Floor Statements

Mr. President, I want to take a few minutes this afternoon to discuss the recent developments on the health care issue and particularly with Senator Bennett on the floor, my friend and colleague, and the effort to make sure health care reform is bipartisan. Also, Senator Baucus and Senator Grassley on the Finance Committee, on which I serve, are putting in killer hours now in an effort to come up with a bipartisan approach in the health care area.

I wanted to take a few minutes and talk about a particularly important part of the health care debate, and that is what the middle class is looking for in terms of health care reform. I think when you talk about middle-class folks, most of whom have health care coverage, they are looking for a way to be wealthier, they are looking for a way to be healthier, and they want to make sure that if they leave their health care coverage, or their coverage leaves them, they can get portable coverage.

Perhaps as much as anything, middle-class folks want choice. They understand--and this is a matter that Senator Bennett and I have talked about often--that if you are going to come up with a health care reform effort that is going to save money, create incentives for people to stay healthy and services to offer prevention, and coverage that is portable, you have to give everybody the chance to choose those kinds of health care plans and those services.

The President, to his credit, has made the matter of guaranteeing choice--what I have put up here on the chart--President Obama has said that is one of his bedrock principles for health care reform. The President has said every American must have the freedom to choose their plan and their doctor. He clearly is on target when he talked about choice being one of the best ways to hold health care costs down, reward people for staying healthy and getting coverage that is portable.

For example, every Member of Congress has the capacity to choose a plan that is more affordable for them. When the sign-up period comes in the beginning of each year, you get a menu of various health services, and you want to choose the one that is the most economical for you, the one that rewards you for staying healthy. All Members of Congress have the opportunity to do that. The President is absolutely right in saying that choice ought to be a bedrock principle of health care reform. Clearly, that is what middle-class folks in Colorado, Utah, and Oregon are looking for; they want to make sure they have choices. Frankly, they wish to have as many choices as we have in the Congress.

So Americans want these kinds of choices. But for too many of our citizens, under the health care reform bills that are now being considered in the Congress, lots of people won't have the kinds of choices that Members of Congress have, or any choice at all. There are proposals in the Senate to create what is known as firewalls, to keep people from being able to go to what is a ``farmer's market''--they are called insurance exchanges--where people could get these kinds of choices, and these exchanges are to be created in the reform legislation.

As odd as it sounds, Congress is going to be creating these insurance exchanges, designed to help people shop around for their insurance, but then limit who can shop at these exchanges.

If you have coverage, for example, and somebody in the government says you ought to consider it affordable, you ought to like it, you are not going to be able to go to this ``farmer's market,'' this exchange, and shop for a plan that is better for you and your family. You aren't going to be able to enjoy more choices; you aren't going to be in a position to get more for your health care dollar. You aren't going to be able to get an affordable package, because only some people will be allowed at these exchanges.

I think everybody ought to be able to shop for their health care insurance like Members of Congress do today, and like our esteemed colleague Senator Kennedy called for in a very fine essay last week.

I have been able, working with colleagues, to come up with a way to do that. I call it the Free Choice proposal. Our Free Choice proposal lets workers who like what they have keep it. But it also lets workers who don't like what they have choose other plans. Half of those fortunate enough to have employer-sponsored insurance today don't have any choice of health plans at all. Think about that. Most Americans don't have the capacity to choose, like we can here in the Congress.

Unfortunately, under the health care reform plans that are being considered in the Congress, we are still going to leave millions and millions of Americans without a choice of health services and health care plans. Under our Free Choice proposal, everybody who has employer coverage is going to have new choices. They can certainly keep what they have. But if they choose, they can take what their employer now pays for their insurance and go to the ``farmer's market'' and buy a plan that is a better fit for them and their families.

It also gives employers more options. If the insurer isn't going to sell them an affordable plan, the employer could then take the whole group to the exchange and get a discount.

What the distinguished Senator from Utah and I have been talking about these many months is something that would give more clout to workers and more clout to employers on day one. It would give employers and workers the ability to save money at the get-go, largely through an old-fashioned concept that is about as American as we have, which is choice and freedom, and the ability, when you shop wisely, to benefit financially and, particularly, our employer approach, where the employer could take the worker to the exchange on day one and get a discount. That the employer could get a discount is one that, in my view, is going to give employers the bargaining power in negotiating with insurers that they don't have today.

This is a proposal we can do without making any adjustments to the Tax Code. The independent analysis Senator Bennett and I got a few days ago indicates we could save consumers $360 billion over the next decade. Those are savings to our people. Those are savings in the health care system. It is an approach that is very much in line with what the President has identified as a bedrock principle for health reform.

I have talked about the value of choice, particularly this August in Colorado, North Dakota, and around the country being able to tell all middle-class people they are going to have more choices. But what I think is particularly useful about the Free Choice proposal, it is one of the pathways to getting more affordable coverage because once you have these choices, just like Members of Congress--if at the beginning of the year the Senator from Colorado does not like one particular plan, he can go to one of the other plans that is a better fit for him and his family. We are talking about using the same principles that have worked for Members of Congress for many years.

I believe that middle-class folks, as they try to sort through this debate, are going to be looking at a handful of fairly straightforward principles. They are going to want to be wealthier, they are going to want to be healthier, they are going to want coverage they can take with them from job to job.

We have had 7 million people laid off since this recession; 3 million of them do not have health care. What happens to them is they go into a program called COBRA. COBRA is the only Federal program named after a poisonous snake. Given how hard it is for people to afford that coverage and all the bureaucracy for employers and employees, we can do better by both workers and employers. Let's make coverage seamlessly portable. Senator Bennett and I have included that in our Free Choice proposal. On day one, more choices for the middle class. On day one, the opportunity to save money. If you don't like the first plan, choose one of the other plans. On day one, coverage that is portable. That is what I think middle-class folks are looking for.

That kind of market competition is what the Congressional Budget Office has scored as actually producing savings in the private sector, not in 10 years, not in 15 years, but in a matter of 2 or 3 years. It actually bends the cost curve downward without exploding the debt and the deficit.

I hope my colleagues on the Finance Committee and here in the Senate and on the HELP Committee--I had a very constructive conversation about the Free Choice proposal with Chairman Dodd recently. I hope colleagues will see this is an approach that can win bipartisan support.

The guarantee of choice is a bedrock principle in President Obama's agenda. For the middle class who is asking now how this is going to work, this is the path that is going to let middle-class people be wealthier, healthier, and protected when they lose their job or if they want to get another opportunity. I am very hopeful that this bedrock principle of President Obama's agenda for fixing health care can win the support of colleagues on both sides of the aisle because I think that is the pathway to responding to the question middle-class people are asking all over this country today: How we are going to make this work for them?

