Floor Statements

Mr. President, I am pleased to reintroduce a very important piece of legislation to accelerate job growth across America, the American Manufacturing Efficiency and Retraining Investment Collaboration Achievement Works Act, also known as the AMERICA Works Act. This bill is part of the solution to the Nation's economic and unemployment problem.

We all know that American families, as well as the manufacturing industry, have faced difficult times over the last few years. But the truth is that the manufacturing industry will always be a vital part of our Nation's economy.

The national unemployment rate has stabilized somewhat, but almost 14 million Americans remain out of work. We still have a long way to go. In my home

State of North Carolina, unemployment hovers at 9.7 percent, with several counties facing double-digit unemployment rates. Job creation is my number one priority and this legislation is an innovative way to get Americans back into the workforce.

The United States needs a strong technical workforce. The AMERICA Works Act would encourage national industries, such as biotechnology, construction, and machinery, to come together and agree on the skill sets they most value in prospective employees. Community colleges would participate, creating the appropriate curricula to meet those needs. Students who complete the programs would receive an industry-recognized credential. Workers who carry these industry-backed credentials would be able to market themselves in any area of the country. Businesses could count on the fact that workers with these credentials have the expertise and skills they are looking for.

The AMERICA Works Act would require certain Federal job training and career development education programs to give priority to programs that provide an industry-recognized and nationally portable credential. This credentialing system starts out with basic competencies that prepare individuals for the workplace. Once basic competencies are completed, individuals can work toward high performance technical competencies and then progress further to highly skilled technical and management competencies. The credentialing levels are stackable, allowing workers flexibility along their career tracks. Stackable credentials provide straightforward paths, with clear entry and exit points, for workers to advance their careers and attain high quality jobs.

In North Carolina, we have an advanced manufacturing skills program at Forsyth Technical Community College in Winston-Salem. Forsyth Tech is participating in the National Association of Manufacturers' Manufacturing Skills Certification System, which offers credit programs toward nationally recognized, stackable credentials. They have had hundreds of students enroll in their programs. Forsyth Tech has already collaborated with state and local businesses to begin the process of incorporating their credentials into job descriptions. They believe that introducing graduates with skill certifications into the local workforce will help improve the hiring process, and the nationally recognized credentials will improve employment opportunities.

When the President's Jobs Council met earlier this month in North Carolina, a leading topic of discussion, and something the President himself mentioned, is the need to improve job training for American industries so that our workers can be competitive in the global economy.

The AMERICA Works Act will help job seekers and employers keep America competitive in every industry, from textiles to aerospace, high-tech to biotech, and connect programs like those offered at Forsyth Tech with employers in the community, region, and across the United States.

As I mentioned before, job creation is my number one priority. I want to do everything I can to create jobs and make sure our workers have the skills necessary to help our businesses grow and thrive. By incentivizing industry-recognized, nationally portable, stackable credentials, we can ensure that America has the best businesses, with the best-trained workers leading the world.

I urge my colleagues to join me in supporting this important bill to expand employment opportunities for hardworking Americans.

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

Mr. President, I ask unanimous consent that the period for morning business be extended until 6 p.m., with Senators permitted to speak for up to 10 minutes each.

I suggest the absence of a quorum.

Mr. President, I, too, come to the floor in support of the amendment by Senator Tester and Senator Corker from Tennessee.

Let me tell you, I threw myself into these negotiations many weeks ago when I saw the great bipartisan work of my colleagues from Montana and from Tennessee. You just heard the Senator from Tennessee talking about this. They have worked tirelessly on this issue. They have shown great leadership in their willingness to modify their approach.

What we have now is a bipartisan, balanced compromise amendment that is going to address the concerns raised by the regulators, small debit card issuers, and many Senators, about the Federal Reserve's approach toward a regulated interchange fee market.

The amendment does not repeal the debit interchange amendment championed by Senator Durbin last year. As the Senator from Tennessee just said, it does not repeal that. In fact, a number of Senators who supported Senator Durbin's amendment, also support this

compromise amendment. It is moderate. It is bipartisan. It is balanced. It now gives the regulators the time and the tools they need to get this rule right.

This is the type of commonsense compromise that Senators on both sides of the aisle can support. This bipartisan, balanced approach is how the Senate should operate.

When the Senate added section 1075 to the Dodd-Frank Act last year, it required that interchange transactions fees charged by issuers be reasonable and proportional.

Importantly, the amendment also exempted banks with fewer than $10 billion in assets. During the rule writing process, this exemption has been characterized as ineffective.

In February, during testimony before the Senate Banking Committee, Federal Reserve Chairman Bernanke, the person ultimately responsible for writing these rules said that, ``it is possible that that exemption will not be effective in the marketplace'' and that ``it is possible that, in practice, community banks would not be exempt from the lower interchange fee.' ''

FDIC Chairwoman Bair and the Conference of State Bank Supervisors echoed those concerns.

These are the people responsible for monitoring the safety and soundness of our community banks and credit unions and they have expressed serious doubts about the practical effectiveness of the small issuer exemption.

This is extremely concerning to me, a Senator from North Carolina, which has a strong presence of community banks and credit unions that serve my constituents across the State.

