Bob Casey

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. I yield the floor and suggest the absence of a quorum.

Mr. CASEY. Mr. President, I ask unanimous consent to speak as in morning business.

Mr. CASEY

Mr. CASEY. Mr. President, I rise tonight to speak of my colleague, Senator Arlen Specter, who tonight cast his 10,000th vote as a Member of the Senate. We watched history tonight. Sometimes we have a chance to witness history. Of course, we look forward to his many more votes, but we also look behind us at some of his own personal political history as well his service here in the Senate. I will offer a few remarks tonight about his service. I can say, after knowing him for many years, and especially after serving with him for now more than 3 years, if you go down that list of votes--all those rollcall votes over many years, serving the people of Pennsylvania--he has had one priority with those votes: Those votes were cast on behalf of the people of Pennsylvania. He has always been an independent voice for the people of our State. He has fought a lot of battles for the people of Pennsylvania. I know the people of our Commonwealth are proud of his service. His public service began after he became a lawyer. He went to the University of Pennsylvania, and then to Yale Law School, and then eventually he joined the District Attorney's Office in Philadelphia. He rose through that office and became the District Attorney of Philadelphia. He was elected twice to that office and served 8 years. He was elected to the Senate in 1980 and was reelected four times after that. He was reelected in 1986, 1992, 1998, and 2004. So he has performed those years of service as a Senator. Of course, it is more than about years and about votes. It certainly is about the substance of those votes, fighting those battles, such as on behalf of the veterans of Pennsylvania. We have had a million or more veterans, for many years, in our State. Those who fought our wars, those who worked in our factories, those who went on to build Pennsylvania gave their first measure of devotion to the country fighting on battlefields. He has always fought for them. He chaired the Veterans' Affairs Committee here in the Senate. He continues those battles on behalf of the veterans of Pennsylvania. On health care, we could talk for a long time about the battles he has fought over and over again; not only the battles he fought in the last year or two as the issue was being debated in the Senate, but especially the battles he fought over many years, battles on behalf of children and women, battles for health care for the vulnerable, those who were poor and may not have a strong advocate other than their Senators or Members of Congress. So he has fought battles on health care. You could isolate a lot of different issues under that general heading, but one that comes to mind for me is the National Institutes of Health. No one I know of in the Senate has fought more battles for the National Institutes of Health and all of the research that comes from the great work done there, and all the cures, all the ways people are saved because of that research at NIH. He has fought battles on job creation, not only to preserve and protect and create more jobs at a time of recession--such as the horrific recession we have been living through and our workers and families have been suffering through--but battles over many years, battles to protect the rights of workers to organize and collectively bargain, battles to make sure jobs are kept in Pennsylvania instead of going overseas or somewhere else. He has fought those battles to protect our workers and our jobs. He has fought battles on national defense, making sure we are doing everything possible to keep the people of our Commonwealth and our country safe from foreign enemies, safe from terrorists, and safe from those who seek to do us harm. Over many years, Arlen Specter has cast those votes as well, keeping us safe and keeping us strong. His independence is something that is critically important to any State, but especially a State such as Pennsylvania. We have a State of over 12 million people. We have a lot of different regions in our State, a lot of different constituencies, and a lot of different challenges all across the State. What the people of Pennsylvania expect their Senators to do is to try their best to fight their battles, to try to remain an independent voice for them, not for some special interests in Washington. Arlen Specter has done that for years, being that strong, consistent, independent voice for the people of our State. He has had a strong sense of justice from the time he was a young lawyer, through his service as a prosecutor making sure our streets were safe in Philadelphia, and through what he has done here in the Senate, fighting battles for justice every day in his service in the Senate. Finally, in a very broad sense, but a very important sense, not only when times are tough, as they are now economically, but even when times seem good, even when the budgets are better and people do not seem to be as concerned about what the Federal Government can do to help them through a difficult period--even in those times of prosperity, he has always fought for our workers and our families. It is very easy for me to stand here, as someone who has watched him over the years in his service in this Senate--and I know as someone who has served with him for more than 3 years--it is very easy for me to say, without any effort at all, that those 10,000 votes he has cast have been votes on behalf of the people of Pennsylvania, and I believe for the best interests of the people of the United States of America. I commend Arlen on that tremendous vote total. I commend him also for his public service, his enduring public service for the people of Pennsylvania. I also commend his wife Joan and his family who I know have supported him for many years to make sure he could help us serve the people of Pennsylvania. Congratulations, Arlen.

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 tonight for two purposes. One is to talk about the state of our economy, the challenges we face but also the obligations we have to address those challenges, and, secondly, to speak for a couple minutes tonight about our brothers and sisters in Haiti and, in particular, children in Haiti. Let me start with our economy here at home. We got word today in Pennsylvania--this is a newspaper story, an AP story, 3:52 p.m. The headline on this very brief story from the wire services is as follows. I know it cannot be read from that distance. But the headline is: ``Pa. Jobless Rate Up, Jobs at Most Scarce in Decade.'' It says: A new report says that jobs in Pennsylvania were harder to find in December than they have been in more than a decade. It goes on to talk about the unemployment rate jumping up four-tenths of a percent, to 8.9 percent. That is disturbing in a lot of ways. First of all, not just the rate, because sometimes when we look at the unemployment rate, it does not tell the whole story. Sometimes it undercounts the people who are not looking for work, and sometimes the numbers do not make sense. What it means in real terms, in numerical terms, I should say, real people, it means that in Pennsylvania, there are well more than half a million people out of work. I cannot even imagine what those numbers look like proportionally, when you have States where the unemployment rate is 10 percent, 11 percent, 12 percent, and even higher in some States. So it is bad enough in a State such as ours when you have 8.9 percent, what that translates into in terms of real life, real families, and the horrific impact of this recession. I cite that number, several of those numbers for a very basic reason. A lot of folks around here are looking for messages from the recent election in Massachusetts or they are looking for messages from the election of this past November. I do not think you need to go very far or do a lot of election analysis to know one of the central and overarching messages I have heard in Pennsylvania--and I am sure others have as well--and that message is this: The American people want us to focus on job creation right now. They do not want to hear about some long-term plan, a multiyear plan to create jobs. They want us to put on the table, to enact into law, strategic, short-term, effective job creation strategies that will have the effect of incentivizing small businesses to hire more employees. The idea that I and others in the Senate have is a job creation tax credit. If you are a small business--in this case we drew the line at 100 or less; I know that is not often the dividing line--if they qualify, they get a 20-percent tax credit; higher than 100 employees, a 15-percent tax credit. That kind of targeted and specific strategy for 1 year--this is a 1- year bill we are about to introduce--will have that effect. It is one of several things we have to do on job creation. We have to have strategies, for example, that have as their intended target the positive impact on small business. All across Pennsylvania-- and I think this is true across the country--it is not just the question of the unemployment rate going up and joblessness increasing, it is small business owners--I do not care where they are from--coming to us and telling us: Please help us with obtaining access to credit. There is no way a small business can grow if they cannot borrow. Our whole system is predicated on borrowing money so you can invest in a new plant and equipment, borrow money so you can hire another employee or two or three or more. If they do not have access to credit, this economy cannot create jobs and grow jobs at a fast enough pace. So that has to be our focus. We also have to understand, as best we can from the distance of Washington and the security we feel here, most people in the Federal Government and certainly individual Members of the Senate do not have to worry about health care. They have it. They do not have to worry about a paycheck. They are getting that. But even in those secure circumstances, we have to do everything we can to understand what real people are up against, what they are up against every day when they wake up in the morning. Even if they have a job, sometimes the costs that are impacting their budget, the costs of paying for health care, the costs of higher education, the costs just to make ends meet in their daily lives have never been more tested, never been more of a severe challenge. So part of it is enacting job creation strategies, but that is not enough. Part of it is also speaking directly to the needs and the concerns and the anxiety and the sense of insecurity a lot of Americans feel. That is our No. 1 obligation. I think, in addition to that, we should pass health care legislation. We do not know how that will happen in light of the new political realities here in Washington. But I think we need to do that as well. But no matter what happened in the elections, no matter what happens on the issue of health care, job creation has to be the No. 1 priority, second to none, in terms of the work we do here in Washington. I ask unanimous consent to have printed in the Record this very brief wire service story about the unemployment situation in Pennsylvania.

Mr. CASEY. Let me conclude this part of my remarks by speaking for a couple minutes about what we have done in this past year: The Recovery and Reinvestment Act, known by--as many things are here--the acronym AARA, the American Recovery and Reinvestment Act. Those two words in the middle are very important, the word ``recovery'' and the word ``reinvestment'' because that is the intended effect of that legislation. It was the right legislation--not perfect but the right legislation--at the right time at the beginning or the early months of 2009. But there are a lot of Americans who believe it is not being implemented fast enough. The jump-starting effect of the spending, whether it is on infrastructure or energy efficiency or investments in education, investments in health care, tax cuts for 95 percent of the American people, which was in the recovery bill, that all of that is not moving fast enough. So one of the jobs we have, in addition to new strategies on job creation, is to implement, at a faster pace, at a faster rate, the recovery bill. I also believe we should remind ourselves that the recovery bill was not a 10-month bill. We are in about the 10th month right now. But the spending that will create the jump-start of a positive economic effect is supposed to take place over 2 and 3 years, depending on the program, depending upon the initiative. So one of the things we have to do is push the recovery bill aggressively to make sure those investments, whether they are recovery, getting our economy out of the ditch, so to speak, and moving down the road or whether they are expenditures that relate to reinvestment, reinvestment in people skills, reinvestment in their opportunities to have higher education, reinvestment or investment, in some cases, in people's ability to recover from this recession, unemployment insurance, COBRA health insurance extensions, food stamps. All those are critically important to our recovery. For those who say: Well, I do not like when we spend money on unemployment insurance or food stamps--we get that criticism from folks once in a while--they should understand there is no comparison, at least according to the economist Mark Zandi, there is no comparison between tax cuts for wealthy folks versus unemployment insurance, food stamps, and other strategies in terms of their positive impact on the economy. By one measurement that Mark Zandi pointed to, bang for the buck, if you spend a buck on unemployment insurance or spend a buck on food stamps, you get a return above $1.50, you get as high as $1.60 to $1.70 in return. You cannot say that, according to his analysis, with regard to some of the tax cut policies we have seen here. So investments in vulnerable Americans who are trying to recover from the recession--food stamps and unemployment insurance being the two best examples--those investments actually have a return to the taxpayer as well. So what do we need to do? We have to focus on job creation. When we focus on that legislation, it should have a couple component parts or elements. First of all, stabilizing that safety net for vulnerable Americans which I just spoke of. Secondly, supporting small business in a very direct and targeted way. Investing and investing more in infrastructure, including broadband infrastructure, which is another kind of knowledge infrastructure and, finally, building a clean energy economy. If we continue to do that, we will create jobs, we will keep our environment clean, we will reduce our dependance on foreign oil and literally make us more secure from a national security standpoint. I think a major part of job creation, in the short term, has to be a job creation tax credit.

