Jeanne Shaheen

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I wish to congratulate the athletes from New Hampshire who represented our country at the Olympic games in Vancouver. As I watched the games over those 2 exciting weeks in February, I know I joined all Granite Staters in celebrating New Hampshire's enduring tradition of excellence in winter sports. More than 125 years ago, in 1882, residents of Berlin, NH, formed the first modern ski club in America. In 1927, the Dartmouth Outing Club organized the first downhill race in the United States at Mount Moosilauke in New Hampshire's White Mountains, where the Outing Club still hikes to this day. The next year, a Dartmouth professor organized the country's first slalom race. In the 1930s and 1940s, as skiing grew in popularity, J-bars and chairlifts were added at mountains in Europe, in the West and across New England, but none could rival Cannon Mountain's Aerial Tramway in Franconia, which was built by the New Hampshire State Legislature and continues to be the platform from which millions of visitors first see our White Mountain range. At the 1960 winter games in Squaw Valley, CA, 37 years after that first race in the White Mountains, a 22-year-old from Center Harbor named Penny Pitou became the first American to win an Olympic medal in downhill. The great ``Skiing Cochrans'' have roots on both sides of the Connecticut River, including Barbara Ann, who won a gold medal in 1972, her brother Bob, and Bob's son Jimmy, who competed in the slalom in Vancouver and grew up in Keene. There were 12 athletes on the U.S. team in Vancouver who have strong New Hampshire ties. On the Alpine team, Jimmy Cochran was joined by Leanne Smith from Conway and Bode Miller from Franconia, along with Andrew Weibrecht, an environmental studies major at Dartmouth. Hillary Knight from Hanover competed in her first Olympics as the youngest member of the U.S. Women's ice hockey team. And from just down the road in Lebanon, Nick Alexander competed in three ski jumping events including the normal hill event, known in the sport as the ``NH Individual.'' Kris Freeman from Andover competed in his third Olympic games in Nordic skiing. Kris trains at Waterville Valley, alongside Michelle Gorgone and Hannah Kearney, members of the famous Waterville Valley Black & Blue Trail Smashers Club. Snowboarder Scotty Lago from Seabrook went to his first Olympics in Vancouver after years of practice at Waterville and Loon. My husband Billy would want me to mention that he went to Dover High School with Jim Westcott, father of snowboarder Seth Westcott, who won back-to-back golds in snowboard cross. The New Hampshire medalists at these Vancouver Games were really spectacular. Scotty Lago spoke with such pride about representing Seabrook and all of New Hampshire when he won a bronze medal in the men's halfpipe competition. We are all very proud of Andrew Weibrecht, who won bronze in the Super-G, and Hillary Knight, who took silver with her team. Of course, the State is still celebrating Bode Miller, who, by winning a gold, silver, and bronze medal on the Whistler slopes, became the most decorated American alpine skier in history. But I am proud of every Granite Stater who represented our country in these Games. As someone in elected office, I can tell you that not every race goes exactly how you would like. What is important is that each of you has achieved so much through focus and hard work, far away from the spotlight. You represent the best of our State. Finally, I want to take a moment to recognize Tyler Walker of Franconia and Chris Devlin-Young of Campton, who will be skiing for Team USA later this week at the Vancouver Paralympic games. The Paralymic games continue to shine as an example to the world of what each of us can achieve. Thank you for representing our State and our country. Good luck.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I rise today to commemorate National Peace Corps Week and to honor the thousands of Americans who serve as Peace Corps volunteers throughout the world. The Peace Corps was founded on the ideal that each of us has the responsibility to serve our country and leave our world in a better place than we found it. Peace Corps volunteers provide innovation, creativity, determination, and compassion in an ever-changing world, advancing U.S. interests and the global good. These volunteers exemplify the true meaning of service to a greater cause and contributing to the well-being of those in need around the world. Since the Peace Corps' founding in 1961 by President John F. Kennedy, nearly 200,000 U.S. citizens have chosen to serve their country as Peace Corps volunteers in 139 countries around the world. Today, nearly 8,000 Peace Corps volunteers serve abroad in 76 different countries, providing critical education, expertise, and development assistance to the poor and impoverished across the globe. Their willingness to dedicate themselves toward the laudable goal of assisting those in need and strengthening the image of America makes them deserving of our respect and admiration. In my own home State of New Hampshire, 48 volunteers have heard the call and are currently devoting their time, energy, and lives to fulfilling the vision of President Kennedy and serving abroad in the cause of peace. They are placed throughout the developing world--from Cambodia to Guatemala to Kazakhstan--making significant and lasting contributions toward the health, education, and development in the places where these things are often needed most. I seek recognition of each of these citizen ambassadors and the many Peace Corps volunteers from New Hampshire that have served since 1961. In honor of their efforts, I will ask consent that the attached list of current New Hampshire volunteers be printed in the Congressional Record. New Hampshire is proud of your service, and we will continue to stand behind you and express thanks for your assistance. In today's interdependent world, American security and prosperity are inextricably linked to the security and prosperity of people in the developing world. Peace Corps volunteers work on the front lines in our battle for hearts and minds around the globe. They serve as teachers, business professionals, health educators, agricultural and environmental specialists, management and information technology advisors, and mentors and friends to citizens across the globe. As the administration plans to double the size of the Peace Corps in the years to come, it is critical to remember that these unofficial ambassadors have become enduring symbols of our nation's commitment to progress, opportunity, and grass-roots development in the far corners of the world. Upon the completion of their service abroad, these volunteers then return home to promote a better understanding here in America of the culture, language and viewpoint of those they have served. In our 21st century world, where the threats and challenges that confront America and the global community cannot be overcome by the might of our military alone, Peace Corps volunteers are laying the foundation for a more secure, prosperous, and compassionate world. In honor of National Peace Corps Week and in celebration of the Peace Corps' 49th anniversary, I would like to recognize those volunteers from New Hampshire, as well as all past and current Peace Corps volunteers, for their commitment to fostering a better world for future generations. As a member of the Senate Foreign Relations Committee and the chair of the Foreign Relations Subcommittee on European Affairs, I will work with our allies and friends throughout the world in the development of an American foreign policy that matches the passion and commitment to service of our Peace Corps volunteers abroad. Mr. President, I ask unanimous consent to have the list of current New Hampshire volunteers to which I referred printed in the Record.

