Benjamin Cardin

Mr. CARDIN

Mr. CARDIN. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of H. Con. Res. 223, the adjournment resolution, received from the House and at the desk.

Mr. CARDIN

Mr. CARDIN. Mr. President, on Wednesday, the junior Senator from Vermont offered his ``single-payer'' health insurance amendment, amdt. No. 2837, to H.R. 3590. Under rule XV of the Standing Rules of the Senate, an amendment must be read aloud into the Record unless its reading is dispensed with by unanimous consent. Such consent is routinely granted but in this instance, the junior Senator from Oklahoma objected so the clerks commenced with reading the 767-page amendment. After several hours passed, Senator Sanders withdrew his amendment. Later in the day, the Republican leader came to the floor and complained that ``the majority somehow convinced the Parliamentarian to break with the longstanding precedent and practice of the Senate'' with regard to the reading of the amendment. He claimed that continued reading of the amendment could not be dispensed with absent consent being granted, suggesting that Senator Sanders had no right to interrupt the reading to withdraw his amendment. The Republican leader cited Riddick's Senate Procedure: Precedents and Practices, pages 43- 44, which states, in part: Under Rule XV, paragraph 1, and Senate precedents, an amendment shall be read by the Clerk before it is up for consideration or before the same shall be debated unless a request to waive the reading is granted; in practice that includes an ordinary amendment or an amendment in the nature of a substitute, the reading of which may not be dispensed with except by unanimous consent, and if the request is denied the amendment must be read and further interruptions are not in order; interruptions of the reading of an amendment that has been proposed are not in order, even for the purpose of proposing a substitute amendment to a committee amendment which is being read. When an amendment is offered the regular order is it reading, and unanimous consent is required to call off the reading. A Senator has, at the sufferance of the Senate, reserved the right to object to dispensing with further reading of an amendment. Later on Wednesday, the senior Senator from Illinois ably addressed the Republican leader's concerns but I bring the matter up again because I was presiding at the time Senator Sanders withdrew his amendment and Senator Coburn called for regular order. I received several phone calls afterwards from individuals who claimed that I acted erroneously in permitting Senator Sanders to withdraw his amendment so I would like to set the record straight. First of all, before Senator Sanders withdrew his amendment, I consulted with the Senior Assistant Parliamentarian, who was on the floor while I was presiding. He assured me that a Senator has the right to withdraw an amendment if no action has been taken on it. No action can be taken on an amendment until it is officially pending. An amendment is not officially pending until it has been read into the Record or such reading has been waived by unanimous consent. It is important to understand that while the Presiding Officer, not the Parliamentarian, makes rulings, it would be unusual for him or her to ignore the advice of the Parliamentarian. Martin Gold, who was the senior floor staffer to two former Republican majority leaders, Howard H. Baker, Jr., and William H. Frist, MD, of Tennessee, writes in his definitive book, ``Senate Procedure and Practice,'' that former Parliamentarian Floyd M. Riddick ``claimed that in twenty-five years of advising the presiding officer, the Senate only once voted to overturn him on appeal. He also cites an example of Vice President Alben Barkley ignoring the parliamentarian's advice, only to be overturned on appeal.'' The Parliamentarian is a nonpartisan officer of the Senate. In the 72 years since the position was created, there have been just five Parliamentarians. The Parliamentarian and his staff are experienced professionals. I sought and received the Parliamentarian's advice on this matter and I followed it, which is how the Senate usually operates. The Parliamentarian and his staff conducted extensive research on rule XV and the precedents governing the reading and withdrawal of amendments prior to what happened during Wednesday's session. While the Riddick's text the Republican leader cited seems plain enough, it is trumped by section 2 of rule XV itself, which clearly and succinctly states: Any motion, amendment, or resolution may be withdrawn or modified by the mover at any time before a decision, amendment, or ordering of the yeas and nays, except a motion to reconsider, which shall not be withdrawn without leave. Prior to the time Senator Sanders withdrew his amendment, no action had been taken on it that would have prevented such a move without consent for a very simple reason: the amendment wasn't officially pending while it was being read into the Record. So Senator Sanders had an unfettered right to withdraw it under such conditions. The precedent for a Senator's ability to withdraw an amendment while it is being read without gaining consent first, either to dispense with the reading or to withdraw it, was firmly established in 1950 and reiterated in 1992. On April 14, 1950, Senator Forrest C. Donnell insisted that an amendment being offered by Senator William Benton be read in its entirety. Afterwards, Senator Benton sought unanimous consent to withdraw his amendment. Senator Donnell made a parliamentary inquiry of the Chair, asking the Presiding Officer whether a Senator may withdraw an amendment while it is being read. He further stated that if consent were necessary he would object. The Presiding Officer replied that an amendment may indeed be withdrawn while it is being read, citing the language in rule XV I just mentioned. And Senator Benton withdrew his amendment. On September 24, 1992, Senator Brock Adams offered an amendment to a tax bill and sought consent twice to dispense with reading it. In both instances, Senator Bob Packwood objected so the clerk proceeded to read the amendment aloud. Later, Senator Adams asked for ``permission'' to withdraw the amendment and the Chair replied affirmatively that he had the right to do so. The 1950 precedent is cited on page 119 of Riddick's for the proposition that an amendment may be withdrawn ``even as soon as it has been read'' but it is, in fact, the same ruling as the 1992 precedent, that a Senator may withdraw his amendment while it is being read. The Republican leader did not refer to the 1950 precedent in his comments on Wednesday but spoke disparagingly of what happened in 1992, saying, ``the Chair made a mistake and allowed something similar (to Senator Sanders' move) to happen. But one mistake does not a precedent make.'' The Parliamentarian doesn't share the Republican leader's contention that the 1992 action was a ``mistake,'' not a precedent. The Parliamentarian's view is echoed by Walter Oleszek, the noted senior specialist in American National Government at the Congressional Research Service, CRS, who wrote last year, ``Senators are free to modify or withdraw their amendments until the Senate takes ``action'' on them.'' This is from Senate Amendment Process: General Conditions and Principles, CRS Report 98-707, May 19, 2008. Martin Gold's book, ``Senate Procedure and Practice,'' states: When a senator sends an amendment to the desk, he continues to ``own'' that amendment in the sense that he can modify or withdraw it at will (my emphasis) . . . Once ``action'' has been taken on the amendment, that situation changes, and the senator can modify or withdraw his amendment only by unanimous consent. This is from page 102. The minority has tried to argue that there was Senate action on the Sanders amendment because the Senate previously had agreed to a unanimous consent request defining the amendment and the Hutchison motion to recommit as the only propositions in order at that stage and prohibiting amendments to them. It is true that if an amendment is on a defined list of the only amendments made in order, that amendment when pending cannot be withdrawn except by unanimous consent. But that order is irrelevant in this case because, as I mentioned before, the Sanders amendment was not pending and could not be until it was read in full or unless the reading was dispensed with by unanimous consent. Another way to put it is that the reading of the amendment was not ``interrupted'' by Senator Sanders; in withdrawing it he obviated the reason for a reading. The order allowed but did not require, as it could not, that Senator Sanders offer the amendment and take steps to make it pending. So, to summarize, rule XV of the Standing Rules of the Senate and the 1950 and 1992 precedents are clear that Senator Sanders was well within his rights to withdraw the amendment, the reading of it notwithstanding. The Parliamentarian advised me accordingly and I followed his advice. I would add that Senator Coburn never explicitly objected to Senator Sanders withdrawing the amendment. He called for regular order. While regular order was indeed the reading of the amendment, that status couldn't prevent Senator Sanders from exercising his right to withdraw it. Finally, I regret that several of my colleagues on the other side of the aisle made comments that were critical of the Parliamentarian and his staff following this incident. The current Parliamentarian helped to write, edit, and revise Riddick's Senate Procedure and he has served in his current capacity as Chief Parliamentarian for 17 years and counting, and as a Senate Parliamentarian for 33 years. He and his staff have a combined total of 84 years of experience. They are professionals who serve this institution and the American people with distinction.

