Ms. KLOBUCHAR. I ask unanimous consent to engage in a colloquy with the Senators from Maryland, Delaware, Massachusetts, and others who will be joining us later in the hour.

Mr. President, as the Senator from New York has so eloquently stated, the time for health care reform is now. We cannot afford to wait any longer. We can’t afford to wait, for the middle class.

There are a lot of numbers that get thrown out in the debate, but I think we can say it pretty simply by just using three numbers. Those numbers are 6, 12, and 24. What do those numbers mean? Ten years ago, the average family in this country paid $6,000 for their health insurance. Now they are paying $12,000. That is an average. I know of one small business in northern Minnesota, a backpack company, paying $24,000 for a family of four. One guy started a company with five employees. He now has 15—a growing business. He is paying $24,000. The average right now is $12,000 for a family of four. Where is it headed if we don’t bend the cost curve for middle-class families—$24,000 average, little towns all over America, $24,000, 10 years from now. That is not the kind of stability the middle class needs.

The middle class needs to know, people I know all over my State need to know that if their kid gets sick, they still can have health care coverage; that if their kid goes to college and they want to keep them on their policy, they can still do that. That is what we are talking about when we talk about stability.

The other piece of this reform effort that is so important, coming from Minnesota, a State with high-quality, highly efficient care, is the cost issue, that we begin the long journey of reforming our Medicare cost so that we actually promote the kind of high-quality care we see in my State at places such as the Mayo Clinic and we promote the kind of efficient care we need to see.

My favorite example is in Pennsylvania, the Geisinger Clinic. They had diabetic patients. They decided it was not going that well. The patients didn’t feel that good about their treatment, and the quality they wanted was costing too much. They tried something else. For routine cases, they said they will see nurses and see them more often. The more difficult cases went to endocrinologists, and they reviewed the routine patients’ records. Higher quality care, happier patients, better care, lower costs—$200 per patient per month—that is what happened. They got less money for that higher quality care, less money. That is what we are talking about. We want to use those kinds of models so we get higher quality care for America at a more efficient rate.
Some of my colleagues across the aisle have been using the name of the Mayo Clinic in vain. This matters to me because I come from Minnesota. It is the home of the Mayo Clinic. The minority has suggested that the Mayo Clinic doesn’t want any part of this bill. They have said the Mayo Clinic wants nothing to do with this bill. They have said the Mayo Clinic—and this is an exact quote from the Senator from Wyoming—"is no longer taking Medicare or Medicaid patients."

Let me set the record straight. Like anyone in this country, the Mayo Clinic is looking at this bill. They like some provisions, and they don’t like others. They have specifically said they support the creation of accountable care organizations, bundling of payments, the creation of an independent commission to evaluate Medicare solvency, which is in the Senate bill, the MedPAC idea. They are supportive of these issues because right now it is becoming harder and harder for them to cope with the current Medicare payment system.

This allegation that they are no longer taking these patients is completely incorrect. They made a decision not to take about 80 patients a year from the State of Nebraska because they weren’t getting paid. They are still taking all Medicare-Medicaid patients from Minnesota and the contiguous States. This is not a small amount. Forty percent of Mayo patients are on Medicare. Six percent—I wrote this on the back of an envelope driving in with one of their chief doctors, so you know it is accurate, unlike the "facts" we are hearing over there. Forty percent of their patients are on Medicare, 6 percent on Medicaid, 46 percent are on Medicare or Medicaid. Sixty percent of their business is from Medicare or Medicaid.

It is just false. But what is true is that they want to see reform. They want to see reform of the Medicare and Medicaid system. They want to have it based on quality, not on quantity. That is why they support the quality index I sponsored, along with Senator Cantwell of Washington.

Just putting your head in the sand and hiding behind the stacking of that bill—by the way, we had a three-page bill with the Bush TARP plan, that didn’t work out that well when there were no accountability measures in that. That is not going to bring us the kind of health care reform the Mayo Clinic wants to see for the rest of this country.

I heard a lot in Minnesota from small businesses. Small businesses are paying 20 percent more than big businesses for their health care right now. Why should employees of little businesses, which are really the entrepreneurial engine of our States and the Nation, why should they have to pay 20 percent more than people who work for big businesses? This reform effort allows them to pool their numbers, allows them to join together so they can buy private insurance off an exchange with the same kind of numbers you have at a major corporation.

I know the Senator from Maryland has been very devoted to the idea of helping small businesses.

I ask Senator Cardin about this specific issue. How does the Senator see this as helping small businesses in Maryland and helping the middle class in his State?

