Barbara Mikulski

Ms. MIKULSKI

Ms. MIKULSKI. Whatever way it will work and accommodate you while we are waiting to see who our speakers are.

Ms. MIKULSKI. Mr. President, I fear the microphone of the Senator from Alaska is not working.

Ms. MIKULSKI. That is so much better. I want to hear about the amendment and continue our conversation.

Ms. MIKULSKI. I ask unanimous consent she be extended an additional 2 minutes. No, I withdraw that request.

Ms. MIKULSKI. Mr. President, how much time is there on our side?

Ms. MIKULSKI. Mr. President, I yield myself 3 minutes. As we get ready to conclude the debate on both the Mikulski as in Barbara Mikulski and Murkowski as in Lisa Murkowski amendments, I want to first say a word about the Senator from Alaska. We have worked together on the Health, Education, Labor and Pensions Committee. We have worked together as women of the Senate, to provide access to women's health services. Not too long ago, when I had my awful fall, she gave me much wisdom and counsel and practical tips because she herself had broken her ankle. To us, when you say to Senator Lisa or Senator Barb, ``Break a leg,'' it has a whole different meaning. I again thank her for all her work. I have great respect for her. I look forward to our continued working together. But I do sincerely disagree with her amendment because what her amendment does is, it guarantees, really, only information. It does not guarantee universal access to preventive and screening services. It also does not remove the cost barriers by eliminating the high deductibles for the copayments when you go to get a preventative or screening service. It tells insurance companies to give information on recommended preventative care. That is a good thing, but it is a threshold thing. You need to have universal access to the service. In addition, we do not mandate that you have the service; we mandate that you have access to the service. The decision as to whether you should get it will be a private one, unique to you. We leave it to personalized medicine. So in the poignant case of the wife of the Senator from Wyoming, it would have been up to the doctor, the physician, to get her the service she needed. It is not only I or one side of the aisle that is opposing the Murkowski amendment. The American Cancer Society, the American Heart Association, and the American academy of GYN services oppose it. My amendment is a superior amendment because it guarantees universal access to preventative and screening services. It also eliminates one of the major barriers to accessing care by getting rid of high payments and deductibles. It doesn't say you will have a mammogram at 40 because, again, we are substituting ourselves for the task force; it says you will have universal access to that mammogram if you and your doctor decide it is medically necessary or medically appropriate. Vote for Mikulski. Don't vote for Murkowski. And please, on this one, get it straight.

Ms. MIKULSKI. I ask for the yeas and nays.

