Bob Casey

Mr. CASEY

Mr. CASEY. Mr. President, I rise this afternoon to speak about one of the amendments we are going to be voting on later today. As we stand here today, we are debating the bill on the floor, the health care bill, where we are trying to do a couple things at one time, and I think we can, and I think this bill does it, even though we will make some changes to it. We are trying to improve the quality of care for Americans, whether they get their health care through a public program or through a private insurance company or a private plan. We are trying to finally use preventive measures to make people healthier and have better health outcomes. We are also working to reduce costs. If you want to talk about it in terms of a doctor and a patient or a health care system and an American, who should benefit from the health care system, we basically want to have people get the care they need from the doctor they choose. What we are engaged in now is a debate about an amendment which the other side says is about the fees going to trial lawyers. That is the way they like to talk about it, and I know that is popular. When the other side makes an amendment such as this, they like to have a target, so their target is trial lawyers. But, unfortunately, for this debate, I think it is misleading because this amendment, which I would urge people to vote against, is not about lawyers. It is about victims and whether we are going to ensure that victims have a shot, a fair chance, when they have a claim for medical negligence when they have been injured as a result of negligent conduct. I said before, we are debating the health care bill and we are talking about costs. This amendment will do nothing to lower costs. What it will do is not lower anyone's costs. What it will do is increase the cost or the burden a claimant has to bear when they have a claim against any kind of hospital or doctor in the case of a medical negligence case. So the question is, are we going to enable people who do not have the means to bring cases versus very powerful interests? That is one of the basic questions we will answer with regard to this amendment. I would hope if a member of my family or any family--and I think this is true of everyone in this Chamber--if a member of your family, as a result of medical negligence, had to bring a claim, you would hope that individual could walk into a courtroom or file a claim with someone who has the skill and the ability to be their advocate. Because I will tell you one thing, they are going to be up against a very powerful interest: insurance companies that write medical liability policies, an incredibly powerful interest. A lot of us come at this question through our own personal experience, through the experiences of our families. I had a grandfather who I never met, my father's father, Alphonsus Casey. He, like a lot of people in northeastern Pennsylvania, as a young kid, went into the coal mines at a very young age. He worked as a mule boy. One of the days he was tending to the mules in that mine, just as a kid, 11 or 12 years old at the time, he was kicked by a mule. He got a scar that started above his eyebrow and went across his face, split his lip, and went down through one side of his chin. So he understood injury as a child, injury in the course of working. I think he also understood that when he became a lawyer, many years later, well into his adulthood. He understood what it is like to suffer an injury and to make a claim for an injury. But what he did is represent injured workers. That was his law practice. I wonder what he would say if he were here talking about what happens to victims when they have an injury they want redress for. Like on so many other things in this debate, I think the other side of the aisle is carrying water for the insurance companies. Just my opinion, but I think that is the case. Yet in the case of medical negligence and what happens in the real world, we know that 98,000 deaths a year are from preventable medical errors. Let me say that again. We know there are 98,000 deaths in America a year, according to the Institute of Medicine, from preventable medical errors. So what this amendment does is deny patients the attorney of their choice. It further restricts access to the courts. It drives up costs for victims. When we talk about bringing a case and the barriers to doing that, that is not some future result of this amendment. Oh, I think this amendment will make that problem a lot worse. But right now--no matter what happens in this debate, no matter what happens on the vote on this amendment--there are barriers right now for people to bring a lawsuit. It costs, in many cases, thousands, if not tens of thousands, to bring a case. And then to see a case all the way through costs a lot more than that. What are we talking about here? We are talking about allowing someone who has a claim for a serious injury to go see a lawyer and to sit down with that lawyer and enter into an agreement for the fee, whatever that fee will be, whatever that will be. If that lawyer and that person, that patient or victim, goes forward with the case, they bear a risk. The victim bears a risk that they will not be successful and that at the end of that they will have no recovery at all. But because of the way the contingent fee works, the lawyer bears a risk as well that he or she will not be paid, and they also stand a risk of having to pay for costs the victim cannot pay--and the lawyer will bear those costs throughout the pursuit of that case. So here is what we are talking about. This is basically a debate about victims and whether they are going to have the kind of representation they need. If I were going in to have surgery in a hospital, I would hope the surgeon would be someone of the best, the highest skill possible. I would want the best surgeon, as I take on that battle. Anyone would. I would hope we would not do something in the debate to reduce the chances that a victim of medical negligence could go into a courtroom or file a claim with the best, most highly skilled lawyer they can find. I would hope we would not want to do anything that would injure that basic right. It is interesting that this amendment applies only to patients--it does not apply to anyone else--patients who would become victims of medical negligence. In conclusion, in terms of what happens in our States, States regulate the conduct of lawyers. They do it all the time. But we also have evidence from the States about what happens in these kinds of cases. In Pennsylvania, for example, in most counties, as to cases going to trial because of medical malpractice claims--those kinds of lawsuits--in most counties in Pennsylvania, 90 percent of those cases are won by the defense, won by the insurance company. That is the evidence in Pennsylvania. I know we have others who are ready to speak on this and other amendments. But I think we should make it very clear. On this amendment, this is a debate about two parties: victims of medical negligence versus insurance companies. It is time to choose up which side you stand on. Unfortunately, this amendment is very clearly drafted and intended to help insurance companies, not victims of medical negligence. I yield the floor. I suggest the absence of a quorum. I withhold that suggestion.