Mr. CARDIN. Let me thank Senator Klobuchar for setting the record straight as it relates to the Mayo Clinic. It is interesting, I have had conversations with people at Johns Hopkins University, the University of Maryland Medical Center. I hear the same thing. They desperately want to see health care reform. The cost issues are beyond their ability to maintain the excellence of our health care system. We have to get health care costs under control.

If I might point out, I was listening to my colleagues on the other side give every reason why we should not move forward with the debate, saying: Don’t worry, things will be OK. Those were the same arguments they made 15 years ago, which was the last opportunity we had to debate comprehensive health care reform. They blocked it from being on the floor of the Senate 15 years ago.

What has happened in the last 15 years, after they said: Don’t worry about it. Everything will be OK. Just keep on with our current system of protecting the private insurance companies. They will do a great job.

In the last 15 years, we have seen health care costs go up, $912 billion, almost a three-time increase. We have seen the per capita cost of health care go from $3,400 to $8,100. We have seen that share of our economy in the last 15 years go from 13 percent of our economy to over 17 percent of our economy. We need to act.

One more number I want to give because it affects Mayo Clinic and affects Johns Hopkins because in many cases they are the provider of last resort, where no one else will give care. Also, the number of the uninsured has increased since 1993 from 39 million to 46 million.

The legislation that is being brought forward by our vote later today will reduce the number of uninsured by 31 million. Mr. President, 98 percent of Americans will be covered by health insurance with this bill. It reduces the growth rate of health care costs in America. It provides an affordable option for every American. This is a critically important bill.

The Senator mentioned small companies. I am glad the Senator did because small companies are the ones that are most discriminated against today in our health care system. They pay 20 percent more for the same coverage as a larger company. They do not have options. They do not have a lot of choices about who they can get to insure them. Not only is the cost so high, the annual increases are unpredictable. How do you run a business, if you are a small business owner, not knowing whether your health care cost is going to go up by 10 percent, 20 percent, or 40 percent in the following year? You cannot.

As the Senator knows, we have had small businesses come before us and tell us they are going to have to decide to eliminate their health care. In one case, we had a small business owner who said: Look, I am going to have to give up my business and start to work for a larger company because I can’t afford the health care.

We are at a crisis. I do not understand my colleagues on the other side saying they do not even want to have a debate on this issue, they do not even want to vote so we can take up this issue. Instead, they want to protect the private insurance companies and let them continue to make these profits, continue to cause real problems for our consumers.

I have letter after letter from people who are confronting the problems of private insurance today, where they are denying coverage based on preexisting conditions or not covering a specific drug under their policies. There is no effective way to challenge private insurance companies today. This bill will give the consumers of America a chance against our private insurance companies.

Ms. KLOBUCHAR. Mr. President, if the Senator would yield, I see the Senator from Delaware is in the Chamber. Both the Senator from Maryland and the Senator from Delaware serve on the Judiciary Committee, and we have had several hearings in that committee about an issue people do not always think about that hurts the middle class, and that is the money that is being sucked down the fraud tube. Medicare fraud is $60 billion a year, I think.

Mr. KAUFMAN. It is up to $220 billion.

Ms. KLOBUCHAR. Mr. President, $220 billion. This bill will give us the tools. I know I wish to add even more to it on this subject, to go after that money, so that money can go back to help the middle class afford health care.

I yield to the Senator from Delaware.

Mr. KAUFMAN. That is absolutely right. What we are going to do is increase the number of whistleblowers, people who will see health care fraud and report it. We are going to get more prosecutors. We are going to get more FBI people. We are going to get more people to make sure we bring this health care fraud down. That is part of this bill.

But I do not understand—to follow up on what the Senator from Maryland said—how can you say you do not want to debate the bill, when you look at the fact that the alternative is our present health care system, which is totally, completely broke? How can you say you do not want to do it? You say you are fiscally responsible. How can you say you are fiscally responsible when you are not going to do anything about Medicare and Medicaid health costs and the cost of health benefits in this country?

As we have said many times before on the floor, my State is one of the worst cases; that is, in 2016, a family of four making $50,000 a year would be paying $29,000 in health care premiums. They cannot afford $29,000 in health care premiums. So what is going to happen? They are going to have the equivalent of half what they have today. If they can afford $12,000 or $13,000, they are going to have half the program.

I heard my colleagues on the other side talking about rationing. What is going to happen to these people when they are getting half as much health care from these health care companies? And the health care companies are the ones that decide what procedures you can have, when you can have them, and those kinds of decisions. When people have their health care insurance cut by this amount, you have to worry about whether they are going to be able to get the things they need.

