Floor Statements

Mr. President, I guess I can say we crossed the Rubicon last night at 1 o'clock. Reading some of the press reports, of course, most of the news didn't have it because it occurred at 1 a.m. Some of the different reports have been online this morning. It occurred to me that a lot of people are missing the overall importance of what happened last night. We can get into the fine tuning and the nitpicking and sort of the fear and the anger I hear from the other side. Every time I listen to speeches over there, with the exception of the last speaker, almost all the speeches I hear from the other side, it is fear, be afraid, be afraid. It is some built-up anger over there. I think what happened last night is, we crossed a demarcation line, the demarcation line of which on one side health care is a privilege. We have been on that side of the line for a long time. On the other side of that line, health care is a right. We stepped across that line last night. We are now in the process of saying health care is a right, an inalienable right of every American citizen.

Is that what so upsets my friends on the Republican side? I don't know. Something is upsetting them. Because this is a momentous change we are doing.

I keep hearing from Republicans they want us to deal in a bipartisan way. We tried all this year, both in the HELP Committee and in the Finance Committee. Senator Baucus bent over backward to accommodate. But at every turn, Republicans said no, no, no, no, no--all year long. How can you be bipartisan when the other side has nothing to offer? There is no bill on the Republican side. There is a bill. It has about nine cosponsors--Senator Coburn, Senator Burr, maybe seven others, but not every Republican is on that. I hear bits and pieces of this and that every time I hear these speeches. Most of it is attacking what we have done. I hear nothing positive from their side. It is very hard to deal with a party that is in total disarray as the Republicans are. If they had a bill they were supporting and that was supported by all of them, such as the bill we have here which is supported by 60 Democrats, I think then you could find some reason for meeting and working things out. But since there is no one on that side who has a comprehensive proposal, it is hard to do that. We have had to kind of plow ahead as best we can. We have not done this alone. In our committee, we met for 13 days. We had 54 hours of markup. No amendment was denied. Republicans offered over 200 amendments. We adopted 161 of them. That is pretty good. Yet in the end, every Republican voted against it. So it is not as if we didn't try and we didn't hold out an olive branch to work with people to get a bill that was truly bipartisan. We did in our committees, both the Finance and HELP Committees. Now it has come down to fear and anger on the other side and some nitpicking.

My friend from Iowa--and he is truly my friend--was talking about some provisions put in the bill for special reasons and so forth. I admit fully and openly that I was part of that. Did I put something in the bill that was sort of particular to my State of Iowa? Yes, I did. But it doesn't just affect Iowa. There are several States in which we have hospitals that are not as big as the big hospitals with the volume. They are not so small that they are low-volume hospitals that get help. They are kind of in between. They call them tweener hospitals. We have eight of them in Iowa: at Grinnell, Keokuck, Spencer Municipal, in Carroll, St. Anthony Regional; Muscatine; Fort Madison; and Lake Regional Hospital at Spirit Lake. There are a number of these in the United States. I forget the total number; not a large number, they just fall in a place where they are too small for the big and too big for the small. As a result, they have been getting a bad deal from Medicare reimbursement. There is a fix in this bill that will allow them to get adequate reimbursement. I don't see anything wrong with that. It is fixing a specific problem that the bureaucracy can't seem to quite get fixed. That is in the bill. I make no bones about having put that in there. I think it is a good deal. It is something that is going to help a lot of hospitals, not only in Iowa but a few other States.

One of the things I wish to talk about today is something I have been on for many years, and that is the huge amount in this bill on prevention and wellness. It has not been written about a lot. People have been focused on the public option and the abortion issue and a few other items such as that. Perhaps one of the most profound parts of this bill and the one I believe will do more to bend the cost curve, as they say, than any other single thing is the provisions dealing with prevention and wellness. In the past I have said many times that we don't have a health care system in America. We have a sick care system. When you think about it, if you get sick, you get care. But precious little is spent out there to keep one healthy in the first place. So people get sick. You go to the doctor, the hospital. We patch and fix and mend and try to make them well.

Your mother was right, you know: Prevention is worth a pound of cure. We have fallen far short of that in this country. There is a remarkable array of provisions in this bill that promote wellness, disease prevention, and public health. Together they will move us from a sick care society into a genuine wellness society, into a true health care system, not just sick care. What better way to reform our health care system than to restrain health care costs by helping Americans to prevent chronic diseases, stay healthy and out of the hospital in the first place. Right now, as we have heard so many times, we spend more than $2 trillion each year on sick care. But 4 cents of every dollar is invested in prevention and public health. I submit this is a major reason why Americans spend twice as much per capita on health care as European countries, but we are twice as sick with chronic disease. We spend twice as much as Europe on health care, but we are twice as sick with chronic diseases.

The good news is that by ramping up the emphasis on wellness and prevention, we have tremendous opportunities to both improve the health of the American people and to restrain health care spending. That is the aim of this bill which makes significant new investments in prevention. For example, our bill would ensure that seniors have access to free annual wellness visits and personalized prevention plans under Medicare. We have never had that. For the first time seniors will have access to free annual wellness visits and personalized prevention plans under Medicare. That is a big deal. So many seniors today, if they get sick, go to the doctor and get more pills. Now they will be able to go in, have their annualized checkup, see what is wrong, and have a personalized prevention plan for each person under Medicare.

It will also encourage States to improve coverage and access to recommended preventative services and immunizations under Medicaid. At a minimum, States will provide Medicaid coverage for comprehensive tobacco cessation services for pregnant women. That is just the start. Right away, at a minimum, they have to do that. In addition, the bill requires insurance companies to cover recommended preventive services with no copayments or deductibles. This is critical because we know that all too often people forgo their yearly checkups or essential screenings because either their insurance companies don't cover them or because they have high copays and deductibles.

Another critical element in the bill essential to a sustainable push for wellness is the creation of a prevention and public health trust fund. Typically prevention and public health initiatives are subject to unpredictable and unstable funding. This means that important interventions, things such as education about nutrition and assistance for smokers who want to quit,

often go unfunded from one year to the next. They get funded a little bit one year or cut the next; funded a little bit the next year, cut the next. The prevention and public health fund in this bill will provide an expanded and sustained national investment in programs that promote physical activity, improve nutrition, and reduce tobacco use. We all appreciate that checkups and immunizations and other clinical services are important. But this bill also recognizes that where Americans live and work and go to school also has a profound impact on our health. That is why a number of provisions in the bill focus on creating healthier communities with better access to nutritious foods as well as safe places to engage in physical activity.

A 2007 study by the Trust for America's Health found major savings from community-based prevention programs designed to increase levels of physical activity, improve nutrition, and reduce smoking rates. This study concluded that a national investment of $10 per person per year in these kinds of community-based programs could yield net savings of more than $2.8 billion annually in health care costs in the first 1 and 2 years, more than $16 billion savings within 5 years, and nearly $18 billion savings annually within 10 to 20 years, starting at $10 per person per year.

More generally, this bill aims to give Americans the tools and information they need to take charge of their own health. For example, it requires large chain restaurants to post basic nutrition information on the menu so consumers can make healthy choices. That is in this bill. It will start next year.

The bill also focuses on prevention and public health needs of a number of generally overlooked populations, including children, individuals with disabilities, Americans living in rural communities, and certain ethnic minorities. For many months I have made the case that it is not enough to talk about how to expand insurance coverage, how to pay the bills--those are important--but it makes no sense to figure out a better way to pay the bills for a system that is dysfunctional, ineffective, and broken.

We have to change the health care system itself, beginning with a sharp new emphasis on prevention and public health. We also have to realize that wellness and prevention must be truly comprehensive. It is not only about what just goes on in the doctor's office; it also encompasses community-wide wellness programs, about which I just spoke, things such as building bike paths, walking trails, getting junk food out of our schools, out of the vending machines, making our school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more.

Some of this is going to be addressed in other bills. For example, next year, in the Agriculture Committee, we will be reauthorizing the child nutrition bill. That deals with school lunches and school breakfasts. We need a major effort there to make our lunches and our breakfasts more nutritious for our kids in school.

Next year, in the committee I chair, the HELP Committee, we are going to reauthorize the Elementary and Secondary Education Act, the so- called No Child Left Behind Act. There are a lot of things we are going to be doing on that. I see one of our committee members, the Senator from Colorado, Mr. Bennet, in the Chamber, a former superintendent of schools, who is going to play a key role in helping get that Elementary and Secondary Education Act through and refined and brought up to date where we will make some changes.

But there is one other part of that bill we have to focus on; that is, the amount of physical activity kids get in school. I talked many times both to Secretary Duncan and, before him, to Secretary Spellings about this idea of No Child Left Behind. If we are not going to leave kids behind in terms of their writing and their math and their English, how about not leaving them behind in terms of their health? Yet recess is gone. I saw a statistic this year that said 80 percent of elementary school kids in America today get less than 1 hour of physical exercise a week in school--80 percent get less than 1 hour a week.

Mr. President, I do not know about you, but I remember when I was in school, in elementary school, we had an hour a day for recess. We had 15 minutes in the morning, 15 minutes in the afternoon, and a half hour at lunch. So there was 1 hour every day, and we had to go out and do stuff. We couldn't sit around and play with Game Boys and things like that. So we got an hour a day of physical exercise. Well, we need to reinvigorate our schools to make sure they get that physical exercise.

So we have done a lot in this bill to move this paradigm toward a health care society rather than a sick care society. There is more to do, as I said, in both the Education bill next year and in the Agriculture Committee in terms of the child nutrition reauthorization. But in this bill we have made a great start. We have laid a great foundation. I am just thrilled so many of the wellness and prevention initiatives I have championed for so many years are included in this bill.

As I look forward to going to conference, we look forward to working with the House to strengthen it even more and to put more emphasis on wellness and prevention.

Just about an hour ago or so, we had a press conference with the president-elect of the American Medical Association, Dr. Wilson. I am proud of the fact that the American Medical Association has now endorsed our bill. As I said at the time, I said the doctors of America have examined this bill, and they have made the right prescription: Pass it. Pass the health care reform bill.

But Dr. Wilson, in his statement, made particular note of the wellness and prevention programs we have in this bill. He did not say this, but I was thinking, when he was talking, that it made sense. Doctors want to keep people healthy. They do not want to see people go to the hospital. They would rather be working with their patients one on one. How can they structure a patient's profile so the patient stays healthy, does not get sick so often? That is what Dr. Wilson was talking about: letting doctors practice medicine in a way that focuses on a person's health and keeping them healthy.

As President Obama said in his speech to Congress early this year:

[It is time] to make the largest investment ever in

preventive care, because that's one of the best ways to keep

our people healthy and our costs under control.

That was the President of the United States in his State of the Union message. Well, President Obama has it right. It is one of the best ways to keep our people healthy and our costs under control, and that is a big part of this bill. I do not know--I have not listened to every speech made by the Republicans on the other side--but I hardly ever hear them talk about this, but it is a very important part of the bill.

So, Mr. President, we are changing the paradigm. We are going to extend quality, affordable health coverage to nearly every American. We are going to transform ourselves into a genuine wellness society, and we are going to give our citizens access to a 21st-century health care system, one that is focused on helping us to live healthy, active, and happy lives.

Mr. President, I yield the floor.

How much time did he ask for, Mr. President?

No objection.

I understand now the Democratic side has 1 hour, from 6:30 to 7:30?

Mr. President, I yield myself the time from 6:30 to 7.

Mr. President, I was in my office a little bit ago, and I was watching the comments made by the distinguished minority whip, the Senator from Arizona, Mr. Kyl. He went on at some length about how this vote at 1 a.m. we are going to be taking is tough on some Members. He mentioned specifically our distinguished colleague, Senator Robert Byrd, who is not up and about at those hours, and they would have to drag him out of bed and bring him down here for this vote. Senator Kyl felt very sorry for Senator Byrd that we would do that at 1 a.m.

He said the majority leader has the power to put this vote back. We could do it at 9 a.m. in the morning. Well, he is absolutely right; we could do it at 9 a.m. in the morning. But because of the intransigence of the Republican side, because they are not willing to let us have these votes without expending the 30 hours under the rules--under the rules--the cloture motions have been filed and, of course, the Republicans, which is their right, can burn up 30 hours.

Well, after the first vote at 1 a.m., the clock starts ticking on the next 30 hours for the underlying substitute. And then after that 30 hours, there is the underlying bill itself, and that gets 30 hours. So if the Republicans really want, they can burn up 90 hours. I ask, to what end? To what end? We have the 60 votes. No one doubts that. There are 60 votes now to pass this bill. So to drag this out and to cause people to come in at 1 a.m. in the morning is not on the Democratic side, it is on the Republican side.

So when I heard the distinguished Senator from Arizona pleading to put the vote off, I thought to myself: Well, if that is what the Republicans would like to do, there is a simple way to do that. You simply move the vote we are going to have at 1 a.m. to 9 a.m. tomorrow morning, and then you have the intervening hours from 1 a.m. to 9 a.m. count toward the 30 hours for the next vote. It is simple, very simple.

So I took that to heart, and I asked our staff to type up a unanimous consent request, and we have given a copy to the other side. So that is what my unanimous consent will do. It will ask that the vote occur at 9 a.m. tomorrow morning, but that the intervening hours from 1 to 9 would count toward the 30 hours for the underlying substitute.

So, Mr. President, I ask unanimous consent that the cloture vote scheduled to occur at 1 a.m. Monday, December 21, occur at 9 a.m. Monday, December 21; and that if cloture is invoked, the postcloture time be considered to have begun at 1 a.m.

My initial request stands, Mr. President.

So, Mr. President, here we go again. There they go again. You know, they want to delay, delay, delay, delay; obfuscate, obfuscate, obfuscate, and try to kill this bill by delaying it ad infinitum. They would be happy to delay this through Christmas, through the New Year, and January and February. Why? They would be happy to delay this bill for 10 years or more because they don't want it to happen. That is really what is going on.

I say to my good friend from Wyoming--and he is my good friend; he is a great Senator--I thought--we did--in our committee, we got the bill through open and aboveboard. I think the reason we are here at this time is because we Democrats bent over backwards to accommodate the minority. We did in our committee, and I can say that Senator Baucus went the extra mile--no, he went the extra 10 miles. He went the extra 100 miles on the Finance Committee to involve and to get the minority side involved. In the end, only one Republican would vote for it, and we know who that was, the Senator from Maine.

We could have emulated the Republicans. We could have emulated what they did when they were in the majority in 2001. I was here. I remember it well. When they came up with this crazy tax package that cut taxes for the wealthiest in our country, stole the surplus we had built up under President Clinton by the year 2000 where we were looking at surpluses on into the future, and they came up with all of these big tax cuts for the wealthy, guess what they did. They didn't involve us at all. They did reconciliation where they only needed 51 votes. Under reconciliation, under the rules of the Senate, as the Presiding Officer knows, there is no filibuster. You cannot filibuster a reconciliation bill under the rules.

So if they had done their tax bill in 2001 like we are doing this, we could have delayed. We could have had some input into that, but they said no. They just went right to reconciliation. We could have done that with this bill. We could have done that with this bill.

I remember having discussions with members of our caucus and others saying: No, no. And the President, President Obama, wanted to do this as bipartisanly as possible to involve the minority in a constructive process. So that is what we decided to do, to do it in a very constructive, open process. What it has gotten us is total--total-- obfuscation and delay and trying to kill the bill by the minority. But we will persevere. We started this open process, and we are going to finish this open process. The die is cast.

We have a vote at 1 a.m. I wish it could be 9 a.m., but you just heard the Republicans object to that because I just asked that the intervening hours be counted toward the next 30 hours, and they wouldn't even do that. So the reason we are here is not because of the Democrats. We are here because the Republicans simply don't want this bill to pass.

That is really the reason.

So we are going to vote. We are going to vote at 1 a.m. On the face of it, it is

really a technical, procedural vote, but it is something more than that. With that vote at 1 a.m. on the managers' package, on cloture on the managers' package, we will have reached a pivotal point at 1 a.m., a pivotal point in a decade-long quest to pass comprehensive health care reform. We have reached a crossroads, a kind of a point in time just as the Senate did in 1935 when we passed Social Security, or in 1965 when we passed the Medicare bill. Each of those bills was a giant step forward for the American people, but each was bitterly opposed in this body by defenders of the status quo, the Republicans.

In each case, Senate opponents waged a strident campaign of fear, warning that the passage of the legislation would lead to socialism. Senator Robert Taft from Ohio kept calling it socialism. We are going to ``Sovietize'' America. You can read it in our history books. But in the end, a critical mass of Senators rose to the historic occasion. Senators ignored the dark warnings and the demagoguery. They voted their hopes and not their fears. As we know now, in retrospect they passed laws that transformed America in profoundly positive ways.

The Senate has arrived at another one of those rare historic moments. This time, we are attempting to pass comprehensive health care reform, a goal that has alluded Congresses and Presidents going back to the administration of Roosevelt. People think I am talking about Franklin Roosevelt. No. I am talking about the administration of Theodore Roosevelt.

Once again, advocates of reform faced bitter opposition, including the filibuster we are seeing now and that has been going on for weeks by defenders of intense interests in the status quo. Once again, each Member of this body must make a choice: fear or hope; stick with the broken status quo or embrace bold change with all of its uncertainties.