Mr. CARDIN

Mr. CARDIN. Mr. President, in a few hours, we in the Senate by our votes will be able to clear the way for the United States at long last to join every other industrial nation in the world and declare that health care is a right. I thank our leader, Senator Reid, for his extraordinary courage and leadership during these many weeks as we have been able to bring together the necessary votes to move this legislation forward. I thank Senator Baucus, Senator Dodd, and many of my colleagues who have worked on so many provisions that are in the managers' amendment and are in the underlying bill. For 23 years, I have been in Congress, and for 23 years I have been supporting universal coverage. I believe every American should have access to affordable, quality health insurance and health care. By our votes later on this evening, we will have a chance to take a giant step forward in accomplishing that goal. As I pointed out, the United States, although we spend more than any other nation in the world by far on health care, whether you want to do it in absolute dollars or on a per capita basis, we spend more than any other nation. Yet we are the only industrialized nation in the world that does not provide universal insurance and universal care. Americans have to make a difficult choice. If someone happens to be walking on the ice tonight and does not have health insurance and they fall and hurt themselves, they have to make a decision whether their arm or leg hurts badly enough to go see a doctor or perhaps to have an x-ray to see whether a bone has been broken because they do not have the money to pay for that type of care. Many people go without checkups because they cannot afford the cost of seeing a doctor today. They do not have insurance or their insurance does not cover what they need. Many people who are on medications have to decide whether they can split their pills to make their dollars last a little bit longer because they literally are choosing between taking their medicines or having food on the table in the United States of America in 2009, the wealthiest nation in the world. We have a chance to change that situation. One can argue this issue on many grounds, and I have. One can argue we need to bring down the growth rate of health care costs, and I certainly believe that or one can argue that we need to provide more people with health insurance or we need to take on the health insurance industry. But I think the most persuasive argument for passing this legislation is the moral argument. It is the right thing to do. It is what America stands for. I met with some students this week, and we were talking about the bill. These were high school students. They said it is the right thing to do, and they are right. This is the right thing for our Nation to do, to make sure everybody has access to affordable health care. In Maryland, this takes on a special note because I know my colleagues have heard me talk frequently about Deamonte Driver, a 12- year-old who lived in Prince George's County, MD, just 7 miles from here. His mom tried to get him to a dentist because he had a toothache. They did not have insurance. No dentist would see him. After many efforts to try to get him to a dentist, he ultimately went to an emergency room. They operated on him because the tooth had become abscessed because of the delay in getting care. He needed emergency surgery. It went into his brain, and he lost his life because in the United States of America, we could not provide someone who was poor access to see a dentist. Tonight we can change that by our votes on this bill. At long last, we have a chance to do something about that. In the last Congress, I introduced a bill that provided universal care by saying each of us has a personal responsibility to make sure we have health insurance. I did that because I think the first thing we need to do as a prerequisite to health care reform is to be sure everyone is covered, everyone is in the system. This bill and the managers' amendment not only provides for universal coverage but makes it affordable for every person in this country. We use the Congressional Budget Office as the objective scorekeeper. Everybody agrees to that--Democrats and Republicans. They are the professionals who tell us whether our numbers add up. The Congressional Budget Office tells us the bill with the managers' amendment will mean 3l million more Americans will have health coverage as a result of the enactment of this legislation. That will take our under 65 group from 83 percent coverage to 94 percent coverage, and for all Americans we will attain 98 percent. Sure, we want to get to 100 percent, but we are making a giant step forward for universal coverage. The Congressional Budget Office tells us that for the overwhelming majority of Americans, they will either see no increase in their health insurance premiums from what it would otherwise be or they will see a decrease, a decline, a reduction in the cost of the health insurance premiums they would otherwise have to pay. For all Americans, they are going to have a better insurance product that is going to cover more. They are going to have less out-of-pocket costs than they would otherwise have. That is what the Congressional Budget Office tells us. Why is that true? The legislation provides for prevention and wellness. It provides that preventive services will be required to be covered in your insurance plan. We even do that for our government programs by providing an enhanced match for States that expand the Medicaid program for our poor to cover the preventive services. It covers oral health for our children as a required part of a required essential coverage package and provides additional help to help people through education and demonstration programs. I could give many examples, but let me give one example from the point of view of trying to expand preventive services, and that is colon cancer. We know that if you have colon screenings, you actually can discover a polyp before it becomes cancerous. You can avoid cancer. The test costs a couple hundred dollars. If you do not have a test and you have cancer and need an operation, that costs tens of thousands of dollars. Prevention and wellness works. It brings down the growth rate of health care costs. It saves us money. This bill invests billions in prevention and wellness directly and through required coverage in our private and public insurance programs. We bring down the growth rate of health care costs by managing complex diseases. We know we spend most of our health care dollars because of major diseases. This bill helps us manage those diseases so people can get the care they need in a more cost-effective way. The legislation invests in health information technology so we can reduce the administrative costs of health care. I was surprised to find that Maryland, similar to most States, if you go into an emergency room, it is very unlikely they will have your medical records. If they do not have your medical records because their information technology is not sophisticated enough to get those records, then surely they are going to do tests they would not otherwise have to do, which ends up costing us all more money. By using health information technology, we can not only take better care of you, we can do it in a less costly way. By reducing the number of uninsured dramatically, we save money. How? Because someone who is uninsured who should see a doctor or go to a clinic instead goes to an emergency room which is much more expensive. By the way, they sometimes do not pay their bills. Each of our families, if you live in Maryland and you have insurance, you pay an extra $1,100 a year on your health insurance because you are paying for people who do not have health insurance and they access the system in a more costly way. This bill brings down the cost. You bring down the cost of health care because of competition. We believe in competition, market forces. That is what made America great. If you live in Maryland and you have private insurance, 71 percent of Marylanders are insured by two companies. That is not competitive. I have talked with more and more business owners who tell me they have no choice. There is one plan they can get. If they do not like that plan, there is no insurance they can get. That is not competition. This bill brings competition by the exchanges that will invite more insurance companies to participate in our States and by the program that is in the managers' package that allows us, for the first time, to have plans available across State lines. That will be particularly helpful for a State such as Maryland, where many of our employers employ people who not only live in Maryland but live in Virginia, live in Pennsylvania, live in Delaware, live in West Virginia. That will certainly help us. This legislation also reduces our Federal budget deficit. That is a challenge. Let me tell you why it is a challenge. There are two different issues. Reducing health care cost growth and reducing Federal spending are two different issues because to get everybody insured, which will help us bring down health care costs, we need to provide subsidies so people can afford their health insurance and provide businesses some help. As more and more people become insured, they can use our tax advantages and pay less income taxes by using before-tax dollars rather than aftertax dollars. All that costs revenue to the Federal Treasury, so it is a challenge to bring this in without adding to the deficit, but we knew we had to do that. The Congressional Budget Office, again our objective scorekeeper, tells us that in the 10-year budget window, it will reduce the Federal budget by $131 billion, but in the next 10 years, which all of us will admit is difficult to predict, they tell us we can reduce Federal spending by one-half percent of our GDP, which can translate to over $1 trillion. My point is, we are reducing the deficit while we are reducing the growth rate of health care costs. The Congressional Budget Office does not score us for a lot of the results from our prevention programs. They cannot assume less people will get cancer and, therefore, the preventive services will save us money. I am convinced the dollar savings will be a lot greater than that for health care costs, for our economy, and for the taxpayers of this country. This legislation protects consumers. That is why the consumer union supports moving this bill forward. The insurance reform that is in the underlying bill is well known. I tell you, the people of Maryland want that. I am sure the people of Massachusetts also do. The insurance reform says: Look, let's get rid of preexisting conditions. Let's not let insurance companies pick and choose whom they want to insure. They should insure everyone. The managers' package makes that available immediately for our children. We eliminate the lifetime caps, put restrictions on the annual caps. We make immediately available coverage for children under the age of 26 and provide a reinsurance program for those between 55 and 64. We provide for an independent appeal from an insurance company's decision on coverage. Too many insurance companies have an internal mechanism to determine coverage which is stacked against the policyholder. The managers' amendment provides for loss ratios. Loss ratios mean a certain amount of the insurance dollar must go back to pay benefits. We know a large amount is spent on advertising, spent on salaries, spent on profits. For the first time, the consumers will know how much of that is actually going to their benefits, and we start to put into law that a certain amount must be returned to the policyholders in benefits and important consumer protection information. I am particularly pleased the Patients' Bill of Rights, an amendment I offered, is included in the managers' package. I thank the leader for including that. In the Balanced Budget Act of 1997, a provision that I authored included a lot of the Patients' Bill of Rights in the Medicare and Medicaid Programs. President Clinton, in 1998, by executive order, extended it to all the government programs. We passed that bill in the House and it passed in the Senate, but we never passed it in both bodies and sent it to the President the basic Bill of Rights for patients. We are making a giant step forward in the managers' package to cover those Bill of Rights. Let me give an example. Access to emergency care that I authored is now in this bill. There are insurance companies today that tell you, you have to get preauthorization before you can go to an emergency room. Think about that. You are having chest pains and sweating and you try to find your insurance card to call your insurance company? That is not what a doctor tells you to do. You go to an emergency room. Suppose the closest emergency room is not in your network. Does that mean you will not get full coverage? Some insurance companies say that is the case. We put in the prudent layperson standard: If it is prudent to go to the emergency room to get care, the insurance company must cover your bill. I cannot tell you the people I talked with on both sides--I had chest pains, sweating, et cetera; I went to the emergency room, found out I did not have a heart attack and almost had one when my insurance company refused to pay the bill. I did what the doctor told me to do, and now they are not covering it. This provision will make sure that person's bill is covered. Frankly, we have had people who delayed treatment who should have gone to an emergency room whose circumstances became much worse and some actually died. We cover access to emergency care in the managers' package, an important consumer protection. We also allow you, as the subscriber, to determine whom you want your primary care provider to be. We give you protection as you make your decision as to whom your primary care provider will be. If you have a child, the pediatrician can be the primary care provider. If you are a woman, the OB-GYN can be your primary care provider. Many insurance companies deny you that today. That protection is in this bill for everyone. I am also pleased to have joined Senator Brown in a matter I worked very closely on when I was in the House for clinical trials. A lot of insurance companies today will not cover the cost of clinical trials, even though it might be the best care option available for an individual and, by the way, sometimes compromises the integrity of the clinical trial if they can't get a representative group to participate. Well, we provide protection in this bill to cover you for clinical trials that your insurance company has to cover. So there is a lot in this bill for consumer protection--the bill of rights. Mr. President, there is a long list of organizations that support the patients' rights amendment that I offered, from the AARP, to the Consumers Union, Families USA, National Women's Law Center--all the different specialists. It is an important amendment, and I am glad to see it is in the managers' amendment. I am proud of a major new effort that has been included in the managers' amendment. I want to talk about minority health for one moment, and I particularly want to thank a member of my staff, Priscilla Ross, who has been working on this issue for many years. She has pointed out to me the vulnerability of minority populations in America. Let me give a couple of examples. The life expectancy for an African American is 5.3 years less than someone who is White. Minorities are two times more likely to have diabetes. African Americans have 33 percent higher death rates for heart disease than the White population. And the list goes on and on. Access to care in the minority communities is much less than in the general communities at large. So we needed to do something about this, and the amendment I offered, which is included in the managers' package, elevates minority health in our government agencies. It provides statutory authority for the Office of Minority Health at the Department of Health and Human Services. It codifies the network of minority health offices located within the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the Substance Abuse and Mental Health Services Administration, and the Health Resources and Services Administration. Mr. President, it elevates the Office of Minority Health at the National Institutes of Health from a center to an institute. That is making a commitment to attack this disparity that currently exists in health care in America. Let me talk about one other issue in this bill that I am proud to work with Senator Sanders on which involves the community health centers and primary care. Senator Sanders was able to get $10 billion in the managers' package so that we could dramatically expand access to care. You see, if you are a Latino in America, there is a 35-percent chance you have no dependable source of health care, compared to 15 percent in the White community. We need more federally qualified health centers. You can have universal health coverage, but if you don't have facilities, it will be difficult to get access to care. The community health center expansion will provide access in underserved areas. Maryland needs this help, and there is substantial investment in primary care in this legislation. This bill will help. It will help those who have good insurance coverage today by protecting that coverage and making sure it is available tomorrow and stopping the erosion that is taking place today with insurance companies cutting back on what is covered and employers putting more of the cost on the employee. This legislation will help. It will help small business owners who today have very little choice as to what insurance plan they can get. They are paying 20 percent more, on average, than a large company pays for the same insurance protection. This will offer choice. We also offer tax credits to help small businesses in order to make it easier for small businesses--which are the economic engine of America--to be able to provide health benefits for their employees. It will help individuals who cannot find insurance today by having large pools they can enter without being discriminated against by the way the actuaries work and will provide subsidies for low-wage workers so they can afford the coverage. The bill will help our Medicare population by starting to close the doughnut hole on prescription drugs, making prescription medicines much more affordable for our seniors, and providing preventative services, such as annual physicals so that seniors can stay healthy. And it provides sustainability to the Medicare Program. Most importantly, this legislation reflects the values of our Nation--affordable, quality health care for all Americans. I am proud to support this legislation, the managers' package, and the underlying bill, and I urge my colleagues to be on the right side of history. I support moving forward with health care reform. With that, Mr. President, I yield the floor.