This legislation helps get the small issuer exemption right. It provides two levels of protection for small banks and credit unions.

First, it considers the impact on small issuers up front as part of a short 6-month study.

It directs the banking and credit union regulators to carefully review the effectiveness of the small issuer exemption, which will be going to the community banks and credit unions.

And it directs the regulators to look at the exemption from a safety and soundness perspective. This is of particular importance at a time when community banks around the country are struggling to provide credit to Main Street businesses.

Then, once the final rules are in place, it would require a review of the effect of the rule on the market.

This approach gives regulators the time to look at small banks and credit unions up front and an opportunity to point out any problems that may occur in the future.

This is a sensible, balanced approach. It is a bipartisan approach. It is one that I would urge my colleagues to support.

I yield the floor.

Mr. President, it is with great pride that I recognize the dedication of the North Carolina Veterans Park. This park will give visitors the opportunity to reflect on the sacrifices made by the courageous women and men of our armed services. The park and its beautiful visitor center, walking paths, and public art honor the lives and service of North Carolina veterans. As a Senator from North Carolina and a member of the Armed Services Committee, I am committed to ensuring our veterans receive the respect they deserve.

Mr. President, I ask unanimous consent to have printed in the Record a resolution that was passed unanimously by the North Carolina House and North Carolina Senate. The resolution honors the dedication of the North Carolina Veterans Park in Fayetteville, NC.

Mr. President, I rise again today to urge my colleagues on both sides of the aisle and on both sides of the Capitol to move beyond the unnecessary and distracting partisan bickering and come together to fund our government through the remainder of the current fiscal year, including our military, our early-childhood programs, and our essential health services for our seniors and children.

Six months into the 2011 fiscal year and less than 12 hours before a government shutdown would close off many of the important services to millions of Americans, Congress has yet to fulfill its most basic responsibility and pass a budget.

I know the people of North Carolina or any State did not send us to Washington to point fingers or blame other people for the challenges our country faces. They sent us here to work with our colleagues on commonsense solutions. During my time as budget cochair in the North Carolina State Senate, I learned two things: First, it is never easy to craft a budget, there are always tough choices to make; and second, our fiscal challenges can only be met if Republicans and Democrats have that commitment to work together.

Despite the impression the American people may have based on what they have seen in recent weeks, I know we can work this out. We have to work together because after we come to an agreement on this year's budget, we must buckle down and chart out a comprehensive bipartisan path to rein in our nearly $14 trillion national debt.

I believe we all share the common goal of reducing this year's deficit, but the national debt will not disappear with one bill or in 1 year alone. It will take a comprehensive and long-term approach that moves beyond a singular focus on domestic discretionary spending.

That is why I remain concerned by some of the cuts passed by the House and especially by the dozens of divisive policy riders that are disrupting our ability to chart a pragmatic and responsible fiscal course for our country.

It is why I remain concerned that we are holding up government funding with threats to take away vital health care to millions of American women who could not otherwise afford it. These health services include Pap tests, breast cancer screenings, birth control, and STD testing and treatment. These services, which are funded through title X, were signed into law by President Nixon and supported by George H.W. Bush. According to independent, nonpartisan studies, every $1 spent on these family planning services saves $4. Is that not what we are supposed to be working on--reducing the amount of our government spending?

These proposals are the only things standing between a reasonable, bipartisan compromise and an irresponsible government shutdown. If such a shutdown does occur, we risk delivering a crippling blow now to our already fragile economic recovery.

More than 1,000 American small business owners, who were already facing difficulties securing the borrowing they need to expand and add jobs, could see their SBA-backed loans delayed.

We have 368 national parks in our country. Millions of dollars will be lost to the businesses surrounding those parks if we shut down the government. In April of 2010 alone, in North Carolina, more than 1.3 million people visited the national parks and spent millions of dollars. These parks include the Great Smoky Mountains, the Blue Ridge Parkway, and Cape Hatteras National Seashore and others. Tourism in North Carolina is one of our State's largest industries. In 2010, tourists spent $17 billion across our State, and the tourism industry supports 185,000 jobs for North Carolinians. More than 40,000 businesses in North Carolina provide direct services to travelers. If we close our national parks, these small businesses are at risk of losing customers, losing money, which will make it much more difficult for my State to recover from this tough economy.

We risk putting even more pressure on our already shaky mortgage market by preventing thousands of homeowners from receiving a loan to buy a new house.

As for North Carolina, I am particularly alarmed about the impact a government shutdown would have on our courageous military personnel and

their families who have dedicated their lives to this country. Two weeks ago marines from North Carolina rescued with amazing speed and skill the American F-15 pilot who went down east of Benghazi in Libya. Last week, I spoke with Marine Corps Commandant General Amos on the amazing work of these North Carolina marines. He told me it took only 90 minutes from start to finish to rescue the F-15 pilot.

These warriors are heroes, as are the 120,000 active-duty troops in North Carolina and the approximately 400,000 American troops who are deployed overseas, including 90,000 troops in Afghanistan and 45,000 troops in Iraq. These heroes and their families do not deserve to have partisan bickering jeopardize their financial stability.

