping to initiate this package.

I wish to take a moment to talk about two provisions in the package that I included: curbing fraud and abuse with 21st-century technology and medication therapy management.

Today, Medicare spends about $430 billion annually; Medicaid, approximately $340 billion; the States Children's Health Insurance Program, an additional $5 billion, for a total of $775 billion.

In Medicare alone, annual waste amounts to between $23 billion and $78 billion. Yet, despite these sky-high numbers, investigations are pursued only after payment has been made, which means government fraud investigators have to recover funds that have already been paid. As a result, it is estimated that only about 10 percent of possible fraud is ever detected, and of that amount only about 3 percent is ever actually recovered. This means the government recovers, at best, about $130 million in Medicare waste, fraud, and abuse. Again, when estimates are between $23 billion and $78 billion, we are only recovering $130 million.

``Doctor shopping'' is an example that was profiled in a recent USA TODAY news article and GAO report. This involves a patient receiving multiple prescriptions from numerous doctors in a short period of time, without getting caught. Each of the claims gets paid by Medicare, Medicaid, or even private health insurers.

The current technology exists to assess in real time if a claim warrants further investigation, and this technology will prevent fraudulent claims from being paid on the front end. A software company in Cary, NC, SAS, has developed this technology.

This amendment will require the Department of Health and Human Services to put into place systems that will detect patterns of fraud and abuse before any money leaves our Federal coffers.

Another source of waste in the system is people not sticking to their medication regimen. As much as one-half of all patients in our country do not follow their doctors' orders regarding their medications. The New England Health Care Institute estimates that the overall cost of people not following directions is as much as $290 billion per year.

This waste can be eliminated with medication therapy management. That is a program where seniors bring all of their prescriptions, in a little brown bag, and their over-the-counter medications and their vitamins and supplements to the pharmacy to be thoroughly reviewed in a one-on-one session. The pharmacist follows up and educates the patient about his or her medication regimen.

North Carolina has some successful medication therapy management programs already in place.

In 2007, the North Carolina Health and Wellness Trust Fund Commission launched an innovative statewide program called Checkmeds NC to provide medication therapy management services to our seniors. During the program's first year, more than 15,000 seniors and 285 pharmacists participated. Just this small program saved an estimated $10 million, and countless health problems were avoided for our seniors.

This amendment takes this successful North Carolina model and implements it nationally, permitting pharmacies and other health care providers to spend considerable time and resources evaluating a person's drug routine and educating them on proper usage.

I urge passage of this freshman amendment package which will further reduce health care costs for American families. Thank you.

Mr. President, I rise in support of the amendment offered by the senior Senator from Maryland.

This amendment tackles a serious problem: Women are increasingly skipping critical preventive health care screenings because of costs, even when they have health insurance.

This summer, I received an e-mail from a woman named Julie in Raleigh, NC, about her sister who had no insurance and waited years to get a mammogram because she couldn't afford to pay the $125 fee for a mammogram. Then she found a lump in her breast.

Eventually, the mass grew so large Julie's sister finally got her mammogram and paid for it with cash. The mammogram confirmed what she had suspected, that she had breast cancer. But now that she had a diagnosis, she had no way to pay for the treatment.

She lost her battle with breast cancer in March of this year. Julie's sister, perhaps, could have beaten this cancer if she had had access to affordable, preventive care and, after her diagnosis, access to insurance or medical care to cover her cancer treatment.

In this heartbreaking situation, Julie's sister was sick and stuck. This health care reform bill will provide people such as Julie's sister with access to affordable, quality health insurance.

The President of Randolph Hospital in Asheboro, NC, wrote to me recently that a few years ago, he was in a meeting with 20 to 30 of his nursing assistants who were covered by the hospital's insurance plan. Of those who were old enough to require a mammogram, only 20 percent had actually gotten one. The reason, they said, was the

high out-of-pocket costs they would have to pay.

When these women had to choose between feeding their children, paying the rent, and meeting other financial obligations, they skipped important preventive screenings and took a chance with their personal health.

