i'm going to give whatever time i've told mike enzi as we laid out. obviously you can't amend language that doesn't exist so we have to have the language down in an adequate time for people to assess and it file necessary amendments. i thinker? macaoski made a good point that we already embraced but will proceed accordingly to deal with this section by section, title by title, so we have a chance to thoroughly explore the various ideas that have been offered. i pointed out that even earlier today i know the majority staff indicated to the minority, or at least members, that there's some 20, 22 amendments or so that we're willing to accept that have been suggested. and they're looking at that. in exchange we've asked for some amendments to be dropped because we think the amendments being offered cover a lot of that ground. ground. ssd& s exactly how irÅsu)@ @ @ báhn%@ @ e, proposal was made in 1948 for a national health care reform package. six long decades. as i said at the outset, every administration, without fail, over those 61 years, has tried to

what i thought i would do at the outset briefly before turning to senator inslee, mike enzi, is try to give you at least a layout of the plan for this week if we could come starting late today. i would like to be able to complete-- we have about five, six, seven amendments to complete as i am told. senator mikulski, how are you? i hope would be this afternoon that we could try to complete whatever-- where you want to sit. to try to complete the quality piece of the could this afternoon. we have it voted 5:30 annika could spend the next couple of hours and get through title to it would be great and start title iii tomorrow which is the prevention section and to work on that through tomorrow, and with the remaining sections dealing with the workforce, fraud and abuse of long-term care. every piece we are working on there are scored numbers for. we thought we would have cbo numbers back today. we don't yet have them john. i know you were interested in the subject matter but we hope to get them by early tomorrow. i am not going to go near the sections that we don't have scored but they wil

mike enzi has had a great relationship with senator kennedy. it is not only unacceptable the system exists as it does today, it is unsustainable, that we have to address this and get it right, and we're determined to do that. >> i thought the president was flexible except in one area, and that is get the job done. and we all want to get the job done. i believe that bipartisanship was spoken about a lot, and i would be unhappy if it hadn't been. i think the president wants to work in a bipartisan way. i expressed to the president that abipartisanship is it how senator baucus and i have done it for 10 years. we start with a blank sheet of paper and build a document. and that's the way we're doing it. bipartisanship is not a a democrat bill with five or six republicans going along with it. we're restructuring 17% of the gross national product. in anything we do in health care. that's something that's never been done by congress before in one piece of legislation. it should be done thoughtfully, it should be done on a con tens senseous basis, and b

i'm committed to it, i know mike enzi is. and we don't obviously agree on all these matters but you are always thoughtful, you know what you're talking about. you make a significant contribution and you've been with us virtually every day most of the time on these matters. and i want you to know i welcome that kind of participation as a newer member over the last several years. and judd greg and i have worked on countless issues over the years and i have great respect for him. i think virtually every one of you at one point or another we have worked on something together. i'm not going to rush anything on you. to try to get it done but i do want to keep working at it. if we could just hear on your amendment so we can move along. >> i will, but let me just express my concern. if we pass the wrong bill, if we're not thoughtful and think about all the contingencies we're going to do, we neert going to help health care, we're going to hurt it. the presumption on this bill is we're going to spend according to president obama $1.3

i believe in it because i know mike enzi and he is determined to be part of a solution and virtually every one of you, i have worked with every one of the on the issues and when it comes down to it we have a common determination to get this right. i know my colleagues on the democratic side very well are deeply committed to these issues and we are going to stick with this and the only way to do it is not walk away. i mentioned to the other day about having my office saying from edward r. murrow because it is true of everything else, he once said the ones is that history will never forgive you for is a problem was too hard and. this is hard, but history will not forgive us because we thought it was too hard. it is hard, it wouldn't be if it weren't, but our job is to move for the. >> mr. chairman, i take him at his word and in this bill we drastically change erisa to note where many of the successes and safer is that my talked about aren't going to be able to do what they did. and now like to work with you personally to make sure that is the successes of people out there providing hea

