Floor Statements

Mr. President, I rise today to once again join my colleagues in addressing the need for comprehensive health care reform. The Senator from New Hampshire, Mrs. Shaheen, earlier spoke on health care reform and its effect on small business. I know my colleague, Senator Udall from Colorado, is going to be speaking soon. And I know we are going to be joined, as well, a little bit later by Senator Landrieu, who takes a leadership role on the issues affecting small businesses, as chair of the Small Business Committee. I rise today to stress how important health care reform is to the small business community. Currently, there are small businesses across America that have been hit very hard by the effects of the recession. Small businesses are struggling as they try to keep their doors open, with the enormous constriction of credit that is taking place. Small businesses are struggling to have the finances to expand; even healthy small businesses, as we have seen. Banks continue to draw back in capital and try to build up their own balance sheets. The people who have taken the hardest hit by the restriction on capital and the restriction on lending have been small businesses across this country.

So we have the enormous challenges small businesses have felt by the recession that has been exacerbated by the constriction of lending, and then we add on top of that the enormous challenges that small businesses face in the health care market. The only people who pay retail--who pay full price for their health care benefits in America today--are small businesses and those who purchase health care on the individual-based market. There is no group that will more benefit, or have more to gain from meaningful health care reform, than small businesses.

Small businesses currently lack the bargaining power of large firms and pay as much as 18 percent more for the same health insurance as larger companies. If you work in a large company you get the benefit of the larger pool, and you are better able to bargain for your health insurance rates. If you are poor and cannot afford health insurance, you get access to Medicaid. If you are a senior, you get access to Medicare. Small businesses are the group that falls through the cracks. They don't have access to this purchasing power, and consequently pay, on average, about 18 percent more for health insurance than larger companies.

As health insurance costs continue to rise, more and more small businesses can no longer even afford to offer health insurance to their employees. And if they do, their employees can't afford the co-payments to purchase health insurance. In fact, nearly one-quarter of the uninsured in our country works for small businesses. Between 2000 and 2009, the percentage of firms with less than 10 employees--the heart of small businesses--offering insurance coverage fell from 57 percent to 46 percent. Among people with employer-based coverage in January of 2006, one-sixth lost their coverage by 2008. Nearly three-quarters of small businesses that do not offer coverage to their employees cite high premiums as the reason. Small businesses want to offer health benefits to their employees, but are priced out of the market and cannot afford it.

Many small business employees are left uninsured and, in turn, rely on the health care system to pick up the costs when they get sick. It is these people who show up at emergency rooms and access the most inefficient part of our health care system. They are oftentimes not people who are unemployed, but employees of small businesses. Enacting market reforms such as creating

insurance exchanges will finally give small businesses affordable options. Their employees will have a place to purchase insurance at large pool rates and, by insuring more people, reform will help drive down the cost of health insurance for all Americans. Insurance exchanges will also significantly reduce administrative costs for small businesses by enabling them to easily and simply compare the prices, benefits, and performance of health care plans.

I know a number of us are working on a series of amendments for when the health care bill gets to the Senate floor to try to make sure we add further disclosure requirements and more transparency to our health care system. Right now we don't have a free market in our health care system because nobody knows what the providers actually pay, and what the doctors and hospitals actually charge. Small businesses will benefit by trying to bring transparency to these health insurance exchanges.

Additionally, reform will enact consumer protections such as prohibiting insurance companies from denying coverage based on preexisting conditions and dropping people when they are sick. This is particularly a challenge to small businesses. If you only have a small group of employees and a few have preexisting conditions, those preexisting conditions drive up the cost of providing insurance for this smaller pool. Oftentimes this results in pricing small businesses out of the market. Reforms such as eliminating preexisting conditions will dramatically help small businesses and their employees obtain affordable health insurance.

These protections are vital for small business employees because they help level the playing field in the small group market. They guarantee the option of large pool rates, lower costs, and prohibit insurance companies from arbitrarily penalizing small businesses when one of their employees becomes seriously ill.

Lowering health care costs for employers is also key to our ability to compete in the global economy. If American business is going to come out of this recession and we can compete with countries around the world, we have to take on the cost of health insurance. American workers are more productive than any other workers in the world. But even with that increased productivity, if American businesses have to pay $3,000 to $4,000 more per employee because of higher health insurance costs than our competitors that puts American businesses at a dramatic disadvantage.

As health care costs continue to rise, other business investments are sacrificed. Forty percent of businesses say health care costs have a negative impact on other parts of their business. As I mentioned, with the great reduction of credit availability to small businesses and in this challenging economic climate, American businesses cannot afford to be at such a disadvantage. With health care reform, more of our Nation's dollars will go toward investments in our economy.

Health care costs also stifle productivity. Too many Americans end up staying in jobs simply because the employer provides health insurance. They aren't able to move around, or move into entrepreneurial startup firms where innovation and real growth potential takes place. Startup firms and, again, small businesses are often not able to offer health insurance. Consequently, we have good workers who are not able to move into these firms and help spur job growth because they are caught in dead-end jobs. They are constrained by the security of health insurance offered at their old jobs or perhaps because they have a preexisting condition and can't move to a new situation.

Again, if we do health insurance reform right, it will put in place reforms such as the elimination of preexisting conditions requirements that will allow more freedom of movement within the job workforce.

