Bob Casey

Mr. CASEY

Mr. CASEY. Mr. President, I rise tonight to also speak about health care, as we have heard from some of my colleagues. I was coming in as Senator Whitehouse was concluding his remarks on the floor and am grateful for his leadership and the leadership demonstrated by so many of our colleagues here on this critically important issue. We have heard a great deal in the last couple of weeks about some of the fundamentals of health care reform. I was speaking last week about children and some of the progress we need to make in the final bill to protect our children, to make sure that especially poor children are not only not worse off at the end of this debate but also that they are, in fact, better off because of the reforms we make. We have great programs to work with. The Children's Health Insurance Program, for example, has been tremendously successful in insuring the children of working parents. We know the kinds of early, periodic screening and diagnostic testing done in Medicaid is very important to poor children and their families. So there is much we have to do just with regard to children. Our older citizens, of course, are a huge focus of this health care reform. We want to control costs. We want to provide better quality, ensure prevention strategies that will not only save lives but also save us a lot of money. We want to wrestle, as we have been trying to do, with the cost issue, and we will continue to do that, and I think successfully. But one area I think we often, unfortunately, overlook is what happens to our small businesses. We know that most of the jobs in America--the foundation of our economy--are created by small businesses. These are the very businesses in States such as Pennsylvania and the Presiding Officer's home State of Illinois and States across the country--big States and small State--where businesses have been devastated by health care costs. Over and over again, we hear it. Just in the last couple of days, we saw this headline in the New York Times: ``Small Business Faces Sharp Rise in Health Costs.'' And the subheadline or the reference to the story says: ``Up 15%, On the Average.'' ``Insurers Increase Rates as Congress Weighs Major Overhaul.'' So there are a lot of small businesses in Pennsylvania and across America that are waiting to see what the House and the Senate will do. What kind of bill will we send to President Obama for his signature? If we do nothing, there is one thing we are sure of. If we do nothing, if we do not pass legislation this year--as I think we will-- but if the Congress did nothing, we know those costs are going up all the time. The New York Times reminds us of that: ``Up 15 percent, On the Average.'' There is an increase in costs, if we do nothing, that has been escalating for years now. We have had people in the Congress, here in this Chamber, and other places saying: We have to help small businesses. We have to be conscious of what their needs are, the difficulties they have had in this recession. Families have had a lot of difficulties, obviously. In addition to that, small businesses have. But we cannot say we really are concerned about what happens to small businesses--small business owners--in America if we do not help them on health care, if we allow this to persist, this spiraling, ever-increasing cost of health care for small businesses. If you look at it just in terms of Pennsylvania--one way to look at this is just in terms of State numbers. These numbers, we will not have to go through. I know some of them are small. But here is the basic point: cost of health benefits to small businesses per year if there is no reform. This is just for Pennsylvania, as shown on this chart. If you look at the year 2009: 7.43--the annual spending in billions of dollars in the State of Pennsylvania. Almost $7.5 billion spent by small businesses on health care. You do not need to read every number here because a lot of them are small, but you can see the trajectory of that graph, that blue line going up and up and up. So by the time 2018 rolls around, not even a decade away--9 years away--if we do nothing, Pennsylvania's small businesses will pay more than $16 billion for health care--just in less than a decade, more than a doubling of health care costs for small businesses in one State. One can just imagine. One doesn't have to be an expert with numbers to extrapolate from that what that means for the United States of America. Small businesses already crushed in many instances by health care costs, being crushed even further. That is the cost of doing nothing. There are a lot of ways to measure that, but the cost to small business is one of them. According to an August 2009 Small Business Majority survey of 200 Pennsylvania small businesses, the top three concerns for small businesses in Pennsylvania--and I have no doubt this is similar to the rest of the country--here are the three top concerns: No. 1, controlling costs; No. 2, having insurance that covers everyone; and, No. 3, ensuring at least high-quality standard benefits. So small businesses have the same concerns that many people here have: controlling costs, enhancing quality, and making sure we have broad coverage. Ninety percent of small businesses in Pennsylvania want to eliminate preexisting condition rules, and 75 percent see these rules as a barrier to starting a business. So someone is making a decision, making a determination about whether they will start a small business, and they think to themselves: I may not be able to get this business off the ground because of health care costs or because of preexisting conditions. Why have we allowed this problem--not just the cost problem but the problem that we point to all the time of preexisting conditions--why have we allowed insurance companies to do that? Well, we have allowed it over many years because we haven't taken them on and defeated them when it comes to passing legislation. This is the year when at long last we are going to say to insurance companies: You cannot have this kind of power over people's lives, over people's business decisions by, for example--one of many examples, but the most prominent, the most egregious example--denying someone coverage because of a preexisting condition. I know this summer, way back in the middle of July, as a member of the Health, Education, Labor and Pensions Committee, we passed our bill out of that committee and the first section of that bill dealt with the preexisting condition problem. In one sentence in that bill we set forth a determined effort to make it illegal to prevent someone from coverage because of a preexisting condition. So this is about individuals and families, as well as about small businesses. They, too, suffer from the preexisting condition problem in our health care system. There are a lot of other numbers I could point to in a survey. I will not go through all of those, but I do wish to highlight tonight as well what we heard just yesterday, or part of what we heard yesterday in the Health, Education, Labor and Pensions Committee where we had a number of witnesses. One of those witnesses was Jonathan Gruber who is an MIT economist. He testified that small businesses--and I am paraphrasing his testimony; it is all in the record--small businesses are disproportionately hurt by the health care status quo and that health insurance reform will lower--lower--premiums and save jobs in the small business sector. I am quoting from Dr. Gruber from MIT: Small business has little to fear and much to gain from health reform. Not my words, the words of an MIT economist who has spent time not just analyzing health care reform over many years, he played a role in helping Massachusetts develop their strategy. But he is talking about reform generally on health care as it relates to small businesses. Professor Gruber also talked about health insurance reform breaking down many of the barriers that currently are faced by small business owners or prospective small businesses. For example, unpredictable premium jumps, as we see on the chart. Whether they are predictable or not, they occur all the time. But they are especially problematic when a small business owner doesn't have any warning. Fear of starting new businesses for lack of affordable health insurance options is an impediment to starting a small business. An impediment to creating jobs is another way of saying it, in my judgment. Professor Gruber talks about other barriers to small businesses under our current system: higher costs and limited choices due to administrative expenses and lack of bargaining power. Just imagine what it is like for a small business owner in a huge environment where they don't have the kind of bargaining power a big company has or they don't have the kind of bargaining power the Federal Government has to go into the marketplace to keep costs down. So they go in virtually unarmed or alone into that marketplace, a small business owner, who might have 4 or 5 or 7 or 8 or 10 or 20 employees. Tax credits would help small businesses who need it the most to help them pay for insurance. Dr. Gruber unveiled a new analysis in his testimony showing that health insurance reform will save small businesses 25 percent over the next decade. One thinks: Well, 25 percent, what does that mean? By his estimate, this 25 percent savings to small business as a result of health care reform, in his judgment, would be a $65 billion-per-year savings for small business. That is Dr. Gruber at MIT, not my words, not the words or the analysis of some Senator or House Member on one side of the debate or the other. So the consequences of those savings would be enormous to small businesses in America. I know we need this kind of reform in Pennsylvania. Workers in small businesses would see an increase in their take-home pay, according to Dr. Gruber, of almost $30 billion a year. That affects all of our lives in a very positive way. If a small business in our community can hire more people, can make an investment in the development of that small business because of health care savings as a result of a health care reform bill, our communities will be stronger. We will have more people working. We will have a much stronger economy right at the community level, not just in a macro or larger scale way. Finally, on this analysis of what health care reform could mean to small businesses in terms of savings, that reform could save almost 80,000 jobs, according to Dr. Gruber--80,000 jobs in the small business sector by 2019. Dr. Gruber also dispelled the myth that health insurance reform will raise costs for small businesses. He said: Objective CBO analysis shows that these claims are clearly wrong. Reform will lower, not increase, nongroup insurance costs. So says MIT economist Dr. Gruber, who has lots of experience in this area and is lending the benefit of his experience and his insight into these analyses on health insurance reform, but in particular as it relates to small businesses. So what we want to try to do with health care reform when it comes to a State such as Pennsylvania is take this blue line of an exponential increase in health care costs for small businesses in one State--and I think this is true of the country as well, in my judgment--we want to make sure this line and this exponential increase is turned the other way or at least begin to flatten out so that the $7 billion that small businesses are paying in Pennsylvania for health insurance reform by the year 2018 might be only something a little less or a little more than $7 billion. We cannot say with a straight face or with any degree of integrity, in my judgment, that we want to lower costs for small businesses, that we want small businesses to hire more people, and then in the next breath say: But I don't think we should pass any health care reform. It is too complicated or it is too something to get it done this year. We cannot do that. We cannot continue to say: Oh, isn't it too bad that health care costs are so high? Isn't it too bad we couldn't do something about the health care costs of small businesses? This, in the end, is not simply about the small business owner, it is not simply about what we are going to do for small businesses to help them get through this recession. This, in the end, is about our economy. We are either going to change course, get control of costs, reform health care and be able to move our economy forward or we won't meet that challenge. We are going to make the changes and institute reforms that will lead to lower costs, better health care outcomes, and a better bottom line for small businesses and, therefore, control long-term health care costs and long-term national debt. All of that comes from a good health care bill in the end. We cannot fail. We cannot at long last say we didn't get the job done. We have to for our families, for children, for older citizens, as well as for small business owners. I think we can. I think we have the strategy that the American people understand fundamentally, and I think we can do it this year. Mr. President, with that I yield the floor and note the absence of a quorum.

