S8006 CONGRESSIONAL RECORD — SENATE November 18, 2010 1987. Throughout her career, Julie played a It is my belief that Congress needs to does not want to be like role in the passage of major pieces of legisla- be held responsible for its actions, for because is different from Mas- tion including: The Federal Highway Reau- the policies it advocates, and the legis- sachusetts. Oregon’s insurance market thorization Bills of 1992, 1998 and 2005; the is different. Its provider network is dif- 1987 Farm Credit Act; the 1991 Clean Air Act lation that ultimately passes through Amendments; the 1992 Family Medical Leave these Halls to become law. When Con- ferent. Its beneficiaries and population Act; and the 2002 Help America Vote Act. In gress passes legislation that is harm- are different than in Massachusetts. 2005, after retiring from the U.S. Senate, ful—in this case the Federal health Oregon might want to implement re- Julie joined Ogilvy Government Relations as care reform legislation, which I did not forms or create a coverage mechanism a Senior Vice President, where she continued support—or there is an unintended con- that I do not like or that I would not her work on various transportation and ap- sequence—which I think is the case want to work in the State of Massachu- propriations issues. Throughout her life, when it deals with Massachusetts and setts, but that is OK. That is what this Julie was an accomplished athlete, including bill is about. It allows the individual playing on the University of Minnesota bas- the innovations we have had for years, where we have 98 percent of our people States to have the right to do what ketball team. Her lifelong love of sports con- they believe is imperative and impor- tinued into her adult life as an avid golfer already insured—Members need to be and a formidable soccer player. She was a bold enough to stand up and fix it re- tant for their particular State, which long-time fan of all Minnesota sports, espe- gardless of party affiliation and regard- is why the legislation we have intro- cially the Vikings and the Minnesota Twins, less of whether it is popular. duced—the Empowering States to Inno- having attended multiple games during the I commend the Senator who is about vate Act—is so important. 1987 World Series. Julie’s focus on family and Right now, as provided under section to speak after me for his leadership on work was only equaled by the intensity with 1332—the Waivers for State Innova- this matter. Senator WYDEN has been which she followed her Minnesota teams, re- tion—of the Patient Protection and Af- working very diligently on addressing membering every play from every game. The fordable Care Act, States can waive out the concerns for his State. Today I get passion with which Julie lived her life will be of provisions of the Federal reform law. sadly missed by all who knew and loved her. a chance to do the same. Today we get That is the good news. We are allowing The family will receive guests on Friday, No- an opportunity to make a correction to States to participate in the process and vember 19, 2010 from 10 a.m. until the time of the Federal bill to allowing them not to have duplicate service at 10:30 a.m. at the Immanuel Lu- be sure we are doing the right thing, theran Church, 1801 Russell Road, Alexan- processes or maybe potentially have dria, VA with a private interment to follow. not just for Massachusetts but for lesser care and coverage if the Federal The family requests that in lieu of flowers, other States that seek to waive out of health care bill is implemented. So it gifts will be received for the ‘‘Julie certain requirements of the Federal allows us to continue to provide the Dammann Family Education Trust’’. Dona- health care reform law. care and services we want to provide to tions may be sent to: Redmon, Peyton & In many ways, Massachusetts has our citizens in Massachusetts. The bad Braswell, L.L.P., 510 King Street, Suite 301, been on the forefront of implementing news is, this waiver authority is not Alexandria, VA 22314. health care reform: expanding access— Mr. BOND. Madam President, I yield scheduled to take effect until 2017. So as I mentioned, 98 percent of our people what are we doing until then—a full 3 the floor and suggest the absence of a are already insured—designing systems quorum. years after the PPACA is scheduled to to increase market participation—from be fully implemented? The ACTING PRESIDENT pro tem- the Cadillac plan, all the way to the pore. The clerk will call the roll. For me and my dear friend from Or- fully subsidized Commonwealth Care egon it does not make any sense. When The legislative clerk proceeded to Program—and increasing transparency call the roll. I see something that does not make for consumers and providers. We con- Mr. BROWN of Massachusetts. any sense in Washington, I do my best, tinue to learn, however, lessons every Madam President, I ask unanimous regardless of party affiliation, to fix it. consent that the order for the quorum day in Massachusetts about what The first thing our bill does is to call be rescinded. works and what does not work, and we allow States to waive out of specific The ACTING PRESIDENT pro tem- are continuing to work on those very parts of the PPACA in 2014 rather than pore. Without objection, it is so or- issues to make sure we can do it better. 