Mr. CARDIN

Mr. CARDIN. Mr. President, I have introduced the Law Student Participation Act of 2009. The bill creates exceptions to Federal conflicts of interest law which generally prohibits Federal employees from acting as an attorney or agent in a matter adverse to the U.S. government. The legislation directs the exceptions to Federal employees attending law school and participating in legal clinics and employees of the District of Columbia who staff legal clinics. Where the Federal employee has participated personally and substantially in the matter or the matter is before the employee's particular agency or department, specific conflicts of interest provisions still apply. The current law is over broad and denies learning and teaching opportunities where no real conflict may exist. Law schools, including schools in my home State, have voiced concern over the present law. Some of these schools include the University of Maryland, the University of the District of Columbia, and Georgetown University School of Law. The schools have related stories of students, who are Federal employees, regulated to clinics dealing only with state matters. In other instances a student might start working on a client's matter, but will be unable to continue once the matter goes to trial or before an administrative proceeding. Law schools complain that under such circumstances the client's right to effective counsel is diminished. Due to a requirement I championed, the University of Maryland School of Law faces unique challenges. Each student must provide legal services to the poor or persons who otherwise lack access to justice prior to graduation. Federal employees, unlike other students, must choose from a smaller selection of clinics due to the current Federal conflicts of interest law. Finally, if Federal employee students seek careers in practice areas where Federal law predominates, they likely will obtain no practical clinic experience in law school. It should be noted that the Office of Government Ethics, OGE, and the Department of Justice are aware of the text of the bill. Both have conveyed informally that they do not have problems with this legislation. The OGE released a report in 2006 that was critical of current Federal conflict of interest law as being overbroad and specifically pointed out that volunteer work was frequently barred even when no potential for conflict of interest existed. The current law deprives law students who are Federal employees of valuable practical educational opportunities. Ultimately participation in these clinics would result in better attorneys many of whom later go on to work for the Federal government.

Mr. CARDIN

Mr. CARDIN. Madam President, I wish to draw the attention of my colleagues to the retirement of Jerahmiel S. Grafstein from the Canadian Senate. As a member and now as Chairman of the Helsinki Commission, I have had the privilege to know and work with Jerry Grafstein over the years through participation in the Parliamentary Assembly of the Organization for Security and Cooperation in Europe--the OSCE. I know that my colleague from Ohio, Senator Voinovich, also knows Jerry well, having just worked with him on a resolution at this year's Annual Session of the Assembly in Vilnius, Lithuania, on combating anti-Semitism. I suspect that many of my other Senate colleagues have also worked with him over the years, as have many of our colleagues in the House of Representatives. Anybody who has met Senator Grafstein immediately recognizes him as a man of tremendous energy, deep commitment and brilliant mind. Commenting on Jerry's career, one of his Canadian Senate colleagues noted the daunting task of paying tribute ``to a force of nature disguised as a person.'' A successful lawyer, businessman and member of the Liberal Party, he was summoned to the Canadian Senate in 1984. Jerry Grafstein's accomplishments over the next 25 years of public service are much more than I can relay here. I do, however, want to highlight Jerry's prominent work with the 56 countries, 300 member OSCE Parliamentary Assembly. Serving for 6 years as the Assembly's treasurer and then, with me since 2007, as one of nine Vice Presidents, Jerry has understood the potential of this multilateral parliamentary forum to promote human rights, democracy and tolerance. Such a vital forum, however, does not just magically appear for the world's benefit. Someone has to take the time to make it function by participating as an officer, attending countless organizational meetings and, for us and our Canadian neighbors, traveling frequently across the Atlantic to do so. Jerry was one who rose to the challenge and then some. Even as he helped on organizational matters, Jerry Grafstein found more time than most others to focus on substance. First and foremost, he has helped to lead the charge against rising anti-Semitism across Europe and around the world. Diplomacy has a tendency to soften the criticism and downplay the negative, often until it is too late, but Jerry has helped to ensure that the OSCE did not shy away from dealing directly with this and other manifestations of hate and prejudice that dangerously confront far too many societies. Today, thanks to the vigilance of Jerry Grafstein and others, efforts to promote greater tolerance are now a solid, ongoing and vital aspect of the OSCE's work. This distinguished Senator from Canada also found time to participate and help lead OSCE PA missions observing elections and referenda in places like Russia, Ukraine, Georgia and Montenegro. By being an international observer, he became a witness to history and, in my view, helped history forward and make the world a more democratic place. In all his public endeavors, Jerry Grafstein has been a close friend of the United States of America. He has helped over the years to develop the bilateral dialogue between the U.S. Congress and the Canadian Parliament. He has come here to Washington on many occasions, including as a participant in Helsinki Commission events. He has always made clear that he is Canadian and proud of the country he represents, but that has never kept him from developing areas of common interest and seeking points of agreement even on some issues where our national views may otherwise diverge. Jerry Grafstein has been and will remain a close personal friend as well, always concerned, always engaging, never pretentious. I wish him and his wife Carole the very best. Although he deserves some time off, I am confident that he will remain prominent in the life of the vibrant city of Toronto. In noting the many accomplishments of Jerahmiel Grafstein and thanking him for his commitment to public service, I respectfully borrow the Canadian Senate's tradition and join his colleagues in saying: ``Hear, Hear!'' On a personal level, I believe I speak for numerous colleagues of my own in saying that Jerry will be missed, and always welcome to come and visit.

Mr. CARDIN

Mr. CARDIN. Mr. President, in 1991, then-Czechoslovak President Vaclav Havel brought together his counterparts from Poland and Hungary. Taking inspiration from a 14th century meeting of Central European kings, these 20th century leaders returned to the same Danube town of Visegrad with a view to eliminating the remnants of the communist bloc in Central Europe; overcoming historic animosities between Central European countries; and promoting European integration. Today, the Czech Republic, Hungary, Poland and Slovakia are together known as the Visegrad Group, and all four have successfully joined NATO and the European Union. They are anchors in the Trans-Atlantic alliance, and I am pleased to have had the opportunity to travel to all four of these countries where I have met with public officials, non- governmental representatives and ethnic and religious community leaders. Unfortunately, it appears that some additional work is necessary to address one of the principal goals of the Visegrad Group; namely, overcoming historic animosities. In recent months, relations between Hungary and Slovakia have been strained. Having traveled in the region and having met with leaders from both countries during their recent visits to Washington, I would like to share a few observations. First, an amendment to the Slovak language law, which was adopted in June and will enter into force in January, has caused a great deal of concern that the use of the Hungarian language by the Hungarian minority in Slovakia will be unduly or unfairly restricted. Unfortunately, that anxiety has been whipped up, in part, by a number of inaccurate and exaggerated statements about the law. The amendment to the state language law only governs the use of the state language by official public bodies. These state entities may be fined if they fail to ensure that Slovak--the state language--is used in addition to the minority languages permitted by law. The amendment does not allow fines to be imposed on individuals, and certainly not for speaking Hungarian or any other minority language in private, contrary to what is sometimes implied. The OSCE High Commissioner on National Minorities has been meeting with officials from both countries and summarized the Slovak law in his most recent report to the OSCE Permanent Council: The adopted amendments to the State Language Law pursue a legitimate aim, namely, to strengthen the position of the State language, and, overall, are in line with international standards. Some parts of the law, however, are ambiguous and may be misinterpreted, leading to a negative impact on the rights of persons belonging to national minorities. Since the law has not yet come into effect, there is particular concern that even if the law itself is consistent with international norms, the implementation of the law may not be. I am heartened that Slovakia and Hungary have continued to engage with one of the OSCE's most respected institutions--the High Commissioner on National Minorities--on this sensitive issue, and I am confident that their continued discussions will be constructive. At the same time, I would flag a number of factors or developments that have created the impression that the Slovak Government has some hostility toward the Hungarian minority. Those factors include but are not limited to the participation of the extremist Slovak National Party, SNS, in the government itself; the SNS control of the Ministry of Education, one of the most sensitive ministries for ethnic minorities; the Ministry of Education's previous position that it would require Slovak- language place names in Hungarian language textbooks; the handling of the investigation into the 2006 Hedvig Malinova case in a manner that makes it impossible to have confidence in the results of the investigation, and subsequent threats to charge Ms. Malinova with perjury; and the adoption of a resolution by the parliament honoring Andrei Hlinka, notwithstanding his notorious and noxious anti- Hungarian, anti-Semitic, and anti-Roma positions. All that said, developments in Hungary have done little to calm the waters. Hungary itself has been gripped by a frightening rise in extremism, manifested by statements and actions of the Hungarian Guard, the ``64 Counties'' movement, and the extremist party Jobbik, all of which are known for their irredentist, anti-Semitic, and anti-Roma postures. Murders and other violent attacks against Roma, repeated attacks by vandals on the Slovak Institute in Budapest, attacks on property in Budapest's Jewish quarter in September, and demonstrations which have blocked the border with Slovakia and where the Slovak flag is burned illustrate the extent to which the Hungarian social fabric is being tested. Not coincidentally, both Hungary and Slovakia have parliamentary elections next year, in April and June respectively, and, under those circumstances, it may suit extremist elements in both countries just fine to have these sorts of developments: nationalists in Slovakia can pretend to be protecting Slovakia's language and culture--indeed, the very state--from the dangerous overreach of Hungarians. Hungarian nationalists--on both sides of the border--can pretend that Hungarian minorities require their singular protection--best achieved by remembering them come election day. Meanwhile, the vast majority of good-natured Slovaks and Hungarians, who have gotten along rather well for most of the last decade, may find their better natures overshadowed by the words and deeds of a vocal few. In meetings with Slovak and Hungarian officials alike, I have urged my colleagues to be particularly mindful of the need for restraint in this pre-election season, and I have welcomed the efforts of those individuals who have chosen thoughtful engagement over mindless provocation. I hope both countries will continue their engagement with the OSCE High Commissioner on National Minorities, whom I believe can play a constructive role in addressing minority and other bilateral concerns.

