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, MONDAY, NOVEMBER 30, 2009 No. 175 House of Representatives The House was not in session today. Its next meeting will be held on Tuesday, December 1, 2009, at 2 p.m. Senate MONDAY, NOVEMBER 30, 2009

The Senate met at 2 p.m. and was U.S. SENATE, At 3 p.m., the Senate will resume called to order by the Honorable MARK PRESIDENT PRO TEMPORE, consideration of the health care legis- R. WARNER, a Senator from the Com- Washington, DC, November 30, 2009. lation. Today, the majority will offer monwealth of Virginia. To the Senate: the first amendment and the Repub- Under the provisions of rule I, paragraph 3, of the Standing Rules of the Senate, I hereby licans will offer the next amendment PRAYER appoint the Honorable MARK R. WARNER, a to the substitute. No other amend- The Chaplain, Dr. Barry C. Black, of- Senator from the Commonwealth of Vir- ments, by virtue of the order that was fered the following prayer: ginia, to perform the duties of the Chair. entered before the Thanksgiving re- Let us pray: ROBERT C. BYRD, cess, will be in order today. O God, the hope of all the ends of the President pro tempore. There will be no rollcall votes during Earth be in our midst today. Endue our Mr. WARNER thereupon assumed the today’s session, and the next vote will lawmakers with a spirit of wisdom that chair as Acting President pro tempore. occur at noon tomorrow on the con- will bring peace and prosperity within f firmation of the nomination of Jac- our borders. Lord, keep them from dis- queline Nguyen to be a U.S. District unity, ignited by selfish fires, that will RECOGNITION OF THE MAJORITY Judge for the Central District of Cali- hinder Your purposes in our world. LEADER fornia. Pardon and overrule what has been left The ACTING PRESIDENT pro tem- f undone or done amiss as You strength- pore. The majority leader is recog- en all that has been worthily achieved. nized. HEALTH CARE REFORM Bless and keep us, and make Your face Mr. REID. Mr. President, I suggest Mr. REID. Mr. President, the next to shine upon us, as You give us Your the absence of a quorum. few weeks will tell us a lot about peace. We pray in Your merciful Name. The ACTING PRESIDENT pro tem- whether Senators are more committed Amen. pore. The clerk will call the roll. to solving problems or creating them. f The legislative clerk proceeded to We have before us a historic occasion. call the roll. That is where we are—a time in history PLEDGE OF ALLEGIANCE Mr. REID. Mr. President, I ask unan- where we have never been before—with The Honorable MARK R. WARNER led imous consent that the order for the the chance to ensure the well-being of the Pledge of Allegiance, as follows: quorum call be rescinded. both our fellow citizens and our recov- I pledge allegiance to the Flag of the The ACTING PRESIDENT pro tem- ering economy. We have before us the United States of America, and to the Repub- pore. Without objection, it is so or- opportunity to relieve the suffering of lic for which it stands, one nation under God, dered. many and prevent even worse pain in indivisible, with liberty and justice for all. f the future. f But if we are to seize this oppor- SCHEDULE tunity, this debate must be on facts, APPOINTMENT OF ACTING Mr. REID. Mr. President, following not fear. We must remain focused on PRESIDENT PRO TEMPORE leader remarks, there will be a period how we can best help the American The PRESIDING OFFICER. The of morning business until 3 o’clock people and the American economy, and clerk will please read a communication today. At that time, the managers of we must avoid the temptation to drown to the Senate from the President pro the bill will be here. Until that time, in distractions and distortions. In tempore (Mr. BYRD). Senators will be allowed to speak for other words, we must do our jobs. The legislative clerk read the fol- up to 10 minutes each as in morning Last week, my counterpart—the dis- lowing letter: business. tinguished Republican leader, Senator

∑ This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor.

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VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00001 Fmt 0637 Sfmt 0634 E:\CR\FM\A30NO6.000 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11980 CONGRESSIONAL RECORD — SENATE November 30, 2009 MCCONNELL—called the health care cri- not say yes to each word of this bill as panded, according to the administra- sis manufactured. The American people it currently reads, let us at least agree tion; we have not passed appropriations would beg to differ. I have said on this that simply saying no isn’t enough. bills; there are tax extenders that ex- floor before, on several occasions, that We will do this work transparently, pire at the end of the year; there are last year 750,000 people filed for bank- and we will do this work tirelessly. PATRIOT Act provisions that expire at ruptcy. That is true. I said previously That may mean debating and voting the end of the year. There are many that half the people who filed bank- late at night. It definitely means, I say things we must do this month. Yet we ruptcy filed because of medical ex- to everyone within the sound of my are going to spend an enormous penses. But we have learned of a report voice, the next weekends—plural—we amount of time working on a bill the that came out last week which states will be working. I have events this American people wish we would not that number is too small; that, real- weekend that I will have to postpone; pass this month. istically, it is about 70 percent of the some will have to cancel. That is the Let me, first, welcome everybody people who file for bankruptcy file be- way it will have to be with everyone. back—Senators and staff—after what, cause of health care costs. There is not an issue more important hopefully, was a restful and happy I have also said on this floor that than finishing this legislation. Thanksgiving. I actually worked Mon- half the people who filed for bank- I know people have things they want day and Tuesday of last week, and I ruptcy because of medical expenses did to do back in their States and right- had a chance to spend a good deal of so even though they had insurance. We fully so. I know people have fundraisers time out in my State of Kentucky with learned last week that number is also because they are running for reelec- a number of folks. I must tell you no- body was shy about telling me what too small; that it is 62 percent. That tion. I know there are other important they thought about the health care means 62 percent of the people who things they have to do. But nothing bill. Nobody was shy about it. They had filed for bankruptcy because of medical could be more important than this. We obviously been paying a lot of atten- expenses were already insured. Is that notified everybody prior to the break tion to it. Many had focused on the a crisis in America—750,000 people fil- we would be working weekends. Our vote to proceed to this 2,074-page bill, ing for bankruptcy and about 70 per- cloakroom did so by e-mails. We have Saturday a week ago. Many people cent of them filing because of health transmitted this message time and have an opinion. So far, not a single, care costs, with 62 percent of those who time again. So we are going to have to solitary Kentuckian did I run into—ad- filed for bankruptcy because of health work Saturdays and Sundays. mittedly, this is anecdotal—but not a care costs having health insurance? This crisis—and, yes, it is a real cri- single, solitary one said anything other What a sad commentary on the present sis—is simply too hazardous to our than you have to stop that health care state of the health care delivery sys- country and to its health not to work bill. I assured them we were going to tem in our country. as much and as long as we have to. do the very best we could to either dra- This weekend the assistant Repub- This is a good bill we have before us. It matically change it by amendment or, lican leader said we should go back to saves lives, saves money, and saves hopefully, on a bipartisan basis, keep square one. In fact, his exact quote Medicare. this 2,074-page bill from passing. was: ‘‘There is no way to fix this bill.’’ The evidence about this continues to A lot of people I met had that kind of That is what we do. We are legislators. pour in. Just a few days ago an MIT observation. I expect it is pretty simi- I have been in Congress a long time. I economist—one of the Nation’s fore- lar across the country. Kentuckians have been fortunate to get things most economists—a man by the name want to know how spending trillions of passed and never, ever have I gotten of Jonathan Gruber, analyzed our bill dollars we don’t have on a plan that the legislation I wrote passed the way and concluded it will help Americans raises health insurance premiums and it was written. With rare exception pay less and get more. He found that taxes on families and small businesses that happens. while the cost of private insurance con- is good for health care or for jobs or for I would say to my friend, the junior tinues to rise at extremely rapid rates, the economy, for that matter. The fact Senator from Arizona, that Repub- those who use the new health care in- is, Americans feel like they have been licans have had a seat at the table from surance changes we propose will save taken for a ride in this debate, and the very beginning of the health care hundreds, and in some cases thousands, they are beginning to realize what ad- debate. An example of that was in the of dollars per year per person. ministration officials meant when they HELP Committee, where 161 of the I am gratified we have already taken said a crisis was a terrible thing to amendments Republicans offered in health insurance reform further than waste. Early this year, they said: A cri- that committee were made a part of at any point in American history, but I sis is a terrible thing to waste. the bill that was reported out of that am not satisfied and will not rest until The notion that we would even con- committee. So when you hear someone we finish the job. Health care fairness sider spending trillions of dollars we say there is no way to fix this bill, you will come if we dedicate the coming don’t have in a way the majority of have to look at the underlying state- weeks to solutions, not scare tactics. Americans don’t even want is proof ments this gentleman has made in the f this health care bill is completely and past: Basically, there is no problem totally out of touch with the American with health care; things the way they RECOGNITION OF THE MINORITY people. It is now perfectly clear what are, are just fine; the fact that 750,000 LEADER happened. The administration and its people filed for bankruptcy last year, The ACTING PRESIDENT pro tem- allies in Congress have wanted to push 70 percent because of health care costs, pore. The Republican leader is recog- government-run health care for many not important. nized. years, and they view the economic cri- That is exactly what the legislative f sis we are in as their moment to do it. process is all about—changing things, So they sold their plan as an antidote HEALTH CARE REFORM working on things, trying to improve to the recession, even though their them, taking out things you don’t like, Mr. MCCONNELL. Mr. President, I plan would only make things worse. debating, amending, and improving. wish to reiterate the point the major- But now Americans are beginning to Democrats stand ready to do so. I hope ity leader made—that he is antici- see the truth behind the rhetoric. No my Republican colleagues recognize pating us being in on the weekends— one believes—no one—that trillions in that, even if the party leaders deny it. and to underscore why that seems to be spending, taxes, and debt will do any- As we round the latest turn along necessary, which is because the major- thing but kill jobs and darken the eco- this journey, I renew my plea to this ity is intent on passing this health care nomic prospects of struggling Ameri- body—to Senators, Democrats, and Re- bill that the American people oppose. cans and their children. publicans: Let us discuss the specifics We know that from all of the surveys. The administration’s health care of this bill, not the whispers and wild In addition to that, there are a num- plan will not alleviate the situation we rumors. While we disagree at times, let ber of things that actually must be are in. Instead, it would punish strug- us at least agree that doing nothing is done this month: We have a debt ceil- gling Americans at a moment when all not an option. While each of us may ing expiring, or needing to be ex- they want is a little help.

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00002 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.001 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S11981 Proponents of this bill couch their ef- this problem in their 2,074 page monu- interesting that a lot of those opinions forts with the refrain that history is ment to more government, more taxes, I heard were from the people who are calling. I think they have got it half more spending, and more debt. just reeling in agony because they are right. Someone’s calling all right, but Americans are fed up with big-gov- in the middle of some medical proce- it is not history. It is the American ernment solutions that drive up taxes dure such as chemotherapy and sud- worker. He is wondering where the jobs and debt and which only seem to create denly they get a notice from their in- are. It is the middle-class family won- more problems, more abuse, and more surance company that they are can- dering how Congress could try to pass a fraud. celed or they are desperate to get scheme that won’t do anything to con- In the face of this, our friends on the health insurance coverage and have trol costs. It is one of the roughly 40 other side of the aisle appear deter- been terminated from their job where million seniors wondering when Medi- mined to plow ahead with their plans. they had it, and then an insurance care became a piggy bank to fund more They don’t seem to care that Ameri- company tells them they will will not government and higher premiums. cans are telling them to stop and start insure them because they have a pre- I have enumerated the specifics over and fix the problem, which is existing condition. about the Medicare cuts in this bill be- health care costs. I do not believe there is anybody in fore: nearly $135 billion in cuts to hos- Democrat leaders may think they America who is satisfied with the way pitals, $120 billion in cuts to Medicare hear history calling. But the sounds the overall health care and health in- Advantage, nearly $15 billion in cuts to they should be hearing are the voices surance industry delivery system is nursing homes, more than $40 billion and the concerns of ordinary Ameri- giving us our health care. Whenever it from home health agencies, early $8 cans. The American people will be is said this bill that is before the Sen- billion from hospices—hospices. Nearly heard in this debate, I assure you. In a ate now is going to increase the cost, one-half trillion dollars in cuts: this is democracy, public opinion should not let’s remember our costs are already what some have audaciously started re- be and never is irrelevant. increased by the people who do not ferring to as ‘‘Saving Medicare.’’ I At the beginning of the health care have insurance who end up at the most don’t know what’s more preposterous: debate, we were told this $1 trillion ex- expensive place, which is the emer- gency room, since they have not had saying that this plan ‘‘saves Medi- periment would actually lower pre- any preventive care when they are in care,’’ or thinking that people will ac- miums for American families. Yet just an emergency. All of the rest of us pay tually believe you. this morning, this very morning, the for it. On average that is $900 to $1,000 Arthur Diersing gets it. He is a con- independent Congressional Budget Of- that is tacked on to our insurance poli- stituent of mine from Versailles, KY. fice provided an analysis showing that cies we are paying as a hidden tax to Here’s what he had to say about this the Democratic bill will actually in- pay for all those whom, if brought into plan. He wrote: crease premiums for American fami- the health insurance system, we would I . . . agree that there are some things in lies. That is the CBO this morning. It not be paying for. the health care system that need to be fixed indicated this will actually increase I will save the rest of my remarks or improved. But let’s work on the most im- premiums for American families. So a until we get on the health bill. portant 5–6 issues rather than turn the whole bill that is being sold as a way to re- system upside down, and run up the cost for duce costs actually drives them up. f all of us and take away from us seniors. The bottom line is this: After 2,074 THE ECONOMY Mr. Diersing knows what he is talk- pages and trillions more in government Mr. NELSON of Florida. Mr. Presi- ing about. He knows this bill doesn’t spending, massive new taxes and one- dent, I want to take this time to talk reflect the views of the American peo- half trillion dollar cuts in Medicare, about this terrible economic recession. ple. Americans have been asking us to most people, according to the Congres- To those people, by the way, who do cut costs, not raise them. They want sional Budget Office—most people— not have a job, it is not a recession, it the kinds of step-by-step reforms that will see their insurance premiums go is a depression. The times are difficult would actually make a difference, up. This is not what the American peo- economically all over this country but without bankrupting the country and ple are asking for, and it certainly is especially in my State of Florida which without further expanding the role of not reform. has an unemployment rate that is well the government in their lives. Ameri- I yield the floor. above the national average, and there cans don’t want this bill to pass. In- f are pockets in Florida where the unem- stead, they want us to earn their trust ployment rate is exceptionally soaring, with the kind of commonsense reforms RESERVATION OF LEADER TIME such as southwest Florida. It is this Republicans have been talking about The ACTING PRESIDENT pro tem- continued economic devastation from all year and which our friends have pore. Under the previous order, the home foreclosures, business closings, brushed aside. leadership time is reserved. and high unemployment rates that is Americans want us to end junk law- threatening the prosperity of the coun- suits against doctors and hospitals f try and particularly States such as that drive up costs. And yet there is MORNING BUSINESS mine, Florida. not a serious word about doing so in For example, in southwest Florida, The ACTING PRESIDENT pro tem- the 2,074 pages of the Democrat bill. we learned last week that another local pore. There will now be a period for Americans want us to encourage bank had been shut down by Federal morning business until 3 p.m. with healthy choices like prevention and regulators. It is the sixth bank failure Senators permitted to speak for 10 wellness programs. And yet Democrat to hit that region this year. On the leaders couldn’t come up with a serious minutes each. housing front, numbers were released word about these kinds of reforms in The Senator from Florida is recog- that indicate Fort Myers still has a 2,074 pages. nized. long way to go to climb out of the Americans want us to lower costs by f housing mess. While the positive news letting consumers buy coverage across was that foreclosures had declined 20 HEALTH CARE REFORM State lines. They want us to let small percent from September to October, businesses band together to negotiate Mr. NELSON of Florida. Mr. Presi- the area still ranks fifth in the country lower insurance rates. And yet Demo- dent, when we start the debate on the in foreclosures. crats have ignored both of these ideas, health bill, I will be exceptionally We need to continue the steps to get despite having 2,074 pages to include eager to take the floor and to address the housing market back on its feet. such ideas. some of the points the Republican lead- One of those steps we did included the Americans also want us to address er has just addressed. $8,000 tax credit for first-time home the rampant waste, fraud, and abuse in Most of us went home. As the minor- buyers. That goes through next spring. the current system before we create an ity leader said, most of us heard from Most recently, we took one step fur- entirely new government program. And our constituents who were not bashful ther when we passed a $6,500 tax credit yet Democrats don’t seriously confront about expressing their opinions. It is for existing homeowners who sell their

VerDate Nov 24 2008 02:11 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00003 Fmt 0637 Sfmt 0634 E:\CR\FM\A30NO6.002 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11982 CONGRESSIONAL RECORD — SENATE November 30, 2009 home and want to buy another. That buyers. It is a vicious downward spiral Second, we need to look at other has spurred home sales. that is not easily broken. One thing is ways to improve access to capital such We need to stabilize the prices, which clear: The Troubled Asset Relief Pro- as promoting direct lending by the remains the top priority. We also need gram has not been the answer. Small Business Administration. to keep the pressure on the banks, the When then-Secretary of the Treasury Third, we need a flexible approach to lenders, to work with folks who are los- Hank Paulson, the former head of dealing with underwater homeowners, ing their homes. Goldman Sachs, first proposed TARP, those whose value is now less than the Many places across the Nation, and there were a number of us on this floor value of their mortgage, which is so specifically Florida, are responding to who opposed and voted against it. I typical in the State of Florida. A flexi- the crisis by adopting mandatory medi- thought it was massive and a wasteful ble approach would be like the one in ation as an alternative to foreclosures, bailout of the Wall Street banks with Philadelphia which is undertaking to thereby forcing banks to modify mort- zero accountability and no meaningful require mediation and loan modifica- gages and avoid a foreclosure alto- reform. What have we found out about tions. gether. it? Of the $700 billion that Congress ap- These are a few suggestions I have in A great success story is a program in propriated for TARP, over $220 billion this very tough economic time. Philadelphia where borrowers can keep has yet to be loaned out and only some I yield the floor. their homes in a program that is being $70 billion has been repaid. I believe we The ACTING PRESIDENT pro tem- looked upon as a model for the rest of should end the program once and for pore. The Senator from Arizona. the Nation. Under a plan put in place all and return those funds to the U.S. Mr. KYL. I ask unanimous consent to by the city’s civil court, no property Treasury to prevent us from falling speak up to 20 minutes in morning can be foreclosed in that court and sold deeper into fiscal debt and a fiscal business. by the sheriff until the mortgage com- black hole. Bringing the deficit under The ACTING PRESIDENT pro tem- pany sits down with the homeowner to control would then help stabilize inter- pore. Without objection, it is so or- try to find a solution. est rates. It would hold borrowing costs dered. Unlike the administration’s effort to down, and it would reduce the growing f stem foreclosures, which relies on giv- debt burden on future generations. HEALTH CARE REFORM ing incentives to mortgage companies That still leaves roughly $400 billion of to encourage them to work with home- TARP funds outstanding. Mr. KYL. Mr. President, I rise to talk owners—a program that has not Bank of America, Citigroup, and about the health care legislation be- worked as the Obama administration Wells Fargo need to repay the TARP cause in a few minutes the official de- has intended—the Philadelphia pro- funds that have propped them up for bate in the Senate will commence. The gram, in contrast, is not a voluntary more than a year. They need to stand American people will have before them program. Mortgage companies are on their own feet. Banks such as Gold- the full panoply of arguments both for forced to participate. While that Phila- man Sachs that have repaid their and against the legislation. They will delphia program will not result in TARP funds still owe a tremendous make their judgment about whether we every troubled homeowner getting the debt to American taxpayers. Goldman are in fact carrying out their will. outcome they are looking for, making Sachs, Merrill Lynch, and a slew of According to public opinion surveys, those lenders come to the table is a other banks all profited from the dol- the will of the American people is that step in the right direction. But if we lar-for-dollar taxpayer bailout of AIG’s this bill should not pass. According to are going to bring back health to our credit default swaps, those insurance a relatively new Rasmussen poll, by an banking and financial system, we are policies. Under that AIG bailout, the 18-point margin, Americans say this going to have to fix the problems that most outrageous of all the bailouts, $70 bill should not pass. By 56 to 38, they are driving our community and re- billion of American taxpayer funds was oppose it. In terms of people in the gional banks to insolvency. The crisis put at risk to ensure that speculators middle, the independents or other vot- in residential and commercial real es- in credit default swaps were fully pro- ers not identified with either political tate values, home foreclosures, and tected. The head of Goldman Sachs re- party, the percentage of people who op- nonperforming commercial real estate cently apologized for his firm’s reck- pose the legislation is even greater. loans is wiping out those regional and less behavior and pledged to commit More than 3 to 1, Independents oppose local bank balance sheets. $500 million for small business lending. this legislation. The majority believes In response, those regional banks are That sounds like a serious commit- it will both increase their costs and de- desperately hanging on to their depos- ment, until we consider that Goldman crease the quality of health care. It is its and other assets. I wish I didn’t Sachs has set aside $17 billion for year- for these reasons that I indicated be- have to say this, but the Obama admin- end bonuses. So while Main Street is fore—and I will say it again—I don’t istration, particularly Secretary tightening its belt and preparing for a think this bill can be fixed. In fact, I Geithner, has not done a good job in lean holiday season, Wall Street is still don’t think the majority will allow it leading our banking system and real living high on the hog. That must to be fixed. That is why, along with my estate markets to recover. Their re- change. Republican colleagues, I believe we sponse to the collapse in residential As banks repay their TARP loans, we should start over and attack the prob- real estate was a tepid loan modifica- need to consider how we use those lems that face our country in a more tion program which in most cases funds, how we reform the financial sec- realistic way, in a step-by-step ap- kicked the can down the road for the tor. To get us back on track, we will proach, first to win back the con- few underwater homeowners who were have to be creative and find new solu- fidence of the people and then to pro- fortunate enough to qualify. Their re- tions to ensure that businesses have vide elements of relief to each of the sponse to the crisis in commercial real access to the capital they need to grow, problems we face, rather than trying to estate has been absent altogether. The prosper, and hire new workers. tackle the entire health care system, consequence is that the commercial I have a few suggestions. First, we the government programs, the private real estate market is on the verge of need to scrap the trickle-down TARP programs, the insurance, the physi- its own collapse as creditors are reluc- model and start working from the bot- cians, the hospitals, trying to do it all tant to refinance commercial projects. tom up. We need to focus on access to in one giant bill that results in massive Half way through the year, Florida capital for small businesses and ways government takeover, over $1 trillion— banks had over $5 billion of commer- to shore up residential and commercial in fact, $2.5 trillion—in expenditures, cial real estate loans in default. Com- real estate values. TARP has focused massive new debt, more taxes, higher mercial real estate makes up over one- far too much on the largest Wall Street insurance premiums, all of which will third of the assets of Florida banks. banks at the expense of community result in, ultimately, the rationing of These growing liabilities are putting and regional banks, the backbone of fi- health care which is, to me, the most the brakes on bank lending in Florida, nance in Florida. We need to increase dangerous part of this entire exercise. and they are hurting creditworthy Federal support and assistance to com- Somehow or other, we could probably small businesses and prospective home munity banks and credit unions. pay the expense of this. Somehow or

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00004 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.003 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S11983 other we will survive. But we won’t Let me go over some of the Medicare I think they have a right to be con- survive the life-and-death decisions cuts in this bill and then ask my cerned about losing these benefits. If that are made every day by patients, Democratic colleagues if they are will- there is any doubt about this, inciden- doctors, and families, if the govern- ing to join Republicans in restoring tally, the Congressional Budget Office, ment begins intruding between the pa- these provisions of Medicare—in other which is a nonpartisan entity which tient and the physician, begins making words, in striking these cuts—if they serves both Democrats and Republicans decisions about what kind of health are willing to join Republicans in that here—it calls it straight; sometimes care we can have, what kind of health effort. Then maybe the majority leader they give answers we do not like, but care the government will allow pay- is right. Maybe we can fix this bill. If they provide the analysis of the costs ment for and the like. Those become they are not willing to do that, then I and benefits—and the Congressional life-and-death decisions. That is why resubmit that this bill can’t be fixed, Budget Office has confirmed that under Americans feel so strongly and person- and it can’t because our Democratic the Democrats’ bill, Medicare Advan- ally about this debate and about the friends won’t allow it to be fixed. tage beneficiaries will lose, and they decisions we are about to be making Here are the ways this bill cuts Medi- will lose big. In fact, they will lose here. care benefits for seniors: $137.5 billion more than half their extra benefits Let me address something the distin- is cut from hospitals that treat seniors; under Medicare Advantage. guished majority leader said a moment $120 billion is cut from Medicare Ad- Well, my senior citizen constituents ago, and then I wish to talk a bit about vantage. I will return to Medicare Ad- do not like that, and they have let me Medicare as one of the aspects of this vantage in a moment. That is the pri- know about that. Let me share a cou- insurance debate. vate insurance company that some- ple letters—just excerpts from letters The majority leader said that Repub- where around a quarter to a third of from two of my constituents. The first licans have had a seat at the table. I seniors take advantage of. Well over a is from Surprise, AZ: am on one of the two major commit- third of the seniors in Arizona, ap- My mother is on Medicare Advantage, and tees, the Finance Committee. I think proaching 40 percent of Arizona sen- I don’t know what she would do without it. one amendment was adopted. It was an iors, participate in the Medicare Pro- The poor and middle class are already hurting much more than government offi- amendment offered by a Republican gram, the benefits of which are sub- cials realize. We are on fixed incomes, and and a Democrat on the committee. stantially cut. Continuing, $14.6 billion have already cut back to bare minimum. There were well over 100 amendments is cut from nursing homes; $42.1 billion What happened to ‘‘government for the peo- that Republicans offered that were all from home health care, $7.7 billion ple, by the people?’’ shot down, defeated, largely on party- from hospice care. That is a total of Another constituent from Gold Can- line votes. I say to my distinguished $464.6 billion in Medicare cuts. Seniors yon, AZ, writes: friend from Nevada that maybe we know we can’t make these kind of cuts I have been on Medicare for 11 years and have a seat at the table but it is a lit- without jeopardizing the care they re- have been subscribing to a Medicare Advan- tle like the kids table at Thanksgiving ceive. That is the concern I have. We tage plan for the past 6 years. It has been ex- dinner where you are told to mind your are not talking about cuts in the ab- cellent, and has provided substantial savings manners and keep the noise down. That stract. We are talking about delay and for us. Now we understand that the govern- is the way Republicans feel about our denial of care for American citizens. ment is dropping its support of the plan. Please try to stop this. It is very important role at the table in fashioning this leg- These folks wonder how it is fair or to many senior citizens in Arizona. islation. justifiable to cut the health care that These constituents of mine, these The majority leader himself would has been promised to them in order to senior citizens, know Medicare cuts acknowledge that after the two com- pay for some kind of new government will hurt seniors’ care, and those who mittees in the Senate acted, he went entitlement. behind the closed doors of his office I receive letters and phone calls try to suggest otherwise are simply and, along with representatives from every day. I have quoted from many of wrong. The Congressional Budget Of- the White House and a couple of other these letters. Many of them have to do fice, as I have said, has confirmed it. One of the newspapers on Capitol Democratic Senators, no Republicans with the proposed cuts in Medicare, in Hill, Politico, recently provided a help- at all, legislation was developed in his particular to Medicare Advantage. ful summary of an actuarial report on office that he then presented here on I mentioned the percentage. In num- the Democrats’ health care plan, pre- the Senate floor just before the bers, it is about 329,000 Arizonans— pared by the Centers for Medicare and Thanksgiving recess. That is how the 329,000 Arizonans—a third of a million Medicaid Services. That is CMS. That legislation got developed. It was with- who enjoy Medicare Advantage plans. is the outfit out of the Department of out Republican participation. That is over 37 percent of overall Medi- We will have a chance to amend this care beneficiaries in my State of Ari- Health and Human Services that actu- bill. Maybe he will prove me wrong. zona. They know $120 billion in Medi- ally runs Medicare. According to page 8 Maybe he will demonstrate that we can care Advantage cuts will hit our State of the report, as Politico summarizes, fix this bill. and, specifically, their coverage very the Democrats’ bill: I do, with all deference, disagree with hard. They worry that under the Reid . . . reduces Medicare payments to hos- his comment that the motivation of bill, they will lose the low deductibles pitals and nursing homes over time, based on productivity targets. The idea is that by Republicans is to do nothing. Of and the low copayments they enjoy paying institutions less money, they will be course, he frequently says doing noth- under Medicare Advantage and many of forced to become more productive. But it’s ing is not an option. Nobody is arguing the other benefits I mentioned a mo- doubtful that many institutions can hit about doing nothing. Republicans have ment ago. those targets, which could force them to presented some very good ideas to do They worry about losing the choices withdraw from Medicare. something, to do a lot of somethings. they have, which is one of the nice We hear it all the time: physicians Our ideas have been rejected. Let’s things about the Medicare Advantage dropping or not taking any new Medi- don’t get into false debate about doing plan, and the extra benefits, including care patients; entities that are no something or nothing and the only al- things such as eyeglasses, hearing aids, longer going to be able to serve Medi- ternative is the bill that is on the Sen- dental benefits, preventative screening, care patients because they are not get- ate floor. There are alternatives, and I free flu shots, home care for chronic ting paid enough by the government will discuss one group of alternatives illnesses, prescription drug manage- for them to even break even. we have presented in a moment. ment tools, wellness programs, medical This report I am quoting from—the There will be a good test to see equipment, and access to physical fit- CMS report—according to Politico, whether in fact we can amend this bill ness programs. These and many more says that by 2014, Medicare Advantage or if my prediction that there is no are the kinds of benefits that are in- enrollment will plunge 64 percent—we way to fix it will turn out to be true. cluded in the Medicare Advantage Pro- are not talking about just a few folks— That has to do, first and foremost, with gram, and they will lose many of these from 13.2 million down to 4.7 million what this bill does to Medicare, the benefits under the legislation that is because of the ‘‘less generous benefit program we have developed for seniors. before us right now. packages.’’

