Al Franken

Mr. FRANKEN

Mr. FRANKEN. In fairness, I am not sure they are all for that. I think I have heard some soundings from the other side to extend what we have this year because this runs out on January 1 and we do not want to see a lot of plugs pulled.

Mr. FRANKEN. I do find that many of my colleagues with whom I am very friendly have not read the bill and are not very familiar with it. I think if you are going to get on your feet and debate and make assertions, you should really be familiar with the content of the bill. That is what I thought. I have only been here a while, so maybe I am naive, but I think when you say none of the benefits are going to start next year, you should be right.

Mr. FRANKEN. Senator Thune did say none of the benefits started next year, but I guess he just hasn't read the bill. I have so many constituents come to me and say: Read the bill, read the bill. I ask-- --

Mr. FRANKEN. We are actually addressing that doughnut hole that was in the Medicare Part D bill. We are closing it by half. Do you know when it starts? Next year.

Mr. FRANKEN. Again, let's think about what these folks, these union folks who negotiated these health care policies and sacrificed in salary--what are they getting? They are getting affordable deductibles. They are getting affordable co-pays. Sometimes, they are getting vision and dental care. This is comprehensive health care we want Americans to get. That is who is going to get hit. Over the last 20, 30 years, we have seen a squeeze on these people. We have seen a squeeze on the middle class, a shift in the risk to people. That is what this whole bill is about. We are trying to eliminate the risk of losing your health care if you have a preexisting condition; we are trying to lose the risk of going bankrupt. That is the whole point of this bill. Let's not shift more risk onto these folks who are doing these kinds of jobs and supporting their families with their salaries and their benefits.

Mr. FRANKEN

Mr. FRANKEN. Madam President, I rise today to speak in support of amendment No. 2795, which would repeal the antitrust exemption for health insurance and medical malpractice insurance. I thank my colleague Chairman Leahy for championing this legislation, which is crucial to health reform and to working families around the country who pay too much in health insurance premiums. We are on the verge of expanding health insurance to 31 million more Americans--an accomplishment that would be truly historic. But as heartened as I am about the relief this will bring to families, I am deeply concerned that this expansion could be a windfall for insurance companies if we don't include additional checks and balances. We should be putting significant Federal funds towards health insurance--but that money should go towards helping people afford health insurance, not towards lining the pockets of insurance companies and their CEOs. As a country, we have long understood the profound importance of economic competition. Competition leads to greater entrepreneurship, creativity, and productivity for businesses. It leads to lower prices and higher quality for consumers. Competition is why America has created so many of the most innovative businesses in the world. It is also why we enacted antitrust laws--because we need to protect this value we hold dear, and we know that competition won't always happen on its own. Because I understand the value of competition, I am extremely concerned about the antitrust exemption in current law for health insurance and malpractice insurance. It is indisputable that health insurance premiums have gone through the roof in recent years. From 1999 to 2008, median income rose about 24 percent, but insurance premiums grew by 131 percent. It is no wonder that so many American families are struggling to afford insurance. These high premiums are directly connected to the lack of competition in statewide health insurance markets. Ninety-four percent of State health insurance markets are considered ``highly concentrated,'' according to the U.S. Department of Justice. In 16 States, the two biggest health care insurance companies controlled 75 percent or more of the market in 2007. In Hawaii, that figure was 98 percent. In Rhode Island and Alaska, it was 95. But while American families suffer, insurance company profits continue to rise. From 2000 to 2008, the major insurance companies made over $59\1/2\ billion. Their profits rose by 428 percent from 2000 to 2007. And their CEOs are making big bucks themselves--in 2007, the CEO of Aetna took home $23 million, while the CEO of CIGNA took home $25.8 million. The antitrust exemption for health insurance and malpractice insurance may have had a purpose at one point in time--it gave the health insurance companies time to respond to a major change in the law. When Congress passed the McCarran Ferguson Act in 1945, it was responding to a 1944 Supreme Court case that upended the insurance industry as they knew it. The bill passed without any hearings in the Senate and with very little debate in the House. Most indications suggest that both the House and the Senate expected the antitrust exemption to be temporary. But somehow, through the conference report, this ``temporary fix'' became permanent--and health insurance markets have become more and more concentrated as a result. This cannot continue. Senator Leahy's amendment gives us the opportunity to further the American ideal of competition, and help working people in the process. I urge my colleagues to bring this amendment up for a vote, and to vote to repeal the antitrust exemption. This issue is just too important for us to wait any longer. I yield the floor.

