senate. when tom daschle was up for confirmation as secretary of h.h.s., he said we should aim for 70 or 80 votes. 60 votes is the minimum, not 51. my colleagues are here to speak. i appreciate it for them to be here. we're trying to follow in the tradition we saw yesterday when former senate majority leaders, democrats and republicans, joined together to put forward a bill that covers every men and that is affordable. why don't i turn it over to mike castle from delaware. >> i agree with jim completely on the legality of the situation in the senate. i think they are going to need 60 votes. that means it is going to have to be a bipartisan piece of legislation. but that is exactly what the american people want. you often hear that disease does not choose whether you're a republican or a democrat and i think the solution to this does not choose either. we need to work together hard

on getting this done. i see many good ideas. there are good ideas in what is introduced in the senate and what is being discussed in the house. the republicans have introduced principles, moderates have introduced principles. these are all concepts that i think can be put into legislation. more than any other thing we're working on, we need to work on this and one of the central themes needs to be cost containment. we have a huge issue with cost containment. we need to make sure people are well and kept well and we need to make absolutely certain we come up with a solution in which we can all wrap our arneds around it and say this is good for the future of the country. i look forward to working with my colleagues and everybody in the house and senate and white house to get this done. >> let me introduce a physician from huntsville, alabama, parker griffith. >> thank you. this does require a bipartisan

effort. every year that goes by without a health care reform bill, without access for every american, we lose 18,000 american lives needlessly. this requires a bipartisan effort. a partisan bill will not get through the legislative process. we either work together, we recognize that we've got strong polarization on many issues, but this should not be one of them. the access to affordable health care is something that we are all agreeing on. we're all agreeing on the diagnosis. we're not agreeing on the treatment. but we have to come together in order to do that. and i think that we will. i think the effort of this group and we have many more downstairs that are in agreement with us, that despite our party differences, this is a must for american business and it is a must for the health care of america. so i appreciate the opportunity

to voice that. i don't think that we can retreat back into our r and our d homes. i think we need to get out front, get it on the table, work together and get this done. thank you. >> the next speaker is joe ann emerson from new jersey. >> i eck-open the commence of my colleagues. let me also mention the cost issue. we've got to balance costs with access. there are a lot of cost containment ideas that we have had individually and collectively. that's got to be part of the process because we've all seen how expensive the senate bills are and they will only get more expensive as they keep adding parts to it. so we believe that we all need to be involved in this discussion and it shouldn't just -- what we come up with shouldn't just be written by those people who sit on committees but rather you should pull the expertise of all of us together. so cost, access, there's got to

be balance. thank you. >> unfortunately, we only have two minutes and 40 seconds left before we have to be downstairs voting. so that's the remaining time of this press conference. >> are there particular things that you as a group are concerned about and think are bogging down the process? >> we're really not here today to discuss the particular bill or even provisions. we're here to discuss the target we should be aiming at, which is bipartisan, which is at least 60 votes in the senate and hopefully a bipartisan majority in the house. the senate alfonso committee has delayed consideration until after the fourth of july reese. we hope all the committees will focus in a bipartisan fashion. >> broadly, the republicans have said no way on public options. >> i would like to point out that we don't really know what a public option looks like.

nobody has explained -- there are probably 18 different types of public options that you could look at. not all republicans are saying that. what i'm saying is you have to look at what the option is is and how you define it and that's not an endorsement of a public option. it's just that we don't have any specifics on anything. so how do you make a comment on it? medicare is a public option. that's what we're doing today. but so is some of the ideas that jim and i came up with and mike in the healthy americans act. >> could some of you in both parties be open to some of the ideas for compromise that are being floated on the nature side, lying co-ops or finding an alternative to taxing employee benefit plans? >> the key of this press conference is bipartisanship. we're not here to slow down the process. we're here to hit the right target. so many press stories have just assumed that reconciliation applies. but it applies to a category of

bills that the senate is completely unlikely to ever past and would not be called health reform. effectively, reconciliation does not apply. you have to aim for a target of at least 60 votes. you have to focus on getting bipartisan support early on in the debate. >> are you happy with the efforts of the democrats to work -- >> we need to work on outreach every day. unfortunately, there are 15 seconds left. thank you for being here. >> thank you. >> also today, the senate health education labor and pensions committee continued work on a comprehensive health care bill. following the previous day's opening statements, committee members began consideration of several amendments to the bill. senator chris dodd is the acting chairman of this hour