I hope colleagues who have additional questions about it will see my friend from Utah or me. We will be happy to discuss it with them further.

Mr. President, I yield the floor.

Mr. President, I wish to take an additional minute. I thank my friend from Utah.

What is striking about this debate is the opportunity to bring both sides together. As I outlined the Free Choice approach and the pathway to savings for middle-class folks--portable coverage, incentives for prevention--it could work its way into a variety of different bills that are being considered. Obviously, Senator Bennett and I feel very strongly about our legislation, the Healthy Americans Act, but I was very pleased with the discussion I had the other night over dinner with the distinguished Senator from Connecticut, the chairman of the HELP Committee, who has some good ideas as well.

What I hope we will do, what Senator Bennett and I have sought to do lo these many months, is focus on some bedrock principles. I cited the three that have been important to President Obama: the question of holding down costs, ensuring choice, maintaining quality.

I believe--Senator Bennett and I have worked together on this--that our approach with Free Choice in particular making sure we don't have all these firewalls that would prevent choice for millions of Americans would--would actually reward Americans for shopping wisely.

I was very glad that both Chairman Baucus, who said he would look at our Free Choice proposal, and Chairman Dodd, the same openness at looking at our proposal, captured that this would be a way to carry out the President's agenda for addressing the questions middle-class people are talking about all over the country.

Obviously, Senator Bennett and I--and I am very pleased the distinguished Senator from Delaware has joined us. He is certainly a veteran of the Senate and what it takes to come up with bipartisan coalitions. I am very pleased to be on the floor with two good friends who know a lot about health care and what it takes to build bipartisan coalitions.

What I wanted to do was to say that in addition to our legislation, which we obviously feel strongly about, this concept of Free Choice and making sure you reward individuals, as we do in so many areas of American life, could really pay off quickly for middle-class people in terms of savings and access to quality health care.

I am very hopeful that as we go into these last couple of weeks before the recess--and we have offered this proposal to Chairman Baucus, the chairman of the committee on which I serve--Democrats and Republicans can come together so that before the August recess, we will have at a minimum identified some ideas.

Our Free Choice proposal is just one that will allow us through the month of August to show middle-class people that we are serious about their concerns.

Right now they are trying to sort this debate out. Suffice it to say, they see a lot of arguing in Washington, DC. They hear a lot of the discussion about health care, which almost sounds like gibberish when you listen to all the technical lingo. If we can come back with ideas such as Free Choice and say: Look, middle-class people, you and your family can be part of a system that is very similar to what my family enjoys--and it has paid off for my family at the beginning of the year when I was choosing a plan that is more economical for me, or rewards prevention--then we get behind proposals that bring Democrats and Republicans together. I point out this is one area that the budget office has indicated will actually score substantial savings--not in 10, 12, 14 years from now, but in the second year after it is fully implemented.

I thank my colleague from Utah for all his support and counsel.

I yield the floor.

I ask unanimous consent to speak in morning business for up to 15 minutes.

Mr. President, I came to the floor this morning to take a few minutes to reflect on this week's developments on the issue of health care reform. For me, the week began with an inspiring essay by the man who has led the crusade for fixing American health care for more than 40 years, the man who continues to lead this body in our efforts to fix health care. I am referring to the wonderful essay by Senator Kennedy. I encourage all Senators to read his article because, as usual, Senator Kennedy lays out the challenge ahead. He says on the front page of the magazine, ``We're Almost There.'' That might be a little much for some folks, given the developments of the week, but as usual, there is a lot of validity in what Senator Kennedy has written in Newsweek magazine.

There is widespread agreement on some very significant areas of health care policy. For example, we have bipartisan support in the Senate for fundamentally changing the inhumane model of private health insurance.

Today, private health insurance is essentially about cherry-picking. It is about going out and finding the healthy people and sending the sick people over to government programs more fragile than they are. There is widespread agreement that needs to be changed. For example, 15 Senators are on legislation that would make it illegal to discriminate against those with preexisting illnesses. That is a fundamental change, a dramatic change in the way the insurance industry does business. Democrats, Republicans, both major committees--the committee Senator Kennedy chairs, the committee led by my chairman, Max Baucus--Democrats and Republicans support fundamental changes in the way private health insurance operates. If someone had told me 3 years ago that there would be such strong bipartisan support for fundamentally altering the model of how private health insurance is sold in our country, I probably would have asked them what hallucinogenic substance they were smoking. But it is an indication, as Senator Kennedy writes in his article, that we have made a lot of progress.

Suffice to say, as Senator Kennedy notes again, there is a lot of heavy lifting to do. In particular, if we go to the President's Web site, the three areas he is focused on are lowering costs, increasing choices, and maintaining quality. Those are the three areas the President has focused on, very correctly. Those are the three areas on which our President has made clear he is going to spend his political capital. This is what he is going to use his bully pulpit for. This is what he is going to put in these killer hours for. Having met with him recently, I can tell my colleagues that President Barack Obama is making that kind of effort with his political capital, using the bully pulpit, and putting in the hours to get the job done.

With respect to lowering people's premiums and lowering costs, one of the areas the Congressional Budget Office has said will generate real savings in the next few years is increasing individual choice, giving all Americans the opportunity, as we have in the Congress, to choose from a variety of plans--big plans, where we spread cost and risk, where they can't discriminate. When an individual makes a wise selection from one of those plans, the individual puts that money in their pocket. That is what the budget office folks have said they will score as real savings for the system, for people's individual premiums in the next few years.

The challenge for our committees is that in many respects, these bills don't give all Americans free choice. They don't give all Americans the choice the Senator from Virginia has--I note the presence of the distinguished leader from Kentucky--these bills don't give all Americans the kinds of choices we have as Senators. Choice and the requirement that companies compete for people's business is what competition is all about. It is what holding premiums down is all about.

I have developed legislation called the free choice proposal. It protects the employer-based system on which we know well over 150 million Americans rely. It also gives us a chance to improve on it. It creates more options for employers and for employees to hold costs down. For employers, our free choice proposal gives them more leverage with their insurance company so they can tell their insurer: I have done business with you for a lot of years. You better give me a better deal or I will take my business somewhere else.

It also says to an employer--hypothetically, in Virginia, Oregon--if you want to take all of your employees to what is called the insurance exchange, kind of a farmers market arrangement, the employer would have the ability to take their workers to the exchange, and the employer could get a discount for doing that against strengthening the employer's role in the effort to hold down cost.