Mr. CARDIN

Mr. CARDIN. Madam President, I ask unanimous consent that I be able to speak as in morning business.

Mr. CARDIN

Mr. CARDIN. Mr. President, we live in a world that is being poisoned by greenhouse gases of our own making. If we do not act, we face irreversible, catastrophic climate change. My grandchildren face a world where there will be not enough food, water, or fuel, a world that is less diverse, less beautiful, less secure. As I speak today, we are witnessing a critical moment in our fight against global warming both at home and abroad. This past Monday, the Environmental Protection Agency acted by releasing its final determination that ``greenhouse gases threaten the public health and welfare of the American people.'' This was an action required by law and ordered by the Supreme Court. This finding will require EPA regulate greenhouse gas emissions under the Clean Air Act. Monday's endangerment finding is a critical step in our country's efforts to stop global warming, which not only poses a threat to public health and welfare but to our national security. I am proud of the strong science-based actions taken by this administration to live up to its Clean Air Act obligations to protect our health. But I strongly believe that the best way for our country to solve the problem of greenhouse gas emissions is through comprehensive legislation enacted in the Congress of the United States. Legislation that invests in clean energy and new, high-tech infrastructure will bring us to long-sought goals: energy independence, good jobs for our citizens, and a healthy planet for our children and grandchildren. We are now closer to that kind of legislation than we have ever been. The House has passed a bill that puts a limit on the pollution in our air. It dedicates funding to develop new domestic sources of clean energy. It invests in a new infrastructure that is less dependent on foreign fuels and creates American jobs. And we need those jobs. Here in the Senate, we have improved on our colleagues' work. Senate legislation makes additional investments in clean transportation. It provides additional oversight and accountability and support for developing countries. It ensures we do not add one penny to our national deficit. This legislation is consistent with the budget of our country to try to help reduce the deficit and yet make us energy independent, create jobs, and be sensitive to our environment. But because climate change is a global problem, we need a global solution. This past Monday was also an important day in the international effort. The international community began a 2-week meeting in Copenhagen, Denmark, to work on an international agreement to address climate change. The international community has set the right objectives to make the meeting a success: a political agreement that promises both immediate action and contains the structure for a future formal treaty. The agreement reached in Copenhagen should include the following points: specific near-term greenhouse gas emission reduction targets--a critical part--the support the developed countries will provide to the developing world to adapt to a changing industrial economy and a changing climate--we have a responsibility to help the developing world--the core elements that will make up the final treaty; and a timeline for reaching that agreement within the next year. We cannot put this off. It is critical we act timely. The administration has taken several very important actions over the past few weeks to help us secure a global agreement in Copenhagen. EPA's endangerment finding sends an important signal to the world about the United States commitment to take decisive action. Similarly, the President's announcement that the United States will commit to an emissions reduction in the range of 17 percent below 2005 levels by 2020 and his pledge to contribute the fair share of the United States of $10 billion a year in financial support for the developing world by 2012 demonstrate that we are prepared to be serious partners in the fight against climate change. That is the type of action we want to see, not only in the United States but in other countries that are major emitters. Many of my colleagues, however, have legitimate concerns that if the United States enacts strong carbon standards, carbon-intense imports will have an unfair advantage in our market. We need to make sure we accomplish our goals internationally and also have a level playing field. To address this fear, I believe it is critical that our international negotiators include in Copenhagen strong verification and compliance procedures that will make it clear that every state has a responsibility to take action to reduce greenhouse gases. I have seen too many international agreements that include the highest ambitions for labor, environmental, and human rights protections that fail to achieve those goals in the absence of any consequences for violations of those principles. The groundwork for achieving a final international agreement in Copenhagen must ensure that major emitting Nations take on clearly defined emissions reductions targets, adopt standardized systems to measure, report, and verify actions and commitments, and it must provide for consequences if countries fail to meet those commitments. Inclusion of these principles in the Copenhagen agreement allows us to pursue these critical components in any final agreement, and sends an important signal that all party countries are committed to real emissions reductions. I am proud that the Senate Foreign Relations Committee climate change bill introduced by Senator Kerry last week includes language I authored that makes clear our expectations that any international agreement should include strong verification and compliance mechanisms, along with emission reduction targets, and a strong commitment to provide assistance to the developing world. I will be watching the negotiations and hope it will produce the kind of agreement I have discussed here today. But regardless of what Copenhagen brings, I will continue to advocate for domestic legislation that invests in clean, domestic energy, and frees us from energy policies that undermine our national security and our economy by being dependent upon imported oil. I will advocate for legislation that invests in the industries of tomorrow to stem the loss of clean energy jobs--jobs that stem from American inventions and ideas--to countries overseas. I will advocate for legislation that provides significant investment in clean fuels and public transit, so we seize an opportunity to build the infrastructure of tomorrow and change the way we move people and goods around this country. Right now, the transportation sector represents 30 percent of our greenhouse gas emissions and 70 percent of our oil use. If we could only double the number of transit riders every day, we could reduce our dependence on foreign oil by 40 percent. That is equivalent to the amount of oil we import every year from Saudi Arabia. That kind of legislation is good for our country and good for Maryland. But we must remember that even after Copenhagen, any deals we reach, any papers we sign, are still but the foundation. The work must continue with earnest followthrough, dedicated to truly changing the way we work and live and move around this Earth.

Mr. CARDIN

Mr. CARDIN. Mr. President, last week the Organization for Security and Cooperation in Europe, OSCE, held its annual Ministerial Meeting in Athens. As always, the OSCE Parliamentary Assembly was strongly represented there. Today, in my capacity as Chairman of the Commission on Security and Cooperation in Europe, I would like to offer a few reflections on the outcome of the meeting, and what this might mean for the future of European security, in which the U.S. has a vital stake. Each year, a different country serves as the OSCE's ``Chairman in Office.'' This year, Greece was the Chairman-in-Office and this year's Ministerial Council meeting subsequently took place in Athens. In recent years discord and paralysis have increasingly begun to overwhelm the cooperation and consensus that once characterized the OSCE. The Greeks thus began their chairmanship facing a difficult challenge. At last year's meeting in Helsinki under Finland's able chairmanship, the Ministers decided that the OSCE should look for ways to overcome this gridlock and to give the organization a new impetus. Greece took this task to heart and launched the ``Corfu Process'' to do just that. This effort has already borne fruit. In Athens, the ministers resolved to continue to try to reaffirm, review, and reinvigorate security in the OSCE region by continuing this process. The Ministers also agreed on decisions that addressed such fundamental and persistent problems as hate crimes, tolerance and nondiscrimination, nonproliferation, terrorism, and the ``protracted conflict'' in Nagorno-Karabakh. One of these decisions, on countering transnational threats, was sponsored by the U.S. and Russia, the first such joint effort in several years. I hope this is a positive portent for the future. The Ministers were not able to agree on how to tackle some other equally important and pressing problems. These included the protracted conflicts in Georgia and Moldova, OSCE assistance to Afghanistan, and the Conventional Forces in Europe Treaty. Clearly, much work remains to be done in putting the OSCE fully back on track. I would be remiss if I concluded my remarks without commending the Greek chairmanship for its untiring and ultimately successful efforts during the course of this year. The chairmanship rekindled the trust and confidence among the participating states that had steadily eroded over the past decade. Greece has clearly set the stage for a brighter and more productive future for the organization, and my colleagues on the Helsinki Commission, and I would like to congratulate the Greek chairmanship on this significant accomplishment. We would also like to wish Kazakhstan, the first Central Asian nation to hold this office, every success in its historic chairmanship in 2010 and to offer them our full support. Indeed, in our view the Kazakh chairmanship is already off to a promising start, for in Athens, at the initiative of the Kazakhs, the Ministers decided to hold a high-level conference on tolerance next year. This proved to be a timely decision, coming as it did just as Switzerland voted to ban the construction of Muslim minarets, and the president of the Swiss Christian Peoples Party called for a ban on Muslim and Jewish cemeteries. These actions reminded us that not even countries that have played a leading role in establishing international human rights standards are immune from the tendencies to discriminate against immigrants and minorities and to place limits on the free expression of religious beliefs. It is very important for the OSCE to combat these troublesome trends. It is also important that all the organization's participating states reaffirm, and commit themselves to upholding, the rights of all religious communities to create places of worship and to rest in line with their own traditions. I very much hope the OSCE's conference on tolerance next year will advance this effort. Finally, let me say that we look forward with great interest to the forthcoming discussions of Kazakhstan's proposal to hold a meeting of heads of state and government during its chairmanship. Should it happen, this would be the first such ``summit'' under OSCE auspices, something that was previously a regular occurrence. In Athens, in acceding to this proposal, the United States expressed the view that it is open to considering such a meeting if, but only if, such a summit can produce results of substance. I think this is the correct approach, and it is one I fully support.

