needs so no child or sought. in shimkus -- just be a nuys call or home for. in should be the rule. and is my belief that we can get there. a line from scriptures comes to mind when thinking about the obligation we have two our childrenspecially those who are poor. a faithful friend is a sergey shelter. says in the scriptures. if we say we're advocates for and friends of our children this legislation, they also legislation we pass must shelter poor children from terrible unintended consequences which may be in the final bill. we have to make sure that we shelter those children. if we don't guarantee that shelter for those for children than we haven't been that faithful friend to our kids that we say we are two rich children who are in five gods children.

one data point i want to make about medicaid and children's health insurance -- we should be proud we expanded health insurance. so many people work on that long before i got here. in but when we pass children's health insurance and when we have work to make sure that medicaid is there a especially for poor children and those who suffer from a disability we should remember that one-third not just about kids in big cities as sometimes people want to make it. this is about kids in cities and towns in suburban communities but also about a girl children. one-third of all rural children in the country are covered by schip for medicated soap and we talk about cutting and talk about government programs i think we should remember a lot of real concern in that program. let me conclude with this story

our constituency i should say. denise lewis. denise lives in pennsylvania, the middle of our said, i met her years ago when she wrote to our office recently but i did know her story before this. i met her in passing. denise and her husband, for children, most of whom are grown and the and this is 19. all during their children's growing up years to the center has been a struggle to be able to afford health care and made a little too much to qualify for public assistance but not enough to afford the kind of coverage they needed. we know this is all too common today. this is what she said -- there are many times that the medical care her children needed determined to the food, but the family with eight. one of the most poignant things he said was this and i quote. wondering whether you should go to the doctor earning a parent is completely different from wondering whether your kids go to the doctor.

so says denise lewis, so well said about the challenge that our children posed in this bill and the legislation overall. no parent should face this choice and no child should be without the health care that they need. from going to close with a quotation from dr. judith paul free. a pediatrician advocate and president-elect of the american academy pediatrics. she said in her testimony last week before us and i quote, sometimes we as town advocates find hard to understand why children's needs are such an afterthought ny because children are little bit, because children are little policy makers and ensures think it should take less effort and less resources to provide them health care. well, she is right. we all recognize that children

are little but they are not just all adults, so many attica's have reminded us in this debate. children may be little but and gauze is there are 7 feet tall. and we must treat them accordingly. so again the rules should be at the end of this long debate no child worse off. dr. palfrey that i just quoted, denise lewis that a code of especially tricia urban are waiting to see when we do. our time to make a difference tricia urban paid a terrible price but again it comes down to basic choice in terms of what we do. in the status quo resist change. status quote forces reform. i know this is a tremendous challenge. i don't have a full appreciation for it because i haven't been valid as long as some my senator dog especially for our kids that you have. in is a great challenge but also believe it is a challenge or the

of a great nation to help us make this nation and more perfect union. thank you. >> thank you. for in love of reasons you mentioned senator hatch and enduring child carriers leo and and all of our colleagues care about children but i'm been so pleased to have taken on this added cost in insisting that our children being paramount in our minds as we move toward an all this. i know everyone else shares are commitment to and the fact you've articulated it more so than anyone else has here today is, indeed, appreciated and thank you for your involvement in this as well. senator schakowsky, thank you again. as in the other day senator rakowski was generously hubbell on the tobacco and that alone i have said over and over again, that set up this debate in some

ways because with so many people to tobacco and no one knows a better than dr. coburn as well as the position and i really thank you for that. that is a 15 year-old debate that one on and we're going to have some regulation of that industry which is a major step and prevention said thank you. >> thank you mr. chairman, thank you for your leadership on that issue and so many. and your willingness i guess to step up. i don't know how many options you had when senator kennedy calls and asks you to take over the reins. but it is appreciated it recognizing which you have in front of you the wake of this task, the responsibility i think we would all agree that in terms of the issues that are first and foremost on the minds of americans, if it is not the impact of the economy on a daily lives is health care. and how that impacts of the family budget and decisions that