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00005 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.013 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11984 CONGRESSIONAL RECORD — SENATE November 30, 2009 One of the reasons this is being done neighborhood of 70 to 80 percent of government-run kind of program you is because those on the left do not like their cost, and we have to make up the are trying to institute under this legis- private competition for the govern- difference in that in the private insur- lation, which, according to CBO, would ment program, Medicare. What I think ance premiums we pay. So increasing raise insurance premiums? they fail to appreciate is what my con- insurance premiums is, to a large de- That is why the American people, by stituents have appreciated, which is gree, the fault of the U.S. Government, a significant margin, say: Do not pass this private alternative to regular not the insurance companies. this bill, why they appreciate it would Medicare provides additional benefits, The Democrats say the answer is yet raise their costs, it would reduce the additional health protections. If they another government program, and they quality of their health care, and why, are willing to pay a little bit more for even have a government insurance pro- therefore, my colleagues and I are those benefits, why shouldn’t they be gram in the legislation they have in- going to try our best to persuade our allowed to take advantage of those troduced. Their other answer is to Democratic colleagues to amend the benefits? No. Those on the left say: We write insurance policies. They actually bill. But if at the end of the day they don’t want any private insurance com- specify in the bill what policies have to are not willing to buy some of these panies competing to get Medicare pa- include. These are called government good Republican ideas and instead in- tients. We want that to be strictly a mandates. What is the effect of these sist on pushing right ahead with their government program. proposals? Is this the right way to go legislation, at the end of the day, we Well, if folks like it, why shouldn’t or is there a better idea? will have to say: We are sorry, it does they be allowed to keep it? Remember Again, the Congressional Budget Of- not appear this bill is going to be fixed what the President said: If you like fice, which the distinguished minority and, therefore, we are going to follow your insurance company, you get to leader referred to a moment ago, in its the wishes of the American people and keep it. No, that is not true, according most recent report said—and it said see to it that it does not pass. to this. Medicare Advantage enroll- the same thing to the Finance Com- I suggest the absence of a quorum. ment will plunge from 13.2 million to mittee—the premiums for private in- The ACTING PRESIDENT pro tem- 4.7 million because of the ‘‘less gen- surance under this Democratic legisla- pore. The clerk will call the roll. erous benefit packages.’’ So I guess it tion will, what, go up. The average The legislative clerk proceeded to is not true: If you like it, you get to family is going to pay more in insur- call the roll. keep it. ance premiums under this legislation, Mr. REID. Mr. President, I ask unan- The Washington Post—a newspaper not less. imous consent that the order for the here in Washington—wrote an article What was the whole idea here? The quorum call be rescinded. about the Center for Medicare and whole idea of health care reform was to The ACTING PRESIDENT pro tem- Medicaid Services report, the same one reduce the cost of health care, to re- pore. Without objection, it is so or- I have been quoting here, and the head- duce our insurance premiums. They are dered. line was ‘‘Bill Would Reduce Senior skyrocketing. My colleagues on the f Care.’’ Well, that says it in a nutshell. other side of the aisle say: Small busi- The story goes on to tell us: ‘‘A plan to nesses cannot afford to buy insurance ORDER OF PROCEDURE slash . . . Medicare spending—one of for their employees; my constituents Mr. REID. Mr. President, the Senator the biggest sources of funding for cannot afford their health insurance from Minnesota is here. She has a brief President Obama’s proposed overhaul premiums, which are increasing in statement to make. I ask unanimous of the nation’s healthcare system— price. All that is true. They are in- consent that she be allowed to speak would sharply reduce benefits for some creasing. So what should we be doing? for 5 minutes and then we go to the senior citizens.’’ We should be lowering them, not rais- bill. ‘‘Would sharply reduce benefits.’’ So ing them. This legislation, according to The ACTING PRESIDENT pro tem- the Medicare cuts, as proposed by the the Congressional Budget Office, in- pore. Without objection, it is so or- majority, do, in fact, jeopardize sen- creases insurance premiums. dered. iors’ benefits. The majority leader says What about the Republican alter- The Senator from Minnesota. we can amend the bill, and that is hy- native, the alternative that was pre- f pothetically correct, of course. sented in the House of Representatives Let’s see how many of our Demo- by the House Republicans? That alter- DETENTION IN IRAN cratic colleagues are willing to join Re- native, according to the Congressional Ms. KLOBUCHAR. Mr. President, I publicans in striking these Medicare Budget Office, reduces average insur- come to the floor to call attention to cuts, the cuts I have just now been re- ance premiums by $5,000 a year. So on the situation of three citizens of the ferring to. If we do not do that, then I the one hand, you have the Democratic United States—Shane Bauer, Sarah will repeat what I have said before, proposal, which increases insurance Shourd, and Josh Fattal—who have which is that we should start over be- premiums; on the other hand, you have been detained by the Government of cause it is clear this bill is not going to the Republican proposal, which de- Iran for nearly 4 months. One of these be fixed and starting over would mean creases premiums. individuals, Shane Bauer, comes from taking some of the Republican sugges- There is a study by a private con- my home State of Minnesota, and so tions. sulting firm, Oliver Wyman, which the safe return of these three young Let me talk about one of these sug- breaks this down by State. The reason Americans is of particular importance gestions. My colleague from Florida I am excited about this Republican to me. was talking about the sorry state of idea is the average family in Arizona On July 31 of this year, Shane, Sarah, real estate in his State of Florida, and would see its premiums go down annu- and Josh—who shared a common pas- I could have added my State of Arizona ally by over $7,400. So think about sion for travel and discovery—were on as well. I agree with much of what he that. On the one hand, you have insur- a hiking trip in a peaceful region in had to say about that. But he also ance premiums going up, under the northern Iraq, when they reportedly noted, with regard to health care, there Democratic legislation; under the accidentally strayed across the poorly is a subsidy in what those of us with other, you have insurance premiums marked border between Iraq and Iran private insurance pay because of the going down, on average, somewhere in and were surrounded by Iranian border care that is given to others who cannot the neighborhood of anywhere from guards. always pay for all of it. That is true. $3,300 to, in my State, up to $7,400. I Since then, Shane, Sarah, and Josh I would add, there is also a subsidy think the average is somewhere be- have been held in near isolation in a for what we pay in insurance premiums tween $3,000 and $5,000. Tehran prison and have been allowed because of the government programs, The point is, you can cut insurance no contact with their families in the such as Medicare and Medicaid, which, premiums with better ideas coming United States. likewise, do not pay for all the benefits from Republicans, and I just ask my Despite repeated requests by the they provide. In fact, they only pay colleagues: Why wouldn’t you do that Swiss Government, which represents doctors and hospitals somewhere in the as opposed to the complicated, costly, U.S. interests in Iran, the three have

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00006 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.015 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S11985 been denied regular consular access re- tries. This is strictly a humanitarian Mr. REID. Mr. President, one of the quired by the Vienna Convention. They case. I urge Iranian officials not to po- major goals of the Patient Protection have been denied repeated requests to liticize it or seek to use the three and Affordable Care Act is to lower be able to speak with their families via hikers as diplomatic pawns. There is no Federal health care costs and reduce telephone, and they have been denied cause for their continued detention, the deficit. Our bill does that. Accord- public information on any charges they and nothing will be gained by pro- ing to the nonpartisan Congressional may face. longing it any further. Iran’s leaders Budget Office, this legislation would In the 4 months they have been de- should demonstrate the necessary com- not add a penny to the Federal deficit. tained, the three have been allowed passion by immediately releasing In fact, it will reduce the deficit over only two meetings with Swiss consular Shane, Sarah, and Josh and allowing both the short term and the long term, officials and have been denied due proc- them to return home to their families. over the long term by as much as $650 ess and access to legal representation. In the meantime, they should at the billion. Even more alarming, Iranian officials very least allow them to speak to their In developing this bill with the Fi- have recently declared the three may families in the United States over the nance and HELP Committees, we were be charged with espionage, a charge telephone. determined to ensure that the legisla- that is not only baseless but also com- I thank my friend, the Ambassador tion not only would reduce our deficit pletely at odds with who Shane, Sarah, to Switzerland, and Swiss officials for and our debt but that it would do so and Josh are as individuals. their work in this area. It has been 122 without relying on additional surpluses Shane, Sarah, and Josh made a sim- days since Shane, Sarah, and Josh were in the Social Security trust fund. This ple mistake in accidentally crossing first detained; 122 days in captivity, ap- legislation would increase revenues in the border, and their continued deten- parently just for straying over a line the trust fund as workers’ wages rise. tion is unwarranted and unreasonable. on a map when they were on a hike. We But those revenues are supposed to be Since the three were detained, I have will continue to work with the fami- for Social Security, so we didn’t touch gotten to know Shane’s mother Cindy lies, with the State Department, and a penny of them—they are all used for and other members of the hikers’ fami- Swiss officials to do everything we can Social Security and nothing else. lies. During our conversations, I have to bring Shane home to Minnesota. Likewise, about $70 billion in reve- learned what a remarkable person Thank you, Mr. President. I yield the nues over the first 10 years of this bill Shane is and how he is dedicated floor. flows from premiums paid into the new long-term care insurance program through his work to bringing the world f closer together through photo jour- known as the CLASS Act. Several CONCLUSION OF MORNING nalism. Members came to me and argued that Shane grew up in Onamia, MN, a BUSINESS none of these funds should be used for small town in the central part of our The ACTING PRESIDENT pro tem- other purposes. I agreed. After all, State, and he graduated from the Uni- pore. Morning business is closed. these premiums would be used to build versity of California at Berkeley. Prior f up a fund that later would be used to to being detained in Iran, Shane was pay benefits. So, as with Social Secu- SERVICE MEMBERS HOME rity, we didn’t use any of the CLASS living with Sarah in Damascus. He has OWNERSHIP TAX ACT OF 2009 traveled around the Middle East as a surpluses for other programs. free-lance journalist, reporting from The ACTING PRESIDENT pro tem- I think it is important that as the Syria, Iraq, Darfur, Yemen, and Ethi- pore. Under the previous order, the Senate considers changing the legisla- opia. His writing and award-winning Senate will resume consideration of tion, we maintain our commitment to photographs have been published in the H.R. 3590, which the clerk will report. protecting Social Security and CLASS The legislative clerk read as follows: United States, the United Kingdom, surpluses. In both cases, all additional revenues are dedicated to pay benefits. Canada, and throughout the Middle A bill, (H.R. 3590), to amend the Internal Revenue Code of 1986 to modify the first-time Diverting them to other purposes East. home buyers credit in the case of members of would not be fiscally responsible, and His latest trip with Sarah and Josh the Armed Forces and certain other Federal brought him to the Kurdistan region of it wouldn’t be fair to Social Security employees, and for other purposes. or to people who paid their CLASS pre- Iraq, which is known for its scenic Pending: hikes among mountainous waterfalls. miums in good faith. Reid amendment No. 2786, in the nature of To help ensure we remain true to this This is hardly the background of some- a substitute. commitment, I now ask unanimous one who would deliberately enter Iran The ACTING PRESIDENT pro tem- consent that all amendments to the in hopes of committing espionage. pore. The majority leader. pending bill be considered out of order A few weeks ago, I met with Shane’s Mr. REID. Mr. President, today is the unless they are consistent with the fol- mom Cindy and members of Sarah and beginning of one of the most important lowing two principles: The additional Josh’s families in my office in Wash- debates in the history of our country. surplus in the Social Security trust ington. As a mother, I can only imag- Today is the beginning of one of the fund generated by this act should be re- ine how difficult this ordeal must be most historic times in the Senate. Our served for Social Security and not for all of them. They have had no con- two chairmen, Senators BAUCUS and spent in this act in any other fashion; tact with their sons or their daughter. DODD, have spent months of their lives and No. 2, the net savings generated by Yet I have been overwhelmed by their working on the legislation that allows the CLASS program should be reserved resolve. They are pursuing every ave- us to be where we are today. We now for the CLASS program and not spent nue they can find to demonstrate to have before us a bill that saves money, in any other manner in this act. the Iranian Government that their saves lives, and saves Medicare. It is a The ACTING PRESIDENT pro tem- children made a simple mistake and bill, if you add in Medicare recipients, pore. Is there objection? clearly deserve to be released. that will insure 98 percent of the people Mr. ENZI. Reserving the right to ob- I came away from our meeting even in America. ject, neither of these requests are the more committed to seeing that Cindy Mr. President, I note the absence of a requests I was just talked to about a and Shane, along with Sarah and Josh quorum. minute and a half ago, so I object. and their families, are united as soon The ACTING PRESIDENT pro tem- The ACTING PRESIDENT pro tem- as possible. As we all know, Iran is in pore. The clerk will call the roll. pore. Objection is heard. the center of many pressing foreign The legislative clerk proceeded to Mr. REID. Mr. President, I think policy challenges we currently face. I, call the roll. what he saw a minute and a half ago is along with my colleagues, will address Mr. REID. Mr. President, I ask unan- essentially the same thing, but I will those, but Shane, Sarah, and Josh have imous consent that the order for the recite this again. absolutely nothing to do with these quorum call be rescinded. I ask unanimous consent that no international fights. They have noth- The ACTING PRESIDENT pro tem- amendment be in order to the Reid sub- ing to do with what is going on in Iran pore. Without objection, it is so or- stitute amendment 2786 or a subse- or Iran’s differences with other coun- dered. quent substitute amendment and H.R.

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00007 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.016 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11986 CONGRESSIONAL RECORD — SENATE November 30, 2009 3590 if the additional surplus in the So- motion to proceed to this bill unless it behind the Senator from Maryland. cial Security trust fund generated by had been available to the public for a The amendment she is going to offer is this act would be expended on other reasonable period of time. She was very sound and good. She will explain provisions of this act and not reserved joined by virtually everyone on this it in detail. It expands women’s health solely for Social Security, and the net side of the aisle to that effect. They services. We had a consternation about savings generated by the CLASS pro- were right. The people did deserve a mammograms a couple weeks ago, and gram in the underlying substitute chance to see the bill before that vote, this will put that all to rest. amendment and any subsequent sub- so we were sure to give them that I express my deep appreciation for stitute amendment are reserved solely chance. The Senator deserves credit for the leadership of the Senator from for the CLASS program provisions of that, and I appreciate her standing up Maryland on this issue and on so many this act. on that issue. other issues she is involved in. The ACTING PRESIDENT pro tem- She believes—and I agree—that we As I have indicated, the managers of pore. Is there objection? can do more on the transparency front the bill on our side will be Senators Mr. ENZI. Mr. President, in the as this bill moves forward to the next BAUCUS and DODD. We look forward to weeks this has been sequestered with- stage of this process; therefore, Sen- a rigorous debate. With the consent of out us being able to review it and now ator LINCOLN has asked me to propound my friend from Wyoming, I ask that having something that is not under- on her behalf a unanimous consent re- the Senator from Maryland be recog- standable in the short period of time quest. nized. we have to do it here, I have to object. I ask unanimous consent that no Mr. ENZI. Mr. President, I was hop- The ACTING PRESIDENT pro tem- amendment be in order to the Reid sub- ing I would have a chance to comment pore. Objection is heard. stitute amendment No. 2786, a subse- on the things I had to object to so I can Mr. REID. Mr. President, I am sorry quent substitute amendment, or H.R. give a more full explanation. I am my friend objected. It is not too dif- 3590 unless the text or Internet link to happy to wait. ficult to comprehend that any Social the text of the amendment is posted on Mr. REID. Mr. President, there is no Security surpluses should be reserved the home page of the official Senate need to cut the Senator off. I have indi- for Social Security. It is not too dif- Web site of the Member of the Senate cated to my staff earlier today that ficult to comprehend that all monies who is sponsoring the amendment prior there is no one easier to get along with related to the CLASS Act would be re- to the amendment being called up for in the Senate than the Senator from served for paying benefits for that. So consideration by the Senate and the Wyoming. I would never, ever cut him I am disappointed that my friends on amendment is filed at the desk. Fur- off intentionally. If there is anything the other side of the aisle are not inter- ther, that this unanimous consent he wishes to say, he should say it. If ested in making sure Social Security agreement shall be in effect for the du- the Senator from Maryland will with- monies are not used and/or CLASS Act ration of the consideration of H.R. 3590. hold for a moment, the Senator from monies are not used for anything other The ACTING PRESIDENT pro tem- Wyoming wishes to speak for a brief than those two programs. pore. Is there objection? Mr. President, I have another unani- Mr. ENZI. Mr. President, in light of period of time. mous consent request. some of the trust problems and trans- The ACTING PRESIDENT pro tem- The process for developing this legis- parency problems we have, and while it pore. The Senator from Wyoming is lation has been very transparent. In appears to lead to greater trans- recognized. fact, the hearings held in the Finance parency, we can also see ways that this Mr. ENZI. Mr. President, I cannot be Committee were done very publicly, can limit the ability for the minority brief on what just happened here. I will and that is an understatement. For to offer amendments. Therefore, I ob- let the Senator go ahead. Frankly, I weeks and weeks, members of that ject. am a little upset about what has hap- committee couldn’t walk out of the The ACTING PRESIDENT pro tem- pened—combining a couple of unani- room without being questioned by the pore. Objection is heard. mous consent agreements so that part press. The press was present at most of Mr. REID. Mr. President, this is not of it would be acceptable and part their meetings. So both the HELP and a good way to start this debate. No. 1, would not be, leaving out the most im- Finance Committees marked up their there is an objection to the moneys in portant one, which is that we wouldn’t legislation in public markups. Repub- Social Security being protected and, take Medicare money from Medicare, lican and Democratic members of both No. 2, to the moneys in the CLASS Act and then not having much time to con- committees offered numerous amend- being protected. That was also objected sider, or to rewrite, or to do anything ments, all of which were available to to. with those. I have a lot of comments I the public. Republican and Democratic Finally, Senator LINCOLN’s request, wish to make on that, plus a general members voted for or against those which I support 100 percent, indicating statement on the bill, which fits in amendments in a public and trans- that amendments should be filed on a with what just happened. I will defer to parent way, and each committee mem- Member’s Web site—that doesn’t sound the Senator from Maryland. ber can be held fully accountable to too outlandish—and filed at the desk The ACTING PRESIDENT pro tem- their constituents for all of those before they are offered, sounds pretty pore. The Senator from Maryland is votes. fair and square to me. I am dis- recognized. The merged bill before us is entirely appointed this is the way the debate AMENDMENT NO. 2791 TO AMENDMENT NO. 2786 consistent with the provisions pro- started. Ms. MIKULSKI. Mr. President, I have Mr. President, there is an order be- duced in those public markups. The bill an amendment at the desk. has been fully available on the Internet fore the body that there will be two The ACTING PRESIDENT pro tem- for about 2 weeks. So each and every amendments in order today. One will pore. The clerk will report. American has had the opportunity, if be offered by the Democrats and one they wanted, to read the text of the will be offered by the Republicans. The The assistant legislative clerk read legislation and to communicate their one to be offered by the Democrats will as follows: views with their Senators. be offered by the distinguished Senator The Senator from Maryland (Ms. MIKUL- One of the main reasons we have from Maryland, BARBARA MIKULSKI, SKI), for herself, Mr. HARKIN, Mrs. BOXER, gone the extra mile in ensuring a fully who I had the good fortune of serving and Mr. FRANKEN, proposes an amendment numbered 2791 to amendment No. 2786. transparent process is because of the with in the House of Representatives. leadership of Senator BLANCHE LINCOLN She and I came here together in 1986 Ms. MIKULSKI. Mr. President, I ask of Arkansas. From the very start of when we were elected to the Senate. unanimous consent that reading of the this debate, she has made clear to me She is a Senator I have such great re- amendment be dispensed with. that a transparent process and debate spect and fondness for. We have been The ACTING PRESIDENT pro tem- on this critical issue is a top priority of literally together and, because of our pore. Without objection, it is so or- hers. To that end, Senator LINCOLN seniority, I am always one step behind dered. said she would not allow a vote on the her. Frankly, most people are a step The amendment is as follows:

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00008 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.018 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S11987 (Purpose: To clarify provisions relating to work his committee did, for bringing in percent to over 100 percent. A 25-year- first dollar coverage for preventive serv- a great bill that establishes new ideas, old woman is charged up to 45 percent ices for women) such as medical homes, emphasizing more than a 25-year-old male in the On page 17, strike lines 9 through 24, and primary care and prevention, and at same identified health status. A 40- insert the following: ‘‘ance coverage shall, at the same time accomplishing the ob- year-old woman is charged anywhere a minimum provide coverage for and shall jectives I have mentioned. from 2 percent to 140 percent more not impose any cost sharing requirements than a 40-year-old man with the same for— However, as I reviewed the bill, I felt ‘‘(1) evidence-based items or services that we could do more to be able to enhance health status for the same insurance have in effect a rating of ‘A’ or ‘B’ in the and improve women’s health care. That policy. current recommendations of the United is what my amendment does. The es- What does my amendment do? It States Preventive Services Task Force; sential aspect of my amendment is guarantees access to those critical pre- ‘‘(2) immunizations that have in effect a that it guarantees women access to ventive services for women to combat recommendation from the Advisory Com- lifesaving preventive services and their No. 1 killers. We will provide mittee on Immunization Practices of the screenings. these services at minimal cost. Centers for Disease Control and Prevention This amendment eliminates one of The overall cost of my amendment with respect to the individual involved; and the major barriers to accessing care in has been scored by CBO. It says the ‘‘(3) with respect to infants, children, and cost is $1 billion. The majority leader, adolescents, evidence-informed preventive the area of cost and preventive serv- care and screenings provided for in the com- ices. It does it by getting rid of, or the Democratic leader, has provided prehensive guidelines supported by the minimizing, high copays and high opportunities to meet this cost. This Health Resources and Services Administra- deductibles that are often over- amendment eliminates this big barrier tion. whelming hurdles for women to access of copayments and deductibles. ‘‘(4) with respect to women, such addi- screening programs. We know that Let’s talk about the benefit package. tional preventive care and screenings not de- screening is important and early detec- This benefit package is based on HRSA scribed in paragraph (1) as provided for in tion is important because it saves recommendations. It is based also on comprehensive guidelines supported by the the recommendations of CDC. If this Health Resources and Services Administra- lives. But it also saves money. It does it by reducing the top diseases that are amendment passes, women will have tion for purposes of this paragraph.’’. access to the same preventive health ‘‘Nothing in this subsection shall be con- killing women today, or certainly im- pairing their lives. services as the women in Congress strued to prohibit a plan or issuer from pro- have. If this passes, again, the women viding coverage for services in addition to Today, according to the CDC, the top those recommended by United States Pre- killers of women are cancer—breast of America will have access to the ventive Services Task Force or to deny cov- cancer, cervical cancer, colorectal can- same preventive services that we erage for services that are not recommended cer, ovarian cancer. Also upfront and women in Congress have. What does that mean? It means a by such Task Force.’’. high on the list is lung cancer which, if mammogram, if your doctor says you Ms. MIKULSKI. Mr. President, before identified early, can be treated with need it; screening for cervical cancer, if I go into the contents of my amend- less invasive procedures and with lower your doctor says you need it; that ment, I thank the Senator from Wyo- costs. Another top killer of women is ming for his unfailing courtesy to check on diabetes, if your doctor is heart and vascular disease. And then worried about you; and along with the allow me to proceed to offer my there are the silent killers that often amendment. I have worked with the symptoms related to menopause, there go undetected, such as diabetes, which are other things, such as a loss of Senator from Wyoming on the Health, can result in terrible consequences, Education, Labor and Pensions Com- weight; and they may want to know at such as the loss of an eye, the loss of a this juncture if you have diabetes. If mittee, and have often valued his limb, or the loss of a kidney. sound counsel and steady hand as we you know that at 40, you are less likely We now have screenings that are to need kidney dialysis when you are have moved complex legislation. His proven to detect these diseases early. considerable experience as an account- 60. Guaranteed access to these screenings, The pending bill doesn’t cover key ant and his commitment to the stew- as I said, will save money and lives. preventive services, such as annual ardship of Federal funds have often If we look at where women are today, screenings for women of all ages to added to the consideration of legisla- we find women often forgo those crit- focus on our unique health needs. We tion. As we move forward on both de- ical preventive screenings because they know that for many people—for exam- bating and refining the health care re- simply cannot afford it, or their insur- ple, there are 15 million people in form bill before us, I look forward to ance company won’t pay for it unless it America with diabetes, and half are working with him. Again, I thank him is mandated by State law. Many women. Often pregnant women with di- for his courtesy. women right now don’t have insurance abetes don’t get the proper prenatal I also want to acknowledge the at all—seventeen million women in the care. Heart disease is one of the top Democratic leader and wish to support United States of America are unin- two leading causes of death in women— him for bringing something called the sured—or when they are insured, they cancer and heart disease. Every year, ‘‘merged’’ bill to the floor, which took have to pay large out-of-pocket ex- over 267,000 women die from heart at- the best elements of both the Finance penses. tacks. Women are generally unaware of Committee and the HELP Committee Three in five women have significant their heart risks. and brought them forth. problems paying their medical bills. My amendment would, again, ensure I believe the overriding bill before us Women are more likely than men to heart disease screening for women. Re- is an excellent bill. No. 1, it expands neglect care or treatment because of member that famous study that said universal access to health care that cost. Fourteen percent of women report ‘‘take an aspirin a day to keep a heart will now cover over 90 percent more they delay or go without needed health attack away.’’ It was done on 10,000 Americans. It will end the punitive care. Women of childbearing age incur male medical residents, and not one practices of insurance companies, par- 68 percent more out-of-pocket health woman was included. Thanks to a bi- ticularly in the area of gender, age dis- care costs than men, simply because of partisan effort, Bernadine Healy, NIH, crimination, and preexisting condi- the maternity aspect. and the women of the Senate, sup- tions. It also stabilizes and makes Women are often faced with the puni- ported by the good guys of the Senate, Medicare secure and, at the same time, tive practices of insurance companies. were able to get that screening for it begins to bend the cost curve by fol- No. 1 is gender discrimination. Women women, get that evaluation. We know lowing innovative practices related to often pay more and get less. For many we manifest things differently than quality control and prevention. insurance companies, simply being a guys do. Now we are on our way to de- I think the overriding bill is an excel- woman is a preexisting condition. Let tection—if you can afford to have a lent one. I congratulate the manager of me repeat that. For many insurance doctor and if you can afford to have the the bill on the floor, the Senator from companies, simply being a woman is a screening. Montana, Mr. BAUCUS, chairman of the preexisting condition. We pay more be- My amendment also guarantees Finance Committee, for the excellent cause of our gender, anywhere from 2 screenings for breast cancer—yes, for

VerDate Nov 24 2008 02:11 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00009 Fmt 0637 Sfmt 0634 E:\CR\FM\A30NO6.001 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11988 CONGRESSIONAL RECORD — SENATE November 30, 2009 mammograms. We don’t mandate that compliment the Senator from Mary- form will work. On this very floor I you have a mammogram at age 40. land for standing up for and essentially have heard arguments that health care What we say is discuss this with your helping the health care of women. As reform is about the government trying doctor. But if your doctor says you she has pointed out, women are dis- to take over health care. That is false. need one, you are going to get one. criminated against today in America in The truth is, health care reform is Studies have found mammogram various ways. Her amendment address- about allowing patients and doctors to screening decreases breast cancer es some of that discrimination. I very take back control of health care. We among women by over 40 percent. Reg- much appreciate that. I know all need to allow patients and their doc- ular Pap smears reduce cervical cancer women in the country do. I do, too. I tors together to take back control by 40 percent. This year, over 4,000 have a mom. I have sisters. I have from the big insurance companies. women will die of cervical cancer. women in my family, and I very much Our plan would not increase the gov- My amendment does focus on wom- care. ernment’s commitment to health care. en’s health needs. Keeping a woman I don’t know if she made this point, But don’t just take my word for it. The healthy not only impacts her own life but about 80 percent of health care de- nonpartisan Congressional Budget Of- but that of her family. It impacts her cisions made for families are made by fice says: ability to care for her child or an aging women. It is all the more important [D]uring the decade following the 10-year parent. women are not discriminated against, budget window, the increases and decreases Early detection saves money by partly because they make so many de- in the federal budgetary commitment to treating diseases early. Screening tests health care stemming from this legislation cisions that affect health care for would roughly balance out, so that there for breast and cervical cancer cost Americans, but second, women them- about $150, but the treating of ad- would be no significant change in that com- selves are often discriminated against. mitment. vanced breast cancer is over $10,000 and Some States have gender ratings which can even go much higher. The treating That is right, health care reform will discriminate against women. In other of early stages of cervical cancer is not increase the Federal Government’s States a preexisting condition is a fac- $13,000 and can go much higher. budgetary commitment to health care. My amendment also leaves the deci- tor that discriminates against women. I have also heard it argued that I thank the Senator from Maryland. sion of which preventive services a pa- health care reform will increase the She has hit the nail on the head. It is tient will use between the doctor and budget deficit. That, too, is false— the patient. The health reform debate another reason this health care reform plainly, patently false. is focused on what you should have is going to mean so much for so many The bipartisan Congressional Budget when. We agree. Decisions should be Americans. I personally very much Office says our plan would reduce the made in doctors’ offices, not in the of- thank the Senator from Maryland. Federal deficit by $130 billion within fice of a Member of Congress or the of- In the Presidential campaign of 1912, the first 10 years—reduce the deficit in fice of an insurance executive. The de- Theodore Roosevelt’s platform said: the first 10 years. That trend would cision about what is medically appro- We pledge ourselves to work unceasingly in continue, the CBO says, over the next priate and medically necessary is be- State and Nation for . . . the protection of decade. During the next decade, CBO home life against the hazards of sickness . . . tween a woman and her doctor. says our bill would reduce the deficit through the adoption of a system of social roughly $450 billion. That is nearly The authors of the bill have done a insurance adapted to American use. very good job in protecting women in one-half trillion dollars in deficit re- Today, nearly a century later, we are many areas. This actually refines and duction, according to the Congres- improves this particular issue. That is closer than ever to enacting meaning- sional Budget Office, in the second 10 why I support the overall health re- ful health care reform. years. As in Teddy Roosevelt’s time, we form bill providing universal access to I have also heard it argued that health care for over 90 percent of the seek protection against the hazards of health care reform will raise taxes. American people, ending those punitive sickness. Of necessity we seek a system That, too, is false. In fact, health care practices of the insurance companies, uniquely adapted to American use. And reform will provide billions of dollars stabilizing and strengthening Medi- recognizing the daunting task still in tax relief to help American families care, and improving quality in public ahead of us, we pledge ourselves to and small businesses afford quality health by using innovation and preven- work unceasingly to get the job done. health insurance—tax cuts. tive services and quality. We can pass a In the years since Teddy Roosevelt, The Joint Tax Committee—again bi- health reform bill. some of our Nation’s greatest leaders partisan and which serves both the I conclude by saying that we will end signed up for this job. But at the same House and the Senate—tells us, for ex- the confusion about what is needed in time, we have never faced a greater ample, that our bill would provide $40 the area of preventive health services need to get the job done than we do billion in the tax cuts in the year 2017 for women when our coverage is often today. alone—$40 billion in tax cuts in the skimpy and spartan. We want to make Why is that? Basically because year 2017. The average affected tax- sure what we do enables us to have ac- health care costs are skyrocketing out payer will get a tax cut of nearly $450. cess to these comprehensive services. of control. Every day American busi- The average affected taxpayer with an I hope this amendment is adopted nesses are forced to cut benefits for income under $75,000 in 2017 will get a unanimously. I believe good people on their workers. Why? To remain com- tax cut of more than $1,300. both sides of the aisle will believe in petitive in the global marketplace. Let me repeat that. The average af- its underlying premise: that early de- Every 30 seconds another American fected taxpayer with income under tection and screening save lives and files for medical bankruptcy. Just $75,000 in 2017 will get a tax cut of more save money. think of that. Every 30 seconds another than $1,300. They will also get a tax cut Often those things unique to women American files for medical bankruptcy. in earlier years, but it ramps up to have not been included in health care Every year, about 1.5 million families that amount in 2017. reform. Today we guarantee it and we lose their homes because of health care In the same vein, I have heard claims assure it and we make it affordable by costs. Our system is in crisis. that health care reform will result in dealing with copayments and We have a historic need and we have an increase in higher costs for Ameri- deductibles in a way CBO believes is a historic opportunity. We have an op- cans. That, too, is false. fiscally achievable. In the long run, I portunity to enact groundbreaking re- Health care reform will not result in think by doing this it will mean a lot form that will finally rein in the higher costs for Americans. Health to families, and it will mean a lot to growth of health care costs and help care reform is fundamentally about the Federal budget. bring financial stability back to Amer- lowering health care costs and making Mr. President, I yield the floor. ican families and businesses. quality health care affordable for all The ACTING PRESIDENT pro tem- Unfortunately, there are some who Americans. Lowering costs is what pore. The Senator from Montana. stand in the way. Unfortunately, there health care reform is designed to do, Mr. BAUCUS. Mr. President, before I are some who are spreading misin- lowering costs; and it will achieve this give a statement on the bill, I wish to formation about how health care re- objective. How? In many ways.

VerDate Nov 24 2008 02:11 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00010 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.021 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S11989 First, health care reform will end dent or disease more broadly. Spread- Seven—still another way this bill re- abusive practices by insurance compa- ing the risk more broadly should lower duces costs. Small business insurance nies. Reform will stop insurance com- premium rates for everybody. It is a exchanges will allow small companies panies from denying coverage or hiking basic tenet of insurance. to pool together to spread their risk up rates for those with a preexisting Fifth, health care reform will reduce and increase their buying power. More condition. We stop that in this legisla- costs by cutting administrative red- pooling available for small business in- tion. That will lower costs. Reform will tape. That is no small item. Today, in- surance exchanges—this will allow stop insurance companies from drop- surance companies spend a lot of time small businesses to negotiate lower ping coverage or reducing benefits for and money finding ways to discrimi- rates and provide more quality insur- those who get sick. nate against people. They spend time ance plans with lower premiums to Those reforms protect consumers, and money to find ways to drop cov- their employees. and they will protect Americans and erage, and insurance companies pass Eight. Health care reform will reduce premium costs for Americans those administrative costs on to all strengthen oversight and enforcement who are sick. These reforms will also Americans in the form of higher pre- measures to cut down on fraud, waste, help lower costs for small businesses miums. The figure I heard is about 18 and abuse in the health care system. and their employees. Right now, if one percent of American health care dol- Fraud, waste, and abuse are estimated employee in a small business gets lars is administrative costs. This legis- to cost our health care system more sick—just one—insurance companies lation would dramatically reduce that than $60 billion every year. This bill can double the premiums they charge percentage to a much lower number. will help reform our system to reduce the whole business. I know that is true. We don’t know to exactly what level fraud, waste, and abuse, which eats up I have heard that time and time again yet but a much lower level. About 18 way too many health care dollars. percent of total health care dollars go from small business owners in Mon- Nine. Health care reform will move to pay administrative costs. That is tana. That is just because one em- the focus of our system toward effi- not the case in other countries. They ployee gets sick, the insurance compa- ciency and value with payment incen- pay 4 to 5 percent in other countries. nies jack up premiums, double the pre- tives that reward quality care—not We have to get that down in America, quantity and volume but reward qual- miums they otherwise would charge and health care reform will signifi- ity care, reward outcomes. Over the the whole business. That is just wrong. cantly achieve that result. We stop that in this legislation. Health care reform will outlaw this long run, paying doctors and other How else do we lower costs in this discrimination, and also reform will health care providers for quality in- bill? Health care reform will provide eliminate those administrative costs stead of quantity will reduce health billions of dollars in tax credits and re- that go along with it. Furthermore, care costs. form will limit out-of-pocket costs health care costs will work to stream- Ten. Health care reform will lower such as copayments that insurance line administrative procedures across costs by working to change the focus of companies are able to charge. We limit the board by requiring standard enroll- our health care system from treating them. This will also help to ensure ment forms and marketing material sickness to promoting wellness. The Americans can afford their total health through insurance exchanges. That, big problem we have today is that we care costs and not just their premiums. too, will help streamline procedures. treat sickness. We don’t spend enough That is very important. Premiums That, too, will help reduce administra- time promoting wellness. Reform will and out-of-pocket costs are both ad- tive costs for providing for standard make critical investments in policies dressed by this bill. It limits growth in enrollment forms and also standard that promote healthy living and help premiums and also limits growth in marketing materials through insur- prevent costly chronic conditions that out-of-pocket costs. So total cost—pre- ance exchanges. That is going to lower drive up costs throughout the system. miums plus out-of-pocket costs—for administrative costs and make it much These are just 10 examples of how Americans will be lower under this leg- easier for a person to shop and know health care reform will reduce health islation than otherwise would be. which policy is best for him or her. care costs and lower premiums for Third, health care reform will work With the other reforms we are making American consumers. There are many to repeal the hidden tax of more than competition is more on the basis of more, but these are those 10, as I said. $1,000 in increased premiums that price not just underwriting, a fancy On the other hand, without reform; American families pay each year in term for denying because of a pre- that is, without passing this legisla- order to cover the cost of caring for the existing condition and putting in all tion, costs are guaranteed to continue uninsured. those extra escape clauses insurance to skyrocket out of control. Today, millions of Americans with- companies often provide in small print. Since Congress failed to enact health out health insurance are too often In a letter released today, the Congres- care reform in the 1990s, health care forced to turn to emergency rooms to sional Budget Office said: premiums have risen eight times faster get the care they need, and then health Compared with plans that would be avail- than wages. Consider that. Since the care providers shift the cost of that able in the nongroup market— last time we attempted to pass health care to other Americans with health And they are referring there to the care reform—and failed—in the 1990s, insurance. People with insurance, individual market— health care premiums have risen eight therefore, pay higher premiums. By under current law, nongroup policies under times faster than wages. And if we providing quality, affordable health in- the proposal would have lower administra- don’t reform our health care system surance to millions more Americans, tive costs. now, premiums will increase 84 percent health care reform will reduce this hid- Let me say that again. Compared in the next 7 years. And that is just den tax and reduce premiums for all with plans that would be available in premiums. What about out-of-pocket Americans—$1,000 per year per family individual markets—individuals seek- costs? Those, too, will increase at a due to uncompensated care. That is ing insurance—under current law, indi- rate much faster than wage increases. that hidden tax. This bill will virtually vidual policies under the proposal Today, health care coverage costs the stop that hidden tax, stop that addi- would have lower administrative costs. average American family more than tional $1,000 that goes to average fam- Lower, not higher. Lower. $13,000 a year, according to the Kaiser ily premiums. Six—another way to reduce costs. Family Foundation. If current trends How else do we reduce health care Health care reform creates insurance continue without reform, the average costs? By providing affordable health exchanges where consumers can easily family plan will cost more than $30,000 care to more Americans which will in- shop and compare plans to find the a year in the next 10 years. That is up crease the number of Americans in the right coverage. Exchanges will make it from $13,000 today to $30,000 10 years insurance market. Why? What is so easier for Americans to choose the from now. And businesses could see good about that? most efficient plans, and that will re- their health care costs double in that One reason is more people will have duce their costs and put pressure on in- same time. Without reform, our Na- health insurance. But also it will surance companies to offer lower cost, tion’s long-term fiscal picture is al- spread the risk of paying for an acci- higher quality plans. most certainly unsustainable.