More than a third of the people in my State are either in the military, a veteran, or have an immediate family member who is in the military or a veteran. So if the government shuts down and we delay paychecks to our military personnel, it is not just our courageous service men and women whose lives are affected but those of their spouses and their children. I know nobody in this body wants to see that happen. Whether you represent a State with a large military population or not, we are all incredibly grateful for the sacrifices our military personnel and their families give this country every day.

Earlier this week, I cosponsored the bipartisan Ensuring Pay for Our Military, sponsored by my Republican colleague from Texas, Senator Hutchison, which would prevent an interruption in the pay for members of the military if there is a government shutdown. This is an important bill--a must-do bill--but I sincerely hope it is an unnecessary bill.

The American people want Members of Congress to work across party lines, avoid an irresponsible government shutdown, and move forward on a sound, comprehensive, and bipartisan plan to put our fiscal house in order. The American people don't care if it is a Republican plan or a Democratic plan, they just want it to be a good plan for our country. That is why this week I signed on to the biennial budgeting bill which is being led by my Republican colleague, Senator Isakson, and my Democratic colleague, Senator Shaheen. This bill, which will move the Federal budget from an every year to every two-year funding process, is a commonsense, bipartisan approach which will hopefully improve the partisan political bickering.

I urge my colleagues to come together now and fund our service men and women, our VA doctors, our Head Start Programs, and our women's health care so we can move on to the Nation's No. 1 priority, which is tackling our unsustainable national debt.

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

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

Mr. President, I rise today to urge my colleagues on both sides of the aisle to join together to prevent an irresponsible government shutdown.

The American people did not elect us to shut down the government.

Democrats and Republicans in both the House and the Senate must tighten the Federal Government's belt, just like Americans are doing every day at their kitchen tables.

As we all know, our escalating national debt is our country's most pressing problem. Our country's current fiscal course is simply unsustainable.

In just the last 10 years, our Federal debt has risen from roughly a third of our gross domestic product to nearly two-thirds of GDP in 2010.

Based on the nonpartisan Congressional Budget Office estimates, without proactive action by Congress, that percentage will continue to increase over the next 10 years, with public debt expected to reach 90 percent of GDP in 2020.

Meanwhile, nearly half of our current debt is owned by China and other foreign creditors.

It is time for Congress to work together to chart a new bipartisan course that puts our fiscal house in order.

Before coming to the United States Senate I served for 10 years as a State senator in the North Carolina General Assembly.

I served as the cochair of the Budget Committee, and I can tell you that crafting a budget is never easy. There are always difficult choices, and both sides have to make sacrifices.

As a Budget cochair, I worked for 5 consecutive years to ensure that North Carolina's budget was balanced, that we still made critical investments in our communities while eliminating unnecessary spending.

It takes cooperation across party lines to meet fiscal challenges and to ensure government is both leaner and more effective.

We need bipartisan cooperation this week to prevent a Federal Government shutdown, which is an irresponsible outcome.

Keeping the government functioning for the American people is Congress's core responsibility.

We must come together to cut spending and support critical priorities, such as education, that strengthen our economy and support economic development in North Carolina communities and in communities across America.

And while I believe we all share the common goal of reducing our Nation's deficit, we should remember that our most troubling economic challenges cannot be solved in 1 year alone.

That is why I am concerned by some of the cuts passed by the House.

The House proposal would result in the loss of some 21,000 North Carolina jobs and decimate important education priorities, like Headstart and investments in historically Black colleges and universities.

Nearly one in five African Americans who earn an undergraduate degree has a diploma from a historically Black college or university. North Carolina has 10 4-year HBCUs, more than any other state in the country.

Funding through the Department of Education allows these institutions to strengthen programs and provide critical services for students who are often among the first in their families to attend college.

The House would cut funding for HBCUs by nearly a quarter below last year's level, a cut that would have a disastrous impact on these institutions and their students, while not even scratching the surface of our current deficit.

In addition, by insisting on dozens of divisive policy riders, House Republicans are disrupting our ability to chart a pragmatic and responsible fiscal course for the country. We cannot take our eyes off the ball.

The President's bipartisan fiscal commission, cochaired by North Carolina's own Erskine Bowles and former Senator Alan Simpson, made important progress in beginning to diagnose and attack the root causes of our Nation's fiscal crisis.

The bipartisan work of the fiscal commission is evidence that common ground is possible.

Reducing spending will absolutely be a part of any comprehensive solution, but we must begin to have a broader discussion to create meaningful deficit reduction.

For that reason, I am supporting S. 211, the Biennial Budgeting and Appropriations Act, which was introduced by my colleagues Senator Isakson and Senator Shaheen.

This bill would take the Washington-as-usual politics out of the budgeting process.

The bill changes the budget process from the current, annual spending debate to a 2-year, deliberative process that allows us to work together on commonsense cuts coupled with sensible investments, similar to what North Carolina, which balances its budget every year, already does.

Right now, Congress rarely passes the 12 government funding bills by the end of the fiscal year, and this year we have been operating on short-term fix after short-term fix. A biennial budgeting process is part of the long-term solution we need to remove partisanship from the budget. The status quo is unacceptable.

I hope we can continue to work across party lines, this week and moving forward, on a bipartisan, comprehensive plan for the Nation's budget that tackles, head on, our mounting debt.

I suggest the absence of a quorum.