So, once again, I join my colleagues in making this case. We have made it time and again. Health care reform is necessary to make sure American businesses remain competitive. Health care reform is necessary because health care costs are the single largest driver of our Federal deficit. Health care reform is necessary because if we don't address rising costs, Medicare will be insolvent by 2017. If we don't reform the system, costs will also rise for families; an average Virginia family, for example, within the next decade, will be paying nearly 40 percent of their disposable income to meet their health insurance premiums.

I will close my comments with where I started. Small businesses are the only players in our market who still pay retail for their health care costs and are increasingly being priced out of the market. Reform is imperative for the small business community.

I know my friend, the Senator from Colorado, is about to speak, and our leader on small business issues, the Senator from Louisiana, who has been so diligent on leading these efforts and making sure that small businesses are protected in health care. We must get this right. We must get this bill to the floor. And we must provide needed relief to the small businesses that will generate the economic recovery that we're all hoping for.

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

Yes.

Mr. President, I rise to address an issue I know this body will be dealing with in much greater detail in the coming weeks and months; that is, financial reregulation.

On Monday, I am introducing legislation to establish a systemic risk council. I have worked with Chairman Dodd on this issue and his staff, and I am very grateful that his discussion draft--although I have not seen the specific language--is expected to include a strong systemic oversight council which I have been advocating.

I appreciate Chairman Dodd's leadership on this issue and look forward to working with him and the administration on making it a reality.

As I have articulated previously on the floor and in an opinion piece published in the Washington Post, we need to establish a framework for addressing systemic risk in our financial system. Systemic risk is not the only area we need to address but is an area where the current system has unequivocally failed.

Systemic risk is actually a number of risks united by the possibility that, if left uncontrolled, they could have consequences for the entire markets or the entire economy. We saw examples of that a year ago.

Most often, systemic risk comes from the failure of an important financial institution. But because that is not the only source, we should not expect to control systemic risks with a rigid, one-size- fits-all approach.

In order to do this, we need a body that can look across our financial system at all sources of risk, that can spot gaps or opportunities for firms to avoid regulation, and that will not be consumed by other day-to-day responsibilities or protecting its own regulatory turf.

Some have proposed that the Federal Reserve serve as the systemic risk regulator. But its monetary policy responsibilities present potential conflicts, and it has proven incapable of properly regulating large institutions.

The Federal Reserve claims to be the systemic risk regulator at the moment, but it has obviously failed to take on that task, and we need to be careful in balancing its responsibilities and authorities in the coming years.

That is why, if we want to ensure that monetary policy and systemic risk are each managed in the best possible manner, we must recognize that institutional structures and responsibilities do matter. Doubling down on a structure of the past that has not performed well outside of its core function is not how we should confront the challenges of the future.

Our Founding Fathers opposed concentrations of power and favored a system of checks and balances. We have resisted creating an all- powerful central bank, and a council would allow for such a system of checks and balances.

The Federal Reserve is, of course, not the only agency that has not performed well in the crisis over the last year or so. The current system has failed to provide proper checks and balances and has replaced healthy competition where efficient and innovative firms flourish with a system where a handful of firms are too large to fail, can threaten the safety of the entire system, and enjoy an implicit--or maybe even more explicit now--government guarantee that destroys any notion of market competition.

This failure points to another task we must take on in financial regulatory modernization. We must end the notion of too big to fail. That is why I believe we should establish a strong systemic risk oversight council, and I will be introducing legislation, as I mentioned, to do that.

A systemic risk council is not a silver bullet but avoids the pitfalls of entrusting systemic risk responsibility with one single agency that has other missions, and those other missions could serve as a source of conflict of interest.

A council could see across the horizon and have all the information and expertise flow up into it. It addresses our stovepipe problems and avoids the conflicts that come from also conducting monetary policy and helps to stave off regulatory capture.

The systemic risk oversight council I propose would consist of the Treasury Secretary, of course, the Chairman of the Federal Reserve-- they would play a valuable role--and the heads of the major financial regulatory agencies, two independent members, including the chair of the council.

This chair of the council would be independently appointed by the President. It would be charged with the responsibility for working to improve our understanding and control of systemic risks. This builds on the model of the President's working group on financial markets. An independent chair, appointed by the President and approved by Congress and supported by a permanent staff, has proven to be relatively effective and ends up resembling the National Transportation Safety Board or the National Security Council.

Critics of this approach have said you cannot convene a committee to put out a fire. But we do convene committees to prepare for and respond to large-scale crises time and again across our whole system. Experience has taught us boards and councils can work in a wide range of contexts, provided they have the right responsibilities, powers, and membership. Even the Federal Reserve and the Federal Deposit Insurance Corporation are run by boards.

In addition, I believe we should leave the real emergency powers with the regulators. The Federal Reserve should retain its 13(3) authority, though it should be tightened up. Bank regulators should retain prompt and corrective action authority, and the FDIC should retain its resolution powers. As a matter of fact, Senator Corker and I have introduced legislation already that expands the FDIC's resolution powers to include bank holding companies.

In a crisis, however, the council should coordinate all of these regulators and their actions, as police, fire, and emergency response all coordinate in local emergencies. But the systemic risk council cannot just be a debating society, and so it would have real resources and power.