are made in the expectation is real and substantive that we. congress will deal with health care reform. but how is that translated, how a person like tricia urban reckoning is is that this is meaningful health-care reform as opposed to when a person in a very small remote village they feel is necessary. oh is the devil is in the details and i appreciate your leadership on this of senator enzi taking a very difficult area and try to bring some sense and some rationale to it. a lot of the members of lease on the republican side this morning and this afternoon have talked about the process and there has been a level of frustration with some much coming at us in such a short order and that it could be better. senator bingaman and i have been

working really sincere began and says the 111th congress began on energy legislation and it has been slow and tortuous but has been very thorough. we just completed our 12th markup to name and passed a bill at of committing. is a bipartisan bill and there's a lot of work and effort and a lot of collaboration and that went into its and i've been around here but not nearly as long as those of the of the table but long enough to know i should never suggest to chairman and ranking member of the way they do it in another committee is what we should be doing here. but it is such a contrast in terms of how we were able to prepare as committee members for the various titles that are coming forth and i know i mentioned to you yesterday and indicated you're going to try t assist with more on of eight blueprint or mack going for it so that we can be better

prepared. i know that our staffs are working literally around the clock to try to be responsive and get information back to our respective states saying how does this sort with saddam division of insurance or had as a sort of our state's plan and it is important that we get good and solid feedback on so much of this so that what we end up happening doesn't fall into not only health care reform but the black hole of the law of unintended consequences on trying to figure out afterwards now what we do. so i am wanted that urges with a thoughtful and deliver their process recognizing that that makes the process longer and perhaps we are not able to achieve the deadlines that have been sent out i think by others

that have said we have to have a health care reform bill through the senate so that it can be approved by the congress and signed by the president's on exit date. i am looking for a good policy in as i think all members of this committee and all members of the congress are. we're looking for good policy rather than just the achievement of a time line and so my request to use mr. chairman is said if we find that our deliberations will take us longer and then we might otherwise like that we've set to kick that deadline down the road because our quest, our goal is to be responsive to the american public out there the answers, who want a level of reform, they want to know that

we in congress have addressed their very important issues when it comes to access to health care. i believe that our success and legislation is going to be measured by whether or not we can craft a health care bill that reduces our cost of providing affordable comprehensive medical coverage managers continuous access to doctors, nurses, medical health services in this legislation should not interfere with the ability of individuals to continue to choose their health care provider in their choice and unfortunately mr. chairman i'm not convinced that the bill before us allows us to meet these goals and these measures of success. what we are embarking on. terms of the legislation is the most expansive and health care

bramah since medicare was enacted back in 1955 by many members have talked about that but we think about that time when we took a minute here with a bank in 1965 when it at that time we made promises to the american people and some of them were the same ones that remain today. we pledge that if you're no longer able to work medicare will take care of you and seller today what we are touting is a government run health care plan that would provide americans with guaranteed access to care and joyce and providing and as

we look to that medicare model coming from alaska or have serious issues with access to care and particularly as it relates to access to providers that will accept medicare people, the thought that we would move to a model such as medicare and i believe medicare is desperately in need of repair, desperately in need of reform and a fix that concerns me a great deal. i think as others have mentioned that our constituents want us to be working on a bipartisan basis. i think they want reform, but again what constitutes reforms may be different depending on where you're coming from and

what your knees are unfurling within this country our federal government provides health bill services for a number of different federal agencies and organizations and when we think of our garment run plans it is iranian health services and two medicare. those men and women who have served our country, their families have access to the virginia and serve over a million are retired service personnel with medicare and misspent 440 billion in 2007 roughly 16% and refer this numbers over and over into the eye a chess threw up the system have 45 hospitals, three and three house centers and i wish i could tell you that the federal

