Christopher Dodd

Mr. DODD

Mr. DODD. Mr. President, before my colleagues from North Dakota and New Hampshire leave, let me commend them for their efforts in this regard. There may be debates about the details of this legislation. One of the first amendments I ever offered, sitting back in the far corner, as a freshman Member of this body was a pay-as-you-go budget in the Reagan administration. Then I was a cosponsor of Gramm-Rudman- Hollings back in 1985--that was 24 years ago--which was an effort to try to put some restraints on the exploding process at the time. While I am not prepared necessarily to sign on this morning, I would be remiss if I did not thank them for their efforts. And either something like this or a variation of it is needed so there is some process in place to allow us to deal with these issues. Before they wandered off and we were back on the health care debate, I wanted to thank them for their efforts. Let me once again address issues that need to be clarified. We have disagreements about the health care bill. I want the record to reflect the efforts that have been made for over a year now to involve our colleagues across the spectrum, beginning with my predecessor, Senator Kennedy, who would be otherwise standing at this very podium but for his illness and his death. My office and his staff worked closely together and I want to share the details of those meetings that occurred beginning about a year ago to formulate the very bill we are grappling with today. I was not a participant in those early meetings. Senator Kennedy was, with his staff and Members of the minority staff right after the elections. I began to work in his place starting around the first of the year or shortly thereafter. There were numerous meetings between Members from across the spectrum from the Budget Committee, the Finance Committee, the HELP Committee, countless meetings of staff in all three of these committees. Many of them occurred in Chairman Baucus's office, the chairman of the Finance Committee. Battling over the substance of the bill is a very legitimate process. There are 100 of us representing various constituencies and various ideas. There is nothing inherently wrong about that. In fact, it is a healthy process to go through. But I cannot stand here and accept the notion that people have been excluded from the process. That is not the case at all. There are times when the majority, who has the responsibility to pose ideas, will meet together to formulate an idea or a series of ideas to bring forward. To say this is a historical, unprecedented occurrence defies what anyone who has known 5 minutes of the history of this institution knows. I recall only a few years ago when the minority leader and others were excluded from conference meetings between the House and the Senate. If Tom Daschle showed up, the word was, the conference committee would be canceled. Imagine, the minority leader, a conferee, dealing with the House and Senate, would show up and the meeting would be canceled. With all due respect, it is that old line of Claude Rains in the famous movie ``Casablanca,'' walking into Rick's Cafe, looking around with Humphrey Bogart there and saying: ``Is there gambling going on here? Shocking.'' Is politics going on in the Senate? Yes, it is. And it has back to 1789, to the founding of the Republic. Politics has happened in this institution where people try to formulate ideas to bring together on behalf of our constituents across the country. It needs pointing out, as I will, and I will lay out and provide shortly every single amendment offered by the other side--hardly technical, so everybody can read them--the provisions in this bill that were specifically offered by Members of the minority that were accepted either in our committee or in other places and are reflected in the substance of this bill. Is it their bill? No. Obviously, they have not voted for it. But a lot of the substance in it is theirs, and to suggest otherwise is not true. The notion that people have been excluded from this process is just not the case at all. In fact, going back, if you will, since January of 2007 the HELP Committee has held 30 bipartisan hearings on health care reform, with 15 alone in 2009. Taken together, the HELP and Finance Committees held more than 100 bipartisan meetings. Beginning in December 2008, the bipartisan leadership of the HELP Committee, the Finance Committee, and the Budget Committee met 10 times to discuss health care reform legislation. Staff met even more frequently. Ideas discussed in those meetings are reflected in this bill. In 2008, the HELP Committee held 15 bipartisan health reform staff roundtables, which included Republican and Democratic staff from the HELP, Finance, and Budget Committees. Over 80 stakeholders from the pharmaceutical industry, the insurance industry, those who advocated single-payer approaches--80 stakeholder meetings were held in the health care debate from across the political spectrum. Democrats, Republicans, patients, providers, employers, unions, insurers, and drug device manufacturers contributed recommendations to this bill. They were not all accepted. The idea that we would take everyone's idea that comes to the table is ludicrous on its face. But certainly the opportunity to affect the outcome of this bill was very much an open process. In addition, committee staff held regular meetings with smaller representative groups. Since April of 2009, these meetings have included staff from Senator Enzi's office, Senator Gregg's office, and Senator Hatch's office. These meetings included groups from across the political spectrum who met for 2-hour sessions twice a week to provide detailed and thoughtful contributions to this bill. In addition to these stakeholders, hundreds of groups attended larger stakeholder meetings on March 13 and May 15 where further recommendations on reform were heard. On June 10 and 11, prior to beginning of the markup of the HELP Committee bill, Members had detailed, bipartisan discussions of the draft legislation, including extensive options contributed by our Republican colleagues. Options provided by Republican Members were reflected in the legislation approved by the committee. On June 22, HELP Committee Senators also met with the nonpartisan Congressional Budget Office Director Doug Elmendorf and other CBO staff. The markup in the HELP Committee lasted almost a month--a record for that committee, by the way. The committee held 56 hours of executive consideration of the legislation, stretching across 23 different sessions over 13 days. Taken together with the Finance Committee, more than 20 days were devoted to the amendment process alone. During the HELP Committee markup--I have mentioned this over and over again--we considered 287 amendments, almost 300 amendments, and 161 of those 287 were accepted Republican amendments. I ask unanimous consent to have printed in the Record all of those amendments that were accepted and the description of those amendments.