For the worker, what it means is, for example, in Virginia or Oregon, if your employer's share of your health care coverage is, say, $13,000 and you can find a plan on the insurance exchange for $12,000, the $1,000 goes into your pocket. Again, you get a financial reward for shopping. Members of Congress get to shop. I would like to see everybody get to shop, everybody have those individual choices.

It is also good for the system because right now, really since the 1940s, since the middle of the last century, the individual has been disconnected from the health care system. The individual does not get many choices. Eighty-five

percent of the employers who offer health care coverage do not offer choice--not because they are evil. They would love to do it. They cannot afford it. The administrative costs are too crushing.

So, again, if we get employers and employees into these larger systems, where they will have clout in the marketplace, there will be the ability for everybody to choose, not just folks who are unemployed or uninsured or small business, but give everybody, over the next few years, the ability to have these choices and be in a position to help drive more competition and more accountability and hold down their premiums in the private sector.

We can do that on a bipartisan basis. We have 15 Senators of both political parties on legislation that does it now. It could fit with the structure of several of the bills that are being considered. We can do this, as Senator Kennedy suggests in his wonderful essay, on a bipartisan basis. Both Democrats and Republicans have a good point.

I believe my party is right on the issue that you cannot fix this system unless you cover everybody. The reason that is the case is, you cannot build a market unless you cover everybody. Unless you cover everybody, there is too much cost shifting. The people who are uninsured shift their bills to the insured.

But my colleagues on the other side of the aisle--the distinguished leader from Kentucky and I have had this conversation on a number of occasions--they have valid points too. The Congress ought to be very careful about freezing innovation, about restricting private choice, about setting up price controls.

There is the sweet spot for a bipartisan bill: Democrats with good ideas, as Senator Kennedy lays out in his wonderful essay, about expanding coverage; Republicans bringing creative ideas to the table about innovation and choice. Both sides have some valid points. That is what Senator Kennedy is saying in his wonderful essay.

I see the leader on the floor. I hope colleagues will go to our Web site. That is where we lay out this free choice proposal. I think it is consistent with the idea of not blowing up the employer-based system but not saying we cannot improve on it. It gives new tools to both employers and employees to hold down costs. It ensures that all Americans will have choices, not just some.

I submit to colleagues, if folks in Virginia and Kentucky and Oregon come away from this and say that only some people got choices, that is not going to go down very well. Let's do what the President says on his Web site and give all Americans choices--choices such as we have in Congress from these big insurance pools, where you cannot discriminate and you have some leverage in terms of holding costs down.

It has certainly been a tumultuous week on this health care issue. But I hope colleagues, this weekend, will pick up a copy of Newsweek and read the inspiring essay by Senator Kennedy, who has led our body for more than 40 years--led the country--on this issue, and continues to lead us because there is a lot for us to build on now to finally end this injustice that we have not been able to fix our system so we hold costs down and all Americans get good, quality, affordable coverage. We can do it. We can do it this year, on the President's timetable, by working together.

Mr. President, with that, I yield the floor.

I believe 10 minutes would be plenty.

Madam President, I rise this morning to support the Levin- McCain amendment. It seems to me that buying more F-22s at this point would meet the very definition of government waste.

What you have is a situation where the Pentagon, which, suffice it to say, has not exactly been shy over the years in terms of calling for additional weapons, is on record as saying this is unnecessary. Further, I have been out talking with members of the Guard at home and trying to get their sense of what is needed in this dangerous time, and they have never once mentioned something like this.

They talk, for example, about body armor. They talk about boots. They don't talk about more F-22s. Suffice it to say, when the Congress is now having a debate about trying to find additional money for health care, for example, to go out and spend close to $2 billion to buy seven more F-22 fighters the Air Force says it doesn't want defies common sense.

My home State, for example, would love to hire back police and other essential workers who have been laid off. Instead of building seven planes, we could be restoring infrastructure and developing renewable energy. Again, in my home State, we have had budget shortfalls. We have seen reductions in essential services, law enforcement being one. The debate is not about necessary steps to ensuring a strong national defense. The question is about whether the U.S. Congress wants to spend close to $2 billion to pay for more fighter jets the Air Force does not want.

It is also important to remember that the F-22 is not being purchased for wars the United States is currently fighting. Certainly, the Taliban and Iraqi insurgents do not have an Air Force. The F-22 is being purchased to fight in possible future conflicts with other countries that may have an air force. While I strongly believe the Pentagon ought to be able to prepare for such possibilities, it is the Pentagon that is telling us we don't need these additional F-22s.

It is also important to note that the Pentagon has purchased 187 F- 22s. There is not a debate about whether the United States ought to have fighters in our arsenal. The question is whether the Air Force needs 194 of them instead of 187. We have a very good Secretary of Defense, Robert Gates. The Secretary has said that 187 is sufficient to combat current and future threats. He is the one who said that more are not needed. He is the one who said:

We must break the old habit of adding layer upon layer of

cost, complexity, and delay to systems that are so expensive

and so elaborate that only a small number can be built, and

that are then usable only in a narrow range of low

probability scenarios.

Secretary Gates has hit the nail about as perfectly on the head as one can. He and our country want the strongest defense possible. But there are ways to make better use of that $1.75 billion than on seven more F-22s.

I serve on the Senate Select Committee on Intelligence. I know there are threats to our forces every single day. I see the Senator from Georgia who serves on the Intelligence Committee. He believes strongly about this as well. We need to make sure we are protecting our troops in harm's way, but we have a variety of choices in order to secure the protection our troops have been in need of. I intend to work with Chairman Levin, Secretary Gates, the distinguished Senator from Arizona, and the President to ensure we replace the current F-15 with more capable and safer fighters.

Last month, I visited with some of the 3,000 members of the Oregon National Guard's 41st brigade combat team, as they trained for their current deployment to Iraq. Not a one of the soldiers told me that their big concern was whether the Air Force would have 194 F-22s instead of 187. They talked to me instead about the best vehicles, the best medical care if they are injured, about the best body armor. Not one of them mentioned the F-22.

I am not voting against the F-22. I am voting for the soldier, the taxpayer. They both deserve our government's greatest protection at this critical time in our history.

I urge colleagues to support the Levin-McCain amendment.

I yield the floor.

Mr. President, these days the country's attention has rightly been focused on turning its financial fortunes around and getting people back to work. The President, his advisers, folks in the agencies, and in Congress have been working night and day to find the solutions that will help the nation climb out of the financial hole it is in.