committee responsibilities that every member of the committee has, i am particularly thankful to mike enzi who has been tremendously patient and worked through virtually every session and worked through this and my colleagues as well. just to mention a couple of housekeeping matters, with the amendments agreed to in title five of the bill, and we have not touched on title one, and obviously, we have to come back to do that, but we have accepted my count about 85 of the amendments from are the republican side by unanimous consent. they are either consented or amended or passed be avote here and another 17 amendments worked out in the long-term care section. let me mention about the long-term care, because again, it is my hope to deal with that section and i promised my colleagues i would not bring up a section that i don't have scored. while the cbo scores it for us, and scores it with real savings and at least up to the proposal so far to now, the score is numbers from cbo and joint tax. the numbers we got from cbo, we could not get to joint tax in time last evening and they have not score

i want to thank chairman kennedy and ranking member mike enzi for their work on the nominations. i recognize mr. enzi. >> i have comments and it's been cleared on our side. >> all those in favor of the nominee say ayes. the nominees are confirmed by the committee and we report it accordingly. let me go back to senator murkowski until the amendments have been cleared. >> thank you, mr. chairman. i want to just say to the committee we had a good day yesterday. we accepted 17 amendments, and very few from their side, but as the other side of the aisle offered suggestions and we can either accept them because they did approve the bill. senator enzi, comparative effectiveness were very constructive and we voted on two of them. i believe we can finish quality today or certainly finish quality on monday. let me get to what we could accept overnight. i have four amendments that we can accept. number one, we can accept murkowski number 9 which adds physician assistant to providers who may be part of a community health team. we can accept 9 which makes an excellent ak mendment and hatch 21

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 d

couple of weeks, three weeks, to get it done but because harry reid and dick durbin and my friend mike enzi have stayed with us and insisted we go through a normal process which was right to do in our committee, good staff people who worked hard on this, we will get this done today. it might just move along to the next issue but for the first time we're going do make a difference by requiring that the food and drug administration regulate the production, the sale and the marketing of these products much that is history. and i can't tell you how proud i am to be involved in it in the name of ted kennedy, in the name of others who is come before us, mike defin dewine of ohio who championed this along with henry waxman in the other body and the thousands of organization whose have joined us today. mr. durbin: i thank the senator from connecticut for his leadership on this issue. just a few week he had historic legislation on credit card reform. senator enzi, thank you for making this a true bipartisan effort. we wouldn't be here today without your cooperative effort and i thank senator dodd fo

it has been my relationship with mike enzi. so, i invite that kind of process in this mark-up and i thank all of you for your attacks on these issues and turn to senator enzi. >> thank you, mr. chairman. i appreciate the flexibility that you built into the program as we worked on it since you took over the reins less than two weeks ago. and i agree with about 80% of what you said, which is usually about where we agree on legislation, too. that 80% would make a huge difference for america. and that 80% would make a huge difference for america. there are some disagreements. i think those could be worked out. i don't think they can be worked out in this short a time frame as we're picturing all of this to happen. my republican colleagues and i have stood ready for months hoping to get a chance to help write a bill that would fundamentally reform the insurance market, that would offer new protections, to guarantee that consumers, all consumers could buy affordable high quality health insurance that includes people with pre-existing

sale, the production as well as in the market of tobacco products particularly to children, and mike enzi was there as well for the bill signing ceremony. in fact, it is in many ways stronger than the advocates of the bill because it goes further in many ways, and what we have done with this. again, a good example of that kind of work that can come together and i think the people like tom davis and mike dine, the republicans did a great job. i appreciate the fact, we have got to do something to help but. is not their fault and their economies going to suffer as a result of this and what we can do to help them. i don't know anyone who wants to see their kids take on health hazard and if we can do things to make a difference in that, that is going to really get to the prevention issue. so, it was the moment of some import and again i think the combination of incentivizing behavior for individuals to assume responsibility for their own health condition as well as the efforts that can be made in the larger context, to promote his efforts at thinker going to produce the results were looking fo

