Kay Hagan

Mrs. HAGAN

Mrs. HAGAN. Mr. President, payday lending institutions prey on people who find themselves in need of quick cash often for things like a necessary car repair or a medical problem. The lenders charge astronomical interest rates and expect immediate repayment. By marketing payday loans as short-term advances, predatory lenders gouge borrowers into a cycle of debt. With repayment due in just days, interest rates that reach 400 percent, and because repayments are due in full, borrowers are often forced to take out new loans to repay the old loan. The lenders themselves recognize that the loans are not for borrowers who intend to use them repeatedly. For example, one lender notes on its website that, ``Since a payday advance is a short-term solution to an immediate need, it is not intended for repeated use in carrying an individual from payday to payday. When an immediate need arises, we're here to help. But a payday advance is not a long-term solution for ongoing budget management. Repeated or frequent use can create serious financial hardship.'' But the statistics do not add up. Over 60 percent of payday loans go to borrowers with 12 or more transactions per year and 24 percent of payday loans go to borrowers with 21 or more transactions per year. This startling statistic illustrates just how devastating this problem can be for families. Take the story of Sandra Harris from Wilmington, NC. She had a job at Head Start and always paid her bills on time. When her husband lost his job, Sandra got a $200 payday loan to pay the couple's car insurance. When she went to repay the loan, she was told she could renew. Sandra ultimately found herself indebted to six different payday lenders, paid some $8,000 in fees. Now, the payday lending industry will argue that they provide a valuable service. I would simply point out that, whether or not you believe that to be true, my amendment does not prohibit payday loans. In fact, it allows up to six payday loans to the same borrower. If your business model relies on your ability to rope borrowers into rolling these loans over again and again, even though you are charging 400 percent per loan, I would have some serious questions about your business model. By reining in payday lenders, we will protect consumers from racking up endless, long-term debt that can ultimately cause a family to declare bankruptcy. This amendment protects consumers by ensuring that short-term cash advances remain short-term. It has three parts to accomplish this goal: First, it limits rollovers by prohibiting creditors from issuing new payday loans to borrowers with six loans in the previous 12 months or 90 days aggregate indebtedness. Second, it would require lenders to give borrowers the option to repay their loan over a longer time period. Creditors would need to offer an extended repayment plan for borrowers who are unable to meet repayment obligations. Finally, the bill gives the Federal Reserve Board the authority to require licensing and bonding of payday lenders. Leading consumer advocates such as the Center for Responsible Lending strongly support this legislation. This is a commonsense amendment, it will help protect Main Street borrowers from predatory lenders, and I would urge all of my colleagues to join me in supporting it. I ask unanimous consent to have printed in the Record the following letter of support from Michael Calhoun, the president of the Center for Responsible Lending.

Mrs. HAGAN. I will yield to the Senator.

Mrs. HAGAN. The Senator from Illinois is certainly correct. I believe, instead of anywhere near a 400-percent rate, there are limitations of 36 percent. The Senator is correct.

Mrs. HAGAN. The Senator is exactly right. This amendment allows, if a family does need to have a short-term advance, for a short-term advance, renewable six times. They can have six of them within a 1-year period of time. If at that point they cannot repay it, the institution has to give them a longer repayment schedule. We are not saying these loans cannot be given. But that recurring debt over and over and over again is what should be stopped by limiting it to six a year.

Mrs. HAGAN. Mr. President, I ask unanimous consent that the pending amendment be laid aside, and that I be allowed to call up amendment No. 3744.

Mrs. HAGAN. Mr. President, I yield the floor.

