Congressional Record United States Th of America PROCEEDINGS and DEBATES of the 108 CONGRESS, FIRST SESSION

E PL UR UM IB N U U S Congressional Record United States th of America PROCEEDINGS AND DEBATES OF THE 108 CONGRESS, FIRST SESSION

Vol. 149 WASHINGTON, SUNDAY, NOVEMBER 23, 2003 No. 172 House of Representatives The House was not in session today. Its next meeting will be held on Tuesday, November 25, 2003, at 12 noon. Senate SUNDAY, NOVEMBER 23, 2003

The Senate met at 1 p.m. and was trust the fact that You know us better faithfulness inspire us. Lead us beside called to order by the President pro then we know ourselves and desire for peaceful streams and renew our tempore [Mr. STEVENS]. us abundant living. strength. Give us strength sufficient for this PRAYER day and blessing that will enable us to Guide our Senators. And Lord, give The Chaplain, Dr. Barry C. Black, of- transform hurting lives. As we rely them a faith that works by love and fered the following prayer: upon Your wisdom, guide our steps and keep them strong and steadfast in their O God, too near to be found and too bring us safely to our desired destina- efforts to do Your will. We pray this in good to make a mistake, help us to tion. Keep us from trouble and let Your Your wonderful Name. Amen.

NOTICE If the 108th Congress, 1st Session, adjourns sine die on or before November 24, 2003, a final issue of the Congres- sional Record for the 108th Congress, 1st Session, will be published on Monday, December 15, 2003, in order to permit Members to revise and extend their remarks. All material for insertion must be signed by the Member and delivered to the respective offices of the Official Reporters of Debates (Room HT–60 or S–410A of the Capitol), Monday through Friday, between the hours of 10:00 a.m. and 3:00 p.m. through Friday, December 12, 2003. The final issue will be dated Monday, December 15, 2003, and will be delivered on Tuesday, December 16, 2003. None of the material printed in the final issue of the Congressional Record may contain subject matter, or relate to any event that occurred after the sine die date. Senators’ statements should also be submitted electronically, either on a disk to accompany the signed statement, or by e-mail to the Official Reporters of Debates at ‘‘[email protected]’’. Members of the House of Representatives’ statements may also be submitted electronically by e-mail, to accompany the signed statement, and formatted according to the instructions for the Extensions of Remarks template at http:// clerkhouse.house.gov/forms. The Official Reporters will transmit to GPO the template formatted electronic file only after receipt of, and authentication with, the hard copy, and signed manuscript. Deliver statements to the Official Reporters in Room HT–60 of the Capitol. Members of Congress desiring to purchase reprints of material submitted for inclusion in the Congressional Record may do so by contacting the Office of Congressional Publishing Services, at the Government Printing Office, on 512–0224, between the hours of 8:00 a.m. and 4:00 p.m. daily. By order of the Joint Committee on Printing. ROBERT W. NEY, Chairman.

∑ This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor.

S15591

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00001 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.000 S23PT1 S15592 CONGRESSIONAL RECORD — SENATE November 23, 2003 The PRESIDENT pro tempore. Is Mr. BUNNING. Mr. President, the list PLEDGE OF ALLEGIANCE there objection? that is published in the calendar only The Honorable TOM DASCHLE led the The Senator from Oregon. has Democratic Senators in it. Obvi- Pledge of Allegiance as follows: Mr. WYDEN. Mr. President, reserving ously, there is an alternative list that I pledge allegiance to the Flag of the the right to object, and I do not intend would allow for Republican Senators to United States of America, and to the Repub- to object, I just want to clarify one have a 30-minute block in between the lic for which it stands, one nation under God, matter. My understanding is, and it is Democratic Senators who speak. indivisible, with liberty and justice for all. printed in the calendar, that there is The PRESIDENT pro tempore. The f already an order of speakers that has Parliamentarian informs me the Sen- RECOGNITION OF THE MAJORITY been established. I want to make clear ator is correct, that a Republican Sen- LEADER that that will be recognized as we go ator will go after each Democratic forward today. I certainly will not ob- speaker if someone is here to be recog- The PRESIDENT pro tempore. The ject to the request of the distinguished nized. majority leader is recognized. minority leader. I just want to be clear Mr. FRIST. Let me also clarify that f that that will be the order of the on the Republican side we are not SCHEDULE speakers. locked into any order. The opponents The PRESIDENT pro tempore. Is to the bill are locked into an order of Mr. FRIST. Today, the Senate will there objection to the original request? speakers. Ours has been just an agree- resume debate on the Medicare pre- The Senator from Massachusetts. ment, so we are not locked into any scription drug conference report. We Mr. KENNEDY. Reserving the right order, but there will be a 30-minute had an extended and vigorous debate to object on the order, I was referred to limit, and we will be alternating back on this historic legislation yesterday. by my good friend, the majority leader, and forth. Again, it is unusual to have a Saturday last evening at about 6:15 in reference Mr. BUNNING. I thank the Chair. session and even more unusual to have to this legislation. The time-honored The PRESIDENT pro tempore. Is a Sunday session, but the historic level tradition of this body is to notify an there objection to the minority lead- which this debate has reached dem- individual when there is going to be er’s request? Without objection, it is so onstrates the importance of doing just reference made to them. I was not noti- ordered. that. fied, and I heard later last evening that Who seeks time? There are a number of Senators who I was referred to. I indicated that to f will be on the Senate floor to discuss the leader. I would like to be able to do this matter during today’s session, and this in a timely way. I was listed yes- RESERVATION OF LEADER TIME in an effort to accommodate the num- terday to be either third or fourth in The PRESIDENT pro tempore. Under ber of Senators who are seeking floor order, but I am not prepared right the previous order, the leadership time time today, we would encourage Mem- now—if there is some other previous is reserved. bers to limit their statements to no order that has been arranged, I want to f more than 30 minutes. We hope to work be able to reserve my rights that have out a schedule so that Members will been respected in this institution for MEDICARE PRESCRIPTION DRUG, have a better understanding of at what 220 years, and that is when a Senator is IMPROVEMENT, AND MOD- point in the day or the evening they referred to in terms of legislation, a ERNIZATION ACT OF 2003—CON- will be able to speak. If we can lock in fair opportunity is given for them to FERENCE REPORT 30 minutes per Member, or possibly respond. The PRESIDENT pro tempore. Under work out alternating hours, which we The PRESIDENT pro tempore. Is the previous order, the Senate will re- will do, hopefully, in a few minutes, we there objection to the original request? sume consideration of the conference will then have an orderly way to move The Senator from Nevada. report to accompany H.R. 1, which the forward so that everybody will have an Mr. REID. Mr. President, I hope that clerk will report. opportunity to address this important Senators would not ask to extend be- The legislative clerk read as follows: issue. yond half an hour because it is so dif- Conference report to accompany H.R. 1, an Yesterday, it became apparent that ficult to object. We have a lot of peo- act to amend Title XVIII of the Social Secu- we would not be able to lock in a time ple. We have 17 on this side. Multiply rity Act to provide for a voluntary prescrip- certain for an up-or-down vote on this that by half an hour and one gets the tion drug benefit under the Medicare Pro- important legislation, and at least one figures. I hope everyone will stick by gram and to strengthen and improve the Democratic Member said that a fili- the half hour that will be entered into, Medicare Program, and for other purposes. buster would be the road to pursue. hopefully, momentarily. The PRESIDING OFFICER. The mi- Thus, I filed a cloture motion on the I say to my friend from Massachu- nority leader is first on the list. conference report. That vote on the setts, the way the order is now set on Mr. DASCHLE. Mr. President, I will motion to invoke cloture is expected to our side, the majority leader would certainly not exceed 30 minutes. I hope occur sometime around 12:30 on Mon- speak first. I would speak second. I I can speak using less time because we day. All Senators will be notified when would be happy to change places with are getting a little bit of a late start. that vote is set. the Senator from Massachusetts so he Let me begin by saying what an im- f can go second, and I will go sixth or portant debate this is. This is a debate seventh. the consequences of which will last for RECOGNITION OF THE MINORITY Mr. KENNEDY. The Senator from generations. This debate in many re- LEADER Nevada, as always, is more than kind spects will be every bit as important as The PRESIDENT pro tempore. The and generous. I appreciate that very the debate on Medicare in 1965. One minority leader is recognized. much. I have no objection. really has to go back to that year, 1965, Mr. DASCHLE. Mr. President, I share The PRESIDENT pro tempore. Is to fully appreciate what we are debat- the view expressed by the majority there objection to changing the order ing now. leader about the need for us to accom- as the Senator from Nevada requested? There was a debate, of course, in that modate as many Senators as possible. Without objection, it is so ordered. The period of our history, in the mid-1960s, It is my understanding that there is no Senator from Massachusetts will take about whether it was possible for us to objection to actually locking in a 30- the place of the Senator from Nevada, address what was a national embar- minute time limit. Senators are free, and the Senator from Nevada will have rassment at the time. About half of all of course, to ask unanimous consent to the place in the order of the Senator senior citizens in the early 1960s had no extend if they wish. So at this time I from Massachusetts. health insurance—none. They were left propound that request. Is there objection to the minority out. There were horror stories about I ask unanimous consent that Sen- leader’s time limit of 30 minutes per what they had to do in order to accom- ators be limited to no more than 30 speaker? modate the health problems they were minutes during the debate today. The Senator from Kentucky. facing. It was a painful chapter. In

VerDate jul 14 2003 00:58 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00002 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.001 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15593 some cases, because seniors had no care wither on the vine, now in the without question, I think most seniors health insurance, they were not living name of Medicare are arguing we need are very concerned about what is going as long, the quality of their lives could to reform it, we need to improve it? We to happen to the costs of their drugs. not have been worse, and they were the are not improving it with this bill. We The answer, with all of the specific poorest of the poor. They often had no are not reforming it with this bill. analysis done to date about the impact income other than Social Security, and Does Medicare need to be changed? Of of this bill, the best analysis we can Social Security took them nowhere in course. And providing a meaningful provide so far, is that up to 25 percent regard to paying for the costs of health prescription drug benefit is probably of all beneficiaries are actually going care. the single best reform we could enact, to pay more, not less, for the drugs Thanks to President Kennedy and because medicine itself has changed. they buy with the passage of this bill— then-President Johnson, the rec- But to those who say we want Medicare 25 percent. It could be more than that. ommendation was made that we pro- to look more like the private sector, I Many Medicaid beneficiaries are vide a national health insurance plan say you don’t speak for me with that going to pay more than what they are for seniors. Republicans, at that time, assertion. paying right now. argued that it was not the role of Gov- Medicare has had about a 4 percent And there are many in the private ernment, that it ought to be the pri- administrative cost over 40 years; 96 sector who are going to pay more. You vate sector that provides health insur- percent of the money that goes into are going to see several million Medi- ance. Democrats argued, in response, Medicare goes to benefits. Do you know care beneficiarie who now have private that given the group of people we were how that compares with the private coverage actually lose that coverage as talking about, providing health insur- sector? I am told the average adminis- a result of the passage of this bill. The ance for senior citizens in the private trative cost in the private sector for in- estimate is now about 2.7 million sen- sector had about as much profit in it as surance plans is not 4 percent. It is not ior citizens will lose their retiree cov- providing insurance for a haircut. You even 10 percent. I am told the adminis- erage when this legislation is enacted are dealing with the sickest, most el- trative cost for a private sector plan into law. derly in our population. So there is not today on the average is about 15 per- There are a number of other concerns much of a profit incentive for insurers; cent—almost four times the adminis- we have with regard to this particular there is not an incentive in terms of trative costs of Medicare. bill, including the coercion of seniors the demographics and all of the actu- So if you want to see the Medicare into HMOs and increasing their Medi- arial circumstances. The private sector plan become more like a private plan, care premiums with the so-called pre- has virtually been loath to insure sen- then count on spending almost four mium support concept. Within 7 years, iors because of that. It is like insuring times more for administrative costs. many seniors are going to be forced a haircut. There is an inevitability, if At most, 85 percent of premiums go to into a pilot project in at least six loca- you are a senior, to that moment in benefits in private sector plans. tions. In those locations at least, and one’s life when illness becomes a seri- How ironic that we find our col- maybe others, we are going to see not ous threat. And obviously, that is when leagues saying: We want to make Medi- only increases in Medicare premiums, the circumstances involving the end of care more like the private sector; we but also seniors coerced into HMOs. life become all the more real. want more competition. These are cases where seniors have Medicare stepped in. Now, over the We don’t mind competition. But the never even thought about an HMO last 40 years, it has been one of the kind of competition they want doesn’t until now. most successful programs in all of make a lot of sense to me. Why would In addition, millions of seniors are American history. Forty years of suc- we provide, instead of 96 percent of the going to go without drug coverage dur- cess, 40 years of providing health care benefits to the beneficiary, only 85 per- ing part of the year. I will talk more with a consistency and a confidence we cent, and call that progress? about that later. have never had in all of our time in To make Medicare more ‘‘competi- We also are going to keep drug prices this country. tive,’’ our colleagues want to give more high as a result of this legislation. My mother has benefits from Medi- than $14 billion of incentives to the pri- There is very little this legislation care. My mother benefits from Social vate sector to get them to insure a does to reduce the cost of drugs at all, Security. I can only imagine what it haircut. Their notion is that somehow as I said just a moment ago. would be like today if she did not have we can find a way to make the private And finally, we squander $6 billion Medicare and Social Security upon sector more interested in providing needed for retiree coverage on tax shel- which to depend. meaningful health care to seniors, ters for the wealthy and the healthy. So Republicans, over the last 40 when Medicare is doing it so well al- For all of these reasons—the cost to years, have tried to find ways to go ready. beneficiaries, the coercion of seniors back to that debate of 1965 and say: We There are a lot of very grave con- into HMOs, millions of seniors who are still believe in the private sector. We cerns we have about this legislation. I going to go part of the year without ought to be able to find a way to pro- brought some charts to the floor to any coverage at all, the fact that drug vide insurance for a haircut and talk about some of these concerns. I prices don’t come down but they go up, incentivize the private sector. want to address them, if I can, in the and that we squander $6 billion on tax I will never forget the extraordinary time I have allotted to me. shelters for the wealthy in the name of statement made by the Speaker of the I think one of the biggest concerns I Medicare—it makes a mockery of the House, I believe it was in 1994. He ad- have is that seniors today are very con- whole word ‘‘reform.’’ dressed that very issue all over again cerned about prices. They are con- I said earlier that up to 25 percent of when he said: It is still our hope and cerned that their drug prices go up all beneficiaries will see more costs for still our design to see Medicare wither each and every year. drugs. There are two categories in par- on the vine. I will never forget talking to a ticular. Studies have shown that 2.7 For 40 years they have attempted to woman in Sioux Falls whose name is million retirees, including about 5,000 bring about an end, if not to Medicare Florence. She told me that, at 73 years South Dakotans, will actually lose the itself, certainly to the concept of uni- old, she must work and she must use coverage they have with the private versal coverage through Medicare for the supplemental pay she gets from her sector when this legislation is enacted. all senior citizens. job—at 73—simply to pay for the drugs And that 2.7 million number, I think, is That is really the backdrop that she needs. Her drug bill is about $400 a actually going to be higher. For those today we must recognize as we begin month. It goes up 10 to 15 percent every millions of Americans and those thou- the debate on this bill. How is it that year. sands of South Dakotans, that would those very colleagues who 40 years ago She drives to Canada once every 3 be the biggest blow of all. They have argued that we really should not have months in order to save $100 a month. confidence now that they can go to the a Government program for universal She figures every 3 months she saves pharmacy, and they can buy their coverage for health care, who just 10 enough to actually buy the drugs for a drugs. They do not have to worry about years ago said we ought to see Medi- month with that trip to Canada. So, whether or not they are covered. They

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00003 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.004 S23PT1 S15594 CONGRESSIONAL RECORD — SENATE November 23, 2003 had better start worrying because the ficiaries with $400 per month in drug wrong. This, if nothing else, ought to problems kick in just as soon as this spending. be a reason we should send this legisla- legislation is enacted, if it is. By the way, the benefit doesn’t kick tion back to the conference to figure Up to 6.4 million low-income bene- in until 2006. So there are premiums out a better way of doing it. ficiaries are going to pay more or lose that kick in, and the benefit lasts for a The bottom line is, when it comes to access to drugs they are now provided. period of time, during the months of the coverage gap, seniors are going to I think the 25 percent number may be February, March, April, and May. They have to pay $4,000 to be eligible for a conservative figure. benefit in June somewhat. But for the $5,000 worth of benefits. Can you imag- When you take the number of retir- entire rest of the year they are on their ine that in the name of reform? ees adversely affected, when you take own. First of all, we are coercing seniors the number of low-income beneficiaries This convoluted benefit structure is into an HMO. We are telling retirees who may be worse off under this plan, scary, as I think of my own mother, they may lose their own health bene- you begin to appreciate the magnitude and I think of all of those who are fits. Two to three million people are of the problem this bill is going to cre- going to try to figure it out: How in the going to lose benefits, and the benefit ate for millions of senior citizens today world do I know how much I owe? How they are going have instead is a $5,000 who are totally unaware of its negative much can I count on? How much of coverage gap and paying $58 a month in implications. these benefits are really going to apply 2013. That, perhaps more than anything The legislation creates a dilemma. to me? else, is disconcerting. As I talk to sen- The choice seniors will face is higher This period of no benefits is called a iors, the concern they have the most is, premiums on one side or an HMO on coverage gap. Some people call it a of course, the high cost of drugs. the other. How is that reform? How donut hole. Whatever you want to call First of all, our conferees wasted no does that possibly relate to this widely it, it is a mistake. time in eliminating the reimportation stated goal we all have that we simply Think of the myriad of administra- of United States-made drugs from Can- want to provide a meaningful drug ben- tive costs involved for every single sen- ada. They will point to language in the efit to senior citizens? This bill isn’t a ior citizen who is going to have to try bill, but the bottom line is we will not drug reform plan, this is a Trojan horse to decide: Are they in the 25 percent see any change in the current law with for the collapse of Medicare. category, the 100 percent category, or regard to reimportation of drugs from We are going to see the loss of Medi- are they in the 95 percent category? Canada. There is virtually a prohibi- care as we know it today if this legisla- By the way, if you are a senior cit- tion on drugs from Canada. South Da- tion passes. I think this chart describes izen with a lower income, you are enti- kotans, North Dakotans, Montanans, it pretty well. tled to a different schedule. First, they Minnesotans, Michigan residents have If you want to see increased pre- have to know what their income is. counted on Canadian relief. That has miums, support this bill. If you want to They are going to have to turn over been a big part of what has been their see seniors forced into an HMO, sup- their tax records to determine what strategy in coping with the high cost of port this legislation. It leaves a ques- drugs today. That is going to be gone. tion mark for a senior citizen right kind of income they have and whether now: What do I do? How do I respond? they are eligible or not. Once those tax They will not be able to reimport un- How can I prepare myself for what is records are determined, they then are less they go to Canada themselves. They also have a prohibition—and about to come? presented with these different tables What is about to come regarding that they are going to have to try to this is amazing to me as one of the drug coverage is described on this cal- figure out. Imagine a 90-year-old things Medicare has been able to show endar. This calendar says more than woman trying to figure out when she is it can leverage better prices; because any speech probably can. This calendar goes to the pharmacy what the cov- of the power of pooling, we can lever- describes in essence the drug benefit erage gap is: Do I pay the premium? Do age, whether it is hospital prices, doc- structure. Of all the concerns I have, I have to pay 100 percent? If I do, how tor prices, prescription drug prices— the benefit structure is one of the most do I pay for it? Am I breaking a law if and there is actually a prohibition for troubling to me. I want to describe it, I expect the pharmacy manager to give Medicare in the negotiation of lower but then I want to use this calendar to me the full benefit? How do I figure drug prices on behalf of senior citizens. talk about its implementation. this out? Drug companies can do it, pharmacy A senior will start paying $35 a This convoluted, confusing, extraor- benefit managers can do it, but there is month. We will come back to that fig- dinarily complex schedule is a disaster. a prohibition on the Federal Govern- ure in just a minute. A senior pays that I will make a prediction. I will pre- ment involving itself in negotiating on $35 a month 12 months out of the dict that within 12 months, we are behalf of senior citizens for lower drug year—January through December. going to be back fixing this so-called prices today. I have never heard of such Then the senior must pay 100 percent coverage gap. It is chasm, it is not a a thing. If we cannot bring about a bet- of all the benefits up to the deductible. gap. It is a confusion chasm. It is a dis- ter price, if we cannot leverage drug That is depicted in red. Then the first aster. That, if nothing else, ought to prices more effectively through Medi- dollar of protection under this plan for warrant reconsideration of this legisla- care, who in the world can do it more drug coverage would kick in, following tion. effectively than the Government itself the $250 deductible. Beneficiaries pay But as I say, the coverage gap widens and Medicare specifically? all of the $250. The drug coverage kicks over time. It is not just now. The pre- The reason prices are going to rein from $250 in spending up to $2,250. mium, as I said, starts at $35. In 2013, main high is, No. 1, there is going to be The Government pays 75 percent of the the premium goes up to $58. The very little competition from those benefit. After the benefit has been deductibles start at $250. But guess sources where competition is already paid—75 percent Government, 25 per- what? In 2013, the actual deductible is shown to be very effective; No. 2, Medi- cent senior, up to $2,250—the Govern- going to be almost $500. The coverage care itself, the Government through ment says: Wait a minute. We paid all gap then goes from $2,850 in 2006 all the Medicare, is actually prohibited from we can pay. You are on your own from way up to $5,066 by 2013. negotiating better prices on behalf of $2,250 up to $5,100. You are going to pay In other words, senior citizens are seniors. That is an amazing provision all the costs during that period. going to have to pay $5,000 even though of law that is inexplicable. After the beneficiary pays $35 a they are paying $35, or in this case $58, It goes on. I said earlier one of the month, 100 percent up to $250, and 25 a month for the benefit. Can you imag- concerns I have is this provision that percent up to $2,250, they have to pay ine a senior citizen coughing up these allows $6 billion to be squandered for the entire cost up to $5,100, even kinds of dollars in just a few short those who are healthy, and in many though they are still paying a pre- years? cases wealthy today, money that could mium, and then they have a 95 percent It is absolutely the most reprehen- actually go for retiree coverage. It cre- benefit that kicks in after that. sible expectation for senior citizens. ates a new health savings account Basically, what this calendar depicts They can no more afford $5,000 in 2013 which is nothing more, of course, than is the drug schedule for 2006 for bene- than they can afford it today. It is a tax shelter for those who are wealthy

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00004 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.024 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15595 and will draw off people who are Recognize the damage you are going to are not eligible for Medicaid and have healthy. Ordinary Americans cannot do—not just to Medicare; recognize the no prescription drug benefits now will afford it and it undermines the em- damage you will do to the confidence have them under this bill. This was im- ployer-based coverage we already have. and the security of senior citizens. portant to me. It is one of the Six billion dollars is a tremendous pool Now more than 200 organizations strengths of the bill. of resources that could have gone to have said they oppose this legislation Analysis shows that this bill will in- making this program far more cost ef- and they want the Senate to oppose it crease the percentage of Medicare fective and far more accessible for a lot as well. beneficiaries with prescription drug of seniors. This legislation would have been coverage from 79 percent to approxi- Instead, even though we did not have killed in the House had they abided by mately 95 percent. it in the Senate bill, even though we the rules. One of the most flagrant To begin with, this bill, as I said, ex- had bipartisan support for this $6 bil- demonstrations of abuse of the institu- pands the drug coverage to the 351,000 lion going to those who need it the tion and rules I have seen: They took Californians who are not eligible for most, in keeping with the trend, in almost over 3 hours the other day to Medicaid. The reason it does that is be- keeping with the philosophy of many bring about the desired vote on the cause it has a much more relaxed as- on the other side, creating this tax House floor in spite of the opposition of sets test. So where the assets tests shelter for the wealthy was a ‘‘must all these organizations. were so stringent for Medicaid, they pass’’ piece of legislation. You have all these organizations on are more relaxed here; and, therefore, The bottom line is we lost $6 billion one side. This picture depicts pretty those 351,000 people who found them- over the next 10 years that could have well what is happening on the other. A selves without Medicaid coverage will gone a long way to reducing the cost of meeting was called on November 13 to now have coverage under this bill. drugs to everyone else. talk about the benefits of this plan, to Secondly, the bill provides a 16-per- How is it that with all these warts, convince seniors that somehow they cent increase in Medicaid dispropor- with all these problems, with all these are going to be better off. And all these tionate-share hospital payments in fis- deficiencies, with all these concerns, empty chairs pretty well depict exactly cal year 2004. This has always been im- this legislation could be before the what happened. Seniors know what is portant to me. Every year we have had Senate today? This chart shows it pret- going on. They were not going to be to fight for it because these are the ty well. part of a sham discussion. No one payments that go to our county hos- The Pharmaceutical Manufacturers showed up. pitals. In California, the county hos- Association had their agenda as well. I No one ought to vote for this either. pitals receive most of the people who must say, they got virtually every sin- This legislation does not deserve our have no coverage who are bereft and gle thing they wanted. support. We can do better. This started who are extraordinarily low income. They wanted an administered drug out as a debate about providing mean- California hospitals who qualified to benefit in the private sector that di- ingful help to seniors. It has turned receive Medicaid DSH money lost $184 luted the purchasing power of Medi- into a debate to save Medicare. million this year due to cuts enacted in care. They got it. We are going to do all we can to live the Balanced Budget Act in 1997. They wanted financial incentives for up to the specific talks, to live up to This bill restores $600 million to Cali- HMOs, another step away from Medi- the needs, the hopes and dreams of sen- fornia’s hospitals over the next 10 care. They got it. ior citizens today. We will do all we years. I must tell you, with about 25 They wanted a prohibition on Medi- can to defeat this bill when those votes hospitals that have closed in my State care negotiating prices, as I just de- are taken. in the last few years, this is a major scribed a minute ago. Guess what. It is I yield the floor. item for me. The DSH money in this there. The PRESIDING OFFICER. The Sen- bill will go a long way toward pro- They wanted a meaningless re- ator from California is recognized. tecting California’s fragile health care importation provision because they did Mrs. FEINSTEIN. Mr. President, I safety net, which is dependent on a not want the competition. Guess what. listened to the distinguished Demo- complex combination of local, State, That is in the bill as well. cratic leader and find that I agree with and Federal funding. They wanted a watered-down generic much of what he said. This may not be Thirdly, the bill improves payments access provision. Check that off the a perfect bill, but clearly there are for indirect medical education in fiscal list. positive and negative features to the year 2004 and beyond. Teaching hos- They wanted no public scrutiny and bill. pitals will receive a 6-percent increase secret kickback arrangement potential I worked a year ago, and through an in payments in the second half of fiscal within the contracts they have with individual’s help, was able to run the year 2004 and will have their payments the benefit managers and the insurers. numbers with respect to a prescription spelled out in future years so they can That is in there, too. drug plan and tried to make them come begin to plan ahead. Now, they do go They wanted a huge windfall profit. in within $400 billion and found it to be down in some years. So there will be They are going to make more money in extraordinarily difficult. In my view, advanced knowledge of that so hos- the next 10 years than virtually any the most positive feature of this bill is pitals can begin to plan for that. other sector within our economy. No that it delivers voluntary prescription This is money that reimburses teach- wonder stock prices are soaring drug coverage to this Nation’s Medi- ing hospitals. My State has some of the today—because they also see the writ- care beneficiaries. I find the low-in- greatest teaching hospitals in the Na- ing on the wall. come benefits of this bill to be one of tion. This money would reimburse PhRMA had a checklist. PhRMA got its biggest strengths. It is better than those hospitals for costs associated their list checked, every single item on anything we ran that came in at $400 with educating our Nation’s next gen- the list. billion or below last year. eration of physicians. That is impor- The bottom line is, of course, Medi- These benefits affect about 1.4 mil- tant to me. I think it is essential fund- care beneficiaries lose, PhRMA wins, lion Californians who have limited saving, and it will allow our major hos- and the bill comes before the Senate ings and low incomes and who will pitals to continue training tomorrow’s with this realization. PhRMA got what qualify for prescription drug benefits caregivers. it wanted. But organizations that rep- under this bill. Some of these are low- Fourthly, the hospitals and physi- resent seniors, organizations that rep- income seniors who do not qualify for cians in California will benefit from resent working families, organizations Medicaid. Because of $3,000 in savings, this bill. Hospitals will see a full mar- that represent State governments and they are ineligible to receive prescrip- ket basket update for fiscal year 2004 city governments, organizations of all tion drug coverage through the Cali- and have the opportunity to receive a kinds—liberal, conservative, name it— fornia Medicaid Program. They will full market basket update for the 3 organizations of all kinds have come now have prescription drug coverage years that follow. With more than 58 forward to say: Please do not pass this which is much better than I had hoped. percent of California’s hospitals losing bill. Send it back to the drawing board. So 351,000 low-income Californians who money treating Medicare beneficiaries,

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00005 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.026 S23PT1 S15596 CONGRESSIONAL RECORD — SENATE November 23, 2003 and all hospitals facing Federal and will lose their retiree health coverage not, but I can promise my colleagues, I State unfunded mandates, the full mar- from approximately 431,420 in the Medi- intend to follow very closely the im- ket basket update is vital to my hos- care bill that passed the Senate, that a pact this bill will have on cancer care pitals as they struggle to meet staff- majority of us voted for, to approxi- up and down the State of California. ing, seismic, and privacy compliance mately 198,000 in this bill. These are My staff and I will be watching the requirements. California numbers, true. I cannot cancer care situation, and I am cer- I have heard overwhelming opposi- speak to other States. But what I am tainly prepared to introduce legislation from doctors in my State to the saying is, because of this bill, the num- tion making technical corrections to projected 4.5-percent payment cut that ber of retirees in California who would Medicare reimbursement for cancer physicians and other health care pro- lose their retirement benefits will drop care if the bill has the impact the on- viders would have faced in fiscal year from 431,420 to 198,000. cology community predicts it will. 2004. In other words, without this bill, Now, I wish the number were zero, It is my understanding that our lead- doctors in my State—and I do not but the point is, the bill makes it bet- ership will appoint an independent know about elsewhere—but doctors in ter, not worse. I think that is a good commission to be headed by my good my State were going to face a pro- thing. friend, former Senator Connie Mack. jected 4.5-percent payment cut. Now, I find it very difficult that this The commission will monitor the im- This bill prevents that payment cut bill does not restore access to Medicaid pact of this bill on cancer care from happening, and it includes an in- and SCHIP for legal immigrant chil- throughout the country and will report crease in payments for fiscal years 2004 dren and pregnant women at the and make policy recommendations to and 2005 of 1.5 percent each year. This State’s option. The Senator from Flor- Congress. means that doctors in my State will be ida, Mr. GRAHAM, authored legislation I am also concerned about the impact paid more for their services. It may not which I voted for which did do this. I this bill will have on 50,000 low-income sound like a lot, but we have doctors intend to introduce—and I hope with Californians who are living with HIV/ leaving California and going to other him—legislation to restore Medicaid AIDS. We have heard a lot from the States because they cannot meet the and SCHIP benefits to California’s HIV/AIDS community. My concern is high cost of living in the State of Cali- legal immigrant children and pregnant with their access to drug treatment fornia and practicing medicine. So women next year. therapy under the Medicare prescrip- even a small amount helps them stay I find it, frankly, troubling that this tion drug benefit. in business. bill actually provides $250 million per What happens in AIDS/HIV treat- In my State, approximately 33 per- year for 4 years to reimburse hospitals ment is that very often a cocktail of cent of all Medicare beneficiaries get for providing emergency care services drugs, three or four different drugs, their health care coverage from for undocumented immigrants, and proves to be the most beneficial. The Medicare+Choice. Now, California’s hospitals will receive ap- type of drugs varies with the indi- Medicare+Choice has not been a posi- proximately $72 million a year to reim- vidual, just as any drug would with any tive experience in every case. I think burse them for their care to undocu- of us. we all know this. This bill, though, mented immigrants, but we take away I have shared this belief, and the con- strengthens the Medicare+Choice Pro- the coverage for legal immigrants. cern is that the formularies would gram, renames it Medicare Advantage, I expressed my concern to Senator limit an individual to two drugs. I and it provides payment increases to BREAUX, to Senator BAUCUS, to Senator spoke at length with Health and HMOs. Some find that objectionable. I, FRIST about this issue. I was told the Human Services Secretary Tommy frankly, do not, because these in- House would not accept this language. Thompson Friday night about it and creased payments to HMOs and pre- I hope next year the Senate will once asked him to put in writing exactly ferred provider organizations should again pass a bill to restore these bene- what would happen. Directly following provide some premium stability fits. This is a big item in California, my remarks, I ask unanimous consent throughout the State. I intend to and I deeply believe people who come to print in the RECORD his Depart- watch and see if, in fact, it does hap- to this country legally should be enti- ment’s response to my concerns. pen. tled to these benefits. The PRESIDING OFFICER. Without Now, I have many concerns about My State spent $3.7 billion in 2002 in objection, it is so ordered. this bill. The Democratic leader point- uncompensated care, so the additional (See exhibit 1.) ed out some of them. This is certainly money that California gets for the care Mrs. FEINSTEIN. I will read just a not a perfect bill. I am not on the com- of illegal immigrants of $72 million a couple of key points made by the Sec- mittee. I did not write the bill. I strug- year at least will go some distance in retary in response. Let me quote the gled to have a little bit of input into covering that deficit. Secretary: the bill, probably much less than I In my role as vice chair of the Na- The Secretary may only approve a plan for would have liked. tional Dialogue on Cancer and cochair participation in the Part D program if the I am deeply concerned about the of the Senate Cancer Coalition, I have Secretary does not find that the design of number of Californians, though, who a very serious concern about this bill’s the plan and its benefits, including any for- Medicare reimbursement cuts for can- mulary and any tiered formulary structure, have lost their retiree health benefits will substantially discourage enrollment in as a result of rising health care costs. cer care, particularly oncology physi- the plan by certain classes of eligible Medi- This is happening right now without a cians. It is my strong view that every care beneficiaries. Thus, if a plan limits bill. It is projected that 10 to 12 percent suffering cancer patient should be able drugs for a group of patients (such as AIDS of retirees who have private health to have a so-called quarterback physi- patients), it would not be permitted to par- care plans are losing their benefits cian, an oncologist, someone who is ticipate in Part D. each year. That is happening without with them who can go through all of I also note that upon completion of this bill. The reality is—and I know the terrible choices and decisions that this bill, Senators GRASSLEY and BAU- people do not like to look at this—if we have to be made by a cancer patient CUS and I will enter a colloquy into the do not pass this bill, employers in my and stay with them through it all. RECORD to emphasize this point. State will continue to drop coverage I have talked to both Senators BAU- This bill says that if a plan doesn’t for their retirees at this estimated rate CUS and BREAUX and also to Senator carry or doesn’t treat a drug that is of 10 to 12 percent a year. Many of FRIST. They have all said this bill will needed by a person with AIDS as a pre- these employers who have chosen to re- leave the oncology community better ferred drug, a simple note from a doc- tain coverage for their retirees have re- off. I don’t see that, candidly. In look- tor explaining the medical need for quired their retirees to pay higher co- ing at this complicated Average Sales that particular drug would get that payments and premiums—not under Price versus Average Wholesale Price drug covered at the preferred price. It this bill but today. issue, I don’t see where they will be cannot take more than 72 hours for Through direct subsidies and tax pro- better off. I want the RECORD to reflect seniors to get a drug under this expe- visions, this bill actually reduces the that I have received those assurances. I dited appeals process. This is my un- number of seniors in California who don’t know whether they are true or derstanding based on conversations

VerDate jul 14 2003 04:05 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00006 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.006 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15597 with the Secretary. I am delighted this ical equipment, physical occupational section 1860D–4(b)(3)(C)(i). A formulary must understanding is now in the CONGRES- and speech therapy, clinical include at least two drugs in each thera- SIONAL RECORD so that we can all fol- diagnostics, lab services, home health peutic category or class unless the category or class only has one drug. low it. care, and outpatient mental health The Secretary will request the U.S. Phar- I want to say a word about something service. macopoeia, a nationally recognized clini- that is very controversial in the bill The premium is $3,196.80. The in- cally based independent organization, to de- that I happen to support and why I sup- come-relating provisions in this bill velop, in consultation with other interested port it. That is income relating the are very mild, much milder than what parties, a model guideline list of therapeutic Medicare Part B premium. Let me tell Senator NICKLES and I presented on the categories and classes. How categories and you why I support it. I have a great Senate floor. classes are designed is essential in deter- fear that as I watch entitlement spend- mining which drugs are included on a plan’s In this bill, beginning in 2007, individ- formulary. USP is clinically based and will ing grow, and I have watched that hap- uals with incomes of more than $80,000, be cognizant of the needs of patients. We ex- pen for a decade in the Senate, our or couples with incomes of more than pect they will design the categories and children and our grandchildren will not $160,000, will have, instead of 75 percent classes in a way that will meet the needs of have access to Social Security or Medi- of their Medicare Part B premium sub- patients. care. Let me tell you why I believe sidized, 65 percent of it will be sub- In designing formularies, plans must use this. sidized by the Federal Government. pharmacy and therapeutic committees that Since 1993, at my constituent break- consist of practicing physicians and phar- This goes up four tiers so that indi- macists who are independent and free of con- fasts we have been using charts to il- viduals with incomes of more than flict with respect to the plan, and that have lustrate outlays, meaning the money $200,000 a year, or a couple with an in- expertise in care of elderly and disabled. The the Federal Government spends every come of more than $400,000 a year, will committee has to use scientific evidence and year. I believe they are the truest way have just 20 percent of their Medicare a scientific basis for making its decisions re- to judge Federal spending. When I Part B premium subsidized by the Fed- lating to formularies. began this, in 1993, entitlement spend- Further, the Secretary may only approve a eral Government. Why should hard- plan for participation in the Part D program ing was $738 million. About 50 percent working taxpayers pay for a million- if the Secretary does not find that the design of the outlays in a given year were en- aire’s health care? That is my view. of the plan and its benefits, including any titlement spending. That was welfare, I don’t see income relating as bring- formulary and any tiered formulary struc- veterans benefits, Social Security, ing about the downfall of Medicare. I ture, will substantially discourage enroll- Medicare, et cetera. Interest on the see it as making the program more sol- ment in the plan by certain classes of eligi- debt was 13 percent. So 63 percent of vent. ble Medicare beneficiaries. If a plan complies the outlays in a given year could not with the USP guidelines it will be considered There is one significant missed op- to be in compliance with this requirement. be controlled by our budget. portunity in this bill that concerns me Thus, if a plan limited drugs for a group of This year, entitlement spending is deeply, and that is the whole area of patients (such as AIDS patients) it would not $1.174 billion. Entitlements have risen the cost of prescription drugs. I am be permitted to participate in Part D. to 54.4 percent, a 4.4 percent increase. particularly concerned about the Under the Bipartisan Agreement, the bene- Interest has dropped some, to 7.5 per- amount of money spent on prescription ficiary protections in the Medicare drug ben- cent. drug promotion by pharmaceutical efit are extremely comprehensive to ensure access to a wide range of drugs and are more Now, if we look at the projection— companies. Perhaps I have reached the and this is with the $400 billion pre- comprehensive than the protections now re- age where I remember when there was quired of state Medicaid programs. scription drug plan—if you look at en- no advertising of prescription drugs. For example, there are extensive informa- titlement spending in 2013, 10 years We were just as well off then as now, tion requirements in Part D so beneficiaries from now, you see that it is $2.048 bil- and without huge costs. will know what drugs the plan covers before lion. So in 10 years it has gone from Let me give you some examples. Pro- they enroll in the plan. $738 billion to $2.48 billion. That is the The plans must set up a process to respond motional spending by pharmaceutical to beneficiary questions on a timely basis. problem. Entitlements will be 58 per- manufacturers has more than doubled, Beneficiaries can also appeal to obtain cov- cent of the outlays, and interest on the from $9.2 billion in 1996 to $19.1 billion erage for a drug that is not on their plan’s debt, 11.6 percent. What does that in 2001. That is an annual increase of 16 formulary if the prescribing physician deter- mean? That means 70 percent of every- percent. mines that the formulary drug is not as ef- thing that is spent by the Federal Gov- Most troubling to me is the rapid fective for the individual or has adverse ef- ernment in fiscal year 2013 cannot be spending growth of direct-to-consumer fects. As a result, there should be access to all drugs in a category or class when needed. controlled. advertising of prescription drugs, The other two pieces, of course, are Because the Medicare drug benefit will be which has increased an average of 28 offered through private plans, plans will defense, projected at about 16.9 per- percent. have an incentive to offer multiple drugs in cent, and discretionary spending, drop- Bottom line, Mr. President: I intend a therapeutic class in order to attract Medi- ping from 20 percent this year down to to support this bill, and not because it care beneficiaries to join their plans. 13.6 percent. Discretionary spending is is perfect, but because I believe it Becuase of the optional nature of the Med- everything else we have to do. It is ev- icaid drug benefit today, states can drop brings substantial help to people who their coverage entirely. According to a re- erything in the Justice Department, need that help in my State of Cali- the Education Department, the Park cent Office of the Inspector General report, fornia. states have identified prescription drugs as Service. All the rest of the Federal I yield the floor. the top Medicaid cost driver (FY 2002, Med- Government in 10 years will be about 13 EXHIBIT 1 icaid prescription drug expenditures totaled percent of what is being spent. That is approximately $29 billion or 12% of the Med- ACCESS TO DRUGS FOR AIDS PATIENTS UNDER the enormity of the entitlement pic- icaid budget). From 1997 to 2001, Medicaid ex- THE BIPARTISAN AGREEMENT ture. penditures for prescription drugs grew at I know it is hard for people to look at Question: Will AIDS patients have access more than twice the rate of total Medicaid to all drugs within a therapeutic class under spending. this because those people who had the the Bipartisan Agreement? Can a PDP limit dream of Medicare decades ago looked Pressures on state budgets have led to the number of drugs that are covered within Medicaid coverage restrictions for drugs and at it as a program that everyone who a therapeutic class? Are dual eligibles in a the use of cost control measures that will paid in got out the same benefit. But Medicare drug plans losing coverage avail- not be used in the Part D program. what the income relating in this bill able to them in Medicaid? Eighteen states contain Medicaid drug talks about is just the Part B Medicare Answer. In the Bipartisan Agreement there costs by limiting the number of prescriptions premium, the cost of which today is are significant safeguards in the develop- filled in a specified time period, limiting the $3,196.80. That is the full cost of the ment of plan formularies that will ensure maximum daily dosage or limiting the fre- that a wide range of drugs will be available Medicare Part B premium in 2004. quency of dispensing a drug. Some states to Medicare beneficiaries. also limit the number of refills. Now, what is Part B? Part B is physi- Plans have the option to use formularies Six states have pharmacy lock-in pro- cian care, other medical services; it is but they are not required to do so. If a plan grams, which require beneficiaries to fill outpatient hospital care, ambulatory uses a formulary, it must include ‘‘drugs’’ in their prescriptions in one designated phar- surgical services, X-rays, durable med- each therapeutic category and class under macy.

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00007 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.008 S23PT1 S15598 CONGRESSIONAL RECORD — SENATE November 23, 2003 States already have the authority to limit back and faced challenging times. We country and whether some were delay- the number of drugs that may be provided in went from a 12 million, mostly man ing this legislation. Many of us have a therapeutic class, and nineteen states are military, down to an Army of just a been fighting for a prescription drug using preferred drug lists in their Medicaid couple of million, with massive unem- program for years. I will not take the programs. Thus, dual eligible beneficiaries will have the same access in Part D that ployment, and they helped to get the time today to discuss the time when it they have in Medicaid, with expanded bene- country back on a peaceful road. We was bottled up in the Republican Fi- ficiary protections and appeal rights. are talking about a generation that nance Committee, and how it only Concerns have been expressed that the faced down the Soviet Union and com- emerged on the Senate floor when we Medicare benefit will result in a loss of cov- munism, and they are now in their had Democratic leadership here just erage for dual eligibles. This is not the case golden years. over a year ago. It is not worth taking for low-income beneficiaries, the Bipartisan As the great philosophers point out up the time because I don’t have it. Agreement provides generous coverage. so well, civilization is measured by how But this is a Senator who fought for The Bipartisan Agreement preserves the universality of Medicare for all eligible bene- it treats its elderly people, whether the Medicare Program, who knows the ficiaries including those now dually eligible they will be able to live in the peace, history of the program, and knows how for both Medicare and Medicaid. Unlike Med- dignity, and security for their con- important the Medicare Program is. I icaid, the new Medicare Part D benefit will tribution to the country. I believe in am also mindful—with all respect to provide a guaranteed benefit to all eligible that. I believe in that very deeply. those on the other side and in the seniors—a benefit they can count on without We have to ask ourselves at the end House of Representatives—that they fear of loss of benefits when state budgets be- of the day whether this legislation be- got 12 votes in support of the Medicare. come tight. fore us, which is being rushed through Dual eligibles, who currently have full I know that they are untrustworthy of Medicaid benefits, will automatically be with effectively 2 or 3 days of debate, is the Medicare Program, that they have given generous subsidies and pay no pre- worthy of our senior citizens. I men- a disdain for the Medicare Program. mium, no deductible and minimal cost-shar- tioned the issue of time again because That is a very important difference. ing regardless of their actual income (which my good friend, the majority leader— They are obviously entitled to their can be higher than 135% of poverty based on and he is my good friend—made ref- view. states’ special income rules). erence to the fact that I believe that But what we have seen is the efforts In addition, full dual eligibles with in- this legislation needed more debate that were made on the floor of the Sen- comes under 100% of the Federal Poverty Level (FPL) will pay no premiums, no de- than a Saturday afternoon and ate earlier this year, where we had a ductible sand only nominal copayments of $1 evening. I watched the debate going on, truly bipartisan effort for a prescrip- for generic and other multiple source pre- and the chairman of the Finance Com- tion drug program. In 1964, Medicare ferred drugs and $3 for all other drugs. These mittee and the Senator from Alaska was defeated in the Senate. It was de- copayments will increase only at the rate of talked up until almost 10 o’clock last feated by 12 or 14 votes. Seven months inflation, the same rate as the Supplemental night, and now we are here on Sunday later, it passed by that number. The Security Income (SSI) payments on which afternoon. only intervening aspect was an elec- many low-income individuals rely. But I wonder whether it needs more tion. And the important aspect of that Dual eligible nursing home patients and other institutionalized persons who only than 2 days debate. I believe it does; I election is that the seniors understood have a small personal needs allowances will do believe so. I believe that particu- what the stakes were in that election. be exempt from copayments altogether. larly after we saw what happened in I am saying here on the floor of the The copayment levels in the Bipartisan the House of Representatives. Senate that the seniors are going to Agreement are similar to what dual eligibles This legislation makes an enormous understand, when they know what is in now pay in what is an optional Medicaid ben- difference to the well-being and the se- this bill, how much it risks their future efit in their states. In fact, because of the op- curity of seniors in this country. And and the future of the Medicare system, tional nature of the Medicaid drug benefit we saw the facade that took place in make no mistake about it. today, states can drop their coverage en- the House of Representatives where the Make no mistake about it, no matter tirely. Current regulations permit states to increase coinsurance to 5%, which is more vote was called at 2 or 3 o’clock in the the outcome of this bill in the Senate, than what will be permitted for dual eligi- morning, and the vote was kept open this issue is going to continue to be de- bles under the new Medicare benefit. beyond the traditional time of 15 to 20 bated as we go into 2004, the 2004 elec- The PRESIDING OFFICER. The Sen- minutes, for nearly 3 hours, in order to tion, 2006, 2008—all the way down the ator from Massachusetts is recognized. try to effectively coerce Members to line. This issue is not going to go away. Mr. KENNEDY. Mr. President, will support the proposal. I was here when the Senate passed the Chair please advise me when I have We are doing that on a measure that catastrophic coverage. I can remember 5 minutes remaining? is supposed to benefit our senior citi- the catastrophic Medicare changes The PRESIDING OFFICER. The zens, and a measure that passed the which allegedly were supposed to be so Chair will do so. House of Representatives by only one helpful to the seniors. There was a Mr. KENNEDY. Mr. President, during vote in a purely partisan proposal. flood of Senators who left this body yesterday and early today, we have had Then, it passed the House of Represent- and rushed down to the television and characterizations and descriptions of atives by less than a handful the sec- radio center to indicate how they sup- this legislation, which is enormously ond time, again, on a purely partisan ported it. And I remember how they all important. We are doing these debates proposal. It seems to me that if the crept back into this body just a couple on Saturday and Sunday, and it is an- House of Representatives had a full op- of months later to vote to rescind that ticipated that we will have a vote to- portunity to have an open discussion change because they got it wrong, be- morrow, Monday, on a bill that will and debate, and then have a reasonable cause they rushed it through the Sen- not go into effect until 2006, and other vote and call them as they see them, ate. And that is just what we are in provisions will take effect in 2010. I then this process would be worth sup- danger of doing with this bill. have right here next to me the bill, the porting. We ought to have the same The Medicare system is a tried and legislation, which was put on every- here in the Senate. But, on the one tested program. It is a beloved pro- one’s desk. I am still waiting for a hand, when we have a Republican lead- gram. The reason we have a Medicare Member to come here and indicate that ership, which is effectively jamming system is that the private insurance he or she has read it, and describe the this legislation through the House of companies failed our elderly people. details of it. Representatives, and then effectively They continued to fail them. Finally, We are dealing with a matter of enor- wants to use the closing off of debate in the late 1950s, we began to have a de- mous importance and consequences, as and discussion in order to effectively bate about a Medicare system, and we are dealing with issues of life and jam it through here, the Senate of the when we had the debate in the 1960 death for our seniors in this country— United States, we ought to take a mo- campaign and 1962 campaigns, we fi- the men and women who have brought ment or two to ask why. nally found we were able to pass Medi- this Nation out of the Great Depres- I note the references of my friend, care legislation in 1965. It took 5 years sion, the ones who fought in World War the majority leader, about who was to pass that program, and we want to II, the greatest generation. They came really representing the seniors of this risk that program in a 2-day debate in

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00008 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.002 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15599 the Senate when this is a lifeline to so There are three major provisions in going to let it go up 5 percent a year many of our seniors, when we are see- this proposal that will effectively un- this year. That is what they say this ing an effort to undermine the Medi- dermine the Medicare system. The first year. Next year in the Budget Com- care Program. I will get into that in is the premium support proposal. I mittee, or the year after, it won’t be 5 one moment. have listened day after day, week after percent. We will have to recalculate. It We had a chance to do something we week, month after month: We have to will be 10 percent or 15 percent, or let’s failed to do in 1965. We passed the give premium support a try. My answer have a free enterprise system and let it Medicare Program that dealt with hos- is: Why? Why? We know what it means sail off. That is what is going to hap- pitalization. We passed the Medicare even before trying it. Committed as pen. Program that dealt with physician they are on the other side of the aisle That is what has happened in the fees. But we did not pass a Medicare to start off with hundreds of thousands Metropolitan Statistical Areas (MSAs), Program that dealt with prescription or a few million and multiply that to and the list goes on: $1,700 in Los Ange- drugs. Only 3 percent of the private millions and millions of people, we un- les, $775 in Yolo, CA. Medicare actu- sector programs had prescription drugs derstand what the results are going to aries—every senior citizen ought to un- at that time. Can you imagine that we be before we even try the program. derstand that premium support is writ- would pass a Medicare Program today They said: Let’s try it; let’s understand ten in this legislation. One can say, without prescription drug coverage? what the outcome is going to be. well, it is written in such a way that Those prescription drugs are as impor- Currently, everyone in the United we are not going to face it for several tant as physician services and hos- States pays into the Medicare system. years. Several years? But it is still pitals today. No matter where you live, you get your there. The only way to repeal it is to We are on the verge of the life range of benefits. You get to pay the come back here to the Congress. science century. The breakthroughs we same premium and you get the same In Yamhill, OR, premiums would be are going to see in the next months and range of benefits all over this country. $1,325, but only $675 in Columbia, OR. It years are going to be breathtaking, and It is uniform. Not under premium sup- is double the amount if one lives in a our seniors ought to be entitled to port. You are going to pay in and you different part of the State. those programs. That is why a pre- are going to pay more. Even the admin- Why do we have to experiment with scription drug program is so necessary. istration has recognized that the min- premium support? We already know We passed a good program in a bipar- imum you are going to pay is 25 per- what the results are going to be. That tisan way, but that is not the proposal cent more. You are going to pay more. is a key element in this legislation. It that is before the Senate. The bill be- So that every elderly person who un- was not in the Senate bill. I did not fore us is not that proposal. The bill derstands premium support, this ad- hear our majority leader make much of that passed the House of Representa- ministration understands you are a case for it. To be honest about it, I do tives is not the proposal we passed. not hear the President of the United We have a major undermining of the going to pay more at the outset. States make much of a case for it. Medicare system. There are those who Secondly, you are never going to Nonetheless, when one is talking say: You are really overstating this, know what your premium is because it is going to depend on where you live. about the House of Representatives, Senator KENNEDY. Where in the world they understood what this was all are you getting this idea? These are not my figures, these are the I understand, as others do, that the figures of the Medicare actuary. Here it about. They committed to it, alright. position of the President of the United is: Under the premium support pro- Now one might say: Well, Senator, States earlier in March was that no gram—this is the Medicare actuary— what about the health delivery system? one who was in Medicare would be enti- the national average under current law We are going to have the health deliv- tled to a prescription drug program. I will be $1,205 by 2013. It is about $700 ery system delivered through the want our seniors to listen to that. In now. Their estimate is $1,205. A year HMOs. Let us have real competition. the spring of this year, this President and a half ago they estimated the pre- How many times have I heard this indicated he supported the program for mium support would be $1,771. The from our Republican friends over there: prescription drugs only when it was de- Medicare actuary estimated that every Let us have competition? We are glad livered by the HMOs. senior citizen would be paying $500 to have competition, but do not sug- He gave up that position. He said: Oh, more in premiums than they would be gest that this bill is competition. It is no, let’s try and see if we can figure paying under Medicare. not. I see the chairman of the Finance out something else that may be related This year they have gone down to Committee. He can correct me if I am to the Medicare system. That was his $1,501. They have gone down nation- wrong about any of these figures. position. That is the position of the wide as starters, and we have to learn We start off with every HMO getting majority of the people who are sup- something more. That is not good a 109 percent increase in the cost of liv- porting this program. Make no mistake enough. ing over Medicare. Is that competition? about it, that is their position. They The difference with premium support Competition? Come on. Beyond that, believe that is what ought to happen: is there is no security. It depends on CMS—the governmental agency that that we ought to dismantle the Medi- where you live. Do you understand administers the Medicare program— care system, undermine it, privatize it. that? Your premiums are going to be pays an additional 16 percent in excess That is what they want to do. based not on the national standard of Medicare’s own costs to private in- You say: Why in the world are you that we have at the present time but surance companies because seniors who saying that? How can you possibly say on where you live. join Medicare HMOs are healthier than that? Read the paper this past week. In my State of Massachusetts, under seniors in the traditional Medicare sys- The Washington Post, Friday, Novem- premium support, it will be $1,450 in tem. ber 21: Barnstable, MA, and $1,050 in Hamden, So, under this bill, Medicare is going Bid to Change Social Security is Back. MA; $400 more. The difference is 100 to pay a 25 percent advantage or bonus They are going to get Medicare first. miles. In Dade County, FL, it is $2,000 for every senior citizen that goes into Social Security is next. Here it is: and, in Osceola, FL, it is $1,000; $1,000 an HMO. Our Republican friends are President Bush’s aide reviving long shelved more. talking about competition, the free en- plan on Social Security. A Presidential ad- Explain that to some senior who terprise system. Is there a business viser said [Bush] is intent on being able to lived there all their life, has a house man or woman in this country who say that reworking Social Security ‘‘is part and is proud to live there, and they would not want a deal such as this? of my mandate.’’ find that their premiums are going to The tragic part is, who is paying for it? There it is, my friends, Social Secu- be $2,000 and their neighbors in another It is our seniors who are paying for it. rity is next; Medicare now. That is why part of Florida are paying $1,000. And you think Medicare is going to I think we ought to have some debate It is very interesting what my friends be able to hold on when they are effec- because, I daresay, I don’t believe the on the other side say: Senator KEN- tively getting a $1,936 overpayment per Members of this body understand what NEDY, you don’t understand what we senior? That is what they are getting is going to be done with the proposals. are going to do in this bill. We are only now. This is not competition with