I would like to point out that there is one portion of the American Recovery and Reinvestment Act that is doing just that, but it is not getting a lot of attention. It is a creative solution. It is putting jobs back in our economy. And, most importantly, it is working.

The Build America Bonds portion of the Recovery Act has been a great success, allowing State and local governments to issue more than $9.5 billion worth of these innovative bonds. They have already begun shoring up our infrastructure and putting jobs back in communities where times are tough. That $9.5 billion of investment supports more than 3,000 jobs.

Build America Bonds have been such a quiet success, so some of you might not be familiar with what they do. The provision that ended up in the Recovery Act is based on a bill that, first Senator Talent, and now Senator Thune and I have been working on for a number of years.

As included in the economic recovery package, the Build America Bonds provision allows any State or local government that can issue tax exempt bonds to issue what are called Build America Bonds. These bonds can offer either a tax credit for investors or a Federal subsidy to issuers, of 35 percent of the interest earned over the life of the bond.

The bonds can only be issued through the end of 2010, but during that time there is no limit on the number or amount of Build America Bonds that can be issued. One of the reasons I am talking to my colleagues today about them is that the clock is ticking on that deadline, and I want to make sure every Senator here knows how much Build America Bonds can benefit the folks back home. The end of 2010 will be here before you know it.

As communities deal with the recession, they need new tools to finance essential construction projects. Build America Bonds has put a new tool in their toolbox.

Before these bonds started being issued, the market for normal municipal bonds was frozen. It was very hard to sell municipal bonds, but that didn't mean the need for financing infrastructure wasn't still there.

Tax credit bonds, in the form of Build America Bonds, were designed to help thaw the bond markets.

And it has worked. They are selling like hotcakes.

Tax-exempt or tax-deferred investors, such as pension funds and IRAs, aren't usually interested in municipal bonds. But by providing the option of a direct payment instead of tax-exempt interest, Build America Bonds have opened up new markets for State and local governments.

I am not surprised that Build America Bonds are proving to be very attractive to investors. They are a good deal for both the investors and our communities. They have freed up financing for badly needed infrastructure construction and created jobs and a foundation for long- term economic growth.

So far, more than $9.5 billion worth of Build America Bonds have been issued, making it easier and cheaper for cash-strapped State and local governments to access capital and grow jobs. The State of California, the New Jersey Turnpike Authority, the University of Virginia, and the Milan Area School District in Michigan are just some of the issuers of Build America Bonds since the passage of ARRA.

Build America Bonds have earned support from organizations across the country that understand how the urgent need is to shore up our infrastructure and create jobs: the American Association of State Highway and Transportation Officials, the Chamber of Commerce, and the National Association of Manufacturers. I appreciate that support.

We recently had another positive milestone in the story of Build America Bonds. The Treasury Department gave cities and counties around the country the authority to issue $10 billion worth of Recovery Zone Build America Bonds.

Recovery Zone Bonds are like Build America Bonds. They provide a Federal tax credit to the buyer or a subsidy to the issuer, but with an even more generous subsidy of 45 percent of the interest.

Only areas hurt by the weakened economy can issue these bonds. They are very targeted to the places they can do the most good. Treasury allocated them based on employment declines in 2008. So the harder an area has been hit, the more Recovery Zone Build America Bonds it can issue, creating jobs where they are needed most.

In some cases, these bonds will make the difference between whether these projects come to fruition or not. In other cases, they will lower the cost of projects and allow the community to reinvest those savings in other projects.

As with the regular Build America Bonds, Recovery Zone bonds are only authorized under current law through the end of 2010.

That is why I am encouraging State and local governments that are going to issue bonds to sit down and do the math so they can see if Build America Bonds will work for them. And if they do, I encourage those governments to take advantage of them while they are available. There is no time like the present to strengthen the Nation's infrastructure and our communities with the jobs folks back home need.

I also encourage my colleagues in Congress to begin working now to continue the success of Build America Bonds. As Congress struggles to find funding for a new transportation bill, innovative approaches like Build America Bonds should be part of the solution. Recently, the Obama administration has proposed delaying the Transportation reauthorization bill for 18 months. If that were to happen, and I hope it doesn't, Build America Bonds could provide additional funding to bridge the gap between our Nation's transportation needs and current funding levels.

Mr. President, I hope my colleagues in Congress will also look into the benefits of Build America Bonds and ensure these unsung financial tools will continue to work helping their constituents and their communities from coast to coast. They are effective. They give benefits to both those who issue them and those who buy them. And most of all, they solve the kinds of problems that affect the daily lives of every American.

Build America Bonds are an example of the creative solutions people are looking for Congress to implement during these uncertain economic times. I urge my colleagues and your constituents to use them.

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

Mr. President, as the Congress focuses on health care reform, I wanted to take a few minutes to discuss one approach that has been documented by the Congressional Budget Office as producing significant cost savings in American health care. That approach is free choice and rewards for selecting health care wisely.

Today, 85 percent of American businesses that offer health care coverage offer no choices. That is not because they would not like to. Quite the contrary; they would very much like to offer additional private sector choices. But for example, if you are a small businessperson--and I know the distinguished Senator from Alaska identifies with this--and you go out into that broken private insurance market, with huge administrative costs very often approaching 30 percent, you can't offer choices. Without choices there can't be real competition and accountability in health care. As a result, costs go up and care for our workers and our employers and small businesses and others becomes less affordable.

Some in America enjoy a better system, one where they have a full array of private sector health care choices.

Everyone in this Chamber knows what that is all about because it is the system we have as Members of Congress. We get a menu--a menu of private health plan offerings. The plans that are offered to Members of Congress can't discriminate, for example, against someone with a preexisting illness.

You go into a large group where you have a lot of bargaining power, which means you can hold down costs, and you don't face discrimination on the basis of age. That is particularly important because it looks as if under some of the approaches that are being discussed in the Congress there could be significant discrimination against older workers.

I believe all Americans should have the opportunity to be part of a health care system where they have more choices, and they are in a position to benefit from the wise selection of those kinds of choices. I think that will lead to reduced costs, and I think it will lead to more affordable health care coverage.

The legislation that is being developed in the Congress would not allow most people to have the free choice of insurance exchange plans. In fact, it wouldn't allow them to have free choice of health plans generally, whether they are in a private plan or a public plan. Without choice, there won't be competition to hold down costs.

So I very much hope in the weeks ahead Democrats and Republicans alike will come to see what the Budget Office has documented, and that is free choice of an increased menu of private sector health care-- where the insurance companies can't cherry-pick, where they can't discriminate against someone with a preexisting illness, where people would go into a large group, and where you don't have older workers being discriminated against--will hold down skyrocketing health care costs and help keep quality health coverage affordable. I would hope Democrats and Republicans would see that kind of approach, with expanded choices, would help hold down health care costs and make health care more affordable for our people.

