Floor Statements

Mr. President, I ask unanimous consent that the following HELP Committee fellows be granted the privilege of the floor for the duration of consideration of H.R. 3590, the legislative vehicle for the Patient Protection and Affordable Care Act of 2009: Sara Selgrade, Bill McConagha, Stephanie Hammonds, Joe Hutter, and Caroline Fichtenberg.

Mr. President, this body often finds itself divided. But today we are united in our respect and affection for the senior Senator from West Virginia, Robert Byrd. I join with my colleagues in congratulating him on yet another historic milestone: becoming the longest serving Member of Congress.

But I hasten to add that to salute Senator Byrd only for his remarkable longevity is to really kind of miss the point. The measure of a Senator is not just how many years he or she serves but the quality and the consequences of that service. That is where Senator Byrd has truly distinguished himself in Congress over the last 20,774 days.

The ``Almanac of American Politics'' says, Robert Byrd ``may come closer to the kind of Senator the Founding Fathers had in mind than any other.'' I could not agree more. He is a person of wise and mature judgment, a patriot with a deep love of country. He is passionately loyal to the Constitution, and a fierce defender of the role and prerogatives of Congress, the Senate in particular.

Senator Byrd was once asked how many Presidents he has served under. He answered he had not served ``under'' any President, but he has served ``with'' 11 Presidents, as a proud Member of a separate and coequal branch of government.

During his more than 56 years in Congress, Senator Byrd has witnessed many changes. Our population has grown by more than 125 million. There has been an explosion of new technologies. America has grown more prosperous, more diverse, more powerful.

But across those nearly six decades of rapid change, there has been one constant: Senator Byrd's tireless service to his country, his passion for bringing new opportunities to the people of West Virginia, and his dedication to this branch of government, the U.S. Congress, and especially to this House of Congress, the U.S. Senate.

Senator Byrd is a person of many accomplishments and a rich legacy. But,

above all, in my brief time today I want to focus on his commitment to improving K through 12 public education in the United States and expanding access to higher education, especially for those of modest means.

As my colleagues know, Robert C. Byrd was raised in the hardscrabble coal fields of West Virginia. His family was poor but rich in faith and values. And his parents nurtured in young Robert Byrd a lifelong passion for education and learning.

He was valedictorian of his high school class but too poor to go to college right away. Of course, that was in the days before Pell grants and loans and Byrd Scholarships. So he worked as a shipyard welder and later as a butcher in a coal company town. It took him 12 years to save enough money to even start college.

He was a U.S. Senator when he later earned his law degree. No other Member of Congress before or since has started and completed law school while serving in the Congress.

But degrees do not begin to tell the story of the education of Robert Byrd. He is the ultimate lifetime learner. It is like for the last seven decades he has been enrolled in the Robert C. Byrd School of Continuing Education.

Senator Byrd's erudition has borne fruit in no less than nine books he has written and published over the last two decades. We all know that he literally wrote the book on the U.S. Senate--a masterful four- volume history of this institution that was an instant classic that will bear the burdens of time. What my colleagues may not know is that he also authored a highly respected history of the Roman Senate. Now, there are some who think Robert Byrd served in the Roman Senate, but that part of the Byrd legend just is not so.

I have talked at length about Senator Byrd's education because this explains why he is so passionate about ensuring every American has access to a quality public education--both K through 12 and higher education.

One thing Senator Byrd and I have in common--and we always kind of talk about it when we get together--is we are the only two Senators whose fathers were actually coal miners. We are both the sons of coal miners, neither of whom had very much formal education. My father only went to the 8th grade. Actually, he only went to the 6th grade, but we will not get into that. But, anyway, he said he went to the 8th grade, but, like I said, I will not get into that. But coming from a poor background, Senator Byrd believes, as I do, that a cardinal responsibility of government is to provide a ladder of opportunity so everyone, no matter how humble their background, has a shot at the American dream.

Obviously, the most important rungs of that ladder of opportunity involve education--beginning with quality K through 12 public schools, and including access to college, vocational education, and other forms of higher education.

During my 25 years in this body, no one has fought harder for public education than Senator Robert Byrd. As the longtime chairman and still the senior member of the Appropriations Committee, he has been the champion of education at every turn--fighting to reduce class sizes, improving teacher training, bringing new technologies into the classroom, boosting access to higher education.

In 1985, he created the only national merit-based college scholarship program funded through the U.S. Department of Education. Congress later named them in his honor. Originally, the Byrd Scholarships consisted of a 1-year $1,500 award to outstanding students. Today, Byrd Scholarships provide grants of up to $6,000 over 4 years.

Senator Byrd is a great student of literature, and I am sure he knows The Canterbury Tales--a lot of it, probably, by heart. Describing the Clerk of Oxford, Chaucer might just as well have been describing Robert C. Byrd. Chaucer wrote:

Filled with moral virtue was his speech; And gladly would

he learn and gladly teach.

Senator Byrd is a great Senator and a great American. He has both written our Nation's history and left his mark on it. It has been an honor to serve with my friend, my longtime chairman, Senator Byrd, for the last 25 years.