Ms. MIKULSKI. Mr. President, I rise in opposition to the Lisa Murkowski amendment. Though well-intentioned, it does not guarantee universal access to preventive and screening services for women. It does not remove the cost barriers of high payments and codeductibles. It is opposed by the American Cancer Society and the American Heart Association. It primarily provides information on those matters. We salute her intention, but we think her amendment is too limited, and, to quote the American Heart Association, it would be an actual ``step backwards'' in the area of making preventive services available, particularly not only in the matter of cancer but in heart and vascular disease--the emerging No. 1 killer for women. I urge defeat of the Murkowski amendment.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, as we debate health care reform, we need to recognize in the United States of America that health care is a women's issue. Health care reform is a must-do women's issue, and health insurance reform must be a must-change women's issue. Too often when we look at when health care is even available to us, we face discrimination. We face continually the punitive practices of insurance companies that charge women more and give us less in a benefit. A 25-year-old woman pays more for health insurance than her male counterpart of the same health status. A 40-year-old woman pays almost 35 percent more for her insurance than a male of the same age, same health status. We want to change that in health care reform. We want to end the punitive practices of the private insurance companies in their gender discrimination. We, the women of the Senate, are concerned that even being a woman is being viewed by the insurance companies as a preexisting condition. Now we have the opportunity to change the law and change the direction of health care. I have offered an amendment to expand the screening and preventive services available to women in order to save our lives, make sure our lives are not impaired as we get older and, at the same time, be able to save money. We know early detection saves lives, curtails the expansion of disease, and, in the long run, saves money. There are certain killers of women, the dread ``c'' word, cancer-- breast cancer, ovarian cancer, cervical cancer that are unique to we women. Then there is the dread disease of lung cancer that affects men and women but is emerging as a main killer of women. Then there is the other issue of heart disease and vascular disease. We know for years women were often left out of the research on heart disease. For years women's heart disease went undetected and unrecognized because our symptoms are different. We can change this law. In my amendment we expand the key preventive services for women, and we do it in a way that is based on recommendations from the Centers for Disease Control and from HRSA. It will be based on the benefit package available to Federal employees. It means if our amendment passes, the women of America will have the same access to preventive and screening services as the women of Congress. What is good enough for a United States Senator should be good enough for any woman in the United States of America. That is why we ask not only the women to join us but the good men of quality who support us. We know people such as Senator Dodd, Senator Reid, Senator Baucus, men of quality, never fear we women who seek equality. They have raced for the cure as long and as hard as we have and have fought for mammogram standards. This is why we are wearing pink today. Pink is the universal color that says while we race for the cure, we want to have access to it when we find it. But to have access to the cure, we are going to need to have access to mammograms to be able to get that diagnosis, and then we are going to have to have health insurance to be able to pay for the treatment we have. This is the Titanic battle we have today: Are we going to have access to health insurance and are we going to have access to these preventive services? We do know in the area of heart disease and cancer and silent, undetected killers such as diabetes, it is often undetected. What happens is, for many women they do not get that early detection and screening, No. 1, because they can't afford it. They can't afford it because they either don't have health insurance and there are other demands on their family or, No. 2, when they go, if they do have insurance, they find their benefit might not be covered. So many of these benefits are based on State mandates, but worse than that it is the copayments and high deductibles. Many women say: Well, my insurance company provides for it, but this copayment and deductible, I have to choose between my children's shoes or my deductible. We want to either eliminate or shrink those deductibles and eliminate that high barrier, that overwhelming hurdle that prevents women from having access to these early detection and screening programs. Much is being debated about mammograms. We believe access to mammograms should be universal, universal access. But the decision on whether to get one should be made with your doctor. Well, that is great to say, but you need to have access to your doctor. You need to not have to overcome the high hurdle of deductions or copayments to be able to do it. We know mammogram screenings decrease breast cancer by over 40 percent. Regular pap smears reduce cervical cancer by 40 percent. This year, 4,000 women will die of cervical cancer. Then let's take the dread, but often overlooked, diabetic screening. Diabetes is the underlying cause of two-thirds of chronic illness in both younger and older women. If we find it early and get everybody in the right program, they are going to be able to get the treatment they need so they don't lose an eye, they don't lose a kidney, they don't lose a leg. We can't lose any more time. We need to provide universal access to health care to the American people and we need to make sure they have access to the screening and early preventive actions that will save lives. Mr. President, I urge the adoption of the Mikulski amendment, and I thank you for your leadership on this issue. I ask unanimous consent that the remaining time be equally divided between Governor Shaheen, Senator Hagan, Senator Murray, and Senator Gillibrand.

Ms. MIKULSKI. Madam President, that concludes our discussion and our responses to this portion of the health care reform bill. I must say: Alert, alert, alert. We have just been informed that a shrill advocacy group is spreading lies about this amendment. They are saying that because it is prevention, it includes abortion services. There are no abortion services included in the Mikulski amendment. It is screening for diseases that are the biggest killers for women--the silent killers of women. It also provides family planning--but family planning as recognized by other acts. Please, no more lies. Let's get off of it and save lives.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I have an amendment at the desk.

