Barbara Boxer

Mrs. BOXER

Mrs. BOXER. Mr. President, I ask unanimous consent to amend the previous order to give Senator Lautenberg 8 minutes, myself 2 minutes, and Senator Cardin 5 minutes.

Mrs. BOXER. Mr. President, I thank Senators Murray, Lautenberg, and Cardin for participating in our half hour of debate. Our block of time has almost expired. I would like to close the half hour by saying one word that I think is a beautiful word, and that word is ``fairness.'' ``Fairness'' is a beautiful word. It should always be the centerpiece of our work here. We should never single out one group of people as targets. We should treat people the same. It has been very clearly stated that the Nelson-Hatch amendment, like the Stupak amendment in the House, singles out an area of reproductive health care that only impacts one group, and that is women. It says to women that they can't use their own private funds to buy coverage for the full range of reproductive health procedures. It doesn't say that to a man. It doesn't say to men: You can't use your own funds to cover the cost of a pharmaceutical product that you may want for your reproductive health. It doesn't say that they can't use their own private funds for a surgical procedure they may choose that is in the arsenal that they may choose for their own reproductive rights. So we say to the men of this country: Look, we are not going to single out any procedure or any pharmaceutical product you may want to use for your reproductive health care. We are saying, if a private insurer offers it, you have the right to buy it. We are singling out women. Again, let me say this as clearly as I can. We have had a firewall between the use of Federal funds and private funds. Senator Reid has kept that firewall in place in the underlying bill. He keeps the status quo of the Hyde amendment. The group here who is coming on the floor continually--mostly men; I think so far all men; there may be some women who have spoken on their behalf, but I have not heard it--are basically saying: Forget the firewall. Forget it. Women, you cannot use your private funds, and government will tell you what you can or cannot do. I will tell you something. That is not what Uncle Sam should do. Uncle Sam should respect women, should respect men. I hope we defeat this amendment. I yield the floor.

Mrs. BOXER. Mr. President, I ask unanimous consent for the following order: Boxer, 1 minute; Durbin, 5 minutes; Stabenow, 5 minutes; Shaheen, 5 minutes; Dodd, 5 minutes; Menendez, 5 minutes; and Baucus, 4 minutes.

Mrs. BOXER. Mr. President, I gave birth to two beautiful children, and I am proud to say that I have now four grandchildren--the light of my life. I am just here to say as a mother, as a grandmother, and as a Senator from California that I trust the women of this country. I don't want to tell the women of this country--or tell anybody else anything like this--that they can't buy insurance with their own private money to cover their whole range of legal reproductive health care. We don't do that to the men. We don't say they can't get any surgery if they might need it for their reproductive health care. We don't tell them they can't get certain drugs, under a pharmaceutical benefit, they may need for their reproductive health care. Imagine if the men in this Chamber had to fill out a form and get a rider for Viagra or Cialis and it was public. Forget about it. There would be a rage in this Chamber. We are just saying treat women fairly. Treat women the same way you treat men. Let them have access to the full range of legal reproductive health care. That is all we are saying. Vote no on this amendment, the Nelson-Hatch amendment, because Harry Reid takes care of the firewall between private funds and Federal funds. We keep that firewall. Is it OK if Senator Durbin goes after Senator Stabenow?

Mrs. BOXER. Mr. President, I ask unanimous consent that in lieu of Senator Baucus's 4 minutes, Senator Casey take that time.

Mrs. BOXER. Mr. President, before we turn this over to the Republican side, I ask unanimous consent to have printed in the Record a letter from religious leaders who support maintaining the underlying bill and who oppose this amendment, and they are: Catholics for Choice, Disciples Justice Action Center, The Episcopal Church, Jewish Women International, Presbyterian Church Washington Office, Religious Coalition for Reproductive Choice, Union of Reform Judaism, United Church of Christ, Justice and Witness Ministries, United Methodist Church-General Board of Church and Society, Unitarian Universalist Association of Congregations. We are proud to have their support for our position.

Mrs. BOXER. I thank the Chair.

Mrs. BOXER. Mr. President, I ask unanimous consent that the Senate proceed to vote in relation to the Nelson-Hatch amendment No. 2962; that regardless of the outcome of the vote with respect to that amendment, there be 2 minutes of debate prior to a vote in relation to the McCain motion to commit, equally divided and controlled in the usual form; that upon the use or yielding back of that time, the Senate proceed to vote in relation to the McCain motion to commit; the McCain motion be subject to an affirmative 60-vote threshold; that if the motion achieves that threshold, then it be agreed to and the motion to reconsider be laid upon the table; that if it does not achieve that threshold, then it be withdrawn; and that no amendment be in order to the motion.

Mrs. BOXER. Mr. President, I move to table the Nelson amendment, and I ask for the yeas and nays.

Mrs. BOXER. I move to reconsider the vote.

Mrs. BOXER

Mrs. BOXER. Madam President, would my friend yield for a unanimous consent request?