Mr. DODD. Mr. President, specific pages in this bill and the language of these amendments or a synopsis of the language is included. These were not just technical amendments. Let me mention some that were included. Our colleague from North Carolina, Mr. Burr, offered an amendment that subjects the public option to the same laws and requirements as private plans. This discussion that they were not involved in the public option--here are amendments offered by Republicans accepted in the committee dealing with the public option. Did we take all of them? Of course not. Of the 287 amendments, 161 of them, as you will now read, are reflected in these efforts. Follow-on biologics: A bipartisan, Enzi-Hatch-Hagan--Hagan, a Democrat, and Hatch and Enzi, Republicans--amendment establishes the pathway for biosimilar biological products. This Republican amendment is reflected in the bill on page 1859. Long-term care: Senator Gregg ensured that the new voluntary program to approve long-term care options would remain solvent for 75 years-- the CLASS Act--reflected on page 1931 of the bill. Prevention--again, a bipartisan amendment offered by Senator Gregg and Senator Harkin that expands and strengthens the incentives available for participation in workplace wellness programs, reflected in the bill on page 80. The Murkowski of Alaska amendment will allow insurance companies to offer discounts for those who do not smoke. This is a Republican amendment reflected on page 80 of the bill. Coverage: Several amendments were offered by Senators Enzi, Coburn, Roberts, and others to make certain that nothing in the legislation would allow for rationing of care and that no one would be denied care based on age, disability, medical dependency, or quality of life. That is reflected as well on page 105 of the bill. My colleague from Wyoming, the ranking member of the committee, had 41 amendments that were included in the bill. For instance, in Title I, Enzi amendment No. 241 appears on page 185 of the marked-up bill. Line 22: to ensure that individuals enrolled in the community health service option have access to all services. Senator Enzi's amendment is included in the bill. He offered amendments on page 272 to prevent denial of care based on patient age, disability, medical dependency, quality of life, and antirationing proposals; follow-on biologics; amendments to protect and ensure that data and prevention programs include rural populations. Again, I will provide a list of the 41 amendments so my colleagues and others can read a synopsis of those amendments--hardly punctuation marks in the bill. We may not agree with every one. We accepted them. I thought they contributed to the bill, made a better bill. I did not decry them; I welcomed them. So the suggestion that this somehow has been jammed down the throats of people, with secret meetings going on--I don't think people ought to engage in that. You can vote against the bill if you want, but don't suggest to me this process denied people a chance to be heard, to be involved, to be engaged. I went out of way my in the markup of that bill to stay for as many hours as people wanted to, for as long as they wanted to, to offer as many amendments as they wanted to. Staff worked all during the weekends of that process to go through these amendments. I remember on one occasion, after work over one weekend, I proposed accepting 40 amendments. I offered to accept all 40 of them, and my Republican friends objected to a request to accept their amendments in the committee. So the notion we marked up titles of this bill without adequate notice of language is false. Titles of the bill had to be scored by CBO. The idea that we would markup our bill without notice of language or CBO scores again is false. The markup dates were postponed by me to allow more time to read language and to ensure that CBO scores were distributed to all Members as well. As someone who has been around here a number of years, I know when there is a true willingness to have a bipartisan effort and I know when there is one that is not going to happen. Senator Kennedy understood that as well. I have had numerous bipartisan agreements with my colleagues on committees I have served on over the years. It is certainly far better when you can achieve that, I don't deny that at all, but I will not accept the notion that there has been a refusal to accept or willingness to listen to bipartisan ideas as part of this bill. Again, there is a debate that I know is going on on the other side as to whether to have amendments or not have amendments, whether Rush Limbaugh is controlling the show, or the Republican leader. Those things happen. I understand that. But the fact is, we have a bill here, far from perfect--I will be the first to acknowledge it. It is not a bill I would have written on my own. But we serve in a body of 100 coequals who bring to our debate and discussion various backgrounds, experiences, and viewpoints. It is not an easy task. Every Congress going back to the 1940s to one degree or another has tried to deal with this issue. Every administration, from Harry Truman through every Republican and Democratic administration since the 1940s, has, to one degree or another, grappled with this issue of health care. To a large extent, everyone has failed or has not tried because it has been so monumental an undertaking that it has been daunting. Certainly, we are seeing that as we grapple with it in our hour of watch. Those of us who are privileged to be here serving with an administration that has made this a priority have been challenged to do what no other Congress and no other administration has been able to achieve over the past 70 years. We are close to achieving a major beginning, and it is a beginning. Anyone who suggests otherwise does not understand the complexity or the largeness of this undertaking--a beginning, to begin to change and bring down costs, increase access, and affordability, as well as the quality of something that ought to be a basic right in the United States of America, and that is health care. I am excited and optimistic about the possibility of achieving that. It is less than what I wished we could have done, but it is far more than has ever been achieved by others. The product we have before us, while it is not one that has been endorsed on a bipartisan basis, reflects a lot of good contributions made by all Members. In fact, every single member of the HELP Committee--every single member--offered amendments that were adopted as part of our product--every single one. Substantive amendments were offered as well. I find it somewhat intriguing, that people claim to feel excluded from the public option idea. I had no idea they were interested in one. It is exciting to know they have some ideas on the public option. The reflection that occurred during our debate was they were totally opposed to any public option in this bill. So we adopted one as part of the HELP Committee process, under the leadership of Sherrod Brown and Sheldon Whitehouse and Kay Hagan of North Carolina, who sat together and, working with others outside, came up with an option that we thought would appeal on a bipartisan basis. It did not, and we are very much involved in that debate as we speak. Anyway, I wanted to respond to these earlier suggestions, and I will leave them as suggestions, that somehow this product and process has been totally written on a partisan basis. It is anything but that, and I want the Record to reflect that, hence the decision to include the specific amendments, the pages on which they exist in our product, and the substance of the ideas that were contributed by our Republican friends. Mr. President, I saw my colleague from Montana a moment ago, who may be interested in addressing some of these ideas and thoughts as well that are coming before us. But while I wait for him to come to the floor, let me say that, again, I hear constantly this talk about Medicare and the cutting of Medicare. Let me reflect on how false those allegations are. Again, what we are trying to do is to reduce the overpayments under the Medicare Advantage Program. That is what has happened here. These private plans--and that is what they are--operating under Medicare Advantage have two options: They can cut benefits or reduce their profits. We have to bring down these costs when you have an average of 14 percent overpayments occurring in the country that are being borne by 80 percent of Medicare recipients. We talk about the numbers. I have a number: 96,000 people in the State of Connecticut who utilize the Medicare Advantage plan. I am not opposed to that. I think it is a wonderful option for people. But the fact is 470,000 other people in my State, who are Medicare recipients, are paying $90 extra in order to subsidize the Medicare Advantage plan and they are getting none of the benefits for it. So there is a huge percentage--about 80 percent of the elderly in this country--who are writing a check every year to subsidize private health care plans. These plans are profiting at the expense of people who never get a benefit from it. What Senator Baucus and others have suggested is let's reduce these overpayments. It is up to the plans to decide what they want to do with that. They can decide to cut the benefits or take less profit. These are for-profit plans that are doing this. Maybe they don't want to take less profit. That might be a part of the motivation. But traditional Medicare, the guaranteed benefits under that--a nonprofit operation-- are not touched in this bill--not a single guaranteed benefit. For over a week now I have challenged any Member in this body to identify a single guaranteed benefit under Medicare that is affected by this bill. Not one. Eliminating the overpayments under Medicare Advantage are, clearly, because we don't think that 80 percent of the population who qualify for Medicare ought to bear the financial burden of financing a benefit they never get. None of us are opposed to Medicare Advantage, but we are opposed to the idea that these for-profit companies can play the game by suggesting they don't want to take less profit, they don't want to reduce any benefit, so they want to leave it exactly as it is. You want to know why Medicare is in trouble? That is why. If you want to put it on a solid footing for an additional 5 years, then take the proposal we have in the bill to reduce these overpayments. In the absence of doing that, the very people who are worried about the solvency of Medicare are going to be correct, because Medicare will be in financial jeopardy far earlier if we have these amendments adopted that would jeopardize the traditional Medicare Program. Clarity is needed on all of this. The fact something is called Medicare Advantage, as I have said repeatedly, doesn't make it Medicare and it is certainly not an advantage. It is only an advantage for those private companies that are benefitting in terms of the profits they make. In fact, studies done by independent analysts say, that these companies have seen a 75 percent growth in profits as a result of this program. They are doing very well financially as a result of this. But they shouldn't be doing necessarily that well at the expense of others who are paying an additional $90, on average per couple of retirees, elderly people, who are contributing that amount every year without receiving a single benefit under Medicare Advantage. Our simple question is: Why should they be asked to pay that much more? Ninety dollars a year may not sound like that much to a Member of Congress, but if you are a retired elderly person, living on a fixed income, that $90 a year can make a huge difference. It may not be much to a Member of Congress, many of whom, of course, are very wealthy indeed, but it is if you are sitting out there across America writing a check each year for $90 to go into a program you never get a benefit from, which serves 20 percent of the senior population. I don't blame the 20 percent at all. I understand how they feel. They wish to continue to get those benefits. And they can get them, provided the companies they are getting those benefits from are willing to take less in profits. That is what our bill is designed to do--to provide that choice. Obviously, we can't mandate that from them--although we were promised early on they would be able to reduce the cost of Medicare. That was the original proposal when Medicare Advantage was adopted many years ago--a number of years ago. Again, it is anything but Medicare and it is anything but an advantage, except for the profit-making companies that have done very well off this program. Our bill here merely restrains the overpayments. I know that may bother these companies. They would like to make more, if they could, and I respect that, from their vantage point. But we should not, as the Senate, sanction and necessarily approve a proposal that allows them to make more money out of the pockets of people on fixed incomes to support a fraction of the population at the expense of the overwhelming majority. Where is the equity in that, when 80 percent of Medicare recipients are writing a check each year to private companies, in effect, to pay for benefits they never get? I appreciate the support of organizations across the country--AARP and certainly the National Committee to Preserve Social Security and Medicare--and we thank them for their very strong letters. These major organizations, representing 43 million of our elderly in this country, have taken a very strong position against the assaults on this bill regarding the overpayments that are occurring, and we thank them for it. That may not be enough for some people to appreciate, but I believe if they look and listen to what is going on here, they will understand what is at stake. If you are part of the 80 percent of seniors out there who are writing those checks every year and getting none of the benefits, those who oppose our bill want to maintain and probably expand on it in the years ahead. So for you out there who are worried about the cost and solvency of Medicare, our bill is a major step in the direction of reducing those overpayments and providing the options that ought to exist to reduce profits or extend benefits. Again, I think it is important to remind our colleagues that under this bill, there is $130 billion in budget reductions in the first 10 years. It is the largest single reduction. We listened to our colleagues from North Dakota and New Hampshire talk about deficit reduction. This bill provides $130 billion in deficit reduction in the first 10 years and $650 billion of deficit reduction in the second 10 years. We are now told by the Congressional Budget Office there are the millions of people today who are paying insurance and watching the costs escalate almost on an hourly basis. Even with zero inflation, we are watching private companies raise the cost of premiums--going up dramatically. There are 32 million people in the individual insurance market, according to the Congressional Budget Office, and they would pay 14 to 20 percent less in premiums for an equivalent plan than under the status quo. That is a huge reduction, potentially, in the years ahead for 32 million of our fellow citizens in the individual market. If you are in the small-group market--there are 25 million people in that, according to the CBO's analysis--you are eligible for tax credits and would pay 8 to 11 percent less in premiums. If you work for a small business and don't qualify for a tax credit, you would see a reduction, potentially, of 2 to 3 percent in premiums. If you are in the large- group market--and there are 134 million of our fellow citizens who are in that market, according to the Congressional Budget Office--again, you could see a reduction. So in any category, you have a choice here to make--and we do in the coming hours. Do you want to continue the present process? And when people say status quo, it is such a misnomer. The status quo might even be acceptable to people if you could freeze everything. But you can't freeze everything. The status quo allows for a dramatic increase in premiums--dramatic increase. If we don't take steps to deal with rising costs, as we do in this bill, you are looking at premiums going from $12,000 a year for a family of four in this country to $24,000 to $35,000 in the next 7 to 10 years. If this gets defeated--and, obviously, our Republican friends want this bill defeated--the idea that we are going to jump back into this is a pipe dream. We will end up with dramatically increasing costs to millions of our fellow citizens, which this bill restrains because of the hard work done by the Finance Committee, particularly, that had to work on these issues. So for those who suggest the status quo is okay, it is anything but okay. In terms of cost reduction overall, as well as premium reduction, which is so important--and I thank my colleague from Indiana, Senator Bayh, who was the one who insisted CBO give us the analysis of what the impact of this bill would be on premiums--the fact is we see significant reductions of premium costs. I see my colleague from Montana is now here, but I would give the example that in Connecticut, premiums in the year 2000 for a family of four were about $6,000. In the year 2009, that family of four in Connecticut is now paying around $12,000. So in 9 years, premiums have jumped from $6,000 to $12,000. And those numbers continue to escalate. So for those who say no to this bill, then--if you succeed in these efforts--prepare to answer the question why is it the premiums of those people you claim you are defending around here--if they have insurance--will escalate to the rates we have talked about. That is what is at stake--nothing less than that. Whether it is so-called Medicare Advantage or cost reduction or premium reduction, this bill, with all of its imperfections, is a major, giant, positive step forward for our country. Again, I thank the members of the Finance Committee and Members of the HELP Committee, both staffs, and others who have worked to include many of the ideas that our friends on the other side wisely and thoughtfully made a part of these efforts. With that, I yield the floor.

