Jeanne Shaheen

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I thank Senator Hagan for organizing the effort today and also for her great work on the HELP Committee to develop a health care reform bill that can be supported by this body. Once again we are here to talk about health care reform and why it is so urgently needed. We are at a critical juncture because health care costs are out of control. They are a threat to our families, our small businesses, our economy and, despite all the money we are spending on health care, we are not guaranteed better health outcomes. That means because we are spending money doesn't mean that people are healthier. The truth is, we can control costs and improve quality. We can do this by promoting effective delivery models. Senator Udall did a great job of talking about what that term means in real language. We can promote effective delivery models that emphasize coordination and individualized care. As I have said on a number of occasions, I am proud of the innovations that are changing health care delivery in New Hampshire, my home State. One of those that has been recognized nationally is the Dartmouth Atlas project, based in Hanover. Because of the work of the Dartmouth Atlas project, we now know that there are significant variations in the way health care resources are used and how money is spent depending on where we live. Right now, providers are rewarded for volume rather than for value. There is a chart here that shows that very clearly. It shows the difference in spending among different regions of the country for Medicare patients. As you can see, the areas that are dark red are the most expensive, these areas. The areas that are lightest are the least expensive areas when it comes to cost per Medicare patient--from $5,280 to $6,600 in the lowest spending regions all the way up to $8,600 to $14,360 per Medicare patient in these darkest regions of the country. Unfortunately, the sad thing about this research is not the changes in cost, but it is the fact that because someone lives in an area where the spending is higher doesn't mean they are going to have better health outcomes. Put very simply, more costly care does not mean better care. This is a fundamental problem with our health care system. The way our health care dollars are being spent right now is analogous to a medical arms race. That is not my term, that is by Dr. Elliott Fisher, from the Atlas Project. Too often we judge the quality of our hospitals, for example, based on a new expansion wing or the latest medical device, and not on comparing the quality of care they provide. Over the past several months, thousands of my constituents have expressed their concerns about our health care system. Last week, Dr. Jim Kelly, from Hollis, NH, was in my office sharing his concerns and frustrations. Dr. Kelly is a family physician and, like so many of our health care providers, he is dedicated to doing the best job he can for his patients. However, inefficiencies in our system often work against the best efforts of our providers. Dr. Kelly shared one of those experiences. He talked about one of his patients who was a 73-year-old woman with diabetes who came into his office on a Friday morning with a swollen, red, and tender leg. In addition to her own illness, she is the sole caretaker for her 79-year- old husband who recently had a stroke. Dr. Kelly diagnosed her condition, a relatively common one, as cellulitis, a skin infection which required IV antibiotics. Dr. Kelly gave her the first dose in his office, but Medicare would not cover her infusion therapy at home. As a result, Dr. Kelly was forced to send her to the local emergency room to receive treatment over the weekend. As a result, she had to bring her disabled husband, whom she couldn't leave at home alone, to the emergency room. Both of them were forced to sit in the crowded ER, exposing them to more germs and using resources that could be used much more efficiently. Unfortunately, our system does not always facilitate efficient and coordinated care. This is too often true with our most vulnerable patients. But there are innovative projects across the country that have adapted to meet the needs of these individuals. By providing increased outreach and care coordination, one pilot program was able to reduce visits to the emergency room by almost two-thirds, after 2 years of participation. I recently introduced the REDUCE Act, which is modeled after these successful pilots, and which I believe will change the way care is delivered to these high-risk patients with multiple chronic conditions. I think that is very important to point out. The REDUCE Act will create demonstration projects in 10 States that are modeled off of these approaches that have been successful in places around the country. This is the type of delivery system reform that improves quality and reduces costs simultaneously. As I have said many times, the challenge we face is great, but we have the resources and the tools we need to reform our health care system. We can do this in a fiscally responsible way. By improving the way we deliver care, we can maximize efficiency and we can improve quality. This is the type of reform all Americans deserve. This is the type of reform we are working on here in the Senate. This is the type of reform I hope our colleagues will all support. I thank Senator Hagan and I yield my time back to her.

