Floor Statements

Mr. President, I am not going to speak very long tonight, and I am not going to speak very formally either. But I did want to come back to the Senate floor and make a point again that I have made repeatedly here on the Senate floor before; that is, there is a path to reform of our health care system that will improve the quality of care for patients, will improve the experience of care for patients, will improve the outcomes of care for patients and for our Nation, and will lower costs for our country.

The reason I come to raise that point again is that the Senate is now awash with rumors that the 12 Members of Congress--Senators and Congressmen--who have been tasked with trying to create a solution to our deficit problem are going to cut Medicare benefits by hundreds of millions of dollars. That is, as best I can tell, only a rumor. I certainly cannot vouch for it being true. Indeed, I hope it is not true.

The time I wish to spend this evening is to remind my colleagues it is a very unfortunate and mistaken path to take to follow the road of benefit cuts at a time when the road to reform is so promising in terms of the win-win of better care at lower cost.

It is not just me saying this. The President's Council of Economic Advisers has said the annual savings that could be accomplished with health care delivery system reform, without reducing anybody's quality of care or access to care--indeed, I would hypothesize actually improving quality of care--is $700 billion a year in the American health care system.

The President's Council of Economic Advisers is not alone in that opinion. The Institute of Medicine has just said it is around $770 billion a year. A few years back, the New England Healthcare Institute said it was $850 billion a year. And the Lewin Group, which is a fairly well respected health care consultancy here in Washington, as well as George Bush's Treasury Secretary, Secretary O'Neill, have both agreed annual savings could be $1 trillion a year--all by improving the quality of care and the coordination of care.

I do not know if it is exactly going to be $700 billion or $1 trillion, but my point is, there is a big savings target out there that everyone from President Obama's Council of Economic Advisers, to George Bush's Treasury Secretary, to a lot of very well thought of groups in between, including our National Institute of Medicine, all agree on. So I think that makes it a very important target to pursue in this discussion.

It is not just me in believing, at this potential split in the road, we should work and fight very hard to make sure we are taking the right path and we do

not go down the easy-to-score but unnecessary and unhelpful path of benefit cuts, which singles out seniors in Medicare and does nothing about the underlying costs of the system and makes it the wrong road to follow when we have a well illuminated path that can move us toward a better, more efficient delivery system that provides better quality health care, better outcomes, fewer hospital-acquired infections, better coordinated care, stronger electronic health records--all of the things that will support a truly modern health care system that can be the envy of the world.

That is the choice we have. I think it would be a terrible mistake to go the benefit cuts route instead of the reform route, and it is not just me who says that. George Halvorson is the chief executive officer, the CEO, of Kaiser Permanente. Kaiser Permanente is one of the biggest health care systems in the country. It provides health care in many States, and George Halvorson is a very serious individual who knows his stuff in health care. He would not be the CEO of that big company if he did not.

Here is what he said the other day:

There are people right now who want to cut benefits and

ration care and have that be the avenue to cost reduction in

this country. And that's wrong. It's so wrong, it's almost

criminal. It's an inept way of thinking about health care.

That is not me. That is the CEO of Kaiser Permanente.

There are people right now who want to cut benefits and

ration care and have that be the avenue to cost reduction in

this country and that's wrong. It's so wrong, it's almost

criminal. It's an inept way of thinking about health care.

Yet that is the direction that it looks like we may be taking, the inept direction. I had a hearing in the HELP Committee--the Presiding Officer, Senator Bennet of Colorado, is a member of that HELP Committee--and we had some very interesting witnesses. Because the path toward savings through reform is not just a HELP Committee path, this is not something that some academic has constructed and maybe if you take that path things will work, this is a path that major corporations, major health systems, major hospitals in this country are already walking. They are already walking down that path.

Kaiser is one of them. Blue Shield of California is another. Intermountain out in the West is a third. Mayo, Geisinger, Gundersen Lutheran--there are a number along the East Coast. These are companies that have determined this is the right path, and they are walking that path.

Two folks were there from such companies. One was Dr. Gary Kaplan, who is at the Virginia Mason health system in Seattle, WA. Despite its name, Virginia Mason, it is actually in Seattle, WA, on the other coast. He pointed out that they went through a quality management transformation in their hospital with a cultural transformation, with a process transformation.

As a result, they have made significant improvements. Just in one back pain reform process they did with 2,000 patients, they calculated they have already saved $1.7 million on 2,000 back pain patients, and those patients are happier with the new regime, the less-expensive regime, than before because they are getting better quality care.