VerDate jul 14 2003 00:58 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00009 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.012 S23PT1 S15600 CONGRESSIONAL RECORD — SENATE November 23, 2003 Medicare. This is a rip-off. This is a that to the 10 million seniors who need this conference report. We had a good scandal. This is a payout. And that is Celebrex to deal with arthritis, or the bill, but that is not the one that is be- what is happening now under our over- 12 million to deal with osteoporosis, or fore us. payment to the HMOs. the 11 million with treatments for dia- Finally, the third part of the inclu- As a matter of fact, you are over- betes, high cholesterol, thyroid defi- sions in this legislation, what they paying them almost the amount that ciency, and depression. These are mil- used to call Medical Savings Account, the average person does for the pre- lions of our fellow citizens who could now referred to as Health Savings Ac- scription drugs. You could almost benefit from that $12 billion. Oh, no. counts (HSAs), which have very high make a deal and say, do not even both- We have to give that as a supplement deductibles and low premiums. Who er with the prescription drug program. to the HMOs. takes advantage of those programs? The HMOs are almost paying the whole I have listened to those who say: The most healthy people take advan- amount. That is what the seniors pay, Well, at least our senior citizens are tage of those and the most wealthy $2,300. We are paying close to a $2,000 going to be better off. Let us just look people take advantage of those. overpayment. what is going to happen to our senior What is the problem with that? The On the one hand, you have the pre- citizens. We have the 2 to 3 million re- problem with that is that if you are the mium support that is going to under- tirees who are going to be dropped. working poor, working middle class, if mine it. Secondly, you have this pro- They are certainly not going to be bet- you have some children, you can’t af- gram on the overpayment of the HMOs. ter off. There are 6 million people ford to constantly pay the deductibles. Given the dramatic overpayment on worse off. Who are these 6 million? So what happens to your premiums? this, we can see what is going to hap- These are the Medicaid beneficiaries Two studies—one study by the Amer- pen with the HMOs. who, the day this bill goes into effect, ican Academy of Actuaries ‘‘Medical Look at what is going to happen with are going to be worse off. These are the Savings Accounts: Cost Implications the HMOs, according to the actuaries. people who are paying the $1 to $3 and Design Issues,’’ May 1995, and an- This year, there is $31 billion that went copays. The States are paying for it other by the Urban Institute, ‘‘Tax- through the HMOs in this country. The with the Medicaid. Know what? They Preferred Medical Savings Accounts best estimate, given the arrangement will not be paying anymore. Why? Be- and Catastrophic Health Insurance that has been made now, will be $181 cause this bill prohibits it. Plans: A Numerical Analysis of Win- billion going through the HMOs. You So one might ask whether they are ners and Losers,’’ April 1996)—indicate call this private competition? Competi- better off. We start right off with 9 mil- that premiums will rise at least 60 per- tion with Medicare? This is outrageous. lion beneficiaries who are going to be cent. That is not just talking about the Do my colleagues think we are having worse off. People say: Well, Senator, elderly people, that is across the coun- that debate here on the floor of the what about all of those low-income try. That is undermining the employer- Senate? Do my colleagues think we people we are all concerned about in based system. have time to change that 109 percent this program? I am going to come back We have enough problems in this down to 102 percent or 104 percent? Ab- to that. country with the uninsured. Now we solutely not. We do not have time to do Let’s take these 6 million people, have an additional proposal that is that. who are the poorest of the poor, who going to raise the cost of premiums for Do my colleagues think we have time are going to be worse off. Is that really working families in this country? That to change this with regard to the 16 going to make much difference, be- has been included. Was that in the Sen- percent advantage? Do my colleagues cause it is only a couple of bucks a ate bill? Absolutely not. But it has think we have any time to do that? Oh, week, $3 to $5 a week, maybe $20, $25 a been in the House. It has been a matter no, let’s stamp it. Let’s close the month? But when one is talking about of faith in the House. There you have books. Let’s say to those who would the average income for seniors at about it: Premium support, not a level play- like to have that kind of debate and $12,000, it adds up. There are studies to ing field, a new form of health insur- offer amendments, this is being de- show what happens to the poor when ance that is going to raise the pre- layed for our senior citizens. they do not pay the copays in terms of miums for workers. What in the world This is absolutely outrageous. We adverse health outcomes. does that have to do with the prescrip- know what is going on. These are the The PRESIDING OFFICER (Mr. AL- tion drug program? It has a lot to do payoffs to the HMOs. LARD). The Senator from Massachu- with ideology. That is what this bill is Beyond that, if that is not enough, setts has 5 minutes remaining. about, to undermine, to privatize Medi- listen to this: Not only do they have Mr. KENNEDY. Will the Chair tell care. After they do that, coming right the additional 25 percent, which is al- me when I have 1 minute remaining, behind it is the Social Security Pro- most $2,000, there is also a $12 billion please. gram, make no mistake about it. slush fund. What did the Senator from This is what happens to those poorest We can do better. We should do bet- Massachusetts say? A $12 billion slush of the poor when they do not have the ter. We ought to take the time to do fund. copays—serious adverse events effec- better. There are enough Republicans Well, what can they do with the $12 tively double. The emergency rooms ef- and Democrats alike in this body who billion? They can give it to the HMOs fectively double. These findings are have demonstrated over the period of as well. This is running-around money, demonstrated by research studies pub- the last year and a half that we can get walking-around money, $12 billion lished in JAMA. a good bill. There is no reason to be more. Who pays for that? The seniors Of course, the sad fact is it ends up stampeded with a bad bill. Why are we pay for that under the Medicare sys- costing hundreds of millions and bil- being stampeded with a bad bill? We tem. lions of dollars more to pay for in these ought to take our time, get a good bill, Do we have an opportunity to offer circumstances. It is bad health policy make a difference for our seniors, an amendment to strike that? Oh, no. and it is bad economics. make a difference for our country. Do my colleagues think we have an op- Finally, we had a good program that That is what I believe. portunity to go back to the Senate po- passed the Senate. We found our I hope we will have the opportunity sition that said let’s take half of that friends in the conference knocked out 3 to take the time so all of our Members and use it for good preventive kinds of million of the neediest elderly people understand it, and not just these Mem- medicine for our seniors, such case in this country. We provided for up to bers but so our seniors, whose lives are management programs? No, no. That 160 percent of poverty, they made it up going to be affected, who are suffering was what we passed in the Senate. Do to 150 percent of poverty. That is a mil- every single day and making choices my colleagues think we can go back? lion people. And they reimposed the between putting food on the table and No, no. We have to rush this proposal asset test for those under 150 percent of paying for their prescription drugs, so in. poverty. As a result of reimposing it, they understand it. Don’t we have In the meantime, we are telling our that is a total of 2.8 million who were enough respect for our seniors so we seniors all across this country that $12 included for help and assistance under can provide some opportunity for those billion is needed to help the HMOs. Tell the Senate bill who were wiped out in individuals to understand it? Or are we

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00010 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.014 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15601 going to be rushed into the situation in continuous debate on judicial nomi- tional fee-for-service Medicare, and it with short debates on Saturday and nations. On Friday, the Energy bill was provides incentives to companies to Sunday and then have the gauntlet blocked. Now it looks as though some continue offering medical benefits to come down. We saw what happened are going to try to kill this bill. I call their retirees. over in the House of Representatives. that obstructionism. Seniors will be able to receive pre- It took them 3 hours in order to galva- I want to show a chart because from scription drug coverage under two op- nize this. I think we should dem- the beginning there have been charts tions: Through the traditional fee-for- onstrate in this institution too much shown on both sides. These are 358 dif- service Medicare and also through a respect for our seniors to be stampeded ferent groups—358 different groups that new Medicare Advantage Program into a bad bill. support this bill in its present form. It made up of private companies offering The PRESIDING OFFICER. The time is headed by the American Association Medicare benefits. of the Senator has expired. The Sen- of Retired People—the AARP, which Under the fee-for-service Medicare, ator from Kentucky is recognized for 30 represents over 35 million seniors. beneficiaries will be able to enroll in minutes. Seniors have been pleading for Con- Medicare drug plans. The standard Mr. REID. If I could offer a unani- gress to expand Medicare to include drug benefit will require a $35 monthly mous consent request? drug coverage, and this bill will do just premium and a $250-a-year deductible. The PRESIDING OFFICER. Does the that. It might not be all things to all Once seniors have met the deductible, Senator from Kentucky yield for a people, and I am sure every Member in they will pay 25 percent of the prescrip- unanimous consent request? here would have written a different bill tion drug cost up to $2,250. Once a bene- Mr. BUNNING. I have a unanimous if it was completely up to him or her, ficiary has received an out-of-pocket consent request first to propose. Then I but that is not the way we work around spending limit of $3,600, they will pay 5 will. here and this bill is a very large com- percent for their prescription drugs. Mr. REID. That is fine. promise. Even the AARP, as I said be- I emphasize this because this is the Mr. BUNNING. I ask unanimous con- fore, has endorsed this bill and said key to the whole Medicare prescription sent that with the previous order that, although the bill is imperfect, it drug benefit. Low-income seniors will be provided standing in place, the 30-minute time is an historic breakthrough. I want to with assistance paying for their drug limit on each Senator be considered repeat that—an historic breakthrough; costs depending on the level of their in- controlled time, so that any remaining and that we should not let this oppor- come. This means that seniors with the time may be yielded to another Sen- tunity pass us by. lowest income—those below 100 percent ator, and if not yielded, the time be Today, Medicare provides health in- of poverty—will not pay a deductible or automatically yielded back. surance to about 40 million seniors and monthly premium and will pay either The PRESIDING OFFICER. Is there disabled individuals each year. The $1 or $3 per prescription drug up to the objection? number is only expected to grow as the catastrophic limit. Once they reach the Mr. REID. In layman’s terms, what baby boomers begin retiring. Medicare catastrophic limit, these seniors will this means is, if there are Senators on provides important medical and health our side or the other side who want to have 100 percent of their drugs paid for. and hospital benefits for seniors. How- These are the seniors who truly use the 30 minutes in any way they ever, it is a program that is still trying struggle to pay for their prescriptions. want—10–10–10, 15–15—that is certainly to provide health care as if it were in At 100 percent of poverty, a senior’s in- permissible. The going back and forth 1965 instead of the year 2003. come is $8,900 per year. Other low-in- would be unfair otherwise because When Medicare was created, prescrip- come seniors below 150 percent of pov- someone here would use 30 minutes and tion drugs played a small role, a very erty will receive additional assistance only 10 there. small role in medical care. Today, as depending upon their level of income. So what we are going to do—I think we all know, that is much different. In Personally, I believe our biggest re- this is totally appropriate. I ask the fact, for many seniors and many Amer- sponsibility is to low-income seniors. distinguished Senator from Kentucky icans, prescription drugs have replaced These are the ones who struggle the to allow a modification, simply a expensive surgeries and extended their most to buy their prescriptions, and housekeeping matter over here. The lives significantly. By tying a drug they deserve a very generous benefit. Senator from Michigan, Mr. LEVIN, and benefit to Medicare, this bill makes Seniors will also be able to choose to the Senator from Florida, Mr. NELSON, these lifesaving and life-enhancing receive their health care through a pri- are going to switch places, and also drugs more available to millions of vate company. I hope everybody heard that Senator EDWARDS would be listed Americans. that. They will be able to choose. This at the end of our list as the final Demo- This has been a very long process, is a voluntary program. You can cratic speaker. and I kind of chuckle when I hear peo- choose to stay in Medicare Part B and The PRESIDING OFFICER. Is there ple say we are rushing into this. I can have no prescription drugs if you objection? tell you as a member of the Finance choose to do that. You can choose to Mr. BUNNING. I have no objection. Committee that we have been working take Medicare Part B and add a pre- The PRESIDING OFFICER. Without on this bill for almost the entire year, scription drug benefit or you can objection, it is so ordered. The Senator working and crafting legislation to choose to go into a private company’s from Kentucky is recognized for 30 make the best drug bill possible for all health care program. minutes. Americans. Under Medicare Advantage, seniors Mr. BUNNING. Mr. President, today I I was supportive of our bill as it will be able to choose whether they rise to talk about the Medicare pre- moved through the Finance Committee would like medical coverage from a scription drug bill. First, let me com- and through the full Senate. Today I preferred provider organization, known mend the members of the conference am supportive of the bill before us. It is as a PPO, or a health maintenance or- committee who worked day and night time to add this benefit to Medicare. ganization, or HMO, operating in their for many months to reach this agree- Seniors have waited too long for their regions. ment. I know it was not easy, but they benefit, and I urge my fellow col- These plans will provide beneficiaries have done a good job that will finally leagues in the Senate to support this with an integrated benefit, which bring Medicare into the 21st century. bill. Talk is cheap, and it is time to act means seniors will receive both med- Second, let me say how disappointed and it is time to act now. ical and drug coverage under the plan. I am that it appears some Members We have $400 billion allocated for this They would have a single deductible for may try to filibuster this bill. In fact, benefit. It would be a shame if we let medical benefits currently provided it seems as though there are Members this opportunity pass us by. It might under Medicare Part A and B. They in this body who want to filibuster just not come again. would also be able to receive preven- about everything we try to do, whether This legislation provides a much tive care, disease management, and it is stopping judicial nominations, the needed prescription drug benefit to chronic care under these programs. Energy bill, or this Medicare bill. Just Medicare beneficiaries. It provides These private plans will have much a few weeks ago we spent several days more options to seniors than just tradi- more flexibility in the type and scope

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00011 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.016 S23PT1 S15602 CONGRESSIONAL RECORD — SENATE November 23, 2003 of benefits they provide than tradi- The PRESIDING OFFICER (Mr. fits, beneficiary cost sharings, pay- tional Medicare, and will provide many BUNNING). There are 14 minutes 50 sec- ments to hospitals, and other health seniors with a valuable health care op- onds remaining. care providers are unaffected by the tion. Mr. GRASSLEY. Mr. President, we demonstration. The Medicare entitle- Please notice—‘‘option, voluntary.’’ have heard in the Senate today and ment to benefits and payments to These are very key to this whole pro- last night that the comparative cost health care providers are unchanged in gram. adjustment demonstration project, these same areas. I know some of my colleagues do not which some of the Members refer to as Fact No. 6: Beneficiaries are not re- like these PPOs and HMOs because premium support, would end Medicare quired to enroll in these private plans. they say seniors will not be able to go as we know it. I want to be very clear, The right for a Medicare beneficiary to to any doctor they choose. Hogwash. nothing could be further from the remain in fee-for-service programs is No one is going to force the seniors truth. I have 10 facts about this dem- maintained in the demonstration into these private plans, and they will onstration to explain why this is not areas. The fee-for-service program will be able to pick a plan in which their the case. We are talking about the remain affordable for all beneficiaries. doctor participates. comparative cost adjustment. Fact No. 7: The prescription drug Please understand that. We are not Fact No. 1: It sunsets in 6 years. The benefit is unaffected. The prescription going to force any senior away from demonstration will only be in existence drug benefit and the drug premiums their given doctor. They will be able to for 6 years. It will not begin until the are not changed. The demonstration choose their own doctor and stay with year 2010. During that time, there will only minimally affects the Part B pre- that doctor. be a 4-year phase-in period. Explicit mium, and that is the maximum of 5 That is one of the key elements of authorization from Congress at the end percent increase. the bill—giving seniors more choices of 6 years is necessary to extend the Fact No. 8: Over the demonstration instead of forcing them to use a health demonstration and/or expand it to period, enhanced payments to private care plan created in 1965, which has other areas of the country. This pro- plans are phased out to ensure that changed very little since then. If these posal is significantly modified from the their payments to private plans are on care advantage plans sound familiar, House of Representatives’ original po- a level playing field with the fee-for- they should. sition. Congress weighs in before this Finally, Medicare will provide sen- service program. becomes something other than a dem- Fact No. 9: The preferred provider or- iors with a modern benefit similar to ganization stabilization fund, referred what is offered to most employees, in- onstration project and becomes policy to on the other side by my colleague as cluding what the Federal Government for the entire country. Fact No. 2: Very limited areas of the offers to employees. a ‘‘slush fund,’’ has no relationship to One of the biggest concerns with the country will be affected in the dem- this demonstration. So one cannot talk legislation as it moved through the Fi- onstration. Under the agreement, the about the demonstration and talk nance Committee and the full Senate Health and Human Services Secretary about a stabilization fund in the same was what would happen to retirees who may select no more than six metropoli- breath. If you do that, you do not know currently have drug coverage from tan statistical areas to participate in what the bill does; you have not read their former employer. No one wants the demonstration. It is not easy to be the bill. this new program to be an excuse for put in that list of six because in order Under the conference agreement, the employers to drop their retirees’ health to be selected, a metropolitan statis- stabilization fund may only be used to coverage. That would be counter- tical area must have at least two local provide assistance to the newly re- productive and unfair to those seniors. coordinated care plans offering services gional PPO options. However, any en- To encourage companies to continue in the area and at least 25 percent of rollment in regional PPOs is not count- providing these benefits, this agree- the Medicare beneficiaries must be en- ed toward the 25 percent enrollment re- ment sets aside almost $70 billion of rolled in these plans. That means the quirement in the metropolitan statis- our $400 billion for subsidies to help private PPOs we are setting up begin- tical areas. The extent to which bene- companies cover their prescription ning in 2006 must succeed. I hope they ficiaries enroll in the new regional drug costs for their medical-eligible re- succeed. But we do not know if they PPO opposite will have no bearing on tirees. This is a substantial commit- will succeed, and if they do not suc- whether a metropolitan statistical area ment by Congress to make sure compa- ceed, at least to the tune of 25 percent becomes a candidate for demonstra- nies do not have an excuse to drop in two local areas, there will not be tion. their coverage. one. If that does happen, according to Last fact, No. 10: Strict quality mon- The members of the conference com- the Congressional Budget Office, some- itoring is required. The Health and mittee have worked long and hard for where between 670,000 and 1 million Human Services Secretary is required many hours and in many meetings over beneficiaries will be included in this to closely monitor access to care and the last year on this compromise. We limited demonstration. It is a dem- quality and submit a report to Con- have a real chance to pass this bill, and onstration. It is not something that gress upon completion of the dem- we shouldn’t pass up this opportunity. could ever, without an act of Congress, onstration to determine if the dem- If we don’t pass this bill now, it will encompass all 40 million seniors. onstration has reduced Medicare spend- be several years before we get another Fact No. 3: Low-income beneficiaries ing and/or increased cost to bene- chance, and seniors have waited much are not affected at all. So if they are ficiaries; second, access to physicians too long already. low-income, below 150 percent of pov- and other health care providers has de- Again, I urge my fellow Senators to erty, none of them will see their Part B clined; and lastly, whether bene- pass this bill and finally fulfill the premiums increase. ficiaries remain satisfied with the pro- promise that each and every one of us Fact No. 4: Premium increases for gram. The evaluation would be on the in the Senate has made either on the beneficiaries above 150 percent of pov- basis of any congressional decision to campaign trail or anywhere that we erty will be limited to 5 percent. For extend that demonstration. have spoken to senior groups. We have everyone else, if premiums go up, there Premium support, as has been de- promised this benefit and we can de- is a cap of 5 percent. As an example, if scribed in the Senate numerous times liver it. the national Part B premium was, say, in the last few days by the Senator I urge my fellow Senators, once $100 in 2010, the fee-for-service pre- from Massachusetts and by other Sen- again, to pass this bill providing premiums in the demonstration areas ators, is not in this bill. It is not in- scription drug coverage to our seniors. could not exceed $105 a month. The included. This bill strengthens and im- We can talk about it for 2 or 4 more crease, by the way, is not compounded proves fee-for-service Medicare. years or we can do it now. over that 6-year period of time. How much time remains? I yield whatever time I have to the Fact No. 5: Other than the limited The PRESIDING OFFICER. Seven Senator from Iowa. impact on the Part B premium calcula- minutes. Mr. GRASSLEY. How much time re- tion, the fee-for-service program is un- Mr. GRASSLEY. It would be good at mains? changed choice. Fee-for-service bene- the start of the third day of debate on

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00012 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.019 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15603 this bill to remind people of the polit- of the organizations that are sup- That bill would have made a signifi- ical situation that has gotten us where porting this bill. Other Senators have cant, and positive, difference in the we are today. That is a very positive put charts up saying how many organi- lives of the nearly 41 million older political situation. zations are supporting this bill. Americans and disabled citizens who Last year, we were beginning to de- We have this opportunity. Let’s hope are covered by Medicare—more than velop a bill in the Senate Finance Com- partisanship—that is demonstrated by 2,770,000 of whom live in Florida. mittee that would have had bipartisan the filibuster that was announced yes- The conference agreement that we support to get it out of the committee. terday—does not keep this bill from are now considering would also make a Bipartisan support in the committee is passing. Democrats who want to fili- significant difference in the lives of our a way to have a chance of success in buster ought to consider that is not the seniors. However, that difference will the Senate where there can always be way to go. They should learn from the not be a positive one. an extraordinary minority who can lesson of the past. That lesson is that I have many grave concerns about keep a bill from being passed because last year when they wanted an issue in- this legislation. The drug portion of we protect minority interests in this stead of a product, they got a defeat at the bill is deeply flawed. It includes an body as no place else in our political the polls. enormous coverage gap. When a senior system. So we must be bipartisan. I yield the floor. has reached $2,250 in total drug ex- About the time that was going to The PRESIDING OFFICER (Ms. MUR- penses, all drug coverage stops. The happen, the majority leader—the Sen- KOWSKI). The Senator from Florida. drug benefit doesn’t begin again until ator from South Dakota, last year—de- Mr. GRAHAM of Florida. Madam total drug spending reaches $5,100. cided we needed to talk about this in President, since its creation in 1965, That is a gap of $2,850. the Senate. But the bill never came out the Medicare Program has helped mil- And during all of the months the sen- of committee. It was brought right to lions of our Nation’s elderly and dis- ior is in that ‘‘gap’’, the senior is re- the floor. When bills are brought to the abled when they desperately needed it, quired to keep paying premiums. floor, there is no chance of developing after they became ill. The bill is projected to cause 2.6 million retirees nationwide, and over bipartisanship. We discussed it for 2 or It has been an extremely successful 160,000 in Florida, to lost their retiree 3 weeks and no one could get the bipar- and popular program, and has improved prescription drug coverage. tisan majority it takes to get pieces of the health of countless seniors. Now that we are in the 21st century, It will cause 6 million low-income legislation passed. it is time to reap the full benefits of seniors nationwide, and over 360,000 in At that time, I surmised, and I think the advances made over the years, and Florida, to pay more for their drugs, the outcome of the debate last year shift the focus of the Medicare Pro- and to face more restrictions on the proves it, that the other side wanted gram from assistance after illness to drugs they can get. more of an issue for the election rather one that promotes wellness. It relies on an untested delivery sys- than a product. They gambled and they To achieve that, a prescription drug tem which would either herd seniors lost because Republicans gained con- benefit is mandatory. Ninety percent of into what we know they don’t like, a trol of the Senate in that election and seniors have at least one chronic condi- managed care organization, or would then we were right back to square 1 tion; drugs are often the best way to turn them into guinea pigs for a never where we went to the Senate Finance manage those conditions. previously utilized drug-only insurance Committee where there could be, even The bill we are considering is fre- plan. with a Republican majority, still a bi- quently divided into two parts—one Millions and millions of seniors who partisan working relationship that was part is the prescription drug benefit, will not have access to drugs through able to report out a bill on 16-to-5 bi- and the other part is Medicare reform. the traditional Medicare Program will partisan vote. Then we brought that Let me state what we all ought to suffer the fate I have just described. bill to the floor during the month of know by now: A prescription drug ben- In addition, the legislation that was June. And it got through here 76 to 21. efit is the most fundamental reform supposed to be about adding a prescrip- We are as successful as we are be- that we can make to the Medicare Pro- tion drug benefit now includes provi- cause the people made a change in the gram. sions that will privatize the Medicare Senate. If we want to truly reform Medicare, Program beginning in the first year of In the Senate, then, we adopted a bi- we must change the approach of the implementation fragmenting the partisan bill, and we were able to get program from one of sickness to one fo- health insurance group by subsidizing through, for the first time on this issue cused on wellness. This prevention ap- health savings and increase the costs of in the history of the Senate, prescrip- proach will require access to prescrip- comprehensive health insurance for our tion drugs for seniors. We were able to tion drugs. non-Medicare citizens. match the House, where it had passed Modern medicine has been altered I am not alone in my concern about three times previously. We went to fundamentally by prescription drugs, this legislation. In a recent survey con- conference. We operated in the con- notably by improving the quality of ducted by Hart Research, of voters ference, at least from the Senate point people’s lives, ending the need for sur- aged 55 and older, only 19 percent said of view, on a bipartisan basis, and we geries and long recovery periods. we should pass this bill. Sixty-four per- were able to produce a product where A side benefit of this change would be cent said we should go back to the here we are doing the best improve- that the cost to the Medicare Program drawing board. This isn’t the Medicare ment and the most sweeping improve- could be lower by reducing these proce- prescription drug benefit that they ment in Medicare in 38 years. We are dures. need. able to do that because of bipartisan- I have introduced several prescrip- And although the AARP has taken ship. tion drug bills over the past few years the inexplicable position of supporting Now, all of a sudden, people on the because I believe a reorientation to- this legislation, the national organiza- other side of the aisle, at this last ward wellness is in the best interest of tion may want to listen to its mem- minute, are filibustering. I hope they our seniors, as well as the Medicare bers. Only 18 percent of AARP mem- do not get away with that filibuster. Program. bers want Congress to pass the bill. But, again, they are trying to be very However—and this is critical—not Sixty-five percent have instructed us partisan, as they were a year ago. I just any prescription drug bill will do. to go back to the drawing board. hope they learned a lesson from a year The bills I have authored have been The percent of seniors in favor in my ago and will not try to be partisan on constructed to provide an affordable, State is even lower. I have received this very important social issue for the comprehensive, reliable prescription over 1,000 calls from seniors opposed to seniors and the disabled of America, drug benefit to our seniors and Medi- this agreement, representing about 80 and that they will not repeat the mis- care beneficiaries with disabilities. percent of all calls. takes of last year when they wanted an The bill I introduced in 2001, cospon- Listen to what some of my constitu- issue instead of a product. sored by Senators ZELL MILLER and ED- ents are saying about the bill: We have a bipartisan product. I listed WARD KENNEDY, was voted on in July of Earl Dangler of Beverly Hills, FL last night, in my closing remarks, all that year. It received 52 votes. said:

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00013 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.021 S23PT1 S15604 CONGRESSIONAL RECORD — SENATE November 23, 2003 This prescription drug benefit is going to At this point, you may be thinking ering the cost of housing, food, and cost my wife and I an additional $750 to $1,000 that things are bound to improve for transportation, there isn’t a lot left. per year whether we use it or not. the senior. But, hold on, because the We need to make sure the prices are Many of my constituents have ex- summer of 2006 is coming. What hap- as low as possible so that our seniors pressed outrage at AARP for endorsing pens then? That is when, for the first are able to actually purchase the drugs this conference agreement. time, seniors—voters—will experience they need to keep them well. One constituent said: the infamous ‘‘gap.’’ Beginning some- Of course, the taxpayers would also I’m really mad at the AARP and I am time after Memorial Day 2006, many benefit from Medicare serving as a going to cancel my subscription that I’ve seniors will reach, and fall into, the tough negotiator. The taxpayer is had for 20 years. gap. going to pay the portion not paid by Another constituent remarked: At this point the senior has been the senior. I’ve been a member of AARP for many, going to the drugstore for about 6 Both parties—the seniors and the many years, and I can’t believe that they months, each month filling prescrip- taxpayers—have an interest in keeping have sold out to the pharmaceutical industry drug prices as low as possible. The and the insurance companies. tions for treatment of any number of chronic illnesses. party that does not share that interest The real test of the reaction to this The senior has met his or her deduct- is the pharmaceutical industry. legislation is a bit down the road—but ible, has never missed a monthly pre- The interests of that industry can be it will come. The impact of the bill mium payment, and dutifully has been the only reason for a provision in- won’t be felt until at least 18 months paying 25 percent of the cost of each cluded at the top of page 54 of the con- after enactment. prescription. ference report. The provision is de- I would predict the vote we cast on But when the drugstore counter is signed to appear helpful by being called this legislation will be politically in- reached in July, the senior finds he is a ‘‘noninterference’’ clause. consequential for those running in the now responsible for paying 100 percent What is a ‘‘noninterference’’ clause? year 2004. The stunning impact will be of the cost of the prescription, and yet According to the authors of this legis- felt first in the fall of 2005, when Medi- still is responsible for paying the lation, it is the following: care beneficiaries get the notice that it monthly premium. NONINTERFERENCE.—In order to promote is time to enroll in the drug benefit. I predict that by Labor Day of 2006, competition under this part and in carrying What choices would the senior face in seniors will have made loud and clear out this part, the Secretary— 2005 when considering whether to en- (1) may not interfere with the negotiations their opinions about this prescription roll in the new, highly touted program? between drug manufacturers and pharmacies Many Medicare beneficiaries will drug benefit. and PDP sponsors; and And yet, there is still more ahead. In have to consider the following: (2) may not require a particular formulary No. 1, sign up for a prescription drug the year 2010, a vast experiment called or institute a price structure for the reimbursement of covered part D drugs. plan, PDP—a private drug-only insur- ‘‘premium support’’ will be imposed on ance plan with no limits on the pre- millions of seniors in several parts of Let me get this straight. A provision mium that may be charged, or No. 2, the country, including Florida. that prohibits the Secretary of HHS enroll in a managed care plan. Seniors in my State, as in others, from negotiating with drug manufac- Given that more than 85 percent of will be forced to choose between enroll- turers to lower the price of drugs—a seniors today have rejected managed ing in a health maintenance organiza- provision that prohibits the Secretary care, I anticipate a ‘‘1980s’’catastrophic tion or paying a much higher premium from using the purchasing power of 41 outrage. But, that is not the end of the to stay in the traditional fee-for-serv- million Medicare beneficiaries to lower outrage. In fact, it may be just the be- ice Medicare Program. the price of drugs—and thus lower ginning. Although we are beginning to hear costs to seniors and taxpayers alike—is As the senior considers his choices, the outrage now, it will be nothing ‘‘noninterference’’? he will soon realize that the private compared to what we will hear in the I put my money on this being a form plans hold all the cards. They have all summer of 2006. of ‘‘interference’’ that senior wouldn’t the flexibility, all the options, and The voters have been polled and my mind. Saying this provision is about none of the commitments. constituents have been calling, and not interfering, and about promoting The plan defines the classes, or cat- they all cite many concerns with the competition, is akin to the fox putting egories of drugs, then decides what bill—many of the same issues I men- on the San Diego chicken costume and drug is in the class or category, and tioned a few moments ago. Each of heading into the chicken coop to ‘‘pro- how much the senior will be charged these issues should be discussed in tect’’ the chickens. for the drug. great detail, and I hope we have the This may sound like dry stuff. But it The plan doesn’t even have to tell the time to do so. has very real life implications. Take senior prior to enrolling what the Today, I am going to concentrate on the case of Patricia Kittredge, a 71- charge for the drug will be, and can one of the aspects of the bill that I find year-old woman who lives in Tamarac, change which drugs are in each cat- to be the most troubling, and one that FL. egory at any point in the year. is shared by 64 percent of those polled: She takes 6 different prescription But the senior? The senior has to the legislation does little to contain drugs to stay healthy, which add up to make an enrollment decision prior to drug costs. The legislation actually $409 a month, or approximately $4,908 the beginning of each calendar year, forbids Medicare from negotiating with annually. Fortunately, her former em- based on limited and subject-to-change the drug companies to reduce costs. ployer picks up the majority of these information, and cannot change plans It doesn’t seem to make much sense. costs so that she pays $65 a month, or at any time during the year. A Medicare prescription drug benefit $781 annually. The private insurance plan can make should allow the Medicare Program to A former credit analysis for a major changes during the year, but the senior do whatever it can to get the best pos- employer in South Florida, Mrs. cannot. sible prices from the drug companies. Kittredge has good retiree health cov- Once enrolled, in the first part of the Why? Because both seniors and tax- erage. Yet she is far from wealthy. She year 2006, seniors will begin to feel the payers would benefit. makes about $18,000 a year when you impact of the deck being stacked in Under this legislation, the majority combine her pension and Social Secu- favor of the private plans. They will of seniors would have to pay either 100 rity income. discover that the plan can make percent or 25 percent of the price of the Because the conference bill does not changes to the drugs covered and the drug—100 percent before the deductible allow the Medicare Program to nego- price of the drugs at any time. is met, and during the time the senior tiate on her behalf—should Ms. They will discover that the drug is in the enormous ‘‘gap’’ in coverage, Kittredge find herself among the 4 mil- prices aren’t all that low, and they will and 25 percent after the deductible and lion Americans who will lose their re- discover that they have to pay the full before reaching the ‘‘gap.’’ tiree coverage—her out-of-pocket cost for part or all of January as they In 2001, the median income of a Medi- costs, including her premium, will ex- struggle to meet the $250 deductible. care beneficiary was $19,688. After cov- plode to $3,830.

VerDate jul 14 2003 01:07 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00014 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.006 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15605 That is nearly 5 times what she cur- prices for our veterans. What was the their benefit, and for the taxpayers rently spends, nearly 5 times what she result of that legislation? In the first 5 benefit. now pays, and nearly $4,000 in out-of- years alone, the VA saved more than $1 I ask unanimous consent to print an pocket drug costs on an income of billion. editorial at the conclusion of my re- $18,000 a year. What kind of benefit is VA’s savings have continued to grow marks. that? exponentially, as both the cost of phar- The PRESIDENT OFFICER. Without But don’t take my word for it, this is maceuticals and the number of vet- objection, it is so ordered. what Patricia Kittredge has to say: erans seeking prescription drugs have (See exhibit 1.) That would really hurt me. The hand- grown. The savings represent valuable Mr. GRAHAM. I’d like to quote from writing is on the wall. The companies that Federal dollars that have been used to the November 21st Miami Herald, have retiree coverage will be walking away provide quality health care to our Na- which editorialized as follows: from it to save money and won’t feel bad tion’s veterans. The problem: Instead of using the free mar- about it at all. In addition, the savings on pharma- ket to drive down the costs of prescription Were Medicare able to use its bar- ceuticals have allowed VA to provide a drugs, the bill would protect pharmaceutical gaining power to negotiate with the long-term care benefit, including nurs- companies from competition and pay more drug manufacturers, our seniors would than $100 billion in incentives to employers ing home care, adult day care. and insurers in an attempt to make its likely see drug prices more in line with What are the implications of allow- the VA drug prices. Mrs. Kittredge’s flawed logic work. The bill also threatens to ing Medicare to negotiate prices? In cap future Medicare spending. drug costs under the proposed plan 1998, the Inspector General, IG, of HHS, True, the measure promises prescription- would decrease dramatically. studied 34 drugs currently covered by drug coverage for low-income seniors not al- Yet the conference bill strictly for- the Medicare program. ready covered by Medicaid and would benefit bids Medicare from using its bar- The IG found that Medicare and its seniors with extremely high prescription gaining power to negotiate lower drug costs. But its coverage for middle-class sen- beneficiaries could save more than $1 iors is modest at best. prices for seniors. billion a year if the allowed amounts How good are these VA prices? Let’s That’s just not enough benefit for a 10-year for just these 34 drugs were equal to compare the VA prices of Mrs. price tag of $400 billion that will add to the the prices obtained by VA. skyrocketing Federal deficit, especially Kittredge’s drugs to their retail prices. when it doesn’t even contain the cost of pre- Diazepam, which Mrs. Kittredge If the Medicare program were able to achieve similar savings on the out- scription drugs. takes to help her sleep, costs the VA A better, more logical approach would be $0.84 for one hundred 5 milligram tab- patient drugs covered in this legislation, Congress would be able to provide to harness the buying power of the 40 million lets, while the same pills cost $16.70 at Medicare seniors to drive down drug costs. the drug store. a much richer prescription drug benefit But this bill actually would prohibit the gov- In addition, a month’s supply of for the same $400 billion we are pro- ernment from doing so. Instead it would dis- pravachol which she takes to regulate posing to spend now, reduce the costs sect the country into 10 regions and pay in- her cholesterol, costs the VA $19.80 at to taxpayers, or both. centives to companies—$12 billion to private 40 mg per pill for the clinical equiva- In terms of the drug benefit: we could insurers and $1.6 billion to HMOs—so they’ll offer prescription-drug coverage. lent, while the drug store charges give seniors a lower deductible and fill $116.75 for the same amount. in the gap; we could remove the gim- For the Record, I’d like to make one Mrs. Kittredge would face similarly micky definition of what counts to- correction in the otherwise excellent high prices for her other prescriptions: ward reaching the catastrophic limit so editorial. Under the latest version of a 20 mg dosage of accupril, a drug to that employers wouldn’t drop their re- the bill, between 10 and 50 regions treat her high blood pressure, costs the tiree drug coverage; we could remove would be allowed—further dissecting VA $7.69 for 30 pills goes for $32.00 at the assets test; We could allow the the country. the drug store. Medicare Program to pay to the cost- The last drug benefit endorsed by the Diltiazem, which Mrs. Kittredge also sharing of our low-income seniors. AARP was the Medicare Catastrophic takes for her blood pressure, costs What would allowing Medicare to use Coverage Act. We all know how seniors $69.20 at the drug store but only $32 its purchasing power do to the pharma- felt about that drug benefit, and it was through the VA. ceutical industry? quickly repealed. Metrocream, which she takes for a Some would have us believe that only If we adopt the proposal before us, we skin disorder, costs $69.99 at the drug the proposal we are discussing today will be turning a deaf ear to history, store compared to $25.13 through the would allow the industry to thrive and and to the seniors across the country VA. continue to develop life-savings drugs. today who are already telling us— If the Medicare bill we are now con- But in June 1999, reaching to the through AARP card burnings, through sidering actively negotiated on Mrs. prospect of a Medicare prescription the messages they are writing on the Kittredge’s behalf, she would likely drug benefit, Merrill Lynch advised in- AARP ‘‘message board’’, and through pay prices more in line with the prices vestors that the hundreds and hundreds of calls available to veterans. Her total bill volume increases could overwhelm negative from seniors we’ve been receiving over would be $2,188 rather than the $3,830 as pricing impact. It is important to remember the last week—that we need to get she will pay under the conference that a reduction in prescription drug prices, back to work. agreement. both with or without associated prescription This drug ‘‘benefit’’ is actually no Mrs. Kittredge’s example is not un- benefit coverage, is likely to be associated such thing. It leaves millions of seniors usual. Look at the price differentials with price elasticity and increased utiliza- worse off. tion. between the VA price and the average Along with many others, I have retail price of some common drugs. The proposal before us fractures the worked to provide an affordable, com- How is the VA able to secure such Medicare market. One of the great prehensive, reliable prescription drug good prices for veterans? strengths of the Medicare Program has benefit for our seniors and citizens In 1992, concerned about the prices been its universality. Seniors from An- with disabilities for the last several veterans were paying for drugs, Con- chorage to Key West knew they would years. gress passed the ‘‘Veterans Health Care get the same benefits for the same pre- It is therefore with great regret that Act’’—a Rockefeller, Simpson, Mur- mium. I have no choice but to vote against a kowski, Cranston amendment—by The proposal before us also uses conference report that does not provide voice vote. scarce Federal dollars in an attempt to the benefit seniors need, and have been It is interesting that an issue that force private insurers into a line of promised. was and is so controversial could be business they have repeatedly said If the proposal is adopted—and I sin- passed by voice vote. We are only ask- they do not want to enter. cerely hope it is not—it will not be the ing that Medicare not be prohibited Instead, we should be using the pur- last chapter. Seniors won’t stand for it. from negotiating prices for seniors. chasing power of the nearly 41 million I predict voters will put Congress on This legislation gave the VA the au- Medicare beneficiaries waiting for a the hook in 2006, and we will spend thority it needed to secure better drug drug benefit to drive down prices—for many, many years attempting to fix

VerDate jul 14 2003 00:58 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00015 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.008 S23PT1 S15606 CONGRESSIONAL RECORD — SENATE November 23, 2003 this deeply flawed legislation—or will The doughnut hole to me from my father and find with repeal it outright as we did with the The standard coverage that the bill offers each passing year how profoundly im- catastrophic legislation. would only benefit a senior who spends more portant they are. Or we could have the worst of both than $835 a year, or some $70 a month, on But dad, although an educator all his worlds. drugs. Then there’s the ‘‘hole in the dough- adult life, did not teach exclusively in We could repeal the prescription drug nut’’ coverage gap in which the govern- a pedagogical manner. Many of the ment’s 75-percent subsidy stops after $2,200 greatest things I learned from dad benefit because the benefits are too in out-of-pocket cash has been spent. If out- meager, its subsidies of health mainte- of-pocket spending reaches $3,600, the sub- came from observing his example—his nance organizations are too great, and sidy kicks in again, this time at 95 percent of commitment to our family, his love for its delivery system too confusing and drug cost. Deductibles and co-payments are mom, his dedication to professional ex- disrespectful. complicated enough without trying to excellence, and his willingness to assume And what would be the price of re- plain the ‘‘hole in the doughnut’’ to elderly leadership roles in the church and in pealing the drug benefit? recipients. our community. We would leave the privatization of AARP and other supporters say that even Dad, it deeply disappoints me that I a flawed benefit is better than nothing. They cannot be with you today, but know Medicare in place and destroy one of reason that once passed, bad provisions could the Federal Governments most effec- that I am with you in thought and spir- be changed before they go into effect. But it. Happy 90th birthday, dad. tive, efficient and popular programs: why fix later what should be fixed now? traditional fee-for-service Medicare. Seniors deserve affordable prescription- I yield the floor. In the event the legislation before us drug coverage. Congress should scrap this Mr. REID. Madam President, Senator does become law, I plan to use my last flawed approach and come up with a plan NICKLES is in the building. I do not know if he is going to speak. year in Congress working to fix it. Our that delivers that coverage while driving I suggest the absence of a quorum. seniors need better from us. costs down. The PRESIDING OFFICER. The Sen- The PRESIDING OFFICER. The EXHIBIT 1 clerk will call the roll. ator from South Dakota. [From the Miami Herald, Nov. 21, 2003] The assistant legislative clerk pro- Mr. JOHNSON. Madam President, I WHEN HALF A LOAF ISN’T NEARLY ENOUGH ceeded to call the roll. ask unanimous consent to speak for 5 Mr. NICKLES. Madam President, I OUR OPINION: REJECT THE FLAWED MEDICARE minutes as in morning business. PRESCRIPTION BILL ask unanimous consent that the order The PRESIDING OFFICER. Without for the quorum call be rescinded. With its $7 million ad campaign to win sup- objection, it is so ordered. port for the Medicare prescription-drug bill, The PRESIDING OFFICER. Without AARP says that the legislation ‘‘isn’t per- f objection, it is so ordered. fect. But millions of Americans can’t afford HAPPY 90TH BIRTHDAY, DAD Mr. NICKLES. Madam President, I to wait for perfect.’’ We agree with AARP’s rise to speak on the Medicare bill that assessment of the bill but not its conclusion. Mr. JOHNSON. Madam President, is before us. First, I compliment a cou- The proposed bill is badly flawed. It deliv- today my father, Van Johnson, is cele- ple colleagues with whom I have had ers too few benefits to seniors at too big a brating his 90th birthday. He is joined the pleasure of working on this bill, cost. Americans don’t need perfect, but for by my mother Ruth, my brother and particularly in the conference com- $400 billion they deserve a bill that helps sister and their spouses, dad’s sister mittee. First would certainly be Sen- more people and drives down the high costs Ardis, and a great many wonderful of prescription drugs. The proposed bill does ator GRASSLEY who, in leading the Sen- little of either. Congress should reject it and friends. I had long planned to be there ate conferees, I think did an out- try again. to join in this celebration, but the Sen- standing job. I also would echo that for The problem: Instead of using the free mar- ate failed to adjourn on time, and now the majority leader. The majority lead- ket to drive down the costs of prescription is staying in session through the week- er seldom gets involved in a con- drugs, the bill would protect pharmaceutical end and into next week in an effort to ference. This majority leader, Dr. BILL companies from competition and pay more conclude legislative business which FRIST, has an interest in Medicare and than $100 billion in incentives to employers should have been completed months he was a very influential member of and insurers in an attempt to make its ago. flawed logic work. The bill also threatens to the conference. In addition, Senator cap future Medicare spending. The good people of South Dakota KYL, Senator HATCH, Senator BAUCUS, True, the measure promises prescription- honored me by electing me to represent and Senator BREAUX and, I would also drug coverage for low-income seniors not al- their interests and values in the Sen- include, Chairman THOMAS. ready covered by Medicaid and would benefit ate, and I simply cannot neglect those This was a very challenging con- seniors with extremely high prescription duties by leaving Washington today. ference between the House and the Sen- costs. But its coverage for middle-class sen- While I cannot be with dad on this ate. The bill that was reported out of iors is modest at best. That’s just not enough very special day in his life, I rise to ex- the Senate—I did not vote for it. I for a 10-year price tag of $400 billion that will press my long appreciation for a father add to the skyrocketing federal deficit, espe- thought it was very heavy on expense cially when it doesn’t even contain the cost who has always been there for me. Dad and very light on reforms. I did not of prescription drugs. taught me about the importance of really think it was a sustainable bill, Don’t repeat the past family, of fatherhood, of faith, and of one that we or our children could af- personal integrity. He taught me about A better, more logical approach would be ford. So I worked very diligently, I to harness the buying power of the 40 million the importance of public service—that guess, or very aggressively, trying to Medicare seniors to drive down drug costs. life is more than about the collection come up with a conference report that But this bill actually would prohibit the gov- of things, and that helping make the would meet the test, that would pro- ernment from doing so. Instead it would dis- world a better place is, indeed, a cen- vide better benefits at a sustainable sect the country into 10 regions and pay in- tral purpose to our lives. level. centives to companies—$12 billion to private Dad was there for me, whether it in- I think the present Medicare system insurers and $1.6 billion to HMOs—so they’ll volved the countless family camping has crummy benefits. It does not cover offer prescription-drug coverage. trips, athletic events, school work, or We’ve tried such incentives before with a lot of things that should be covered. HMOs, and experience shows that they didn’t church activities—all at a time when It is so far behind the times, I really work. Half of the Medicare Plus Choice plans he was intensely busy with his own ca- did want to modernize it. I also wanted provided by HMOs have folded, even though reer as a highly regarded teacher, to add the new benefits in a way that taxpayers still pay more to subsidize a senior coach, professor, and university admin- would be affordable and sustainable. in a Medicare HMO than a senior in tradi- istrator. He and mom were and are a Under the present situation in Medi- tional Medicare. great team, and my brother Tom and care, just to give people a little thumb- The compromise measure also guts provi- my sister Julie and I have benefited all nail sketch—and this is without pro- sions that would have allowed seniors to le- our lives from their loving guidance viding any new benefits—the total debt gally buy prescription-drugs from Canada, another concession to pharmaceutical com- and care. held by the public is $3.6 trillion. So- panies, some of which now are retaliating As a father of three children, and cial Security unfunded liabilities is against Canadian wholesalers who sell to now a new grandfather myself, I con- about $4.6 trillion. Medicare is almost Americans. tinue to draw from the values imparted three times as much. It is $13.3 trillion,

VerDate jul 14 2003 00:58 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00016 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.011 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15607 and that is without adding a new ben- present form. I do not want to be add- dually eligible. We have subsidies in efit, which most people would estimate ing new benefits that will just accel- this bill for low-income to the tune of to be $6 trillion or $7 trillion. So my erate the day where it collapses, where $190-some billion. These are subsidies colleagues can see we have an enor- it is not sustainable, where our kids for seniors which many of whom al- mous challenge before us. are going to be saying: What about this ready had drug coverage. So what is Then just look at Medicare today. tax? the total package? Everybody says this There is a lot more money going out Some people say: Well, this is not a package is a $395 billion package. In re- than coming in. Medicare is primarily tax. And that is correct, we are not cre- ality it is much more than that. In re- financed by two things. One is payroll ating a direct tax to pay for the new ality, this bill is closer to $800 billion. taxes; 2.9 percent of all payroll, not benefits, but what we are doing is in- It nets out about $400 billion. It is $800 capped at the same amount that Social curring enormous debt to pay for bene- billion because we have $507 billion in Security is up to the 80,000-something fits. Frankly, our kids are either going drug benefits, but we also have low-in- dollars. It is 2.9 percent of all payroll. to be paying for that in the form of come subsidies of $192 billion, and we That is the money going in. It is also taxation tomorrow or they are going to have employer subsidies of $89 billion. financed by general revenue. We sub- be paying for it in an increased interest If you add that up, it is almost $800 bil- sidize Part B. rate because debts will increase sub- lion of checks that are going to be If it is added all together and we take stantially under this bill. written. The Federal Government is out the intergovernmental transfers, The budget resolution we passed last going to be writing those checks. Medicare had net deficits last year—in year said we should strengthen and en- The Federal Government will be re- 2002—of almost $70 billion. It gets a lot hance Medicare. That means make it ceiving money back in the form of pre- worse—by 2012 the deficit will be above more solvent, more sustainable, more miums from seniors, $131 billion, and a $150 billion. That is present law. That affordable. Unfortunately, I am not reach-back or call-back from the is without adding a new benefit. So sure we did that under this bill. In fact, States. Since we are assuming Med- Medicare is in very difficult fiscal wa- we focused too many resources in this icaid, which in my opinion is a serious ters, a lot more challenging than even bill to cover the covered and not im- mistake, one that was opposed by the Social Security, a lot more challenging prove Medicare. administration and certainly opposed than any other program because demo- What do I mean by that? If we look by this Senator, but we were not suc- graphically there are a lot of people at this chart, we find out that 76 per- cessful. It was not the Senate position who are living longer, health care ex- cent of seniors now have prescription to assume federalization of Medicaid. penses are exploding, and there are drug coverage, but we are going to Medicaid is a Federal-State program. fewer people paying the payroll tax. So spend billions, almost $100 billion, to It is now an all-Federal program when it is going to take a greater share of provide assistance to those people who this bill becomes law. Again, we are general revenue, money from taxpayers already have drug coverage. For em- covering the covered. We are going to to pay for these obligations. ployer-sponsored plans, for example, we subsidize Medicaid to the tune of $190- So I thought, let’s provide better are going to spend $89 billion to sub- some billion in this bill. That is a lot. benefits. What do I mean by that? sidize employers so they can continue We recoup some of the money we Medicare does not provide drug bene- providing health care benefits, drug were paying. Now it is all Medicare, so fits. Everyone knows that. Medicare benefits, for their employees. We are the offset will say we will spend less in also has unaffordable deductibles. It going to bribe them to keep covering Medicaid because we are not going to has a deductible for the hospital of the people they have already contrac- do that. In the future we will make it $840. I compare this to what the private tually obligated to cover. This is a big all Medicare. The net is—we will spend sector offers. If a person buys Blue bailout, in my opinion, for employer $800 billion, recoup $400 billion—so the Cross or Aetna, any of the private plans, union plans. It is way too high of net cost to future generations is about plans, they do not have an $840 deduct- a subsidy. I know AARP wanted these $400 billion. Yes, that meets the so- ible to pay if they go in the hospital for subsidies and in fact wanted more called budget restraint we put in, in one day, but Medicare does. All private money. this year’s budget. But we didn’t fi- plans certainly should—I think most Now, some people were criticizing nance that, we don’t pay for it, so we do—have catastrophic. Medicare does Senator BAUCUS. Mr. Hunt in the Wall have benefits, frankly, that are cer- not have catastrophic. Street Journal criticized him as a ne- tainly overpromised and underfunded. If a person is really in trouble, if gotiator. I take issue with that. He was They are not funded. The $400 billion is they are in the hospital more than 150 a very successful negotiator because in not funded. That is just additional days, it is all on them; they do not get the last several days of negotiating the debt. any help from Medicare. I think that is bill—we spent months negotiating— I happen to think it will be a lot pathetic. That is not a very good ben- Senator BAUCUS was a very effective more than that. I happen to think once efit. As a matter of fact, if someone is negotiator. He kept winning. I kept you end up paying some benefits you in the hospital more than 60 days, they losing. We were on opposite sides in will find that utilization will sky- have to pay $210 a day. If they are in many battles. I complimented him. I rocket. This is just what CBO has told the hospital more than 90 days, they said: You just keep winning. us. People without drug coverage in have to pay $420 a day. So if someone is He got more money for the employer this age category spend about $732 on really sick, if they are really in trou- and union subsidy, another $18 billion their drugs per year. If they have drug ble, look out, Medicare does not come in the last few days to cover the cov- coverage, they spend about double through. So it is a program that has, ered. It went from $71 billion to $89 bil- that, $1,337. frankly, not been modernized since its lion by making it tax free. He also got I think this figure will skyrocket. I creation in 1965. an additional $18.5 billion for low-in- asked my mother: Do you have drug Medicare does not do enough for pre- come subsidies and more benefits. That coverage? She said yes. She buys it ventive care. It does not offer prescrip- makes the bill more expensive and I with AARP. She pays $140 or $160 a tion drugs. It does not have cata- think will make utilization go way up. month for drug coverage. I said: How strophic. Its deductibles are way too So I compliment Senator BAUCUS for much is your drug coverage? high for hospitalization. So I think it his negotiations, but I also think it It is 50 percent of whatever she needs significant improvement. makes the bill less sustainable or less spends up to $1,000. She gets $500 in I want to pass a Medicare bill that affordable for future generations. drug benefits from AARP. She pays al- will help solve all of these problems. I So we spend a lot of money to take most $1,000 for that $500. Maybe there want to pass a bill that will provide care of employer sponsored. I also have are some other benefits in there I am drug benefits. I think we are way be- issues with covering the covered in the not aware of. My point is, a lot of peo- hind the times. We should be doing it. Medicaid program. We have low-income ple have drug coverage, but they only I also want to be cognizant of the fact subsidies in this bill not just for those have a little drug coverage. The reason that Medicare is in real financial trou- who are higher incomes than Medicaid I say this bill may not be sustainable ble, that it is not sustainable in its but for the Medicaid population that is or affordable is because 36 percent of