and 40 minute mark-up session. >> the meeting will come to order. we have a aquarium present and i thank i my colleagues for being here this morning and let me say yesterday was a long day of opening statements but i think worthwhile. given the importance of the legislation and the magnitude of it, i recommended a five-minute rule. obviously i wasn't ridged, to put it mildly, about that at all. men's i hope felt they had an adequate time to express themselves on the overriding issues and concerns for what we're confronting with all of this. so i think them and was happy to spend the the time. we probably ought to give a special award to jeff bingaman since he was the the only member of the committee that did not make an opening statement yesterday. he was running back and forth between both committees as they were working as well. by unanimous consent, your statement as long as you want

it to be will be included in the record. today again we're back on the agenda for the affordable health choices act. i announced yesterday the way we're going to proceed with the mark-up and that is title 2, the quality section, which our colleague, senator mikulski, has spent a tremendous amount of time since january, held hearings. they had tremendous witnesses. they talked about the paradigm shift of going from a quantity -based system to a quality-based system, a value-based system, as a way of not only improving the quality of health care but also contributing significantly to the cost issue, which is an overriding issue for all of us on these matters. what i'd like to do today and tomorrow for the half day or so of work tomorrow is to continue to invite the staffs to work on the various amendments that have been already submitted not only in this section but others. i gather there's some room and i'll let senator mikulski

address the issue herself. but i gather there is some room and possibility of agreement on some of these ideas that haven't arrived yet but nonetheless, we're getting closer to it. on the issues involving long-term services and support, fraud and abuse, i really encourage our staffs and members to be working to see if we can't achieve some understanding in those areas as well as we move forward. we'll reconvene again on monday on this issue. assuming we're complete, we'll work on the quality section as well as the prevention areas. we'll move into these other matters. in the meantime, i mentioned we might have an opportunity to meet with our former leaders that have produced a paper themselves, senator daschle, senator dole, senator baker and senator mitchell. we might set up a breakfast meeting for members to meet

with them to have a discussion about their various ideas, which could be helpful. that may be in the middle of next week some time. obviously i'll chat with mike about that in terms of timing. let me turn to senator mikulski and thank her for the job they have done in developing these ideas in quality prevention coverage as well as workforce issues. i'm going to ask the senator to lead the debate on this and we recognize her. >> thank you very much, senator dodd. good morning to all my colleagues. this morning we're taking up title 2, the quality section, and after that i believe senator dodd wants to proceed on prevention. these two titles go hand in hand and even interface with each other. much of the conversation we've had over the last several days has been related to the cost of

health care and there is no doubt that it is skyrocketing. we see, as do all public health policy experts, that the issues are quality and prevention could, in the long term, actually reduce the cost of health care while it increases health. in my area we focused on those issues, five big issues that were readily agreed upon by all as drivers, the reduction of administrative errors, the administrative simplification, preventing hospital readmission within 30 days, and also better management of chronic disease as well as creating a quality infrastructure that would be appropriate in data collection. we've moved in those

directions. i'm going to offer some amendments now. but before i do, between now and when we gather, i would really say to my colleagues, i would recommend to them reading the the report that was issued by former colleague and former leaders bob dole, tom daschle, howard baker, george mitchell until he became special envoy, called really crossing the divide, i believe. and many of our recommendations you'll see follows their outline promoting high quality and high value. i'll refer to that later on in the debate. but i think everybody would really like to read how we could get to solutions on a bipartisan basis and there is a fairly agreed upon consensus in the area of quality. but let me move on now to the hard work of the day. the first thing i'd like to do is offer two technical

amendments and i seek unanimous consent to adopt the mikulski technical amendment and the dodd technical amendment. my understanding, it's been reviewed by the staff. these incorporate technical -- limited technical clarifications to title 1, they don't affect substantive policy. they are like editing typos. there is noticeable clarification, includes includes corrections to the definitions of a patient-centered medical home. it includes senator dodd's clarification regarding evidence informed information rarned evidence behaved information. as i understand, senator dodd, that comes from the national academy of pediatrics? >> that's correct. >> we also included senator hatch's clarify amendment to include chiropractors as part of the community health teams, which is more than agreeable to

us. it adds the standard of i.o.m. to define what is primary care and it provides authorization for such sums as may be necessary to carry out this title. so that's a brief description of the amendment. and i ask unanimous consent that both mikulski and dodd be accepted? >> is there objection? >> by unanimous consent they're agreed to. >> so those amendments are agreed to? >> yes, they are. >> now, i understand that the first amendment, senator jack reed -- >> let me apologize. we need 12 members to adopt amendments. we need eight for discussion. we have to wait until a couple more show up to actually vote on those. >> so lay the votes aside? >> yes. >> we can't do a unanimous consent unless we have eight here? >> we need 12.