Of course, Medicare and Medicaid prices are going through the roof. It is going to bankrupt the country. In 6 or 7 years, Medicare and Medicaid costs will cost more than everything else in the Federal Government. So how you can talk about——

Mr. CARDIN. Will my colleague yield?

Mr. KAUFMAN. Absolutely.

Mr. CARDIN. On the Medicare issue, during the last hour we heard all these people, who for a long time have been trying to privatize Medicare and reduce the program, now saying that Medicare is going to be in jeopardy if this bill moves forward. It is very interesting. The AARP gets it right when it says:

The new Senate bill makes improvements to the Medicare program by creating a new annual wellness benefit, providing free preventive benefits, and—most notably for AARP members—reducing drug costs for seniors who fall into the dreaded Medicare doughnut hole, a costly gap in prescription drug coverage.

This bill strengthens our health care system, strengthens Medicare for the future, and that is what is going to be critically important to our seniors.

I thank my colleague.

Mr. KAUFMAN. I think that is absolutely right. Right now, medical bankruptcies are 60 percent of U.S. personal bankruptcies—a rate 1 1/2 times what it was 6 years ago—because of medical bills. The thing that is striking about this is, 75 percent of the families entering bankruptcy because of medical bills actually have health insurance. 
Two-thirds of all Americans filing for bankruptcy because of medical bills already have health insurance. We cannot stop that unless we change the system and give people more insurance and give them better insurance and make sure you cannot be denied for preexisting conditions and make sure—the killer—once you get sick—it is bizarre. You get sick, and then the health insurance company comes in and cuts off your health insurance. No wonder so many people are going into bankruptcy.

Ms. KLOBUCHAR. If the Senator would yield, I see the Senator from Massachusetts is in the Chamber, who I think has firsthand knowledge of the importance of this bill, having taken the seat once held by our dear friend Senator Kennedy, who worked so hard to get this bill done, to get health care to the people of his State.

I say to the Senator, maybe he would want to talk about what this would mean to the people of Massachusetts.

Mr. KIRK. I thank the Senator.
I thank Senator Klobuchar for her leadership, as we approach the important moment on voting on a motion to proceed with this debate.

I was appointed by the Governor of the Commonwealth basically in conformity with Senator Kennedy’s wishes. He knew how divided this body was over the important health care legislation and the importance of 60 votes so we could proceed to debate the merits of this bill. I am honored and humbled to be standing at his desk, to be one voice and one vote from Massachusetts.

It is a historic moment, and it is a poignant moment. As I reflect on my experience on his staff, as Senator Kaufman was on Senator Biden’s staff at that time, my experience began 40 years ago under the leadership of Senator Kennedy. That was the time he first spoke about the need for national health insurance that would be affordable and accessible to every single American—in hearing after hearing, in speeches on the Senate floor, and in field hearings throughout America, prodding, listening, leading.

I can only reflect on how proud he would be of his colleagues and the leadership of Senator Reid and Senator Dodd, Senator Harkin, Senator Baucus, all his colleagues who are now uniting in this moment of history to do for the American people what they have waited for for several decades, even since the first utterance of this important health insurance coverage by former President Harry Truman.

Having read through this bill and knowing how proud Senator Kennedy would be of this legislation, I will tell you why he would be. If you look through the bill, what does it do? It saves money. It controls costs. It reduces the Nation’s deficit. It stimulates competition. It expands coverage. It strengthens Medicare. It attacks fraud, waste, and abuse. It increases transparency. It eliminates patient discrimination. It promotes flexibility and innovation. It rewards quality and value—not quantity and volume—of health care. It provides affordable, quality health care choices for individuals, families, and small businesses across America.

It introduces, through Senator Kennedy’s leadership, a provision which provides long-term services for the elderly and the disabled.

Mr. CARDIN. Mr. President, will the Senator yield for one moment?

Mr. KIRK. Before I do, I say to the Senator from Maryland, there is one large, major question. If this bill promises to do all these things, for the life of me, I cannot understand how 1 of the 100 of us could go home for Thanksgiving and be able to explain to middle-class families, who are stretched and looking for health security and financial stability, that he or she would not vote even to debate the merits of this legislation.

Mr. CARDIN. I was going to comment, listening to the Senator, at the desk that was Senator Kennedy’s desk, how proud he would be of the statements the Senator is making here this evening. Senator Kennedy was our champion for middle-income families in America. He understood they needed a voice in the Senate, and he was their strong, passionate voice.

This bill speaks to middle-income families. It is what Senator Kennedy fought his whole career for here in the Senate, to do something that would help middle-income families.

