Jay Rockefeller

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, there is a stark choice looming before Congress. It is the choice between enacting a comprehensive reform bill that truly improves our health care system for the American people or enacting a mediocre reform bill that largely maintains the status quo--which is an ineffective and costly health care system run by the insurance industry. I know that most of my colleagues want the former--a 21st Century health care system that provides meaningful and affordable coverage for all, improves health outcomes, and brings accountability and responsibility back into health care. I am absolutely convinced that the inclusion of a strong public health insurance plan option is the only way to guarantee that all consumers have affordable, adequate, and accountable options available in the insurance marketplace. It is for this reason that I rise today with my good friend, Senator Sherrod Brown of Ohio, to introduce the Consumers Health Care Act of 2009--legislation to provide a strong public plan option in the National Health Insurance Exchange. One of the most contentious, yet critical, pieces of the national health care reform effort is whether or not Americans should have the option to buy their health insurance from a publicly run organization. In other words, in addition to choosing among numerous health plans run by private insurers, should consumers also have the option of choosing an affordable, stable, and transparent public plan when they are deciding what is best for them and their families? I believe consumers should have the option of choosing a public plan. Opponents of giving Americans a public option regularly use alarmist rhetoric such as ``big government'' and ``socialized medicine.'' And, somehow, protecting the rights of private health insurers to make profits has become more important to some than offering Americans the choice of a plan that seeks to insure everyone, no matter how sick, that is less expensive, and that is responsible to the American people--not to private profit-seeking stockholders. I'm not sure when the word ``public'' became such a bad word in the eyes of some of my colleagues. Public means acting in the interest of the general public--which is exactly what we should aspire to in comprehensive health reform. The private health insurance market has significantly contributed to the broken nature of our health care system, with a long history of cutting coverage off or charging too much for too little. A public plan option--repeat, option--is an effective way to bring competition to the insurance market, hold down costs, and encourage innovation and quality improvements. To deny this option is not only shortsighted, but downright harmful. Everyone knows the sobering statistics that have highlighted the need for comprehensive health reform. More than 45 million Americans are uninsured and another 25 million are underinsured. Since 1909, the average health insurance premium for a family has increased by 119 percent, from $5,791 in 1999 to $12,680 in 2008. Yet, Americans have seen their benefits decrease and have faced substantially larger out- of-pocket expenses. An estimated 62 percent of all personal bankruptcies involve medical expenses and 78 percent of the individuals who cited medical expenses in their bankruptcy claims had health insurance. Health care costs already consume 17 percent of the United State's gross domestic product, which everyone can agree is unsustainable. However, representing the great state of West Virginia has shown me that the need for health reform is far more essential and personal than frightening statistics could ever show. I have listened at roundtable discussions where West Virginians described how the current health care system has failed them. One woman was really struggling to care for both herself and her son. She was uninsured because her son, who had a serious brain disorder, needed 24 hour a day, seven day a week, assistance. Another family wrote to me because their son, who was born with serious congenital heart defects, had reached the $1 million limit on his mother's insurance policy within the first nine months of his life. They were unsure of how to obtain lifesaving treatment for their son, now that the insurance company would no longer pay for his care. I have heard from countless other West Virginians who have been unable to find affordable health care, or have figured out too late that the health insurance they had was inadequate for what they needed. As Congress works to achieve the transformative reform necessary to create a sustainable health care system, a vital component of this reform is the inclusion of a strong public plan option like the Consumer Choice Health Plan included in the Consumers Health Care Act. A public plan will help establish a new insurance framework, one that compels insurers to provide Americans with the best value for their health care at the best price, rather than the current insurance framework, which is focused on avoiding risk and increasing profits. The Consumer Choice Health Plan will be available for all individuals and small businesses, regardless of health status, and will not be concerned with paying a CEO salary or broker commissions. The Consumers Health Care Act will increase transparency and accountability throughout the health insurance market, as well as give individuals guaranteed access to health care coverage should they be denied or priced out of affordable private insurance coverage. Currently, insurers are allowed to operate in a black box, with little oversight of their coverage and payment decisions. Individuals with pre-existing conditions are routinely denied access to affordable care. For years, United Health was able to underpay providers and overcharge patients for out-of-network services. The Consumers Health Care Act will address this and other issues by bringing greater transparency to the private health insurance market. Consumer Choice Health Plans will serve as a vital safety-net of coverage for individuals and families that have been unable to obtain affordable and comprehensive health care coverage through the private market. A private insurance company's desire to earn greater profits will always trump over the need to make health care coverage affordable and accessible to all Americans, and greater insurance regulation is not enough. The Consumers Health Care Act is necessary in order to achieve the sustainable change that the health care system in this country needs. I trust the good sense of the American public to choose the health coverage they want, and they deserve the choice of a public plan with lower costs and the guarantee of always being there when they need it. The American people trust us to get this right and deliver the best coverage options that will keep their families healthy and safe. The days of packaging half-baked legislation into a bill and calling it transformative reform when it is not have to end now, or the shame is on all of us: Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, there is a stark choice looming before Congress. It is the choice between enacting a comprehensive reform bill that truly improves our health care system for the American people or enacting a mediocre reform bill that largely maintains the status quo--which is an ineffective and costly health care system run by the insurance industry. I know that most of my colleagues want the former--a 21st Century health care system that provides meaningful and affordable coverage for all, improves health outcomes, and brings accountability and responsibility back into health care. I am absolutely convinced that the inclusion of a strong public health insurance plan option is the only way to guarantee that all consumers have affordable, adequate, and accountable options available in the insurance marketplace. It is for this reason that I rise today with my good friend, Senator Sherrod Brown of Ohio, to introduce the Consumers Health Care Act of 2009--legislation to provide a strong public plan option in the National Health Insurance Exchange. One of the most contentious, yet critical, pieces of the national health care reform effort is whether or not Americans should have the option to buy their health insurance from a publicly run organization. In other words, in addition to choosing among numerous health plans run by private insurers, should consumers also have the option of choosing an affordable, stable, and transparent public plan when they are deciding what is best for them and their families? I believe consumers should have the option of choosing a public plan. Opponents of giving Americans a public option regularly use alarmist rhetoric such as ``big government'' and ``socialized medicine.'' And, somehow, protecting the rights of private health insurers to make profits has become more important to some than offering Americans the choice of a plan that seeks to insure everyone, no matter how sick, that is less expensive, and that is responsible to the American people--not to private profit-seeking stockholders. I'm not sure when the word ``public'' became such a bad word in the eyes of some of my colleagues. Public means acting in the interest of the general public--which is exactly what we should aspire to in comprehensive health reform. The private health insurance market has significantly contributed to the broken nature of our health care system, with a long history of cutting coverage off or charging too much for too little. A public plan option--repeat, option--is an effective way to bring competition to the insurance market, hold down costs, and encourage innovation and quality improvements. To deny this option is not only shortsighted, but downright harmful. Everyone knows the sobering statistics that have highlighted the need for comprehensive health reform. More than 45 million Americans are uninsured and another 25 million are underinsured. Since 1909, the average health insurance premium for a family has increased by 119 percent, from $5,791 in 1999 to $12,680 in 2008. Yet, Americans have seen their benefits decrease and have faced substantially larger out- of-pocket expenses. An estimated 62 percent of all personal bankruptcies involve medical expenses and 78 percent of the individuals who cited medical expenses in their bankruptcy claims had health insurance. Health care costs already consume 17 percent of the United State's gross domestic product, which everyone can agree is unsustainable. However, representing the great state of West Virginia has shown me that the need for health reform is far more essential and personal than frightening statistics could ever show. I have listened at roundtable discussions where West Virginians described how the current health care system has failed them. One woman was really struggling to care for both herself and her son. She was uninsured because her son, who had a serious brain disorder, needed 24 hour a day, seven day a week, assistance. Another family wrote to me because their son, who was born with serious congenital heart defects, had reached the $1 million limit on his mother's insurance policy within the first nine months of his life. They were unsure of how to obtain lifesaving treatment for their son, now that the insurance company would no longer pay for his care. I have heard from countless other West Virginians who have been unable to find affordable health care, or have figured out too late that the health insurance they had was inadequate for what they needed. As Congress works to achieve the transformative reform necessary to create a sustainable health care system, a vital component of this reform is the inclusion of a strong public plan option like the Consumer Choice Health Plan included in the Consumers Health Care Act. A public plan will help establish a new insurance framework, one that compels insurers to provide Americans with the best value for their health care at the best price, rather than the current insurance framework, which is focused on avoiding risk and increasing profits. The Consumer Choice Health Plan will be available for all individuals and small businesses, regardless of health status, and will not be concerned with paying a CEO salary or broker commissions. The Consumers Health Care Act will increase transparency and accountability throughout the health insurance market, as well as give individuals guaranteed access to health care coverage should they be denied or priced out of affordable private insurance coverage. Currently, insurers are allowed to operate in a black box, with little oversight of their coverage and payment decisions. Individuals with pre-existing conditions are routinely denied access to affordable care. For years, United Health was able to underpay providers and overcharge patients for out-of-network services. The Consumers Health Care Act will address this and other issues by bringing greater transparency to the private health insurance market. Consumer Choice Health Plans will serve as a vital safety-net of coverage for individuals and families that have been unable to obtain affordable and comprehensive health care coverage through the private market. A private insurance company's desire to earn greater profits will always trump over the need to make health care coverage affordable and accessible to all Americans, and greater insurance regulation is not enough. The Consumers Health Care Act is necessary in order to achieve the sustainable change that the health care system in this country needs. I trust the good sense of the American public to choose the health coverage they want, and they deserve the choice of a public plan with lower costs and the guarantee of always being there when they need it. The American people trust us to get this right and deliver the best coverage options that will keep their families healthy and safe. The days of packaging half-baked legislation into a bill and calling it transformative reform when it is not have to end now, or the shame is on all of us: Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, once tourists come to West Virginia, they often return. From the Appalachian Trail to the Monongahela National Forest, the beauty of our State is unparalleled and our people are welcoming. Tourism in West Virginia also creates jobs. As a result, our State spends money to promote West Virginia in the surrounding States as a tourist destination. But we surely would welcome more international tourists as well. Increasing overseas travel and tourism is a shovel-ready economic stimulus that will create thousands of jobs across the country-- including West Virginia. With the dollar at a low compared to other currencies, America is a bargain. We are open and ready for business. Unfortunately, the rest of the world doesn't know it. Compared to other countries, the United States fails to effectively advertise and promote itself overseas as a tourism destination. In 1992, the United States attracted 9.4 percent of all international tourists; in 2007, the United States attracted only 6.8 percent. Since 2000, the United States' share of international travelers has declined by 20 percent. Meanwhile, the rest of the world is promoting itself--often employing the best Madison Avenue techniques used for marketing heart medications and luxury cars. We all see enticing television advertisements to visit Italy, Greece, Jamaica, Ireland, Canada, Australia and Brazil. But few residents of those countries see advertisements enticing them to come to the United States--and to spend their money in the United States. If the United States had simply kept pace with global travel trends, 58 million more overseas travelers would have visited the United States between 2000 and 2008. Those travelers would have generated 245,000 tourism jobs in 2008 alone. The average overseas visitor to the United States spends $4,500 per visit. That means every 23,000 overseas visitors pump $100 million into the U.S. economy. We have spent billions of dollars to prevent the collapse of industries and billions of dollars to put people to work. But today, through the Travel Promotion Act of 2009, just $10 million will plant the seeds for leveraging private sector investment to increase the number of U.S.