The hospital then decided to remove the financial barrier to preventive care and pay for 100 percent of preventive screenings.

With the passage of Senator Mikulski's amendment, we will do the same for all women. A comprehensive list of women's preventive services will be covered with no added out-of-pocket expenses.

With this amendment, we will ensure that, as the old saying goes, ``An ounce of prevention is worth a pound of cure,'' for women across America.

I think one of the key points is the fact that this bill is going to eliminate discrimination based on gender and preexisting conditions. I have two children right now who are in their midtwenties. My daughter is paying more per month for health insurance than her brother. Yet it is the exact same policy. The same with preexisting conditions. How many people do we know who have a condition such as diabetes or asthma, or a woman who has had a C-section who is, therefore, denied from getting health insurance? We have to be sure we correct this, and that is what this bill does.

Let me give a couple of examples. So many people in North Carolina I have heard from have some of these situations. Recently, I got an e- mail from a family in Greensboro. It is a working family. The husband has Graves disease, which is a treatable condition, but he can't obtain health insurance because of this condition. Without health insurance, his life is gravely in danger. He repeatedly uses the emergency room for care.

To make matters worse, he has a 2-year-old son who has hemophilia and has to be taken to the emergency room every time he bumps his head, which sometimes can cost, for a 2-day supply of medicine, $4,600. The family makes too much money to qualify for Medicaid and, obviously, with these preexisting conditions, health insurance is way out of reach for them. It is heartbreaking for this family. What the father has decided to do is to purchase life insurance instead of trying to get health insurance, and he is 29 years old.

That is right. In all but 12 States, insurance companies are currently permitted to charge women more than men for the exact same policies.

Yes. A lot of what we have been talking about are people who don't have health insurance and who want it enhanced because of preexisting conditions. We have people who are sick and stuck with health insurance.

I received an e-mail from a young North Carolinian who works for AmeriCorps. She was the valedictorian of her high school class. She suffers from a brain abscess. Her illness has put her into debt for the rest of her life. She has health insurance, but it ran out when she hit a $50,000 cap. Her bills far exceed the cap. It is sinking her entire family into debt. She is sick and stuck.

How many people do we know who have a spouse or themselves who have health insurance, and they are working, but they cannot switch jobs because they would lose their health insurance? I have a good friend whose husband has cancer. She wants to change jobs, but she cannot do it because of the condition of her husband. Once again, people are sick and they are stuck. We have to be sure we can have a debate, that we can move forward on health care reform so we can help people.

Mr. President, the United States spends $2.3 trillion each year on health care--the most per capita of all industrialized nations. Yet we still have higher infant mortality and lower life expectancy than many of the other industrialized nations. Moreover, medical errors kill 100,000 patients per year and cost the system tens of billions of dollars, and $700 billion is spent each year on treatments that do not lead to improved patient health.

Today, my freshman Senate colleagues and I are going to speak about

the need to reform our health care delivery systems. You will hear from all of us about innovative initiatives that are successfully bringing down the cost of health care and at the same time improving the quality of care.

Mr. President, I would like to yield 5 minutes to my colleague from Colorado, Senator Mark Udall, to discuss accountable care organizations.

I thank Senator Udall. Accountable care organizations are extremely important in health care reform.

Mr. President, I would like to yield 5 minutes to my colleague from Delaware, Senator Ted Kaufman, to discuss Delaware's health information network.

I thank Senator Kaufman. A health information network is critical to improving patient care and reducing health care costs.

Now I would like to yield 5 minutes to my colleague from Alaska, Senator Mark Begich, to discuss customer-driven care.

Mr. President, Senator Begich's comments on customer- driven care is certainly working in Alaska.

I now yield 5 minutes to my colleague from Colorado, Senator Michael Bennet, for his discussion on transitional care.

Mr. President, I thank Senator Bennet for his comments on transitional care and certainly the need to make sure no patients are denied insurance coverage for preexisting conditions and in particular because a wife is pregnant.