Today, as he reaches yet another historic milestone that no other Member of Congress has ever achieved--and I daresay probably no one ever will--we honor his service. And we express our respect and our love for this remarkable U.S. Senator.

I yield the floor.

Mr. President, I want to speak in support of extending the unemployment insurance program, to provide up to 20 weeks of additional unemployment insurance benefits for out-of-work Americans and their families.

American workers are facing tough times. During the last recession, our country lost millions of good jobs--jobs that have never been replaced. And the downturn of the past 2 years, brought on by the subprime mortgage disaster and skyrocketing oil costs, has created a perfect storm leading to severe unemployment, with official unemployment approaching 10 percent. Today, 15.1 million Americans are out of work, and more than a third of them have been out of a job for 6 months or more. Unfortunately, the jobless rates jumps closer to 20 percent when you take into account the millions more who have given up looking for work, or can only find part-time work when they need full- time incomes.

In recent weeks we have seen signs that our economy is starting to turn the corner, with growth in consumer spending, improved home sales and expansion in some manufacturing industries. Thanks to the Recovery Act, we have also been able to keep teachers in the classroom, and get construction workers started on new jobs because this administration and this Congress made significant investments that saved or created these and hundreds of thousands of other jobs. But we know that achieving a full economic recovery won't happen overnight. As our economy gradually improves, American families will still need help to get by.

The recession has meant hardship for many thousands of families in my home state. Des Moines' nine food banks have seen a significant increase in demand. And organizations like the Salvation Army are also seeing a surge of requests for assistance with utilities, food, and clothing.

When a family member is out of work, times are particularly tough. One survey found that 70 percent of families with a person out of work reported having cut back spending on food and groceries. That is why it is important that we act now to extend unemployment insurance benefits.

The unemployment insurance program provides a vital safety net during times of economic hardship. Workers have paid into the system through their hard work, so when they are out of a job they deserve support to see them through tough times. These benefits are fundamental to helping families meet basic necessities--to provide a roof over their heads, to put food on the table, or to keep the heat on. A recent survey found that 90 percent of people receiving unemployment benefits used them for just such necessities.

With over one-third of unemployed Americans out of a job for more than half a year, unemployment benefits have been a lifeline for these families. The critical nature of these benefits has enabled us to pass previous extensions with bipartisan support. Earlier this year we provided additional weeks of unemployment assistance and a small increase in workers' weekly benefits. Yet 400,000 workers ran out of benefits last month and another 200,000 exhausted their unemployment by the end of October. Over 30,000 Iowans have run out of State benefits since June.

Running out of unemployment support means even tougher times for Americans who are already strapped--and so I hope my colleagues will join me in supporting and quickly passing this extension of unemployment benefits.

The amendment before us will provide critical help to working families as our economy gets going again. Nationwide, it provides 14 additional weeks of benefits for workers who have run out of safety net support. In States where unemployment is at or above 8.5 percent, workers are eligible for 20 additional weeks of benefits. This amendment will provide much needed help to 1.9 million people across the country, including 31,000 in Iowa.

This help can't come too soon for hardworking men and women who are trying to hang on for better times ahead; people like Kimberly Anders, from West Des Moines, IA. She writes:

As an older person, I feel lost in the face of not being

able to find a job, especially after I've worked hard my

whole life and never once relied on any state or federal aid

. . . now my unemployment is about to run out, and my hope

with it . . .

Unemployment benefits help Michelle Paulson from Huxley, IA, who is trying to train for a new career while caring for her family. A mother of two, Michelle went back to community college after she was laid off by a window manufacturer last August. As the lagging economy continues to take its toll on Iowans, Michelle is pursuing a degree in advanced manufacturing. Unemployment benefits provide Michelle the safety net to meet basic needs for her family while building her own workforce skills.

The American people are counting on us to help them. It is time to act now.

Passing this amendment now will give people like Kimberly Anders and Michelle Paulson the immediate help they need. What's more, it will benefit them and all American workers in the long run by helping to get our economy back on track. That is because unemployment benefits provide a major, immediate boost to the economy. Economists calculate that every $1 invested in the unemployment insurance safety net generates $1.63 in economic activity. Unemployed households spend these dollars on immediate needs--to pay the rent or a medical bill, buy groceries and school supplies, or repair the family car--all economic activities that quickly inject dollars into our communities.

An extension of unemployment benefits gives workers and their families the support they need while people continue to look for work. And it provides a needed stimulus to the rest of our economy. I urge my colleagues to support this amendment and pass it without delay.

Mr. President, I move to reconsider the vote.

Mr. President, I move to reconsider the vote and to lay that motion on the table.

Mr. President, the legislation I am introducing would suspend temporarily, through the end of 2011, the import duty on ortho- toluidine, a chemical compound used by several U.S. companies in manufacturing an important agricultural herbicide used for crops including corn, soybeans, peanuts, and cotton. One of the manufacturing plants is a facility in Muscatine, IA, that employs 500 workers. Other U.S. companies use the compound in manufacturing dyestuffs, pigments, optical brighteners, and pharmaceuticals. This legislation is drafted and intended for inclusion in the miscellaneous tariff bill being assembled by the Committee on Finance.