The reason I have focused on this question of holding down costs, making coverage more affordable by expanding choices--free choice, as I call it--is in light of the discussion we have held this week in the Senate on the costs of health care reform.

I note my friend from Utah, Senator Hatch, is here. He is someone who has, in my view, done so much good work on health care for children, for community health centers, for a variety of needs in our country. He and I participated in discussions, particularly in the Senate Finance Committee, about how to come up with additional money to expand coverage, particularly for the more than 45 million Americans who don't have coverage.

The Finance Committee is going to continue to grapple with this issue, but I only wanted to talk about cost savings through free choice today because I believe that is what most Americans look at first.

Most Americans feel very strongly that they want to get all our people covered. They know it is a disgrace that, in a country as rich and strong and good as ours, that close to 50 million people do not have coverage.

But they are also very concerned about the idea that, when you are already spending $2.5 trillion annually on health care, before you go out and spend a trillion dollars or more to pay for expanding coverage, you better have a plan to save money through choice, through the kinds of approaches I have been talking about in order to be credible. It is not credible to go to the American people and say we need $1 trillion or more to expand coverage, expand coverage and pay this huge sum on top of the $2.5 trillion being spent today, unless you have an actual plan to hold down costs and generate savings.

That is why I hope the Democrats and Republicans will look at how the Congressional Budget Office has documented that, through choice, you can generate significant cost savings and make health care more affordable.

I am concerned that the point I have made this morning has gotten a bit lost as the focus this week has been on the question of paying this very large additional sum to finance coverage expansion. There is no question that at a time of soaring deficits, the Congress must pay attention to what it costs to pay for health reform.

It would be fiscally irresponsible to pass health reform that is not paid for. But it would be equally irresponsible to pass a bill that is labeled health reform that fails to put a lid on the skyrocketing costs of our health care system. The two go hand in hand.

So what will provide significant savings? All the experts agree that we need to change incentives and behavior to change how people buy and use their health care.

First, show that you can generate cost savings for all Americans through increasing choice and rewarding those who make a wise selection of their coverage. That, in my view, ought to be built around what the Congressional Budget Office has documented, which is savings through an approach very much like what Members of Congress have. If you do that first, then you have the credibility to go back and say to the American people: Here are the choices in front of us for expanding coverage to the close to 50 million people who do not have it today.

What I have tried to describe this morning is a way to keep faith with the small business owners who are across this country, from Coos Bay, OR, to Oyster Bay, Long Island. Let's keep faith with them by showing we are going to hold down costs and then also, in a bipartisan way, come together and grapple with the question Senator Hatch and I were discussing with our colleagues this week, which is how to best and most responsibly finance coverage for the close to 50 million Americans who do not have it. I believe we can do it. I believe the approach I have outlined this morning is one path to do it.

I have never said, in the course of health reform debates, that it is my way or the highway. But I think we certainly ought to learn from the constructive analyses done by the Congressional Budget Office that show it is possible to get hard cost savings, not within a decade but within a matter of years, by expanding choices for our people and rewarding those who make a wise selection from that menu of choices.

I yield the floor.

Mr. President, I have unanimous consent requests to make. Before I do that, I wish to say, again, how much I appreciate the Senator from Utah and his involvement and particularly his leadership on health care issues. When you look at the array of important legislation that has clearly improved American health care, Senator Hatch's name is all over that legislation.

Think about landmark legislation for children. It could not have happened without Senator Hatch. He and I have written legislation together. One of the accomplishments of which I am most proud is that we found a bipartisan way to increase coverage for community health centers by lowering their malpractice costs. I think it was an example of the way Senator Hatch approaches that kind of legislation. He brought together advocates of low-income people, trial lawyers, community health centers. Everybody said you could not find common ground among those kinds of organizations, and with Senator Hatch's leadership we were able to do it.

I am going to make a unanimous consent request, but I wish to tell the Senator from Utah I am convinced this year we are going to be able to pass health reform. One of the reasons we are going to be able to do it is because of both the good will and the expertise of the Senator from Utah. I am very

much looking forward to working with him on that.

Mr. President, I rise today to introduce the U.S. Outdoor Act. no denying that this economy has got Americans worried. People are stressed, and with good reason. One thing that we see time and again during recessions is that people look to get their minds off the tough times for just a little while with low-cost, simple activities that the whole family can enjoy. Outdoor recreation fits that bill; it makes people healthier and happier too.

But recreational performance outerwear--jackets and pants used for skiing and snowboarding, mountaineering, hunting, fishing, and dozens of other outdoor activities--are assessed some of the highest duty rates applied to any products imported into the U.S. These disproportionately high tariffs, let us call them what they are, taxes, were originally implemented to protect U.S. outerwear manufacturers from foreign competition. Instead, now these import taxes stifle innovation, add substantial costs for outdoor businesses, and ultimately raise the prices we all pay at the cash register. We can fix this, help these companies to better compete globally while investing in eco-friendly technology and jobs here in the U.S., and help consumers in these tough times so more people can get out and enjoy the great outdoors.

So today, I am proud to introduce the U.S. Optimal Use of Trade to Develop Outerwear and Outdoor Recreation Act, or the U.S. Outdoor Act. This bill is the result of partnership between performance outerwear manufacturers and the domestic textile and

apparel industry. In 2007, the U.S. International Trade Commission found that there was no commercially viable production of performance outerwear in the U.S.. This legislation reflects those findings, and makes a solid investment in U.S. jobs. It spurs outdoor recreation and its industry, which accounts for $730 billion dollars and 65 million jobs across the U.S., with 73,000 jobs in Oregon, and this bill can potentially create many more. This would also help lower costs for consumers, who pay $289 billion in outdoor retail sales and services across the country, with $4.6 billion in Oregon.

The U.S. Outdoor Act eliminates the import duty for qualifying recreational performance outerwear, bringing duties that can be as high as 28 percent down to zero. It also establishes the Sustainable Textile and Apparel Research, STAR, fund, which invests in U.S. technologies and jobs that focus on sustainable, environmentally conscious manufacturing, helping textile and apparel companies work towards minimizing their energy and water use, reducing waste and their carbon footprint, and incorporating efficiencies that help them better compete globally.

The U.S. Outdoor Act reduces the costs for U.S. companies and consumers, encourages Americans to take part in healthy and active lifestyles through outdoor recreation, spurs economic activity, invests in the U.S. textile industry, supports American jobs and competitiveness, and encourages sustainable business practices to benefit the environment so we all can continue to enjoy the beauty that is the great outdoors.

