Bob Casey

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the Committee on Health, Education, Labor, and Pensions be authorized to meet, during the session of the Senate, conduct a hearing entitled ``Access to Prevention and Public Health for High Risk Populations'' on Tuesday, January 27, 2009. The hearing will commence at 10 a.m. in room 385 of the Russell Senate Office Building.

Mr. CASEY. Mr. President, I ask unanimous consent that the Committee on Finance be authorized to meet during the session of the Senate on Tuesday, January 27, 2009, at 10:30 a.m., in room 215 of the Dirksen Senate Office Building.

Mr. CASEY. Mr. President, I ask unanimous consent that the Committee on Banking, Housing, and Urban Affairs be authorized to meet during the session of the Senate on January 27, 2009 at 10 a.m.

Mr. CASEY

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

Mr. CASEY. Mr. President, a couple of points: Obviously, based upon what my two colleagues have said this morning, we do not agree on a number of points. That is pretty obvious. But I think there is one area of common ground which maybe we can make progress on; that is, the point that was raised by both the Senator from Oklahoma and the Senator from North Carolina about the eligible but not enrolled. I know one of the biggest problems over time, for example, in Pennsylvania with this program has been that you have a great program but not enough people know about it. If you do outreach by way of television advertising, that is the most effective by far, but any kind of outreach would be welcomed certainly by me and by those who are supportive of the legislation. The problem is, if we do not pass this legislation, all of the good intentions that I think are evident in what was said about getting people enrolled is without merit. So that is an area on which we can agree. I have to say, one of the things I get from this chart with the carriers on it, one of the points that has been made about this is, because it is a Federal and State program that is obviously supported by public resources, the impression is that somehow it is a 100-percent public program, it is just growing government, and the usual arguments that are made against it. I understand the philosophy behind it. This is often lost; that this is indeed now for 15 years, and will be, a very successful public- private partnership. These, for example, are in Pennsylvania, the private providers for the Children's Health Insurance Program in our State: Aetna, Ameri Choice, Capital Blue Cross, First Priority Health, Highmark, Highmark Blue Cross Blue Shield of Western Pennsylvania, Keystone Health Plan, Unison Kids and UPMC for Kids. This is the very definition of a successful--remarkably successful--public-private partnership where hundreds of thousands of children in our State and literally millions across the country have been provided health insurance. With regard to the numbers, where are we now in terms of covered versus not covered under this program? Nationally, the covered number is 6.7 million right now. The number of children who are not covered amounts to 4.1 million children. And 83 percent, or 3.4 million of those 4.1 million uninsured covered by the legislation are currently eligible. So we have all of these children, more than 4 million children, who are eligible but are not enrolled. Some of the issues we talked about earlier about enrollment, simplifying paperwork, and eliminating bureaucratic areas, we should work on that, and that is what is contemplated by this legislation: funding for outreach and enrollment, which has been pushed by people in both parties in connection with this legislation, and incentives to States to encourage them to provide coverage for those who are eligible but not enrolled. The point was made also about bipartisanship. Look, the definition of bipartisanship does not mean unanimous. I realize in the Finance Committee there was more Democratic support than Republican support. But the fact remains this program, the birth of this program and the continuation of it, has been bipartisan. The votes in 2007 were evidence of that, and I think even the debate today and the support--I should say more than the debate--the support is bipartisan. When this is voted on in the Senate, you will have a lot of Democratic support, obviously, but you will also have significant Republican support. That is the definition of bipartisan, in my judgment. Maybe it is in the eye of the beholder, but I am trying to emphasize this is indeed bipartisan. We are going to have time today in the hours ahead of us on the question of immigration. Two points I wanted to make: One is the 5-year bar. Basically, what we are talking about is a restoration of something that was in place before. Prior to 1996, lawfully residing immigrants, those holding green cards and those defined as ``permanently residing under the color of law,'' those individuals, prior to 1996, were indeed eligible for Medicaid. And this amendment, the Rockefeller-Snowe- Bingaman-Kerry-Wyden, a lineup of names that is bipartisan, by the way--that amendment offers a restoration of eligibility for only some of these immigrants: children and pregnant women who are here lawfully--lawfully--who intend to remain in the United States and who meet all other Medicaid and CHIP eligibility requirements. That is what we are talking about. We are talking about children, legal immigrant children, and pregnant women. Removing the 5-year bar could help States provide coverage to additional low-income children. What do we mean by that? You would think, listening to this debate, that removal of this is somehow brandnew, that it has never happened before, and no States are doing that. In fact, right now 23 States use their own funds to pay for health coverage for lawfully residing immigrants, immigrant children. Let me say that again: lawfully residing immigrant children or pregnant women, those 23 States, during the 5 years, who have become ineligible for Medicaid or CHIP. If this 5-year waiting period were removed, these States could secure Federal matching funds which would free up State funds to cover additional low-income children. So this is something States are wrestling with now, and what this would do is provide an option for States to have some help in the coverage they are providing for those individuals. So it is nothing dramatically new, but I think it is humane, and it is prudent based upon what has happened with this program over time. Let me make one other point about the issue of legal immigration and the so-called public charge: Nothing in the bill changes the agreement a person makes when sponsoring an immigrant, when an immigrant comes to this country. Citizenship and Immigrant Services, so-called CIS, does not consider participation in a public health program a failure to support the immigrant. Longstanding Citizenship and Immigration Service guidance makes it clear that immigrants will not be considered a public charge if they use health care benefits, including Medicaid and CHIP, prenatal or other low-cost care at clinics. So when we are talking about this issue, it is important to put that on the table, what Citizenship and Immigration Services would consider to be a public charge. I want to get back to some of the provisions in the bill. I wanted to get that chart on rural children. One of the discussions we have had over many months now is, Who benefits from this program? Certainly, children across the board, children in urban and suburban communities. But what is often not emphasized is--and I want to make this point because I have a significant part of our State that is rural, and most of our State, when you get outside of the major urban areas of Philadelphia and Pittsburgh, is indeed rural. Rural children are more likely to be poor. Nearly half of rural children live in low-income families at or below 200 percent of the poverty level. In this economy, when you consider the confluence of bad circumstances for rural children and rural families, here is what you have: escalating costs for energy, which disproportionately affects rural Americans; significant job loss in rural communities; an inability to have access to health care--I should say a lack of access to health care in rural communities. All kinds of problems. This bill, among the many other good things it does, would have a disproportionately positive impact, in my judgment, when you look at the data on rural children. Rural children increasingly rely on children's health insurance. More than one-third of rural children rely upon the Children's Health Insurance Program or Medicaid. One-third of rural children rely upon one of these two programs. So in this debate it is important that we stress the broad reach of this bill as it pertains to children from across the board, across the demographic and even economic landscape. Mr. President, I yield the floor.