I yield 5 minutes to myself. I take this opportunity to talk about health care reform and how it will improve the delivery of health care to Americans.

One successful delivery system that health care reform will expand upon is patient-centered medical homes which were pioneered in my State of North Carolina. Since 1998, North Carolina has been implementing an enhanced medical home model of care and its Medicaid Program called Community Care of North Carolina.

Under this model, each patient has access to a primary care physician who is responsible for providing comprehensive and preventive care, working in collaboration with nurses, physician specialists, and other health care professionals.

The primary care physician is the go-to doctor and the gatekeeper of a patient's information. Within each network, patients are linked to a primary care provider to serve as a medical home that provides acute and preventive care, manages chronic illness, coordinates speciality care, and provides round-the-clock, on-call assistance. Case managers are integral members of the network and work in concert with the physicians to identify and manage care for high-cost, high-risk patients.

As of May of this year, Community Care of North Carolina was comprised of 14 networks that included more than 3,200 physicians and covered over 913,000 Medicaid patients in North Carolina, accounting for over 67 percent of the State's entire Medicaid population.

As an example of the benefits of a program such as this, consider the impact on asthma patients because patients get to see the same doctor and get more consistent, coordinated care. Physicians are able to quickly recognize a condition such as asthma and can more quickly and efficiently determine the most appropriate treatment. The support network then educates the patients and their families about the management of their disease.

Due to the increased likelihood of complications when asthma patients get the flu, it is very important that they receive the flu vaccine. Since 2004, within the Community Care of North Carolina, there has been a 112-percent increase in flu shots administered to asthma patients. More than 90 percent of patients are using the most appropriate medications.

Between 2003 and 2006, asthma-related hospitalizations were decreased by 40 percent, and emergency room visits decreased by 17 percent. That saves all of us dollars.

Community Care of North Carolina has improved patient care and saved the State money. An independent analysis by Mercer, which is a government consulting group, found that this program saved between $150 million and $170 million in 2006.

A University of North Carolina evaluation of asthma and diabetes patients found that it saved $3.3 million for asthma patients and $2.1 million for diabetic patients between 2000 and 2002.

In addition to asthma patients, diabetic patients also had fewer hospitalizations, and they visited the primary care doctors more often instead of specialists and had better health outcomes.

I would like to tell a story about how access to a medical home has helped someone in North Carolina overcome the challenges of an illness.

Donald from Charlotte has type 2 diabetes. This diabetic condition of his went untreated for a long time and, as a result, he began having ministrokes, had to cut back on his work in landscaping, and he ended up in an emergency room. He was referred to a Charlotte-based medical home program called Physicians Reach Out. He now has a primary care doctor who has helped get him on a medication regimen, returning his blood sugar to a normal level which allowed him to work full time again. His primary care physician was the key to teaching him how to manage his diabetes. Without his medical home, he said getting his condition under control would have been a ``wild goose chase.''

The Health, Education, Labor, and Pensions Committee included two provisions in the health care reform bill to

encourage patient-centered medical homes, such as we have in North Carolina. The Secretary of Health and Human Services will create a program to support the development of medical homes, and then the other States will apply for grants.

The bill also provides grants for physician training programs, giving priority to those who educate students in these physician training programs that are team-based approaches, including the patient-centered medical home.

I have been focused on a reform bill that prevents insurance companies from turning patients away who have a preexisting condition, that expands coverage, and ensures that if you like your insurance and your doctors, you keep them. This bill actually will reduce our deficit, and that, obviously, has been a requirement of mine all along. This bill also encourages innovation in the delivery of health care to Americans using successful programs, such as the Community Care of North Carolina and the Physicians Reach Out patient-centered medical home as a model.

Mr. President, now I wish to yield 5 minutes to my colleague from New Mexico, Senator Tom Udall, to talk about a model of community health service delivery.

Mr. President, I thank Senator Udall. His example of the community health service delivery in New Mexico is excellent.