Currently, there is only one U.S. manufacturer of orthotoluidine, and that company has already announced plans to end production of the compound by the end of this year. Manufacturers in the U.S. will soon have no choice but to import this ingredient and to pay a duty of 6.5 percent unless it is suspended. Suspending this duty will help to control U.S. production costs, keep jobs at home, and enhance the competitiveness of U.S. businesses, workers, farmers, and the communities in which they are located.

I encourage my colleagues to support this legislation.

Mr. President, the legislation I am introducing would suspend temporarily, through the end of 2011, the import duty on ortho- toluidine, a chemical compound used by several U.S. companies in manufacturing an important agricultural herbicide used for crops including corn, soybeans, peanuts, and cotton. One of the manufacturing plants is a facility in Muscatine, IA, that employs 500 workers. Other U.S. companies use the compound in manufacturing dyestuffs, pigments, optical brighteners, and pharmaceuticals. This legislation is drafted and intended for inclusion in the miscellaneous tariff bill being assembled by the Committee on Finance.

Currently, there is only one U.S. manufacturer of orthotoluidine, and that company has already announced plans to end production of the compound by the end of this year. Manufacturers in the U.S. will soon have no choice but to import this ingredient and to pay a duty of 6.5 percent unless it is suspended. Suspending this duty will help to control U.S. production costs, keep jobs at home, and enhance the competitiveness of U.S. businesses, workers, farmers, and the communities in which they are located.

I encourage my colleagues to support this legislation.

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

Madam President, yesterday I got a call from my friend and my colleague from Pennsylvania, Senator Specter. He said: Have you read the New York Times yet?

I said: Well, no, as a matter of fact I have not.

He said: Well, there was a front page story in the New York Times on Sunday about what was happening with small businesses, in terms of their insurance rates going up unduly, huge increases.

I said: Well, no, I have not read about it. I will get the paper and read it.

It struck a chord with me because somehow, over the last several weeks, I have gotten an influx of inquiries to me personally and also into my office from small businesses in Iowa, some elsewhere but mostly from my State, wondering what was happening to the huge increases in their premiums this year.

They have always been used to increases in premiums, but these seemed unduly large. Plus, a lot of copays and deductibles were going up. So I went out and got the newspaper and read the story in the New York Times that Senator Specter pointed out to me. It was alarming.

As I said, I thought about all the inquires that had come into any office. I said: Something is going on out there. Something is going on out there. So we have this health care bill now, reform, that will be going down to CBO, I guess today, for scoring.

I wish to commend Senator Reid for his leadership. I was actually in Pittsburgh today giving a lecture on disability policy at the University of Pittsburgh law school, with former Attorney General Dick Thornburgh, who had endowed the law school with an endowment. They have a very strong legal scholarship program dealing with disability law at the University of Pittsburgh law school.

So I rushed back from there so I could be on the floor with Senator Specter to talk about this a little bit because there is something very funny going on.

When I was in the airport, I saw Senator Reid had said he was sending the bill down to CBO for scoring. I commend Senator Reid for his leadership and for putting in a strong public option. I am told it is basically the public option the Senator from North Carolina worked so hard on in the committee to develop. I guess he married that up with the provisions from the Finance Committee bill that would allow States to opt out by 2014. I commend Senator Reid for putting that strong public option in the bill. The vast majority of the American people want that. They see it as necessary for trying to keep some control on cost and leaving more choice and more competition for policyholders.

As a matter of fact, this would be a great help to small businesses, because small businesses could go on the exchange, and they would have that public option also available to them. I have said many times: The two biggest winners I can see in the health reform bill are small businesses and the self-employed. Small businesses are at the end of the line. They have been whipsawed all over the place. They have no bargaining power. The same with the self-employed. This bill will turn the tables by providing the exchanges and providing more help for small businesses. They will be much better able to negotiate and to pick and choose among different policies rather than what they have now.

Now in many cases they get one or two, and that is about it in a lot of States, one or two different insurance companies. In the New York Times article, some suggest the insurance companies are raising their rates to generate as much revenue as possible before health reform obliges them to change the way they do business.

Isn't that interesting. They are anticipating health reform passing so they want to jack up their premiums as much as possible before that happens. Others assert the industry is responding to Wall Street's demands for ever higher profits in the health insurance industry, that Wall Street is putting pressure on them to increase profit margins.

Again, I always have to ask: Why are we doing health reform? Are we doing health reform to help the health insurance industry or are we doing health reform to help the American people? That had to be our first response, that we are here to help the American people, not to help the health insurance industry.

I have had many small businesses tell me how tough it has been. I have a small newspaper in Iowa with 12 employees. The owner Art Cullen recently turned 50. Their insurance premiums for his small business jumped by 58 percent in 1 year and more than 100 percent in 2 years. They have a $5,000 deductible.

I asked Art: Why don't you get another company? He said: I can't. I only have one in this area that will offer insurance. So that is why we need the exchanges, why we need health reform, so that Art Cullen and his small business can join with other small businesses on these exchanges to get a better deal.

