Tom Udall

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. Mr. President, I am pleased to have worked with Senator Hatch, and my other colleagues in the Senate to unanimously pass the Feed America Day resolution. Over the past several years, States, cities, and communities throughout the country have declared the Thursday before Thanksgiving as Feed America Day. In observance of this day, citizens are encouraged to sacrifice two meals and donate the money they would have spent on food to a local religious or charitable organization for the purpose of feeding the hungry. As the economic downturn has struck our nation, employment rates have dropped and more and more families have had to turn to food banks and other emergency food services to meet their day-to-day needs. Our emergency food providers are being stretched to their limits to try to meet the current demand for assistance. Vicki Metheny, a constituent of mine who has run the food bank in San Juan County, NM for the last 18 years, told my office earlier this week that this is the first time in her years of service that she has been really worried about whether the food bank will be able to keep up with the unprecedented need in local communities. A similar message is coming from food pantries and emergency food providers across the country. As we approach the Thanksgiving festivities, it is my hope that individuals will take the time to think of those in their community who may be struggling to keep food on the table. To miss a few meals and make a modest donation to a local food pantry is a small thing, but if many of us join together in this effort, we can have a large impact. And a large impact is what we must have if we are to keep our families and food pantries afloat this year. According to the U.S. Department of Agriculture, last year more than 49 million Americans, including almost 17 million children, live in households with either ``low'' or ``very low'' food security, meaning that these households cannot keep healthy food on the table without the assistance of Federal programs or local emergency food providers. In my home State of New Mexico, food insecurity impacts over 14 percent of the population. There are many efforts underway at the Federal level and at the local level to build up the economy and create opportunities for families to become more financially stable. This resolution is just one reminder that there is a need for assistance in each of our communities, and that each of us can and should take steps to confront hunger locally.

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. Mr. President, tomorrow we will observe Veterans Day, a day to honor the millions of men and women who put on the uniform to defend our Nation. In communities across the Nation, we will gather to thank all veterans for their service, for their having risked their lives so that the rest of us could enjoy freedom. I rise to offer legislation that is meant to honor veterans who are too often forgotten. Tonight, on the eve of the day meant to highlight their heroism, more than 130,000 veterans will be homeless, left without a home and without a warm meal. For many, they are on the streets with their families--husbands and wives and children left without any safety net. Perhaps they recently lost their job. Perhaps they recently lost their home to foreclosure. Why they are on the streets matters less than why we have left them on their own. When coming into office, President Obama set a goal of ending homelessness among veterans within 5 years. This is a goal that I strongly support. VA Secretary Shinseki, himself a decorated veteran, has aggressively taken on this challenge, focusing efforts and funding toward eradicating homelessness. Last Friday, I rose on this floor to increase funding for the homelessness and grant per diem program to the fully authorized amount of $150 million. This vital program has produced real results, offering transitional housing to veterans and their families and allowing organizations to construct and renovate facilities that can provide a multitude of services. I am hopeful that we will see this amendment pass and this level of funding included in the final bill. However, if we are going to reach the President's goal of ending veterans' homelessness in five years, more will be needed. For that reason, I am joined today by Senator Bond in introducing S. 2760, legislation to increase the authorization of the grant and per diem program to $200 million. This increased funding can provide hundreds, perhaps thousands, of new beds and facilities for veterans in all 50 States. Congressman Harry Teague introduced similar legislation earlier this year in the House where it has been marked up in subcommittee and is awaiting further action. I am hopeful that we will see Congress stand up to this moral obligation and provide the full resources needed for the thousands of veterans who have no home, who have no hope. Last week, as I offered my amendment, I read a letter from a 15-year- old Boy Scout from Albuquerque. His father and grandfather are veterans and he is planning to follow in their footsteps and join the military himself when he is old enough. This young man wrote to say how angry he is that we are not doing enough to help our homeless veterans. ``These men and women are doing what they were called to do by our government,'' he wrote, ``but then they come back and are treated so poorly by everyone. We, as a Nation, need to do more to help our veterans.'' To the smart young man who wrote me that letter and to all of America's veterans, this bill builds on efforts to meet our country's moral obligations to the men and women who so bravely served our country. I thank Senator Bond for his support and I urge fast action to move this legislation forward.