Mrs. HAGAN

Mrs. HAGAN. Madam President, I, too, am disappointed that my colleagues on the other side of the aisle have decided against even debating Wall Street reform legislation in the Senate. It has been almost 2 years since our financial system stood on the brink of absolute catastrophe. The meltdown on Wall Street has wreaked havoc on Main Street across America. Millions of Americans lost their homes, their jobs, their retirement savings. Taxpayers were asked to fund a massive bailout of Wall Street. Here we are, a full 2 years later, trying to debate a bill that will establish new rules of the road, create a more stable financial system, and ensure the American taxpayer will not be asked to bail out Wall Street banks again. I am sorry to say my colleagues today voted to stand up for Wall Street instead of standing up for all the people on Main Street who lost their job and their entire life savings. They voted against the seniors who saw their 401(k)s instantly eaten away by the reckless games Wall Street was playing with their hard- earned money. In my State, this recession, the worst since the Great Depression, has meant that currently half a million North Carolinians are out of work. In many families, both the husband and wife are out of a job. They are worried how they will put food on the table for their families. Democrats have been working in good faith for many months on a bill to hold Wall Street accountable for gambling with the money of North Carolinians and people across the country. I know Chairman Dodd has been working with Republicans on the Banking Committee for the last year and a half. The time has come to have this debate on the floor of the Senate. Wall Street reform means ending taxpayer-funded bailouts. It also means establishing new standards for the complicated financial products that contributed to this economic downturn. The purpose of this bill is to ensure the recent financial meltdown never happens again and that we protect seniors who lost retirement savings and small business owners who got caught up in the credit freeze and the countless Americans who lost their job. It means protection for consumers from irresponsible banking practices and greater certainty for bankers. Banks need to be able to understand what the ground rules will be so they can focus on the business of banking. North Carolina is a leader in the banking industry. Both our State's banks and banking customers will benefit from responsible financial reforms. The proposed legislation also creates an office of financial literacy that will develop initiatives intended to educate and empower consumers to make informed financial decisions. Our students today need the tools to understand financial products and how to manage debt, including mortgages, student loans, and credit cards. I hope my colleagues will listen to the American people on this issue. It is imperative we pass commonsense Wall Street reform so American taxpayers will never again have to shoulder the cost of a financial crisis. Madam President, I yield my time.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, there are two judicial nominees on the calendar from North Carolina who I believe would be confirmed by this body overwhelmingly. Judges Jim Wynn and Al Diaz, nominees for the Fourth Circuit Court of Appeals, were both approved by the Senate Judiciary Committee in January. Judge Diaz had the vote of every single member of the committee, and just one Senator opposed Judge Wynn. The reality of this situation, though, is that North Carolina has been waiting for one of these judges since 1994. That is 1994. Since then, there has been only one judge from North Carolina on the 15-judge panel of the Fourth Circuit Court of Appeals, even though North Carolina is the largest and fastest growing of the five States in the Fourth Circuit. Partisan bickering has continually blocked qualified North Carolinians from confirmation since the court's establishment back in 1891. But in consultation with both me and Senator Burr, the President has appointed two highly qualified, experienced, and fairminded North Carolina judges: Al Diaz and Jim Wynn. Judge Diaz, of Charlotte, a Business Court judge, handles extremely complex business cases. Before that, he was a State superior court judge. Judge Wynn, of Cary, is a 19-year veteran of the North Carolina Court of Appeals and formerly served on the North Carolina Supreme Court. The American Bar Association has given them both its highest possible rating. They both have served our country in the military. They have the support of Democrats and Republicans, including my North Carolina Senate colleague, Senator Richard Burr. They have no real opposition that I am aware of. Finally, we have not one but two qualified and bipartisan choices to serve North Carolina and our country on the Fourth Circuit. I am hopeful that we are close to confirming these two outstanding nominees for the Fourth Circuit. I will continue working with my colleagues to ensure they are confirmed as swiftly as possible. I yield the floor.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I thank the Senator from Virginia for helping us come together to talk about this issue because it is of critical importance. In North Carolina, we have two justices for the Fourth Circuit Court coming before this body. They were heard in the Judiciary Committee back in January. They are ready to go. However, once again, the individual who is to vet justices has not been heard, Chris Schroeder. We need to bring him up. Although both of these individuals, Judge Wynn and Judge Diaz, have come out of the Judiciary Committee, they are waiting to come up for a vote. They are behind in the queue from all the other district court judges who have not come forward. I will say that my colleague, Republican Senator Burr, is in total agreement with both of these nominees. We need to bring them forward for a vote. The interesting fact is that one of these positions has been open since 1994. Talk about justice delayed is justice denied. It is high time this body had an opportunity to vote to put forward Judge Diaz and Judge Wynn to represent our State on the Fourth Circuit Court of Appeals.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I rise today to speak in support of the education provisions in H.R. 4872, the Health Care and Education Affordability Reconciliation Act of 2010. Over 40 years ago, Congress passed the Higher Education Act of 1965 with the conviction that no qualified student should be denied the opportunity to attend college simply because of the cost. Who knew that today, in the year 2010, this concern would still ring true? The passage of this legislation will provide greater access to higher education for thousands of American students. The Health Care and Education Affordability Reconciliation Act represents the single largest investment in college affordability in history. From increasing the maximum Pell grant for low-income students to eliminating excessive subsidies for banks, this bill makes significant improvements to Federal student loan programs. Also, as students and their families look to Federal loans to pay for their post-secondary education, this legislation will allow non-profit student loan servicers in states like mine to continue servicing student loans. This legislation provides funding for the college access challenge grant program, a program created in the College Cost Reduction and Access Act of 2007. This program was designed to assist states working in partnership with organizations with expertise in improving access to college. These guarantee agencies ensure that students have access to high-quality, affordable higher education. In my home State, the College Foundation of North Carolina serves as our State guarantee agency and plays a critical role in providing students and families with financial literacy, debt management, and loan counseling information. I fully support the intent of the access and completion challenge grants included in this legislation. They will allow State guarantee agencies to continue the important work that they do. The College Foundation of North Carolina has done extraordinary work in this regard and, as a result, has had a default rate consistently below the national average for the past several years. As a strong advocate for financial literacy education, I can think of nothing more important than ensuring that students and families are armed with the tools they need to understand the dynamics of their student loans. In North Carolina, we have 58 community colleges and 10 historically Black colleges and universities. The students at these institutions of higher education stand to benefit greatly from the passage of this legislation. A $2.55 billion investment over the next 10 years for Minority Serving Institutions, and more specifically Historically Black Colleges and Universities, is unprecedented. While HBCUs only make up 3 percent of all colleges and universities across the country, they graduate 40 percent of African-Americans with degrees in science, technology, engineering and mathematics, 50 percent of African-American teachers, and 40 percent of African-American health professionals. Community colleges play an instrumental role in our education and workforce systems by providing postsecondary education and job training. We need to keep our community colleges open and thriving. I can't think of a better investment as we encourage people to get the training and skills necessary to get back to work. Making the commitment to create greater access to higher education, and ensuring that our students have the tools that they need to complete their postsecondary education is at the core of the education provisions in the Health Care and Education Affordability Reconciliation Act, and I am proud to support this legislation.