Mrs. BOXER. Madam President, we are trying to get the times locked in so that Senators who have come over here get their time. So I ask unanimous consent that Senator Nelson speak for 10 minutes, Boxer for 5, Mikulski for 10, Grassley for 10, Cornyn for 10, Gillibrand for 10, and then Senator McCain wishes to comment.

Mrs. BOXER. Madam President, it is an honor to be here in the Senate at a time when we are working on one of the major issues of our time. We know that generations of leaders in both parties have tried to solve the health care crisis, and they have done it bit by bit. We read history. We know that leaders struggled with Social Security. The Democrats were in the forefront. Republicans fought us every step of the way. Franklin Roosevelt took the lead on that, and we had John Kennedy and Lyndon Johnson take the lead on Medicare. The Republicans fought us every inch of the way. We had some cooperation from certain Senators and certain Members of Congress, but overall it was very difficult. This fight is very difficult to make sure that we turn things around. We live in a society where, if we do not step into the breach--we are told by nonpartisan surveys that if we do nothing--and this is important--average premiums for our families in California will be 41 percent of income. In States such as Pennsylvania it will be 50 percent of income. We know what that means. People will not have health insurance. So we can pull the covers over our heads and say it is too hard; it is too tough. We can turn our backs on the fact that 62 percent of bankruptcies are related to a health care crisis. We could turn our backs on that. We could turn our backs on the fact that the infant mortality rate in America is 29th out of 30 nations--that is where we come out. This is America, the greatest country in the world. Something is wrong when so many people do not have access to insurance; and even if they do, when they need it most it is gone. How proud am I to be here at this time? Very proud. How grateful am I to the people of my State for sending me back here three times, so I can stand here and be a voice for them? I can't tell you how proud I am. When we started this health care debate we knew it was important to the people we represent and we knew it was important to the economy of this country. Senator Cornyn has gotten up and said this bill is terrible for the economy. Let me tell you, there are $27 billion of tax cuts in this bill. Let me repeat that--$27 billion of tax cuts for small business. There are billions of dollars of tax breaks for individuals. For people to stand up and say this is not good for our economy, I don't think they understand or get it. If we continue with the status quo, that is when we are in trouble. The women of the Senate have been very involved, the Democratic women. We have worked together to make sure this bill meets the needs of all of our families, including the women of this country. Senator Mikulski, who is on the floor, took the lead and made sure that we corrected a problem that was in the bill, a problem which basically was unclear as to who was going to set the benefits. We wanted to make sure that women could get mammograms after 40 every year. Senator Mikulski fixed it by making sure the head of Health and Human Services is going to be the one to decide what is covered. Women's prevention has now gone way up to the top of the list because of Senator Mikulski and the women who worked with her. We are very proud of that. There is one thing that was taken care of in the Reid bill that we didn't think we would have an argument about; that is, we thought we had an understanding that we were not going to bring up the issue of abortion; that it was not necessary to do it because we were not doing anything in the bill--Senator Reid doesn't do anything in the bill that changes the current agreement. Let me say, because I started in the House in the 1980s, I was part of that agreement. I offered the amendment that said, yes; it is true no Federal funds could be used unless the life of the woman was at stake, for abortion. Through my amendment we added rape and incest. Those are the only three exceptions. No Federal funds could be used for abortion except to save the life of the woman or if she is a victim of rape or incest. That agreement has held for three decades. It is fair to say neither side is thrilled with it, but the fact is, the agreement has held. The fact is, Senator Reid has crafted a bill, which is the underlying bill, that preserves that three-decades-long agreement. But over on the House side they passed the radical Stupak amendment which strikes at the heart of this delicate compromise by preventing women from using their own private funds for their legal reproductive health care. That is a big shock because women have been able to utilize their own private funds in order to get a legal procedure-- legal procedure--and never has anyone, to my knowledge, on either side of the aisle said she could not get access to insurance to cover the whole range of legal reproductive health care if she uses her own funds. This amendment takes us way back. Here is what is interesting. The people who bring us this--mostly it is going to be the men who speak on this, I think. We will see if that is right or wrong, but I predict that. The men who have brought us this do not single out a procedure that is used by a man, or a drug that is used by a man, that involves his reproductive health care and say they have to get a special rider. There is nothing in this amendment that says if a man someday wants to buy Viagra, for example, that his pharmaceutical coverage cannot cover it; that he has to buy a rider. I would not support that. And they should not support going after a woman, using her own private funds, for her reproductive health care. Is it fair to say to a man: You are going to have to buy a rider to buy Viagra--and this is public information. It could be accessed. No, I don't support that. I support a man's privacy just as I support a woman's privacy. So it is very clear to me that this amendment would be the biggest rollback of a woman's right to choose in decades. We didn't ask for this fight. We didn't plan for this fight. We don't want this fight. We simply want to ensure that this three-decades-long agreement is kept in place. And that is what Senator Reid does in the underlying bill. It is very clear that in the underlying bill, there is a firewall between Federal funds and private funds. All we are saying is, please leave it alone. We believe it is discriminatory to single out a procedure only women can utilize and say to the women of this Nation: Yes, this is a legal procedure, but you can't use your own private funds. Senator Reid is very clear. He puts a firewall in place between the Federal funds and the private funds. Roe v. Wade is still the law of the land. I know a lot of my colleagues would like to see it overturned. They would like to make abortion illegal at the earliest stages. They would like to criminalize it. They would like to put women and doctors in jail. The fact is, Roe v. Wade is the law of the land. At the early stages of a pregnancy, a woman has a right to choose. That is the law. Later on, she can't do it. There are restrictions for her, hurdles for her. That is what Roe does. There are many people, particularly on the other side of the aisle-- more than on our side, for sure--who want to overturn Roe. They know they can't do it because the vast majority of the people support a woman's right to choose at the early stages of a pregnancy. So what can they do? They can make it impossible for her to access a doctor for this procedure. In this bill, they go after her insurance. It is surprising to me that such an amendment could pass the House, but it did. I am asking my colleagues, women and men, both sides of the aisle, to please stand up for equality. Please don't single out women. What have women done to deserve this? They are our mothers, our daughters, our grandmas. They serve in the military with dignity. Why punish them this way? Why have such a lack of respect for them that they can't even get reproductive health care with their own private funds? It is, to me, such a rollback of women's rights. I believe we will defeat this in the Senate. I believe Senator Reid deserves a lot of credit because what he did in the underlying bill is preserve the status quo--no Federal funds for abortion, not a dollar, but a woman can use her own private funds to buy health insurance. I yield the floor.

