Amy Klobuchar

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Maybe the Senators can answer this. In these thousands of letters and calls we get from these people, they are asking us to be their voice. They don't want to say we are not going to debate this bill at all, that we are going to put it in a drawer and pretend it didn't exist.

Ms. KLOBUCHAR. If the Senator could yield, I have exactly the same kind of example where someone wants to buy coverage, they are willing to pay for some coverage, but they can't. They basically are cut out because they are sick. This is one of the saddest letters. We just got this from Cheryl from Bemidji, MN. She says: I am writing to you because I just got off the phone with my daughter Mickey. At first I couldn't understand her because she was sobbing so hard. Her husband had just been told by his boss that they wouldn't be carrying health insurance on their employees any longer. They are a small company in northern Minnesota and it was costing them $13,000 a month. For her, for my daughter, this is a matter of life and death. She has cystic fibrosis. Because it is a preexisting condition, the insurance companies won't touch her unless it is under a group plan such as the one her husband just lost. She says: You need to stand and be my voice, be Mickey's voice. Mickey is a fighter, but she can't keep fighting a system that is so against her. Mickey has already lived longer than any of the doctors expected. I want her to live to see her 5- year-old son become President one day. That is from a mom in Bemidji, MN. So I will just ask my colleagues, how can we continue to go down this path where hardworking families--a man who has a job, who is working for a small business, gets cut off from his insurance, and because his wife has cystic fibrosis, they aren't going to be able to afford insurance. The Senator from Delaware.

Ms. KLOBUCHAR. If the Senator will yield, I think what the people will be shocked to find out is that I think in eight States domestic abuse is actually a preexisting condition. You talk about gender discrimination. If a woman is a victim of domestic abuse, she will basically not be able to get certain insurance policies. Is that right?

Ms. KLOBUCHAR. If the Senator will yield, I think we have been joined by the Senator from North Carolina, who is a member of the HELP Committee and I know has a background in business and understands a little bit about competition. So how does she see this as being a problem? I know in the State of the Senator from Maryland there is limited competition, and in a number of our States one or two providers--Minnesota is an exception, but one or two providers dominate the market, jacking up the prices. The Senator from North Carolina.

Ms. KLOBUCHAR. The Senator from Delaware.

Ms. KLOBUCHAR. Mr. President, if the Senator would yield, I also see the Senator from Rhode Island in the Chamber. Rhode Island is a State that has one of the highest unemployment rates right now in the country, and it certainly is a State that would welcome this kind of reform. And also on the issue we have been talking about, Medicare, the Senator from Rhode Island has long fought for seniors. As to Medicare, as has been pointed out, if we do nothing, it is going to go in the red by 2017. The seniors I know who are 65 want to live to be 95 and still have Medicare. People who are in their fifties want to make sure Medicare is there for them when they are 65. That is why it is so important we make these smart reforms, to raise the quality of the care, and to make sure we preserve and save Medicare. And that is what this bill is about. I yield to the Senator from Rhode Island.

Ms. KLOBUCHAR. If the Senator would yield, I see the Senator from Massachusetts is in the Chamber, who I think has firsthand knowledge of the importance of this bill, having taken the seat once held by our dear friend Senator Kennedy, who worked so hard to get this bill done, to get health care to the people of his State. I say to the Senator, maybe he would want to talk about what this would mean to the people of Massachusetts.

Ms. KLOBUCHAR. Mr. President, $220 billion. This bill will give us the tools. I know I wish to add even more to it on this subject, to go after that money, so that money can go back to help the middle class afford health care. I yield to the Senator from Delaware.

Ms. KLOBUCHAR. Mr. President, if the Senator would yield, I see the Senator from Delaware is in the Chamber. Both the Senator from Maryland and the Senator from Delaware serve on the Judiciary Committee, and we have had several hearings in that committee about an issue people do not always think about that hurts the middle class, and that is the money that is being sucked down the fraud tube. Medicare fraud is $60 billion a year, I think.