Ms. MIKULSKI. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Ms. MIKULSKI. Mr. President, before I go into the contents of my amendment, I thank the Senator from Wyoming for his unfailing courtesy to allow me to proceed to offer my amendment. I have worked with the Senator from Wyoming on the Health, Education, Labor and Pensions Committee, and have often valued his sound counsel and steady hand as we have moved complex legislation. His considerable experience as an accountant and his commitment to the stewardship of Federal funds have often added to the consideration of legislation. As we move forward on both debating and refining the health care reform bill before us, I look forward to working with him. Again, I thank him for his courtesy. I also want to acknowledge the Democratic leader and wish to support him for bringing something called the ``merged'' bill to the floor, which took the best elements of both the Finance Committee and the HELP Committee and brought them forth. I believe the overriding bill before us is an excellent bill. No. 1, it expands universal access to health care that will now cover over 90 percent more Americans. It will end the punitive practices of insurance companies, particularly in the area of gender, age discrimination, and preexisting conditions. It also stabilizes and makes Medicare secure and, at the same time, it begins to bend the cost curve by following innovative practices related to quality control and prevention. I think the overriding bill is an excellent one. I congratulate the manager of the bill on the floor, the Senator from Montana, Mr. Baucus, chairman of the Finance Committee, for the excellent work his committee did, for bringing in a great bill that establishes new ideas, such as medical homes, emphasizing primary care and prevention, and at the same time accomplishing the objectives I have mentioned. However, as I reviewed the bill, I felt we could do more to be able to enhance and improve women's health care. That is what my amendment does. The essential aspect of my amendment is that it guarantees women access to lifesaving preventive services and screenings. This amendment eliminates one of the major barriers to accessing care in the area of cost and preventive services. It does it by getting rid of, or minimizing, high copays and high deductibles that are often overwhelming hurdles for women to access screening programs. We know that screening is important and early detection is important because it saves lives. But it also saves money. It does it by reducing the top diseases that are killing women today, or certainly impairing their lives. Today, according to the CDC, the top killers of women are cancer-- breast cancer, cervical cancer, colorectal cancer, ovarian cancer. Also upfront and high on the list is lung cancer which, if identified early, can be treated with less invasive procedures and with lower costs. Another top killer of women is heart and vascular disease. And then there are the silent killers that often go undetected, such as diabetes, which can result in terrible consequences, such as the loss of an eye, the loss of a limb, or the loss of a kidney. We now have screenings that are proven to detect these diseases early. Guaranteed access to these screenings, as I said, will save money and lives. If we look at where women are today, we find women often forgo those critical preventive screenings because they simply cannot afford it, or their insurance company won't pay for it unless it is mandated by State law. Many women right now don't have insurance at all--seventeen million women in the United States of America are uninsured--or when they are insured, they have to pay large out-of-pocket expenses. Three in five women have significant problems paying their medical bills. Women are more likely than men to neglect care or treatment because of cost. Fourteen percent of women report they delay or go without needed health care. Women of childbearing age incur 68 percent more out-of-pocket health care costs than men, simply because of the maternity aspect. Women are often faced with the punitive practices of insurance companies. No. 1 is gender discrimination. Women often pay more and get less. For many insurance companies, simply being a woman is a preexisting condition. Let me repeat that. For many insurance companies, simply being a woman is a preexisting condition. We pay more because of our gender, anywhere from 2 percent to over 100 percent. A 25-year-old woman is charged up to 45 percent more than a 25-year-old male in the same identified health status. A 40-year-old woman is charged anywhere from 2 percent to 140 percent more than a 40-year-old man with the same health status for the same insurance policy. What does my amendment do? It guarantees access to those critical preventive services for women to combat their No. 1 killers. We will provide these services at minimal cost. The overall cost of my amendment has been scored by CBO. It says the cost is $1 billion. The majority leader, the Democratic leader, has provided opportunities to meet this cost. This amendment eliminates this big barrier of copayments and deductibles. Let's talk about the benefit package. This benefit package is based on HRSA recommendations. It is based also on the recommendations of CDC. If this amendment passes, women will have access to the same preventive health services as the women in Congress have. If this passes, again, the women of America will have access to the same preventive services that we women in Congress have. What does that mean? It means a mammogram, if your doctor says you need it; screening for cervical cancer, if your doctor says you need it; that check on diabetes, if your doctor is worried about you; and along with the symptoms related to menopause, there are other things, such as a loss of weight; and they may want to know at this juncture if you have diabetes. If you know that at 40, you are less likely to need kidney dialysis when you are 60. The pending bill doesn't cover key preventive services, such as annual screenings for women of all ages to focus on our unique health needs. We know that for many people--for example, there are 15 million people in America with diabetes, and half are women. Often pregnant women with diabetes don't get the proper prenatal care. Heart disease is one of the top two leading causes of death in women--cancer and heart disease. Every year, over 267,000 women die from heart attacks. Women are generally unaware of their heart risks. My amendment would, again, ensure heart disease screening for women. Remember that famous study that said ``take an aspirin a day to keep a heart attack away.'' It was done on 10,000 male medical residents, and not one woman was included. Thanks to a bipartisan effort, Bernadine Healy, NIH, and the women of the Senate, supported by the good guys of the Senate, were able to get that screening for women, get that evaluation. We know we manifest things differently than guys do. Now we are on our way to detection--if you can afford to have a doctor and if you can afford to have the screening. My amendment also guarantees screenings for breast cancer--yes, for mammograms. We don't mandate that you have a mammogram at age 40. What we say is discuss this with your doctor. But if your doctor says you need one, you are going to get one. Studies have found mammogram screening decreases breast cancer among women by over 40 percent. Regular Pap smears reduce cervical cancer by 40 percent. This year, over 4,000 women will die of cervical cancer. My amendment does focus on women's health needs. Keeping a woman healthy not only impacts her own life but that of her family. It impacts her ability to care for her child or an aging parent. Early detection saves money by treating diseases early. Screening tests for breast and cervical cancer cost about $150, but the treating of advanced breast cancer is over $10,000 and can even go much higher. The treating of early stages of cervical cancer is $13,000 and can go much higher. My amendment also leaves the decision of which preventive services a patient will use between the doctor and the patient. The health reform debate is focused on what you should have when. We agree. Decisions should be made in doctors' offices, not in the office of a Member of Congress or the office of an insurance executive. The decision about what is medically appropriate and medically necessary is between a woman and her doctor. The authors of the bill have done a very good job in protecting women in many areas. This actually refines and improves this particular issue. That is why I support the overall health reform bill providing universal access to health care for over 90 percent of the American people, ending those punitive practices of the insurance companies, stabilizing and strengthening Medicare, and improving quality in public health by using innovation and preventive services and quality. We can pass a health reform bill. I conclude by saying that we will end the confusion about what is needed in the area of preventive health services for women when our coverage is often skimpy and spartan. We want to make sure what we do enables us to have access to these comprehensive services. I hope this amendment is adopted unanimously. I believe good people on both sides of the aisle will believe in its underlying premise: that early detection and screening save lives and save money. Often those things unique to women have not been included in health care reform. Today we guarantee it and we assure it and we make it affordable by dealing with copayments and deductibles in a way CBO believes is fiscally achievable. In the long run, I think by doing this it will mean a lot to families, and it will mean a lot to the Federal budget. Mr. President, I yield the floor.