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

Mr. DODD. Mr. President, I ask unanimous consent that over the next 30 minutes, the time be equally divided with 15 minutes for the majority and 15 minutes for the minority for debate purposes only.

Mr. DODD. If my colleague will yield, he raises an interesting point. I am going back several months. As we get older, it is hard enough to remember what happened yesterday. The Presiding Officer is on the committee, as is my colleague from Vermont. There was a debate over the word ``construed'' to prohibit. I remember that word, talking about various practices. As I recall, the compromise that was offered either by my friend and colleague from Kansas or some other member was to strike the word ``construed,'' so nothing would be prohibited. I still, to this day, am not quite sure why we should not accept language that eliminates the word ``construed.'' That went on for about a day back and forth. I invite my colleague, again, to maybe get our staffs together and talk about that. I don't think he is wrong about this. I think it is good to have best practices. If a physician and patient decide, as a certainty, it is essential for that patient, then you should not be prohibited from doing that. As I recall, the debate was over the word ``construed.'' I don't want to take time from the Senator from Vermont.

Mr. DODD. Mr. President, I thank Senator Roberts for his amendment in the HELP Committee to protect patients by preventing rationing of health care. That is in the Senate bill. That was language we adopted, I say to my friend from Vermont. It was a Roberts amendment that was adopted in our markup that prohibits any rationing of health care in our bill. I thank him for that. I yield the floor.

Mr. DODD

Mr. DODD. Mr. President, in 1998, the Hartford Courant ran an award- winning series of stories about the use of restraint and seclusion in hospitals, residential facilities, and group homes for individuals with psychiatric and developmental disabilities. The Courant uncovered a hidden epidemic, confirming 142 deaths occurring during or after the use of restraint or seclusion. One of those 142 was an 11-year-old boy from my home State of Connecticut. He was restrained face-down in a position that restricted his air flow. He died as a result. In response, I led the charge to establish Federal standards to prevent the misuse of these practices. I helped pass The Children's Health Act of 2000, which included the Compassionate Care Act that I originally drafted to put these standards in place in certain hospitals and residential facilities. We wanted to include schools in this legislation, but were unable to do so. Sadly, the need could not have been greater. Over the past year, reports from the National Disability Rights Network, NDRN, the Alliance to Prevent Restraint, Aversive Interventions, and Seclusion, APRAIS, the Council of Parent Attorneys and Advocates, Inc., COPAA, and the Government Accountability Office, GAO, have painted a picture disturbingly similar to the one the Hartford Courant discovered more than a decade ago. The statistics are chilling--hundreds of incidents of physical injury, psychological trauma, even death--but the stories are devastating. Here are some of the examples the GAO found in their report released on May 19, 2009. A 14-year-old boy was restrained face-down by a teacher because he would not stay seated in class. The 230 lb. teacher sat on the 129 lb. boy, restricting his airflow and resulting in the boy's death. A 4-year-old girl with cerebral palsy and autism was restrained in a wooden chair with leather straps for being ``uncooperative.'' In one school district, children with disabilities as young as 6 years old were allegedly placed in strangleholds, restrained for extended periods of time, confined to dark rooms, tethered to ropes, and prevented from using the restroom until they urinated on themselves. To be clear, school personnel mean no harm, and my concern signifies no disrespect for the difficult job they do or the dangers they sometimes face. But these tragic stories reflect inadequate training, and a lack of resources on the local level to implement effective interventions, such as school-wide positive behavioral supports. Just as students have a right to learn in a safe environment, educators have a right to work in a safe environment. They should be provided with training and support to prevent injury to themselves and others. In some States, like Connecticut, parents have successfully advocated for laws that provide these resources, as well as guidelines to ensure that they are used effectively. But the patchwork of State laws and regulations is confusing. According to the GAO study, 19 States have no law or regulations concerning restraint and seclusion in schools. Some laws apply to only certain schools or situations. Some apply to restraint but not seclusion. Only 19 States require parental notification. Only 17 States require staff training. Only 8 specifically prohibit restraints that restrict air flow. Furthermore, this patchwork is obviously inadequate; according to a report by COPPA, over 71 percent of the 185 incidents they identified occurred in schools with no positive behavioral interventions or supports. Therefore, I rise today to introduce the Preventing Harmful Restraint and Seclusion in Schools Act, a bill that will address this void. It will establish clear minimum standards for the use of restraint and seclusion in schools, closely based on the Children's Health Act of 2000. It will also provide resources to assist with policy implementation and provide school personnel with necessary tools, training, and support. Finally, it will improve data collection, analysis, and identification of effective practices to prevent and reduce restraint and seclusion in schools, so we may better understand the scope of the problem and the effectiveness of our solutions. Specifically, the legislation will prohibit the use of restraint and seclusion in schools unless the student's behavior imposes an immediate danger of physical injury and less restrictive interventions would be ineffective. It will prohibit the use of mechanical, chemical, and physical restraints that restrict air flow to the lungs. It will require adequate training and state certification of school personnel imposing restraint or seclusion, immediate parental notification when such an incident occurs, and debriefing to prevent future incidents. As a condition of receiving federal education funding, states will be required to submit annual plans to the Secretary of Education which describe their restraint and seclusion policies, and certify that minimum standards are being met. States will also be required to report annually the total number of incidents of restraint and seclusion, disaggregated by demographic and other categories. In order to assist States, local educational agencies, and schools with implementing policies and procedures to meet the minimum standards, competitive grants will be provided. Grants will also assist with the implementation of school-wide positive behavioral supports to further prevent incidents of restraint and seclusion. Finally, the Department of Education will conduct, and provide to Congress, a national assessment which analyzes data on restraint and seclusion and effective practices in preventing and reducing incidents. This will provide us with a more accurate picture of the extent of restraint and seclusion in schools and help direct additional future efforts to ensure that our children and those who educate them are safe. I want to thank the many organizations representing individuals with disabilities, students, teachers, and schools that all came to the table with recommendations. I am also grateful to Secretary Duncan for his leadership on this issue. Finally, I want to thank my colleague and good friend Chairman George Miller in the House of Representatives. Today, he's introducing companion legislation, and I look forward to working with him to make it law. Every child has a right to be safe in the place where they go to learn and grow. Every educator deserves the training and support they need to do their jobs safely and effectively. This legislation will help to prevent tragedies in our schools. I am proud to introduce it today, and I urge my colleagues to join me.

Mr. DODD

Mr. DODD. Mr. President, I will be very brief because we want to take the time to hear from our colleagues. I, too, want to commend them. A number of them serve on the Health, Education, Labor, and Pensions Committee and were tremendously valuable in helping us craft the legislation we now have before us in this compromised, melded bill. I also want to make a note. I listened to the Republican leader this morning--and I will talk more about this later--but you would almost begin to believe that 300 days ago Barack Obama arrived as President of the United States, and all these problems emerged miraculously. The fact is, in the previous 8 years we watched the Nation accumulate more debt in one administration than all prior 43 administrations combined. The situation we find ourselves in economically did not happen overnight. It happened over a number of years of carelessness, with a lack of regulation and a lack of the enforcement of the regulation that existed. We have been grappling with these problems. In December of last year, more than 700,000 people lost their jobs--in that 1 month alone. In January, almost 700,000 again, and the same was true in March. Almost 3 million jobs were lost before the ink on the inauguration papers was dry. We are now finding ourselves--while still too high an unemployment rate--with a vastly improved economic condition in this country. Much more needs to be done. Yet we hear the same sort of ``Chicken Little'' arguments. Just say no, every time, to an idea that might make a difference to this country getting back on its feet again. Certainly the decisions made a year ago to provide the stabilization of major financial institutions contributed directly to the benefits we are seeing today. Certainly the efforts of taking some of these resources that have gone to bail out major financial institutions now being used to try to create jobs in the country is something I think would be welcomed by the American people--not rejected by Members of Congress who seem only to be interested in whether we are going to take care of those large firms that got us into this mess in the first place. So I welcome the President's ideas in this area. We welcome particularly this effort on health care, to make a difference not only for individuals but for our economy, to reduce those costs, reduce those premiums, and make those insurance products available to all Americans who worry every night about whether they are going to fall into that abyss because of a health care crisis that happens to a family member or a loved one. So today we are going to hear from a number of our colleagues who have been deeply engaged in these issues over the last several years and in their new membership in this wonderful body of the Senate. I welcome tremendously their efforts. Mr. President, I yield the floor to allow them to discuss their ideas. I believe the first one to speak is our new colleague from Delaware.