As the Senator points out, we need to bring down the cost of health care. Health care costs are rising three times faster than wages. Senator Kennedy understood better than any of us that Americans are falling farther and farther behind because of the health care issues, because of health care costs. Private insurance companies can make lots of money if health care costs go up. They are not losing. It is the middle-income families who are getting hurt by the system.

He understood that small businesses could not survive unless we figured out a way to deal with the health care issues. And as to people on Medicare—most people on Medicare are from middle-income families. We need to protect Medicare for the future. That is why, again, I get very concerned when I hear what we have heard over the last hour in the discussions, because one of the principal reasons we need to bring this bill forward on the floor of the Senate tonight is to strengthen Medicare, to make sure it is there for the future, to make sure it stays strong, and to make sure we expand benefits, as we do under this bill.

I thank the Senator because those of us who have heard Senator Kennedy speak on the floor of the Senate know how sorely missed he is here, and we are proud you are representing that vote here on the floor of the Senate tonight.

Mr. KIRK. Mr. President, I thank the Senator from Maryland very much.

Ms. KLOBUCHAR. Mr. President, if the Senator would yield, I also see the Senator from Rhode Island in the Chamber. Rhode Island is a State that has one of the highest unemployment rates right now in the country, and it certainly is a State that would welcome this kind of reform. And also on the issue we have been talking about, Medicare, the Senator from Rhode Island has long fought for seniors.

As to Medicare, as has been pointed out, if we do nothing, it is going to go in the red by 2017. The seniors I know who are 65 want to live to be 95 and still have Medicare. People who are in their fifties want to make sure Medicare is there for them when they are 65. That is why it is so important we make these smart reforms, to raise the quality of the care, and to make sure we preserve and save Medicare. And that is what this bill is about.

I yield to the Senator from Rhode Island.

Mr. REED. Mr. President, I thank the Senator from Minnesota. I want to add my comments to that of the Senator from Maryland and the Senator from Delaware to commend the new Senator from Massachusetts. He not only carries on the great work of Ted Kennedy, but he does it with the same passion and eloquence.

What struck me in this legislation—and reminiscent of Senator Kennedy—is that this legislation will provide real help to real people. It is about solutions, not slogans.

Let me illuminate, if I may. Premium relief. What is troubling so many middle-class families? They are too wealthy to qualify for direct public assistance in terms of the Medicaid Program, but they are not wealthy enough to pay for insurance.

This legislation will cap family outlays on medical insurance premiums. Families making under $88,000 will pay no more than 10 percent of their income on premiums. They will be given direct assistance through the tax system. There will be a rebate. So people now, rather than staring at 20 percent, 15 percent, 18 percent increases, will at least know there is a cap. And perhaps if we do our work well enough, the whole system will begin to reduce below the 10-percent mark, and everyone will benefit.

It is also notable that real families worry about many things. They worry about educating their children. They want them to be educated, but they also recognize as full-time students in higher education, they can stay on the family health care plan. It is interesting to note that decisions made about education are tied into health care, and also, in fact, as to where you work, if you should keep your job you do not like because you have health care or go on, whether you strike out to start a new business because you have this brilliant idea or stay in your current position because there is health care there. But what this bill does, again, is provide real help for real people and allows families to keep their children on their health care plan until they are 26 years old.

It also reforms dramatically the insurance system. Again, we listen to many of the complaints: Oh, we don’t want a government-run health care system; we don’t want bureaucrats telling us what to do. The irony, of course, as you mentioned, and Senator Schumer did, too, is that one of the most popular health care programs in this country is Medicare, which is government run. One of the other most popular health care programs in this country is run through the Veterans’ Administration, which is a government agency. The least popular programs are private health insurance, where everyone has complaints—doctors, patients, providers. This legislation will prevent lifetime limits that insurance companies dictate. It will also do many other things.

So let me conclude because I appreciate very much—and if the time allows, I have a question for the Senator from Massachusetts. But this is a bill that when you move past all of the rhetorical smokescreens—because, frankly, most of our colleagues on the other side don’t want to do anything. They didn’t want to do it in 1993 and 1994; they didn’t want to do it in 1933 and 1935; and they still don’t want to do it—this legislation helps real people with solutions not slogans about nationalization and bureaucrats.

Ms. KLOBUCHAR. The Senator from Delaware.

