Kay Hagan

Mrs. HAGAN

Mrs. HAGAN. I thank Senator Kaufman. A health information network is critical to improving patient care and reducing health care costs. Now I would like to yield 5 minutes to my colleague from Alaska, Senator Mark Begich, to discuss customer-driven care.

Mrs. HAGAN. Mr. President, Senator Begich's comments on customer- driven care is certainly working in Alaska. I now yield 5 minutes to my colleague from Colorado, Senator Michael Bennet, for his discussion on transitional care.

Mrs. HAGAN. Mr. President, I thank Senator Bennet for his comments on transitional care and certainly the need to make sure no patients are denied insurance coverage for preexisting conditions and in particular because a wife is pregnant. I yield 5 minutes to myself. I take this opportunity to talk about health care reform and how it will improve the delivery of health care to Americans. One successful delivery system that health care reform will expand upon is patient-centered medical homes which were pioneered in my State of North Carolina. Since 1998, North Carolina has been implementing an enhanced medical home model of care and its Medicaid Program called Community Care of North Carolina. Under this model, each patient has access to a primary care physician who is responsible for providing comprehensive and preventive care, working in collaboration with nurses, physician specialists, and other health care professionals. The primary care physician is the go-to doctor and the gatekeeper of a patient's information. Within each network, patients are linked to a primary care provider to serve as a medical home that provides acute and preventive care, manages chronic illness, coordinates speciality care, and provides round-the-clock, on-call assistance. Case managers are integral members of the network and work in concert with the physicians to identify and manage care for high-cost, high-risk patients. As of May of this year, Community Care of North Carolina was comprised of 14 networks that included more than 3,200 physicians and covered over 913,000 Medicaid patients in North Carolina, accounting for over 67 percent of the State's entire Medicaid population. As an example of the benefits of a program such as this, consider the impact on asthma patients because patients get to see the same doctor and get more consistent, coordinated care. Physicians are able to quickly recognize a condition such as asthma and can more quickly and efficiently determine the most appropriate treatment. The support network then educates the patients and their families about the management of their disease. Due to the increased likelihood of complications when asthma patients get the flu, it is very important that they receive the flu vaccine. Since 2004, within the Community Care of North Carolina, there has been a 112-percent increase in flu shots administered to asthma patients. More than 90 percent of patients are using the most appropriate medications. Between 2003 and 2006, asthma-related hospitalizations were decreased by 40 percent, and emergency room visits decreased by 17 percent. That saves all of us dollars. Community Care of North Carolina has improved patient care and saved the State money. An independent analysis by Mercer, which is a government consulting group, found that this program saved between $150 million and $170 million in 2006. A University of North Carolina evaluation of asthma and diabetes patients found that it saved $3.3 million for asthma patients and $2.1 million for diabetic patients between 2000 and 2002. In addition to asthma patients, diabetic patients also had fewer hospitalizations, and they visited the primary care doctors more often instead of specialists and had better health outcomes. I would like to tell a story about how access to a medical home has helped someone in North Carolina overcome the challenges of an illness. Donald from Charlotte has type 2 diabetes. This diabetic condition of his went untreated for a long time and, as a result, he began having ministrokes, had to cut back on his work in landscaping, and he ended up in an emergency room. He was referred to a Charlotte-based medical home program called Physicians Reach Out. He now has a primary care doctor who has helped get him on a medication regimen, returning his blood sugar to a normal level which allowed him to work full time again. His primary care physician was the key to teaching him how to manage his diabetes. Without his medical home, he said getting his condition under control would have been a ``wild goose chase.'' The Health, Education, Labor, and Pensions Committee included two provisions in the health care reform bill to encourage patient-centered medical homes, such as we have in North Carolina. The Secretary of Health and Human Services will create a program to support the development of medical homes, and then the other States will apply for grants. The bill also provides grants for physician training programs, giving priority to those who educate students in these physician training programs that are team-based approaches, including the patient-centered medical home. I have been focused on a reform bill that prevents insurance companies from turning patients away who have a preexisting condition, that expands coverage, and ensures that if you like your insurance and your doctors, you keep them. This bill actually will reduce our deficit, and that, obviously, has been a requirement of mine all along. This bill also encourages innovation in the delivery of health care to Americans using successful programs, such as the Community Care of North Carolina and the Physicians Reach Out patient-centered medical home as a model. Mr. President, now I wish to yield 5 minutes to my colleague from New Mexico, Senator Tom Udall, to talk about a model of community health service delivery.

Mrs. HAGAN. Mr. President, I thank Senator Udall. His example of the community health service delivery in New Mexico is excellent. Now I yield 5 minutes to my colleague from New Hampshire, Senator Jeanne Shaheen, to talk about reducing overutilization of emergency departments and reducing hospital readmissions.

Mrs. HAGAN. Mr. President, I thank my colleague. She has made it abundantly clear that by reducing the overutilization of emergency departments, at the same time reducing hospital admissions, we can maximize efficiencies and improve patient health and health care. I yield 5 minutes to my colleague from Virginia, Senator Mark Warner, to talk about delivery system reforms in Virginia.

Mrs. HAGAN. I thank Senator Warner. It is obvious that coordinated care will reduce costs and at the same time provide higher quality for our patients. What Senator Warner has discussed is very similar to the patient centered medical homes in North Carolina where we currently cover over 900,000 Medicaid patients. Finally, I yield 5 minutes of my time to my new colleague from Massachusetts, Senator Paul Kirk, to discuss some key national indicators.