Mr. DODD. Madam President, quickly, because I know my colleagues are here on the other side, I want to commend 10 of the 11 new freshmen who are here and who have spoken with great eloquence and passion about this issue. I think all of us, regardless of which side of the aisle we are on, owe them all a great deal of gratitude for putting together a very fine package. I particularly thank Senator Mark Warner, our colleague from Virginia, who has led this effort, but obviously so much of this has happened because of the cooperation and ideas that each Member who has spoken here this morning has brought to this particular cluster of ideas on cost containment. All Americans owe them a deep debt of gratitude and can feel pretty good about the future of our country with this fine group of Americans leading it.

Mr. DODD

Mr. DODD. Mr. President, I commend my colleague from Illinois, the Democratic whip of the Senate, for his arguments. He speaks for me when he identifies the pillars of our views on this issue. I was elected to the House of Representatives in 1974, 2 years after Roe v. Wade, and I have been in Congress now for 35 years. We have lived with those guidelines since then. I know it has not resolved the matter for many people. But it has served us well. What we have in this bill is a reflection of a continuation of those pillars. Having been the acting chair of the Health, Education, Labor, and Pensions Committee during the markup of the bill--in fact, Senator Kennedy voted by proxy, as they call it in that process--we insisted upon the adoption of a Kennedy amendment that maintained the notion of conscience in these matters. So we would not be forcing individuals to engage in abortion practices if they felt otherwise. We have long held the view in this Congress, under Democratic and Republican leadership, despite the differences--others have different views on this matter--that clearly public money should not be used. Despite the arguments to the contrary, we have done that again with this bill. The Senator from Illinois made a point about the measures in the bill that deal with wellness and reproductive rights. We minimize the likelihood of there being a demand for abortion on the part of many. I appreciate the fact that our leadership has made this matter, the Nelson-Hatch amendment, a matter of conscience. There is no caucus position on this amendment. There never has been and nor should there be, in my view, given the nature of this debate. I want to mention another argument we fail to understand here, in addition to the eloquent ones made by the Senator from Illinois. We rank 29th in infant mortality in the United States. It is an incredible statistic when you consider the wealth of our Nation. I worked on legislation with our colleague, Lamar Alexander, on infant births, prescreening, trying to provide resources and help for families with infants who suffer these debilitative and fatal problems. This legislation takes a major step forward in taking the United States out of the basement when it comes to infant mortality and gets us back to where we ought to be in reducing the tragedy that occurs in infant mortality. There is a distinction, clearly, between abortion and infant mortality. But this legislation takes a major step in improving quality of life, assisting children who arrive prematurely, as many do in our country today, and many do not survive that prematurity. Today many women are not getting the kind of support they need during their pregnancy, thus increasing the likelihood of premature births occurring, or not getting the screenings that need to occur immediately so you can avoid the terrible problems that can ensue thereafter. This legislation takes a major step in that direction. While we have done what is necessary for us to do, that is, protect the longstanding distinction between public and private dollars when it comes to abortion, we also have gone so much further. This bill provides support for families when it comes to minimizing the likelihood a child will be lost because they are not getting support services, as well as providing the reproductive services that will assist women during their pregnancies. My colleagues know I am a late bloomer. I am a parent of a 4-year-old and an 8-year-old. My colleagues talk about being grandparents. I always said I was the only candidate in the country who used to get mail from AARP and diaper services at the same time, having qualified for Medicare and also being a parent of infant children, two little girls, Grace and Christina. I want them to grow up having all the rights of young women in this country. I am hopeful that one day I may even be around to be a grandparent. We fought very hard to make sure those children were going to get the protections they could during my wife's pregnancies, to see to it they would be born healthy and sound. I have a great health care plan, as a Federal employee, to make sure that will happen. I want every American to have that same sense of security when that blessing occurs with the arrival of a child or grandchild. This bill does that. For all of those reasons, this amendment ought to be defeated. This bill ought to be supported and achieve a great success for our fellow citizens. I yield the floor.

Mr. DODD

Mr. DODD. Will my colleague yield?

Mr. DODD. No, no, but I certainly like these moments where we engage a little bit.

Mr. DODD. Be careful about that. The last thing you want to have is a debate here. We used to have them. It doesn't happen often enough these days. A couple of points you made can't be reinforced enough. One of the great worries, obviously, is the cost issue. I think everyone agrees this is the great nightmare we have, the growing problem of cost--the premium costs. Again, we either love or hate CBO depending on what numbers they come back to us with. I have been on both sides of those emotions when dealing with CBO, but we have come to recognize and accept the fact--I think collectively here--that we rely on them. This is not Mount Olympus, not to say they are 100 percent right on every occasion. But I was going over the numbers, and I wondered if my colleague from Illinois--I know he is aware of these, but I may be wrong on some of this. If you take the individual market in the country, there are 32 million people under CBO's analysis that are in the individual market. They would pay, according to CBO, 14 to 20 percent less in premiums of an equivalent plan than under the status quo. In the small group market, there are 25 million people, according to CBO, who fall into the small business market--the small group market, and the ones who are eligible for tax credits would pay 8 to 11 percent less in premiums than for an equivalent plan under the status quo. If you work for small business and don't qualify for the tax credit, your premiums would be about 2 or 3 percent lower. So you go from 8 to 11 percent to 2 or 3. And, lastly, where most people are--where five out of every six people work, in the large group market--people who work for large employers-- roughly 134 million people, according to CBO--would see lower premiums up to 3 percent than what they pay under the status quo. That, to me, goes to the heart of this. Obviously, getting down and reducing our budget deficit by $130 billion, $150 billion the second decade, is terribly important. But if I am sitting out there as a consumer and I want to know one thing more than anything else--how is this going to affect me; am I going to be paying more or less--as the Senator points out, we are now looking at the year 2000 in Connecticut where a family of four paid between $6,000 and $7,000 for health care and they are now paying $12,000, the same family, and in the next 7 years they will go to 24,000, and some predict within 10 years going to 35,000. Those are staggering increases. Compare that, if you will, with what we are being told, even if these numbers are off a little bit, and they may well be one way or the other. But assume for the sake of debate they are not off quite that much; they may almost be flat, the cost; not actually a reduction in premiums. I can't understand why people wouldn't embrace this in a wholehearted fashion and say this is a great achievement. No one has been able to improve these numbers. Am I wrong about some of these numbers, or are those your calculations as well?

Mr. DODD. One other statistic that again jumps off the page at you, and I went back to my staff and said: Are you sure these numbers are right? I am told they are correct. For people who receive tax credits-- and many do under our proposal here--the premium savings, on average, are 56 to 59 percent lower relative to the current individual market premiums--56 to 59 percent lower. That is an incredible achievement in a piece of legislation designed to deal with cost--how do you get costs down? And of course the added elements of this--which again CBO doesn't calculate in showing reductions in premiums--include catastrophic options available to young adults, reinsurance provisions, which would reduce premiums even further. None of those calculations were actually calibrated by CBO in arriving at their conclusion. So, actually, I think these numbers turn out to be far better than the ones we have just talked about.

Mr. DODD. If I could get a last minute on the floor, Mr. President, I commend Senator Mark Pryor, our colleague from Arkansas, whose amendment we will vote on shortly. I commend him for his work. This is a very worthwhile amendment he is offering, and gives individuals and small businesses better and more consistent information about insurance plans that would be sold in the exchange. All of us in this Chamber, and every Federal employee, gets one of these. This is a little booklet. What it says is: ``Guide to Federal Benefits.'' I think I get some 15 or 20 options this year. I get options--take a look. I can open this book to various pages, and there is a comparative analysis of consumer reactions to the various plans over the last year or so, what they thought of them, how well they worked. There is nothing similar to this. We put language in our bill out of the HELP Committee to try to put this in common language people can understand, getting away from the small print, telling people what exactly will be the benefits under their plan, or the disadvantages, to some degree. The Pryor amendment includes this kind of provision in the bill and strengthens it tremendously. I commend Senator Pryor of Arkansas for including a provision in this bill that will provide greater clarity and greater understanding, the same kind of clarity we get under the Federal Employees Health Benefits package that allows us to make that very simple. You don't have to have a Ph.D. in economics to understand this. You can go right through and they list it quickly, if it is only yourself, yourself and your family, what it is like in Delaware, the District of Columbia, Florida, Georgia, every State. It is a very simple, very clear understanding of how this works. One of the complaints all of us get all the time, this is complicated. No matter how sophisticated you may think you are, trying to sort out what is the best plan for you--and I say this candidly, the insurance industry isn't always as forthcoming in letting you know what the disadvantages are as they are marketing their various plans to people. So the Pryor amendment, I think, will go a long way toward providing that kind of clarity and understanding that all Americans want. I urge my colleagues to support the Pryor amendment when that issue comes up for a vote. I see the time is 3. I inquire and see I have gone over a little bit past 3 o'clock. I apologize to my colleague.