Mike Landeaur owns a muffler shop. He has 10 employees. He offers insurance to them, but his premiums have jumped 66 percent in the last 3 years. His deductibles have gone from $4,000 to $16,000. Mike is expensive. He was born with a congenital heart disease, so he dropped himself from his company's policy. He is the owner, taking himself out of the pool. But he can't get any kind of individual insurance because of his preexisting condition. Now he is worried he will have to sell the small business, all because of excessive health insurance costs.

This is unconscionable. As we speak, the majority leader is sending his bill down to CBO. And make no mistake, the bill we are bringing to the floor will offer real solutions for small businesses. It will enable them to purchase insurance through an exchange so they can choose among multiple plans at lower costs than are now available in the small group market. Small businesses and the self-employed can go on the exchanges and, if they want, they also are eligible for the public option.

It will sharply reduce administrative overhead that drives up the cost of insurance through such practices and medical underwriting and preexisting condition exclusion clauses. We provide a new small business tax credit to make insurance more affordable for the most vulnerable small businesses. We make new investments in wellness and disease prevention for all businesses, including small businesses.

In addition, we will put a stop to the outrageous and unacceptable insurance industry practices that harm the ability of small employers to cover their workers. We will require that insurance companies document how much of each premium dollar is going for medical expenses. We will require that insurance companies document how much of each premium dollar goes for medical expenses, and we are going to require rebates for excessive overhead charges. We will end the broken status quo where insurance executives make tens of millions of dollars in salaries and bonuses while their small business customers go out of business because they can't afford health insurance. We will end the exceptional and unwarranted antitrust exemptions the industry has enjoyed without public benefit for far too long. We will end the ability of insurers to jack up premiums by as much as 160 percent, which is what they did for one small business, because they thought the group was ``getting too old.'' Therefore, they jacked up their premiums by 160 percent.

I thank Senator Specter for having a keen eye and for giving me a heads up on this yesterday. There is something happening out there right now all over this country. Small businesses are being inundated with higher costs and huge increases in their insurance premiums. To America's small business community, we have a simple message: Help is on the way. We will get this health reform bill done, and we are going to help small businesses and the self-employed.

I hope they can hang on long enough so we can get this bill through, hopefully before the end of the year, so that

next year when their policies are up for renewal, we won't see these kinds of huge increases and gouging of small businesses.

We need reform. We always think about it in terms of individuals and how this affects individuals. But we also think about how it affects the majority of workers who work for small businesses who don't have the kind of large group power that maybe big businesses and bigger industries have. That is why this health reform bill is so important for everyone, but none more so than the small businesses and the self- employed.

I am hopeful, along with Senator Specter, that we can bring some more of this to light. I encourage anyone who has any evidence, stories, anything we can document of what the increases are to small businesses, please get them in to us. I have heard about enough of these to know it is not just a few here and there. It must be more widespread. We need those. Hopefully, we can shed more light on this as we move forward to bring the bill to the floor.

I thank my colleague for his leadership and for bringing this out. I look forward to working with him to try to help small businesses in Pennsylvania, Iowa, and everywhere else.

I yield the floor.

Madam President, I thank the Senator again for bringing this to light and urging us. I think we do need information. We do need to bring them in and check on what is happening with small business. We need to bring in some small businesses, some representatives of small businesses. I think we need to bring in some of those insurance people, find out what is going on here. How come premiums are going up so much this year? I think we were in a recession, were we not?

Madam President, I am not in the former prosecutor's league in that regard, I can say that. But we are working on that. As the Senator knows, sometimes it is tough to get these hearings put together. But hopefully we will have something we can pull together by next week.

I thank my friend from Pennsylvania.

Mr. President, today marks an important milestone in our ongoing national effort to combat HIV and AIDS. Twenty-eight years ago, the Centers for Disease Control and Prevention issued its first warning about the disease we now know as AIDS. Today, we are approving the fourth extension of the Ryan White CARE Act, comprehensive legislation first enacted

in 1990 for the prevention and treatment of HIV and AIDS.

In those early days, the Nation failed on all levels to fully recognize the dangers posed by this disease. Its victims suffered in silence and stigma. Shamefully, those who had the power to help did nothing.

Then, belatedly, in the mid 1990s, a young boy's courage opened the Nation's eyes to the tragedy of AIDS. A disease that had seemed distant was suddenly a potential threat to any of us. We realized that it is a deadly virus that does not discriminate based on color, religion, political affiliation, or income status. I have no doubt that Ryan White would be proud of the bipartisan effort that, after months of negotiation and compromise, has produced the bill before us today.

In 1987, bipartisan legislation was first introduced calling for a comprehensive national strategy focusing on education, prevention, and research to halt the spread of AIDS. We summoned government, the public health community, and the media all to do their part raise public awareness and combat the AIDS epidemic across America.

Yet, today, more than two decades later, the battle continues. We mourn the more than 500,000 Americans who have been lost to the AIDS virus. However, we take heart from the fact that AIDS is no longer a death sentence. Through testing and treatment, people are living long, full, productive lives with HIV. We are identifying victims earlier in the progression of the disease, and keeping them healthier longer.