Mrs. BOXER. Madam President, will the Senator yield for just a brief question on time, I say to Senator McCain? I just wondered how much longer the Senator was going to go because we have people waiting on both sides to speak up to 10 minutes.

Mrs. BOXER

Mrs. BOXER. Mr. President, I thank the Senator. I have been listening to this debate. It has been very interesting. It is very clear what this amendment does. It hurts the victims who, through no fault of their own, get hurt in a medical malpractice case by essentially making it very difficult for them to get the best attorneys. Some of these cases cry out for the best attorneys. But let me tell you, I have been in Congress since the 1980s. When a House Member or a Senator gets into trouble, do you know the first person they call? An attorney--the best attorney--and they do not come on this floor and say: Oh, let's make sure those attorneys do not earn enough money. They are willing to pay whatever it takes with their campaign accounts. By the way, that is all legal. But I find it amazing that Senators--who the first person they call when they are in trouble through their work is an attorney--would wind up going after victims the way they do. When they are a victim of a problem, as they see it, they get the best attorneys and they pay the high price. It is just not right.

Mrs. BOXER. I hope we will defeat the Ensign amendment.

Mrs. BOXER

Mrs. BOXER. Mr. President, I take this opportunity to honor the life of Tom Graff, a pioneer of the environmental movement. Mr. Graff passed away on November 12, 2009, after a long battle with cancer. He was 65. Born in Honduras in January 1944, Tom Graff was the son of German Jewish refugees. He spent his childhood in Syracuse, NY, attending Phillips Exeter Academy. He later graduated from Harvard University, Harvard Law School, and the London College of Economics. After graduation, Tom clerked for Federal judge Carl McGowen in Washington, DC, and was a legislative assistant to New York Mayor John Lindsay. In 1970, he moved to California to work for Howard, Prim, Smith, Rice & Downs, a law firm based in San Francisco. In 1971, Tom founded the California office of the Environmental Defense Fund. From then until 2008 when he retired, Tom served as Environmental Defense Fund's regional director. For more than 37 years, Tom worked tirelessly and passionately as an advocate for the environment. He established a new form of environmental activism based on the idea that economics could, and probably should, play a significant role in environmental policymaking. Tom believed that paying attention to how economic incentives influenced business and personal behavior was critical to bringing about environmental improvements. Although he was involved with a number of environmental issues, it was Tom's significant contributions to water policy that left an indelible mark in California. From the American River to Mono Lake to the Sacramento-San Joaquin Delta, Tom strove to ensure that water was distributed appropriately, and that the environment got its fair share. Working together with Senator Bill Bradley of New Jersey and Congressman George Miller of Martinez, Tom was a guiding force behind the Central Valley Project Improvement Act of 1991, a milestone in the environmental movement to protect the delta. He helped craft the historic proposal to use water markets and public subsidies that ultimately resolved the controversy around Mono Lake. He also did battle with the East Bay Municipal Utility District when it sought a second source of water from the American River, known for its abundant fall salmon run. Concerned for the health of the river, the Environmental Defense Fund filed suit against EBMUD. Seventeen years later, a landmark decision designated a baseline environmental flow need for the American River that stands to this day as a benchmark in river policy. Throughout his career, Tom's commitment to conservation and the benefits it brought was evident in the work he did every day. His lifetime of contributions and his stewardship of the environment will not soon be forgotten. Tom is survived by his wife Sharona Barzilay; his three children Samantha, Benjamin, and Rebecca; and two grandsons Avi and Rafael. I extend my deepest sympathies to his family. Tom was a true pioneer and advocate for a healthy and sustainable environment, working tirelessly to provide new approaches for managing natural resources. His efforts will continue to shape California's water policies for generations to come.