Mr. DODD

Mr. DODD. How much time remains?

Mr. DODD. I thank my colleagues. Mr. President, some of these numbers get thrown around so much that it is almost dizzying. I wonder how the average person, even someone who is intently listening to these debates, can sort it all out: 47 million who have no coverage; 14,000 people every single day in our country who lose health care coverage either because they are thrown into personal bankruptcy or because of medical costs or job loss around the country--14,000 a day, every day, 7 days a week. Just do the math. For 7 or 8 days, we have been debating this legislation. You can run the numbers yourself to determine over that period of time how many citizens across the country have found themselves in that free fall, that dreaded fear that a child or a loved one may end up needing care. It is not as though you can postpone the decision to some later time, as you can about whether to take a vacation or to buy that new car or maybe to spend more than you thought you would over the holidays coming up. If you now have a medical emergency and you are one of those 14,000 a day who have lost coverage, what do you do? So sometimes the sheer magnitude of these numbers can cause us to lose sight of the individual stories, anecdotes that are not exclusive or isolated but commonplace stories that are happening as we speak here on this Sunday, on a rare Sunday session in the Senate because of the importance of this issue. So I rise today to share a few stories from my own State that I think put a face on these issues and why we are here. Let me start by asking some questions because I think too often when we debate these issues, sometimes we are so removed as Members of this body, from what goes on in the daily lives of the people we represent that we fail to appreciate what is happening right outside these doors from this very Chamber on a daily and an hourly occasion. The 535 of us who have the privilege of serving in the Congress, including Members of the other body, none of us here are worrying about losing our health care. Not a single Member here ever spent a nanosecond worrying about whether they are going to be dropped from their health care coverage--not one. Is there anybody among the 535 of us who ever worries about whether we will be able to afford health care insurance? I don't know of anyone who ever worries about that, of the 535 who are here. Has anyone ever been up late at night with a child or a loved one, wondering whether they are going to be able to afford the treatment that child may need, or that loved one? I would go so far as to say I don't think that happens here. God forbid if we are confronted with a child or a loved one who needs that care. We may worry about that, but we are not going to worry about whether the insurance will be there or whether we will have the ability to pay for it. Not one of us ever worries about that. Has anybody ever spent hours being bounced from voice mail to voice mail to voice mail trying to find out why the insurance company you pay thousands of dollars to every year suddenly refuses to pay for your spouse's cancer treatments? Has that ever happened to anyone here? I doubt it. I sincerely doubt it. Is there anyone stuck in a job that pays very little because you can't afford to change jobs because you have a preexisting condition and you know if you go to that new job that may pay more, you are going to find yourself without the insurance coverage to take care of that preexisting condition? No one here worries about being in that particular predicament. Has anyone been driven into bankruptcy, any Members of Congress, because they had a medical crisis? We now know that 62 percent of all bankruptcies this year alone are medical crisis related, and 70 percent of that 62 percent have health care insurance--70 percent of that 62 percent. Is anybody here a small business owner who has had to choose between cutting coverage or putting your employees out of work? Well, the answer to all of these questions obviously is a resounding no. None of us have ever had to grapple with what 14,000 people do in this country every day: losing their coverage, or the underinsured who discover all of a sudden that the coverage they thought they had doesn't quite cover the problems, or the out-of-pocket expenses you have to pay before getting to insurance are so high that you can't possibly meet them. That goes on every minute of every day all across our Nation, and it is why we are here on this Sunday in December, to try to finally see if we cannot come to terms and start moving on a coverage program, a health care and health insurance coverage program that makes it possible for all of our fellow citizens to be in the same position we are. None of us are immune from health care crises. Every one of us here has grappled with that at one time or another. The difference is, we don't ever worry about the ability to pay for it, losing our coverage, having to go through what every other citizen does every single day. These are real people who go through this. We can get so lost in the weeds on this debate. I am not suggesting the details are unimportant-- they are important--but we are losing sight of the whole; that is, for 80 years every single Congress, whether it has been controlled by Republicans or Democrats, whether a Democrat or Republican has been in the White House, has been unable to even come close to solving this problem. We are now that close--closer than we have ever been in our history-- to coming up with a health care system that can begin to take care of that basic right every American ought to have--and it is a right--that if you are a citizen of the United States and you get sick, you ought not to be shoved into bankruptcy, lose your job, or have your family suffer because of your economic circumstances. The privilege of getting good health care ought not to be based on wealth; it ought to be based on the fact that we live in the United States of America and we are able to take care of our fellow citizens when they reach those difficult times every one of us will at one point or another. There are stories, and I know my colleagues have them as well. A young woman in Connecticut, Maria, diagnosed with non-Hodgkins lymphoma, asked her insurance company to cover her treatments. The insurance company found out that Maria had once gone to a doctor for what she thought was a pinched nerve. Even though no tests had been done for cancer, they denied her claim based on a preexisting condition. How many have heard these stories? She passed away, by the way, from that illness. A young man named Frank disclosed on his insurance application that he sometimes got headaches. Some months after he got his policy, he went in for a routine eye exam. The doctor saw something he didn't like and sent him to a neurologist, who told him that he had multiple sclerosis. The insurance company told him he should have known his occasional headaches were a sign of MS and took away his coverage retroactively. Frank's doctor wrote them a letter saying there was no way anyone could have known that an ordinary headache was related to multiple sclerosis. But the insurance left Frank out to dry, sticking him with a $30,000 medical bill he couldn't afford. Frank's condition got worse. He had to leave his job and go on public assistance. Kevin Galvin is a small business owner in my State. I have met with Kevin a number of times, and we have talked over the last year or so during my Connecticut Prescriptions for Change listening tour. Kevin owns a small business, a maintenance company. He employs seven people, some older, some younger. He can't afford to insure them. He would like to, but he can't afford it. His younger employees use the emergency room as their regular doctor. If one of them has a child with an ear infection----

Mr. DODD. I ask unanimous consent for 1 additional minute, I ask my colleagues.

Mr. DODD. I thank my colleagues. Kevin has three employees in their twenties and thirties. This is Kevin here, by the way, running this maintenance shop in Hartford, CT. He has employees in their twenties and thirties who have never had a physical or a dental cleaning by a hygienist. One of them, age 28, with two children to support, was out of work for 12 weeks and nearly died from a staph infection he got from an untreated cavity. Kevin has been working hard to try to provide for these people, but he has recently lost people who worked for him for more than 20 years because they got a job that paid less than he pays them but they can get health insurance coverage. So here is an employee who leaves a job in order to get a job where he can have health insurance. Again, small business owners who go through this are all across our country. My simple point is this: Anyone who suggests this bill is the end-all obviously hasn't been through this process over the last several years. There will be a lot more work that needs to be done in the years to come. But we need to do what no other Congress has done before: We need to start. That is why I feel so passionately about getting this bill passed and moving it forward. I ask my colleagues to join us. I yield the floor.

Mr. DODD

Mr. DODD. Mr. President, before he leaves the floor, I wish to thank our new colleague from Pennsylvania. From the moment he arrived here, he has raised the profile of this issue involving children and families. As someone who has been involved, myself, for a long time chairing the Subcommittee on Children and Families, and with the help of the Presiding Officer and others, we did the Family and Medical Leave Act back some 17 years ago; the childcare legislation almost 25 years ago, dealing with infant screening, premature births, autism--a whole host of other issues. I wish to thank him for bringing what has been a tireless effort since he has arrived in this Chamber, adding yet another voice, another strong voice, on behalf of children in our country. Jay Rockefeller, our colleague from West Virginia, has been a stalwart for years on these issues as well. I know Sherrod Brown of Ohio is also working very hard on these issues, and I wish to commend him. So I wish to say thank you to my colleague from Pennsylvania. The points that he raises are good ones. I know our time has expired, and I apologize for interfering with our other colleagues' time, but I wish to thank him for his efforts. I cannot think of a more noble cause to be involved in. There will be a lot of debate about this bill, but we must keep in mind that the most innocent in our society, our children, are born into circumstances totally beyond their own control. And there are too many instances where they are suffering from one problem after another. A great country such as this, with great resources and potential, ought to be able to ensure that every child in this country--regardless of the economic circumstances or the physical circumstances they are born into--gets the kind of care that America can be proud of. I say to the Senator, you are a champion of that, and I thank you for it. I yield the floor. I66F

Mr. DODD. Mr. President, I would like to yield my 3\1/2\ minutes to my distinguished friend from Kentucky and my friend from Arizona and my friend from Utah and my friend from Florida and my friend from Wyoming as well--3\1/2\ minutes for all of them.