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00017 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.028 S23PT1 S15608 CONGRESSIONAL RECORD — SENATE November 23, 2003 all Medicare seniors are going to get an People who have incomes above 150 reach-back by States will be reduced enormous benefit and they pay almost percent of poverty, they have a copay dramatically, and the expansion of low- nothing. They will have only $1 and $3 of 25 percent. Then you are getting into income definition will be enlarged tre- copays, or $2 and $5 copays; in most the area where it is not quite as good mendously, so the cost of this bill will cases they will have no premiums, as what they had in the private sector. more than double, more than double. deductibles or gap in coverage. So my point is, for low income, for that That is just my guesstimate. I may not I have heard some colleagues say we 36 percent of Medicare seniors, for be in the Senate when that happens, should be doing that for everybody. Let about 14 million seniors, this is one but my guess is it will happen. me just give you an example of who is great package. My guess is, it will ex- What is my other complaint about pushing that proposition. I saw that plode in cost. the bill? Its explosive nature in cost. I AARP ran an ad today and is asked: Another reason I think it will ex- knew it would cost a lot. I knew it Why should you vote for this bill? They plode in cost is because a lot of our col- would explode. One of the things I real- had three or four reasons. If you have leagues will say whatever we pass, that ly wanted to do was come up with some income less than 100 percent of the fed- is just the beginning. I think Senator reforms that would help make this pro- eral poverty level—for an individual, KENNEDY alluded to that when this gram more sustainable, more afford- that is $9,600; for a couple it would be passed the Senate: This is a beginning able for the future. $13,000, this is the best deal you have and he wants to expand upon it. I be- Presently, we have a system that is ever seen because all you have to pay is lieve that is what AARP says: We will bifurcated. We have Medicare hos- $1 if you are buying a generic, or $3 if take this and expand upon it. pitalization. That is called Part A. It you are buying a brand-name drug, and How do you expand upon it? Well, has Part B for doctors. It will now have you have unlimited drugs—no limit, no let’s just fill the donut hole. In other a new part D for prescription drugs. deductible, no copay other than that $1 words, the basic benefit after you get The benefits are not integrated. and $3; no premiums, and no donut past the low-income subsidies, the A lot of people also buy Medigap. hole. That is unlimited. All you have basic again goes up to $2,250. Then Under present law they buy A and B to pay is $1 to $3 and all your drugs— above that amount you have to basi- and they buy Medigap. So it is not a whether they are $5,000 or $10,000—are cally self-insure or in other words you very good integrated system, unlike all covered. pay the next couple of thousand dollars the private sector. The private sector It is almost the same if you have an on your own before the Federal Gov- offers the benefits that I said that income of less than 135 percent of pov- ernment catastrophic kicks in. Medicare lacks. I wanted to have an in- erty. That would be for individuals A lot of people would say: Let’s just tegrated private-sector alternative to with $13,000 and a couple with $17,600 of fill that donut hole up. We don’t have the present Medicare system, one that income. If they have less, they have that donut hole in the private sector, people could look at and say: Wait a the same thing, except their copay is $2 we should not have it in this. If you fill minute, this works better. I think I and $5. There is no donut hole, no cata- that up, in other words, if Government would rather be in the everyday pri- strophic, no limitation. They don’t expands its liability, the cost of this vate sector type system, the same one have to pay premiums, no $35 a month program goes up by the hundreds of bil- Federal employees have, the same one in premiums. They have a great ben- lions of dollars—hundreds of billions of private sector employees have. efit. They should be celebrating. They have better plans. They have a I am surprised to hear some of our dollars. In fact, one does not have to better package. It is more modern. It is colleagues on the other side say they predict that this will happen, it actu- can’t support this bill because it is not ally already did. The Conference Com- not tied to a government-controlled a very good deal. If they are so-called mittee negotiated an initial benefit fee-for-service system that does not champions of the poor, this is the most level of $2,200. This was an agreement. work. Do you want the private sector generous federalization of a govern- Tuesday night, armed with a CBO score to become a 1965 Medicare fee for serv- ment benefit in U.S. history. Maybe that was under $400 billion the nego- ice model? This bill is spending billions they are ignoring the low-income sub- tiators closed the donut by $50. This and billions of dollars to make adjust- sidies. It is not insignificant—$192 bil- cost $4 billion. I have no doubt in my ments for doctors and hospitals and lion according to CBO. I think it is so mind that once this passes, future Con- providers because government is under- much more than that. I think when gresses will be working to fill that funding them? That is not the private people find out their only copay is $1 or donut hole, and my guess is they will market and we should not tie them to $3 or even $2 and $5, utilization will be successful. My guess is they will be Medicare’s price controls. skyrocket. This chart will be so inac- successful in increasing the number of Senator GRASSLEY has been a cham- curate. people eligible for these enormous low- pion for increasing assistance to rural We will find out if we have underesti- income subsidies. It doesn’t have to be areas, and he is exactly right. The mated the impact of providing a fed- 150 percent. As a matter of fact, the present system hasn’t worked very eral benefit upwards of a 90 percent Senate bill passed at 160 percent of pov- well. I wanted to come up with a more subsidy. In a few years we will find out. erty. So I am sure there will be amend- modern system with integrated bene- People who don’t have to pay much—in ments year by year to increase that fits that integrates Part A, Part B, and other words, if the Government is pay- level up for the super government ben- Part D—hospitals, doctors, and pre- ing 90-some-odd percent of it, 95 or 97 efit. Let’s make that eligible up to scription drugs—and avoid the neces- percent, which would be the case in $30,000 or $40,000 so that will be hap- sity of a Medigap plan. People had to many of these income categories, utili- pening. have Medigap because Medicare alone zation will skyrocket. At least that is I also think areas in which there are didn’t pay for a lot of benefits, and it my opinion. Maybe I am wrong. We will significant savings in the bill—and I had too high of a deductible. People find out. I am making this statement was involved in this—the reach-back, had to buy Medigap. They shouldn’t for the record because I think this ben- where we try to recapture a portion of have to do that. I was hoping we could efit is going to cost a lot more than the savings going to States we will see come up with a good, reasonable inte- people estimate. I think utilization slowly undone. My guess after this be- grated system. I am afraid that maybe will skyrocket. comes law, States will be lobbying us we haven’t quite attained that. I am For individuals who have incomes extensively: You are taking too much afraid our reforms are really not ade- less than $14,500, or as a couple, $19,500, back. We want that reduced. In fact the quate for the explosiveness of the bene- between that 135 percent and 150 per- reach-back provision was reduced just fits we are looking at today. cent of poverty, their copay is 15 per- this past week at a cost to the tax- Let me touch on the integrated ben- cent. The Government is going to pay payers of $4 billion. efit. I have heard some people say this 85 percent. Again—no donut hole. They I am afraid in many cases States will is a ripoff because we are giving money will have a reduced sliding scale pre- continue to be successful. So that cost to insurance companies; that it should mium and a reduced deductible of $50. will explode. As a matter of fact, I will be done by the Government. I have al- This too is an enormous benefit that make a prediction. Within a few years, ready mentioned that Government will skyrocket. the donut hole will be eliminated, the doesn’t do a very good job in providing

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00018 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.030 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15609 the benefits today. Now we are trying fix it, and Congress has some proce- fordable or sustainable. Right now, it to have the private sector come in dures. Nothing mandates Congress do is estimated to cost $400 billion over after Part D, the private sector for a it. We tell the President he should. the next 10 years. The program doesn’t prescription drug package. Nobody in That is years away. I find that to be a even start for a couple of years; that is, the real market right now offers to little hollow. I wanted real cost con- over the next 8 years. The Congres- Medicare beneficiaries or for that mat- tainment. It was opposed by many— sional Budget Office directive said that ter anyone a stand-alone drug benefit. particularly on the Democrat side—and in the next 10 years they thought this We hope and pray they will in the fu- we weren’t successful in getting that program might cost up to $1.5 trillion ture. But if they do, they will have to in. That is unfortunate. to $1.7 trillion. That is with the bene- basically offer exactly what we told There are several provisions in this fits structure as we have outlined it them to offer, and that is the benefit bill that are good. I want to com- today. As it expands, it will be much structure of 75–25 up to $2,250. We are pliment again Senator GRASSLEY and more than $1.7 trillion. When the donut limiting the private sector to only of- Chairman THOMAS. We did get health hole is filled—and I predict it will be— fering a government-designed benefit. savings accounts. It is not directly re- when you have the number of eligibles There is this big donut hole in the lated to Medicare, but I think it would increase dramatically to receive the government standard benefit and we help reform health care as we know it. low-income subsidies, when we reduce have a governmental catastrophic, People would actually be spending the reach-back or claw-back from some call it Government reinsurance— their own money. I think that is a very States, this $1.7 billion in the next dec- which ties the hands of the private sec- positive and a good significant change, ade will probably be much more than tor and denies seniors the best the pri- and it will change people’s behavior. that. vate sector has to offer. For example, That is about $6 billion or $7 billion. That brings me to my final comment. After you spend $3,600 of your own That is very positive. I compliment Can we sustain it? I am not sure. It money, then Government reinsurance Senator GRASSLEY and Chairman looks to me like we are building a will kick in, and individual beneficiary THOMAS especially for putting that in. brand new deck on a house with a very will be liable for 5 percent. The Govern- We did put in income-relating Part B unstable foundation. I think we are ex- ment is responsible for 80 percent of all premiums. Senator FEINSTEIN and I panding this program like it is on a costs above the $3,600 ‘‘true out of worked on that amendment on the Sen- solid foundation, and it is not. We are pocket’’, the health plan is covering 15 ate floor. We included a lot of that in not paying for these new benefits. We percent and the individual 5%. The pri- the bill, not exactly as we put it in the are saddling our future generations bill on the Senate floor, but I think vate sector is not able to assume full with enormous liability. risk and offer the benefits they want. If that is a positive change. But to my re- I conclude by saying I have the great- the private health plans did offer in- gret, it puts more money in the bill, est respect for the chairman of the creased benefits they would lose or and basically we spent that money. committee. I have the greatest respect We did get income-related Part B. delay government subsidies. This is for the majority leader. I want them to Basically, that means we are going to crazy. All they are able to offer is basi- be successful. I want the President to have less subsidies for higher income cally the basic benefit up to the $2,250, be successful, and I want senior citi- people. Part B has always been paid or the actuarial equivalent, but they zens to have prescription drugs. I want are not able to offer both. They are not for. When it was created, it was 50 percent for individuals. Over the years them to have a modern Medicare sys- able to say they will take all of Part tem. This bill takes some steps in D—that they will assume all of Part D that has been declining. Now the individual only pays 25 percent, and the those directions, but my conclusion is and combine it with Part A and Part B Federal Government pays 75 percent. that the benefits greatly exceed the re- and use efficiencies between the sys- What we said is if you have income forms. Without necessary reform, I am tem having an integrated benefit and above $80,000 up to $100,000, eventually not sure this program will be sustain- maybe doing something better in hos- you have to pay 35 percent. If you have able in the future. So it is my inten- pitalization and doctors, have some individual income above $100,000, even- tion not to support this bill. savings and offer a more generous drug tually you have to go up to 50 percent Also, I want to compliment some benefit. They are not able to do that where it used to be. If you have in- people who have worked very ener- because under this bill, they are re- comes much higher than that, you will getically on this bill. One is my staff, quired to maintain this true out-of- have to pay 65 percent, or you will have Stacey Hughes, who has just worked pocket cost. This bill puts the private to pay 80 percent. Even very wealthy unbelievable hours; on Senator GRASS- plans in straight jacket. people will still get a 20-percent sub- LEY’s staff, Linda Fishman and Mark I think that is very unfortunate. It sidy under this provision. I think that Hayes, and the Senate legislative coun- really kind of locks in an inflexible is good reform. sel. There are a lot of people who have structure. We are telling the private We also index Part B deductibles. It put in more hours than you can imag- sector, which have extensive experi- has been $100 for a long time. Now we ine to put forth this bill. I compliment ence in offering comprehensive benefits index that to the cost of the program. them for their efforts. They worked in for all types of individuals including Those are good changes. They will help a very positive way. It is a pleasure to public and private sector employee and improve it. Unfortunately, the savings work with them and to work with the individuals, that they have to sell a to the taxpayers as a result of these chairman. government benefit. They can not offer changes have already been spent in this I yield the floor. a plan with prescription drugs for our bill. As a matter of fact, in the 2 or 3 Mr. President, how much time do I seniors without having a donut hole. days of negotiations, we amended the have remaining? We are mandating that they have that benefits and the subsidies in the bill by The PRESIDING OFFICER. One before they can get into catastrophic. I about $40 billion. Most of the good done minute five seconds. find that to be very unfortunate and by the income-relating of the Part B Mr. NICKLES. I yield that time to very shortsighted and maybe even un- premiums and the indexing of the de- the Senator from Iowa. workable. It doesn’t really transcend ductible were undone. The PRESIDING OFFICER. The Sen- the movement to private sector. It I have no doubt that in future Con- ator from Iowa is recognized. doesn’t trust the private sector. By gresses that the current 75 percent up Mr. GRASSLEY. Mr. President, I cer- doing that, I am afraid we have put in to that $2,250 subsidy will be changed tainly think the cooperation we have a rigidity that won’t allow it to work and the $2,250 is going to be climbing had from the chairman of the Budget as we would like for it to. up. I have no doubt that people will say Committee, Senator NICKLES, helped to We did not get cost containment. We we need the most generous subsidies move this bill along. Even though he tried. Maybe I should say we have and low-income subsidies which needs has not liked some parts of the bill, he minor cost containment. We did put in to apply to a lot of other people. It will has been cooperative all the way a provision that says if general revenue increase spending dramatically. through the process and, more impor- contributions exceed 45 percent, the My point is, Yes. We made some re- tantly, through the crucial time of President shall come up with a plan to forms, but this program may not be af- conference.

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00019 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.032 S23PT1 S15610 CONGRESSIONAL RECORD — SENATE November 23, 2003 There is a claim that pharmacies are I hereby submit the following revi- scription drug benefits and more about concerned about beneficiary access to sions to H. Con. Res. 95, and I ask a prescription to benefit large drug pharmacies, pricing transparency unanimous consent to have it printed companies. America’s seniors deserve issues, and insurance risk. in the RECORD. better. I understand the concerns of phar- There being no objection, the mate- As I have traveled around the coun- macists with regard to local access. rial was ordered to be printed in the try and heard from countless numbers This bill provides several provisions to RECORD, as follows: of seniors about their health care ensure that Medicare beneficiaries are Current Allocation to Sen- needs, they repeat again and again how provided with adequate choice and easy ate Finance Com- they need and they want more afford- accessibility to local pharmacies. mittee: able prescription drugs. ‘‘More afford- First, the conference report provides ($ in millions) able’’ are key words when measured choice to beneficiaries by containing FY 2004 Budget Author- against this bill. They need and want a an ‘‘any willing provider’’ provision. ity ...... 771,171 quality Medicare plan—I emphasize This provision requires prescription FY 2004 Outlays ...... 773,820 FY 2004–2008 Budget Au- Medicare plan—that lets seniors choose drug plans to accept any and all phar- thority ...... 4,618,622 their own doctors, their own hospitals, macies willing to agree to the terms FY 2004–2008 Outlays ...... 4,627,988 and provides prescription drug cov- and conditions of the plan. By adding FY 2004–2013 Budget Au- erage. this provision, we have given all phar- thority ...... 10,991,722 I have met seniors across the country macies, big and small, the chance to FY 2004–2013 Outlays ...... 11,007,116 who have cut their medication, they participate in the modernization of Adjustments: have cut the dosage in half, because Medicare. FY 2004 Budget Author- they cannot afford their prescription Second, the conference report pro- ity ...... 4,800 drugs. I met a woman the other day vides beneficiaries with convenient ac- FY 2004 Outlays ...... 3,800 FY 2004–2008 Budget Au- who could not even afford to start her cess to pharmacies by adopting the thority ...... 11,725 prescription drugs because the initial TRICARE standard for prescription FY 2004–2008 Outlays ...... 11,576 bill was $100 and she did not have the drug plans. In urban areas, 90 percent FY 2004–2013 Budget Au- cash. I met people in small businesses of beneficiaries would have a pharmacy thority ...... ¥5,000 who have seen their health care pre- within two miles of their residence; 90 FY 2004–2013 Outlays ...... ¥5,200 miums more than double because drug percent of beneficiaries in suburban Revised Allocation to Sen- prices are rising so fast. And I met sen- areas would have access to a pharmacy ate Finance Com- iors in New Hampshire and elsewhere within five miles of their home; In mittee: FY 2004 Budget Author- who have no idea how they are going to rural areas, plans would be required to ity ...... 775,971 possibly pay their rent and cover the provide 70 percent of beneficiaries with FY 2004 Outlays ...... 777,620 prescription drugs they need. a pharmacy 15 miles within their resi- FY 2004–2008 Budget Au- When we break past the advertising dence. thority ...... 4,630,347 bought and paid for by the special in- By adopting this standard, bene- FY 2004–2008 Outlays ...... 4,639,564 terests to sell this bill as something it ficiaries are ensured adequate conven- FY 2004–2013 Budget Au- is not, we will notice that America’s ient access to pharmacies of their thority ...... 10,986,722 seniors are outraged by what they have choice. FY 2004–2013 Outlays ...... 11,001,916 seen already about this legislation. I The conference report also requires The PRESIDING OFFICER. The Sen- was at a forum the other day sponsored that plans permit beneficiaries the ator from Nevada. by AARP, and when it was mentioned ability to fill their prescriptions at a Mr. REID. Parliamentary inquiry. what was happening in the bill, seniors community pharmacy rather than This, of course, has nothing to do with booed their own leadership in the through the mail. Again, ensuring ac- the legislation. It is my understanding AARP. It is no wonder AARP members cess to local pharmacies. the action of the distinguished chair- are tearing up or burning their cards. In addition to providing convenient, man of the Budget Committee would For Senators who are planning to local access to pharmacies, the con- not be in derogation of the consent vote for this bill, I ask a very straight- ference report provides safeguards to order before the Senate for debate forward question: How are you going to ensure fair drug pricing and protects today. explain to seniors that Congress stuck pharmacies from insurance risk. The PRESIDING OFFICER. The them with a Medicare plan that forces Under the report, pharmacy benefit Chair’s understanding is that changes those seniors into HMOs? How are you manager’s, PBMs, would be required to in the allocation being submitted by going to explain to seniors that this disclose all discounts, rebates, and the Senator are just being printed in plan will stick them with a raw deal charge backs given to them by drug the RECORD. that raises premiums for those who do manufacturers. This places local phar- The Senator from Massachusetts is not want to go into an HMO by $56 to macies on a fair playing field with recognized. $200 a month? What do you say to the PBMs. Mr. KERRY. Mr. President, I believe 2 or 3 million seniors who are actually The report also prevents insurance we ought to reject this Medicare bill. going to lose quality retiree prescrip- risk to pharmacies by clarifying that When I look at it carefully—which has tion drug coverage under this bill and pharmacies could not accept insurance been hard because there has not been a they are going to get something much risk. lot of time—it is clear it is a cruel hoax worse? This conference report adequately for seniors and a cynical giveaway to We have to, in future years, add a addresses the concerns of pharmacies drug companies and to the insurance real prescription drug benefit to Medi- and pharmacists alike. It makes sure industry. Even as we speak, there are care in order to make seniors’ lives that beneficiaries have local and con- lobbyists scurrying around Capitol Hill better. By now accepting a phony drug venient access to pharmacies, provides working feverishly to pass a bill that benefit, Congress literally risks mak- transparency pricing, and protects has already driven up the stock of ing it worse for those seniors. pharmacies from insurance risk. those corporations I have mentioned, How do you explain to seniors that REVISIONS TO H. CON. RES. 95 the insurance industry and drug com- Congress was not willing to let them Mr. NICKLES. Mr. President, section panies across the country. The rise in buy cheaper prescription drugs from 401 of H. Con. Res. 95, the budget reso- that stock tells the story about the Canada, but Congress was willing to lution, permits the chairman of the windfall profits that come with this hand the pharmaceutical companies Senate Budget Committee to make ad- bill. new windfall profits of more than $139 justments to the allocation of budget With the help of President Bush, they billion? authority and outlays to the Senate produced a Medicare bill that lines the How are you going to explain this bill Committee on Finance, provided cer- pockets of the powerful moneyed inter- could only be passed in the House tain conditions are met pursuant to ests and it leaves America’s seniors out under the cloak of darkness in the section 401. in the cold. This bill is less about pre- early morning hours, and only then by

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00020 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.016 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15611 stretching the rules of the House be- the vote. Time and again, the Presi- you about three or five cards they al- yond almost anything in history? And dent chooses to get cozy with the lob- ready carry in their wallets to get a that the Senate then jammed through byists. We saw it on the Energy bill. discount on drugs. a 700-page bill with only 3 days of de- We have read it in the newspapers in Seniors deserve and expect more than bate, giving seniors very little chance the last weeks about who gained and a discount card with $400 billion on the to understand what is involved in the who lost on any particular debate each table. If we were really crafting a drug biggest and most dangerous change day in the debate over this bill. This benefit and allowing the Government ever made to Medicare? administration’s motto ought to be: to institute cost-saving measures in I ask those Senators who are plan- Leave no special interest behind. This order to tame out-of-control prices, we ning to support this bill why they Medicare bill lays that record bare for could deliver a benefit sooner than think it is worthy to hold a prescrip- all Americans to see. 2006. The Government ought to be tion drug benefit hostage to a back- The President goes around the coun- ready to do this within a matter of door deal to privatize Medicare, a deal try at a furious pace, fundraising at months. that will help lobbyists, help powerful record levels. He has a group of insiders The entire Medicare plan was set up Washington interests and other inter- who provide his campaign with a min- in 11 months. Now that it is already set ests around the country and help phar- imum of $100,000 of campaign cash. up, in the age of computers, are we say- maceutical companies but will literally They have a name. They are called ing we could not deliver a prescription make the lives of a lot of our seniors ‘‘rangers’’ and ‘‘pioneers.’’ Well, it drug benefit in a matter of months? worse off than they are today? should come as no surprise to Ameri- Why are we waiting until 2006? I will Seniors need relief from inflated pre- cans, and particularly to seniors, that tell you why. It is for the private, for- scription drug prices, and they need it 24 ‘‘rangers’’ and ‘‘pioneers’’ are execu- profit companies that need to lure peo- now. Nearly 40 percent of Medicare tives or lobbyists for the very compa- ple into the market. And it is going to beneficiaries report having no prescrip- nies that will benefit from this Medi- take them time to warm up to the tion drug coverage. Yet the average care bill, and they are getting a good plan. We are waiting for 2006 for those amount they have to pay out of their return on their money. companies. own pocket for prescription drugs is This bill makes it easier for the big This bill sets aside a $12 billion slush going to more than double between the drug companies to gouge seniors and fund for the Secretary of Health and years 2000 and 2006. It is on track to be jack up health care costs so that top Human Services to entice private $1,400 the year this bill is scheduled to executives can walk away with mil- HMO-style plans to come into the mar- go into effect. If you deduct the lions. I am all for people who work ket in order to offer prescription drug plans to seniors. Larded up financial amount of money given by this bill hard to make a living, and I want peo- inducements are needed to attract from the amount seniors will be paying ple to be able to get rich in America. on average out of pocket, the benefit to these plans to the market because the But when the drug companies’ CEOs most seniors in this country for being risk is so high. are making $40 million a year while the pushed into an HMO will not be worth Insuring seniors for drugs usually seniors they sell to are choosing be- the cost. makes about as much sense as trying Congress ought to be demanding tween their medicine and their mort- to sell a homeowner’s policy to some- more. We ought to be demanding a real gage, I do not consider that just plain one whose house is burning down. In deal for seniors, a Medicare bill that old free enterprise; I consider that other words, you are going to lose does what it says instead of this phony plain old greed. money. But in the name of ‘‘private This bill smooths the way for even bait-and-switch legislation. We ought competition,’’ and to prevent the Fed- higher drug company profits. In the to go back to the drawing board and eral Government from running this past 6 months, drug companies, HMOs, pass a real Medicare prescription drug program, this is what they came up benefit. This bill does more harm than and other powerful industries have with: a great big cookie jar from which it does good. Seniors are not guaran- spent $139 million in lobbying Congress to dole out public dollars to private teed that the price of their plan is not to give them what they want. Now they companies to get them to do what we going to skyrocket. This bill prohibits have gotten a bill that will give them could do less expensively and at less the Government from even negotiating an estimated $139 billion over the next cost to seniors. discounts for Medicare prescription 8 years. A thousandfold return on an On top of giving them extra pay- drugs. It prohibits the Government investment is not bad. You can say ments to participate, the bill does from doing that. It denies the oppor- what you want about President Bush, nothing to require that private plans tunity for seniors to import reasonable but it is clear that his powerful cam- actually operate efficiently. The Medi- drugs from Canada and other industri- paign contributors got what they paid care Program, in its entirety, now alized countries. How extraordinary for. And it is easy to see why they spends only 2 percent of total expendi- that the acolytes of free trade are clos- make so much profit, given this bill, tures on administration. By contrast, ing down the ability of Americans to which does nothing to control the ris- many health plans in the private mar- exercise free trade and import a prod- ing prices of prescription drugs, noth- ket often commit as much as 15 to 20 uct from another country at a lower ing to control the rising prices. percent of their expenditures to admin- price. Without an effective means to re- istration. So every dollar that goes to This bill is really about President strain double-digit price increases, this administrative costs is a dollar not Bush passing the buck on prescription bill does nothing to protect seniors available to improve benefits for Medi- drug coverage and passing the bucks from ever-growing out-of-pocket costs. care beneficiaries. from seniors to the pharmaceutical in- Someone needs to explain why we are I think smart stewards of taxpayer dustry. And this bill is being pushed in such a rush to do this. Is someone dollars ought to demand that private through Congress without adequate de- concerned that the more this cynical plans be more efficient if they want to bate and exposure to the public light, bill is exposed, the less likely seniors participate. Instead, they are being re- with too many backroom deals, and will be to accept it? What harm would warded from the slush fund and given with blatant contempt for the public be done if the Nation took some time advantages that only their lobbying in- interest. to look carefully at what is in this bill? fluence could get written into law. The Republicans could not win a le- This plan does not kick in until 2006 In addition, this bill squanders an- gitimate victory in the House, so they anyway. So it is not as if seniors are other $6 billion on tax breaks for held the vote open for an unprece- going to get the relief they deserve at wealthy Americans that is going to dented 3 hours of special interest lob- the stroke of a Presidential signing harm Medicare. The legislation would bying, of almost $900 million of give- ceremony—no indeed. For the next 2 create a tax-free, high-deductible cata- aways in exchange for votes, so they years, seniors are going to get a dis- strophic health policy known as health could get enough people to switch over count drug card to give them a 15-per- savings accounts. That account will to their side. cent discount. Well, it does not take an undermine the traditional Medicare President Bush twisted arms, twisted act of Congress to do that. Ask any Program because it will result in cher- facts, until he finally managed to get senior today, and he or she will show ry-picking. The healthiest and the

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00021 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.037 S23PT1 S15612 CONGRESSIONAL RECORD — SENATE November 23, 2003 wealthiest seniors will come out of the called donut hole. I think we ought to will help them. We should pass a bill risk pool where they share the risk of go back to the drawing board. They that offers a real prescription drug ben- coverage, and that will result in rais- know this bill does not adequately pro- efit under Medicare. We need to rebuild ing the premiums for everyone else— tect them with a guaranteed govern- Medicare, not sell it out to the highest for the poorer and the sicker—and it ment fallback with a national pre- bidders. Medicare is one of the best will raise those premiums by as much mium. Until this bill stops slanting all Federal programs we have. I don’t be- as 60 percent. the advantages toward the HMOs and lieve it is time to shred it. It is time to The so-called cost containment pro- private companies, I believe we have to strengthen it. This Congress and Presi- visions in the bill add insult to injury vote it down. dent Bush will be held accountable by by essentially placing a cap on Medi- I believe seniors deserve a guaranteed America’s seniors and American his- care spending. This bill would attempt Government fallback plan. Seniors tory for the decision we make now. I to force future Congresses to reconcile know that this bill will jack up the believe we ought to give seniors a real Medicare spending growth by cutting out-of-pocket costs in order to visit deal, a prescription drug benefit under benefits, raising premiums, or increas- doctors and hospitals. This is supposed Medicare that works for them, and not ing the payroll tax. I believe that is un- to be a bill to add a prescription drug a phony prescription drug benefit that acceptable. benefit, but along the way beneficiaries provides benefits only for the most So what do America’s seniors get got stuck holding the bill for an addi- powerful special interests that stand in from this bill? tional $25 billion in increased out-of- their way. More than 2 million seniors who have pocket costs from means testing the I yield the floor. good drug coverage now, through re- Part B premium and increasing the de- The PRESIDING OFFICER (Mr. tiree health plans, are going to lose it. ductible and indexing it to inflation. GRASSLEY). The Chair recognizes the About 61⁄2 million low-income seniors— This revenue raiser isn’t done in Senator from Missouri. the very people we need to help the order to improve Medicare but to give Mr. TALENT. Mr. President, I appre- most—could get less drug coverage sweet deals, slush funds, and tax ac- ciate the opportunity to speak about than they have now. That is a raw deal counts to corporations and to the rich. this landmark piece of legislation that for seniors. It is wrong. We should vote it down. is so necessary and has been so nec- Under this bill, 7 million seniors will I believe the proponents know that essary for too long and of which we be given this choice: Pay more for this bill fails to fix protections for low- have deprived America’s seniors for too Medicare and get forced into an HMO, income seniors—certainly low-income long. If I may say with great respect, I give up on choosing your own doctor seniors know that across the country— had a chance to listen to the last two and hospital, or watch your bills sky- and people with disabilities that cur- speakers, my friend from Oklahoma rocket. That is the choice for seniors. rently rely on both Medicare and Med- and my friend from Massachusetts. Lis- The name of this provision in the bill icaid for their coverage and should be tening to those speakers just summed is called premium support, but like defeated. They know it and you know up for me why we have not passed this Clear Skies, which means dirtier air, or it. This is not a good deal for seniors. bill in the years and years it has been Healthy Forests, which means cutting This week in November of 1945, Harry necessary and that seniors have been down the trees, it is an innocent-sound- Truman sent to Congress a proposal for demanding it. The last two speakers ing name for a plan that could raise health care for Americans. He said: represented pretty well and eloquently, Medicare premiums from about $60 to Millions of our citizens do not now have a with their usual vigor, the opposite thousands of dollars. It breaks the full measure of opportunity to achieve and ends of the political spectrum on this compact of Medicare. to enjoy good health. And the time has now bill. In fact, what it really means is the arrived for action to help them attain that For the first speaker, the bill rep- beginning of the end of Medicare as we opportunity and to help them get that pro- resented too much government, too know it. Those are not my words, those tection. much money. For the second speaker, are the proud boasts of the author of But powerful interests mobilized 1945 it represented too little government, this bill, House Ways and Means chair- on Capitol Hill and defeated health too little money. Both speakers are man, BILL THOMAS. He said: care for Americans, Harry Truman’s terribly disappointed with President To those who say that it would end Medi- proposal, and especially for our seniors. Bush. Both want more time to consider care as we know it, our answer is, we cer- It was almost 20 years later that a this bill and, if necessary, go back to tainly hope so. young American President took up the drawing board; if necessary, wait It is not surprising that Newt Ging- Harry Truman’s cause and called for years more before we provide a pre- rich is supporting this deal because he health care for America’s seniors. This scription drug benefit that millions of long wanted Medicare to ‘‘wither on week in November of 1963, the House of seniors around the country need and the vine.’’ Most Americans and most Representatives was considering John have needed for many years. Democrats have a different hope, that Kennedy’s Medicare proposal. The I rise to speak in favor of the bipar- Medicare remain secure and strong. I same powerful interests were swarming tisan Medicare conference agreement. I intend to fight with everything I have through this building, but there was a think it is necessary. Medicare is a to make that happen. spirit of hope and possibility. Now great program. My dad passed away We need a real-world, affordable those who support this bill are break- last October. He was 91 years old. My Medicare prescription drug benefit for ing the promise of Truman and Ken- mom had passed away about 15 years seniors, a plan that won’t force seniors nedy that was fulfilled under President before then in her early seventies. into an HMO, that won’t undermine the Lyndon Johnson. They both used Medicare and stayed coverage for seniors who are already This has been tried before. This week alive as long as they did and as healthy getting help today, that will be run by in November of 1995, 30 years after and as happy as long as they did in part Medicare instead of an insurance com- Medicare became law, Speaker Newt because of Medicare. It has covered pany in search of a buck, and that will Gingrich and his ideological allies shut tens and tens of millions of seniors, not send a real benefit to every senior, no our Government down for the first only with good medical care but with matter whether the costs are average time ever in order to achieve their rad- the security of knowing that they had or high. That is a real deal for Amer- ical objective of tearing down Medi- medical care if they got sick. ica’s seniors. But as I said before, right care. Millions of seniors would have Medicare was a great program and is now this bill is a bad deal for seniors been harmed by those cuts, but we a great program in 1965 terms. That is and they know it. stood up and we stopped Newt Gingrich when it was developed. It covers the They know that this bill provides the because President Bill Clinton and oth- kinds of things that good health care skimpiest of benefits, with holes in ers stood their ground and defended covered in 1965, and it doesn’t cover the coverage and complex rules. The cov- Medicare. kinds of things that were not covered erage gaps remain too high, and seniors I believe we need to stand our ground in 1965. It doesn’t have very many pre- are still charged premiums even after today and stand on principle again. ventive health care benefits, cata- their benefits shut down in the so- This bill will hurt seniors more than it strophic coverage for long-term acute

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00022 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.039 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15613 illnesses. And it does not have coverage conditioner working in the summer is ests. I have been in a lot of meetings on for outpatient prescription drugs be- hard for her. All of these statements this, and that hasn’t come up once. cause in 1965 you didn’t use prescrip- about the problems in this bill mean They are trying to do the best they can tion drugs very often, unless you had nothing to Audrey, who struggles for seniors, in a way that will work and an infection or some kind of pain kill- month after month because of this gap be affordable for everybody. That is er. Now they are a part of almost every in Medicare. what this bill does. I am going to vote ongoing medical care treatment plan. What would the bipartisan agreement for it on that basis. I hope it passes. Everybody who has health insurance— mean for Missouri? We have over I congratulate the chairman, who is and not enough do—just about every- 888,000 beneficiaries in Missouri. They presiding now, for his fine work. body who does has some kind of pre- all have the opportunity to get a dis- How much time remains? scription drug coverage because it count card—a 15- to 25-percent discount The PRESIDING OFFICER. There helps keep you healthy. immediately. Better than that, low-in- are 21 minutes remaining. In providing insurance to somebody, come seniors get, in addition to that, Mr. TALENT. I am pleased to yield you want them to stay healthy because $600 a month in annual assistance to that time to my friend from Colorado. The PRESIDING OFFICER. The Sen- if they get sick, it ends up costing help them afford their medicines, along ator from Colorado is recognized for 21 more money for everybody. That is the with discount cards. That is a total of minutes. reason we haven’t had this coverage in over $200 million in assistance for over Mr. ALLARD. Mr. President, I thank Medicare, and it has hurt people. 170,000 Missouri residents over the next the Senator for yielding the balance of There was a parade I used to be in 2 years, if we pass this bill—not other- his time. every year when I was in the House. I wise. Mr. President, first I want to com- Beginning in 2006, every Missouri like parades. You get a lot of exercise, pliment Majority Leader BILL FRIST, and they are fun. It is in Hazelwood, senior in Missouri would be eligible for from Tennessee; Chairman of the Fi- coverage in this bill for approximately MO. I would go down the same street. I nance Committee, CHUCK GRASSLEY; always walk parades. I remember run- $35 a month. They get at least 50 per- and the Conference Committee on ning up this driveway and these two cent off—or approximately 50 percent working diligently and in good faith seniors would be sitting at the top of off their prescription drug costs. Of the toward a workable prescription drug their driveway watching the parade approximately 270,000 beneficiaries in program for elderly citizens. Some every year. Every year I would stop Missouri who have limited savings and have come to this floor and proclaimed there for 60 seconds, and they would low income, they will qualify for even it is about politics. I couldn’t disagree ask me when we were going to cover more generous coverage. Additionally, more. President George Bush, Majority prescription drugs in Medicare. the Government will help the State Leader BILL FRIST, and Chairman I would say: Well, we haven’t done it pick up the cost of the Medicaid-eligi- GRASSLEY have not only talked about yet. ble seniors. That will help Missouri, the need for a prescription drug pro- And they would say: We know that. which is in a cash-strapped situation gram but have worked hard for several Then the issue finally moved on the with regard to its budget. years toward a workable program. front burner here at the end of late This bill meets the conditions that I It is the Democrats who have 1990s and the House began passing bills, thought was important for a Medicare demagoged this issue. We just have to 3 or 4 years in a row. We never passed prescription drug bill. It has an imme- look at last year when the prescription one until this year here. The senti- diate benefit, reasonable monthly pre- bill was brought to the floor by the ments we have heard today—I respect miums, strong catastrophic coverage, Democrat majority leader, without so much the Senators who uttered targeted help for low-income seniors, having it debated and reported out of them—are the reasons why. quality benefits for rural areas, protec- committee. I believe that it was their I just do not want to wait until we tions for local pharmacies, choice and hope that they could embarrass Repub- get a bill that satisfies every extreme access to all medicine, and participa- licans in an election year. Instead, it in politics and the political exigencies tion in it is voluntary. If you like what only helped point to the failures of a for everybody because we will wait for- you have, you don’t have to partici- Democrat-led Senate that couldn’t ever. We will never get a bill then. I pate. even pass a budget because they did would rather go ahead with this bill, That is the reason I am supporting not want to deal with the tough votes which is a good bill, and take what is this. I will be pleased to vote for it on they would have to face on this floor. good about it and then see what is final passage. I hope a majority of the I believe this Republican-led Senate working and what isn’t working and Senate does. I hope we are allowed to is wrapping up one of the most success- then go back and fix it. vote. You never know these days. This ful sessions since 1994. There have been That is the reason the AARP sup- is the most important Medicare bill in long hours and a lot of hard work that ports this. They are tired of waiting, a generation and maybe we will be able has paid off, despite filibusters on too. I had a hearing on this. I have the to vote on it and maybe we will not. I judges and attempts to slow down and honor of sitting on the Special Com- know most of the people want to have kill many provisions, such as the budg- mittee on Aging, a great committee, an opportunity to vote on this bill. I et. But Republicans passed a budget. with a great chairman, Senator LARRY think most will vote for it if they get Republicans are still working hard to CRAIG. The hearing was in St. Louis. that opportunity. pass an energy bill that was blocked One of the witnesses was Audrey I am going to close by saying what I through the efforts of key Democrats, Vallely, a delightful lady, who at- have said on the fairly rare occasions and the Republicans are now working tended the Route 66 Senior Center in when I have spoken on this issue on the hard to pass a description drug benefit Eureka, MO, regularly. I have been out Senate floor. In this body, everything that is facing a possible filibuster on there for lunch a couple of times. She always gets said but not everybody the Senate floor by the Democrats. testified about her experiences over the says it. Once in a while, I feel maybe I Mr. President, I am very dis- last 12 years. Audrey suffers from os- should deprive the Senate of my com- appointed that we have had to face all teoarthritis, a degenerative bone dis- ments on something in the service of this obstruction on the floor, despite ease, and she also has a sinus disease. expedition. But I have said, look, if the the concerted effort to work respon- She ought to be taking two different bill is reasonable, I am going to move sibly and respectively through the Sen- types of prescription drugs for these ahead with it. I am tired of waiting. I ate committee system, then bringing conditions, but it costs $100 a month would like to help these people, such as the prescription drug bill to the floor for 15 pills. So she often cannot take the folks I saw in that parade, and like and passing it. Now, here we are again, the drugs. She gets some pain relief Audrey Vallely, and others, get access facing a threatened filibuster by the over-the-counter pills; sometimes it to prescription drugs. I think most of Democrats. Mr. President, we need to makes her feel better and sometimes it the people who have worked on this on have an up or down vote on this con- doesn’t. She does the best she can. She both sides have done their best. As far ference report. Again, I know that the has to choose between paying for those as I can tell, they are not motivated by conferees worked hard in a bipartisan drugs or paying her rent. Having an air all the lobbyists or the special inter- way.

VerDate jul 14 2003 00:58 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00023 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.042 S23PT1 S15614 CONGRESSIONAL RECORD — SENATE November 23, 2003 I plan on voting for cloture because I This Congress puts forth a health will do better at controlling drug costs want to see the conference report on savings account that will work. Indi- than other proposals. To suggest that Medicare voted on the floor of the Sen- viduals can put in $5,000 a year or a no one should support a Medicare drug ate. I have stated that I am undecided family can put up to $10,000 per year benefit because it will lead to increased on final passage. That is because, as a and save on their taxes. The income drug sales turns logic on its head. If general rule, in the process of negotia- builds up within the health savings this were our basic principle, then we tions, legislation doesn’t get less ex- fund without tax liability and, finally, should not have food stamps because pensive, it gets more expensive through can be pulled out to pay for the family this will lead to increased profits by spending to attract more support and medical needs without paying addi- grocery stores and farmers. How about votes. I hope to act as a counterbalance tional taxes. housing subsidies? This might lead to with the clear message that, if spend- This is wonderful reform because it profits by construction companies and ing gets out of hand, I will not vote for reestablishes the doctor-patient rela- utility companies and increased sales the bill. tionship and makes individuals respon- of lumber, bricks, and nails. This is I am not happy with creating a new sible for their own health care with just an absurd issue, and it is easy to program that could lead to a mon- much fewer regulations, and it brings see why. strous program in the future. That is common sense to the decisionmaking I am here to tell you that this bill why I opposed the bill as it left the process. It builds upon previously en- will strengthen and improve the Medi- Senate, because it was not limited to acted medical savings accounts that care Program. The spending on this bi- just the most needy and I felt it broke have been limited to small business partisan prescription drug bill goes to the budget. It was later proved that I and the self-employed by Congress. better benefits for America’s seniors was right in the assessment that it One other attractive feature in this and the disabled. would break the budget, and with more bill is that the elderly are not forced to As I draw to a conclusion, unfortu- accurate budget figures the conference participate. It is voluntary. It also nately, those who want universal committee set to work to reduce the tries to prevent large businesses and health care and the big Government so- scope of the program to keep it below local governments from dumping their lution to drugs, making people more $400 billion for 10 years and within the current prescription programs into the vulnerable to Government control, are parameters of the budget. This, in ef- Federal system to save themselves fu- vehemently opposed to this conference fect, forced the conference committee ture liabilities and further burden the report. to means test the program and keep Federal prescription drug program. The conference report lays out a plan certain provisions that would hold the The other side has repeatedly made for Medicare reform and a way to help user accountable by forcing that pa- the claim that this bill is full of give- the most needy. It is a balance that tient to participate with a deductible aways to Republican contributors. This does not come easily and not without a and the so called ‘‘donut hole.’’ is simply not true. That is simply more lot of discussion on both sides of the In my view, it is very difficult to absurd ‘‘medi-scare’’ tactics by the op- aisle. We should at least have a vote on have a third party pay system and yet ponents of a bipartisan drug benefit for the bill. It is time to put partisan ob- maintain accountability. Users feel our Nation’s seniors and the disabled. struction aside and think about what is that they have already paid for the sys- The argument I find most amusing is good for America. I ask my colleagues to join me in tem and are going to utilize it to its the claim that this bill will lead to in- voting yes on cloture to stop the fili- maximum to get their just return, and creased drug company profits. The rea- buster and to help hold down costs to providers feel that it has already been son this bill is so desperately needed is within the budget limits. paid for and creates no particular hard- because our Nation’s seniors and the Mr. President, I yield the floor. ship on the individual so they charge disabled, particularly those with low The PRESIDING OFFICER (Mr. TAL- with little restraint the third party. So incomes, are unable to afford their pre- ENT). The Senator from Oregon. utilization is regulated. And we end up scriptions today. Let me stress that Mr. WYDEN. Mr. President, as Con- with regulations like we have now in again. The reason this bill is so des- gress considers Medicare and prescrip- the current Medicare system, which perately needed is that our Nation’s tion drugs, I keep remembering the prevents a patient from paying for seniors and the disabled, particularly older people whose stories spurred me their own medical care if they want, those with lower income, are unable— to choose a career in public service. and it prevents the physician from re- unable—to afford their prescriptions For 7 years, before I came to the Con- ceiving cash outside the system that today. Today they are forced to choose gress, I worked with seniors and spent could reduce the burden on taxpayers. between food and rent and taking their many hours visiting with them in their It ends up creating a system where the medicine. We have all heard the stories homes. During those visits, seniors close patient-doctor relationship is dis- of seniors cutting their pills in half to would often bring out shoeboxes full of rupted to where the patient can’t use get by and in so doing taking a lower health insurance policies that were whomever they desire to care for their dose than their doctor prescribed. supposed to fill the gaps in their Medi- medical needs. So what we have today When this Medicare prescription drug care. It was common for a senior then is a Medicare system that is not actu- benefit goes into effect, they will be to have seven or eight of these policies, arially sound and, if not reformed, will able to get their prescriptions filled. Of and many of them were not worth the lead to much higher payroll taxes and course, this is going to lead to in- paper they were written on. Slick, fast- huge demands on the general budget. creased drug sales. Surely, this is no talking insurance hucksters kept com- That is why I was pleased to see some surprise to anyone. With new tech- ing around and scaring the older folks, reform proposals on medicare emerge nologies and new medications, invasive and it was heartbreaking to see seniors from the conference committee, such procedures become less likely. Any pre- ripped off this way. as health saving accounts. scription drug bill that works is going After working all their lives, seniors When I served in the Colorado State to lead to increased drug sales. That is would go without each month because Senate, I sponsored, with State Rep- just common sense. they were paying for junk health insur- resentative Phil Pankey, a bill to put Where are the medicines supposed to ance policies with the precious funds in place an individual medical saving come from except the manufacturers of they needed to pay the heating bill or account; and Colorado became the first those medicines? Every single medical buy some groceries. State to have such a program. prescription drug bill introduced by When I got elected to the Congress, I Unfortunately, in an effort to pass these naysayers would also increase vowed to stop this fleecing of Amer- the bill, we allowed the program to be- drug sales and the bipartisan con- ica’s seniors. I helped to write the first come so limited that the risk pool be- ference report has the same basic drug and only tough law to stop the ripoffs came too small to function as insur- benefit structure that passed the Sen- of private health insurance sold to the ance against future liabilities. Con- ate by a vote of 76 to 21. elderly. This statute has worked to sequently, when Colorado moved to a The Congressional Budget Office has drain the swamp of fly-by-night modified flat tax, this program became concluded that the competitive ap- Medigap policies that used to rob sen- a victim of tax reform. proach in this bipartisan drug benefit iors blind.

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00024 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.018 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15615 The days of the shoebox full of health from those strongly in favor of the leg- about another employer dropping their insurance policies are gone, but the islation, such as the Federal Center for retiree benefits or cutting them back skyrocketing drug costs and lack of ac- Medicare and Medicaid Services. I significantly. There has been a dra- cess to medicine—two of the problems looked at the information from those matic reduction in corporate retiree that plagued seniors even back then— strongly opposed to the bill, such as health benefits, and it is taking place are more of a problem today. the nonprofit Center on Budget and right now before the enactment or re- During those home visits I made with Policy Priorities. jection of any legislation. seniors, I saw firsthand the pain they The critics say the legislation has The percentage of large employers of- felt when they couldn’t afford life- significant gaps in coverage for seniors, fering retiree health benefits over a saving medicine. Their anguish was especially those of modest income. relatively short period of time has physical, and it was emotional. They Proponents of the bill claim that mil- dropped from 66 percent to 34 percent. feared for their futures. They worried lions of seniors will have coverage they Consistently, the employers who keep that the choices that financial con- did not have before. There does seem to coverage have required the retirees to straints forced on them would not be be truth on both counts. So I have tried shell out for higher copayments and the right ones. to keep the focus on figures that were premiums. Employers say they have to We are very familiar with those sto- beyond any doubt. Using data from the make these cuts because of the rising ries today. Caseworkers in every office 2000 Oregon census, my staff and I have costs of health care and the effects of a in the Senate hear them constantly. A determined that 78,829 older people in lousy economy. Now along comes the senior is supposed to take four pills, Oregon had prescription costs that ex- Congress with a bill that many believe but because they can’t make ends ceeded $5,000, and under this bill these will dramatically affect retiree plans meet, they take three or two. Eventu- seniors would have their prescription in the future. ally, that senior ends up in the hospital drug costs reduced by one-half. It seems to me that with legislation where the hospital portion of Medicare, Using 2001 data from the nonprofit offering $71 billion to employers to known as Part A, covers drug treat- Kaiser Family Foundation, my staff keep their coverage, these funds can ment, but often it is too late. determined that Oregon has 106,765 sen- only be a plus in developing a strategy I have tried to rewrite stories such as iors on Medicare with incomes at or for getting more employers to retain that since I came to the Congress. That below $12,123 for an individual or $16,362 existing coverage. This is a subsidy the is why I worked with Senator PRYOR’s for a couple. companies are not going to see absent father so that States could bargain ag- Under this legislation, this low-in- this legislation. gressively and get more for their Med- come group would pay no premium for So I ask the Senate: Will companies icaid dollar when buying prescription their drug coverage and would be re- not be less likely, not more likely, to drugs that would help the low-income sponsible for a copay of no more than drop coverage if they get the funds of- elderly. I have tried to expand coverage $2 for generic drugs and no more than fered tax free under this legislation? for generic drugs. I have worked to sup- $5 for brand name drugs. The least for- I would also note that corporate retiree provisions in the conference re- plement those efforts by creating new tunate would pay only $1 for generics port are better than the provisions in health care options for seniors, includ- and $3 for brand name drugs. ing in-home care and increased pay- Most seniors with low incomes and the original Senate bill which was approved by more than 75 members of ments for providers in low-cost areas, high drug costs are likely to be eligible this body. funds that can be used to offer pre- for both Medicaid and Medicare. These Bernstein Research says employers older people are known as dual eligi- scription drug benefits to some of the spend about $1,900 per year per senior bles. This legislation assures that they elderly. Because of my history, I am on retiree drug benefits. Based on my receive at least some measure of pre- acutely aware that there is so much calculations, this bill gives corpora- more to do. The reason the debate on scription drug coverage through Medi- tions a significant tax-free incentive to this bill is so important is that Govern- care so they are not left at the mercy cover not only retiree drug benefits but ment has the obligation to do right by of perennial State budget crises and so other senior health care costs as well. a generation that deserves our respect they will not have to compete against The next question I asked was: Does and care and not give those seniors the other vulnerable groups in State budg- this bill significantly undermine tradi- runaround. et battles. tional Medicare? Critics of the bill My years working with the older peo- Another factor I considered was the have focused on this issue, and I share ple have governed the decision I have expectations for this legislation. What their view that seniors believe in Medi- made on this bill. I have tried to keep I hear from seniors at senior centers care, want to modernize it, and do not the focus on determining whether this and at meal sites is that expectations want it undermined. prescription drug benefit legislation are very high. I know some seniors will The critics seem to believe that any would make a genuine positive dif- find that this bill does not offer bene- effort, however, to create more choices ference for a significant number of fits that match their expectations. outside the basic Medicare fee-for-serv- older people or whether it falls short of Some seniors fear this bill is going to ice program is a mistake. I disagree. I that objective. fence them in and require that they believe seniors need good quality As part of the process, I have devel- participate in a program they do not choices beyond fee for service. I simply oped a set of criteria to evaluate this support. So at the very least, because believe those choices must be accom- legislation. I would like to describe the this program is voluntary, it strikes panied by strong consumer protections questions I believed were key and the me as a plus that no senior will be and that it is essential to strike a bal- answers I have found. forced to accept the terms of this legis- ance, making sure that the new choices The first question I asked was: Does lation. never, ever cut off access to traditional this bill help a significant number of So on this particular issue, with re- Medicare that seniors know so well and older people with low incomes or big spect to who benefits, what we found a program with which they feel so com- prescription drug bills? In their edi- that seniors in my State with very fortable. torial endorsing this legislation, the high drug bills would have their costs I have never been opposed to private New York Times stated: reduced by half. We found a great many sector involvement with Medicare. In The bill is strongest when it comes to the low-income people who would receive many Oregon communities, upwards of most important target groups: Elderly peo- very significant benefits with no pre- 40 percent of the elderly get their ple with low incomes or very high drug bills. mium and a very modest copay for Medicare through private plans. The It is not my job to take the word of their drugs. law I wrote stopped the rip-offs of pri- editorial writers simply because they The second question we asked was: vate health supplements to Medicare, are just one voice in a chorus that How does this bill affect seniors who standardized 10 private sector policies comes from both sides. So I have gone currently get their prescription drug to help seniors fill the holes in Medi- to some length to examine the figures coverage through corporate retiree care, and consumer advocates across and data from all perspectives. I looked benefit packages? Almost every day the country believe that law is work- at the data that has been available now we pick up a newspaper and read ing.