He testified they saved $11 million in planned capital investment, reduced inventory costs by $2 million through supply chain expense reductions, reduced staff walking distance by 60 miles per day, reduced labor expenses and overtime and temporary labor by half a million dollars in just 1 year, reduced professional liability insurance premiums by 56 percent, reduced their self-insured retention fund by 70 percent, reduced the time it takes to report lab tests by more than 85 percent, and improved their medication distribution, reducing errors, reducing the time when a patient first calls Virginia Mason's breast clinic with a concern to the time they receive a diagnosis from 21 days to 3 days, and many patients receive their results on the same day.

These are the kind of improvements that have put Virginia Mason at the front end and make them, according to the Leapfrog Group, one of the top hospitals in the country. They are walking the walk of improving the quality of their operations, improving the quality of care and saving money by doing so.

The other witness was Greg Poulsen from Intermountain. He described two examples. One was a sepsis program for people who are admitted to the hospital suffering from sepsis throughout their system. Sepsis is a dangerous condition. Sepsis, on average, has a 40-percent mortality rate. So 4 out of 10 people with sepsis die of it. They have reduced the 40-percent mortality rate from sepsis to 5 percent--from 4 in 10 dying to 1 in 20 dying. Did it cost a lot of money to do that? Was that a big investment they had to make? Did it cost the taxpayers a lot to save those lives? No. What they found is they saved $10 million with that improvement.

Similarly, they have a diabetes program that has been described by the former CEO of the Mayo Clinic as the diabetes program he would go to if he were sick with diabetes that has ``the best outcomes and lowest costs in the country.''

They saved $5 million a year on diabetes treatment by going to better health care providing. There is a problem, as he pointed out. That $10 million they saved is actually a revenue loss. Because when they saved money by not having unnecessary care, by not having complications, by having things be more efficient and streamlined, what they did was they reduced their billing to the insurance companies, and it is actually the insurance companies, it is the payers who saved the $10 million.

What the providers spend is a revenue loss. So we have our system upside down in that respect, and that is one of the ways we need to reform our system. A third witness who was there was a Rhode Islander. His name is Chris Koller. We have a unique office in Rhode Island, an office of health insurance commissioner. He is the only health commissioner in the country. Also, I tease him that he is the tallest insurance commissioner because he is unusually tall, but that is easy because he is the only one.

But he has done a very good job of bringing our hospitals and insurance companies together to try to focus on the ways we can deliver care better. One way is through prevention and primary care. It turned out that in Rhode Island, the amount of every health care dollar that was spent on primary care was 5.9 percent. So every $1 spent on health care in Rhode Island, less than 6 cents, went to primary care, went to your regular family doctor and the basic health care providers. Less than 6 cents out of every $1.

The insurance companies have more overhead than that, administering the system. The costs of administration of the health care system is more than the primary care providers get out of the system. That is another sign that the system is upside down. He is encouraging them, and they have agreed, to step up the spending on primary care by 1 percent a year for 5 years. We believe that is going to make a very substantial cost savings because there is so much that a primary care provider can handle without having to go to a specialist, without having to go to the emergency room, without the condition getting worse because they could not find you, by simply making primary care more accessible and more available.

So the additional expense for primary care should bring down system costs overall and having it designed more intelligently.

I will close with a few words from the witness, Dr. Kaplan, who said that through the work they have been doing on reform and efficiency, he said: ``We have demonstrated that the path to higher quality, safer care is the same path to lower costs.''

He actually said that if we could get more transparency to the system about who is doing a better job and who is not, what the outcomes are for different hospitals, that basically where we are right now in the delivery system reform provisions that were in the Accountable Care Act, he described them as one of the last chances of a market-based system.

This is somebody who is in this business all the time and is actually running a hospital that is actually producing results. This is a person who is steeped in the reality of health care, and contrary to what we hear in the cartoon version that infects Washington, where ObamaCare is socialized medicine and is a step away from market-based care, this practitioner says the potential of the Accountable Care

Act, as I see it, is one of the last chances of a market-based system.

It could actually lead to a market, whether it was Medicare and Medicare Advantage as parts of Medicare or the commercial sector, that we would actually be able to understand what we are buying and what we are paying for.

That is the kind of commonsense transformation we need. You remember, Dr. Kaplan said: We have demonstrated the path to higher quality, safer care is the same path to lower costs.

Gary Paulsen, Intermountain, and other organizations have shown that improving quality is compatible with lowering costs. Indeed, high- quality care is generally less expensive than substandard care, and the primary challenge for us and the main reason more organizations do not adopt the high-value model discussed in the hearing that we held is the underlying fee-for-service payment system which predominates, of course, in the United States. We pay doctors for doing more, not for doing better. We pay doctors for doing more things to you rather than getting you well.