Mr. CASEY. Mr. President, I know our colleague from North Carolina has been waiting. I wish to make a couple brief points and come back to them. Our colleague has been waiting. The Senator from Oklahoma makes a number of interesting points. Some of them are going to be the subject of even more debate. I will make a couple brief points about the question of enrollment and, therefore, outreach. One of the biggest problems with the veto and the blockage of the children's health insurance legislation in 2007 was we did not have the resources to do the kind of outreach, to enroll those who are eligible but not enrolled. We would have gotten as many as 3.3 million more eligible kids had the 2007 bill not been blocked. Point No. 1 on outreach. This bill, in fact, has steps to improve enrollment. In fact, it provides bonuses if States do a better job of enrolling children. We will get back to that in a moment. The point about single payer that the Senator made, we are going to have a lot of debate about philosophy on health care overall and where this whole health care debate is going to go. That statement is premature or unrelated to what we are doing today. What we are doing today is talking about whether we are going to pass the children's health insurance bill, not some new program but a program that has been tested. We want to add millions more children to that program. The final point--and I know our colleague has been waiting--is the question of choice. The Senator from Oklahoma made a point about what choices people will have if they are enrolled, if families are enrolled in SCHIP, Medicaid or any other program of its kind. The problem for a lot of families right now is not that they are lacking in choice of options; the problem for a lot of families, if their children are not enrolled, is they have no choice, they have no health insurance at all, except if they want to go to the emergency room, which is bad for the economy and bad for that family because it is usually too late in the game, so to speak, to get the kind of preventive care or to mitigate a problem. For a lot of families right now, this is not a question of choices. They have no choice because they have no health insurance. I will come back to this point, but I wish to yield for my colleague from North Carolina.

Mr. CASEY. Well, I don't have a number on them.

Mr. CASEY. Mr. President, I rise at this moment to review, in a summary form, pertinent aspects of the legislation. I know we are going to be having a debate on various parts of this bill that have been the subject of a lot of conflict in the last couple of days. But I think it is very important we kind of get back to the basics to talk about why we are here. We are not here to only debate several provisions of this legislation. We are here to debate, in a larger sense, whether we are going to pass a children's health insurance bill this year, this month, or not. That is the fundamental debate we are having. We had the opportunity, in 2007, in a bipartisan way, here in the Senate to achieve a rare and, frankly, unprecedented bipartisan agreement on a significant piece of legislation, the result of which would have been, over a 5-year period of time, to insure 10 million American children. I am not sure any other generation of Americans has had that opportunity. We had a bipartisan consensus in the Senate. It approached 70 votes--in the high sixties--every time it was voted on; a veto-proof number of votes, a majority. It went to the House, of course. The House debated it, and they had an overwhelming bipartisan vote in the House. It went to President Bush, and he vetoed it twice. Then it came back for an override, and we were able to override it in the Senate, but in the House they fell short. That is where we are. So because of the actions of President Bush, that bill never became law. Now we are back to debating whether this Congress is going to provide health insurance to not just 10 million--it is now 10.6 million-- American children. We are either going to do it or we are not. All this other stuff is interesting to debate, and we will continue to debate it, but we are either going to do it or we are not. Let me give you one example of what this means. Forget all the numbers for a second and all the programs and all the quibbling about some point of conflict. We will address those issues today, and I will as well. But let's get back to the basics: what this legislation means to a family. For example, as a result of this legislation, if we do our job here and get this legislation passed, and if the House does its job and passes this legislation, millions of American children will have the opportunity for all kinds of good health care provisions, a lot of them preventive in nature. We have a lot of discussions in this body where people talk about the workforce and growing the economy and building a stronger skilled workforce in the future. None of that means much unless you are going to do this, OK. A child will not develop, they will not achieve in school, and they will not be productive members of our workforce unless we pass legislation such as the children's health insurance bill. I will give you one example: well-child visits. Anyone who knows anything about child development--I do not consider myself in any way an expert on this issue; others may--but we all know, as parents-- forget legislators or experts--it is as parents we know how important it is to have a child go to the doctor a couple times, at a minimum, several times in their first year of life. It is a key time for parent and physician to communicate. Doctors recommend six visits in the first year of a child's life. Now, with this legislation we have an opportunity to guarantee that millions more children will see a doctor six times in their first year of life. That is something we ought to do. They get a complete physical exam. Height, weight, and other developmental milestones are mentioned. Hearing and vision are checked. Important topics, such as normal development, nutrition, sleep, safety, infectious diseases, and all kinds of other issues, are discussed; general preventive care. Now, if we allow some of these discussions and debates today to bog this down and not get it passed in a bipartisan way, what we are preventing is, among other things, millions of children getting this care. It is as simple as that. So those who are going to use these other things to put them in the way as impediments or obstacles, to block this legislation, should be reminded and the American people should be reminded what they are stopping. This is not complicated. It is whether millions of children are going to have health insurance; and one aspect of that care or that health insurance is a well-child visit. The other point I want to make in the early going today is there is a good bit of mythology that surrounds this legislation, and sometimes facts are not put on the table. This is mostly a question of whether working families are going to have health insurance. There is a frustration now that so many families are living with the loss of a job, the loss of a home, the loss of their livelihood and, therefore, their hopes and their dreams. The least the Senate should do, in the midst of what is arguably the worst economic circumstance in more than a generation--maybe the worst economy we have faced since the 1930s; we can debate all that, but it is bad out there, it is real bad for families--the least we could do is to say, we may not have solved the larger health care challenge, we may not have fully debated all the aspects of health care we are going to debate and I hope we can vote on, but at least we can take an existing program that we know works, that is battle tested, that has results for 15 years now--my home State of Pennsylvania; when my father served as Governor, he signed this into law, which was the first big State to do it. He knew it worked. He knew it worked then, and he supported it strongly. It has worked in Pennsylvania. We have over 180,000 kids covered. This legislation would increase that to the point we could almost cover every child in the State, for example. But in the midst of this economy, the least the Senate should do is say: We may not have solved all of our economic trouble, we may not have even solved significant aspects of our health care challenge, but the minimum--the minimum--this Senate and this Congress and this administration should do is get this done, and get it done now. All these other debates are interesting and important, but, frankly, some of them are academic in nature. I know they have risen to the level of conflict, and I know the media likes to report on conflict. That is their job. But a lot of them, compared to the gravity of what is at stake here, are academic, in my judgment. And I think for some-- not everyone but for some--they are deliberately calculated to stop this legislation, deliberately so. I hate to say that, but it is the way I feel. We are getting down to the details now of getting this done, and we have to be blunt and direct. So we are going to have debates about parts of this legislation, but at the end of the day the question is whether the Senate is going to provide millions more children with health care. That is the question. All this other stuff does not amount to or does not rise to that level. They may be important debates, but they do not rise to that level. One more point, and I will yield because I know we have colleagues waiting. Seventy-eight percent of children covered by CHIP are from working families--working families. I will get into some of the other aspects as well. But at this time I will yield the floor because I know we have colleagues waiting.