First, in addition to gathering and analyzing data, the council could help to determine how to regulate new products and markets in order to minimize regulatory gaps. Those regulatory gaps often end up with regulatory arbitrage, as we have seen recently. It would first identify gaps in the system and then have the appropriate regulators work together to fill these gaps.

With these tools, we will eliminate the huge blind spots our regulators had last fall when new and unregulated markets tail-spun out of control. We will eliminate the ability of firms to avoid regulation or find the weakest regulator by ensuring consistent treatment of activities across the financial markets.

Second, in order to address the too-big-to-fail issue, the council will work to prevent firms from becoming too large to fail. It would do this in three specific ways.

First, it would have the authority to identify large firms that could pose systemic risk if they failed but did not currently have an end-to- end prudential regulator and would assign them a Federal regulator. This could include hedge funds, insurance companies or other nonbank financial companies. Making sure those companies that have no regulatory oversight, if they fall into this category of too big to fail, have some kind of oversight is terribly important.

Second, the council would establish systemwide prudential standards for large firms, including counterparty exposure limits, increased capital requirements, reduced leverage and strengthened risk management requirements, all to make sure that while we would not set arbitrary caps

on size, we would make sure, as a firm gets too large or takes on too much excessive risk, that there are additional requirements, such as additional capital and others I outlined.

Finally, it would work with the council to ensure that any firm could fail safely--we saw in the past that there was no plan on how we would unwind a Lehman or an AIG--by working with the financial regulators, the day-to-day prudential regulators, to develop clear, written plans for the unwinding or failure of a financial company. In a sense, we would be asking some of these too-big-to-fail institutions to preapprove or put forward their own funeral plans or dissolution plans so we would know how we go through this process, should that unfortunate event take place. These plans would be made in advance of trouble and could not rely on the type of government intervention we were forced into last fall.

As I have said, the systemic risk council is not a silver bullet. Many systemic risks already lie squarely within the responsibility of our day-to-day financial regulators. We need to make sure our current regulators have clear missions, including managing risks within their institutions and regulated markets, and we must ensure these regulators do their job.

But that is only half of the answer because other systemic risks lay outside of the day-to-day prudential regulators' job description, in between the cracks of our existing regulatory system. The Systemic Risk Council's responsibilities would be clear and focused. Systemic risk would be its only job, and it would help fill in the cracks and prevent problems from becoming unmanageably large or complex.

What I am proposing today boils down to a simple, consistent, and I believe common sense idea: If we want to do something constructive about systemic risk, we should create a mechanism that can ensure our regulators do their jobs, avoid conflicts of interest, and fully leverage our existing regulatory resources to promote the proactive identification and control of systemic risks. By having this council, made up of the heads of the day-to-day prudential regulators--the Fed, the Treasury, independent members, and this independent chair appointed by the President--I believe we create this mechanism.

We need to make sure we never again put the American taxpayer into the kind of financial duress we had take place last year. I believe the Systemic Risk Council approach, working as one piece of an overall financial modernization and reregulation, will lead us in that direction.

I would yield for a question.

I am very familiar with what happened in the UK, with the situation with the Bank of Scotland, which had received governmental assistance--somewhat similar to the banks that had received our TARP financing. They came in and said: We are going to start to break up this institution. Former Fed Chair Paul Volcker has suggested that certain banks should perhaps be prohibited from taking on excessive risk activities, in a sense going back almost to a Glass-Steagall approach. Those are both areas that I believe warrant further consideration.

Our approach here has been to say that while it is hard, in this interconnected financial system we have where institutions crisscross all across the world, to put an arbitrary size cap on it, what we can do, by putting this type of Systemic Risk Council in place, we can put barriers and a price of getting too large by having added capital requirements; by having this designation that you have to show us a dissolution plan and that the Systemic Risk Council would weigh in; by assuring that if you take on too much risk activities on your own trading desk, there is a higher price to pay for that.

There are these other examples, as you mentioned, that we will be debating through this whole process. I know the Senator has raised this issue at times on the floor as well, and I will solicit his advice and comments. And perhaps we need to go even beyond that in looking at, as I think you appropriately pointed out, at the end of the day, does too big to fail mean just too big? It is a hard place to draw a line. But I thank the Senator for his question, and I yield my time.

I thank the Senator from North Dakota for his comments, and I look forward to working with him. I think this is clearly an area where we will find common cause with our colleagues on the other side of the aisle. Never again should the American taxpayer have to pick up the burden from institutions that have been financially irresponsible and then from those financial irresponsibilities that pose a systemic risk where we the taxpayers are left basically holding the bag.

So I thank the Senator for his comments, and I look forward to working with him on this very important issue.

Mr. President, I thank my colleague from North Carolina for organizing the freshmen one more time to talk about our vision for health care reform. We invite our colleagues not only on our side of the aisle but our colleagues across the aisle to join us in this conversation about how to get health care reform right. I also commend my colleague from New Hampshire, Senator Shaheen, on her comments about how we can fix financial incentives in our current health care system. I think reforming our delivery system ought to be, clearly, part of any overall health care reform we take on.