Mr. CASEY

Mr. CASEY. Mr. President, over the past week, we have witnessed the immense destruction that the earthquake in Haiti and its subsequent aftershocks have wrought on the Haitian people. Old and young, rich and poor, weak and strong, no matter who you are, this earthquake has brought heartache and sadness to numerous lives. First, I want to send my condolences to the people of Haiti and their family and friends around the world who lost loved ones in this tragedy. I also want to send my condolences to our brave men and women in the U.S. Embassy who also have lost loved ones, but who are continuing to help the people of Haiti and Americans in Haiti in the midst of this natural disaster. These individuals represent the very best of what America encompasses. I am proud that as soon as this earthquake struck our southern neighbor, the U.S. Government as well as the American people galvanized their resources to ensure that resources were delivered for people who have lost everything. Today, I come to the floor to speak about a specific population that has been and will continue to be affected by this disaster, the most vulnerable population of all, Haitian orphans. Before the earthquake, these children were looking for families, for people to love them and for people to love. This quest has not changed; however, their tenuous situation in life only further deteriorated after the earthquake. While I know that everyone has suffered so much, these children are without the natural protection that parents provide. Therefore, it is our duty to be their voice and to make sure that if they survived the earthquake that they also survive this critical period of time while resources are trying to be delivered and a sense or order is trying to be restored. This weekend several of my constituents have contacted me about their concern for this most vulnerable population. One constituent wrote: Senator Casey: I am writing on behalf of our friends, Michael and Monica Simonsen who have been in the process of adopting their son, Stanley Hermane (DOB: 4/9/2008), from Haiti since August 2008. Stanley was brought to Petit Anges de Chantal orphanage when he was only two months old. He was severely malnourished and covered in scabies. They have visited him in Haiti three times, each time bringing supplies and donations to the orphanage. The resources are scarce under normal circumstances and with the current crisis, there is a genuine concern that the children will not survive. I am writing to request that you support initiatives created to help expedite the adoption process for children who already have completely committed U.S. approved families waiting at home. Expediting the process will not only secure their safety but will free up already scarce resources for children orphaned by this disaster. Senator Casey: After years of personal investment there, Jamie and Ali McMutrie, of Pittsburgh, Pennsylvania, have brought 30 children almost through the entire adoption process to anxiously waiting families here in America. Almost. The recent earthquake of January 12th has destroyed their orphanage leaving Jamie and Ali to sleep outside on the lawn with all their children. With food and water in short supply and rioters all around, the clock is ticking for you to do something. I am happy to report that Jamie and Ali McMutrie, who help run the BRESMA orphanage in Haiti, were able to evacuate 53 of their orphans and united them with their American adoptive parents earlier this week. However, Jamie and Ali were not able to bring back all 150 children at their orphanage home. Many people across the nation like Michael and Monica Simonsen are still waiting to know that their child is safe and many orphans like Jamie and Ali's orphans who remain in Haiti still need food, clean water and a safe place to stay until they can complete an adoption process. This Monday, the Department of Homeland Security announced that they would use their authority to extend humanitarian parole to Haitian orphans already in the adoptive process with an American family. I commend the Department of Homeland Security and the State Department's Office of Children's Issues for making this policy decision and I fully support their desire to assure that the best interests of these orphans are put first. However, I am very concerned that when the Department of Homeland Security announced its decision to provide humanitarian parole, there was no plan at that time to ensure a safe and orderly process by which eligible orphans could be processed and evacuated. I continue to hear reports that orphanage directors in Haiti are going to the U.S. Embassy and while some are being admitted others are being turned away. Some of these orphanages are more than 125 miles away. I am concerned for the safety of the 600-700 orphans that this announcement affects. They may be harmed trying to get to the embassy, and if they are okay on that journey and even succeed in obtain travel documents, they may be harmed when they are told to wait back at the orphanage until a plane is available. I am also hearing from American families so desperate to ensure their child is safe that they are trying to make their way to Haiti. We don't need more chaos in an already chaotic situation. I along with some of my colleagues have called on the State Department and USAID to set up safe havens for orphans, which will provide food, water and protection for all orphans as well as time to ensure that those orphans who are eligible for humanitarian parole are processed and evacuated in a timely manner. This is just one idea; however, in the absence of an alternative plan, more and more children will continue to show up at the Embassy's gate. Therefore, I ask the administration to implement a plan to ensure that these 600-700 orphans are safely and efficiently processed and evacuated to be united with their awaiting adoptive parents, and that we work with the international community and other NGOs on the ground to ensure the safety of all orphans until they can be placed in loving homes. Again, I thank the U.S. governmental officials who have been working around the clock trying to ensure the safety of these orphans and all those affected in Haiti. ``Though he brings grief, he will show compassion, so great is his unfailing love.'' Lamentations 3:32. In this time of darkness, I believe that Haiti can emerge in a better place. And I am grateful that our country will be a friend with Haiti in this endeavor. Similar to a lot of Americans, I am not surprised but heartened and proud by the response of the American people, a tremendous outpouring of generosity. People in America from all walks of life recognized immediately that the people of Haiti, in the depths of an incalculable, an indescribable horror and tragedy, in the depths of that, the American people showed their generosity, they showed that they understand that our Haitian brothers and sisters are just that, they are part of the family, the human family, and they are our brothers and sisters. The most vulnerable member of that family, in most instances--maybe not in every instance in every family but most of the time--will be a child. We are seeing unforgettable imagery and video of young children being rescued in Haiti, surviving for days at a time in the rubble and the horror they have been living through. Thank goodness so many people have invested in ways to save those children. But what we still have to do a better job on is making sure that if a Haitian child is in the adoption process, is in the pathway, so to speak, to being adopted, we have to do everything possible, in addition to the obvious safeguarding, to provide that child with security, physical security and food and water and medicine and medical treatment and, in addition to that, that we provide, as expeditiously as possible, a process for their adoption and ways to make it possible for them to be adopted, that the adaptive parent or guardian can have that assurance but also so that child can be well on the way to being adopted. We do not quite have that yet in terms of what the Federal Government can do and should do. I had a call late this afternoon with Secretary of State Clinton, who should be commended for her work, in a broad way, with regard to the response to the tragedy in Haiti but, in particular, her concern and her actions that she has taken to make sure these young children are taken care of. I will not go into all the details now, but let me cite in summary fashion that a number of my colleagues in the Senate and I have called upon the State Department and USAID to set up safe havens which will provide food, water, and protection for all orphans, as well as time to ensure that these orphans in Haiti who are eligible for what is called humanitarian parole--those who are on the way to being adopted through the process--that those who are eligible for that process, humanitarian parole, are indeed evacuated and processed in a timely manner. This is just one idea, one way to help. In the absence of an alternative plan, more and more children will continue to show up at the American Embassy. It is vitally important that happen. I commend the work of our government at various levels in terms of what they have been doing to respond to the challenge posed by these orphans and their circumstances. I know in our home State of Pennsylvania, Governor Rendell and Congressman Altmire worked very hard to bring some of these children back to Pennsylvania. I commend them for the effort they put forth. For all these reasons, there is plenty of evidence to show that the American people understand that these individuals, these families, and especially these children are God's children. We have to be cognizant of that as we go forward with sound policies in the days ahead. I yield the floor.

Mr. CASEY

Mr. CASEY. May I ask the Senator from Iowa to yield for a question about the managers' amendment, amendment 3276, to amendment 2786 to H.R. 3590? Mr. HARKIN: Of course.

Mr. CASEY. I thank the chairman. So, for example, an Amish person working in a factory or store for a non-Amish employer and meeting the 1402(g) requirements would not be required to obtain insurance coverage against his or her religious convictions?

Mr. CASEY. Chairman Harkin, the managers' amendment includes a religious conscience exemption from the individual requirement to maintain minimum essential coverage in section 1501. Is it the intent of the managers that this exemption apply to an individual who is a member of recognized religious sect described in Internal Revenue Code section 1402(g) regardless of employment status?

Mr. CASEY. I thank the Senator for that clarification.

