Service Members Home Ownership Tax Act Of 2009

Floor Speech

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Mr. DURBIN. Mr. President, I wish to thank my colleague. That letter from his constituent is heartfelt and should be an inspiration to all of us to get this job done. We have sacrificed. This is the 24th day debating this bill. Some of these sessions have been early in the morning and late at night, but I think the time has been well spent. People have come to the floor and spoken at great length but no one more eloquently than your constituent who sent you that letter.

Come tomorrow morning, we will have the official vote--very early in the morning. I would like to say to my colleagues from West Virginia and Minnesota that we have a piece of news. A lot of what has been said on the floor has been said by others and said before, but this is a piece of news worth reporting. Our bill--the health care reform bill--has been endorsed by the American Medical Association, the largest physician organization in this country; endorsed by the American Hospital Association, the largest organization representing our hospitals; it has been endorsed by the American Association of Retired Persons, the largest senior citizens organization, which focuses intensely on the future of Medicare; and today we have received the endorsement of what is regarded by most as the most highly respected medical organization in America. If you ask most Americans whom do you respect the most, it is the nurses. You know why. Because when you are in a hospital with someone you love or in the care of a doctor, it is the nurse who is with you in those moments that make a lifetime. The nurses today have issued their formal endorsement of this health care reform bill.

The nurses today have Rose Gonzalez, director of government affairs for the American Nurses Association, who writes:

Nurses across this country have waited decades for this historic moment and the time is at hand.

Once again, the need for fundamental reform of the U.S. health care system is critical. ANA and nurses around the country are ready to work with you toward enactment of the strongest possible health care reform legislation.

For all of our critics from the other side of the aisle, the simple fact is this: The people who are on the front line of health care, the people to whom we turn every day for critical care and critical treatment of the people we love, endorse this measure. They have come out foursquare for it. I would rather have their endorsement than any political endorsement we might find.

Now let me tell you how this is significant. This bill will change many things. Some on the other side have criticized the bill because it is too big; they want a small bill. I want a bill that is large enough to treat the problem. It is like saying to a doctor: You can give me a prescription but only give me one; I can only take one prescription at a time.

In this bill we address problems existing in our health care system that go to the heart of the challenge that faces our Nation. We have great doctors and hospitals and nurses. But we spend more than twice as much as any other nation on Earth per person for health care in some areas. Many countries spend a fraction of what we spend and get much better results.

We know the cost of health care is getting beyond us. We know a family of four with a health insurance plan now through their employer pays, on average, $12,000 a year for premiums. Ten years ago it was $6,000. It is projected to double again in just 8 years. People would be working to earn $2,000 a month just to pay for health insurance. That is before you take the first penny home for your family. That is unsustainable.

The first thing we do is address affordability, start bringing down the increase in cost in health care. That is our first responsibility, and this bill does it. The second thing it does is extend the reach of health insurance protection.

As I stand here, one out of every six Americans has no health insurance. These are not lazy, shiftless people. These are people who can't afford it, who work at a place that doesn't offer it, or happen to be unemployed. At the end of the day, 60 percent of those people, 30 million, will have the protection of health insurance. That is critically important.

This bill provides protections needed by the people who have health insurance. How many times have you heard about a friend or a family member who has to fight an insurance company for the payment for critical care that the doctor has ordered, or over a prescription which the doctor believes will keep a person healthy or make that person well? Those battles are now going to tip to the side of the consumers of America. Health insurance companies will not be able to discriminate based on preexisting conditions or put caps on lifetime policies or tell kids that at age 24 they can no longer be covered by the family health care plans. All of those things are changed in this bill, giving consumers across America a fighting chance when it comes to health insurance.

Last night I met with several of my colleagues. We talked over dinner about how America is going to react to this. It is hard enough to digest the contents of this bill, to expect the average American who has so many other concerns to digest it may be too much to ask. But I asked my staff to give me a list of the things that most Americans can expect to see, the changes they can expect to see on a timely basis--not the long-term changes where 94 percent of people have health insurance or would have a better standing to fight health insurance companies when they complain, but what will we be able to see. My staff came up with a convenient top 10 list which most of us are familiar with from late night television shows.

Within 6 months or a year after this bill is enacted into law, here are the top 10 things Americans will notice changing when they buy a new health plan: No. 1, if you own a small business you will start receiving within 6 months tax credits to help your business pay for health insurance for your employees beginning with tax year 2010. Mr. President, 144,000 small businesses in my State of Illinois will be eligible for the small business tax credit so that small businesses can afford to offer health insurance for the owners of the business and for their employees. That is No. 1--and this is all within 90 days of enactment.

No. 2, we are going to create immediate options for people who can't get health insurance today. We estimate that 8 percent of the people in my State have diabetes; 28 percent have high blood pressure, and all of them could be denied coverage because of this so-called preexisting condition. We are going to put in place high-risk pools so these people who can't buy health insurance today because of these preexisting conditions, have an option, a place to turn to, to buy health insurance. That is No. 2.

No. 3, and this is good news for every family and every parent: Within 6 months after the enactment of this bill, the parents of loved ones--3.6 million kids in my State--will sleep better knowing that whatever health insurance they have will be required to cover their child regardless of any preexisting condition. Any child under the age of 18 with a diagnosis of diabetes or a history of cancer or asthma or whatever it may be cannot be denied coverage under the family plan, within 6 months of this bill being enacted.

No. 4, you will no longer need to fear an insurance company dropping you from coverage once you get sick. It is called rescission, and it means as soon as you need the health insurance, the health insurance companies run away and say: We are not covering you anymore. Hire a lawyer and fight us if you don't like that. That comes to an end within 6 months after this bill passes.