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. Mr. President, tomorrow we will observe Veterans Day, a day to honor the millions of men and women who put on the uniform to defend our Nation. In communities across the Nation, we will gather to thank all veterans for their service, for their having risked their lives so that the rest of us could enjoy freedom. I rise to offer legislation that is meant to honor veterans who are too often forgotten. Tonight, on the eve of the day meant to highlight their heroism, more than 130,000 veterans will be homeless, left without a home and without a warm meal. For many, they are on the streets with their families--husbands and wives and children left without any safety net. Perhaps they recently lost their job. Perhaps they recently lost their home to foreclosure. Why they are on the streets matters less than why we have left them on their own. When coming into office, President Obama set a goal of ending homelessness among veterans within 5 years. This is a goal that I strongly support. VA Secretary Shinseki, himself a decorated veteran, has aggressively taken on this challenge, focusing efforts and funding toward eradicating homelessness. Last Friday, I rose on this floor to increase funding for the homelessness and grant per diem program to the fully authorized amount of $150 million. This vital program has produced real results, offering transitional housing to veterans and their families and allowing organizations to construct and renovate facilities that can provide a multitude of services. I am hopeful that we will see this amendment pass and this level of funding included in the final bill. However, if we are going to reach the President's goal of ending veterans' homelessness in five years, more will be needed. For that reason, I am joined today by Senator Bond in introducing S. 2760, legislation to increase the authorization of the grant and per diem program to $200 million. This increased funding can provide hundreds, perhaps thousands, of new beds and facilities for veterans in all 50 States. Congressman Harry Teague introduced similar legislation earlier this year in the House where it has been marked up in subcommittee and is awaiting further action. I am hopeful that we will see Congress stand up to this moral obligation and provide the full resources needed for the thousands of veterans who have no home, who have no hope. Last week, as I offered my amendment, I read a letter from a 15-year- old Boy Scout from Albuquerque. His father and grandfather are veterans and he is planning to follow in their footsteps and join the military himself when he is old enough. This young man wrote to say how angry he is that we are not doing enough to help our homeless veterans. ``These men and women are doing what they were called to do by our government,'' he wrote, ``but then they come back and are treated so poorly by everyone. We, as a Nation, need to do more to help our veterans.'' To the smart young man who wrote me that letter and to all of America's veterans, this bill builds on efforts to meet our country's moral obligations to the men and women who so bravely served our country. I thank Senator Bond for his support and I urge fast action to move this legislation forward.

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. UDALL of New Mexico. Mr. President, I call up amendment No. 2737.

Mr. UDALL of New Mexico. Mr. President, if the Senator will yield for a comment, I, once again, thank Senator Johnson. I know when he looks at these veterans issues and deals with them, he has the utmost respect. I believe he has a son who has served. He brings a compassion to these veterans issues that shows in this legislation we have on the floor today. I hope all of my colleagues will review the legislation and see that the Senator from South Dakota put a lot of hard work in and his staff has put a lot of hard work in. I once again appreciate him and his staff for working with me on this amendment. I look forward to working with him to see that it is accepted.

Mr. UDALL of New Mexico. Mr. President, let me, first of all, thank Senator Johnson for all his hard work on this appropriations bill. The Military Construction, Veterans Affairs appropriations bill is one of the most important bills we do in the Congress because, as he has said earlier, it supports our veterans, supports their health care, supports military construction, and supports what they do in the communities around the country and across the world. In particular, it supports the Department of Veterans Affairs. After reviewing this piece of legislation, I commend Senator Johnson on his excellent leadership. I also thank him for working with me on this particular amendment. I also thank his excellent staff. I rise to talk about America's forgotten heroes and to offer this amendment to improve upon the excellent legislation before us today. Imagine dedicating your life to serving your country. You give up time with your family, you put your life on the line, you sacrifice everything for the freedom and security of your fellow Americans. Then, you come home and you cannot hold down a job or you cannot adjust to everyday life because of the traumatic experience you have been through. Soon, you find yourself without four walls to call home. Many of our veterans transition back into civilian life without problems. For many others, it simply takes more time. But for some veterans, that transition is painfully difficult. Sometimes, it never happens at all. Right now, more than 130,000 of our Nation's 24 million military veterans--brave Americans who answered the call to serve--are homeless on any given day. They are in their greatest hour of need, living on the streets without support or any hope for a better tomorrow. If every American living on the street is a tragedy, every veteran living on the street is a crime. Our veterans deserve better than that from the Nation they served. At the bare minimum, this country has a responsibility to provide its veterans with a place to lay their heads. Sadly, when it comes to this basic duty, we have not lived up to our ideals. Roughly, 200,000 American veterans experience homelessness at some time during the year. Veterans are twice as likely as other Americans to be homeless. This is a statistic that should outrage all of us. President Obama has set a goal of eliminating the homelessness of veterans in 5 years. I commend him for that. I commend the subcommittee for the legislation they have put together to provide funding for several VA homelessness programs--and I commend Senator Johnson for his leadership on this legislation--including $144 million for the Homeless Grant and Per Diem Program. My amendment, however, increases the funding in the bill by a modest $6 million, bringing it to the program's full authorization level. Senators Bond and Bingaman are joining in this effort as amendment cosponsors, and I thank them for their support. This amendment will provide additional funds to construct, renovate, and acquire buildings to be used as service centers or transitional housing for homeless veterans. These grants are critical to organizations working to provide shelter to our homeless veterans. In my home State of New Mexico, six organizations in Albuquerque, Gallup, Las Cruces, and Las Vegas, have received these funds over the past 8 years. They will tell you firsthand how critical this funding is to our veterans and to our country. While I know this funding is not an end-all, be-all solution to veteran homelessness, it is a good start. I received a letter from a 15-year-old Boy Scout from Albuquerque a bit ago. His father and grandfather are veterans, and he is planning to follow in their footsteps and join the military himself when he is old enough. This young man wrote to say how angry he is that we are not doing enough to help our homeless veterans. Here is what he said in his letter that he wrote me: These men and women are doing what they were called to do by our government . . . but then they come back and are treated so poorly by everyone . . . We, as a nation, need to do more to help our veterans. As long as America faces threats and values freedom, we will need men and women to protect us. And as long as men and women serve in uniform, we all have a sacred responsibility to support them. To the smart young man who wrote me that letter and to all America's veterans, this bill and this amendment builds on efforts to meet our country's moral obligations to the men and women who so bravely served our country. I urge my colleagues to support passage of both. Mr. President, I yield the floor.

