Debbie Stabenow

Ms. STABENOW

Ms. STABENOW. Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on Thursday, January 25, 2007, at 2:30 p.m. to hold a hearing on Iraq.

Ms. STABENOW. Mr. President, I would like to announce that the Committee on Indian Affairs will meet on Thursday, January 25, 2007, at 9:30 a.m. in room 485 of the Russell Senate Office Building to conduct a business meeting to consider changes to the committee rules and a funding resolution for the committee budget for the 110th Congress. Those wishing additional information may contact the Indian Affairs Committee at 224-2251.

Ms. STABENOW. Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet to conduct a markup on Thursday, January 25, 2007, at 10 a.m. in Dirksen room 226. Agenda I. Committee Organization Committee Rules for the 110th Congress; Subcommittees for the 110th Congress; Funding Resolution for the 110th Congress. II. Nominations Lisa Godbey Wood to be U.S. District Judge for the Southern District of Georgia; Philip S. Gutierrez to be U.S. District Judge for the Central District of California; Valerie L. Baker to be U.S. District Judge for the Central District of California; Lawrence Joseph O'Neill to be U.S. District Judge for the Eastern District of California; and Gregory Kent Frizzell to be U.S. District Judge for the Northern District of Oklahoma. III. Bills S. 188, To Revise the Short Title of the Voting Rights Act Reauthorization and Amendments Act of 2006, Salazar. S. 214, To Amend Chapter 35 of Title 28, To Preserve the Independence of U.S. Attorneys, Feinstein. IV. Resolutions S. Res. 21, Recognizing the Uncommon Valor of Wesley Autry, Clinton, Schumer. S. Res. 24, Designating January as ``National Stalking Awareness Month'', Biden. S. Res. 29, Expressing the Sense of the Senate Regarding Martin Luther King, Jr. Day, Stabenow, Leahy, Kennedy, Biden, Kohl, Feinstein, Feingold, Schumer, Durbin, Cardin, Whitehouse, Specter.

Ms. STABENOW. Mr. President, I ask unanimous consent that the Select Committee on Intelligence be authorized to meet during the session of the Senate on January 25, 2007, at 2:30 p.m. to hold a hearing.

Ms. STABENOW. Mr. President, I ask unanimous consent that the Subcommittee on Oversight of Government Management, the Federal Workforce and the District of Columbia be authorized to meet on Thursday, January 25, 2007, at 2:30 p.m. for a hearing entitled, ``Lost in Translation: A Review of the Federal Government's Efforts to Develop a Foreign Language Strategy.''

Ms. STABENOW

Ms. STABENOW. I absolutely agree with our distinguished assistant majority leader. Let me say I indicated a moment ago that he has a better proposal himself, and Senator Lincoln. We know for the majority of people who are not insured, 80 percent of those who are uninsured work for small businesses. I am very excited about the approach that the Senator has proposed in terms of a national pool and a tax credit to help fund it. I think we all are very committed to expanding health care coverage and to doing it the right way.

Ms. STABENOW. I thank my friend. I couldn't agree more. I think he very eloquently stated what is in front of us. We have 8 billion precious dollars in the middle of a deficit, and we have to be very strategic about where we put our dollars. The proposal for small business pooling is similar to what we receive. I think that is the least we can do for small business, particularly when we know that 80 percent of the people who do not have health insurance are in small businesses. I thank my colleague. I know colleagues on both sides of the aisle want very much to address this issue of health care. It is a question of how we do it.

Ms. STABENOW. I ask in closing at the moment that we, at a minimum, withhold on this amendment; that we not proceed on this particular proposal to allow us on the Finance Committee to look at all of the options, to look at the facts, to look at what actually expands coverage, what actually lowers costs, and do this together. This is something we need to do on a bipartisan basis, and I hope we will do this in a very positive way so that when we are spending $8 billion, we know we are getting every single penny of value out of that for people who desperately need health care today.

Ms. STABENOW

Ms. STABENOW. Mr. President, I rise today in celebration of my longtime friend and staff member, Connie Feuerstein. After working with me for over a decade, Connie has decided to join her husband, Jack, in retirement. Long before joining my staff, Connie was active in her church, community, and Genesee County politics. Her efforts were critical in my successful campaign for the U.S. House of Representatives in 1996, and I am so fortunate that she was willing to join my congressional staff. For Connie, her work has always been so much more than just a job. She brings such passion and energy to everything she does. Whether it is attending a community event, walking in a parade or advocating on behalf of a family or for the needs of her community, Connie always gives 110 percent to whatever she is doing. As a district representative in my congressional offices in Brighton and Flint and a regional manager in my Flint/Saginaw/Bay office in the Senate, Connie has been my link to the community. She is a respected community leader in her own right. Through the years, she has mentored interns and staff members, many of whom have caught her zeal for public service and have kept in touch with her long after they left the office. My staff and I will miss her sense of humor, boundless energy, optimism and enthusiasm, although I am certain that retirement will not stop her from staying involved. I also know that many people in Michigan, whose lives she touched through her work, will miss her. Upon leaving the Senate, Connie plans to spend time in Florida, where she will be closer to one of her daughters and her three precious grandchildren. She has a love for life that is contagious and I know her family will appreciate having more of her time and attention. Mr. President, I am sad because I am losing a trusted and valued member of my staff, but I am happy to see a dear friend move on to new challenges, and I wish her the best of everything.