Mr. CASEY

Mr. CASEY. Mr. President, I commend the work of our Finance Committee chairman, Max Baucus, for so many things in this debate. First, for helping us get health care legislation moving in 2009 and now at the point of getting close to passing the bill. I am grateful for his leadership. There are some highlights of the bill I want to note in the remaining moments of our time. First, there has been a lot of debate over the last couple of days and weeks--but even over months--about cost and care. Fortunately, we are able to report that with this bill coming out of the Senate, we will have more care and less costs. The deficit will be cut by $132 billion over 10 years as a result of this bill; $1.3 trillion will be cut in the deficit in the second decade. It will provide coverage for 94 percent of the American people. This has not been talked about much, but the bill is a net tax cut for the American people. We are going to crack down on insurers' practices that have gone on too long, were allowed to go on for too many years: ending preexisting condition discrimination, and discrimination based upon gender, providing protection from exorbitant out-of-pocket costs, something we hear about all the time. Just with regard to older citizens across our country, one, the bill will extend the solvency of Medicare; two, it makes prescription drugs more affordable by filling the so-called doughnut hole and helping people with those costs; cutting waste, fraud, and abuse in Medicare; ensuring Medicare funding to improving care for seniors not to insurance companies. Small businesses--if there was one sector of our economy we have heard from over and over about the crushing burden of health care costs, it is small businesses. I know that tens of thousands of small businesses in Pennsylvania, for example, will benefit from this legislation. There are two points with regard to the bill and small business. First, the bill provides tax credits to small businesses to make employee coverage more affordable. Second, tax credits of up to 50 percent of premiums will be available to eligible firms that choose to offer coverage--a tremendous breakthrough for people out there who are creating most of the jobs in Pennsylvania and most of the jobs nationally. One of the more unreported or underreported aspects of the bill is what happens immediately. A lot of folks say: We like your bill. We like what is going to happen. But a lot of it won't take effect for at least several years, until 2014. A good part of the bill takes effect in 2010. A quick summary of those provisions: First, it provides affordable coverage to the uninsured with preexisting conditions. If there is an insurance company that excludes you because of a preexisting condition, you can go into a high-risk pool to get help right away. It improves care to older citizens, as I mentioned, and lowers prescription drug costs. It reduces costs for small businesses through tax credits. Fourth, it extends coverage for young adults--young adults 25, 26 years old, who may be living under difficult circumstances and don't have insurance coverage. Preventive care--we preached and talked about that for years, and we point to studies and good practices, but we have never made it part of our overall health care bill. This bill does it. We eliminate lifetime limits on the amount of coverage a person may receive--a terrible problem for families. The message from our system has been that we can cure you, but we have to limit the kind of care we are going to provide for you. Three more points in this area: What are the immediate benefits in 2010? It prohibits discrimination based upon salary, gender, or illness. We make insurance plans more transparent and competitive. Finally--and this is a rather new change--it prohibits insurance companies from denying children coverage due to a preexisting condition. That has moved up in the bill, so to speak, to an immediate benefit for children. So at least in the short term for children, there will be no more denying them coverage due to a preexisting condition--a tremendous breakthrough for a child, for his or her family, and for our economy and for our health care system, to protect children in a very substantial way. Whether it is cutting the deficit, providing better quality of care, providing opportunities for great prevention which will lead to a healthier outcome, protecting people so they do not have to go bankrupt to get the care they need, and especially for protecting older citizens and children, this bill moves forward in a way we have never had an opportunity to move our system forward in a very positive way. I again commend Chairman Baucus on his work and our majority leader, Harry Reid, and all those who made it possible to move this bill forward and to have it passed through the Senate and move it to enactment. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, I rise this afternoon to speak about health care and the bill that is on the Senate floor that we have been debating now for a number of days, the Patient Protection and Affordable Care Act. I want to provide, first, a brief overview, but in particular to focus on provisions that relate to our children and then get into some detail about those provisions and the important programs that are contained within those parts of the bill. First of all, as we all know from the debate, what this side of the aisle has been trying to do is not just to pass legislation, but to do it in a way that meets the goals we set forth many months ago and, as well, what President Obama indicated much earlier this year in terms of some basic goals. I will just cite a few of those: To make sure when we are enacting legislation that we do not add to the deficit; that we at least break even, so to speak. But the good news is, on the scoring done by the Congressional Budget Office, the Patient Protection and Affordable Care Act will actually lower--lower--the deficit over 10 years by some $130 billion, and then lower it even further over the course of the next 10 years, by one estimate, over $600 billion. So that is good news about deficit reduction as it relates to this bill. Even if we broke even, it would be significant. Also, we are obviously trying to cover tens of millions of Americans who do not have coverage. The foundation of the bill on that issue is that some 94 percent of the American people will be covered, adding some 30 million to 31 million in terms of coverage. That is also a goal. I think we are going to be able to meet that. Then there are a whole series of things we have talked and talked about for years and have never done. We talk about how we have to enhance health care quality. We have not done much about it, and we are going to be able to make changes in this bill to do that. Certainly prevention. Everyone knows--the studies on this are, in a word, irrefutable--that prevention is not only good for a patient and good for his or her own family, and good for the economy long term because you are going to have a healthier worker, but it is also a giant cost saver, sometimes in a way that you cannot quantify or even often get credit for from the Congressional Budget Office. I have no doubt--and I think I join a lot of other people who know a lot more about prevention than I do--that this will be a huge cost saver in addition to being something that leads to better health outcomes. So in terms of quality and prevention and deficit reduction and coverage, it is a very strong bill. It is also a strong bill in terms of dealing with what we can call, in two words, consumer protections. That does not even begin to describe what this bill will do in terms of helping at least one category of Americans. We saw a study a couple months ago that indicated over a several-year period of time--if my recollection serves me, 3 years--millions of Americans--not thousands or tens of thousands, but millions of Americans--have been denied coverage because of a preexisting condition. That is because we have allowed insurance companies to do it year after year, and in some cases a lot longer than that. Well, we do not need to just talk about it and decry it and condemn it, we need to make it illegal. But we also have to make sure we do not just pass legislation--a lot of which has to be implemented down the road--and then say to those with preexisting conditions: We have changed the law, but you have to wait several years. One of the immediate benefits under the Patient Protection and Affordable Care Act relates to those Americans who have preexisting conditions. The act will provide $5 billion in immediate Federal support for a new program to provide affordable coverage to uninsured Americans with preexisting conditions. Coverage under the program will continue until the new exchanges are operational. That is good news for millions of Americans who have been denied coverage. I cannot tell you--I think every Senator in this Chamber on both sides of the aisle, Democrat, Republican, Independent--has received letters from Americans, horrific, tragic stories, in many instances, where they have been denied coverage, sometimes leading to death, sometimes leading to, even if it is not death, the worst of health care outcomes. So that high-risk pool, as it is called, for those with preexisting conditions will mean immediate benefit under the bill. I will mention a couple of other things that will happen immediately, and then I will move to the provisions on children. We hear a lot about business on this floor and arguments about who is stronger or who is more of an advocate for small business especially. But what we do not say enough is, this act, the Patient Protection and Affordable Care Act, will offer tax credits to small businesses to make employee coverage more affordable, and those tax credits will go up to 50 percent of premiums, which will be available to firms that choose to offer coverage. That is another not just good reform--good for the small businesses, good for the employee, and really good for our economy short term and long term--but it is one of those immediate benefits. I will cite one more, and then I will move on. This Congress, a couple years ago, passed Medicare Part D, as it is known, adding prescription drug coverage. One of the adverse impacts from that legislation is, an older citizen gets the benefit of that and is able to benefit from the prescription drug coverage, but then they fall into the so-called doughnut hole. That is a very innocent-sounding phrase, ``doughnut hole.'' It does not sound that bad. It is a nightmare for someone. Basically, what it means is that an older citizen has to carry the whole freight for a long time and pay a lot of money at a certain period of time when they fall within that category. The Patient Protection and Affordable Care Act will reduce the size of the so-called doughnut hole by raising the ceiling on the initial coverage period by $500 in 2010. That is another immediate benefit of the enactment of this bill. The act will also guarantee 50-percent price discounts on brand-name drugs and biologics purchased by low-income and middle-income beneficiaries up to the coverage cap. That is another immediate benefit. These are benefits in terms of small business, in terms of covering those with preexisting conditions immediately, as well as helping older citizens deal with and manage the difficult doughnut hole problem so many of them have been suffering from. Let me do a quick summary. I will start with this chart. As shown on this chart, this is just a summary of some of the challenges of where we are now and what happens if we do nothing. It says: Status Quo is Unacceptable and Unsustainable. That is an understatement. The first bullet point on there: Every week, 44,230 people are losing their health insurance coverage. So every week that goes by, every day that goes by, we have Americans losing their coverage--bad for the individual and their family, and it is real bad for our economy. The second bullet point: Between January 2008 and December 2010-- roughly you are looking there at a 3-year type period--178,520 individuals in Pennsylvania are projected to lose their health care coverage. There is no way to adequately describe the adverse impact that projection and that data point has on the people of Pennsylvania. You cannot have a growing economy if people are losing their health coverage. The numbers are spiraling out of control, not only in Pennsylvania but across the country. You cannot sustain any economy that way long term. The third and final bullet point: Without reform, family coverage will cost $26,679 in 2016--just 7 years from now--consuming 51.7 percent of projected Pennsylvania family median income. The cite is the New American Foundation. That same number for the country--in other words, the percentage of median family income going to pay for health care--for health care, something so fundamental and basic in our society--it is 51.7 percent in