Mr. CASEY. Let me finish the answer. If we do not pass this--if we don't pass this, those children won't get that preventive care. It is as simple as that.

Mr. CASEY. How are they going to get preventive care?

Mr. CASEY. This is the way to do it.

Mr. CASEY

Mr. CASEY. Mr. President, I rise tonight to speak of the Children's Health Insurance Program and the debate we are having in the Senate. I appreciate what my colleague from Ohio just spoke of, the tremendous trauma that has been caused across the country with this terrible recession so many families are living through. I appreciate the fact he reminded us about what has been happening in our States and our communities as a result of this economic horror that so many families are living through. That horror and that trauma will only be increased in the months and years ahead if we do not pass this children's health insurance legislation. I think it is directly related to what we are talking about here when it comes to the terrible recession so many families are living through. So I want to speak about the bill and deal with some of the questions that have been raised about the bill. But in particular, I want to, first, step back from the bill, from the debate, even step back for a few minutes from the program itself, to reflect on what the reality is for families. I think when we speak of families and children's health insurance we speak and we think mostly about parents and the relationship they have to their children and what they want for their children. They, of course, want their children to succeed in life. They have hopes and dreams for their children. But, of course, for a parent, and especially for a mother, who is often providing most of the care for a child, her initial hopes, her initial fears, her concerns at the beginning of that child's life are very basic: Will that child be born healthy? Will that child grow and develop as he or she should? I was thinking back to 2007 when we were having this debate at that time, thinking of the love of a mother and what she can provide for a child, especially a very young child. That mother can provide all of the protection she can muster for that child, she can envelop or embrace that child with protection and love and nurturing and all the wonderful things that a mother--a parent but especially a mother--can provide for a child. But there are some things that no matter what that mother does, no matter how much she loves her son or her daughter, there are some things she cannot provide on her own. She cannot provide health insurance on her own. She cannot provide medical care if she is not trained in that profession as a doctor or a nurse. So there are a lot of mothers out there who have children they worry about every day of the week. They go to bed worrying what if that child has a problem in the middle of the night or some kind of a health care challenge in the middle of the day, what will happen to that child? So when we are thinking about this debate and this issue, we should think about the love of a mother and what she can and cannot provide. That is one of the reasons why as a country we come together to solve problems such as this. We know an individual person cannot build a road, so we come together and provide public resources to build a road. We know one person or one family cannot provide law enforcement protection, so we all contribute to that. The same is true on health care. No matter how much that mother loves her child, she cannot on her own provide health insurance. So what did we do? We created a program which in my State of Pennsylvania is called the Children's Health Insurance Program--CHIP for short. The program ``name'' is kind of redundant because the last word of the acronym is ``Program.'' But the CHIP Program then developed into a national program, as the Presiding Officer knows from his time in the House of Representatives, the so-called SCHIP, State Children's Health Insurance Program. That is what the debate is about. What did we do? We created a program which now covers 6.7 million American children, most of whom, probably the overwhelming majority of whom would not have any health insurance coverage because, as we know, these are families who are above the income levels for Medicaid but they are often below or outside the category of families who have employer-sponsored health insurance. So they are in that gap: lower middle or middle-income families, in many cases. So we have covered 6.7 million children. That is wonderful. The only problem is there are millions more who are not covered. This bill--strip away all the debate, all of the back and forth, all of the fighting about this--at its core, just as it did a couple years ago, is to provide health insurance to more than 4 million additional children. So 6.7 million, roughly, and you add 4.1 million, that is what you are talking about. So we have the program in the legislation now to cover more than 10.5 million American children. Few, if any, generations of Americans who have served in a legislative body could say they cast a vote to cover that many children. It is a tremendous opportunity for a child, for their family, for the community and neighborhood they live in, for their State, and for their country now and in the next months and years ahead, but it is also important to all of us down the road. Who would you want to hire 20 years from now? A child we invested in? A child who had health care in the dawn of his or her life? A child who had early learning opportunities? A child who had a good healthy start in life? I think as an employer you would want to hire a person who had that investment. They are bound to be more productive. So there is a long-term workforce argument. But even if that argument was not there, this is the right thing to do for the obvious reasons. Now, what are we talking about? We are talking about health care and benefits. There is a long list of benefits I won't go through. We have charts we have all pointed to, and we will continue to do that. But just consider one aspect of the benefits, one that I focus on because I think it is crucial to the life of a child and crucial to their--I should say, not just crucial, determinative of the kind of future they are going to have or not have, and that is well-child visits. One of the benefits that is covered in Pennsylvania is that in the first year of the life of that child he or she will get six well- child visits. Every child in America should have that opportunity. Every family should have the peace of mind to know that if all does not go well, at least their child has health insurance, and in the first year of their life they have been to the doctor at least six times, and they have been to the dentist and any other specialty they can get to and that the benefits cover. So if we want to just focus on one benefit of the children's health insurance: a kid gets to the doctor six times in a year--pretty important. I am not a doctor, but we all know the benefit, as parents and as legislators from our work. Another aspect of this legislation that does not get a lot of attention: When people hear about a government-inspired initiative, or a program in this case, that is partially paid for with public dollars, we often hear about: Well, that is just for communities where people are low income, but they are covered by Medicaid, so why do we need to help them? It does not help people kind of across the length and breadth of the country. It is somehow targeted to one group and, therefore, it is not good for everyone. Well, I just made the case about the workforce long term. But one aspect of this issue in terms of a group of children who are often not in the headlines but benefit directly and are reliant upon the Children's Health Insurance Program and the Medicaid Program for children is that a lot of poorer