The other side is saying what about this? What is going to happen here? I keep talking about this bill we are passing. It is not like the Ten Commandments carved in stone. It is a bill. It is a law. Laws change as times and conditions change, as we get different information. So there are uncertainties in the future. The future is uncertain. But we can lay down a good start toward bringing people into a health insurance system and stopping some of the most horrible practices of the health insurance industry, moving us toward more of a health care system rather than a sick care system.

So, yes, there are uncertainties, but we know one thing: The certainty of the status quo leads to too many people not having any kind of health care whatsoever. It leads to people dying younger than they should because they don't go in for their checkups and their screenings, children and others.

We know the other side made clear sometime ago they wanted to obstruct and delay and filibuster and kill this bill. As far as my friends on the other side of the aisle are concerned, this floor debate is not about offering amendments to improve the bill. It is really not about allowing more time to fully read it and understand the bill. That is nonsense. It is not about playing a constructive role to pass a better bill. All the other side wants to do is kill this bill. Period.

All this yakking that is going on--I was home this afternoon and I turned on C-SPAN and I was listening to the debate. And I thought, you know, people are at home. They are getting ready for Christmas. The trees are up. People are feeling good. Here we are going back and forth, back and forth, back and forth, but people have tuned this out.

They really have. It is Christmastime and people have tuned this out. Yet we are here.

We are here for a good reason. We are here because we are determined to pass meaningful health care reform for America, and we need to do it before Christmas.

Well, again, in the defense of the broken system and the status quo, the Republicans joined at the hip with the health insurance companies. They use the same talking points, the same distortions, the same bogus, cooked-up studies, the same outrageous stories about death panels and pulling the plug on grandma. We have heard all that from the other side, week after week, month after month. Every step, as I said, we on this side have acted in good faith. We did not go the reconciliation route. In our futile quest for bipartisanship, we have repeatedly given the Republicans more time.

In the Senate HELP Committee, under the great leadership of Senator Dodd, we spent nearly 3 weeks marking up the bill. No amendments were denied. Republicans could offer any amendment they wanted. It took 13 days, a total of 54 hours of meetings. We went out of our way to accommodate our Republican colleagues. We accepted 161 of their amendments, either by vote or just by accepting them. After all that time, all that goodwill on our side, accepting 161 of their amendments, every Republican on the committee voted against the bill.

Now, every time I have told this story in Iowa or wherever I have been, people shake their heads. They say: What? They offered 161 amendments? Surely, they would have been kind of happy with that. They might have voted for the bill. They don't understand that. Every single Republican voted against it after all of those amendments.

In the Finance Committee, deliberation on the bill stretched out for months solely to accommodate the wishes of the Republican members of the committee. Yet after all that time, despite the fact that Senator Baucus had bent over backwards to pursue bipartisanship and to accommodate the minority's requests--he acted in good faith at every step of the way--all but one Republican on the committee voted against the bill.

Now, today, Republican Senators say they are opposing the cloture motion because they need more time. They say we are rushing things, rushing things, there is a big rush going on. Good grief. This bill has been on the Senate floor for 21 days. We have been deliberating about health care reform for almost the entire year. Congresses and Presidents, as I have said, have been trying to get this done since Theodore Roosevelt.

So Republican colleagues say: Slow down. You are moving too fast. Well, that is absurd and disingenuous. We have to ask ourselves: Are our Republican friends going to be more constructive, more willing to act in good faith after the Christmas or New Year's break? Of course not. Their aim, understand, is not to improve the bill or to even understand it; it is to kill health care reform. Period. That is all it is. They just want to kill it.

Now, because they don't have enough votes to kill it outright, they have opted for a course of delay and obstruction and filibustering. But let's be clear. They are not only delaying and obstructing the Senate; they are delaying and obstructing the millions of Americans who desperately need the reforms in this bill. They are delaying and obstructing the 31 million Americans who will finally get health coverage. They are delaying and obstructing the underinsured, millions of Americans who know they are just one serious illness away from bankruptcy and financial catastrophe. They are delaying and obstructing millions of Americans with preexisting conditions who can't get insurance. They are delaying and obstructing women in this country who face systematic discrimination by health insurance companies. They are delaying and obstructing Americans who fear if they get cancer or heart disease, their health insurance company will cancel their coverage.

Let's be clear. Again, Republicans are not only trying to kill health care reform, in doing so they are killing the hope for millions of Americans who are desperate for reform of the current broken system. Too many Americans are literally dying because they do not have health coverage and proper access to a doctor.

All told, nearly 45,000 Americans die each year because they lack meaningful health insurance. A Johns Hopkins study found that children without health insurance who are hospitalized are 60 percent more likely to die than those with insurance. Why? It is obvious. Kids without health insurance are much less likely to get preventive care or to be taken to a doctor in the early stages of their illness--60 percent more. Think about that. Children without health insurance who are hospitalized are 60 percent more likely to die than children who have health insurance. So that is the real cost of delay and obstruction on the floor of the Senate.

This is our job. We are here. We are going to finish this job. But it is a tragic human cost. And these victims can be found in every one of our cities, our farms, our rural communities.

I refuse to allow any obstacle to stand in the way of the Senate addressing the needs of these Americans. I have, along with my friends on this side, opposed the Republicans' filibuster. Likewise, I have been willing to disappoint many whose views I respect by agreeing to painful compromises in order to keep this bill on track. I agreed to those compromises not because I lacked passion or fight--I think my colleagues who know me know well enough that I can fight--I did so because of the harsh but unavoidable reality that because of the Republicans' obstructionism, we need 60 votes to pass this bill, and the only path to securing 60 votes was by making necessary compromises. But I add, that is also the way our predecessors in this body were able to get the votes to pass Social Security and Medicare, both of which had big gaps in coverage when they were first enacted. What they did is they passed bills that were sort of a half a loaf. Then they came back for the remainder of the loaf in the following years.

Despite these compromises, make no mistake, this remains a profoundly progressive bill. One analyst put it this way:

This legislation will be the most important social policy

achievement since the Great Society.

That is exactly why the rightwing in this country is pulling out the stops to kill it. This bill will usher in three huge reforms. First, this bill will be the biggest expansion of health coverage since the creation of Medicare. Some 31 million Americans who do not have coverage now will get it, thanks to this bill. This is a monumental achievement. We do this by expanding Medicaid and by providing subsidies to low-income, modest-income families.

In addition, if you are a small business owner, this bill will offer tax credits of 35 percent of employer contributions toward premiums in order to make it more affordable for small businesses and their employees to have health insurance. That 35 percent will go up to 50 percent. But the 35 percent starts next year. That is why I have said many times in my State of Iowa, and around it, that actually the biggest winners under this bill, aside from the totally uninsured, are small businesses and the self-employed. Small businesses and the self- employed are the big winners in this bill.

What is more, our bill will end the discriminatory practice of jacking up premiums for businesses because an employee is older or has a preexisting condition. They will not be able to do that anymore.

Through these new health insurance exchanges, small businesses and people currently without access to affordable coverage will be able to shop and choose from a menu of quality health plans, much in the same way Members of Congress do.

This bill does much more than extend health coverage. The second great reform in this bill is an array of provisions cracking down on pervasive, outrageous abuses by the health insurance companies, abuses that currently leave most Americans just one serious illness away from financial catastrophe.

Right now, the health insurance industry in this country is extraordinarily profitable. But these profits come at a staggering human cost. Think about it. When Americans get a diagnosis, let's say, of cancer or some other grave illness, they fear two things: First, they fear the illness and, second, they fear the health insurance company. They wonder, is my company going to authorize treatment and pay the bills or will I have to go to war to prevent it from sticking me or rescinding my policy?

I always tell people: Look at your policy. Is there a rescission clause in there? I have had so many people say: What is a rescission clause? It is a little clause in there, probably in the fine print, and it says that when your policy is up for renewal, the insurance company can terminate you. They do not have to renew your policy. This is what happens. Someone gets a very serious long-term illness such as cancer or heart disease. When their policy is up for renewal, the insurance company says, no, they will not renew your policy. Now you are out in the cold with a preexisting condition. Now you can't get insurance anywhere. This bill will end that practice.

Health insurance companies now employ whole armies of claim adjusters just to deny requests. In fact, the health insurance companies give bonuses--they reward people for denying claims, saying no to policyholders. In the State of California, the largest insurers deny one out of every five requests for medical claims, even when recommended by the patient's doctor. One large insurer, PacifiCare, denies medical claims nearly 40 percent of the time. Think about that. That is almost one out of two. CIGNA denies claims 33 percent of the time. So if you get a terrible illness and you are insured by PacifiCare, good luck in getting them to pay for your medical treatment.

Republican Senators give us all the scare talk about a government bureaucrat standing between you and your doctor. Right now, we have corporate bureaucrats standing between you and your doctor, and they earn good evaluations and bonuses and money for denying you coverage.

I can remember a town meeting I had in Mason City in August, one of those famous town meetings. Toward the end of it--it was OK. There was a lot of contention there, people voicing their concerns, as they ought to do, as they have a right to do. But at the end, there was a man sitting down in the front. I thought, this will be my last one. I called on him. He stood up and he said: You know, I have been a doctor here for over 40 years in Mason City--40 years.

He said: I can say honestly during those 40 years, I have never once had a government bureaucrat come between me and my patients on Medicare or Medicaid. He said: However, I can't tell you how many times during those 40 years I have had insurance bureaucrats come between me and my patients.

This is a doctor, practicing for 40 years, and never once did he have a government bureaucrat come between him and his patients.

Nearly 62 percent of bankruptcies in the United States are linked to medical bills. And here is the kicker: Nearly 80 percent of those are people who had health insurance.

When is the last time you ever heard of a health insurance executive claiming bankruptcy? I would like to find one someplace.

The American people have lived in fear and under the heavy hand of these health insurance companies long enough. But help is on the way.

Let me mention a few of the ways this bill immediately cracks down on abuses by the health insurance industry. First, if you are uninsured with a preexisting condition, the bill would give you access to affordable coverage without discrimination. Our bill immediately bans those rescissions I talked about where the insurance company can rescind your policy. We stop that right away.

We prohibit insurers from imposing lifetime limits on benefits, and we impose and restrict the use of annual limits.

Our bill ends discrimination against women. As I said, currently they pay as much as 48 percent more for the same coverage a man has.

Our bill requires insurers right away, next year, to let children stay on their family's policy until they are age 26. Those are a few of the things.

But there is a third area in this bill I have championed for many years, and in many ways I think it may be the most profound part of the bill, and that is a whole array of provisions promoting wellness and prevention, turning America into a general wellness society.

To this end, at the clinical level, the bill requires reimbursement for proven, cost-effective preventive services such as cancer screenings, nutrition counseling, and smoking cessation programs. This means health professionals will be able to offer these services to you before you get diabetes or cancer or emphysema.

For essential screenings and annual physicals, there are no copays, no deductibles. We encourage people to do this so they will not have to pay a copay or deductible.

Our bill makes major new investments in community wellness and public health, and we help businesses both large and small create workplace wellness programs for their employees.

One thing I do not think has been mentioned before, our bill requires large chain restaurants to post basic nutritional information right on the menu so consumers, when they are going out to eat, can make healthy choices.

What we are trying to do is change the paradigm from our current sick care system to a true health care system--one that keeps people out of the hospital in the first place. Our aim is to recreate America as a wellness society focused on healthful lifestyles, good nutrition, physical activity, and preventing the chronic diseases that take such a toll.

As a proud progressive, I make no bones about my enthusiasm for the three great reforms in this bill--vastly expanding coverage, cracking down on the abuses by the health insurance companies, and making robust investments in wellness and disease prevention.

Today we are closer than we have ever been to making Senator Ted Kennedy's dream of universal health insurance a reality. This bill has many authors. We have all been involved in it. But in a very real sense, this is Senator Kennedy's bill.

I urge Senators, when the vote occurs at 1 a.m., to vote their hopes, not their fears. Seize the moment. Let's move ahead. Let's vote for cloture. At long last, let's give every American access to the quality, affordable health care they need and they deserve.

Mr. President, I yield the floor.

Objection.

Mr. President, first, I commend Senator Durbin for his great leadership--he is our assistant majority leader--and for all of his handiwork on this bill. He has been one of our strongest proponents for making coverage more affordable for small businesses. He just spoke about that.

In fact, under the managers' amendment, we have expanded, even more than what we did in the original bill, credits for small businesses. These credits now start in 2010. They start next year. They are available to more small business firms than we had in the original bill--all of that, thanks to the hard work and intervention by Senator Durbin.

I might note we have a provision also in the managers' amendment relating to cardiac care, congenital heart disease. I know Senator Durbin had a personal tragedy in his own family because of that. So we now have a new program to track the epidemiology of congenital heart disease; it is section 10411, in case anyone is taking notes. It expands on research at NIH on congenital heart disease. We are grateful to Senator Durbin for including that.

Basically, of all the things we have for consumer protection, consumers of America have no more dogged champion here in the Congress than Senator Durbin of Illinois. No matter what it is we are passing here, Senator Durbin always looks to see how consumers are affected. He has done that also on this health care bill, by making sure that consumers have better protections and health care is more affordable. I personally thank Senator Durbin for all of his hard work on this bill.

As Senator Durbin said, and as our leader, Senator Dodd, said, in about 4 hours--a little less than 4 hours now--the historic vote will take place in the Senate. It will be the defining vote of my Senate career. That has been about 25 years, I guess, I have been here. It will probably be the defining vote for all of us during our tenure here in the Senate. It will be the cloture vote on the managers' package. From that we move forward.

I hope after that cloture vote, and after we take that cloture vote, the minority side would see fit, then, since we have the 60 votes, after we have crossed that hurdle, that perhaps they would be willing to close up the debate a little bit sooner than ending on Christmas Eve. But if that is their desire--I mean, they have the rules. We will abide by the rules. If the Republicans want to exercise every single right they have under the rules, they can keep us here until Christmas Eve. There is no doubt about it. But to what end, I ask? To what end?

We are going to have the vote at 1 o'clock that is going to require the 60 votes. Then why stay here until Christmas Eve to do what they know we are going to do, and that is to have the 60 votes on the managers' amendment, on the substitute, and on the underlying bill? I hope our Republican leader and others on the other side would perhaps see that it is not in the best interest of the Chamber, it is not in the best interests of the country.

I know one of the Senators on the other side was talking about waste today. I am thinking, you know, this is kind of a waste, that we are here yakking about this and doing it up until Christmas Eve, when we could collapse all these votes and get it done tomorrow. We could actually be done here tomorrow with this whole bill if the Republicans would see fit. Like I say, it is up to them. They can keep us here if they want to. But the managers' amendment we are going to vote on at 1 o'clock--again, I keep hearing all day today from the Republicans that they have not had a chance to read it, we are rushing it, and it just came out the other day. The Republicans had it read word for word. The few times I came on the floor during the reading, I didn't see many Republicans over there listening to it. You have to wonder, did they all go home and read it? They made the clerk read it. Why didn't they sit here and listen to it? They would have found out what was in it if they were so interested.

Anyway, this is all gamesmanship around here right now. People of America understand that, too. They know we are going to pass health reform, and the first vote is going to be at 1 a.m. this morning. I heard the Senator from Arizona earlier today talking about why should we have it at 1? Why can't we have it at 9 a.m. in the morning? He said the majority leader, Senator Reid, has the power. He could move it to 9 a.m. in the morning and we would not have to bring people here at 1 a.m. He referred to the Senator from West Virginia, Senator Byrd, by name--elderly, frail, but he shows up here to vote. But dragging him out of bed at 1 in the morning to come here? He said, Why don't we do it at 9 in the morning?

I thought that was a pretty good idea. When I got to the floor a couple of hours ago, I asked unanimous consent at that time that we have the vote at 9 a.m. but that the hours from 1 to 9 be counted for purposes of the 30 hours. The Republicans objected. So much for their concern for the Senator from West Virginia.

We are on the cusp. We are going to expand small business credits. We are going to reduce administrative costs. We are requiring insurance companies to spend 80 to 85 percent of their income on health care--on health care, not fancy corporate offices, not high, expensive CEO salaries of millions of dollars a year, not fancy jets, but 80 to

85 percent must be spent on health care and paying medical claims.

As Senator Durbin said, we make major investments in community health centers--10,000 more community health centers in America. We are investing in the National Health Service Corps to get more young people to serve in the National Health Service Corps. We have new protections for patients, access to a primary care provider of their choice, and an important provision championed by the Senator from Maryland--I think Senator Cardin--to provide access for women in their choice of an OB- GYN. In other words, they get to pick who their OB-GYN is, not their primary care provider, not the health insurance company, not anyone else. The individual woman can pick her own OB-GYN.

The amendment we have before us immediately allows children to stay on their parents' health insurance until they are age 26. The managers' amendment also prohibits insurance companies from imposing preexisting conditions on children up through the age of 18 right away, next year. Think about that. Think about what that means to a family who has a child who maybe was born with a defect--something that is chronic. The insurance companies tend to exclude them. Our bill says that beginning next year they cannot do that anymore to children. That is a big deal for so many families in this country who have kids who have been afflicted with a birth defect or maybe something happened, maybe they had an accident, maybe they had an illness early in life that has turned chronic. This is a very big deal for those families.