Mr. President, I also rise to speak for women and children across this country but especially in North Carolina.

Prenatal and postnatal maternal care translates into healthy moms and healthy families.

Children who receive regular well-child visits to their doctors and recommended immunizations live healthier lives. They can go to school and just be kids.

But the House-passed continuing resolution for the remainder of fiscal year 2011 makes draconian cuts to community health centers and the title V maternal child health block grant--two programs that are vital in reducing maternal and child mortality.

If these cuts go through, nearly 4 and a half million women and children under age 6 are at risk of losing care.

Consider that community health centers account for 17.2 percent of all low-income births, but prenatal patients at health centers are less likely to give birth to low birth weight babies compared to their counterparts nationally. It is because they are getting good prenatal care.

Moreover, rates of vaccination among children receiving regular care at a health center are uniformly higher than those of children with another source of care.

With the House-proposed cuts, pregnant women and children, who rely on community health centers for care, will be left with literally nowhere to turn for health care.

By slashing $50 million in funding from the maternal child health block grant program, the House bill would dramatically curtail services to the 35 million women and children across this country, including the nearly half a million women and children in North Carolina who receive such services as newborn hearing screenings and postnatal care.

In North Carolina, infants born to minorities are twice as likely to die as those born to Caucasians. However, the Healthy Beginnings Program is working to reverse infant mortality and low birth weights among minorities in North Carolina.

Healthy Beginnings provides case management, general health education, and other support for at-risk women throughout their pregnancy and until their child turns two. In 3 years, this initiative reduced infant mortality by 60 percent in participating communities.

Also, early detection of permanent hearing loss is essential for children to progress at age-appropriate rates.

Research shows that by the time a child with hearing loss graduates from high school, more than $400,000 per child can be saved in special education costs if the child is identified early and given appropriate educational, medical, and audiological services.

The North Carolina Early Hearing Detection and Intervention, EHDI, Program was established in 1999 as part of the State's title V Maternal and Child Health Program.

Since the establishment of the EHDI Program, there has been a remarkable increase in the percentage of infants screened in the State. All neonatal facilities in North Carolina offer initial newborn hearing screening prior to infant discharge.

In 2009, 96 percent of infants completed newborn hearing screening-- about 100,000; 450 children receive hearing aids or cochlear implants annually through a contract funded by the maternal and child health block grant.

I heard from three families in North Carolina--all whose children failed the screening tests. Their stories were heartwrenching as they described their hours-old babies not being able to hear their parents' first words to them.

But in all three families, the hearing loss was detected as part of the newborn screening, and the North Carolina EHDI program immediately provided them with followup and hearing aids or cochlear implants. As a result of these programs, in each of these families, the child is ahead of their peers verbally.

These are just two critical programs that are funded by the title V maternal and child health block grant. As we can see, these are not just statistics but real women and kids and families who benefit from this important program.

I strongly believe we have to work together to get our country back on solid fiscal ground. I am very much concerned about it and want to work on it. But the path we are on is obviously unsustainable. In fact, I was one of the Senators who advocated for the creation of the Bowles- Simpson fiscal commission. But our fiscal challenges require a thoughtful bipartisan solution that gets us on the right track and encourages economic growth. These cuts are simply counterproductive. We cannot balance the budget on the backs of our Nation's future--our children.

Mr. President, I yield the floor.

Mr. President, I rise today to urge the Senate to quickly pass a long-term extension of the Trade Adjustment Assistance, TAA, program for workers, as well as the Andean Trade Preference program. These programs make our workforce more competitive in the global marketplace and support jobs in North Carolina.

Both are critical Federal programs to North Carolina, and both expired this past Saturday.

North Carolina's workforce has been particularly hard hit as manufacturing has suffered, factories have closed, and companies have moved operations overseas.

The TAA program for workers offers benefits, including job retraining, to workers displaced by imports or a shift of production to other countries. Once a laid-off worker has exhausted State unemployment benefits, he or she can qualify to receive supplemental benefits under TAA.

These include weekly cash payments equal to unemployment benefits. To qualify, the worker must be involved in job retraining.

TAA payments can last for 52 weeks if a worker is in job training and 26 weeks more if a worker needs remedial education.

Many North Carolinians who have lost their jobs through no fault of their own have turned to our network of affordable community colleges to retool their skills.

Yesterday, I met with trustees for the North Carolina Community College System, which is among the best in the Nation.

These leaders told me how valuable it is for these laid-off workers to get a community college education and gain the necessary skills to be competitive in today's job market.

I agree wholeheartedly. Since coming to the Senate I have advocated to expand and enhance the TAA program for workers. In the American Recovery and Reinvestment Act, we significantly enhanced TAA programs by expanding eligibility and increasing the training funds available to States by 160 percent, or $575 million per fiscal year.

Earlier this month, I was among a group of Senators who sent a letter to leaders in the House of Representatives asking that they quickly introduce and pass a long-term extension of TAA, which is something they did in a bipartisan way last December.

Since Congress expanded this crucial program, over 17,000 North Carolinians have been certified for assistance under TAA.

Last year, displaced workers in North Carolina received over $56 million through TAA--the second largest amount given to a single State to help workers develop new skills and find new jobs.