Ms. KLOBUCHAR. I ask unanimous consent to engage in a colloquy with the Senators from Maryland, Delaware, Massachusetts, and others who will be joining us later in the hour.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, I am going to focus for the next 10 minutes on the issue of costs. I know many people are focused on important issues like the fact that this bill will finally eliminate the limitations on preexisting conditions, so if your kid gets sick, you don't have to lose your health care; and the fact that people will be able to keep their kids on their health care until they are 26. These are very important parts of the bill. It is very important to people of my State. The other facet that is very important to people in my State is something I heard about all over the last few months: the issue of more affordable health care. This is why: At $2.4 trillion per year, health care spending represents close to 17 percent of the American economy. It will exceed 20 percent by 2018 if the current trend continues. Hospitals and clinics are providing an estimated $56 billion in uncompensated care. In fact, today, Peter Orszag, the Budget Director for the President, wrote an opinion piece for the Washington Post that highlights the fiscal importance of passing health care reform. One of the things he said is, looking forward, if we do nothing to slow the skyrocketing costs of health care, the Federal Government will eventually be spending more on Medicare and Medicaid than all other government programs combined. He notes that it is time to move toward the high-quality, lower cost health care system of the future. As you know, Mr. President, coming from Wisconsin, we know how to deliver high-quality, highly efficient care. They do it in Wisconsin and in Minnesota. They also do it in Washington State. A number of States have figured out how to do this. Those are the models we need to see all across the country. We need to make health care affordable for everybody, and we need to reduce the waste and fraud that plagues the current system in this country. In 2008, employer health insurance premiums increased by 5 percent, two times the rate of inflation, and the annual premium for an employer health plan covering a family of four averaged nearly $12,000. In fact, I tell people around me that they have to know 3 numbers: 6, 12, and 24. Ten years ago, the average family was paying $6,000 for their health care premiums. Now it is $12,000. That is average. A lot of small companies in Minnesota--the owners of companies are paying more than that. But right now the average nationally is $12,000. If we do nothing to bend the cost curve, the average family will be paying, on an annual basis, $24,000 for their health care 10 years from now. Meanwhile, a new study found that small businesses pay up to 18 percent more to provide health insurance for their employees. We are talking about a backpack company up in Two Harbors, MN. A guy started that small company, and it is now up to 15 employees. He has a family of four and is paying $24,000--in Two Harbors, MN--for his family to make sure they have health insurance. He said if he knew it would have cost that much, he might not have started that company. Now they are providing beautiful, great backpacks for our troops who are serving us--high-quality backpacks. Those backpacks wouldn't have existed if he knew what was happening. Those jobs would not have existed. He could be working at a big company and paying less. But he was an entrepreneur, and we should reward that. The American people know inaction is not an option. If we don't act, costs will continue to skyrocket, and 14,000 Americans will continue to lose their health insurance every single day. We must keep what works and fix what is broken. Let me tell you about some good news. It is encouraging news that the Senate will start considering the bill that will reduce the Federal deficit by $127 billion in 10 years. If we go out 20 years, it is a $650 billion reduction in the deficit. That is good news. We achieve these long-term savings by making our health care system more efficient, rewarding quality, and improving patient outcomes, and reducing administrative spending and waste. Most health care is purchased on a fee-for-service basis. So more tests and more surgery mean more money--quantity not quality pays. According to researchers at Dartmouth Medical School, nearly $700 billion per year is wasted on unnecessary or ineffective health care. That is 30 percent of total health care spending. One study showed if the hospitals in some of these inefficient areas would follow the high- quality protocol the Mayo Clinic uses--and a lot of people would like