Mr. CASEY. Mr. President, I also ask unanimous consent that after the next, I believe, 10 minutes expires on our time, that I be permitted to speak in morning business beyond that time by, oh, say 10 minutes at the most.

Mr. CASEY

Mr. CASEY. Mr. President, as in executive session, I ask unanimous consent that the nomination of Suresh Kumar, to be Assistant Secretary of Commerce and Director General of the United States and Foreign Commercial Service, received in the Senate on October 29, 2009, and referred to the Banking Committee on November 2, now be jointly referred to the Commerce Committee.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that S. 1506 be discharged from the Committee on Commerce, Science, and Transportation and be referred to the Committee on Banking, Housing, and Urban Affairs.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 9:30 a.m., Thursday, November 5; that following the prayer and the pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate proceed to a period for the transaction of morning business for 2 hours, with Senators permitted to speak therein for up to 10 minutes each, with the time equally divided and controlled between the two leaders or their designees, with the majority controlling the first half and the Republicans controlling the final half; that following morning business, the Senate execute the order with respect to H.R. 2847, the Commerce, Justice, Science appropriations bill, as provided for under the previous order.

Mr. CASEY

Mr. CASEY. Mr. President, if there is no further business to come before the Senate, I ask unanimous consent that it adjourn under the previous order.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid upon the table, with no intervening action or debate, and any statements related to the resolution be printed in the Record.

Mr. CASEY. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. Res. 336, submitted earlier today.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the Senate proceed to a period of morning business with Senators permitted to speak for up to 10 minutes each.

Mr. CASEY

Mr. CASEY. Mr. President, I would like to recognize the contributions of the 56th Stryker Brigade, which recently returned to homes and families across Pennsylvania. For nine months, the 56th Stryker Brigade has been deployed to Camp Taji, Iraq. Here, these civilian soldiers, known as the Independence Brigade, worked side by side with their Iraqi counterparts to continue to bring stability and security to the Iraqi people. On the front lines, they patrolled neighborhoods in unrelenting conditions, targeted insurgents, and swept for improvised explosion devices, IEDs. They performed more than 800 combined operations, captured seven brigade-level high valued targets, and discovered more than 80 enemy weapon caches. Any success we have had in Iraq is not only the result of military achievements. In this regard, it is equally important to recognize the $22 million in reconstruction efforts that the 56th Stryker Brigade assisted with in coordination with an embedded U.S. provincial reconstruction team. While these young men and women are now home, we must also remember those who fell in battle. Two members of the 56th gave ``the last full measure of devotion.'' Specialist Chad Edmundson of Williamsburg was killed by an IED and Staff Sergeant Mark Baum of Quakertown was killed by enemy small arms fire. To these soldiers' families and friends, I want to express condolence and gratitude on behalf of the people of Pennsylvania for their sacrifice. Please know that our prayers are with you, and that we will never take for granted their personal courage and sacrifice. We pray for Chad and Mark and ourselves that we may be worthy of their valor. While deployed, many things may have changed for these members of the Pennsylvania National Guard. For example, some service members met their sons and daughters for the first time. Nevertheless for all, a time of readjustment and reintegration back into their communities and daily lives lies ahead. I want the National Guard to know that I will always be committed to helping them during this phase. I know that there are other Guard members who bear scars from battle, some visible and some not. The U.S. Senate must ensure that our citizen soldiers' jobs are maintained while they are deployed and we must provide opportunities for them to find employment upon their return. For this reason, I will continue to urge my colleagues to take up and adopt the Service Members Access to Justice Act and the FORCE Act, which will make National Guard assistance programs more effective and responsive, and ensure that National Guard troops keep their jobs and employment benefits as required under law. Again, I want to express my appreciation to the 56th Stryker Brigade and all of our men and women in service.