Ms. STABENOW

Ms. STABENOW. Mr. President, I rise today to speak to the Medicare prescription drug benefit. I have a different view, and the Michigan seniors and people with disabilities who are trying to access this program have a different experience and view than my friend from Texas. As I said yesterday, I think it is incredibly important that we join with the House of Representatives to do the first step, which is to require negotiation for the best price on prescription drugs through Medicare. I also know there is incredible confusion, that seniors have been offered a variety of private choices but not the one that most seniors asked for, which is to be able to go through Medicare and sign up as they do for Part B and the rest of Medicare and get a good price. I also know there is great concern from seniors who find themselves in this gap, somehow being called a doughnut hole, but the gap in coverage where you continue to pay a premium but don't receive any help. There are a number of concerns I hope we are going to address. Number 1 needs to be to say clearly that we want the Secretary to negotiate the best price for people. Right now, as we know, the law actually prohibits, actually stops the Secretary from using the bargaining power of all of the seniors and the people with disabilities on Medicare to be able to get the best price. Why in the world does that make sense? In fact, it doesn't make sense--particularly for something that is lifesaving; it is the major way we provide health care today from a preventive and maintenance standpoint, as well as in a crisis. There are huge differences between the way the Veterans' Administration successfully serves our veterans and what is being done through, unfortunately, inflated prices through the Medicare system that not only seniors are paying, disabled are paying, but taxpayers are paying as well. Yesterday, I talked about a report--and I want to talk to that today--from Families U.S.A. released last week, which looked at 20 prescription drugs commonly used by seniors. The results are startling. The report compares the prices the private Medicare Part D plans charge and the prices obtained by the VA, which negotiates for low drug prices on behalf of America's veterans. It showed, again, what we have been seeing over the past year: For each of the top 20 drugs prescribed to seniors, the lowest prices charged by any of the top private Part D providers are higher than the price secured by the VA. It is not just a little bit higher, but in many cases it is astoundingly higher. Let's look at some examples. I am mentioning specific drugs, not to pick on particular drugs, but we talked about the fact in the committee that transparency, the ability to compare price, and the ability for people to know what they are purchasing is very important. This is something we want the Secretary, on behalf of the people of America, to be doing--looking at the differences in these prices, and the particular points where there is a wide disparity, using their negotiating power to be able to step in on behalf of seniors and the disabled. When we look at Zocor, which I mentioned yesterday--the drug many seniors use to control their cholesterol levels--the lowest VA price for a year is just over $127. The lowest price under a private plan is $1,485.96--over a 1,066-percent difference. That is astounding. I argue that you could still continue to work with the Federal Government and partner to do research and bring that price down. Why should seniors pay $1,359 more in a year for this particular prescription drug than veterans do? It is exactly the same drug. Now, I also mentioned Protonix yesterday. It is the same thing. We are looking at $214.52 for a year, the VA price, negotiating the best price, and $1,148.40 with the lowest Part D plan, a difference of 435 percent. It is the same thing as we go through the next one, which is Fosamax, which is a 205-percent difference, and on down. We are talking about substantial differences in price--some smaller than others. But the reality is negotiation works. All we have to do is look at the fact that, on average, we are seeing a price difference of 58 percent between the Veterans' Administration and what is happening from the lowest possible plan with the top 20 most prescribed drugs for our seniors. In other words, for half of the drugs our seniors need most, the lowest price charged is almost 60 percent higher, and it is not demagoguery to say people are choosing between food and medicine. It is not. It is not an exaggeration to say that right now somebody is sitting down and deciding: am I going to pay the heating bill or get the medicine I need? That is the reality for people. We need to have a sense of urgency about fixing this. I also want to speak to the fact that we have heard a lot about the VA. Unfortunately, we have heard things that are not true, according to information from the Veterans' Administration. Yesterday, I was asked if I knew there were well over 1 million veterans who moved to Medicare Part D. The assertion was made that veterans were leaving the VA because the VA could not give them the drugs they wanted. I knew there were veterans who were adding Medicare Part D coverage. We went back to look and see what that was all about after I received that question. In fact, approximately 280,000 veterans have signed up for Medicare. They are not leaving the VA. In fact, it is not even clear that they are getting any drugs through Medicare at this point. They may have done it to add extra coverage. We are not sure what that mix is, but we are not talking about a million veterans or more running to leave VA because it is such a bad program. Moreover, according to both the Government Accountability Office and the Institute of Medicine, the VA system is working well. According to the GAO, an overwhelming majority of VA physicians report that the formulary, the grouping of drugs that are available, allows them to prescribe drugs that meet their patients' needs. The Institute of Medicine has reported that veterans believe their needs are being met. Access to drugs is an issue in less than one-half of 1 percent of the complaints about the VA health system. One-half of 1 percent relate an inability to be able to get the medicine they need. I also need to point out that at our Finance Committee hearing last week it was mentioned that there are fewer drugs available to our veterans. In fact, we have heard it today on the floor. That is exactly the opposite of what is true. The VA actually has more drugs on its formulary, its list of available drugs. I have not heard anybody say, first of all, that we should take the VA system and impose it on Medicare. But there is a lot of misinformation about what is happening in the VA and what is happening for our veterans, and there is a lot we need to do to focus on the reality and the facts of the huge disparities, an average of 58 percent, and the highest is over 1,000 percent. I find it very interesting that, on the one hand, we hear two different kinds of arguments occurring. One is that negotiation will make no difference in price. On the other hand, we hear we will lose lifesaving research because of negotiation. Those two arguments don't fit together, even though they are being made by the same people. We don't have to worry about research and development if, in fact, negotiation doesn't lower prices. I argue--and I think common sense dictates--that when you are looking at a 1,000-percent difference in price, at the fact that the American taxpayer is contributing, on average, at least as many dollars for research as the brandname industry is--overall, at least contributing that, because we want the lifesaving drugs--when you look at all of the facts, it doesn't add up; it doesn't add up for anybody but the industry itself to be able to argue that they want to keep the prices this high. I appreciate that. Any industry that has such a significant advantage certainly wants to fight to keep it. But I am very hopeful we will join with the House in saying this is lifesaving medicine, it is not an optional product, and we have to get the best price for our seniors and for the disabled in America. I thank the Chair.