I want to pick up, actually, where Senator Shaheen left off and talk about how we can readjust our financial incentives system in health care. We have them all wrong. We have a health care system right now that rewards bad practices. We have a health care system that rewards hospitals for multiple readmissions rather than a low readmission rate. We have a health care system that rewards volume of care rather than quality of care. Reforming the financial incentives in our delivery system has to be a key component of any health care reform going forward.

I join my colleagues in citing examples of delivery system reforms that are happening now in my own state. I have three examples here from the Commonwealth of Virginia.

In 2000, VCU Health System in Richmond, our capital, developed a system called Virginia Coordinated Care to manage health care services for the uninsured. The uninsured often rely on emergency rooms to be treated for their illnesses and then go back home until they get sick again. There is no continuity of care and oftentimes that uninsured person will end up back on an emergency room doorstep because, outside of being treated for the episodic incident, there was no management of that patient's care during that period.

What VCU developed was a program that assigned a primary care physician to oversee each uninsured patient's health. The goal was to increase coordination between doctors and hospitals and, as a result, increase accountability, improve quality of care, and lower costs.

The Virginia Coordinated Care program started with a few participants in 2000; by 2009, there were over 20,000 members. One of the most important outcomes of the program was a significant drop in emergency room visits by enrolled patients. By increasing continuity of care, emergency room visits dropped 14 percent between 2000 and 2005. Costs were reduced for Richmond area hospitals, as well as surrounding Virginia hospitals as fewer patients showed up at other emergency rooms. By treating the patient earlier in their illness the program achieved better quality of care, and better results for the health care system as a whole.

Another example of delivery system reform took place at another end of our State, at Sentara Healthcare, located in Norfolk, VA. In 1999, Sentara studies found that intensive care units that were monitored by a doctor full time had lower mortality rates and shorter length of stays than those that were not. In order to improve quality of care, Sentara worked with a company called VISICU to install Web-based television cameras in each patient's room. With this technology, a single physician in a central location can follow patients in multiple rooms at the same time. Again, this kind of logical approach produced more efficient care at a lower cost. Sentara saw a 25-percent reduction in mortality among these patients, a 17-percent reduction in their length of stay, and a 150-percent return on investment in the program.

Perhaps the best example is now being modeled by the Carilion Clinic in Roanoke, VA. Carilion Clinic is a multispecialty health care organization, with more than 600 doctors and 8 health care organizations.

In 2010, next year, Carilion Clinic will join with Engelberg Center for Health Care Reform at Brookings and the Dartmouth Institute for Health Policy and Clinical Practice to implement a new and innovative health care model that rewards providers for improving patient outcomes while also lowering costs. This Accountable Care Organization will encourage physicians, hospitals, insurance companies, and the

government to work together to coordinate care, improve quality, and reduce costs. Under this model, providers will assume greater responsibility not only for treating the patient's illness but for the overall quality and cost of care to be delivered. They will actually be incentivized to take steps to keep patients healthy, while avoiding costly medications and procedures. Additionally, this model will encourage, and make it affordable, for doctors to finally practice preventive care. Carilion Clinic is doing the right thing: moving away from the current, and very flawed, fee-for-service system.

As long as our health care system--one-sixth of our economy-- continues to reward providers simply based on quantity rather than quality of care, we are never going to get health care reform right. By increasing coordination of care, and putting in place smarter financial incentives, we can have higher quality care at lower costs. We can focus on the health of patients, rather than the number of procedures. Changing our payment mechanisms and restructuring financial incentives are a key part of health care reform.

I know my freshmen colleagues stand ready to work with our colleagues on this side of the aisle, and I again invite our colleagues on the other side of the aisle to join us in this effort. Getting it right will lead to improved quality of care, lower costs, and a healthier America.

I thank our leader today, the Senator from North Carolina, for granting me this time. I look forward to working with Senator Hagan and all my colleagues as we move forward.

I yield the floor.

Mr. President, I thank my colleague, the Senator from New Hampshire, for leading the freshmen Senators here this morning as we once again take the floor to talk about health care reform.

I also commend my friend, the junior Senator from Florida, for his comments today. I share his views about the necessity of bringing our Federal deficit in line.

In the Commonwealth of Virginia, we have a balanced budget requirement and we meet our budget every year. I am proud of the fact that Virginia has been named the best managed State in America. So I do have to take issue with some of the comments made by my colleagues, who I think understand States' needs. The fastest growing costs in my State, as well as the State of Colorado, New Hampshire, and I would assume the State of Florida, are health care costs.

Medicaid is going to bankrupt virtually every State in the Nation by 2025 if we do not act. I hope for, and welcome, my colleagues' efforts to try to reach a bipartisan consensus on health care reform.

I will again make the point I have made repeatedly over the last few weeks: What happens if we don't act? What happens if we simply kick the can down the road another 10 years? That is the appeal I make to my colleagues on the other side. Join us. Particularly join the freshmen Senators, who don't come to the Senate with the same background of the last 20 years and experience of past battles. Join a group who does, however, come to this body wanting to do the people's business. That means driving down health care costs, expanding coverage, and making sure our health care system is financially sustainable.

If we don't act, not only will States' increasing Medicaid costs go unmet, State budgets will not be balanced. If we don't act, the Federal deficit will explode. The largest driver of the deficit is not the TARP spending or stimulus spending; it is health care spending. If we don't act, the current Medicare Program, which seniors depend on, will go bankrupt by 2017. That is not a political statement; that is a fact.