Because we do that, we have the results we have. When you look at that mess, you can say, OK, we are going to leave all that alone. We are not going to follow the path that Intermountain, that Gundersen, Lutheran, that Virginia Mason has proven, that Kaiser has argued for and proven, that so many systems around the country are doing, you can say, we are going to forget all that. We are going to leave it in place. We are going to leave it a mess, and we are just going to cut benefits away from seniors, from our elderly, from the people who need care the most, from the people who paid into the system, from the people who do not have a chance to recover, very often from people who are not in a position to direct their own care and make effective choices if they are the very elderly on Medicare or worse, the Medicare-Medicaid dual eligibles.

We are going to go after those people. We are going to cut their benefits, and we are not going to take the trouble to follow the path the professionals who are doing this are already showing is a path that leads to saving, is a path that leads to a better health care system, is a path that leads us out of the difficult position of being the only country in the world that spends 18 percent of our GDP on health care, of being the most inefficient country in the world in health care by a 50-percent margin. The next closest country in terms of inefficiency in health care is about 12 percent of GDP. We are at 18. Why is it necessary that America has to be the most inefficient health care provider in the world of all the countries we compete with by a factor of nearly 50 percent? That is half again worse than the most inefficient competitor we face. It makes no sense to be in that position.

There is enormous room for improvement. The path to that improvement is clear. It is already being walked by serious and responsible institutions that have set this as their corporate goal. That is where we should go. I will close again by repeating George Halvorson's exhortation. He is one of the great health care leaders in this country. He is a savvy corporate manager. He runs an enormous health care corporation. This is not an idle opinion of his.

There are people right now who want to cut benefits and ration care and have that be the avenue to cost reduction in this country and that's wrong. It's so wrong, it's almost criminal. It's an inept way of thinking about health care.

Those are CEO George Halvorson's words, not mine.

I hope that they ring through this body and we don't make the mistaken decision to go after Medicare benefits and instead take the positive path of reform and improvement.

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

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

Mr. President, I ask unanimous consent that Val Molaison, a fellow in Senator Tester's office, be granted floor privileges for the duration of today's session.

Mr. President, I ask unanimous consent that the Senate proceed to the consideration of Calendar No. 229, S. Res. 296.

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

Mr. President, I ask unanimous consent that the Environment and Public Works Committee be discharged from further consideration of S. Res. 251 and the Senate proceed to its immediate consideration.

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

Mr. President, I ask unanimous consent that the Armed Services Committee be discharged from further consideration of S. Res. 303 and that the Senate proceed to its consideration.

I ask unanimous consent that the resolution be agreed to; the Nelson amendment to the preamble, which is at the desk, be agreed to; the preamble, as amended, be agreed to; the motions to reconsider be laid upon the table with no intervening action or debate; and that any statements related to the resolution be printed in the Record.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration en bloc of the following resolutions which were submitted earlier today: S. Res. 326, S. Res. 327, S. Res. 328, S. Res. 329, and S. Res. 330.

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

Mr. President, I ask unanimous consent that when the Senate completes its business today, the Senate stand adjourned until 10 a.m. on Thursday, November 17, 2011; that following the prayer and pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, and the time for the two leaders be reserved for their use later in the day; that following any leader remarks, the Senate be in a period of morning business for 1 hour, with Senators permitted to speak therein for up to 10 minutes each, with the time equally divided and controlled between the two leaders or their designees, with the Republicans controlling the first half and the majority controlling the final half; and that following morning business, the Senate proceed to the consideration of S. 1867, the Department of Defense Authorization Act, under the previous order.

Mr. President, we expect to receive the conference report, which contains the continuing resolution, from the House tomorrow. Senators will be notified when votes are scheduled.

If there is no further business to come before the Senate, I ask unanimous consent that the Senate stand adjourned under the previous order.

Mr. President, today I express my thanks and congratulations to a son and servant of my State of Rhode Island. Bruce Q. Morin, associate judge of the Rhode Island Workers' Compensation Court, has recently retired after a long career in public service.

I first had the pleasure of getting to know Judge Morin in the early 1990s, when I was a policy adviser to then-Rhode Island Governor Bruce Sundlun. At the time, the Rhode Island worker's compensation system was broken and on the verge of insolvency. Costs had risen to unbearable levels. Insurers were departing the Rhode Island system. The problem seemed politically intractable. And worst of all, the means of providing adequate support to injured workers in Rhode Island was in danger.

Well, working together we completely overhauled the system. A central component of the overhaul was the creation of Rhode Island's Workers' Compensation Court, specifically designed to hear and decide all disputes between an injured employee and an employer relating to workers' compensation benefits. Governor Sundlun appointed Bruce Morin to the court in 1991, the year it was created, and he has dutifully and honorably served both the state of Rhode Island and the citizens who have come before his bench for 20 years.