Mr. FRANKEN

Mr. FRANKEN. Madam President, I rise to speak in opposition to the Nelson-Hatch amendment, which replaces the compromise language in the current bill with unprecedented restrictions on women's access to safe and legal abortion services. I think we can all agree that women's health is fundamental to our Nation's health. We all know that when women are healthier, families, communities, and countries are healthier. But I also know the issue of abortion is difficult, no matter where you stand on it, and I truly respect the fact that we have a range of opinions among us. Women have abortions for different reasons. Some of these reasons may not seem right to some of us. But even if we disagree, it is better that each woman be able to make her own decision with her doctor. In a perfect world, no woman should have to face the decisions we are discussing today. But the reason we have insurance coverage is to help us deal with the unexpected. No woman expects to have an unplanned pregnancy. No woman expects to end a wanted pregnancy because of fetal anomalies or risks to her own health. If we limit options in private health insurance coverage, we take away a woman's right to make a decision that may be best for her and for her family in their circumstances. But unplanned pregnancies do occur, and we have a responsibility to provide women with the full range of choices regarding their health. The Supreme Court has repeatedly ruled on this issue and made it clear that women have a constitutional right to access abortion. It is our responsibility to make sure abortions are safe, legal, and rare. Supporting a woman's right to make decisions about her health means more than keeping abortion services legal; it means supporting a woman's decision to terminate a pregnancy safely and with dignity. It also means teaching honest, realistic sex education. It means the right to choose contraception. It means standing with women who choose to continue their pregnancies--with the hope and expectation that a compassionate society will support them in their responsibilities raising a child. It is about respecting women's personal decisions and the challenges they face, especially at times when they are the most vulnerable. I strongly oppose the Nelson-Hatch amendment because it undermines the status quo and breaks new ground by restricting women's fundamental rights. The amendment stipulates that health plans cannot cover abortion services if they accept even one subsidized customer, even if the abortion coverage would be paid with the private premiums health plans receive directly from individuals. If adopted, this would mark the first time in Federal law that we would restrict how individuals can use their own dollars in the private health insurance marketplace. I also oppose the amendment because we have a workable solution. The existing compromise in our bill represents genuine concessions by both pro-choice and pro-life Members of Congress. The current bill prohibits Federal funding of abortion but also allows women to pay for abortion coverage with their own private funds. It makes clear abortion can't be mandated or prohibited and stipulates that Federal funds cannot be used for abortion. Let me be clear. The compromise within the current bill is as far as we can go. We have negotiated to get to this point. We cannot negotiate further without literally undermining the compromise we have made on behalf of women's health in this country. We are on the verge of passing a historic health reform law that will do more to improve the health of women and families than any legislation in recent history. We will end discrimination based on health history, on gender, or history of domestic violence. We will provide access to preventive health services so women can get annual exams and mammograms at no cost. It is our responsibility to guarantee women are not worse off--under the health reform we are going to pass-- than they are today. As my friend Paul Wellstone used to say: ``If we don't fight hard enough for the things that we stand for, at some point we have to recognize that we don't really stand for them.'' I urge my colleagues to stand with me today to oppose this amendment. I yield the floor, and I suggest the absence of a quorum.

Mr. FRANKEN

Mr. FRANKEN. Madam President, let me use the 16 seconds I had but use it in a better way, so maybe it won't be 2 minutes. I was going to talk about Senator Lincoln's amendment to limit tax benefits health insurance companies receive on salaries for CEOs, but let me just talk about the nature of this debate. My esteemed colleague from Arizona, Senator McCain, quoted Ronald Reagan saying facts are stubborn things. We just had my distinguished colleague from South Dakota say that this bill does not extend for 1 day the solvency of Medicare. Well, according to the Office of the Actuary for the Centers for Medicare and Medicaid Services, it extends it for 5 years. Now, facts are either stubborn things or they aren't. The Actuary for CMS is either the Actuary for CMS or not. You can't have a debate such as this and throw things around. Facts are stubborn things. We are entitled to our own opinions. We are not entitled to our own facts. You cannot stand up here and wave your arms and say this doesn't extend Medicare 1 minute, 1 day, when the Actuary for Medicare says the bill extends it for 5 years. I yield the floor.