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00011 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.024 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11990 CONGRESSIONAL RECORD — SENATE November 30, 2009 As Peter Orszag said when he was Di- itself is depending on us to answer the wouldn’t have prohibited any modifica- rector of the Congressional Budget Of- call. I am confident we will. I am con- tions to amendments, which is kind of fice: fident we will at long last answer the what we ran into in the Finance Com- Rising health care costs represent the sin- call of history. I am confident we will mittee when we were trying to do gle most important factor influencing the soon enact meaningful health care re- amendments. Federal Government’s long-term fiscal bal- form that will lower costs and bring So good ideas—they need a lot more ance. quality, affordable coverage to millions work. And to just throw those out at He was right. Without reform, in- of Americans. the beginning and to have about 11⁄2 stead of working to reduce our national The ACTING PRESIDENT pro tem- minutes’ notice that they are going to deficit and stabilize the Federal budg- pore. The Senator from Wyoming. be thrown out—I just don’t think that et, we will see total health care spend- Mr. ENZI. Mr. President, as I men- is the right way to go about this whole ing nearly double to encompass one- tioned earlier following the unanimous process. fifth of our gross domestic product in consent requests the leader made—who I have been working on the Nation’s less than 10 years. And the Congres- then introduced Senator MIKULSKI so broken health care system ever since I sional Budget Office projects entitle- that she could do her amendment, entered the Senate more than 12 years ment spending will double by the year which kept me from commenting on ago, and I had high hopes this would be 2050. the unanimous consent requests he the year the Democrats and the Repub- Without reform, millions of unin- made—I have to say I think those licans of the Senate would work to- sured Americans will continue to suf- unanimous consent requests would gether to provide health insurance to fer. A Harvard study found that every have to be put in the category of a every American. I urged my colleagues year in America, lack of health care stunt. Unanimous consent usually to start with a blank piece of paper and coverage leads to about 45,000 deaths. means the two leaders have gotten to- develop a bipartisan bill that up to 80 People without health insurance have a gether and negotiated some kind of Members of the Senate could support. 40-percent higher risk of death than agreement that we would abide by dur- Unfortunately, the majority leader- those with private health insurance. ing this time. There was no agreement ship had other ambitions, because the You have a 40-percent higher chance of on this. Yet they went ahead and did bill being debated today is a testament death if you don’t have health insur- the unanimous consent request solely to a partisan ideological vision. It ap- ance compared with those who do. That so they could get the objection. pears that the drafters of this bill took is 46 million Americans at risk today Nobody here, I am sure, wants to use to heart the sentiments expressed by because they do not have health insur- Social Security money for anything ex- the Speaker of the House, who earlier ance. A recent Johns Hopkins study cept Social Security. So the real key to this year said, ‘‘We won the election, found that children without insurance the stunt was the second one, which is we write the bills.’’ And for a number have a 60-percent higher risk of death the net savings generated by the of weeks, the majority leader closed his than those with private health insur- CLASS program. That is a long-term door and wrote this bill on his own ance—a 60-percent higher risk of death care program that wound up in the terms without any input from many of than those with private health insur- Health, Education, Labor, and Pen- his colleagues or anybody on this side ance. sions Committee bill. of the aisle. Another recent Harvard study found The flaw with that particular amend- This is a deeply flawed bill that fails that the risk of dying from car acci- ment was that it collected money for 10 to address the real needs of the Amer- dents and other traumatic injuries is 80 years without spending any and then it ican people. Americans overwhelm- percent higher for those without insur- wound up with a huge liability. So we ingly want reforms that will help lower ance—80 percent higher. The risk of put in a little provision that it had to their health care costs. Instead, this dying from car accidents and other be actuarially sound because, quite bill will spend $2.4 trillion when it is traumatic injuries is 80 percent higher frankly, it is not very good accounting fully implemented and contains numer- if you don’t have health insurance. In to collect $70 billion in exchange for a ous provisions that will actually drive the greatest country on Earth, no $2 billion—excuse me, $2 trillion—I get up the costs millions of Americans pay American should die simply because the b’s and the t’s mixed up here, be- for their health care. they do not have health insurance. cause we are talking about real money It is important to understand how we So, Mr. President, we are at a cross- here—a $2 trillion bill. That is how got here. At the beginning of this proc- roads in history. We have a historic op- much we are going to have to pay out ess, the majority staff of the HELP portunity to enact meaningful health over the next 10 years to cover the $70 Committee decided they were going to care reform that will work to stabilize billion we accept in payments for this draft a partisan bill based on the re- our economy and provide quality, af- new kind of insurance that would be forms that had recently been adopted fordable health care coverage for mil- provided. That kind of insurance is pro- in Massachusetts. Republicans were lions of Americans. We are not the first vided—it is provided in the private sec- shut out of the process during the to be here, but we have come further tor—but for considerably more than drafting of the HELP Committee bill. than ever before. what they were providing for in the Rather than working to resolve the dif- We laid the groundwork in the Fi- CLASS Act. ficult issues, the drafters of the bill in- nance Committee and the HELP Com- So that was to bring a little more at- cluded over 200 separate instances mittee. We held many hearings and tention to it, and I want to bring a lit- where the bill gave the Secretary of countless hours of meetings on health tle more attention to it because I want Health and Human Services the au- care reform. Each committee crafted people to take a closer look at the way thority to make important decisions meaningful legislation and held ex- that winds up. It is a good idea that is about the types of health care plans haustive markups where we incor- not paid for, and it is not paid for in millions of Americans can receive. porated amendments from both sides of such a way that it winds up, once Rather than confronting and debating the aisle. We produced balanced, mean- again, adding to the deficit but in some these important policies—getting to ingful legislation, and I am proud—I cagey ways. the details, and the devil is always in am very proud—of the work both com- As for having the amendments posted the details—the majority empowered mittees accomplished. Now we have on the Web site before they are given, unelected government bureaucrats to one health care plan before us in the I hope the initial version is posted on make decisions that will affect the Senate, two basic bills merged to- the Web site by everybody before they health care of every single American. gether. We have an opportunity to de- do it. But one of the things that hap- As a result of this partisan process, bate that plan and offer amendments pens on this floor is that occasionally a we were forced to file hundreds of to make it even better. Then we will be good idea can be built on by somebody amendments. The chairman and other called upon to vote. from the other side or even somebody Democratic members of the committee The health care of our Nation is de- from your own party, and when that have repeatedly commented on the nu- pending on us. The health care of our happens you can modify the amend- merous amendments accepted by the economy is depending on us. History ment. I am not sure that agreement majority during the markup. At the

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00012 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.025 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S11991 same time, they ignored the reality should develop legislation that will im- This bill also shows how this will that most of these amendments were pact one-sixth of our Nation’s economy never be a truly science-based process. merely technical corrections which and affect the health of every Amer- Bureaucrats will always have to re- were necessary because the underlying ican. spond to political pressure for powerful bill was hastily written and filled with The former chairman of the Senate constituencies. numerous drafting errors. Unfortu- Finance Committee, Daniel Patrick I guess we are part of the powerful nately, nearly all of the accepted Re- Moynihan, a Democrat from New York, constituencies. If we decide something publican amendments merely tinkered once provided the following perspective should or should not be in there, that around the edges. Almost all of the on how the Senate should consider eliminates the science-based part of it. substantive alternative-idea amend- major policy changes. He said: I understand what they are trying to ments suffered the failing fate of the Never pass major legislation that affects do. In the HELP Committee, when we party-line vote. In 12 days of markup most Americans without real bipartisan sup- were doing the markup, we did numer- port. It opens the doors to all kinds of polit- ous amendments around this clinical at HELP, we had 45 rollcall votes on ical trouble. Republican-sponsored amendments and effectiveness research, to see what it Chairman Moynihan noted that ab- only 2 prevailed. was supposed to eliminate from the After the markup, the majority re- sent such bipartisan support, the party health care for the person, separating that didn’t vote for it would feel free to fused to release a final copy of the bill them from their doctor by making take shots at the resulting program for over 2 months, denying the Amer- these science-based decisions. whenever things go wrong and a large ican people the chance to see what We did a series of amendments and segment of the public would never ac- they had done. Once we finally got a found there, evidently, are a lot of cept it unless it was an overwhelming copy of the bill, we learned that major- things they are hoping will be pre- success. Chairman Moynihan under- ity staff had unilaterally made numer- cluded from people being able to get. I stood a partisan legislative process ous changes to the bill, in some cases invite people to take a look at those guarantees that any glitches that undoing agreements that had been amendments. We may have to try those occur in implementing the bill would worked out by Members on issues such again to see exactly where this process provide ammunition for future attacks; is going. I appreciate the Senator from as prevention and wellness. thereby, further undermining public While this was happening, there were Maryland making an attempt to solve support of the new policies. There will, also ongoing bipartisan negotiations, a part of the problem, but I am having unfortunately, be plenty of glitches if led by Senator MAX BAUCUS. And I have a little trouble with the reading of the this bill is ever enacted. to congratulate him for the process he The Reid bill will impose $493 billion amendment itself. At any rate, enough started and got people involved in and in new taxes, and many of them go into of that. for his persistence and the amount of effect immediately. At same time, The Reid bill spends millions—bil- time he put into it. This dwindled down most Americans will not see any insur- lions. There is that word again. The to a Gang of 6. The Gang of 6 discus- ance reforms or other potential bene- Reid bill spends billions of taxpayer sions were not an honest attempt to fits from this bill until at least 2014. dollars on new pork-barrel spending. try to develop a bipartisan health care That leads to some interesting ac- The bill would build new sidewalks, bill that would offer real solutions to counting. jungle gyms, and farmers’ markets and the problems that face our health care The Reid bill will kill jobs and cut creates a $15 billion slush fund for addi- system. wages. The Congressional Budget Office tional pork-barrel projects, a real devi- Ultimately, these negotiations failed has told us the employer mandates in ation from what the Appropriations to produce a bipartisan bill. I do not this bill will likely result in lower Committee has ever allowed. believe the failure was due to a lack of wages and higher unemployment. This bill also fails to achieve the effort on the part of the participants These job and wage cuts would hit low- commonsense goals Republicans and but, rather, we were unsuccessful be- income workers, women, and minori- Democrats share. This bill even breaks cause the Democratic leadership chose ties the hardest. It is hard to believe many of the promises President Obama to impose arbitrary and unrealistic that with unemployment at a genera- has made about health care reform. time deadlines on the process that we tional high, Democrats would even con- President Obama repeatedly called for commented on. The deadline slipped a sider putting more jobs on the chop- a health care bill that will reduce few times, moved up a week, and then ping block. The Reid bill mandates costs. This bill will actually drive up became finalized. The decision was that Washington bureaucrats ration health care costs for millions of Ameri- made that it was more important to care. The bill lays the groundwork for cans as a result of new mandates and move fast than it was to get it right, a government takeover of health care, taxes. President Obama has also said and the decision ultimately doomed giving Washington bureaucrats the that if Americans like the insurance our efforts. power to prevent patients from seeing they have, they can keep it. Under the This, in turn, led to another partisan the doctor they choose and obtaining bill, millions of Americans will lose markup where the Finance Committee new and innovative medical therapies. their employer-provided health insur- rejected most GOP health reform ideas. I think that is attested to by the first ance. Proposals such as medical liability re- amendment we have, the amendment President Obama promised not to form were rejected on jurisdictional by the Senator from Maryland, because raise taxes on individuals earning less grounds, while the chairman unilater- her amendment preempts the provision than $250,000 per year. The bill would ally included Democratic provisions in the bill that allows the U.S. Preven- impose several new taxes on people that were clearly within the jurisdic- tive Services Task Force to determine who make considerably less than tion of other committees. Republican what preventive services should be cov- $250,000 a year. amendments were voted on and then ered. This amendment recognizes the President Obama said the health care unilaterally changed at the eleventh problems associated with government reform would not increase the deficit. hour—actually, 1:30 in the morning—by bureaucrats determining what benefits This bill will not increase the deficit amendments offered by the chairman. should be covered. The majority real- only if you believe certain things. This The two bills were then merged, ized it had a political problem when bill will not increase the deficit if you merged in secret, with no input from the U.S. Preventive Services Task believe Medicare payments to physi- the many Republicans who want to Force said that women aged less than cians will be cut by 40 percent over the enact a bipartisan health bill. We now 50 years old should not have annual next decade. I don’t think anybody be- have a 2,074-page bill that reflects breast screening exams. This amend- lieves that. many of the worst provisions from both ment doesn’t do anything to protect The bill would reduce the deficit only the HELP and the Finance Committee patients who might be denied access to if you believe Medicare payments to bills. preventive tests in the future, such as other providers will be slashed to levels We did not need to end up here today prostate exams, colonoscopies, Pap that endanger patients’ ability to get with Republicans opposing a partisan smears, and so on, if bureaucrats de- the care they need. No one believes health care reform bill. The Senate cide to deny access. that.

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00013 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.026 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11992 CONGRESSIONAL RECORD — SENATE November 30, 2009 The bill will also reduce the deficit if this issue to be what he called the pas- Before we left for the Thanksgiving you believe Congress will allow a mas- sion of his public life, to make a dif- holiday, the Senate held a landmark sive new tax to be imposed on middle- ference for all Americans when it vote on whether we should even debate class tax payers. I hope no one believes comes to their health care. So I know health care. I must say a lot of atten- that. it is with a sense of sadness that, on tion was given to that. There must be If you don’t believe Congress will the day on which we begin this historic a lot of confusion in the minds of many allow all these things to happen, then debate and discussion, he is not here to Americans, wondering why we had to you can’t believe this bill will reduce participate—at least physically. We debate whether we could debate. The the deficit. President Obama, in his re- sense his presence, of course, those of one issue this body is known for is end- marks to the American Medical Asso- us who had the privilege of serving less debate. We are not limited, under ciation this summer, acknowledged the with him for so many years, as Senator our rules of the Senate, at least not need to address our out-of-control med- BAUCUS and I did, and worked with him formally limited, by how much time we ical liability. Rather than addressing on these many issues. Of course, our can consume when we want to talk. this issue, this partisan bill preserves colleague from Wyoming, Senator The filibuster is a unique practice the costly, dangerous, duplicative med- ENZI, and Senator GRASSLEY did as well which only the Senate has. So we had ical malpractice system. over the years. I thank all members of to vote as to whether we could actually President Obama finally said no Fed- the committee. have a vote. We had a debate on wheth- eral dollars will go to pay for abortion. It was a laborious undertaking. The er we could have a debate on the sub- According to the National Right to Presiding Officer was very much a part ject matter that is obviously of great Life and the Conference of Catholic of that as well, during those many concern, whether you agree or dis- Bishops, the Reid bill fails this require- hours we gathered in the Senate caucus agree. ment as well. room—the Russell caucus room now I think all Americans agree the Despite all these failures, it is still named the Kennedy caucus room—in present system needs a lot of work. not the worst health care bill in Con- some 23 sessions, over many hours. But The vote we took simply stated that gress. The Wall Street Journal got it that was only the culmination of an ef- after decades of inaction, despite the efforts of others over the years, this right when they described the House- fort that began a long time ago. time the Senate would not fail to de- passed bill as the worst bill in America. Actually, the business of writing this liver the change the people we rep- Even if the Senate passed the bill be- bill began months and months earlier. resent across America want and need. fore us today, it would still have to go My colleague from Montana can appre- ciate the hours I know I spent in meet- We now begin that long, overdue con- to conference with the House bill and versation over exactly what change any final bill would have to move to- ings in his office, late into the evening, long before a markup began. Long be- should look like in the area of health ward several provisions in the House fore any formal conversations and dis- care. There are, as has been made clear bill and poll after poll suggests that cussions, there was a significant reach- over the past months, many different the American people are opposed to ing out to our colleagues, to try to opinions on the subject matter, almost this bill, let alone the wild one from bring us together and develop what we as many as there are Members of this the House. all hoped to be the case and still can be body. I hope my fellow Senators are If we cannot defeat this partisan bill the case; that is, a consensus bill, a bi- ready to share their thoughts, listen to and get back to work for the American partisan bill on health care. the ideas of their colleagues and, most people and write a bill that garners the I know as a matter of fact here, be- importantly, join together to act. The support of both parties, doing it step ginning last fall, Senator Kennedy, legislation we present for debate is de- by step so we can assure, for instance, when he did have his strength, met on signed to fix the things that are wrong the seniors that Medicare money will countless occasions with members of with our system, while protecting and only be spent on Medicare—that is one the minority to try and navigate the strengthening the things that are great of the pieces that ought to have been in minefield of health care ideas, to see if about health care in America. As I that unanimous consent I started talk- it couldn’t be possible to put together have heard my colleague from Montana ing about. That is not going to happen, that kind of a consensus bill. say on so many occasions, we are not though. They are going to take a bunch I know our committee began a long out here to design or copy what goes on of money out of there. process, beginning last winter, to try in Canada or Europe or Australia or I think this legislation fails to mean- to begin, long before the markup of New Zealand or any other country ingfully address these goals and will this summer, to draft such a proposal, around the world. We are here to de- stick the American people with a bill having what they call a walk-through sign an American health care plan, an we cannot afford. I believe we can do of legislation, going through the var- American plan, one we are forging better, and we owe it to the American ious ideas and listening. after listening to health care providers, people to do so. It was with some regret that I say our constituents, and others who have I yield the floor. this idea that the bill somehow being great interest in the debate and discus- The PRESIDING OFFICER (Mrs. jammed down people’s throats, with sion and who bring very valuable facts HAGAN). The Senator from Connecticut little or no thought given to other peo- to the table, as all of us, individually, is recognized. ple’s ideas and thoughts, is not borne even those not on the committee, have Mr. DODD. Madam President, let me out by the facts. I have been here for listened over many weeks and begin, if I may, by congratulating the many years. I have been through many months—in fact, over many years that majority leader and my colleague and markups over three decades in this we have been debating this subject dear friend from Montana, Senator body on various committees. This ef- matter. BAUCUS, and members of the Finance fort was and still remains an effort to Our long history of innovation and Committee as well as the members of try to bring us together about this discovery—cures, vaccines, and treat- the HELP Committee. As I said before, issue, which has such a massive impact ments, discovered and produced right I am sort of an accidental participant on not only the individuals of our Na- here in our own country, that have in all this, in the sense that the person tion who go through the fear every day saved countless lives here and around who should be standing at this desk of wondering whether the coverage the world—is something for which and at this podium as the chairman of they have will be adequate; and if they every American ought to be proud. Our the HELP Committee is, of course, our don’t have that coverage, whether an legislation, this combined bill, encour- deceased colleague from Massachu- illness or tragedy could befall them ages that innovation so more setts. I was filling in for him during that could wipe out everything they groundbreaking medical discoveries the months of his illness and managing have—not only today but for the rest of can be made in America. the markup of the bill that produced their lives. In fact, one of the debates that oc- part, half—whatever the percentage This journey begins. My hope is, be- curred in the HELP Committee, as my is—of the combined legislation. All our fore we have finished the task, we will colleague and the Presiding Officer colleagues know, whether you agreed find that common ground that we each may recall, was on an amendment of- or disagreed with him, he considered bear responsibility to try and achieve. fered by Senator HATCH—no technical

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00014 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.027 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S11993 amendment—dealing with how to cre- pleted a round of going to see them all their health care. They are paying ate a pathway for the Food and Drug about this bill, sitting down with rural more and more in premiums, twice Administration to approve follow-on hospitals in northeastern Connecticut what they paid even a decade ago. Yet biologics and how many years of exclu- to major urban hospitals in Bridgeport they are getting less and less and less sivity innovators should receive for and Hartford. I wish I could take every- coverage for their money. They lie their original product. We had a heated one with me to see what everyone does. awake at night wondering, what if I debate in the committee. It went on for I know this is the case in other States lose my job, as many have over these a day or so. In a divided vote, the where people do a remarkable job every last number of weeks and months, Hatch amendment was approved with day. If you show up in a hospital, they what if I get sick and find out my pol- bipartisan support for this very critical treat you. No one gets turned away. It icy doesn’t cover the care I need or, and important issue. No technical is a wonderful thing about our health even worse, my insurance company change, I might add, a significant part care system, the people who work in cancels my policy altogether. What if I of this bill. them every single day, reaching out to run out of benefits and have to pay out Our legislation recognizes that we do try and make a difference in the lives of my pocket. These are not irrational best by our citizens when the public of these individuals, and how frus- fears. They are anything but irrational and private sectors work together. It trating it is for these health care pro- fears. Millions of our fellow citizens has been our history in so many areas, viders. have them every single day, and these not just in this area. I met with a group of nightmares come true for far too many Medicare, the ironclad commitment ophthamologists in Hartford. One doc- of our citizens. People lose their homes to take care of our seniors, dating back tor was telling me how a family came because they get sick. People die be- to 1965, when Members who preceded us to him the other night with a child cause they can’t afford care. in this Chamber, in a heated debate that clearly needed a medical device This does not happen to the 8 million that went on for days, heated debate and technology and knowing what a of us who are Federal employees, all of over whether we would have a health difference it could make for her. Yet us who serve in this body and the 435 care program for seniors, decided not that insurance company said: No, you who serve in the other body. Like all on a partisan vote but nearly as much, can’t do it; we don’t provide that kind Federal employees, we have a special that there ought to be something of coverage. The frustration that doc- marketplace. Every year each one of us called Medicare. It took the poorest tor expressed because he couldn’t pro- gets to choose from a long menu of in- sector of our population, the elderly, vide what that family needed. They surance options. We sit down. We pick and lifted them out of poverty. Because didn’t have the resources financially to a plan that makes sense for us and our we said: After their works on behalf of pay for it, and they were being turned families, and we know the coverage we all of us, their defense of our Nation in down. That child could not get that have chosen will be there when we need two world wars, and their contribution help. Under our bill that won’t happen, it. Every American should have the coming out of a depression, we ought if we can get this legislation done. Ex- same opportunity as the people who to be able to do better by them when it amples like that child happen every represent them in the Halls of Con- comes to their health care needs, Medi- day across this great country of ours. gress. That is what our bill tries to do. care was established. And despite what The high cost of health care has For too long health insurance has some critics have said, this legislation bankrupted millions of families. The been a seller’s market. Depending upon protects and strengthens Medicare. I system, in many ways, despite its where you live, you may or may not hope even our friends who have taken strengths, is broken in too many places have more than one option or two op- to labeling government-run programs as well. Without reform, health care tions to choose from. Sometimes there such as Medicare as socialist takeovers will continue to eat up larger and larg- aren’t any good options at all. You pay will join us in keeping this important er shares of budgets—the Federal budg- whatever the insurance companies promise to our seniors. et, State budgets, business budgets want to charge you, and you get what- Of course, Americans are justifiably and, of course, family budgets. Budg- ever coverage they feel like giving you. proud of and happy with our workforce ets, particularly family and business You are covered only until they decide of dedicated health professionals, the budgets, are at breaking points. The they don’t want to cover you any doctors, specialists, primary care phy- high cost of health care has bank- longer. By the way, if you lose your sicians, compassionate nurses, dedi- rupted millions of families, shuttered job, or if you want to change your job, cated medical technicians, and family the doors of businesses, forced States if you want to start a business, if you doctors all across the Nation who make to make impossible choices, and put want to move, you could lose your cov- a difference every single day in serving unimaginable strain on the Federal erage entirely. the people of our Nation. This legisla- bottom line. If we don’t address the Our bill is designed to help you get a tion is designed to guarantee that you skyrocketing cost of health care, more better deal and empowers every Amer- can get the care you need when you and more families, more and more ican family to pick the plan that works need it from the doctor you like. Mean- businesses could lose everything and for them, creating a real marketplace, while, it will help that physician spend our deficit will explode. As bad as it is like the one Federal employees have, less time filling out redundant paper- today, it gets worse if we do nothing. that members of congress have, with work and more time taking care of you That is the bigger picture. But the multiple insurance companies com- and your family. It will help you spend reality of our broken system can be peting for your business and a real less time fighting with your insurance captured by the tragedies that play out choice for you and your family. If you company and more time getting better in American homes every single day. like what you have now, great, keep it. and getting back on your feet again. As we have discussed, tens of millions If you don’t, you will have more and There are many things to like about of our fellow citizens who don’t have better options to consider. If you are our health care system in the United health insurance at all go to bed every one of the millions of uninsured Ameri- States. This legislation doesn’t change single night knowing that if they wake cans who has been denied coverage be- them. There are many things that are up sick or their children wake up ill or cause of a preexisting condition, you wonderful about our health care sys- in need of medical care, they might not will immediately have access to afford- tem. I think it is important at the out- be able to see a doctor to get the med- able coverage so that you will have in- set to acknowledge that and to under- ical care they need. Many of these surance while this marketplace is stand, again, the quality of innovation Americans don’t have insurance be- being established. In that marketplace, that occurs, the compassionate work cause they can’t get insurance, they you will finally have a chance to find done by health care providers in every have a preexisting condition, and no in- affordable insurance that works for community. In my State, there are 31 surance company wants them on their you and your family. No matter who hospitals, all nonprofit hospitals, in rolls. you are or which plan you choose, you the State of Connecticut. I have visited There are even more Americans who will have less expensive options. Insur- all of them over the years, but I have do have insurance but can’t be sure of ance will be available regardless of gone back recently and almost com- anything these days when it comes to your age or your health. And once you

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00015 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.029 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11994 CONGRESSIONAL RECORD — SENATE November 30, 2009 have it, the insurance company won’t tremendous problems that are associ- your business—competition that is in- be allowed to take it away. You stay ated with four or five illnesses that creased even further with a strong pub- covered even if you lose your job, even consume about 70 or 75 percent of the lic option as well. if you move, even if you get sick. health care dollar. You can’t wipe The analysis confirms that if you On the day this bill is enacted, health them out altogether, but by working like the plan the way it is, the bill ex- insurance becomes a buyer’s market, on prevention, dealing with obesity, plicitly provides that you will be able not a seller’s market. That is as Amer- smoking, cardiovascular problems, you to keep it. In fact, just so we are clear, ican as apple pie, having choices, good can make a difference in those areas let me quote from the CBO, the Con- old competition out there. So little of alone. gressional Budget Office, analysis re- it exists today. Our bill is designed to I know my fellow members of the leased today. I quote them: promote and create more of it. When HELP Committee, we passed legisla- [I]f they wanted to, current policyholders businesses have to compete for your tion—and my good friend MIKE ENZI in the nongroup market would be allowed to business, we all do better. Businesses was a part of this and a strong sup- keep their policy with no changes, and the do well and, obviously, the consumer porter on the floor of this body—when premiums for those policies would probably for the first time in America history, not differ substantially from current-law has better choices. As other pieces of levels. the legislation begin to take effect, our the Food and Drug Administration can The CBO estimates that as the mar- now regulate tobacco products. They health care system will become less ex- ketplace gets up and running, the def- can regulate mascara, cat food, dog pensive and more responsive to the icit will go down by $130 billion in the food, men’s cologne, all of those things needs of the American people. Because first 10 years after this bill passes and get regulated, but tobacco did not. We American families and businesses lit- by $650 billion more in the second dec- changed that. We finally have regula- erally can’t afford more of the status ade. quo, our bill makes health care more tion of the sale, marketing, and the This bill lets you keep your insur- affordable. production of tobacco products by the ance if you like it, this bill protects According to the Congressional Budg- Food and Drug Administration. That is seniors, this bill gives families more et Office, if you are buying health in- $180 billion a year in health-care re- choice, and this bill saves money. surance in the individual market under lated costs. Four hundred thousand While I hope we can keep our facts the senate bill, premiums may be up to people die every year from smoking-re- straight, let me say at the outset that 20 percent lower than equivalent cov- lated products; 3,500 young people I expect this to be a full, open, and at erage today. According to CBO, if you today will start smoking in the United times passionate debate in this Cham- are buying health insurance in the in- States; 1,000 will become addicted for ber, as it should be. This is an issue dividual market, you could see pre- life, 3,500 a day just in that one area. If that represents a full one-sixth, as you mium costs be as much as 20 percent we can reduce people’s dependency on have heard already, Madam President, lower than what they are today. If you those products, if we can get people to of our economy, and it affects every are working for a small business, ac- quit, if we can stop children from start- single one of our citizens. Still, I un- cording to CBO, your premiums may be ing in the first place, what a difference derstand that no matter how patiently up to 11 percent lower than what they that can make for people all across the and thoroughly we discuss this issue, are today. And according to the Con- country. From diabetes screenings to some will, of course, insist we are at- gressional Budget Office, if you work quit smoking programs to mammo- tempting to rush through a piece of for a large employer, which five out of grams, you will be able to get preven- partisan legislation. Again, let’s get six Americans do, your premiums could tive care at no cost to you under this our facts straight. Thus far, between be lowered by as much as 3 percent. In bill. That we do right off the bat so you the two committees responsible for every single category—individuals, can stay well even if your family is not drafting this bill, we have held more small businesses, as well as large em- wealthy. than 100 bipartisan meetings, devoted ployers—premium costs come down Because our seniors should be able to more than 20 days toward the amend- under our bill, according to the Con- afford the prescriptions they need to ment process, considered more than 400 gressional Budget Office. stay healthy, this bill will shrink the amendments, and, despite what I have Compare that to the status quo of Medicare Part D doughnut hole, giving heard, we accepted 170 amendments of- doing nothing or defeating this bill. I seniors a 50-percent discount on medi- fered by the minority, including some can’t speak for every State, but I sus- cations. That is a huge savings to our very substantive ones. Clearly, there pect these numbers are probably pretty people. Because 200 million American were technical ones. I am not sug- much true across the country. In Con- adults don’t have insurance protection gesting otherwise. But to suggest that necticut, in the year 2000, a family of in place to handle the cost of long-term all of these were such is not to portray four paid on average around $6 to $7,000 services and supports, our bill creates a an accurate picture of what occurred. a year in health care premiums. Today new program that will give American The legislation we will now debate was that same family in my State, 9 years families peace of mind, help working made available online 72 hours before later, is paying over $12,000 for that people who are also taking care of a even a procedural vote was cast. same coverage. And if we do nothing in loved one, and save Medicaid dollars in Well, Madam President, I am com- the coming days, those numbers will State and Federal budgets. mitted to ensuring every Senator has jump to around $24 to $25,000 in 7 years Because we need our small businesses the opportunity to offer his or her sug- and as much as $35,000 in 10 years. to do what they do best—create jobs— gestions. That is what we did in our Compare that with what we offer our bill alleviates their burden by pro- committee. It took a long time. But here in this bill. The CBO says we can viding a tax credit to help them cover while people may not have been happy actually lower premium costs in the in- the cost of providing health care to with the final outcome, I believe people dividual market, the small group mar- their employees, as so many of them ought to have an opportunity to be ket, and the large group market. That want to do. And because a buyers’ mar- heard and their ideas to be vetted here is what is in this bill. That is why it is ket depends on educated buyers, our and to engage, I hope, in a civil debate, deserving of our support. bill will empower consumers by elimi- a passionate but civil debate, not to en- Because investing in keeping people nating the fine print in insurance poli- gage in the ad hominem personal at- well is more cost effective than waiting cies. You will be able to make an ap- tacks that too often have contami- to treat them when they get sick, this ples-to-apples comparison when shop- nated debate but, rather, you ought to legislation puts a focus on prevention. ping for health insurance. stand or fail based on the soundness of Let me pay a particular tribute to Sen- Again, according to the Congres- your ideas. ator TOM HARKIN, now chairman of the sional Budget Office, families and busi- My dear friend Ted Kennedy spent a HELP Committee, who spent a long nesses will save money because this lifetime, as I said at the outset of these time on the prevention piece of this new marketplace will bring down ad- remarks, fighting for every American’s bill, as I know the Finance Committee ministrative costs, ensuring you get right for decent health care. It is a did as well, combining efforts to en- the most out of your premium pay- cause I know we all support. This is our courage more effort in reducing the ments and increased competition for chance to get it right.