Pennsylvania in 2016. The good news for the rest of the country is that the national average is only--only--a little more than 45 percent. I have not met a person in Pennsylvania or anywhere else in this country, but I know I have not met a person in Pennsylvania who says: Do you know what. Don't worry about it. Don't worry about passing any health care reform bill. Don't worry about getting it done because in 2016--I am living in Pennsylvania--I can come up with 51.7 percent of my income for health care. Don't worry about it. I can handle it. We know no one can afford that. Even a family of tremendous means might have trouble affording more than half their income--half their income--to pay for health care. What if the projection is wrong? What if it is off by 10 percentage points? That is 40 percent. What if it is wrong even more? What if it is only 30 percent? I do not know of a family who can afford that. So we have a lot of reasons to get this right and to pass the bill. That projection is one of the most horrific. Now I will move to the chart on children. I will give just a quick summary of what the bill does for children, and then we will walk through the Children's Health Insurance Program. A couple of basic points: pediatric benefit package; that comes with this legislation, including oral and vision coverage for children. Many health plans do not provide that kind of coverage. It is one of those unwritten stories--or if it has been written, it has not been written about enough--where children lose out, sometimes even in a good health care plan for their parents. So it is not good enough to say, well, we have some coverage here and kids will be just OK. Children, as the advocates remind us all the time--these are not my words--are not small adults. They have different health care needs, and they have different health care problems and challenges. Pediatric benefits, as part of the benefit package, is a dramatic change and a very important change. This bill will not only require coverage for basic pediatric services under all health plans but also oral and vision needs, which improve a child's ability to learn and perform in school. So we can't talk about getting better test scores in school and doing all kinds of things that are in our education system if a child is not given the basic health care a child needs, not the health care an adult needs. The second point under what the bill would do is more pediatric providers. We have to have strategies in place to recruit and incentivize and train more pediatricians. You can't just say you want more coverage for kids and throw more money at it; you need to have the workforce to do it. The Patient Protection and Affordable Care Act will expand the workforce, including pediatricians, pediatric nurse practitioners, specialists in pediatrics, and pediatric oral health professionals to give kids what they should have in this country of ours where we know what works. We know exactly what works when it comes to children's health insurance. Then, providing greater quality, improving the quality of coverage for children. The preventive health care we are going to provide for children is dramatic. Finally, let me make a point about children overall. We hear a lot of discussion about where health care--what part of the country benefits the most and who will benefit the most. Well, under this legislation, there is not an American, I believe, who will not be positively impacted one way or another, sometimes directly. But one message came out loudly and clearly during the debate on children's health insurance going back a number of years in the Senate. Often, most people think of children under the benefit of the Children's Health Insurance Program as living in urban areas maybe or in a big city because that is where poverty is highest and, therefore, lower and middle-income families benefit from Medicaid or children's health insurance. That is largely true, for sure. But what came through to me in that debate many years ago--several years ago now--is something I never knew before, which is that one-third of rural children in America are the beneficiaries of either Medicaid or the Children's Health Insurance Program. Not many people heard that until a couple years ago. So this isn't about one specific demographic--or geographic, I should say--location where children are and who need these benefits, where there is Medicaid or the Children's Health Insurance Program. We know this is a problem for rural children, for urban children, for children who live in small towns, and even in suburban communities that are perceived to be a little more secure economically. When I have been talking about what we have to do for children, I often point to a line from the Scriptures, a very simple line, but I think it holds us accountable in this debate as it relates to children. There is a line in the Scriptures that says, ``A faithful friend is a sturdy shelter.'' The question we have to ask when we are debating how we are going to help our children in this legislation is: Will we be a faithful friend to children? It is actually a pretty simple question, with profound, almost incalculable implications. Are we going to be that sturdy shelter for children, children who don't have a voice, who don't have economic power, who don't have a lobbyist showing up on Capitol Hill every day saying: Take care of this child or help this group of children. So the question for the Senate, one of many questions we have to answer by the end of this debate is: Will we be a sturdy shelter for children? Will we be a faithful friend to children? Let me conclude with a couple remarks about the Children's Health Insurance Program, in particular. My colleagues can see up here, in Pennsylvania--this is typical of a number of States but not every State--through Pennsylvania's Children's Health Insurance Program benefits, children are guaranteed to receive comprehensive insurance coverage, including the following: Every child should have this. I don't care who they are or where they live or what their economic status is, they should have immunizations. They should have routine checkups, prescription drugs, dental care, maternity care for their mothers, mental health benefits, up to 90 days' hospitalization per year, durable medical equipment, substance abuse treatment, partial hospitalization for mental health services, and, finally, rehabilitation therapies and home health care. That whole menu of benefits for children is not some theory or some hope, in a sense; this is what the Children's Health Insurance Program means to America's children, their parents, their family, and, I would argue, this is about economic development in the long run. This is about developing a high-skilled workforce. If a child has these benefits in place, they can make it in life, with a couple other breaks and some other incentives. But if they don't have this list and they don't have the best possible health care, they are going to be in a lot of trouble. All of us will be in trouble because our economy will never be as strong as it can be and must be unless we do that. Let me go to the next chart, which is a subset of that. This chart depicts what is in children's health insurance now: Well-child visits. I have talked about that a lot. It is not a real glitzy subject for people to debate but a critically important part of what children's health insurance means and the benefits mean, a well-child visit. In the course of 1 year, under the Children's Health Insurance Program-- under the program we put in place and Congress enacted almost 15 years ago and then we reauthorized it just this year and President Obama signed the legislation--it means, instead of 7 million kids covered-- that is a great amount and that is great, but in a couple years, we are going to be able to expand that to 14 million children. I wish to make sure--and I am sure this view is shared across the aisle as well--that every child should have six of those well-child visits in a year. It is a key time for a parent and physician to communicate. Doctors recommend six visits in the first year. They get a complete physical examination, including height, weight, and other developmental milestones are measured. Hearing and vision are checked. We have all had the experience where a child doesn't get those kinds of basic checks and they have a hearing problem because it wasn't detected early or a vision problem. One of my four daughters had a vision problem. It wasn't caught at an early enough stage and we had some real difficulties making sure she had the right care. Important topics discussed, including normal development. What does that mean? A doctor should be able to talk to a parent about that, and the program covers that. Nutrition, sleep, safety, infectious diseases, and then general preventive care. Why should there even be a debate about whether children get this? The good news is, we have a program that does that and the good news is also that we have just expanded that program. Here is where the challenge comes in. In the midst of health care reform, the House of Representatives did a lot of good things in their bill. One thing they did not do well is make sure the Children's Health Insurance Program is as strong as it needs to be and must be, and that is the reason why I received the following letter. I will not read the whole letter, but this letter came from Barbara Ellis. She is in Broomall, PA. I spoke to her a couple days ago about her letter. I will not read all of it, but I think it describes pretty aptly what we are talking about. Barbara and her husband Ben live in Delaware County, PA, in Broomall. She says: We are a one income family with two sons, ages 6 and 8. Due to the high price of health insurance my children are currently covered under the free Pennsylvania Children's Health Insurance Program. That is the good news. But here is the part where she is worried: We qualify for free Children's Health Insurance coverage in Pennsylvania, but my husband's income is greater than 150 percent of the Federal poverty level which means our children won't qualify for the coverage under the House's proposed plan. Then she says--probably the most important part of this whole letter: ``This has us terrified.'' So it would any parent who does not have the peace of mind to know, when they fall asleep at night, they don't have to worry about whether their children have health insurance. But if we don't do the right thing, she will have that sense of terror. She says this as she concludes the letter: It would help us tremendously if you could support keeping the Children's Health Insurance provisions intact which would, in turn, support families like ours. That is what I have done by way of an amendment to our bill to make sure we strengthen what the House did and strengthen even our own bill. Our children's health insurance amendment, which I will not go through today, strengthens and safeguards the program through 2019 and beyond to address any changes health care reform may bring. We will talk more about it, but this is key to be able to make sure we have not just a set of benefits for children that are directly tied to their care and will help them for decades afterward and help our economy and give their families peace of mind but also that in the process of making sure we keep these kinds of benefits, we keep the program strong, not just until 2013 but at least all the way to 2019. I think we can do that. I think we can do that in the midst of this debate and get it right and give families and especially children that kind of protection. In a word, what we have to make sure we do is to ensure that the Senate and the Congress and this administration do everything they can to prove and to demonstrate that we are a faithful friend to children, that we will always be their sturdy shelter. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, we are in our discussion of health care. We have been focused on a couple of major goals. The obvious goals that I think are a major part of the legislation we are debating are controlling costs, the goal of providing better quality of care, providing health care to millions of Americans--tens of millions, really--who would have no chance to get that kind of coverage without this legislation, and also the concern we have about not only controlling costs, but we have legislation on the floor that actually reduces the deficit by $130 billion and beyond the 10 years by hundreds of billions. One of the concerns we have is that in the midst of a health care debate about numbers and the details of the programs is that we also do not forget that some parts of our health care system work well but often might need an adjustment or an amendment or a change that would benefit a vulnerable population of Americans who do not have the kind of coverage or protection or peace of mind they should have. One of the more successful parts of our health care system as it relates to new parents, especially new mothers and new children, is what is known by the broad category of nurse home visitation programs. They have been enormously successful over many years. I have an amendment I filed for this health care bill called the nurse home visitation Medicaid option amendment. It sounds a little complicated, but it is actually rather simple. It is part of what we need to do in the next couple of days and weeks as we complete our work on health care. One point to make initially is that we know these nurse home visitation programs work. They get results for new parents, new mothers, and have positive benefits to a new mother and her children. We all have had the experience, if we are parents, of the anxieties of what it is like to be a new parent but especially what a new mother goes through--all of the anxiety. It is not limited to one income group. No matter what income you are, no matter what background, it is a challenge to fully understand what it is like to have a baby and to care for that child appropriately. That is one of the underlying concerns we have. In our health care system, we have to do everything possible to give that child a healthy start in life, and the best way to give a child a healthy start is to make sure his or her mother--and hopefully both parents--is able to handle the pressures and manage the anxieties that so many new parents have. The amendment I filed supports optional nurse home visits. That means that if someone chooses not to take advantage of this program, obviously, they do not have to. The amendment simplifies the process for providers of nurse home visitation to seek Medicaid reimbursement. Some will say there is Medicaid reimbursement now. Yes, there is, but it gets complicated to a point where a lot of States are not getting the full benefit of that reimbursement. This amendment will impact the lives of Medicaid-eligible pregnant women and their children, and the impact is profound. The amendment is cosponsored by Senator Gillibrand of New York. It will allow States the option to seek more adequate reimbursement for nurse home visitation services. Again, a State is not forced to seek greater reimbursement, but I believe a lot of States could and should take advantage of this kind of an option. In Pennsylvania, we have been trying to do this for years, even in the midst of having very effective nurse home visitation programs. One can just imagine how valuable that is for a new mother, that they can get advice and help from a nurse or another kind of professional and get them through the early days and weeks of being a new parent. I believe a State such as Pennsylvania that has had a track record of these kinds of programs that have a direct and positive impact on children and their families, their mothers especially, should be able to take advantage of this, as I am sure many other States. The amendment helps States cut through the redtape and allow these evidence-based nurse home visitation services--let me say those words again: ``evidence-based.'' This is not some theory; this is not some maybe--let's try to create a program. These programs work. The evidence is, in a word, irrefutable over many years that these nurse home visitation programs work. We want to allow States to be reimbursed under a State Medicaid option. We have about 30 years of research to back up the following claims. Let me give four or five points. We start with a category for every 100,000 families who are served by nurse home visitation programs or nurse-family partnership programs-- all in that same category. For every 100,000 families, 14,000 fewer children will be hospitalized for injuries and 300 fewer infants will die in their first year of life. That alone, that number alone is worth making sure States have this option. What is the price of saving 300 infants a year out of 100,000 families? It is incalculable. There is no value we could put on that kind of lifesaving as well as down the road saving money. Let me give a couple of other examples. For every 100,000 families served by these nurse home visitation-type programs, 11,000 fewer children will develop language delays by age 2. That is a profound impact on the child--his or her ability to achieve in school and then his or her ability to develop a high skill and therefore contribute positively to our economy. There is no price one can put on 11,000 new children learning more at a younger age. Out of 100,000 families, 23,000 fewer children will suffer child abuse and neglect in the first 15 years of life. Again, there is no way we can quantify that with a number or budget estimate. But I would like to say we support strategies around here that are evidenced-based and scientifically based to make sure children are not abused, that they live through the first couple years of their lives when they are at risk of dying. One more statistic. Out of the 100,000 families we use as a measurement, 22,000 fewer children will be arrested and enter the criminal justice system in the first 15 years of their lives. Just like the statistic about the first year of life and surviving the first year of life or not having in this case 23,000 more children suffer child abuse and neglect, these are impossible to measure. In a sense, it is the measure itself that we save children's lives, we make them healthier. They and their families are able to contribute more to society. This is the right thing to do to give our States the option--just the option--of seeking greater reimbursement for these important services. I have seen it firsthand. Many years ago--it must be at least 10 years ago--in Pennsylvania, I actually went to the home of a brand-new mother, a lower income mother in northeastern Pennsylvania. We walked in the door, with her permission, with the nurse who was working with her after she left the hospital with her new baby. There is no way to put into words how valuable that relationship was between a new mother and a nurse, between a new mother and a health care professional to give her the start in any circumstance but especially if a new mother has financial pressures which are extraordinary and almost unbearable for some new mothers or has pressures as it relates to her husband or boyfriend, whoever is part of her life. Sometimes there is violence. Sometimes there are other pressures that some of us cannot even begin to imagine, in addition to the obvious pressure of being a new mother, being a new parent, and wanting to do the right thing. These programs, as the evidence and science tell us, work to give new mothers peace of mind and to give States the ability to directly and positively impact the lives of that new mother and her child. So we should give States this option, and that is why I urge my colleagues to support the nurse home visitation Medicaid option amendment. 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. CASEY. Mr. President, I rise this morning to speak about health care and our children and the health care reform, the Patient Protection and Affordable Care Act, as relates to our children. The chart on my left makes a couple of fundamental points. For children, health care reform must follow one simple principle, and I also say it is only four words: No child worse off. When I say ``no child,'' of course I am speaking of children who do not often have a voice. Obviously, if they are children from a family that is very wealthy, I think they will be just fine no matter what happens here. But children who are poor and children who experience and have to live with special needs are the ones I am talking about when I say ``no child worse off.'' I filed many weeks ago--actually, months ago now--a joint resolution, No. 170. I was joined in that resolution by Senator Dodd, Senator Rockefeller, Senator Brown, Senator Whitehouse, and Senator Sanders. We filed that resolution just to make this point with a couple more words than ``no child worse off,'' but that was the fundamental point to guide us through this process because sometimes in a debate on something that is this significant, and parts of it are complicated to be enacted into law--it is a challenge to pass health care reform. I think we will. I think we must. But we do need guiding principles, and I believe one of these should be ``no child worse off'' for special needs children. A lot of the child advocates across America have told us, for many years, something so simple but something very meaningful in terms of providing further guidance for this debate. Children are not small adults. That does not sound so profound, but it really matters when it comes to health care. We can't just say: If you have a health care plan for adults, it will work for kids, do not worry about it. Unfortunately, that is not the case. If we do not do the right thing, we could lose our way on that basic principle. We have to get it right, and we have to give poor and special needs children a voice in this debate. I do not think there is any question that Senators on this side of the aisle are guided by that basic principle. I want to next turn to the bill, the Patient Protection and Affordable Care Act, and walk through some of the provisions. There are many good provisions in the bill for children, but I want to walk through a couple. How does it help children? That is a fundamental question. You cannot escape the basic implications of that. First, the bill eliminates preexisting condition exclusions. That is in the first couple pages of the bill. Obviously, it has an enormously positive impact for adults. We have heard story after story of literally millions of Americans denied coverage year after year because of the problem of preexisting conditions. It has special meaning when it comes to children. No. 2, the bill ensures that benefits packages include oral and vision care. We know what that means for children, and in particular we are thinking about the horrific, tragic, and preventable death recently of Deamonte Driver of Maryland, a young boy who lost his life because his family did not have the coverage for an infected tooth--an infected tooth, not something that is complicated to deal with. His family couldn't afford the care. A child in America died from an infected tooth that would have cost $80 to treat. So when we talk about insuring benefit packages that include oral and vision care, that doesn't say it too well until you connect it to the life and the death--the tragic death--of a young child not too far from Washington, DC. Thirdly, the Patient Protection and Affordable Care Act will mandate prevention and screenings for children. This is so important. We know our poorest children, who have the benefit of being covered by Medicaid, get these kinds of services so we can prevent a child from getting sicker or prevent a disease or a condition or a problem from becoming that much worse for that child. As I said before, children are not small adults, so we have to make sure we have strategies and procedures in place that deal with the special needs and the special challenges that children face in our health care system. Finally, the act has increasing access to immunizations. I don't think I have to explain to any American how important immunizations are. The Centers for Disease Control will provide grants to improve immunizations for children, adolescents, and adults. Let me move to the third chart. The third chart outlines some other provisions for children. Here are three more ways the Patient Protection and Affordable Care Act helps children, among many others. It creates pediatric medical homes. People may say: What is a medical home? What does that mean? Well, I need simplicity just like anyone does. This is my best summary of a medical home. A medical home obviously isn't a place. It is treating people in the way they ought to be treated in our health care system. The ideal--and I think this bill gets us very close to meeting this goal--is that every American should have a primary care physician and then be surrounded by the expertise of our health care system. Children especially need that kind of help. So we want to make sure every child not only has a primary care physician--in this case a pediatrician--but also has access to all of the expertise that pediatricians and our system can give them access to. Next, the act strengthens the pediatric workforce. We can't just say we want children to have access to pediatric care. We have to make sure we have the workforce in America to provide that kind of care. Thirdly, the act expands drug discounts to children's hospitals. Before this act, before the act that we are debating, children's hospitals did not have access to a program that provides discounts on the drugs they need for sick children. Now children will benefit from the discounted prices that result from the passage of this act. This is vitally important. Let me go to one more chart. Parliamentary inquiry, Mr. President: How much time do I have remaining?