Mrs. SHAHEEN

Mrs. SHAHEEN. Madam President, I ask unanimous consent to speak as in morning business.

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

Mrs. SHAHEEN

Mrs. SHAHEEN. Madam President, last week Senate leadership reached agreement on a short-term extension of Federal unemployment benefits and other critical programs that were set to expire. But when we tried to pass the bill, sadly, one single Senator objected. Because of that one Senator and his filibuster, Federal unemployment benefits and health care subsidies for people who have lost their jobs have now expired. This Senator also single-handedly halted highway projects across the country and put workers' futures in jeopardy. The obstruction of this bill has brought to a standstill small business lending programs that have been successful at boosting the number of SBA-guaranteed loans since the Recovery Act was passed. Because of the Senator's actions, physicians will see their immediate care reimbursements slashed by over 21 percent, threatening the health care of too many seniors in New Hampshire and across this country. There may be some people who don't realize the damage caused by these lapses, so I am here, as so many people have been here on the floor over the last several days, to talk about what is happening to too many people because of this filibuster. First, this is about the struggles faced by individual workers and their families. Right now, with a record number of unemployed workers competing for each job, it has become harder than ever for people who lose a job to get back to work. Of the 16 million Americans who are out of work today, nearly 6 million--more than 1 in 3--have run through the benefits provided by their States. These 6 million people are the ones served by Federal unemployment, which is a critical safety net that helps families buy gas and groceries and helps them heat their homes and pay their mortgages and their rents while they look for the next job. Because of the actions of just one Member of this body--actions that I believe are irresponsible--more than 1.2 million people will get their last check during the month of March. My office has heard from hundreds of constituents in the last week who are on the verge of losing their benefits, and their stories are heartbreaking. I wish to tell my colleagues about just one. A woman named Linda wrote me. She said: I've been unemployed for the first time in my life since August. I will be 60 on March 14, and I have not been able to find another full-time job. I own an older mobile home in Epping and don't have a retirement plan, a nest egg, or anything of that nature. The prospect of my unemployment benefits going away very soon (I may only have two to three weeks left) because of one Senator digging in his heels makes me feel sick. Please, please do everything you can to get an extension for unemployment benefits passed. God has a plan for us all; I just pray that I don't lose everything, as many others have, and that one Senator isn't playing the partisan card just because he can. I'm not sure that America is the land of opportunity that it used to be. That is the end of her quote. While some may think it is no big deal to make people such as Linda wait a week or 2 weeks to get another unemployment check, even short- term expirations have damaging results. When State workforce agencies are forced to shut down and restart complicated Federal benefits programs, they experience huge backlogs in their systems that delay getting checks out the door. Phone lines at call centers are jammed with claimants, holding up others from filing for benefits, and lines at one-stop centers get longer and longer. In the best of circumstances, individuals who see their benefits lapse while this filibuster continues will have to wait weeks before they begin receiving checks again. That is a long time when you are living on unemployment. Then there is the uncertainty and the fear that comes when someone opens the mail to find a notice that this check is the last one they will receive. Families can't make responsible budget choices when we abruptly interrupt safety net programs. So this filibuster isn't just holding up benefits to those who are already out of work; it is causing more Americans to lose their jobs. By cutting off highway funding, one Senator has put thousands more Americans at risk of losing their jobs. For the first time in 20 years, construction projects across the country have halted. Without an extension of highway programs, construction companies in New Hampshire can't plan ahead. Workers in New Hampshire don't know whether there will be a job for them when construction season starts back up in the spring. Due to the actions of just one Senator, the future of these workers is uncertain. This filibuster is especially egregious because it abuses the Senate rules, but, unfortunately, abusing the rules in order to prevent us from addressing the needs of families and small businesses has sadly become too routine. That is why I believe we need to take a very hard look at changing the Senate rules. It is time to stop playing political games with the lives of the American people. I hope that at least on this bill, every Member of the Senate can come together to support the millions of people who are counting on our leadership. Thank you very much. I yield the floor and note the absence of a quorum.

Mrs. SHAHEEN

Mrs. SHAHEEN. Madam President, it is with a heavy heart that I rise today to pay tribute to the life and service of Army SPC Marc P. Decoteau of Waterville Valley, NH. Tragically, this young soldier, just 19 years old, died while serving as part of Operation Enduring Freedom in Wardak Province, Afghanistan on January 29, 2010. Specialist Decoteau was a member of the 6th Psychological Operations Battalion, 4th Psychological Operations Group based at Fort Bragg, NC. He had been deployed in Afghanistan less than 1 month at the time of his death. Specialist Decoteau enlisted in the Army shortly after his graduation from Plymouth Regional High School in 2008. He made this honorable decision without reservation, having long declared his desire to serve. Marc followed in the footsteps of his father, an Army veteran and West Point graduate. His decorations include the National Defense Service Medal, Afghanistan Campaign Medal with Campaign Star, Army Service Ribbon, and Global War on Terrorism Service Medal. Marc was posthumously awarded the Army Commendation Medal, Army Good Conduct Medal and NATO Medal. Despite his young age, Specialist Decoteau left an indelible mark on those who knew him. Marc was an upstanding young man with an infectious sense of humor and warm smile. His hometown of Waterville Valley is an exceptionally tight-knit community of just 340 residents, and he was an integral member of it. While at Plymouth Regional, he was also an outstanding student-athlete who played lacrosse and football and was known for his work ethic. He was a member of two State champion football teams. Each day, the men and women of our Armed Forces offer their service so that we might enjoy freedom and security. Specialist Decoteau selflessly gave his life to that cause. No words can diminish the pain of losing such a young soldier, but I hope Marc's family--and the town of Waterville Valley, his extended family--can find solace in knowing that all Americans share a deep appreciation of Marc's service. Daniel Webster's words, first spoken during his eulogy for Presidents Adams and Jefferson in 1826, are fitting: ``Although no sculptured marble should rise to their memory, nor engraved stone bear record of their deeds, yet will their remembrance be as lasting as the land they honored.'' Specialist Decoteau has earned our country's enduring gratitude and recognition. Specialist Decoteau is survived by his parents Nancy and Mark, his sister Medora and brother Andrew, as well as grandparents, aunts, uncles and cousins. This young patriot will be dearly missed by all; his death while deployed far from home is a true loss for New Hampshire and for our nation. I ask my colleagues and all Americans to join me in honoring the life, service and sacrifice of SPC Marc P. Decoteau. Captain Daniel Whitten