Mrs. HAGAN. Mr. President, I thank Senator Kirk. I thank him for his comments and the discussion on the transparency and openness of the new key national indicators system. I think this is critically important so that our public can see the progress we are making in improving health outcomes, healthy behavior, and cost- effectiveness. In this last hour, we have heard from many of our new freshman colleagues about the successful efforts to reform the way we deliver health care in our country. I thank my colleagues for sharing those ideas with us. I yield the floor.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I am joining my colleagues on the floor today to discuss how health care reform will support innovative private sector programs that will save taxpayers money and make our Nation healthier in the long run. I wish to take this opportunity to discuss groundbreaking work at SAS, a software company based in Cary, NC. Since 1985, SAS has established itself as a global leader in employer-sponsored wellness programs. Although SAS provides health insurance for its employees, almost 90 percent of their families use the company's on-site health care center, and more than 50 percent, including the company's CEO, use the health care center as their primary care provider. SAS started providing wellness programs to its employees because the company realized the value of having healthy employees--they are more productive, they are more loyal--which translates into low employee turnover and reduced recruitment and retention costs. Disease prevention and wellness also translate into lower health care costs for the company as employees take better care of themselves. Recently, one SAS employee--a man in his 30s--was told he had early signs of Type 2 diabetes. Through their diabetes self-management program and other onsite SAS resources, this man was able to make real changes in his lifestyle, eating habits, weight and exercise, and now he no longer meets the diagnostic parameters for diabetes. I also recently visited Lenoir Memorial Hospital in Kinston, NC, where this hospital provides their employees and members of this community with access to a gym and a wellness program. More than 40 percent of the hospital's employees participate because of incentives the hospital provides for basic preventive screenings. People who don't work at the hospital--people in the community--can pay a low monthly fee to use the gym, including its indoor and outdoor track, weights, and yoga classes. Many of the people who use the facility are middle- aged and older. Health care staff monitor the facility and help create a comfortable and safe environment for everyone who comes to exercise. This opportunity is a benefit to the entire community. Two weeks ago, I visited the showroom of the North Carolina furniture manufacturers Mitchell Gold and Bob Williams. This company currently employs 550 North Carolinians, and for the past 10 years the company has provided their employees with a free annual health fair, where employees can receive preventive exams at no cost. This spring, more than 200 women received free mammograms from a mobile unit that came to the plant. The company recently started a part-time, onsite medical clinic to address their employees' medical needs. Companies such as SAS, Lenoir Memorial Hospital, and Mitchell Gold and Bob Williams reap tremendous economic benefits from their investments in these wellness programs. In 2008 alone, SAS saved more than $5 million in productivity and insurance costs as a result of its onsite health care center. Businesses across our country can improve worker productivity and save money by encouraging their employees to adopt healthier lifestyles. Obesity, chronic heart disease, and diabetes continue to rise in America at a significant cost to our health care system. The time to be innovative is now. In the health care reform bill, we are building on these successful wellness programs and encouraging all employers to invest in the health and well-being of their employees. Specifically, in the Health, Education, Labor and Pensions Committee bill, employers can offer their employees who participate in a wellness program a discount of up to 30 percent in their health insurance premiums. Currently, the average employee insurance premium is $250 a month, or $3,000 a year. This 30- percent discount would mean a savings of $900 per year to that employee. Expanding employer wellness programs will bring the cost of health care down and will make America a healthier nation. I thank the Chair.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I am proud to recognize a group of 102 World War II veterans from the Triad region of North Carolina who are traveling to Washington, DC, on October 28 to visit the memorials and monuments that recognize the sacrifices of our Nation's invaluable servicemembers. The Triad Flight of Honor sponsored this trip to the Nation's Capital for surviving World War II veterans in the Triad area. Our veterans will visit the World War II, Korean, Vietnam, and Iwo Jima Memorials. This will be the second Triad Flight of Honor trip. The organization flew their inaugural group of veterans to Washington, DC, on October 3, 2009. I had the honor of visiting with that group of veterans when they returned to Greensboro, NC. I was joined by my father-in-law, MG (Ret) Charles T. Hagan, Jr., U.S. Marine Corps Reserve, a World War II veteran, just before he died. Two more Triad flights for the spring of 2010 have already been scheduled, and hundreds of veterans in the area are hoping to participate. World War II was the defining period for a generation that bravely answered the call to serve our country. Young men and women, driven to protect America, enlisted in droves. Unfortunately, too many of those brave servicemembers met an untimely death on the battlefields of Europe and the South Pacific. More than 400,000 American servicemembers were slain during the course of the long war, and over 60 million people worldwide were killed, including 40 million civilians. The Allied Forces' ultimate victory is a testament to the brave soldiers, sailors, airmen, and marines who put their lives on the line to fight for liberty and freedom. This week, 102 Triad veterans will see the memorials dedicated to their service. I thank the Triad Flight of Honor for making these trips a reality. I ask the Senate to join me in honoring these brave veterans who are true North Carolina heroes.