families with children are in rural areas--people who live in rural areas across the State of Pennsylvania and across the country. In my State of Pennsylvania, when you get outside of Philadelphia and Pittsburgh and Erie and Harrisburg--a couple of major urban areas--we are a very rural State. We have literally millions of people who live in the demographic category that we refer to as rural areas. Those children--one-third of them--rely upon either the Children's Health Insurance Program or the Medicaid Program. So it helps a high percentage of rural children. In the midst of this economy, when those rural communities in Pennsylvania and across the country have been disproportionately adversely impacted by high energy costs, including everything from gasoline to home heating oil, to all kinds of other energy costs, when they have also been hit hard by the downturn in the economy--job losses are rampant in rural communities--when you factor in those realities with the dependence or reliance they have on this program, it is critically important we provide as much in the way of resources as we can and outreach to get those children enrolled in rural areas, as well as in our urban and even suburban communities. I want to conclude with a recitation of some myths and facts, some of which we have heard on the floor in the debate over the last couple days. I will do just one, two, three, four--about four or five myths. Myth No. 1, the children's health insurance bill reduces documentation requirements, allowing illegal immigrants to receive benefits. That is the myth. Here are the facts. Fact No. 1: Under current law, only individuals applying for Medicaid are subject to the citizenship documentation requirements. This bill actually extends those requirements to the Children's Health Insurance Program, requiring documentation in CHIP just like documentation is required in the Medicaid Program. You would never know that by some of the debate here. Fact No. 2 about this documentation issue: Because the requirements have resulted in the widespread denial of coverage to many citizens, the children's health insurance bill also gives States a new way to prove citizenship through matching Social Security Administration records. So that is further help on documentation. Fact No. 3 under this section: These citizen documentation provisions are the same as they were in the children's health insurance bill passed in the Senate overwhelmingly--overwhelming--with bipartisan support in 2007. So it is the same. So for those who are creating the myth that somehow it is new, that is not true. Myth No. 2: The bill ends the mandatory 5-year waiting period for legal immigrants to receive benefits--opening the program to abuse by illegal immigrants. It is another myth. Fact No. 1 under this myth: The bill allows but does not require--it allows but does not require--States to cover legal immigrant children without forcing them to wait 5 years for coverage. Why should a child who is a legal immigrant or why should a pregnant woman in the same circumstance--why should they have to wait 5 years? Does that make any sense at all? Does that make any of us safer or does that make our country better to have vulnerable people wait to get these benefits, especially when 23 States are doing this now? By listening to the debate, you would think this is some new concept that just fell out of the sky. Twenty-three States right now are doing this. So what does this bill do? It allows States to cover legal immigrant children without forcing them to wait 5 years for coverage. Only immigrant children here legally--legally--are eligible for the benefits provided by Medicaid and the Children's Health Insurance Program. So if anyone uses the word ``illegal'' in this context, you know automatically they are deliberately attempting to mislead people. Children and pregnant women who will now be eligible must document their immigration status. State Medicaid agencies use the Bureau of Citizenship and Immigration Services' automated SAVE system to verify the immigration status of legal immigrants applying for Medicaid. So that is a protection that is built into this bill. The next myth: This bill will allow children from families making over $80,000 per year to receive coverage while poor children are still not enrolled. That is another myth. This bill would extend coverage to 4 million more low-income children and help struggling families in this time of economic downturn. The CHIP bill prioritizes enrolling low-income children by establishing a performance-based system to reward States for enrolling low-income kids while giving them new tools to do so. So we incentivize States to go out and enroll more children, which is a worthy thing to do, and critically important. Under the bill, States would be allowed to designate CHIP funds to help families afford private coverage afforded by employers or other sources. Finally, under this section, the bill maintains provisions to reduce the Federal match rate for the cost of covering children above 300 percent of the Federal poverty level. Let me get to two more myths, and I will conclude. The next myth: The revenue stream to pay for the Children's Health Insurance Program with tobacco tax is unsteady and will not be able to fund the program in the future, increasing the burden on taxpayers. That is the myth. We have heard that a lot. The fact is, according to the nonpartisan Congressional Budget Office, the proposed $31.5 billion in spending will be fully paid for by the fee increase to tobacco products over the authorized 5-year timeframe. Finally, this myth: Democrats have made unilateral changes to CHIP, which has jeopardized the bipartisan support of the previous version passed by the Senate. Fact: The CHIP legislation introduced this year is almost identical to the legislation in 2007 which received broad bipartisan support in the House and the Senate. Two prior bipartisan efforts were blocked by President Bush when he vetoed the legislation. Providing health care for children is not a Democratic or Republican issue. We know that. It is a moral issue and one that all Senators should support. The few unresolved policy disagreements were put to a vote in the committee. So we have had a committee vote as well. So I would conclude tonight with where I began. What is the Senate going to do when faced with the question, the stark and fundamental question: Are we going to act this week to cover 4.1 million more children? It is up or down. There have been a lot of discussions about so-called immigration issues which I think have been misleading. A lot of the debate is about numbers. But we are either going to act to do this, to cover 4 million kids, or not. Finally, what will the Senate do this week to speak to that one mother and to say to her: We understand a little bit--a little bit-- about what you are going through, and we understand that with all of the love you surround your son or daughter with, we know you cannot provide them health insurance on your own. We are going to help you because we have the program that has been in place for 15 years, which is one of the best pieces of legislation this body or the other body ever voted on; we know how to help you, and we are going to do everything we can to help you. We know this economy is especially tough on that mother and that family. We are going to act to help you through this difficult period in your life so that you can have the peace of mind to know that your son or daughter at least--at least--is covered by health insurance and can get six visits to the doctor in a year. That is not asking too much of all of us and of the American people, to show some degree of understanding and some degree of solidarity with that mother and her children. Thank you, Mr. President. I yield the floor and note the absence of a quorum.