Mr. CASEY. Two minutes. I will just do one chart and then we will move quickly. This chart makes a very fundamental point. At a time in our history when over the course of a year the national poverty rate went up by 800,000, and the number of people without insurance is going up--and in the midst of a recession, you would understand and expect that--the one thing we don't focus on is that because of the effectiveness of the Children's Health Insurance Program, there is one number on this chart that is going down--and we hope it keeps going down--and that is the number of uninsured children. It is interesting that on this chart between 2007-2008, as the child poverty rate went up by 800,000 children, the number of children without insurance is down by that same number--800,000. It shows the Children's Health Insurance Program is working, even in the midst of a recession. So I have an amendment that strengthens the Children's Health Insurance Program in the bill. I know I am out of time, Mr. President, and I yield the floor.

Mr. CASEY

Mr. CASEY. Madam President, we are on the floor today, as we have been for many days and weeks now, discussing health care. One thing I think is undeniably clear is that there is a basic divide in the Senate on health care. That is not news to most people. But I believe on this side of the aisle there is a great deal of consensus about what health care reform should be about. We have been trying throughout this debate to make it very clear that we are not only concerned about the tens of millions of Americans who do not have any insurance at all--that is obviously a focus of our work and focus of the debate--but we are also concerned at the same time, as we must be, with those who have insurance--with families with insurance, families who believe they have the security of insurance but, unfortunately, under our system many of them don't. Many families, in fact millions of families, over the last couple of years have had a member of their family denied coverage because of a preexisting condition. That should be illegal. In this legislation we deal with that directly for the first time ever. We also provide other protections. When you say ``consumer protections,'' that is a nice sounding phrase but in some ways it does not describe what we are trying to do. We are trying to prevent people from being denied coverage because of preexisting conditions. We are trying to make sure that other families don't have a tragedy such as the family I have spoken on before on this floor, the Ritter family in Manheim, PA. They had the tragedy of finding out a number of years ago that their two 4-year-old daughters, twins, had leukemia but also the insult and the outrage of our system saying to them: Your daughters have leukemia, we can treat them, we have a lot of experts and knowledge and technology to help them, but we are going to limit their care. That is an outrage. The first provision in this bill says we are not going to put caps on treatment for people who are very sick. We also recognize that, as President Obama said a number of months ago, if you get sick, you shouldn't go bankrupt. But that is happening more and more in America. It is an outrage and we should not allow it to go on any longer. We are trying also to keep premiums affordable. Fortunately, the Congressional Budget Office helped us make that argument. In their own way they weighed in on that question and talked about the fact that so many American families will have their premiums reduced if not kept level. We are obviously trying to enhance quality and prevention. All of these strategies that we know work, the research is irrefutable, but we talk about them as a way of a good example instead of talking about them as something we ought to put in the law and make part of our system. Why should we have all of those prevention strategies and then throw up our hands and say that would be nice if insurance companies did that in their policies instead of make it part of the law. And we will, both in terms of prevention strategies as well as quality. Finally, as a quick summary of what we are trying to do, we are trying to control costs. I think this bill does that. We still have a bill to do and amendments to make. It also cuts the deficit by $130 billion over 10 years, and much more, several hundred billion, in the years after that. One fundamental recognition, I guess, in this debate--at least on this side of the aisle--is that our system has left people out. In some cases it has left them out in a very tragic way when they are denied coverage because of a preexisting condition. Our health care system has left out others in different ways, and I rise today to speak about an amendment I filed, along with Senator Klobuchar, my cosponsor on this amendment, that seeks to address a group of Americans who have been left out of our health care system and forgotten at a very difficult time in their lives. The name of the amendment is the Pregnant and Parenting Teens and Women Amendment. It recognizes what I believe to be a fundamental reality in America. I will describe two scenarios--one that so many of us have had the opportunity to experience as parents but especially those in this Chamber and those who are listening to this debate who are women who become pregnant. For many women that moment when they find out they are pregnant is a moment of joy. It is the miracle of pregnancy. They feel that joy and they share it with their family and their friends. It is a time of real happiness. Many of these women in that first scenario do not need help beyond what their families provide or what they might receive by way of adequate support within our existing framework of programs and services--whether that is government help or private sector or nonprofit help. That is wonderful and we hope that becomes more and more the case. But there is a second scenario in America, a second category where a woman finds out she is pregnant and that moment of discovery is not a moment of joy. For her, it is a moment of terror or panic or even shame. She may be in a doctor's office or she may be at home--she may be in a number of places--but for her that moment begins with a crisis in which she feels overwhelmingly and perhaps unbearably alone, all alone. She could be wealthy, middle income, or poor--but most likely, if that pregnancy is a crisis, she is poor. Whatever her income, she feels very simply all alone. A pregnant woman who is facing those horrific circumstances may be a woman who has an abusive spouse or boyfriend who is tormenting her. She is all alone in many instances. Another pregnant woman may believe that she cannot support or care for her new baby at this point in her life. She is all alone. Another woman might believe that her financial situation is so precarious that she cannot care for or raise a child. She may feel all alone and helpless. If she decides to bear a child, she needs our help. She needs our help to walk with her along that difficult journey--not only through the 9 months of her pregnancy but also through the early months and years of that child's life. I believe that is an obligation we have. I know some may not agree with that, but it is important that we are honest about where we stand. We understand that many women face that reality. So what do we do about it? Do we say: That is too bad and that is kind of their problem and let them find their own way or there is a little program down the street that might help them or there might be a little government program over here or there might be some charity that will help them. They will do fine. Don't worry about them. This country has shown a capacity to reach out and help people who are in crisis, to try to give people a sense that they are not all alone, that there are lots of ways to help. Unfortunately, neither political party has adequately met this challenge, in my judgment. We hear a lot of discussion about it. We hear a lot of sentiment about it. But we do not do nearly enough about it. Here is what the amendment will do. First, it will provide assistance and support for pregnant and parenting college students. Second, it will provide assistance and support for pregnant and parenting teens. Third, it will improve services for pregnant women who are victims of domestic violence, sexual violence, and stalking. And fourth, it will increase public awareness of the resources available to pregnant or parenting teens and women. Let me give some examples of these services. First, funding for colleges to provide pregnant and parenting resources located on campus or within the local community and improve such resources, including: the inclusion of maternity coverage, which a lot of insurance companies do not provide now, unfortunately and insultingly, in my judgment; make available riders for coverage for additional family members in student health care on a college campus; make sure that woman, if she has chosen to bear a child, gets housing and childcare and flexible or alternative academic scheduling to allow her to remain in school; education to improve her parenting skills; maternity and baby clothing, baby food, baby furniture--all of the things some of us take for granted in our families prior to or upon the birth of a child. The other part of this is funding for programs that help pregnant and parenting teens stay in or complete high school and prepare for college or vocational education, by providing resources and assistance. Next, assistance to States in providing intervention services, accompaniment and supportive social services for pregnant victims of domestic violence and other kinds of violence as well, to start. Finally, making people aware, providing public awareness and outreach so that pregnant and parenting teens and women are aware of the services available to them. We cannot stand here on the floor and say we care about these folks and we want to help them if we are not willing to make good on that promise. It is not enough to have good intentions. It is not enough to say there might be a program out there. We know for sure that at least these three categories--maybe others could add to it, maybe others may not, but these three categories of pregnant women are in many cases all alone. Neither political party nor our Government--and I would argue other parts of our society--are doing enough. It is time as we debate health care that we say one part of our health care system is going to be made much better. In addition to the substantial changes on protecting families from the ravages of what insurance companies have done to some families, protecting them at long last, those with insurance, ensuring 30 million Americans, cutting the deficit, having prevention strategies, controlling chronic disease and making it something we can manage better, and save money--all of that is important. But I do not think in the debate here we should leave out those who are asking for a little bit of the help we are not giving them. We should never ask a pregnant woman to walk that journey all alone. I think that is the least we can do in this Chamber, in this debate. I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, I rise this afternoon to speak on two subjects as part of our health care debate. The first is what happens to our children. We have had an opportunity over the last couple of weeks, and will continue to have a full debate about so many aspects of this legislation. When it comes to the question of what happens to our children--and I speak of in this case poor children and special needs children--I have said from the beginning of this debate and even before the debate began many months ago that the standard ought to be four words: No child worse off. It is a very simple standard. I think it is a standard we can meet and I believe it is a standard we should meet for the most vulnerable children in America--those who happen to be poor or suffer from or are burdened by special needs, both the impact on that child, that individual life, as well as the impact on his or her family. The good news is that over the last couple of years, we have gotten it right with regard to children's health insurance, a program I am proud to say had a good bit of its foundation and its origins in Pennsylvania. It became a national effort in 1997 when President Clinton signed the legislation. We have had, frankly, a lot of bipartisan support for this program over many years, although we had less bipartisan support when it was reauthorized this past year when President Obama signed it into law. Here is what it means. The Children's Health Insurance Program, known by the acronym CHIP, has provided millions of children with health insurance coverage they would never have absent that program. We don't know the exact number as we speak today, but we are at a point now where we have in the range of 7 million or more children covered. Over the next couple of years, we will have 14 million American children covered. That is an enormous achievement, but more important than any kind of legislative achievement, it will mean that 14 million children or their families won't have to worry about whether they get quality health care. In the first year of a child's life, the experts tell us they should get to the doctor at least six times for a so-called well child visit. A Children's Health Insurance Program in America ensures these children receive many benefits, including dental, immunization, and preventive care. But the fact I always point to is that for six times in the first year of a child's life, he or she will get to see a doctor because they are in the CHIP program, and that has an enormous impact for that one life, for that one family, but I would argue--and I think the evidence is irrefutable--it will have a positive impact on all of our lives, because of the impact of millions of children getting that kind of help in the early years of their life. We know this program works. The Children's Health Insurance Program works. That is an understatement. It works well. What we are worried about, though--what I am worried about--is that there have been people in Washington who have advocated putting the Children's Health Insurance Program in the new insurance exchange. The exchange is going to be a very positive development for our health care system and for adults, but I would argue strongly and vigorously that it is not good for kids. So we are going to be debating that maybe in a couple of years, but we want to make sure as we debate that question that we have as much evidence to show that and put forth the reasons why the Children's Health Insurance Program should not--should not--be part of the exchange. In terms of why we say that, the research on this question is indisputable. The director of CBO, the Congressional Budget Office, Doug Elmendorf--and we know a lot about CBO. They make determinations about this bill and about costs. CBO has said that children will have better benefits and more cost savings in CHIP than they will in the exchange. Yesterday, an organization many people here know as First Focus released a white paper which compared Children's Health Insurance coverage versus coverage those children would get in the exchange. Here are some of the results of that research paper. No. 1, the question of children's coverage from 2009 through 2013: If health reform were to repeal CHIP in 2013, States would not invest in improving coverage for those children when those very efforts will be dismantled just a few years later. It stands to reason. Why would a State go forward to strengthen a program they know is going to change as a matter of Federal policy a couple of years later? The increased coverage of 4 million children that is expected from passing Children's Health Insurance legislation earlier this year would be largely lost. That whole effort that took years--years--and two Presidential vetoes, before President Obama became President, to get to continue the CHIP program and expand. No. 2, First Focus, another one of their conclusions: Children in most State Children's Health Insurance Plans receive coverage for all approved vaccinations, dental care and well-baby and well-child visits. This level of benefits stand in contrast to private plans, like those in the exchanges. What is good for an adult may not be good for a child. Children are not small adults as so many advocates have said over and over. But the level of benefits that children get in CHIP stands in contrast to the provisions in private plans such as those in the exchange which often impose limits that are particularly harmful to low-income children and children with special needs. That is conclusion No. 2 by First Focus. Conclusion No. 3 is the following: An actuarial study-- A recent study-- finds that children moved from CHIP to the exchange plans would dramatically increase out-of-pocket costs for those kids. Out-of-pocket costs for a child living in a family earning 225 percent of the Federal poverty level would increase by 1,100 percent-- not 1,100 dollars, but 1,100 percent-- if the Senate were to join the House in repealing Children's Health Insurance Program. This is another reason why it is a bad idea. We want to make sure this program is strong. We know it works. We also don't want to exponentially, radically increase out-of-pocket costs. Conclusion No. 4, premiums: Because Children's Health Insurance keeps premiums and other out-of-pocket costs for children at low levels, the cost of health insurance exchange plans will be many times higher than that, even for just covering children. An increase in premiums will lead to a number of children currently enrolled in CHIP to lose coverage--to lose coverage--according to the Congressional Budget Office. No. 5, reason to do the right thing, access to pediatric providers: Children's Health Insurance plans specifically focus on the unique health care needs of children, which is not the case in the proposed exchanges. The recent Children's Health Insurance reauthorization-- For those who watch these Senate debates, we use words such as ``reauthorization.'' My simple way of saying that is we do it again. We take an existing program, evaluate it, see if it is working, and keep doing it. That is what reauthorization is all about. But we did that earlier in the year, thank goodness, for children's health insurance. The recent effort to continue CHIP included improvements to pediatric-specific quality measures that may get lost in the conversion of CHIP as a stand-alone program put into the exchange. We don't want to do that for kids. We want to make sure every pediatric-specific quality measure that we have in place now, all of these years later, is maintained. We don't want to injure that. We don't want to cut that back. Finally, in terms of another item on the list of reasons, guarantee to care: In exchange plans, some children currently eligible for the Children's Health Insurance Program may be barred--may be barred--from receiving subsidies for coverage due to the cost of employer-sponsored plans. Once again, what is good for an adult may not be good for our kids. We have to watch this. Moreover, the families that are eligible for subsidies and coverage through exchange plans may find coverage so unaffordable that they are left without insurance entirely. So we don't want to send a family into the exchange who is trying to get insurance for themselves and their kids and find out that they can't cover their kids because it costs too much. We have an existing, stand-alone Children's Health Insurance Program that we know works. This amendment I filed for this debate on health care--the children's health insurance amendment to guarantee that we keep it strong, strengthen it and continue it--the Children's Health Insurance Program has the support of over 500 national and State organizations that focus on children's health, health policy generally, social workers, children's mental health advocates, school educators, health plans in particular, faith groups across the country, and more. These 500 national and State organizations speak volumes about why this amendment is so important. We must strengthen and ensure the continuity of CHIP in this health care reform bill. That is what our amendment is all about. Mr. President, I ask unanimous consent to hae printed in the Record a letter addressed to me, dated December 9, from more than 500 organizations.