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I am joining my colleagues on the floor today to discuss the need for health care reform and what it means for Americans with preexisting conditions. Millions of Americans live today with what insurance companies describe as preexisting conditions. They range from something as common as asthma or diabetes to diseases such as cancer or MS. Some insurance companies, believe it or not, even consider a C-section to be a preexisting condition. Under our current system, if you are shopping for insurance on the individual market and you have a preexisting condition, you are faced with one of three frightening choices: One, you could be denied coverage altogether; two, you could be charged an exorbitant premium; three, you could be granted insurance with a rider that stipulates your insurance company is not required to cover your preexisting condition. Recently, I received an e-mail from a family in Mooresville, NC, that truly underscores why millions of Americans living with preexisting conditions simply can no longer afford inaction on this issue. Seven years ago, Tim became disabled and lost his job. Because he lost his job, his wife Marilyn also lost her coverage under his employer-provided plan. Tim's health care, which requires his wife Marilyn to provide constant home care, is covered by Medicare. But Marilyn has Osler's disease, which is a blood disease considered to be a preexisting condition by her insurance company. Marilyn is only able to purchase a high-cost, high-deductible plan. Compared to Tim's illness, her condition is relatively minor. But over the last 7 years, they have racked up more than $72,000 in debt for her health care. And this past year, her health insurance premiums cost more than the mortgage on their home. Unfortunately, there are millions of Americans all across our country such as Tim and Marilyn who are literally one medical emergency away from bankruptcy. This couple is sick and stuck. Over the last 10 years, medical premiums in North Carolina have skyrocketed, increasing 98 percent, while wages, on the other hand, have increased only 18 percent. The Health, Education, Labor, and Pensions Committee, of which I am a member, crafted a bill that ensures a preexisting condition never again prevents anyone from obtaining health insurance. It also provides security and stability for people with insurance, expands access to health insurance for people without it, and it will stop draining the finances of American families and the Treasury. The Finance Committee's bill also includes these critical elements. My goal is to send the President a bill that gives people the peace of mind that if they change or lose their job, as Tim did, they will no longer have to fear losing their health insurance too. Every single day I hear from North Carolinians who are looking for an opportunity to purchase quality affordable health insurance and protect their families. Hard-working Americans, such as Tim and Marilyn, simply cannot afford to wait any longer. I yield back my time.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I am joining my colleagues on the floor today to talk about how health care reform will improve women's access to care. I recently received an e-mail from a woman in Raleigh that truly underscores why women need health care reform in America. Julie wrote to me about her sister who was uninsured and waited years for a mammogram because she literally couldn't afford to pay for one. Then she found a lump in her breast. By the time the lump became a mass, Julie's sister finally got a mammogram and had to pay for it with cash. The mammogram confirmed what she suspected: She had breast cancer. But now that she had the diagnosis, she had no way to pay for the treatment. Julie's sister lost her battle with breast cancer this March. Like thousands of women across America, perhaps Julie's sister could have beaten this cancer if she had had access to affordable, preventive care and, after her diagnosis, access to either insurance or medical care to cover her cancer treatment. In this heartbreaking situation, Julie's sister was sick and stuck. Unfortunately, I hear about such cases far too often. Inefficiencies and discriminatory practices in our health care system disproportionately affect women. In all but 12 States, insurance companies are allowed to charge women more than they charge men for coverage. The great irony here is that mothers, the people who care for us when we are sick, are penalized under our current system. My daughter Carrie recently graduated from college and had to purchase her own health insurance. For no other reason than her gender, her insurance policies cost more than they do for my son Tilden. Yesterday, a 23-year-old staffer in my office, a female from Fayetteville, shopped for health insurance on the individual market for the most basic, bestselling plan. It would cost her $235 a month; for a man of the same age, $88. That is 2\1/2\ times more expensive, close to $1,800 more per year. Many women who have health insurance are still stuck. Insurance companies don't often cover key preventive services such as mammograms and pap smears. Often, the copays for these critical services can be out of reach for many women when they range as high as $60 a visit. More than half of all women, like Julie's sister, have reported delaying preventive screenings. Without insurance, mammograms cost well over $100. In many cases, the difference between life and death is early detection. The Affordable Health Choices Act--which I worked with my colleagues on the Health, Education, Labor and Pensions Committee to craft--makes preventive care possible for women across America. It eliminates all copays and deductibles for recommended preventive services. We are also stopping insurance companies from charging women more than men or using preexisting conditions as a reason to deny anyone health insurance.