-based tourism jobs. Americans always have had a healthy skepticism about the role of government--what it should do and what it shouldn't do. To promote travel and tourism, we have long thought that the private sector--the companies that make money from tourism--should promote themselves. And some of the larger private sector players have promoted their specific interests overseas. But a private sector effort to fund a general ``Come to America'' campaign targeting overseas travelers has never fully materialized. When a resort or theme park spends advertising money overseas, they want the viewers to visit their destination, not just the United States. Some of our larger States promote themselves overseas. But, as you would expect, the advertisements entice foreigners to visit their States. As a result, potential tourists overseas may not be aware that the United States has far more to offer than California, New York, and Florida. They likely have never heard of hiking, rafting, or fishing in the mountains of West Virginia. For anyone who has not enjoyed those activities in my State, you are really missing something special. Because the hotels and tourist destinations of States like West Virginia cannot effectively launch their own international promotional campaigns, we must find a mechanism to pool and leverage resources so that these States become part of the international tourism economy. After the terrorist attacks of 2001, the subsequent security measures deterred overseas tourists. Many of those entry problems have been corrected now. But the negative perception still remains. Potential foreign tourists still are reluctant to deal with what they believe will be a difficult time entering the United States. No private sector company--and certainly not the hotels and tourist destinations in the States I have mentioned--will spend their own money to promote the improved process for entering the United States. Only a national, coordinated campaign--with some help from the Federal Government--can accomplish that goal. We have occasionally appropriated one-shot advertising campaigns to promote the United States overseas. But the Travel Promotion Act of 2009 will create a sustained and stable public-private sector partnership in which Federal seed money is leveraged to increase private investment to promote tourism overseas. The bill would establish a travel promotion fund that is capitalized by a $10 fee paid by foreign travelers from visa-waiver countries. The bill would require the travel industry to match those contributions--50 percent in 2011 and 100 percent thereafter. The fund would receive $10 million in Federal seed money for 2010. The new fee for foreign travelers would cumulatively provide the means to lure them to the United States, but is too small to have any impact on an individual's decision whether to come to the United States. The funds would be used for overseas advertising campaigns to promote travel to the United States, including to areas not traditionally visited by overseas tourists. More importantly, the advertising campaigns would educate potential foreign travelers about U.S. visa and entry policies. Removing fears about entering the United States would dramatically increase tourism among overseas residents who might consider a range of vacation choices. If foreign tourists better understand U.S. entry and visa policies, the more likely it is that they will come to the United States--and the more likely it is that they will spend their money here, creating the jobs we so desperately need. Drug companies and luxury automakers spend billions of dollars on advertising for one reason: it works. The State of Florida estimates that its own State travel promotion campaign returns $3 in increased sales tax revenue for every dollar spent on promotion. The countries advertising foreign tourist destinations on American television every night would not spend the money to do it but for one reason: it works. The United States--with so many spectacular destinations--must embark on its own worldwide promotion program because it will work. A sustained and stable tourism promotion program is a small investment that will generate huge dividends when foreign tourists spend their money in the United States, generating jobs and local revenue. Foreigners visiting the first time have the potential to become repeat visitors and will tell their friends to visit as well. In addition to stimulating jobs, we will improve America's image around the world through tourism. People who visit the United States are more likely to have a favorable opinion of America when they return home. Developing that kind of good will in a changing world makes travel promotion worthwhile. I would like to thank the sponsors of this bill: Senator Dorgan, Senator Inouye, Senator Reid, Senator Klobuchar, Senator Begich, Senator Mikulski, Senator Bennet, Senator Udall of New Mexico, Senator Udall of Colorado, Senator Ensign, Senator Martinez, and Senator Vitter. America is open for business. The people who work in our tourism industries are ready to work. Now we need to tell the world. vote explanation

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, oceans affect human health both directly and indirectly from the water quality at our beaches to the safety of seafood at U.S. markets; therefore, it is important to understand the relationship between environmental stressors, coastal conditions, climate change, and human health. Over the last several decades ocean and coastal waters have become channels for environmental threats to human health including infectious disease, harmful toxins from algae, and chemical pollutants from contact with contaminated seafood, polluted drinking water, and dirty beaches. Since the 1960s, scientists have realized that marine plants, animals, and microbes can also produce substances that benefit human health, such as anticancer, anti-inflammatory, and antibiotic medicines. Through well designed research and monitoring programs, we can maximize the health benefits derived from the oceans, improve the safety of American seafood, reduce beach closures, and detect emerging threats to human health in a proactive rather than reactive manner. In 2004, Congress enacted the Oceans and Human Health Act which authorized the National Oceanic and Atmospheric Administration, the National Science Foundation, and the National Institutes of Health to conduct research to improve understanding of the connection between the oceans and public health. Today, Senator Inouye, Senator Cantwell, and I are introducing the Oceans and Human Health Reauthorization Act of 2009. This legislation would direct the President, working through the National Science and Technology Council, to coordinate a national research program to improve understanding of the role of the oceans, coasts and Great Lakes in human health and deliver information, products, and services to assist the nation in reducing public health risks, including those related to climate change, and enhancing health benefits from the ocean. It would establish the Oceans and Human Health Task Force that will include a number of federal agencies, such as the National Oceanic and Atmospheric Administration, the National Institutes of Health, the National Science Foundation, the National Institute for Environmental Health Science, and the Center for Disease Control. It would direct the Interagency Oceans and Human Health Task Force to develop an implementation plan that: establishes the goals and priorities for federal research that advance scientific understanding of the connections between oceans and human health; provides information for the prediction, surveillance, and forecasting of marine-related public health problems, including those related to climate change; and uses the biological and chemical potentials of the oceans to develop new products for the prevention and treatment of diseases and to increase our understanding of the biological properties of ocean resources. The legislation would also reauthorize the National Oceanic and Atmospheric Administration's Oceans and Human Health Initiative and establish a Distinguished Scholars program for scientists to work with the National Oceanic and Atmospheric Administration on the oceans and human health initiative. Importantly, this bill would recognize the effects of climate change on oceans and human health. The effects of climate change do not stop with sea level rise and increased water temperatures. Without physical and ecological boundaries, climate change causes a cascade of effects throughout ocean environments that can result in surprising impacts on ocean and human health. This reauthorization bill would include climate change and oceans and human health as a new research area. Our oceans impact every American and they are a foundation of America's economy. The research and monitoring supported by this bill will help make sure we have healthy oceans where people can swim, fish, play, and eat seafood. It will also help us develop new blue jobs in marine natural products and lead to new discoveries in medicines to cure deadly diseases. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, oceans affect human health both directly and indirectly from the water quality at our beaches to the safety of seafood at U.S. markets; therefore, it is important to understand the relationship between environmental stressors, coastal conditions, climate change, and human health. Over the last several decades ocean and coastal waters have become channels for environmental threats to human health including infectious disease, harmful toxins from algae, and chemical pollutants from contact with contaminated seafood, polluted drinking water, and dirty beaches. Since the 1960s, scientists have realized that marine plants, animals, and microbes can also produce substances that benefit human health, such as anticancer, anti-inflammatory, and antibiotic medicines. Through well designed research and monitoring programs, we can maximize the health benefits derived from the oceans, improve the safety of American seafood, reduce beach closures, and detect emerging threats to human health in a proactive rather than reactive manner. In 2004, Congress enacted the Oceans and Human Health Act which authorized the National Oceanic and Atmospheric Administration, the National Science Foundation, and the National Institutes of Health to conduct research to improve understanding of the connection between the oceans and public health. Today, Senator Inouye, Senator Cantwell, and I are introducing the Oceans and Human Health Reauthorization Act of 2009. This legislation would direct the President, working through the National Science and Technology Council, to coordinate a national research program to improve understanding of the role of the oceans, coasts and Great Lakes in human health and deliver information, products, and services to assist the nation in reducing public health risks, including those related to climate change, and enhancing health benefits from the ocean. It would establish the Oceans and Human Health Task Force that will include a number of federal agencies, such as the National Oceanic and Atmospheric Administration, the National Institutes of Health, the National Science Foundation, the National Institute for Environmental Health Science, and the Center for Disease Control. It would direct the Interagency Oceans and Human Health Task Force to develop an implementation plan that: establishes the goals and priorities for federal research that advance scientific understanding of the connections between oceans and human health; provides information for the prediction, surveillance, and forecasting of marine-related public health problems, including those related to climate change; and uses the biological and chemical potentials of the oceans to develop new products for the prevention and treatment of diseases and to increase our understanding of the biological properties of ocean resources. The legislation would also reauthorize the National Oceanic and Atmospheric Administration's Oceans and Human Health Initiative and establish a Distinguished Scholars program for scientists to work with the National Oceanic and Atmospheric Administration on the oceans and human health initiative. Importantly, this bill would recognize the effects of climate change on oceans and human health. The effects of climate change do not stop with sea level rise and increased water temperatures. Without physical and ecological boundaries, climate change causes a cascade of effects throughout ocean environments that can result in surprising impacts on ocean and human health. This reauthorization bill would include climate change and oceans and human health as a new research area. Our oceans impact every American and they are a foundation of America's economy. The research and monitoring supported by this bill will help make sure we have healthy oceans where people can swim, fish, play, and eat seafood. It will also help us develop new blue jobs in marine natural products and lead to new discoveries in medicines to cure deadly diseases. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Annual and Lifetime Health Care Limit Elimination Act of 2009, legislation that would prohibit insurance companies from imposing any annual or lifetime limit on any individual or group health insurance policy, thus providing continuity and affordability of health care coverage for those with serious chronic conditions. Each year, thousands of insured Americans face daunting medical expenses and challenges when they reach the annual or lifetime limit on their individual or employer-sponsored health insurance plan. Once a beneficiary's medical costs have exceeded the annual or lifetime limit of their plan, the insurance company no longer pays for the medical costs incurred by that individual. In April, I held a roundtable discussion on health care in Raleigh County. There, I met a woman who had myelodysplastic syndrome, which is a non-curable pre-leukemia type disease. Unfortunately, her husband's insurance policy had a lifetime limit of $300,000, which she had reached. Another young West Virginian, born with serious congenital heart defects, reached the $1 million limit on his mother's insurance policy within the first nine months of his life. The limits on their health insurance plans have left these families struggling to find a way to pay for the expensive and life-sustaining treatments their loved ones desperately need. Unfortunately, these two West Virginia families are not alone. In 2007, it was estimated that 55 percent of all people who obtain health benefits from their employer have some type of lifetime limit on their plan, an increase of approximately 4 percent since 2004. More than 23 percent of people have health insurance plans that impose limits of $2 million or less. Also, some health insurance policies renew less frequently than annually and contain annual limits to reduce the medical expenses paid by insurance companies. It is estimated that approximately 20,000 to 25,000 people no longer have health care benefits through their employers because of lifetime limits on their employer-sponsored health care plans. When individuals with serious chronic conditions--such as transplant recipients, patients living with hemophilia, and newborns with life- threatening illnesses--hit the annual or lifetime limits on their policies, they are often left with very few options to meet their health care needs. Individuals and families that can afford it can try to pay for their health care costs completely out-of-pocket. However, this is rarely financially feasible; therefore, many people are forced to leave good, stable jobs and seek different employment in an effort to obtain new employer-sponsored coverage. Unfortunately, new enrollees are often subject to a waiting period for coverage if there was any break in their previous health care coverage. Should an individual try to find health insurance in the individual market, coverage is likely to be prohibitively expensive. More often then not, these individuals are denied coverage altogether because of the insurer's pre-existing condition exclusion. Annual or lifetime limits can force people to turn to public programs such as Medicaid, or spend down their savings to meet the financial restrictions of the program. Others are forced to forgo treatment altogether, which can lead to serious complications and greater long-term health care costs. It is time to stop health insurance companies from imposing annual or lifetime limits on health insurance policies. The beneficiaries affected by these limits have paid their premiums, deductibles, and copays faithfully, only to lose access to life-saving treatment when they need care the most. This is unacceptable and I encourage my colleagues to join me in supporting the Annual and Lifetime Health Care Limit Elimination Act. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER. Mr. President, I rise today with my friends and colleagues--Senators Collins, Kohl, Wyden and Carper--to introduce the Advance Planning and Compassionate Care Act of 2009, comprehensive legislation that recognizes the critical importance of advance care planning and quality end-of-life care. Senator Collins and I have worked on this legislation for over a decade--with the ultimate goal of one day passing comprehensive end-of-life care legislation. We are encouraged by the prospect of comprehensive health reform this year and believe that it is absolutely critical that end-of-life care provisions be included. In preparation for the impending health reform debate, Senator Collins and I decided last year that it was time to update our Advance Planning and Compassionate Care Act to incorporate all of the best ideas out there on improving end-of-life care--including new and innovative approaches being implemented in the states, approaches suggested by scholars in this field, and recommendations based on our own experiences with loved ones facing the end of life. This new and improved bill is truly a labor of love and we are certainly hopeful that we can finally get something comprehensive and meaningful done for the millions of individuals and families faced with the agonizing issues surrounding the end of life. A modern health care delivery system is well within our reach and something that we can start to achieve this year. A critical component of a modernized health system is the ability to address the health care needs of patients across the life-span--especially at the end of life. Death is a serious, personal, and complicated part of the life cycle. Yet, care at the end of life is eventually relevant to everyone. Americans deserve end-of-life care that is effective in providing information about diagnosis and prognosis, integrating appropriate support services, fulfilling individual wishes, and avoiding unnecessary disputes. The bitter dispute that played out publicly for Terri Schiavo and her family is an agonizing experience that countless other families quietly face over the care of a loved one because clear advance directives are not in place. End-of-life care is a very delicate, yet important, issue and we must act to ensure that all Americans have the dignity and comfort they deserve at the end of life. Services should be available to help patients and their families with the medical, psychological, spiritual, and practical issues surrounding death. Most people want to discuss advance directives when they are healthy and they want their families involved in the process. Yet, the vast majority of Americans have not completed an advance directive expressing their final wishes. In 2007, RAND conducted a comprehensive review of academic literature relating to end-of-life decision-making. This review found that only 18 to 30 percent of Americans have completed some type of advance directive expressing their end-of-life wishes. RAND also found that acutely ill individuals, for whom these decisions are particularly relevant, complete advance directives at only slightly higher rates--35 percent of dialysis patients and 32 percent of Chronic Obstructive Pulmonary Disease, COPD, patients. Perhaps most alarmingly, between 65 and 76 percent of physicians whose patients had an advance directive were unaware of its existence. In its present form, end-of-life planning and care for most Americans is perplexing, disjointed, and lacking an active dialogue. In its 1997 report entitled Approaching Death: Improving Care at the End of Life, the Institute of Medicine found several barriers to effective advance planning and end-of-life care that still persist today. In addition to the substantial burden of suffering experienced by many at the end of life, there are also significant financial consequences for family members and society as a whole that stem from ineffective end-of-life care. According to one Federal evaluation, 80 percent of all deaths occur in hospitals--the most costly setting to deliver care--even though most people would prefer to die at home. Current studies indicate that around 25 percent of all Medicare spending occurs in the last year of life. Largely because of their poorer health status, dually eligible beneficiaries have Medicare costs that are about 1.5 times that of other Medicare beneficiaries. Research also shows significant variation in expenditures at the end-of-life by geography and hospital, without evidence that greater expenditures are associated with better outcomes or satisfaction. We must find ways to improve the quality of end-of-life care. Quality measures provide not only information for oversight, but data with which to improve care practices and models. No core sets of end-of-life quality measures are required across provider settings. Even for certified hospices, reporting of quality measures has only recently been required, with each hospice deciding its own indicators. Hospice surveys are behind schedule and not conducted frequently enough. Facilitating greater advance planning and improving care at the end of life also requires an adequate workforce. Unfortunately, there is a substantial shortage of health professionals who specialize in palliative care. There is a severe shortage of physicians and advance practice nurses trained in palliative medicine. Contributing to these shortages is a shortage of medical and nursing school faculty in palliative medicine and care. There is also a lack of content about end-of-life care in medical school curricula. Medical students in general receive very little formal end-of-life education. Almost half of medical residents in a survey felt unprepared to address patients' fears of dying. For Americans to have a full range of choices in end- of-life care, we must strengthen our health care workforce, including palliative care education of physicians and other health professionals. Care at the end-of-life can, and should, be better and more consistent with what Americans want. The Advance Planning and Compassionate Care Act takes enormous steps forward to fully inform consumers of their treatment options at the end of life and to actually address patient end-of-life care needs when the time comes. To promote advance care planning, this legislation provides both patients and their physicians with the information and tools to help them in this most personal and often difficult discussion. Last year's Medicare Improvements for Patients and Providers Act, PL 110-275, took a significant step forward toward improving advance care planning. MIPPA included a provision that I authored, requiring physicians to provide an advance care planning consultation as part of the Welcome to Medicare physical exam. Unfortunately, less than 10 percent of new enrollees use the Welcome to Medicare visit. The MIPPA provision also does not address the advance care planning needs of existing Medicare enrollees. The legislation we are introducing today establishes physician payment under Medicare, Medicaid, and CHIP for vital patient advance care planning conversations. It provides help in documenting decisions from these conversations in the form of advance directives and in the form of actionable orders for life sustaining treatment. It also takes steps to address the problem of accessing advance directives when needed, including state grants for electronic registries. This legislation establishes a National Geriatric and Palliative Care Service Corps, modeled after the National Health Service Corps, to increase the woefully inadequate supply of geriatric and palliative specialists and to even out their geographic distribution. It adopts MedPAC's 2009 hospice payment reforms aimed at aligning payment with the actual trajectory of resources expended over hospice episodes of care, while remaining within the constraints of current reimbursement. Demonstration projects are funded to explore ways to better meet the needs of patients over longer time periods than the 6-month prognoses inherent in the hospice benefit. Certification standards and processes are developed for hospital- based palliative care teams. Such teams are critical to providing consultation and care to dying patients. Quality measurement and oversight are strengthened, with development of end-of-life measures across care settings and greater data reporting requirements of hospices--so that we can make sure the hospice benefit is keeping pace with the changing diagnostic mix of patients that hospice serves. Finally, this bill takes the important step of establishing a National Center on Palliative and End-of-Life Care within the NIH. This is a vital step toward prioritizing biomedical research in the areas of palliative and end-of-life care. It will also serve as a symbol to remind us that, as in other phases of life, we need care at the end of life that addresses our individual needs and circumstances. Death is a serious, personal, and complicated issue that is eventually relevant to each and every one of us. Americans deserve end- of-life care that is effective in fulfilling individual wishes, avoiding unnecessary disputes, and, most importantly, providing quality end-of-life care. Therefore, I urge my colleagues to join us in improving end-of-life care and reducing the amount of grief that inevitably comes with losing those who we hold dear. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER. Mr. President, today I am pleased to introduce with my distinguished colleague Senator Olympia Snowe, bipartisan legislation known as the State Child Well-Being Research Act of 2009. Companion legislation has already been introduced in the House by Congressmen Fattah and Camp. This bill is designed to enhance child well-being by requiring the Secretary of Health and Human Services to facilitate the collection of state-specific data based on a defined set of indicators. The well-being of children is important to both national and State governments. Therefore, data collection is a priority that cannot be ignored if we hope to make informed decisions on public policy. In 1996, Congress passed bold legislation, which I supported to dramatically change our welfare system. The driving force behind this reform was to promote the work and self-sufficiency of families and to provide the flexibility to States necessary to achieve these goals. States, which is where most child and family legislation takes place, have used this flexibility to design different programs that work better for the families who rely on them. The design and benefits available under other programs that serve children, ranging from the Children Health Insurance Program, CHIP, to child welfare services, can vary widely among States. It is obvious that in order for policy makers to evaluate child well- being, we need state-specific data on child well-being to measure the results. Current surveys provide minimal data on some important indicators of child well-being, but insufficient data is available on low-income families, geographic variation, and young children. Additionally, the information is not provided in a timely manner, which impedes legislators' ability to effectively measure child well-being and design effective programs to support our children. The State Child Well-Being Research Act of 2009 is intended to fill this information gap by collecting up-to-date, State-specific data that can be used by policymakers, researchers, and child advocates to assess the well-being of children. As we strive to promote quality programs, we need basic benchmarks to measure outcomes. Our bill would require that a survey examine the physical and emotional health of children, adequately represent the experiences of families in individual states, be consistent across states, be collected annually, articulate results in easy to understand terms, and focus on low-income children and families. This legislation also establishes an advisory committee, consisting of a panel of experts who specialize in survey methodology and indicators of child well-being, and the application of this data to ensure that the purpose is being achieved. Further, this bill avoids some of the problems in the current system by making data files easier to use and more readily available to the public. As a result, the information will be more useful for policy- makers managing welfare reform and programs for children and families. Finally, this legislation also offers the potential for the Health and Human Service Department to partner with private charitable foundations, like the Annie E. Casey Foundations, which has already expressed an interest in forming a partnership to provide outreach, support and a guarantee that the data collected would be broadly disseminated. This type of public-private partnership helps to leverage additional resources for children and families and increases the study's impact. Given the tight budget we face, partnerships make sense to meet this essential need. I hope my colleagues review this legislation carefully and choose to support it so that Federal and state policy makers and advocates have the information necessary to make good decisions for children. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today I am pleased to introduce with my distinguished colleague Senator Olympia Snowe, bipartisan legislation known as the State Child Well-Being Research Act of 2009. Companion legislation has already been introduced in the House by Congressmen Fattah and Camp. This bill is designed to enhance child well-being by requiring the Secretary of Health and Human Services to facilitate the collection of state-specific data based on a defined set of indicators. The well-being of children is important to both national and State governments. Therefore, data collection is a priority that cannot be ignored if we hope to make informed decisions on public policy. In 1996, Congress passed bold legislation, which I supported to dramatically change our welfare system. The driving force behind this reform was to promote the work and self-sufficiency of families and to provide the flexibility to States necessary to achieve these goals. States, which is where most child and family legislation takes place, have used this flexibility to design different programs that work better for the families who rely on them. The design and benefits available under other programs that serve children, ranging from the Children Health Insurance Program, CHIP, to child welfare services, can vary widely among States. It is obvious that in order for policy makers to evaluate child well- being, we need state-specific data on child well-being to measure the results. Current surveys provide minimal data on some important indicators of child well-being, but insufficient data is available on low-income families, geographic variation, and young children. Additionally, the information is not provided in a timely manner, which impedes legislators' ability to effectively measure child well-being and design effective programs to support our children. The State Child Well-Being Research Act of 2009 is intended to fill this information gap by collecting up-to-date, State-specific data that can be used by policymakers, researchers, and child advocates to assess the well-being of children. As we strive to promote quality programs, we need basic benchmarks to measure outcomes. Our bill would require that a survey examine the physical and emotional health of children, adequately represent the experiences of families in individual states, be consistent across states, be collected annually, articulate results in easy to understand terms, and focus on low-income children and families. This legislation also establishes an advisory committee, consisting of a panel of experts who specialize in survey methodology and indicators of child well-being, and the application of this data to ensure that the purpose is being achieved. Further, this bill avoids some of the problems in the current system by making data files easier to use and more readily available to the public. As a result, the information will be more useful for policy- makers managing welfare reform and programs for children and families. Finally, this legislation also offers the potential for the Health and Human Service Department to partner with private charitable foundations, like the Annie E. Casey Foundations, which has already expressed an interest in forming a partnership to provide outreach, support and a guarantee that the data collected would be broadly disseminated. This type of public-private partnership helps to leverage additional resources for children and families and increases the study's impact. Given the tight budget we face, partnerships make sense to meet this essential need. I hope my colleagues review this legislation carefully and choose to support it so that Federal and state policy makers and advocates have the information necessary to make good decisions for children. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today with my friends and colleagues--Senators Collins, Kohl, Wyden and Carper--to introduce the Advance Planning and Compassionate Care Act of 2009, comprehensive legislation that recognizes the critical importance of advance care planning and quality end-of-life care. Senator Collins and I have worked on this legislation for over a decade--with the ultimate goal of one day passing comprehensive end-of-life care legislation. We are encouraged by the prospect of comprehensive health reform this year and believe that it is absolutely critical that end-of-life care provisions be included. In preparation for the impending health reform debate, Senator Collins and I decided last year that it was time to update our Advance Planning and Compassionate Care Act to incorporate all of the best ideas out there on improving end-of-life care--including new and innovative approaches being implemented in the states, approaches suggested by scholars in this field, and recommendations based on our own experiences with loved ones facing the end of life. This new and improved bill is truly a labor of love and we are certainly hopeful that we can finally get something comprehensive and meaningful done for the millions of individuals and families faced with the agonizing issues surrounding the end of life. A modern health care delivery system is well within our reach and something that we can start to achieve this year. A critical component of a modernized health system is the ability to address the health care needs of patients across the life-span--especially at the end of life. Death is a serious, personal, and complicated part of the life cycle. Yet, care at the end of life is eventually relevant to everyone. Americans deserve end-of-life care that is effective in providing information about diagnosis and prognosis, integrating appropriate support services, fulfilling individual wishes, and avoiding unnecessary disputes. The bitter dispute that played out publicly for Terri Schiavo and her family is an agonizing experience that countless other families quietly face over the care of a loved one because clear advance directives are not in place. End-of-life care is a very delicate, yet important, issue and we must act to ensure that all Americans have the dignity and comfort they deserve at the end of life. Services should be available to help patients and their families with the medical, psychological, spiritual, and practical issues surrounding death. Most people want to discuss advance directives when they are healthy and they want their families involved in the process. Yet, the vast majority of Americans have not completed an advance directive expressing their final wishes. In 2007, RAND conducted a comprehensive review of academic literature relating to end-of-life decision-making. This review found that only 18 to 30 percent of Americans have completed some type of advance directive expressing their end-of-life wishes. RAND also found that acutely ill individuals, for whom these decisions are particularly relevant, complete advance directives at only slightly higher rates--35 percent of dialysis patients and 32 percent of Chronic Obstructive Pulmonary Disease, COPD, patients. Perhaps most alarmingly, between 65 and 76 percent of physicians whose patients had an advance directive were unaware of its existence. In its present form, end-of-life planning and care for most Americans is perplexing, disjointed, and lacking an active dialogue. In its 1997 report entitled Approaching Death: Improving Care at the End of Life, the Institute of Medicine found several barriers to effective advance planning and end-of-life care that still persist today. In addition to the substantial burden of suffering experienced by many at the end of life, there are also significant financial consequences for family members and society as a whole that stem from ineffective end-of-life care. According to one Federal evaluation, 80 percent of all deaths occur in hospitals--the most costly setting to deliver care--even though most people would prefer to die at home. Current studies indicate that around 25 percent of all Medicare spending occurs in the last year of life. Largely because of their poorer health status, dually eligible beneficiaries have Medicare costs that are about 1.5 times that of other Medicare beneficiaries. Research also shows significant variation in expenditures at the end-of-life by geography and hospital, without evidence that greater expenditures are associated with better outcomes or satisfaction. We must find ways to improve the quality of end-of-life care. Quality measures provide not only information for oversight, but data with which to improve care practices and models. No core sets of end-of-life quality measures are required across provider settings. Even for certified hospices, reporting of quality measures has only recently been required, with each hospice deciding its own indicators. Hospice surveys are behind schedule and not conducted frequently enough. Facilitating greater advance planning and improving care at the end of life also requires an adequate workforce. Unfortunately, there is a substantial shortage of health professionals who specialize in palliative care. There is a severe shortage of physicians and advance practice nurses trained in palliative medicine. Contributing to these shortages is a shortage of medical and nursing school faculty in palliative medicine and care. There is also a lack of content about end-of-life care in medical school curricula. Medical students in general receive very little formal end-of-life education. Almost half of medical residents in a survey felt unprepared to address patients' fears of dying. For Americans to have a full range of choices in end- of-life care, we must strengthen our health care workforce, including palliative care education of physicians and other health professionals. Care at the end-of-life can, and should, be better and more consistent with what Americans want. The Advance Planning and Compassionate Care Act takes enormous steps forward to fully inform consumers of their treatment options at the end of life and to actually address patient end-of-life care needs when the time comes. To promote advance care planning, this legislation provides both patients and their physicians with the information and tools to help them in this most personal and often difficult discussion. Last year's Medicare Improvements for Patients and Providers Act, PL 110-275, took a significant step forward toward improving advance care planning. MIPPA included a provision that I authored, requiring physicians to provide an advance care planning consultation as part of the Welcome to Medicare physical exam. Unfortunately, less than 10 percent of new enrollees use the Welcome to Medicare visit. The MIPPA provision also does not address the advance care planning needs of existing Medicare enrollees. The legislation we are introducing today establishes physician payment under Medicare, Medicaid, and CHIP for vital patient advance care planning conversations. It provides help in documenting decisions from these conversations in the form of advance directives and in the form of actionable orders for life sustaining treatment. It also takes steps to address the problem of accessing advance directives when needed, including state grants for electronic registries. This legislation establishes a National Geriatric and Palliative Care Service Corps, modeled after the National Health Service Corps, to increase the woefully inadequate supply of geriatric and palliative specialists and to even out their geographic distribution. It adopts MedPAC's 2009 hospice payment reforms aimed at aligning payment with the actual trajectory of resources expended over hospice episodes of care, while remaining within the constraints of current reimbursement. Demonstration projects are funded to explore ways to better meet the needs of patients over longer time periods than the 6-month prognoses inherent in the hospice benefit. Certification standards and processes are developed for hospital- based palliative care teams. Such teams are critical to providing consultation and care to dying patients. Quality measurement and oversight are strengthened, with development of end-of-life measures across care settings and greater data reporting requirements of hospices--so that we can make sure the hospice benefit is keeping pace with the changing diagnostic mix of patients that hospice serves. Finally, this bill takes the important step of establishing a National Center on Palliative and End-of-Life Care within the NIH. This is a vital step toward prioritizing biomedical research in the areas of palliative and end-of-life care. It will also serve as a symbol to remind us that, as in other phases of life, we need care at the end of life that addresses our individual needs and circumstances. Death is a serious, personal, and complicated issue that is eventually relevant to each and every one of us. Americans deserve end- of-life care that is effective in fulfilling individual wishes, avoiding unnecessary disputes, and, most importantly, providing quality end-of-life care. Therefore, I urge my colleagues to join us in improving end-of-life care and reducing the amount of grief that inevitably comes with losing those who we hold dear. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Annual and Lifetime Health Care Limit Elimination Act of 2009, legislation that would prohibit insurance companies from imposing any annual or lifetime limit on any individual or group health insurance policy, thus providing continuity and affordability of health care coverage for those with serious chronic conditions. Each year, thousands of insured Americans face daunting medical expenses and challenges when they reach the annual or lifetime limit on their individual or employer-sponsored health insurance plan. Once a beneficiary's medical costs have exceeded the annual or lifetime limit of their plan, the insurance company no longer pays for the medical costs incurred by that individual. In April, I held a roundtable discussion on health care in Raleigh County. There, I met a woman who had myelodysplastic syndrome, which is a non-curable pre-leukemia type disease. Unfortunately, her husband's insurance policy had a lifetime limit of $300,000, which she had reached. Another young West Virginian, born with serious congenital heart defects, reached the $1 million limit on his mother's insurance policy within the first nine months of his life. The limits on their health insurance plans have left these families struggling to find a way to pay for the expensive and life-sustaining treatments their loved ones desperately need. Unfortunately, these two West Virginia families are not alone. In 2007, it was estimated that 55 percent of all people who obtain health benefits from their employer have some type of lifetime limit on their plan, an increase of approximately 4 percent since 2004. More than 23 percent of people have health insurance plans that impose limits of $2 million or less. Also, some health insurance policies renew less frequently than annually and contain annual limits to reduce the medical expenses paid by insurance companies. It is estimated that approximately 20,000 to 25,000 people no longer have health care benefits through their employers because of lifetime limits on their employer-sponsored health care plans. When individuals with serious chronic conditions--such as transplant recipients, patients living with hemophilia, and newborns with life- threatening illnesses--hit the annual or lifetime limits on their policies, they are often left with very few options to meet their health care needs. Individuals and families that can afford it can try to pay for their health care costs completely out-of-pocket. However, this is rarely financially feasible; therefore, many people are forced to leave good, stable jobs and seek different employment in an effort to obtain new employer-sponsored coverage. Unfortunately, new enrollees are often subject to a waiting period for coverage if there was any break in their previous health care coverage. Should an individual try to find health insurance in the individual market, coverage is likely to be prohibitively expensive. More often then not, these individuals are denied coverage altogether because of the insurer's pre-existing condition exclusion. Annual or lifetime limits can force people to turn to public programs such as Medicaid, or spend down their savings to meet the financial restrictions of the program. Others are forced to forgo treatment altogether, which can lead to serious complications and greater long-term health care costs. It is time to stop health insurance companies from imposing annual or lifetime limits on health insurance policies. The beneficiaries affected by these limits have paid their premiums, deductibles, and copays faithfully, only to lose access to life-saving treatment when they need care the most. This is unacceptable and I encourage my colleagues to join me in supporting the Annual and Lifetime Health Care Limit Elimination Act. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, for the Committee on Commerce, Science, and Transportation I report favorably the following nomination lists which were printed in the Record on the dates indicated, and ask unanimous consent, to save the expense of reprinting on the Executive Calendar that these nominations lie at the Secretary's desk for the information of Senators.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Special Disability Workload Liability Resolution Act, legislation that will resolve Medicare's longstanding liability to state Medicaid programs for individuals who were covered by Medicaid when they should have been covered by Medicare. For the past several decades, hundreds of thousands of disabled people have had their health care paid for by Medicaid; however, their health care was actually the responsibility of Medicare. Therefore, states have been left financially responsible for individuals whose care should have been paid for entirely by the Federal Government. Both the Centers for Medicare and Medicaid Services, CMS, and the Social Security Administration, SSA, acknowledge Medicare's responsibility for these beneficiaries. The Social Security Administration is in the process of correcting the cash insurance payments that were due to disabled individuals. However, CMS has not acted to establish a means of satisfying Medicare's liability. This is unacceptable. Nearly every state is struggling to balance its budget in the midst of this terrible economic crisis, and it is estimated that the Medicare program owes the states an estimated $4 billion. This figure continues to grow as the SSA corrects additional cases. When it is determined that a state owes the Federal Government money for Medicaid expenses, states have only 60 days to pay this debt. Yet, now that the situation is reversed, the Federal Government has not even established a timeline with which to pay its debt to the States. The legislation I am introducing today, the Special Disability Workload Liability Resolution Act, would provide $4 billion in Federal funding to settle this debt to the States. It requires the Social Security Administration and CMS to develop an accurate payment methodology to reimburse states within 6 months of the bill's enactment. Resolving this Federal debt would inject critical funds into State and local economies and help maintain state jobs. This bill is based on language successfully included in the Senate- passed American Recovery and Reinvestment Act, but it was dropped in conference. It is my hope that my colleagues will once again support this important legislation. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Medicare Payment Advisory Commission MedPAC Reform Act, legislation to elevate MedPAC to an executive branch entity and give it the resources and authority to implement Medicare payment policies. It is a fact that the quality of U.S. health care is mediocre and its costs are unsustainable. Nonetheless, a modern health care delivery system is within our reach and something that we can start to achieve this year. Payment reforms, particularly in Medicare, are the cornerstone for driving quality improvement and improving the efficiency of our health care system. However, Congress must adopt a mechanism to implement and maintain Medicare reimbursement policies that are based on the best evidence and driven by the right incentives. This is simply not the case today. Currently, Congress has the sole authority to change the cost curve for Medicare. Unfortunately, this process is riddled with political influence and is slowed by an inadequate structure to research, analyze, test, and implement successful delivery system reforms. Given the role of Medicare in determining market norms among all health care payers, both public and private, the federal government has an opportunity to realign our nation's health care system to drive quality improvement and greater efficiency. The federal government already has a well-respected, independent entity--the Medicare Payment Advisory Commission, MedPAC--that currently advises Congress on Medicare payment policies. MedPAC, established by the Balanced Budget Act of 1997 (P.L. 105-33), employs a number of mechanisms to inform Congress on issues affecting the Medicare program. Specifically, MedPAC analyzes provider reimbursement, beneficiary access to care, and quality of care; delivers this information to Congress through regular reports and recommendations; engages in public meetings to discuss policy issues and formulate its recommendations to the Congress; and seeks input on Medicare issues in non-public forums through frequent meetings with a wide variety of parties. Despite MedPAC's reputation for providing thoughtful, evidence-based recommendations to improve Medicare's payment policies, MedPAC has no power to implement its recommendations. That power rests solely with Congress. Unfortunately, Members of Congress face unyielding pressure from the health care industry to pick and choose which MedPAC recommendations they consider, despite the evidence. This routinely leads to the passage of laws that put the special interests of industry over the needs of patients. MedPAC has proven, through its objectivity and its open and deliberative process, that they have the appropriate expertise to change the cost curve for Medicare and strengthen it for the future. The Medicare Payment Advisory Commission Reform Act of 2009 helps to achieve this goal. Specifically, this legislation would restructure MedPAC as an independent executive branch entity, like the Federal Reserve Board. This would provide MedPAC the appropriate authority to implement its recommendations for Medicare provider reimbursement policies. In addition to extending the terms and requirements of the Commissioners to be full-time employees of the Commission, this legislation also establishes three new advisory councils to assist them in their decision-making--a Council of Health and Economic Advisors, a Consumer Advisory Council, and a Federal Health Advisory Council with representatives from the health care industry. Lastly, MedPAC's authority to analyze health services research is also enhanced in this legislation by providing them with additional resources and staff to bolster their current analytical role. Given the limitations of the current Medicare demonstration process, this legislation provides new authority and resources to MedPAC to design and evaluate new payment models through Medicare demonstrations. I strongly feel that establishing MedPAC as an independent executive branch agency--which can only happen through an act of Congress--is the type of bold step forward that can truly transform our delivery system. Congress has proven itself to be inefficient and inconsistent in making decisions about provider reimbursement under Medicare. If we want serious improvements in our health care delivery system, then Congress should leave the reimbursement rules to the independent health care experts. I urge my colleagues to join me in support of a policy that truly improves Medicare today and in the future. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Medicare Payment Advisory Commission MedPAC Reform Act, legislation to elevate MedPAC to an executive branch entity and give it the resources and authority to implement Medicare payment policies. It is a fact that the quality of U.S. health care is mediocre and its costs are unsustainable. Nonetheless, a modern health care delivery system is within our reach and something that we can start to achieve this year. Payment reforms, particularly in Medicare, are the cornerstone for driving quality improvement and improving the efficiency of our health care system. However, Congress must adopt a mechanism to implement and maintain Medicare reimbursement policies that are based on the best evidence and driven by the right incentives. This is simply not the case today. Currently, Congress has the sole authority to change the cost curve for Medicare. Unfortunately, this process is riddled with political influence and is slowed by an inadequate structure to research, analyze, test, and implement successful delivery system reforms. Given the role of Medicare in determining market norms among all health care payers, both public and private, the federal government has an opportunity to realign our nation's health care system to drive quality improvement and greater efficiency. The federal government already has a well-respected, independent entity--the Medicare Payment Advisory Commission, MedPAC--that currently advises Congress on Medicare payment policies. MedPAC, established by the Balanced Budget Act of 1997 (P.L. 105-33), employs a number of mechanisms to inform Congress on issues affecting the Medicare program. Specifically, MedPAC analyzes provider reimbursement, beneficiary access to care, and quality of care; delivers this information to Congress through regular reports and recommendations; engages in public meetings to discuss policy issues and formulate its recommendations to the Congress; and seeks input on Medicare issues in non-public forums through frequent meetings with a wide variety of parties. Despite MedPAC's reputation for providing thoughtful, evidence-based recommendations to improve Medicare's payment policies, MedPAC has no power to implement its recommendations. That power rests solely with Congress. Unfortunately, Members of Congress face unyielding pressure from the health care industry to pick and choose which MedPAC recommendations they consider, despite the evidence. This routinely leads to the passage of laws that put the special interests of industry over the needs of patients. MedPAC has proven, through its objectivity and its open and deliberative process, that they have the appropriate expertise to change the cost curve for Medicare and strengthen it for the future. The Medicare Payment Advisory Commission Reform Act of 2009 helps to achieve this goal. Specifically, this legislation would restructure MedPAC as an independent executive branch entity, like the Federal Reserve Board. This would provide MedPAC the appropriate authority to implement its recommendations for Medicare provider reimbursement policies. In addition to extending the terms and requirements of the Commissioners to be full-time employees of the Commission, this legislation also establishes three new advisory councils to assist them in their decision-making--a Council of Health and Economic Advisors, a Consumer Advisory Council, and a Federal Health Advisory Council with representatives from the health care industry. Lastly, MedPAC's authority to analyze health services research is also enhanced in this legislation by providing them with additional resources and staff to bolster their current analytical role. Given the limitations of the current Medicare demonstration process, this legislation provides new authority and resources to MedPAC to design and evaluate new payment models through Medicare demonstrations. I strongly feel that establishing MedPAC as an independent executive branch agency--which can only happen through an act of Congress--is the type of bold step forward that can truly transform our delivery system. Congress has proven itself to be inefficient and inconsistent in making decisions about provider reimbursement under Medicare. If we want serious improvements in our health care delivery system, then Congress should leave the reimbursement rules to the independent health care experts. I urge my colleagues to join me in support of a policy that truly improves Medicare today and in the future. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Special Disability Workload Liability Resolution Act, legislation that will resolve Medicare's longstanding liability to state Medicaid programs for individuals who were covered by Medicaid when they should have been covered by Medicare. For the past several decades, hundreds of thousands of disabled people have had their health care paid for by Medicaid; however, their health care was actually the responsibility of Medicare. Therefore, states have been left financially responsible for individuals whose care should have been paid for entirely by the Federal Government. Both the Centers for Medicare and Medicaid Services, CMS, and the Social Security Administration, SSA, acknowledge Medicare's responsibility for these beneficiaries. The Social Security Administration is in the process of correcting the cash insurance payments that were due to disabled individuals. However, CMS has not acted to establish a means of satisfying Medicare's liability. This is unacceptable. Nearly every state is struggling to balance its budget in the midst of this terrible economic crisis, and it is estimated that the Medicare program owes the states an estimated $4 billion. This figure continues to grow as the SSA corrects additional cases. When it is determined that a state owes the Federal Government money for Medicaid expenses, states have only 60 days to pay this debt. Yet, now that the situation is reversed, the Federal Government has not even established a timeline with which to pay its debt to the States. The legislation I am introducing today, the Special Disability Workload Liability Resolution Act, would provide $4 billion in Federal funding to settle this debt to the States. It requires the Social Security Administration and CMS to develop an accurate payment methodology to reimburse states within 6 months of the bill's enactment. Resolving this Federal debt would inject critical funds into State and local economies and help maintain state jobs. This bill is based on language successfully included in the Senate- passed American Recovery and Reinvestment Act, but it was dropped in conference. It is my hope that my colleagues will once again support this important legislation. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today--with my colleagues Congresswoman Rosa DeLauro and Congresswoman Alyson Schwartz--to introduce the Informed Consumer Choices in Health Care Act, legislation to hold insurance companies accountable by increasing transparency in insurance coverage and to provide consumers critical information about their health care so they can make informed decisions. All Americans deserve affordable, meaningful health care coverage that meets their needs when they need it. However, there is an unsettling trend in America that is growing at an alarming rate-- hardworking Americans are suffering from serious economic hardship because of medical bills. There countless consumers all across the country who thought they were safe because they had health insurance coverage. Health insurance is meant to protect against the risk that, if you get sick, severely injured or require extensive medical care for one reason or another, it would not bankrupt you. However, the exact opposite is happening. People who thought they had coverage for health care events--small and large--found out much too late that they were not protected at all. The lack of insurance transparency leads consumers to purchase coverage that actually does not meet their needs and leads to disaster for them financially. In June 2008, the Senate Finance Committee held a hearing on health insurance reform where we heard devastating testimony from Mrs. Lisa Kelly, who purchased a limited benefit plan that did not provide adequate coverage when she needed treatment for leukemia. Mrs. Kelly paid a monthly premium of $185 for AARP's Medical Advantage plan, underwritten by UnitedHealth Group, only to be told that she had to pay M.D. Anderson $105,000 up front, prior to starting her chemotherapy treatment. This situation left Ms. Kelly in the untenable situation of leaving her cancer untreated or finding a way to pay on a limited budget. Medical bills are the second highest cause of bankruptcy in our country. It is estimated that 50 percent of all bankruptcies are a result of medical expenses. Sixty-one percent of the 72 million adults under age 65 who had problems paying medical bills or were paying off medical debt in 2007 were insured at the time health care was provided. An additional 1.5 million families lose their homes every single year due to medical costs. This is simply unacceptable. This is not just a coincidence. Plans that provide bare-bones coverage may be fine if you live in a bubble, but that is not the reality most Americans live in. If we as a nation are serious about protecting all Americans from the devastating financial consequences of serious illness, then Congress must hold the insurance industry accountable by arming consumers with comprehensive information about the benefits covered and not covered under their health plan, the true cost of their coverage, and the cost-sharing they are responsible for. This information should not be shrouded in the legalese of health insurance companies, but in clear language that is easy for consumers to understand. As we seek to give consumers greater coverage choices, we should also give them the necessary tools to understand those choices. Another example of where the lack of insurance transparency has hurt consumers is in the experience of the Medicare prescription drug benefit. Seniors and individuals with disabilities have simply been overwhelmed by the number of prescription drug plans offered--without any meaningful way to decipher the differences between plans in terms of benefits covered or cost-sharing. Over the last recess, I held a health care roundtable discussion in Charleston, which has more than 50 Medicare prescription drug plans for seniors and individuals with disabilities to choose from. I heard from countless West Virginians about the extreme difficulty they have wading through their prescription drug coverage options each and every plan year. The most compelling stories came from a retired chemical engineer and a retired attorney--both very smart individuals--who have had major problems determining what is and is not offered and how much they will have to pay out of their pockets for it. When consumers buy cars, computers, or even cereal, they generally know what they are buying and how much it will cost. But, when it comes to making choices about health care coverage, it is often very difficult for consumers to tell what is actually covered and how much they will have to pay out-of-pocket in case of a serious illness or injury. Consumers cannot make meaningful choices if details about coverage are obscure or if the definitions of key terms such as ``hospitalization'', ``outpatient care'', or ``out-of-pocket limit'' vary from plan to plan. The lack of health insurance transparency also contributes to administrative waste and complexity. According to the American Medical Association, more than half of health insurers do not provide physicians with the transparency necessary for an efficient claims processing system. Physicians and hospitals must divert substantial resources away from patient care to accurately determine patient insurance eligibility and benefit structure. The black box in which insurers operate also provides them with the opportunity to use flawed payment structures, like the Ingenix database, to underpay patients who choose to get health care out of network. An investigation by the New York Attorney General and hearings conducted this spring by the Senate Commerce Committee revealed American consumers have been paying billions of dollars out of their own pockets for health care that the insurance companies should have been paying. The numbers the insurance industry relied on justify these under-payments came from a secretive health care data company called Ingenix. Insurers refused to tell patients or doctors how Ingenix came up with their payment amounts. And they didn't disclose that Ingenix was a wholly owned subsidiary of UnitedHealth Group, the Nation's second largest health insurance company. The Ingenix investigations show tat the health insurance industry is willing to go to great lengths to withhold accurate, objective health care payment information from American consumers. While they talk about transparency, they spent hundreds of millions of dollars creating a reimbursement system that kept patients and doctors in the dark. The U.S. Department of Labor currently lacks the capacity to oversee insurance industry compliance with federal health insurance laws and to provide states with the technical assistance necessary to effectively enforce federal standards for health insurance. These federal standards include crucial protections like the Genetic Information and Nondiscrimination Act, GINA, the Health Insurance Portability and Accountability Act, HIPAA, the Newborns' and Mothers' Health Protection Act, the Women's Health and Cancer Rights Act of 1998, Michelle's Law, and mental health parity. As states continue to be overwhelmed by the increasing pressure of the recession and cost-cutting measures by insurers, state regulators are in desperate need for additional resources. In a 21st Century health system where there will be even greater health insurance choices, adequate federal oversight is absolutely critical. There is no excuse for limiting access to information that has such widespread consequences for consumers. The Informed Consumer Choices in Health Care Act is the type of transformative legislation we need to address the very significant issues stemming from the lack of health insurance transparency. First, this legislation promotes transparency in coverage by providing crucial data and assistance to consumers and health care providers. This includes new ``Coverage Facts'' labels for insurance, similar to nutrition labels, which accurately portray the financial obligations of patients in a given year under various medical scenarios. The legislation also requires the development of consistent standards for insurance, including standard definitions of key insurance terms to be used in descriptions of plan benefits, so that consumers can make ``apples to apples'' comparisons of coverage options. Lastly, it strengthens insurance accountability and oversight by creating a new Office of Health Insurance Oversight within the Department of Health and Human Services, and provides new resources for states to help enforce federal standards. In the most recent Presidential election, the voice of American voters was clear--they want medical care they can afford and health care coverage they can trust. The traditional role of insurers to hide or misrepresent insurance coverage options can longer be tolerated; therefore, I urge my colleagues to stand up for informed consumer decisions in health care and support this bill. Mr. President, I ask unanimous consent that the text of the bill and support material be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today--with my colleagues Congresswoman Rosa DeLauro and Congresswoman Alyson Schwartz--to introduce the Informed Consumer Choices in Health Care Act, legislation to hold insurance companies accountable by increasing transparency in insurance coverage and to provide consumers critical information about their health care so they can make informed decisions. All Americans deserve affordable, meaningful health care coverage that meets their needs when they need it. However, there is an unsettling trend in America that is growing at an alarming rate-- hardworking Americans are suffering from serious economic hardship because of medical bills. There countless consumers all across the country who thought they were safe because they had health insurance coverage. Health insurance is meant to protect against the risk that, if you get sick, severely injured or require extensive medical care for one reason or another, it would not bankrupt you. However, the exact opposite is happening. People who thought they had coverage for health care events--small and large--found out much too late that they were not protected at all. The lack of insurance transparency leads consumers to purchase coverage that actually does not meet their needs and leads to disaster for them financially. In June 2008, the Senate Finance Committee held a hearing on health insurance reform where we heard devastating testimony from Mrs. Lisa Kelly, who purchased a limited benefit plan that did not provide adequate coverage when she needed treatment for leukemia. Mrs. Kelly paid a monthly premium of $185 for AARP's Medical Advantage plan, underwritten by UnitedHealth Group, only to be told that she had to pay M.D. Anderson $105,000 up front, prior to starting her chemotherapy treatment. This situation left Ms. Kelly in the untenable situation of leaving her cancer untreated or finding a way to pay on a limited budget. Medical bills are the second highest cause of bankruptcy in our country. It is estimated that 50 percent of all bankruptcies are a result of medical expenses. Sixty-one percent of the 72 million adults under age 65 who had problems paying medical bills or were paying off medical debt in 2007 were insured at the time health care was provided. An additional 1.5 million families lose their homes every single year due to medical costs. This is simply unacceptable. This is not just a coincidence. Plans that provide bare-bones coverage may be fine if you live in a bubble, but that is not the reality most Americans live in. If we as a nation are serious about protecting all Americans from the devastating financial consequences of serious illness, then Congress must hold the insurance industry accountable by arming consumers with comprehensive information about the benefits covered and not covered under their health plan, the true cost of their coverage, and the cost-sharing they are responsible for. This information should not be shrouded in the legalese of health insurance companies, but in clear language that is easy for consumers to understand. As we seek to give consumers greater coverage choices, we should also give them the necessary tools to understand those choices. Another example of where the lack of insurance transparency has hurt consumers is in the experience of the Medicare prescription drug benefit. Seniors and individuals with disabilities have simply been overwhelmed by the number of prescription drug plans offered--without any meaningful way to decipher the differences between plans in terms of benefits covered or cost-sharing. Over the last recess, I held a health care roundtable discussion in Charleston, which has more than 50 Medicare prescription drug plans for seniors and individuals with disabilities to choose from. I heard from countless West Virginians about the extreme difficulty they have wading through their prescription drug coverage options each and every plan year. The most compelling stories came from a retired chemical engineer and a retired attorney--both very smart individuals--who have had major problems determining what is and is not offered and how much they will have to pay out of their pockets for it. When consumers buy cars, computers, or even cereal, they generally know what they are buying and how much it will cost. But, when it comes to making choices about health care coverage, it is often very difficult for consumers to tell what is actually covered and how much they will have to pay out-of-pocket in case of a serious illness or injury. Consumers cannot make meaningful choices if details about coverage are obscure or if the definitions of key terms such as ``hospitalization'', ``outpatient care'', or ``out-of-pocket limit'' vary from plan to plan. The lack of health insurance transparency also contributes to administrative waste and complexity. According to the American Medical Association, more than half of health insurers do not provide physicians with the transparency necessary for an efficient claims processing system. Physicians and hospitals must divert substantial resources away from patient care to accurately determine patient insurance eligibility and benefit structure. The black box in which insurers operate also provides them with the opportunity to use flawed payment structures, like the Ingenix database, to underpay patients who choose to get health care out of network. An investigation by the New York Attorney General and hearings conducted this spring by the Senate Commerce Committee revealed American consumers have been paying billions of