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00016 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.030 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S11995 This moment calls for commonsense the challenge and met its obligations. I scribe everything in this bill and it problem-solving that cuts the cost of feel optimistic we can achieve that. does not describe the opposition that health care, protects patient choice, Madam President, I yield the floor. comes to a certain part of this bill now, and ensures every American gets the The PRESIDING OFFICER. The Sen- not only by Members of the body, but if care they need when they need it, from ator from Montana. you follow polls and town meetings the doctors and providers of their Mr. BAUCUS. Madam President, I around the country, you find a lot of choice. have a few small matters here before I the people are having second thoughts This moment calls for compassion. yield to my friend from Iowa. about the words ‘‘health care reform.’’ We must finally hear the cry of the First, I cannot thank my colleague I would suggest to you, if you were in child whose ear infection goes un- from Connecticut enough. He has a coffee shop in any small town of the treated because his or her parents can- worked so hard as the former chairman United States and they were talking not find jobs and cannot afford a doc- of the HELP Committee and now as a about health care reform, and I came tor; the voice of the small business very active participant in the HELP into that coffee meeting and I said: The owner who must choose between laying Committee, along with Chairman HAR- bill before the U.S. Senate is going to off workers and cutting off health ben- KIN. I cannot thank him enough. The raise premiums, it is going to raise efits for them; the call of future gen- Senator from Connecticut has worked taxes, it is going to take hundreds of erations who will see the rising tide of on health care in such a constructive billions of dollars out of Medicare, and health care costs become a tsunami if way. I deeply appreciate his efforts. it is not going to do anything about the we do not act in these days. Before I give up the floor, I wish to inflation of health care, I will bet you Perhaps most of all, this moment pay my strongest compliments to my that people at the end of that would calls for courage. This bill does not colleague from Iowa, Senator GRASS- say: Well, that doesn’t sound like necessarily guarantee a tickertape pa- LEY. Senator GRASSLEY is one heck of a health care reform to me. rade or a lot of applause lines. There guy. He represents his State, in my Even though Senator DODD describes are some very tough choices in this judgment, very, very well. As I am sure a lot of things that are neither Demo- bill. the Presiding Officer knows—certainly cratic nor Republican nor even bipar- With the possible exception of the my colleague from Connecticut tisan, there is kind of a consensus that public option and a few other items, I knows—we have worked very closely these things ought to be done. He de- suspect that if the roles were reversed together, Senator GRASSLEY and I, on a scribes it accurately. But, still, a lot of here and we were sitting in the minor- nonpartisan basis as much as we pos- goals that were sought by those of us ity and our friends on the other side sibly can because we both think—and I who were negotiating these things over were in the majority, frankly, the bill know most people think—good legisla- a period of several months—that we we would be considering today might tion is legislation where you work to- ought to have it be revenue neutral— not be substantially different because, gether, not where you are fighting each and on the 10-year budget window, it is frankly, the options are not unlimited other. revenue neutral. But, remember, that as to how to deal with costs and in- Senator GRASSLEY and I started out is 10 years of increased taxes and 6 creased access and prevention. Yes, trying to get this bill put together on years of program to make that happen. there are differences. I accept that and a bipartisan basis working together. As So you raise the question, if it was 10 understand that. But the kinds of it turned out, we did not quite get years of expenditures and 10 years of choices Senator BAUCUS and his com- there. But I know in the end he would income, would it be revenue neutral? mittee made, and the ones we consid- very much like to find a way to vote Well, obviously not. And it does not do ered in our committee, were ones I be- for health care reform, as most Mem- anything about health care inflation. lieve most of my colleagues believe bers of the Senate would. Those are two goals that were sought generally have to be dealt with: the I am an optimist. I think most of us over a long period of time. This 2,074- quality of care, strengthening our in this body are optimists. I have not page bill does not do that. workforce, dealing with the delivery given up yet. Who knows how this is I believe the people of the United system, increasing prevention and going to evolve? Who knows what the States think our country has the best wellness in this country. What steps do amendments are going to be? Who doctors and nurses in the world. But as we take? We can differ over this item knows what the votes are going to be Senator DODD pointed out, there is or that, but I believe we generally be- in the next several weeks or so? But I widespread agreement that the health lieve these are items that must be part am looking for an opportunity where care system in America does have prob- of a significant health care proposal. Senator GRASSLEY and other very con- lems. Costs are rising three times the So I suspect these bills, were the roles structive Senators will join us, all to- rate of inflation. Americans are unin- reversed, might not be substantially gether, in a way, with a little give and sured. Millions more fear losing their different. It might not be that dif- take here, perhaps, to find a solution. insurance in a weak economy and be- ferent. So I just want to end by saying how cause of preexisting conditions. Doc- Perhaps most of all, it is important much I appreciate the Senator. He does tors are ready to close their doors over we find the means to come together. a super job. high malpractice costs and low govern- The road we are on, the status quo, The PRESIDING OFFICER. The Sen- ment reimbursement. So everybody leads to ruin, in my view, for our econ- ator from Iowa. says we need health care reform. Ev- omy and for our fellow citizens. The Mr. GRASSLEY. Madam President, I erybody agrees on that very much. road to reform is a long and difficult thank the Senator from Montana for But, today, the Senate begins debate one, but we have taken so many un- his kind remarks. He does describe the on a bill—2,074 pages—that would make precedented steps just to come to this situation very well, particularly one a bad situation worse. It is unfortunate place. It is time now to finish the job. where there was a very close working that early efforts to reach bipartisan So I am prepared—as I know our relationship during the summer and up solutions in Congress deteriorated into leader is and as I know my friend from until the middle of September, when leadership-driven, partisan exercises. Montana, the chairman of the Finance people in this body felt we were not The bills in Congress slide rapidly Committee, is, as are the members of moving fast enough to get a product down the slippery slope to more and that committee, as I believe most of before the body, and so some of us were more government control of health our colleagues here—we would like a shoved to the side, not by Senator BAU- care. They contain the biggest expan- legacy to be left long after we have de- CUS but by other people in this body. sion of Medicaid since it was created 43 parted this Chamber that will say that I also compliment Senator DODD years ago. They impose an unprece- in the first decade of the 21st century, from this standpoint—that as I look at dented Federal mandate for coverage, when faced with the daunting chal- this 2,074-page bill we call health care backed by enforcement authority of lenge of doing something positive to reform, that as he described parts of the Internal Revenue Service. They in- increase the availability, increase the this bill, I think you get a broad con- crease the size of government by $2.5 quality, and decrease the cost of health sensus that the things he talked about trillion when fully implemented. They care in America, this Congress rose to should be done. But that does not de- give the Secretary of Health and

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00017 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.031 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11996 CONGRESSIONAL RECORD — SENATE November 30, 2009 Human Services extraordinary powers would drive private insurers out of government of limited powers under to actually define benefits for every business and lead to a government the 10th amendment. To my knowl- private health plan in America and to takeover of the health care system. edge—and I think I know a lot about redefine those benefits annually. They From rationing health care to infring- U.S. history—never in 225 years has the create dozens of new Federal bureauc- ing on doctor-patient relationships, a Federal Government said you had to racies and programs to increase the government-run system would guar- buy anything. You don’t have to buy— scope of the Federal Government’s role antee U.S. taxpayers a staggering tax you buy what you want to buy in in health care. That is a lot of power burden for generations to come. America, but not when this 2,054-page over people’s lives, and it is con- The government cannot be a regu- bill goes into effect. Then you will buy centrated here in Washington, DC, in lator, a funder, and a competitor at the health insurance. the Federal Government. same time without doing a great deal Somebody is going to throw at us: The excesses of the bill appear will- of damage to what the private sector Well, the States make you buy car in- fully ignorant of what is going on in has been doing for 60-some years. A surance, and probably most States do. the rest of the economy outside of government-run plan is not necessary My State of Iowa does. But under the health care. These excesses make the for health care reform unless perchance 10th amendment, the State govern- bill far worse than doing nothing. the goal is to put in place the power of ments have a lot of power the Federal At this point in our Nation’s history, the Federal Government to drive down Government doesn’t have. we are a nation facing very challenging costs by—how? Not just driving them The Reid bill also makes problematic economic times—some people would down but the consequences of that: ra- changes to Medicare. It imposes higher say the great recession, not quite the tioning care and slashing payments to premiums for prescription drug cov- Great Depression; other people would providers. These problems are bad erage on seniors and the disabled. The say the worst recession we have had enough, but much worse is that this Reid bill creates a new independent since 1982. What have we seen? We have bill—this bill—fails to solve the funda- Medicare board with broad authority seen the auto industry go into bank- mental problems in health care. None to make further cuts in Medicare, and ruptcy. We have seen banks shutter of them take serious steps to reduce this bill makes that commission per- their doors. costs in health care. manent. The damage this group of I have a chart that is up. We call it The bills will cause health care pre- unelected people could do to Medicare the wall of debt chart. The Federal miums for scores of people to go up, is, in fact, unknown. debt has increased by $1.4 trillion just not down. An analysis just released What is more alarming is that so since inauguration. This chart shows this very day by the Congressional many providers got exempted—they the growing amount of debt the Fed- Budget Office confirms our worst fears have political power, so they got ex- eral Government is taking on. The about the impact this bill will have on empted from the cuts this board would amount of increased debt added just people’s health insurance premiums. make—that it forces the cuts. Then since the inauguration is $11,500 per According to the Congressional Budget what happens? They fall directly and household. It now exceeds $12 trillion Office, the new benefit mandates and disproportionately on seniors and the for the first time in history. regulatory changes will actually in- disabled. Within 5 years, the Obama adminis- crease costs of nongroup health insur- Sooner or later, it has to be acknowl- tration’s policies will more than double ance for individuals and families by 10 edged that by making this board per- the amount of debt held by the public, to 13 percent. That means millions of manent, those savings are coming more and by 2019 it will more than triple the people who are expecting lower costs as and more—are going to bring more and debt. That is not according to this Sen- a result of health care reform will end more cuts to Medicare. That is a good ator but according to the Congres- up paying more in the form of higher example of the philosophical dif- sional Budget Office and the White premiums. For large and small employ- ferences between the two sides in this House Office of Management and Budg- ers that have been struggling for years body, and as the country divides itself et. Already, foreign holdings of U.S. with skyrocketing health insurance more against this 2,054-page bill than Treasurys stands at nearly $3.5 trillion premiums, the Congressional Budget for it, but still a large number of peo- or 46 percent of the Federal debt held Office concludes this bill will do little, ple in America support going in this di- by the public. In other words, people if anything, to provide relief. rection. So those are philosophical dif- outside of this country are holding 46 In fact, they cover their increased ferences between the two sides. percent of our Federal debt. premiums they cause by spending even There are alternatives. Some of us At the beginning of this debate, one more on subsidies because of the in- want to reduce the overall cost of the of the key promises of health care re- creased premiums. So what happens? legislation. We want to try to reduce form was—and I said this previously, They do this by handing over close to the pervasive role of government, but I will repeat it now—that it would $500 billion in hard-earned taxpayer make it harder for undocumented bring down Federal health costs. This dollars directly to health insurance workers to get benefits, allow alter- needs to be done before health spending companies. That sure doesn’t sound as natives to the individual mandate and sinks the Federal budget and saddles though this bill is actually reforming harsh penalties, and add medical mal- the taxpayer. the market. The nonpartisan Congres- practice reforms. I bring a little bit of I have another chart, a health spend- sional Budget Office analysis makes emphasis to medical malpractice re- ing chart or, more accurately, a Fed- clear the Reid bill is not fixing the form because at my town meetings eral health spending chart. As this problem. throughout this past year and particu- chart illustrates, this bill bends the The Reid bill also imposes new fees larly during the month of August peo- Federal spending curve further upward and taxes that will be pushed directly ple would say: Why don’t you first try by $160 billion over the next decade. to the consumer. These new fees and to save money in health care costs by The red area of this chart, emphasizing taxes will total about one-half trillion taking on the lawyers and doing med- the red area of the chart, shows net ad- dollars over the next few years. On the ical malpractice reform? But, instead, ditional Federal health spending— front end, these fees and taxes will the prevailing view is to move millions again, not according to this Senator cause premium increases beginning of people from private coverage into but according to the Congressional next year when they go into effect, and public coverage and create new govern- Budget Office. those new fees increase premiums—for ment programs that cover families Americans have rightly lost faith 4 years; they are there for 4 years—be- making close to $90,000. Yet, even with when, in the face of the current eco- fore most of the reforms take effect in all of these changes, after raising one- nomic crisis—the ‘‘great recession’’— 2014. half trillion dollars in new taxes, cut- Congress thinks this $2.5 trillion re- Then after forcing health premiums ting one-half trillion dollars in Medi- structuring of our health care system to go up, the legislation makes it man- care, imposing stiff new penalties for is a good idea. datory to buy health insurance. Let’s people who don’t buy insurance, and in- The Reid bill also includes a govern- think about mandatory health insur- creasing costs for those who do—after ment-run plan. A government-run plan ance. The Federal Government is a all of these changes, the Congressional

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00018 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.032 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S11997 Budget Office says there are still 24 from different committees met with a (5) Reporting requirements for long-term million people who will not have solemn pledge. We were going to work care hospitals, inpatient rehabilitation hos- health insurance under the Reid bill. together in a bipartisan way to get this pitals, and hospice programs totaling ¥0.2 I don’t think this is what the Amer- billion. job done. We met again for the next 6 ¥ ican people had in mind when the (6) Penalties to hospitals totaling 1.5 bil- months several times, but it just didn’t lion. President and the Congress promised to work out. (7) The expansion of CMS spending totaling fix the health care system. But when that debate began last ¥1.3 billion It is not too late for bipartisan legis- year, interested legislators of both par- (8) A Medicare shared savings program to- lation, so I have the hope that Senator ties set benchmarks that were no- taling ¥4.9 billion. BAUCUS just expressed before I spoke brainers: (9) Hospital penalties totaling ¥7.1 billion. that builds on common ground to im- Health care reform should lower the (10) A revision to the Medicare Improve- prove coverage, affordability, increased cost of premiums. It should reduce the ment Fund totaling ¥22.3 billion. ¥ quality, and decreased costs. So here deficit. It should bend the growth curve (11) Home health care cuts totaling 42.1 billion. are some more alternatives. I have in health care the right way—down- ¥ ward. The Reid bill doesn’t do any of (12) Hospice payment changes totaling 0.1 worked for years on bipartisan legisla- billion. tion that would transform Medicare these things. (13) Medicare disproportionate share hos- from paying for volume of services pro- It is not too late to start over. I pital payments changes totaling ¥20.6 bil- vided to the quality of care delivered. guess Senator BAUCUS has put forth lion. There is also widespread support for that invitation. I hope it materializes. (14) Cuts to advanced imaging services to- stronger rules on insurance companies If both sides can set aside some philo- taling ¥3.0 billion. to make coverage more affordable and sophical differences, and if the Demo- (15) A revision of the payment for power- driven wheelchairs totaling ¥0.8 billion. accessible, especially for small busi- cratic leaders are willing to refocus on the principles that brought us to the (16) Cuts for certain medigap plans totaling nesses and for people who aren’t offered ¥ table months ago, I believe we can 0.1 billion. coverage by their employers, and for (17) A reduction in the part D premium reforms to stop denials of coverage due produce health care reform that im- subsidy for high-income beneficiaries total- to preexisting conditions. Tort reform proves the quality of life for Americans ing ¥10.7 billion. would reduce abusive lawsuits that who are suffering under the current (18) Outpatient prescription drug cuts in drive up costs and surely limit access health care system and doesn’t degrade long-term care facilities totaling ¥5.7 bil- to doctors. The nonpartisan Congres- the quality of life for everyone else. lion. But it is not the entirety of this (19) Changes to preventive services in sional Budget Office estimates that 2,074-page bill. These issues can be ad- Medicare totaling ¥0.7 billion. comprehensive medical liability reform dressed without upending the entire (20) A limitation on the Medicare excep- would reduce Federal budget deficits health care system, with the result of tion to the prohibition on certain physician by roughly $54 billion over the next 10 ¥ higher taxes, higher insurance pre- referrals for hospitals totaling 0.7 billion. years. It would save even more when (21) Comparative effectiveness research to- miums, and deficits and debt that will nonfederal health spending is taken taling ¥0.3 billion. get in the way of opportunities that re- into account. That would mean lower (22) The elimination of indexing for part B sult from the ingenuity and produc- ¥ premiums for individuals and families. premiums totaling 25.0 billion. tivity and industry of the American So far the Democratic leaders in Con- And reflects the Sense of the Senate that people. any savings to the Federal Hospital Insur- gress have little interest in creating an I get back to that coffee shop meet- ance Trust Fund under section 1817 of the So- environment where doctors don’t have ing, where people are discussing health cial Security Act (42 U.S.C. 1395i) and the to engage in defensive medicine just to care reform. As I walk into that coffee Federal Supplementary Medical Insurance keep their practices open because meeting and I tell them that this 2,074- Trust Fund under section 1841 of such Act (42 somebody might sue them. The med- page bill increases taxes, increases pre- U.S.C. 1395t) by reason of the provisions of, ical community should continue to and amendments made by, sections 6401, 6405, miums, takes 400 or more billion dol- 6407, and 6410 should be used to strengthen make the case for reasonable reforms lars out of Medicare, and it doesn’t do that will cut down on unnecessary the Medicare program under title XVIII of anything about controlling costs, ac- such Act. medical tests that serve no purpose ex- cording to the Congressional Budget cept to reduce malpractice premiums Mr. MCCAIN. Madam President, sim- Office, that group again will say: That ply put, this motion to commit would and to protect against frivolous law- doesn’t sound like health care reform suits. be a requirement that we eliminate the to me. one-half trillion dollars in Medicare On several occasions, Republicans As we start this debate this week, I tried to take the legislative substance cuts that are envisioned by this bill— urge my colleagues to listen to the one-half trillion dollars in cuts that in a whole different direction. We tried American people. The Reid bill is in to ensure the President’s pledge not to are unspecified as to how, and one-half the wrong direction. trillion dollars in cuts that would di- tax middle-income families, seniors, I yield the floor. rectly impact the health care of citi- and veterans was carried out. However, The PRESIDING OFFICER. The Sen- zens in this country—Medicare Advan- we were rebuffed at every step of the ator from Arizona is recognized. tage cuts totaling $118 billion; an inde- way. Republicans’ efforts to provide MOTION TO COMMIT pendent Medicare advisory board that consumers with a lower cost benefit op- Mr. MCCAIN. Madam President, I ask would cost $23 billion; an expansion of tion were consistently defeated. That unanimous consent to send to the desk Medicare hospital penalties totaling means despite the promise, a lot of peo- at this time a motion to commit with $7.1 billion; home health care cuts to- ple are not actually going to be able to instructions. taling $42.1 billion; and hospice—of all keep what they have as they were The PRESIDING OFFICER. Without the things—payment changes. The list promised in the last Presidential cam- objection, it is so ordered. goes on and on. paign. The clerk will report the motion. All of these are cuts in the obliga- The Democratic leaders in Congress The legislative clerk read as follows: tions we have assumed and that are the are advancing their extremist health The Senator from Arizona [Mr. MCCAIN] rightful benefits people have earned— care reform bills with a bare minimum moves to commit the bill H.R. 3590 to the particularly our senior citizens—across of votes to do the job. I disagree with Committee on Finance with instructions to this Nation. This eliminates one-half that approach. Health care is one-sixth report the same back to the Senate with trillion dollars in cuts to Medicare that changes that do not include the following: of the economy. That is as large as the are cuts that are unspecified. entire British economy. The legislation (1) Medicare Advantage cuts totaling I eagerly look forward to hearing ¥ Congress is considering will affect $118.1 billion. from the authors of this legislation as every American at every level of (2) Medicare Advantage payment changes totaling ¥$1.9 billion. to how they can possibly achieve one- health and at every stage of employ- (3) Provider cuts totaling ¥$150.0 billion. half trillion dollars in cuts without im- ment. When the debate began last (4) The establishment of the Independent pacting existing Medicare programs year—in fact, it was just this month of Medicare Advisory Board totaling ¥$23.4 bil- negatively and eventually lead to ra- November that I remember 8 or 10 of us lion. tioning of health care in this country.

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00019 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.033 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11998 CONGRESSIONAL RECORD — SENATE November 30, 2009 That is what this motion is all about. interests have made 575 visits to the White years. That is how you get deficit neu- This motion is to eliminate those un- House between January and August. The re- trality. That is how you get deficit warranted cuts. All of us know there port is based on records released by the neutrality. White House on Wednesday. If you started giving the benefits at are enormous savings in fraud, abuse, The timing of the release smells of a clas- and waste that can be identified. No ex- sic Washington tactic—dumping bad news on the same time you raise the taxes, you pert I know of believes that would the getaway day before a long weekend. have got about $1.3 trillion in deficit in come up to one-half trillion dollars. Clearly, the White House, which prides itself a $2.5 trillion bill—a $2.5 trillion piece Hospitals are cut by $105 billion. Nurs- as being the most transparent administra- of legislation. Here we are with the ing homes are cut by $14.6 billion. Hos- tion in the history of the world, hopes this highest deficits in history, with defi- pices are cut by $7.6 billion. nugget gets lost over the four-day Thanks- cits and debt as far as the eye can see, These are not attainable cuts, with- giving weekend. with a stimulus package that has done out eventually rationing health care in AP’s Sharon Theimer: so well that we now have 10.2 percent America and rationing health care for Top aides to President Barack Obama have unemployment, and many predict it our senior citizens, who have earned met early and often with lobbyists, Demo- will go even higher. Wall Street is these benefits, and we have guaranteed cratic political strategists and other inter- doing fine, and lobbyists are doing fine. them these benefits. ests with a stake in the administration’s na- tional health care overhaul, White House Mr. Tauzin, the PhRMA lobbyist, is For the life of me, how the AARP can doing fine. I understand his salary is a support this 2,000-page legislation is be- visitors records obtained Wednesday by the Associated Press show. couple million dollars a year, not to yond my imagination. Seniors all over All of my fellow citizens watching, I mention all the other perks. But the America, including Arizona, including average citizen, including the 330,000 the 330,000 senior citizens in my State urge you to call the White House and say you want to have an appointment citizens of my State, who have the who are under the Medicare Advantage Medicare Advantage Program, are Program, which will be drastically cut to meet with the President or members of the administration in the White going to see it cut and cut over and by some $120 billion, are outraged. The over again—about $120 billion worth. more they find out about it, the more House. Five-hundred-seventy-five spe- cial interests were able to get in. Why So what happened? The White House angry they are becoming. engaged in the tradition of handing out Here we are, as my colleague from can’t you? Give them a call. Tell them you want to meet with the members of favors to special interests, including the great State of Iowa, a leader on PhRMA, AARP, and AMA. Shame on health care, articulated, with a totally the administration. That is what 575 lobbyists have been able to do. Give AARP and shame on the AMA. We partisan measure before the Senate, in know there are many commonsense re- which no Member on this side of the them a call. Continuing to quote: forms that Americans want. aisle has been consulted in any way. I By the way, in this monstrosity, find point out that, historically, there has The records show a broad cross-section of the people most heavily involved in the me any significant, real medical mal- never been a major reform imple- practice reform. The threat of medical mented by the Congress of the United health care debate [except for average citi- zens] weighted heavily with those who want malpractice causes physicians to prac- States unless it is bipartisan in nature, to overhaul the system. tice defensive medicine. The CBO esti- and I don’t believe the American peo- It talks about who were among them. mates it would be roughly a savings of ple want this 2,000-some-page mon- $54 billion over 10 years. That does not strosity, which is full of all kinds of The list also includes George Halvorson, chairman and CEO of Kaiser Health Plans; take into consideration the cost of de- provisions that they are either un- Scott Serota, president and CEO of Blue fensive medicine that doctors have to aware of, or even in the study of this Cross and Blue Shield Association; Kenneth practice because of fear of being sued. legislation, many of us have also be- Kies, a Washington lobbyist who represents I ask the distinguished chairman of come unaware of. But fundamentally, Blue Cross/Blue Shield, among other clients; the committee: Where is any meaning- the Bernie Madoff/Enron accounting Billy Tauzin, head of PHARMA, the drug in- ful medical malpractice reform in this that has been going on with this bill is dustry lobby; and Richard Umbdenstock, 2,000-page bill? Where is it? dependent upon envisioning one-half chief of the American Hospital Associations. I had a townhall meeting the other trillion dollars in cuts that are not at- Several lobbyists for powerful health care interests, including insurers, drug compa- day in Arizona, as I do quite fre- tainable. If they are attainable, it nies, and large employers also visited the quently. There were a lot of doctors, would mean a direct curtailment and White House complex, the records show. nurses, and caregivers who came. I reduction of the benefits we have prom- Again, citizens, why don’t you call asked them: What do you do about ised the senior citizens of this country. the White House and ask for an ap- medical malpractice reform? Every one That is not acceptable. What this motion to commit does is pointment? The lobbyists and special of them said: We practice defensive send it back to the Finance Com- interests—big donors—get it. They are medicine. We prescribe additional tests mittee: Come back with another bill. not ambassadors. They are lobbying and procedures. We have to do it be- Only this time, don’t put the cost of it the White House on this issue. cause we will find ourselves in court by Health care reform should have been on the backs of senior citizens of this the trial lawyers. country. Don’t do it. It was back last about both sides sitting down together Do not underestimate, I say to my summer, 3 months before he was elect- and fixing what is broken, reducing friends, the many special interests and ed President, on a campaign stop not health care costs, while preserving the their influence in this legislation, but far from Washington, DC, now-Presi- highest quality health care in the do not underestimate the stunning suc- dent Obama vowed not only to reform world. cess of the American Trial Lawyers As- Somewhere in the course of this de- health care but to do it in a new way. sociation that has made sure there is bate, in the process of this legislation, He said: no provision in this bill that has to do we have lost sight of the fundamental I am going to have all the negotiations with medical malpractice reform. around a big table, televised on C–SPAN, so problem with health care in America, By the way, if there is an example, it that people can see who is making argu- and that is the cost of health care in is called the State of Texas. The State ments on behalf of their constituents and America, not the quality. This legisla- of Texas enacted meaningful and yet who are making arguments on behalf of the tion will destroy the quality and the not draconian medical malpractice re- drug companies or the insurance companies. availability, if the cuts envisioned in form. Premiums have gone down. Cases Americans wanted to believe this this legislation—this Enron accounting have gone down. Doctors are flooding would be true. Republicans offered to measure, where the first 4 years after back into the State of Texas. It has work with the majority on our ideas. this legislation—suppose this legisla- worked. But that was rejected. So what has tion were signed on the 1st of January We are going to hear from the other happened? Business as usual. Let me by the President of the United States. side that there may be demonstration read from a report of this past weekend Immediately benefits will begin being projects, there may be this, there may about business as usual: cut. Immediately taxes will go up. be that. The demonstration project is The Associated Press has moved a story Guess what. None of the benefits will the State of Texas. That is all we have saying that health care lobbyists and other be given to any American citizen for 4 to do. It has already been proven.

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00020 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.036 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S11999 Instead of a reform which could save The day after the Congressional Budget Of- But you know what we are going to do tens if not a couple hundred billion dol- fice gave its qualified blessing to the version about the doctor fix. Every year we are lars, what are we going to do? We are of health reform produced by Senate Major- going to delay it, delay it and delay it going to cut hospitals by $505 billion, ity Leader Harry Reid, a Quinnipiac Univer- and it will never happen. That has been sity poll of a national cross section of voters nursing homes by $14.6 billion, hospices reported its latest results. the history of the so-called doctor fix by $7.6 billion, and the list goes on and . . . by a 16-point margin, the majority in since its beginning. on, up to one-half trillion dollars. My this poll said they oppose the legislation And will this Congress enact the excise tax motion will send it back to the Finance moving through Congress. on high-premium insurance policies (the so- Committee and tell them to remove Broder went on to say: called Cadillac plans) in Reid’s bill? Obama these unnecessary, unneeded, un- I have been writing for months that the has never endorsed them, and House Demo- wanted, harmful cuts in the Medicare acid test for this effort lies less in the pub- crats—reacting to union pressure—turned system, which will not allow us to ful- licized fight over the public option or the them down in favor of a surtax on million- aires’ income. fill our obligation to the senior citizens issue of abortion coverage than the plausi- bility of its claim to be fiscally responsible. The challenge to Congress—and to of this country. Obama—remains the same: Make the prom- Buried in this partisan legislation, as This is obviously turning out to be the case. While the CBO said that both the ised savings real, and don’t pass along un- I mentioned, are 10 years of tax in- House-passed bill and the one Reid has draft- funded programs to our children and our creases and Medicare cuts, a total over ed meet Obama’s test by being budget-neu- grandchildren. $1 trillion. Using CBO numbers, this tral, every expert I have talked to says that That means taking this legislation stack of partisan legislation costs $2.5 the public has it right. These bills, as they back, taking out these cuts in Medi- trillion over its 10-year implementa- stand, are budget-busters. care and programs that are vital to the tion. Here, for example, is what Robert Bixby, citizens of this country and come back the executive director of the Concord Coali- Let me put this in different terms for with a realistic—a realistic—piece of you. Suppose you want to buy a house. tion, a bipartisan group of budget watchdogs, told me: ‘‘The Senate bill is better than the legislation that has malpractice re- You go and buy the house, but the House version, but there’s not much reform form, the ability to go across State terms of the contract of purchasing the in this bill. As of now, it’s basically a big en- lines to get the health insurance policy house say you have to make payments titlement expansion, plus tax increases.’’ of your choice, rewards for wellness on the house for the first 4 years and These are nonpartisan sources, but Repub- and fitness, expansion of health savings then after 4 years you can move in. lican budget experts such as former CBO di- accounts, and medical malpractice re- rector Douglas Holtz-Eakin amplify the That is why this is Bernie Madoff ac- form. counting. It is a sham. It is a sham. It point with specific examples and biting lan- guage. Holtz-Eakin cites a long list of Demo- There are many cost-saving measures is a sham to make people pay taxes and cratic-sponsored ‘‘budget gimmicks’’ that we can enact to bring the cost of have their benefits cut for 4 years and made it possible for the CBO to estimate health care in America under control then only after 4 years do the benefits that Reid’s bill would reduce federal deficits and preserve quality. Instead, we are kick in. That is the way, with this kind by $130 billion by 2019. doing the opposite. of accounting, they get to deficit neu- Perhaps the biggest of these maneuvers If you are going to make these kinds tral. It is crazy. It is crazy. was Reid’s decision to postpone the start of of cuts—the $420 billion in cuts to subsidies to help the uninsured buy policies The increased taxes and Medicare Medicare and Medicaid and other Fed- cuts begin impacting Americans and from mid-2013 to January 2014—long after taxes and fees levied by the bill would have eral health programs—then you are our economy in 32 days, if this is begun. going to impact the provision of health passed. Let me repeat this. Starting in Even with that change, there is plenty in care in America. January 2010, just 1 month from now, the CBO report to suggest that the promised Americans have been clear over- the majority begins tax increases and budget savings may not materialize. If you spending has to stop, nor do the Amer- Medicare cuts, starting in January, read deep enough, you will find that under ican people believe empowering Wash- and incredibly delays implementation the Senate bill, ‘‘federal outlays for health care would increase during the 2010–2019 pe- ington bureaucrats in a new Federal of this bill for 4 years. That is 1,460 health care entitlement is health care days and 208 weeks of new taxes and riod’’—not decline. The gross increase would be almost $1 trillion—$848 billion, to be reform. The other side disregards the Medicare cuts before implementation. exact, mainly to subsidize the uninsured. message from the American people all That is playing games with the Amer- The net increase would be $160 billion. across the country, and the bill does ican people. But this depends on two big gambles. Will the opposite. If they were not playing games by de- future Congresses actually impose the as- I wish to talk just for a minute about laying implementation of the bill 4 sumed $420 billion in cuts to Medicare, Med- a provision in this bill that is very im- years after the tax increases and Medi- icaid and other federal programs? They never have. portant; that is, the transfer of power, care cuts, we would not even be dis- the massive transfer of power in this Why don’t we tell the truth to the cussing this pile of legislation because bill to the Secretary of Health and American people and take these sup- it would be scored as adding over $1 Human Services. This is a huge trans- posed cuts out of this bill? Tell them trillion to our deficit. fer. ‘‘HHS would become federal giant the truth about what it costs and tell If the other side wanted to be honest under Senate plan’’ by Susan them the truth that this is a dramatic and reject the Madoff-Enron account- Ferrechio: ing, they would be talking about the expansion of entitlements, but at the same time those presently eligible, A quick search of the Senate health bill first 10 years of real costs and the first will bring up ‘‘secretary’’ 2,500 times. 10 years of their tax increases and those senior citizens, such as the That’s because Health and Human Services Medicare cuts. 330,000 who are under the Medicare Ad- Secretary Kathleen Sebelius would be award- The respected dean of the Wash- vantage Program in my home State of ed unprecedented new powers under the pro- ington press corps, David Broder, Arizona, will not see that program posal, including the authority to decide what pointed this out just last week in his maintained. You cannot reach these medical care should be covered by insurers column in the Washington Post enti- kinds of savings, these kinds of reduc- as well as the terms and conditions of cov- tled ‘‘A Budget-Buster in the Making.’’ tions, these kinds of cuts without im- erage and who should receive it. By the way, the majority leader then pacting existing programs. I know of I wish to repeat that. In this bill, the felt compelled to come down and trash no expert who says it will who is an ob- Secretary has the ‘‘authority to decide one of the most respected columnists jective observer. I believe Dr. COBURN, what medical care should be covered by in America whom I don’t need to take Dr. BARRASSO, and others in the med- insurers as well as the terms and condi- the time to defend; he can defend him- ical profession will say the same thing. tions of coverage and who should re- self and so will many others who have Every time Congress has enacted so- ceive it.’’ great respect for David Broder. called cuts in Medicare or con- We saw a little precursor of that the David Broder’s column said: templated it, they have never taken other day with, for example, rec- It’s simply not true that America is ambiv- place. ommendations concerning mammo- alent about everything when it comes to the That doctor fix? We took care of that grams. A board recommended that Obama health plan. problem. We just took it out of the bill. women under 50 should not get routine