Mrs. HAGAN. I thank the Chair and yield the floor.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, today I honor a woman of great character; a woman who provided unquestionable leadership to our Nation and a woman who proudly hailed from North Carolina. Our State motto, ``Esse Quam Videri,'' ``To be, rather than to seem,'' richly describes BG Mildred Inez Caroon Bailey; a trailblazer who thrived on challenges, especially when she was told, ``it can't be done.'' As a member of the Senate Armed Services Committee, I am proud to recognize General Bailey's contributions to the U.S. Army in this Chamber today. Brigadier General Bailey was born in 1919 in Fort Barnwell, NC, and raised in nearby Kinston. Inez, as she was known to her friends, directed the Women's Army Corps, WAC, from 1971 to 1975. Enlisting at a time when a woman's role in uniform was unclear, she experienced unquestionable changes for women in the military throughout her 33-year career. General Bailey was the third female to be promoted to brigadier general, a rank she never sought, but would never have thought to turn down. When she wasn't studying her favorite subject, French, Inez worked in her parents' grocery store. Upon graduation, she enrolled in Flora McDonald College in Red Springs, NC, and later transferred to the Woman's College of the University of North Carolina--now the University of North Carolina at Greensboro. She graduated in 1940 with a degree in education and one professional goal--to be a French teacher. She eventually accepted a job teaching French in Taylorsville, NC. When World War II broke out, this North Carolina French teacher thought a job in the Army Air Corps might be interesting, but it wasn't until a friend dragged her along to Fort Bragg that she really gave the military a second thought. The Army needed women to take the place of male soldiers who worked nonbattlefield jobs in order to free them for service on the front lines. Six months after Pearl Harbor, Inez joined the Women's Army Auxiliary Corps, WAAC, the predecessor to WAC, at Fort Bragg. Although her parents were unhappy about her decision, they supported her nonetheless. Although women held primarily administrative, clerical and supply-type positions, she was encouraged to discover that women were also packing parachutes and were even mechanics. Due to her college degree, General Bailey was eligible for officer candidate school. Her first unit command was at George Field Army Air Base in Illinois. There, she became very good at marching. She said, ``I didn't know any women who didn't like marching. We thought it was fun and we were proud of our marching, we could keep a good beat with the Colonel Bogey March!'' They even added words to the march, ``Duty is calling you and me. We have a date with destiny. Ready, the WACs are ready. Our hearts are steady, the world to set free. Service, we're in it heart and soul. Victory is our only goal. We love our country's honor, and we'll defend it against any foe.'' Eventually the Army made use of her background as a French teacher, assigning her to teach English to freed French prisoners of war who had been held in Morocco. She was thrilled to teach the soldiers because they were excited to learn, unlike the high school students she taught before joining the Army. At the end of the war, the debate about women serving in the military continued. Brigadier General Bailey could have left, but by then she was married and making, as she recalled, ``a magnificent sum of $166.60 and 2/3 cents a month--much more than a teacher's salary.'' She commanded a WAC attachment in the 98th General Hospital in Munich, where she was the highest ranking first lieutenant, male or female, in the European Command. She made first lieutenant within 6 months after she joined the service and had many great assignments that she described as ``wonderful assignments--but there were no promotions involved, because women weren't promoted.'' Eventually General Bailey returned to the States where she was initially assigned to intelligence work in the Military District of Washington before reporting for duty as a recruiter in charge of recruiting women in the seven Southeastern States; including North Carolina. Recruiting was a turning point for Inez Bailey. She discovered she was a ``ham and loved being interviewed on television and making speeches.'' She led a team of recruiters who exhibited around the country with a program that highlighted the historic contributions of women in every branch of the military. The exhibit included Belle Boyd, a Confederate spy who was a captain and honorary aide de camp to GEN Stonewall Jackson. After recruiting, Brigadier General Bailey became the Army's Senate liaison. She said for the first few weeks, all she saw were the backs of the Senators' heads from the Senate galleries. After 29 years of service, she was assigned to Fort McClellan, AL, as the deputy commander of the training center. When General Westmoreland summoned her to Washington, she asked if the meeting could be postponed because she was involved in a theater production she didn't want to miss. All the while she thought, ``If General Westmoreland suggests I might be the new director of the Women's Army Corps, I'm just going to say no thank you. If I'm your first choice, then take the second choice.'' She didn't get a chance to argue when he told her she would be the new WAC director. She was needed because the Army needed to recruit more women. Under her tenure the number of women in the Army tripled; from 13,000 to 39,000. And for the first time, women were allowed to command men. She retired from the Army with the rank of brigadier general. Her military decorations included the Distinguished Service Medal and the Legion of Merit. General Bailey will be interred at Arlington National Cemetery on October 14. Her husband, Marine Sergeant Major Roy C. Bailey, died in a traffic accident in 1966.