Mrs. SHAHEEN

Mrs. SHAHEEN. Madam President, I agree with my colleague from New Hampshire. We have too many people who are struggling right now in this recession. We have too many people who are unemployed, who need help until they can get back on their feet, find a new job, until the economy starts creating jobs again. That is why I am having so much trouble understanding why it has taken this body so long--4 weeks now-- to extend unemployment benefits for those people who are losing their benefits before the end of this year, almost 2 million Americans, and we have been trying to pass an extension of unemployment for the last month. I rise to speak in support of the Worker Home Ownership and Business Assistance Act, a bill that will extend unemployment benefits 14 weeks for unemployed workers in every State and for an additional 6 weeks in those States with over 8.5 percent unemployment. I am pleased that today the Senate has voted by an overwhelming majority, 97-to-1, to proceed to final passage of this legislation. This broad, bipartisan vote acknowledges that unemployment affects every community in every State in every part of the country. In fact, this is the third vote we have had now to proceed to this bill. Every vote has passed overwhelmingly with a bipartisan vote. Despite those strong votes in support of an extension, opponents have put up obstacles at every turn to delay passage of the bill. As a result of these delay tactics, approximately 200,000 workers have lost their benefits in the last month. Hopefully after 4 long weeks, the end is in sight. Soon people like Richard, one of my constitutents from Winchester, NH, who called my office yesterday, will get the help he desperately needs. Richard is a single father of three boys. He lost his job as a machinist at Greenfield Tap and Dye plant, a small manufacturing plant in the southwestern part of the State, more than a year ago. Since then he has been using his savings, his unemployment benefits to pay his mortgage, to buy food, to buy gas, and to pay for other necessities. Richard has been out looking for other manufacturing jobs, but no one is willing to hire him until this economy improves. That is what the Senate has been working on. I disagree respectfully with my colleague from New Hampshire. Much of the effort we have expended in the Senate has been to support the economy so it does improve, so we can create jobs again. We are on the cusp of finally passing this legislation to help Richard and his family and millions of other jobless Americans whose benefits will run out, to help them get through the holidays. As I have said many times, when we extend unemployment, we are not only helping those workers whose benefits have been exhausted, we are helping small businesses that provide the goods and services the unemployed are going to need. They are going to go out and spend those unemployment checks on those goods and services so that for every $1 we spend on unemployment, it turns over $1.61 in the economy. People collecting unemployment spend their benefits immediately on necessities to keep their families going, which means these dollars get into communities almost as soon as the checks arrive. Economists say that dollar for dollar, extending unemployment benefits is one of the most cost- effective actions we can take to stimulate the economy. Passing this extension is the right choice for unemployed workers and for communities. I look forward to passing this extension for Richard and for the millions of Americans who are counting on us to act. I yield the floor and suggest the absence of a quorum.

Mrs. SHAHEEN. Go ahead.

Mrs. SHAHEEN

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

Mrs. SHAHEEN. Mr. President, the Senate has just voted on a motion to advance the Unemployment Compensation Extension Act. This is the second time--that is right, the second time--we voted on this critical legislation. But, unfortunately, opponents of the extension are still holding it up. The bill under consideration today incorporates important ideas from both sides of the aisle. When the House bill included additional weeks only for workers in States with unemployment rates above 8.5 percent, the chairman and the majority leader allowed us to work out a compromise that would support jobless workers in all 50 States. An amendment by Senator Isakson to extend the home buyers tax credit has now been incorporated into the Senate bill, as well as an important amendment from Senator Bunning to extend the carryback of net operating losses for up to 5 years. Both of these are good ideas that will help homeowners, help our housing market, and provide relief to businesses that are trying to weather this economic recession. Both have now been included in the Unemployment Compensation Extension Act. Now it is time for all of us to stop playing politics and to focus on the critical issue we started to address a month ago: the devastating rates of unemployment and the nearly 2 million Americans who are exhausting their benefits at the rate of 7,000 a day. This is good legislation. It is legislation that provides at least 14 additional weeks of unemployment insurance for those Americans who have been hardest hit by this recession and those whose benefits are starting to be exhausted. I was pleased that once again the motion to advance this bill received broad bipartisan support. The vote was 85 to 2. The first vote was 87 to 13. It should receive this kind of support because unemployment isn't a New England problem or a Montana problem or a southern problem; it isn't a Republican or an Independent or a Democratic problem; it is a hardship that hits every community in every State in every part of our country. Last week, I spoke about my constituent Jane McDermott from Stoddard, NH. Jane wrote me last week that without this extension, she doesn't know how she is going to pay for the gas she needs to get out and look for a job, she doesn't know how she is going to pay for groceries for her family or any of the other family necessities. I was hoping that today Jane would get the news she has been waiting for--that this extension will be put into effect and that she, along with millions of other Americans who need it, will get the help to be able to continue to look for a job and continue to get the family necessities while she does that. I think it is time--again, way past time--for us to put politics aside. We shouldn't make Jane or any of the other hundreds of thousands of Americans who have been waiting for this extension wait one more day. Mr. President, I yield the floor with the hopes that we will get an agreement today, tomorrow, as soon as possible, to help the people who need help. Thank you. I note the absence of a quorum.

