Floor Statements

Madam President, even though America has the best doctors and the best nurses, our Nation spends too much on health care for what it gets. Because the problem in American health care will not cure itself, I rise in support of this motion to proceed to beginning the debate about how to fix American health care.

Before I lay out the many provisions in Majority Leader Reid's bill that constitute real reform, I wish to talk for a couple of minutes about how the Senate can come together, Democrats and Republicans, to fix American health care. I have had a chance to visit with almost every Member of the Senate in their office on this issue, to listen to them, and it is very clear to me that both Democrats and Republicans have valid points. I believe my party is absolutely right in saying you cannot fix American health care unless all Americans get good quality, affordable coverage. If you don't cover everybody with that kind of coverage, what happens is those who are uninsured shift their bills to the insured folks who are already getting shellacked, and there is an underemphasis on prevention. So my party is right that to fix this, we have to offer all Americans secure, quality, affordable coverage.

I think colleagues on the other side of the aisle have valid points as well. They focus on the need for marketplace forces, for choice, for competition. I subscribe to each of these principles as well.

I think many believe it is an absurd fantasy that before the Senate completes its work on this legislation, the Senate could actually come together, Democrats and Republicans. I simply don't share that view. Let me be clear: It is my intent when this bill gets to the floor to work very closely with Majority Leader Reid and with all of our colleagues to finally break through, to get beyond some of the polarization, the near brawling we have seen in townhall meetings where folks sit in opposite sections depending on their political points of view. That is not the American way to face big challenges. This certainly is such a challenge.

I believe fixing the economy and fixing American health care are two sides of the same coin. We can't spend more than 16 percent of our gross product on health care, spot our foreign competition hundreds of millions of dollars a year, and have enough money left over to focus on education, transportation, and domestic needs. The reason so many Americans don't see their take-home pay go up is because health care gobbles up all the costs in sight. So this is certainly a big enough challenge that it demands that the Senate get beyond the fighting--near brawling--about this subject across the land. On the basis of the conversations I have had with colleagues, I continue to believe the Senate can break through and produce a bipartisan bill, working with Senator Reid, working with colleagues on both sides of the aisle.

In terms of the real reforms that are in Senator Reid's bill, some of the most important have to do with the delivery system--the way American health care is essentially experienced across the land. The fact is that today's delivery system essentially rewards inefficiency. Payments are based on volume rather than quality. In my part of the country, we have plans like Kaiser and Group Health, and we have actually been in the forefront of trying to move away from a system that rewards inefficiency, rewards volume. What we have shown is that changing these incentives pays off. People can be healthier and America can do it for less money.

Senator Reid's bill begins to move in the direction of what we have been doing in our part of the country for some time. His bill promotes what are called accountable care organizations. There are also changes in reimbursement. Probably folks on Main Street are not familiar with what is called ``bundling.'' In effect, instead of paying for each specific service, under bundling there is essentially one payment to reward trying to deliver care in an integrated fashion.

We have been able to have included in the legislation incentives to care for folks at home. The majority leader included a version of the bill I introduced called the Independence at Home Act that is backed by many colleagues on the other side of the aisle, and many Democrats as well. When we think about the challenges of American health care going forward, we certainly ought to agree it makes sense to deliver more good quality, affordable care at home, rather than forcing the sickest Americans to spend a big chunk of their day fighting through traffic simply to get to a doctor's office, and we have the technologies, we have the trained physicians and nurse practitioners to offer these kinds of services

at home. I highlight the fact that this is real reform, it is in Senator Reid's bill, and Republicans and Democrats alike are behind it.

The majority leader makes a number of long overdue changes in the private health insurance market. In many respects, today the private health insurance system is simply inhumane. What we have is a system that rewards cherry picking; where the private insurance companies take only the healthy people and send the sick people over to government programs more fragile than they are. What we need is a very different system where the private insurance companies compete on the basis of price, benefit, and quality, and not who is the best at selecting out the good risks.

Senator Reid's bill does away with the unconscionable practice of pre-existing condition exclusions and the practice of rescission where the insurance companies abruptly drop coverage for the sick. The bill also does away with charging a person more simply because they are sick, because they are a woman, or because they work in a high-risk job.

These are very constructive insurance reforms. We are going to try to build on those as we go forward in the legislation. Colleagues should make no mistake about it: The insurance changes in Senator Reid's bill are very real reform.

I wish to focus for a few minutes, though, on what I think is the great promise of this legislation for health care in the future. Since World War II, there has essentially been no market for American health care. Back in the days of wage and price controls, we didn't have a way to get good health care to Americans and we simply said we will put it on the backs of employers. They were patriotic citizens then, like there are patriotic citizens now, and they said, We will figure out how to do it. We are going to have to pass on the costs in the form of higher prices for goods and services. That probably made sense back then. We had people essentially work at a job for 20 or 25 years, and after their last day at work they got a gold watch and a dignified retirement. Today, there is a very different economy. The typical worker changes their job 11 times by the time she is 40. She needs a different set of health care choices. She needs the opportunity to be empowered to go into the marketplace to hold insurance companies accountable and to get more value for her health care dollar. The majority leader in his bill lays the foundation for this kind of system.

He establishes a system of what are called health insurance exchanges. They are kind of like farmers markets for health insurance. Senator Reid has improved this so that these farmers markets, these exchanges, could only let in good-quality plans, and under Senator Reid's bill, it will be possible to more easily compare the plans in these exchanges. This is something I have been interested in for years, really going back to the days when I was co-director of the Oregon Gray Panthers, because I think it is simply bizarre that it is possible in other parts of American life--in a Costco store or any other big store--to compare products, look at alternatives, have a measure of uniformity, and not have that in American health care.

What Senator Reid's bill does is set the foundation for a marketplace so that health care in 2009 will be dramatically different than it was, say, 60 years ago, in 1949, when I was born. I don't see anybody outside the Capitol driving a car from 1949, but much of American health care still resembles the middle of the last century. Senator Reid, through his legislation, lays the foundation for modernizing that.

I would like to see more people in these new marketplaces, the exchanges, more quickly. Under the estimates we have been given, only about 10 percent of our population would be able to enjoy the fruits of real choice and real competition. Real choice and real competition in that marketplace is the path to holding premiums down. My goal in the years ahead is to allow every consumer--every consumer, for example, in New York and Oregon--to be able to deliver an ultimatum to their insurance company. That ultimatum should be: Treat me right or I am taking my business elsewhere. It is that simple. That is the way we do it in every other part of American life.

By the way, that is the way it works for all of us here in the Senate. We belong to a real marketplace. We belong to a real exchange called the Federal Employees Health Benefits Program. If a Member of the Senate doesn't like his health care coverage in November of 2009, come January of 2010, that Member of the Senate can take his business elsewhere, to another insurer that does a better job. I think that kind of marketplace--the marketplace every Member of the Senate now enjoys-- ought to be available to everybody else in the country. I think there ought to be public choices. I think there ought to be private choices. I think all Americans ought to be able to have access to all of those choices. We are not going to be able to have real insurance company accountability, real choice, and real competition unless we make the exchanges robust and get more people in.

To illustrate the fact that the majority leader and other leaders, such as Chairman Baucus, are open to new ideas, just yesterday the majority leader and Chairman Baucus and I agreed on an approach that will allow more people to enjoy the marketplace, the fruits of a competitive system, more quickly, when they indicated yesterday they would support my legislation to expand access to the exchanges for those who otherwise would have forgone having health insurance under health reform. Let me emphasize that--letting folks get to the exchanges who otherwise would have no health insurance at all. We have been able to do it. According to the CBO, we will be able to add an additional million people, middle-class folks walking on an economic tightrope, at 10 percent or less of what it would cost to have those people get their coverage through Medicaid or through subsidies. It is my intent to work with the majority leader and Chairman Baucus closely to allow others to have a chance to be part of this kind of competitive system. I commend the majority leader and Chairman Baucus for their commitment to work with me, as this bill goes to the floor, to expand access to the marketplace.

Let me close with one last point. I see my colleague from New Mexico in the Chamber, and he is a welcome addition to the Senate.

A lot of Americans listening may wonder why the Senate is turning its attention to health care when there is so much economic hurt in our land. The fact is, fixing the economy and fixing American health care are literally two sides of the same coin. We have to rein in these costs. We have to rein in these costs for Americans to have more take- home pay, to be in a position to pay for essentials, and to allow our workers to compete in ferociously challenging markets around the world.