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I thank my fellow colleague from Oregon, Senator Merkley. I also welcome our new colleague from Massachusetts. I am joining my freshmen colleagues on the floor today to talk about how health care reform will improve women's access to care. I received a heartbreaking e-mail this week from a young woman in North Carolina. When this woman was 27 years old, she was diagnosed with breast cancer. She had a 16-month-old son and was in an abusive relationship with her husband. Her husband knew she would not leave him because she could not afford medical treatment without his employer-provided insurance. She looked into COBRA. She looked into other individual insurance plans. But her breast cancer was, obviously, considered a preexisting condition. So for 7 years, this woman stayed in an abusive relationship because she had to have health insurance for herself and her child. Unfortunately, women across America face similar challenges to exactly what that woman has faced. Inefficiencies and discriminatory practices in our health care system disproportionately affect women. In a majority of States, insurance companies are permitted to charge women more than men for the exact same insurance policy. In Washington, DC, and in eight States, insurance companies can deny coverage to victims of domestic violence, citing that as a preexisting condition. In all but 12 States, insurance companies are allowed to charge women more than they charge men for coverage. In my family, my daughter, who just graduated from college--out there looking for health insurance on her own--was quoted many times more money for her coverage than if she had been a male. Only 12 percent of individual market policies provide comprehensive maternity care. When women do have health insurance, it often does not cover basic preventive care such as mammograms and Pap smears. In the HELP Committee and in the Finance Committee bill, insurance companies can no longer charge women more than men or use preexisting conditions to prevent anyone from purchasing health insurance, and we are ensuring that basic preventive screenings will be covered. I am focused on sending our President a bill that ends discriminatory practices against women, provides security and stability for people with insurance, expands access to health insurance for those without it, and slows down the skyrocketing cost of health care. Women across America cannot afford inaction any longer. Mr. President, I yield the floor.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I rise with my colleagues to discuss the urgent need for comprehensive health care reform and why I believe the cost of inaction is simply too high for North Carolina and America's working families. As I traveled across the State during the August recess, it was clear that North Carolinians are concerned about the rising cost of health care. In the past 10 years in my State, the cost of health care premiums has increased 98 percent, whereas wages have increased only 18 percent. That is a startling statistic. Just last week, the chamber of commerce from Dunn, NC, came to visit me in Washington. One man has a company that employs 600 employees. The cost of health care last year for his company increased 28 percent--in 1 year. That is simply unsustainable for America's businesses. The Treasury Department issued a stern warning just last week: If we do nothing to tackle the skyrocketing cost of health care, nearly half of all Americans under the age of 65 will lose their health insurance in 10 years. Those are frightening numbers. Right now, the average family's health insurance premium is $13,375. If Congress does not send our President a reform bill, premiums are expected to rise to a staggering $25,000 in 2016. Today, this average premium represents a little over a quarter of a family's income. But, by 2016, that average premium will represent almost half of a family's income. How are people going to able to afford to pay for mortgages and save for college tuition if they are paying half their monthly income for insurance premiums? This past year, North Carolina's unemployment rate rose to 11 percent. Many of the thousands of North Carolinians who have lost their jobs in this recession have also lost their health care, and many more families are facing this frightening reality: One medical emergency could send them into bankruptcy. In 2005, nearly half of all Americans who filed for bankruptcy cited major medical expenses as the reason for their financial decline. Between 2001 and 2008, the number of uninsured in North Carolina increased from 1.1 million to 1.4 million people. Without action, this number is going to continue to grow. The Senate Health, Education, Labor, and Pensions Committee crafted a bill that ensures that people who like their insurance and their doctors keep them. It also expands access to health insurance for those without it, and slows down the skyrocketing cost of health care--the three critical components President Obama called for in his speech to Congress 2 weeks ago. The President has been adamant that health care reform must not add one dime to our Federal deficit now or in the future, which has been a requirement of mine all along. The exploding cost of health care has put our Nation's economic security at risk. We simply cannot afford inaction any longer. In 1960, health care spending was 4.7 percent of GDP. Today, it is 18 percent. On the current trajectory, by 2030, health care costs will account for 28 percent of GDP. We need health care reform to get our deficit under control. We need a reform package that ensures a preexisting condition, such as diabetes or cancer, no longer prevents anyone from obtaining health insurance. We need health care reform to ensure America's families do not have to fear bankruptcy when a loved one gets sick. Thank you, Mr. President.