Ms. STABENOW

Ms. STABENOW. Madam President, I felt it was important today to come to the floor and speak about the efforts of the House of Representatives to lower the cost of prescription drugs for our seniors. There has been a measure passed that will require that the Secretary of Health and Human Services negotiate prices. It sounds like something that is pretty straightforward and common sense: to negotiate the very best price for our seniors and people with disabilities. I know my distinguished colleague and friend, the now-ranking member of the Finance Committee, has spoken about his objection to that approach. I think it is important that we also have voices speaking out about why we believe this makes sense for Medicare, for taxpayers, for our seniors, and for the disabled. The facts really bear out that this makes sense. We are not talking about whether we do research and development on new breakthrough drugs versus being able to get prices that are affordable for our seniors. There is an ample way to be able to do both. In fact, we, as taxpayers, provide a tremendous amount of the money that is currently being spent on R&D, and it is important we know we can afford the medicine that we are helping to pay to have developed. A report by Families USA, released last week, looked at the prices of prescription drugs most commonly used by our seniors. The conclusion could not have been more clear. The report compared the prices the private Medicare Part D plans charge now and the prices charged by the Department of Veterans Affairs, the VA, which negotiates, as we all know, for the best price on behalf of America's veterans. The report showed, again, what we have been seeing over the past year. The lowest drug prices charged by the private Part D plans are significantly higher than the prices obtained by the VA. Among the top 20 most used drugs, the median difference between the lowest Part D plan and the lowest VA plan is 58 percent; 58 percent difference between what the VA is able to do for veterans and taxpayers versus what is happening under the Medicare Part D plan. In other words, for half of the drugs our seniors need most, the highest price charged by the private drug plans is almost 60 percent higher. That makes no sense. I hope we will act to change that. It can be a lot worse, however. When we look at half of the top 20 drugs, the highest price charged by a private plan is twice as high as the average price through VA for the lowest priced drugs. Seniors and people with disabilities who get their drugs through Medicare are forced to pay more because the law actually prohibits the Secretary of Health and Human Services from negotiating the best price. It is not only that they are trying and are not able to do it; the law that was passed prohibits them from doing that. That does not make sense. We have all heard from seniors, from families, from people with disabilities across the country trying to wade through all of the private plans and the complexities and dealing with the doughnut hole, and so on. We know that, in fact, one of the reasons that there is that gap in coverage is that we are not using the purchasing power of the Federal Government through Medicare to get the best price so that our dollars and the dollars of the people on Medicare are stretched as far as possible to help people get the medicines they need.

Ms. STABENOW. I am happy to.

Ms. STABENOW. Yes, reclaiming my time, I am aware that, in fact, there are veterans who have moved to the Medicare system. One of the reasons the House bill that passed did not include a national formulary was because of those kinds of concerns. We are not talking about that. We are talking about the ability to negotiate to get the best price. I would also say, though, from the VA's standpoint, that there are millions of veterans who are getting much better prices as a result of the fact that they can negotiate the best price for veterans. We are working to find that balance to provide a choice so that you can get the specific prescription drug that you need but at the same time be able to get the best price. I don't know why we wouldn't want to do that. It makes absolutely no sense not to do that. We are seeing huge differences on prescription drugs that are commonly used by our seniors. Let me give an example. Zocor, which is a drug many seniors use for keeping their cholesterol levels under control, the lowest VA price is about $127 a month. But people under Medicare are paying $1,486. We are talking about a difference of over 1,000 percent. If you account for an aggressive R&D budget, if you account for differences, there is a lot of wiggle room when you are talking about a 1,000-percent difference in price between someone going through the VA and someone going through Medicare. I don't understand why we would not say to the Secretary of Health and Human Services: We want you to negotiate a better price for Zocor. There were 7.5 million veterans enrolled in the VA health system in 2005. The administration estimated that over 29 million seniors were enrolled in private plans last year. So there are four times more seniors enrolled in Medicare than there are people under the VA system. And I do not understand--to me it defies logic--why we would not give them the same negotiating power. I would also like to give the Secretary a chance to negotiate a better price for Protonix, a drug that is commonly used to treat heartburn. The lowest VA price for Protonix for a year is $214.52. Seniors paying the lowest private Part D price have to pay $934 more to get their heartburn treated. Again, that makes no sense. Older Americans are forced to pay 435 percent more for Protonix because the Secretary is forbidden from negotiating prices on behalf of our seniors. When we look at what is happening, the claim that private plans could actually negotiate a better price under Medicare but also under Medicaid has not borne truth. The Wall Street Journal, the New York Times, and expert testimony before the Finance Committee last week all indicated that, in fact, drug prices are now higher for these individuals, those who were before on Medicaid and now on Medicare. These are our poorest seniors and people with disabilities. Our seniors are being charged more than veterans for the same drugs and our poorest seniors are not getting the price break we had anticipated. It doesn't make sense to me why we would be paying more and why prices would have gone up once Medicare came into place for prescription drugs, why prices have gone up rather than down. There are two arguments that I am hearing all the time. One is that we can't possibly rigorously negotiate for lower prices for seniors and people with disabilities because we will see prices go down so much that the companies will not be able to conduct research and development on breakthrough drugs. At the same time, we hear also that negotiating would not make a difference; it would not lower prices. It is impossible to argue both of those positions at the same time. If negotiating will, in fact, not lower prices, then it certainly can't affect R&D expenses. But yet both of those assertions are being made at the same time. We are all committed. This Congress last year appropriated $29 billion for research and development through NIH. And I know the distinguished Chair has been involved in advocating for those efforts as well as for Medicare. The fact that we have put into place $29 billion of taxpayers' money indicates our commitment to R&D and to work with the industry. The research that is done through that effort is available free of charge to the industry. They are able to take that information. They are able to deduct as a business expense their R&D efforts, and they get a 10-percent tax credit for R&D efforts on top of that for breakthrough drugs, all of which I support. We then give about an 18-year patent to protect a company from a particular drug. They have to be able to recoup their costs and not have full competition from the private marketplace or from generic drugs. I, also, support that. All we are asking--all the people of the country are asking, particularly our seniors and disabled--is that when one gets through with the process they have invested in, they should be able to afford to buy the medicine. Medicine that is not affordable is not available, and health care today is becoming more and more a question of treatment through medicine. I am hopeful we will move quickly. I know the chairman of the Finance Committee has held a hearing. We are grateful for that. I am hopeful we will move forward together on a bill that will mirror what the House of Representatives has done in order to say that the Secretary should negotiate the best price for medicine for our seniors, for people with disabilities, and certainly for the taxpayers who are paying a substantial amount for this benefit.

Ms. STABENOW

Ms. STABENOW. I say thank you very much to my distinguished colleague from Utah managing the floor.