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. Mr. President, access to quality, affordable health care is an issue that impacts every American across our country. Whether someone is struggling to find coverage for themselves or their family members, or searching in vain for a doctor who is accepting new patients, or giving advice to a friend who has just lost his job and, and as a result, his health insurance, no American is spared. These problems hit particularly hard in America's rural communities. Residents there are more likely to be uninsured than their urban counterparts, have higher rates of chronic disease, and are often forced to travel hundreds of miles for preventive or emergency care, if they can find it at all. As we continue moving forward with health care reform, we must make sure we do not leave our rural communities behind. In my home State of New Mexico, for example, 30 of our 33 counties are designated as medically underserved. That is why I am please to introduce the Rural TECH Act of 2009, Rural Telemedicine Enhancing Community Health. Through this legislation, I propose that we use technology to connect experts with providers, facilities and patients in rural areas, and to extend critical health care services to underserved areas across the country. Telehealth technology can help diagnose and treat patients, provide education and training, and conduct community-based research. It uses video-conferencing, the Internet, and handheld mobile devices to provide consultation and case reviews, direct patient care and coordinate support groups, for example. There are many benefits with telehealth, including increased access to education and care, such as connecting remote generalists to urban specialists. This knowledge bridge will help remote areas retain health care providers, and improve the continuity of care. it also would allow patients to stay in their homes and communities, rather than spend precious time and money to travel for treatment and care. In New Mexico, Dr. Steve Adelsheim at the University of New Mexico has been using telehealth during the past few months to provide therapy to a Navajo teenager who is at high risk of suicide. My bill would create three telehealth pilot projects, expand access to stroke telehealth services, and improve access to ``store-and- forward'' telehealth services in Indian Health Service, IHS, and Federally Qualified Health Centers, FQHCs. I'd like to tell you a bit about each today. First, the creation of three telehealth pilot projects. These projects would analyze tie clinical heath outcomes and cost- effectiveness of telehealth systems in medically underserved and tribal areas. The first pilot project focuses on using telehealth for behavioral health interventions, such as post traumatic stress disorder. A second pilot project focuses on increasing the capacity of health care workers to provide health services in rural areas, using knowledge networks like New Mexico's Project ECHO. And lastly, I am proposing a pilot project for stroke rehabilitation using telehealth technology. Second, we will expand access to telehealth services for strokes, a leading cause of death and long-term disability. Travel time to hospitals and shortages of neurologists--especially in rural areas--are among the barriers to stroke treatment. However, Primary Stroke Centers are not accessible for much of the population. For example, there is only one certified Primary Stroke Center in my State, at the University of New Mexico Hospital. This bill would connect many more residents with needed services. In New Mexico alone, there are almost 173,000 Medicare beneficiaries who would gain access to telestroke services. Third, we will improve access to store-and-forward telehealth services. These services allow rural health facilities to hold and share transmission of medical training, diagnostic information and other data, which is important for remote areas. This bill also would allow IHS facilities to be reimbursed as users of telehealth services. Finally, it would establish regulations for credentialing and privileging telehealth providers at rural sites, saving important resources and time as they accept telehealth services from an area of specialty. I am pleased to note that my bill is supported by the University of New Mexico Center for Telehealth and Cybermedicine Research, the American Telemedicine Association, and the Telehealth Leadership Initiative. In addition, it is supported by the New Mexico Stroke Advisory Committee, the American Heart Association/American Stroke Association, the American Academy of Neurology, the American Physical Therapy Association, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association. I want to thank each of these groups for their support and encouragement.

