E PL UR UM IB N U U S Congressional Record United States th of America PROCEEDINGS AND DEBATES OF THE 111 CONGRESS, FIRST SESSION

Vol. 155 WASHINGTON, TUESDAY, DECEMBER 8, 2009 No. 183 Senate The Senate met at 10 a.m. and was make them exemplary models of the APPOINTMENT OF ACTING called to order by the Honorable RO- highest and finest in faithful, loyal, PRESIDENT PRO TEMPORE LAND W. BURRIS, a Senator from the and dedicated leadership. Give them The PRESIDING OFFICER. The State of Illinois. wisdom, strength, and clarity to meet clerk will please read a communication PRAYER today’s daunting challenges. to the Senate from the President pro tempore (Mr. BYRD). The Chaplain, Dr. Barry C. Black, of- We pray in Your great Name. Amen. fered the following prayer: The legislative clerk read the fol- Let us pray. f lowing letter: God of wonder, beyond all majesty, U.S. SENATE, PRESIDENT PRO TEMPORE, may our lives and our world be awak- PLEDGE OF ALLEGIANCE ened by Your grace. Open our eyes to Washington, DC, December 8, 2009. To the Senate: Your works and our ears to Your words The Honorable ROLAND W. BURRIS led of life. Under the provisions of rule I, paragraph 3, the Pledge of Allegiance, as follows: of the Standing Rules of the Senate, I hereby Stir within our lawmakers a desire to appoint the Honorable ROLAND W. BURRIS, a I pledge allegiance to the Flag of the please You. Enable them to hear with Senator from the State of Illinois, to per- United States of America, and to the Repub- objectivity and respond with integrity, form the duties of the Chair. as they comprehend their individual lic for which it stands, one nation under God, ROBERT C. BYRD, and collective responsibilities. Lord, indivisible, with liberty and justice for all. President pro tempore.

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VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00001 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.000 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12648 CONGRESSIONAL RECORD — SENATE December 8, 2009 Mr. BURRIS thereupon assumed the Senate will resume consideration of bled government program in order to chair as Acting President pro tempore. H.R. 3590, which the clerk will report. create another is a mistake. I will say f The legislative clerk read as follows: that again: $1⁄2 trillion in cuts to Medi- A bill (H.R. 3590) to amend the Internal care for seniors is not reform. RECOGNITION OF THE MAJORITY Revenue Code of 1986 to modify the first-time But Medicare cuts are just one leg of LEADER home buyers credit in the case of members of the stool holding up this misguided vi- The ACTING PRESIDENT pro tem- the Armed Forces and certain other Federal sion of reform. Let’s take a look at an- pore. The majority leader is recog- employees, and for other purposes. other. Let’s look at how this bill pun- nized. Pending: ishes not only seniors but how it kills f Reid amendment No. 2786, in the nature of jobs at a time when 1 in 10 working a substitute. Americans is looking for one. This bill SCHEDULE Nelson (NE) amendment No. 2962 (to doesn’t just punish seniors, it punishes Mr. REID. Mr. President, following amendment No. 2786), to prohibit the use of job creators too. leader remarks, the Senate will resume Federal funds for abortions. That is the message we got yesterday McCain motion to commit the bill to the from small businesses across the coun- consideration of the health reform leg- Committee on Finance, with instructions. islation. Following leader remarks, the try. They sent us a letter opposing this The ACTING PRESIDENT pro tem- time until 12:30 will be for debate only. bill because it doesn’t do the things pore. Under the previous order, the The majority will control the first half proponents of this bill promised it time until 12:30 p.m. will be for debate of the time allotted until 12:30. The Re- would. It doesn’t lower costs, it doesn’t only, with the time equally divided and publicans will control the next half. help create jobs, and it doesn’t help the controlled between the two leaders or The remaining time will be equally di- economy. Here are just some of the their designees, with Senators per- vided and controlled between the two groups that signed that letter: the As- mitted to speak for up to 10 minutes leaders or their designees. The Senate sociated Builders and Contractors, the each, with the majority controlling the will recess from 12:30 until 2:15 p.m. to Associated General Contractors, the first hour and the Republicans control- allow for the weekly caucus luncheons. International Food Service Distribu- ling the next hour. There are two amendments now pend- tors Association, the National Associa- RECOGNITION OF THE MINORITY LEADER tion of Manufacturers, the National ing. One is the Nelson of Nebraska Association of Wholesale Distributors, amendment and the other is the The ACTING PRESIDENT pro tem- the National Retail Federation, Small McCain motion to commit. Senators pore. The Republican leader is recog- Business and Entrepreneurship Coun- should expect votes after the recess in nized. HEALTH CARE REFORM cil, and the U.S. Chamber of Com- relation to the pending amendment and merce. Mr. MCCONNELL. Mr. President, motion. Here is what these groups had to say over the past several days, Americans f about this bill. I am reading from their have seen in vivid detail what some letter dated December 7, 2009, a letter NEW DEMOCRATIC SENATORS supporters of this plan plan to do for that was addressed to every Member of the Medicare Program for seniors. Mr. REID. Mr. President, we have the Senate: They plan to use it as a giant piggy scheduled this morning, as soon as the In order to finance part of its $2.5 trillion leader time is used, a group of Demo- bank to pay for an entirely new gov- price tag, HR 3590 imposes new taxes, fees cratic Senators. These are all new Sen- ernment program. Yesterday, we heard and penalties totaling nearly half a trillion ators. I hope those people who are floated, for the very first time, that dollars. This financial burden falls dispropor- watching understand the quality of the they want to radically expand Medi- tionately on the backs of small business. people who are now going to make a care. So what is becoming abundantly Small firms are in desperate need of this pre- presentation before this body. The clear is that the majority will make cious capital for job creation, investment, business expansion, and survival. States that will be represented here any deal, agree to any terms, sign any The letter goes on to detail all the today will be Oregon, Delaware, New dotted line that brings them closer to ways in which this bill punishes small Hampshire, Colorado—we have two Col- final passage of this terrible bill. They businesses, thus making it harder for orado Senators who will speak—the entertain adding new experiments them to retain or hire workers. These new Senator from Massachusetts, New without any assessment of the impact groups point out that under this bill, Mexico, Virginia, Illinois, Alaska, and this backroom deal-making will have on the American people or our econ- small businesses in the United States the opening will be by Senator would see major cost increases as a re- omy. They are, for lack of a better MERKLEY and the closing will be by sult of new taxes on health benefits term, winging it on one of the most Senator MERKLEY. Such quality indi- and health insurance, costs that would consequential pieces of legislation af- viduals we are so fortunate to have in be passed on to employees and which fecting our country in memory. the Senate. I am grateful for the time would make health insurance more ex- Let me suggest to the majority, they have taken to speak on this issue. pensive, not less. Much of what they have done has set Americans would much rather we get it Under this bill, self-employed busi- the tone for this debate on our side of right than scurry around, throwing to- ness owners who buy coverage for the aisle. It has been constructive, it gether untested, last-minute experi- themselves could see a double-digit has been positive, and it has been very ments in order to get 60 votes before jump in their insurance premiums. For lucid. They were all successful individ- Christmas. Let me say that again. other small businesses, the bill won’t uals before they came to the Senate. Americans would much rather we get it lead to a significant decrease in cost— Certainly, that is acknowledged every right than scurry around, throwing to- something they were promised as a re- time we hear one of them say a word gether untested, last-minute experi- sult of the bill. here on the Senate floor. ments in order to get 60 votes before Under this bill, jobs would be lost Would the Chair announce the mat- Christmas. and wages depressed as a result of a ter before the Senate. Over the past several days, our new law that would require businesses f friends on the other side repeatedly either to buy insurance for their em- voted to preserve nearly $1⁄2 trillion in ployees or to pay a fine. RESERVATION OF LEADER TIME Medicare cuts to finance their vision of Needless to say, this is not the kind The ACTING PRESIDENT pro tem- reform, a vision that includes cutting of legislation the American worker pore. Under the previous order, the nearly $8 billion from hospice care, $40 needs or wants at a moment of double- leadership time is reserved. billion in cuts to home health agencies, digit unemployment. Perhaps that is f $120 billion in cuts to Medicare Advan- the reason that poll after poll after tage, $135 billion in cuts to hospitals public opinion poll shows that the SERVICEMEMBERS HOME that serve Medicare patients, and near- American worker opposes this bill. OWNERSHIP TAX ACT ly $15 billion in cuts to nursing homes. Some business groups may have sup- The ACTING PRESIDENT pro tem- What these cuts really illustrate is a ported this plan earlier in the year be- pore. Under the previous order, the lack of vision because cutting one trou- cause they thought it was inevitable.

VerDate Nov 24 2008 03:13 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00002 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.001 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12649 They didn’t want to be critical of a bill Mr. BAUCUS. Mr. President, for the Mr. DODD. Mr. President, I will be they thought they had no power to benefit of all Senators, I would like to very brief because we want to take the stop. But something happened between take a moment to lay out today’s pro- time to hear from our colleagues. I, then and now: The American people re- gram. It has been more than 21⁄2 weeks too, want to commend them. A number alized what this bill meant for them. since the majority leader moved to of them serve on the Health, Edu- They realized what it would mean for proceed to the health care reform bill, cation, Labor, and Pensions Committee seniors, for business owners, for the and this is the ninth day of debate. The and were tremendously valuable in economy, for our future as a country. Senate has considered 18 amendments helping us craft the legislation we now Americans stood up, they made their or motions. We have conducted 14 roll- have before us in this compromised, voices heard, and now the tide has call votes. melded bill. turned. The American people oppose Today, the Senate will debate the I also want to make a note. I listened this bill. They want us to start over. amendment by the Senator from Ne- to the Republican leader this morn- They want us to make commonsense, braska, Mr. NELSON, on a woman’s ing—and I will talk more about this step-by-step reforms that everyone can right to choose. At the same time, we later—but you would almost begin to support, not some backroom deal to will debate the motion by Senator believe that 300 days ago Barack have the government take over the MCCAIN on Medicare Advantage. Obama arrived as President of the health care system that is then forced The time between now and the cau- United States, and all these problems on the American people without discus- cus lunches is for debate only. The ma- emerged miraculously. The fact is, in sion. jority will control the first hour of de- the previous 8 years we watched the Our friends on the other side can read bate this morning; the Republicans will Nation accumulate more debt in one the writing on the wall. They know the control the second hour. administration than all prior 43 admin- American people oppose this bill. But We are hopeful the Senate will be istrations combined. they have apparently made a calcula- able to conduct votes on or in relation The situation we find ourselves in tion to force it through Congress over to the Nelson amendment, a side-by- economically did not happen overnight. the next several days before the Amer- side amendment to the McCain motion, It happened over a number of years of ican people even have a chance to ab- and the McCain motion sometime this carelessness, with a lack of regulation sorb the details. The only thing that afternoon. and a lack of the enforcement of the can stop them is the realization by Thereafter, we expect to turn to an- regulation that existed. We have been Democrats themselves that this plan other Democratic first-degree amend- grappling with these problems. In De- would be a tragic mistake for seniors, ment, which is likely to be the amend- cember of last year, more than 700,000 for the economy, and for our country ment by the Senator from North Da- people lost their jobs—in that 1 month and that a better path would be the kota, Mr. DORGAN, on drug reimporta- alone. In January, almost 700,000 again, tion, and another Republican first-de- kind of step-by-step reforms Americans and the same was true in March. Al- gree amendment. We are working on have been asking of us, reforms Ameri- most 3 million jobs were lost before the lining up those amendments. ink on the inauguration papers was cans really want. Americans don’t I note that the pending McCain mo- think reform should come at the ex- dry. tion is the third such effort by the Re- We are now finding ourselves—while pense of seniors, and they don’t think publicans to defend the private insur- still too high an unemployment rate— it should come at the expense of jobs. ance companies that run the program with a vastly improved economic con- They don’t think it should make cur- called Medicare Advantage. That is the dition in this country. Much more rent problems worse. same so-called Medicare Advantage needs to be done. Yet we hear the same TARP Program that the nonpartisan MedPAC sort of ‘‘Chicken Little’’ arguments. Mr. President, we are now hearing says is overpaid—overpaid by 14 per- Just say no, every time, to an idea that talk that the administration is think- cent—compared with traditional Medi- might make a difference to this coun- ing of using the bank bailout TARP care, which does the same thing. try getting back on its feet again. money that taxpayers reluctantly That is the same so-called Medicare Certainly the decisions made a year handed over during last year’s credit Advantage Program whose overpay- ago to provide the stabilization of crisis on another spending spree like ments add $90 to the Medicare pre- major financial institutions contrib- the stimulus which they said would miums of a typical retired couple, even uted directly to the benefits we are see- stop unemployment at 8 percent but though that couple gets nothing in ex- ing today. Certainly the efforts of tak- hasn’t. One trillion dollars later, unem- change. ing some of these resources that have ployment is now at 10 percent. This is That is the same so-called Medicare gone to bail out major financial insti- not only irresponsible, since the pur- Advantage Program that has been the tutions now being used to try to create pose of these emergency funds was to major source of strong profits for the jobs in the country is something I prop up the credit system in the midst private insurance companies that re- think would be welcomed by the Amer- of a crisis, it also violates both current ceive those overpayments. And that is ican people—not rejected by Members law and the pledge we made that every the same so-called Medicare Advantage of Congress who seem only to be inter- dollar we got back would be returned Program that helps those private in- ested in whether we are going to take to the taxpayer to reduce the national surance companies to pay their CEOs care of those large firms that got us debt. That is the pledge we made when $8 million a year, $9 million a year, and into this mess in the first place. we passed the TARP proposal. in one instance more than $20 million a So I welcome the President’s ideas in This proposal from the administra- year in compensation. this area. We welcome particularly this tion is completely wrongheaded, but it So that is the same so-called Medi- effort on health care, to make a dif- is perfectly illustrative of the way care Advantage Program that, in our ference not only for individuals but for Democrats in Congress have been deal- view, needs a healthy dose of competi- our economy, to reduce those costs, re- ing with taxpayer money all year—by tion. That is all our bill would do. Our duce those premiums, and make those throwing it at one problem after an- bill would move to competitive bidding insurance products available to all other without much regard for the con- in the private insurance Medicare mar- Americans who worry every night sequences. Whether it is the stimulus, ket. It is high time we did so. about whether they are going to fall Cash for Clunkers, or the health care This morning we are going to have a into that abyss because of a health bill that is currently on the Senate colloquy among many new Senators, care crisis that happens to a family floor, Americans are running out of pa- the group of Senators who were just member or a loved one. tience with politicians who promise elected last year, which is a very active So today we are going to hear from a jobs but who deliver nothing but more group. I have met with them many number of our colleagues who have debt, higher taxes, and longer unem- times. They are very thoughtful, very been deeply engaged in these issues ployment lines. active, and they have a lot to say. over the last several years and in their Mr. President, I yield the floor. The ACTING PRESIDENT pro tem- new membership in this wonderful The ACTING PRESIDENT pro tem- pore. The Senator from Connecticut is body of the Senate. I welcome tremen- pore. The Senator from Montana. recognized. dously their efforts.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00003 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.002 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12650 CONGRESSIONAL RECORD — SENATE December 8, 2009 Mr. President, I yield the floor to $650 billion in the second 10 years. This Thank you, Mr. President. allow them to discuss their ideas. I be- will truly bend the cost curve, which The ACTING PRESIDENT pro tem- lieve the first one to speak is our new we have to do if we are not going to go pore. The Senator from Virginia is rec- colleague from Delaware. into insolvency. ognized. The ACTING PRESIDENT pro tem- It is interesting, when the other side Mr. WARNER. Thank you, Mr. Presi- pore. The Senator from Delaware is talks about deficits, deficits, deficits— dent. recognized. the thing that is driving the deficit is I thank my colleague, the Senator Mr. KAUFMAN. Mr. President, I health care costs because what drives from Delaware, for his comments and want to start by agreeing—and I prac- Medicare and Medicaid costs is health for his leadership on this issue. I also tically always agree with the Senator care costs. thank all of the freshmen. This is, I from Connecticut—with his summation This bill makes quality, affordable think, the seventh time the freshmen as to how we got to where we are, and health care within reach of all Ameri- have come to the floor on this very im- why it is important we do something cans. But there is always more we can portant issue. Our colleagues have had about it. He is right. The chairman of do. That is why I am pleased to join my to now endure 65 speeches from the the Finance Committee is right too. other freshman colleagues to support a freshmen on the subject of health care. The freshman Senators who come very promising amendment to the bill. Before I get into my remarks, I want from all over this country got together So much of what is broken in our to personally thank Senator BAUCUS, and, frankly, with the leadership of present health care system revolves Senator DODD, the majority leader, and Senator WARNER from Virginia, put to- around basic inefficiencies that drive their staffs, for working with the 11 gether a package which I think is a up costs, while simultaneously driving freshmen Members who have come to- very constructive package for the down quality. That is right. Costs go gether today to unveil a package of Health Care Reform Act we have to up, quality goes down. That is not the health care amendments focused on the pass. way we want to have it. We want costs issue of cost containment. I appreciate the opportunity to join to go down and quality to go up. We have been working on this now with the other freshmen, including the Even worse, inefficiencies in the sys- for close to 3 months. Acting President pro tempore, to dis- tem often give way to the waste, fraud, Let me say at the outset, I am proud cuss the unique opportunity we have to and abuse that drains somewhere be- of the enormous broad-based support finally enact meaningful health care tween $72 and $220 billion annually we are receiving for this package of from doctors, patients, private insur- reform. amendments. The Business Roundtable Make no mistake, we need health ers, and the State and Federal Govern- has endorsed the amendments. Compa- care reform now. When you look out ments. This is significantly increasing nies such as Walmart, Intel, Target and there and you see everything from ris- health care costs for Americans. These Quad/Graphics endorse this package. are inefficiencies that can and will be ing premiums to insurers denying cov- Groups such as the AARP and the AFL, curbed. erage for people with preexisting condi- and important think tanks such as the By seeking creative ways to encour- New America Foundation have en- tions, the health care system is failing age innovation and lower costs even dorsed this package. We also have sup- individual Americans. There is no further—and more quickly—for Ameri- port from Mark McClellan, who was doubt about that. cans across the country, this amend- Not only is it doing that, it is threat- the head of CMS under President Bush. ment complements the underlying While the merged bill starts to move us ening the fiscal solvency of our coun- health care bill. try. Medicare and Medicaid are swal- It adopts the full spectrum of 21st- in the right direction in addressing lowing up more and more of our Fed- century technologies and innovative health care spending in this country, eral spending. If we do not act soon, it methods of delivery to further cut this package strengthens that move- will become the largest contributor to through the redtape that continues to ment. Our package further moves us the deficit. plague our system and stifle innova- away from a current system that The time for reform is now. We can- tion. It provides commonsense, prac- makes no financial sense—one that re- not wait any longer. As the Senator tical solutions that help contain costs, wards volume over quality and one from Connecticut said, this is not improve value, and increase quality. It that reimburses hospitals for higher, something that just came out of no- increases penalties for health care rather than lower, readmission rates. where. It has been there for a long fraud and enhances enforcement We are taking the payment reform time. But we cannot let any more time against medical crooks and utilizes the aspects of the health care bill—sections go by. We have to act now. most sophisticated technology to bet- that increase accountability, and focus Thanks to the hard work of Senators ter detect and deter fraud in the health on data mining and administrative REID, BAUCUS, DODD, and HARKIN and care system. simplification—and accelerating them. their staffs, we have a bill before us It quickens the implementation of We are giving the Secretary, as we that can finally reform our health care uniform administrative standards, al- move forward, the ability to take pilot system. It is a good bill. It is a bill that lowing for more efficient exchange of programs and broaden their approach truly protects what works in our sys- information among patients, doctors, and appeal. And if it works, we’ll bring tem and, at the same time, fixes what and insurers. It provides more flexi- that reform to our whole system. is broken. bility in establishing accountable care While we anticipate a very good score No longer will Americans be denied organizations that realign financial in- from CBO in terms of lowering health coverage on the basis of preexisting centives and help ensure Americans re- care costs overall, another thing we fo- conditions. No longer will their cov- ceive high-quality care. It provides cused on with this package is not just erage be revoked when they get sick greater incentives to insurers in the health care reform in the context of and need it the most. This bill will help exchange to reduce health care dispari- government-related programs, such as protect seniors by offering new preven- ties along racial lines. Medicare and Medicaid, but also how tive and wellness benefits. These are just a few examples of the we partner with those in the private It will extend the solvency of the provisions in the amendment that I be- sector. Medicare trust fund by an additional 5 lieve will mesh well with the Patient One of the reasons the Business years. It will also help our economy by Protection and Affordable Care Act. As Roundtable is so supportive is the fact significantly cutting health care costs I have said before, it is time to gather that our package recognizes that well and reducing the Nation’s deficit by our collective will and do the right over half of the American public still $130 billion. thing during this historic opportunity receives their health care through pri- You hear a lot of numbers. You see a by passing health care reform now. I vate insurance or in conjunction with lot of numbers. You read about it in think this amendment can help us their employers. With these amend- the newspaper. Especially, you hear reach that goal. We cannot afford to ments, we look at how we take the best about it on the other side of the aisle. wait any longer. We need to act now. of the private sector, and the lessons This will cut the deficit by $130 billion We can do no less. The American peo- we’ve learned from them, and bring for the first 10 years and maybe up to ple deserve no less. those into health care reform.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00004 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.013 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12651 My friend, the Senator from Dela- there—but it will move us further down an eye. We can’t hope to compete in ware, has raised this point. There are the field. I say this modestly, again, to this global economy if we are devoting still issues to be resolved in this bill. the originators of the bill—it is a very a fifth of our economy to health care I still have some concerns, particu- good bill, a very good framework. But and everyone else in the world is devot- larly with the public option portion. humbly I might say, as some know, I ing less than half that. Finally, as the But I know that with a good-faith ef- was lucky enough in the old days to Senator from Virginia also said, if you fort, we are going to get those issues fall into the cell phone industry. I have any concern about these deficits resolved. managed to eke out a small living in we are facing in Washington becoming One thing that needs to be re- that industry. I like to think about the completely untenable, what you need affirmed, time and time again, is what cell phone industry as a metaphor for to know is, the biggest driver of those happens if we don’t enact health care this package of amendments. If we is rising Medicare and Medicaid costs reform. Not acting is a policy choice; it think of the original bill as creating and the biggest driver of those is, of is every bit as much of a policy choice the cell phone of the 20th century, our course, health care costs. as moving forward on this bill. What package of amendments is basically So my view has been, from the start, many don’t realize is that the largest the iPhone version to your Motorola no matter what your entry point was driver of our Federal deficit is not edu- flip phone original version. We literally into this debate, cost was the central cation funding, transportation funding, provide dozens of new applications on a question for our working families and and not even TARP funds or the stim- good, basic framework that has been for our small businesses. We have ulus. The largest driver of our Federal provided by this merged bill. And we stressed the need over and over for deficit is health care spending. take these applications a little bit fur- health care reform to contain the ris- If we fail to act now, Medicare, which ther into the 21st century. ing costs that are plaguing our current provides health care to millions of sen- I am very proud of the work all these system. That is why I think the Senate ior citizens, will go bankrupt in the freshmen Senators and their staffs needs to adopt the freshman amend- next 8 years. If we fail to act now, an have done over the last 3 or 4 months. ment package, which would cut costs, average Virginia family will see their Again, I thank the chairman of the Fi- save taxpayers money, and in this bill health care costs eat up 40 percent of nance Committee, the chairman of the it can make our health care system their disposable income in the next HELP Committee, the majority leader function more efficiently. decade. and their staffs for helping us work This package of amendments will One of the reasons we are seeing so through this package, and I look for- help strengthen the reform proposal’s much broad-based business support for ward to its adoption. ability to deliver affordable, quality our amendment package is business un- With that, I yield the floor, and I be- health care to all Americans, whether derstands that if we can’t drive down lieve the junior Senator from Colorado they are in private plans or whether overall health care costs, the ability of will speak next. they are in public plans. These provi- the United States to come out of this The ACTING PRESIDENT pro tem- sions will remove much of the redtape recession and remain competitive in a pore. The Senator from Colorado is rec- that, for so long, has slowed the deliv- global marketplace will be seriously ognized. ery of care. Doctors from all over Colo- undermined. As long as American busi- Mr. BENNET. Mr. President, I wish rado have told me, time and time ness has to pay twice as much per per- to thank our colleague from Virginia, again, their medical practices are son—as much as $3,000 to $4,000 more Senator WARNER, for his extraordinary mired in paperwork and their staffs per employee—for their health care leadership throughout this process of spend far too much time and money costs than any of our industrial com- the freshmen coming together to see jumping through administrative hoop petitors around the world, regardless of what we can do to move this legisla- after hoop. The time our doctors and how productive the American work- tion forward to improve it. I think a nurses spend on unnecessary paper- force is, American businesses will be at lot has been said about how the bill work is time they can’t spend becom- a serious disadvantage. that was drafted by the HELP Com- ing better professionals and, most im- Our amendment package is complex. mittee, by the Finance Committee, and portantly, providing quality care to It is a bit dense. There are some 30-odd now by the majority leader is direc- their patients. This amendment will re- different provisions that take very tionally correct in its efforts to get a quire the Secretary of Health and good parts of the merged bill and move handle on these skyrocketing costs. I Human Services to adopt and regularly them faster. It increases price trans- think this amendment package will update a single national standard for parency in health care pricing, and in- move us much further in the right di- some of the most basic electronic creases our ability to take programs rection of trying to hold down costs for transactions that occur between insur- and pilots that work and roll them out our working families and small busi- ers and providers, and meeting these on a wider basis. My good friend, the nesses across the country. standards will be enforceable by pen- Senator from Colorado, has been work- Throughout this entire debate and alties if insurance providers don’t take ing hard on the administrative reform going back to the very beginning, what steps to comply. My provision will portion. I have said is, no matter where you are make sure that as we implement This is a good package of amend- on many of the issues, there can’t be health care reform, we are consistently ments. I was asked yesterday by some- any disagreement that the current sys- identifying and implementing new body in the press how I would describe tem, with respect to costs, is com- standards. the package. I guess I would sum it pletely insane. Our families in Colo- There are also terrible inefficiencies up—because some of this stuff gets rado faced double-digit cost increases in the way we pay health care pro- fairly dense—with two things that this every year over the last decade. Their viders and allow them to deliver care package of amendments is trying to do. median family income has actually to patients. This package helps elimi- I think we all remember, years back, gone down by $300, and the cost of nate bottlenecks so patients are cared in the travel industry, when you called health care has gone up by 97 percent for in a reasonable amount of time. up and tried to get an airline reserva- over that period of time. Our small This package of amendments also ex- tion and depending on whom you called businesses are paying 18 percent more pands the Senate bills reforms being and what time you called, you might for health insurance than large busi- made to Medicare and Medicaid. There get a totally different price on your nesses just because they are small. As is a provision that will allow account- airline ticket. Well, this package of the Senator from Virginia was men- able care organizations to work with amendments is trying to do for health tioning, we are spending, as a country, private insurance companies to better care what Travelocity did for the air- more than twice what almost any craft strategies for Medicare and Med- line business. And that is bring some other industrialized country in the icaid and private sector plans to im- true pricing transparency to the health world is spending as a percentage of prove care. In the current system, doc- care system. our gross domestic product on health tors are forced into requesting a mul- Our package of amendments will care. We are spending roughly 18 per- titude of tests to confirm a diagnosis move us—it will not get us all the way cent, going to 20 percent in the blink of they have already made. This creates

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00005 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.014 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12652 CONGRESSIONAL RECORD — SENATE December 8, 2009 unnecessary work for doctors, their ad- cial regulations and our financial sys- amendment rewards providers of Medi- ministrative staffs, lab technicians, tems so the American people will un- care who give high-quality care rather and so on. It is time we create a system derstand we are one country, with one than high-volume procedures. We will that empowers doctors to practice important financial system and not also allow Medicare to test promising medicine and do their jobs efficiently. somehow second tier, unrelated and new models to reduce costs, increase Under the current broken system, unconnected to the decisions made on quality, and improve patient health. doctors have to endure needless hurdles Wall Street and elsewhere. When Sen- We must make these changes for the to even set up a practice. It is no won- ator Kennedy of Massachusetts was sake of our patients and for the sake of der the number of primary care doctors stricken, Senator DODD of Connecticut our economy. has been steadily declining for some stepped forward, not only because Sen- In short, our amendments strengthen time now. ator Kennedy was his very close friend the reforms of the Patient Protection This package of amendments would but because the Senator from Con- and Affordable Care Act. I urge all my create an environment that attracts necticut understood the enormity of colleagues to support these amend- doctors back to the field rather than the challenge and important effort that ments and take these important steps make it more difficult for them to pro- is being made in the Senate. I wish to with us to bring America’s health care vide care. Along with the savings this salute him for sharing his wisdom and system into the 21st century. bill already creates, these amendments his strength and his leadership, not I thank the leadership once again, will help doctors remove the redtape only in the areas of financial reform and I thank the Senator from Virginia that has limited their ability to help but in this important area as well. and my other freshman colleagues for patients in a timely manner. As I said, this is nothing less than a their good work on this historic health We cannot go on allowing the middle bill of rights for the American people care bill of rights. class to absorb the rising costs of our on the issues of health care. With this I yield the floor. Nation’s health care system. We need legislation, all Americans, finally, will The ACTING PRESIDENT pro tem- health care reform that will control be guaranteed access to the affordable pore. The Senator from Colorado is rec- costs and put us back on a path toward health care coverage they deserve. ognized. fiscal responsibility. This package of Families who need a helping hand to Mr. UDALL of Colorado. Mr. Presi- amendments will help us do that. care for an aging relative will be pro- dent, my freshman colleagues and I I wish to, again, say thank you to my tected. Insurance companies will be have come to the floor on a regular colleagues from the freshman class for prohibited from arbitrarily refusing basis over the last few months to make their work. This sometimes has seemed coverage and from stopping benefits clear to both sides of the aisle just how tedious and sometimes hard to de- when they are needed the most. Doc- critical it is that we succeed in reform- scribe, but these amendments are very tors will be given the support they ing our health care insurance system. critical if we are going to get hold of need to practice the best medicine pos- Right now, too many Americans lack costs as we go forward. That is the re- sible. That is why they took their oath. the freedom to move to a new job, fur- lief working families in this country With the help of the measures in this ther their education, or start a small need more than anything. In order to total legislation and some of the par- business because doing so can put them have stability in their lives, we have to ticular reforms suggested by our fresh- at risk of losing health care coverage get hold of our rising health care costs. man colleagues, that best medicine for their family. If you think about it, With that, I yield the floor. will be practiced. The American econ- freedom is, after all, about choices. The ACTING PRESIDENT pro tem- omy will be protected from the sky- What motivates me—and I know it mo- pore. The Senator from Massachusetts rocketing costs of health care, with tivates my freshman colleagues—is the is recognized. which every American family is now desire to preserve and enhance the free- Mr. KIRK. Thank you, Mr. President. inflicted. dom of all Americans. With great joy and enthusiasm, I can Over the past month, I have had the This legislation we have been debat- say that today we are closer than ever privilege of working with my fellow ing and amending over the past 2 weeks to guaranteeing that all Americans, at freshman colleagues on a series of can and should be a vehicle that we use long last, will have full access to qual- amendments that we are discussing to enhance freedom for all of our Amer- ity, affordable health care. The Patient this morning to make this health care ican citizens. We are going to repair Protection and Affordable Care Act, bill of rights even stronger. These and modernize a broken health care which our colleague and fellow fresh- amendments plant the seed for an inno- system. If we fail to do so, we perpet- man Senator JEFF MERKLEY of Oregon vative 21st-century health care system uate an antiquated status quo that suggests, as Senator Kennedy of Massa- that offers what American families stalls economic growth, stifle the en- chusetts would have subscribed to, that want most: better results for lower trepreneurs who make up the American this is the health care bill of rights. It costs. It is as simple as that. These business landscape, and keep stability will help fix a health care system that amendments focus on the root causes and security out of reach for millions is failing to meet the needs of the of our skyrocketing health care costs of American families. American people. I am extremely proud to provide Medicare the support it The package of amendments we to join with Majority Leader REID, needs to become a leader in moving present today is designed to inject with Senator BAUCUS, with my good away from the reimbursement models more cost containment into the bill, friend, Senator DODD of Connecticut, that increase costs without improving cut down on regulatory and bureau- and with my fellow freshman Senators. care. cratic redtape, and push us more ag- I wish to single out, if I may, the Sen- Public-private arrangements will be gressively toward a reformed health ator from Virginia, MARK WARNER, one established to smooth reform and pre- care system that rewards better pa- of the more enlightened business lead- vent private insurance from shifting tient care rather than simply more ers of our time, who brought his wis- costs onto public plans. The redtape, care. dom and innovation and skills and with which we are all familiar, which In developing these ideas, my fellow practices of the private sector to help weighs down the current health care freshmen and I have relied upon the improve the important challenge we system in both the public and private input of people back home. And have in the public sector. I thank the sectors will be reduced. All of this will through my discussions with constitu- Senator for his leadership on this ef- contribute to lower costs and higher ents, health care providers, and busi- fort, in contributing to legislation that quality in our health care system. nesses from all over Colorado, a com- will mark a historic stride forward for One focus that is particularly of in- mon theme has emerged: They want a the American people. terest and important to me is the de- health care system that tackles costs, I wish to say a word as well, a par- livery system reform. We must move while keeping the focus on patients and ticular word, about the chairman of toward a system of paying hospitals quality. I believe we have accomplished the Finance Committee who has enor- and doctors for the quality of care they that with our freshman proposal be- mous responsibilities in the Senate provide rather than the quantity of cause more than 30 groups have come chairing the effort to reform our finan- tests and procedures they perform. Our out in the past few days in support of

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00006 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.003 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12653 our efforts. This is a wide-ranging concrete. We have talked about the im- out my assistants, Alison MacDonald number of groups, including consumer portance of reforming the way we de- and Dr. Manny Jimenez, for the work champions such as AARP, business liver care, about how we need to slow they have done on this package. It is a leaders such as the Business Round- down the skyrocketing costs of health great effort, and I am pleased to be table, and health providers such as care, while improving quality, and here with my fellow freshmen. Denver Health in my home State. about the need to provide incentives to I urge all of our colleagues to join us My freshman colleagues have spoken make the changes happen. Today, we in support of this effort. about individual pieces of this effort deliver on that talk. Our proposals are The ACTING PRESIDENT pro tem- that combine to make the whole. I will about containing costs, about looking pore. The Senator from North Carolina single out a section that I think will into the future, thinking about our de- is recognized. have a particularly strong influence on livery system, and finding ways to Mrs. HAGAN. Mr. President, I rise in the future of our health care system. make small but very important support of the freshman value and in- Senator ROCKEFELLER has authored changes that will make a difference. novation package, which builds on ef- an important provision that creates Throughout this debate, I have been forts to provide quality, affordable the independent Medicare advisory talking about the importance of in- health care at a lower cost to families. board. This board would be tasked with creasing the quality of care while re- I, too, applaud our colleague, Senator keeping down the costs in the Medicare ducing the cost. This amendment pack- MARK WARNER, for helping to initiate system by issuing proposals to cut age does just that. this package. spending and increase the quality of This amendment package matters. It I wish to take a moment to talk care for beneficiaries. matters to all the health care con- about two provisions in the package I applaud this contribution to the sumers who are interested in reducing that I included: curbing fraud and bill, but I have wondered why we can- costs and increasing the value in our abuse with 21st-century technology and medication therapy management. not take it a step further by looking at health care system. It especially mat- Today, Medicare spends about $430 the whole health care system and not ters to business. The high cost of billion annually; Medicaid, approxi- just Medicare in isolation. If we are health care and insurance coverage going to tackle spiraling health costs mately $340 billion; the States Chil- eats away at the bottom line for busi- dren’s Health Insurance Program, an across the country, we need to push nesses. If we can reduce waste and inef- each area of our health care system to additional $5 billion, for a total of $775 ficiency, attack fraud, and simplify our billion. be smarter and more efficient in deal- system, we can reduce costs. The inno- ing with cost growth. In Medicare alone, annual waste vations in this package attract busi- One of my contributions to the pack- amounts to between $23 billion and $78 ness because business understands that age is a provision to expand the scope billion. Yet, despite these sky-high of the Medicare advisory board to ex- we need to take steps in our public and numbers, investigations are pursued amine not just Medicare but the entire private health care systems to lower only after payment has been made, health care system and task the board costs and deliver value. which means government fraud inves- I am proud that, with this amend- with finding ways to slow down the tigators have to recover funds that ment, we are able to promote the good growth of health costs across the coun- have already been paid. As a result, it try. This would include providing rec- work of Elliot Fisher and his col- is estimated that only about 10 percent ommendations on the steps the private leagues at the Dartmouth Institute for of possible fraud is ever detected, and sector should take to make our deliv- Health Policy and Clinical Practice of that amount only about 3 percent is ery system more efficient. Health care and to recognize the work they have ever actually recovered. This means leaders and economists agree that such done on accountable care organiza- the government recovers, at best, an approach can help push our system tions. about $130 million in Medicare waste, toward a more streamlined and coordi- Accountable care organizations are fraud, and abuse. Again, when esti- nated way of delivering health care to about coordinating care among pro- mates are between $23 billion and $78 all Americans. viders—hospitals, primary care physi- billion, we are only recovering $130 In sum, I thank the Senator from cians, specialists, and other medical million. Virginia for his leadership, the Senator professionals. These accountable care ‘‘Doctor shopping’’ is an example from Oregon, Mr. MERKLEY, and Sen- organizations make decisions with pa- that was profiled in a recent USA ator SHAHEEN from New Hampshire. It tients. I think that is the operative TODAY news article and GAO report. has been a delight to work with 11 of phrase. They make decisions ‘‘with’’ This involves a patient receiving mul- my fellow Senators. This is a bold con- patients about what steps they can tiple prescriptions from numerous doc- tribution to the package that I know take together to improve care. When tors in a short period of time, without we will pass out of the Senate. We these efforts result in cost and quality getting caught. Each of the claims gets come from varying parts of the country improvements, providers and con- paid by Medicare, Medicaid, or even and have varied political outlooks and sumers can share in the savings. This private health insurers. backgrounds. This will attract broad is the essence of true reform. We must The current technology exists to as- support in our Chamber. It is a winning demand performance, quality, and sess in real time if a claim warrants addition to health care reform, and I value from our health care system. further investigation, and this tech- encourage all Senators to support our This package makes great strides. nology will prevent fraudulent claims efforts. I will close by thanking all of my fel- from being paid on the front end. A I yield the floor. low freshmen. I am so proud to be part software company in Cary, NC, SAS, The ACTING PRESIDENT pro tem- of this freshman class and all of the has developed this technology. pore. The Senator from New Hampshire great work they have done. This amendment will require the De- is recognized. I especially wish to recognize Sen- partment of Health and Human Serv- Mrs. SHAHEEN. Mr. President, I am ator WARNER, who has really been the ices to put into place systems that will so pleased this morning to join my driving force behind this health care detect patterns of fraud and abuse be- freshman colleagues in introducing our package. I am not sure I agree with his fore any money leaves our Federal cof- innovation and value package. cell phone analysis, but I certainly fers. For the last several months, the agree with the leadership he has shown Another source of waste in the sys- freshmen in the Senate have been com- on this package. tem is people not sticking to their ing to the floor to help make the case Also, I recognize our senior col- medication regimen. As much as one- for health care reform, to tell our col- leagues, Senators DODD, BAUCUS, REID, half of all patients in our country do leagues and the public about what we and HARKIN, for the leadership they not follow their doctors’ orders regard- have heard from our constituents, and have shown in getting us to this point. ing their medications. The New Eng- to come together as one voice in sup- Finally, I recognize all of the staff of land Health Care Institute estimates port of reform. all of us freshman Senators, many of that the overall cost of people not fol- Today, we back up that rhetoric with whom are here today, who have worked lowing directions is as much as $290 bil- action. Today, we propose something so hard to get us to this point. I single lion per year.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00007 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.005 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12654 CONGRESSIONAL RECORD — SENATE December 8, 2009 This waste can be eliminated with costs as part of a deal that also provides the need for comprehensive health care medication therapy management. That Americans with the security of guaranteed reform. I am pleased to join them is a program where seniors bring all of health care. today as we discuss our cost contain- their prescriptions, in a little brown With these amendments, we take ad- ment package. bag, and their over-the-counter medi- ditional steps to transform our deliv- This set of provisions will help pro- cations and their vitamins and supple- ery system, to contain costs, and to mote accountability, increase effi- ments to the pharmacy to be thor- curb abuses and excess spending. With ciency, and reduce disparities in our oughly reviewed in a one-on-one ses- these amendments, we encourage a health care system. Our amendment sion. The pharmacist follows up and faster transition to a 21st-century sys- will reinforce and improve the prin- educates the patient about his or her tem that is more efficient, costs less, ciples of high-value, low-cost care that medication regimen. and holds providers and insurers ac- is central to the Patient Protection North Carolina has some successful countable. and Affordable Care Act. medication therapy management pro- I am proud to sign on to all of the Our amendment will strengthen grams already in place. amendments in this package. But there Medicare’s ability to act as a payment In 2007, the North Carolina Health is one proposal that is particularly im- innovator, paying for value and not for and Wellness Trust Fund Commission portant to the people of New Mexico. In volume. In speeding this process, our launched an innovative statewide pro- my State, 30 of 33 counties are classi- amendment gives Medicare more of the gram called Checkmeds NC to provide fied as medically underserved. Resi- resources it needs to gather data, ex- medication therapy management serv- dents of these highly rural counties are pand programs that work, and reach ices to our seniors. During the pro- more likely to be uninsured. They are the neediest patients. gram’s first year, more than 15,000 sen- more likely to have higher rates of dis- We also work to strengthen waste, iors and 285 pharmacists participated. ease. And because of a shortage in fraud, and abuse provisions in the Pa- Just this small program saved an esti- health care providers, they are often tient Protection and Affordable Care mated $10 million, and countless health forced to travel long distances for care. Act in order to make sure that the De- problems were avoided for our seniors. This amendment would help us take partment of Health and Human Serv- This amendment takes this success- the first steps toward alleviating the ices has the tools to not only punish of- ful North Carolina model and imple- growing shortage of primary care phy- fenders but to prevent fraud from hap- ments it nationally, permitting phar- sicians in New Mexico and across the pening in the first place. But this is not just about our public macies and other health care providers country. By 2025, there will be a short- programs. We also promote private- to spend considerable time and re- age of at least 35,000 primary care phy- public data sharing to get a better pic- sources evaluating a person’s drug rou- sicians in the United States. As this ture of our whole medical system. shortage grows, our rural areas will be tine and educating them on proper Our amendment further takes aim at hardest hit. usage. administrative costs, another barrier In this amendment, we call for expert I urge passage of this freshman often cited to getting the most effec- recommendations on how to encourage amendment package which will further tive care, by encouraging public-pri- providers to choose primary care and reduce health care costs for American vate collaboration to create uniform families. Thank you. to establish their practices in medi- standards and reduce the mountain of Mr. UDALL of New Mexico. Madam cally underserved areas. These experts paperwork that takes doctors’ time President, I seek recognition. would analyze things such as com- away from their patients. The PRESIDING OFFICER (Mrs. pensation and work environment. They Finally, we put pressure on private GILLIBRAND). The Senator from New would recommend ways to increase in- insurers to change the way they pay. Mexico. terest in primary care as a career. By encouraging insurers to reward pro- Mr. UDALL of New Mexico. Madam We are closer than ever to providing grams that reduce disparities, pro- President, this package today is a re- all Americans with access to quality, viders will increasingly focus attention sult of collaboration that began affordable health care. I am proud to be on populations that need it most. months ago when the Senate’s fresh- a part of a group of freshmen who By proactively targeting these needy man class united as advocates for com- refuse to sit on the back bench and folks through cultural competency prehensive health reform, when we watch this reform develop from the training, language services, and com- united in the belief that the status quo sidelines. I am proud to be part of a munity outreach, our amendment will is not an option. group that from the beginning refused increase wellness and reduce the use of The health care status quo does not to accept the status quo as an option. costly emergency room care. work for Americans and it does not I thank the staff of all these fine Sen- My colleagues and I are supported by work for America either. If we fail to ators and thank personally my staff top business groups, consumer groups, act, every person, every institution, members, Fern Goodheart and Ben and providers because they all know we every small business in this country Nathanson. have to transform the way care is de- will pay the price. I look forward to continuing the livered in this country. Businesses Achieving true reform means making work with this outstanding group as we know that without the reduced cost of insurance available and affordable to debate a bill that will improve our care and promoting transparency, the all Americans. It also means reining in health care system for generations to cost of premiums continues to rise, out-of-control spending. For some, come. putting a stranglehold on wage in- those two goals seem diametrically op- Madam President, I yield the floor. creases and making them less competi- posed. They ask: How can you contain The PRESIDING OFFICER. The Sen- tive. costs when you are expanding access to ator from Illinois. Consumer groups want to ensure the millions of additional people? Mr. BURRIS. Madam President, it is patients get more value for their dol- One of our country’s great economic also my pleasure to stand with my col- lar, that they do not just get more care thinkers, Paul Krugman, recently chal- leagues and be a part of this health re- but they get the type of coordinated, lenged this hypothesis. First, he said a form package, to give recognition to effective care that will keep them majority of Americans uninsured are those distinguished senior Senators healthy and out of the emergency young and healthy. Covering them who have put so much heart into draft- rooms. Those providers who focus on would not increase costs very much. ing this important legislation, to our targeted care to get the best patient Second, he noted that this reform links Leader REID and to Senator BAUCUS, outcome want to be rewarded for doing coverage expansion to ‘‘serious cost- Senator DODD, and all the individuals. so. control measures.’’ It is a pleasure for me to be a part of The evidence could not be clearer, These goals are two sides of the same this freshman colloquy on this major the conclusions could not be more deci- coin. Without one, we cannot have the package. sive that the Patient Protection and other. As Mr. Krugman said: Over the past several months, my Affordable Care Act, coupled with our The path to cost control runs through uni- freshman colleagues and I have taken amendment, will lower costs for ordi- versality. We can only tackle out-of-control the floor many times to speak about nary Americans.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00008 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.006 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12655 I call upon my colleagues to take an chased through an employer at the eloquence and passion about this issue. honest look at what we are doing, and start of this decade cost about $6,700, I think all of us, regardless of which I defy them to say that health care re- almost 14 percent of the family income. side of the aisle we are on, owe them form will not reduce costs and improve Last year, the same premium cost all a great deal of gratitude for putting the functioning of our health care sys- $13,000—21 percent of the family in- together a very fine package. tem. come. I particularly thank Senator MARK The debate over health care reform If we do nothing, if we do not reform WARNER, our colleague from Virginia, cannot be scoring political points. It the system and do not contain costs, who has led this effort, but obviously must be about the health and well- this country will be in big trouble. By so much of this has happened because being of the American people. All of 2016, the same family health insurance of the cooperation and ideas that each our great work will bear fruit, and we will cost more than $24,000. Because Member who has spoken here this will reform our Nation’s health system health costs are skyrocketing com- morning has brought to this particular because there is no other option. Our pared to wages, that $24,000 will rep- cluster of ideas on cost containment. citizens demand it, and they deserve no resent 45 percent of the family budget. All Americans owe them a deep debt of less. Enough is enough. The package we are gratitude and can feel pretty good I thank our distinguished colleagues. offering today will help. about the future of our country with I am happy to be a part of this fresh- I want to focus briefly on a small but this fine group of Americans leading it. man colloquy in presenting such an im- significant piece of this package that The PRESIDING OFFICER. The mi- portant issue at this time in history in addresses rural health care. It will help nority now has 60 minutes. this great country of ours. hospitals in several States, including Mr. BAUCUS. Madam President, may I yield the floor. Alaska, my home State, by extending I ask unanimous consent to speak for a The PRESIDING OFFICER. The Sen- the Rural Community Hospital Dem- couple of minutes to comment on the ator from Alaska. onstration Program. We are building freshman package? It will just take a Mr. BEGICH. Madam President, I on known success. The program is few minutes. seek the floor to talk about this pack- small. Even with this amendment, the The PRESIDING OFFICER. Without age of cost containment offered by the number of eligible hospitals nationwide objection, it is so ordered. freshmen. I am proud to join them in will expand from 15 to 30, and 20 rural Mr. BAUCUS. Madam President, I offering this amendment today. States will be eligible to participate in- join my good friend from Connecticut The technical work in this package is stead of the current 10. in thanking—I don’t know if calling complex and complicated, but the Part of what we are saying in this them freshmen would be wise, because themes it addresses are simple and package is this: If something is work- our colleagues act as though they have straightforward, which I know our col- ing to provide better health care access been here for years and know the sub- leagues on the other side will appre- and value, for goodness sake, let’s keep ject extremely well. ciate and we hope support—value, inno- it going and do what we can to improve Delivery system reform has always vation, quality, transparency, and cost on it. been something I have been pushing containment. My thanks go to Senator BEN NELSON for, and I am happy to see it is part of The full legislation now under debate who has been a champion of this pro- your package, and also with additional in the Senate makes wonderful strides gram and is also pushing for the exten- emphasis on rural areas and Indian res- in fixing what is broken in America’s sion. ervations. We clearly need more of current health care system. Under the As I conclude, I wish to stress once that, and more transparency. I firmly leadership of Senators BAUCUS, DODD, again how proud I am to stand with my believe that will help us get costs down HARKIN, and our Majority Leader REID, freshman colleagues. The cost contain- and get quality of care up. Your work the committees have done incredible ment package we are proposing today on the independent Medicare advisory work. will help all Americans, and I hope it board is great too. What the freshmen are saying today will move the Senate that much closer To be honest, these are all the next is we believe our package can help. We to a historic vote on the landmark leg- steps in ideas that are pretty much in can go further. We can do better. Our islation that is before us today. the bill, but they are the proper next goal is a health care system that is I yield the floor. steps, and the next steps I firmly be- more efficient and more affordable. The PRESIDING OFFICER. The Sen- lieve should be taken. So I compliment In a few moments, I will stand to- ator from Virginia. you and thank you very much, and I gether at a news conference with all Mr. WARNER. Madam President, I thank my friend from Arizona for al- my freshman colleagues to formally know our time is about to expire. I lowing me this time. announce this package. What I most wish to close by thanking all my fresh- The PRESIDING OFFICER. The Sen- appreciate is that we will do so with man colleagues and their staffs for the ator from Arizona. the support of consumer and business great work they have done on this leg- Mr. MCCAIN. Madam President, I groups. islation. wish also to add my words of congratu- While the language of this amend- I see a number of my colleagues from lations to the new Members for their ment promotes efficiency and encour- the other side of the aisle. This is an eloquence, their passion, and their ages innovation within the health de- amendment package that brings great- well-informed arguments, although livery system, what it is about is help- er transparency, greater account- they are badly misguided. But I do con- ing individual Americans and busi- ability, greater efficiency, and greater gratulate them for bringing forth their nesses get a better deal on health care. innovation, and is supported by the ideas and taking part in this spirited I am proud of that, especially when we Business Roundtable, small businesses debate. We welcome it, and I hope that know that cost containment is the No. and health care systems around the someday we will be able to agree on 1 priority of small business owners in country. I ask for their consideration. both sides for us to engage in real col- this health reform debate. I again thank the Chair, Senator loquy between us, back and forth. I Insurance premiums alone in the last DODD, for allowing us to lay out this think the American people and all 10 years for small businesses have risen package of amendments. I think it will Members would be well informed. 113 percent. It was reported in the add an important component to this Madam President, I ask unanimous media that small businesses in this bill in trying to rein in costs not just consent for the next 30 minutes to en- country face another 15-percent in- on the government side but system- gage in a colloquy with my colleagues. crease in the health premiums in the wide. The PRESIDING OFFICER. Without coming year. I yield the floor. objection, it is so ordered. What about families, our friends, and Mr. DODD. Madam President, quick- Mr. MCCAIN. Madam President, I our neighbors? Health insurance pre- ly, because I know my colleagues are talk a lot about C–SPAN. I am a great miums are eating up ever growing here on the other side, I want to com- admirer of C–SPAN. And the Presi- chunks of the family budget. Nation- mend 10 of the 11 new freshmen who are dent—at least when he was running for wide, family health insurance pur- here and who have spoken with great the presidency—believed in C–SPAN as

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00009 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.007 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12656 CONGRESSIONAL RECORD — SENATE December 8, 2009 well, because he said C–SPAN would be nesseans. We have 243,000 Tennesseans Is there any Member on the other in on the negotiations. Here is what who have opted for Medicare Advan- side who can guarantee that seniors in was posted by a reporter from Politico tage. About one-fourth of all Ameri- his or her State in Medicare Advantage last night at 5:48 p.m., entitled ‘‘No C– cans who are on Medicare have chosen will not lose a single benefit they have SPAN Here.’’ Medicare Advantage because it pro- today—not the guaranteed benefit the Right now a group of moderate Senators is vides the option for increased dental other side goes to great pains to talk meeting behind closed doors to try to hash care, for vision care, for hearing cov- about. I think those who are enrolled out a compromise on the public option. Re- erage, for reduced hospital deductibles, in the Medicare Advantage system be- porters, waiting for the meeting to break, and many benefits. It is helpful to low- lieve that since they receive those ben- were just moved out of the corridor nearest income and minority Americans, and it efits, they are guaranteed benefits as the meeting and shunted around the corner, making it harder for the press to catch Sen- is especially helpful to people in rural well. ators as they leave. C–SPAN this is not. areas. I would ask our two physicians here What the Republicans have been ar- on the floor, who both have had the op- I would remind my colleagues that guing all week is that, contrary to portunity to deal directly with the the amendment we are discussing here what our friends on the other side are Medicare Advantage Program, if you is drafted to prevent drastic Medicare saying, this bill cuts those Medicare have a patient come in and you say: By Advantage cuts from impacting all sen- Advantage benefits. The Director of the way, you are having your Medicare iors in Medicare Advantage. The the Congressional Budget Office says Advantage Program cut, but don’t amendment says simply: Let’s give that fully half—fully half—of the bene- worry, we are protecting your guaran- seniors who are members of Medicare, fits in Medicare Advantage for these 11 teed Medicare benefits, do you think who have enrolled in Medicare Advan- million Americans will be cut. Our they understand that language? tage, the same deal that Senator NEL- Democratic friends say: No, that is not Mr. COBURN. I would respond to the SON was able to get for the State of true. That is not true. We are going to Senator from Arizona in the following Florida—at least most of the seniors cut $1 trillion out of Medicare over a way. First of all, they won’t under- who enrolled in the Medicare Advan- fully implemented 10-year period of stand that language. But more impor- tage Program. There are 11 million this bill, but nobody will be affected by tantly, if you look at the law, there is American seniors who are enrolled in it. Medicare Part A, Medicare Part B, the Medicare Advantage Program. This Well, the Senator from Florida ap- Medicare Part C, and Medicare Part D. amendment would allow all 11 million parently doesn’t believe that. He says: They are all law. They are all law. to have the same benefits and there We have 900,000 Floridians who don’t What is guaranteed under the law would be no carve-out for various want their Medicare Advantage cut. today is that if you want Medicare Ad- groups of seniors because of the influ- And he is saying, in effect, we don’t vantage, you can have it. What is going ence of a Member of this body. trust this Democratic bill to protect to change is that we are going to take I want to quote again the New York these seniors in Medicare Advantage. away that guarantee. We are going to Times, my favorite source of informa- So I ask the Senator from Texas: If modify Medicare Part C, which is Medi- tion, from an article entitled ‘‘Senator the people of Florida and the Senator care Advantage. Tries to Allay Fears on Health Over- from Florida don’t trust the Demo- So we have this confusing way of say- haul.’’ cratic bill to protect Medicare Advan- ing we are not taking away any of your . . . Mr. Nelson, a Democrat, has a big tage, why should 240,000 Tennesseans guaranteed benefits, but in fact, under problem. The bill taken up this week by the trust the Democratic bill to protect the current law today, Medicare Ad- committee would cut Medicare payments to insurance companies that care for more than Medicare Advantage? vantage is guaranteed to anybody who 10 million older Americans, including nearly Mr. CORNYN. I agree with the distin- wants to sign up for it. So it is one million in Florida. The program, known guished Senators from Tennessee and duplicitous to say we are not cutting as Medicare Advantage, is popular— Arizona, that what is good enough for your benefits, when in fact we are. And the article lists the benefits, and the seniors in Florida ought to be good Let me speak to my experience and then continues as follows: enough for all seniors. In my State of then I will yield to my colleague from Texas, we have 532,000 seniors on Medi- ‘‘It would be intolerable to ask senior citi- Wyoming, who is an orthopedic sur- zens to give up substantial health benefits care Advantage, and they like it, for geon. they are enjoying under Medicare,’’ said Mr. the reasons that the Senator from Ten- What is good about Medicare Advan- Nelson, who has been deluged with calls and nessee mentioned. They do not want us tage? We hear it is a money pot to pay complaints from constituents. ‘‘I am offering cutting those benefits. for a new program for other people. an amendment to shield seniors from those But I say to the Senators from Ari- Here is what is good about it. We get benefit cuts.’’ zona and Tennessee, I seem to recall coordinated care for poor Medicare He is offering an amendment to that we had amendments earlier which folks. Medicare Advantage coordinates shield senior citizens. Well, I am offer- would have protected everybody from the care. When you coordinate care, ing a motion that deals with all of the cuts in Medicare benefits, and now we what you do is you decrease the num- 11 million seniors who are under Medi- have a targeted effort, negotiated be- ber of tests, you prevent hospitaliza- care Advantage, as the Senator from hind closed doors, to protect States tions, you get better outcomes, and Florida said, to shield seniors from such as Florida and Pennsylvania and consequently you have healthier sen- benefit cuts. That is what this motion others, and I wonder whether the Nel- iors. is all about. We should not carve out son amendment to protect the seniors So when it is looked at, Medicare Ad- for some seniors what other seniors are of Florida would even be necessary if vantage doesn’t cost more. It actually not entitled to. That is not America. our colleagues across the aisle had saves Medicare money on an individual That is not the way we should treat all agreed with us that no Medicare bene- basis. Because if you forgo the inter- of our citizens, and I hope my col- fits should be cut. ests of a hospital, where you start in- leagues will understand this amend- Mr. MCCAIN. As the Senator points curring costs, what you have done is ment is proposed simply in the name of out, a few days ago, by a vote of 100 to saved the Medicare Trust Fund but you fairness. 1, we voted to pass an amendment pro- have also given better care. I ask the Senator from Tennessee and posed by the Senator from Colorado, The second point I wish to make is the Senator from Texas, who have a Senator BENNET, which included words that many people on Medicare Advan- large number of enrollees in the Medi- such as ‘‘protecting guaranteed Medi- tage cannot afford to buy Medicare care Advantage Program, whether they care benefits’’ or ‘‘protecting and im- supplemental policies. Ninety-four per- feel this would be unfair? proving guaranteed Medicare benefits.’’ cent of the people in this country who Mr. ALEXANDER. Well, I thank the The wording was: ‘‘Nothing in the pro- are on Medicare and not Medicare Ad- Senator from Arizona for his motion, visions of or amendments made by this vantage are buying a supplemental pol- and I thank the Senator from Florida act shall result in the reduction of icy. Why is that? Because the basic un- for his amendment, because Medicare guaranteed benefits under title XVIII derlying benefit package of Medicare is Advantage is very important to Ten- of the Social Security Act.’’ not adequate. So here we have this

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00010 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.009 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12657 group of people who are benefitted be- lected Senator from one State when we ator from Florida is saying: Floridians cause they have chosen a guaranteed want to have that same advantage; and don’t trust you. You are cutting their benefit of Medicare Part C, and all of a why are the Democrats voting to elimi- Medicare Advantage. I want to have an sudden we are saying: Time out. You nate all this Medicare money. amendment to protect them. Senator don’t get that anymore. Mr. CORNYN. May I ask my col- MCCAIN is saying: Let’s protect all sen- Mr. MCCAIN. So a preponderance of leagues a question—maybe starting iors’ Medicare Advantage. people who enroll in Medicare Advan- with the Senator from Arizona—on a Mr. MCCAIN. May I also point out, tage are low-income people, and a lot related issue. Medicare Advantage is a for the record, on September 20, 2003, of them are rural residents? private sector alternative or choice to there was a letter to the conferees of Mr. COBURN. A lot of them are Medicare, which is a government-run Medicare, urging them to include a rural. I don’t know the income levels, program. I am detecting throughout all meaningful increase in Medicare Ad- but I know there is a propensity for ac- of this bill sort of a bias against the vantage funding for fiscal years 2004– tually getting a savings, because you private sector and wanting to elimi- 2005—a group of 18 Senators, including don’t have to buy a supplemental pol- nate choices that aren’t government- Senators SCHUMER, LAUTENBERG, CLIN- icy if you are on Medicare Advantage. run plans. TON, WYDEN, et cetera, including Sen- Mr. BARRASSO. I would add to that, Am I reading too much into this or ator KERRY, who now obviously wants following on my colleague from Okla- do any of my colleagues see a similar to reduce the funding for Medicare Ad- homa, that there is the coordinated propensity in this bill? vantage. Again, perhaps he was for it care, which is one of the advantages of Mr. ALEXANDER. If I may respond before he was against it. Medicare Advantage, but there is also to the Senator from Texas, I think he I would also like to point out, as the preventive component of this. We is exactly right. There is a lot of very short a time ago as April 3, 2009, a talk about ways to help people keep appealing talk that we hear from the group of Senators, bipartisan, includ- their health care costs down, and that advocates of the so-called health re- ing Senators WYDEN, MURRAY, SPEC- has to do with coordinated care and form bill. But when we get right down TER, BENNET, KLOBUCHAR, and others, preventing illness. to it, and when we examine it closely, wrote to Charlene Frizzera, acting ad- Mr. COBURN. And we heard from the we find a big increase in government- ministrator of the Centers for Medicare freshman Democrats that they want to run programs. What does that mean for and Medicaid Services: low-income Americans, and what does put a new preventive package into the We write to express our concerns regarding program. Yet they want to take the it mean for seniors who depend on our the Centers for Medicare and Medicaid Serv- preventive package out of Medicare biggest government-run programs, ices’ proposed changes to Medicare Advan- Advantage. It is an interesting mix of Medicare and Medicaid? It means they tage rates for calendar year 2010. The ad- amendments, isn’t it? risk not having access to the doctor vance notice has raised two important issues Mr. BARRASSO. We want to keep they want. The Senator from Wyoming that, if implemented, would result in highly our seniors healthy. That is one way mentioned the Mayo Clinic, widely problematic premium increases and benefit they can stay out of the hospital, out cited by the President and by many on reductions for Medicare Advantage enrollees of the nursing home, and stay active. the other side as an example of control- across the country. Yet with the cuts in Medicare Advan- ling costs, is beginning to say: We can’t Again, as recently as last April, there tage, the Democrats have voted to do take patients from the government-run was concern on the other side about that—to cut all the money out of this programs in some cases because we are cuts in the Medicare Advantage Pro- program that seniors like. Eleven mil- not reimbursed properly. gram. lion American seniors who depend upon What is going to happen behind all Mr. COBURN. I wonder if the Senator Medicare for their health care choose this happy talk we are hearing about is aware, in Alabama, there will be this because there is an advantage to health care is, we are going to find 181,000 people who will get a Medicare them. more and more low-income patients Advantage cut; in California, 1,606,000 My colleague from Oklahoma, the dumped into a program called Med- seniors are going to have benefits cut; other physician in the Senate, has icaid. Under this program half the doc- Colorado, 198,000; Georgia, 176,000; Illi- talked, as I have, extensively about pa- tors will not see a new Medicaid pa- nois, 176,000; Indiana, 148,000; Ken- tient-centered health care—not insur- tient. It is akin to giving someone a tucky, 110,000; Louisiana, 151,000; Mas- ance centered, not government cen- bus ticket on a bus line that runs half sachusetts, 200,000; Michigan, 406,000— tered. Medicare Advantage helps keep the time. Medicare is going to increas- that is exactly what Michigan needs it patient centered. So when I see deals ingly find itself in the same shape as right now, isn’t it, for their seniors to being cut behind closed doors where Medicaid. The Mayo Clinic has already have their benefits cut—Minnesota, they are cutting out people from all said they can’t afford to serve patients 284,000; Missouri, 200,000; Nevada, across the country and providing from the government-run programs. 104,000; New Jersey, 156,000; New York, sweetheart deals to help seniors on The Senator from Texas is exactly 853,000; Ohio, 499,000; Oregon, 250,000; Medicare Advantage in Florida in order right. We don’t have to persuade the 11 Pennsylvania—maybe, maybe not be- to encourage one Member of the Senate million Americans who have chosen cause they may have the deal—865,000; to vote a certain way, I have to ask Medicare Advantage that it is a good Tennessee, 233,000; Washington State, myself: What about the seniors in the program. They like it. In rural areas, 225,000; Wisconsin, 243,000. rest of the country, whether it is between 2003 and 2007, more than 600,000 I ask unanimous consent that the list Texas, Oklahoma, Tennessee, or Ari- people signed up for it. In a way, the of what the enrollment is by CMS on zona? Senator from Florida may have a Medicare and Medicare Advantage en- A lot of seniors have great concern, sweetheart deal, but in a way he has rollment, as of August 2009, be printed and I would hope they would call up done us a favor. We have been trying to in the RECORD. and say this is wrong; we need to know say all week the Democrats are cutting There being no objection, the mate- what is going on, and to ask why it is Medicare. They are saying: Trust us, rial was ordered to be printed in the there is a sweetheart deal for one se- we are not cutting Medicare. The Sen- RECORD, as follows:

MA Enrollment MA Penetration State (August 2009) Eligibles (percent)

Alabama ...... 181,304 819,112 22.1 Alaska ...... 462 61,599 0.8 Arizona ...... 329,157 876,944 37.5 Arkansas ...... 70,137 515,175 13.6 California ...... 1,606,193 4,562,728 35.2 Colorado ...... 198,521 591,148 33.6 Connecticut ...... 94,181 553,528 17.0 Delaware ...... 6,661 142,716 4.7 DC ...... 7,976 75,783 10.5

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MA Enrollment MA Penetration State (August 2009) Eligibles (percent)

Florida ...... 946,836 3,239,150 29.2 Georgia ...... 176,090 1,176,917 15.0 Hawaii ...... 79,386 197,660 40.2 Idaho ...... 60,676 218,225 27.8 Illinois ...... 176,395 1,792,581 9.8 Indiana ...... 148,174 973,732 15.2 Iowa ...... 63,902 508,942 12.6 Kansas ...... 43,867 421,593 10.4 Kentucky ...... 110,814 735,953 15.1 Louisiana ...... 151,954 664,692 22.9 Maine ...... 26,984 256,214 10.5 Maryland ...... 56,812 754,638 7.5 Massachusetts ...... 199,727 1,029,357 19.4 Michigan ...... 406,124 1,597,119 25.4 Minnesota ...... 284,101 758,981 37.4 Mississippi ...... 44,772 483,403 9.3 Missouri ...... 195,036 976,397 20.0 Montana ...... 27,592 162,779 17.0 Nebraska ...... 30,571 273,589 11.2. Nevada ...... 104,043 336,581 30.9. New Hampshire ...... 13,200 208,125 6.3 New Jersey ...... 156,607 1,294,052 12.1 New Mexico ...... 73,567 299,538 24.6 New York ...... 853,387 2,909,216 29.3 North Carolina ...... 251,738 1,424,360 17.7 North Dakota ...... 7,633 106,969 7.1 Ohio ...... 499,819 1,852,596 27.0 Oklahoma ...... 84,980 585,906 14.5 Oregon ...... 249,993 593,232 42.1 Pennsylvania ...... 864,040 2,233,074 38.7 Puerto Rico ...... 400,991 631,298 63.5 Rhode Island ...... 65,108 179,044 36.4 South Carolina ...... 110,949 734,772 15.1 South Dakota ...... 8,973 133,420 6.7 Tennessee ...... 233,024 1,015,771 22.9 Texas ...... 532,242 2,853,472 18.7 Utah ...... 85,585 269,378 31.8 Vermont ...... 3,966 106,562 3.7. Virginia ...... 151,942 1,094,976 13.9 Washington ...... 225,918 919,899 24.6 West Virginia ...... 88,027 375,303 23.5 Wisconsin ...... 243,443 883,419 27.6 Wyoming ...... 3,942 77,197 5.1

Mr. MCCAIN. The point of all this is, supplementals, but, more importantly, we think are important about health the Senator from Florida, a member of poorer health outcomes. That is what care. Jobs are going to be lost as a re- the Finance Committee, felt so strong- it is going to mean—or a much smaller sult, if this bill gets passed. People who ly that Medicare Advantage was at risk checkbook, one or the other. A smaller have insurance will end up paying more he decided to carve out, and was able checkbook because now the govern- in premiums, if this bill is passed. Peo- to get the majority on a party-line ment isn’t going to pay for it—you ple who depend on Medicare, whether it vote of the Finance Committee to are—or poorer health outcomes. If your is Medicare Advantage or regular Medi- carve out a special status for a group of checkbook is limited, the thing that care, will see their health care deterio- seniors under Medicare Advantage in happens is, you will get the poorer rate as a result of this proposal. I turn his State. My motion simply says, ev- health outcome. to the Senator from Arizona, who has eryone whom the Senator from Okla- Mr. BARRASSO. Additionally, the been a special student of this. homa made reference to deserves that Senator from Arizona talked about the Mr. MCCAIN. So seniors, by losing same protection. That is all this mo- closed-door meetings, secretly trying Medicare Advantage, would then lose tion is about. to come up with things. certain provisions Medicare Advantage Mr. CORNYN. If the Senator would There was an article in the paper provides and then they would be forced, yield for a question, if this motion is today that the Democrats are turning if they can afford it, which they are not agreed to, which protects all Medi- to actually throwing more people on now paying zero because it is covered care Advantage beneficiaries—all 11 the Medicare and Medicaid rolls as under Medicare Advantage, then they million of them, 532,000 in my State— they are trying to come up with some would have to buy Medigap policies and as a result of not only these cuts compromise; the idea being it is going that would make up for those benefits but perhaps additional cuts to come in to be compromising the care of the they lost when they lose Medicare Ad- the future to Medicare Advantage, people. They are trying to put more vantage. which will make it harder for Medicare people onto the Medicaid rolls. The Guess who offers those Medigap in- beneficiaries to get coverage, I ask par- Senator from Tennessee has said many surance policies. Our friends at AARP, ticularly my doctor colleagues, what is physicians don’t take those patients which average $175 a month. We are the impact of eliminating Medicare Ad- because reimbursement is so poor. It is telling people who are on Medicare Ad- vantage and leaving people with Medi- putting more people into a boat that is vantage today, when they lose it, they care fee for service, which is, as I re- already sinking. They want to put can be guaranteed, if they want to call, the Bennet amendment earlier? more people on Medicaid and more on make up for those benefits they are You have to parse the language closely, Medicare, but at the same time they losing, they would be paying $175 a but it talked about guaranteed bene- are cutting Medicare by $464 billion. month, minimum, for a Medigap pol- fits. I think the Senator from Okla- This is a program we know is already icy. A lot of America’s seniors cannot homa makes a good point. Right now, going broke. Yet they want to now put afford that. Medicare Advantage has guaranteed people age 55 to 64, add those to the Mr. COBURN. That is $2,000 a year. benefits. Medicare rolls, which is a program we Mr. MCCAIN. They can’t afford it. Mr. COBURN. Absolutely. have great concerns about. Mr. COBURN. I will make one other Mr. CORNYN. What is the con- Special deals for some, cutting out point. Over the next 10 years, 15 mil- sequence of seniors losing Medicare Ad- many others, now adding more people lion baby boomers are going to go into vantage and being forced onto a Medi- to the Medicare rolls—to me, this is Medicare. We are taking $465 billion care fee-for-service program? not sustainable. Yet these are the deals out of Medicare; on the 10-year picture, Mr. COBURN. Limited prevention that are being cut less than 100 feet $1 trillion. So we are going to add $15 screening, no coordinated care, loss of from here off the floor of the Senate, million and cut $1 trillion. What do you access to certain drugs, loss of acces- when we are out here debating for all think is going to happen to the care for sory things, such as vision and hearing the American people to see the things everybody in Medicare? The ultimate

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The Sen- have you treated people under Medi- We have been saying: Yes, you are. ator’s time is expired. care Advantage? No, we are not. Mr. MCCAIN. Madam President, I ask Mr. BARRASSO. I have. People know I am sure the people at home must unanimous consent for an additional 30 there is an advantage to being in this say: Well, who is right about this? seconds for the Senator. program, and that is why they sign up Well, the Senator from Florida, who The PRESIDING OFFICER. Without for it. That is why citizens all around sits on the other side of the aisle, has objection, it is so ordered. the country have signed up for Medi- said: I am not willing to go back to Mr. ALEXANDER. I say to the Sen- care Advantage. They realize there is Florida and say to the people of Flor- ator from Arizona, I believe there are value in prevention and there is value ida that your benefits are going to be other Medicare benefits that are likely in coordinated care. There is value in cut if you are on Medicare Advantage, to be cut in this bill. Aren’t there cuts having eye care, dental care, hearing so I want an amendment to protect to hospice? Aren’t there cuts to hos- care. There are advantages to wanting you. The Senator from Texas wants pitals? Aren’t there cuts to home to stay healthy, to keep down the cost and amendment to protect 11 million health care, which we talked about of care. seniors and so does the Senator from yesterday? So if Floridians do not trust Mr. MCCAIN. So you are making the Oklahoma and so does the Senator the Democratic bill to protect their case that even though it may cost from Louisiana and so does the Senator Medicare benefits from Medicare Ad- more, the fact that you have a weller from Wyoming, and the Senator from vantage, why should they trust the and fitter group of senior citizens, you, Tennessee. Democratic bill to protect any of their in the long-run, reduce health care So the Senator from Arizona is say- Medicare benefits? costs because they take advantage of ing, we believe you are cutting Medi- Mr. MCCAIN. I wish to finally point the kind of care that, over time, would care Advantage benefits for 11 million out what Dr. COBURN said. Medicare keep them from going to the hospital Americans. The Senator from Florida Part C, which is Medicare Advantage, earlier or having to see the doctor does not trust your bill. We do not ei- is part of the law, and to treat it in any more often. ther. We want an amendment that pro- way different, because those on the Mr. BARRASSO. That is one of the tects 11 million seniors. other side do not particularly happen reasons that Medicare Advantage was Mr. CORNYN. Madam President, I to like it, I think is an abrogation of brought forth. I know a lot of Senators would ask our Senators to expand in the responsibilities we have to the sen- from rural States supported it because the brief time we have. It seems as if iors of this country. all of the discussion about health care it would allow people in small commu- I thank my colleagues and yield the reform is a bit about accountable care nities to have this advantage to be in a floor. organizations, coordinating care, par- program such as that. It could encour- The PRESIDING OFFICER. The Sen- ticularly in the later part of life, avoid- age doctors to go into those commu- ator from Texas. ing chronic diseases in life. nities to try to keep those people well, When I was at Kelsey-Seybold Clinic AMENDMENT NO. 2962 work with prevention. The 11 million in Houston, TX, they told me it is Mrs. HUTCHISON. Madam President, people who are on Medicare Advantage Medicare Advantage that allows them I rise today to talk about another know they are on Medicare Advantage. to coordinate care, to hold down costs, amendment that is pending, the Nel- They have chosen it. It is the fastest to keep people healthier longer. Yet son-Hatch-Casey amendment. This is growing component because people re- the irony, to me, it seems, is that by an amendment that I think has been alize the advantages of being on Medi- cutting Medicare Advantage benefits, discussed in the last day as well. That care Advantage. If they want to stay we are going backward rather than for- is the amendment that would assure independent, healthy, and fit, they sign ward when it comes to that kind of co- that no Federal funds are spent for up for Medicare Advantage. I would ordinated, less expensive care. abortion. That was unclear. It is un- think people all across the country, Would the Senator concur with that? clear in the underlying bill. I think it who are seniors on Medicare but are Mr. BARRASSO. I would concur that is very important we talk about it, not on Medicare Advantage, would this is actually taking a step back- that we make sure it is very clear ex- want to say: Why didn’t I know about ward. That is why the Senator from actly what the Nelson-Hatch-Casey this program? As seniors talk about Florida has demanded they make ac- amendment does; and that is, it would this at senior centers—and I go to cen- commodations for the people of Flor- bar Federal funding for abortion, which ters and meetings there and visit with ida. The people of Wyoming want those is basically applying the Hyde amend- folks and hear their concerns—they are same accommodations, as do the peo- ment to the programs under this converting over and joining, signing up ple of Arizona and Texas. Because 11 health care bill. for Medicare Advantage because they million Americans have chosen the Since the Hyde amendment was first know there are advantages to it. For Medicare Advantage Program because passed in 1977, the Senate has had to this Senate and the Democrats to say: it does help coordinate care. It has pre- vote on this issue many times, prob- We want to slash over $100 billion from ventive care. It keeps it more patient ably just about every year, and I have Medicare Advantage, I think the people centered as opposed to government consistently voted to prohibit Federal of America understand this is a great centered, insurance company centered. funding for abortions, as I know my loss to them and a peril to their own That is the way for people to stay colleague and friend from Utah has health, as they lose the coordinated healthy, live longer lives, and keep done, as well as the Democratic spon- care and the preventive nature of the their independence. sors of this amendment. care. We have seen cuts across the board Yet it seems that some Members Mr. MCCAIN. I ask the Senator from on Medicare, whether it is home were on the floor last night miscon- Tennessee, do you know of any expert health, nursing homes, hospice care, struing exactly what the Nelson-Hatch- economist on health care who believes Medicare Advantage. And across the Casey amendment does. Specifically, we can make these kinds of cuts in board, they are cutting Medicare in a their claim was that the Hyde language Medicare Advantage and still preserve way that certainly the seniors of this only bars direct funding for elective the same benefits the enrollees have country do not deserve. They have paid abortions while the Nelson-Hatch- today? into that program for many years and Casey amendment bars funding of an Mr. ALEXANDER. The answer to the they deserve their benefits. entire benefits package that includes Senator from Arizona is no. I do not Mr. ALEXANDER. If I may say to elective abortions and therefore is un- know of one. I know of one Senator at the Senator from Arizona one other precedented.

VerDate Nov 24 2008 03:18 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00013 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.012 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12660 CONGRESSIONAL RECORD — SENATE December 8, 2009 I wish to ask the distinguished Sen- IN GENERAL.—No funds authorized or ap- choice people, who do not believe tax- ator from Utah, what exactly did the propriated by this Act (or an amendment payers should pay for abortions, to 68 Hyde language say? Let’s clarify what made by this Act) may be used to pay for any percent. The polls are from 61 to 68 per- Hyde was, so we can then determine if abortion or to cover any part of the costs of cent of those who do not believe the any health plan that includes coverage of your amendment is the same. abortion. taxpayers ought to be paying for abor- Mr. HATCH. I thank the Senator so tion, except to save the life of the much. Mrs. HUTCHISON. So based on what mother or because of rape or incest. The current Hyde language contained you have said, this is not new Federal And we have provided for those ap- in the fiscal year 2009 Labor-HHS Ap- abortion policy. The Hyde amendment proaches in this amendment. So any- propriations Act says the following: currently applies to the plans dis- body who argues otherwise is plain not cussed, including the plans that Mem- SEC. 507. (a) None of the funds appropriated being accurate. in this Act, and none of the funds in any bers of Congress have. And the abor- Mr. SPECTER. Madam President, trust fund to which funds are appropriated in tion protections for all of the Federal will the Senator from Utah be willing this Act, shall be expended for any abortion. health programs all say exactly the to yield for a question? (b) None of the funds appropriated in this same thing. Mr. HATCH. Sure. Act, and none of the funds in any trust fund The amendment we are going to vote Mr. SPECTER. My question relates to which funds are appropriated in this Act, on that is the Nelson-Hatch-Casey to the provisions of the pending bill, shall be expended for health benefits cov- amendment would preserve the three- section 1303(2)(A), which specifies that erage that includes coverage of abortion. decades-long precedent—that is what the plan will not allow for any pay- Mrs. HUTCHISON. So Federal funds your amendment does—and that we ments of abortion, and where there is, are prohibited from being used in abor- must pass it if we are going to guar- as provided under section 1303(2)(B), tions in that particular bill. antee that the bill that is on the floor there will be a segregation of funds. So What about programs such as CHIP, is properly amended so it is the same that under the existing statute, there that was created in the Balanced Budg- as our 30 years of abortion Federal pol- is no Federal funding used for abortion. et Act? And in 2009, it was reauthorized icy in this country? But a woman has the right to pay for by Congress and signed by the Presi- Mr. HATCH. Right. The reason it is her own abortion coverage. And with dent earlier this year. What about the so critical we pass the Nelson-Hatch- the status of Medicaid, where the pro- CHIP program? Casey amendment is that it is the only hibition applies to any Federal funds Mr. HATCH. I know a little bit about way to guarantee that taxpayers’ dol- being used to pay for an abortion, there CHIP. That was the Hatch-Kennedy lars are not used by the insurance are 23 States which allow for payment bill. I was one of the original authors plans under the Democrats’ bill to pay for abortion coverage coming out of of the program and insisted that the for abortions. In other words, the Hyde State funds. following language be included in the language is in the appropriations proc- So aren’t the provisions of this stat- original statute: ess. We have to do it every year rather ute, which enable a woman to pay for LIMITATION ON PAYMENT FOR ABORTIONS than making it a solid amendment. But an abortion on her own, exactly the (A) IN GENERAL.—Payment shall not be this bill is not subject to appropria- same as what is now covered under made to a State under this section for any tions. So if we leave the Hyde language Medicaid, without violating the provi- amount expended under the State plan to out of this bill, the language we have sions of the Hyde amendment? pay for any abortion or to assist in the pur- in the amendment, the Nelson-Hatch- Mr. HATCH. Well, the way we view chase, in whole or in part, of health benefit Casey amendment, then we would be the current language in the bill is that coverage that includes coverage of abortion. there is a loophole there whereby they (B) EXCEPTION.—Subparagraph (A) shall opening up a door for people who be- lieve that abortion ought to be paid for can even use Federal funds to provide not apply to an abortion only if necessary to for abortion under this segregation lan- save the life of the mother or if the preg- by the Federal Government to do so. guage, and that is what we are con- nancy is the result of an act of rape or in- And we should close that door because cest. that has been the rule since 1977. cerned about. We want to close that loophole and make sure that the Fed- That is what the CHIP bill said, and Mrs. HUTCHISON. I thank the Sen- eral funds are not used for abortion. ator for the explanation. I thank the that was the Hatch-Kennedy bill. Like I say, there are millions of peo- Mrs. HUTCHISON. I would assume Senator from Utah because I do think ple who are pro-choice who agree with you do know what is in that bill. What it is important people know. There has the Hyde language. All we are doing is about the Federal Employees Health been a lot of questions raised about the putting the Hyde language into this Benefits Plan, what does it say? bill and whether it would be a foot in bill in a way that we think will work Mr. HATCH. The reason I mentioned the door for changing a policy that has better. Senator Kennedy is because he was the been the law of our country, and ac- Mr. SPECTER. If the Senator will leading liberal in the Senate at the cepted as such. Whether it was a Demo- yield further. time, and yet he agreed to that lan- cratic-controlled Congress or a Repub- Mr. BROWNBACK. Will the Senator guage. lican-controlled Congress, I think ev- yield for a comment? As to the Federal Employees Health eryone has agreed this Hyde amend- Mr. HATCH. I would be happy to Benefits package, the following lan- ment language has protected Federal yield. guage appears in the Financial Serv- taxpayers who might have a very firm Mr. BROWNBACK. In responding to ices and General Government Appro- conviction against abortion so they the Senator from Pennsylvania as well, priations Act for fiscal year 2009: would not have to be subsidizing this I wish to quote BART STUPAK, who car- SEC. 613. No funds appropriated by this Act procedure. ried the same sort of amendment you shall be available to pay for an abortion, or Mr. HATCH. I appreciate the Senator are putting forward, only on the House the administrative expenses in connection from Texas pointing this out. The cur- side. The same sorts of questions, natu- with any health plan under the Federal em- rent bill has language that looks like it rally, were coming forward, saying: ployees’ health benefits program which pro- is protective, but it is not. That is OK, you are blocking abortion funding vides any benefits or coverage for abortions. SEC. 614. The provisions of Section 613 shall what we are trying to do: close the for the individual. He said this—and I not apply where the life of the mother would loophole in that language and get it so am quoting directly from Representa- be endangered if the fetus were carried to we live up to the Hyde amendment, tive STUPAK: term, or the pregnancy is the result of an act which has been in law since 1977. The Capps amendment—Which is in the of rape or incest. To be honest with you, I do not see base Reid bill here—departed from Hyde in Mrs. HUTCHISON. Well, isn’t that how anybody could argue that the tax- several important and troubling ways: by the same as the language in the Nel- payers ought to be called upon to foot mandating that at least one plan in the the bill for abortions. Let’s be brutally health insurance exchange provide abortion son-Hatch-Casey amendment? coverage, by requiring a minimum $1 month- Mr. HATCH. You are absolutely frank about it. The taxpayers should ly charge for all covered individuals that right. not be called upon to pay for abortions. would go toward paying for abortions and by Let me read the language for you in The polls range from 61 percent of the allowing individuals receiving Federal af- the Nelson-Hatch-Casey amendment. American people, including many pro- fordability credits—

VerDate Nov 24 2008 03:18 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00014 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.016 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12661 Those are Federal dollars— issuer of the plan should not use any grams, but the Reid bill specifically al- to purchase health insurance plans that amount of the Federal funds for abor- lows abortion to be offered in two huge cover abortion. . . . tion? So there is a flatout prohibition new government programs. The Reid In all those ways, the Capps amend- for use of Federal funds. And under sec- bill tries to explain this contradiction ment—which is in the Reid bill—ex- tion 1303(2)(B), there is a segregation of by calling for the segregation of Fed- pands and does allow Federal funding funds which is identical to Medicaid. eral dollars when Federal subsidies are of abortion that we have not done for So however you may want to charac- used to purchase health plans. This 33 years. terize it, how do you respond to the ‘‘segregation’’ of funds actually vio- Going on with Representative STU- flat language of the statute which ac- lates the Hyde amendment which pre- PAK’s statement: complishes the purpose of the Hyde vents funding of abortion not only by Hyde currently prohibits direct federal amendment and allows for a payment Federal funds but also by State match- funding of abortion. . . . The Stupak amend- by collateral funds, just as Medicaid ing funds within the same plan. Simply ment— pays for abortions without Federal put, today, Federal and State Medicaid Which is also the Nelson-Hatch funds? dollars are not segregated. So that is amendment— Mr. HATCH. Let me respond to the the difference. If the distinguished Senator from is a continuation of this policy— distinguished Senator, although I am not going to ask him a formal ques- Pennsylvania believes the current lan- Of the Hyde amendment— tion. If that is true, then why have the guage in the Reid bill meets the quali- nothing more, nothing less. Capps language in there? Why don’t we ties of the Hyde language, then why I think it is important to clarify that just take the Hyde language, which is not just put the Hyde language in once this is a continuation of what we have what we are trying to do. It isn’t true. and for all since it has been in law been doing for 33 years that the Sen- We know in this bill there will be sub- since 1977? ator from Utah and the Senator from sidization to help people pay for health It is important to note that today Nebraska are putting forward with this insurance. In fact, the subsidization there is no segregation of Federal funds amendment. can go to people up to $88,000 a year, in any Federal health care program. I thank my colleague for yielding. and that could be indirectly used for For example, the Medicaid Program re- Mr. HATCH. Madam President, I abortion. It is a loophole that Hyde ceives both Federal and State dollars. thank my colleague for bringing it for- closes. There is no segregation of either the ward. The segregation language is very If the distinguished Senator from Federal Medicaid dollars or the State problematic language. That is what we Pennsylvania believes the Capps lan- Medicaid dollars. are trying to resolve. We basically have guage does what Hyde meant to begin With that, I know I have some col- all agreed with the Hyde amendment, with and what it has been since 1977, leagues who have asked for some time which is from 1977, and this would, in what is wrong with putting the Hyde to speak, so I will yield the floor. effect, incorporate the language in the Mr. VITTER addressed the Chair. language in here and solving the prob- Mr. SPECTER. The Senator from bill. lem once and for all? We see it as a Utah has not yet answered the ques- Mr. JOHANNS. Would the Senator loophole through which they can actu- tion. yield for another comment? ally get help from the Federal Govern- The PRESIDING OFFICER. The Sen- Mr. HATCH. Sure. ment directly and indirectly to pay for ator from Louisiana is recognized. Mr. JOHANNS. I might just offer a abortion. Mr. VITTER. Thank you, Madam thought here on that language. The Na- Now, let’s think about it. There are President. tional Right to Life group saw through no mandates in this language that we I strongly support the efforts of the that gimmick immediately. It took have for elective abortion coverage. distinguished Senator from Utah and them about 20 seconds to figure out Plans and providers are free from any his amendment offered along with Sen- what was happening here. I think they government mandate for abortion. ator NELSON and Senator CASEY. And I referred to it as a ‘‘bookkeeping gim- There is no Federal funding of elective think this exchange and this colloquy mick,’’ that somehow there would be abortion or plans that include elective is very helpful. In fact, I think it some segregation if the Federal money abortion except in the cases where the proves the point, particularly the par- went in your left pocket but you paid life of the mother is in danger or the ticipation of the Senator from Pennsyl- for abortions out of your right pocket. pregnancy is caused by rape or incest. vania in it. The only folks who are de- It doesn’t make any sense. That seg- The amendment allows individuals to fending the language in the Reid bill regation isn’t going to work. They saw purchase a supplemental policy from a are folks who are clearly and strongly through it. They saw the gimmick it plan that covers elective abortion as pro-choice, pro-abortion. Folks who was. long as it is purchased with private have a fundamental problem with that Let me just say, I support the Sen- dollars. The amendment prohibits the all say the underlying language in the ator’s amendment. I applaud Senator public plan from covering elective Reid bill has huge loopholes. That in- HATCH and Senator NELSON and Sen- abortions. It prevents the Federal Gov- cludes people who want to support the ator CASEY for bringing this very im- ernment from mandating abortion cov- bill otherwise. I am strongly against portant issue forward. I applaud you erage by private health plans or pro- this bill. I am not in that category. for keeping this effort that started viders within such plans. And insur- But, as the distinguished Senator, Mr. with the Hyde amendment—or Hyde ance plans are not prevented from sell- BROWNBACK, mentioned, Representative language, rather—because what we are ing truly private abortion coverage, STUPAK wants to support the under- really doing here is we are saying very even through the exchange. This lying bill. He supported it in the House, clearly to the American people, wheth- amendment doesn’t prohibit that. but he was very clear in his efforts on er directly or indirectly, your tax dol- The bottom line: The effect on abor- the House floor that the underlying lars are not going to be used to buy tion funding and mandates is exactly language, which is now in the Reid bill, abortions. the same as that of the House bill had huge loopholes, wasn’t good Thank you for your leadership on changed by the Stupak amendment. enough, needed to be fixed. That is why this issue. I am happy to be here to Now, look, if the distinguished Sen- he came up with the Stupak language, support that. ator from Pennsylvania believes the and that is essentially exactly what we Mr. SPECTER. Would the Senator Capps language is the same as Hyde, he have in this amendment. from Utah respond to my question? is wrong. And if he believes it does Similarly, the U.S. Conference of How can you disagree with the provi- what Hyde would do, he is wrong there. Bishops is very supportive of the con- sions of section 1303(2)(A) of the bill Why not just put the Hyde language in cepts of the underlying bill, but they which is pending which specifies that if once and for all, which has been there have said clearly that the Reid bill is a qualified health plan provides serv- since 1977? That is what the Stupak ‘‘completely unacceptable’’ on this ices for abortion—this is the essence of language is. abortion issue and ‘‘is actually the it—if a qualified health plan provides The Hyde amendment specifically re- worst bill we have seen so far on the coverage for services for abortion, the moves abortion from government pro- life issues.’’