Mr. CASEY

Mr. CASEY. Mr. President, we gather today on a Saturday which, as many Americans know, is rare, but it is entirely appropriate and essential that we make sure we spend the time on a weekend to debate this bill and to get the bill passed. I commend the words of Senator Harkin and his great work over many months on this legislation. We are grateful for his leadership. I commend Senator Lincoln on the amendment we will vote on today regarding executive compensation. I rise to speak about children, as this bill affects their lives--in particular, the lives of children who are particularly vulnerable. I have said a number of times in this debate that at the end of this debate, when the bill is enacted into law, we should be able to say that no child is worse off, especially a child who happens to be poor or has special needs. That is what I rise to speak of this morning. I had a joint resolution a number of months ago that was filed relating to this bill. It was joined in by Sen- ators Dodd, Rockefeller, Brown, Whitehouse, and Sanders. It was simple. It basically said what this chart says: No child worse off at the end of the debate. It is a fundamental principle, but I also believe it is a commitment we must keep. When we talk about the legislation before us, we are not talking about some new system. We are talking about figuring out a way--and I think we have in the Senate--to fix what is broken and build upon what works. I believe that is what we are trying to do. When it comes to children, we have special considerations, and we have to have unique strategies to make sure they get the best health care possible. As so many child advocates tell us--and it seems like such a simple maxim--children are not small adults. That is a profound statement. You can't just take a health care program for adults and overlay that on the health care that is provided to children. Children are not small adults. They are different. The care they get has to be different. It has to be tailored and focused on their needs. The care they get, especially a child who is vulnerable, is determinative of their life. If we don't provide them the kind of care in the dawn of their life, as Hubert Humphrey talked about, there is very little after that we can do to save them or to allow them to reach their full potential. That bright light inside a child, if we miss the opportunity to care for that child, will never be the same. We have an opportunity in this debate, and at the end of the debate with the legislation, to positively affect the lives of countless American children. I have some changes I will propose to the Children's Health Insurance Program, but I wanted to speak this morning about parts of the bill that speak directly to the needs of at least two vulnerable children, two young girls by the name of Hannah and Madeline from Pennsylvania. I will get to their story in a moment, but their mother, Stacie, communicated with us and a lot of other people about their lives and their challenges. I did want to first review some of the basic parts of the bill. We often say this bill contains consumer protections. That is a nice-sounding phrase, but when you talk about consumer protections in the lives of young children such as Hannah and Madeline, it takes on a whole new meaning. I will talk more about them in a moment. I want to walk through some of the basic provisions in the bill as they relate to children and what we have in the bill already. No. 1, the bill ensures pediatric input into benefit packages so that the skill and the knowledge of a pediatrician and the kind of care they can provide to a child is part of the benefits package. Again, children are not small adults. The bill also ensures benefit packages that include pediatric benefits including critical oral and vision health care. We all remember the tragedy last year of Diamante Driver of the State of Maryland, a young boy who lost his life because his family did not have coverage for an infected tooth and couldn't afford the care. We are talking about a child in America who died from an infected tooth that would have cost $80 to treat. This horrible tragedy that everyone in Washington was talking about at the time was entirely preventable. We remembered his story and his tragedy in the bill by making sure that oral and vision health care are part of what we do. In addition, the bill mandates prevention and screenings for children. It creates pediatric medical homes. People say: What is a medical home? That is not a place. It is a way to treat someone, so if an American, especially a child, has a primary care doctor, which many of them unfortunately don't--and that is another part of what we are trying to do--that primary care doctor should be surrounded by the expertise we can bring to bear to help the child. We have so much knowledge and wisdom and ability when it comes to our doctors. We have remarkable pediatricians whose sole focus is to help a child in one part of their needs, the health care needs of that child. Why should not every child be surrounded by that kind of expertise? That is what we are trying to do. We strengthen the pediatric workforce. We can't just say we need a lot of pediatricians and hope it happens. We have to make sure we have a workforce and a recruiter workforce to do that. Senator Dodd and I and Senator Brown--I know Senator Dodd is on the floor--added a loan repayment provision in the bill for pediatric specialists and providers for mental health services for children. I have two more items and then I will get to the story of Hannah and Madeline. We expand drug discounts for children's hospitals and finally increase access to immunizations. The CDC will provide grants to improve immunizations for children and adolescent adults. But let me talk for a couple moments--I know we have others who are waiting to talk this morning--about these two children: Hannah and Madeline. The good news is--this picture is a dramatic depiction of what they were suffering from when they were