to have that kind of health care--we would save $50 billion in taxpayer money every 5 years for chronically ill patients--$50 billion. That is just one example for one set of patients. That is what we do in Minnesota. We want that same kind of health care, the same kind of high-quality care, the incentives on the Federal level that aren't there now, and that is what we are seeing in this reform package. I am pleased the ``value index'' I proposed, which was cosponsored by Senator Cantwell of Washington and Senator Gregg of New Hampshire, was included in the Senate bill. This indexing will help reduce unnecessary procedures because those who produce more volume will need to also improve care or the increased volume will negatively impact their fees. Doctors will have a financial incentive to maximize the value and quality of their service instead of the quantity. This is supported by doctors in my State. Linking rewards to the outcomes for the entire payment area creates an incentive for doctors and hospitals to work together to improve quality and efficiency. In too many places patients struggle against a fragmented delivery system, running all over with x rays in the back of the car, seeing specialists, and not having someone in charge, or a quarterback running the team, having 20 wide receivers running this way and that way. That is why we need the integrated care that is rewarded in the bill--bundling of services. What you pay for is the result, the combination of services that gives you good results. That is what bundling is about. There is another good thing about the bill. In 1 year, hospital readmissions cost Medicare $17.4 billion. A study found that Medicare paid an average of $7,200 per readmission that was likely preventable. Who wants to go back in the hospital if you don't need to? One of the problems, if we don't have quality indexes in place--my State has one of the lowest hospital readmission rates in the country. If we don't have that index in place, we are rewarding bad practice. We want to reward high quality and put the patient in the driver's seat. That is what we do with the provisions in the bill. I am encouraged the Senate bill includes a provision that calls for reduced payments to hospitals if they have preventable readmissions. In this bill, we also work to better reward integrated health care systems. At places such as Mayo Clinic or Health Partners in Duluth, a patient's overall care is managed by a primary care doctor in coordination with specialists, nurses, and other care providers, as needed--one-stop shopping. In our rural communities, critical access hospitals utilize this model and provide quality health care for residents in their communities with a team of providers. To better reward and encourage collaboration, we encourage the creation of accountable care organizations. This is what I hear from the people in my State and across the country: We want more accountability in this health care system. Do you know what else accountability means? It means better enforcement of Medicare fraud. When the dollars are so tight and people are having so much trouble affording health care, why do we want to waste $60 billion a year on fraud? Think what that money could be spent for to make it easier to go to the hospital or doctor instead of $60 billion wasted on fraud. This bill and some of the amendments we are going to propose in the next month will bring us much closer to reducing that fraud, bringing that fraud down, and will hold the perpetrators accountable, including criminal penalties--that is important--making sure we have direct deposit, a bill that Senator Snowe and I have, so nobody can make out false checks and try to get the money that way; giving our law enforcement officers more tools to go after Medicare fraud. We can save $60 billion a year. In today's Washington Post, Peter Orszag writes: As we enter the homestretch, the greatest risk we run is not completing health reform and letting this chance to lay a new foundation for our economy and our country pass us by. I argue one of the most important things we can do--and I know everybody is focusing on who pays and what the provision means--is to change the delivery system in this country, reward that kind of high- quality, highly efficient care, so that our big companies are able to compete with companies in other countries that have more highly efficient delivery systems so our small companies are able to exist and multiply and keep their employees on health care, so that individuals in this country aren't cut off just because their child gets sick. That is what this reform is about. Thank you. I look forward to the vote tomorrow. I yield the floor.