However, we still have a long way to go. Many who live with HIV and AIDS do not have insurance to pay for costly treatments. As a result, heavy demands are placed on community-based organizations, as well as on State and local governments. For most of these citizens, the Ryan White CARE Act continues to provide the only means to obtain the care and treatment they need.

The Ryan White CARE Act began as an emergency response to the HIV/ AIDS crisis in urban America, but today it has been broadened into a national strategy to provide care and support for people living with HIV and AIDS anywhere in America.

This bill builds on a consensus among States, cities, community-based organizations, hospitals and health providers, and persons living with HIV and AIDS their families and advocates: It maintains access to life- saving medications, quality health care, and support services for persons living with HIV and AIDS who have come to depend on publicly funded systems, it extends this system of quality care to persons with HIV and AIDS who have faced long waiting lists for medications and severe limits on their access to specialty health care; it bolsters governmental and community-based institutions charged with providing this care, all of whom face growing case loads and the greater challenges of an evolving population of persons with HIV/AIDS; it balances the needs of high-prevalence cities and States with those facing rapidly growing epidemics; it assures those who have been relying on their local system of care that it will continue to be there for them; and it reassures persons seeking tests for HIV that comprehensive care and support will be available.

At its best, the United States has the finest HIV/AIDS care system, truly the gold standard for the rest of the world to emulate. Our goal in this legislation is to make the U.S. HIV/AIDS care system also the fairest in the world, with equal access for all, high quality standards, and guaranteed continuity of care--regardless of geographical location.

This bill is a great example of the good and important things we can accomplish in this body when we work together with bipartisanship, goodwill, and a spirit of compromise. This is also complex legislation, and all our committee staff members, Democratic and Republican alike, deserve great credit for their expertise, and for their diligence in bringing us to this day. I want to recognize Connie Garner and Jenelle Krishnamoorthy from my staff, Hayden Rhudy from Senator Enzi's staff, Tamar Magarik Haro from Senator Dodd's staff, and Evan Feinberg from Senator Coburn's staff for their dedication and hard work on this legislation.

To say the least, this legislation is extremely important to Americans living with HIV and AIDS. For them, it is a lifeline. It offers hope for an active, productive, dignified life. This legislation shows America at its very best: compassionate, generous, extending a hand up to those in great need. Mr. President, I thank my colleagues for coming together to support this important, bipartisan bill.

Mr. President, all five congressional committees involved in the health care reform debate have completed their work now and the core elements of this landmark legislation are now clear.

The media has done a good job of reporting that the emerging bill will crack down on abuses by health insurance companies and extend quality health coverage to the vast majority of Americans. In addition, much attention has been paid to the public option which I am confident will be in the bill we send to the President later this year. So there has been a lot in the press about the public option; about coverage; how much this costs; will there be an excise tax; what will the penalties be. Almost all of the debate we see--I should say discussion--surrounding the health care reform is about how we pay the bills, when we think about it. It is about how are we going to pay all of these bills.

There is one huge part of the health reform bill that is not being discussed very much that I believe will have a transformative effect on the system we have in America today, which I have often referred to as not a health care system but a sick care system. When we think about it, that is what we have in America: a sick care system. If you get sick, you get care one way or the other, but we do precious little to keep you healthy in the first place. As one of the comedians on one of these late night talk shows I happened to tune in to one night said, you know, they are talking about everything except health care.

What do we need to do to keep people healthy in the first place? Well, quite frankly, that is in our bill. That is what I wanted to discuss this morning, which is some of the aspects of the bill that I believe will bend the cost curve in the future and make us a genuine wellness society. The bill we reported out of our HELP Committee creates a sharp new emphasis on fitness, physical activity, good nutrition, disease prevention; in short, keeping people out of the hospital in the first place. This will give Americans access to a 21st century true health care system focused on preventing disease and helping us live healthy, active, productive lives, and it will reduce wasteful, avoidable costs that are built into our current system. Again, this sort of disease management approach we have in our country now is about patching things up after people develop a serious illness or a chronic condition. It is a system that overspends, which we know, and underperforms. It has been a colossally expensive failure.

We can and must do better. As President Obama said in his speech to Congress back in February:

[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 keep our costs under control.

To most of us, it is self-evident that cost-effective preventive services will save money in the long term. This first chart is of a poll taken which shows that 76 percent of the American people said we should invest more in preventive care--76 percent. They get it. The American people get it. This support comes from across the political spectrum. Eighty-six percent of Democrats, 71 percent of Republicans, and 70 percent of Independents say we should be spending more on prevention.

This next chart shows that 77 percent of Americans support a new emphasis on prevention in a health care reform bill because they know it is the right thing to do. It is common sense. If we can use cost- effective screenings and other upfront intervention programs to prevent tens of millions of occurrences of chronic diseases such as cancer, diabetes, and cardiovascular disease, it is self-evident that we are going to slash health care costs very significantly.