2017. This makes sense not only from dered. This is an important point because it an operational standpoint, because the speaks directly to the purpose of this f PPACA takes effect in 2014, but also piece of legislation that I have intro- from an economic and fiscal stand- EMPOWERING STATES TO duced in a bipartisan manner with Sen- point. Why should Massachusetts be INNOVATE ACT ator WYDEN from Oregon. delayed in obtaining a waiver from the Mr. BROWN of Massachusetts. As you know, the health care reform Federal reform bill when it may al- Madam President, I rise today and join efforts of Massachusetts are our own. ready have met or exceeded, in many my colleague, Senator WYDEN, to speak We were one of the first States in the cases, the provisions of the act? So about legislation we have introduced country to take this upon ourselves to holding Massachusetts back by lim- that will protect not only his State but address the very serious problem we iting my State’s ability to continue to my State of Massachusetts and other had in providing funds to hospitals innovate and remain flexible and re- States by allowing them to waive out that were providing care for people who sponsive to the health care market of specific requirements of the Patient were making a good wage but who were costs money, and it costs the taxpayers Protection and . not paying the bills. As a result, the money at a point right now where we As my colleagues know, my single citizens had to subsidize the hospitals don’t have a whole heck of a lot of priority is and always has been to en- to the tune of over $1 billion. So we be- money to go around. sure that what we do in Washington lieved it was imperative for us to get The second piece our bill does is to does not harm my State of Massachu- something done. provide States with certainty with the setts or the rest of the country, and As difficult as it is to admit this, not waiver process. Not every State will be that we are responsible stewards with every State wants to be like Massachu- eligible. Let me repeat that: Not every every tax dollar that flows from the setts. I understand that. They may not State will be eligible for a waiver and States into the Federal Government. want to be like Oregon either. Massa- not every waiver will be granted. But This has been true when it comes to chusetts is a great State, with, I be- our bill provides some certainty for voting against raising taxes on families lieve, the best hospitals, physicians, States that apply for a waiver by re- and businesses. It has been true when it doctors, nurses, treatment facilities, quiring the Secretary of Health and comes to fighting for commonsense, research facilities in the country and Human Services to begin reviewing ap- progrowth policies that will create jobs around the world. There is a reason plications within 6 months of the en- in Massachusetts. It has been true in why people come to Massachusetts for actment of this bill. I hope this bill is my efforts to be sure that the Federal the care and coverage they need so enacted quickly. The earlier a State health care reform bill does not dimin- badly. knows whether it has received a waiv- ish or harm the health care innova- But I recognize that my colleague er, the earlier it can begin imple- tions that have occurred in Massachu- from Oregon is interested in protecting menting its specific plans and pro- setts. reform efforts in Oregon as well. He posals. It makes fiscal sense.

VerDate Mar 15 2010 00:27 Apr 30, 2011 Jkt 099060 PO 00000 Frm 00006 Fmt 4624 Sfmt 0634 E:\RECORD10\RECFILES\S18NO0.REC S18NO0 bjneal on DSK69SOYB1PROD with CONG-REC-ONLINE November 18, 2010 CONGRESSIONAL RECORD — SENATE S8007 Taken together, these two changes While the Commonwealth is still years The ACTING PRESIDENT pro tem- are not only good for Massachusetts away from decisions that will be made in pore. The Senator from Oregon. 2014 and beyond, we believe allowing Massa- but potentially for other States. They Mr. WYDEN. Madam President, let are good for the other States that are chusetts the opportunity to apply for such waiver earlier than 2017 may allow the Com- me commend the Senator from Massa- trying to innovate and advance in the monwealth flexibility it may desire to con- chusetts on a very fine statement, areas of health care reform, cost con- tinue the success it has achieved thus far. which I think highlights exactly what tainment, and coverage. That is what We note that Massachusetts is often referred we are seeking to do. it should be. It should be a symbiotic to as a model for national healthcare reform relationship between the Federal Gov- and we believe any waiver that the Common- The Senator from Massachusetts has ernment and the States. The States wealth would apply for, if it so chose, would been a real pleasure to work with on should have the right to determine seek to achieve a similar goal of affordable, this matter. As he says, the whole what they want to do for their citi- comprehensive health insurance coverage as point of this, as shown by the recent zenry. Do we think maybe some States required by Section 1332. election, is that people want to find Massachusetts hospitals have been and could do it better than the