Today, the Rhode Island workers' compensation system stands as a national model. Rhode Island has been able to permanently reduce costs, stabilize the workers' compensation market, eliminate fraud, protect injured workers, and save Rhode Island businesses hundreds of millions of dollars. Rhode Island's system now has the lowest average medical cost per employee per year in the entire country.

We owe a great measure of that success to Judge Morin, Chief Judge Healey, former Chief Judge Arrigan, and the rest of the court for implementation of the law in the best interests of the State of Rhode Island.

From his days serving his country, both with the Judge Advocate General

Corps of the U.S. Naval Reserve and as an instructor at the Naval Justice School in Newport; to his time as a member of the Rhode Island State senate; to his distinguished tenure on the Workers' Compensation Court, Bruce Morin has been a lifelong public servant.

After a long and successful career in Rhode Island, I know Judge Morin is looking forward to an enjoyable retirement, more hours on the links, and more time to share with his two wonderful children Jeffrey and Amy. I congratulate him on his many accomplishments and wish him great luck and happiness in all his future endeavors.

Mr. President, I am here this evening to express my unwavering support for the men and women who have answered the call of duty in our military services, our Guard and Reserve, and for their family members whose love and steady support for them have carried our servicemembers through challenging times and difficult missions.

In honor of Veterans Day, coming up the day after tomorrow, and Military Family Month, which we observe all month long this November, we need to reflect on the enormous contributions military families have made on behalf of all of us.

Since September 11, the spouses, children and parents of our service men and women have been faced with huge demands. They have endured repeated deployments, and spent many holidays and birthdays and anniversaries apart from each other. We should do everything we can in our communities to help military families cope with the difficulties and stresses of these multiple deployments.

I commend First Lady Michelle Obama and Dr. Jill Biden for their commitment to our troops' families and for their work on initiatives to address the unique challenges military families face in this environment. I especially appreciate the First Lady's recent visit to Rhode Island. It provided a warm and welcome boost to military family members in my State, which has the second highest per capita National Guard deployment rate of all the States, as well as a significant active-duty presence at Naval Station Newport.

With so many men and women leaving home to serve on multiple deployments, the strain on the family can be particularly difficult. Last month I had the privilege of meeting two extraordinary Rhode Island students, Kathleen Callahan, who goes by Katie, and Kaitlyn Hawley, who presented a powerful and compelling message to school superintendents and educators from across Rhode Island who came together to learn about how they can better respond to the needs of military families.

These two impressive young ladies shared their personal stories and described the challenges their families faced while their parents were deployed. The event was part of a collaborative initiative to help military-connected children thrive in school through deployments. I was proud to share in this joint effort with the Rhode Island National Guard, with Governor Chaffee, with our Commissioner of Education, the Commanding Officer of Naval Station Newport, our Military Child Education Coalition, and my senior Senator, Jack Reed.

Katie is the daughter of a National Guard member. She described how her father's deployment affected the roles in her family. Like most children of deployed servicemembers, Katie assumed additional responsibilities in caring for her younger sibling and helping her mother, whom she referred to as a superwoman. Together, they shouldered the burden of her father's absence and kept the family intact and sound.

Katie described the feeling of--to use her words--silent suffering that can occur when military families feel isolated in civilian communities that may not completely understand what it is like when a loved one is deployed.

Kaitlyn is the daughter of an active-duty member. She talked about her experience living in eight different States and attending seven different schools. Kaitlyn is a highly motivated student and she explained how she threw herself into her schoolwork during her father's deployment. However, she cautioned that for other students, the opposite can also occur. Some students may have a lot of difficulty focusing on their schoolwork when a parent is deployed half a world away. As Kaitlyn so well put it, there is no one-size-fits-all approach to coping with the stress of deployment.

I am proud of Katie and Kaitlyn for their courage, their resilience, and their powerful articulation of a message that I hope everyone hears. We owe our military families an enduring debt of gratitude for everything they have done. We should do everything we can to ensure that no family feels isolated or left out or endures the silent suffering Katie described. I hope every American, as we approach Veterans Day, will actively support our military families, and do what we can to make our communities more welcoming and supportive in accommodating their needs.

As Veterans Day approaches, let's celebrate our military families and recognize their extraordinary contributions. Let us thank not only our service men and women but also the spouses, children, and other family members who have shared in the sacrifice of military service. We should also remember the families of our civilian and intelligence servicemembers deployed in danger and away from their families around the world.

In concluding, I wish to also express my strong support for the bipartisan legislation the Senate is considering to boost employment opportunities for veterans. Unemployment has been disproportionally high among veterans and we must act now. The last thing our returning service men and women need is to have to face an unemployment line. I urge my colleagues to swiftly pass this much needed legislation, which I am very proud to cosponsor.