VerDate Nov 24 2008 03:18 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00015 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.017 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12662 CONGRESSIONAL RECORD — SENATE December 8, 2009 So this colloquy involving the distin- view, and I surely hope that tradition possibly can, to fund it in a variety of guished Senator from Pennsylvania, I continues today. ways, with Federal dollars, if we don’t think that general debate proves the Again, I applaud the Senator from put the Hyde language in. That is what point clearly. Utah and his leading cosponsors, Sen- this is about. I again compliment the Senator from ator NELSON and Senator CASEY, on Mr. BROWNBACK. Will my colleague Utah, along with Senator NELSON, Sen- this effort, and I encourage all of my yield? ator CASEY, and others—I am a cospon- colleagues, Democrats and Repub- Mr. HATCH. I am happy to. sor of the amendment—on this effort. licans, to come together around what Mr. BROWNBACK. If you are not We need to pass this on the bill. This the American people consider a real clear about this, then abortion will be will do away with the loophole. This no-brainer, a true consensus, some- funded. If there is any of this that will be real language to truly prohibit thing that clearly reflects the common needs clarity one thing is for certain taxpayer funding of abortions. This sense of the American people. Is abor- with the Capps language in the base- constitutes exactly the same as that tion a divisive issue? Yes. Is using tax- line of the Reid bill, that abortion will long tradition, since 1977, of the Hyde payer dollars to fund abortion a close be funded. amendment. This marries the Stupak question? No. There is a clear con- The Commonwealth of Massachusetts language, so it should be crystal-clear. sensus in America not to use any tax- recently passed its State-mandated in- What will this amendment specifi- payer dollars to fund abortion. It is surance, Commonwealth Care, without cally do? It will mean there are no crystal-clear that we need to pass this an explicit exclusion on abortion. mandates for elective abortion cov- amendment, and the underlying lan- Guess what. Abortions there were also erage. Plans and providers are free guage in the Reid bill is completely un- funded immediately. In fact, according from any government mandate for acceptable. to the Commonwealth Care Web site, abortion under this amendment lan- With that, thank you, Madam Presi- abortion is considered covered as out- guage. It would mean there is no Fed- dent. I yield the floor. patient medical care. That is a point eral funding of elective abortion or The PRESIDING OFFICER. The Sen- about being clear with the Hyde-type plans that include elective abortion ex- ator from Utah. language, which is the Nelson-Hatch cept in the case of when the life of the Mr. HATCH. Madam President, I am language, which says: No, we are not mother is in danger or in case of rape very appreciative of the Senator from going to fund this, and we are going to or incest. It means this amendment Texas, the distinguished Senator from continue the 33-year policy. If we keep would allow individuals to purchase a Louisiana, the distinguished Senator the Capps language in that funds abor- supplemental policy or a plan that cov- from Nebraska, and, of course, the dis- tion—the last time the Federal Govern- ers elective abortion as long as that tinguished Senator from Kansas and ment funded abortions was during that separate policy is purchased com- the distinguished Senator from South 3-year period after Roe, but before pletely with private dollars. It would Dakota who are here on the floor and Hyde, and we were funding about prohibit the public plan from covering participating. I believe we have until 300,000 abortions a year. The Federal those elective abortions and prevent 12:27, so I am going to relinquish the taxpayer dollars funded abortions the Federal Government from man- floor. through Medicaid. dating abortion coverage by any pri- Mr. THUNE. Before the Senator I cannot believe any of my colleagues vate plan. Insurance plans are not pre- leaves, I wish to put one fine point on would say: Yes, I would be willing to vented from selling truly private abor- something the Senator said in response buy into that 300,000 abortions a year tion coverage, including through the to the question from the Senator from when President Obama and President exchange, but taxpayer dollars would Pennsylvania about the use of Med- Clinton said we want to make abor- have nothing—absolutely nothing—to icaid funds in the States. tions safe, legal, and rare. Well, 300,000 do with it. There are a number of States that do a year would not be in that ballpark. Bottom line: The effect on abortion provide programs that have abortion That is the past number that happened funding and mandates is exactly the funding, but I think there is a very when you didn’t have Hyde language in same as the long and distinguished tra- clear distinction that needs to be made place at the Federal level. dition of the Hyde amendment with in Medicaid funds which are matching Mr. HATCH. That is what it will do this amendment, and it would be ex- funds, and none of those funds can be here too. All this yelling and scream- actly the same as the Stupak language used to fund abortions. You said that ing when they say it equals the Hyde on the House side. in response to his question, but I think language—it doesn’t. That is the prob- I also agreed with the distinguished that point needs to be made very clear- lem. If they want to solve the problem, Senator from Utah when he said this ly because the Senator from Pennsyl- why not use the Hyde language that should not be of any great controversy. vania was implying that somehow, has been accepted by every Congress Abortion is a deeply divisive issue in since States have created programs to since 1977? The Senator is right that this country, but taxpayer dollars fund abortions and since Medicaid is a there were 300,000 abortions a year be- being used to pay for abortion is not. Federal and State program, that some- tween 1973 and 1977 because we didn’t There is a broad and a wide and a deep how those two are being mixed, and have the Hyde language. We got tired consensus against using any taxpayer that this idea that because they are of the taxpayers paying for them. Why dollars to pay for abortion. The Sen- calling for ‘‘segregation,’’ that really should they pay for it? Why should tax- ator from Utah mentioned polls. That doesn’t exist in the Medicaid Program. payers who are pro-life—for religious is why the Hyde amendment has been The Medicaid Program—those are reasons or otherwise—have to pay for longstanding since 1977. That is why it matching funds—is a Federal-State abortions, elective abortions by those has been voted for and supported and program. The Federal dollars that go who are not? They should not have to. passed again and again in Congresses into the Medicaid Program—the prohi- To be honest, the language in the with Democratic majorities and Repub- bition that exists on Federal funding of current bill is ambiguous and it would lican majorities. It is a solid consensus. abortions applies to Medicaid dollars allow that. Anybody who is arguing It does represent the common sense of that go to the States, to the degree this is the same as the Hyde language the American people. Certainly, I will that States have adopted programs hasn’t read the Capps language. We follow in a similar, proud tradition of that fund abortion. Those are State want to change it to go along with Louisiana Senators supporting that funds and not Medicaid funds, which Hyde. It doesn’t affect the right to consensus. Every U.S. Senator from are matching funds. abortion, except that we are not going Louisiana since the Hyde amendment Mr. HATCH. I am glad the Senator to have taxpayers paying for it. was originally adopted has strongly made that even more clear. Last night, Mr. THUNE. If the Senator will supported this commonsense consensus a number of Democrats completely dis- yield—— view—every Senator. Everyone but me torted this issue. If they think the Mr. HATCH. Yes. has been Democratic, but every sitting Capps language equals the Hyde lan- Mr. THUNE. That is what STUPAK U.S. Senator from Louisiana has sup- guage, why not put it in? They want to and other Members of the House of ported that commonsense consensus be able to fund abortion any way they Representatives saw; that this created

VerDate Nov 24 2008 03:18 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00016 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.019 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12663 tremendous ambiguity and they sought tion to proceed and I said, at that time, the five health care reform bills approved by to tighten it up and reinstate the long- to me, this is the pro-life vote, because committee in the 111th Congress violate this standing policy regarding Federal if this bill goes to the floor, we will policy. funds and their use to finance abor- now need 60 votes to get an amendment Following the Hyde amendment prin- tions since 1977, the Hyde language. passed. I said I don’t count the 60. I ciples is what we have done for 33 The Stupak amendment to the House issued a challenge and I said: If there is years, until this moment, until the bill passed with 240 votes. There was a any Member who has a list of 60 Mem- Capps language in the Reid bill. Now sizable, decisive majority of Members bers who will vote for this amendment, we have flipped that on its head and in the House of Representatives who I am willing to look at that and change are saying you can combine Federal saw through what the ambiguity was my view of the world. Well, that hasn’t funds with non-Federal funds to pay for that exists regarding the House bill happened. elective abortions. That was the policy and now the Senate bill. In fact, there are many predictions prior to Hyde in 1977. That funded This is intentionally ambiguous for being made that, sadly and unfortu- 300,000 abortions, roughly, a year at the reasons you mentioned. This sim- nately, this amendment will not get that point in time. There is no way in ply clarifies, once and for all, what has the 60 votes it needs. this country that is a policy the Amer- been standard policy at the Federal Let me put this into context. For ican people support. They don’t. They level going back to 1977. As the Senator pro-life Senators, this is the vote, but may be divided about abortion but not stated earlier, I believe it represents it doesn’t stop here. In my estimation, about Federal funding for elective the consensus view in America of both you are pro-life on every vote. You abortion. There is no division about Republicans and Democrats who be- don’t get a pass on this vote or that that at all. It has been very consistent lieve this is ground we can all stand on, vote or the next vote or whatever the policy, until we have seen the Reid bill, irrespective of where people come down vote is. You are pro-life all the way this particular piece of legislation. We on this issue; that the idea that some- through. have been quite consistent about this. how Federal taxpayer funds ought to Even if this amendment doesn’t pass, It is my hope my colleagues will say: I finance abortions is something most I wish to make the case that this bill may be pro-choice, but I have consist- Americans disagree with. That is why should not go forward because it lit- ently supported Hyde because I think there has been such broad, bipartisan erally will create a system, a struc- we should not be funding elective abor- support for this particular policy, and ture, a way to finance abortions. I tions. that is why it should be extended into don’t believe that is what this country I hope they will vote for the Nelson- the future. wants. Many Senators, including the Hatch amendment because of that very As the Senator from Utah said, 61 Senator from South Dakota and the feature. It is not about abortion, it is percent are against funding abortions. Senator from Kansas, have very clearly about the funding of elective abortions. But I have seen polls that suggest it is made the case that the people of the I hope we don’t go in that direction. much higher than that. I know it is United States do not want their tax I yield the floor. much higher in my State of South Da- dollars to go to buying abortions. The PRESIDING OFFICER. The Sen- kota. I commend the Senator for seeing My hope is, 60 Senators will step up ator’s time has expired. The Senator his way to offer an amendment that on this amendment. I will sure support from Montana has 3 minutes 17 sec- clarifies and removes all this ambi- it. I will speak everywhere I can in sup- onds. guity and what, to me, is clearly an in- port of it. I am so appreciative that Mr. BAUCUS. Madam President, with tentional ambiguity regarding this Senator NELSON and Senator HATCH respect to the last debate, let’s be clear issue and the underlying bill. and Senator CASEY brought this for- that the underlying bill keeps the Mr. HATCH. Madam President, I ask ward. I am glad to be a cosponsor. It is three-decades-old agreement that has unanimous consent that Senator my hope this amendment will pass. implemented the Hyde amendment to CORNYN be added as a cosponsor to the It is my conviction that we need to separate Federal funds from private Nelson-Hatch-Casey amendment. stand strong throughout this debate funds when it comes to reproductive The PRESIDING OFFICER. Without and make sure this language doesn’t health care. objection, it is so ordered. The Nelson-Hatch amendment is un- The Senator from Nebraska is recog- end up in the final bill. I yield the floor. necessary. It is discriminatory against nized. Mr. JOHANNS. Madam President, The PRESIDING OFFICER. The Sen- women. Women are the only group of how much time remains? ator from Kansas is recognized. people who are told how to use their The PRESIDING OFFICER. There is Mr. BROWNBACK. Madam President, own private money. That is unfair. 4 minutes remaining. I think the Catholic bishops have put it On another matter, with respect to Mr. JOHANNS. Madam President, I as concisely as anybody: the McCain motion, let me explain a have been on the floor a number of In every major Federal program where little bit about Medicare Advantage times debating this issue, a while back Federal funds combine with nonfederal funds and how it works. Essentially, the on a motion to proceed and since this (e.g. state or private) to support or purchase Medicare Advantage Programs are in- health coverage, Congress has consistently amendment has come up. I wish to tell surance companies. They are insurance sought to ensure that the entire package of companies that have their own officers, the Senator from Utah that I don’t be- benefits excludes elective abortion. For ex- lieve I have seen a more concise, clear ample, the Hyde amendment governing Med- directors, their own marketing plans explanation of the history of the Hyde icaid prevents the funding of such abortions and their own administrative costs and language than I saw over the last half not only using federal funds themselves, but they are concerned about the rate of hour of debate on the Senate floor. The also using the state matching funds that return on investment for their stock- Senator laid it out perfectly. The Sen- combine with the federal funds to subsidize holders. These are simple, garden vari- ator laid out how we have, over a long the coverage. A similar amendment excludes ety, ordinary insurance companies. elective abortions from all plans offered period of time, stayed with that Hyde In this case, they are insurance com- under the Federal Employees Health Bene- panies that get general revenue from language. That was the agreement that fits Program, where private premiums are had been reached. supplemented by a federal subsidy. Where payroll taxes and premiums. They are Our colleague from Texas said this is relevant, such provisions also specify that basically insurance companies that a foot in the door, and I agree with her. federal funds may not be used to help pay for give benefits to senior citizens. These If this Reid bill passes with the current administrative expenses of a benefits pack- insurance companies are overpaid. language on abortion, it is not only a age that included abortions. Under this pol- There is not much disagreement that foot in the door but, in my estimation, icy, those wishing to use state or private they are overpaid. How are they paid? it kicks down the door. It kicks down funds to purchase abortion coverage must do Well, believe it or not, these insurance so completely separately from the plan that companies—Medicare Advantage the door and sets up structure for the is purchased in whole or in part with federal Federal funding of abortions. That is financial assistance. This is the policy that plans—are paid according to the what we are going to end up with. health care reform legislation must follow if amount Congress sets in statute. That A couple weeks ago, I came to the it is to comply with the legal status quo on is their payment rate, what Congress floor when we were debating the mo- federal funding of abortion coverage. All of sets in statute.

VerDate Nov 24 2008 03:18 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00017 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.020 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12664 CONGRESSIONAL RECORD — SENATE December 8, 2009 The problem is, by doing so, these system which sets statutory amounts utes, Senator LAUTENBERG for 5 min- preset rates overstate the actual cost in effect. Rather, we say, OK, why not utes, Senator HARKIN for 5 minutes, of providing care by 30 percent. We pay have these companies bid? Let them and Senator CARDIN for 5 minutes. more than it costs to provide care by compete based on costs in their re- We have many Members who wish to about 30 percent, in many cases. These gions. One region of the country is dif- come and speak, and I would urge them overpayments also clearly promote in- ferent from another region of the coun- to contact us. I will just take a minute efficiencies in Medicare. Also, these try. We are going to say what is fair to get my notes in order, so I suggest payments have not been proven to in- here to get rid of a lot of waste and the absence of a quorum, and the time crease the quality of care seniors re- overpayments is provide that Medicare should be taken off our time. ceive. In the estimate I saw, about half Advantage plans can compete in their The PRESIDING OFFICER. The the Medicare Advantage plans have area based on cost. clerk will call the roll. care coordination and half don’t. Half The plan will be paid the average bids The legislative clerk proceeded to are no better than ordinary fee-for- that are based on competition in the call the roll. service plans. Because of this broken, area. We, the authors of this bill, think Mrs. BOXER. Mr. President, I ask irrational payment system, some plans that is a far better way of paying for unanimous consent that the order for receive more than $200 per enrollee per Medicare Advantage. the quorum call be rescinded. month and others receive about $36 per Will that reduce payments to bene- enrollee per month. The PRESIDING OFFICER. Without ficiaries? Certainly no. All guaranteed objection, it is so ordered. Again, the payment rates are set by benefits are guaranteed in this legisla- Mrs. BOXER. Mr. President, we are statute, relating to fee for service in tion. In fact, I am going to check up on in the middle of a very important de- the area. It is broken. It doesn’t make another statistic. I heard somewhere bate about whether we are going to sense. It causes great dislocations and under this legislation there will be an move forward and make sure our peo- differences in the payment rates. increase of enrollees—not a decrease, ple in America have health care. That Frankly, under this broken system, all an increase of enrollees. I am going to is what it is about. I am going to throw beneficiaries are not receiving the track that down because I want to be out a few numbers that are always on same care. I believe all beneficiaries sure I am accurate. my mind as I talk about this issue. One should be able to have access to the I will conclude. I want to talk more of them is 14,000. Every day, 14,000 best care, not just those who happen to about this issue later. There may be a Americans lose their health insurance. live in States with high payment rates. separate amendment on this subject of- It is not because they did anything The PRESIDING OFFICER. The Sen- fered on our side. By and large, it is wrong. A lot of times it is just because ator’s time has expired. wrong to continue a current system Mr. BAUCUS. Madam President, I they get sick and their insurance com- that dramatically overpays and where ask unanimous consent to continue for pany walks away from them or they 86 percent of the overpayment goes to an additional 5 minutes. may reach the limit of their coverage, the company and only 14 cents goes to The PRESIDING OFFICER. Without which they didn’t realize they had, and the beneficiaries. We have to come up objection, it is so ordered. they are done for. They could lose their with a fair way of paying Medicare Ad- Mr. BAUCUS. Madam President, I job and suddenly they can’t afford to vantage. I think a fair way is to have have said these Medicare Advantage pay the full brunt of their premium. the companies competitively bid based plans are overpaid. Nobody disagrees They could get sick and then all of a on cost in their areas. That way they with that. They are overpaid. The Sen- sudden are now branded with a PC— are going to get reimbursed at a level ator from Oklahoma, Mr. COBURN, and that is not a personal computer, it that is relevant to their area, and it is when I asked him a few days ago if he is a preexisting condition—and they also relative to the cost they incur thought they were overpaid, said: Yes, can’t get health care. when they run their plans. I will have they are overpaid. The MedPAC advi- So we are in trouble in this country, sory board tells us: Yes, they are over- more to say about that later. I yield the floor. with 14,000 Americans a day losing paid. their health care, and a lot of them are Here is a statement made by Tom f working Americans. As a matter of Scully, former Administrator of the RECESS fact, most of them are working Ameri- Center for Medicare and Medicaid Serv- cans. Sometimes a child, for example, ices: The PRESIDING OFFICER. Under will reach the age where they can no I think Congress should take some of it the previous order, the Senate stands away. There’s been huge over-funding. in recess until 2:15 p.m. longer be covered through their par- ents’ plan, and the child might have There are lots of other citations from Thereupon, the Senate, at 12:34 p.m., had asthma. When they go to the doc- Wall Street analysts and others in the recessed until 2:15 p.m. and reassem- tor, they beg the doctor not to say they industry saying clearly the Medicare bled when called to order by the Pre- have asthma. I have doctors writing to Advantage plans are overpaid. Frankly, siding Officer (Mr. FRANKEN). me saying that parents are begging we, in Congress, put a statutory provi- f them: Please, don’t write down that sion in law that has caused this over- SERVICE MEMBERS HOME OWNER- my child has asthma; say she has bron- payment. Clearly, we should fix it. SHIP TAX ACT OF 2009—Resumed In addition, something that is pretty chitis because when she goes off my alarming is, according to a study I saw, The PRESIDING OFFICER. The Sen- medical plan, she is going to be brand- only about 14 cents on the dollar of ator from California is recognized. ed with a preexisting condition. So extra payments to Medicare Advantage Mrs. BOXER. Mr. President, I ask 14,000 Americans a day, remember that plans goes to beneficiaries—only 14 unanimous consent that the time be- number. cents—which means 86 cents on the tween 2:15 p.m. and 4:15 p.m. be equally Then, Mr. President, 66 percent, that dollar goes to the company, not to the divided between the two leaders, or is the percentage—66 percent—of all beneficiaries, not to the enrollees but their designees, in alternating 30- bankruptcies that are due to a health to the companies—‘‘the companies’’ minute blocks of time, with the major- care crisis. People are going bankrupt meaning the officers, directors, admin- ity controlling the first 30 minutes and not because they didn’t manage their istrative costs, marketing costs, rate the Republicans controlling the second money well or they didn’t work hard of return. It is to the company, any or- 30 minutes; further, that no amend- and save but because they are hit with dinary, garden variety company. ments be in order during this time. a health care crisis and either they had Therefore, it behooves us to find a bet- The PRESIDING OFFICER. Is there no insurance or the insurance refused ter way to pay Medicare Advantage objection? them. The stories that come across my companies so it is efficient, there is not Without objection, it is so ordered. desk, as I am sure yours, are very waste, and payments go primarily to Mrs. BOXER. Mr. President, since heartbreaking. So people are going enrollees, to beneficiaries. this is the 30 minutes of time for our bankrupt. They lose their dignity, they How do we do that? This legislation side, I ask that I be recognized for 10 lose everything because of a health moves away from the current archaic minutes, Senator MURRAY for 5 min- care crisis.

VerDate Nov 24 2008 03:18 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00018 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.021 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12665 Yesterday, I brought up a couple of can be used for abortion, but private concerns we have, and I rise today not numbers—29 out of 30 industrialized na- funds can be used as long as abortion is only in strong opposition to the Nelson tions. That is where we stand on infant legal, and it is. Roe v. Wade made it amendment but in strong support of mortality. We are not doing very well. legal in the early stages of a preg- women’s health care choices, which It is no wonder; more than 50 percent nancy. Women have had that right. this amendment would eliminate. of the women in this Nation are not Well, this amendment says there is Mr. President, we can’t allow a bill seeking health care when they should. one group of people we are going to that does so much for women and for They are putting it off or they are treat differently. We are going to take families and for our businesses and for never getting it. No wonder we don’t do one procedure, that only applies to the future strength of this Nation to well with infant mortality. them, and say they can’t buy health in- get bogged down in ideological politics Now, why don’t women do this? Be- surance for that procedure—only if it is because in every single sense of the cause they either don’t have insurance a separate rider, which everyone knows word, health insurance reform is about or they do not have good enough insur- is unaffordable, impractical, and will choices—giving options to those who ance or they can’t afford the copay or not work. don’t have them: options for better they are fearful. They are fearful that I don’t see any amendment saying to care or better quality, and insurance maybe if they go this time, the insur- men that if they want to have a proce- that is within reach. This bill was ance company will say: No more. dure that relates to their reproductive never supposed to be about taking We rank 24 out of 30 industrialized health they can’t use their own private away choices, and we cannot allow it nations for life expectancy. My con- money to buy coverage for it. No, it is to become that. stituents are shocked to hear that. not in there. We don’t tell men, if they Mr. President, this bill already does They are shocked at the infant mor- want to make sure they can buy insur- so much for millions of women across tality ranking, and they are shocked at ance coverage through their pharma- America. Already so far, the Senate the life expectancy ranking. I have ceutical plan for Viagra, that they has passed Senator MIKULSKI’s amend- heard my Republican friends try to ra- can’t do it. No, we don’t do that, and I ment to be sure that all women have tionalize this: Well, it is because our wouldn’t support that. It would be access to quality preventive health population is diverse—and all the rest. wrong. Well, it is wrong to single out care services, and that screenings, This is the most powerful, richest Na- women and to say to the women of this which are so critical to keeping women tion on Earth. There is no reason we country that they can’t use their own healthy, are available. This underlying have to be 24 out of 30 in terms of our private funds to purchase insurance bill will also help women by ending dis- life expectancy, especially when we that covers the whole range of repro- crimination based on gender-rating or know so much of our problem deals ductive health care. gender-biased preexisting conditions, with about five diseases—diseases such You have to look behind this amend- on covering maternity care, preventive as diabetes, which can be prevented ment to understand how pernicious it care and screenings, including mammo- and certainly treated. really is. I have five male colleagues on grams and well-baby care, expanding The last number I will talk about is the other side of the aisle who were on access to coverage even if an employer 45 percent. The average family in the Senate floor for at least an hour or doesn’t cover it, and giving freedom to America, by 2016, if we do nothing, will so talking about this amendment, and those who are forced to stay in abusive be paying 45 percent of their income on one thing about each and every one of relationships because if they leave, premiums. Now, this is disastrous, and them, they want to make abortion ille- they or their children could lose their 2016 is around the corner by my cal- gal. There is no question about it. They coverage. culations. So that means more and want to take away a woman’s right to Mr. President, the amendment before more of us will not be able to afford in- choose, even in the earliest stages of us today would undermine those efforts surance, and we are going to show up the pregnancy, even if it impacts her and goes against the spirit and the goal at hospital emergency rooms. That health, her ability to remain fertile, or of this underlying bill. All Americans costs a lot and the outcomes are bad her ability to avoid a very serious should be allowed to choose a plan that and America will continue on this health issue such as a heart problem, a allows for coverage of any legal health downward spiral in relation to our stroke. They do not want to have an care service, no matter their income, health care system. exception for a woman’s health. No and that, by the way, includes women. Why do I take time to talk about this question, that is what they want. But if this amendment were to pass, it issue? It is because we need to keep our The PRESIDING OFFICER. The Sen- would be the first time that Federal eye on the big picture, and the big pic- ator’s 10 minutes has expired. law would restrict what individual pri- ture is not a pretty picture for our peo- Mrs. BOXER. I ask unanimous con- vate dollars can pay for in the private ple right now. The status quo is not be- sent for an additional 30 seconds, and health insurance marketplace. nign, it is not neutral, it is cruel. then I will turn to Senator LAUTEN- Let me repeat that: If this amend- Every one of us could wake up in the BERG. ment were to pass, it would be the first morning having lost a job and having The PRESIDING OFFICER. Without time that Federal law would restrict no health care. So what we are doing is objection, it is so ordered. what individual private dollars can pay going to help every American, and I Mrs. BOXER. So to sum up my part, for in the private health insurance think one of the best things we do in the amendment that has been offered marketplace. the underlying bill is to make sure by Senators NELSON, HATCH, VITTER, Now, the opponents of this bill have that health care premiums are afford- BROWNBACK, et al., hurts women. It sin- taken to the floor day in and day out able for everyone. That is the key, and gles out one legal procedure and says: for months arguing that this bill takes we do it in a number of ways. You know what. You can’t use your away choice. This bill doesn’t take But, Mr. President, in the middle of own private funds to buy insurance so away choice, Mr. President, but this all this, we have an amendment that that in case you need to use it for that amendment sure does. This amendment would roll back the clock on women’s legal procedure, you can. So I hope we stipulates that any health plan receiv- rights. I am here to say, as I said last will vote it down. ing any funds under this legislation night—and I am happy to see other col- I yield the floor, Mr. President, and cannot cover abortion care, even if leagues joining me—it is unacceptable note that Senator LAUTENBERG is here such coverage is paid for using the pri- to single out one group of people— for 5 minutes. Oh, I am sorry. May I vate premiums that health plans re- namely the women of this country— say that the order was Senator MUR- ceive directly from individuals. and tell them they can’t use their own RAY for 5 minutes to be followed by Simply put, the amendment says if a private money to buy an insurance pol- Senator LAUTENBERG for 5. health plan wants to offer coverage to icy that covers the range of reproduc- The PRESIDING OFFICER. The Sen- individuals who receive affordability tive health care. Why are women being ator from Washington is recognized. credits—no matter how small—that singled out? It is so unfair. Mrs. MURRAY. Mr. President, I coverage cannot include abortion. We have had a firewall in place for 30 thank the Senator from California for In this way, the amendment doesn’t years. It said this: No Federal funds her debate, for outlining the serious only restrict Federal funds, it restricts

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00019 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.024 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12666 CONGRESSIONAL RECORD — SENATE December 8, 2009 private funds. It doesn’t just affect hibit any of the health plans on the ex- against women in our current health those receiving some amount of afford- change from covering abortion. It will care system. Right now, our health ability credits, it also impacts people ban coverage even for women who don’t care bill takes a balanced approach to who are paying the entire cost of cov- get a dime in Federal subsidy. abortion coverage. It preserves existing erage but who just happen to purchase Women’s reproductive rights are al- Federal law. Women have fought since the same health plan as those with af- ways being challenged here in Con- this Nation’s founding to have full fordability credits. gress. What about men’s reproductive rights under the law, including suf- The bottom line: This amendment rights? Let’s turn the tables for a mo- frage, including many other things. would be taking away options and ment. What if we were to vote on a Unfortunately, this amendment would choices for American women. Viagra amendment restricting cov- force them to take a step backward. I There is no question this amendment erage for male reproductive services? don’t want to see it happen. goes much further than current law, no The same rules would apply for Viagra I urge my colleagues, please, use matter what our colleagues on the as being proposed for abortion. Of your judgment, make your own choices other side contend. Current law re- course, that means no health plan on about your own family. Make your de- stricts public funds from paying for the exchange would cover Viagra avail- cisions as to what you would rec- abortion except in cases of rape or in- ability. How popular would that de- ommend to a daughter or a wife. But cest or where the woman’s life is in mand be around here? I understand for God’s sake, let the woman choose danger. The existing bill before us rep- that abortion and drugs such as Viagra what is best for her. resents a genuine compromise. It pro- present different issues, but there is a I urge my colleagues to vote against hibits Federal funding of abortion, fundamental principle that is the same: the amendment. other than the exceptions I just men- restricting access to reproductive I yield the floor. tioned, but it also allows women to pay health services for one gender. This The PRESIDING OFFICER. The Sen- for coverage with their own private amendment is exclusively directed at a ator from Maryland. funds. It maintains current law; it woman’s right to decide for herself. It Mr. CARDIN. Mr. President, I rise in doesn’t roll it back. doesn’t dare to challenge men’s per- strong opposition to the Nelson-Hatch This amendment now before us would sonal decisions. amendment. Let me start by saying I have the good fortune of being a fa- be an unprecedented restriction on that I support a woman’s right of ther of three daughters and grand- women’s health choices and coverage. choice as a constitutionally affirmed father of six granddaughters. I am Health insurance reform should be a right. I understand how difficult and deeply concerned by the precedent this giant step forward for the health and divisive this issue is. That is why the amendment would set. I don’t want economic stability of all Americans. underlying bill we have before us car- politicians making decisions for my This amendment would be a giant step ries out the compromise that has al- daughters or my granddaughters when backward for women’s health and wom- ready been reached between pro-choice it comes to their health and well-being, en’s rights. Women already pay higher and pro-life supporters. It represents but that is exactly what this amend- costs for health care. We should not be maintaining the prohibition on Federal ment does. funds for abortion but allows a woman forced into limited choices as well. Nothing made me happier than when to pay for abortion coverage through We are standing on the floor today any of my daughters announced a preg- use of her own funds. That is current having a debate about a broken health nancy. I watched them grow and pros- law, and that is what the underlying insurance system. It is broken for per in their health and well-being, as bill makes sure we continue. women who are denied coverage or they were carrying that child. I was Many of us believe the health care charged more for preexisting condi- fully prepared to support a decision she debate is critically important. It is tions such as pregnancy or C-sections might make for the best health of that also controversial. Let’s not bring the or domestic violence. It is broken when new baby and protecting her health to abortion issue into the bill. The Nel- insurance companies charge women of be able to offer her love and care for a son-Hatch amendment would go beyond childbearing age more than men but new child, as I saw in my years. don’t cover maternity care or only I don’t want to stand here and think that. It would restrict a woman’s abil- offer it for hefty additional premiums. that somebody is going to make a deci- ity to use her own funds for coverage The status quo is not working. sion in this room that affects what my to pay for abortions. It blocks a woman Women and their families need health granddaughters or my daughters have from using her personal funds to pur- insurance reform that gives them op- to think about. If they want to restrict chase insurance plans with abortion tions, doesn’t take them away. themselves, let them do it. But how coverage. If enacted, for the first time I urge my colleagues to stand up for can we stand here and permit this to in Federal law, this amendment would real reform. Reject this shortsighted take place when we are trying to make restrict what individual private dollars amendment. people healthier and better informed? can pay for in the private insurance I yield the floor. This amendment wants to take away marketplace. The PRESIDING OFFICER. The Sen- that right. When you look at those who are sup- ator from California. Right now, the majority of private porting this amendment, you can’t Mrs. BOXER. Mr. President, I ask health insurance plans do offer abor- help but have some concern that this unanimous consent to amend the pre- tion coverage. This amendment would amendment is being offered as a way to vious order to give Senator LAUTEN- force private health insurance compa- derail and defeat the health care re- BERG 8 minutes, myself 2 minutes, and nies to abandon those policies, elimi- form bill. Most of the people who are Senator CARDIN 5 minutes. nate services, and limit a woman’s op- going to be supporting the amendment The PRESIDING OFFICER. Without tions. The amendment does not, con- will vote in opposition to the bill. It is objection, it is so ordered. trary to statements being made here quite clear that the Senate health re- The Senator from New Jersey. on the floor, simply preserve the Hyde form bill already includes language Mr. LAUTENBERG. Mr. President, language that has been in place for banning Federal funds for abortion throughout my service in the Senate, I more than three decades. Make no mis- services. So supporters of this bill are have been a strong supporter for health take, this amendment goes well beyond not satisfied with the current funding care reform. But we can’t allow reform the concept of limiting Federal funds ban; they are trying to use this to to be used as an excuse to roll back from paying for abortion. This amend- move the equation further in an effort women’s rights that they have had for ment would make it impossible for a to defeat the bill. This is really wrong almost half a century. That is why I woman who pays for her premiums out as it relates to women in America. strongly oppose the amendment offered of her own pocket to purchase a private I am outraged at the suggestion that by my friend, the Senator from Ne- health plan that offers her the right to women who want an abortion should be braska. I think he is wrong. choose what is best for her, for her able to purchase a separate rider to What this amendment does is remove health, and her family’s well-being. cover them. Why would we expect this a woman’s right to make her own deci- We have been working hard for a long overwhelmingly male Senate to expect sion, as a practical matter. It is to pro- time to eliminate discrimination women to shop for a supplemental plan

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00020 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.026 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12667 in anticipation of an unintended preg- that is women. It says to women that cut $120 billion from a program without nancy or a pregnancy with health com- they can’t use their own private funds cutting its benefits. A lot of seniors in plications? Who plans for that? The to buy coverage for the full range of re- Arizona are asking, What happened to whole point of health insurance is to productive health procedures. It the President’s repeated promise that protect against unexpected incidents. doesn’t say that to a man. It doesn’t if you like your insurance, you get to Currently, there are five States— say to men: You can’t use your own keep what you have? They do not like Idaho, Kentucky, Oklahoma, Missouri, funds to cover the cost of a pharma- the idea that under this bill their bene- and North Dakota—that only allow ceutical product that you may want for fits would be slashed by 64 percent, abortion coverage through riders. your reproductive health. It doesn’t from $135 of value per month to $49 of Guess what. The individual market say that they can’t use their own pri- value per month, which is exactly what does not accept this type of policy. It vate funds for a surgical procedure the Congressional Budget Office doesn’t exist. they may choose that is in the arsenal projects would happen. They do not Abortion riders severely undermine that they may choose for their own re- want the money they paid into Medi- patient privacy, as a woman would be productive rights. care going to fund a new government placed in a position of having to tell So we say to the men of this country: entitlement program for nonseniors. her employer or insurer and, in many Look, we are not going to single out They are not satisfied with the major- cases, their husband’s employer that any procedure or any pharmaceutical ity’s promise to protect ‘‘guaranteed’’ they anticipate terminating a preg- product you may want to use for your benefits. They want Members of Con- nancy. reproductive health care. We are say- gress to be straight about our inten- Also, requiring women to spend addi- ing, if a private insurer offers it, you tions and not engage in semantics. tional money to have comprehensive have the right to buy it. We are sin- They want an unequivocal promise health care coverage is discriminatory. gling out women. they will be able to keep exactly what We don’t do that for services that af- Again, let me say this as clearly as I they have now, just as the President fect men’s reproductive rights. can. We have had a firewall between promised. I hear frequently from my friends on the use of Federal funds and private Here is the problem. There is an ear- the other side of the aisle that the funds. Senator REID has kept that fire- mark buried on page 894 of the legisla- statements we make; that is, those wall in place in the underlying bill. He tion before us that suggests that senior who support the underlying bill—that keeps the status quo of the Hyde citizens in Florida must have insisted this allows individuals who currently amendment. The group here who is on this exact kind of protection for have insurance to be able to maintain coming on the floor continually—most- their Medicare Advantage as well. their insurance builds on what is good ly men; I think so far all men; there This provision, in section 3201(g), was in our health care system. This amend- may be some women who have spoken specifically drafted at the request of ment takes away rights people already on their behalf, but I have not heard the senior Senator from Florida to pro- have. So if you have insurance today as it—are basically saying: Forget the tect the benefits for at least 363,000 Medicare Advantage beneficiaries in an individual that covers abortion firewall. Forget it. Women, you cannot Florida but very few anywhere else. services, if this amendment were use your private funds, and govern- Nothing in the bill grants the same adopted, you will not be able to get ment will tell you what you can or can- protection that is granted to these sen- that. So we are denying people the not do. I will tell you something. That ior citizens to those in my State or in ability to maintain their own current is not what Uncle Sam should do. the other States in which there are a insurance, if this amendment were Uncle Sam should respect women, lot of seniors who have the Medicare adopted. should respect men. I hope we defeat It is the wrong amendment. The pol- Advantage Program. this amendment. That is why I support the motion of icy is wrong. But clearly, on this bill it I yield the floor. my colleague, Senator MCCAIN, to com- is wrong. The PRESIDING OFFICER. The Sen- mit this bill to the committee and re- I urge my colleagues to accept the ator’s time has expired. turn it without these—actually, what compromise reached on this bill. Many The Senator from Wyoming. his bill does is to ensure that all sen- of us who would like to see us be more Mr. ENZI. Mr. President, I yield up iors, whatever State they are in, enjoy progressive in dealing with this issue to 10 minutes to the Senator from Ari- the same grandfathering status as the and remove some of the discriminatory zona. senior citizens in Florida would have provisions in existing law understand The PRESIDING OFFICER. The Sen- under the Nelson proposal. we will have to wait for another day to ator from Arizona. The McCain motion to commit is Mr. KYL. Mr. President, America’s do that. Let’s not confuse the issue of straightforward. First of all, it would health care reform. Let’s defeat this seniors have made clear they value the help the President keep his commit- amendment that would be discrimina- Medicare Advantage Program. They ment that seniors get to keep their in- tory against women. That is wrong. like their access to private plans, plan surance if they like it. And it applies I urge my colleagues to reject the choices, lower cost sharing, and all the to all of America’s seniors the same Nelson-Hatch amendment. extra benefits not included in tradi- protection granted to Floridians, as I I yield the floor. tional Medicare, such as vision, dental, said. Isn’t that what all seniors de- The PRESIDING OFFICER. The Sen- hearing, and the wellness programs serve, the security of knowing their ator from California. that help them stay fit. current benefits are safe? If our Demo- Mrs. BOXER. Mr. President, I thank Before the Medicare Modernization cratic colleagues are not willing to ex- Senators MURRAY, LAUTENBERG, and Act of 2003, seniors had been decrying tend this protection to every Medicare CARDIN for participating in our half their lack of choices. We made sure, Advantage beneficiary, then I cannot hour of debate. Our block of time has under the Medicare Modernization Act, imagine how they can claim to be in almost expired. I would like to close that seniors would be assured health favor of protecting Medicare. the half hour by saying one word that care choices, just as all of us here in I have been sharing letters that I I think is a beautiful word, and that the Congress enjoy. have received from Arizona constitu- word is ‘‘fairness.’’ ‘‘Fairness’’ is a Now that they have access to private ents describing what the Medicare Ad- beautiful word. It should always be the coverage and enjoy more benefits and vantage Program means to them. I centerpiece of our work here. We choices, seniors want us to make sure thought today I would share some ex- should never single out one group of Medicare Advantage stays viable, and cerpts from a few more of these letters. people as targets. We should treat peo- they are not happy about the proposed A constituent in Surprise, AZ—I hope ple the same. cuts in the majority leader’s bill. the Presiding Officer likes the name of It has been very clearly stated that I have received more than 500 phone that town: Surprise, AZ—just west of the Nelson-Hatch amendment, like the calls since November 1 from constitu- Phoenix, says: Stupak amendment in the House, sin- ents who oppose the $120 billion Medi- I truly hope you will consider keeping the gles out an area of reproductive health care Advantage cuts proposed by the Medicare Advantage plans for seniors. I find care that only impacts one group, and majority’s bill. They know you cannot the savings a must on my fixed income.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00021 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.027 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12668 CONGRESSIONAL RECORD — SENATE December 8, 2009 I appreciate the [high quality] doctor care Mr. ENZI. Mr. President, I yield up I yield the floor. on my MediSun Advantage plan. Prescrip- to 10 minutes to the Senator from The PRESIDING OFFICER (Mr. tions are included in the cost of my plan, Ohio, Mr. VOINOVICH. UDALL of Colorado). The Senator from providing further savings for me. Medicare The PRESIDING OFFICER. The Sen- Wyoming. Advantage has made a real difference in my ator from Ohio. Mr. ENZI. Mr. President, I yield up life. Please don’t let anything happen to this Mr. VOINOVICH. Mr. President, I to 10 minutes to the Senator from important program. want to spend a minute discussing the Idaho, Mr. CRAPO. A constituent from Fountain Hills, very emotional and divisive issue of Mr. CRAPO. Mr. President, I rise AZ, writes: abortion. I personally believe that all today to discuss the Medicare Advan- I suffer from a specific type of children, born or unborn, are a precious tage Program again. It is one that is amyotrophic lateral sclerosis, and rely on gift from God, and we have a moral re- facing nearly $120 billion in cuts under Medicare Advantage for all of my medical needs. I am asking that you do all that is in sponsibility to protect them. It grieves the Democratic health care bill. your power to protect and provide for the me to think that there have been more Currently, there are nearly 11 million continued funding of this program. In Ari- than 40 million abortions performed in seniors enrolled in Medicare Advan- zona, we have over 329,000 people who count this country since 1973. tage, which is about one out of every on Medicare Advantage. Our lives would be I am pleased to support the Nelson four seniors in the United States. In devastated without it. amendment that would apply the long- my home State of Idaho, that is about A constituent from Wickenburg, AZ, standing Hyde amendment, which cur- 60,000 people or 27 percent of all Medi- says: rently prohibits Federal funding to pay care beneficiaries in the State. Please don’t let anything happen to my for abortion services except in cases of Medicare Advantage is an extremely Medicare Advantage. I like my Medicare Ad- rape, incest, or to save the life of the popular program. In fact, it is probably vantage plan because I can choose my own mother, to the health care reform bill. the most popular and fastest growing doctor in my own town and also choose a The issue of abortion is one that re- part of Medicare. A 2007 study reported specialist if I need one. sults in very strong emotions on both high overall satisfaction with the I can also get regular check-ups and don’t sides of this issue. Because of the con- Medicare Advantage Program. Eighty- have trouble getting to see the doctor. So, I four percent of the respondents said ask that you don’t let the government cut cerns that millions of Americans have my Medicare Advantage. with using Federal taxpayer dollars for they were happy with their coverage, and 75 percent would recommend Medi- A constituent from Mesa, AZ, says: abortion, Congress enacted the Hyde amendment. As my colleagues know, care Advantage to their friends or fam- I am a senior citizen. I am becoming more ily members. and more concerned about President the Hyde amendment has restricted Obama’s healthcare plans, and I am writing Federal Medicaid dollars from paying But despite the popularity of the pro- to tell you that I am happy with my Medi- for abortion services since 1977, and has gram, the massive cuts in the Reid bill care Advantage plan. I request that you do been applied to all other federally will result in most seniors losing bene- all you can not to cut my benefits. funded health care programs, including fits or coverage or both under Medicare I have a fairly wide choice of doctors and the Federal Employees Health Benefits Advantage. specialists, who have always treated me with Program. I have a chart in the Chamber which respect, given me the time I feel I need, and Think about that, this language has I have shown before. You cannot see have given me excellent care. the individual States too well on it I have a fitness benefit, which entitles me been in place since the Ford adminis- to the Silver Sneakers program at our local tration, and has survived through the from this distance at this size, but you YMCA; two choices of a dental plan; a vision administrations of Presidents Carter, can see the coloring on the United plan; plus many other options to maintain Reagan, George H.W. Bush, Clinton, States in this chart. my level of health or to try to improve it. and George W. Bush. That is 33 years, If you live in a State that is red, deep Please, I beg you, do whatever you can to and all of a sudden, my colleagues want red, or the pinkish color—which is al- maintain our Medicare Advantage plan. Do to change our policy on Federal fund- most every State in the Union—then NOT cut any of our benefits. ing of abortion. you are going to see your benefits cut We know there are millions of seniors We shouldn’t be making this type of under Medicare Advantage under this out there who absolutely depend on sweeping policy change in the health bill. Medicare Advantage. Many have sto- care legislation, and the Nelson amend- Why am I bringing it up again? We ries to tell about how this program has ment is a necessary addition to the bill have already had a vote on it. In fact, improved the quality of their life and in order to protect our current policy we have had two votes on it. The ma- their health. I urge my colleagues to and the unborn. jority has insisted on keeping these support the McCain motion to commit I understand that not everyone in cuts in the bill. The reason I am bring- to ensure that all of America’s seniors, this country agrees with my position ing it up again is because, as we have not just those in certain preferred on abortion, but I am deeply concerned combed through this 2,074-page bill, we counties, primarily located in the about the possible implications of have found out there is a provision in State of Florida, are grandfathered in spending taxpayer dollars on abortions the Reid bill that would protect Medi- these benefits. when the issue so deeply divides Ameri- care Advantage benefits for some peo- Again, to make it very clear, Medi- cans on ethical grounds. ple in the United States, for just a few care Advantage benefits are cut by the While as I have said, I don’t agree in this country. $120 billion reduction in Medicare with abortion and believe Roe v. Wade During the Finance Committee under the bill. The Senator from Flor- should be overturned, the Nelson markup, Senator BILL NELSON of Flor- ida found a way to grandfather the amendment does not prohibit anyone ida advocated on behalf of Medicare Medicare Advantage benefits for many from seeking an abortion, it does not Advantage and the beneficiaries in his of his constituents. What the McCain overturn Roe v. Wade, and it does not home State of Florida. Subsequently, motion to commit does is to apply that place any new restrictions on access to during closed-door negotiations, the same grandfathering to all seniors in abortions. legislative language was added to pro- all States so that none of the seniors It simply ensures that the taxpayer tect those beneficiaries. who have Medicare Advantage today dollars will not pay for services that This is interesting because one of the would lose any of the benefits they cause such deep moral divisions in our responses to us, as we have tried to enjoy today. Nation. I think it is notable that this stop the imposition of these cuts to It seems to me what is good for our amendment is one of the few bipartisan Medicare, has been this bill will not senior citizens in Florida ought to be amendments that the Senate will con- cut any Medicare benefits. Well, if not, good for our senior citizens in Arizona sider as part of this debate. then why does Florida need a special or any other State in which they re- I am pleased that a similar amend- exemption for its citizens? If not, why side. I urge my colleagues to consider ment in the House of Representatives not support the McCain amendment and to support the McCain motion to passed with a convincing margin, and I that would give the same protection to commit. urge my colleagues to support the Nel- all Medicare Advantage beneficiaries The PRESIDING OFFICER. The Sen- son-Hatch amendment before the Sen- that the bill gives to primarily just a ator from Wyoming. ate. few in Florida?

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00022 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.028 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12669 Specifically, section 3201(g) of the McCain motion to commit is simply an tized a few minutes after birth, as she Reid bill, very deep in the bill on page amendment that will protect nearly 11 worked and struggled to live. Watching 894, has a $5 billion provision drafted to million seniors today enrolled in the an infant fight with every fiber of her prevent the drastic cuts in the Medi- Medicare Advantage Program and help being, unquestionably showing the de- care Advantage Program from impact- to keep the President’s promise when sire to live, even though they are only ing those enrollees who reside pri- he said if you like what you have, you 6 months developed, is something that marily in three counties in Florida: can keep it. If this bill is not amended will show you the value of life. Amy Broward, Miami-Dade, and Palm in the way it is being proposed to be survived and is now a teacher so gifted Beach. It seems unfair that taxpayers amended by Senator MCCAIN’s amend- she teaches other teachers. would foot a $5 billion provision that ment, 11 million Americans are not Amy’s birth changed my whole out- provides protection for only some of going to be able to keep what they look on life. It reminded me of the mir- the Medicare Advantage beneficiaries. have in the Medicare Program, and acle of life and the respect we owe that It certainly proves there are cuts to that is just a start on the impact of miracle. The Reid bill, as it is cur- Medicare Advantage benefits in this what people in America are going to rently, does not respect life. But the bill; again, benefits that one out of four see under this legislation in terms of a amendment before us will allow that beneficiaries in America receives—one reduction of their benefits and the respect to be given to every American of the fastest, if not the fastest, grow- quality of services they have access to. who benefits from that bill. ing parts of Medicare. Instead of pref- I urge my colleagues to support this On September 9, President Obama told a joint session of Congress: ‘‘No erential treatment for some, why not amendment, and I yield the floor. Federal dollars will be used to fund extend these same protections for The PRESIDING OFFICER. The Sen- abortions.’’ I agree. No Federal dollars Medicare Advantage to all bene- ator from Wyoming. should ever be used to pay for abor- ficiaries under Medicare? I know the Mr. ENZI. I yield myself the balance of the time. tions. To do otherwise would compel 60,000 Medicare beneficiaries on Medi- millions of taxpayers to pay for abor- AMENDMENT NO. 2962 TO AMENDMENT NO. 2786 care Advantage in Idaho, my home tion procedures they oppose on moral Mr. President, I rise to speak in sup- State, want and deserve that same or ethical grounds. Unfortunately, the port of the Nelson amendment. We level of protection. Reid bill fails to meet that standard That is why I am here to support the have been talking about the McCain set by the President. Section 1303 of McCain motion to commit, and that is amendment, which provides fairness the bill provides the Secretary the au- what his motion to commit would ac- for seniors who have Medicare Advan- thority to mandate and fund abortions. complish, very plain and very simple. tage so everybody across the country Some have questioned exactly how The McCain motion would extend can have the same thing Florida is get- this bill funds abortions. It is quite this grandfathering provision to all ting. But the critical amendment I simple. The bill funds abortions beneficiaries in the Medicare Advan- wish to talk about is the Nelson through the government-run insurance tage Program so all seniors in this pop- amendment. option and through subsidies to indi- ular and successful program could This amendment needs to be adopted viduals to help pay for the cost of pri- maintain that same level of benefits if we truly want to prevent Federal vate insurance. Both of these options that today they enjoy under the cur- dollars from being used to pay for abor- are funded with Federal dollars. Under rent law. Every senior in the Medicare tions. I am asking my colleagues to the community health insurance op- Advantage Program deserves to keep support a Democratic amendment. This tion, also known as the government- these critical extra benefits, which in- isn’t a partisan issue; it is a human run plan, the Secretary of Health and clude things such as dental protection, issue. Even if you are on the other side, Human Services could allow the plan vision coverage, preventive and I hope you can agree it is not right to to cover abortions. In addition, the new wellness services, flu shots, and much force people to pay for a procedure tax subsidies in the bill could also go more. they may find offensive to the core of to private plans that cover abortions. In fact, most people who are not on their morality. This issue is very per- In both these cases, Federal subsidies Medicare Advantage in the Medicare sonal for many of us. It is for me. would be paid to plans that cover abor- Program have to buy supplemental in- When my wife Diana gave birth to tion. surance to get access to this coverage. our first child, Amy was 3 months pre- The Reid bill attempts to use budget Those in Medicare Advantage, which is mature. She weighed just 2 pounds and gimmicks so its sponsors can argue one of the reasons it is such a popular the doctor’s advice was: Wait until that Federal funds will not pay for program, have the opportunity to get morning and see if she lives. The doc- abortions. As the accountant in the it through their Medicaid services. tors couldn’t do anything to help this Senate, I am not fooled by these gim- Why is Medicare Advantage so op- newborn baby. She survived the night. micks and neither should anyone else posed? Well, some say it is because of The next day I took Amy to a hos- be. If the Reid bill is passed, Federal the extra costs, except that the extra pital in Casper. An ambulance wasn’t dollars will be used to pay for abor- costs in Medicare Advantage are re- available so we went in a Thunderbird. tions. turned to the government or shared It was in a huge blizzard, the same bliz- Money is fungible. That is an inter- with the beneficiaries. I think the rea- zard that prevented us to fly Amy to a esting word. It means Federal dollars son might be because Medicare Advan- hospital in Denver that specialized in paid into a health plan could be shifted tage is one part of the Medicare Pro- that. But we took this car and went to across accounts. We don’t have a good gram that we have successfully been the center of the State to the biggest accounting system for that. It can re- able to turn over to the private mar- hospital to get the best care we could place other spending and those dollars kets for operation. Interestingly, when find. We ran out of oxygen on the way could then go to pay for abortions. the private sector gets involved in ad- because the snow slowed us. The high- There is no way to absolutely prevent ministering this part of the Medicare way patrol was looking for us, and they Federal dollars from paying for abor- Program, the Medicare beneficiaries were looking for an ambulance. All tions once they are paid to plans that get more benefits, and it becomes the along the way, we were watching every cover abortions. most popular program in Medicare. breath of that child. That is why Federal laws for the last I know my colleague from Pennsyl- We arrived at the hospital in Casper 30 years have explicitly prohibited Fed- vania, Senator CASEY, has filed an and put her in the care of doctors. eral funding going to such plans. That amendment to protect the 864,000 Medi- There were several times when Diana is right. It is already Federal law, al- care Advantage beneficiaries in his and I went to the hospital and found though it comes in, in the appropria- home State, and I would expect strong her isolette with a shroud around it. tions bill, on an annual basis. Federal bipartisan support for the McCain mo- We would knock on the window and the law currently prohibits funds going to tion to commit, since I think every nurses would come and say: It is not pay for abortions under the Medicaid Senator representing their constitu- looking good. We had to help her to Program, under FEHBP—that is the ents in their State wants to see this breathe again or: Have you had your program where we get our health insur- kind of protection. At the end, the baby baptized? We did have Amy bap- ance; it is the one that provides all the

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00023 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.035 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12670 CONGRESSIONAL RECORD — SENATE December 8, 2009 health insurance for all Federal em- Some have also said this amendment can’t get certain drugs, under a phar- ployees, the same choices of plans—and would ban abortion procedures. That, maceutical benefit, they may need for the TRICARE Program, which is for all too, is false. The amendment does not their reproductive health care. Imagine our Active military and their families. ban abortions; it simply prohibits Fed- if the men in this Chamber had to fill Current law recognizes the only way eral dollars from paying for abortions, out a form and get a rider for Viagra or to actually prevent Federal funds from which is consistent with the current Cialis and it was public. Forget about being used to pay for abortion is to law. it. There would be a rage in this Cham- offer the coverage of abortion in sepa- Many of my Democratic colleagues ber. rate insurance plans and collect sepa- have argued during the debate that the We are just saying treat women fair- rate premiums to pay for that plan. health care we provide under this bill ly. Treat women the same way you This is what States who want to cover should be as good as the coverage given treat men. Let them have access to the abortion for their Medicaid populations to Senators. If they believe that, they full range of legal reproductive health already do. As I said earlier, Medicaid should all support applying the same care. That is all we are saying. Vote no is prohibited from using Federal dol- rules regarding abortion coverage that on this amendment, the Nelson-Hatch lars to pay for abortions. As a result, apply to our own health plans. Federal amendment, because HARRY REID takes States set up separate plans and collect employees’ plans are prohibited from care of the firewall between private non-Federal dollars in separate ac- covering abortion—all Federal employ- funds and Federal funds. We keep that counts to pay for those services. ees, not just Senators. firewall. If anyone has any doubts about the I will work hard to see that tax- Is it OK if Senator DURBIN goes after impact of the Reid bill, I would point payers are not compelled to fund abor- Senator STABENOW? them to the comments made by the tion services. I believe those of us in Mr. DURBIN. Yes. senior staff at the U.S. Conference of elected office have a duty to work to The PRESIDING OFFICER. The Sen- Catholic Bishops. The associate direc- safeguard the sanctity of human life, ator from Michigan is recognized. tor, Richard Doerflinger, recently de- since the right to life was specifically Ms. STABENOW. Mr. President, first, scribed the Reid bill as ‘‘completely named in the Declaration of Independ- I thank the Senator from California for unacceptable’’ and said it was the ence. By safeguarding our right to life, her passionate advocacy and standing worst health reform bill they had seen our government fulfills the most funda- up for all of us, the women of this so far on life issues. mental duty to the American people. country. She is a mom, as she said. I, It is probably worth it to note that When that right is violated, we violate too, am a mom. As hard as it is for me the bishops have been longtime sup- our sacred trust with our Nation’s citi- to believe, I am also a grandmother porters of health care reform and cov- zens and the legacy we leave to future with wonderful 2-year-old Lily and a ering the uninsured. Similarly, Na- generations. little grandson Walter, who was born tional Right to Life said the Reid bill Regardless of what some people on his daddy’s—my son’s—birthday in ‘‘seeks to cover elective abortions in think, God doesn’t make junk. He August. Obviously, they are the light two big new Federal health programs, makes people in a variety of sizes, of my life, as well. but tries to conceal that unpopular re- shapes, and abilities, and disabilities. One of the reasons I feel so pas- ality with layers of contrived defini- There is a purpose even if we cannot sionate about the broader bill on tions and hollow bookkeeping require- understand it. I like the sign just out- health care reform is that this is about ments.’’ side Gillette. It says: ‘‘If it’s not a extending coverage to babies so they There has also been some misin- baby, you’re not pregnant.’’ can be born healthy, and about pre- formation out there regarding this I don’t believe Federal funding natal care; it is about making sure amendment, and I wish to take a should be used to pay for abortions, that in the new insurance exchange we minute to clear up a couple arguments and I will work to ensure that it have basic coverage for maternity care. used against the Nelson amendment. doesn’t happen under this bill. I will I was shocked to learn that 60 percent First, it does not prohibit individuals vote in support of the Nelson amend- of the insurance policies offered right from purchasing abortion coverage ment and encourage my colleagues to now in the individual market don’t with their own private dollars. When do the same to protect life and respect offer maternity care as basic care. We similar arguments were made during the miracle of life that I witnessed happen to think that is incredibly im- the House debate on the Stupak lan- with the birth of my daughter Amy. portant. We are 29th in the world in the guage, PolitiFact, a Pulitzer Prize-win- I thank the Chair and yield the floor. number of babies—below Third World ning, fact-checking organization, con- The PRESIDING OFFICER. The Sen- countries—that survive the first year cluded that such statements were false. ator from California is recognized. of life. This health care reform bill is The Nelson amendment only prohibits Mrs. BOXER. Mr. President, I ask about making sure we have healthy ba- Federal funds from subsidizing those unanimous consent for the following bies, healthy moms, and it is about plans. order: Boxer, 1 minute; Durbin, 5 min- saving lives and moving forward in a Some have argued the Nelson amend- utes; Stabenow, 5 minutes; Shaheen, 5 way that is positive, expanding cov- ment could cause individuals to lose minutes; Dodd, 5 minutes; Menendez, 5 erage, not taking away important cov- the abortion coverage they currently minutes; and Baucus, 4 minutes. erage for women who, frankly, find receive from their current health in- The PRESIDING OFFICER. Is there themselves in a crisis situation. surance plans. That also isn’t accurate. objection? That is what we are doing, unfortu- I would urge everyone to read section Without objection, it is so ordered. nately, through the Nelson-Hatch 1251 of the bill. Section 1251 says, clear- Mrs. BOXER. Mr. President, I gave amendment. I have great respect for ly and unequivocally, that: birth to two beautiful children, and I both of my colleagues who have offered Nothing in this act or an amendment made am proud to say that I have now four this amendment, and for others who to this act shall be construed to require that grandchildren—the light of my life. I feel deeply about this issue. In the bill an individual terminate coverage under a am just here to say as a mother, as a that has come before us, I think we re- group health plan or health insurance cov- grandmother, and as a Senator from spect all sides and keep in place the erage in which such individual was enrolled California that I trust the women of longstanding ban on Federal funding at the date of the enactment of this act. this country. I don’t want to tell the for abortion services, and no one is ob- According to the sponsors of this bill, women of this country—or tell any- jecting to that. No one is trying to this section protects the ability of per- body else anything like this—that they change that. sons with existing insurance coverage can’t buy insurance with their own pri- As my friends have said, this is about to keep that same coverage. If section vate money to cover their whole range whether we cross that line into private 1251 works as its authors describe it, of legal reproductive health care. We insurance coverage—whether we say to this bill should make no changes to ex- don’t do that to the men. We don’t say a woman, to a family: You are going to isting insurance plans that cover abor- they can’t get any surgery if they have to decide whether, when you have tion and should allow individuals to might need it for their reproductive a child and you are having a crisis in keep the plans they have. health care. We don’t tell them they the third trimester and might need

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00024 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.036 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12671 some kind of crisis abortion services— Members of the Senate and House meet the fact that there will be fewer abor- whether you are going to find yourself with people who have varying degrees tions in America with these health in a situation where you are going to of intensity on this issue all the time. care services. need abortion services, and you are We are not going to resolve this issue Senator MIKULSKI, in the first going to have to publicly indicate that today with this amendment or this bill. amendment we adopted, provided for and buy a rider on insurance because We are going to do several things that more preventive services for women you can’t use your own money to buy I think are important. across the board. Those services, I be- an insurance policy. What we set out to do in health care lieve, would result in more counseling, Here is what we know now. We know reform was honor the time-honored more contraception, and fewer unin- five States have riders right now— principles that we have now accepted. tended pregnancies. That is a reality. Idaho, Kentucky, Oklahoma, Missouri, They are these: Abortion is a legal pro- Every Federal dollar that we spend on and North Dakota. There is no evi- cedure since the Supreme Court case of family planning saves $3 in Medicaid dence there are any riders available in Roe v. Wade. For over 30 years now, we costs. In 1972, we established a special the individual market. So even though, have said no public funds can be used matching rate of 90 percent for family technically, they say you can buy addi- for an abortion but to save the life of a planning services in Medicaid. Across tional coverage, it is not offered or mother or in cases of rape or incest. We the board, we know this money, well available. We are told by the insurance have said that no doctor or hospital spent to allow women to decide their carriers that, in fact, it probably will will be compelled to perform an abor- own reproductive fate, means there are not be available. tion procedure if it violates their con- fewer unintended pregnancies. We all know what this is about. This science. Those are the three basic pil- I argue that whether your position is is about effectively banning abortion lars of our abortion policy in this coun- for or against abortion, if you believe services coverage in the new insurance try. there should be fewer abortions, you exchange we are setting up, which Now comes this debate about health want this health care reform bill to could, in fact, have a broader implica- care reform and a question about pass—with or without the Stupak tion of eliminating the coverage for whether, if we offer health insurance amendment. I think that the Stupak health plans outside the exchanges. So policies through an exchange that of- amendment goes too far, and I think that is what this is about, which is why fers abortion services, and the people we have come up with a reasonable al- it is so important. are paying for the premiums for those ternative that adheres to the three pil- Again, we are agreeing on the elimi- policies with a tax credit, whether we lars I mentioned earlier on abortion nation or banning of Federal funding are indirectly somehow or another fi- policy in America, and it sets up rea- for abortions, other than extreme cri- nancing and supporting abortion. I sonable accounting on these insurance ses circumstances. We have done that argue that we are not. We find, on a policies. I think this language in the in Federal law. This is about whether daily basis, many instances where Fed- bill is the right way to move to lessen we go on to essentially create a situa- eral funds go to a private entity, even the number of abortions in America tion where effectively people cannot a religious entity with clear guidelines and stay consistent with the basic get that coverage with their own that none of the Federal funds can be principles that guide us. I yield the floor. spent for religious or private purposes. money. The PRESIDING OFFICER. The Sen- The Center for American Progress Organizations far and wide across ator from Connecticut is recognized. noted that because approximately 86 America live within those bounds. Mr. DODD. Mr. President, I commend percent of the people who are going to They keep their books clean, and they my colleague from Illinois, the Demo- be offered new opportunities for insur- account for the money received, and no cratic whip of the Senate, for his argu- ance—small businesses, individuals, in questions are asked. The audits show ments. He speaks for me when he iden- the private market—that because 86 that they followed the guidelines. This tifies the pillars of our views on this percent of them will, in fact, receive bill before us strictly follows these issue. some kind of tax credit or tax cut, in guidelines, as well. No Federal funds I was elected to the House of Rep- fact, again, we are talking about elimi- shall be used for any abortion proce- resentatives in 1974, 2 years after Roe nating this option altogether because dure in an insurance policy. It has to v. Wade, and I have been in Congress the majority of people will get some be privately funded. now for 35 years. We have lived with kind of a tax cut during this process. I want to step back and make a those guidelines since then. I know it I think there are also some broader slightly different argument too. There has not resolved the matter for many implications around the tax policy. If are those who have said in the House people. But it has served us well. we are saying that someone can’t pur- and in the Senate that unless the Stu- What we have in this bill is a reflec- chase an insurance policy of their lik- pak language in the House is adopted, tion of a continuation of those pillars. ing if they are getting a tax credit to they would seriously consider voting Having been the acting chair of the help with health insurance, the fact is, against health care reform. I argue to Health, Education, Labor, and Pen- what about other tax credits? What them that is a wrong position to take sions Committee during the markup of about other kinds of ways in which if they are opposed to abortion because the bill—in fact, Senator Kennedy people get tax credits or tax cuts the health care reform bill before us voted by proxy, as they call it in that today? The implications of this are ex- dramatically expands health care cov- process—we insisted upon the adoption tremely broad. erage. of a Kennedy amendment that main- I urge a ‘‘no’’ vote. Let’s keep Fed- Today, there are 17 million women of tained the notion of conscience in eral policy in place that doesn’t allow reproductive age in America who are these matters. So we would not be forc- Federal funding for abortion but re- uninsured. This bill will expand health ing individuals to engage in abortion spects the women of this country. insurance coverage to the vast major- practices if they felt otherwise. The PRESIDING OFFICER. The Sen- ity of them, which means millions We have long held the view in this ator from Illinois is recognized. more women will have access to afford- Congress, under Democratic and Re- Mr. DURBIN. Mr. President, I rise in able birth control and other contracep- publican leadership, despite the dif- opposition to the Hatch-Nelson amend- tive services. This expanded access will ferences—others have different views ment. For 27 years, it has been my reduce unintended pregnancies and re- on this matter—that clearly public honor to serve in both the House and duce abortions. So the family planning money should not be used. Despite the Senate. During that 27 years, the issue aspect of our health care reform will arguments to the contrary, we have of abortion has been front and center actually net fewer abortions in Amer- done that again with this bill. as one of the most controversial and ica—we know this because of the his- The Senator from Illinois made a contentious issues we have faced. When tory of the issue—as more women have point about the measures in the bill I returned home to my congressional access to family planning. So those that deal with wellness and reproduc- district, and now to the State, there who argue that they either have this tive rights. We minimize the likelihood have been many strong, heartfelt posi- amendment or they will vote against of there being a demand for abortion on tions on this issue that are in conflict. health care reform should reflect on the part of many.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00025 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.037 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12672 CONGRESSIONAL RECORD — SENATE December 8, 2009 I appreciate the fact that our leader- ing occurs with the arrival of a child or (a) None of the funds appropriated in this ship has made this matter, the Nelson- grandchild. This bill does that. Act, and none of the funds in any trust fund Hatch amendment, a matter of con- For all of those reasons, this amend- to which funds are appropriated in this Act, ment ought to be defeated. This bill shall be expended for any abortion. science. There is no caucus position on (b) None of the funds appropriated in this this amendment. There never has been ought to be supported and achieve a Act, and none of the funds in any trust fund and nor should there be, in my view, great success for our fellow citizens. to which funds are appropriated in this Act, given the nature of this debate. I yield the floor. shall be expended for health benefits cov- I want to mention another argument The PRESIDING OFFICER. The Sen- erage that includes coverage of abortion. we fail to understand here, in addition ator from New Hampshire is recog- (c) The term ‘‘health benefits coverage’’ to the eloquent ones made by the Sen- nized. means the package of services covered by a ator from Illinois. We rank 29th in in- Mrs. SHAHEEN. Mr. President, I rise managed care provider or organization pur- today to speak in opposition to the suant to a contract or other arrangement. fant mortality in the United States. It This restriction on the use of appropriated is an incredible statistic when you con- Nelson-Hatch amendment. The Patient Protection and Afford- funds to pay for abortions is commonly re- sider the wealth of our Nation. I able Care Act we have before us does so ferred to as the ‘‘Hyde Amendment.’’ In 1976, worked on legislation with our col- Rep. Henry J. Hyde offered an amendment to many good things. It gives women ac- league, LAMAR ALEXANDER, on infant the Departments of Labor and Health, Edu- cess to preventive care. It makes births, prescreening, trying to provide cation, and Welfare, Appropriation Act, 1977, health care more accessible to families resources and help for families with in- that restricted the use of appropriated funds across the country. It changes the way fants who suffer these debilitative and to pay for abortions provided through the patients receive the care they need. We Medicaid program. fatal problems. An exception to the general prohibition on This legislation takes a major step must not let the issue of reproductive choice overshadow all of the things using appropriated funds for abortions is pro- forward in taking the United States this bill gets right. vided in section 508(a) of the omnibus meas- out of the basement when it comes to For over three decades, the Hyde ure: infant mortality and gets us back to The limitations established in the pre- amendment, which prohibits the use of ceding section shall not apply to an abor- where we ought to be in reducing the Federal funds to pay for abortions ex- tragedy that occurs in infant mor- tion— cept in cases of rape, incest, or if the (1) if the pregnancy is the result of an act tality. life of the mother is at risk, has been of rape or incest; or There is a distinction, clearly, be- the law of this land. Abortion should (2) in the case where a woman suffers from tween abortion and infant mortality. play no role in this health care debate. a physical disorder, physical injury, or phys- But this legislation takes a major step The Finance and HELP Committees ical illness, including a life-endangering in improving quality of life, assisting physical condition caused by or arising from spent countless hours drafting legisla- children who arrive prematurely, as the pregnancy itself, that would, as certified tion that is part of the language in our by a physician, place the woman in danger of many do in our country today, and health care bill to make sure it re- many do not survive that prematurity. death unless an abortion is performed. mains neutral on the issue of choice. In other words, funds appropriated to the Today many women are not getting the The Patient Protection and Afford- Department of Health and Human Services kind of support they need during their able Care Act that is currently before (‘‘HHS’’) for FY2009 could be used to pay for pregnancy, thus increasing the likeli- us maintains the Hyde amendment pro- an abortion if a pregnancy is the result of an hood of premature births occurring, or hibiting Federal funding of abortions. act of rape or incest, or if a woman’s life not getting the screenings that need to As a result, neither the pro-choice nor would be endangered if an abortion were not occur immediately so you can avoid performed. Appropriated funds remain un- the pro-life agendas are advanced. available, however, for elective abortions. the terrible problems that can ensue This is clearly explained in an anal- thereafter. This legislation takes a Under the Senate measure, the issuer of a ysis done by the nonpartisan Congres- qualified health plan would determine major step in that direction. sional Research Service. I ask unani- whether or not the plan provides coverage While we have done what is necessary mous consent to have printed in the for either elective abortions or abortions for for us to do, that is, protect the long- RECORD this analysis. which the expenditure of federal funds appro- standing distinction between public There being no objection, the mate- priated for HHS is permitted. If a qualified and private dollars when it comes to rial was ordered to be printed in the health plan decides to provide coverage for elective abortions, it could not use any abortion, we also have gone so much RECORD, as follows: amount attributable to a premium assist- further. This bill provides support for NOVEMBER 30, 2009. ance credit or any cost-sharing reduction to families when it comes to minimizing MEMORANDUM the likelihood a child will be lost be- pay for such services. The community health To: Hon. Jeanne Shaheen. insurance option established by the Senate cause they are not getting support From: Jon O. Shimabukuro, Legislative At- measure would be similarly restricted. H.R. services, as well as providing the repro- torney, American Law Division, Congres- 3590 would allow coverage for elective abor- ductive services that will assist women sional Research Service. tions by the community health insurance op- during their pregnancies. Subject: Abortion and the Patient Protec- tion, but amounts attributable to a premium My colleagues know I am a late tion and Affordable Care Act. assistance credit or cost-sharing reduction bloomer. I am a parent of a 4-year-old This memorandum responds to your re- could not be used to pay for such abortions. and an 8-year-old. My colleagues talk quest concerning abortion and the Patient 2. ‘‘Does the Senate’s Patient Protection about being grandparents. I always Protection and Affordable Care Act. The and Affordable Care Act ensure that the measure was proposed by Senator Harry Reid community health insurance option does not said I was the only candidate in the on November 21, 2009 as an amendment in the use federal funds to pay for abortions beyond country who used to get mail from nature of a substitute for H.R. 3590, the Serv- those permitted by the most recent appro- AARP and diaper services at the same ice Members Home Ownership Tax Act of priation for the Department of Health and time, having qualified for Medicare and 2009. You asked several questions about the Human Services?’’ also being a parent of infant children, Patient Protection and Affordable Care Act The Senate measure would allow coverage two little girls, Grace and Christina. I and the use of federal funds to pay for abor- for elective abortions by the community want them to grow up having all the tion services. This memorandum addresses health insurance option, but amounts attrib- utable to a premium assistance credit or rights of young women in this country. those questions. 1. ‘‘Does the Senate’s Patient Protection cost-sharing reduction could not be used to I am hopeful that one day I may even and Affordable Care Act prohibit afford- pay for such abortions. be around to be a grandparent. We ability and cost-sharing credits from paying 3. ‘‘Under current law, the Weldon Amend- fought very hard to make sure those for abortions beyond those permitted by the ment prohibits Federal agencies or programs children were going to get the protec- most recent appropriation for the Depart- and State or local governments who [sic] re- tions they could during my wife’s preg- ment of Health and Human Services?’’ ceive certain federal funds from discrimi- nancies, to see to it they would be born Division F of the Omnibus Appropriations nating against certain health care entities, healthy and sound. I have a great Act, 2009, provides appropriations for the De- including individuals and facilities, that are partments of Labor, Health and Human Serv- unwilling to provide, pay for, provide cov- health care plan, as a Federal em- ices, Education, and Related Agencies for erage of, or refer for abortions. Does the Sen- ployee, to make sure that will happen. FY2009. Section 507, included within Division ate’s Patient Protection and Affordable Care I want every American to have that F, prohibits generally the use of appro- Act offer an additional, new conscience pro- same sense of security when that bless- priated funds to pay for abortions: tection for individual health care providers

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00026 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.039 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12673 and facilities that are unwilling to provide, have seen from the National Women’s cated abortions. In any supplemental cov- pay for, provide coverage of, or refer for Law Center shows us that in the five erage arrangement, it is essential that the abortions?’’ States that do require such a rider, supplemental coverage be administered in Under the Senate measure, individual there is no evidence that such plans conjunction with basic coverage. This inter- health care providers and health care facili- twined administration approach is barred ties could not be discriminated against be- exist. And even if they did exist, who under Stupak/Pitts because of the prohibi- cause of a willingness or unwillingness to would purchase that kind of a rider? No tion against financial commingling. This bar provide, pay for, provide coverage of, or refer woman expects to need an abortion. is in addition to the challenges inherent in for abortions, if their decisions are based on This is not something you go into plan- administering any supplemental policy. their religious or moral beliefs. Section ning ahead of time. These challenges would be magnified in the 1303(a)(3) of the Senate measure states: ‘‘No Finally, this amendment would have case of medically indicated abortions be- individual health care provider or health effects that reach well into the private cause, given the relatively low number of care facility may be discriminated against insurance market. An independent medically indicated abortions, the coverage because of a willingness or an unwillingness, supplement would apply to only a handful of if doing so is contrary to the religious or analysis by the School of Public Health procedures for a handful of conditions. Fur- moral beliefs of the provider or facility, to and Health Services at George Wash- thermore, the House legislation contains no provide, pay for, provide coverage of, or refer ington University concluded that a direct economic incentive to create such a for abortions.’’ similar amendment adopted in the market. Indeed, it is not clear how such a 4. ‘‘Does the Senate’s Patient Protection House—what is commonly known as market even would be regulated or whether and Affordable Care Act ensure that there is the Stupak amendment—will have an it would be subject to the requirements that a health plan available in every exchange ‘‘industry-wide effect,’’ eliminating apply to all products offered inside the ex- that does not cover abortion beyond those coverage of medically indicated abor- change. Finally, because supplemental cov- permitted by the most recent appropriation erage must of necessity commingle funds for the Department of Health and Human tions over time for all women.’’ That with basic coverage, the impact of Stupak/ Services?’’ means any type of abortion for which Pitts on states’ ability to offer supplemental The Senate measure would require the Sec- there is a medical indication of need Medicaid coverage to women insured through retary of HHS to ensure that in any health would go uncovered. a subsidized exchange plan is in doubt. insurance exchange (‘‘Exchange’’), at least I ask unanimous consent that ‘‘Intro- Spillover effects as a result of administra- one qualified health plan does not provide duction and Results in Brief’’ of the tion of Stupak/Pitts. The administration of coverage for abortions for which the expendi- George Washington University analysis any coverage exclusion raises a risk that, in ture of federal funds appropriated for HHS is applying the exclusion, a plan administrator not permitted. If a state has one Exchange be printed in the RECORD. There being no objection, the mate- will deny coverage not only for the excluded that covers more than one insurance market, treatment but also for related treatments the Secretary would be required to provide rial was ordered to be printed in the that are intertwined with the exclusion. The the aforementioned assurance with respect RECORD, as follows: risk of such improper denials in high risk to each market. AN ANALYSIS OF THE IMPLICATIONS OF THE and costly cases is great in the case of the Mrs. SHAHEEN. Mr. President, the STUPAK/PITTS AMENDMENT FOR COVERAGE Stupak/Pitts Amendment, which, like the health reform legislation before us pre- OF MEDICALLY INDICATED ABORTIONS Hyde Amendment, distinguishes between serves the Hyde language and main- (By Sara Rosenbaum, Lara Cartwright- life-threatening physical conditions and con- tains the status quo in this country. Smith, Ross Margulies, Susan Wood, D. ditions in which health is threatened. Unlike Medicaid agencies, however, the private We should keep it so. This should be a Richard Mauery) INTRODUCTION AND RESULTS IN BRIEF health benefit services industry has no expe- debate about health care. It should be rience with this distinction. The danger is This analysis examines the implications about patients and about ensuring they around coverage denials in cases in which an for coverage of medically indicated abortions have access to quality care at all abortion is the result of a serious health con- under the Stupak/Pitts Amendment (Stupak/ dition rather than the direct presenting stages of their lives, regardless of what Pitts) to H.R. 3962, the Affordable Health treatment. may happen in their lives. It is a mis- Care for America Act. In this analysis we The remainder of this analysis examines take to make this debate one about focus on the Amendment’s implications for these issues in greater detail. abortion. the health benefit services industry as a The amendment that is before us, the whole. We also consider the Amendment’s OVERVIEW OF CURRENT FEDERAL LAW Nelson-Hatch amendment, would re- implications for the growth of a market for 1. The Hyde Amendment and Medicaid The Hyde Amendment has been part of strict any health plan operating in the public or private supplemental coverage of medically indicated abortions. Finally, we each HHS-related appropriation since FY exchange that accepts affordability 1977. As set forth in the most recent annual credits from offering abortion services. examine the issues that may arise as insur- ers attempt to implement coverage deter- Labor/HHS federal appropriations legisla- In essence, the amendment before us minations in which abortion may be a con- tion, the Hyde Amendment provides in perti- would amount to a ban on abortion sequence of a condition, rather than the pri- nent part as follows: coverage in the health insurance ex- mary basis of treatment. Sec. 507. (a) None of the funds appropriated change regardless of where the money Industry-wide impact that will shift the in this Act, and none of the funds in any comes from. Put another way, a woman standard of coverage for medically indicated trust fund to which funds are appropriated abortions for all women: In view of how the under this Act, shall be expended for any who pays for insurance with money out abortion. of her own pocket would most likely health benefit services industry operates and how insurance product design responds to (b) None of the funds appropriated in this not be able to get insurance that cov- broad regulatory intervention aimed at re- Act, and none of the funds in any trust fund ers abortion. shaping product content, we conclude that to which funds are appropriated in this Act, Make no mistake about it, this the treatment exclusions required under the shall be expended for health benefits cov- amendment is much more than a de- Stupak/Pitts Amendment will have an indus- erage that includes coverage of abortion. (c) The term ‘‘health benefits coverage’’ bate on whether Federal funds should try-wide effect, eliminating coverage of means the package of services covered by a medically indicated abortions over time for be used for abortion, which is already managed care provider or organization pur- all women, not only those whose coverage is established law. It is established law suant to a contract or other arrangement. that is maintained in the Patient Pro- derived through a health insurance ex- Sec. 508. (a) The limitation established in tection and Affordable Care Act before change. As a result, Stupak/Pitts can be ex- the preceding section shall not apply to an pected to move the industry away from cur- us. abortion— rent norms of coverage for medically indi- (1) if the pregnancy is the result of an act The Nelson-Hatch amendment is a cated abortions. In combination with the very far-reaching intrusion into the of rape or incest; or Hyde Amendment, Stupak/Pitts will impose (2) in the case where a woman suffers from lives of women in how we would get a coverage exclusion for medically indicated a physical disorder, physical injury, or phys- private insurance. It is unprecedented, abortions on such a widespread basis that ical illness, including a life-endangering and it would mean millions of women the health benefit services industry can be physical condition caused by or arising from would lose coverage they currently expected to recalibrate product design down- the pregnancy itself, that would, as certified have. ward across the board in order to accommo- by a physician, place the woman in danger of It is true, as we have heard from date the exclusion in selected markets. death unless an abortion is performed. Supplemental insurance coverage for medi- those people who support this amend- cally indicated abortions: In our view, the Mrs. SHAHEEN. When we pass this ment, that a woman would be able to terms and impact of the Amendment will legislation that will reform our health buy an abortion rider. What we heard work to defeat the development of a supple- care system, it should not be done in a from Senator STABENOW and what we mental coverage market for medically indi- way that would lose benefits for

VerDate Nov 24 2008 05:44 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00027 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.008 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12674 CONGRESSIONAL RECORD — SENATE December 8, 2009 women. All women should have access The language in this bill is clear: It Mr. CASEY. Mr. President, I rise in to comprehensive health care, includ- preserves a woman’s reproductive support of the Nelson amendment for ing reproductive health care, from the rights without any taxpayer funding. two reasons, and I speak for myself, provider of their choice. Yet we are engaged in a debate in not for other Members of the Senate. I urge my colleagues to oppose any which we are basically being told that Obviously, I know there is a good bit of amendment that threatens reproduc- neutrality is not good enough; that disagreement on both sides and even tive care that women have counted on there needs to be an antichoice bill, within both sides of the aisle. for over 30 years. not a health care reform bill; that neu- But I support this amendment for The PRESIDING OFFICER. The Sen- trality on the issue is not acceptable; two reasons. One, I wish to make sure ator from New Jersey is recognized. that only effectively banning abortion we ensure, through this health care Mr. MENENDEZ. Mr. President, is acceptable. We are not going to be legislation, the consensus we have had health care reform legislation we are dragged down that road, and the as part of our public policy for many considering is good for America, it is women of this country will not stand years now—that taxpayer dollars don’t good for women and for families. It is a for it. Certainly, this Senator will not pay for abortions. I believe we can and health care reform bill; it is not an either. should and will get this right by the abortion bill. In fact, not a dime of tax- The sponsors claim the amendment end of this debate. payers’ money goes to subsidize abor- simply reinforces existing law restrict- The second reason I support this is, I tion coverage in this bill. It is, in fact, ing Federal funding of abortion cov- abortion neutral. believe it is important to respect the erage. Let’s be very clear: There is no conscience of taxpayers, both women This amendment, however, would taxpayer money going to a woman’s re- and men across the country, who don’t change that. It would roll back the productive choices—none—and to say want taxpayer dollars going to support clock on a woman’s right to choose. It otherwise is simply wrong. unfairly singles women out and takes The fact is, this amendment that abortions. If there is one or maybe two away benefits they already have. It sin- clearly takes us back in time would areas where both sides can agree—peo- gles out our daughters and legislates leave our daughters with the same ple who are pro-life and pro-choice—it limits on their reproductive health, hopeless lack of options their grand- is on these basic principles: No. 1, we their reproductive rights. If we were to mothers faced, and that is not where don’t want to take actions to increase do the same to men, if we were to sin- we ought to be. the number of abortions in America. I gle out men’s reproductive health in This amendment would make it vir- think that is the prevailing view across this legislation, imagine the outcry. tually impossible for insurance plans in the divide of this issue. No. 2, we also Imagine if men were denied access to the exchange to offer abortion cov- have to do more to help those women certain procedures. Imagine if they erage even if a woman were to pay pre- who are pregnant, and I don’t believe were denied access to certain prescrip- miums entirely out of her own pocket. we are doing enough. We will talk more tion drugs. Imagine if the majority had It would do so by forbidding any plan about that later. Even as we debate to suffer the decision of the minority. that includes abortion coverage from this amendment, the third thing I But that is exactly what we are being accepting even one subsidized cus- think we can agree on is, no matter asked to do to our daughters with this tomer. what happens on this vote—and this de- amendment—rolling back the hands of This amendment is nothing more bate will continue, even in the context time. I personally find that offensive, than a backdoor effort to restrict of this bill—I believe we have to pass as do women across this country. rights women already have. Would I health care legislation this year. The language of this bill has been like to see it clearly stated in this leg- There are all kinds of consumer pro- carefully negotiated to ensure that we islation that a woman should have a tections in this bill that will help men are preserving a woman’s right to right to choose and all aspects of her and women—prevention services that choose but doing so without Federal reproductive health should be available have never been part of our health care funding. To claim otherwise is hypo- under every plan? Yes, I would. But am system before, insurance reforms to critical and misleading. I willing to accept neutrality as a rea- protect families and, finally, the kind We need not fight all battles that sonable compromise for the sake of of security we are going to get by pass- have nothing to do with the real issue passage of a bill that will provide af- ing health care legislation for the at hand—that millions of Americans do fordable, accessible health care to American people. I believe we can get not have health insurance and many every American and not spend a dime this decisive issue correct in this bill. are being forced into debt to buy cov- of taxpayers’ money on women’s repro- We are not there yet, but I believe we erage that insurers later deny. But ductive choices? I will. can. I believe we must pass health care now, instead, we are not only reopen- Under this bill, if a plan chooses to legislation this month through the ing long-settled debates over this issue, provide abortion coverage, only private Senate and then, from there, get it en- we are actually faced with a proposal funds can go toward that care. That is acted into law. that would turn back the clock and further than I would like to go, but it I yield the floor. deny women access to reproductive is neutrality. In this bill, in each State The PRESIDING OFFICER. The Sen- health care. It is the wrong debate at exchange, there would be at least one ator from California. the wrong time. plan that covers abortion and one plan Mrs. BOXER. Mr. President, before Over the years, we have made ex- that does not. That is neutrality. It is traordinary progress in addressing we turn this over to the Republican fair. Let’s accept it and move on. side, I ask unanimous consent to have women’s reproductive rights. We have Under this legislation, women will printed in the RECORD a letter from re- debated this issue in the Senate. We keep their fundamental right to repro- ligious leaders who support maintain- have debated it in our churches, in our ductive health benefits and gain other ing the underlying bill and who oppose homes, in our communities, and in the benefits. U.S. Supreme Court that has said a The PRESIDING OFFICER. The Sen- this amendment, and they are: Catho- woman’s right to choose is the law of ator has spoken for 5 minutes. lics for Choice, Disciples Justice Ac- the land. Let’s not turn back the clock. Mr. MENENDEZ. That is what we tion Center, The Episcopal Church, I respect the deeply held views of my should do in terms of the underlying Jewish Women International, Pres- friend from Nebraska and the deeply bill. Let’s vote down this amendment. byterian Church Washington Office, held views of my friend from Utah. I Let’s not turn back the clock. Religious Coalition for Reproductive know we will debate the issue many Mrs. BOXER. Mr. President, I ask Choice, Union of Reform Judaism, times in many forums. They will raise unanimous consent that in lieu of Sen- United Church of Christ, Justice and their voices in protest of a woman’s ator BAUCUS’s 4 minutes, Senator Witness Ministries, United Methodist right to choose, as I will raise mine to CASEY take that time. Church-General Board of Church and protect it. But this is neither the time The PRESIDING OFFICER. Without Society, Unitarian Universalist Asso- nor the legislative vehicle for hot-but- objection, it is so ordered. ciation of Congregations. ton politics to get in the way of badly The Senator from Pennsylvania is We are proud to have their support needed health care reform. recognized. for our position.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00028 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.041 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12675 There being no objection, the mate- They have long been champions of the to fund abortions directly or indi- rial was ordered to be printed in the pro-life cause, and I applaud them for rectly. Health care reform, under the RECORD, as follows: putting the time and effort into this Reid language, has become a vehicle RELIGIOUS LEADERS SUPPORT MAINTAINING amendment to get it right, bringing it for changing the current law of the THE STATUS QUO ON ABORTION IN HEALTH to the floor, and offering it. I am very land regarding abortion coverage. Here CARE REFORM proud to stand here today as a cospon- is what some of my constituents have The undersigned religious and religiously sor of this legislation. said to me, and I am quoting from a affiliated organizations urge the Senate to Fundamentally, this legislation is gentleman in Kearney: support comprehensive, quality health care simply about doing the right thing. It It is time to make sure that abortion is ex- reform that maintains the current Senate ensures that current Federal law is plicitly prohibited by any language that may language on abortion services. upheld. In its most basic form, it says be put forward. We believe that it is our social and moral obligation to ensure access to high quality taxpayer dollars are not going to be Another Nebraskan said to me: comprehensive health care services at every used, directly or indirectly, to finance I know that the pro-life issue is not the stage in an individual’s life. Reforming the elective abortions. In fact, this has only component of the Healthcare bill to health care system in a way that guarantees been the law of our country now dating consider, but it is probably the most impor- affordable and accessible care for all is not back three decades. tant issue of concern that I have in this bill. simply a good idea—it is necessary for the Basically, this amendment applies Abortion is not health care. well-being of all people in our nation. the Hyde amendment to the health From central Nebraska I heard this: The passage of meaningful health reform care reform bill. It bars Federal fund- legislation will make significant strides to- I’m taking a minute to send a note to say ing for abortion, except in the case of ‘‘thank you’’ for standing up for life. Life is ward accomplishing the important goal of rape, incest, or to protect the life of access to health care for all. Unfortunately, precious, whether you are just conceived or the House-passed version of health reform in- the mother. The Hyde amendment—as over 100 years of age. cludes language that imposes significant new we have heard so many times during Pro-life groups across the board sup- restrictions on access to abortion services. this debate—finds its genesis in 1977. port this amendment—the National This provision would result in women losing The language in the Nelson-Hatch Right to Life, Catholic Bishops, Family health coverage they currently have, an un- amendment is virtually identical to Research Council, and others. They fortunate contradiction to the basic guiding the Stupak language that was included represent millions of Americans. But principle of health care reform. Providing af- in the House bill, where 240 Represent- fordable, accessible health care to all Ameri- the reality is, Americans support this. atives in the House supported it and it In a recent CNN survey, we confirm cans is a moral imperative that unites Amer- passed on a vote of 240 to 194. icans of many faith traditions. The selective that 6 in 10 Americans favor a ban on withdrawal of critical health coverage from The Stupak language very clearly the use of Federal funds for abortion. A women is both a violation of this imperative prohibits Federal funding of abortions. recent Washington Post-ABC News poll and a betrayal of the public good. It says this: No. 1, the government-run indicates 65 percent of adults believe The use of this legislation to advance new plan cannot cover abortions. That private insurance plans paid for with restrictions on abortion services that sur- seems very straightforward. No. 2, government assistance should not in- pass those in current law will serve only to Americans who receive a subsidy can- clude coverage of abortion. derail this important bill. The Senate bill is not use it to buy health insurance that already abortion neutral, an appropriate re- I was in McCook, NE, a while back, covers abortion. No. 3, the Federal doing a townhall meeting in August. flection of the fact that it is intended to Government cannot mandate abortion serve Americans of many diverse religious After everybody had left, a gentleman and moral views. The bill includes com- coverage by private providers or plans. came up to me. He told me something promise language that maintains current Then, finally, No. 4, as has been the about that I will remember all the law, prohibiting federal funds from being case for 30 years, private insurance years I am in the Senate. First, he used to pay for abortion services, while still plans may cover abortion, and individ- spoke about his faith, and then he said: allowing women the option to use their own uals may purchase a plan that covers I hope you understand, Senator, I can- private funds to pay for abortion care. Amer- it, but taxpayer dollars cannot be in ican families should have the opportunity to not, under any circumstances, agree to the mix to purchase that. anything that would allow my tax- choose health coverage that reflects their Compare that to what is in the cur- payer dollars, either directly or indi- own values and medical needs, a principle rent Senate bill. The government-run that should not be sacrificed in service of rectly, to fund abortions. He said: I plan can cover abortion. Americans any political agenda. cannot go there. He said: Please, do ev- who receive a subsidy can use it to buy We urge the Senate to support meaningful erything you can to stop this from hap- a health insurance policy that covers health reform that maintains the com- pening. promise language on abortion services cur- abortion. The Federal Government can Today, I stand with that gentleman rently in the bill. and does mandate abortion coverage by from McCook, NE, to say we have to Respectfully, at least one provider or plan. There is stop this. Catholics for Choice, Disciples Justice a stipulation in the current bill that Action Center, The Episcopal Church, I applaud my colleague from Ne- requires the Health and Human Serv- Jewish Women International, braska, and I wish to end my com- ices Secretary to assure the segrega- NA’AMAT USA, National Council of ments with this. Senator NELSON stood Jewish Women, Presbyterian Church tion of funds, the tax credit/Federal on this issue and in a recent interview (U.S.A.) Washington Office, Religious dollars can’t be used. he said this: Coalition for Reproductive Choice, The But the reality is, it is akin to say- Religious Institute, Union of Reform ing: Here, put those Federal dollars in I have said at the end of the day, if it doesn’t have the Stupak language on abor- Judaism, United Church of Christ, Jus- your left pocket. When you are pur- tice and Witness Ministries, United tion in it, I won’t vote to move it off the chasing the abortion coverage, make floor. Methodist Church—General Board of sure it is your right hand that is reach- Church and Society, Unitarian Univer- I think that is a courageous state- ing into your right pocket. How do you salist Association of Congregations. ment. I do not mind standing here and segregate those funds? It is impossible. Mrs. BOXER. I thank the Chair. saying I am very pleased to associate What it does is to simply erase the line Mr. ENZI. Mr. President, I assume myself with Senator NELSON and Sen- between taxpayer dollars and funding that added a few additional minutes to ator HATCH on this important amend- of abortions. our time as well. Quoting the National Right to Life: ment. I yield 10 minutes to the Senator Mr. President, how much time do I Senator Reid included in his substitute bill from Nebraska. language that some have claimed would pre- have remaining? The PRESIDING OFFICER. The Sen- serve the principles of the Hyde Amendment. The PRESIDING OFFICER. The Sen- ator from Nebraska is recognized. Such claims are highly misleading. In re- ator has 2 minutes 45 seconds. Mr. JOHANNS. Mr. President, let me ality, the Reid language explicitly author- Mr. JOHANNS. I yield my 2 minutes start my remarks today, if I could, by izes direct funding of elective abortion by a 45 seconds to Senator HATCH when he offering my words of support and com- Federal Government program. speaks. I yield the floor. mendation to Senators NELSON and Well, I feel very strongly we must en- The PRESIDING OFFICER. Without HATCH for offering this amendment. sure that Federal dollars are not used objection, it is so ordered.