Mr. CASEY

Mr. CASEY. Mr. President, I rise today to introduce the Bonus TEFAP Assistance Act of 2009 with my colleagues Senator Snowe and Senator Voinovich. Our bill provides immediate and valuable assistance to our national food banks and the families who rely on food banks to put meals on the table by ensuring that food banks can accept and distribute food donations they might otherwise have had to decline. Our bill has the support of Feeding America, formerly known as America's Second Harvest, the national hunger relief charity that operates a network of over 200 food banks across America. We are in the middle of a crisis. The on-going economic crisis is the worst in a generation, but this crisis is more than stock prices and market certainty. The economic crisis has a face. The faces of hardworking Pennsylvanians who suddenly find themselves unable to afford food for the family meals. The economic crisis is also a hunger crisis--a crisis that is pushing more people to apply for Federal nutrition programs and stand in line at the local food bank. It is a crisis that threatens to undo all of the progress we have made over the past few decades to end hunger in America. The United States Department of Agriculture, USDA, reported that, for 2006, 35.5 million Americans did not have enough money or resources to get food for at least some period during the year. This figure was an increase of 400,000 over 2005 and an increase of 2.3 million since 2000. With the fragile State of our economy, it is extremely likely that these figures for 2007 and 2008 will be even more devastating. The only recourse for these millions of families is to turn to federal food assistance programs and emergency food banks for their basic food needs. Unfortunately, as articles in national publications like the USA Today and the New York Times have highlighted, there is a critical lack of food inventories available in local food pantries across the country. Rising demand, sharp drops in federal supplies of excess commodities, and declining donations have forced food banks to cut back on rations, and in some cases, close their doors. In short, America's food banks are facing critical shortages now. As a member of the Senate Committee on Agriculture, Nutrition, and Forestry, I was proud to help create last year's farm bill. The bill helps food banks by providing additional annual funding to shore up food bank supplies. But there are additional measures that we can take to help ensure that food banks can continue to fulfill their mission. That's why today I'm pleased introduce the Bonus TEFAP Assistance Act of 2009. This legislation provides the critical support needed to ensure food assistance agencies, already in desperate need of supplies, can take full advantage of the distributions of bonus food commodities supplied by USDA through the Emergency Food Assistance Program, TEFAP. By helping to offset the intrastate storage, transportation, and distribution costs the food assistance agencies incur to distribute these bonus food surpluses, the bill ensures that commodities reach the greatest number of needy individuals. The Emergency Food Assistance Program began in 1981 as a temporary program with dual purposes; it was intended to help reduce the Federal food inventories and storage costs while also assisting the needy. Because of the program's success in helping distribute food to those in need, in 1988, after much of the federal inventory was depleted, the Hunger Prevention Act authorized funds to be appropriated to purchase food for TEFAP. Under current-day TEFAP, the USDA provides states and food assistance agencies with commodities bought specifically for the program and with funding to help cover distributing agencies' intrastate storage, handling, and distribution costs. In addition, when available, USDA provides any excess food not needed to fulfill other program requirements to States for allocation to local food assistance agencies. This excess food is known as ``bonus TEFAP.'' Unfortunately, while the USDA generously distributes these bonus TEFAP commodities to the States, many of the State and food assistance agencies are unable to accept the bonus TEFAP commodities because they do not have the resources to store, transport, or distribute them. The Bonus TEFAP Assistance Act of 2009 that I am introducing today alleviates this problem by providing offsetting funds to recipient agencies to assist with the costs of storing, transporting, and distributing bonus TEFAP commodities. The funds provided through this legislation will help to provide more food to those in need through food banks, food pantries, emergency shelters, soup kitchens, and other organizations that directly provide these resources to the public. To solve the problem the inadequacy of local resources causes, the bill authorizes the Secretary of Agriculture to use existing funds granted under Section 32 of the Agricultural Adjustment Act of 1935. Currently, Section 32 funds are used to fund child nutrition programs and other programs to support the farm sector at the discretion of the Secretary. Through this legislation, a small portion of Section 32 funds would be allocated to each eligible recipient agency in the lesser amount of $0.05 per pound or $0.05 per dollar value of bonus TEFAP commodities. With this modest increase in funding, the States and their food assistance agencies will be able to accept more food distributions from the USDA through TEFAP, benefitting the many low- income recipients who rely on the program for emergency food and nutrition assistance. I urge all of my colleagues to join Senator Snowe, Senator Voinovich and me in ensuring that the States and food assistance agencies can accept the available excess commodity foods the USDA provides under the Emergency Assistance Food Program. Food assistance agencies are in dire need of funds, food, and supplies and we owe it to them to ensure that they can take full advantage of every opportunity to serve those in our nation who are in desperate need. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CASEY