diagnosed with leukemia at the age of 4. They are 11 years old now, and they are doing better, but they still have enormous challenges in their lives. Their mother Stacie Ritter wrote as follows: When my identical twins were both diagnosed with [a kind of leukemia]-- And she talks about it-- at age four, we were told they would need a bone marrow transplant in order to survive. Imagine that. I have four daughters, and I remember when they were about the age of 4. I never had to worry about any of this. I never had to even think about it. But if my wife and I--my wife Teresa and I-- were given this news, we would have been given coverage for a condition such as that by an insurance policy because I happened to be a State government employee, and now I am a Federal Government employee. So I never had to worry about that diagnosis for my daughters. Other than the challenge of the diagnosis itself, I did not have to worry about coverage. But Stacie Ritter and her husband Ben did. She says: I learned that the insurance company thought my daughters were only worth $1,000,000 each. It sounds like a lot of money. It's not! She says that with an exclamation point. When you add up the costs involved in caring for a patient with a life threatening disease like cancer $1,000,000 barely covers it. I think that is an understatement. Fortunately the hospital social worker recommended we apply for a secondary insurance through the state considering the highly probable chance we would hit that [million dollar] cap. And we did hit that cap before the end of treatment. Thankfully the state program kicked in and helped pay for the remainder of treatment. The State program--it sounds a lot like a public option, doesn't it, an awful lot like a public option. So at least for this part of the story, they were able to get some help through a State program, a kind of public option. We will talk more about that later. But then Stacie goes on, and the lead headline of this section is one word, ``Bankruptcy.'' During this time my husband had to take family medical leave so we could take turns caring for our one year old son and our twins-- These twins, as shown in these pictures-- at the hospital. . . . For the 7 months my husband was out on family medical leave, he was able to maintain his employer based insurance for us via $117.18 a month COBRA payments. My recollection is, COBRA was an initiative by the Federal Government to make sure, if you lose your job, you do not lose your health insurance. We have to extend it right now--another government initiative that was helpful here. After spending all our savings to pay the mortgage and other basic living expenses we had to rely on credit cards. So a mother and a father who get this diagnosis for their children at age 4 have to rely on credit cards to get the help their daughters need. Stacie writes: In the end we had no choice but to file bankruptcy. And when you file bankruptcy everything must be disclosed, we even had to hand over the kids' savings accounts that their great grandparents-- Their great grandparents-- had given them. . . . Is this the kind of system we want, when a mother and a father are hit with that diagnosis for their two daughters, when they are age 4, that we have a system that says: Do you know what. We have to cap your coverage. We can help you a little bit, but we are going to limit it. You will figure it out. Don't worry. That is basically what the system said to them. So what are we doing? Well, we have a bill that happens to speak to these kinds of situations. It is ironic--I guess is the word--that on page 16 of the bill, which is actually the second page of the text, we have a provision that says this: A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish . . . lifetime limits on the dollar value of benefits for any participant or beneficiary. . . . It is not complicated. It is not legalese. It is very specific to the lives of these two children. The first provision in the bill says there are no lifetime limits. So you cannot say to Hannah and Madeline: Sorry, we know you have leukemia and we know you need expert care and treatment, but we are going to limit your care. So for those who think this is complicated and difficult in a lot of debate here in Washington, it is not complicated. If we had this provision as a matter of law in effect when Stacie got that diagnosis for her daughters, she would not have had to worry about coverage. She would not have had to use credit cards and go into bankruptcy and take the savings these children were given by their great grandparents. Why do we tolerate this system? Why do we go, year after year, and talk about changing it, saying: Oh, isn't that terrible we have these situations and we let it go and we say that is too bad we couldn't get the bill passed; it got a little difficult in Washington. Well, the time for talk and debate and discussing the finer points of this is over. We have to act to make sure a family such as this never has to go through what these parents went through but especially what these two young girls went through. I will conclude with this: This picture, as dramatic as it is, I think connotes a lot of hope. Look at those two young girls, facing the most horrific of circumstances, and they are smiling and hopeful. But they still need help. We are going to be spending time in the next couple days getting this bill done so we can make sure we help them in the future. With that, I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, I thank my colleague from Rhode Island, Senator Whitehouse, who has been among the more forthright and capable advocates of what we are talking about today, not only with regard to health care generally, but in particular what brings us to the floor at this moment, among several issues, but principally his work and the work over many years that Senator Kennedy did for the so-called CLASS Act, the Community Living Assistance Services and Supports Act. What is this all about? I wish to talk for a