Some critics have claimed that a new emphasis on wellness and prevention will cost more money and it will drive up health care costs. To support this claim, they have created a straw man, assuming that we are going to do all of these preventive services for everybody all the time, but that is not what is in our bill. I wish to emphasize that our committee's bill takes a very rigorous approach to prevention. We target appropriate preventive services and screenings only to those segments of the population that are at risk of a disease or a condition.

For example, under our bill, mammogram screenings would be free--no copays, no deductibles--but to those most at risk of breast cancer-- women over the age of 40.

At every step, what we have relied on are the latest recommendations of the U.S. Preventive Services Task Force. This task force has been in existence since the early 1980s. It evaluates clinical preventive services on the basis of scientific evidence related to effectiveness, appropriateness, and cost-effectiveness. So what we have said is that if the U.S. Preventive Services Task Force gives a certain preventive measure or screening an A or a B score, then the insurance companies and providers must provide that without any copays or deductibles. So it is targeted. It is not everything, but we are targeting the most cost-effective.

We also say that this task force has to meet at least once every 5 years and take in the latest scientific evidence and make recommendations for revising the mix of clinical preventive services.

Let me review some of the ways the Senate HELP Committee bill, in a very careful way, will put prevention and wellness at the very heart of health reform.

First, we create a Federal level prevention and public health council to improve coordination among Federal agencies in incorporating wellness into a national policy, and will develop a national prevention and a public health strategy. All of the departments should be doing this, not just the Department of Health and Human Services but the Department of Agriculture, the Department of Defense, the Department of Veterans Affairs, the Department of Transportation, and on and on. All of them ought to have as an integral part of their deliberations and proposals for future legislation that they might propose in the Congress an element of prevention and wellness. Take the Department of Transportation, for example. When they are thinking about highways, bridges, roads, and things such as that, are they thinking about bike paths and walking paths and sidewalks in cities that could be incorporated into the planning if they want Federal money? Well, they have not so far. This is what I mean. We need this kind of an overall coordinating council at the White House level, at the department level.

We also start a prevention and public health investment fund to provide for expanded and sustained national investments in prevention and public health programs in communities all across America.

A 2007 study by the Trust for America's Health found major savings from community-based prevention programs. There is clinic-based prevention where you get a screening, but then there are community- based programs to improve physical activities, nutrition, reduce smoking rates, and things such as that. They found that a national investment of just $10 per person per year--think about that, $10 per person per year--in certain community-based wellness programs would yield these kinds of savings: in 1 to 2 years, $2.8 billion; 5 years, $16 billion; and 10 to 20 years, $18.5 billion.

Again, on both the community level and the clinical level, we provide for funding and a structure to make wellness and prevention an integral part of our health care system. For example, our bill would target nutrition counseling to prediabetic patients. Right now, under Medicare, for example, and most insurance companies, they will reimburse thousands of dollars to take care of your diabetic conditions once you get diabetes. They

will pay for amputating a foot or a leg. They will pay for all these expensive things after you get diabetes. They will pay for a lifetime of treatment. But now they will not reimburse for the cost of nutrition counseling--a few hundred dollars for someone who is prediabetic and who could prevent the disease through changes in diet. That doesn't make sense. Our bill would change this by requiring insurance plans to reimburse for nutrition counseling for prediabetic individuals--another example of a cost-effective approach.

For essential screenings and annual physicals, our bill would get rid of copays and deductibles for things such as your annual physical checkups, vaccinations, mammogram screenings, and colonoscopies for the right population group, things like that--no copays, no deductibles.

We are going to make major new investments in the public health and primary care workforce. Senator Murray, of Washington, did a great job of incorporating workforce development in our committee bill. A lot of that workforce development is in the area of primary care and preventive care and wellness.

Finally, we give a powerful boost to employer-sponsored wellness programs. Our bill would allow employers to reward employees for participating in wellness programs by giving them a health insurance premium discount of up to 30 percent. In other words, if you participate in a wellness program that is provided by your employer, you can get a discount of up to 30 percent on your health insurance premium. I believe this is something that has been done by Safeway and others, and they have shown that they have had great results. People can see the benefit of wellness and prevention by getting a reduction in their health care premiums.

Workplace wellness programs--everything from nutrition counseling to smoking cessation--typically cost about $20 to $200 per employee per year. Again, they have a proven rate of return, ranging from $2 to $10 within 18 months, for every dollar spent. If you don't believe me, ask Pitney-Bowes what they did or Safeway. I single those two out, but many companies have gone way ahead of us in providing wellness programs for their employees. Are they doing it just out of sheer generosity? No. They know the bottom line. They know that when they provide wellness and prevention programs for their employees, their rate of return per dollar spent on an employee is 2 to 10 times as much within just a year or two. They have healthier employees. They don't go to the hospital as often. They don't have chronic diseases and they are more productive. They show up for work and they are more productive. What we have done in our bill is expanded this nationwide to give more companies the incentive to do that.

Our bill also directs the CDC to study and evaluate the best employer-based wellness programs and to create an educational campaign to promote these workplace wellness programs throughout America.