Mr. DODD

Mr. DODD. Mr. President, let me, first of all, commend our colleague from Michigan, who is a member of the Finance Committee and has been a stalwart defender of the traditional Medicare Program and of our elderly not only in her State but around the country. She has offered, I think, some very cogent and worthwhile information this morning once again on this subject matter. We keep going around and around in this debate. It is a little frustrating because we are talking about basically whether we are going to limit to some degree the profits of some private insurance companies that are under the rubric of something called Medicare Advantage. Again, these are private companies that are receiving subsidies, supported by Medicare beneficiaries and the taxpayers of this country. We are not talking about eliminating Medicare Advantage but rather--we had a big chart a few minutes ago. We will get it in a few minutes. It shows we are not eliminating the program, we are restraining profit growth in the program. We are rewarding Medicare Advantage in the bill, as the chairman pointed out. Based on performance and quality, we actually give bonuses in Medicare Advantage--contrary to the arguments you have heard by those who are heralding Medicare Advantage, despite the fact that the very companies who argued for it to begin with, promised they were going to prove how they could reduce costs and be more efficient. In fact, today, it is quite the opposite. Right now the government pays these Medicare Advantage insurance companies $1.14 to do the same thing for seniors that Medicare does for $1. That is basically, on average, what it amounts to. The question is, can we reduce the cost of the overpayments, which are basically ending up in the pockets of insurance companies? There is nothing wrong with profits in private companies, but let's declare them what they are. This is not traditional Medicare. They are private companies that are anxious not only, I presume, to provide benefits to their beneficiaries, but they are also looking to make a profit. There is nothing wrong with that, but since the premiums were set by statute, and we have an obligation to try to keep our costs down, we are trying to do so because the promises that were made have not been kept. The costs are vastly exceeding the promises made. The amendment we are going to hear about from our friends on the other side is nothing more than a recycled compilation of some of the ``greatest hits'' we have heard: stalling with arcane obstruction tactics, while standing up for some of the private companies--and I have no objection to standing up for private companies that do a good job, but when you do so at the expense of scaring seniors with baseless claims, then I do object. That is what is going on here because, quite frankly, today almost 80 percent of our elderly are paying $90 a year in additional premium costs, without getting any benefit from it whatsoever, to provide benefits under the Medicare Advantage Program. That is not equitable. The 80 percent of our elderly need to know that they are being disadvantaged by this. What the Finance Committee, under the leadership of Max Baucus, is trying to do is bring some equity back into this. He pointed out--and it deserves being repeated--that nothing in the bill does away with Medicare Advantage. We are trying to get it back to a sense of reality and not, again, disadvantage 80 percent of our seniors. Right now, there is Medicare ``disadvantage''--that is what it ought to be called, because that is what it does--disadvantages. Why should 80 percent of the elderly in this country pay higher premiums, with no benefits, at the expense of the 20 percent who are going to get some small advantage under this--but very little, because most of it ends up in profits. I will tell you why that happens in a minute. To make my point, according to the Oppenheimer Capital analyst Carl McDonald, in a report issued a month ago: Between 2006 and 2009, we estimate that Medicare Advantage accounted for nearly 75 percent of the increase in gross profits among the larger plans in the industry, highlighted by an estimated gross profit increase of $1.9 billion in 2009, relative to commercial risk earnings gains of nearly $600 million. I know the chairman of the Finance Committee made that point. Seventy-five percent of the increase in gross profits came from the Medicare Advantage plans. These profits come out of the pockets of the American taxpayer because of the subsidies and, of course, the Medicare beneficiaries who are paying those extra dollars every year, without receiving any of the benefits at all. Our bill will protect and strengthen Medicare and extend the life of the trust fund, as you have heard over and over again. That is not a fact to dispute. That is a fact. We extend the life of the Medicare Program. Part of the way our bill adds to the use of Medicare is to eliminate wasteful overpayments. These are overpayments far beyond what was anticipated when the program was written. As I mentioned a moment ago, the government pays insurance companies in the Medicare Advantage Program $1.14 to do the very same things for seniors that traditional Medicare does for $1. So those are the overpayments we are trying to rein in. There is no evidence these wasteful overpayments do anything to improve the care of our seniors. At the same time, they speed Medicare's descent into bankruptcy and raise premiums for all Medicare beneficiaries. Our bill would end that waste and use the money we save to help seniors pay for prescription drugs by closing the doughnut hole. For the second time in less than a week, our friends on the other side are using these tactics to halt progress completely, fighting for these profits and overpayments that, again, come out of the hide of taxpayers and our elderly. If you look at this chart, if you extend to 2019, almost 10 years from now, what is the difference between what our bill does and what those who want no change do? The difference is $20 billion. In the post-reform period, in 2019, it is $183 billion going to Medicare Advantage. What the opposition wants is to hold it at $204 billion in 2019. That is $20 billion. That is the savings we are looking for in order to reduce overpayments and provide those resources to the elderly so they can afford prescription drugs. If you want to side with these companies--they are still going to make a profit. This will not deprive them of that. The profit margins will be far more realistic and it will reduce subsidies, as well as overpayments being made by the elderly who receive nothing from this program at all. Let me make my case on this point. Senator Stabenow listed the guaranteed benefits under Medicare. The chairman did it as well. Also, we add benefits as a result of our bill. In addition to the inpatient hospital care, doctor office visits, lab tests, kidney dialysis, emergency care, occupational therapy, organ transplants--all of these issues--we also do things in our bill that are not available presently. We reduce the size of the Medicare doughnut hole. That is an added benefit that does not exist today. We reduce premiums to pay for drugs and medical care. We eliminate the copays. What an advantage that is here. Ask yourself whether you would like to eliminate copays or watch private companies make an additional $20 billion in 10 years. Which is the better choice? Ask the overwhelming majority of seniors which they would rather have--an elimination of the copays they are paying today, or continue to provide excess profits for the companies here that have made so much under the Medicare Advantage Program. Lastly, of course, and most important, we help keep Medicare solvent. People say: Give me some examples on why the differences exist between Medicare and Medicare Advantage. I have a couple of examples from my home State that I think highlight the point. These come from the Center for Medicare Advocacy, or CMA, which is a nonprofit organization, as my colleagues know, that does casework on behalf of individuals who need assistance dealing with Medicare Advantage plans. They provided two cases from my State. I presume most of my colleagues could find cases in their own States. A woman living in Madison, CT, a shoreline community in Connecticut, had Lou Gehrig's disease, ALS. We are all familiar with ALS. We know the stories people go through with that disease. She was in a Medicare Advantage plan. She was denied coverage for home health care because she was said to be ``stable.'' That was the quote, ``she was stable.'' That is not a valid reason for denial, and she was hardly stable with ALS. CMA, the Center for Medicare Advocacy, had to go to Federal court to get her care covered despite firm written support regarding her medical condition from her doctors. Here is a woman under Medicare Advantage with ALS being declared by Medicare Advantage ``she was stable.'' Her doctors said anything but the case. When my friends talk about rationing of care under the present system, here is Medicare Advantage, a private firm, making a medical decision that should have been made between her and her doctor. They eventually got it overturned, but they had to go to Federal court to get it overturned. That would not have happened under Medicare. If she had been under Medicare, she would have gotten that help, no questions asked. When people say there is no distinction, this is a live case. Let me give the second one. A woman from Vernon, CT, and her husband traveled to Florida to visit their daughter living there. When she got to Florida, she fell down and sustained some physical injuries. While being treated at a Florida hospital for her injuries, it was discovered that she had a brain tumor, the reason she had the fall. She had no idea of this beforehand. The Medicare Advantage plan covered treatment for the fall as an emergency--which Medicare Advantage plans must cover, even out of network, by the way--but not any diagnosis or treatment for the brain tumor. The woman had another daughter who was a nurse who lived in Utah. So they traveled from Florida to Utah where she went for the cancer treatment for the brain tumor. While undergoing chemotherapy, this woman had a life-threatening reaction to one of the medications from which she almost died. The Medicare Advantage plan denied coverage for all of this care because it was out of network. She was in Utah. They said no, leaving the client and her husband with $100,000 in bills. Again, the Center for Medicare Advocacy went to court and battled against this decision. They were successful in recovering $90,000 out of the $100,000. This woman is now deceased, but she and her family were left with over $10,000 in bills, all of which would have been covered under traditional Medicare, but she had gone into a Medicare Advantage plan. In both instances, they would have avoided having to go to Federal court, having to fight as hard as they did, going through the trauma and turmoil. It is bad enough you have to wrestle with cancer or wrestle with a brain tumor, but then you get saddled with $100,000 in bills and Medicare would have taken care of them. This Medicare Advantage Program disadvantaged her in the process. These are examples of how private Medicare Advantage does not always operate in good faith. They are not always there when you need them. There are significant differences between Medicare Advantage and Medicare. With traditional Medicare, you know what services you get. I ask unanimous consent to have printed in the Record a list of services so people can read about it, if people have not already done that.