VerDate Nov 24 2008 02:11 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00021 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.037 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S12000 CONGRESSIONAL RECORD — SENATE November 30, 2009 mammograms. Of course, the response guiding the new Federal plan under President Obama has promised that was incredible and justified. Women all mammograms had been implemented? seniors will not see a reduction in ben- over America are now alive today be- Then, on the following page, 1,190, the efits. In fact, he said recently: cause they had mammograms prior to Secretary is authorized to deny pay- People currently signed up for Medicare the age of 50. The Secretary of Health ment for prevention services that the Advantage are going to have Medicare and and Human Services said that would task force recommends against. So if the same level of benefits. not be carried out, et cetera. We are this unelected panel changes the pre- How did he get there? How do you get creating a situation where the Sec- ventive recommendation for some there when you are cutting Medicare retary of Health and Human Services other type of cancer, the Federal Gov- Advantage by $120 billion? There is no and a board would decide that. ernment plan would not cover it. I math—old or new—that gets you to no ‘‘The legislation lists 1,697 times where the don’t think the American people want change in the benefits that they have Secretary of Health and Human Services is their health coverage decisions coming under Medicare Advantage and yet cut- given the authority to create, determine or from a panel in Washington. ting $120 billion. Traditional Medicare define things in the bill,’’ said Devon Her- The Reid bill drives up costs and pre- doesn’t offer coordinated benefits that rick, a health care expert at the National miums. Just today the CBO released its can improve the quality of care. Tradi- Center for Policy Analysis. assessment of what will happen to tional Medicare doesn’t have many of For instance, on Page 122 of this 2,079-page health insurance premiums under the the aids or benefits for our seniors. bill, the secretary is given the power to es- new entitlement compared with pre- tablish ‘‘the basic per enrollee, per month President Obama has also promised cost, determined on average actuarial basis, miums today. The CBO dealt a blow to several times, ‘‘If you like what you for including coverage under a qualified claims the health care bill introduced have, you can keep it.’’ The American health care plan.’’ by Senator REID will lower premiums people took those words as a promise The HHS secretary would also have the when they released an analysis show- that if they had a health benefit they power to decide where abortion is allowed ing that premiums will go up signifi- were happy with, they could keep it. I under a government-run plan, which has cantly in the individual market. Pre- want to make sure we are helping the drawn opposition from Republicans and some miums for individuals without em- President keep his promise. I want to moderate Democrats. ployer-sponsored coverage would in- And the bill even empowers the depart- help him keep his promise by sending ment to establish a Center for Medicare and crease 10 to 13 percent or $2,100 per this bill back, taking out the cuts that Medicaid Innovation that would have the au- family in 2016. The Democrats’ bill are in it on Medicare, on the $105 bil- thority to make cost-saving cuts without therefore requires individuals to pur- lion cuts to hospitals, nursing homes having to get the approval of Congress first. chase insurance that is more expensive by $14.6 billion, hospices cut by $7.6 bil- ‘‘It’s a huge amount of power being shifted than would be available under current lion, Medicare Advantage by $120 bil- to HHS, and much of it is highly discre- law. For small businesses and employ- lion. I want to send it back to the Fi- tionary,’’ said Edmund Haislmaier, an expert ers, the bill largely preserves the sta- nance Committee and come back with in health care policy and insurance markets tus quo and does little if anything to at the Heritage Foundation, a conservative a bill that the American people can be- think tank. lower the cost. In fact, CBO estimates lieve in that will preserve the solemn Haislmaier said one of the greatest powers that under the Reid bill the average obligations we have made to our senior HHS would gain from the bill is the author- family with employer-sponsored cov- citizens. ity to regulate insurance. States currently erage will soon pay more than $20,000 Medicare Advantage provides the hold this power, and under the Senate bill, per year for health insurance. only choice in the Medicare Program the federal government would usurp it from President Obama said the following allowing an option for seniors who them. This could lead to the federal govern- during the campaign: want additional benefits or a better op- ment putting restrictions and changes in I have made a solemn pledge that I will place that destabilize the private insurance tion. Medicare Advantage is working sign a universal health care bill into law by for nearly 11 million seniors to give market by forcing companies to lower pre- the end of my first term as President that miums and other charges, he said. will cover every American and cut the cost them a choice about their health care ‘‘Health and Human Services doesn’t have of a typical family’s premium by up to $2,500 and better benefits. As I mentioned, any experience with this,’’ Haislmaier said. a year. 330,000 beneficiaries in my State of Ari- ‘‘I’m looking at the potential for this whole Well, CBO’s analysis shows that the zona are in Medicare Advantage, and thing to just blow up on people because they they will see benefit reductions or have no idea what they are doing. Who in the President is breaking that pledge by Federal Government regulates insurance both failing to achieve universal cov- their plan disappear. Eighty-nine per- today? Nobody.’’ erage and raising premiums, just as it cent of seniors need and have some ‘‘The health care reform legislation would contradicts an analysis by MIT econo- form of supplemental coverage on top rely on the U.S. Preventive Services Task mist John Gruber released by the of Medicare to provide protections Force for recommendations as to what kind White House this weekend claiming against out-of-pocket costs or addi- of screening and preventive care should be that individual premiums would go tional benefits. Many low-income covered. Last week, the group, which oper- down. In fact, even with the generous Americans and minorities rely on ates under HHS, drew sharp criticism for ad- Medicare Advantage as their supple- vising that mammograms should begin at assumptions made by CBO in a number age 50, a decade later than the current stand- of areas, premiums will either go up or mental coverage. ard.’’ remain unchanged. Some have claimed that cutting the ‘‘Critics of the bill said this was an exam- From the CBO report just today, CBO ‘‘extra payments’’ to Medicare Advan- ple of how the new bill could empower HHS says premiums in the individual mar- tage plans reduces insurance company to alter health care delivery, but Democrats ket would be 10 percent to 13 percent profits. Under Federal law, that is sim- argue they would rather have the govern- higher in 2016 than under the current ply not the case. The fact is, 75 percent ment making these decisions.’’ law. Average premiums would increase of those ‘‘extra payments’’ go directly That is the key to it. They would by $300 for an individual policy and by to better benefits for seniors under cur- rather have the government making $2,100 for a family policy. The new ben- rent law. The other 25 percent goes these decisions. If you like the way the efit and coverage mandates actually back to the Federal Government. Un- post office is run, you will love the way drive up premiums by 27 to 30 percent, fortunately, those extra benefits will HHS runs health care in America. and this increase is offset by other fac- be taken from seniors who are enrolled I understand the amendment of the tors, such as new administrative effi- in Medicare Advantage. other side may address some of this, ciencies. This bill contains $120 billion in di- but under the Reid bill the Senate CBO says that little more than half rect cuts to private Medicare plans. moved to consider, beginning in 32 of enrollees in the individual market Common sense says you can’t do that days, the language from the bill on would receive a government subsidy. without affecting benefits. The Con- page 1,189 authorizes the Secretary to However, the bill before us would still gressional Budget Office thinks so as modify benefits under Medicare pursu- require nearly 14 million Americans to well. CBO assumes the Reid bill will ant to task force recommendations. As purchase unsubsidized insurance that cut benefits by more than half, from an I mentioned, how many women would is more expensive than they have average of $98 in additional benefits to have died if the coverage provisions today. $41 a month.

VerDate Nov 24 2008 02:11 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00022 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.038 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S12001 I see one of my colleagues is waiting Medicare, will protect Medicare’s al- this, month after month. Then it went to speak, but I hope the American peo- ready guaranteed benefits. The bill also into the summer, working on health ple will understand what we are trying reduces premiums and copays for older care reform in the Health, Education, to do. All we are trying to do is send citizens. It will ensure that older citi- Labor, and Pensions Committee and this back to be reworked, to be fixed on zens can keep their own doctor or doc- the Finance Committee, improving a bipartisan basis, and not to force tors with whom they have developed a bills, changing the bills. Now we have $400-some billion in cuts and benefits relationship, on whom they have come one bill that is the result of all that that we have promised the American to rely, and in whom they have con- work. So this has been going on for people. We want to send it back and fidence. So we want to make sure they months and months. come out with a bipartisan approach. can keep their own doctors. I keep hearing criticisms from my Sit down, for the first time, Repub- The bill keeps Medicare from going Republican colleagues on various as- licans and Democrats, have the C– bankrupt in 8 years by stopping waste, pects of the bill. There is nothing un- SPAN cameras rolling—the way the fraud, and abuse and by other provi- usual about that. It is natural to have President promised he would a year sions as well. The bill provides new pre- a decision and a debate. We are start- ago last October. ventive and wellness benefits—some- ing that today, at least on the floor. Let’s sit down together and figure thing we have talked about for every But we have been having a debate over out how we can fix this. age group, but we are finally going to many months. My point is that on the The best way to fix it is to preserve do something about it to give people one hand you have the legislation that the quality of health care in America better health care options. resulted from work by the two commit- and bring down the cost, not to pass a The bill also, as it relates to older tees into one bill, so you have the Pa- 2,074-page monstrosity that is full of citizens, lowers prescription drug costs. tients Protection and Affordable Care the measures that would impair the We will talk more about that. We have Act on the floor and you have had basi- ability, particularly of our senior citi- had a lot of discussion over the last cally the ideas contained in that being zens, to keep the benefits they have couple of years about the so-called discussed for many months. But what earned and we have promised them. doughnut hole. That is a very nice- we have not seen, what I have been Madam President, I yield the floor. sounding way of describing falling into waiting for and have not seen, is a bill The PRESIDING OFFICER. The Sen- a period of coverage, if you are an older by the other side. ator from Pennsylvania. citizen getting prescription drug cov- In other words, when we were work- Mr. CASEY. Madam President, I rise erage, where you have to pay the whole ing in June and July in the HELP Com- to speak about health care, as we begin freight, so to speak. This bill provides mittee or when the Finance Committee the debate in the Senate. I am grateful relief for those who are in that so- was working all summer and into the we are finally at this point where the called doughnut hole with regard to fall, you would think that one of the Senate at long last will be debating our Medicare prescription drug coverage. results from that would be that Demo- health care bill. It has been a long time Finally, this bill keeps older citizens crats had a point of view and they pro- in coming. Some of us have waited in their homes and limits those who duced a bill; Republicans had a point of years, some have waited for decades to would be compelled, if they didn’t get view. But they did not produce a bill. be at this point in our history. additional help, to go into nursing So you basically have a choice before On the Senate floor now is the Pa- homes. Some do. Some choose to do the American people: the bill before us, tient Protection and Affordable Care that. But we want to provide more op- which will change and which will be Act, and we are going to be discussing portunity for people to stay in their amended. I have some things I would various aspects of that over the next homes, if they can. want to change. But the answer cannot couple of weeks. In terms of preserving Medicare with- be let’s go back to square one, where I am reminded, as I rise today, of out the changes made in this bill, we were a year ago or 5 years ago or 10 something Hubert Humphrey said a Medicare is going broke in 8 years—not years ago and just cancel this and try long time ago. He said the test of the 18, not 80, but 8 years—if we do noth- to start over. This is the result of government is how it treats those in ing. Older citizens will have trouble ac- many years of work, especially many the dawn of life—our children—those in cessing their doctors if we don’t take months of work by people at the staff the shadows of life—those who have action. Older citizens will have trouble level and Senators across the board. challenges in their life, as we try to affording prescription drugs if we don’t Unfortunately, the other side does help them—and those in the twilight of take action. Finally, without reform, not have a plan, so I can only conclude life—older citizens across America. In cost sharing for older citizens will in- they want to stay with the status quo. large measure, we will be talking about crease to completely unaffordable lev- They think where we are in health care each of those Americans in one way or els. is OK; that we should stay where we another and a lot of other Americans Next, we have to make sure older are, maybe tinker with it a little bit as well. I rise to speak of our children citizens across America have the op- but not change much. I think that is but also to spend a couple of moments portunity to continue to receive guar- unacceptable. Too many people I run talking about older citizens, especially anteed protection for hospital stays, into, in Pennsylvania especially, have in light of some of the arguments made access to doctors, home health care, said to us: Please provide some protec- most recently on the Senate floor. nursing home, and prescription drug tions for me. We are talking about in- I will start with our older citizens. I coverage. We have to make sure we ex- dividuals who have health care. Pro- come from the State of Pennsylvania tend the life of the Medicare trust fund vide some consumer protections. Make where in our little State, with more beyond 2022. Without reform, we can- sure the Medicare trust fund will al- than 12 million Pennsylvanians, we not extend the Medicare trust fund be- ways be there. Help me with this have almost 1 million Pennsylvanians yond 2022. Without reform, we do not doughnut hole problem. This is the over the age of 65. We have a very high have the opportunity to ensure that problem too many seniors run into number of Pennsylvanians on Medicare trust fund will be there for older citi- when they cannot pay for prescription and also a lot of families who rely upon zens across America. Finally, health drugs at a certain point in the delivery that kind of health care coverage, as reform will not interfere with any med- of that benefit. we have for many generations. So when ical decisions made by patients and I do not think the response of doing we speak of those in the twilight of their doctors. nothing or staying where we are is ac- life, we speak of many Americans who Let me step back a moment and re- ceptable. That is one of the reasons are covered by Medicare. flect upon what we are talking about why we have to make sure we focus on I want to make a couple of points with regard to Medicare: Protecting changes or debates about this bill, not about the bill that is on the floor now. our seniors, protecting their benefits. going back to where we were in Janu- First of all, with regard to older citi- It is interesting to note this whole de- ary or where we were 5 years ago and zens, a couple of basic points on which bate started January of 2009, in a fully basically doing nothing year after year I will provide a little more background. engaged way, when staffs of all rel- about health care and saying it is OK First of all, this bill, as it relates to evant committees were working on to stay where we are.

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00023 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.039 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S12002 CONGRESSIONAL RECORD — SENATE November 30, 2009 We have a long way to go. But I of their ability, because of advantages I will not go through the whole let- think it is also important to point out they have. Their potential is unlimited ter, but suffice it to say we have a pro- this is not just a debate between Re- and that light burns very brightly gram in place now, the Children’s publicans and Democrats. We have had without any help from anyone else. Health Insurance Program, that works groups, across the board, that are neu- That is some children. for families right now. Now we are en- tral arbiters that weigh in on public Then there are other children who gaged in a great debate on health care policy but are not representing a have a light inside them and are de- on the floor of the Senate and we deal serving of our care and protection and Democratic point of view or a Repub- with programs such as the Children’s advocacy. We have a lot of people lican point of view. The AARP said on Health Insurance Program. What we around here who get besieged by lobby- November 20 of this year: have to make sure about is that we do Opponents of health reform won’t rest. ists for different points of view, but very rarely do we have the same kind nothing in this process to injure or They are using myths and misinformation to harm or set limits on what we can do distort the truth and wrongly suggest that of lobbying power, the same kind of Medicare will be harmed. After a lifetime of power in our system to stand for chil- with a program that we know works. hard work, don’t seniors deserve better? dren. So we have to do that if an inter- This is a program which is good for a So says the AARP, just a couple of est group will not. There are plenty child, to make sure he or she reaches weeks ago—not even a couple of weeks who have advocated strongly for our the full potential of that light inside ago, 10 days ago. The AARP also said children, but they don’t get enough at- them. This is good for his or her fam- on November 18, 2 days earlier: tention in my judgment. ily. Imagine the peace of mind that a The new Senate bill makes improvements There are some children who are born mother or father has in the course of to the Medicare program by creating a new with a light inside them that does not the day, whether they are going off to burn very brightly because of their own annual wellness benefit, providing preven- work or whether they are home, to tive benefits, and most notably for AARP circumstances or limitations or be- members, reducing drug costs for seniors cause of particular vulnerabilities that know their child has health care. Yet who fall into the dreaded Medicare donut they have. They are the ones for whom we have some families, some parents, hole [that I spoke about earlier] a costly gap we have to fight the hardest. They are terrified even with the coverage they in prescription drug coverage. the ones we have to stand up to the have, worried that coverage will not re- That is the AARP weighing in on not special interests for because they can- main in effect for their children. So we a concept, not a theory but the bill in not do it for themselves. They don’t have to make sure that rule is fol- front of us. have a voice sometimes in this debate lowed: No child worse off in America. The American Medical Association, unless the Senate stands up for them. We want to fix what is broken and on that same day, November 20, 2009: I believe no matter what the light is build upon what works. We are working to put the scare tactics to inside a child, no matter what the bed once and for all, and inform patients I wish to make sure, as we go limit or whether it is unlimited poten- through this, we have a sense of what about the benefit of health care reform. tial, we have to make sure that poten- the difference is between these benefits I could go on from there, but we have tial is reached, the full potential—not and what can happen down the road. ample evidence that there is strong most of it, not some of it, the full po- support for the ways this bill will tential of every child, the full burning One of the things that will have an ad- strengthen Medicare. of that light inside them. verse impact on our health care sys- I wish to move to the second topic I There are two programs that work tem, generally, but in particular on a was going to cover today and that is well to do that. They are Medicaid and program such as the Children’s Health the other end of Hubert Humphrey’s the Children’s Health Insurance Pro- Insurance Program, will be the sky- test of government, what we do and gram. Thank goodness both these pro- rocketing cost of coverage. The share what the test is of our Government as grams came along: Medicaid, some 40 of household incomes spent on pre- it relates to those in the dawn of life. years ago, and Children’s Health Insur- miums is climbing. The New America I spoke of older citizens a moment ago. ance Program less than the last 15 Foundation reports that in 2008, house- At the dawn of our life are children. years. hold income spent—on the side, ‘‘per- It has been a topic and a focus of We have the opportunity to listen to cent of median household income spent mine since the very beginning of this people who come up to us on the street on health care’’—is 26.3 percent. That debate, which for me began last spring or who send us an e-mail or who send is far too high as of 2008. when I was working in the Health, Edu- us a letter. It just so happens one of my cation, Labor, and Pensions Committee constituents in Pennsylvania sent us a With no action, if we stay where we before our work this summer on the note the other day, literally 2 days ago, are, go down the same road we are on, bill. The Patient Protection and Af- November 28. I will not give away her the status quo, don’t change anything, fordable Care Act, which is the bill be- identity, but I will give you a general let’s start over and keep scratching our fore us today, deals with many aspects sense of what her challenge is. head about this, here is what is going of our health care system. One of them She wrote to us talking about her to happen by 2016, 7 years away. That is how we take care of our children. I two children who are covered by the median household income dedicated to have come back to this issue over and Children’s Health Insurance Program health care will skyrocket to 45 per- over. I have had just a basic test for in Pennsylvania. By the way, Pennsyl- cent nationally. this legislation. It is very simple. It is vania is one of the first States that put Unfortunately, in Pennsylvania, it four words: No child worse off, espe- into place this program, almost 20 goes up over 51 percent instead of 45 cially and importantly, children who years ago, back in 1992–1993. percent, so that is the ‘‘do nothing’’ are low income and are particularly She wrote and said she was concerned path right now. Do nothing, and we can vulnerable, therefore, and children that the House, in their bill, had made guarantee that those costs are going to with special needs. So ‘‘no child worse some changes that would adversely im- keep going up and up. pact her situation. She said: off’’ should be the foundation of what I said before we know the Children’s we do in this bill for our children. We qualify for free Children’s Health Insur- That is particularly true for those ance Program benefits in Pennsylvania but Health Insurance Program works. By who are vulnerable, as I said before; my husband’s income is greater than the 150 the way, when that bill passed and percent of the Federal poverty level which when it was reauthorized, we had help they are vulnerable or children with means our children wouldn’t qualify for the special needs. That is the foundation of from both sides of the aisle—some- coverage under the House’s proposed plan. times not enough help but we have had what we should be doing, the founda- Then she says: tion for a guiding philosophy. The way help supporting that program. We This has us terrified. know this program works because we I look at this, every child in America, She goes on to talk about what she no matter who they are, no matter can see it from the results achieved by and her husband are trying to do to our children because of this program. what circumstance, every child in make ends meet. She says: America is born with a light inside Our water bills will increase and we are Let’s compare this to some other them. For some, that light is boundless nervously awaiting the annual increase in challenges in the economy. The na- because of their circumstance, because heating. tional poverty rate. In 2007, a little

VerDate Nov 24 2008 02:11 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00024 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.041 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S12003 more than 37 million Americans were health insurance exchange that will be I want to constrain my comments to in poverty, 12.5 percent of the popu- created as a result of this bill. The ex- the Medicare amendment because I lation. In 2008, it was up to 13 percent. change is a good idea to cover a lot of think that is one of the key parts of So the poverty rate went up from 2007 people. It just happens to be a bad idea this whole bill. The Senator from to 2008. The child poverty rate went when it comes to merging or putting Pennsylvania mentioned that there from 18 percent to 19 percent, almost 1 the Children’s Health Insurance Pro- wasn’t a Republican bill. Actually, million more kids in 1 year falling into gram in there. It needs to remain a there are four Republican bills, and poverty because of changes in the econ- stand-alone program. there is one bipartisan bill out there omy. People without health insurance, One of the reasons why we can say we that meets all of the goals the Presi- 2007 versus 2008, that has gone up. It are at that point where it is a stand- dent put out. When we were going may only be 15.3 to 15.4, but look at the alone program still is because during through the HELP Committee amend- overall number, from 45.7 to 46.3. Ev- the debate in the Finance Committee, ment process, we put one of those out, erything is going up. We would expect Senator ROCKEFELLER of West Virginia and it was voted down with one vote. that, as tragic as that is, when times ensured that we kept the Children’s We said: That didn’t work very well. are bad. The national poverty rate is Health Insurance Program out of the There were a lot of good ideas in there. up, the child poverty rate up, and the exchange and that the program would They ought to have to consider every uninsured rate is up. continue until 2019. Unfortunately, the one of those. What has not gone up between 2007 House doesn’t have the same provi- We have been putting our ideas out and 2008 is the number of uninsured sions, and we want to make sure we do one at a time so that hopefully the children: 8.1 million in 2007 were cov- that by the end of the debate. other side will glean something out of ered; 7.3 million kids covered in 2008. I filed an amendment today to make the amendment that will be worth- That is good news, that the number of sure that children are protected by while to be a part of the bill. All the uninsured children is actually going health care reform, so we can truly say good ideas couldn’t be on one side of down from roughly 8 to 7 million. That that no child is worse off as a result of the aisle. is good news. Why is that happening? It our health care reform bill. In a nut- We began the day with kind of a is not magic. If we didn’t have a Chil- shell, this amendment will strengthen stunt which, of course, was to have the dren’s Health Insurance Program, that and safeguard health care for children leader propose a unanimous consent. number would be going up just as the in CHIP from now until 2019 and be- He proposed that the Social Security other numbers. Why is the uninsured yond with whatever changes the future money ought to stay with Social Secu- number for children going down? One of health care reform brings. rity. I don’t think there was any prob- basic reason—and we could point to I will provide a couple of highlights. lem with that. But then he proposed maybe a few others—is because we It continues funding through 2019. It that CLASS Act money ought to stay have a program called the Children’s ensures that children have access to with the CLASS Act. That is a fund Health Insurance Program which the essential care they need. It stream- that isn’t even actuarially sound to works and which, fortunately, we reau- lines and simplifies enrollment. The begin with. It is just a piece of the bill thorized a couple of months ago. Thank amendment also provides financial in- that is already in existence around goodness we did that, or more and centives for States to increase enroll- here. He left out what he should have more children would fall into poverty. ment of eligible but uninsured children put in that unanimous consent request. We are on a path now to go from the and calls for a study of children under He should have said Medicare money number of children who are insured, to the Children’s Health Insurance Pro- should be reserved for Medicare. That get that number that is now in the dou- gram compared to coverage of children would have relaxed a lot of seniors. But ble figure millions, to get that to 14 under the so-called insurance ex- it would have been untrue and impos- million children, to have that unin- change. sible to pass this bill if that were the sured number keep going down and These are just some highlights of my UC, because Medicare money is going cover more and more children. In a amendment. I will be talking more to expansion of new programs outside couple of years, we will have the oppor- about it. of Medicare. That is what is upsetting tunity to say that in America, we have I conclude with this thought. I know seniors. And it ought to. 14 million kids covered. What we have Senator BAUCUS was here a moment Medicare, as everybody has said, is to do is make sure we have a successful ago, chairman of the Finance Com- going broke. That is a government op- program that works for the child, for mittee, who has worked very hard on tion that is going broke. Well, never their family, and for our society. Be- this bill, this program, the Children’s mind. But Medicare is going broke. We cause guess what. We are going to have Health Insurance Program, and on the all agree on that. So why would we a better economy because of the Chil- health care reform bill overall to pro- take $464 billion out of Medicare to use dren’s Health Insurance Program. If we tect our kids. I return to this letter I on other programs and then recognize invest in a child early, they get health got 2 days ago from a mother, in es- that Medicare is going broke and throw care, and they will learn better. When sence commending the benefits of this in a special commission that will come they learn better, they will be doing program, that this program gives her to us once a year and suggest cuts to better in school and have a better job peace of mind. What we have to do is Medicare? That is not a bad idea, but and have a higher skill level. This make sure we keep the Children’s some side deals have been made in this whole debate about children’s health Health Insurance Program intact and, whole thing that keep that from being insurance isn’t just a nice thing to do; if anything, strengthened over time so a very realistic option either. The hos- it is how we compete around the world this mother doesn’t have to worry pitals can’t be cut any more. The doc- in a tough economy. It is how we build again, so she doesn’t have to be ‘‘terri- tors, we are going to have to fix that, a skilled workforce in a tough econ- fied’’ of changes that will adversely im- and that is where some of the phony omy. It is how we build strong families. pact her two children, especially in the accounting comes in. This isn’t just some nice program. midst of a bad economy but even if it The pharmaceuticals, the little deal This has real results for our economy, were not. they made for the doughnut hole, that for gross national product growth, eco- I thank the Chair and yield the floor. will provide extra help to seniors nomic growth, for a skilled workforce. The PRESIDING OFFICER (Mrs. through the doughnut hole, but it has Fill in the blank. You could add 10 SHAHEEN). The Senator from Wyoming. to be on brand name products. We themes to that in terms of the impact Mr. ENZI. Madam President, I thank know that generics are a lot less expen- of the legislation. But you have to be the Senator from Pennsylvania for his sive and a lot of seniors switch to careful. In the midst of this health care comments. I certainly hope no one who generics, especially when they get to reform debate, we have to make sure is listening thinks that anybody wants the doughnut hole and have to make we don’t do what some have urged to make any child worse off. That is a decisions on their own and they want which is to take the Children’s Health basic premise, and I appreciate his to save a few dollars. But that will not Insurance Program, this program that pointing out the way the House makes be a possibility under this bill because we know works, and drop that into the some children potentially worse off. of the deal that was made with the

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00025 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.043 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S12004 CONGRESSIONAL RECORD — SENATE November 30, 2009 pharmaceuticals. They are going to in some cases loss of access alto- There are a lot of people who are out pay their percentage on brand name gether.’’ of nursing homes because they are get- products only. Why would they do In rural States—and we are about as ting home health care. If we eliminate that? If they can get you to use brand rural as you can get; we have the least home health care, we drive up the cost name products through the doughnut population in the Nation, and we have of care. If the Senate passes this bill, it hole, when the government starts pay- a lot of land mass—there is a lot of dis- will mean that Medicare patients may ing again, you will still use the brand tance between towns. If the nursing not be able to get the skilled nursing name. home in your town closes down, it is a care, the physical and speech therapy, One of the ideas with health care is long way to the next nursing home. and the assistance that home health to get a little skin in the game with ev- The Reid bill would also cut $135 billion aides provide with many daily activi- erybody so people are making good in Medicare payments to hospitals. In a ties, such as dressing, bathing, helping choices on health care. How much of a State such as Wyoming, with an older patients live more fully with a dis- good choice are you going to make if population, between 40 to 50 percent of ability. you don’t have to make a choice and our hospital revenue comes from Medi- The Medicare cuts in the Reid bill you can keep on doing what you have care. Medicare already pays a fraction are not limited to slashing payments been doing, whether it is the best of what private insurers pay, and the to hospitals and other providers. The choice for you, whether it is even what cuts in this bill will undermine those bill also cuts $120 billion from the 11 the doctor agrees with, and whether it hospitals’ ability to continue to oper- million seniors on Medicare Advan- is a whole lot more expensive for the ate. I have heard from several Wyo- tage. These cuts make a mockery out government to keep Medicare going? ming hospital executives that because of President Obama’s promise that if I rise to support the McCain motion of the payment cuts in this bill, they you like what you have, you can keep to commit this bill and eliminate its are going to need to ask their people to it. As a result of these cuts, millions of Medicare cuts. Senator REID’s bill cuts work fewer hours and take pay cuts. Medicare beneficiaries will lose the $464 billion from the Medicare Pro- They also said they may need to lay benefits currently provided by Medi- gram. These cuts will eliminate bene- some folks off and to find ways to scale care Advantage plans. fits for Medicare patients. They will back the services they offer to their pa- Supporters of Senator REID’s bill make it harder for them to see doctors tients. They do not want to com- have tried to gloss over the impact and other providers and will threaten promise the care they provide, but the these Medicare Advantage cuts will the survival of hospitals, nursing payment cuts in this bill will not leave make, arguing they will only result in homes, and home health agencies. them a choice. a loss of ‘‘extra benefits.’’ For the sen- Don’t take my word for it. The admin- The Reid bill also cuts nearly $8 bil- iors who have come to rely on Medicare istration’s own chief actuary recently lion in payments to hospice care. Hos- Advantage plans to provide things such as flu shots, eyeglasses, hearing aids, reviewed the House bill with its similar pice care helps to relieve the suffering and protections against catastrophic levels of Medicare payment cuts and of people who are dying from diseases costs, these are not extra benefits but reached the same conclusion I just such as cancer. These are terminal pa- tients, terminal patients who, of items and services they depend on. said. We all agree Medicare needs to be Richard Foster, chief actuary at the course, are not going to be cured. But strengthened and reformed. Its financ- Centers for Medicare and Medicaid the hospice is intended to help manage ing is unsustainable. The Hospital In- Services, CMS, wrote that if these cuts the pain and other symptoms of the pa- surance Trust Fund, which pays for were to take effect, many providers tients with the terminal illness, and hospital services, will be insolvent in ‘‘could find it difficult to remain prof- working with the families, much on a 2017. The physician payment formula, itable and might end their participa- volunteer basis. which calls for Medicare payments to According to National Hospice and tion in the program.’’ He also noted doctors to be cut by more than 40 per- Palliative Care Organization, the cuts that this could jeopardize Medicare cent over the next 10 years, is fun- in the Reid bill, combined with prior beneficiaries’ access to care. I have damentally broken. We know that. We regulatory cuts, would reduce Medicare heard similar messages from doctors, even had a vote on that in this Cham- home health aides, and nursing home payments to hospice providers by 14.3 ber. We said it had to be paid for. owners back in Wyoming. They are all percent through 2019. According to a Let’s see, $464 billion coming out of concerned about the one-half trillion June 2008 report from the Medicare Medicare. Medicare is what is being af- dollars in Medicare cuts and what it Payment Advisory Commission, hos- fected by the doctors’ payments. Why will do to their ability to treat Medi- pices already operate with narrow prof- wouldn’t we use some of that? But it is care patients. it margins that average just 3.4 per- a lot of money. It is a lot of money, but I have heard from folks at the Baggs cent. it is not as much money as we are tak- Senior Center, the Star Valley Senior Smaller nonprofits and hospices in ing out of Medicare. Citizens, the Southwest Sublette Coun- rural areas such as Wyoming already Unfortunately, the Reid bill does ty Pioneers Senior Citizen Center, and operate with negative profit margins. nothing to fix these problems. Instead, from other Wyoming nursing homes Many depend on charitable fundraising it cuts one-half trillion dollars from about how the $15 billion in Medicare to keep their doors open and to enable Medicare to create a brandnew entitle- cuts to nursing home payments will them to keep treating patients. Yet the ment program for the uninsured. This devastate their ability to provide care Reid bill would further cut their Medi- approach fails to address the real prob- for seniors in Wyoming. Many of these care payments by $8 billion. This will lem facing Medicare; and that is the nursing homes are small businesses. force many hospices to close, which physician formula. Instead, it uses the They struggle to make payroll every will threaten dying seniors’ access to same gimmick that Congress has re- month and deal with an ever increasing that type of care. peatedly used to fix this problem and burden of government regulations. We The Reid bill also cuts more than $40 provides a temporary fix in 2010, which have never cut those back. They tell billion in Medicare payments to home will actually lead to steeper cuts in me how their Medicare payment rates health agencies. According to the anal- subsequent years. have already been reduced and how the ysis done by one industry association, Physicians have grown increasingly additional cuts in the bill could force this level of cuts could put nearly 70 frustrated by Congress’s repeated fail- them to close their doors. percent of all home health agencies at ure to replace the current payment for- Connie Jenkins, executive director of risk of having to close their doors. I mula. We kind of like to keep them the Star Valley Senior Center, recently want to say that again. The $40 billion hanging on a year at a time. I think it wrote to me about the important role in Medicare cuts to home health agen- is a little bit of a hostage situation, nursing homes play in rural towns in cies, according to an analysis done by but that is the way Washington works. Wyoming. She noted that ‘‘in a rural one industry association, could put It should not be that way. We should state such as ours, closure of nursing nearly 70 percent of all home health redo the formula. If we do not address homes would mean families travelling agencies at risk of having to close their this problem soon, many more physi- farther to visit [their] loved ones and doors. cians are going to decide it is not