I want to thank the Outdoor Industry Association, for their tireless work with my office, and with the U.S. ITC and other agencies in perfecting this bill. I also want to acknowledge and thank those in the U.S. textile and apparel industry who have partnered with the outdoor industry to develop a thoughtful and well balanced bill that supports American jobs and U.S. technologies. I thank my house colleague, Congressman Blumenauer, who had introduced an earlier version of this bill in the last Congress and is introducing companion legislation. Finally, thank you to my Senate colleagues, Senator Crapo, who is an original cosponsor of this bill, Senator Cantwell, Senator Enzi, and Senator Schumer.

Mr. President, I rise today to introduce the U.S. Outdoor Act. no denying that this economy has got Americans worried. People are stressed, and with good reason. One thing that we see time and again during recessions is that people look to get their minds off the tough times for just a little while with low-cost, simple activities that the whole family can enjoy. Outdoor recreation fits that bill; it makes people healthier and happier too.

But recreational performance outerwear--jackets and pants used for skiing and snowboarding, mountaineering, hunting, fishing, and dozens of other outdoor activities--are assessed some of the highest duty rates applied to any products imported into the U.S. These disproportionately high tariffs, let us call them what they are, taxes, were originally implemented to protect U.S. outerwear manufacturers from foreign competition. Instead, now these import taxes stifle innovation, add substantial costs for outdoor businesses, and ultimately raise the prices we all pay at the cash register. We can fix this, help these companies to better compete globally while investing in eco-friendly technology and jobs here in the U.S., and help consumers in these tough times so more people can get out and enjoy the great outdoors.

So today, I am proud to introduce the U.S. Optimal Use of Trade to Develop Outerwear and Outdoor Recreation Act, or the U.S. Outdoor Act. This bill is the result of partnership between performance outerwear manufacturers and the domestic textile and

apparel industry. In 2007, the U.S. International Trade Commission found that there was no commercially viable production of performance outerwear in the U.S.. This legislation reflects those findings, and makes a solid investment in U.S. jobs. It spurs outdoor recreation and its industry, which accounts for $730 billion dollars and 65 million jobs across the U.S., with 73,000 jobs in Oregon, and this bill can potentially create many more. This would also help lower costs for consumers, who pay $289 billion in outdoor retail sales and services across the country, with $4.6 billion in Oregon.

The U.S. Outdoor Act eliminates the import duty for qualifying recreational performance outerwear, bringing duties that can be as high as 28 percent down to zero. It also establishes the Sustainable Textile and Apparel Research, STAR, fund, which invests in U.S. technologies and jobs that focus on sustainable, environmentally conscious manufacturing, helping textile and apparel companies work towards minimizing their energy and water use, reducing waste and their carbon footprint, and incorporating efficiencies that help them better compete globally.

The U.S. Outdoor Act reduces the costs for U.S. companies and consumers, encourages Americans to take part in healthy and active lifestyles through outdoor recreation, spurs economic activity, invests in the U.S. textile industry, supports American jobs and competitiveness, and encourages sustainable business practices to benefit the environment so we all can continue to enjoy the beauty that is the great outdoors.

I want to thank the Outdoor Industry Association, for their tireless work with my office, and with the U.S. ITC and other agencies in perfecting this bill. I also want to acknowledge and thank those in the U.S. textile and apparel industry who have partnered with the outdoor industry to develop a thoughtful and well balanced bill that supports American jobs and U.S. technologies. I thank my house colleague, Congressman Blumenauer, who had introduced an earlier version of this bill in the last Congress and is introducing companion legislation. Finally, thank you to my Senate colleagues, Senator Crapo, who is an original cosponsor of this bill, Senator Cantwell, Senator Enzi, and Senator Schumer.

Mr. President, I ask unanimous consent the Senate proceed to the immediate consideration of H. Con. Res. 131 at the desk and just received from the House.

Mr. President, I ask unanimous consent that the concurrent resolution be agreed to, the motion to reconsider be laid upon the table, and that any statements relating to the concurrent resolution be printed in the Record, without intervening action or debate.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of H. Con. Res. 135 at the desk, just received from the House.

Mr. President, I ask unanimous consent that the concurrent resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid upon the table en bloc, and that any statements relating to the concurrent resolution be printed in the Record, without intervening action or debate.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 88, S. 1107.

Mr. Presdient, I ask unanimous consent that the bill be read a third time and passed, the motion to reconsider be laid upon the table, with no intervening action or debate, and that any statements relating to the bill be printed in the Record.

Mr. President, I ask unanimous consent that the Judiciary Committee be discharged from further consideration of S. 1289, and the Senate proceed to its immediate consideration.

Mr. President, I ask unanimous consent that the bill be read a third time and passed, the motion to reconsider be laid upon the table, with no intervening action or debate, and that any statements relating to the bill be printed in the Record.

Mr. President, along with my friend, Senator Barrasso, I am introducing legislation to keep rural America from becoming a health care sacrifice zone. Our legislation, the Rural Health Clinic Patient Access and Improvement Act, will make it more financially attractive for doctors and other providers to treat patients in rural areas. Both Senator Barrasso and I have heard from the folks back home about how hard it is to get doctors and mid-level practitioners in rural areas. My constituents have had to travel hours to get treatment when they need it. This bill takes major strides to ensure access to health care by building on the successes of the rural health clinic program. When it comes to health care, rural residents should not have to accept second-class status.

As the Senate takes up comprehensive healthcare reform, this Congress must not lose focus on the health needs of folks in rural areas. Too many Oregonians cannot get the kind of affordable and comprehensive coverage or access to care their Members of Congress receive. In addition, many patients in rural Oregon, even those with good health benefits, do not have access to providers or have to travel long distances to get medical care.

Meanwhile, providers lack incentives to go to--or stay in--rural areas. It is a lot more lucrative for them to work in big cities where they can work in state-of-the art facilities and earn top dollar. According to the Oregon State Office of Rural Health, a major obstacle facing Oregon's rural health clinics is the severe shortage of health care providers willing or able to work in a rural area. One out of three Oregon rural health clinics was recruiting in 2008.

That is why Senator Barrasso and I come here to introduce the Rural Health Clinic Patient Access and Improvement Act. Simply put, our bill would help improve access for patients in rural areas, while increasing reimbursement rates and giving incentives to providers in rural areas.