>> i got it. i've been to those kind of meetings. perhaps we could proceed to the discussion on senator reed's? >> sure. thank you. i would offer an amendment to section 218. this is on behalf of myself and senator ensign. i want to thank senatorencey and their staff. i also ask that senator hatch sh added as a co-sponor. >> without objection. >> this is an amendment that goes to the drug facts box which has been shown by researchers to give consumers significantly better information, are more understandable information. recently f.d.a.'s risk advisory committee unanimously recommended that the f.d.a. adopt standards in this regard. the the essential change is that it would apply to

promotional labeling and print advertising. so it would not, as i understand it, beyond the bottle itself, but it would be the promotional advertising, the magazines, circulars, etc. this has been, again, agreed to with the ranking member. we do not intend, actually, to displace the decision of the f.d.a. essentially telling them to study this for a year. if they propose it, they have a year to promulgate the rule. i think this is entirely consistent with a reasonable approach to adopting this drug box. >> i thank the senator for working on this and i don't think that the current presentation of drug labeling is helpful. it is highly technical designed more for trial lawyers than for patients. i think senator reed is really

on to something with the study and the report he proposed and i'm pleased we've been able to work out this bipartisan solution and been able to reach agreement on the provision. so i co-sponsored the amendment. no senator hatch has co-sponsored it as well. i want to thank them for working on this issue and coming up with a solution. >> any further comment on this amendment? again, we're missing the necessary votes, so we'll have to lay this amendment aside until the requisite number of members show up. senator mikulski, do you have any additional amendments that you want to propose at this point? >> there were amendments to be sucked by senator gregg on improving data collection, which i know we would also -- to be suggested by senator greg on improving data collection. >> there are two amendments

we've worked out and i would like to move to an amendment which isn't worked out. >> well, wait. those amendments -- you had a gregg amendment 9 related to shared decision-making and you had gregg amendment 10 related to data collection. >> those are both agreed to, as i understand it. >> i would agree. then when we get a aquarium, we could do a unanimous consent. >> we'll just accept those when we get a aquarium. i would offer gregg amendment 35. >> do we have that out? >> as soon as one more member shows up, we'll consider these amendments that have already been discussed. >> what page is -- >> which title is this? >> it goes to title 2, generally, title 3 and title 4, generally.

it's the g.a.o. review of the activities of those titles. >> if i can -- we now have -- is that right? do we have 10 or 12 here? we only have 10. i'm sorry. we still have to go forward. i apologize. we're still missing people. >> i can talk about it if you don't mind. >> go ahead. >> mr. chairman, as we all know, in the -- >> the house is coming back in. members approved a spending bill earlier today for the commerce and egypt and the house is coming back in now to file a rule on a spending bill for the legislative branch. statement that the emergency declared in section 13159 of june 25, 2000, that the risk of knew rear proliferation due to the large

amount of fiss isle material is to continue beyond 2009. it remains a national security goal that fiss isle material removed from russia's nuclear weapons pursuant to various arms controls is dedicated to peaceful uses, subject to transparency measures. the accumulation of large volume of weapons, usable fiss isle material in the ter -- fiss ill material in the territory of the russian federation is against the foreign poll san francisco othe united states. i have determined it is necessary to continue the national emergency declared with respect to the risk of nuclear proliferation created by the accumulation of a large volume of weapon he was usable fissile material and maintain

in force these authorities to remain, signed barack obama, the white house, june 18, 2009. the speaker pro tempore: sent to the committeed on ordered printed. the clerk: leaves of absence for ms. ve laz quezz for today and the balance of the week, mrs. schmidt of ohio for today until 1:50 p.m. the speaker pro tempore: without objection, the requests are granted. the gentleman from new york. mr. arcuri: i move that the house do now adjourn. the speaker pro tempore: those in favor say aye. those opposed, no. the ayes have it. the motion is agreed to. accordingly, the hou