Mr. FRANKEN. How much time do I have? Two minutes.

Mr. FRANKEN. I suggest the absence of a quorum.

Mr. FRANKEN. Mr. President, I ask unanimous consent to speak as in morning business for 5 minutes.

Mr. FRANKEN. Madam President, I actually was kind of feeling bad because I thought I was going to be changing the subject, when Senator Durbin said I would be the next Democrat to speak. Because our good colleague from Nevada brought up an amendment on medical malpractice liability and the Senator from Illinois responded to it and I thought the Senator from Nevada was going to respond to his response with some factual information or something, he completely changed the subject. So he went from the Canadian system to rationing, and he will include his entire statement, which included this: We don't ration care here in the United States, we let--meaning the government--we let the private sector do that. They do a great job of rationing care in the private sector. That is where we ration care in this country. They ration it by cutting off your insurance when you get sick. They ration care by not giving you insurance if you have a preexisting condition. I wish to speak about an amendment I have--that is why I was going to change the subject--but let me talk a little bit about tort reform, liability insurance. Senator Durbin mentioned Atul Gawande. He wrote that article in the New Yorker. Senator Ensign talked about how great the tort reform was in Texas. McAllen, TX, has the most expensive health care in the country. What kind of progress is that? They have the most draconian medical liability reform. In Minnesota, we don't have anything such as that. We do it for a third of the cost that they do it for in Texas and with better outcomes. The reason I actually asked for time today is to express my support for Senator Lincoln's amendment to limit the tax benefits that health insurance CEOs receive--not limit their salaries, limit the tax benefits. This does not limit their compensation, as was claimed by the Senator from Nevada. Most Americans would agree that the government, though, shouldn't be giving tax breaks to insurance companies for lining the pockets of their CEOs at the expense of working families who are forced to pay more and more as their premiums spiral out of control. The savings from removing this tax deduction in Senator Lincoln's amendment will go directly to our seniors as a direct deposit into the Medicare trust fund. This amendment is immensely important because it reinforces one of our primary goals with this bill, which is to rein in the cost of health care. One of the key ways we can control costs is by holding insurance companies accountable. I am pleased to be working with Senator Lincoln on another effort to make our health care system focused on patients, not profits. Yesterday, Senator Lincoln joined me, Senator Rockefeller, and others in introducing an amendment to require that at least 90 percent of your premium dollars go toward actual health services. We do that in Minnesota. We do that in Minnesota--91 cents, actually. I urge my colleagues to support both our amendments to ensure we get the highest possible value for our premium dollars because nobody can contest the fact that for-profit health insurance companies have been making obscene amounts of money, while Americans watch their premiums skyrocket. From 2000 to 2007, insurance company profits rose 428 percent--in 8 years. During that same time, we saw more than 6 million more Americans become uninsured. During that same period, American families saw their premiums almost double. So nobody can stand on this floor and argue that American families aren't suffering. No one can dispute what I hear from Minnesotans every day, that in this economic downturn, one of the greatest fears families have is: What happens if I get sick? What happens if my spouse or my child gets sick? We are hardly holding on now. We are just one illness away from losing everything. That is what I hear. That is what I hear from Minnesota families, and this is a State that has less-expensive, higher quality health care than the rest of the country. If Minnesotans are struggling, we know we have a crisis on our hands. That is why I am working to make sure this bill does everything it can to bring down costs, improve quality, and hold private insurance companies accountable. The current reality is, most of us don't know where our health insurance premiums go. It is difficult enough to understand a billing statement from your health insurer, much less track where your money is spent. Well, we are going to change that. We are going to change that with transparent reporting of how health insurance companies are spending your money. That is in this bill. Clear reporting, written in plain English will help us hold them accountable for every dollar we spend on health insurance. But reporting isn't enough because, right now, some of the health insurance plans being marketed and sold in this country are nothing short of a rip-off. A recent report in BusinessWeek magazine described a policy being sold in Florida to college students in which only 10 percent of the premium went toward actual health services. Again, only 10 cents out of every dollar goes to health care in this plan. The rest goes to marketing, wasteful administrative costs, and, of course, profits. And this is legal. It has been legal. It was legal when the Republicans had the White House and controlled this Congress. We are going to make it illegal. I don't think this is what we want for our children--insurance companies pocketing millions of dollars at the expense of our physical and economic health. Is that the kind of country we want to be? I believe we can all agree this health care reform bill must guarantee that Americans get value for the premiums we pay. I implore my colleagues to support these efforts because health insurance should be about providing the best possible health care, not about marketing, wasteful administrative costs, CEO pay, and profits. Madam President, I yield the floor.