Now I yield 5 minutes to my colleague from New Hampshire, Senator Jeanne Shaheen, to talk about reducing overutilization of emergency departments and reducing hospital readmissions.

Mr. President, I thank my colleague. She has made it abundantly clear that by reducing the overutilization of emergency departments, at the same time reducing hospital admissions, we can maximize efficiencies and improve patient health and health care.

I yield 5 minutes to my colleague from Virginia, Senator Mark Warner, to talk about delivery system reforms in Virginia.

I thank Senator Warner. It is obvious that coordinated care will reduce costs and at the same time provide higher quality for our patients.

What Senator Warner has discussed is very similar to the patient centered medical homes in North Carolina where we currently cover over 900,000 Medicaid patients.

Finally, I yield 5 minutes of my time to my new colleague from Massachusetts, Senator Paul Kirk, to discuss some key national indicators.

Mr. President, I thank Senator Kirk. I thank him for his comments and the discussion on the transparency and openness of the new key national indicators system. I think

this is critically important so that our public can see the progress we are making in improving health outcomes, healthy behavior, and cost- effectiveness.

In this last hour, we have heard from many of our new freshman colleagues about the successful efforts to reform the way we deliver health care in our country. I thank my colleagues for sharing those ideas with us.

I yield the floor.

Mr. President, I am joining my colleagues on the floor today to discuss how health care reform will support innovative private sector programs that will save taxpayers money and make our Nation healthier in the long run. I wish to take this opportunity to discuss groundbreaking work at SAS, a software company based in Cary, NC.

Since 1985, SAS has established itself as a global leader in employer-sponsored wellness programs. Although SAS provides health insurance for its employees, almost 90 percent of their families use the company's on-site health care center, and more than 50 percent, including the company's CEO, use the health care center as their primary care provider.

SAS started providing wellness programs to its employees because the company realized the value of having healthy employees--they are more productive, they are more loyal--which translates into low employee turnover and reduced recruitment and retention costs. Disease prevention and wellness also translate into lower health care costs for the company as employees take better care of themselves.

Recently, one SAS employee--a man in his 30s--was told he had early signs of Type 2 diabetes. Through their diabetes self-management program and other onsite SAS resources, this man was able to make real changes in his lifestyle, eating habits, weight and exercise, and now he no longer meets the diagnostic parameters for diabetes.

I also recently visited Lenoir Memorial Hospital in Kinston, NC, where this hospital provides their employees and members of this community with access to a gym and a wellness program. More than 40 percent of the hospital's employees participate because of incentives the hospital provides for basic preventive screenings. People who don't work at the hospital--people in the community--can pay a low monthly fee to use the gym, including its indoor and outdoor track, weights, and yoga classes. Many of the people who use the facility are middle- aged and older. Health care staff monitor the facility and help create a comfortable and safe environment for everyone who comes to exercise. This opportunity is a benefit to the entire community.

Two weeks ago, I visited the showroom of the North Carolina furniture manufacturers Mitchell Gold and Bob Williams. This company currently employs 550 North Carolinians, and for the past 10 years the company has provided their employees with a free annual health fair, where employees can receive preventive exams at no cost. This spring, more than 200 women received free mammograms from a mobile unit that came to the plant. The company recently started a part-time, onsite medical clinic to address their employees' medical needs.

Companies such as SAS, Lenoir Memorial Hospital, and Mitchell Gold and Bob Williams reap tremendous economic benefits from their investments in these wellness programs. In 2008 alone, SAS saved more than $5 million in productivity and insurance costs as a result of its onsite health care center.

Businesses across our country can improve worker productivity and save money by encouraging their employees to adopt healthier lifestyles. Obesity, chronic heart disease, and diabetes continue to rise in America at a significant cost to our health care system. The time to be innovative is now.