dollars out of their own pockets for health care that the insurance companies should have been paying. The numbers the insurance industry relied on justify these under-payments came from a secretive health care data company called Ingenix. Insurers refused to tell patients or doctors how Ingenix came up with their payment amounts. And they didn't disclose that Ingenix was a wholly owned subsidiary of UnitedHealth Group, the Nation's second largest health insurance company. The Ingenix investigations show tat the health insurance industry is willing to go to great lengths to withhold accurate, objective health care payment information from American consumers. While they talk about transparency, they spent hundreds of millions of dollars creating a reimbursement system that kept patients and doctors in the dark. The U.S. Department of Labor currently lacks the capacity to oversee insurance industry compliance with federal health insurance laws and to provide states with the technical assistance necessary to effectively enforce federal standards for health insurance. These federal standards include crucial protections like the Genetic Information and Nondiscrimination Act, GINA, the Health Insurance Portability and Accountability Act, HIPAA, the Newborns' and Mothers' Health Protection Act, the Women's Health and Cancer Rights Act of 1998, Michelle's Law, and mental health parity. As states continue to be overwhelmed by the increasing pressure of the recession and cost-cutting measures by insurers, state regulators are in desperate need for additional resources. In a 21st Century health system where there will be even greater health insurance choices, adequate federal oversight is absolutely critical. There is no excuse for limiting access to information that has such widespread consequences for consumers. The Informed Consumer Choices in Health Care Act is the type of transformative legislation we need to address the very significant issues stemming from the lack of health insurance transparency. First, this legislation promotes transparency in coverage by providing crucial data and assistance to consumers and health care providers. This includes new ``Coverage Facts'' labels for insurance, similar to nutrition labels, which accurately portray the financial obligations of patients in a given year under various medical scenarios. The legislation also requires the development of consistent standards for insurance, including standard definitions of key insurance terms to be used in descriptions of plan benefits, so that consumers can make ``apples to apples'' comparisons of coverage options. Lastly, it strengthens insurance accountability and oversight by creating a new Office of Health Insurance Oversight within the Department of Health and Human Services, and provides new resources for states to help enforce federal standards. In the most recent Presidential election, the voice of American voters was clear--they want medical care they can afford and health care coverage they can trust. The traditional role of insurers to hide or misrepresent insurance coverage options can longer be tolerated; therefore, I urge my colleagues to stand up for informed consumer decisions in health care and support this bill. Mr. President, I ask unanimous consent that the text of the bill and support material be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today, along with my colleague Senator Snowe of Maine and Senator Kerry of Massachusetts, I am introducing legislation to provide incentives for States to adopt the 21st Century Skills Framework. I take this step because the knowledge base and skills set that most students learn in school should expand to provide students with the skills like critical thinking and problem solving, needed to succeed in modern workplaces and communities. Increasingly, these settings are no longer defined by conventional boundaries such as time, distance, language, and culture. Moreover, rigorous higher education coursework, career challenges, and a globally competitive workforce--all demand that America's schools align their classroom environments with real world environments by infusing 21st century skills into their learning and teaching. What are those skills? The framework describes essential attributes of learning that America's children need in order to succeed as citizens and workers in the 21st century. These include mastery in the core subjects of English, reading, mathematics, science, foreign languages, civics, Government, economics, art, history, and geography. This bill does not ignore core curriculum, but it seeks to add skills and new awareness to this basic knowledge. Today's students need preparation to put their education in context including a sense of global awareness; financial, economic, business and entrepreneurial literacy; civic literacy; and health and wellness awareness that complements the traditional core subjects. Given the fast pace of our workplace and culture, our students need the ability to engage in life- long learning that ensures adaptability in the face of rapidly changing work environments brought on by new scientific, technological, and social developments. Plus, students need to be able to use information and communications technology both to learn core academic subjects and to gain 21st century content knowledge and abilities. The 21st Century Skills Framework also identifies the critical role teachers must play in bringing life skills into their classrooms-- skills that include leadership, ethics, accountability, adaptability, personal productivity, personal responsibility, self-direction, and social responsibility. West Virginia is working to include this model in their classrooms, and I have watched how this model enhances the engagement of students. In today's global, knowledge-based economy these 21st Century skills form the lifeblood of a productive workforce particularly in scientific, engineering, and other advanced technological sectors. If the U.S. is to exercise continued economic leadership internationally we must enable strong partnerships to form among educators, administrators, policy makers, and the business community so that they may work collectively to better prepare our students for the realities of the 21st century. This initiative began in 2002 with funding from the U.S. Department of Education to support innovative education reforms. The partnership was a collaboration of educators and businesses, particularly high-tech business that did surveys and meetings to discuss the real skills that students need to learn to succeed. It clearly builds on the core subjects, but it adds the skills and awareness that are essential to the workplace. The purpose of the 21st Century Skills Incentive Fund Act is to offer competitive grants from in the Department of Education for States willing to invest in education reform. To qualify, States need to have a plan for implementations of the 21st Century Skills Framework. It also calls an assessment of progress towards the four student learning priorities and evaluation. Ten States have also already taken steps to implement the 21st Century Skills initiative, including Arizona, Iowa, Kansas, Maine, Massachusetts, New Jersey, North Carolina, South Dakota, West Virginia, and Wisconsin. Such States that are willing and eager to engage in such reforms deserve the chance to compete for incentives. In my own State of West Virginia and in the other committed States, education leaders report enthusiasm for reforms. Although the economic downturn has current challenges for new investment in education, waiting for a better time to engage in reform would be unwise. Today's sixth grade class, will be entering the work force in 2015, after high school or 2019 after college, they need to be prepared. The 21st Century Skills Incentive Act makes attention to this imperative a national priority.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today, along with my colleague Senator Snowe of Maine and Senator Kerry of Massachusetts, I am introducing legislation to provide incentives for States to adopt the 21st Century Skills Framework. I take this step because the knowledge base and skills set that most students learn in school should expand to provide students with the skills like critical thinking and problem solving, needed to succeed in modern workplaces and communities. Increasingly, these settings are no longer defined by conventional boundaries such as time, distance, language, and culture. Moreover, rigorous higher education coursework, career challenges, and a globally competitive workforce--all demand that America's schools align their classroom environments with real world environments by infusing 21st century skills into their learning and teaching. What are those skills? The framework describes essential attributes of learning that America's children need in order to succeed as citizens and workers in the 21st century. These include mastery in the core subjects of English, reading, mathematics, science, foreign languages, civics, Government, economics, art, history, and geography. This bill does not ignore core curriculum, but it seeks to add skills and new awareness to this basic knowledge. Today's students need preparation to put their education in context including a sense of global awareness; financial, economic, business and entrepreneurial literacy; civic literacy; and health and wellness awareness that complements the traditional core subjects. Given the fast pace of our workplace and culture, our students need the ability to engage in life- long learning that ensures adaptability in the face of rapidly changing work environments brought on by new scientific, technological, and social developments. Plus, students need to be able to use information and communications technology both to learn core academic subjects and to gain 21st century content knowledge and abilities. The 21st Century Skills Framework also identifies the critical role teachers must play in bringing life skills into their classrooms-- skills that include leadership, ethics, accountability, adaptability, personal productivity, personal responsibility, self-direction, and social responsibility. West Virginia is working to include this model in their classrooms, and I have watched how this model enhances the engagement of students. In today's global, knowledge-based economy these 21st Century skills form the lifeblood of a productive workforce particularly in scientific, engineering, and other advanced technological sectors. If the U.S. is to exercise continued economic leadership internationally we must enable strong partnerships to form among educators, administrators, policy makers, and the business community so that they may work collectively to better prepare our students for the realities of the 21st century. This initiative began in 2002 with funding from the U.S. Department of Education to support innovative education reforms. The partnership was a collaboration of educators and businesses, particularly high-tech business that did surveys and meetings to discuss the real skills that students need to learn to succeed. It clearly builds on the core subjects, but it adds the skills and awareness that are essential to the workplace. The purpose of the 21st Century Skills Incentive Fund Act is to offer competitive grants from in the Department of Education for States willing to invest in education reform. To qualify, States need to have a plan for implementations of the 21st Century Skills Framework. It also calls an assessment of progress towards the four student learning priorities and evaluation. Ten States have also already taken steps to implement the 21st Century Skills initiative, including Arizona, Iowa, Kansas, Maine, Massachusetts, New Jersey, North Carolina, South Dakota, West Virginia, and Wisconsin. Such States that are willing and eager to engage in such reforms deserve the chance to compete for incentives. In my own State of West Virginia and in the other committed States, education leaders report enthusiasm for reforms. Although the economic downturn has current challenges for new investment in education, waiting for a better time to engage in reform would be unwise. Today's sixth grade class, will be entering the work force in 2015, after high school or 2019 after college, they need to be prepared. The 21st Century Skills Incentive Act makes attention to this imperative a national priority.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Mother's Day Centennial Coin Commemorative Coin Act. I am proud to have the senior Senator from West Virginia, Senator Byrd, as an original cosponsor given that this is a special event for our state. We are joined by Senators Bayh, Begich, Ben Nelson, Whitehouse and Levin. In 1908, a West Virginian woman by the name of Anna Jarvis petitioned her local church to declare May 9th as Mother's Day. Within 6 years, the holiday became nationally recognized. Now, more than 100 years after that first Mother's Day, we have the opportunity to commemorate the centennial of this great holiday and further recognize the millions of American mothers whose essential role in life cannot be overstated. The legislation I am introducing today would recognize the centennial of Mother's Day by authorizing the Treasury to mint commemorative Mother's Day coins. Profits generated from the sale of the coins would be donated to Susan G. Komen for the Cure and The National Osteoporosis Foundation. Susan G. Komen for the Cure has raised more than $1 billion for breast cancer research since 1982, and the National Osteoporosis Foundation is considered our Nation's leading voluntary health organization. Thousands of women have benefited from the efforts of these organizations and they are well deserving of our support. These coins will not only raise awareness of the proud history of Mother's Day, but will help improve the health of thousands of our Nation's mothers. Therefore, I encourage my colleagues to reflect upon their relationships with the mothers in their lives, and join me in supporting this legislation to recognize the past century's worth of noble women and help ensure the health of those to come in the next century.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Mother's Day Centennial Coin Commemorative Coin Act. I am proud to have the senior Senator from West Virginia, Senator Byrd, as an original cosponsor given that this is a special event for our state. We are joined by Senators Bayh, Begich, Ben Nelson, Whitehouse and Levin. In 1908, a West Virginian woman by the name of Anna Jarvis petitioned her local church to declare May 9th as Mother's Day. Within 6 years, the holiday became nationally recognized. Now, more than 100 years after that first Mother's Day, we have the opportunity to commemorate the centennial of this great holiday and further recognize the millions of American mothers whose essential role in life cannot be overstated. The legislation I am introducing today would recognize the centennial of Mother's Day by authorizing the Treasury to mint commemorative Mother's Day coins. Profits generated from the sale of the coins would be donated to Susan G. Komen for the Cure and The National Osteoporosis Foundation. Susan G. Komen for the Cure has raised more than $1 billion for breast cancer research since 1982, and the National Osteoporosis Foundation is considered our Nation's leading voluntary health organization. Thousands of women have benefited from the efforts of these organizations and they are well deserving of our support. These coins will not only raise awareness of the proud history of Mother's Day, but will help improve the health of thousands of our Nation's mothers. Therefore, I encourage my colleagues to reflect upon their relationships with the mothers in their lives, and join me in supporting this legislation to recognize the past century's worth of noble women and help ensure the health of those to come in the next century.