Mr. CARDIN

Mr. CARDIN. Mr. President, I rise in strong opposition to the Nelson- Hatch amendment. Let me start by saying that I support a woman's right of choice as a constitutionally affirmed right. I understand how difficult and divisive this issue is. That is why the underlying bill we have before us carries out the compromise that has already been reached between pro-choice and pro-life supporters. It represents maintaining the prohibition on Federal funds for abortion but allows a woman to pay for abortion coverage through use of her own funds. That is current law, and that is what the underlying bill makes sure we continue. Many of us believe the health care debate is critically important. It is also controversial. Let's not bring the abortion issue into the bill. The Nelson-Hatch amendment would go beyond that. It would restrict a woman's ability to use her own funds for coverage to pay for abortions. It blocks a woman from using her personal funds to purchase insurance plans with abortion coverage. If enacted, for the first time in Federal law, this amendment would restrict what individual private dollars can pay for in the private insurance marketplace. When you look at those who are supporting this amendment, you can't help but have some concern that this amendment is being offered as a way to derail and defeat the health care reform bill. Most of the people who are going to be supporting the amendment will vote in opposition to the bill. It is quite clear that the Senate health reform bill already includes language banning Federal funds for abortion services. So supporters of this bill are not satisfied with the current funding ban; they are trying to use this to move the equation further in an effort to defeat the bill. This is really wrong as it relates to women in America. I am outraged at the suggestion that women who want an abortion should be able to purchase a separate rider to cover them. Why would we expect this overwhelmingly male Senate to expect women to shop for a supplemental plan in anticipation of an unintended pregnancy or a pregnancy with health complications? Who plans for that? The whole point of health insurance is to protect against unexpected incidents. Currently, there are five States--Idaho, Kentucky, Oklahoma, Missouri, and North Dakota--that only allow abortion coverage through riders. Guess what. The individual market does not accept this type of policy. It doesn't exist. Abortion riders severely undermine patient privacy, as a woman would be placed in a position of having to tell her employer or insurer and, in many cases, their husband's employer that they anticipate terminating a pregnancy. Also, requiring women to spend additional money to have comprehensive health care coverage is discriminatory. We don't do that for services that affect men's reproductive rights. I hear frequently from my friends on the other side of the aisle that the statements we make; that is, those who support the underlying bill--that this allows individuals who currently have insurance to be able to maintain their insurance builds on what is good in our health care system. This amendment takes away rights people already have. So if you have insurance today as an individual that covers abortion services, if this amendment were adopted, you will not be able to get that. So we are denying people the ability to maintain their own current insurance, if this amendment were adopted. It is the wrong amendment. The policy is wrong. But clearly, on this bill it is wrong. I urge my colleagues to accept the compromise reached on this bill. Many of us who would like to see us be more progressive in dealing with this issue and remove some of the discriminatory provisions in existing law understand we will have to wait for another day to do that. Let's not confuse the issue of health care reform. Let's defeat this amendment that would be discriminatory against women. That is wrong. I urge my colleagues to reject the Nelson-Hatch amendment. I yield the floor.

Mr. CARDIN

Mr. CARDIN. First, let me thank my colleague, Senator Mikulski, for her leadership on this issue. I strongly support her amendment for the reasons she said. This is a very important point about providing preventive health services to the women of America, a critically important part of our strategy not only to bring down costs in health care, but to have a health care system that is fair in America. I have been listening to my colleagues on the other side of the aisle talk about the underlying bill. They talk about it as if this is a static situation. Many of the criticisms I hear about the underlying bill are criticisms about our current health care system. I can tell my colleagues the people in Maryland, many of whom are finding it difficult to find affordable coverage today, are outraged with what is happening with private insurance companies and the attitudes they are taking. As Senator Mikulski pointed out, they are denying coverage for preexisting conditions or imposing arbitrary caps. As has been indicated, if we are unable to get this bill passed, what is going to happen in the future? We know costs are going to become even greater, more people are going to lose their coverage, insurance companies are going to continue their arbitrary practices, and the health care of Americans is in jeopardy. We are already spending so much of our economy on health care, and if we don't take action, it will be a greater part of our economy. But we have some good news. The underlying bill has now been analyzed by the CBO; that is the independent scorekeeper. What they tell us is, if we pass the underlying bill, for the overwhelming majority of Americans, they are going to find that their health insurance premiums will either stay the same or go down. For the overwhelming majority of Americans, they will have a better insurance product that will cover the types of preventive services Senator Mikulski is talking about, which are in her amendment. We are not only going to bring down the cost for the overwhelming majority of Americans as to what will happen if we don't pass a bill, we are going to provide better coverage for them. The underlying bill will also reduce dramatically the number of people who don't have health insurance in America by 31 million. That will make our system much more effective. I have heard my colleagues talk about what is going to happen with Medicare. If we pass the underlying bill, we are going to strengthen Medicare. We already have a provision that there cannot be reductions in the guaranteed benefits. We pointed out that AARP endorses the bill. They understand there will be additional preventive health care for our seniors, and we will help fill the doughnut hole in prescription drugs. When you reduce the number of uninsured, the amount of cost Medicare has to pay for health care in our hospitals is reduced. That is why we can reduce our payments to hospitals in America, because the amount of uncompensated care they currently have will be dramatically reduced. I have heard colleagues on the other side of the aisle talk about Medicare Advantage. I remember when we used to pay the private insurance companies in Medicare a little less than people in traditional Medicare. Then we paid them the same. Now we are paying them more. That is corporate welfare. Medicare Part B premiums are higher than they should be. Taxpayer support is higher than it used to be. We know these benefits that are being paid could be gone tomorrow. We saw the private insurance companies leave the Maryland market and so many other markets. These are reforms that save the taxpayers money and strengthen Medicare for the future. Bottom line: The bill is good for middle-income families. It will provide the insurance reform so they have an insurance product that can cover their needs, including wellness and prevention programs. It is good for small business because it offers more choice. I can tell you chapter and verse of small companies in Maryland that, today, cannot get an affordable product and are seeing 20, 30 percent increases in their premiums. They need this bill in order to be able to preserve health care for their employees. This bill, with the Mikulski amendment, will provide the preventive health care for all Americans that is so desperately needed, which will reduce costs, improve quality, and make our health care system more efficient and effective in the future, bringing down costs by investing in wellness and prevention. I urge my colleagues to support the Mikulski amendment and to support the underlying bill. I yield the floor.

Mr. CARDIN

Mr. CARDIN. Mr. President, I rise today in recognition of World AIDS Day, an international commemoration held each year on December 1 to raise awareness of HIV and AIDS around the world. The theme for this year's World AIDS Day is ``universal access and human rights.'' Around the world, 33 million people were living with HIV in 2007, including 2.7 million new infections. In the U.S., more than 1.2 million people are infected with HIV. According to the Joint United Nations Program on HIV/AIDS, or UNAIDS, global reports indicated that 2 million people died from AIDS-related causes in 2007. Globally, sub-Saharan Africa is the hardest-hit region when it comes to HIV infection, accounting for two-thirds of all people living with HIV and for three-quarters of AIDS deaths in 2007. Sadly, 75 percent of young people worldwide who are diagnosed with HIV are girls living in sub-Saharan Africa. According to the results of a global youth survey conducted in 99 countries, 50 percent of young people have a dangerously low knowledge of how the disease is contracted and can be prevented. Another report by UNAIDS collected data from 64 countries and found that fewer than 40 percent of young people have basic information about HIV. This knowledge gap is particularly disturbing when taking into account a UNICEF report that indicates that 4.9 million young people, ages 15-24, are living with HIV worldwide. Despite these statistics, recent advances in prevention and treatment of HIV give hope for the future. Globally, approximately 38 percent of the 730,000 children under 15 who needed antiretroviral drugs to treat HIV in 2008 were receiving the necessary therapy, according to UNAIDS. This is a huge increase from just a little over 10 percent in 2005. The percentage of pregnant women living with HIV who received antiretroviral treatment to prevent mother-to-child transmission has increased from 9 percent in 2004 to 33 percent in 2007. Despite recent improvements in treatment coverage and declining mother-to-child transmission of HIV, problems remain in preventing and treating the disease. In addition, the number of new HIV infections continues to outpace the advances made in treatment numbers for every two people put on antiretroviral drugs, another five become newly infected with the disease. Clearly, prevention measures are essential to continue the fight against HIV/AIDS. No State in the U.S. is immune from the effects of HIV/AIDS, and the epidemic is deeply felt among Marylanders as well. At the end of 2007, Maryland had 28,270 people living with HIV and AIDS. That same year, Maryland ranked fourth in the U.S. for the number of AIDS cases per 100,000 people. The Maryland Department of Health and Mental Hygiene has estimated that there are between 6,000 and 9,000 Marylanders who are unaware that they are infected with HIV. Of the 1.2 million people in the United States who are estimated to be infected with HIV, as many as 21 percent are unaware that they have the virus. To address this problem, it is crucial that HIV screening be readily available and accessible to everyone at little or no cost. This will increase the rate of diagnosis in individuals that have HIV and will accelerate their treatment. The Patient Protection and Affordable Care Act will address this need and will help achieve the goals outlined by the theme of this year's World AIDS Day campaign of ``universal access and human rights.'' First and foremost, the bill eliminates discrimination based on pre- existing conditions. Individuals with HIV will no longer be rejected from insurance coverage because of their disease. The bill also encourages outreach to enroll vulnerable and underserved populations in Medicare and CHIP, including adults and children with HIV/AIDS. It provides personal responsibility education grants to States to create HIV/AIDS education programs for adolescents. The bill will also cover preventive services recommended by the U.S. Preventive Services Task Force, including HIV testing for all pregnant women. This testing will be provided at no individual cost, making it universally accessible to all women in the U.S. Testing pregnant women for HIV is vital for prevention efforts, allowing women who test positive to begin antiretroviral drugs to prevent transmission to their baby. Furthermore, the Mikulski amendment, which I have cosponsored, would allow coverage for HIV testing for all women, regardless of risk, based on expert recommendations from the Health Resources and Services Administration. The Patient Protection and Affordable Care Act also provides grants to encourage training health care workers to treat individuals with HIV/AIDS and other vulnerable populations. Because of the numerous provisions in the bill that will help the prevention and treatment of HIV/AIDS, several groups have expressed their support for the Patient Protection and Affordable Care Act. Among the groups that I have heard from is the HIV Medicine Association, an organization representing 3,600 physicians, scientists, and health care professionals who work on the frontlines of the HIV/AIDS epidemic in communities across the country. We must continue to fight HIV/AIDS, and I urge my colleagues to support the measures outlined in the Patient Protection and Affordable Care Act that will further our efforts to combat this disease.