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. Mr. President, access to quality, affordable health care is an issue that impacts every American across our country. Whether someone is struggling to find coverage for themselves or their family members, or searching in vain for a doctor who is accepting new patients, or giving advice to a friend who has just lost his job and, and as a result, his health insurance, no American is spared. These problems hit particularly hard in America's rural communities. Residents there are more likely to be uninsured than their urban counterparts, have higher rates of chronic disease, and are often forced to travel hundreds of miles for preventive or emergency care, if they can find it at all. As we continue moving forward with health care reform, we must make sure we do not leave our rural communities behind. In my home State of New Mexico, for example, 30 of our 33 counties are designated as medically underserved. That is why I am please to introduce the Rural TECH Act of 2009, Rural Telemedicine Enhancing Community Health. Through this legislation, I propose that we use technology to connect experts with providers, facilities and patients in rural areas, and to extend critical health care services to underserved areas across the country. Telehealth technology can help diagnose and treat patients, provide education and training, and conduct community-based research. It uses video-conferencing, the Internet, and handheld mobile devices to provide consultation and case reviews, direct patient care and coordinate support groups, for example. There are many benefits with telehealth, including increased access to education and care, such as connecting remote generalists to urban specialists. This knowledge bridge will help remote areas retain health care providers, and improve the continuity of care. it also would allow patients to stay in their homes and communities, rather than spend precious time and money to travel for treatment and care. In New Mexico, Dr. Steve Adelsheim at the University of New Mexico has been using telehealth during the past few months to provide therapy to a Navajo teenager who is at high risk of suicide. My bill would create three telehealth pilot projects, expand access to stroke telehealth services, and improve access to ``store-and- forward'' telehealth services in Indian Health Service, IHS, and Federally Qualified Health Centers, FQHCs. I'd like to tell you a bit about each today. First, the creation of three telehealth pilot projects. These projects would analyze tie clinical heath outcomes and cost- effectiveness of telehealth systems in medically underserved and tribal areas. The first pilot project focuses on using telehealth for behavioral health interventions, such as post traumatic stress disorder. A second pilot project focuses on increasing the capacity of health care workers to provide health services in rural areas, using knowledge networks like New Mexico's Project ECHO. And lastly, I am proposing a pilot project for stroke rehabilitation using telehealth technology. Second, we will expand access to telehealth services for strokes, a leading cause of death and long-term disability. Travel time to hospitals and shortages of neurologists--especially in rural areas--are among the barriers to stroke treatment. However, Primary Stroke Centers are not accessible for much of the population. For example, there is only one certified Primary Stroke Center in my State, at the University of New Mexico Hospital. This bill would connect many more residents with needed services. In New Mexico alone, there are almost 173,000 Medicare beneficiaries who would gain access to telestroke services. Third, we will improve access to store-and-forward telehealth services. These services allow rural health facilities to hold and share transmission of medical training, diagnostic information and other data, which is important for remote areas. This bill also would allow IHS facilities to be reimbursed as users of telehealth services. Finally, it would establish regulations for credentialing and privileging telehealth providers at rural sites, saving important resources and time as they accept telehealth services from an area of specialty. I am pleased to note that my bill is supported by the University of New Mexico Center for Telehealth and Cybermedicine Research, the American Telemedicine Association, and the Telehealth Leadership Initiative. In addition, it is supported by the New Mexico Stroke Advisory Committee, the American Heart Association/American Stroke Association, the American Academy of Neurology, the American Physical Therapy Association, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association. I want to thank each of these groups for their support and encouragement.

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. I thank Senator Hagan very much, and thank her for her statement today and leading us on the floor in this discussion of health care. In my case, I want to talk a little bit about health care delivery systems. First, let me say I know when we talk about a health care delivery system it is a little bit of a wonky term. Most Americans' eyes probably glaze over when experts, politicians, or pundits describe the problems with our health care delivery system. They don't know what it has to do with their health care experience, their doctors, or their lives. The reality is health care delivery systems have everything to do with all of that. These delivery systems determine how Americans receive their care. They dictate how a doctor treats their patients, how long a patient must wait for treatment, how much a hospital charges for its services, and how the medical community is held accountable for its mistakes. As we continue working to reform health care, we must take an honest look at our current health care delivery system and ask ourselves some basic questions, questions such as: Do the systems we currently use to deliver health care work? Are we, as patients, businesses, and governments, getting the best value for our health care dollar? Do these systems encourage efficient, coordinated care? If you ask the experts on this subject, the answer you will likely get is a loud and resounding ``no.'' The way I look at the role of health care delivery systems is the same way I look at building a house. To build a strong, solid, safe house, you have to start with a strong, solid, safe foundation. Our health care delivery systems are the foundation for all of our efforts in health care. If that foundation is off center or cracked or built on uneven ground, it does not even matter how straight the walls are or how efficient the electrical system is, nothing is going to work right. Right now, the vast majority of health care in America rests on shaky foundations. It is our job to rebuild these foundations before more Americans slip through the cracks. The good news is that across the country, communities are achieving success with innovative health care delivery programs. We should look at these models as we continue our work here in Washington. There is one example I wish to highlight today. That example comes from my home State of New Mexico, from a county that makes up the boot heel of the southwestern corner. Hidalgo County is one of the most rural counties of my State, with a population of 5,000 people. Hidalgo faces the same health care delivery problems as other rural areas. There are not enough doctors. Patients must travel long distances for care and, as a result, there are higher rates of chronic diseases and health problems that require specialized treatment. To meet these challenges, the Hidalgo County medical community had to think outside the box. What they came up with is the Hidalgo Health Commons. It uses four guiding principles in its approach to health care. First, they acknowledge that in rural areas, chronic health conditions are worsened by limited access to health providers and are often compounded by poverty. Second, to respond to this challenge they established a one-stop shop for medical and social services. At the clinic you can find doctors, nurses, and dentists, seek mental health treatment, fill a prescription, get Medicaid or Medicare, or apply for public assistance such as WIC. Third, they work with the community to identify local health priorities and then align their services accordingly. Finally, they are a source of local economic and social development by creating jobs, serving schools, and offering family support. The health commons model has worked so well that it has grown to serve five sites across New Mexico and they are not stopping there. The new Hidalgo initiative, which is still in development, will expand on the success of the health commons. The goal is to enroll all 5,000 residents of Hidalgo County into the health services program. Hidalgo County is just one example of the innovative work going on across the country and it serves as a lesson to all of us that faulty foundations do not fix themselves. They require hard work and ingenuity and significant investment. If we are going to fully transform our Nation's ailing health care system, we must first focus on the foundation. We must first reform our health care delivery systems. Mr. President, I yield the floor.