Mr. CASEY. Mr. President, I rise today to introduce the Bonus TEFAP Assistance Act of 2009 with my colleagues Senator Snowe and Senator Voinovich. Our bill provides immediate and valuable assistance to our national food banks and the families who rely on food banks to put meals on the table by ensuring that food banks can accept and distribute food donations they might otherwise have had to decline. Our bill has the support of Feeding America, formerly known as America's Second Harvest, the national hunger relief charity that operates a network of over 200 food banks across America. We are in the middle of a crisis. The on-going economic crisis is the worst in a generation, but this crisis is more than stock prices and market certainty. The economic crisis has a face. The faces of hardworking Pennsylvanians who suddenly find themselves unable to afford food for the family meals. The economic crisis is also a hunger crisis--a crisis that is pushing more people to apply for Federal nutrition programs and stand in line at the local food bank. It is a crisis that threatens to undo all of the progress we have made over the past few decades to end hunger in America. The United States Department of Agriculture, USDA, reported that, for 2006, 35.5 million Americans did not have enough money or resources to get food for at least some period during the year. This figure was an increase of 400,000 over 2005 and an increase of 2.3 million since 2000. With the fragile State of our economy, it is extremely likely that these figures for 2007 and 2008 will be even more devastating. The only recourse for these millions of families is to turn to federal food assistance programs and emergency food banks for their basic food needs. Unfortunately, as articles in national publications like the USA Today and the New York Times have highlighted, there is a critical lack of food inventories available in local food pantries across the country. Rising demand, sharp drops in federal supplies of excess commodities, and declining donations have forced food banks to cut back on rations, and in some cases, close their doors. In short, America's food banks are facing critical shortages now. As a member of the Senate Committee on Agriculture, Nutrition, and Forestry, I was proud to help create last year's farm bill. The bill helps food banks by providing additional annual funding to shore up food bank supplies. But there are additional measures that we can take to help ensure that food banks can continue to fulfill their mission. That's why today I'm pleased introduce the Bonus TEFAP Assistance Act of 2009. This legislation provides the critical support needed to ensure food assistance agencies, already in desperate need of supplies, can take full advantage of the distributions of bonus food commodities supplied by USDA through the Emergency Food Assistance Program, TEFAP. By helping to offset the intrastate storage, transportation, and distribution costs the food assistance agencies incur to distribute these bonus food surpluses, the bill ensures that commodities reach the greatest number of needy individuals. The Emergency Food Assistance Program began in 1981 as a temporary program with dual purposes; it was intended to help reduce the Federal food inventories and storage costs while also assisting the needy. Because of the program's success in helping distribute food to those in need, in 1988, after much of the federal inventory was depleted, the Hunger Prevention Act authorized funds to be appropriated to purchase food for TEFAP. Under current-day TEFAP, the USDA provides states and food assistance agencies with commodities bought specifically for the program and with funding to help cover distributing agencies' intrastate storage, handling, and distribution costs. In addition, when available, USDA provides any excess food not needed to fulfill other program requirements to States for allocation to local food assistance agencies. This excess food is known as ``bonus TEFAP.'' Unfortunately, while the USDA generously distributes these bonus TEFAP commodities to the States, many of the State and food assistance agencies are unable to accept the bonus TEFAP commodities because they do not have the resources to store, transport, or distribute them. The Bonus TEFAP Assistance Act of 2009 that I am introducing today alleviates this problem by providing offsetting funds to recipient agencies to assist with the costs of storing, transporting, and distributing bonus TEFAP commodities. The funds provided through this legislation will help to provide more food to those in need through food banks, food pantries, emergency shelters, soup kitchens, and other organizations that directly provide these resources to the public. To solve the problem the inadequacy of local resources causes, the bill authorizes the Secretary of Agriculture to use existing funds granted under Section 32 of the Agricultural Adjustment Act of 1935. Currently, Section 32 funds are used to fund child nutrition programs and other programs to support the farm sector at the discretion of the Secretary. Through this legislation, a small portion of Section 32 funds would be allocated to each eligible recipient agency in the lesser amount of $0.05 per pound or $0.05 per dollar value of bonus TEFAP commodities. With this modest increase in funding, the States and their food assistance agencies will be able to accept more food distributions from the USDA through TEFAP, benefitting the many low- income recipients who rely on the program for emergency food and nutrition assistance. I urge all of my colleagues to join Senator Snowe, Senator Voinovich and me in ensuring that the States and food assistance agencies can accept the available excess commodity foods the USDA provides under the Emergency Assistance Food Program. Food assistance agencies are in dire need of funds, food, and supplies and we owe it to them to ensure that they can take full advantage of every opportunity to serve those in our nation who are in desperate need. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CASEY