We think about the United States and our sick care system this way: We spend twice as much per capita on health care as European countries--twice as much--but we are twice as sick with chronic diseases. How is this possible? The reason is clear: We have neglected wellness prevention and disease prevention. In the United States, 95 cents of every health care dollar is spent on treating illnesses and conditions after they occur. Two-thirds of the increase in health care spending is due to increased prevalence of treated chronic disease. This chart illustrates that. In the late 1980s, we were spending about $313 billion a year on chronic disease. We have now doubled that. It is up to $627 billion, and it is going up at an ever-increasing rate. These are diseases that are mostly preventable. Yet we just continue to spend the money dealing with these chronic diseases.

The good news is that by reforming our system and keeping people healthy and preventing chronic illnesses, we have a great opportunity to not only save hundreds of billions of dollars but to improve the health of the American people.

Right now, 75 percent of health care costs are accounted for by heart disease, diabetes, prostate cancer, breast cancer, and obesity--five of them. These five diseases account for 75 percent of our health care costs. What do they have in common? They all have this in common: They are largely preventable, and even reversible, by changes in nutrition, physical activity, and lifestyle.

Again, for every dollar spent, 75 cents went toward treating patients with chronic disease. The CDC said this:

The United States cannot effectively address escalating

health care costs without addressing the problem of chronic

diseases.

Ninety-six cents of every Medicare dollar--we always hear that we are not going to have enough money for Medicare in the next 10 or 12 years, however long it is. Well, 96 cents goes for chronic disease. If you want to cut down on how much money we spend on Medicare, let's focus on prevention and wellness, especially for that group of individuals who are between 55 and 65, about ready to go on Medicare. Eighty-three cents of every dollar spent on Medicaid is spent on chronic diseases. Why don't we understand this and get it right? Yet, just like blind dodos, we say we will just keep spending the money and we won't address wellness and prevention. And we wonder why we can't get health care costs under control. Well, that is why. We are not addressing the underlying issues of wellness and prevention.

Again, it makes no sense to me that we spend all this time and all this effort to figure out a better way to pay the bills in a system that is dysfunctional, ineffective, and broken. We have to change the health care system itself. We have to change from a sick care system to a health care system, beginning with a sharp new emphasis on prevention and public health and wellness. That is in this bill, and that is not being talked about by the media. It is one of the fundamental parts of the health care reform we are going to be putting through here on the Senate floor and, hopefully, in Congress and to the President by the end of the year.

It also has to be comprehensive. Not everything that deals with wellness and prevention can be done in this bill. For example, very soon we have to reauthorize the child nutrition bill, which deals with the School Lunch Program and the Breakfast Program. We have to get better food, more nutritional food for our kids in school and get the junk food out. Why do we have vending machines in schools? Do we have vending machines in schools to provide more healthy food for kids in school? You know the answer to that. Of course not. Why do you have the vending machines in schools? Is it so that the school can make money so it can buy band uniforms or maybe football uniforms and things like that? Is it so we can get our kids on junk food and high-sugar sodas, which leads to obesity and leads to diabetes and other kinds of chronic illnesses? Do we really want that for our kids in school? We have to have more nutritional foods. That is the child nutrition reauthorization.

Next year, under our committee, I say to the occupant of the chair, who is now a distinguished member of our committee, we are going to reauthorize the Elementary and Secondary Education Act, which is also called No Child Left Behind. What about making sure we leave no child behind also in terms of their health? Right now, we are cutting down on physical activity with kids in school. We are cutting down on recess and time for them to exercise. That is just nonsense. We have to do more to provide for exercise and healthy foods for our kids in school. That is where it all begins.

To close, Winston Churchill once said something I always thought was pretty much right on point:

Americans always do the right thing--after they have tried

everything else.

We have tried everything else in health care, and it has failed. It has led us to bad health and to the brink of bankruptcy. Let's try something new--wellness and prevention. Times change the paradigm of health care. Let's recreate America as a genuine wellness society. Let's change the focus and make it easier to be healthy and harder to be unhealthy. Right now, it is easier to be unhealthy and hard to be healthy. Let's change that around, and in doing so we will build a health care system and bend that cost curve. That is the only way to get the job done.

Mr. President, I will be glad to get that for the Senator. I will get that to the Senator.

Mr. President, I ask unanimous consent that Shauna Agan and Amber Oldham of my staff be granted floor privileges for the duration of today's session.

Mr. HARKIN. Mr. President, I would like to congratulate the ACT organization, which is celebrating its 50th anniversary, this year. As many of our colleagues know, ACT is an independent, nonprofit group based in Iowa City that provides an array of testing, assessment, and research services in the areas of education and workforce development.

ACT was launched in 1959 as the American College Testing Program by a University of Iowa professor of education and colleagues from 16 Midwestern States. Their goal was to help college-bound students find a good match for their interests and aptitudes, and to help colleges and universities place students into appropriate freshman-level classes.

On November 7, 1959, about 75,000 students took the first ACT assessment. This year, nearly 1.5 million graduating seniors 45 percent of all high school graduates in the Nation took the ACT exam.