Mrs. SHAHEEN

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

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I came to speak because there are Senators--anonymous Senators--who are blocking the confirmation of Susan Carbon, who has been nominated to be the new Director of the Office of Violence Against Women. Susan is from my home State of New Hampshire. For 2 months, the Office of Violence Against Women was denied leadership and direction, not because there are Senators who think Susan Carbon is unqualified for this position but because they believed that blocking her confirmation somehow gains them leverage on completely unrelated pet issues. I understand that, hopefully, finally today, after the issue had been raised in the press, that hold has been lifted. Blocking the confirmation of Susan Carbon as Director of the Office of Violence Against Women is a perfect example of what people see as what is wrong with Washington. Every 2 minutes, someone in this country is a victim of sexual violence. Every 52 seconds, a woman is victimized by a spouse or a partner. These crimes devastate victims' lives. They shatter families. They often create fear in whole communities. The Office of Violence Against Women leads our Nation's efforts to prevent these deadly crimes and to identify, capture, and punish the perpetrators. The Office of Violence Against Women works with law enforcement, with victim advocates, with the health care community, and so many others. It provides financial and technical assistance to communities across the country that are working to end domestic violence, sexual assault, and stalking. I am sure every Senator in this body personally knows someone who has been the victim of domestic violence or sexual assault. I am sure all Senators know how hard their local police and victim advocates work to stop domestic and sexual violence. They know how much the communities in their States appreciate the assistance they get from the Office of Violence Against Women. I would bet almost every Senator, at one time or another, has taken credit for the funding that the Office brings back to organizations within their home States. Yet despite a unanimous vote by the Judiciary Committee back on December 3 of last year that recommended Susan Carbon's confirmation, unnamed Senators have blocked her confirmation for 2 months. President Obama's choice to lead our country's efforts against domestic and sexual violence happens to be a State court judge from New Hampshire. It might interest some of the Republican Senators in this body to know--those who are blocking her confirmation--that it was Judd Gregg, the senior Republican Senator from New Hampshire, who first recognized Susan's capabilities and potential. In 1991, then-Governor Gregg appointed Susan Carbon to be a part-time district court judge. After I became Governor, I appointed Susan to be a full-time judge. Because of her commitment to ending domestic violence and her expertise in family law, she was named the supervisory judge of the family division in New Hampshire, a position she still holds. Susan Carbon is exceptionally qualified to serve as the Director of the Office of Violence Against Women. She is the leading voice in New Hampshire on domestic violence and family law, and she has been the driving force behind so many of New Hampshire's efforts to strengthen legal protections for victims of domestic violence. Susan also has become a national leader on domestic violence. She frequently serves as a faculty member for the National Judicial Institute on Domestic Violence, and she chaired the project which produced the guidebook for professionals and their work around domestic violence court orders. I do not know what political party Susan Carbon belongs to and it does not matter because she is a good and decent person who is anxious to take on the responsibility of leading the Office of Violence Against Women. I ask Senators who think about blocking such nominations in the future to imagine what it is like to explain to a nonpartisan, earnest public servant, eager to assume a new position of national leadership, that her confirmation is being blocked because one or two anonymous Senators want a new Federal building or some other project in their States or want a defense contract awarded to a certain company or because they are mad at Attorney General Eric Holder for some unrelated issue. These Senators, cloaked in anonymity, were not punishing Attorney General Holder by blocking Susan Carbon's confirmation. These Senators were punishing the victims of domestic and sexual violence in States across this country. They were punishing the police officers who put their lives at risk every time they enter homes plagued by domestic violence. They were punishing community groups that are working to prevent domestic and sexual violence. What these Senators did by blocking the confirmation of the Director of the Office of Violence Against Women for 2 months was, simply and plainly, wrong. I hope the news that her confirmation is moving forward is a correct one. I hope that for the 70 or so other good public servants who are just trying to serve this country who have been nominated, that their nominations will also go forward so we can make sure people are in the positions they should be to run this government on behalf of the citizens of this country. I yield the floor and suggest the absence of a quorum.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I wish to begin by congratulating Senator Landrieu and thanking her for all the hard work she has done on this bill--first of all for small business. I think we have significantly, with her leadership, improved this legislation for small business so that many of the small businesses in this country--many in my home State of New Hampshire--will now be able to get help as they try to cover their employees for health care. I also wish to congratulate her for all her good work to help children in the foster system. It is significant they will be able to get health insurance once they age out of the foster system and, of course, to help those, as she has pointed out, who have children who are in their early twenties and who are still trying to get settled in a profession. My daughter was fortunate enough to have health insurance last year in her first job out of college. But now she is going to a new job that doesn't have health insurance, and so she will be able to be covered once this legislation is passed under our plan. As Senator Landrieu points out, it is going to make a real difference for families and for small business. I am very pleased to be here today to support this legislation and also to try to dispel some of the myths we have heard from our colleagues on the other side of the aisle about what is actually in this legislation. Despite what many of our colleagues may want us to believe, passing this bill is the fiscally responsible thing to do. Our current health care system is a threat to the security of our families, our small businesses, and the entire economy of this Nation. The costs of health care in America make up almost 18 percent of our economy--our gross domestic product. That is more than any other industrialized country. Health care costs are rising three times faster than wages. The leading cause of about two-thirds of the bankruptcies in America is medical bills. Our current health care system is simply not sustainable. The Patient Protection and Affordable Care Act moves us in a new direction--a direction that is fiscally responsible because this bill is fully paid for. In fact, according to the Congressional Budget Office, the Patient Protection and Affordable Care Act would reduce our Federal deficit by $132 billion over the next 10 years. In fact, this legislation represents one of the largest deficit-reduction measures we have seen certainly in many years and possibly ever. Small businesses in my home State of New Hampshire and across this country are going to benefit from this legislation. We heard Senator Landrieu talk about many of the provisions she worked on--and many of which I cosponsored--to help improve the legislation for small business. The fact is, the steep annual increases in the cost of health insurance have been forcing more and more businesses to make the very difficult decision to either drop coverage for their workers or to increase their employees' contribution to the point that too many workers have had to decline coverage. I have heard from a number of businesspeople in New Hampshire, and I wish to read what a couple of them have said. A young woman named Adria Bagshaw testified this summer at a Small Business Committee field hearing we held in New Hampshire. Adria and her husband Aaron own the W.H. Bagshaw Company. It is a fifth- generation small manufacturing company in Nashua, NH. There aren't a lot of those fifth-generation companies left that are owned by the same family. They offer health insurance to their 18 employees and cover anywhere between 10 to 25 percent of their monthly premium. But now the premiums are $1,100 per month per family, and Adria is afraid she will have to cut back on the quality of their health insurance plan or the amount the company covers to make ends meet. The sad thing is that she says right now they are spending more on health insurance than they are for raw materials to make their products. I also heard from a man named John Colony, who is a small business owner in the small, very picturesque town of Harrisville, NH. He e- mailed me saying: The cost of health insurance is the biggest problem that our small business faces. He has 24 employees. He went on to say: The present system is expensive, inefficient and broken. I can't tell you how the 20 to 35 percent annual rate increases depress us all and there is no end in sight. Over the past five years, most of our employees have had to drop coverage because they simply can't afford to pay their share of the premium. I really believe that the time has come to put the existing system out of its misery. Well, I am happy to tell John we are about to do that, because under this legislation, beginning next year, we provide significant tax credits for small businesses to help them pay for the cost of coverage for their workers. This bill contains a number of significant measures to rein in runaway health care costs--measures such as creating a new pathway for biologic drugs so we can get biologic generic drugs to the market and help lower costs for people. There are measures in this bill that will eliminate waste, fraud, and abuse--something that takes too big a chunk out of our health care dollar. There are also measures in here that will get rid of the subsidies the government pays to insurance companies for Medicare Advantage plans. These are all commonsense actions that will save the government and health care consumers money over time. In addition, this bill makes significant improvements to our health care delivery system. That is the way we provide health care for people. It injects more competition into the health care marketplace. Controlling health care spending is critical to address the fiscal health of this Nation--no pun intended. This legislation takes a very important first step in slowing down the growth. I am sure every Member of the Senate--Republican and Democratic alike--has heard heartbreaking stories from our constituents about health care--stories about being denied health insurance, about having to stay at a job they do not like because of the fear of losing coverage, about frustration over the lack of choice and who provides their health insurance or a lack of understanding about their plan's limits until it is too late and they are facing financial peril. Well, this bill will, I am happy to say, change that. Not only do we ensure coverage for an additional 31 million people----