Mr. CASEY. Mr. President, I would like to take a moment today to recognize the career of journalist Dick Hoxworth who, after serving the residents of central Pennsylvania for 40 years, retired from his post as anchor on WGAL-TV on Christmas Eve. The longest serving anchor in the Harrisburg media market, Dick covered some of the most newsworthy events in the region's history. Most notably, he covered the Agnes flood in 1972 and was one of the first reporters on the scene at the Three Mile Island nuclear accident. During the Vietnam war he reported on the return of the first American prisoners of war, as well as the arrival of the first Vietnamese refugees to the United States. In the political arena, Dick Hoxworth covered stories at both the Pennsylvania State Capitol and the White House. Dick was a highly decorated newsman. Over the course of his distinguished career, he received awards from the Associated Press, the Pennsylvania Association of Broadcasters, and was nominated for 29 regional Emmy Awards, winning 3 times. But simply listing Dick Hoxworth's accomplishments and accolades within the field of journalism doesn't tell his full story. Dick was an old-fashioned ``news man,'' getting his start before blogs, the Internet, 24-hour cable news, and live satellite feeds. However, as time went on, he did one of the most difficult things to do in a profession he transcended the changes that were taking place in his field. Dick continued broadcasting, writing, and reporting even as the faces and technology around him changed with the times. Rather than be deterred by these changes, he embraced them and continued to thrive. Edward R. Murrow once said, ``the newest computer can merely compound, at speed, the oldest problem in the relations between human beings, and in the end the communicator will be confronted with the old problem, of what to say and how to say it.'' For 40 years, Dick Hoxworth knew what to say and how to say it And, in doing so, he has made Pennsylvania proud. Today I would like to recognize and pay tribute to that service and his long and successful career.

Mr. CASEY

Mr. CASEY. I ask unanimous consent that the Senate stand in recess subject to the call of the Chair.

Mr. CASEY

Mr. CASEY. Mr. President, I rise today to introduce the Promoting Small House Nursing Homes Act. This is a bill I expect will play a significant role in the way we care for our older citizens in this country. I also hope and expect this bill to make an important contribution to the framing and substance of the landmark health care reform we anticipate in the coming year. Moreover, because our current economic problems are interwoven with out-of-control health care costs, this bill will contribute to a revitalization of our economy and the creation of new jobs. Finally, it will establish solid criteria for long term residential care that will not only improve the quality of life of older citizens, but save money through cost-effective, comprehensive and coordinated long term and health care. This bill provides a dramatically different approach to long term residential care for older citizens than is offered by the traditional nursing home model. The Promoting Small House Nursing Home Act incorporates the principles of person-centered care as a cornerstone of all aspects of long term residential care. What do we mean by person-centered care? The philosophy is simple: Our older citizens deserve to live lives of dignity and respect through all stages of life. About 10 years ago, the Philadelphia Inquirer reported, ``Life can have quality and meaning even until the very last breath.'' Our older citizens have a profound right to be decision-makers in their own care--to be at the center of their own care, with a partnership of family and providers. Our older citizens are critically important to the overall health and well-being of our society. I quote a well known expert in person-centered care, Dr. Bill Thomas, who says, ``People of all ages will live better lives when we succeed in bringing elders back to the heart of our society.'' My bill translates this profound philosophy into a specific policy prescription by doing the following: creating a low-interest loan fund for building new or renovating existing long term care facilities that follow articulated small house nursing home model guidelines; etablishing clear and specific program requirements and guidelines that build upon existing programs that have successfully implemented substantial culture change and person-centered care; creating a home- like and non-institutional model of care for long term care residential facilities that is based upon the principles of: collaborative decision-making; respect; and significantly improved quality of life for residents and staff alike. We currently have an estimated 38 million Americans over the age of 65, and that number is expected to double within the next 20 years. In the midst of this, health care costs are rising exponentially, the quality of outcomes is not consistent, and older citizens are often abandoned to navigate a confusing and complex health care system. Older citizens also report extremely low levels of satisfaction with life in nursing homes. This $122 billion industry includes 16,000 nursing homes and significant concerns persist about maltreatment and neglect of our older citizens in 20 percent of these homes. As I know from my work in State government, most nursing homes provide quality care but that 20 percent is what we hear most about. However, a recent survey by the AARP found that fewer than 1 percent of individuals over 50 with a disability want to move to a nursing home. There has to be a better way, and in fact there is. Person-centered care provides that better way. It is a straightforward concept and yet it has taken years of hard work to get concrete initiatives underway. We have a long way to go and much to learn. But in order to succeed, we must pass legislation like the bill I have introduced today. Traditional nursing facilities require residents' lives to revolve around institutional schedules for waking, bathing and dressing. Traditional facilities far too often identify residents by their health conditions, vulnerabilities and room numbers rather than their unique strengths and gifts. Staff members are attracted to the field of direct care service because they want to help older citizens but they are just as ill-served by this institutionalized culture as are the residents. Workers are minimally trained, over-worked and carry patient loads that make it impossible to engage in any personal time with residents--in fact, such relationships are often discouraged. They have little or no say in decision-making, relegated--like the residents--to the fringes of a system that places the needs of the institution over those of the human beings in it. In July of this year, I chaired a hearing for the Aging Committee that examined this small house nursing home model. One of our witnesses was a nursing assistant who previously worked for a traditional nursing home and now works in a small house nursing home in Pennsylvania. She recounted the difference, saying, ``Looking back on it, now, I realize that while we offered our residents excellent nursing care, that did not always translate into a high quality of life.'' She described handling a wider range of duties now, yet having more time to spend with individual residents and really getting to know--and even love-- them because the staffing is consistent and the turnover is almost non- existent. Another witness at our July hearing was the daughter of a woman who moved from a traditional nursing home to a small house nursing home. She summed up the dramatic change in her mother with this simple phrase, ``Suddenly, life mattered again.'' It should be a given that ``life matters'' to every person. While every citizen has this fundamental right, our older citizens who have worked hard their whole lives truly deserve to enjoy their later years in homes that offer them comfort, respect and autonomy. I strongly believe the Promoting Small House Nursing Homes Act will make this possible and I urge my Senate colleagues to join me in supporting this effort in its own right as well as the significant role it can play in the larger issues of comprehensive health care reform and revitalizing our economy. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CASEY