From its relatively humble beginnings a half century ago, ACT has grown into an enterprise with a global reach. In addition to its testing and assessment services, it has developed programs to prepare students for success in college. It has created the National Career Readiness Certificate, a tool that thousands of educators and employers nationwide use to confirm that individuals have essential core employability skills. In addition, ACT is one of several partners in a new Manufacturing Skills Certification System designed by the National Association of Manufacturers, the Nation's largest industrial trade organization.

In addition to its Iowa City headquarters, ACT has 12 field offices across the United States, as well as offices in Australia, Korea, China, Singapore, and Spain. It has a global workforce of nearly 1,500.

I salute all of the superb professionals at ACT, whose vision and hard work have built an organization respected worldwide for its innovation and excellence. And I wish them even greater success in their next half century.

Mr. President, I would like to congratulate the Muscatine History & Industry Center for being selected to participate in the rigorous Museum Assessment Program sponsored by the American Association of Museums.

The entire Muscatine community takes great pride in the History and Industry Center's success in showcasing the city's past role as ``pearl button capital of the world,'' as well as the historic contributions of three local enterprises: Bandag, a half-century-old company specializing in silver tubes, mesh venting, and tire treads; HNI Corporation, the world's second largest manufacturer of office furniture and the nation's No. 1 maker of gas- and wood-burning fireplaces; and Stanley Consultants, a global provider of engineering, environmental, and construction services.

The Muscatine History and Industry Center is a relatively small museum, but it has a very big impact. Not only does it welcome many thousands of visitors annually, it reaches out to the community with a variety of programs and activities, and hosts daily visits by school groups--from prekindergarten through high school. Students and youth groups learn by interacting with the Center's artifacts and many hands- on activities.

As the center begins participation in the Museum Assessment Program, it looks forward to an extended period of self-examination and peer review designed to improve its operations and programming, and to identify current and future challenges.

I congratulate the Muscatine History and Industry Center for taking this giant step forward in its development as a museum. And I salute all the outstanding professionals and volunteers at the center whose vision and tireless efforts have made this institution such an important part of Muscatine's cultural life.

Mr. HARKIN. Mr. President, I would like to congratulate the University Museums at Iowa State University for earning formal accreditation by the American Association of Museums, an honor that is bestowed on fewer than 10 percent of museums across the United States.

As a proud alumnus of Iowa State, I know that the university community takes great pride in its diverse collection of museums, including the three museums that together make up University Museums at Iowa State University: the Brunnier Art Museum, the Art on Campus Collection, and the Farm House Museum.

The Brunnier is dedicated to the decorative arts, including works by Grant Wood and Louis Comfort Tiffany. The Art on Campus Collection consists of more than 2,000 works of public art located all across the campus in buildings, courtyards, open spaces, and offices. The Farm House Museum is a wonderful 19th century house and a National Historic Landmark, offering visitors a window into what life was like on campus in the university's earliest days, when most faculty members lived on the college grounds.

These collections and museums make a powerful contribution to the cultural

life of the ISU campus. They do so thanks to the quality of their art works and artifacts. Just as importantly, they do so by inviting the community to participate in special conferences, lectures, panel discussions, gallery walks, and gallery talks. University Museums has reinvented the idea of the museum as an educational and intellectual center, reaching out beyond the campus to the wider Ames community, including K-12 schools, with a wide range of cultural programs and activities.

Accreditation by the American Association of Museums does not come easily. It involves a rigorous process in which a museum demonstrates its commitment to the highest professional standards, public service, and excellence in education. University Museums at Iowa State University now joins an elite group of 778 AAM-accredited institutions spanning the United States.

I congratulate University Museums for this hard-earned recognition. And I salute all the outstanding museum professionals and volunteers whose vision and tireless efforts have contributed so much to the campus and to the entire Ames community.

Mr. HARKIN. Mr. President, I would like to congratulate the University of Northern Iowa Museums and Collections for being selected to participate in the rigorous Museum Assessment Program sponsored by the American Association of Museums.

I know that the university and the entire Cedar Falls community take great pride in the University Museum, the Marshall Center School, and the various collections that they encompass. The University Museum's collections and temporary exhibits focus on the natural world and traditional cultures. The Marshall Center School is a restored one-room schoolhouse, with a permanent exhibit celebrating Iowa's rural schools.

These museums and collections make a powerful contribution to the cultural life of the UNI campus. They do so thanks to the quality of their exhibits and artifacts. Just as importantly, they do so by inviting the community to participate in special conferences, lectures, panel discussions, and other activities. The university views its museums not as static institutions but as active educational and intellectual centers, reaching out beyond the campus to the wider Cedar Falls community, including K-12 schools.

The UNI Museums and Collections have been accredited by the American Association of Museums since 1975--an honor that is bestowed on fewer than 10 percent of museums in the United States. As this institution now begins participation in the Museum Assessment Program, it looks forward to an extended period of self-examination and peer review designed to improve its operations and programming, and to identify current and future challenges.

I congratulate the UNI Museums and Collections for taking this important step forward in its development as an institution. And I salute all the outstanding professionals and volunteers whose vision and tireless efforts have contributed so much to the campus and to the entire Cedar Falls community.