Mrs. BOXER

Mrs. BOXER. I move to lay that motion on the table. The motion to lay on the table was agreed to. Motion To Commit

Mrs. BOXER

Mrs. BOXER. Mr. President, if I might respond.

Mrs. BOXER. The plan is, women colleagues will be coming to the floor. As they come, I will yield to them, until Senator Mikulski gets here, and then she will yield the time, if that is all right.

Mrs. BOXER. Mr. President, before I start, I want to say to my colleague from Connecticut how much I appreciate his work and the work of Senator Baucus and Senator Reid. What a remarkable moment we have here. When I go home--and I was home for the holidays--people are urging us to get this done. They know their biggest chance of going into bankruptcy is a health care crisis--62 percent. They know, as my friend Senator Dodd has said almost every day of this debate, every morning 14,000 people lose their health care. They know if we do not intervene with a good bill, their premiums--in my home State, I say to the Senator--will be 41 percent of their income, the average income, by 2016. Can you imagine? That is unsustainable. For people who say: Why don't we address the economy instead of health care, let me say what happens to my constituents if they have to pay 41 percent of their income for premiums. Even if they have a good job, I say to my friend from Connecticut, they cannot make it. So the status quo is cruel, and it is particularly cruel to women. Amendment No. 2791

Mrs. BOXER. Mr. President, I am proud to support the Mikulski-Harkin- Boxer amendment to improve preventive health coverage for women. The Mikulski amendment addresses this critical issue by requiring that all health plans cover comprehensive women's preventive care and screenings--and cover these recommended services at little or no cost to women. These health care services include annual mammograms for women at age 40, pregnancy and postpartum depression screenings, screenings for domestic violence, annual women's health screenings, and family planning services. The preventive services covered under this amendment would be determined by the Health Resources and Services Administration to meet the unique preventive health needs of women. HRSA is an agency within the Department of Health and Human Services. HHS Secretary Kathleen Sebelius has already said that ``Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today.'' The Secretary made clear that recommendations by the U.S. Preventive Services Task Force ``do not set federal policy and they don't determine what services are covered by the federal government.'' This is not the first time that experts have disagreed about this issue. I have been in this battle before, with Senator Mikulski, who called a hearing with all of the women Senators in 1994 where I insisted that routine mammograms for women over 40 must be covered. And thank goodness we fought back then, and in 1997 and in 2002 when this issue was raised again and again. Since 1991, the death rate from breast cancer has been reduced by over 20 percent. According to a 2007 Partnership for Prevention report, 3,700 additional lives would be saved each year if we increased to 90 percent the portion of women age 40 and older who have been screened for breast cancer in the past 2 years. The most recent data show us that approximately 17 percent of breast cancer deaths occurred in women who were diagnosed in their forties. That is why the American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Mammograms are still the most effective and valuable tool for decreasing suffering and death from breast cancer. The Mikulski amendment will ensure women are able to get access to this and other lifesaving preventive services at no cost. The underlying bill introduced by Senator Reid already requires that preventive services recommended by the U.S. Preventive Services Task Force be covered at little to no cost. These recommendations already include some women's preventive services such as osteoporosis screenings. But they do not include certain recommendations that many women's health advocates and medical professionals believe are critically important, such as screenings for ovarian cancer--a disease that will claim the lives of nearly 15,000 women this year. We know that when ovarian cancer is diagnosed early, more than 93 percent of women survive longer than 5 years. Women are often the decisionmakers for their families when it comes to health care. But women too often put the health needs of their family members and their children ahead of their own. By passing this amendment, we are saving the lives of countless mothers, daughters, grandmothers and sisters who would otherwise forgo preventative health care because of high copays and expensive deductibles. I would like to share with my colleagues a story from a doctor in my home State of California, William Leininger, that drives home the importance of this amendment: In my last year of residency, I cared for a mother of two who had been treated for cervical cancer when she was 23. At that time, she was covered by her husband's insurance, but it was an abusive relationship, and she lost her health insurance when they divorced. For the next five years, she had no health insurance and never received follow-up care (which would have revealed that her cancer had returned). She eventually remarried and regained health insurance, but by the time she came back to see me, her cancer had spread. She had two children from her previous marriage--her driving motivation during her last rounds of palliative care was to survive long enough to ensure that her abusive ex- husband wouldn't gain custody of her kids after her death. She succeeded. She was 28 when she died. That is not a story that should be told in the