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the remaining Democratic time be divided equally between myself, Senator Stabenow, and Senator Bingaman.

Mrs. SHAHEEN.--but we eliminate the abuses of the insurance companies. I will be back to talk about some of these other areas. I thank the Chair, and I yield the floor.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, today I congratulate Professor Andrew Samwick for being recognized for his dedication to and his excellence in teaching. Professor Samwick is the winner of the 2009 New Hampshire Professor of the Year Award, one of the most prestigious awards for undergraduate teaching. Honorees are recognized for their influence in the lives and careers of their students. Mr. Samwick has taught at Dartmouth College since 1994 and is a professor of economics and the director of the Nelson A. Rockefeller Center for Public Policy and Social Sciences. He is a well-known expert on the economics of retirement and social security reform, and has testified several times before Congress and has served as chief economist on the staff of the President's Council of Economic Advisors. He is also a research associate at the National Bureau of Economic Research where he cochairs the Social Security Working Group. Professor Samwick graduated summa cum laude from Harvard College and received a Ph.D. in economics from the Massachusetts Institute of Technology. He has won numerous prizes, grants, and fellowships for his work. His articles frequently appear in prestigious economics and finance journals and he often provides commentary and opinion for national public radio and national newspapers. The U.S. Professors of the Year program acknowledges the most exceptional undergraduate instructors in the country--those who stand out in their teaching and positive influence on the lives and careers of their students. It is important that we recognize the critical work and contribution that our talented professors make in educating the next generation of young people. I am extremely proud that Professor Samwick has been honored by this prestigious distinction.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I rise today to support the health care reform legislation that is before us. I want to talk a little bit, specifically, about what the bill does to reform our health care delivery system. That is really health care jargon for the way we provide health care to people who need it. I heard a lot of debate earlier this afternoon about the fact that the health care bill doesn't do anything to address costs. I think that is just wrong. The fact is, this health care bill does begin to address costs in our system. That is one of the reasons we have to pass it. In fact, we know that over the next 10 years it is going to reduce our deficit by $130 billion. But more important than that are the changes that I believe this is going to begin to make in how we provide health care for the people of this country. The fact is--we all know it, even our colleagues on the other side of the aisle--our current health care system is not working; it costs too much; and for too many families quality health care is simply out of reach. One of the problems is that 30 percent of the $2.5 trillion we spend right now each year on health care goes to unnecessary, inappropriate care and administrative functions that do little to improve our health. Our health care system didn't get this way overnight. Years of perverse incentives have encouraged health care professionals to practice more medicine rather than better medicine. They struggle to see more patients and do more procedures to keep up. Hospitals race to build new wings and state-of-the-art units. As patients, we too often live unhealthy lifestyles, and we expect the newest high-tech services to fix it. In the meantime, we have undervalued things such as primary care, preventive care, and mental health services. Despite all of our spending, we are not any healthier. Over the past few months, I have joined, as the Presiding Officer has, with all of our freshman colleagues on the floor to discuss why we can't continue this current system. It is too costly and too inefficient. Last week, the freshman Senators introduced a package of amendments that emphasizes cost containment. The provisions contained in our package may not be those that are currently grabbing headlines, but I believe they really go to the crux of our reform efforts. They are the delivery system reforms that will improve quality and control costs over the long run. How are these going to work? Well, our delivery system reforms build upon the current underlying bill. They reward improvement in providing care for a better health outcome. One way we can be more efficient in delivering care is through what are called accountable care organizations or ACOs. These ACOs allow medical providers to work in teams, to take responsibility for decisionmaking, and they offer financial rewards for better health outcomes. Our amendments allow medical providers to align Medicare, Medicaid, and private sector strategies for improving care. Doing this will help ensure all Americans receive high-quality care no matter how they are insured. ACOs provide the right kind of incentives and promote value over volume. For years, the Dartmouth Institute of Health Policy and Clinical Practice has shown us that there are regional differences in the way care is delivered and how health care dollars are spent. Over the summer, Dr. Atul Gawande eloquently highlighted Dartmouth's findings in an article he wrote for New Yorker Magazine. He clearly made the case that higher quantity do not necessarily translate into higher quality, so that more procedures do not necessarily mean better care. Dr. Gawande's article has had a tremendous influence on the health care debate. It has been quoted frequently by President Obama and referenced right here on the floor of the Senate. In his latest article, which just came out recently, Dr. Gawande has once again made an important contribution to the health care reform dialog. In this article, he emphasizes the importance of delivery system reforms and fixing our health care system. He points out that there is not one single answer, there is no silver bullet to what we need to do to change our health care system. While we can all agree that something must be done, what we can't agree on is what specific model or provision will be the best and have the most desirable outcomes. Dr. Gawande pointed out that our country faced a similar challenge before. In the article, Dr. Gawande draws a parallel between our current health care system--one that is very costly, a money drain, one that is fragmented, disorganized, and inconsistent. He compares our current health care system to the agricultural system at the start of the 20th century. At that time, more than 40 percent of a family's income went to paying for food. The inefficiency of farms meant lower crop yields, higher prices, limited choice, and uneven quality. Agriculture was on an unsustainable path. Dr. Gawande points out that the Federal Government did not, however, offer a grand solution; rather, it provided incentives to change the way farmers produced crops. Through innovation, the promotion of best practices, and smart dissemination, today food only accounts for about 8 percent of a family's income compared to that 40 percent at the start of the last century. As you know, as we have heard discussed on the floor, we have examples of great innovation and excellence in health care, such as Dartmouth in my State; the Mayo Clinic in Minnesota, which Senator Klobuchar can speak to; Intermountain in Utah, and numerous other places of excellence around the country. These institutions have developed integrated health care systems that are patient focused. Their practices have promoted high value and excellent outcomes, best practices, which should be shared throughout the country. The Patient Protection and Affordable Choices Act identifies some of these best practices and provides the types of incentives for doctors, nurses, and patients to change the status quo and to experiment with innovation and excellence. The many programs supported in the bill before us move us in the direction of delivery system reform, which is so important to our effort. By promoting innovative practices, such as accountable care organizations, payment reform, and medical homes, we can move away from the current fee-for-service system that rewards volume over value. That is true reform. I urge my colleagues to support the bill.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, today I wish to express my sincerest condolences and deepest sympathies to the family of SSG Stephen F. Murphy, who died in Al Asad, Iraq, on November 8. Staff Sergeant Murphy, a native of Troy, NH, served his country for 16 years as a member of the U.S. Marine Corps. The American people will forever be grateful for his service. Staff Sergeant Murphy exemplified the best in America's long tradition of duty, sacrifice and service. Despite being turned away from a Marine recruiting station as a teenager for being too small and still lacking a high school diploma, Stephen was determined to enlist and rededicated himself to his studies and weight training until he could join the Corps. The selfless determination he displayed is what makes our Armed Forces the best in the world. When he formally established Veterans Day in 1954, President Eisenhower described the importance of a national day of remembrance: ``On that day let us solemnly remember the sacrifices of all those who fought so valiantly, on the seas, in the air, and on foreign shores, to preserve our heritage of freedom, and let us reconsecrate ourselves to the task of promoting an enduring peace so that their efforts shall not have been in vain.'' In the town of Troy this past Veterans Day, those words undoubtedly took on a new poignancy as the community came together to honor the sacrifice of one of its own. Our nation can never fully repay this sacrifice, nor fully assuage the loss to Stephen's family. Through his years of service, he helped preserve the safety and security of the American people. It now falls to all of us to honor his memory by supporting our veterans and their families and ensuring America's continued security. I ask my colleagues to join me and all Americans in honoring the life of SSG Stephen Murphy.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I rise today to speak in opposition to the Nelson-Hatch amendment. The Patient Protection and Affordable Care Act we have before us does so many good things. It gives women access to preventive care. It makes health care more accessible to families across the country. It changes the way patients receive the care they need. We must not let the issue of reproductive choice overshadow all of the things this bill gets right. For over three decades, the Hyde amendment, which prohibits the use of Federal funds to pay for abortions except in cases of rape, incest, or if the life of the mother is at risk, has been the law of this land. Abortion should play no role in this health care debate. The Finance and HELP Committees spent countless hours drafting legislation that is part of the language in our health care bill to make sure it remains neutral on the issue of choice. The Patient Protection and Affordable Care Act that is currently before us maintains the Hyde amendment prohibiting Federal funding of abortions. As a result, neither the pro-choice nor the pro-life agendas are advanced. This is clearly explained in an analysis done by the nonpartisan Congressional Research Service. I ask unanimous consent to have printed in the Record this analysis.