Federal continue to be supportive of the federal ef- some common ground. They are not in- Government? I believe when we deal fort to expand coverage to the uninsured and terested anymore in food fights and with health care, Massachusetts is sec- provide affordable health insurance for all bickering back and forth between the ond to none, with all due respect to the Americans. At the same time, we have political parties. What Senator BROWN other Senators in this Chamber. stressed throughout the national healthcare and I are seeking to do is to show it is During Wednesday’s Finance Com- debate that national reform should support possible on a significant issue—I think mittee hearing, Dr. Berwick, who is the Commonwealth’s own health reform we all understand health care is about from the State of Massachusetts, I achievements. as important as it gets—that we can On behalf of Massachusetts member hos- might add, said this about State inno- come together, and the two of us have vation and flexibility: pitals and the patients they serve, we look forward to working with you to preserve said we are going to come together to The cliche about states as laboratories of Massachusetts healthcare reform as the na- put the focus on innovation. It is pret- democracy is not just a cliche, it’s true. The tion begins to implement the national ty clear that what works in Spring- diversity of approaches that we’re seeing healthcare reform law. field, OR, may not be exactly ideal for emerge state by state has been there for long Sincerely, time. I think we should be doing everything Springfield, MA. But what we can do is LYNN NICHOLAS, come up with a way to provide more we can to encourage it. President & CEO, I couldn’t agree more. I am a strong Massachusetts Hospital Association. flexibility and particularly more choice and more competition for our supporter of States rights, especially Mr. BROWN of Massachusetts. Thank States and other States around the when it makes sense, and for allowing you, Madam President. country. States to solve problems without the We should be encouraging State inno- Federal Government’s interference. vation and not hampering it, and that So I am very grateful to the Senator Madam President, I ask unanimous is what the Empowering States to In- from Massachusetts for his effort. It is consent to have printed in the RECORD novate Act does. It helps ensure that early in the lameduck session, and it is a letter from the Massachusetts Hos- States are not held back from inno- my hope this will be a signal in the pital Association in support of my ef- vating and seeking solutions that work Chamber that even on these difficult forts today. for their citizens, their taxpayers, and issues—issues that were so contentious There being no objection, the mate- their communities. in the political campaign—it is going rial was ordered to be printed in the Finally, I wish to associate myself to be possible to come together and Record, as follows: with the comments of the Senator from find some common ground. MASSACHUSETTS HOSPITAL Oregon when he makes them about how ASSOCIATION, As the Senator suggests, if we can Burlington, MA, November 16, 2010. our bill fits into the Federal health just move away from a Federal cookie- Hon. SCOTT BROWN, care reform debate. Enacting this leg- cutter approach and encourage the Russell Senate Office Building, islation is the right thing to do because kind of creative thinking we have seen Washington, DC. it is good for States such as Massachu- in Oregon and in Massachusetts and DEAR SENATOR BROWN: As you know, the setts and Oregon and that have other parts of the country, I think we Commonwealth of Massachusetts has suc- begun to make changes and reform at ceeded in expanding healthcare coverage to will be well served and will be in a posi- the State level that make sense for tion to better contain health care more than 400,000 uninsured residents. We their citizens. can be proud of the fact that the state has costs. I think we all understand that the lowest rate of uninsured in the country, The legislation provides flexibility how to rein in these medical costs that which has improved the lives of so many and says one size fits all is not appro- are gobbling up everything in sight is Massachusetts residents and allowed the priate and it does not always meet the first and foremost on the minds of our healthcare system to operate more effi- needs of that individual State. I know constituents. Literally, for the amount ciently. Our state was able to achieve ex- the Federal standard is not in the best panded coverage of this magnitude through of money we are spending today in this interests of the people of Massachu- country, one can go out and hire a doc- innovative programs like Commonwealth setts, which is why passing this bill is tor for every seven families in the Care and Commonwealth Choice, along with the right thing to do. other provisions that were part of the Com- United States and pay the doctor more Let me say I deeply appreciate the monwealth’s 2006 healthcare reform law. than $225,000 a year just for taking care Senator from Oregon and his effort to For these reasons, the Massachusetts Hos- of seven families. I always bring up pital Association (MHA) supports the bill weed through the