Mr. KAUFMAN. I was presiding yesterday for I don’t know how many hours. When you listen to what is said on the Senate floor by the other side, they are talking about a model where there is no competition. Any tax on an insurance company is going to be passed on to the consumer. What kind of a business—I don’t know anybody in business who, if they get an increase in cost, they just pass it on to the consumer. Right? I mean, we have a law of supply and demand the last time I checked. But every single one got up and talked about the cost and said this is going to hurt the consumer. It is not going to hurt the insurance companies because they are just going to pass it on to us. The reason they are going to pass it on to us is kind of obvious.

Here is a list, a small list, that lists all the States in America and how much of their insurance is tied up in two or less companies. Do you know what you have to do? You have to get down to No. 40, Oregon, because the first 39 States on this list, two insurance companies make up over 50 percent of the market in their State. How can you have competition when you have so much of the business tied up in just one entity?

The way you can tell there is not competition? You don’t have to have an advanced degree in economics to figure out there is no competition. How do you know there is no competition? Every January, my premiums go up. The only other thing I know that I get that goes up every January is my cable bill, right? There is no competition in cable. You either take cable or you don’t. They say there is competition. So every year, whether it is January, February, or March my cable bill goes up. And every year, just like clockwork, my health insurance premiums go up. So clearly, there is not competition.

That is why a public option is so important. We have to have a public option so there is competition not only in the top 39 States where one firm has over 50 percent—two firms have over 50 percent of the business—but in all 50 States.

That is what this bill does. It is amazing to think on the other side, the support they have for competition, and I believe they do and I know them and I respect them and they all are concerned about competition—except every once in a while they kind of turn a blind eye to the fact of how powerful competition is. Competition is valuable and powerful in keeping costs down and increasing benefits and quality of care—only when there is actually competition. So we are going to have to have competition. This bill will actually do it.

Ms. KLOBUCHAR. If the Senator will yield, I think we have been joined by the Senator from North Carolina, who is a member of the HELP Committee and I know has a background in business and understands a little bit about competition.

So how does she see this as being a problem? I know in the State of the Senator from Maryland there is limited competition, and in a number of our States one or two providers—Minnesota is an exception, but one or two providers dominate the market, jacking up the prices.

The Senator from North Carolina.

Mrs. HAGAN. I think one of the key points is the fact that this bill is going to eliminate discrimination based on gender and preexisting conditions. I have two children right now who are in their midtwenties. My daughter is paying more per month for health insurance than her brother. Yet it is the exact same policy. The same with preexisting conditions. How many people do we know who have a condition such as diabetes or asthma, or a woman who has had a C-section who is, therefore, denied from getting health insurance? We have to be sure we correct this, and that is what this bill does.

Let me give a couple of examples. So many people in North Carolina I have heard from have some of these situations. Recently, I got an e-mail from a family in Greensboro. It is a working family. The husband has Graves disease, which is a treatable condition, but he can’t obtain health insurance because of this condition. Without health insurance, his life is gravely in danger. He repeatedly uses the emergency room for care.

To make matters worse, he has a 2-year-old son who has hemophilia and has to be taken to the emergency room every time he bumps his head, which sometimes can cost, for a 2-day supply of medicine, $4,600. The family makes too much money to qualify for Medicaid and, obviously, with these preexisting conditions, health insurance is way out of reach for them. It is heartbreaking for this family. What the father has decided to do is to purchase life insurance instead of trying to get health insurance, and he is 29 years old.

Ms. KLOBUCHAR. If the Senator will yield, I think what the people will be shocked to find out is that I think in eight States domestic abuse is actually a preexisting condition. You talk about gender discrimination. If a woman is a victim of domestic abuse, she will basically not be able to get certain insurance policies. Is that right?

Mrs. HAGAN. That is right. In all but 12 States, insurance companies are currently permitted to charge women more than men for the exact same policies.

Mr. CARDIN. If the Senator will yield for a moment, as Senator Klobuchar pointed out, if you don’t have competition—and Senator Kaufman said the same thing—if you don’t have competition, what is your choice? You are going to have to pay the premium.

There was a Washington Post article written about a street in Gaithersburg. Gaithersburg is a growing suburban community not far from here, certainly middle-class families. They think they are doing fairly well. It talked about one street in Gaithersburg, and they gave half a dozen stories about people—real stories—about people having problems with our current system. They talk about Patty, who has private insurance and thought she was in good shape. She talks about having to search a book in order to find out what doctor she could go to to stay in the network because it is too expensive to go out of network, and then she hits her deductible and finds that her fees and copayments come in fast and strange, making it unaffordable for her with her current insurance coverage. She has no other choice. That is the only insurance she can get.

Two doors down the road is Chuck who needs oxygen, needs certain medicines. He had to fight with his insurance company to get the prescription drug covered. He got the prescription drug covered, only to find out the nurse who administered the drug was not covered, and it cost $400—another problem with a private insurance company.