Mrs. HAGAN

Mrs. HAGAN. I thank Senator Warner. I too appreciate the time for us to come down here and talk about the need for health care reform. The bill that was signed into law yesterday is getting us on that track. The new and historic law, combined with the bill we are now considering in the Senate, is going to reform our health care system to reduce costs and improve patient care for those families in North Carolina and in Virginia and families across America. In 1996, the average premium in North Carolina for a family of four was $6,000. Today it is $12,000. It is projected, in 2016, to be 24,000. People cannot afford that. That is why we need to have change. After decades of working to fix a broken health care system, this law controls exploding costs, increases access to health care, and reduces our long-term deficit, which I know we are very concerned about, by as much as $1.2 trillion over the next 20 years. But in addition to containing costs, health care reform will improve access and quality of health care for millions of Americans. Right now, in North Carolina, we have 1.7 million people without insurance. They will now have access to a family doctor. This bill provides immediate benefits to small businesses, middle- class families, and seniors in North Carolina. The small business owners whom I talk to want to provide coverage for their employees, but the costs are prohibitive. This month, I received an e-mail from a small chiropractic practice in eastern North Carolina that had to drop its health plan for its employees because the rates doubled over the last 2 years. But starting today, 112,000 North Carolinian small businesses will be eligible for tax credits to provide health care to their employees. Within the next 6 months, hard-working, middle-class families will be able to add their children up to the age of 26 on their health care plans. This will benefit about 870,000 young adults in my State. This year, insurance companies will no longer be able to deny coverage to a child for a preexisting condition, such as asthma or diabetes. And it means insurance companies will no longer be able to drop your coverage because you get sick or because you file too many claims. In North Carolina, 1.4 million seniors will receive preventive services with no additional costs, and 250,000 seniors will have their drug costs in the doughnut hole immediately reduced and eventually eliminated. I am proud of these immediate benefits and our efforts to reform the health care system over the long term. The health care reform effort would not have been possible without the work of tenacious Capitol Hill staffers. I personally want to thank two incredible health care staffers on my team, Michelle Adams and Tracy Zvenyach, who worked countless hours for reform in our country.