couple of minutes about how it works. I think sometimes we get lost in the discussion about the finer points of a policy or program and we tend to forget what it means. Here is what it means. Here is what it means for an American who is working and wants to continue working to support his or her family or to support themselves, contribute to our economy, demonstrate that people who happen to live with a disability of one kind or another can be so significant in our economy, can contribute so much with their ability and their brain power and their ability to contribute in a very positive way. We are talking about the dignity of work, whether the Senate is going to stand up and say: With this act, with this program for someone who happens to have a disability and wants to work and wants to voluntarily contribute premiums so they have some security, some peace of mind down the road if they should need this help, we are talking about the dignity of that work. This is a test of the Senate, whether we are going to stand up for people who have a disability and their opportunity to work. It is a very simple question. You either stand with them or you do not. It is also about one important word, I think--independence, whether we are going to say to someone who wants to work and has a disability, are they going to have the independence, the freedom to work and live the life they choose? Here is how it works. This is not complicated. This is not some mysterious program. Here is how it works. Here is how they qualify to get these benefits. They qualify to receive benefits when they do three things. First, they need help with certain activities of daily living. We all know what those are. There are so many people out there who can work and can contribute if we give them a little help, just a little bit of help that we are talking about today to do the basic things in life--to be able to wake up in the morning and, if you have a disability, maybe have someone help you get ready for work, whether that is getting in the shower, shaving, whatever you have to do to get ready for work in the morning--activities of daily living, things that people who do not have disabilities take for granted. That is the first thing you have to have is that need that we can all understand. Secondly, this person would have to pay premiums for at least 5 years before they could benefit from the program. I said ``premiums.'' I did not say a ``government subsidy.'' We are talking about premiums here, and this is a program that certainly has its origin in government, but this is not exactly similar to the Children's Health Insurance Program, for example, or Medicaid, where it is a government program that helps a particular person, a person who happens to have a disability or is a child. In this case, people are paying premiums, and they have to pay those premiums for 5 years. In addition to the need and paying premiums, the third requirement is they have to work at least 3 of those 5 years. We are talking about people who are employed, working people who happen to have a disability. This is a creative program to help them do that. Why do we get the opposition we do from across the aisle? I think it is pretty simple. We have a lot of folks across the aisle who want to kill this bill. So they are going to try to strike the CLASS Act, which is outrageous and insulting. They are going to try to strike whatever they can, if they can, to kill the bill. So this is a bill-killing exercise. This is not a debate about the finer points of the CLASS Act. This is a bill-killer exercise. It is very simple, and I think it will tell a lot about where people stand. Let me go into a couple more details. I know we are almost out of time. Here is what happens to that beneficiary--a person working, a person who has a need, and a person who has paid premiums. That beneficiary receives a lifetime cash benefit based on the degree of impairment, not just any old formula. We want to make sure the benefit corresponds to someone's impairment, their inability to do their job or live their life the way they hope to. It is expected to average about $75 a day or more in the case of an individual. That is what we are talking about here. We are not talking about, in this case, a government entitlement program. Few people are as passionately supportive of the Children's Health Insurance Program or Medicaid as I am. I believe there are programs that are funded by the government, run by the government, that work very well. But in this case, we are not talking about that kind of a program. We are talking about a program that does not confer rights or an obligation on government funding, nor does it affect the receipt or eligibility for other benefits. The program stands on its own financial feet because people are paying premiums out of their own pocket for 5 years to save for that day when they have a need because they have some kind of disability. And it is solvent--solvent. It is a program that people sign up for voluntarily. It is a voluntary program. When you line up all of the reasons to support this program that Senator Dodd, as the chairman of our committee, the Health, Education, Labor, and Pensions Committee, this summer when we were debating this bill--he carried the ball for Senator Kennedy in the chairmanship of our committee and in our hearings and also for this program. I am grateful for his leadership and also grateful for Senator Harkin's leadership to support this voluntary program. I am also grateful that Senator Whitehouse has lent his voice and his expertise and his focus on getting this program as part of our health care reform bill. It makes a lot of sense. It is solvent, and it will help those who have a disability who want to work, who want to go to work every day and live a full life. Mr. President, I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, we currently have one amendment and one motion to commit pending to the bill. Senators should expect rollcall votes throughout the day tomorrow.