It is time to move beyond the townhall brawls of this past summer and for the Senate to work with Senator Reid and all colleagues to break through and deal with this critical issue, the premier long-term challenge of our time for our economy, and do it in a bipartisan way. I urge my colleagues to vote for the motion to proceed.

I yield the floor.

Mr. President, transforming American health care so that more Americans get good health care at home, instead of only in a doctor's office, is an idea whose time has come.

Quality, affordable home-based care makes sense for patients. It generates good-paying jobs for our people and sparks development of exciting technologies through research that will pay even bigger dividends in the years ahead. Care at home is an idea that Democrats and Republicans, conservatives and progressives, can all come together on and get behind.

Right now, getting to see a doctor in their office can be an onerous process. You start by calling the doctor's office and testing your patience while you sit through menu after menu of options just to get past the doctor's voicemail system. You are in trouble if you don't listen carefully and miss the option you wanted. You might get sent to records or accounting and have to start all over again. After you have run that gauntlet, you have to match your schedule up to whatever days the doctor's in. With doctors having other obligations like surgeries or teaching, you could be up against a schedule where the doctor only has office hours a few days a week. That will lead to your getting an appointment two months from now. That won't do much good if you are sick today.

Once you have won that prized appointment, you have to navigate to the doctor's office on the day in question. In rural areas, you might end up driving yourself and your family long distances to get there. In urban areas, workers lose a big part of their day getting themselves, or maybe their elderly parent, to and from the doctor's office or hospital. That can be a difficult task if your parents have a hard time getting around at home--never mind getting them from the car to the doctor's office safely. By the time you get to the doctor's waiting room, you feel like you have run a marathon. It's the opposite of the well-oiled machine you would expect from a country that leads the world in health care innovation.

Our current health care system seems modern, but it is actually based on a 19th century model of institutionalized health care. It is like riding a horse-drawn wagon all the way from here to Oregon. Just because the Pioneers did it and found the beauty of Oregon at the end, it doesn't mean that is the best way to get there in 2009. Likewise, just because the majority of American health care is delivered in a doctor's office or hospital doesn't mean that is the best way either.

There is a lot of wasted time and effort spent on services that could be done more easily--and in some cases, more effectively--done from home thanks to something called ``telehealth technologies.'' Telehealth technologies are simple-to-use, home-based systems that use tools, such as home security sensors and the internet to connect patients to their medical providers. Home telehealth has already been used by the Veterans' Administration and has lowered costs for treating patients with multiple chronic diseases like diabetes and high blood pressure.

Here's how it works. Some systems help patients with chronic conditions like diabetes or high blood pressure send their daily blood sugar or blood pressure readings straight to their medical professional. There, the readings can be checked and monitored for signs that the patient's care needs to be adjusted. Sudden weight gains, which can be a sign that someone's about to go into congestive heart failure, can also be noted and addressed right away, so that the patient can be treated and avoid that outcome.

These are just a few of the ways that telehealth technologies can help patients better manage their health issues from home, instead of waiting for their occasional checkup in a doctor's office, when it might be too late to correct their health problems. Telehealth technologies give medical professionals a new tool by increasing the amount of data they can collect on their patients over a long period of time. That aggregated information improves the quality of care that the patient then receives when they do visit the doctor's office.

Some of these telehealth technologies are so advanced they sound like science fiction, but they are real, they are here today and they need to be part of building our new health care system. They offer more than just unique, time-saving solutions. Telehealth technologies also open a new world of jobs and services that will shore up our economy with good-paying work right here at home.

Researchers from around the country are working to tap the potential of these technologies, and I am proud to report that much of the cutting edge work is being done in the Pacific Northwest. Their discoveries address everything from depression to neurological disorders. For example, new technologies can help isolated seniors stay connected to the world through a variety of social networking sites. This would be a simple, high-tech fix that can help cure the loneliness that so many seniors suffer from, and that often leads to depression. Some seniors with cognitive issues are being taught how to use personal computers to play games that exercise the brain, like Sudoku puzzles. Neurologists can then analyze the changes in patients' success at the games over time and to understand how and when their cognitive abilities start to deteriorate.

Technologies like this give us the chance to learn about devastating diseases like Alzheimer's so that, hopefully, we can one day find new drugs and treatments for those who suffer from it.

Other technologies are moving forward to help those with memory loss and help to improve the quality of life for our seniors. ``Caller ID on Steroids'' is what one technology has been called that would be life- changing, and give them more confidence as they age, despite possible memory loss. It is a system that brings up a whole host of information on a senior's telephone every time someone calls. The system would show a photo of the person and their name. It would tell them the last time they spoke on the phone--and even a brief description of what they talked about. Another new invention would help seniors remember to take their medications on schedule.

There is a day-a-week pill caddy with sensors built it to tell whether or not a patient had come close to it or opened the particular day's drawer. A screen on the caddy displays reminders or hints about how to take the medication. This kind of technology improves patients' adherence to taking their medications as prescribed, which increases their effectiveness and improves their overall health. Imagine the differences these kinds of technology would make in the life of a senior who is suffering frightening and debilitating memory loss.

In the case of neurological illnesses like Parkinson's disease, telehealth has been shown to be a better way to manage medications and personalize treatment. Parkinson's patients can perform neurological tests on a laptop at home and have their success at these tasks reported to the doctor in real time. No longer will an annual visit to the doctor be the only opportunity to demonstrate how their illness is progressing and be the basis for the prescription the doctor writes. This kind of innovation could improve the quality of life for such patients and reduce the physical and economic toll that unnecessary medications cause.

But telehealth technologies do more than just help patients. There are some

that also help the people who care for them. Many caregivers for people with Alzheimer's find themselves, caring for their patients in the middle of the night. Telehealth technologies have been developed to let someone else from their caregiver support group know that they're up and available to talk, even at 3:30 in the morning. A ``presence lamp'' system uses simple home security sensors and the internet to turn on a lamp in one person's home when their friend also happens to be awake in the middle of the night, and vice versa. It becomes a lifeline between family caregivers who could reach out for emotional and social support, even in those darkest and bleakest of hours.

All these innovations point to the fact that a technological revolution is going on right now in home health care solutions, and it's time health care reform brought those solutions into the mix. If done right, reform should do more than give affordable, quality care to all Americans. As these technologies prove, health care reform should also stimulate the economy with new jobs and industries that will allow us to care for our rapidly aging population.

Home health care will help put America at the forefront of a new health care services industry that will generate more than a million new jobs that can never be outsourced. Those jobs will come from inventing new home-based care technologies and using those technologies to deliver virtual and remote care services here at home and abroad.

I have already introduced legislation that uses the concept of coordinated home health care to help people on Medicare live healthier by managing their chronic conditions and reducing duplicative and unnecessary services, hospitalization, and other health care costs. This bill has broad bipartisan support, from Senators Burr and Chambliss to Senators Stabenow, Mikulski, and, previously, the late Senator Kennedy.

My bill, the Independence at Home Act, establishes a 3-year Medicare pilot project that helps Medicare beneficiaries with multiple chronic conditions remain independent for as long as possible in a comfortable environment. It provides for coordinated-care programs that hold physicians, nurse practitioners, physician assistants, and other team members accountable for quality, patient satisfaction, and mandatory minimum savings. The act was accepted into the Senate Finance Committee health reform bill and I will pull out all the stops to see it included as part of the final health reform legislation that the Senate will vote on.

Before Congress finishes writing the bill for 21st century health care reform, it is important to define what Americans are paying for, how best to deliver much-needed personalized care to patients where they live, work, and play, and how to make the U.S. a world leader in home-based care industries. The home can become a fundamental location for health and wellness and also a priority for reform. In addition, all this can be done with a focus on stimulating our economy with new jobs, technologies, and services for a world that will share the challenge of caring for an aging population.

I encourage my colleagues to ensure that health care reform is about new approaches to patient care, quality of life, and growing old with independence and dignity, not just about who's paying the bill. This is a chance to redesign our health care system with a new vision that sees the patient as the center of a more efficient and effective system. It is a chance to change our health care system to one that helps prevent disease, treat patients, support family caregivers, and enable seniors to maintain their independence, by bringing health care reform home.

Mr. President, today I rise to introduce the Affordable Housing Preservation and Revitalization Act. I am delighted and honored to be joined in this effort by my good friend and colleague, Senator Jeff Merkley. It has been my privilege to work with Senator Merkley and his staff on an issue that is so important to our state of Oregon and to folks around the country.

There has been a lot of talk about housing in the media over the past year. The topic of most of these conversations has been the turmoil in lending industry and the fallout from the mortgage meltdown. So much so that many Americans have by now become familiar with terms like ``subprime'' and ``securitization.''