Mrs. SHAHEEN. When we pass this legislation that will reform our health care system, it should not be done in a way that would lose benefits for women. All women should have access to comprehensive health care, including reproductive health care, from the provider of their choice. I urge my colleagues to oppose any amendment that threatens reproductive care that women have counted on for over 30 years.

Mrs. SHAHEEN. Mr. President, the health reform legislation before us preserves the Hyde language and maintains the status quo in this country. We should keep it so. This should be a debate about health care. It should be about patients and about ensuring they have access to quality care at all stages of their lives, regardless of what may happen in their lives. It is a mistake to make this debate one about abortion. The amendment that is before us, the Nelson-Hatch amendment, would restrict any health plan operating in the exchange that accepts affordability credits from offering abortion services. In essence, the amendment before us would amount to a ban on abortion coverage in the health insurance exchange regardless of where the money comes from. Put another way, a woman who pays for insurance with money out of her own pocket would most likely not be able to get insurance that covers abortion. Make no mistake about it, this amendment is much more than a debate on whether Federal funds should be used for abortion, which is already established law. It is established law that is maintained in the Patient Protection and Affordable Care Act before us. The Nelson-Hatch amendment is a very far-reaching intrusion into the lives of women in how we would get private insurance. It is unprecedented, and it would mean millions of women would lose coverage they currently have. It is true, as we have heard from those people who support this amendment, that a woman would be able to buy an abortion rider. What we heard from Senator Stabenow and what we have seen from the National Women's Law Center shows us that in the five States that do require such a rider, there is no evidence that such plans exist. And even if they did exist, who would purchase that kind of a rider? No woman expects to need an abortion. This is not something you go into planning ahead of time. Finally, this amendment would have effects that reach well into the private insurance market. An independent analysis by the School of Public Health and Health Services at George Washington University concluded that a similar amendment adopted in the House--what is commonly known as the Stupak amendment--will have an ``industry-wide effect,'' eliminating coverage of medically indicated abortions over time for all women.'' That means any type of abortion for which there is a medical indication of need would go uncovered. I ask unanimous consent that ``Introduction and Results in Brief'' of the George Washington University analysis be printed in the Record.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I am so pleased this morning to join my freshman colleagues in introducing our innovation and value package. For the last several months, the freshmen in the Senate have been coming to the floor to help make the case for health care reform, to tell our colleagues and the public about what we have heard from our constituents, and to come together as one voice in support of reform. Today, we back up that rhetoric with action. Today, we propose something concrete. We have talked about the importance of reforming the way we deliver care, about how we need to slow down the skyrocketing costs of health care, while improving quality, and about the need to provide incentives to make the changes happen. Today, we deliver on that talk. Our proposals are about containing costs, about looking into the future, thinking about our delivery system, and finding ways to make small but very important changes that will make a difference. Throughout this debate, I have been talking about the importance of increasing the quality of care while reducing the cost. This amendment package does just that. This amendment package matters. It matters to all the health care consumers who are interested in reducing costs and increasing the value in our health care system. It especially matters to business. The high cost of health care and insurance coverage eats away at the bottom line for businesses. If we can reduce waste and inefficiency, attack fraud, and simplify our system, we can reduce costs. The innovations in this package attract business because business understands that we need to take steps in our public and private health care systems to lower costs and deliver value. I am proud that, with this amendment, we are able to promote the good work of Elliot Fisher and his colleagues at the Dartmouth Institute for Health Policy and Clinical Practice and to recognize the work they have done on accountable care organizations. Accountable care organizations are about coordinating care among providers--hospitals, primary care physicians, specialists, and other medical professionals. These accountable care organizations make decisions with patients. I think that is the operative phrase. They make decisions ``with'' patients about what steps they can take together to improve care. When these efforts result in cost and quality improvements, providers and consumers can share in the savings. This is the essence of true reform. We must demand performance, quality, and value from our health care system. This package makes great strides. I will close by thanking all of my fellow freshmen. I am so proud to be part of this freshman class and all of the great work they have done. I especially wish to recognize Senator Warner, who has really been the driving force behind this health care package. I am not sure I agree with his cell phone analysis, but I certainly agree with the leadership he has shown on this package. Also, I recognize our senior colleagues, Senators Dodd, Baucus, Reid, and Harkin, for the leadership they have shown in getting us to this point. Finally, I recognize all of the staff of all of us freshman Senators, many of whom are here today, who have worked so hard to get us to this point. I single out my assistants, Alison MacDonald and Dr. Manny Jimenez, for the work they have done on this package. It is a great effort, and I am pleased to be here with my fellow freshmen. I urge all of our colleagues to join us in support of this effort.