Mr. FRANKEN. I do have the microphone, and I thank you for the 16 seconds. I would like to now--oh, I have used it up. I yield my time.

Mr. FRANKEN. Madam President, I will just take the 16 seconds.

Mr. FRANKEN

Mr. FRANKEN. Madam President, I rise today to talk about Shane Bauer, Sarah Shourd, and Josh Fattal. These three young Americans have been in custody in Iran since July 31, 2009. That is more than 4 months. Shane is from Minnesota, where his devoted mother, Cindy Hickey, still lives. I have been in constant and close touch with Cindy over the phone, and last month I was able to meet with all the families of the young hikers, and they have been back in Washington again this week. I have to say, they are a remarkable group of people who want nothing more than to be reunited with their children. On behalf of their families, I have come to the floor today to urge the Government of Iran to make a humanitarian gesture and release these young Americans so they can be together with their families again. As many of you know, Josh, Sarah, and Shane were hiking near the Iraqi-Iranian border in a remote region that is famous for a beautiful waterfall when they were taken into custody by Iranian authorities. The Iranians have indicated that the Americans strayed across the border in this remote region. There can be no doubt that it was an accident. Four months later, Josh, Sarah, and Shane remain in prison in Iran. The Iranian Government has allowed the Swiss Embassy, in its capacity as protection power for U.S. interests in Iran, to have consular access to them twice during the time they have been held. I hope this will continue, and continue more regularly. The Swiss have been enormously helpful in working with us to resolve the situation to bring these Americans home. I have been assured by one of the Swiss that Josh, Sarah, and Shane were all in decent physical condition as of the last visit. But it is also clear the imprisonment is taking its toll on these young people. The President of Iran has indicated that their case will be examined expeditiously and with compassion, which is encouraging. President Ahmedinejad first made that statement around the time the U.N. General Assembly met this past September. These young American tourists find themselves in unfortunate circumstances. One thing is clear: These circumstances do and should have nothing to do with politics. I hope that Josh, Sarah, and Shane's situation can be resolved on the same basis--as purely a human gesture by the Government of Iran. I understand that people on all sides tend to get caught in the middle of geopolitical events they have nothing to do with. That is a cycle that can and should be stopped. We do not want to perpetuate that cycle. Above all, I hope the Iranian Government will recognize that these Americans have committed nothing more than an innocent mistake and want nothing more than to be brought back together with their families. The Americans should be released. In the meantime, I hope Josh, Sarah, and Shane will be able to speak with their families by phone immediately. That would be the first direct contact they have had since their detention over 4 months ago. As we approach the holiday season and the end of the year, this is an especially important time for families to be together. That is not an American value or an Iranian value, it is a human value. It is my fervent hope that Josh, Sarah, and Shane will be brought back together with their families now. I urge the Government of Iran to make a humanitarian gesture and make that family reunion possible.

Mr. FRANKEN

Mr. FRANKEN. I will use it.

Mr. FRANKEN. I talked to my wife Franni. We have been married 34 years now. I talked to her a couple of weeks ago. I said if this passes, we should do the public option. She said, absolutely. Yes, I am perfectly serious about this.