If we don't act, American companies will not be competitive in the global economy. We have the most productive workforce in the world. But no American company can compete when they have built in health care costs of $3,000 to $4,000 more per worker than any other competitor in the world. If we don't act, for the 65 percent of us who get our health care coverage through the private insurance market, an average Virginia family will be paying 40 percent of their disposable income on health insurance premiums within the next decade.

I ask my colleague from Florida and others on the other side of the aisle to join us in this bipartisan effort to reform health care. This morning we will lay out how we think health care reform can both expand coverage and drive down costs. We will look at some of the models currently being used by large employers who have had the flexibility to design their own benefit plans. These models have successfully driven down costs by putting in place prevention and wellness activities, negotiating better prices with providers, and restructuring a financial incentive system which currently rewards hospitals based on higher readmission rates, rather than quality care.

I thank the Senator from New Hampshire for organizing the freshmen one more time. As a former Governor, I know she has been a leader on issues like Medicaid and health care costs. I call on my colleagues on the other side of the aisle to actually join in this effort to make sure we do achieve bipartisan health care reform.

I yield the floor.

Mr. President, first of all, I thank my colleague, the Senator from Colorado, for organizing this effort today and leading freshmen Senators this week as we, once again, come down to the floor, as some of the folks who are newest to the Senate, most recently hired in most cases, to talk about the need for health care reform. I particularly thank my colleague, the Senator from Colorado, for raising the very important issue of the cost of health care to small businesses.

The remarkable thing about small businesses is they are basically the only people who pay retail for their health care costs in America today. Those who have Medicare, those who have Medicaid, large employers--they all can leverage their purchasing power. But small businesses are the folks who take it on the chin, and I am grateful for my colleague's comments today, describing how health care reform can benefit small businesses.

My colleagues, the Senator from Alaska and the Senator from Oregon, have also pointed out some other myths, as the Senator from Colorado indicated. The one I am going to take on today, because we hear a lot from our friends on the other side of the aisle about the problems with reform, and sometimes they do actually dispel some of these myths--but one of the myths I have dealt with for 18 years, as somebody who founded the Virginia Health Care Foundation in the early 1990s, is, how do we deal with the uninsured? Yes, part of our health care reform is about extending coverage to the uninsured. There will be some additional cost to do that, but I think it is very important to recognize that under our current system, right now we pay for the uninsured. We pay for the uninsured through uncompensated care, as my colleague from Colorado mentioned. We pay for the uninsured in higher health insurance premiums for all of us who buy private insurance. We pay for the uninsured, candidly, in higher costs to our Medicare and Medicaid system.

Our uninsured end up on the emergency room doorsteps, oftentimes receiving care in the most inefficient way possible and oftentimes without good quality care.

We have seen, on average, 8 percent of families' 2009 health care premiums--about $1,000 a year for all of us who purchase private health insurance--we pay in effect a $1,000-a-year tax to compensate and pay for the cost of the uninsured.

As my colleague mentioned, and I know from my experience in Virginia 18 years ago, we started this Virginia Health Care Foundation to deal with how we could provide health care coverage for the uninsured. We saw folks ending up, as I mentioned, on hospital doorsteps. We saw folks waiting too

long before they could access the health care system. Oftentimes, if they had a chronic disease and then waited to get that health care coverage, the cost of covering that person was not only much higher-- obviously, the person has to deal with a much more serious illness--but they too ended up in the emergency room, which is an inefficient delivery mechanism.

If we are going to truly start to bring down the cost of insurance, if we are going to do the right thing in giving the uninsured in this country a chance to receive a medical home and make sure they access health care through a more affordable and more long term, healthier way, we must pass health care reform this year.

A lot of numbers have been bandied about concerning what kind of extended coverage we are talking about in this health care reform. There have been arguments that we are talking about covering 30 million additional people. I believe the Senate Finance bill covers 25, 26 million. One of the things that is often absent from this debate is that while these are the numbers we are trying to deal with right now, literally triple that number, about 87 million Americans during a year, at one point or another, through either being unemployed for a while or moving off one plan to another, go through some period of being uninsured and uncovered.

On top of that 87 million, we also have the problem of literally tens of millions of people who are stuck in dead-end jobs, who want to change jobs, who want to become more productive, but they are afraid to make that change because of concerns over losing their health care coverage. If we can provide the kind of health care reform we are talking about, if we can provide the kind of coverage we are talking about, those kinds of problems will go away. We will become a more effective and cost-effective society.

I know we have other colleagues who want to speak, and I want to come back to where we started, at least the freshmen did a few weeks back, and why some of our colleagues on the other side who seem to be this ``caucus of no,'' who seem to say: Let's take more time, let's put it off, let's wait a little bit longer before we take on health care reform--why that policy choice is so wrong.

If we do nothing, if we choose not to act this year, our current health care system is financially unsustainable. If we do nothing, Medicare, under the current projections, will go bankrupt in 2017. Many of us on this side of the aisle share the concerns of some of our colleagues on the other side of the aisle about the exploding deficit our Nation faces. The largest single driver of our Federal deficit is not the stimulus program, it is not the TARP program, it is not some of the other things we debate back and forth, it is the rising cost of health care that we pay for with Federal dollars in Medicare, Medicaid, and the VA.