The Rural Health Clinic Patient Access and Improvement Act increases the all-inclusive Medicare payment rate for rural health clinics by more than 20 percent per visit from an average of $76 to $92. This bill would provide an additional $2 bonus for rural health clinics that participate in a quality improvement program. Quality of care should be a focus for all providers.

The bill will allow for better collaboration between community health centers and rural health clinics. It also creates a 5-state demonstration project to recruit and retain providers in rural communities by subsidizing a portion of the provider's medical liability costs if they practice in a rural health clinic. These reforms will help ensure rural residents have access to the same level of quality care as those in other parts of the country.

This bill builds upon the success of Oregon's 54 rural health clinics that serve 26 out of 36 counties across the state. These rural health clinics help to ensure access to primary care for the underserved elderly and low-income populations. Ninety-eight percent of Oregon's rural health clinics are willing to see Medicare and Medicaid patients as well as patients with no insurance. Not only are they willing to see these patients, but 96 percent are currently accepting new patients. Many rural residents--whether they are uninsured, publically insured or have private insurance--would have nowhere to go to receive primary care without rural health clinics.

When it comes to health care, people want to go to a provider they know and trust. One of the reasons rural health clinics have been so successful is that they have become an integral part of their communities. A great example of this is Gilliam County Medical Center. Gilliam County hosted a succession of short-term physicians placed in the community through the National Health Service Corps. In the 1970s, the community, in conjunction with the State, sought a more permanent, stable health care provider situation. The Oregon legislature appropriated $20,000 as seed money to attract a team of health professionals to the community and the residents of Gilliam County created the South Gilliam Health District to support Gilliam County Medical Center, a certified rural health clinic.

Two physician assistants, David Jones and Dennis Bruneau who were on the faculty at the University of Washington PA program at the time they heard about the opportunity with the clinic were hired. Dave, Dennis, their spouses, who also work at the clinic, and supervising physician Dr. Bruce Carlson created a team that continues to sustain one of the most stable and long-term small rural primary care clinics in the state.

Dr. Carlson visits the clinic one day every 2 weeks to see those patients in need of his services and provide overall medical direction. Otherwise, the clinic is staffed full-time by physician assistants Jones and Bruneau. David's wife is a medical technician who works in the clinic and Dennis' wife serves as the clinic manager. When Dr. Carlson is not in Condon, he has his own medical practice 70 miles away in Hermiston, OR, which is also the location of the nearest hospital to Condon.

Not all rural areas are alike and the rural health clinic program gives these providers the flexibility they need to be the regular source of care of primary care in their communities. Regular access to primary care, as you know, is one of the key tests of whether or not you will receive the preventive health screenings that can mean the difference that could save your life. They allow for health problems to be caught early on so that they can be headed off for just a little money, instead of at later stages, which require costly specialty care that runs up the bill for the patient and the taxpayer.

Oregonians in rural areas have the same right to quality, affordable medical care as those living in urban areas, but they do not have it under our current system. This bill will expand access to health care for folks in rural areas and level the playing field for rural health clinics by giving them the tools they need to attract and retain quality medical providers.

I want to thank Senator Barrasso and his staff for their hard work in bringing this important bipartisan legislation before the Senate.

I hope my colleagues will join Senator Barrasso and me, and support this much needed and bipartisan bill.

Mr. President, today I am introducing a bill to amend the Wild and Scenic Rivers Act to designate segments of the Molalla River as Wild and Scenic. I am pleased to be introducing this legislation with my colleague from Oregon, Senator Merkley. This legislation has already been introduced by Representative Schrader in the House, who is a champion for protecting the river. The Molalla River Wild and Scenic Rivers Act of 2009 will designate an approximately 15.1-mile segment of the Molalla River, and an approximately 6.2-mile segment of Table Rock Fork Molalla River as a recreational river under the Wild and Scenic Rivers Act.

The Molalla River Wild and Scenic Rivers Act protects a popular Oregon destination that provides abundant recreational activities all of which take place among the abundant wildlife that call this area home. The scenic beauty of the Molalla River provides a backdrop for hiking, mountain biking, camping, and horseback riding, while the waters of the river are a popular destination for fishing, kayaking, and whitewater rafting enthusiasts. My bill would not only preserve this area as a recreation destination, but would also protect the river habitat of the Chinook salmon and Steelhead trout,

along with the wildlife habitat surrounding the river, home to the northern spotted owl, the pileated woodpecker, golden and bald eagles, deer, elk, the pacific giant salamander, and many others.

The Molalla River is not only an important habitat for wildlife and a popular northwest recreation destination, but it is also the source of clean drinking water for the towns of Molalla and Canby, Oregon. Protecting the approximately 21.3 miles of the Molalla River will provide the residents of these Oregon towns with the assurance that they will continue to receive clean drinking water, and will provide all the people of the Pacific Northwest and beyond the knowledge that this important natural resource will be preserved for continued enjoyment for years to come.

I want to express my thanks to the Molalla River Alliance--a coalition of more than 45 organizations that recognize that this river is a jewel. Michael Moody, the President of this Alliance, made sure that irrigators, city councilors, the mayor, businesses and environmentalists all came together on this. I look forward to working with Senator Merkley, Representative Schrader, and the bill's supporters to advance this legislation to the President's desk.

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

Mr. President, today I am introducing legislation that I hope will enable our national intelligence agencies to increase their employees' proficiency in critical foreign languages. I have been a member of the Senate Intelligence Committee for over eight years, and during that time I have sat in a number of briefings and hearings that addressed foreign language capabilities. While specific details regarding the intelligence community's capabilities are generally classified, it is no secret that there is still a great need for more analysts and agents trained in key foreign languages. Over the past few years there have been a number of new initiatives designed to address this problem from different angles, and even newer initiatives are being introduced this year. The legislation that I am introducing today, which I have drafted along with Senator Chambliss of Georgia, is not designed to replace any of those initiatives--rather, we think it will complement those other initiatives by filling a key gap.

Let me explain this gap a little, so it will be clear what problem we are trying to fix. Most efforts to improve the language capabilities of various intelligence agencies focus on recruiting Americans who have a background in critical foreign languages--either from their education, or from their family. But this only attacks the problem from one angle. If you want the national security workforce to have the strongest language skills possible, you also need to improve language training for people who already work for the intelligence agencies. This means both teaching the basics of key languages to more people, and helping people who are already proficient improve their skills further. Unfortunately, language training is time-intensive, and this can mean that personnel are diverted from short-term priorities.