VerDate Nov 24 2008 05:44 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00029 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.005 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12676 CONGRESSIONAL RECORD — SENATE December 8, 2009 Mr. GRASSLEY. Mr. President, I that we don’t do Federal funding of ing Federal funding of abortion is fis- yield 10 minutes to the Senator from abortions. I will read to you what the cally irresponsible and morally inde- Kansas. normal status is. The U.S. Conference fensible. Those are the two central The PRESIDING OFFICER. The Sen- of Catholic Bishops, which supports pieces we are discussing, the fiscal re- ator from Kansas is recognized. this base bill but does not support sponsibility or irresponsibility of this Mr. BROWNBACK. Mr. President, I funding of abortions, describes it this and the moral indefensibility. At a appreciate this very much. It has been way: time of hemorrhaging debt, the Federal a healthy debate, a big debate, and it is In every major federal program where fed- Government being supportive and fund- an unusual debate because we haven’t eral funds combined with nonfederal funds to ing elective abortions flies in the face debated Hyde around here for 20 years. support or purchase health coverage, Con- of trying to restrain or bend the cost So this is an unusual debate we are gress has consistently sought to ensure that curve down in this legislation. That is having. Normally, we debate about the entire package of benefits excludes elec- not us being fiscally responsible. abortion but not about abortion fund- tive abortions. For example, the Hyde I have shown this chart before, but I ing because there has been an agree- amendment governing Medicaid prevents the think it is so striking. Back when we funding of such abortions not only using fed- ment in this body for 33 years about did do funding for abortions, we funded eral funds themselves, but also using the about 300,000 a year. How is that extra that. So this is an unusual debate, but state matching funds that combine with the I think it is an important one. federal funds to subsidize the coverage. A funding going to help us be more fis- I think it is extraneous, in many re- similar amendment excludes elective abor- cally responsible? That is why a major- spects, to the health care bill itself. tions from all plans offered under the Fed- ity of the people, pro-life and pro- Abortion is not health care, and so why eral Employees Health Benefits Program, choice, are saying the Federal Govern- we are debating the funding of abortion where private premiums are supplemented ment should not be funding this. I in a health care bill seems odd to me. by a federal subsidy. don’t believe that is fiscally respon- But it is in the base bill, and we need So there it is prohibited as well. sible. And it is morally indefensible. to deal with that. Where relevant, such provisions also speci- Whether you are pro-choice or pro- A lot of people are coming forward fy that federal funds may not be used to help life, we are having 300,000 children who and saying: Well, OK, which way is pay the administrative expenses of a benefits are not going to be here that we are this; is it in the bill or not on funding package that includes abortions. Under this funding the elimination of. Under any- policy, those wishing to use state or private for abortion? I am going to go to an body’s definition of looking at that, funds to purchase abortion coverage must do they would say that is morally indefen- independent fact checker and cite this. so completely separately from the plan that This is an independent research and sible for the Federal Government that is purchased in whole or in part with federal has long debated abortion policy, has prize-winning fact checker, financial assistance. not debated abortion funding, that that PolitiFact.com, and they say our oppo- Here I take a quick aside. That is is morally indefensible for us to do nents’ characterization of this amend- what we are saying should be done in something along that line. ment was ‘‘misleading’’ and that ‘‘the this bill, but it is not what is done in There are many issues to debate but people who would truly pay all their this bill. thankfully Hyde has not been one of premium with their own money, and Going on: them we have been debating until now. who would not use Federal subsidies at This is the policy that health care reform I say to my colleagues the admonition all, not barred in any way from obtain- legislation must follow if it is to comply we have had many times, whether you ing abortion coverage, even if they ob- with the legal status quo on federal funding of abortion coverage. All of the five health choose this day life or death, blessing tain their insurance from the federally or curse, why wouldn’t we choose the administered health exchange.’’ care reform bills approved in the 111th Con- gress violate this policy. life route on this one? Even if you have That is an independent group, a close call or you are questioning this, PolitiFact.com, saying this doesn’t This is from a group, the United States Conference of Catholic Bishops, why wouldn’t we choose the route that limit the ability for somebody on their says: I am not going to fund 300,000 own to be able to purchase abortion that supports health care reform but not the abortion funding in it. They abortions. I want abortion to be safe, coverage, if they want to do that, but legal and rare, as some people in this say as well that this fails in the Reid in the base bill, what we are saying is body, but that is not rare, 300,000. Why bill, that there is explicit funding for we don’t want to put Federal funds in wouldn’t we choose the life route that abortion in this bill. it as the longstanding policy has been says this is a controversial issue some- I thank my colleagues, particularly here. time way in the past, not recently. We on the other side of the aisle, Senators As the President himself has said don’t fund these things. So many peo- NELSON and CASEY, for being major co- when he spoke to a joint session of ple in America don’t want their money sponsors of this amendment. They are Congress, launching the health care de- used to pay for abortions. Yet in this the ones who look at this and say: I bate: base Reid bill, it is there. I urge my don’t want this in the base bill. This One more misunderstanding I want to clear colleagues to vote in favor of the Nel- should not be in the base bill. It up—under our plan, no Federal dollars will son-Hatch-Casey amendment that puts be used to fund abortions, and Federal con- doesn’t belong in the base bill. The lan- into Hyde language that is the status science laws will remain in place. guage should be different. quo that there is not taxpayer funding Unfortunately, in the Reid bill, this I also wish to note that most people going toward abortion and to reject is not true. This is not true in the Reid across the country don’t want this in those who would put the Reid language bill. What is in the Reid bill is the so- the base bill. A majority of the country forward that would take us back dec- called Capps amendment language, is opposed to the bill overall. They ades to an era when we did fund abor- which allows for the Federal funding of don’t think this is the way we should tion procedures. abortion. go. They think it is the wrong way. But I yield the floor. I wish to describe—and I think a even people who support the bill itself Ms. SNOWE. Mr. President, I rise great deal of what is in here has been by and large don’t want Federal fund- today to voice my opposition to the described, but what is taking place is ing for abortion to be in this bill. Nelson-Hatch amendment. In delib- the Federal subsidization of an insur- A Pew poll even showed that 46 per- erating how to construct a fair equi- ance program that will have abortion cent of people who support health care table solution to such a divisive ques- funding in it. According to most reform want to see the radical abortion tion, the one thing that our Group of 6 groups, that is what is taking place in language removed, the Capps language agreed on during our meetings prior to the Capps language, which is in the in the Reid bill, and all pro-choice Re- the markup of legislation in the Fi- base Reid bill. publicans and several pro-choice Demo- nance Committee was that we wanted I say this is an unusual debate that is crats supported the measure in the to remain neutral and preserve the sta- taking place because we haven’t de- House that put Stupak language in tus quo. bated Hyde for years around here. I that removed the Federal funding for I am pleased that Majority Leader wish to read to you what is our normal abortion. The American people feel REID chose to reflect the Finance Com- status on funding of abortions; that is, this way because they know that forc- mittee’s work because I believe that we

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00030 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.043 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12677 achieved that careful balance. Federal leading it to drop coverage in all mar- This is critical as mothers who re- funds continue to be prohibited being kets in order to meet the lowest com- ceive no prenatal care have an infant used to pay for abortions unless the mon denominator in both the exchange mortality rate more than six times pregnancy is due to rape, incest or if and expanded Medicaid markets.’’ that of mothers receiving early pre- the life of the mother is in danger. As opposed to the demonstrated evi- natal care. Yet 20 percent of women of Health plans that choose to cover abor- dence from States that separating Fed- childbearing age are uninsured and ap- tion care must demonstrate that no eral funds can and does work, we can- proximately 13 percent of all pregnant tax credits or cost-sharing credits are not say the same about the availability women are uninsured. used to pay for abortion care. of supplemental, abortion-only cov- This bill also at long last ends the The Finance Committee adopted this erage. discriminatory practice of gender rat- solution primarily because the policy In the five States that have similar ing. For years, women in this age of separating Federal dollars from pri- prohibitions on abortion coverage to group seeking insurance coverage have vate dollars has been achieved in other the Nelson-Hatch amendment, supple- faced clear inequities compared to instances and there is a precedent for mental coverage is generally not of- men. A study conducted by the Na- that approach. Today, 17 States cover fered—as a result of a lack of market tional Women’s Law Center found that abortion beyond the Hyde limitations demand for riders. And even if supple- insurers who practice gender rating with State-only dollars in their Med- mental coverage were available, there charged 25-year-old women anywhere icaid Programs. States and hospitals, are significant privacy concerns. If a from 6 percent to 45 percent more than which in no way want to risk their eli- woman opted to purchase supplemental 25-year-old men, and charged 40-year- gibility for Medicaid funding, use sepa- abortion coverage, it could be inferred old women from 4 percent to 48 percent rate billing codes for abortions that are that she plans to obtain an abortion. more than 40-year-old men. These crit- allowable under the Hyde amendment, Confidentiality is vital to women who ical improvements will enhance both and those that are not. And let me em- are making this choice and the possi- access and health care outcomes for phasize, there have never been any vio- bility that this information could be women. This is precisely the direction lations among the States in this re- disclosed is both serious and dis- we should be heading in . . . rather gard. Moreover, a similar approach has turbing. Women may face harassment than placing additional obstacles in also been taken with Title X family and intimidation on what should be a front of women. planning funds and the United Nations private matter between her family and Throughout my tenure in Congress I Population Fund. We ought to hew to her physician. have opposed Federal funding for abor- current law and what we know already The fact of the matter is, whether to tion. At the same time, as a champion works. undergo an abortion is one of the most of women’s health, I have profound res- Yet some want to prohibit women wrenching decisions a woman can ever ervations about limiting coverage op- from using their own money—beyond make—and we shouldn’t ignore the real tions for women when they are contrib- taxpayer dollars—towards purchasing a life circumstances that lead them to uting private dollars. Women who are plan in the exchange that covers abor- this choice. For some expecting moth- subject to an individual mandate and tion or limit coverage only through a ers, tragedy strikes when a lethal fetal are contributing private dollars to the supplemental policy. I have strong res- anomaly is discovered. Other times cost of their insurance should not have ervations about taking such an ap- there may be adverse health con- coverage choices dictated for them by proach. sequences to continuing a pregnancy. the Federal Government. We are mak- Under the Nelson-Hatch amendment, In these heartbreaking cases, a woman ing decisions that will affect women on a woman must try to predict whether without coverage can face severe finan- an intensely personal level and if we or not she will require that coverage. cial hardship in paying for these health fail to craft the right solution, it could This is an unfair proposition. Half of costs—not to mention emotional an- have serious implications for women’s all pregnancies in this country are un- guish from ending a planned preg- health and privacy. planned and most women do not antici- nancy. I appreciate the Finance Commit- pate the necessity for abortion cov- Rather than focusing on abortion, we tee’s effort to navigate this difficult erage. Furthermore, in most cases, should concentrate on the significant issue and hope we can concentrate on women already have that coverage. obstacles women of child-bearing age the task at hand—providing coverage Today, between 47 and 80 percent of face under our current health care sys- to the 30 million uninsured Americans. private plans cover abortion services. tem. And we have achieved some clear In that light, I urge my colleagues to So for a middle income woman who al- victories for women in this bill. For ex- vote against the Nelson-Hatch amend- ready purchases coverage in the indi- ample, maternity and newborn care is ment. vidual market and could now receive a specifically included as an essential The PRESIDING OFFICER (Mr. subsidy, let me be clear about the ef- health benefit. Pregnancy is typically CASEY). Who yields time? fect this change would have. This the most expensive health event for Mr. GRASSLEY. I yield such time as would take away coverage she cur- families during their childbearing is remaining to the Senator from Utah. rently has essentially creating a two years and there are significant con- Mr. HATCH. Mr. President, I had a tiered system for women who don’t sequences in a lack of coverage or even longer statement I was going to deliver have coverage through their employer minimal coverage. Maternity coverage this afternoon, but after listening to and instead receive it through the ex- in the individual insurance market is my colleagues speak about the Nelson- change. That is fundamentally wrong, difficult to find and exceedingly expen- Casey-Hatch amendment, I want to and it is patently unfair. sive if it is available. Maternity cov- take my time to refute some of the ar- And the fact is, over time, more and erage riders alone ranged from $106 to guments they are making about our more individuals will receive coverage $1,100 per month, required waiting peri- amendment. through the exchange, which means ods of one to 2 years with either no or It does not even sound as though that the number of women who will limited coverage during that period they are talking about the same confront these restrictions will grow. and capped total maximum benefits as amendment I filed with Senators NEL- Not only that but this amendment low as $2,000 to $6,000. Yet expenditures SON and CASEY. Our amendment does threatens to reach even further than for maternity care average $8,802. nothing to roll back women’s rights. the exchange. According to a study by I am also pleased that we passed the When my colleagues on the other side the George Washington University Mikulski amendment, which I was say that, they are simply School of Public Health that reviewed proud to cosponsor, that will enhance mischaracterizing our amendment. Our the Stupak/Pitts provisions from the preventive services for women. This amendment ensures that the Hyde lan- House ‘‘the size of the new market is could include preconception care, guage, a provision that has been in the large enough so that Stupak/Pitts can where doctors counsel women on nutri- HHS appropriations legislation for the be expected to alter the ‘default’ cus- tion and other health interventions be- last 33 years, will apply to the new toms and practices that guide the fore they become pregnant, as well as health care programs created through health benefits industry as a whole, proper prenatal care. this bill. We are applying current law

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00031 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.009 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12678 CONGRESSIONAL RECORD — SENATE December 8, 2009 to these programs. That is it. The cur- counting scheme. Under the accounting (B) such coverage or plan is not purchased rent Hyde language ensures that no scheme, the government is permitted using— Federal Government funds are used to to subsidize abortion coverage provided (i) individual premium payments required pay for elective abortion or health for a qualified health plan offered through that funds used to reimburse for abor- the Exchange towards which a credit is ap- plans that provide elective abortion. tions are labeled ‘‘private’’ funds. This plied under section 36B of the Internal Rev- Today States may only offer Medicaid is an end run around the Hyde restric- enue Code of 1986; or abortion coverage if the coverage is tion on funding for plans that cover (ii) other non-Federal funds required to re- paid for using entirely separate State abortion. ceive a Federal payment, including a State’s funds, not State Medicaid matching Furthermore, under the accounting or locality’s contribution of Medicaid match- funds. They cannot do that under cur- scheme, premium holders will be forced ing funds. rent law. This is a longstanding policy to pay at least $12 per year as an abor- Under the Nelson-Hatch-Casey based on a principle that the Federal tion surcharge to be used to pay for amendment, women are allowed to pur- Government does not want to encour- abortions. The Nelson-Casey-Hatch chase separate elective abortion cov- age abortion. amendment would ensure that no funds erage with their own money. I wish For example, Guttmacher studies under H.R. 3590 will subsidize plans they would not, but we allow it. Any- show that when abortion is not covered that cover abortion. However, it does body who says otherwise is misrepre- in Medicaid, roughly 25 percent of nothing to prohibit individuals from senting what this amendment does. I women in the covered population who purchasing separate abortion coverage am sure they are not intentionally would have otherwise had an abortion or from purchasing plans that cover misrepresenting but nevertheless mis- choose to carry to term. I wanted to abortion without a Federal subsidy. representing. So have fair warning. explain why the Reid-Capps language Another issue I want to raise is the It is also true that our amendment in the Reid bill is not the Hyde lan- impact the Nelson-Hatch-Casey amend- allows women to purchase a health guage. First, the Hyde amendment pro- ment would have on coverage of elec- plan that includes coverage of elective hibits funding for abortions through tive abortions by private health plans. abortions in addition to the supple- Medicaid and other programs funded I heard some of my colleagues say that mental abortion policy as long as they through the HHS appropriations bill. our amendment would prohibit women pay for it with their own money. So However, the public option is not sub- from purchasing health plans with when those who oppose our amendment ject to further appropriation and there- abortion coverage, even if they spend say a woman would never want to pur- fore is not subject to Hyde. Directly their own money. I understand there is chase abortion coverage as a separate opposite of the Hyde amendment, the a Politifact story with the headline rider, they are truly misunderstanding Reid-Capps language explicitly author- ‘‘Lowey Says Stupak Amendment Re- that our language also permits women izes the newly created public option to stricts Abortion Coverage, Even for to purchase an identical exchange plan pay for elective abortions. The public Those Who Pay for Their Own Plan.’’ that includes coverage of elective abor- option will operate under the authority That is simply not true. Our amend- tions, in addition to other health bene- of the Secretary of HHS and draw funds ment would not prohibit the ability of fits. To be clear, under our amendment, from the Federal Treasury account. women to obtain elective abortions as a woman may purchase with her own Regardless of how these funds are col- long as they use their own money to funds either a supplemental policy that lected, these funds from the Treasury purchase these policies and not the covers elective abortions or an entire are Federal funds. Funding of abortion money of the taxpayers of America, di- health plan that includes the coverage through this program will represent a rectly or indirectly. Again, our oppo- of elective abortions. clear departure from longstanding pol- nents will argue that it does, but if Today, Federal funds may not pay for icy by authorizing the Federal Govern- they take the time to read our amend- elective abortions or plans that cover ment to pay for elective abortion for ment, they will note on page 3, line 6, elective abortions. This is the funda- the first time in decades. that it ensures there is an option to mental component of the Hyde lan- The Nelson-Hatch-Casey amendment purchase separate supplemental cov- guage. And to be clear, the Nelson- would prohibit funding for abortion erage or a plan with coverage for elec- Hatch-Casey language does not prevent under H.R. 3590 except in the cases of tive abortions. In fact, let me read it to people purchasing their own private rape, incest, or to save the life of the my colleagues so we are all clear on plans that include elective abortion mother. As is the case with the CHIP what the language actually says. I am coverage with private dollars. program and Department of Defense going to read it because I am tired of In addition, our amendment explic- health care, the Nelson-Hatch-Casey hearing some of the misrepresentations itly states that these types of policies amendment would be permanent law made on the floor by, I am sure, well- may be offered. In other words, our rather than an appropriations rider, meaning people who are very poorly in- amendment does not restrict these subject to annual debate and approval. formed on this amendment. It is easy policies from being offered. The only Any funding ban subject to annual ap- for me to see why they are poorly in- caveat is that they may not be pur- proval will be in jeopardy in the future. formed when I look at this itty-bitty chased with Federal subsidies. We want Even if there are the votes to maintain bill. to make that clear, and the Reid-Capps the Hyde language, procedural tactics My gosh, no matter how bright you language does not. and veto threats could be employed and are, who could know everything in this Let me read that section of the Nel- make it impossible to retain an annual itty-bitty bill that will break the desk, son-Hatch-Casey amendment for my ban. if I drop it on it. colleagues. It may be found on page 4, Secondly, the Hyde amendment pro- I am sorry. I scared the distinguished line 3, of the Nelson-Hatch-Casey hibits funding for health benefits cov- Senator from Iowa with this itty-bitty amendment. erage that includes coverage of abor- bill. I should have dropped it a little (3) Option To Offer Supplemental Coverage tion. This requirement ensures that bit softly. I apologize. Or Plan.— the Federal Government does not en- Let me tell you what it actually Now get this: courage abortion by providing access says. Nothing in this subsection shall restrict to it. When the government subsidizes (2) OPTION TO PURCHASE SEPARATE SUPPLE- any non-Federal health insurance issuer of- a plan, it is helping to make all of the MENTAL COVERAGE OR PLAN.—Nothing in this fering a qualified health plan from offering covered services available. Federal pre- subsection shall be construed as prohibiting separate supplemental coverage for abor- mium subsidies authorized and appro- any non-Federal entity (including an indi- tions for which funding is prohibited under priated in H.R. 3590 are not subject to vidual or a State or local government) from this subsection, or a plan that includes such annual appropriations and they are, purchasing separate supplemental coverage abortions, so long as— therefore, not subject to the Hyde lan- for abortions for which funding is prohibited (A) premiums for such separate supple- under this subsection, or a plan that includes mental coverage or plan are paid for entirely guage. Directly opposite of the Hyde such abortions, so long as— with funds not authorized or appropriated by language, the Reid-Capps explicitly al- (A) such coverage or plan is paid for en- this Act; lows federal subsidies to pay for plans tirely using only funds not authorized or ap- (B) administrative costs and all services that cover abortion by applying an ac- propriated by this Act; and offered through such supplemental coverage

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00032 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.046 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12679 or plan are paid for using only premiums col- I appreciate my colleagues. I appre- about whether it is appropriate for lected for such coverage or plan; and ciate what my colleagues stand for. public funds to, for the first time in (C) any such non-Federal health insurance But this is very important stuff. more than three decades, cover elective issuer that offers a qualified health plan through the Exchange that includes coverage I ask unanimous consent that a num- abortions. In my opinion, most Ameri- for abortions for which funding is prohibited ber of constituent letters be printed in cans and most of the people in my under this subsection also offers a qualified the RECORD. State would say no. health plan through the Exchange that is There being no objection, the mate- As it is currently written, though, identical in every respect except that it does rial was ordered to be printed in the the Senate health care bill enables tax- not cover abortions for which funding is pro- RECORD, as follows: payer dollars, directly and indirectly, hibited under this subsection. CONSTITUENT LETTERS to pay for insurance plans that cover Our amendment has the support of Senator HATCH: I am absolutely and ada- abortion. We should not open the door the U.S. Conference of Catholic mantly opposed to having any of my tax dol- to do so. As I said yesterday, when we Bishops, the National Right to Life lars go to fund abortion directly or indi- offered the amendment, some sug- Committee, the Family Research rectly. I urge you in the strongest possible gested the Stupak language imposes Council, the Ethics & Religious Liberty terms to vote against any motion to have new restrictions on abortion. But that Commission of the Southern Baptist the Senate consider any bill that does not in- is not the case. We are seeking to apply Convention, Concerned Women for clude specific language like the Stupak the same standards to the Senate Amendment. America, the National Association of Please let me know how you vote on the health care bill that already exist for Evangelicals, and Americans United for upcoming motion to proceed to consider any many Federal health programs. Life Action. healthcare legislation. But the bill does set a new standard. Polls across the country indicate a Thank you. It is a standard in favor of public fund- majority of Americans do not want ing of abortion. Our amendment does their tax dollars paying for elective Senator HATCH: I am extremely concerned not limit the procedure, nor prevent abortions. According to a CNN/Opinion that the majority of members of all the con- people from buying insurance that cov- Research Corporation survey, 6 in 10 gressional committees that have considered ers abortion with their own money. It healthcare legislation have refused to spe- Americans favor a ban on the use of cifically include language that would pro- only ensures that when taxpayer dol- Federal funds for abortion. Anybody hibit allowing any of my tax dollars from di- lars are involved, people are not re- who understands that figure knows rectly or indirectly funding abortions. quired to pay for other people’s abor- there are pro-choice people who also I am absolutely opposed to being forced to tions. favor a ban on the use of Federal funds fund abortions in any way with my tax dol- Some have claimed that the amend- for abortion. lars, and I urge you not to support any ment restricts abortion coverage even It also indicates that the public may healthcare bill that does not specifically pre- for those who pay for their own plan. also favor legislation that would pre- vent this. I consider abortion to be the tak- That is not true, according to ing of innocent life and a fundamental moral politfact.com, a prize-winning, fact- vent many women from getting their issue. I do not want to be forced to support health insurance plan to cover the cost it in any way. . . . checking Web site, which looked at of an abortion, even if no Federal funds Thank you. similar claims by a House Member dur- are involved. This poll indicates that 61 ing House debate on the Stupak percent of the public opposes the use of Senator HATCH: During floor debate on the amendment. PolitFact found, and I public money for abortions for women health care reform bill, please support an quote: who cannot afford the procedure, with amendment to incorporate longstanding First, she suggests the amendment applies 37 percent in favor of allowing the use policies against abortion funding and in to everyone in the private insurance market favor of conscience rights. If these serious of Federal funds. when it just applies to those in the health concerns are not addressed, the final bill care exchange. Second, her statement that So my question to my fellow Sen- should be opposed. ators is the following: When is this the restrictions would affect women ‘‘even Genuine health care reform should protect when they would pay premiums with their Congress going to start listening to the the life and dignity of all people from the own money’’ is incorrect. In fact, women on American people, people on both sides moment of conception until natural death. the exchange who pay the premiums with of this issue, who do not feel that tax- The PRESIDING OFFICER. The Sen- their own money will be able to get abortion payers ought to be saddled with paying ator from Montana. coverage. So we find her statement false. for abortion through their tax dollars, Mr. BAUCUS. Mr. President, I ask The Nelson-Hatch-Casey amendment or in any other way, for that matter? unanimous consent that the Senator only incorporates the longstanding I urge my colleagues to support the from Nebraska be allowed to speak for rules of the Hyde amendment, which Nelson-Hatch-Casey amendment. Do up to 10 minutes. Congress approved in 1976, to ensure the right thing and support our amend- The PRESIDING OFFICER. Without that no Federal funds are used to pay ment, which truly protects the sanc- objection, it is so ordered. for abortion in the legislation. tity of life and provides conscience pro- The Senator from Nebraska. This standard now applies to Federal tections to health care providers who Mr. NELSON of Nebraska. Mr. Presi- health programs covering such wide do not want to perform abortions. That dent, I rise to discuss the bipartisan and broad groups as veterans, Federal is an important aspect of this issue, amendment which I have proposed with employees, Native Americans, active- and I have waited until the last minute Senator HATCH, the Presiding Officer, duty servicemembers, and others—all to say something about that issue. Why and others. As my good friend and col- of whom are covered under some form should people of conscience be forced league from Utah has so eloquently ex- of a Federal health program. to participate in any aspect of elective plained, our amendment mirrors the Thus, this standard applies to indi- abortions? They should not. People language offered by Representative viduals participating in the Children’s who have deep feelings of conscience STUPAK that was accepted into the Health Insurance Program, Medicare, should not be forced—that includes House health care bill. Our view is that Medicaid, Indian Health Services, vet- nurses, doctors, health care providers, it should become part of the Senate erans health, and military health care hospitals—they should not be forced to health care bill we are debating as programs. do this, just because of the radicalness well. I wish to emphasize another point. of some people who exist in our society It is a fact that the issue of abortion All current Federal health programs today, and some think the radicalness stirs very strong emotions involving disallow the use of Federal funds to of some in this body and in the other strongly held principles all across help pay for health plans that include body. It is radical to expect the Amer- America, from those who support the abortion. Our amendment only con- ican taxpayers to pay for elective abor- procedure and those who do not. We are tinues that established Federal policy. tions, especially when such a high per- hearing that passion at times here on Some have said the Hyde amendment centage—up to 68 percent, according to the Senate floor. already is in effect in this bill. But some polls, and I think even higher—do But we are not here to debate for or that is not the case at all. The bill says not want to have Federal dollars used against abortion. This is a debate the Secretary of Health and Human for this purpose. about taxpayer money. It is a debate Services may allow elective abortion

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00033 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.048 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12680 CONGRESSIONAL RECORD — SENATE December 8, 2009 coverage in the Community Health In- State law, that requires a private ligion to receive Federal funds as long surance Option—the public option—if health plan to include abortion cov- as these funds are segregated from reli- the Secretary believes there is suffi- erage. But the bill before us, as writ- gious activities. We all know that. We cient segregation of funds to ensure ten, does. see it in program after program. If Federal tax credits are not used to pur- As I have said, the current health these organizations can successfully chase that portion of the coverage. care bill we are debating should not be segregate their sources of funding, The bill would also require that at used to open a new avenue for public surely health insurance plans can do least one insurance plan that covers funding of abortion. We should preserve the same. Additionally, the Secretary abortion and one that does not cover the current policies, which have stood of Health and Human Services must abortion be offered on every State in- the test of time, which are supported certify that the plan does not use any surance exchange. by most Nebraskans and most Ameri- Federal funding for abortion coverage Federal legislation establishing a cans. The Senate bill, as proposed, goes based on accounting standards created public option that provides abortion against that majority public opinion. I by the GAO. coverage and Federal legislation allow- think most Americans would prefer This amendment would place an un- ing States to opt out of the public op- that this health care bill remain neu- precedented restriction on a woman’s tion that provides abortion coverage tral on abortion, not chart a new right to use her own money to pur- eases—let me repeat the word course providing public funds for the chase health care coverage that would ‘‘eases’’—the standards established by procedure. Public opinion suggests so. cover abortions. Let me give my col- the Hyde amendment. So does the fact that over the last 30- leagues one example. Recently, my The claim that the segregation of plus years Congress has passed new staff met with a bright, young, married funds accomplishes the Hyde intent Federal laws that have not broken with attorney who works for the Federal falls short. Segregation of funds is an precedent. Government. She and her husband des- accounting gimmick. The reality is, Finally, as President Obama has said, perately wanted to start a family and taxpayer-supported Federal dollars this is a health care reform bill. It is were overjoyed to learn she was preg- would help buy insurance coverage not an abortion bill. So it is time to nant. Subsequently she learned the that includes covering abortion. simply extend the longstanding stand- baby she was carrying had I wish to offer some other points ard disallowing public funding of abor- anencephaly, a birth defect whereby about the effect of the Nelson-Hatch- tion to new proposed Federal legisla- the majority of the brain does not de- Casey amendment. Under the amendment, no funds au- tion. velop. She was told the baby could not thorized or appropriated by the bill Mr. President, I yield the floor. survive outside of the womb. She ended could be used for abortions or for bene- The PRESIDING OFFICER. The Sen- the pregnancy but received a bill of fits packages that include abortion. ator from Montana. nearly $9,000. Because she is employed The amendment would prohibit the use Mr. BAUCUS. Mr. President, I yield by the Federal Government, her insur- of the affordability tax credits to pur- to the Senator from California. At ance policy would not cover the proce- chase a health insurance policy that least indirectly it is our understanding dure. Her physician argued that con- covers abortion. It would also prohibit that Senator REID will soon come to tinuing the pregnancy could have re- Federal funding for abortion under the the floor to speak. sulted in ‘‘dysfunctional labor and Community Health Insurance Option. Mrs. FEINSTEIN. As soon as he postpartum hemorrhage, which can in- In addition, the amendment makes comes in, I would be happy to yield. crease the risk for the mother.’’ The exceptions in the cases of rape or in- Mr. BAUCUS. That would be my re- physician also warned that the com- cest or in cases of danger to the moth- quest. plications could be ‘‘life threatening.’’ er’s life. Mrs. FEINSTEIN. Thank you. I ap- However, OMB found that this cir- In addition, the amendment allows preciate that. cumstance did not meet the narrow ex- an individual to use their own private The PRESIDING OFFICER. The Sen- ception in which a woman’s life, not funds to purchase separate supple- ator from California. her health, is in danger. The patient mental insurance coverage for abor- Mrs. FEINSTEIN. Mr. President, sim- was told: ‘‘The fetal anomaly presented tions, perhaps even what is called a ply put, I believe this amendment no medical danger to you,’’ despite the rider to an existing plan. would be a harsh and unnecessary step admonitions of her physician. The best The amendment allows an individual back in health coverage for American she could do was to negotiate down the whose private health care coverage is women. cost to $5,000. not subsidized by the Federal Govern- What this amendment would do, as I Now, this story, without question, is ment to purchase or be covered by a read it, is to prohibit any health insur- tragic. A very much-wanted pregnancy plan that includes elective abortions, ance plan that accepts a single govern- could not be continued and, on top of paid for with that individual’s own pre- ment subsidy or dollar from providing this loss, the family was left with a mium dollars. coverage for any abortion, no matter substantial unpaid medical bill. Health Under the amendment, a private in- how necessary that procedure might be insurance is designed to protect pa- surer participating in the exchange can for a woman’s health, even if she pays tients from incurring catastrophic bills offer a plan that includes elective abor- for the coverage herself. following a catastrophic medical event. tion coverage to nonsubsidized individ- The proponents of this amendment But if this amendment passes, insured uals on the exchange, as long as they say their sole aim is to block govern- women would lose any coverage in- also offer the same plan without elec- ment funds from being used to cover cluded in the underlying bill, even if tive abortion coverage to those who re- abortion, but the underlying bill al- she pays for it herself. Why would this ceive Federal subsidies. ready does that. In the bill before us, body want to do that? I can’t support On another point, under Federal law, health plans that opt to cover abortion that. States are allowed to set their own services—in cases other than rape, in- A woman’s pregnancy may also exac- policies concerning abortion. Many cest, or when the life of the mother is erbate a health condition that was pre- States oppose the use of public funds at stake—must segregate the premium viously under control, or a woman may for abortion. Many States have also dollars they receive to ensure that only receive a new diagnosis in the middle passed laws that regulate abortion by private dollars and not government of her pregnancy. It happens. If this requiring informed consent and waiting money is used. They argue that segre- amendment passes, women in these cir- periods, requiring parental involve- gating funds means nothing—you heard cumstances would also learn that their ment in cases where minors seek abor- that—and that money is fungible. How- insurance does not cover an abortion. tions, and protecting the rights of ever, this method of separating funds In some cases, it may be unclear health care providers who refuse, as a for separate uses is used in many other whether the woman’s health problem matter of conscience, to assist in abor- areas, and there is ample precedent for meets the strict definition of life tion. the provision. endangerment. But perhaps most importantly, there For example, charitable choice pro- The National Abortion Federation is no Federal law, nor is there any grams allow agencies that promote re- has compiled calls they receive on

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00034 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.049 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12681 their hotline which are available to fornia has outlined would not have Mr. REID. Mr. President, I ask unan- women who need assistance obtaining been covered under the Federal Em- imous consent that the order for the abortion care. Let me give you a few ployees Health Benefits Plan either be- quorum call be rescinded. examples. cause the Federal Employees Health The PRESIDING OFFICER (Mr. Molly was having kidney problems Benefits Plan does not provide abortion KAUFMAN). Without objection, it is so and was in a great deal of pain. She coverage for such circumstances. ordered. couldn’t go to work. She couldn’t pro- Our amendment mirrors the language Mr. REID. Mr. President, there were vide for her two children. When she be- that has been offered by Representa- 45,000 funerals in America this year. came pregnant, she made the decision tive STUPAK that was adopted into the These funerals, 45,000 in number, stood to terminate the pregnancy in order to House health care bill, and we believe out from all the rest. Why? They were have her kidney removed to begin her it should be applied to the Senate bill tearful, as all funerals are. They filled recovery. She knew carrying the preg- as well. As I said earlier, the issue of loved ones with sorrow and grief, as nancy would create additional health abortion certainly prompts strong many of us know firsthand. But these problems and would leave her unable to opinions, fierce passions, and deep- 45,000 funerals were avoidable. That is provide for her family. seated principles for millions and mil- why they were more tragic than most, Jamie already had severe health lions of Americans, those who support because 45,000 times this year—nearly problems when she learned she was the procedure and those who don’t. But 900 times a week, more than 120 times pregnant. She was a severe diabetic our amendment does not take sides on each day, about every 10 minutes in and her low blood sugar levels caused abortion. It is about the use of tax- America, every day, without end— her to suffer from seizures. She was un- payer money. someone dies as a direct result of not able to continue her pregnancy but had The question before us is whether having health insurance. difficulty affording the procedure. public funds, for the first time in more That is a sickening number. You Another was suffering from a serious than three decades, should cover elec- would have to be heartless not to be liver illness when she became pregnant. tive abortions. Numerous public opin- horrified. It doesn’t even include those Doctors were unsure of the cause, but ion polls have shown that most Ameri- who did have health insurance but died she was in a great deal of pain. She al- cans, including a number who support because it was not enough to meet ready had two children. She could not abortion, do not support public funds their most basic needs. That is what care for them because of this pain. The this is all about. paying for abortion. But the Senate tests and medications she needed to ad- But it is not even just about death. bill we are debating allows taxpayer dress her medical condition were in- How many citizens in each of our dollars, directly and indirectly, to pay compatible with pregnancy. States are bankrupt and broke because None of these women experienced im- for insurance plans to cover abortion. of a broken health care system? How mediate threats to their lives, so under That is out of step with the majority of many have to choose between their this amendment their circumstances Nebraskans and of all Americans. mother’s chemotherapy and their would not meet the narrow exceptions Our amendment does not impose new daughter’s college tuition? How many permitted for abortion coverage. restrictions on women despite what have to work two or three jobs to pro- This is a problem. How can one say some have claimed, and I respect but vide for a family they never have time we are going to provide insurance, but strongly disagree with them. We are to see, all because of an accident they we don’t like one aspect of it. We don’t seeking to just apply the same stand- had or an illness they acquired that want the government to pay for it. OK, ards to the Senate health care bill that some insurance big shot calls a pre- OK. But the woman herself can’t pay already exist for every Federal health existing condition. for it. That is the extra step that this program. So many of these tragedies could be legislation takes. Our amendment does not add a new prevented. If our Nation truly values To this day, it is still legal to have restriction, but the bill does add a new the sanctity of life, as I believe it does, an abortion. Women in this situation relaxation of a Federal standard that we will do everything we can to pre- don’t buy insurance for abortion, but has worked well for more than 30 years. vent them. That is why we are pushing they buy a policy that may cover Under our amendment, abortion isn’t so hard to make it possible for every them, married women, should some- limited, nor would people be prevented American to afford good health. That thing happen in a pregnancy in the from buying insurance on the private is why we cannot take no for an an- third trimester. If they find a baby is market covering abortion with their swer, and that is why we will not let without a brain, she can have an abor- own money. the American people down. tion, and it is covered. Our amendment only ensures that That value is also evident in the One of the problems with this whole where taxpayer money enters the pic- amendment before us. As some know, debate is everybody sees something ture, people are not required to pay for for many years—nearly 28 years as a through their own lens. They don’t see people’s abortions. Member of the House of Representa- the grief and trouble and morbidity The Nelson-Hatch-Casey amendment tives, of the Senate, and as majority that is out there and the circumstances incorporates the longstanding standard leader—I have consistently cast my that drive a woman to decide—mar- established by the Hyde amendment vote against abortion. ried—she has to terminate her preg- which Congress approved in 1976. Today To me, it is not about partisanship of nancy for very good medical reasons. it applies to every Federal health pro- any kind or political points or even Nobody considers that. This is all gram. That includes plans that cover polling data. To me, it is a matter of ideologic, and it really, deeply bothers veterans, Federal employees, including conscience. me. Members of Congress, Native Ameri- I might not be the loudest on this So I can only tell my colleagues I cans, Active-Duty servicemembers, and topic, but that doesn’t make my beliefs very much hope this amendment goes a whole host of others. any less strong. I might oppose abor- down. Some people have called our amend- tion, but that does not mean I am op- Thank you very much, Mr. President. ment radical. Nothing could be further posed to finding common ground for I yield the floor. from the truth. It is reasonable. It is the benefit of the greater good. We can The PRESIDING OFFICER. The Sen- rational because it follows established find common ground. ator from Nebraska. Federal law. It is right. Taxpayers My belief in the sanctity of life is Mr. NELSON of Nebraska. Mr. Presi- shouldn’t be required to pay for peo- why I have repeatedly voted against dent, I would like to summarize the ple’s abortions. It is just that simple. using taxpayer money for abortion. It reasons for and the intent of the Thank you, Mr. President. I yield the is why I have repeatedly voted against amendment that Senator HATCH and floor, and I note the absence of a covering abortions in Federal employ- the Presiding Officer and I, together quorum. ees health insurance plans and repeat- with others, have proposed to the The PRESIDING OFFICER. The edly voted against allowing Federal fa- health care bill. clerk will call the roll. cilities to be used for abortions. First of all, I should say the exam- The assistant bill clerk proceeded to But I recognize abortion is an emo- ples our very good friend from Cali- call the roll. tional issue. Many Senators in this

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00035 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.050 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12682 CONGRESSIONAL RECORD — SENATE December 8, 2009 body disagree, as many citizens in the would treat it and what this amend- long list of Federal laws regarding con- country disagree, on the issue. But di- ment would require in addition and science protections and refusal rights, visive issues don’t have to divide us. then evaluating whether it improves it even outlaws discrimination against There is value in finding common the overall effort. those health care providers and facili- ground. As current law dictates, not a single ties with moral and religious objec- Among this institution’s immortals taxpayer dollar—not one—can be used tions to abortion. That means if a doc- is Senator Henry Clay, who worked to pay for an abortion. There are very tor does not believe it is right to per- under the premise that, as he said: few—but very serious—exceptions to form an abortion, he or she can say no, All legislation is founded upon the prin- this rule: Those are explicitly limited no questions asked. Health care facili- ciple of mutual concession. to cases in which the life of the mother ties such as Catholic hospitals, which It is in that spirit that I have been is in danger and when the pregnancy is are the largest nongovernment, non- able to work with my colleagues to my the result of rape or incest. profit health care providers in the left and to my right—Congressmen and This law is called the Hyde amend- country, would continue to have the Senators who are pro-life, such as I am, ment. It has been on the books since same right to refuse to perform abor- and those who are pro-choice. One of the late Republican Congressman tions. the ways I have done this is by trying Henry Hyde wrote it in 1976. I have Under our bill, at least one plan that to reduce the rate and number of unin- great respect for Henry Hyde, and I re- does not cover abortion services will tended pregnancies. call with fondness how this Illinois Re- have to be offered in each exchange so Our great country leads the world in publican Congressman came to Nevada no one will be forced to enroll in a plan many ways. But this area is not one in and campaigned for me. We worked to- that covers abortion services. This is which we take much pride. The United gether at a time when a Republican an improvement since the current mar- States has one of the highest rates of could campaign for a Democrat and ketplace does not provide a similar unintended pregnancies among all in- vice versa and not fear retribution and guarantee. dustrialized nations, and that is an un- condemnation from his own party. It is clear that the current bill does derstatement. Half of all pregnancies When we drafted the health reform not expand or restrict anyone’s access in America—every other one—is unin- bill now under consideration, we to abortion, period. It does not force tended. Of those, more than half result worked hard to come up with a com- any health plans to cover abortion or in abortions. promise between pro-life and pro- prohibit them from doing so, period. I have worked to stop this problem choice Senators. On one side, there are Why? Because this bill is about access before it starts. In 1997, Senator Olym- some Senators who don’t believe abor- to health care, not access to abortions. pia Snowe and I started the first of tion should be legal, let alone men- I have great respect for Senator BEN many efforts to improve access to con- tioned in any health plan. On the other NELSON. His integrity and independ- traception. We said health plans should side, there are Senators who don’t ence reflect on the Nebraskans he rep- treat prescription contraception the want a woman’s access to legal abor- resents. His strong beliefs are rooted in same way it treats other prescription tion to depend on which health plan his strong values. But he shows, better medications. We even passed a law that she could afford, and they wanted that than most, that one can be steadfast ensures that Federal employees have reflected in this bill. without being stubborn. Senator NEL- access to contraception. This proves So legislating in pursuit of mutual SON has always been a gentleman what is possible when Senators have concession, as Senator Clay advised, we whose consideration is the true por- different backgrounds, both of good struck a compromise. It is a com- trait of how a Senator should conduct faith, work with each other rather than promise that recognizes people of good oneself. against each other. faith can have different beliefs, and in- I mentioned that our underlying bill In this case, a pro-life Democrat and stead of trying to settle the sensitive leaves current law where it is. This a pro-choice Republican followed com- question of abortion rights in this bill, amendment, however, does not. It goes mon sense and found common ground. I we found a fair middle ground. further than the standard that has have always been appreciative of Sen- That compromise is, we maintain guided this country for 33 years. It ator SNOWE for her cooperation and her current law. We are faithful to the would place limits not only on tax- courage. I continue, to this day, to be Hyde amendment, which has been in payer money, which I support, but also grateful. place now for 33 years. Let me be clear. on private money. Again, current law Let’s not forget that the historic bill As our bill currently reads, no insur- already forbids Federal funds from pay- before this body will continue those ef- ance plans in the new marketplace we ing for abortions, and our bill does not forts. By making sure that all Ameri- create—whether private or public— weaken that rule one bit. I believe cur- cans can get good health care, we will would be allowed to use taxpayer rent law is sufficient, and I do not be- reduce the number of unintended preg- money for abortion, beyond the limits lieve we need to go further. Specifi- nancies at the root of this issue. That of existing law. cally, I do not believe the Senate needs is a goal both Democrats and Repub- But we don’t stop there. The bill to go as far as this amendment would licans can agree is worthwhile. takes special care to keep public and take us. No one should use the health Let’s talk about current law and this private dollars separate to make sure care bill to expand or restrict abortion, bill. In that and many other respects, that happens. This isn’t a new concept. and no one should use the issue of abor- this bill is a good, strong, and historic It is worth noting this practice of seg- tion to rob millions of the opportunity one. It is a bill that will affect the lives regating money is consistent with to get good health care. of every single American, and it will do other existing rules that make sure the This is not the right place for this de- so for the better. It will—as you have public doesn’t pay for things it bate. We have to get on with the larger heard me say many times—save lives, shouldn’t. It is consistent with the ex- issue at hand. We have to keep moving save money, and save Medicare. isting Medicaid practice that gives toward the finish line and cannot be But you have also heard me say this States the option of covering abortion distracted by detours or derailed by di- bill deserves to go through the legisla- also at their expense. It mirrors prac- versions. tive process. That process includes tices already in place to separate Our health reform bill now before amendments. It warrants additions, church and State by ensuring money this body respects life. I started by say- subtractions, and modifications, as the the Federal Government gives religious ing I believe in the sanctity of life. But Senate sees fit. This is an appropriate organizations is not used for religious my strong belief is that value does not process, one that has served this body practices. So we are not reinventing end when a child is born; it continues well for more than two centuries. the wheel. throughout the lifetime of every per- The amendment before us today, of- Just as current law demands, the bill son. fered by Senator NELSON of Nebraska, respects the conscience of both indi- With this bill, nearly every American would make dramatic changes in cur- vidual health care providers and health will be able to afford the care they rent law in America. It is worth exam- care facilities. And once again, it goes need to stay healthy or care for a loved ining what that law says, how this bill further. Our bill not only safeguards a one. It respects life.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00036 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.052 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12683 Those who today have nowhere to lute rights. Jefferson put it even before Menendez Rockefeller Tester Merkley Sanders Udall (CO) turn will soon have security against liberty, even before the pursuit of hap- Mikulski Schumer Udall (NM) what President Harry Truman called piness—life. Murray Shaheen Warner ‘‘the economic effects of sickness.’’ It If we still truly value life in Amer- Nelson (FL) Snowe Webb respects life. ica—and I believe we do—if we still Reed Specter Whitehouse Reid Stabenow Wyden Those who suffer from disease, from truly value the life of every American, injury, or from disability will no longer we cannot turn our backs on the 14,000 NAYS—45 be told by claims adjustors they never of us who lose health coverage every Alexander Crapo LeMieux met that they are on their own. It re- single day of every week of every Barrasso DeMint Lugar Bayh Dorgan McCain spects life. month of every year in this country— Bennett Ensign McConnell It will help seniors afford every pre- no weekends off, no vacations. How Bond Enzi Murkowski scription drug they need so they do not many of the thousands of men, women, Brownback Graham Nelson (NE) have to decide which pills to skip and Bunning Grassley Pryor and children who today will be kicked Burr Gregg Risch which pills to split. It respects life. out in the cold will next year become Casey Hatch Roberts It will stop terrible illnesses before one of the tens of thousands who die Chambliss Hutchison Sessions they start and stop Americans from because of it? If we value the sanctity Coburn Inhofe Shelby Cochran Isakson Thune dying of diseases we know how to of life, as I know we do, and fix what is Conrad Johanns Vitter treat. It respects life. broken, as I know we must, we will not Corker Kaufman Voinovich We will stop terrible abuses, such as have to find out. Cornyn Kyl Wicker insurance companies looking at earn- I believe in this bill and what it will NOT VOTING—1 ings reports instead of your doctor’s re- do for our country for generations to Byrd port and charging rates that make the come, what it will do for our constitu- The motion was agreed to. health we want a luxury. It respects ents, my children, my grandchildren, Mrs. BOXER. I move to reconsider life. and their children and their grand- the vote. We will ensure the most vulnerable children. I will not support efforts to Mrs. FEINSTEIN. I move to lay that and the least prosperous among us can undermine this historic legislation. motion on the table. afford to go to a doctor when they are Mrs. BOXER. Mr. President, I ask The motion to lay on the table was sick or hurt, not to the emergency unanimous consent that the Senate agreed to. room where the rest of us pick up the proceed to vote in relation to the Nel- The PRESIDING OFFICER. Under bill. It respects life. son-Hatch amendment No. 2962; that the previous order, there will be 2 min- This bill recognizes that health care regardless of the outcome of the vote utes of debate equally divided prior to is a human right. This bill respects life. with respect to that amendment, there a vote in relation to the motion to The issue in this amendment is not be 2 minutes of debate prior to a vote commit offered by the Senator from the only so-called moral issue in this in relation to the McCain motion to Arizona. debate. The ability of all Americans to commit, equally divided and controlled Who yields time? afford and get the access to care they in the usual form; that upon the use or The Senator from Montana. need to stay healthy is also a question yielding back of that time, the Senate Mr. BAUCUS. Mr. President, the of morality. proceed to vote in relation to the McCain motion to commit on Medicare The reason I oppose abortion and the McCain motion to commit; the McCain Advantage would keep overpayments reason I support the historic bill is the motion be subject to an affirmative 60- in the Medicare Advantage program, same: I respect the sanctity of life. vote threshold; that if the motion even though the Medicare Payment Ad- This is a health care bill. It is not an achieves that threshold, then it be visory Commission recommends that abortion bill. We cannot afford to miss agreed to and the motion to reconsider they be eliminated. the big picture. It is bigger than any be laid upon the table; that if it does The McCain motion to commit is a one issue. Neither this amendment nor not achieve that threshold, then it be tax on all seniors. It would maintain any other should be something that withdrawn; and that no amendment be the overpayments to private insurers overshadows the entire bill or over- in order to the motion. whelms the entire process. and require beneficiaries to pay higher The PRESIDING OFFICER. Without Throughout my entire public career, Part B premiums. The average couple objection, it is so ordered. I voted my conscience on the subject of pays $90 per year just so insurers can Mrs. BOXER. Mr. President, I move abortion. As I said, that decision is reap greater profits under Medicare. to table the Nelson amendment, and I based on something personal with me. The McCain amendment is a raid on ask for the yeas and nays. My vote today will also honor another the Medicare trust fund. MA overpay- principle I believe to my very core and The PRESIDING OFFICER. Is there a ments take 18 months off the life of the that I will believe until my very last sufficient second? Part A trust fund. And according to day on Earth: We must make it pos- There is a sufficient second. MedPAC, there is no evidence of great- sible for every American to afford a The question is on agreeing to the er quality of care. In fact, MedPAC told healthy life. motion. The clerk will call the roll. Congress this year that ‘‘only some’’ I believe the compromise in our cur- The legislative clerk called the roll. MA plans are of high quality. MedPAC rent bill and the current bill itself fully Mr. DURBIN. I announce that the finds that ‘‘only half of beneficiaries fulfill both of these moral imperatives. Senator from West Virginia (Mr. BYRD) nationwide have access to a plan that And I believe when we are given the is necessarily absent. Medicare rates above average on over- trust of our neighbors, friends, rel- The PRESIDING OFFICER. Are there all plan quality.’’ atives, the privilege to lead the oppor- any other Senators in the Chamber de- The more than 45 million seniors tunity to improve others’ lives, we can- siring to vote? with Medicare deserve better. They do not turn our backs. We cannot turn our The result was announced—yeas 54, not deserve to subsidize high profits of backs on the tens of millions of Ameri- nays 45, as follows: private insurers. And the more than 11 cans who have no health insurance at [Rollcall Vote No. 369 Leg.] million Medicare beneficiaries who all—none—not thousands, not hun- YEAS—54 choose to enroll in private plans also dreds, not millions but tens of millions. Akaka Collins Kerry deserve better. They deserve plans that We cannot turn our backs on the many Baucus Dodd Kirk coordinate care. Most plans today do who do but live one accident, one ill- Begich Durbin Klobuchar not. They deserve plans that are of Bennet Feingold Kohl ness, or one pink slip away from losing Bingaman Feinstein Landrieu high quality. Many plans today do not. that insurance they have. Boxer Franken Lautenberg If Senators want to help bene- One of the most cherished charters Brown Gillibrand Leahy ficiaries, they will vote to eliminate this Nation has, drafted by one of our Burris Hagan Levin overpayments under Medicare Advan- Cantwell Harkin Lieberman most beloved leaders, declared life to Cardin Inouye Lincoln tage. And they should vote against the be the first among several of our abso- Carper Johnson McCaskill McCain motion.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00037 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.053 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12684 CONGRESSIONAL RECORD — SENATE December 8, 2009 The PRESIDING OFFICER. The Sen- Tester Udall (NM) Whitehouse right kind of insurance could see a pen- ator from Arizona. Udall (CO) Warner Wyden alty as high as $3,000 per employee. Mr. MCCAIN. Mr. President, this NOT VOTING—1 We should be encouraging people to amendment is about an earmark. It is Byrd hire in this kind of environment. That about a special deal cut for a special The PRESIDING OFFICER. On this should be job No. 1: creating jobs. group of people who happen to reside in vote, the yeas are 42, the nays are 57. Yet imposing taxes and fines are what is in this bill, and that is not the State of Florida. I am never so pre- Under the previous order requiring 60 going to encourage hiring; it is going sumptuous. I have lost too many votes votes for adoption of the motion, the to discourage hiring. That is economics trying to eliminate earmarks. But motion is withdrawn. what I am trying to do is allow every Mrs. HUTCHISON addressed the 101. Individual taxes: There are $8 billion American citizen who is enrolled in Chair. in taxes for those who don’t purchase Medicare Advantage to have the same The PRESIDING OFFICER (Mrs. insurance on their own. The tax is $750 protection of their Medicare Advantage SHAHEEN). The Senator from Texas. Program as the Senator from Florida Mr. DORGAN. Madam President, will per person. Again, because you are in- sured today does not mean you will has carved out in this bill. That is all the Senator from Texas yield for a avoid the tax. You must have the right it is about. It is about equality. It is unanimous consent request? kind of insurance—insurance that the about not letting one special group of Mrs. HUTCHISON. I will. Federal Government approves and says people who reside in a particular State Mr. DORGAN. Madam President, I ask unanimous consent that following is the right amount of insurance. get a better deal than those who live in How about the taxes on high-benefit the presentation by the Senator from the rest of the country. That is all this plans? There are $149 billion in taxes on Texas that I be recognized to offer an amendment is about. health insurance plans that the Fed- amendment, and following that Sen- It will probably be voted down on a eral Government says are too robust. ator CRAPO be recognized to offer an party-line vote. But what you have These high-benefit plans—Cadillac amendment, and Senator CRAPO, I be- done is you have allowed a carve-out plans some call them—would be subject lieve, wishes to speak 2 or 3 minutes, for a few hundred thousand people in to a 40-percent excise tax. To make it and following that then I would be rec- the State of Florida and have dis- worse, the tax is not indexed, so it is a allowed the other 11 million who have ognized as well for a presentation on new AMT, a new alternative minimum Medicare Advantage from having their the amendment I have offered, and fol- tax that everyone says was not sup- health care cut. That is what this is all lowing my presentation, the Senator posed to encroach on lower income peo- about. from Minnesota, Ms. KLOBUCHAR, would ple, but, in fact, it has because it is not Mr. BOND. I ask for the yeas and be recognized, and Senator KAUFMAN indexed for inflation. nays. would be recognized as part of the col- So here we are. In this bill, you get The PRESIDING OFFICER. Is there a loquy with Senator KLOBUCHAR. taxed if you don’t provide enough bene- sufficient second? The PRESIDING OFFICER. Without fits and you get taxed if you provide There is a sufficient second. objection, it is so ordered. too many benefits. So this is beginning The question is on agreeing to the The Senator from Texas. to sound like government-run health motion. Mrs. HUTCHISON. Madam President, care to me, and I can only imagine how we have spent the last few days high- The clerk will call the roll. the unions feel because they are the lighting how this health care reform The assistant legislative clerk called ones that have these high-benefit plans bill is paid for by cutting benefits to the roll. and here they are under fire because seniors, jeopardizing their access to Mr. DURBIN. I announce that the they have too much coverage. care. Almost $500 billion will be cut Senator from West Virginia (Mr. BYRD) Medicare payroll tax: This is the new from the Medicare Program. is necessarily absent. payroll tax that is imposed on individ- But this bill also imposes $1⁄2 trillion The PRESIDING OFFICER. Are there uals making more than $200,000 and in new taxes. These are taxes that hit couples making more than $250,000. any other Senators in the Chamber de- every American and virtually every siring to vote? That tax raises another $54 billion. health care business or related business This additional payroll tax is a mar- The result was announced—yeas 42, in the country. nays 57, as follows: riage penalty. It is not indexed to infla- During an economic downturn, this tion, meaning it is another AMT in the [Rollcall Vote No. 370 Leg.] approach is counterintuitive. These making because today, that may sound YEAS—42 taxes will discourage investment and high—$200,000 and $250,000—but it is a Alexander DeMint McCain hiring. We are in one of the worst eco- huge marriage penalty, and it could Barrasso Ensign McConnell nomic downturns in the history of our begin then to go down in numbers so Bennett Enzi Murkowski country. We do not need to tell any- Bond Graham Nelson (NE) that more and more people are af- Brownback Grassley Risch body that. We are all feeling it. We fected. Bunning Gregg Roberts know people who are suffering right This body voted unanimously during Burr Hatch Sessions now. the budget debate—unanimously—that Chambliss Hutchison Shelby Coburn Inhofe Snowe I look at what has been done in the a point of order would be made against Cochran Isakson Thune past when we have had economic down- legislation that would impose a mar- Collins Johanns Vitter turns, and I look at President Kennedy, riage penalty in the budget. So we have Corker Kyl Voinovich President Reagan, President Bush. Cornyn LeMieux Webb voted unanimously that a budget point Crapo Lugar Wicker They lowered taxes. What happened? of order would stand if there is a mar- The economy was spurred. Lower taxes riage penalty in the budget. So now NAYS—57 have proven to spur the economy. Yet here we are a few months later, and the Akaka Feinstein McCaskill in this bill we see $1⁄2 trillion in new majority is not only retreating from Baucus Franken Menendez Bayh Gillibrand Merkley taxes on families and small businesses. the opposition to the marriage penalty, Begich Hagan Mikulski Let’s walk through some of these but we now have for the first time in Bennet Harkin Murray taxes. our Tax Code—or will when this bill Bingaman Inouye Nelson (FL) Employer taxes. Madam President, Boxer Johnson passes—a payroll tax marriage penalty. Pryor $28 billion in new taxes is imposed on How on Earth can we do that? Brown Kaufman Reed Burris Kerry Reid businesses that do not provide health I am going to fight this marriage Cantwell Kirk Rockefeller insurance to their employees. To avoid penalty, and I hope the Senate will Cardin Klobuchar Sanders Carper Kohl the tax, an employer has to provide the vote against this concept. It is a new Casey Landrieu Schumer right kind of insurance—insurance that precedent that could be set in other Conrad Lautenberg Shaheen the Federal Government approves. It is areas that would say if you are mar- Specter Dodd Leahy going to be a certain percentage and ried, you are going to get fewer bene- Dorgan Levin Stabenow Durbin Lieberman have certain coverage requirements. fits than if you are single. That is not Feingold Lincoln Employers who do not provide the a precedent we ought to be setting.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00038 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.055 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12685 Then there is the medical deduction which we know they are—that maybe As the motion which has just been cap. There is a change in our Tax Code they might consider bringing every- read clearly states, this motion would that would limit the itemized deduc- body into this process and listening to be to commit this bill to the Finance tion for medical expenses. We have al- other ideas that would not be a govern- Committee for the Finance Committee ways had one that said if your medical ment takeover of our health care sys- to do one simple thing, and that is to expenses go above 7.5 percent of your tem; that would not be more govern- make the bill conform to President income, that you would be able to de- ment mandates, more taxes, cuts from Barack Obama’s pledge to the Amer- duct anything above that. This bill in- Medicare services. This is a recipe for ican people about health care reform creases that threshold to 10 percent so disaster for our country, and I hope it and who would pay for health care re- that if you are going to get deduc- is not too late for the Democratic ma- form. tions—and this is going to affect people jority to say: OK, let’s get together and In a speech he has given in a number who have catastrophic accidents, real- try to put together a bipartisan plan of different places, President Obama ly, really high medical bills, debili- that will not hurt the quality of health has very clearly stated: tating health conditions, or very, very care that Americans have known and I can make a firm pledge . . . no family expensive medicine—if you go above 7.5 expected in our country, one that will making less than $250,000 will see their taxes percent today, you would be able to de- increase . . . not your income taxes, not bring costs down and make health care your payroll taxes, not your capital gains duct. But in this bill, it is going to be more affordable, one that will give car- 10 percent of your income before the taxes, not any of your taxes. You will not see rots to our employers not sticks that any of your taxes increase one single dime. government is going to allow you to will switch them if they don’t have the All this motion does is to commit deduct these added expenses. right kind of coverage or the govern- Then there is the drug, device, and this bill to the Finance Committee to ment-approved coverage or the right have the Finance Committee assure insurance company taxes: $60 billion in percentage of coverage. taxes assessed to insurance companies, that its provisions comply with this We can do better and I hope we will. pledge. $22 billion to prescription drug manu- Thank you, Madam President. I yield facturers, and $20 billion on medical Now, why would we want to do that? the floor. I think most Americans are very aware device manufacturers. The experts The PRESIDING OFFICER. The Sen- have said, all of the economists have today that this bill comes at a huge ator from North Dakota. price. There are $2.5 trillion of new said these taxes will be paid by the AMENDMENT NO. 2793, AS MODIFIED, TO public. Of course they are going to be Federal spending, $2.5 trillion of new AMENDMENT NO. 2786 Federal spending that is offset, if you passed on: higher premiums for every (Purpose: to provide for the importation of insurance policy that is already there, will, by about $500 billion worth of cuts prescription drugs) in Medicare and $493 billion worth of and higher prices for medications and Mr. DORGAN. Madam President, I medical equipment. cuts in the first 10 years are tax in- call up amendment No. 2793, as modi- creases, $1.2 trillion of tax increases in So medications you take for diabetes fied, and ask for its immediate consid- or heart disease, medications or med- the first real 10 years of the full imple- eration. mentation of the bill. There is no ques- ical devices that you need to fight can- The PRESIDING OFFICER. The tion but that much of the tax increase cer would all become more expensive clerk will report. because every one of them would have The bill clerk read as follows: that is included in this bill to pay for this massive increase in Federal spend- a higher cost because the company is The Senator from North Dakota [Mr. DOR- ing will come squarely from people in going to pay an added fee just for pro- GAN], for himself, Ms. SNOWE, Mr. GRASSLEY, ducing these medicines and equipment. Mr. MCCAIN, Ms. STABENOW, Ms. KLOBUCHAR, the United States who make less than So many people today are struggling Mr. BROWN, Mrs. SHAHEEN, Mr. VITTER, Mr. $250,000 as a family or less than $200,000 with their medical bills. They are KOHL, Mr. LEAHY, Mr. FEINGOLD, and Mr. as individuals. struggling to fill prescriptions. Why NELSON of Florida, proposes an amendment All we need to do is to go through aren’t we bringing costs down? Isn’t numbered 2793 to amendment No. 2786, as this bill to see that by the analysis we modified. medical cost part of the reason for re- have made so far, it appears that at form because the costs are going up? Mr. DORGAN. Madam President, I least 42 million households in America Wasn’t the point of reform to bring the ask unanimous consent that the read- will pay a portion of this $1.2 trillion in costs down so more people would have ing of the amendment be dispensed new taxes, people who are under these affordable options for health care cov- with. income levels to whom President erage? What happened to that? All of The PRESIDING OFFICER. Without Obama made the pledge. these taxes on individuals and busi- objection, it is so ordered. I will have a greater opportunity to- (The amendment is printed in today’s nesses are going to drive prices and morrow to discuss this motion in more RECORD under ‘‘Text of Amendments.’’) costs up. detail. Tonight I just had a few min- In closing, the bill before us imposes Mr. DORGAN. Madam President, my utes to make the introduction and to understanding is that the Senator from call up the motion, and we will then $1⁄2 trillion in new taxes at a time when unemployment is soaring and our econ- Idaho is to be recognized next for lay- get into a fuller discussion on how this ing down an amendment. bill provides a heavy tax burden on the omy is struggling. We have $1⁄2 trillion The PRESIDING OFFICER. The Sen- in cuts to Medicare which is going to middle class of this country in direct ator from Idaho. severely hurt our senior citizens and violation of the President’s pledge. their access to health care, and then MOTION TO COMMIT So as I conclude, I would simply say Mr. CRAPO. Madam President, I have this is a very simple amendment. We $1⁄2 trillion in tax increases, taxing marriage, taxing Tylenol, taxing high- a motion at the desk which I wish to can debate about whether the bill does benefit plans, taxing low-benefit plans, call up and ask for its immediate con- or does not increase taxes—I think taxes if you offer employee health care sideration. that is absolutely clear—on those in coverage, and taxes if you offer not The PRESIDING OFFICER. The the middle class. But all the motion quite enough. This is a tax-and-spend clerk will report. would do is to commit this bill to the The bill clerk read as follows: bill. Finance Committee to have the Fi- Republicans have repeatedly put for- The Senator from Idaho [Mr. CRAPO] moves nance Committee make the bill com- ward ideas that would reform our to commit the bill H.R. 3590 to the Com- port with the President’s pledge. mittee on Finance with instructions to re- I will conclude by just reading his health system, bring the costs down port the same back to the Senate with without burdening our employers with pledge one more time. The President, changes that provide that no provision of in his words, said: more taxes that would keep them from this Act shall result in an increase in Fed- I can make a firm pledge . . . no family helping our economy by hiring more eral tax liability for individuals with ad- making less than $250,000 will see their taxes justed gross income of less than $200,000 and people; ideas that would increase com- increase . . . not your income taxes, not married individuals with adjusted gross in- petition and transparency and ensure your payroll taxes, not your capital gains access to affordable care. come of less than $250,000. taxes, not any of your taxes. . . . you will So I hope while our colleagues are Mr. CRAPO. Thank you, Madam not see any of your taxes increase one single meeting to try to get their 60 votes— President. dime.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00039 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.058 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12686 CONGRESSIONAL RECORD — SENATE December 8, 2009 That is what this motion accom- I’ve got this one body and this one life, so These advertisements are telling peo- plishes. I wanted to stop my bone loss. But I did ple sitting at home watching a tele- With that, I yield the floor. more than that; I reversed it with Boniva. vision program tonight that you need Ask your doctor if Boniva is right for you. The PRESIDING OFFICER. The Sen- to get up and go talk to your doctor ator from North Dakota. Here is another one: and see if you don’t need some of these Mr. DORGAN. Madam President, the Some of us need help falling asleep. Some pills. It is trying to create consumer amendment I have offered with many of us need help staying asleep. A good night’s demand for something you can get only colleagues—over 30 colleagues, Repub- sleep doesn’t have to be an on/off thing any- because a doctor believes you should more. licans and Democrats, a bipartisan leg- have it. islation—deals with the issue of pre- From the makers of the most prescribed name in sleep medicine comes controlled re- Well, that is where we are now with scription drugs; specifically, the impor- lease Ambien CR. It’s the only one with two prescription drugs in our country. A lot tation of FDA-approved drugs that the layers of sleep relief. of people are taking prescription drugs. American people would be able to ac- Ambien CR is a treatment you and your A lot of these drugs are miracle drugs, cess for a fraction of the price they are doctor can consider along with lifestyle and they allow people to stay out of a charged in this country. changes and can be taken for as long as your hospital. They don’t have to be in an The American people are paying the health care provider recommends. acute-care hospital bed if they manage highest prices in the world for brand- So ask your health care provider about Ambien CR, for a good night’s sleep from the disease—whether it is high blood name prescription drugs. pressure, high cholesterol—with medi- It is not even close. Let me just show start to finish. cine. That is good, and I understand the first chart. I have many. I will Here is another one: that. But this consumer demand-driven show the first one to describe what Does your restless mind keep you from brings me to the floor of the Senate. sleeping? Do you lie awake exhausted? Well, urge for prescription drugs is pretty Here are prices for Lipitor. There are maybe it’s time to ask whether Lunesta is unbelievable. Go talk to a doctor and so many people who take Lipitor that right for you. ask that doctor what happens every they probably ought to put it in the For a limited time, you’re invited to take single day in the doctor’s office. Some- the 7-night Lunesta challenge. Ask your doc- body is coming in and saying: I wonder water supply—the most popular choles- tor how to get 7 nights of Lunesta free and terol-lowering drug in America, per- if I shouldn’t be taking some of this see if it’s the sleep aid you’ve been looking medicine. I read about it or saw the ad- haps in the world. Here is what the for. American people pay for an equivalent Get your coupon at Lunesta.com and ask vertisement about this. I wonder if I quantity: $125. The same quantity costs your doctor today. shouldn’t be taking some of it. It is $40 in Britain, $32 in Spain, $63 in the Here is another one: quite a deal. Netherlands, $48 in Germany, $53 in You produce all of this demand with They’re running the men’s room marathon, dramatic amounts of marketing, pro- France, and $33 in Canada. Once again, with lots of guys going over and over. And it is $125 to the American consumer. here’s the dash to the men’s room with lots motion, and advertising, and then you Here are the two bottles for Lipitor. of guys going urgently. Then there’s a night jack up the price and keep it up. The It is made in Ireland by an American game waking up to go. question is, Who can afford these pre- company and then sent around the These guys should be in a race to see their scription drugs? Who can afford them? world. This happened to go to Canada, doctors. Those symptoms could be signs of So that is what brings me to the and this went to the United States. It BPH or enlarged prostate. Waking up to go, floor of the Senate today saying that starting and stopping, going urgently, in- is the same pill, same bottle, same when the American people are charged complete emptying, weak stream, going over the highest prices for brand-name company, made at the same manufac- and over, straining. turing plant, and it is FDA approved. For many guys, prescription Flomax re- drugs—and this year, it goes up close Difference? The American consumer duces urinary symptoms associated with to 10 percent once again in price—at a gets to pay three to four times higher BPH in one week. Only a doctor can tell if time when we have almost no inflation, cost. Fair? Not for me. you have BPH and not a more serious condi- isn’t that pricing prescription drugs That is what this amendment is tion like prostate cancer. out of the reach of too many Ameri- about. This amendment is about free- Call 1–877–FLOMAX to see if Flomax works cans? dom, giving the American people the for you and to see if you qualify for $40 off We are now talking about health care your prescription. reform. There is nothing in any of this freedom in the global economy to buy For many men, Flomax can make a dif- the same FDA-approved drug from ference in one week. legislation in the House or the Senate those countries that have an identical that addresses this question of the Here is another one: chain of custody as we do in this coun- steep and relentless price increases on try, so an FDA-approved drug sold for a There are moments you look forward to, prescription drugs. There is nothing in and you shouldn’t have to miss out on them. fraction of the price—why should we Sometimes a bladder control problem can any of this legislation that does that. prevent the American people from cause unwanted interruptions. It doesn’t The question is, Shouldn’t we be ad- being able to exercise and see the same have to be that way. Overactive bladder is a dressing this as well? savings every other consumer in the treatable medical condition. I talked about Lipitor. Let me show world sees? Enablex is a medication that can help re- you Plavix. Do you see the U.S. price? Let me see whether anybody recog- duce bladder leaks and accidents for a full 24 The U.S. consumer pays the highest nizes this. Prescription drugs are a sig- hours. Ask your doctor about Enablex. prices in the world. nificant part of our lives. We are Well, I have a couple dozen more. Here is Nexium. If you want to buy bombarded with ads every single day. Most people understand what this is that, you get to pay $424 in the United Let me show a demonstration of the because they have heard them all— States, and it is $41—one-tenth the push for consumption of prescription things like: Go ask your doctor if the price—in England, $36 in Spain, and $37 drugs at the highest brand-name prices purple pill is right for you. They don’t in Germany. The question is this: If in the world. have the foggiest idea what a purple Nexium is an FDA-approved drug—and On television, Sally Field says to pill is for. They think that with all it is—made in plants approved by our us—and I have seen it many mornings these scenes of trees and green grass FDA—and it is—why should an Amer- when I am brushing my teeth—she says and convertible cars and pillow clouds ican citizen not be able to access this this: in the sky, if life is like that when you drug from here, from here, and from I always thought calcium, vitamin D, and are on the purple pill, give me some here? It is because the pharmaceutical exercise would keep my bones healthy. But I purple pills. I mean, that is what this industry doesn’t want them to. They got osteoporosis anyway, so my doctor start- advertising is all about. have had enough friends here to keep ed me on once-a-month Boniva. And he told I don’t mean to make light or fun of in place a law that prevents the Amer- me something important: Boniva works with all of it. Prescription drugs are impor- ican people from reimporting these your body to help stop and reverse bone loss. My test results proved I was able to stop tant in people’s lives. I understand drugs. That is why. and reverse my bone loss with Boniva. And that. But you know what, you can only That is what this amendment is studies show that after one year, 9 out of 10 get a prescription drug if your doctor about. This amendment says: Give the women did, too. prescribes it and believes you need it. American people the freedom to access

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00040 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.059 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12687 FDA-approved drugs where they are drugs. How many people have said to capabilities and, in fact, dramatically sold at a fraction of the price. you: Yes, I take the drugs my doctor enhances the safety of our existing Madam President, there is a lot to asks me to take, but I cut them in half drug supply. talk about, and I will describe a num- because I cannot afford the whole dose. I am going to show tomorrow that ber of circumstances that have brought We have all heard that. So the question the existing drug supply has all kinds us to this point. is, Are we going to do something about of issues. I will show batch lots of ex- This is the place for this amend- it? isting drugs that have gone through ment—not some other place; this is the This is a chart that shows price in- strip joints, in the back room in cool- place. It is about health care. We have creases in 2009. Enbrel, for arthritis, is ers, and distributed out of strip joints. been told over and over again that our up 12 percent. Singulair, for asthma, is I am going to talk about that. But, problem is that health care is con- up 12 percent. Boniva is up 18 percent. first, I wish to say I was surprised to suming too large a portion of the GDP Nexium is up 7 percent. get this letter because both the Presi- of this country—roughly 17.3 percent, I I want to talk a bit about the issue of dent and the Chief of Staff at the White believe. All right, part of health care— drug prices versus inflation. This chart House were a cosponsor in the Senate not the largest part but one of the fast- shows what has happened to the price and a leader in the House for re- est growing parts is prescription drugs. of prescription drugs, the red line, and importation of prescription drugs. So if the issue is that health care is ris- the inflation rate in this country, the I called the head of the FDA yester- ing in cost relentlessly and consuming yellow line. It describes why it is ur- day afternoon about this time and said: too large a portion of our GDP because gent that we do something, why we I have heard rumors that there was a we spend much more on health care cannot allow a health reform bill to letter coming to Capitol Hill on this than anybody else in the world by far— leave this Chamber and do nothing issue. She told me she was not aware of it is not even close—if that is the case about the issue of prescription drugs. such a letter. Twenty-four hours later, and if one of the fastest rising areas of We must at least address this question apparently she is aware of that letter health care is drug costs, then why of whether the American people should because she signed it. I am interested would legislation that leaves this not have the freedom to access these in where it was written, but that is an- Chamber or the House of Representa- identical drugs where they are sold other subject I will save for tomorrow tives not include something that ad- elsewhere for a fraction of the price. as well. dresses these unbelievable price in- This year, there was a 9.3-percent in- We will be told, as we have been so creases for prescription drugs? How is crease in brand-name prescription drug often, that if you allow the American it that we would allow that to happen? prices, at a time when inflation is people to buy prescription drugs that I don’t know how we got to this point going down. We have had deflation. are FDA approved from elsewhere, it without having it in the bill, but I aim That is not justifiable. will be somehow unsafe. The implica- to try to put it in. Madam President, I know we are tion is, we are not smart enough and I understand, by the way, that there going to have a lot of debate here in we are not capable enough of putting is tremendous pushback by the phar- the Chamber about a lot of things. I together a system that the Europeans maceutical industry. If I had the sweet- will describe tomorrow morning, when have had together for 20 years. heart deal they have, I would fight to I speak, that 40 percent of the active In Europe, they do this routinely. the finish to try to keep it. I under- ingredients in U.S. prescription drugs For 20 years, they have had something stand that. currently come from India and China. called parallel trading. You are in Ger- By the way, let me just say, as I have And they are worried about somebody many and want to buy a prescription always said and nobody hears it very from Sioux Falls, SD, buying prescrip- drug from Spain? No problem. You are much—certainly the pharmaceutical tion drugs from Winnipeg. Are you kid- in Italy and want to buy a prescription industry will never hear this—that ding me? Again, 40 percent of the ac- drug from France? No problem. They some of the things the pharmaceutical tive ingredients in U.S. prescription have a specific parallel trading system, industry does for this country are laud- drugs currently come from India and and it works and works well. able. I say, good for you. They talk China. In most cases, the places those I am going to describe, in the words about the prescription drugs they active ingredients come from have of someone who has been involved in produce. Good for them. A substantial never been inspected. that system for many years, that the portion of that comes from research we I will talk about that, but I am not Europeans can do, have done it, do it have done and paid for at the National going to go into it tonight. I will talk today with no problems at all. Are peo- Institutes of Health with taxpayer about a number of issues related to ple saying they can do it, they are funds. But that doesn’t matter to me. drug safety of the existing drug supply smart enough, they are capable That information ought to be available and how what we have included in this enough, but we are not? Give me a to the pharmaceutical industry—and it legislation with respect to pedigree, break. That makes no sense to me at is—so they can produce these new mir- batch lots and track and trace will dra- all. Of course, we can do this. acle drugs. I commend them. matically improve the existing drug It is just that those who do not want My beef is not that they produce supply in our country and make cer- to do it have decided this current pharmaceutical drugs that help people. tain we prevent safety problems com- ‘‘deal,’’ which allows the pharma- I am all for that. My beef is the way ing from the importation of drugs. ceutical industry to price as they wish they price those drugs, saying to the I am going to speak about this at in this country and make certain the American people: You will pay the some length tomorrow. But I just re- American people cannot do anything to highest prices in the world, and there ceived a letter from the head of the get the lesser prices in other countries, is nothing you can do about it. It is FDA, Margaret Hamburg, who raises lower prices for the identical drug, it their pricing policy. It is just not fair. some questions about the amendment. means they will price this year up 9.3 How many in this Chamber have vis- I am not going to read the letter into percent, just this year alone. They will ited with somebody at a town meeting the RECORD. I will talk more about it do whatever they want to price those someplace—I have—and they come up tomorrow. prescription drugs and too often will to you—in this case, an elderly woman I must say, I am in some ways sur- price them out of reach of the Amer- who was close to 80 touched me gently prised by the letter and in some ways ican people. It is not fair to me. It does on the elbow and said, ‘‘Senator DOR- not surprised at all. Surprised, because not make any sense to me. GAN, can you help me?’’ She was talk- this administration, President Obama, I know some will view this as just an ing about how many prescription drugs was a cosponsor of this legislation last attack on the pharmaceutical industry. she had to take, how little money she year in the Senate—a cosponsor of my It is not intended to be that. As I said, had to pay for them, and how she al- legislation. He was part of a bipartisan I don’t have a grievance against that ways had to try to determine what her group that believed the American peo- industry at all. The only problem I rent cost was and how much groceries ple ought to have this right and be- have is the way they price their prod- she could buy to determine how much lieved we could put together a piece of uct, and I think it is not fair to the she had left to pay for prescription legislation that has sufficient safety American people.

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00041 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.060 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12688 CONGRESSIONAL RECORD — SENATE December 8, 2009 We are dealing with health care, ical. People said: Socialist plot, gov- it is not the way it has to end if enough which is a big issue and an unbeliev- ernment takeover. But we did it. I was of us have the courage to take on this ably controversial issue. This is one not here. They did it—God bless the fight. piece of it—not even the biggest ones who did it—and it enriched this As I said, I will have a lot more to piece—but it is an important piece. country, to say all those who lived say tomorrow morning. I appreciate I have a lot to say tomorrow morn- their lives and built the roads and built the indulgence of my colleagues to lis- ing, and I will take substantial time. I the schools and built the communities ten tonight about why we have offered know there are others who want to and left a better place for us: You are this legislation. speak tonight. I wish to say this. I have not going to have to lay awake at I started and let me finish by saying watched and listened in this Chamber night frightened about your health this is broadly bipartisan. It is, first now for some while. I have not spoken care; we are going to provide health and foremost, a Dorgan-Snowe bill. a lot on health care. I have been pretty care for you. Senator DORGAN—myself—and Senator distressed about some of what has been All these issues have been difficult, SNOWE from the State of Maine, but said on the floor of the Senate. I espe- draining, wrenching issues, and they many others—my colleague, Senator cially have been distressed with the have all provoked great criticism and GRASSLEY, who is on the floor, Senator television ads that have been running great anger, in many cases. This issue MCCAIN, who spent a lot of time on this that are unbelievably dishonest with of health care brought to the floor of issue—Republicans and Democrats respect to the facts. The first amend- the Senate—I, perhaps, would have a have come together. ment allows all that. I would be the different view of what is the priority. By the way, this has not happened last to suggest we ought to alter the I have spent most of my time saying: very often on this bill. But this is a bi- first amendment. The economic engine, restart the en- partisan bill with Republicans and This is a great country in which we gine, get people back to work. But that Democrats pulling their oars together live. Over the last century, for exam- does not mean health care is not im- to try to get this done. ple, we have made a lot of changes, and portant. It is. Health care continues to I yield the floor. The PRESIDING OFFICER. The Sen- in most every case—in most every sin- gobble up more and more of this coun- ator from Iowa. gle case—the changes have been unbe- try’s economy. At some point, some- Mr. GRASSLEY. Madam President, lievably painful. body has to say: How do we stop that? before the Senator from North Dakota I think of the Presiding Officer and If we are spending much more than leaves and before I speak on another think of the period in which the women anybody else, how do we fix this? issue, I wish to tell him I am going to in this country wanted the right to That is what this is about. It is going speak in support of his amendment. vote and were taken to the Occoquan to take some courage to do it. One But I would like to ask him a question Prison and beaten. Lucy Byrne and piece of it is this issue of prescription now, if he will answer it for me—a Alice Paul, they nearly choked to drugs and pricing. Some of us have friendly question, but it is something I death one of them; the other hung with been working on this for a long time. don’t know absolutely for sure, but I a chain from a prison door all night The breadth of the support of this issue believe that pharmaceuticals are about long with blood running down her in this Chamber extends from the late the only thing a consumer in the arms. Why? Because they wanted the Senator Ted Kennedy, who sat in that United States cannot buy anywhere in right to vote. Think of the pain of that. seat back there—and God bless his the world that they want to buy. We Now we look back and say: How memory—to JOHN MCCAIN over there; ought to give them that same right we could anybody have decided we are all it extends to Senator CHUCK GRASSLEY, do on everything else. There may be Americans except women do not have DEBBIE STABENOW, AMY KLOBUCHAR—a some other items I am not aware of, full participation because they cannot whole series of Republicans and Demo- but I think it is only pharmaceuticals vote? Think of that. You can go right crats who have come together to say: that you cannot import from wherever up the line. Social Security: a Com- You know what, let’s make sure there you want to buy them. munist socialist plot. Medicare: What is fair pricing of prescription drugs for Mr. DORGAN. Madam President, I are you thinking about? A takeover of the American people. say to the Senator from Iowa, that and We are not asking for anything other health care for senior citizens. Cohiba cigars from Cuba, I reckon. We I bet there is not—I was going to say than fair pricing. How do you get it? have a special embargo with respect to I bet there is not one. I shouldn’t say My goal is not to ask the American Cuba. With that exception, I don’t that. I bet there are not more than two people to buy their prescription drugs think there is a legal product the or three people in this Chamber, if we overseas. My goal is to say, if we allow American consumer cannot access any- said: Let’s get rid of Medicare, who the American people the freedom to do where else in the world. would say: Yes, let’s do that. Almost that, the pharmaceutical industry will This is about giving the American everybody believes that providing be required to reprice their drugs in consumer the freedom that the global health care for senior citizens was the this country. It is as simple as that. economy should offer everybody. The I know others wish to speak. As I right thing to do. big shots got it. The big interests can There were no insurance companies said, I have a lot to say tomorrow. I am do it. How about the American people in the fifties and early sixties that going to go home kind of upset about having the opportunity to shop around said: Here is our business strategy. Our this letter today from the FDA, which the world for the same product and pay business strategy is to go look for old is, in my judgment, completely bogus. a fraction of the price of the charges people and see if we can’t sell them I will read it tomorrow. I am not sur- that are imposed on them in the United health insurance because we think that prised. I expected this. I heard rumors States. would be a very good deal. They were about it. Mr. GRASSLEY. I thank the Senator not doing that. They would not even Tomorrow my hope is with my col- from North Dakota. make health insurance available to a leagues—Republicans and Democrats— I would like to talk about a recent lot of old folks because they know, we will pass this legislation at last, at news—— somewhere toward the end of their long last. Many of us have been work- Ms. KLOBUCHAR. Madam President, lives, they were going to need a lot of ing on this issue 6, 8, 10 years. We will we had a unanimous consent agree- health care. One-half of the senior citi- pass this legislation. Why? Because ment. I am trying to figure out the zens in America had no access to this is the place for it. This is the bill order. health care. Think of that—lie down on that should be amended. This is the The PRESIDING OFFICER. Under your pillow at night frightened that to- time to do this. We cannot walk out of the previous order, the next speaker is morrow might be the day you have this this Chamber and say something hap- to be the Senator from Minnesota, fol- dreaded disease and you have no cov- pened in that Chamber to deal with lowed by the Senator from Delaware. erage to see a doctor or go to a hos- health care. But did you do something Mr. GRASSLEY. I ask unanimous pital. It is unbelievable. about prescription drugs? No, no, we consent to speak now, if I may. So some people in this Chamber said: couldn’t do that, couldn’t do that. This The PRESIDING OFFICER. Is there Let’s do Medicare. Man, that was rad- is not the way I want this to end, and objection?