Mr. CASEY

Mr. CASEY. Madam President, may I ask the Senator from Maryland to yield for a question about her amendment, No. 2791 to H.R. 3590, the purpose of which is to clarify provisions relating to first dollar coverage for preventive services for women?

Mr. CASEY. Senator Mikulski had a similar amendment in the HELP Committee bill and at that time, I commended the Senator on its substance as I am a strong supporter of preventive care for women. I thank her for offering this important amendment and particularly for calling our attention to the importance of first dollar coverage of preventive services for women.

Mr. CASEY. Particularly in view of some of the recent controversy about mammograms and coverage, I am particularly grateful that the Senator has clarified this with this amendment and allow for the fact that preventive services must preserve the doctor-patient relationship. Thus, women under 50 may decide with their doctor that they should have a mammogram screening and this amendment would ensure coverage of such service.

Mr. CASEY. There is one clarification I would like to ask the Senator. I know we discussed it during the HELP markup and it was not clarified at that time and thus I chose to vote against the amendment because of the possibility that it might be construed so broadly as to cover abortion. But I understand that the Senator has now clarified specifically that this amendment will not cover abortion in any way. Specifically, abortion has never been defined as a preventive service and there is neither the legislative intent nor the language in this amendment to cover abortion as a preventive service or to mandate abortion coverage in any way. I ask the Senator is that correct?