government has done a good job matisse three areas in terms of delivering of health care to the people at a service by canada cement and i don't think that anyone of us really can stand up and say yes absolutely. we have been great with the ia test system when the virginia system. i think the record of the federal government's management of health care delivery across the country has been very weak. i serve on the indian affairs committee and senator dorgan has done a great job that only in committee but on the floor time and time again speaking to the failures of the indian health system. there is a story that was published just a few days ago, there was a little girl from montana that went with her mom

to the indian health service clinic 11 times complaining of severe stomach pain. the clinic diagnosed this five year old with depression and that apparently she went worse and then had to medevac her to a children's hospital in denver. she was diagnosed in there with terminal cancer in the family had known all along that something must be wrong and she died a few weeks later. this story unfortunately is just the latest one that has come up in the press. i can still pete -- i can still see pictures that were put up on the floor of the individuals that have gone for services to the eye ages facilities and the stories have been tragic. there is a saying out there and

is repeated just about every time i have a hearing in indian affairs and about the system that they say don't get sick after june because after june the money and that goes to the clinics is gone so is full-scale rationing of health care and that is going on right now within our system. senator dorian and senator coburn as well have pledged that we have got to get more money to the system and that will help it and certainly it will and i pledge to work with them on that but i think we have got to recognize that within the indian health system we're not providing the level of care that we need interest to six among the native people infant mortality is 40% higher than it

is for caucasians and native people are twice as likely to die from diabetes and cystic% better chance of dying of stroke and is of the fess of live better and americans are living with other federally provided health care and lost our situation is a bit better and i think we've got a new story to tell the part of it is because we don't have a hiatus from clinics. we have nonprofit arms of the native corporations that are designed to, basically run their own programs in the have been innovative and used telemedicine -- telemedicine, they have this creative -- they have worked to build symbols and the medical home model that is spoke about before to this committee and i have been able to do it because

there weren't restricted to the conference of the federal bureaucracy. they get the funding and they treat their program. it is really a nice contrast with what we have within the federal system as with his. is a versus what can happen when you allow for a level of flexibility within the system. as far as the virginia system knows, and it wasn't too many years back when we all read the resource coming out of walter reed was some of the conditions there. that also is a fact of federally provided health care of. the veterans administration provides health care to our retired military personnel through the mass of civil periderm run health care system. i have 153 medical centers in

seven her 55 community-based outpatient clinics. 232 cancelling centers and yet they still can effectively provide a minute routine medical service to all of its clients and in many cases have to rely on the private sector to fill in many of the services. fattah situation and i appreciate that alaska is different because of our geography and lack of providers but we still have situations in my state where for routine care you get to be shipped outside to seattle or other parts for a level of care that ought to be available within our system would and yet it is simply not there and it is not just alaska. and thing from any of several states throughout the country we have a tendency to see this and that medicare would. perhaps most specifically for a

state like alaska and other rural states and those areas where our elderly population resigns medicare by farm the most costly and largest and most rapidly growing the federal health-care programs is failing our seniors and disabled population every day when it comes to the primary-care so we know we've got a reform for medicare and ultimately bring down the costs of the medicare programs and that is said to be at the heart of what we do with this legislation. i think our success and failure is going to depend on reining in it the royal spending within the medicare program. in alaska we're in a situation now where our doctors are turning away on a daily basis medicare patients. there are being forced to pay

out a pocket for their medical whether other choices for those all together and this is not a situation that is acceptable. we made that promise to them, we told them that you pay into the system and you will receive benefits and yet that care is not there. in a bridge which is the state's largest city and of every 75 in general practice doctors only 13 are accepting medicare peer know these are statistics that just simply don't work and what happens is even with an increase reimbursement rate in our state we cannot get our providers to except new medicare patients with the increase in reimbursements that we're able to achieve last year when we were able to do with stem the flow a little bit by encouraging providers not to unload their