Though we are making progress in turning around our economy, that doesn't mean much if you are one of the 430,000 North Carolinians still out of work.

One North Carolinian, Wayne Kizewski, is 42 years old and 2 years ago lost his job at a Cary company that molded plastic parts for Chrysler. Wayne used the TAA program to go back to school at Wake Technical Community College to study information systems.

Wayne was also able to receive help from the TAA program to pay for 80 percent of his health insurance premiums, including coverage for his 5-year-old son.

I hear from business owners all the time who tell me that workers in North Carolina have a work ethic that is second to none. When these men and women lose their jobs through no fault of their own they are determined to continue providing for their families, and this program allows them to go back to school and retool their skills for the 21st- century economy.

With our State's excellent community colleges, we can get our workforce prepared to lead the way in emerging industries.

The TAA program for workers is essential to maintaining our Nation's global competitiveness and supporting workers in North Carolina and across the country.

I would also like to address the Andean Trade Preference program.

I know my colleagues from Arizona and Ohio were on the floor earlier discussing both TAA and the Andean Trade Preference program.

I know that extending this program is important to my friends on the other side of the aisle. It is important to me too as this program has an impact on jobs in North Carolina.

For example, one of the products eligible for preferential treatment under this agreement is apparel made of U.S. combed-cotton yarn, much of which is made by workers in North Carolina.

In fact, one North Carolina company, Parkdale Mills, exports 1 million pounds of cotton yarn annually that is valued at $2 million.

These exports support more than 100 jobs in North Carolina.

Earlier this week I received a letter from the CEO of Parkdale Mills. He wrote, ``a lapse of duty free benefits, even if a short period of time, is catastrophic to our business.''

Over the last 4 years, the Andean program has been extended or renewed three different times, often at the last minute.

American firms doing business in the Andean region do not know from year to year whether they will pay duties or not. That is no way to run a business.

So I agree with my colleague, the senior Senator for Arizona, that a long-term extension of this program is important.

I believe we should be able to extend both of these programs, TAA and ATPA, together. I know that my colleague from Pennsylvania, Senator Casey, made a number of unanimous consent requests last week to do just that. The bill that Senator Brown asked consent to pass earlier would provide an 18 month extension of both programs.

Mr. President, these programs have bipartisan support. Workers and businesses need the certainty and support they provide. We should extend them as soon as possible.

Mr. President, today, I am proud to reintroduce the Medication Therapy Management, MTM, Empowerment Act of 2011, with my colleagues from Minnesota, Senator Franken, from Ohio, Senator Brown, and from South Dakota, Senator Johnson.

A recent analysis conducted by the New England Healthcare Institute estimates that the overall cost of medication nonadherence is as much as $290 billion per year. According to a recent article published in the New England Journal of Medicine, over $100 billion is spent annually on avoidable hospitalizations because patients do not take their medications correctly.

Not only does nonadherence cost our system billions of dollars, nonadherence to medication regimens also affects the quality of life for seniors and may lead to early death. The elderly typically take many more prescription medicines than the general population and therefore are at greater risk for problems associated with improper use of medications. For example, the same New England Journal of Medicine article I just referenced found that better adherence to antihypertensive treatment alone could prevent 89,000 premature deaths in the U.S. annually.

With as much as one half of all patients in the U.S. not following their doctors' orders regarding their medications, medication therapy management could help reduce some of the wasted health care costs in our system.

North Carolina has implemented some very successful MTM programs.

The Asheville Project, which focuses on diabetes, asthma, and cardiovascular disease, has seen improved

health outcomes and significant savings among city employees since it began in 1997. For example, in the Asheville Project's diabetes MTM Project, they have seen a decrease in medical costs of between $1,622 to $3,356 per patient per year; a decrease in insurance claims of $2,704 per patient in year one and a $6,502 decrease in year five; a 50 percent decrease in use of sick days; and increased productivity gains estimated at $18,000 annually.

In 2007, the North Carolina Health and Wellness Trust Fund Commission launched an innovative statewide program, Checkmeds NC, to provide MTM services to North Carolina seniors. During the program's first year, more than 15,000 North Carolina seniors and 285 pharmacists participated. A total of 31,000 seniors have participated since 2007. The seniors bring all of their prescriptions, over-the-counter medicines, 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. The program has saved an estimated $34 million to date, and countless health problems have been avoided.

During consideration of health care reform, I was pleased to have successfully secured language in the bill that built off these North Carolina models and implemented MTM nationally for seniors suffering from two or more chronic conditions.

The bill I am reintroducing today takes MTM one step further. Specifically, this bill would expand MTM eligibility to seniors with any chronic condition that accounts for high spending in our health care system, such as heart failure and diabetes. Currently, only 12.9 percent of Part D beneficiaries are eligible under the MTM criteria for multiple chronic conditions. However, of those, more than 85 percent have chosen to participate in the benefit. Clearly this program is very popular and widely utilized by those who are already eligible. By expanding eligibility to more seniors, MTM will certainly result in Medicare savings.

The bill also ensures access to MTM for seniors at a pharmacy or with a qualified health care provider of their choice.