Across the courtyard, Will and Sarah, they have insurance today. They are going to lose it because he just lost his job, and he has no prospect for being able to afford insurance.

The last one is Martha. This is a very interesting one. Martha went to the emergency room for delivery of her child. She needed an epidural. She made sure she went to a hospital that was in-network because she wanted to make sure it was covered. Guess what. That anesthesiologist she had no control over was not in-network and she had to pay all that extra money. Again, no choice. She had no choice in the system. There is no competition.

I know we have Senator Kirk here who is our newest Member. Perhaps the Senator could tell us what he is hearing from Massachusetts. He is a new Member here. I don’t know whether he is getting the same stories of what is happening in his State.

Mr. KIRK. Well, it is exactly the same story, with one exception, I would say to the Senator from Maryland, which is that 3 years ago, Massachusetts adopted its own health reform. Now, 97 percent of the people in Massachusetts are covered with health insurance.

As you have said and as the Senator from Rhode Island has said, the best illustrations of the need for health reform are the individuals, the real people. So I will tell my colleagues a story about a young lady. She is a waitress, a 24-year-old girl. Her name is Jessica Wheeler from Somerville, MA. She is a waitress and works part time as an intern. She had dreams of graduate school, but she was concerned about health insurance. We have an exchange in Massachusetts not dissimilar to what is being offered in this legislation where there is increased competition from private insurers and others. She applied to the exchange and was found eligible and enrolled and took out an insurance plan.

Shortly after, she was stricken gravely ill with organ failure and was hospitalized for an extended period of time. She was made well. She has to take a pill every day in order to keep up with her condition, but her coverage was complete. She has applied now to graduate school, and although she probably has her tuition issues stretching her means and so forth, she is free of the concern and need of expensive health care bills; otherwise, she would have been without. So it is just another illustration.

Just one other point on competition that keeps coming back and back, I ask myself: Why do middle-class families save their hard-earned money to buy health insurance? Obviously, the answer is so that they will have coverage if they get sick. Without competition, I will tell you what is going on. Insurance companies—now get this—are denying coverage because people are sick or they say: Well, you reached a certain limit, and we didn’t realize you were going to get that sick, so we dropped the coverage.

Ms. KLOBUCHAR. If the Senator could yield, I have exactly the same kind of example where someone wants to buy coverage, they are willing to pay for some coverage, but they can’t. They basically are cut out because they are sick.

This is one of the saddest letters. We just got this from Cheryl from Bemidji, MN. She says:

I am writing to you because I just got off the phone with my daughter Mickey. At first I couldn’t understand her because she was sobbing so hard. Her husband had just been told by his boss that they wouldn’t be carrying health insurance on their employees any longer. They are a small company in northern Minnesota and it was costing them $13,000 a month. For her, for my daughter, this is a matter of life and death. She has cystic fibrosis. Because it is a preexisting condition, the insurance companies won’t touch her unless it is under a group plan such as the one her husband just lost.

She says:

You need to stand and be my voice, be Mickey’s voice. Mickey is a fighter, but she can’t keep fighting a system that is so against her. Mickey has already lived longer than any of the doctors expected. I want her to live to see her 5-year-old son become President one day.

That is from a mom in Bemidji, MN.

So I will just ask my colleagues, how can we continue to go down this path where hardworking families—a man who has a job, who is working for a small business, gets cut off from his insurance, and because his wife has cystic fibrosis, they aren’t going to be able to afford insurance.

The Senator from Delaware.

Mr. KAUFMAN. I think the reason we use these examples so much is because certain words kind of roll off your lips; words such as "preexisting condition."

Here is an example involving Angela in Dover, and she is a bartender, not a waitress. Her income is from tips. She has no health insurance through her employer. She became pregnant. She tried to find private health insurance, but she was declined coverage because pregnancy was considered a preexisting condition.

Now, just do a visual for a minute. This woman has been living off of tips. She is about to have a baby, and there is nowhere she can go to get health insurance. She applied for Medicaid to find prenatal care for herself and her baby, was denied coverage because she earned $200 more than the monthly income limit. I mean, just picture this now, if you were in this situation. She called organizations and clinics and was unable to find a payment plan she could afford.

Midway through her pregnancy, Angela decided to cut back her work hours so she could qualify for Medicaid. She worked all 9 months of her pregnancy and delivered the baby on May 27. The Medicaid coverage she got was especially crucial because she had complications with hyperthyroidism and was able to get the necessary prescriptions to control her condition.