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00025 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.045 S23PT1 S15616 CONGRESSIONAL RECORD — SENATE November 23, 2003 The key to making the private sector large buying groups is an absolute pre- care system. Health care advances choices work is a combination of requisite for a long-term strategy for mean that seniors will live longer, and strong consumer protections and a keeping prescription costs down for many of those advances will come in level playing field between the private older people. pill form. What is exciting is that the sector choices and health services of- That was the principle behind the more researchers learn about the way fered by the Government. I have con- Medicaid drug rebate law that I helped medicines affect individuals, the more siderable ambivalence about how this author with the first Senator Pryor. personalized treatments, emphasizing legislation will affect that balance. That is the principle that Senator pharmaceuticals, will become. Drugs In the bipartisan prescription drug SNOWE and I have proposed in our bi- that work one way for Bob will work legislation I drafted with Senator partisan legislation. We looked to a differently for Mary. In the years SNOWE, we offered private sector op- market-based proposal that was built ahead, I believe a new field known as tions for seniors that contain strong around the Federal Employees Health ‘‘personalized medicine through phar- consumer safeguards. Our bill was Benefits Plan, a program that has been maceuticals’’ is going to help to in- known as SPICE, the Senior Prescrip- proven to contain costs because of the crease the quality of patient care and tion Insurance Coverage Equity Act. It sheer size of the group of Federal em- cut down on wasteful spending. did not tilt the playing field toward the ployees for which it bargains. As of now, however, baby boomers private sector the way the legislation I think it is very unfortunate that face the prospect of joining a Medicare before Congress does today with its this legislation did not put in place a Program that is already short of funds. health savings accounts and premium model like the Federal Employees That is why the $400 billion authorized support. Unfortunately, the health sav- Health Benefits Plan to contain costs. in this legislation is a lifeline for the ings accounts in this bill, which are tax But I think it has to be noted that baby boomers who are going to retire breaks for purchasing health care, are some baby steps in the right direction in just a few years. Those funds provide structured to disproportionately ben- have been taken with respect to cost some measure of security for future re- efit the healthy and the wealthy. Seven containment. The bill begins to lever- tirees, and some tangible evidence that billion dollars of tax subsidies are di- age the potential bargaining power of Congress is laying the groundwork to rected to these accounts. This has gone 30 million seniors by giving older peo- support the growing Medicare popu- from a demonstration project to a ple the opportunity to join large man- lation which will need both prescrip- major expense, one that siphons away aged care plans and big fee-for-service tion drugs and the broader program. funds that could go to beef up the drug plans that can use their sheer numbers There are several modest benefits in benefits. to negotiate discounts for older people this bill, in addition, that sounds excit- Another drawback of the legislation on their medicine. The bill also re- ing to me for Medicare’s future. One is the premium support provisions, moves some of the barriers to getting would focus on an approach known as which are designed to test competition cheaper generics to market faster. disease management. This is going to between traditional Medicare and pri- It also recognizes that there is great be attractive in the years ahead be- vate plans. These could drive seniors value in comparing the effectiveness of cause it will allow many of our coun- out of the fee-for-service programs similar drugs so seniors, providers, and try’s future seniors to have better, they want. Premium support dem- the Government can spend funds on the more cost-effective care for chronic onstrations could allow insurance com- best medicines at the lowest cost. This conditions. Medicare has lacked this panies to cherry-pick the healthy sen- is very much in keeping with the way benefit. iors, leaving the truly ill to go to poor- my own State has approached cost con- In addition to these direct benefits ly funded Government programs that tainment. for seniors, the legislation helps gear are sicker than they are. Even though I do wish this bill went further on up Medicare for the baby boomers with premium support doesn’t start until cost containment. There should be a significant increases to many deserving 2010, I don’t believe it has a responsible way to bargain for even bigger seg- health care providers. Over 10 years, role to play in this legislation. ments of the elderly, not just the frac- hospitals in my State will receive al- I don’t believe this legislation is tions of the population who end up in most $95 million. I am especially going to wipe out traditional Medicare. HMOs or various private health plans. I do believe that Congress is going to I am concerned that while private pleased that a number of medical pro- have to be extraordinarily vigilant plans have the power to bargain under viders, a number of our hospitals that with respect to ensuring that tradi- this bill, the Medicare Program is now see a small number of patients and tional Medicare can coexist and pros- barred from giving seniors the kind of those that have a large share of patients who are too poor to pay for their per along with the new choices. With- bargaining power that Senator SNOWE out careful management, it is certainly and I wanted them to have in our care, would get help. possible that health savings accounts model that looked to the Federal em- In addition, doctors across the coun- and premium support could tilt the ployee program for seniors. try who are expecting decreases in Medicare Program away from pro- I am also concerned that there is not Medicare reimbursements in 2004 and viding traditional fee for service for all ongoing monitoring to assure that drug 2005 would find this reduction blocked the seniors who want it. If this legisla- prices are not increased unfairly before in this legislation. In fact, the legislation passes, it will be the job of the the bill takes effect, or in the first few tion increases Medicare provider pay- Congress to make sure that does not months after it does. ments in both of the years where other- happen. So the legislation does not contain wise there would be cutbacks. This is The next question I asked is espe- costs the way Senator SNOWE and I important because Government cost cially important. Virtually every sen- would have liked. It does take some shifts have already cut reimbursement ior in America wants to know: What modest steps in the right direction. It to doctors, many of whom have large will this legislation do to keep their borrows from the principles of our leg- numbers of low-income patients, to prescription drug bills down? In my islation, but in the end I strongly be- record lows. mind, the key to effective containing lieve that more and better cost con- I would also note that these benefits of prescription costs is to make sure tainment measures with respect to pre- to providers will be especially useful in older people have bargaining power in scriptions are going to be needed in the rural areas where we have the nation- the health care marketplace. Today, future. wide crisis with respect to declining when a senior gets his or her prescrip- Next, I asked: Does this legislation access as a result of providers simply tions through a health plan with many address Medicare’s broader challenges, not being able to stay in business. members, that plan has significantly including the large number of retirees Finally, I ask one last question that more bargaining power than that same that will join in the near future? A de- looked beyond the issue of prescription senior would have by walking into a mographic tsunami is about to occur in drugs. I asked: Is there any way this Walgreen’s, a Safeway, or a Fred Meyer our country. As the baby boomers legislation could provide a path to a to buy medicine. Getting seniors more come of age, there are going to be ex- health care system that works, not just purchasing power by getting them into traordinary pressures on our health for older people, but for all Americans?

VerDate jul 14 2003 23:39 Nov 23, 2003 Jkt 029060 PO 00000 Frm 00026 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.047 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15617 There is a provision in this bill that of- words of the debate over this legisla- limit, then they will get their prescrip- fers health care hope, not just to sen- tion. There have been some very cold tions fully covered with no copays. iors, but for all Americans. It is a pro- considerations entering into this dis- That’s right, no copays at all. vision that I helped to write with Sen- cussion. I know that some believe pas- Next, as you can see on the chart, an ator HATCH, based on our Health Care sage of this legislation will hand the additional 4.4 million lower income that Works for All Americans Act. This President a great victory. Others on seniors will get even more generous legislation would ensure that, for the the other side of the aisle say Demo- coverage. These Seniors will pay only very first time, the American people crats who oppose this bill shouldn’t $1 for generic drugs and only $3 for would be involved in the process of dare raise questions. Those aren’t the brand name drugs. And if these seniors comprehensive health care reform. concerns that ought to drive the debate reach the catastrophic coverage limit, There would be a blueprint for making on Medicare at a time when the coun- then they too will get their prescrip- health care more accessible and more try has to get ready for a demographic tions fully covered with no copays. affordable, not just to seniors, but for phenomenon. Polarization and division In addition, some of these people are all Americans. do not do our country any good. enrolled in both Medicare and Medicaid Senator HATCH and I have been able This legislation is a very tough call and are living in a nursing home— to convince those on the Medicare con- for me and I think for many others. about 1.3 million of them. This bipar- ference committee that the key is to Congress could make a mistake by tisan bill creates a special benefit for make sure that the public understands believing the $400 billion available in these people. For them, Medicare will what the real choices are with respect this legislation will still be there in cover 100 percent of the prescription to health care, how the health care dol- February of 2005. As a member of the costs. They pay nothing. lar is used today, and how it might be Budget Committee, I know how hard it These groups of seniors in total rep- used in the future. has been to get funding for this benefit. resent 12.2 million seniors and disabled In 1993, then-President Clinton an- Americans. When Senator SNOWE and I began in The bill also provides coverage to nounced his intention to create a 1999 to work for funding for a drug ben- health care system that worked for all about 2 million more lower income sen- efit, the Senate thought we lassoed the Americans. But by the time that 1,390- iors and disabled Americans. These Moon when we successfully got $40 bil- page bill was written with no input seniors have 85 percent of their drug lion in the budget. How then can you from the public, sent to the Congress, costs covered after meeting a $50 de- argue that Congress should walk away and torn apart on the airwaves by spe- ductible, and if they hit the cata- from $400 billion? cial interest groups, the people strophic coverage limit, they would I wish there were a better bill. I wish couldn’t distinguish the truth from the pay only $2 for generic drugs and $5 for it didn’t include medical savings ac- special interest spin, and the effort brand-name drugs. counts and premium support and had died. Without public support, the op- This is full coverage with no cov- done better in the area of cost contain- portunity for change was lost. erage gap and 85–98 percent of drug The bipartisan leadership of the Sen- ment. costs covered for about 14 million senate at that time has told Senator There are going to be various proce- iors and disabled Americans. That is dural considerations that may come HATCH and I that, had our bill been in about 36 percent of all Medicare bene- effect in 1993, our country would be out, and I intend to weigh each of them ficiaries. well on its way to implementing a sys- before I vote on those procedural con- That is what this bill does. It pro- tem that ensured coverage for all our cerns. If it finally becomes clear that vides very generous prescription drug citizens. So I think it is of additional the bill, as is, represents the Senate’s coverage through the Medicare pro- benefit that this legislation gives us a sole opportunity to inject $400 billion gram for about 14 million lower income chance to restart the debate that died in long-sought prescription drug bene- seniors and disabled Americans. And it in 1994. Our legislation creates a Citi- fits in Medicare, I will vote yes. provides this full coverage to 8 million zens Health Care Working Group that At the end of the day, I will not vote lower income seniors who have no cov- would take steps, through on-line op- to let the last train that leaves the erage at all today. portunities, townhall meetings and Senate go out without $400 billion that On top of that, of course, this bill other forms, to involve the public; and can be used to help vulnerable seniors provides all beneficiaries with access then there is a requirement, after that and those who are getting crushed by to basic prescription drug coverage public involvement, that the Congress prescription drug costs. I will continue with protections against catastrophic follow up on the views that come from to fight to make this legislation better drug costs. The average beneficiary the citizens’ participation. and for better health care for all Amer- who does not quality for the low in- There are tough calls to be made in icans. come benefits I have just described will today’s health care system, including I yield the floor. still have about half of their drug costs in the Medicare Program. But it is The PRESIDING OFFICER. The Sen- covered under this bill. time to make them together. I think if ator from Iowa. Finally, no one is forced into this one lesson has been learned in the last Mr. GRASSLEY. Mr. President, the drug benefit. It is a purely voluntary few months of discussion about pre- opponents of this bipartisan Medicare benefit. No one is forced to enroll and scription drugs, it is that health care is bill have made the claim that 6 million any senior or disabled American that like an ecosystem. When you make seniors are hurt by this bill. The other does not see the drug coverage offered changes in one area, such as prescrip- side has also claimed that 25 percent of as a good deal for them does not have tion drugs, it can affect many other seniors will be forced to pay more for to enroll. areas, such as corporate retiree bene- their prescription drugs under this bill. So this bipartisan bill before us does fits, provider payments, and various I want to be very clear that this is not harm seniors. That is an absurd other parts of the health care system. not accurate at all. I’m here to tell the charge to make by the opponents of The legislation Senator HATCH and I American public the truth. this bill. have put together and which is in- The truth is that 14 million lower in- This bill provides an affordable, vol- cluded in this conference report treats come seniors and disabled Americans untary and universal drug benefit for health care as an entire and a system- are benefited greatly by this bipartisan all seniors and disabled Americans in wide concern for the American people. bill. These 14 million people will get this country. And it provides very gen- Nothing is taken off the table. I believe very generous prescription drug cov- erous coverage to those 14 million there is in that legislation a path to erage through Medicare in this bill. lower income beneficiaries. making sure this Congress helps not First, as you can see on this chart, It is time to put the partisan rhetoric just older people but sets out ways to 7.8 million seniors and disabled Ameri- aside and approve this bipartisan bill ensure that all Americans have access cans get full coverage with no deduct- that the AARP calls ‘‘an historic to good quality and affordable health ible, no gap in coverage, and would pay breakthrough and [an] important mile- care. only $2 for generic drugs and only $5 stone in the nation’s commitment to Finally, let me note that collegiality for brand name drugs. And if these sen- strengthen and expand health security hasn’t exactly been one of the watch- iors reach the catastrophic coverage for its citizens.

VerDate jul 14 2003 00:58 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00027 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.049 S23PT1 S15618 CONGRESSIONAL RECORD — SENATE November 23, 2003 I yield the remainder of this half care beneficiaries obtain affordable and no gap coverage. Unquestionably, hour to Senator DOMENICI. prescription drugs. The bill will also these provisions will help improve ac- The PRESIDING OFFICER (Mr. EN- provide substantial relief for those cess to health care and treatment for SIGN). The Senator from New Mexico is with the highest drug costs. It will also seniors. recognized. He has 23 minute 20 seconds provide prescription drug coverage at We have a great opportunity, fellow remaining. little or no cost to those with low in- Senators, to fulfill our promise to the Mr. DOMENICI. Mr. President, today comes. American people and provide our sen- I rise in support of the Medicare Pre- When this bill passes, we will be pro- iors with high-quality prescription scription Drug and Modernization Act. viding seniors with prescription drug drug benefits. I believe prescription I thank the Senate and the House con- coverage for the first time since the costs will be manageable, even with the ferees, as well as the leadership of both program’s creation in 1965. Across baby boom generation that will then be bodies, for their work over the past few America, there are still millions of retiring. Some worry about the costs of months. Their perseverance has paid people who do not know that Medicare this bill, but I am confident about the off. This bill represents a major step provides by law not one nickel’s worth future of American ingenuity and com- forward for this body on behalf of the of prescription benefits. It is not that petition, America’s science achieve- seniors of this country. the benefit is inadequate or that it is ments, and America’s wellness achieve- Experts and fair-minded people have written wrong, it just did not provide ments. known for many years that the Medi- for a benefit; that need was not con- As I said this spring when we were care Program must be reformed. For templated in 1965. debating this bill, we are not living in more than 6 years, Republicans have It has been hard to get a bill that a stagnant world. American scientists led efforts to overhaul the Medicare really has a chance. This bill has a today are reaching for health care system and ensure American seniors chance. It contains new accounting breakthroughs linked to the mapping continue to have access to high-qual- safeguards that put the program on a of the human genome. Advances in ity, comprehensive health care in the stronger financial foundation. The leg- nanoscience and microtechnology will future. First, a little history. The islation contains preventive care meas- change medicine and health care as we Budget Act of 1997, when I was chair- ures, including screening for diabetes know it today. However, while that man of the Budget Committee, created and cardiovascular disease. It provides work continues, this long-awaited pre- the National Bipartisan Commission on benefits for coordinated care for people scription drug plan is what we need the Future of Medicare. This Commis- with chronic illnesses. None of these now. I am suggesting when I talk about sion was created to address the issue of benefits was provided under the 1965 the future breakthroughs that we may modernization. The Commission sup- act because the need was not con- be astonished at how much we are ported changes to the program that templated as part of the health deliv- going to be able to do that we cannot would have provided an additional pre- ery system. These benefits are needed do today that may save lives and save scription drug benefit as well as mod- today, but they are excluded from the money. ernized the Medicare system—not one current Medicare system. I encourage my colleagues to put without the other, but both. This is by far the best opportunity, their differences aside today and, most Unfortunately, that Commission speaking on behalf of my constituents of all, to put their politics aside, and failed in part because of lack of support in my home State, that New Mexico do what is best for the American peo- from the previous administration’s ap- has had to get doctors, hospitals, home ple. Overwhelmingly, my constituents pointees to address the fundamental health care providers, nursing homes, have contacted me and asked that I problem of the program’s design. A ma- and Medicare beneficiaries fair and support this legislation. jority of the Commission was for it, equal treatment. Before this bill, each Seniors need affordable prescription but we structured it where 60 percent of these groups had been shortchanged drugs, and if Congress fails to act this was required, and the President with- by the health care laws of our country. year, it will likely be many more years held his support after all the work that I am particularly pleased this bill before beneficiaries are able to access was done. The point is, clearly even contains $25 billion in initiatives aimed prescription drugs through Medicare. back then we were tying modernization at providing health care in rural areas. It is for those reasons—all of them; to prescriptions. We can thank Senator GRASSLEY for the national reasons and the parochial In 2001, again as chairman of the being so steadfast on that provision. New Mexico reasons—that I have indi- Budget Committee, the budget resolu- The Finance Committee estimates my cated that lead me to saying I will sup- tion provided $300 billion, and we are home State of New Mexico can expect port this bill. And I hope we do it now up to $400 billion. The budget reso- approximately $140 million over the quickly. lution said $300 billion for prescription next 10 years in increased doctor and Now, we have an additional Senator. drug benefits and it required mod- hospital reimbursements. That is be- Mr. President, how much time do we ernization of the program. It said $300 cause we are so low. This brings us to have left in this block of time? billion way back then. DON NICKLES, as parity and fairness. The PRESIDING OFFICER. Thirteen chairman, took it up to $400 billion. It This bill includes $50 million to minutes fifty seconds. did not say for prescription drugs, it equalize payments between large urban Mr. DOMENICI. Mr. President, I un- said for prescription drugs and mod- hospitals and rural and small hospitals, derstand we have a Senator who is ernization. Why? Because one without $15 million to increase payments to dis- coming over to use that time. Until the other is never going to work. If you proportionate share hospitals, $1 mil- they do, I will yield that time to Sen- have a prescription drug benefit for the lion in payments to critical access hos- ator GRASSLEY. seniors and do nothing to the under- pitals, $50 million in increased pay- Mr. REID. Mr. President, if I could lying Medicare Program, you have ments for doctors, and $3 million in in- just be heard briefly. taken care of one of the problems for a centive payments to encourage physi- Mr. DOMENICI. Sure. couple of years but you will be back cians to practice in areas where there The PRESIDING OFFICER. The Sen- with a bigger problem. That bigger are shortages. ator from Nevada. problem is the Medicare system itself. Beginning in 2006, again for my Mr. REID. We had a Senator who With the great change in demographics State, all 250,000 Medicare beneficiaries took an extra 5 minutes today because this country is going to be experi- living in New Mexico will be eligible to of various reasons, so it is my under- encing, we will be in big trouble. get prescription drug coverage through standing that the distinguished Sen- Medicare beneficiaries have waited a Medicare-approved plan. This bipar- ator from Kentucky wants an extra 5 too long for prescription drug coverage. tisan agreement will give 55,000 Medi- minutes. We would be happy to agree I am pleased this year appears to be a care beneficiaries in New Mexico access to that. So we would just add that on breakthrough year. Before we are fin- to drug coverage they would not other- to what time he has. ished, there will be many Senators we wise have. Nearly 17,000 of those bene- Mr. DOMENICI. I say to the Senator, will be able to thank. This will be the ficiaries will qualify for reduced pre- Senator GRASSLEY is in charge. I will year we finally help millions of Medi- miums, lower deductibles, coinsurance, just wait to see what he says.

VerDate jul 14 2003 02:35 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00028 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.051 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15619 Mr. REID. Is the Senator on his way This unprecedented investment in with a full drug benefit added. But if down? our seniors’ health translates into an we do not offer that to them now, when Mr. GRASSLEY. I say to the distin- incredible amount of relief for our sen- will we offer it to them? guished Democratic whip, it is my un- iors. Another choice is every Medicare derstanding the Senator is on his way Back home, in my State of Ken- senior can choose from three or even to the Chamber from Senator FRIST’s tucky, for example, there are about more preferred provider organizations. office right now. 650,000 seniors who will share in that But if we do not offer this choice now, Mr. REID. We would agree to give relief. So what does this relief mean to when will we? Or, if we act now, every him that extra 5 minutes. them? The first comfort is that all Medicare senior can get help to main- I suggest the absence of a quorum. 650,000 Kentucky seniors—whether rich, tain their current employer-based drug The PRESIDING OFFICER. The poor, or in between—will never again plan. But if we do not offer that now, clerk will call the roll. face the fear of being wiped out—com- when are we going to offer it? When The legislative clerk proceeded to pletely wiped out—by catastrophic would be a better day than now? Or call the roll. drug costs. every Medicare senior can do nothing Mr. MCCONNELL. Mr. President, I Under this plan, Medicare will cover ask unanimous consent that the order at all and keep exactly what they have for the quorum call be rescinded. a minimum of 95 percent of all cata- today. Every senior, I repeat, can stay The PRESIDING OFFICER. Without strophic prescription drug costs. in exactly the same coverage they are objection, it is so ordered. Next, all Kentucky seniors currently in today, if they choose to. Mr. MCCONNELL. Mr. President, fi- paying full retail drug prices will be That is a lot of freedom and a lot of nally, after 38 years, Medicare will fi- able to cut their prescription drug choices—much like those which Fed- nally give our most frail citizens help costs by an estimated 50 percent or eral employees and Members of Con- in acquiring the miracle of modern more once they enroll in this new plan. gress enjoy today. But if we do not medicine: prescription drugs. They For those 235,000 Kentucky seniors offer these choices now, when are we save lives, but they are not cheap. with low incomes—low-income sen- going to offer them? After decades of talking, while our iors—they will never again have to This bill provides an excellent pre- seniors waited, tomorrow we vote yes choose between food on the table or scription drug benefit, a great array of or no on a Medicare prescription drug medicine in the cabinet—never again. choices to get that drug benefit, and a benefit. It is now or never for our sen- They will get 95 percent to 99 percent host of new benefits, such as preventive iors. And for their drug benefit, this is of their prescription drug costs fully care, disease management, and com- the bill and this is the time. covered. None of those 235,000 Kentuck- prehensive chronic care. On one side stand 40 million seniors, ians will pay more than $2 for generic But after all we did for prescription the American Medical Association, the drugs or $5 for brand-name drugs, and drugs, what did we do to secure Medi- AARP, and hundreds of other citizen most will pay even less than that. care’s future, you might ask? The re- groups. On the other side stand some Another 56,000 Kentuckians, with forms may not have gone as far as Senate Democrats itching to kill this moderate incomes, will get assistance some would have liked, but the good bill. Do not be fooled by those who with their premiums, deductibles, and news—the paramount good news—is for think we can do something better at coinsurance. our Medicare system, a little reform some point later. We are already 38 While the full drug plan will not can go a long way. years late, and this is as close as we start until 2006, all Kentuckians can So how far can it go? will ever come. benefit from an immediate helping When a scam artist can make $7 mil- So for our seniors to get a Medicare hand thanks to the Medicare prescrip- lion by selling gauze pads that cost a drug benefit, it is now or never. Incred- tion drug discount card available as penny but sell them to Medicare for as ibly, there are those in this Senate who soon as April of next year. This pre- much as $7, a little reform can go a say never. They plan to filibuster the scription drug benefit card will be long way. Medicare drug benefit or use proce- available by April of next year. When a shakedown artist can bilk dural measures designed to do the same Through group purchasing power and Medicare for as much as $300,000 by al- thing as a filibuster—kill the bill. negotiated prices, this card can save legedly providing health care services Let me repeat that. Some of our seniors between 10 and 25 percent of to a deceased patient—I repeat, a de- Democratic colleagues are trying to their drug costs, starting, as I indi- ceased patient—a little reform can stop kill this bill. For 38 years there has cated, just next April—right around a real abuse. When two rented mail- been no prescription drug benefit, the corner. boxes and a beeper is all one fugitive none. Now, when it comes time to actu- Finally, also starting next April, needed to scam Medicare out of $2.1 ally pass a drug benefit, some of our about 123,000 low-income Kentucky million, a little reform can go a long Democratic colleagues are filibus- seniors will be credited up to $600 on way. When Medicare imposes 110,000 tering. That is truly astonishing. that same prescription drug card to pages of regulations, a tower of paper- Now, we will hear a lot more debate help tide them over until the full plan work 6 feet tall that requires a regi- about whether there is too much or too takes effect. ment of clerks to handle, a little re- little Medicare prescription drugs. And So this is real relief, and it is just form can mean real savings. When esti- we will hear a lot of talk that there is around the corner. But we did not just mates suggest that as much as $33 bil- too much or too little reform to pre- give Kentucky seniors that real relief, lion a year is wasted in Medicare and serve Medicare. we also gave them real choices. Medicaid—$33 billion a year in waste in Mr. President, I believe we do more Today, Medicare offers no prescrip- Medicare and Medicaid—a little reform for Medicare prescription drugs than tion drug benefit and few choices in can do a lot of good. most could have ever expected. We do health care. All that is offered is the When computational errors at Medi- more to preserve Medicare for the fu- traditional hospital and doctor benefit, care cost $4.5 billion a year, when $2.2 ture than most presently expect. with a limited managed care option billion is paid out annually to phony Before I discuss the reforms to pre- called Medicare+Choice. businesses, when $23 billion is annually serve Medicare, I would like to focus on Tomorrow, Medicare also could pro- overpaid to doctors, hospitals, and the new Medicare prescription drug vide seniors a prescription drug benefit other health care providers, and when benefit. The facts are that we provide and almost unlimited choices in health study after study shows not just poor $400 billion for a Medicare prescription care. If we act now, every senior on business practices but rampant and drug benefit over a decade, about a Medicare will soon have the choice of outright fraud, waste, and abuse third more than our Senate colleagues two prescription drug benefit plans, throughout Medicare, costing tens of proposed just 2 years ago—a third more along with a Federal backup. billions of dollars a year, year after than was proposed just 2 years ago— But if not now, then when will sen- year, decade after decade, then a little and one and a half times more than iors get that benefit? Or, if we act now, reform can do enormous good. President Clinton proposed for a Medi- every Medicare senior can choose from The reform in this bill is real. We in- care drug benefit. a variety of Medicare+Choice plans, fuse real competition, market forces,

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00029 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.053 S23PT1 S15620 CONGRESSIONAL RECORD — SENATE November 23, 2003 and private sector dynamics to provide petition, the gas shortages and eco- there was a gaming of the system that the best health care at the best price nomic stagnation of the 1970s were re- went on by some insurance companies. for our seniors. A wide array of health placed by energy stability and two dec- By having group coverage, a group was care providers, insurers, plans, and or- ades of solid economic growth. When established, a rate was set for that ganizations will compete to offer the we reformed Welfare-to-Work, we re- group. Usually the rate was a very low best health care at the best price, and lied on the private sector to provide rate or premium in order to entice peo- seniors will be free to choose the best the best welfare program man had ever ple into that group to be insured for plan for themselves. devised—a job. And the welfare reform their health care. And then, as the With all of these choices, with all of of 1996 has worked better than we could group got older and it got sicker, they this competition, ordinary people pro- ever have imagined. would not expand the group, so the size viding health care across this land are Today we tap those same forces that of the group began to contract. Yet soon going to do a very extraordinary saved our economic security and im- people in the group are getting older thing. They are going to figure out how proved the well-being of the neediest to and sicker, and you can guess what to provide seniors all the quality save Medicare for our children and im- happens to the cost of that health care; health care they want without all the prove Medicare for our parents. and as those costs rise, so do the pre- waste, fraud, and abuse in Medicare I believe this new drug benefit will miums and those people in that group that no one wants. meet the needs of our seniors. I believe had no other choice. They could not go And who will benefit? Of course, our the reforms will meet the needs of our out and get into another group, unless seniors will benefit. And so, too, will children. Now is the time to act. Now they happened to join an employer who our children. When our seniors get a is not the time to filibuster. Our sen- had a large one. quadcane such as this one for $15, like iors deserve better than that from us. That is the way the system in Amer- the Veterans Administration pays—the Thirty-eight years of waiting is long ica is organized. That is not a logical VA pays $15 for this quadcane, but enough. We must not filibuster and kill system. What we ought to do is be cre- Medicare pays $44 for the very same the bill providing a prescription drug ating the largest groups possible, the cane—stopping this kind of abuse is benefit for 40 million seniors. largest pools, so that you can take the going to save our parents and our chil- Doctors, hospitals, and seniors have health risk and spread it over that dren. When our seniors get a catheter all said this Medicare prescription drug large number of people—young and old, for a dollar, as most Federal Employee plan is the right plan at the right time. sick and well, geographically dis- Health Plans pay, instead of the $12 They all strongly support this. We bursed—so that the cost of that health Medicare typically pays, our parents should support it, too. Our seniors, the care is spread over the larger number and children both win. greatest generation, have been there and, therefore, the cost per person, the These potential savings are not con- for us. Now we need to be there for premiums, are much lower. jecture. This is not guesswork. We them. know that under imperfect—if not hos- I yield the floor. One of the reasons I oppose this legis- tile—rules and regulations, the health The PRESIDING OFFICER. The Sen- lation is that it is the beginning of the care providers in the Medicare+Choice ator from Florida. violation of that principle of insurance, Program were able to give our seniors Mr. NELSON of Florida. Mr. Presi- for what this legislation is doing is be- all the services of traditional Medicare dent, here it is, about 675 pages of a ginning to fragment the seniors as a and wring out enough savings to pro- bill. I have spent the better part of this group and beginning to create groups vide seniors an average drug benefit of past week trying to comprehend all of where well senior citizens will be en- about $857 a year. With this bill, the the nuances in this legislation, and of couraged to join, leaving the sicker power to convert Medicare waste into course a lot of that was difficult since senior citizens for the traditional fee- Medicare benefits, which we only saw a the conference committee was still ne- for-service Medicare and for the pre- flash of in the Medicare+Choice plans, gotiating up through Thursday night, scription drugs that go along with that will now be fully unleashed. and some of the final things that are in Medicare. There was always a riddle to the the legislation we didn’t find out until For example, what we have in this Medicare drug benefit. That riddle was: late in the game. bill is that prescription drugs will be Could we help our parents without But having spent a considerable bit provided in an area. I think the coun- harming our children? Could we add a of time, I believe I have a fairly com- try is divided into 10 areas. I heard it prescription drug benefit to Medicare prehensive knowledge of it. I want to said earlier that it may be as many as today yet still preserve Medicare bene- give my comments and conclusions as 50. But whatever it is, the whole coun- fits tomorrow? The answer to the rid- to why this legislation is not in the try is divided. In that particular area, dle was always reform. In this bill, we best interest of this country and is it there has to be a prescription drug plan have done enough reform to rein in the not in the best interest of our seniors. for Medicare, as the basic underpinning waste I have touched upon earlier. Therefore, I am going to give my rea- of fee-for-service, and also the oppor- To my colleagues on this side, I sons why I am going to vote against tunity for managed care, either a PPO would agree there could be more re- this legislation. or an HMO. form in Medicare than we have in this At the end of the day, what we need Now, here is what is going to happen. bill. But there can be no reform of in America is a health care delivery First of all, the PPOs and the HMOs, Medicare without this bill. We could system that is organized in a logical under this bill, are heavily subsidized have more reform than we have in this manner. The way we organize health by the U.S. Government. There is $12 bill, but we will have no reform with- insurance, as it has grown up histori- billion in this bill that is a subsidy to out this bill. The reforms are more cally around employers, if the em- PPOs, money to be released at the dis- than a first step. They reflect a bold, ployer is large enough, then the group cretion of the Secretary of HHS. This new direction. That new direction for of people who are insured for their Medicare flows from the market-based medical expenses, you can spread the money would be to help the PPOs, incentives in this bill that I believe health risk over that large group. That managed care, to become more com- will do more good to reform Medicare brings down the per-unit price or the petitive. And guess what. It is going to than our colleagues can possibly imag- costs, the premiums that people pay. help them go out and recruit senior ine. But all employers are not large. In- citizens to come into the PPOs. Our colleagues need to recall that deed, in my experience for 6 years as So, too, there is a subsidy here for every time we have placed our faith in Florida’s elected insurance commis- HMOs. Medicare fee-for-service is reim- the ability of free market forces to pro- sioner, what I found was that not only bursed at 100 percent. In this bill, a vide for our people, our Nation has was it very difficult for individuals to kicker is given to HMOs of 109 percent; been richly rewarded. When we infused get health insurance and pay the pro- they are going to be reimbursed for our energy markets with market com- hibitive costs of the premiums but those medical expenses.

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00030 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.056 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15621 So, by this legislation, we are setting not much because this 675 pages in- Medicare premium that has been in ef- a policy that says we are going to en- cludes a new assets test that is going fect since 1965 is going to be abolished courage seniors to go into those man- to drop a lot of those people who are for prescription drugs, what is going to aged care plans—managed care plans not covered by Medicaid in Florida, happen? The prescription drug pre- that, in fact, will then take away a lot who would be covered under the bill— mium is going to get hiked all the way of the choice for seniors to select their they are not going to be eligible be- to the Moon. own doctor. cause there is now a new assets test A fourth reason for opposing this leg- What is that going to leave then? As and there is a part in this 675-page bill islation is that $400 billion is a lot of they recruit the more well senior citi- that will not allow them to receive all money, indeed, and if we were getting a zens, then Medicare, with its own pre- of the brands of drugs that they want true comprehensive drug benefit for scription drug plan, is going to have all because there is a limitation in here on $400 billion, it would well be worth it others. And guess what is going to hap- the class of drugs, and how it is de- because Medicare needs to be modern- pen to that $35 premium that has been fined. ized. If we were doing Medicare again promised. It hasn’t been promised that Let me tell you, Mr. President, there in 1965, would we include a prescription it is going to stay the same. To the are going to be some upset seniors who drug benefit? Of course we would, be- contrary, that $35 premium per month think they are in the range of 150 per- cause of all the wonders of these mir- is going to start escalating. It is going cent of the poverty level and below, acle drugs. to be hiked. Therefore, what is going to and they are going to get covered and So $400 billion is a lot of money, but happen to the poor and the sick among then they are going to suddenly realize it is not being efficiently spent in this our senior citizens? It is not going to they are not. That is going to happen a bill. Why? Aside from all of these probe as it has been represented here. lot in my State of Florida. This is an- visions I talked about—about splitting So I see this as a giveaway to HMOs other reason I am not going to vote for up all of the groups and making them and PPOs. I see it as pushing seniors the bill. inefficient and siphoning off well sen- into managed care, where they will A third reason is that there is no iors and leaving the sick seniors for the lose their choice of doctors. That is my competition for the prescription drug remainder—we cannot do anything in first objection. plan. I happen to think if we want to this bill about the prices of drugs. Of course, there is a lot in this bill have a comprehensive, overall health In this bill, there are two little para- that is salutary. I voted for the bill insurance plan in this country, it graphs that do not allow Medicare to when it came through the Senate be- ought to be as wide as possible with the negotiate the price. I always thought cause I believed that it was a first step biggest possible pools, and there ought the free market was about economies in what I thought was a very important to be private sector competition so we of scale, of being able to get better policy goal—that we modernize Medi- get the efficiencies and economies prices. That is the whole theory of Wal- care with a prescription drug benefit. through competition. Mart. In bulk purchasing, they bring But what has been added has made it That is not what happens in this bill. down the price. This is an anti-Wal- too onerous for me to support. Let me What happens in this bill is if you don’t Mart policy bill because it does not tell you about the second reason I am have two prescription drug plans at- allow bulk buying, as has been stated not going to vote for this legislation. tached to Medicare in that particular many times before, which has been It is widely acknowledged by several region of the country, there is no com- done with other agencies of Govern- very respected studies that the private petition between the two. You can’t ment, particularly the Veterans Ad- sector employers who are covering the say there is just going to be competi- ministration. prescription drugs for their retirees, tion with the PDP and the PPO or the Mr. President, I supported the bipar- from their private employment, are HMO. No, they are going to siphon off tisan bill we crafted in the Senate ear- going to drop that drug coverage that the more well seniors so if you don’t lier this year. Unfortunately, this agreement does not adequately protect is now coming from the private sector. have two prescription drug plans com- seniors’ retire coverage, moves too It is estimated by several, including peting in price and there is only one, many seniors into private plans, and CBO, the Congressional Budget Office— what do you think is going to happen to the cost? What do you think is going fails to do anything about the esca- an arm of the Congress of the United to happen to the monthly premium lating costs of prescription drugs. States—that some 2.7 million seniors that was set initially at $35 a month? It When Medicare was passed 40 years in this country are going to be dropped, is going to go one way. It is going to go ago, we promised our seniors they which means they will only have the up because the cost of those drugs is would have access to medical care as choice of getting prescription drugs going to go up. they grew older. As a matter of fact, under the deficient plan that comes This bill is not pro-competition. This since the passage of Medicare, seniors’ under this bill. So they are going to be bill is pro private plans. life expectancy has increased about 25 getting less. Another reason 35 bucks is going to percent. You talk about being mad. You talk go up is the fact that right now under The agreement that we will be voting about being upset. When they have a the Medicare system, Medicare Part B, on has little to do with providing a pre- very robust plan and they could go to seniors pay the same premium scription drug benefit to seniors and a the pharmacy and have their former throughout the country, but we know lot more about enticing private insur- employer, under that retiree plan, pay in some parts of the country health ance companies to take over for the for their drugs and suddenly they get care costs are higher than in other Government. dropped because now there is an inad- parts. The costs in South Florida are The financial incentives to private equate prescription drug plan, well, in higher than the costs in Iowa. But now companies and creative trappings in- my State of Florida alone, it is going the country is going to be divided up, serted in the bill will do nothing less to be 166,000 people who are going to be in how many regions? I thought it was than limit seniors’ choices—mostly be- dropped. There is going to be, indeed, 10. I heard earlier in the debate it is 50. cause of cost. Seniors may be forced some increase under the bill of those However many regions, it is going to be into HMOs or PPOs because it may be who are not covered now up to 150 per- divided up, it is going to more reflect the only affordable way to at least cent of the poverty level of senior citi- the cost in that region. have access to a prescription drug ben- zens, and I salute that. You might say that is a good thing efit. Affordable, because the bill pro- You would think that in a State such unless you come from a State such as vides a $12 billion subsidy for PPOs and as mine, which only covers poor seniors mine which has a higher percentage of a reimbursement rate of 9 percent with Medicaid, a Federal and State the population of seniors than any above Medicare for HMOs. health care program, you would think, other State because, why? When they Since 1999, in Florida alone over since our State of Florida only covers retire they want to come to the land of 260,000 seniors and people with disabil- up to 88 percent of poverty level, that sunshine and enjoy the benefits of our ities were abandoned by their private would be a big benefit—to go from 88 to environment. Medicare HMOs. As Florida’s former 150 percent of poverty level. Yet, in So because there is no competition insurance commissioner, I recall hav- fact, there is some help there, but it is and because the universality of the ing to beg these plans to stay in our

VerDate jul 14 2003 02:14 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00031 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.059 S23PT1 S15622 CONGRESSIONAL RECORD — SENATE November 23, 2003 State and continue providing care to ers at least one drug in each ‘‘thera- The limited formularies allowed under our seniors. peutic class.’’ The definition of a thera- the agreement for Medicare could jeop- This conference agreement, with its peutic class; however, is left up to the ardize a senior’s access to the drugs various incentives—from a $12 billion plan itself. A plan might choose to ex- they need. slush fund, to its risk buyout, is noth- clude certain high-cost drugs for finan- Despite our best efforts in trying to ing more than a give-away to insurance cial reasons, leaving seniors who de- minimize cuts to cancer care in this companies. pend on those drugs without coverage legislation, the agreement will result Private health plans are in the busi- for them. in an $11.5 billion cut. The ripple effect ness of making money, and have rou- I am also very disappointed that this of these cuts and the reaction of pri- tinely blamed low profit margins as agreement prohibits Medicare from ne- vate sector insurers will threaten com- their reason to drop seniors. In com- gotiating better prices from drug man- munity cancer centers’ ability to con- parison to Medicare, they have failed ufacturers. tinue treating patients. to be as effective in controlling their In 2001, the cost of prescription drugs I reiterate my support for the pro- own costs. rose more than 15 percent—the seventh viders of care to America’s seniors. To HMOs have managed to lure the straight year of double-digit increases. our doctors, our hospitals, and nursing healthiest of our seniors in order to When we consider the fact that drug homes—I support the provisions in this maximize their reimbursement from prices have been increasing by double bill that will allow them to continue to the government. Currently, they re- digits in recent years, it does not make serve our seniors. ceive about 16 percent more per bene- any sense to let these prices go un- For Florida’s hospitals alone, this ficiary than is paid out through the checked. bill means almost $740 million in im- traditional Medicare program. If these In light of our limited resources, proved Medicare reimbursement over savings aren’t enough to feed their wouldn’t our seniors have been better the next 10 years, and I am pleased profit margins, then the increased pay- served if we had addressed the issue of about that. But these reimbursements ments included in the bill will. drug costs? We even have a proven to health care providers should not be The agreement proposes payments to model for success in the Veterans Ad- held hostage in a 675-page bill that has HMOs of 109 percent of the fee-for-serv- ministration, which has used its bulk many defects. ice rate. This cumulative effect results purchasing power to negotiate with the In the final analysis, this agreement in our government paying private plans drug companies for dramatically re- fails to fulfill my promise to provide 25 percent more than what it would duced prices. Medicare could do the comprehensive prescription drug ben- cost Medicare to provide that same same, saving our seniors and the tax- efit to seniors. We can do better. Re- care. How can that be considered com- payers billions of dollars. gardless of whether this bill passes or petition? Our Nation’s seniors, when unable to fails, I intend to keep working to pro- I am also concerned that the agree- afford their own drugs, turned to Can- vide that comprehensive benefit. Our ment before us could create premium ada for relief. This bill continues the seniors deserve nothing less. variations across the country, and even stalemate between supporters of impor- I want to yield the rest of my time to within my own State of Florida. tation and the FDA by including the one of my colleagues who needs some While we all keep hearing about this poison pill provision requiring a cer- time. I wanted to state at least these $35 monthly premium, there is nothing tification from the Secretary of Health reasons and try to give the comprehen- written in the law that limits the pre- and Human Services before medica- sive overview of the health insurance mium to that amount. That number is tions can be legally imported. marketplace, where we need to go simply an average which between now At a Commerce Committee hearing eventually to straighten out the mess and 2006 could certainly increase just last week on this exact issue, sup- so that all people can be insured and as the rest of the costs of health care porters of importation argued that in not just the ones who have it and the 42 are. the absence of trying to control the in- million people in this country who In addition, I am envisioning a sce- creasing prices of drugs, importation don’t have it. Indeed, this bill is not nario where seniors who do not have should be at least an option to provide the first step toward that kind of access to a fallback because there is short-term price relief. health care reform. one HMO or PPO plan and one prescrip- In making my decision to oppose this I yield to the Senator from North tion drug plan are left without any real legislation, I considered who would be Carolina the remaining time that I choice. Then, if the drug plan, PDP, better off versus who would be worse have, which should be about 13 min- has no competition, it can raise the an- off. utes. nual premium at will. One-third of Medicare beneficiaries The PRESIDING OFFICER. It is Since there are no limits and the pre- have no drug coverage at all, another about 10 minutes. The Senator from mium from a private drug plan could one-third of them have access to pre- North Carolina is recognized. be hiked to the moon, they could essen- scription drugs through their retiree Mr. EDWARDS. Mr. President, may I tially create a situation where a senior health care plans. inquire how much time the Senator has no other choice—based on costs— The legislation before us will cause from Florida has remaining? but to join an HMO or PPO and give up private employers to drop 25 percent of The PRESIDING OFFICER. About 10 their choice of doctors. their retirees. In the State of Florida, minutes. Again, we see an example of this that could mean over 166,000 retired Mr. EDWARDS. Mr. President, I bill’s failure to allow true competition seniors would lose the coverage they thank the Senator from Florida very to take place. worked all of their lives to earn. much for yielding time and allowing Under the fallback plan included in Another group that fares worse under me to speak tonight. the Senate bill there would be at least this agreement are those seniors who Medicare was created 40 years ago two of the same kinds of plans com- are over 65 and also eligible for Med- with the idea of giving seniors health peting in each region. This would have icaid. We fought long and hard to have care to allow them to live out their created an incentive for the drug plans these duel-eligible seniors covered lives in dignity and self-respect. It was to keep their premiums competitive. under Medicare. However, provisions in a promise that they could choose their During a careful examination of this the agreement raise the asset tests and own doctor and afford their health agreement, I also became aware that restrict the Medicaid program from care. the private drug plans are allowed the paying the senior’s copayment, and We clearly need a real prescription greatest flexibility possible. Little con- that leaves seniors worse off. drug benefit under Medicare, there is sideration is given to the particular Medicaid beneficiaries in Florida no question about that. The problem is needs of the beneficiary. have access to all classes of drugs and that this bill does a great deal more For example, each Medicare drug all drugs within those classes. Should harm than good. It is very good for the plan could have its own list of covered patients have trouble getting their drug companies, it is very good for the drugs, or formulary. The only require- medications, their physicians are al- HMOs, but it is very bad for seniors and ment is that the private drug plan cov- lowed to appeal directly to Medicaid. very bad for America as a result.

VerDate jul 14 2003 02:14 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00032 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.014 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15623 Here are some of the reasons: First, Then on top of that, we see that the medical savings accounts. The only it has billions of dollars in giveaways justification for this is that they need people who are going to be able to af- to HMOs and insurance companies, money so they can ‘‘compete’’? What in ford to take advantage of it are the money that could be and should be the world is that all about? wealthy. Regular folks cannot save used to provide a better benefit to sen- On top of what is being done for the anyway. They are not going to be able iors who desperately need prescription HMOs, we have the drug companies. to put money away in one of these ac- drugs. This bill does almost nothing to con- counts. Second, it does almost nothing to trol costs. We have been fighting in the The bottom line is, this is a bad bill. control the skyrocketing costs of pre- Senate to bring down the cost of pre- It is not a first step; it is a misstep. It scription drugs which seniors all over scription drugs for months and years takes this country in exactly the America face every single day when now. The battle is always uphill be- wrong direction. We need to stand up they go to the pharmacy. cause the drug companies have more and say so. The American people need Third, it contains billions of dollars lobbyists in this town than people who to hear our voices loudly and clearly. in tax breaks for millionaires, for the live in my hometown where I grew up. They also need to know what it is we wealthy, which is part of a long pat- They are all over the place. actually need to do to provide a pre- tern by this President of trying to shift So we are trying to bring down the scription drug benefit because they de- the tax burden. The President is in the cost of prescription drugs. The Wall serve one. middle, as I speak, of shifting the tax Street Journal itself calls this a big I will tell my colleagues what we burden in America from wealth to win for the drug companies. Their need to do—put controls on the cost of prescription drugs by allowing re- work. He wants to get rid of the divi- stock is going up. dends tax, capital gains tax, taxation Why have we not been able to do the importation from Canada, by doing something about misleading adver- of the largest estates, and shift that things that need to be done to bring tising on television, by cracking down tax burden right on the backs of mid- the cost of this program under control on some of the price gouging that is dle-class working Americans who are and, more importantly, to bring the going on. We ought to provide this pre- already struggling, already having a cost of prescription drugs under con- scription drug benefit under Medicare. difficult time saving, putting money trol? I will tell my colleagues why. Be- We can give people choices and still aside, having any level of financial se- cause the drug companies are against stand by the very program that has curity. And here we go again, the it. It is just that simple. It is the an- provided seniors with health care for 40 President of the United States is in the swer to everything we try to do on the years now, that so many seniors have process of putting an additional burden Senate floor to bring down the cost of depended on for four decades now. on the very people who are struggling prescription drugs. At the end of the day, the American and who are so critical to getting this We try to do something about mis- people, seniors, want us to do some- economy moving again. leading drug company advertising on thing about prescription drugs. We This is just another in a long series television. No, no, we cannot do it. The ought to do it. We ought to give them of efforts by this President and this ad- drug companies are against it. a real benefit. We ought to bring down ministration to shift the tax burden. We try to allow the reimportation of the costs. We ought to make it cost ef- There is no question the lobbyists all prescription drugs from Canada to ficient in terms of taxpayer dollars. In over Washington are popping the cham- bring down costs for everybody, but we order to do it, we are going to actually pagne corks as we speak. The drug cannot get it passed. Why? The drug have to have the backbone to stand up company stocks are going up. The HMO companies are against it. to these drug companies and these stocks are going up. Do not the drug We try to do all of this, to allow the HMOs and their armies of lobbyists all companies and HMOs make enough al- market power of the Government to be over Washington. ready? For all the seniors who go to used to negotiate a better price to I, for one—and I believe some of my the pharmacy to try to buy medicine bring down the cost of prescription colleagues will join me in this—intend and cannot afford it, is the really nice drugs. We cannot get it done. Why? The to stand up to these people, and I in- thing for us to do right now to help the drug companies are against it. tend to stand up for the American peo- HMOs and drug companies? Are they We are never going to get health care ple and fight with everything I have for not doing all right? costs under control in this country a real prescription drug benefit under The truth is we ought to forget the until we stand up to these people, Medicare that does not give billions of drug companies, forget about the stand up to the drug companies, stand dollars to HMOs and drug companies. HMOs. They are doing a terrific job of up to the HMOs. I yield the floor. taking care of themselves. We in the I know in Washington, DC, they are The PRESIDING OFFICER. The Sen- Senate ought to be focused on trying to powerful, but out across America, the ator from Nevada. help seniors who are struggling. American people have a great deal Mr. REID. Senator BAUCUS is the Let me say a word about the give- more power in this democracy than next scheduled speaker. I will ask for a aways to the HMOs. This bill contains these lobbyists in Washington. We need quorum call, but I also ask unanimous something that is called a stabilization to stand up to drug companies and consent that the time be taken off his fund of $12 billion, which is nothing but HMOs and stand up for the American time. It is not fair to wait because we a giveaway to HMOs. The idea is we people. have 41⁄2 hours’ worth of speakers. have been hearing all along that it is In the middle of not controlling The PRESIDING OFFICER. Is there important to have competition and the costs, billions of dollars of taxpayer objection? HMOs can be more cost-effective than money going to HMOs and drug compa- Without objection, it is so ordered. Mr. REID. I suggest the absence of a Medicare. I am missing something. If nies, we have another effort to shift quorum. they can be more cost effective than the tax burden in this country. It is not The PRESIDING OFFICER. The Medicare, why in creation are we giv- as if working, middle-class families are clerk will call the roll. ing them $12 billion of taxpayer not struggling enough. It is not as if The assistant legislative clerk pro- money? At least where I come from, over the last 20 years we have not gone ceeded to call the roll. you do not have to give somebody $12 from them saving money, having finan- Mr. GRASSLEY. Mr. President, I ask billion to be more cost effective. That cial security, to today not being able unanimous consent that the order for is taxpayer money that could be used to save, having negative savings as a the quorum call be rescinded. to help seniors who desperately need matter of fact, with one medical emer- The PRESIDING OFFICER. Without prescription drugs. But, oh, no, we are gency or one layoff keeping them from objection, it is so ordered. going to give them $12 billion, money going under. Mr. GRASSLEY. Over the last couple that could go to the seniors, money Here is a good idea: Why do we not of days there have been many asser- that could give them a decent benefit. take another step to shift the tax bur- tions from my colleagues on the other Instead, we are going to give it to den away from the wealthy and to the side of the isle that this bill does noth- HMOs. I guess they are struggling so middle class and working people? That ing to lower the cost of prescription much, they need our help. is exactly what is happening with these drugs.