If we do nothing, our deficit and those health care costs will continue to explode, undermining the dollar, undermining our ability for economic recovery. If we do nothing, an average family in Virginia--and I would argue probably an average family in the State of Colorado--will see literally 40 percent of their disposable income go to paying their health insurance premiums within the next decade. Those costs are unaffordable and unsustainable.

Finally, as a former business guy and somebody who believes, as my colleague from Denver does, that the heart of what keeps our economy growing is the business community, and particularly the small business community, if we can't lower our health care costs, then American business will not be competitive in the global economy. No matter how productive American workers are, America builds into our cost structure, for almost every business, about $3,000 to $4,000 more per employee because we have so much higher health care costs than any of our competitors around the rest of the world. We cannot maintain that competitive disadvantage in a global economy.

The time is now. There are ways we can continue to improve these bills. We are looking forward to the melding of the Finance bill and HELP bill, and I know myself and some of my fellow freshmen colleagues will have some ideas about how we can improve programs even in that package.

I thank my colleague from Colorado for his leadership on this issue, and I look forward to working with not only my freshmen colleagues but all colleagues on this side of the aisle, and hopefully those on the other side, to make sure we do get health care reform this year.

I yield my time.

Madam President, I thank my colleague, the Senator from Oregon, for helping organize this morning. I thank all other colleagues for once again coming together and speaking with different voices but with similar themes. I also thank our newest colleague, the new Senator from Massachusetts, for being here. I know he will take time in another moment to give his maiden speech. Being here and giving us moral support is helpful.

One of the things we all get to do as freshmen Senators is sit in that chair and preside over the Senate at various times. Consequently, we often get, perhaps more than other colleagues, a chance to hear the folks on the other side and their talking points. Monday afternoons, I get to hear it for uninterrupted hours. What I hear time and again from our colleagues on the other side is complaints about the various proposals this side--and, hopefully, some on the other side will join us on--has put forward.

What I do not hear from the other side is what happens if we take their approach, which is doing nothing. What I do not hear from the other side is a simple recognition not of the moral challenges of covering close to 30 million additional Americans, but the fiscal challenges of not acting, a fact that we all brought forward last week when we pointed out, if we fail to act, we will see Medicare go bankrupt by 2017; if we fail to act, our deficit numbers will continue to explode; if we fail to act, an average Virginia family, and an average Colorado family as well, will be spending close to 40 percent of their disposable incomes within the next decade paying for health care. Senator Merkley and Senator Begich have mentioned if we fail, American business cannot compete when we have to pay $3,000 to $4,000 more per employee than our competitors across the world in terms of increased health care costs.

Some may say that the simple reason for these increasing health care costs is because we have an aging population. We do. But an aging population is not the only reason for rising health care costs. Our rising health care costs are increasingly driven by an inefficient delivery system, by a system that does not reward value, by a system that does not compensate based upon any rational basis. That is where so many of the reforms are focused through the Senate Finance Committee and the HELP Committee bills--and others we will be putting forward in later weeks, perhaps even on the floor, that will bring these reforms to the overall delivery system.

Again, some of my colleagues have already mentioned wellness. Senator Shaheen mentioned the enormous differential between states in terms of Medicaid reimbursements. We can and must do a better job.

For example, if as we see here, we can put health care reform in place and drive system reform, we could potentially save $3 trillion over the next 10 years across the entire system. If we fail to act, we leave those costs in a system that does not provide good quality health care and, with 70 percent of the cost going for chronic diseases, does not provide better coverage, either.

On this last chart, in terms of what we are talking about in expanded savings, if we fail, if we simply expand the current system--this is based upon Lewin Group studies, the Commonwealth Fund that has been cited many times on the other side--if we simply put in place expanded coverage without reform, we will continue to explode the deficit. But if we put in place the kinds of reforms we are talking about, which is wellness, and increased transparency--and I strongly believe in a free market system--but we have no transparency in our system in terms of what costs are and what people actually pay. If we take advantage of some of the best examples in the private sector, where health reform is taking place right now, we can bring about not only reform but bring about reform with lower costs, higher value, and truly make sure Americans all across the country get the coverage they need and that does not break the deficit.

Mr. President, I rise with a group of my freshmen colleagues to discuss an issue that is on all our minds and on the minds of many Americans and that is the issue of health care reform. The subject most of us are going to address today is what happens if we do nothing on this critically important issue because we, as recent additions to this body, are united by a simple but important truth: the rising cost of health care is

hobbling American business, stressing family budgets and, if we do nothing and it is left unchecked, it will explode our national debt.

While many of my colleagues have raised important and valid questions about some of the health care proposals, one of the things I hope all my colleagues will realize is that doing nothing to reform our health care system is a policy choice. It would be a misguided choice, an irresponsible choice, but it is a choice nonetheless.

Today, health care costs in America consume nearly 17 percent of our GDP. This is projected to grow to one-third of our GDP by 2040 if we do nothing. This chart shows this ever-escalating cost of health care and its percentage of our GDP. Here we see the cost in actual dollar amounts, $2.4 to $2.5 trillion spent on health care in the past year.