richest nation in the world. As I said, I am so proud to support the Mikulski-Harkin-Boxer amendment to improve preventive health care coverage for women. Here is why. It is a fact that women are increasingly delaying or skipping altogether preventive health care, and they are doing it because of costs. I read a statistic done by a nonpartisan group that said about 39 percent of men are delaying going to a physician to check on a problem. But over 50 percent of women are doing that either because they do not have health coverage or they are fearful of the copay. So we could sit here and do nothing--that is the easy thing to do: Scare people, do nothing--or we could step to the plate, save Medicare, which is very important to save, and that is what this bill does. Because we say we are not going to spend money on waste, fraud, and abuse. We are going to spend money on health care for our people. And to believe that my friends on the other side are the ones who are going to save Medicare? You just have to read history. Senator Dodd explained it; Newt Gingrich saying: Let Medicare wither on the vine; Bob Dole, our friend, who said, at the time of his Presidential campaign: I fought against Medicare. It was a failure. Well, if you ask our seniors, I think they are the group most pleased with their coverage. It is not perfect, but it is critical, and we save it here. We extend the life of Medicare. So here we are in a situation where many women are delaying going to the doctor, getting their preventive services, and the Mikulski amendment addresses this critical issue. It requires that all health plans cover comprehensive women's preventive care and screenings, and cover them at little or no cost. The reason this is so important is--first of all, in the HELP Committee, under Senator Dodd's and Senator Kennedy's leadership, this piece of the package was in the bill because Senator Mikulski and others pushed so hard to get it placed into the bill. Mr. President, I would ask my friend from Maryland, Senator Mikulski, if I could complete my remarks and then give the floor over to her? Mr. President, I thank the Senator. I am so proud to work with Senator Mikulski. I say to the Senator, we worked on this issue over the years. I just asked my staff to go back and look at the first time we teamed up to ensure that women get mammograms at age 40. That was in 1994. Then, again, over the years, every 3 or 4 years, this whole notion would rear its ugly head: Well, women can do without mammography. The question I have is, What is going to replace it? They would keep trying to take away our tools of self- examination and mammography. We know if you look through the years--and Senator Mikulski and I are proud of a lot of the work we do, but this goes right at the top of the list--we know mortality for breast cancer is way down since the early 1990s. It is 20 percent down since the early 1990s. We have had to stand our ground to protect women, to make sure they get those services they need, those lifesaving services, at little or no cost. I would also say the American Cancer Society continues to recommend annual screening using mammography and clinical breast exams for all women beginning at age 40. There are a lot of other very important tests that are included in the Mikulski amendment--very important tests--to deal with cervical cancer and ovarian cancer, finding the markers so we know how to deal with these deadly diseases. To give up the tools we have, to turn it over to some organization that does not report to the Secretary of HHS, makes no sense. What my friend has done with her amendment is to make sure the group that decides this is under the jurisdiction of the HHS Secretary. We know the HHS Secretary has already said she wants to make sure women, starting at age 40, get those mammograms. I am going to close by reading from an article in the March 10, 1994, San Francisco Chronicle. It says: Joining what became a phalanx of six female Senators staring down at federal health officials Boxer said she will insist that routine mammograms and a host of other women's health needs be part of any new nationwide benefit package. The article goes on. It is very clear. What I said at the time is: After all of these years of women being told it is crucial by age 40 to get a baseline mammogram, now to have this tremendous confusion hit us is very disturbing. Well, it was disturbing on March 10, 1994, when I first got involved in this issue. It was disturbing when Senator Snowe, 3 years later, had us pass S. Res. 47 which said this is our only tool. Let's do it. Thank goodness we have now in this body women and men who get the fact that we refuse as women to be stripped of the only tools we have. Making all of these important tests part of this package is going to save lives. It is going to save money. It is going to mean our families can breathe a deep sigh of relief out there. So I wish to thank Senator Mikulski for her leadership on this issue and to always stand right at her side on this issue of mammography. We also worked on standards for mammography. Remember that one? It was the deregulation fever that hit the Republican side. They wanted to take away the regulations for mammography, roll them back. We fought the fight, and we will continue to fight the fight. So thank you very much. I strongly support this amendment. I yield the floor for my friend, Senator Mikulski.

Mrs. BOXER

Mrs. BOXER. Mr. President, what is the order?

Mrs. BOXER. Thank you very much, Mr. President. I have listened to several of my Republican colleagues and I wish to note that they have the bill in front of them and they are attacking this health care bill, but nowhere on their desks do we see their bill. They have no answers, no solutions.