But there is another housing story here, even though it may not get the same attention or airtime: It is the story of homelessness and the struggle to find affordable housing, and for thousands of Oregonians it's a daily reality.

Like many States, Oregon is experiencing a sharp rise in homelessness.

In Multnomah County this past January, a count found 2,438 people homeless on a particular night. That was 13 percent higher than in 2007. The deterioration in the economy since January means there are probably more homeless on Portland streets now, officials said.

In July, the Department of Housing and Urban Development released a report that listed Oregon as the State with the highest concentration of homeless people.

According to a September report by the National Alliance to End Homeless, Central Oregon now ranks sixth in the Nation in overall homelessness rates and third among rural communities.

In times like these, the Federal Government can hardly stand to lose its stock of affordable housing. Sadly, that is exactly whats happening.

As long term contracts are coming due, many landlords are leaving the business of affordable housing for the private market. As these owners convert to market rents, which is in their economic interest, the low- income tenants will be unable to afford their homes. With fewer and fewer places to turn, many of these folks will end up on the street.

Some of properties have what are known as residual receipts--funds left over once the operating expenses and owner's distribution have been paid. Currently, this money can only be used in the most extreme of situations. As a result, many of these residual receipts have accumulated for nearly 3 decades. In Oregon alone, estimates suggest there are more than $10 million in untapped residual receipts.

Senator Merkley and I believe these funds represent a substantial asset that could be used to help preserve affordable housing projects with expiring contracts. That is why we are introducing the Affordable Housing Preservation and Revitalization Act.

Our legislation would permit residual receipts to be transferred with affordable housing properties that are sold to non-profits, provided the non-profits commit to preserving and maintaining the housing stock as affordable.

Our legislation isn't a magic bullet and it certainly will not ensure that every American can put a roof over their head. But we think it's the kind of common sense approach that Americans can get behind. I hope that our colleagues will join us in supporting this bill.

Mr. President, today I rise to introduce the Affordable Housing Preservation and Revitalization Act. I am delighted and honored to be joined in this effort by my good friend and colleague, Senator Jeff Merkley. It has been my privilege to work with Senator Merkley and his staff on an issue that is so important to our state of Oregon and to folks around the country.

There has been a lot of talk about housing in the media over the past year. The topic of most of these conversations has been the turmoil in lending industry and the fallout from the mortgage meltdown. So much so that many Americans have by now become familiar with terms like ``subprime'' and ``securitization.''

But there is another housing story here, even though it may not get the same attention or airtime: It is the story of homelessness and the struggle to find affordable housing, and for thousands of Oregonians it's a daily reality.

Like many States, Oregon is experiencing a sharp rise in homelessness.

In Multnomah County this past January, a count found 2,438 people homeless on a particular night. That was 13 percent higher than in 2007. The deterioration in the economy since January means there are probably more homeless on Portland streets now, officials said.

In July, the Department of Housing and Urban Development released a report that listed Oregon as the State with the highest concentration of homeless people.

According to a September report by the National Alliance to End Homeless, Central Oregon now ranks sixth in the Nation in overall homelessness rates and third among rural communities.

In times like these, the Federal Government can hardly stand to lose its stock of affordable housing. Sadly, that is exactly whats happening.

As long term contracts are coming due, many landlords are leaving the business of affordable housing for the private market. As these owners convert to market rents, which is in their economic interest, the low- income tenants will be unable to afford their homes. With fewer and fewer places to turn, many of these folks will end up on the street.

Some of properties have what are known as residual receipts--funds left over once the operating expenses and owner's distribution have been paid. Currently, this money can only be used in the most extreme of situations. As a result, many of these residual receipts have accumulated for nearly 3 decades. In Oregon alone, estimates suggest there are more than $10 million in untapped residual receipts.

Senator Merkley and I believe these funds represent a substantial asset that could be used to help preserve affordable housing projects with expiring contracts. That is why we are introducing the Affordable Housing Preservation and Revitalization Act.

Our legislation would permit residual receipts to be transferred with affordable housing properties that are sold to non-profits, provided the non-profits commit to preserving and maintaining the housing stock as affordable.

Our legislation isn't a magic bullet and it certainly will not ensure that every American can put a roof over their head. But we think it's the kind of common sense approach that Americans can get behind. I hope that our colleagues will join us in supporting this bill.

Mr. President, I come here today to introduce the bipartisan Improving Access to Clinical Trials Act. I would like to begin by thanking my friend Congressman Edward Markey for introducing this legislation in the House. I also want to thank Senator Dodd, Senator Shelby and Senator Inhofe for cosponsoring this legislation. I would also like to thank the Cystic Fibrosis Foundation for bringing this issue to my attention.

The legislation I am introducing today is important because it would give people who are eligible for Social Security Income and Medicaid the same access to clinical trials as those who are more financially fortunate. Currently, those with rare diseases, such as Cystic Fibrosis and Tuberous Sclerosis rely on clinical trials as their only hope. Little is known about these diseases and a clinical trial may often be the only way individuals can seek treatment for these rare diseases and contribute to helping find a cure.

Currently, SSI and Medicaid eligible individuals who want to participate in a clinical trial have to worry about whether or not they will see a loss or a reduction in their benefits for their participation in a clinical trial if the trial offers any sort of research compensation to participants as part of its approved Internal Review Board study design. This legislation would make it so benefits that these individuals receive from clinical trials are not counted against those who are seeking SSI or Medicaid benefits or those who are already eligible for these benefits.

A good example of why this legislation is needed is Sean from Maryland. Sean is a Medicaid beneficiary who voluntarily enrolled in a clinical trial. He was paid for his participation in the study and subsequently lost his health benefits. Shortly after the study he contracted pneumonia and was treated for the illness. After hospitalization he found out that the money he received would disqualify him for Medicaid. Because he lost his health benefits he now owes $80,000 for the two weeks of treatment he received for pneumonia.

While I believe this bill fixes a fundamental problem that has precluded hope for too many people who have a rare disease and receive SSI or Medicaid, I have heard some legitimate concerns that research compensation may create the wrong kind of incentives for low-income people. These are important concerns and when it comes to this issue I believe there do need to be important safeguards in place. That is why this bill includes a GAO study to make sure that the program is working and that it is fair to those on SSI and Medicaid who are participating in clinical trials for rare diseases. The bill sunsets in 5 years so that Congress can reexamine the issue after getting the GAO report on the program.

I urge my colleagues to support this legislation so that adults on SSI and Medicaid can have the same access to clinical trials as those more financially fortunate. I look forward to working with Chairman Baucus and Ranking Member Grassley on passing this bill this year.

Mr. President, I come here today to introduce the bipartisan Improving Access to Clinical Trials Act. I would like to begin by thanking my friend Congressman Edward Markey for introducing this legislation in the House. I also want to thank Senator Dodd, Senator Shelby and Senator Inhofe for cosponsoring this legislation. I would also like to thank the Cystic Fibrosis Foundation for bringing this issue to my attention.

The legislation I am introducing today is important because it would give people who are eligible for Social Security Income and Medicaid the same access to clinical trials as those who are more financially fortunate. Currently, those with rare diseases, such as Cystic Fibrosis and Tuberous Sclerosis rely on clinical trials as their only hope. Little is known about these diseases and a clinical trial may often be the only way individuals can seek treatment for these rare diseases and contribute to helping find a cure.

Currently, SSI and Medicaid eligible individuals who want to participate in a clinical trial have to worry about whether or not they will see a loss or a reduction in their benefits for their participation in a clinical trial if the trial offers any sort of research compensation to participants as part of its approved Internal Review Board study design. This legislation would make it so benefits that these individuals receive from clinical trials are not counted against those who are seeking SSI or Medicaid benefits or those who are already eligible for these benefits.

A good example of why this legislation is needed is Sean from Maryland. Sean is a Medicaid beneficiary who voluntarily enrolled in a clinical trial. He was paid for his participation in the study and subsequently lost his health benefits. Shortly after the study he contracted pneumonia and was treated for the illness. After hospitalization he found out that the money he received would disqualify him for Medicaid. Because he lost his health benefits he now owes $80,000 for the two weeks of treatment he received for pneumonia.

While I believe this bill fixes a fundamental problem that has precluded hope for too many people who have a rare disease and receive SSI or Medicaid, I have heard some legitimate concerns that research compensation may create the wrong kind of incentives for low-income people. These are important concerns and when it comes to this issue I believe there do need to be important safeguards in place. That is why this bill includes a GAO study to make sure that the program is working and that it is fair to those on SSI and Medicaid who are participating in clinical trials for rare diseases. The bill sunsets in 5 years so that Congress can reexamine the issue after getting the GAO report on the program.