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, for the past several months, my office has responded to thousands of letters and phone calls about health care. I have traveled all across New Hampshire talking to small business owners and families who are desperate for help. I have talked to health care providers that are frustrated with the current system. The underlying message is very clear: Health care reform cannot wait any longer. My colleagues on the other side of the aisle continue to offer amendments that would take this bill off the floor of the Senate, arguing we need to go back to the beginning and start all over or, worse, do nothing at all. But, Mr. President, you and I both know we need to act and we need to act as soon as possible. We need to continue to move forward. We need to move forward on behalf of thousands in New Hampshire and millions across this country who need health care reform. I have listened to these families, these individuals, and I want to take a few minutes this afternoon to share two of their stories. Judith Pietroniro from Francestown, NH, was diagnosed with breast cancer in 2005 after her doctor found a lump during a routine mammogram. After undergoing multiple surgeries and radiation treatment, I am very pleased to report that Judith is now in her fourth year of being cancer free. However, at a time in her life when she should be celebrating her good health, Judith is facing a new challenge--finding affordable health insurance--because, you see, when Judith was in treatment, she was fortunate to be covered on her husbands's insurance plan. They paid $82 a week for a family plan. Unfortunately, her husband lost his job last year. But the family has been able to take advantage of COBRA. However, when her COBRA option runs out, which is going to be at the end of this year, she will be unable to buy an insurance plan from her current carrier. That is because breast cancer is considered a preexisting condition until the patient is cancer free for 5 years under her plan. But the rub is, once she is cancer free for 5 years and able to qualify for insurance under her current plan, she will face a monthly premium of over $2,000 for a plan that has a huge deductible. Health care for Judith will simply be out of reach. Now, Mr. President, you and I both know cancer does not discriminate. This could happen to any of us. I also recently heard from Colleen Conners, a woman who lives in my hometown of Madbury, NH. Like so many others, she has struggled with our ailing health care system. She was born with a hip condition, and she has suffered from several other medical problems, including lupus and scoliosis. As a result, she has also been denied coverage because of her preexisting conditions. I heard my colleague from Oklahoma talking about the people who he said were being denied care in other health care systems. But let me read what Colleen, my neighbor in Madbury, says about her situation under our health care system. She writes: It's very difficult to be in this position. As a part-time lecturer at a college, I'm not eligible to buy health insurance through the system. She says: I was born with a serious congenital hip deformity and have incurred some 30, mostly related, surgical procedures to make it possible for me to walk and function with relative normalcy. It has given-- She names her insurer; I will not report that-- all the reason, it seems, to legally deny me the coverage I so desperately need. All other venues I have attempted to engage to secure affordable, sustainable, and efficacious coverage have similarly been denied me. I cannot tell you how hurtful this has been. The trickle down economics of my currently uninsured state has had a terrible impact on my daughter also, who just earlier today asked me, ``Mom, how long ago is it since your last mammogram?'' I told her, ``Five years, I think,'' to which she replied, ``Well, I've already lost one parent. I don't want to lose two.'' What is happening to people in New Hampshire and throughout this country is devastating to people like Colleen and Judith. But despite Colleen's struggles and the difficulties life has placed in her path, she has remained optimistic and hopeful that things will get better. I, too, am optimistic. I am optimistic we can pass comprehensive health reform that changes the way the insurance market works so my neighbors Colleen and Judith from New Hampshire and Americans in communities all across this country no longer face this discrimination. The reality is we can't always control whether we get sick, and when we are at our most vulnerable moments, we shouldn't have to worry about whether we are going to be kicked off our insurance or whether our coverage is going to run out. Health care reform will offer this peace of mind to millions of Americans. Health care reform will touch the lives of all Americans. We have the opportunity to improve our health care system for everyone in New Hampshire and across the country, and we must act now on this opportunity and pass meaningful, comprehensive health care reform. I thank the Chair.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that Manny Jimenez, a fellow in my office, be granted floor privileges for the duration of the consideration of H.R. 3590.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I rise today in support of Senator Mikulski's amendment to ensure that women have access to preventive health care screenings and care at no cost. I wish to thank Senator Mikulski for her leadership not just in this effort but over the years to make sure women are treated fairly when it comes to our health care. As a woman, a mother of three daughters and a grandmother of three granddaughters, this is an issue that is critically important to me personally. But as a former Governor, now a Senator and a policymaker, I understand these preventive services are not just good for women but they are good for families--for the children and husbands and brothers and fathers of the women we are talking about today. This amendment is good for our society as a whole. Women must have access to vitally important preventive services such as screenings for breast cancer, cervical cancer, pregnancy, and postpartum depression screenings, annual well-woman visits, and preconception counseling that promotes healthier pregnancies and optimal birth outcomes. It is the right thing to do, but it is also fiscally responsible. Not only does diagnosing disease early significantly increase a woman's chance for survival, but it also significantly decreases the projected costs of treatment. In fact, one recent study estimated that almost 80 percent of all health care spending in the United States can be attributed to potentially preventable chronic illness. This amendment takes a great step forward to early diagnosis of these costly and potentially preventable diseases. We must ensure these important services are provided at no cost. Too often, women forgo their health care needs because they are not affordable. We know cost plays a greater role in preventing women from accessing health care than it does men. In 2007, more than half of all women reported problems accessing needed health care because of costs. It is clear we need to support Senator Mikulski's amendment that will give women access to important health care screening.