No. 5, you will no longer need to worry if you get sick or get in an accident because you are out of town and out of the network of hospitals and doctors your insurance policy provides. This bill ensures access to emergency care in-network and out-of-network without additional cost sharing beginning 6 months after the date of enactment.

No. 6, you will have the freedom to choose your doctor, the person you think is right for you and your family. This bill protects your choice by allowing plan members to pick any participating primary care provider and prohibit insurers from requiring prior authorization before a woman, for example, goes in for a gynecological examination.

No. 7, you will no longer fear losing your home or going bankrupt because of a bad car accident or a serious illness such as cancer. This bill, when it becomes law, will bar insurance companies from limiting lifetime benefits and severely restricting annual benefits under health insurance policy.

No. 8, this bill will require providing preventive services and immunizations without copay. Mr. President, 41 percent of the people in my State have not had a colorectal cancer screening; 22 percent of women in Illinois over the age of 50 have not had a mammogram in the past 2 years. Health insurance reform will ensure that people can access preventive services for free through the health care plans. It makes sense. It is an ounce of prevention and built into the law 6 months after it passes.

No. 9, senior citizens are going to notice the difference within 6 months. They will have access to dramatic discounts in the purchase of name-brand prescription drugs under Medicare Part D beginning July 1, 2010. Roughly 314,000 Medicare beneficiaries in Illinois hit the so-called doughnut hole, the gap in coverage. They are going to have protection. It is going to be provided by this bill.

No. 10, seniors across America will be eligible for one free wellness visit each year without charge. Think about that: the peace of mind which it brings to you and to your family to know that you have had a checkup, and the doctor said you are doing fine and takes care of a problem before it becomes major.

Those are the top 10 things to expect in the first 6 months or a year, and more to follow. This is a bill worth voting for. This is a bill which finally puts us on record as a Nation that health care is not just the privilege of the lucky and the wealthy. It is a privilege of living in this great Nation. It is a right that comes to all of us. If we truly want to enshrine that guarantee of life, let's enshrine in this bill guaranteed access to quality health care.

We have had a long debate. Those on the other side have been critical of this bill. They have never offered an alternative--not one substitute comprehensive alternative. They just can't do it, and they won't. But we know we have the responsibility to do it.

With votes this afternoon, in just a couple of hours and again tomorrow morning, we are going to make this bill a bill that is passed by the Senate, on its way to conference with the House, and by the first of this new coming year, we will be able to offer that promise of quality care which the American people are asking for.

Madam President, I yield the floor.

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Mr. DURBIN. The Patient Protection and Affordable Care Act offers community health workers some overdue recognition, and more importantly, authorizes grants to help support and expand their work.

Community health workers are from the communities they serve. From rural small towns to the urban inner city, community health workers reach out to underserved communities in ways that the current health care system cannot, providing culturally and linguistically appropriate health information in a more familiar and welcoming manner. Their work helps to bridge the healthcare gap and diminish disparities.

Nowhere is this more evident than in the community-based doula program. Community-based doulas support pregnant women during the months of pregnancy, birth, and the immediate post-partum period. They provide parent education, logistical and emotional support. They help new mothers make better lifestyle choices and deliver healthier babies. What makes these programs work is the culturally sensitive mentoring within the community.

In Chicago, the community-doula model has made a big difference in the lives of these young moms and their babies. The Chicago Health Connection came up with this model. They trained mentors from the community to work with at-risk moms, many of whom didn't know where else to turn. These mentors spend time in the neighborhood, finding and befriending pregnant women who need help.

With the guidance of the doula, the Chicago Health Connection found that more young mothers were going to their prenatal care appointments, making better lifestyle choices, and--not surprisingly--delivering healthier babies. The doulas stay with the moms through the early months, encouraging breastfeeding, cuddling, and interactive play.

Bina Holland is a community-based doula at the Easter Seals Children's Development Center in Rockford, IL. Bina has had a powerful impact on one of her clients--a 14 year old girl who was 5 months pregnant and severely underweight. Bina taught her about healthy nutrition habits to strengthen her body to carry a baby. Bina also encouraged the young woman to visit her doctor regularly and to openly talk with the doctor about the health status of the baby.

The girl delivered her baby early at 2.5 lbs, and Bina was there to explain the health benefits of breastfeeding. The young mom agreed to nurse her child, and each week the mother monitored the baby's growth. The child was nursed to health, and the mother successfully graduated from the doula program. Thanks to Bina.

Community-based doulas are a powerful resource for maternal and child health, and the model is effective. In communities that have employed it, outcomes include better prenatal care, higher birth weight, higher breastfeeding rates, better parenting skills, fewer preterm births and c-section deliveries, and delays in subsequent pregnancy for teenages.

With Chicago Health Connection's success, they took on the challenge of working with other communities to build their own community-based doula program. Today, they have transformed into Health Connect One, a training organization for communities nationwide interested in starting their own community based doula programs. The need is everywhere, and these women are working hard to make these important services available everywhere for all moms.

I am encouraged by the language in Section 5313 of the Patient Protection and Affordable Care Act, Grants to Promote the Community Health Workforce and want to ensure that the definition of community health worker includes community-based doulas. The Federal Government currently funds community-based doula programs through the Maternal and Child Health Bureau's Special Projects of Regional and National Significance. Expanding the definition of community health workers in the reform bill will give these evidence-based programs greater support to meet the needs of families in underserved communities.

Community-based doula programs are a proven example of the health outcomes that education, prevention and health literacy can bring. With grants to promote the community health workforce, doulas will continue to promote positive health behaviors in pregnant women and improve the lives of families nationwide.

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