Ms. MIKULSKI

Ms. MIKULSKI. Madam President, I wish to pay to tribute the life and legacy of Malcolm Sherman. Malcolm Sherman was part of that extraordinary generation that fought for America during World War II, and then fought for what America stands for during the rest of his life. He joined the Marines after the Japanese attack on Pearl Harbor and served during the Guadalcanal campaign. When he returned home, he built a family with his beloved wife Mimi, and he built a career in real estate. He truly lived his life according to the Jewish principle of ``tikkun olam''--the repair of the world through the pursuit of social justice. He worked for peace and civil rights throughout his life. He also was a leader in the effort to ending segregation and discrimination in housing. Perhaps his greatest legacies are his children and grandchildren, who live by his principles of service. I ask that an obituary of Mr. Sherman written by Frederick Rasmussen of the Baltimore Sun be printed in the Record. The information follows.

Ms. MIKULSKI

Ms. MIKULSKI. Madam President, I rise today to pay tribute to my friend and colleague, Senator Robert C. Byrd from West Virginia. Today, Senator Byrd becomes the longest serving Member of the U.S. Senate, the longest serving Member of the U.S. Congress, and the longest serving Member in Congressional history. Today, Senator Byrd marks his 20,744th day in the Congress. This is an extraordinary milestone for a man who has played such an important role in the Senate. Senator Byrd has a compelling personal story. He lost his parents as a young child and was raised by his aunt and uncle in a coal mining community. He became the first in his family to attend college and law school, working a series of jobs to support himself and his family. He was blessed with a wonderful wife, Erma Ora Byrd, who was beloved in the Senate family. Senator Byrd never forgot where he came from. His work on behalf of the people of West Virginia is legendary. He never forgot the coal mining community he came from. He always worked to strengthen the opportunity ladder that he used to put himself through college and law school. He never forgot the people and communities that too often are left out and left behind. When I first came to the U.S. Senate in 1987, Senator Byrd was the majority leader. He helped me get on some of the best committees, including the Appropriations Committee. Senator Byrd helped me learn the arcane Senate procedure. He helped me learn the ropes on the Appropriations Committee and how the appropriations process could be used to help communities and people in Maryland--and to create jobs. As majority leader and as chairman, Senator Byrd set a tone of bipartisanship. He worked across the aisle to meet the day-to-day needs of his constituents and the long-range needs of our Nation. I join my colleagues in celebrating Senator Byrd's many accomplishments--and in thanking him for his friendship.

Ms. MIKULSKI

Ms. MIKULSKI. Madam President, I ask unanimous consent to speak as in morning business for the purposes of introducing a very poignant bill.

Ms. MIKULSKI. I yield the floor and suggest the absence of a quorum.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, today I rise to introduce legislation that I am calling ``Rosa's Law.'' It began by listening to the people in my own State. It began when a mother told me a compelling story about her own daughter, her family's efforts to give her daughter an opportunity for an education and to be treated with respect and with dignity. And, at the same time, it began with the advocacy of not only she and her husband but of her entire family, including her 14 year old son, Nick, who testified at the Maryland General Assembly. As a result of their effort, I am introducing Rosa's Law. But I want to tell you about the family. I want to tell you about the Marcellinos--two determined parents with four children: Nick, age 14; Madeleine, age 12; Gigi, age 10; and Rosa, age 8. I wish you could have been with me in my office as I met with them, as I met with the parents and talked with the family. Last year, at a roundtable on special education, I met Nina Marcellino. She told me about her daughter Rosa and the fact that Rosa had been labeled at her school some years ago as ``mentally retarded'' and told me of the stigma, the pain, the anguish it caused both Nina and her husband, Rosa's brother and sisters as well as Rosa herself. The mother and father reached out to the advocacy organization, the Arc, to see what could be done to change the law. They then reached out to a member of the Maryland General Assembly in our own Maryland Legislature--a wonderful representative named Ted Sophocleus. Mr. Sophocleus introduced legislation in the Maryland General Assembly that would change the words ``mentally retarded'' and substitute that with the phrase ``an individual with an intellectual disability.'' That is why I stand on the Senate floor today to introduce, at the request of this family, legislation on behalf of this little girl and on behalf of all of the children of the United States of America who are labeled, stigmatized, and bear a burden the rest of their lives