quagmire of rules this as almost a metaphor for health that you intend to introduce that will ad- and regulations and come up with a care, but usually after I am done, the vance the timeframe for waivers that were commonsense solution. I am hopeful physician who was listening in the au- included in the Patient Protection and Af- others in this Chamber will learn from dience comes up and says: Where can I fordable Care Act (PPACA). As we under- our example, that we can work to- stand Section 1332 of PPACA, states may go to get my seven families? It sounds gether in a bipartisan manner to tackle apply for a waiver to certain requirements of like a pretty good deal. It just shows the federal law so long as the changes problems and try to solve them with- out the rhetoric and without the bomb that we are spending this enormous achieve healthcare coverage that is at least sum of money. as comprehensive as the federal law would throwing and just solve problems. Be- have provided. The changes are also required cause right now, we need more people What Senator BROWN and I are seek- not to increase the federal deficit. The law like the Senator from Oregon to do just ing to do is to encourage additional in- currently allows states to apply for such a that. novative approaches in States, ap- waiver beginning in January 1, 2017. Your The ACTING PRESIDENT pro tem- proaches that are tailored to the needs proposed legislation does not change the terms or process for approving a waiver that pore. The Senator’s time has expired. of States’ own residents, that will help currently exist in the PPACA but does move Mr. BROWN of Massachusetts. Thank us, in my view, to promote choice and up the date by which the waiver process may you, Madam President. competition in the American health begin. I yield the floor. care system. The States are free to do

VerDate Mar 15 2010 00:27 Apr 30, 2011 Jkt 099060 PO 00000 Frm 00007 Fmt 4624 Sfmt 0634 E:\RECORD10\RECFILES\S18NO0.REC S18NO0 bjneal on DSK69SOYB1PROD with CONG-REC-ONLINE S8008 CONGRESSIONAL RECORD — SENATE November 18, 2010 whatever they choose. I just offer up cosponsors, depending on when you I yield the floor. my own judgment that right now, at a look back at the legislative history, The ACTING PRESIDENT pro tem- time when most Americans still don’t that were almost evenly divided be- pore. The junior Senator from Oregon get much choice in their health care tween the political parties. In the is recognized. coverage, this is an ideal opportunity Healthy Americans Act, there was a Mr. MERKLEY. Madam President, I that both Democrats and Republicans specific section called ‘‘Empowering applaud the work my senior Senator can support. As States seek to go for- States to Innovate.’’ There was a provi- from Oregon, , has been ward with this approach, they can sion in that bill that was first intro- doing in seeking affordable, effective make their own choices. duced in 2006, and a similar provision health care for all Americans and, in I hope, in particular, States will take was included as section 1332 in the law particular, his work to utilize our a look at what you, Madam President, the President signed. State laboratories in developing smart the Senator from New York, and I have So I have long been interested in let- health care strategies that then, if suc- in our own health care plan. The Fed- ting all States have the opportunity to cessful, can become a model for the Na- eral Employee Health Benefit Plan pro- innovate. One of the reasons I have tion. vides a lot of choice, a lot of competi- been interested—and my good friend, This process of utilizing waivers isn’t tion. You can go out and fire your in- Senator MERKLEY, is here—is that our about a State wanting an exception so surance company if you don’t think State has been one of the leaders in the that it can be different; it is about rec- they are doing a good job. That is the whole effort to reform American health ognizing that States have powerful op- kind of idea a State could pursue and care. From time to time, folks have portunities to form policies that work do so, we hope, more quickly if we act said I am the Senator from the State of well under particular circumstances legislatively to speed up the waiver Waiver rather than the State of Oregon but also may provide insights into our process. But as Senator BROWN has cor- because we have tried so often to pur- whole national strategy for affordable, rectly noted, this is about giving sue innovative approaches in health quality health care. States the freedom to chart their own care waivers. We were, as Senator So for the work Senator WYDEN and course, and I am very hopeful we will MERKLEY knows, one of the first States Senator SCOTT BROWN are doing, I ap- be able to get this legislation passed. to say dollars that have been plaud them and support them, and I In particular, what I have been con- authorized for seniors to pay for serv- thank Senator WYDEN for his decades cerned about, after talking to health ices in institutions such as nursing of advocacy for affordable health care. policymakers over the last few months, homes should be used instead for home f is if, in the State of New York, for ex- health care; thereby giving seniors FOOD SAFETY ample, you go out and set up a process