Mrs. BOXER. I can't yield. They have no solutions at all on an issue that affects every single American. What we have before us is the Reid bill which I think is an excellent piece of legislation that will make life better for every single American. I will spell that out in the course of my remarks. We all know change isn't easy. It is easy to come down here and demagog and pound your fists and complain. It is human nature to resist change. But every once in a while a situation cries out for change, and that is the case today with our health care system. The status quo is not benign. It is hurting our people. I wish to share the story of Nikki White as brought to us in the book ``The Healing of America'' by T.R. Reid. He talks about Nikki in the prologue where he poses it as a moral question: What we do about health care? This is what he writes: If Nikki White had been a resident of any other rich country, she would be alive today. Around the time she graduated from college, Nikki White contracted Lupus. That is a serious disease, but one that modern medicine knows how to manage. If this bright, feisty, dazzling young woman had lived in say, Japan, the world's second richest Nation, or Germany, the third richest, or Britain, France, Italy, Spain, Canada, et cetera, the health care systems there would have given her the standard treatment for Lupus and she could have lived a normal life span. But Nikki White was a citizen of the world's richest country--the United States of America. Once she was sick, she couldn't get health insurance. Like tens of millions of her fellow Americans, she had too much money to qualify for health care under welfare, but too little money to pay for the drugs and the doctors she needed to stay alive. She spent the last months of her life frantically writing letters and filling out forms pleading for help. When she died, Nikki White was 32 years old. That is a story that should move every one of us, move every one of us to action. Look, we have spent years studying and analyzing what is working in our health care system and what is not working. What it comes down to is this: Too many of our fellow citizens are suffering because of the broken promises of a health insurance system that abandoned them when they needed it the most. Too many cannot afford health insurance. Too many are getting sick after praying to God that they wouldn't because they knew that sickness could leave them in economic ruin. Praying is not a health care insurance plan. Americans will spend over $2.5 trillion on health care next year; $2.5 trillion. In all, we spend twice as much per person on health care as other advanced nations. Yet, the United States of America, out great Nation, ranks near the bottom of the 30 leading industrialized nations in basic measures of health, such as infant mortality rate and life expectancy--the bottom of the list. That is where we are. So we spend twice as much and the results are not anywhere near where they should be. It is clear why. Too many people don't have affordable health insurance, and they wait too long before they get the help they need. Or, they are like Nikki and they never get the help they need. Health care premiums have more than doubled in the last 9 years--more than doubled in the last 9 years--and one respected nonpartisan study says if we fail to act, the average American family will have to spend 45 percent of their income on health insurance premiums alone, and that is by 2016. By 2016, 45 percent of their income, the average family, by 2016, if we do nothing. My friends on the other side stand there with the bill and downgrade what we are doing and never address that issue. It is time for change. When we know that two-thirds of all bankruptcies are due to a health care crisis, it is time for change. When we know that every day--every day--another 14,000 Americans lose their health care coverage, that tells me it is time for change. I know there are many people listening who think the uninsured are not their problem, that it doesn't affect their health care. They are flat wrong. Right now, every one of us with insurance is paying $1,100 a year--each of our families--for those who are uninsured. Why? Because we have to pay for the emergency room services they get when they are rushed into the hospital because they have neglected a health care problem and it is very expensive, and we are paying for it. That tells me it is time for change. When family after family tells us they paid for insurance for years, but when they had a crisis their insurance company walked away from them--in T.R. Reid's book, we learn about a man who paid all his life for insurance and he got struck by an automobile and he was in the hospital with a terrible situation, and the insurance company knew it was going to cost them a lot. You know what they did? They rescinded his insurance. They told him that he weighed more than he should have, and they walked away from him. Story after story. Good, hard-working people unable to get health insurance, knowing that their future is dark. It is time for a change. Today, I want to say to America's families: Change is definitely on the way. It won't be easy. It is going to be tough. But all these things I have said are truths. Everybody here has to be moved by that. I believe we will finally bring change. I am hopeful. I am hopeful because of the work of so many of our colleagues and the work of Senator Harry Reid. He has put a bill before us that, as I said, will make life better for every single American. It is called the Patient Protection and Affordable Care Act. First and foremost, if you have health insurance you like, this bill gives you the security of knowing it will be there for you when you need it. And if you don't have health insurance, you will be able to get affordable coverage through a new exchange which includes the public option. Ultimately, under this bill, we are expanding health care to cover more than 94 percent of the American people, and all the while we are cutting the Federal deficit by an estimated $130 billion over 10 years, because there are real savings and real revenues in this bill to offset the new important programs. When this bill is signed into law, America's families will see immediate improvements to their health care. They won't have to wait. For example, right away, when President Obama signs this bill, your insurance company won't be able to kick you off your plan for some made-up reason because they no longer want to cover you. They will no longer be able to cap your coverage. I can't tell my colleagues how many people think they are safe because they had a $500,000 cap on their insurance. They never dreamed they would use it up. But one difficult and