because of the language we use in the law books. My law simply changes the phrase ``mentally retarded'' to an ``individual with an intellectual disability.'' We do it in health, education, and labor policy without in any way negatively impinging upon either the educational or other benefits to which these children are entitled. When it came time to bring the bill before the General Assembly, the family was there. And who spoke up for Rosa? Well, her mom and dad had been speaking up for her. Her brother Nick and her sisters Madeleine and Gigi had been speaking up for her. This wonderful boy, Nick, at the time 13 testified before the general assembly and said: What you call people is how you treat them. ``What you call people is how you treat them.'' What you call my sister is how you will treat her. If you believe she is ``retarded,'' it invites taunts, it invites stigmas, it invites bullying, and it also invites the slammed doors of not being treated with respect and dignity. Nick's words were far more eloquent that day than mine are today. I want to salute Nick for standing up for his sister. But I think we need to stand up for all because in changing the language we believe it will be the start of new attitudes toward people with intellectual disabilities. Hopefully, people will associate these new words with the very able and valuable people that go to school, work, play soccer, or live next door. Eunice Shriver believed in this when she created the Special Olympics. She knew special needs children need special attention, but they can do very special things and look what she started. This bill has gotten unanimous support in the Maryland legislative body. It passed in Annapolis. A few weeks before this bill swept through the General Assembly, I had the opportunity to talk to Rosa's mom, Nina. I promised her then that if that bill passed the Maryland Legislature, I would bring it to the floor of the Senate. Well, it passed unanimously, Governor O'Malley has signed it, and today I stand before you introducing the legislation. It makes nominal changes to policy. It gets into Federal education, health, and labor law. It simply substitutes ``intellectual disability'' for ``mental retardation,'' ``individual with an intellectual disability'' for ``mentally retarded.'' This bill, as I can assure all who might be concerned, will not expand nor diminish services, rights, or educational opportunities. We vetted it with legal counsel. We reached out to the very wonderful advocacy groups in this field, and they concur that this legislation would be acceptable. The Senate has changed terminology for this population before. In the 1960s, Congress passed legislation where we took--I am almost embarrassed to say our law once referred to boys and girls as ``feeble- minded.'' We thought we were being advanced when we changed it to ``mentally retarded.'' Now, 40 years later, let's take another big step and change it to ``intellectual disability.'' This bill makes language used in the Federal Government consistent. The President's Committee on Mental Retardation was changed by Executive order so it is now the Committee on Individuals with Intellectual Disabilities. The CDC uses ``intellectual disability.'' The World Health Organization uses ``intellectual disability.'' I have always said the best ideas come from the people. ``Rosa's Law'' is a perfect example of effective citizen advocacy--a family that pulled together for their own, and in pulling together they are pulling us all along to a new way of thinking. I want to recognize the Marcellino family who is here with us in the gallery, and the namesake of the law, Rosa, whose picture is behind me, and she is also up there in the gallery today. It was indeed an honor to represent this family. I believe in our country people have a right to be heard, and we listen. They have a right to be represented, which I have tried to do. Now let's try to change the law. I also want to take this opportunity to thank my colleagues. It is a pleasure to work with Senators Harkin and Enzi, the chair and ranking member of the HELP Committee. I have their wholehearted support in working together. This is going to be a bipartisan bill. It is going to be a nonpartisan bill. We are going to check our party hats at the door and move ahead and tip our hats to these boys and girls. This bill is driven by passion for social justice and compassion for the human condition. We have done a lot to come out of the dark ages of institutionalization and exclusion when it comes to people with intellectual disabilities. I urge my colleagues to join me in going a step further. Cosponsor the legislation I offer on a bipartisan basis. Help me pass the law and know that each and every one of us can make a difference. When we work together, we can make change. I look forward to working with my colleagues in moving this bill forward in our legislative process.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I ask unanimous consent that the Committee on Agriculture, Nutrition, and Forestry be authorized to meet during the session of the Senate on November 17, 2009, at 10:30 a.m., in room 562 of the Russell Senate Office Building.