Mr. CASEY

Mr. CASEY. Mr. President, I thank my colleague and friend, Senator Harkin, who is now the chairman of the Health, Education, Labor, and Pensions Committee, taking over for Senator Kennedy. I know he feels an obligation not only to get this health care bill passed, but he also feels an obligation to the American people, as I think most people in this Chamber do, when it comes to health care. In particular, I commend Senator Harkin for his great support for this legislation over a long period of time, and in particular for the CLASS Act. One of the best moments in our deliberations this summer was when Senator Harkin told a story about a relative of his. In a few moments, if he would tell that story, it brought home to me how important this program is and how it relates to the American people and what they do not have now, especially those Americans with disabilities. When I step back and look at this program, a couple of things come to mind--a couple of themes, really. One is the word ``dignity,'' the dignity of work. So many Americans--by one estimate, 5 million Americans--under the age of 65 are living in our country who have long- term care needs, and there are over 70,000 workers with severe disabilities in the Nation today, who need daily assistance to maintain their jobs and their independence. So we are talking about a program which allows them to continue working with a disability. It allows them to overcome or surmount the barrier that is in front of them. Why would anyone not want to support this kind of a program, just in that brief description? But it is a lot more than that. It is about the dignity of work. It is about having independence, the ability to continue to work even with a disability. But it is also a very strong program for other reasons as well. One is, as Senator Harkin said so well--and Senator Kennedy led us on this program for many years, advocating for this approach--one important feature of this, as Senator Harkin says, is it is voluntary. It is a voluntary, self-funded--self-funded--insurance program with enrollment for people who are currently employed. So we are talking about enabling and helping people to work and maintain their dignity and contribute to our economy. That is what we are talking about here. We are not talking about some government program we are going to create that no one knows what the results will be. We know exactly what this will do for millions of Americans. Let me make a couple of points before I turn again to our chairman, Senator Harkin. First of all, there have been a lot of arguments made on the other side that we do not need this. Boy, I have not heard an alternative, which is true in a lot of the debates in the last couple of days. We hear a lot of criticism and critiques, some of them grossly inaccurate. But I am still waiting--still waiting--to hear an alternative, another idea. We do not hear much about that. But the other side made a lot of points about cost and the budget and how you pay for programs such as this. Well, let's just turn to the first chart on my left. Medicaid pays for a majority of long-term care in the United States of America. For long-term care, 40 percent of it is paid for by Medicaid. A lot of people think of the Medicaid Program, which I guess covers about 60 million Americans, roughly. We should think about long- term care. People do not often think about Medicaid as being connected directly to long-term care for older citizens, those who fought our wars, who worked in our factories, who raised our families, who gave us life and love, and all they ask for in the twilight years of their lives is a little help with their health care. Plenty of them are given skilled care in nursing homes, and for many of those who are in nursing homes, they have skilled care, and they have a good experience. For some, it is not so good. They would rather be able to stay at home. They would rather be able to have opportunities to be provided some help at home. So they want the kind of dignity I spoke about earlier. The same is true of those who might be a lot younger but who have disabilities and want to continue working. They want to continue working. Here is another way to look at this: Projected Medicaid spending on long-term services and supports is unsustainable because if nothing is done, Medicaid services for older citizens in America alone will rise by 500 percent by 2045. You do not have to be--I am certainly not an expert on how these costs are going up, but you do not have to be an expert to know that in the year 2000, you are at this level, and by the year 2045--not that far in the future--you are going to be over at above $200 billion. So Medicaid long-term services and support spending for those who happen to be aged 65 or older: $200 billion by 2045. So this is going up. This is when you do not do anything to meet a health care challenge. If we want to just keep this number going up, well, listen to the other side and just not enact any kind of a program. Let me do one more chart, and then I will turn to Senator Harkin for a discussion about this. We hear a lot about spending and savings and how we are going to pay for health care. Well, if we want to pay for a part of this health care bill--and a big part of the challenge--we should enact the CLASS Act because Medicaid savings from this act, as you can see here: $1.6 billion just over the first 4 years. We are not talking about 10 years or 20 years or 40 years; we are talking about, in 4 years, you get $1.6 billion in savings--over the first 4 years of the implementation of the CLASS Act--starting in 2016. So this is affirmative in the sense that it ensures people's dignity. It allows people to work even with a disability. And it is also fiscally responsible. And those who benefit from it are paying into it, and it is voluntary. No one has to do it. It is voluntary. We have heard a lot of arguments, I say to Senator Harkin, but I think we know from the work he did, working so many years with Senator Kennedy on these issues and working in the committee this summer, as one of our leaders--with Senator Dodd chairing the hearings this summer--and now as the chairman of the committee, the Senator has been instrumental in getting not just this legislation moving forward but especially on the CLASS Act, and I am grateful for him taking on this responsibility. I want to get the Senator's sense of what he hears from people in Iowa and his own experience with why this is so essential for the American people.