Mr. CASEY

Mr. CASEY. Mr. President, I rise tonight to speak about health care and all the issues we have been debating under the broad umbrella of health care reform. Obviously, I will not get to all of them tonight, but I am going to spend a few minutes talking about two general areas. One is a list of changes that I believe will take place when our work is completed in the Senate and after what I hope will be President Obama signing a bill on health care reform in a matter of weeks. That will change what I believe has been an unfair burden carried by the American people, at the expense of the American people but brought on by the power, sometimes the awesome power, of insurance companies. I will talk about that, but also I want to speak mostly about changes that need to be made in our health care system for children. There are a couple of points on basic reform measures that I believe will be part of what we complete in the next couple of weeks. First, a basic list of consumer protections that we talked about for many years but we have never made illegal will prevent insurance companies from continuing what is often blatant discrimination. One of the things we have to do this year is end discrimination for preexisting conditions. If what I believe is the prevailing point of view in this body is successful, insurance companies will be prohibited from refusing you coverage because of your medical history. Out-of-pocket costs will be limited, as well as deductibles or copays. Free preventive care: Why should we say on the one hand we encourage prevention, as we have for years, but now we are going to get serious about prevention in our health care system and make it part of every insurance policy and demand that we all engage in steps that will be preventive in nature and we also will say, for example, for a woman a mammogram is important but why, in the face of all of that, do we say to women in America, as is the current policy, that women have to pay exorbitant costs for mammograms? Frankly, I believe they should have to pay nothing for something as essential to prevention. So preventive care should be free or at a very low cost. If you are seriously ill, an insurance company should be prohibited from dropping your coverage. We should make that practice illegal. We should make gender discrimination illegal as it relates to insurance companies. I find it hard to believe that in 2009 we have to legislate to prevent insurance companies from discriminating against women, but we have to because that in fact happens today. Insurance companies will not be able to charge you more because you happen to be a woman, as happens today. Eliminating annual lifetime caps on coverage has to be part of the final health care legislation. Extending coverage for young adults is critically important. Guaranteed issue renewal: Insurance companies, I believe, should be required to renew any policy as long as the policyholders pay their premium in full and insurance companies will not be allowed to refuse to renew a policy because someone gets sick. If you get sick you should not lose your coverage, and if you get sick you should not have to bankrupt your family to pay for the health care you deserve. Finally on this list, and it is not an exhaustive list but I think it is an important list to review: protecting small businesses. Small businesses should receive tax credits so they can give their employees comprehensive and affordable health care and include a limit on out-of- pocket costs. These are some of the basic consumer protections I believe we should enact as part of this health care legislation. I also believe if you want to focus on a particularly vulnerable group of Americans, a group of Americans we have made some progress with in terms of their coverage, though we have not done nearly enough yet, I speak of children. We have made tremendous progress with the Children's Health Insurance Program, for example, and also the children in America covered by Medicaid, so children have the opportunity to receive very good care in almost every instance. But there are still some problems. Even in a State such as Pennsylvania, where you have, by last count, in a survey done in Pennsylvania last year for the Insurance Department, it showed that just 5 percent of Pennsylvanians up to the age of 18 were uninsured. That 5 percent is too high. We want to get that to zero, of course, but it is a lot lower than it would have been without the Children's Health Insurance Program or without other strategies. Unfortunately in our State, and I think it is true of most States, when you look at the age category 19 to 64, in that category the uninsured rate is more than double the uninsured rate for children. Instead of being 5 percent uninsured for children age 19 to 64, it is 12 percent. In Pennsylvania what that means is, if you are between the ages of 19 and 64, you are one of more than 870,000 Pennsylvanians who are uninsured. We cannot build an economy or improve our economy in Pennsylvania if we have that many people uninsured for a long period of time. I still believe, even with the progress we have made on children, we have much to do. For example, we have to do everything possible to increase outreach and facilitate enrollment for low-income families and children. We should not have a program such as Children's Health Insurance, or Medicaid, and then make it hard for families to enroll. So I led the effort in our HELP Committee this summer, even before we voted on a bill, to make sure that enrollment is made easier. I worked very closely with Senator Dodd, who long has been a champion for children and a strong advocate for children's health insurance. We should also focus on the benefit packages related to pediatrics, pediatricians. We had an amendment this summer in the HELP Committee that Senator Merkley and I cosponsored, ensuring that a pediatric representative would be part of any advisory commission to the Secretary of Health and Human Services regarding what should be in a benefit package. It is very important to have a pediatric representative at the table. Another thing that is critical is to have a requirement that pediatric preventive care be included in the list of mandatory preventive services that insurance plans offer with a minimum of cost- sharing requirements for families. No. 4 on this list, in terms of what happens to children in pediatric settings: In our committee bill we talked about medical homes--not a physical place, but a way to provide treatment, that is the idea for every American to have a primary care physician and then a network of specialists around them they have access to. That is certainly the ideal and the intent of a large part of the HELP Committee bill. Also it is important to remember that children are not just smaller adults or smaller versions of an adult; they have particular and special needs in terms of their treatment. So for children, their primary care doctor is a pediatrician and therefore pediatricians must be among those practitioners who are at the center of the care or the center of the medical home that surrounds a child. Also ensuring critical health care for children involving their oral health care: We ensured in the HELP Committee this summer the establishment of an oral health care education prevention campaign at the CDC focusing on preventive measures. We also increased funding for training for pediatric dentists in the bill we passed this summer out of the committee. It is critically important that children have access to that kind of health care in the early years of their life. We had a tragic, horrific example of what could go wrong when a child died here in the Washington region a couple of years ago--I believe actually the State of Maryland--when that child did not have access to a dentist and had horrific problems which led to that child's death. As a result of changes we make in our health care system, we must ensure that does not happen. Strengthening the pediatric workforce: Along with both Senator Brown and Senator Dodd, this summer in our HELP Committee bill we added a loan repayment program for pediatric specialists and providers for mental health services for children. We can't say that we care about children and not build in these particular protections for them in our health care system. Part of that is a workforce issue. We heard a lot in this debate about the shortage of primary care physicians. The intent of our bill in the HELP Committee was to make sure we would have a building up, an increase, in the number of primary care physicians. Again, for a child, his or her primary care physician is a pediatrician and it is critically important that pediatric specialists be available to children when they have special needs and special challenges that need to be treated by a specialist. I know I am over my time. I will conclude. One last point about the CHIP program: The Children's Health Insurance Program as we know is now a stand-alone program. There were some efforts this past summer and into the fall to have that program folded into any exchange that would be created as a result of the health care legislation. I thought that was a mistake. I made that very clear to others and to the Finance Committee as we were debating it. Thank goodness, Senator Rockefeller worked so hard and led the fight to keep the Children's Health Insurance Program as a stand-alone program. We should not fix what ``ain't broken,'' as the expression goes, and the Children's' Health Insurance Program works well for millions of children today. Within the next couple of years, that program will cover 4 million children who will be given access to the kind of care we would hope every child has. I think all these changes I have talked about, and more, come under the headline of ``No Child Worse Off.'' That should be, and will continue, I believe, to be one of the goals of health care reform. At the end of this process no child in America, especially poor children and children with special needs, will be worse off. We have a long way to go, lots more work to do. But if we are guided by that principle we will make sure our children have the kind of health care that we all hope for and they have a right to expect. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, last week the United Nations Food Agency announced there are now a record 1 billion people in the world who go hungry--nearly one-sixth of the world's population. The crisis that caught the world's attention last year has escalated and has had a devastating effect in all corners of the globe. On my left is a headline from the Associated Press from a few days ago: ``A Record One Billion Are Hungry, U.N. Report Says.'' This chart tracks from 1969 forward. We can see where it remained relatively stable for a while and then started to pick up in the early part of this decade, to the point now it is above 1 billion and is going in the wrong direction, going far too high--1 billion people in the world hungry. While the number of undernourished has increased steadily since the 1990s, there was a sharp spike last year due to the global food crisis. We can work to address this problem, I believe. We should work to address this problem, and I believe we must work to address this problem. Some people might say there is a bad economy in the United States. We have other major challenges and priorities. Why should we worry or address a problem that might seem too big to deal with and it is mostly about other places, they might argue. We know what hunger has done here in America, what a lack of food security has done to our country. But we also know it has devastating impacts across the world. There are at least two major reasons why the United States of America has to be deeply concerned about that headline of 1 billion people going hungry. First, it is a humanitarian crisis of incalculable proportions. As one of the richest countries in the world, we have, I believe, a moral obligation to help as we can and help when we can. I think this is one of those moments. This crisis is solvable with a combination of assistance and emphasis on providing small farmers around the world with the know-how, the technology, and the means to provide for themselves. There is also a second reason why we have to address this problem, and it involves something as fundamental as national security. Instability arising from conflict over access to food is a documented and real problem. It is irrefutable based upon what we have seen in the last couple of years. Last year's food crisis, unfortunately, brought this into acute focus. We saw it in Somalia where struggles to gain access to food have enveloped population centers in violence. We have seen it in Egypt during last year's bread riots. And we have seen it in Haiti where hospital beds filled last year with those injured during food riots. Increased instability in any of these countries, not to mention so many others, has a direct impact on U.S. national security and our national interests. There are a host of examples from across the world that illustrate the scope of the problem. Here are a few. Higher rates of hunger are shown to be linked to gender inequality, especially in terms of education and literacy, which also negatively affects the rate of child malnutrition. It is estimated that 60 percent--imagine this--60 percent of the world's chronically hungry are women and girls. Sixty percent of those chronically hungry in the world are women and girls. And 20 percent of that 60 percent are children under the age of 5. This is particularly evident in Chad which, according to the International Food Policy Research organization, ranks fifth worst on the 2009 global hunger index, second in terms of gender inequality, and has a female literacy rate of 13 percent, compared to 41 percent for men in that country. IFPR's research shows that equalizing men and women's status could reduce the number of malnourished children in Chad by 1.7 million people in sub-Saharan Africa and a shocking 13.4 million in South Asia. It goes beyond the one example in Chad. Hunger in Pakistan poses both problems. It poses both a humanitarian problem as well as a security problem. Last year, over 77 million people in Pakistan were considered ``food insecure'' by the World Food Program. That is nearly half of the population of that country. As Pakistan's military is conducting new operations against the Taliban, that number is expected to increase. Hunger and competition for food can lead to further instability and potentially undermine government leadership at a very critical time. Finally, the last example. In South America, Bolivia remains one of the least developed countries with more than two-thirds of its population living below the poverty line. Poverty is the main cause of food insecurity in Bolivia. The income of 40 percent of its population and 59 percent in rural areas is not enough to meet basic food needs. This also has had a real impact on the health of the population. Malnutrition, for example, in Bolivia has stunted the growth of nearly 30 percent of children. What should be done to address this urgent humanitarian and national security crisis? A couple of things. First, for too long, the international community has relied on an assistance model that provided food but not the capacity to grow food. We are starting to see a shift in thinking as the assistance community is more strategic about how they provide the training and technical assistance necessary to help the world's hungry. In 1980--another stunning number that I recite here--17 percent of aid contributed by foreign countries went to agriculture. This number plummeted to 3.8 percent in 2006 and has only slightly improved in recent years. Imagine that: The percent of aid contributed by foreign countries that goes to agriculture was 17 percent worldwide but has now gone down to a little less than 4 percent. Last year, the Bush administration responded quickly to the food crisis with emergency assistance. I was proud to be part of an effort to urge them to do that along with Senator Durbin and others. This was an important thing to do at the time and it was the right thing to do. While we may need to provide additional emergency aid to address the current crisis, we should simultaneously attack the root cause of the problems. I applaud President Obama and his administration for their efforts to help the hungry in America and across the world. In September, the White House announced the Global Hunger and Food Security Initiative, a comprehensive approach to food security based on a commitment, led by people in the administration, that focuses on both planning and collaboration. Secretary of State Clinton is leading a visionary ``whole of government'' effort to help the world's hungry. As the administration works out the details of implementation, I hope and trust we will maintain a sharp focus on the ability of small-scale farmers to grow food at an increased and sustainable rate. In the Senate, we have also worked to bring attention to the world's hungry. Senator Lugar, a respected leader in this field for decades, and I joined together to introduce the Global Food Security Act earlier this year. Our bill has three fundamental objectives. First, the bill will provide for enhanced coordination within the U.S. Government so that USAID, the Department of Agriculture, and other involved entities are not working at cross-purposes. We do that by establishing a new position, the Special Coordinator for Food Security, who will report directly to the President of the United States on international food security issues and who would forge a comprehensive food security strategy. Second, our bill would expand U.S. investment in the agricultural productivity of developing nations so that nations facing escalating food prices can rely less on emergency food assistance and instead take the steps to expand their own production. Every dollar invested in agricultural research and development generates $9 worth of food in the developing world. This provision can serve as a vehicle for the President's pledge to more than double the U.S. agricultural development assistance over the next 3 years. Third, our bill would modernize our system of emergency food assistance so that it is more flexible and can provide aid on short notice. We do that by authorizing a new $500 million fund for U.S. emergency food assistance when appropriate. Finally, we should note that our bill, the Global Food Security Act, has passed through our Senate Foreign Relations Committee, and we hope it will be on the Senate floor soon. This is one of those rare occasions where a serious crisis is greeted with serious administration support, interagency cooperation, as well as--we don't hear this too often--bipartisan collaboration in the Senate and House. This is the right thing to do and will ultimately enhance the security of the United States and our allies. The global food crisis last summer had a devastating effect on the poor in every corner of the world, and today we continue to see its terrible results. In times of economic troubles, it is difficult to find funds for all programs, including international affairs. Yet I believe we are summoned by our conscience to respond to this humanitarian crisis. I also believe we have an obligation--a deep abiding obligation--to strengthen our national security by enhancing food security here at home and around the world, especially in places where food insecurity threatens U.S. national interests. If enacted, the Global Food Security Act has the potential to help us meet these challenges and obligations. We have a plan that can work. Let's start to attack the roots of this terrible problem so another record number of hungry is not set next year, and let's hope we can somehow alter or change that headline of 1 billion people going hungry in the world. I yield the floor, and I suggest the absence of a quorum.