Mrs. SHAHEEN

Mrs. SHAHEEN. Thank you very much, Madam President. I rise to join my colleague, Senator Bennet from Colorado, to express my strong support for moving forward to consider the Patient Protection and Affordable Care Act. My office has responded to thousands of letters and phone calls about health care since we began this debate. I have traveled all across my home State of New Hampshire, talked to small business owners, talked to families who are desperate for help and to health care providers who are frustrated with our current system. Time and time again, what we have heard is that our health care system is not working. Costs are too high. Access is too limited. The status quo is not sustainable. Now is the time to act. To put it very simply, our health care system is too expensive for families, for workers, for business owners, and for our Nation's economy. I think Senator Bennet laid out very clearly why, if we are going to be fiscally responsible, we have to address health care reform now. It is critical for the Senate to act. I thank Majority Leader Reid and Senators Baucus, Dodd, and Harkin, who have led the effort to bring forward the Patient Protection and Affordable Care Act. This is a very good starting point, and contrary to what we have heard, it incorporates many of the changes that have been offered by our Republican colleagues over these past months we have been working on health care. This bill will help ensure Americans have greater access to quality affordable health care, and it will help begin the transformation within the health care system that is necessary if we are going to contain costs to accomplish the fiscal improvements Senator Bennet talked about. I think particularly important is the fact that the Patient Protection and Affordable Care Act is fully paid for, so it will not increase the deficit one dime. In fact, by eliminating waste, fraud, and inefficiencies, by doing a more cost-effective job of providing health care, the bill is projected to reduce the deficit by almost $130 billion over the next 10 years. That is what I want to talk about this afternoon--some of those ways in which we can provide health care more cost-effectively and also improve health outcomes for people. Research shows us that spending on health care does not necessarily translate into better health care. I am proud of the Dartmouth Institute for Health Policy, which is in my home State of New Hampshire, because it has been leading the way on some of this important research. What Dartmouth's research shows us is that when patients are engaged in their treatment decisions, they will choose the less invasive and less costly procedures 40 percent of the time. So almost half of the time, we know patients, when they are involved, are going to choose the less costly procedures--not only that, they are going to be happier about those treatment decisions. We know, based on this research, that the health care system can do better in so many cases for less and that we can recoup savings in our system. One example of that, which I have worked hard on, along with Senator Collins from Maine, is something we call the Medicare Transitional Care Act. Experts estimate that we can save $5,000 per Medicare beneficiary if we can reduce costly readmissions. That is what our work shows. Medicare costs can be reduced and we can offer better support and coordination of care to Medicare patients if we keep seniors who are discharged from the hospital from unnecessarily returning. We know that 30 percent of seniors who are discharged from the hospital, who are on Medicare, are going to get readmitted within 90 days because we do not do a good job of providing for that transition. If we add a benefit through Medicare that helps with that transition, we have a commonsense solution that will improve the quality of health care for our seniors and save taxpayers money. I am very pleased that this provision is included in the health care bill that is before us now or that we hope will be before us soon. We can also contain health care costs by improving access to lower cost generic drugs. Again, that is something that is in the health care reform bill we are going to be considering. It gives people access to those lower cost generic drugs in a way that saves, generally, anywhere from 25 to 35 percent for generic drugs. It also sets up a process to give people access to lower cost biologic drugs--something we do not yet have, the ability to set up a process to give people access to generic biologics. So that is going to be able to save people money. This legislation we hope to be able to work on will help Americans access lower cost medications. It will save taxpayers money. This is our opportunity to improve the quality of care available to Americans and to control costs at the same time. It is critical we achieve this for the citizens of New Hampshire and for all Americans. The Patient Protection and Affordable Care Act is a very important step forward. I hope all my colleagues will, as we debate this bill, look at the important changes we are making and decide this is our opportunity to get real, meaningful health care reform done. Thank you, and I yield the floor.