Last, for someone like me who represents a lot of rural areas and small towns, we have increased, in the managers' amendment, more workforce. We are going to have more people for rural and underserved communities. We will increase the funding in the training programs for rural health providers, so small towns and rural areas of the country have a big boost in the managers' amendment.

We are going to put more money and more loan repayments for people who want to serve in underserved areas, in rural areas, to make sure they do not have to go someplace where they get a lot of money to pay back their debts for medical school. We are going to be providing some of those payments if they serve in a rural area, an underserved area.

I know we have now another hour to listen to the Republicans tell us why we ought to put this off for another century or so, I suppose. The people of America know the time has come now. We are committed to this. At 1 a.m., we will have the 60 votes, and we will get this passed before Christmas. It will be one of the best Christmas presents this Congress has ever given the American people.

I yield the floor.

Mr. President, first I thank the Senator from Alaska for all of his hard work on this bill. I think it is fair to say the Senator from Alaska, a new Member of the Senate, I might add, has been very much involved in this bill and his focus has been on rural health and better health care for native Alaskans. As the Senator knows, the Indian Health Care Improvement Act, which also covers Native Alaskans, is included in this bill. I thank the Senator from Alaska for insisting on that and for being a strong supporter of making sure we do help primary care practitioners, both doctors but also nurse practitioners, physicians assistants, other health care and primary health care people who are going to serve in our small towns and rural communities. The Senator from Alaska has been one of our best leaders on making sure that we have this in the bill. I thank him for that very much.

Let me thank Senator Nelson for his strong commitment to Medicare. I know of no Senator who fights harder for Medicare and for making prescription drugs more affordable to seniors than the Senator from Florida. He has contributed his great expertise as a former insurance commissioner to the provisions we have in this bill on cracking down on insurance company abuses, and he just went through some of them there. I thank my good friend Senator Nelson from Florida for all of his great input into this bill.

In a few minutes, the Senate will close its doors for a brief recess. When those doors reopen just after midnight, the Senate will reconvene for a historic purpose: to bring the promise of quality, affordable health care to millions of Americans. When those doors reopen, we who have the privilege of serving in this body will have the opportunity to vote for hope and opportunity and new help for working families who worry every day that their illness will cause them to go bankrupt.

Mr. President, I yield the floor.

I ask for the yeas and nays.

Mr. President, with over 2 million inmates, many who are in prison for nonviolent drug offenses, the United States has the highest rate of incarceration in the world. In recent years, we have rightly begun to question how our criminal justice system can better ensure our communities are safe and free of drugs and violence, while fostering healthy families and communities through drug treatment and rehabilitation for those who are not violent or a danger to society. That is why I cosponsored the Second Chance Act, which became law last Congress. It is also why I am a proud cosponsor of S. 714, the National Criminal Justice Commission Act of 2009, introduced by Senator Webb.

As we engage in a dialogue regarding the criminal justice system, I strongly recommend to my colleagues recent remarks Chief Judge Robert W. Pratt of the Southern District of Iowa made before the U.S. Sentencing Commission. Chief Judge Pratt authored the trial court decision in Gall v. United States, where the Supreme Court provided for greater discretion for Federal court judges in imposing criminal sentences, and he has become one of the leading

legal thinkers in our country on criminal sentencing. While I do not necessarily endorse every idea Chief Judge Pratt discusses, I commend to my colleagues his incredibly thought-provoking speech on this complex and challenging topic.

Mr. President, I ask unanimous consent that the entire text of Chief Judge Pratt's statement be printed in the Record.

Parliamentary inquiry: How much time would I be recognized for now?

Mr. President, today and every day an estimated 14,000 Americans will lose their health insurance coverage. The historic legislation before us takes unprecedented steps to expand this coverage to the great majority of Americans, while cracking down on the abusive practices of the health insurance industry. However, expanding coverage alone is not going to solve our problem. The additional 31 million Americans who will gain coverage thanks to this bill are going to need health care providers, mainly primary health care providers--the doctors, the nurses, the many other health professionals whose skills and hard work provide patients with the high-quality health care they need. We are going to need public health professionals who can provide assistance during times of emergency such as the current H1N1 pandemic. They will need places to go when they become sick, including doctors' offices, community health centers, and nurse-managed health clinics.

Today, many communities are facing shortages of primary care practitioners and other health care providers. This map gives an indication of the lack of primary health care providers in America. The darker area is where we have the lowest number of primary health care practitioners. We can see it is mostly rural America. That is not entirely true, but it is mostly in rural America in which we lack that kind of care.

Currently, 65 million Americans live in areas suffering from a shortage of these health care professionals. The Department of Health and Human Services estimates it would take more than 16,000 additional practitioners to meet our need. Many of my constituents--and I am sure those of the occupant of the chair--don't have the primary care practitioners they need.

I must say, I was up this morning; I was working out; I was watching CNN news. Along came a little blurb: Shortage of primary care health care people in America. That is going to put a crunch on us in terms of meeting our health care needs. People are now beginning to pick up on this all over the country.

What are we doing about it? First, we have to recognize some of the root causes. One of the root causes is debt. It is the amount of money health care students pay to go to school. Here is the debt of graduates of medical school: 44 percent have over $175,000 of debt; the vast majority have over $125,000; and some, almost half, have $175,000 of debt. What happens is that with this huge debt, they can't afford to work in rural areas or areas where they don't get recompensed.

Qualified applicants are not admitted because of a shortage of faculty members. In 2008, an estimated 50,000 applicants were turned away from baccalaureate and graduate schools of nursing. This is unacceptable. Again, not only do we have to have more primary care practitioners, we need the faculty.

It is a growing problem. The Bureau of Labor Statistics estimates that by 2016, we will have a shortage of over 1 million direct care workers, including home health aides, nursing aides, and others who care for our aging population. That is why expanding access to primary and preventative care has been a key focus throughout our health reform efforts.

With Senator Murray's leadership of the workforce group, the HELP Committee has focused on expanding resources to increase the supply of qualified health care providers. In the Finance Committee, Senator Baucus also made expanding access to primary care a priority, as well as expanding residency and training initiatives for primary care practitioners. Under Majority Leader Reid's guidance, the Patient Protection and Affordable Care Act, the health reform bill before us, combined both HELP Committee and Finance Committee provisions to expand the health care workforce, especially the primary care workforce.

Let's see what this does.

First, the bill will train an additional 24,000 primary care physicians via the National Health Services Corps. It provides loan repayment, scholarships, and higher reimbursement for primary care providers in underserved areas. It also increases the supply of public health workers at the Federal, State, and local level, and tribal health agencies. We provide new resources for more community health centers and nurse-managed health centers. We expand primary care residency and training initiatives and hospitals and community health centers.

Our bill will improve health care providers' ability to serve our increasingly diverse population by providing training in cultural competency, in working with individuals with disabilities, in providing care within the medical home model. Because innovative health care delivery models such as the medical home emphasize team-based care, we invest in a range of health care professionals, from physicians, to nurses, to dentists, to home health aides, to allied health professionals.

In addition, to increase the capacity of health professionals schools and faculty to train new providers, we offer loan repayment programs to doctors, nurses, and dentists who agree to serve as faculty members at medical, nursing, and dental schools.

Finally, our bill creates an independent national health care workforce commission to examine and provide recommendations to Congress on how Federal workforce programs can be improved and how Federal dollars can be most effectively spent.

It is critical that we act on this historic legislation for many reasons. Most of the debate has been about expanding coverage, cracking down on health insurance abuses, and expanding preventative care to keep people healthy in the first place.

But there is also one other aspect of this bill that has not been talked about; that is, what we are doing to increase the number of people whom we are going to have to have for primary care, for our community health centers, for faculty members in the future. This is something we have ignored for

far too long at our own peril. We can't forget that while we are expanding coverage--and we are going to cover 94 percent of the American people with this health care bill--while we will make it more affordable, while we are going to protect Medicare, while we are going to do all the things to really make our health system more affordable, more quality-conscious, cover more people, make sure people can get in to their primary care first rather than go to an emergency room, we can't forget that we need the faculty. We need teachers, and we need to help in debt repayment, loan repayments, by giving more scholarships to these young people, the nurses, the nurses aides, the physical therapists, the people who work with people with disabilities, doctors, dentists--the whole panoply of people involved in primary care. We have to help them get through school so they don't have a mountain of debt on their heads, so they can practice medicine where they want, not where they are forced to go in order to pay back their debts.

Again, I thank Senator Murray on the HELP Committee, who did so much to put all of this into our bill. This is a major provision of the health care legislation we are not hearing debated about here on the floor very much, but it is one of the most critical parts of the bill.

I thank Senator Baucus and all the work they did on the Finance Committee to put in the tax provisions and others to help us, first, invest in and grow the primary care workforce and also to make it possible for people to become faculty members and teachers by helping them pay back their loans and their debts.

I wanted to take this time to highlight this part of the bill. It is not talked about much, but I believe it is one of the most important parts of the health reform bill before us.

I yield the floor and retain the remainder of my time.

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

Mr. President, I ask for the yeas and nays.

Mr. President, I want to speak for a few minutes on the Labor, Health and Human Services, Education, and Related Agencies appropriations bill. The Senator from Michigan was kind enough to let me do this now, even though she had been on the floor.

I ask unanimous consent that at the end of my comments, the Senator from Michigan be recognized.

Mr. President, as chairman of the subcommittee on Labor, Health and Human Services, Education and Related Agencies, I want to take a few minutes to go over the bill we have before us, the so-called ``minibus.''

I wish in the beginning the Senate could have debated and voted on the Labor-HHS bill individually, rather than having it as part of the so-called minibus. Unfortunately, it is now December. We still have to complete the health care bill and, frankly, we have run out of time.

However, I want to assure my colleagues that the Labor-HHS appropriations bill is a bipartisan bill. We worked closely with Senator Cochran and his staff to reflect Democratic and Republican priorities alike. That is the tradition in our subcommittee--one we take very seriously.

In fact, the full Appropriations Committee approved our bill by a vote of 29 to 1. You cannot do much better than that to accommodate the concerns of both parties.

I also want to assure Senators that this is a fiscally responsible bill. Overall, our bill increases discretionary spending by just 2 percent over the fiscal year 2009 Labor-HHS appropriations bill.

With money so tight, we had to be selective about which programs received increases. One high priority is worker protections. Agencies that enforce rules protecting the health, safety, and rights of workers have been seriously shortchanged in recent years. This bill adds $121 million over last year's level and brings staffing levels at the Occupational Safety and Health Administration, the Employee Benefits Administration, and the Employment Standards Administration back to where they were in 2001. This means the agencies will have the resources they need to prevent wage theft and ensure safe workplaces for our Nation's workers.

The bill also includes a 50-percent increase--a total $1.1 billion-- to reduce improper payments, fraud, and abuse from mandatory benefit programs, such as unemployment insurance, Medicare, and Social Security. These antifraud, anti-abuse measures could result in over $48 billion in savings and increased revenues over the next 10 years.

Another priority we had was getting people back to work. This bill provides an increase of $72 million, or 43 percent, for nurse training programs, including a new program to train nursing home aides and home health aides.

This bill also provides a major increase--$260 million--for the national service programs. This will boost the number of AmeriCorps members significantly and create a new social innovation fund that will help small nonprofits tackle a host of social programs.

In the area of education, increases are targeted to programs that are designed to reform schools, such as performance-based pay for teachers and principals, charter schools, and a comprehensive new literacy program.

Providing increases, such as the ones I have described, meant making some tough choices. Our bill eliminated 11 duplicative and ineffective programs, and we cut several others. Not everybody will be happy with all of those decisions. I may not be happy with all of them, but we did the best we could, struck compromises, and I stand by the outcome.

I also support the other five bills in this minibus, if I might say that. I worked closely with our colleagues on the Appropriations Committee. I want to particularly thank Senator Murray regarding her work to allow fiscal year 2009 Community Development Block Grant funds to be used as a match for other Federal programs. The reason this is important is because many States and local governments were hard hit by both disasters--such as the floods in Iowa--and the poor economy. They would have great difficulty providing Federal match requirements without this modification. I thank Senator Murray for putting that in her bill.

I also thank Senator Durbin for the inclusion of a provision regarding auto dealers. In my State, there are a number of decisions that were made by General Motors to close down certain dealerships that met the criteria set down by General Motors for staying in business. I hope this provision that Senator Durbin put in will allow for needed fairness for a number of these family businesses.

Again, I believe the package of bills we have before us is fiscally responsible. They move our country in the right direction, and I hope the Senate will approve them as soon as possible so we can send them to the President.

With that, I yield the floor.

Mr. President, I thank my colleague from Montana, the chairman of the Finance Committee, for his great leadership on this issue, on this bill, and Senator Dodd, who took the leadership of our HELP Committee, in putting our bill together. The two of them have done an admirable job of getting our bill this far along and, hopefully, we are going to see the light at the end of the tunnel pretty soon. One of the best Christmas presents we can give the American people is to bring this bill to a close, have our votes up or down and let's get this bill passed so the American people can look ahead to a brighter future in terms of their health care and its quality, affordability, and accessibility.

Amendment No. 2939

I wish to take a little bit of time this morning to speak in strong support of Senator Pryor's amendment, which is before us, which would provide information on the consumer satisfaction of health plans offered through the exchanges. The Pryor amendment develops an enrollee satisfaction survey for these plans and requires exchanges to include information from this survey on an Internet Web site. This, too, will allow consumers, both individuals and small businesses, to easily compare survey results and make well-informed choices.

Currently, OPM manages an enrollee satisfaction survey for the Federal Employees Health Benefits Plan, the one we are all in and the one our staffs are in, the one that postal workers are in and civil servants all over this country are in. Right now OPM, in managing that plan, has an enrollee satisfaction survey. The Pryor amendment would provide a tool to all Americans that we as Members of Congress have when we select a plan.

The survey results could be used by GAO, the Government Accountability Office, and the committee I chair, the Senate HELP Committee, to monitor the quality of exchange plans and fulfill our oversight responsibilities over the exchanges.

As a little aside, I keep reminding people we will pass this bill, we will get this health reform bill passed. It will be signed into law. But that does not mean, like the Ten Commandments, it is written in stone, never to be changed. Laws are laws and laws change. They get amended, and we change and adapt as times and conditions demand. As we move ahead and as we look at how the exchanges work, what is happening out there, I have no doubt in my mind there will be some bumps in the road and we will have to come back and revisit it and make some changes. By having this Pryor amendment and what we have in the bill to provide for this kind of survey to see how satisfied people are with the plans, it gives us that kind of oversight ability, that oversight responsibility to look ahead and plan on changes that we will probably be making in the future.

But most important, the Pryor amendment will give consumers an important voice. It will keep the insurance companies honest because they will know to maintain and grow their enrollment they must satisfy their customers.

This amendment truly complements and reinforces the purpose and function of the exchanges. The Patient Protection and Affordable Care Act, our reform bill, creates exchanges as a place for one-stop shopping where consumers, the self-employed, and small businesses can easily compare plans. This amendment will increase competition and lower premiums as the exchanges will increase competition and lower premiums.

This past week, the Congressional Budget Office validated this approach, and the CBO said this about the exchanges:

The exchanges would enhance competition among insurers in

the nongroup market--

That is small businesses, individuals, self-employed--

by providing a centralized marketplace in which consumers

could compare the premiums of relatively standardized

insurance products. The additional competition would slightly

reduce average premiums in the exchanges by encouraging

consumers to enroll in lower-cost plans and by encouraging

plans to keep their premiums low in order to attract

enrollees.

What we have been hearing from the other side of the aisle all along is premiums are going to go up, everything is going to skyrocket. CBO debunked this last week. CBO also said it will benefit small business:

Those small employers that purchase coverage through the

exchanges would see similar reductions in premiums because of

the increased competition among plans.

The Senate bill before us ensures consumers and small businesses have the information they need to make informed choices.

One, our bill requires exchange plans to provide information on quality measures for health plan performance. This was a provision offered in our committee by Senator Jack Reed, and I commend him for it.

Second, our bill develops a rating system that will rate exchange plans based on quality and price--ratings, again, that will be available on an Internet Web site.

Third, our bill requires exchanges to operate a toll-free hotline to respond to requests for consumer assistance.

Fourth, our bill develops an online calculator so that consumers can figure out how much they will have to pay, factoring in their tax credits and cost-sharing reductions.

And fifth, and perhaps most important, I want to acknowledge a contribution made by Senator Dodd in this area. He authored a key provision in our bill to require all plans--all plans--not just exchange plans, all plans--to provide a uniform, easily understandable summary of coverage to enrollees and applicants. In other words, no longer will Americans have to read and try to comprehend the fine print.

All of these provisions are currently in our bill to enhance consumer choice, which is what this bill is about--enhancing and expanding affordable choices.

Some of them have been overlooked in a lot of the verbiage going on about cutting Medicare and all that stuff, but these provisions will do a great deal to change the way Americans shop for and buy health insurance.

This amendment by Senator Pryor will add one more important tool to help our consumers. It is a consumer amendment to make sure consumers get the information they need and the input, a satisfaction survey so consumers can have an input. That way we know here if we need to make changes down the road.