>> we're going to go back now to the health committee, the senate health committee mark-up. they've been marking up this bill for a time to last through the end of next week. >> the meeting will come to order. we have a aquarium present and

i thank my colleagues for being here this morning. yesterday was a long day of openings statements. but i think worthwhile. given the magnitude of the legislation, the importance of it. i recommended a five-minute rule. obviously i wasn't ridged, to put it mildly, about that at all. members i hope felt they had an adequate time to express themselves on the overriding issues and concerns for what we're confronted with all of this. so i thank them and was happy to spend the time. we probably ought to give a special award to jeff bingaman since he was the the only member of the committee who did not make an opening statement but was involved in both economies as well as running back and forth between both committees as they were working as well. senator, by unanimous consent, your statement, as long as you want it to be, will be included in the record along the way. today, again, we're back on the agenda for the affordable health choices act.

i announced yesterday the way we're going to proceed with the mark-up and that is title 2, the quality section, which our colleague, senator mikulski, has spent a tremendous amount of time. she's held hearings since january on the matter. they had tremendous witnesses. they talked about the paradigm shift of going from a quantity-based system to a value-based system as a way not only of improving the quality of health care but also contributing significantly to the cost issue, which is an overriding issue for all of us on these matters. what i'd like to do today and tomorrow for the half day or so of work tomorrow is to continue to invite the staffs to work on the various amendments that have been already submitted and not only in this section but others. i gather there's some room and i'll let senator mikulski address the issue herself. but i gather there is some room and possibility of agreement on some of these ideas that haven't arrived yet but

nonetheless we're getting close to it. obviously on prevention, on the workforce issues, on the issues involving long-term services and support, the fraud and abuse title, i really encourage our staffs and members to be working to see if we can't achieve some understanding in those areas as well as we move forward. we'll reconvene again on monday on this issue of the mark-up, assuming we're complete work on the quality section as well as on the prevention areas. we'll move into these others matters as we move along. in the meantime, i mentioned senator enzi, we might have an opportunity to meet with our former leaders that have produced a paper themselves, senator daschle, senator dole, senator baker and senator mitchell. we might set up a breakfast meeting for members to meet and have a discussion with them about their various ideas, which could be helpful. do that maybe in the middle of

next week sometime. obviously chat with mike enzi about that in terms of timing. but let me turn to senator mikulski and thank her immensely for the job she and her colleagues have done in developing these ideas in quality prevention coverage as well as workforce issues. i'm going to ask senator mikulski to lead the debate on this and we recognize her. >> thank you very much, senator dodd. and good morning to all of my colleagues. this morning we're taking up title 2, the quality section. after that i believe senator dodd wants to proceed on prevention. these two titles go hand in hand and even interface with each other. much of the conversation we've had over the last several days has been related to the cost of health care. there is no doubt that it is skyrocketing.

we see, as do all public health policy experts, that the issues of quality and prevention could, in the long term, actually reduce the cost of health care while it increases health outcomes. in my area, we focused on those issues, five big issues that will -- that were readyly agreed upon by all as drivers where there needed to be improvement in quality. the reduction of administrative errors, the administrative simplification, preventing hospital readmission within 30 days, and also better management of chronic disease as well as creating a quality infrastructure that would be appropriate in data collection. and we moved in those directions. i'm going to offer some amendments now. but before i do, between now and when we gather, i would

really say to my colleagues, i would recommend to them reading the report that was issued by former colleagues and former leaders bob dole, tom daschle, howard baker, george mitchell, until he became special envoy, called really crossing the divide, i believe. and many of their recommendations you'll see follows their outline promoting high quality and high value. i'll refer to that later on in the debate. but i think everybody would really like to read how we could get to solutions on a bipartisan basis. there is a fairly agreed-upon consensus in the area of quality. but let me move on now to the hard work of the day. the first thing i'd like to do is offer two technical amendments and i seek unanimous consent to adopt the mikulski technical amendment and the

dodd technical amendment. my understanding, it's been reviewed by the enzi staff. they incorporate limited technical clarifications to title 1. they're minor changes. they don't affect substantive policy. they're like typing, editing typos. there's note able clarification which is includes corrections to the definitions of a patient-centered medical home. it includes senator dodd's clarification regarding evidence-informed information rather than evidence-behaved information. i understand that comes from the national academy of pediatrics? >> theash. >> we also included senator hatch's clarify amendment to include chiropractors as part of the community health teams, which is more than agreeable to us. it adds the standard of i.o.m. to define what is