VerDate Nov 24 2008 02:11 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00026 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.044 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S12005 worth it to continue to treat Medicare This morning, the nonpartisan Con- The nonpartisan Congressional Budg- patients. gressional Budget Office sent a letter et Office goes on to say that 14 million The Congressional Budget Office has to Senator BAYH providing a very de- people who cannot get coverage estimated that truly fixing the physi- tailed analysis of what health insur- through an employer will not get any cian payment formula could cost up- ance premiums will look like as a re- help either, but they will see a 10- to wards of $250 billion, yet the Reid bill sult of this 2,074-page bill. I have the 13-percent increase in premiums. And, does not address this problem. letter from the Congressional Budget of course, an intrusive new insurance Spiraling costs associated with med- Office right here, if anybody wants to mandate will be enforced by the IRS if ical liability lawsuits directly increase read it in detail. you do not do what has never been done Medicare costs. These costs are cal- Like many of us, Senator BAYH wants in the 225-year history of America. culated directly into payment formulas to know if the Reid bill is addressing Never has the Federal Government said for providers such as physicians. In ad- our constituents’ No. 1 priority: costs. any American had to buy anything. dition, physicians and hospitals order I think if you were to have a Saturday Now you have to buy insurance. If you billions of dollars in extra tests and morning coffee club meeting in almost do not buy it, pay the IRS more money. procedures to protect themselves from any of the small towns of America, and Some people are going to say: Well, the threat of potential lawsuits. they were discussing health care re- you have to buy car insurance. But We know that enacting commonsense form—and emphasis upon the word ‘‘re- under the tenth amendment, the State form’’—and I walked into that meet- medical liability reforms directly re- governments have any powers that are ing, and if I told them under this 2,074- duces the liability insurance premiums not prohibited by the Federal Constitu- page Reid bill that costs were not doctors pay. We have seen the results tion to them. going to be brought under control, in States such as Texas, where physi- So families who would have paid taxes were going to go up, premiums cians liability insurance premiums $13,100 under current law will actually were going to go up, and we were tak- have decreased every year since the pay more than $15,000 as a direct result ing $400 billion out of Medicare to set State-enacted reforms, with average li- of this 2,074-page bill. And people in up a new health care program, they ability rates dropping a total of 27 per- employer-based coverage will be paying would probably unanimously respond: cent. more than $20,000 a year for health in- Well, that does not sound like health The Reid bill does nothing to address surance in 2016. care reform to me. the problems of medical liability. In- The second big problem is this: stead of including reforms that would A lot of Senators are concerned about costs because that is what we are Health insurance premiums are still help reduce Medicare costs and extend hearing from the grassroots of Amer- more expensive in the Reid bill than the solvency of the program, the only ica. Everyone, from the dean of Har- they would be under current law. The thing the Reid bill does is include a vard’s Medical School to even the New government is cutting Medicare and meaningless sense-of-the-Senate reso- York Times, has said this bill does not raising taxes to offset the increases. So lution on liability reform. That will sufficiently address the rising cost of instead of addressing the underlying not pay the bills. health care. But before today, we were issue of cost, as was promised, this bill We owe it to the 43 million people still all anxiously waiting to hear what enacts policies that drive up costs by who depend on Medicare to reject the the Congressional Budget Office has close to 30 percent, and then hands arbitrary cuts in the Reid bill. We need now said about that issue of rising over close to $500 billion in hard-earned to come up with better solutions that costs. Well, today, CBO has spoken taxpayer dollars directly to health in- will not endanger their ability to see a loudly and clearly. The Reid bill not surance companies to offset the in- doctor or to get care at a hospital or a only fails to bring down costs, it will creases. nursing home. Yes, if we do not pay the actually raise costs for millions of Well, you might not believe the spin. doctors, the doctors will not take them Americans. I think that bears repeat- In fact, you better not believe the spin because in Medicaid they already will ing. The Reid bill will make health in- because the nonpartisan Congressional not take 40 percent of the patients; and surance more expensive. Families will Budget Office has confirmed it. This in Medicare it is 20 percent already. A end up paying 10 to 13 percent more as bill fails to drive down the cost of lot of people are being asked, when a result of this 2,074-page bill. health insurance premiums. It simply they call a doctor, if they are a Medi- Some proponents of the bill are try- drives up prices with a bunch of arbi- care patient. It is my contention if you ing to spin this, what they consider un- trary regulatory reforms, very cutely cannot see a doctor, you do not have fortunate news, and tell the American shifting the cost on to the American any kind of insurance at all. We do not people that taxpayer-funded subsidies people in the form of higher taxes and take care of that problem, so we do will actually offset these cost in- massive Medicare cuts. So, once again, need to come up with a better solution creases. In fact, tonight some Members don’t take my word for it. Read what that will not endanger their ability to have already been saying that this CBO the nonpartisan Congressional Budget see a doctor or to get care at a hospital analysis shows costs will come down. Office says. They have confirmed what or a nursing home or to have home But I want to make it very clear CBO we have been hearing for months: The health care. says that is not the case. Well, this Democratic leadership bill means high- I believe we can do better. If the Sen- may be true; if you take $500 billion of er costs for millions of Americans. ate passes this motion to commit, we taxpayers’ hard-earned money and give I yield the floor. can develop bipartisan reforms that it out in subsidies directly to insurance Mr. ENZI. Madam President, I sug- will eliminate the unsustainable pay- companies, sure, some people may end gest the absence of a quorum. ment cuts and address the underlying up paying less for health insurance. The PRESIDING OFFICER. The problems facing the Medicare Program. But this argument fails to recognize clerk will call the roll. I yield the floor. two big underlying problems. The legislative clerk proceeded to The PRESIDING OFFICER. The Sen- First, most Americans will not qual- call the roll. ator from Iowa. ify for any subsidies. They will end up Mr. DURBIN. Madam President, I ask Mr. GRASSLEY. Madam President, I paying higher premiums. In fact, 160 unanimous consent that the order for am not in favor of doing nothing. The million Americans who stay in em- the quorum call be rescinded. previous Democratic speaker, Senator ployer-based plans will not see any The PRESIDING OFFICER. Without CASEY, said if we do nothing, costs will help. In fact, despite all the rhetoric objection, it is so ordered. go up. I think the fact is, if you look at about how employers cannot afford the f CBO’s analysis, it says costs will go up status quo, CBO says this bill does lit- even more if this bill, this 2,074-page tle, if anything, to lower costs for em- MORNING BUSINESS bill, passes. So I want to spend some ployers. Maybe that is why the Na- Mr. DURBIN. Madam President, I ask time because there has been some ob- tional Federation of Independent Busi- unanimous consent that the Senate fuscation on what this Congressional nesses, the U.S. Chamber of Commerce, proceed to a period of morning busi- Budget Office letter to Senator BAYH and a host of other business groups, op- ness, with Senators permitted to speak means. pose this 2,074-page bill. therein for up to 10 minutes each.

VerDate Nov 24 2008 00:33 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00027 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.045 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S12006 CONGRESSIONAL RECORD — SENATE November 30, 2009 The PRESIDING OFFICER. Without the 169th FW mobilized and deployed as tled blockbusting and worked tirelessly for objection, it is so ordered. part of what became Operation IRAQI integrated neighborhoods during the 1950s and 1960s, died Thursday of pneumonia at the f FREEDOM. The Swamp Foxes flew more than 400 combat missions, per- Broadmead retirement community in ADDITIONAL STATEMENTS Cockeysville. He was 87. forming the Suppression of Enemy Air Mr. Sherman was born in Philadelphia and Defenses mission and flying numerous spent his early years there. After the death precision bombing missions over Iraq. TRIBUTE TO PAT VEZINA of his father in 1927, he was sent abroad to a However, when the 169th isn’t defend- boarding school in Lausanne, Switzerland, ∑ Mr. BEGICH. Madam President, ing freedom, they are winning awards where he lived until returning to New York today I wish to recognize a milestone and bringing home trophies. We are es- City in 1932. for my constituent Pat Vezina. On Fri- pecially proud of the 169th’s accom- After graduating from Horace Mann School day, December 4, 2009, Pat will mark plishments at the 2009 Falcon Air Meet, in New York City, Mr. Sherman attended the the 50th anniversary of her arrival in a multinational F–16 competition. The University of North Carolina at Chapel Hill. the State of Alaska. Alaska became a Swamp Foxes represented the United He dropped out of college and enlisted in the Marine Corps two days after the Japa- State in January 1959 and Pat made it States against other Nation’s fighter nese attack on Pearl Harbor. her home less than a year later, one of crews. They finished first in four of five Mr. Sherman was wounded while serving as thousands of people who have built our competition categories, earning the a master sergeant during the Guadalcanal State over the last half century. Large Force Employment Trophy, campaign and was honorably discharged at Pat was born in Wallsend, North- Scramble Launch and Intercept Com- war’s end. umberland, England, on June 4, 1931, to petition, Weapons Load Competition, He was a founder of the United Nations Clement and Constance Boothroyd. She Top Overall Maintenance Award, and Veterans League, which worked for world peace. grew up in Jesmond, Northumberland, was recognized with the Top Overall Competition Award. These are impres- After the war, Mr. Sherman and his wife, and was evacuated for a short time the former Miriam ‘‘Mimi’’ Heller, whom he during World War II before returning sive achievements that bring great married in 1943, moved to San Francisco, home to live with her parents for the credit upon the 169th. where he was a salesman for Paul Masson duration of the war. After attending On behalf of the people of the State Wines. nursing school in Leeds, England, she of South Carolina and our great coun- In 1949, Mr. Sherman moved to Baltimore emigrated to Canada and then to Alas- try, Senator GRAHAM and I want to sa- to be closer to his wife’s family. He earned ka lute the outstanding work of the 169th. his real estate license and established Mal We are amazed by their stories, and Sherman Inc. Realtors. His staff consisted of Pat worked as a registered nurse in humbled by the immense burdens they 18 men and 18 women, at a time when there the labor and delivery department at have shouldered. Their dedication, and were few women in the business. Providence Hospital, one of Alaska’s their families’ sacrifices are an inspira- ‘‘I always had an interest in houses and finest institutions. She began her Alas- tion, and our country owes them a debt land,’’ Mr. Sherman said in a 1999 interview ka nursing career at ‘‘Old Providence’’ with the Maryland Realtor. ‘‘I thought I of gratitude for their patriotic serv- could help people make a decision. I wanted hospital where hundreds of new Alas- ice.∑ kans, including me, were born. After to help families find a better quality of life. marrying and having two children of f It was a way for me to combine business and social work all in one.’’ her own, she returned to nursing at REMEMBERING MALCOM SHERMAN In the early days, Mr. Sherman confronted ‘‘New Providence’’ where she worked ∑ Ms. MIKULSKI. Madam President, I anti-Semitism and segregated neighbor- for 30 years before her retirement in wish to pay to tribute the life and leg- hoods. 1996. acy of Malcolm Sherman. ‘‘As a Jewish real estate broker, I was not Pat has an abiding love for the beau- Malcolm Sherman was part of that allowed to show property east of Falls ty of Alaska. She enjoys walking on extraordinary generation that fought Road,’’ he recalled in the interview. the beaches of Homer, buying summer for America during World War II, and In 1953, when Mr. Sherman tried to sta- bilize a neighborhood that was undergoing flowers for her garden in the green- then fought for what America stands blockbusting, he appealed to white residents houses of the Matanuska Valley, pick- for during the rest of his life. to stay. ing berries at Sheep Mountain Lodge, He joined the Marines after the Japa- They rebuffed his plea and refused to do and an afternoon with a friend at Sum- nese attack on Pearl Harbor and served business with him because of his integra- mit Lake Lodge. She is loved by her during the Guadalcanal campaign. tionist views. children Karen and John and by the When he returned home, he built a Even after the Supreme Court’s Brown v. close friends she has made over the last family with his beloved wife Mimi, and Board of Education decision in 1954 that de- he built a career in real estate. clared ‘‘separate but equal’’ unconstitu- 50 years. tional, discrimination in real estate contin- Madam President and colleagues, He truly lived his life according to the Jewish principle of ‘‘tikkun ued. please join me in honoring and recog- In 1960, Mr. Sherman decided it was time nizing Pat Vezina on the 50th anniver- olam’’—the repair of the world through to hire African-American real estate agents sary of her arrival in Alaska.∑ the pursuit of social justice. He worked and brought Lee Martin, a Morgan State for peace and civil rights throughout graduate, into his company. f his life. He also was a leader in the ef- While working for Baltimore Neighbor- RECOGNIZING THE 169TH FIGHTER fort to ending segregation and dis- hoods Inc. in the early 1960s, Mr. Sherman WING crimination in housing. Perhaps his began to push fair-housing issues and in a news conference said he would sell to anyone ∑ Mr. DEMINT. Madam President, Sen- greatest legacies are his children and grandchildren, who live by his prin- ‘‘regardless of race, creed, or color.’’ ator GRAHAM joins me today to con- When baseball great Frank Robinson came gratulate the men and women of the ciples of service. to Baltimore to play for the Orioles in 1966, 169th Fighter Wing stationed at I ask that an obituary of Mr. Sher- he instructed Mr. Sherman to find a home McEntire Joint National Guard Base, man written by Frederick Rasmussen for him and his family in a white neighbor- SC, for their outstanding service in de- of the Baltimore Sun be printed in the hood. fending our Nation and for their great RECORD. ‘‘He didn’t want to be segregated,’’ Mr. The information follows. Sherman recalled in an interview. After per- achievements at the 2009 Falcon Air There being no objection, the mate- suading the white neighbors to accept Mr. Meet. rial was ordered to be printed in the Robinson, Mr. Sherman was still attacked by It has been 8 years since the attacks RECORD, as follows: a local builder for ‘‘breaking the block.’’ President John F. Kennedy appointed him of 9/11 and the record of continuous op- [From the Baltimore Sun, Nov. 21, 2009] erations for the 169th is an inspiration to the Equal Opportunity for Housing in MALCOLM SHERMAN: FORMER ROUSE CO. EXEC- America Committee. to us all. Shortly after the attacks, UTIVE BATTLED BLOCKBUSTING IN BALTI- McEntire personnel deployed to South- Mrs. Sherman, who died in 2005, joined her MORE NEIGHBORHOODS IN THE 1950S AND husband in his quest for open housing and west Asia, directly participating in 1960S civil rights. combat operations in support of Oper- (By Frederick N. Rasmussen) ‘‘All that black people wanted was the ation ENDURING FREEDOM, pounding Malcolm ‘‘Mal’’ Sherman, a former Rouse right to buy or rent anyplace, regardless of al-Qaida and Taliban insurgents. Later, Co. executive and real estate agent who bat- race, creed or color, and once given that

VerDate Nov 24 2008 02:11 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00028 Fmt 0637 Sfmt 0634 E:\CR\FM\G30NO6.017 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S12007 right, they didn’t necessarily inundate and REMEMBERING ROYAL J. ‘‘BUD’’ of the fine work he has done and wish run to the neighborhoods that they had been WOOD him continued success in the years to barred from,’’ Mr. Sherman told The Sun in come.∑ 2001. ∑ Mr. THUNE. Madam President, today He was later joined by other local brokers I mourn the loss of Royal J. ‘‘Bud’’ f such as Russell T. Baker and Bill Wilson in Wood, of Warner SD. Bud passed away TRIBUTE TO DENNIS D’AQUILA the push for fair-housing laws that finally on November 19, 2009, at the age of 87. became a reality in 1968 when Congress Born and raised in Warner, Bud will ∑ Mr. THUNE. Madam President, today passed legislation, but his crusade took a be remembered as a man who com- I recognize Dennis D’Aquila, an intern toll on his firm. in my Washington, DC, office, for all of ‘‘Because he felt so strongly about these mitted his life to his family and com- issues, it eventually put him out of business. munity. Bud celebrated his life with the hard work he has done for me, my It was a terrible thing to have happened,’’ his wife Dorothy, his 4 children, 12 staff, and the State of South Dakota said Sandy Marenberg, president of MEI Real grandchildren, and 6 great-grand- over the past several months. Estate in Baltimore. children. His passion for his faith, fam- Dennis is a graduate of Wantagh ‘‘Mal held to his views all the way until ily, and friends was unwavering as he High School in Wantagh, NY. Cur- the end of his life. He was a real hero and spent much of his time at church and rently he is attending the Catholic mentor in the Baltimore real estate commu- University of America, where he is ma- nity,’’ Mr. Marenberg said. family activities. In 1967, Mr. Sherman was named residen- Although Bud was extremely dedi- joring in politics. He is a hard worker tial land sales director for the Rouse Co., and cated to his family, he will also be re- who has been dedicated to getting the three years later was promoted to director of membered for his service to the State most out of his internship experience. sales and land marketing in Columbia. of South Dakota. I got to know Bud I would like to extend my sincere Mr. Sherman was named Rouse Co. vice when his wife Dorothy managed Sen- thanks and appreciation to Dennis for president in 1971 with responsibilities for all ator James Abdnor’s office in Aber- all of the fine work he has done and residential land sales and helped steer Co- wish him continued success in the lumbia toward racial diversity. deen. Elected to the South Dakota When he went to work for the Rouse Co., House of Representatives in 1966, Bud years to come.∑ Mr. Sherman found a boon companion in Jim was one of the longest serving rep- f Rouse, the company founder, who shared his resentatives, working for the people of views. South Dakota for 26 years. While a TRIBUTE TO DYLAN KESSLER ‘‘We were combating a trend, and Jim was ∑ Mr. THUNE. Madam President, today frightened. He didn’t want it [Columbia] to member of the State legislature, he come out like the city,’’ Mr. Sherman re- served in many different capacities in- I recognize Dylan Thomas Kessler, an called in a 2000 interview in The Sun. ‘‘He cluding: assistant majority leader, intern in my Washington, DC, office, wanted all of the people mixed all over the speaker pro tempore, speaker of the for all of the hard work he has done for place; that was the social goal.’’ house, along with vicechairman of the me, my staff, and the State of South ‘‘He was a charismatic man always trying Legislative Research Council and Dakota over the past several months. to help someone. He discriminated against chairman of the Local Government Dylan is a graduate of Roncalli High no one,’’ said James Holechek, a retired Bal- Study Commission and Local Govern- School in Aberdeen, SD. Currently he timore public relations executive. ‘‘It was a personal testimony when he was ment Standing Committee. Bud also is attending the Hillsdale College, sought out and hired by Jim Rouse. To me, served on the Presidential Task Force where he is majoring in English. He is Mal Sherman was always Mr. Real Estate in for both President Ronald Reagan and a hard worker who has been dedicated Maryland,’’ he said. President George H.W. Bush. to getting the most out of his intern- A liberal Democrat and an anti-war activ- Beyond his political career, Bud was ship experience. ist, Mr. Sherman found himself on the Nixon a talented auctioneer at Hub City Live- I would like to extend my sincere White House’s enemies list after founding thanks and appreciation to Dylan for Businessmen Against the Vietnam War. stock Auction for 25 years. He was on That’s ‘‘great news’’ he told The Sun in the board of directors for the South all of the fine work he has done and 1973. ‘‘It’s the best thing I have to tell my Dakota Wheat Growers, the Warner El- wish him continued success in the son about myself. I feel better about this evator Board, and at one time a church years to come.∑ than any kind of honor that could come to council member at St. John’s Lutheran f me,’’ he said. Church in Warner. After leaving the Rouse Co. in the early Bud was a man who was always will- TRIBUTE TO BRITTNI PALKE 1970s, Mr. Sherman went to work for Phipps Land Co. and later Ackerman & Co., a real ing and determined to help out his ∑ Mr. THUNE. Madam President, today estate firm based in Atlanta. He returned neighbor. A mentor, confidant, and I recognize Brittni Jo Palke, an intern from Atlanta in 1981 when he was appointed friend, he selflessly impacted his com- in my Washington, DC, office, for all of Baltimore-Washington area regional vice munity in a positive way. the hard work she has done for me, my president for the firm. Today I wish to celebrate the life of staff, and the State of South Dakota Mr. Sherman continued working as a real an extraordinary public servant and over the past several months. estate consultant after leaving Ackerman. leader. As we mourn the loss of this He retired in 2001. Brittni is a graduate of MACCRAY in ‘‘He was arguably the wisest, most caring great South Dakotan, I extend my Clara City, MN. Currently she is at- adviser and thinker in the Baltimore real es- thoughts, prayers and best wishes to tending the Southeastern University, tate world,’’ said Martin L. Millspaugh Jr., Bud’s family, friends, and loved ones.∑ where she is majoring in journalism. who was the first chief executive of Charles f She is a hard worker who has been Center-Inner Harbor Management Inc. dedicated to getting the most out of ‘‘His life made a difference over many TRIBUTE TO THOMAS KURT JAROS his internship experience. years, in ways that will become even more apparent as time goes by,’’ Mr. Millspaugh ∑ Mr. THUNE. Madam President, today I would like to extend my sincere said. I recognize Thomas Kurt Jaros, an in- thanks and appreciation to Brittni for He was a former president of the Real Es- tern in my Washington, DC, office, for all of the fine work she has done and tate Board of Greater Baltimore and in 1999 all of the hard work he has done for wish her continued success in the years was awarded the Maryland Real Estate me, my staff, and the State of South to come.∑ Board Life Achievement Award. Recently, he Dakota over the past several months. was honored for his civil rights work by the f Kurt is a graduate of Downers Grove National Association of Realtors. TRIBUTE TO ALELI PARDO A former resident of the Colonnade in South High School in Downers Grove, Homewood, Mr. Sherman was a member of IL. Currently he is attending the Biola ∑ Mr. THUNE. Madam President, today the Baltimore Hebrew Congregation. University, where he is majoring in I recognize Aleli Marie Pardo, an in- Services will be held at 1 p.m. Sunday at philosophy and political science. He is tern in my Washington, DC, office, for Sol Levinson and Bros., 8900 Reisterstown a hard worker who has been dedicated all of the hard work she has done for Road, Pikesville. Surviving are two daughters, Wendy R. to getting the most out of his intern- me, my staff, and the State of South Sherman of Bethesda and Andrea Sherman of ship experience. Dakota over the past several months. Dobbs Ferry, N.Y.; and two grandchildren. I would like to extend my sincere Aleli is a graduate of Carrollton His son, Douglas Sherman, died in 1981.∑ thanks and appreciation to Kurt for all School of the Sacred Heart in Miami,

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Currently she is attending the Treasury should direct the United States Ex- S. 510 George Washington University, where ecutive Directors to the International Mone- At the request of Mr. DURBIN, the she is majoring in political science. tary Fund and the World Bank to use the names of the Senator from Iowa (Mr. voice and vote of the United States to oppose She is a hard worker who has been HARKIN) and the Senator from Wyo- making any loans to the Government of An- ming (Mr. ENZI) were added as cospon- dedicated to getting the most out of tigua and Barbuda until that Government her internship experience. cooperates with the United States and com- sors of S. 510, a bill to amend the Fed- I would like to extend my sincere pensates the victims of the Stanford Finan- eral Food, Drug, and Cosmetic Act thanks and appreciation to Aleli for all cial Group fraud; to the Committee on For- with respect to the safety of the food of the fine work she has done and wish eign Relations. supply. her continued success in the years to By Mr. VOINOVICH (for himself and S. 619 come.∑ Mr. BROWN): At the request of Mrs. FEINSTEIN, the S. Res. 363. A resolution honoring the life name of the Senator from Oregon (Mr. f and service of breast cancer advocate, WYDEN) was added as a cosponsor of S. MESSAGES FROM THE PRESIDENT Stefanie Spielman; to the Committee on the Judiciary. 619, a bill to amend the Federal Food, Messages from the President of the By Mrs. SHAHEEN (for herself and Mr. Drug, and Cosmetic Act to preserve the United States were communicated to DURBIN): effectiveness of medically important the Senate by Mrs. Neiman, one of his S. Res. 364. A resolution supporting the ob- antibiotics used in the treatment of secretaries. servance of National Diabetes Month; consid- human and animal diseases. ered and agreed to. f S. 678 f At the request of Mr. LEAHY, the EXECUTIVE MESSAGES REFERRED ADDITIONAL COSPONSORS name of the Senator from Maryland As in executive session the Presiding (Mr. CARDIN) was added as a cosponsor S. 254 Officer laid before the Senate messages of S. 678, a bill to reauthorize and im- At the request of Mrs. LINCOLN, the from the President of the United prove the Juvenile Justice and Delin- name of the Senator from Ohio (Mr. States submitting sundry nominations quency Prevention Act of 1974, and for BROWN) was added as a cosponsor of S. which were referred to the appropriate other purposes. 254, a bill to amend title XVIII of the committees. Social Security Act to provide for the S. 781 (The nominations received today are coverage of home infusion therapy At the request of Mr. ROBERTS, the printed at the end of the Senate pro- under the Medicare Program. name of the Senator from Delaware ceedings.) (Mr. CARPER) was added as a cosponsor S. 332 f of S. 781, a bill to amend the Internal At the request of Mrs. FEINSTEIN, the Revenue Code of 1986 to provide for col- INTRODUCTION OF BILLS AND name of the Senator from Georgia (Mr. legiate housing and infrastructure JOINT RESOLUTIONS CHAMBLISS) was added as a cosponsor of grants. S. 332, a bill to establish a comprehen- The following bills and joint resolu- S. 795 sive interagency response to reduce tions were introduced, read the first At the request of Mr. HATCH, the lung cancer mortality in a timely man- and second times by unanimous con- name of the Senator from New York ner. sent, and referred as indicated: (Mr. SCHUMER) was added as a cospon- By Mrs. GILLIBRAND: S. 354 sor of S. 795, a bill to amend the Social S. 2817. A bill to amend part D of title V of At the request of Mr. WEBB, the name Security Act to enhance the social se- the Elementary and Secondary Education of the Senator from Massachusetts curity of the Nation by ensuring ade- Act of 1965 to provide grants to schools for (Mr. KIRK) was added as a cosponsor of quate public-private infrastructure and the development of asthma management S. 354, a bill to provide that 4 of the 12 to resolve to prevent, detect, treat, in- plans and the purchase of asthma inhalers weeks of parental leave made available tervene in, and prosecute elder abuse, and spacers for emergency use, as necessary; to a Federal employee shall be paid to the Committee on Health, Education, neglect, and exploitation, and for other Labor, and Pensions. leave, and for other purposes. purposes. By Mr. LEMIEUX: S. 436 S. 823 S. 2818. A bill to amend the Energy Con- At the request of Mr. CORNYN, the At the request of Ms. SNOWE, the servation and Production Act to improve name of the Senator from Louisiana name of the Senator from Florida (Mr. weatherization for low-income persons, and (Mr. VITTER) was added as a cosponsor LEMIEUX) was added as a cosponsor of for other purposes; to the Committee on En- of S. 436, a bill to amend title 18, ergy and Natural Resources. S. 823, a bill to amend the Internal By Mrs. FEINSTEIN: United States Code, to protect youth Revenue Code of 1986 to allow a 5-year S. 2819. A bill to amend the Poultry Prod- from exploitation by adults using the carryback of operating losses, and for ucts Inspection Act, the Federal Meat In- Internet, and for other purposes. other purposes. spection Act, and the Federal Food, Drug, S. 456 S. 870 and Cosmetic Act to require processors of At the request of Mr. DODD, the name At the request of Mrs. LINCOLN, the food products to certify to the applicable of the Senator from Virginia (Mr. WAR- name of the Senator from New York Secretary that the processed food products are not adulterated; to the Committee on NER) was added as a cosponsor of S. 456, (Mrs. GILLIBRAND) was added as a co- Agriculture, Nutrition, and Forestry. a bill to direct the Secretary of Health sponsor of S. 870, a bill to amend the and Human Services, in consultation Internal Revenue Code of 1986 to ex- f with the Secretary of Education, to de- pand the credit for renewable elec- SUBMISSION OF CONCURRENT AND velop guidelines to be used on a vol- tricity production to include elec- SENATE RESOLUTIONS untary basis to develop plans to man- tricity produced from biomass for on- The following concurrent resolutions age the risk of food allergy and ana- site use and to modify the credit period and Senate resolutions were read, and phylaxis in schools and early childhood for certain facilities producing elec- referred (or acted upon), as indicated: education programs, to establish tricity from open-loop biomass. school-based food allergy management By Mr. BENNETT (for himself and Mr. S. 987 HATCH): grants, and for other purposes. At the request of Mr. DURBIN, the S. Res. 361. A resolution commending Real S. 461 name of the Senator from Louisiana Salt Lake for winning the 2009 Major League At the request of Mrs. LINCOLN, the (Mr. VITTER) was added as a cosponsor Soccer Cup; to the Committee on the Judici- names of the Senator from New Hamp- of S. 987, a bill to protect girls in devel- ary. shire (Mrs. SHAHEEN) and the Senator oping countries through the prevention By Mr. SHELBY (for himself, Mr. from Connecticut (Mr. DODD) were of child marriage, and for other pur- VITTER, Mr. COCHRAN, Mr. CORNYN, poses. Mrs. HUTCHISON, Mr. ISAKSON, Mrs. added as cosponsors of S. 461, a bill to SHAHEEN, and Mr. WICKER): amend the Internal Revenue Code of S. 1008 S. Res. 362. A resolution expressing the 1986 to extend and modify the railroad At the request of Mr. THUNE, his sense of the Senate that the Secretary of the track maintenance credit. name and the name of the Senator

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Illinois (Mr. BURRIS) were added as co- lectual disability. S. 1067 sponsors of S. 1756, a bill to amend the S. 2787 At the request of Mr. FEINGOLD, the Age Discrimination in Employment At the request of Ms. COLLINS, her names of the Senator from Minnesota Act of 1967 to clarify the appropriate name was added as a cosponsor of S. (Ms. KLOBUCHAR) and the Senator from standard of proof. 2787, a bill to repeal the authority of Iowa (Mr. HARKIN) were added as co- S. 1799 the Secretary of the Treasury to ex- tend the Troubled Asset Relief Pro- sponsors of S. 1067, a bill to support At the request of Mr. DODD, the stabilization and lasting peace in names of the Senator from Missouri gram. S. CON. RES. 39 northern Uganda and areas affected by (Mrs. MCCASKILL) and the Senator from the Lord’s Resistance Army through Minnesota (Mr. FRANKEN) were added At the request of Mr. MENENDEZ, the development of a regional strategy to as cosponsors of S. 1799, a bill to amend name of the Senator from New York support multilateral efforts to success- the Truth in Lending Act, to establish (Mrs. GILLIBRAND) was added as a co- fully protect civilians and eliminate fair and transparent practices related sponsor of S. Con. Res. 39, a concurrent the threat posed by the Lord’s Resist- to the marketing and provision of over- resolution expressing the sense of the ance Army and to authorize funds for draft coverage programs at depository Congress that stable and affordable humanitarian relief and reconstruc- institutions, and for other purposes. housing is an essential component of an effective strategy for the preven- tion, reconciliation, and transitional S. 1859 justice, and for other purposes. tion, treatment, and care of human im- At the request of Mr. ROCKEFELLER, munodeficiency virus, and that the S. 1217 the name of the Senator from Michigan At the request of Ms. STABENOW, the United States should make a commit- (Mr. LEVIN) was added as a cosponsor of ment to providing adequate funding for name of the Senator from Louisiana S. 1859, a bill to reinstate Federal (Ms. LANDRIEU) was added as a cospon- the development of housing as a re- matching of State spending of child sponse to the acquired immuno- sor of S. 1217, a bill to amend title XIX support incentive payments. of the Social Security Act to improve deficiency syndrome pandemic. S. 1927 and protect rehabilitative services and S. RES. 71 At the request of Mr. DODD, the name case management services provided At the request of Mr. WYDEN, the of the Senator from California (Mrs. under Medicaid to improve the health name of the Senator from Michigan FEINSTEIN) was added as a cosponsor of and welfare of the nation’s most vul- (Mr. LEVIN) was added as a cosponsor of S. 1927, a bill to establish a morato- nerable seniors and children. S. Res. 71, a resolution condemning the rium on credit card interest rate in- Government of Iran for its state-spon- S. 1317 creases, and for other purposes. At the request of Mr. LAUTENBERG, sored persecution of the Baha’i minor- S. 2097 the names of the Senator from Con- ity in Iran and its continued violation At the request of Mr. THUNE, the necticut (Mr. LIEBERMAN), the Senator of the International Covenants on name of the Senator from Wyoming from Michigan (Mr. LEVIN), the Sen- Human Rights. ator from Rhode Island (Mr. (Mr. BARRASSO) was added as a cospon- S. RES. 337 sor of S. 2097, a bill to authorize the re- WHITEHOUSE) and the Senator from At the request of Mr. BYRD, the dedication of the District of Columbia New York (Mrs. GILLIBRAND) were names of the Senator from Washington added as cosponsors of S. 1317, a bill to War Memorial as a National and Dis- (Mrs. MURRAY), the Senator from Penn- increase public safety by permitting trict of Columbia World War I Memo- sylvania (Mr. SPECTER), the Senator the Attorney General to deny the rial to honor the sacrifices made by from Wyoming (Mr. BARRASSO), the transfer of firearms or the issuance of American veterans of World War I. Senator from Ohio (Mr. BROWN), the firearms and explosives licenses to S. 2740 Senator from Montana (Mr. BAUCUS) known or suspected dangerous terror- At the request of Mrs. MURRAY, the and the Senator from Montana (Mr. ists. name of the Senator from Alaska (Mr. TESTER) were added as cosponsors of S. Res. 337, a resolution designating De- S. 1353 BEGICH) was added as a cosponsor of S. cember 6, 2009, as ‘‘National Miners At the request of Mr. LEAHY, the 2740, a bill to establish a comprehen- name of the Senator from New Jersey sive literacy program. Day’’. (Mr. MENENDEZ) was added as a cospon- S. 2757 f sor of S. 1353, a bill to amend title 1 of At the request of Mr. MENENDEZ, the STATEMENTS ON INTRODUCED the Omnibus Crime Control and Safe name of the Senator from Hawaii (Mr. BILLS AND JOINT RESOLUTIONS Streets Act of 1986 to include nonprofit AKAKA) was added as a cosponsor of S. 2757, a bill to authorize the adjustment By Mrs. FEINSTEIN: and volunteer ground and air ambu- S. 2819. A bill to amend the Poultry of status for immediate family mem- lance crew members and first respond- Products Inspection Act, the Federal bers of persons who served honorably ers for certain benefits. Meat Inspection Act, and the Federal in the Armed Forces of the United S. 1458 Food, Drug, and Cosmetic Act to re- States during the Afghanistan and Iraq At the request of Ms. LANDRIEU, the quire processors of food products to conflicts and for other purposes. name of the Senator from South Da- certify to the applicable Secretary that kota (Mr. JOHNSON) was added as a co- S. 2779 the processed food products are not sponsor of S. 1458, a bill to encourage At the request of Ms. KLOBUCHAR, the adulterated; to the Committee on Agri- the development and implementation name of the Senator from Wisconsin culture, Nutrition, and Forestry. of a comprehensive, global strategy for (Mr. FEINGOLD) was added as a cospon- Mrs. FEINSTEIN. Mr. President, I the preservation and reunification of sor of S. 2779, a bill to promote Depart- rise today to introduce the Processed families and the provision of perma- ment of the Interior efforts to provide Food Safety Act. When enacted, this nent parental care for orphans. a scientific basis for the management bill will make one very important prin- S. 1535 of sediment and nutrient loss in the ciple clear: It is the producer’s respon- At the request of Mrs. FEINSTEIN, the Upper Mississippi River Basin, and for sibility to produce safe food, it is not name of the Senator from New Jersey other purposes. the consumer’s responsibility to make (Mr. LAUTENBERG) was added as a co- S. 2781 their food safe. sponsor of S. 1535, a bill to amend the At the request of Ms. MIKULSKI, the This legislation gives food producers Fish and Wildlife Act of 1956 to estab- name of the Senator from Louisiana and anyone else who modifies our food