I commend Senator Pryor for offering the amendment. I urge my colleagues to support it.

I yield the floor.

Mr. President, I would say that a lot of what Senator Bennett says I agree with. That is why, in this bill--and I keep reminding people because it is not talked about much--there are more provisions in this bill to promote wellness and prevention than any health bill we have ever passed--ever--in the United States. There are huge investments in this bill on prevention and wellness.

I happen to think that perhaps one of the reasons Salt Lake City is so good is because people don't smoke and don't drink and that goes a long way toward providing for a healthier form of living. So I say to my friend from Utah, people talk about bending the cost curve only in terms of the spending. I think--and I sincerely believe this--the only way we are going to bend that cost curve is by pushing more of this upstream, by keeping people healthy in the first place, starting with kids and adults, community-based, clinical-based, workplace-based wellness programs.

So I ask my friend from Utah to look at that part of the bill.

First, I thank my friend from Vermont. There is no one who has been leading the charge longer and stronger and more fervently than the Senator from Vermont, Mr. Sanders. I thank him for that. Obviously, we all have community health centers in our States. In Iowa they have been a godsend for so many people in rural areas who did not have access to these kinds of facilities.

I remember one time I was in Fort Dodge several years ago. They had a small free clinic there. It was in a church basement one night a week, so people could come in who didn't have insurance and couldn't get access to a doctor. They had one old dental chair there. I think every couple of weeks a dentist would come in for people. A woman had come in who had an abscessed tooth. It was hurting her so much she took a hammer and screwdriver and tried to knock her tooth out. Of course she damaged her gums. That is how desperate people get.

Because of that, I got the Fort Dodge community looking at a community health center. They now have a wonderful community health center. They have doctors there, they have nurses there, and people have access to that kind of dental care and health care.

I thank the Senator again. I can't help but every time we talk about community health centers, I always have to add one thing. A lot of people think community health centers are just for poor people who do not have anything. Nothing could be further from the truth. They will take anyone who walks in the door. You can have health insurance, you can be on Medicare, you can be on Medicaid, you can have no insurance, you can have a great insurance plan--whoever walks in the door. They have a sliding scale based on income, based on resources, of who they will take.

It has been my experience--I ask the Senator from Vermont what it has been in his area, but it has been my experience in our growing number of community health centers in my State of Iowa that more and more people----

Come to community health centers. Why? Because they get the kind of hands-on care, they get many kinds of supportive services. A lot of times there are language barriers that are a problem. They get preventive care, they get all the things that make people feel better about their own quality of health care. So more and more we are finding people who actually have health insurance going to community health centers.

I ask if that has been the experience in Vermont?

I can assure my friend from Vermont that this Senator will be in the forefront of fighting for the maximum possible support, money, and input for community health centers that we can possibly get out of this bill. I can assure him that.

As long as we get an additional minute.

Mr. President, do I have 2 minutes?

Mr. President, I listened to my colleague from Iowa earlier talking about the ``meaningless amendments'' and that amendments that do not have any teeth are just meaningless, stuff like that. I listened to that.

I want to make it very clear that the Gregg amendment is not a meaningless amendment. It has a lot of meaning because what it does is it kills health reform. Oh, yes, this is a meaningful amendment, make no mistake about it. It goes right to heart of what the health reform is all about: making sure people at the low-income end of the scale have a little bit better coverage; that is, people on Medicaid--that is section 2001--the tax credits and the copays that are in there, again, to help moderate-income people and families be able to afford better coverage for themselves and their families--he guts that too--and, of course, the expansion of SCHIP.

So really, yes, I say to my friend from Iowa, this is a meaningful amendment--if you want to kill the bill, if you want to kill it. I suppose since most of my friends on that side of the aisle would like to kill the bill, they will probably vote for the Gregg amendment. But it completely guts it--completely guts it. Why? To help protect the wasteful subsidies to the insurance companies at the expense of families who are struggling to afford insurance and seniors who rely on Medicare.

This bill lowers premiums for American families, businesses, and the country as a whole. The Congressional Budget Office just said that this week. It strengthens Medicare, it improves benefits, and it adds years of life to the Medicare trust fund.

Let's be clear. Not one dime of the Medicare trust fund is used to pay for this reform, and no guaranteed Medicare benefits will be cut. If anyone can prove otherwise, please come forward. We have had a lot of rhetoric about it, but prove that this statement is not true: Not one dime of the Medicare trust fund is used to pay for reform and no guaranteed Medicare benefits will be cut.

Mr. President, I ask unanimous consent that the Senate now proceed to vote in relation to the Pryor amendment No. 2939; and that upon disposition of that amendment, there be 2 minutes of debate prior to a vote in relation to the Gregg amendment No. 2942; that no amendments be in order to either amendment, and that the second vote in this sequence be 10 minutes in duration; that each of the above- referenced amendments be subject to an affirmative 60-vote threshold, and if the amendment achieves that threshold, then it be agreed to and the motion to reconsider be laid upon the table; that if the amendment does not achieve that threshold, then it be withdrawn; that upon disposition of the above amendments, Senator Nelson of Nebraska be recognized to call up his amendment No. 2962; that once the amendment has been reported by number, it be set aside, and the Republican leader's designee be recognized to call up his motion to commit with instructions.

Mr. President, reserving the right to object, will the Senator please repeat what he just asked?

Mr. President, I will have to object to that. I have no instructions from Senator Pryor. I believe he wants a vote on his amendment. So I would have to object to that.

Mr. President, I want to modify my request, that the 2 minutes I asked for for debate prior to the vote be evenly divided between the two sides.

Mr. President, I will have more to say about this later. But there has been so much talk about fear, fear, fear. Everybody has a fear. Let's get away from that. It is time to quit talking about fear. Let's talk about hope. Let's talk about the realities of

what is affecting people out there, what we are trying to do to make their lives better. Why do we always want to inject fear into people? Let's talk about hope. Let's talk about real people and what this bill does.

As shown in this picture, this is Sarah Posekany of Cedar Falls, IA. Let me tell you her story. It is incredible. She was diagnosed with Crohn's disease when she was 15 years old. During her first year in college, she ran into complications from the disease and had to drop classes. Because she was no longer a full-time student, her parents' private health insurance company terminated her coverage. Then the medical bills piled up. Four years later, she found herself $180,000 in debt, and was forced to file for bankruptcy.

Sarah has undergone seven surgeries--seven. Here is what is disturbing. Two of those came as a direct result of not being able to afford medication. So again, it is an incredible story, but it is a true story.

So many people have to go through this. Our bill says: Look, you can stay on your parents' coverage until you are age 26, and--guess what-- no preexisting conditions will apply to you from here on out. Think about Sarah when we are talking about this bill and the hope she needs--and so many like her--that we are going to change this system to make her life better.

Second, this is a picture of Tasha Hudson of Des Moines, IA. She is a single mother, with three kids. She had a job which provided health insurance, but she took a new job that paid her more, 50 percent more. You would think: Isn't that the American way? You learn, you get better, you get a better paying job. The problem is, the private sector job did not come with health insurance. Despite the higher pay, she could not afford the coverage.

Ironically, her higher pay led to cuts in her Medicaid benefits and the loss of childcare services. As a result, Tasha is now in the process of returning to a lower paying job, despite its limited opportunities, for one reason: because it will provide health insurance for her family. These are real people. These are the people to whom we need to give hope.

Here is one last one. Eleanor Pierce lives in Cedar Falls, IA. She lost her job when her company was eliminated. She had the option of purchasing COBRA, but she couldn't afford it. So she searched for coverage, but because of high blood pressure--preexisting condition-- she was denied access. So age 62, suffering from high blood pressure, she had no choice but to go without insurance.

That is why we need this bill. Not for fear--let's quit talking about fear. Let's talk about hope for the people I just talked about, the hope that their lives will be better, that they will get the insurance coverage they need, that they will be able to get on with their lives and not have to go so far in debt that they have to go into bankruptcy.

If you are a 62-year-old woman with a serious heart condition such as the one Eleanor has, high blood pressure, you just don't have a prayer, you are on your own, and the odds of premature death are disturbingly high. We can and must do better. That is what we ought to be talking about: hope for the future, not fear.

Mr. President, I yield the floor.

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

Mr. President, first of all, let me say I am glad we are here

this weekend. Oh, I know we like to be with our families, we have Christmas shopping to do and things such as that. It is always nice to be with our families on the weekends. But think about it this way: Millions of Americans today are giving up their weekends, they are giving up their nights, their holidays, because they are either out of work, they are working part time, they are trying to do odd jobs to get enough money together to keep their families intact. So they are working at nights, they are working on weekends. They are not taking time off. They are out there looking for work now or out there doing odd jobs, whatever they can possibly do. They are making sacrifices. They are making sacrifices for their families, but they are also making these sacrifices to pay their medical bills or to afford their needed prescriptions. It seems to me we owe them nothing less than the same level of commitment to the task of bringing quality, affordable health care within their reach.

Our leader, Senator Reid, was right to call the Senate into session this weekend. We ought to keep at this bill, this health care reform bill, working hard, until the Senate finishes the job before us. Nothing less will do.

I do not plan to spend a lot of time on the debate over Medicare Advantage that we had yesterday. However, after listening to the comments yesterday, I did want to mention briefly editorials that appeared in the Des Moines Register. The first was published 6 years ago when the Senate considered the Republican Medicare drug legislation. The major element of that bill was to give outrageous bonuses to private health plans in Medicare Advantage. In criticizing that proposal, the Register called on Members of Congress ``to remind themselves their job is to serve the interests of the people, not industry lobbyists.''

Sadly, we didn't heed that call that time, 6 years ago. Instead, Congress, under Republican leadership at that time, enacted a bill that provided a massive and unjustified windfall to the insurance industry.

The Register revisited the same subject in an editorial this year, May 31 of this year. Here is what they said:

Congress encouraged private insurance plans, known as

Medicare Advantage plans, which have cost taxpayers more than

covering seniors in traditional government-administered

Medicare.

Congress should not repeat the mistakes it made in 2003

when reforming Medicare--catering to special interests and

pushing people into private-sector insurance coverage.

Our health bill, the one we have before us, heeds these words. We stand up to the special interests that even today are demanding billions of dollars in taxpayer funds to prop up their inflated profits. So yesterday was a good day. Yesterday we said no to giving the insurance industry a $120 billion bonus for doing the same job that Medicare can do for far less.

Today we will consider a proposal from Senator Lincoln to say no to the outrageous salaries that top executives in these companies receive. Chief executive officers at the seven leading insurance companies made a combined $118.6 million in 2007 alone, an average of $11.9 million each. Let's compare that to the wages of millions of Americans or the minimum wage. For someone making the minimum wage, it would take nearly 800 years to make what these insurance company executives make in 1 year.

Again, here is the CEO compensation. For United Health Group, they made $2.9 billion in profit in 2008 and they paid their CEO $9.4 million; WellPoint, $9.8 million; Aetna, $24.3 million; Humana, $47.3 million; Coventry Health Care, $11 million; Cigna, $4.4 million. That is the CEO compensation. That probably is not the whole package when you consider all the other benefits they get, deferred compensation and on and on--golden parachutes, all that kind of stuff. That is basically their CEO compensation for the year.

As you can see, they get paid pretty well and $11.9 million is the average. Here is Aetna, $24 million a year. They had a profit of $1.3 billion that year. So they did well, their shareholders did well, their CEO did well. But how about the consumers, the working families?

In 2003, by the way, Aetna, this company right here, making all this money, paying their CEO $24 million a year--in 2003 Aetna settled a lawsuit. You know, usually when you settle lawsuits it is because you think you are going to get hit worse down the line. They settled a lawsuit brought by who? Brought by physicians, a whole group of physicians brought a class action against Aetna because they had a history of shortchanging patient care. Aetna settled for $470 million, just to get away from it, in 2003.

There was not any money to help them afford the coverage patients need, but they had billions for profits and they had millions for salaries--nothing for working families.

The reality for working families across America is simply this: Insurance premiums have skyrocketed, outpacing the growth in wages over the same period. Quality affordable health care is slipping further and further from the grasp of middle-class Americans. Between 1999 and 2007, the average American worker saw wages increase 29 percent. Insurance premiums during that same time rose more than 120 percent. They see the premiums skyrocketing, but their health care is slipping away.

There is something else. The profit margins of the insurance industry soared. Over the last 7 years the profits of the seven largest publicly traded health insurance companies increased by 428 percent. Profits increased by 428 percent, from $2.4 billion to $12.9 billion. Yet look at what our workers' wages went up--29 percent.

Now you begin to understand why people in this country are upset and discouraged and outright mad about their lack of health insurance coverage, about the affordability of that coverage and the quality of that coverage. Yet with all of this money that is going to their CEOs and huge increases in the profits they make, our Republican friends on the other side of the aisle say they still need a Federal handout. The industry cannot find a dime to bring down prices for consumers but they can find millions to lobby for more special favors.

The Wall Street Journal reported that the health care industry boosted their efforts in lobbying this year. In a quote from the Wall Street Journal:

Overall, the health-care sector reported a five percent

increase in lobbying expenditures to $133 million, making it

the single largest spender on lobbying of the 10 major

industry sectors tracked by the Center for Responsive

Politics. Health-insurance companies increased lobbying

activity by 11 percent to $7.8 million, according to the

data.

An increase of 11 percent. You wonder why all this health sector this year had $133 million in lobbying expenditures. I think, if I am not mistaken, the supposed, stated purpose of health insurance is to protect Americans from the cost of illness. Supposedly their purpose is to keep the American people healthy and productive for the benefit of society. Yet over some 60 years, this industry, the health insurance industry, has transformed itself from an industry that is there to help you to an industry that is there to take money from you when you are healthy and avoid paying your bills when you get sick. This is an industry with armies of actuaries and functionaries whose job is to prevent you from enrolling if you have a preexisting condition. It is an industry that looks at the fine details of your medical records when you get sick so they can figure out how to cancel your policy and leave you high and dry when you need their help the most, as has been said many times around here.

The majority, actually 62 percent of bankruptcies in America, is because of medical costs, and 80 percent of that group had health insurance. They actually had health insurance, but they had to file for bankruptcy because--they didn't know it, but in their contract, in their policy, there was some fine print called a rescission clause, or there is fine print in there on terms of their annual or lifetime caps, which most people do not even know are in their policies. But when they got very sick, all of a sudden their policy got rescinded, which means when it came up for renewal the insurance company didn't renew it, and here you are with an expensive chronic disease or illness such as cancer or heart disease or disability, and they cancel your policy. You are left with only one recourse--file for bankruptcy.

This is an industry which defines being a victim of domestic violence as a preexisting condition. I spoke about this previously. Only in America, with this health insurance industry running

everything in terms of our health care coverage, only here would we have a situation where a woman can be the victim of domestic violence, be battered, get medical help, go to the hospital perhaps, a victim of domestic abuse, and then later on find that she can't get her policy renewed because she has a preexisting condition, the preexisting condition of being the victim of domestic violence.

You may think that is outlandish, but it is true, and it happens. All we are seeking is competition, openness, transparency, and fairness.

The insurance industry, what are they seeking? They are seeking to preserve and protect a sweet deal they have been enjoying on the backs of middle-class Americans and seniors. The proposal Senator Lincoln is offering says basically: Enough is enough. In defense of their outlandish salaries, the insurance company CEOs cite the difficulty of their jobs and the complexity of their tasks. The President of the United States probably has a pretty difficult job. He has a few complex tasks to confront. There is no reason insurance company CEOs should get a tax break on salaries higher than the President's. That is exactly what the Lincoln amendment does.

I thank Senator Lincoln for her commonsense proposal. I think consumers across America should know that when they pay their hard- earned dollars to cover the soaring cost of premiums, they are not just chipping in to pay for the CEOs' next new yacht or the newest Mercedes in the driveway. In homes across Iowa people are clipping coupons and making do with secondhand, patching up instead of buying new. They have had to make sacrifice after sacrifice to afford premiums that provide coverage for their health care. It is outrageous that their hard-earned cash goes for gold-plated salaries and bonuses. Senator Lincoln is right to take a stand against these excesses. I urge my colleagues to support her amendment.

The Lincoln amendment is consistent with a major theme of our legislation. It is basically standing up to the health insurance industry on behalf of consumers. Her proposal will add one more important item to the list of benefits our legislation will bring to American patients.

As I said before, this bill ends the practice of denying coverage because a person has a preexisting medical condition. I would wager probably every Member of this Senate has some kind of a preexisting condition of some sort, and every one of us could be turned down if we didn't have the kind of secured program under the Federal employees program. Why shouldn't the rest of the American people have the same kind of security?

This legislation ends the lifetime limits and bans unreasonable annual limits. Our bill gives young people better options to stay on their family's and parents' plan until they are age 26. It also ends the outrageous practice of charging women higher prices for the same policy, the exact same policy a man gets. I can remember, during my town meetings back in August, talking about this issue. People were startled to learn that an insurance company can charge a woman up to twice as much for the same policy--same age, all the same parameters, same occupation, same kind of history. They can charge a woman up to twice as much as a man for the exact same coverage, the exact same policy. We get rid of that in this bill. We do not allow that kind of discrimination in any other kind of industry. Why should we allow it in this industry?