Ms. STABENOW. No more than 10 minutes.

Ms. STABENOW. Madam President, I ask unanimous consent to speak as in morning business.

Ms. STABENOW

Ms. STABENOW. Mr. President, I move to reconsider the vote.

Ms. STABENOW

Ms. STABENOW. Mr. President, I rise today to oppose the Gregg amendment because as a member of the Budget Committee, as we have watched this develop and as we worked on it last year in committee, I believe it is too broad and not in the public interest. I am not opposed to line-item veto. In Michigan, when I was in the State legislature for 16 years, we had and have a line-item veto, but it is a very narrowly crafted line-item veto in a very different setting. We have a germaneness rule in Michigan that certainly we do not have here, where topic by topic is taken up separately, or legislation separately. We here work in a larger format where we are many times--most of the time--negotiating very complex legislation, and frequently we have a number of different issues and interests coming into the same bill, and it creates a very different climate in which this is being discussed. Also, this is a very broad application, and I believe too broad. Let me give my colleagues an example. The amendment would give the President unprecedented powers to dramatically weaken any legislation we might put together that would strengthen Social Security or Medicare or any other areas of mandatory spending such as veterans' benefits or other areas where we have critical needs. Let's suppose for a moment that we come together, and this is the way it is always done, and we negotiate an agreement around Social Security or around Medicare, and as always, it is a give and take. Let's say, for instance, around Medicare, it is a provision where the industry receives certain things they would like to see happen, and on the other side, those things that are important for people, for seniors, for the disabled, for those trying to be able to afford medicine, we negotiate things there that allow prices to go down or more competition or better benefits. But then it goes to the President, and under this particular bill the President will be allowed to go into that legislation and veto certain parts of an agreement that the Senate and the House made to come up with something that was balanced, that would allow legislation to happen. The President will be able to come in, for instance, and decide to keep the provisions of the pharmaceutical industry, an industry he has been very close to, and at the same time he might then strike out provisions regarding negotiation or improved benefits or something else that might help seniors or people and put pressure on the industry to have a more competitive pricing system. This is something that I believe we should not, in good conscience, allow to happen. It is our job to sort through all of the pieces of the legislative process, all the complexities, all the competing needs. If we come up with something that is balanced and supported by this Senate and the House of Representatives and it is sent to the President, the President should not be able to go in and cherry-pick which provisions of a compromise he supports or does not support. This particular amendment in this proposal would undermine the very intent of Congress. In the case of Medicare, I believe it would create a situation where it is impossible for us, certainly within this time and this administration, to move forward on many positive things that are necessary to improve Medicare for seniors or to address Social Security in a way that keeps Social Security secure for the future. Also, it is important to say that this is not a necessary tool to reduce the deficit. In fact, we, on both sides of the aisle, have been speaking about reducing the deficit. On this side of the aisle our distinguished incoming chairman of the Budget Committee has been our leader on speaking out through that committee, as has our leader in this Senate. Senator Reid has spoken out and made pay-go a priority, fiscal responsibility a priority for us coming into this new year. We will soon adopt what is called pay-as-you-go legislation that basically says, if we decide to spend dollars, whether it is in the form of a tax cut or in new spending of some kind, we have to pay for it. It is the same thing that any family or any business has to do: figure out how you are going to pay for it. We are the ones who have committed, as part of our agenda, our priority: to bring this huge deficit under control and try to get our arms around some fiscal responsibility in this Government. We have put that forward and that will play a major role, reinstituting pay-go. Unfortunately, our colleagues on the other side of the aisle have blocked this for 6 years. During that time we have seen deficits go up and up and up and decisions being made that have added to the spending of this country. We have seen policies that turned a $5.6 trillion surplus created under the Clinton policies into record deficits. Now we understand that we are at a crossroads in this country. It is absolutely critical that we bring fiscal responsibility and we begin to turn this around. But this proposal in front of us does not do that. I hope we will see strong support on both sides of the aisle for fiscal responsibility and pay-go legislation and begin to make tough decisions about what is in the interests of America, what is in the interests of our businesses trying to do business and stay in America, of our families who need jobs and health care and want to know they can send the kids to college and breathe the air and drink the water and all of those things that are critical to our quality of life. We have a lot of tough decisions to make. But one strategy is not to create this broad tool for the President to be able to undermine anything that we are doing together on a bipartisan basis to get to agreement, to be able to move things forward. I am very concerned particularly at this time with this type of legislation. I speak a lot about Medicare. I know the distinguished Chair is also deeply concerned and involved in health care issues and Medicare. We want very much to be able to see change occur, change that is good for our seniors, change to make health care coverage and prescription drugs more affordable and make sure our businesses, large and small, have the capacity to compete effectively in Michigan and be able to afford health care for their employees. I am very concerned this kind of proposal would enable the President to come in in support of those interests he supports, that I believe are on the opposite side of what we are trying to do, unfortunately, in the health care arena, and allow him to undermine any effort that we make to go forward together. People are desperately asking that we move forward and get something done on the issues that are critical to them, that matter to them. Again, I rise to oppose the Gregg amendment. I encourage colleagues to do the same. We stand together and we can move forward together around fiscal responsibility. This is not the way to do that. This gives unprecedented power and flexibility to the President for him to undermine what we need to do together in order to solve big problems and get things done for people.