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

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, this afternoon the Senate will resume consideration of the Military Construction and Department of Veterans Affairs appropriations bill. This critical legislation will provide full funding for veterans health care and other essential VA services. Last week, Mr. President, as I am sure you and many of my colleagues did, I had the opportunity to meet with veterans around my State, really for 2 days, and I came back to Washington with a renewed commitment to provide our Nation's veterans with full support and the benefits they so clearly deserve. Passing this VA appropriations bill is an important step toward fulfilling the promise we make to our veterans when they enlist: that we will take care of them when they return home. I figure, when they signed up for war there was no waiting line, so when they come home to the United States of America and they need a job or they need health care or they need any type of help from this government, there should not be a waiting line. But funding the VA's health care system--as we are doing this week-- and other existing veterans programs is only part of fulfilling that promise. Another critical component of fulfilling that promise is helping our newest generation of veterans make the difficult transition from military to civilian life--and what a difficult transition it is. New figures have recently come out that show that for post-9/11 veterans, their unemployment in October was 11.6 percent--significantly above the national average. But, like many of the national unemployment rate statistics, this statistic conceals the true scope of the problem. Here is the number to remember: 18. Eighteen percent of veterans who left the military in the past 1 to 3 years are unemployed, according to a 2008 Department of Veterans Affairs employment survey. Of those veterans who have found work, 25 percent earn less than $21,800 per year and only 58 percent of veterans who are employed have been able to find work in the private sector. These are the people whom I saw when I was at home. One of the things that came to my attention was that a number of them would choose, if they could, to pursue apprenticeships. A lot of them want to go to college for 2-year or 4-year degrees. We have large numbers of returning soldiers in college in Minnesota. One of the things I found from visiting some of our technical colleges is that a number of them would like to choose to pursue a different way to find a job. A recent VA survey of private sector employers found there is a perception that servicemembers do not perform duties within tightly defined skill sets. The study concluded there should be a greater emphasis placed on business and professional training of veterans coupled with increased efforts to match their skills with available jobs. That is why I introduced bipartisan legislation last week, joined by Senator Johanns of Nebraska and Senator Murray of Washington, to help Iraq and Afghanistan veterans obtain the training and experience necessary for full-time employment by allowing them to use their post- 9/11 GI bill benefits for job training and apprenticeship programs. As my colleagues know, last year, under the leadership of Senator Webb, we passed into law the Post-9/11 Veterans' Educational Assistance Act, which will provide the men and women who served on active duty since September 11, 2001, with comprehensive educational benefits similar to those World War II veterans received. While I believe there is no greater investment we can make in the future of our veterans than granting them the chance to pursue the higher education of their choosing, I also believe we must not limit veterans' opportunities to only the pursuit of academic degrees. Not every returning soldier chooses to go to college, but they still want a job. Job training, from pipefitting to law enforcement, should also be covered by the GI bill. Our legislation, the Post-9/11 Veterans' Job Training Act, would allow veterans who wish to enter the workforce immediately rather than pursuing an academic degree to use their post-9/11 GI bill benefits to obtain critical training and job skills. Specifically, veterans enrolled in an on-the-job training or apprenticeship program could use their benefits to pay for a percentage of their monthly housing costs, which would decline over a period of months; certification and testing fees; relocation and travel expenses; and tutoring costs. We put these things together based on our discussion with veterans across the country to see what their exact needs were to make it easier for them to go through the pipefitting apprenticeship programs and others that land them in the workforce more immediately. In order to qualify under this legislation, veterans must be enrolled in programs that have been approved by their State's accrediting agency. As under the old GI bill, veterans can also receive a salary from their employer during this training. This bill will restore the same eligibility and benefits for job training and apprenticeship programs that were available to veterans under the Montgomery GI bill, but are no longer available under the post-9/11 GI bill. I talked to Senator Webb and I know there were some reasons this got changed. He is, in fact, supportive of including this, because we have seen this skyrocketing unemployment rate, in part because of the economy, and we want to find every opportunity we can for our veterans to find work. According to the VA, up to 10 percent of veterans use their Montgomery GI bill benefits for education other than college or graduate school, including for on-the-job training and apprenticeship programs. Through this legislation, post-9/11 veterans will be able to use their expanded benefits for the very same purposes. In Minnesota alone, there are over 50 such programs currently providing training and employment opportunities to veterans, including jobs in law enforcement, construction, engineering, and education. I was at one of these institutions in Minneapolis this last week and met with some of our veterans, some of whom have done multiple tours in Iraq and one who was leaving in a few months, and they found it very helpful to return to these apprenticeship programs--some of which involve incredibly complex subjects--offering them the opportunity to learn those trades, and this will greatly help them so they can better afford these programs. By applying the new GI bill benefits they have earned toward these programs, veterans can acquire the skills and experience they need for success in the civilian workforce. Last week, President Obama signed an Executive order creating a Council on Veterans Employment and directing each Federal agency and department to establish an office to focus on the hiring of veterans. Like the President, I am committed to ensuring that veterans have a path to stable employment when they leave the military. One other piece of legislation I wish to mention, because I am hopeful it will be included in our health care reform, is the Veterans to Paramedics Transition Act which I introduced along with Senator Enzi. It helps returning veterans with medical training to pursue further education as paramedics. One of the things I found in our State was that in rural areas of the country--rural areas of Minnesota, rural areas of Virginia, rural areas in Wyoming--there are not enough paramedics. Here we have these returning soldiers who are trained in this area, but for them to have to move again and to go through an entire 2 years of training can be very difficult. The idea is not to say no training is needed but to simply give them some credit; set up rules to make it easy for colleges to give them credit for that on-the- job training they had as paramedics in Iraq and Afghanistan. It involves two problems: the problem of returning veterans who don't have jobs, and the problem of the lack of paramedics in the rural areas. So we are very hopeful, with the help of Senator Enzi and Senator Harkin, that we will be able to get this bill on the health care reform bill. I look forward to working with my colleagues to pass not just the Veterans to Paramedics Act but also this bill we introduced last week to make it easier for veterans, when they come home--our soldiers--to choose if they want to go to a pipefitting program or to go to a law enforcement program. For those veterans, there will probably be 10 percent of them who don't feel at that moment that they want to pursue an academic degree, but they need a job. Thank you, Mr. President. I yield the floor, and I note the absence of a quorum.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, I ask unanimous consent to speak in morning business for up to 10 minutes.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Will the Senator yield for a question?