Our per capita health care cost is double that of virtually every other developed nation in the world--nations we compete against every day. As we come out of this recession and American business has to compete against these countries around the world, our economy is hobbled by costs that, on average, include $3,000 more per employee due to our higher health care costs than our competing nations.

If we look at an issue that is equally important and one that I know our colleagues, especially my freshmen colleagues, continue to raise-- but we hear concerns about from our friends on the other side of the aisle--that is the concern about our Federal deficit. The primary cause of our Federal deficit and our overall debt is the increasing per- person costs of Medicare and Medicaid. We pay more and more dollars in the Federal budget each year to basically pay for the same level of care. As this chart shows, increasing Medicare and Medicaid costs alone will exceed all other Federal spending. Clearly, this situation is not sustainable.

In my home State of Virginia, since 2000, insurance premiums have increased nearly 90 percent, while wages have only increased 27 percent. If we do nothing, and this was reaffirmed by the Business Roundtable report just last week, nationwide insurance premiums are projected to double by 2016. This is of particular concern to small businesses. Today, small businesses are the only group that still pay retail for their health care services. Their size makes their bargaining power weak and makes them susceptible to enormous increases in health care premiums.

Once again, it is a policy choice. Doing nothing means exploding our Federal debt and deficit. Doing nothing means doubling health care premium costs for American families. Doing nothing means American companies will be less competitive in a global market and our small businesses will continue to pay retail for health care.

Mr. President, I think I speak for all my freshmen colleagues when I say we were not elected to do nothing. We did not run for office because we were satisfied with the direction of our Nation. We were elected to work together with willing Republicans and Democrats to help turn this country around. I hope this will be the first of a series of statements from the freshman class, who are not only here to point out the challenges we face but to join Senators from both sides of the aisle who are committed to getting things done.

I would now like to yield 5 minutes to my colleague, the distinguished Senator from New Hampshire.

I thank my colleague, the Senator from New Hampshire, on her very excellent comments. We are running a little behind. I do want to come back, if we have time, to talk about the costs to State budgets, something both she and I experienced.

I yield 5 minutes of our time to the distinguished Senator from Delaware.

I thank my colleague from Delaware for pointing out the enormous cost of inaction both to our Federal deficit and to families who are struggling with these costs.

Now I yield 4 minutes of our time to the distinguished Senator from Alaska.

I thank my friend from Alaska for pointing out, particularly, with small businesses, that in our current system they are the only people who pay retail for their health care expenses. Reform must rectify that.

I yield 4 minutes to the Senator from Oregon.

I thank my friend from Oregon for pointing out, in vivid terms, the challenges the status quo presents to so many American families. I yield 4 minutes to my friend, the distinguished Senator from Colorado.

Mr. President, I thank my colleague from Colorado.

We are hearing a common theme. These freshman Members all care about driving down cost, and they see health care reform as stimulative to the American economy and recognize that ensuring the growth of our economy means we have to get the deficit under control. That means driving health care costs down.

I yield 4 minutes to my colleague from New Mexico.

Mr. President, I know our time allotment is drawing to a close and we still have more Senators who wish to speak.

I yield 3 minutes to my distinguished colleague, the Senator from Illinois.

Mr. President, I thank the Senator from Illinois. I also thank my distinguished colleague from Tennessee for granting our group 4 additional minutes.

I now yield 4 minutes to the Senator from North Carolina, my friend.

Mr. President, I thank my colleague from North Carolina and all these freshmen Senators who have talked today about the very real costs of inaction.

I would like to now call on our final colleague, my friend, the junior Senator from Colorado.

Mr. President, I thank our colleagues on the other side of the aisle for the additional time.

I appreciate the opportunity we have had to make our statements.

Mr. President, I commend my colleague and good friend from Delaware for his compassionate interest, not only in what sounds like a very worthy project in Delaware, but his constant commitment to making sure we are always looking over that next horizon, whether it is in education or energy issues he has been involved with as a Member of Congress and as a Governor, and now as the senior Senator from Delaware. The project he describes sounds like a good one, and I hope it gets favorable consideration from the Senate. I welcome the chance to support him.

I wanted to take a moment to talk about a project that is already in this very important 2010 Transportation-HUD appropriations bill. I commend the subcommittee chair, the Senator from Washington, and the ranking member for their good work on this bill. There is a certain amount of celebration in this bill for us in the greater Washington region because this Transportation appropriations bill is actually the culmination, in many ways, of an effort that has been ongoing for close to 50 years. Even when your dad served in the other body, one of the things I know he probably experienced was flying into our region, particularly flying into Dulles, and he might have found it difficult to get from Dulles into greater Washington.

One of the most remarkable things that has always stunned me as a Virginian, and as a long-time resident of the national capital area is that we have never had rail or metro linkage from our international gateway airport out at Dulles into our Nation's capital. With this legislation, with actions taken earlier this year, we finally have in place a financing arrangement and the beginnings of construction for the long overdue Dulles Metrorail project.

The Dulles metrorail project is part of a 50-year plan that started with the construction of Dulles Airport. Throughout that time, there was always a reserve. Anybody who made that drive--and I know the Presiding Officer has made that drive many times--has seen the corridor in the middle of the road. That corridor has been reserved for ultimately building out rail, from the existing Washington metro system, all the way to Dulles.