VerDate jul 14 2003 02:14 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00033 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.062 S23PT1 S15624 CONGRESSIONAL RECORD — SENATE November 23, 2003 I would like to take this opportunity In June 2000, Mr. STARK included the prices, they are not talking about this to set the record straight. same language in his motion to recom- bill. The conference report contains a mit H.R. 4680. That motion received My friend and colleague on the Fi- number of significant reforms to lower the support of 203 Democrats and Mr. nance Committee, Senator BAUCUS, has the cost of prescription drugs for not SANDERS. come to the floor. He is primarily re- just Medicare beneficiaries, but for all The provision protects patients by sponsible for the legislation that is be- Americans. keeping the Government out of deci- fore us because he has been very will- This bill provides immediate relief to sions about which medicines they will ing to work in a bipartisan way to get 40 million Medicare beneficiaries by be able to receive. Under this section, things done. We would not be here providing a discount drug card starting CMS will not be able to dictate that today if it was not for the hard work of in April 2004. drugs must be excluded from a PDP Senator BAUCUS, the ranking Democrat The voluntary drug card program formulary or subjected to reimburse- on the Finance Committee, and a per- will save beneficiaries an average of 10 ment limits that effectively deny ac- son with whom I can work very well. to 25 percent on the cost of their pre- cess. I yield the floor. scription drugs. Beneficiaries will have The bill relies on market competi- The PRESIDING OFFICER. The Sen- the choice of at least two Medicare-en- tion, not price fixing by CMS, to de- ator from Montana. dorsed drug discount cards. liver the drug benefit. The bill’s entire Mr. BAUCUS. Mr. President, first I The drug discount program included approach is to get seniors the best deal deeply thank my good friend from in the Medicare Prescription Drug and through vigorous market competition, Iowa, Senator GRASSLEY. I know people Modernization Act also provides low- not price controls. in his home State greatly respect him. income beneficiaries with an additional CBO scores the bill’s approach of re- I read somewhere that he has the high- subsidy of $600 to help with the costs of lying on at-risk private sector plans to est approval rating of any politician in their prescription drugs. deliver the prescription drug benefit as the State of Iowa. I am sure that is This program provides immediate re- getting a higher cost management fac- true and I can understand why. It is belief to Medicare beneficiaries now pay- tor for Medicare than bills where pri- cause he is straight, down to Earth, ing extremely high prices for their pre- vate sector competition is handicapped and honest. He tells it like he sees it, scription drugs. by Government. The noninterference no guile. I want Senators to know that This bill also lowers the price of pre- provision protects this approach, by this is my impression, as well. I say scription drugs for Medicare bene- preventing politicians and bureaucrats this because when he explains the pro- ficiaries, by eliminating the Average from getting into the middle of the visions of this bill, I hope people listen. Wholesale Price, AWP, paid for pre- very negotiations that drive these sav- Senator GRASSLEY is not one to gild the lily, not one to indulge in inflam- scription drugs. ings. This provision significantly reduces Private plans have strong incentives matory rhetoric, not one to exag- the prices that Medicare and many pri- under the bill to negotiate the best gerate. He is someone who tells it like possible deals on drug prices, because it is. This is a very important personal vate insurers pay for physicians-admin- they are at risk for a large part of the quality of his, and one that I revere istered drugs. Under this agreement, Medicare re- cost of the benefit. They also will have deeply. the market clout to obtain large dis- I thank the Senator for allowing me imbursements will now be based on accounts. By driving hard bargains, they to work with him as the chairman of tual prices paid by physicians, rather will be able to offer lower premiums the Senate Finance Committee. than fictitious numbers reported by and attract more enrollees. I would like to take a few minutes to manufacturers, providing a ripple ef- The alternative is a command-and- discuss the Medicare conference report fect lowering the cost of prescription control system that would not be re- before us. I am sure a lot of people drugs for not just Medicare bene- sponsive to consumer desires or mar- across the country have heard state- ficiaries but individuals in the private ketplace realities. Bureaucrats would ments by many Senators and House market. swing between adding benefit require- Members and are wondering who is The conference report also contains a ments without a means of paying for telling the truth. They hear a set of al- ‘‘non-interference’’ provision that will them and restricting choices and ac- legations from one side and lots of re- protect patients and deliver lower cess in an effort to contain costs. This sponses from the other side. It must be prices through market competition. bill wisely rejects that approach. The incredibly difficult to determine the The conference bill specifies that the noninterference provision is the funda- truth. Government ‘‘may not interfere with mental protection against it. A few days ago, Senator BREAUX and the negotiations between drug manu- Finally, the conference report lowers I met with 20 or 25 House Democrats. facturers and pharmacies and PDP the cost of drugs for all Americans by The group is known as the New Demo- sponsors’’ and ‘‘may not require a par- reforming the Hatch-Waxman drug crats. Senator BREAUX and I explained ticular formulary or institute a price pricing laws. to them what was in the bill. structure.’’ It is right here on page 53. The agreement will speed the process Over and over again, the New Demo- Opponents claim that this provision, of allowing generic drugs to come to crats asked: What is going on here? Our which originated with Democratic pro- market, which will significantly reduce leadership tells us one thing and you posals, is a concession to the pharma- drug prices. are telling us something else. Whom ceutical industry. That is plain wrong. The agreement will provide brand are we to believe? The noninterference provision is at drug companies only one 30-month stay Senator BREAUX and I explained the the heart of the bill’s structure for de- on the approval or a generic compet- bill to the best of our ability. We tried livering prescription drug coverage itor. to be honest and straight with the through market competition that gets Generics would be forced to forego facts. It is my belief that the facts are a good deal for consumers, rather than their 180-day generic exclusivity if they usually controlling. Once people under- through price fixing by the CMS bu- do not bring a product to market withstand the facts of a bill or legislation, reaucracy. As CMS Administrator Tom in a specified time period. they can make up their own minds. It Scully explained in the November 21, These reforms are the most aggres- was our intention to just give the facts 2003 issue of the Washington Post, if sive since Hatch-Waxman laws took ef- so these House Members could make up Medicare negotiated prices, ‘‘I wouldn’t fect in 1984. their own minds. be negotiating; I’d just be fixing the These reforms have also earned the I suspect that a lot of them were in a price. Let’s get seniors organized into strong endorsement of the Generic difficult place: stuck between their big purchasing pools that get bulk dis- Pharmaceutical Association and dozens leadership, which was pressuring them counts and see how they fare.’’ of allied groups who are advocates of to do one thing, and the facts which Ironically, this provision was created increased generic usage and low drug were inclining them in the other direc- by the Democrats and first appeared in prices. tion. May 2000 in a bill sponsored by Senator So to my colleagues who say there is I further suspect that many people DASCHLE and 33 Democratic cosponsors. nothing in this bill to lower drug watching across the country tonight

VerDate jul 14 2003 02:14 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00034 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.019 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15625 are wondering the same thing. There we do not act now, the chances of pass- pass, I do not know when we are going are compelling speeches on both sides ing prescription drug benefits for sen- to be able to address this issue. Noth- of this debate. Who is telling the truth? iors in the next several years is very ing is guaranteed in the future. Times After all, that is what it is all about. slim. Next year we will be faced with change. Congresses changes. It is dif- I am going to do the best I can to ex- higher budget pressures: The national ficult to predict the future. A bird in plain why I am supporting this Medi- debt is increasing; our deficits are ris- the hand is worth two in the bush. We care legislation, why I personally think ing due primarily to uncertainties have a bird in the hand now. it is a good bill. I am going to use the overseas—Iraq and Iran; due to ter- We have strong rural provisions in facts, as opposed to rhetoric. I am not rorism; and due to greater domestic this legislation. If it does not pass now, a great rhetorical speaker. As with the needs. If we do not pass prescription the chances of rural areas getting a Senator from Iowa, I tend not to em- drug benefits now, we are unlikely to square deal and a level playing field bellish. Maybe it is because we are have another opportunity again. If we are going to be in serious jeopardy. from agricultural states. We have do not act today, the $400 billion will I say to those Senators from rural learned to accept that we cannot con- not be there next year. states, how can you vote against a bill trol everything—we cannot control the I also support this legislation be- and deny increased payments to your weather for the crops and the live- cause of its very generous low-income home states when you are probably not stock; we cannot control the market subsidies for one-third of all senior going to get them again, when you price. We accept reality for what it is citizens. These senior citizens, one- have been fighting so hard to get them and tell it like it is because that is the third of all senior citizens, will have 90 for so many years? way we have grown up. I will do my percent of their drug costs paid for. I would now like to turn to another very best to give a fair take on facts of Under this legislation, 90 percent of issue that has been discussed fre- this bill. their drug costs are going to be paid for quently and which is of great concern Why do I support this bill? For many by the federal government. to many Senators, and well it should years, Congress has been trying to pass This is a very important measure in be. As indicated on this chart, employer- legislation that gives prescription drug this bill. It provides very strong low-in- sponsored retiree coverage is declining. benefits to seniors. For many years we come protections. I do not know if we Eighty percent of companies offered have been talking about it. Some years are going to have these protections retiree health care coverage in 1991. In we have come pretty close. Last year, again in future Medicare legislation, if 1996, it fell to 71 percent. In 1999, it fell for example, we were very close. I can we even have future Medicare bills. to 66 percent. In 2001, it fell to 62 per- remember a meeting I had convened in When are we going to again have such cent, and 2003, 61 percent. There is a my office with the key Senators: OLYM- generous assistance for our low-income steady decline of companies dropping PIA SNOWE, TED KENNEDY, CHUCK seniors? or reducing their retiree coverage. GRASSLEY, Senator GRAHAM, and four An additional reason I support this You might ask, Why is that hap- or five or six other Senators from both legislation is that it contains a strong pening? It is happening because of com- sides of the aisle—liberals and conserv- government fall-back plan. This is a petitive pressures. Companies want to atives. We came very close. technical term which means that when cut back on costs wherever they can to But in the end, partisan politics there are not two private drug plans maximize their profits. Retiree health dominated—I think because some available in any region, a senior is able benefits is one area where they are cut- wanted an issue, not a solution. We to access a guaranteed government ting down their costs. They are reduc- were pulled apart, and in the last mo- fall-back plan for their drug benefits. ing coverage for their retirees. It is in- ments, we were unable to pass a pre- The only question is: Are there two evitable and it is happening. scription drug bill. private plans in any given region of the Why do I mention this? What does Here we are again today. We are even country? If there are, your prescription this bill do to address this phe- closer this year because we have actual drug benefits are covered through the nomenon? This is an extremely impor- legislation that has passed both bodies private plan with all of the guarantees tant point, and I hope Senators and of the Congress, and a conference re- that are written in the legislation to staff are listening. This bill discour- port before us. It is not possible to get ensure that seniors are not taken ad- ages employer retiree droppage; dis- any closer. If we do not pass legislation vantage of. If there are not two private courages, not encourages, it. It pro- this time, I do not know if we ever will. plans in the area, then the Government vides tax-free subsidies for companies And this would be a tragedy. This bill fall-back plan goes into effect. to discourage them from dropping their provides $400 billion over 10 years to The bottom line is that all seniors in retiree benefits. create a prescription drug benefits for America will get a prescription drug This bill provides $88 billion—$88 bil- seniors. This is what the debate comes benefit. All seniors in America are cov- lion—to companies for their retiree down to. ered by this bill, whether it is in a pri- plans. Eighty-eight billion dollars is We know the importance of this bill vate drug plan or through the govern- going to companies to discourage them because drug prices are increasing rap- ment fall-back plan. This is what we from dropping their retiree plans. idly, while at the same time, drugs are mean by a strong Government fall- The Congressional Budget Office said becoming ever-more important. They back—all seniors will get the prescrip- under the Senate bill that there would oftentimes replace expensive hospital tion drug benefit. be about a 37-percent droppage rate; in procedures. And new medications are It is true that the House bill did not the House bill, about 32 percent. constantly being developed. New, so- include a strong government fallback. But in this Conference report, we called miracle drugs are being devel- But we are talking about the Con- have provided additional funding. The oped today that will help treat many ference report. And in this legislation, rate is now down to about 22 percent. different illnesses in the future. all seniors will have access to the drug But that 22 percent would be higher if Many of our seniors with low in- benefit. this additional money was not pro- comes and fixed incomes simply cannot The fourth reason I support this leg- vided. afford the drugs they depend on. It is islation is rural payment equalization, The actual number in the conference critical that we pass this legislation. as well as other strong provider provi- report is 17 percent. This number re- Every other country in the industri- sions. flects a more accurate calculation. 22 alized world provides prescription drug During the many years I have been in percent is apples to apples to the 37 and benefits for their seniors. We are the this body, I have worked hard to make 32 percent in the Senate and House United States of America. Why in the sure that Montana and other rural bills. The 17 percent is a more accurate world do we not provide prescription States get the same payments for hos- figure. drug benefits for our seniors? pitals and doctors as urban States, as The net effect is the droppage rate is We should. the big States. about 50 percent less as a consequence And we now have the opportunity be- We have been fighting for this for of the provisions in the conference re- fore us. I do not know when we are years. Finally this legislation address- port. Companies are getting $88 billion going to get this opportunity again. If es this inequity. If this bill does not to maintain their retiree coverage.

VerDate jul 14 2003 02:14 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00035 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.065 S23PT1 S15626 CONGRESSIONAL RECORD — SENATE November 23, 2003 I ask my colleagues, if you vote In the year 2010 there will be six dem- port. It is not the 10 million figure we against this bill, what are you going to onstration projects. That is far better have heard. Take the figure of 10 mil- say to those employees who lose their than the House bill which wanted a lion, cross out the zero, and you get the retiree coverage when you had the op- full-blown nationwide premium sup- real figure of 1 million or fewer. portunity to vote for a bill that would port. We have heard a lot of horror sto- Next, this legislation limits the num- have provided funding to address this ries about premium support, but that ber of sites to six. There can be no problem? What are you going to say to is based upon the House bill, which had more than six MSAs in the Nation. The those retirees when you tell them you full-blown, nationwide premium sup- Secretary has no discretion to add voted against a bill which would have port. This is not a fair criticism. Peo- more. discouraged retiree droppage? What are ple are talking about another bill, not In addition, this legislation says you going say to them? I don’t know; it the Conference report before the Sen- these demonstrations are limited to 6 wasn’t perfect. ate. years. That is in statute. That is not This bill has the effect of discour- What is before the Senate is a bill regulation. The Secretary cannot aging—not encouraging—retiree drop- which says in the year 2010 there will change that at his discretion. page. I hope Senators pay very close be up to six MSAs, metropolitan statis- It takes an act of Congress to extend attention to this point. This issue con- tical areas, that could test this concept or expand these six. After 6 years, the cerns many Senators. of premium support. I might add, as I issue will be before Congress to decide I would like to address another have said before, that Medicare fee for what to do: Do we want to extend the issue—the impact of this bill on dual service is held harmless. People in premium support areas? Do we want to eligibles. these areas who want to stay in fee for eliminate them? Do we want to change We have heard criticism that the ef- service can. There is no requirement them? This cannot, by regulation or fect of this bill is to make drugs more they get out of fee for service. the Secretary’s decision or by the expensive than current law for dual eli- Remember, the President earlier pro- President’s decision, be changed; it gible senior citizens. posed legislation that would have re- takes an act of Congress to change. This is completely inaccurate. The quired people to join private plans to I might add, as well, that there are assumption behind this argument is get a drug benefit. That was then. This payments in this legislation that go to that this bill has a $1 and $3 copay for is now. This bill does not say that. This preferred provider organizations to see drugs for dual eligibles. For seniors bill says, if you want to stay in fee for if they can work. who are under 100 percent of poverty, service, that is fine. You do not have to But preferred provider organizations this bill has a $1 copay for generic join a private plans. have to be regionwide. They have to drugs, and a $3 copay for brand-name Some Senators also worry that Part serve the whole region. They cannot prescription drugs. B premiums might rise because the pri- pick and choose individual MSAs. As The assumption behind the argument vate plans will take the healthiest sen- we know of today, HMOs pick and that the 6 or 7 million dual eligibles iors, forcing up the fee-for-service Part choose. They go to the counties they B premium. will be worse off is that these seniors like and avoid the counties they do not This argument is not true. do not currently have copays under All low-income people are held harm- like. They cherry-pick the healthiest Medicaid. That is not true. Most less in Medicare fee for service. Their people. They do not go to the counties States, at least 38 States, already have Part B premium cannot go up. They they don’t like, those with the less Medicaid copays. The 6 or 7 million are held totally harmless. As I men- healthy people. This is not the Amer- worse off is simply a false figure. tioned earlier, a third of America is ican way. In fact, most States are under tre- classified as low income in this bill. This legislation provides for addi- mendous pressure to reduce the costs What about those who are not low in- tional funding for the regionwide PPOs of their Medicaid programs. One of the come? This bill limits any premium in- which go into existence in the year ways they decrease costs is through increase to 5 percent. This is significant. 2006. There is a $12 billion fund which creasing copays. Part B premiums for next year, 2004, helps get these plans up and started. For those Senators who have been are going up about 13 percent for all But again—— claiming that 6 or 7 million will be senior citizens. Why is that? Because The PRESIDING OFFICER. The Sen- worse off, please look at the Medicaid this Congress, using its best judgment, ator’s time has expired. copays in many States and anticipate has decided to increase dollars to doc- Mr. BAUCUS. Mr. President, may I what will be the situation in the year tors. Seniors pay for 25 percent of this ask for a few more minutes? 2006. It will be worse; 38 States have increase through higher Part B pre- Mr. REID. Mr. President, we have 41⁄2 copays. Not all are greater than $1 in $3 miums. hours of speeches still tonight, and now, but if States continue to cut back In this bill, the premiums cannot go that is why we have limited it to half on Medicaid to balance their budgets, up by more than 5 percent in the pre- an hour each. then the copays will rise. mium support areas. Mr. BAUCUS. If I could just have 1 Today, Illinois already has $1 and $3 Another point: A maximum of 1 mil- minute? copay. The bill does not hurt low-in- lion beneficiaries may be affected. I Mr. REID. Sure. come seniors in Illinois. In Maryland, mention this number because there are The PRESIDING OFFICER. Without there is a $2 co-pay for brand-name pre- a lot of other figures being discussed, objection, it is so ordered. scription drugs. In Massachusetts, it is including that 10 million senior citi- The Senator from Montana. for all drugs. The same is true for Ne- zens will be affected by premium sup- Mr. BAUCUS. Mr. President, I will vada. I see my good friend Senator port. Ten million is not an accurate just sum up by saying, I have spent a REID is here. He knows more about Ne- figure. It is not true. We went to an ob- lot of time on this legislation. I am not vada than I hope to know. North Da- jective source to find out what is true going to do anything to hurt senior kota is $3 for a prescription. South Da- and accurate. We went to the CBO. citizens. It would be foolhardy, foolish, kota, about the same. And these are CBO told us that between 670,000 and 1 stupid. And this bill does not hurt sen- just some examples. million people could be affected by this ior citizens, it helps them. If you look at the facts, the 7 million bill in the six areas. Even so, these peo- There have been a lot of charges figure is closer to about 1 million. ple can stay in standard fee for service. against this bill. It is very easy to be Another inaccurate criticism is pre- They are not required to go into pri- negative. It is very easy to find fault mium support. There has been a lot of vate plans. There is no incentive, un- with anything. talk that premium support will under- less a premium support plan does offer This bill is not perfect, but it is very mine Medicare as we know it. I would a much better package, much more in good. never vote for a bill that I thought benefits, much lower in costs. That is I urge all of us to remember, this is would undermine fee-for-service Medi- possible. I don’t think it is likely, but a very good bill. It gives great assist- care. I would not do that because I it is possible. ance to our seniors. We have subse- know how important it is to seniors, The main point is that very few peo- quent years to work on it, build upon certainly in my State of Montana. ple could be affected by premium sup- it, and to make changes. But if we do

VerDate jul 14 2003 02:14 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00036 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.067 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15627 not pass it now, the chances are very was to pan for gold. Of course, we never tion drug benefit for seniors, has gone slim we will be able to pass prescrip- had much. He never found much for way beyond that and is now a bill tion drug benefits for seniors again. what he did. There was not much gold mostly dealing with Medicare reform. So I strongly urge my colleagues to there. This legislation is OK at first glance, support this bill and oppose procedural But I knew how to pan for gold. You but if you look at it closely, I believe, motions which will impede passage of would take the rock and grind it up as I have indicated on this chart, it is this bill. real fine into a little metal bowl. Then really not the gold, shown on the left, The PRESIDING OFFICER. The as- you would put it in like a frying pan, a but it is the fool’s gold, the iron pyri- sistant Democratic leader. pan that was made just for that, and tes, shown on the right. Mr. REID. Mr. President, first of all, shake it with water coming down. And This summer, we passed a bipartisan I want to underscore the comments gold, of course, is very heavy, and the prescription drug bill, which was not about the Senator from Iowa, Mr. gold would be at the bottom. You could perfect. As it returned from the House, GRASSLEY, which were made by the see if there was any gold there. though, the prescription drug bill that senior Senator from Montana. The other way, of course, you could passed the Senate has taken a step Senator GRASSLEY is a dedicated Sen- find if there was gold is you could send backward. It is not imperfect; it is bad. ator, a gentleman, and I have great re- it to an assayer and find out. But the I think there are millions of people spect for him. So I appreciate the Sen- first preliminary thing you did was pan worse off. It gnaws away at the founda- ator from Montana saying those nice for gold. tions of Medicare. things about the senior Senator from Mr. President, one of the things I Seniors have trusted this program for 40 years. My position has been that we Iowa, Mr. GRASSLEY. learned as a boy in Searchlight is there But I also want to say that on our was a lot of something called iron pyri- should make health care available to side we have two people who have been tes. It is fool’s gold. every American, we should cut costs, so heavily involved in getting a bill I have this little rock in my hand. It we should improve quality, and we here. One is the ranking member of the is the same kind of rock I have pic- should expand access. Upon review of this legislation, we don’t have that. We Finance Committee, Senator BAUCUS, tured on the right side of this chart. If who, as he said, is my friend. I have the you were up close, you could see this have what I believe is an image, an deepest respect for him, and I know glittery, gold stuff on the rock. It is all image that looks like gold, but it isn’t, it is fool’s gold. how hard he has worked on this legisla- over the rock, and it looks like gold. It All you have to do is look at the tion. He has kept me apprised of his glistens like gold. The only way that facts. In Nevada, 20,000 low-income sen- you can find out if it is real gold is if progress and slippage on occasion. iors will have to pay more when this Senator BREAUX and I, of course, you either pan it or assay it. legislation goes into effect. This bill came to the Senate together. There is What I have shown on the left side of contains an unfair and confusing assets this chart is gold. And what is shown a bond of friendship between us that test. Why would we charge someone on the right side of the chart looks like will last forever. negatively because they have planned So even though I do not agree with gold, but it is fool’s gold. ahead and have a burial plot, maybe a I say to my friends within the sound my two friends, Senators BAUCUS and car, maybe some furniture? This bill of my voice, even though this product BREAUX, on this legislation, no one can contains an unfair and confusing assets looks like gold, I think if you examine take away how hard they have worked test. More affluent seniors are going to on it and how they believe they are it, if you assay it, you will find it is not be punished. That is not right. doing the right thing. gold. It is like the iron pyrites in the I have been through this once before Mr. President, the Presiding Officer mines of Searchlight. It is something as a Member of Congress. On cata- knows that my father was a hard rock we call fool’s gold. strophic, I introduced legislation in the miner. As I look back, the best times This legislation started as a Medicare Senate that the chairman of the Fi- we spent together were when I was a prescription drug benefit for seniors. nance Committee, Lloyd Bentsen, per- little boy. Now, this large bill we have here, of ap- sonally criticized me for introducing. My dad worked in a number of mines, proximately 700 pages—approximately That legislation was to repeal cata- but the mine that I remember is a mine 700 pages—about 150 pages of it deal strophic. I did it because the seniors of called The Elvira. My dad worked un- with prescription drugs for Medicare. America were up in arms. I was a rel- derground alone, which was, of course, The rest of it is something that I never atively new Senator, and I won’t say against the law. No one ever prevented thought was to be part of the legisla- my colleagues shunned me, but they him from doing that. The mining in- tion; it is to reform Medicare. weren’t happy for a while. But that leg- spectors rarely came to Searchlight. Now, my friend, JOHN BREAUX, has islation passed. It repealed cata- It was during the summertime, when spent a lot of his legislative life talk- strophic. I was out of school, the first summer I ing about the need to reform Medicare. Catastrophic was directed toward can remember going down with him, And I have not talked in detail with people who had taken care of them- keeping him company. Senator BREAUX, but I am confident he selves, had provided for the future. As I look back on my father, those was much more involved in and con- They were being punished for having were times we had together under- cerned about reforming Medicare than done a good job, taking care of the fu- ground. I had my own little hat, with a the prescription drug aspect. That is ture. They rebelled. And that is what carbide lamp. I was not much help to not necessarily bad, but that is what he we are going to find here. him, but I kept him company. was focused on. Clearly, they will pay more in Medi- My dad was a very quiet man, but he Senator BREAUX believes that Medi- care premiums. The costs of Medicare would talk to me. We had wonderful care needs reform. During the Clinton will go up for them. They already pay times. I would have my own lunch. My years, he was the chairman of a com- more than their share of payroll and mom would pack my lunch. mittee to come up with some Medicare income taxes. They already pay the But my dad taught me a lot of reform. And he came up with it. He was greater share of Medicare costs. things. As I indicated, the finest the chairman of that committee. More I have received some letters from memories of my dad are from those than 50 percent of the people who people in Nevada, constituents of the days we spent together underground. served on that panel believed that his Presiding Officer and me. Let’s note As I got older and stronger there program was good that they had come what some of them say. were things I did later, as I became a up with. But under the rules of engage- Mrs. Betty Sweet of Las Vegas: Don’t teenager, that I could do to help him ment, it took a supermajority to do sell the seniors out to big business physically other than just keep him that, and he could not get that. HMOs. The HMO plan will be a step company. But those days were not like So Senator BREAUX, as I have already down in our care. the days I spent alone underground said about my friend—Senator BAUCUS Martha Pruter of Reno: This plan is with my dad. and Senator BREAUX, fine people, won- only going to benefit the pharma- He taught me a lot of things. But one derful Senators, but I think this legis- ceutical companies. It will not benefit of the things he taught me how to do lation, which started out as a prescrip- consumers.

VerDate jul 14 2003 02:14 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00037 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.076 S23PT1 S15628 CONGRESSIONAL RECORD — SENATE November 23, 2003 Mary Ann Brim of Henderson: I op- pushes it off into a fund for private in- by leaders. I believe their whole con- pose the Medicare bill. Has anyone surance companies. That is why we cept is what is behind this legislation. done the math? I can’t believe they have read in all of the papers around First of all, this is Senator Bob would support this bill if they had. Cer- the country that the insurance indus- Dole’s direct quote: tainly you can come up with something try is wild about this legislation. The I was there fighting the fight— better than this. pharmaceutical companies are wild He was 1 of 12 against Medicare— Now, these people, Mrs. Brim in par- about this legislation. They wiped out because we knew it would not work in 1965. ticular, actually did their homework the reimportation we had in our bill, He and many colleagues believed it on the math. The actual drug benefit something that went to the House, would never work. Senator Dole was 1 created by this bill is confusing and of- where we could reimport drugs which of 12 who voted against it then. fers seniors only a meager drug benefit. are much cheaper in Canada. That is Former House Speaker Newt Ging- Someone who spends approximately eliminated, and that is too bad. It was rich, said: $5,000 a year on drugs will be stuck a concept that both the House and the with almost 80 percent of the bill. Senate approved. This is something Now, we didn’t get rid of it in round one People have come to me and said: because we didn’t think it was politically that is hard to comprehend. smart, but we believe Medicare is going to Vote for this. Nothing is going to kick This bill even says that when Medi- wither on the vine. in for a couple of years. You are pro- care becomes the largest purchaser of Former House Member Dick Armey tected. You can talk about the benefits prescription drugs, it is expressly for- said this: of this bill. Maybe they are right. But bidden to negotiate prices with the in a couple years I would look back on drug companies. That is why we want Medicare has no place in a free world. So- cial Security is a rotten trick. this vote saying, I didn’t do the right these large purchasers of pharma- thing because thousands of retirees in ceuticals, so they can go to the drug He goes on to say: Nevada will lose their coverage as a re- companies and get lower prices. In this I think we are going to have to bite the sult of this bill. legislation, they are forbidden from bullet and phase it out over time. In Nevada, tens of thousands of sen- doing this. If we really believe in a free Those are direct quotes. I think part iors stand to lose their current retiree market, why shouldn’t Medicare also of what we have behind this legislation drug benefits. The Nevada senior pre- be able to bargain for good prices? It is is an effort to have Medicare wither on scription program that Governor Guinn no wonder big insurance companies and the vine, and it will be withering on of Nevada tried, it was one program, big drug companies are spending mil- the vine. I think we should understand and nobody even signed up for it. He lions of dollars on lobbyists and ads to that this legislation is not what it pur- has one now that is good, people like support this bill. ports to be; it is not. As a result of it, and we don’t know what is going to I have to say they have done a good that, I believe we should vote against happen. We don’t know what is going job. I want everyone to know that the this legislation. to happen to this program. drug companies and the insurance com- Mr. President, how much time do I We heard the distinguished ranking panies have spent their money well. have left? member of the Finance Committee, Because the lobbyists have really done The PRESIDING OFFICER (Mr. Senator BAUCUS, talk about dem- well by them, this bill is a dream for ENZI). The Senator has 11 minutes. onstration projects, six of them. We the insurance industry and the big Mr. REID. Mr. President, I yield that could get as many as three of them in drug companies. It tilts the playing time to my colleague from Nevada, Nevada. I don’t think we should be field in their favor at the expense of Senator ENSIGN. used as guinea pigs in an ideological senior citizens. That is not competi- The PRESIDING OFFICER. The Sen- experiment that would force them to tion, it is corporate welfare. ator from Nevada is recognized. give up their doctor and join an HMO This bill is not what it claims to be, Mr. ENSIGN. Mr. President, I want or pay higher premiums to remain in and seniors are smart enough to see to talk about one Senator’s journey traditional Medicare. Those who opt this bill for what it really is, fool’s through this bill, trying to make a de- for private plans would have to use a gold. Betty Sweet, Martha Pruter, cision based on the facts and trying to doctor approved by the insurance com- Mary Ann Brim, they all did their get through the rhetoric, because there pany in these areas. Over time the sen- homework and understand that this is a lot of that going on in any piece of iors who remained in the traditional legislation is not good. legislation. So I am trying to write fee-for-service Medicare would likely As I have indicated, the actual drug down the pros and the cons of this leg- be the oldest, the sickest, and the poor- benefit created by this bill is confusing islation and go through them in a sys- est. They would have to pay an ever-in- and offers seniors only a meager drug tematic fashion and try to make a de- creasing premium to maintain their benefit. It is a poor trade when you cision based on policy and not based on coverage. spend approximately $5,000 a year on politics, a decision based on what is in This bill would make a wide range of drugs and you will be stuck with 80 per- the bill, not on what people are saying seniors worse off than they are today, cent of the bill. When we talk about a is in the bill. from seniors who are eligible for Med- pharmaceutical benefit for Medicare, As I have gone through this, I have a icaid, seniors who have coverage people think they are going to get the whole list of general principles that I through former employers, seniors en- drugs at a reasonable price. believe are good. I have still not made rolled in State pharmacy programs, to The Medicare conference agreement up my mind on this final piece of legis- seniors who will be forced to pay high- would make fundamental changes to lation because it is really a balancing er premiums to stay in traditional Medicare as we know it, changes that act. There are good things and there Medicare. That is not the type of pre- have nothing to do with a prescription are things that are not so good. Just to scription drug coverage our seniors de- drug benefit or building a stronger mention a few of the things that I be- serve. It is fool’s gold. foundation for the program. It would lieve are good in this bill, probably the Many of my colleagues support this use our senior citizens as guinea pigs best thing is something called the bill because they like the concept of to test the theories of Newt Gingrich health savings account, which has competition. I like competition, too. and other ideologues. nothing to do with Medicare today. It But I am in favor of competition where Am I off base on this? I carry this has to do with reforming the overall in- there is a level playing field. This bill with me because I have used it on a surance system in our country for does not provide for fair competition. number of occasions, and now it is kind health care. It is something I have been This rigs the rules in favor of private of withered and dilapidated. I have seen fighting for, for many years and intro- insurance companies by paying them Newt Gingrich, with whom I served in duced legislation on when I was in the off to serve a patient whom Medicare the Congress—a fine person. I like him. House of Representatives on the Ways would also take care of without the ad- I think he has a great mind. And he has and Means Committee. ditional incentive that these compa- been able, with his great mind, to do We passed it several times, but unfor- nies get. It siphons off $12 billion that some things with which I don’t agree. tunately, when we passed the final should be used to help our seniors. It But I have here some statements made version, we had to water it down so

VerDate jul 14 2003 02:14 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00038 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.068 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15629 much that we enacted a piece of legis- pilot project. Right now in Medicare, the prescription drug benefit should be lation that did not work. So the health you go to one doctor and Medicare means tested. That is another negative savings accounts in this piece of legis- pays, and maybe you have diabetes and in this particular piece of legislation. lation, I believe, are going to be one of you have to go to several specialists, Just mentioning a couple of the the most significant reforms we can internists, or whatever; there is noth- things, there are some really good possibly enact for the future of bringing really coordinating care. So you pieces of this bill, but there are some ing the patient back into the account- get different prescriptions and dif- major negatives in this bill. ability loop. When you have a third- ferent doctors. There is no real coordi- When we are going through all of the party payer system—what I mean by nation of care and also not a lot is rhetoric, I think all of us have to be that is the person receiving the care being done preventively. So we end up honest. The supporters of the bill doesn’t directly pay for the care; it is a with poor-quality care, poor outcomes, should be honest that there are some third-party payer system. and we spend more money. problems with it, but the people who So when you walk into a doctor and We have a great demonstration are against the bill should also be hon- the doctor says we need to run this test project, a pilot project that Repub- est. This does not end Medicare as we and that test, the person doesn’t even licans and Democrats actually should know it. This is a bill incredibly gen- say how much do those tests cost or is like in this bill on the disease manage- erous to low-income seniors. Even if I there a cheaper place to go get an MRI, ment part of it. In the future, I believe vote against this bill, I have to say this for instance, or is one place better or it will improve outcomes for seniors is incredibly generous to low-income cheaper or is a certain specialist better healthwise, and it will also save costs. seniors. That is just being honest. All than others or is one cheaper than oth- As to some of the negative parts of seniors pay out of pocket is a $1 copay ers, and maybe of the same quality— the bill, first of all, it does not kick in for generics and a $3 copay for brand none of those kinds of discussions hap- right away. A bill that I introduced name prescription drugs. That is an in- pens because they are not paying the would have kicked in as soon as the credibly generous benefit. bill. The health savings account allows drug discount card kicks in. That is In conclusion, as I go through this them to put money into an account tax the only thing that really kicks in, in next 24 to 48 hours—whenever we are free. It builds up in the account tax the next 5 or 6 months—the drug dis- going to vote on final passage of the free, and when it is taken out for count card. The legislation I had intro- bill—it is a 700-page document we got a health care expenses, it is taken out duced actually would have fully kicked couple of days ago. I think we have to tax free. Then that person directly in. The Democrat bill and Republican take our time to go through the bill. pays the doctor. bill we had debated, none of those The PRESIDING OFFICER. The Sen- Now, why is that significant? It is kicked in right away, and neither does ator’s time has expired. significant because in our current sys- this bill. Mr. ENSIGN. Taking our time to go tem, whether it is traditional Medicare The other problem with this bill is through the bill is very wise to do be- fee for service, or even the HMOs or the there is a cliff at 150 percent of pov- cause my biggest fear—and we see this PPOs, all the payments go through erty. After that, you kind of drop right happen with legislation all the time— some kind of bureaucracy, whether it off the cliff. So for those below 150 per- when we have this kind of complexity is a Government bureaucracy or a pri- cent of poverty, this is too generous. in a document is the law of unintended vate one. Anybody that has experi- With a $1 and $3 copay, we are going to consequences. enced our health care system today incentivize people to overutilize drugs, We enact bills all the time. When we knows that maybe companies are not pure and simple. You are going to see enacted HIPAA—and the majority trying to deny payment but it cer- overutilization of drugs. We see it in leader is on the floor and he knows bet- tainly seems like that in a lot of cases. Medicaid today because of the low ter than anybody—the HIPAA law is a My in-laws are dealing with this copays and we are going to see it here. terrible piece of legislation, and we are right now. My father-in-law had cancer That was a huge mistake that we suffering consequences today. We are last year. They have been battling for didn’t once again have people receiving driving up health care costs unneces- almost a year now on whether the in- the drugs having anything financial at surance company should pay for a large sarily because of that legislation. That stake. And $1 and $3 copays will not part of their coverage or not. That is why I am still trying to go through takes a lot of time for people to proc- change behavior in any way whatso- this legislation to make up my mind. ess, to answer phones, go through the ever. I thank my colleague, the senior Sen- The other thing that actually we whole process. If somebody is paying ator from Nevada, Mr. REID, for yield- have to consider—and we should at out of their own pocket to the doctor, ing me the time to speak tonight. I least go into this with open eyes—this none of these conversations has to take look forward to hearing the majority is the largest wealth transfer since place, and that money that is saved leader’s comments on this legislation Medicare was first put into effect. We through the bureaucratic process can as I am still battling through what I go directly to health care. I believe just have to know that. The $400 billion am going to do on it. health savings accounts are one of the is being taken from younger people and I thank the Chair. I yield the floor. most positive things in this bill. given to older people. The older people The PRESIDING OFFICER. The ma- Mr. President, will the Chair please didn’t pay for it. We are giving that. So jority leader. notify me when there is 1 minute re- we have to go into this with open eyes. Mr. FRIST. Mr. President, I will be maining? The other thing I believe is a problem speaking for about 30 minutes. I ask The PRESIDING OFFICER. The with the drug benefit we have in Medi- that the Chair notify me when I have Chair will do so. care is that it is giving it to the used 25 minutes. Mr. ENSIGN. Second is the means wealthy. I don’t believe we should be. The PRESIDING OFFICER. The Sen- testing idea of Part B, the affluence We should be helping and putting al- ator will be notified. testing, as it is being called. I think it most all the benefit into the people Mr. FRIST. Mr. President, we are at is wrong. This is not a part of Medicare who are literally having to choose be- a truly historic time. A lot of times we where people are paid in their taxes tween prescription drugs and rent and exaggerate a bit to make a point. It over the year. Part B is something that maybe whether they are going to eat seems as if on every bill somebody younger generations—such as the pages that month or what kind of food they says: This is a historic bill. we have here—people paying taxes out are going to eat that month. As a physician, as someone who has there are paying for seniors, and we Instead, this bill gives coverage for had a great privilege in life, a blessing should, at least for those wealthy sen- everybody on Medicare. I don’t believe in life to have served as a physician iors, have them pay for that benefit that is right. When Bill Gates turns 65, and to have taken an oath to serve hu- they are getting, instead of shifting the I don’t believe he should be getting a mankind in such an intimate and per- benefit on to middle-class taxpayers. prescription drug benefit that is paid sonal way, I truly believe it is an his- That is also very good. for by some union worker who worked toric time because with the action we Another part that is good in the bill hard all of their life and paid taxes. I are almost certainly going to take to- is this idea of a disease management don’t believe that is right. So I believe morrow night, we are going to change

VerDate jul 14 2003 02:14 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00039 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.070 S23PT1 S15630 CONGRESSIONAL RECORD — SENATE November 23, 2003 the lives of 40 million seniors and also put it way up off the chart. That is row night or tomorrow afternoon—the 77 million baby boomers who will be where this change is going. sooner the better on my part—I think seniors over the coming years by this The first successful heart and liver we are not going to fill this gap, and we single piece of legislation. transplant was in 1965. That is a fas- are going to be stuck down here when It is rare we can say that. It is so cinating history. That is the field I all of these advances are up here and rare. Everybody gets sick at some ended up going into, heart transplant these advances are being denied sen- point later in life—everybody. If it surgery. iors. reaches a certain threshold, you seek Coronary angioplasty, when people That is why when people say ‘‘fili- medical care. This bill will affect the have drug-eluting stents, and we hear buster,’’ use procedural moves to stop type of care you receive, whether or about it all the time. It wasn’t that this, do they mean they want to stay not you have appropriate access, the long ago. That was just in 1977. We had down here when we have the oppor- quality of that care, and the response the first open heart surgery cases in tunity, to catch up and let these health of the type of care that is given to you. the 1960s. advances be delivered to our seniors? That is why I say it is a historic bill. In 1974, the HMO Act was passed in So that is the way I think about I am confident we will pass this bill this body. Prozac, a drug many people things—in terms of what is at stake. tomorrow night. I know there are a lot are on today, was first used in 1988. It I do not think anybody can defeat of statements that have been made: We is interesting, when the PPOs—and I this bill and go home from here. They are going to obstruct; we are going to will talk more about PPOs shortly— cannot face 40 million seniors and say filibuster; we are going to use proce- began in 1985, 1 million people were en- we are not going to give them the ad- dural moves. But at the end of the day, rolled. Within 13 years, 90 million peo- vances that are available to the rest of nobody from this body, I believe, can ple are enrolled in these PPOs. the world. It is not right, if that is the go home and say—when we are an eye- We had the human genome project, a case. lash away, after 6 years of hard work of fantastic project which just finished Now, why today? I have heard from trying to put together the very best this year. It was a successful public- the other side of the aisle again and bill possible—that we would go home private partnership. This chart shows again: Let’s do it next year, 2 years having denied the President, with the all the advances. The point is, these ad- from now, 3 years from now. leadership he has shown, and the House vances are getting faster and faster. It is because we have this earth- of Representatives, with the leadership The next chart uses the same format, quake, or this mountain, moving to- they have shown, and the hard bipar- but it shows what Medicare has done. wards us, defined in 1945 by the baby tisan work on this floor, and then tell Has it changed as well? Medicare has boomers. This is a fertility curve. We seniors: It is not going to happen. Once not changed very much. It started in know after the war, fertility went up again the promises that have been 1965. It was enacted into law in 1965. It 3.5 births per woman. Then it fell back made have been denied you. is a great program, a fantastic pro- down. This is moving through the sys- Why do I say that? That is the ques- gram. I had the opportunity to treat tem to the point that in about 2008 or tion I wish to answer over the next few thousands of patients in Medicare. It 2010, this curve will begin to move minutes. has given them health care security. through the Medicare program as these I want to start from afar and then But, contrast Medicare to all the baby boomers age, beginning in about 4 come down to some of the specifics of health care advances, and we can see it to 5 years. the bill and paint a picture, paint a hasn’t changed much over time. When they hit the system, what hap- portrait that I think helps, at least in In 1972, it was expanded to include pens is potentially catastrophic if we my own thinking, to explain to the end-stage renal disease and dialysis. have not prepared the system for that. American people why this is a pivotal That was a a good advance. To explain that, I will use the fol- time, why we have to act now, why we There was a good advance in 1985 lowing several charts. No. 1, let’s say I can’t wait another year or 3 years or 5 with prospective payments for patients am the Medicare system right here. I years, why at this moment in history who are actually in hospitals. It was have seniors who are taken care of over events have come together in conver- pretty revolutionary at the time. here, and I have people who are pay- sion. There is a reason, and when we We have had people refer to cata- ing—that is all the working people act, we will have a much more dra- strophic coverage. Notice line went up today—to support the Medicare system matic impact in improving health care and went down because catastrophic which takes care of these seniors. Well, and improving health care security coverage was repealed. A lot of people what is happening is we are having a than if we were to wait. said: Is this bill going to be repealed? If doubling of the number of seniors be- In 1965, Medicare began. I didn’t start I have time, I will comment on that because of the baby boom. So the popu- practicing medicine until the eighties, cause there is a clear answer to why lation is getting bigger because of the but through that period of time, it is that is different. baby boom demographic shift. It is this just amazing. We have seen health care There were prospective payments for point in history that it occurs. It was advances that are remarkable in terms physicians 1990. In 1997, we added the not 10 years ago, and it is not 30 or 40 of medicine, science, and technology. Medicare+Choice Program and other years from now. It is beginning right The half-life of medicine—that is a sta- prospective payments. now. We have a doubling of the number tistical way of looking at medicine and Now we are in 2003. And tomorrow of seniors. advances. It got smaller and smaller night are we going to improve and At the same time, because there is a and smaller and smaller because of our change Medicare in a positive way. big curve moving through, we have knowledge and understanding. Ad- People say you can change Medicare fewer people working to pay. So we vances have been made in both health and that is bad. That is not bad; that is have fewer and fewer people paying the services delivery—that is how health good. health care of more and more people care is delivered and how it is orga- We are going to strengthen and im- over time because it is a pay-as-you-go nized—as well as scientific and techno- prove Medicare, and that is the whole system. The people supporting the sys- logical advances. purpose. The next chart shows very tem today are the people working I am going to show three graphs clearly the advances in technology go today. using this same format. On this Y axis on up, but Medicare is too rigid. It does I will show my colleagues graphically is change. It is fairly arbitrary in de- not change. We are not capable of exactly what I said. Medicare enroll- scribing change, but it is improve- changing the structure of Medicare fast ment—that is the number of seniors ments, it is how things change over enough in this body and therefore that over 65 years of age—in 1970 it was only time. Along this X axis, it starts in 1965 rigid structure cannot adapt to new 20 million. What is important is that when Medicare started and ending in drugs, new pharmaceutical agents, new there are 40 million people today, but the year 2005, as we project ahead. ways to deliver health care, new types because of the baby boom—look at this We can see this change came along of PPOs. We just do not change. curve going up—we are going to have pretty steadily, and all of a sudden it So the gap, is what we are address- twice that in 2030, right at 77 million, started to go up, up, up, and I would ing. If we do not pass this bill tomor- this chart says, but it will be right at

VerDate jul 14 2003 02:20 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00040 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.079 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15631 80 million. So we have a doubling of the Now, just an example: Cancer, diabe- keep exactly what they have today, number of people we are going to be tes, rheumatoid arthritis, with no change in their benefits. They taking care of over the next 30 years. osteoporosis—there are drugs for all of might already have prescription drugs What about the people who are actu- these diseases. There are 402 drugs so they would not want prescription ally taking care of each one of those? right now in clinical development for drugs. All of this is voluntary. It is not In 1970, there were seven people over cancer. So whatever we do, we do not mandatory. Nobody is making any sen- here working to take care of every sen- want to destroy the research that is ior even make a decision to do any- ior, but because the fertility curve is going on in this country. If drugs are thing. They can keep exactly what moving through in the year 2000, it was the most important part of health care they have if they are satisfied. about four people working. So for every today, we want to make sure that we In addition to this discount, there is person working to support one, they promote research and development. a $600 value if a senior is low income, are having to work a lot harder. There That is why we do not engage in gov- less than 135 percent of poverty. The are fewer people. Instead of seven ernmental price fixing, setting prices chart I just showed my colleagues was working, four are working for each one. by Government, because it destroys all Medicare today. Remember, the senior What is even worse is that over the of this in terms of research. could choose either traditional Medi- next 30 years, instead of four people, it NIH does a good job, and we can fund care, which 35 million people have, or goes to two people. So they are going it. We fund several billion dollars Medicare+Choice. After this bill passes, to have to be working twice as hard for through our NIH, but the private sec- we are going to expand the opportunity every one person that is benefiting. Yet tor’s contribution to research is many to choose, so seniors for the first time we have twice as many people who are fold what the government provides. So can choose the health care plan that benefiting. That is the challenge that we have to continue to support that best suits their individual needs. If you we have and that is the reason for private sector research. have Alzheimer’s you might choose a ‘‘why now.’’ That answers the question So what do we do? Where are we plan that specializes in Alzheimer’s. If as to why we should do it in this Con- today? Here we go in terms of how we you have Parkinson’s disease or coro- gress. We should have done it 2, 4, even modernize this system, and at the same nary artery disease or you have had a 6 years ago. If we do not do it now, it time address the issue of prescription stroke or you have seizures, there may is too late. drugs. How do we marry it? This bill be plans out there that can best suit That is the reality of Medicare. So does it in a bipartisan way. your needs that for the first time you people say, why do we not give a drug I predict this bill will pass tomorrow will have access to. That is not avail- card and leave it at that, take care of with a bipartisan vote. I know a lot of able in traditional Medicare. a group of people and give them 50 or 70 people are bringing partisan issues to So a senior can choose under new percent on the card? The point is, that the floor and saying we are going to Medicare. Either the traditional Medi- does not address everything that I have stop it with such things as procedural care, keep what you have, don’t change said to date. It does not address the votes, but this bill is going to pass with anything. If you stay in traditional challenge of having a rigid, inflexible, a strong bipartisan vote tomorrow. Medicare, for the first time, if you Again, what are we going to do? outdated, antiquated Medicare Pro- want it—you don’t have to take it—you Today, a senior right now has a choice. gram, and that is why not just a drug can choose from one of two and maybe They can stay in traditional Medicare, card, though a drug card is important, three or four drug plans. They will just like 35 million have, with good and I will come back to that. But that have equal value, but you can have care and a strong system. It is anti- is why that is not the answer. that choice. A lot of people say we should not be quated, it is out of date, and it is inad- spending $400 billion. They say we equate compared to other options that People say what if the drug plans should spend $100 billion and take care people have today. It does not include don’t show up? If they don’t show up, of the people who need it the very prescription drugs, for example. Or a there is a fall-back Government plan most. But, that approach does not ad- senior can go into Medicare+Choice. there. Everybody can have this new dress the fact that we have an outdated Five million seniors have chosen to go choice, but if you don’t want to, keep system. into Medicare+Choice. They do get what you have. I have said on this Senate floor many some prescription drugs. Prescription In addition, you can choose times the most important tool a physi- drugs are in green on these charts. For Medicare+Choice, which are primarily cian or a nurse has today to treat a pa- my colleagues who are in the Chamber HMOs. HMOs are maligned on the Sen- tient is not the surgeon’s knife that I tonight, they can see the green. ate floor a lot. You talk to these 5 mil- used every day. It is not the hospital So seniors can get some prescription lion people who are in them, they real- bed. It is not even the hospital. It is drugs, but there are no prescription ly like them. But if you want to, you pills. It is medicines. It is prescription drugs in traditional Medicare today. are also going to be able to choose, drugs. No. 1, I mentioned the drug discount from a preferred provides organization Why today? Why are we acting card. In this legislation, maybe 6 or 8 or PPO or C. There may be five, there today? That was not true 10 years ago. months from now, after we pass this may be three, there may be two, there It was not true 20 years ago. But today bill and the President signs it, seniors may be one PPO. These PPOs are inte- it is the most important tool a physi- will have access to a drug discount grated health care plans. They have cian has. Yet it is denied seniors in the card. It will last for a 2-year period. disease management. They have this Medicare Program. Seniors cannot get What it says is while we are developing little green down there showing all of outpatient prescription drugs through this system, they can get immediate them will have access to prescription Medicare today. It is the most impor- relief through a card. This card will drugs. tant part of health care. Yet we deny it allow a senior to go to the local phar- People say sick people may stay here to our seniors. That is why nobody can macy and get an additional 20-percent or they may go into here or they may filibuster this bill in good conscience discount. Maybe it is a 10 or 25-percent go into here. You don’t really know. because we are denying our seniors the discount, but however a senior gets the My heart transplant patients, who are most important tool in medicine today. drugs they might get today, they will among the sickest patients going in— Tomorrow, after we pass this bill, have an additional discount. before they get their transplant they since it has been passed by the House, It is voluntary. This word ‘‘vol- are all going to die. Coming out, they and the President is going to sign it, untary’’ is key because everything that require a lot of medicines. I would en- for the first time in the history of this we put into this program today in courage a lot of those who are among Medicare Program we are going to have terms of prescription drugs or giving a the most challenging to take care of, I the most important part of health care choice of a health care plan that might would encourage them to go into these as a tool. The most important tool in a better suit a senior’s needs is vol- PPOs. Why? Because they can have a physician’s armamentarian is prescrip- untary. They can keep exactly what health care plan that is tailored to tion drugs. It is being denied seniors they have today—and this is important their needs, that is able to respond to today. for people who are listening. They can infectious disease, acute care, chronic

VerDate jul 14 2003 04:05 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00041 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.081 S23PT1 S15632 CONGRESSIONAL RECORD — SENATE November 23, 2003 care, disease management, coordinated It is amazing; as a heart specialist, 50 This bill is good for doctors and hos- care, none of which is available under percent of people in this body are going pitals. Physicians right now, if we traditional Medicare. So this is the de- to die of heart disease, probably. It is don’t do anything today, are going to sign. Opportunity to choose all of this. higher for women than it is for men. A be cut by 4.5 percent, under current Nobody is forced to choose at any point lot of people don’t realize that, in law, as to what they are reimbursed. in time. terms of morbidity. More women will When we pass this bill, it will increase, Transformational: I won’t go through die of heart disease than men this year. instead of being cut, by 1.5 percent. all of this, but I wanted to show this Right now there is no screening test Hospitals, if they give us the quality because it is hard as you listen to ev- reimbursed. Your cholesterol level data—which they should give do—will erybody. Everybody is talking about right now, as a screening test, in Medi- get full market basket. little pieces. Using the same format, care is not reimbursed. Once we pass Paperwork: You hear physicians all let me show some of the things we do. this bill tomorrow, and it is imple- the time, and hospitals, complain In the PPOs, in the choice over here mented, cholesterol screening and lipid about the regulations and the paper- that we are going to give for the first profiles, preventive tests will be reim- work. We have significant paperwork time—I say it is FEHBP-like. What bursed for the first time. People say, reduction in this bill. that simply means is we in the Senate come on; it has got to be reimbursed Back in Tennessee, the most common have a choice among a group of plans. today. It is not reimbursed today. That request is: What is this bill to me? I happen to take the Blue Cross/Blue is just an example—prevention. What does it mean to me? Shield plan. That might be one of these As to physical exams, people know To seniors, it means a lot. To individ- plans. But seniors will be able to that is important as a screening meas- uals with disabilities, it means a lot. choose, just like we choose, a plan that ure. A lot of people get to 65 years of But in addition, the State of Ten- might best suit their needs. age and have never had a physical nessee, above current law, is going to These are integrated plans; that is, exam. For the first time in Medicare, receive for hospitals, $655 million more; acute care, chronic care, preventive everybody is going to have available to for doctors, $240 million more; and for medicine, coordinated care. You have a them, under Medicare, an entry level our Medicaid Program, almost $700 choice. You can choose among these physical exam. Before, it wasn’t there. million more, because of this bill. We hear regarding prescription drug plans. There is competition in that It is not there today, but it is going to costs that there is nothing in this bill these plans will compete one versus the be there under the bill. to control prescription drug costs. other based on quality, access, and Information technology, I mention That is not true. It is simply not true. cost. They give the same benefits as that because it has to do with medical I encourage my colleagues to read that traditional Medicare, but there will be errors. Right now we know there are too many medical errors that are being bill and continue to read it tonight. competition among those plans based We speed generic drugs to the mar- on any of the issues that I just men- made. We need to facilitate, and adapt information to come into the system ket. All of us know brand-name drugs tioned. are expensive. Generic drugs are not The flexibility: What that really says and be handled in a way that is con- very expensive. What we do through is that this PPO may be different than sistent, in which the data can be as- this bill and the work of Senator SCHU- this PPO, different than this PPO. It similated and reported back. There will MER and the work of Senator JUDD may give a different range of benefits, be e-prescribing for prescriptions with GREGG is speed generics to the market although all of them will give at least incentives—not mandatory, but incentives to encourage physicians to be in this bill. the benefits given in traditional Medi- We have competition. All the com- care. able, instead of writing each prescription and have it go through 10 or 15 dif- petition, the marketplace dynamics— If you look at the drug plans, I have competition is the only thing we know down that they are risk bearing. Risk ferent hands and come back where mistakes can be made, by computer it can that over time can slow the growth of, bearing means the Government itself whether it is drug prices or any prices. shares the risk with the plan. That go all the way through the system where the mistakes are less likely to Price fixing simply does not work. It plays into the marketplace. That is the hasn’t worked in Germany, it hasn’t way the private sector works. It cap- be made. It is a complicated chart, but it gives worked in England, and it hasn’t tures the dynamism of the marketplace my colleagues the feel for everything worked in this country when we tried and, over time, and with the element of that we are accomplishing in this bill— it in health care. I am going to keep competition, that can bring the cost of not everything, but how important the moving here. drugs and Medicare down. These are various elements of this bill are. Are we helping the people who need competitively bid. Again, they have Senator KENT CONRAD in this body is it the most, poor people? The answer is the flexibility. the person who is probably as focused yes. Below 100 percent of the poverty Traditional Medicare: You have as anybody on this particular issue. I level: If you have $100 in monthly drug heard people talking about income re- agree with him 100 percent. spending, 95 percent of the cost of lating, means testing. For the first How much time do I have? drugs is paid for through this plan. time, the very rich, the Ross Perots of The PRESIDING OFFICER. The lead- Let’s take another example. If you the world, will no longer have their as- er has 51⁄2 minutes. are below the poverty level and you sistants or their secretaries subsidizing Mr. FRIST. Five and a half. OK. I have $500 a month in drug spending, their Part B premiums, their health will move fairly quickly. you have 97 percent of all of the costs care. For the very rich, they are going The issue is that most people in taken care of by this plan; $1,000, you to have to be responsible for more of Medicare today are not very expensive, have 98 percent. the subsidy—not all of the Government in terms of their health care. But 6 per- These are the people who need it the subsidy for them but more. There is cent are. most. This plan is generous to the peo- cost containment built in. There are In this body there are 100 people. Not ple who need it the most. disease management programs that are everybody is here right now, but 6 of In closing, again, I will keep it very going to be part of the traditional the 100 people in this body would ac- short. Hopefully, I can speak for a cou- Medicare. count for 50 percent of all expenditures ple of minutes tomorrow morning. Quality is going to be rewarded. This in Medicare. That is amazing. We are providing access to prescrip- is fantastic. I will come back to this if Wouldn’t it be great if you could tion drugs, the most important tool in I have time. For the first time, the hos- identify which 6 it is, and if you identi- medicine today. Seniors don’t have it pitals, for example, if they report the fied them you could focus resources, today. They are going to have it after quality data, they will get their full, coordinate their care, get preventive we pass this bill. what is called, market basket update. medicine, give them disease manage- This program is voluntary. If you do The important thing is if they don’t re- ment, and that would take care of 50 not want to change anything, if you port that quality data over time, they percent of the cost? In this bill we es- like what you have today, then keep are not going to get paid as much. tablish data collection to identify and what you have. Nobody is forcing you Quality is being rewarded. begin that disease management. to choose. All of this is voluntary.