VerDate Nov 24 2008 00:54 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00031 Fmt 0637 Sfmt 0634 E:\CR\FM\A30NO6.009 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S12010 CONGRESSIONAL RECORD — SENATE November 30, 2009 two options: they can take an addi- cause both of these seemingly unre- When asked if a sample of their prod- tional ‘‘kill-step’’ to eliminate all lated products have been the subject of uct that was cooked above and beyond verifiable traces of pathogens within two recent expose´s in the New York their recommendations was safe to eat each ingredient they have added to the Times. even though it did not reach the rec- product, or they can certify to the Sec- On October 4, 2009, writer Michael ommended temperature, the company retary of Agriculture that each of the Moss highlighted the disturbing reali- conceded that it was not safe for ingredients used to make our food con- ties in the ground beef industry, at human consumption. tains no verifiable traces of pathogens. each step in the process. He found Other frozen food products from Nes- One would think that this is common slaughterhouses don’t take time to tle, Swanson, and Hungry-Man were sense. Wouldn’t any company pro- properly remove intestines and fecal also tested to see if their cooking di- ducing or modifying our food take the matter which then contaminate meat rections were clear, simple, and ade- time, and the care, to make sure that with E. coli. These slaughterhouses quate. Not surprisingly, the New York their product was safe for us to eat? then sell to grinders who agree not to Times found that their tests on these Unfortunately not. Today, more than test their product for contaminants. products yielded similar results. 100 years after the publishing of Upton Meat grinders purchase scraps from a Increasingly, food producers are Sinclair’s ‘‘The Jungle,’’ much of our variety of slaughterhouses across the using consumer cooking instructions food is still produced by companies country and across the globe. They as a method to deflect responsibility that put their profits over the health of then combine their scraps in a way for the safety of their product. These their customers. that makes it virtually impossible to companies effectively said that it was On any given week I can open up the trace back their ingredients for public up to the consumer to kill potentially newspaper and find another heart- health purposes. Federal agencies offer deadly doses of E. coli and Salmonella breaking story about the serious regulations and guidance, but they fail in their frozen meals. health effects of food-borne illnesses to compel the industry to comply with Under current law, food producers from tainted products. Anyone who vis- their safety standards. are allowed to get away with this. That its the Web sites of the USDA or the Each individual oversight is a prob- is why I am introducing the Processed FDA can see that recalls are not a rare lem, but together, they represent a Food Safety Act. occurrence. clear, systematic failure of the overall The bill will dean up the food indus- In the last month the USDA has re- food safety system. try by: amending the Poultry Products called: Roast beef in Iowa due to the This story makes it abundantly clear Inspection Act, the Federal Meat In- presence of undeclared allergens; that the companies producing our spection Act and the Federal Food, canned soup in Pennsylvania due to the ground beef spend more time worrying Drug and Cosmetic Act to prohibit the undeclared presence of egg in the prod- about how to avoid testing for patho- sale of any processed poultry, meat or uct; beef tongues in Nebraska and Wis- gens than they spend trying to make FDA-regulated food that has not un- consin because of improperly removed their products safe. dergone a pathogen reduction treat- tonsils, which, when consumed, in- The New York Times ran another ment or been certified to be virtually crease the risk of contracting Mad Cow story on May 15 that highlights serious pathogen free; doing away with loop- Disease; and hundreds of thousands of concerns about frozen chicken pot pies. holes in current laws that allow for pounds of ground beef in California, The newspaper discovered that producers to add coloring, synthetic New York, and Massachusetts due to ConAgra, a frozen food giant which flavorings and spices to their products the presence of E. coli 0157—the dead- produced and sold over 100 million pot without informing the consumer; and liest strain of this common pathogen. pies last year, decided to make con- banning the sale of food that has not The FDA this month has recalled: sumers responsible for killing patho- undergone these rigorous inspections Dove ice cream bars in 19 States in- gens in their products instead of taking and safety procedures. cluding California for the undeclared the responsibility themselves. The Processed Food Safety Enhance- presence of peanuts, a potentially dead- As consumers, we expect that pro- ment Act will force companies to ly allergen; Jelly Belly Jelly Beans ducers of these frozen meals have prop- produce safe foods. And, it will let con- were also recalled due to the presence erly cleaned and washed their ingredi- sumers know that their health is more of peanuts and peanut butter in their ents before repackaging them for sale. important than the financial interests product; apple and carrot pouches in We expect that these frozen entrees are of the food industry. California that may contain a spore ready for consumption—just ‘‘heat and Some may argue that this bill will be that can lead to botulism; vegetarian eat,’’ the popular advertising motto too expensive, because the inspections spring rolls in Maine, which were found tells us. and tests required by this bill may to have meat products. The However, as this story points out, raise the cost of food. I believe that uninspected meat could have contained companies have actually tried to shift these concerns are short-sighted. any number of food-borne pathogens; this burden to the consumer by requir- The Centers for Disease Control and pre-made sandwiches in North Carolina ing very specific, often burdensome Prevention estimate that food-borne due to concerns about the presence of cooking instructions which require the illnesses sicken up to 76 million people, Listeria. These bacteria can cause seri- use of a meat thermometer to test the cause 325,000 hospital visits, and cause ous illness, pregnancy complications temperature of a product in several dif- more than 5,000 deaths each year. The and even death; salted herring in New ferent places. CDC estimates that these illnesses an- York because of the possible presence What is even more shocking is that nually cost American taxpayers up to of the spore that can lead to botulism; the authors found that it was virtually $6 billion. and dried plums in Texas, found to con- impossible to meet the cooking speci- By another metric, the USDA food- tain traces of lead. fications put on the box by ConAgra. borne illness cost calculator estimates Simply put, the state of our food sup- On the outside of the box, the cook- that Salmonella cost the United States ply is alarming. And without serious ing instructions state that the product $2.6 billion in 2008, and E. coli 0157 cost reform and leadership from this Con- must reach 160 degrees in several $478 million. gress, things will not get any better. places as tested by a meat thermom- By implementing more rigorous safe- That is why today I am introducing the eter, before the product is safe to eat. ty standards for our food, the Proc- Processed Food Safety Act. However the New York Times found essed Food Safety Act may actually re- As I said, this bill will require com- that even after using a higher power sult in a substantial cost savings to the panies that process any kind of food, microwave than recommended by average American consumer. from ground beef to frozen pot pies, to ConAgra, and cooking the product for But that misses the point. This bill, test their finished products and their an additional 1 minute and 30 seconds, and this problem cannot be measured ingredients to make sure that they are 30 percent longer than recommended, in dollars and cents. Food-borne ill- safe to eat and pathogen free. parts of the pot pie did not reach the nesses kill up to 5,000 people every I mentioned ground beef and frozen temperature recommended by ConAgra year. In this day and age, this is simply pot pies, two very different items, be- to kill pathogens within their product. unacceptable. We cannot let this go on.

VerDate Nov 24 2008 00:54 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00032 Fmt 0637 Sfmt 0634 E:\CR\FM\A30NO6.015 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S12011 Food producers must be held respon- try product that was added, modified, or oth- (c) PHASE-IN PERIOD.—Paragraph (5) of sec- sible for the safety of their products. In erwise handled by the person contains no tion 10 of the Federal Meat Inspection Act the early 1900s Congress acted force- verifiable traces of pathogens.’’. (as added by subsection (b)(5)) shall not (c) PHASE-IN PERIOD.—Paragraph (6) of sec- fully to prohibit the most egregious apply until the date that is 18 months after tion 9 of the Poultry Products Inspection the date of enactment of this Act. violations in food production. Today, Act (as added by subsection (b)(2)) shall not SEC. 4. FOOD SAFETY. 104 years after ‘‘The Jungle’’ was pub- apply until the date that is 18 months after (a) PATHOGEN REDUCTION TREATMENT.— the date of enactment of this Act. lished, it is time for Congress to again Chapter IV of the Federal Food, Drug, and take up this important fight. SEC. 3. MEAT SAFETY. Cosmetic Act (21 U.S.C. 351 et seq.) is amend- The Processed Food Safety Act puts (a) DEFINITION OF MISBRANDED.—Section ed by adding at the end the following: the responsibility for food safety back 1(n) of the Federal Meat Inspection Act (21 U.S.C. 601(n)) is amended— ‘‘SEC. 418. PATHOGEN REDUCTION TREATMENT. where it belongs. This legislation pro- (1) in paragraph (5)— ‘‘(a) IN GENERAL.—The Secretary shall pro- tects consumers and keeps our food (A) by inserting ‘‘(A)’’ after ‘‘(5)’’; mulgate regulations requiring each facility safe. (B) by striking ‘‘showing (A) the name’’ registered under section 415 to apply patho- I am proud to introduce this legisla- and inserting the following: ‘‘showing— gen reduction treatments to each food, as tion, and I urge my colleagues to sup- ‘‘(i) the name’’; the Secretary determines appropriate, that port this important, commonsense bill. (C) by striking ‘‘distributor; and (B) an ac- such facility manufactures, processes, pack- Mr. President, I ask unanimous con- curate’’ and inserting the following: ‘‘dis- ages, or holds for consumption in the United States. sent that the text of the bill be printed tributor; ‘‘(ii) subject to subparagraph (B), an accu- ‘‘(b) CERTIFICATION.—The Secretary shall in the RECORD. rate’’; and promulgate regulations requiring each facil- There being no objection, the text of (D) by striking ‘‘count: Provided, That ity described in subsection (a) to certify to the bill was ordered to be printed in under clause (B) of this subparagraph (5), the Secretary that— the RECORD, as follows: reasonable’’ and inserting the following: ‘‘(1) each food manufactured, processed, S. 2819 ‘‘count; and packaged, or held (including each ingredient of such food that is added, modified, or oth- Be it enacted by the Senate and House of Rep- ‘‘(iii) an accurate description of each cut of erwise handled) by such facility contains no resentatives of the United States of America in meat or meat food product contained in the verifiable traces of pathogens; or Congress assembled, package or other container; and ‘‘(B) except that under subparagraph ‘‘(2) each food leaving such facility has re- SECTION 1. SHORT TITLE. (A)(ii), reasonable’’; ceived pathogen reduction treatments, as re- This Act may be cited as the ‘‘Processed (2) in paragraph (7)(B), by striking ‘‘(other quired by the regulations promulgated under Food Safety Act of 2009’’. than spices, flavoring, and coloring)’’; and such subsection.’’. SEC. 2. POULTRY SAFETY. (3) in paragraph (9)(B), by striking ‘‘; ex- (b) PHASE-IN PERIOD.—The requirements (a) DEFINITION OF MISBRANDED.—Section cept that spices, flavorings, and colorings under section 418(b) of the Federal Food, 4(h) of the Poultry Products Inspection Act may, when authorized by the Secretary, be Drug, and Cosmetic Act (as added by sub- (21 U.S.C. 453(h)) is amended— designated as spices, flavorings, and color- section (a)) shall not apply until the date (1) in paragraph (5)— ings without naming each’’. that is 18 months after the date of enact- (A) by inserting ‘‘(A)’’ after ‘‘(5)’’; (b) PROHIBITED ACTS.—Section 10 of the ment of this Act. (B) by striking ‘‘showing (A) the name’’ Federal Meat Inspection Act (21 U.S.C. 610) is (c) TECHNICAL AMENDMENT.—Section 402 of and inserting the following: ‘‘showing— amended— the Federal Food, Drug, and Cosmetic Act ‘‘(i) the name’’; (1) by striking ‘‘SEC. 10. No person’’ and in- (21 U.S.C. 342) is amended by adding at the (C) by striking ‘‘distributor; and (B) an ac- serting the following: end the following: curate’’ and inserting the following: ‘‘dis- ‘‘SEC. 10. PROHIBITED ACTS. ‘‘(j) If the facility has not provided a cer- tributor; ‘‘No person’’; tification required under section 418.’’. ‘‘(ii) subject to subparagraph (B), an accu- (2) in subsection (c)— (d) LABELING WITH RESPECT TO SPICES, rate’’; and (A) by striking ‘‘in commerce (1) any’’ and FLAVORING, AND COLORING.—Section 403 of (D) by striking ‘‘count: Provided, That inserting the following: ‘‘in commerce— the Federal Food, Drug, and Cosmetic Act under clause (B) of this subparagraph (5), ‘‘(A) any’’; (21 U.S.C. 343) is amended— reasonable’’ and inserting the following: (B) by striking ‘‘which (A) are capable of (1) in paragraph (g), by striking ‘‘(other ‘‘count; and use as human food and (B) are’’ and inserting than spices,’’ and inserting ‘‘(including ‘‘(iii) an accurate description of each cut of the following: ‘‘that— spices,’’; poultry or poultry product contained in the ‘‘(i) are capable of use as human food; and (2) in paragraph (i), by striking ‘‘; except package or other container; and ‘‘(ii) are’’; and that spices, flavorings, and colors not re- ‘‘(B) except that under subparagraph (C) by striking ‘‘(2) any’’ and inserting the quired to be certified under section 721(c) un- (A)(ii), reasonable’’; following: less sold as spices, flavorings, or such colors, (2) in paragraph (7)(B), by striking ‘‘(other ‘‘(B) any’’; may be designated as spices, flavorings, and than spices, flavoring, and coloring)’’; and (3) by redesignating subsections (a) colorings without naming each’’; (3) in paragraph (9)(B), by striking ‘‘; ex- through (d) as paragraphs (1) through (4), re- (3) in paragraph (k), by striking ‘‘The pro- cept that spices, flavorings, and colorings spectively, and indenting appropriately; visions of this paragraph and paragraphs (g) may, when authorized by the Secretary, be (4) in paragraph (4) (as so redesignated), by and (i) with respect to artificial coloring designated as spices, flavorings, and color- striking the period at the end and inserting shall not apply in the case of butter, cheese, ings without naming each’’. ‘‘; or’’; and or ice cream.’’; and (b) PROHIBITED ACTS.—Section 9 of the (5) by adding at the end the following: (4) in paragraph (x), by striking ‘‘Notwith- Poultry Products Inspection Act (21 U.S.C. ‘‘(5) sell, transport, offer for sale or trans- standing subsection (g), (i), or (k), or any 458) is amended— portation, or receive for transportation, in other law, a’’ and inserting ‘‘A’’. (1) in paragraph (5), by striking the period commerce, any meat or meat food product at the end and adding ‘‘or’’; and that is capable of use as human food, unless f (2) by adding at the end the following: the person, firm, or corporation (including SUBMITTED RESOLUTIONS ‘‘(6) sell, transport, offer for sale or trans- any slaughterer, meat broker, renderer, portation, or receive for transportation, in processor, reprocessor, retail food store, or commerce, any poultry or poultry product official establishment) affirmatively cer- SENATE RESOLUTION 361—COM- that is capable of use as human food, unless tifies to the Secretary that— MENDING REAL SALT LAKE FOR the person (including any slaughterer, poul- ‘‘(A) each ingredient in the meat or meat WINNING THE 2009 MAJOR try products broker, renderer, processor, re- food product that was added, modified, or processor, retail food store, or official estab- otherwise handled by the person, firm, or LEAGUE SOCCER CUP lishment) affirmatively certifies to the Sec- corporation has undergone a pathogen reduc- Mr. BENNETT (for himself and Mr. retary that— tion treatment in accordance with require- HATCH) submitted the following resolu- ‘‘(A) each ingredient in the poultry or ments of the Secretary that will reduce the tion; which was referred to the Com- poultry product that was added, modified, or presence of pathogens of public health con- mittee on the Judiciary: otherwise handled by the person has under- cern and other harmful food borne contami- gone a pathogen reduction treatment in ac- nants; or S. RES. 361 cordance with requirements of the Secretary ‘‘(B) the person, firm, or corporation has Whereas on November 22, 2009, Real Salt that will reduce the presence of pathogens of tested and certified that each ingredient in Lake (RSL) won the Major League Soccer public health concern and other harmful food the meat or meat food product that was Cup in front of 46,011 fans in Seattle, Wash- borne contaminants; or added, modified, or otherwise handled by the ington; ‘‘(B) the person has tested and certified person, firm, or corporation contains no Whereas RSL overcame substantial obsta- that each ingredient in the poultry or poul- verifiable traces of pathogens.’’. cles to outplay and outlast the formidable

VerDate Nov 24 2008 02:34 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00033 Fmt 0637 Sfmt 0634 E:\CR\FM\A30NO6.017 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S12012 CONGRESSIONAL RECORD — SENATE November 30, 2009 Los Angeles Galaxy in the championship Mrs. HUTCHISON, Mr. ISAKSON, Mrs. pointed receiver in investigating the Stan- game; SHAHEEN, and Mr. WICKER) submitted ford Financial Group fraud and marshaling Whereas RSL began the second half trail- the following resolution; which was re- the assets of Mr. Stanford and Stanford-af- ing the Galaxy by a score of 1-0 and were also ferred to the Committee on Foreign filiated entities; without starter Will Johnson and key play- Relations: (2) an agreement by the Government of An- maker Javier Morales; tigua and Barbuda to be subject to the juris- Whereas Robbie Findley scored for RSL in S. RES. 362 diction and bound by the judgment of any the 64th minute to tie the game at 1-1; Whereas thousands of investors, many of United States court or international court Whereas RSL won by a score of 5-4 in the them in the United States, lost billions of that is adjudicating the claims of victims of seventh round of penalty kicks on a shot by dollars that they invested in fraudulent the Stanford Financial Group fraud; Robbie Russell; Stanford International Bank certificates of (3) the transfer of the assets seized by the Whereas RSL goalkeeper Nick Rimando deposit; Government of Antigua and Barbuda and the made more saves than any other goalkeeper Whereas Allen Stanford had close ties with liquidators in Antigua and Barbuda to the in the 2009 Major League Soccer (MLS) play- the Government of Antigua and Barbuda United States court-appointed receiver for offs, as he stopped 2 penalty kicks during the and, among other things, Mr. Stanford is al- the benefit of victims of the Stanford Finan- final shootout and was named the MLS Cup leged to have loaned at least $85,000,000 to cial Group fraud; Most Valuable Player; the Government of Antigua and Barbuda, (4) a contribution by the Government of Whereas RSL head coach Jason Kreis, at which likely came from investor funds; Antigua and Barbuda to the United States age 36, became the youngest manager to win Whereas the relationship of the Stanford receivership estate, for the benefit of victims a MLS title; Financial Group with the Government of An- of the Stanford Financial Group fraud, in an Whereas the MLS Cup victory capped off tigua and Barbuda was described in a joint amount equal to the amount of any funds an improbable season for RSL, as the team statement by the Stanford Financial Group provided to Antigua and Barbuda by Mr. accumulated an 11-12-7 record during the reg- and the Cabinet of Antigua and Barbuda as a Stanford or any Stanford-affiliated entity; ular season but went on to become the first ‘‘productive and mutually beneficial rela- and franchise in professional sports history to tionship’’; (5) a contribution by the Government of win a championship after finishing the reg- Whereas the United States Securities and Antigua and Barbuda to the United States ular season without a winning record; Exchange Commission alleged that Leroy receivership estate, for the benefit of victims Whereas the victory in the championship King, the chief executive officer of the Fi- of the Stanford Financial Group fraud, in an game was the second straight shootout win nancial Services Regulatory Commission of amount equal to any payments made by Mr. for RSL, after beating the Chicago Fire in Antigua and Barbuda, was bribed by Mr. Stanford or the Stanford Financial Group to the Eastern Conference Championship by a Stanford not to investigate the Stanford officials of the Government of Antigua and score of 5-4 on penalties; International Bank, to provide Mr. Stanford Barbuda for the purpose of subverting regu- Whereas RSL defeated the defending MLS with access to the Financial Services Regu- latory oversight of the Stanford Inter- champion Columbus Crew in the Eastern latory Commission’s confidential files, to national Bank. Conference Semifinals, winning 4-2 on aggre- allow Mr. Stanford to dictate the Financial gate; Services Regulatory Commission’s responses f Whereas Salt Lake City, Utah, has been to inquiries by the Securities and Exchange home to RSL since the team’s founding in Commission about the Stanford Inter- SENATE RESOLUTION 363—HON- 2005; national Bank, and to withhold information ORING THE LIFE AND SERVICE Whereas the people of the State of Utah from the Securities and Exchange Commis- OF BREAST CANCER ADVOCATE, have provided stalwart support for RSL and sion; STEFANIE SPIELMAN Whereas, after the fraud allegedly per- deserve to celebrate this championship, Mr. VOINOVICH (for himself and Mr. which is the first professional sports crown petrated by the Stanford Financial Group in the State of Utah since 1971; and was made public, the Government of Antigua BROWN) submitted the following resolu- Whereas the players of RSL are good role and Barbuda seized Stanford property in An- tion; which was referred to the Com- models to young athletes for their hard tigua and Barbuda worth up to several hun- mittee on the Judiciary: dred million dollars; work, tenacity, and determination in the S. RES. 363 face of difficult obstacles, and have served as Whereas, in an October 28, 2009 report, the United States court-appointed receiver, Whereas Stefanie Spielman, a tremendous outstanding representatives for the State of advocate and a true champion for the cause Utah both on and off the field: Now, there- Ralph Janvey, reported that ‘‘the total of all cash collected is $128.8 million, of which $71.5 of breast cancer research, passed away on fore, be it November 19, 2009, after a decade-long battle Resolved, That the Senate— million remains on hand after payment of with breast cancer; (1) congratulates Real Salt Lake for win- expenses’’, which falls far short of investor Whereas despite her constant battle with ning the 2009 Major League Soccer Cup; losses; her own illness, Stefanie showed grace and (2) recognizes the achievements of the Whereas Janvey’s report also noted that compassion for others, touching countless players, coaches, and staff whose hard work ‘‘the Antiguan liquidators object to every at- lives in Ohio and beyond; and dedication helped Real Salt Lake win tempt to secure and liquidate assets, world- Whereas Stefanie tirelessly advocated for the championship; and wide’’, and ‘‘[t]he government of Antigua re- additional research into the prevention and (3) respectfully directs the Secretary of the fuses to recognize US orders even as to enti- treatment of breast cancer, and along with Senate to transmit an enrolled copy of this ties for which there is no other owner i.e. the her husband, Chris, founded the Stefanie resolution to Real Salt Lake for appropriate Antiguan liquidators were only appointed to Spielman Fund for Breast Cancer Research display, as well as owner Dave Checketts and liquidate two of the more than 150 Stanford at the Ohio State University Comprehensive head coach Jason Kreis. entities, but we are hindered by Antigua’s refusal to recognize the Court’s orders even Cancer Center—James Cancer Hospital and f as to non-disputed entities’’; and Solove Research Institute shortly after her SENATE RESOLUTION 362—EX- Whereas the Government of Antigua and diagnosis; PRESSING THE SENSE OF THE Barbuda is seeking loans from the Inter- Whereas Stefanie and Chris later estab- national Monetary Fund and the World lished the Stefanie Spielman Fund for Pa- SENATE THAT THE SECRETARY tient Assistance, which to date has gen- OF THE TREASURY SHOULD DI- Bank: Now, therefore, be it Resolved, That it is the sense of the Senate erated more than $6,500,000 to help translate RECT THE UNITED STATES EX- that the Secretary of the Treasury should di- laboratory discoveries into effective treat- ECUTIVE DIRECTORS TO THE rect the United States Executive Directors ments for breast cancer patients; INTERNATIONAL MONETARY to the International Monetary Fund and Whereas Stefanie served as an active and FUND AND THE WORLD BANK TO World Bank to use the voice and vote of the vital member of the James Cancer Hospital USE THE VOICE AND VOTE OF United States to ensure that any loan made and Solove Research Institute Foundation THE UNITED STATES TO OPPOSE by the International Monetary Fund or the Board; World Bank to the Government of Antigua Whereas Stefanie was actively engaged in MAKING ANY LOANS TO THE and Barbuda is conditioned on providing advocacy issues, including Ohio Mammog- GOVERNMENT OF ANTIGUA AND complete redress to the victims of the Stan- raphy Day, which received the strong sup- BARBUDA UNTIL THAT GOVERN- ford Financial Group fraud, including port of former Ohio First Lady Janet MENT COOPERATES WITH THE through— Voinovich and was designated by the Ohio UNITED STATES AND COM- (1) the full cooperation of the Government General Assembly as the third Thursday in PENSATES THE VICTIMS OF THE of Antigua and Barbuda and the liquidators October; STANFORD FINANCIAL GROUP appointed for the liquidation proceeding re- Whereas in 2000, Stefanie and Chris estab- FRAUD lating to the Stanford International Bank in lished ‘‘Stefanie’s Champions’’ to honor one Antigua and Barbuda with the Securities and of the most important factors in cancer Mr. SHELBY (for himself, Mr. Exchange Commission, the Department of treatment—the loving and healing presence VITTER, Mr. COCHRAN, Mr. CORNYN, Justice, and the United States court-ap- of a devoted caregiver;

VerDate Nov 24 2008 02:11 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00034 Fmt 0637 Sfmt 0634 E:\CR\FM\A30NO6.013 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S12013 Whereas Stefanie gave the first Champion aging people in the United States to fight di- (B) in clause (iv), by striking the period at award to her beloved husband after Chris put abetes through raising public awareness the end and inserting ‘‘; and’’ and his professional football career on hold to about stopping diabetes and increasing edu- (C) by adding at the end the following: care for her when she was first treated; and cation about the disease; ‘‘(v) with respect to fiscal years beginning Whereas Stefanie was a loving mother to (2) recognizes the importance of early de- with fiscal year 2014, may not deny eligi- her 4 children: Now, therefore, be it tection, awareness of the symptoms of diabe- bility or enrollment, because of excess fam- Resolved, That the Senate— tes, and the risk factors for diabetes, which ily income, to any child whose family in- (1) acknowledges the outstanding achieve- include— come is at or below the percentage of pov- ments and profound impact of Stefanie (A) being over the age of 45; erty level specified in section 2110(b)(1)(B), Spielman in the fight against breast cancer; (B) coming from certain ethnic back- determined using the methodology described (2) commends Stefanie for her commitment grounds; in such section.’’. to caring for others suffering from breast (C) being overweight; (b) MAINTENANCE OF EFFORT.—Section cancer; and (D) having a low physical activity level; 2105(d) of the Social Security Act (42 U.S.C. (3) celebrates her life as a wife, mother, (E) having high blood pressure; and 1397ee(d)) is amended by adding at the end and advocate for breast cancer awareness, re- (F) a family history of diabetes or a his- the following: search, and treatment. tory of diabetes during pregnancy; and ‘‘(3) CONTINUATION OF ELIGIBILITY STAND- f (3) supports decreasing the prevalence of ARDS FOR CHILDREN.— diabetes, developing better treatments, and ‘‘(A) FISCAL YEARS BEFORE FISCAL YEAR SENATE RESOLUTION 364—SUP- working toward an eventual cure in the 2014.—During the period that begins on the PORTING THE OBSERVANCE OF United States through increased research, date of enactment of the Patient Protection NATIONAL DIABETES MONTH treatment, and prevention. and Affordable Care Act and ends on Sep- tember 30, 2013, a State shall not have in ef- Mrs. SHAHEEN (for herself and Mr. f fect eligibility standards, methodologies, or DURBIN) submitted the following reso- AMENDMENTS SUBMITTED AND procedures under its State child health plan lution; which was considered and PROPOSED (including any waiver under such plan) for agreed to: children (including children provided med- S. RES. 364 SA 2790. Mr. CASEY submitted an amend- ical assistance for which payment is made ment intended to be proposed to amendment Whereas there are nearly 24,000,000 people under section 2105(a)(1)(A)) that are more re- SA 2786 proposed by Mr. REID (for himself, in the United States with diabetes and strictive than the eligibility standards, Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to 57,000,000 with pre-diabetes; methodologies, or procedures, respectively, the bill H.R. 3590, to amend the Internal Rev- under such plan (or waiver) as in effect on Whereas diabetes contributed to the deaths enue Code of 1986 to modify the first-time of over 300,000 people in the United States in October 1, 2009. homebuyers credit in the case of members of ‘‘(B) FISCAL YEAR 2014 AND THEREAFTER.— 2007, making diabetes the seventh leading the Armed Forces and certain other Federal cause of death; ‘‘(i) IN GENERAL.—Subject to clause (ii), employees, and for other purposes; which with respect to fiscal years beginning with Whereas every minute, 3 people are diag- was ordered to lie on the table. nosed with diabetes; fiscal year 2014 a State shall not have in ef- SA 2791. Ms. MIKULSKI (for herself, Mr. fect eligibility standards, methodologies, or Whereas each day approximately 4,384 peo- HARKIN, Mrs. BOXER, and Mr. FRANKEN) pro- ple are diagnosed with diabetes and, in 2007, procedures under its State child health plan posed an amendment to amendment SA 2786 (including any waiver under such plan) for approximately 1,600,000 new cases of diabetes proposed by Mr. REID (for himself, Mr. BAU- were diagnosed in people 20 years or older; children that are more restrictive than the CUS, Mr. DODD, and Mr. HARKIN) to the bill eligibility methodologies or procedures, re- Whereas between 1990 and 2001, diabetes H.R. 3590, supra. prevalence in the United States increased by spectively, under such plan (or waiver) as in more than 60 percent; f effect on October 1, 2009. Whereas over 24 percent of diabetes is TEXT OF AMENDMENTS ‘‘(ii) EXCEPTION.—A State that, prior to fis- undiagnosed, down from 30 percent in 2005, cal year 2014, has an income eligibility and 50 percent 10 years ago; SA 2790. Mr. CASEY submitted an standard, methodology, or procedure under Whereas over 10 percent of adults and near- amendment intended to be proposed to its State child health plan (including any ly 1⁄4 (23.1 percent) of people in the United amendment SA 2786 proposed by Mr. waiver under such plan) for children that re- States age 60 and older have diabetes; REID (for himself, Mr. BAUCUS, Mr. sults in children whose family’s modified Whereas diabetes is a serious chronic con- DODD, and Mr. HARKIN) to the bill H.R. gross income (as determined for purposes of dition that affects people of every age, race, 3590, to amend the Internal Revenue allowing a premium credit assistance income level, and ethnicity; Code of 1986 to modify the first-time amount for the purchase of a qualified health plan under section 36B of the Internal Rev- Whereas Hispanic, African, Asian, and Na- homebuyers credit in the case of mem- tive Americans are disproportionately af- enue Code of 1986) exceeds 250 percent of the fected by diabetes and suffer at rates much bers of the Armed Forces and certain poverty line may modify such standard, higher than the general population; other Federal employees, and for other methodology, or procedure so that it will not Whereas annually, 15,000 youth in the purposes; which was ordered to lie on result in eligibility for children under the United States are diagnosed with type 1 dia- the table; as follows: State plan in whose family modified gross betes and approximately 3,700 youth are di- Beginning on page 436, strike line 18 and income exceeds that percentage of the pov- agnosed with type 2 diabetes; all that follows through page 439, line 20, and erty line. Whereas 1 in 3 people in the United States insert the following: ‘‘(C) RULE OF CONSTRUCTION.—Subpara- born in the year 2000 will develop diabetes in SEC. 2101. PROTECTING LOW-INCOME CHILDREN graphs (A) and (B) shall not be construed as their lifetime, and this statistic grows to FROM HARM AND ENSURING THAT preventing a State from applying eligibility nearly 1 in 2 for minority populations; THEY BENEFIT FROM HEALTH RE- standards, methodologies, or procedures for Whereas diabetes costs the United States FORM. children under the State child health plan or an estimated $174,000,000,000 in 2007, and $1 in (a) INTEGRATING CHIP ELIGIBILITY WITH under any waiver of the plan that are less re- every $10 spent on health care is attributed METHODOLOGIES USED FOR OTHER SUBSIDIES strictive than the eligibility standards, to diabetes and its complications; WHILE PRESERVING CHIP FOR CHILDREN WHO methodologies, or procedures, respectively, Whereas approximately 1 out of every 4 CURRENTLY QUALIFY AND ASSURING CHIP for children under the plan or waiver that Medicare dollars is spent on the care of peo- COVERAGE FOR LOW-INCOME CHILDREN.— were in effect on October 1, 2009.’’. ple with diabetes; (1) DEFINITION OF TARGETED LOW-INCOME (c) PROTECTING CHIP CHILDREN AGAINST Whereas every day 230 people with diabetes CHILD.—Effective January 1, 2014, section UNAFFORDABLE COSTS FOR ESSENTIAL HEALTH undergo an amputation, 120 people enter end- 2110(b)(1) of the Social Security Act (42 CARE.— stage kidney disease programs, and 55 people U.S.C. 1397jj(b)(1)) is amended by striking (1) CONTINUATION OF COST-SHARING PROTEC- go blind from diabetes; subparagraph (B) and inserting the fol- TIONS FOR CHILDREN.—Section 2103(e) of such Whereas there is not yet a cure for diabe- lowing: Act (42 U.S.C. 1397cc(e)) is amended by add- tes; ‘‘(B) whose family’s modified gross income, ing at the end the following: Whereas there are proven means to reduce as determined for purposes of allowing a pre- ‘‘(5) CONTINUATION OF COST-SHARING PRO- the incidence of and delay the onset of type mium credit assistance amount for the pur- TECTIONS FOR CHILDREN.— 2 diabetes; chase of a qualified health plan under section ‘‘(A) IN GENERAL.—Except as described in Whereas people with diabetes live healthy, 36B of the Internal Revenue Code of 1986, subparagraph (B), during the period that be- productive lives with the proper manage- does not exceed 250 percent of the poverty gins on the date of enactment of the Patient ment and treatment; and line for a family of the size involved; and’’. Protection and Affordable Care Act, a State Whereas National Diabetes Month is cele- (2) STATE PLAN ELIGIBILITY REQUIREMENT.— shall not have in effect cost-sharing policies brated in November: Now, therefore, be it Section 2102(b)(1)(B) of such Act (42 U.S.C. under its State child health plan (including Resolved, That the Senate— 1397bb(b)(1)(B)) is amended— any waiver under such plan) that increase (1) supports the goals and ideals of Na- (A) in clause (iii), by striking ‘‘and’’ at the premiums or out-of-pocket costs above the tional Diabetes Month, including encour- end; amounts for children of the same income