Our bill provides better options for individuals, small businesses, farms, for the self-employed. I have said many times the biggest winners in our health care reform bill are small businesses and the self-employed. Right now they are sort of at the end of their rope. They have no bargaining power whatsoever. Our bill will create exchanges so they will be able to go on the exchange and pool with other people for more options, more competition, more transparency available.

Some places in Iowa we have only one insurance company offering policies. There is absolutely no competition. Setting up the exchanges will allow our self-employed and small businesses to get more bargaining power.

These are the kinds of measures the American people want and need to make sure they get a fair deal on the coverage they buy. We need a health insurance industry that is a partner for employers and ordinary Americans, charges fair premiums, treats us right, and pays our bills when we get sick. That is what our bill is all about. It is to end a lot of these outrageous practices that have gone on for far too long in the health insurance industry.

A lot of times people say: You are always beating up on the health insurance industry. Not really. We are just taking them to task for where they have gone. Years ago when they first started out, they were doing a good job. Then the greed, the normal human nature and greed for more profits, higher CEO salaries, $24 million salaries for CEOs, gold- plated benefits packages for all their CEOs and corporate executives; it just got out of hand. It became a situation where almost one health insurance company was trying to outdo the others in terms of how much money they could squeeze out of the consumers. It is just a system that sort of ran amok.

Now it is up to us in the Congress to rein it in, to make the health insurance industry what it ought to be--a fair and reasonable, competitive system for the consumers. That is what this bill does. To me, that is the American way. That is why we have to stay here on the weekends, if we have to. If we have to be here today, fine; and tomorrow, fine; and all next week, fine; and next weekend; and, if we have to, right through the holidays.

The American people are looking to us to get this job done. We are going to get the job done. No matter how much our friends on the Republican side want to delay, delay, delay, and try to kill this bill, it is not going to happen. This bill is unstoppable because the American people are demanding that we do something about it. We are responding to that, and we are going to get the job done.

I yield the floor.

Mr. President, I wish to thank our friend and leader on this issue, Senator Dodd, for his eloquence in supporting what so many of our elderly in this country want more desperately than just about anything else; that is, the peace of mind of knowing that if they should become disabled, they will not be forced to go into a nursing home, they will have some support, and they will be able to live in their homes in their communities. Talk to anyone with a disability--not just the elderly, anyone with a disability--and they will tell you how important it is that you have that kind of assurance that if, God forbid, you become disabled, your only hope will not be to go into a nursing home for the rest of your natural life.

Senator Kennedy worked on this for years. The couple times I talked to him this summer and this spring, this is what he wanted to talk to me about: making sure we included this in the bill. This was his cause, to make sure we had a program people could contribute to that would afford them some support if, in fact, they became disabled.

I do not understand the move by my Republican friends to strike this. This is not a mandatory program. This does not force anyone to pay a dime. It is all voluntary. We say, if you want to, you can put some money aside during your working years in a fund that will vest so that if you become disabled, you can get some support to stay at home, maybe with your own family, maybe with just enough support so you can get another job and work even though you have a disability. This is voluntary.

I ask my friends on the other side of the aisle, why are you against a voluntary program that will enable people to have that kind of peace of mind? Well, I have heard it said: Well, maybe the taxpayers will have to pay for this and everything.

I will tell you this: In the committee, Senator Gregg--Senator Gregg from New Hampshire, Republican Senator Gregg, my good friend--offered an amendment to make sure the contributions were the only things that would sustain this program, that it would not become an entitlement. Here is what he said, his own words:

I offered an amendment, which was ultimately accepted, that

would require that

CLASS Act premiums be based on a 75-year actuarial analysis

of the program's costs. My amendment ensures that instead of

promising more than we can deliver, the program will be

fiscally solvent and we won't be passing the buck--or really,

passing the debt--to future generations. I'm pleased the HELP

Committee unanimously accepted this amendment.

The CBO has scored this. This is completely paid for over 75 years-- over 75 years. I do not understand why anyone would want to strike it.

What Senator Whitehouse has said--again, I think this is very appropriate for us--is that any savings we get from this be reinvested either in the CLASS Act--so when people do get disabled, maybe they will get a little bit more money. So we have some savings in the CLASS Act. What Senator Whitehouse has said is, put those savings back in the CLASS Act or Social Security. It makes sense to me. So again, I think it is an improvement on the bill, what Senator Whitehouse is suggesting.

I plead--I plead--with my fellow Senators, do not kill this program aborning. We stood here on this floor 19 years ago, on July 20, 1990. We stood on this floor to pass the Americans with Disabilities Act. There were a few votes against it. In fact, there are one or two people still here who voted against it. I think if you asked them now, they would say it has been a pretty darn good bill. It has broken down a lot of barriers, opened a lot of doors for people with disabilities in our country, changed our environment in this country, not only in terms of physical access, but I think, more importantly, it has changed how we view people with disabilities, no longer looking at people with a disability to say, what is their disability, we now look at those people and say, what are your abilities, what can you do--not just looking at someone's disability. So we have come a long way.

The one thing we have never been able to really do is to set up a functioning system so people could put some money aside to protect themselves in case they got disabled. Well, this is it. This is our chance. This is a big part of this health care bill, a big part.

Well, maybe, I suppose, if you are trying to kill the bill, you would want to kill the CLASS Act. But this is vitally important for our country. It is really the next logical step after the Americans with Disabilities Act. It is going to provide for so many people in this country that security and that peace of mind of knowing they will not have to go into a nursing home or an institution if they become disabled. And it can happen to any one of us here on the Senate floor, our families, our staff, our loved ones. No one knows what might happen to us either from an accident or a physical ailment. No one knows. But shouldn't we at least have some part of this health care bill that provides that kind of voluntary program? No one is forced into anything. I guess that is what perplexes me more than anything else-- why my Republican friends want to prevent something like a voluntary program--a voluntary program--from going into existence that would do this, that is fiscally sound for 75 years. I just do not get it.

So I hope we will support the Whitehouse amendment and make sure this fund is totally solvent. I think he is on the right track, that if there are savings, to put the money back in there, so maybe that $75 a day could be maybe $80 a day, or something like that, to help people.

I see, Mr. President, we now have a statement from the AARP about the CLASS program. Here is what they said. They said:

Decades of talking to our members tell us that older

Americans want to live in their homes as they age. That's why

AARP strongly supports the Community Living Assistance

Services and Supports (CLASS) program, which recognizes that

older individuals and people with disabilities should have

the right to live independently in their own homes and

communities, and to receive the help they need without having

to spend down to poverty.

Mr. President, I ask unanimous consent to have that statement from the AARP printed in the Record.

Mr. President, I am going to put this in personal terms-- personal terms. I have told this story before, and I am going to tell it again because I think it indicates why we need a program such as this.

I have a nephew, Kelly; my sister's boy. He got injured at a very young age; he was only 19 years old. It made him a severe paraplegic, almost a quadriplegic. My sister and her husband did not have any money at all. Yet Kelly was able to go to college--go to school. He was able to get a job, able to live in a house by himself. He had his own little home. He had his own van he drove that had a lift on it, and he could get his wheelchair in there and drive it to work. He actually started a small business and employed some people. He has lived a full life. He is now a man of about 50. He has had a great life. Even with that disability, he has been able to get around and do things. He is a taxpayer. He has paid taxes. He has employed people. Every night when he goes home, he has to have a nurse come in the home and get him ready for bed and for him to do his exercises and things such as that. Then, in the morning, he has to have another nurse to get him out of bed and take care of his needs, get him ready to go. Actually, Kelly gets his own meals and stuff. Then he goes off to work and comes back. This happens every day.

How was he able to afford to do that? He did not have any money. He did not have any insurance. How was he able to afford to do that? He got injured in the military. He got injured in the military. So for all these years, the Veterans' Administration has been paying for this. It has been wonderful. It has kept him out of an institution, kept him out of a nursing home, and it has allowed him to live by himself, to go to school, to go to work, to be with his family, to be with his friends.

I have often thought, this is wonderful, but why should that just be for people who are injured in the military? What about so many other people who get injured like my nephew Kelly who are not in the military, maybe even injured before they could go into the military? He was only 19 when it happened to him. So for all these years, I have thought we should have some system in this country that would allow people like my nephew--who were not in the military but who, through an unfortunate accident, became disabled--that they could have that same kind of life, where they could live in their own homes in their own communities with their own families, have their own friends. That is why this is so important. This is perhaps one of the most important things we have done since the passage of the Americans with Disabilities Act to make sure people with disabilities have a full, enjoyable, productive, quality life.

I hope Senators will decisively defeat the amendment that wants to strike this. Say yes. Say yes to so many people with disabilities and young people today and working people today. Say yes that we are going to have a system whereby you will have the peace of mind of knowing that if you want to contribute the money, you will be able to do so. Say no to the amendment that would strike that, and say yes to the Whitehouse amendment that actually supports the CLASS Act, makes sure that any savings from it are reinvested in that program.

I thank the President and I yield the floor.

Mr. President, I yield 3 minutes to the Senator from Ohio.

Parliamentary inquiry: How much time remains?

I yield 2 minutes to the Senator from Illinois.

How much time do I have remaining?

I yield 2 minutes to the Senator from Rhode Island.

How much time do I have remaining?

Mr. President, it was interesting to hear the last speaker say: Don't take away the option for seniors in Medicare Advantage. Yet they have an amendment to take away the option for people who buy insurance against having a disability so they can stay in their own homes and have support. It is voluntary. It is not mandatory. No one is forcing them to do anything, I say to my friend from Texas. Yet there is an amendment on that side to take away that voluntary program, the CLASS Act, so that people can voluntarily put money into it to protect themselves against a future disability. Let's kind of keep our arguments a little bit straight.

A lot of people have talked about Medicare Advantage. I will not close the argument on that. I will close on the necessity of keeping the CLASS Act in this bill. I have spoken many times about that. It is not a partisan issue. It is like when we passed the Americans with Disabilities Act. It was not a partisan issue. This should not be a partisan issue too. We should not let politics get involved. Over 275 groups representing people with disabilities of all ages, from AARP to Paralyzed Veterans of America to the Interfaith Coalition, support the CLASS Act. It was unanimously adopted by the HELP Committee, unanimously adopted by Republicans and Democrats. Senator Gregg offered an amendment to insist that it be actuarially sound over 75 years, and it is actuarially sound over 75 years.

Secretary Sebelius said the administration supports it. President Obama supports it. There is broad-based support for the CLASS Act.

Today we received some letters from people around the country. I don't have time to read them all but just a couple. Here is one from Arkansas:

My wife has a journalism degree, cerebral palsy and brings

money to the state of Arkansas with her stay at home job with

occasional travel. If her health worsens she could still earn

money for the state under the CLASS Act working from home

with the assistance from an attendant, [rather than having to

go to a nursing home.]

Here is Virginia:

I don't currently need the services under the CLASS Act,

but having been born with a disability I've always been

acutely aware of the possibility of serious issues down the

road . . . it would be a good thing for me, a thirty-year-old

working person, [to be able to put some money away.]

I beg my colleagues, for the sake of people with disabilities, let's not adopt the amendment of the Republicans to take away the CLASS Act. It was Senator Kennedy's premier goal.

Mr. President, I ask for the yeas and nays.

Madam President, I heard the distinguished minority leader earlier in his comments say that one of the reasons they are slowing this bill down and having all this debate is it has been a strictly partisan venture thus far. I beg to differ with the minority leader.

I see our distinguished ranking member of the HELP Committee here on the floor. In the HELP Committee, for the enlightenment of Senators, we had 13 days of markup, 54 hours, 788 amendments were filed, 287 amendments were considered and debated and voted on or accepted, and 161 Republican amendments were adopted. No one was denied the opportunity to offer any amendment, to discuss them, debate them, and get a vote or have it accepted, whatever the case might be. To me, this is truly a bipartisan way of proceeding.

The minority leader's argument basically goes to the fact that the people of this country overwhelmingly elected Democrats to guide and make changes for the future. One of the biggest changes is in our health care system. One of the responsibilities of being a majority party is to propose. That is what we have done. We are proposing changes in the health care system. The function of the minority is to offer amendments, constructive amendments, offer different ideas, and if their ideas are better or if they receive majority approval, then the bill is thus changed. That happened in the HELP Committee. As I said, 161 Republican amendments were adopted. To me, that is bipartisan. That is what we have been doing. What is kind of not acceptable is this idea that things are just going to slow down for the purposes of delaying and eventually making sure we don't have a bill.

Let me say that after all that lengthy debate we had in the HELP Committee, we passed a bill. The same will happen here on the Senate floor. I don't care how many times the minority wants to drag it out and slow it down to try to kill this bill, this bill will pass the Senate, we will go to conference, and we will have it on the President's desk early next year.

Madam President, parliamentary inquiry: There is time between now and the hour of 11:45 a.m. equally divided between the Republican side and the Democratic side; is that correct?

Madam President, I assume, then, the normal thing will be to go back and forth from one side to the other, the Republican side and the Democratic side?

Madam President, I ask unanimous consent to be recognized for 7 minutes.

Yes.

Madam President, I ask if the Chair will remind me when the 7 minutes is up.

Madam President, I have to respond to my friend from Wyoming about doing this in a hurry. He mentioned that we did the bill in a hurry in our committee. Actually, it was last November, shortly after the election, when I received a call from Senator Kennedy talking about doing a health reform bill, asking if I would take charge of a section dealing with public health and prevention and wellness. I think then he asked Senator Murray to take over workforce development, Senator Bingaman did coverage, and Senator Mikulski did quality improvements. So that was in November.

I cannot speak for the others who did the other sections. All I can say is, on our side, in what I did, we had five hearings. We had five hearings on public health and prevention and wellness and what ought to go into a bill. I think those hearings commenced in December and went through about February. Then we worked until June, and we did not start our markup until June. So we had almost 6 months of hearings and putting things together in the bill before we started a markup. I rather doubt that can be said to be rushing anything.

But I just want to focus on the vote that is coming up on the amendment offered by the Senator from Maryland, Ms. Mikulski, which will strengthen provisions in the bill concerning preventive health benefits for women.

As an initial matter, I am proud of the significant investments the bill makes overall in wellness and prevention. It has not been talked about very much. If you read the public press out there, the popular press, and watch TV, about the only thing you think is in the bill is a public option and abortion and that is what this bill is about. Well, those may be the hot points and the flashpoints--it makes for good press--but I submit that one of the most important parts, if not the most important part, of this bill is what it does for prevention and wellness, trying to move our costs upstream, keeping people healthy in the first place.

I have said many times, what good does it do us if we are just going to pour more money into paying bills for a broken, dysfunctional, sick care system--not a health care system, a sick care system? That is what we have in America today. This bill begins the transformation of moving us from a sick care system to a true health care system.

The Senator from Maryland has a very important amendment to make clear--to make clear--that what is included in the bill is to strengthen the preventive services that basically inure to the women of this country. The Mikulski amendment reiterates the recommendations of our bill, and it also points out that the recommendations of the U.S. Preventive Services Task Force is a floor, not a ceiling--it is a minimum. In other words, health plans are required at a minimum to provide first-dollar coverage for preventive services recommended by the Preventive Services Task Force, but that is just the minimum. The Secretary of Health and Human Services has full discretion to identify additional preventive services that will be part of the essential package offered by health insurance on the exchange.

Again, there has been some talk here about this task force, the Preventive Services Task Force, that somehow this is a bunch of bureaucrats, it is a government-run task force, it has a political agenda. I have heard all these things said on the floor in the last day or so. Well, in fact, the Preventive Services Task Force is an independent body that evaluates the benefits of clinical preventive services. It makes recommendations--again, no decisions, merely recommendations--about which services are most effective.

Who is on this task force? Experts and leaders in primary care who are renowned internists, pediatricians, family physicians, gynecologists, and obstetricians. And these professionals are not located in Washington, DC; they are based all over the country. Some may be in one State or another State. They are all over the country, and they are experts in these different areas, recognized by their peers. They do not sit in an office at Health and Human Services. They bring years of medical training and experience to the jobs they do.

Does that mean they never make a mistake? No. No one is perfect. No Senator is perfect. Neither is every doctor perfect. And neither is any task force always going to make what we might consider to be the perfect answer. But our bill does not grant them the authority to tell insurance companies what not to cover. That is clear. But to hear the debate on the floor, you would think it is just the opposite, that the Preventive Services Task Force can tell insurance companies what they cannot cover. That is not true. Our bill says that those recommendations that are A and B--categorized by the Preventive Services Task Force, by these expert doctors around the country--these are the ones they say really are key preventive services, have the most benefit. We say in our bill that those services must be covered without copays, without deductibles. That means that is the floor. That is the floor.

Again, I might also add that preventive services that are rated by the Advisory Committee on Immunization Practices and comprehensive guidelines supported by the Health Resources and Services Administration are also part of the recommendations to establish that floor.

So, again, I would say it is a pretty big floor when you put all those together. Again, it does not establish a ceiling and it does not say what cannot be done. It just says you have to do these basics. That is the floor.