In the health care reform bill, we are building on these successful wellness programs and encouraging all employers to invest in the health and well-being of their employees. Specifically, in the Health, Education, Labor and Pensions Committee bill, employers can offer their employees who participate in a wellness program a discount of up to 30 percent in their health insurance premiums. Currently, the average employee insurance premium is $250 a month, or $3,000 a year. This 30- percent discount would mean a savings of $900 per year to that employee.

Expanding employer wellness programs will bring the cost of health care down and will make America a healthier nation.

I thank the Chair.

Mr. President, I am proud to recognize a group of 102 World War II veterans from the Triad region of North Carolina who are traveling to Washington, DC, on October 28 to visit the memorials and monuments that recognize the sacrifices of our Nation's invaluable servicemembers.

The Triad Flight of Honor sponsored this trip to the Nation's Capital for surviving World War II veterans in the Triad area. Our veterans will visit the World War II, Korean, Vietnam, and Iwo Jima Memorials.

This will be the second Triad Flight of Honor trip. The organization flew their inaugural group of veterans to Washington, DC, on October 3, 2009. I had the honor of visiting with that group of veterans when they returned to Greensboro, NC. I was joined by my father-in-law, MG (Ret) Charles T. Hagan, Jr., U.S. Marine Corps Reserve, a World War II veteran, just before he died. Two more Triad flights for the spring of 2010 have already been scheduled, and hundreds of veterans in the area are hoping to participate.

World War II was the defining period for a generation that bravely answered the call to serve our country. Young men and women, driven to protect America, enlisted in droves. Unfortunately, too many of those brave servicemembers met an untimely death on the battlefields of Europe and the South Pacific. More than 400,000 American servicemembers were slain during the course of the long war, and over 60 million people worldwide were killed, including 40 million civilians. The Allied Forces' ultimate victory is a testament to the brave soldiers, sailors, airmen, and marines who put their lives on the line to fight for liberty and freedom.

This week, 102 Triad veterans will see the memorials dedicated to their service. I thank the Triad Flight of Honor for making these trips a reality.

I ask the Senate to join me in honoring these brave veterans who are true North Carolina heroes.

Mr. President, I am joining my colleagues on the floor today to discuss the need for health care reform and what it means for Americans with preexisting conditions.

Millions of Americans live today with what insurance companies describe as preexisting conditions. They range from something as common as asthma or diabetes to diseases such as cancer or MS. Some insurance companies, believe it or not, even consider a C-section to be a preexisting condition.

Under our current system, if you are shopping for insurance on the individual market and you have a preexisting condition, you are faced with one of three frightening choices: One, you could be denied coverage altogether; two, you could be charged an exorbitant premium; three, you could be granted insurance with a rider that stipulates your insurance company is not required to cover your preexisting condition.

Recently, I received an e-mail from a family in Mooresville, NC, that truly underscores why millions of Americans living with preexisting conditions simply can no longer afford inaction on this issue.

Seven years ago, Tim became disabled and lost his job. Because he lost his job, his wife Marilyn also lost her coverage under his employer-provided plan. Tim's health care, which requires his wife Marilyn to provide constant home care, is covered by Medicare. But Marilyn has Osler's disease, which is a blood disease considered to be a preexisting condition by her insurance company. Marilyn is only able to purchase a high-cost, high-deductible plan. Compared to Tim's illness, her condition is relatively minor. But over the last 7 years, they have racked up more than $72,000 in debt for her health care. And this past year, her health insurance premiums cost more than the mortgage on their home.

Unfortunately, there are millions of Americans all across our country such as Tim and Marilyn who are literally one medical emergency away from bankruptcy. This couple is sick and stuck.

Over the last 10 years, medical premiums in North Carolina have skyrocketed, increasing 98 percent, while wages, on the other hand, have increased only 18 percent.

The Health, Education, Labor, and Pensions Committee, of which I am a member, crafted a bill that ensures a preexisting condition never again prevents anyone from obtaining health insurance. It also provides security and stability for people with insurance, expands access to health insurance for people without it, and it will stop draining the finances of American families and the Treasury. The Finance Committee's bill also includes these critical elements.