VerDate jul 14 2003 02:20 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00042 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.084 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15633 Private health plan choices: Why? disabled at the mercy of ever-increas- appears as though this bill is being Because private health plans today ing premiums. railroaded through Congress on twisted capture the advances I showed you ear- I am unhappy at the prospect that arms and backroom pressure. lier—coordinated care, disease manage- this plan could tell patients who have When I look at Social Security and ment, and integrated care. That is complex medical conditions they can- Medicare, I don’t just see a program, I what it is in private plans today that is not get direct access to specialists they see a promise. It is a promise from one being denied to our seniors. Seniors need to see. generation to the next. It is a promise don’t have access to them. I am unhappy at the prospect that from our Government to our seniors. Appropriate reimbursement and reg- this plan could tell patients with MS, And it is a promise that reflects our ulatory relief to providers, to doctors, or Parkinson’s disease, or ALS they values. to hospitals, to nurses—I just men- can’t get the drugs they need because Coupled with Social Security, Medi- tioned what the impact is for a State their plan will not cover them. care is the most important antipoverty such as Tennessee. Payment linked to I am unhappy at the prospect that program ever. In fact, before Medicare, quality is not done today. It is not this plan could tell our rural seniors in 1963, 44 percent of our seniors were done today in Medicare. For the first they will have to roll the dice on how uninsured. Today, it is just 1 percent. time, reimbursement is being linked to they receive health care coverage be- In 1966, 29 percent of seniors lived in quality care. cause this is not a real choice in their poverty. Today, it is down to about 10 Lastly, preventive care, physical communities. percent. Since 1960, life expectancy for exam for the first time, if we pass this I am unhappy at the prospect that those over 65 has increased by 25 per- bill; lipid profile; improvement in this plan would tell disabled Americans cent. mammography screening; chronic care who are fighting poverty that the Medicare is a success story. It prom- management and disease management. drugs they get today can be off limits ised our seniors that they will have I know my time is up. Let me close tomorrow. health care security, regardless of their by saying this bill does four things. It I am unhappy at the prospect that ability to pay, regardless of where they strengthens and improves Medicare; it this plan would tell seniors if their live, and regardless of their medical offers prescription drugs for the first drugs cost more than $2,300, they won’t condition. time in the history of our Medicare get a dime of help until they pay $3,600 Not only has Medicare helped sen- Program; it does it on a voluntary out of their own pockets. iors, but it forms the foundation of all basis; and for the first time in the his- I am unhappy at the prospect that of our health care. Medicare helps train tory of this program it gives seniors this plan could break the promise that our doctors. Medicare payments help access to plans that better suit their Medicare has had for our seniors and keep our rural hospitals open. And needs. our disabled since 1965. Medicare helps keep emergency rooms I encourage every Member in this This isn’t just about plans and and neonatal units operating. Medicare body to vote for this bill. formularies and medical services areas; is open to every doctor and every hos- Thank you, Mr. President. this is about people. It is about our pital. It doesn’t force providers into re- The PRESIDING OFFICER. The Sen- parents and our grandparents and gen- stricted networks. It lets doctors make ator from Washington is recognized. erations of Americans coming behind decisions based on what their patients Mrs. MURRAY. Mr. President, would us. need—not on some mandate from some you notify me when I have 5 minutes I have sat down with seniors in my accountant. remaining? State, and I have heard how badly they It is troubling to think of what rural The PRESIDING OFFICER. The Sen- need a real drug benefit. Just last Au- America would be today and whether ator will be notified. gust, I met with more than 200 seniors inner-city trauma centers would even Mrs. MURRAY. Mr. President, I have in Edmonds, WA, at the South County be in existence today without Medi- been fighting for a real prescription Senior Center. They told me in their care. drug benefit for years. In the 106th own words just how important the drug Let us not forget the reason we cre- Congress, I helped draft the MEND Act, benefit is. ated Medicare in the first place. The and year after year I have used my seat During this debate, I have listened to market failed our seniors. on the Budget Committee to set aside my colleagues. I have listened to sen- I approach this debate with a clear money for a good drug benefit. I voted iors and the disabled in Washington understanding of the importance of for several Medicare prescription drug State. I have heard from doctors and Medicare to our seniors and to our en- bills, including S. 1 last June and the hospitals at home. I have read the key tire health care system. When I look at Graham-Miller-Kennedy bill in the last provisions in the package, and I have this bill, I want to know what it means Congress. I have written and I have in- reviewed the Congressional Budget Of- to the seniors I represent. So far, I troduced legislation to make Medicare fice estimates. Without a doubt, this is have found five big dangers for Wash- more fair to the people of my home one of the most complex and controver- ington State seniors. State of Washington. I have worked to sial proposals this Congress has consid- First, this plan jeopardizes the improve health care for seniors on the ered. health benefits retirees have earned HELP Committee, on the Labor-HHS One needs only to review what hap- during their working years. In Wash- appropriations subcommittee, and here pened in the House a few days ago to ington State, 47,250 seniors could lose on the Senate floor. see how controversial and political the their retiree health benefits. In return, After all of these years of work, no vote was. What occurred during that they get much less coverage and they one wants prescription drug benefits vote speaks volumes about the failures will pay for more than they had more than I do. But I am very troubled of this bill and the lengths the major- planned. by the proposal that is now before us. ity will go to in order to pass this This plan is an unpredictable benefit I am unhappy at the prospect that flawed measure. that requires huge out-of-pocket costs this plan could force seniors and the At the end of the allocated time for and has massive gaps in coverage. This disabled into an overly restrictive that vote in the House, the bill had bill changes the ground rules on sen- health care rationing regime in which been rejected. But the majority leader- iors in the middle of their golden years, they could lose their choice of doctors ship refused to close that vote. They and that is just not right. just to get a pretty meager drug ben- held it open for many more minutes, Second, seniors could be forced into efit. and those minutes turned into hours, an overly restrictive health care ra- I am unhappy at the prospect that and finally at about 6 o’clock in the tioning regime if they want a drug ben- this plan could tell our seniors they morning, after holding that vote open efit. On paper, it looks as if seniors must give up the good retirement for 3 hours, the majority managed to have a choice. That is what the pro- health plan they have worked all of pressure a few Members to switch their ponents keep repeating. When we take their lives to earn. votes. a closer look, we see what is going on. I am unhappy at the prospect that An issue this important deserves a Supporters claim that seniors can stay this plan could leave our seniors and thorough debate. I am troubled that it in traditional Medicare, but that is

VerDate jul 14 2003 02:20 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00043 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.088 S23PT1 S15634 CONGRESSIONAL RECORD — SENATE November 23, 2003 only if insurance companies decide to eficiary paid $2,322 for prescription ing Medicare through a offer drug-only plans. They could offer drugs. If you spend the average, you Medicare+Choice plan. drug-only plans, but the affordability are already in the coverage gap. Those Washington State also has a long of those plans is unknown and unknow- figures were included in the Los Ange- tradition of managed and efficient able. That is because there is no limit les Times article that appeared in the care, so we will be a prime target for on how much a plan can charge, so sen- Seattle Times on November 21. They the new PPOs and HMOs. That means iors will not be protected from price show that the average senior will end Medicare benefits in my State, just gouging. up with a gap in coverage from which within my State, will vary from region On paper it may look as if seniors get few seniors will ever emerge. to region and county to county depend- a choice, but in reality many will face When I ask, what does this bill mean ing on where you live. In theory, sen- a new system that rations their health for the seniors I represent, I am pretty iors in my home State may have more care in exchange for a very small drug troubled by the answers. I am troubled choices, but they give up a guarantee benefit. Seniors could get fewer choices this could force 47,000 seniors in Wash- of a defined benefit. and less coverage than they have ington State to give up the retiree Providers in Washington State could today. They will face fewer choices be- health benefits they have worked for also face the same changes and uncer- cause of an imposed system of ration- their entire lives. I am troubled this tainty. Every year, seniors in Wash- ing that may not let them pick their could force seniors in Washington ington State would have to evaluate own doctor, and they will have less State into overly restrictive health each insurance plan to find the one coverage because the plans they will be care rationing, to get a limited drug that best meets their needs. Here are some of the things seniors forced into do not need to cover every benefit and to lose their choice of doc- every year in my State will have to fig- drug that is medically necessary. tor. I am troubled this could force pa- ure out. While not knowing what med- Third, if you get a chronic, life- tients with cancer, AIDS, and other ical conditions they may confront, threatening disease such as cancer or life-threatening diseases into a system they will have to figure out how much AIDS, you are not guaranteed the that will deny them the drugs they they have to pay out of pocket. With- drugs you need. Here is what one client need. I am troubled this could force out knowing what their future holds, of The Lifelong AIDS Alliance in Wash- 92,000 low-income seniors or disabled they will have to predict what pro- ington State had to say: Washingtonians out of Medicaid into a viders they will be able to see. Without market where they lose access to the The current bill as it is written will affect knowing, they will have to figure out drugs they get today. I am troubled me personally as it limits the drugs I can what doctors have dropped out of their have access to because it only allows for up this could force millions of seniors into plan or may drop out, what restrictions to two drugs under the prescription part of a coverage gap where they have to will be on drug coverage, what their co- the bill. Since I am on a multiple-drug regi- spend more than $3,600 out of their own payments will be, what plan formulary men, I will not have access to the other life- pocket without getting coverage or saving drugs that I will have to take to stay includes expensive new drugs, what HIV healthy. benefits. This bill is also bad for Washington hospitals are in their network. That is an awful lot to figure out, es- Those are the chilling words of one of State in seven ways: pecially since health plans, as we all my constituents who is HIV positive It could result in unequal benefits know, are never written in plain and understands what this bill will throughout Washington. English and no one knows what med- mean for him. That is why AIDS serv- It could force providers and seniors ical conditions they may confront in ice providers in my State oppose this to reevaluate their participation every their future. bill. single year, and they will get very lit- In addition, if you need access to a Today, Medicare provides predict- tle in return for that added unpredict- ability. An 85-year-old woman in her clinical trial, forget it. This bill does ability. not require any plan to give you access home knows what Medicare provides. It could encourage seniors who are Under the Medicare+Choice plan, sen- to experimental treatments. healthier and financially secure to This plan will mean fewer choices iors got more than they gave up. leave traditional Medicare. I do want to state there have been and less coverage for millions of sen- It could undermine Medicaid in some managed care success stories in iors. Washington State. my home State. We have some great Fourth, this bill is especially bad for It could require my State to send to providers in Washington State that led seniors and disabled Americans who the Federal Government a very large the way in providing innovative, com- are fighting poverty. Today, about 6 chunk of the savings it realizes. prehensive care that puts the focus on million Americans are eligible for both It could force Washington State to patients, not profits. But overall, we Medicare and Medicaid. Through these manage new bureaucracies to test the need to think how this plan would ex- two programs, they get the coverage assets of seniors in my home State. pand the Medicare+Choice model. for the drugs they need. But this new And it could put Washington State Medicare+Choice has worked only in bill we are looking at strips away what even further down the list in Medicare limited parts of Washington State. A is known as wraparound coverage. In reimbursements per beneficiary. total of 131,391 seniors in Washington Washington State, that means about Let me walk through how this pro- State participate in these plans. But 92,000 people will get less coverage than gram would work to show how it is bad they are not open to all seniors and they have today. That is just in my for my home State. Under this plan, they are limited to a very few select re- State. Those are the most vulnerable the country will be divided into as gions. Even in this limited program, we among us, the very people Medicare many as 50 regions. States such as have seen significant changes and in- and Medicaid were designed to protect. Washington could be divided into as stability just within Washington State. Fifth, there is a huge gap in cov- many as three regions. Within these I am not at all convinced this is a erage. Many seniors will see a big hole new, undefined regions, private insur- model we should now expand for all in their coverage. Payments will not ance plans would be able to run the seniors and disabled. stop. What you have to pay will not Medicare Program—not just the drug If these new plans that are coming in stop, but your coverage will. If your benefit, but Part A and Part B of the attract higher income, healthier sen- drugs cost you more than $2,250 a year, Medicare Program as well. iors, we need to ask, what will be left you will get zero help until you spend Washington State will be an attrac- of traditional Medicare? I am afraid a total of $3,600 out of your own pocket. tive market for the PPOs and HMOs be- traditional Medicare will begin to look You get no coverage, but you still have cause we have areas that are healthier more and more like Medicaid. to pay the premium. and wealthier and a tradition of health The prospects for this plan are deeply When you look at what the average care delivery. troubling. They could have a massive Medicare beneficiary spends for drugs, Currently, Washington State has one financial impact on Washington State. this coverage gap gets even worse. Ac- of the highest Medicare+Choice partici- I will turn to how this plan will af- cording to the Kaiser Family Founda- pation rates in the country with 18 perfect Washington State and its Medicaid tion, in 2003, the average Medicare ben- cent of Medicare beneficiaries receiv- Program.

VerDate jul 14 2003 04:05 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00044 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.091 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15635 I received a letter from the Demo- In order to get any additional finan- I was proud to support the Graham- cratic Governors’ Association. It is cial assistance under this plan, many Miller-Kennedy bill in the 107th Con- signed by three Governors, including seniors and the disabled will be forced gress that would have provided an af- Governor Locke of Washington. to impoverish themselves and give up fordable, reliable, comprehensive pre- Mr. President, I ask unanimous con- almost everything they have worked so scription drug benefit as part of Medi- sent that letter be printed in the hard to earn. Even if the States want care. We had a chance to do much bet- RECORD at the conclusion of my re- to provide a more humane benefit or ter. marks. assistance, they will not be allowed to I believe a prescription drug benefit The PRESIDING OFFICER. Without do so. ought to be a seamless part of Medi- objection, it is so ordered. Now, many of us fought to provide care. It should be treated just like a (See exhibit 1.) relief to States just this year by tem- doctor’s office visit or an outpatient Mrs. MURRAY. Mr. President, the porarily increasing the Federal Med- surgical procedure. Governors’ letter urges Congress to icaid match. This was a critically im- By implementing a seamless, afford- give the States time to determine the portant fight to save Medicaid and pre- able benefit as part of Medicare, as we impact on their Medicaid programs be- vent massive Medicaid cuts on doctors did when we added the Part B benefit, fore enacting sweeping changes in how and hospitals. Our success in achieving we would guarantee that all seniors we treat Medicaid beneficiaries and a small measure of relief is now being have access to the same level of care, how States pay for coverage for low-in- undone by imposing an even greater regardless of their health status or come seniors and the disabled. burden on the States. their age or their income or their as- So under this plan, if States save Finally, Mr. President, this bill will sets or where they live. That access money by shifting drug costs from punish Washington State even further would be stable, and it would be pre- Medicaid to Medicare, States have to in Medicare payments. For several dictable. give a portion of those savings that years, I have been working to address I know we can do this. Many of us in they get back to the Federal Govern- the geographic disparities that punish this Chamber, on both sides of the ment every year. providers and seniors in my State of Many States, such as Washington, aisle, have worked to significantly Washington. For years, Washington boost our investment in NIH funding. have stepped up to the plate and have State has received unfair treatment. tried to fill the gap in Medicare by pro- We have fought to reform and mod- Today, Washington State ranks 41st ernize the FDA to ensure timely ap- viding affordable, comprehensive pre- in the Nation in Medicare payments scription drug coverage through Med- proval of new, lifesaving drugs. I want per beneficiary. We are being penalized all of my seniors and disabled constitu- icaid for people who are eligible for because we have a tradition of low- both programs. ents to benefit from those kinds of in- cost, efficient health care, and healthy vestments. Over the past 10 years, as drug costs seniors. Medicare should reward that. have rapidly increased, this burden has Under the plan before us today, I can- Instead, its outdated reimbursement not be sure they will reap the rewards become overwhelming. Many States formulas are causing doctors to leave are now being forced to scale back of this Federal investment. my State or close their practices to The PRESIDING OFFICER (Mr. their coverage in access. new Medicare patients. GRASSLEY). The Chair is responding to In 2002, Washington State spent an I have spoken at great length on the the request that the Senator be noti- estimated $212.8 million on drug costs Senate floor before about this, and I fied when she has 5 minutes left. for people who are eligible for both have introduced legislation to correct Mrs. MURRAY. Thank you, Mr. Medicare and Medicaid. That was a that inequity. But under this bill, the President. huge strain on my State. situation would be even worse. Mr. President, we should be on the Under this plan we are considering, Washington State would fall from the States will see some relief by shift- 41st in the Nation to 45th in the Na- floor today debating a prescription ing Medicaid beneficiaries to Medicare tion. Even though there will be a slight drug benefit package, not a proposal to for drug coverage. But, unfortunately, increase in payments to Washington, radically alter Medicare. This should the plan gives with one hand and takes because of what happens to other be a fight about providing good, afford- back with the other. States, we end up falling even further able, stable coverage, not about experi- Washington State, under this plan, behind. This is a fundamental shift in menting with Medicare. will be forced to surrender much of the the Medicare entitlement, in exchange I do want to thank my friend and col- savings it sees back to the Federal for a very weak benefit. league, Senator BAUCUS, for his efforts. Government. That could reduce Wash- Philosophically, this plan goes in the I know he worked hard to do the best ington State’s Federal Medicaid dollars wrong direction. We should be he could. Senator BAUCUS understands by almost $2 billion from 2006 to 2013. strengthening the foundation of Medi- the importance of Medicare for seniors That could devastate the entire pro- care, not experimenting with imposing and the disabled, and I know he fought gram and result in further Medicaid re- a new health care system on seniors. against incredible odds. He was sitting ductions for low-income children and This plan undermines the role of the across the table from Members of Con- families. It could force the State to Federal Government in ensuring that gress who tried before to privatize again implement reductions in pro- every senior can live with the dignity Medicare, and many who still hope to vider payments for doctors, hospitals, and respect and stability they deserve. turn Social Security over to Wall and nursing homes. It could force seniors into an overly re- Street. He faced an impossible task. A $2 billion give-back, just for my strictive, ever-changing health system. I know he did all he could, and I State, will mean more uninsured, lower Let’s not forget why Medicare was thank him for his fight. provider payments, and more children enacted in the first place. It was cre- Mr. President, I do want to note losing any health care safety net they ated because the private insurance there are some things in this bill that have today. market failed seniors and the disabled. I fought for that are important. Let’s not forget that States will be Coverage was sporadic, expensive, and It does prevent additional cuts in handed a massive new administration unpredictable. Medicare, when it was payments to doctors who are scheduled burden under this plan. Washington enacted, changed all of that for our Na- to take effect early next year. The State will now have to administer new tion’s seniors. Now I am afraid we are scheduled reduction of 4.5 percent, as asset tests to determine who qualifies flirting with that original failed model. we all know, is unacceptable. I worked under Medicare for low-income assist- I believe we can do better. hard to prevent that scheduled reduc- ance. These tests are extremely restric- During my time in the Senate, I have tion of 4 percent in 2003, and I do ap- tive and will result in many low-in- been proud to work on prescription plaud the conferees for meeting our de- come seniors being pushed into higher drug coverage—from helping to draft mands on this issue. income categories. the MEND Act in the 106th Congress to The package also provides additional Under the conference agreement, as- working on the Budget Committee over relief for rural hospitals, home health sets will be limited to $6,000 for a single the past 4 years to fund prescription care agencies, and rural health care person and $9,000 for a married couple. drugs. providers. This relief is truly a life line

VerDate jul 14 2003 02:20 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00045 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.094 S23PT1 S15636 CONGRESSIONAL RECORD — SENATE November 23, 2003 for saving rural health care. I have al- With this in mind, we urge you to reject bill that not only the 100 Senators ways supported these provisions, and I any effort to vote on this legislation before agree with—and not all 100 Senators will continue to fight for fair and equi- you know its full content and cost impact on do—as many of the Senators as pos- table rural payments. your state and the people we both serve. To sible, and as many of the House as pos- I can promise health care providers this end, CBO estimates on Medicare reform impact and expedited state reviews of the di- sible, because a bill to go through to and patients in my home State that re- rect and indirect cost/savings impact from the President has to pass both the gardless of the outcome of this legisla- this legislation must be done and fully dis- House and the Senate. When it gets tion, I remain committed to stabilizing seminated. Any rush to judgment, without this complicated, it is an extremely Medicare payments. this information, may have both short and talented person who is able to put to- Now, Mr. President, I know many or- long-term consequences that could prove to gether the kind of legislation that ganizations representing doctors and be irrevocably severe. reaches a compromise that will be able hospitals think we can come back in Early in the deliberations of the Medicare to pass. 2006 and correct the mechanisms in reform conference, governors were advised that at a minimum, the conferees were com- This is a copy of the bill. If anybody this bill that undermine Medicare. thinks it is simple, they haven’t looked That is a pretty dangerous gamble. Not mitted to ensuring that states would face no new costs as a consequence of the Medicare at it. It takes a long time to wander only that, but we don’t know what the Prescription Drug, Improvement, and Mod- through this. We have been working on people who put this bill together will ernization Act of 2003. This commitment was it for a few days and now have the fi- demand down the road in exchange for made for each and every state, for each and nalized copy, the copy that has passed changes—premiums support or vouch- every year, of the ten-year budget. For this the House. It is the most significant ers for States; larger gaps in coverage; reason, we are writing to urge you to not change in the history of Medicare. It vote on this legislation until it is absolutely more copayments; more restrictions on may be the most significant change in access; more deals on the House floor clear that this assurance has been upheld. In recent days, there have been reports medical delivery in the history of the in the middle of the night? world. We do not know what the pricetag that the new administrative and other indirect state costs of this program—combined I congratulate the Presiding Officer, will be to undo the damage that this with the bill’s exceedingly high ‘‘claw-back’’ the Senator from Iowa, Mr. GRASSLEY, bill will impose. I assure everyone, it of state savings—would more than exceed for all the hard work he put in on this will not be easy. any Medicare savings for many states. Such bill. We will soon be voting on it. I had looked forward to the day when an unacceptable outcome would be in addi- This bill will add a prescription drug the Senate would pass a Medicare pre- tion to another misguided policy, reportedly benefit to Medicare, it will offer new scription drug benefit. That day is seeking to mandate states and the terri- Medicare coverage options to seniors, upon us, but I believe that the price of tories to permanently pay 75 percent of the current Federal prescription drug cost-shift and it will expand tax incentives for this benefit is far too high. people who save money to pay for their In the coming months and years we to states. In 2006, the first year of the bill’s own health care needs. That is quite a will see the theory behind this bill put enactment, states would have to pay 90 percent of these costs. package. to practice. As more and more people Some have already suggested that this is a I want to strengthen Medicare. Sen- discover what this bill and this Presi- poorly crafted bill and in the long run it iors and disabled people in Wyoming dent have done to their health care, I would do more harm than good to the very depend upon Medicare to pay for their am confident we will hear from seniors population it was intended to benefit. Al- health care needs. We have relatively though some states are witnessing a small as we have never heard before. few major employers in Wyoming so This is a difficult decision. The $400 increase in revenues, most states will con- most of our retired seniors don’t have billion in this bill does represent a step tinue to experience budget shortfalls for the access to health care coverage through forward. The provider payments concurrent fiscal year. Some analysts believe that the overall shortfall will likely be $25 to their former employers. Medicare is tained in this bill are needed in my $40 billion. With the continued sluggish critical to the health and well-being of State, and seniors deserve the prescrip- growth in state revenues, any increases in 66,000 elderly and disabled citizens in tion drug coverage they have been ask- state costs imposed by this legislation would my home State. That may not sound ing for. Passage of this bill and being be yet another unfunded federal mandate, like a lot of people, but it is over 13 signed into law is not the end of the creating additional pressure on states to cut percent of Wyoming’s population. story. A tremendous amount of work essential programs and/or raise taxes. Similarly, any permanent continuation of Adding a prescription drug benefit to will be required to fix the deficiencies Medicare makes sense. Medicare is the in this bill. I will be there, as I have the Federal government’s prescription drug cost-shift to states runs counter to existing only traditional insurance plan in the been all these years, working the best National Governors Association (NGA) pol- United States that does not cover out- I can to do the right thing for the peo- icy that, ‘‘if Congress decides to expand pre- patient prescription drugs. The reason ple I represent in my State and the scription drug coverage to seniors, it should Medicare does not cover prescription people across this country. not shift that responsibility or its costs to medications is that pharmaceuticals I yield the floor. the states and territories’’ and establishes a were not a major part of medical care damaging precedent. EXHIBIT 1 in the 1960s, when Medicare was found- DEMOCRATIC GOVERNORS’ ASSOCIATION, Sincerely, Gov. GARY LOCKE, ed. It is a different story today. Today, Washington, DC, November 21, 2003. prescription drugs are absolutely inte- MEMBERS OF THE U.S. SENATE, Washington, DGA Chair. U.S. Capitol, Gov. TOM VILSACK, gral to providing quality health care. Washington, DC. Iowa, DGA Vice-Chair. All of us rely on them. It makes sense DEAR SENATOR: As you know, the near 700- Gov. BILL RICHARDSON, for Medicare to keep up with the times page Medicare reform bill was unveiled yes- New Mexico, DGA Federal Liaison. by offering voluntary prescription drug terday. As a consequence, states have not The PRESIDING OFFICER. The coverage to seniors. thoroughly reviewed the language or seen in- Chair recognizes the Senator from Wy- Let me emphasize the voluntary na- dividual cost estimates needed to make an oming. ture of this program some more. We accurate determination of its benefits and/or Mr. ENZI. Mr. President, as we all costs. Late yesterday, the Congressional have heard that the AARP is going to Budget Office (CBO) released numbers por- know by now, the Medicare conferees regret supporting this Medicare bill traying a net savings to states of $17 billion have reached agreement on the most just as they regretted supporting the over ten years. Notwithstanding this pro- significant changes to the Medicare catastrophic coverage bill of the 1980s. jected rosy scenario, neither CBO, nor any Program in history. I thank the Pre- I will come back to that a little bit other independent entity has completed a siding Officer for the hours he has later. The reason seniors revolted state-by-state impact analysis of this legis- spent working on this, the agony he against the catastrophic coverage bill lation. Even CBO is projecting that states has gone through at understanding and back then was that it was mandatory. will be $900 million in the red in the first reaching agreement with this diverse year of the Medicare’s program implementa- They didn’t have a choice. They had to tion in 2006. States need to ensure that their body of Senators. There are 100 of us. pay for the coverage even if they didn’t reading of the legislation confirms that the We usually amount to probably 150 want it. projected new state costs have not been un- opinions on anything. The Chair has This bill does not make that mis- derestimated by CBO. had to put all of that together into a take. This bill is different. If seniors

VerDate jul 14 2003 04:22 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00046 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.096 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15637 don’t want Medicare drug coverage, seniors who are without drug coverage. sidies for their prescription drugs. they don’t have to pay for it. If they It would provide incentives to employ- Even the critics admit that seniors have coverage through their former ers to encourage them to maintain the with catastrophic drug expenditures employer, they can keep that. Plus we coverage they provide to their retirees. get measurable relief under this bill. provide a lot of support in this bill for At the same time, the bill would create There is a generous 95 percent coverage employers to continue providing their new Medicare options for seniors. It of a seniors’ drug cost over $5,000. retirees with drug coverage so that also would create incentives for private This bill also includes important pro- seniors won’t be forced to buy a Medi- health plans to innovate and compete jections for which I fought on the Sen- care drug plan because they lost their for the businesses of today’s seniors ate floor this summer, which protect retiree coverage. So this is indeed a and invigorate the Medicare Program every senior’s right to visit their com- voluntary program. for future generations. munity pharmacy and receive the high It gives seniors a chance to sign up Let’s also be clear on what the bill level of service they are accustomed to for Medicare drug coverage or stay in won’t do. It won’t force seniors and the receiving from them. We have put a the traditional Medicare and keep what disabled to pay for a Medicare drug huge burden on our pharmacists in this they have. Choice is a great concept. benefit if they don’t want it. It won’t country, the local ones that are right America was built on the idea that peo- encourage employers to drop drug cov- there to answer your questions face to ple should have the freedom to choose erage for their retirees. It won’t force face. There is a provision in the bill how to live their lives, as long as their seniors and the disabled into HMOs. that will help to keep that local phar- choices don’t infringe on the freedom I should also point out that the Medi- macist in place and operating. It gives of others. care bill won’t pay for every dollar of a them an equal chance under the bill to When it comes to health care, choice senior’s prescription drug costs. A drug be providing prescription drugs for sen- is also important. Today seniors don’t benefit for needy seniors is important, iors on Medicare. It is important that have choices. Medicare is a one-size- but it is also important that we pre- we keep those small businesses and fits-all program, take it or leave it. serve Medicare for future generations. pharmacists—local people that you can But we all know that most seniors can- Already 30 percent of Medicare funding talk to—in place. not afford to leave it. So right now comes from the general government This bill doesn’t cover every dollar of they are stuck with Medicare, warts revenues. Projected expenditures are every prescription for every senior. But and all. The fact that Congress has to expected to exceed projected tax and that is not a reasonable expectation. pass a law to add a prescription drug premium revenues after 2015. I will be What this bill does is provide help and benefit is part of the problem with the keeping a careful eye on Medicare protection for the two groups that need Medicare system. Medicare is not flexi- spending, especially now that we have it the most—those who can least afford ble enough to adjust and adapt to the passed this drug benefit. If we are prescription drugs, and those who oth- complex nature of health care today. going to add anything new to Medicare erwise would be bankrupted by a seri- As I have noted, prescription drugs beyond a basic and sensible drug ben- ous illness that requires expensive drug play a much greater role in treating efit, we need to pay for it directly. therapies. These are worthy objectives disease today than they did when Medi- This drug benefit isn’t free, but it is and this agreement accomplishes those care was created nearly four decades responsible. We set aside $400 billion of goals. ago. But unlike private health plans, the Federal budget over the next 10 I want to discuss a couple of other as- Medicare has not changed with the years to pay for this benefit. That is pects of this agreement. First, the bi- times. Under this Medicare agreement, how much the agreement is projected partisan Medicare agreement would es- seniors will have the option to choose to cost. Actually, it comes in slightly tablish health savings accounts, HSAs. drug coverage through Medicare. They under that. But last year when we were These HSAs are tax advantaged savings will also have options that go beyond doing the appropriations, we set aside accounts that all people could use to voluntary drug coverage. the $400 billion. Some people say $400 pay for medical expenses. This is a The conference agreement would billion is not enough. They point out huge advancement in taking care of allow a variety of private health plans that seniors are expected to spend $1.8 the uninsured. Health savings accounts to offer coverage of Medicare bene- trillion on prescription drugs over the would be open to everybody with a high ficiaries. I am not talking about HMOs. next 10 years. deductible health insurance plan. The Despite what I have heard here on the Well, nothing in life is truly free, and higher the deductible, the less the cost Senate floor, this bill does not force prescription drugs will not be an excep- to the insurance plan. The higher the seniors and disabled into HMOs. Medi- tion. We need to remember that every deductible, the more a person is al- care HMOs exist today, and no one is new Federal program comes at a price. lowed to put into a HSA. Employers being forced into them. What this bill We need to be aware of just what that would also be able to contribute to the does is allow preferred provider organi- price is when we ask for a new pro- employee’s health savings account, and zations, or PPOs, to offer Medicare gram. It is not always the people re- neither the employer’s nor the employ- plans. ceiving the benefit that are paying the ee’s contribution would be taxable. Tax Most of us are familiar with PPOs. benefit. The $400 billion is the equiva- free, you can set up this account. They are the type of health plans to lent of $1,600 from every taxpayer over If you have an HSA, your total year- which more Americans belong than any that 10-year period. What would tax- ly contributions to it would be as large other type. HMOs give you a list of payers say about the need for any pro- as your health insurance plan deduct- doctors. If your doctor is not on the gram if we put it into that kind of a ible. Just like an individual retirement list, you can’t visit him. The great form for them? There would be in- account, the interest and investment thing about PPOs is, you can use any creased concern just like there is in- earnings your health savings account doctor you choose. And if the doctor is creased concern when people have to would generate are not taxable. Fur- part of the plan’s network, you get a pay their own costs of medical treat- thermore, the money you take out of discount on the cost of his or her serv- ment. HSAs to pay for medical costs are not ices. These private PPO plans will com- That is how the competition comes taxable, as long as the money is used pete to serve seniors by offering new into the market. I suppose we could to pay for health care expenses. Let’s choices and benefits, choices that are have passed a $1.8 trillion drug benefit. see, you don’t pay taxes on it when you currently unavailable under Medicare’s Of course, we would have had to raise put it in, you don’t pay taxes on the one-size-fits-all structure. taxes by $1.4 trillion to do it. I cannot earnings, and you don’t pay taxes when To be blunt, I believe the legislation speak for the rest of my colleagues, but you take it out. It is a little incentive could be bolder in stimulating competi- I just became a grandfather this year to put away money to cover tion. But it represents a good step in and I am not willing to put that kind deductibles, or anything to do with the direction of flexibility, innovation, of a tax burden on my grandson. health care later on. I hope that every and here is that word again—choice. Even the critics of this agreement ac- young person in this country will es- Let’s be clear on what the Medicare knowledge that low-income seniors tablish a health savings account. No bill would do. It would offer security to would be eligible for substantial sub- matter what their income level is, no

VerDate jul 14 2003 02:20 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00047 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.099 S23PT1 S15638 CONGRESSIONAL RECORD — SENATE November 23, 2003 matter how good their health is, it is rural areas, it wasn’t even semi-humor- Our Federal Government’s own Medi- an opportunity to put away money for ous, and it wasn’t accurate either. I care Payment Advisory Commission when the health is not as good, and to suppose I could ask that this column be published a report in 2001 on Medicare take care of any deductibles that are printed in the CONGRESSIONAL RECORD, in rural America. That report found necessary at any point in life with an but I would not want to waste the that the Medicare ‘‘payment system insurance plan. It is an opportunity to space. I will, however, cite a paragraph does not recognize factors that have a be insured from the time you enter the from the column in which this gen- greater effect on the cost of rural hos- job market, and to put a little away tleman called politicians from rural pitals.’’ The study also found that and perhaps have a lot for the years States ‘‘nothing more than welfare there are aspects of Medicare’s pro- when 50 to 80 percent of the health care queens in overalls.’’ At this point, I’ll spective payment system for inpatient costs come up. state that I still believe Senators hospital care that tend to work against One of the best features of health ought to be able to bring laptops onto rural hospitals. savings accounts is they would be port- the floor. But I assure my colleagues I Every hospital has to buy a certain able. That means that if you change will not be petitioning them to wear amount of medical equipment from jobs, the health savings account goes overalls on the Senate floor. hospital beds to x-ray machines. If with you, you still have it. It is yours. Let me read one of the paragraphs rural hospitals get a rural discount on Health savings accounts are a great in- that Mr. Pearlstein wrote: this equipment, it is news to me. In novation. Health savings accounts cre- Then there is Medicare bill, which was sup- fact, I think there are probably some ate a tax incentive for everybody—not posed to be about providing drug benefits to quantity discounts on which they lose just seniors—to save for health care ex- seniors, but wound up being yet another out. penses, plus it doesn’t matter whether chance to whine about the plight of country Rural hospitals also have to hire doctors and hospitals. Although the cost to your employer offers health insurance nurses and technicians, just as urban providing medical service is actually lower hospitals. It is hard enough to recruit or not; you can still save money in a out there in God’s country [the God’s coun- health savings account and receive the nurses because we have a nationwide try is true] that hasn’t stopped your guys shortage. Trying to recruit nurses to tax benefit. This provides some tax from squeezing $25 billion more from the come to the Wyoming frontier is even fairness for those of you who don’t Federal Treasury over the next decade to pad harder. So our rural hospitals have to have access to tax advantages of the Medicare payments to rural providers. I don’t know if this gentleman has offer a competitive wage. employer-sponsored health insurance. Most rural hospitals also have a low ever been to God’s country or not. Let me say that again. This provides patient volume compared to their Maybe he has flown over God’s coun- some tax fairness to those who don’t urban counterparts, and this contrib- try, Mr. President. I doubt he has ever have access to the tax advantage of utes to a higher cost of rural hospital visited the Niobrara Health and Life employer-sponsored health insurance. care. There is a certain amount of staff Center, a very small hospital in Lusk, Employer-sponsored health insurance and everything that has to be on hand WY. Lusk has a population of 1,500. is tax free. It doesn’t even show up on ready for patients if they show up. anything that you have to file. This Lusk is the county seat Niobrara Coun- As the Medicare Payment Advisory would give the average person the same ty, population 2,500. That is Wyoming’s Commission rightly points out in its opportunity to have tax-free health least populated county. Incidentally, it study, hospitals in small and isolated coverage. is a little bigger than the State of communities ‘‘cannot achieve the Health savings accounts are an idea Delaware. It has one person for every economies of scale and service scope of whose time has come. Giving people 524 acres of land. their larger counterparts and thus have more flexibility and responsibility in The hospital in Lusk has been closed higher per-case costs.’’ The current their health care spending will result since May of 2000. Since then, folks in Medicare rates do not directly account in healthier and wiser consumers. I Niobrara have had to travel to Douglas for the relationship between cost and wholeheartedly support this part of the and Torrington for surgery or other volume, potentially placing smaller Medicare agreement. It is long over- hospital care. Douglas and Torrington providers at a financial disadvantage due. It needs to be advertised. Young are in different directions from Lusk. relative to the other facilities. people of this country need to under- They are both about 55 miles from I am pleased to note that the Lusk stand that that is their part of Medi- Lusk. That is a long drive any time, hospital is scheduled to reopen in Octo- care, that they can get into this now but in winter—and we are having win- ber 2004 after completing some impor- and it will save them costs later. It ter there now. I don’t know if you saw tant upgrades and renovations. I am will be a part that will shore up the pictures of the Bronco football game confident the hospital will be able to system. where they were scraping snow off of survive this time because Congress I also want to speak to the provisions the field; but yesterday there was a passed a law in 1997 to allow for special that would address a very sore subject blizzard in Colorado and in Wyoming, payments to hospitals in rural areas on the frontier, the inequity in Medi- and the temperatures were about 16 de- that are too sparsely populated to sup- care reimbursement between urban and grees, and it gets a little tough to get port a full-service facility. rural areas. I am pleased that the con- around, if you can at all. The Medicare conference agreement ference agreement ensures reimburse- Fifty-five miles is a long drive in would increase payments over the 1997 ment equity to doctors, hospitals, and winter when the winds are howling and law to critical access hospitals, such as other providers of health care in Wyo- the snow blows across two-lane roads. the one in Lusk. Despite Mr. ming and other rural States. That is an important hospital for the Pearlstein’s criticisms, he ignored the Right now, Medicare underpays rural people of Niobrara County, and they fact that urban hospitals have higher hospitals, home health alleges, and are getting ready to reopen it. They Medicare margins than rural hospitals. other providers, as compared to urban are hoping to be able to afford it. It is The additional support for rural counterparts. This limits the ability of also important for the State of Wyo- health care providers in this bill will these providers to maintain their serv- ming because there is a State prison help close the gap between higher ices and their infrastructures and to for women in Lusk. The State tried to Medicare margins of urban hospitals recruit qualified personnel. keep the hospital open in the 1990s, but and the lower Medicare margins of the Some people do not understand the the financial pressures were simply too rural hospitals. This additional help challenges that rural health care pro- great. will not come a moment too soon for viders face in providing quality care to Hospitals across rural America are the people of Niobrara County, WY, seniors and the disabled. For instance, struggling, particularly the smallest and other counties in Wyoming and I read a column in the Washington hospitals, such as the one in Lusk. If it other counties throughout the United Post last Friday by a gentleman named were really true that the ‘‘cost of pro- States. I hope Mr. Pearlstein will visit Steven Pearlstein. I think it was sup- viding medical service was actually Lusk if he ever visits Wyoming. I have posed to be a semi-humorous column— lower out there in God’s country’’ then been there, and I can tell you that the I hope so—although it was in the busi- why are the rural hospitals struggling Medicare payments he considers ‘‘pad- ness section. Well, to those of us in to stay open? ding’’ are critical to the hospital in

VerDate jul 14 2003 03:10 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00048 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.101 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15639 Lusk and to the seniors who depend on people under Medicare. That is a dou- I particularly find it unfortunate and it. bling. By 2030, 77.6 million people will disappointing because there are 300,000 It is a long drive to Lusk from Yel- be under Medicare. That is another seniors in New Jersey, out of about 1.2 lowstone National Park or skiing in doubling. That is a huge increase in the million, who lack any prescription Jackson Hole, but I think it would be number of people who will come under drug coverage. Those seniors make quite educational for him or anyone Medicare. tough choices between medicine and else who makes the journey. How is it paid for? It is paid for by other of life’s expenses, as we have There are a lot of good aspects about people who are in the workforce, not heard talked about in political debate this Medicare agreement. Adding a pre- the people who are retired—the people for years. scription drug benefit to the program in the workforce. is good. Providing seniors and the dis- In 1973, there were 7.3 people. That I truly want to be a positive partici- abled with new Medicare options is tenth of a person probably didn’t feel pant in assuring access to quality drug good. Offering all Americans new ways too well. But 7.3 people were paying for coverage at an affordable price for all to save money for their health care ex- every person under Medicare. In the of America’s seniors. I think all of us penses is good. Providing fair Medicare year 2000, there were 3.9 people paying do. That is why I voted affirmatively payments to rural doctors and hos- the bill for those in Medicare. By the on a bipartisan Senate bill. I worked pitals is good. Having health savings year 2030, 2.4 people per person will be very closely with the senior Senator accounts is outstanding. paying the bill for those on Medicare. from Iowa to put together what I For these reasons, I am going to vote These people have to pick up the costs thought was an outstanding bill, one I for this bipartisan Medicare agree- of all of Medicare for those people. So would have been proud to support. ment, and I am going to work in the fu- it is important we have some cost con- Those 300,000 seniors badly need and ture to ensure that Medicare continues tainment, that we put in some reforms deserve affordable, quality coverage. to offer a reasonable drug benefit for to make sure the system is available But just as badly as they need it, we many of America’s seniors, but one for those 77 million people in the year need to make sure their gain does not that does not place a huge financial 2030. come at the expense of harming others. burden on future generations. Prescription drugs are the most im- If the left-out seniors were the only Earlier the majority leader, Senator portant treatment factor now. They ones impacted by this bill, I would vote FRIST from Tennessee, the only doctor were not in 1965. We have come a long for this plan we now are debating. I in this body, gave an outstanding way on the issue of prescription drugs. would vote for it because I thought it speech outlining the reasons that in a This is where we are headed. These are was going to provide access to those bipartisan way he and others have the number of drugs in clinical devel- 300,000 folks and that would happen re- worked on this for 6 years to bring this opment: Cancer, 402 different kinds in gardless of all the ideological or polit- to fruition. A person from the other clinical development. The percentage ical arguments that have been made side of the aisle who has worked on of drugs that actual make it is very over the last several days. that for 6 years has been Senator small. Is there a high cost to develop a BREAUX from Louisiana. They served drug? Yes. Diabetes, there are 30 dif- Sadly, hundreds of thousands of on a special task force to come up with ferent kinds of medicines; rheumatoid other seniors in my State will be seri- a way to make Medicare be solvent for arthritis, 24; osteoporosis, 20; obesity, ously and negatively impacted by this generations to come. This will be the overweight, 29; depression 19; conges- bill. The fact is, this plan harms more first significant piece of legislation to tive heart failure, 18; Alzheimer’s dis- New Jersey seniors than it helps. I cal- address what they have talked about ease, 17; schizophrenia, 16; hyper- culate that, at a minimum, 500,000 sen- for 6 years. tension, 11; hyperlipidemia, 10; mi- iors will be harmed, breaking the first Mr. President, how much time do I graine headaches, 20, and so on. rule of medicine: ‘‘Do no harm.’’ have remaining? There are a lot of drugs that are The negative impact comes at a very The PRESIDING OFFICER. The Sen- being worked on. That is a new treat- high financial cost not only to my ator from Wyoming has 4 minutes 15 ment. That is a tool that has to be put State but to the Nation at large. I be- seconds remaining. in the hands of doctors. lieve the scarce resources we are using Mr. ENZI. I thank the Chair. Now, we have heard some comments, Mr. President, in the Senator’s re- would be better used to make the lim- as well as different versions, about sur- ited and complex benefit more substan- marks he did point out there have been prise that AARP has backed this bill. tial and to reduce the harm to those a lot of health care advances. Science It is not a perfect bill. We never pass a who already have benefits that they has played a great part in health from perfect bill out of the Senate. genetically engineered vaccines, to cor- AARP has had some comments on it. will lose. onary angioplasties, to heart trans- I hope my colleagues all pay attention This Senator can only wonder in that plants, to the human genome project to them. AARP believes that millions context that we feel compelled to lav- that is coming up with a lot of new of older Americans and their families ish $14 billion of subsidies on HMOs and medicines that will take care of us. will be helped by this legislation. other insurers to provide them profit That project, incidentally, came in 2 AARP also endorses the Medicare bill. incentives to compete with traditional years ahead of time, in 2003, and has On November 17, they stated, ‘‘The in- Medicare as opposed to improving the led to a massive increase in the number tegrity of Medicare will be protected.’’ benefits to uninsured seniors who are of projects that are being done to come These are the most significant re- constructively a part of this bill. We up with new drugs that will help us. forms. It provides access to medical could close that so-called donut hole, This is the way Medicare has ad- prescription drugs. It dramatically ex- that gap. vanced. It is pretty inflexible. There pands voluntary, private health plan With all due respect to the Herculean has not been much advancement. We choices. I hope my colleagues will look efforts of those on both sides of the have an opportunity to correct that at the comments the leader made and aisle who cobbled together this com- right now. We need to get the flexi- read them in full. promise—and I really do want to con- bility of Medicare to increase the same I thank the President for the time, gratulate and thank those who worked way that medical advances are increas- and I yield the floor. so hard. Ranking Member BAUCUS, and ing, and those are mostly in the area of The PRESIDING OFFICER. The Senator BREAUX, the senior Senator prescription drugs. So it is time we Chair now recognizes the Senator from added a prescription drug benefit. New Jersey. from Louisiana, as well the senior Sen- The bill also takes care of some prob- Mr. CORZINE. Mr. President, I rise ator from Iowa, have done a great job lems we have with Medicare. I men- today to join this historical debate on of trying to get to a conclusion on tioned this task force that Senator health care for America’s seniors. I which we could all agree. In my case, BREAUX and Senator FRIST were on. also rise so that I can provide a per- the cost/benefit for New Jersey seniors The task force recognized the problem spective to the people of New Jersey on just does not work. It just flat out does that when Medicare got underway, why I will regrettably be voting not work. there were 20.4 million people under against this Medicare conference re- My staff and I have done the num- Medicare. Today there are 40.8 million port. bers. We have worked very hard, to the

VerDate jul 14 2003 03:10 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00049 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.104 S23PT1 S15640 CONGRESSIONAL RECORD — SENATE November 23, 2003 best of our ability, to really scrub come at too high a price, and that is well beyond the $6 billion in cost over down these numbers and to come up before one weighs in on the serious a period of time, particularly as it is with a conclusion on whether this push in this bill to get Medicare on a more of a savings program than it is works for our folks. Considering we are pathway to privatization and the dis- one that is going to help on health in a mad dash to absorb and analyze mantling of the social safety net and care. this 1,100-page bill, I will bet there is coverage of our seniors’ health which That is the big picture for me. As you not a single Senator who has read it. I has been so fundamental to the success can tell, I don’t think it is so good. But could be wrong. Maybe there are one or of moving so many of our seniors out of let me now illustrate the specifics, as two who just did not have anything to poverty into longer, healthier lives. least as I see them, in a cost-benefit do in the last 24, 36, 48 hours, but I While this bill fundamentally being analysis for New Jersey’s seniors be- doubt if there is anyone who has read debated is in the context of prescrip- cause that is what I care about. It is this. The result is that the only cer- tion drugs in general, spending $400 bil- clear to me this is the analysis that is tainty about this bill is that in addi- lion, one would think that might have the most important from my perspec- tion to its unintended consequences, some positive implications for the tive. It is the primary driver for how I even from the well-intended, it is cer- broader health care system. To that came to my conclusion with respect to tain to have unfortunate consequences end, I believe this bill falls far short of this bill. for many American seniors, as well as the mark. Once again, at least from my This is not about insurers and HMOs. all of us who might hope to be seniors perspective, it does more harm than It is not about what the Democratic one of these days. good. caucus would argue. It is not about So my reason for opposing this legis- Cost containment through Medicare what political scorekeepers think. It is lation is that this body should be negotiating the cost of drugs with the not even about the pharmaceutical in- thoughtful and careful when we are drug industry could have led to lower dustry, which, by the way, in our coun- spending $400 billion for a good cause, prices for everybody in America. You try is most heavily concentrated in my but we ought to make sure we are not have unbelievably strong buying power State. It generates about 65,000 jobs doing more harm than good. That is out of Medicare—if they were negoti- and produces about $30 billion worth of objection 1. Objection 2 is if we do not ating those prices. We are talking business and revenues. It is really im- plan to implement this bill in its broad about reimportation? We could do a portant to our State. But simply my form before 2006, I do not understand heck of a lot better if we just had Medi- analysis is about New Jersey’s seniors why we need to cram all of this anal- care go out and negotiate those prices. and their role and participation in this ysis into 48 hours or 72 hours over a 3- That would help all Americans: Chil- program across this Nation. On that or 4-day period. dren, generation Xers, juniors, seniors, basis, I would like to talk about some Why before Thanksgiving? What is corporate America. That is not hap- of what we see. the hurry when we have a bill this pening. First of all, I think from all of the complex, this big, and we only have 3 Other missed opportunities? Cost independent analyses we see, approxi- or 4 days to look at it? I think there containment is omitted in this bill. mately 94,000 New Jersey retirees will are a lot of problems stuck right in The only containment of costs that I lose their employer-based prescription here. see falls on the shoulders of bene- drug benefits. There are estimates of So let me repeat what I do know. For ficiaries with escalating copays and 2.1 to 2.7, whether it is CBO or some roughly $4,000 of out-of-pocket pay- premium hikes. private estimates. The middle of the ments, a senior will get $5,000 worth of Equally troubling, reforming reim- range number for New Jersey is about return, plus a catastrophic coverage for bursement rates for cancer treatment 94,000. everything above $5,000 of drug spend- by doctors would have strengthened We have, in New Jersey, a substan- ing. Medicare, as opposed to limiting tial number of seniors, what people call Let me repeat: A $4,000 payment for oncological drug payments that under- dual eligible, who would receive this $5,000 worth of coverage will come with mines cancer care. For my State, this wraparound of their Medicaid benefits, a complex concoction of HMOs, PPOs, is really a troubling and unacceptable various low-income folks, 152,000 of PDPs, premiums, deductibles, copays, aspect. The fact is, we have the third those who receive their benefits formularies, annual price increases, highest incidence of cancer in our through Medicaid and, as we all know, shifts of providers, and a bevy of State. I think we are putting at risk will be paying copays and potentially choices that are more to the confusion the treatment of that not only for our have an accelerated rise in health of seniors than they are to the security seniors but for the whole of the com- costs. They certainly will be on of seniors. In fact, the complexity of munity. formularies that may limit their navigating this proposal for an indi- Egregiously—and this is where I choices of drugs. Those 152,000 seniors I vidual senior is almost enough of a rea- strongly disagree with those who would think will find this difficult. son for me to vote no on the bill to make this case—the diversion of $6 bil- We also have 220,000 seniors who are start with. lion into these health savings accounts currently enrolled in our State phar- I have stood in all kinds of townhall in this bill I think is a big mistake. It maceutical plan. I first want to con- meetings with seniors just trying to encourages the healthy and the gratulate the conferees because they explain the simple first steps of this wealthy out of the employer-based did provide for a wrap here around bill. I think we are going to be creating health care system, leaving the older State programs. It is going to be cum- a tremendous industry of opportunity and sicker and more poor in the system bersome and anything but seamless to out there informing seniors about what that remains or until employers drop move from the program that has been is going to be borne from this 1,100 coverage altogether. Frankly, I think in place for 25 years, created by a bi- pages, 1,200 pages of work. Somebody is this appears to be a handout to insur- partisan set of Governors and legisla- going to have to tell folks how they get ers. Several credible studies, including tors over that period of time, that have through this. the Rand Corporation’s, suggest a provided the State program. We are That said, this bill does provide fa- major reduction in employer health going to have to change it. We are vorable relief to doctors, as I have care coverage will follow as the likely going to have to have our seniors go heard some talk about, serving Medi- outcome of this tax cut proposal be- into private programs, and then the care patients. It gives some needed aid cause of adverse selection. State is going to have to fill in those to hospitals, particularly America’s I don’t understand this. This doesn’t gaps, to be able to make sure that our rural hospitals, as the Senator from seem to be relevant to the purpose we low-income seniors, who have terrific Wyoming adequately presented. Of are about in a $400 billion prescription programs, probably the best in the course, in a thousand pages plus, there drug benefit for seniors. Once again, I country, are able to maintain the same have to be some good things, and there think this legislation in this area does coverage. are. We are spending $400 billion. more harm than good. It certainly does As I say, I think the facilitating lan- A few of the benefits I have talked with respect to the U.S. Treasury be- guage with regard to financial obliga- about are good but, in my view, they cause I think it has the capacity to go tions has been very good. I am very

VerDate jul 14 2003 03:10 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00050 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.106 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15641 grateful for the work of the conferees folks who are going to be hurt. There cally about this, I think it is a very se- with regard to this estimate. But the are now only 300,000 New Jerseyans rious consideration for those of us who seamless element, the quality of cov- who are without drug coverage. I think believe that traditional Medicare erage with regard to this element, this that speaks for itself. There is a tough should be enhanced. particular program, is going to be very tally when you look at those who are I looked at three steps that will put hard to implement. Each of these sen- harmed and those who are benefited. it on that pathway. iors, the lowest income seniors in our That, to me, is an important consider- Fourteen-billion dollars in subsidies State, is going to end up being faced ation. and protection against skyrocketing with formularies and be experiencing That is an important consideration. health care costs provided to health in- changes each year with regard to who Those are not the only considerations. surers in this bill doesn’t seem to me has maximum coverage, and it will be With regard to New Jersey, we have to be the right place to put us into a a major impact on how they look at it. certainly one that already meets the comparative cost-benefit analysis with Plus they are going to end up poten- Medicare privatization approach that the private providers who I think have tially paying copays and premiums falls under the premium support pro- many incentives to cherry-pick the that are slightly more than what they gram demonstration projects. Actu- healthiest, the wealthiest, and the have in current benefits. So there is ally, it looks as if there will probably most able versus what is going to be another 220,000. be two. I don’t think our seniors are left in the traditional Medicare pro- Finally, there are about 52,000 seniors going to say they want that in their gram, which raises costs. I think that in New Jersey’s program who pay more backyard. They like prescription drugs, is step 1. for Part 3 premiums due to the pre- but they also like traditional Medi- Step No. 2, this series of demonstra- mium test—the means testing—that is care. tion projects which is hardly a level coming out. Some can argue means I think it is hard for me to go back to playing field by comparison—and I testing is good. That is said where you them and argue when they have had a think it is actually going to be difficult have already very high income seniors. chance—by the way, we have seen a lot for us to make a real assessment if it— Now $80,000 in New Jersey, which is of people dropping out of I have heard actually limits this pro- where this means testing begins, is not Medicare+Plus Choice because they gram under 600,000 folks. I think it is exactly superrich. We happen to have haven’t felt like the program is good. also possible that it will be cherry- the most wealthy average population Plus a number of insurers dropped peo- picked in the areas as opposed to the in the country. We also have the most ple who signed up for it. They thought difficulty of looking at the wide diver- expensive cost of living of any place in it was going to be a good deal and it sity of populations that we have in the the country. We pay more in taxes; we didn’t turn out to be so. That is an- country. I am particularly troubled send more to Washington than any- other one that a lot of folks talked when I look at what I see with regard place else in the country. This means about. There are approximately 1 mil- to what fits into New Jersey with re- testing, which is going to affect about lion New Jersey Medicare beneficiaries gard to this program. It could be very 52,000 of our seniors, is not going to Bill who are going to see their Part B de- difficult. Then the third step is this 45-percent Gates-like folks or Warren Buffett; it is ductible rise at a faster rate than their trigger on general fund expenditures going to middle class New Jerseyans Social Security benefit. that will cause an overall review of tra- and I think is going to have a lot more Some people will say that is not a ditional Medicare when the breach oc- bite. I would have liked to have seen it part of this bill, that it is something curs. I think all of us realize with the set higher. It was cut back. I frankly else. But the fact is, we are building an changing demographics and the baby wonder if this is going to be good for escalator on Part B. It doesn’t compare boomers going into retirement, and the overall Medicare Program because with what I think is going on with So- with 40 million seniors growing to 75 we are ultimately going to start pull- cial Security. At least when I go to million or 77 million seniors over the ing out a lot of these high-income sen- townhall meetings, that is a real prob- next 10 to 15 years, we are going to iors. As people know, Part B is vol- lem for me to try to deal with and ex- have that happen. I think that is going untary, and we could end up again pro- plain to folks. That is the challenge. to lead to pretty hard choices without viding another adverse selection ele- Roughly 100,000 seniors will be nega- the kind of triggers we have here. ment to the overall underlying tradi- tively impacted and a lot of others will I think that it is just one more step, tional Medicare Program. feel as if they were somehow not prop- one more nail in the box that is trying We will come back to some other per- erly protected in it. Again, 300,000 don’t to change us and move us away from spectives with regard to New Jersey. now have drug coverage. traditional Government-supported and But by my calculations, it is 94,000 re- That system doesn’t work. It is underwritten Medicare to privatiza- tirees with employer-based coverage. arithmetic. It is very straightforward. tion. In my view, after an inadequate They are going to lose that coverage, It seems to me that there is more harm analysis of this 1,100-page bill, I really at least that quality coverage relative than benefits. For me, the case is think that may be the most troubling to what they will get in a new prescrip- closed. piece. tion drug program in Medicare. There It would be remiss of me not to say I think it is very difficult to be cer- are 152,000 dual eligibles who will end that I have another objection that I be- tain about any of the conclusions that up with payments that are different lieve is built into this package. If I any of us are drawing with regard to than what they would have had under could convince myself that New Jersey this bill. The one thing that I do know the old program; 220,000 of our State seniors were going to be benefitted, I for certain as it shows up both in the beneficiaries will end up with a lower would come around on this issue. But I marketplace and in the phone calls quality, less seamless program than think this package puts America on a that we are receiving is that there are what they have today, and 40,000—I pathway to privatization of Medicare. I great benefits for the insurance indus- talked about this earlier in my re- suggest that is not the right direction. try and the pharmaceutical industry marks—40,000 diagnosed with cancer I think we ought to be enhancing and built into this. every year are going to have a much extending the traditional Medicare By the way, as I said, the pharma- harder time getting drug treatments Program and have a prescription drug ceutical industry is right smack dab in that they previously had. It is going to benefit. We ought to be using that $12 the middle of my State. I like to see cost about $50 million to the State over billion to $14 billion that is going to them do well. I like to see them press the 10-year period in payments with re- benefit the managed care industry and forward in their research. But I don’t spect to these drugs. Those folks are the insurance industry to cover up one think that should come at the serious going to be impacted. of those donut holes that we are talk- expense of many of America’s seniors. I Then there are the 52,000 subject to ing about. We ought to be putting that can say, at least based on what I under- means testing. That is 558,000. I am not money to work to enhance traditional stand by my analysis, that is not the going to be so certain there are not Medicare. case with regard to New Jersey seniors. some overlaps here, but we are talking While others have spoken eloquently Frankly, I just do not understand in the neighborhood of about 500,000 and extensively, maybe even politi- this mad dash to get this done before