I do understand the concerns of some that the task force has not spent enough time studying preventative services that are unique to women. Senator Mikulski goes back a long way on this issue. I can remember some years ago Senator Mikulski pointing out to me, in my capacity as the then-chairman of the Appropriations subcommittee that funds NIH----

Madam President, I ask unanimous consent for 3 more minutes.

Senator Mikulski said: If you look at the research being done at NIH, it is almost all done on men and not on women. I remember that some years ago, and all of a sudden a lightbulb went off in my head. I said: You are right. So we had to start changing the focus of a lot of the research done to focus on the unique situations faced by women.

Well, this was also a concern that was raised in our HELP Committee by Senator Mikulski, and we included language to require all health plans to cover comprehensive women's preventive care and screenings based on guidelines promulgated by the Health Resources and Services Administration--again, without any copays or deductibles. That was in our health bill but unfortunately was not included in the merged bill. But Senator Mikulski's amendment, which we are about to vote on, brings us back to the position we had in the HELP Committee bill. I think that was largely supported, if I am not mistaken, on both sides, at least in our HELP Committee. At least no one offered any amendment to strike it when we were debating it in committee. So I assume it was supported generally by both Republicans and Democrats.

By voting for the Mikulski amendment, we can make doubly sure that the floor we are establishing in the bill for preventive services that are unique to women also has no copays and no deductibles. Again, that is why this amendment is so important.

I know our friend Senator Murkowski has a different way of approach. I commend her for her involvement and her interest in this issue. She has been a great member of our committee, and I have done a lot of great work with Senator Murkowski. But I think her amendment misses the mark in this way: It asks insurers to use guidelines from provider groups when making coverage decisions. Well, that does not guarantee women will get any of the preventive services they need.

Here is a statement from the American Heart Association and the American Stroke Association. It says:

. . . we are concerned that Senator Murkowski's preventive

health services amendment would take a step backwards by

substituting the judgment of the independent U.S. Preventive

Services Task Force with the judgment of private health

insurance companies.

Madam President, I ask unanimous consent that this letter from the American Heart Association and the American Stroke Association be printed in the Record.

Madam President, I will have more to say about the Murkowski amendment later. But, again, the point is, the Mikulski amendment is right on point. It should be adopted.

How much time would the Senator like to consume?

I am deeply saddened that my Republican colleagues have, now we see very clearly, resorted to fear tactics in their desperate attempt to preserve a dysfunctional, costly, status quo medical system that we have in this country today. Republicans, in their attempt to strike fear in seniors across the country, are trying to convince the people that they have changed from the party that has always opposed Medicare to now being Medicare's staunchest defenders. But we all know, if it were up to our friends on the other side of the aisle, there would be no Medicare. They fought its very creation. Don't take my word for it, take one of their standard-bearers who ran for President. Senator Bob Dole, who was here when we created Medicare, Senator Dole, a friend of mine--I have a good deal of admiration for Senator Dole-- said, ``I was there, fighting the fight, voting against Medicare--one of twelve--because we knew it wouldn't work in 1965.'' He said that in 1995 when he was running for President. He was proud of the fact that he and Republicans had opposed the establishment of the Medicare system.

You might say: That was then, what about recently? Here is the former Speaker of the House, Newt Gingrich. He said, ``We believe it's going to wither on the vine,'' speaking of Medicare.

Now my friends on the other side of the aisle--listening to them, you would think they were the biggest supporters of Medicare forever, when they opposed it from its very beginning.

Now we hear all the stuff about Medicare Advantage. If, in fact, we are going to be cutting a little bit out of Medicare Advantage, they would like to tell you that somehow this is going to ruin Medicare. If that were true, why would the National Committee to Preserve Social Security and Medicare, AARP, the alliance for retired Americans, groups that represent tens of millions of seniors--why would they stand with us in support of our bill and not with the Republicans, who want to gut the very provisions we have in there that will strengthen and preserve Medicare?

Do people really believe our Republican colleagues care more about seniors than these groups that actually represent seniors?

The truth is, when we talk about Medicare Advantage, we are talking about private insurance companies who promised that through competition they were going to deliver better quality health care to seniors at a lower cost. It all sounded good. But what has happened since Medicare Advantage has come in? The reality is, Medicare is now paying on average 14 percent more to these private plans than it would cost to cover the same beneficiaries under traditional Medicare. In some cases, it is as high as 50 percent more. That is $12 billion a year more than if these beneficiaries stayed in Medicare. Basically, we are giving a $12 billion subsidy to these companies.

Again, don't take my word for it. This is from a June 2009 MedPAC report:

We estimate that in 2009, Medicare paid about $12 billion

more for enrollees of [Medicare Advantage] plans than it

would if they were in [fee-for-service] Medicare.

A $12 billion slush fund. We are saying we are going to reduce some of those subsidies. I hear my friends on the other side: My gosh, Medicare is going to take away all these benefits, and all that other kind of stuff. Not necessarily. Right now we know, according to CBO, our bill will lower seniors' Medicare premiums by $30 billion over 10 years.

Then the other side says: But if you cut these Medicare Advantage payments, you will see their benefits cut.

That is absolutely not true. All Medicare plans, whether traditional Medicare or private, must offer all required Medicare benefits. Here is the kicker. If, in fact, there are some cuts made in Medicare Advantage, then these private companies that are making $12 billion in their slush fund, maybe rather than cutting benefits, maybe they will decide to cut their CEO salaries from $12 million a year to $10 million a year. Maybe they will decide instead of three or four corporate jets, they only need one. Maybe they will start reducing some of the profits they are making, huge profits they are making off of the taxpayers and off of Medicare payees right now.

Again, if we cut the Medicare Advantage Program, I guess my friends on the other side would say, No. 1, they can continue to pay their CEOs $12 million a year salaries. They can continue the corporate jets. They can continue to have fancy buildings. They can continue to have outrageous profits. But they will have to cut Medicare. That is what the other side is saying.

We are saying: No, cut the CEO salaries. Cut the enormous profits. Cut those corporate jets. Cut all of that stuff you are using the slush fund for, but keep the benefits for Medicare.

As I said, under present law they cannot cut the basic Medicare benefits. No senior anywhere in America will lose their core Medicare benefits under our bill. Let's be clear about that. If they did, AARP, the National Committee to Preserve Social Security and Medicare, and the National Alliance for Retired Americans would never be supporting our bill.

Lastly, according to an economic survey done at Boston University, they extensively analyzed Medicare Advantage payments and found that just 14 percent of the additional funds these private plans have received have gone to benefit Medicare enrollees. The vast majority of the payments, 86 percent, go to profits, CEO salaries, corporate jets, all these other things, or some of it may go to things such as gym memberships, spa memberships. I raised the point the other day. Why should my Medicare beneficiaries in Iowa have to pay more in Medicare so that a Medicare beneficiary, say, in Arizona can go to a spa and have it paid for by Medicare Advantage, paid for by the subsidies of $12 billion that we give them that come both from taxpayers and from Medicare recipients right now? I don't think it is fair for my seniors in Iowa to have to pay for that.

A lot has been said about all the people who are in the Medicare Advantage plans. I looked up the figures. Right now, nationally, only 18.6 percent of all enrollees are in Medicare Advantage, a little less than one out of five. In my State, in Iowa, it is 10 percent, 1 out of every 10. Why is that? We don't have a lot of spas in Iowa. We don't have those fancy things like they have in Florida and Texas and Arizona and California, wherever else all this stuff is going. What my seniors need is the peace of mind of knowing that Medicare is going to be there for them in the future. They need to know they are going to get the benefits we have put in this plan that are in our bill and that will help Medicare beneficiaries.

Here is what they are. AARP says:

The new Senate bill makes improvements in the Medicare

program by creating a new annual wellness benefit, providing

preventive benefits and, most notably for AARP members,

reducing drug costs for seniors who fall into the dreaded

Medicare doughnut hole.

The bill also makes improvements on age rating, a

discriminatory practice that allows insurers to charge

exorbitant age-based premiums to older Americans.

Finally, AARP strongly supports provisions in the Senate

bill to strengthen long-term services and supports. We also

applaud inclusion of provisions to improve access to Medicaid

home and community-based services.

All is in our bill, all of which would fall if we adopt the McCain amendment. I urge colleagues not to listen to the rhetoric from the other side. Listen to those who really do represent seniors. Make sure we preserve and protect the basic Medicare functions for seniors and for those who are about to retire. You will not get that through Medicare Advantage. If Medicare Advantage wants to exist and compete on a level playing field, God bless them. Go ahead and get it done. That is what we were promised when Medicare Advantage came through here. I remember. Competition. But what we found is, we had to cough up an additional $12 billion to subsidize them.

It is time for us again to say no to the fearmongers, to those who are trying to strike fear in seniors. It is time to stand up, support the Bennet amendment, which makes very clear that any savings that come from Medicare has to go back into Medicare. That is the way it ought to be. That is what is in this bill. The Bennet amendment makes that crystal clear. The McCain motion does away, basically, with all of the protections, all of the things we have worked so hard for since 1965 to provide. The McCain motion, when you strip away all the verbiage, really what it does is, it basically takes us back to pre-1965 when we didn't even have Medicare. That is the kind of intent behind it.

I am glad to yield.

As I said earlier, what they are talking about in preserving these benefits and this subsidy for Medicare Advantage is the big CEO compensation packages, the corporate jets, the fancy buildings, the high profits, somewhere between 30 percent and 200 percent profits made by these companies that are providing Medicare Advantage. That is what the Republicans are trying to protect, not the Medicare recipients.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Parliamentary inquiry: What rule are we under right now? How much time do we have? Are we under any time constraints?

Mr. President, first I wish to thank my colleague for all the work he did in our committee. I am sorry he is not still on our committee. I wish he were. But a lot of the good work we have in our bill is due to Senator Whitehouse's involvement in the development of this bill. He was a great member of our committee, and as the chairman, I sure wish he would come back. That is all I can say.

I say to the Senator, thank you for all the great work you did on this bill and especially all the wonderful work you did on getting us the public option that we had in our bill that was adopted by the House but also all the great work you did on making sure we had a robust prevention and wellness program in our bill. I have always said that the best way to bend the cost curve is to keep people healthy in the first place and keep them out of the hospital.

So I thank my colleague for all his great work on the bill.

Mr. President, I would like to engage my friend from Pennsylvania in a little discussion on one part of the bill that was mentioned earlier today but really has not received much attention. I think there are some misconceptions about what it does. It is called the CLASS Act.

Basically, the CLASS Act is a bill that was championed by Senator Kennedy for many years. It has its genesis in the kind of convoluted system we

have now in how we provide for people who become disabled.

Either through their work, through an accident, through illness, or whatever, people become disabled. As you know, we have a portion of that under the Social Security system, disability insurance. But, in fact, it does not take care of any kind of long-term care. So Senator Kennedy, for many years, championed the idea of giving people the ability to set aside some money during their working years that would be sort of like Social Security. It would vest, and then, if, God forbid, they became disabled, they would then have a certain monthly income that would enable them to live in their own homes, live in their own communities, and to ease some of the burdens of their disability.

Before he passed away, Senator Kennedy talked to all of us on the committee about his dream and his hope that we would have this incorporated in our health reform bill.

Well, we did this in the HELP Committee. We brought it forward. We had it scored. We know exactly how it operates. As we will make clear, I am sure, in our colloquy, it is a program that can be paid for. It is voluntary, as we said. It will stand on its own two feet. It is not another entitlement program, as I heard someone say here earlier today. In fact, it has to be self-financing by the premiums people pay in during their working years. It is an affordable, long-term care program. Again, it will allow families to plan for any possibility of a chronic illness, without having the fear of being put in a nursing home. As I said, it is voluntary.

The CBO gave us a scoring on this that it was actuarially sound for 75 years--actuarially sound for 75 years. What that means is that the premiums paid in and the benefits paid out will be kept in proper alignment. It will be fully solvent.

Quite frankly, Mr. Gregg, the Senator from New Hampshire, on our committee, basically talked about this, and here is what he said:

I offered an amendment, which was ultimately accepted, that

would require the CLASS Act premiums to be based on a 75-year

actuarial analysis of the program's costs. My amendment

ensures that instead of promising more than we can deliver,

the program will be fiscally solvent and we won't be passing

the buck--or really, passing the debt--to future generations.

I'm pleased the HELP Committee unanimously accepted this

amendment.

Well, we did, and that is why I make the point that this is not another entitlement program, as was said here earlier today.

Even better, the CBO believes the CLASS Act will save Medicaid $1.4 billion in the first 4 years alone--$1.4 billion in the first 4 years alone--as a result of families who will be paying into and then using the CLASS benefit instead of Medicaid to similarly pay for the help they need to remain at home. That is really what people want. People want to stay in their own communities. They do not want to have to go to a nursing home.

The CLASS Act would provide money for assisted transportation, in- home meals, help with household chores, professional help getting ready for work, adult daycare, professional personal care. Now, will it pay for all those things? No, it will not pay for all those things, but it will give you enough of a basic support so that, coupled with other things, you would be able to stay at home and maybe even go to work. You may be disabled, but you may not be so disabled you cannot do some work; therefore, you need a little bit of help at home to get out in the morning and go to work or maybe you just need some personal assistance care that would enable you to stay in your own home rather than going to a nursing home.

So that is why this amendment is so important. It is voluntary, long overdue. I think it will begin to give people the peace of mind of knowing if they pay into this system, after it vests--after 5 years of vesting--they will then be able to access this program in case they get disabled.

Mr. President, I see my colleague and my friend from Pennsylvania is on the floor, a strong supporter of the CLASS Act and what we are trying to do here in terms of giving people the ability to maintain themselves if, God forbid, they should become disabled. I will be delighted to yield whatever time he needs to the Senator from Pennsylvania and engage in any colloquies he would like.

I thank my friend and my colleague from Pennsylvania for laying out why this is so important, the fact that we are actually going to get savings for Medicaid from this. That is helping the States. That helps the States a lot. So we get a lot of bangs for the buck, as one might say, with the CLASS Act that we have in this bill.

I say to my friend from Pennsylvania I think one of the biggest concerns people have--they may not express it when they are younger, but once they start working and they start having a family and they see one of their friends, a relative, someone in their neighborhood, become disabled--and believe me, it happens in our neighborhoods, it happens to our friends--they see that and they wonder, Maybe but for the grace of God there go I, but what would I do if something like that happened to me? How would my family, my children function? Where would the money come from?

So to be able to have the peace of mind, to know there is a program whereby they can put some money aside every month, voluntarily, for 5 years, and then after that, they would then be able to access money if they got disabled--talk about a great insurance program. Talk about the peace of mind this would provide for people.

As I said, as we both have pointed out, this is actuarially sound for 75 years. So it seems to me that for all of these reasons, including the savings in Medicaid for the soundness of the program, but also for the peace of mind for people who are working, to know they now have a program, something they can access, that will provide them--again, I don't want to sell this for more than it is. This is not something that will make someone 100 percent whole from their earnings. We are not trying to tell people that. What this will give them is up to $75 a day to help them with all of the things I pointed out: maybe getting up, getting ready to go to work; maybe it is personal attendant services. It could be a whole host of different things that will enable them to live in their home, in their community, and, yes, maybe even be able to go to work every day.

My friend from Pennsylvania referred to the story I told earlier this summer, and I like to tell it because I think it illustrates what we are talking about here. I have a nephew, Kelly, my sister's boy. Well, he is not a boy anymore; he is an older man now, I guess you might say. He became disabled at a very young age, age 19, a severe paraplegic, but he was able to go to school, go to college. He was able then to live by himself in his own home. He had a van with a lift. He could get his wheelchair up there and punch the button and the doors would open and the thing would come down and he would get in the van. He had use of his hands. He could drive to work. He was able to start his own small business. But every morning he needed a nurse to come into the home, get him ready to go to work, get him up, get him going, get him out the door. Every night when he came home, he would stop and do some shopping on the way, come home to his own house where he lived, in his own community, among his family. His family was close by. They would have a nurse every evening do his exercises with him, keep his arms strong, do all of his other internal things that needed to be done, make sure he could get to bed. It happened every day. But because of that, he was able to live a full life, and he still is. Kelly is still an active man. But that was--gee, I am trying to remember now. I have to think. That was in 1979, 30 years ago. Kelly must be about almost 50 years old now. I never thought about that. I always think of him as a kid. But he was able to do that, and he has lived a full life. He has been able to work, live by himself, do all kinds of wonderful things.

How was he able to afford this? Was his family wealthy? Not a bit, not at all. In fact, his mother died shortly after the accident happened. My sister, who had breast cancer, died at an untimely, young age. But the way Kelly was able to do all this was because he got injured in the military. He got injured while he was onboard a ship off the coast of Vietnam. So the VA paid for all of this and is still paying for it--for his personal services--so that he can live by himself and get out the door and go to work. I have seen what that has done for him.

I thought to myself: Well, if we can do this for veterans, what about other people in our society who, through no fault of their own or through an accident or whatever, become disabled. I thought about how much Kelly was able to earn during his lifetime, the fact that he paid taxes, had his own business. You know, that was a pretty darn good deal for the taxpayers of this country.