Ms. KLOBUCHAR. If the Senator will yield, I was thinking, as the Senator from Illinois was talking about the number of pages in bills, when we were in the middle of this country's worst economic crisis since the Depression under the Bush administration and people were trying to figure out what to do, if you remember, the administration came forward with a bill that gave nearly $1 trillion out to banks, and it was something like 25 pages long, if I remember. I think the people in this country said: Hey, wait a minute, this is a major issue; 25 pages or 10 pages or 3 pages or 100 pages is not enough. We are dealing with an incredibly complicated issue--with insurance companies that have been running this show for so long. The fact that we are going to spend some time on this bill, as the Senator from Illinois has pointed out--and the Senate bill is not even done yet. We are still working on this, we are still bringing through these consumer reforms and that which is going to be good for the people of America. I really am a little tired of hearing about the number of pages. As I said, I think there are 3 numbers that matter here: 6, 12 and 24. Mr. President, $6,000 is what an average family paid 10 years ago--$6,000. Now an average family pays $12,000. What are you going to pay 10 years from now? What are you going to pay if nothing is done here--just keep going the way we are going, with the cost, the waste in the system, the Medicare fraud, and all these things that should not be going on? Mr. President, $24,000 is what the average family is going to pay. We need to start bringing those costs down, and the only way we take on these companies that have been putting in place these rules that say if a baby is 4 months old and happened to weigh 17 pounds, just a little underweight, you can't get insurance, and his family's insurance company--the only way we are going to help by taking them on, and I don't care how many pages it takes.

Ms. KLOBUCHAR. I was just with a group of seniors this past weekend in Richfield, MN, and they are worried because they hear about these numbers--that by 2017, if we don't do something, Medicare will go in the red. Those seniors are living longer and longer lives, which is a great thing. Hopefully, my mom is watching right now; she is 82 years old. But those who are 65 want to have Medicare when they are 95 years old, and those who are 65 want to make sure Medicare is there for them when they are 90 years old. That is why it is so important to look at this reform and make sure this is working for the seniors. The doughnut hole, I am so tired of worrying about that problem. These seniors have their health care coverage for their drugs, and then it vanishes and goes down the doughnut hole. One of the great things I like about this health care reform is that it will help them pay for the doughnut hole. I think 50 percent of those costs they will not have to worry about anymore.

Ms. KLOBUCHAR. If the Senator will yield, I think it is unfair to middle-class families who are trying to save every penny so they can send their kids to college--and those costs are going up--and to put food on the table and fill their car with gas, to have this hidden tax where they are paying for people who aren't getting health insurance or can't afford health insurance. That is why I think one of the most important things for people to understand about this bill is that we are already paying for these people who don't have health insurance. So let's make it more efficient and work for everyone so you can get some benefit out of this yourself.