To ensure pharmacists and health care providers are able to provide MTM to seniors, this bill requires that they are appropriately reimbursed for their time and service. This provision will permit pharmacies and other health care providers to spend considerable time and resources evaluating a person's drug routine and educating them on proper usage--all critical components of a successful MTM program.

Finally, this bill would establish standards for data collection to evaluate and improve the Part D MTM benefit.

The value of MTM is widely known and discussed. I am proud that North Carolina is a leader in this arena. Expansion of MTM to more seniors will no doubt improve their overall health, while at the same time reducing waste in our health care system.

I urge my collegues to support this bill.

Mr. President, today, I am proud to reintroduce the Medication Therapy Management, MTM, Empowerment Act of 2011, with my colleagues from Minnesota, Senator Franken, from Ohio, Senator Brown, and from South Dakota, Senator Johnson.

A recent analysis conducted by the New England Healthcare Institute estimates that the overall cost of medication nonadherence is as much as $290 billion per year. According to a recent article published in the New England Journal of Medicine, over $100 billion is spent annually on avoidable hospitalizations because patients do not take their medications correctly.

Not only does nonadherence cost our system billions of dollars, nonadherence to medication regimens also affects the quality of life for seniors and may lead to early death. The elderly typically take many more prescription medicines than the general population and therefore are at greater risk for problems associated with improper use of medications. For example, the same New England Journal of Medicine article I just referenced found that better adherence to antihypertensive treatment alone could prevent 89,000 premature deaths in the U.S. annually.

With as much as one half of all patients in the U.S. not following their doctors' orders regarding their medications, medication therapy management could help reduce some of the wasted health care costs in our system.

North Carolina has implemented some very successful MTM programs.

The Asheville Project, which focuses on diabetes, asthma, and cardiovascular disease, has seen improved

health outcomes and significant savings among city employees since it began in 1997. For example, in the Asheville Project's diabetes MTM Project, they have seen a decrease in medical costs of between $1,622 to $3,356 per patient per year; a decrease in insurance claims of $2,704 per patient in year one and a $6,502 decrease in year five; a 50 percent decrease in use of sick days; and increased productivity gains estimated at $18,000 annually.

In 2007, the North Carolina Health and Wellness Trust Fund Commission launched an innovative statewide program, Checkmeds NC, to provide MTM services to North Carolina seniors. During the program's first year, more than 15,000 North Carolina seniors and 285 pharmacists participated. A total of 31,000 seniors have participated since 2007. The seniors bring all of their prescriptions, over-the-counter medicines, 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. The program has saved an estimated $34 million to date, and countless health problems have been avoided.

During consideration of health care reform, I was pleased to have successfully secured language in the bill that built off these North Carolina models and implemented MTM nationally for seniors suffering from two or more chronic conditions.

The bill I am reintroducing today takes MTM one step further. Specifically, this bill would expand MTM eligibility to seniors with any chronic condition that accounts for high spending in our health care system, such as heart failure and diabetes. Currently, only 12.9 percent of Part D beneficiaries are eligible under the MTM criteria for multiple chronic conditions. However, of those, more than 85 percent have chosen to participate in the benefit. Clearly this program is very popular and widely utilized by those who are already eligible. By expanding eligibility to more seniors, MTM will certainly result in Medicare savings.

The bill also ensures access to MTM for seniors at a pharmacy or with a qualified health care provider of their choice.

To ensure pharmacists and health care providers are able to provide MTM to seniors, this bill requires that they are appropriately reimbursed for their time and service. This provision will permit pharmacies and other health care providers to spend considerable time and resources evaluating a person's drug routine and educating them on proper usage--all critical components of a successful MTM program.

Finally, this bill would establish standards for data collection to evaluate and improve the Part D MTM benefit.

The value of MTM is widely known and discussed. I am proud that North Carolina is a leader in this arena. Expansion of MTM to more seniors will no doubt improve their overall health, while at the same time reducing waste in our health care system.

I urge my collegues to support this bill.

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

Mr. President, I am honored to join my colleagues in honoring my mentor and dear friend, Senator Barbara Mikulski, on becoming the longest serving woman in the history of the Senate. For more than 24 trailblazing years, Senator Mikulski has been one of the Senate's fiercest advocates for women, families, and for the people of Maryland who have now elected her to the Senate for five consecutive terms. Before she arrived in Washington in 1977 as the Representative from the Third District of Maryland, Senator Mikulski already had a distinguished career in public service, working in Baltimore as a social worker, then a community activist, and as a city council member. When she was first sworn in as a Member of the House of Representatives, she was one of just 18 female Members. When she entered the Senate 10 years later as the first Democratic woman Senator elected in her own right, she was one of just two women in this upper Chamber. But while those numbers have intimidated most, they only motivated and emboldened Senator Mikulski. She soon impressed her colleagues, as she continues to do today, with her work ethic, determination, keen understanding of issues, humor, and her commitment to her constituents.

She has broken many barriers in her career. She was the first woman ever elected statewide in Maryland, the first to chair an appropriations subcommittee, and the first woman to serve in the Democratic leadership. If we are no longer surprised today when we see women in power in Washington, it is only because we had pioneers such as Barbara Mikulski. As she recently told CNN: ``I might be the first, but I don't want to be the last.''