Mrs. HAGAN. Mr. President, today I rise in support of a bill that builds upon the health care reform legislation that was signed into law yesterday. The new--and historic--law combined with the bill the Senate is now considering, will reform our health care system to reduce costs and improve patient care for North Carolina families and families across America. In 1996, the average family premium was $6,000. Today it is $12,000. Without health care reform, premiums would skyrocket to $24,000 by 2016--or half of the average North Carolina family income. Without reform, health care costs were projected to reach 20 percent of GDP, or $4.3 trillion, by 2017. This trajectory was simply unsustainable. After decades of working to fix a broken health care system, President Obama yesterday signed into law a reform bill that controls exploding costs, increases access to health care and reduces our long- term deficit by as much as $1.2 trillion within 20 years. By passing this bill, we will reduce the deficit, for a total savings of $143 billion by 2019. In addition to containing costs, health care reform will improve access and quality of health care for millions of Americans. 1.7 million North Carolinians without insurance will now have access to a family doctor. It will provide immediate benefits to small businesses, middle class families, and seniors in North Carolina. While small businesses make up 98 percent of North Carolina's private sector employers, in 2008, only 38 percent offered health insurance. Small business owners I talk to want to provide coverage for their employees, but costs are prohibitive. This month, I received an e-mail from a small chiropractic practice in eastern North Carolina that had to drop its health insurance plan for employees because rates were doubled over 2 years. Most of the practice's employees are young women under 30. But starting today, 112,000 North Carolina small businesses will be eligible for tax credits to provide health care to employees. Within the next 6 months, hard-working, middle-class families will be able to add their children up to age 26 onto their health plans. This will benefit about 877,000 young adults in North Carolina. This year, insurance companies will no longer be able to deny coverage to a child for a preexisting condition, like asthma or diabetes. Health care reform means people can access preventive care without being saddled with copays or deductibles. This includes well-child visits and seasonal flu immunizations. I recently heard a story about a North Carolinian who, as a junior in college, had terrible stomachaches. But he could not afford a colonoscopy. He learned of his colon cancer too late for the doctors to save him. Health care reform means this young man would have had a chance. Health care reform means people with chronic illnesses will no longer have to fear losing their insurance because of an arbitrary, insurance company-set lifetime cap. And it means insurance companies will no longer be able to drop your coverage because you get sick or file too many claims. Seniors also will see immediate benefits. In North Carolina, 1.4 million seniors will receive preventive services with no additional costs, and 247,000 seniors will have their drug costs in the ``donut hole'' immediately reduced and eventually eliminated. I am proud of these immediate benefits and our efforts to reform the health care system for the long term. This reform effort contains provisions that I have championed since coming to the Senate. In the United States, 23 million adults and children suffer from diabetes, and in North Carolina, diabetes costs our State $5.3 billion per year in medical interventions, lost productivity, and premature mortality. Given these dire numbers, I added to the health care reform bill the second piece of legislation I introduced as a U.S. Senator--The Catalyst to Better Diabetes Care Act. The Senator from Texas, Mr. Cornyn, cosponsored the bill last July. It creates a national and State-by- State level diabetes report card to track progress at beating the disease. It also requires the promotion of physician education on properly completing birth and death certificates, and requires that recommendations be made on appropriate levels of diabetes medical education that should be completed prior to medical licensing and board certification. I also worked with the Senior Senator from Colorado, Mr. Udall, to add a section to health care reform to improve access to health care in rural areas. The section we added will help medical schools establish programs designed to increase the number of graduates who practice in rural areas. It will give schools resources to recruit students from rural areas who have an interest in practicing medicine in their communities, and it provides for additional training in pediatrics, emergency medicine, obstetrics and behavioral health. I also want to take this opportunity to discuss how the bill the Senate is currently considering will help make college affordable for our families. One of the most significant provisions for our students in this legislation is the over $2.5 billion investment over the next 10 years in historically Black colleges and universities. There are 10 outstanding HBCUs in North Carolina. HBCUs graduate 40 percent of African Americans with degrees in science, technology, engineering and mathematics; 50 percent of African-American teachers; and 40 percent of African-American health professionals. North Carolina A&T, an HBCU in my hometown of Greensboro, graduates more African Americans with PhDs in engineering than any other school in the country. This is a milestone week for the State of North Carolina. I am working with my colleagues to send this bill to the President's desk to further reduce costs for North Carolina's families and small businesses. This health care reform effort would not have been possible without the work of some tenacious Capitol Hill staff, and I want to personally thank my two incredible health care staffers, Michelle Adams and Tracy Zvenyach, who worked countless hours for reform in our country.