VerDate Nov 24 2008 00:54 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00035 Fmt 0637 Sfmt 0634 E:\CR\FM\A30NO6.014 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S12014 CONGRESSIONAL RECORD — SENATE November 30, 2009 level (stated as a percentage of the Federal ‘‘(ii) reduces erroneous eligibility deter- household member, if such information can- poverty level) under such plan (or waiver) as minations under the state plans described in not be obtained through other means)— in effect on October 1, 2009. clause (i); and ‘‘(i) to the extent that an eligibility re- ‘‘(B) EXCEPTION.—With respect to fiscal ‘‘(iii) lowers operational administrative quirement for subsidies cannot be decided years beginning with fiscal year 2014, a State costs under the state plans described in based on the information described in sub- may increase cost-sharing amounts above clause (i).’’. paragraph (A); those described in subparagraph (A) by an (f) CONTINUING PERFORMANCE BONUSES FOR ‘‘(ii) if the agency has good reason to be- amount that does not exceed the median per- STATES THAT ENROLL LARGE NUMBERS OF EL- lieve that the information described in sub- centage increase in national household in- IGIBLE CHILDREN.—Section 2105(a)(3) of such paragraph (A) is inaccurate; or come since fiscal year 2013, as determined by Act (42 U.S.C. 1397dd(a)(3)) is amended— ‘‘(iii) if the information described in sub- the Secretary, for households with incomes (1) in subparagraph (A), by striking ‘‘and paragraph (A) does not result in a finding of at or below the percentage of poverty level ending with fiscal year 2013’’; and eligibility for medical assistance under title specified in section 2110(b)(1)(B). (2) in subparagraph (E), by adding at the XIX of the Social Security Act, in which ‘‘(C) RULE OF CONSTRUCTION.—This para- end the following: case— graph shall not be construed to prevent a ‘‘(iv) LATER APPROPRIATIONS.—There is ap- ‘‘(I) the agency shall provide the individual State from reducing premiums or out-of- propriated, out of any money in the Treas- with notice of— pocket costs below the amounts described in ury not otherwise appropriated, for each of ‘‘(aa) the circumstances under which such subparagraph (A).’’. fiscal years 2013 through 2019, 25 percent of individual or applicable household members (2) EQUITABLE COVERAGE OF ESSENTIAL BEN- the amount described in clause (i), adjusted may qualify for additional assistance; and EFITS.—Section 2103(f) of such Act (42 U.S.C. to reflect the proportionate change in Con- ‘‘(bb) an opportunity to request a deter- 1397cc(f)) is amended by adding at the end sumer Price Index for All Urban Consumers mination of whether such circumstances the following: since fiscal year 2009, as determined by the apply to the individual or applicable house- ‘‘(4) EQUITABLE COVERAGE OF ESSENTIAL Secretary.’’. hold members; and BENEFITS.—With respect to fiscal years be- (g) GIVING FAMILIES THE OPTION OF USING ‘‘(II) if the individual requests such a de- ginning with fiscal year 2014, the State plan THEIR FEDERAL INCOME TAX RETURNS TO ES- termination, the agency shall ensure that for child health assistance (including any TABLISH ELIGIBILITY.—Section 6055 of the In- the individual and applicable household waiver under such plan) may not deny ternal Revenue Code of 1986, as added by sec- members receive— (whether through a restriction on amount, tion 1502(a) of the Patient Protection and Af- ‘‘(aa) an opportunity to provide any addi- duration, or scope, through excluding a cat- fordable Care Act, is amended by adding at tional information needed to determine egory of health care services or items, or the end the following: whether the circumstances described in sub- otherwise) a service or item to a child whose ‘‘(f) USE OF INDIVIDUAL INCOME TAX RE- clause (I)(aa) apply; family income is at or below the percentage TURNS TO HELP DETERMINE ELIGIBILITY FOR ‘‘(bb) a determination of whether the cir- of poverty level specified in section SUBSIDIES.— cumstances described in subclause (I)(aa) 2110(b)(1)(B), determined using the method- ‘‘(1) IN GENERAL.—For taxable years begin- apply (but only if the individual or applica- ology described in such section, if the State ning not later than January 1, 2012, the Sec- ble household members furnish requested in- would cover or be required to cover such retary shall develop forms that require all formation that is necessary to such deter- service or item had the child qualified for individuals filing returns with respect to in- mination); and medical assistance under sub-clause (IV), come taxes under subtitle A— ‘‘(cc) receive any subsidies for which the (VI) or (VII) of section 1902(a)(10)(i).’’. ‘‘(A) to identify the members of the indi- individual or applicable household members (d) BASING FEDERAL PAYMENTS ON STATE vidual’s household who lack health insur- qualify. CONDITIONS, RATHER THAN INFLEXIBLE DOL- ance at the time the return is filed; and ‘‘(4) DEFINITIONS.—In this subsection: LAR AMOUNTS.—Section 2104(a) of such Act ‘‘(B) to indicate whether there are mem- ‘‘(A) HOUSEHOLD.—The term ‘household’ in- (42 U.S.C. 1397dd(a)) is amended by striking bers of the individual’s household who are cludes the individual filing the return, the paragraph (16) and inserting the following: under 19 years of age and for whom the indi- individual’s spouse (if any), and all depend- ‘‘(16) notwithstanding any other provision vidual requests disclosure of pertinent tax ents of the individual or the individual’s of this title, for each of fiscal years 2013 return information, pursuant to section spouse (if any). through 2019, such amounts as are necessary 6103(c), to agencies determining eligibility ‘‘(B) SUBSIDIES.—The term ‘subsidies’ in- to carry out this title.’’. for subsidies for purposes of helping such cludes premium credits under section 36B, (e) DEFRAYING STATE EXPANSION COSTS agencies determine whether the applicable medical assistance under title XIX of the So- WITH ADDITIONAL FEDERAL DOLLARS.—Sec- household members qualify for subsidies. cial Security Act, child health assistance tion 2105(b) of such Act (42 U.S.C. 1397dd(b)) In developing the applicable language on tax under title XXI of such Act, and cost-sharing is amended— forms, the Secretary shall consult with the subsidies under section 1402 of the Patient (1) by striking ‘‘For purposes’’ and insert- Secretary of Health and Human Services. Protection and Affordable Care Act. ing the following: The goals of such consultation shall include ‘‘(C) PERTINENT TAX INFORMATION.—The ‘‘(1) IN GENERAL.—For purposes’’; and maximizing the form’s comprehensibility to term ‘pertinent tax information’ refers to all (2) by adding at the end the following: low-income taxpayers and the convenience of information on the tax return that is poten- ‘‘(2) OPTION FOR INCREASED FEDERAL FINAN- making such identification and indication. tially relevant to determining the applicable CIAL PARTICIPATION BEGINNING IN FISCAL YEAR ‘‘(2) TRANSFER OF INFORMATION.—When an household member’s eligibility for subsidies 2014.—Notwithstanding paragraph (1), begin- individual identifies a household member or that may facilitate data-matching with ning with fiscal year 2014, the enhanced pursuant to paragraph (1)(B), the Secretary other records that are potentially relevant FMAP determined for a State for a fiscal shall promptly transfer pertinent tax return to determining such eligibility. year (or for any portion of a fiscal year oc- information to all agencies determining eli- ‘‘(5) RULE OF CONSTRUCTION.—Nothing in curring during such period) shall be in- gibility for subsidies in such member’s state this subsection shall be construed to forbid creased by 23 percentage points, but in no of residence, except that such transfer shall the Secretary, pursuant to section 6013(c) case shall exceed 94 percent. The increase in not take place to an agency unless it is sub- and other applicable legal authority, or the the enhanced FMAP under the preceding sen- ject to an enforceable agreement or other Secretary of Health and Human Services tence shall not apply with respect to deter- legal obligation that meets the Secretary’s from implementing, with respect to individ- mining the payment to a State under sub- requirements for safeguarding taxpayer pri- uals who have attained age 19, policies and section (a)(1) for expenditures described in vacy and data security. The transfer de- procedures similar to those described in subparagraph (D) of that subsection, para- scribed in this paragraph may take place paragraphs (1) through (3) with respect to in- graphs (8), (9), or (11) of subsection (c), or through the data matching program de- dividuals under 19 years of age.’’. clause (4) of the first sentence of section scribed in section 1413(c)(2) of the Patient (h) CONTINUING CHIP OUTREACH AND EN- 1905(b). A State may not qualify for an en- Protection and Affordable Care Act. ROLLMENT GRANTS.—Section 2113(a) of the hanced FMAP pursuant to this paragraph ‘‘(3) ELIGIBILITY DETERMINATION.— Social Security Act (42 U.S.C. 1397mm(a)) is unless it implements— ‘‘(A) IN GENERAL.—Notwithstanding any amended— ‘‘(A) each enrollment and retention provi- other provision of law except subparagraph (1) in paragraph (2), by striking ‘‘such sion described in subparagraphs (A), (B)(i), (B), when an agency determining eligibility amounts’’ and inserting ‘‘the amounts de- and (C) through (G), respectively, of section for subsidies receives the information de- scribed in paragraph (1)’’; and 2105(a)(4); and scribed in paragraph (2), it shall determine (2) by adding at the end the following: ‘‘(B) any other practice for eligibility de- such eligibility on the basis of such informa- ‘‘(3) ADDITIONAL GRANTS FOR FISCAL YEAR termination, enrollment or retention that tion and other information obtainable by 2012 AND THEREAFTER.—There is appropriated, the Secretary finds— data-matching, to the maximum extent pos- out of any money in the Treasury not other- ‘‘(i) has a substantial impact increasing sible. wise appropriated, $50,000,000 for each of fis- the number of eligible children who receive ‘‘(B) EXCEPTIONS.—An agency described in cal years 2012 through 2019, for purposes of health coverage through State plans for subparagraph (A) shall base eligibility on in- awarding grants to eligible entities to con- child health assistance under this title or formation other than described in paragraph duct outreach and enrollment efforts that State plans for medical assistance under (2) (including through seeking additional in- are designed to increase the enrollment and title XIX; formation from the applicable individual or participation of eligible children under this

VerDate Nov 24 2008 00:54 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00036 Fmt 0637 Sfmt 0634 E:\CR\FM\A30NO6.020 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 30, 2009 CONGRESSIONAL RECORD — SENATE S12015 title and title XIX and, with respect to fiscal 653(j)) is amended by adding at the end the (ii) Providing additional supports or serv- years beginning with fiscal year 2014, pre- following: ices for low-income children with autism mium credits under section 36B of the Inter- ‘‘(12) INFORMATION COMPARISONS AND DIS- spectrum disorders or other disabilities. nal Revenue Code of 1986 and cost-sharing CLOSURE TO ASSIST IN ADMINISTRATION OF (iii) Assisting in the provision of services subsidies under section 1402 of the Patient HEALTH SUBSIDY PROGRAMS.— to improve health care services (including Protection and Affordable Care Act. Such ‘‘(A) IN GENERAL.—If, for purposes of ad- mental health care services) for children in grants and appropriations shall supplement ministering a State’s medical assistance pro- foster care under the responsibility of a and not supplant grants and appropriations gram under title XIX, a State’s children’s State and homeless children. that are made pursuant to other provisions health assistance program under title XXI, (B) ANNUAL REPORTS.—The Secretary shall of this section.’’. premium assistance under section 36B of the provide annual reports to the Congress that (i) SECRETARIAL REPORT COMPARING CHIP Internal Revenue Code of 1986, or reduced provide a full accounting of the revenue and TO SUBSIDIZED COVERAGE IN THE EXCHANGE.— cost-sharing subsidies under section 1402 of expenditures of the Fund for Vulnerable (1) IN GENERAL.—Not later than March 1, the Patient Protection and Affordable Care Children and Families. 2016, the Secretary of Health and Human Act, a State or Federal agency responsible (3) DEFINITIONS.—In this subsection: Services (in this subsection referred to as the for the administration of the program trans- (A) DEFICIT REDUCTION CONTINGENCY.—A ‘‘Secretary’’) shall submit to Congress a re- mits to the Secretary the names and social ‘‘deficit reduction contingency’’ applies to port that compares— security account numbers of individuals, the this section and the amendments made by (A) the health plan coverage offered to eli- Secretary shall disclose to such agency in- this section if the Director of the Congres- gible children in fiscal year 2015 by an aver- formation on the individuals and their em- sional Budget Office has found that such pro- age or median State plan for child health as- ployers maintained in the National Direc- visions, taken together (but without regard sistance under title XXI of the Social Secu- tory of New Hires, subject to this paragraph. to this subsection), will cause a net reduc- rity Act; and ‘‘(B) CONDITION ON DISCLOSURE BY THE SEC- tion in the projected Federal budget deficit (B) the health plan coverage that such RETARY.—The Secretary shall make a disclo- over the period of fiscal years 2010 through children would have received in fiscal year sure under subparagraph (A) only to the ex- 2019. 2015 if they were enrolled in a qualified tent that the Secretary determines that the (B) ANNUALIZED DEFICIT REDUCTION CONTIN- health benefits plan through an Exchange es- disclosure would not interfere with the effec- GENCY AMOUNT.—The term ‘‘annualized def- tablished by the State under section 1311 of tive operation of the program under this icit reduction contingency amount’’ means the Patient Protection and Affordable Care part. the amount of the net deficit reduction de- scribed in subparagraph (A) divided by 10. Act, and received all premium credits under ‘‘(C) USE AND DISCLOSURE OF INFORMATION section 36B of the Internal Revenue Code of BY STATE OR FEDERAL AGENCIES.— (l) CONFORMING AMENDMENT TO TITLE XXI 1986 and all cost-sharing subsidies under sec- ‘‘(i) IN GENERAL.—A State or Federal agen- MEDICAID MAINTENANCE OF EFFORT.—Section tion 1402 of the Patient Protection and Af- cy may not use or disclose information pro- 2105(d)(1) of the Social Security Act (42 fordable Care Act for which such children vided under this paragraph except for pur- would have qualified if they were not eligible U.S.C. 1397ee(d)(1)) is amended by adding be- poses of administering a program referred to fore the period ‘‘, except as required under for child health assistance under title XXI of in subparagraph (A). the Social Security Act. section 1902(e)(14)’’. ‘‘(ii) INFORMATION SECURITY.—A State or (2) POLICY ANALYSIS.—If, as to an aspect of Federal agency shall have in effect data se- health plan coverage described in paragraph curity and control policies that the Sec- SA 2791. Ms. MIKULSKI (for herself, (3) (except as provided in the next sentence retary finds adequate to ensure the security of this paragraph), the Secretary finds that Mr. HARKIN, Mrs. BOXER, and Mr. of information obtained under this para- the coverage described in paragraph (1)(A) is graph and to ensure that access to such in- FRANKEN) proposed an amendment to more favorable to families and children than formation is restricted to authorized persons amendment SA 2786 proposed by Mr. is the coverage described in paragraph (1)(B), for purposes of authorized uses and disclo- REID (for himself, Mr. BAUCUS, Mr. the report shall describe policy changes that sures. would be needed to improve the latter cov- DODD, and Mr. HARKIN) to the bill H.R. ‘‘(iii) PENALTY FOR MISUSE OF INFORMA- erage so that it reaches the level of 3590, to amend the Internal Revenue TION.—An officer or employee of a State favorability achieved by the former cov- agency described in this paragraph who fails Code of 1986 to modify the first-time erage. The analysis described in the previous to comply with this subparagraph shall be homebuyers credit in the case of mem- sentence need not address the aspect of subject to the sanctions under subsection bers of the Armed Forces and certain health plan coverage described in paragraph (3)(C)). (l)(2) to the same extent as if the officer or other Federal employees, and for other employee were an officer or employee of the (3) HEALTH PLAN COVERAGE.—In this sub- purposes; as follows: section, the term ‘‘health plan coverage’’ in- United States. cludes the following: ‘‘(D) PROCEDURAL REQUIREMENTS.—State or On page 17, strike lines 9 through 24, and (A) The adequacy of covered benefits in Federal agencies requesting information insert the following: ‘‘ance coverage shall, at meeting the health care needs of children, under this paragraph shall adhere to uniform a minimum provide coverage for and shall including those with special health care procedures established by the Secretary gov- not impose any cost sharing requirements needs. erning information requests and data match- for— (B) Families’ out-of-pocket and premium ing under this paragraph. ‘‘(1) evidence-based items or services that costs. ‘‘(E) REIMBURSEMENT OF COSTS.—The State have in effect a rating of ‘A’ or ‘B’ in the (C) Public-sector costs. or Federal agency shall reimburse the Sec- current recommendations of the United (D) Adequacy of pediatric provider net- retary, in accordance with subsection (k)(3), States Preventive Services Task Force; works. for the costs incurred by the Secretary in ‘‘(2) immunizations that have in effect a (E) Quality of care measures focused spe- furnishing the information requested under recommendation from the Advisory Com- cifically on children. this paragraph.’’. mittee on Immunization Practices of the (F) Legal protections for children. (k) DEFICIT REDUCTION CONTINGENCY.— Centers for Disease Control and Prevention (G) Barriers to enrollment and service uti- (1) IN GENERAL.—If a deficit reduction con- with respect to the individual involved; and lization. tingency applies to this section and the ‘‘(3) with respect to infants, children, and (H) Interstate variation. amendments made by this section, then adolescents, evidence-informed preventive (I) Continuity of coverage and care. there is appropriated, for each of fiscal years care and screenings provided for in the com- (J) The impact of placing children and par- 2010 through 2019, to the Fund for Vulnerable prehensive guidelines supported by the ents in different health plans. Children and Families described in para- Health Resources and Services Administra- (4) RULE OF CONSTRUCTION.—Nothing in this graph (2), out of any money in the Treasury tion. subsection shall be construed to prevent the not otherwise appropriated, an amount equal ‘‘(4) with respect to women, such addi- report required under paragraph (1) from— to 50 percent of the annualized deficit reduc- tional preventive care and screenings not de- (A) analyzing State programs of child tion contingency amount. scribed in paragraph (1) as provided for in health assistance under title XXI of the So- (2) THE FUND FOR VULNERABLE CHILDREN comprehensive guidelines supported by the cial Security Act that go beyond the average AND FAMILIES.— Health Resources and Services Administra- or median such program; or (A) AUTHORITY TO ESTABLISH.—If a deficit tion for purposes of this paragraph.’’. (B) including in its comparative analysis reduction contingency applies as described ‘‘Nothing in this subsection shall be con- factors in addition to those described in in paragraph (1), the Secretary of Health and paragraph (3). Human Services shall establish a Fund for strued to prohibit a plan or issuer from pro- (j) SAFEGUARDING PROGRAM INTEGRITY AND Vulnerable Children and Families. Any dol- viding coverage for services in addition to IMPROVING EFFICIENCY BY PROVIDING HEALTH lars appropriated or donated to such Fund those recommended by United States Pre- SUBSIDY PROGRAMS WITH ACCESS TO THE NA- shall be used for any of the following pur- ventive Services Task Force or to deny cov- TIONAL DIRECTORY OF NEW HIRES.—Section poses: erage for services that are not recommended 453(j) of the Social Security Act (42 U.S.C. (i) Combating infant mortality. by such Task Force.’’.

VerDate Nov 24 2008 00:54 Dec 01, 2009 Jkt 089060 PO 00000 Frm 00037 Fmt 0637 Sfmt 0634 E:\CR\FM\A30NO6.020 S30NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S12016 CONGRESSIONAL RECORD — SENATE November 30, 2009 NOTICE OF HEARING Mr. DURBIN. Madam President, I ask (A) being over the age of 45; unanimous consent that the resolution (B) coming from certain ethnic back- COMMITTEE ON INDIAN AFFAIRS grounds; Mr. DORGAN. Mr. President, I would be agreed to, the preamble be agreed to, the motions to reconsider be laid (C) being overweight; like to announce that the Committee (D) having a low physical activity level; on Indian Affairs will meet on Thurs- upon the table, with no intervening ac- (E) having high blood pressure; and day, December 3, 2009, at 2:15 p.m. in tion or debate, and that any state- (F) a family history of diabetes or a his- room 628 of the Dirksen Senate Office ments relating to the resolution be tory of diabetes during pregnancy; and Building to conduct a business meeting printed in the RECORD. (3) supports decreasing the prevalence of The PRESIDING OFFICER. Without diabetes, developing better treatments, and on pending committee issues, to be fol- objection, it is so ordered. working toward an eventual cure in the lowed immediately by an oversight The resolution (S. Res. 364) was United States through increased research, hearing on Expanding Dental Health agreed to. treatment, and prevention. Care in Indian Country, and a second The preamble was agreed to. f hearing entitled ‘‘Promises Made, The resolution, with its preamble, Promises Broken: The Impact of reads as follows: ORDERS FOR TUESDAY, Chronic Underfunding of Contract DECEMBER 1, 2009 Health Services.’’ S. RES. 364 Whereas there are nearly 24,000,000 people Mr. DURBIN. Madam President, I ask Those wishing additional information unanimous consent that when the Sen- may contact the Indian Affairs Com- in the United States with diabetes and 57,000,000 with pre-diabetes; ate completes its business today, it ad- mittee at 202–224–2251. Whereas diabetes contributed to the deaths journ until 10 a.m. tomorrow, Tuesday, f of over 300,000 people in the United States in December 1; that following the prayer PRIVILEGES OF THE FLOOR 2007, making diabetes the seventh leading and the pledge, the Journal of pro- cause of death; ceedings be approved to date, the Mr. BAUCUS. Mr. President, I ask Whereas every minute, 3 people are diag- morning hour be deemed to have ex- nosed with diabetes; unanimous consent that Stic Harris, a pired, the time for the two leaders be fellow in the office of Senator Whereas each day approximately 4,384 peo- ple are diagnosed with diabetes and, in 2007, reserved for their use later in the day, FRANKEN, be granted floor privileges and the Senate resume consideration of for the duration of the debate on H.R. approximately 1,600,000 new cases of diabetes were diagnosed in people 20 years or older; H.R. 3590, the health care reform legis- 3590. Whereas between 1990 and 2001, diabetes lation, for debate only, until 11:30 a.m., The PRESIDING OFFICER. Without prevalence in the United States increased by with the Republicans controlling the objection, it is so ordered. more than 60 percent; first 30 minutes and the majority con- Mr. DODD. Mr. President, I ask unan- Whereas over 24 percent of diabetes is trolling the next 30 minutes, and with imous consent that privileges of the undiagnosed, down from 30 percent in 2005, and 50 percent 10 years ago; the remaining time equally divided and floor be granted for the remainder of controlled between the two leaders or this Congress to the following members Whereas over 10 percent of adults and near- 1 their designees, and with Senators per- of my staff: Joe Caldwell and Melinda ly ⁄4 (23.1 percent) of people in the United States age 60 and older have diabetes; mitted to speak therein for up to 10 Leidy. Whereas diabetes is a serious chronic con- minutes each; further, that at 11:30 The PRESIDING OFFICER. Without dition that affects people of every age, race, a.m. the Senate proceed to executive objection, it is so ordered. income level, and ethnicity; session to consider the nomination of Mr. CASEY. Mr. President, I ask Whereas Hispanic, African, Asian, and Na- Calendar No. 487, Jacqueline Nguyen, tive Americans are disproportionately af- unanimous consent that a member of as provided for under the previous my staff, Avni Shridharani, be granted fected by diabetes and suffer at rates much higher than the general population; order; and finally, I ask that the Sen- the privilege of the floor for the re- ate recess from 12:30 until 2:15 p.m. to mainder of the Senate consideration of Whereas annually, 15,000 youth in the United States are diagnosed with type 1 dia- allow for the weekly caucus luncheons. H.R. 3590. betes and approximately 3,700 youth are di- The PRESIDING OFFICER. Without The PRESIDING OFFICER. Without agnosed with type 2 diabetes; objection, it is so ordered. objection, it is so ordered. Whereas 1 in 3 people in the United States Mr. DURBIN. Mr. President, I ask born in the year 2000 will develop diabetes in f their lifetime, and this statistic grows to unanimous consent that Jeff Peltola PROGRAM and Rob Paolucci, fellows in the office nearly 1 in 2 for minority populations; Whereas diabetes costs the United States of Senator PRYOR, be granted floor Mr. DURBIN. Madam President, privileges during the consideration of an estimated $174,000,000,000 in 2007, and $1 in under a previous order, at 12 noon, the every $10 spent on health care is attributed H.R. 3590. Senate will proceed to vote on the con- to diabetes and its complications; firmation of the Nguyen nomination. The PRESIDING OFFICER. Without Whereas approximately 1 out of every 4 objection, it is so ordered. Medicare dollars is spent on the care of peo- That will be the first vote of the day. Following the recess for the caucus f ple with diabetes; Whereas every day 230 people with diabetes luncheons, the Senate will resume con- SUPPORTING THE OBSERVANCE OF undergo an amputation, 120 people enter end- sideration of the health care reform NATIONAL DIABETES MONTH stage kidney disease programs, and 55 people legislation. Additional rollcall votes Mr. DURBIN. Madam President, I ask go blind from diabetes; are expected to occur throughout the Whereas there is not yet a cure for diabe- day. unanimous consent that the Senate tes; proceed to the immediate consider- Whereas there are proven means to reduce f ation of S. Res. 364, which was sub- the incidence of and delay the onset of type mitted earlier today. 2 diabetes; ADJOURNMENT UNTIL 10 A.M. The PRESIDING OFFICER. Without Whereas people with diabetes live healthy, TOMORROW objection, it is so ordered. productive lives with the proper manage- Mr. DURBIN. Madam President, if The clerk will report. ment and treatment; and there is no further business to come be- The assistant legislative clerk read Whereas National Diabetes Month is cele- fore the Senate, I ask unanimous con- brated in November: Now, therefore, be it as follows: Resolved, That the Senate— sent that it adjourn under the previous A resolution (S. Res. 364) supporting the (1) supports the goals and ideals of Na- order. observance of National Diabetes Month. tional Diabetes Month, including encour- There being no objection, the Senate, There being no objection, the Senate aging people in the United States to fight di- at 6:55 p.m., adjourned until Tuesday, proceeded to consider the resolution. abetes through raising public awareness December 1, 2009, at 10 a.m. Mr. DURBIN. Madam President, I ask about stopping diabetes and increasing edu- cation about the disease; f unanimous consent that my name be (2) recognizes the importance of early de- NOMINATIONS added as a cosponsor of the resolution. tection, awareness of the symptoms of diabe- The PRESIDING OFFICER. Without tes, and the risk factors for diabetes, which Executive nominations received by objection, it is so ordered. include— the Senate:

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DEPARTMENT OF STATE UNITED STATES OF AMERICA TO THE DOMINICAN REPUB- MICHIGAN FOR THE TERM OF FOUR YEARS, VICE STE- LIC. PHEN JOSEPH MURPHY III, RESIGNED. ALLAN J. KATZ, OF FLORIDA, TO BE AMBASSADOR EX- FEDERAL MINE SAFETY AND HEALTH REVIEW JAMES L. SANTELLE, OF WISCONSIN, TO BE UNITED TRAORDINARY AND PLENIPOTENTIARY OF THE UNITED STATES ATTORNEY FOR THE EASTERN DISTRICT OF WIS- STATES OF AMERICA TO THE PORTUGUESE REPUBLIC. COMMISSION CONSIN FOR THE TERM OF FOUR YEARS, VICE STEVEN M. IAN C. KELLY, OF MARYLAND, A CAREER MEMBER OF PATRICK K. NAKAMURA, OF ALABAMA, TO BE A MEM- BISKUPIC, RESIGNED. THE SENIOR FOREIGN SERVICE, CLASS OF MINISTER- BER OF THE FEDERAL MINE SAFETY AND HEALTH RE- THOMAS GRAY WALKER, OF NORTH CAROLINA, TO BE COUNSELOR, TO BE U.S. REPRESENTATIVE TO THE ORGA- VIEW COMMISSION FOR A TERM OF SIX YEARS EXPIRING UNITED STATES ATTORNEY FOR THE EASTERN DISTRICT NIZATION FOR SECURITY AND COOPERATION IN EUROPE, AUGUST 30, 2010, VICE ROBERT H. BEATTY, JR., TERM EX- OF NORTH CAROLINA FOR THE TERM OF FOUR YEARS, WITH THE RANK OF AMBASSADOR. PIRED. VICE GEORGE E. B. HOLDING. BISA WILLIAMS, OF NEW JERSEY, A CAREER MEMBER PATRICK K. NAKAMURA, OF ALABAMA, TO BE A MEM- CHRISTOPHER A. CROFTS, OF WYOMING, TO BE UNITED OF THE SENIOR FOREIGN SERVICE, CLASS OF COUN- BER OF THE FEDERAL MINE SAFETY AND HEALTH RE- STATES ATTORNEY FOR THE DISTRICT OF WYOMING FOR SELOR, TO BE AMBASSADOR EXTRAORDINARY AND VIEW COMMISSION FOR A TERM OF SIX YEARS EXPIRING THE TERM OF FOUR YEARS, VICE KELLY HARRISON PLENIPOTENTIARY OF THE UNITED STATES OF AMERICA AUGUST 30, 2016. (REAPPOINTMENT) RANKIN. TO THE REPUBLIC OF NIGER. DEPARTMENT OF JUSTICE WILLIE LEE RICHARDSON, JR., OF GEORGIA, TO BE RAUL YZAGUIRRE, OF MARYLAND, TO BE AMBASSADOR UNITED STATES MARSHAL FOR THE MIDDLE DISTRICT OF GEORGIA FOR THE TERM OF FOUR YEARS, VICE THE- EXTRAORDINARY AND PLENIPOTENTIARY OF THE BARBARA L. MCQUADE, OF MICHIGAN, TO BE UNITED STATES ATTORNEY FOR THE EASTERN DISTRICT OF RESA A. MERROW, RESIGNED.

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