I yield the floor.

Mr. President, it was fairly recently that this summer I came to the Senate floor to commend the Environmental Protection Agency for finalizing what we called the cross-State air pollution rule, which limits the out-of-State pollution that one State can dump into the wind currents that drop on other States.

To my State, Rhode Island, this is particularly important. Nearly a decade after the EPA began working to address this problem of interstate air pollution, we finally had a path forward that is sensible and protective of public health. That was then, this is now.

Today, Senator Paul of Kentucky proposes to halt this progress, to undo that rule through a Congressional Review Act resolution. That resolution would, one, void the cross-State air pollution rule and, two, bar EPA permanently from ever writing a ``substantially similar'' rule. This means that EPA could never use the Clean Air Act to create a cost-effective pollution trading program to address upwind pollution.

Mr. President, this hits home in my State of Rhode Island. Rhode Island has the sixth highest rate of asthma in the country. More than 11 percent of the people in my State suffer from this chronic disease, and many of them are children.

In 2009 there were 1,750 hospital discharges in Rhode Island for asthma cases. Those hospital stays cost about $8 million in direct medical costs, not to mention the costs of the medication or missed days of work and school.

On a clear summer day in Rhode Island, driving along the sparkling Narragansett Bay, commuting into work, you will often hear the warning on drive-time radio:

Today is a bad air day in Rhode Island. Infants, seniors,

people with breathing difficulties should stay indoors today.

On those days, people in those categories are forced to stay at home, missing work, school, and other important activities. Others even in good health are urged to avoid strenuous activities on these bad air days. These are real costs--costs paid in lives and reduced quality of life, in medical bills,

public services strained responding to health risks, and in missed days of work and school--all from pollution in our air.

We don't know everything about the causes and cures of asthma, but we do know one thing: air pollution triggers asthma attacks. We know air pollution is a preventable problem.

Rhode Island has worked hard and made great strides to reduce air pollution. We passed laws to prohibit cars and buses from idling their engines and to retrofit all State schoolbuses with diesel pollution controls. We require heavy-duty vehicles used in federally funded construction projects to install diesel pollution controls, adhere to the anti-idling law, and use only low-sulfur diesel. Our transit agency voluntarily retrofitted half of its bus fleet with diesel pollution control equipment.

But Rhode Island cannot solve its air pollution problem on its own. In fact, Doug McVay, who is acting as chief of Rhode Island's Office of Air Resources, told me all of Rhode Island's major sources of air pollution--not just powerplants but any source that holds a major title 5 permit--emit less than 3,000 tons a year of nitrogen oxide, also called NOX, and sulfur dioxide, also called SO2.

Let me repeat that. All major sources in Rhode Island taken together emit annually less than 3,000 tons of these two pollutants. Polluters that will be subject to the cross-State air pollution rule in other States have single units that emit more than that. Some of the larger coal-fired boilers may emit 10,000 to 12,000 tons of these pollutants every year, nearly four times the pollution emitted by all Rhode Island major sources combined.

In Rhode Island, we are willing to pull our weight in achieving air pollution reductions. Indeed, we have done more than pull our own weight; we are pulling above our weight. But we need all States to be pulling their weight, too, to make the air safe to breathe in America from coast to coast.

This year at my request the GAO completed a report about tall smokestacks at coal powerplants. The report found that in 1970, the year the Clean Air Act was enacted, there were two what they call tall stacks--smokestacks over 500 feet in the United States--two.

By 1985 there were more than 180 tall stacks. As of 2010, 284 tall smokestacks were operating at 172 coal powerplants, representing 64 percent of the coal-generating capacity in our country. The industry literally smokestacked its way into compliance with the Clean Air Act.

What do I mean by that? In the early days of the Clean Air Act, some States allowed sources of pollution to build tall smokestacks instead of installing pollution controls. The concept back then was that pollution sent high enough into the atmosphere would be sent far away from the source and would not contribute to air pollution problems--at least in that State. Well, it turns out this air pollution causes problems downwind in other States.

As the GAO report put it, tall stacks generally disburse pollutants over greater distances than shorter stacks and provide pollutants greater time to react in the atmosphere to form ozone and particulate matter.

For this antiquated practice, Rhode Island pays the price. Smokestacking, instead of scrubbing, is what is behind a lot of the ozone in Rhode Island that gives rise to those bad air days. The GAO found that more than half of the boilers attached to tall stacks at coal powerplants do not have a scrubber to control sulfur dioxide emissions--more than half, no scrubber, just a tall smokestack to pump it out to the downwind States. Nearly two-thirds of boilers connected to tall stacks do not have postcombustion controls for nitrogen oxide.