There are now 17 women serving in the Senate, and Senator Mikulski, the dean of the women, is our leader and our champion. I was both humbled and honored to have her escort me when I was sworn in as a Senator 2 years ago. That was just the beginning of her ongoing mentorship. Although the Senate can often be bogged down by partisanship, I appreciate that Senator Mikulski encourages and creates an environment of teamwork, respect, and friendship. But while we today mark her place in history as a woman Senator, she is widely regarded as one of the most respected, accomplished, and effective public servants in all of Congress. To use Senator Mikulski's own words, she showed it is not about gender, it is about agenda.

She is one of the Senate's strongest advocates for science and technology and the importance of investing in innovation to spur our economy. In fact, earlier this year, I was watching a 3D movie about the Hubble telescope at the Smithsonian with my daughter, a scientist, and there was Senator Mikulski featured in the movie for her role in preserving the telescope's budget, a feat she calls one of her proudest accomplishments.

She also wrote the Spousal Anti-Impoverishment Act, which protects seniors across our country from going bankrupt while paying for a spouse's nursing home care.

She shepherded through the Lilly Ledbetter Act, which helps to ensure that no matter your gender, your race, your national origin, religion, age, or disability, you will receive equal pay for equal work.

She fought tenaciously for her important amendment to health care reform legislation ensuring that a comprehensive list of women's preventive services, such as screenings for breast and cervical cancer, would be covered with no added out-of-pocket expenses.

I thank Senator Mikulski for her mentorship, her leadership, and her fierce belief in the empowerment of women in our communities and in public office. I congratulate her on this tremendous accomplishment, and I join my colleagues in looking forward to many more years of her distinguished service.

Mr. President, last weekend the Nation lost Dr. Helen Maynor Scheirbeck--a great civil rights leader and a passionate advocate for American Indian rights.

Born in Lumberton, NC, as a proud member of the Lumbee Tribe, Dr. Scheirbeck's passing is a true loss for the Lumbee and the greater American Indian community. A champion for American Indian sovereignty, Dr. Scheirbeck worked constantly throughout her incredibly prolific career to enable future generations of Indian leaders to build healthier and better-educated communities.

In her early work on Capitol Hill, Dr. Scheirbeck served on the staff of North Carolina Senator Sam Ervin, then chair of Senate Subcommittee on Constitutional Rights. This work helped lay the foundation for the historic 1968 Indian Bill of Rights that extended constitutional rights and protections to American Indians nationwide. Similarly, Dr. Scheirbeck's efforts to organize the 1962 Capitol Conference on Poverty helped to ensure that Indian communities were a focus of the nationwide war on poverty.

Her commitment to self-determination and individual responsibility is further exemplified by Dr. Scheirbeck's work to empower tribal leaders to govern and educate their communities. Working on behalf of the Carter administration, Dr. Scheirbeck's leadership was instrumental in realigning Federal policies to support Indian sovereignty. Most notably, her efforts helped to ensure the passage of the Indian Education Act of 1975 and the Tribally Controlled Community College Assistance Act of 1978, which have enabled Indian leaders to provide better educational opportunities for current and future generations.

Working throughout her life to provide a forum for Indian leaders in our Nation's Capital, Dr. Scheirbeck was instrumental in establishing the National Museum of the American Indian. As Assistant Director in the early years of the museum, Dr. Scheirbeck guided the Office of Education and its program in cultural arts. In so doing, she sought to bring the experience of the American Indian to the National Mall and to demonstrate the applicability of Indian education models to educators throughout the world.

Finally, much of Dr. Scheirbeck's life was devoted to the cause of recognition for the Lumbee Tribe of North Carolina. Her life's work helped reverse the Federal Government's efforts to terminate relationships with American Indian tribes. Sadly, though, Dr. Scheirbeck's own Lumbee Tribe still bears the burden of this unfortunate policy, and she fought throughout her life to provide the Lumbee with the full recognition that they so deserve. While Dr. Scheirbeck did not live to see this dream become a reality, her life and work have helped to sustain the drive for Lumbee recognition for decades.

Dr. Helen Maynor Scheirbeck's presence and contributions throughout Indian Country are irreplaceable, and her tireless efforts on behalf of American Indians throughout the country will continue to inspire future Indian leaders for generations to come.

Mr. President, today I rise in support of Senate ratification of the New Strategic Arms Reduction Treaty. The Secretary of State, Secretary of Defense, Secretary of Energy, and the entire uniformed leadership of our military believe it is in our national interest. Former Secretaries of State from previous administrations of both political parties have also endorsed the New START Treaty.

Relations between the United States and Russia have evolved beyond what they were during the Cold War. Within this context, and in the face of aging nuclear stockpiles, strategic arms reduction is in the best interest of both nations.

New START will strengthen strategic nuclear weapons stability, enable us to modernize our nuclear triad of strategic weapons and delivery systems, and ensure our flexibility to develop and deploy effective missile defenses and conventional global strike capabilities.

It will also promote stability, transparency, and predictability in the U.S.-Russia relationship.

The treaty limits strategic offensive nuclear weapons and delivery vehicles through effective verification and compliance measures. Our negotiators ensured that the United States would be able to protect our ability to field a flexible and effective strategic nuclear triad composed of land-based intercontinental ballistic missiles, submarine- launched ballistic missiles, and nuclear-capable heavy and strategic bombers. Our negotiators also ensured that the United States can enable modernization of our strategic delivery systems and the nuclear weapons they carry.