Here is an example of how this problem might crop up in practice. Imagine that you are the supervisor of a group of 10 people somewhere in the intelligence community, working on counterterrorism issues, and that one of those employees decides he wants to go spend several months in intensive language training to improve his Arabic. This would be a good career move for that individual, and a good long-term investment for your agency. But for you, the supervisor, it means that you might be short-handed for several months while one of your employees is off getting language training. Since you have a fixed number of positions available for your office, it is difficult for you to replace someone while they are gone. This means that as the supervisor you actually have an incentive to resist letting that employee head off for language training, since it will leave your team less well-equipped to meet short-term priorities.

I am not saying that all supervisors within the intelligence community are focused solely on short-term priorities, to the detriment of our long-term security interests. But I am saying that if we want our intelligence agencies to effectively balance short- and long-term priorities, we need to give them incentives that encourage them to do so, and not penalize people who try to balance short-term needs and long-term goals.

Here is how the bipartisan legislation that Senator Chambliss and I are introducing today would attempt to address this problem. Our bill would give the Director of National Intelligence the authority to transfer additional positions to offices whose personnel are

temporarily unavailable due to language training. The Director of National Intelligence is uniquely situated to evaluate which offices are most in need of these extra positions, and could transfer them to the places where they would do the most good.

So, to return to my previous example, if you were the supervisor of a young counterterrorism analyst who wants to take 6 months to go learn Arabic, you could go ask the Director of National Intelligence to transfer an extra position to your office for that 6 month period. That way, you could bring someone else in on a temporary basis to do that analyst's work while they are gone for training. The analyst and the agency would get the long-term benefits of additional language training, and you, the supervisor, would not have to sacrifice in the short-term.

Senator Chambliss and I do not claim that this legislation will revolutionize the intelligence community's language capabilities overnight. But it is our hope that it will make it easier than it is today for managers to balance short- and long-term priorities. If we can achieve that it will be good for our national intelligence workforce, and for our national security interests.

Mr. President, along with my friend, Senator Barrasso, I am introducing legislation to keep rural America from becoming a health care sacrifice zone. Our legislation, the Rural Health Clinic Patient Access and Improvement Act, will make it more financially attractive for doctors and other providers to treat patients in rural areas. Both Senator Barrasso and I have heard from the folks back home about how hard it is to get doctors and mid-level practitioners in rural areas. My constituents have had to travel hours to get treatment when they need it. This bill takes major strides to ensure access to health care by building on the successes of the rural health clinic program. When it comes to health care, rural residents should not have to accept second-class status.

As the Senate takes up comprehensive healthcare reform, this Congress must not lose focus on the health needs of folks in rural areas. Too many Oregonians cannot get the kind of affordable and comprehensive coverage or access to care their Members of Congress receive. In addition, many patients in rural Oregon, even those with good health benefits, do not have access to providers or have to travel long distances to get medical care.

Meanwhile, providers lack incentives to go to--or stay in--rural areas. It is a lot more lucrative for them to work in big cities where they can work in state-of-the art facilities and earn top dollar. According to the Oregon State Office of Rural Health, a major obstacle facing Oregon's rural health clinics is the severe shortage of health care providers willing or able to work in a rural area. One out of three Oregon rural health clinics was recruiting in 2008.

That is why Senator Barrasso and I come here to introduce the Rural Health Clinic Patient Access and Improvement Act. Simply put, our bill would help improve access for patients in rural areas, while increasing reimbursement rates and giving incentives to providers in rural areas.

The Rural Health Clinic Patient Access and Improvement Act increases the all-inclusive Medicare payment rate for rural health clinics by more than 20 percent per visit from an average of $76 to $92. This bill would provide an additional $2 bonus for rural health clinics that participate in a quality improvement program. Quality of care should be a focus for all providers.

The bill will allow for better collaboration between community health centers and rural health clinics. It also creates a 5-state demonstration project to recruit and retain providers in rural communities by subsidizing a portion of the provider's medical liability costs if they practice in a rural health clinic. These reforms will help ensure rural residents have access to the same level of quality care as those in other parts of the country.

This bill builds upon the success of Oregon's 54 rural health clinics that serve 26 out of 36 counties across the state. These rural health clinics help to ensure access to primary care for the underserved elderly and low-income populations. Ninety-eight percent of Oregon's rural health clinics are willing to see Medicare and Medicaid patients as well as patients with no insurance. Not only are they willing to see these patients, but 96 percent are currently accepting new patients. Many rural residents--whether they are uninsured, publically insured or have private insurance--would have nowhere to go to receive primary care without rural health clinics.

When it comes to health care, people want to go to a provider they know and trust. One of the reasons rural health clinics have been so successful is that they have become an integral part of their communities. A great example of this is Gilliam County Medical Center. Gilliam County hosted a succession of short-term physicians placed in the community through the National Health Service Corps. In the 1970s, the community, in conjunction with the State, sought a more permanent, stable health care provider situation. The Oregon legislature appropriated $20,000 as seed money to attract a team of health professionals to the community and the residents of Gilliam County created the South Gilliam Health District to support Gilliam County Medical Center, a certified rural health clinic.

Two physician assistants, David Jones and Dennis Bruneau who were on the faculty at the University of Washington PA program at the time they heard about the opportunity with the clinic were hired. Dave, Dennis, their spouses, who also work at the clinic, and supervising physician Dr. Bruce Carlson created a team that continues to sustain one of the most stable and long-term small rural primary care clinics in the state.

Dr. Carlson visits the clinic one day every 2 weeks to see those patients in need of his services and provide overall medical direction. Otherwise, the clinic is staffed full-time by physician assistants Jones and Bruneau. David's wife is a medical technician who works in the clinic and Dennis' wife serves as the clinic manager. When Dr. Carlson is not in Condon, he has his own medical practice 70 miles away in Hermiston, OR, which is also the location of the nearest hospital to Condon.

Not all rural areas are alike and the rural health clinic program gives these providers the flexibility they need to be the regular source of care of primary care in their communities. Regular access to primary care, as you know, is one of the key tests of whether or not you will receive the preventive health screenings that can mean the difference that could save your life. They allow for health problems to be caught early on so that they can be headed off for just a little money, instead of at later stages, which require costly specialty care that runs up the bill for the patient and the taxpayer.

Oregonians in rural areas have the same right to quality, affordable medical care as those living in urban areas, but they do not have it under our current system. This bill will expand access to health care for folks in rural areas and level the playing field for rural health clinics by giving them the tools they need to attract and retain quality medical providers.

I want to thank Senator Barrasso and his staff for their hard work in bringing this important bipartisan legislation before the Senate.

I hope my colleagues will join Senator Barrasso and me, and support this much needed and bipartisan bill.