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. Mr. President, it is with great sorrow that today I pay tribute to one of the finest men Northern New Mexico has ever known, Silviano Romero, or ``Silver,'' as he was known to all who knew and loved him. On Sunday, October 25, 2009, Silver passed away, 1 month shy of his 90th birthday, in the small Northern New Mexico town of Embudo where he was born on November 27, 1919. But for his service to our Nation in the Pacific Theater and Phillipines during World War II, Embudo is where Silver lived his entire life with his extraordinary and beautiful wife and best friend of 67 years, Mary B. Romero, of Dixon. Together, after Silver returned from military service, they built the house in Embudo on County Road 0062 where their three sons, Alfonso, David, and Richard, grew up and where Silver lived and worked until his passing last week. Silver was a pillar of his community. He was a man dedicated to others--to his family, his community, his country, and his God. Like so many others of his noble generation, he served his country in the military and continued to serve his community upon his return home. Not only did Silver work for Los Alamos County, the Espanola School District, and as the Rio Arriba County clerk, but he was also actively involved as a county school board member, a Jemez co-op board member, a member of the East Rio Arriba Soil and Water Conservation District, and a lifelong active member of the Rio Arriba Democratic Party. Yes, Silver was a pillar of the extended Embudo community, and he was something of an institution in Rio Arriba County. But it was on County Road 0062, at La Junta, and the confluence of the Rio Embudo and Rio Grande, that one could see and feel Silver's love for the people and world around him. The cats, dogs, and horses who came under Silver's care knew full well the enormity of Silver's heart. And one need look no further than see the joy on Silver's face as he drove his four- wheeler down the road to inspect what may or may not be a rattlesnake, wind whipping through his appropriately silver-colored hair, to understand his appreciation and love for life. That Silver lived at the confluence of the little-known Rio Embudo and the Rio Grande, one of the largest rivers in the United States, is appropriate. The Rio Grande stretches almost 2,000 miles, providing water and sustenance to parts of this country where no one has heard of the little Rio Embudo. Yet without it, and other tributaries along the way, the Rio Grande would likely not be the force it is. So, too, does a life like Silver's contribute to the world around him. Those of us who knew him and knew of his commitment to his community understand the contributions he made and the ways in which it improved the lives of many beyond Embudo, Rio Arriba County, and even New Mexico. But a life lived as Silver lived his touches even those who never had the honor and pleasure of knowing him. Quite simply, the world was a much better, kinder place with Silver in it. While we are profoundly saddened by the passing of this humble yet extraordinary man, we can take great solace in the fact that he is survived by many deeply touched by him: his wife Mary; his brothers, Tom and Uvaldo Romero; his sister, Julia Montoya; his sons, Alfonso, David, and Richard; his grandchildren, Ann Williams, Amy Shelly, Dee Romero, David Romero, Jason Romero, Ryan Romero, Richard Romero, Jr., and Marquita Romero; his great-grandchildren, Taylor, Tyrell, Ashton, Saren, Katherine, Emma, Isla, Noah Silviano, Juan Diego, and Mark. The spirit of Silviano ``Silver'' Romero lives on in all of them and will forever live in the Dixon and Embudo Valley, Rio Arriba County, and in all of the great State of New Mexico.

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. Mr. President, the example on the savings is right there, in the examples before us. We just talked about Medicaid. Medicaid has a 3-percent administrative cost. We are talking about a program, when I go into my townhall meetings and visit with people, people say they like Medicaid, they like what they have. Here is a program that is running with 3 percent administrative costs. When we talk about the insurance companies, because of what the Senator mentioned, how they fight the claims and you have to get all these people in the doctor's office trying to prove claims, and then back and forth--doctor's offices many times told me 50 percent of the people in the office are there doing this administrative work because of what the insurance companies have created. When you ask the big question to insurance companies, how much is your administrative cost on the health insurance industry--30 percent. I think there is enormous room for improvement when we are talking about the hundreds of billions of dollars that are out there, from 3 percent in Medicare to 30 percent or more in the health insurance industry. There is no doubt that the savings can be squeezed out of this system. That is what the public option does. That is what we have been tonight talking about, night after night. I am so thankful that Senator Whitehouse, in the HELP Committee, his service in the HELP Committee, volunteered to write the public option for that health bill. That contributed so much to this debate. It gave us the outside parameters for what we are debating right now, and our leader, Senator Reid, has now stepped forward and said he wants a public option with this opt-out provision.