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00042 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.062 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12689 Mr. KAUFMAN. Will the Senator solve problems on the horizon so that Ms. KLOBUCHAR. What I like about yield for a question? How long will the financial disasters can be averted. the amendment is it will protect our Senator be? In the midst of the debate concerning increased national investment in the Mr. GRASSLEY. Fifteen minutes. comprehensive health care reform, we health of Americans. We have decided The PRESIDING OFFICER. The Sen- must be proactive in combating health Americans should be covered by health ator from Minnesota. care fraud and abuse. Each year, crimi- care; that people shouldn’t be thrown Ms. KLOBUCHAR. Madam President, nals drain between $72 billion and $220 off of their health insurance by pre- I believe our speeches are 10 minutes billion from private and public health existing conditions. The way we pro- long. If the Senator from Iowa could care plans through fraud, increasing tect that investment, and the way we wait for 10 minutes, then we will be the costs of medical care and health in- make sure the funds are there to help able to complete our speeches, as rec- surance and undermining public trust people, is by doing things such as in- ognized by the Chair. in our health care system. Think of all creasing the tools we need to prosecute Mr. GRASSLEY. I will let the Sen- the money wasted—$72 billion to $220 these kinds of cases. ators speak, and I will speak tomorrow billion each year—drained by crimi- These criminals scheme the system because I have to go to a meeting. I nals, that could be going to our sen- to rob the American taxpayers of will let the unanimous consent agree- iors, that could be going for care. money that should be used to provide ment stand. Let me give a couple of examples, health care to those who need it most. Ms. KLOBUCHAR. I was not aware Senator KAUFMAN, of the kinds of fraud We must put a stop to this, and we are the Senator from Iowa had to leave. If we need to address. On June 23 of this doing that with this amendment. It he can keep it to 10 minutes, that year, eight individuals were indicted in provides straightforward but critical would be helpful. Miami for cashing $30,000 to $80,000 sev- improvements to the Federal sen- Mr. GRASSLEY. I cannot keep it to eral times a week at two check-cashing tencing guidelines, to health care fraud 10 minutes, and I cannot shorten it. So facilities they owned themselves. statutes, to forfeiture, money laun- I will let the unanimous consent agree- These crooks defrauded the U.S. health dering, and obstruction statutes, all of ment stand. care system by creating a phony clinic which would strengthen prosecutors’ The PRESIDING OFFICER. The Sen- that churned out medical bills in five ability to combat health care fraud. ator from Delaware. States. They were not providing health As a former prosecutor, I can tell you Mr. KAUFMAN. Madam President, care. They were phony clinics. Federal that when we had these types of cases, the Senator from Minnesota and I are prosecutors announced this on Tues- we used every tool you could use to going to engage in a colloquy. day. push someone to plead guilty, every We rise to talk about health care Some of the purported clinics were tool you could use to make sure you fraud enforcement. It is no secret fraud empty storefronts with handwritten got the maximum sentence so a mes- represents one of the fastest growing signs while others existed only as post sage would be sent not just to that par- and most costly forms of crime in office boxes, but none provided any ac- ticular criminal but to other white col- America today. tual medical services, according to lar offenders who thought this might In no small part, our current eco- prosecutors. By the time they were be a quick way to make a buck. They nomic crisis can be linked to financial caught, in this one incident, this one need to hear they can be caught and fraud, starting with unchecked mort- group of con men, had bilked the gov- they will go to jail. I know Senator KAUFMAN has worked gage fraud generated by loan origina- ernment of $100 million. That is $100 on this and is taking a lead, and per- tors through securities fraud that has- million at a time when our taxpayers haps he can provide the details on this tened the eventual market crash and are trying to save every dime, while maximized its impact on Main Street amendment. they are holding on to their jobs and Mr. KAUFMAN. Sure. This amend- and the average American investor. trying to pay their bills. This one ment directs a significant increase in In response, this body passed the group of con men—$100 million. the Federal sentencing guidelines for Fraud Enforcement Recovery Act, Here is another example. In Novem- large-scale health care fraud offenses. which directed critical resources and ber of 2007, the Department of Justice It is incredible that despite enormous tools to antifinancial fraud efforts. I indicted a woman for billing Medicare losses in many health care fraud cases, was proud to work on FERA with my for motorized wheelchairs that bene- analysis from the U.S. Sentencing friend from Minnesota, a former pros- ficiaries didn’t need and for children’s Commission suggests that health care ecutor, who understands both the harm psychotherapy services never provided. fraud offenders often receive—and I that financial fraud causes ordinary According to the indictment, the know this is hard to believe—shorter Americans and the importance of de- woman then laundered the money sentences than other white collar of- terring criminal behavior before it hap- through a Houston check-cashing busi- fenders in cases with similar loss pens. ness, cashing several Medicaid checks amounts. For some reason, people Ms. KLOBUCHAR. Madam President, each for more than $10,000. Those are think health care fraud is kind of okay. I thank Senator KAUFMAN. Before I just examples of what we are dealing Ms. KLOBUCHAR. If people knew begin, I wish to, first, acknowledge the with. this, they would be shocked. In health amendment that has been offered by Mr. KAUFMAN. I say to the Senator, care fraud, you are taking money from Senator DORGAN on drug reimporta- those are sobering examples of the people who need it most—when they tion, something I support and I know kinds of fraud we must stop. As we are at the hospital—and yet they would Senator KAUFMAN supports as well. We take steps to increase the number of have shorter sentences than other look forward to talking about that Americans covered by health insurance types of fraud. amendment in the days to come. and to improve the health care system Mr. KAUFMAN. There is data to The bill Senator KAUFMAN referred for everyone—and we will do that—we show that criminals are drawn to to, the Fraud Enforcement and Recov- must ensure that law enforcement has health care fraud, when they are sit- ery Act, was passed in response to an the tools it needs to deter, detect, and ting around deciding what kind of unprecedented financial crisis. punish health care fraud. fraud they are going to do, because the I was proud to work on that bill in The Finance and HELP Committees, risk-to-reward ratio is so much lower. the Senate Judiciary Committee along as well as leadership, have worked long That is ridiculous. We need to ensure with Senator KAUFMAN. and hard to find ways to fight fraud these offenders are punished not only But Americans should expect Con- and bend the cost curve down, and they commensurate with the costs they im- gress to do more than simply react to have done a great job. But there is pose on our health care system but also crises after their most destructive im- more work to be done. That is why at a level that will offer real deter- pacts have already been felt. We are al- Senator KLOBUCHAR and I, along with rence. People have got to understand ways coming in after the fact and put- Senators LEAHY, SPECTER, KOHL, SCHU- they can’t go out and commit health ting out the fire. That is not what we MER, and HARKIN, have introduced our care fraud. want to do. We owe it to our constitu- health care fraud enforcement, No. There are so many different ways it ents to be proactive, to seek out and to 2792. can be presented; that if in fact they do

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00043 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.063 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12690 CONGRESSIONAL RECORD — SENATE December 8, 2009 it, they are going to get real time for cause Americans have waited too long hold against the Taliban, and they are the crime. As a result, our amendment for these kinds of changes. not capable of taking over from U.S. directs changes to the sentencing Mr. KAUFMAN. That is a great troops. And in light of the President’s guidelines that, as a practical matter, amendment that I think will be a big 18-month deadline, it is clear that self- amount to sentence increases of be- help in terms of cutting down this sufficiency for the Afghans is not op- tween 20 and 50 percent for health care fraud, and that is what we are all tional; it is mandatory. Secretary fraudsters stealing over $1 million. about. This is a bipartisan issue, if Gates confirmed for me in last week’s Ms. KLOBUCHAR. The other thing there was ever a bipartisan issue. I Senate Foreign Relations hearing that that is great about this amendment is don’t know of anyone who doesn’t July 2011 is a firm deadline. In 18 it updates the definition of ‘‘health think we have to do more in terms of months, we will begin our withdrawal care fraud offense’’ in the Federal health care fraud. When we have $70 and we will not send additional troops criminal code so it includes violations billion to $220 billion a year in health after this time. This was reiterated by of the anti-kickback statute, the Food care fraud, we have to do everything Secretary Clinton and Chairman of the and Drug and Cosmetic Act, and cer- we can to stop it. Joint Chiefs Mullen. tain provisions of ERISA. These As we consider and debate meaning- The fourth question is do we have changes will allow the full array of law ful health care reform, we must ensure enough qualified U.S. civilians in Af- enforcement tools to be used against that criminals who engage in health ghanistan to partner with the Afghan all health care fraud. care fraud—and more importantly people in promoting governance and The amendment also provides the De- those who contemplate doing so—un- economic development? We must send partment of Justice with subpoena au- derstand that they face swift prosecu- even more and ensure that the ‘‘civil- thority for investigations conducted tion and substantial punishment. ian surge’’ extends to all 34 provinces, pursuant to the Civil Rights for Insti- When the time comes, Senator so they can partner with Afghans in tutionalized Persons Act—also known KLOBUCHAR and I, along with our fellow the field. as CRIPA. Under current law, the De- cosponsors, will urge our colleagues to I visited Afghanistan in April and partment of Justice must rely upon the support these amendments. September and had the opportunity to cooperation of the nursing homes, men- Madam President, I yield the floor. speak with our military and civilian tal health institutions, facilities for I suggest the absence of a quorum. leaders, President Karzai, and numer- persons with disabilities, and residen- The PRESIDING OFFICER. The ous Afghan ministers. I traveled to tial schools for children with disabil- clerk will call the roll. Helmand and Kandahar Provinces, and ities that are the target of these The legislative clerk proceeded to met with local government officials CRIPA investigations. While such tar- call the roll. and tribal elders at a ‘‘shura,’’ or com- gets often cooperate, they sometimes Mr. KAUFMAN. Madam President, I munity council. What I heard from the do not, and the current lack of sub- ask unanimous consent that the order Afghan people was frustration with poena authority puts vulnerable vic- for the quorum call be rescinded. their government’s inability to provide tims at needless risk. The PRESIDING OFFICER. Without security, administer justice, and de- Finally, in addition to the very im- objection, it is so ordered. liver basic services. They welcomed portant piece of this amendment that Mr. KAUFMAN. Madam President, I international assistance in the short- Senator KAUFMAN has pointed out— ask unanimous consent to speak as in term but sought improved security and where we are actually increasing the morning business. governance. Most importantly, they ability to get better criminal pen- The PRESIDING OFFICER. Without wanted control transferred to Afghan alties—the amendment corrects an ap- objection, it is so ordered. security forces once they were capable parent drafting error by providing that AFGHANISTAN STRATEGY of holding against the Taliban them- obstruction of criminal investigations Mr. KAUFMAN. Madam President, I selves. involving administrative subpoenas rise today to speak about the Afghani- Since returning from Afghanistan, under HIPAA—the Health Insurance stan strategy President Obama an- my No. 1 concern has been the ability Portability and Accountability Act of nounced last week. The dilemma facing of the Karzai government to be an ef- 1996—should be treated in the same the President and our national security fective and trusted partner. In his sec- manner as obstruction of criminal in- team in Afghanistan is one of the most ond term, President Karzai must elimi- vestigations involving grand jury sub- complex and difficult I have seen in nate corruption, strengthen rule of poenas. more than three decades of public serv- law, and deliver essential services in Senator KAUFMAN and I also plan to ice. order to win the trust of the Afghan file an additional health care fraud President Obama’s speech laid out a people. Ultimately, the battle is not amendment that would require direct bold plan, and he has been both delib- between the U.S. and the Taliban. It is depositing of all payments made to erative and courageous in his approach. a struggle between the Afghan govern- providers under Medicare and Med- At the same time, I share the concerns ment and the Taliban, and the fight icaid. This amendment is incredibly of many Americans about the chal- must be won by the Afghans them- important because the Medicare regu- lenges that lie ahead for our troops. selves. The notion of a corrupt govern- lations already require direct depos- Sending young men and women into ment has emboldened the Taliban and iting or electronic transfer, but these harms way is the most difficult choices further undermined trust between regulations have not been uniformly we must face. Each life lost is one too President Karzai and his people. Presi- enforced and criminals are taking ad- many. dent Karzai must translate promises in vantage of this system. The decision in Afghanistan is espe- his inauguration speech into action, Again, I ask the question: Why would cially difficult because four primary because increased government trans- we want this money—$60 billion esti- questions remain. The first question is parency and accountability is abso- mated for Medicare fraud alone—to be do we have a trusted and effective part- lutely critical. going to con men and crooks, people ner in President Karzai? No matter For me, the key point in President who are setting up fake storefronts how many troops we deploy, we cannot Obama’s speech was that our military with fake signs that say doctor’s office, succeed with an Afghan government commitment is not open-ended. In July instead of to the hard-working people plagued by corruption. 2011, we will begin our troop drawdown. in this country who can hardly afford The second question is to what This has created an 18-month deadline their health care insurance? It is an length is Pakistan willing to go to for progress, injecting a sense of ur- outrage. help? We cannot defeat al-Qaida and gency to our mission that has been That is why I am so glad Senator degrade the Taliban without Paki- missing for the past 8 years. It sends a KAUFMAN would take the leadership stan’s support. message that the clock is ticking for here, that we have a group of us who The third question is can we accel- the Afghan government to eliminate were prosecutors working on this in erate the training of Afghan National corruption. They will no longer get a the Judiciary Committee to include Security Forces? Today, there are too ‘‘blank check’’ because the time for ac- this in the health care reform bill, be- few Afghan security forces to clear and tion is now. On the security front, the

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00044 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.064 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12691 Afghan National Army and Police have The PRESIDING OFFICER (Mr. I am quoting him— no choice but to assume greater re- UDALL of Colorado). The clerk will call (that’s more money than John McCain spent sponsibility given the certainty of a the roll. on TV advertising in last year’s presidential U.S. withdrawal. The legislative clerk proceeded to campaign), after having already spent a bun- As President Obama outlined, Paki- call the roll. dle through advocacy groups like Healthy stan is central to this fight. We cannot Mr. SESSIONS. Mr. President, I ask Economies Now and Families USA. succeed without its cooperation be- unanimous consent the order for the I don’t know what has happened. cause developments in the region are quorum call be rescinded. There is a memorandum in, I believe, inextricably tied to both sides of the The PRESIDING OFFICER. The Sen- one of the blogs here, the Huffington border. After my April visit, I was con- ator from Alabama. Without objection, Post. That is supposed to be the memo- cerned about the Pakistani commit- it is so ordered. randum that documents the agree- ment. When I returned in September, Mr. SESSIONS. Mr. President, I see ment. I don’t know what the facts are, however, I was impressed by the Paki- my good friends, Senators KAUFMAN but I know this, it is not a healthy stani military’s decision to go after and KLOBUCHAR, had talked about ac- thing, as somebody who has been in- elements of the Taliban in the Swat tions we could take to deal with fraud volved in Federal law enforcement, for Valley and South Waziristan. At the in health care. I support that. I had the a government official, under color of same time, Pakistan must take action opportunity in the past, as U.S. attor- right, to say to a private individual against the Afghan Taliban and al- ney, to lead a group that would do that you will help me with an adver- Qaida, which continue to find safe that. But something is troubling me tising campaign and spend your private haven in Pakistani tribal areas. If ex- today a great deal. I am uneasy about money, or I will do you a favor in ex- tremists continue to operate freely be- it. It goes to the heart of how the legis- change for an $150-million television tween Afghanistan and Pakistan, it lation that is before us today has been campaign. will undermine security gains made on put together. I wish to tell you that is not good. the Afghan side of the border. And the Earlier today, we had Senator That is beyond the pale. If things such stakes are even higher in Pakistan, MCCAIN offering an amendment to say as this have been done in the past, it is which has both nuclear weapons and that every State should have the same not the kind of thing that ought to be delivery vehicles. policies with regard to Medicare Ad- continued. I think it is a big deal. In Afghanistan, we must break the vantage that the State of Florida will The New York Times has reported, as momentum of the Taliban by improv- under this bill. Presumably, that was they go forward: ing security and strengthening our an effort to gain some support. We Shortly after striking that agreement, the ability to partner with the Afghans. have seen other situations such as that trade group—the Pharmaceutical Research That is why I support efforts to accel- with Louisiana and other places get- and Manufacturers of America, or PhRMA— erate the training of Afghan National ting special advantages. also set aside $150 million for advertising to Security Forces, ANSF. I am concerned Let me tell you about something support health care legislation. that the President’s goal of increasing that is particularly troubling to me. It I am quoting a New York Times arti- the Afghan Army to 134,000 in 2010 does was written about by Robert Reich, cle by Duff Wilson. not go far enough in building the ca- who was Secretary of Labor in Presi- But an industry official involved in the dis- pacity of the ANSF. By comparison, dent Clinton’s Cabinet. He is a prolific cussions said the group and its advertising Iraq—a geographically smaller country writer about economic and health care money would now be aimed specifically at with the same sized population—has matters. He starts his Sunday August 9 the approach being pushed by Mr. Baucus, 600,000 trained security forces. This is article this way on his blog. It says: Democrat of Montana and chairman of the Senate Finance Committee. why we must accelerate our targets for I’m a strong supporter of universal health building the army and improve the ca- insurance— Is that the way this thing is being pability of the police, which has faced He is not pulling any punches there. done? I hope not. I will examine these even greater challenges in terms of He believes in a single-payer govern- circumstances in more detail, but I corruption, incompetence, and attri- ment policy. Then he goes on to say— would like to say, right now and today, tion. and a fan of the Obama administration. But that I am not happy about it. I don’t Finally, our success in Afghanistan I am appalled by the deal the White House like the looks of it, it doesn’t smell depends on more than troops—we need has made with the pharmaceutical industry’s good to me, it does not strike me as an integrated civilian-military strat- lobbying arm to buy their support. something that is legitimate, and I egy in order to sustain progress. Many That is a pretty serious charge. He think maybe we need to find out more dedicated U.S. civilians continue to goes on to say: about it, frankly. serve in Afghanistan, and we must fur- Last week, after being reported in the Los I wish to share with my colleagues a ther augment these numbers and en- Angeles Times, the White House confirmed it fundamental concern I have with this sure they can directly interact with Af- had promised Big Pharma that any health care bill. Supporters of the bill ghans in the field. Given their role as a healthcare legislation will bar the Govern- have made a great deal of promises. force multiplier for the military and ment from using its huge purchasing power They alleged it would do a lot of very international nongovernmental organi- to negotiate lower drug prices. That’s basi- great sounding things, and we were cally the same deal George W. Bush struck zations, NGOs, this is an area where we asked to support it on the basis of their in getting the Medicare drug benefit, and it’s promises. But a careful examination of must channel even more resources and proven a bonanza for the drug industry. the legislation shows it fails to deliver people in the near term. We need a I will say, as I recall, that Mr. Reich stronger civilian capacity, because on almost all the major promises it was a critic of that at the time. Right made and is likely to cause a great deal counterinsurgency cannot and should or wrong, it was done and he was a crit- not be conducted with the military of adverse, unanticipated con- ic of it. I give him credit for it. He said sequences. As a result, I think the alone. a continuation of that would be an Over the coming months, I will close- American people have intuitively un- even larger bonanza. He goes on to de- ly monitor our progress in Afghan gov- derstood this; that is, why they are so scribe why he thinks it is a bonanza. ernance, partnering with Pakistan, strongly opposed to it. They cannot Right or wrong, as a matter of policy building the Afghan National Security imagine why the leadership of this Sen- and so forth, it is no doubt that is Forces, and increasing the U.S. civilian ate continues to try to push down on something Big Pharma would like. He surge. Improvements in these areas are their brow this piece of legislation that goes on to say this: critical to our overall success in Af- does not do what it promised to do. ghanistan, and will determine when In return, Big Pharma isn’t just supporting For example, the sponsors of the leg- universal health care. It’s also spending lots islation say the bill’s total cost is $848 our brave men and women in uniform of money on TV and radio advertising in sup- can return home. port. Sunday’s New York Times reports that billion. However, they do not begin the I yield the floor. Big Pharma has budgeted $150 million for TV benefits of the bill until 5 years after Mr. SESSIONS. Mr. President, I sug- ads promoting universal health insurance, enactment and that $848 billion is the gest the absence of a quorum. starting this August— cost of expenditures over 10 years. So

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00045 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.065 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12692 CONGRESSIONAL RECORD — SENATE December 8, 2009 when you move forward to when the the bill out, that one that would have just general Medicare accounts rep- benefits actually start for those who fixed this aberrational law we have resent cuts to Medicare, which is our will be receiving them and go 10 years that requires it to be cut 23 percent, seniors program. from that point, the total costs are not and so they put it in a separate bill. How is it, then, that we have this dis- $848 billion, they are $2.5 trillion. That Every penny of this separate bill would agreement? How is it possible that you is a huge difference. It is a monu- be paid for by increased debt, so not can’t agree on where $465 billion comes mental difference. It is a difference so really paid for at all. They offered that from? The sponsors of the bill, this is large I cannot understand how we can, bill on the Senate floor, and it got what they say. They say: We promised with a straight face, try to contend voted down because Republicans all we wouldn’t cut Medicare benefits. Any that we have a sound budget-minded voted against it as being utterly fis- guaranteed benefit any senior citizen bill that is going to cost $848 billion, cally irresponsible. Enough Democrats has, we promised not to cut it. All we and we have tax increases of about half joined in to kill the bill. They wouldn’t are doing is cutting the providers, the of that, and raids on Medicare for support it either. A number of Demo- people who provide the benefit. about half of that and that is how we crats know the budget has to have Give me a break. So you come in and are going to pay for it. It is not work- some rationality. So they failed to do you cut hospice, nursing homes, other ing in that way, in my view. that. providers, $118 billion from Medicare Another promise for the bill that was But if you put the doctor fix in, you Advantage, $192 billion from the hos- made by the President in the joint ses- are increasing the costs of the bill by pices, nursing homes, and other pro- sion to the Congress, he said this: $250 billion, so the $130 billion surplus viders, $43 billion from hospitals that serve a disproportionate number of This bill will not add one dime to the def- is reduced to a $120 billion deficit. So it icit. does add to the deficit. It adds more poor and uninsured, $23 billion from That is just not accurate. You can than one dime to the debt; it adds $120 unspecified Medicare accounts, and make anything deficit neutral if you billion to the debt. that this doesn’t weaken Medicare. If pay for it by slashing Medicare and Another fiction was their promise we could cut that, why haven’t we done taking the money from Medicare to that they would fix the physician pay- it already? If this didn’t reduce the pay for it. Or you can make a bill be ments and make a permanent policy of quality of care for seniors, if we could deficit neutral if you raise enough paying them so every year they reduce these hospitals and others and taxes. So they are raising $494 billion wouldn’t have to run to Congress and they could still provide care to our sen- in taxes. They are cutting Medicare by hire lobbyists to come here and meet iors, why haven’t we done it already? Mike Horsley, head of our hospital $465 billion. That is the plan. with Senators to beg them not to have association in Alabama, tells me that They claim they have a $130 billion a 23-percent cut. That happens every as a result of an abominable wage surplus. So don’t worry about the budg- year. It is ridiculous. But this bill does index program that helps to determine et. We have created a bill that is going not deal with that. It only has a 1-year how much hospitals get paid primarily to reduce the deficit. That is what they fix, and for 9 years it is reduced just and lien payments in general, two- have said repeatedly. like it has been done in the past. There thirds of the hospitals in Alabama are But they forgot something. They for- is no reform in that part of health care operating in the red. They don’t need got we have to pay our physicians. that needs to be done. to be cut any more. That was always supposed to be part of Another fiction is that they are not I guess what I would say is, this is health care reform. In fact, the physi- cutting Medicare benefits. They say: the way the game has been played. My cian groups were told they were going We are not cutting Medicare benefits. colleagues are saying we are not cut- to be paid. But under this bill, to show We are cutting that bad old Medicare ting guaranteed benefits. We are just you how it has been doctored—and this Advantage that 11 million seniors are cutting the money from the people who has been done before, Republicans have benefiting from and enjoy and partici- provide the benefits. How many of participated in this in the past, and it pate in. They are cutting that $100-plus them are going to keep doing so, as the has been something that has been billion which is about one-fourth of CMS Actuary’s report questioned? How going on for a decade, but it is really what the cuts to Medicare are. They many of those will give it up? relevant today, particularly in this leg- say that is not truly cutting Medicare. Fiction No. 6—I have 10, and I will islation because this legislation was But that clearly is cutting Medicare not go through all of them tonight—is supposed to fix this problem—they because Medicare Advantage is part of that hospitals that treat the poorest keep the physician rates slightly above the Medicare Program. It is cutting and sickest will somehow be better off last year’s rate for 1 year. Then for 9 Medicare. However you feel about under this program. But they are not years in the 10-year budget, they as- Medicare Advantage, this is a cut to feeling that way. They are not feeling sume that doctor payments, physician Medicare Programs that millions of they are going to make up for the fact reimbursements are going to be cut 23 seniors favor. that the hospitals that qualify as dis- percent. That is unthinkable. That is why Florida didn’t want to proportionate share hospitals, those We are not going to cut physicians 23 have their Medicare Advantage cut. So who serve a high percentage of individ- percent. We can’t cut the physicians at they got a special deal in this legisla- uals who are very low income or who all because they are already wondering tion. Everybody else in America won’t have no insurance, they are going to whether they will continue to take get that. They want to keep it. lose $43 billion in cuts under this bill. Medicare patients and, even more so, Let’s go on a little bit further just to These hospitals that provide so much Medicaid patients, where they get paid show you why the American people are charity care and provide a safety net in less. unhappy with Congress. They have a the communities are going to suffer We could have a mass walkout of right to be unhappy. People say: Those under this legislation. They are telling physicians who couldn’t afford to see people out there at the tea parties and me that. I don’t know who in Wash- seniors if we were to cut their pay by 23 townhall meetings, they were just ington may say they are not, but that percent. In fact, we are not going to do upset. They are poor Americans. They is what they are telling me. I think that. We all know this. So what did are not good Americans. Good Ameri- they are telling the truth. they do? I know they were meeting cans would come in and say: How much Fiction No. 5 is that average family down in the hallways somewhere, and more money can we give you, big gov- premiums are going to decrease. Have they were plotting out this bill. They ernment, to take care of all our needs you heard that through this proposal? said: The President said it will not add from cradle to the grave? Senator EVAN BAYH asked the CBO to the debt. What are we going to do? The people at the tea parties under- about this, and they said families who The numbers don’t add up. We can’t stand the kind of games that are being do not receive coverage from their em- raise taxes any more. We can’t cut played here. They understand the cuts ployer would see their premiums rise Medicare any more. We have done all to home health care, to hospice pro- ‘‘about 10 to 13 percent higher by 2016’’ we can do. What are we going to do? grams, to hospitals, the hospitals that than under the current law. The ones So what they obviously decided was care for a disproportionate share of the who claim they are seeing some reduc- to take the physician pay portion of poor people, and the $23 billion from tions, those reductions are only the

VerDate Nov 24 2008 02:30 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00046 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.066 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12693 slightest reduction, less than 3 percent what the Senator says, but every number of e-mails we are getting—his- in most cases, of the 5- or 6-percent in- spring the trustees of Social Security torically high. I have never had that crease expected to occur every year and Medicare look ahead 75 years and before on any issue. I assume it is the under current law. they predict what the income and the same for the State of Alabama, con- So instead of going up 5.56 percent, it outlays are going to be based upon the tacting their two Senators as well. goes up 5.41 percent. They are claim- population and the projected growth of Mr. President, I rise to bring up an ing, I guess, that is some sort of cut. the economy and all that stuff. Right issue that is a relatively new issue in But it is misrepresentation to say that now, they are projecting $37 trillion of this debate, as in the secrecy of the ne- family premiums are going to decrease, shortfall over that 75-year period of gotiations that are going on around when people who are not in group time. They already told us, and it has Capitol Hill on the issue of health care health plans through their employers materialized, that in the year 2008 we reform. These secret negotiations actu- are the ones who are going to see the started paying more money out of ally started about October 2 when Sen- largest increases, perhaps 10 to 13 per- Medicare than was coming into Medi- ator REID, the leader, had to merge the cent by 2016, more than would occur care, and by the year 2017, as the Sen- bill out of the Senate Finance Com- under present law. ator correctly stated, the trust fund mittee and the bill out of the Senate I am pleased to be able to serve in will be out of reserves. HELP Committee into one bill. It took the Senate with Senator GRASSLEY who Mr. SESSIONS. So we are spending a long period of time to do that. chaired the Finance Committee, is the reserves in Social Security, which We are in the second week of debate. ranking member now, who does over will be exhausted by 2017. I hope people realize that 99 Senators 100 townhall meetings a year or some- Mr. GRASSLEY. In Medicare. Mr. SESSIONS. Medicare. Excuse ought to have the same privilege that 1 thing in the counties in Iowa. He met Senator had of getting a grasp of this with thousands of people and got the me. I am going to yield the floor to Sen- huge 2,074-page bill. There are still ne- same message I got, which is you peo- gotiations going on because the leader ple are irresponsible. The debt is surg- ator GRASSLEY. I say to the Senator, I appreciate your leadership and insight still does not have locked down the 60 ing and will double in 5 years, the votes that it is going to take to get to whole debt of America, and triple in 10. into this issue. I value your whole ap- proach to it. I think most Americans— finality. I want to say that the American people if they understood this information as So some of these discussions are: are concerned about this. Senator the Senator does and as the Senator what can we do to get a few votes if we GRASSLEY worked so hard to see if he has articulated, the opposition to the do not have a so-called public option? could get a bill that would be bipar- bill would be even greater than it is. And the latest of that is: Well, allow tisan, that we all could support, or I urge my colleagues to examine the people to buy into Medicare. So I want large numbers of the Senate could sup- fact that the bill simply does not do to speak about that issue because it port. But we got off track. what it sets out to do. It does not meet sounds pretty simple. It may get 4 I talked to one person who dealt with its promises, and as a result, we abso- more votes and may get 60 votes, but it this issue. He said the way things got lutely should not go down this road to is bad. It may be good politically, but off track was that we abandoned ways a major Federal takeover of health it is bad for Medicare and particularly to legitimately contain costs increases. care, with ramifications that go far be- for Medicare in rural areas where we The way to create more competition, yond what it might appear today. have a difficult time keeping hospitals the more personal stake in your health I thank the Chair and yield the floor. open, and we have a difficult time re- care, other things that would actually The PRESIDING OFFICER. The Sen- cruiting doctors in rural America. help reduce the cost of health care, is ator from Iowa is recognized. So I would talk about the recent what we got away from, and it became Mr. GRASSLEY. Mr. President, I had news reports of a proposal being con- driven by President Obama’s deter- a chance to hear a great deal of what cocted behind closed doors to allow 55- mination to have a government option. the Senator from Alabama said. I think to 64-year-olds to buy into the Medi- That, in my estimation, may have been I would highlight that what he said is care Program. Supposedly, this idea the decisive event in the negotiations what he is hearing from the grassroots has been put on the table to get the breaking down. of his State, which is very much what votes for supporters of having a This is a serious piece of legislation. I hear from the grassroots of my State: brandnew government-run health plan It seeks to alter one-sixth of the Amer- people are very concerned about this and the people who do not like that. ican economy. It does not do what it piece of legislation leading to the na- Back in the spring, such a proposal promises. It surges spending. It in- tionalization of health care, similar to creases taxes dramatically. It rep- what they have seen this administra- came up during the early stages of our resents a major governmental takeover tion previously do this year with the Finance Committee’s health care re- and will ultimately undermine the spe- nationalization of General Motors, par- form efforts. The idea was originally cial relationship between patients and tial nationalization of the financial proposed by President Clinton even their doctors. It will also substantially system—a big deficit. And then they going back to 1998. I opposed such a threaten the viability of Medicare. see the money being spent on this proposal back then, and I oppose such a This money that is being taken out of bill—$2.5 trillion after it gets fully im- proposal now. I oppose the proposal be- Medicare will only accelerate its insol- plemented. And where are you going to cause of its negative effect on the vency. By 2017, Medicare—I believe get money? And what is that going to Medicare Program and our senior citi- Senator GRASSLEY will agree—is ex- do to the economy? And, more impor- zens who use Medicare. pected to go into default. It will go tantly, what sort of a legacy is that The best way to describe the effect of down rapidly, actually. leaving to our children and grand- this proposal on the Medicare Program Is that correct, Senator GRASSLEY, children? and its beneficiaries is to quote former that by 2017, under current law, Medi- He also correctly stated that I do Senator Phil Gramm of Texas when he care is projected to go into default and visit every county every year. The was asked about President Clinton’s go rapidly into default, and if we could number of counties the Senator had proposal when President Clinton put save any money out of Medicare, if we was just a little bit high. We only have that proposal on the table back in 1998. can save $400 billion, shouldn’t it be 99 counties. But for the 29 years I have Senator Gramm said this about Presi- kept in the Medicare Program to try to been in the U.S. Senate, I have held a dent Clinton’s proposal, which would extend its life and make it a viable pro- town meeting in each one of our coun- be applicable today as our colleagues gram that seniors can rely on rather ties every year. So I do have the ben- are studying it: than creating a whole new spending efit of 2,871 town meetings as a basis If your mother is on the Titanic, and the program with that money? for suggesting what people tell me face Titanic is sinking, the last thing on Earth Mr. GRASSLEY. Mr. President, if the to face, besides the large number of you want to be preoccupied with is getting Senator is asking me that question, I phone calls we get. more passengers on the Titanic. will tell him that he is absolutely You cannot believe the number of Since its inception in 1965, the Medi- right, not based upon what I say or phone calls that are coming in now, the care Program has helped ensure senior

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Medicare Program for Iowa to compete of Texas was referring to as the Ti- Adding millions more Americans to for providers with urban areas where tanic? You would not load more people Medicare on top of the $1⁄2 trillion in Medicare reimbursement is higher. on it as it was going to sink. Medicare cuts in this Reid bill would I hear countless stories from con- This is not to say that this entitle- make beneficiaries’ access to care stituents where they make great ef- ment program, Medicare, is not in need much worse. But do not take my word forts to recruit doctors only to lose of improvement, but having the 36 mil- for it. Even national hospital associa- them to areas where Medicare reim- lion Americans who are age 55 to 64 tions such as the American Hospital bursement is higher. The Medicare buy into the program is not an im- Association and the Federation of buy-in will only make this situation provement. Even groups supporting the American Hospitals are opposing this worse in my State of Iowa, because Reid bill, such as the AARP, are point- proposal. They are mobilizing their more and more reimbursement would ing out the severe shortcomings of ranks against this proposal even as I come from Medicare. So the current such an approach. speak. Yes, the same groups that and future Medicare beneficiaries Last summer, the AARP Public Pol- agreed already—and this was back in would be assured of limited access to icy Institute published an analysis of June—to $155 billion in Medicare cuts— providers because of this buy-in. the Medicare buy-in concept. In their and they did that in an agreement with AARP pointed out another flaw in report, the AARP points out the poten- the White House and got sweetheart this buy-in proposal. In their analysis, tial for increased Federal entitlement deals in this bill—do not want the Sen- AARP warned that there are large spending. AARP said: ate to go the route of expanding Medi- cost-sharing requirements in Medicare, Expanding the program to more people care for people under 65 years of age. so buy-in enrollees would still be ex- could raise federal spending even further if The American Medical Association has posed to significant cost sharing. their care is made affordable through sub- also opposed this proposal. These Maybe these buy-in enrollees would sidies that would be funded by the existing groups recognize the potential for fi- have the resources to purchase supple- Medicare trust funds. nancial disaster by boosting the num- mental Medicare policies to defray And do not forget the effects of ad- ber of patients with coverage that pays these cost-sharing requirements. Per- verse selection from a Medicare buy-in well below cost. haps AARP is thinking of making even program. Here AARP has studied it, This Medicare buy-in proposal would more money by selling supplemental and this is what they say about that: also jeopardize retiree benefits. Going policies to these retirees. . . . the premium may be too uncompeti- back to the same AARP analysis that I I share the goal of getting more tive for those who don’t use much health have quoted, they concluded that a Americans covered, but expanding the care and unaffordable for those with modest Medicare buy-in program could further Medicare Program to early retirees is incomes. This may limit buy-in enrollment reduce employer-sponsored health ben- not the answer. Medicare beneficiaries and drive up cost further. efits. have paid in to this program all these According to the AARP: So this means that this buy-in pro- years and rightfully have the expecta- posal is likely unsustainable. And we . . . a buy-in program might displace re- tion to receive the benefits to which all know what happens when the gov- tiree coverage now available through [their] employers. they are entitled under the program. ernment creates an unsustainable new The Medicare buy-in proposal would Still quoting AARP, they said: program. What happens? The taxpayers jeopardize these benefits. It would end up on the hook for bailing it out As health care costs tend to rise with age, employers might have the incentive to find jeopardize existing retiree benefits. It down the road sometime. ways to avoid offering private coverage for would leave retirees exposed to signifi- We all know the Medicare Program early retirees. . . . cant cost sharing. It would be has $37 trillion in unfunded obligations. So with fewer patients with higher unsustainable and taxpayers would end We all know about the pending insol- paying private coverage, there is less up footing the bill. vency of the Medicare Program. The opportunity for providers to cost-shift I yield the floor. trustees say so every spring. to make up for low Medicare payments, The PRESIDING OFFICER. The Sen- The Medicare hospital insurance because everybody recognizes the Fed- ator from Pennsylvania. trust fund started going broke last eral Government does not pay 100 per- Mr. CASEY. Mr. President, thank year. In 2008, the Medicare Program cent of costs. This would make it even you very much. I rise tonight to con- began spending more out of this trust harder for providers to treat Medicare tinue the discussion and debate on fund than was coming in through the beneficiaries, and as a result, bene- health care. I had the chance over the payroll tax. The Medicare trustees ficiaries would have an even harder last couple of months not only to do a have been warning all of us for years time finding a provider to treat them. good bit of work on a number of issues that this trust fund is going broke. I come from a rural State where that relate to the bill and the two bills They now predict that it will go broke Medicare reimbursement is already that came before and were merged into right around the corner in 2017. Well, lower than almost every other State in one bill, but also to hear from constitu- as the AARP has pointed out, adding the Nation, so I have serious concerns ents across Pennsylvania. Some of millions to the Medicare Program about the ability of the Iowa providers them are writing to us and urging us to would almost certainly make things to keep their doors open if more and pass a bill and some are urging us to go much, much worse for the fiscal health more of their reimbursement is coming in the other direction. But the commu- of a program that is not in very good from Medicare. I know this is a concern nications I get from people who write financial shape. This proposal would that is shared by rural State Members about their own stories, their own fam- also make things worse for the 45 mil- of this body from both sides of the ily, their own challenges are, of course, lion Medicare beneficiaries who paid aisle. But losing providers to serve the most compelling and the most wor- into the program over the years and Medicare beneficiaries would only be thy of time and attention. are receiving benefits under the pro- the beginning of access problems Often they come from Pennsylvania gram. caused by a Medicare buy-in program. families who are not only facing health Since we started debate on this 2,074- Because if you think it would be tough care challenges but facing economic page bill, Members on this side of the to keep existing Medicare providers, challenges that I don’t think anyone in aisle have questioned the wisdom of think how hard it would be then to re- this Chamber can fully understand, at slashing Medicare by $1⁄2 trillion and cruit new ones. least not at this point in someone’s then using the savings to start a new Provider recruitment is already a life. Because when you become a Mem- Federal entitlement program. We on major problem in rural States, particu- ber of Congress, you are usually in

VerDate Nov 24 2008 03:19 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00048 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.068 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12695 pretty good shape. You may not have a the Ritter family in Manheim, PA. I Here is a picture down here taken lot of wealth, but you at least have a spoke with them several days ago and last year in Washington, DC, then at job to go to every day, you have a lot I spoke with these two young girls. One the age of 11. Here is what their mother of people helping you, and you have daughter’s name is Hannah—one twin, said: health care. That is not something I should say, is Hannah and her sister— Without meaningful health reform my that can be said for tens of millions of after I spoke on the floor I called their girls will be unable to afford care, that is if Americans. mom to talk about what I had said on they are even eligible for care, that is criti- This legislation is the culmination of the floor and I said to her, I think I re- cally necessary to maintain this chronic con- a lot of debate and discussion and anal- ferred to one of your daughters as Mad- dition. Punished and rejected because they had ysis and study over many decades now. eline, and that is incorrect, it is Mad- the misfortune of developing cancer as a It is nice that we have been talking for eline. So I want Madeline to know I child. years and years about preventing a pre- correctly pronounced her name my sec- What is the particular problem here existing condition from barring some- ond time around. Part of that is be- with this case? The obvious problem is one’s coverage or treatment. It is nice cause of a story I read to my daughters that these young girls were diagnosed to talk about it, but it is a lot better when they were kids all the time. But with leukemia. That is bad enough. there was a story about Madeline, and when we do something about it. It is But we have a system that made their a lot of parents know that story. So I nice we have talked about limiting life a lot worse than the leukemia, be- apologize to Stacie Ritter. out-of-pocket costs for families who cause we had a system that said—basi- But here is the story that Stacie Rit- are trying to take care of their chil- cally what the system said to them is: ter has told me through this commu- dren, trying to care of themselves, but We can help you and maybe cure you, nication, but has told a lot of other it is a lot better to do it, to enact it but we are going to put limits on it. We people, and now we try to tell her story into law. are going to say that it is nice to have This bill makes it illegal to use pre- on the Senate floor to give meaning to all of this technology and all of this existing conditions to deny someone what we are talking about here. But great medical knowledge and great coverage. This bill makes it illegal for this isn’t some public policy discussion doctors and hospitals across America— insurance companies to put a lifetime about health care; this is about what and we do. We are the envy of the cap on services, or an annual cap. This happens to real families when we don’t world on some of this stuff: the doctors bill makes it illegal to discriminate so get the policy right, when we talk and and the nurses and the health care pro- that no longer, if we do what we must talk year after year, decade after dec- fessionals, and the hospitals and the do and get this bill passed, can an in- ade, and talk about good intentions, technology and the know-how. We are surance company discriminate against but never get it done, never get a bill the envy of the world. We should ac- a woman, which they do all the time passed. This is what happens to people. knowledge that. But then we have this now, just as they prevent people from Stacie Ritter had to declare bank- ridiculous system that says to these getting coverage due to a preexisting ruptcy after her twins were diagnosed two little girls: But the care we want condition. We have an opportunity to with leukemia at the age of 4. My wife to give you and the results we can get change the way we provide health care Teresa and I have four daughters, and from that care are going to be limited. in ways we haven’t been able to imag- thank goodness they are all healthy. Two of them are in college, one is in So we hope it works out for you. ine, let alone enact into law. That is ridiculous. It is an abomina- One issue that has motivated me high school, and one is in seventh tion. I don’t understand why we have throughout this whole debate is what grade. We have never had to face that gone year after year and settled for happens to our children at the end of kind of diagnosis, thank goodness. this. Why do we have limits on the the debate, at the end the legislative Thank God I have never had to face kind of care people get? Because insur- line, so to speak. Will children in that, nor has my wife Teresa had to ance companies thought that was a America—and I am speaking about face that as a parent. But if we did, we good idea. I don’t know why. I don’t poor children and those with special would have been given some protection know whether it is for their bottom needs because they are the ones who and so would our daughters if we faced line or for whatever reason, but there need help. If you are in a wealthy fam- that horrific diagnosis, because when I is no excuse—no rationale—for saying ily, you will figure it out, and your was working as a lawyer or when I was to someone: We can cure you, but we family will figure it out. If you happen a public official, I had health care. are going to limit your care. Sometimes, for a lot of that time pe- to be a child of a poor family or a child You are in real trouble, and we know riod, a decade in State government who has special needs, will you be bet- how to help you. But we are going to health care, because I was a State em- ter off at the end of this debate or will limit it. Here is what Stacie said about ployee, I had a tremendous health care you be worse off. her kids: As it relates to poor children and plan, a kind of public option, a good When my identical twins were both diag- children with special needs, the goal public health care plan. So I never had nosed with [this leukemia] . . . at the age of here has to be no child worse off. It is to worry about that as a parent nor did four, we were told they would need a bone very simple. It is a very simple test. my wife if something horrific were di- marrow transplant in order to survive. That is what we have been working on. agnosed. That’s when I learned that the insurance I believe this bill that is on the floor These two little girls pictured here— company thought my daughters were only right now is a dramatic improvement and you can see even though because of worth $1 million each. in the lives of so many families. I still that diagnosis they are facing the kind I don’t know a parent in America think we have some more work to do as of challenge I can’t even imagine, let who believes their son or daughter—in it relates to children, but there is no alone endure—I hope I could, but I am this case, two daughters, her twins—is question that the bill we are debating not sure I could if I were in their place. worth any amount of money or their will make children a priority in ways But you can see that even though it is care is worth any amount of money. we haven’t been able to do in any kind obvious they are facing a real chal- Why does the insurance company do it? of other legislation, other than the lenge with regard to the leukemia, We hear they say that is policy, and children’s health insurance legislation they are very hopeful, aren’t they, in then they get pressure from a TV sta- that Congress enacted going back more that picture. They have their arms tion or news organization and they than a decade ago and that we reau- around each other. They have these give the care. thorized this past year. stethoscopes and they are dressed up If the policy makes sense, why would I wish to speak about two families like two doctors. So even in the midst public pressure change a policy? The tonight. This isn’t a discussion about of the horror of that kind of a diag- policy is ridiculous and insulting. It theory or about the nuances of a pol- nosis, you have these two brave little should be changed. It is one of those icy. This is about real people and what girls who are looking forward, not just things we have to make illegal, and has happened to them under our exist- worried about their one situation but this bill does that. We should make it ing system. I wish to put up the first looking forward with hope and opti- illegal for an insurance company to do chart. This chart depicts one family, mism. that to children. But it doesn’t make a

VerDate Nov 24 2008 03:19 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00049 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.069 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12696 CONGRESSIONAL RECORD — SENATE December 8, 2009 lot of sense unless you talk about it in And when you file bankruptcy, everything senses as we get lost in the politics. I terms of a real story. must be disclosed. We even had to hand over received a letter this fall that I think Here is what Stacie Ritter said after the kids’ savings accounts that their great sums it up in a way that both Hannah’s she talked about the limit—very flatly, grandparents had given them when they and Madeline’s story does as well. This were born. she said two words about whether a $1 is a letter that I received from a million is enough to care for two That is another problem with this woman in Havertown, PA, suburban daughters with leukemia over many messed up system we have. It forced Philadelphia. She says: years: this family not only to worry about On September 9, 2009, my sister-in-law’s It’s not! When you add up the costs in- whether their daughters were going to cousin had to take her three-week-old son off volved in caring for a patient with a life- be taken care of with leukemia, it not of life support. He took two shallow breaths threatening disease like cancer, $1 million only said they probably had to declare and passed away peacefully. He did not have barely covers it. bankruptcy to take care of themselves to die, he did not have to be on life support, and get the care they needed, but in he did not even have to be in the [neonatal We have lots of stories like this. intensive care unit] NICU. Fortunately, the hospital social worker the course of the bankruptcy pro- At 36 weeks gestation, his mother was told recommended we apply for secondary insur- ceedings, they had to turn over savings that she had Placenta-previa, but the insur- ance through the State considering the high- accounts. ance company and the doctor were at a tug ly probable chance we would hit the cap. And I don’t care if it was $1 or $1,000 or a of war on getting it covered. we did hit that cap before the end of treat- much higher amount. I don’t care what This is America. Why should a doctor ment. the amount was. We should never allow have to be in any tug of war about The State program sounds a lot like a system to force two little girls with whether this mother, who is pregnant, a public option. I may be wrong, but it leukemia to turn over their savings ac- will be covered? That should not even sounds an awful lot like that. counts that their great grandparents be a discussion. There should not have Thankfully, the State program kicked in started for them. That is how bad the to be any discussion about that. But and helped pay for the remainder of treat- system is. that is how messed up our system is. ment. I will spend lots of time compli- At 39 weeks, Brandon’s umbilical cord rup- So that part of the story worked menting doctors, hospitals, and nurses. tured. His mother Karen was rushed to the itself out. It didn’t work itself out be- We have a lot of good things. We have hospital and Brandon was taken to Jefferson cause the insurance company said: We [hospital] in Philadelphia to undergo brain good technology. OK. I am acknowl- cooling treatment to return brain activity. have a way to help you, and we are edging all that. But this system is It was too late. After minimal return of going to do it and figure out the cost in messed up when we have this happen to brain activity, it was decided after 3 weeks another way. No, the insurance com- one family. I don’t care if it is one fam- to remove life support. pany didn’t help them. It was the State ily or 1 million, but we know there are She concludes with this haunting program in this case—the kind of pub- lots of them out there who face similar sentence, this haunting reminder of lic option that helped these kids. That circumstances. how bad a case this is: part of the story has somewhat of a Some people might say you are talk- Who saved money here? Was it worth a positive outcome. These kids are only ing about the family and all these child’s life to save a few dollars? And I am 11. When they were 4 and 5, they didn’t problems. What does your bill do? It so sure 3 weeks of life support costs more than have that kind of an option. happens the first provision in the bill— a C-section. This story gets worse. This is what go by the table of contents and go to That is the end of her letter. So any- Stacie says: the page—I think page 16. The first body who says that we have to make a During this time, my husband had to take provision of the bill talks about not couple little changes on the margins, family medical leave so we could take turns having limits on lifetime coverage. If but we have a great system that is not caring for our one-year-old son and our twins that were in effect when Stacie Ritter in need of major reform—I need only at the hospital. . . . and her husband got the diagnosis for point to these two examples. That is For the 7 months my husband was out on all the information I need. family medical leave, he was able to main- their daughters—if that was in effect, the following would have happened, Unfortunately, we have thousands— tain his employer-based insurance for us via hundreds of thousands of additional ex- a $717.18 a month COBRA payment. and this is irrefutable: No. 1, they were amples—literally millions of people upset, and as worried as they were Let me get this straight. We are now who are denied coverage because of a about their daughters, at least they talking about COBRA—the extension preexisting condition. Sometimes be- would have had the peace of mind to of insurance coverage for people who cause a woman has been a victim of do- are hurting, laid off or unemployed. know they didn’t have to worry about mestic violence, that has been used as That is another government initiative it costing too much to get them care. a preexisting condition in terms of enacted by Congress. I am sure there They would not have had to worry whether she gets health care. So we were some folks who thought let’s not about this causing bankruptcy. So at have a messed up system. use government to extend health insur- least we would have given them some When we allow these tragedies to ance. But in this case, it was helpful to peace of mind and some security. Then happen day after day, year after year, this family. But it wasn’t enough. on top of that, we would have given and we have people in Washington say- Here is what Stacie says, as she them the kind of care they needed, in- ing: We just could not get it done, we keeps going: cluding the follow-up care. have to debate a little longer—we have After spending all our savings to pay the When some people say we need to de- to get a bill passed. We are going to do mortgage and other basic living expenses, we bate a little longer, 3 months or 6 that in the next couple of weeks. We had to rely on credit cards. months more, or let’s talk about it for will take whatever steps are necessary We have a health care system that a couple more years—we have talked to get this legislation passed because forced Stacie Ritter, and lots of other this issue to death for years. We know we cannot say to this woman who families in America, to rely upon cred- exactly what is wrong. This is what is wrote to me from Havertown, PA, nor it cards so they could get the health wrong. That story alone is reason to can we say to these two girls and their care for their daughters who have leu- pass the bill. There are a lot of other parents—we can’t walk up to Hannah kemia and make ends meet so they reasons, a lot of other tragedies that and Madeline and other kids like them could pay the mortgage and all the are preventable if we do the right in the country and say we tried to get other things they had to pay for for thing. that lifetime limit matter done, but it themselves and their daughters and We have a bill that we are going to got a little contentious. their son. That is what this health care pass, and the first provision speaks to We have to get it done, and we will system has forced them to do. this family’s challenge. get it done because we are summoned This isn’t unambiguous. This is ex- Let me read one more letter and I by a lot of things. But I think we are actly the result of the worse part of will stop. I know I am over my time. summoned by our conscience to get our health care system. This last sen- We have heard a lot of discussion in the this done and make sure we can do ev- tence might be the most poignant. She last couple of days about people whose erything possible—no system is per- mentions they filed bankruptcy: personal tragedies bring all of us to our fect—to prevent these tragedies.

VerDate Nov 24 2008 03:19 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00050 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.071 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12697 I yield the floor. To my mind, quite frankly, there is People are entitled to a choice. If you The PRESIDING OFFICER. The Sen- only one way that I know of that we want to stay with your private health ator from Vermont is recognized. can provide universal, cost-effective, insurance company, great, you can do Mr. SANDERS. Mr. President, let me and comprehensive health care for all it. But as many people as possible in begin by thanking Senator CASEY for our people, and that is a Medicare-for- this country should be able to say: You his consistent efforts in fighting to all, single-payer system. Very briefly, know what, I am not comfortable with make sure that every American has the reason for that is we are wasting a private insurance company. I would good-quality, cost-effective health about $400 billion every single year on rather have a Medicare-type plan. care. He has been a leader and I con- administrative costs, on profiteering, Poll after poll suggests that the gratulate him. on advertising, on billing—all in the American people want that public op- Mr. President, I wish to touch on name of profits for the private insur- tion. That is point No. 1, freedom of some of the health care issues that are ance companies that have thousands choice. People should have that choice. out there and tell you what I think is and thousands of separate plans out If they do not want it, that is fine. positive in the bill we are dealing with there, creating an enormously com- Point No. 2 may be even more impor- in the Senate and tell you what I think plicated and burdensome system. With tant, if we are going to get a handle on is not so positive. each one of their thousands of plans, if exploding health care costs, somebody To begin with, as Senator CASEY has you are young and do not get sick and is going to have to rein in the private aptly described, we have a system are healthy, they have a plan for you. insurance companies whose only func- which, in many ways, is disintegrating. If you are older and you get sick, they tion in life is to make as much money It is an international embarrassment have another plan for you. There are as they possibly can. We need a non- that in the United States of America, 1,300 private insurance companies with profit, government-run public plan to we remain the only Nation in the in- thousands and thousands of plans, and do that. If we do not have that in this dustrialized world that does not guar- to administer all of this costs hundreds bill, I am not sure how we are going to antee health care to all its people as a and hundreds of billions of dollars. get any handle on cost containment. right. The result of that is, some 46 That is money not going into doc- I will fight to make sure we have as million Americans today have no tors—we have a huge crisis in primary strong a public option as we possibly health insurance. Even more are under- health care physicians—not money can. As I have said publicly many insured, with large copayments and going into dentists. Many areas, in- times, my vote for this legislation is deductibles. cluding Vermont, have a serious dental not at all certain. I have a lot of prob- We have some 60 million Americans access problem. That is money not today who, because of our very poor lems with this bill. We have to have at going to nurses. We have a nursing least, among other things, a strong primary health care outreach network, shortage. This is money going into bu- do not have access to a doctor on a reg- public option. reaucracy, profiteering, and salaries Let me tell my colleagues something ular basis. The result of that is, as in- for the CEOs of insurance companies. It else I think we have to address in this credible as it may sound, according to is going into inflated prices for pre- a recent study at Harvard University, bill. As I mentioned a moment ago, we scription drugs in this country. As a have a disaster in terms of primary some 45,000 people die every single year nation, we pay the highest prices in the health care in America. Some 60 mil- because they do not get to a doctor world for prescription drugs. lion Americans are finding it difficult when they should. As a result, by the To my mind, as a nation, what we time they walk into a doctor’s office, have to finally deal with is that so long to get to a doctor on a regular basis, their illness may be terminal. In addi- as we have thousands of separate plans, and that is dumb in terms of the health tion to that, God only knows how each designed to make as much money and well-being of our people. It is also many people end up in a hospital, at as possible, we are not going to get a dumb in terms of trying to control great expense to the system, because handle on the cost of health care in health care costs. they did not get care when they should America. If somebody does not have a doctor have. In the bill we are now talking about they can go to when they get sick, Meanwhile, as Senator CASEY indi- in the Senate, we have to be clear that where do they end up? They end up in cated, bankruptcy is an enormous the projections, according to the CBO, the emergency room, and everybody problem because of our health care sys- are that, everything being equal, over a knows the emergency room, by far, is tem. Close to 1 million Americans this 10-year period, the cost of health care the most expensive form of primary year will be going bankrupt because of for most Americans is going to con- health care. Yet millions of people medically related bills. Furthermore, tinue to soar. That is the reality. This have no other options. They end up in when we talk about economic growth is bad not only for individuals, not an emergency room. If they have a bad in America, all of us understand that only for businesses, this is bad for our cold, Medicaid may pay $500 to $600 for small businesses, medium-sized busi- international competitive capabilities their visit to the emergency room. nesses are plowing an enormous because we are starting off from the That is totally absurd. amount of money into health care for position that today we spend much Furthermore, if you have a primary their workers rather than reinvesting more than any other country. Guess health care physician, that person can that money and expanding their oper- what? While this bill does a number of work with you on disease prevention— ations and creating the kind of jobs we very good things, it is not strong on helping you get off cigarette smoking need as a nation in the midst of our cost containment. or helping you with alcohol, a drug very deep recession. If we are going to try to improve cost problem, a whole myriad of issues in We have a major problem. At the end containment—and I wonder how much terms of good prevention, good nutri- of the day, despite so many people un- we can do within the context of this tion. That we have a disaster in pri- insured, underinsured, so many people particular approach to health care mary health care which is driving peo- dying because they do not get health without being a Medicare-for-all, sin- ple to the ER makes no sense at all. care when they need it, so many people gle-payer system—at the very least, we As I mentioned the other day, there going bankrupt, we end up spending al- need a strong public option. We need is a provision in this legislation in the most twice as much per capita on that for two reasons. First of all, there Senate which authorizes a very signifi- health care as any other nation. is widespread mistrust of private cant expansion of federally qualified It is clear to me and I think it is health insurance companies for all the community health centers which, in a clear to the vast majority of the Amer- right reasons. nonpartisan way, a bipartisan way is ican people that we need real health Most Americans understand that the widely supported by, I suspect, almost care reform. What real health care re- function of a private health insurance everybody in the Senate and in the form must be about is at least two company is not to provide health care; House as well. things. No. 1, providing coverage to all the function is to make as much money These community health centers Americans as a right of citizenship as possible. People do not trust private today allow 20 million people to access and, No. 2, doing that in the most cost- health insurance companies, and they not only good, quality primary health effective way we possibly can. are right in terms of their perceptions. care but dental care, which is a huge

VerDate Nov 24 2008 03:19 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00051 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.072 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12698 CONGRESSIONAL RECORD — SENATE December 8, 2009 issue all over this country, mental are the wealthiest people in this coun- Health Benefits Tax Will Hit CWA— health counseling, a very big issue, and try. What the House has said, quite ap- And they are talking about many low-cost prescription drugs. propriately, is that at a time when the union workers here. The problem is, while the community gap between the rich and everybody —CWA-negotiated Plans Hard and Result in health centers today do an excellent else is growing wider and at a time Deep Cuts. In 40 of 43 states examined over 10 job, there are not enough of them. So when the top 1 percent earn more in- years (2013–2022) the average excise taxes as- in this legislation, we have greatly ex- come than the bottom 50 percent, it is sessed on each worker in CWA’s most pop- panded community health centers. If appropriate, especially after all of ular plans will be: $13,300 per active worker we as a Congress are talking about President Bush’s tax breaks, to ask the in the family plan. bringing 13, 14, 15 million more people wealthy to start paying their fair share That is for a 10-year period, $13,300. into Medicaid, I am not quite sure how of taxes so we can provide health insur- $5,800 per active single worker, $13,600 for a struggling Medicaid Program is going ance to tens of millions of Americans. pre-Medicare retiree in the family plan, and to accommodate those people, unless That, in my view, is exactly the right $4,400 for pre-Medicare retiree in the single we provide the facilities and the med- way to go. plan. ical personnel to treat them. Unfortunately, in the Senate, we The bottom line is that the middle We need this. We need to expand pri- have not done that. What we have cho- class in this country is struggling. We mary health care. Community health sen to do in the Senate is to raise are in the midst of the most severe re- centers are the most cost-effective way about—I do not know the exact num- cession since the Great Depression of I know how to do that. There are stud- ber—but we have chosen to impose an the 1930s. People are working longer ies that suggest providing that primary excise tax of 40 percent on so-called hours for lower wages. The middle class care, keeping people out of the emer- Cadillac plans. The problem is, given is on the verge of collapse. The Senate gency room, keeping them out of the the substantial increase in health care should not be imposing an additional hospital because they have gotten sick- costs in this country, a Cadillac plan tax on middle-class workers. The House er than they should have gotten, we today in 5 or 10 years may be a junk got it right; the Senate got it wrong, can, in fact, pay for these community car plan. and I intend to offer an amendment to health centers over a period of years by I believe with a struggling middle take out this tax and replace it with a simply saving money. class, with people desperately trying to progressive tax similar to what exists In the Senate, we have very good lan- hold onto their standard of living, the in the House. guage authorizing an expansion. In the last thing the Senate wants to do is Let me conclude by simply saying House, they have similar language, ex- impose a tax on millions and millions this: I understand that the leadership cept in the House they have a trust of working people who have fought wants to move this bill forward as fund which actually pays for this. I am hard to get a halfway decent health quickly as possible. I understand that. going to do my best to make sure we care plan. But in my view, we have a lot of work adopt the House language, which pays Let me very briefly read from a fact in front of us to improve this plan. for, through a trust fund, a substantial sheet that came from the Communica- Among many other things—many increase in community health centers tions Workers of America. CWA is one other things—and I know other Mem- and, in addition, a very significant ex- of the largest unions in this country. bers have different ideas—at the very pansion of the National Health Service Similar to almost every union, they least, States in this country—indi- Corps, which is a Federal program are strongly opposed to this excise tax vidual States—if they so choose, should which provides debt forgiveness and on health care benefits. This is what be able to develop a single-payer plan scholarships for medical students who they say. I read right from it. This is a for their States. Because at the end of are prepared to serve in medically un- document from the CWA: the day, in my view, the only way we derserved areas in primary health care. The U.S. Senate will soon vote on legisla- are going to provide comprehensive, We desperately need more primary tion that would tax CWA-negotiated em- cost-effective, universal care is health care physicians, nurses, den- ployer health plans. The tax will be passed through a single payer. tists. That is what the National Health directly onto working families. To avoid the I know some people are saying: Well, tax, employers will try to significantly cut we are dealing with health care, we are Service Corps does. My hope is the Sen- benefits for active workers and pre-Medicare ate will adopt the House provision to retirees. not going to be back for a long time. If greatly expand the National Health How the House Benefits Tax Works. this bill were passed tomorrow, trust Service Corps and the Health Service A 40-percent excise tax would be assessed me, we would be back in a few years, programs. That is an issue that is very on the value of health care plans exceeding because health care costs are going to important to me. $23,000 for a family and $8,500 for an indi- continue to soar. Winston Churchill Let me touch on another issue, which vidual starting in 2013. (Levels are higher for once said: ‘‘The American people al- pre-Medicare retiree plans and high-risk in- ways do the right thing when they have is clearly going to be contentious; that dustry plans—$26,000 and $9,850.) is, at the end of the day, we are going no other option.’’ And I think that is And here is an important point. Be- to be spending on health care some- what we are looking at right now. We cause while people may not have to pay where around $800 billion to $1 trillion. are running out of options. this tax in a couple of years, with The American people want to know a What we have put together is an health care costs soaring, they will couple of things. They want to know: Is enormously complicated patchwork have to pay this tax in the reasonably this going to raise our national deficit? piece of legislation. It is going to help near future. a lot of people. It involves insurance What CBO tells us is, no, it will not. Quoting from the CWA document: reform, which is absolutely right. We More money is going to come in than These ‘‘thresholds’’ would increase at the goes out. There will be savings incor- rate of general inflation, plus 1 percentage have a lot of money into disease pre- porated in the legislation, and that is a point, or 3 percent. This is well below the vention, which we should have. There good thing. We have a $12 trillion na- medical inflation rate (4 percent) and about are a lot of very good things in this tional debt, and we do not want to add half the rate (6 percent) at which employer bill. But it is not going to solve, in my to that. and union plan costs have been increasing. view, the health care crisis. Costs are But people are also asking how are In other words, the cost of health going to soar. If we don’t have the you going to raise the money? How are care is rising a lot faster than infla- courage as a body to take on the insur- you going to pay for this? Where does tion, which today is almost zero. It ance companies, to take on the drug the $800 billion to $1 trillion come may actually be below zero, the point companies, at the very least let us give from? Here is where we have a bit of being that in a number of years, so- States—whether it is Vermont, Penn- differences of opinion. called Cadillac plans are going to reach sylvania, California, or other States— In the House, I think they have, once the threshold upon which middle-class the right to become a model for Amer- again, done the right thing. What the workers are going to be forced to pay a ica; to provide health care to all people House has done is raise $460 billion, lot in taxes. in a cost-effective way through a Medi- with a surcharge on the top three- Let me go back to the CWA now. care-for-all, single-payer system. We tenths of 1 percent of taxpayers. These They write: have to do that.

VerDate Nov 24 2008 05:44 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00052 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.073 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12699 The other thing we have to do, in my wise mistreated by someone on whom tification systems triggered by the re- view, is to get rid of this tax on the they depend for care or protection. port of a missing senior. Postings on middle class by taxing health care ben- As Federal policymakers, it is time highways, radio, television, and other efits. Mr. President, you will recall that we step forward and tackle this forms of media broadcast information that a year ago we were in a highly chaenge with dedicated efforts and about the missing senior to assist in lo- controversial and difficult Presidential more vigorous programs that will cating and returning the senior safely campaign. One candidate, who hap- make fighting elder abuse as high a home. Now we have an opportunity to pened to have lost that election—a priority as ongoing efforts to counter finish the job and create Silver Alert Member of the Senate, Senator child abuse. programs across the country. MCCAIN—came up with a plan that was It is in this spirit that I am offering Both of the provisions in this amend- exactly—or very close to it—to what an amendment to give the Department ment are strongly supported by the we are talking about today. Then-Sen- of Justice a roadmap for how to estab- Elder Justice Coalition. I ask my col- ator Barack Obama, who won that elec- lish programs to bolster the frontline leagues to support this amendment, tion, came up with a different plan, be- responses of state and local prosecu- and by doing so to markedly reduce the cause he said that wasn’t a good idea. tors, aid victims, and build a robust in- risk of harm to our most vulnerable Well, how do you think millions of frastructure for identifying and ad- citizens. American workers are going to feel dressing elder abuse far more effec- Mr. SANDERS. Mr. President, it ap- when they say: Wait a second, the guy tively than we do today. pears I am going to be closing tonight. who won told me he was against taxing We need to provide assistance to our The PRESIDING OFFICER. The Sen- health care plans, and now we are courts, which would benefit from hav- ator from Vermont is recognized. ing access to designated staff that adopting the program of the guy who f lost. How do the American people who boast particular expertise in elder voted in that election have faith in abuse. Specialized protocols may be re- MORNING BUSINESS quired where victims are unable to tes- their elected officials if we do exactly Mr. SANDERS. Mr. President, I ask tify on their own behalf, due to cog- what we said we would not do? unanimous consent that the Senate nitive impairments or poor physical So I believe we have to move toward proceed to a period of morning busi- health. And there is a great need for a progressive way of funding this ness, with Senators permitted to speak specialized knowledge to support suc- health care plan. As I stand here right for up to 10 minutes each. cessful prosecutions and enhance the now, this plan has a lot of good stuff in The PRESIDING OFFICER. Without development of case law. Today, many it, but there are a lot of problems in it. objection, it is so ordered. I very much look forward to the oppor- state elder abuse statutes lack ade- tunity to be able to offer a number of quate provisions to encourage wide re- f porting of abuse and exploitation, more amendments to strengthen this bill. It TRIBUTE TO VIDA CHAN LIN is very important to the people of thorough investigations and greater Vermont and to people all over this prosecution of abuse cases. Mr. REID. Mr. President, I rise today country that not only I but the Pre- For the victims of elder abuse, many to honor Vida Chan Lin. The Las Vegas siding Officer and other Members have of whom are physically frail and very Asian Chamber of Commerce recently a right to offer amendments. Because if frightened, we must do much more. named Vida Chan Lin as their first fe- this bill gets whizzed right through, First and foremost, we must be more male president. For many years, Lin and is not as strong as it possibly can responsive. Not too long ago, it was dif- has been an advocate for Nevada’s be, I think we will not have done the ficult to even get an abuse case inves- Asian Pacific Islander American, job we need to do. tigated. While that is starting to APIA, community. Her early exposure Mr. President, with that, I yield the change, we have much work ahead. For to the complexities of business and the floor. example, sometimes emergency inter- APIA community has cultivated the Mr. KOHL. Mr. President, as chair- ventions are necessary, particularly if passion and talent necessary for suc- man of the Special Committee on the older person is being harmed at the cess. Aging, the plight of vulnerable seniors hands of family members or trusted Vida Chan Lin moved to Las Vegas in is a subject of great concern to me. The ‘‘friends.’’ It may be necessary to re- 1994 and began developing her career as committee is charged with uncovering move the older adult from his or her an insurance sales representative. problems that endanger the health and home to a temporary safe haven. To do Within a few years, Lin pursued her en- welfare of older adults and developing this, we must build a much more ro- trepreneurial interests and launched an policy to prevent seniors from becom- bust system of support. insurance agency named V&J Insur- ing victims of fraudulent scams and And there is more we must do to as- ance. The company was committed to abuse. sist vulnerable seniors who may not be providing outstanding service and edu- During this Congress, I have been for- abused, but who are nonetheless vul- cation to Asian and minority commu- tunate to be joined by my colleagues, nerable because they suffer from cog- nities in Nevada. Vida Chan Lin’s suc- Senators LINCOLN and HATCH and nitive impairment. As the prevalence cess continued when she was named STABENOW, in advancing policy to re- of dementia rises in our aging society, vice president after a merger between duce elder abuse. The Senate health we have a special responsibility to en- V&J Insurance and Western Risk In- care reform bill now includes both the sure that those who ‘‘go missing’’ from surance. Elder Justice Act and the Patient Safe- home are returned promptly and safe- Vida Chan Lin’s continued involve- ty and Abuse Prevention Act, and we ly. This is the purpose of the second ment and dedication with supporting will do our utmost to see that they be- part of the amendment, which proposes local community and business organi- come law. to create a national program to coordi- zations resulted in a significant part- Today I am pleased to continue the nate State Silver Alert systems. nership that benefits families and busi- effort to protect America’s vulnerable The Amber Alert system, on which nesses across Nevada. Lin has also ad- seniors by introducing an amendment the Silver Alert Act is modeled, was vanced local business endeavors that combines two very valuable bills, created as a Federal program to rap- through her work with the Asian the Elder Abuse Victims Act and the idly filter reported information on Chamber of Commerce, ACC, and the National Silver Alert Act. Both have missing children and transmit relevant OCA Las Vegas Chapter. During her been passed by the House of Represent- details to law enforcement authorities tenure in ACC, she helped develop an- atives. and the public as quickly as possible. nual events such as the Chinese New Elder abuse is a sad scourge on our Using the same infrastructure as Year Community Achievement Awards society, often hidden from sight by the Amber Alerts, 11 States have already Dinner, Bill Endow Golf Tournament, victis themselves. Even so, experts con- responded to the problem of missing and Asian Business Night. Her help servatively estimate that as many as 2 seniors by establishing Silver Alert with the OCA Las Vegas Chapter re- million Americans age 65 and older systems at very little additional cost. sulted in two national events to be held have been injured, exploited or other- These programs have created public no- in Las Vegas for the first time—the

VerDate Nov 24 2008 03:19 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00053 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.075 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12700 CONGRESSIONAL RECORD — SENATE December 8, 2009 OCA National Convention and the Na- Al’s life, which was published by The By sponsoring an annual State Journal tional Asian Pacific American Cor- State Journal on December 3, 2009. I All-Academic Banquet, Dix encouraged stu- porate Achievement Awards. ask unanimous consent that the full dents to excel in the classroom, Roach said, ‘‘and he encouraged teachers by recognizing Being a leader in the Asian Pacific article be printed in the RECORD. them as well.’’ Islander American community has pro- There being no objection, the mate- Dix could also be a confidant, Roach said. vided Vida Chan Lin an opportunity to rial was ordered to be printed in the ‘‘You could go talk to him about an issue affect younger generations. Her posi- RECORD, as follows: and you knew it would always be in con- tive attitude and passion for APIA [From the State-Journal, Dec. 2, 2009] fidence,’’ Roach said. ‘‘And I knew his advice issues brought forth an inspiration FORMER PUBLISHER AL DIX REMEMBERED AS would be on target.’’ within our youth to provide for their CARING LEADER Attorney Bill Kirkland, a former Paul communities. Lin promotes and en- (By Charlie Pearl) Sawyier Public Library president, said Dix was on a special gifts committee during Journalists, bankers, politicians, educators sures that the voice of APIA youth is fundraising for the new library and he came and others today paid tribute to Al Dix as a heard. She continues to dedicate time faithfully to every meeting. for students involved in the OCA Las sensitive and caring publisher who was dedi- ‘‘He had numerous contacts in the commu- Vegas Chapter and ACC by engaging cated to improving the community but kept nity and personally added immeasurably to his good works private. the quality of the library through the gifts them in entrepreneurial development Dix died at his home in Frankfort Tuesday he solicited. opportunities such as the Clark County morning of pancreatic cancer. He was 80. ‘‘He was a person of intellect, humor, good Summer Business Institute. Services will be 2 p.m. Friday at South personality and good judgment. There was Frankfort Presbyterian Church with visita- As she continues to advance her ca- never a kinder soul and more generous per- tion at noon. Burial will follow at Frankfort reer and charitable interests, Vida con- son in the community.’’ Cemetery. tinues to give great care to her family. Kirkland said their friendship spanned four Richard Wilson, who retired from The Las Vegas is better as a place because decades. (Louisville) Courier-Journal as its higher ‘‘About 40 years ago, we played one-wall of dedicated people like Vida Chan Lin. education reporter, got his first job in news- handball at the old YMCA on Bridge Street. Vida’s dynamic ambition reminds me papers with The State Journal under Dix in I knew him first through his connection with of a quote from one of this country’s 1963 and 1964. greatest Presidents. Teddy Roosevelt ‘‘That helped me immensely during a near- South Frankfort Presbyterian Church, and through a few Republican endeavors. He cer- once said: ly 40-year career in journalism,’’ Wilson said. ‘‘Much of the reason for that was Al, who tainly was a conservative after my own The credit belongs to the man who is actu- was unquestionably a reporter’s publisher. heart. ally in the arena, whose face is marred by ‘‘He had extraordinary compassion and was He was encouraging, respected quality work dust and sweat and blood, who strives val- interested in literacy, education, good gov- and openly shared his enthusiasm for its ap- iantly; who errs and comes short again and ernment and ethical behavior.’’ pearance in the newspaper. again; because there is not effort without ‘‘While he may have held strong views on Bruce Dungan, retired president of Farm- error and shortcomings; but who actually many subjects, he never permitted them to ers Capital Bank Corporation, said when Dix strive to do the deed; who knows the great permeate The State Journal’s news columns first came to Frankfort from Ohio, ‘‘I could enthusiasm, the great devotion, who spends and he respected those who believed other- tell he was here to be a friend of Frankfort. himself in a worthy cause, who at the best wise. He also frequently took a personal in- He was very thoughtful of people. knows in the end the triumph of high ‘‘He was here to help people, charities, gov- terest in his employees and their well-being, achievement and who at the worst, if he ernment and his church. He worked so hard both professionally and personally.’’ fails, at least he fails while daring greatly. Bruce Brooks, retired executive vice presi- at charities. He would call me and say what So that his place shall never be with those dent at Farmers Bank, said he always con- I had given last year, and then say, ‘Don’t cold timid souls who know neither victory sidered Dix ‘‘a dear friend. He was a little bit you think you ought to raise it a little this not defeat. of a mentor to me. time?’ Vida is not a timid soul. She strives ‘‘He was always willing to be a listening ‘‘If it hadn’t been for Al, the YMCA (on for success with her family, career, and board for any situation. He was free with his Broadway) may never have happened. He advice and usually it was pretty sound and kept pushing everybody. He did whatever he community. could to improve Frankfort. He was one of I know that Vida Chan Lin and the analytical.’’ Brooks said Dix was master of ceremonies the greatest guys in Frankfort that I know Las Vegas Asian Chamber of Commerce at various functions, ‘‘and was really, really of. We’re going to miss him. I sure will.’’ have a bright and blessed future. I con- skilled at it. And he always had an open Irvine Gershman, a retired downtown mer- gratulate Vida on being the first checkbook for a worthy cause. He would chant, said Dix ‘‘coming here from Ohio was woman to lead the Asian Las Vegas walk the walk and talk the talk.’’ probably one of the best things to happen to Chamber of Commerce. Former City Commissioner Pat Layton Frankfort. He was always willing to do said Dix encouraged her to start her real es- things for other people. f tate career. ‘‘He and his family have contributed so REMEMBERING ALBERT E. DIX ‘‘He had a lot of insight of what was going much to this community. When I would call on in the community,’’ Layton said. ‘‘It on him for a little help (to various charities), Mr. MCCONNELL. Mr. President, all wasn’t because he was publisher of a news- he would just say, ‘How much do you need?’ ’’ of the Commonwealth of Kentucky has paper but because he really loved his com- Gershman’s wife, Priscilla, said Dix ‘‘was a suffered a great loss with the recent munity. precious jewel. He will be sorely missed by death of Albert E. Dix. A fourth-gen- ‘‘He was truly a leader. But a lot of people everyone.’’ eration journalist, Al Dix moved to didn’t know about the many things he did for Russ McClure, a former vice president of Frankfort, Kentucky’s State capital, Frankfort because he was very private about Morehead State University, said he was ‘‘under the gun a lot of times’’ while serving to become publisher of The State Jour- it. He was a silent supporter. When there was a need, he was there and stepped right up as Finance Cabinet secretary to Carroll and nal in 1962, a post he would keep until front. He was a special guy.’’ assistant budget director to Bert Combs his retirement in 1996. Known for being State Sen. Julian Carroll, who was gov- when they were governors. a mentor to aspiring journalists, Al ernor while Dix was publisher, said, ‘‘Al was ‘‘One thing I could always count on was Al Dix helped train scores of individuals a great community-minded leader. Although being straight up and fair,’’ McClure said. who went on to work at papers with he was a Republican and I’m a Democrat, he ‘‘He was always straightforward with his much larger circulations. But he was was always very nice and cordial to me. I questions and always accurate in his report- more than just one of Kentucky’s fin- considered him to be one of our outstanding ing of my answers and the facts.’’ citizens.’’ The Rev. John Hunt, retired pastor of est journalists. As one of his former Bob Roach, a retired school teacher and South Frankfort Presbyterian Church, said press foremen put it, ‘‘He treated all former city commissioner and county judge- he has fond memories of getting to cover one employees really well, just like they executive, said Dix ‘‘was certainly interested of the launches of the Gemini space program were his family. He was a really good in young people and education, and he be- in the early 1960s for The State Journal be- person all around.’’ lieved in excellence. He was a prince of a fel- cause of Dix. Indeed, Al Dix leaves behind a legacy low.’’ ‘‘He knew of my interest in science and he as not only a superb publisher but as a While teaching at Franklin County High credentialed me,’’ Hunt recalled. School, Roach said he took groups of stu- When Hunt got to Cape Canaveral, bad pillar of his community. While I could dents to Washington, D.C., for 25 years to weather caused the flight to be postponed, so say much more about my friend Al Dix, participate in a North American Invitational he figured he would have to miss the experi- I think it appropriate for me to share Model United Nations program, ‘‘and we ence because he would need to get back to with my colleagues a recent account of could always count on him for a donation.’’ Frankfort for Sunday church services.