Mr. CARDIN

Mr. CARDIN. Mr. President, for six decades the Voice of America's, VOA, Ukrainian-language service has been providing an invaluable service through its consistent broadcasting of factual and comprehensive news and information to the people of Ukraine. During the first four decades of its existence, the Ukrainian service reached a Ukrainian population starving for information under an extremely strictly controlled, propagandistic Soviet media environment. Ukrainians went to great lengths and some risks to overcome Soviet censorship, which included the jamming of VOA and other shortwave international broadcasting. During the Cold War VOA Ukrainian provided its listeners with uncensored news about such monumental events as the Hungarian Revolution, the Prague Spring, rise of Solidarity, and the fall of the Berlin Wall. A variety of shows worked to open the outside world to Ukrainian listeners, including a Popular Music Show, a Youth Show, and the long running series Democracy in Action, which was about how democracy works in the United States. The Ukrainian service also focused on developments within Ukraine itself. VOA broadcasts about Soviet human rights violations in Ukraine, including its coverage of activities of the Helsinki process and the Helsinki Commission, gave sustenance to Helsinki Monitors and other Ukrainian human rights activists, especially those languishing in the gulag for daring to call upon the Soviet government to live up to its Helsinki Final Act obligations. They knew that they were not forgotten. Furthermore, the Ukrainian service also provided objective information about the Chornobyl nuclear disaster and the development of Ukraine's movement for democracy and independence, culminating in the December 1, 1991, referendum in Ukraine in which an overwhelming majority of Ukrainians voted for the restoration of their nation's independence. For nearly two decades since, VOA's Ukrainian service has continued to fill an important role in Ukraine's evolving democracy. VOA reported on the challenges that Ukraine faced and on the U.S.'s considerable support and assistance for Ukraine, including in the dismantling of the nuclear arsenal it inherited from the Soviet Union. During the Orange Revolution, VOA Ukrainian helped to reassure millions of Ukrainians that the international community would not sanction electoral fraud. As Ukraine has evolved, so has the Ukrainian Service. While no longer broadcasting on radio as it did for most of its 60 years, it reaches more Ukrainians than ever with daily broadcasts over Ukrainian television--something unthinkable during Soviet rule--and reporting on its website. It continues to report on what is happening in Ukraine, but also it continues to cover every aspect of American life and society. As Chairman of the Helsinki Commission, I commend the ongoing role of VOA's Ukrainian service in helping Ukraine fulfill its aspirations in becoming a more fully democratic, independent, and secure.

Mr. CARDIN

Mr. CARDIN. Mr. President, first, let me thank the Senator from Montana, Mr. Baucus, for bringing forward a bill that has been long overdue on the Senate floor. This is a historic moment as we debate health care reform. Many of us have been looking forward to this moment for many years. As to this bill, the Congressional Budget Office has now confirmed, for the overwhelming majority of Americans, it will bring down their health care insurance premiums. This bill will bring down the growth rate of health care costs. It will provide affordable options for millions of Americans who today have been denied the opportunity to buy health insurance. The Congressional Budget Office tells us that it will insure 31 million Americans who otherwise would not have insurance, bringing down the uninsured rate. And, most importantly, the Congressional Budget Office--that objective scorekeeper; that is not Democrats, not Republicans; this is the objective scorekeeper--tells us this bill will bring down the Federal deficit. So it is a responsible bill, a bill that will provide affordable insurance options for millions of Americans who are denied insurance today. It will reduce our deficit, and will start to get a handle on the escalating cost of health care. It saves money. It saves lives through prevention and early detection of diseases, and by expanded coverage. And it saves Medicare. Why does it save Medicare? Because many of us who have been here for a long time understand that the only way you can bring down the cost of Medicare is to bring down the cost of health care. That is exactly what this bill does, providing for the long-term safety of Medicare for our seniors. It also expands benefits for our seniors in prevention and helps to start to fill the doughnut hole in prescription drug coverage. The underlying bill moves us toward what we need to do in health care reform. It brings down health care costs. How? By managing diseases and understanding the way we pay for diseases today is where most of the cost in health care is. This helps us manage diseases. It expands insurance coverage, which will bring down costs. It provides for investments in health information technology so we can bring down the administrative costs, and it invests in wellness and prevention. Amendment No. 2791 Mr. President, I rise today to encourage my colleagues to support the Mikulski amendment, which will ensure women have access to essential preventive services. The leading causes of death for women are heart disease, cancer, and stroke. Early screening for risk factors could prevent many of these deaths and lead to improved health and quality of life for women. But despite the benefits of early screening, many insurers do not cover them, and too often women skip them because the costs are prohibitive. We know early detection of disease saves lives, and so we must ensure that needed preventive services are available to all Americans, regardless of gender. I have long worked to improve access to preventive services. Knowing what we do now about the importance of prevention, it seems hard to believe that before 1998 Medicare did not cover cancer screenings or other preventive services. I am proud of a bill I authored in 1997 as a Member of the House of Representatives. It established the first package of preventive benefits in traditional Medicare. It was part of the 1997 Balanced Budget Act, and it would not have passed but for strong bipartisan support. Medicare now covers screenings for breast, colon, and prostate cancer, bone mass measurement for osteoporosis, diabetes testing supplies, glaucoma, and more. Last year's bill, the Medicare Improvements for Patients and Providers Act, gave HHS the authority to expand the list of covered services so that as new, highly effective procedures are discovered, they can be made available to beneficiaries without having to wait the length of time for Congress to act. This bill wisely builds on the benefit package for seniors and expands it to cover all Americans as part of their insurance coverage. We are expanding prevention and making sure it is available so all Americans will have a better insurance product that will cover preventive services. Basic screenings can have an enormous impact on health and save money in the long run. Chronic disease incurs a huge cost for our health care system. Today, more than half of Americans live with at least one chronic condition, accounting for 75 percent of all health care spending each year. To bend the cost curve, we need to reduce the onset of chronic diseases before they become much more expensive to treat. The American Cancer Society reports that the incidence of cervical cancer and mortality rates have decreased by 67 percent over the past three decades. This is mainly attributable to the introduction of the Pap test. The average cost for normal cervical screening in 2004 was $31. In contrast, the treatment for early-stage cervical cancer averaged $20,255, and the treatment for late-stage cervical cancer was almost $37,000. Screening saves lives, saves money. The bill before us invests in prevention. It will save money. It will save lives. Breast cancer screening has also been shown to reduce mortality. Early-stage diagnosis gives a 5-year survival rate of 98 percent, and statistics compiled by the American Cancer Society indicate that 61 percent of breast cancers are diagnosed at this stage, largely due to mammographies and other early screening methods. The bill before us guarantees coverage for a number of services to promote public health and wellness and to prevent devastating chronic disease. Some of these measures include providing coverage for everyone for services that have an ``A'' or ``B'' rating by the U.S. Preventive Services Task Force. These tests and screenings are either recommended or strongly recommended and include screenings for osteoporosis, colon cancer, and would be covered with no cost sharing--a strong incentive for people taking advantage of these screenings. Covering immunizations recommended for adults by the Advisory Committee on Immunization Practices of the CDC is also covered. Preventive care services and screenings for infants, children, and adolescents that are supported in comprehensive guidelines from the Health Resources and Services Administration--all that is in the underlying bill that will save us money and will save us lives. In addition to these vital services, the women's preventive health services must also be covered, the Mikulski amendment. The Mikulski amendment extends the preventive services covered by the bill to those evidence-based services for women that are recommended by the Health Resources and Services Administration. HRSA, a division of the Department of Health and Human Services, has as its goal to improve access to primary and preventive care services to uninsured and underinsured individuals. It focuses on maternal and child health, HIV/AIDS care, recruiting doctors in underserved areas, health care in rural areas, and organ donation. HRSA strives to develop ``best practices'' and create uniform standards of care, including eliminating health disparities among minority populations. Some of the additional services for women that will be covered under the Mikulski amendment include mammograms for women under 50. In 2000, breast cancer was the most common cancer affecting Maryland women, and nearly 800 women died from the disease, according to the Maryland Department of Health and Mental Hygiene. According to the Kaiser Family Foundation, 76.6 percent of women aged 40 and over had a mammography within the past 2 years. This amendment would ensure that all of these women would have access to mammography with no out-of-pocket cost. Also covered under the Mikulski amendment are cervical cancer screenings for all women, regardless of whether they are sexually active, and ovarian cancer screenings--all those will be made available under the Mikulski amendment. Ovarian cancer is the fifth leading cause of cancer deaths among women in Maryland. General yearly well-women visits would be covered; pelvic examinations, family planning services, pregnancy, and post partum depression screenings, chlamydia screenings for all women over 25. Chlamydia is the most prevalent sexually transmitted disease diagnosed in the United States. Approximately 4 million new cases of this disease occur each year, and up to 40 percent of the women infected with this disease may be unaware of its existence. It is the leading cause of preventable infertility and ectopic pregnancy. Also included are HIV screenings for all women regardless of exposure to risk. According to the Kaiser Foundation, among those women who are HIV positive, 33 percent of the women were tested for HIV late in their illness and were diagnosed with AIDS within 1 year of testing positive. We need to do a better job here. This is International Aids Awareness Day. I think it is very appropriate we have the Mikulski amendment on the floor today. Studies reported by the Kaiser Foundation indicate that women with HIV experience limited access to care and experience disparities in access, relative to men. Women are the fastest growing group of AIDS patients, accounting for 34 percent of all new AIDS cases in 2001, compared with 10 percent in 1985. So this amendment will help in regard to that issue for our women. Also included is sexually transmitted infection counseling for all women. Women disproportionately bear the long-term consequences of STDs. Screenings for domestic violence are covered. The Maryland Network Against Domestic Violence reports that one out of every four American women--one out of every four American women--reports she has been physically abused by a husband or a boyfriend at some time in her life. Well, the Mikulski amendment provides screenings for domestic violence. Also included are overweight screenings for teens, gestational diabetes screenings, thyroid screenings. Much of the debate on health care reform has focused on quality--how do we make our health care system work better and produce better outcomes for the money we spend. Ensuring that women have access to preventive services that are recommended by experts on women's health is absolutely essential to providing quality care. This amendment protects the rights of a woman to consult with a doctor to determine which services are best for her and guarantees access to these services at no additional cost. Preventive health care initiatives is one area I hoped we could all agree upon. The Senate has a long history of bipartisan support for women's preventive services. I hope the string remains unbroken with this amendment. I strongly support the efforts spearheaded by Senator Mikulski to extend the services that are covered for women. I strongly urge my colleagues to support this very important amendment that makes a good bill better. This bill is desperately needed. Let's vote for those amendments that improve it, such as the Mikulski amendment, and let's move forward with this debate. With that, I yield the floor.