Mrs. HAGAN

Mrs. HAGAN. I thank the Senator from Colorado for yielding. I am joining my freshman colleagues on the floor to express my amazement at the difficulty this body is having conducting even the simplest legislative functions. When I came to Washington last year from the North Carolina State Senate, I was certainly under no illusions that the process here would be lightening fast. In fact, I believe strongly we should take the time to make reasoned judgments about legislative and executive branch and judicial nominees. The American people are better served when we take the time to make the best decisions. But there is a difference between taking time for reasoned judgment and impeding progress for the sole purpose of delay. There currently are 67 executive branch nominations awaiting action by the full Senate. Every one of these has been approved by the committee of jurisdiction, many having been approved unanimously. Thirty-one of those sixty-seven nominees were approved in committee last year and have been waiting for months for action by the full Senate. One individual awaiting action by the Senate, Michael Punke, has been nominated to be our ambassador to the World Trade Organization. He was approved unanimously by the Senate Finance Committee in December. As my colleagues know, the member countries of the WTO are currently engaged in a round of trade talks that could have enormous implications for American workers and industries. Would it not make sense to have the best possible American representation at those talks? Should we not want someone there who is advocating forcefully on behalf of our American workers, producers, and businesses? It has been reported the delay in considering this particular nomination is connected to a concern one Senator has regarding a recent tobacco law passed in the Canadian Parliament. Well, I represent the largest tobacco State in the country. I will be honest, I understand the concerns of my fellow tobacco-State Senator regarding this legislation. But I guess I have not been here long enough to understand how concerns with Canadian tobacco legislation lead you to the conclusion that you should prevent the United States from being represented in international trade negotiations. How are we supposed to address our issues with Canada and all trading partners when our seat at the table is empty? That is just one example. The calendar is full of nominees who deserve a vote. In fact, there are two judicial nominees on the calendar from North Carolina who would be easily confirmed should they come up with for a vote, Jim Wynn and Al Diaz, nominees for the Fourth Circuit Court of Appeals. They were both approved by the Senate Judiciary Committee in January. But truth be told, we have not just been waiting since January, we have been waiting since 1994. There has been an opening for a North Carolina judge on the Fourth Circuit since 1994. Partisan politics has gotten in the way of filling that vacancy time and again. Finally, we have not one but two qualified judges, supported by both myself and Senator Burr. Let's bring them up for a vote. The government cannot function without qualified appointees in place. Let's stop the delays and bring these nominees up for a vote so they can get on with the business of the American people. I yield the floor.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, today, I am proud to recognize the contributions of our Nations' pharmacies to the American health care system. Over 200 members of the pharmacy community--including practicing pharmacists, pharmacy school faculty and students, state pharmacy leaders, and pharmacy company executives--will come together to highlight the importance of supporting policies that protect access to neighborhood pharmacies and utilizes pharmacists to improve quality and reduce health costs. Currently, there are over 50,000 community pharmacies operating nationwide. Pharmacists are one of the Nation's most accessible health care providers, and nearly all Americans live within about 2 miles from a community retail pharmacy. Pharmacy has a long history of receiving, filling, billing, and dispensing prescriptions in tandem with counseling. But pharmacists, utilizing their specialized education, also play a major role in medication therapy management, disease state management, immunizations, health care screenings, and other health care services designed to improve patient health and reduce overall health care costs. Pharmacists help patients adhere to their medications to improve health outcomes and reduce the risks of adverse events and unnecessary costly hospital readmissions and emergency room visits. Pharmacists are uniquely qualified to work with patients to help manage their medications and play an essential role in helping them take their medications as prescribed. Unfortunately, only 50 percent of Americans living with chronic diseases adhere to their drug regimens. Patient nonadherence costs the Nation's economy an estimated $290 billion each year, not to mention the avoidable loss of quality of life for patients and their loved ones. Congress recognized the important role of local pharmacists when it included a medication therapy management, MTM, benefit in Medicare Part D. As we have seen the increasing power of this benefit in improving patient health outcomes, I support community pharmacy's efforts to strengthen the MTM benefit so it is available for seniors and others struggling with chronic conditions and other illnesses. As the face of neighborhood health care, pharmacies across the Nation offer these and other cost-saving programs and services to help patients take medicines they need to achieve positive results from appropriate use of their medications. For more than a century, pharmacies and pharmacists have made a difference in the lives of people in North Carolina and the rest of America. In order to ensure pharmacies continue to exist in our local communities, pharmacists deserve fair reimbursements for the cost effective medications that they dispense. Today, I celebrate the value of pharmacy and support efforts to protect access to neighborhood pharmacies and utilize pharmacies to improve the quality and reduce the costs of health care. Finally, I would like to congratulate over 200 pharmacy leaders, pharmacists, students, and executives and the pharmacy community for their contributions to the good health of the American people.