Mr. DODD. Mr. President, all medically necessary hospital care and doctor office visits are covered under Medicare. You know you can get these services from any Medicare provider anywhere in the country. Out of network you get this kind of help, whether you are in Utah, Florida, or Vernon, CT, where one woman was from. Medicare would have provided that care. Here she was bouncing around the country and denied one place after another under Medicare Advantage. With traditional Medicare, she would not have had to worry about a private insurance plan playing games with her coverage. The Medicare Advantage plans run the show. They change the benefits. Cost sharing goes on. This is why Medicare Advantage is not like traditional Medicare. So when people say it is just like Medicare, no, it is not just like Medicare. If you doubt me, then call that family in Madison, CT, or call that woman's family from Vernon, CT. Ask them whether Medicare Advantage is just like Medicare. You will get an earful from them on what they went through. We should be clear that we are not eliminating Medicare Advantage. Again, I appreciate Senator Baucus making this point. It needs to be made over and over again. We are not eliminating it at all. We are reducing payments to private plans and making the system work more uniformly. We actually give bonus payments for care coordination and quality improvements. These plans can use those payments to improve benefits for beneficiaries. So we are hardly eliminating it. We are making it work better. I have serious reservations about how this plan operates, I will say that, but I would not advocate on the floor of the Senate the elimination of Medicare Advantage. I do want to make it work better, and I do want to cut back when we have overpayments occurring. I don't think it is fair that 80 percent of the seniors in my State or elsewhere are paying $90 a year extra to cover this program and get none of the help from it and people under Medicare Advantage, who could have been protected, are not because they opted to be in that plan and then found out it is anything but what they thought it was. We are going to hear these arguments over and over about Medicare Advantage. A little truth in advertising is necessary here. So people understand, it is not Medicare and it is not an advantage, not under the present system, not at all. That is what we have been trying to say over and over again here so people understand. This is a good bill. This is a solid bill. This took a tremendous amount of work in the Finance Committee, which had the responsibility of crafting these provisions which are highly complicated and very delicate in what they do. What we have done is preserve and strengthen our Medicare system, expanding benefits for people, eliminating copays, allowing those preventive and screening services to be available to our elderly, seeing to it they will have prescription drugs at lower costs. That is all in this bill. That is a great advantage. What a tragedy it would be if in these next few days, after all the debate, that we lose all the work that has been done to make these improvements in our health care system. I commend my colleague from Montana and my colleagues on the committee who worked so hard to put this bill together, this balance together that can make a great difference in people's lives. I also thank our colleague from Rhode Island for offering his amendment, which we are going to be considering at some point when we get to vote occasionally on some matters here. I hope at some point we get to do that. We have done it a couple of times. There has been over a year of debate and discussion. I think the American people want to see some action. We think we have a good bill. It is going to take on important market insurance reforms that ensure Americans can get access to health care promised by their insurance plans. It is going to make sure if someone loses his or her job, they can get insurance. It is going to improve the quality of health care and focus our system more on prevention and wellness. On top of all these things, it is going to reduce the deficit. As we have heard over and over again, CBO is talking about saving $130 billion in the first 10 years and $650 billion in the second. I have to say something. The other day we got the news that CBO said the premiums on the individual plans, the small business plans and the large business plans, are actually going to reduce premiums costs by as much as 20 percent in one area, and 3 percent in another. I would have thought there would be wild applause. Even those who oppose the bill would have said: Isn't this great news? What we got was almost a deep disappointment that CBO gave us a report that people are actually going to save money under this bill. All of a sudden they attack CBO because they did not like the results coming out of CBO. I guarantee had they come back and said they are going to increase premiums, we all would be talking about that. Here we get a report that actually we are going to save premium costs, reduce the costs to the Federal budget as has been pointed out. Senator Whitehouse is going to offer an amendment that makes clear these savings we are talking about are used to strengthen Social Security, reduce the deficit, and contribute to the long-term solvency of the CLASS Act, that it will be for that purpose and that purpose alone. The third part of his amendment is particularly important. Many of our colleagues have come to the floor in the last few days to claim the CLASS Act will be a long-term drain on the budget. It is not true. Thanks to our colleague from New Hampshire, Senator Gregg, the CLASS Act will be required by law to be solvent for 75 years. This was not in our original proposal. It was added in the HELP Committee markup by Senator Gregg, and I thank him for it. The Gregg amendment was unanimously adopted in our markup. CBO says it produces $72 billion in savings for the Federal Government over the first 10 years of its existence and it will save nearly $2 billion for Medicaid. We further added language to the bill to require the Secretary to maintain enough reserves after the first 10 years to pay off any claims that may emerge. We have included language to prevent Federal appropriations from being used to pay benefits to ensure the program is self-funded. Finally, at the request of several Senators, the distinguished majority leader made sure we did not use any of the savings in the CLASS Act for any other purpose than to pay for the CLASS Act itself. This amendment offered by Senator Whitehouse will give Senators a chance to commit themselves to that purpose. Senators who claim the CLASS Act will hurt the Federal budget, of course, should vote for this amendment because statutorily it will prohibit any of those funds from being used for any other purpose other than for the CLASS Act and the recipients who want to use them. I commend him for that move and thank him. When that vote occurs, I urge colleagues to vote for the Whitehouse amendment. Lastly, I ask unanimous consent to be included as a cosponsor, along with my colleague from Maryland, Senator Mikulski, of Senator Coburn's amendment No. 2789 which adds Members of Congress to the public option.

Mr. DODD. Mr. President, we added that provision to the HELP Committee bill. Senator Coburn offered that amendment. Senator Kennedy, myself, and others voted for that Coburn amendment. I think it may have shocked the Senator from Oklahoma at the time that we actually voted for his amendment. I know Senator Brown has been added as a cosponsor. I have no objection to that amendment. That is how much I think the public option would be worth. If we have a public option in this plan-- and my hope is we will--there is nothing wrong with insisting Members of Congress be included in that public option proposal. His amendment suggests that. We supported it in committee, and I am prepared to support it again on the floor of the Senate. I point out, I wish we could get Members as well who are reluctant to support this bill to recognize that as Members of Congress today, we all have pretty good health care plans under the Federal employees benefits package, some 23 options every year that are available to us, along with the 8 million Federal employees in this country under those plans. I wish we could get others to recognize how valuable that is to all of us and our fellow Federal employees. Unfortunately, that does not seem to be the case. I hope before this is concluded we will have far more support for this effort we have crafted and provided to our colleagues for their consideration. Again I compliment the Finance Committee and my friend from Montana for the work he has done on this issue. It is very well thought out, very balanced and fair. I said this over and over: I challenge any Member to come to the floor and identify a single guaranteed benefit under Medicare that is cut out under this bill. There is not one. Three days have gone by since I made the charge that not a single guaranteed benefit under Medicare is cut. You will not find one; not one. I see my friend from Wyoming has come to the floor. I know I have probably gone over my time. I yield the floor.