I urge my colleagues to support this legislation so that adults on SSI and Medicaid can have the same access to clinical trials as those more financially fortunate. I look forward to working with Chairman Baucus and Ranking Member Grassley on passing this bill this year.

Mr. President, businesses like airlines, trucking companies, and heating oil distributors buy and sell oil and futures contracts because they need to do so to run their day-to-day business and hedge their risk against wild swings in oil prices like consumers saw last year.

But there are also buyers and sellers in the market--financial speculators--who are simply there to try to make a quick dollar on oil as an investment strategy. The explosion of speculators into the marketplace has distorted the oil and gas market and driven up the price of oil for everybody. When commercial businesses see fuel prices go up, they try to consume less. But when speculators see prices go up, they buy more and keep driving up demand. This distorts the normal supply-demand balance of the markets and digs a huge financial hole for average Americans.

In 2000, speculative trading in the oil futures markets accounted for 37 percent of crude oil trading on the New York Mercantile Exchange. By last summer when prices were approaching $150 a barrel, that number had grown to more than 70 percent. I do not think that is a coincidence.

There are a lot of proposals around to fix the regulatory system to prevent trading abuses. Oregon's economy really suffered from abusive energy trading by Enron, and I am all for closing trading loopholes. But my bill is aimed at something different. It is aimed at the giant financial bubble that has been created by people who are simply chasing speculative profits in the commodities markets and creating artificial demand that is driving up prices.

The legislation I am introducing today--Stop Tax-breaks for Oil Profiteering, STOP, Act of 2009--will let some of the air out of this speculative balloon and help create a level playing field among companies participating in the commodity markets.

Under the tax code, commercial traders, those who truly need to buy, sell and hedge their purchases of oil, pay taxes on whatever profits they make on trading at the same rates as ordinary income. Speculators get a much better deal from the TAX CODE. Some, such as pension funds or endowments, do not pay any tax whatsoever when they profit on their oil or futures investments. Others, like hedge or index funds can get lower tax rates by treating some of their trading profits as capital gains. Clearly, the deck is stacked against the businesses who really buy and use oil. That means it is also stacked against the consumer who needs the services and products those businesses provide.

My proposal removes incentives in the tax code that make such investments attractive to both tax-exempt and tax-paying investors. It also makes everyone in the United States who is buying and selling oil and gas or futures contracts play by essentially the same tax rules across the board. Tax-paying entities would lose the ability to treat any of these investments as capital gains and be subject to comparable tax treatment on oil and gas investments as airlines or trucking companies or fuel distributors or other businesses that truly need to be in these markets.

Tax-exempt entities, like pension funds, would be required to pay ``unrelated-business-income-tax'' on their oil and gas trading gains. UBTI already exists as a well-established tax obligation for income that is not directly related to the tax exempt purpose of the organization. UBTI was created precisely to keep tax exempt organizations from competing unfairly with taxpaying businesses, which is what they are doing when they enter the commodity markets solely for investment income purposes. The bill also includes provisions that would prevent tax exempt organizations from investing in off-shore funds to try to avoid the new UBTI tax.

By focusing on tax fairness, my bill would realign the profit incentives that are currently attracting non-commercial actors to the markets. If speculators are truly in the markets and are wrecking havoc with oil and gas prices, this bill will do away with their tax subsidies and cause many to leave. It deflates the speculative balloon of artificially inflated profits that has made this investment arena so attractive.

If speculators are not a problem, then this bill will help prove the theory that the wild swings in oil prices of the past year truly can be blamed on supply and demand.

The bill would only cover the oil and natural gas markets, and related products like gasoline and diesel fuel, and be in effect for the next 4 years. However, after 3 years, it would require the Treasury Department to issue a report analyzing the impact of these changes on these markets, making recommendations on what changes to make.

Other proposals on oil speculation focus on regulation of the market or limiting the amounts of oil traders could purchase. These approaches are ``top down'' efforts to prevent trading abuses and financial investors from swamping the market. This bill approaches the problem from the bottom line up. Willy Sutton, the bank robber was asked why he robbed banks, to which he is said to have replied, ``It's where the money is.'' That is why this bill focuses on the flow of financial investment funds into the oil and gas markets, it's where the speculation is.

In these tough economic times, I believe consumers need protection from people who try to game the system to pad their own pockets. By putting an end to the imbalances in the tax code that currently feed oil profiteers, the STOP Act will be good for American businesses and consumers. I hope my colleagues will join me in protecting our economy and leveling the playing field in the oil and gas markets by voting in favor of the STOP Act.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I rise today to introduce the Take Back Your Health Act of 2009. I want to thank my friends Senator Cornyn and Senator Harkin for joining as original cosponsors of this bill.

This bill is another example of how Democrats and Republicans can come together on health reform. This bill incorporates ideas that bridge the philosophies of both parties: prevention, individual responsibility, and paying for health care services that provide value.

These days, health care reformers talk about bending the cost curve down and focusing on delivery system ``game changers''. Often my friends and I have talked about how pevention--preventing disease or illness before it happens--does both, but is not scored as bending the cost curve by the Congressional Budget Office.

Over the last year, I have worked with some of the brightest minds in prevention--Doctors Dean Ornish, Mike Roizen, and Mark Hyman--on how to design a program that will change the focus of medicine from treating medical problems to preventing them while delivering savings. The road that took us to this bill has not been an easy one, but I believe this bill achieves all of our goals when it comes to encouraging healthier behaviors that will help prevent disease, especially chronic diseases.

The heart of this bill is what's called an intensive lifestyle treatment program. This program is an individualized health plan prescribed by a doctor that gets people living healthier and getting healthier through exercise, nutrition counseling, care coordination, medication management, and stopping smoking.

This type of program has been proven to help or even reverse the progression of many chronic diseases. A Highmark Blue Cross Blue Shield study found that their costs went down 50 percent after their patients took part in an intensive lifestyle program. That can mean big savings for Medicare and for seniors.

Even a CMS Medicare demonstration--which notoriously does not score

savings for anything--found that people who went through a lifestyle program had the same or lower costs over three years than as Medicare beneficiaries who didn't go through the program.

In times like these, the American people want to know that the Medicare program is going to get their money's worth. The Take Back Your Health Act embraces a pay-for-performance type system. Doctors are paid a bundled payment to encourage efficiency and teamwork, and they are held responsible for their success. If a patient's health status does not improve according to at least two measures, the doctor doesn't get paid. In addition, if a patient goes through the program for diabetes, but still has problems and has to go to the hospital, the lifestyle treatment doctor doesn't get paid.

The last innovation in this program is that it gives individuals a financial incentive for getting healthier. Every person who goes through this treatment program and improves his or her health status gets a one-time $200 reward.

The beauty of this bill is that everyone has skin in the game: the doctor, the patient, and the government. That will be the secret of its success. It is just this kind of innovative program that can be a real game-changer for Medicare and for our entire health care system, by bringing the focus of our health care system back to the basics of making us healthier.

I look forward to working with Chairman Baucus and Senator Grassley on including this bill in health reform. I urge my colleagues to join me as cosponsors on this bill.

Mr. President, businesses like airlines, trucking companies, and heating oil distributors buy and sell oil and futures contracts because they need to do so to run their day-to-day business and hedge their risk against wild swings in oil prices like consumers saw last year.

But there are also buyers and sellers in the market--financial speculators--who are simply there to try to make a quick dollar on oil as an investment strategy. The explosion of speculators into the marketplace has distorted the oil and gas market and driven up the price of oil for everybody. When commercial businesses see fuel prices go up, they try to consume less. But when speculators see prices go up, they buy more and keep driving up demand. This distorts the normal supply-demand balance of the markets and digs a huge financial hole for average Americans.

In 2000, speculative trading in the oil futures markets accounted for 37 percent of crude oil trading on the New York Mercantile Exchange. By last summer when prices were approaching $150 a barrel, that number had grown to more than 70 percent. I do not think that is a coincidence.

There are a lot of proposals around to fix the regulatory system to prevent trading abuses. Oregon's economy really suffered from abusive energy trading by Enron, and I am all for closing trading loopholes. But my bill is aimed at something different. It is aimed at the giant financial bubble that has been created by people who are simply chasing speculative profits in the commodities markets and creating artificial demand that is driving up prices.

The legislation I am introducing today--Stop Tax-breaks for Oil Profiteering, STOP, Act of 2009--will let some of the air out of this speculative balloon and help create a level playing field among companies participating in the commodity markets.