Ms. KLOBUCHAR. Well, I thank Senator Cardin. As I was listening, I was thinking about how I first got involved in this whole debate. My story is like so many moms and middle-class parents. It involved rules, rules that made no sense when it is your family's health at stake. When my daughter was born, she was very sick. She couldn't swallow. They thought she had a tumor. She was in intensive care overnight. Back then, the insurance companies had a rule that you could only stay in the hospital 24 hours--new moms and their babies. For some people, when you have been in labor for 24 hours and you think your daughter might die for 24 hours, it doesn't make sense. So 24 hours after giving birth, I was kicked out of the hospital. I was wheeled out of the hospital while my daughter was there in intensive care. I thought to myself: This is never going to happen to anyone again. I went to the legislature with a number of other moms and got one of the first bills passed in the country guaranteeing new moms and babies a 48-hour hospital stay. I still remember the conference committee where we had a number of lobbyists who couldn't say they were against the bill, but they were trying to delay the implementation. They were trying to make it so that it wouldn't take effect for years and years and years. I finally decided to bring my pregnant friends to that conference committee so they outnumbered the insurance company lobbyists 2 to 1. When the legislators said: When should this bill take effect, all the pregnant moms raised their hands and said: Now. And that is what was happening. I can tell Senator Cardin, this is what the American people are saying. They are saying: Now. They need reform now because of what you have just talked about--the fact that costs have been escalating and escalating, and it is becoming more and more unaffordable for so many middle-class Americans. In 2008, employer health insurance premiums increased by 5 percent, two times the rate of inflation. Everyone feels it. Everyone knows what I am talking about. When people throw out all these numbers--and we hear all these numbers from the other side--I believe you only have to know three numbers. Senator Cardin brought them up before, three simple numbers. They are easy to remember: 6, 12, and 24. What do the numbers 6, 12, and 24 represent? Well, $6,000 was the cost of insurance for the average American family 10 years ago. They were paying that in their premiums. They are now paying $12,000. Some people are paying a lot more, such as the small business owner I talked about in Two Harbors, MN. But the average is $12,000. What do the studies show? They show that in 10 years people in Billings, MT, people in Delaware, people in Baltimore, people in the tiniest towns in this country will be paying an average of $24,000 a year. Do you think they are going to be able to afford that, the average middle-class family, $24,000 a year? I think every family can look at their own checkbook and figure out that answer. That is why we need health care reform now. I think of the people I have heard from in my State, such as Jan in Plymouth who wrote the other day about her 20-year-old daughter Jennifer. Jennifer was diagnosed almost a year ago with Hodgkin's lymphoma. She made it through chemotherapy but is still being monitored. She had to continue going to college to keep her health care coverage. Despite having good health care insurance, Jan and her husband had to use their retirement fund to cover the out-of-pocket expenses of Jennifer's chemotherapy. Jennifer has since taken some time off from school to recover and is going to be transferring to a new school soon. Her parents don't know how they are going to keep her insured. That is why the point was made about this plan allowing parents to keep their kids on their insurance until they are 26 years old. I can't tell you what good news that is to the parents of America who are struggling and who are thinking: Once my kid goes to college, what is going to happen because they would not have a job? How are they going to get insurance? Now, until they are 26 years old, they are going to get insurance. That would help this family in Minnesota tremendously. The preexisting conditions--I talked about three women with breast cancer who were there with the First Lady--unbelievable stories of people who, through no fault of their own, get a disease, they are not sick anymore but they get thrown off their insurance policies; kids who are a little overweight or a little underweight--the only way they can get rid of this thing off their backs and get health insurance is by going on TV? I think we would have to have permanent TV stations going around the clock to cover all these families who want to get their preexisting conditions off their backs. That is not going to work in this country. The better way is to pass health care reform. The Senator from Maryland brought up the cost, and I can tell you that for a lot of people in Minnesota, that is the No. 1 issue I hear: How can we afford this? What can we do about it? Well, I can tell the Senator from Delaware--and I see the Senator from Illinois, Mr. Durbin, is here, and he has been working hard on the Medicare fraud issue on the Judiciary Committee, as well as the Senator from Maryland--that 3 to 10 percent of our health care dollars go down the tube to crooks, to con men, and we are not doing anything about this. There is money in the system, and it is just going to the wrong places. Another way to solve this is with trying to put more quality measures into our system, trying to have high quality care at the lowest cost. People understand if you go to a hotel and you spend more money on a room, you tend to get a better room, a bigger room, with a nicer view. With health care, it is not the case. With health care, some of the highest cost places have the lowest quality care. So one of the things that health reform allows us to do is to put in those high-quality measures. So we start having incentives. We say to hospitals: If you have less infections in your hospital, which means more people live, you will be treated better in the system. So we will put in incentives so that doctors treat their patients better and, believe it or not, that is the way we are going to save money. Why is that? So many times the way the system operates, it is about reimbursing for every little test, every little thing you do, instead of looking at the rules or looking at the quality of care that you can get at the end of the road. And that is what we want to do with this legislation. There is a value index in this legislation. The bill that came out of the Finance Committee, which Senator Cantwell and I have worked hard on, let's us look at the value to the patient. Let's put patients in the driver's seat so they can get the value, so middle-class families can get the same kind of health care that Members of Congress get, so they can get the kind of value they want out of their health care. So when we look at how we can pay for this, there are so many ways. We can not only save some money, such as plug that doughnut hole so that seniors can get better deals on their prescription drugs, but we can do it so we can give people higher quality care. We are going to link rewards to outcomes to create the incentives for doctors and hospitals to work together to improve quality and efficiency. That is what we are trying to do. So I thank Senator Cardin for bringing up this issue of cost because for so many middle-class families in my State, they understand we want to have not only more affordable care but also high-quality care. They do not like these kinds of mistakes that go on, and there are some things we can do by creating incentives for safer procedures and for better standards for hospitals and for doctors that I think could go a long way toward paying for a lot of what we need to do.