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today with my colleague, Senator Whitehouse of Rhode Island, to introduce the National Health Care Quality Act, legislation that makes health care quality a national priority. We have before us an overwhelming opportunity to make sweeping changes to our health care system. The dramatic change we need to improve America's health care delivery system requires a solid coordinated infrastructure to guide quality improvement; however this infrastructure does not exist today. The lack of a coordinated effort to improve health care quality has hindered our nation's ability to improve patient health outcomes and reduce inefficiencies in our health care system. In order to achieve our goals for true delivery system reform, health care quality must be elevated as a national priority. As the cost of health care in America continues to increase, the quality of care Americans receive continues to decrease. The average cost of health insurance premiums has doubled in the last nine years, from $5791 in 1999 to $12,680 in 2008. However, less than half of adults receive recommended care. More is spent per person on health care in the United States than in any other nation in the world, and yet America has some of the worst health outcomes. Wide-spread inefficiencies plague our health care system. The Congressional Budget Office, CBO, estimates that 30 percent of annual health care spending, or as much as $700 billion, could be eliminated with little to no impact on the system. Additionally, the Commonwealth Fund estimates that more than 100,000 American lives could be saved annually by improving health care quality to the level of performance achieved in other nations. Several entities contribute to health care quality improvement in the U.S., including numerous federal departments, several key Federal agencies within those departments, and additional private-sector partners. While there has been some progress to coordinate efforts among these entities and create a framework for navigating quality improvement efforts, there is no defined structure in place to guide the process of quality improvement, prioritize limited resources, and provide oversight to ensure these efforts reflect the best interests of all patients. Therefore, legislation is needed to modernize our health care structure to create better coordination of quality efforts, and make certain the decisions about reimbursement and coverage will allow the government to effectively deliver care that is of the highest quality. The National Health Care Quality Act would create a sensible infrastructure for health care quality improvement by creating an accountable entity--a new Office of National Health Care Quality Improvement within the Executive Office of the President--to set health care quality priorities for the nation. This office will be led by a new Director of National Health Care Quality, who will work with public and private stakeholders to establish and routinely update health care quality priorities for the nation based on a number of mandatory considerations, including the needs of children and the void in pediatric quality measures. This legislation also puts forth a construct to coordinate health care quality improvement efforts across all federal agencies involved in purchasing, providing, studying, or regulating health care services. The bill statutorily re-establishes the Quality Interagency Coordinating Council, QuICC, first created during the Clinton administration, within the Office of National Health Care Quality Improvement. The purpose of the Quality Interagency Coordinating Council is to coordinate health care quality improvement efforts across all relevant Federal departments and agencies involved in health care services. It also provides a framework for the development and implementation of Department- and agency-specific quality improvement strategies. Lastly, the legislation enhances health care quality improvement efforts within the Department of Health and Human Services, HHS, by expanding the authority of the Agency for Healthcare Research and Quality and elevating the role of the Director of AHRQ to a Senate- appointed position. By building on and improving the public-private process for health care quality measure development, AHRQ can also help to streamline the implementation of quality improvement measures within federal health programs under the jurisdiction of HHS. AHRQ will establish a standardized method for reporting quality measures and data to all federal health programs. Lastly, AHRQ would be required to develop and launch a public education campaign, aimed at both providers and consumers of health care, about health care quality improvement. It is my belief that the multi-pronged approach provided in the National Health Care Quality Act will lead to vast improvements in the coordination of quality efforts and, most importantly, patient health outcomes. Given the current problems in the health care system, Congress has a responsibility to the American people to guarantee individuals have access to high quality, safe and effective care, and I urge my colleagues to join us in support of this important bill. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today with my colleague, Senator Whitehouse of Rhode Island, to introduce the National Health Care Quality Act, legislation that makes health care quality a national priority. We have before us an overwhelming opportunity to make sweeping changes to our health care system. The dramatic change we need to improve America's health care delivery system requires a solid coordinated infrastructure to guide quality improvement; however this infrastructure does not exist today. The lack of a coordinated effort to improve health care quality has hindered our nation's ability to improve patient health outcomes and reduce inefficiencies in our health care system. In order to achieve our goals for true delivery system reform, health care quality must be elevated as a national priority. As the cost of health care in America continues to increase, the quality of care Americans receive continues to decrease. The average cost of health insurance premiums has doubled in the last nine years, from $5791 in 1999 to $12,680 in 2008. However, less than half of adults receive recommended care. More is spent per person on health care in the United States than in any other nation in the world, and yet America has some of the worst health outcomes. Wide-spread inefficiencies plague our health care system. The Congressional Budget Office, CBO, estimates that 30 percent of annual health care spending, or as much as $700 billion, could be eliminated with little to no impact on the system. Additionally, the Commonwealth Fund estimates that more than 100,000 American lives could be saved annually by improving health care quality to the level of performance achieved in other nations. Several entities contribute to health care quality improvement in the U.S., including numerous federal departments, several key Federal agencies within those departments, and additional private-sector partners. While there has been some progress to coordinate efforts among these entities and create a framework for navigating quality improvement efforts, there is no defined structure in place to guide the process of quality improvement, prioritize limited resources, and provide oversight to ensure these efforts reflect the best interests of all patients. Therefore, legislation is needed to modernize our health care structure to create better coordination of quality efforts, and make certain the decisions about reimbursement and coverage will allow the government to effectively deliver care that is of the highest quality. The National Health Care Quality Act would create a sensible infrastructure for health care quality improvement by creating an accountable entity--a new Office of National Health Care Quality Improvement within the Executive Office of the President--to set health care quality priorities for the nation. This office will be led by a new Director of National Health Care Quality, who will work with public and private stakeholders to establish and routinely update health care quality priorities for the nation based on a number of mandatory considerations, including the needs of children and the void in pediatric quality measures. This legislation also puts forth a construct to coordinate health care quality improvement efforts across all federal agencies involved in purchasing, providing, studying, or regulating health care services. The bill statutorily re-establishes the Quality Interagency Coordinating Council, QuICC, first created during the Clinton administration, within the Office of National Health Care Quality Improvement. The purpose of the Quality Interagency Coordinating Council is to coordinate health care quality improvement efforts across all relevant Federal departments and agencies involved in health care services. It also provides a framework for the development and implementation of Department- and agency-specific quality improvement strategies. Lastly, the legislation enhances health care quality improvement efforts within the Department of Health and Human Services, HHS, by expanding the authority of the Agency for Healthcare Research and Quality and elevating the role of the Director of AHRQ to a Senate- appointed position. By building on and improving the public-private process for health care quality measure development, AHRQ can also help to streamline the implementation of quality improvement measures within federal health programs under the jurisdiction of HHS. AHRQ will establish a standardized method for reporting quality measures and data to all federal health programs. Lastly, AHRQ would be required to develop and launch a public education campaign, aimed at both providers and consumers of health care, about health care quality improvement. It is my belief that the multi-pronged approach provided in the National Health Care Quality Act will lead to vast improvements in the coordination of quality efforts and, most importantly, patient health outcomes. Given the current problems in the health care system, Congress has a responsibility to the American people to guarantee individuals have access to high quality, safe and effective care, and I urge my colleagues to join us in support of this important bill. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Health Information Technology Public Utility Act, legislation I have recently introduced to facilitate nationwide adoption of electronic health records, EHRs, particularly among small, rural providers. This legislation will build on the successful open source models for EHRs developed by the Department of Veterans Affairs and the Indian Health Service--as well as the open source exchange model recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative. Health information technology, IT, that is interoperable and meaningful is a necessary tool to improve the quality of health care Americans receive and make our health care system more efficient. It is the cornerstone of health care communication and coordination between patients and providers and among providers in order delivery high- quality medical care. Several of the mechanisms embedded in this technology--clinical decisions support, interoperability--achieve the long-term policy goals we are considering as part of our broader health reform discussions. It is clear that coordination and communication among providers, improved efficiencies in resource use, streamlined administration and billing, and increased access to meaningful data about quality improvement and improved health outcomes will not be possible without meaningful use of this technology among all providers. However, access to affordable technology is the primary reason why providers across the nation do not invest in this valuable tool. The licensing fees of proprietary software are expensive and beyond the reach of many of health care providers--particularly small, rural providers. Moreover, the federal government has spent substantial taxpayer dollars in the development of open source technology--with the Department of Veterans Affairs and the Indian Health Service, IHS, national leaders in open source electronic health record, EHR, development and implementation. Both the Veterans Health Administration's VistA software and the Indian Health Services' Resource and Patient Management System, RPMS, are affordable and dependable systems that have been in place for decades. Most recently, the health IT funding included in the American Recovery and Reinvestment Act, ARRA, although substantial, is likely to fall short of offering affordable options to all providers. In fact, CBO estimates that, even with funding and incentives in the ARRA, 30 percent of hospitals and 10 percent of physicians will not have adopted health IT by 2019. And, there are some providers that are ineligible for funding under ARRA altogether. The Health Information Technology Public Utility Act will address this problem by increasing access to open source software through a public utility model. The public utility model proposed in this bill would be administered by a Federal Consolidated Health Information Technology Board under the umbrella of the ONCHIT, separate from the Policy and Standards Committees. Members of this Board would represent relevant agencies across the federal government. The Board would be responsible for linking efforts of current and new VistA and RPMS user groups, and updating VistA and RPMS open source software (including provider-based EHRs, personal health records, and other software modules) on a timely basis. The legislation also establishes a new 21st Century Health Information Technology Grant Program to provide funding to public and not-for-profit safety net providers to cover the costs of implementation and initial maintenance of VistA and/or RPMS systems. Grants will focus on eligible hospitals and clinics, with some additional funding for demonstrations in long-term care, home health, and hospice. The Health Information Technology Public Utility Act fills a crucial gap in health IT affordability and accessibility. This legislation does not replace commercial software; instead, it complements the private industry in this field--by making health information technology a realistic option for all providers and by making it possible for the benefits of health IT to accrue to all patients and I urge my colleagues to join me in support of this important policy. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.