This is a project that my predecessor, John Warner, worked on for years. It was one of his proud accomplishments, finalizing Federal support for this project. I commend his efforts in the past. It is a project I have been involved with for over 20 years, first when I was on the Commonwealth Transportation Board, when we had to preserve that corridor for a metrorail project. I recall, back in the late 1980s and early 1990s, efforts to try to take away that right-of-way so it could be used for additional highway construction. There was always a need to say: No, we have to reserve that. At some point, we will finally get metrorail to Dulles. This has now become a reality.

It was a project I worked on as Governor. There were a number of times we tried to put together a very complex financing arrangement in order to make sure all the partners, State and local and Federal, would step to the plate and do what was right but also do what was terribly important to the national capital region: making sure our international gateway airport is linked to the capital. I am proud to report that earlier this year in March, Secretary LaHood and former Senator Warner and myself, Governor Kaine, Congressman Frank Wolf, who has been a long-time supporter, got together and signed the final funding arrangement that committed the Federal Government, the Commonwealth of Virginia, and local communities on this critically important project.

It is needed for a variety of reasons. It is needed not only to link international and domestic passengers who come into Dulles to visit our Nation's capital, but this corridor has rapidly become the economic hub of all northern Virginia. Dulles Airport currently serves about 24 million passengers each year. Population in the Dulles corridor is expected to increase by 50 percent and employment to increase by 47 percent by 2030. As someone who I know travels that corridor on a regular basis, you have seen how it has been built up, and there will continue to be the expansion of a great deal of economic activity for all northern Virginia and for the entire Washington area, particularly in the high-tech sector.

This past March, the full funding agreement was signed, and $900 million over the period of the whole project was committed from Federal funds. But let me make clear it is not only the Federal Government that is stepping up on this critically important project. The Commonwealth of Virginia has committed to be a major partner in funding. The localities have stepped forward in terms of funding. There have been very creative activities in terms of creating a special taxing district of our local property owners in the region who will benefit from this metrorail extension. They have skin in the game as well. The State is contributing some of the toll revenues from our toll road in the corridor. This is a project, even during these difficult economic times, where the State, the localities, and the Federal Government have stepped up in a major way.

It will be enormously beneficial to our whole region. It will be enormously beneficial to the Commonwealth and to our Nation's capital in terms of the millions of visitors who come in from all over the country and the world. They will have the opportunity not only to take one of those increasingly expensive cabs, but also simply to jump on the train and come into Washington.

There is also another very important reason for continuing this project. The Dulles Corridor Metrorail Project is an important multimodal project with critical homeland security implications. Expanding metrorail into the Dulles corridor is terribly important in terms of evacuation opportunities, should the capital ever be under assault. It is obviously terribly important in economic development activities, in terms of tourism activities. This project is crucial to the well-being of the whole national capital region.

As a matter of fact, earlier today I was out in Tysons Corner, one of our major development areas on the way out to Dulles rail. Although we were caught in some pretty dreadful traffic, it was a little bit of a mixed blessing. Part of the traffic was because construction has actually started on some of the rail stops in the Tysons area that will ultimately relieve not only traffic congestion but will, obviously, decrease greenhouse gases. So this project has added benefits as well, an issue I know is very important to the Presiding Officer in terms of dealing with climate change.

I know there are others in this body who perhaps have raised questions about some of the projects that are included in this 2010 Transportation-HUD appropriations bill. This is one of those projects I can't imagine anyone being critical of. This has been 50 years in the making. Enormous time, effort, and resources have gone into it. The fact that the final funding agreement has now been signed and we actually have broken ground is a time to celebrate. The $85 million included in this year's appropriations funding for the downpayment and first installment of what is going to be a critical Federal funding stream is a very worthy sum that is going to provide benefits for this region and for our capital for many years to come.

I, again, commend the chair of the Appropriations subcommittee, my colleague and friend, the Senator from

Washington, for her great work on not only this particular Dulles metrorail project, which I believe, as a frequent flier in and out of Dulles, I hope she will be the immediate beneficiary of as well, but to all members of her subcommittee. I thank them for their good work on this bill, this important project, and the many other projects in this legislation.

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

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

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 69, S. 713.

Mr. President, I ask unanimous consent that the committee-reported amendment be agreed to, the bill, as amended, be read a third time and passed, the motions to reconsider be laid upon the table, with no intervening action or debate, and that any statements related thereto be printed in the Record.

Mr. President, I ask unanimous consent the Senate proceed to the immediate consideration of calendar items Nos. 150 and 151, H.R. 1275 and H.R. 2938, en bloc.

I ask unanimous consent that the bills be read a third time and passed en bloc, the motions to reconsider be laid upon the table en bloc, with no intervening action or debate, and any statements related to the bills be printed in the Record.

Mr. President, I ask unanimous consent the Senate proceed to the immediate consideration of H. Con. Res. 171, at the desk, and just received from the House.

I ask unanimous consent the concurrent resolution be agreed to and the motion to reconsider be laid upon the table and any statements be printed in the Record.

Mr. President, I ask unanimous consent the Judiciary Committee be discharged from further consideration of S. Res. 226 and the Senate proceed to its immediate consideration.

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

Mr. President, I ask unanimous consent the Senate proceed to the immediate consideration of S. Res. 244, submitted earlier today.

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