My goal is to send the President a bill that gives people the peace of mind that if they change or lose their job, as Tim did, they will no longer have to fear losing their health insurance too.

Every single day I hear from North Carolinians who are looking for an opportunity to purchase quality affordable health insurance and protect their families. Hard-working Americans, such as Tim and Marilyn, simply cannot afford to wait any longer.

I yield back my time.

Mr. President, I am joining my colleagues on the floor today to talk about how health care reform will improve women's access to care.

I recently received an e-mail from a woman in Raleigh that truly underscores why women need health care reform in America. Julie wrote to me about her sister who was uninsured and waited years for a mammogram because she literally couldn't afford to pay for one. Then she found a lump in her breast. By the time the lump became a mass, Julie's sister finally got a mammogram and had to pay for it with cash. The mammogram confirmed what she suspected: She had breast cancer. But now that she had the diagnosis, she had no way to pay for the treatment. Julie's sister lost her battle with breast cancer this March. Like thousands of women across America, perhaps Julie's sister could have beaten this cancer if she had had access to affordable, preventive care and, after her diagnosis, access to either insurance or medical care to cover her cancer treatment. In this heartbreaking situation, Julie's sister was sick and stuck.

Unfortunately, I hear about such cases far too often. Inefficiencies and discriminatory practices in our health care system disproportionately affect women. In all but 12 States, insurance companies are allowed to charge women more than they charge men for coverage. The great irony here is that mothers, the people who care for us when we are sick, are penalized under our current system.

My daughter Carrie recently graduated from college and had to purchase her own health insurance. For no other reason than her gender, her insurance policies cost more than they do for my son Tilden.

Yesterday, a 23-year-old staffer in my office, a female from Fayetteville, shopped for health insurance on the individual market for the most basic, bestselling plan. It would cost her $235 a month; for a man of the same age, $88. That is 2\1/2\ times more expensive, close to $1,800 more per year.

Many women who have health insurance are still stuck. Insurance companies don't often cover key preventive services such as mammograms and pap smears. Often, the copays for these critical services can be out of reach for many women when they range as high as $60 a visit. More than half of all women, like Julie's sister, have reported delaying preventive screenings. Without insurance, mammograms cost well over $100.

In many cases, the difference between life and death is early detection. The Affordable Health Choices Act--which I worked with my colleagues on the Health, Education, Labor and Pensions Committee to craft--makes preventive care possible for women across America. It eliminates all copays and deductibles for recommended preventive services.

We are also stopping insurance companies from charging women more than men or using preexisting conditions as a reason to deny anyone health insurance.

I thank the Chair and yield the floor.

Mr. President, today I honor a woman of great character; a woman who provided unquestionable leadership to our Nation and a woman who proudly hailed from North Carolina. Our State motto, ``Esse Quam Videri,'' ``To be, rather than to seem,'' richly describes BG Mildred Inez Caroon Bailey; a trailblazer who thrived on challenges, especially when she was told, ``it can't be done.'' As a member of the Senate Armed Services Committee, I am proud to recognize General Bailey's contributions to the U.S. Army in this Chamber today.

Brigadier General Bailey was born in 1919 in Fort Barnwell, NC, and raised in nearby Kinston. Inez, as she was known to her friends, directed the Women's Army Corps, WAC, from 1971 to 1975. Enlisting at a time when a woman's role in uniform was unclear, she experienced unquestionable changes for women in the military throughout her 33-year career. General Bailey was the third female to be promoted to brigadier general, a rank she never sought, but would never have thought to turn down.

When she wasn't studying her favorite subject, French, Inez worked in her parents' grocery store. Upon graduation, she enrolled in Flora McDonald College in Red Springs, NC, and later transferred to the Woman's College of the University of North Carolina--now the University of North Carolina at Greensboro. She graduated in 1940 with a degree in education and one professional goal--to be a French teacher. She eventually accepted a job teaching French in Taylorsville, NC.