In a small way, that is what we are trying to do here. That is what we are trying to do, to build a system for someone who gets injured, becomes disabled, has some support mechanisms so they can also live a full, rich, and happy quality life without having to go to a nursing home. That is what this is all about.

As I said before, I say to my friend, it has so much to offer. I can't imagine there would be any real opposition to this--voluntary, actuarially sound. It provides a stipend to help people if they become disabled.

I say to my friend from Pennsylvania it seems to me of all the things we have been discussing on this health reform bill so far, to me this is one of the most important. This is one of the most important parts of this health reform bill. We have never done it before. It is long overdue. It will be good for our families. It will be good for businesses. It will help our States because of the cutbacks and they won't have to pay so much into Medicaid.

I thank my friend from Pennsylvania for his strong support of this. I say to my friend Ted Kennedy: We are going to get it done. It is going to happen. We are not going to let this bill get through and go to the President without having this in it. It is going to be there. There is no doubt about it. We are going to make it work, just as the Veterans' Administration worked for my nephew Kelly.

I yield back to my friend from Pennsylvania. Actually, he asked me a question and I kind of got off a little bit there on telling my stories.

That is right.

If the Senator would yield again to me, two other things. I am glad the Senator mentioned Connie Garner who again, with Senator Kennedy, has worked so many years on this, and has her own personal story to tell regarding this, a very poignant story. But I now want to thank Connie for all of her wonderful work on this and shepherding this through. She is probably sitting over there wishing we had said this and that, because we probably forgot something she knows better than we know. But we do our best, Connie. We do our best with what we have, anyway, to try to explain this. But I thank Connie for all of her great work and leadership in getting this to this point.

I wonder if I might impose upon the Senator, if I might--not digress but talk about one other part of the picture here we are talking about, in terms of covering people with disabilities. We have been talking about the CLASS Act, which is prospective. It looks ahead; it provides the mechanism whereby middle-class families can plan for the future possibility of an illness or a disability by putting this money away every month. We have talked about that. But one might ask the question: What about those who are disabled now? What is happening to them, the millions of Americans who are already living with a disability? Well, in 1990, we passed the Americans With Disabilities Act. We began to break down a lot of barriers in terms of people with disabilities and accessing daily living, accessing employment, transportation. But what happened was a few court cases started interfering with this. There was one court case in particular called the Olmstead decision 10 years ago. It came out of Georgia. It was a case in Georgia. It went to the Supreme Court. The Supreme Court said that based upon the Americans With Disabilities Act, a State had to provide the least restrictive environment for a person with a disability.

Well, this was wonderful because the only option for many people with disabilities right now is to go to a nursing home. In fact, our Federal laws are basically skewed toward putting people in nursing homes.

Let me explain. Right now, about the only support a person with a severe disability has is through Medicaid. As you know, through Medicaid you have to spend down until you become poor and then you get access to Medicaid. But under our laws, Medicaid must pay for you, if you are disabled, and then you qualify--they must pay for you to be in an institution or nursing home. They must. They have to pay for you. If, however, you are a person with a disability and you say: But I don't want to live in a nursing home; I would like to live--like my nephew Kelly--in my own house with my friends, in my own neighborhood, Medicaid doesn't have to pay for it, and in most cases it does not pay for that. In the vast majority of cases, it doesn't pay for that.

So their beginning movement was in the mid-1990s to provide for funding for individuals with disabilities so they can live in their own homes in the community and not have to go to the nursing home. Well, that bill never--it was called MCASSA, the Medicaid Community Attendant Support and Services Act.

I always like telling people, I say to my friend from Pennsylvania, while we sponsored it over in the Senate, the first sponsor of it in the House was the Speaker at that time who had taken over, and his name was Newt Gingrich. To this day, he is still supportive of that. A few years ago, I talked to him, and he was still a strong supporter of MCASSA. It later became the Community Choice Act. We could never get it enacted into law.

It is a part of this health care reform bill in this way: It provides that if a State implements this Community Choice Act, which would allow people with disabilities to live in the community rather than in a nursing home, it will then get a bump up. It will get a 6-percent increase in its Federal match for Medicaid.

As you know, now the Federal Government provides some and the State provides some for Medicaid. It is roughly 60/40. It varies a little, but that is roughly it, 60/40. Well, that means that a State now that would do this would not have to come up with its 40 percent; it would only have to come up with 34 percent. So it is an incentive for States to begin to implement the Supreme Court decision of over 10 years ago that people with disabilities have a right to live in the least restrictive environment. Again, Medicaid, right now, as I said, will provide only for nursing home care. States are obligated to pay for that. They must.

Again, this also is a part of what the elderly in this country are concerned about too. A lot of them say that if they become disabled, they don't want to go to a nursing home, but that is their only option under Medicaid. So that explains why the second biggest priority in poll after poll for seniors in this bill, after strengthening Medicare--which we do--is changes to the health care system that will allow them to get the help they need to stay at home rather than going to a nursing home.

Again, you might say, why is this so important? Well, a couple of stories. Two women who brought the Olmstead case, Lois Curtis and Elaine Wilson, when asked at a hearing what it changed for them, because they were no longer institutionalized, both spoke of things that we kind of take for granted: They had new friends. They could meet new people. They could attend family celebrations. They said:

We could make Kool-Aid whenever we wanted to. Simple things. They could go outside and walk in the neighborhood. They got a little dog, and they could walk the dog in the neighborhood--something they could not do in the nursing home. That is another part of the bill--very closely aligned with the CLASS Act, but it pertains to those people with disabilities right now.

We know, again, from data and statistics we have that by paying for personal care services and home care services--and you might say that is really expensive. But we know from data that we get three for one. In other words, for every one person in a nursing home, for what that costs, we can provide community and home-based services for three people. That is three people for every one in a nursing home. So in a way, yes, it costs money, but for every person we get out of a nursing home, we can pay for three living in the community. Again, that is not to mention the kind of quality of life I just mentioned.

This bill for the first time creates the community first choice option, which gives States an extra share of Federal money--6 percent-- if they agree to provide personal care and services to all eligible people in their State--I mean those eligible for institutional care. If they provide that to them, then they get a bump up. And only by making personal care services available on an equal basis to all those eligible can we satisfy the promise of the Americans with Disabilities Act and really meet the Supreme Court mandate in the Olmstead decision.

I say to my friend from Pennsylvania, there are two aspects of the bill. One is the CLASS Act, which looks ahead and provides that peace of mind that people know they can have that access. Then we provide for people with disabilities who are living out there, fearful that the only thing that will happen to them is they will have to go to a nursing home. Now we are going to say to States: You provide community- and home-based services, and we will give you more money to do so through your Medicaid Program. Hopefully, with that, the States will begin to move more rapidly to fulfill the mandate of that Supreme Court decision.

I thank my friend for yielding me this time to explain that.

Well, Mr. President, sitting here listening to the Senator from Arizona and the Senator from Oklahoma go on, I hardly know where to start. There have been so many accusations and so much misinformation it is hard to know where to begin.

I would begin by, first of all, saying the people who keep saying we are slashing Medicare and we are going to harm seniors are totally wrong. The fact is, the bill we have before us protects Medicare's guaranteed benefits, reduces premiums and copays for seniors, ensures that seniors can keep their own doctors, and ensures Medicare will not go broke in 8 years by stopping the waste, fraud, and abuse.

I might also say, as an aside, every time I hear the Senator from Oklahoma talking about waste and abuse and fraud in Medicare, it sounds like it is all in Medicare. The waste, fraud, and abuse we are talking about are the ripoffs of Medicare by pharmaceutical companies, many of which have been fined big fines and have settled. One of the most recent ones, I think, was almost for a billion-some dollars. It was one of the largest settlements in our history with a pharmaceutical company that was caught ripping off Medicare. And insurance companies have ripped off Medicare, and others. It is not within Medicare; it is those who are coming at Medicare and trying to plunder it.

But that is what we do in this bill: We are stopping that kind of waste and abuse against Medicare; not in Medicare but against Medicare. We provide new preventive and wellness benefits for seniors. We lower prescription drug costs, keep seniors in their own homes, and not nursing homes, with the CLASS Act and the Community Choice Act that is also in this bill.

When they talk about going after Medicare, boy, talk about crocodile tears. Was it not Newt Gingrich, the former Speaker of the House, the leader of the Republican revolution, who said he wanted Medicare to ``wither on the vine''? Was it not Senator Bob Dole, their standard bearer for President in the 1990s, who said he had fought against Medicare and was proud he voted against it? Now, all of sudden, it seems as though Republicans are the guardians of Medicare.

People know the truth. The American people know the truth. They know it is the Democrats who fought for Medicare. Lyndon Johnson, as President, and the Democrats in the House and Senate, if it were not for them, Medicare would have never been passed. It is the Democrats who have fought to keep Medicare alive and well and healthy, and expanding it to people all over this country every step of the way-- being opposed by our friends on the other side of the aisle. And now to hear them talk about how much we are going after Medicare, boy, talk about crocodile tears.

The other thing I want to say is that I want to correct something the Senator from Oklahoma said. He talked about the recommendations that recently came out--I will have more to say about this in a minute--on mammograms. He said the U.S. Preventive Services Task Force--all they did was look at costs. That is what the Senator said. They looked at costs but they did not look at the people.

Recommendations that come from the U.S. Preventive Services Task Force cannot take into account cost. Cost cannot be a factor. They can only look at scientific evidence, safety, and efficacy. Cost cannot be taken in as any factor in their deliberations. So I wanted to set the record correct on that.

As I said, there were so many things I heard from the other side it is hard to know where to start. I see my leader here, Senator Dodd, who did such a great job in getting our bill to the committee and getting it in the form that it is now and on the floor.

I wish to ask the Senator--I know the Senator was here listening to our friend, the Senator from Arizona, speak. Did it strike you that what he said was kind of missing the mark here a little bit and maybe not quite what we are doing in this bill?

Mr. President, the only thing I would say to my friend from Connecticut--he said that in 2005 we had made all of these cuts in the Deficit Reduction Act. I just want to say for the record that I didn't vote for it and neither did the Senator from Connecticut.

Is this not when the Republicans were in charge and they had a Republican President and a Republican House and Senate? That is when they cut all the mammogram screenings and things such as that?

I thank my friend for pointing out those facts.

Mr. President, I have a letter dated December 1, 2009, from the National Committee to Preserve Social Security and Medicare. It says:

Dear Senator:

On behalf of the millions of members and supporters of the

National Committee to Preserve Social Security and Medicare,

I am writing to express our opposition to the amendment

offered by Senator McCain which would recommit the bill to

the Senate Finance Committee.

Much of the rhetoric from opponents of health care reform

is intended to frighten our Nation's seniors by persuading

them that Medicare will be cut and their benefits reduced so

that they too will oppose this legislation. The fact is that

H.R. 3590, the Patient Protection and Affordable Care Act--

The bill we have before us--

does not cut Medicare benefits; rather, it includes

provisions to ensure that seniors receive high quality care

and the best value for our Medicare dollars. This legislation

makes important improvements to Medicare which are intended

to manage costs by improving the delivery of care and to

eliminate wasteful spending.

I won't read all of it, but it concludes:

The committee urges you to oppose the motion to recommit

the bill to the Finance Committee.

Sincerely, Barbara B. Kennelly, President and CEO.

Mr. President, I ask unanimous consent to have this letter printed in the Record.

Mr. President, I wish to talk about the amendment before us which has been offered by the Senator from Maryland, my colleague, Senator Mikulski. I am going to have more to say about the bill and engage with, perhaps, the Senators from Arizona and Oklahoma in the days and weeks ahead on the structure of the bill itself, but I wish to focus on the amendment that is now before us.

First of all, I am proud that this bill, the Patient Protection and Affordable Care Act, makes significant investments in prevention and wellness because I have long believed that such investments are essential for transforming our sick care system--that is what we have now, a sick care system--into a true health care system, one that keeps Americans healthy in the first place. It keeps them out of the hospital. It will keep a check on rising costs in both the public and private health care markets.

It does this in a number of ways. I won't go into all of them, but among the most important is that this bill requires insurance companies to cover highly effective preventive services with no copayments or deductibles--no copayments or deductibles. This is critical because we know that all too often people forgo their yearly checkups or screenings either because their insurance company doesn't cover them or, secondly, because they have high copays or deductibles that make them simply unaffordable. For example, I had a recent conversation with a small business owner in western Iowa, and he and his few employees have a $5,000 deductible. He recently turned 50. His doctor said: Time for you to get your first colonoscopy. Well, he found out that the colonoscopy was $3,000. He has a $5,000 deductible. This is all out-of- pocket. So not being a man of wealth and not having a lot of means, trying to struggle to keep his small business afloat, he is putting it off. He is putting it off. So that is what is happening now. But what we say in our bill is that these have to be covered without copays or deductibles.

There has been a lot of discussion recently on the coverage of preventive services for women in light of the recent recommendations issued by the U.S. Preventive Services Task Force on mammogram screenings. It has been alleged that the Reid bill, like the HELP and Finance bills that preceded it, only requires coverage of those services strongly recommended by the Preventive Services Task Force. This simply is not true. Under the language of this bill, health plans are required at a minimum--at a minimum--to provide coverage without cost for preventive services recommended by the Preventive Services Task Force. Understand that. It only says that health plans are required at a minimum to provide coverage at no cost for certain preventive services recommended by the Preventive Services Task Force. But these are

simply the minimum level, not the maximum. The task force will establish the floor of covered preventive services, not the ceiling. No health plan will be prohibited from providing free coverage of a broader range of preventive services, and in many cases the Secretary of Health and Human Services may well require that. That is because our bill gives the Secretary of Health and Human Services the authority to identify additional preventive services that will be part of the essential health benefits offered by health insurers in the exchange.

The simple fact is, the Preventive Services Task Force cannot set Federal policy and they cannot deny coverage, period, although there has been a lot of misinformation that has gone out about this. They simply give doctors and patients the best medical information, as I said earlier, not based on cost--cost cannot be a factor--but based on science and based upon efficacy and based upon outcomes and nothing else.

Still, I share the concerns of some that the task force has not spent enough time studying preventive services that are unique to women. This is a concern that was raised when the HELP Committee debated the bill in committee. At that time, I worked with the Senator from Maryland, Ms. Mikulski, to include language requiring that all health plans cover comprehensive women's preventive care and screenings based upon guidelines supported by what we call HRSA, the Health Resources and Services Administration, again, with no copays, no deductions. That language is in our bill. It was not included in the merged bill. Senator Mikulski's amendment which is now before us and which I have cosponsored would add that language--would add that language--like we had in our committee bill, and I strongly urge its adoption.

By voting for this amendment, which I understand we will do in a couple of hours, we can ensure all women will have access to the same baseline set of comprehensive preventive benefits that Members of Congress and those in the Federal Employees Health Benefits Program currently enjoy. Let me repeat that. If you vote for the Mikulski amendment, you will ensure that all women will have access to the same baseline set of preventive services that are enjoyed by Members of Congress, women Members of Congress, and all women Federal employees in the Federal Employees Health Benefits Plan. That is what voting for the Mikulski amendment will do.

Expanding preventive health care is just one of the ways this bill benefits women. Again, our health care system is broken. It is expensive. Today, less than half of women have access to employer- sponsored insurance coverage. Think about that. Less than half of the women in this country have access to employer-based insurance coverage. Again, many of these women work for very small businesses, and they can't afford to provide that kind of insurance coverage.

In most States, it is legal for insurance companies to charge women more than men for the same policy. Women can pay more than double what men pay at the same age for the same coverage. Each year, thousands of women are denied coverage from health insurance companies for preexisting conditions. In many States, a history of hospitalizations from domestic violence is considered a preexisting condition. Think about that. A battered woman lives through domestic violence and now can't get health insurance coverage because of a preexisting condition--being battered. That happens in many States. With these options, it is not surprising that more than 16 million women are uninsured in this country.

Women are often the health care decisionmakers for their families. They face difficult choices daily. One-third of women are forced to make tradeoffs between basic necessities and health care. In 2009, more than one-half of women reported delaying care because of its high cost.

Today, we have the opportunity to fix these problems. This historic legislation now before us increases access to affordable health insurance and ensures that women's coverage meets their health care needs.

We will end premium discrimination against women. We will end discrimination against those with preexisting conditions. We will prohibit the rescission of health insurance coverage because of an illness. We will provide more affordable insurance choices through the health insurance exchange, including a strong public option to increase competition and choice. We will ensure that the policies families buy are good enough. We will require that all insurance policies sold in all markets provide adequate coverage for primary and preventive care, for screenings, maternity services, and many other services that women and their families need to stay healthy.

As has been said many times before, this bill will extend coverage to an additional 31 million Americans who are currently uninsured. As I said, 16 million women in America are uninsured. So that is why Senator Mikulski's amendment is so important, vitally important. That is why this bill is so vitally important.

We are going to talk a lot about Medicare. I see the Republicans are focusing on that, although a recent letter I read and had inserted in the Record from the National Committee to Preserve Social Security and Medicare says we ought to oppose the McCain amendment. We will hear a lot about that.