Mr. UDALL of New Mexico. Well, Mr. President, to talk a little about that situation, I think it is important to understand, first of all, that we have so many people out there who are uninsured--absolutely uninsured. As Senator Durbin has described, many times they lose their job and they lose their insurance, and that is what this reform is all about. We are not going to have that connection any longer. We are going to say to Americans: You are going to have your health care coverage, and if you go from job to job, you are going to be able to continue your health care coverage. If you are unemployed, you are going to be able to continue your health care coverage. That is a big new step for us, to take people who didn't have insurance, who were subject to the vagaries of existence out there, and point the way to where they are going to get insurance. They are going to get help for their families, and I would just say that we are at the right place at the right time. Things have aligned. We have President Obama, we have a Democratic Senate, we have a Democratic House, and we need to get this done in this time period. We know we are going to be opposed. Our friends on the other side are going to do the same thing the Senator mentioned on unemployment benefits. They are going to stand up and use every trick in the book. They are going to use all these filibuster rules, and they are going to make us file everything. But we will stay here long nights, we will stay through to the end so that we can help the individuals like those we have been talking about to get insurance regardless of what their personal circumstances are, regardless of things such as preexisting conditions and serious illnesses and getting dropped by insurance companies. Senator Whitehouse.

Mr. UDALL of New Mexico. If the Senator will yield, the Senator from Illinois has hit on an example that comes home to me because I had a gentleman write to me from a small community in New Mexico--Pena Blanca--about his wife. He said his wife had reached the age of 50, and she wanted to do what she could in preventive care, which is what we want to encourage, as the Senator is talking about, to get out in front of illnesses and try to do that preventive care. So she wanted a colonoscopy, and she went to the insurance company that said: Well, it is going to cost you $3,000. They didn't have $3,000, so she had to forgo the colonoscopy. That was when she was 50 years of age. At 54 years of age, she was diagnosed with colon cancer. So he writes to me saying that his wife is dying and he is in this situation now where he realizes if they had had that kind of preventive care, he would have his wife with him and would have her with him a lot longer. It demonstrates what the Senator has just said, that if we reorient our health care system to prevention, to wellness, if we use the public option--we use the nonprofit method--we will then be moving in the direction of getting way out in front of these illnesses rather than having tragedies such as this gentleman from the small town of Pena Blanca, NM, describes. It is a crying shame to see that kind of thing happen to a family. As Senator Whitehouse has said, we talk about all these things-- skyrocketing premiums and profits and everything--but it comes down to families and individuals with serious health care problems. In many cases, those problems are not being dealt with in our health care system.

Mr. UDALL of New Mexico. Please.

Mr. UDALL of New Mexico. We are near the end of our hour right here. I wish to read one more letter and then Senator Whitehouse may have some concluding remarks. But I think this letter drives home what we have been talking about all night. I received a letter from a man in Carlsbad, NM. This man's wife was denied insurance benefits after she fell at the school where she is a teacher. And here is what he said: Her orthopedic surgeon told us that her fall aggravated her degenerative condition in her knees and spine. He felt he could no longer treat her without surgery and recommended that she have both knees replaced. She had one knee replaced . . . , but before she could have the other knee replaced or her back treated, she was summoned to Albuquerque where she had to appear before a panel of three doctors. The lead doctor on this panel rules that she needed no further treatment of any kind. One of the doctors wrote a dissenting opinion, but her coverage was cut off. The dissenting doctor later apologized to my wife, stating that he hated serving on those panels because the lead doctor always ruled in favor of the insurance company and against the patient. The health insurance industry cannot be trusted. Without the public option the American people will not have the choice they deserve. The public option would bring needed competition to the industry. I strongly urge you to support the public option. That is my constituent writing me. He has really hit it on the head. I think the gentleman from Carlsbad said it best when he said: The public option would bring needed competition to the industry. You saw this chart earlier here about the lack of competition and how we have these insurance companies with a monopoly. Right now health insurance companies are basically monopolies or duopolies, at best. In New Mexico, we have two companies that hold 65 percent of the market. This kind of control means there is no incentive for competition. There is no incentive to drive down those costs. A public option would insert that competition back into the market and it would keep those insurance companies honest. I thank Senator Whitehouse, Senator Durbin, Senator Bennet from Colorado, for being down here. We have been doing this for weeks now and we are going to continue this. I do not know if you have any concluding remarks. But I think this has been a very productive session. I hope we will continue until we get health care reform done and with a public option as part of it.