OK. Do we have the picture? How would we like to see ourselves with our spouses or our kids with this kind of a decision? The sad part of the story, as if it is not sad enough, is that Angela was so anxious to ensure that everything possible was done for a healthy baby and the system threw up roadblocks. Pregnancy should not be considered a preexisting condition.

People in this country who are pregnant should not have to worry, in addition to going through the trauma of being pregnant for 9 months and the baby being healthy and all the fears you have and on top of that fear they may go into bankruptcy because they cannot afford to pay for the doctor bills for their baby. This is real stark to me.

We are going to vote tonight on cloture so we can move to a bill that will, once and for all, make sure Angela Austin and all the women similar to her who have the "preexisting condition" of pregnancy will only have to worry about their baby and what is going to happen to her and not worry about what she is going to do when the child is 2 and she is in bankruptcy, because so many people are going into bankruptcy.

Ms. KLOBUCHAR. Maybe the Senators can answer this. In these thousands of letters and calls we get from these people, they are asking us to be their voice. They don’t want to say we are not going to debate this bill at all, that we are going to put it in a drawer and pretend it didn’t exist.

Mr. CARDIN. That is the interesting point. These are all real stories, people who are being denied health care today because of arbitrary practices from private insurance companies or the way our system is currently organized.

The vote tonight is a pretty simple vote. If you think the current system is what you want, OK, I understand why you are voting against cloture. I understand that you say the status quo is fine; we don’t even want to debate the issue; we don’t care about the people who have been affected by the arbitrary actions of private insurance companies and saying that pregnancy and childbirth is a "preexisting condition" or when you are using over-the-counter drugs to keep your cholesterol under control and the insurance company says that was a preexisting condition.

All we are saying tonight is: Is this worthy of debate on the floor of the Senate—a clear vote? Those who vote for cloture say this is worthy. The people who have written us these letters are entitled to have the Senate take up this issue. That is why we point out that there are numerous groups, including the American Medical Association, that say vote for cloture, let’s have this debate before the American people.

Ms. KLOBUCHAR. Along those lines, before I yield to the Senator from Massachusetts, I started out talking about the cost issue. I wanted to put in the Record the statement of November 5, 2009, from the Mayo Clinic. There have been things said about their position. My friends on the other side have said they "don’t want any part of this bill" and they "want nothing to do with it." Those are exact quotes. They said they "are not taking Medicare and Medicaid patients anymore."

Those are exact quotes. They are all incorrect. I will put this in the Record. It is dated November 5, 2009. "Points of Agreement and Divergence." They say:

We are encouraged by much—including provisions to pay for value in health care, an insurance exchange, individual mandate, subsidies for people to achieve coverage, and pilot projects on accountable care organizations and bundling of payments.

To be fair, they also say they are “concerned about other areas including a public option that is based on Medicare rates . . ."

As you know, the options in the House and Senate bills are not based on Medicare rates but negotiated rates. They are concerned about the long timeline for implementation of value provisions, as I am. They are concerned about across-the-board cuts for providers. They neither endorse nor support the bill. To say they don’t want any part of the bill is false.

I ask unanimous consent that this material be printed in the Record.

Mr. KIRK. I know time is running short. I want to say one thing about this. We have heard talk about the status quo. Make no mistake, this is a situation with respect to—we assume when we hear the words “status quo” that things will remain as they are.

In the area of health care and health insurance, things are not going to remain where they are. The status quo is not the status quo. We either move forward or we fall back. If we don’t address or at least debate the merits of the bill and don’t move it forward, we all know what is going to happen. The figures are there. The average family premium, which is now over $13,000, in 2016 will double to $24,000. That is not the status quo. That is falling back. Similarly, the number of uninsured will rise from 47 million today to 54 million in 2014. That is not the status quo. That is falling back. Fourteen-thousand people will continue to be dropped from coverage each day. That is not the status quo. That is falling back. I could go on.

There is a reason this bill needs to be debated. It is because the average middle-class working family deserves and needs health care security and financial stability. This bill will bring them that. At least I hope that the Members of the Senate—all 100—would say that, on the merits, this bill and this need should be debated.

Ms. KLOBUCHAR. I thank the Senator from Massachusetts. The Senator from North Carolina is here. I know the people of North Carolina and the people in the South have concerns about the current state of affairs in health care as well.
    Mrs. HAGAN. Yes. A lot of what we have been talking about are people who don’t have health insurance and who want it enhanced because of preexisting conditions. We have people who are sick and stuck with health insurance.