Mrs. HAGAN

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

Mrs. HAGAN. Mr. President, I ask unanimous consent to speak for 10 minutes as in morning business.

Mrs. HAGAN. Mr. President, today I am pleased to rise in support of Judge Sonia Sotomayor's nomination to be an Associate Justice of the Supreme Court of the United States. Judge Sotomayor's background demonstrates that she is an extremely well-qualified, mainstream judge who has the utmost respect for precedent and believes in fidelity to the law. I have always said I do not believe in a litmus test for judicial nominees, and I will look at the nominee's record as a whole. Judge Sotomayor's record, in its entirety, is nothing short of impressive. With 17 years on the Federal bench, she has more Federal judicial experience than any Supreme Court nominee in 100 years. Judge Sotomayor has a compelling, ``pull yourself up by your bootstraps'' personal story. She was raised by a single mom who emphasized education as she struggled to support her family while working as a nurse. With her mother's strong work ethic and focus on education deeply ingrained in her, Judge Sotomayor went on to graduate summa cum laude from Princeton University, and she received her law degree from Yale Law School, where she was editor of the Yale Law Journal. She then became a prosecutor in the Manhattan District Attorney's office, where she was tough on criminals and gained valuable perspective for her later career as a judge. She also became active in many areas of her community, showing her desire to serve others and promote justice in society. Having served as a volunteer for many efforts in my hometown of Greensboro, North Carolina, I know how serving others can enhance one's understanding and appreciation of the world. After her time as a prosecutor, Judge Sotomayor went into practice as a commercial litigator, where she dealt with business and finance law-- an area of importance to my State of North Carolina. In 1991, upon the recommendation of then-Senator Daniel Patrick Moynihan of New York, she was nominated by President George H.W. Bush to serve as a Federal judge for the Southern District Court of New York, and in 1992 she was unanimously confirmed for that position by the Senate. While serving as a district court judge, she was known for her toughness, fairness, and dedication to the law--characteristics of a strong judge. Because of her outstanding record on the district court level, Judge Sotomayor was nominated, in 1997, by President William Jefferson Clinton, to serve as a judge on the U.S. Court of Appeals for the Second Circuit. In 1998, the Senate confirmed her by a wide margin. Among the Senators voting for her confirmation was former North Carolina Senator Jesse Helms. I would like to think that Senator Helms saw in Judge Sotomayor the same qualities President Obama saw: fairness of mind, supreme intellect, and an unsurpassed devotion to the law and to our system of government. Some opponents have repeatedly brought up a few select comments made by Judge Sotomayor to suggest that she will not be impartial. However, Judge Sotomayor has made it clear she does not let her background influence her interpretation of the law. Her statements to the Judiciary Committee and her 17-year record on the bench confirm this. As Judge Sotomayor has said: My record shows that at no point or time have I ever permitted my personal views or sympathies to influence an outcome of a case. In every case where I have identified a sympathy, I have articulated it and explained to the litigant why the law requires a different result. Judge Sotomayor has also said that as much as her experiences influence her perspective, they have also taught her to be aware of other people's perspectives. In 2001, she said: I am reminded each day that I render decisions that affect people concretely and that I owe them constant and complete vigilance in checking my assumptions, presumptions and perspectives and ensuring that to the extent that my limited abilities and capabilities permit me, that I reevaluate them and change as circumstances and cases before me require. As Judge Sotomayor said in her confirmation hearing, her underlying judicial philosophy is ``fidelity to the law.'' In an independent study, Supreme Court expert Tom Goldstein looked at 97 race-related cases in which Judge Sotomayor participated while on the Second Circuit. He found that she and the rest of her panel ``rejected discrimination claims roughly 80 times and agreed with them 10 times.'' The circuit rejected discrimination claims by a margin of 8 to 1. Goldstein wrote: ``Of the 10 cases favoring claims of discrimination, 9 were unanimous'' and ``of those 9, in 7, the unanimous panel included at least one Republican-appointed judge.'' ``Given that record,'' Goldstein concluded, ``it seems absurd to say that Judge Sotomayor allows race to infect her decisionmaking.'' Judge Sotomayor has also demonstrated she does not legislate from the bench, and she gives deference to Congress in clarifying the intent of laws. In her dissent to the majority's opinion in Hayden v. Pataki, Judge Sotomayor wrote: The duty of a judge is to follow the law, not to question its plain terms. I do not believe that Congress wishes us to disregard the plain language of any statute or to invent exceptions to the statutes it has created. She also said: I trust that Congress would prefer to make any needed changes itself, rather than have courts do so for it. Additionally, a comprehensive study of Judge Sotomayor's criminal appellate decisions by the majority staff of the Senate Judiciary Committee found, as an appellate judge, Sotomayor sat with Republican- appointed judges on more than 400 criminal cases. In those cases, she agreed with all Republican-appointed judges 97 percent of the time; and she agreed with at least one Republican-appointed judge 99 percent of the time. Judge Sotomayor's sensible attitude toward following the law and her ability to objectively evaluate all angles of her cases has resulted in high ratings and endorsements by numerous organizations. The American Bar Association unanimously found Sotomayor to be ``well qualified,'' which is the highest rating the ABA gives to judicial nominees. The Congressional Research Service conducted an analysis of her opinions and concluded: As a group, the opinions belie easy categorization along any ideological spectrum. . . . Perhaps the most consistent characteristic of Judge Sotomayor's approach as an appellate judge has been an adherence to the doctrine of stare decisis, i.e., the upholding of past judicial precedents. Judge Sotomayor has an impressive list of law enforcement endorsements and supporters, including the International Association of Chiefs of Police; the National Association of Police Organizations; the National District Attorneys Association; the Fraternal Order of Police; the National Latino Peace Officers Association; the Federal Law Enforcement Officers Association; the Federal Hispanic Law Enforcement Officers Association; the National Organization of Black Law Enforcement Executives; and the National Sheriffs' Association. Judge Sotomayor has also been endorsed by the U.S. Chamber of Commerce, which stated: The Chamber evaluated Judge Sotomayor's record from the standpoint of legal scholarship, judicial temperament, and an understanding of business and economic issues. Based on the Chamber's evaluation of her judicial record, Judge Sotomayor is well-qualified to serve as an Associate Justice of the U.S. Supreme Court. The nonpartisan Brennan Center for Justice reviewed all of Judge Sotomayor's constitutional law decisions and said: Based on this exhaustive review, the conclusion is unmistakable: in constitutional cases, Judge Sotomayor is solidly in the mainstream of the Second Circuit. Judge Sotomayor's former law clerks wrote a letter endorsing her nomination, in which they said: As former law clerks to Judge Sotomayor, each of us can attest to her intellectual prowess, extraordinary work ethic, and commitment to the rule of law. Working for Judge Sotomayor is an awe-inspiring experience. We each had the privilege of working closely with her as she confronted, and resolved, incredibly complex and intellectually demanding legal challenges. Judge Sotomayor approaches each case with an open mind and arrives at her decision only after carefully considering all of the pertinent facts and applicable rules of law. The law clerks said they agree with many of Judge Sotomayor's other colleagues, who ``respect her intellectual dynamism, collegiality, and balanced, fair jurisprudence.'' I would like to thank and congratulate the members of the Judiciary Committee for holding an extraordinarily civil and open Supreme Court nomination process. I commend President Obama for selecting a woman, a Hispanic, and, above all, an extremely well-qualified nominee. I am thrilled to have the opportunity to be a part of this historic moment, and if she is confirmed, I believe she will serve our country well. Based on my conversations with the nominee, her statements in her confirmation hearings, and my review of her record, I intend to support her confirmation when it is voted upon later this week, and I urge my colleagues to do the same. I yield the floor.