Ms. STABENOW

Ms. STABENOW. Mr. President, I rise today to honor one of Michigan's great sons. Today we honor the remarkable life and lasting legacy of President Gerald R. Ford. I thank our leaders and colleagues for the wonderful tribute that will be voted on at noontime today. This past week our Nation mourned the passing of a President, while Michigan mourned the loss of a family member. Throughout his decades in public service, including a quarter century representing Michigan in the Congress, Gerald Ford worked tirelessly to serve the people and the interests of our great State and his beloved country. It is an honor that the State of Michigan will serve as the final resting place for one of our Nation's great leaders. The funeral last Wednesday, which I was fortunate enough to attend, was truly a moving tribute to a man who cared deeply for the city of Grand Rapids, his home State of Michigan, and the country. The thousands of mourners who came to pay their respects is evidence of what he meant to us. People standing in line for hours, on into the night, and the wonderful, gracious way the family greeted so many of those coming to show their respect for Gerald Ford was a wonderful, meaningful act to watch. I would be remiss if I didn't take the opportunity to speak about Gerald Ford's family. Betty Ford's grace and strength throughout the past few weeks have stood as a reminder not only of the importance of family in the life of Gerald Ford but also how much she has given to America through her courage, her example, and her charity. Betty Ford stood shoulder to shoulder with President Ford as a true partner throughout his life, while redefining the role of First Lady and serving the country with her own dedicated work on issues such as alcohol and drug abuse. Together the Fords raised four remarkable children--Michael, John, Steven, and Susan. It is a testimony to Gerald Ford's character that he will be remembered not only as a great leader but as a wonderful husband, father, grandfather, and great-grandfather. Born July 14, 1913, in Omaha, NE, Ford moved at a young age with his mother to Grand Rapids, MI, to live with his stepfather. While attending South High School in Grand Rapids, Ford proved himself an academic and athletic prodigy, being named not only to the honor society but all-city and all-State football teams. In 1931, Gerald Ford entered the University of Michigan, playing center and linebacker for the Wolverines. He played on two undefeated teams and was named the team's most outstanding player in 1934. Ford's legacy will always be felt at the university. To this day, his number 28 is one of only 5 football jerseys retired by the University of Michigan, while the School of Public Policy bearing his name will shape and produce America's leaders for generations to come. Gerald Ford's childhood in Grand Rapids and his education both on and off the field at the University of Michigan helped forge a man whose character and actions throughout his life exemplified what is best about Michigan--hard work, loyalty, honesty, and selflessness. After graduating from Michigan, Ford rebuffed offers from the Detroit Lions and the Green Bay Packers in order to attend Yale University Law School. He continued his love of athletics there by serving as a boxing coach and assistant varsity football coach. In 1941, he earned his law degree from Yale, graduating in the top quarter of his class. Gerald Ford then returned to the city he considered his home, Grand Rapids, to practice law before joining the U.S. Naval Reserve in April 1942, serving as an assistant navigator with the USS Monterey in the Pacific during World War II. Ford was discharged from the Navy in 1946 as a lieutenant commander, returning to Michigan to practice law. Entering politics with the encouragement of his stepfather, Gerald Ford ran for Congress in 1948, unseating incumbent Bartel Jonkman in the primary and going on to receive 61 percent of the vote in the general election. Gerald Ford would go on to represent the people of Michigan in Congress for the next 25 years, in 1965 rising to become the minority leader in the House. In late 1973, Ford was called on to serve the country in a different capacity, as we all know, being named and confirmed Vice President. Within 8 short months, he was again called on to take the mantle of responsibility he had not sought, taking the oath of office as the 38th President of the United States. Stepping into the Oval Office during one of America's greatest constitutional crises, President Ford's quiet demeanor and steady hand helped calm a nation and kept the Government moving forward during some of its darkest days. It is a testament to President Ford and his time in public office, highlighted by his years in the White House, that even those who disagreed with his policy positions respected him as a person and a public servant. Gerald Ford dedicated his life to make our State and our Nation a better place to live, work, and raise a family. He was a man who understood that integrity and service are more than just words, they are ideals--ideals he learned in our wonderful Michigan and practiced every day of his life. As a husband, a father, a Congressman, and our President, he led quietly by example, earning respect and friendship on both sides of the aisle through the hard work and honesty for which he was known. President Ford was a man utterly deserving of the words inscribed on a football resting on a homemade memorial outside the Ford Museum in Grand Rapids this week: A true American and a hometown hero. President Ford, we thank you for your service. You will be missed. Our continuing prayers and support go to your family.

Ms. STABENOW

Ms. STABENOW. Mr. President, I suggest the absence of a quorum.