Mr. CARDIN

Mr. CARDIN. Will my colleague yield?

Mr. CARDIN. If the Senator will yield for a moment, as Senator Klobuchar pointed out, if you don't have competition--and Senator Kaufman said the same thing--if you don't have competition, what is your choice? You are going to have to pay the premium. There was a Washington Post article written about a street in Gaithersburg. Gaithersburg is a growing suburban community not far from here, certainly middle-class families. They think they are doing fairly well. It talked about one street in Gaithersburg, and they gave half a dozen stories about people--real stories--about people having problems with our current system. They talk about Patty, who has private insurance and thought she was in good shape. She talks about having to search a book in order to find out what doctor she could go to to stay in the network because it is too expensive to go out of network, and then she hits her deductible and finds that her fees and copayments come in fast and strange, making it unaffordable for her with her current insurance coverage. She has no other choice. That is the only insurance she can get. Two doors down the road is Chuck who needs oxygen, needs certain medicines. He had to fight with his insurance company to get the prescription drug covered. He got the prescription drug covered, only to find out the nurse who administered the drug was not covered, and it cost $400--another problem with a private insurance company. Across the courtyard, Will and Sarah, they have insurance today. They are going to lose it because he just lost his job, and he has no prospect for being able to afford insurance. The last one is Martha. This is a very interesting one. Martha went to the emergency room for delivery of her child. She needed an epidural. She made sure she went to a hospital that was in-network because she wanted to make sure it was covered. Guess what. That anesthesiologist she had no control over was not in-network and she had to pay all that extra money. Again, no choice. She had no choice in the system. There is no competition. I know we have Senator Kirk here who is our newest Member. Perhaps the Senator could tell us what he is hearing from Massachusetts. He is a new Member here. I don't know whether he is getting the same stories of what is happening in his State.

Mr. CARDIN. We are running out of time, with only a few more minutes left. I want the people in Maryland and of the Nation to understand what this vote means. We are going to bring an amendment to the floor of the Senate for debate. Any Senator will be able to offer an amendment to how we should advance health care. The Senator from Massachusetts is absolutely correct. We are either going to continue to see our health care system with more people being denied coverage, with the costs escalating much faster than our economic growth, with businesses having to decide to terminate plans--that is what is going to happen--or we can take up health care reform and try to rein in the practices of private insurance companies and provide a way where every American can get access to affordable health care. That is why the American Cancer Society Cancer Action Network says: The American Cancer Society Cancer Action Network urges all Senators to vote in favor of allowing critical health care legislation introduced by Senator Harry Reid this week to be debated on the Senate floor. With thousands of cancer patients being denied coverage, charged excessive premiums, and facing exorbitant out-of-pocket costs, it is urgent that the Senate take action now, not later, to protect and extend health coverage to millions of Americans in need. Last week, Cynthia and Eric Cathcart were here in the Senate. They are two people who are self-employed. They cannot even get an insurance policy to cover their family. They have to have two separate policies, with two deductibles and two premiums, and they cannot afford it. We must take up this issue for the Cathcarts and the millions of Americans who cannot make it under this current system. Middle-income families are depending upon us tonight.

Mr. CARDIN. I was going to comment, listening to the Senator, at the desk that was Senator Kennedy's desk, how proud he would be of the statements the Senator is making here this evening. Senator Kennedy was our champion for middle-income families in America. He understood they needed a voice in the Senate, and he was their strong, passionate voice. This bill speaks to middle-income families. It is what Senator Kennedy fought his whole career for here in the Senate, to do something that would help middle-income families. As the Senator points out, we need to bring down the cost of health care. Health care costs are rising three times faster than wages. Senator Kennedy understood better than any of us that Americans are falling farther and farther behind because of the health care issues, because of health care costs. Private insurance companies can make lots of money if health care costs go up. They are not losing. It is the middle-income families who are getting hurt by the system. He understood that small businesses could not survive unless we figured out a way to deal with the health care issues. And as to people on Medicare--most people on Medicare are from middle-income families. We need to protect Medicare for the future. That is why, again, I get very concerned when I hear what we have heard over the last hour in the discussions, because one of the principal reasons we need to bring this bill forward on the floor of the Senate tonight is to strengthen Medicare, to make sure it is there for the future, to make sure it stays strong, and to make sure we expand benefits, as we do under this bill. I thank the Senator because those of us who have heard Senator Kennedy speak on the floor of the Senate know how sorely missed he is here, and we are proud you are representing that vote here on the floor of the Senate tonight.

Mr. CARDIN. That is the interesting point. These are all real stories, people who are being denied health care today because of arbitrary practices from private insurance companies or the way our system is currently organized. The vote tonight is a pretty simple vote. If you think the current system is what you want, OK, I understand why you are voting against cloture. I understand that you say the status quo is fine; we don't even want to debate the issue; we don't care about the people who have been affected by the arbitrary actions of private insurance companies and saying that pregnancy and childbirth is a ``preexisting condition'' or when you are using over-the-counter drugs to keep your cholesterol under control and the insurance company says that was a preexisting condition. All we are saying tonight is: Is this worthy of debate on the floor of the Senate--a clear vote? Those who vote for cloture say this is worthy. The people who have written us these letters are entitled to have the Senate take up this issue. That is why we point out that there are numerous groups, including the American Medical Association, that say vote for cloture, let's have this debate before the American people.

Mr. CARDIN. On the Medicare issue, during the last hour we heard all these people, who for a long time have been trying to privatize Medicare and reduce the program, now saying that Medicare is going to be in jeopardy if this bill moves forward. It is very interesting. The AARP gets it right when it says: The new Senate bill makes improvements to the Medicare program by creating a new annual wellness benefit, providing free preventive benefits, and--most notably for AARP members--reducing drug costs for seniors who fall into the dreaded Medicare doughnut hole, a costly gap in prescription drug coverage. This bill strengthens our health care system, strengthens Medicare for the future, and that is what is going to be critically important to our seniors. I thank my colleague.

Mr. CARDIN. Mr. President, will the Senator yield for one moment?

Mr. CARDIN. AARP not only wants us to advance the bill; they support the bill. They believe this bill will improve the Medicare system, make it stronger, and provide additional benefits, particularly in reducing the dread Medicare doughnut hole. They want the Members of the Senate to vote to allow this bill to come to the floor.

Mr. CARDIN. Let me thank Senator Klobuchar for setting the record straight as it relates to the Mayo Clinic. It is interesting, I have had conversations with people at Johns Hopkins University, the University of Maryland Medical Center. I hear the same thing. They desperately want to see health care reform. The cost issues are beyond their ability to maintain the excellence of our health care system. We have to get health care costs under control. If I might point out, I was listening to my colleagues on the other side give every reason why we should not move forward with the debate, saying: Don't worry, things will be OK. Those were the same arguments they made 15 years ago, which was the last opportunity we had to debate comprehensive health care reform. They blocked it from being on the floor of the Senate 15 years ago. What has happened in the last 15 years, after they said: Don't worry about it. Everything will be OK. Just keep on with our current system of protecting the private insurance companies. They will do a great job. In the last 15 years, we have seen health care costs go up, $912 billion, almost a three-time increase. We have seen the per capita cost of health care go from $3,400 to $8,100. We have seen that share of our economy in the last 15 years go from 13 percent of our economy to over 17 percent of our economy. We need to act. One more number I want to give because it affects Mayo Clinic and affects Johns Hopkins because in many cases they are the provider of last resort, where no one else will give care. Also, the number of the uninsured has increased since 1993 from 39 million to 46 million. The legislation that is being brought forward by our vote later today will reduce the number of uninsured by 31 million. Mr. President, 98 percent of Americans will be covered by health insurance with this bill. It reduces the growth rate of health care costs in America. It provides an affordable option for every American. This is a critically important bill. The Senator mentioned small companies. I am glad the Senator did because small companies are the ones that are most discriminated against today in our health care system. They pay 20 percent more for the same coverage as a larger company. They do not have options. They do not have a lot of choices about who they can get to insure them. Not only is the cost so high, the annual increases are unpredictable. How do you run a business, if you are a small business owner, not knowing whether your health care cost is going to go up by 10 percent, 20 percent, or 40 percent in the following year? You cannot. As the Senator knows, we have had small businesses come before us and tell us they are going to have to decide to eliminate their health care. In one case, we had a small business owner who said: Look, I am going to have to give up my business and start to work for a larger company because I can't afford the health care. We are at a crisis. I do not understand my colleagues on the other side saying they do not even want to have a debate on this issue, they do not even want to vote so we can take up this issue. Instead, they want to protect the private insurance companies and let them continue to make these profits, continue to cause real problems for our consumers. I have letter after letter from people who are confronting the problems of private insurance today, where they are denying coverage based on preexisting conditions or not covering a specific drug under their policies. There is no effective way to challenge private insurance companies today. This bill will give the consumers of America a chance against our private insurance companies.