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

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the Senate proceed to a period of morning business, with Senators permitted to speak for up to 10 minutes each, and that the time during morning business count against the postcloture time.

Mrs. SHAHEEN

Mrs. SHAHEEN. Thank you, Madam President. I wish to thank Senator Dodd from Connecticut for his kind words and for all of the work he has done to try and move an unemployment extension for people, and for his eloquence in talking about the need to help those people who are currently running out of their benefits. As is the Senator from Connecticut, I am here one more time to voice my support for the Unemployment Compensation Extension Act. I am pleased, as the Senator from Connecticut is, that yesterday the Senate voted by an overwhelming majority to move this legislation forward. But like the Senator from Connecticut, I remain very disappointed that even with 87 votes to move forward, we are still here today. Another day has gone by, a day when 7,000 more workers have lost their benefits, and the opponents of this extension are still playing politics to hold up the help that so many people around the country need. During the delay of the past 3 weeks, more than 100,000 Americans have exhausted their unemployment benefits. Without this extension, nearly 2 million jobless workers will lose their benefits by the end of the year. The American people should be outraged by this continued delay. I would like to read an e-mail I got this morning from Jane McDermott from Stoddard, NH. Jane has been unemployed for over a year, and she will exhaust her remaining benefits in the next 2 weeks. She writes: Right now, receiving unemployment means I can eat and I can pay for my medication. Those of us who are still unemployed still have bills and property taxes to pay. With the rug being pulled out from under us, it means being on the edge of homelessness. She writes to me: I urge you to make this fight a priority. Here in New Hampshire there are many, including myself, who depend on having heat, lights, and even enough gas in our cars to search for employment each and every day, especially over the holidays. She signs her e-mail: Sincerely, Jane McDermott from Stoddard. Jane McDermott is out looking for work every day, but with more than six people out of work for every job opening, she hasn't been able to find that new job. She is like millions of hard-working Americans from every community and every State and every part of our country. This is just one out of dozens of calls and e-mails my office gets every single day. So I urge my colleagues to stop playing politics and to pass this extension. It is the right thing to do for our unemployed workers, and it is the right thing to do to stimulate our economy. Let's not let one more day go by without extending unemployment benefits for the tens of thousands who need them all across this country. Madam President, I yield the floor.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I am pleased to, once again, join my freshman Democratic colleagues to make the case for health care reform. I wish to recognize and thank Senator Begich for his leadership and coordination of this effort this morning. Today, as you have heard, I will discuss three exciting initiatives in New Hampshire that are transforming our health care system. These innovative ideas are shaping the debate and are changing the way we think about health care. They are revolutionizing how we deliver necessary health care services, and they are transforming our payment mechanisms. Most importantly, these initiatives go to the heart of this debate. They focus on the needs of patients, they make the system more efficient, and they use our dollars more wisely. The Center for Informed Choice at the Dartmouth Institute for Health Policy and Clinical Practice is dedicated to one simple idea: that patients deserve to be equal partners in making choices about their health care. We know when patients and their families have good information about procedures, treatments, and therapies, they make