Ms. STABENOW

Ms. STABENOW. Mr. President, I rise to speak, as my colleague from New Mexico has spoken so eloquently, about a very serious issue we have to address before we leave for the year. Once again, I rise to speak about the urgency of providing our Nation's physicians with the resources they need to provide high-quality Medicare services to our seniors and people with disabilities. As my colleague indicated, this is something of the utmost importance that needs to be addressed now. There is no reason we cannot address this before we leave. On September 21, I asked unanimous consent for the Senate to approve S. 1574, legislation that would provide for a 2-percent update to physicians as recommended by the Medicare Payment Advisory Commission, MedPAC. This particular bill was introduced by my colleague Senator Cantwell, and I thank her for her leadership on this important issue. My Republican colleagues objected to this request, and so nothing has happened in the last 75 days. We are running up to the end of the year, and yet nothing has happened. Nothing has happened to ensure that physicians will receive a modest update to their Medicare payments. Nothing has happened to ensure seniors and people with disabilities will have access to their doctors. Senator Cantwell and I each introduced legislation over a year ago to override the sustainable growth rate formula for Medicare physician payments--in other words, a formula that has been putting us on this road to a 5.1-percent cut come January. We knew then that the formula was wrong. It is not sustainable. It doesn't work. It needs to be fixed. We have known this day was coming. We know physician payments will be cut by over 5 percent on January 1--just a few weeks from now--if Congress doesn't act. We know Congress has only a few short days to complete the business for the year. We know what we need to do to solve the problem. While the clock is ticking down, we have time to address this issue. It is critical that we not leave here without addressing this for our seniors, for our families, for people with disabilities, and for the physicians of this country who are caring for those individuals. People say we are out of time. Some people buy Christmas presents on the afternoon of December 24, but there are people who run right up to the deadline. There are people who mail their tax returns right before midnight on April 15. We are in one of those situations. We have to decide to get this done because the deadline is here. We are running right up to the deadline. But we have to make this a priority before we leave. I know colleagues are working on both sides of the aisle as well as in the House to find a solution. It is critical that something be done, that it be fair, that it moves us in the right direction, not the wrong direction. It is not going to take long to get this done if people want to get it done. In less than 1 month, payments to physicians will be cut by 5 percent. Under current law, while costs continue to increase, physicians will actually be paid less than they are paid today. As I mentioned in September, we know from the recent survey conducted by the AMA that if the scheduled cuts go into effect, 45 percent of doctors will decrease the number of Medicare patients they accept. Almost half of physicians will decrease the number of Medicare patients they can accept. Fifty percent of doctors will defer purchase of health information technology, which is another critical issue that I am pleased to be working on with colleagues on the other side of the aisle. We have a bipartisan consensus that we need to move forward on health information technology to save both money and lives. Yet we can't say to physicians: We are cutting the income coming in, we are cutting your payments for serving people, and by the way, we want you to spend money on new hardware and software and training people for a system that is critically important for the Federal Government to save money. That doesn't make any sense, and that is not going to happen. We also know that 37 percent of doctors practicing in rural communities--and Michigan has many rural communities--will be forced to discontinue rural outreach services. This is unfortunate for the people of Michigan as well as around the country. And 43 percent of physicians will decrease the number of TRICARE patients they serve. We are talking about people in the military and their families. This doesn't have to happen, if we can act and act quickly. Further, MedPAC considers the Medicare SGR formula to be flawed. It is an inequitable mechanism for controlling the volume of services. They recommended repeal of it in 2001 because it is not working. It is not working mostly for patients, and it is not working for physicians. Since that time in 2001, they have consistently recommended repealing the formula. MedPAC has stated that the cuts will be particularly devastating for primary care doctors--the very doctors many Medicare beneficiaries rely on for important health care management. This doesn't have to happen. We have the power to make sure it doesn't. While the problem is clear, fortunately so is the solution. MedPAC is an independent Federal body established by Congress in 1997 to advise us on issues affecting the Medicare Program. In addition to advising Congress on payments to providers, MedPAC is also tasked with analyzing access to care and quality of care. In carrying out their charge, MedPAC has recommended a 2-percent physician payment update to keep them moving forward for next year. The change is one that I have advocated, and in fact 79 of my colleagues have joined me in seeking and directly tracking MedPAC's recommendations. In fact, 80 Senators have said that physicians must be provided with a positive Medicare payment update for 2007 before we adjourn. Eighty Members have signed a letter to the two leaders of the Senate. Senator Reid has indicated his full support in moving forward with this. Eighty Members have said yes, we know the problem, we know the solution. The will should be there. Eighty out of 100 Senators have said this needs to get done. I joined these 79 other Senators in sending a letter in July to our leaders. Senator Reid has positively responded. I thank him for that. We have less than 3 days to get this done. My colleagues working on this need to know we want to get this done, get this done in the right way, and that we will not leave until it is completed. We know if we do not provide some kind of modest update to Medicare physicians payments, our seniors and people with disabilities will lose access to their doctors. That is what this is all about. Shame on us if this happens. I am very proud of the work that over 20,000 MDs and DOs in Michigan each day provide 1.4 million seniors and people with disabilities in Michigan high quality medical services under the Medicare Program. I want them to be able to continue to do that. There is no way they can if, while their costs are going up, their time with patients goes up because of the complexities of dealing with many older citizens and people with disabilities, yet at the same time their reimbursements for those services are going down. Beginning January 1, the average cut for a physician in Michigan would be $34,000 per year. How can we ask them to increase their level of care to support and expand what they are doing as more and more people enter the Medicare Program while we are making those cuts every year? It is not sustainable. It does not make any sense that at a time when medical costs are going up, the payments and reimbursements are going down. I have had many opportunities to hear from physicians in Michigan. Let me mention a couple of them. I will read a letter I received from Dr. Gela Pala, geriatrician and resident of Oakland County, MI. She puts the problems in words that make the situation we face very clear. As a resident of Oakland County, Michigan and practicing geriatrician I believe cutting further Medicare physician reimbursement will be a mistake. Most of my patients are above 70 years old and they come to the office with a list of 10 to 20 medications and 10 or more diagnoses. I routinely spend 1 hour or more with a patient and family to discuss options of care, realistic goals/ expectations and coordinate care. As medicine is becoming more and more complex I anticipate we, patients and doctors, will need to increase the time we spend together. I doubt an 80 year old cognitively impaired grandmother will need less medical attention in the future. I doubt that she will be able to navigate the complexities of the medical system alone or with help from brochures, computers, etc. I can see my patient getting lost in the shuffle of ``cost effective'' medicine. I can see the doctors ordering more tests because nobody had the time to discuss the prognosis. I can see my patient going from one office to another trying to understand what is wrong, how to fix things and how to differentiate between what is fixable and what is not. Cutting physician reimbursement will not make our nation stronger, healthier or safer. I believe that less physician time will mean less health and more healthcare cost. Please take action to prevent further deterioration of the medical care for the elderly. I couldn't agree more. I have heard from so many people regarding this issue. I will read one more statement, from Dr. Thomas Watkins, a DO and family practice physician in Muskegon, MI: It will be a travesty for many seniors if doctors stop accepting Medicare due to fund cutting. With our expenses going up 5-10 percent annually and Medicare cutting 5 percent next year it will be very difficult for many of my colleagues and myself to continue to practice medicine for Medicare recipients. Please at least vote to freeze the fee schedule to allow access for all seniors to the physician of their choice, just as you have that privilege. I simply ask that we act now. We have no more time to wait. People are counting on us.