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I thank Chairman Levin and Ranking Member McCain for reporting out a bill that enacts reforming the Defense Department's budget and reorients weapons systems geared toward the wars we are fighting today. Our soldiers, sailors, marines, and airmen need capabilities that are conducive to implementing the Department's shift to counterinsurgency tactics, techniques, and procedures. There is nothing more important than enhancing the force protection of our troops. That is why I am pleased that this bill provides proven, effective ground capabilities, such as the MRAP vehicles to protect against IEDs. I want to highlight a couple of provisions in the bill. First, I support funding the administration's request for $7.5 billion for the Afghanistan security forces fund to train and equip the Afghan national army and police. The commander of the 2nd Marine Expeditionary Brigade, Brigadier General Nicholson, recently indicated that the success of the Marine offensive in the Helmand Province is dependent upon placing an Afghan face on the operation, in order to instill confidence among local Afghans in the Afghan Government's abilities to provide safe communities and to govern efficiently. Equally important is providing coalition support funds for Pakistan. The stability of Afghanistan is dependent on the stability of Pakistan, and vice versa. We need to enable the Pakistan Army and Frontier Corps with the capability to conduct sustained direct action missions against the dangerous elements of the Pakistani Taliban along the federally ministered tribal areas, as well as against the Afghan Taliban High Command in Pakistan's Balochistan province. Key to successful operations in theater are effective aviation assets. I am a big proponent of the Joint Strike Fighter as it can serve multiple roles, including close air support, tactical bombing, and air defense missions. I am disappointed that we were unable to secure enough votes for Senator Bayh's amendment. I want to reiterate that I think it is important we safeguard language to authorize funding to develop and procure an alternate Joint Strike Fighter engine. I know the issue of the location of the Navy's OLF has already been debated and voted on, so I will not spend a lot of time on it. I cosponsored an amendment with Senator Burr to prevent the Navy from building an OLF in the Sandbanks and the Hale's Lake locations within Camden, Currituck, and Gates Counties in North Carolina. I am against an OLF at these proposed sites because it would destroy small family farms that have been around for generations, as well as thousands of acres of farmland, essential to the livelihood and economic base of those communities. An OLF in these locations would only bring 52 jobs, and it would destroy valuable farmland that currently employs over 2,000 workers. Moreover, the OLF would only be a few miles away from ongoing projects that will attract new businesses and tourists. Last week, I met with local government leaders of the respective counties to discuss their concerns regarding construction of the OLF. The State of North Carolina recently passed a law banning the construction of an OLF at these sites. I do not think it would be in the Navy's interests to continue to pursue construction of an OLF at these sites, knowing that it will more likely than not be tied up in litigation for years. I want to make sure North Carolina is treated fairly. The residents of these counties simply do not want the OLF there. The State of North Carolina is the friendliest military State in the Nation, and we would welcome the opportunity to work with the Navy in identifying sites that could potentially meet the Navy's OLF requirement, and also have the support of the North Carolinians in those counties. One of those sites can be at Marine Corps Air Station Cherry Point or a site close to it within Craven County. All of the elected local officials in that community are in support of having an OLF located there. The Navy excluded Cherry Point as a potential OLF site because Navy standards specify that an OLF should be no more than 120 nautical miles from home base. Cherry Point sits approximately 135 nautical miles from Oceana, VA. That is just 15 nautical miles beyond the Navy's current requirement. I want to work with the Navy to examine the impact of having an OLF that is located just outside its current requirements, and especially on the readiness of the Navy's personnel and aircraft fleet. Senator Webb and I worked together to insert additional language within the committee report to do two things: one, to mandate the Secretary of the Navy issue a report detailing the Navy's consultations with local governments, communities, and stakeholders in North Carolina and Virginia regarding OLF site options; two, to mandate the Navy identify all suitable options for the location of an OLF beyond the five sites identified in both States. However, I don't think that is good enough. The State of North Carolina has had previous negative experiences with the manner in which the Navy has implemented its OLF site selection process. I strongly feel that the Navy should delete the two current sites in North Carolina. I also thank the chairman and ranking member for accepting my amendment in committee that provides the Department of Defense with the option to increase the acquisition of additional C-27s in the outyears as mission requirements dictate. That amendment requires the Department to provide its strategic plan to deploy and station C-27 joint cargo aircraft in theater and in the continental United States, as well as plans to procure additional aircraft beyond the 38. Forty-eight adjutants of the National Guard signed a letter to the committee last month supporting the funding of 78 joint cargo aircraft. Their letter emphasized the C-27 provides an essential airlift capability in war, as well as to State emergency management teams in 48 States. I also thank the chairman and Ranking Member McCain for accepting my amendment to direct the Secretary of the Army to submit a report to assess the feasibility and advisability of creating a trainees, transients, holdees, and students account within the Army National Guard to ensure all soldiers in units have completed their initial entry training prior to being deployed. Approximately 27,000 of the National Guard's end strength are not deployable because they are awaiting training. This account would allow new Guardsmen to be fully trained prior to reporting to their assignment. A TTHS account with the National Guard would improve the unit readiness, increase individual dwell time between deployments, and provide more predictability to soldiers, families, and employers. Finally, I thank the chairman and ranking member for accepting my amendment involving depot maintenance work. This amendment directs the Secretary of the Navy to submit a cost-benefit analysis report identifying each alternative the Secretary is considering for the performance of the AV-8B Harrier aircraft planned maintenance and aircraft modifications. We are working with the Navy and the Marine Corps to ensure that depots allow partnerships with the commercial sector, while recognizing the legitimate national security need for the Department of Defense civilian and military personnel to retain the key skills to be responsive to our soldiers fighting in these two wars. This is an important bill, and despite my and Senator Burr's ongoing concerns about this outlying landing field, I think that Senators Levin and McCain deserve our gratitude for their work on this bill, and this bill deserves the support of all of my colleagues. I suggest the absence of a quorum.