Ms. KLOBUCHAR. One of the things I have learned in the past year meeting with small business owners is this huge disparity. Small businesses pay 20 percent more. The ones that are the bedrock of our entrepreneurial system in this country pay 20 percent more than big businesses for health care. Their employees are in a small business, but the ones who need it the most, the ones who probably make less income, pay 20 percent more for health insurance. I was up in Two Harbors, MN, visiting a little backpack company that has done such a good job. They now make backpacks for our troops because they are lighter weight and better for their backs. This little company started with a few employees; it now has 15, 20 employees. When the owner of that company started it, he didn't have kids. He now has two kids--four in their family. He is paying $24,000 a year for his health insurance. This is a little tiny backpack company in Two Harbors, MN. When the Senator from Maryland was telling us about people having to adjust, they cannot plan, he told me if he had known when he started that much of his profits were going to go into his health insurance, he would not even have started the company to begin with. This not only hurts our employees, it actually stops small businesses from starting--the incubator of so many of our great ideas in this country and jobs in this country. This is truly something that needs to be solved because it is hurting jobs in this country, the fact that it is so difficult for small business owners to afford health care.

Ms. KLOBUCHAR. Will the Senator yield?

Ms. KLOBUCHAR. I also was listening to this and thinking, about a week ago, I was at an event that Mrs. Obama, the First Lady, put on for breast cancer in honor of Breast Cancer Awareness Month. There were three women there who all had breast cancer. They were all survivors, and they had incredibly low rates of possibly getting breast cancer again because of advances in science. I was stunned to hear of their difficulty. Even though their possibilities of getting breast cancer again were so low, it was still considered a preexisting condition for an insurance policy. A recent example, when you think about it hitting middle-class families--and some of the people watching this on C-SPAN may have seen this on television--a little boy named Alex was denied coverage by his family's health plan. Alex's parents have coverage through their employers, similar to so many middle-class Americans. But their 4-month-old son Alex, who weighed 17 pounds--and my daughter was one of those low percentages when she was born. He weighed 17 pounds at 4 months old, so he was denied coverage. The insurance company claims this was a preexisting condition for the otherwise healthy baby because of his weight. Here is the interesting part--and I know the Presiding Officer from Montana will appreciate this. After his family went on TV with the little boy, then the insurance company changed its mind and, suddenly, decided to cover him. I guess the lesson is that middle-class families have to go on TV to make their case in order to get coverage or when a woman who has been a victim of domestic abuse is denied coverage--which is considered to be a preexisting condition in eight States--maybe if she was willing to talk about her domestic abuse on TV, there would be a change of heart. That is not good enough--coverage by cable TV--for the majority of Americans. They need stability in the system. They need a guarantee that they are going to have coverage. I thank the Senator from Maryland for raising this important issue.