Mrs. SHAHEEN

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

Mrs. SHAHEEN. Mr. President, I rise this morning, along with a group of my colleagues who will be here, to talk about the importance of addressing health care reform to help small businesses. Senator Landrieu is leading this effort, and she is going to be coordinating the speakers this morning. Mr. President, before I begin, I want to thank Senator Rockefeller for his eloquent comments about Senator Byrd. My family lived in West Virginia for about 30 years and truly appreciated the difference Senator Byrd made for the State, and I am very honored to be able to serve with him, even for a very brief time. So I say to Senator Rockefeller, thank you very much for those comments.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, as the former owner and manager of a small retail business, I know very personally what it is like to worry about meeting the payroll, about whether you can pay for the inventory to keep your business going, about complying with the myriad of regulations you have to comply with. As a former Governor, I certainly understand it is business and not government that creates jobs and drives new ideas and innovation. But I also know that government has a vital role to play in addressing the challenges businesses and small businesses face, especially in these very difficult economic times. One of those challenges small businesses are struggling with is the high cost of health care. In New Hampshire, between 2002 and 2006, small businesses paid 42 percent more in premiums for health insurance for their employees; and for our smallest businesses, those with fewer than 10 employees, the increase was almost double that--a 71-percent increase in the cost of premiums. So what does that mean for the small businesses and their employees who want health care? It means small businesses have to make the tough decision to either drop coverage for their workers or to increase the employee contributions, often to the point where their workers cannot afford coverage. Everywhere I go in New Hampshire, I hear from small business owners who tell me about these tough decisions they face. I heard this concern from Adria Bagshaw who testified this summer at a Small Business Committee field hearing Senator Snowe and I did in Portsmouth, NH. Adria and her husband Aaron own the W.H. Bagshaw Company, a fifth- generation family manufacturing company in Nashua, NH. They offer health insurance to their 18 employees and cover a portion of the monthly premium for them. But with those premiums at $1,100 per month per family, they spent more on health insurance for the first half of this year than they spent on the raw materials they need to make their products at their manufacturing company. Understandably, Adria worries they are going to need to cut back on the quality of health insurance plans they offer their employees or the amount the company covers to help pay for those premiums. I have also heard from people such as Chick Colony who is a small business owner in Harrisville, NH. He has a wonderful weaving company that has been in Harrisville for generations. He e-mailed me, saying: The cost of health insurance is the biggest problem that our small . . . business faces. They have 24 employees. He went on to say: The present system is expensive, inefficient and broken. I can't tell you how the 20 to 35 percent annual rate increases depress us all and there is no end in sight. Over the past five years, most of our employees have had to drop coverage because they simply can't afford to pay their share of the premium. I really believe that the time has come to put the existing system out of its misery. Certainly we hope we can do that. I have also heard from Kevin Boyarsky, who is an owner of a small printing company in Concord. He told me: Health insurance premiums have gone up 30 percent last year and 22 percent the year before. It's now a very big item in our company's budget. We want to grow and be competitive, but the high costs make it hard. From a small business perspective, I can't attract employees without good coverage, but if I hire you now, I'll only be able to offer you 50 percent of the individual plan. It's all I can afford and it isn't very attractive to employees. Small businesses in New Hampshire and across the country are burdened by high premiums for health insurance. In fact, statistics show us that small businesses pay, on average, 18 percent more than large plans for the same insurance policy. And for small businesses that do not offer their employees health insurance, they cite the high cost of premiums as the reason why. We need comprehensive health reform to help these small businesses. The small business owners I have spoken with want to offer insurance to their employees, both because they believe it is not only the right thing to do, but it is critical to being competitive, to recruiting and retaining good employees. But as they so often tell me, the high cost of insurance stands in their way. Health reform is critical to these folks. We can help them by passing comprehensive insurance reforms that rein in health care premiums, so it stabilizes costs, and provide tax credits to small businesses to help them afford the cost of health insurance. I believe we must take these measures to help level the playing field for small businesses and to make insurance premiums more affordable. Small businesses are the backbone of our economy. That is where most of the jobs in this country are created. We have to control health care costs to relieve the financial burden, so that so many of these small businesses in New Hampshire and across the country no longer have to face the choice of whether they can keep health insurance or hire employees. I urge all of my colleagues to work together so we can pass comprehensive health reform legislation. We need to pass it, and we need to pass it soon. Mr. President, I yield the floor.