So how does it get to Rhode Island? As GAO concluded, in the Mid- Atlantic U.S. the wind generally blows from west to east. Ozone can travel hundreds of miles with the help of high-speed winds known as the low-level jet. This phenomenon particularly occurs at night due to the ground cooling quicker than the upper atmosphere, which can allow the low-level jet to form and transport ozone and particulate matter with its high winds.

This wind map shows that condition. These are all the midwestern powerplants, and this is the wind that carries them down here to, among other States, Rhode Island.

Five States on this map--Ohio, Pennsylvania, West Virginia, Illinois, and North Carolina--have been identified by EPA as contributing significantly to Rhode Island pollution.

This electricity that comes from uncontrolled powerplants tied to these tall smokestacks might seem cheaper to consumers than a well- controlled powerplant, a powerplant that is scrubbed instead of smokestacking its pollution, but that is really not so. There are costs. The costs just got shifted. The lungs of children and seniors in Rhode Island and other downwind States pay for that cheap electricity, and, truth be told, the lungs of children and seniors in many of the upwind States are paying as well. The States upwind of Rhode Island are downwind of someone else. Ohio and Pennsylvania are upwind of Rhode Island, but they are downwind of other States. That is why EPA's regulatory impact analysis determined that instate and upwind pollution reductions from this rule will save approximately 3,209 lives in Ohio and 2,911 lives in Pennsylvania every year by 2014 and prevent hundreds of heart attacks, emergency room visits, and hospitalizations in those States. This rule opposed by Senator Paul will even save an estimated 1,705 lives in his home State of Kentucky every year by 2014.

It is not just lives saved. EPA estimates that by 2014, the benefits from this rule will range between $110 billion and $280 billion. At the same time, EPA estimates that the rule will cost utilities $4.1 billion to comply in 2012 and another $.8 billion through 2014--a grand total of $4.9 billion against $110 billion to $280 billion in quantifiable benefits.

At the lower end of the range, this rule generates a 22-to-1 ratio of benefits over costs. For every $1 in cost to the polluters who are creating this pollution, to clean it up, there is $22 in benefit to the rest of the country. That is a pretty good investment, and that is at the low end.

At the high end, if it is $280 billion, we are talking about a 56-to- 1 ratio of benefits over costs. We have people from polluting States who, to save a buck for their polluters who are running it up smokestacks instead of scrubbing their pollution, to save the buck in putting the scrubber and quit smokestacking their pollution and dumping it on Rhode Island and other States, are willing to blow $56 in benefits to Americans across the country, even in their States. It doesn't make any sense.

The cross-State air rule is good for public health. It is fair. There is no other way Rhode Island can affect these States. We have done everything we can to clean our air. We could stop everything, and we would still be a nonattainment clean air quality State because of what gets bombed in on us from other States. If we don't have EPA defending us, we have no defense at all from States that choose to export their pollution rather than clean it up. And it is very cost effective, better than 51 by the highest estimates. So that is why I will be voting against Senator Paul's resolution to void this rule. I urge my colleagues to do the same.

I yield the floor.

I thank the chair and yield the floor and note the absence of a quorum.

Mr. President, I was here last week in this Chamber to discuss a variety of areas in which the American people are not getting a straight deal compared to special interests and folks who have a lot of power for themselves and their industries in Washington. In that speech I proposed a number of concrete steps we could take to help restore the balance of power in our Nation between ordinary Americans on the one hand and the giant corporations and special interests that give themselves special deals and privileges that the American people do not share on the other hand.

Today I am here to introduce legislation to take one of those steps; that is, to protect ordinary consumers from runaway interest rates on credit cards from Wall Street banks. This is something that has gone unchecked for far too long. In the last Congress we passed two pieces of banking legislation. We passed the Credit Card Act, which ended some of the worst tricks and traps hidden in credit card contracts, and we passed the Dodd-Frank Act, which restructured our system of financial regulation and created a new agency to protect consumers from hazardous mortgages and credit cards.

Regrettably, one particularly bad practice was not addressed in either of those two pieces of legislation: the runaway credit card interest rates with which families are too often burdened. I will add it is not just families. I went through Olneyville in Providence about 2 weeks ago and spoke to a small business owner who was having tough times. His bank had pulled his line of credit, so he was having to fund his business off his credit card, and they had bumped up his credit card rate to--you guessed it--30 percent.

The Empowering States' Right to Protect Consumers Act, which I am introducing today, would pick up where the Credit Card Act and Dodd- Frank left off by restoring to our 50 sovereign States the power which they have properly had through the vast bulk of the history of this Republic to protect their home State consumers with limits on credit card and other loan interest rates. This is not a new power to States. This is not a new principle or idea. This is the restoration of a historic States right which was just eliminated a few decades ago.