Mr. CASEY. Thank you very much. I wish to inquire as to how much time I have.

Mr. CASEY. I will move quickly. The second part of my remarks focuses on pregnant and parenting teens and women. We have an amendment that focuses on a group of pregnant women in America that we are not doing enough about. Neither party, in my judgment, is doing enough about them, enough about help for those women. I will come back to this maybe later today. But it is vitally important, whether we are Democrats, Republicans, or Independents, but as Americans, that we give integrity and meaning to the sentiment that is often expressed that we care about pregnant women, that we care about a teen mother who decides to bear a child, that we are going to help her through if she makes that decision. If a woman on a college campus becomes pregnant and decides to have that child, we want to give her all the help we can. If a woman is a victim of domestic violence or other sexual violence or stalking, and through all of the horrific nightmare of that violence, she determines that she is going to go through with a pregnancy and have a child, that we help her in the midst of that darkness, that we give her some light in that darkness. What we don't want to have is women who are deciding to bear a child who feel all alone, who have to walk that path all by themselves. That is what this amendment is about. I will return to it later today. With that, Mr. President, I yield the floor.

Mr. CASEY

Mr. CASEY. Madam President, I rise this morning--or this afternoon, I guess it is--to speak about health care, but in a very particular context--an area of our health care debate which we, unfortunately, haven't spent enough time on. The purpose of my remarks today will focus on an amendment that I will be filing today that is entitled ``Support for Pregnant and Parenting Teens and Women.'' It is a challenge within our health care system which I think has gone largely unaddressed, or at least for a segment or a category of pregnant women in our society. We know many teens and women who face an unplanned pregnancy do so with little or no support. This amendment--the Pregnant and Parenting Teens and Women amendment--offers teens and young women the support they need to finish their education and provide for their children. This is especially important to those teenagers or women who are victims of domestic violence or other kinds of violence, and also women on college campuses. Just a quick overview of the amendment, and then I will walk through some of the main reasons why I think it is important we make this a priority. First of all, the amendment will provide assistance and support for pregnant and parenting college students. Secondly, the amendment will provide assistance and support for pregnant and parenting teens. Third, it will improve services for pregnant women who are, as I mentioned before, victims of domestic violence, sexual violence, and stalking. Fourth and finally, it will increase public awareness of the resources available to pregnant and parenting teens and women. I will go through some of the background in the time I have, but the way I look at this--and I think the way a lot of families look at this challenge in America--is that often after a woman becomes pregnant, she has a decision to make. Under our law, she can carry the child to term or not. We want to make sure if she decides to carry that child to term she has all of the help she needs. And not just a little help--not just a program or two here and there--but the full range of help that we can provide, in addition to what so many people and so many organizations do so well. There are many individuals and organizations in the nonprofit sector, and there are great programs out there right now that help women with their pregnancies, but I look upon this challenge as one that is faced by pregnant women of all incomes, of all backgrounds, and of all circumstances. Even a woman who has the resources and the means often feels that she has to walk that path alone. Sometimes her family abandons her or doesn't provide her the help she needs. But it is especially urgent and especially difficult when a woman is both pregnant and without means or is pregnant and poor, pregnant and vulnerable to all of the challenges she will face. If a woman makes the decision to bring a child to term and to raise the child, she often does that all alone. What I believe we have to do here--not just as Democrats and Republicans, because that doesn't matter, candidly, on this--we have to do as Americans, if we mean what we all say, that we want to help people who are vulnerable, and we want to help people with their health care, and many of us say that over and over--people in both parties say that--then we have to help women during what can be a very difficult time in their lives. I realize for some people this is not an issue. Pregnancy is a time of joy and a time when they have no challenges and they bring a child into the world with a lot of support and all the help they need. But there are plenty of women out there who have to walk this road all alone--all alone. And so if we mean what we say about helping, as Americans--forget parties here--we should do everything possible to walk that road with her, if she wants the help and if she can benefit from the services we are talking about. Why should a woman on a college campus who makes a decision to have a baby be left alone? Why shouldn't we be giving her help? We don't do it now. I know some do it, and I will hear from others that this group does this and this group does that, but unfortunately it is not nearly enough, especially for someone who happens to be a teenager, a woman who is pregnant, or a young woman who is pregnant as a teenager or before the age of 18. Are we doing enough to help that woman who happens to be pregnant get through the challenge of a pregnancy? Finally, and most horrifically, if a woman is both pregnant and the victim of domestic violence, sexual violence, or stalking, what are we doing to help her? Unfortunately, the answer to that is very little-- very little. I think this is a criticism I am making of both political parties. We could have a debate about who is doing more, and that might be instructive, but neither party is doing enough for at least those three categories of pregnant women--teens, women on college campuses, and women who are victims of violence. I believe we are going to have an awful lot of support for this amendment. I think it is an essential part of this health care debate, and I believe it is an opportunity to bring people together to agree on something around here when we have a lot of disagreement. But also I think it is vitally important to our society in general. It is not just a good thing to do, it is not just the right thing to do or the compassionate thing to do, it is, I believe, a very important part of how we deliver health care and how we help people through what is often a crisis. Think of the kind of life that mother will have during her pregnancy and after her pregnancy. Think of the life that child will have, while the child is in the womb and then after the child is born. If the pregnancy goes well, the child will learn more. If the pregnancy goes well, the child will grow and develop appropriately so that he or she can be healthy. If a pregnancy goes well, the child will contribute a lot more to society. The real challenge, the urgent question for us is: What are we doing to help pregnant women, especially in these particular categories? I have been so fortunate, and I am grateful to have worked with Senator Klobuchar on this amendment. We will be talking about it more, but I wanted to provide a summary of it now. Madam President, I yield the floor.