I received an e-mail from a young North Carolinian who works for AmeriCorps. She was the valedictorian of her high school class. She suffers from a brain abscess. Her illness has put her into debt for the rest of her life. She has health insurance, but it ran out when she hit a $50,000 cap. Her bills far exceed the cap. It is sinking her entire family into debt. She is sick and stuck.

How many people do we know who have a spouse or themselves who have health insurance, and they are working, but they cannot switch jobs because they would lose their health insurance? I have a good friend whose husband has cancer. She wants to change jobs, but she cannot do it because of the condition of her husband. Once again, people are sick and they are stuck. We have to be sure we can have a debate, that we can move forward on health care reform so we can help people.

Mr. KAUFMAN. We are all concerned about the economy. Even with health care reform, I think for every Senator I talk to on both sides of the aisle, their biggest problem is getting people back to work again and getting the economy moving. It is truly tragic when you think so many people are losing their jobs. Under our present system, the way it is structured, when you lose your job, you not only lose the money coming in to you, you lose your health insurance. You lose your self-respect because we are all judged on where we work. That is how people judge us.

As has been said, the longest walk is the walk home to tell your spouse and your kids that you lost your job. The irony of ironies and the thing that makes this so incredible is that you don’t just lose your job and self-respect, you lose your health care insurance.

We have a system, and we have to change the system so these people out their right now can maintain their health care insurance and care for their children and their families, as they and everybody in their families go through this very traumatic experience.

Mr. CARDIN. We are running out of time, with only a few more minutes left. I want the people in Maryland and of the Nation to understand what this vote means. We are going to bring an amendment to the floor of the Senate for debate. Any Senator will be able to offer an amendment to how we should advance health care. The Senator from Massachusetts is absolutely correct. We are either going to continue to see our health care system with more people being denied coverage, with the costs escalating much faster than our economic growth, with businesses having to decide to terminate plans—that is what is going to happen—or we can take up health care reform and try to rein in the practices of private insurance companies and provide a way where every American can get access to affordable health care. That is why the American Cancer Society Cancer Action Network says:

The American Cancer Society Cancer Action Network urges all Senators to vote in favor of allowing critical health care legislation introduced by Senator Harry Reid this week to be debated on the Senate floor. With thousands of cancer patients being denied coverage, charged excessive premiums, and facing exorbitant out-of-pocket costs, it is urgent that the Senate take action now, not later, to protect and extend health coverage to millions of Americans in need.

Last week, Cynthia and Eric Cathcart were here in the Senate. They are two people who are self-employed. They cannot even get an insurance policy to cover their family. They have to have two separate policies, with two deductibles and two premiums, and they cannot afford it. We must take up this issue for the Cathcarts and the millions of Americans who cannot make it under this current system. Middle-income families are depending upon us tonight.

Ms. KLOBUCHAR. There is a lot of talk about Medicare and our seniors and what this bill does. Think of the woman I talked about who is a fighter, as her mom says, but she cannot keep fighting a system that is so against her. As you pointed out, the advantage of this bill is, it gives our seniors a better playing field with the drug companies paying for their drugs in the doughnut hole. Also, it is my understanding that AARP wants to advance the bill. Certainly, AARP has stood up for seniors for years and years and years. They know we need to preserve Medicare and keep it safe.

Can the Senator comment on AARP?

Mr. CARDIN. AARP not only wants us to advance the bill; they support the bill. They believe this bill will improve the Medicare system, make it stronger, and provide additional benefits, particularly in reducing the dread Medicare doughnut hole. They want the Members of the Senate to vote to allow this bill to come to the floor.

Ms. KLOBUCHAR. Maybe we should end with the Senator from Massachusetts, the home State of Ted Kennedy, having the last word of this very interesting colloquy, in which we heard from the Senators from North Carolina, Rhode Island, and Maryland.

Mr. KIRK. I thank the Senator. I am honored to be a Senator in this body. Back home, they think I am the 60th vote. I would like to believe we would have a more enlightened full body and that 60 would be a number we would pass through.

The American people are looking forward to debate on this issue. I think they believe they deserve many of the aspects that are contained in the bill. On behalf of my constituents in Massachusetts and those who, for so many years, revered and loved and elected and reelected Senator Kennedy—I think they all, as we do, have him in our minds and hearts tonight, and we hope we can advance this bill to the American people, knowing his spirit and years of work are a reminder of our obligation.

I hope we will have a successful vote this evening. That will provide an opportunity for the American people to hear a debate and perhaps allow corrections by whatever amendments may be needed, so we proceed, keeping in mind, as is true in all legislation, we cannot let the perfect be the enemy of the good. The good is something our people have been waiting for, for decades. The time is now. Let the debate begin.