Under the tax code, commercial traders, those who truly need to buy, sell and hedge their purchases of oil, pay taxes on whatever profits they make on trading at the same rates as ordinary income. Speculators get a much better deal from the TAX CODE. Some, such as pension funds or endowments, do not pay any tax whatsoever when they profit on their oil or futures investments. Others, like hedge or index funds can get lower tax rates by treating some of their trading profits as capital gains. Clearly, the deck is stacked against the businesses who really buy and use oil. That means it is also stacked against the consumer who needs the services and products those businesses provide.

My proposal removes incentives in the tax code that make such investments attractive to both tax-exempt and tax-paying investors. It also makes everyone in the United States who is buying and selling oil and gas or futures contracts play by essentially the same tax rules across the board. Tax-paying entities would lose the ability to treat any of these investments as capital gains and be subject to comparable tax treatment on oil and gas investments as airlines or trucking companies or fuel distributors or other businesses that truly need to be in these markets.

Tax-exempt entities, like pension funds, would be required to pay ``unrelated-business-income-tax'' on their oil and gas trading gains. UBTI already exists as a well-established tax obligation for income that is not directly related to the tax exempt purpose of the organization. UBTI was created precisely to keep tax exempt organizations from competing unfairly with taxpaying businesses, which is what they are doing when they enter the commodity markets solely for investment income purposes. The bill also includes provisions that would prevent tax exempt organizations from investing in off-shore funds to try to avoid the new UBTI tax.

By focusing on tax fairness, my bill would realign the profit incentives that are currently attracting non-commercial actors to the markets. If speculators are truly in the markets and are wrecking havoc with oil and gas prices, this bill will do away with their tax subsidies and cause many to leave. It deflates the speculative balloon of artificially inflated profits that has made this investment arena so attractive.

If speculators are not a problem, then this bill will help prove the theory that the wild swings in oil prices of the past year truly can be blamed on supply and demand.

The bill would only cover the oil and natural gas markets, and related products like gasoline and diesel fuel, and be in effect for the next 4 years. However, after 3 years, it would require the Treasury Department to issue a report analyzing the impact of these changes on these markets, making recommendations on what changes to make.

Other proposals on oil speculation focus on regulation of the market or limiting the amounts of oil traders could purchase. These approaches are ``top down'' efforts to prevent trading abuses and financial investors from swamping the market. This bill approaches the problem from the bottom line up. Willy Sutton, the bank robber was asked why he robbed banks, to which he is said to have replied, ``It's where the money is.'' That is why this bill focuses on the flow of financial investment funds into the oil and gas markets, it's where the speculation is.

In these tough economic times, I believe consumers need protection from people who try to game the system to pad their own pockets. By putting an end to the imbalances in the tax code that currently feed oil profiteers, the STOP Act will be good for American businesses and consumers. I hope my colleagues will join me in protecting our economy and leveling the playing field in the oil and gas markets by voting in favor of the STOP Act.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I rise today to introduce the Take Back Your Health Act of 2009. I want to thank my friends Senator Cornyn and Senator Harkin for joining as original cosponsors of this bill.

This bill is another example of how Democrats and Republicans can come together on health reform. This bill incorporates ideas that bridge the philosophies of both parties: prevention, individual responsibility, and paying for health care services that provide value.

These days, health care reformers talk about bending the cost curve down and focusing on delivery system ``game changers''. Often my friends and I have talked about how pevention--preventing disease or illness before it happens--does both, but is not scored as bending the cost curve by the Congressional Budget Office.

Over the last year, I have worked with some of the brightest minds in prevention--Doctors Dean Ornish, Mike Roizen, and Mark Hyman--on how to design a program that will change the focus of medicine from treating medical problems to preventing them while delivering savings. The road that took us to this bill has not been an easy one, but I believe this bill achieves all of our goals when it comes to encouraging healthier behaviors that will help prevent disease, especially chronic diseases.

The heart of this bill is what's called an intensive lifestyle treatment program. This program is an individualized health plan prescribed by a doctor that gets people living healthier and getting healthier through exercise, nutrition counseling, care coordination, medication management, and stopping smoking.

This type of program has been proven to help or even reverse the progression of many chronic diseases. A Highmark Blue Cross Blue Shield study found that their costs went down 50 percent after their patients took part in an intensive lifestyle program. That can mean big savings for Medicare and for seniors.

Even a CMS Medicare demonstration--which notoriously does not score

savings for anything--found that people who went through a lifestyle program had the same or lower costs over three years than as Medicare beneficiaries who didn't go through the program.

In times like these, the American people want to know that the Medicare program is going to get their money's worth. The Take Back Your Health Act embraces a pay-for-performance type system. Doctors are paid a bundled payment to encourage efficiency and teamwork, and they are held responsible for their success. If a patient's health status does not improve according to at least two measures, the doctor doesn't get paid. In addition, if a patient goes through the program for diabetes, but still has problems and has to go to the hospital, the lifestyle treatment doctor doesn't get paid.

The last innovation in this program is that it gives individuals a financial incentive for getting healthier. Every person who goes through this treatment program and improves his or her health status gets a one-time $200 reward.

The beauty of this bill is that everyone has skin in the game: the doctor, the patient, and the government. That will be the secret of its success. It is just this kind of innovative program that can be a real game-changer for Medicare and for our entire health care system, by bringing the focus of our health care system back to the basics of making us healthier.

I look forward to working with Chairman Baucus and Senator Grassley on including this bill in health reform. I urge my colleagues to join me as cosponsors on this bill.

Mr. President, while this is my first opportunity to vote for a Supreme Court nominee named by a Democratic President, I don't view the confirmation of judges through a partisan lens. Instead of partisanship, I have developed several criteria for assessing Supreme Court nominations. I believe these criteria are straightforward, and they are easy to understand:

Does the nominee have extensive experience with the law and a judicial temperament?

Has the nominee demonstrated sharp legal intelligence and sound judgment?

Does the individual display a judicial philosophy that falls within the mainstream of American legal thought?

Is he or she able and willing to separate their personal beliefs from their constitutional obligations?

On each count, I rule in favor of Judge Sotomayor.

My colleagues and I have all been listening carefully to Judge Sotomayor's testimony, and we have reviewed her record. In that record, everything I have been able to ascertain indicates that Justice Sotomayor will look a lot like Judge Sotomayor--an exemplary arbiter of the law, firm but practical, tough but fair.

For these reasons, I will cast my vote to confirm her as the next Associate Justice of the Supreme Court.

I speak from, perhaps, a unique position among Senators. I may be the shortest serving Senator in the history on our Senate Judiciary Committee. At the beginning of the 111th Congress, Senator Reid asked me to serve on this extraordinarily important committee. Senator Reid told me it would be a

temporary assignment, but I was still on the committee when Judge Sotomayor was nominated to the Supreme Court. I very much enjoyed my meeting with Judge Sotomayor, and I told her I wasn't sure how long I would be serving on the committee. I said I felt a little bit like a snowflake with the prospect of an Oregon rain coming in the afternoon. In fact, the rain came just a few days before the Judiciary Committee began the confirmation hearing for Judge Sotomayor. I did get a chance to talk with her and discuss, at some length, her views with respect to the key issues surrounding how a Senator evaluates a nominee to the Supreme Court.

On the basis of that discussion and a review of her record, while I wasn't able to cast a vote for her in committee, it is going to be, later this week, an honor for me to vote for her on the Senate floor.

When I met with Judge Sotomayor, we discussed a number of important issues--particularly matters relating to national security, the power of the Commander in Chief, and we also spent some time on a matter that I know the occupant of the chair is most interested in and that is end- of-life health care. What struck me the most about Judge Sotomayor was her openness, her intellectual curiosity, and her desire to make sure she had all the facts, all the information, all the views and background and the reading material that you have to have when you are going to make a call not on the basis of your predisposition but on the basis of the law and the law as it is applied to the facts.

In a number of areas we discussed with respect to end of life, Judge Sotomayor acknowledged that these were issues she hadn't personally considered. The occupant of the chair and I have talked at some length about the politicized case of the late Terri Schiavo. I objected on the floor of the Senate to the Senate considering that matter.

Of course, Judge Sotomayor could not go into how she would rule on end-of-life cases. But we talked at some length about those issues, and I am going to discuss them later in this statement tonight.