When World War II broke out, this North Carolina French teacher thought a job in the Army Air Corps might be interesting, but it wasn't until a friend dragged her along to Fort Bragg that she really gave the military a second thought. The Army needed women to take the place of male soldiers who worked nonbattlefield jobs in order to free them for service on the front lines. Six months after Pearl Harbor, Inez joined the Women's Army Auxiliary Corps, WAAC, the predecessor to WAC, at Fort Bragg. Although her parents were unhappy about her decision, they supported her nonetheless. Although women held primarily administrative, clerical and supply-type positions, she was encouraged to discover that women were also packing parachutes and were even mechanics. Due to her college degree, General Bailey was eligible for officer candidate school.

Her first unit command was at George Field Army Air Base in Illinois. There, she became very good at marching. She said, ``I didn't know any women who didn't like marching. We thought it was fun and we were proud of our marching, we could keep a good beat with the Colonel Bogey March!'' They even added words to the march, ``Duty is calling you and me. We have a date with destiny. Ready, the WACs are ready. Our hearts are steady, the world to set free. Service, we're in it heart and soul. Victory is our only goal. We love our country's honor, and we'll defend it against any foe.''

Eventually the Army made use of her background as a French teacher, assigning her to teach English to freed French prisoners of war who had been held in Morocco. She was thrilled to teach the soldiers because they were excited to learn, unlike the high school students she taught before joining the Army. At the end of the war, the debate about women serving in the military continued. Brigadier General Bailey could have left, but by then she was married and making, as she recalled, ``a magnificent sum of $166.60 and 2/3 cents a month--much more than a

teacher's salary.'' She commanded a WAC attachment in the 98th General Hospital in Munich, where she was the highest ranking first lieutenant, male or female, in the European Command. She made first lieutenant within 6 months after she joined the service and had many great assignments that she described as ``wonderful assignments--but there were no promotions involved, because women weren't promoted.''

Eventually General Bailey returned to the States where she was initially assigned to intelligence work in the Military District of Washington before reporting for duty as a recruiter in charge of recruiting women in the seven Southeastern States; including North Carolina. Recruiting was a turning point for Inez Bailey. She discovered she was a ``ham and loved being interviewed on television and making speeches.'' She led a team of recruiters who exhibited around the country with a program that highlighted the historic contributions of women in every branch of the military. The exhibit included Belle Boyd, a Confederate spy who was a captain and honorary aide de camp to GEN Stonewall Jackson. After recruiting, Brigadier General Bailey became the Army's Senate liaison. She said for the first few weeks, all she saw were the backs of the Senators' heads from the Senate galleries.

After 29 years of service, she was assigned to Fort McClellan, AL, as the deputy commander of the training center. When General Westmoreland summoned her to Washington, she asked if the meeting could be postponed because she was involved in a theater production she didn't want to miss. All the while she thought, ``If General Westmoreland suggests I might be the new director of the Women's Army Corps, I'm just going to say no thank you. If I'm your first choice, then take the second choice.'' She didn't get a chance to argue when he told her she would be the new WAC director. She was needed because the Army needed to recruit more women. Under her tenure the number of women in the Army tripled; from 13,000 to 39,000. And for the first time, women were allowed to command men.

She retired from the Army with the rank of brigadier general. Her military decorations included the Distinguished Service Medal and the Legion of Merit. General Bailey will be interred at Arlington National Cemetery on October 14. Her husband, Marine Sergeant Major Roy C. Bailey, died in a traffic accident in 1966.

Mr. President, I thank my fellow colleague from Oregon, Senator Merkley. I also welcome our new colleague from Massachusetts.