Simply put, our country is better off with New START as opposed to not having a treaty at all. There has been no formal verification system in place since the last treaty expired a year ago. New START reestablishes a strategic nuclear arms control verification regime that provides access to Russian strategic nuclear capabilities-- specifically, nuclear warheads and delivery systems. It ensures a measure of predictability in Russian strategic force deployments over the life of the treaty. Access and predictability allow us to effectively plan and undergo strategic modernization efforts.

Failure to ratify the treaty will prevent us from obtaining information on Russian strategic nuclear weapons capabilities. Without the treaty going into effect, the United States will have no inspectors on the ground and no ability to verify Russian nuclear activities. This will result in our country losing insight into Russian strategic nuclear force deployments. It would also complicate our strategic force strategy and modernization planning efforts, as well as drive up costs in response to the need to conduct increased intelligence and analysis on Russian strategic force capabilities.

Secretary of State Hillary Clinton, Secretary of Defense Robert Gates, Secretary of Energy Steven Chu, and Chairman of the Joint Chiefs of Staff ADM Mike Mullen have expressed their support for Senate ratification of New START. All indicated that ratifying the treaty provides our country with an opportunity to negotiate with Russia on tactical nuclear weapons, of which Russia holds a sizable advantage. Tactical nuclear weapons are the most vulnerable to theft and the most likely to end up in the hands of rogue states and terrorist organizations. It is important to understand that we will not be able to obtain Russian cooperation on tactical nuclear weapons without ratifying New START.

The treaty will not affect our ability to improve our missile defenses either qualitatively or quantitatively, to defend our homeland against missile attacks, and to protect our deployed forces, allies, and partners from growing regional missile threats. Secretary of State Clinton and Secretary of Defense Gates have testified that our phased adaptive approach to overseas missile defense is not constrained by the treaty.

Senate ratification of New START will demonstrate that the United States is committed to reducing nuclear weapons, which is important as we advance our nonproliferation goals. This will assist us in obtaining international consensus regarding nuclear weapons proliferation challenges from rogue states, such as Iran and North Korea. It will also send a positive message in achieving consensus with other countries on nuclear issues.

It is important to keep in mind that the United States and Russia hold over 95 percent of the world's nuclear weapons. If the two nations that possess the most nuclear weapons agree on verification and compliance and are committed to nonproliferation, it will improve our ability to achieve consensus with other countries.

Failure to ratify the treaty will have a detrimental effect on our ability to influence other nations with regard to nonproliferation of weapons of mass destruction. It will also send conflicting messages about the administration's emphasis and commitment to the nonproliferation treaty.

Additionally, failure to ratify New START would send a negative signal to Russia that may cause them to not support our objectives with respect to dealing with the Iranian nuclear program. As Secretary of Defense Gates has said, without ratification, we put at risk the coalition and momentum we have built to pressure Iran.

The debate over New START has facilitated a consensus to modernize our nuclear deterrent. The Administrator of the National Nuclear Security Administration, Mr. Thomas D'Agostino, indicated that for the first time since the end of the Cold War, there is broad national consensus on the role nuclear weapons play in our defense and the requirements to maintain our nuclear deterrent. The NNSA and the three National Laboratories support Senate ratification of New START and congressional approval of the President's budget to invest in nuclear security and modernization. Our nuclear enterprise and stockpile have been neglected for too long.

Consistent with recommendations in the Nuclear Posture Review, we need to move forward with a number of nuclear enterprise sustainment projects, including strengthening our nuclear command and control structure, continuing development and deployment of our triad of delivery systems, maintaining a safe, secure, and effective stockpile, and revitalizing our aging infrastructure.

On December 1, the Directors of the three nuclear national laboratories signed a letter to the Senate emphasizing that they were very pleased with the administration's plan to spend $85 billion over the next decade to upgrade the nuclear weapons complex. They believe the requested amount will further a balanced program that sustains the science, technology, and engineering base. They also believe that the proposed budget will support the ability to sustain the safety, security, reliability, and effectiveness of our nuclear deterrent within the limit of 1,550 deployed strategic warheads established by New START.

The Nuclear Posture Review also recognizes the importance of supporting a highly capable workforce with specialized skills to sustain the nuclear deterrent. It emphasizes three key elements of stockpile stewardship: hands-on work on the stockpile; the science, technology, and engineering base; and the infrastructure at the laboratories and plants.

I share the concerns expressed by Secretary Chu regarding our ability to recruit the best and brightest nuclear scientists and engineers. We need to infuse a sense of importance and financial stability to the stockpile stewardship and life extension programs. Nuclear scientists and engineers need to believe the U.S. Government cares about nuclear life extension. An effective science, technology, and engineering human capital base is needed to conduct effective nuclear weapons system lifetime extension programs, increase nuclear weapons reliability, certify nuclear weapons without the need to undergo nuclear testing, and provide annual stockpile assessments through weapons surveillance.

I hope my colleagues on both sides of the aisle will join me in voting to ratify New START.

I yield the floor.