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00051 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.108 S23PT1 S15642 CONGRESSIONAL RECORD — SENATE November 23, 2003 Thanksgiving. It obviously must re- Medicare. We have to provide prescrip- seniors themselves to be facing but flect some other agenda than what tion drugs for the seniors. We have to also for those who are trying to decide seems sensible. I think we ought to change Medicare for the future. He how we are investing $400 billion. slow down. We ought to be careful. We says: We do not want something like I congratulate the Senator for his ef- ought to be thoughtful. I know there that cobbled-up tripartisan plan. forts. Unfortunately, as I look at it, I are a lot of people who have spent a lot Obviously, the President cannot come out with a different perspective, of time. We have heard about the 6 know everything that goes on in the but I don’t think it is for lack of good years of debate and discussion. But to Congress of the United States about intentions, hard work, and great com- come to a conclusion where we have to forming legislation, but if he knew the promise on the Senator’s part. make a decision about something that hours and hours, not only at the staff Mr. GRASSLEY. I surely appreciate is extraordinarily important to the level but at the Member level, that the good nature in which the Senator lives of the people across this coun- went into the tripartisan plan that we from New Jersey just stated his feel- try—not only to our seniors but to the unfolded here a year ago in July, the ings about this legislation. I wanted to families, and the impact it has on the President would not use the words give equal treatment to the President, markets that we deal with with regard ‘‘cobbled up.’’ I never heard the Presi- as I did the Senator from New Jersey to prescription drugs—investing $400 dent use the words ‘‘cobble up’’ after and vice versa. billion is a very important issue. It that because I tried to impress upon One of the aspects of this legislation ought to help our seniors as much as him there was a great deal of thought, that is misunderstood is the issue of possible. It is a good thing. I think all a great deal of hard work, and most im- health savings accounts, which is a of us want to be supportive. We should portantly, time, plus bill compromise new name for what people hear Con- do our best with what we have to in- that the word ‘‘tripartisan’’ implies to gressmen talk about as medical savings vest in this project. You have to think bring together where we were at that accounts, only different in name, par- about it in the context of a very lim- time. ticularly, as it relates to people in my ited amount relative to how much sen- If he had appreciated it, he would see State, the benefit to farmers and small iors are going to spend over the next we have to have the same sort of business people. decade. I hear estimates that it may be thought and hard work go into what he This bipartisan agreement includes as much as $1.8 trillion. What we are was thinking about. I never heard him these provisions establishing health talking about here is about 20 percent say that again. I am reminded of that savings accounts. I will refer to them of that. story now that the Senator from New as HSAs. We have to make tough choices. I ap- Jersey said this legislation is cobbled HSAs are tax-advantaged savings ac- preciate the difficulty with which the together. counts that can be used to pay for med- Senator from Iowa had to work his way To some extent, I suppose every po- ical expenses incurred by individuals, through these difficult areas. I think litical compromise, for every piece of their spouse, or dependents. HSAs are he made a lot of good choices, but legislation, one could use those words similar to medical savings accounts. there are some in here that are very to describe it. I know the Senator from However, medical savings account eli- difficult. I think we ought to be wise New Jersey participates in a lot of very gibility has been restricted to employ- and reflect on this 1,100-page report. difficult legislation in the committees ees of small businesses and the self-em- I am convinced we can do better, at he serves on and knows what it takes ployed. HSAs are open to everyone least in the cost-benefit analysis that I to put a bill together. However, I look with a high deductible health insur- put together for my State. at this piece of legislation, the com- ance plan. The only limitation on the As a consequence, I have to oppose promise it takes, the hard work it health plan is that the annual deduct- this report. I hope we can slow it down takes, all the long hours it takes, as ible must be at least $1,000 for indi- and make some revisions and bring it not a perfect piece of legislation but vidual coverage, and $2,000 for family to a positive conclusion which is not surely not a cobbled-together piece of coverage. Contributions to the HSA by ideological and which is not political; legislation. an employer are not included in the in- that is, believing we are searching for From that point of view I will re- dividual’s taxable income. Contribu- the best interests of all of our seniors spond not to the Senator from New tions to an individual are tax deduct- in America. Jersey any further but to speak about ible. I yield the floor. some of the aspects of this legislation Total yearly contributions to an HSA The PRESIDING OFFICER (Mr. as we get ready to vote on it tomorrow. can be as large as the individual’s ENZI). The Senator from Iowa. Mr. CORZINE. Will the Senator from health insurance plan deductible, be- Mr. GRASSLEY. Mr. President, be- Iowa yield for just a question and a tween $1,000 and $5,000 for self-cov- fore the Senator from New Jersey comment? erage, and $2,000 and $10,000 for family leaves, I want to speak about a couple Mr. GRASSLEY. I would be glad to coverage. of words which he mentioned. And I yield for a short question or short com- The interest in investment earnings don’t say it to take exception with ment and reserve my right to the floor. generated by this account is also not what he said or to quibble with his de- Mr. CORZINE. I appreciate the com- taxable while in the health savings ac- scription of the legislation before us. ment with regard to cobbling. It is count. Amounts distributed are not But if the President of the United great to be put in the same company of taxable as long as they are used to pay States saw Senator GRASSLEY speaking criticism with regard to the use of the for qualified medical expenses such as right after some words that the Sen- term. I do not want to leave the im- prescriptions, over-the-counter drugs, ator from New Jersey used about legis- pression that I don’t think there was and long-term care services, as well as lation, the President would be offended great thought and effort in putting to- the purchase of continued health care because I found fault with the Presi- gether this extraordinary piece of leg- coverage for the unemployed indi- dent using those very same words back islation. It is actually a tremendous vidual. That is legislation we passed a on December 10 last year when I had tribute to the Senator from Iowa for long time ago called COBRA. my first meeting with the President on the ability to put together all the var- Amounts distributed which are not the Medicare issue. ious interests in common and come up used to pay for qualified medical ex- The words that the Senator from New with something that is pretty doggone penses will be taxable, plus an addi- Jersey used about the legislation be- close for all Members to be able to con- tional 10-percent tax being applied in fore the Senate is that it is cobbled up. sider. order to prevent the use of HSAs for As everyone in this body knows, for My concern is that it is very hard to nonmedical purposes. These accounts about a year and a half I worked with know from this Senator’s point of view are portable, so an individual is not de- five Members of this body on what was all the details. I wish I could say I was pendent on a particular employer to then called the tripartisan plan. The absolutely certain that I had analyzed enjoy the advantages of having an President started his lecture to me last this exactly the right way for those HSA, low-income individual retirement December, something along this line: seniors in my State. But this is an in- account. The HSA is owned by the indi- We have to have a dramatic change of credibly complex issue, not only for the vidual, not by the employer, and if the

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00052 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.111 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15643 individual changes jobs, the HSA goes miums, $2 and $5 cost-sharing up to the ping employees, and since we have gone with the individual. catastrophic limit, and no cost-sharing to such great strides in the conference In addition, individuals over age 55 after the catastrophic level has been report to overcome that problem and may contribute extra contributions to reached. reduce that possibility, I want to spend their accounts and still enjoy the same Now, we go to the neediest of our some time on that and make clear that tax advantage. seniors, the dual eligibles, those who what we did in this respect—I think it In 2004, an additional $500 can be are presently low income and getting is fair for me to say that the con- added to the HSA. By the year 2009, an help not only from Medicare but from ference report, the compromise be- additional $1,000 can be added to the the State Medicaid Program. They cur- tween the House bill and the Senate HSA. rently have their drug costs paid for by bill, is very much better than either In regard to this legislation before the Medicare Program that differs a the Senate bill, when it passed in June, the Senate beyond the health savings little bit from State to State based or the House bill, when it passed the accounts, I point out what a great pre- upon the laws of those States. other body in June. So I would make scription drug benefit structure we Our conference report calls for Medi- these comments about whether or not have. First and foremost, it is impor- care to pick up the cost of their pre- employers are going to drop coverage tant to point out that this is a vol- scription drugs. Most of this popu- of their retirees. untary program. If you currently have lation will have a $1 and $3 cost-shar- Now, we have heard a lot from oppo- drug coverage and you like it, you can ing up to the cost-sharing limit, and nents of this historic bipartisan effort keep it or, if you do not have drug cov- then, after that, no cost-sharing on the alleging that this bill will cause em- erage and do not want it, you do not catastrophic. Now, that $1 and $3, ployers to drop their retiree health have to take it. If you are covered by again, is generic for the $1, and $3 for coverage. But one thing these oppo- Medicare fee for service today, and you the brand-name drugs. nents do not do is tell the people the are satisfied with it, you can stay right By providing coverage to all seniors whole story. where you are. based on income levels, you can see So as Paul Harvey says, the rest of This drug benefit also offered that the number of individuals with no the story and the reality is that em- through Medicare will be a comprehen- prescription drug coverage will fall ployers have been dropping retiree cov- sive benefit that will provide real relief from 24 percent in the year 2002 to 2 erage for years. for our seniors. Seniors that now pay percent in the year 2009. As you can see from this chart, there full retail price could see a 25-percent Now let’s make it clear. About over has been a gradual decline in the num- reduction in their prescription spend- half of individuals today have some ber of corporations providing coverage ing. Additionally, these seniors’ overall prescription drug coverage—some very for their retirees. Since 1991, the num- out-of-pocket drug spending could fall good, some not so good—and then 25 ber of larger employers offering health by as much as 77 percent. This is real percent, maybe 30 percent have noth- coverage to their retirees has dropped relief for real people, not some hypo- ing. Now, we expect this to go down by nearly 20 percent, from 80 percent thetical. under this program to just 2 percent of down to 61 percent. This chart shows what we have been To provide relief to all seniors, the our population, after 3 years of phase seeing in our States and hearing from drug benefit is based upon income in. our constituents. So employers have level. It is quite simple. Those who Mr. President, 98 percent of the sen- been dropping coverage for their retir- need more help because they are low iors receiving prescription drug cov- ees, and this has already been going on income will receive more help under erage in 2009 will receive it from pri- for more than a decade. this program. vately insured plans. Moreover, 33 per- We know these days employers are We divide this up according to the cent of the beneficiaries will get their finding it harder and harder to con- levels of poverty under the official pov- prescription drug coverage from inte- tinue voluntarily providing health in- erty indexes of the Federal Govern- grated private plans, three times the surance coverage for their retirees. ment. rate in 2002. That is why we in the Medicare con- For those individuals and couples Additionally, seniors will see imme- ference worked diligently—put re- who are above 150 percent of the Fed- diate benefits with discount drug cards. sources behind it—to help employers eral poverty level, they can expect to These are going to be available in the continue providing coverage for retir- see a monthly premium of $35, an an- middle of next year, and through all of ees, not just to be nice to the retirees nual deductible amounting to $250, a the year 2005. Then, after the year 2005, but to be nice to the taxpayers because 75–25 percent cost-sharing up to a pay- the new program, in its entirety, kicks it is a heck of a lot cheaper to keep ment of $2,250, and a true out-of-pocket in. So the discount drug card is for an these retirees in their corporate plans catastrophic cap at $3,600. interim period of time while it takes than have them go on our plan. Additional benefits, including help the Department of HHS a period of That is our goal. Let me make it with both the premium and initial time to set up what we are going to very clear; we have done a very good cost-sharing, are targeted to seniors pass tomorrow. These discount drug job of accomplishing that goal. with income levels below 150 percent of cards will pass on between 15 and 25 So let me tell you the three impor- the Federal poverty level. These sub- percent of savings on seniors’ current tant ways we have done it. sidies will be available at increasing drug prices. First, the bill provides a 28-percent levels for those between 135 and 150 per- It is clear to see that the conference subsidy for the prescription drug costs cent of the poverty index, and those be- agreement has come a long way since for retirees so they will continue pro- tween 100 and 135 percent. And then we passed this bill in this body the first viding this coverage. That is about $750 there is still another category of great- time in June. Many of my colleagues per retiree, but that is just on average er help for those below 100 percent of wanted a lower deductible. We have a because every corporation has a dif- poverty. lower deductible. Other colleagues ferent plan. I will explain how this differs for were more concerned with getting the Second, we exclude this retiree sub- each of these categories. First, for indi- dual eligibles’ drug costs out of the sidy from the Federal corporate tax. viduals who are 135 to 150 percent of Medicaid Program and covering every- This dramatically increases the value poverty, this group would have a $50 body by Medicare. We have done that of this subsidy for retiree coverage and deductible, sliding-scale premium as- as well. helps the employer continue offering sistance, and 15 percent cost-sharing up So this is a good, solid drug benefit this coverage. to the benefit limit of $2,250, and $2 or that will provide real relief to all sen- Third, the bill provides additional $5 cost-sharing above the catastrophic iors. Not only is this a good bill, with flexibility for employers to structure level—$2 meaning for generic, $5 for a good benefit, this bill provides an in- plans that complement Medicare’s new brand-name drugs. centive for employers not to drop their drug benefit. For individuals who are below 135 retiree coverage. Overall, the conferees agreed to put percent of the poverty index, they Because there has been so much mis- $89 billion in this bill to protect retiree would have no deductibles, no pre- information about corporations drop- health coverage.

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00053 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.113 S23PT1 S15644 CONGRESSIONAL RECORD — SENATE November 23, 2003 This funding makes it more likely— It is also important to recognize that ation of the conference report to ac- obviously not less likely—that employ- keeping employers in the game lowers company H.R. 1, the Medicare mod- ers will continue their retiree benefits. the Federal cost of the drug benefit. ernization bill, provided that the time I think I ought to emphasize what $89 That is why we are concerned about until 12:30 p.m. be equally divided be- billion happens to be. That is 20 per- the taxpayer as well as the corporate tween the chairman of the Finance cent of all the money we are putting in retiree. Obviously, if it is dumped, it is Committee or his designee and the mi- this bill for prescription drugs for sen- going to cost the plan more than if nority leader or his designee. I further iors. Now the Congressional Budget Of- they stay on the corporate plan. So ask unanimous consent that the clo- fice estimates that 17 percent of the re- providing this 28 percent subsidy actu- ture vote on the conference report tirees will not receive supplemental ally lowers the cost of the Medicare begin at 12:30 p.m. Finally, I ask that drug coverage from their employers be- benefit. This generous 28 percent sub- the last 10 minutes prior to the vote be yond what is offered by Medicare in sidy for retiree coverage is good policy. allocated to the Democratic leader for this bill. We have a different estimate And because it is good policy, it is good 5 minutes, to be followed by the major- from the Employee Benefits Research politics. This bipartisan bill protects ity leader for 5 minutes. Institute that is outside of our govern- retiree benefits. That has been our The PRESIDING OFFICER. Without ment. It is a nationally respected orga- goal, and we have accomplished it. objection, it is so ordered. nization that studies retiree benefits. Mr. GRASSLEY. Mr. President, f They estimate that that number is Medicare contractor reform will not going to be much smaller: 2 to 9 per- succeed if contractors are subject to PROGRAM cent of the retirees might not receive unlimited civil liability in carrying out Mr. GRASSLEY. Mr. President, to- supplemental coverage from their em- the payments, provider services, and morrow morning we will resume debate ployer in the future if Congress passes beneficiary services functions expected on the Medicare modernization con- the Medicare benefit. of them. The conference agreement ference report. Under the previous According to the Employee Benefits would therefore continue the past pol- order, there will be approximately 31⁄2 Research Institute, if Congress creates a Medicare drug benefit of any kind, icy of limiting the liability of certi- hours of debate prior to the cloture some employers will want their retir- fying and disbursing officers, and the vote on the conference report which is ees to take advantage of that new ben- Medicare administrative contractors locked in to occur at 12:30 p.m. The clo- efit. This is an important part of the for whom those officers serve, with re- ture vote on the conference report will rest of the story. The only way to pre- spect to certain payments. be the first vote of the day. It is my vent employers from putting their re- In addition, the language contained hope and expectation that cloture will tirees in the Medicare drug program is in section 911 of the conference agree- be successful. This issue deserves an if we don’t pass legislation such as ment clarifies that Medicare adminis- up-or-down vote. I urge my colleagues this, if we say we don’t give a darn trative contractors are not liable for on the other side of the aisle to allow about the 25 to 30 percent of the people inadvertent billing errors but, as in the this process to move forward. who don’t now have prescription drugs past, are liable for all damages result- f ing from reckless disregard or intent to and we don’t care if they ever have it. MORNING BUSINESS That is not the attitude of Congress. defraud the United States. Impor- That is why this legislation is before tantly, the reckless disregard standard f us, because we do care about people is the same as the standard the stand- THE FLORIDA CITRUS INDUSTRY who can’t afford or don’t have avail- ard under the False Claims Act. This standard balances the practical need to Mr. NELSON of Florida. Mr. Presi- able a plan for prescription drugs. dent, this week, leaders from thirty- For those people, particularly on this shelter Medicare administrative con- four countries around the Western side of the aisle, who have been com- tractors from frivolous civil litigation Hemisphere gathered in Miami for the plaining about not doing enough or by disgruntled providers or bene- Free Trade Area of the Americas that passing this bill might cause some ficiaries with the Medicare program’s corporations to change their health interest in protecting itself from con- (FTAA) Ministerial and Americas Busi- benefits and prescription drugs for tractor fraud. ness Forum for the purposes of expand- their seniors, do they think we should The False Claims Act, 31 U.S.C. ing free trade within the Western do nothing? No, they don’t think so. §§ 3729–3733, applies to Medicare fiscal Hemisphere. They are crying because we aren’t intermediaries and carriers under cur- The negotiations at this and future doing enough. I tell you honestly, we rent law. This legislation makes it Ministerial meetings will greatly im- could put $400 billion, all of this bill, clear that the False Claims Act con- pact my State of Florida. into just those 30 percent of the people tinues, as in the past, to remain avail- This event drew large headlines in in this country who retire from cor- able as a remedy for fraud against the papers across the hemisphere as porations that have a pretty good pre- Medicare by certifying officers, dis- leaders converged upon Miami and scription drug program, probably bet- bursing officers, and Medicare adminis- anti-globalization protesters gathered ter than most people have, and I trative contractors alike and that, outside to voice opposition. In this con- couldn’t guarantee anybody in this among other things, the remedy sub- text, I feel it appropriate to commend country that some corporation, big or jects Medicare contractors to adminis- Miami-Dade County, the City of little, wouldn’t dump their programs, trative, as well as trust fund, damages. Miami, and all the local and Federal law enforcement officers who helped just dump them, as they have been f doing for 20 years. keep the peace during a tense week of Let me be clear, these retirees will ORDERS FOR MONDAY, NOVEMBER negotiations, and everyone who made not be left without drug coverage. Re- 24, 2003 it a success. tirees are not going to lose drug cov- Mr. GRASSLEY. Mr. President, for But in light of these talks, I want to erage. Why? Because of this bipartisan the leader, I would like to give what is share my own concerns regarding the bill before us. These retirees will still referred to daily as the closing script, FTAA negotiations, and the path be better off than today, because today if I may. ahead. when their employer drops coverage, I ask unanimous consent that when These talks did generate positive they are left with nothing—no cov- the Senate completes its business movement forward, towards greater erage whatsoever. Because of this bill, today, it adjourn until 9 a.m., Monday, economic integration in the hemi- these retirees will be getting drug cov- November 24. I further ask that fol- sphere. Trade Ministers agreed to a erage from Medicare, and their former lowing the prayer and pledge, the baseline of minimum standards for a employer will likely pay the monthly morning hour be deemed expired, the full and comprehensive agreement that premium for them. They will still be Journal of proceedings be approved to takes into account differing levels of better off than they would be today date, the time for the two leaders be development among nations. This where there is no Medicare drug benefit reserved for their use later in the day, framework is a step forward that gives to back them up. and the Senate then resume consider- nations flexibility.

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00054 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.116 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15645 A carefully negotiated Free Trade two places: the United States and Without this tariff, the Florida citrus Area of the Americas could generate Brazil. Florida’s growers provide the industry could collapse, and Brazil new economic opportunities for Flor- vast majority of U.S. citrus that is would have a monopoly over the global ida, our country, and the entire West- used for orange juice. market. Already, Brazil produces 53 ern Hemisphere. Florida’s citrus industry is efficient, percent of the world’s orange juice and Yet, the FTAA poses opportunities competitive, and environmentally re- has a virtual monopoly over the Euro- and challenges for Florida as we work sponsible; it is also one of only a hand- pean market. to make Miami the premier U.S. can- ful of U.S. agricultural commodities Removal of this tariff would not en- didate city for the location of the per- that receives no federal or state sub- hance free trade—it would, rather, manent FTAA Secretariat, while at the sidies. Let me say it another way: giver Brazil a total world monopoly same time protecting the viability of a American taxpayers do not subsidize and make that country the world’s key part of our way of life in Florida— the citrus industry, unlike many other dominant citrus and citrus juice pro- the domestic citrus industry. sectors that reaped benefits in last ducer and enable them to control mar- We must be cautious about the scope year’s farm bill. ket supply, access and prices with no of the final FTAA and consider how it Florida’s citrus industry is composed competition. affects our domestic industries. I urge of 12,000 growers, many of them small This would not only devastate Flor- U.S. negotiators to take some impor- family-owned operations, in addition to ida’s citrus industry, it would also be tant concerns into account as an agree- the many tens of thousands of others bad for all consumers. Absent competi- ment is shaped in the months ahead. around the state and country who con- tion from Florida’s growers, the large The different parties, alliances, and tribute to this $9 billion industry. But, Brazilian cartels would have all con- groups involved in the negotiations this is more than just an economic en- sumers at their mercy. have gone back and forth on which gine to Florida. It is an American way I have worked to bring these issues goods and products to include in a final of life. to the attention of the Administration agreement, and the flexibility provided Brazil’s citrus industry, in contrast, and to ensure that one of Florida’s pri- for in the final Miami Declaration re- is dominated by four large producers mary industries is not traded away at flects this fact. who form large export cartels to maxi- the negotiating table, and I will con- Citrus is one product that must not mize their advantage and squeeze small tinue to do so. In fact, I plan to travel be included in these negotiations. I producers. The industry also benefits to Brazil in the coming weeks and have again call upon the Administration, as from advantages brought by years of asked to meet with President Lula da I have done in the past, to give citrus past subsidization and dumping, lax en- Silva so that I can carry the message special consideration; given the unique vironmental laws, weak and largely un- of the Florida citrus growers: free enforced labor laws, and price manipu- nature of the citrus fruit and juice trade can only benefit American con- lation. And, Brazilian orange juice al- trade. sumers if it offers free and fair com- The administration should state un- ready has access to U.S. markets. petition and is not monopolistic—so ambiguously that it will not agree to Their government’s pronouncements to Brazil must reform its monopolistic the contrary are counterproductive to any reduction of the current tariff on citrus industry. advancing greater hemispheric eco- It is past time for this administra- imported orange juice in the context of nomic cooperation. tion to acknowledge the inequalities the FTAA or any other trade negotia- Brazil’s citrus industry also con- between the U.S. and Brazilian citrus tion, until Brazil ceases its monopo- tinues to rely heavily on child labor industries, and recognizing these in- listic, anticompetitive trade practices. and the low wages associated with equities, to treat citrus accordingly. Let me explain why this is so impor- using children. I would like to conclude by again tant to the State of Florida. In Florida, we do not allow children urging the administration not to agree This tariff is a lifeline for Florida’s to work in our orange groves. to any reduction of the current tariff citrus industry and the State’s econ- Until Brazil whole-heartedly enforces on imported orange juice, because if omy because it helps to promote com- its labor laws, putting an end to child they do, an American industry and petition—and it enables us to compete labor and paying workers a decent liv- American consumers will pay a steep in the global marketplace. ing wage, there will not be a level play- price. These issues are too important It is very clear that any reduction in ing field for competition. to the people of Florida to be ignored, the tariff would destroy Florida’s cit- Florida’s citrus industry can compete and we will all be watching closely in rus industry and devastate the State’s with Brazil, or anyone else, as long as the months ahead. economy. The citrus industry is the there is a fair playing field. WTO nego- I ask unanimous consent to have State’s second largest, contributing tiations should deal with these prob- printed in the record conclusions in the over $9 billion to our economy. And the lems. But in the meantime, the tariff testimony from Executive Vice Presi- citrus industry accounts for nearly on frozen concentrated orange juice dent and CEO of Florida Citrus Mutual, 90,000 direct and indirect jobs through- imports acts to balance the anti-com- from a hearing before the House Agri- out Florida and the country. petitive practices of Brazil. It also acts culture Committee on June 18, 2003, A collapse of this industry would not to prevent the large Brazilian pro- and Squire Smith, President of Florida only cost tens of thousands of jobs, it ducers from overwhelming the U.S. Citrus Mutual, before the House Agri- would also cost the State and county market and driving Florida’s 12,000 culture Committee, Subcommittee on governments of Florida up to $1 billion growers out of business. Livestock and Horticulture on Novem- in lost tax revenues. During the Trade Promotion Author- ber 5, 2003, and an Op-Ed that appeared This would mean less money for ity debate in 2001, Senator GRAHAM and in the Miami Herald on November 19, other vital public services, such as po- I offered an amendment that would 2003. lice and firefighters. have prevented tariffs from being re- There being no objection, the mate- This spring, I arranged for Andrew duced on commodities imported from rial was ordered to be printed in the LaVigne, Executive Vice President and other countries in violation of trade RECORD, as follows: CEO of Florida Citrus Mutual to testify laws, such as Brazilian orange juice. CONCLUSION before the Senate Foreign Relations Although this amendment was de- The U.S. market is by far the most signifi- Committee and share these arguments, feated, we were successful in including cant market we have. Unlike dairy and crop for the benefit of my colleagues in the language that required the Administra- commodities, which are consumed through- U.S. Senate so that they could be made tion to study and report to the Con- out the world, orange juice is consumed pri- a permanent part of the record, be- gress on the economic effects that a marily in the highly developed market cause they are so strong. tariff removal would have on import- economies of the United States and Europe. Orange juice consumption is con- sensitive commodities like frozen con- With Brazilian juice firmly entrenched in Europe at rock bottom prices, it only makes centrated chiefly in two places: the centrated orange juice and citrus. I sense for Florida producers to concentrate United States and the European Union. look forward to reviewing the results on sales at home. Our growth in exports of Unlike other agricultural products, of these studies as the debate pro- specialty products, such as NFC, must nec- production is also limited chiefly to gresses. essarily be incremental and secondary to the

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00055 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.034 S23PT1 S15646 CONGRESSIONAL RECORD — SENATE November 23, 2003 domestic market for FCOJ. While the Flor- national Trade Organization (ITO). The Platts believed that he could engage in ida industry will continue to seek out new stared goal for the organization was full em- a personal, patient-centered style of export markets, both for fresh and processed ployment and the need to global monopolies medicine that was impossible in a larg- products, it is myopic to think that we are and predatory trade practices. At that time, er, more urban hospital setting. And likely to be as large a factor in foreign mar- the nations gathered knew well the ravages kets as Brazil. We simply do not have the do- of war and the role that brutal trade con- there, he opened the first recovery mestic subsidies we would need to compete flicts played in creating the economic De- room in the St. Louis metropolitan with the Brazilians and Europeans in Eu- pression of the 1930s, the breeding ground for area, and established one of the first rope. Furthermore, we cannot be there to de- fascism. coronary care units and intensive care velop those new foreign markets slowly over BALANCING NEEDS units in the St. Louis area, along with the many years it will take them to achieve At the talks in Havana, the U.S. Depart- Barnes Hospital. Upon Dan’s retire- higher disposable incomes, if the Florida in- ment of Agriculture brought forward a spe- ment in 2002, Alton Memorial Hospital dustry is forced out of existence by the cial set of agricultural trade rules that dedicated its surgical and emergency elimination of the tariff. We want to serve would help balance the needs of producers building in his name, to commemorate the U.S. market and we can do so without and consumers with an emphasis on pro- his 48 years of service to the commu- the huge government payments that other tecting food security over the long term. In agricultural sectors receive. However, the nity, complete with a bust and a plaque essence, U.S. negotiators, with the Great De- paying tribute to Dan as ‘‘the consum- U.S. orange juice tariff is necessary to offset pression still very much on their minds, de- the unfair or artificial advantages that lower veloped rules that helped nations balance mate physician.’’ the price of Brazilian juice. supply and demand. As Dan worked long hours at the hos- Florida Citrus Mutual understands that The ITO never got off the ground, but these pital, Jo Ann was busy, as well. Over free trade in many industries, including agricultural rules were included in the origi- the years, she has served the commu- many agricultural industries, leads to in- nal general Agreement on Tariffs and Trade, nity in many capacities, including as a creased competition, eventual price benefits precursor to the WTO. The rules allowed na- member of the board of trustees of St. to consumers, and overall global economic tions to use quantitative import controls as growth. Unfortunately, free trade cannot de- Louis Country Day School, on the ves- long as they were imposing supply controls. try of The Church of Saint Michael and liver these rewards to such a concentrated This spurred countries to address domestic and polarized global industry, especially one oversupply, helping to bring global supply Saint George, on the board of gov- in which the developing country’s industry and demand into balance. This plan was key ernors of the Saint Louis Woman’s is, in fact, already the most highly developed to the ‘‘golden era’’ for U.S. and global agri- Club, on the board of the St. Louis in the world. Florida Citrus Mutual appre- culture in the 1950s and 60s. Charitable Foundation, and as a board ciated the opportunity to explain to the The WTO Agreement on Agriculture undid member for both the Jennie D. Hayner Committee the unique global structure of this important work, but now the ministers Library Association and the Alton Mu- the orange juice industry and the negative gathering in Miami have an opportunity to economic effects that would occur as a result seum of History. make improvements by returning to the Yet the bulk of Jo Ann’s time was of U.S. tariff reduction or elimination. work done by the pioneers back in Havana in 1947. They have to tackle global over-supply spent in supporting Dan’s practice of DOMESTIC POLICIES AFFECTING THE SPECIALTY in ways that can help producers in Florida medicine—which she considered a min- CROP INDUSTRY and Brazil earn a profit by restoring the bal- istry—and being a devoted and fun-lov- CONCLUSION ance between supply and demand that has ing mother to their three children: The U.S. Government’s approach to domes- been damaged by the ‘‘race to the bottom’’ Drew, now a commercial realtor and tic policy that impacts the fruit and vege- results of free trade. developer in Evansville, IN; Brett, who Negotiators must address monopoly-style table industry, including the citrus industry, runs his own currency hedge fund in business practices that dominate global is to a large extent driven by the U.S. trade London, England, and recently became trade in highly competitive products when policy as it affects the industry. Our ability global prices fall too far. engaged to Mariela Ferro; and Carol, to properly address issues of pest and disease TARIFFS BENEFICIAL an attorney, political analyst and com- interdiction and eradication, labor law re- mentator, who lives in San Marino, CA, form, agricultural research and export mar- The solution to low commodity prices in ket growth depend almost entirely upon the general, be it orange juice or coffee, is not with her husband Jack Liebau, a port- balancing impact of the tariff, which assures that complicated. Every business knows that folio manager who recently opened his that the industry can continue to exist in an when supply and demand are out of balance, own investment management firm. unsubsidized domestic environment along- there is going to be trouble. In agriculture, Carol, after surviving Harvard Law side otherwise artificially manipulated glob- when there is not enough supply, some peo- School as an overt Republican, worked al competition. ple go hungry. When there is too much sup- faithfully on my staff in Washington ply, prices drop, farmers suffer and many go for 2 years before realizing that her [From the Miami Herald, Nov. 19, 2003] out of business. We need modern trade agreements that en- colleagues simply could not listen fast TARIFFS WOULD CONTROL OVERSUPPLY able countries to restore the balancing enough. All three children remember (By Mark Ritchie) mechanisms for supply and demand. To take lives filled with the love, support and Last September in Canc´un, the Bush ad- that step, the Bush administration needs to encouragement of their parents—and ministration’s promises of free trade’s bene- unlock the ‘‘free trade’’ straitjacket of many, many good times. fits ran headlong into the reality of the last eliminating tariffs at all costs, and start fo- Truly, Dan and Jo Ann’s life together ten years under the World Trade Organiza- cusing on agricultural market fundamentals. has been full of accomplishments and tion and the U.S.-Canada-Mexico arrange- f blessings—most notably, the heartfelt ment known as NAFTA—the North Amer- ican Free Trade Agreement. ADDITIONAL STATEMENTS love and respect of their children and Governments from Latin America, Africa children-in-law. We wish them every and Asia decried the loss of millions of farm happiness in the years to come, to- jobs, and denounced a system that promotes DANIEL AND JO ANN PLATT gether with our warmest congratula- the continued export of agricultural com- ∑ Mr. BOND. Mr. President, today I tions and best wishes.∑ modities below their cost of production price rise to honor two outstanding Missou- f (dumping) by U.S. and European agribusiness corporations. That’s why the WTO talks in rians, Daniel and Jo Ann Platt. The oc- INTRODUCTION OF BILLS AND Canc´un collapsed. casion is a special one, as they cele- JOINT RESOLUTIONS brate their 50th wedding anniversary. Fortunately, a close look at the underlying The following bills and joint resolu- conflicts at the WTO reveals the potential Only a year after Jo Ann, a native of for a new approach that negotiators trying Indiana, and Dan, a New Yorker, were tions were introduced, read the first to create a Free Trade Area of the Ameri- married on December 5, 1953, they came and second times by unanimous con- cans should use as a blueprint. It would cre- to the Midwest from Manhattan, where sent, and referred as indicated: ate a win-win solution to the chronic low Dan—an anesthesiologist—had been By Mr. NICKLES (for himself, Ms. prices that plague farmers in the United asked to become chief of the Anes- LANDRIEU, Mr. CRAIG, Mr. BINGAMAN, States, Brazil and elsewhere. Mr. INHOFE, and Mr. SMITH): International trade negotiations used to be thesia Department at Knickerbocker S. 1934. A bill to establish an Office of about finding solutions that were aimed at Hospital and the New York Eye and Intercountry Adoptions within the Depart- benefiting societies as a whole. In 1947, just Ear Infirmary. ment of State, and to reform United States a few miles from Miami, governments met in Instead, Dan practiced at Alton Me- laws governing intercountry adoptions; to Havana to discuss the creation of the Inter- morial Hospital, a place where the the Committee on the Judiciary.

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00056 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.037 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15647 By Mr. CORZINE: sidered as if ‘‘natural born.’’ As a child successfully with the Romanian gov- S. 1935. A bill to amend the Public Health of an American citizen, the foreign ernment to have these adoptions proc- Service Act to require employers to offer adopted child should be treated as essed and persuaded Romania to grant health care coverage for all employees, to amend the Social Security Act to guarantee such, not as an immigrant. exceptions to the moratorium for these comprehensive health care coverage for all The second goal is to consolidate the American families and their adopted. children born after 2001, and for other pur- existing functions of the Federal Gov- Unfortunately, the moratorium is still poses; to the Committee on Finance. ernment relating to foreign adoption in place leaving many orphans stuck in f into one centralized office located orphanages across Romania. within the Department of State. Cur- There also have been major adoption STATEMENTS ON INTRODUCED rently, these functions are performed issues involving Cambodia, Vietnam, BILLS AND JOINT RESOLUTIONS by offices within the Department of and Guatemala in the last 2 years. By Mr. NICKLES (for himself, Homeland Security and the Depart- These issues are still being addressed Ms. LANDRIEU, Mr. CRAIG, Mr. ment of State. Consolidation of these by various officials within the Depart- BINGAMAN, Mr. INHOFE, and Mr. functions into one office will result in ment of State and the Department of SMITH): focused attention on the needs of fami- Homeland Security. It will be greatly S. 1934. A bill to establish an Office of lies seeking to adopt overseas and on beneficial to have a point person with- Intercountry Adoptions within the De- the children they are hoping to make in the Federal Government to work on partment of State, and to reform part of their families. these issues, facilitate resolutions, and United States laws governing inter- Today, when a family seeks to adopt intercede on behalf of American fami- country adoptions; to the Committee overseas, it has to first be approved to lies. on the Judiciary. adopt by the Department of Homeland There also are some very significant Mr. NICKLES. Mr. President, today Security. Then, after a child has been procedural changes in the foreign adop- on National Adoption Day, I rise to in- chosen, the Department of Homeland tion process included in this bill. Under troduce the Intercountry Adoption Re- Security has to determine if the child the Child Citizenship Act of 2000, a for- form Act along with my colleagues is adoptable under Federal adoption eign child adopted by a U.S. citizen ac- Senators LANDRIEU, CRAIG, BINGAMAN, law. After this determination is made, quires automatic citizenship upon INHOFE and SMITH. The primary focus the Department of State has to deter- entry into the United States to reside of this bill is to streamline, simplify mine whether the child qualifies for a permanently. This bill proposes to and improve the foreign adoption proc- visa as an immediate relative of an change the point of acquisition of citi- ess for families, adoption agencies and American citizen. This bill seeks to zenship from entry into the United more importantly for the foreign minimize the paperwork involved and States to the time when a full and final adopted children of American citizens. streamline the process by having these adoption decree is entered by a foreign In the last decade, there has been a functions all performed in one, central- government or a court in the United significant growth in intercountry ized office, the Office of Intercountry States. Prior to citizenship attaching, adoption. In 1990, Americans adopted Adoptions, staffed by expert personnel the child must be determined to be an more than 7,000 children from abroad. trained in adoption practices. ‘‘adoption child’’ under U.S. law as de- In 2002, Americans adopted almost The focus of this office will be on for- fined in this bill. This provision is 20,000 children from abroad. Families eign adoptions and only on foreign made retroactive to January 1, 1950, are increasingly seeking to create or adoptions. Officials in the Department the year Americans began to adopt enlarge their families through inter- of Homeland Security and the Depart- from abroad. This date also addresses country adoptions. There are many ment of State that currently perform the issue of children adopted during children worldwide who are without the functions being transferred to this this time period whose parents failed permanent homes. It is the intent of new office have many other duties, to naturalize them under previous law. this bill to make much-needed reforms such as screening for terrorists or deal- Additionally, the Secretary of State to the intercountry adoption process ing with illegal immigrants. Adoption shall issue a U.S. passport and a Con- used by U.S. citizens and therefore help is frequently a low priority on the desk sular Report of Birth for a child who more homeless children worldwide find of such officers. By consolidating these satisfies the requirements of the Child a permanent home here in the United functions into one office, with its sole Citizenship Act as amended by this States. focus being foreign adoption, these Act. No visa will be required for such a There are two main goals of this leg- issues can be handled more promptly child; instead it will be admitted to the islation. First, and more importantly, and given the priority they deserve. United States upon presentation of a this bill acknowledges and affirms that Another aspect of the Office of Inter- valid U.S. passport. No affidavit of sup- foreign adopted children of American country Adoptions that I consider export under 213A of the Immigration and citizens are to be treated in all respects tremely important is the proactive role Nationality Act will be required nor the same as children born abroad to an that we intend for it to take in assist- will the child be required to undergo a American citizen. Under existing law, ing other countries in establishing medical exam. These changes are again foreign adopted children are treated as fraud-free, transparent adoption prac- made to more closely equate the proc- immigrants to the United States. They tices and interceding on behalf of ess of bringing a foreign adopted child have to apply for, and be granted immi- American citizens when foreign adop- home to the process of documenting grant visas to enter the United States. tion issues occur. By establishing an and bringing home a biological child Once they enter the United States, Ambassador at Large for Intercountry born abroad to a U.S. citizen. citizenship is acquired automatically. Adoption, this legislation will provide When a U.S. citizen gives birth Had these children been born abroad to a point of contact for foreign govern- abroad, the parents simply go to the American citizens, they would have ments when issues involving foreign U.S. Embassy, present the child’s birth traveled back to the United States adoptions arise. certificate, their marriage license and with a U.S. passport and entered as In the last few years there have been proof of U.S. citizenship. Upon receiv- citizens. This bill provides for equal many examples of instances where our ing this documentation, the embassy treatment for foreign adopted children. government has had to intercede on be- provides the parents with a U.S. pass- Furthermore, these children are not half of Americans seeking to adopt a port for the child and a Consular Re- immigrating to the United States in foreign child. For example, Romania port of Birth that serves as proof of the traditional sense of the word. They has been closed to foreign adoption for their child’s citizenship as well as the are not choosing to come to our coun- more than 2 years now. When Romania child’s birth certificate. This process try, but rather American citizens are issued its moratorium on foreign adop- takes little to no time to complete. choosing to bring them here as part of tion, hundreds of American families The process for foreign adopted chil- their families. Once a full and final who were in the process of adopting dren, however, is anything but quick adoption has occurred, then the adopt- Romanian orphans were unable to com- and easy. Currently, an adoptive fam- ed child is a full-fledged member of the plete their adoptions. Fortunately, the ily may have to travel from the coun- family and under adoption law is con- Department of State was able to work try where it adopts a child to another

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00057 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.027 S23PT1 S15648 CONGRESSIONAL RECORD — SENATE November 23, 2003 country in order to get the child’s im- dren whose parents have irrevocably S. 1934 migrant visa. Only certain embassies relinquished them. Be it enacted by the Senate and House of Rep- are able to grant such visas. On the The bill also includes many safe- resentatives of the United States of America in Congress assembled, other hand, most embassies are guards such as: requirements that the SECTION 1. SHORT TITLE. equipped to provide passports and Con- Secretary of State is satisfied that the sular Reports of Birth. This will elimi- This Act may be cited as the ‘‘Inter- proper care will be furnished the child; country Adoption Reform Act of 2003’’ or the nate the need and expense associated that the purpose of the adoption is to ‘‘ICARE Act’’. with families having to travel with form a bona fide parent-child relation- SEC. 2. FINDINGS; PURPOSES. their newly adopted children to an- ship; that the biological parent-child (a) FINDINGS.—Congress finds the fol- other U.S. Embassy in a different loca- relationships have been terminated; lowing: tion prior to bringing the children that the Secretary of State, in con- (1) That a child, for the full and harmo- home. sultation with the Secretary of Home- nious development of his or her personality, should grow up in a family environment, in This bill also provides that the adop- land Security, is satisfied that the tive parents do not have to prove twice an atmosphere of happiness, love, and under- child is not a security risk; and that standing. that they are financially capable of whose adoption and emigration to the providing for their child and eliminates (2) That intercountry adoption may offer United States has been approved by the the advantage of a permanent family to a the immigration requirement of having competent authority of the country of child for whom a suitable family cannot be the child undergo a medical exam. Be- the child’s place of birth or residence. found in his or her country of origin. fore a family is approved to adopt a (3) There has been a significant growth in foreign child, the Federal Government Now that I have covered some of the intercountry adoptions. In 1990, Americans has to be satisfied that the family is fi- significant aspects of this bill, let me adopted 7,093 children from abroad. In 2001, nancially able to care for the child. tell you what this bill does not do. It they adopted 19,237 children from abroad. This is part of the approval process. does not create more bureaucracy or (4) Americans increasingly seek to create They should not have to repeat this additional regulation. It does not in- or enlarge their families through inter- crease fees for adoption. It does not country adoptions. process once they have fully and fi- (5) There are many children worldwide that nally adopted a child. slow down the adoption process. It does not add more red tape or additional pa- are without permanent homes. In addition, prior to a family choos- (6) In the interest of United States citizens ing to adopt a child, they should ac- perwork. In fact, it does just the oppo- and homeless children, reforms are needed in quire and be provided as much medical site. the intercountry adoption process used by information as is available on the It consolidates existing Federal proc- United States citizens. health of the child so that it can make esses for foreign adoptions into what is (7) In addition, Congress recognizes that an informed decision on its ability to intended to be a ‘‘one stop shop’’—the foreign born adopted children do not make Office of Intercountry Adoptions. It the decision whether to immigrate to the care for the child. Once that informa- United States. They are being chosen by tion has been provided and the child eliminates paperwork involved in get- Americans to become part of their imme- has been adopted, the child is now a ting an immigrant visa and provides diate families. member of the family. No biological citizenship documentation up front for (8) As such these children should not be child is denied entry because of med- the child, saving the adoptive family classified as immigrants in the traditional ical reasons, nor should an adopted from having to deal with this upon its sense. Once fully and finally adopted, they child be denied. return home. Instead the fully and fi- should be treated as children of United Another section of this bill provides nally adopted child enters the United States citizens. for a new type of visa for children trav- States on a U.S. passport as a U.S. cit- (9) Since a child who is fully and finally adopted is entitled to the same rights, du- eling to the United States for the pur- izen and child of a U.S. citizen. ties, and responsibilities as a biological pose of being adopted by an American This bill is intended to ease the pa- child, the law should reflect such equality. citizen who has been approved to perwork burden on adoptive parents (10) Therefore, foreign born adopted chil- adopt. Currently children who are not who have already gone through exten- dren of United States citizens should be ac- adopted overseas prior to their entry sive paperwork and documentation pro- corded the same procedural treatment as bi- into the United States are allowed duction to accomplish their adoption. ological children born abroad to a United States citizen. entry using an immigrant visa. As I It is intended to recognize that chil- have stated earlier, these children are (11) If a United States citizen can confer dren adopted by American citizens are citizenship to a biological child born abroad, not immigrants. They are being the children of American citizens and then the same citizen is entitled to confer brought to the United States, at the re- entitled to all the same rights, duties such citizenship to their legally and fully quest of a U.S. citizen, to become a and responsibilities of biological chil- adopted foreign born children immediately member of that family. This new visa dren of U.S. citizens born abroad. upon final adoption. is a non-immigrant visa which author- (12) If a United States citizen cannot con- I introduce this bill with the hope izes admission of the child for the pur- fer citizenship to a biological child born that its passage will significantly imposes of adoption. The authorized ad- abroad, then such citizen cannot confer citi- prove the foreign adoption process so mission under this section terminates zenship to their legally and fully adopted that more children worldwide can find foreign born child, except through the natu- on the date the adoption is finalized, or loving, permanent homes. It is my ralization process. 2 years after the date of admission if prayer that someday, adoption will not (b) PURPOSES.—The purposes of this Act the adoption has not been finalized. be needed. That all children will be are— Until the child is adopted, the child (1) to ensure that foreign born children born into stable, loving homes to par- will receive temporary treatment as a adopted by United States citizens will be ents who want them and are able to legal permanent resident. treated identically to a biological child born This bill also redefines the criteria care for them. However, until that day abroad to the same citizen parent; used to determine a child’s eligibility comes the foreign adoption process can (2) to improve the intercountry adoption be improved and should be improved. process to make it more citizen friendly and for adoption This is a critical piece of child oriented; and this legislation. The existing statutory Foreign adopted children should be treated as children of U.S. citizens, not (3) to foster best practices. language has not been revised since it SEC. 3. DEFINITIONS. was first written over 50 years ago. as immigrants, and should be accorded all the same rights as biological chil- In this Act: When it was written it was intended to (1) ADOPTABLE CHILD.—The term ‘‘adopt- deal primarily with war orphans and it dren of U.S. citizens. To that end, I in- able child’’ has the same meaning given such does not permit voluntary relinquish- troduce this bill. term in section 101(c)(3) of the Immigration ment of children who have two living I ask unanimous consent that the and Nationality Act (8 U.S.C. 1101(c)(3)), as parents. The provision in this bill has text of the bill be printed in the added by section 204(a) of this Act. RECORD. (2) AMBASSADOR AT LARGE.—The term been written to more fully comport ‘‘Ambassador at Large’’ means the Ambas- with the language as agreed to in the There being no objection, the bill was sador at Large for Intercountry Adoptions Intercountry Adoption Act of 2000 ordered to be printed in the RECORD, as appointed to head the Office pursuant to sec- which does permit the adoption of chil- follows: tion 101(b).

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(3) FULL AND FINAL ADOPTION.—The term I of the Intercountry Adoption Act of 2000 (42 (IX) the range of fees charged for accredi- ‘‘full and final adoption’’ means an adop- U.S.C. 14911 et seq.); tation of agencies and the approval of per- tion— (ii) contacts with foreign governments, sons in the United States engaged in pro- (A) that is completed according to the laws intergovernmental organizations, and spe- viding adoption services under The Hague of the child’s country of origin or the State cialized agencies of the United Nations and Convention; and law of the parent’s residence; other international organizations of which (X) recommendations of ways the United (B) under which a person is granted full the United States is a member; and States might act to improve the welfare and and legal custody of the adopted child; (iii) multilateral conferences and meetings protection of children and families in each (C) that has the force and effect of severing relevant to international adoption. foreign country. the child’s legal ties to the child’s biological (D) INTERNATIONAL POLICY DEVELOPMENT.— (c) FUNCTIONS OF OFFICE.—The Office shall parents; To advise and support the Secretary of State have the following 6 functions: (D) under which the adoptive parents meet and other relevant Bureaus in the develop- (1) APPROVAL OF A FAMILY TO ADOPT.—To the requirements of section 205; and ment of sound policy regarding child protec- approve or disapprove the eligibility of (E) under which the child has been adju- tion and intercountry adoption. United States citizens to adopt foreign born dicated to be an adoptable child in accord- (E) REPORTING RESPONSIBILITIES.—The Am- children. ance with section 206. bassador at Large shall have the following (2) CHILD ADJUDICATION.—To adjudicate the (4) OFFICE.—The term ‘‘Office’’ means the reporting responsibilities: status of a child born abroad as an adoptable Office of Intercountry Adoptions established (i) IN GENERAL.—The Ambassador at Large child. under section 101(a). shall assist the Secretary of State and other (3) FAMILY SERVICES.—To provide assist- (5) READILY APPROVABLE.—A petition or relevant Bureaus in preparing those portions ance to United States citizens engaged in the certification is considered ‘‘readily approv- of the Human Rights Reports that relate to intercountry adoption process in resolving able’’ if the documentary support provided the abduction, sale, and trafficking of chil- problems with respect to that process and to demonstrates that the petitioner satisfies dren. track intercountry adoption cases so as to the eligibility requirements and no addi- (ii) ANNUAL REPORT ON INTERCOUNTRY ADOP- ensure that all such adoptions are processed tional information or investigation is nec- TION.—On September 1 of each year, the Sec- in a timely manner. essary. retary of State, with the assistance of the (4) INTERNATIONAL POLICY DEVELOPMENT.— Ambassador at Large, shall prepare and TITLE I—ADMINISTRATION OF To advise and support the Ambassador at transmit to Congress an annual report on INTERCOUNTRY ADOPTIONS Large and other relevant Bureaus in the de- intercountry adoption. Each annual report velopment of sound policy regarding child Subtitle A—In General shall include— protection and intercountry adoption. SEC. 101. OFFICE OF INTERCOUNTRY ADOP- (I) a description of the status of child pro- (5) CENTRAL AUTHORITY.—To assist the Sec- TIONS. tection and adoption in each foreign coun- retary of State in carrying out duties of the (a) ESTABLISHMENT.—There is established try, including— central authority as defined in section 3 of within the Department of State, an Office of (aa) trends toward improvement in the the Intercountry Adoption Act of 2000 (42 Intercountry Adoptions which shall be head- welfare and protection of children and fami- U.S.C. 14902). ed by the Ambassador at Large for Inter- lies; (6) ADMINISTRATION.—To perform adminis- country Adoptions who shall be appointed (bb) trends in family reunification, domes- trative functions related to the functions pursuant to subsection (b). tic adoption, and intercountry adoption; performed under paragraphs (1) through (5), (b) AMBASSADOR AT LARGE.— (cc) movement toward ratification and im- including legal functions and congressional (1) APPOINTMENT.—The Ambassador at plementation of The Hague Convention; and Large shall be appointed by the President, liaison and public affairs functions. (dd) census information on the number of (d) ORGANIZATION.— by and with the advice and consent of the children in orphanages, foster homes, and (1) IN GENERAL.—All functions of the Office Senate, from among individuals who have other types of nonpermanent residential shall be performed by officers housed in a background, experience, and training in care; centralized office located in Washington, intercountry adoptions. (II) the number of intercountry adoptions D.C. Within the Washington, D.C., office, (2) AUTHORITY.—The Ambassador at Large by United States citizens, regardless of there shall be 6 divisions corresponding to shall report directly to the Secretary of whether the adoption occurred under The the 6 functions of the Office. All 6 divisions State, in consultation with the Assistant Hague Convention, including the country and their respective directors shall report di- Secretary for Consular Affairs. from which each child emigrated, the State rectly to the Ambassador at Large. (3) DUTIES OF THE AMBASSADOR AT LARGE.— in which each child resides, and the country (2) APPROVAL TO ADOPT.—The division re- In carrying out the functions of the Office, in which the adoption was finalized; sponsible for approving parents to adopt the Ambassador at Large shall have the fol- (III) the number of intercountry adoptions shall be divided into regions of the United lowing responsibilities: involving emigration from the United States as follows: (A) IN GENERAL.—The primary responsibil- States, regardless of whether the adoption (A) Northwest. ities of the Ambassador at Large shall be— occurred under The Hague Convention, in- (B) Northeast. (i) to ensure that intercountry adoptions cluding the country where each child now re- (C) Southwest. take place in the best interests of the child; sides and the State from which each child (D) Southeast. and emigrated; (E) Midwest. (ii) to assist the Secretary of State in ful- (IV) the number of Hague Convention (F) West. filling the responsibilities designated to the placements for adoption in the United States (3) CHILD ADJUDICATION.—To the extent central authority under title I of the Inter- that were disrupted, including the country practicable, the division responsible for the country Adoption Act of 2000 (42 U.S.C. 14911 from which the child emigrated, the age of adjudication of foreign born children as et seq.). the child, the date of the placement for adop- adoptable shall be divided by world regions (B) ADVISORY ROLE.—The Ambassador at tion, the reasons for the disruption, the reso- which correspond to those currently used by Large shall be a principal advisor to the lution of the disruption, the agencies that other divisions within the Department of President and the Secretary of State regard- handled the placement for adoption, and the State. ing matters affecting intercountry adoption plans for the child, and in addition, any in- (4) USE OF INTERNATIONAL FIELD OFFICERS.— and the general welfare of children abroad formation regarding disruption or dissolu- Nothing in this section shall be construed to and shall make recommendations regard- tion of adoptions of children from other prohibit the use of international field offi- ing— countries received pursuant to section cers posted abroad, as necessary, to fulfill (i) the policies of the United States with 422(b)(4) of the Social Security Act; the requirements of this Act. respect to the establishment of a system of (V) the average time required for comple- (e) QUALIFICATIONS AND TRAINING.—In addi- cooperation among the parties to The Hague tion of an adoption, set forth by the country tion to meeting the employment require- Convention; from which the child emigrated; ments of the Department of State, officers (ii) the policies to prevent abandonment, (VI) the current list of agencies accredited employed in any of the 6 divisions of the Of- strengthen families, and to advance the and persons approved under the Intercountry fice shall undergo extensive and specialized placement of children in permanent families; Adoption Act of 2000 (42 U.S.C. 14901 et seq.) training in the laws and processes of inter- and to provide adoption services; country adoption as well as understanding (iii) policies that promote the well-being of (VII) the names of the agencies and persons the cultural, medical, emotional, and social children. temporarily or permanently debarred under issues surrounding intercountry adoption (C) DIPLOMATIC REPRESENTATION.—Subject the Intercountry Adoption Act of 2000 (42 and adoptive families. The Ambassador at to the direction of the President and the Sec- U.S.C. 14901 et seq.), and the reasons for the Large shall, whenever possible, recruit and retary of State, the Ambassador at Large debarment; hire individuals with background and experi- may represent the United States in matters (VIII) the range of adoption fees charged in ence in intercountry adoptions. and cases relevant to international adoption connection with Hague Convention adoptions (f) USE OF ELECTRONIC DATABASES AND FIL- in— involving adoptions by United States citi- ING.—To the extent possible, the Office shall (i) fulfillment of the responsibilities des- zens and the median of such fees set forth by make use of centralized, electronic databases ignated to the central authority under title the country of origin; and electronic form filing.