VerDate Nov 24 2008 03:19 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00054 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.032 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12701 But Dix encouraged him to stay in Florida, The Kentucky Book Fair was founded by For example, it can be reasonably ar- saying he would give the sermon on Sunday, The State Journal in 1981. gued that U.S. pressure contributed to Hunt said. Dix also was a member of the board of di- Cuba’s decision to cease its military ‘‘He filled the pulpit for me and did an ex- rectors of First Capital Bank of Kentucky, cellent job,’’ Hunt said. ‘‘He got rave reviews the Frankfort/Franklin County Industrial adventurism in Africa and its support and supplied the pulpit on my absences after Development Authority and the local for the violent insurgencies that ripped that. I was about ready to swap places with Kiwanis Club; and served two terms as chair- apart Central America in the 1980s. him.’’ man of the American Saddlebred Museum at But on the two most important ques- Scottie Willard, who retired in September the Kentucky Horse Park in Lexington. tions, the verdict is decisive: as press foreman after 44 years at The State He loved fishing and making fishing rods, First, did this policy fulfill its often- Journal, remembers when Dix became pub- electric trains and saddlebred horses. stated purpose of overthrowing the lisher in 1962. Other survivors include his wife of 56 Castro regime? Fidel Castro outlasted ‘‘He made a lot of improvements as far as years, Edna Dix; a son, Troy Dix, publisher nine American Presidents, from Eisen- press equipment when he took over,’’ Willard of the Ashland Times-Gazette in Ohio; and said. ‘‘He treated all employees really well, four grandchildren, Evan, Stewart and Me- hower to Clinton, and retired only for just like they were his family. He was a real- lissa Dix and Lauren Maenza. reasons of health during the tenth. ly good person all around.’’ f When he passed on the reins to his Ronnie Martin, retired composing foreman brother, Fidel joined Omar Bongo of who worked at the newspaper 43 years, CUBA Gabon and Libya’s Colonel Qaddafi as agrees. Mr. KERRY. Mr. President, I rise as one of the world’s longest-serving head ‘‘He was super to work for,’’ Martin said. a cosponsor for S. 428, the Freedom to of states. ‘‘He gave me all sorts of opportunities and Second, have the benefits of our pol- challenges at the same time, but they all Travel to Cuba Act. worked out. He was a great guy. He treated It is time we brought our strengths icy outweighed the costs? It is hard to everybody fairly.’’ to bear—our people, our vision, our en- argue they have. The embargo has cost Ann Maenza, Dix’s daughter, now publisher ergy—to help the Cuban people shape Cubans access to our markets, and for of The State Journal, said her father ‘‘never the future direction of Cuba and to fix many years to our food and medicine— cut corners. He always made sure things a policy that has manifestly failed. For with little progress to show. But it has were done right. He was old school, fair and America to act as the great power we cost us as well. It has limited the influ- honest.’’ are, with confidence in our values and ence of our people and our democracy. Amy Dix Rock, senior director of regu- latory and scientific affairs at Cumberland vision, we need a Cuba policy that What’s more, this fall’s U.N. vote con- Pharmaceuticals Inc. in Nashville, Tenn., looks forward. demning America’s embargo showed said her father was ‘‘always thinking of oth- The truth is, we have reached out to yet again: Cuba is not the only country ers. We don’t know how many things he’s countries where our wounds were far isolated by our policy. The vote done for others because he didn’t talk about deeper, and far more recent. When against our policy was 187 to 3. All of it. JOHN MCCAIN and I led the efforts to our major allies voted against us, and ‘‘That’s the way he was. He was soft-spo- unfreeze our relationship with Viet- one of the two voting with us itself ken but when he did speak you listened.’’ Al Smith, who rose to prominence in the nam, we said: ‘‘let’s be honest . . . the routinely trades with Cuba. state as a weekly newspaper publisher and as Cold War is over. All the American Is it morally satisfying to sanction a the longtime host of KET’s ‘‘Comment on trade embargo is doing is keeping Viet- government whose human rights prac- Kentucky,’’ said Dix was a newspaper pub- nam poor and thus encouraging a flood tices we abhor and whose political sys- lisher of the old school, ‘‘but the opposite of of refugees.’’ tem rejects many of our values? Sure. the domineering egotistic bosses who bullied For nearly 20 years after the fall of And helping Cubans to live in democ- employees and squeezed the news to match Saigon, the Vietnam war took a less racy and liberty absolutely remains a their biases. bloody but equally hostile form. The goal of American policy. But for 47 ‘‘ ‘Old school’ means that we always knew that with Al at The State Journal, it was U.S. and Vietnam had no diplomatic years now, we have endorsed an embar- like the grocery slogan of years ago, ‘the relations. Vietnamese assets were fro- go in the name of democracy that pro- owner is in the store.’ He didn’t have to call zen. Trade was embargoed. But in 1995 duced no democracy! a distant headquarters to know what to say the United States normalized relations In fact, our rhetoric and policies have or do. with Vietnam. The Cold War had actually helped to consolidate the ‘‘He had strong views, conservative Repub- ended, and we even signed a trade deal Cuban government. We have provided lican in a ‘company town’ (state govern- with a country where 58,000 Americans the Castro regime with an all-pur- ment) of readers who are mostly Democratic, had given their lives. pose—if exaggerated—excuse to draw but he ran the paper on principles of fairness in the news columns and gave his editorial The results? A Vietnam that is less attention away from its many short- writers, who were mostly more liberal than isolated, more market-oriented, and, comings, including its shamelessly he, free rein on the opinion page.’’ yes, freer—though it has miles to go. flawed economic model. For too many Smith noted how The State Journal under And yet, when it comes to Cuba, a Cubans, our threats have legitimized Dix supported a constitutional amendment small, impoverished island 90 miles off Castro’s outsized nationalism and re- that overhauled the state’s judicial system the shores of Florida, we maintain a pression of opponents. Our posture has and created what is today the Supreme policy of embargo—motivated by past played to his strengths. Court. Smith also noted the newspaper’s grievance, not present realities and fu- At the same time, we have not spotlight on corruption in government and brought our strengths to bear—our peo- how Dix shunned personal publicity. ture dreams. Fidel Castro has stepped ‘‘Once I wrote him a private note about aside from day-to-day government, ple, our vision, our energy, our oppor- something very generous he had done to help there is a new American President, and tunities. It is time for America to act someone in trouble,’’ Smith said. ‘‘I heard Cuban-Americans increasingly want as the great power it is—with greatness nary a word in reply. But I didn’t expect it. broad, far-reaching interaction across built on confidence in our values and I am sure he was embarrassed that I even the Florida Straits. Times are chang- vision. knew.’’ ing, and we cannot live in the past. Of course, the greatest cost of our Born Aug. 18, 1929, in Ravenna, Ohio, Al- Forty-seven years ago, I was in my policy has been borne by the Cuban bert E. Dix majored in political science and ´ ´ was a 1951 graduate of Denison University in first semester of college when Soviet people themselves. Jose Martı, Cuba’s Granville, Ohio. missiles, deployed in Cuba, threatened great ‘‘Apostle’’ and man of letters, He served in the U.S. Army Intelligence to set the world on fire. No one who once said: ‘‘Everything that divides from 1953–1955. lived through those thirteen harrowing men, everything that classifies, sepa- A fourth-generation journalist, Dix first days in October will ever forget them. rates or shuts off men, is a sin against worked at The Times-Leader in Bellaire, Certainly, the threat from Cuba was humanity.’’ More than 70 percent of Ohio, where his father was publisher. He real. Cuba’s 111⁄2 million people have lived moved to Frankfort in October 1962 to be- It is true that we continue to dis- their entire lives in this stalemate. A come publisher of The State Journal. He re- tired in 1996 as publisher and president of approve of Cuba’s dismal human rights Cuban boy or girl of 10 when Fidel Cas- Wooster Republican Printing Co., the parent record and palpable lack of freedom. tro drove victorious into Havana is 60 company of The State Journal, which now And it is also true that, over 50 years, years old today. His whole life has been owns seven newspapers. the embargo can claim some successes. spent deprived of basic freedoms but

VerDate Nov 24 2008 05:44 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00055 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.021 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12702 CONGRESSIONAL RECORD — SENATE December 8, 2009 also deprived—in accordance with U.S. ture. People-to-people relations were cant audience in Cuba. Report after re- policies except during brief periods—of made secretive, filtered, and for narrow port has documented that the Martı´ interaction with America’s people. objectives. That is the opposite of pro- services are hindered by bad manage- We must have the courage to admit democracy. ment, weak professional tradecraft, the need for a new approach. President Regrettably, that was the record of and serious politicization. We are look- Kennedy, who instituted sanctions the Bush administration: an enormous ing at whether its business model—as a against Cuba, had by mid-1963 set in step backwards. Now it’s up to the ‘‘surrogate service’’ exempt from many motion secret contacts aimed at nor- Obama administration to craft a Cuba Voice of America standards and regula- malizing relations. Ford and Carter, policy that moves us forward. tions—has failed, and whether the TV too, looked for ways out of the box. In May 2008, Barack Obama said on service should be closed entirely and George H.W. Bush cooperated with the Presidential campaign trail that it radio should be integrated into the Cuba on the Angola peace accord, and was ‘‘time for a new strategy.’’ While high-quality VOA services. We ought to his administration even dangled a he wasn’t ready to give up the embargo be especially concerned that human promise of improved ties with America. as a source of leverage, he did declare rights activists in Cuba a key bell- Each initiative failed for a different at the Summit of the Americas: ‘‘The wether audience are unanimous in reason, but all were grounded in the United States seeks a new beginning their view that the Martı´ brand must same recognition: there must be a bet- with Cuba,’’ and announced that he was be repaired. ter way forward. ‘‘prepared to have [the] Administration Meanwhile, USAID’s civil-society Fortunately, we know there is a dif- engage with the Cuban government on programs, totaling $45 million in 2008, ferent strategy that can succeed. The a wide range of issues.’’ have noble objectives, but we need to Clinton administration worked to As promised, the Obama administra- examine whether we’re achieving any refocus our policy around what mat- tion has expanded licenses for Cuban- of them. The Bush administration ters: on the Cuban people, not the Cas- Americans—albeit only Cuban-Ameri- changed the program’s focus from sup- tro brothers; on the future, not the cans—to travel to Cuba. Controls on porting the Cuban people to accel- past; and on America’s long-term na- family remittances, gift parcels, and erating regime change, and the fact tional interests, not the political expe- certain transactions with tele- that some of our grantees have ex- diencies of a given moment. communications companies were loos- travagantly high overheads has raised The Clinton administration promoted ened as well. Mid-level talks about im- concerns about where all the money is people-to-people relations ‘‘unilater- migration matters and postal relations going. It is also fair to ask whether ally’’—without conditions on Havana. have resumed. And we’ve turned off an these programs even work. Bush’s refocus on regime change We worked to improve bilateral co- Orwellian electronic billboard flashing made it difficult for Cubans outside de- operation on issues like migration and political messages from our Interests clared antiregime groups to accept the combating drug trafficking, which were Section in Havana. informational materials or assistance clearly in our national interest. Fam- These are positive steps, but they are offered—even if they had a burning de- ily travel in both directions quickly only a start. So what comes next? sire for it. Our interests section used to skyrocketed. And tens of thousands of At a minimum, the administration distribute tens of thousands of books a Americans from across society—church should use the authorities that it has year to Cubans across the political members, academics and students, to reinvigorate people-to-people rela- spectrum and the books could be seen, medical professionals, athletes, jour- tions—to unleash the energy of the well-worn, in government and Com- American people who want to help Cu- nalists, and more—were permitted to munist party think tanks. Today, bans build their future. The policy interact with their Cuban counter- politicization has reduced the flow of worked in the past and enjoyed wide parts. information to many of the very same Those policies sent a clear and effec- support in both countries. people eager to steer Cuba toward a tive message to the Cuban people: the When announcing expanded family better future. United States is not who your leaders travel, the President said, ‘‘There are The Foreign Relations Committee say we are. Our problem is not now, nor no better ambassadors for freedom has begun a review of these programs. has it ever been, with the Cuban peo- than Cuban-Americans.’’ But I think It is in the administration’s interest to ple. We completely changed the dy- it’s also fair to say that there are ex- take the lead in overhauling them. namic: A synagogue with holes in its cellent ambassadors for freedom among Finally, as I mentioned at the outset, roof so big that birds flew around the the 299 million other Americans—reli- I want to address legislation that will sanctuary has been repaired with funds gious faithful, teachers and students, go even farther toward fixing our Cuba and materials from American sup- environmentalists, scholars, doctors policy. S. 428, the Freedom to Travel to porters. Environmentalists worked to- and nurses, political scientists, and Cuba Act, does not lift the embargo or gether to save species and protect our artists—whose challenging minds, eco- normalize relations. It merely stops shared environment. The children who nomic success, love for democracy, and our government from regulating or received bats and balls—and moral sup- advocacy of solid American values prohibiting travel to or from Cuba by port—from Baltimore Orioles players make them proud ambassadors as well. U.S. citizens or legal residents, except visiting Cuba for an exhibition game The New York Philharmonic and its in certain obviously inappropriate cir- will never forget the gesture of Amer- board of directors have been brilliant cumstances. ican generosity. representatives of America on trips to The Freedom to Travel to Cuba Act And guess what. Across the board, North Korea, Vietnam and around the has strong support in Congress—33 Cubans seeking a better future for world. I don’t understand why the ad- sponsors in the Senate and 180 cospon- their country have said that nothing ministration recently blocked their sors for similar legislation in the energized civil society in Cuba more proposed trip to Cuba. What are we House. I cosponsored similar legisla- than contact with U.S. civil society. afraid of? tion in the past, and I am proud to do Even Cuba’s human rights and democ- Second, as we reinvigorate people-to- so again. We are talking about restor- racy activists benefitted immeasurably people diplomacy, the administration ing a fundamental American right—the from the contact. should review the programs that the right to travel—that is denied to Amer- Unfortunately, the Bush administra- Bush administration funded generously icans nowhere else in the world. Ameri- tion shut down most forms of contact to substitute for it. cans who can get a visa are free to and dramatically reduced our inter- The Senate Foreign Relations Com- travel to Iran, Iraq, Sudan, and even actions to a tightly regulated, govern- mittee is already undertaking an inves- North Korea, and it makes no sense to ment controlled trickle. They tight- tigation into the need to reform Radio deny them the right to travel to a poor ened licensing procedures, reduced and TV Martı´—programming beamed island near Florida. There is a certain transparency, and put government in into Cuba at a cost of $35 million a irony in the fact that Americans have the people’s way in what amounted to year. Many Cubans call TV Martı´ ‘‘La to apply for licenses and wait, with lit- a unilateral suspension of Americans’ TV que no se ve’’ because it has never, tle or no feedback, to travel to a coun- ability to help Cubans shape their fu- in 18 years of broadcast, had a signifi- try that we criticize for denying its

VerDate Nov 24 2008 05:44 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00056 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.015 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12703 citizens the right to travel. The cur- people came to hear the concert. From dressed. Indeed, her appearance was so rent ban on travel contravenes the the stage, he looked out at the Cuban picture-perfect that she probably made spirit of the Universal Declaration of people and started a simple chant: Una many a Hollywood starlet feel shabby Human Rights’ statement that ‘‘every- Sola Familia Cubana. The crowd roared by comparison. To say she was dressed one has the right to leave any country, approval at the thought of ending the to the nines is like saying Jack including his own, and to return to his conflict between Cubans across the Nicklaus was a fair golfer or that country.’’ Florida Straits. Shakespeare sort of had a way with Free travel also makes for good pol- There is a hunger out there among words. icy inside Cuba. Visits from Americans the Cuban people. America should cap- But Paula was more than a pretty would have the same positive effects as italize on it. They want contact with face. Sure, she had perfectly coiffed people-to-people exchanges, but on a their own families, and they want con- hair and wore designer clothes and jew- larger scale. Visiting Europeans and tact with American people and Amer- elry, but she had a razor-sharp mind to Canadians have already increased the ican ideas. go with her smart appearance, and she flow of information and hard currency There is no other country in the quickly showed she was nobody’s push- to ordinary Cubans, with a significant world to which we have closed our lives over. She could stand toe to toe and impact on the country. Cuba’s eco- as long as we have to Cuba. The Berlin verbally slug it out with some of the nomic model, for sure, remains pro- Wall fell 20 years ago, but the wall sep- most powerful and even most obnox- foundly flawed, and human rights con- arating Americans and Cubans has yet ious Senators. In other words, she gave ditions remain dismal. But the hard- to come down. more than she got—and her opponents, currency sectors of the Cuban economy We have a choice to ignore change more often than not, got more than have significantly altered workers’ de- and resist it or to mold it and channel they bargained for. pendence on the regime, introduced it into a new set of policies. After 50 She was a great debater, a human dy- material incentives that are changing years of trying to isolate and destroy, namo who brought unrivaled energy economic culture, and raised expecta- it’s time to try working with the and unbridled enthusiasm to the Sen- tions, if not demands, for greater im- Cuban people and making a new future ate. She was extremely intelligent and provements in the future. After years together. tremendously interested in politics— of Cuban government propaganda, f and she was very good at it. A quick Americans are even better positioned REMEMBERING SENATOR PAULA look at her successful Senate campaign than Europeans and Canadians to be HAWKINS in 1980 attests to just how good she catalysts of change. We can do more if Mr. HATCH. Mr. President, I rise was. By today’s big-bucks standards, we let them. today to speak about the passing of Paula’s campaign was strictly bargain- That is one reason why all of Cuba’s Paula Hawkins, a former colleague of basement. Fox News pundit Dick Mor- major pro-democracy groups support mine in the U.S. Senate and a very ris, her pollster at the time, recalls the free travel. Freedom House, Human dear and close personal friend whose Rights Watch, and other groups crit- service to the Nation and her home campaign being too cash-strapped to ical of Cuba’s government agree. Stud- State of Florida will endure for genera- afford a teleprompter. Aides made do ies of change in Eastern and Central tions in the heads and hearts of her by writing scripts on paper towels and Europe show a direct correlation be- posterity, friends and legions of admir- unrolling them as Paula spoke. In the tween contact with the outside world ers. end, her powers of persuasion and com- and the peacefulness and durability of In the ranks of those who greatly ad- mand of the facts carried the day with democratic transitions. mire and will dearly miss Paula, I voters. This is a policy whose time has come. stand front and center today to salute After stirring voters’ hearts in Flor- Numerous polls of Americans—of this extraordinary woman for her ac- ida, Paula stirred things up in the Na- Cuban origin and otherwise—show complishments, outstanding public tion’s Capital. Change was in the wind strong support. Non-Cuban-Americans service, wonderful family and exem- when she blew into wintry Washington have long supported easing restric- plary life. As I do so, I am humbled by in January 1981. For starters, she be- tions. But here is what is surprising: the magnitude of the task. It is not came the first Senator to bring her one recent poll found that 59 percent of easy to find the right words to do jus- husband to Washington, which resulted Cuban-Americans—the group most tice to such a unique and choice indi- in the Senate wives’ club being re- widely thought to oppose a change in vidual. named the Senate spouses’ club. She policy—actually support allowing all That said, I guess the first thing that helped spearhead legislation to help American citizens to travel to Cuba. As comes to mind about Paula Hawkins is widows and women divorcees get back the proportion of Cuban Americans that, true to her Utah Mormon herit- into the job market. She supported ef- who arrived after 1980 increases, sup- age, she was a pioneer—a real trail- forts to improve pensions for women port for free travel is only growing. In blazer who opened doors and windows and make them more equal to that of fact, even many Cuban e´migre´s 65 of opportunity for others to follow. men. She further fought to get daycare years and older, once passionately op- Long before there was a KAY BAILEY for the children of Senate employees. posed to it, now favor free travel. This HUTCHISON, DIANNE FEINSTEIN, OLYMPIA Even the all-male Senate gym was no is a sea change in the attitudes of SNOWE or MARIA CANTWELL in the U.S. sweat for Paula, who forced her fellow Cuban-Americans, and we should not Senate, there was Paula Hawkins. In Senators to wear swimming suits so ignore it. 1980, she became the first woman elect- that she could swim there as well. Change is in the air—in Havana, in ed to that august body for a full term To me, Paula was a ray of Florida Washington, and in major Cuban-Amer- without the benefit of family connec- sunshine that brightened my days dur- ican communities. I don’t personally tions, and she was the first woman ing the years we served together in the hold high hopes that the transfer of from Florida to serve as a Senator. Senate. She was a true blue conserv- power from Fidel to Rau´ l Castro and to And to the surprise of no one who ative who was warm, witty and cracked the next generation of hand-picked loy- knew her, she was no shrinking violet wise. We shared many a joke and a alists portends rapid change, but it is in Washington once she arrived. The laugh along with our commonly held obvious that the Cuba of today is not media may have dismissively billed her moral, ethical and religious beliefs. the Cuba of the 60s or even the 90s, and as that ‘‘housewife from Maitland,’’ And we became political allies and fast that our policy should not be stuck in but she quickly showed everyone that friends. In fact, Paula became and al- time either. Cubans are searching for this was one tough homemaker who ways remained one of my closest models for the future, and our eco- was acclimated to the political kitchen friends. nomic system and democratic ideals and could weather the heat that goes Both on and off Capitol Hill, she al- appeal to them. with it. I mean to tell you she was ways could be counted on through good In September, when the Colombian tough. times and bad. I quickly learned that rock star Juanes came to Havana, by Anyone who knows Paula also knows her word was her bond. Whenever I some estimates as many as a million that she was always impeccably needed help, she was always there. And

VerDate Nov 24 2008 03:19 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00057 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.015 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12704 CONGRESSIONAL RECORD — SENATE December 8, 2009 I certainly hope the reverse was true— the back seat moaning between appear- flect on her service and follow her ad- that I was there whenever she needed ances, according to Congressman John vice to that State Senator: Try Harder! help. Mica, her aide at the time. While she f Women, minorities, as well as the el- lost that race to Bob Graham, it is derly with disabilities also learned amazing that she did so well and a tes- ADDITIONAL STATEMENTS they could count on Paula. She was a tament to her courage and determina- tireless advocate in their behalf—and tion. TRIBUTE TO ROY OBREITER they loved her for it. She also showed Paula’s service did not end with her great political courage in 1984, when Senate term. Her contributions to her ∑ Mr. LEVIN. Mr. President, the Office she disclosed during a hearing that she State, community, family and church of Rural Development within the had been molested as a child. I am sure over the past 23 years have been truly United States Department of Agri- that horrific childhood experience, in significant. She also didn’t lose her culture will soon say goodbye to Roy part, informed her efforts to champion sense of humor. When a Florida State Obreiter, a longtime trusted adviser, children’s causes. senator told Paula several years ago friend, and colleague to all who have While her legislative accomplish- that she was trying to do a good job, worked with him. I am delighted to ments are too numerous to mention Paula smiled, grasped her hand firmly have this opportunity to pay tribute to here, I would like to make mention of and said simply: ‘‘Try harder, dear.’’ Roy, a staff appraiser with the agency one in particular. Paula spearheaded As great a public servant she was, in Michigan, who will retire after 38 the Missing Children’s Act of 1982, the Paula was just as remarkable in her years of dedicated service. I join many bill that instituted the National Center private life—as a wife, mother, grand- within the USDA, as well as the many for Missing & Exploited Children. mother and great-grandmother. She who have benefitted from his work over Thanks to that landmark legislation, had a fierce love for each member of the years, in celebrating this impres- the names of thousands of missing chil- her immediate and extended family. sive milestone. dren are now part of the FBI’s national And her husband Gene is no less re- Roy has an encyclopedic knowledge crime database. markable. He is one of the kindest, of agency programs and appraisal To secure the bill’s passage, Paula most friendly, decent and honorable guidelines. Through his hard work, personally lobbied President Reagan. men I have ever known—and his love focus, and passion, Roy has endeared As great a communicator as he was, for Paula has always been uplifting to himself to those who have had the the ‘‘Great Communicator’’ knew he behold. pleasure of working with him. had met his match in Paula and lent In every aspect of their lives, they Roy has been a role model and men- his support. Of course the President have been an exemplary couple. They tor to his peers and coworkers. His knew that Paula could always be relied have been just as exemplary as parents. kind and gentle demeanor, combined on to help deliver a legislative win for As members of The Church of Jesus with his ability to connect on a per- ‘‘the Gipper’’ in the Senate—which she Christ of Latter-day Saints, Gene and sonal level, have helped him earn the did many times. Paula took to heart the Mormon teach- respect and admiration of his col- As a staunch conservative, she found ing that families are forever. They leagues within the agency. Roy is an common cause with the President and were determined to ensure that every incredibly decent human being, de- other conservatives, including myself, family member worked hard toward voted to family and work, and loyal to on numerous issues. She was, for exam- achieving the goal of being able to be those around him. ple, an ardent anti-communist who together in the hereafter. They have a Beyond his personal qualities, Roy supported the President’s hard line great family and are well on their way has distinguished himself with a re- against Soviet expansionism. She also toward achieving that lofty goal. markable record of contributions to despised overly big government—and, In the Old Testament book of Prov- the agency. The assistance he has pro- there is certainly a lot to despise in erbs, we read: vided to Rural Development programs Washington, especially these days. Who can find a virtuous woman, for her during his career has been invaluable. Paula was an unwavering friend for price is far above rubies. The heart of her Roy can be proud of his contributions husband doth safely trust in her, so that he those who shared her values and com- shall have no need of spoil . . . She to Michigan and to rural America. He mitment, but she was an implacable stretcheth out her hand to the poor; yea, she will be missed by his colleagues and by foe of political corruption and to those reacheth forth her hands to the needy . . . those throughout Michigan who have who peddled illegal drugs on our Strength and honor are her clothing; and she been touched by his work. streets and in our schools. She fought shall rejoice in the time to come . . . She I congratulate Roy Obreiter on a job for legislation to cut foreign aid to na- looketh well to the ways of her household, well done and wish him the best as he tions that refused to reduce their ex- and eateth not the bread of idleness. Her embarks on the next phase of his life.∑ port of harmful drugs. She further as- children arise up, and call her blessed; her husband also, and he praiseth her . . . Fa- f sisted in creating the Senate Caucus on vour is deceitful and beauty is vain: but a TRIBUTE TO TERRY SHERWOOD International Narcotics Control and woman that feareth the Lord, she shall be helped initiate the South Florida Drug praised. Give her of the fruit of her hands; ∑ Mrs. LINCOLN. Mr. President, today Task Force. and let her own works praise her in the gates I join many of my fellow Arkansans in I would be remiss if I didn’t say (Proverbs 31:10–31). recognizing and thanking Terry Sher- something about Paula’s stamina. She Today, I am honored to have the wood with the Southwest Arkansas could endure as well as endear—often privilege of adding my voice to the Planning and Development District for when she was in great pain. In 1982, she chorus of praise for my dear friend, his 40 years of work with this agency was knocked unconscious when a TV Paula Hawkins. I feel deeply that a lov- and to wish him all the best in his re- studio partition fell on her during an ing Father in heaven and Jesus Christ tirement. interview in Florida. have already embraced Paula and Since the Southwest Arkansas Plan- Those of us who worked closely with taken her into their care and treat- ning and Development District was or- her know that the years that followed ment as one of truly great women who ganized and began operation in 1967, it were often filled with crippling pain. graced this Earth. has served local governments by work- Between votes on the Senate floor, she I truly loved Paula Hawkins. We were ing as an indispensable partner to iden- would often go to a room lent to her by best friends. Like Gene and the Haw- tify and implement State and Federal Senator Strom Thurmond in the Cap- kins’ three children—Genean, Kevin programs. Through Terry’s hard work itol and lie in traction in a hospital and Kelly—11 grandchildren and 10 and leadership with the Southwest Ar- bed. great-grandchildren, my wife Elaine kansas Planning and Development Dis- Despite the immense pain stemming and I look forward to a joyous reunion trict, communities throughout south- from her debilitating injury, Paula sol- one day with Paula on the other side of west Arkansas have been positively im- diered on during her 1986 bid for re- the veil. pacted and their lasting results are a election. On campaign trips across In the meantime, it is my hope that testament to his dedication and vision Florida Paula would sometimes lay in all of us here in this chamber will re- and will be felt for decades to come.

VerDate Nov 24 2008 03:19 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00058 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.030 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12705 Not only has Terry admirably served MESSAGES FROM THE PRESIDENT the Senate to the bill (H.R. 3288 ) in his chosen career, but he has also of- Messages from the President of the ‘‘making appropriations for the De- fered his talents and expertise to a va- United States were communicated to partments of Transportation, and riety of local, state and national orga- the Senate by Mr. Williams, one of his Housing and Urban Development, and nizations. Terry has served as past secretaries. related agencies for the fiscal year end- ing September 30, 2010, and for other President and board member of the Na- f tional Association of Development Or- purposes’’; it agrees to the conference ganizations, chairman of the Arkansas EXECUTIVE MESSAGES REFERRED asked by the Senate on the disagreeing I–69 Association and vice-president of As in executive session the Presiding votes of the two Houses thereon, and Arkansas Good Roads, board member Officer laid before the Senate messages appoints Mr. OLVER, Mr. PASTOR, Ms. of the Council of Peers and Southwest from the President of the United KAPTUR, Mr. PRICE of North Carolina, Regional Economic Development Asso- States submitting sundry nominations Ms. ROYBAL-ALLARD, Mr. BERRY, Ms. ciation, chairman of the Association of which were referred to the appropriate KILPATKRICK of Michigan, Mrs. LOWEY, Delta Development Districts, member committees. Mr. OBEY, Mr. LATHAM, Mr. WOLF, Mr. of the Arkansas Highway and Trans- (The nominations received today are TIAHRT, Mr. WAMP, and Mr. LEWIS of portation Public Participation’s Com- printed at the end of the Senate pro- California, as managers of the con- mittee, and a member of the Arkansas ceedings.) ference on the part of the House. Association of Development Organiza- f f tions. Terry’s efforts have enhanced MESSAGES FROM THE HOUSE MEASURES REFERRED the lives of the citizens of our state. I am thankful for his work and his At 10:03 a.m., a message from the The following bills were read the first friendship and wish him a productive House of Representatives, delivered by and the second times by unanimous retirement. Ms. Niland, one of its reading clerks, consent, and referred as indicated: announced that the House has passed H.R. 118. An act to authorize the addition I am proud to represent Terry in the the following bills, in which it requests of 100 acres to Morristown National Histor- U.S. Senate and pleased to have this the concurrence of the Senate: ical Park; to the Committee on Energy and opportunity today to publicly thank H.R. 118. An act to authorize the addition Natural Resources. him for his contributions to the State of 100 acres to Morristown National Histor- H.R. 1454. An act to provide for the of Arkansas and the people he ical Park. issuance of a Multinational Species Con- touched.∑ H.R. 1454. An act to provide for the servation Funds Semipostal Stamp; to the Committee on Homeland Security and Gov- ∑ issuance of a Multinational Species Con- Mr. PRYOR. Mr. President, today I servation Funds Semipostal Stamp. ernmental Affairs. pay tribute to the professional career H.R. 1672. An act to reauthorize the North- H.R. 2062. An act to amend the Migratory and community achievements of Terry west Straits Marine Conservation Initiative Bird Treaty Act to provide for penalties and Sherwood of Magnolia, AR. Act to promote the protection of the re- enforcement for intentionally taking pro- sources of the Northwest Straits, and for tected avian species, and for other purposes; Terry Sherwood, a graduate of Michi- other purposes. to the Committee on Environment and Pub- gan State University, began working as H.R. 2062. An act to amend the Migratory lic Works. an employee of Southwest Arkansas Bird Treaty Act to provide for penalties and H.R. 3388. An act to modify the boundary of Planning and Development District, enforcement for intentionally taking pro- Petersburg National Battlefield in the Com- Inc. in 1969. His hard work and dedica- tected avian species, and for other purposes. monwealth of Virginia, and for other pur- tion showed as he became the executive H.R. 3388. An act to modify the boundary of poses; to the Committee on Energy and Nat- Petersburg National Battlefield in the Com- ural Resources. director in January 1992. He has pro- monwealth of Virginia, and for other pur- H.R. 3804. An act to make technical correc- vided the people of Arkansas with poses. tions to various Acts affecting the National many accomplishments that are spread H.R. 3804. An act to make technical correc- Park Service, to extend, amend, or establish throughout the State. tions to various Acts affecting the National certain National Park Service authorities, Park Service, to extend, amend, or establish and for other purposes; to the Committee on He has served on several boards in certain National Park Service authorities, Energy and Natural Resources. several leadership roles such as past and for other purposes. H.R. 3940. An act to amend Public Law 96– president and board member of the Na- H.R. 3940. An act to amend Public Law 96– 597 to clarify the authority of the Secretary tional Association of Development Or- 597 to clarify the authority of the Secretary of the Interior to extend grants and other as- ganizations, NADO, vice president and of the Interior to extend grants and other as- sistance to facilitate political status public member of the executive board of the sistance to facilitate political status public education programs for the peoples of the I–69 Mid-Continent Highway Coalition, education programs for the peoples of the non-self-governing territories of the United chairman of the Arkansas I–69 Associa- non-self-governing territories of the United States; to the Committee on Energy and States. Natural Resources. tion, vice-president of Arkansas Good ENROLLED BILL SIGNED Roads, board member of the Council of f At 3:16 p.m., a message from the Peers Southeast Regional Executive House of Representatives, delivered by MEASURES PLACED ON THE Directors Institute, board member of Ms. Niland, one of its reading clerks, CALENDAR the Southwest Regional Economic De- announced that the Speaker has signed The following bill was read the first velopment Association, chair of the As- the following enrolled bill: and second times by unanimous con- sociation of Delta Development Dis- sent, and placed on the calendar: tricts Delta Regional Authority, mem- S. 1422. An act to amend the Family and Medical Leave Act of 1993 to clarify the eligi- ber of the Public Participation Com- H.R. 1672. An act to reauthorize the North- bility requirements with respect to airline west Straits Marine Conservation Initiative mittee Arkansas Highway and Trans- flight crews. Act to promote the protection of the re- portation Department, and member of sources of the Northwest Straits, and for Arkansas Association of Development At 4:27 p.m., a message from the other purposes. Organizations. House of Representatives, delivered by f Terry has brought great leadership Mrs. Cole, one of its reading clerks, an- nounced that the House has passed the EXECUTIVE AND OTHER and outstanding integrity to the south COMMUNICATIONS Arkansas community. His leadership is following bill, in which it requests the unique and has inspired many other concurrence of the Senate: The following communications were people in the area to get involved in H.R. 4218. An act to amend titles II and laid before the Senate, together with their local neighborhoods and towns. XVI of the Social Security Act to prohibit accompanying papers, reports, and doc- retroactive payments to individuals during uments, and were referred as indicated: Mr. President, I ask that my col- periods for which such individuals are pris- EC–3964. A communication from the Com- oners, fugitive felons, or probation or parole leagues join me in recognizing the missioner of the Social Security Administra- violators. great contributions Terry Sherwood tion, transmitting, the report of a proposed has made to Arkansas and the United The message also announced that the bill to amend titles II and XVI; to the Com- States of America.∑ House disagrees to the amendment of mittee on Finance.

VerDate Nov 24 2008 03:19 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00059 Fmt 0624 Sfmt 0634 E:\CR\FM\G08DE6.033 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12706 CONGRESSIONAL RECORD — SENATE December 8, 2009 EC–3965. A communication from the Attor- 6. Brothers and Spouses: None. $4,200, 6/6/2005, Friends of Hillary Clinton; ney Advisor, U.S. Coast Guard, Department 7. Sisters and Spouses: None. $5,000, 8/26/2005, Searchlight Leadership Fund; of Homeland Security, transmitting, pursu- $2,100, 11/11/2005, John Sarbanes for Congress; ant to law, the report of a rule entitled *Eleni Tsakopoulos Kounalakis, of Cali- $2,100, 11/16/2005, Bilirakis for Congress; ‘‘Quarterly Listings; Safety Zones; Security fornia, to be Ambassador Extraordinary and $4,200, 2/21/2006, Feinstein for Senate; $4,200, 3/ Zones; Special Local Regulations; Regulated Plenipotentiary of the United States of 13/2006, Stabenow for US Senate; $2,100, 4/4/ Navigation Areas; Drawbridge Operation America to the Republic of Hungary. 2006, Francine Busby for Congress; $4,200, 5/ Regulations’’ (Docket No. USG–2009–1039) re- Nominee: Eleni Tsakopoulos Kounalakis. 18/2006, John Doolittle for Congress; $10,000, 6/ ceived in the Office of the President of the Post: Hungary. 30/2006, Democratic State Central Committee Senate on December 3, 2009; to the Com- (The following is a list of all members of of CA-Levin Funds Account; $5,000, 8/31/2006, mittee on Commerce, Science, and Transpor- my immediate family and their spouses. I HILL PAC; $2,100, 9/7/2006, Madrid for Con- tation. have asked each of these persons to inform gress; $2,100, 9/7/2006, Arcuri for Congress; me of the pertinent contributions made by $2,100, 9/7/2006, Kilroy for Congress; $500, 9/27/ f them. To the best of my knowledge, the in- 2006, John Sarbanes for Congress; $1,900, 10/5/ EXECUTIVE REPORTS OF formation contained in this report is com- 2006, Bilirakis for Congress; $15,000, 11/1/2006, plete and accurate.) COMMITTEES DCCC; $4,600, 2/21/2007, Hillary Clinton for Contributions, Amount, Date, and Donee: President ($2,300 redesignated to Friends of The following executive reports of 1. Self: $1,998.11, 2/7/2005, Doris Matsui for Hillary Clinton on 7/21/2008); $1,000, 2/16/2007, nominations were submitted: Congress; $2,000, 3/21/2005, Olympia Snowe for Friends of Patrick Kennedy; $26,700, 2/21/2007, Senate; $26,700, 3/21/2005, DCCC; $1,000, 3/21/ By Mr. KERRY for the Committee on For- DCCC; $500, 2/21/2007, Doris Matsui for Con- 2005, Arizona Democratic Party/Federal; gress; $28,500, 3/28/2007, DSCC; $5,000, 4/10/2007, eign Relations. $4,000, 3/28/2005, Van Hollen for Congress; $500, Calumet PAC; $4,600, 5/7/2007, Mike Thomp- *Rajiv J. Shah, of Washington, to be Ad- 3/24/2005, Friends of Dennis Cardoza; $4,200, 4/ son for Congress; $2,300, 5/11/2007, Tom ministrator of the United States Agency for 4/2005, Mike Thompson for Congress; $5,000, 4/ Vilsack for President; $4,600, 5/24/2007, International Development. 19/2005, VINE PAC; $1,000, 4/26/2005, Keeping Friends of Harry Reid; $2,300, 5/16/2007, Zack *Mary Burce Warlick, of Virginia, a Career America’s Promise; $4,200, 6/13/2005, Friends Space for Congress; $500, 6/17/2007, Udall for Member of the Senior Foreign Service, Class of Hillary Clinton; $5,000, 8/25/2005, Search- Colorado; $2,300, 9/20/2007, Niki Tsongas for of Minister-Counselor, to be Ambassador Ex- light Leadership Fund; $4,200, 9/2/2005, Cant- Congress; $2,300, 10/31/2007, Bilirakis for Con- traordinary and Plenipotentiary of the well 2006; $2,100, 11/14/2005, John Sarbanes for gress; $2,300, 12/28/2007, Dean Scontras for United States of America to the Republic of Congress; $2,100, 11/4/2005, Bilirakis for Con- Congress; $2,300, 1/24/2008, Jared Polis for Serbia. gress; $2,100, 2/21/2006, Doris Matsui for Con- Congress; $500, 2/29/2008, Wexler for Congress; Nominee: Mary Burce Warlick. gress; $3,246.44, 2/22/2006, Feinstein for Sen- $200, 3/28/2008, Lungren for Congress; $2,300, 4/ (The following is a list of all members of ate; $4,200, 3/13/2006, Stabenow for US Senate; 4/2008, Solis for Congress; $2,300, 5/8/2008, Zack my immediate family and their spouses. I $5,000, 3/17/2006, DSCC; $2,100, 4/7/2006, Space for Congress; $1,600, 5/12/2008, Titus for have asked each of these persons to inform Francine Busby for Congress; $10,000, 6/30/ Congress; $1,600, 5/13/2008, Bilirakis for Con- me of the pertinent contributions made by 2006, DSCC of CA; $5,000, 9/5/2006, HILL PAC; gress; $1,000, 3/5/2009, Lungren for Congress. them. To the best of my knowledge, the in- $500, 9/27/2006, John Sarbanes for Congress; Elaine Tsakopoulos: $1,000, 6/3/2005, Friends formation contained in this report is com- $2,100, 10/17/06, Amy Klobuchar (In preparing of Hillary Clinton; $1,000, 6/15/2007, Hillary plete and accurate.) this report, we discovered that this contribu- Clinton for President; $2,000, 12/10/2007, Hil- Contributions, amount, date, and donee: tion was reported by the Kolbuchar for Min- lary Clinton for President ($700 refunded on 1. Self: None. nesota committee as a contribution from 8/28/2008); $2,300, 10/20/2008, Obama for Amer- 2. Spouse: James B. Warlick, Jr., None. Eleni Tsakopoulos and not from Alexandra ica/Obama Victory Fund. 3. Children and Spouses: James B. Warlick, Tsakopoulos. This appears to have been an 5. Grandparents: Deceased III, None; Jason A. Warlick, None; Jordan V. inadvertent reporting error by the com- 6. Brothers: Kyriakos Tsakopoulos (no C. Warlick, None. mittee.); $1,936.55 10/18/2006 DCCC; $1,000, 2/8/ spouse): $1,907, 6/28/2006, John Sarbanes for 4. Parents: Willard and Elinor Burce, 2007, Emily’s List; $2,300, 2/21/2007, Hillary Congress; $10,000, 10/10/2006, Democratic State $35.00, 8/14/08, Republican National Com- Clinton for President; $320, 2/20/2007, Friends Central Committee of CA—Levin Funds Ac- mittee; $25.00, 10/3/08, Republican National of Patrick Kennedy; $1,000, 3/29/2007, The count; $26,700, 10/24/2006, DCCC; $28,500, 3/7/ Committee; $35.00, 10/30/08, Republican Na- Reed Committee; $28,500, 3/7/2007, DCCC; 2007, DCCC; $500, 6/10/2007, Udall for Colorado; tional Committee. $28,500, 3/29/2007, DSCC; $1,000, 4/6/2007, Com- $4,600, 12/28/2007, Hillary Clinton for Presi- 5. Grandparents: Deceased. petitive Edge PAC; $4,600, 5/7/2007, Mike dent ($2,300 refunded on 8/28/2008); $2,300, 12/28/ 6. Brothers and Spouses: Gregory C. Burce Thompson for Congress; $2,300, 5/11/2007, Tom 2007, Dean Scontras for Congress; $2,300, 4/1/ and Jan Rhodes: $30.00, 2/20/08, Obama for Vilsack for President; $4,600, 5/24/2007, 2008, Obama for America; $500, 6/7/2008, America; $30.00, 2/20/08, Al Franken for Sen- Friends of Harry Reid; $2,300, 5/21/2007, Zack Mitakides for Congress; $28,500, 7/28/2008, ate; $25.00, 8/21/08, Al Franken for Senate; Space for Congress; $500, 5/23/2007, Al DNC/Obama Victory Fund ($2,300 refunded $25.00, 8/21/08, Obama for America; $25.00, 9/21/ Franken for US Senate; $500, 6/15/2007, Udall from Obama for America on 8/31/2008). 08, Obama for America; $25.00, 12/20/08, Al for Colorado; $2,300, 9/21/2007, Niki Tsongas 7. Sisters: Katina Tsakopoulos (no spouse): Franken for Senate; $25.00, 4/16/08, Demo- for Congress; $2,300, 11/27/2007, Jeanne $2,000, 1/20/2005, Doris Matsui for Congress; cratic Legislative Campaign Committee; Je- Shaheen for Senate; $2,300, 11/27/2007, Honda $2,000, 3/18/2005, Olympia Snowe for Senate; rome E. and Nancy Burce: None; Charles A. for Congress; $1,000, 2/21/2008, Kristen $26,700, 3/22/2005, DCCC; $4,200, 5/4/2005, Mike Burce: None. Gillibrand for Congress; $2,300, 5/12/2008, Zack Thompson for Congress; $5,000, 5/4/2005, VINE 7. Sisters and Spouses: Amy E. Burce, Space for Congress; $2,300, 5/12/2008, Titus for PAC; $2,100, 6/1/2005, Doris Matsui for Con- $25.00, 3/18/08, Obama for America; $25.00, 5/31/ Congress; $4,600, 6/10/2008, Obama for Amer- gress; $4,200, 6/13/2005, Friends of Hillary Clin- 08, Obama for America; $25.00, 11/02/08, Obama ica; $2300 6/10/2008, Obama for America; ton; $5,000, 8/25/2005, Searchlight Leadership for America; Juliana and Brian Tanning: $(2300), 6/10/2008, Obama for America refund; Fund; $2,100, 10/25/2005, Francine Busby for None; Carrie and Myron Koehn: None. $6,500, 9/22/2008, DNC/Obama Victory Fund; Congress; $2,100, 11/11/2005, John Sarbanes for $2,300, 9/29/2008, Titus for Congress; $2,300, 10/ Congress; $2,100, 11/18/2005, Bilirakis for Con- *James B. Warlick, Jr., of Virginia, a Ca- 14/2008, Al Franken for US Senate; $2,300, 10/ gress; $4,200, 4/7/2006, Francine Busby for Con- reer Member of the Senior Foreign Service, 14/2008, Jill Derby for Congress; $215, 3/24/2009, gress; $24,700, 5/23/2006, DCCC; $2,100, 9/8/2006, Class of Minister-Counselor, to be Ambas- DSCC of CA. Madrid for Congress; $2,100, 9/8/2006, Arcuri sador Extraordinary and Plenipotentiary of 2. Spouse: Markos Kounalakis: for Congress; $2,100, 9/8/2006, Kilroy for Con- the United States of America to the Republic (My husband does not make contributions gress; $2,100, 9/27/2006, John Sarbanes for Con- of Bulgaria. because he is a journalist. However, on occa- gress; $2,100, 10/5/2006, Bilirakis for Congress; Nominee: James B. Warlick, Jr. sion, when I have made a contribution with $2,100 10/19/2006, Francine Busby for Congress; Post: Sofia, Bulgaria. a check payable on a joint checking account, $2,100, 10/25/2006, Zach Space for Congress; (The following is a list of all members of the contribution has been incorrectly attrib- $4,600, 2/12/2007, Hillary Clinton for President my immediate family and their spouses. I uted to him including the following during ($2,300 refund received on 8/28/2008); $1,000 2/16/ have asked each of these persons to inform the relevant time period:) 2007, Friends of Patrick Kennedy; $28,500, 3/7/ me of the pertinent contributions made by $2,300, 3/6/2007, Hillary Clinton for Presi- 2007, DCCC; $4,600, 5/4/2007, Mike Thompson them. To the best of my knowledge, the in- dent (contribution refunded on 10/6/2008). for Congress; $2,300, 5/11/2007, Tom Vilsack for formation contained in this report is com- 3. Children: Antoneo: None. Congress; $2,300, 9/17/2007, Zach Space for plete and accurate.) Evangelos: None. Congress; $2,300, 3/7/2008, Susan Davis for Contributions and amount: Spouses: None. Congress; $2,300, 5/12/008, Titus for Congress. 1. Self: None. 4. Parents: Angelo Tsakopoulos: $2,000, 1/21/ Athena Tsakopoulos (no spouse): $2,000, 1/ 2. Spouse: None. 2005, Doris Matsui for Congress; $2,000, 3/18/ 24/2005, Doris Matsui for Congress; $2,000, 3/21/ 3. Children and Spouses: None. 2005, Olympia Snowe for Senate; $26,700, 3/21/ 2005, Olympia Snowe for Senate; $4,200, 4/13/ 4. Parents: None. 2005, DCCC; $4,200, 4/5/2005, Mike Thompson 2005, Mike Thompson for Congress; $5,000, 4/ 5. Grandparents: None. for Congress; $5,000, 4/20/2005, VINE PAC; 29/500, VINE PAC; $4,200, 6/16/2005, Friends of

VerDate Nov 24 2008 05:39 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00060 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.022 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12707 Hillary Clinton; $2,100, 11/11/2005, John Sar- Friends of Hillary on 8/28/2008); $1,000, 2/16/ 2. Spouse: Calvin D. Wills, Sr.: None. banes for Congress; $2,100, 11/18/2005, Bilirakis 2007, Friends of Patrick Kennedy; $28,500, 3/7/ 3. Children and Spouses: Calvin D. Wills, for Congress; $847.97, 2/28/2006, Feinstein for 2007, DCCC; $4,600, 5/4/2007, Mike Thompson Jr., None; Anthony R. Wills, None. Senate; $2,100, 4/4/2006, Francine Busby for for Congress; $2,300, 5/11/2007, Tom Vilsack for 4. Parents: Edna D. Randall; $50.00; Barack Congress; $4,200, 5/16/2006, Francine Busby for Congress; $500, 6/14/2007, Udall for Colorado; Obama; Joseph R. Randall, Sr.—deceased. Congress; $10,000 6/30/2006, Democratic State $2,300, 9/11/2007, Zach Space for Congress; 5. Grandparents: Lenear B. Randall—de- Central Committee of California Levin $2,300, 9/20/2007, Niki Tsongas for Congress; ceased; Jessie Randall—deceased; Marie Funds Account; $5,000, 8/31/2006, HILL PAC; $2,300, 11/28/2007, Jeanne Shaheen for Senate; Barnett—deceased; George Denny—deceased. $25,000 9/8/2006, DSCC/Senate Victory Fund; $2,300, 11/28/2007, Honda for Congress; $2,300, 8/ 6. Brothers and Spouses: George E. Ran- $2,100, 9/8/2006, Madrid for Congress; $2,100, 9/ 11/2008, Jeanne Shaheen for Senate; $2,300, 9/ dall, None; Dawn Randall, None; Joseph R. 8/2006, Arcuri for Congress; $2,100, 9/8/2006, 19/2008, Obama for America; $26,200, 9/19/2008, Randall, Jr., None; Angelia Randall, None. Kilroy for Congress; $2,100, 9/27/2006, John DNC/Obama Victory Fund. 7. Sisters and Spouses: Deborah I. Randall, Sarbanes for Congress; $2,100, 10/25/2006, Zach *Leslie V. Rowe, of Washington, a Career None; Gloria Jean Randall, None; Toni M. Space for Congress; $10,000, 11/1/2006, DCCC; Member of the Senior Foreign Service, Class Randall, $150.00, Barack Obama. $4,600, 2/12/2007, redesignated to Friends of of Minister-Counselor, to be Ambassador Ex- Hillary Clinton on 7/10/2008; $1,000, 2/16/2007, traordinary and Plenipotentiary of the *Anne Slaughter Andrew, of Indiana, to be Friends of Patrick Kennedy; $4,600, 5/4/2007, United States of America to the Republic of Ambassador Extraordinary and Pleni- Mike Thompson for Congress; $2,300, 5/11/2007, Mozambique. potentiary of the United States of America Tom Vilsack for Congress; $2,300, 9/11/2007, Nominee: Leslie V. Rowe. to the Republic of Costa Rica. Zach Space for Congress; $2,300, 5/12/2008, Post: Mozambique. Nominee: Anne Slaughter Andrew. Zach Space for Congress; $2,300, 5/12/2008, (The following is a list of all members of Post: Ambassador. Titus for Congress; $2,300, 10/23/2008, Obama my immediate family and their spouses. I (The following is a list of all members of for America; $26,200, 10/31/2008, DNC/Obama have asked each of these persons to inform my immediate family and their spouses. I Victory Fund. me of the pertinent contributions made by have asked each of these persons to inform Chrysanthy Tsakopoulos (no spouse): them. To the best of my knowledge, the in- me of the pertinent contributions made by $2,000, 1/21/2005, Doris Matsui for Congress; formation contained in this report is com- them. To the best of my knowledge, the in- $2,000, 3/18/2005, Olympia Snowe for Senate; plete and accurate.) formation contained in this report is com- $26,700, 3/22/2005, DCCC; $4,200, 4/6/2005, Mike Contributions, amount, date, and donee: plete and accurate.) Thompson for Congress; $5,000, 4/19/2005, 1. Self: None. Contributions, Amount, Date, and Donee: VINE PAC; $4,200, 6/6/2005, Friends of Hillary 2. Theodore Einar Dieffenbacher, Spouse: 1. Self: $2,100, 9/30/2005,Evan Bayh Com- Clinton; $5,000, 8/26/2005, Searchlight Leader- None. mittee; $1,000, 6/9/2006, Ellsworth for Con- ship Fund; $2,100, 11/11/2005, John Sarbanes 3. Children: Paul Vicente Dieffenbacher, gress; $250, 7/26/06, Mahoney for Florida; for Congress; $2,100, 11/18/2005, Bilirakis for None; Daniele Dieffenbacher, None; Jac- $2,300, 9/30/2007, Hillary Clinton for President; Congress; $4,200, 2/21/2006, Feinstein for Sen- queline Liisa Dieffenbacher, None. $100, 5/29/08, Obama for America; $500, 6/24/ ate; $4,200, 3/12/2006, Stabenow for US Senate; 4. Parents: Sara Ventura Rowe—deceased; 2008, Obama for America; $2,300, 7/8/2008, $2,100, 4/4/2006, Francine Busby for Congress John Leslie Rowe—deceased; Leon Ventura— Obama for America; $28,500, 8/4/2008, Obama for special election on 4/11/06; $4,200, 5/16/2006, deceased; Pauline Ventura—deceased; John Victory Fund/DNC; $4,000 designated by DNC Francine Busby for Congress $2100 for special E. Rowe—deceased; Mary E. Rowe—deceased. to Obama for America; $24,500 designated by runoff election held on 6/6/2006 and $2100 for 5. Sister: Nancy Ventura Rowe; None. DNC to DNC; ($2,300), 11/12/09, Refund by primary election held on 6/6/2006; $10,000, 6/30/ Obama for America. 2006, Democratic State Central Committee of *Alberto M. Fernandez, of Virginia, a Ca- 2. Spouse: Joseph J. Andrew: $5,000, 2005, California Levin Funds Account; $5,000, 8/31/ reer Member of the Senior Foreign Service, Sonnenschein PAC; $2,100, 9/30/2005, Evan 2006, HILL PAC; $2,100, 9/20/2006, Zach Space Class of Minister-Counselor, to be Ambas- Bayh Committee; $5,000, 2006, Sonnenschein for Congress; $2,100, 9/27/2006, John Sarbanes sador Extraordinary and Plenipotentiary of PAC; $500, 4/27/2006, Ben Cardin for Senate; for Congress; $2,100, 10/5/2006, Bilirakis for the United States of America to the Republic $1,000, 6/27/2006, Hoosiers for Hill; $500, 1/08/07, Congress; $10,000, 10/18/2006, DCCC; $1,000, 10/ of Equatorial Guinea. IN Dem Cong. Victory Cmte.; $5,000, 2007, 30/2006, Montana Democratic Party/Federal; Nominee: Alberto M. Fernandez. Sonnenschein PAC; $2,300, 6/30/2007; Hillary $4,600, 2/12/2007, Hillary Clinton for President Post: Ambassador to Equatorial Guinea. Clinton for President; $5,000, 2008, (2,300 redesignated to Friends of Hillary on 8/ (The following is a list of all members of Sonnenschein PAC; $504, 9/1/2008, Obama Vic- 28/2008; $1,000, 2/16/2007, Friends of Patrick my immediate family and their spouses. I tory Fund; $3,000, 9/30/2008, Obama Victory Kennedy; $28,500, 3/7/2007, DCCC; $4,600, 5/4/ have asked each of these persons to inform Fund; $5,000, 2009, Sonnenschein PAC; $1,000, 2007, Mike Thompson for Congress; $2,300, 5/ me of the pertinent contributions made by 5/1/2009, Harry Reid for U.S. Senate. 11/2007, Tom Vilsack for Congress; $500, 6/14/ them. To the best of my knowledge, the in- 3. Children and Spouses: Will Andrew— 2007, Udall for Colorado; $2,300, 9/17/2007, Zach formation contained in this report is com- None; Meredith Andrew—None. Space for Congress; $2,300, 9/20/2007, Niki plete and accurate.) 4. Parents: Marjorie Slaughter—Deceased; Tsongas for Congress; $2,300, 11/28/2007, Jim Contributions, amount, date, and donee Owen L. Slaughter, M.D.—Deceased. Costa for Congress; $2,300, 5/12/2008, Titus for 1. Self: None. 5. Grandparents: Jack Slaughter—De- Congress; $2,300, 6/30/2008, Zach Space for 2. Spouse: Katy Fernandez: None. ceased; Margaret Sullivan Slaughter—De- Congress; $2,300, 10/23/2008, Obama for Amer- 3. Children: Josrah P. Fernandez; None; ceased; Mr. and Mrs. George Specht—De- ica; $26,200, 10/31/2008, DNC/Obama Victory Adam F. Fernandez; None. ceased. Fund; $2,300, 10/23/2008, Bilirakis for Congress; 4. Parents: Diana Rodriguez; $25.00; 7–23–08; 6. Brothers and Spouses: Owen Slaughter— $4,800, 3/24/2009, Alexi for Illinois Exploratory John McCain; Jorge L. Rodriguez; None. None; Julie Slaughter (spouse): $100, 2006, Committee. 5. Grandparents—deceased; None. Baron Hill for Congress; $100, 2008, Baron Hill Alexandra Tsakopoulos (no spouse): $5,000, 6. Brother and Spouses: None. for Congress; $50, 2008, Obama for America; 8/26/2005, Searchlight Leadership Fund; $2,100, 7. Sister and Spouse: Diana Valencia; Mark Slaughter: $2,300, 8/24/2008, 2008, 11/11/2005, John Sarbanes for Congress; $2,100, None; Guillermo Valencia; None. Yarmuth for Congress; Martha Slaughter 11/18/2005, Bilirakis for Congress; $4,200, 2/21/ (spouse): $2,300, 11/14/2007, Hillary Clinton for 2006, Feinstein for Senate; $44,200, 3/12/2006; *Mary Jo Wills, of the District of Colum- President; $300, 1/27/2008, Citizens for Rick Stabenow for US Senate; $2,100, 4/4/2006, bia, a Career Member of the Senior Foreign Stock; $500, 5/5/2008, Friends of Scott Harper; Francine Busby for Congress for special elec- Service, Class of Minister-Counselor, to be $500, 6/30/2008, Friends of Scott Harper; $250, tion on 4/11/06; $4,200, 5/16/2006, Francine Ambassador Extraordinary and Pleni- 10/23/2008, Friends of Bruce Lunsford. Busby for Congress $2100 for special runoff potentiary of the United States of America 7. Sisters and Spouses: Sara Slaughter: election held on 6/6/2006 and $2100 for primary to the Republic of Mauritius, and to serve $500, 4/25/2007, Obama for America; $50, 10/ election held on 6/6/2006; $10,000, 6/30/2006, concurrently and without additional com- 2008, Obama for America; Tom Smith Democratic State Central Committee of pensation as Ambassador Extraordinary and (spouse)—None; Lynne Hodge—None; Chris- California Levin Funds Account; $2,000, 8/29/ Plenipotentiary of the United States of topher Hodge (spouse)—None. 2006, Honda for Congress; $5,000, 8/31/2006, America to the Republic of Seychelles. HILL PAC; $25,000, 9/8/2006, DSCC/Senate Vic- Nominee: Mary Jo Wills. *David Daniel Nelson, of Minnesota, a Ca- tory Fund; $25,000, 9/8/2006, DCCC/House Vic- Post: reer Member of the Senior Foreign Service, tory Fund; $2,100, 9/8/2006, Madrid for Con- (The following is a list of all members of Class of Minister-Counselor, to be Ambas- gress; $2,100, 9/8/2006, Arcuri for Congress; my immediate family and their spouses. I sador Extraordinary and Plenipotentiary of $2,100, 9/8/2006, Kilroy for Congress; $2,100, 9/ have asked each of these persons to inform the United States of America to the Oriental 20/2006, Zach Space for Congress; $2,100, 9/27/ me of the pertinent contributions made by Republic of Uruguay. 2006, John Sarbanes for Congress; $2,100, 10/5/ them. To the best of my knowledge, the in- Nominee: David D. Nelson. 2006, Bilirakis for Congress; $10,000, 10/18/2006, formation contained in this report is com- Post: Montevideo. DCCC; $1,000, 10/30/2006, Montana Democratic plete and accurate.) (The following is a list of all members of Party/Federal; $4,600, 2/12/2007, Hillary Clin- Contributions, amount, date, donee: my immediate family and their spouses. I ton for President (2,300 redesignated to 1. Self: None. have asked each of these persons to inform

VerDate Nov 24 2008 05:44 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00061 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.069 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12708 CONGRESSIONAL RECORD — SENATE December 8, 2009 me of the pertinent contributions made by the Secretary’s desk for the informa- Awareness Month’’ and supporting efforts to them. To the best of my knowledge, the in- tion of Senators. increase awareness of autoimmune diseases formation contained in this report is com- The PRESIDING OFFICER. Without and increase funding for autoimmune disease plete and accurate.) objection, it is so ordered. research; to the Committee on the Judiciary. Contributions, amount, date, and donee: *Foreign Service nominations beginning f 1. Self: David Nelson: $0, n/a, n/a. with Christopher William Dell and ending 2. Spouse: Gloria Nelson: $0, n/a, n/a. ADDITIONAL COSPONSORS with Mark J. Steakley, which nominations 3. Children and Spouses: Alexander D. Nel- were received by the Senate and appeared in S. 428 son: $0, n/a, n/a. the Congressional Record on September 24, At the request of Mr. DORGAN, the 4. Parents: Edmund K. Nelson: No dona- 2009. (minus 1 nominee: Barbara J. Martin) name of the Senator from Massachu- tions, but ran for State Legislature in South *Foreign Service nominations beginning setts (Mr. KERRY) was added as a co- Dakota, 2004 (he lost). Marlys M. Nelson: $50, with Carleene H. Dei and ending with Robert 2008, Republican Senatorial Campaign Com- sponsor of S. 428, a bill to allow travel E. Wuertz, which nominations were received between the United States and Cuba. mittee. by the Senate and appeared in the Congres- 5. Grandparents: Joel Nelson—deceased; sional Record on September 25, 2009. (minus S. 696 Estelle Nelson—deceased; Albert Billman— 2 nominees: Earl W. Gast; R. Douglass Ar- At the request of Mr. CARDIN, the deceased; Edith Billman—deceased. buckle) names of the Senator from Minnesota 6. Brothers and Spouses: none. *Foreign Service nominations beginning (Ms. KLOBUCHAR) and the Senator from 7. Sisters and Spouses: Suzanne Babich: with Jeffrey D. Adler and ending with New Jersey (Mr. LAUTENBERG) were $50, 2008, Minn. State Republican Party; $50, Conrad William Turner, which nominations 2007, Minn. State Republican Party; $50, 2006, added as cosponsors of S. 696, a bill to were received by the Senate and appeared in amend the Federal Water Pollution Minn. State Republican Party, $50, 2005, the Congressional Record on November 9, Minn. State Republican Party; Elizabeth 2009. Control Act to include a definition of fill material. Thorson: $0, n/a, n/a; David Thorson: $50, 2004, *Nomination was reported with rec- Doug Meslow; $50, 2004, Rebecca Otto; $50, S. 762 2006, Hutchinson/Reed; $50, 2006, Matt Dean; ommendation that it be confirmed sub- ject to the nominee’s commitment to At the request of Mrs. FEINSTEIN, the $50, 2006, Scott Wright; $50, 2006, Thomas name of the Senator from Colorado Huntley; $356, 2009, AAFP PAC; $100, 2009, respond to requests to appear and tes- (Mr. UDALL) was added as a cosponsor MMA MEDPAC; $356, 2008, AAFP PAC; $100, tify before any duly constituted com- 2008, MMA MEDPAC; $356, 2007, AAFP PAC; mittee of the Senate. of S. 762, a bill to promote fire safe $100, 2007, MMA MEDPAC; $356, 2006, AAFP communities and for other purposes. f PAC; 100, 2006, MMA MEDPAC; $356, 2005, S. 841 AAFP PAC; $100, 2005, MMA MEDPAC. INTRODUCTION OF BILLS AND At the request of Mr. KERRY, the *Betty E. King, of New York, to be Rep- JOINT RESOLUTIONS name of the Senator from Arkansas resentative of the United States of America The following bills and joint resolu- (Mr. PRYOR) was added as a cosponsor to the Office of the United Nations and Other of S. 841, a bill to direct the Secretary International Organizations in Geneva, with tions were introduced, read the first the rank of Ambassador. and second times by unanimous con- of Transportation to study and estab- Nominee: Betty King. sent, and referred as indicated: lish a motor vehicle safety standard Post: USUN Geneva. By Mr. NELSON of Nebraska: that provides for a means of alerting (The following is a list of all members of S. 2846. A bill to authorize the issuance of blind and other pedestrians of motor my immediate family and their spouses. I United States War Bonds to aid in funding of vehicle operation. have asked each of these persons to inform the operations in Iraq and Afghanistan; to S. 878 me of the pertinent contributions made by the Committee on Banking, Housing, and At the request of Mr. LAUTENBERG, them. To the best of my knowledge, the in- Urban Affairs. the name of the Senator from Rhode Is- formation contained in this report is com- By Mr. WHITEHOUSE (for himself and land (Mr. WHITEHOUSE) was added as a plete and accurate.) Mr. SCHUMER): Contributions, date, donee, and amount: S. 2847. A bill to regulate the volume of cosponsor of S. 878, a bill to amend the 1. Self: 2009, Democratic National Com- audio on commercials; to the Committee on Federal Water Pollution Control Act to mittee; $200, 2008 Barack Obama Presidential Commerce, Science, and Transportation. modify provisions relating to beach Campaign; $1,750, 2008 Hillary for President; By Mr. LAUTENBERG: monitoring, and for other purposes. S. 2848. A bill to amend the Federal Food, $1,250, 2008, Democratic National Committee; S. 936 $150, 2007, Democratic National Committee; Drug, and Cosmetic Act to require manufac- turers of bottled water to submit annual re- At the request of Mr. LAUTENBERG, $100, 2006, Harold Ford Senate Campaign; the name of the Senator from New $250, 2005, Paul Aronshen for Congress; $100. ports, and for other purposes; to the Com- mittee on Environment and Public Works. York (Mr. SCHUMER) was added as a co- *Laura E. Kennedy, of New York, a Career By Ms. MURKOWSKI: sponsor of S. 936, a bill to amend the Member of the Senior Foreign Service, Class S. 2849. A bill to require a study and report Federal Water Pollution Control Act to of Minister-Counselor, for the rank of Am- on the feasibility and potential of estab- authorize appropriations for sewer bassador during her tenure of service as U.S. lishing a deep water sea port in the Arctic to overflow control grants. protect and advance strategic United States Representative to the Conference on Disar- S. 1066 mament. interests within the evolving and ever more important region; to the Committee on At the request of Mr. SCHUMER, the *Eileen Chamberlain Donahoe, of Cali- name of the Senator from New York fornia, for the rank of Ambassador during Armed Services. her tenure of service as the United States By Mr. VITTER: (Mrs. GILLIBRAND) was added as a co- Representative to the UN Human Rights S. 2850. A bill to permit the use of Federal sponsor of S. 1066, a bill to amend title Council. funds from the Community Development XVIII of the Social Security Act to *Jide J. Zeitlin, of New York, to be Rep- Block Grant Program to be used to reme- preserve access to ambulance services resentative of the United States of America diate damage from the installation of taint- ed drywall, and for other purposes; to the under the Medicare program. to the United Nations for U.N. Management S. 1304 and Reform, with the rank of Ambassador. Committee on Banking, Housing, and Urban At the request of Mr. GRASSLEY, the *Jide J. Zeitlin, of New York, to be Alter- Affairs. nate Representative of the United States of By Mr. GRASSLEY: name of the Senator from West Vir- S. 2851. A bill to make permanent certain America to the Sessions of the General As- ginia (Mr. BYRD) was added as a co- education tax incentives, to modify rules re- sembly of the United Nations during his ten- sponsor of S. 1304, a bill to restore the lating to college savings plans, and for other ure of service as Representative of the economic rights of automobile dealers, purposes; to the Committee on Finance. United States of America to the United Na- and for other purposes. f tions for U.N. Management and Reform. S. 1313 Mr. KERRY. Mr. President, for the SUBMISSION OF CONCURRENT AND At the request of Mr. LUGAR, the Committee on Foreign Relations I re- SENATE RESOLUTIONS name of the Senator from New York port favorably the following nomina- The following concurrent resolutions (Mrs. GILLIBRAND) was added as a co- tion lists which were printed in the and Senate resolutions were read, and sponsor of S. 1313, a bill to amend the RECORD on the dates indicated, and ask referred (or acted upon), as indicated: Internal Revenue Code of 1986 to per- unanimous consent, to save the ex- By Mr. LEVIN: manently extend and expand the chari- pense of reprinting on the Executive S. Res. 372. A resolution designating March table deduction for contributions of Calendar that these nominations lie at 2010 as ‘‘National Autoimmune Diseases food inventory.

VerDate Nov 24 2008 05:44 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00062 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.040 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12709 S. 1421 Emergency Economic Stabilization Act ment No. 2878 intended to be proposed At the request of Mr. LEVIN, the of 2008, with respect to considerations to H.R. 3590, a bill to amend the Inter- name of the Senator from Minnesota of the Secretary of the Treasury in pro- nal Revenue Code of 1986 to modify the (Ms. KLOBUCHAR) was added as a co- viding assistance under that Act, and first-time homebuyers credit in the sponsor of S. 1421, a bill to amend sec- for other purposes. case of members of the Armed Forces tion 42 of title 18, United States Code, S. 1938 and certain other Federal employees, to prohibit the importation and ship- At the request of Mr. ROCKEFELLER, and for other purposes. ment of certain species of carp. the name of the Senator from Virginia AMENDMENT NO. 2898 S. 1524 (Mr. WARNER) was added as a cosponsor At the request of Mr. LIEBERMAN, the At the request of Mr. KERRY, the of S. 1938, a bill to establish a program name of the Senator from Rhode Island name of the Senator from Maine (Ms. to reduce injuries and deaths caused by (Mr. WHITEHOUSE) was added as a co- SNOWE) was added as a cosponsor of S. cellphone use and texting while driv- sponsor of amendment No. 2898 in- 1524, a bill to strengthen the capacity, ing. tended to be proposed to H.R. 3590, a transparency, and accountability of S. 2128 bill to amend the Internal Revenue Code of 1986 to modify the first-time United States foreign assistance pro- At the request of Mr. LEMIEUX, the homebuyers credit in the case of mem- grams to effectively adapt and respond name of the Senator from Florida (Mr. bers of the Armed Forces and certain to new challenges of the 21st century, NELSON) was added as a cosponsor of S. other Federal employees, and for other and for other purposes. 2128, a bill to provide for the establish- purposes. S. 1547 ment of the Office of Deputy Secretary AMENDMENT NO. 2909 At the request of Mr. REED, the name for Health Care Fraud Prevention. At the request of Mr. NELSON of Flor- of the Senator from New Jersey (Mr. S. 2810 ida, the names of the Senator from LAUTENBERG) was added as a cosponsor At the request of Mr. COCHRAN, the New York (Mrs. GILLIBRAND), the Sen- of S. 1547, a bill to amend title 38, name of the Senator from Arkansas ator from Pennsylvania (Mr. CASEY) United States Code, and the United (Mr. PRYOR) was added as a cosponsor and the Senator from Wisconsin (Mr. States Housing Act of 1937 to enhance of S. 2810, a bill to require the Sec- KOHL) were added as cosponsors of and expand the assistance provided by retary of Agriculture to provide emer- amendment No. 2909 intended to be pro- the Department of Veterans Affairs gency disaster assistance to certain ag- posed to H.R. 3590, a bill to amend the and the Department of Housing and ricultural producers that suffered Internal Revenue Code of 1986 to mod- Urban Development to homeless vet- losses during the 2009 calendar year. ify the first-time homebuyers credit in erans and veterans at risk of homeless- S. 2831 the case of members of the Armed ness, and for other purposes. At the request of Mr. REED, the name Forces and certain other Federal em- S. 1578 of the Senator from New Jersey (Mr. ployees, and for other purposes. At the request of Mr. LEAHY, the LAUTENBERG) was added as a cosponsor AMENDMENT NO. 2912 name of the Senator from Florida (Mr. of S. 2831, a bill to provide for addi- At the request of Mr. WHITEHOUSE, LEMIEUX) was added as a cosponsor of tional emergency unemployment com- the name of the Senator from Rhode Is- S. 1578, a bill to amend chapter 171 of pensation and to keep Americans work- land (Mr. REED) was added as a cospon- title 28, United States Code, (com- ing, and for other purposes. sor of amendment No. 2912 intended to monly referred to as the Federal Torts S. RES. 320 be proposed to H.R. 3590, a bill to Claim Act) to extend medical mal- At the request of Mr. BOND, the name amend the Internal Revenue Code of practice coverage to free clinics and of the Senator from Georgia (Mr. 1986 to modify the first-time home- the officers, governing board members, ISAKSON) was added as a cosponsor of S. buyers credit in the case of members of employees, and contractors of free clin- Res. 320, a resolution designating May the Armed Forces and certain other ics in the same manner and extend as 1 each year as ‘‘Silver Star Banner Federal employees, and for other pur- certain Federal officers and employees. Day’’. poses. AMENDMENT NO 2913 S. 1589 AMENDMENT NO. 2790 . At the request of Mr. WHITEHOUSE, At the request of Ms. CANTWELL, the At the request of Mr. CASEY, the name of the Senator from New Hamp- names of the Senator from New York the name of the Senator from Rhode Is- land (Mr. REED) was added as a cospon- shire (Mr. GREGG) was added as a co- (Mrs. GILLIBRAND) and the Senator sor of amendment No. 2913 intended to sponsor of S. 1589, a bill to amend the from Rhode Island (Mr. REED) were be proposed to H.R. 3590, a bill to Internal Revenue Code of 1986 to mod- added as cosponsors of amendment No. amend the Internal Revenue Code of ify the incentives for the production of 2790 intended to be proposed to H.R. 1986 to modify the first-time home- biodiesel. 3590, a bill to amend the Internal Rev- buyers credit in the case of members of S. 1660 enue Code of 1986 to modify the first- the Armed Forces and certain other At the request of Ms. KLOBUCHAR, the time homebuyers credit in the case of Federal employees, and for other pur- name of the Senator from Illinois (Mr. members of the Armed Forces and cer- poses. DURBIN) was added as a cosponsor of S. tain other Federal employees, and for AMENDMENT NO. 2923 1660, a bill to amend the Toxic Sub- other purposes. At the request of Mr. DORGAN, the stances Control Act to reduce the emis- AMENDMENT NO. 2807 sions of formaldehyde from composite name of the Senator from Washington At the request of Mr. CORNYN, the (Mrs. MURRAY) was added as a cospon- wood products, and for other purposes. name of the Senator from Kansas (Mr. sor of amendment No. 2923 intended to S. 1666 ROBERTS) was added as a cosponsor of be proposed to H.R. 3590, a bill to At the request of Ms. COLLINS, the amendment No. 2807 intended to be pro- amend the Internal Revenue Code of name of the Senator from North Caro- posed to H.R. 3590, a bill to amend the 1986 to modify the first-time home- lina (Mr. BURR) was added as a cospon- Internal Revenue Code of 1986 to mod- buyers credit in the case of members of sor of S. 1666, a bill to require the Ad- ify the first-time homebuyers credit in the Armed Forces and certain other ministrator of the Environmental Pro- the case of members of the Armed Federal employees, and for other pur- tection Agency to satisfy certain con- Forces and certain other Federal em- poses. ditions before issuing to producers of ployees, and for other purposes. AMENDMENT NO. 2930 mid-level ethanol blends a waiver from AMENDMENT NO. 2878 At the request of Ms. STABENOW, the certain requirements under the Clean At the request of Mr. CARDIN, the name of the Senator from Louisiana Air Act, and for other purposes. names of the Senator from Connecticut (Ms. LANDRIEU) was added as a cospon- S. 1822 (Mr. LIEBERMAN), the Senator from Illi- sor of amendment No. 2930 intended to At the request of Mr. MERKLEY, the nois (Mr. BURRIS), the Senator from be proposed to H.R. 3590, a bill to name of the Senator from North Caro- New Jersey (Mr. MENENDEZ) and the amend the Internal Revenue Code of lina (Mrs. HAGAN) was added as a co- Senator from Illinois (Mr. DURBIN) 1986 to modify the first-time home- sponsor of S. 1822, a bill to amend the were added as cosponsors of amend- buyers credit in the case of members of

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00063 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.024 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12710 CONGRESSIONAL RECORD — SENATE December 8, 2009 the Armed Forces and certain other sor of amendment No. 2969 intended to War bonds are a cost-effective way to Federal employees, and for other pur- be proposed to H.R. 3590, a bill to reduce our dependence on foreign credi- poses. amend the Internal Revenue Code of tors and create an outlet for Americans AMENDMENT NO. 2943 1986 to modify the first-time home- to express their patriotism and support At the request of Mr. CARPER, the buyers credit in the case of members of for our servicemembers and America’s name of the Senator from New Hamp- the Armed Forces and certain other mission. War bonds allow us to borrow shire (Mrs. SHAHEEN) was added as a co- Federal employees, and for other pur- from ourselves, rather than other coun- sponsor of amendment No. 2943 in- poses. tries. tended to be proposed to H.R. 3590, a AMENDMENT NO. 2991 This legislation finds a precedent in bill to amend the Internal Revenue At the request of Mr. MENENDEZ, the World War II savings bonds. From May Code of 1986 to modify the first-time name of the Senator from New York 1, 1941 through December 1945, the War homebuyers credit in the case of mem- (Mrs. GILLIBRAND) was added as a co- Finance Division and its predecessors bers of the Armed Forces and certain sponsor of amendment No. 2991 in- were responsible for the sale of nearly other Federal employees, and for other tended to be proposed to H.R. 3590, a $186 billion worth of government secu- purposes. bill to amend the Internal Revenue rities. Of this, more than $54 billion AMENDMENT NO. 2944 Code of 1986 to modify the first-time was in the form of War Savings bonds. At the request of Mrs. BOXER, the homebuyers credit in the case of mem- Although the times and economic name of the Senator from Wisconsin bers of the Armed Forces and certain circumstances are different than the (Mr. KOHL) was added as a cosponsor of other Federal employees, and for other 1940s, America’s commitment to pro- amendment No. 2944 intended to be pro- purposes. tecting freedom and our way of life has not waned. My hope is that we can tap posed to H.R. 3590, a bill to amend the AMENDMENT NO. 2993 into the same spirit of patriotism and Internal Revenue Code of 1986 to mod- At the request of Mr. SCHUMER, the create a sense of participation in the ify the first-time homebuyers credit in names of the Senator from Connecticut war effort akin to that shown by the the case of members of the Armed (Mr. DODD), the Senator from Massa- greatest generation. Forces and certain other Federal em- chusetts (Mr. KERRY) and the Senator ployees, and for other purposes. The new military strategy increasing from North Dakota (Mr. CONRAD) were troops by 30,000 for Afghanistan an- AMENDMENT NO. 2957 added as cosponsors of amendment No. nounced last week by President Obama At the request of Mr. BENNET, the 2993 intended to be proposed to H.R. is estimated to cost $30 billion beyond names of the Senator from Illinois (Mr. 3590, a bill to amend the Internal Rev- the baseline for Iraq and Afghanistan DURBIN), the Senator from New Mexico enue Code of 1986 to modify the first- funding, which stands around $130 bil- (Mr. BINGAMAN) and the Senator from time homebuyers credit in the case of lion for 2010. The United States public Michigan (Mr. LEVIN) were added as co- members of the Armed Forces and cer- debt is currently more than $7.6 tril- sponsors of amendment No. 2957 in- tain other Federal employees, and for lion and nearly $3.5 trillion—46 per- tended to be proposed to H.R. 3590, a other purposes. cent—of the debt is held by foreign in- bill to amend the Internal Revenue AMENDMENT NO. 2995 vestors.While there are no simple solu- Code of 1986 to modify the first-time At the request of Mr. SCHUMER, the tions to our fiscal woes, while we en- homebuyers credit in the case of mem- name of the Senator from Pennsyl- deavor to get our fiscal house in order, bers of the Armed Forces and certain vania (Mr. CASEY) was added as a co- we must also be responsible borrowers other Federal employees, and for other sponsor of amendment No. 2995 in- and reduce our dependence on foreign purposes. tended to be proposed to H.R. 3590, a creditors; this is a step in that direc- AMENDMENT NO. 2961 bill to amend the Internal Revenue tion. At the request of Mrs. SHAHEEN, the Code of 1986 to modify the first-time names of the Senator from Alaska (Mr. homebuyers credit in the case of mem- By Mr. WHITEHOUSE (for him- BEGICH) and the Senator from Lou- bers of the Armed Forces and certain self and Mr. SCHUMER): isiana (Mr. VITTER) were added as co- other Federal employees, and for other S. 2847. A bill to regulate the volume sponsors of amendment No. 2961 in- purposes. of audio on commercials; to the Com- tended to be proposed to H.R. 3590, a f mittee on commerce, Science, and bill to amend the Internal Revenue Transportation. Code of 1986 to modify the first-time STATEMENTS ON INTRODUCTED Mr. WHITEHOUSE. Mr. President, I homebuyers credit in the case of mem- BILLS AND JOINT RESOLUTIONS rise today to introduce the Commercial bers of the Armed Forces and certain By Mr. NELSON, of Nebraska: Advertisement Loudness Mitigation other Federal employees, and for other S. 2846. A bill to authorize the Act of 2009—the CALM Act. I want to purposes. issuance of United States War Bonds to thank my original cosponsor Senator AMENDMENT NO. 2962 aid in funding of the operations in Iraq SCHUMER for his support of this At the request of Mr. HATCH, the and Afghanistan; to the Committee on straightforward and commonsense leg- name of the Senator from Texas (Mr. Banking, Housing, and Urban Affairs. islation, which would require the Fed- CORNYN) was added as a cosponsor of Mr. NELSON of Nebraska. Mr. Presi- eral Communications Commission, amendment No. 2962 proposed to H.R. dent, I rise today to introduce legisla- FCC, to limit the volume of television 3590, a bill to amend the Internal Rev- tion to help finance the war effort advertisements to a level no louder enue Code of 1986 to modify the first- without sharp tax increases or in- than the average volume level of the time homebuyers credit in the case of creased foreign borrowing, The United programs during which the advertise- members of the Armed Forces and cer- States War Bonds Act of 2009 will au- ments appear. This time for this Act is tain other Federal employees, and for thorize the Treasury to issue and mar- overdue. All too often over the years, other purposes. ket War Bonds to the American people Americans, sitting down after a long At the request of Mr. ISAKSON, his to help finance the wars in Afghanistan workday or workweek to enjoy their name was added as a cosponsor of and Iraq. favorite television shows, have been as- amendment No. 2962 proposed to H.R. I believe that we need shared sac- saulted by commercials at volumes 3590, supra. rifice and fiscal discipline in financing that are degrees of magnitude louder At the request of Mr. NELSON of Ne- the war effort. I don’t believe our first than the shows themselves. The FCC braska, the name of the Senator from instinct should always be a rush to tax. first received enough complaints from Texas (Mrs. HUTCHISON) was added as a The government has gone to great viewers to look into the problem in the cosponsor of amendment No. 2962 pro- lengths to address the economic down- 1960s—when television was in its ear- posed to H.R. 3590, supra. turn and adding new taxes right now liest stages—but technology did not AMENDMENT NO. 2969 could undermine those efforts. We need exist to fix the problem. Each decade, At the request of Mr. COBURN, the to work to reduce Federal spending as consumer complaints piled up, the name of the Senator from Nebraska wherever possible and reduce the FCC had to reexamine the loudness (Mr. JOHANNS) was added as a cospon- growth in spending to finance the war. issue. Unfortunately, it took no action

VerDate Nov 24 2008 05:44 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00064 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.026 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12711 even with the technology improved. Port Act of 2009 is a major step towards treatment of employer-provided edu- The complaints continue to this day; in protecting vital U.S. interests in the cational assistance. These tax policies the 25 quarterly reports on consumer region. The Arctic Deep Water Sea and many others, including those for complaints released by the FCC since Port Act of 2009 directs the Secretary school renovations, repairs and con- 2002, 21 have listed as a top complaint of Defense, in consultation with the struction, have proven their value to the loudness of television commercials. Secretary of Homeland Security, to Iowa students in dollars and cents, But now, with the digital transition conduct a study to determine the feasi- year after year. The tax relief has de- complete and new broadcast tech- bility of establishing a deep water port livered measureable educational assist- nology available, we can finally take in the arctic to protect U.S. strategic ance to Iowans and students and fami- this long-overdue action. We now have interests in the region. As the lead De- lies nationwide, making education a common digital platform used by all partments for National Defense and more affordable and accessible. broadcasters, which presents a terrific Homeland Security initiatives for the One draw-back of enacting these pro- opportunity to standardize the loud- U.S., the Department of Defense and visions in the 2001 tax relief bill, how- ness of the ads broadcast into our liv- the Department of Homeland Security, ever, is that there was a sunset provi- ing rooms. As Consumers Union, the while working alongside their subordi- sion attached to that entire piece of nonprofit organization that publishes nate agencies, are best suited for deter- legislation. All of the tax relief needs Consumers Report has stated, in testi- mining and implementing policy deci- to be made permanent. Especially the mony before the House of Representa- sions that protect U.S. sovereignty and education-related tax provisions. That tives, ‘‘the CALM Act provides an ele- national security. is what my bill today does. My bill gant and commonsense solution to fi- This two-year study is designed to makes these provisions permanent. nally ending a forty-five year consumer determine what strategic capabilities a It is no coincidence that I am intro- complaint in the United States.’’ deep water port could provide as well ducing my education tax bill on the The House has already begun its con- as an optimal location that would pro- day the President of the United States sideration of companion legislation, vide protection for a wide spectrum of talked about jobs. Our economy de- and I applaud the leadership of Rep- U.S. initiatives. While studying the in- mands well-educated workers. The pop- resentative ESHOO on this issue. The frastructure needs for such a port, this ularity of education tax incentives is television industry has been deeply in- study will also endeavor to determine good news for workers who find them- volved in the drafting of this legisla- the resource and timeframe needs to selves unemployed or who want to go tion, and the standards it adopts are establish such a port, given the com- back to school to advance, or even practicable, affordable, and effective. I plex environmental constraints that change, their careers. Congress is will- hope my Senate colleagues will act the arctic marine environment pro- ing to consider permanent tax relief for quickly to pass the CALM Act and fi- vides. Upon completion of this study, companies to buy machinery. Why isn’t nally put an end to this longstanding the U.S. will be better positioned to Congress willing to make an invest- irritation. understand the resource and develop- ment in people? That is what tax relief ment needs for the arctic region that for education is. An investment in our By Ms. MURKOWSKI: are required to protect our interests in future. It is just as important as job- S. 2849. A bill to require a study and the region. creating tax incentives for businesses. report on the feasibility and potential Some will say we can’t afford this, but of establishing a deep water sea port in Mr. GRASSLEY: we really can’t afford to lose billions of the Arctic to protect and advance stra- S. 2851. A bill to make permanent dollars of help for Americans working tegic United States interests within certain education tax incentives, to hard to educate their kids. the evolving and ever more important modify rules relating to college savings Education has made this country region; to the Committee on Armed plans, and for other purposes; to the great. We should not let this oppor- Services. Committee on Finance. tunity pass us by. We should not let Ms. MURKOWSKI. Mr. President, as Mr. GRASSLEY. Mr. President, these education-related tax provisions you are undoubtedly aware, the U.S. is today I am offering legislation to make expire. We should also continue to help an arctic Nation. As such, the U.S. permanent a number of education-re- make education affordable for families must ensure that not only its economic lated tax relief measures. My legisla- and students. This makes education ac- and environmental interests in the re- tion also improves and makes perma- cessible for all. I look forward to work- gion are protected, but also its na- nent helpful provisions for 529 plans ing with my colleagues on passing this tional defense and homeland security and the American Opportunity tax bill. interests. While the U.S. maintains a credit for education. Mr. President, I ask unanimous con- strong working relationship with the 7 At the first hearing I held when I be- sent that the text of the bill be printed other arctic nations—Canada, Den- came Chairman of the Finance Com- in the RECORD. mark, Finland, Iceland, Norway, the mittee in 2001, I made clear that edu- There being no objection, the text of Russian Federation and Sweden—these cation tax policy was a priority of the bill was ordered to be printed in nations also have their own interests mine. As Chairman, I was able to re- the RECORD, as follows: to protect in the arctic region. Despite move the 60-payment limit for deduct- S. 2851 those relationships, the U.S. cannot as- ing student loan interest and I was able Be it enacted by the Senate and House of Rep- sume that these nations will protect to increase the income limits for that resentatives of the United States of America in our interests in the region. The ability deduction. This was not the only time Congress assembled, for the U.S. to project its territorial I fought hard to allow students to de- SECTION 1. AMENDMENT OF 1986 CODE. claims and protect its economic inter- duct their student loan interest. In Except as otherwise expressly provided, ests in the arctic will become increas- 1997, I was able to re-instate the stu- whenever in this Act an amendment or re- ingly important as the arctic shipping dent loan interest deduction that Con- peal is expressed in terms of an amendment lanes become more accessible as the gress had eliminated from our tax laws. to, or repeal of, a section or other provision, However, the 60-payment limit on the the reference shall be considered to be made seasonal arctic ice decreases. With the to a section or other provision of the Inter- high potential for increased and indus- deductibility of student loan interest nal Revenue Code of 1986. trial and commercial activity in the remained. I ensured that the 2001 tax SEC. 2. PERMANENT EXTENSION AND INCREASE arctic region, the U.S. must ensure relief bill took care of that problem. OF AMERICAN OPPORTUNITY TAX that it is prepared to protect human Other incentives for education that I CREDIT. life as well as the vulnerable arctic en- was able to enact into law in 2001 in- (a) PERMANENT EXTENSION OF CREDIT; IN- vironment. cluded raising the amount that can be CREASE OF CREDIT AMOUNT.—Section 25A is With an expected increase in arctic contributed to an education saving ac- amended— (1) by striking ‘‘$1,000’’ each place it ap- activity on the horizon, the U.S. can- count from $500 to $2,000; making dis- pears in subsection (b)(1) and inserting not wait until our interests in the re- tributions from pre-paid college sav- ‘‘$2,000’’, gion are threatened before we act. In ings plans and tuition plans tax-free; (2) by striking ‘‘the applicable limit’’ in that light, the Arctic Deep Water Sea and making permanent the tax-free subsection (b)(1)(B) and inserting ‘‘$4,000’’,

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00065 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.053 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12712 CONGRESSIONAL RECORD — SENATE December 8, 2009 (3) by striking paragraph (4) of subsection sections 23, 25D, and 30D) and section 27 for ‘‘(B) the cost-of-living adjustment deter- (b), the taxable year. mined under section 1(f)(3) for such calendar (4) by striking ‘‘2 TAXABLE YEARS’’ in the Any reference in this section or section 24, year by substituting ‘calendar year 2010’ for heading of subparagraph (A) of subsection 25, 25B, 26, 904, or 1400C to a credit allowable ‘calendar year 1992’ in subparagraph (B) (b)(2) and inserting ‘‘4 TAXABLE YEARS’’, under this subsection shall be treated as a thereof. (5) by striking ‘‘2 prior taxable years’’ in reference to so much of the credit allowable If any increase determined under this para- subsection (b)(2)(A) and inserting ‘‘4 prior under subsection (a) as is attributable to the graph is not a multiple of $1,000,000, such in- taxable years’’, Hope Scholarship Credit. crease shall be rounded to the next lowest (6) by striking ‘‘2 YEARS’’ in the heading of ‘‘(5) PORTION OF CREDIT MADE REFUND- multiple of $1,000,000.’’. subparagraph (C) of subsection (b)(2) and in- ABLE.—40 percent of so much of the credit al- (c) CREDITS NOT TO BE STRIPPED.—Section serting ‘‘4 YEARS’’, lowed under subsection (a) as is attributable 54E is amended by adding at the end the fol- (7) by striking ‘‘first 2 years’’ in subsection to the Hope Scholarship Credit (determined lowing new subsection: (b)(2)(C) and inserting ‘‘first 4 years’’, after the application of subsection (d)(1) and ‘‘(e) CREDITS NOT TO BE STRIPPED.—Sub- (8) by striking ‘‘tuition and fees’’ in sub- without regard to this paragraph and section section (i) of section 54A shall not apply with paragraph (A) of subsection (f)(1) and insert- 26(a)(2) or paragraph (4), as the case may be) respect to any qualified zone academy ing ‘‘tuition, fees, and course materials’’, shall be treated as a credit allowable under bond.’’. (9) by striking paragraphs (1) and (2) of subpart C (and not allowed under subsection (d) DAVIS-BACON RULES NOT TO APPLY TO SORSCHOOL CONSTRUCTION BONDS.— subsection (d) and inserting the following (a)). The preceding sentence shall not apply QZAB Section 1601 of the American Recovery and new paragraphs: to any taxpayer for any taxable year if such Reinvestment Act of 2009 is amended by ‘‘(1) HOPE SCHOLARSHIP CREDIT.—The taxpayer is a child to whom subsection (g) of striking paragraphs (3) and (4), by inserting amount which would (but for this paragraph) section 1 applies for such taxable year.’’, and ‘‘and’’ at the end of paragraph (2), and by re- be taken into account under paragraph (1) of (17) by striking subsection (i). designating paragraph (5) as paragraph (3). subsection (a) for the taxable year shall be (b) CONFORMING AMENDMENTS.— (e) EFFECTIVE DATES.— reduced (but not below zero) by the amount (1) Section 24(b)(3)(B) is amended by strik- (1) IN GENERAL.—Except as provided in which bears the same ratio to the amount ing ‘‘25A(i)’’ and inserting ‘‘25A(b)’’. paragraph (2), the amendments made by this which would be so taken into account as— (2) Section 25(e)(1)(C)(ii) is amended by section shall apply to obligations issued ‘‘(A) the excess of— striking ‘‘25A(i)’’ and inserting ‘‘25A(b)’’. after December 31, 2010. ‘‘(i) the taxpayer’s modified adjusted gross (3) Section 26(a)(1) is amended by striking (2) DAVIS-BACON RULES.—The amendments income for such taxable year, over ‘‘25A(i)’’ and inserting ‘‘25A(b)’’. made by subsection (d) shall apply to obliga- ‘‘(ii) $80,000 ($160,000 in the case of a joint (4) Section 25B(g)(2) is amended by striking tions issued after the date of the enactment return), bears to ‘‘25A(i)’’ and inserting ‘‘25A(b)’’. of this Act. ‘‘(B) $10,000 ($20,000 in the case of a joint re- (5) Section 904(i) is amended by striking turn). ‘‘25A(i)’’ and inserting ‘‘25A(b)’’. SEC. 6. PERMANENT EXTENSION OF SCHOOL CONSTRUCTION BONDS. ‘‘(2) LIFETIME LEARNING CREDIT.—The (6) Section 1400C(d)(2) is amended by strik- (a) IN GENERAL.—Subsection (c) of section amount which would (but for this paragraph) ing ‘‘25A(i)’’ and inserting ‘‘25A(b)’’. (7) Section 6211(b)(4)(A) is amended by 54F is amended— be taken into account under paragraph (2) of (1) by striking paragraph (3), subsection (a) for the taxable year shall be striking ‘‘25A by reason of subsection (i)(6) thereof’’ and inserting ‘‘25A by reason of sub- (2) by inserting ‘‘and’’ at the end of para- reduced (but not below zero) by the amount graph (1), and which bears the same ratio to the amount section (b)(5) thereof’’. (c) EFFECTIVE DATE.—The amendments (3) by striking ‘‘for 2010, and’’ in paragraph which would be so taken into account as— (2) and inserting ‘‘thereafter.’’. ‘‘(A) the excess of— made by this section shall apply to taxable (b) ALLOCATIONS FOR INDIAN SCHOOLS.— ‘‘(i) the taxpayer’s modified adjusted gross years beginning after December 31, 2010. (d) APPLICATION OF EGTRRA SUNSET.—The Paragraph (4) of section 54F(d) is amended by income for such taxable year, over amendment made by subsection (b)(1) shall striking ‘‘for calendar year 2010’’ and insert- ‘‘(ii) $40,000 ($80,000 in the case of a joint re- be subject to title IX of the Economic ing ‘‘for each calendar year after 2009’’. turn), bears to Growth and Tax Relief Reconciliation Act of (c) EXTENSION OF SMALL ISSUER EXCEP- ‘‘(B) $10,000 ($20,000 in the case of a joint re- 2001 in the same manner as the provision of TION.— turn).’’, such Act to which such amendment relates. (1) IN GENERAL.—Clause (vii) of section (10) by striking ‘‘DOLLAR LIMITATION ON SEC. 3. PERMANENT EXTENSION OF CERTAIN 148(f)(4)(D) is amended by striking AMOUNT OF CREDIT’’ in the heading of para- ‘‘$10,000,000’’ and inserting ‘‘$15,000,000’’. graph (1) of subsection (h) and inserting EGTRRA PROVISIONS RELATING TO EDUCATION. (2) ELIMINATION OF EGTRRA SUNSET.—Title ‘‘HOPE SCHOLARSHIP CREDIT’’, (a) IN GENERAL.—Title IX of the Economic IX of the Economic Growth and Tax Relief (11) by striking ‘‘2001’’ in subsection Growth and Tax Relief Reconciliation Act of Reconciliation Act of 2001 shall not apply to (h)(1)(A) and inserting ‘‘2011’’, 2001 shall not apply to the amendments made the amendments made by section 421 of such (12) by striking ‘‘the $1,000 amounts under by sections 401, 402, 411, 412, 413, and 431 of Act. subsection (b)(1)’’ in subsection (h)(1)(A) and such Act. (d) CREDITS NOT TO BE STRIPPED.—Section inserting ‘‘the dollar amounts under sub- (b) CONFORMING AMENDMENT.—Section 222 54F is amended by adding at the end the fol- sections (b)(1) and (d)(1)’’, is amended by striking subsection (e). lowing new subsection: (13) by striking ‘‘calendar year 2000’’ in (c) EFFECTIVE DATE.—The amendment ‘‘(f) CREDITS NOT TO BE STRIPPED.—Sub- subsection (h)(1)(A)(ii) and inserting ‘‘cal- made by subsection (b) shall apply to taxable section (i) of section 54A shall not apply with endar year 2010’’, years beginning after December 31, 2009. respect to any qualified school construction (14) by striking ‘‘If any amount’’ and all SEC. 4. PERMANENT EXTENSION OF DEDUCTION bond.’’. that follows in subparagraph (B) of sub- FOR CERTAIN EXPENSES OF ELE- (e) EFFECTIVE DATE.—The amendments section (h)(1) and inserting ‘‘If any amount MENTARY AND SECONDARY SCHOOL made by this section shall apply to obliga- under subsection (b)(1) as adjusted under TEACHERS. tions issued after December 31, 2010. subparagraph (A) is not a multiple of $100, (a) IN GENERAL.—Subparagraph (D) of sec- SEC. 7. PERMANENT EXTENSION AND MODIFICA- such amount shall be rounded to the next tion 62(a)(2) is amended by striking ‘‘during TION OF SECTION 529 RULES. lowest multiple of $100. If any amount under 2002, 2003, 2004, 2005, 2006, 2007, 2008, or 2009’’ (a) IN GENERAL.—Clause (iii) of section subsection (d)(1) as adjusted under subpara- and inserting ‘‘after 2001’’. 529(e)(3)(A) is amended by striking ‘‘in 2009 graph (A) is not a multiple of $1,000, such (b) EFFECTIVE DATE.—The amendment or 2010’’. amount shall be rounded to the next lowest made by this section shall apply to taxable (b) ABILITY TO CHANGE INVESTMENT OP- multiple of $1,000.’’, years beginning after December 31, 2009. TIONS.—Subsection (e) of section 529 is (15) by inserting ‘‘OF LIFETIME LEARNING SEC. 5. PERMANENT EXTENSION OF QUALIFIED amended by adding at the end the following CREDIT’’ after ‘‘INCOME LIMITS’’ in the head- ZONE ACADEMY BONDS. new paragraph: ing of paragraph (2) of subsection (h), (a) IN GENERAL.—Paragraph (1) of section ‘‘(6) ALLOWABLE CHANGE OF INVESTMENT OP- (16) by adding at the end of subsection (b) 54E(c) is amended by striking ‘‘and, except as TIONS.—A program shall not fail to be treat- the following new paragraphs: provided in paragraph (4), zero thereafter’’ ed as meeting the requirements of subsection ‘‘(4) CREDIT ALLOWED AGAINST ALTERNATIVE and inserting ‘‘and, except as provided in (b)(4) merely because such program allows a MINIMUM TAX.—In the case of a taxable year paragraph (5), $700,000,000 for each calendar designated beneficiary to change investment to which section 26(a)(2) does not apply, so year thereafter’’. options under the plan not more than 4 times much of the credit allowed under subsection (b) INFLATION ADJUSTMENT.—Subsection (c) per year.’’. (a) as is attributable to the Hope Scholarship of section 54E is amended by adding at the (c) EFFECTIVE DATES.— Credit shall not exceed the excess of— end the following new paragraph: (1) EXTENSION.—The amendment made by ‘‘(A) the sum of the regular tax liability ‘‘(5) INFLATION ADJUSTMENT.—In the case of subsection (a) shall apply to taxable years (as defined in section 26(b)) plus the tax im- any calendar year after 2011, the $700,000,000 beginning after December 31, 2010. posed by section 55, over amount in paragraph (1) shall be increased (2) INVESTMENT OPTIONS.—The amendment ‘‘(B) the sum of the credits allowable under by an amount equal to— made by subsection (b) shall apply to taxable this subpart (other than this subsection and ‘‘(A) such amount, multiplied by years beginning after December 31, 2009.