Mr. UDALL of New Mexico. Madam President, I say to Senator Whitehouse, let me join in here with him and Senator Durbin because the thing he pointed out--and that is the crux of this argument, right here on this chart--that when we talk about a public option--and the Senator has hit it over and over again and Senator Durbin mentioned it--it is competitiveness. That is what we want to see, competitiveness. We are not talking about a government takeover. We are not talking about single payer. We are not talking about all these things our friends on the other side of the aisle say about this reform. We are talking about making the system more competitive. People may not realize that in many of our States, when you talk about insurance company monopolies, there are States where more than 75 percent are covered by just two insurers. So we have the State of Montana with two insurers, more than 75 percent of the market. Look at Minnesota, Iowa, all these darker States, Maine. These States have very little competition going on. What the Senator talked about is, No. 1, the Federal Government cannot move in. I don't know if Senator Durbin heard this. But at the beginning, there was a big national news article that said the insurance companies are getting ready to raise the rates because they know reform is coming, and there is not a single thing the Federal Government can do about it. We have a great antitrust unit over in the Justice Department, but they cannot do anything about it because we have these laws in place. This is, once again, what we are going to see. This is the pattern in the past: Skyrocketing insurance premiums, sky-high insurance company profits. In the last 7 years, a 428-percent increase, and all that is going on while these 47 million Americans are without insurance, premiums doubled in 9 years, and these huge CEO salaries. I think the public option is the key to bringing competitiveness to this market. I am glad the Senator from Rhode Island and the Senator from Illinois are working in committee to see that our antitrust units may be able to get involved in these kinds of situations in the future. (Mr. BENNET assumed the chair.)

Mr. UDALL of New Mexico. Mr. President, I suggest the absence of a quorum.

Mr. UDALL of New Mexico. Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. UDALL of New Mexico. Madam President, I note the absence of a quorum.

Mr. UDALL of New Mexico. Madam President, I ask unanimous consent to speak as in morning business for 1 hour. I also ask unanimous consent to engage in a colloquy with other Senators who may join me.

Mr. UDALL of New Mexico. Madam President, first, let me speak on the issue that Senator Jeanne Shaheen spoke about before me just briefly. I wish to compliment her for being such a champion for extending unemployment compensation. We are talking about people who, in many cases, through no fault of their own, lost employment. They may well be the only provider for their family. They don't have the wherewithal to support their family. We have in this recession, this deep recession we are in the middle of, several times for people like that, extended unemployment benefits. Senator Shaheen and Senator Dodd and others who have spoken have described the personal circumstances people are in. We can't believe we can't move this legislation along to extend unemployment compensation benefits. These people need help in the recession and most likely they are the dollars that will be spent in the economy. I wish to describe the procedure that has occurred. We had 87 Senators vote on a motion to proceed. The first thing we did to get on to a piece of legislation such as this unemployment benefits compensation legislation was we filed a motion to proceed because we didn't have the consent of the Republican leadership. We were then required to let that motion for cloture ripen over a 2-day period. So as many have watched, there hasn't been necessarily a lot of debate. It has ripened. We had the vote after 2 days--87 votes. Then, after 87 said we should move forward on the motion to proceed, there was a 30- hour postcloture period. Well, what has happened with that is we also haven't had that much debate occurring on the Senate floor, but the time continues to run. So these delay tactics--they are called filibuster tactics, but in a way it isn't a filibuster. There is nobody here filibustering most of the time. So it is a delay tactic to do something the Nation needs. So I compliment all of the Senators who are standing up for this legislation. I know Senator Whitehouse is also one who believes we should pass unemployment compensation legislation very quickly. Health Care Reform Madam President, we are here again this evening as a group of Senators--Senator Whitehouse has joined me--to strongly support the inclusion of a public option in health care reform legislation. I encourage other Senators who support the public option to come down and join us. We were heartened earlier this week when majority leader Harry Reid announced that he would include a public option in the bill he is merging from the Senate Finance and HELP Committees. Senator Reid showed real leadership in developing a compromise that includes the public option, something that a wide majority of Americans support and want included in this reform. This is another step in the direction of meaningful reform, but we are by no means finished with this debate. We expect defenders of the status quo, as well as those who continue to put insurance company profits over people, to step up their attacks and step up their misinformation campaign. The bottom line is that a public option is the best proposal on the table to help keep the insurance companies honest. It will insert much needed competition into the insurance market, and it will give Americans another affordable, quality choice for their health insurance needs. So with all of that said tonight, I want to continue by highlighting a story out of New Mexico. It is a letter I received from a woman from Placitas, NM. She is a small business owner who wrote to tell me about a rate increase notice she got from her health insurer. She was told to expect a 9- or 10-percent increase next year. For two people, that will mean $2,300 a month in premiums she will have to pay. Here is what she wrote: We can't afford it. I am now faced with the likelihood of having to drop insurance which for two cancer survivors is not the right answer. I know I speak for many of my colleagues here tonight when I say our offices get dozens and dozens of e-mails and letters like this each and every week. Americans are struggling, and they are looking to us for relief from an impossible situation they cannot fight or win. There was a story in the newspaper over the weekend that I think illustrates how urgent this situation has become. It illustrates why a public option must be a part of this reform. In the newspaper it was reported that many small businesses are facing the steepest rises in insurance premiums they have seen in years. That is saying a lot considering that insurance premiums have already more than doubled over the past 9 years. In this news story, insurance brokers and benefits consultants said their small business clients are seeing premiums go up an average of about 15 percent for next year and in some places as high as 23 percent. That is double the rate of last year's increases which were already unacceptably high. Do you know why these small businesses are seeing such big increases? This report said it is because insurers are trying to raise their premiums ahead of anything we do legislatively that might reduce their profits. Health insurance companies are only looking out for themselves and their own profits. It is up to us to look out for hard-working Americans. It is up to us to look out for America's entrepreneurs, those small business men and women whose companies employ some 40 percent of American workers. With that, I will open the floor to my colleagues. Let's talk about what a public option would mean for small businesses and how difficult it is for American entrepreneurs to keep their heads above water as health insurance companies continue to raise their rates, deny them coverage, or drop them completely when they place a claim to be reimbursed. I see Senator Whitehouse here. He has been a champion throughout this process in terms of the public option. I will yield to him. I also see Senator Durbin here, our majority whip, who I hope will join us, who has also been an incredible champion when he stands up in leadership time and throughout the day on the public option.