Mr. CASEY

Mr. CASEY. Mr. President, I rise to speak about the unemployment insurance issue and the bill that is before the Senate. Sometimes in a bad economy and when we have so many families, so many communities that are hurting, maybe the best way to convey information, other than a personal story, is in the few words of a headline. Unfortunately, in Pennsylvania today--and I am sure this is true in many communities throughout the country--the headlines in just the last 24 or 48 hours have told the whole story or at least most of the story. This is a headline you may not be able to see clearly, so I will read it. This is from the Times Tribune, my hometown newspaper. This was from yesterday: ``Jobless rate hits 9.5 percent.'' The subhead says: ``Regional unemployment reaches highest level since December '93; highest in 15 years in northeastern Pennsylvania.'' Then we go to southwestern Pennsylvania--Pittsburgh and that region, some 5 hours by car from where I live--and this is what the Pittsburgh Post-Gazette said on the same day, October 27: ``Region's jobless rate hits 23-year high in southwestern Pennsylvania.'' That is a part of our State that has been hit hard over a couple of decades now by the loss of manufacturing jobs and steel jobs. We know that tragic story. So a corner of the State that was doing much better than the national average is having its numbers go up. Northeastern Pennsylvania is at a 15-year high and southwestern Pennsylvania is at a 23-year high in unemployment. But this last one might tell the story even more graphically for those who have a sense of the Pennsylvania economy. This is from the Harrisburg Patriot-News. This is from our capital city, Harrisburg, but it is in a region of the State that is more south central Pennsylvania, which has had a lower unemployment rate historically and more recently. ``Jobless rate in region hits 26-year high.'' The subhead reads as follows: The midstate is faring better than the State as a whole and the Nation, but we are still hurting. Professional and retail jobs disappeared while health care and education held steady. But other than those two sectors, all the other sectors are hurting--Dauphin County, 8.4 percent--right where the capital is; Cumberland County, 7.2 percent; Lebanon County 7.4; Perry County, 8.8. For some parts of our country, one might say: Well, 7.2 or 7.4 sounds a lot better than a lot of communities. But you have to put it in the context of this region of Pennsylvania, where the unemployment rate is usually at 4 or 5 percent. So we are way above that now, and it is in places where we don't expect it. Unfortunately, in Pennsylvania, as I am sure is true in many States-- in the State of Florida, the Presiding Officer's home State, I am sure he sees this--this isn't limited to big urban areas. Philadelphia has a lot of unemployment, but there are small rural counties in northwestern Pennsylvania and now we see even in south central Pennsylvania that are hurting. And in some places, it is not just 7.2 or 7.4 but 11 and 12 and 13 percent in a very small area in terms of population. So these job figures and these headlines tell the whole story. And we know now, just as we knew weeks ago, that the Senate has stalled too long on providing an extension of unemployment insurance. Think of it this way: Each day, 7,000 Americans lose their unemployment benefits. Over 23,000 Pennsylvanians have lost unemployment insurance just through the month of September, and that number is expected to go to over 60,000 by the end of the year. Pennsylvania ranks fifth highest in the Nation with respect to the number of persons who will lose unemployment benefits by the end of the year if the Senate and the Congress overall do not act. As I mentioned before, our statewide unemployment rate is about 8.8 percent. Someone living in another State might say: Well, that is not nearly as high as this State or another State. But 8.8 percent in Pennsylvania means roughly half a million people are unemployed. And there are some people here in the Senate who say: Well, we shouldn't act on this now. We don't have time for it. We don't think it is important to act. Well, I would like to have them say that to the half million people in Pennsylvania who are out of work or the tens of thousands right now who are losing their unemployment insurance month after month, week after week. The legislation that is before the Senate would provide needed relief by extending benefits to all States by 14 weeks. At the expiration of those 14 weeks, if a State has an unemployment rate of higher than 8.5 percent, it would receive an additional 6 weeks of unemployment insurance benefits. So it contemplates an extension for everyone by 14 weeks and then additional help if a State is above the 8.5-percent level. I have to commend the work of our majority leader, Senator Reid, who has made this a central focus, as it should be, in the midst of a recession. One of the biggest challenges we face in the midst of a recovery-- even the beginnings of a recovery--is that you don't see the unemployment rate get much better. You don't see the jobless number come down. The unemployment figure is often the last number to come down during a recession. But for an economist or a Senator or anyone else to say: Well, the unemployment rate is a lagging indicator, that is not much comfort to someone who is out of work, and it is not a very good reflection on the urgency of the problem. So we have to be concerned with the unemployment rate even in what we hope is the beginning of a recovery. Even though our economy has shown promising signs of a recovery, which I just spoke of, the rate of unemployment is far too high. In order to boost our economy, passage of this unemployment extension would benefit so many communities. Another way to look at this is not just from the vantage point of the most important thing here, which is helping those who are unemployed, though that is reason alone to get this passed, but also what we will get for the rest of our economy, the kind of positive impact it has. It certainly has a positive impact for someone out of work--that is obvious--for his or her family and their community. But there is another way to measure it as well. Moody's chief economist, Mark Zandi, who is not a partisan either way, is a skilled and capable economist who says that every dollar spent in unemployment benefits generates $1.63 in new demand. So if you spend $1, you get $1.63 back. There is a return on investment for the overall economy when we target resources for unemployment insurance. The Congressional Budget Office, quoted widely in our health care debate, has also stated that unemployment benefits are one of the most cost-effective forms of economic stimulus. I mentioned some of the rates throughout Pennsylvania, throughout both urban and rural areas. All of these communities--whether a small town, a rural area, suburban or urban area--would benefit by keeping our citizens at work and not facing the threat of joblessness. I think it also helps our overall economy. We have tried to move the unemployment extension through the Senate two times by the so-called unanimous consent process. A lot of things move through the Senate by agreement on both sides. So you would think that would be the case in the midst of a recession, in the midst of these unemployment numbers, in the midst of week after week of bad news on jobs. And we know the unemployment rate doesn't choose between a Republican area and a Democratic area. The unemployment rate does not have a Republican or Democratic flavor to it. Everyone is out of work no matter who they are or of what party. But what has happened? We tried to move the unemployment extension through the Senate by unanimous consent, and the Republican side of the Senate blocked it both times. We could have had this done weeks ago but for one reason: the Senate Republicans blocking the unemployment extension going forward. It is tragically and I think painfully ironic that we are having to face this difficulty with our Republican colleagues because I keep hearing the following argument in the context of another topic. We are having an argument as to what our President should do with regard to our policy in Afghanistan and Pakistan. We hear people on the other side of the aisle, and pundits around Washington, saying the President has to decide on Afghanistan right now. They were saying that 3 or 4 or 5 weeks ago. They didn't want to give him more than a few days to decide on what our policy should be. I have a strong disagreement with that. I think when you are committing men and women on a field of battle, you ought to have a policy that you have thought about and where all the options are analyzed and reviewed thoroughly, completely, and with the kind of scrutiny we should apply to that question. Some Republican Members of the Senate wanted to move very quickly and wanted to have the President decide in a matter of days--not weeks but days. They wanted him to make up his mind on Afghanistan in days. Yet when we went to them with the sense of urgency about unemployment insurance and an extension of that, where you can literally document the impact of a delay on real people's lives and real jobs and real communities across our country, many of them in Republican communities, what do we hear from the other side? No, we don't think we want to do that right now. So they want what I think is a kind of dangerous and, I would argue, irresponsible speed on a decision about war, the grave question of war, but they want to delay and block and be an impediment to an extension of unemployment insurance, which is an urgent problem. We can document exactly the number of people who are running out of their unemployment insurance. We can document the exact number of people who are out of work in a State or in a community. So I think they have it backward. I think when it comes to a question such as the President is facing regarding Afghanistan, he should take a couple of weeks to analyze it, and thank goodness he has. But on unemployment insurance, I think it is a much simpler question: We are either going to extend it now and help people who are out of work or not. And I think it is long overdue for the Republicans in the Senate to release their hold or their blockade of this. So we tried on October 8, and now it is late October. Over 140,000 Americans have lost their coverage in the past 20 days--140,000 Americans--because we have people on the Republican side of the aisle blocking what we have tried to do. Thousands of Americans have withdrawn their last dollars from their savings accounts over the past 20 days. Thousands of Americans have been wondering for the past 20 days how they are going to provide a meal for their families or keep a roof over their head, pay the mortgage, pay the bill for their electricity, or make an investment in their children's future. Every day for the last several weeks, Jackie, from Monaca, PA, out in southwestern Pennsylvania, which, as I said, is suffering a 23-year high in unemployment, has called our office. She is wondering whether we are going to pass a bill. Her benefits expired at the end of September. So this isn't theoretical to Jackie and to her family and to many people like her. She used the last of her savings to pay her rent at the beginning of the month and now is struggling to get by on nothing--nothing right now. She waits every day to see if we will provide her with just a lifeline--not some handout, not some promise, but a lifeline to get from here to there, to get her over the bridge, so to speak, from where she is now to where she hopes to be in a couple of weeks or months. She looks for work and she tries to keep up with her bills, but her story is similar to that of thousands of others who have been directly impacted by the Senate Republican blockade. It is vitally important we pass this legislation right now. Finally, I will conclude with a comment about health care in the context of the unemployment rate and our economy. In addition to the obvious problem with unemployment insurance benefits that we should pass and get done, a lot of people are losing their health care at the same time. The recovery bill, the bill we passed and the President signed back in March, the Recovery and Reinvestment Act, provided a subsidy of 65 percent, where an individual pays 35 percent of the coverage for so-called COBRA coverage for those who were involuntarily terminated from their job. This subsidy only lasted for 9 months and is expected to expire at the end of the year. Following passage of an unemployment insurance extension, we should also, in addition, push for an extension of the COBRA health care subsidy. If we pass an unemployment insurance extension and do not provide an extension of COBRA health care subsidy, Americans who are out of work will have to decide between using their unemployment check to pay for a drastic increase in their monthly premium or no health insurance, no health coverage at all. I urge the Senate to swiftly pass not only the unemployment extension but, when we get to it in the next couple days or weeks, an immediate extension of COBRA and health care. We have to do both to protect people from the ravages of this economy which, as I said before, knows no party, which is not a partisan issue. It is an issue that affects all of America, urban and rural, big city and small town. We have to continue to push hard. I urge my colleagues on the other side of the aisle, the Senate Republicans, to allow this to go forward because, if they do not, I think their own constituents are going to be as harmed as many of my constituents are, in both parties. I yield the floor and suggest the absence of a quorum.