I am joining my freshmen colleagues on the floor today to talk about how health care reform will improve women's access to care. I received a heartbreaking e-mail this week from a young woman in North Carolina. When this woman was 27 years old, she was diagnosed with breast cancer. She had a 16-month-old son and was in an abusive relationship with her husband. Her husband knew she would not leave him because she could not afford medical treatment without his employer-provided insurance. She looked into COBRA. She looked into other individual insurance plans. But her breast cancer was, obviously, considered a preexisting condition. So for 7 years, this woman stayed in an abusive relationship because she had to have health insurance for herself and her child. Unfortunately, women across America face similar challenges to exactly what that woman has faced. Inefficiencies and discriminatory practices in our health care system disproportionately affect women. In a majority of States, insurance companies are permitted to charge women more than men for the exact same insurance policy. In Washington, DC, and in eight States, insurance companies can deny coverage to victims of domestic violence, citing that as a preexisting condition. In all but 12 States, insurance companies are allowed to charge women more than they charge men for coverage. In my family, my daughter, who just graduated from college--out there looking for health insurance on her own--was quoted many times more money for her coverage than if she had been a male.

Only 12 percent of individual market policies provide comprehensive maternity care. When women do have health insurance, it often does not cover basic preventive care such as mammograms and Pap smears. In the HELP Committee and in the Finance Committee bill, insurance companies can no longer charge women more than men or use preexisting conditions to prevent anyone from purchasing health insurance, and we are ensuring that basic preventive screenings will be covered.

I am focused on sending our President a bill that ends discriminatory

practices against women, provides security and stability for people with insurance, expands access to health insurance for those without it, and slows down the skyrocketing cost of health care. Women across America cannot afford inaction any longer.

Mr. President, I yield the floor.

Mr. President, I rise with my colleagues to discuss the urgent need for comprehensive health care reform and why I believe the cost of inaction is simply too high for North Carolina and America's working families.

As I traveled across the State during the August recess, it was clear that North Carolinians are concerned about the rising cost of health care. In the past 10 years in my State, the cost of health care premiums has increased 98 percent, whereas wages have increased only 18 percent. That is a startling statistic. Just last week, the chamber of commerce from Dunn, NC, came to visit me in Washington. One man has a company that employs 600 employees. The cost of health care last year for his company increased 28 percent--in 1 year. That is simply unsustainable for America's businesses.

The Treasury Department issued a stern warning just last week: If we do nothing to tackle the skyrocketing cost of health care, nearly half of all Americans under the age of 65 will lose their health insurance in 10 years. Those are frightening numbers.

Right now, the average family's health insurance premium is $13,375. If Congress does not send our President a reform bill, premiums are expected to rise to a staggering $25,000 in 2016. Today, this average premium represents a little over a quarter of a family's income. But, by 2016, that average premium will represent almost half of a family's income. How are people going to able to afford to pay for mortgages and save for college tuition if they are paying half their monthly income for insurance premiums?

This past year, North Carolina's unemployment rate rose to 11 percent. Many of the thousands of North Carolinians who have lost their jobs in this recession have also lost their health care, and many more families are facing this frightening reality: One medical emergency could send them into bankruptcy.

In 2005, nearly half of all Americans who filed for bankruptcy cited major medical expenses as the reason for their financial decline. Between 2001 and 2008, the number of uninsured in North Carolina increased from 1.1 million to 1.4 million people. Without action, this number is going to continue to grow.

The Senate Health, Education, Labor, and Pensions Committee crafted a bill that ensures that people who like their insurance and their doctors keep them. It also expands access to health insurance for those without it, and slows down the skyrocketing cost of health care--the three critical components President Obama called for in his speech to Congress 2 weeks ago.

The President has been adamant that health care reform must not add one dime to our Federal deficit now or in the future, which has been a requirement of mine all along. The exploding cost of health care has put our Nation's economic security at risk. We simply cannot afford inaction any longer.

In 1960, health care spending was 4.7 percent of GDP. Today, it is 18 percent. On the current trajectory, by 2030, health care costs will account for 28 percent of GDP.

We need health care reform to get our deficit under control. We need a reform package that ensures a preexisting condition, such as diabetes or cancer, no longer prevents anyone from obtaining health insurance. We need health care reform to ensure America's families do not have to fear bankruptcy when a loved one gets sick.

Thank you, Mr. President.