What about the women of this country and what is happening to them? The Mikulski amendment addresses that in a very profound way. But then this bill takes it even a step further by making sure that women, many of whom work for small businesses, who are sort of in an uncovered pool, so to speak, out there by themselves, now they can go on the exchange. Now they can get the kind of coverage they need. They will have choices available to them--not just maybe one option and in some States no option. They will have different options available. They will be able to join with other like women around so they will have a bigger pool and better coverage for themselves and their families.

Yes, I can honestly say the health care reform bill before us, the Patient Protection and Affordable Care Act, is a pro-woman bill. It is not talked about a lot, but many of the things in this bill will go to ease the dilemma so many women find themselves in, in this country-- providing basic necessities for their children or trying to get health care coverage for themselves. I can tell you so many women whom I have met and talked to have given up on buying health insurance for themselves so they will have enough money to feed and clothe their kids and send them to school. Women should not be forced to make that kind of a choice.

This bill before us will enable women to not have to make that choice. They will be able to get the insurance coverage they need at an affordable price, with the tax credits that are included for low-income women, and they will be able to have the piece of mind of knowing that they and their kids are truly covered with the health insurance they need.

I will keep coming back to these two things, time after time, as we go through the bill: prevention and wellness. Keeping people healthy in the first place is a big part of this bill. If there is one thing that will bend the cost curve, it is putting more focus upfront on prevention and more focus on keeping people healthy in the first place. That will save us money in the future.

The second theme is what this is going to do for the women of America; how is it going to help them and their families to have peace of mind and to have the health insurance coverage they need.

With that, I yield the floor.

Mr. President, I thank the Senator from New Jersey for his very strong and poignant statement. I listened to it all. I think he really summed it all up.

Let me add to that by saying we are at a momentous crossroads right now in the history of our country. We are at a time that likens itself to 1935, when this Congress passed the Social Security Act. It is like the time in 1965 when Congress passed Medicare. Both of them were giant steps forward in the health and economic security of the American people. But as much as they are part and parcel of our American life today, both Social Security and Medicare were bitterly opposed in this Senate by conservatives who did not want to change. In fact, one conservative Republican Senator said that passing Social Security would put an ``end to the progress of our great country.'' They attacked Medicare as socialized medicine. As Senator Robert Taft said at that time, ``It is going to Sovietize America if we have Medicare. It is going to be a government takeover.'' Well, here they go again. They are unduly frightening people in this country. We saw it earlier with the death panels--all bogus. It was to instill fear in people.

It is hard to change, but the people of America voted last November overwhelmingly for Barack Obama and for Democrats in the House and Senate because they wanted to change the system. They knew we had to change.

People don't fear change. They know it is tough, but they don't fear it. They don't fear change in our health care system either. What people fear is keeping the present system. That is what I hear. They fear being denied coverage because they have a preexisting condition or one of their children has a preexisting condition and they will not be able to get health care coverage. That is what people fear. They fear they will be dropped from their policy because they have come down with cancer or heart disease or some other chronic illness. They fear that if they have a serious illness, they will have to go into bankruptcy to pay the bills. Sixty-two percent of all the bankruptcies in this country are because of medical causes. Eighty percent of those are people who already had coverage. That is what people really fear.

Another reason I think conservative forces will fail this time is because they believe people who have good health insurance really lack compassion and they don't care about the 46 million other Americans who don't have it. I disagree. People care deeply about those 46 million Americans who don't have insurance. It is a national shame when children don't have access to a doctor.

It is unfortunate that our Republican friends are determined to prevent us from even debating and amending the bill. That is what the vote tonight is about. Republicans and the health insurance industry are joined at the hip, using the same talking points, same distortions, same cooked-up scare tactics.

All I can say is, since the Republicans' goal is to obstruct, obstruct, and obstruct, the people of this country are looking to us, to the Democrats, as they did in Social Security and as they did in Medicare, they are looking to us to move this country forward. So this is a call to arms for our caucus. I hate to put it in those kinds of partisan terms, but what can I do when every single Republican says they want to obstruct and stop this bill? It is now on us, the Democratic caucus, all 60 Members, to come here and stand strong for the American people. Now is not the time to go wobbly in the knees, I say to my friends in the Democratic caucus. Now is the time to stand strong, the time to come to the well at 8 o'clock tonight and move this country forward. It is time to say yes to the American people and no to these fears and unfounded allegations you will hear from the other side. Now is the time to take the next step forward in the real progress of this country.

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

Mr. President, the debate has now begun on the bill we call our health care reform bill. It has taken us a long time to get here. After a lot of hearings, a lot of markup, a lot of public discussion, a lot of town meetings around the country, now we are at the final pivotal moment, a historic moment in the long march to pass meaningful health care reform.

I say long march because it started with Theodore Roosevelt and continued on through the New Deal, continued on to Harry Truman's administration, and on to this time. Every time we have been turned back by the status quo forces, those who want to stick with what we have, those who are afraid of making changes. This time they are not going to stop us. This time it is unstoppable. We have come this far, and we are not going to turn back.

Just listening to a little bit of the discussion on the Republican side today and listening to what the Republicans have had to say about health care reform in the last few months and anticipating what we will hear from Republicans in the next few weeks, it will be a message of fear that somehow by changing the status quo, the American people are going to be worse off than they are now, that somehow we are going to take away something they have, that somehow if we just stick with what we have, everything will be fine. But you will hear a lot of words and messages from the Republican side meant to frighten people, to put a pall of fear over what we are trying to do.

The frightening thing for the American people is if we do nothing, if we stick with the status quo. Too many people in this country have no health insurance whatsoever. Thousands every day in this country, every single day thousands of people lose health care insurance coverage. So many people who have preexisting conditions cannot get coverage at all. People who are beginning to retire but they are not quite 65 and cannot get on Medicare are left in a state of limbo, where they cannot get health care coverage.

So many people in this country are being discriminated against in health insurance because--well, because they are a woman or perhaps because they are older, perhaps they are a person with a disability. For a variety of reasons, they are being discriminated against in health insurance coverage.

We have to make these changes. We cannot continue to spend over the $2 trillion a year and still be so lacking in the essential health care services for the people of this country. We spend twice as much in this country on health care as Europe. Yet we have twice as many people sick with chronic illnesses. That does not seem to make sense.

We have some of the highest of high-tech medical devices and procedures and interventions anywhere in the world and, of course, people who have a lot of money in other countries--we always see kings and princes and wealthy people from other countries come here. They come here for the very high-tech, high-cost interventions. We are very good at that. We are the best. We are unequaled in that. But where we fall short is helping the very broad mass of American people to have the peace of mind knowing that if something happens to them, if they do get ill, they are not going to lose everything.

The single biggest cause of bankruptcy--I know in my State of Iowa and I think most of the country, the single biggest cause of bankruptcy is because of medical expenses because people bump up against lifetime caps or annual caps, they cannot make it, and they declare bankruptcy. In no other country in the world is this allowed to happen. It is incumbent upon us to get this bill through.

At the beginning, I wish to salute our majority leader Harry Reid for what he has done. We had our bill that came out of the committee that I am now privileged to chair after the untimely death of our esteemed colleague and friend, Senator Ted Kennedy. Our HELP Committee bill came through under the great leadership of Senator Chris Dodd. We passed it on July 15. Then the Finance Committee, under the able leadership of my friend and classmate Senator Max Baucus of Montana, did their work. Then the two bills had to be put together and that was done by the majority leader and he did a masterful job of putting the two bills together and getting it down to the Congressional Budget Office and getting a score on what it would cost, what it would cover. When we saw the bill come back--the bill we now have in front of us, the so-called merged bill--it truly is a work of genius by the majority leader.

I said the other day that he has the patience of Job, the wisdom of Solomon, and the stamina of Sampson to get this job done.

I also salute all the Senators--Democrats and Republicans--whose ideas are incorporated in this bill. It is a robust bill. It went through a long, bipartisan process. In our committee, we had proceedings that spanned 13 days, 54 hours. Republicans were full- fledged participants. They offered 210 amendments. We accepted 161, many of them making substantive changes in the bill.

A similar open and inclusive process was followed in the Finance Committee. I daresay, when we got our bill through, after all that, after all the

amendments offered, accepted or adopted, not one Republican would vote for our bill--not one. It is truly unfortunate now that we have put these bills together, we have gone through this long process that has taken most of this year, that Republicans have now chosen the path of delay and filibuster and obstruction.

Why are we even here today? We are here because the Republicans are trying to prevent us from even bringing the bill to the floor for debate. How many people in America know that? The reason we are here is because the Republicans do not even want to bring the bill to the floor for debate and amendment. That is their right under the rules of the Senate. It is their right. They can filibuster. They can delay. They can obstruct. They can say no. But just as surely as that is their right, it is our responsibility, as Democrats, to move this bill forward.

I remind my colleagues on the other side of the aisle that last year voters overwhelmingly voted for Barack Obama to make changes, and one of the changes he campaigned so hard on was changes in the health care system and, just as surely, voters elected Democrats to majorities--big majorities--in the House and the Senate to do the same thing. So it is our responsibility to lead, and that is what we are doing now by bringing this bill to the floor. We are taking another giant step toward fulfilling the mandate--the mandate--the people of this country gave to President Obama and the Democratic Party last November to undertake a comprehensive reform of America's health care system.

As not only the long debate has made clear to the American people, but innately the American people know and they understand the current system is hugely dysfunctional, it is wasteful, and it is abusive. People are aware of the abuses that have become standard practice in the health insurance industry: denied coverage because of preexisting conditions; health insurance being dropped because they get sick; their insurance premiums jacked up 100 percent, 200 percent in a year simply because they had an illness.

People know they can be charged higher rates simply because they are a woman. We know, we have the data. Woman, man, same age, same occupation, same status--a woman is charged more than a man for the same policy or they are charged more if they are older. We know about annual caps and lifetime caps I just mentioned that cause people to go into bankruptcy.

The bottom line is this: Every American family knows that in many cases, they are one illness away from financial catastrophe. If you want to talk about fear, that is what people are afraid of, not so much of getting sick--that is part of life--but the fact that illness will drive them to financial ruin, that they will not have enough money to take care of their kids, to send them to college, or to take care of themselves in their old age to supplement their Social Security because the money will be used for an illness.

As I said earlier, 62 percent of U.S. bankruptcies are linked to medical bills. What is the kicker in this is that 80 percent of those were people who actually had health insurance, but they ran up against their lifetime cap. Abuses, abuses by the health insurance industry because they can do it and they can get by with it.

Think about it this way: Health insurance companies employ armies of claims adjustors who routinely deny requests for medical tests and procedures. Why do they do that? Because they get bonuses by saying no to the policyholder. Think about that. An insurance company says to their claims adjustors: We will pay you more the more people you deny. What a system. It is outrageous. It is intolerable, and we cannot afford to let it go on any longer.

One of the many things we do in this bill is to crack down on these health insurance companies' abuses in a very strong and robust way. Again, I deeply regret that our Republican colleagues refuse to join us in this reform effort. They have chosen to defend the status quo, protect the insurance companies and their profits over the health of the American people.

Indeed, my friends on the Republican side and the health insurance companies are now joined at the hip--same talking points, same distortions, same untruths about this bill, same bogus, cooked-up studies, the same determination to obstruct and kill any health care reform effort.

As I said earlier, this time they will not succeed. The more the American people learn about this bill and what is in this bill, the more they like it and the more they are demanding that we get the job done.

President Obama pledged that we would do health reform and not add to the deficit. We have done that with this bill. The Congressional Budget Office says this bill will actually reduce the deficit by $130 billion next year and by $650 billion in the next decade--$650 billion--and it will reduce the deficit continually every decade thereafter. All the budget concerns have been put to rest. Now we can focus on what is in the bill.

The Congressional Budget Office says our bill will cover 94 percent of the American people; 94 percent will now be able to have the peace of mind to know they have health insurance coverage.

Our bill says if you have a health care plan that you like and that you want to keep, nothing will disturb that--nothing. You can keep whatever plan you want if you like it.

A lot of people say this plan doesn't go into effect until 2014. It does take some time to get these exchanges and things set up, but there are some immediate things that will happen next year, and the American people ought to know what that means. For example, our bill right now would ban lifetime and excessive annual limits on coverage next year-- not 2014 or 2015, next year. Think about that in your own policy. Your policy, I guarantee, has some kind of lifetime cap or annual caps. Next year, they will not be able to do that any longer.

Our bill bans rescissions. What that means is that right now so many people don't know that their health insurance policy can drop them. There is a clause in it that says that when you are up for renewal, they can drop you for any reason. The reason they use is, if you get sick. Think about that.

I can't tell you how many people I have talked to in my State of Iowa who have come up to me, especially during the town meetings we have had this summer, and have said: I like my health insurance policy. I have a good policy, and I would like to keep it.

My rejoinder is: That is fine, but I want to ask you a couple of questions. What is your lifetime or annual cap?

Most often, people say: I don't know.

I say: Do you have a lifetime or annual cap in your policy?

They aren't certain.

I say: Do you have a rescission clause in your policy?

I can tell you 100 percent of the people I have talked to said: What does that mean?

I said: What it means is, if you get sick, if you have to have a kidney transplant or if you have cancer or heart disease, can your insurance company drop you when your policy comes due, with no explanation whatsoever?

They don't know.

I said: You have to look at your policy and find out, because most policies have those rescission clauses.

I daresay, when a lot of people say they have a good health insurance policy, they answer yes, they do have a good health insurance policy, as long as they are healthy. As long as you are healthy. Once you get sick, out the window it goes because you have a cap, either a lifetime or an annual, or you have a rescission clause.

The other thing I hear from a lot of families: You know, my kids were covered when they were in school. They are now out of school, they have not quite gotten a job yet, and I can't keep them on my policy and it costs a lot of money to put them on a different policy.

Our bill says that now these young people can stay on their family policy until they are age 26. This is a huge benefit to working families.

I have said many times that the two biggest winners under our health care reform bill are small businesses and the self-employed. Small businesses--we are in a deep recession. If we want to get out of that recession, we better start focusing on small businesses because it is small businesses that create over 65 percent of the jobs in this country. Yet small businesses are thwarted in their effort to expand and grow. One

of the biggest reasons is because of the cost of health care for their employees. So many small businesses now have dropped health care coverage for their employees because they simply cannot afford it or the premiums have gone up, the deductibles are huge, and basically what it has gotten to be is basically catastrophic coverage for their employees. Small businesses need help in order to grow and expand and get us out of this recession. This bill will provide immediately, next year, up to a 35-percent tax credit for health insurance policies for their workers. That is a big deal. It is not just for small businesses, it is for my farmers and for those who are self-employed--for so many self-employed in this country, next year, a tax credit of up to 35 percent.

Next year, we are going to have a new policy option for people who have preexisting conditions. So if you had an illness in the past, if you have been living with cancer and you have it under control, you have a chronic illness, next year we are going to provide a new policy option to put people like that into a high-risk pool and provide that they can get insurance coverage at prices they can afford. When the exchanges come on in 3 years, all of that will go by the wayside. They will not be able to discriminate because of preexisting conditions. But next year, right away, people who have preexisting conditions can get policies at prices they can afford.

How many times do I hear people tell me: Here I am, I have been working hard, I have been a construction worker, or something like that, that is hard work. I am 55. I have had some accidents. I have a bum leg and my back is bad. I can't work until I am 65. But what am I going to do about my health insurance?

We have in here, starting next year, if you are an early retiree, we have a program to protect your coverage and at the same time reduce your premiums, both for you and your employer, until the time you get to be age 65. This is a big deal for so many people in this country.

Last, in whatever time I have left--parliamentary inquiry: How much time does the Senator from Iowa have left?

Madam President, I understand my friend from North Dakota wishes to speak. I will wrap this up by saying there is one other part of this bill that is so important that doesn't get much play but I consider to be one of the most significant parts of this bill, and that is an emphasis on prevention and wellness, keeping people healthy in the first place.

There is a lot of talk about bending the cost curve and how we are going to bend that curve and get costs down. I submit that not only the best way but perhaps the only way we are going to do this is by keeping people healthy in the first place, putting more emphasis on prevention.

I have often said that we don't have a health care system in America, we have a sick care system. If you get sick, you get care. Almost all of our expenditures go for interventions and patching and fixing and mending once somebody gets sick. Very little goes for prevention. About 96, 97 cents of every dollar goes for taking care of you after you get sick. Only about 3 or 4 cents goes to prevention. It is time to do more for that, time to do more for prevention and wellness, keeping people healthy in the first place.

In this bill, we have a provision that says that if you want to go in for your annual checkup and your annual screening, no copay, no deductions, and for certain other screenings, such as colonoscopies, breast cancer screenings, and things like that, no co-pays, no deductibles.

In the ensuing days and weeks when we debate that, I will be talking a lot more about the prevention and wellness part of this bill. It is big. It is the first time we have ever done anything like this, to begin to move the paradigm in this country away from sick care to health care. Our goal in this bill with this provision is to change America into a wellness society, where it is easier to be healthy and harder to be unhealthy--just the opposite of what it is today. It is easy to be unhealthy in America today. It is hard to be healthy. We are going to change that around, and we are going to start with this bill.

One of the most important parts of this bill is the massive change we are going to make in prevention and wellness.

I note the presence on the floor of my distinguished colleague from North Dakota. I yield the floor.