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00066 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.028 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12713 SUBMITTED RESOLUTIONS tional organizations focused on autoimmune autoimmune diseases and the contin- diseases, working to consolidate the voices ued need for research towards accurate of patients with autoimmune diseases and to diagnosis, and effective treatments. SENATE RESOLUTION 372—DESIG- promote increased education, awareness, and NATING MARCH 2010 AS ‘‘NA- research into all aspects of autoimmune dis- f TIONAL AUTOIMMUNE DISEASES eases through a collaborative approach; and Whereas designating March 2010 as ‘‘Na- AMENDMENTS SUBMITTED AND AWARENESS MONTH’’ AND SUP- tional Autoimmune Diseases Awareness PROPOSED PORTING EFFORTS TO INCREASE Month’’ would help educate the public about AWARENESS OF AUTOIMMUNE SA 3001. Mrs. HAGAN submitted an amend- autoimmune diseases and the need for re- ment intended to be proposed to amendment DISEASES AND INCREASE FUND- search funding, accurate diagnosis, and ef- SA 2786 proposed by Mr. REID (for himself, fective treatments: Now, therefore, be it ING FOR AUTOIMMUNE DISEASE Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to Resolved, That the Senate— RESEARCH the bill H.R. 3590, to amend the Internal Rev- (1) designates March 2010 as ‘‘National enue Code of 1986 to modify the first-time Mr. LEVIN submitted the following Autoimmune Diseases Awareness Month’’; homebuyers credit in the case of members of resolution; which was referred to the (2) supports the efforts of health care pro- the Armed Forces and certain other Federal Committee on the Judiciary: viders and autoimmune patient advocacy employees, and for other purposes; which S. RES. 372 and education organizations to increase was ordered to lie on the table. awareness of the causes of, and treatments Whereas autoimmune diseases are chronic, SA 3002. Mrs. HAGAN submitted an amend- for, autoimmune diseases; and disabling diseases in which underlying de- ment intended to be proposed to amendment (3) supports the goal of increasing Federal fects in the immune system lead the body to SA 2786 proposed by Mr. REID (for himself, funding for aggressive research to learn the attack its own organs and tissues; Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to root causes of autoimmune diseases, as well Whereas autoimmune diseases can affect the bill H.R. 3590, supra; which was ordered as the best diagnostic methods and treat- any part of the body, including the blood, to lie on the table. ments for people with autoimmune diseases. blood vessels, muscles, nervous system, gas- SA 3003. Mrs. HAGAN submitted an amend- trointestinal tract, endocrine glands, and Mr. LEVIN. Mr. President, this reso- ment intended to be proposed to amendment multiple-organ systems, and can be life- lution designates March 2010 as Na- SA 2786 proposed by Mr. REID (for himself, threatening; tional Autoimmune Diseases Aware- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to Whereas researchers have identified over 80 ness Month. The purpose of the resolu- the bill H.R. 3590, supra; which was ordered different autoimmune diseases, and suspect tion is to raise awareness of auto- to lie on the table. at least 40 additional diseases of qualifying SA 3004. Mrs. HAGAN (for herself and Mr. as autoimmune diseases; immune diseases and the need for ag- gressive research to learn the root BENNET) submitted an amendment intended Whereas researchers have identified a close to be proposed to amendment SA 2786 pro- genetic relationship and a common pathway causes of autoimmune diseases, as well posed by Mr. REID (for himself, Mr. BAUCUS, of disease that exists among autoimmune as the best diagnostic methods and Mr. DODD, and Mr. HARKIN) to the bill H.R. diseases, explaining the clustering of auto- treatments for people with auto- 3590, supra; which was ordered to lie on the immune diseases in individuals and families; immune diseases. table. Whereas the family of autoimmune dis- Autoimmune diseases are chronic, SA 3005. Ms. LANDRIEU (for herself, Mrs. eases is under-recognized, and poses a major disabling diseases in which underlying SHAHEEN, Ms. SNOWE, and Mr. BAYH) sub- health care challenge to the United States; defects in the immune system lead the mitted an amendment intended to be pro- Whereas the National Institutes of Health posed to amendment SA 2786 proposed by Mr. (NIH) estimates that autoimmune diseases body to attack its own organs and tis- REID (for himself, Mr. BAUCUS, Mr. DODD, and afflict up to 23,500,000 people in the United sues. They can affect any part of the Mr. HARKIN) to the bill H.R. 3590, supra; States, 75 percent of whom are women, and body—blood, blood vessels, muscles, which was ordered to lie on the table. that the prevalence of autoimmune diseases nervous system, gastrointestinal tract, is rising; endocrine glands, and multiple-organ SA 3006. Ms. LANDRIEU (for herself, Mrs. Whereas NIH estimates the annual direct SHAHEEN, Ms. SNOWE, and Mr. BAYH) sub- systems—and can be life-threatening. mitted an amendment intended to be pro- health care costs associated with auto- Researchers have identified over 80 immune diseases at more than posed to amendment SA 2786 proposed by Mr. different autoimmune diseases, includ- REID (for himself, Mr. BAUCUS, Mr. DODD, and $100,000,000,000, with over 250,000 new diag- ing multiple sclerosis, rheumatoid ar- noses each year; Mr. HARKIN) to the bill H.R. 3590, supra; Whereas autoimmune diseases are among thritis, juvenile diabetes, Crohn’s dis- which was ordered to lie on the table. the top 10 leading causes of death in female ease, scleroderma, polymyositis, lupus, SA 3007. Ms. LANDRIEU (for herself, Mrs. children and adult women; Sjogren’s disease and Graves’ disease, SHAHEEN, Ms. SNOWE, and Mr. BAYH) sub- Whereas autoimmune diseases most often and suspect at least 40 additional dis- mitted an amendment intended to be pro- affect children and young adults, leading to eases of having an autoimmune basis. posed to amendment SA 2786 proposed by Mr. a lifetime of disability; The National Institutes of Health esti- REID (for himself, Mr. BAUCUS, Mr. DODD, and Whereas diagnostic tests for most auto- mates that autoimmune diseases af- Mr. HARKIN) to the bill H.R. 3590, supra; immune diseases are not standardized, mak- which was ordered to lie on the table. flict more than 23 million people in the SA 3008. Ms. LANDRIEU (for herself, Ms. ing autoimmune diseases very difficult to di- U.S. Seventy-five percent of the people agnose; SNOWE, and Mrs. SHAHEEN) submitted an Whereas because autoimmune diseases are affected with autoimmune diseases are amendment intended to be proposed to difficult to diagnose, treatment is often de- women, and the prevalence of auto- amendment SA 2786 proposed by Mr. REID layed, resulting in irreparable organ damage immune diseases is rising. However, (for himself, Mr. BAUCUS, Mr. DODD, and Mr. and unnecessary suffering; the family of autoimmune diseases is HARKIN) to the bill H.R. 3590, supra; which Whereas the Institute of Medicine of the underrecognized, and this poses a was ordered to lie on the table. National Academies reported that the United major health care challenge to the U.S. SA 3009. Ms. LANDRIEU (for herself, Mrs. States is behind other countries in research Diagnostic tests for autoimmune dis- SHAHEEN, Ms. SNOWE, and Mr. DURBIN) sub- into immune system self-recognition, the eases are not standardized, which mitted an amendment intended to be pro- posed to amendment SA 2786 proposed by Mr. cause of autoimmune diseases; makes autoimmune diseases very dif- REID (for himself, Mr. BAUCUS, Mr. DODD, and Whereas a study by the American Auto- ficult to diagnose. Because auto- immune Related Diseases Association re- Mr. HARKIN) to the bill H.R. 3590, supra; vealed that it takes the average patient with immune diseases are difficult to diag- which was ordered to lie on the table. an autoimmune disease more than 4 years, nose, treatment is often delayed, re- SA 3010. Ms. LANDRIEU (for herself, Mrs. and costs more than $50,000, to get a correct sulting in irreparable organ damage SHAHEEN, Ms. SNOWE, Mr. DURBIN, and Mr. diagnosis; and unnecessary suffering. BAYH) submitted an amendment intended to Whereas there is a significant need for There is a significant need for more be proposed to amendment SA 2786 proposed more collaboration and cross-fertilization of collaboration and cross-fertilization of by Mr. REID (for himself, Mr. BAUCUS, Mr. basic autoimmune research; basic autoimmune research, with a par- DODD, and Mr. HARKIN) to the bill H.R. 3590, Whereas there is a significant need for re- ticular focus on the etiology of all supra; which was ordered to lie on the table. search focusing on the etiology of all auto- autoimmune-related diseases in order SA 3011. Ms. LANDRIEU (for herself, Mrs. immune-related diseases, in order to in- SHAHEEN, Mrs. LINCOLN, Ms. SNOWE, Mr. to increase understanding of the root crease understanding of the root causes of WARNER, and Mr. BAYH) submitted an these diseases rather treating the symptoms causes of these diseases rather than amendment intended to be proposed to after the disease has already had its destruc- treating the symptoms after the dis- amendment SA 2786 proposed by Mr. REID tive effect; ease has had its destructive effect. (for himself, Mr. BAUCUS, Mr. DODD, and Mr. Whereas the National Coalition of Auto- It is my hope that this resolution HARKIN) to the bill H.R. 3590, supra; which immune Patient Groups is a coalition of na- will help educate the public about was ordered to lie on the table.

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SA 3012. Ms. LANDRIEU (for herself, Mrs. SA 2786 proposed by Mr. REID (for himself, HARKIN) to the bill H.R. 3590, supra; which SHAHEEN, Ms. STABENOW, and Mr. BAYH) sub- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to was ordered to lie on the table. mitted an amendment intended to be pro- the bill H.R. 3590, supra; which was ordered SA 3041. Mr. ROCKEFELLER submitted an posed to amendment SA 2786 proposed by Mr. to lie on the table. amendment intended to be proposed to REID (for himself, Mr. BAUCUS, Mr. DODD, and SA 3027. Mr. ENSIGN submitted an amend- amendment SA 2786 proposed by Mr. REID Mr. HARKIN) to the bill H.R. 3590, supra; ment intended to be proposed to amendment (for himself, Mr. BAUCUS, Mr. DODD, and Mr. which was ordered to lie on the table. SA 2786 proposed by Mr. REID (for himself, HARKIN) to the bill H.R. 3590, supra; which SA 3013. Ms. LANDRIEU (for herself, Mrs. Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to was ordered to lie on the table. SHAHEEN, Ms. STABENOW, and Mr. BAYH) sub- the bill H.R. 3590, supra; which was ordered SA 3042. Mr. ROCKEFELLER submitted an mitted an amendment intended to be pro- to lie on the table. amendment intended to be proposed to posed to amendment SA 2786 proposed by Mr. SA 3028. Mr. ENSIGN submitted an amend- amendment SA 2786 proposed by Mr. REID REID (for himself, Mr. BAUCUS, Mr. DODD, and ment intended to be proposed by him to the (for himself, Mr. BAUCUS, Mr. DODD, and Mr. Mr. HARKIN) to the bill H.R. 3590, supra; bill H.R. 3590, supra; which was ordered to lie HARKIN) to the bill H.R. 3590, supra; which which was ordered to lie on the table. on the table. was ordered to lie on the table. SA 3014. Ms. LANDRIEU (for herself, Mrs. SA 3029. Mr. THUNE submitted an amend- SA 3043. Mr. ROCKEFELLER submitted an SHAHEEN, Ms. STABENOW, and Mr. BAYH) sub- ment intended to be proposed to amendment amendment intended to be proposed to mitted an amendment intended to be pro- SA 2786 proposed by Mr. REID (for himself, amendment SA 2786 proposed by Mr. REID posed to amendment SA 2786 proposed by Mr. Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to (for himself, Mr. BAUCUS, Mr. DODD, and Mr. REID (for himself, Mr. BAUCUS, Mr. DODD, and the bill H.R. 3590, supra; which was ordered HARKIN) to the bill H.R. 3590, supra; which Mr. HARKIN) to the bill H.R. 3590, supra; to lie on the table. was ordered to lie on the table. which was ordered to lie on the table. SA 3030. Mrs. FEINSTEIN (for herself, Mr. SA 3044. Mr. ROCKEFELLER submitted an SA 3015. Mr. ENSIGN submitted an amend- ROCKEFELLER, and Mr. WHITEHOUSE) sub- amendment intended to be proposed by him ment intended to be proposed to amendment mitted an amendment intended to be pro- to the bill H.R. 3590, supra; which was or- SA 2786 proposed by Mr. REID (for himself, posed to amendment SA 2786 proposed by Mr. dered to lie on the table. SA 3045. Mr. KERRY (for himself, Mr. Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to REID (for himself, Mr. BAUCUS, Mr. DODD, and KIRK, Mr. SCHUMER, Mrs. GILLIBRAND, Mr. the bill H.R. 3590, supra; which was ordered Mr. HARKIN) to the bill H.R. 3590, supra; LEAHY, Mr. SANDERS, Mr. CARPER, and Mr. to lie on the table. which was ordered to lie on the table. KAUFMAN) submitted an amendment in- SA 3016. Mr. ENSIGN submitted an amend- SA 3031. Mr. WHITEHOUSE (for himself ment intended to be proposed to amendment tended to be proposed to amendment SA 2786 and Mr. CASEY) submitted an amendment in- proposed by Mr. REID (for himself, Mr. BAU- SA 2786 proposed by Mr. REID (for himself, tended to be proposed to amendment SA 2786 Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to CUS, Mr. DODD, and Mr. HARKIN) to the bill proposed by Mr. REID (for himself, Mr. BAU- the bill H.R. 3590, supra; which was ordered H.R. 3590, supra; which was ordered to lie on CUS, Mr. DODD, and Mr. HARKIN) to the bill to lie on the table. the table. H.R. 3590, supra; which was ordered to lie on SA 3017. Mr. ENSIGN submitted an amend- SA 3046. Mr. KERRY (for himself, Ms. the table. ment intended to be proposed to amendment STABENOW, Ms. COLLINS, Ms. SNOWE, Mr. SA 3032. Mrs. BOXER submitted an amend- SA 2786 proposed by Mr. REID (for himself, WYDEN, Mrs. LINCOLN, Mr. JOHNSON, Mr. ment intended to be proposed to amendment Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to SPECTER, and Mrs. GILLIBRAND) submitted an SA 2786 proposed by Mr. REID (for himself, the bill H.R. 3590, supra; which was ordered amendment intended to be proposed to Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to to lie on the table. amendment SA 2786 proposed by Mr. REID the bill H.R. 3590, supra; which was ordered SA 3018. Mr. ENSIGN submitted an amend- (for himself, Mr. BAUCUS, Mr. DODD, and Mr. to lie on the table. ment intended to be proposed to amendment HARKIN) to the bill H.R. 3590, supra; which SA 3033. Mr. CASEY (for himself and Mr. SA 2786 proposed by Mr. REID (for himself, was ordered to lie on the table. SPECTER) submitted an amendment intended Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to SA 3047. Mr. KERRY (for himself, Mr. to be proposed to amendment SA 2786 pro- the bill H.R. 3590, supra; which was ordered WYDEN, Mr. WHITEHOUSE, and Mr. REED) sub- posed by Mr. REID (for himself, Mr. BAUCUS, to lie on the table. mitted an amendment intended to be pro- SA 3019. Mr. ENSIGN submitted an amend- Mr. DODD, and Mr. HARKIN) to the bill H.R. posed to amendment SA 2786 proposed by Mr. ment intended to be proposed to amendment 3590, supra; which was ordered to lie on the REID (for himself, Mr. BAUCUS, Mr. DODD, and SA 2786 proposed by Mr. REID (for himself, table. Mr. HARKIN) to the bill H.R. 3590, supra; SA 3034. Mr. TESTER submitted an amend- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to which was ordered to lie on the table. the bill H.R. 3590, supra; which was ordered ment intended to be proposed to amendment SA 3048. Mr. BARRASSO submitted an to lie on the table. SA 2786 proposed by Mr. REID (for himself, amendment intended to be proposed to SA 3020. Mr. ENSIGN submitted an amend- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to amendment SA 2786 proposed by Mr. REID ment intended to be proposed to amendment the bill H.R. 3590, supra; which was ordered (for himself, Mr. BAUCUS, Mr. DODD, and Mr. SA 2786 proposed by Mr. REID (for himself, to lie on the table. HARKIN) to the bill H.R. 3590, supra; which Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to SA 3035. Mr. ENSIGN submitted an amend- was ordered to lie on the table. the bill H.R. 3590, supra; which was ordered ment intended to be proposed to amendment SA 3049. Mr. BARRASSO submitted an to lie on the table. SA 2786 proposed by Mr. REID (for himself, amendment intended to be proposed to SA 3021. Mr. ENSIGN submitted an amend- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to amendment SA 2786 proposed by Mr. REID ment intended to be proposed to amendment the bill H.R. 3590, supra; which was ordered (for himself, Mr. BAUCUS, Mr. DODD, and Mr. SA 2786 proposed by Mr. REID (for himself, to lie on the table. HARKIN) to the bill H.R. 3590, supra; which Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to SA 3036. Mr. ENSIGN submitted an amend- was ordered to lie on the table. the bill H.R. 3590, supra; which was ordered ment intended to be proposed to amendment SA 3050. Mr. BARRASSO submitted an to lie on the table. SA 2786 proposed by Mr. REID (for himself, amendment intended to be proposed to SA 3022. Mr. ENSIGN submitted an amend- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to amendment SA 2786 proposed by Mr. REID ment intended to be proposed to amendment the bill H.R. 3590, supra; which was ordered (for himself, Mr. BAUCUS, Mr. DODD, and Mr. SA 2786 proposed by Mr. REID (for himself, to lie on the table. HARKIN) to the bill H.R. 3590, supra; which Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to SA 3037. Mr. JOHNSON (for himself, Mr. was ordered to lie on the table. the bill H.R. 3590, supra; which was ordered FRANKEN, Mr. BURRIS, and Mr. WARNER) sub- SA 3051. Mr. BARRASSO submitted an to lie on the table. mitted an amendment intended to be pro- amendment intended to be proposed to SA 3023. Mr. ENSIGN submitted an amend- posed to amendment SA 2786 proposed by Mr. amendment SA 2786 proposed by Mr. REID ment intended to be proposed to amendment REID (for himself, Mr. BAUCUS, Mr. DODD, and (for himself, Mr. BAUCUS, Mr. DODD, and Mr. SA 2786 proposed by Mr. REID (for himself, Mr. HARKIN) to the bill H.R. 3590, supra; HARKIN) to the bill H.R. 3590, supra; which Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to which was ordered to lie on the table. was ordered to lie on the table. the bill H.R. 3590, supra; which was ordered SA 3038. Mr. ROCKEFELLER submitted an SA 3052. Mr. BARRASSO submitted an to lie on the table. amendment intended to be proposed to amendment intended to be proposed to SA 3024. Mr. ENSIGN submitted an amend- amendment SA 2786 proposed by Mr. REID amendment SA 2786 proposed by Mr. REID ment intended to be proposed to amendment (for himself, Mr. BAUCUS, Mr. DODD, and Mr. (for himself, Mr. BAUCUS, Mr. DODD, and Mr. SA 2786 proposed by Mr. REID (for himself, HARKIN) to the bill H.R. 3590, supra; which HARKIN) to the bill H.R. 3590, supra; which Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to was ordered to lie on the table. was ordered to lie on the table. the bill H.R. 3590, supra; which was ordered SA 3039. Mr. ROCKEFELLER submitted an SA 3053. Mr. INHOFE submitted an amend- to lie on the table. amendment intended to be proposed to ment intended to be proposed to amendment SA 3025. Mr. ENSIGN submitted an amend- amendment SA 2786 proposed by Mr. REID SA 2786 proposed by Mr. REID (for himself, ment intended to be proposed to amendment (for himself, Mr. BAUCUS, Mr. DODD, and Mr. Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to SA 2786 proposed by Mr. REID (for himself, HARKIN) to the bill H.R. 3590, supra; which the bill H.R. 3590, supra; which was ordered Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to was ordered to lie on the table. to lie on the table. the bill H.R. 3590, supra; which was ordered SA 3040. Mr. ROCKEFELLER submitted an SA 3054. Mr. ROBERTS (for himself and to lie on the table. amendment intended to be proposed to Mr. KYL) submitted an amendment intended SA 3026. Mr. ENSIGN submitted an amend- amendment SA 2786 proposed by Mr. REID to be proposed to amendment SA 2786 pro- ment intended to be proposed to amendment (for himself, Mr. BAUCUS, Mr. DODD, and Mr. posed by Mr. REID (for himself, Mr. BAUCUS,

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Mr. DODD, and Mr. HARKIN) to the bill H.R. to be proposed to amendment SA 2786 pro- (1) by redesignating subparagraphs (C), (D), 3590, supra; which was ordered to lie on the posed by Mr. REID (for himself, Mr. BAUCUS, and (E) as subparagraphs (E), (F), and (G), re- table. Mr. DODD, and Mr. HARKIN) to the bill H.R. spectively; and SA 3055. Mr. ENSIGN submitted an amend- 3590, supra; which was ordered to lie on the (2) by inserting after subparagraph (B) the ment intended to be proposed to amendment table. following new subparagraphs: SA 2786 proposed by Mr. REID (for himself, SA 3069. Mr. KOHL submitted an amend- ‘‘(C) REQUIRED INTERVENTIONS.—For plan Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to ment intended to be proposed by him to the years beginning on or after the date that is the bill H.R. 3590, supra; which was ordered bill H.R. 3590, supra; which was ordered to lie 2 years after the date of the enactment of to lie on the table. on the table. the Patient Protection and Affordable Care SA 3056. Mr. ENSIGN submitted an amend- SA 3070. Mrs. HAGAN submitted an amend- Act, prescription drug plan sponsors shall ment intended to be proposed to amendment ment intended to be proposed to amendment offer medication therapy management serv- SA 2786 proposed by Mr. REID (for himself, SA 2786 proposed by Mr. REID (for himself, ices to targeted beneficiaries described in Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to subparagraph (A)(ii) that include, at a min- the bill H.R. 3590, supra; which was ordered the bill H.R. 3590, supra; which was ordered imum, the following to increase adherence to to lie on the table. to lie on the table. prescription medications or other goals SA 3057. Mr. ENSIGN submitted an amend- SA 3071. Mrs. HAGAN submitted an amend- deemed necessary by the Secretary: ment intended to be proposed to amendment ment intended to be proposed to amendment ‘‘(i) An annual comprehensive medication SA 2786 proposed by Mr. REID (for himself, SA 2786 proposed by Mr. REID (for himself, review furnished person-to-person or using Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to telehealth technologies (as defined by the the bill H.R. 3590, supra; which was ordered the bill H.R. 3590, supra; which was ordered Secretary) by a licensed pharmacist or other to lie on the table. to lie on the table. qualified provider. The comprehensive medi- SA 3058. Mr. ENSIGN submitted an amend- SA 3072. Mrs. HAGAN submitted an amend- cation review— ment intended to be proposed to amendment ment intended to be proposed to amendment ‘‘(I) shall include a review of the individ- SA 2786 proposed by Mr. REID (for himself, SA 2786 proposed by Mr. REID (for himself, ual’s medications and may result in the cre- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to ation of a recommended medication action the bill H.R. 3590, supra; which was ordered the bill H.R. 3590, supra; which was ordered plan or other actions in consultation with to lie on the table. to lie on the table. the individual and with input from the pre- SA 3059. Mr. ENSIGN submitted an amend- SA 3073. Mrs. FEINSTEIN submitted an scriber to the extent necessary and prac- ment intended to be proposed to amendment amendment intended to be proposed by her ticable; and SA 2786 proposed by Mr. REID (for himself, to the bill H.R. 3590, supra; which was or- ‘‘(II) shall include providing the individual Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to dered to lie on the table. with a written or printed summary of the re- the bill H.R. 3590, supra; which was ordered SA 3074. Mrs. FEINSTEIN submitted an sults of the review. to lie on the table. amendment intended to be proposed to The Secretary, in consultation with relevant SA 3060. Mr. ENSIGN submitted an amend- amendment SA 2786 proposed by Mr. REID stakeholders, shall develop a standardized ment intended to be proposed to amendment (for himself, Mr. BAUCUS, Mr. DODD, and Mr. format for the action plan under subclause SA 2786 proposed by Mr. REID (for himself, HARKIN) to the bill H.R. 3590, supra; which (I) and the summary under subclause (II). Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to was ordered to lie on the table. ‘‘(ii) Follow-up interventions as warranted the bill H.R. 3590, supra; which was ordered SA 3075. Mr. DURBIN submitted an amend- based on the findings of the annual medica- to lie on the table. ment intended to be proposed to amendment tion review or the targeted medication en- SA 3061. Mr. ENSIGN submitted an amend- SA 2786 proposed by Mr. REID (for himself, rollment and which may be provided person- ment intended to be proposed to amendment Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to to-person or using telehealth technologies SA 2786 proposed by Mr. REID (for himself, the bill H.R. 3590, supra; which was ordered (as defined by the Secretary). Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to to lie on the table. ‘‘(D) ASSESSMENT.—The prescription drug the bill H.R. 3590, supra; which was ordered SA 3076. Mr. DURBIN (for himself and Mr. plan sponsor shall have in place a process to to lie on the table. SANDERS) submitted an amendment intended assess, at least on a quarterly basis, the SA 3062. Mr. ENSIGN submitted an amend- to be proposed to amendment SA 2786 pro- medication use of individuals who are at risk ment intended to be proposed to amendment posed by Mr. REID (for himself, Mr. BAUCUS, but not enrolled in the medication therapy SA 2786 proposed by Mr. REID (for himself, Mr. DODD, and Mr. HARKIN) to the bill H.R. management program, including individuals Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to 3590, supra; which was ordered to lie on the who have experienced a transition in care, if the bill H.R. 3590, supra; which was ordered table. the prescription drug plan sponsor has access to lie on the table. SA 3077. Mr. DURBIN submitted an amend- to that information. SA 3063. Mr. AKAKA (for himself and Mr. ment intended to be proposed to amendment ‘‘(E) AUTOMATIC ENROLLMENT WITH ABILITY INOUYE) submitted an amendment intended SA 2786 proposed by Mr. REID (for himself, TO OPT-OUT.—The prescription drug plan to be proposed to amendment SA 2786 pro- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to sponsor shall have in place a process to— posed by Mr. REID (for himself, Mr. BAUCUS, the bill H.R. 3590, supra; which was ordered ‘‘(i) subject to clause (ii), automatically Mr. DODD, and Mr. HARKIN) to the bill H.R. to lie on the table. enroll targeted beneficiaries described in 3590, supra; which was ordered to lie on the SA 3078. Ms. KLOBUCHAR (for herself and subparagraph (A)(ii), including beneficiaries table. Ms. SNOWE) submitted an amendment in- identified under subparagraph (D), in the SA 3064. Mr. CASEY submitted an amend- tended to be proposed to amendment SA 2786 medication therapy management program ment intended to be proposed to amendment proposed by Mr. REID (for himself, Mr. BAU- required under this subsection; and SA 2786 proposed by Mr. REID (for himself, CUS, Mr. DODD, and Mr. HARKIN) to the bill ‘‘(ii) permit such beneficiaries to opt-out of Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to H.R. 3590, supra; which was ordered to lie on enrollment in such program.’’. the bill H.R. 3590, supra; which was ordered the table. (b) RULE OF CONSTRUCTION.—Nothing in to lie on the table. f this section shall limit the authority of the SA 3065. Mr. CARDIN (for himself and Mr. Secretary of Health and Human Services to BROWN) submitted an amendment intended TEXT OF AMENDMENTS modify or broaden requirements for a medi- to be proposed to amendment SA 2786 pro- SA 3001. Mrs. HAGAN submitted an cation therapy management program under posed by Mr. REID (for himself, Mr. BAUCUS, amendment intended to be proposed to part D of title XVIII of the Social Security Mr. DODD, and Mr. HARKIN) to the bill H.R. Act or to study new models for medication 3590, supra; which was ordered to lie on the amendment SA 2786 proposed by Mr. therapy management through the Center for table. REID (for himself, Mr. BAUCUS, Mr. SA 3066. Mrs. BOXER submitted an amend- DODD, and Mr. HARKIN) to the bill H.R. Medicare and Medicaid Innovation under sec- ment intended to be proposed to amendment 3590, to amend the Internal Revenue tion 1115A of such Act, as added by section 3021. SA 2786 proposed by Mr. REID (for himself, Code of 1986 to modify the first-time Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to homebuyers credit in the case of mem- SA 3002. Mrs. HAGAN submitted an the bill H.R. 3590, supra; which was ordered bers of the Armed Forces and certain to lie on the table. amendment intended to be proposed to SA 3067. Mr. PRYOR (for himself, Mrs. other Federal employees, and for other amendment SA 2786 proposed by Mr. BOXER, and Mr. ROCKEFELLER) submitted an purposes; which was ordered to lie on REID (for himself, Mr. BAUCUS, Mr. amendment intended to be proposed to the table; as follows: DODD, and Mr. HARKIN) to the bill H.R. amendment SA 2786 proposed by Mr. REID On page 974, between lines 9 and 10, insert 3590, to amend the Internal Revenue (for himself, Mr. BAUCUS, Mr. DODD, and Mr. the following: Code of 1986 to modify the first-time HARKIN) to the bill H.R. 3590, supra; which SEC. 3316. IMPROVEMENT IN PART D MEDICA- homebuyers credit in the case of mem- was ordered to lie on the table. TION THERAPY MANAGEMENT (MTM) SA 3068. Mr. KYL (for himself, Mr. ROB- PROGRAMS. bers of the Armed Forces and certain ERTS, Mr. VITTER, Mr. GRASSLEY, Mr. CRAPO, (a) IN GENERAL.—Section 1860D–4(c)(2) of other Federal employees, and for other Mr. COBURN, Mr. BARRASSO, and Mr. the Social Security Act (42 U.S.C. 1395w– purposes; which was ordered to lie on JOHANNS) submitted an amendment intended 104(c)(2)) is amended— the table; as follows:

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00069 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.049 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12716 CONGRESSIONAL RECORD — SENATE December 8, 2009 On page 1722, after line 24, insert the fol- the small business community, who have ex- and appropriate associations and councils, lowing: perience with diabetes or in administering conduct a study of the impact of diabetes on ‘‘(C) USE OF TECHNOLOGY.—The Secretary and operating employee wellness and disease the practice of medicine in the United States shall incorporate the use of technologies, in- management programs. and the appropriateness of the level of diabe- cluding analytics and predictive modeling, (b) DUTIES.—The advisory group estab- tes medical education that should be re- as part of the analysis process for the pur- lished under subsection (a) shall examine quired prior to licensure, board certification, pose of identifying fraud, abuse, or improper and make recommendations of best practices and board recertification. payments prior to the payment of claims. of employee wellness and disease manage- (b) REPORT.—Not later than 2 years after Such analysis technologies shall at a min- ment programs in order to— the date of the enactment of this Act, the imum— (1) provide public and private sector enti- Secretary shall submit a report on the study ‘‘(i) have the capability to detect emerging ties with improved information in assessing under subsection (a) to the Committees on fraud schemes through the use of automated the role of employee wellness and disease Ways and Means and Energy and Commerce predictive modeling techniques; and management programs in saving money and of the House of Representatives and the ‘‘(ii) improve the efficiency and effective- improving quality of life for patients with Committees on Finance and Health, Edu- ness of current fraud and abuse detection chronic illnesses; and cation, Labor, and Pensions of the Senate. methods by incorporating predictive risk (2) encourage the adoption of effective em- SEC. ll7. AUTHORIZATION OF APPROPRIA- scoring techniques that minimize investiga- ployee wellness and disease management TIONS. tions that result in false positive out- programs. There are authorized to be appropriated to comes.’’. (c) REPORT.—Not later than 1 year after carry out this subtitle such sums as may be the date of the enactment of this Act, the necessary. SA 3003. Mrs. HAGAN submitted an advisory group established under subsection amendment intended to be proposed to (a) shall submit to the Secretary the results SA 3004. Mrs. HAGAN (for herself and amendment SA 2786 proposed by Mr. of the examination under subsection (b)(1). Mr. BENNET) submitted an amendment ll intended to be proposed to amendment REID (for himself, Mr. BAUCUS, Mr. SEC. 4. NATIONAL DIABETES REPORT CARD. (a) IN GENERAL.—The Secretary, in col- SA 2786 proposed by Mr. REID (for him- DODD, and Mr. HARKIN) to the bill H.R. laboration with the Director of the Centers self, Mr. BAUCUS, Mr. DODD, and Mr. 3590, to amend the Internal Revenue for Disease Control and Prevention (referred Code of 1986 to modify the first-time HARKIN) to the bill H.R. 3590, to amend to in this section as the ‘‘Director’’), shall the Internal Revenue Code of 1986 to homebuyers credit in the case of mem- prepare on a biennial basis a national diabe- modify the first-time homebuyers cred- bers of the Armed Forces and certain tes report card (referred to in this section as it in the case of members of the Armed other Federal employees, and for other a ‘‘Report Card’’) and, to the extent possible, Forces and certain other Federal em- purposes; which was ordered to lie on for each State. (b) CONTENTS.— ployees, and for other purposes; which the table; as follows: (1) IN GENERAL.—Each Report Card shall in- was ordered to lie on the table; as fol- At the end of title III, insert the following: clude aggregate health outcomes related to lows: Subtitle ll—Better Diabetes Care individuals diagnosed with diabetes and On page 32, after line 24, add the following: SEC. ll1. SHORT TITLE. prediabetes including— ‘‘(d) CLEAR TRANSPARENCY OF HEALTH CARE This subtitle may be cited as the ‘‘Catalyst (A) preventative care practices and quality CHARGES.— to Better Diabetes Care Act of 2009’’. of care; ‘‘(1) PUBLIC DISCLOSURE OF REIMBURSEMENT SEC. ll2. DIABETES SCREENING COLLABORA- (B) risk factors; and AMOUNTS.—A health insurance issuer offering TION AND OUTREACH PROGRAM. (C) outcomes. group or individual health insurance cov- (a) ESTABLISHMENT.—With respect to diabe- (2) UPDATED REPORTS.—Each Report Card erage shall report at least once a year to the tes screening tests and for the purposes of re- that is prepared after the initial Report Card Secretary the current allowable reimburse- ducing the number of undiagnosed seniors shall include trend analysis for the Nation ment that the issuer will provide for all cov- with diabetes or prediabetes, the Secretary and, to the extent possible, for each State, ered benefits and services (other than pre- of Health and Human Services (referred to in for the purpose of— scription medications dispensed through a li- this subtitle as the ‘‘Secretary’’), in collabo- (A) tracking progress in meeting estab- censed pharmacy), including— ration with the Director of the Centers for lished national goals and objectives for im- ‘‘(A) with respect to services provided by Disease Control and Prevention (referred to proving diabetes care, costs, and prevalence in-network providers where payment is made in this section as the ‘‘Director’’), shall— (including Healthy People 2010); and in part or in full on a fee for service basis, (1) review uptake and utilization of diabe- (B) informing policy and program develop- the current allowed charge for specific serv- tes screening benefits to identify and address ment. ices using currently accepted procedure cod- any existing problems with regard to utiliza- (c) AVAILABILITY.—The Secretary, in col- ing associated with each provider; and tion and data collection mechanisms; laboration with the Director, shall make ‘‘(B) the expected reasonable and allowed (2) establish an outreach program to iden- each Report Card publicly available, includ- charges made for services by out-of-network tify existing efforts by agencies and by the ing by posting the Report Card on the Inter- providers and the amount the issuer would private and nonprofit sectors to increase net. reimburse for such charges. awareness among seniors and providers of di- SEC. ll5. IMPROVEMENT OF VITAL STATISTICS ‘‘(2) ACCESSIBILITY.—Information sub- abetes screening benefits; and COLLECTION. mitted to the Secretary under paragraph (1) (a) IN GENERAL.—The Secretary, acting (3) maximize cost effectiveness in increas- shall be maintained by the Secretary in a through the Director of the Centers for Dis- ing utilization of diabetes screening benefits. manner that ensures that such information ease Control and Prevention and in collabo- (b) CONSULTATION.—In carrying out this is readily accessible by the public. section, the Secretary and the Director shall ration with appropriate agencies and States, ‘‘(3) REGULATIONS.—Not later than one shall— consult with— year after the date of enactment of the Pa- (1) promote the education and training of (1) various units of the Federal Govern- tient Protection and Affordable Care Act, physicians on the importance of birth and ment, including the Centers for Medicare & the Secretary shall promulgate regulations death certificate data and how to properly Medicaid Services, the Surgeon General of to implement the requirements of this sub- complete these documents, including the col- the Public Health Service, the Agency for section.’’. Healthcare Research and Quality, the Health lection of such data for diabetes and other Resources and Services Administration, and chronic diseases; SA 3005. Ms. LANDRIEU (for herself, (2) encourage State adoption of the latest the National Institutes of Health; and Mrs. SHAHEEN, and Ms. SNOWE) sub- (2) entities with an interest in diabetes, in- standard revisions of birth and death certifi- mitted an amendment intended to be cluding industry, voluntary health organiza- cates; and tions, trade associations, and professional (3) work with States to re-engineer their proposed to amendment SA 2786 pro- societies. vital statistics systems in order to provide posed by Mr. REID (for himself, Mr. SEC. ll3. ADVISORY GROUP REGARDING EM- cost-effective, timely, and accurate vital BAUCUS, Mr. DODD, and Mr. HARKIN) to PLOYEE WELLNESS AND DISEASE systems data. the bill H.R. 3590, to amend the Inter- MANAGEMENT BEST PRACTICES. (b) DEATH CERTIFICATE ADDITIONAL LAN- nal Revenue Code of 1986 to modify the (a) ESTABLISHMENT.—The Secretary shall GUAGE.—In carrying out this section, the first-time homebuyers credit in the establish an advisory group consisting of Secretary may promote improvements to the case of members of the Armed Forces representatives of the public and private sec- collection of diabetes mortality data, includ- and certain other Federal employees, tor. The advisory group shall include— ing the addition of a question for the indi- (1) representatives of the Department of vidual certifying the cause of death regard- and for other purposes; which was or- Health and Human Services; ing whether the deceased had diabetes. dered to lie on the table; as follows: (2) representatives of the Department of SEC. ll6. STUDY ON APPROPRIATE LEVEL OF On page 150, line 5, strike ‘‘small business Commerce; and DIABETES MEDICAL EDUCATION. development centers’’ and insert ‘‘resource (3) members of the public, representatives (a) IN GENERAL.—The Secretary shall, in partners of the Small Business Administra- of the private sector, and representatives of collaboration with the Institute of Medicine tion’’.

VerDate Nov 24 2008 05:44 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00070 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.051 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12717 SA 3006. Ms. LANDRIEU (for herself, and certain other Federal employees, mitted an amendment intended to be Mrs. SHAHEEN, and Ms. SNOWE) sub- and for other purposes; which was or- proposed to amendment SA 2786 pro- mitted an amendment intended to be dered to lie on the table; as follows: posed by Mr. REID (for himself, Mr. proposed to amendment SA 2786 pro- On page 54, between lines 16 and 17, insert BAUCUS, Mr. DODD, and Mr. HARKIN) to posed by Mr. REID (for himself, Mr. the following: the bill H.R. 3590, to amend the Inter- BAUCUS, Mr. DODD, and Mr. HARKIN) to (f) ALLOCATION OF FUNDING FOR SMALL nal Revenue Code of 1986 to modify the the bill H.R. 3590, to amend the Inter- BUSINESSES.—Of the amount appropriated first-time homebuyers credit in the under subsection (e), a reasonable amount, nal Revenue Code of 1986 to modify the as determined by the Secretary, shall be case of members of the Armed Forces first-time homebuyers credit in the used to provide reimbursement to partici- and certain other Federal employees, case of members of the Armed Forces pating employment-based plans of small em- and for other purposes; which was or- and certain other Federal employees, ployers with 50 or fewer employees. dered to lie on the table; as follows: and for other purposes; which was or- On page 2074, after line 25, add the fol- dered to lie on the table; as follows: SA 3013. Ms. LANDRIEU (for herself, lowing: Mrs. SHAHEEN, and Ms. SNOWE) sub- On page 1280, between lines 18 and 19, insert SEC. 9024. EXTENSION OF SMALL BUSINESS TAX CREDIT TO 5 YEARS. the following: mitted an amendment intended to be (a) IN GENERAL.—Section 45R(e)(2) of the (VIII) small business concerns (as defined proposed to amendment SA 2786 pro- Internal Revenue Code of 1986, as added by under section 3 of the Small Business Act (15 posed by Mr. REID (for himself, Mr. section 1421(a), is amended by striking ‘‘2- U.S.C. 632)) and self-employed individuals; BAUCUS, Mr. DODD, and Mr. HARKIN) to consecutive-taxable year’’ and inserting ‘‘5- and the bill H.R. 3590, to amend the Inter- consecutive-taxable year’’. nal Revenue Code of 1986 to modify the (b) CONFORMING AMENDMENT.—Section SA 3007. Ms. LANDRIEU (for herself, first-time homebuyers credit in the 45R(i)) of the Internal Revenue Code of 1986, Mrs. SHAHEEN, and Ms. SNOWE) sub- case of members of the Armed Forces as so added, is amended by striking ‘‘2-year’’ mitted an amendment intended to be and certain other Federal employees, and inserting ‘‘5-year’’. proposed to amendment SA 2786 pro- and for other purposes; which was or- (c) EFFECTIVE DATE.—The amendments posed by Mr. REID (for himself, Mr. made by this section shall take effect as if dered to lie on the table; as follows: included in the enactment of section 1421. BAUCUS, Mr. DODD, and Mr. HARKIN) to Beginning on page 55, line 4, strike the bill H.R. 3590, to amend the Inter- ‘‘website,’’ and all that follows through line SA 3013. Ms. LANDRIEU (for herself, nal Revenue Code of 1986 to modify the 5 on page 56 and insert the following: Mrs. SHAHEEN, and Ms. STABENOW) sub- first-time homebuyers credit in the ‘‘website, through which a resident of, or mitted an amendment intended to be case of members of the Armed Forces small business in, any State may identify af- proposed to amendment SA 2786 pro- fordable health insurance coverage options and certain other Federal employees, posed by Mr. REID (for himself, Mr. in that State. and for other purposes; which was or- BAUCUS, Mr. DODD, and Mr. HARKIN) to dered to lie on the table; as follows: (2) CONNECTING TO AFFORDABLE COVERAGE.— An Internet website established under para- the bill H.R. 3590, to amend the Inter- On page 163, between lines 21 and 22, insert graph (1) shall, to the extent practicable, nal Revenue Code of 1986 to modify the the following: provide ways for residents of, and small busi- first-time homebuyers credit in the (4) a survey of the cost and affordability of nesses in, any State to receive information case of members of the Armed Forces health care insurance provided under the Ex- on at least the following coverage options: and certain other Federal employees, changes for owners and employees of small (A) Health insurance coverage offered by business concerns (as defined under section 3 and for other purposes; which was or- health insurance issuers, other than cov- dered to lie on the table; as follows: of the Small Business Act (15 U.S.C. 632)), in- erage that provides reimbursement only for cluding data on enrollees in Exchanges and the treatment or mitigation of— On page 274, after line 25, add the fol- lowing: individuals purchasing health insurance cov- (i) a single disease or condition; or erage outside of Exchanges; and (ii) an unreasonably limited set of diseases SEC. 90ll. PARTIAL DEDUCTION FOR HEALTH INSURANCE COSTS IN COMPUTING or conditions (as determined by the Sec- SA 3008. Ms. LANDRIEU (for herself, SELF-EMPLOYMENT TAXES. retary). (a) IN GENERAL.—Paragraph (4) of section Ms. SNOWE, and Mrs. SHAHEEN) sub- (B) Medicaid coverage under title XIX of mitted an amendment intended to be 162(l) of the Internal Revenue Code of 1986 is the Social Security Act. amended to read as follows: proposed to amendment SA 2786 pro- (C) Coverage under title XXI of the Social ‘‘(4) REDUCED DEDUCTION FOR SELF-EMPLOY- posed by Mr. REID (for himself, Mr. Security Act. MENT TAX PURPOSES.—In determining an in- BAUCUS, Mr. DODD, and Mr. HARKIN) to (D) A State health benefits high risk pool, dividual’s net earnings from self-employ- the bill H.R. 3590, to amend the Inter- to the extent that such high risk pool is of- ment (within the meaning of section 1402(a)) nal Revenue Code of 1986 to modify the fered in such State; and for purposes of chapter 2, the deduction al- (E) Coverage under a high risk pool under first-time homebuyers credit in the lowable by reason of this subsection shall be section 1101. reduced by an amount equal to 50 percent of case of members of the Armed Forces (F) Coverage within the small group mar- and certain other Federal employees, the amount which would otherwise be allow- ket for small businesses and their employees, able (determined without regard to this and for other purposes; which was or- including reinsurance for early retirees paragraph).’’. dered to lie on the table; as follows: under section 1102, tax credits available (b) EFFECTIVE DATE.—The amendments On page 2074, after line 25, add the fol- under section 45R of the Internal Revenue made by this section shall apply to taxable lowing: Code of 1986 (as added by section 1421), and years beginning after the date of the enact- SEC. 9024. SMALL BUSINESS PROCUREMENT. other information specifically for small busi- ment of this Act. Part 19 of the Federal Acquisition Regula- nesses regarding affordable health care op- tion, section 15 of the Small Business Act (15 tions.’’. SA 3014. Ms. LANDRIEU (for herself, Mrs. SHAHEEN, and Ms. STABENOW) sub- U.S.C. 644), and any other applicable laws or SA 3011. Ms. LANDRIEU (for herself, regulations establishing procurement re- mitted an amendment intended to be quirements relating to small business con- Mrs. SHAHEEN, and Mrs. LINCOLN) sub- proposed to amendment SA 2786 pro- cerns (as defined in section 3 of the Small mitted an amendment intended to be posed by Mr. REID (for himself, Mr. Business Act (15 U.S.C. 632)) may not be proposed to amendment SA 2786 pro- BAUCUS, Mr. DODD, and Mr. HARKIN) to waived with respect to any contract awarded posed by Mr. REID (for himself, Mr. the bill H.R. 3590, to amend the Inter- under any program or other authority under BAUCUS, Mr. DODD, and Mr. HARKIN) to nal Revenue Code of 1986 to modify the this Act or an amendment made by this Act. the bill H.R. 3590, to amend the Inter- first-time homebuyers credit in the nal Revenue Code of 1986 to modify the SA 3009. Ms. LANDRIEU (for herself, case of members of the Armed Forces first-time homebuyers credit in the and certain other Federal employees, Mrs. SHAHEEN, and Ms. SNOWE) sub- case of members of the Armed Forces mitted an amendment intended to be and for other purposes; which was or- and certain other Federal employees, dered to lie on the table; as follows: proposed to amendment SA 2786 pro- and for other purposes; which was or- posed by Mr. REID (for himself, Mr. On page 2074, after line 25, add the fol- dered to lie on the table; as follows: lowing: BAUCUS, Mr. DODD, and Mr. HARKIN) to Beginning on page 349, line 16, strike all SEC. 9024. EXTENSION OF SMALL BUSINESS TAX the bill H.R. 3590, to amend the Inter- through page 350, line 14. CREDIT TO 2010. nal Revenue Code of 1986 to modify the (a) IN GENERAL.—Subsections (d)(3)(B)(i) first-time homebuyers credit in the SA 3012. Ms. LANDRIEU (for herself, and (g) of section 45R of the Internal Rev- case of members of the Armed Forces Mrs. SHAHEEN, and Ms. STABENOW) sub- enue Code of 1986, as added by section 1421(a),

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00071 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.036 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12718 CONGRESSIONAL RECORD — SENATE December 8, 2009 is amended by striking ‘‘2011’’ each place it amendment made by that Act, any taxpayer SEC. ll. APPOINTMENT OF HEALTH CARE appears and inserting ‘‘2010, 2011’’. who— CZARS. (b) CONFORMING AMENDMENTS.— ‘‘(I) is a citizen or national of the United Notwithstanding any other provision of (1) Section 280C(h) of the Internal Revenue States; and this Act, any individual appointed by the Code of 1986, as added by section 1421(d)(1), is ‘‘(II) has a household income which is not President as a czar to handle health care amended by striking ‘‘2011’’ and inserting greater than 133 percent of an amount equal issues shall be subject to Senate confirma- ‘‘2010, 2011’’. to the poverty line for a family of the size in- tion. (2) Section 1421(f) is amended by striking volved, ‘‘2010’’ both places it appears and inserting may elect to enroll in a qualified health plan SA 3019. Mr. ENSIGN submitted an ‘‘2009’’. through the Exchange established by the amendment intended to be proposed to (c) EFFECTIVE DATE.—The amendments State under section 1311 of the Patient Pro- amendment SA 2786 proposed by Mr. made by this section shall take effect as if tection and Affordable Care Act instead of REID (for himself, Mr. BAUCUS, Mr. included in the enactment of section 1421. enrolling in the State Medicaid plan under DODD, and Mr. HARKIN) to the bill H.R. title XIX of the Social Security, or under a SA 3015. Mr. ENSIGN submitted an 3590, to amend the Internal Revenue waiver of such plan. Code of 1986 to modify the first-time amendment intended to be proposed to ‘‘(ii) SPECIAL RULES.— amendment SA 2786 proposed by Mr. ‘‘(I) An individual making an election homebuyers credit in the case of mem- REID (for himself, Mr. BAUCUS, Mr. under clause (i) shall waive being provided bers of the Armed Forces and certain DODD, and Mr. HARKIN) to the bill H.R. with medical assistance under the State other Federal employees, and for other 3590, to amend the Internal Revenue Medicaid plan under title XIX of the Social purposes; which was ordered to lie on Code of 1986 to modify the first-time Security, or under a waiver of such plan the table; as follows: while enrolled in a qualified health plan. On page 100, line 16, insert ‘‘ or meets the homebuyers credit in the case of mem- ‘‘(II) In the case of an individual who is a bers of the Armed Forces and certain requirements for a high deductible health child, the child’s parent or legal guardian plan under section 223(c)(2) of the Internal other Federal employees, and for other may make such an election on behalf of the purposes; which was ordered to lie on Revenue Code of 1986’’ after ‘‘section child. 1302(a)’’. the table; as follows: ‘‘(III) Any individual making such an elec- At the appropriate place, insert the fol- tion, or on whose behalf such an election is SA 3020. Mr. ENSIGN submitted an lowing: made, shall be treated as an applicable tax- amendment intended to be proposed to payer with a household income which is SEC. ll. PROTECTION OF ACCESS TO QUALITY amendment SA 2786 proposed by Mr. HEALTH CARE THROUGH THE DE- equal to 100 percent of the poverty line for a PARTMENT OF VETERANS AFFAIRS family of the size involved. REID (for himself, Mr. BAUCUS, Mr. AND THE DEPARTMENT OF DE- DODD, and Mr. HARKIN) to the bill H.R. FENSE. SA 3017. Mr. ENSIGN submitted an 3590, to amend the Internal Revenue (a) HEALTH CARE THROUGH DEPARTMENT OF amendment intended to be proposed to Code of 1986 to modify the first-time VETERANS AFFAIRS.—Nothing in this Act amendment SA 2786 proposed by Mr. homebuyers credit in the case of mem- shall be construed to prohibit, limit, or oth- REID (for himself, Mr. BAUCUS, Mr. erwise penalize veterans and dependents eli- bers of the Armed Forces and certain DODD, and Mr. HARKIN) to the bill H.R. other Federal employees, and for other gible for health care through the Depart- 3590, to amend the Internal Revenue ment of Veterans Affairs under the laws ad- purposes; which was ordered to lie on ministered by the Secretary of Veterans Af- Code of 1986 to modify the first-time the table; as follows: fairs from receiving timely access to quality homebuyers credit in the case of mem- At the appropriate place, insert the fol- health care in any facility of the Department bers of the Armed Forces and certain lowing: or from any non-Department health care other Federal employees, and for other SEC. ll. EQUIVALENT BANKRUPTCY PROTEC- provider through which the Secretary pro- purposes; which was ordered to lie on TIONS FOR HEALTH SAVINGS AC- vides health care. the table; as follows: COUNTS AS RETIREMENT FUNDS. (b) HEALTH CARE THROUGH DEPARTMENT OF At the end of part I of subtitle C of title I, (a) IN GENERAL.—Section 522 of title 11, DEFENSE.— insert the following: United States Code, is amended by adding at N GENERAL (1) I .—Nothing in this Act shall SEC. 1202. APPLICATION OF WELLNESS PRO- the end the following new subsection: be construed to prohibit, limit, or otherwise GRAMS PROVISIONS TO CARRIERS ‘‘(r) TREATMENT OF HEALTH SAVINGS AC- penalize eligible beneficiaries from receiving PROVIDING FEDERAL EMPLOYEE COUNTS.—For purposes of this section, any timely access to quality health care in any HEALTH BENEFITS PLANS. health savings account (as described in sec- military medical treatment facility or under (a) IN GENERAL.—Notwithstanding section tion 223 of the Internal Revenue Code of 1986) the TRICARE program. 8906 of title 5, United States Code (including shall be treated in the same manner as an in- (2) DEFINITIONS.—In this subsection: subsections (b)(1) and (b)(2) of such section), dividual retirement account described in sec- (A) The term ‘‘eligible beneficiaries’’ section 2705(j) of the Public Health Service tion 408 of such Code.’’. means covered beneficiaries (as defined in Act (as added by section 1201) (relating to (b) EFFECTIVE DATE.—The amendment section 1072(5) of title 10, United States Code) wellness programs) shall apply to carriers made by this section shall apply to cases for purposes of eligibility for mental and entering into contracts under section 8902 of commencing under title 11, United States dental care under chapter 55 of title 10, title 5, United States Code. Code, after the date of the enactment of this United States Code. (b) PROPOSALS.—Carriers may submit sepa- Act. (B) The term ‘‘TRICARE program’’ has the rate proposals relating to voluntary wellness meaning given that term in section 1072(7) of program offerings as part of the annual call SA 3021. Mr. ENSIGN submitted an title 10, United States Code. for benefit and rate proposals to the Office of Personnel Management. amendment intended to be proposed to amendment SA 2786 proposed by Mr. SA 3016. Mr. ENSIGN submitted an (c) EFFECTIVE DATE.—This subsection shall take effect on the date of enactment of this REID (for himself, Mr. BAUCUS, Mr. amendment intended to be proposed to Act and shall apply to contracts entered into amendment SA 2786 proposed by Mr. DODD, and Mr. HARKIN) to the bill H.R. under section 8902 of title 5, United States 3590, to amend the Internal Revenue REID (for himself, Mr. BAUCUS, Mr. Code, that take effect with respect to cal- Code of 1986 to modify the first-time DODD, and Mr. HARKIN) to the bill H.R. endar years that begin more than 1 year 3590, to amend the Internal Revenue after that date. homebuyers credit in the case of mem- Code of 1986 to modify the first-time bers of the Armed Forces and certain Mr. ENSIGN submitted an homebuyers credit in the case of mem- SA 3018. other Federal employees, and for other amendment intended to be proposed to bers of the Armed Forces and certain purposes; which was ordered to lie on amendment SA 2786 proposed by Mr. other Federal employees, and for other the table; as follows: REID (for himself, Mr. BAUCUS, Mr. purposes; which was ordered to lie on On page 816, after line 20, insert the fol- DODD, and Mr. HARKIN) to the bill H.R. the table; as follows: lowing: 3590, to amend the Internal Revenue SEC. 3115. ENSURING THAT AN INDIVIDUAL WHO On page 246, between lines 7 and 8, insert Code of 1986 to modify the first-time ELECTS TO OPT-OUT OF MEDICARE the following: homebuyers credit in the case of mem- PART A BENEFITS IS NOT ALSO RE- ‘‘(C) SPECIAL RULES TO ENSURE CITIZENS AND bers of the Armed Forces and certain QUIRED TO OPT-OUT OF SOCIAL SE- NATIONALS OF THE UNITED STATES HAVE THE CURITY BENEFITS. SAME HEALTH CARE CHOICES AS LEGAL IMMI- other Federal employees, and for other Notwithstanding any other provision of GRANTS.— purposes; which was ordered to lie on law, in the case of an individual who elects ‘‘(i) IN GENERAL.—Notwithstanding any the table; as follows: to opt-out of benefits under part A of title other provision of this Code, the Patient At the appropriate place, insert the fol- XVIII of the Social Security Act, such indi- Protection and Affordable Care Act, or any lowing: vidual shall not be required to opt-out of

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00072 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.042 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12719 benefits under title II of such Act as a condi- Social Security Act may not be counted as at least 1 percent in the total amount of ex- tion for making such election. an offset to any outlays under any other pro- penditures by the State for providing med- gram or activity of the Federal Govern- ical assistance to all individuals enrolled SA 3022. Mr. ENSIGN submitted an ment.’’. under the State plan, when compared to the amendment intended to be proposed to total amount of such expenditures for the amendment SA 2786 proposed by Mr. SA 3025. Mr. ENSIGN submitted an most recently ended State fiscal year. REID (for himself, Mr. BAUCUS, Mr. amendment intended to be proposed to SA 3028. Mr. ENSIGN submitted an DODD, and Mr. HARKIN) to the bill H.R. amendment SA 2786 proposed by Mr. 3590, to amend the Internal Revenue REID (for himself, Mr. BAUCUS, Mr. amendment intended to be proposed by Code of 1986 to modify the first-time DODD, and Mr. HARKIN) to the bill H.R. him to the bill H.R. 3590, to amend the homebuyers credit in the case of mem- 3590, to amend the Internal Revenue Internal Revenue Code of 1986 to mod- bers of the Armed Forces and certain Code of 1986 to modify the first-time ify the first-time homebuyers credit in other Federal employees, and for other homebuyers credit in the case of mem- the case of members of the Armed purposes; which was ordered to lie on bers of the Armed Forces and certain Forces and certain other Federal em- the table; as follows: other Federal employees, and for other ployees, and for other purposes; which was ordered to lie on the table; as fol- On page 923, between lines 7 and 8, insert purposes; which was ordered to lie on the following: the table; as follows: lows: SEC. ll. LIMITATION ON IMPLEMENTATION. On page 1050, between lines 9 and 10, insert At the appropriate place, insert the fol- Notwithstanding any other provision of the following: lowing: law, the Secretary of Health and Human ‘‘(n) REDUCTIONS IN MEDICARE PROGRAM SEC. ll. STUDY AND REPORT ON MEDICARE Services (in this section referred to as the SPENDING NOT COUNTED TOWARDS THE PAY- COVERAGE FOR MEDICAL EQUIP- MENT USED IN THE TREATMENT OF AS-YOU-GO SCORECARD.—Any reductions in ‘‘Secretary’’) shall not implement the CIRCULATORY DISEASES. amendments made by and the provisions of Medicare program spending enacted pursu- (a) STUDY.—The Secretary of Health and ant to this section shall not count towards this part for any year unless the Secretary Human Services shall conduct a study on the the pay-as-you-go scorecard under section certifies with respect to such year that such feasibility and advisability of providing for 201(a)(6) of S. Con. Res. 21 (110th Congress).’’. amendments and provisions will not result in reimbursement under the Medicare program any individual who would otherwise be en- Mr. ENSIGN submitted an under title XVIII of the Social Security Act rolled in a Medicare Advantage plan under SA 3026. for gradient pumps and compression stock- part C of title XVIII of the Social Security amendment intended to be proposed to ings that are used in the treatment of indi- Act being forced away from or losing their amendment SA 2786 proposed by Mr. viduals with lymphedema, chronic venous in- enrollment in such plan, as such enrollment REID (for himself, Mr. BAUCUS, Mr. sufficiency, and other circulatory diseases. was in effect on the day before the date of DODD, and Mr. HARKIN) to the bill H.R. Such study shall include an analysis of the enactment of this Act. 3590, to amend the Internal Revenue following: Mr. ENSIGN submitted an Code of 1986 to modify the first-time (1) The types of gradient pumps and com- SA 3023. pression stockings that are currently avail- amendment intended to be proposed to homebuyers credit in the case of mem- bers of the Armed Forces and certain able on the market. amendment SA 2786 proposed by Mr. (2) The clinical appropriateness of pro- REID (for himself, Mr. BAUCUS, Mr. other Federal employees, and for other viding gradient pumps and compression DODD, and Mr. HARKIN) to the bill H.R. purposes; which was ordered to lie on stockings for Medicare beneficiaries who 3590, to amend the Internal Revenue the table; as follows: have been diagnosed with lymphedema, Code of 1986 to modify the first-time On page 2044, between lines 7 and 8, insert chronic venous insufficiency, and other cir- homebuyers credit in the case of mem- the following: culatory diseases. bers of the Armed Forces and certain (d) ADDITIONAL HOSPITAL INSURANCE TAX (3) The financial impact on the Medicare SOLELY DEDICATED TO MEDICARE.—It is the program (including a description of any re- other Federal employees, and for other policy of Congress that the additional hos- sulting costs or savings) if reimbursement purposes; which was ordered to lie on pital insurance taxes resulting from the were to be provided for gradient pumps and the table; as follows: amendments made by this section shall, as is compression stockings that are used in the On page 1053, between lines 2 and 3, insert the case regarding such taxes under the So- treatment of lymphedema, chronic venous the following: cial Security Act as in effect on the date of insufficiency, and other circulatory diseases. SEC. 3404. ENSURING MEDICARE SAVINGS ARE the enactment of this Act, be deposited into (b) REPORT.—Not later than 1 year after KEPT IN THE MEDICARE PROGRAM. the Federal Hospital Insurance Trust Fund the date of enactment of this Act, the Sec- No reduction in outlays under the Medi- and under the terms of that Trust Fund used retary of Health and Human Services shall care program under title XVIII of the Social only for purposes of funding the medicare submit a report to Congress on the study Security Act under the provisions of and program under part A of title XVIII of the conducted under subsection (a), together amendments made by this Act may be uti- Social Security Act. with recommendations for such legislation lized to offset any outlays under any other and administrative action as the Secretary program or activity of the Federal govern- SA 3027. Mr. ENSIGN submitted an determines appropriate. ment. amendment intended to be proposed to amendment SA 2786 proposed by Mr. SA 3029. Mr. THUNE submitted an SA 3024. Mr. ENSIGN submitted an REID (for himself, Mr. BAUCUS, Mr. amendment intended to be proposed to amendment intended to be proposed to DODD, and Mr. HARKIN) to the bill H.R. amendment SA 2786 proposed by Mr. amendment SA 2786 proposed by Mr. 3590, to amend the Internal Revenue REID (for himself, Mr. BAUCUS, Mr. REID (for himself, Mr. BAUCUS, Mr. Code of 1986 to modify the first-time DODD, and Mr. HARKIN) to the bill H.R. DODD, and Mr. HARKIN) to the bill H.R. homebuyers credit in the case of mem- 3590, to amend the Internal Revenue 3590, to amend the Internal Revenue bers of the Armed Forces and certain Code of 1986 to modify the first-time Code of 1986 to modify the first-time other Federal employees, and for other homebuyers credit in the case of mem- homebuyers credit in the case of mem- purposes; which was ordered to lie on bers of the Armed Forces and certain bers of the Armed Forces and certain the table; as follows: other Federal employees, and for other purposes; which was ordered to lie on other Federal employees, and for other On page 436, between lines 14 and 15, insert purposes; which was ordered to lie on the following: the table; as follows: the table; as follows: SEC. 2008. STATE OPTION TO OPT-OUT OF MED- On page 356, between lines 19 and 20, insert At the appropriate place, insert the fol- ICAID COVERAGE EXPANSION TO the following: lowing: AVOID ASSUMING UNFUNDED FED- ‘‘(f) LIMITATION.—A full-time employee ERAL MANDATE. SEC. ll. PROHIBITION ON USING MEDICARE shall not be taken into account for purposes SAVINGS TO OFFSET PROGRAMS UN- Notwithstanding any other provision of of calculating the amount of any assessable RELATED TO MEDICARE. this Act (or an amendment made by this payment imposed under subsections (a), (b), Title III of the Congressional Budget Act Act), the Governor of a State shall have the or (c) if such employee performs the major- of 1974 (2 U.S.C. 621 et seq.) is amended by authority to opt out of any provision under ity of services in a State— adding at the end the following: this Act or any amendment made by this Act ‘‘(1) the unemployment rate of which ex- ‘‘SEC. 316. PROHIBITION ON USING MEDICARE that requires the State to expand coverage ceeds 6 percent, and SAVINGS TO OFFSET PROGRAMS UN- under the Medicaid program if the State ‘‘(2) the Governor of which has certified RELATED TO MEDICARE. agency responsible for administering the that the assessable penalties imposed under ‘‘For purposes of this title and title IV, a State plan under title XIX certifies that this section have contributed to such unem- reduction in outlays under title XVIII of the such expansion would result in an increase of ployment rate.’’.

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00073 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.055 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12720 CONGRESSIONAL RECORD — SENATE December 8, 2009 SA 3030. Mrs. FEINSTEIN (for her- other appropriate body, will provide to the described in subparagraph (B) shall make self, Mr. ROCKEFELLER, and Mr. Secretary and the Authority a report on— recommendations to State Exchanges about WHITEHOUSE) submitted an amendment ‘‘(i) State authority to review rates in each whether particular health insurance issuers intended to be proposed to amendment insurance market, and methodologies used in should be excluded from participation in the such reviews; Exchange based on a pattern of excessive SA 2786 proposed by Mr. REID (for him- ‘‘(ii) rating requests received by the State premium increases, low medical loss ratios, self, Mr. BAUCUS, Mr. DODD, and Mr. in the previous 12 months and subsequent ac- or market conduct. HARKIN) to the bill H.R. 3590, to amend tions taken by States to approve, deny, or ‘‘(B) REVIEWING OFFICIAL.—Either the Sec- the Internal Revenue Code of 1986 to modify such requests; and retary or the relevant State insurance com- modify the first-time homebuyers cred- ‘‘(iii) justifications by insurance issuers for missioner or commissioners, based on the de- it in the case of members of the Armed rate requests. termination in paragraph (4)(C), shall make Forces and certain other Federal em- ‘‘(C) DETERMINATION OF WHO CONDUCTS RE- the recommendations described in subpara- ployees, and for other purposes; which VIEWS FOR EACH STATE.—Using the report graph (A). was ordered to lie on the table; as fol- submitted pursuant to subparagraph (B), the On page 144, line 12, strike ‘‘may’’ and in- Secretary shall determine not later than 1 sert ‘‘shall’’. lows: year after the date of enactment of the Pa- On page 37, strike line 10 through line 14 tient Protection and Affordable Care Act— SA 3031. Mr. WHITEHOUSE (for him- and insert the following: ‘‘(i) for which States the State insurance self and Mr. CASEY) submitted an ‘‘(1) IN GENERAL.— commissioner shall undertake the actions ‘‘(A) ESTABLISHMENT.—The Secretary, in amendment intended to be proposed to described in subparagraph (A)— conjunction with States, shall establish a amendment SA 2786 proposed by Mr. ‘‘(I) based on the Secretary’s determina- uniform process for the annual review, begin- REID (for himself, Mr. BAUCUS, Mr. tion that the State has sufficient authority ning with the 2010 plan year and subject to DODD, and Mr. HARKIN) to the bill H.R. and capability to deny rates, modify rates, subsection (b)(2)(A), of unreasonable in- provide rebates, or take other corrective ac- 3590, to amend the Internal Revenue creases in premiums for health insurance tions; and Code of 1986 to modify the first-time coverage. ‘‘(II) as a condition of receiving a grant homebuyers credit in the case of mem- ‘‘(B) ELECTRONIC REPORTING.—The process under subsection (c)(1); and bers of the Armed Forces and certain established under subparagraph (A) shall in- ‘‘(ii) for which States the Secretary shall clude an electronic reporting system estab- other Federal employees, and for other undertake the actions described in subpara- lished by the Secretary through which purposes; which was ordered to lie on graph (A), based on the Secretary’s deter- health insurance issuers shall report to the the table; as follows: mination that such States lacks the author- Secretary and State insurance commis- On page 1507, after line 19, insert the fol- ity and capability described in clause (i). sioners the information requested by the lowing: ‘‘(D) TRANSITION PERIOD.—Until the Sec- Secretary pursuant to this subsection. SEC. 5510. SUPPORT OF GRADUATE MEDICAL retary makes the determinations described EDUCATION PROGRAMS IN WOMEN’S On page 37, between lines 24 and 25, insert in subparagraph (C), the relevant State in- the following: HOSPITALS. surance commissioner shall, as a condition Subpart IX of part D of title III of the Pub- ‘‘(3) HEALTH INSURANCE RATE AUTHORITY.— of receiving a grant under subsection (c)(1), lic Health Service Act (42 U.S.C. 256e et seq.) ‘‘(A) IN GENERAL.—The Secretary shall es- carry out the action described in subpara- is amended— tablish a Health Insurance Rate Authority graph (A). (1) in the subpart heading, by adding ‘‘ (referred to in this paragraph as the ‘Author- and ‘‘(E) SUNSET.—Beginning on the date on ’’ at the end; and ity’) to be composed of 7 members to be ap- Women’s Hospitals which subsection (b)(2)(A) applies, the re- (2) by adding at the end the following: pointed by the Secretary, of which— quirements of this paragraph shall no longer ‘‘(i) at least 2 members shall be a consumer ‘‘SEC. 340E-1. SUPPORT OF GRADUATE MEDICAL have force or effect. EDUCATION PROGRAMS IN WOMEN’S advocate with expertise in the insurance in- ‘‘(5) PRIORITIZING PROPOSED PREMIUM IN- HOSPITALS. dustry; CREASES FOR REVIEW.—In determining which ‘‘(a) PAYMENTS.—The Secretary shall make ‘‘(ii) at least 1 member shall be an indi- proposed premium increases to review under two payments under this section to each vidual who is a medical professional; this subsection, the Secretary or the rel- women’s hospital for each of fiscal years 2010 ‘‘(iii) at least 1 member shall be a rep- evant State insurance commissioner may through 2014, one for the direct expenses and resentative of health insurance issuers; and prioritize— the other for indirect expenses associated ‘‘(iv) such remaining members shall be in- ‘‘(A) rate increases which exceed market with operating approved graduate medical dividuals who are recognized for their exper- averages; residency training programs. The Secretary tise in health finance and economics, actu- ‘‘(B) rate increases that will impact large shall promulgate regulations pursuant to the arial science, health facility management, numbers of consumers; and rulemaking requirements of title 5, United health plans and integrated delivery sys- ‘‘(C) rate reviews requested from States, if States Code, which shall govern payments tems, reimbursement of health facilities, and applicable. made under this subpart. other related fields, who provide broad geo- ‘‘(6) ANNUAL REPORT.— ‘‘(b) AMOUNT OF PAYMENTS.— graphic representation and a balance be- ‘‘(A) UNIFORM DATA COLLECTION SYSTEM.— ‘‘(1) IN GENERAL.—Subject to paragraphs (2) tween urban and rural members. The Secretary, in consultation with the As- and (3), the amounts payable under this sec- ‘‘(B) ROLE.—In addition to the other duties sociation and the Authority, shall develop a tion to a women’s hospital for an approved of the Authority set forth in this subsection, uniform data collection system for rate in- graduate medical residency training pro- the Authority shall advise and make rec- formation, which shall include information gram for a fiscal year shall be each of the ommendations to the Secretary concerning on rates, medical loss ratios, consumer com- following: the Secretary’s duties under this subsection. plaints, solvency, reserves, and any other ‘‘(A) DIRECT EXPENSE AMOUNT.—The ‘‘(4) CORRECTIVE ACTION FOR UNJUSTIFIED relevant factors of market conduct. amount determined in accordance with sub- RATE INCREASES.— ‘‘(B) PREPARATION OF ANNUAL REPORT.— section (c) for direct expenses associated ‘‘(A) IN GENERAL.—Pursuant to the proce- Using the data obtained in accordance with with operating approved graduate medical dures set forth in this paragraph, the Sec- subparagraph (A), the Authority shall annu- residency training programs for a fiscal year. retary or the relevant State insurance com- ally produce a single, aggregate report on in- ‘‘(B) INDIRECT EXPENSE AMOUNT.—The missioner shall— surance market behavior, which includes— amount determined in accordance with sub- ‘‘(i) review potentially unreasonable rate ‘‘(i) State-by-State information on rate in- section (c) for indirect expenses associated increases and determine whether such in- creases from one year to the next, including with the treatment of more severely ill pa- creases are justified; and by issuer and by market and including med- tients and the additional costs relating to ‘‘(ii) take action to ensure that any rate ical trends, benefit changes, and relevant de- teaching residents in such programs for a fis- increase found to be unjustified under clause mographic changes; and cal year. (i) is corrected, through mechanisms includ- ‘‘(ii) a national growth rate percentage for ‘‘(2) CAPPED AMOUNT.— ing— every issuer, which shall be based on aggre- ‘‘(A) IN GENERAL.—The total of the pay- ‘‘(I) denial of the rate increase; gated data of such issuer from premiums sold ments made to women’s hospitals under ‘‘(II) modification of the rate increase; in the each market. paragraph (1) in a fiscal year shall not exceed ‘‘(III) ordering rebates to consumers; or ‘‘(C) DISTRIBUTION.—The Authority shall the funds appropriated under subsection (e) ‘‘(IV) any other actions that correct for share the annual report described in subpara- for such payments for that fiscal year. the unjustified increase. graph (B) with States, and include such re- ‘‘(B) PRO RATA REDUCTIONS OF PAYMENTS.— ‘‘(B) REQUIRED REPORT.—The Secretary port in the information disclosed to the pub- If the Secretary determines that the amount shall ensure that, not later than 6 months lic. of funds appropriated under subsection (e) after the date of enactment of the Patient ‘‘(7) RECOMMENDATION ON EXCHANGE PAR- for a fiscal year is insufficient to provide the Protection and Affordable Care Act, the Na- TICIPATION.— total amount of payments otherwise due for tional Association of Insurance Commis- ‘‘(A) IN GENERAL.—Based on the informa- such periods under paragraph (1), the Sec- sioners (referred to in this section as the ‘As- tion provided pursuant to this subsection retary shall reduce the amounts so payable sociation’), in conjunction with States, or and other relevant information, the official on a pro rata basis to reflect such shortfall.

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‘‘(3) ANNUAL REPORTING REQUIRED.—The ‘‘(A) that has a Medicare provider agree- ‘‘(4) DATA PROTECTION AND PRIVACY.—The provisions of subsection (b)(3) of section 340E ment under title XVIII of the Social Secu- Secretary and the Secretary of Labor shall shall apply to women’s hospitals under this rity Act; ensure the confidentiality and privacy of any section in the same manner as such provi- ‘‘(B) that has an approved graduate med- claims data submitted pursuant to this sec- sions apply to children’s hospitals under ical residency training program; tion. Within 1 year of the date of enactment such section 340E. In applying such provi- ‘‘(C) that has not been excluded from the of this section, the Secretary shall promul- sions, the Secretary may make such modi- Medicare prospective payment system; gate a proposed regulation to ensure that fications as may be necessary to apply such ‘‘(D) that had at least 3,000 births during such data is protected against any violation provisions to women’s hospitals. 2007, as determined by the Centers for Medi- of the privacy and confidentiality of an indi- care & Medicaid Services; and ‘‘(c) APPLICATION OF CERTAIN PROVISIONS.— vidual’s medical records. Within 180 days of The provisions of subsections (c) and (d) of ‘‘(E) with respect to which and as deter- such promulgation, the Comptroller General mined by the Centers for Medicare & Med- section 340E shall apply to women’s hospitals shall publish a report on the adequacy of icaid Services, less than 4 percent of the under this section in the same manner as such regulation to ensure such protection. total discharges from the hospital during such provisions apply to children’s hospitals The database shall not include names, 2007 were Medicare discharges of individuals under such section 340E. In applying such unencrypted Social Security numbers, ad- who, as of the time of the discharge— provisions, the Secretary may make such dresses, or other information that may ‘‘(i) were enrolled in the original Medicare modifications as may be necessary to apply uniquely identify an individual. fee-for-service program under part A of title such provisions to women’s hospitals. ‘‘(5) TABULATION; CLASSIFICATION.—The XVIII of the Social Security Act; and Secretary shall work with the NAIC to de- ‘‘(d) MAKING OF PAYMENTS.— ‘‘(ii) were not enrolled in— velop a procedure for centralized tabulation ‘‘(1) INTERIM PAYMENTS.—The Secretary ‘‘(I) a Medicare Advantage plan under part and classification of consumer complaints shall determine, before the beginning of each C of title XVIII of that Act; related to claims handling, appeals, and re- fiscal year involved for which payments may ‘‘(II) an eligible organization under section views by the entities described in paragraph be made for a hospital under this section, the 1876 of that Act; or (1). amounts of the payments for direct graduate ‘‘(III) a PACE program under section 1894 ‘‘(c) IMPLEMENTATION.—The Secretary shall medical education and indirect medical edu- of that Act.’’. implement the database not later than 2 cation for such fiscal year and shall (subject years after the date of enactment of this sec- to paragraph (2)) make the payments of such SA 3032. Mrs. BOXER submitted an tion. amounts in 12 equal interim installments amendment intended to be proposed to ‘‘(d) DISSEMINATION.—The Secretary shall during such period. Such interim payments amendment SA 2786 proposed by Mr. make the database available to State insur- to each individual hospital shall be based on REID (for himself, Mr. BAUCUS, Mr. ance regulators, health exchanges, and con- the number of residents reported in the hos- DODD, and Mr. HARKIN) to the bill H.R. sumer assistance ombudsmen, provided that pital’s most recently filed Medicare cost re- 3590, to amend the Internal Revenue such entities ensure the confidentiality and port prior to the application date for the Code of 1986 to modify the first-time privacy of medical records and comply with Federal fiscal year for which the interim all existing privacy laws, and shall update payment amounts are established. In the homebuyers credit in the case of mem- the database on a quarterly basis. case of a hospital that does not report resi- bers of the Armed Forces and certain ‘‘(e) REPORTING.—Not later than January 1, dents on a Medicare cost report, such in- other Federal employees, and for other 2013, and on an annual basis thereafter, the terim payments shall be based on the num- purposes; which was ordered to lie on Secretary shall issue a public report assess- ber of residents trained during the hospital’s the table; as follows: ing the performance of the plans and issuers most recently completed Medicare cost re- On page 36, strike line 23 and insert the fol- described in subsection (b)(1)(A) regarding port filing period. lowing: ‘‘be necessary to carry out this sec- claims handling, appeals, and reviews. Such ‘‘(2) WITHHOLDING.—The Secretary shall tion. report shall assess whether there is any evi- withhold up to 25 percent from each interim ‘‘SEC. 2793A. IMPROVING OVERSIGHT OF IN- dence of a pattern of denial or delay of medi- installment for direct and indirect graduate SURER SERVICE TO BENEFICIARIES. cally necessary claims or appeals.’’. medical education paid under paragraph (1) ‘‘(a) DEFINITIONS.—In this section— as necessary to ensure a hospital will not be ‘‘(1) the term ‘database’ means the data- SA 3033. Mr. CASEY (for himself and overpaid on an interim basis. base established under subsection (b); and Mr. SPECTER) submitted an amendment ‘‘(3) RECONCILIATION.—Prior to the end of ‘‘(2) the term ‘NAIC’ means the National intended to be proposed to amendment each fiscal year, the Secretary shall deter- Association of State Insurance Commis- SA 2786 proposed by Mr. REID (for him- mine any changes to the number of residents sioners. self, Mr. BAUCUS, Mr. DODD, and Mr. reported by a hospital in the application of ‘‘(b) MONITORING INSURER HANDLING OF RE- HARKIN) to the bill H.R. 3590, to amend the hospital for the current fiscal year to de- QUESTS FOR COVERAGE OF MEDICAL CARE.— the Internal Revenue Code of 1986 to ‘‘(1) ESTABLISHMENT.—The Secretary shall, termine the final amount payable to the hos- modify the first-time homebuyers cred- pital for the current fiscal year for both di- in consultation with the NAIC, establish and rect expense and indirect expense amounts. maintain a nationally consistent database it in the case of members of the Armed Based on such determination, the Secretary that, using standardized definitions, tracks Forces and certain other Federal em- shall recoup any overpayments made and claims handling performance by— ployees, and for other purposes; which pay any balance due to the extent possible. ‘‘(A) all group health plans (and health in- was ordered to lie on the table; as fol- The final amount so determined shall be con- surance issuers offering group health insur- lows: ance coverage in connection with a group sidered a final intermediary determination On page 1133, between lines 22 and 23, insert health plan) and health insurance issuers for the purposes of section 1878 of the Social the following: Security Act and shall be subject to adminis- that offer health insurance coverage in the individual market; and SEC. 3511. CONSISTENT QUALITY ACCREDITA- trative and judicial review under that sec- TION REQUIREMENTS FOR PRO- tion in the same manner as the amount of ‘‘(B) external review organizations that VIDERS CONTRACTING WITH MEDI- payment under section 1886(d) of such Act is consider and resolve external appeals from CARE ADVANTAGE PLANS AND subject to review under such section. such plans and issuers. STATE MEDICAID PROGRAMS. ‘‘(2) CONTENT.—The database shall include (a) MEDICARE ADVANTAGE.—Section ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— information on the nature, timing, final dis- 1854(a)(6)(B)(iii) of the Social Security Act There are authorized to be appropriated to posal, and other relevant details (as deter- (42 U.S.C. 1395w–24(a)(6)(B)(iii)) is amended— carry out this section, $12,000,000 for fiscal mined by the Secretary) of claims, appeals, (1) by striking ‘‘In order to’’ and inserting year 2010, and such sums as may be necessary reviews, and requests for or denials of treat- the following: for each of fiscal years 2011 through 2014. ment by the entities described in paragraph ‘‘(aa) IN GENERAL.—In order to’’; and ‘‘(f) DEFINITIONS.—In this section: (1). The Secretary may limit the content of (2) by adding at the end the following: ‘‘(1) APPROVED GRADUATE MEDICAL RESI- the database to those claims that are mone- ‘‘(bb) QUALITY ASSURANCE.—An MA organi- DENCY TRAINING PROGRAM.—The term ‘ap- tarily significant, as determined by the Sec- zation shall not prohibit a particular hos- proved graduate medical residency training retary. pital, physician or other entity within a cat- program’ has the meaning given the term ‘‘(3) COLLECTION OF DATA.—The Secretary egory of healthcare providers from eligi- ‘approved medical residency training pro- shall have the authority to collect and audit bility to contract with the MA organization gram’ in section 1886(h)(5)(A) of the Social data from entities described in paragraph (1) because of a separate policy of the MA orga- Security Act. necessary to implement the database, except nization that does not recognize an approved ‘‘(2) DIRECT GRADUATE MEDICAL EDUCATION that, in the case of such plans and issuers nationally recognized accreditation organi- COSTS.—The term ‘direct graduate medical subject to the Employee Retirement Income zation with the appropriate ‘deeming author- education costs’ has the meaning given such Security Act of 1974, such data shall be col- ity’ from the Secretary.’’. term in section 1886(h)(5)(C) of the Social Se- lected by the Secretary of Labor for use by (b) STATE MEDICAID PLAN REQUIREMENT.— curity Act. the Secretary. At the discretion of the Sec- Section 1902(a)(23) of the Social Security Act ‘‘(3) WOMEN’S HOSPITAL.—The term ‘wom- retary, such data collection authority may (42 U.S.C. 1396a(a)(23)) is amended by insert- en’s hospital’ means a hospital— be delegated to State insurance regulators. ing ‘‘and (C) the State plan and a primary

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00075 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.052 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12722 CONGRESSIONAL RECORD — SENATE December 8, 2009 care case-management system (described in spect to the loans outstanding at any time failure to provide, any medical service to a section 1915(b)(1)), a medicaid managed care with respect to which guarantees have been medically underserved or indigent individual organization, or a similar entity shall not issued, or which have been directly made, while engaging in the provision of pro bono prohibit a particular hospital, physician or under subsection (a) may not exceed medical services. other entity within a category of healthcare $50,000,000 per year. (b) REQUIREMENTS.—Subsection (a) shall providers from being qualified to perform a ‘‘(2) TOTAL AMOUNTS.—Subject to para- not apply— service or services because of a separate pol- graph (1), the total of the principal amount (1) to any act or omission by a health care icy of the State plan, system, organization, of all loans directly made or guaranteed professional that is outside the scope of the or entity that does not recognize an ap- under subsection (a) may not exceed services for which such professional is proved nationally recognized accreditation $400,000,000 per year. deemed to be licensed or certified to provide, organization with the appropriate ‘deeming ‘‘(d) CAPITAL ASSESSMENT AND PLANNING unless such act or omission can reasonably authority’ from the Secretary’’ after ‘‘sub- GRANTS.— be determined to be necessary to prevent se- section (g) and in section 1915’’. ‘‘(1) NONREPAYABLE GRANTS.—Subject to rious bodily harm or preserve the life of the (c) EFFECTIVE DATE.—The amendments paragraph (2), the Secretary may make a individual being treated; made by this section take effect on the date grant to a rural entity, in an amount not to (2) if the services on which the medical of enactment of this Act and, in the case of exceed $50,000, for purposes of capital assess- malpractice claim is based did not arise out MA organizations under part C of title XVIII ment and business planning. of the rendering of pro bono care for a medi- of the Social Security Act, apply to plan ‘‘(2) LIMITATION.—The cumulative total of cally underserved or indigent individual; or years beginning after that date. grants awarded under this subsection may (3) to an act or omission by a health care not exceed $2,500,000 per year. professional that constitutes willful or SA 3034. Mr. TESTER submitted an ‘‘(e) TERMINATION OF AUTHORITY.—The Sec- criminal misconduct, gross negligence, reck- amendment intended to be proposed to retary may not directly make or guarantee less misconduct, or a conscious, flagrant in- amendment SA 2786 proposed by Mr. any loan under subsection (a) or make a difference to the rights or safety of the indi- REID (for himself, Mr. BAUCUS, Mr. grant under subsection (d) after September vidual harmed by such professional. 30, 2013.’’. (c) DEFINITION.—In this section— DODD, and Mr. HARKIN) to the bill H.R. (b) RURAL ENTITY DEFINED.—Section 1624 of (1) the term ‘‘medically underserved indi- 3590, to amend the Internal Revenue the Public Health Service Act (42 U.S.C. vidual’’ means an individual who does not Code of 1986 to modify the first-time 300s–3) is amended by adding at the end the have health care coverage under a group homebuyers credit in the case of mem- following: health plan, health insurance coverage, or bers of the Armed Forces and certain ‘‘(15)(A) The term ‘rural entity’ includes— any other health care coverage program; and other Federal employees, and for other ‘‘(i) a rural health clinic, as defined in sec- (2) the term ‘‘indigent individual’’ means purposes; which was ordered to lie on tion 1861(aa)(2) of the Social Security Act; and individual who is unable to pay for the the table; as follows: ‘‘(ii) any medical facility with at least 1 health care services that are provided to the bed, but not more than 49 beds, that is lo- individual. On page 828, between lines 3 and 4, insert cated in— the following: ‘‘(I) a county that is not part of a metro- SA 3036. Mr. ENSIGN submitted an SEC. 3130. CAPITAL INFRASTRUCTURE REVOLV- politan statistical area; or amendment intended to be proposed to ING LOAN PROGRAM FOR RURAL EN- ‘‘(II) a rural census tract of a metropolitan TITIES. amendment SA 2786 proposed by Mr. statistical area (as determined under the REID (for himself, Mr. BAUCUS, Mr. (a) IN GENERAL.—The Public Health Serv- most recent modification of the Goldsmith DODD, and Mr. HARKIN) to the bill H.R. ice Act (42 U.S.C. 201 et seq.) is amended by Modification, originally published in the inserting after section 1602 the following: Federal Register on February 27, 1992 (57 3590, to amend the Internal Revenue ‘‘SEC. 1603. CAPITAL INFRASTRUCTURE REVOLV- Fed. Reg. 6725)); and Code of 1986 to modify the first-time ING LOAN PROGRAM FOR RURAL EN- ‘‘(iii) a hospital that is classified as a crit- homebuyers credit in the case of mem- TITIES. ical access hospital or a rural hospital with bers of the Armed Forces and certain ‘‘(a) AUTHORITY TO MAKE AND GUARANTEE fewer than 1,500 discharges per year. other Federal employees, and for other LOANS.— ‘‘(B) For purposes of subparagraph (A), the ‘‘(1) AUTHORITY TO MAKE LOANS.—The Sec- purposes; which was ordered to lie on fact that a clinic, facility, or hospital has retary may make loans from the fund estab- the table; as follows: been geographically reclassified under the lished under section 1602(d) to any rural enti- At the appropriate place, insert the fol- Medicare program under title XVIII of the ty for projects for capital improvements, in- lowing: Social Security Act shall not preclude a hos- cluding— pital from being considered a rural entity SEC. ll. DISASTER VOLUNTEER HEALTH CARE ‘‘(A) the acquisition of software and hard- PROFESSIONAL PROTECTION. under clause (i) or (ii) of subparagraph (A).’’. ware necessary to implement electronic (a) LIMITATION ON LIABILITY.—Notwith- (c) CONFORMING AMENDMENTS.—Section standing any other provision of law, with re- health records as required under section 3011; 1602 of the Public Health Service Act (42 spect to an area in which a major disaster ‘‘(B) the acquisition of land necessary for U.S.C. 300q–2) is amended— has been declared in accordance with the the capital improvements; (1) in subsection (b)(2)(D), by inserting ‘‘or Robert T. Stafford Disaster Relief and Emer- ‘‘(C) the renovation or modernization of 1603(a)(2)(B)’’ after ‘‘1601(a)(2)(B)’’; and gency Assistance Act (42 U.S.C. 5721 et seq.), any building; (2) in subsection (d)— a health care professional who is providing ‘‘(D) the acquisition or repair of fixed or (A) in paragraph (1)(C), by striking ‘‘sec- health or dental services on a voluntary major movable equipment; and tion 1601(a)(2)(B)’’ and inserting ‘‘sections basis in such area, or to a non-resident vic- ‘‘(E) such other project expenses as the 1601(a)(2)(B) and 1603(a)(2)(B)’’; and tim of the disaster involved, shall not be lia- Secretary determines appropriate. (B) in paragraph (2)(A), by inserting ‘‘or UTHORITY TO GUARANTEE LOANS ble for damages in a medical malpractice ‘‘(2) A .— 1603(a)(2)(B)’’ after ‘‘1601(a)(2)(B)’’. ‘‘(A) IN GENERAL.—The Secretary may lawsuit for a cause of action arising out of guarantee the payment of principal and in- SA 3035. Mr. ENSIGN submitted an an act or omission of such professional in terest for loans made to rural entities for amendment intended to be proposed to providing the services involved. projects for any capital improvement de- (b) REQUIREMENTS.—Subsection (a) shall scribed in paragraph (1) to any non-Federal amendment SA 2786 proposed by Mr. not apply— lender. REID (for himself, Mr. BAUCUS, Mr. (1) to any act or omission by a health care ‘‘(B) INTEREST SUBSIDIES.—In the case of a DODD, and Mr. HARKIN) to the bill H.R. professional that is outside the scope of the guarantee of any loan made to a rural entity 3590, to amend the Internal Revenue services for which such professional is under subparagraph (A), the Secretary may Code of 1986 to modify the first-time deemed to be licensed or certified to provide, pay to the holder of such loan, for and on be- homebuyers credit in the case of mem- unless such act or omission can reasonably half of the project for which the loan was bers of the Armed Forces and certain be determined to be necessary to prevent se- rious bodily harm or preserve the life of the made, amounts sufficient to reduce (by not other Federal employees, and for other more than 3 percent) the net effective inter- individual being treated; est rate otherwise payable on such loan. purposes; which was ordered to lie on (2) if the services on which the medical ‘‘(b) AMOUNT OF LOAN.—The principal the table; as follows: malpractice claim is based did not arise out amount of a loan directly made or guaran- At the appropriate place, insert the fol- of the rendering of voluntary care in the dis- teed under subsection (a) for a project for lowing: aster area or were provided to an individual capital improvement may not exceed SEC. ll. HEALTH CARE SAFETY NET ENHANCE- who was not a victim of the disaster; or $2,500,000. MENT. (3) to an act or omission by a health care ‘‘(c) FUNDING LIMITATIONS.— (a) LIMITATION ON LIABILITY.—Notwith- professional that constitutes willful or ‘‘(1) GOVERNMENT CREDIT SUBSIDY EXPO- standing any other provision of law, a health criminal misconduct, gross negligence, reck- SURE.—The total of the Government credit care professional shall not be liable in any less misconduct, or a conscious, flagrant in- subsidy exposure under the Federal Credit medical malpractice lawsuit for a cause of difference to the rights or safety of the indi- Reform Act of 1990 scoring protocol with re- action arising out of the provision of, or the vidual harmed by such professional.