Mr. CASEY

Mr. CASEY. Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CASEY. Madam President, we are in the midst of a terrible economic recession. Over the course of the last year, we have lost millions of jobs. In Pennsylvania, for example, by comparison, the unemployment rate percentage is lower than a lot of States, but in many parts of our State it is at a historic high, or at least a 15-year high. What that means in Pennsylvania is that we have just about a half a million people out of work, even though some States have a much higher percent in their unemployment rate. So we have a half million people out of work. The fact that we just had this vote on unemployment insurance is vitally important. It helps us meet a real need across the country. So we have an economic crisis. People are living through the loss of a job, the loss of a home, or both--in some ways, the loss of their hopes and their dreams. Unfortunately, even as we get through this, even as we begin to recover, and even as we are dealing with a longer term challenge to our economy, which is health care--which is one of the reasons I think we have to pass a bill this year--there are other threats we have to bear in mind. One of them involves not just businesses but, by extension, workers and families. I speak of the funding of pension plans. A lot of businesses across the country--a lot of workers have come to Washington to remind us that this pension issue is a looming problem for a lot of businesses. I happen to be a member of the Health, Education, Labor, and Pensions Committee, and that is one of the issues we must deal with, and I think we will be dealing with, in the near term. Millions of Americans, not just throughout our history our recent history but especially now, rely upon any kind of retirement vehicle, and one of those, of course, is a good pension plan. We need to give people in the twilight of their life the kind of security that comes with a pension plan. We also have to make sure workers have that same peace of mind as they make their way through this very difficult economy. In 2006, the Pension Protection Act was passed by Congress. The main purpose of that act was to strengthen pension plans by implementing tougher funding rules. Most of the rules under the act took effect in 2008, and at that time the stock market was in turmoil. The combination of stronger pension funding rules in a chaotic stock market caused almost all pension plans to sustain a net loss, in essence. I wish to turn to one chart that depicts that. One study released by Mercer stated that the combined loss for pension plans totaled $469 billion for 2008. We can see the differential from 2007 where there was an overfunding of some $60 billion. So in 2007, $60 billion up; the next year lost over $400 billion, down; to be exact, $469 billion in terms of where we were in 2007 versus where we were at the end of 2008. Based upon this loss, pension plans have a funding deficit, a differential of $409 billion--$409 billion in 2008. In 2009, the pension funding deficit is expected to increase yet again despite recent recoveries in the stock market. We have to do what we must to strengthen our economy and to give our workers and their families and our businesses some peace of mind. That might be the best way to describe it. So this is more than just a looming crisis, more than just a problem in the near term, it is a problem we have to deal with right now, in the next couple of months. Recently, the House Ways and Means Committee held a hearing that focused on pension funding relief. They gave an example at the hearing. NCR Corporation, a 125-year-old global technology company, testimony at this hearing provided a specific example of how company pension plans have been affected. NCR, this global technology company, had a pension plan that was 110 percent funded as of January 1, 2008. So at the beginning of 2008, they were funded at 110 percent. They were in good shape, for the most part. The funding status, as those in the business know, is based on the amount of assets compared to the amount of liabilities. By January 1, 2009, just 1 year later, this same company, due to unprecedented losses in the market, had its funding percentage drop to 75 percent. So in 1 year, this company goes from 110 up of funding to 75 percent, a huge loss. This is what it means in terms of dollars. The percentages only tell part of the story. Prior to the market loss, this company, NCR Corporation, expected to make payments totaling $200 million over a 7- year period. That is what they could see down the road: $200 million over that period. Instead, that payment has increased to $1.5 billion-- $1.5 billion looking out ahead of them instead of $200 million. So $200 million becomes $1.5 billion, and that is what we are going to see unless Congress provides some relief. We have heard from countless companies across Pennsylvania and across the country that are in the same situation as this one example, the NCR company. The companies are not requesting a bailout. Let me say that again: They are not requesting a bailout. The companies are not requesting the American taxpayer to assist directly. The companies are simply asking Congress to extend the time period of recognizing the losses incurred during the market downturn. In 2009--I will point to another study--Watson Wyatt reported that there would be $32 billion in payments to fund pension plans in America. Without any relief from Congress in 2010, that amount will increase to over $90 billion and increase to $146 billion in 2011. So we go from, in 2009, $32 billion, to 2010, and it keeps going up until we get to 2011, just 2 years from now, $146 billion to pension plans in America. American companies that are already struggling to break even today will have to decide between funding their pension plans and cutting jobs. In order to avoid losing more jobs, at a time when the national unemployment rate is 9.8 percent, Congress should act swiftly to extend the amortization period for recognizing certain losses in pension plan assets, including other temporary provisions that will provide funding relief. Any relief should apply to single- and multiemployer pension plans. As companies recover from the economic recession, we should not discourage economic growth by requiring a pension payment that will require companies to cut jobs. Instead, Congress should provide targeted relief--targeted relief--that will enable companies to spread out the losses over an extended period of time, which will allow capital to be invested in activities that will promote growth. Ultimately, the intention of any pension funding relief legislation is to ensure the survival of the pension plan system. The American people have a right to expect that pension plans be stable and secure for their future. In Congress, we should work to implement any legislation that provides a healthy pension system just in the same way we provide security with a reformed health care system. In exchange for ensuring a good pension, a secure pension, and a better health care system--that is what we are saying to the American workers and to American businesses--it is important that we be very honest with people, with our workers. We are going to say to our workers: We want you to compete in a world economy; we want you to go out and get more education; we want you to enhance your skill level; we want you to have a broader-based skill level so that when the economy takes a turn or market forces lead to a change in the industry that you are employed in or lead to a change in our economy, you will have the skill and the knowledge and the training and the education to be able to adjust. So we encourage people all the time to get more education. We encourage people all the time to enhance their skill level. But we will be more successful in achieving that goal and we will be more honest with workers if we can say to them: You don't have to worry as much as you used to about your pension or about health care. That should be a large part of the bargain, a large part of the agreement we make with our workers and our businesses because, if we are going to compete in a world economy, if we are going to have a highly skilled workforce that does that for us over time, we cannot say to people: Go out and improve your skills, go out and get more education, but we are not sure we can help you with your retirement security or your health care security. We can't ask them to do three things at one time. We can't ask them to go to work every day and worry about whether they are going to have health care coverage or worry about whether their kids are going to be covered or worry about whether there is going to be a preexisting condition that will bar them from treatment or coverage. We can't allow a situation to persist where we say to them: Go to work every day and continue to improve your skills and maybe get more education, but we are not sure we can help you on health care and, by the way, your pension plan might be at risk in the future; it may not be there for you when you retire. We have to do something in a very strategic and focused way to take away some of that worry on health care and on pension and retirement security. If we do that, if we lessen that anxiety for people, I believe we are going to have a much more successful strategy as it relates to telling people and encouraging our workers to get more education, to get a heightened degree of training. If we do that, we are going to have a much stronger long-term economy. But we can't ask people to do it all themselves--to bear the burden of health care, to bear the burden of retirement security, and to bear the full burden of their education, their training, and their skill development. So that is why this pension issue, even in the midst of a health care debate, is so critically important. Madam President, I yield the floor and note the absence of a quorum.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CASEY. Mr. President, I rise today with regard to the importance of international development efforts in Afghanistan, as well as the role of women in that same country. Much of the public debate around Afghanistan is focused on troop levels, especially in Washington. This is a critical decision on troops, but a focus only on troops ignores so many of the crucial elements that will contribute to our strategy in Afghanistan; namely, what should be done to help promote democratic institutions. That is one question we have to spend more time on. How can we accelerate the training of the Afghan security forces? What impact does Pakistan have on this conflict? I have spoken about these issues in depth. I want to directly address the formidable development challenges before the Afghan people and what this means for the security environment. Let me be clear. We are not conducting development in Afghanistan for development's sake. Promoting development has a direct national security impact and, if done right, can result in a safer environment for coalition troops, as well as Afghan security forces, and it can ultimately contribute to stability in the region. Before discussing these issues, I want to applaud the extraordinary efforts of Senator Kerry, the chairman of the Senate Foreign Relations Committee, to seek a resolution to the Afghan election crisis. As we all saw from news reports, his tireless work over the past few days to support the democratic process in Afghanistan renewed the chance for much needed legitimacy in the electoral process. I hope the second round of the elections will be free from violence and the terrible fraud that was seen in August. I also want to recognize the work of the Electoral Complaints Commission, which meticulously rooted out corruption in the election process. Those guardians of Afghan democracy should be commended for their work, and I trust they will perform equally well on November 7 and the days following. The development changes facing Afghanistan are formidable. Destroyed by 30 years of war, Afghanistan is the third poorest country in the world. Large swaths of the country don't have access to roads, electricity, water, or prospects for jobs. As I discussed on the floor last week, there are some positive aspects of the development process already in Afghanistan. There are now 6 million children in school, one-third of whom are girls. Basic health care now reaches more of the country than ever before. The public health care system has made strides in this regard to have organizations such as the Pennsylvania-based Cure International, which is working to train doctors. The economy has grown at 10 percent a year in aggregate terms, and mobile telephones are starting to connect more and more people across the country. When this process began in 2002, we started at zero. We should not be content with the pace of reform in Afghanistan, but we should acknowledge that some progress has been made. While the debate in Washington revolves around the prospect of a troop surge, not much has been said about the civilian surge to assist in development and diplomatic efforts. I support this important initiative, but we must encourage the administration to match this international surge with an Afghan surge. We must increase our efforts to build the skills and capacity of Afghans to develop Afghanistan. We must constantly work to instill the idea that Afghanistan's prospects lie not with the efforts of the international community--though we should do our part, and we have and we will--but with the talent and the will of the Afghan people. It is not only the best way to conduct development, it is in fact the only way it has ever been truly successful. The strong roots of an Afghan-led development process have been years in the making. The Government's National Solidarity Program has worked to develop the ability of Afghan communities to identify, plan, implement, and monitor their own development projects. This model of community-based development is essential to building civic ownership for the country's future. The World Bank reports that more than 20,000 communities now have local government consultative institutions or community development councils. Afghanistan's Ministry of Rural Rehabilitation and Development oversees this effort, which is financed by a consortium of international donors. It employs more than 4,000 Afghan nationals and has developed the skills of 600,000 Community Development Council members across the country in planning and supervising projects and managing finances transparently. More than 80 percent of the labor has been provided by communities themselves, generating wages for the poor and cutting in half the cost of their projects. While substantial progress has been made, the National Solidarity Plan faces three main challenges: First, the security environment is the biggest hurdle to rapid development. Second, the international community can play a helpful role in supporting the government's efforts to ensure that these structural gains are sustainable. The democratic process has begun to take hold in these communities but will require years to grow strong roots. Finally, the Community Development Councils will need regular assistance in building capacity. As local communities start to work together on multivillage projects, they will need technical help to implement the projects. Afghanistan's development infrastructure is important and represents an important effort to mesh traditional community-based decisionmaking structures with the official governing structure. In order for these bodies to work properly, there must be an important focus on the provision of basic services, irrigation, access to transportation and the construction of roads, basic health care and education, and access to drinking water and electricity. Much of the development work on Afghanistan must take place in an environment of extreme insecurity. USAID works in countries all over the world, but its impressive staff doesn't usually contend with the small arms fire, roadside bombs, and the militant attacks that they confront in Afghanistan. In the most crucial regions of Afghanistan, along the Pashtun belt in the east and south, USAID must operate alongside the U.S. military, the State Department, and the U.S. Department of Agriculture in provincial reconstruction teams. The military forces provide protection for the aid workers and diplomats as they seek to implement their projects. This configuration is clearly not ideal but has allowed for some development progress and has also played a critical role in the overall counterinsurgency effort. While there has been significant funding provided for development efforts, not enough of the funding is actually reaching the Afghan people. Lately, international organizations have been criticized for high consultant fees and overhead costs associated with doing business in Afghanistan. Some nongovernmental organizations, so-called NGOs, and contractors are performing excellent work in extraordinary circumstances in Afghanistan. While much of the cost associated with their efforts is understandable given the high pricetag associated with security and paying quality staff to live in Afghanistan, I do believe that more of an effort should be made and must be made to work directly with the Afghan organizations where possible to implement development programs. This will likely mean an increase in USAID staff to oversee implementation of the programs and assure accountability. This would also serve in rebuilding USAID's capability to implement programs instead of relying upon contractors. Developing the capacity of USAID is long overdue. I want to acknowledge Ambassador Holbrooke's work in this regard and support his efforts to deliver more of our assistance directly to the Afghan people. International development experts have highlighted the critical role played by women in the security, stability, and development of Afghanistan. We cannot expect progress on any of these fronts if half of the population is ignored. As I have said before, we have seen progress on women's and girls' political participation, education, and health since the fall of the Taliban. However, women are still largely excluded from public life and economic participation, and they remain targets of endemic violence. We must support the Afghan Government's efforts to empower women and ensure their right to work in both public service and at community levels. Promoting the economic participation of women will pay long- term dividends in terms of education, health, GDP, and even the security and stability of their country. International development experts in the region have noted that women are more likely than men to invest their extra savings and earnings in their families, specifically toward much needed education and health care, assisting women, whether through small grants, access to credit, or skills training as a potential to improve the lives of the entire household, including those susceptible to be drawn in by the Taliban. Military strategists have focused on this important nexus of advancing development for women and security. In a society where young men are loathe to make decisions against their mother's wishes, convincing mothers that their children have future prospects beyond joining a militant group is a key part of our strategy. By working with women on a host of development issues, international and Afghan groups can have a clear and convincing impact on the security environment where our soldiers are operating today. In closing, the security challenges in Afghanistan grow more acute by the day. We are rightly focused on the question of troop deployment and how to stem the tide of militancy across the country. But as we debate the merits of our presence in Afghanistan and our efforts to bring stability, we must fully account for the developmental shortcomings in the country. This, as well as the establishment of durable democratic institutions, will most likely be the ultimate determining factor in resolving this conflict. I yield the floor and suggest the absence of a quorum.