patients when they turn 65 because that is what was happening. it could've been with the same writer for 20 years and when his 65 the doctor would say have a birthday but i'm sorry i can no longer receiving is not taking medicare eligible individual. this is not acceptable. medicare is broken and unfortunately the problem seems to be getting worse. we know the situation with the insolvency by 2017 would. i think it is almost predictable that as we look to make reform work where dramatically expanding the scope of a program that is soon to be bankrupt. medicare programs without taking steps to fixer stabilize the underlying programs with him and this is making a bad situation even worse. i laid out the government programs of that doubt failing

in meeting the needs of the patients and in these programs were promised that we would take care of them whether a veteran or an american indian or alaskan native or an elderly or disabled. we promise that we would give them ill level of service. we ask them to sacrifice something in order for the federal derrin to ensure providing care will and we are not keeping that promise to them. mr. chairman, moi as we have gone through not only the various walk-throughs and we have had an but in the conversations today with people's opening statements were there have been so many questions that have been raised and i would encourage us as a move to this process that we take these questions seriously would because they are begging for answers. should the government require

all americans to purchase health insurance will face monetary federal tax penalty is looking at what is going on with our economy should we force employers to provide insurance for both part-time in and full-time employees? i ask the question the other day about seasonal workers and in my state nearly half of our workers are seasonal workers so what to do with them? what we may ultimately see possibly in this legislation and are we going to see employers that will lower their wages to pay for health-care benefits and instead bring on will people full time looking to bring on contract employees instead of just to avoid the burden of paying the health care costs, will a new insurance program modeled on medicare put more americans at risk of limiting access to their doctors like we have seen of north?

in light of the massive debt damages this reform going to cost? and can wait for the price tags? numbers have been mentioned that we've got to be really boring down into this. we are already facing a debt of 1.8 trillion for this year alone. when we look at as a family as to what we do with honor household budgets we don't buy a car, we don't buy a home also know the president is and whether or not we can afford it. the cbo estimates of this bill are at one trying to cover only one-third of the uninsured population. in his important that we make sure that the american taxpayers, the american people know what it is that they're going to be paying for. a few members of this committee publicly said they don't support tax health benefits so how do we pay for the legislation?

i want to make sure and that again we spend time working through these difficult issues of. i will tell you that i agree with the comment that was made by secretary of health and human services secretary sebelius. she made a statement and i share her commitment to comprehensive and carefully crafted legislation, those are her words, that reforms are health care system. we should all stand with the secretary on this -- we owe it to the american people to make sure that we carefully craft this legislation with and i will close my comments mr. chairman and i appreciate in gold as you've given me and all members of this committee. it's quite extraordinary that we take a full day for opening statements but i think it was important. with -- we do know the issues that we have before us at the

committee and we have before us as a congress when it comes to health care. are sufficient and broad enough that we cannot afford to have a model kind of hit and run policy coming mandate that has not been scrutinized or properly debated by all members of this committee. we owe to our constituents and the american people to try to get right. we need to be derivative, careful, thoughtful and i agree with the secretary -- secretary sebelius, we need to proceed with great care and make sure that we carefully craft will we have in front of us. i'm willing to work with you to do that, but i do think it will take time. thank you for your indulgence. >> thank you very much senator and your point about how the energy committee proceeded with is certainly our intention here. we want to deal with this area

by area, a title by title rather than just opening this up in a way that will be impossible given the magnitude of the issues to prepare properly for discussion and debate about those matters and you never knew which was the book next item up so we can confine ourselves with advance notice and i've asked with senator and state because obviously we did leave out the committee market may not all, i did not understand this and i have been on this committee for a long time but having this gavel the last couple of weeks that the rules of our committee, this committee are different than the finance rules committees. the rules of this committee in order to have a markup you must have a product down one week in advance of the markup, the finance committee has no such role. thick and syrupy markup and put something down and so i was trying to get moving so we have