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I rise in support of Senate passage of H. Con. Res. 158, the House companion to a resolution I introduced last August to highlight greater awareness of breast and other cancers by designating an early cancer detection month. This House resolution is sponsored by my good friend and colleague from North Carolina, Congressman Bob Etheridge. Almost every person has been touched by cancer, either personally or through a family member or friend who has suffered from some form of the disease. Sadly, every year, more than 2 million new cases of cancer are diagnosed in the United States. The most common forms of cancer diagnosed in Americans are skin cancer, breast cancer in women, prostate cancer in men, lung cancer, and colorectal cancers. And it is estimated that in 2009, over half a million Americans died from all types of cancer. Last year, in North Carolina, there were an estimated 42,270 new cases of cancer and more than 18,000 deaths due to cancer. Of those lost, 1,300 deaths were from breast cancer in women and 860 deaths from prostate cancer. Current cancer treatments include surgery, radiation, chemotherapy, hormone therapy, biological therapy, and targeted therapy; however, there is no cure. Many oncologists and breast cancer researchers believe that a cure for breast cancer will not be discovered until well into the future. However, we cannot sit idly by while we wait for a cure. Instead, we must continue to support organizations, health care providers, and even our friends who work so hard to raise awareness about cancer, particularly cancer prevention and early detection. Fortunately, many forms of cancer can be prevented altogether, such as skin cancer and lung cancer. In addition, at least half of all new cancer cases can be prevented or detected earlier by screening, and if detected early enough, more than 75 percent of all people could be saved when cancer is most treatable. For breast cancer, early detection has been proven to reduce mortality. This is encouraging, due to the fact that 1 in 8 women in the United States will develop breast cancer in her lifetime. In 2008 alone, the overall cost of cancer in the United States was estimated at $228.1 billion. Greater awareness and early detection of all cancers will not only save tens of thousands of lives, but also greatly reduce the financial strain on the government and private health care services by detecting cancer before it requires very expensive treatment. Cancer has taken an enormous toll on our society's health and economy. But this disease, in all its forms, is often detectible at early stages. By designating a month to focus on early detection for breast cancer and all other forms of cancer, we will address some of the principle challenges that inhibit screening and prolong detection. Enhanced awareness and screening are the keys to reducing morbidity and mortality from cancer and reducing the financial and emotional stress that this disease places on Americans. I want to thank Senator Richard Durbin for joining me in cosponsoring the Senate resolution. I also would like to thank Representative Etheridge for sponsoring the House companion, which passed on January 21. I am extremely pleased that both Chambers have been supportive of this issue and that the Senate is adopting this concurrent resolution today.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I rise today to speak about drug reimportation. With millions of seniors balancing drug regimens that entail taking several medicines per day on a fixed income, I believe we need to find a way to ensure that they have access to affordable drugs. If we could reduce the cost of drugs with reimportation and guarantee the safety of those drugs, I would be very supportive. However, I have serious doubts that we can adequately ensure the safety of our drug supply with the drug reimportation amendment proposed by my colleague from North Dakota. Even without reimportation, the United States has had trouble with counterfeit drugs. At the height of the H1N1 epidemic this fall, the FDA was warning consumers to be wary of counterfeit H1N1 treatments. These counterfeits came from foreign online pharmacies. In one instance, the FDA seized so-called H1N1 treatment tablets from India and found them to contain talc and acetaminophen. Last month, the Washington Post reported on a coordinated global raid of counterfeit drugs from the United States to Europe to Singapore. The United States discovered about 800 alleged packages of fake or suspicious prescription drugs, including Viagra, Vicodin, and Claritin, and shut down 68 alleged rogue online pharmacies. Counterfeit pharmaceutical drugs are appearing on the market at increasingly alarming rates. In 2007, drugs comprised 6 percent of the total counterfeit product seizures. In 1 year, they have now jumped to 10 percent of all counterfeit product seizures. This growing problem is all about unscrupulous criminals preying on the sick and the elderly who are in desperate need of cheaper drugs. But the consequences are harmful and, in some cases, deadly. Officials estimate that some of these counterfeit drugs contain either a dangerous amount of active ingredients or were placebos. Some counterfeits include toxic chemicals such as drywall material, antifreeze, and even yellow highway paint. According to a recent Washington Post article, tracing the origins of drugs such as Cialis and Viagra took investigators across the globe and back again. Supposedly these drugs came from a warehouse in New Delhi, though the online company selling the drug was headquartered in Canada and was licensed to sell medicine in Minnesota. However, when Federal officials investigated the drug origins further, they actually found that the online Web site was registered in China, its server was hosted in Russia, and its headquarters had previously been listed in Louisiana. On a local level near our capital, the Baltimore Sun yesterday reported on the death of a University of Maryland pharmacologist, Carrie John. Ms. John suffered an allergic reaction to a counterfeit version of a legal drug in the United States but purchased illegally from the Philippines. Apparently, the counterfeit drug so closely resembled the legal version that two pharmacologists conducting the analysis after Ms. John's death could not tell the difference. Local police have yet to identify the contents of the counterfeit drug. A few of my colleagues have already mentioned the letter sent last week by FDA Commissioner Margaret Hamburg outlining the safety concerns the FDA has about reimportation. Specifically, the FDA stated that importing non-FDA-approved prescription drugs posed four potential risks to patients. Let me go over those four risks. No. 1: The drug may not be safe and effective because it did not undergo the rigorous FDA regulatory review process. No. 2: The drug may not be a consistently made, high quality product because the facility in which it was manufactured was not reviewed by the FDA. No. 3: The drug may not be substitutable with the FDA-approved product because of differences in composition or manufacturing. No. 4: The drug could be contaminated or counterfeit as a result of inadequate safeguards in the supply chain. If the agency that oversees drug safety is saying it would have difficulty guaranteeing the safety of our Nation's drug supply with reimportation, I have grave concerns, particularly since the FDA is already underfunded and understaffed. But let's take a moment to examine how Europe, which does allow reimportation, has fared in terms of safety. British authorities say counterfeit drugs often exchange hands between middlemen and are repackaged multiple times before reaching a legitimate hospital or pharmacist. This creates opportunities for counterfeit products, often produced in China and shipped through the Middle East, to penetrate the European market.