Ms. KLOBUCHAR. That is a very important point about the hidden tax. When I was county attorney in Minnesota, representing one of our biggest hospitals in the State, a lot of people came in who didn't have a doctor. Their doctor was the emergency room. Their doctor still is the emergency room, and it is incredibly expensive. If you could explain that a little more because many people don't understand that when people don't have insurance, we are still paying for them. They call it the hidden tax.

Ms. KLOBUCHAR. Will the Senator yield?

Ms. KLOBUCHAR. Mr. President, I rise today to talk about extended unemployment benefits. I just received a call this afternoon from one of my State legislators in Minnesota who represents the Iron Range of Minnesota where my grandpa grew up and worked 1,500 feet underground in the mines in Ely, MN, never graduated from college, and saved money in a coffee can in the basement of his and my grandma's house to send my dad to college, and my dad and brother also worked in the mines. It is tough times up in Ely, MN. Things go up and down, up and down in the iron ore business. Right now, they are in a downtime. There are some glimmers of hope out there. Some of the mines have started up again, but there is high unemployment up there, high unemployment in the double digits. That is why this is so important, as America has been trying to really pick itself up and get moving again after this economic crisis. Someone once said that when Wall Street gets a cold, Main Street gets pneumonia. That is what we are still seeing across this country despite the glimmers of hope we see with the GDP, the good numbers there and some of the other good numbers with house sales going up. There are some positives going on in this country, there is no doubt about that. But there are still so many people looking for jobs. I think for every job out there, there are six unemployed people trying to find that job. I have gotten letters from people saying they have applied for hundreds of jobs, sent in their resumes. That is why it is so important, while Wall Street is starting to do well again, to make sure we are protecting the people in this country who need their unemployment. In the past 125 days alone, over 185,000 Americans lost their unemployment benefits. Each passing day without an extension, more and more Americans are losing the last lifeline they have to keep their heads above water in this difficult economy. One of the things I really like about the Senate bill--I see the Senator from Illinois is back. I thank him for his leadership, and Senator Reid and Senator Shaheen and others who have worked on this issue. The Senate bill doesn't say: OK, only certain States are going to be able to get this extension of unemployment benefits. The Senate bill says what the people of my State say: The unemployment rate in Minnesota might be 7.3 percent right now, but in my house it is 100 percent, and I have been trying to find work over and over again. I don't know what I would have said to the people of my State if I had to come home and say to them: Look, the people of Wisconsin are going to get their unemployment benefits extended, right across the border there, but the people of Minnesota are not. We were glad to get Brett Favre from Wisconsin. That was a nice pickup. But it doesn't mean they get unemployment benefits and we don't. That is not a fair trade. So we are very glad the Senate bill takes care of States such as Minnesota and so many other States such as Montana and others across this country. I urge the Senate to pass this as quickly as possible in the name of all the people in my State and others who have been looking for work. I will end with a letter I got from a woman named Barbara, from Mahtomedi, MN. She wrote: My husband has been looking for a job since March and without unemployment to help us out I don't know what will happen. All of us [our kids] have been looking for steady employment for months. We drive old cars, we bought a house within our means that we have been fixing up slowly for ourselves for the past 22 years. We buy everything used or on sale. Please don't let [the people of our State] get left out in the cold [because it is starting to get cold and we need the unemployment until we find a job.] I thank you for allowing me a few minutes to talk about this important bill pending before the Senate, and I urge the Senate to quickly adopt our unemployment bill. I yield the floor.