Mr. DODD. Mr. President, a few moment ago I started to describe an amendment that will be offered by our colleague from Rhode Island, Senator Whitehouse, regarding the CLASS Act. As a bit of background, the CLASS Act is a proposal that was originally conceived by a former colleague and dear friend, Ted Kennedy of Massachusetts, years ago, the idea behind it being that we ought to try to figure out a way to support people in this country who end up with disabilities. Their disabilities are not so dramatic that they would deprive them of the opportunity to continue with work but serious enough that they would require some additional help in order to provide a basic standard-of-living, either a driver, some help on food assistance, whatever it may be. Under present disability formulas, which are basically income- replacement bills, in order to get some help if you are disabled, you almost have to impoverish yourself to qualify and then be restrained about how much you can actually earn, if you want to continue to work. So while it has been a good program and certainly has helped a lot of people, in a sense there are catch-22s in it, that to qualify for it, you have to divest whatever you have acquired or earned and impoverish yourself. Then, even though you may be capable of continuing to work, you are limited on how much you can actually earn under those programs. It was the vision of Senator Kennedy years ago to try to come up with a different idea, not to replace that but an idea that might allow for people who are disabled to get some help during that period of disability, however long it might last, without necessarily having to then impoverish themselves or to limit their outside earnings, given the fact that they may be able to continue to perform and, in fact, would like to continue to work. The question was, how could we do this, particularly in light of the fact that we don't want to necessarily be adding a cost to taxpayers. It was his idea to come up with a totally voluntary program that individuals would have to contribute to out of their own pocketbooks, not out of taxpayers pocketbooks, by putting aside resources on a monthly basis over a period of years--5 in the case of this bill--where the plan would become vested and then to contribute that amount thereafter. Then, in such case if you found yourself disabled--and there are criteria that would determine whether you met those thresholds--you would then qualify, based on the fact that you have paid your own money into this program continuously, without exception, to receive at least about $75 a day, providing assistance to you so that you might get along and be able to continue to operate without having to impoverish yourself and put limitations on your work. At $75 a day, that would provide over $27,000 a year for those individuals who meet it. Again, entirely voluntary, your money, not public money--no taxpayer money goes into the plan. Five million people under the age of 65 living in the community have long-term care needs, and there are over 70,000 workers with severe disabilities in the Nation today who need daily assistance to maintain their jobs and their independence. Long-term care supports and services are an area that is not currently affordable or accessible for millions of our fellow citizens. It is estimated that 65 percent of all those who are 65 or over today will spend some time at home in need of long- term care services, for which average costs run at least $18,000 a year. Mr. President, 1\1/2\ million people today are in nursing homes, and roughly 9 million of our fellow elderly Americans will need help with activities of daily living during the current year. By the year 2030, that number will increase to 14 million, as we watch the baby boom population age. And while those lives will be extended and hopefully the quality improved, we all accept the notion that as we get older, we have greater needs physically. That certainly is something anyone over the age of 65 can tell you. So as the years progress, the quality of care, longevity tables increase, the number of people who will need some form of services or another will jump from 9 million today to roughly 14 million. Those numbers are apt to increase. Many people who need long-term services and supports rely on unpaid family and friends to provide that care. They have children or grandchildren who are around to provide that kind of assistance. A lot can't, of course. But ultimately many of these individuals have to impoverish themselves to qualify for Medicaid. We know what happens. They transfer the house, their assets. They shove everything over to their children or someplace else so that they qualify for that title XIX window. They become desperately poor, so they can then qualify for Medicaid, which remains the primary payer for these services. The CLASS Act is designed to avoid that, if we can, in as many cases as possible by providing a lifetime cash benefit--voluntary, totally paid for by the beneficiaries--that offers seniors and people with disabilities some protection against the cost of paying for long-term care services and supports and helps them obtain services and supports that will enable them to remain in their homes, reside in their communities, and, in many cases, continue to work. Let me tell you how the program works. The program is a totally voluntary, self-funded insurance program with enrollment for people who are currently employed. Affordable premiums will be paid through payroll deduction, if the individual's employer decides to participate. It is totally voluntary, nothing required whatsoever. If the employer does not want to participate, the employee would have to find some other way. If the employer decides to allow a payroll deduction, they can do that. Participation by workers, again, is entirely voluntary. Self-employed people or those whose employers do not offer the benefit will also be able to join this program through a government payment mechanism. Individuals qualify to receive benefits when they need help with certain activities of daily living and they have paid premiums for at least 5 years and have worked for at least 3 of those 5 years. Beneficiaries receive lifetime cash benefits based on the degree of impairment, expected to average roughly $75 a day or roughly $27,000 a year. Benefits can be used to maintain independence at home or in the community and should be sufficient to cover typical costs of home care services or adult daycare. Benefits can also be used to offset the cost of assisted living and nursing home care. Let me tell you how the improved version of this act protects the taxpayer. There have been issues raised about how they are going to be protected under this program. All CLASS Act benefits are paid by voluntary participants, not taxpayers. The CLASS Act actually would save taxpayer dollars by reducing Medicaid costs--according to CBO, almost $2 billion. CLASS Act premiums must be set at a level sufficient to guarantee actuarial soundness of the program. We thank Senator Gregg for his amendment in the debate on the CLASS Act bill when it came up in committee. The current CLASS Act includes significant improvements over earlier versions, such as tighter eligibility standards, a new reserve requirement, and an absolute prohibition on the use of taxpayer dollars to pay benefits. The Congressional Budget Office determined that the improved program is totally actuarially sound. This bill, the Patient Protection and Affordable Care Act, creates a voluntary insurance program. Under the program, working people pay premiums for at least 5 years before it would vest. After that point, if the individual has paid in for 5 years and worked for at least 3 of those 5 years and develops a disability, they can receive a cash benefit of no less than $50 a day for as long as that disability persists. Contrary to popular belief, Medicare and most private health insurance only pay for long-term care for a short period, meaning that most people pay out of their own income or assets or their family's assets to provide this kind of benefit. Those with the most intense needs will frequently exhaust these assets and have to rely on Medicaid, thus impoverishing themselves in order to qualify. The CLASS Act provides essential options for 65 percent of those age 65 and older who will need long-term care services at some point in their lives and for the 70,000 workers with severe disabilities in the Nation today who need daily assistance to maintain their jobs and their independence. It has been said that this program is not financially stable and amounts to nothing more than a Ponzi scheme. This program, they say, will create a new government entitlement program. It is not a government entitlement program--anything but. The CLASS Act does not confer rights or an obligation on the government funding, nor does it affect receipt of or eligibility for other benefits. The program stands on its own financial feet. CBO has estimated the program to be actuarially sound for the next 75 years. The CLASS Act is solvent, according to the CBO. The program would run only on its own cashflows. CBO estimates an average monthly premium of $123 for an average daily cash benefit of $75 for those who qualify. It may not seem like much, but over a year that would provide needed assistance for those who suffer under disabilities. CBO uses very conservative participation rates. CBO assumes participation rates that do not consider that CLASS would offer a lifetime cash benefit, be endorsed by the government, and provide a convenient way for employees to auto-enroll through their employers with a voluntary opt-out. All of these features would increase participation rates, which will result in lower premiums, encourage enrollment, and make the program even stronger financially. Solvency of the program is bolstered by flexibility to adjust the program. In their November 25 letter to the Congress, the CBO acknowledges that the legislation gives flexibility to the Health and Human Services Secretary to adjust premiums and benefits where or if ever needed. This provides a lever to ensure that the program stays solvent even if real life does not perfectly mirror the models of the CBO, as good as they are. As the Congressional Budget Office discusses, the CLASS Act would function just like any other private long-term care insurance program which finances benefit payments from a premium reserve and interest income off that reserve. Due to budget scorekeeping, the CBO finds that premium revenue exceeds benefit payments in the third decade but does not take into consideration accumulated reserves and income off those reserves that keep the program fiscally independent. Beyond being self-supporting and voluntary, this program can actually generate savings in Medicaid. Direct offset of the $75 daily benefit is applied toward any Medicaid long-term care costs. Beyond that, the CLASS Act program will help people live independently at home or in the community. When people with disabilities get the services they need, they are less likely to spend down to get Medicaid and less likely to enter a nursing home or hospital, all of which generates additional Medicaid savings. Of course, what we don't calculate here, because I don't know how one would calculate it, is that notion of independence. I suspect maybe all of us know people who are on Medicaid and know the frustration particularly of someone who is otherwise healthy but suffers from disabilities who would like to work and wants to keep independent. Yet if you go into the Medicaid Program, there are huge restraints on your ability to do so. So by this program, aside from financially reducing Medicaid costs, we are actually providing that additional sense of human dignity and decency that just because you have a disability and you need help doesn't mean you don't want to be self-sufficient and keep working. There is the gratification of knowing you are contributing in some way other than being shuttered away, having impoverished yourself, relying on others' assets to take care of you because you do not have those resources. Senator Kennedy generated this idea years ago, and now I think it is improved because of the amendments and ideas that have been suggested by a number of our colleagues here, as well as others, and we have actually strengthened the concept to give it the kind of financial independence Members want it to have, sheltering these dollars against being used for other purposes, such as going off to some other program that people may have a great desire to fund by tapping into these resources. We prohibit that from happening. If employers do not want to have a payroll deduction, they do not have to have that. No one is required to join the program. We believe, though, when members of our society and country see the benefits of this, they will gravitate to it as a wonderful way to ensure against that dreaded possibility all of us face; that is, becoming disabled, being unable to work as much as we would like to, needing additional assistance and help, and, of course, having very few places to turn to get it. The disability groups and others that support this, 275 organizations, aging, religious groups, disability organizations across the country--I am not going to read all of them here because 275 names is a lot, but I have here the list of all 275 organizations that have strongly supported this proposal. I cannot think of any finer way to celebrate the memory of our former colleague, who cared so much about this bill we are now engaged in debating, who brought this idea to the table years ago, and who championed it for so many years. Today, we have a chance to include this wonderful concept, this creative, innovative idea. It saves money. It provides independence for people. It gives them a chance to lead good lives. It provides support to their families who otherwise have to bear a lot of that burden. None of us want our children or our grandchildren to have to bear burdens as they are trying to raise their own families. So here is a little idea that has generated support, totally by voluntary contributions. There is no government money involved at all. And it is to give people a chance to live out the remaining time of their lives with decency and dignity, having the sense of making a contribution and making a difference. All of those facts I cannot put a dollar amount on. I cannot tell you what the financial benefit is of someone getting up in the morning, getting a little help but going off to a job and knowing they are needed and have worth and value as a human being. What is the dollar amount on that? I cannot tell you, except I know it has value in our country. Or the alternative? Getting rid of all your assets, impoverishing yourself, relying on your family or friends to take care of you in order to try to survive, when you could be doing more. So I hope my colleagues will support the Whitehouse amendment when it is offered to strengthen this program and that they will resoundingly defeat the effort to cut this program out of the bill altogether. I cannot think of a worse thing we could do with a piece of legislation that is designed to be creative, innovative, reduce costs, and make a difference for millions of our fellow citizens. And a growing number-- as was pointed out, by the year 2030, 14 million Americans in our country, and I suspect more--will be in need of services such as these. I see my colleague and friend from Iowa on the floor, who has been as strong a champion as this Congress has ever had when it comes to the disabled in our country, having been the author of the Americans with Disabilities Act, along with others but nonetheless the principal architect of that effort, and he can speak more eloquently than any other human being I have ever known about why this program is important and what it means. Mr. President, I ask unanimous consent that the list of 275 organizations that strongly endorse and support Senator Kennedy's CLASS Act be printed in the Record.