When you and I were growing up, a credit card offer with a 20-percent or 30-percent interest rate might be something to bring to the attention of law enforcement. Such interest rates were illegal under most State laws. Today, in contrast, credit card companies routinely charge rates of 30 percent or more. We may not know, going through our credit card agreement, that is where we are going to end up. They may have a teaser rate up front that is a lower rate. But make one of those mistakes in that 20-page-long contract that is full of tricks and traps, and, pow, there we are at 30 percent.

What happened between our childhood when a 30-percent interest rate was something to bring to the attention of law enforcement, and now, when ordinary families are bedeviled

with 30 percent interest rates on their credit cards? Before 1978-- which is for the first 202 years of the American Republic--each State had the ability to enforce usury laws, interest rate limits to protect their citizens. Our economy grew and flourished during those two centuries, and lenders profited while complying with the laws in effect where they operated.

Then came 1978 and a seemingly uneventful Supreme Court case. It was little noticed at the time. It was decided in Marquette National Bank of Minneapolis v. First of Omaha Service Corporation. The Supreme Court had to decide what State's law to apply when the bank was domiciled in one State but the customer lived in a different State.

The Court looked at the word ``located'' in the National Bank Act of 1863, and it decided it meant the location of the bank and not the location of the customer. They did not get it right away, but it did not take long before some big banks spotted the opportunity. They could avoid interest rate restrictions by reorganizing as national banks and moving to States that had weak interest rate protections and comparatively weak consumer protections. The proverbial race to the bottom followed as a small handful of States eliminated interest rate caps and degraded consumer protection in order to attract lucrative credit card business and related tax revenue to their States.

That is why the credit card divisions of major banks are based in just a few States and why consumers in other States are often denied protection from outrageous interest rates and fees, even though those outrageous interest rates and fees are against the law of the consumer's home State.

My bill would reinstate the historic longstanding powers of States to set interest rate caps that protect their own citizens.

Let me be clear about what this bill would not do. It would not prescribe or recommend any interest rate caps nor would it impose any other lending limitations. It is pure States rights. It would restore to the States the power they enjoyed for over 200 years from the founding of the Republic: the power to say enough, the power to say that 30 percent or 50 percent or whatever the State deems appropriate should be the limit on interest charged to their people.

The current system is not only unfair to consumers, it is unfair to our local lenders and retailers who continue to be bound by the laws of the State in which they are located. This is a special privilege for big national banks that can move their offices to whatever State will give them the best deal in terms of lousy consumer protection and unlimited interest rates. A small local lender has to play by the rules of fair interest rates. Gigantic credit card companies can avoid having any rules at all. We need to level the playing field to eliminate this unfair and lucrative advantage for Wall Street banks against our local credit unions and other small lenders.

When we pass this bill, States can dust off or reenact their usury statutes--most of which still limit interest rates to 18 percent or less--and once again begin protecting their consumers from excessive interest rates. This is the historic norm in our constitutional Republic. It is the 30-percent and over interest rates that are the recent anomaly that are the historic peculiarity. We should go back to the historic States rights norm, the way the Founding Fathers saw things under the doctrine of federalism and close this modern bureaucratic loophole that allows big Wall Street banks a special deal to gouge our constituents.

As I close, I thank Senators Levin, Durbin, Begich, Franken, Reed of Rhode Island--most significantly my senior Senator--Sanders, and Merkley for their cosponsorship of this bill. In the past, similar legislation has garnered bipartisan support. It did so as an amendment to Dodd-Frank, and I hope my Republican colleagues will consider giving this bill a close look and join with us. This is purely an issue of restoring the balance of power to the States and to the people of those States as voters--federalism, something I know many Republicans support in other contexts.

I ask all of my colleagues for their consideration and support.

Mr. President, I was here last week in this Chamber to discuss a variety of areas in which the American people are not getting a straight deal compared to special interests and folks who have a lot of power for themselves and their industries in Washington. In that speech I proposed a number of concrete steps we could take to help restore the balance of power in our Nation between ordinary Americans on the one hand and the giant corporations and special interests that give themselves special deals and privileges that the American people do not share on the other hand.

Today I am here to introduce legislation to take one of those steps; that is, to protect ordinary consumers from runaway interest rates on credit cards from Wall Street banks. This is something that has gone unchecked for far too long. In the last Congress we passed two pieces of banking legislation. We passed the Credit Card Act, which ended some of the worst tricks and traps hidden in credit card contracts, and we passed the Dodd-Frank Act, which restructured our system of financial regulation and created a new agency to protect consumers from hazardous mortgages and credit cards.