Mr. CARDIN

Mr. CARDIN. Mr. President, shortly we will have an opportunity to vote on moving forward and considering health care reform in this country. I thank the majority leader, Senator Reid, for putting together the bill that came out of our two committees that accomplishes what I think are the three goals we need to accomplish in health care reform. I have been asked by the people of Maryland whether I would support a particular bill. I told them in order for me to vote for a bill, it has to do three things: First, it needs to bring down the cost of health care in America; second, it needs to provide an affordable quality insurance option to every American; and, third, it must be done in a fiscally responsible way. The bill Senator Reid is bringing forward accomplishes those three goals. First, it brings down the cost of health care in America by about $1 trillion. It does it by investing in prevention and healthy lifestyles; by cracking down on fraud, waste, and abuse; and by eliminating unnecessary administrative costs in our health care system. That is the way we should bring down health care costs in America. That will improve quality but bring down costs. Second, this bill allows every American to have access to affordable health insurance and health care. The Congressional Budget Office estimates the bill will reduce the number of uninsured in America by 31 million. We will be able to get 98 percent of Americans who are in this country legally, citizens, covered by health insurance as a result of this legislation. Third, this bill moves forward in a fiscally responsible way by not only staying within our budget but by actually reducing our budget deficit by $127 billion with no new tax burdens on middle-income families. I am particularly pleased this bill will help middle-income families in America. Mr. President, I know you have received letters from your constituents. I have received letters from my constituents that tell us the status quo is unacceptable for middle-income families in America. Let me give two examples of people who wrote to me. I got hundreds of letters from Marylanders telling me they cannot make it under the status quo. This is from Meg, from Rock Hall, MD. Rock Hall, MD, is on the eastern shore. She is a healthy, active 62-year-old woman. She plays tennis four times a week. She is not on prescription medicines and has never had a major medical issue. She wanted to change her insurance coverage. She has insurance, but she wanted to go to a more affordable insurance plan for her family. She was denied coverage. Why? Because she had received counseling 3 years earlier due to a stressful family situation and because she had a slightly elevated cholesterol level. Her cholesterol has been brought under control taking over-the-counter medication, and she has not had counseling in over a year. She writes to me, and how do I answer that? It says: If I am considered high-risk, where does that leave Maryland residents who have serious health conditions, are on medications, or require on-going care? Meg is absolutely right. The bill the leader is bringing forward will deal with middle-income families such as Meg's by telling health insurance companies they cannot participate in such discriminatory practices, by restricting preexisting conditions. In fact, Meg doesn't have preexisting conditions, but they are using that to deny her full coverage. Earlier this week, Cynthia and Eric Cathcart came to us, came to this Capitol to tell us their stories. I must tell you, I was shocked to hear of their circumstance. Here are two individuals who are self-employed, trying to make it. They have two children. They are trying to get along. Eric told us he is basically giving up on his business and is going to have to work for a larger company because he can't afford health insurance. Cynthia, who is a piano instructor, tells us the same story. Listen to this. Here are a husband and wife, two children, and they cannot get an insurance policy to cover their whole family because of the preexisting condition restrictions. These are small business owners who are going to have to literally give up their businesses. Today they have two separate insurance plans: one for the husband and child, one for the wife and child, because that is the only way they can get it. They have to pay two separate deductibles because they couldn't get an insurance plan to cover the family. The amount of money they are paying for health insurance is prohibitively expensive. The status quo is not acceptable for the Cathcarts and should not be acceptable for any of us. Under the health care bill the leader is bringing forward, though, discriminatory practices by private insurance companies would be prohibited, and the Cathcarts would have the option of a lot of different plans they could choose from to cover their entire family without separate deductibles for different members of their family. That is the type of health care reform we need that will help middle- income families in America. It will help middle-income families by bringing down the cost of health care. The cost of health care in America is growing at way too fast a rate. Ten years ago in Maryland it cost an average family about $6,000 for health insurance. Maybe their employer paid part; maybe they paid part. Today that is $12,000 a family. By 2016 it will be $24,000 a family if we do not take action. We need to help middle-income families. We need to move forward with health care reform. The average family in Maryland today is paying $1,100 per family for the cost of those who do not have health insurance. Those who have health insurance are paying for those who do not have health insurance. That is why the bill the leader is bringing forward, that will cover 98 percent of Americans, is going to help middle-income families by eliminating that hidden tax of $1,100 per family in Maryland and around the country. Health care costs are growing three times faster than wages are growing in America. Inaction should not be an option. For small businesses the situation is very dire. They are spending 20 percent more than a comparable company that does the same business that is larger. Just as stressful, they cannot predict what the annual premium increase is going to be. How can you run a business without knowing what your costs are going to be from 1 year to another? For the sake of small businesses we need to move forward with health care reform. A lot of families in Maryland depend upon Medicare; a lot of middle- income families in Maryland depend upon Medicare. This bill will strengthen Medicare by dealing with the underlying costs of health care, by getting that under control. At the same time we protect Medicare for the future, we provide additional benefits for our seniors by starting to close the doughnut hole, getting prescription drug costs under control, and providing preventive care for our seniors. This legislation will help middle-income families by dealing with insurance reform and eliminating preexisting conditions. It will provide larger pools to offer more choice for middle-income families. This legislation will help workers who work for small companies. It will help those people in our community who have preexisting conditions. It will help those people in our community who are changing jobs. It will help those in our community who depend upon Medicare. This is legislation that is critically important for middle-income families in America. The status quo is unacceptable. We need to act, and we are going to have a chance to do that when we vote Saturday on proceeding with health care reform. I urge my colleagues to move forward on this vital legislation for America. I yield the floor. The PRESIDING OFFICER . The distinguished Senator from Utah is recognized.

Mr. CARDIN

Mr. CARDIN. Mr. President, as we prepare to depart for the Thanksgiving break, I wish to thank those who work to combat hunger in this country and to commend the administration for its goal of eliminating child hunger by 2015. I encourage the administration to work with Congress to find solutions to achieve this goal and end hunger in America. We must commit ourselves to solving this crisis. The U.S. Department of Agriculture has just released findings that 14.6 percent of Americans were ``food insecure,'' up from 11.1 percent in 2007. Food insecurity is measured by the number of persons who experience hunger at some point during the year because they could not afford enough food. The Agriculture Department also found that one-third of these households had what the researchers called ``very low food security,'' which mans that they were forced to skip meals or cut portions. The other two-thirds of households got by only through reliance on food stamps, soup kitchens, and food pantries. The nearly 4 percent increase in food insecurity between 2007 and 2008 is the largest since USDA began reporting hunger statistics in 1995. Even more disturbing, USDA reports that nearly 17 million children live in households where food was scarce at some point during the last year. This figure amounts to more than one out of every five children in the United States. An astonishing 1.1 million children went to sleep hungry at some point in 2008--a 36-percent increase from 2007. In my State of Maryland, more than 135,000 children currently live in food insecure households. Sixty-three thousand of these children are under the age of 5. No child should ever know what it means to be hungry. Childhood hunger hinders development in the long term, and children who are hungry have difficulty learning and are at much higher risk to be in poverty as adults. Hunger negatively affects children's behavior, school performance, and cognitive development. As we celebrate this holiday season, it is important to reflect on how each of us can support our communities. In my home State, the employees and volunteers at the Maryland Food Bank provide 14 million pounds of food annually to those in need. Working with more than 1,000 partner organizations, including soup kitchens, senior centers, daycare centers and afterschool programs, the food bank works to fill unmet needs of Maryland families. In these difficult economic times, the services of the Maryland Food Bank are more important than ever. During the past year, the staff at the food bank's facilities in Baltimore and Salisbury saw demand increase by 50 percent. Middle-class families who a year ago made donations to the food bank are now turning to the organization to put food on their own tables. Americans with full-time jobs are the fastest growing cohort of those in need. As unemployment continues to rise, families are being forced to spend their savings and are too quickly moving from middle to low income. America's working poor are most at risk. They live from paycheck to paycheck and have no safety net if their company downsizes or their hours are cut. When money is short, Americans are forced to make excruciating choices. It is estimated that one-third of Marylanders relying on food assistance must choose between buying food and paying utility bills. Fifty-three percent of those who receive food assistance have unpaid medical bills. The number of working poor families in Maryland is 70 percent higher than it was two decades ago. In addition to the food bank, I also want to highlight the work of employees at the many social service agencies across our State. These dedicated workers devote their time and energy to helping their community and work side-by-side with the Maryland Food Bank and other organizations to provide meals and services to those in need. For example, the Maryland Department of Education works closely with the Maryland Food Bank on several projects that provide students with nutritious meals. More than 303,000 Maryland children rely on free or reduced-price meals in schools. Through the Backpack Program, the food bank provides schools such as Baltimore Highlands Elementary with backpacks filled with food. Children receive the backpacks on Friday afternoons to ensure they are not hungry over the weekend. Kids Cafe is an innovative partnership between the food bank, the Maryland Department of Education, and local afterschool programs that provides nutritious meals and teaches children how to make healthful food choices. Our seniors are also at risk of food insecurity at much higher levels than the general population. I applaud efforts such as the SNAP Outreach Program in Maryland, which is a partnership between the USDA and local organizations to help register seniors for food assistance programs. Despite these efforts, we need to do more. In my State alone, it would take 82 million pounds of food to support the more than 350,000 Marylanders in need every year. We must recommit ourselves to serving our communities and work together to support those in need during these difficult times. So as Senators and staff leave Washington for their home States and prepare to give thanks and enjoy the company of family and friends, I encourage us all to show our support for those who work daily to make mealtime possible for millions of Americans in need.