Mr. CASEY

Mr. CASEY. Mr. President, I rise to talk about health care in three ways, three different subjects but all vitally important to making sure we get the job done in the next couple weeks. As many Americans know, in the Senate right now, we have the HELP Committee bill that passed in July and the recent passage of the Finance Committee bill coming together in a merger process which is days away from completion or certainly in the near future. As that process unfolds, there are parts of our bill, meaning the HELP Committee bill, that I hope remain intact or at least, in large measure, are left as part of the final Senate bill. One part is on the issue of children's health insurance. We had an important debate about this program, which was authorized in 2009, so that within the next several years, within the next 4 years, maybe by the end of 4 years, we will have as many as 14 million children across America covered by that program, a tremendous advancement from where we were even 10 years ago. It has shown results in a lot of places. It is a well-tested program. One of the more recent debates, within the Finance Committee, was whether children in CHIP, whether that program itself would be stand- alone--as I believe and as I am glad the Finance Committee agreed with me and with others--or whether it would be folded into the exchange. They didn't do that in the Finance Committee. I am glad they did not. In this instance, we have a program which started in States such as Pennsylvania back in the early 1990s and then became a national program in the mid-1990s, about 1997. What we have seen in Pennsylvania are tremendous results. I ask unanimous consent to have printed in the Record a one-page survey by the Pennsylvania Insurance Department from 2008 about uninsured numbers, ages zero to 18 and then 19 to 64.