Mrs. HAGAN

Mrs. HAGAN. I ask unanimous consent that the order for the quorum call be rescinded.

Mrs. HAGAN. I ask unanimous consent to speak as in morning business.

Mrs. HAGAN. Mr. President, I suggest the absence of a quorum.

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

Mrs. HAGAN

Mrs. HAGAN. Mr. President, I ask unanimous consent that the Senate proceed to a period of morning business, with Senators permitted to speak for up to 10 minutes each.

Mrs. HAGAN

Mrs. HAGAN. Mr. President, today I am proud to introduce the Catalyst to Better Diabetes Care Act, which is S. 1473. Without question, diabetes is an epidemic in our country, and we have to do something. Twenty-three million adults and children suffer from diabetes. Another 57 million Americans are prediabetic cases. In North Carolina, my State, 600,000 adults have been diagnosed with diabetes and another 288,000 are undiagnosed and over 400,000 have prediabetes. But with our lifestyle choices, it is not surprising that these numbers are so high. Nearly three in five North Carolinians are overweight or obese. Being overweight is a leading cause of diabetes. A quarter of our State's citizens do not exercise. Unfortunately, it is not just adults who are suffering from this disease. In North Carolina, there are over 4,000 children who have diabetes. While type 1 diabetes is the most frequent diabetes in children, it is because of increasing obesity rates that the incidence and prevalence of type 2 diabetes is growing. Not only is diabetes wreaking havoc on people's health, it is also costing the country millions of dollars to treat. In my State of North Carolina, diabetes costs $5.3 billion annually in medical interventions, lost productivity, and premature mortality. Annually diabetes accounts for 16,000 hospitalizations. People suffering from diabetes have greater risk of renal disease, heart attack, stroke, and blindness. Diabetics also have a high risk of amputations if they fail to get appropriate foot care. However, with proper prevention and treatment, we can curb the staggering cost of diabetes and people can live healthier, happier lives. Lifestyle changes in diet and physical activity can reduce the development of diabetes in prediabetics. Early detection and treatment of diabetic eye disease can reduce blindness and lowering one's blood pressure can reduce the decline in kidney function, thereby averting renal failure. It is because of these proven interventions that I introduce this important bill today. The Catalyst to Better Diabetes Care Act will address five major issues to further the fight against this debilitating and deadly disease. This bill creates a cross-agency, collaborative patient and provider outreach program to increase the utilization of the Medicare diabetes screening benefit. Although this screening program was established in 2003, at present, very few seniors are taking advantage of this benefit. Early screening allows diabetics to better monitor and control their condition and prevent complications. This provision will save money and lives. When employees have incentives to select more nutritious food and to exercise, not only are they more productive, their overall health is improved. Companies like Pitney Bowes are implementing innovative practices to encourage their employees to live healthier lives, and such initiatives have shown remarkable results. Building upon these experiences, this bill establishes an advisory group to promote innovative private sector wellness and disease management programs. Diabetes takes an enormous toll on society. Yet we have very little consolidated data which measures the true impact and outcome of this disease. To address this gap, this bill creates a national and State-by-State level diabetes report card which will track our progress toward beating diabetes. The report card will contain information on preventative care practices and quality of care, risk factors, and outcomes of individuals who are diagnosed with diabetes and prediabetes. Studies indicate that only 35 to 40 percent of diabetics who die have diabetes listed anywhere on their death certificate, and only about 10 to 15 percent have diabetes listed as the underlying cause of death. Without this information, our country is not able to grasp the full impact that complications from diabetes has on our health care system and society. In order to better understand the scope of this epidemic, this bill requires the director of the CDC to promote the education and training of physicians on properly completing a birth and death certificate as well as the possibility of promoting language to improve the collection of diabetes mortality data, despite estimates that nearly one in three children today will go on to develop diabetes. Today's medical students are only required to have 4 hours of education in diabetes to become a board-certified physician. As diabetes touches more and more Americans, it will be critical that our doctors recognize this disease and have the tools and understanding to discuss prevention and proper treatment with their patients. That is why this bill requires HHS to collaborate with the Institute of Medicine and other related entities to study the impact of diabetes on the practice of medicine and develop recommendations to appropriate levels of diabetes medical education that should be required prior to licensure, board certification, and board recertification. Diabetes has taken an enormous toll on our society's health and our economy. But in many cases, this disease can be preventable. The Catalyst of Better Diabetes Care will address some of the fundamental obstacles that prevent us from tackling this disease head on. Better outreach, better data, and better education of patients and physicians are the keys to reducing morbidity and mortality from diabetes and lessening the costly burden this condition has inserted upon our country. I wish to thank my Republican colleague, Senator John Cornyn, for joining me in cosponsoring this measure. I urge my other colleagues to join us in supporting this very important bill.