Ms. STABENOW

Ms. STABENOW. Mr. President, I rise today in celebration of my longtime friend and staff member, Rob McClintic. After 23 years of work in the U.S. Congress, Rob has decided to retire from the Senate. Rob started with my office on March 13, 1998, while I was still in the U.S. House of Representatives. When I won the election to the Senate in 2000, I couldn't imagine not bringing Rob to work in the Senate with me. Rob is often the first contact with my constituents and visitors. As a staff assistant, Rob has been tasked with answering phone calls from constituents and greeting visitors. Everyone who works in Congress knows that answering phones is an extremely important job and can be tremendously challenging. This is one of the main ways that Senators and Representatives hear how their constituents are feeling on important issues. Rob has at busy times answered well over 100 or more phone calls a day. In 23 years on the Hill, Rob surely has answered over 600,000 phone calls. This is, needless to say, a tremendous feat. Rob is also responsible for giving tours of the Capitol building and for setting up other tours around Washington, DC. His knowledge of the history of the Capitol is outstanding. He knows every corner of the Capitol and provides a personal touch on each and every tour. Rob not only just gave tours, he made sure that the visitors from Michigan enjoyed their stay in DC, and experienced the history of Congress. Prior to working for me, Rob worked for Congressman Phil Sharp from Indiana, Rob's home State, from April 1983 through January 1995 and Congresswoman Marcy Kaptur of Ohio from August 1995 through February 1998. Upon leaving the Senate, Rob will be moving back to his home State of Indiana to be closer to friends and family. I know his family is proud of him and will welcome him home with open arms. I also know that Rob's friendly demeanor and unparalleled professionalism will be dearly missed here in Washington, DC. Rob McClintic is irreplaceable. Mr. President, I am sad because I am losing my trusted and valued staffer who has worked with me for nearly a decade, but I am happy to see a dear friend move on to new challenges, and I wish him the best of luck.

Ms. STABENOW

Ms. STABENOW. I have heard from many seniors, the Center for Social Gerontology in Ann Arbor, and Michigan's Area Agencies on Aging and senior centers about the need for reauthorizing the Older Americans Act, which was last reauthorized in 2000. While the reauthorization of the OAA is a positive step for America's seniors, funding for Federal seniors services has failed to keep place with inflation and an aging population. I am also pleased that the OAA reauthorization will contain the core elements of S. 409, the Federal Youth Coordination Act, which I cosponsored with Senator Norm Coleman. I was also pleased to work with Congressman Tom Osbourne on pushing this legislation forward. I thank Chairman Enzi and Senators Kennedy and Mikulski and their staff for including this important piece of legislation in the OAA reauthorization. In 2003, the White House Task Force for Disadvantaged Youth report identified numerous programs in 12 different Federal agencies that serve or relate to disadvantaged youth. But the task force could not determine precisely how much funding directly impact our young people because there is no uniform, focused Federal youth policy. The task force recommended the establishment of a coordinating body to facilitate the evaluation, coordination, and improvement of Federal programs serving youth. In response, our legislation creates a 2-year coordinated council to evaluate, coordinate, and improve Federal youth programs. Membership on the council includes 12 Federal agency officials, representatives of youth-serving nonprofits and faith-based organizations, and the youth who actually participate in these important programs. The purpose of our bill is not to cut programs but to look at ways we can better serve our young people. Our children, especially those most at risk, should not be lost in a Federal bureaucracy. We must ensure that our taxpayers' investment produces a strong return on our Nation's investment in our children. America's youth deserve high-quality, effective and meaningful youth development programs that achieve the greatest possible impact. I urge the President to convene a council that will take its mission seriously and includes members with strong backgrounds in children's services. Most importantly, the council ought to include young people, especially those positively impacted by federally funded programs. At a January briefing I sponsored with Senators Coleman and DeWine, one of the most powerful stories we heard from Terry Harrak, a former foster youth once caught in the middle of the maze of services. She called on the Senate to pass the Coleman-Stabenow bill and for Congress to not cut the number of programs but to improve how they work together. Again, I thank my colleagues for their support for serving two of our most vulnerable populations, our seniors and our children. Additionally, I thank the many Michigan organizations who supported the Federal Youth Coordination Act, and I ask unanimous consent that a copy of the letters in support of S. 409 be printed in the Record.