Regrettably, one particularly bad practice was not addressed in either of those two pieces of legislation: the runaway credit card interest rates with which families are too often burdened. I will add it is not just families. I went through Olneyville in Providence about 2 weeks ago and spoke to a small business owner who was having tough times. His bank had pulled his line of credit, so he was having to fund his business off his credit card, and they had bumped up his credit card rate to--you guessed it--30 percent.

The Empowering States' Right to Protect Consumers Act, which I am introducing today, would pick up where the Credit Card Act and Dodd- Frank left off by restoring to our 50 sovereign States the power which they have properly had through the vast bulk of the history of this Republic to protect their home State consumers with limits on credit card and other loan interest rates. This is not a new power to States. This is not a new principle or idea. This is the restoration of a historic States right which was just eliminated a few decades ago.

When you and I were growing up, a credit card offer with a 20-percent or 30-percent interest rate might be something to bring to the attention of law enforcement. Such interest rates were illegal under most State laws. Today, in contrast, credit card companies routinely charge rates of 30 percent or more. We may not know, going through our credit card agreement, that is where we are going to end up. They may have a teaser rate up front that is a lower rate. But make one of those mistakes in that 20-page-long contract that is full of tricks and traps, and, pow, there we are at 30 percent.

What happened between our childhood when a 30-percent interest rate was something to bring to the attention of law enforcement, and now, when ordinary families are bedeviled

with 30 percent interest rates on their credit cards? Before 1978-- which is for the first 202 years of the American Republic--each State had the ability to enforce usury laws, interest rate limits to protect their citizens. Our economy grew and flourished during those two centuries, and lenders profited while complying with the laws in effect where they operated.

Then came 1978 and a seemingly uneventful Supreme Court case. It was little noticed at the time. It was decided in Marquette National Bank of Minneapolis v. First of Omaha Service Corporation. The Supreme Court had to decide what State's law to apply when the bank was domiciled in one State but the customer lived in a different State.

The Court looked at the word ``located'' in the National Bank Act of 1863, and it decided it meant the location of the bank and not the location of the customer. They did not get it right away, but it did not take long before some big banks spotted the opportunity. They could avoid interest rate restrictions by reorganizing as national banks and moving to States that had weak interest rate protections and comparatively weak consumer protections. The proverbial race to the bottom followed as a small handful of States eliminated interest rate caps and degraded consumer protection in order to attract lucrative credit card business and related tax revenue to their States.

That is why the credit card divisions of major banks are based in just a few States and why consumers in other States are often denied protection from outrageous interest rates and fees, even though those outrageous interest rates and fees are against the law of the consumer's home State.

My bill would reinstate the historic longstanding powers of States to set interest rate caps that protect their own citizens.

Let me be clear about what this bill would not do. It would not prescribe or recommend any interest rate caps nor would it impose any other lending limitations. It is pure States rights. It would restore to the States the power they enjoyed for over 200 years from the founding of the Republic: the power to say enough, the power to say that 30 percent or 50 percent or whatever the State deems appropriate should be the limit on interest charged to their people.

The current system is not only unfair to consumers, it is unfair to our local lenders and retailers who continue to be bound by the laws of the State in which they are located. This is a special privilege for big national banks that can move their offices to whatever State will give them the best deal in terms of lousy consumer protection and unlimited interest rates. A small local lender has to play by the rules of fair interest rates. Gigantic credit card companies can avoid having any rules at all. We need to level the playing field to eliminate this unfair and lucrative advantage for Wall Street banks against our local credit unions and other small lenders.

When we pass this bill, States can dust off or reenact their usury statutes--most of which still limit interest rates to 18 percent or less--and once again begin protecting their consumers from excessive interest rates. This is the historic norm in our constitutional Republic. It is the 30-percent and over interest rates that are the recent anomaly that are the historic peculiarity. We should go back to the historic States rights norm, the way the Founding Fathers saw things under the doctrine of federalism and close this modern bureaucratic loophole that allows big Wall Street banks a special deal to gouge our constituents.

As I close, I thank Senators Levin, Durbin, Begich, Franken, Reed of Rhode Island--most significantly my senior Senator--Sanders, and Merkley for their cosponsorship of this bill. In the past, similar legislation has garnered bipartisan support. It did so as an amendment to Dodd-Frank, and I hope my Republican colleagues will consider giving this bill a close look and join with us. This is purely an issue of restoring the balance of power to the States and to the people of those States as voters--federalism, something I know many Republicans support in other contexts.

I ask all of my colleagues for their consideration and support.

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

I ask that I be allowed to speak for up to 15 minutes.