Ms. MIKULSKI. Mr. President, I ask unanimous consent that the Committee on Banking, Housing, and Urban Affairs be authorized to meet during the session of the Senate on November 17, 2009, at 3 p.m., to conduct a hearing entitled ``Protecting Consumers From Abusive Overdraft Fees: The Fairness and Accountability in Receiving Overdraft Coverage Act.''

Ms. MIKULSKI. Mr. President, I ask unanimous consent that the Committee on Commerce, Science, and Transportation be authorized to meet during the session of the Senate on November 17, 2009, at 2:30 p.m., in room 253 of the Russell Senate Office Building.

Ms. MIKULSKI. Mr. President, I ask unanimous consent that the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate on November 17, 2009, at 10 a.m., in room SD- 366 of the Dirksen Senate Office Building.

Ms. MIKULSKI. Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on November 17, 2009, at 2:15 p.m.

Ms. MIKULSKI. Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on November 17, 2009, at 3 p.m., to hold a hearing entitled ``The U.S. and the G-20: Remaking the International Economic Architecture.''

Ms. MIKULSKI. Mr. President, I ask unanimous consent that the Committee on Homeland Security and Governmental Affairs be authorized to meet during the session of the Senate on November 17, 2009, at 2:30 p.m., to conduct a hearing entitled ``H1N1 Flu: Getting the Vaccine to Where It Is Most Needed.''