Ms. STABENOW

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

Ms. STABENOW

Ms. STABENOW. Mr. President, I rise today to urge my colleagues to come together to pass an update of the physician Medicare payments and to stop what will be over a 5-percent cut that will take place in January if we do nothing. We need to have a sense of urgency about this issue. Eighty Senators on both sides of the aisle--80 out of 100--came together and signed a letter to our leader asking that a positive Medicare payment update for 2007 happen before the Senate adjourns. Senator Reid spoke on the floor in support of that effort. I urge our Senate leader to come to the floor, and in the final days of the session before we break for the elections do what 80 people in this Senate--80 Senators out of 100-- have come together and agreed physicians must be provided, which is a positive Medicare payment update for 2007. I am deeply concerned that after the election we may or may not have the focus in order to be able to get that done before the end of the year. It is vital not just to physicians but to the people we represent--the seniors, people with disabilities--that we get this done. Eighty Senators out of 100 have sent a letter to our two Senate leaders and have urged that we act now. Senator Reid has indicated his support for doing that. We need our Senate leader to bring this to the floor so we can get it done. I joined these 80 Senators in sending that letter in July because we know that if we don't provide even a minimum update, we destabilize the Medicare system and put all patient access to health care at risk. That is not an understatement. There needs to be a tremendous sense of urgency about this issue. What has happened since July 17 when we sent the letter? Nothing. There has been no committee hearings, no markups--despite 80 Senators agreeing that we have a need to provide a minimum update for physician services. There has been no effort by the majority leader to bring this issue to the floor. We have had no willingness to bring up an issue that has incredible significance to tens of millions of Americans all across our country. I am here this morning because we have only 7 days or 8 days-- whatever the number is--left before we adjourn for the elections. We don't know what will be happening after that. We certainly know there are many critical issues left and much to be done. The appropriations process isn't completed. There are many items on the agenda after the election. It is very uncertain what will be happening. We know that right now we can get it done. We do know with certainty that come January there is going to be a 5-percent cut for physicians and fewer physicians being able to care for our seniors and people with disabilities if we do not act. With 80 people urging that we act, this should be a simple process. This should be, as they say, a no-brainer to bring this to the floor and simply get it done. We need to do something today. There is no reason not to do this today. We can get it done quickly. Eighty Senators wrote: The undersigned Members respectfully urge you to ensure that these impending cuts are addressed before Congress adjourns. At a minimum, we must provide physicians with a positive Medicare payment update for 2007. So we have the critical mass necessary to get this approved. The change we are seeking in law directly tracks MedPAC's recommendation for what the physician payment update should be for 2007. So we have a solid policy. We have an overwhelming majority of Senators, based on solid policy, and we know if we don't make this change, our seniors and people with disabilities are going to lose access to their doctors. We know from a recent survey conducted by the AMA that if the scheduled cuts go into effect, 45 percent of doctors will decrease the number of Medicare patients they accept. Fifty percent of doctors will defer the purchase of health information technology which, I might add, is an area where we, under our budget jurisdictions for Medicare and Medicaid and other health care programs, will reap huge savings, hundreds of billions of dollars with health information technology. But you cannot tell a physician who is trying to make ends meet to be able to continue to serve people that, by the way, we are going to cut your payments coming in, but we want you to buy new hardware and software and train people and do all of these other things so that the Federal Government can save dollars. It doesn't make any sense. We also know that 37 percent of doctors practicing in rural communities--and in my great State of Michigan, we have a huge, beautiful rural part of our State. I grew up in one of those small towns, in Clare, in the northern low peninsula. I understand about access to physicians and access to health care. We know that 37 percent of doctors practicing in rural communities will be forced to discontinue rural outreach, and 43 percent of physicians will decrease the number of new TRICARE patients they serve. So we clearly have a need. Also, we know that when we cut payments, whether it is to physicians, hospitals, home health care agencies, or nursing homes, we do not really save any money. We just create more people who cannot get the care they need when they need it. And what happens? They walk into the emergency room sicker than they should be. They get the care they need. Our hospitals provide that care. But then they have to recoup those costs, so they roll those costs over to everybody with insurance. In a State with a huge manufacturing base, with employers that provide health care, this goes right on their backs. Businesses large or small end up seeing their health insurance rates go up. So the private sector ends up paying for all of these expenses, and it does not save money to cut physicians' payments or other Medicare or Medicaid payments, either one, because then the private sector has to look for ways to cut. They ask working people and their families to pay more for health care or they cut the kind of health insurance they have. What happens? More people walk into the emergency room. This happens every day. What are we waiting for? We have 7, 8 days left. We have a clear problem and a clear solution and a clear majority of Senators who want to see this fix happen. Over 20,000 M.D.s and D.O.s in Michigan provide more than 1.4 million seniors and people with disabilities in Michigan with high-quality medical services under the Medicare Program. Our Michigan families get wonderful care from wonderful doctors. Our American families receive wonderful care from wonderful doctors. But the question is, Will they be able to continue to receive those services? I would argue, not unless we do something now about the payment system used to reimburse physicians for Medicare services. Beginning January 1, 2007, the Medicare sustainable growth rate formula will cut payments to physicians and health care professionals by 5.1 percent. What does that mean in real dollars? In Michigan alone, it is $137 million in cuts to Medicare. The average cut for a physician in Michigan will be $34,000. As medical costs go up--as we see the cost of sustaining an office and other costs and medicine going up, everything is going up--we are cutting back on the physicians' reimbursements. These cuts will be particularly devastating for primary care doctors, the very doctors, according to the Medicare Payment Advisory Commission, MedPAC, many Medicare beneficiaries rely on for important health care management. Again, we are scheduled to adjourn in 7 days. It is time to resolve this issue so that our physicians know they are going to be able to continue to care for Medicare patients come January. This is not a new issue. MedPAC considers the Medicare SGR formula a flawed, inequitable mechanism for controlling the volume of services and first recommended repeal of the Medicare SGR formula in 2001. Since then, they have consistently recommended repealing the formula. I have, in fact, put forward a bill that would do that and set up a physicians commission to recommend what should be done. We don't have time for that between now and the end of the year, but we do have time to do what needs to be done in the next 7 days, which is to stop the cut that is scheduled to take effect in January. We need to stop that, and instead of a freeze that was given last year, we need to give a modest update for our physicians so they will know that we understand how important their services are to seniors and people with disabilities. In conclusion, I wish to share a couple of letters I have received. I have received so many letters from physicians around Michigan expressing grave concern. These are people who care very much about the people they serve. They are trying to keep it together so they can continue to serve people, whether it is in Detroit, Lancing, or Grand Rapids, up north, in the upper peninsula. I received a letter from a physician in Cheboygan, MI, which is a small town on the lower tip of the northern peninsula. Timothy M. Burandt, D.O. in surgery, wrote me a letter that says: In 1982, I graduated from medical school and took an oath to care for all patients in need. As a general surgeon practicing in rural northern Michigan, I am committed to caring for all of my neighbors, not just those with insurance. My expenses keep going up as I also have a responsibility to my staff to support them with fair wages and benefits. Without adequate reimbursement, I cannot continue to offer my services to everyone who walks through my door. There simply aren't enough resources. Please don't force me to choose which patients I should care for. I would rather retire early and close the practice. I don't want Dr. Burandt to have to close his practice in Cheboygan, MI. The families in Cheboygan, MI, cannot afford for him to close his practice, and there is no excuse for us not to act so he doesn't have to. Also, Tara Eding, a doctor of internal medicine in Hamilton, MI, writes: It will be very difficult to remain in practice as internist. The majority of my practice (including 3 other partners) is made up of Medicare patients. It is already difficult to maintain a primary care practice in this field. We have recently had to ``trim'' overhead by cutting staff, restricting our services, etc. and I only see things getting worse. If these cuts are made it will drive us out of practice. I have already stopped accepting new Medicare patients and if these cuts go through I will not have a choice. I will be forced to stop participating in one way or another. We would not be able to keep our practice open as it exists today. There is a sense of urgency in these letters. There is a sense of urgency that we need to feel on the floor of the Senate. We have 80 people in this body on both sides of the aisle who have called on our leaders to act. We have a sound policy, we have a sense of urgency, and we have time to get this done in the next few days. Unanimous Consent Request--S. 1547 Mr. President, I ask unanimous consent that the Finance Committee be discharged from further consideration of S. 1574, a bill to provide for a minimum update for physician services under Medicare, and that the Senate proceed to its immediate consideration; that the amendment at the desk to strike the language pertaining to an update for 2006 be considered and agreed to; that the bill, as amended, be read three times, passed, and the motion to reconsider be laid upon the table, without intervening action or debate.