good decisions. The researchers at Dartmouth found that 40 percent of the time, patients who are fully involved in the decisionmaking process during the course of their medical care choose the less invasive and lower cost medical procedures. Forty percent of the time, patients choose the less invasive, lower cost procedures. More importantly, their research shows these patients have better clinical outcomes and higher rates of satisfaction as the result of their treatment. The providers at Dartmouth put this research into practice. They recognized it can be hard to decide whether to have surgery, to have a test, or to continue with a treatment. So they offer patients a variety of resources to help. Patients can talk to a counselor. They can do research in the library or talk to medical professionals. They can find out all their treatment options. They can learn what other people have done and fully understand recovery time and the impact on their quality of life. And they can do all of this online. I have been to the center. It is very impressive what they do. Soon this information is going to be available to the public online. Armed with information, these patients become empowered and equal partners in their health care. This is the direction that health care reform must take. Another exciting initiative in New Hampshire is our medical home pilot program. With close to 40,000 patients involved, the medical home is changing the way health care is delivered in New Hampshire. You see, a medical home is about collaboration. It is about a team of health professionals who are working together to provide individualized care for each patient. In New Hampshire, our medical home pilot has integrated the use of electronic medical records that import hospital, radiology, and laboratory tests directly into the patient's record. New Hampshire medical home model offers two important services to patients, including same-day scheduling and secure e-mail communications with their doctors. Unquestionably, the pilot is changing the way health care is delivered in New Hampshire. My third initiative I wish to talk about deals with changes that are happening at the local level to improve health in New Hampshire. In the western part of New Hampshire is a small city called Keene that has set its goal on becoming the healthiest community in America by 2020. So for all my freshman colleagues, they have to share this with the cities in their States and let them know we plan to be first in Keene, NH. The citizens of Keene took a look at the data and found out that our State's leading cause of death is heart disease related to tobacco use, poor diet, and physical inactivity. The folks in Keene realized that we spend a disproportionately high amount of money on our medical costs instead of focusing on prevention and wellness. The citizens of Keene took action. Led by a local hospital, Keene established a coalition of partners from all sectors of the community, including education, private business, nonprofit organizations, and municipal and State government. This coalition, which is called Keene Vision 2020, has made it a priority to engage citizens in healthy lifestyles. They have sponsored educational briefings, screenings, health clinics, health fairs, and Keene's Vision 2020 promotes the local farmer's market, and it has established a local walking group. All of this is done with one goal in mind: to be healthy. I have no doubt that Keene will be a healthier community in 2020, and I have no doubt that the preventive measures in which citizens have become engaged will lower our health care costs well into the future. We should all applaud and encourage this sort of community-wide commitment to prevention and wellness and to public health. This is an exciting time. Congress is closer than ever before to passing comprehensive health reform. Time and time again we have heard we cannot continue on the present trajectory. I am pleased to point out these exciting initiatives underway in New Hampshire that demonstrate we can improve the quality of care and lower our health care costs. I yield back to Senator Begich.