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. Mr. President, I seek recognition.

Mr. UDALL of New Mexico. Mr. President, let me thank the Senator from Alaska for being down here and helping all of the freshman Senators work through these health care issues we have been discussing. We have had Senator Warner play that role, I think, and several others. I think Senator Shaheen from New Hampshire has also done that. It is important to realize that all of us in the freshman class believe we need health care reform. We have to have health care reform. Last week, during our gathering of freshman Senators in this Chamber, I talked about how health care reform must benefit rural America. As I explained then, rural Americans face unique challenges in finding quality, affordable health care. And rural health care systems face increased strain due to doctor shortages and inefficient and insufficient funding. Successful reform hinges, in large part, on how we meet the challenges of health care in rural America. But what many may not realize is that rural America, precisely because of these challenges, has become an incubator for the very innovation that will help us achieve our goal. Rural America is trying to meet these health care challenges head-on with innovative programs in communities across the country. In the process, they are offering a blueprint for the Nation as we work to enact reform that will benefit all Americans, no matter where they call home. In my home State, several innovative programs are already paying dividends. The two I wish to talk about today are the result of partnerships between our rural communities and one of our key academic institutions, the University of New Mexico, our big teaching hospital in New Mexico. Academic health centers, such as the one at UNM, have the potential to be hubs of knowledge and expertise, not just for the communities where they are physically based but for the entire State. UNM recognized this potential and reached out to partners in rural areas throughout New Mexico. They asked two basic but often overlooked questions: What do you need? How can we help? What emerged from these conversations was the development of a statewide Health Extension Rural Office program. Through this program, which we call HERO for short, agents live and work in communities they serve, and they act as liaisons and resources to health partners in the area. We know this extension model for agriculture, and we are proving it can work for health services too. Here is one example. In the frontier county of Hidalgo, in southwest New Mexico, HERO agents discovered the community needed help recruiting local health professionals. To meet that need, HERO helped establish a partnership between UNM and community providers to offer free local housing for UNM medical residents during their regular rural rotation. It was a win-win for everybody. Hidalgo County got increased access to doctors and other specialists. The doctors got free housing during their rural rotations. UNM increased its profile and reputation in Hidalgo County. The communities got the opportunity to persuade these young doctors to continue their medical careers in that area. That is just one example of HERO's work. In addition to increasing the number of doctors in a community, HERO also helps develop plans for addressing health issues such as diabetes and teen pregnancy, for retaining pharmacy services after a community loses its only pharmacist or for establishing a one-stop-shopping model for medical, dental, behavioral health, and social services. In addition to its work with the HERO project, UNM also is achieving breakthroughs in the delivery of medical care through a project founded by one of its physicians, Dr. Sanjeev Arora. It is called Project ECHO, which is short for Extension for Community Healthcare Outcomes. Back in 2002, Dr. Arora was a physician specializing in hepatitis C. He had become increasingly frustrated with the lack of treatment options for the thousands of New Mexicans suffering from the disease. Many of these patients lived in the States' rural and frontier areas. There weren't enough specialists to treat them, and local providers often didn't have the expertise to provide treatment themselves. What Dr. Arora did was establish what he calls a one-to-many knowledge network, which includes a specialist and up to 40 rural providers. The doctors meet by videoconference to co-manage patients and to eventually teach these rural medical professionals to be minispecialists themselves. Over the years, what began as a program designed to treat hepatitis C patients has grown and expanded. Today, it includes more than a dozen knowledge networks and telehealth clinics on a wide variety of specialties, including HIV, diabetes, pediatric obesity, and psychotherapy. In closing, I believe these two programs, along with the other initiatives discussed by my freshman colleagues today, are strong reminders that American innovation doesn't always begin in the Halls of Congress or down the street on Pennsylvania Avenue. Historically, the greatest American innovation is a grassroots phenomenon, bubbling up from individuals and communities across America, from enterprising folks who recognize a problem and work together to develop a solution that best meets their needs. This health care reform remains a work in progress. It is our job as legislators to seek out programs such as HERO or Project ECHO, to seek out these best practices, to find programs that work, and to expand that knowledge and ingenuity for the benefit of all Americans. I thank the Chair and yield the floor.

Mr. UDALL of New Mexico

Mr. UDALL of New Mexico. Correct. Would Senator Whitehouse like to speak?