U.S. Senate Floor
March 24, 2010

Senator Mikulski gave the following speech on the Senate floor to urge her colleagues to support a reconciliation bill to adjust the health care reform legislation already signed into law by the President.

"Mr. President, this is indeed a great day because we're passing real health care reform for American families, for American workers, for American small business, for seniors, and our communities. Health care reform will save lives. No longer will dreams and lives be endangered because people lost their health care insurance when they either got sick, lost a job, or had an accident.

"Now, Mr. President, I listened to the other side, the side that says they listen to the people. Well, you know, you've heard the old saying, 'men are from Mars, women are from Venus'? I think that party is from mars and we're from planet earth. I think they've been out in our orbit. The planet Earth that I'm on tells me to pass health insurance.

"One of the reasons I'm voting for this bill is is the story of the lives that I heard from my constituents in Maryland. Round-tables, town halls, hearings, lots of letters, phone calls, e-mails. They told me about the situation in their lives where they were terrified that one big health care incident could lead them into bankruptcy. They were terrified that if they changed to a job in one of our new high-tech communities, a job that could have offered great opportunity for them, they would lose their health insurance. So they didn't take it.

"When I listened to people, I think about the lady in Cumberland who works full-time, but her employer doesn't provide health insurance and she's terrified that she's one sickness away from a catastrophic situation. Or from Karen in Kensington, whose father had to quit work because he had Crohn's Disease. When he was making payment on his insurance, he was two pennies short and they canceled his insurance, and it took him six months to try to get it back. He lost his coverage and he was only 59 years old when he passed away.

"And then there were the breast cancer survivors, the wonderful women and the men that they loved who are out there racing for the cure. But even in a prosperous community like Annapolis, a woman told me how she lost her job and with it, her family's health insurance, and when her insurance ran out, she was terrified if she would lose her cancer treatment.

"Walking around the diners – and I love diners, I see myself as a diner Democrat –  it's usually multigenerational people I hear from. And what do they tell me? 'Barb, don't forget the old people.' 'Senator Barb, no matter what, keep Medicare stable.' If you're 50 years old, you're terrified that your parents could lose their Medicare and it's going to fall on you. Medicare has multigenerational implications. This is why in this bill I'm so proud of the fact that we're going to stabilize Medicare for another ten years and do very important reforms in Medicare.

"I'm also very pleased to respond to the people who said 'no matter what, make health care available and affordable.' For every parent who's ever worried about covering a child with a chronic illness, whether it's autism or cerebral palsy or juvenile diabetes, they will always be able to get health insurance. For the small business owner, like my own father who once had a grocery store, or my grandmother, who had the best bakery shop in town, worried about how they were going to provide health care for themselves. Well, this generation won't have to worry about that.

"I think this bill is really an exceptional one. We save and strengthen Medicare, expand the solvency for nearly another decade, we end the punitive practices of insurance companies, we expand universal access, and we pay for it with an emphasis on wellness and quality, saying goodbye to quantity medicine and emphasizing quality medicine. Goodbye to volume medicine and hello to getting value for our dollar. For our seniors, one of the most important things we'll do is close that doughnut hole. The doughnut hole has been hard to swallow ever since this bill was passed, and we're going to provide a $250 rebate to seniors who hit the gap in the prescription drug benefit and also offer a better discount on prescription drugs.

"But where I'm also very excited and honored is because the role that I played in making sure that we ended the punitive practices of insurance companies towards women. For too long, in too many ways, they treated simply being a woman as a preexisting condition. They charged us 30 percent to 40 percent more just simply to be able to get insurance. Then they would have the punitive practices of denying us health insurance for a preexisting condition. In eight states, domestic violence was viewed as a preexisting condition. You talk about being abused, you were abused by your husband, then you were abused by your insurance company. Well, we're not going to be battered any more by these companies. We've ended that in this bill.

"And then there was the hearing that shocked and chilled me; a hearing on gender discrimination in insurance. A woman told a compelling story -- Peggy from Colorado -- that after she had had a C-section and a premature baby, the costs were high and the lost her health insurance. When she went to apply, they told her that because she had a premature baby, because she had a C-section, in order to get health insurance she had to be sterilized. I couldn't believe it. That's what fascist countries do. That's what authoritarian regimes would be. It wasn't the Taliban in Afghanistan. It was an insurance company in Colorado. Well, we took that fight and we ended those abusive practices in this bill. Never again will a woman be able to be denied health insurance because of any preexisting condition. We end the gender discrimination in charging women more.

"But then, as the debate went forward, they wanted to take our mammograms away from us and they didn't want to put mammogram and preventive services for women in the bill. They said it cost too much money. Well, I didn't want to hear that, and I asked the women to suit up and come to the floor and we offered an amendment. The good men of the Senate also joined us. Many remember we wore pink that day, and today we're in pink as well. We offered our amendment to ensure preventive services for women so that if your doctor says you need a mammogram, you're going to get one. If you need screening for cervical cancer or a pap smear, you're going to get one and you're not going to have to pay a co-pay or a deductible.

"But we, like the old song 'bread and roses,' we fight not only for women but also we fight for men, too, because it is for us, it's not about gender, it is about the agenda. And the biggest agenda is to make sure we provide health care to as many Americans we can in the most affordable way, with value, quality and prevention as our underpinnings. So we were able to make significant changes in this bill. But affordability is an issue, and I believe that we did that by emphasizing quality.

"At Senator Kennedy's request, I led the quality task force. This bill makes people healthier. We want to prevent disease and manage chronic disease. By the emphasis on the management of chronic disease, we're going to save lives and save money.

"First of all, we're getting more value for the dollar. Yes, we will be looking at comparative effectiveness. So when you go for a treatment or you buy a drug, you know that we're getting value for the dollar. The other is that we're going to emphasize reduction of medical errors and also medical infections in hospitals by introducing quality initiatives that reward hospitals for being able to do that.

"But you know I also listen to the providers. I represent iconic institutions like the Johns Hopkins Medical Institution and the University of Maryland. And I listened to my primary care physicians as well, and they said, 'Senator Barb, please, reduce the hassle factor, too much paperwork and not enough time to be with patients, too many contradictory rules from insurance companies and not a clear enough path on how to help people. We made sure that we're going to save money by reducing the hassle factor, by simplifying administrative costs by emphasizing medical health technology.

"We're going to promote the medicine through this comparative effectiveness research and we're going to follow the recommendations of the Finance Committee, which encouraged of medical homes in order to be able to manage chronic disease. These are the many reforms that are in this bill and I'm very, very proud of them. "And I'm also, as the daughter of a small business, I'm really excited about how we're going to be able to help small businesses be able to provide health care to their employees. The fact that we're going to offer tax breaks for small businesses and be able to have health exchanges that they can buy those health care bills at a better cost are, indeed, important.

"So, again, the other party might be Mars, but I'm glad that my feet were planted in planet Earth. By listening to the people that I represent, by listening to their concerns, and then listening to the excellent ideas that came from both the people themselves and, I must say, the people who are the providers that could help us lead the way.

"Mr. President, I'm going to vote for this bill, and I know there's much to reform it in the years ahead. But this is more than a beginning. This is a leap into the future. And it's a leap that we can take with confidence that when this bill passes with reconciliation, we will have done a major historic advance for the American people. Our job is about creating opportunity, an opportunity to have health care is one of the greatest opportunities we can provide."