Mr. CASEY. I am glad the Senator told that story. For me, this summer, beginning to learn about the details of the CLASS Act, it was a way, through the life of the Senator's nephew, to be able to tell the story about why it was so important. I was thinking as you were talking about the program and the CLASS Act itself and your own personal story and why it makes so much sense. Sitting here to my left on the floor is Connie Garner. She has worked for years on this legislation with Senator Kennedy. She would know better than I, and Senator Harkin would know better than I. Ted Kennedy not only liked this and fought hard for this program, but he wasn't a guy who just liked interesting ideas, he wanted them to work.

Mr. CASEY. There are times we will be talking about the Children's Health Insurance Program in this legislation. That is a program that had its origin in government, and there is a lot of government involvement in that program. I support it and will fight to the end of the Earth for it. This program, the CLASS Act, the program that results from the CLASS Act, is different. It is a hybrid. It is in many ways a creative way to provide these kinds of services for people with disabilities. It is not a government entitlement program. It is a program that doesn't confer rights or an obligation on government funding, nor does it affect the receipt of or eligibility for other benefits. It stands on its own financial feet, which is the point that Senator Harkin made. Why wouldn't we do this? This wasn't just dreamed up this summer. Senator Kennedy, Senator Harkin, Connie Garner, and plenty of other folks were working on this for a lot of years. This is the result of years of work, not a couple of weeks or months. So they worked on this to get it right, and we have it right. It makes sense fiscally and it makes sense in terms of the dignity of people's work, the dignity of people able to stay in their home and be provided basic services. All of our families are affected by this. At some point or another, you are going to have a loved one who wants to work but has a disability, maybe; or needs long-term care services and doesn't want to leave the home. Everyone is affected by that. There is not a Member of the Senate on either side who isn't going to be affected personally some day by this challenge. All we are saying is we have a way to make it a little easier for folks. As Senator Harkin said, it doesn't solve all of the problems, but it helps provide the kind of services we should have the right to expect. We have this figured out. Some of these things we can figure out because of all of the work that was done over many years. This program, this voluntary self-funded program is one way to do it. Senator Harkin has been a leader on this and we are grateful for that leadership.

Mr. CASEY. Mr. President, I yield the floor and suggest the absence of a quorum.

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

Mr. CASEY. Mr. President, I ask unanimous consent that on Friday, December 4, after any leader remarks, the Senate then resume consideration of H.R. 3590 with debate only in order until 11:30 a.m., with no amendments, motions to commit, or any other motion, other than a motion to reconsider a vote, if applicable, in order during this period, except those that are currently pending, with the time after the leader time equally divided and controlled between the leaders or their designees, with the majority controlling the first portion of time.

Mr. CASEY

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

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the Senate proceed to executive session to consider Executive Calendar No. 1, Treaty Document No. 111-4, Protocol Amending Tax Convention with France; that the treaty be considered as having advanced through the various parliamentary stages, up to and including the presentation of the resolution of ratification; that any committee understanding, declaration, or condition be agreed to as applicable; that any statements be printed in the Record; further, that when the vote on the resolution of ratification is taken, the motion to reconsider be considered made and laid upon the table, and the President be immediately notified of the Senate's action.

Mr. CASEY. Mr. President, I ask for a division vote on the resolution of ratification.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the Senate consider en bloc Executive Calendar Nos. 550, 555, 559, 562, 565 to and including 577, and all nominations on the Secretary's desk in the Air Force, Army, and Navy; 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; that the President be immediately notified of the Senate's action, and the Senate resume legislative session.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the Judiciary Committee be discharged from further consideration of S. Res. 337 and that the Senate proceed to its immediate consideration.

Mr. CASEY. 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 that any statements related to the resolution be printed in the Record.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the Senate now proceed to the consideration of S. Res. 369, which was submitted earlier today.

Mr. CASEY. I ask unanimous consent that the resolution be agreed to and the motion to reconsider be laid upon the table.

Mr. CASEY

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

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. tomorrow, Friday, December 4; 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 resume consideration of H.R. 3590, the health care reform legislation, as provided for under the previous order.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that a member of my staff, Avni Shridharani, be granted the privilege of the floor for the remainder of the Senate consideration of H.R. 3590.