Mr. CASEY. Mr. President, yesterday, I came before the Senate to pay tribute to Pennsylvanians who gave, as Abraham Lincoln said, ``the last full measure of devotion'' to their country serving in Operation Iraqi Freedom. Therefore, today, I would like to take this opportunity to honor the men and women of Pennsylvania who have served in Operation Enduring Freedom in Afghanistan. This struggle began in the weeks following the gravest attack on American soil; it was a direct response to eliminate the sanctuary of those who plotted the horrific events of 9/11. The men and women who have served in Afghanistan have faced extreme danger but have persevered with a can-do spirit. Our men and women of the U.S. Armed Forces are indeed in a class of their own--all their own, I should say. And, like their brothers and sisters serving in Iraq, they mourn the sacrifices of their own. So today in the Senate, I would also like to enter into the Congressional Record the names of those 25 Pennsylvanian heroes who may have fallen in the battles of Afghanistan but who have only risen in our appreciation for their service and sacrifice. I list them now: CWO Michael Slebodnik of Gibsonia, PA; PFC Michael Dinterman of Littlestown, PA; LTC Richard Berrettini of Wilcox, PA; SPC Jonathan L. Luscher of Scranton, PA; SPC Derek Holland of Wind Gap, PA; PV2 Matthew Brown of Zelienople, PA; 1LT Jeffrey Deprimo of Pittston, PA; 2LT Michael Girdano of Apollo, PA; SGT Douglas Bull of Wilkes-Barre, PA; SSG Troy Ezernack of Lancaster, PA; Po3 John Fralish of New Kingstown, PA; CPT Bryan Willard of Hummelstown, PA; SGT Jonathan McColley of Gettysburg, PA; SGT James Fordyce of Newtown Square, PA; SGT Brett Hershey of State College, PA; PFC James Dillon, Jr., of Grove City, PA; SSG Paul Sweeney of Lakeville, PA; SGT Christopher Geiger of Allentown, PA; SFC Scott Ball of Mount Holly Springs, PA; SGT Jan Argonish of Peckville, PA; SSG Patrick Kutschbach of McKees Rocks, PA; CPT David Boris of Pottsville, PA; MSG Arthur Lilley of Smithfield, PA; 1SG Christopher Rafferty of Brownsville, PA; MSG Thomas Maholic of Bradford, PA. To the families of these brave Americans, please know your son's or daughter's service will always be remembered and appreciated. Every time a child is able to go to school in America without fear, that service is appreciated. Every time a graduate looks positively toward their future, to live in a land of freedom and liberty, those who have served are appreciated and their sacrifice is appreciated. The response of these men and women--whether it was in Afghanistan or anywhere in the world that they served--their response to the ultimate call to service ensures that each of us may live in freedom. As Benjamin Disraeli once said: The legacy of heroes is the memory of a great name and the inheritance of a great example. During this holiday season, when thoughts of our families and loved ones are on our minds, I wish to express my condolences and gratitude to those families who have loved and lost someone dear to them and also to express gratitude to those whose loved ones are now serving in a war theater far from home. Please know you are in our prayers. Mr. President, I yield the floor and suggest the absence of a quorum.

Mr. CASEY

Mr. CASEY. Thank you, Mr. President.

Mr. CASEY

Mr. CASEY. Mr. President, as we bring the 110th Congress to a close, our Nation confronts a daunting set of challenges. While we face the gravest crisis, perhaps, since the Great Depression, we must also remember that we are a nation at war. From Iraq to Afghanistan, from the Pacific to Europe and countless places in between, American service men and women are proudly carrying out their duties to protect our country and our way of life. Under stressful conditions and the constant threat of danger, members of our Armed Forces do what it takes to get the job done every day. During this holiday season, I wish to take a moment to express my gratitude to our servicemembers. Their personal courage and honor should not be taken for granted but genuinely appreciated. I know that is the sentiment of the Senate on both sides of the aisle. Today, on behalf of my family, the people of Pennsylvania, and people throughout the country, I thank the members of our armed services and their families, especially those who gave, as Lincoln said, ``the last full measure of devotion to their country.'' To the families of those who have died or for those family members who are remembering those who are far away serving our country, in either instance, either by way of the loss of a loved one or because of distance, there is obviously a void in their lives. The words of the great recording artist Bruce Springsteen come to mind when I think of what these families are living through today. I remember the words from a song he wrote right after the 9/11 tragedy as he came out with a number of songs. One of them was ``Missing.'' Some of the lines from that song go as follows: When I shut out the lights, you're missing. When I close my eyes, you're missing. When I see the sunrise, you're missing. I believe so many families feel that today. They know that someone who was in their lives, a member of their family, a son or daughter, a husband or wife who was among them and living and then went off to serve and lost their life, they feel that sense of missing a family member or a loved one. But even if they are just away for 6 months or a couple of months or even a year, they are missing, especially at this holiday season. So we are thinking of them today, those families who are living with that loss or living with that void. So far, 190 sons and daughters of the Commonwealth of Pennsylvania have sacrificed their lives during Operation Iraqi Freedom. Since the last time I paid tribute to those who have fallen, 21 Pennsylvania families have lost their loved ones. Today I would like to honor each of them by reading their names into the Record: Aviation Boatswain Mate 3rd Class Daniel Verbeke of Exton,

Mr. CASEY

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

Mr. CASEY

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

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that the Chair now lay before the Senate the House message to accompany S. 1193.

Mr. CASEY. Mr. President, I ask unanimous consent that the Senate concur in the House amendments, the motion to reconsider be laid upon the table, and that any statements relating to the bill be printed in the Record.

Mr. CASEY

Mr. CASEY. Mr. President, I ask unanimous consent that when the Senate completes its business today, it stand in adjournment until 9:30 a.m. tomorrow, Thursday, November 20; that following the prayer and pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate proceed to a period of morning business for up to 1 hour, with Senators permitted to speak for up to 10 minutes each; that following morning business, the Senate resume consideration of the motion to proceed to Calendar No. 1123, H.R. 6867, an act to provide for additional emergency unemployment compensation.