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(c) LIMITATION ON VICARIOUS LIABILITY.— years’’ and after ‘‘with respect to fiscal SEC. 2008. AUTOMATIC INCREASE IN THE FED- An individual or a health care institution years’’; ERAL MEDICAL ASSISTANCE PER- that deploys or uses a volunteer described in (5) in subsection (g)(1), by striking ‘‘Sep- CENTAGE DURING PERIODS OF NA- TIONAL ECONOMIC DOWNTURN. subsection (a) shall not be vicariously liable tember 30, 2011’’ and inserting ‘‘December 31, (a) NATIONAL ECONOMIC DOWNTURN ASSIST- in a medical malpractice lawsuit with re- 2011’’; and ANCE FMAP.— spect to services described in such subsection (6) in subsection (h)(3), by striking ‘‘De- (1) IN GENERAL.—Section 1905 of the Social unless the volunteer involved is determined cember 31, 2010’’ and inserting ‘‘June 30, Security Act (42 U.S.C. 1396d), as amended by to be liable. 2011’’. sections 2001(a)(3), 2006, 4106(b), and 4107, is (d) RECIPROCITY WITH RESPECT TO LICENSED amended— OR CERTIFIED HEALTH CARE PROFESSIONALS.— A health care professional that is licensed or SA 3039. Mr. ROCKEFELLER sub- (A) in subsection (b), in the first sentence— certified in a State and who is providing mitted an amendment intended to be (i) by striking ‘‘and (5)’’ and inserting health or dental services on a voluntary proposed to amendment SA 2786 pro- ‘‘(5)’’; and (ii) by inserting ‘‘and (6) with respect to basis in an area in which a major disaster posed by Mr. REID (for himself, Mr. has been declared in accordance with the each fiscal year quarter other than the first BAUCUS, Mr. DODD, and Mr. HARKIN) to Robert T. Stafford Disaster Relief and Emer- quarter of a national economic downturn as- gency Assistance Act (42 U.S.C. 5721 et seq.), the bill H.R. 3590, to amend the Inter- sistance period described in subsection shall be deemed to be licensed or certified by nal Revenue Code of 1986 to modify the (cc)(1), the Federal medical assistance per- the State in which such area is located with first-time homebuyers credit in the centage for any State described in subsection respect to such health or dental services, case of members of the Armed Forces (cc)(2) shall be equal to the national eco- subject to any additional conditions, limita- and certain other Federal employees, nomic downturn assistance FMAP deter- tions, or expansions that may be applied by and for other purposes; which was or- mined for the State for the quarter under subsection (cc)(3)’’ before the period; and the chief executive of the State in which dered to lie on the table; as follows: such area is located. (B) by adding at the end the following: On page 436, between lines 14 and 15, insert ‘‘(cc) NATIONAL ECONOMIC DOWNTURN AS- SA 3037. Mr. JOHNSON (for himself, the following: SISTANCE FMAP.—For purposes of clause (6) Mr. FRANKEN, Mr. BURRIS, and Mr. of the first sentence of subsection (b): SEC. 2008. MANAGED CARE ORGANIZATIONS. ‘‘(1) NATIONAL ECONOMIC DOWNTURN ASSIST- WARNER) submitted an amendment in- ANCE PERIOD.—A national economic down- tended to be proposed to amendment (a) MINIMUM MEDICAL LOSS RATIO.— (1) MEDICAID.—Section 1903(m)(2)(A) of the turn assistance period described in this para- SA 2786 proposed by Mr. REID (for him- Social Security Act (42 U.S.C. 1396b(m)(2)(A)) graph— self, Mr. BAUCUS, Mr. DODD, and Mr. is amended— ‘‘(A) begins with the first fiscal year quar- HARKIN) to the bill H.R. 3590, to amend (A) by striking ‘‘and’’ at the end of clause ter for which the Secretary determines that the Internal Revenue Code of 1986 to (xi); for at least 23 States, the rolling average un- modify the first-time homebuyers cred- (B) by striking the period at the end of employment rate for that quarter has in- it in the case of members of the Armed clause (xii) and inserting ‘‘; and’’; and creased by at least 10 percent over the cor- Forces and certain other Federal em- (C) by adding at the end the following new responding quarter for the most recent pre- ployees, and for other purposes; which clause: ceding 12-month period for which data are ‘‘(xiii) such contract has a medical loss available (in this subsection referred to as was ordered to lie on the table; as fol- the ‘trigger quarter’); and lows: ratio, as determined in accordance with a methodology specified by the Secretary, that ‘‘(B) ends with the first succeeding fiscal On page 731, between lines 16 and 17, insert is a percentage (not less than 85 percent) year quarter for which the Secretary deter- the following: specified by the Secretary.’’. mines that less than 23 States have a rolling ‘‘(xix) Utilizing a diverse network of pro- (2) CHIP.—Section 2107(e)(1) of such Act (42 average unemployment rate for that quarter viders of services and suppliers to improve U.S.C. 1397gg(e)(1)), as amended by sections with an increase of at least 10 percent over care coordination for applicable individuals 2101(d)(2), 2101(e), and 6401(c), is amended— the corresponding quarter for the most re- described in subsection (a)(4)(A)(i) with 2 or (A) by redesignating subparagraphs (H) cent preceding 12-month period for which more chronic conditions and a history of through (O) as subparagraphs (I) through (P); data are available. prior-year hospitalization through interven- and ‘‘(2) ELIGIBLE STATE.—A State described in tions developed under the Medicare Coordi- (B) by inserting after subparagraph (G) the this paragraph is a State for which the Sec- nated Care Demonstration Project under sec- following new subparagraph: retary determines that the rolling average tion 4016 of the Balanced Budget Act of 1997 ‘‘(H) Section 1903(m)(2)(A)(xiv) (relating to unemployment rate for the State for any (42 U.S.C. 1395b–1 note). application of minimum loss ratios), with re- quarter occurring during a national eco- nomic downturn assistance period described Mr. ROCKEFELLER sub- spect to comparable contracts under this SA 3038. title.’’. in paragraph (1) has increased over the cor- mitted an amendment intended to be (3) EFFECTIVE DATE.—The amendments responding quarter for the most recent pre- proposed to amendment SA 2786 pro- made by this subsection shall apply to con- ceding 12-month period for which data are posed by Mr. REID (for himself, Mr. tracts entered into or renewed on or after available. BAUCUS, Mr. DODD, and Mr. HARKIN) to July 1, 2010. ‘‘(3) DETERMINATION OF NATIONAL ECONOMIC DOWNTURN ASSISTANCE FMAP.— the bill H.R. 3590, to amend the Inter- (b) PATIENT ENCOUNTER DATA.— ‘‘(A) IN GENERAL.—The national economic nal Revenue Code of 1986 to modify the (1) IN GENERAL.—Section 1903(m)(2)(A)(xi) downturn assistance FMAP for a fiscal year first-time homebuyers credit in the of the Social Security Act (42 U.S.C. quarter determined with respect to a State 1396b(m)(2)(A)(xi)) is amended by inserting case of members of the Armed Forces under this paragraph is equal to the Federal ‘‘and for the provision of such data to the and certain other Federal employees, medical assistance percentage for the State State at a frequency and level of detail to be and for other purposes; which was or- for that quarter increased by the number of specified by the Secretary’’ after ‘‘patients’’. dered to lie on the table; as follows: percentage points determined by— (2) EFFECTIVE DATE.—The amendment ‘‘(i) dividing— On page 436, between lines 14 and 15, insert made by paragraph (1) shall apply with re- ‘‘(I) the Medicaid additional unemployed the following: spect to contract years beginning on or after increased cost amount determined under SEC. 2008. EXTENSION OF ARRA INCREASE IN January 1, 2010. FMAP. subparagraph (B) for the quarter; by Section 5001 of the American Recovery and ‘‘(II) the State’s total Medicaid quarterly Reinvestment Act of 2009 (Public Law 111-5) SA 3040. Mr. ROCKEFELLER sub- spending amount determined under subpara- is amended— mitted an amendment intended to be graph (C) for the quarter; and (1) in subsection (a)(3), by striking ‘‘first proposed to amendment SA 2786 pro- ‘‘(ii) multiplying the quotient determined calendar quarter’’ and inserting ‘‘first 3 cal- under clause (i) by 100. posed by Mr. REID (for himself, Mr. endar quarters’’; ‘‘(B) MEDICAID ADDITIONAL UNEMPLOYED IN- BAUCUS, Mr. DODD, and Mr. HARKIN) to (2) in subsection (b)(2), by inserting before CREASED COST AMOUNT.—For purposes of sub- the period at the end the following: ‘‘, and the bill H.R. 3590, to amend the Inter- paragraph (A)(i)(I), the Medicaid additional such paragraph shall not apply to calendar nal Revenue Code of 1986 to modify the unemployed increased cost amount deter- quarters beginning on or after October 1, first-time homebuyers credit in the mined under this subparagraph with respect 2010’’; case of members of the Armed Forces to a State and a quarter is the product of the (3) in subsection (c)(4)(C)(ii), by striking and certain other Federal employees, following: ‘‘December 2009’’ and ‘‘January 2010’’ and in- and for other purposes; which was or- ‘‘(i) STATE INCREASE IN ROLLING AVERAGE serting ‘‘June 2010’’ and ‘‘July 2010’’, respec- dered to lie on the table; as follows: NUMBER OF UNEMPLOYED INDIVIDUALS FROM tively; THE BASE QUARTER OF UNEMPLOYMENT.— (4) in subsection (d), by inserting ‘‘ending On page 436, between lines 14 and 15, insert ‘‘(I) IN GENERAL.—The amount determined before October 1, 2010’’ after ‘‘entire fiscal the following: by subtracting the rolling average number of

VerDate Nov 24 2008 05:44 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00077 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.045 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12724 CONGRESSIONAL RECORD — SENATE December 8, 2009 unemployed individuals in the State for the available data from the Bureau of Labor Sta- quired by the State under State law in effect base unemployment quarter for the State de- tistics Local Area Unemployment Statistics on the first day of the fiscal year quarter oc- termined under subclause (II) from the roll- for each State referred to in paragraph (5), curring immediately prior to the trigger ing average number of unemployed individ- the most recently available— quarter for the period.’’. uals in the State for the quarter. ‘‘(A) data from the Bureau of the Census (2) EFFECTIVE DATE; NO RETROACTIVE APPLI- ‘‘(II) BASE UNEMPLOYMENT QUARTER DE- with respect to the number of nonelderly CATION.—The amendments made by para- FINED.— adults and children who reside in a State de- graph (1) take effect on January 1, 2012. In no ‘‘(aa) IN GENERAL.—For purposes of sub- scribed in paragraph (2) with family income event may a State receive a payment on the clause (I), except as provided in item (bb), below the poverty line (as defined in section basis of the national economic downturn as- the base quarter for a State is the quarter 2110(c)(5)) applicable to a family of the size sistance Federal medical assistance percent- with the lowest rolling average number of involved (or, if the Secretary determines it age determined for the State under section unemployed individuals in the State in the appropriate, a multiyear average of such 1905(cc)(3) of the Social Security Act for 12-month period preceding the trigger quar- data); amounts expended by the State prior to Jan- ter for a national economic downturn assist- ‘‘(B) data reported to the Secretary by a uary 1, 2012. ance period described in paragraph (1). State described in paragraph (2) with respect (b) GAO STUDY AND REPORT.— ‘‘(bb) EXCEPTION.—If the rolling average to expenditures for medical assistance under (1) STUDY.—The Comptroller General of the number of unemployed individuals in a State the State plan under this title for non- United States shall analyze the previous pe- for a quarter occurring during a national disabled, nonelderly adults and children; and riods of national economic downturn, includ- economic downturn assistance period de- ‘‘(C) econometric studies of the responsive- ing the most recent such period in effect as scribed in paragraph (1) is less than the roll- ness of Medicaid enrollments and spending to of the date of enactment of this Act, and the ing average number of unemployed individ- changes in rolling average unemployment past and projected effects of temporary in- uals in the State for the base quarter deter- rates and other factors, including State creases in the Federal medical assistance mined under item (aa), that quarter shall be spending on certain Medicaid populations. percentage under the Medicaid program with treated as the base quarter for the State for ‘‘(5) DEFINITION OF ‘ROLLING AVERAGE NUM- respect to such periods. such national economic downturn assistance BER OF UNEMPLOYED INDIVIDUALS’, ‘ROLLING (2) REPORT.—Not later than April 1, 2011, period. AVERAGE UNEMPLOYMENT RATE’.—In this sub- the Comptroller General of the United States ‘‘(ii) NATIONAL AVERAGE AMOUNT OF ADDI- section, the term— shall submit a report to Congress on the re- TIONAL FEDERAL MEDICAID SPENDING PER ADDI- ‘‘(A) ‘rolling average number of unem- sults of the analysis conducted under para- TIONAL UNEMPLOYED INDIVIDUAL.—In the case ployed individuals’ means, with respect to a graph (1). Such report shall include such rec- of— calendar quarter and a State, the average of ommendations as the Comptroller General ‘‘(I) a calendar quarter occurring in fiscal the 12 most recent months of seasonally ad- determines appropriate for modifying the na- year 2012, $350; and justed unemployment data for each State; tional economic downturn assistance FMAP ‘‘(II) a calendar quarter occurring in any ‘‘(B) ‘rolling average unemployment rate’ established under section 1905(cc) of the So- succeeding fiscal year, the amount applica- means, with respect to a calendar quarter cial Security Act (as added by subsection (a)) ble under this clause for calendar quarters and a State, the average of the 12 most re- occurring during the preceding fiscal year, to improve the effectiveness of the applica- cent monthly unemployment rates for the increased by the annual percentage increase tion of such percentage in addressing the State; and in the medical care component of the con- needs of States during periods of national ‘‘(C) ‘monthly unemployment rate’ means, sumer price index for all urban consumers economic downturn, including recommenda- with respect to a State, the quotient of— (U.S. city average), as rounded up in an ap- tions for— ‘‘(i) the monthly seasonally adjusted num- propriate manner. (A) improvements to the factors that begin ber of unemployed individuals for the State; ‘‘(iii) STATE NONDISABLED, NONELDERLY and end the application of such percentage; divided by ADULTS AND CHILDREN MEDICAID SPENDING (B) how the determination of such percent- ‘‘(ii) the monthly seasonally adjusted num- INDEX.— age could be adjusted to address State and ber of the labor force for the State, ‘‘(I) IN GENERAL.—With respect to a State, regional economic variations during such pe- the quotient (not to exceed 1.00) of— using the most recent data available from riods; and ‘‘(aa) the State expenditure per person in the Bureau of Labor Statistics Local Area (C) how the determination of such percent- poverty amount determined under subclause Unemployment Statistics for each State, age could be adjusted to be more responsive (II); divided by— ‘‘(6) INCREASE IN CAP ON PAYMENTS TO TER- to actual Medicaid costs incurred by States ‘‘(bb) the National expenditure per person RITORIES.—With respect to any fiscal year during such periods, as well as to the effects in poverty amount determined under sub- quarter for which the national economic of any other specific economic indicators clause (III). downturn assistance Federal medical assist- that the Comptroller General determines ap- ‘‘(II) STATE EXPENDITURE PER PERSON IN ance percentage applies to Puerto Rico, the propriate. POVERTY AMOUNT.—For purposes of subclause Virgin Islands, Guam, the Northern Mariana (I)(aa), the State expenditure per person in Islands, or American Samoa, the amounts SA 3041. Mr. ROCKEFELLER sub- poverty amount is the quotient of— otherwise determined for such common- mitted an amendment intended to be ‘‘(aa) the total amount of annual expendi- wealth or territory under subsections (f) and proposed to amendment SA 2786 pro- tures by the State for providing medical as- (g) of section 1108 shall be increased by such sistance under the State plan to nondisabled, percentage of such amounts as the Secretary posed by Mr. REID (for himself, Mr. nonelderly adults and children; divided by determines is equal to twice the average in- BAUCUS, Mr. DODD, and Mr. HARKIN) to ‘‘(bb) the total number of nonelderly adults crease in the national economic downturn the bill H.R. 3590, to amend the Inter- and children in poverty who reside in the assistance FMAP determined for all States nal Revenue Code of 1986 to modify the State, as determined under paragraph (4)(A). described in paragraph (2) for the quarter. first-time homebuyers credit in the ‘‘(III) NATIONAL EXPENDITURE PER PERSON ‘‘(7) SCOPE OF APPLICATION.—The national case of members of the Armed Forces IN POVERTY AMOUNT.—For purposes of sub- economic downturn assistance FMAP shall and certain other Federal employees, clause (I)(bb), the National expenditure per only apply for purposes of payments under and for other purposes; which was or- person in poverty amount is the quotient section 1903 for a quarter and shall not apply of— with respect to— dered to lie on the table; as follows: ‘‘(aa) the sum of the total amounts deter- ‘‘(A) disproportionate share hospital pay- On page 397, beginning on line 2, strike mined under subclause (II)(aa) for all States; ments described in section 1923; ‘‘under’’ and all that follows through line 6, divided by ‘‘(B) payments under title IV or XXI; or and insert ‘‘not pregnant and are’’ ‘‘(bb) the sum of the total amounts deter- ‘‘(C) any payments under this title that are mined under subclause (II)(bb) for all States. based on the enhanced FMAP described in SA 3042. Mr. ROCKEFELLER sub- ‘‘(C) STATE’S TOTAL MEDICAID QUARTERLY section 2105(b). mitted an amendment intended to be SPENDING AMOUNT.—For purposes of subpara- ‘‘(8) ADDITIONAL REQUIREMENT FOR CERTAIN proposed to amendment SA 2786 pro- graph (A)(i)(II), the State’s total Medicaid STATES.—In the case of a State described in quarterly spending amount determined paragraph (2) that requires political subdivi- posed by Mr. REID (for himself, Mr. under this subparagraph with respect to a sions within the State to contribute toward BAUCUS, Mr. DODD, and Mr. HARKIN) to State and a quarter is the amount equal to— the non-Federal share of expenditures re- the bill H.R. 3590, to amend the Inter- ‘‘(i) the total amount of expenditures by quired under section 1902(a)(2), the State nal Revenue Code of 1986 to modify the the State for providing medical assistance shall not require that such political subdivi- first-time homebuyers credit in the under the State plan to all individuals en- sions pay for any fiscal year quarters occur- case of members of the Armed Forces rolled in the plan for the most recent fiscal ring during a national economic downturn and certain other Federal employees, year for which data is available; divided by assistance period a greater percentage of the and for other purposes; which was or- ‘‘(ii) 4. non-Federal share of such expenditures, or a ‘‘(4) DATA.—In making the determinations greater percentage of the non-Federal share dered to lie on the table; as follows: required under this subsection, the Secretary of payments under section 1923, than the re- On page 553, between lines 14 and 15, insert shall use, in addition to the most recent spective percentage that would have been re- the following:

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00078 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.059 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12725 SEC. 2708. EVALUATION OF STATE COMPLIANCE Medicare program and the month of the ini- SEC. l. REQUIREMENTS FOR MEDICAID PRO- WITH PROVISION OF COMMUNITY- tial Medicare program eligibility for such VIDERS TO ACCEPT IN-NETWORK BASED SERVICES TO INDIVIDUALS cases. PAYMENT RATES FOR SERVICES WITH DISABILITIES. PROVIDED TO MEDICAID MANAGED (B) The applicable non-Federal share of ex- Not later than December 31, 2010, and an- CARE ENROLLEES. penditures made by a State under the Med- nually thereafter, the Inspector General of (a) IN GENERAL.—Section 1932(b) of the So- icaid program during the time period for the Department of Justice shall prepare and cial Security Act (42 U.S.C. 1396u–2(b)) is SDW cases. submit a report to Congress that evaluates amended by adding at the end the following (C) Such other factors as the Secretary and the adequacy of efforts by States to provide ‘‘(9) ASSURING ACCESS TO SERVICES FUR- the Commissioner, in consultation with the appropriate home and community-based NISHED BY NON-CONTRACT PROVIDERS.—Any States, determine appropriate. services to individuals with disabilities in provider of items or services for which med- (2) CONDITIONS FOR PAYMENTS.—A State accordance with the requirements under ical assistance is provided under the State shall not receive a payment under this sec- Olmstead v. L.C., 527 U.S. 581 (1999). plan or under a waiver of the plan that does tion unless the State— not have in effect a contract with a Medicaid SA 3043. Mr. ROCKEFELLER sub- (A) waives the right to file a civil action managed care entity that establishes pay- mitted an amendment intended to be (or to be a party to any action) in any Fed- ment amounts for items or services fur- eral or State court in which the relief sought proposed to amendment SA 2786 pro- nished to a beneficiary enrolled in the enti- includes a payment from the United States ty’s Medicaid managed care plan shall accept posed by Mr. REID (for himself, Mr. to the State related to the Medicare liability as payment in full no more than the BAUCUS, Mr. DODD, and Mr. HARKIN) to under title XVIII of the Social Security Act amounts (less any payments for indirect the bill H.R. 3590, to amend the Inter- (42 U.S.C. 1395 et seq.) as a result of the Spe- costs of medical education and direct costs nal Revenue Code of 1986 to modify the cial Disability Workload project; and of graduate medical education) that it could first-time homebuyers credit in the (B) releases the United States from any collect if the beneficiary received medical case of members of the Armed Forces further claims for reimbursement of State assistance under this title other than and certain other Federal employees, expenditures as a result of the Special Dis- through enrollment in such an entity. In a and for other purposes; which was or- ability Workload project (other than reim- State where rates paid to hospitals under the bursements being made under agreements in dered to lie on the table; as follows: State plan are negotiated by contract and effect on the date of enactment of this Act as not publicly released, the payment amount Beginning on page 397, strike line 15 and a result of such project, including payments applicable under this subparagraph shall be all that follows through page 398, line 25. made pursuant to agreements entered into the average contract rate that would apply under section 1616 of the Social Security Act under the State plan for general acute care SA 3044. Mr. ROCKEFELLER sub- or section 211(1)(1)(A) of Public Law 93–66). hospitals or the average contract rate that mitted an amendment intended to be (3) NO INDIVIDUAL STATE CLAIMS DATA RE- would apply under such plan for tertiary hos- proposed by him to the bill H.R. 3590, QUIRED.—No State shall be required to sub- pitals.’’. to amend the Internal Revenue Code of mit individual claims evidencing payment (b) EFFECTIVE DATE.—The amendment 1986 to modify the first-time home- under the Medicaid program as a condition made by subsection (a) takes effect on Janu- buyers credit in the case of members of for receiving a payment under this section. ary 1, 2010. the Armed Forces and certain other (4) INELIGIBLE STATES.—No State that is a Federal employees, and for other pur- party to a civil action in any Federal or SA 3045. Mr. KERRY (for himself, Mr. State court in which the relief sought in- poses; which was ordered to lie on the KIRK, Mr. SCHUMER, Mrs. GILLIBRAND, cludes a payment from the United States to Mr. LEAHY, Mr. SANDERS, Mr. CARPER, table; as follows: the State related to the Medicare liability and Mr. KAUFMAN) submitted an At the appropriate place, insert the fol- under title XVIII of the Social Security Act lowing: (42 U.S.C. 1395 et seq.) as a result of the Spe- amendment intended to be proposed to amendment SA 2786 proposed by Mr. SEC. l. PAYMENT OF MEDICARE LIABILITY TO cial Disability Workload project shall be eli- STATES AS A RESULT OF THE SPE- gible to receive a payment under this section REID (for himself, Mr. BAUCUS, Mr. CIAL DISABILITY WORKLOAD while such an action is pending or if such an DODD, and Mr. HARKIN) to the bill H.R. PROJECT. action is resolved in favor of the State. 3590, to amend the Internal Revenue (a) IN GENERAL.—The Secretary, in con- (d) DEFINITIONS.—In this section: Code of 1986 to modify the first-time sultation with the Commissioner, shall work homebuyers credit in the case of mem- with each State to reach an agreement, not (1) COMMISSIONER.—The term ‘‘Commis- later than 6 months after the date of enact- sioner’’ means the Commissioner of Social bers of the Armed Forces and certain ment of this Act, on the amount of a pay- Security. other Federal employees, and for other ment for the State related to the Medicare (2) MEDICAID PROGRAM.—The term ‘‘Med- purposes; which was ordered to lie on program liability as a result of the Special icaid program’’ means the program of med- the table; as follows: ical assistance established under title XIX of Disability Workload project, subject to the Beginning on page 402, strike line 15 and the Social Security Act (42 U.S.C. 1396a et requirements of subsection (c). all that follows through page 403, line 9, and seq.) and includes medical assistance pro- (b) PAYMENTS.— insert the following: vided under any waiver of that program ap- (1) DEADLINE FOR MAKING PAYMENTS.—Not ‘‘(A) NEWLY ELIGIBLE.—The term ‘‘newly proved under section 1115 or 1915 of such Act later than 30 days after reaching an agree- eligible’’ means an individual described in (42 U.S.C. 1315, 1396n) or otherwise. ment with a State under subsection (a), the subclause (VIII) of section 1902(a)(10)(A)(i) (3) MEDICARE PROGRAM.—The term ‘‘Medi- Secretary shall pay the State, from the who, on the date of enactment of the Patient care program’’ means the program estab- amounts appropriated under paragraph (2), Protection and Affordable Care Act, is not the payment agreed to for the State. lished under title XVIII of the Social Secu- eligible under the State plan for full benefits (2) APPROPRIATION.—Out of any money in rity Act (42 U.S.C. 1395 et seq.). or for benchmark coverage described in sec- the Treasury not otherwise appropriated, (4) SECRETARY.—The term ‘‘Secretary’’ tion 1937(b)(1) or benchmark equivalent cov- there is appropriated $4,000,000,000 for fiscal means the Secretary of Health and Human erage described in section 1937(b)(2), or is eli- year 2010 for making payments to States Services. gible but not enrolled (or is on a waiting list) under paragraph (1). (5) SDW CASE.—The term ‘‘SDW case’’ for such benefits or coverage through a waiv- (3) LIMITATIONS.—In no case may the ag- means a case in the Special Disability Work- er under the plan that has a capped or lim- gregate amount of payments made by the load project involving an individual deter- ited enrollment that is full. Secretary to States under paragraph (1) ex- mined by the Commissioner to have been eli- ceed $4,000,000,000. gible for benefits under title II of the Social SA 3046. Mr. KERRY (for himself, Ms. (c) REQUIREMENTS.—The requirements of Security Act (42 U.S.C. 401 et seq.) for a pe- STABENOW, Ms. COLLINS, Ms. SNOWE, this subsection are the following: riod during which such benefits were not pro- YDEN INCOLN OHN (1) FEDERAL DATA USED TO DETERMINE vided to the individual and who was, during Mr. W , Mrs. L , Mr. J - AMOUNT OF PAYMENTS.—The amount of the all or part of such period, enrolled in a State SON, Mr. SPECTER, and Mrs. payment under subsection (a) for each State Medicaid program. GILLIBRAND) submitted an amendment is determined on the basis of the most recent (6) SPECIAL DISABILITY WORKLOAD intended to be proposed to amendment Federal data available, including the use of PROJECT.—The term ‘‘Special Disability SA 2786 proposed by Mr. REID (for him- proxies and reasonable estimates as nec- Workload project’’ means the project de- self, Mr. BAUCUS, Mr. DODD, and Mr. essary, for determining expeditiously the scribed in the 2008 Annual Report of the HARKIN) to the bill H.R. 3590, to amend amount of the payment that shall be made Board of Trustees of the Federal Old-Age and the Internal Revenue Code of 1986 to to each State that enters into an agreement Survivors Insurance and Federal Disability under this section. The payment method- Insurance Trust Funds, H.R. Doc. No. 110–104, modify the first-time homebuyers cred- ology shall consider the following factors: 110th Cong. (2008). it in the case of members of the Armed (A) The number of SDW cases found to (7) STATE.—The term ‘‘State’’ means each Forces and certain other Federal em- have been eligible for benefits under the of the 50 States and the District of Columbia. ployees, and for other purposes; which

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00079 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.057 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12726 CONGRESSIONAL RECORD — SENATE December 8, 2009 was ordered to lie on the table; as fol- (C) An analysis of the feasability of reduc- SEC. 2008. PROTECTION OF MEDICAID WAIVER lows: ing the lag time with respect to data used to AUTHORITY. Beginning on page 983, strike line 11 and determine the average sales price under sec- No provision of this Act or any amendment all that follows through page 984, line 3, and tion 1847A of the Social Security Act (42 made by this Act shall limit or otherwise re- insert the following: U.S.C. 1395w-3a). strict any authority in effect on the date of enactment of this Act which the Secretary of ‘‘(vi) PRODUCTIVITY ADJUSTMENT.—After de- (D) An update to the report entitled ‘‘Anal- termining the home health market basket ysis of Supply, Distribution, Demand, and Health and Human Services may exercise percentage increase under clause (iii), and Access Issues Associated with Immune Glob- under section 1915 or 1115 of the Social Secu- after application of clause (v), the Secretary ulin Intravenous (IGIV)’’, issued in February rity Act or otherwise to encourage States to shall reduce such percentage, for 2015 and 2007 by the Office of the Assistant Secretary develop innovation programs to provide each subsequent year, by the productivity for Planning and Evaluation of the Depart- health insurance to uninsured individuals or adjustment described in section ment of Health and Human Services. to contain health care costs by granting 1886(b)(3)(B)(xi)(II). The application of the (2) FINAL EVALUATION AND REPORT.—Not States budget neutral Medicaid waivers Any preceding sentence may result in the home later than July 1, 2014, the Secretary shall provision of this Act or an amendment of health market basket percentage increase submit to Congress a report that contains a this Act that is contrary to the preceding under clause (iii) being less than 0.0 for a final evaluation of the impact of the dem- sentence is null and void. year, and may result in payment rates under onstration project on access for Medicare the system under this subsection for a year beneficiaries to items and services needed for SA 3050. Mr. BARRASSO submitted being less than such payment rates for the the administration of intravenous immune an amendment intended to be proposed preceding year.’’. globin within the home. to amendment SA 2786 proposed by Mr. (e) OFFSET.— REID (for himself, Mr. BAUCUS, Mr. SA 3047. Mr. KERRY (for himself, Mr. (1) IN GENERAL.—Section 1861(n) of the So- cial Security Act (42 U.S.C. 1395x(n)) is DODD, and Mr. HARKIN) to the bill H.R. WYDEN, Mr. WHITEHOUSE, Mr. REED) 3590, to amend the Internal Revenue submitted an amendment intended to amended by adding at the end the following: ‘‘Such term includes disposable drug deliv- Code of 1986 to modify the first-time be proposed to amendment SA 2786 pro- ery systems, including elastomeric infusion homebuyers credit in the case of mem- posed by Mr. REID (for himself, Mr. pumps, for the treatment of colorectal can- bers of the Armed Forces and certain BAUCUS, Mr. DODD, and Mr. HARKIN) to cer.’’. other Federal employees, and for other the bill H.R. 3590, to amend the Inter- (2) EFFECTIVE DATE.—The amendment purposes; which was ordered to lie on nal Revenue Code of 1986 to modify the made by paragraph (1) shall apply to items first-time homebuyers credit in the furnished on or after the date of enactment the table; as follows: case of members of the Armed Forces of this Act. On page 1998, strike lines 13 through 24. and certain other Federal employees, (f) DEFINITIONS.—In this section: (1) DEMONSTRATION PROJECT.—The term SA 3051. Mr. BARRASSO submitted and for other purposes; which was or- ‘‘demonstration project’’ means the dem- dered to lie on the table; as follows: onstration project conducted under this sec- an amendment intended to be proposed At the appropriate place, insert the fol- tion. to amendment SA 2786 proposed by Mr. lowing: (2) MEDICARE BENEFICIARY.—The term REID (for himself, Mr. BAUCUS, Mr. SEC. ll. MEDICARE PATIENT IVIG ACCESS DEM- ‘‘Medicare beneficiary’’ means an individual DODD, and Mr. HARKIN) to the bill H.R. ONSTRATION PROJECT. who is entitled to, or enrolled for, benefits 3590, to amend the Internal Revenue (a) ESTABLISHMENT.—The Secretary shall under part A of title XVIII of the Social Se- Code of 1986 to modify the first-time establish and implement a demonstration curity Act or enrolled for benefits under part homebuyers credit in the case of mem- project under title XVIII of the Social Secu- B of such title. bers of the Armed Forces and certain rity Act to evaluate the benefits of providing (3) SECRETARY.—The term ‘‘Secretary’’ payment for items and services needed for means the Secretary of Health and Human other Federal employees, and for other the administration, within the homes of Services. purposes; which was ordered to lie on Medicare beneficiaries, of intravenous im- the table; as follows: mune globin for the treatment of primary SA 3048. Mr. BARRASSO submitted On page 816, after line 20, insert the fol- immune deficiency diseases. an amendment intended to be proposed lowing: (b) DURATION AND SCOPE.— to amendment SA 2786 proposed by Mr. (1) DURATION.—Beginning not later than SEC. 3115. RURAL HEALTH CLINIC REIMBURSE- REID (for himself, Mr. BAUCUS, Mr. January 1, 2011, the Secretary shall conduct MENT. the demonstration project for a period of 3 DODD, and Mr. HARKIN) to the bill H.R. Section 1833(f) of the Social Security Act years. 3590, to amend the Internal Revenue (42 U.S.C. 1395l(f)) is amended— (2) SCOPE.—The Secretary shall enroll not Code of 1986 to modify the first-time (1) in paragraph (1), by striking ‘‘, and’’ at greater than 4,000 Medicare beneficiaries who homebuyers credit in the case of mem- the end and inserting a semicolon; have been diagnosed with primary immuno- bers of the Armed Forces and certain (2) in paragraph (2)— deficiency disease for participation in the other Federal employees, and for other (A) by striking ‘‘in a subsequent year’’ and demonstration project. A Medicare bene- purposes; which was ordered to lie on inserting ‘‘after 1988 and before 2010’’; and (B) by striking the period at the end and ficiary may participate in the demonstration the table; as follows: project on a voluntary basis and may termi- inserting a semicolon; and nate participation at any time. On page 172, between lines 11 and 12, insert (3) by adding at the end the following new (c) REIMBURSEMENT.—The Secretary shall the following: paragraphs: establish an hourly rate for payment for (E) REPAYMENT OF FUNDS.—A person that ‘‘(3) in 2010, at $85 per visit; and items and services needed for the adminis- receives Federal funds under a loan or grant ‘‘(4) in a subsequent year, at the limit es- tration of intravenous immune globin based under this section shall be required to reim- tablished under this subsection for the pre- on the low-utilization payment adjustment burse the Federal Government for the full vious year increased by the percentage in- under the prospective payment system for amount received under such loan or grant on crease in the MEI (as defined in section home health services established under sec- terms established by the Secretary, but in no 1842(i)(3)) applicable to primary care services tion 1895 of the Social Security Act (42 event shall such repayment be made later (as defined in section 1842(i)(4)) furnished as U.S.C. 1395fff). than 10 years after the date on which such of the first day of that year.’’. (d) STUDY AND REPORT TO CONGRESS.— loan or grant was made. (1) INTERIM EVALUATION AND REPORT.—Not SA 3052. Mr. BARRASSO submitted later than 24 months after the date of enact- SA 3049. Mr. BARRASSO submitted an amendment intended to be proposed an amendment intended to be proposed ment of this Act, the Secretary shall submit to amendment SA 2786 proposed by Mr. to Congress a report that contains the fol- to amendment SA 2786 proposed by Mr. lowing: REID (for himself, Mr. BAUCUS, Mr. REID (for himself, Mr. BAUCUS, Mr. (A) An interim evaluation of the impact of DODD, and Mr. HARKIN) to the bill H.R. DODD, and Mr. HARKIN) to the bill H.R. the demonstration project on access for 3590, to amend the Internal Revenue 3590, to amend the Internal Revenue Medicare beneficiaries to items and services Code of 1986 to modify the first-time Code of 1986 to modify the first-time needed for the administration of intravenous homebuyers credit in the case of mem- homebuyers credit in the case of mem- immune globin within the home. bers of the Armed Forces and certain bers of the Armed Forces and certain (B) An analysis of the appropriateness of other Federal employees, and for other other Federal employees, and for other implementing a new methodology for pay- purposes; which was ordered to lie on ment for intravenous immune globulins in purposes; which was ordered to lie on all care settings under part B of title XVIII the table; as follows: the table; as follows: of the Social Security Act (42 U.S.C. 1395k et On page 436, between lines 14 and 15, insert On page 1266, between lines 17 and 18, insert seq.). the following: the following:

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00080 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.072 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12727 SEC. 4403. RURAL HEALTH CLINIC AND COMMU- cost of any medical treatment, item, or serv- homebuyers credit in the case of mem- NITY HEALTH CENTER COLLABO- ice described in subsection (b) be considered bers of the Armed Forces and certain RATIVE ACCESS EXPANSION. a factor in any comparative effectiveness re- Section 330 of the Public Health Service other Federal employees, and for other search conducted— purposes; which was ordered to lie on Act (42 U.S.C. 254b), as amended by section (1) by the Federal Government; or 4206, is amended by adding at the end the fol- (2) by any other entity using funding pro- the table; as follows: lowing: vided by the Federal Government. On page 340, strike lines 1 through 14 and ‘‘(t) RULE OF CONSTRUCTION WITH RESPECT (b) MEDICAL TREATMENT, ITEM, OR SERV- insert the following: TO RURAL HEALTH CLINICS.— ICE.—The medical treatments, services, and ‘‘(A) WAIVER OF CRIMINAL AND CIVIL PEN- ‘‘(1) IN GENERAL.—Nothing in this section items described in this subsection are health ALTIES AND INTEREST.—In the case of any shall be construed to prevent a community care interventions, protocols for treatment, failure by a taxpayer to timely pay any pen- health center from contracting with a feder- care management, and delivery, procedures, alty imposed by this section— ally certified rural health clinic (as defined medical devices, diagnostic tools, pharma- ‘‘(i) such taxpayer shall not be subject to by section 1861(aa)(2) of the Social Security ceuticals (including drugs and biologicals), any criminal prosecution or penalty with re- Act) for the delivery of primary health care integrative health practices, and any other spect to such failure, and services that are available at the rural strategies or items being used in the treat- ‘‘(ii) no penalty, addition to tax, or inter- health clinic to individuals who would other- ment, management, and diagnosis of, or pre- est shall be imposed with respect to such wise be eligible for free or reduced cost care vention of illness or injury in, individuals. failure or such penalty. if that individual were able to obtain that (c) INCLUSION.—The comparative effective- ‘‘(B) LIMITED COLLECTION ACTIONS PER- care at the community health center. Such ness research described under subsection (a) MITTED.—In the case of the assessment of services may be limited in scope to those pri- includes any such research conducted or any penalty imposed by this section, the mary health care services available in that funded by— Secretary shall not take any action with re- rural health clinic. (1) the Patient-Centered Outcomes Re- spect to the collection of such penalty other ‘‘(2) ASSURANCES.—In order for a rural search Institute under section 1181 of the So- than— health clinic to receive funds under this sec- cial Security Act (as added by section 6301); ‘‘(i) giving notice and demand for such pen- tion through a contract with a community (2) the Department of Health and Human alty under section 6303, health center under paragraph (1), such rural Services, including the Agency for ‘‘(ii) crediting under section 6402(a) the health clinic shall establish policies to en- Healthcare Research and Quality and the Na- amount of any overpayment of the taxpayer sure— tional Institutes of Health; and against such penalty, and ‘‘(A) nondiscrimination based upon the (3) the Federal Coordinating Council for ‘‘(iii) offsetting any payment owed by any ability of a patient to pay; and Comparative Effectiveness Research estab- Federal agency to the taxpayer against such ‘‘(B) the establishment of a sliding fee lished under section 804 of Division A of the penalty under the Treasury offset program.’’. scale for low-income patients.’’. American Recovery and Reinvestment Act of SA 3057. Mr. ENSIGN submitted an SA 3053. Mr. INHOFE submitted an 2009 (42 U.S.C. 299b–8). (d) APPLICATION.—This section shall apply amendment intended to be proposed to amendment intended to be proposed to to any comparative effectiveness research— amendment SA 2786 proposed by Mr. amendment SA 2786 proposed by Mr. (1) that is ongoing as of the date of enact- REID (for himself, Mr. BAUCUS, Mr. REID (for himself, Mr. BAUCUS, Mr. ment of this Act; or DODD, and Mr. HARKIN) to the bill H.R. DODD, and Mr. HARKIN) to the bill H.R. (2) that is conducted after the date of en- 3590, to amend the Internal Revenue 3590, to amend the Internal Revenue actment of this Act. Code of 1986 to modify the first-time Code of 1986 to modify the first-time homebuyers credit in the case of mem- SA 3055. Mr. ENSIGN submitted an homebuyers credit in the case of mem- bers of the Armed Forces and certain amendment intended to be proposed to bers of the Armed Forces and certain other Federal employees, and for other amendment SA 2786 proposed by Mr. other Federal employees, and for other purposes; which was ordered to lie on REID (for himself, Mr. BAUCUS, Mr. purposes; which was ordered to lie on the table; as follows: DODD, and Mr. HARKIN) to the bill H.R. the table; as follows: On page 2026, strike line 3 and insert the 3590, to amend the Internal Revenue Beginning on page 334, line 19, strike all following: Code of 1986 to modify the first-time through page 335, line 2, and insert the fol- (i) EXCLUSION OF ASSISTIVE DEVICES FOR homebuyers credit in the case of mem- lowing: ‘‘(2) MIDDLE INCOME INDIVIDUALS AND FAMI- PEOPLE WITH DISABILITIES.— bers of the Armed Forces and certain LIES.—Any applicable individual for any (1) IN GENERAL.—The term ‘‘medical device other Federal employees, and for other sales’’ shall not include sales of any assistive month during a calendar year if the individ- device for people with disabilities. purposes; which was ordered to lie on ual’s household income for the taxable year (2) REDUCTION OF AGGREGATE FEE AMOUNT.— the table; as follows: described in section 1412(b)(1)(B) of the Pa- The $2,000,000,000 amount in subsection (b)(1) On page 1983, strike lines 1–11 and insert tient Protection and Affordable Care Act is shall be reduced in each calendar year by the the following: less than $200,000 ($250,000 in the case of a amount which bears the same ratio to such ‘‘(II) the 3-year average FEHB program joint return), determined in the same man- $2,000,000,000 amount as the amount of the premium increase for such year. ner as under subsection (c)(4). sales of devices described in paragraph (1) for If any amount determined under this clause SA 3058. Mr. ENSIGN submitted an such calendar year bears to the amount of is not a multiple of $50, such amount shall be total medical device sales (without regard to rounded to the nearest multiple of $50. amendment intended to be proposed to this subsection) for such calendar year, as (iv) 3-YEAR AVERAGE FEHB PROGRAM PRE- amendment SA 2786 proposed by Mr. determined by the Secretary. MIUM INCREASE.—For purposes of clause REID (for himself, Mr. BAUCUS, Mr. (j) APPLICATION OF SECTION.—This section (iii)— DODD, and Mr. HARKIN) to the bill H.R. shall (I) IN GENERAL.—The term ‘‘3-year average 3590, to amend the Internal Revenue FEHB program premium increase’’ means, Code of 1986 to modify the first-time SA 3054. Mr. ROBERTS (for himself with respect to any calendar year, the aver- and Mr. KYL) submitted an amendment homebuyers credit in the case of mem- age of the FEHB program premium increases bers of the Armed Forces and certain intended to be proposed to amendment for the preceding 3 calendar years. other Federal employees, and for other SA 2786 proposed by Mr. REID (for him- (II) FEHB PREMIUM INCREASE.—The term self, Mr. BAUCUS, Mr. DODD, and Mr. ‘‘FEHB program premium increase’’ means, purposes; which was ordered to lie on HARKIN) to the bill H.R. 3590, to amend with respect to any calendar year, the aver- the table; as follows: the Internal Revenue Code of 1986 to age amount of the increases in premiums (if On page 2074, after line 25, add the fol- modify the first-time homebuyers cred- any) for all plans offered under the Federal lowing: it in the case of members of the Armed Employee Health Benefits Program under SEC. llll. NO FEDERAL TAX INCREASE IM- Forces and certain other Federal em- chapter 89 of title 5, United States Code, POSED ON MIDDLE INCOME INDIVID- which were offered under such program for UALS AND FAMILIES. ployees, and for other purposes; which the preceding calendar year. (a) IN GENERAL.—Notwithstanding any pro- was ordered to lie on the table; as fol- vision of, or amendment made by this Act, lows: SA 3056. Mr. ENSIGN submitted an no such provision or amendment which, di- On page 1703, between lines 4 and 5, insert amendment intended to be proposed to rectly or indirectly, results in a Federal tax the following: amendment SA 2786 proposed by Mr. increase shall be administered in such man- ner as to impose such an increase on any SEC. 6303. PROHIBITION ON THE USE OF COST IN REID (for himself, Mr. BAUCUS, Mr. COMPARATIVE EFFECTIVENESS RE- middle income taxpayer. SEARCH. DODD, and Mr. HARKIN) to the bill H.R. (b) MIDDLE INCOME TAXPAYER.—For pur- (a) IN GENERAL.—Notwithstanding any 3590, to amend the Internal Revenue poses of this section, the term ‘‘middle in- other provision of law, in no case may the Code of 1986 to modify the first-time come taxpayer’’ means, for any taxable year,

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00081 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.073 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12728 CONGRESSIONAL RECORD — SENATE December 8, 2009 any taxpayer with adjusted gross income (as purposes; which was ordered to lie on mines is equal to the Federal medical assist- defined in section 62 of the Internal Revenue the table; as follows: ance percentage component attributable to Code of 1986) of less than $200,000 ($250,000 in disproportionate share hospital payment ad- On page 357, strike line 15 and insert the the case of a joint return of tax). justments for such year that is reflected in following: the budget neutrality provision of the (d) REPORT ON IMPACT OF PENALTIES.—Not QUEST Demonstration Project.’’. SA 3059. Mr. ENSIGN submitted an later than 18 months after the date of the en- amendment intended to be proposed to actment of this Act, the Comptroller General (b) CONFORMING AMENDMENT.—Effective Oc- amendment SA 2786 proposed by Mr. shall submit to Congress a report on the as- tober 1, 2011, paragraph (7) of section 1923(f) REID (for himself, Mr. BAUCUS, Mr. sessable payments imposed under section of such Act (42 U.S.C. 1396r–4(f)), as added by DODD, and Mr. HARKIN) to the bill H.R. 4980H of the Internal Revenue Code of 1986 section 2551, is amended— 3590, to amend the Internal Revenue (as added by the amendments made by this (1) in subparagraph (A), in the matter pre- Code of 1986 to modify the first-time section). The report submitted under this ceding clause (i), by striking ‘‘subparagraph homebuyers credit in the case of mem- subsection shall include a detailed analysis (E)’’ and inserting ‘‘subparagraphs (E) and of the impact of such assessable penalty on— (G)’’; and bers of the Armed Forces and certain (1) employer profits, (2) by adding at the end the following: other Federal employees, and for other (2) Federal revenues, including any de- ‘‘(G) NONAPPLICATION.—The preceding pro- purposes; which was ordered to lie on crease in tax revenues due to any decrease in visions of this paragraph shall not apply to the table; as follows: employer profits as a result of such assess- the DSH allotment determined for the State On page 1999, strike lines 1 through 20. able penalties, of Hawaii for a fiscal year under paragraph (3) the level of wages and benefits of em- (6).’’. SA 3060. Mr. ENSIGN submitted an ployees, (4) the hours worked by employees, includ- amendment intended to be proposed to SA 3064. Mr. CASEY submitted an amendment SA 2786 proposed by Mr. ing whether employees are classified as part- time or full-time employees, and amendment intended to be proposed to REID (for himself, Mr. BAUCUS, Mr. (5) the termination of employees. amendment SA 2786 proposed by Mr. DODD, and Mr. HARKIN) to the bill H.R. (e) EFFECTIVE DATE.—The amendments REID (for himself, Mr. BAUCUS, Mr. 3590, to amend the Internal Revenue made by DODD, and Mr. HARKIN) to the bill H.R. Code of 1986 to modify the first-time 3590, to amend the Internal Revenue homebuyers credit in the case of mem- SA 3063. Mr. AKAKA (for himself and Code of 1986 to modify the first-time bers of the Armed Forces and certain Mr. INOUYE) submitted an amendment homebuyers credit in the case of mem- other Federal employees, and for other intended to be proposed to amendment bers of the Armed Forces and certain purposes; which was ordered to lie on SA 2786 proposed by Mr. REID (for him- other Federal employees, and for other the table; as follows: self, Mr. BAUCUS, Mr. DODD, and Mr. purposes; which was ordered to lie on Strike section 9004. HARKIN) to the bill H.R. 3590, to amend the table; as follows: the Internal Revenue Code of 1986 to SA 3061. Mr. ENSIGN submitted an modify the first-time homebuyers cred- On page 124, between lines 16 and 17, insert amendment intended to be proposed to it in the case of members of the Armed the following: amendment SA 2786 proposed by Mr. Forces and certain other Federal em- (4) NONDISCRIMINATION ON ABORTION AND RE- SPECT FOR RIGHTS OF CONSCIENCE.— REID (for himself, Mr. BAUCUS, Mr. ployees, and for other purposes; which (A) NONDISCRIMINATION.—A Federal agency DODD, and Mr. HARKIN) to the bill H.R. was ordered to lie on the table; as fol- or program, and any State or local govern- 3590, to amend the Internal Revenue lows: ment that receives Federal financial assist- Code of 1986 to modify the first-time On page 515 of the amendment, between ance under this Act (or an amendment made homebuyers credit in the case of mem- lines 11 and 12, insert the following: by this Act), may not— bers of the Armed Forces and certain SEC. 2552. ESTABLISHMENT OF PERMANENT (i) subject any individual or institutional other Federal employees, and for other MEDICAID DSH ALLOTMENT FOR HA- health care entity to discrimination; or purposes; which was ordered to lie on WAII. (ii) require any health plan created or reg- ulated under this Act (or an amendment the table; as follows: (a) IN GENERAL.—Section 1923(f)(6) of the Social Security Act (42 U.S.C. 1396r–4(f)(6)) is made by this Act) to subject any individual On page 2074, after line 25, add the fol- amended— or institutional health care entity to dis- lowing: (1) by striking the paragraph heading and crimination, SEC. 9024. TAXES NOT FEES, PENALTIES, OR AS- inserting the following: ‘‘ALLOTMENT ADJUST- on the basis that the health care entity does SESSABLE PAYMENTS. MENTS FOR TENNESSEE AND HAWAII’’; and not provide, pay for, provide coverage of, or (a) TAXES NOT FEES.—Sections 4375, 4376, (2) in subparagraph (B), by adding at the refer for abortions. 4377, and 9511 of the Internal Revenue Code of end the following: (B) DEFINITION.——In this section, the term 1986 (as added by section 6301(e)) and sections ‘‘(iii) ALLOTMENT FOR 2D, 3RD, AND 4TH ‘‘ ‘health care entity’ ’’ includes an individual 9008, 9009, and 9010 are each amended by QUARTER OF FISCAL YEAR 2012, FISCAL YEAR physician or other health care professional, a striking ‘‘fee’’ or ‘‘fees’’ each place they ap- 2013, AND SUCCEEDING FISCAL YEARS.—Notwith- hospital, a provider-sponsored organization, pear and inserting ‘‘tax’’ or ‘‘taxes’’, respec- standing the table set forth in paragraph (2) a health maintenance organization, a health tively. or paragraph (7): insurance plan, or any other kind of health (b) TAXES NOT PENALTIES.—Section 5000A ‘‘(I) 2D, 3RD, AND 4TH QUARTER OF FISCAL care facility, organization, or plan. of the Internal Revenue Code of 1986 (as YEAR 2012.—The DSH allotment for Hawaii for (C) ADMINISTRATION.—The Office for Civil added by section 1501(b)) is amended by the 2d, 3rd, and 4th quarters of fiscal year Rights of the Department of Health and striking ‘‘penalty’’ each place it appears 2012 shall be $7,500,000. Human Services is designated to receive (other than the second place in paragraphs ‘‘(II) TREATMENT AS A LOW-DSH STATE FOR complaints of discrimination based on this (1) and (2)(A) of subsection (g) thereof) and FISCAL YEAR 2013 AND SUCCEEDING FISCAL section, and coordinate the investigation of inserting ‘‘tax’’. YEARS.—With respect to fiscal year 2013, and such complaints. (c) TAXES NOT ASSESSABLE PAYMENTS.— each fiscal year thereafter, the DSH allot- Section 4980H of the Internal Revenue Code ment for Hawaii shall be increased in the of 1986 (as added by section 1513(a)) and sec- same manner as allotments for low DSH SA 3065. Mr. CARDIN (for himself tion 1513(c)(1) are each amended by striking States are increased for such fiscal year and Mr. BROWN) submitted an amend- ‘‘assessable payment’’ or ‘‘assessable under clauses (ii) and (iii) of paragraph ment intended to be proposed to payments’’each place they appear and insert- (5)(B). amendment SA 2786 proposed by Mr. ing ‘‘tax’’ or ‘‘taxes’’, respectively. ‘‘(III) CERTAIN HOSPITAL PAYMENTS.—The REID (for himself, Mr. BAUCUS, Mr. Secretary may not impose a limitation on DODD, and Mr. HARKIN) to the bill H.R. SA 3062. Mr. ENSIGN submitted an the total amount of payments made to hos- amendment intended to be proposed to pitals under the QUEST section 1115 Dem- 3590, to amend the Internal Revenue amendment SA 2786 proposed by Mr. onstration Project except to the extent that Code of 1986 to modify the first-time REID (for himself, Mr. BAUCUS, Mr. such limitation is necessary to ensure that a homebuyers credit in the case of mem- DODD, and Mr. HARKIN) to the bill H.R. hospital does not receive payments in excess bers of the Armed Forces and certain 3590, to amend the Internal Revenue of the amounts described in subsection (g), other Federal employees, and for other or as necessary to ensure that such pay- Code of 1986 to modify the first-time purposes; which was ordered to lie on ments under the waiver and such payments the table; as follows: homebuyers credit in the case of mem- pursuant to the allotment provided in this bers of the Armed Forces and certain clause do not, in the aggregate in any year, On page 396, between lines 8 and 9, insert other Federal employees, and for other exceed the amount that the Secretary deter- the following:

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00082 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.065 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12729 Subtitle H—Patient Protections thing of value to its employees, agents, or ficiary, or enrollee (or authorized represent- PART I—IMPROVING MANAGED CARE contractors in a manner that encourages de- ative) may make an initial claim for benefits Subpart A—Utilization Review; Claims nials of claims for benefits. orally, but a group health plan, or health in- (C) PROHIBITION OF CONFLICTS.—Such a pro- surance issuer offering health insurance cov- SEC. 1601. UTILIZATION REVIEW ACTIVITIES. gram shall not permit a health care profes- erage, may require that the participant, ben- (a) COMPLIANCE WITH REQUIREMENTS.— sional who is providing health care services eficiary, or enrollee (or authorized represent- (1) IN GENERAL.—A group health plan, and to an individual to perform utilization re- ative) provide written confirmation of such a health insurance issuer that provides view activities in connection with the health request in a timely manner on a form pro- health insurance coverage, shall conduct uti- care services being provided to the indi- vided by the plan or issuer. In the case of lization review activities in connection with vidual. such an oral request for benefits, the making the provision of benefits under such plan or (3) ACCESSIBILITY OF REVIEW.—Such a pro- of the request (and the timing of such re- coverage only in accordance with a utiliza- gram shall provide that appropriate per- quest) shall be treated as the making at that tion review program that meets the require- sonnel performing utilization review activi- time of a claims for such benefits without re- ments of this section and section 1602. ties under the program, including the utili- gard to whether and when a written con- (2) USE OF OUTSIDE AGENTS.—Nothing in zation review administrator, are reasonably firmation of such request is made. this section shall be construed as preventing accessible by toll-free telephone during nor- (b) TIMELINE FOR MAKING DETERMINA- a group health plan or health insurance mal business hours to discuss patient care TIONS.— issuer from arranging through a contract or and allow response to telephone requests, (1) PRIOR AUTHORIZATION DETERMINATION.— otherwise for persons or entities to conduct and that appropriate provision is made to re- (A) IN GENERAL.—A group health plan, or utilization review activities on behalf of the ceive and respond promptly to calls received health insurance issuer offering health insur- plan or issuer, so long as such activities are during other hours. ance coverage, shall make a prior authoriza- conducted in accordance with a utilization (4) LIMITS ON FREQUENCY.—Such a program tion determination on a claim for benefits review program that meets the requirements shall not provide for the performance of uti- (whether oral or written) in accordance with of this section. lization review activities with respect to a the medical exigencies of the case and as (3) UTILIZATION REVIEW DEFINED.—For pur- class of services furnished to an individual soon as possible, but in no case later than 14 poses of this section, the terms ‘‘utilization more frequently than is reasonably required days from the date on which the plan or review’’ and ‘‘utilization review activities’’ to assess whether the services under review issuer receives information that is reason- mean procedures used to monitor or evaluate are medically necessary and appropriate. ably necessary to enable the plan or issuer to the use or coverage, clinical necessity, ap- SEC. 1602. PROCEDURES FOR INITIAL CLAIMS make a determination on the request for propriateness, efficacy, or efficiency of FOR BENEFITS AND PRIOR AUTHOR- prior authorization and in no case later than health care services, procedures or settings, IZATION DETERMINATIONS. 28 days after the date of the claim for bene- and includes prospective review, concurrent (a) PROCEDURES OF INITIAL CLAIMS FOR fits is received. review, second opinions, case management, BENEFITS.— (B) EXPEDITED DETERMINATION.—Notwith- discharge planning, or retrospective review. (1) IN GENERAL.—A group health plan, or standing subparagraph (A), a group health (b) WRITTEN POLICIES AND CRITERIA.— health insurance issuer offering health insur- plan, or health insurance issuer offering (1) WRITTEN POLICIES.—A utilization review ance coverage, shall— health insurance coverage, shall expedite a program shall be conducted consistent with (A) make a determination on an initial prior authorization determination on a claim written policies and procedures that govern claim for benefits by a participant, bene- for benefits described in such subparagraph all aspects of the program. ficiary, or enrollee (or authorized represent- when a request for such an expedited deter- (2) USE OF WRITTEN CRITERIA.— ative) regarding payment or coverage for mination is made by a participant, bene- (A) IN GENERAL.—Such a program shall uti- items or services under the terms and condi- ficiary, or enrollee (or authorized represent- lize written clinical review criteria devel- tions of the plan or coverage involved, in- ative) at any time during the process for oped with input from a range of appropriate cluding any cost-sharing amount that the making a determination and a health care actively practicing health care professionals, participant, beneficiary, or enrollee is re- professional certifies, with the request, that as determined by the plan, pursuant to the quired to pay with respect to such claim for a determination under the procedures de- program. Such criteria shall include written benefits; and scribed in subparagraph (A) would seriously clinical review criteria that are based on (B) notify a participant, beneficiary, or en- jeopardize the life or health of the partici- valid clinical evidence where available and rollee (or authorized representative) and the pant, beneficiary, or enrollee or the ability that are directed specifically at meeting the treating health care professional involved re- of the participant, beneficiary, or enrollee to needs of at-risk populations and covered in- garding a determination on an initial claim maintain or regain maximum function. Such dividuals with chronic conditions or severe for benefits made under the terms and condi- determination shall be made in accordance illnesses, including gender-specific criteria tions of the plan or coverage, including any with the medical exigencies of the case and and pediatric-specific criteria where avail- cost-sharing amounts that the participant, as soon as possible, but in no case later than able and appropriate. beneficiary, or enrollee may be required to 72 hours after the time the request is re- (B) CONTINUING USE OF STANDARDS IN RET- make with respect to such claim for benefits. ceived by the plan or issuer under this sub- ROSPECTIVE REVIEW.—If a health care service (2) ACCESS TO INFORMATION.— paragraph. has been specifically pre-authorized or ap- (A) TIMELY PROVISION OF NECESSARY INFOR- (C) ONGOING CARE.— proved for a participant, beneficiary, or en- MATION.—With respect to an initial claim for (i) CONCURRENT REVIEW.— rollee under such a program, the program benefits, the participant, beneficiary, or en- (I) IN GENERAL.—Subject to clause (ii), in shall not, pursuant to retrospective review, rollee (or authorized representative) and the the case of a concurrent review of ongoing revise or modify the specific standards, cri- treating health care professional (if any) care (including hospitalization), which re- teria, or procedures used for the utilization shall provide the plan or issuer with access sults in a termination or reduction of such review for procedures, treatment, and serv- to information requested by the plan or care, the plan or issuer must provide by tele- ices delivered to the enrollee during the issuer that is necessary to make a deter- phone and in printed form notice of the con- same course of treatment. mination relating to the claim. Such access current review determination to the indi- (C) REVIEW OF SAMPLE OF CLAIMS DENIALS.— shall be provided not later than 5 days after vidual or the individual’s designee and the Such a program shall provide for a periodic the date on which the request for informa- individual’s health care provider in accord- evaluation of the clinical appropriateness of tion is received, or, in a case described in ance with the medical exigencies of the case at least a sample of denials of claims for ben- subparagraph (B) or (C) of subsection (b)(1), and as soon as possible. efits. by such earlier time as may be necessary to (II) CONTENTS OF NOTICE.—Such notice (c) CONDUCT OF PROGRAM ACTIVITIES.— comply with the applicable timeline under shall include, with respect to ongoing health (1) ADMINISTRATION BY HEALTH CARE PRO- such subparagraph. care items and services, the number of ongo- FESSIONALS.—A utilization review program (B) LIMITED EFFECT OF FAILURE ON PLAN OR ing services approved, the new total of ap- shall be administered by qualified health ISSUER’S OBLIGATIONS.—Failure of the partic- proved services, the date of onset of services, care professionals who shall oversee review ipant, beneficiary, or enrollee to comply and the next review date, if any, as well as a decisions. with the requirements of subparagraph (A) statement of the individual’s rights to fur- (2) USE OF QUALIFIED, INDEPENDENT PER- shall not remove the obligation of the plan ther appeal. SONNEL.— or issuer to make a decision in accordance (ii) RULE OF CONSTRUCTION.—Clause (i) (A) IN GENERAL.—A utilization review pro- with the medical exigencies of the case and shall not be construed as requiring plans or gram shall provide for the conduct of utiliza- as soon as possible, based on the available in- issuers to provide coverage of care that tion review activities only through personnel formation, and failure to comply with the would exceed the coverage limitations for who are qualified and have received appro- time limit established by this paragraph such care. priate training in the conduct of such activi- shall not remove the obligation of the plan (2) RETROSPECTIVE DETERMINATION.—A ties under the program. or issuer to comply with the requirements of group health plan, or health insurance issuer (B) PROHIBITION OF CONTINGENT COMPENSA- this section. offering health insurance coverage, shall TION ARRANGEMENTS.—Such a program shall (3) ORAL REQUESTS.—In the case of a claim make a retrospective determination on a not, with respect to utilization review activi- for benefits involving an expedited or con- claim for benefits in accordance with the ties, permit or provide compensation or any- current determination, a participant, bene- medical exigencies of the case and as soon as

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00083 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.075 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12730 CONGRESSIONAL RECORD — SENATE December 8, 2009 possible, but not later than 30 days after the sional who is available to accept such indi- 22(d)(2)). Such reimbursement shall be pro- date on which the plan or issuer receives in- vidual for such care. vided in a manner consistent with subsection formation that is reasonably necessary to (2) LIMITATION.—Paragraph (1) shall not (a)(1)(C). enable the plan or issuer to make a deter- apply to specialty care if the plan or issuer (c) COVERAGE OF EMERGENCY AMBULANCE mination on the claim, or, if earlier, 60 days clearly informs participants, beneficiaries, SERVICES.— after the date of receipt of the claim for ben- and enrollees of the limitations on choice of (1) IN GENERAL.—If a group health plan, or efits. participating health care professionals with health insurance coverage provided by a (c) NOTICE OF A DENIAL OF A CLAIM FOR respect to such care. health insurance issuer, provides any bene- BENEFITS.—Written notice of a denial made (3) CONSTRUCTION.—Nothing in this sub- fits with respect to ambulance services and under an initial claim for benefits shall be section shall be construed as affecting the emergency services, the plan or issuer shall issued to the participant, beneficiary, or en- application of section 114 (relating to access cover emergency ambulance services (as de- rollee (or authorized representative) and the to specialty care). fined in paragraph (2)) furnished under the treating health care professional in accord- SEC. 1612. ACCESS TO EMERGENCY CARE. plan or coverage under the same terms and ance with the medical exigencies of the case (a) COVERAGE OF EMERGENCY SERVICES.— conditions under subparagraphs (A) through and as soon as possible, but in no case later (1) IN GENERAL.—If a group health plan, or (D) of subsection (a)(1) under which coverage than 2 days after the date of the determina- health insurance coverage offered by a is provided for emergency services. tion (or, in the case described in subpara- health insurance issuer, provides or covers (2) EMERGENCY AMBULANCE SERVICES.—For graph (B) or (C) of subsection (b)(1), within any benefits with respect to services in an purposes of this subsection, the term ‘‘emer- the 72-hour or applicable period referred to emergency department of a hospital, the gency ambulance services’’ means ambu- in such subparagraph). plan or issuer shall cover emergency services lance services (as defined for purposes of sec- (d) REQUIREMENTS OF NOTICE OF DETER- (as defined in paragraph (2)(B))— tion 1861(s)(7) of the Social Security Act) fur- MINATIONS.—The written notice of a denial of (A) without the need for any prior author- nished to transport an individual who has an a claim for benefits determination under ization determination; emergency medical condition (as defined in subsection (c) shall be provided in printed (B) whether the health care provider fur- subsection (a)(2)(A)) to a hospital for the re- form and written in a manner calculated to nishing such services is a participating pro- ceipt of emergency services (as defined in be understood by the participant, bene- vider with respect to such services; subsection (a)(2)(B)) in a case in which the ficiary, or enrollee and shall include— (C) in a manner so that, if such services are emergency services are covered under the (1) the specific reasons for the determina- provided to a participant, beneficiary, or en- plan or coverage pursuant to subsection tion (including a summary of the clinical or rollee— (a)(1) and a prudent layperson, with an aver- scientific evidence used in making the deter- (i) by a nonparticipating health care pro- age knowledge of health and medicine, could mination); and vider with or without prior authorization, or reasonably expect that the absence of such (2) the procedures for obtaining additional (ii) by a participating health care provider transport would result in placing the health information concerning the determination. without prior authorization, the participant, of the individual in serious jeopardy, serious (e) DEFINITIONS.—For purposes of this part: beneficiary, or enrollee is not liable for impairment of bodily function, or serious (1) AUTHORIZED REPRESENTATIVE.—The amounts that exceed the amounts of liability dysfunction of any bodily organ or part. term ‘‘authorized representative’’ means, that would be incurred if the services were SEC. 1613. TIMELY ACCESS TO SPECIALISTS. with respect to an individual who is a partic- provided by a participating health care pro- (a) TIMELY ACCESS.— ipant, beneficiary, or enrollee, any health vider with prior authorization; and (1) IN GENERAL.—A group health plan or care professional or other person acting on (D) without regard to any other term or health insurance issuer offering health insur- behalf of the individual with the individual’s condition of such coverage (other than exclu- ance coverage shall ensure that participants, consent or without such consent if the indi- sion or coordination of benefits, or an affili- beneficiaries, and enrollees receive timely vidual is medically unable to provide such ation or waiting period, permitted under sec- access to specialists who are appropriate to consent. tion 2701 of the Public Health Service Act, the condition of, and accessible to, the par- (2) CLAIM FOR BENEFITS.—The term ‘‘claim section 701 of the Employee Retirement In- ticipant, beneficiary, or enrollee, when such for benefits’’ means any request for coverage come Security Act of 1974, or section 9801 of specialty care is a covered benefit under the (including authorization of coverage), for eli- the Internal Revenue Code of 1986, and other plan or coverage. gibility, or for payment in whole or in part, than applicable cost-sharing). (2) RULE OF CONSTRUCTION.—Nothing in for an item or service under a group health (2) DEFINITIONS.—In this section: paragraph (1) shall be construed— plan or health insurance coverage. (A) EMERGENCY MEDICAL CONDITION.—The (A) to require the coverage under a group (3) DENIAL OF CLAIM FOR BENEFITS.—The term ‘‘emergency medical condition’’ means health plan or health insurance coverage of term ‘‘denial’’ means, with respect to a a medical condition manifesting itself by benefits or services; claim for benefits, a denial (in whole or in acute symptoms of sufficient severity (in- (B) to prohibit a plan or issuer from includ- part) of, or a failure to act on a timely basis cluding severe pain) such that a prudent ing providers in the network only to the ex- upon, the claim for benefits and includes a layperson, who possesses an average knowl- tent necessary to meet the needs of the failure to provide benefits (including items edge of health and medicine, could reason- plan’s or issuer’s participants, beneficiaries, and services) required to be provided under ably expect the absence of immediate med- or enrollees; or this part. ical attention to result in a condition de- (C) to override any State licensure or (4) TREATING HEALTH CARE PROFESSIONAL.— scribed in clause (i), (ii), or (iii) of section scope-of-practice law. The term ‘‘treating health care professional’’ 1867(e)(1)(A) of the Social Security Act. (3) ACCESS TO CERTAIN PROVIDERS.— means, with respect to services to be pro- (B) EMERGENCY SERVICES.—The term (A) IN GENERAL.—With respect to specialty vided to a participant, beneficiary, or en- ‘‘emergency services’’ means, with respect to care under this section, if a participating rollee, a health care professional who is pri- an emergency medical condition— specialist is not available and qualified to marily responsible for delivering those serv- (i) a medical screening examination (as re- provide such care to the participant, bene- ices to the participant, beneficiary, or en- quired under section 1867 of the Social Secu- ficiary, or enrollee, the plan or issuer shall rollee. rity Act) that is within the capability of the provide for coverage of such care by a non- Subpart B—Access to Care emergency department of a hospital, includ- participating specialist. SEC. 1611. CHOICE OF HEALTH CARE PROFES- ing ancillary services routinely available to (B) TREATMENT OF NONPARTICIPATING PRO- SIONAL. the emergency department to evaluate such VIDERS.—If a participant, beneficiary, or en- (a) PRIMARY CARE.—If a group health plan, emergency medical condition, and rollee receives care from a nonparticipating or a health insurance issuer that offers (ii) within the capabilities of the staff and specialist pursuant to subparagraph (A), health insurance coverage, requires or pro- facilities available at the hospital, such fur- such specialty care shall be provided at no vides for designation by a participant, bene- ther medical examination and treatment as additional cost to the participant, bene- ficiary, or enrollee of a participating pri- are required under section 1867 of such Act to ficiary, or enrollee beyond what the partici- mary care provider, then the plan or issuer stabilize the patient. pant, beneficiary, or enrollee would other- shall permit each participant, beneficiary, (C) STABILIZE.—The term ‘‘to stabilize’’, wise pay for such specialty care if provided and enrollee to designate any participating with respect to an emergency medical condi- by a participating specialist. primary care provider who is available to ac- tion (as defined in subparagraph (A)), has the (b) REFERRALS.— cept such individual. meaning give in section 1867(e)(3) of the So- (1) AUTHORIZATION.—Subject to subsection (b) SPECIALISTS.— cial Security Act (42 U.S.C. 1395dd(e)(3)). (a)(1), a group health plan or health insur- (1) IN GENERAL.—Subject to paragraph (2), a (b) REIMBURSEMENT FOR MAINTENANCE CARE ance issuer may require an authorization in group health plan and a health insurance AND POST-STABILIZATION CARE.—A group order to obtain coverage for specialty serv- issuer that offers health insurance coverage health plan, and health insurance coverage ices under this section. Any such authoriza- shall permit each participant, beneficiary, or offered by a health insurance issuer, must tion— enrollee to receive medically necessary and provide reimbursement for maintenance care (A) shall be for an appropriate duration of appropriate specialty care, pursuant to ap- and post-stabilization care in accordance time or number of referrals, including an au- propriate referral procedures, from any with the requirements of section 1852(d)(2) of thorization for a standing referral where ap- qualified participating health care profes- the Social Security Act (42 U.S.C. 1395w– propriate; and

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00084 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.075 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12731 (B) may not be refused solely because the may not require authorization or referral by respect to the course of treatment by such authorization involves services of a non- the plan, issuer, or any person (including a provider with the provider’s consent during a participating specialist (described in sub- primary care provider described in sub- transitional period (as provided for under section (a)(3)). section (b)(2)) in the case of a female partici- subsection (b)). (2) REFERRALS FOR ONGOING SPECIAL CONDI- pant, beneficiary, or enrollee who seeks cov- (4) CONTINUING CARE PATIENT.—For pur- TIONS.— erage for obstetrical or gynecological care poses of this section, the term ‘‘continuing (A) IN GENERAL.—Subject to subsection provided by a participating health care pro- care patient’’ means a participant, bene- (a)(1), a group health plan or health insur- fessional who specializes in obstetrics or ficiary, or enrollee who— ance issuer shall permit a participant, bene- gynecology. (A) is undergoing a course of treatment for ficiary, or enrollee who has an ongoing spe- (2) OBSTETRICAL AND GYNECOLOGICAL a serious and complex condition from the cial condition (as defined in subparagraph CARE.—A group health plan or health insur- provider at the time the plan or issuer re- (B)) to receive a referral to a specialist for ance issuer described in subsection (b) shall ceives or provides notice of provider, benefit, the treatment of such condition and such treat the provision of obstetrical and gyne- or coverage termination described in para- specialist may authorize such referrals, pro- cological care, and the ordering of related graph (1) (or paragraph (2), if applicable); cedures, tests, and other medical services obstetrical and gynecological items and (B) is undergoing a course of institutional with respect to such condition, or coordinate services, pursuant to the direct access de- or inpatient care from the provider at the the care for such condition, subject to the scribed under paragraph (1), by a partici- time of such notice; terms of a treatment plan (if any) referred to pating health care professional who special- (C) is scheduled to undergo non-elective in subsection (c) with respect to the condi- izes in obstetrics or gynecology as the au- surgery from the provider at the time of tion. thorization of the primary care provider. such notice; (B) ONGOING SPECIAL CONDITION DEFINED.— (b) APPLICATION OF SECTION.—A group (D) is pregnant and undergoing a course of In this subsection, the term ‘‘ongoing special health plan, or health insurance issuer offer- treatment for the pregnancy from the pro- condition’’ means a condition or disease ing health insurance coverage, described in vider at the time of such notice; or that— this subsection is a group health plan or cov- (E) is or was determined to be terminally erage that— (i) is life-threatening, degenerative, poten- ill (as determined under section (1) provides coverage for obstetric or tially disabling, or congenital; and 1861(dd)(3)(A) of the Social Security Act) at gynecologic care; and (ii) requires specialized medical care over a the time of such notice, but only with re- (2) requires the designation by a partici- prolonged period of time. spect to a provider that was treating the ter- pant, beneficiary, or enrollee of a partici- (c) TREATMENT PLANS.— minal illness before the date of such notice. pating primary care provider. (b) TRANSITIONAL PERIODS.— (1) IN GENERAL.—A group health plan or (c) CONSTRUCTION.—Nothing in subsection (1) SERIOUS AND COMPLEX CONDITIONS.—The health insurance issuer may require that the (a) shall be construed to— transitional period under this subsection specialty care be provided— (1) waive any exclusions of coverage under with respect to a continuing care patient de- (A) pursuant to a treatment plan, but only the terms and conditions of the plan or scribed in subsection (a)(4)(A) shall extend if the treatment plan— health insurance coverage with respect to for up to 90 days (as determined by the treat- (i) is developed by the specialist, in con- coverage of obstetrical or gynecological ing health care professional) from the date of sultation with the case manager or primary care; or the notice described in subsection (a)(3)(A). care provider, and the participant, bene- (2) preclude the group health plan or (2) INSTITUTIONAL OR INPATIENT CARE.—The ficiary, or enrollee, and health insurance issuer involved from requir- transitional period under this subsection for (ii) is approved by the plan or issuer in a ing that the obstetrical or gynecological pro- a continuing care patient described in sub- timely manner, if the plan or issuer requires vider notify the primary care health care section (a)(4)(B) shall extend until the ear- such approval; and professional or the plan or issuer of treat- lier of— (B) in accordance with applicable quality ment decisions. (A) the expiration of the 90-day period be- assurance and utilization review standards of SEC. 1616. CONTINUITY OF CARE. ginning on the date on which the notice the plan or issuer. (a) TERMINATION OF PROVIDER.— under subsection (a)(3)(A) is provided; or (2) NOTIFICATION.—Nothing in paragraph (1) (1) IN GENERAL.—If— (B) the date of discharge of the patient shall be construed as prohibiting a plan or (A) a contract between a group health from such care or the termination of the pe- issuer from requiring the specialist to pro- plan, or a health insurance issuer offering riod of institutionalization, or, if later, the vide the plan or issuer with regular updates health insurance coverage, and a treating date of completion of reasonable follow-up on the specialty care provided, as well as all health care provider is terminated (as de- care. other reasonably necessary medical informa- fined in subsection (e)(4)), or (3) SCHEDULED NON-ELECTIVE SURGERY.— tion. (B) benefits or coverage provided by a The transitional period under this subsection (d) SPECIALIST DEFINED.—For purposes of health care provider are terminated because for a continuing care patient described in this section, the term ‘‘specialist’’ means, of a change in the terms of provider partici- subsection (a)(4)(C) shall extend until the with respect to the condition of the partici- pation in such plan or coverage, completion of the surgery involved and post- pant, beneficiary, or enrollee, a health care the plan or issuer shall meet the require- surgical follow-up care relating to the sur- professional, facility, or center that has ade- ments of paragraph (3) with respect to each gery and occurring within 90 days after the quate expertise through appropriate training continuing care patient. date of the surgery. and experience (including, in the case of a (2) TREATMENT OF TERMINATION OF CON- (4) PREGNANCY.—The transitional period child, appropriate pediatric expertise) to pro- TRACT WITH HEALTH INSURANCE ISSUER.—If a under this subsection for a continuing care vide high quality care in treating the condi- contract for the provision of health insur- patient described in subsection (a)(4)(D) shall tion. ance coverage between a group health plan extend through the provision of post-partum SEC. 1614. ACCESS TO PEDIATRIC CARE. and a health insurance issuer is terminated care directly related to the delivery. (a) PEDIATRIC CARE.—In the case of a per- and, as a result of such termination, cov- (5) TERMINAL ILLNESS.—The transitional son who has a child who is a participant, erage of services of a health care provider is period under this subsection for a continuing beneficiary, or enrollee under a group health terminated with respect to an individual, the care patient described in subsection (a)(4)(E) plan, or health insurance coverage offered by provisions of paragraph (1) (and the suc- shall extend for the remainder of the pa- a health insurance issuer, if the plan or ceeding provisions of this section) shall tient’s life for care that is directly related to issuer requires or provides for the designa- apply under the plan in the same manner as the treatment of the terminal illness or its tion of a participating primary care provider if there had been a contract between the plan medical manifestations. for the child, the plan or issuer shall permit and the provider that had been terminated, (c) PERMISSIBLE TERMS AND CONDITIONS.—A such person to designate a physician but only with respect to benefits that are group health plan or health insurance issuer (allopathic or osteopathic) who specializes in covered under the plan after the contract may condition coverage of continued treat- pediatrics as the child’s primary care pro- termination. ment by a provider under this section upon vider if such provider participates in the net- (3) REQUIREMENTS.—The requirements of the provider agreeing to the following terms work of the plan or issuer. this paragraph are that the plan or issuer— and conditions: (b) CONSTRUCTION.—Nothing in subsection (A) notify the continuing care patient in- (1) The treating health care provider (a) shall be construed to waive any exclu- volved, or arrange to have the patient noti- agrees to accept reimbursement from the sions of coverage under the terms and condi- fied pursuant to subsection (d)(2), on a time- plan or issuer and continuing care patient tions of the plan or health insurance cov- ly basis of the termination described in para- involved (with respect to cost-sharing) at the erage with respect to coverage of pediatric graph (1) (or paragraph (2), if applicable) and rates applicable prior to the start of the care. the right to elect continued transitional care transitional period as payment in full (or, in SEC. 1615. PATIENT ACCESS TO OBSTETRICAL from the provider under this section; the case described in subsection (a)(2), at the AND GYNECOLOGICAL CARE. (B) provide the patient with an oppor- rates applicable under the replacement plan (a) GENERAL RIGHTS.— tunity to notify the plan or issuer of the pa- or coverage after the date of the termination (1) DIRECT ACCESS.—A group health plan, or tient’s need for transitional care; and of the contract with the group health plan or health insurance issuer offering health insur- (C) subject to subsection (c), permit the pa- health insurance issuer) and not to impose ance coverage, described in subsection (b) tient to elect to continue to be covered with cost-sharing with respect to the patient in

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00085 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.075 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12732 CONGRESSIONAL RECORD — SENATE December 8, 2009 an amount that would exceed the cost-shar- health plan or health insurance issuer in re- insurance issuer offering health insurance ing that could have been imposed if the con- lation to health insurance coverage (includ- coverage, the participating health care pro- tract referred to in subsection (a)(1) had not ing any partnership, association, or other or- fessionals and providers through whom the been terminated. ganization that enters into or administers plan or issuer provides health care items and (2) The treating health care provider such a contract or agreement) and a health services to participants, beneficiaries, or en- agrees to adhere to the quality assurance care provider (or group of health care pro- rollees. standards of the plan or issuer responsible viders) shall not prohibit or otherwise re- (7) NONPARTICIPATING.—The term ‘‘non- for payment under paragraph (1) and to pro- strict a health care professional from advis- participating’’ means, with respect to a vide to such plan or issuer necessary medical ing such a participant, beneficiary, or en- health care provider that provides health information related to the care provided. rollee who is a patient of the professional care items and services to a participant, ben- (3) The treating health care provider about the health status of the individual or eficiary, or enrollee under group health plan agrees otherwise to adhere to such plan’s or medical care or treatment for the individ- or health insurance coverage, a health care issuer’s policies and procedures, including ual’s condition or disease, regardless of provider that is not a participating health procedures regarding referrals and obtaining whether benefits for such care or treatment care provider with respect to such items and prior authorization and providing services are provided under the plan or coverage, if services. pursuant to a treatment plan (if any) ap- the professional is acting within the lawful (8) PARTICIPATING.—The term ‘‘partici- proved by the plan or issuer. scope of practice. pating’’ means, with respect to a health care (d) RULES OF CONSTRUCTION.—Nothing in (b) NULLIFICATION.—Any contract provision provider that provides health care items and this section shall be construed— or agreement that restricts or prohibits med- services to a participant, beneficiary, or en- (1) to require the coverage of benefits ical communications in violation of sub- rollee under group health plan or health in- which would not have been covered if the section (a) shall be null and void. surance coverage offered by a health insur- provider involved remained a participating Subpart D—Definitions ance issuer, a health care provider that fur- nishes such items and services under a con- provider; or SEC. 1631. DEFINITIONS. (2) with respect to the termination of a tract or other arrangement with the plan or (a) INCORPORATION OF GENERAL DEFINI- contract under subsection (a) to prevent a issuer. TIONS.—Except as otherwise provided, the (9) PRIOR AUTHORIZATION.—The term ‘‘prior group health plan or health insurance issuer provisions of section 2791 of the Public from requiring that the health care pro- authorization’’ means the process of obtain- Health Service Act shall apply for purposes ing prior approval from a health insurance vider— of this part in the same manner as they (A) notify participants, beneficiaries, or issuer or group health plan for the provision apply for purposes of title XXVII of such or coverage of medical services. enrollees of their rights under this section; Act. or (10) TERMS AND CONDITIONS.—The term (b) SECRETARY.—Except as otherwise pro- ‘‘terms and conditions’’ includes, with re- (B) provide the plan or issuer with the vided, the term ‘‘Secretary’’ means the Sec- name of each participant, beneficiary, or en- spect to a group health plan or health insur- retary of Health and Human Services, in con- ance coverage, requirements imposed under rollee who the provider believes is a con- sultation with the Secretary of Labor and tinuing care patient. this part with respect to the plan or cov- the term ‘‘appropriate Secretary’’ means the erage. (e) DEFINITIONS.—In this section: Secretary of Health and Human Services in SEC. 1632. PREEMPTION; STATE FLEXIBILITY; (1) CONTRACT.—The term ‘‘contract’’ in- relation to carrying out this part under sec- cludes, with respect to a plan or issuer and a CONSTRUCTION. tions 2706 and 2751 of the Public Health Serv- (a) CONTINUED APPLICABILITY OF STATE treating health care provider, a contract be- ice Act and the Secretary of Labor in rela- LAW WITH RESPECT TO HEALTH INSURANCE tween such plan or issuer and an organized tion to carrying out this part under section ISSUERS.— network of providers that includes the treat- 713 of the Employee Retirement Income Se- (1) IN GENERAL.—Subject to paragraph (2), ing health care provider, and (in the case of curity Act of 1974. this part shall not be construed to supersede such a contract) the contract between the (c) ADDITIONAL DEFINITIONS.—For purposes any provision of State law which establishes, treating health care provider and the orga- of this part: implements, or continues in effect any nized network. (1) APPLICABLE AUTHORITY.—The term ‘‘ap- standard or requirement solely relating to (2) HEALTH CARE PROVIDER.—The term plicable authority’’ means— health insurance issuers (in connection with ‘‘health care provider’’ or ‘‘provider’’ (A) in the case of a group health plan, the group health insurance coverage or other- means— Secretary of Health and Human Services and wise) except to the extent that such standard (A) any individual who is engaged in the the Secretary of Labor; and or requirement prevents the application of a delivery of health care services in a State (B) in the case of a health insurance issuer requirement of this part. and who is required by State law or regula- with respect to a specific provision of this (2) CONTINUED PREEMPTION WITH RESPECT TO tion to be licensed or certified by the State part, the applicable State authority (as de- GROUP HEALTH PLANS.—Nothing in this part to engage in the delivery of such services in fined in section 2791(d) of the Public Health shall be construed to affect or modify the the State; and Service Act), or the Secretary of Health and provisions of section 514 of the Employee Re- (B) any entity that is engaged in the deliv- Human Services, if such Secretary is enforc- tirement Income Security Act of 1974 with ery of health care services in a State and ing such provision under section 2722(a)(2) or respect to group health plans. that, if it is required by State law or regula- 2761(a)(2) of the Public Health Service Act. (3) CONSTRUCTION.—In applying this sec- tion to be licensed or certified by the State (2) ENROLLEE.—The term ‘‘enrollee’’ tion, a State law that provides for equal ac- to engage in the delivery of such services in means, with respect to health insurance cov- cess to, and availability of, all categories of the State, is so licensed. erage offered by a health insurance issuer, an licensed health care providers and services (3) SERIOUS AND COMPLEX CONDITION.—The individual enrolled with the issuer to receive shall not be treated as preventing the appli- term ‘‘serious and complex condition’’ such coverage. cation of any requirement of this part. means, with respect to a participant, bene- (3) GROUP HEALTH PLAN.—The term ‘‘group (b) APPLICATION OF SUBSTANTIALLY COMPLI- ficiary, or enrollee under the plan or cov- health plan’’ has the meaning given such ANT STATE LAWS.— erage— term in section 733(a) of the Employee Re- (1) IN GENERAL.—In the case of a State law (A) in the case of an acute illness, a condi- tirement Income Security Act of 1974, except that imposes, with respect to health insur- tion that is serious enough to require spe- that such term includes a employee welfare ance coverage offered by a health insurance cialized medical treatment to avoid the rea- benefit plan treated as a group health plan issuer and with respect to a group health sonable possibility of death or permanent under section 732(d) of such Act or defined as plan that is a non-Federal governmental harm; or such a plan under section 607(1) of such Act. plan, a requirement that substantially com- (B) in the case of a chronic illness or condi- (4) HEALTH CARE PROFESSIONAL.—The term plies (within the meaning of subsection (c)) tion, is an ongoing special condition (as de- ‘‘health care professional’’ means an indi- with a patient protection requirement (as de- fined in section (b)(2)(B)). vidual who is licensed, accredited, or cer- fined in paragraph (3)) and does not prevent (4) TERMINATED.—The term ‘‘terminated’’ tified under State law to provide specified the application of other requirements under includes, with respect to a contract, the ex- health care services and who is operating this subtitle (except in the case of other sub- piration or nonrenewal of the contract, but within the scope of such licensure, accredita- stantially compliant requirements), in ap- does not include a termination of the con- tion, or certification. plying the requirements of this part under tract for failure to meet applicable quality (5) HEALTH CARE PROVIDER.—The term section 2720 and 2754 (as applicable) of the standards or for fraud. ‘‘health care provider’’ includes a physician Public Health Service Act (as added by part Subpart C—Protecting the Doctor-Patient or other health care professional, as well as II), subject to subsection (a)(2)— Relationship an institutional or other facility or agency (A) the State law shall not be treated as SEC. 1621. PROHIBITION OF INTERFERENCE that provides health care services and that is being superseded under subsection (a); and WITH CERTAIN MEDICAL COMMU- licensed, accredited, or certified to provide (B) the State law shall apply instead of the NICATIONS. health care items and services under applica- patient protection requirement otherwise (a) GENERAL RULE.—The provisions of any ble State law. applicable with respect to health insurance contract or agreement, or the operation of (6) NETWORK.—The term ‘‘network’’ means, coverage and non-Federal governmental any contract or agreement, between a group with respect to a group health plan or health plans.