Mr. FRANKEN. Mr. President, I rise today to ask unanimous consent to be added as a cosponsor to the amendment of Senator Coburn, amendment No. 2789, to require all Members of Congress to enroll in the public option. I am pleased to cosponsor this amendment because I strongly support the public option and I will have no qualms at all enrolling in this plan. There is a lot of misinformation about the public option, so I want to be clear about why we need a public option and why I would be proud to enroll in a public health insurance plan. We need a public option because health insurance premiums for Minnesota residents have risen 90 percent since 2000 and because 444,000 Minnesotans went without health insurance in 2008. We need a public option because, while millions of Americans struggle to pay for health care, insurance executives continue to make bloated, obscene salaries. From 2000 to 2007, American families saw their premiums almost double. During that same time, we saw more than 6 million more Americans become uninsured. During that same period, insurance companies' profits rose 428 percent--428 percent in 8 years. They are making outrageous profits by gouging American families. That is why we need a public option. The public option will offer affordable premiums and a comprehensive benefits package for Americans struggling with their health care costs. It is going to provide the kind of coverage Americans need to be healthy. The public option will foster competition among private health insurance companies and lower long-term costs for Minnesotans and for families all across the country. There is no cost for the public option to the Treasury. In fact, CBO estimates it saves $3 billion. It is a win-win situation. It is important to remember that a public option doesn't mean private health insurance goes away. In fact, after health reform, 188 million Americans will have coverage through a private insurer. Only 2 percent of the overall insured population is projected to enroll in the public option. This is just another option you will have. It is an option because that is what the bill is about.

Mr. FRANKEN. Absolutely.

Mr. FRANKEN. I thank the Senator. I need 3 minutes.

Mr. FRANKEN

Mr. FRANKEN. I request another 45 seconds.

Mr. FRANKEN. Madam President, I rise to express my support for Senator Mikulski's amendment for women's health. This amendment is crucial because it is about prevention. Prevention is one of the key ways this bill will transform our system of sick care into true health care. It is common sense. You get the right screenings at the right time so you find diseases earlier. It saves lives and it saves money. The Senate bill already has several provisions for preventive care, which I strongly support. For example, colonoscopies and screening for heart disease will be covered at no cost. It is a good start. The current bill relies solely on the U.S. Preventive Services Task Force to determine which services will be covered at no cost. The problem is, several crucial women's health services are omitted. Senator Mikulski's amendment closes this gap. Under her amendment, the Health Resources and Services Administration will be able to include other important services at no cost, such as the well woman visit, prenatal care, and family planning. These preventive services will truly improve women's health. For example, if all women got the recommended screening for cervical cancer, we could detect this disease earlier and prevent four out of every five cases of this invasive cancer. This will improve the health of our mothers, sisters, and our daughters. This bill and this amendment will make prevention a priority and not an afterthought. Although I respect the efforts of my distinguished colleague from Alaska, the Murkowski alternative falls short. The Murkowski amendment does nothing to guarantee women will have improved access to coverage and cost-sharing protections for preventive services. Rather than establish objective, scientific standards about which preventive services should be covered, this alternative only requires insurers to consult with medical organizations when making coverage decisions. While we know the U.S. Preventive Services Task Force recommendations do not cover all necessary services, the Murkowski amendment entirely removes even this basic coverage requirement from the bill, leaving women without any protections under health care reform for essential preventive care. This means that important preventive care for women, including screening for osteoporosis and sexually transmitted infections, may not be covered by insurance plans. In the simplest terms, the Murkowski amendment maintains the status quo, and we know the status quo is not working for millions of women who are forgoing preventive care because they simply cannot afford it. The Murkowski amendment continues to leave prevention coverage decisions up to health insurance companies, and that means there would be no guarantee that any health plan will cover basic preventive services at all. Do we want to leave these important decisions up to the insurance companies? The health of American women is too important to leave in their hands. That is why I urge my colleagues to support Senator Mikulski's amendment and vote to make sure women can get the preventive screenings they need to stay healthy. Most important, this amendment will make sure women have access to these lifesaving screenings at no cost.

Mr. FRANKEN. Madam President, prevention is just one of the ways this bill will improve women's health. It also ends insurance companies' practice of charging women more because they happen to be women, or denying coverage based on a history of pregnancy, C-section, or domestic violence. We need to pass this bill this year to ensure comprehensive, affordable care for women throughout the country. And we need to include this amendment because I want to be able to look my wife in the eye, I want to be able to look my daughter in the eye--my son, too--and my future grandchildren in the eye and say we did everything we could in this bill to improve women's health. We cannot wait any longer. I urge all my colleagues to stand with us and support this amendment. I yield the floor.