Mrs. HAGAN. Mr. President, I ask unanimous consent for 3 additional minutes.

Mrs. HAGAN. In 2008, British authorities identified 40,000 doses of counterfeit Casodex, a hormone treatment for men with advanced prostate cancer, and Plavix, a blood thinner. More recently, the European Union seized 34 million fake tablets at customs points in all member countries. In other countries around the world, the World Health Organization estimates that up to 30 percent of the medicines on sale may be counterfeit. As a result, numerous people have died. Earlier this year, 80 infants in Nigeria died from teething medicine that contained a toxic coolant. In July, 24 children in Bangladesh died from the consumption of poisonous acetaminophen syrup. The Dorgan amendment does not require imported drugs to be FDA approved or meet FDA misbranding standards. Furthermore, it does not prevent criminals in other countries from repackaging imported drugs. Although our safety system is not perfect, we have a thorough FDA review system for drug safety that actively involves physicians, pharmacists, and patients. As a result, Americans can be generally confident that our medications are safe and contain the ingredients on the bottle. Supporters of reimportation argue that the sick and elderly need an alternative way to obtain affordable drugs. However, a study by the London School of Economics found that in the European Union, middlemen reaped most of the profits with relatively little savings passed down to the consumer. Nothing in the Dorgan amendment requires the savings to be passed on to the consumer, leaving the door wide open for unscrupulous, profit-seeking third parties to get into the reimportation game. In the United States, we are already trying to reduce the cost of prescription drugs through the use of generics. This is one of the most effective ways for customers to reap savings, and the generic dispensing rate at retail pharmacies is close to 65 percent. The FDA is already working with stakeholders to develop drug reimportation policy. With the FDA looking into this and significant outstanding safety concerns, I cannot in good conscience support the amendment offered by my colleague from North Dakota. Instead, I will support the amendment offered by my colleague from New Jersey. The Lautenberg amendment will allow the importation of drugs only if the Secretary of Health and Human Services certifies that doing so would save money for Americans and would not adversely affect the safety of our drug supply. While it is critical that all Americans, especially our Nation's seniors, have access to affordable drugs, it is imperative that we not compromise the safety of U.S. drugs on the market. After all, what good are cheap drugs if they are toxic or ineffective? Thank you, Mr. President. I yield the floor.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I rise in support of the freshman value and innovation package, which builds on efforts to provide quality, affordable health care at a lower cost to families. I, too, applaud our colleague, Senator Mark Warner, for helping to initiate this package. I wish to take a moment to talk about two provisions in the package that I included: curbing fraud and abuse with 21st-century technology and medication therapy management. Today, Medicare spends about $430 billion annually; Medicaid, approximately $340 billion; the States Children's Health Insurance Program, an additional $5 billion, for a total of $775 billion. In Medicare alone, annual waste amounts to between $23 billion and $78 billion. Yet, despite these sky-high numbers, investigations are pursued only after payment has been made, which means government fraud investigators have to recover funds that have already been paid. As a result, it is estimated that only about 10 percent of possible fraud is ever detected, and of that amount only about 3 percent is ever actually recovered. This means the government recovers, at best, about $130 million in Medicare waste, fraud, and abuse. Again, when estimates are between $23 billion and $78 billion, we are only recovering $130 million. ``Doctor shopping'' is an example that was profiled in a recent USA TODAY news article and GAO report. This involves a patient receiving multiple prescriptions from numerous doctors in a short period of time, without getting caught. Each of the claims gets paid by Medicare, Medicaid, or even private health insurers. The current technology exists to assess in real time if a claim warrants further investigation, and this technology will prevent fraudulent claims from being paid on the front end. A software company in Cary, NC, SAS, has developed this technology. This amendment will require the Department of Health and Human Services to put into place systems that will detect patterns of fraud and abuse before any money leaves our Federal coffers. Another source of waste in the system is people not sticking to their medication regimen. As much as one-half of all patients in our country do not follow their doctors' orders regarding their medications. The New England Health Care Institute estimates that the overall cost of people not following directions is as much as $290 billion per year. This waste can be eliminated with medication therapy management. That is a program where seniors bring all of their prescriptions, in a little brown bag, and their over-the-counter medications and their vitamins and supplements to the pharmacy to be thoroughly reviewed in a one-on-one session. The pharmacist follows up and educates the patient about his or her medication regimen. North Carolina has some successful medication therapy management programs already in place. In 2007, the North Carolina Health and Wellness Trust Fund Commission launched an innovative statewide program called Checkmeds NC to provide medication therapy management services to our seniors. During the program's first year, more than 15,000 seniors and 285 pharmacists participated. Just this small program saved an estimated $10 million, and countless health problems were avoided for our seniors. This amendment takes this successful North Carolina model and implements it nationally, permitting pharmacies and other health care providers to spend considerable time and resources evaluating a person's drug routine and educating them on proper usage. I urge passage of this freshman amendment package which will further reduce health care costs for American families. Thank you.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I rise in support of the amendment offered by the senior Senator from Maryland. This amendment tackles a serious problem: Women are increasingly skipping critical preventive health care screenings because of costs, even when they have health insurance. This summer, I received an e-mail from a woman named Julie in Raleigh, NC, about her sister who had no insurance and waited years to get a mammogram because she couldn't afford to pay the $125 fee for a mammogram. Then she found a lump in her breast. Eventually, the mass grew so large Julie's sister finally got her mammogram and paid for it with cash. The mammogram confirmed what she had suspected, that she had breast cancer. But now that she had a diagnosis, she had no way to pay for the treatment. She lost her battle with breast cancer in March of this year. Julie's sister, perhaps, could have beaten this cancer if she had had access to affordable, preventive care and, after her diagnosis, access to insurance or medical care to cover her cancer treatment. In this heartbreaking situation, Julie's sister was sick and stuck. This health care reform bill will provide people such as Julie's sister with access to affordable, quality health insurance. The President of Randolph Hospital in Asheboro, NC, wrote to me recently that a few years ago, he was in a meeting with 20 to 30 of his nursing assistants who were covered by the hospital's insurance plan. Of those who were old enough to require a mammogram, only 20 percent had actually gotten one. The reason, they said, was the high out-of-pocket costs they would have to pay. When these women had to choose between feeding their children, paying the rent, and meeting other financial obligations, they skipped important preventive screenings and took a chance with their personal health. The hospital then decided to remove the financial barrier to preventive care and pay for 100 percent of preventive screenings. With the passage of Senator Mikulski's amendment, we will do the same for all women. A comprehensive list of women's preventive services will be covered with no added out-of-pocket expenses. With this amendment, we will ensure that, as the old saying goes, ``An ounce of prevention is worth a pound of cure,'' for women across America.