terrible illness can use it up, and then they are out of luck. No more rescissions, no more caps. Parents will be able to keep their children on their health care policy up to the age of 26. Small businesses will have immediate access to tax credits to make covering their employees more affordable. And seniors will have a more generous benefit through their prescription drug coverage. We all hear about that doughnut hole that affects seniors as soon as they need to buy more pharmaceuticals. This will give them another $500 before they reach that point. Those are just a few of the immediate benefits of the Patient Protection and Affordable Care Act. Here is a sample of other major provisions. This is a very important one. In this bill, no family of four making less than $88,200 a year will have to pay more than 9.8 percent of their income for health insurance premiums. Let me say that again. No family of four making less than $88,200 a year will have to pay more than 9.8 percent of their income for health care premiums. So if you make anything between say the poverty rate all the way up to $88,200, you never have to pay more than 9.8 percent of your income for health care premiums, and if you are on the lower end, it is even less. It goes down to about 2 percent. So it ranges from 2 percent to 9.8 percent at $88,200. That means that more than 62 percent of all of our families will be able to be assured that they will not have to go broke to buy health insurance. Remember what I said. A respected study has already stated that if we do nothing, by 2016 people will be paying 45 percent of their income on premiums. In this bill, we ensure that our middle class down to our working poor do not have to worry about those kinds of premium increases. For the rest of our Nation's families who are more affluent, there is the security of knowing that the insurance company reforms in this bill are going to help you. The insurance company can't walk away from you. If you have a preexisting condition, they can't turn you down. If you have a child you want to keep on until age 26, you can. If you are a small business, you will get tax credits to help you pay for your employees. There are many other benefits, including some free prevention coverage that kicks in right away. So no more discrimination against those with a preexisting condition. By the way, no longer will insurance companies be able to discriminate based on gender. Right now, women in my home State of California are paying almost 40 percent more for the same insurance as men. There is gender discrimination. That will end when this bill becomes law. In this bill we increase competition, which is perhaps one of the most important things we can do to bring down costs to our families. We have the health care exchange which includes a public option that will compete on a level playing field with insurance companies to keep them honest. In other words, there will be a government option, but there won't be anything different about the government plan in terms of the way it negotiates with the insurance companies. There has been a lot of shouting from my colleagues about the public option. Why shouldn't the American people have access to a public option? I ask that question. I don't hear my Republican friends coming down to the floor and saying they are going to give up their public option. More than 90 percent of us have a public option right now--the Federal Employee Health Benefits Program. I don't see one of my colleagues who have been trashing the public option coming to the floor and saying I wish to get rid of mine. Oh, no. They like it. But they don't want it for the rest of the people. I don't understand it. There are lots of public options we have here. Medicare is a public option, run by the government. I don't hear my Republican friends coming here and saying we should end Medicare. They used to say that. They don't say it anymore. Now they say they depend on it. It is a public option; 45 million Americans are covered by it. Not one of them said get rid of Medicare. I don't hear any of my Republican friends coming to the floor saying we should get rid of another public option called Medicaid. That is for the poor. It works well. It is tough, and there are problems with it, but it works and it covers 60 million Americans. So you have 45 million Americans in a public option called Medicare, 60 million Americans in a public option called Medicaid. How about the veterans health care program? I don't hear them pounding the table and saying get rid of the public option for our veterans. I will tell you, maybe they want to, but they would not say it because the veterans would be at their door because that public option covers 7.9 million veterans. Not one of my Republican colleagues say they want to end it. I don't hear my Republican friends coming to the floor to say we should end our TRICARE program for our military. That is a public option for 9.5 million people. I don't hear them saying stop that public option. Again, their own health care, brought to them by FEHBP, Federal Employees Health Benefits Program, that is a public option that covers 8 million people, including them, and they don't seem to want to end that. But when it comes to everybody else, they come down here and basically say: a government takeover of health care. False. The public option is just one option in the exchange. It has to run by the rules of all the other insurance companies. I say if it is good enough for a Republican Member of the Senate and a Democratic Member of the Senate, a public option ought to be an option for the people whom we represent. Small business needs help here. I don't know if everybody is aware of this, but small businesses pay as much as 18 percent more for the same health insurance as large businesses. In California, we have seen increased premiums to small businesses that have meant a choice between laying off employees or not providing health insurance at all. More and more of these businesses are dropping health care coverage. If you are in the position where you work for a small business, you don't have health care coverage, and you want to stay there, when this bill goes into effect, you can go into the exchange and then you will have some buying power or your small business can go into the exchange. This bill will protect our seniors, and it will strengthen Medicare. Medicare is a success story. Before Medicare became law, half our senior citizens went without health insurance. Now, 98 percent of our seniors are covered by Medicare. They believe in the program and they want it to continue. Those of us supporting this bill want to make Medicare stronger, and we do. This bill will ensure a stronger, more sustainable