Mr. FRANKEN

Mr. FRANKEN. Mr. President, I thank Senator Dodd for his leadership on this bill. I want to talk about Senator Mikulski's amendment. First, a little bit about some of the claims that have been made on the floor today about Medicare. Senator Dodd pointed out that in the Bush budget--the last Bush budget--there was a bigger cut to Medicare, but not in the context of any kind of health care reform. Senator Baucus said it so well about what the cuts are. They are to hospitals, and the hospitals are fine with it. They are not jumping-up-and-down excited about it, but they are fine with it because it comes in the context of health care reform. We are covering 30 million more people. What does that mean to hospitals? When people come into the emergency room, they have coverage. The hospitals get paid. That is the context in which we are doing this; whereas, when President Bush was proposing those kinds of cuts, they were not in the context of insuring 31 million more people. When the uninsured were going into emergency rooms for the most inefficient care possible--and won't be now--it was costing every American family $1,100 in additional insurance costs. So they are comparing apples and oranges. We are doing so many things, and Senator Dodd talked about some of the things this bill does. I want to talk about Senator Mikulski's amendment, because women are among the most severely disadvantaged in our current health care system. Right now, health insurance companies can and do discriminate against women solely on the basis of their gender. Right now, it is legal in many States--again, not in all States, and this is why, when you are talking about getting health insurance from another State, you have to be careful. In Minnesota, we have stronger regulations. In other States, you don't. In many States, it is legal to charge women higher premiums, or deny them coverage at all, if they have had a C-section. It is a preexisting condition. If they have been the victim of domestic violence--in many States in this country an insurance company can deny a woman coverage because she has been the victim of domestic violence, because it is considered a preexisting condition. That is wrong. I am immensely pleased that under this bill, for the first time, women will have access to comprehensive health benefits, including maternity care, without having to pay more than their male counterparts. But we can do even more for women's health in this country. Senator Mikulski's amendment improves the bill to make sure women can get the preventive screenings they need to stay healthy. Most important, the amendment will make sure that women have access to these lifesaving screenings at no cost. So it doesn't interfere with a woman and her doctor, as my distinguished colleague from Texas said a few minutes ago. It makes these screenings available at no cost. Why is this important? Because right now, women are delaying or skipping preventive health care because they cannot afford it. That is not just bad for women's health, it is bad for our system because it drives up costs unnecessarily. Even in Minnesota, where we generally do a good job at health care, there are women right now who are not getting the care they need. They are skipping their annual exam because they are uninsured. Women who are uninsured are twice as likely not to get the care they need. Other women in Minnesota simply cannot afford the coverage they have now. Since 2007, the number of women who have delayed or avoided preventive care because of cost has doubled. The economic crisis has only made things worse. But the economic situation is no excuse. The reality is that women are forgoing preventive services that could save their lives because of the way insurance works now. Make no mistake what that is about. From 2000 to 2007, the health insurance companies saw their profits increase 428 percent. Women are forgoing preventive measures that could save their lives. Is this the kind of country we want to live in? There was some good news yesterday. The CBO confirmed what many of us already knew--that with the insurance market reforms and subsidies in our bill, women will be able to purchase better coverage at a lower cost than they would be paying without the bill. That is huge. With Senator Mikulski's amendment, we will go even further, guaranteeing that women receive preventive care when they need it, without barriers. These screenings catch potential problems such as cancer as early as possible. This saves lives and, by the way, it saves money. For example, cervical cancer screenings every 3 to 5 years could prevent four out of every five cases of invasive cancer. Regular screenings could prevent more than half of the cases of infertility. Senator Mikulski's amendment will give women the care they need when they need it. This is a huge step forward for justice and equality in our country. It is also a top priority for me that health reform includes another crucial women's health service, which is access to affordable family planning services. These services enable women and families to make informed decisions about when and how they become parents. Access to contraception is fundamental, a fundamental right of every adult American, and when we fulfill this right, we are able to accomplish a goal we all share--all of us on both sides of the aisle to reduce the number of unintended pregnancies. And so I believe that affordable family planning services must be accessible to all women in our reformed health care system. We can't wait any longer, and I urge all of my colleagues to stand up with us and support this amendment.

Mr. FRANKEN. My apologies to Senator Dodd. I guess I, as a freshman, am not necessarily familiar with all the rules. I think that means I must yield the floor, is that right?