Mr. CASEY. What this chart shows is when we compare individuals who happen to be zero to 18 in age versus 19 to 64, we find that in Pennsylvania, across the 67 counties, we have an uninsured rate of 5 percent among children. So ages zero to 18, it is 5 percent uninsured. It is still too high--we want to bring that down to zero--but much lower than it had been. But among the age category 19 to 64, meaning everyone above the age of 18 prior to the time they have an opportunity to receive Medicare, 12 percent are uninsured in Pennsylvania. I doubt that is much different across the country. One of the lessons from that is that when we take concerted action to focus, whether it is public resources or private resources but of a strategy for health care, we can bring the numbers down dramatically. So children's health insurance in Pennsylvania is in much better shape than it was 10 or 15 and certainly 20 or 25 years ago. But we haven't, as a country, begun to focus on that age category 19 to 64. If it is 12 percent in Pennsylvania, it is probably similar across the country because there has been no strategy for people in that age category comprising our workforce. We have to bear that in mind. When we have one category with an uninsured rate of 5 percent versus another that is more than double that at 12 percent, we have to continue to focus strategies in the debate on that age category. In this process of coming to a bill, I believe there are several policies and several strategies that will get us to the point where the rate for ages 19 to 64 will come down as well. As many Americans know, the Affordable Health Choices Act, the bill from the HELP Committee, has as its goal and is premised upon the idea of covering as many as 97 percent of the American people. We finally have a strategy for every age group in addition to what we have tried to do for children and what we have done to help older citizens, over more than 40 years now, over the age of 65 or 65 and up. One of the parts of the HELP Committee bill which does not get a lot of attention is a part of the bill which is set forth in sections 3201 to 3210. It starts on about page 228 of the HELP Committee bill. I know these bills are big, well more than 800 pages, but this section on the Community Living Assistance Services and Supports Act, the so-called CLASS Act, is a breakthrough--I think to be understated--because what it does is provide individual Americans who have functional limitations to be able to continue working but also to provide some of the help that goes into providing them the wherewithal to continue working. Here is what the fundamental purpose is. I am reading from the summary: The fundamental purpose of the bill ``is to establish a national voluntary''--voluntary--``insurance program for purchasing community living assistance services and supports in order to provide individuals with functional limitations with tools that will allow them to maintain their personal and financial independence''--probably the most important word in that paragraph--``and live in the community through a new financing strategy for community living assistance services and supports,'' and ``establish[ing] an infrastructure that will help address the Nation's community living assistance services and supports needs, and alleviate burdens on family caregivers.'' What we have now, unfortunately, in many places is two or three major problems. The individuals themselves are not able to work sometimes; they have an inability to work because of limitations, and they are not able to pay for the kind of care they need. That is the main problem. The second problem is, in many families, caregivers try to make up for that. If the family member with limitations cannot pay for services, family members provide the kind of services they would hope to get from some other person or entity. What we are doing here is relieving a burden on individuals so they can be fully functional and independent because of the support and help they get, such as someone coming into their home in the morning to help them get off to work and to be able to meet them at the end of the day and help them with so-called activities of family living, things we all take for granted in our daily lives: everything from feeding and bathing and other fundamental things that all of us have to do every day. With a little bit of help from someone, many Americans can lead a life of employment, a life of dignity, and a life of contribution to our economy. It also gives some real help to family members. So we will talk more about the details of how this works. I should mention the person who was the driving force on this legislation--and he and his staff worked on this for years--was the late Senator Kennedy. He spent many years developing this program, developing the CLASS Act, and making sure it was part of our bill. That is why we wanted to make sure it was part of the Affordable Health Choices Act, and it should be part of the final health care legislation we enact here in the Senate. If we are going to do the right thing, it will be in the bill. I think most people here want to do the right thing as it relates to people with functional limitations who can contribute more to their workplace and contribute more to our economy. Senator Kennedy's work was focused not just on providing a program to give people that opportunity, his focus was also: How can we do it in a way that is fiscally responsible? Well, this program provides not just a lot of help for people with limitations and their families, but it also does not cost the Federal Government in the process because people will be paying in overtime and then have the opportunity to use those resources when they need them. Let me finally move to another area in the remaining time I have. In addition to the importance of preserving the Children's Health Insurance Program the way it is right now--which I think was a great advancement in the Finance Committee--in addition to enacting legislation which will have the CLASS Act as part of it, the third thing I am going to mention today is an issue that has received a lot of attention, but sometimes we do not highlight some of the elements that are very important to the American people. I speak of the so- called public option, which in our Senate health care bill, the HELP Committee bill, is entitled the ``Community Health Insurance Option.'' One of the most important parts of the bill--in fact, I think the first word in the section is the word ``voluntary.'' When I was going across Pennsylvania talking to people about our health care bill--and our bill passed in July, so when I was on the road in August, we had a chance to talk about a bill, not just a concept but a bill we had already passed out of committee--some people who were opposed to the public option would ask a question or make a statement, and often they would say to me: Well, I don't want to be forced into some government program and lose my ability to choose or lose some of the rights I have now. I would point to the Community Health Insurance Option section of the bill and say: The first word is ``voluntary.'' There is no requirement here. I think that mythology kind of got ahead of the truth. It is voluntary; that is, voluntary as it relates to an individual but also voluntary as it relates to a provider. Second, as to the benefit package, as we wrote it in our bill, in the HELP Committee, it would meet the so-called gateway. In our bill we call it a ``gateway.'' In the other bills, they call it an ``exchange.'' But it meets the gateway standard by offering coverage that has an essential benefit package, including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative services and devices, preventive and wellness services, and pediatric services. States can offer additional benefits beyond that essential benefit package with any cost of such additional benefits being assumed by the State. So that is what the public option in our bill, the Community Health Insurance Option, would offer as a benefit package. The premium rates will be set by the Secretary of Health and Human Services at an amount sufficient to cover expected local costs--local costs. So you are going to have a lot of impact and relevance as to what is happening in the local community. And also--this is very important--the Community Health Insurance Option has to meet solvency standards. It cannot just operate and not worry about standards that involve solvency. If there are States that have higher levels or higher requirements as to solvency, the public option would have to meet that. The reimbursement rates will be negotiated by the Secretary and shall not be higher than the average of all local--local--gateway reimbursement rates. I mentioned the importance of solvency as a requirement. Startup funds will be provided by the Treasury to cover costs of initial operations and cover payments for the first 90 days of the plan's operation. But then that public entity, which is State based, would have to pay the money back over time. I think that is critically important to point out. Finally, State-based advisory councils will provide recommendations to the Secretary on operations and policies regarding the Community Health Insurance Option, to take advantage of local innovative efforts and meet local concerns. So this is not some entity that is going to operate in Washington. It is an entity that will have not just public input and local input and local relevance but actually will take advantage of local innovative efforts that we see all across the country. I know in Pennsylvania there are hospitals or hospital systems or communities that do things a different way and are very successful, and we have to be giving them the opportunity to have that kind of flexibility. I believe it is the right thing to do to have as part of the final bill a public option. I believe our bill we passed out of committee is the right way to do it. Others might have another version of it. But I believe the Community Health Insurance Option is a voluntary, focused way to make sure we are injecting real competition and thereby lowering costs but also enhancing choice. One thing we do not want to do at the end of this road is limit choices people have. A lot of people will stay with their private insurance policy or their private plan. They will want to stay there. But others may say: I am in such a predicament or I am in such a cost situation that I need to choose a public option. Finally, Mr. President--I will wrap up with this--I believe this debate has been critically important to the American people, even the debates that get a little heated. It is very important we get this right. It is very important we have spent the time we have spent over these many weeks and months. But we are reaching the point now where we are down to weeks, thank goodness, not months. I believe we can get this right, we can put in place strategies to give people peace of mind, so when they go to work in the morning, they do not have to worry, as they do, about health care--the cost of it, the burden of it, being denied coverage because of a preexisting condition or having a child denied coverage because of that or a loved one. I believe we can also begin to wrestle the costs to the ground and not have them spiraling upward, as they have been doing for 10 or 15 or more years. I also believe we can enhance choice and quality. Even with all the debates we are having, all the disagreements we sometimes have here in Washington, there is a lot of consensus about the need to pass a bill, about the need to enhance prevention efforts and quality efforts. I believe we can get there. But we will continue to highlight some major aspects of the bill, and we are going to continue to fight hard for these fundamental priorities of health insurance reform. Mr. President, with that, I yield the floor.

Mr. CASEY

Mr. CASEY. I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CASEY

Mr. CASEY. Mr. President, under the previous order, at 5:30 p.m., Monday, the Senate will proceed to vote on the motion to invoke cloture on the motion to proceed to S. 1776.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 2 p.m. on Monday, October 19; that following the prayer and pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate proceed to a period of morning business until 4:30 p.m, with Senators permitted to speak therein for up to 10 minutes each; that following morning business, the Senate resume consideration of the motion to proceed to S. 1776, the Medicare Physicians Fairness Act of 2009, under the previous order.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the Senate proceed to executive session to consider Calendar Nos. 481, 482 and 483; that the nominations be confirmed en bloc, the motions to reconsider be laid upon the table en bloc; that no further motions be in order; that any statements relating to the nominations be printed in the Record as if read; provided further that the President be immediately notified of the Senate's action and the Senate return to legislative session.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CASEY