Medicare Program. It lowers prescription drug costs, as I mentioned before. It increases access to preventive services for our seniors, and it extends the solvency of the Medicare Program by 4 to 5 years. My Republican colleagues are standing here saying that Democrats want to hurt Medicare--by the way, Medicare is a public option. They are saying the Democrats want to hurt Medicare, a public option. Honestly, who could believe that? In 1964, George H. W. Bush called Medicare ``socialized medicine.'' Newt Gingrich, when he was Speaker of the House, said he wanted to see Medicare ``wither on the vine.'' In 1995, while seeking the Republican nomination for President, Senator Bob Dole bragged that he voted against creating Medicare in 1965. He bragged about it and said: ``I was there fighting the fight, voting against Medicare . . . because we knew it wouldn't work in 1965.'' The Republicans are saying the Democrats want to destroy Medicare in this bill. That is beyond ridiculous. The American people know who is on their side when it comes to protecting Medicare. We didn't just wake up this morning. We know who brought us Medicare. This bill expands Medicaid. That is for the poor to ensure that the poorest and sickest among us can get into the program. We are going to get those with incomes below 133 percent of the poverty level into the program. That means that more than 1.5 million Californians who are uninsured or are struggling with the cost of health care, that will allow them to be covered. I thank the majority leader for working with us to ensure that California receives increased Federal support as we expand Medicaid. For the first 3 years of this expansion, the Federal Government will fully cover the cost of expanding Medicaid. I talked a little bit about prevention. Today, only 4 cents of every $1 we spend on health care is on prevention. Yet more than half our people live with one or more chronic conditions. Five chronic diseases--heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes--are responsible for more than two-thirds of the deaths in America. This bill will eliminate copays and deductibles for preventive care so people don't get to that serious illness. Those preventive services go into effect immediately. That is an overview of the Patient Protection and Affordable Care Act. My friends on the other side have already come out against this bill. They say it is too long, too complex. One of them said it is ``holy war.'' This bill will cause them to fight a ``holy war,'' for some reason. Where is their bill? They don't have one. After all the things we know are wrong with the system--and you don't have to agree with us on everything, but where is your bill? It seems like my Republican friends care more about playing politics than about protecting our families. That is what it feels like. They seem to care more about bringing down our President than bringing down the cost of health care. They seem to care more about all that than Tim and Josie Jentes, of Los Angeles, CA. Tim is retired from Raytheon. He gets his health care through his retirement plan. During 2007, the first year of his retirement, their monthly health care premium was $460. During 2008, it rose to $630. In 2009, it rose to $850. That is an 85-percent increase in 2 years for this retiree. Tim wrote to me and said: I understand that compared to many we are fortunate to have good health care and insurance. But we look forward to you, Senator Boxer, the Senate, and the House . . . addressing the seemingly unbounded increase in health care cost. We do it in this bill. People such as Tim will be protected. But my friends across the aisle say: No, we are not going to help Tim. What about Madeleine Foote of Costa Mesa, California? She turned 25 and lost the health care coverage she had under her parents. She tried to get coverage, but because she is taking medicine, she was denied. They said it was a preexisting condition. They said you can have health care, but you have to have a $3,000 deductible and premiums of $300 a month. She wrote: As a young person working in a restaurant, repaying student loans and trying to make it on my own, this is a huge financial burden. I cannot afford insurance that charges me so much. . . . For now, I am forced to hope that nothing extremely bad befalls me. She is another one who prays not to get sick. That is not a health care plan. My friends on the other side say: No, sorry, we are not going to help you, Madeleine. I have so many other stories. There is Douglas Ingoldsby, a small business owner in Santa Barbara, CA. He has 11 employees, and soon he will not be able to afford to get them insurance anymore. He asked that I support a public option, and I do. My Republican colleagues are saying: Douglas, no, we are not going to help you. It goes on. The stories go on. One of the stories is from a doctor, a retired pediatrician in Sacramento, Robert Meagher, who wrote and said that some parents begged him not to write on the form--after he saw a child with asthma, they asked: Please don't write down asthma. Say it was bronchitis. If you write down that my child has asthma, they will have a preexisting condition and when they go out on their own, they cannot get insurance. Can you imagine a doctor having to face a parent like that? My Republican friends don't want to think about that. They seem to be thinking about politics and the next election. We all know the bill before us isn't perfect. They should vote to start debate. They can try to make it better. There are many issues I am working on for California. There is the Disproportionate Share Hospital Program. I am working to get better prevention for women. At the end of the day, this is where we are. Health care coverage for all of America's families has been an elusive goal since Teddy Roosevelt first proposed it nearly a century ago. Our dear friend, Senator Ted Kennedy, whom we miss so much, fought for health care right here on this Senate floor from the moment he arrived in the Senate in 1962 to the moment he died. Today, I am proud to say we are moving closer to fulfilling this promise of health care for all. Robert Kennedy once said: Few will have the greatness to bend history itself; but each of us can work to change a small portion of events, and in the total of all those acts will be written the history of this generation. This is our time. This is our moment. This is the moment for us to come together as a nation and make sure our people never again have to face what Nikki White faced in her last days--filling out forms, praying to God she could get health care, not being able to get it, and dying at age 32. That is immoral. It is not necessary. We can fix it, and we should. I yield the floor.