Mr. CASEY

Mr. CASEY. Mr. President, thank you very much. I rise tonight to continue the discussion and debate on health care. I had the chance over the last couple of months not only to do a good bit of work on a number of issues that relate to the bill and the two bills that came before and were merged into one bill, but also to hear from constituents across Pennsylvania. Some of them are writing to us and urging us to pass a bill and some are urging us to go in the other direction. But the communications I get from people who write about their own stories, their own family, their own challenges are, of course, the most compelling and the most worthy of time and attention. Often they come from Pennsylvania families who are not only facing health care challenges but facing economic challenges that I don't think anyone in this Chamber can fully understand, at least not at this point in someone's life. Because when you become a Member of Congress, you are usually in pretty good shape. You may not have a lot of wealth, but you at least have a job to go to every day, you have a lot of people helping you, and you have health care. That is not something that can be said for tens of millions of Americans. This legislation is the culmination of a lot of debate and discussion and analysis and study over many decades now. It is nice that we have been talking for years and years about preventing a preexisting condition from barring someone's coverage or treatment. It is nice to talk about it, but it is a lot better when we do something about it. It is nice we have talked about limiting out-of-pocket costs for families who are trying to take care of their children, trying to care of themselves, but it is a lot better to do it, to enact it into law. This bill makes it illegal to use preexisting conditions to deny someone coverage. This bill makes it illegal for insurance companies to put a lifetime cap on services, or an annual cap. This bill makes it illegal to discriminate so that no longer, if we do what we must do and get this bill passed, can an insurance company discriminate against a woman, which they do all the time now, just as they prevent people from getting coverage due to a preexisting condition. We have an opportunity to change the way we provide health care in ways we haven't been able to imagine, let alone enact into law. One issue that has motivated me throughout this whole debate is what happens to our children at the end of the debate, at the end the legislative line, so to speak. Will children in America--and I am speaking about poor children and those with special needs because they are the ones who need help. If you are in a wealthy family, you will figure it out, and your family will figure it out. If you happen to be a child of a poor family or a child who has special needs, will you be better off at the end of this debate or will you be worse off. As it relates to poor children and children with special needs, the goal here has to be no child worse off. It is very simple. It is a very simple test. That is what we have been working on. I believe this bill that is on the floor right now is a dramatic improvement in the lives of so many families. I still think we have some more work to do as it relates to children, but there is no question that the bill we are debating will make children a priority in ways we haven't been able to do in any kind of other legislation, other than the children's health insurance legislation that Congress enacted going back more than a decade ago and that we reauthorized this past year. I wish to speak about two families tonight. This isn't a discussion about theory or about the nuances of a policy. This is about real people and what has happened to them under our existing system. I wish to put up the first chart. This chart depicts one family, the Ritter family in Manheim, PA. I spoke with them several days ago and I spoke with these two young girls. One daughter's name is Hannah--one twin, I should say, is Hannah and her sister--after I spoke on the floor I called their mom to talk about what I had said on the floor and I said to her, I think I referred to one of your daughters as Madeline, and that is incorrect, it is Madeline. So I want Madeline to know I correctly pronounced her name my second time around. Part of that is because of a story I read to my daughters when they were kids all the time. But there was a story about Madeline, and a lot of parents know that story. So I apologize to Stacie Ritter. But here is the story that Stacie Ritter has told me through this communication, but has told a lot of other people, and now we try to tell her story on the Senate floor to give meaning to what we are talking about here. But this isn't some public policy discussion about health care; this is about what happens to real families when we don't get the policy right, when we talk and talk year after year, decade after decade, and talk about good intentions, but never get it done, never get a bill passed. This is what happens to people. Stacie Ritter had to declare bankruptcy after her twins were diagnosed with leukemia at the age of 4. My wife Teresa and I have four daughters, and thank goodness they are all healthy. Two of them are in college, one is in high school, and one is in seventh grade. We have never had to face that kind of diagnosis, thank goodness. Thank God I have never had to face that, nor has my wife Teresa had to face that as a parent. But if we did, we would have been given some protection and so would our daughters if we faced that horrific diagnosis, because when I was working as a lawyer or when I was a public official, I had health care. Sometimes, for a lot of that time period, a decade in State government health care, because I was a State employee, I had a tremendous health care plan, a kind of public option, a good public health care plan. So I never had to worry about that as a parent nor did my wife if something horrific were diagnosed. These two little girls pictured here--and you can see even though because of that diagnosis they are facing the kind of challenge I can't even imagine, let alone endure--I hope I could, but I am not sure I could if I were in their place. But you can see that even though it is obvious they are facing a real challenge with regard to the leukemia, they are very hopeful, aren't they, in that picture. They have their arms around each other. They have these stethoscopes and they are dressed up like two doctors. So even in the midst of the horror of that kind of a diagnosis, you have these two brave little girls who are looking forward, not just worried about their one situation but looking forward with hope and optimism. Here is a picture down here taken last year in Washington, DC, then at the age of 11. Here is what their mother said: Without meaningful health reform my girls will be unable to afford care, that is if they are even eligible for care, that is critically necessary to maintain this chronic condition. Punished and rejected because they had the misfortune of developing cancer as a child. What is the particular problem here with this case? The obvious problem is that these young girls were diagnosed with leukemia. That is bad enough. But we have a system that made their life a lot worse than the leukemia, because we had a system that said--basically what the system said to them is: We can help you and maybe cure you, but we are going to put limits on it. We are going to say that it is nice to have all of this technology and all of this great medical knowledge and great doctors and hospitals across America--and we do. We are the envy of the world on some of this stuff: the doctors and the nurses and the health care professionals, and the hospitals and the technology and the know-how. We are the envy of the world. We should acknowledge that. But then we have this ridiculous system that says to these two little girls: But the care we want to give you and the results we can get from that care are going to be limited. So we hope it works out for you. That is ridiculous. It is an abomination. I don't understand why we have gone year after year and settled for this. Why do we have limits on the kind of care people get? Because insurance companies thought that was a good idea. I don't know why. I don't know whether it is for their bottom line or for whatever reason, but there is no excuse--no rationale--for saying to someone: We can cure you, but we are going to limit your care. You are in real trouble, and we know how to help you. But we are going to limit it. Here is what Stacie said about her kids: When my identical twins were both diagnosed with [this leukemia] . . . at the age of four, we were told they would need a bone marrow transplant in order to survive. That's when I learned that the insurance company thought my daughters were only worth $1 million each. I don't know a parent in America who believes their son or daughter-- in this case, two daughters, her twins--is worth any amount of money or their care is worth any amount of money. Why does the insurance company do it? We hear they say that is policy, and then they get pressure from a TV station or news organization and they give the care. If the policy makes sense, why would public pressure change a policy? The policy is ridiculous and insulting. It should be changed. It is one of those things we have to make illegal, and this bill does that. We should make it illegal for an insurance company to do that to children. But it doesn't make a lot of sense unless you talk about it in terms of a real story. Here is what Stacie Ritter said after she talked about the limit-- very flatly, she said two words about whether a $1 million is enough to care for two daughters with leukemia over many years: It's not! When you add up the costs involved in caring for a patient with a life-threatening disease like cancer, $1 million barely covers it. We have lots of stories like this. Fortunately, the hospital social worker recommended we apply for secondary insurance through the State considering the highly probable chance we would hit the cap. And we did hit that cap before the end of treatment. The State program sounds a lot like a public option. I may be wrong, but it sounds an awful lot like that. Thankfully, the State program kicked in and helped pay for the remainder of treatment. So that part of the story worked itself out. It didn't work itself out because the insurance company said: We have a way to help you, and we are going to do it and figure out the cost in another way. No, the insurance company didn't help them. It was the State program in this case--the kind of public option that helped these kids. That part of the story has somewhat of a positive outcome. These kids are only 11. When they were 4 and 5, they didn't have that kind of an option. This story gets worse. This is what Stacie says: 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 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 a $717.18 a month COBRA payment. Let me get this straight. We are now talking about COBRA--the extension of insurance coverage for people who are hurting, laid off or unemployed. That is another government initiative enacted by Congress. I am sure there were some folks who thought let's not use government to extend health insurance. But in this case, it was helpful to this family. But it wasn't enough. Here is what Stacie says, as she keeps going: After spending all our savings to pay the mortgage and other basic living expenses, we had to rely on credit cards. We have a health care system that forced Stacie Ritter, and lots of other families in America, to rely upon credit cards so they could get the health care for their daughters who have leukemia and make ends meet so they could pay the mortgage and all the other things they had to pay for for themselves and their daughters and their son. That is what this health care system has forced them to do. This isn't unambiguous. This is exactly the result of the worse part of our health care system. This last sentence might be the most poignant. She mentions they filed bankruptcy: And when you file bankruptcy, everything must be disclosed. We even had to hand over the kids' savings accounts that their great grandparents had given them when they were born. That is another problem with this messed up system we have. It forced this family not only to worry about whether their daughters were going to be taken care of with leukemia, it not only said they probably had to declare bankruptcy to take care of themselves and get the care they needed, but in the course of the bankruptcy proceedings, they had to turn over savings accounts. I don't care if it was $1 or $1,000 or a much higher amount. I don't care what the amount was. We should never allow a system to force two little girls with leukemia to turn over their savings accounts that their great grandparents started for them. That is how bad the system is. I will spend lots of time complimenting doctors, hospitals, and nurses. We have a lot of good things. We have good technology. OK. I am acknowledging all that. But this system is messed up when we have this happen to one family. I don't care if it is one family or 1 million, but we know there are lots of them out there who face similar circumstances. Some people might say you are talking about the family and all these problems. What does your bill do? It so happens the first provision in the bill--go by the table of contents and go to the page--I think page 16. The first provision of the bill talks about not having limits on lifetime coverage. If that were in effect when Stacie Ritter and her husband got the diagnosis for their daughters--if that was in effect, the following would have happened, and this is irrefutable: No. 1, they were upset, and as worried as they were about their daughters, at least they would have had the peace of mind to know they didn't have to worry about it costing too much to get them care. They would not have had to worry about this causing bankruptcy. So at least we would have given them some peace of mind and some security. Then on top of that, we would have given them the kind of care they needed, including the follow-up care. When some people say we need to debate a little longer, 3 months or 6 months more, or let's talk about it for a couple more years--we have talked this issue to death for years. We know exactly what is wrong. This is what is wrong. That story alone is reason to pass the bill. There are a lot of other reasons, a lot of other tragedies that are preventable if we do the right thing. We have a bill that we are going to pass, and the first provision speaks to this family's challenge. Let me read one more letter and I will stop. I know I am over my time. We have heard a lot of discussion in the last couple of days about people whose personal tragedies bring all of us to our senses as we get lost in the politics. I received a letter this fall that I think sums it up in a way that both Hannah's and Madeline's story does as well. This is a letter that I received from a woman in Havertown, PA, suburban Philadelphia. She says: On September 9, 2009, my sister-in-law's cousin had to take her three-week-old son off of life support. He took two shallow breaths and passed away peacefully. He did not have to die, he did not have to be on life support, he did not even have to be in the [neonatal intensive care unit] NICU. At 36 weeks gestation, his mother was told that she had Placenta-previa, but the insurance company and the doctor were at a tug of war on getting it covered. This is America. Why should a doctor have to be in any tug of war about whether this mother, who is pregnant, will be covered? That should not even be a discussion. There should not have to be any discussion about that. But that is how messed up our system is. At 39 weeks, Brandon's umbilical cord ruptured. His mother Karen was rushed to the hospital and Brandon was taken to Jefferson [hospital] in Philadelphia to undergo brain cooling treatment to return brain activity. It was too late. After minimal return of brain activity, it was decided after 3 weeks to remove life support. She concludes with this haunting sentence, this haunting reminder of how bad a case this is: Who saved money here? Was it worth a child's life to save a few dollars? And I am sure 3 weeks of life support costs more than a C-section. That is the end of her letter. So anybody who says that we have to make a couple little changes on the margins, but we have a great system that is not in need of major reform--I need only point to these two examples. That is all the information I need. Unfortunately, we have thousands--hundreds of thousands of additional examples--literally millions of people who are denied coverage because of a preexisting condition. Sometimes because a woman has been a victim of domestic violence, that has been used as a preexisting condition in terms of whether she gets health care. So we have a messed up system. When we allow these tragedies to happen day after day, year after year, and we have people in Washington saying: We just could not get it done, we have to debate a little longer--we have to get a bill passed. We are going to do that in the next couple of weeks. We will take whatever steps are necessary to get this legislation passed because we cannot say to this woman who wrote to me from Havertown, PA, nor can we say to these two girls and their parents--we can't walk up to Hannah and Madeline and other kids like them in the country and say we tried to get that lifetime limit matter done, but it got a little contentious. We have to get it done, and we will get it done because we are summoned by a lot of things. But I think we are summoned by our conscience to get this done and make sure we can do everything possible--no system is perfect--to prevent these tragedies. I yield the floor.

Mr. CASEY. Mr. President, I rise in support of the Nelson amendment for two reasons, and I speak for myself, not for other Members of the Senate. Obviously, I know there is a good bit of disagreement on both sides and even within both sides of the aisle. But I support this amendment for two reasons. One, I wish to make sure we ensure, through this health care legislation, the consensus we have had as part of our public policy for many years now--that taxpayer dollars don't pay for abortions. I believe we can and should and will get this right by the end of this debate. The second reason I support this is, I believe it is important to respect the conscience of taxpayers, both women and men across the country, who don't want taxpayer dollars going to support abortions. If there is one or maybe two areas where both sides can agree--people who are pro-life and pro-choice--it is on these basic principles: No. 1, we don't want to take actions to increase the number of abortions in America. I think that is the prevailing view across the divide of this issue. No. 2, we also have to do more to help those women who are pregnant, and I don't believe we are doing enough. We will talk more about that later. Even as we debate this amendment, the third thing I think we can agree on is, no matter what happens on this vote--and this debate will continue, even in the context of this bill--I believe we have to pass health care legislation this year. There are all kinds of consumer protections in this bill that will help men and women--prevention services that have never been part of our health care system before, insurance reforms to protect families and, finally, the kind of security we are going to get by passing health care legislation for the American people. I believe we can get this decisive issue correct in this bill. We are not there yet, but I believe we can. I believe we must pass health care legislation this month through the Senate and then, from there, get it enacted into law. I yield the floor.