Mrs. SHAHEEN

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

Mrs. SHAHEEN. Mr. President, I suggest the absence of a quorum.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I thank Senator Baucus for his very kind remarks and for his leadership to do something to help those workers who are unemployed across this country who are losing their benefits and don't know where to turn. As Senator Baucus has said, the Senate is about to vote on a motion to advance the Unemployment Compensation Extension Act. I am disappointed that we still haven't been able to pass this extension, but this evening we can vote to overcome a procedural hurdle and take an important step forward. As Senator Baucus has said, this is critical legislation that will help nearly 2 million jobless Americans who are about to have the safety net pulled out from under them. The bill provides 14 additional weeks of unemployment insurance to jobless workers in all 50 States, and in those States where unemployment is the highest, they would receive an additional 6 weeks. For 3 weeks, this critical legislation has been delayed for nothing more than political reasons. In that time, more than 100,000 Americans have exhausted their unemployment benefits. The American people should be outraged about these delays. I hope today those in opposition will end their obstruction, will stop the political games, and will help us pass this bill to stimulate our economy and help those Americans who, through no fault of their own, can't find a job. I am confident that when we finally get to the vote, this extension will garner the broad bipartisan support it deserves. That is because unemployment isn't a New England problem or a Montana problem or a southern problem. It isn't a Republican, an Independent, or a Democratic problem. It is a hardship that hits every community in every State in every part of our country. I recently visited an unemployment office in Manchester, NH, and I heard from people who, despite their best efforts, are unable to find a job. They want to get back to work, but they face one of the worst job markets since the Great Depression. I want to share this afternoon a couple of stories I heard from unemployed workers and those who have called my office pleading for help. Carry-Ann is a 39-year-old single mother from Concord. She wrote that she has been out of a job for more than a year, and she has been relying on unemployment to support her two teenagers and to pay the mortgage. Carry-Ann qualified for a job training program, and she has been training for a career in health care. That is appropriate, given the other debate that is going on in this body. She has been training for that career in health care because she knows that is a sector that needs workers. But if her unemployment runs out, she wrote, she will lose her home and she will have to relocate, which means she would not be able to finish her job training program and will lose the prospects of getting a good new job. Carry-Ann isn't asking for a handout. She is trying to gain self- sufficiency for herself and for her family by getting educated and gaining the skills she needs to build a career. But she will be unable to do so unless we pass this extension. Richard is a 43-year-old from Somersworth, NH, one town over from where I live in the southern part of the State. He explained that he has been looking for work for over a year. He has been using his unemployment benefits to support his family. Richard used to have a management job, and at interviews he has been told time after time that he is overqualified and he would not be considered. Employers think he will leave their job as soon as better opportunities open. But Richard has a family to support today and his benefits are going to run out soon. He is like many Americans looking for work right now. If we do nothing, he could lose his credit, his car, and his home. Extending unemployment benefits will help Richard and Carry-Ann and their families and tens of thousands of others like them across this country. It will help them weather this storm. As I have said many times, when we extend unemployment, we are not just helping jobless workers, we are also helping the businesses that provide the goods and services that unemployed workers need. People collecting unemployment spend their benefits immediately on necessities to keep their families going, which means these dollars get into communities almost as soon as the check arrives. Economists say, dollar for dollar, extending unemployment benefits is one of the most cost-effective actions we can take to stimulate the economy. Passing this extension of unemployment benefits is the right choice for unemployed workers and for our communities. Mr. President, this extension is long overdue. We owe it to those Americans who are out of work to pass this extension. I yield the floor.

Mrs. SHAHEEN. I have finished, but I thank my colleague very much, and I yield the floor.

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

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the Senate proceed to a period of morning business, with Senators permitted to speak therein for up to 10 minutes each.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. Res. 325, which was submitted earlier today.

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid upon the table, with no intervening action or debate, and that any statements related to the resolution be printed in the Record.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 9:30 a.m. tomorrow, Wednesday, October 28; that following the prayer and pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate then proceed to a period for the transaction of morning business for 2 hours, with Senators permitted to speak therein for up to 10 minutes each, with the time equally divided and controlled between the two leaders or their designees, with the majority controlling the first half and the Republicans controlling the final half; that following morning business, the Senate resume consideration of the motion to proceed to H.R. 3548, the Unemployment Compensation Extension Act of 2009, postcloture; and that time during any period of morning business, recess or adjournment count postcloture.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, cloture was invoked on the motion to proceed to the unemployment extension legislation. It is my hope that some of the postcloture debate time can be yielded back and that we can proceed to the bill tomorrow.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, if there is no further business to come before the Senate, I ask unanimous consent that it adjourn under the previous order.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the Senate now proceed to the consideration of S. Res. 324, which was submitted earlier today.

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, and the motions to reconsider be laid upon the table.

Mrs. SHAHEEN

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the Committee on Science and Space of the Committee on Commerce, Science, and Transportation be authorized to meet during the session of the Senate on October 21, 2009, at 2:30 p.m. in room 253 of the Russell Senate Office Building.

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the Committee on Veterans' Affairs be authorized to meet during the session of the Senate on October 21, 2009. The Committee will meet in room 418 of the Russell Senate Office Building beginning at 9:30 a.m.

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet during the session of the Senate, on October 21, 2009, at 2 p.m., in room SD-226 of the Dirksen Senate Office Building, to conduct a hearing entitled ``Nominations.''