I wish to start my comments by saying I believe, with the young people at home in Oregon, this nomination by President Obama is regarded as an inspiration and a remarkable personal story. Oregonians have told me they look at her journey as the realization of the American dream. Oregonians have followed her testimony before the Senate Judiciary Committee. They believe she is qualified for this job. They are very excited about the fact that this nomination makes history, and I commend the President for demonstrating with this nomination how it is possible to increase the diversity, talent, and experience on the Supreme Court with one very capable individual.

Chairman Leahy and others have done an excellent job of going through the judge's impressive background. I do want to spend some time talking about the issues that Judge Sotomayor and I discussed in my office most extensively--Presidential power and end of life.

Serving on the Senate Select Committee on Intelligence, I have followed the history with respect to a President's Commander in Chief authority. Disagreements about this authority and how it is applied are certainly nothing new. There have been vigorous debates about this issue since our country was founded. But over the past several years, there has been especially heated debate around these questions and, in particular, the issue of whether, during times of war, the President has the authority to ignore laws passed by the Congress. As a result, there have been several occasions, over the past few years, where the Supreme Court has had to rule on major national security issues and address this question directly.

Our Court has frequently been sharply divided on this issue. At the same time, it has consistently ruled that--in Justice Sandra Day O'Connor's words--``a state of war is not a blank check for the President.'' I believe this is a principle that has to be upheld.

When I raised these issues with Judge Sotomayor, I was impressed with her thoughtfulness, her knowledge, and the experience she discussed about dealing with these thorny issues. Her answers made me believe that, as a Supreme Court Justice, she would apply the Constitution in a way that struck a balance--a very careful balance--between protecting our collective security and protecting our individual liberty.

We have always had, in the national security area, something of a constitutional teeter-totter, where the Founding Fathers always sought to try to ensure that there was an appropriate balance between protecting our Nation and securing our individual liberties; and maintaining that balance is what the Founding Fathers saw as paramount.

While Judge Sotomayor certainly gave no inkling to me in our discussion about national security how she might rule in a particular case, I felt very strongly that she would be able to define the reach of the Commander in Chief's power so as to strike that appropriate balance between collective security and individual liberty.

I must say, I don't want judges who will defer to any one President. I want judges who are going to defer to the Constitution. I believe Judge Sotomayor will do that in her service on the U.S. Supreme Court.

As I mentioned, I discussed with the judge the matter of end-of-life health care. This is a very sensitive issue for millions of Americans. What was striking about this in our discussions, when she and I met, is she recognized it was a contentious area of the law--one that deals with the rights of individuals and family members; and she certainly indicated she was going to spend a lot of time trying to learn about the history of cases in this area and the Court's judgments on end-of- life care.

I have been very interested particularly in Justice Brandeis's dissent in the Olmstead case. This was a 1928 case. The Supreme Court later adopted Justice Brandeis's view in the Katz case which essentially made it clear there is a right to be left alone, a right to be respected in these very delicate questions.

What concerned me so much about the Terry Schiavo case--and again, Judge Sotomayor gave no inkling about how she would rule on an end-of- life case--I think she understood my concern, and would follow up on it, that we cannot have elected officials, and particularly the Senate, become something of a medical court of appeals where the Senate essentially appoints itself the arbiter of these very difficult tragedies.

Judge Sotomayor did not commit herself to any specific position on end-of-life issues or any of the other issues. And, in fact, the judge said that coming from New York where they have a very sophisticated set of laws and legal protections to empower the individual to make their own choices--not government--empower the individual to make these very difficult questions, the judge said because New York had those statutes empowering individuals that she would spend time looking at the laws and the decisions of the Supreme Court in this area, reflecting, again, her commitment to follow the facts, follow the law, and not bring any predisposition of one sort or another to a very difficult and contentious area of the law, one that is as sure as night follows the day is going to be before the Supreme Court again--the matter of end- of-life health care.

Let me also mention one of our colleagues talked about her respect for precedent. I asked her about a woman's right to choose. She said that is an area of the law that has been settled for decades.

On the second amendment, she indicated she would not try to eliminate the right to own guns for hunting or for personal protection, again, what amounts to a recognition of existing law.

On foreign law, she said she would not rely on international legal decisions to interpret the Constitution.

This is a nominee who is going to be very sensitive to following precedent, following the facts, and ensuring that those principles are what guide her service on the U.S. Supreme Court.

Before I close, I wish to submit a letter the Senate Judiciary Committee received in support of Judge Sotomayor from the Federal Bar Association. They passed a resolution in support of the judge's nomination. The Senate Judiciary Committee has also received statements of support from the Hispanic National Bar Association, from the past presidents of NHBA.

I ask unanimous consent to have printed in the Record the letter and resolution and statement of support.

Mr. President, this organization, the Hispanic National Bar Association is not for profit, a national membership association that represents the interests of more than 100,000 attorneys, judges, law professors, legal assistants, and law students of Hispanic descent in United States, its territories, and Puerto Rico.

After a review of her qualifications and overall record, the Hispanic National Bar Association's Special Committee on the U.S. Supreme Court concluded that Judge Sotomayor is extraordinarily well qualified to serve on the Nation's highest Court.

Let me close simply by saying that when we have to review a nominee for this extraordinarily important position, one of the most important measures for me is to know that the nominee's views are squarely in the mainstream of American jurisprudence.

I came away believing that, but I hope that the Senate will not take my word for it or any other colleague's word for it. I think we ought to reflect on what the American Bar Association said. They gave her their highest rating. Or listen to former FBI Director Louis Freeh who called her an ``outstanding judge.'' Or read the dozens of endorsements for her, including those from the American Hunters & Shooters Association, the Chamber of Commerce, and the National Association of Women Lawyers.

I started my statement tonight by laying out the criteria that I believe ought to be used in evaluating a Supreme Court nominee. In terms of those criteria, Judge Sotomayor is an individual who will bring great credit to the Supreme Court. She will be a role model for millions and millions of young people in our country. I hope our colleagues will vote in a resounding fashion in favor of her nomination to serve on the U.S. Supreme Court.

Mr. President, I yield the floor.

Mr. President, today I pay tribute to the 100th anniversary of an Oregon icon the Tillamook County Creamery Association, makers of Tillamook Cheese.

Since 1909, this world-famous, farmer-owned cooperative has been dedicated to producing the highest quality cheeses and other products from local dairies that have thrived in the lush coastal valleys around the community of Tillamook, OR. Tillamook Cheese is not just a commercial enterprise. It is the proud symbol of a way of life that has been passed on for generations.

The members of the Tillamook County Creamery Association have been mainstays of the local and state dairy industries and committed stewards of the environment. They employ more than 600 people at two factories in Oregon and have annual sales of nearly $400 million.

With all due respect to my colleagues from the great State of Wisconsin, Tillamook is cheese. Over the years, the Tillamook County Creamery Association has won hundreds of awards, including six at the 2009 Oregon Dairy Industries products contest and six at the 2008 National Milk Producers Association. It has also been recognized by the Portland Business Journal for the third year in a row as one of Oregon's ``Most Admired Companies.''

For decades, the Tillamook Cheese Factory has been a must-see stop for millions of tourists who travel highway 101. In recent years, the creamery association has expanded to other parts of the State, but its traditions are deeply rooted in the pastures and dairies that make Tillamook County and Tillamook Cheese what it is.

Mr. President, today I am introducing legislation to provide more clean water for the City of Hermiston, for irrigators in the area and for the Umatilla River. It is good for farmers, fish and in-stream flows.

My legislation amends the Reclamation Wastewater and Groundwater Study and Facilities Act--P.L. 102-575--to authorize the City of Hermiston, OR, to participate in what is known as the Title XVI water reclamation program. This long-standing U.S. Bureau of Reclamation program encourages the reclamation and use of municipal, industrial and agricultural waste water. In this case, the City of Hermiston will treat municipal waste water and deliver it to a local irrigation district--the West Extension Irrigation District--for agricultural use. My bill is a companion bill to legislation already introduced for this same purpose in the House of Representatives by Representative Greg Walden, H.R. 2714. As with other Title XVI projects, this legislation would authorize the Bureau to assist the City in developing this project and provide a cost-share of 25 percent for the project.

The current Hermiston Water Plant discharges ``Class C'' water that can be used only for a limited amount of off-project pastureland irrigation or discharged into the Umatilla River. Beginning in December 2010, a new National Pollutant Discharge Elimination System limit will go into effect, changing the water temperature and pollutants requirements of treated water being put back into the river. Although the city is currently in compliance, once the new limits take effect, the city's current plant will not allow the city to meet the new requirements. As a result, the city will need to construct a new treatment plant, but it would still have difficulty meeting the water temperature requirements.