>> mike enzi, please. >> i appreciate the senator from new hampshire bringing this up. there's a part here that i think we're missing the point on. we're talking about access, access to a doctor, and i've got to just mention one brief story. we've got the town of wheatland and the town of douglas and they are 70 miles apart, and there used to be one ob-gyn that served them both until a couple years ago, when in the middle of a basketball game at halftime, he announced his retirement. and the reason he picked that @> no access. you can have a midwife or something deliver the baby but you couldn't have an ob-gyn. >> my point, i'm not debating at all about whether or not the premium costs are skyrocketing and it's having an effect on the number of ob-gyns or others. i've had a series of town hall meetings in my own state and had physicians bring up this matter and talk a lot, i can't remember the exact numbers but they're staggering numbers, the premium costs. i'm not disagreeing about the fact that this is having an impact. the question is why is it having an impact. to p

. >> this is a major issue and i want, i was just telling mike enzi, i have the district is. i know a lot of this around this table have tried to do this and i would ask tom about this as well and our resident physician. my understanding is that, we did not have any form to work off of. belvoir i used to help us to this represents a local hospital so he is not only familiar with the hospital procedures by been told hospitals, even with well-prepared documents and there's still a lot of reluctance about following these directives. if they are not here to fight. if there's any guesswork, any family member has questions, the general reaction is be fearful of litigation, that you stepped into early and didn't listen to other people so there is a reluctance. but i think what you are touching on is critically important. to the extent people can be advised about this, it being courage to do this is something i think we ought to promote. i get uneasy about a mandate here that requires it and particularly a simple sentence. i think the simple sun sounds good but you will find people w

mike enzi said, and will say again today and i agree totally, all of us here on this committee have dealt with major legislation in our lives. whether it is my work with orrin hatch on child care or working with other senators on the -- on the no child left behind act, the family medical leave act, i look at colleagues here, john, you work on immigration issues, others, major bills we have all worked on over the years that are huge and significant. but this bill affects everybody. 100% of our fellow citizens will be affected by what we do in the area of health care. every consumer, every business, every provider as well. and so this is truly historic, the journey that we're beginning this morning in this committee to deal with this issue. it may be that none of us will ever work on another issue as significant as the one that we're charged to respond to as members of this committee working obviously with members of the finance committee and significance and importance. and so we begin the markup of the affordable health care choices act. though he's not with us here in person, we make no

with that, let me turno senator enzi who may have opening comments, mike, and i know that senator gregg has some comments, right, judd? and with that we will go to senator harkin has the senate agreement for two amendments we have reached agreement on already. >> i will refer to senator gregg since he is ranking member on the budget committee looks at these scores for us, and would give us comments on where we are to date, and where we are going. >> good. >> well -- i appreciate the chairman's decision not to go forward the class act because we don't have joint tax and of course we don't have jurisdiction over the tax section, but it is important to put in con text the cbo's score in context, because what the class act is creating is a brand new entitlement and brand new major entitlement for long-term health care and yes over the first ten years, it is logical to score positively, because premiums will come in and people who are able to take advantage of the long-term care coverage will not have moved into long term care facilities over the first ten years, the majority of them. so it

mike is on there. >> there it is. there it is. let me call up amendment number 94. >> hatch number 94? >> it's enzi'samendment with 94 with his permission. >> oh, senator enzi number 94. senator enzi. but it's with his permission. and only with his

senator enzi has an amendment or two and then -- are there other amendments pending on our side over here, on title 3? senator binghaman. let his staff know if -- >> we let him know. >> okay, great. mike? >> senator byrd, do you want to do byrd number 3 right now? >> mr. chairman, i call up byrd number 3. >> byrd number 3, please. >> and i don't know how many members we have pending. i know there may be -- we took about 50 this morning. whatever number we've dealt with here. my intention is this evening to continue to work on title 3 with the hopes of completing it this evening if we can. so i'll put my colleagues on notice. >> good. >> mr. chairman, you have successfully chased off the cavalry, so, mr. chairman, amendment number 3. the kennedy bill does not explicitly require the school-based health senators to follow state laws requiring notification of the reporting of child abuse, child molestation, sexual abuse, rape or incest. this amendment clearly states that the school-based health clinics shall follow any such state law and that any provider of services found to be in violation of such state law shall not be eligible to receive additional funding under this section. now some