Mr. CASEY. Mr. President, I know the hour is late and many are ready to end the week. I wish to say a few words tonight about the challenge we have with regard to Afghanistan and Pakistan and our strategy going forward. I spent some time in the last couple of weeks talking about the obligation we have in the Senate to have a full debate on these issues and not simply to point down Pennsylvania Avenue and say the White House has to do this or that or the President has to do this or that. It is important, I believe, that the President and his team have taken the kind of time they have to get the strategy right with regard to Afghanistan and Pakistan. But I believe the Congress has a role to play. If we simply fall into partisan corners with regard to our strategy in Afghanistan and dust off and reintroduce talking points from the war in Iraq, we will not get it right; we will get it wrong. I believe we have to listen to a lot of different points of view. The President has undertaken that kind of review, and we have to do that as well. Part of that is doing what we have already begun to do, which is to have a series of hearings. In the Foreign Relations Committee, we have had a number of hearings. I know the Presiding Officer, as a member of the Intelligence Committee and his work as a Senator, has engaged in this review as well. We are trying to get different points of view in front of us. I know Chairman Kerry and the Foreign Relations Committee have had too many hearings to count, and not just in the last couple of weeks but over many months. Chairman Levin and the Armed Services Committee have outlined a strategy, or at least an approach to part of a strategy, to focus on building up the Afghan National Army and the police on an accelerated basis so we can begin to move the responsibility more to the Afghan people and the Afghan governing institutions as opposed to having the United States and other coalition partners bear this responsibility solely. Chairman Levin has spent a good deal of time trying to contribute to this debate. We have heard both Democrats and Republicans contributing to this discussion. As much as we have heard about General McChrystal's report and his recommendations--and we have heard a good bit about that, and we should, and we have heard an awful lot about his recommendation with regard to troop levels, almost exclusively, General McChrystal's recommendations about troops. If you read his report--the report that is now public--he talks at length in that report about every topic under that heading and does refer to troops, but he also talks about at least three areas. One, he talks about security. Obviously, as the commander, he should address that issue, and he does. But he also talks about governance and development. Those three areas are critically important. We can get the troop level right and get the whole strategy wrong. Even if we focus on security, which obviously involves troop levels and military determinations we have to make, we have to get it right with regard to development and also with regard to governance. I note for the record an article from--I do not have it in front of me, but I will refer to it. The New York Times on October 2 had a story about General McChrystal's approach to the strategy, but he was quoted in that story talking about debate and deliberation. I have been listening to some people who talked about what he is recommending. One would think all he did was put together a report, send it to Washington, and the report said ``add troops'' and that is all he had to say. General McChrystal--I am paraphrasing--did refer to both debate and deliberation to get the strategy right. He also said we do not have the luxury of moving too fast. I think that is instructive of what he has been recommending. I want to talk tonight briefly about one of those three areas, not security or development, but governance, and in particular talk for a moment about elections and other aspects of governance as well as the judiciary. I know the Senator from Rhode Island, the Presiding Officer, is a member of the Senate Judiciary Committee and a former prosecutor and understands how important the judiciary is to a functioning democracy. We have a ways to go and the Afghan people have a ways to go between here and there, meaning here where they are today and where they must get to with regard to their judiciary. In terms of the election, we heard a lot about the problems, and some of it bears repeating. As documented by the National Democratic Institute, the International Republican Institute, Democracy International, and a host of other international observers, the elections in Afghanistan saw widespread fraud amid an atmosphere of escalated violence. We saw many of these problems coming before the elections, and despite having years to prepare, there is still not a reliable voters list, which opened the possibility of wholesale fraud on election day. The ``single nontransferable vote system'' for the provincial government elections has led to candidates gaining seats with only a few actual votes. On election day, many citizens were too scared to vote, citing Taliban threats to bomb polling stations or literally cut fingers off of voters. Afghanistan itself can and should take several concrete steps or measures to address these issues prior to the next election, including fixing the voters list, considering moving away from the single nontransferable voter system, and enhancing the security environment for voters in the preelection period and on election day. I would add to this that when I was in Afghanistan and Pakistan back in August with Senator Brown and Congressman Zack Space, we had several briefings and one of them was on the election. One point that was made we shouldn't lose sight of. This election, for all the fraud that we know is on the record now, for all the problems, the security environment was generally good. The fact that despite those threats by the Taliban an election took place in a time of war and under an adverse, difficult security environment shouldn't be glossed over. It was a significant challenge. So we had a lot of fraud, but in terms of security there is some good news on the security front. Organized representation of any citizen's interests in Afghanistan also remains underdeveloped. The electoral system disincentivizes the development of vibrant party structures. This is problematic, because without political parties--it is hard for us to understand this is still a problem--without political parties that can help to organize and represent the policy concerns of the people, there is little hope that the Parliament's legislation can truly reflect the will of the Afghan people. Governing institutions in Afghanistan have atrophied over decades of civil war and Taliban rule and have begun to develop other problems as well, but institutional reform is vitally necessary. We know that the idea of a strong central government in the history of Afghanistan is somewhat of a foreign concept. In recent years, the international community has placed an emphasis on the development of governing institutions in Kabul, capable of projecting its presence and influence across the country, but it has been a difficult challenge. Not enough attention has been paid to the development of proper financing of local governing institutions. Provincial government is underfunded, and that opens the door to local level corruption. Local and international development nongovernmental organizations often take the lead in local development projects, which can serve to minimize the role of the provincial government at a time when we need their role to be strengthened in terms of what people see. So just at a time when you need strong evidence of local government, sometimes the NGOs are doing a lot of the work. While the international community has not paid enough attention to the development of local governing structures, the Taliban, unfortunately, understands the importance of connecting with the people at the local level. Over the past few years, the Taliban has established shadow governments across the south which mete out their form of Sharia justice. They have ombudsmen who travel from district to district to gauge the work of the Taliban shadow government and their officials. And of course we know that Mullah Omar, the former head of the Taliban-led government, now runs the so-called Quetta Shura--QST as it is known by its acronym--and they have produced a 30-page manual, believe it or not, on how best to win the favor of the local population. So the Taliban is not just thinking in military terms. They have already not just thought about but have begun to implement a governing strategy, and our government--our strategy--and also the Afghan people, as well as our coalition partners--have to think this through as well and get it right. It is important we get this right--the governing part of our challenge--as much as we get the military part of this right. The Afghan Government should make every effort to devolve power and resources to the local level to bring good governance as close to the people as possible. The provincial reconstruction teams can help and play a supporting role, but this essential connection between the Afghan citizen and government must be an Afghan-led enterprise. Let me conclude with this thought about the judiciary. The Taliban are threatened by a strong judiciary, as evidenced by its deadly attack on the Ministry of Justice in Kabul earlier this year. High levels of endemic corruption, insufficiently trained staff, and a complicated system of western, customary, and Sharia law hinders the Afghan Government's ability to provide justice for its people. This is perhaps the biggest threat to the Afghan Government's viability, the Taliban's ability to provide quick, albeit brutal, justice, which sharply contrasts with the corrupt government officials who are unwilling or unable to take action. So in the absence of a strong effort by the government to provide the kind of judiciary that we would hope they could provide, the Taliban has filled the void. Thus a majority of legal disputes are settled outside of the state's formal justice system. With little trust in the government, the population can easily turn to the Taliban for a swift, brutal form of justice. As we ramp up our efforts to train the Afghan National Police force, we must at the same time consider parallel reforms that must take place within the formal justice sector. We must support Afghan efforts toward institutional reform in the Ministry of Justice so that the local population will not rely only upon the informal justice sector, or worse, turn in fact to the Taliban for justice. There has been noteworthy progress in some democratic institution building within the country. First, by way of example, the Ministries of Defense and Interior are often recognized for their positive efforts. And while considerable work remains to be done, each has made significant strides in recent years. I can say from somewhat of a firsthand observation that both Defense Minister Wardal and Interior Minister Akmar, two ministers we met with on our trip in August and sat down with, indicated to me they have a strong sense of where they have to go to develop the Afghan army and police force, the security for the country. But they still have to demonstrate that over time. No matter who ultimately wins the Presidential election, I hope that the Afghan Government will retain these important ministers, who have the institutional knowledge of success and of clear plans for continued development. Second, the health sector, in particular, has seen impressive gains since the fall of the Taliban government. Today, in Afghanistan, 82 percent of the population lives in districts with access to a government-provided health care package, up from 9 percent in 2003. That is a bit of good news we don't often hear about, but I am sure there is progress yet to be made there as well in terms of health care. Third, the education sector has seen improvements as well. In 2001, less than 1 million children--probably about 10 percent of the school- aged population--were enrolled in elementary or secondary education, and almost none of them were girls at that time. Today, more than 6 million children are enrolled, 2 million of whom are girls. So there has been measurable and significant progress in Afghanistan despite the recent deteriorating security environment. Building on these fragile gains will rest in large part on the viability of the Afghan democratic institutions. The United States can help in this effort through the continued provision of development assistance and other forms of diplomatic and political support for Afghanistan's institutions. While the security situation is increasingly grave, between 79 and 91 percent of the population remains opposed to the Taliban and their brand of violent politics and their brand of justice. I hope we can consolidate on the gains made in Afghanistan and seriously begin to address the severe shortcomings that remain in the democratic development of the country. In conclusion, I would say that despite all the bad news about the security environment, which is news we need to hear, we need to put it in the context of the two other challenges beyond security--governance and development. I have pointed out some real problems with the governance, especially as it relates to the judiciary, but we have had some progress on health and on education. We need to accelerate and develop that and incentivize it and get it right, but we have seen some good news. So I think as we debate this strategy going forward, those of us in the Senate who have a role to play here and who feel the obligation to get this right have to focus on more than just security and troops and the military. We have to make sure that we get strategies in place to enhance and increase the governance priority as well as development. We will talk more at another time about development. I thank the Chair and yield the floor.