An upgrade of the plant would not only bring the city into compliance with the new discharge requirements, but it would increase the quality of the recycled water output from ``Class C'' water to ``Class A'' water, making it suitable for all irrigation needs, not just pastureland. Further, the proposed new plant would be configured to discharge its treated water to the West Extension Irrigation District, a Bureau of Reclamation-supported irrigation project. This will significantly increase the amount of water available to the District and will have a beneficial, long-term impact on a regional farming community that faces dwindling water supplies. Acreage available to utilize the city's recycled water discharge would increase from roughly 550 acres to nearly 11,000 acres.

Finally, by ending the discharge of warmer, lower quality water into the Umatilla River, the project will improve the habitat for wildlife and fish in the River, especially for endangered and threatened species. I am pleased that the Confederated Tribes of the Umatilla Indian Reservation, which has fishing rights in the Umatilla River, supports the city's efforts in this regard.

Mr. President, today I am introducing legislation to provide more clean water for the City of Hermiston, for irrigators in the area and for the Umatilla River. It is good for farmers, fish and in-stream flows.

My legislation amends the Reclamation Wastewater and Groundwater Study and Facilities Act--P.L. 102-575--to authorize the City of Hermiston, OR, to participate in what is known as the Title XVI water reclamation program. This long-standing U.S. Bureau of Reclamation program encourages the reclamation and use of municipal, industrial and agricultural waste water. In this case, the City of Hermiston will treat municipal waste water and deliver it to a local irrigation district--the West Extension Irrigation District--for agricultural use. My bill is a companion bill to legislation already introduced for this same purpose in the House of Representatives by Representative Greg Walden, H.R. 2714. As with other Title XVI projects, this legislation would authorize the Bureau to assist the City in developing this project and provide a cost-share of 25 percent for the project.

The current Hermiston Water Plant discharges ``Class C'' water that can be used only for a limited amount of off-project pastureland irrigation or discharged into the Umatilla River. Beginning in December 2010, a new National Pollutant Discharge Elimination System limit will go into effect, changing the water temperature and pollutants requirements of treated water being put back into the river. Although the city is currently in compliance, once the new limits take effect, the city's current plant will not allow the city to meet the new requirements. As a result, the city will need to construct a new treatment plant, but it would still have difficulty meeting the water temperature requirements.

An upgrade of the plant would not only bring the city into compliance with the new discharge requirements, but it would increase the quality of the recycled water output from ``Class C'' water to ``Class A'' water, making it suitable for all irrigation needs, not just pastureland. Further, the proposed new plant would be configured to discharge its treated water to the West Extension Irrigation District, a Bureau of Reclamation-supported irrigation project. This will significantly increase the amount of water available to the District and will have a beneficial, long-term impact on a regional farming community that faces dwindling water supplies. Acreage available to utilize the city's recycled water discharge would increase from roughly 550 acres to nearly 11,000 acres.

Finally, by ending the discharge of warmer, lower quality water into the Umatilla River, the project will improve the habitat for wildlife and fish in the River, especially for endangered and threatened species. I am pleased that the Confederated Tribes of the Umatilla Indian Reservation, which has fishing rights in the Umatilla River, supports the city's efforts in this regard.

Mr. President, I wanted to come tonight as a member of the Finance Committee and particularly highlight the extraordinary contributions that those on the HELP Committee have made in the prevention area. This is going to be a landmark bill. This is going to be an absolute turning point in American history

when we finally say that instead of spending loads of money on various health care services, we will start keeping people healthy. You look, for example, at the Medicare Program. Medicare Part A will pay thousands and thousands of dollars on senior citizens' hospital bills. And then Medicare Part B, the outpatient portion, can't do anything to reward somebody for staying healthy. Along comes Senator Harkin, who has consulted very extensively with the private sector, worked on a bipartisan effort. Senator Enzi and Senator Gregg were very involved. And you found the sweet spot. Prevention.

What you all were able to do in the preventive area is to show that you could give very dramatic incentives to reward people for staying healthy, lowering their cholesterol, lowering their blood pressure, picking up on some of the good work that is being done in the private sector but not getting into where one could, in effect, be said to be discriminating against an individual who would have a lot of health problems and would have difficulty just with an incentive-based system.

That is a very thoughtful approach, in my view, to moving this country forward. I hope we will be able to pick up on it in the Senate Finance Committee. There is a lot of bipartisan support for it. I came to the floor tonight to particularly highlight that.

There is time, perhaps, for one other thought. I was struck--as we talk about the lack of choice in this country--the distinguished Presiding Officer and I woke up this morning to our statewide newspaper, the Oregonian, which described, in great detail, our health insurance as Members of Congress. Senator Harkin and I have talked about this, Chairman Dodd as well. It described how Senator Merkley and I have access to 23 health care packages, which, by the way, understand the HELP lesson. They cannot discriminate against you if you have a preexisting condition. You go into a big group so you can play hardball with the insurance companies.

What is striking about this--and Senate Merkley and I heard about this on the front page of our newspaper--is most of the country thinks this is some kind of ``Cadillac,'' gold-plated operation. But, as the newspaper pointed out today, that is what somebody who works for the Forest Service gets in central Oregon, that is what somebody who is a janitor, for example, the paper said, gets at the Bureau of Engraving.

I very much look forward to working with all of you on the HELP Committee, as Chairman Dodd and I have talked about, to make sure everybody can have a wide array of choices, have a lot of clout to take on the insurance companies, get reduced administrative costs, which is what you get with the big groups, and, by the way, have a financial incentive to choose one of these Harkin-type packages that reward prevention.

One of the things that is troubling about this debate is if we do not get the choice issue right, a lot of Americans are not going to be able to choose those kinds of packages. I think, under the Senator's leadership, we will be able to do it.

The last point I would make is--and I thank the Senator for all the time--I think working together over the next few months we can close the sale with folks who have insurance. This is going to be the key to getting health reform passed.

Mr. President, 150 million-plus people say: Not only do I want to make sure I am not worse off, I want to be better off. Well, we want to make sure they are going to be able to choose a package such as Senator Harkin has been able to advance in the HELP Committee, where they get rewarded for prevention. We want to make sure they can choose a package where they can get lower premiums. We want to make sure everybody can keep what they have, but if they do not like what they have they can go somewhere else, which is what we can do as Members of Congress.

So I think tonight's program, particularly focusing on prevention and the incentives you all have laid out--and as Senator Whitehouse has talked about, changing this insurance model, which in many respects is inhumane to reward all this cherry-picking and, in effect, sending the sick people over to government programs more fragile than they are--you all have done some very good work, particularly in prevention and making sure the consumer gets a fair shake with the insurance industry.

Working together, particularly by adding choices, we are going to be able, over the next few months, to show we can close the sale with those who have insurance in this country and come back in the fall and win bipartisan support to go where this country has not been able to go for 60 years; that is, quality, affordable coverage for all Americans.

We have already made it clear that in any legislative effort we are a part of, we will mandate good health for the Dodd household because we are all thinking about you, and we want you to know how much affection we have for you and how much support both personally and professionally we have for you from all of us in the Senate.

I thank the Senator for giving me all this time.

(Mr. WHITEHOUSE assumed the chair.)

If the chairman would yield on that point, the reason I wanted to speak at this point is, in fact, today there is an entrepreneurship tax in America. What it means is, if you have a health care problem and you work in a small business and you have a good idea and you would like to go out and set up your own small business, you are not going to be able to do it because you have a preexisting illness. You are locked into your job. What your insurance reforms do in the HELP legislation, and what I think a lot of Senators want to do, is lift that entrepreneurship tax.

This is very appropriate that you talk about taxes because that is what

this always comes down to. Your insurance reforms specifically, as a result of making sure that person who has a good idea--perhaps that gentleman's business the Senator just described--they are going to be able to do what makes America great, which is use their ingenuity and talent because when they go to their next job, they are not going to face insurance discrimination.

I appreciate the Senator bringing up the entrepreneurship tax. I am looking forward to working with the chairman over the next few weeks. I think there is additional work we can do on the exchanges. The Senator from Oregon, Mr. Merkley, my colleague who is doing such a good job, talked about some of those options. I think we can get additional people more bargaining power, and in effect build on the good work done in the HELP Committee.

Thanks for all the time tonight. You have done a first-rate job on prevention. Again, I appreciate lifting that entrepreneurship tax. That is why I wanted to take a minute to point that out.

I look forward to working specifically with my colleagues on the HELP Committee. Let's expand those exchanges because that makes the system work for us and Members of Congress.