more of what they want, which is to Mr. MERKLEY. Madam President, it to comply with the legislation for pur- stay in their homes, at a cheaper price is a pleasure to rise to speak about the poses of 2014 and you see that the waiv- to taxpayers. We began those efforts, historic Food Safety Modernization er, as now constituted under 1332, as Senator MERKLEY knows, with waiv- Act. starts in 2017, you say: How am I going ers from traditional Federal law. So we I thank Chairman HARKIN, who to reconcile those two? Am I going to have a long history of doing this, and I worked with me to include provisions set up one approach for 2014 and then have spent well over a decade trying to to help small farms and processors and do another approach in 2017? It is going establish the principle that all States organic farms so that they have before to put us through a lot of bureaucratic ought to have the opportunity to bring them in this bill provisions that sup- water torture to try to figure out how their creative juices to this issue of port them and will help make them to synchronize those two dates. So it health care reform. successful. The last thing we want to only makes sense to speed it all up and We have outlined the two key see is an effort to make our food safety make it possible for everybody to get changes in the legislation that is law system work better be used as a tool to started in 2014. today. The first change is to make the diminish the ability of small farms and One other point because my inten- waivers effective in 2014 rather than in organic farms to thrive. That has been tions have been much discussed. When 2017 so States only have to change effectively addressed in the bill but I originally started talking about the their systems once. The second thing also by provisions I will speak to in a State waiver, people questioned wheth- the Empowering States to Innovate while that Senator TESTER is bringing er this was something that was going Act does is it requires the Department forward. to be a special opportunity for Oregon of Health and Human Services to begin I also compliment Senator DURBIN, and not for other States. For over a to review State waiver applications who has been advocating for this bill, decade, I have been promoting the idea within 6 months of enactment of the working on the elements of the bill for that all States—all States—be given legislation. This would allow States a very long time, and his determined, the freedom to innovate under health early notification of whether their tenacious advocacy is the reason this care reform legislation. In fact, to give State waivers have been approved and bill is on the floor before us at this mo- a sense of how I got into this, going would give them adequate time to roll ment. back and looking at the history of the out their State-specific plans. I think I also appreciate the bipartisan prob- Clinton health care plan, in the early this, too, will help us create more com- lem-solving approach of the ranking 1990s it was pretty evident that had petition, more choice, and more afford- member of the Health, Education, President Clinton and Republicans ability in American health care be- Labor, and Pensions Committee, Sen- thought then about giving States the cause it will give the States adequate ator ENZI, and all of the members of kind of freedom Senator BROWN and I time to gear up. That is the philosophy the committee for coming together to envision, it might well have been pos- behind the Empowering States to Inno- say: This is not a Republican or a sible back in the early 1990s to enact vate Act, whether one likes one par- Democratic problem, this is a national health care reform that would have ticular approach or another. Clearly, health care issue, a national nutrition gotten all Americans quality, afford- there will be great diversity of ap- issue, and let’s tackle it together. able coverage. That opportunity was proaches tried at the State level. The safety of the Nation’s food sup- missed. So I decided by the mid 1990s— At a time when we are looking for ply is a serious concern for every fam- if I had the opportunity, the honor, of ways to bring this country together to ily in Oregon and across this Nation. I representing Oregon in the Congress, I deal with the most contentious issues wish to highlight one Oregon family in was going to use every single oppor- of our time, we ought to be supporting particular, Jake Hurley and his dad tunity to let all States—and I want to innovation. We ought to be supporting Peter. I am sure they are very happy to underline all States—have the oppor- unleashing creative kinds of ap- see that we have this bill on the floor, tunity to innovate in health care. proaches to deal with domestic issues. and they will be particularly thrilled So in mid 2005 I started putting to- That is what Senator BROWN and I pro- when we have it on the President’s gether a piece of legislation called the pose in this legislation. I look forward desk because the issue of tracing con- Healthy Americans Act. It was a bipar- to working with colleagues on both taminated food is an issue that has af- tisan bill, that had 14 or 15 Senators as sides of the aisle. fected their family very directly.

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