Mrs. HAGAN

Mrs. HAGAN. I think one of the key points is the fact that this bill is going to eliminate discrimination based on gender and preexisting conditions. I have two children right now who are in their midtwenties. My daughter is paying more per month for health insurance than her brother. Yet it is the exact same policy. The same with preexisting conditions. How many people do we know who have a condition such as diabetes or asthma, or a woman who has had a C-section who is, therefore, denied from getting health insurance? We have to be sure we correct this, and that is what this bill does. Let me give a couple of examples. So many people in North Carolina I have heard from have some of these situations. Recently, I got an e- mail from a family in Greensboro. It is a working family. The husband has Graves disease, which is a treatable condition, but he can't obtain health insurance because of this condition. Without health insurance, his life is gravely in danger. He repeatedly uses the emergency room for care. To make matters worse, he has a 2-year-old son who has hemophilia and has to be taken to the emergency room every time he bumps his head, which sometimes can cost, for a 2-day supply of medicine, $4,600. The family makes too much money to qualify for Medicaid and, obviously, with these preexisting conditions, health insurance is way out of reach for them. It is heartbreaking for this family. What the father has decided to do is to purchase life insurance instead of trying to get health insurance, and he is 29 years old.

Mrs. HAGAN. That is right. In all but 12 States, insurance companies are currently permitted to charge women more than men for the exact same policies.

Mrs. HAGAN. Yes. A lot of what we have been talking about are people who don't have health insurance and who want it enhanced because of preexisting conditions. We have people who are sick and stuck with health insurance. I received an e-mail from a young North Carolinian who works for AmeriCorps. She was the valedictorian of her high school class. She suffers from a brain abscess. Her illness has put her into debt for the rest of her life. She has health insurance, but it ran out when she hit a $50,000 cap. Her bills far exceed the cap. It is sinking her entire family into debt. She is sick and stuck. How many people do we know who have a spouse or themselves who have health insurance, and they are working, but they cannot switch jobs because they would lose their health insurance? I have a good friend whose husband has cancer. She wants to change jobs, but she cannot do it because of the condition of her husband. Once again, people are sick and they are stuck. We have to be sure we can have a debate, that we can move forward on health care reform so we can help people.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, the United States spends $2.3 trillion each year on health care--the most per capita of all industrialized nations. Yet we still have higher infant mortality and lower life expectancy than many of the other industrialized nations. Moreover, medical errors kill 100,000 patients per year and cost the system tens of billions of dollars, and $700 billion is spent each year on treatments that do not lead to improved patient health. Today, my freshman Senate colleagues and I are going to speak about the need to reform our health care delivery systems. You will hear from all of us about innovative initiatives that are successfully bringing down the cost of health care and at the same time improving the quality of care. Mr. President, I would like to yield 5 minutes to my colleague from Colorado, Senator Mark Udall, to discuss accountable care organizations.

Mrs. HAGAN. I thank Senator Udall. Accountable care organizations are extremely important in health care reform. Mr. President, I would like to yield 5 minutes to my colleague from Delaware, Senator Ted Kaufman, to discuss Delaware's health information network.