I checked the other day. My pool--put on the front page of our paper--is 1 million people. That is a lot of folks to spread costs and risk among. Senator Harkin and I have talked about it. It is not possible to replicate that exactly, for a variety of reasons. We can get close. We can get pretty close because we can build on the good work Senators have done in the HELP Committee, expand the exchanges, and give more people choices and more opportunities to lower their premiums and, in my view, close the sale with the insured people over the next few months.

I thank the Chairman for all the time.

(Mr. MERKLEY assumed the chair.)

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

Mr. President, I wish to spend a few minutes this morning talking about some of the positive developments that are taking place right now on this issue of health care reform. For example, this morning, the President is out talking to workers who already have insurance about how health care reform will work for them. He is spending his political capital. He is using the bully pulpit that is the White House. It is clear that this is a priority for the President of the United States.

A second positive development is in the Senate Finance Committee. We have a bipartisan group of six Senators. They are putting in killer hours at this point. I have been kidding them that I suspect they are being fed intravenously, but they are trying to put together a bipartisan health reform effort, and I appreciate what they are doing.

Third, I note my good friend from Utah on the floor of the Senate this morning. He and I have made it clear that the sponsors of the Healthy Americans Act, a bipartisan group of 15 of senators, are very open to working with Chairman Baucus, Chairman Dodd, and the President of the United States in a bipartisan fashion to fix health care.

So the question that is front and center in all of these discussions with the President, with the bipartisan group in the Finance Committee, with the bipartisan group of Healthy Americans Act sponsors that Senator Bennett and I are part of, is how we control costs in health care. What are we going to do to make health care more affordable?

It is our judgment that the key to making health care more affordable is to make sure people have bargaining power and people have choice-- the same choice that Members of Congress have. The distinguished Senator from New Mexico, the Senator from Utah, and myself actually belong to something that is pretty much an exchange, which is like a farmers market for health insurance. But essentially what we in the Senate have is the opportunity to choose from a menu of private health policies. We get rewarded for making an economical selection to save on our premiums, and we get rewarded when we choose a program that puts more emphasis on prevention and health. So when Senators shop wisely, they end up being wealthier and healthier as a result of being able to participate in a big exchange.

What Senator Bennett and I wish to do today is extend that kind of bargaining power to everybody in our country. After a period of time, a phase-in over a few years, everybody in our country ought to have a chance to have the kind of bargaining power and the kind of clout that Members of Congress have. Everybody in our country ought to be in a position to choose a policy that works for them. And when they make a good choice, when they

shop wisely, the extra money should go into their own pockets. That is the kind of approach Senator Bennett and I have advocated. It is a way to focus on these exchanges, these farmers markets which, in my view, are the key to getting health reform right.

What these exchanges do, if we set it up right, is they give all the middle-class people who are insured today in New Mexico, Utah, and Oregon a chance to come out winners under health reform at the get-go. And if you are already insured, the President has said he is going to let you keep the coverage you have. Now that makes a lot of sense. We senators hear that at every meeting back in our states.

But if, for example, in Utah, Oregon, or New Mexico, you don't like the coverage you have and you can get a better deal at the exchange, something that puts more money in your pocket, something that helps you and your family, let's let people do that under Free Choice.

Under the Free Choice proposal Senator Bennett and I have advocated, that we have presented to Chairman Baucus, Chairman Dodd, and the President of the United States, this is something we can do for the insured that helps them save money right at the get-go.

Regrettably, a number of the bills that have been considered in the Congress do not give people those kinds of choices. And when we look at how these bills are set up, there are what are called ``firewalls'' that restrict people from getting these choices. A lot of the people who are advocating for a public option are not even going to get the choice to enroll in one.

The key to helping people who already have insurance, the 160 million who get coverage through their employer today, is to get these exchanges right and to make sure that everybody has bargaining power within these exchanges as part of a big group.

I have a private policy as a Member of Congress. The people in Oregon, in effect, are my employer. They pay a portion of it. We have a million people in our group. That is the way to spread a lot of cost and risk through a group so you can get real value. Let's set these exchanges up at least so they contain big groups through a regional approach. Senator Bennett and I said we are open to a variety of ways of doing this. But let's make sure that everybody has some clout in the marketplace. If you are a small business in New Mexico today, you get strangled by the administrative costs of health care. You don't have much clout in the marketplace. As a small employer, you may be paying 30 percent of your health care dollar for administration. It should not be that way. We should be giving those small businesses relief.

What Senator Bennett and I have said with our free choice proposal is if you are an employer in New Mexico or elsewhere in this country, you may want to take your workers to the exchange. This is employer- sponsored insurance. This is an employer taking their workers to the exchange. As an employer, you can go to the exchange in New Mexico and say you want a discount because you are taking your group of workers to the exchange. That is playing hard ball with the private insurance business. That is saying to the insurers in New Mexico you are not doing good enough; you are not giving me a good enough deal, so I am going to have a chance to go to the insurance exchange and get a better one. We call it Free Choice: more options for employers and more options for workers. Options that look like what Members of Congress have.

I fear if we do not set up a system that gets this exchange right so that people have bargaining power--employers and employees--we are not going to be able to get the kind of cost containment the President of the United States has identified correctly as the heart of health care reform. It is about holding down costs. It is about making coverage more affordable.

I urge colleagues to look at the article that was written in this morning's Washington Post by Ezra Klein talking about the importance of the exchange and what it can mean for the bargaining power of middle- class people and businesses if it is set up right.

We know how to set it up right because it resembles the system that all of us enjoy in the Senate. At the beginning of the year, senators have a choice, a menu of options. If you make a good one, the money goes right into your pocket.

One last point with respect to Free Choice. Sometimes the best choices are not the most expensive choices. Senator Bennett knows a lot about this because in Utah they have a system, intermountain, that has illustrated that the best choices are not always the expensive choices. Let's make it easier for people to choose an Intermountain program or a Mayo program or any of the other integrated systems that are regarded as the gold standard in terms of quality.

One of the concerns I have about all of these firewalls in the legislation that is being considered is that Americans around this country, after a big push in the Congress to choose quality, are not even going to have the opportunity to choose a program like Mayo or Intermountain that gets more value for the health care dollar.

There are some positive developments in the health care debate going on today. To highlight some of these developments, the President is out talking to workers; negotiations are going on in the Senate Finance Committee; and there is the very gracious approach that Senator Bennett and a number of Republicans are taking in terms of saying: Look, we want this to be bipartisan, we want to meet the President halfway.

Each of those developments, it seems to me, is very positive. Fixing health care is absolutely key to fixing the economy.

As Ezra Klein pointed out this morning in the Washington Post, the reason people's take-home pay isn't going up is because medical costs are gobbling up everything in sight. So the key to fixing health care is promoting free choice; getting these exchanges right so employers and employees have more opportunities to hold costs down.

I think, in view of these positive developments I have highlighted, there is reason for Senators to stay at it and keep working in a bipartisan way, and real progress is going to be made before this body leaves for the August break.

I yield the floor.

Mr. President, let me pick up on the point made by the Senator from North Dakota because he is very accurate in his assessment.

One of the reasons they like so much this idea of trying to set up a model as we have in the Congress, with our exchanges, is because, for example, somebody who is working for the Forest Service in the State of Oregon has essentially the same kinds of choices I have for the Wyden family.

I think Senator Dorgan's point about trying to make clear to the American people that these choices Members of Congress have, somebody, for example, who works for the Forest Service in Oregon, has essentially the same choices, which involve basic health care--what we think of as preventive care, primary care, being able to go see a doctor, being able to get hospital coverage, and a reasonable catastrophic benefit. That is what Members of Congress can essentially choose from, and that is what somebody has an opportunity to get if they work at the Forest Service.

I think Senator Dorgan's point is very valid. The reason I have come back to this is because, under our free choice proposal, people in this country would, in effect, be able to go to one of these exchanges, which is similar to a farmer's market, and choose from a menu of private policies, not unlike what a Member of Congress has and somebody who works for the Forest Service. So I think the Senator from North Dakota has made a good point.

We, of course, have a lot of bargaining power because we go into these big groups, and that bargaining power can hold down administrative costs and get a better deal for somebody who has insurance. I would like to see, as we go forward with this legislation, that these exchanges are set up around a lot of the same principles Members of Congress have. Because if you do that, that is going to hold costs down for people who have insurance, and it is going to make their coverage more affordable. For example, the workers the President is going to see today would have additional choices in the future and save money when they are purchasing quality health care.

With that, I thank the Senator from North Dakota for making an important point.