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(2) LIMITATION.—In the case of a group (ii) promptly publish in the Federal Reg- of subtitle H of title I of the Patient Protec- health plan covered under title I of the Em- ister a notice that a State has submitted a tion and Affordable Care Act, and each ployee Retirement Income Security Act of certification under paragraph (1); health insurance issuer shall comply with 1974, paragraph (1) shall be construed to (iii) promptly publish in the Federal Reg- patient protection requirements under such apply only with respect to the health insur- ister the notice described in clause (i) with part with respect to group health insurance ance coverage (if any) offered in connection respect to the State; and coverage it offers, and such requirements with the plan. (iv) annually publish the status of all shall be deemed to be incorporated into this (3) DEFINITIONS.—In this section: States with respect to certifications. subsection.’’. (A) PATIENT PROTECTION REQUIREMENT.— (4) CONSTRUCTION.—Nothing in this sub- (b) CONFORMING AMENDMENT.—Section The term ‘‘patient protection requirement’’ section shall be construed as preventing the 2721(b)(2)(A) of such Act (42 U.S.C. 300gg– means a requirement under this part, and in- certification (and approval of certification) 21(b)(2)(A)) is amended by inserting ‘‘(other cludes (as a single requirement) a group or of a State law under this subsection solely than section 2720)’’ after ‘‘requirements of related set of requirements under a section because it provides for greater protections such subparts’’. or similar unit under this part. for patients than those protections otherwise SEC. 1642. APPLICATION TO INDIVIDUAL HEALTH (B) SUBSTANTIALLY COMPLIANT.—The terms required to establish substantial compliance. INSURANCE COVERAGE. ‘‘substantially compliant’’, substantially (5) PETITIONS.— Part B of title XXVII of the Public Health complies’’, or ‘‘substantial compliance’’ with (A) PETITION PROCESS.—Effective on the Service Act is amended by inserting after respect to a State law, mean that the State date on which the provisions of this subtitle section 2753 the following new section: law has the same or similar features as the become effective, as provided for in section ‘‘SEC. 2754. PATIENT PROTECTION STANDARDS. patient protection requirements and has a 1652, a group health plan, health insurance ‘‘Each health insurance issuer shall com- similar effect. issuer, participant, beneficiary, or enrollee ply with patient protection requirements (c) DETERMINATIONS OF SUBSTANTIAL COM- may submit a petition to the Secretary for under part I of subtitle H of title I of the Pa- PLIANCE.— an advisory opinion as to whether or not a tient Protection and Affordable Care Act (1) CERTIFICATION BY STATES.—A State may standard or requirement under a State law with respect to individual health insurance submit to the Secretary a certification that applicable to the plan, issuer, participant, coverage it offers, and such requirements a State law provides for patient protections beneficiary, or enrollee that is not the sub- shall be deemed to be incorporated into this that are at least substantially compliant ject of a certification under this subsection, subsection.’’. with one or more patient protection require- is superseded under subsection (a)(1) because SEC. 1643. COOPERATION BETWEEN FEDERAL ments. Such certification shall be accom- such standard or requirement prevents the AND STATE AUTHORITIES. panied by such information as may be re- application of a requirement of this part. Part C of title XXVII of the Public Health quired to permit the Secretary to make the (B) OPINION.—The Secretary shall issue an Service Act (42 U.S.C. 300gg–91 et seq.), as determination described in paragraph (2)(A). advisory opinion with respect to a petition amended by section 1002, is further amended (2) REVIEW.— submitted under subparagraph (A) within the by adding at the end the following: (A) IN GENERAL.—The Secretary shall 60-day period beginning on the date on which ‘‘SEC. 2795. COOPERATION BETWEEN FEDERAL promptly review a certification submitted such petition is submitted. AND STATE AUTHORITIES. under paragraph (1) with respect to a State (d) DEFINITIONS.—For purposes of this sec- ‘‘(a) AGREEMENT WITH STATES.—A State law to determine if the State law substan- tion: may enter into an agreement with the Sec- tially complies with the patient protection (1) STATE LAW.—The term ‘‘State law’’ in- retary for the delegation to the State of requirement (or requirements) to which the cludes all laws, decisions, rules, regulations, some or all of the Secretary’s authority law relates. or other State action having the effect of under this title to enforce the requirements (B) APPROVAL DEADLINES.— law, of any State. A law of the United States applicable under part I of subtitle H of title (i) INITIAL REVIEW.—Such a certification is applicable only to the District of Columbia I of the Patient Protection and Affordable considered approved unless the Secretary no- shall be treated as a State law rather than a Care Act with respect to health insurance tifies the State in writing, within 90 days law of the United States. coverage offered by a health insurance issuer after the date of receipt of the certification, (2) STATE.—The term ‘‘State’’ includes a and with respect to a group health plan that that the certification is disapproved (and the State, the District of Columbia, Puerto Rico, is a non-Federal governmental plan. reasons for disapproval) or that specified ad- the Virgin Islands, Guam, American Samoa, ‘‘(b) DELEGATIONS.—Any department, agen- ditional information is needed to make the the Northern Mariana Islands, any political cy, or instrumentality of a State to which determination described in subparagraph subdivisions of such, or any agency or in- authority is delegated pursuant to an agree- (A). strumentality of such. ment entered into under this section may, if (ii) ADDITIONAL INFORMATION.—With re- SEC. 1633. REGULATIONS. authorized under State law and to the extent spect to a State that has been notified by the The Secretaries of Health and Human consistent with such agreement, exercise the Secretary under clause (i) that specified ad- Services and Labor shall issue such regula- powers of the Secretary under this title ditional information is needed to make the tions as may be necessary or appropriate to which relate to such authority.’’. carry out this part. Such regulations shall be determination described in subparagraph PART III—AMENDMENTS TO THE EM- issued consistent with section 104 of Health (A), the Secretary shall make the determina- PLOYEE RETIREMENT INCOME SECU- Insurance Portability and Accountability tion within 60 days after the date on which RITY ACT OF 1974 such specified additional information is re- Act of 1996. Such Secretaries may promul- SEC. 1651. APPLICATION OF PATIENT PROTEC- ceived by the Secretary. gate any interim final rules as the Secre- taries determine are appropriate to carry out TION STANDARDS TO GROUP (3) APPROVAL.— HEALTH PLANS AND GROUP HEALTH (A) IN GENERAL.—The Secretary shall ap- this part. INSURANCE COVERAGE UNDER THE prove a certification under paragraph (1) un- SEC. 1634. INCORPORATION INTO PLAN OR COV- EMPLOYEE RETIREMENT INCOME less— ERAGE DOCUMENTS. SECURITY ACT OF 1974. (i) the State fails to provide sufficient in- The requirements of this part with respect (a) IN GENERAL.—Subpart B of part 7 of formation to enable the Secretary to make a to a group health plan or health insurance subtitle B of title I of the Employee Retire- determination under paragraph (2)(A); or coverage are deemed to be incorporated into, ment Income Security Act of 1974, as amend- (ii) the Secretary determines that the and made a part of, such plan or the policy, ed by section 1562, is further amended by State law involved does not provide for pa- certificate, or contract providing such cov- adding at the end the following new section: tient protections that substantially comply erage and are enforceable under law as if di- ‘‘SEC. 716. PATIENT PROTECTION STANDARDS. with the patient protection requirement (or rectly included in the documentation of such ‘‘(a) IN GENERAL.—Subject to subsection requirements) to which the law relates. plan or such policy, certificate, or contract. (b), a group health plan (and a health insur- (B) STATE CHALLENGE.—A State that has a PART II—APPLICATION OF QUALITY CARE ance issuer offering group health insurance certification disapproved by the Secretary STANDARDS TO GROUP HEALTH PLANS coverage in connection with such a plan) under subparagraph (A) may challenge such AND HEALTH INSURANCE COVERAGE shall comply with the requirements of part I disapproval in the appropriate United States UNDER THE PUBLIC HEALTH SERVICE of subtitle H of title I of the Patient Protec- district court. ACT tion and Affordable Care Act (as in effect as (C) DEFERENCE TO STATES.—With respect to SEC. 1641. APPLICATION TO GROUP HEALTH of the date of the enactment of such Act), a certification submitted under paragraph PLANS AND GROUP HEALTH INSUR- and such requirements shall be deemed to be (1), the Secretary shall give deference to the ANCE COVERAGE. incorporated into this subsection. State’s interpretation of the State law in- (a) IN GENERAL.—Subpart 2 of part A of ‘‘(b) PLAN SATISFACTION OF CERTAIN RE- volved and the compliance of the law with a title XXVII of the Public Health Service Act, QUIREMENTS.— patient protection requirement. as amended by section 1001, is further ‘‘(1) SATISFACTION OF CERTAIN REQUIRE- (D) PUBLIC NOTIFICATION.—The Secretary amended by adding at the end the following MENTS THROUGH INSURANCE.—For purposes of shall— new section: subsection (a), insofar as a group health plan (i) provide a State with a notice of the de- ‘‘SEC. 2720. PATIENT PROTECTION STANDARDS. provides benefits in the form of health insur- termination to approve or disapprove a cer- ‘‘Each group health plan shall comply with ance coverage through a health insurance tification under this paragraph; patient protection requirements under part I issuer, the plan shall be treated as meeting

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00087 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.075 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12734 CONGRESSIONAL RECORD — SENATE December 8, 2009 the following requirements of part I of sub- the date on which the last of the collective its employees or members shall not be title H of title I of the Patient Protection bargaining agreements relating to the cov- deemed to be a health insurer or a medical and Affordable Care Act with respect to such erage terminates. Any coverage amendment malpractice insurer, provided that this ex- benefits and not be considered as failing to made pursuant to a collective bargaining clusion shall not apply to a separate entity meet such requirements because of a failure agreement relating to the coverage which that issues insurance or to an organization of the issuer to meet such requirements so amends the coverage solely to conform to whose sole or primary membership benefit is long as the plan sponsor or its representa- any requirement added by this section (or insurance.’’. tives did not cause such failure by the issuer: amendments) shall not be treated as a termi- ‘‘(A) Section 1611 (relating to choice of nation of such collective bargaining agree- SA 3068. Mr. KYL (for himself, Mr. health care professional). ment. ROBERTS, Mr. VITTER, Mr. GRASSLEY, ‘‘(B) Section 1612 (relating to access to SEC. 1652. EFFECTIVE DATE. Mr. CRAPO, Mr. COBURN, Mr. BARRASSO, emergency care). This subtitle (and the amendments made and Mr. JOHANNS) submitted an amend- ‘‘(C) Section 1613 (relating to timely access by this subtitle) shall become effective for ment intended to be proposed to to specialists). plan years beginning on or after the date amendment SA 2786 proposed by Mr. ‘‘(D) Section 1614 (relating to access to pe- that is 6 months after the date of enactment REID (for himself, Mr. BAUCUS, Mr. diatric care). of this Act. ‘‘(E) Section 1615 (relating to patient ac- DODD, and Mr. HARKIN) to the bill H.R. cess to obstetrical and gynecological care). SA 3066. Mrs. BOXER submitted an 3590, to amend the Internal Revenue ‘‘(F) Section 1616 (relating to continuity of amendment intended to be proposed to Code of 1986 to modify the first-time care), but only insofar as a replacement amendment SA 2786 proposed by Mr. homebuyers credit in the case of mem- issuer assumes the obligation for continuity REID (for himself, Mr. BAUCUS, Mr. bers of the Armed Forces and certain of care. DODD, and Mr. HARKIN) to the bill H.R. other Federal employees, and for other ‘‘(2) APPLICATION TO PROHIBITIONS.—Pursu- purposes; which was ordered to lie on ant to rules of the Secretary, if a health in- 3590, to amend the Internal Revenue surance issuer offers health insurance cov- Code of 1986 to modify the first-time the table; as follows: erage in connection with a group health plan homebuyers credit in the case of mem- At the appropriate place, insert the fol- and takes an action in violation of section bers of the Armed Forces and certain lowing: 1621 of the Patient Protection and Affordable other Federal employees, and for other SEC. ll. PROHIBITION ON CERTAIN USES OF DATA OBTAINED FROM COMPARA- Care Act (relating to prohibition of inter- purposes; which was ordered to lie on ference with certain medical communica- TIVE EFFECTIVENESS RESEARCH; the table; as follows: ACCOUNTING FOR PERSONALIZED tions), the group health plan shall not be lia- MEDICINE AND DIFFERENCES IN PA- ble for such violation unless the plan caused On page 1907, after line 25, add the fol- lowing: TIENT TREATMENT RESPONSE. such violation. (a) IN GENERAL.—Notwithstanding any ‘‘(P) An entity that is owned or operated ‘‘(3) CONSTRUCTION.—Nothing in this sub- other provision of law, a Federal depart- by a unit of local government which provides section shall be construed to affect or modify ment, office, or representative— mental health or health care services and is the responsibilities of the fiduciaries of a (1) shall not use data obtained from the located in a county in which the rate of group health plan under part 4 of subtitle B. conduct of comparative effectiveness re- uninsurance is above the national rate of ‘‘(4) TREATMENT OF SUBSTANTIALLY COMPLI- search, including such research that is con- uninsurance for the under-65 population, ANT STATE LAWS.—For purposes of applying ducted or supported using funds appropriated based on the best available estimate of the this subsection, any reference in this sub- under the American Recovery and Reinvest- rate of uninsurance published by the Bureau section to a requirement in a section or ment Act of 2009 (Public Law 111–5), to deny of the Census.’’. other provision in subtitle H of title I of the coverage of an item or service under a Fed- Patient Protection and Affordable Care Act SA 3067. Mr. PRYOR (for himself, eral health care program (as defined in sec- with respect to a health insurance issuer is tion 1128B(f) of the Social Security Act (42 deemed to include a reference to a require- Mrs. BOXER, and Mr. ROCKEFELLER) U.S.C. 1320a–7b(f))), including under plans of- ment under a State law that substantially submitted an amendment intended to fered under the Federal Employees Health complies (as determined under section 1632(c) be proposed to amendment SA 2786 pro- Benefits Program (under chapter 89 of title 5, of such Act) with the requirement in such posed by Mr. REID (for himself, Mr. United States Code), or under private health section or other provisions. BAUCUS, Mr. DODD, and Mr. HARKIN) to insurance; and ‘‘(c) CONFORMING REGULATIONS.—The Sec- the bill H.R. 3590, to amend the Inter- (2) shall ensure that comparative effective- retary shall issue regulations to coordinate ness research conducted or supported by the the requirements on group health plans and nal Revenue Code of 1986 to modify the first-time homebuyers credit in the Federal Government accounts for factors health insurance issuers under this section contributing to differences in the treatment with the requirements imposed under the case of members of the Armed Forces response and treatment preferences of pa- other provisions of this title.’’. and certain other Federal employees, tients, including patient-reported outcomes, (b) SATISFACTION OF ERISA CLAIMS PROCE- and for other purposes; which was or- genomics and personalized medicine, the DURE REQUIREMENT.—Section 503 of such Act dered to lie on the table; as follows: unique needs of health disparity populations, (29 U.S.C. 1133) is amended by inserting ‘‘(a)’’ At the appropriate place, insert the fol- and indirect patient benefits. after ‘‘SEC. 503.’’ and by adding at the end lowing: (b) RULE OF CONSTRUCTION.—Nothing in the following new subsection: ll this section shall be construed as affecting ‘‘(b) In the case of a group health plan (as SEC. . FEDERAL TRADE COMMISSION OVER- SIGHT OVER HEALTH INSURANCE the authority of the Commissioner of Food defined in section 733) compliance with the ISSUERS. and Drugs under the Federal Food, Drug, and requirements of subpart A of part I of sub- Section 6 of the Federal Trade Commission Cosmetic Act or the Public Health Service title H of title I of the Patient Protection Act (15 U.S.C. 46) is amended in the undesig- Act. and Affordable Care Act, and compliance nated matter following subsection (l), by (c) PATIENT CENTERED OUTCOMES RESEARCH with regulations promulgated by the Sec- striking ‘‘Nothing’’ and all that follows INSTITUTE BOARD.—Notwithstanding section retary, in the case of a claims denial shall be through ‘‘was made.’’ and inserting the fol- 1181(f)(1)(A) and (B) of the Social Security deemed compliance with subsection (a) with lowing: Act (as added by section 6301(a)), no Federal respect to such claims denial.’’. ‘‘Notwithstanding the Act of March 9, 1945 officer or employee (including Federally (c) CONFORMING AMENDMENTS.—(1) Section (15 U.S.C. 1011 et seq.) and the definition of elected officials and members of Congress) 732(a) of such Act (29 U.S.C. 1185(a)) is corporation in section 4, the Commission shall serve on the Board of Governors of the amended by striking ‘‘section 711’’ and in- may use the authority described in this sec- Patient Centered Outcomes Research Insti- serting ‘‘sections 711 and 716’’. tion to conduct studies, prepare reports, and tute. (2) The table of contents in section 1 of disclose information relating to insurance, such Act is amended by inserting after the without regard to whether the subject of the SA 3069. Mr. KOHL submitted an item relating to section 715 the following study, report, or the information is for-profit amendment intended to be proposed by new item: or not-for-profit. him to the bill H.R. 3590, to amend the ‘‘Sec. 716. Patient protection standards’’. ‘‘Subject to the Act of March 9, 1945 (15 Internal Revenue Code of 1986 to mod- (d) EFFECT ON COLLECTIVE BARGAINING U.S.C. 1011 et seq.) and notwithstanding the ify the first-time homebuyers credit in AGREEMENTS.—In the case of health insur- definition of corporation in section 4, the the case of members of the Armed ance coverage maintained pursuant to one or provisions of this Act shall apply to an in- Forces and certain other Federal em- more collective bargaining agreements be- surer without regard to whether such insurer tween employee representatives and one or is for-profit or not-for-profit. For purposes of ployees, and for other purposes; which more employers that was ratified before the this paragraph, an employer or membership was ordered to lie on the table; as fol- date of enactment of this title, the provi- organization not organized for its own profit lows: sions of this section (and the amendments or that of its members that provides health At the appropriate place, insert the fol- made by this section) shall not apply until care or medical malpractice benefits only to lowing:

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00088 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.075 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12735 TITLE ll—COMBATING ELDER ABUSE House of Representatives, and the Secretary opment, and other types of support to State AND SILVER ALERTS of Health and Human Services, and make prosecutors and courts, employees of State SEC. l11. SHORT TITLE. available to the States, a report that con- Attorneys General, and Medicaid Fraud Con- This title may be cited as the ‘‘Combating tains— trol Units handling elder justice-related Elder Abuse and National Silver Alert Act of (A) the findings of the study conducted matters. 2009’’. under paragraph (1); (b) CREATING SPECIALIZED POSITIONS.— (B) a description of the objectives, prior- Grants under this section may be made for— Subtitle A—Elder Abuse Victims Act of 2009 ities, policies, and a long-term plan devel- (1) the establishment of specially des- SEC. l21. SHORT TITLE. oped under paragraph (2); and ignated elder justice positions or units in This subtitle may be cited as the ‘‘Elder (C) a list, description, and analysis of the State prosecutors’ offices and State courts; Abuse Victims Act of 2009’’. best practices used by States to develop, im- and PART I—ELDER ABUSE VICTIMS plement, maintain, and improve elder justice (2) the creation of a position to coordinate systems, based on such findings. elder justice-related cases, training, tech- SEC. l31. ANALYSIS, REPORT, AND REC- OMMENDATIONS RELATED TO (b) GAO RECOMMENDATIONS.—Not later nical assistance, and policy development for ELDER JUSTICE PROGRAMS. than 18 months after the date of enactment State prosecutors and courts. (a) IN GENERAL.—Subject to the avail- of this Act, the Comptroller General shall re- (c) AUTHORIZATION OF APPROPRIATIONS.— ability of appropriations to carry out this view existing Federal programs and initia- There are authorized to be appropriated to section, the Attorney General, in consulta- tives in the Federal criminal justice system carry out this section $6,000,000 for each of tion with the Secretary of Health and relevant to elder justice and shall submit to the fiscal years 2010 through 2016. Human Services, shall carry out the fol- Congress— SEC. l35. SUPPORTING LAW ENFORCEMENT IN lowing: (1) a report on such programs and initia- ELDER JUSTICE MATTERS. (1) STUDY.—Conduct a study of laws and tives; and (a) IN GENERAL.—Subject to the avail- practices relating to elder abuse, neglect, (2) any recommendations the Comptroller ability of appropriations under this section, and exploitation, which shall include— General determines are appropriate to im- the Attorney General, after consultation (A) a comprehensive description of State prove elder justice in the United States. with the Secretary of Health and Human laws and practices relating to elder abuse, (c) AUTHORIZATION OF APPROPRIATIONS.— Services, the Postmaster General, and the neglect, and exploitation; There are authorized to be appropriated to Chief Postal Inspector for the United States (B) a comprehensive analysis of the effec- carry out this section $6,000,000 for each of Postal Inspection Service, shall award grants tiveness of such State laws and practices; the fiscal years 2010 through 2016. to eligible entities to provide training, tech- and SEC. l32. VICTIM ADVOCACY GRANTS. nical assistance, multidisciplinary coordina- (C) an examination of State laws and prac- (a) GRANTS AUTHORIZED.—The Attorney tion, policy development, and other types of tices relating to specific elder abuse, neglect, General, after consultation with the Sec- support to police, sheriffs, detectives, public and exploitation issues, including— retary of Health and Human Services, may safety officers, corrections personnel, and (i) the definition of— award grants to eligible entities to study the other first responders who handle elder jus- (I) ‘‘elder’’; special needs of victims of elder abuse, ne- tice-related matters, to fund specially des- (II) ‘‘abuse’’; glect, and exploitation. ignated elder justice positions or units de- (III) ‘‘neglect’’; (b) AUTHORIZED ACTIVITIES.—Funds award- signed to support first responders in elder (IV) ‘‘exploitation’’; and ed pursuant to subsection (a) shall be used justice matters. (V) such related terms the Attorney Gen- for pilot programs that— (b) AUTHORIZATION OF APPROPRIATIONS.— eral determines to be appropriate; (1) develop programs for and provide train- There are authorized to be appropriated to (ii) mandatory reporting laws, with respect ing to health care, social, and protective carry out this section $8,000,000 for each of to— services providers, law enforcement, fidu- the fiscal years 2010 through 2016. (I) who is a mandated reporter; ciaries (including guardians), judges and SEC. l36. EVALUATIONS. (II) to whom must they report and within court personnel, and victim advocates; and (a) GRANTS UNDER THIS PART.— what time frame; and (2) examine special approaches designed to (1) IN GENERAL.—In carrying out the grant (III) any consequences for not reporting; meet the needs of victims of elder abuse, ne- programs under this part, the Attorney Gen- (iii) evidentiary, procedural, sentencing, glect, and exploitation. eral shall— choice of remedies, and data retention issues (c) AUTHORIZATION OF APPROPRIATIONS.— (A) require each recipient of a grant to use relating to pursuing cases relating to elder There are authorized to be appropriated to a portion of the funds made available abuse, neglect, and exploitation; carry out this section $3,000,000 for each of through the grant to conduct a validated (iv) laws requiring reporting of all nursing the fiscal years 2010 through 2016. evaluation of the effectiveness of the activi- home deaths to the county coroner or to SEC. l33. SUPPORTING LOCAL PROSECUTORS ties carried out through the grant by such some other individual or entity; AND COURTS IN ELDER JUSTICE recipient; or (v) fiduciary laws, including guardianship MATTERS. (B) as the Attorney General considers ap- and power of attorney laws; (a) GRANTS AUTHORIZED.—Subject to the propriate, use a portion of the funds avail- (vi) laws that permit or encourage banks availability of appropriations under this sec- able under this part for a grant program and bank employees to prevent and report tion, the Attorney General, after consulta- under this part to provide assistance to an suspected elder abuse, neglect, and exploi- tion with the Secretary of Health and eligible entity to conduct a validated evalua- tation; Human Services, shall award grants to eligi- tion of the effectiveness of the activities car- (vii) laws relating to fraud and related ac- ble entities to provide training, technical as- ried out through such grant program by each tivities in connection with mail, tele- sistance, policy development, multidisci- of the grant recipients. marketing, or the Internet; plinary coordination, and other types of sup- (2) APPLICATIONS.— (viii) laws that may impede research on port to local prosecutors and courts handling (A) SUBMISSION.—To be eligible to receive a elder abuse, neglect, and exploitation; elder justice-related cases, including— grant under this part, an entity shall submit (ix) practices relating to the enforcement (1) funding specially designated elder jus- an application to the Attorney General at of laws relating to elder abuse, neglect, and tice positions or units in local prosecutors’ such time, in such manner, and containing exploitation; and offices and local courts; and such information as the Attorney General (x) practices relating to other aspects of (2) funding the creation of a Center for the may require, which shall include— elder justice. Prosecution of Elder Abuse, Neglect, and Ex- (i) a proposal for the evaluation required in (2) DEVELOPMENT OF PLAN.—Develop objec- ploitation to advise and support local pros- accordance with paragraph (1)(A); and tives, priorities, policies, and a long-term ecutors and courts nationwide in the pursuit (ii) the amount of assistance under para- plan for elder justice programs and activities of cases involving elder abuse, neglect, and graph (1)(B) the entity is requesting, if any. relating to— exploitation. (B) REVIEW AND ASSISTANCE.— (A) prevention and detection of elder (b) AUTHORIZATION OF APPROPRIATIONS.— (i) IN GENERAL.—An employee of the De- abuse, neglect, and exploitation; There are authorized to be appropriated to partment of Justice, after consultation with (B) intervention and treatment for victims carry out this section $6,000,000 for each of an employee of the Department of Health of elder abuse, neglect, and exploitation; the fiscal years 2010 through 2016. and Human Services with expertise in eval- (C) training, evaluation, and research re- SEC. l34. SUPPORTING STATE PROSECUTORS uation methodology, shall review each appli- lated to elder justice programs and activi- AND COURTS IN ELDER JUSTICE cation described in subparagraph (A) and de- ties; and MATTERS. termine whether the methodology described (D) improvement of the elder justice sys- (a) IN GENERAL.—Subject to the avail- in the proposal under subparagraph (A)(i) is tem in the United States. ability of appropriations under this section, adequate to gather meaningful information. (3) REPORT.—Not later than 2 years after the Attorney General, after consultation (ii) DENIAL.—If the reviewing employee de- the date of enactment of this Act, submit to with the Secretary of Health and Human termines the methodology described in such the chairman and ranking member of the Services, shall award grants to eligible enti- proposal is inadequate, the reviewing em- Special Committee on Aging of the Senate, ties to provide training, technical assistance, ployee shall recommend that the Attorney and the Speaker and minority leader of the multidisciplinary coordination, policy devel- General deny the application for the grant,

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or make recommendations for how the appli- tity receives a grant under this section the (D) JOB PLACEMENT ASSISTANCE.—A pro- cation should be amended. entity shall provide a record of community gram that provides job placement assistance (iii) NOTICE TO APPLICANT.—If the Attorney coordination or established contacts de- and information on employment, training, or General denies the application on the basis scribed in such paragraph through memo- volunteer opportunities for victims of elder of such proposal, the Attorney General shall randa of understanding, contracts, sub- abuse. inform the applicant of the reasons the ap- contracts, and other such documentation. (E) BEREAVEMENT COUNSELING.—A program plication was denied, and offer assistance to (c) ADMINISTRATIVE PROVISIONS.— that provides bereavement counseling for the applicant in modifying the proposal. (1) CONSULTATION.—Each program estab- families of victims of elder abuse. (b) OTHER GRANTS.—Subject to the avail- lished pursuant to this section shall be de- (F) OTHER SERVICES.—A program that pro- ability of appropriations under this section, veloped and carried out in consultation with vides such other care, services, and assist- the Attorney General shall award grants to the following entities, as appropriate: ance as the entity considers appropriate for appropriate entities to conduct validated (A) Relevant Federal, State, and local pub- purposes of the program. evaluations of grant activities that are fund- lic and private agencies and entities, relat- (f) TECHNICAL ASSISTANCE.—The Director ed by Federal funds not provided under this ing to elder abuse, neglect, and exploitation shall enter into contracts with private enti- part, or other funds, to reduce elder abuse, and other crimes against elderly individuals. ties with experience in elder abuse coordina- neglect, and exploitation. (B) Local law enforcement including po- tion or victim services to provide such tech- (c) AUTHORIZATION OF APPROPRIATIONS.— lice, sheriffs, detectives, public safety offi- nical assistance to grantees under this sec- There are authorized to be appropriated to cers, corrections personnel, prosecutors, tion as the entity determines appropriate. carry out this section $7,000,000 for each of medical examiners, investigators, and coro- (g) REPORTS TO CONGRESS.—Not later than the fiscal years 2010 through 2016. ners. 12 months after the commencement of the SEC. l37. DEFINITIONS. (C) Long-term care and nursing facilities. Program, and annually thereafter, the entity In this part: (2) GRANT PERIOD.—Grants under the Pro- shall submit a report to the Chairman and (1) ELDER.—The term ‘‘elder’’ means an in- gram shall be issued for a three-year period. Ranking Member of the Committee on the dividual age 60 or older. (3) LOCATIONS.—The Program shall be car- Judiciary of the House of Representatives, and the Chairman and Ranking Member of (2) ELDER JUSTICE.—The term ‘‘elder jus- ried out in six geographically and demo- tice’’ means— graphically diverse locations, taking into ac- the Special Committee on Aging of the Sen- (A) from a societal perspective, efforts to— count— ate. Each report shall include the following: (i) prevent, detect, treat, intervene in, and (A) the number of elderly individuals resid- (1) A description and assessment of the im- prosecute elder abuse, neglect, and exploi- ing in or near an area; and plementation of the Program. tation; and (B) the difficulty of access to immediate (2) An assessment of the effectiveness of (ii) protect elders with diminished capacity short-term housing and health services for the Program in providing care and services while maximizing their autonomy; and victims of elder abuse. to seniors, including a comparative assess- (d) PERSONNEL.—In providing care and (B) from an individual perspective, the rec- ment of effectiveness for each of the loca- services, each program established pursuant ognition of an elder’s rights, including the tions designated under subsection (c)(3) for to this section may employ a staff to assist right to be free of abuse, neglect, and exploi- the Program. in creating an Emergency Crisis Response tation. (3) An assessment of the effectiveness of Teams under subsection (e)(1). the coordination for programs described in (3) ELIGIBLE ENTITIES.—The term ‘‘eligible (e) USE OF GRANTS.— subsection (e) in contributing toward the ef- entity’’ means a State or local government (1) EMERGENCY CRISIS RESPONSE TEAM.— agency, Indian tribe or tribal organization, fectiveness of the Program. Each entity that receives a grant under this (4) Such recommendations as the entity or any other public or nonprofit private enti- section shall use such grant to establish an ty that is engaged in and has expertise in considers appropriate for modifications of Emergency Crisis Response Team program the Program in order to better provide care issues relating to elder justice or a field nec- by not later than the date that is six months essary to promote elder justice efforts. and services to seniors. after the entity receives the grant. Under (h) DEFINITIONS.—For purposes of this sec- PART II—ELDER SERVE VICTIM GRANT such program the following shall apply: tion: PROGRAMS (A) Such program shall include immediate, (1) ELDER ABUSE.—The term ‘‘elder abuse’’ SEC. l41. ESTABLISHMENT OF ELDER SERVE short-term emergency services, including means any type of violence or abuse, wheth- VICTIM GRANT PROGRAMS. shelter, care services, food, clothing, trans- er mental or physical, inflicted upon an el- (a) ESTABLISHMENT.—The Attorney Gen- portation to medical or legal appointment as derly individual, and any type of criminal fi- eral, acting through the Director of the Of- appropriate, and any other life services nancial exploitation of an elderly individual. fice of Victims of Crime of the Department deemed necessary by the entity for victims (2) ELDERLY INDIVIDUAL.—The term ‘‘elder- of Justice (in this section referred to as the of elder abuse. ly individual’’ means an individual who is ‘‘Director’’), shall, subject to appropriations, (B) Such program shall provide services to age 60 or older. carry out a three-year grant program to be victims of elder abuse, including those who (i) AUTHORIZATION OF APPROPRIATIONS.— known as the Elder Serve Victim grant pro- have been referred to the program through There is authorized to be appropriated for gram (in this section referred to as the ‘‘Pro- the adult protective services agency of the the Department of Justice to carry out this gram’’) to provide grants to eligible entities local law enforcement or any other relevant section $3,000,000 for each of the fiscal years to establish programs to facilitate and co- law enforcement or referral agency. 2010 through 2012. ordinate programs described in subsection (C) A victim of elder abuse may not receive Subtitle B—National Silver Alert (e) for victims of elder abuse. short-term housing under the program for SEC. l51. SHORT TITLE. (b) ELIGIBILITY REQUIREMENTS FOR GRANT- more than 30 consecutive days. This subtitle may be cited as the ‘‘Na- EES.—To be eligible to receive a grant under (D) The entity that established the pro- tional Silver Alert Act’’. the Program, an entity must meet the fol- gram shall enter into arrangements with the SEC. l52. DEFINITIONS. lowing criteria: relevant local law enforcement agencies so For purposes of this subtitle: (1) ELIGIBLE CRIME VICTIM ASSISTANCE PRO- that the program receives quarterly reports (1) STATE.—The term ‘‘State’’ means each GRAM.—The entity is a crime victim assist- from such agencies on elder abuse. of the 50 States, the District of Columbia, ance program receiving a grant under the (2) ADDITIONAL SERVICES REQUIRED TO BE the Commonwealth of Puerto Rico, the Victims of Crime Act of 1984 (42 U.S.C. 1401 PROVIDED.—Not later than one year after the United States Virgin Islands, Guam, Amer- et seq.) for the period described in subsection date an entity receives a grant under this ican Samoa, and the Commonwealth of the (c)(2) with respect to the grant sought under section, such entity shall have established Northern Mariana Islands. this section. the following programs (and community col- (2) MISSING SENIOR.—The term ‘‘missing (2) COORDINATION WITH LOCAL COMMUNITY laborations to support such programs): senior’’ refers to any individual who— BASED AGENCIES AND SERVICES.—The entity (A) COUNSELING.—A program that provides (A) is reported to, or identified by, a law shall demonstrate to the satisfaction of the counseling and assistance for victims of enforcement agency as a missing person; and Director that such entity has a record of elder abuse accessing health care, edu- (B) meets the requirements to be des- community coordination or established con- cational, pension, or other benefits for which ignated as a missing senior, as determined tacts with other county and local services seniors may be eligible under Federal or ap- by the State in which the individual is re- that serve elderly individuals. plicable State law. ported or identified as a missing person. (3) ABILITY TO CREATE ECRT ON TIMELY (B) MENTAL HEALTH SCREENING.—A pro- SEC. l53. SILVER ALERT COMMUNICATIONS NET- BASIS.—The entity shall demonstrate to the gram that provides mental health screenings WORK. satisfaction of the Director the ability of the for victims of elder abuse to identify and The Attorney General shall, subject to the entity to create, not later than 6 months seek assistance for potential mental health availability of appropriations under section after receiving such grant, an Emergency disorders such as depression or substance l57, establish a national Silver Alert com- Crisis Response Team program described in abuse. munications network within the Department subsection (e)(1) and the programs described (C) EMERGENCY LEGAL ADVOCACY.—A pro- of Justice to provide assistance to regional in subsection (e)(2). gram that provides legal advocacy for vic- and local search efforts for missing seniors For purposes of meeting the criteria de- tims of elder abuse and, as appropriate, their through the initiation, facilitation, and pro- scribed in paragraph (2), for each year an en- families. motion of local elements of the network

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(A) the development of the network; and health care needs) are disseminated to the (a) NATIONAL COORDINATOR WITHIN DEPART- (B) regional coordination of alerts for appropriate law enforcement, public health, MENT OF JUSTICE.—The Attorney General missing seniors through the network. and other public officials. shall designate an individual of the Depart- (c) COORDINATION.— (3) GEOGRAPHIC AREAS.—The minimum ment of Justice to act as the national coor- (1) COORDINATION WITH OTHER AGENCIES.— standards shall, to the maximum extent dinator of the Silver Alert communications The Coordinator shall coordinate and con- practicable (as determined by the Coordi- network. The individual so designated shall sult with the Secretary of Transportation, nator in consultation with State and local be known as the Silver Alert Coordinator of the Federal Communications Commission, law enforcement agencies), provide that the the Department of Justice (referred to in the Assistant Secretary for Aging of the De- dissemination of an alert through the Silver this subtitle as the ‘‘Coordinator’’). partment of Health and Human Services, the Alert communications network be limited to (b) DUTIES OF THE COORDINATOR.—In acting head of the Missing Alzheimer’s Disease Pa- the geographic areas which the missing sen- as the national coordinator of the Silver tient Alert Program, and other appropriate ior could reasonably reach, considering the Alert communications network, the Coordi- offices of the Department of Justice in car- missing senior’s circumstances and physical nator shall— rying out activities under this subtitle. and mental condition, the modes of transpor- (1) work with States to encourage the de- (2) STATE AND LOCAL COORDINATION.—The tation available to the missing senior, and velopment of additional Silver Alert plans in Coordinator shall consult with local broad- the circumstances of the disappearance. the network; casters and State and local law enforcement (4) AGE REQUIREMENTS.—The minimum (2) establish voluntary guidelines for agencies in establishing minimum standards standards shall not include any specific age States to use in developing Silver Alert under section l55 and in carrying out other requirement for an individual to be classified plans that will promote compatible and inte- activities under this subtitle, as appropriate. as a missing senior for purposes of the Silver grated Silver Alert plans throughout the (d) ANNUAL REPORTS.—Not later than one Alert communication network. Age require- United States, including— year after the date of enactment of this Act, ments for determinations of whether an indi- (A) a list of the resources necessary to es- and annually thereafter, the Coordinator vidual is a missing senior shall be deter- tablish a Silver Alert plan; shall submit to Congress a report on the ac- mined by each State, and may vary from (B) criteria for evaluating whether a situa- tivities of the Coordinator and the effective- tion warrants issuing a Silver Alert, taking State to State. ness and status of the Silver Alert plans of (5) PRIVACY AND CIVIL LIBERTIES PROTEC- into consideration the need for the use of each State that has established or is in the such Alerts to be limited in scope because TIONS.—The minimum standards shall— process of establishing such a plan. Each (A) ensure that alerts issued through the the effectiveness of the Silver Alert commu- such report shall include— nications network may be affected by over- Silver Alert communications network com- (1) a list of States that have established ply with all applicable Federal, State, and use, including criteria to determine— Silver Alert plans; (i) whether the mental capacity of a senior local privacy laws and regulations; and (2) a list of States that are in the process (B) include standards that specifically pro- who is missing, and the circumstances of his of establishing Silver Alert plans; or her disappearance, warrant the issuance a vide for the protection of the civil liberties (3) for each State that has established such and sensitive medical information of missing Silver Alert; and a plan, to the extent the data is available— (ii) whether the individual who reports seniors. (A) the number of Silver Alerts issued; (6) STATE AND LOCAL VOLUNTARY COORDINA- that a senior is missing is an appropriate and (B) the number of individuals located suc- credible source on which to base the issuance TION.—In carrying out the activities under cessfully; subsection (a), the Coordinator may not of a Silver Alert; (C) the average period of time between the (C) a description of the appropriate uses of interfere with the current system of vol- issuance of a Silver Alert and the location of the Silver Alert name to readily identify the untary coordination between local broad- the individual for whom such Alert was nature of search efforts for missing seniors; casters and State and local law enforcement issued; and agencies for purposes of the Silver Alert (D) the State agency or authority issuing (D) recommendations on how to protect communications network. Silver Alerts, and the process by which Sil- the privacy, dignity, independence, and au- ver Alerts are disseminated; SEC. l56. TRAINING AND OTHER RESOURCES. tonomy of any missing senior who may be (E) the cost of establishing and operating the subject of a Silver Alert; (a) TRAINING AND EDUCATIONAL PRO- such a plan; (3) develop proposed protocols for efforts to GRAMS.—The Coordinator shall make avail- (F) the criteria used by the State to deter- recover missing seniors and to reduce the able to States, units of local government, mine whether to issue a Silver Alert; and number of seniors who are reported missing, (G) the extent to which missing individuals law enforcement agencies, and other con- including protocols for procedures that are for whom Silver Alerts were issued crossed cerned entities that are involved in initi- needed from the time of initial notification State lines; ating, facilitating, or promoting Silver Alert of a law enforcement agency that the senior (4) actions States have taken to protect plans, including broadcasters, first respond- is missing through the time of the return of the privacy and dignity of the individuals for ers, dispatchers, public safety communica- the senior to family, guardian, or domicile, whom Silver Alerts are issued; tions personnel, and radio station per- as appropriate, including— (5) ways that States have facilitated and sonnel— (A) public safety communications protocol; improved communication about missing in- (1) training and educational programs re- (B) case management protocol; dividuals between families, caregivers, law lated to the Silver Alert communication net- (C) command center operations; enforcement officials, and other authorities; work and the capabilities, limitations, and (D) reunification protocol; and and anticipated behaviors of missing seniors, (E) incident review, evaluation, debriefing, (6) any other information the Coordinator which shall be updated regularly to encour- and public information procedures; determines to be appropriate. age the use of new tools, technologies, and (4) work with States to ensure appropriate SEC. l55. MINIMUM STANDARDS FOR ISSUANCE resources in Silver Alert plans; and regional coordination of various elements of AND DISSEMINATION OF ALERTS (2) informational materials, including bro- the network; THROUGH SILVER ALERT COMMU- chures, videos, posters, and websites to sup- (5) establish an advisory group to assist NICATIONS NETWORK. port and supplement such training and edu- States, units of local government, law en- (a) ESTABLISHMENT OF MINIMUM STAND- cational programs. forcement agencies, and other entities in- ARDS.—Subject to subsection (b), the Coordi- volved in the Silver Alert communications nator shall establish minimum standards (b) COORDINATION.—The Coordinator shall network with initiating, facilitating, and for— coordinate— promoting Silver Alert plans, which shall in- (1) the issuance of alerts through the Sil- (1) with the Assistant Secretary for Aging clude— ver Alert communications network; and of the Department of Health and Human (A) to the maximum extent practicable, (2) the extent of the dissemination of alerts Services in developing the training and edu- representation from the various geographic issued through the network. cational programs and materials under sub- regions of the United States; and (b) LIMITATIONS.— section (a); and (B) members who are— (1) VOLUNTARY PARTICIPATION.—The min- (2) with the head of the Missing Alz- (i) representatives of senior citizen advo- imum standards established under sub- heimer’s Disease Patient Alert Program cacy groups, law enforcement agencies, and section (a) of this section, and any other within the Department of Justice, to deter- public safety communications; guidelines and programs established under mine if any existing material with respect to (ii) broadcasters, first responders, dis- section l54, shall be adoptable on a vol- training programs or educational materials patchers, and radio station personnel; and untary basis only. developed or used as subtitle of such Patient (iii) representatives of any other individ- (2) DISSEMINATION OF INFORMATION.—The Alert Program are appropriate and may be uals or organizations that the Coordinator minimum standards shall, to the maximum used for the programs under subsection (a).

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DRUGS AS COVERED MEDICARE PART D DRUGS. the Department of Justice such sums as may (3) In most cases, families and local law en- (a) ELIMINATION OF MEDICAID EXCLUSION.— be necessary to carry out the Silver Alert forcement officials have neither the re- Section 1927(d)(2)(A) of the Social Security communications network as authorized sources nor the expertise to undertake ap- Act (42 U.S.C. 1396r-8(d)(2)(A)) is amended by under this subtitle. propriate search efforts for a missing adult. inserting ‘‘, other than prescription weight SEC. l58. GRANT PROGRAM FOR SUPPORT OF (4) The search for a missing adult requires loss agents approved by the Food and Drug SILVER ALERT PLANS. cooperation and coordination among Fed- Administration when used for obese patients (a) GRANT PROGRAM.—Subject to the avail- eral, State, and local law enforcement agen- or for overweight patients with a weight-re- ability of appropriations to carry out this cies and assistance from distant commu- lated co-morbidity, such as hypertension, section, the Attorney General shall carry nities where the adult may be located. type 2 diabetes, or dyslipidemia’’ after out a program to provide grants to States for (5) Federal assistance is urgently needed to ‘‘weight gain’’. the development and enhancement of pro- help with coordination among such agencies. grams and activities for the support of Silver (b) INCLUSION OF COVERAGE UNDER MEDI- Alert plans and the Silver Alert communica- SEC. l63. GRANTS FOR THE ASSISTANCE OF OR- CARE PART D.—Section 1860D-2(e)(1) of the tions network. GANIZATIONS TO FIND MISSING Social Security Act (42 U.S.C. 1395w-102(e)(1)) ADULTS. (b) ACTIVITIES.—Activities funded by is amended in the flush matter after and grants under the program under subsection (a) GRANTS.— below subparagraph (B), by inserting ‘‘and (a) may include— (1) GRANT PROGRAM.—Subject to the avail- prescription weight loss agents approved by (1) the development and implementation of ability of appropriations to carry out this the Food and Drug Administration when education and training programs, and associ- section, the Attorney General shall make used for obese patients or for overweight pa- ated materials, relating to Silver Alert competitive grants to public agencies or tients with a weight-related co-morbidity plans; nonprofit private organizations, or combina- such as hypertension, type 2 diabetes or (2) the development and implementation of tions thereof, to— dyslipidemia,’’ before the period. law enforcement programs, and associated (A) maintain a national resource center (c) EFFECTIVE DATE.—The amendments equipment, relating to Silver Alert plans; and information clearinghouse for missing made by this section shall apply to services (3) the development and implementation of and unidentified adults; furnished on or after January 1, 2011. new technologies to improve Silver Alert (B) maintain a national, interconnected communications; and database for the purpose of tracking missing SA 3071. Mrs. HAGAN submitted an (4) such other activities as the Attorney adults who are determined by law enforce- amendment intended to be proposed to General considers appropriate for supporting ment to be endangered due to age, dimin- amendment SA 2786 proposed by Mr. the Silver Alert communications network. ished mental capacity, or the circumstances REID (for himself, Mr. BAUCUS, Mr. (c) FEDERAL SHARE.—The Federal share of of disappearance, when foul play is suspected DODD, and Mr. HARKIN) to the bill H.R. the cost of any activities funded by a grant or circumstances are unknown; 3590, to amend the Internal Revenue under the program under subsection (a) may (C) coordinate public and private programs Code of 1986 to modify the first-time that locate or recover missing adults or re- not exceed 50 percent. homebuyers credit in the case of mem- (d) DISTRIBUTION OF GRANTS ON GEOGRAPHIC unite missing adults with their families; BASIS.—The Attorney General shall, to the (D) provide assistance and training to law bers of the Armed Forces and certain maximum extent practicable, ensure the dis- enforcement agencies, State and local gov- other Federal employees, and for other tribution of grants under the program under ernments, elements of the criminal justice purposes; which was ordered to lie on subsection (a) on an equitable basis through- system, nonprofit organizations, and individ- the table; as follows: out the various regions of the United States. uals in the prevention, investigation, pros- On page 861, between lines 19 and 20, insert (e) ADMINISTRATION.—The Attorney Gen- ecution, and treatment of cases involving the following: eral shall prescribe requirements, including missing adults; SEC. 3137A. TREATMENT OF CERTAIN MEDICARE application requirements, for grants under (E) provide assistance to families in locat- GEOGRAPHIC CLASSIFICATION RE- the program under subsection (a). ing and recovering missing adults; and VIEW BOARD (MGCRB) RECLASSI- (f) AUTHORIZATION OF APPROPRIATIONS.— (F) assist in public notification and victim FICATIONS. (1) There is authorized to be appropriated advocacy related to missing adults. (a) IN GENERAL.—Notwithstanding any to the Department of Justice $5,000,000 for (2) APPLICATIONS.—The Attorney General other provision of law, for purposes of mak- each of the fiscal years 2010 through 2014 to shall periodically solicit applications for ing payments under Section 1886(d) of the carry out this section and, in addition, grants under this section by publishing a re- Social Security Act (42 U.S.C. 1395 ww (d)), $5,000,000 for each of the fiscal years 2010 quest for applications in the Federal Reg- the Secretary of Health and Human Services through 2014 to carry out subsection (b)(3). ister and by posting such a request on the shall permit any hospital with Medicare Geo- (2) Amounts appropriated pursuant to the website of the Department of Justice. graphic Classification Review Board reclassi- authorization of appropriations in paragraph (b) OTHER DUTIES.—The Attorney General fications that overlap for one fiscal year (1) shall remain available until expended. shall— with the option to continue year three of the SEC. l59. SAMMY KIRK VOLUNTARY ELECTRONIC (1) coordinate programs relating to missing earlier reclassification while waiving year MONITORING PROGRAM. adults that are funded by the Federal Gov- one of the subsequent reclassification. Such (a) PROGRAM AUTHORIZED.—The Attorney ernment; and option shall be in addition to the option to General, after consultation with the Sec- (2) encourage coordination between State immediately transition to year one of the retary of Health and Human Services, is au- and local law enforcement and public agen- subsequent reclassification with the loss of thorized to award grants to States and units cies and nonprofit private organizations re- year three of the earlier reclassification. of local government to carry out programs ceiving a grant pursuant to subsection (a). (b) APPLICATION.— to provide voluntary electronic monitoring (1) IN GENERAL.—Subsection (a) shall apply services to elderly individuals to assist in SEC. l64. AUTHORIZATION OF APPROPRIATIONS. to discharges occurring on or after October 1, the location of such individuals if such indi- There are authorized to be appropriated to 2009. viduals are reported as missing. carry out this subtitle $4,000,000 for each of (2) SPECIAL RULE FOR FY 2010.—In the case of (b) AUTHORIZATION OF APPROPRIATIONS.— fiscal years 2010 through 2020. any hospital whose year three Medicare Geo- There are authorized to be appropriated to graphic Classification Review Board reclassi- carry out this section $2,000,000 for each of fication was lost or eliminated for fiscal 2010, the fiscal years 2010 through 2014. SA 3070. Mrs. HAGAN submitted an the Secretary of Health and Human Services (c) DESIGNATION.—The grant program au- amendment intended to be proposed to shall establish a process under which such thorized under this section shall be referred amendment SA 2786 proposed by Mr. hospital shall have 30 days from the date of to as the ‘‘Sammy Kirk Voluntary Elec- REID (for himself, Mr. BAUCUS, Mr. the enactment of this Act to notify the Sec- tronic Monitoring Program’’. DODD, and Mr. HARKIN) to the bill H.R. retary of the hospital’s election to continue Subtitle C—Kristen’s Act Reauthorization 3590, to amend the Internal Revenue for fiscal 2010 the third year of their earlier Medicare Geographic Classification Review SEC. l61. SHORT TITLE. Code of 1986 to modify the first-time Board reclassification. This subtitle may be cited as ‘‘Kristen’s homebuyers credit in the case of mem- Act Reauthorization of 2009’’. bers of the Armed Forces and certain SA 3072. Mrs. HAGAN submitted an SEC. l62. FINDINGS. other Federal employees, and for other amendment intended to be proposed to Congress finds the following: purposes; which was ordered to lie on amendment SA 2786 proposed by Mr. (1) Every year thousands of adults become the table; as follows: missing due to advanced age, diminished REID (for himself, Mr. BAUCUS, Mr. mental capacity, or foul play. Often there is On page 510, between lines 9 and 10, insert DODD, and Mr. HARKIN) to the bill H.R. no information regarding the whereabouts of the following: 3590, to amend the Internal Revenue

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00092 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.077 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12739 Code of 1986 to modify the first-time SEC. l. ADULT DAY HEALTH CARE SERVICES. Title III of the Public Health Service Act (42 homebuyers credit in the case of mem- (a) IN GENERAL.—The Secretary of Health U.S.C. 241 et seq.), as amended by section bers of the Armed Forces and certain and Human Services shall not— 4303, is further amended by adding at the end other Federal employees, and for other (1) withhold, suspend, disallow, or other- the following: wise deny Federal financial participation ‘‘PART V—PROGRAMS RELATING TO purposes; which was ordered to lie on under section 1903(a) of the Social Security the table; as follows: CONGENITAL HEART DISEASE Act (42 U.S.C. 1396b(a)) for the provision of ‘‘SEC. 399NN-1. PUBLIC EDUCATION AND AWARE- On page 1255, line 14, after the first period adult day health care services, day activity NESS OF CONGENITAL HEART DIS- insert the following: and health services, or adult medical day EASE. ‘‘SEC. 399MM–4. WORKPLACE DISEASE MANAGE- care services, as defined under a State Med- ‘‘(a) IN GENERAL.—The Secretary, acting MENT AND WELLNESS PUBLIC-PRI- icaid plan approved during or before 1994, through the Director of the Centers for Dis- VATE PARTNERSHIP. during such period if such services are pro- ease Control and Prevention and in collabo- ‘‘(a) IN GENERAL.—The Secretary, in co- vided consistent with such definition and the ration with appropriate congenital heart dis- ordination with the Secretary of Labor, the requirements of such plan; or ease patient organizations and professional Secretary of the Treasury, the Secretary of (2) withdraw Federal approval of any such organizations, may directly or through Commerce, the Administrator of the Small State plan or part thereof regarding the pro- grants, cooperative agreements, or contracts Business Administration, employers (includ- vision of such services (by regulation or oth- to eligible entities conduct, support, and pro- ing small, medium, and large employers), erwise). mote a comprehensive public education and employer organizations, worksite health pro- (b) EFFECTIVE DATE.—Subsection (a) shall awareness campaign to increase public and motion organizations, State and local health apply with respect to services provided on or medical community awareness regarding departments, Indian tribes and tribal organi- after October 1, 2008. congenital heart disease, including the need zations, and academic institutions, shall pro- for life-long treatment of congenital heart vide for the implementation of a national SA 3074. Mrs. FEINSTEIN submitted disease survivors. public-private partnership to— an amendment intended to be proposed ‘‘(b) ELIGIBILITY FOR GRANTS.—To be eligi- ‘‘(1) promote the benefits of workplace to amendment SA 2786 proposed by Mr. ble to receive a grant, cooperative agree- wellness programs; ment, or contract under this section, an en- REID (for himself, Mr. BAUCUS, Mr. ‘‘(2) understand what types of disease pre- tity shall be a State or private nonprofit en- vention and workplace wellness programs DODD, and Mr. HARKIN) to the bill H.R. tity and shall submit to the Secretary an ap- are effective, considering different environ- 3590, to amend the Internal Revenue plication at such time, in such manner, and ments, factors, and circumstances; Code of 1986 to modify the first-time containing such information as the Sec- ‘‘(3) understand the obstacles to the imple- homebuyers credit in the case of mem- retary may require.’’. mentation of disease prevention and work- bers of the Armed Forces and certain ‘‘SEC. 399NN-2. NATIONAL CONGENITAL HEART place wellness programs, issues relating to other Federal employees, and for other DISEASE REGISTRY. employer size and resources, and best prac- purposes; which was ordered to lie on ‘‘(a) IN GENERAL.—The Secretary, acting tices for the scalable implementation of such through the Director of the Centers for Dis- programs; the table; as follows: ease Control and Prevention, may— ‘‘(4) understand what factors influence em- On page 453, between lines 5 and 6, insert ‘‘(1) enhance and expand infrastructure to ployees to participate in workplace disease the following: track the epidemiology of congenital heart prevention and wellness programs; SEC. 2203. PERMITTING LOCAL PUBLIC AGENCIES disease and to organize such information ‘‘(5) emphasize an integrated and coordi- TO ACT AS MEDICAID ENROLLMENT into a nationally-representative surveillance nated approach to workplace disease man- BROKERS. system with development of a population- agement and wellness programs; Section 1903(b)(4) of the Social Security based registry of actual occurrences of con- ‘‘(6) ensure informed decisions through the Act (42 U.S.C. 1396b(b)(4)) is amended by add- genital heart disease, to be known as the sharing of high quality information and best ing at the end the following new subpara- ‘National Congenital Heart Disease Reg- practices; and graph: istry’; or ‘‘(7) recommend policies to encourage or ‘‘(C)(i) Subparagraphs (A) and (B) shall not ‘‘(2) award a grant to one eligible entity to stimulate the utilization of worksite disease apply in the case of a local public agency undertake the activities described in para- management and wellness programs, includ- that is acting as an enrollment broker under graph (1). ing specific recommendations as to the types a contract or memorandum with a State ‘‘(b) PURPOSE.—The purpose of the Con- of technical and other assistance that may medicaid agency, provided the local public genital Heart Disease Registry shall be to fa- be necessary to fully implement section agency does not have a direct or indirect fi- cilitate further research into the types of 399MM. nancial interest with any medicaid managed health services patients use and to identify ‘‘(b) REPORT.—Not later than 180 days after care plan for which it provides enrollment possible areas for educational outreach and the date of enactment of this Act, the Sec- broker services. prevention in accordance with standard prac- retary shall submit to the Committee on ‘‘(ii) In determining whether a local public tices of the Centers for Disease Control and Health, Education, Labor, and Pensions of agency has a direct or indirect financial in- Prevention. the Senate and the Committee on Energy terest with a medicaid managed care plan ‘‘(c) CONTENT.—The Congenital Heart Dis- and Commerce of the House of Representa- under clause (i), the status of a local public ease Registry— tives, a report that contains— agency as a contractor of the plan does not ‘‘(1) may include information concerning ‘‘(1) the findings of the public-private part- constitute having a direct or indirect finan- the incidence and prevalence of congenital nership implemented under subsection (a); cial interest with the plan.’’. heart disease in the United States; and ‘‘(2) may be used to collect and store data ‘‘(2) recommendations for statutory SA 3075. Mr. DURBIN submitted an on congenital heart disease, including data changes that may be required or useful to amendment intended to be proposed to concerning— implement the findings described in para- amendment SA 2786 proposed by Mr. ‘‘(A) demographic factors associated with graph (1) and to encourage the development REID (for himself, Mr. BAUCUS, Mr. congenital heart disease, such as age, race, of worksite disease management and ethnicity, sex, and family history of individ- DODD, and Mr. HARKIN) to the bill H.R. wellness programs. uals who are diagnosed with the disease; ‘‘(c) RECOMMENDATIONS BY CDC.—The Di- 3590, to amend the Internal Revenue ‘‘(B) risk factors associated with the dis- rector of the Centers for Disease Control and Code of 1986 to modify the first-time ease; Prevention shall collect information con- homebuyers credit in the case of mem- ‘‘(C) causation of the disease; cerning workplace wellness programs and bers of the Armed Forces and certain ‘‘(D) treatment approaches; and make recommendations to the Secretary on other Federal employees, and for other ‘‘(E) outcome measures, such that analysis ways to improve such programs.’’. purposes; which was ordered to lie on of the outcome measures will allow deriva- the table; as follows: tion of evidence-based best practices and SA 3073. Mrs. FEINSTEIN submitted guidelines for congenital heart disease pa- On page 1266, between lines 17 and 18, insert an amendment intended to be proposed tients; and the following: by her to the bill H.R. 3590, to amend ‘‘(3) may ensure the collection and analysis the Internal Revenue Code of 1986 to Subtitle F—Programs Relating to Congenital of longitudinal data related to individuals of modify the first-time homebuyers cred- Heart Disease all ages with congenital heart disease, in- it in the case of members of the Armed SEC. 4501. PROGRAMS RELATING TO CON- cluding infants, young children, adolescents, Forces and certain other Federal em- GENITAL HEART DISEASE. and adults of all ages. (a) SHORT TITLE.—This subtitle may be ‘‘(d) COORDINATION WITH FEDERAL, STATE, ployees, and for other purposes; which cited as the ‘‘Congenital Heart Futures Act’’. AND LOCAL REGISTRIES.—In establishing the was ordered to lie on the table; as fol- (b) PROGRAMS RELATING TO CONGENITAL National Congenital Heart Registry, the Sec- lows: HEART DISEASE.— retary may identify, build upon, expand, and At the appropriate place, insert the fol- (1) PUBLIC EDUCATION AND AWARENESS; NA- coordinate among existing data and surveil- lowing: TIONAL REGISTRY; ADVISORY COMMITTEE.— lance systems, surveys, registries, and other

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00093 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.079 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12740 CONGRESSIONAL RECORD — SENATE December 8, 2009 Federal public health infrastructure, includ- the Secretary concerning the information cessation agents approved by the Food and ing— described in subsection (c), including rec- Drug Administration) for cessation of to- ‘‘(1) State birth defects surveillance sys- ommendations with respect to the results of bacco use by individuals who use tobacco tems; the Advisory Committee’s review of such in- products or who are being treated for to- ‘‘(2) the State birth defects tracking sys- formation.’’. bacco use that is furnished— tems of the Centers for Disease Control and (2) CONGENITAL HEART DISEASE RESEARCH.— ‘‘(A) by or under the supervision of a physi- Prevention; Subpart 2 of part C of title IV of the Public cian; or ‘‘(3) the Metropolitan Atlanta Congenital Health Service Act (42 U.S.C. 285b et seq.) is ‘‘(B) by any other health care professional Defects Program; and amended by adding at the end the following: who— ‘‘(4) the National Birth Defects Prevention ‘‘SEC. 425. CONGENITAL HEART DISEASE. ‘‘(i) is legally authorized to furnish such Network. ‘‘(a) IN GENERAL.—The Director of the In- services under State law (or the State regu- ‘‘(e) PUBLIC ACCESS.—The Congenital Heart stitute may expand, intensify, and coordi- latory mechanism provided by State law) of Disease Registry shall be made available to nate research and related activities of the the State in which the services are fur- the public, as appropriate, including con- Institute with respect to congenital heart nished; and genital heart disease researchers. disease, which may include congenital heart ‘‘(ii) is authorized to receive payment for ‘‘(f) PATIENT PRIVACY.—The Secretary disease research with respect to— other services under this title or is des- shall ensure that the Congenital Heart Dis- ‘‘(1) causation of congenital heart disease, ignated by the Secretary for this purpose. ease Registry is maintained in a manner including genetic causes; ‘‘(2) Subject to paragraph (3), such term is that complies with the regulations promul- ‘‘(2) long-term outcomes in individuals limited to— gated under section 264 of the Health Insur- with congenital heart disease, including in- ‘‘(A) services recommended with respect to ance Portability and Accountability Act of fants, children, teenagers, adults, and elderly individuals in ‘Treating Tobacco Use and De- 1996. individuals; pendence: 2008 Update: A Clinical Practice ‘‘(g) ELIGIBILITY FOR GRANT.—To be eligible ‘‘(3) diagnosis, treatment, and prevention; Guideline’, published by the Public Health to receive a grant under subsection (a)(2), an ‘‘(4) studies using longitudinal data and Service in May 2008, or any subsequent modi- entity shall— retrospective analysis to identify effective fication of such Guideline; and ‘‘(1) be a public or private nonprofit entity treatments and outcomes for individuals ‘‘(B) such other services that the Secretary with specialized experience in congenital with congenital heart disease; and recognizes to be effective for cessation of to- heart disease; and ‘‘(5) identifying barriers to life-long care bacco use. ‘‘(2) submit to the Secretary an application for individuals with congenital heart disease. ‘‘(3) Such term shall not include coverage at such time, in such manner, and con- ‘‘(b) COORDINATION OF RESEARCH ACTIVI- for drugs or biologicals that are not other- taining such information as the Secretary TIES.—The Director of the Institute may co- wise covered under this title.’’. may require. ordinate research efforts related to con- (b) EXCEPTION FROM OPTIONAL RESTRICTION ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— genital heart disease among multiple re- UNDER MEDICAID PRESCRIPTION DRUG COV- There are authorized to be appropriated to search institutions and may develop research ERAGE.—Section 1927(d)(2)(F) of the Social carry out this section such sums as may be networks. Security Act (42 U.S.C. 1396r–8(d)(2)(F)), as necessary for each of fiscal years 2010 ‘‘(c) MINORITY AND MEDICALLY UNDER- redesignated by section 2502(a), is amended through 2014.’’. SERVED COMMUNITIES.—In carrying out the by inserting before the period at the end the ‘‘SEC. 399NN-3. ADVISORY COMMITTEE ON CON- activities described in this section, the Di- following: ‘‘, except when recommended in GENITAL HEART DISEASE. rector of the Institute shall consider the ap- accordance with the Guideline referred to in ‘‘(a) ESTABLISHMENT.—The Secretary, act- plication of such research and other activi- section 1905(bb)(2)(A), agents approved by the ing through the Director of the Centers for ties to minority and medically underserved Food and Drug Administration under the Disease Control and Prevention, may estab- communities.’’. over-the-counter monograph process for pur- lish an advisory committee, to be known as (c) AUTHORIZATION OF APPROPRIATIONS.— poses of promoting, and when used to pro- the ‘Advisory Committee on Congenital There are authorized to be appropriated to mote, tobacco cessation’’. Heart Disease’ (referred to in this section as carry out the amendments made by this sec- (c) REMOVAL OF COST-SHARING FOR COUN- the ‘Advisory Committee’). tion such sums as may be necessary for each SELING AND PHARMACOTHERAPY FOR CES- ‘‘(b) MEMBERSHIP.—The members of the Ad- of fiscal years 2010 through 2014. SATION OF TOBACCO USE.— visory Committee may be appointed by the (1) GENERAL COST-SHARING LIMITATIONS.— Secretary, acting through the Centers for SA 3076. Mr. DURBIN (for himself Section 1916 of the Social Security Act (42 Disease Control and Prevention, and shall in- and Mr. SANDERS) submitted an amend- U.S.C. 1396o) is amended in each of sub- clude— sections (a)(2)(D) and (b)(2)(D) by inserting ‘‘(1) at least one representative from— ment intended to be proposed to amendment SA 2786 proposed by Mr. ‘‘and counseling and pharmacotherapy for ‘‘(A) the National Institutes of Health; cessation of tobacco use (as defined in sec- ‘‘(B) the Centers for Disease Control and REID (for himself, Mr. BAUCUS, Mr. tion 1905(bb)) and covered outpatient drugs Prevention; and DODD, and Mr. HARKIN) to the bill H.R. (as defined in subsection (k)(2) of section 1927 ‘‘(C) a national patient advocacy organiza- 3590, to amend the Internal Revenue and including nonprescription drugs de- tion with experience advocating on behalf of Code of 1986 to modify the first-time scribed in subsection (d)(2) of such section) patients living with congenital heart disease; homebuyers credit in the case of mem- that are prescribed for purposes of pro- ‘‘(2) at least one epidemiologist who has bers of the Armed Forces and certain moting, and when used to promote, tobacco experience working with data registries; cessation in accordance with the Guideline ‘‘(3) clinicians, including— other Federal employees, and for other purposes; which was ordered to lie on referred to in section 1905(bb)(2)(A)’’ after ‘‘(A) at least one with experience diag- ‘‘section 1905(a)(4)(C),’’. the table; as follows: nosing or treating congenital heart disease; (2) APPLICATION TO ALTERNATIVE COST- and Strike section 4107 and insert the fol- SHARING.—Section 1916A(b)(3)(B) of such Act ‘‘(B) at least one with experience using lowing: (42 U.S.C. 1396o–1(b)(3)(B)) is amended by add- medical data registries; and SEC. 4107. COVERAGE OF COMPREHENSIVE TO- ing at the end the following: ‘‘(4) at least one publicly or privately fund- BACCO CESSATION SERVICES IN ‘‘(xi) Counseling and pharmacotherapy for ed researcher with experience researching MEDICAID. cessation of tobacco use (as defined in sec- congenital heart disease. (a) REQUIRING COVERAGE OF COUNSELING tion 1905(bb)) and covered outpatient drugs ‘‘(c) DUTIES.—The Advisory Committee AND PHARMACOTHERAPY FOR CESSATION OF (as defined in subsection (k)(2) of section 1927 may review information and make rec- TOBACCO USE.—Section 1905 of the Social Se- and including nonprescription drugs de- ommendations to the Secretary concerning— curity Act (42 U.S.C. 1396d), as amended by scribed in subsection (d)(2) of such section) ‘‘(1) the development and maintenance of sections 2001(a)(3)(B) and 2303, is further that are prescribed for purposes of pro- the National Congenital Heart Disease Reg- amended— moting, and when used to promote, tobacco istry established under section 399NN-2; (1) in subsection (a)(4)— cessation in accordance with the Guideline ‘‘(2) the type of data to be collected and (A) by striking ‘‘and’’ before ‘‘(C)’’; and referred to in section 1905(bb)(2)(A).’’. stored in the National Congenital Heart Dis- (B) by inserting before the semicolon at (d) EFFECTIVE DATE.—The amendments ease Registry; the end the following new subparagraph: ‘‘; made by this section shall take effect on Oc- ‘‘(3) the manner in which such data is to be and (D) counseling and pharmacotherapy for tober 1, 2010. collected; cessation of tobacco use (as defined in sub- ‘‘(4) the use and availability of such data, section (bb))’’; and SA 3077. Mr. DURBIN submitted an including guidelines for such use; and (2) by adding at the end the following: amendment intended to be proposed to ‘‘(5) other matters, as the Secretary deter- ‘‘(bb)(1) For purposes of this title, the term amendment SA 2786 proposed by Mr. mines to be appropriate. ‘counseling and pharmacotherapy for ces- EID AUCUS ‘‘(d) REPORT.—Not later than 180 days after sation of tobacco use’ means diagnostic, R (for himself, Mr. B , Mr. the date on which the Advisory Committee is therapy, and counseling services and DODD, and Mr. HARKIN) to the bill H.R. established and annually thereafter, the Ad- pharmacotherapy (including the coverage of 3590, to amend the Internal Revenue visory Committee shall submit a report to prescription and nonprescription tobacco Code of 1986 to modify the first-time

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00094 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.080 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE December 8, 2009 CONGRESSIONAL RECORD — SENATE S12741 homebuyers credit in the case of mem- ‘‘PART S—PROGRAMS RELATING TO ‘‘(A) of breast health, symptoms, and early bers of the Armed Forces and certain BREAST HEALTH AND CANCER diagnosis and treatment of breast cancer in other Federal employees, and for other ‘‘SEC. 399HH. YOUNG WOMEN’S BREAST HEALTH young women, including specific risk factors purposes; which was ordered to lie on AWARENESS AND SUPPORT OF such as family history of cancer and women that may be at high risk for breast cancer, the table; as follows: YOUNG WOMEN DIAGNOSED WITH BREAST CANCER. such as Ashkenazi Jewish population; On page 816, after line 20, add the fol- ‘‘(a) PUBLIC EDUCATION CAMPAIGN.— ‘‘(B) on how to provide counseling to young lowing: ‘‘(1) IN GENERAL.—The Secretary, acting women about their breast health, including SEC. 3115. MEDICARE PASS-THROUGH PAYMENTS through the Director of the Centers for Dis- knowledge of their family cancer history and FOR CRNA SERVICES. ease Control and Prevention, shall conduct a importance of providing regular clinical (a) TREATMENT OF CRITICAL ACCESS HOS- national evidence-based education campaign breast examinations; PITALS AS RURAL IN DETERMINING ELIGIBILITY to increase awareness of young women’s ‘‘(C) concerning the importance of dis- FOR CRNA PASS-THROUGH PAYMENTS.—Sec- knowledge regarding— cussing healthy behaviors, and increasing tion 9320(k) of the Omnibus Budget Rec- ‘‘(A) breast health in young women of all awareness of services and programs available onciliation Act of 1986 (42 U.S.C. 1395k note), racial, ethnic, and cultural backgrounds; to address overall health and wellness, and as added by section 608(c)(2) of the Family ‘‘(B) breast awareness and good breast making patient referrals to address tobacco Support Act of 1988 and amended by section health habits; cessation, good nutrition, and physical activ- 6132 of the Omnibus Budget Reconciliation ‘‘(C) the occurrence of breast cancer and ity; Act of 1989, is amended by adding at the end the general and specific risk factors in ‘‘(D) on when to refer patients to a health the following: women who may be at high risk for breast care provider with genetics expertise; ‘‘(3) Any facility that qualifies as a critical cancer based on familial, racial, ethnic, and ‘‘(E) on how to provide counseling that ad- access hospital (as defined in section cultural backgrounds such as Ashkenazi dresses long-term survivorship and health 1861(mm)(1) of the Social Security Act) shall Jewish populations; concerns of young women diagnosed with be treated as being located in a rural area for ‘‘(D) evidence-based information that breast cancer; and purposes of paragraph (1) regardless of any would encourage young women and their ‘‘(F) on when to provide referrals to orga- geographic reclassification of the facility, health care professional to increase early de- nizations and institutions that provide cred- including such a reclassification of the coun- tection of breast cancers; and ible health information and substantive as- ty in which the facility is located as an ‘‘(E) the availability of health information sistance and support to young women diag- urban county (also popularly known as a and other resources for young women diag- nosed with breast cancer, including— Lugar county) under section 1886(d)(8)(B) of nosed with breast cancer on— ‘‘(i) re-entry into the workforce or school; the Social Security Act (42 U.S.C. ‘‘(i) fertility preservation; ‘‘(ii) infertility as a result of treatment; 1395ww(d)(8)(B)).’’. ‘‘(ii) support, including social, emotional, ‘‘(iii) neuro-cognitive effects; (b) TREATMENT OF STANDBY AND ON-CALL psychosocial, financial, lifestyle, and care- ‘‘(iv) important effects of cardiac, vas- COSTS.—Such section 9320(k), as amended by giver support; cular, muscle, and skeletal complications; subsection (a), is further amended by adding ‘‘(iii) familial risk factors; and and at the end the following: ‘‘(iv) prevention and early detection strate- ‘‘(v) secondary malignancies. ‘‘(4) In determining the reasonable costs gies to reduce recurrence or metastasis; ‘‘(2) MATERIALS.—The education campaign incurred by a hospital or critical access hos- ‘‘(2) EVIDENCE-BASED, AGE APPROPRIATE under paragraph (1) may include the dis- pital for the services of a certified registered MESSAGES.—The campaign shall provide evi- tribution of print, video, and Web-based ma- nurse anesthetist under this subsection, the dence-based, age-appropriate messages and terials on assisting physicians and other Secretary shall include standby costs and materials as developed by the Centers for health care professionals in achieving the on-call costs incurred by the hospital or crit- Disease Control and Prevention and the Ad- goals of this section. ical access hospital, respectively, with re- visory Committee established under para- ‘‘(c) PREVENTION RESEARCH ACTIVITIES.— spect to such nurse anesthetist.’’. graph (4). (c) EFFECTIVE DATES.— The Secretary, acting through— ‘‘(3) MEDIA CAMPAIGN.—In conducting the (1) TREATMENT OF CAHS AS RURAL IN DETER- education campaign under paragraph (1), the ‘‘(1) the Director of the Centers for Disease MINING CRNA PASS-THROUGH ELIGIBILITY.—The Secretary shall award grants to entities to Control and Prevention, shall conduct pre- amendment made by subsection (a) shall establish national multimedia campaigns vention research on breast cancer in younger apply to calendar years beginning on or after oriented to young women that may include women, including— the date of the enactment of this Act (re- advertising through television, radio, print ‘‘(A) behavioral, survivorship studies, and gardless of whether the geographic reclassi- media, billboards, posters, all forms of exist- other research on the impact of breast can- fication of a critical access hospital occurred ing and especially emerging social net- cer diagnosis on young women; before, on, or after such date). working media, other Internet media, and ‘‘(B) formative research to assist with the (2) INCLUSION OF STANDBY COSTS AND ON- any other medium determined appropriate development of educational messages and in- CALL COSTS IN DETERMINING REASONABLE by the Secretary. formation for the public, targeted popu- COSTS OF CRNA SERVICES.—The amendment lations, and their families about breast ‘‘(4) ADVISORY COMMITTEE.— made by subsection (b) shall apply to costs health, breast cancer, and healthy lifestyles; ‘‘(A) ESTABLISHMENT.—Not later than 60 incurred in cost reporting periods beginning days after the date of the enactment of this ‘‘(C) testing and evaluating existing and in fiscal years after fiscal year 2003. section, the Secretary, acting through the new social marketing strategies targeted at Director of the Centers for Disease Control young women; and SA 3078. Ms. KLOBUCHAR (for her- and Prevention, shall establish an advisory ‘‘(D) surveys of health care providers and self and Ms. SNOWE) submitted an committee to assist in creating and con- the public regarding knowledge, attitudes, amendment intended to be proposed to ducting the education campaigns under para- and practices related to breast health and amendment SA 2786 proposed by Mr. graph (1) and subsection (b)(1). breast cancer prevention and control in high- risk populations; and REID (for himself, Mr. BAUCUS, Mr. ‘‘(B) MEMBERSHIP.—The Secretary, acting ‘‘(2) the Director of the National Institutes DODD, and Mr. HARKIN) to the bill H.R. through the Director of the Centers for Dis- ease Control and Prevention, shall appoint of Health, shall conduct research to develop 3590, to amend the Internal Revenue and validate new screening tests and meth- Code of 1986 to modify the first-time to the advisory committee under subpara- graph (A) such members as deemed necessary ods for prevention and early detection of homebuyers credit in the case of mem- to properly advise the Secretary, and shall breast cancer in young women. bers of the Armed Forces and certain include organizations and individuals with ‘‘(d) SUPPORT FOR YOUNG WOMEN DIAG- other Federal employees, and for other expertise in breast cancer, disease preven- NOSED WITH BREAST CANCER.— purposes; which was ordered to lie on tion, early detection, diagnosis, public ‘‘(1) IN GENERAL.—The Secretary shall the table; as follows: health, social marketing, genetic screening award grants to organizations and institu- At the appropriate place in title IV, insert and counseling, treatment, rehabilitation, tions to provide health information from the following: palliative care, and survivorship in young credible sources and substantive assistance women. SEC. ll. YOUNG WOMEN’S BREAST HEALTH directed to young women diagnosed with AWARENESS AND SUPPORT OF ‘‘(b) HEALTH CARE PROFESSIONAL EDU- breast cancer and pre-neoplastic breast dis- YOUNG WOMEN DIAGNOSED WITH CATION CAMPAIGN.— eases on issues such as— BREAST CANCER. ‘‘(1) IN GENERAL.—The Secretary, acting ‘‘(A) education and counseling regarding (a) SHORT TITLE.—This section may be through the Director of the Centers for Dis- fertility preservation; cited as the ‘‘Young Women’s Breast Health ease Control and Prevention, and in con- ‘‘(B) support, including social, emotional, Education and Awareness Requires Learning sultation with the Administrator of the psychosocial, financial, lifestyle, and care- Young Act of 2009’’ or ‘‘EARLY Act’’. Health Resources and Services Administra- giver support; (b) AMENDMENT.—Title III of the Public tion, shall conduct an education campaign ‘‘(C) familial risk factors; and Health Service Act (42 U.S.C. 241 et seq.) is among physicians and other health care pro- ‘‘(D) prevention and early education strat- amended by adding at the end the following: fessionals to increase awareness— egies to reduce recurrence or metastasis.

VerDate Nov 24 2008 04:36 Dec 09, 2009 Jkt 089060 PO 00000 Frm 00095 Fmt 0624 Sfmt 0634 E:\CR\FM\A08DE6.081 S08DEPT1 dcolon on DSK2BSOYB1PROD with SENATE S12742 CONGRESSIONAL RECORD — SENATE December 8, 2009 ‘‘(2) PRIORITY.—In making grants under ized to meet during the session of the remarks of the chair and ranking mem- paragraph (1), the Secretary shall give pri- Senate on December 8, 2009, at 1:30 p.m. ber of the Finance Committee, or their ority to applicants that deal specifically The PRESIDING OFFICER. Without designees, for up to 10 minutes each, with young women diagnosed with breast objection, it is so ordered. the next 2 hours be for debate only, cancer and pre-neoplastic breast disease. ‘‘(e) NO DUPLICATION OF EFFORT.—In con- COMMITTEE ON ENVIRONMENT AND PUBLIC with the time equally divided and con- ducting an education campaign or other pro- WORKS trolled between the two leaders or gram under subsections (a), (b), (c), or (d), Mr. BAUCUS. Mr. President, I ask their designees, with Senators per- the Secretary shall avoid duplicating other unanimous consent that the Com- mitted to speak for up to 10 minutes existing Federal breast cancer education ef- mittee on Environment and Public each; the Republicans controlling the forts. Works be authorized to meet during first 30 minutes and the majority con- ‘‘(f) MEASUREMENT; REPORTING.—The Sec- the session of the Senate on December trolling the second 30 minutes, with retary, acting through the Director of the the remaining time equally divided and Centers for Disease Control and Prevention, 8, 2009 at 10 a.m. in room 406 of the shall— Dirksen Senate Office Building. used in an alternating fashion; further, ‘‘(1) measure— The PRESIDING OFFICER. Without that no amendments are in order dur- ‘‘(A) young women’s awareness regarding objection, it is so ordered. ing this time. breast health, including knowledge of family COMMITTEE ON FOREIGN RELATIONS The PRESIDING OFFICER. Without cancer history, specific risk factors and Mr. BAUCUS. Mr. President, I ask objection, it is so ordered. early warning signs, and young women’s unanimous consent that the Com- proactive efforts at early detection; f mittee on Foreign Relations be author- ‘‘(B) the number or percentage of young PROGRAM women utilizing information regarding life- ized to meet during the session of the style interventions that foster healthy be- Senate on December 8, 2009, at 2:15 p.m. Mr. SANDERS. Mr. President, roll- haviors such as tobacco cessation, nutrition, The PRESIDING OFFICER. Without call votes are possible throughout the and physical activity; objection, it is so ordered. day tomorrow. Senators will be noti- ‘‘(C) the number or percentage of young SELECT COMMITTEE ON INTELLIGENCE fied when any votes are scheduled. women receiving regular clinical breast exams; and Mr. BAUCUS. Mr. President, I ask f unanimous consent that the Select ‘‘(D) the number or percentage of young ADJOURNMENT UNTIL 9:30 A.M. women who perform breast self exams, and Committee on Intelligence be author- the frequency of such exams, before the im- ized to meet during the session of the TOMORROW plementation of this section; Senate on December 8, 2009, at 2:30 p.m. Mr. SANDERS. Mr. President, if ‘‘(2) establish quantitative benchmarks to The PRESIDING OFFICER. Without there is no further business to come be- measure the impact of activities under this objection, it is so ordered. fore the Senate, I ask unanimous con- section; sent that the Senate stand adjourned ‘‘(3) not less than every 3 years, measure SUBCOMMITTEE ON ENERGY the impact of such activities; and Mr. BAUCUS. Mr. President, I ask under the previous order. ‘‘(4) submit reports to the Congress on the unanimous consent that the Sub- There being no objection, the Senate, results of such measurements. committee on Energy be authorized to at 8:38 p.m., adjourned until Wednes- ‘‘(g) DEFINITIONS.—In this section— meet during the session of the Senate day, December 9, 2009, at 9:30 a.m. ‘‘(1) the term ‘State’ means each of the in order to conduct a hearing on De- f several States, the District of Columbia, the cember 8, at 2:30 p.m., in room SD–366 Commonwealth of Puerto Rico, American NOMINATIONS Samoa, Guam, the Commonwealth of the of the Dirksen Senate Office Building. Northern Mariana Islands, the United States The PRESIDING OFFICER. Without Executive nominations received by Virgin Islands, and the Trust Territory of objection, it is so ordered. the Senate: the Pacific Islands; and f DEPARTMENT OF TRANSPORTATION ‘‘(2) the term ‘young women’ means women ORDERS FOR WEDNESDAY, MICHAEL PETER HUERTA, OF THE DISTRICT OF COLUM- 15 to 44 years of age. BIA, TO BE DEPUTY ADMINISTRATOR OF THE FEDERAL ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— DECEMBER 9, 2009 AVIATION ADMINISTRATION, VICE ROBERT A. To carry out subsections (a), (b), (c)(1), and Mr. SANDERS. Mr. President, I ask STURGELL, RESIGNED. (d), there are authorized to be appropriated unanimous consent that when the Sen- IN THE AIR FORCE $9,000,000 for each of the fiscal years 2010 ate completes its business today, it ad- THE FOLLOWING NAMED OFFICER FOR APPOINTMENT through 2014.’’. IN THE UNITED STATES AIR FORCE TO THE GRADE INDI- journ until 9:30 a.m., Wednesday, De- CATED UNDER TITLE 10, U.S.C., SECTION 624: f cember 9; that following the prayer and To be brigadier general pledge, the Journal of proceedings be AUTHORITY FOR COMMITTEES TO COL. KORY G. CORNUM approved to date, the morning hour be MEET IN THE ARMY deemed expired, the time for the two THE FOLLOWING NAMED OFFICER FOR APPOINTMENT COMMITTEE ON ARMED SERVICES leaders be reserved for their use later IN THE RESERVE OF THE ARMY TO THE GRADE INDI- Mr. BAUCUS. Mr. President, I ask in the day, and the Senate resume con- CATED UNDER TITLE 10, U.S.C., SECTION 12203: unanimous consent that the Com- sideration of H.R. 3590, the health care To be major general mittee on Armed Services be author- reform legislation; that following any BRIG. GEN. STEVEN W. SMITH

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