enzi's staff has already done the work on prevention. they haven't had as much as they'd like. we're making real progress here. i want to thank all of my colleagues, particularly mike for being here with me. tom, you've been terrific and a real help and others. senator harkin, i thank him as well. we don't have to go into evening and finish up 40 minutes, half hour. >> we're going to finish this now? okay, good. tomorrow we'll begin on wo workforce. that will be the goal. >> want you to go ahead, mike. start talking about it. >> i've been informed that i'm number 80, that that is kind of included in the burr amendment. >> okay. adopted? so we can drop number 80? >> yes. >> number 80 is gone. 80 is withdrawn. is this enzi 80? >> yes. okay. so i'd offer enzi amendment 50. >> enzi amendment 50. i have 51. >> while that is being passed out, i would say that is to ensure that the secretary conducts workplace wellness evaluations in publicly funded programs before evaluating the privately-funded programs. i'm not sure why we are having cdc evaluate programs outside of the government when we haven't evaluated the ones in the government, so this would ensure that we would

but because mike enzi is such a gentleman, and he thought it would be the right thing to do, we went ahead in spite of the very difficult schedule that we have, and the schedule that especially senator dodd had, that all of the things that we were doing under the jurisdiction of the banking committee, senator kennedy was the one obligated to do this legislation, so we have done that. we jumped -- see wee have jumped through all of the hoops. i hope that no one will in voting cloture say that we have been unfair. it would be unfair to say that we have been unfair. madam president, i would ask that we now terminate morning business and have the bill reported. the presiding officer: morning business is closed. under the previous order the senate will consider h.r. 1256 which the the clerk will report. the clerk: h.r. 1256, an act it protect the public health by providing the food and drug administration with certain authority to regulate tobacco products and for other purposes. mr. reid: madam president? i send a cloture motion on the dodd substitute amendment to the desk. the presiding

i want to publicly thank mike enzi, and senator enzi and all members.it is a long day again today, but we covered a lot of ground. i appreciate tom harkin's efforts and the staff's efforts over the weekend to get to over 50 of those amendments. it certainly made today a lot easier and i think that the workplace issues, there is a lot of agreement in that area, anyway, but a few differences to work on, and we will try to finish up the fraud and abuse potentially tomorrow as well, and the long-term care, the two other remaining issues to try to get done. my goal is that i would love to get this done by tomorrow or thursday and then we will still have when we come back from the break, and i presume i will have these numbers and i'm not about to bring up language without numbers, so on the issues of the coverage, and including the pay gea go, we will have to have numbers. we have worked hard for this for two weeks and making progress. i am grateful to the members and particularly to staff. the staff has worked hard on this over weekendts and nights and when

my good friend, mike enzi, is not on the floor this minute, but he and i have had a good relationship on this bill, and we'd like to complete it if we could. it's been now almost a week and a half on the legislation, so it shouldn't take much more to get to final passage on the legislation. i make that offer to my colleagues that they can sit down and see if we can't resolve some of those matters or at least allow for some time to be debated on those outstanding germane amendments that are pending. and with that, mr. president, i ask consent that we now go into morning business. the presiding officer: is there objection? seeing, hearing no -- mr. dodd: with the time not to exceed ten minutes each by members. the presiding officer: without objection. a senator: mr. president? the presiding officer: the senator from utah. mr. hatch: mr. president, i ask unanimous consent that the distinguished senator from missouri be given a couple of minutes to make his -- put his speech in the record, and that i be immediately given the floor. mr. wyden:b mr. president? reserve the right to object, a