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00059 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.022 S23PT1 S15650 CONGRESSIONAL RECORD — SENATE November 23, 2003 SEC. 102. RECOGNITION OF CONVENTION ADOP- such date pursuant to their terms as in ef- and Nationality Act (8 U.S.C. 1431) is amend- TIONS IN THE UNITED STATES. fect on such effective date); ed— Section 505(a)(1) of the Intercountry Adop- shall continue in effect according to their (1) by amending the section heading to tion Act of 2000 (42 U.S.C. 14901 note) is terms until modified, terminated, super- read as follows: ‘‘CHILDREN BORN OUTSIDE amended by inserting ‘‘301, 302,’’ after ‘‘205,’’. seded, set aside, or revoked in accordance THE UNITED STATES; CONDITIONS UNDER SEC. 103. TECHNICAL AND CONFORMING AMEND- with law by the President, any other author- WHICH CITIZENSHIP AUTOMATICALLY AC- MENT. ized official, a court of competent jurisdic- QUIRED’’; and Section 104 of the Intercountry Adoption tion, or operation of law, except that any (2) in subsection (a), by striking para- Act of 2000 (42 U.S.C. 14914) is repealed. collective bargaining agreement shall re- graphs (1) through (3) and inserting the fol- Subtitle B—Transition Provisions main in effect until the date of termination lowing: specified in the agreement. ‘‘(1) Upon the date the adoption becomes SEC. 111. TRANSFER OF FUNCTIONS. (b) PROCEEDINGS.— full and final, at least 1 parent of the child (a) IN GENERAL.—All functions under the (1) PENDING.—The transfer of functions is a citizen of the United States, whether by immigration laws of the United States with under section 111 shall not affect any pro- birth or naturalization, who has been phys- respect to the adoption of foreign born chil- ceeding or any application for any benefit, ically present in the United States or its dren by United States citizens and their ad- service, license, permit, certificate, or finan- outlying possessions for a period or periods mission to the United States that have been cial assistance pending on the effective date totaling not less than 5 years, at least 2 of vested by statute in, or exercised by, the of this title before an office whose functions which were after attaining the age of 14 Commissioner of Immigration and Natu- are transferred pursuant to this title, but years. Any periods of honorable service in ralization, the Immigration and Naturaliza- such proceedings and applications shall be the Armed Forces of the United States, or tion Service (or any officer, employee, or continued. periods of employment with the United component thereof), of the Department of (2) ORDERS.—Orders shall be issued in such States Government or with an international Homeland Security (or any officer, em- proceedings, appeals shall be taken there- organization as that term is defined in sec- ployee, or component thereof) immediately from, and payments shall be made pursuant tion 1 of the International Organizations Im- prior to the effective date of this title, are to such orders, as if this Act had not been en- munities Act (22 U.S.C. 288) by such citizen transferred to the Office on such effective acted, and orders issued in any such pro- parent, or any periods during which such cit- date for exercise by the Ambassador at Large ceeding shall continue in effect until modi- izen parent is physically present abroad as in accordance with applicable laws and title fied, terminated, superseded, or revoked by a the dependent unmarried son or daughter II of this Act. duly authorized official, by a court of com- and a member of the household of a person— (b) EXERCISE OF AUTHORITIES.—Except as petent jurisdiction, or by operation of law. ‘‘(A) honorably serving with the Armed otherwise provided by law, the Ambassador (3) DISCONTINUANCE OR MODIFICATION.— Forces of the United States; or at Large may, for purposes of performing Nothing in this section shall be considered to ‘‘(B) employed by the United States Gov- any function transferred to the Ambassador prohibit the discontinuance or modification ernment or an international organization as at Large under subsection (a), exercise all of any such proceeding under the same terms defined in section 1 of the International Or- authorities under any other provision of law and conditions and to the same extent that ganizations Immunities Act (22 U.S.C. 288); that were available with respect to the per- such proceeding could have been discon- may be included in order to satisfy the phys- formance of that function to the official re- tinued or modified if this section had not sponsible for the performance of the function ical presence requirement of this paragraph. been enacted. ‘‘(2) The child is an adoptable child de- immediately before the effective date of the (c) SUITS.—This title shall not affect suits scribed in section 101(c)(3). transfer of the function pursuant to this commenced before the effective date of this ‘‘(3) The child is the beneficiary of a full title. title, and in all such suits, proceeding shall and final adoption decree entered by a for- SEC. 112. TRANSFER OF RESOURCES. be had, appeals taken, and judgments ren- eign government or a court in the United Subject to section 1531 of title 31, United dered in the same manner and with the same States. States Code, upon the effective date of this effect as if this title had not been enacted. ‘‘(4) For purposes of this subsection, the title, there are transferred to the Ambas- (d) NONABATEMENT OF ACTIONS.—No suit, term ‘‘full and final adoption’’ means an sador at Large for appropriate allocation in action, or other proceeding commenced by or adoption— accordance with section 115, the assets, li- against the Department of State, the Immi- ‘‘(A) that is completed under the laws of abilities, contracts, property, records, and gration and Naturalization Service, or the the child’s country of origin or the State law unexpended balance of appropriations, au- Department of Homeland Security, or by or of the parent’s residence; thorizations, allocations, and other funds against any individual in the official capac- ‘‘(B) under which a person is granted full employed, held, used, arising from, available ity of such individual as an officer or em- and legal custody of the adopted child; to, or to be made available to the Immigra- ployee in connection with a function trans- ‘‘(C) that has the force and effect of sev- tion and Naturalization Service or the De- ferred pursuant to this section, shall abate ering the child’s legal ties to the child’s bio- partment of Homeland Security in connec- by reason of the enactment of this Act. logical parents; tion with the functions transferred pursuant (e) CONTINUANCE OF SUIT WITH SUBSTI- TUTION OF PARTIES.—If any Government offi- ‘‘(D) under which the adoptive parents to this title. cer in the official capacity of such officer is meet the requirements of section 205 of the SEC. 113. INCIDENTAL TRANSFERS. party to a suit with respect to a function of Intercountry Adoption Reform Act; and The Ambassador at Large may make such the officer, and pursuant to this title such ‘‘(E) under which the child has been adju- additional incidental dispositions of per- function is transferred to any other officer dicated to be an adoptable child in accord- sonnel, assets, liabilities, grants, contracts, or office, then such suit shall be continued ance with section 206 of the Intercountry property, records, and unexpended balances with the other officer or the head of such Adoption Reform Act.’’. of appropriations, authorizations, alloca- other office, as applicable, substituted or (b) EFFECTIVE DATE.—This section shall tions, and other funds held, used, arising added as a party. take effect as if enacted on January 1, 1950. from, available to, or to be made available in (f) ADMINISTRATIVE PROCEDURE AND JUDI- SEC. 202. REVISED PROCEDURES. connection with such functions, as may be CIAL REVIEW.—Except as otherwise provided (a) IN GENERAL.—Notwithstanding any necessary to carry out this title. The Ambas- by this title, any statutory requirements re- other provision of law, the following require- sador at Large shall provide for such further lating to notice, hearings, action upon the ments shall apply with respect to the adop- measures and dispositions as may be nec- record, or administrative or judicial review tion of foreign born children by United essary to effectuate the purposes of this that apply to any function transferred pursu- States citizens: title. ant to any provision of this title shall apply (1) Upon completion of a full and final SEC. 114. SAVINGS PROVISIONS. to the exercise of such function by the head adoption, the Secretary of State shall issue a (a) LEGAL DOCUMENTS.—All orders, deter- of the office, and other officers of the office, United States passport and a Consular Re- minations, rules, regulations, permits, to which such function is transferred pursu- port of Birth for a child who satisfies the re- grants, loans, contracts, agreements, includ- ant to such provision. quirements of section 320 of the Immigration ing collective bargaining agreements, certifi- Subtitle C—Effective Date and Nationality Act (8 U.S.C. 1431), as cates, licenses, and privileges— SEC. 121. EFFECTIVE DATE. amended by section 201 of this Act, upon ap- (1) that have been issued, made, granted, or This title shall take effect 180 days after plication by a United States citizen parent. allowed to become effective by the Presi- the date of enactment of this Act. (2) An adopted child described in paragraph dent, the Ambassador at Large, the former TITLE II—REFORM OF UNITED STATES (1) shall not require the issuance of a visa for Commissioner of the Immigration and Natu- LAWS GOVERNING INTERCOUNTRY travel and admission to the United States ralization Service, their delegates, or any ADOPTIONS but shall be admitted to the United States other Government official, or by a court of upon presentation of a valid, unexpired SEC. 201. AUTOMATIC ACQUISITION OF CITIZEN- competent jurisdiction, in the performance SHIP FOR ADOPTED CHILDREN United States passport. of any function that is transferred pursuant BORN OUTSIDE THE UNITED (3) No affidavit of support under section to this title; and STATES. 213A of the Immigration and Nationality Act (2) that are in effect on the effective date (a) AMENDMENTS OF AUTOMATIC CITIZENSHIP (8 U.S.C. 1183a) shall be required in the case of such transfer (or become effective after PROVISIONS.—Section 320 of the Immigration of any adoptable child.

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00060 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.022 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15651 (4) The Secretary of State shall not require furnished the child if admitted to the United residence a certification, together with docu- an adopted child described in paragraph (1) States; mentary support, that the child sought to be to undergo a medical exam. ‘‘(C) with respect to whom the Secretary of adopted meets the description of an adopt- (b) REGULATIONS.—Not later than 90 days State is satisfied that the purpose of the able child; and after the date of enactment of this Act, the adoption is to form a bona fide parent-child (2) within 30 days of receipt of the certifi- Secretary of State shall prescribe such regu- relationship and that the parent-child rela- cation referred to in paragraph (1), the Office lations as may be necessary to carry out this tionship of the child and the biological par- shall make a final determination on whether section. ents has been terminated (and in carrying the certification and the documentary sup- SEC. 203. NONIMMIGRANT VISAS FOR CHILDREN out both obligations under this subparagraph port are sufficient to meet the requirements TRAVELING TO THE UNITED STATES the Secretary of State, in consultation with of this section. TO BE ADOPTED BY A UNITED the Secretary of Homeland Security, may (b) PROCESS FOR DETERMINATION.— STATES CITIZEN. consider whether there is a petition pending (1) IN GENERAL.—The Ambassador at Large (a) IN GENERAL.—Section 101(a)(15) of the to confer immigrant status on one or both of shall work with the competent authorities of Immigration and Nationality Act (8 U.S.C. the child’s country of residence to establish 1101(a)(15)) is amended— the biological parents); a uniform, transparent, and efficient process (1) by striking ‘‘or’’ at the end of subpara- ‘‘(D) with respect to whom the Secretary of for the exchange and approval of the certifi- graph (U); State, in consultation with the Secretary of cation and documentary support required (2) by striking the period at the end of sub- Homeland Security, is satisfied that the per- under subsection (a). paragraph (V) and inserting ‘‘; or’’; and son is not a security risk; and (2) NOTICE OF INTENT.—If the Office finds (3) by adding at the end the following: ‘‘(E) whose adoption and emigration to the that the certification submitted by the com- ‘‘(W) an adoptable child who is coming into United States has been approved by the competent authority of the child’s country of or- the United States for adoption by a United petent authority of the country of the child’s igin is not readily approvable, the Office States citizen and a spouse jointly or by an place of birth or residence.’’. (b) CONFORMING AMENDMENT.—Section shall— unmarried United States citizen at least 25 204(d) of the Immigration and Nationality (A) notify the competent authority and the years of age, who has been approved to adopt Act (8 U.S.C. 1154(d)) is amended by inserting prospective adoptive parents, in writing, of by the Ambassador at Large, acting through ‘‘and an adoptable child as defined in section the specific reasons why the certification is the Office of Intercountry Adoptions estab- 101(c)(3)’’ before ‘‘unless a valid home- not sufficient; and lished under section 101(a) of the Inter- study’’. (B) provide the competent authority and country Adoption Reform Act.’’. SEC. 205. APPROVAL TO ADOPT. the prospective adoptive parents the oppor- (b) TERMINATION OF PERIOD OF AUTHORIZED (a) IN GENERAL.—Prior to the issuance of a tunity to address the stated insufficiencies. ADMISSION.—Section 214 of the Immigration visa under section 101(a)(15)(W) of the Immi- and Nationality Act (8 U.S.C. 1184) is amend- TITLE III—FUNDING gration and Nationality Act, as added by sec- ed by adding at the end the following: SEC. 301. FUNDS. ‘‘(q) In the case of a nonimmigrant de- tion 203(a) of this Act, or the issuance of a The Secretary of State shall provide the scribed in section 101(a)(15)(W), the period of full and final adoption decree, the United Ambassador at Large with such funds as may authorized admission shall terminate on the States citizen adoptive parent shall have ap- be necessary for— proved by the Office a petition to adopt. earlier of— (1) the hiring of staff for the Office; Such petition shall be subject to the same ‘‘(1) the date on which the adoption of the (2) investigations conducted by the Office; terms and conditions as are applicable to pe- nonimmigrant is completed by the courts of and titions for classification under section 204.3 the State where the parents reside; or (3) travel and other expenses necessary to of title 8 of the Code of Federal Regulations, ‘‘(2) the date that is 2 years after the date carry out this Act. as in effect on the day before the date of en- of admission of the nonimmigrant into the Ms. LANDRIEU. Mr. President, two United States.’’. actment of this Act. (b) EXPIRATION OF APPROVAL.—Approval to (c) TEMPORARY TREATMENT AS LEGAL PER- years ago, I had the distinct pleasure of adopt under this Act is valid for 24 months MANENT RESIDENT.—Notwithstanding any spending an hour with the President of other law, all benefits and protections that from the date of approval. China, Jiang Jiamin. As you know, (c) EXPEDITED REAPPROVAL PROCESS OF apply to a legal permanent resident shall President Jiamin is tremendously busy FAMILIES PREVIOUSLY APPROVED TO ADOPT.— apply to a nonimmigrant described in sec- and has numerous requests for personal tion 101(a)(15)(W) of the Immigration and Na- The Ambassador at Large shall prescribe such regulations as may be necessary to pro- meetings, but he agreed to meet with tionality Act, as added by subsection (a), this particular U.S. delegation because pending a full and final adoption. vide for an expedited and streamlined proc- (d) EXCEPTION FROM IMMUNIZATION RE- ess for families who have been previously ap- of the importance of the subject we QUIREMENT FOR CERTAIN ADOPTED CHIL- proved to adopt and whose approval has ex- were there to discuss, international DREN.—Section 212(a)(1)(C) of the Immigra- pired, so long as not more than 3 years have adoption. During this meeting, he tion and Nationality Act (8 U.S.C. lapsed since the original application. shared with us that the Chinese believe (d) DENIAL OF PETITION.— 1182(a)(1)(C)) is amended— every child born is born with a red (1) in the heading by striking ‘‘10 YEARS’’ (1) NOTICE OF INTENT.—If the officer adjudicating the petition to adopt finds that it is string attached to their heart, the and inserting ‘‘18 YEARS’’; and other end of which is tied to the ankle (2) in clause (i), by striking ‘‘10 years’’ and not readily approvable, the officer shall no- inserting ‘‘18 years’’. tify the petitioner, in writing, of the officer’s of their soul mate. It is because of this (e) REGULATIONS.—Not later than 90 days intent to deny the petition. Such notice string, they believe, that soul mates after the date of enactment of this Act, the shall include the specific reasons why the pe- eventually find each other and spend Secretary of State shall prescribe such regu- tition is not readily approvable. the rest of their lives together. It is his lations as may be necessary to carry out this (2) PETITIONERS RIGHT TO RESPOND.—Upon belief, that perhaps the same is true of section. receiving a notice of intent to deny, the peti- children who are adopted. That when tioner has 30 days to respond to such notice. SEC. 204. DEFINITION OF ‘‘ADOPTABLE CHILD’’. they are born, their hearts have a (a) IN GENERAL.—Section 101(c) of the Im- (3) DECISION.—Within 30 days of receipt of migration and Nationality Act (8 U.S.C. the petitioner’s response the Office must string that is tied to the ankle of their 1101(c)) is amended by adding at the end the reach a final decision regarding the eligi- forever family, and it is because of that following: bility of the petitioner to adopt. Notice of a heartstring that they eventually find ‘‘(3) The term ‘‘adoptable child’’ means an formal decision must be delivered in writing. one another. unmarried person under the age of 18— (4) RIGHT TO AN APPEAL.—Unfavorable deci- I will treasure the memory of this ‘‘(A) whose biological parents (or parent, in sions may be appealed to the appropriate ap- meeting forever. Not only because it the case of a child who has one sole or sur- pellate jurisdiction of the Department of was an extreme honor to meet with viving parent) or other persons or institu- State, and if necessary, Federal court. such a learned and distinguished lead- tions that retain legal custody of the child— (5) REGULATIONS REGARDING APPEALS.—Not ‘‘(i) have freely given their written irrev- later than 6 months after the date of enact- er, but because it reminds me of how ocable consent to the termination of their ment of this Act, the Ambassador at Large profound adoption is. 19,237 children legal relationship with the child, and to the shall promulgate formal regulations regard- were adopted by American citizens last child’s emigration and adoption; ing the process for appealing the denial of a year. 18,477 children the year before ‘‘(ii) are unable to provide proper care for petition. that, 16,363 in 1999 and 15,744 children in the child, as determined by the appropriate SEC. 206. ADJUDICATION OF CHILD STATUS. 1998. That is almost 100,000 children in governmental authority of the child’s resi- (a) IN GENERAL.—Prior to the issuance of a four years. I think it is easy for us to dence; or full and final adoption decree or a visa under understand the impact that these adop- ‘‘(iii) have voluntarily relinquished the section 101(a)(15)(W) of the Immigration and child to governmental authorities pursuant Nationality Act, as added by section 203(a) of tions have had on the adoptive families to the law of the child’s residence; this Act— and the orphan children, but what I ‘‘(B) with respect to whom the Secretary of (1) the Office shall obtain from the com- would like to focus on this morning is State is satisfied that the proper care will be petent authority of the country of the child’s the impact that this has for

VerDate jul 14 2003 04:05 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00061 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.022 S23PT1 S15652 CONGRESSIONAL RECORD — SENATE November 23, 2003 the diplomatic relations between the Now, you may be asking yourself, as and I look forward to seeing it passed United States and countries through- I have many times, what does adoption as soon as possible. out the world. have to do with immigration? You see, Mr. INHOFE. Mr. President, I rise In sheer numbers alone, the impact is under current law children adopted by today, National Adoption Day, to join evident. In real terms, these children United States citizens abroad are my colleagues in introducing this bill are ‘‘mini-ambassadors’’ to 200,000 treated as immigrants, forced to apply to give children everyhwere around the American citizen parents, 400,000 for an immigrant visa to enter the world a greater chance to find a loving, grandparents, conservatively 800,000 United States. This process is not only permanent home. aunts and uncles, and 300,000 siblings. impractical, since these children ob- This bill, the Intercountry Adoption According to a recent report by the tain automatic citizenship upon entry Reform Act (ICARE), will automati- U.S. Census Bureau, 1.6 million people into the United States, it is inequi- cally make a child who is adopted from in the United States were adopted, fif- table. Children born to U.S. citizens another country a citizen the minute teen percent of them from abroad. Be- abroad are conferred automatic citi- the adoption is finalized. cause of this magnificent process, com- zenship upon their birth and are there- This legislation has a personal immunities all over the U.S. are deep- fore permitted to travel to the United pact for me. My granddaughter was ening this understanding and affinity States on a U.S. passport. Children adopted from Ethiopia a few years ago. for the people of the world. September adopted by United States citizens Even though she is a vital part of our 11 reminded us of the importance of should be afforded this same protec- family, she was not a citizen when she continuing to build bridges with the tion. This bill affords them that pro- arrived. We now have to do work to nations of the world. International tection. make the law recognize her in the same adoption is one very effective and last- This bill also proposes that we up- light we do—as a legal member of our ing way to build these bridges. date the current law definitions of an family and a lawful citizen of this Over this past year, I have also had ‘‘adoptable child’’ to reflect the types country—entitled to the same rights the privilege of meeting with the Presi- of children in need of homes through- and privileges as all my other biologi- dents of Kazakstan, Romania and Rus- out the world. The current law defini- cal grandchildren. sia and high-ranking government offi- tion of ‘‘orphan’’ reflects the reality ICARE will ensure that foreign-born cials from Cambodia, Vietnam, Guate- for which it was created; to help U.S. children, such as my granddaughter, mala, Africa, and the Ukraine. Each citizens adopt children orphaned by the will be treated the same as biological time the message is the same. They children born abroad to the same par- wars in Korea and Vietnam. As such, it want to do what they can to make the ent who is an American citizen. It will is an extremely narrow definition that Hague more than just a piece of paper help streamline international adop- in many cases prohibits a family from with 59 signatures on it. They are look- tions and implement best practices for bringing their newly adopted child to ing to the U.S. to lead the way toward all adoptions. a system of international adoption and the United States. Situations such as one that happened In creating an Ambassador at Large child welfare that is based on best in my State of Oklahoma would not for international adoption, this bill practices. A system comprised of have happened under this legislation. hopes to provide the leadership and meaningful protections for the adop- Anna Lynn Fincher was born in the high level diplomatic representation so tive parents, the birth parents, and Philippines and adopted by a U.S. mili- desperately needed in international perhaps most importantly the children; tary couple in the Philippines. Even a system that universally recognizes adoption. Under his or her leadership, though they adopted Anna Lynn in the that a government institution is not the Office of International Adoptions Philippines, they never brought her to and cannot be an adequate replacement will be able to take the proactive the United States. Sadly, both of Anna for a family and works toward the measures necessary to limit corruption Lynn’s American parents died while in shared mission of finding every child in and ensure that adoptions are per- the Philippines—before Anna Lynn was this world a loving and nurturing, performed in the most efficient, trans- able to set foot on American soil and manent family. parent manner possible. The Hague become a U.S. citizen. As a result, she I am proud to be here today, along Treaty already gives the State Depart- had to be granted Humanitarian Pa- with my colleague, the Senior Senator ment this responsibility; this bill is de- role, which is granted to people in ex- from Oklahoma, to introduce legisla- signed to help them fulfill it. treme circumstances, so that she could Let me tell you why we need to act tion that will take us in that direction. come to the United States and be now to pass this legislation. Because of What it proposes to do is simple, but adopted by her adoptive sister. what it might help us to achieve is lim- the lack of consistent leadership by the Under ICARE, Anna Lynn would have itless. Simply put, this bill hopes to United States in this area, many coun- become a citizen as soon as her adop- streamline the existing international tries around the world are in ‘‘crisis tion was finalized—eliminating the adoption process, consolidate its fed- mode’’ and have been forced to take need for Humanitarian Parole and an- eral functions into one agency and to unilateral actions to solve perceived other adoption. empower that agency with the staff problems in the system. For two years, Providing children, such as my and resources it needs to represent the there has been a moratorium on inter- granddaughter and Anna Lynn, with a United States, the largest beneficiary national adoption in Romania. The sec- permanent, stable family is the most from international adoption. With this ond anniversary of the INS issued sus- precious gift we can give a child. I am office in place, the United States can pension in Cambodia is fast approach- proud to lend my support to this im- begin to lead the world community in ing. The governments of Guatemala portant legislation that will help give forging an international system of and Vietnam have taken actions to these young people a home. adoption that protects the interests of limit the number of international all those involved. adoptions. In each and every one of By Mr. CORZINE: Under current law the federal respon- these cases, the foreign governments S. 1935. A bill to amend the Public sibility for international adoption lies have expressed frustration with the Health Service Act to require employ- with the Department of State and the lack of action on the part of the U.S. to ers to offer health care coverage for all U.S. Citizenship and Immigration Serv- limit corruption or close potential employees, to amend the Social Secu- ices. This dual jurisdiction gives rise to loopholes in the system. The end re- rity Act to guarantee comprehensive several problems including: lack of co- sult, hundreds and thousands of chil- health care coverage for all children ordination, lack of accountability, du- dren are left in orphanages. This can- born after 2001, and for other purposes; plication of efforts and unnecessary pa- not be. to the Committee on Finance. perwork and fees for prospective adop- I have spent the past two years talk- Mr. CORZINE. Mr. President, I rise tive families. It also impedes the State ing to foreign governments, agencies, today to introduce legislation on an Departments ability to fulfill its re- and most importantly, adoptive par- issue that is of utmost importance to sponsibilities as the central authority ents and they tell me that this legisla- me, to the State of New Jersey, and to under the Hague Treaty on Coopera- tion is needed. I urge my colleagues to our Nation: providing universal access tion in International Adoption. join me in supporting this legislation to health insurance.

VerDate jul 14 2003 04:05 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00062 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.087 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15653 This is an issue I talked about inces- $624 million in charity care to the un- credits to the self-employed to assist santly during my campaign, because I insured and underinsured, but were them in purchasing health insurance strongly believe it is a national out- only reimbursed for $381 million of and would allow them to buy into the rage that we are the only industrial so- these costs. FEHBP program. But although I am ciety on earth that does not insure the In sum, health insurance coverage passionate about universal access to health of all its people. matters. It matters to families who health care, I realize we can’t get there I begin with a basic premise. Health don’t receive adequate care, and it yet. Not because the popular will is not care is a basic right, and neither the matters to communities. We ignore the there, but because the political will government nor the private sector is issue of the uninsured at our peril and isn’t. doing enough to secure that right for at a great cost to the quality of life— Therefore I believe we can and should everyone. and to the very life—of our citizens. be doing all that we can to make incre- Unfortunately, as I have traveled That is why today I am introducing mental progress. So I support incre- across the State of New Jersey, I have legislation that will provide universal mental changes, starting with the most talked to many men and women who access to health care for all Americans. vulnerable populations, and building on lay awake nights trying to figure out My legislation, the Universal Secure Medicaid and CHIP, success public pro- how to care for loved ones. I’ve met Access to (USA) Health Care Act has grams. That is why I am a strong sup- people who work two jobs to support several components: porter of the Family Care proposal, their family, and end up taking their First, we must cover all children. De- which would cover the parents of chil- kids to the emergency room when spite the success of the CHIP program, dren already enrolled in the CHIP pro- they’re sick because they are unable to over nine million children are still un- gram. afford preventive care and timely insured. These children are less likely I was also pleased to be an original treatment for their children. to have immunizations and receive less cosponsor of Senator BINGAMAN’s bipar- In 2002, more than 43 million Ameri- preventive care, which often results in tisan legislation, the Start Healthy, cans—or a staggering 17 percent of the health problems later in life and also Stay Healthy Act, which would expand total nonelderly population—were un- leads to poor school performance. The coverage for children and pregnant insured. In my State of New Jersey, 1.1 millions of uninsured children cannot women. It is based on the common million citizens lack health insurance. control whether they have health care sense principle that children deserve to The number of uninsured grew stead- coverage, and it is a measure of the start life healthy and stay healthy. ily throughout the 1990’s until 1999, failure of our politics that we do not Health professionals agree that one when modest increases in employer take care of our children. of the best ways to ensure the birth of coverage due to the robust economy, My proposal, modeled on legislation a healthy baby is to ensure adequate coupled with expansion and improved introduced by Senator ROCKEFELLER, prenatal care. Yet as a Nation, we do enrollment in the State Children’s would create a MediKids program that far too little to provide this type of Health Insurance Program (CHIP), led would provide universal health insur- care. This is evident by the stark sta- to the first decline in the number of ance for children up to age 23 through tistics on the subject: the United uninsured in over a decade. Unfortu- a new federal program modeled after States ranks 27th in infant mortality nately, the number of uninsured is on Medicare, but with benefits tailored to- and 21st in material mortality—the the rise again, as State budget deficits ward the needs of children. worst among developed nations. The have forced deep cuts in public health Maintaining the health of our chil- statistics in New Jersey are equally programs and as unemployment has dren is critical to the future of our stark: New Jersey ranks an abysmal risen. country. Indeed, it is clear that pro- 44th among the States in the percent- Unemployment, however, is not the viding health care coverage to children age of mothers receiving adequate pre- leading cause of being uninsured. In impacts more than just their health—it natal care, 34th in low birth weights, fact, more than eighty percent of the impacts their ability to learn, their and 12th in infant mortality rates. uninsured—four out of five Ameri- ability to thrive, and their ability to Specifically, this important legisla- cans—are in working families. Sev- become productive members of society. tion would allow States to cover pre- enty-two percent live in households MediKids simplifies the confusing natal care services for women up to 185 with a full-time worker, and 11 percent array of health insurance assistance percent of the Federal poverty level live with a part-time worker. Low- programs for children today and guar- through the Children’s Health Insur- wage workers are at greater risk of antees them coverage until adulthood. ance (CHIP) Program. It would also being uninsured, as are unskilled labor- The next step is to demand that the allow States to extend coverage to ers, service workers, and those em- private sector do its part. Under my children under the CHIP program ployed in small businesses. bill, large employers would be required through age 20, and would increase The consequences of our Nation’s sig- to provide health coverage for all their CHIP funding by $2.65 billion over four nificant uninsured population are dev- workers. A minimum wage in America years. astating for our health and our econ- should include with it minimum bene- I often say that we are not a Nation omy. fits, among them health insurance. But of equal outcomes, but we should be a The uninsured are significantly more unfortunately, the current system puts Nation of equal beginnings. likely to delay or forego needed care the responsible employer who provides Until we give all Americans access to and are less likely to receive preven- health insurance at a disadvantage rel- health care, however, we cannot live up tive care. ative to the employers who do not. to that promise. Delaying or not receiving treatment When employers fail to cover employ- I ask unanimous consent that the can lead to more serious illness and ees, society pays their share of the bill text of the bill be printed in the avoidable health problems, which in at the emergency room. In fact, the RECORD. turn results in unnecessary and costly universal health care delivered in the There being no objection, the bill was hospitalizations. For example, the un- emergency rooms of our community ordered to be printed in the RECORD, as insured are more likely than those hospitals is the most expensive and follows: with insurance to be hospitalized for short-sighted approach to address the S. 1935 conditions that could have been avoid- problem of the uninsured Americans. Be it enacted by the Senate and House of Rep- ed, such as pneumonia and uncon- Under my bill, small businesses, the resentatives of the United States of America in trolled diabetes. In addition, the unin- self-employed and unemployed would Congress assembled, sured with various forms of cancer are be able to buy coverage in the Federal SECTION 1. SHORT TITLE; FINDINGS. more likely to be diagnosed with late Employee Health Benefit Program. If (a) SHORT TITLE.—This Act may be cited as stage cancer. it is good enough for Senators, it is the ‘‘Universal Secure Access to Health Care Act of 2003’’. Indeed, my own State of New Jersey good enough for America. Those who (b) FINDINGS.— struggles to deal with the costs of are between the ages of 55 and 64 would (1) In 2002, 43,600,000 Americans, nearly 17.2 charity care provided to the uninsured. be able to buy-in to the Medicare pro- percent of the total nonelderly population, In 2002, New Jersey hospitals provided gram. My legislation would provide tax were uninsured.

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00063 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.024 S23PT1 S15654 CONGRESSIONAL RECORD — SENATE November 23, 2003 (2) The number of uninsured has grown by ‘‘(1) medical history; that is a State or political subdivision of a nearly 10,000,000 over the past decade. ‘‘(2) health status; State or an agency or instrumentality of a (3) While 61 percent of Americans receive ‘‘(3) a preexisting medical condition, dis- State or political subdivision that does not health insurance coverage through their em- ease, or disorder; or comply with the requirements of this title ployers, millions of Americans lack access to ‘‘(4) genetic information. shall not be eligible to receive a grant, con- such coverage either because their employer ‘‘(c) OPEN ENROLLMENT.—A standard health tract, cooperative agreement, loan, or loan does not offer such coverage or the employer benefit plan offered by an employer under guarantee under this Act. cannot afford to pay for such coverage. section 2801(a) shall offer an annual open en- ‘‘(b) CIVIL PENALTY FOR PRIVATE EMPLOY- (4) Today, fewer Americans have health in- rollment period during which an individual ERS.— surance through their employment to cover may change enrollment from such plan to ‘‘(1) IN GENERAL.—Any nongovernmental themselves and their dependents than 10 another standard health benefit plan offered employer that does not comply with this years ago. by such employer. title shall be subject to a civil penalty of not (5) Eighty-two percent of the individuals ‘‘(d) MEDICALLY NECESSARY SERVICES.—A more than 10 percent of the total amount of that are uninsured in the United States are standard health benefit plan offered by an the employer’s expenditures for wages for in working families. employer under section 2801(a) shall, if such employees in that year. plan provides coverage for a certain health (6) Low-wage workers have more difficulty ‘‘(2) ASSESSMENT PROCEDURE.—A civil care item or service, provide coverage for obtaining affordable health care coverage money penalty under this section shall be as- such item or service if a doctor determines since such workers are less likely than high- sessed by the Secretary and collected in a that such item or service is medically nec- wage workers to have such coverage offered civil action brought by the United States in essary. as a benefit by an employer, and prohibitive a United States district court. The Secretary ‘‘(e) DATE OF INITIAL COVERAGE.—In the premiums for individually purchased cov- case of an employee enrolled in a standard shall not assess such a penalty on an em- erage often prevents such workers from pur- health benefit plan provided by an employer ployer until the employer has been given no- chasing such coverage independently. under section 2801(a), the coverage under tice and an opportunity to present its views (7) The consequences of our nation’s sig- such plan shall commence not later than 5 on such charge. nificant uninsured population are dev- days after the day on which the employee ‘‘(3) AMOUNT OF PENALTY.—In determining astating. first performs an hour of service as an em- the amount of the penalty, or the amount (8) The uninsured are significantly more ployee of that employer. No waiting period agreed to in compromise, the Secretary shall likely to delay or forego needed health care. beyond this initial 5-day period may be im- consider the gravity of the noncompliance (9) The uninsured are less likely to receive posed regarding such coverage. and the demonstrated good faith of the employer charged in attempting to achieve preventive health care. ‘‘SEC. 2803. PREMIUMS. rapid compliance after notification of a vio- (10) Delaying or foregoing health care ‘‘(a) IN GENERAL.—Each employer shall— treatment when such treatment is needed ‘‘(1) contribute to the cost of any standard lation of this title. can produce unnecessarily dire and expensive health benefit plan that an employee has en- ‘‘SEC. 2805. DEFINITIONS. results. More severe health care conditions rolled in in accordance with this section; and ‘‘In this title: may arise and more expensive health care ‘‘(2) withhold from wages of an employee, ‘‘(1) EMPLOYER.—The term ‘employer’ treatments, such as costly hospitalizations, the employee share of the premium assessed means, with respect to a calendar year and may be necessary even though such condi- for coverage under the standard health ben- plan year, an employer that employed an av- tions or treatments could have been avoided efit plan. erage of at least 50 full-time employees on by the initial provision of adequate and ‘‘(b) CONTRIBUTION.— business days during the preceding calendar timely health care. The uninsured, for exam- ‘‘(1) EMPLOYER SHARE.— year and employs not less than 50 employees ple, are more likely to be hospitalized for ‘‘(A) FULL-TIME EMPLOYEES.—Each em- on the first day of the plan year. conditions that could have been avoided, ployer who has enrolled an employee in a ‘‘(2) PART-TIME EMPLOYEE.—The term ‘part- such as pneumonia and uncontrolled diabe- standard health benefit plan shall contribute time employee’ means any individual em- tes, than the insured. The uninsured with not less than 72 percent of the monthly pre- ployed by an employer who works less than various forms of cancer are also more likely mium for such employee. 40 hours a week. ‘‘(3) WAITING PERIOD.—The term ‘waiting to be diagnosed with late stage cancer than ‘‘(B) PART-TIME EMPLOYEES.— period’ means, with respect to a plan and an the insured. ‘‘(i) PRO-RATED PORTION PAID.—Each em- SEC. 2. AMENDMENT TO THE PUBLIC HEALTH ployer who has enrolled a part-time em- individual who is a potential beneficiary or SERVICE ACT. ployee in a standard health benefit plan shall participant in the plan, the period that must The Public Health Service Act (42 U.S.C. pay a portion of the monthly premium for pass with respect to the individual before the 201 et seq.) is amended by adding at the end such employee that is pro-rated to cor- individual is eligible to be covered for bene- the following: respond with the number of hours of work fits under the terms of the ‘‘TITLE XXVIII—UNIVERSAL HEALTH that such employee has provided during the plan.noncompliance by the Secretary. INSURANCE COVERAGE past month. ‘‘SEC. 2806. EFFECTIVE DATE. ‘‘Subtitle A—Employer Mandated Health ‘‘(ii) EXCEPTION.—No employer contribu- ‘‘This title shall take effect 2 years after Insurance Coverage tion is required under this section with re- the date of enactment of the Universal Se- cure Access to Health Care Act of 2003. ‘‘SEC. 2801. EMPLOYER MANDATED HEALTH IN- spect to an employee who works less than 10 SURANCE COVERAGE. hours per week. ‘‘Subtitle B—Individual and Employer ‘‘(a) IN GENERAL.—Each employer shall ‘‘(2) EMPLOYEE SHARE.— Subsidies offer to enroll each of its employees and ‘‘(A) IN GENERAL.—Each employee enrolled ‘‘SEC. 2811. SUBSIDY PROGRAM. their families in a standard health benefit in a standard health benefit plan under sec- ‘‘(a) IN GENERAL.—The Secretary shall es- plan. tion 2801(a) shall pay the remaining portion tablish a Federal program to award grants to ‘‘(b) STANDARD HEALTH BENEFIT PLAN.— of the monthly premium after payment by States for State premium assistance pro- For purposes of this title, the term ‘standard the employer as required under subsection grams. health benefit plan’ means a plan that pro- (a). ‘‘(b) FEDERAL PROGRAM.— vides benefits for health care items and serv- ‘‘(B) PART-TIME EMPLOYEES.—An employee ‘‘(1) IN GENERAL.—The Secretary shall es- ices that are actuarily equivalent or greater who is enrolled in a standard health benefit tablish a Federal program that shall set all in value than the benefits offered as of Janu- plan under section 2801(a) and works for such standards for administration of State pro- ary 1, 2000, under the Blue Cross/Blue Shield employer for not more than 30 hours and not grams, receive applications from States for Standard Option Plan provided under the less than 10 hours per week shall be eligible the establishment of such programs, and re- Federal Employees Health Benefit Program for a subsidy to aid such employee in paying ceive reports from States regarding the de- under chapter 89 of title 5, United States his or her portion of the monthly premium. velopments of such programs. Code. ‘‘(3) LOW-INCOME EMPLOYEES.—An employee ‘‘(2) REGULATIONS.—The Secretary shall ‘‘(c) PART-TIME EMPLOYEES.—Subsection who is enrolled in a standard health benefit promulgate regulations specifying require- (a) shall apply to part-time employees. plan under section 2801(a) whose family in- ments for State programs under this sub- ‘‘SEC. 2802. TYPE OF COVERAGE. come does not exceed 250 percent of the pov- title, including— ‘‘(a) IN GENERAL.—Each standard health erty line (as defined by the Office of Manage- ‘‘(A) standards for determining eligibility benefit plan offered by an employer under ment and Budget, and revised annually in ac- for premium assistance; section 2801(a) shall conform to the require- cordance with section 673(2) of the Commu- ‘‘(B) standards for States operating pro- ments of this section. nity Services Block Grant Act (42 U.S.C. grams under this subtitle which ensure that ‘‘(b) PROHIBITION AGAINST DISCRIMINATION.— 9902(2)) as applicable to a family of the size such programs are operated in a uniform A standard health benefit plan offered by an involved, shall be eligible to receive a sub- manner with respect to application proce- employer under section 2801(a) shall not es- sidy from the State as described in subtitle dures, data processing systems, and such tablish rules for eligibility of any individual B to aid in payment of premiums. other administrative activities as the Sec- to enroll under the plan or exclude or other- ‘‘SEC. 2804. ENFORCEMENT. retary determines to be necessary; and wise limit any individual from coverage ‘‘(a) STATE INELIGIBILITY FOR PUBLIC ‘‘(C) standards for accepting reports re- under the plan based on— HEALTH SERVICE ACT FUNDS.—An employer garding developments of such programs.

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‘‘(3) CONTENT.—The regulations described standard health benefit plan and determined ‘‘(A) deny or limit access to or the avail- in paragraph (2) shall require that a State to be eligible for premium assistance under ability of health care services, or otherwise program— this subtitle. discriminate in connection with the provi- ‘‘(A) enable an individual to file an appli- ‘‘SEC. 2813. SUBSIDIES FOR SMALL BUSINESS EM- sion of health care services; or cation for assistance with an agency des- PLOYERS. ‘‘(B) limit, segregate, or classify an indi- ignated by the State at any time, in person, ‘‘(a) IN GENERAL.—A small business em- vidual in any way which would deprive or by mail, or online; ployer that offers to enroll its employees and tend to deprive such individual of health ‘‘(B) provide for the use of an application their families in a standard health benefit care services, or otherwise adversely affect form developed by the Secretary; plan shall be eligible for premium assistance his or her access to health care services; ‘‘(C) make applications accessible at loca- if the State determines that such employer on the basis of race, national origin, sex, re- tions where individuals are most likely to qualifies for such assistance under sub- ligion, language, income, age, sexual ori- obtain the applications; section (b). entation, disability, health status, or antici- ‘‘(D) require individuals to submit revised ‘‘(b) ELIGIBILITY.—A small business em- pated need for health services. applications to reflect changes in estimated ployer is eligible for premium assistance if ‘‘(5) COORDINATING MULTIPLE COMMUNITY family incomes, including changes in em- such employer employs an average of not RATING AREAS.—Nothing in this section shall ployment status of family members, during more than 75 full-time employees on business be construed as preventing a State from co- the year, and the State shall revise the days during the preceding calendar year and ordinating the activities of 1 or more com- amount of any premium assistance based on employs not more than 75 employees on the munity rating areas in the State. such a revised application; and first day of the plan year. ‘‘(6) INTERSTATE COMMUNITY RATING ‘‘(E) provide for verification of the infor- ‘‘(c) AMOUNT OF ASSISTANCE.—The amount AREAS.—Community rating areas with re- mation supplied in applications under this of premium assistance for a small business spect to interstate areas shall be established subtitle, including examining return infor- employer for a month shall be determined by in accordance with rules established by the mation disclosed to the State. the Secretary. Secretary. ‘‘(4) APPLICATION.—The Secretary shall de- ‘‘(d) PAYMENTS.—The amount of the pre- ‘‘(7) COORDINATION IN MULTI-STATE AREAS.— velop an application form for assistance to mium assistance available to a small busi- One or more States may coordinate their op- be used by a State which shall— ness employer shall be paid by the State in erations in contiguous community rating ‘‘(A) be simple in form and understandable which the business is located directly to the areas. Such coordination may include, the to the average individual; standard health benefit plan in which the adoption of joint operating rules, con- ‘‘(B) require the provision of information employee of such business is enrolled. Pay- tracting with standard health benefit plans, necessary to make a determination as to ments under the preceding sentence shall enforcement activities, and establishment of whether an individual is eligible for assist- commence in the first month during which fee schedules for health providers. the employee is enrolled in a standard health ance, including a declaration of estimated ‘‘(c) OPEN ENROLLMENT.—Each State, based income by the individual based, at the elec- benefit plan and the employer is determined on rules and procedures established by the tion of the individual— to be eligible for premium assistance under Secretary, shall specify a uniform annual ‘‘(I) on multiplying by a factor of 4 the in- this subtitle. open enrollment period for each community dividual’s family income for the 3-month pe- ‘‘Subtitle C—Election of Coverage rating area during which all eligible individ- riod immediately preceding the month in ‘‘SEC. 2815. ELECTION OF COVERAGE. uals are permitted the opportunity to change which the application is made; or ‘‘(a) IN GENERAL.—A small business em- enrollment among the standard health ben- ‘‘(II) on estimated income for the entire ployer as described in subsection (b) may efit plans offered to such individuals in such year for which the application is submitted; elect to enroll its employees in— area under this Act. The initial annual open and ‘‘(1) a plan provided under the Federal Em- enrollment period shall be for a period of 90 ‘‘(C) require attachment of such docu- ployees Health Benefit Program under chap- days. mentation as deemed necessary by the Sec- ter 89 of title 5, United States Code; or ‘‘(d) STANDARD PREMIUM.—Each standard retary in order to ensure eligibility for as- ‘‘(2) the medicare program under title health benefit plan shall establish within sistance. XVIII of the Social Security Act (42 U.S.C. each community rating area in which the ‘‘(c) STATE ADMINISTRATION.— 1395 et seq.), if such employees are not less plan is to be offered a standard premium for ‘‘(1) IN GENERAL.—A State shall have in ef- than 50 years of age. enrollment of eligible individuals who seek fect a program for furnishing premium as- ‘‘(b) SMALL BUSINESS EMPLOYER.—In this enrollment in such plan. sistance in accordance with this subtitle. section, the term ‘small business employer’ ‘‘(e) UNIFORM PREMIUMS WITHIN COMMUNITY ‘‘(2) DESIGNATION OF STATE AGENCY.—A means an employer that employs an average RATING AREAS.— State may designate any appropriate State of not more than 75 full-time employees on ‘‘(1) IN GENERAL.—Subject to paragraphs (2) agency to administer the program under this business days during the preceding calendar and (3), the standard premium for each group subtitle. year and employs not more than 75 employ- health plan to which this section applies ‘‘(3) EFFECTIVENESS OF ELIGIBILITY.—A de- ees on the first day of the plan year. shall be the same, but shall not include the termination by a State that an individual is ‘‘Subtitle D—Community Rating costs of premium processing and enrollment. eligible for premium assistance shall be ef- ‘‘SEC. 2821. COMMUNITY RATING. ‘‘(2) APPLICATION TO ENROLLEES.— fective for the calendar year for which such ‘‘(a) IN GENERAL.—Each State shall estab- ‘‘(A) IN GENERAL.—The premium charged determination is made unless a revised appli- lish community rating areas in which stand- for coverage in a group health plan which cation indicates that an individual is no ard health benefit plans shall offer a stand- covers eligible employees and eligible indi- longer eligible for assistance. ard premium in accordance with this subtitle viduals shall be the product of— ‘‘SEC. 2812. SUBSIDIES FOR LOW-INCOME WORK- for enrollment for all eligible individuals. ‘‘(i) the standard premium (established ERS. ‘‘(b) COMMUNITY RATING AREAS.— under paragraph (1)); ‘‘(a) IN GENERAL.—A low-income worker ‘‘(1) IN GENERAL.—In accordance with this ‘‘(ii) in the case of enrollment other than shall be eligible for premium assistance if subtitle, each State shall, subject to ap- individual enrollment, the family adjust- such worker is eligible under subsection (b). proval of the Secretary, provide for the divi- ment factor specified under subparagraph ‘‘(b) ELIGIBILITY.—A low-income worker is eligible for premium assistance under sub- sion of the State into 1 or more community (B); and section (a) if the State determines that such rating areas. ‘‘(iii) the age adjustment factor (specified worker has a family income which does not ‘‘(2) REVISION OF AREAS.—Each State may, under subparagraph (C)). exceed 250 percent of the poverty line (as de- subject to approval of the Secretary, redraw ‘‘(B) FAMILY ADJUSTMENT FACTOR.— fined by the Office of Management and Budg- the boundaries of such community rating ‘‘(i) IN GENERAL.—The Secretary shall et, and revised annually in accordance with areas as described in paragraph (1) if such re- specify family adjustment factors that re- section 673(2) of the Community Services vision is reasonable or necessary. flect the relative actuarial costs of benefit Block Grant Act (42 U.S.C. 9902(2)) as appli- ‘‘(3) MULTIPLE AREAS.—With respect to a packages based on family classes of enroll- cable to a family of the size involved. community rating area— ment (as compared with such costs for indi- ‘‘(c) AMOUNT OF ASSISTANCE.—The amount ‘‘(A) no metropolitan statistical area in a vidual enrollment). of premium assistance for a month for a low- State may be incorporated into more than 1 ‘‘(ii) CLASSES OF ENROLLMENT.—For pur- income worker determined to be eligible such area in the State; poses of this subtitle, there are 4 classes of under subsection (b) shall be determined by ‘‘(B) the number of individuals residing enrollment: the Secretary. within such an area may not be less than ‘‘(I) Coverage only of an individual (re- ‘‘(d) PAYMENTS.—The amount of the pre- 250,000; and ferred to in this subtitle as the ‘individual’ mium assistance available to a low-income ‘‘(C) no area incorporated in a community enrollment or class of enrollment). worker shall be paid by the State in which rating area may be incorporated into an- ‘‘(II) Coverage of a married couple without the individual resides directly to the stand- other such area. children (referred to in this subtitle as the ard health plan in which the individual is en- ‘‘(4) NONDISCRIMINATION.—In establishing ‘couple-only’ enrollment or class of enroll- rolled. Payments under the preceding sen- boundaries for community rating areas, a ment). tence shall commence in the first month dur- State shall not directly or through contrac- ‘‘(III) Coverage of an individual and one or ing which the individual is enrolled in a tual arrangements— more children (referred to in this subtitle as

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00065 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.032 S23PT1 S15656 CONGRESSIONAL RECORD — SENATE November 23, 2003 the ‘single parent’ enrollment or class of en- ‘‘(iii) FEHBP.—The Federal employees years of age as determined under section rollment). health benefit program under chapter 89 of 1859B(c)(3). ‘‘(IV) Coverage of a married couple and one title 5, United States Code. ‘‘(b) ENROLLMENT PERIODS.— or more children (referred to in this subtitle ‘‘(iv) TRICARE.—The TRICARE program ‘‘(1) INDIVIDUALS 62-TO-65 YEARS OF AGE.—In as the ‘dual parent’ enrollment or class of (as defined in section 1072(7) of title 10, the case of individuals eligible to enroll enrollment). United States Code). under this part under section 1859(b)— ‘‘(iii) REFERENCES TO FAMILY AND COUPLE ‘‘(v) ACTIVE DUTY MILITARY.—Health bene- ‘‘(A) INITIAL ENROLLMENT PERIOD.—If the CLASSES OF ENROLLMENT.—In this subtitle: fits under title 10, United States Code, to an individual is eligible to enroll under such ‘‘(I) FAMILY.—The terms ‘family enroll- individual as a member of the uniformed section for July 2002, the enrollment period ment’ and ‘family class of enrollment’ refer services of the United States. shall begin on May 1, 2002, and shall end on to enrollment in a class of enrollment de- ‘‘(C) GROUP HEALTH PLAN.—The term ‘group August 31, 2002. Any such enrollment before scribed in any subclause of clause (ii) (other health plan’ has the meaning given such July 1, 2002, is conditioned upon compliance than subclause (I)). term in section 2791(a)(1) of the Public with the conditions of eligibility for July ‘‘(II) COUPLE.—The term ‘couple class of Health Service Act. 2002. enrollment’ refers to enrollment in a class of ‘‘(b) ELIGIBILITY OF INDIVIDUALS AGE 62-TO- ‘‘(B) SUBSEQUENT PERIODS.—If the indi- enrollment described in subclause (II) or (IV) 65 YEARS OF AGE.— vidual is eligible to enroll under such section of clause (ii). ‘‘(1) IN GENERAL.—Subject to paragraph (2), for a month after July 2002, the enrollment ‘‘(iv) SPOUSE; MARRIED; COUPLE.— an individual who meets the following re- period shall begin on the first day of the sec- ‘‘(I) IN GENERAL.—In this subtitle, the quirements with respect to a month is eligi- ond month before the month in which the in- terms ‘spouse’ and ‘married’ mean, with re- ble to enroll under this part with respect to dividual first is eligible to so enroll and shall spect to an individual, another individual such month: end 4 months later. Any such enrollment be- who is the spouse of, or is married to, the in- ‘‘(A) AGE.—As of the last day of the month, fore the first day of the third month of such dividual, as determined under applicable the individual has attained 62 years of age, enrollment period is conditioned upon com- State law. but has not attained 65 years of age. pliance with the conditions of eligibility for such third month. ‘‘(II) COUPLE.—The term ‘couple’ means an ‘‘(B) MEDICARE ELIGIBILITY (BUT FOR AGE).— individual and the individual’s spouse. The individual would be eligible for benefits ‘‘(2) AUTHORITY TO CORRECT FOR GOVERN- MENT ERRORS.—The provisions of section ‘‘(C) AGE ADJUSTMENT FACTOR.—The Sec- under part A or part B for the month if the retary shall specify uniform age categories individual were 65 years of age. 1837(h) apply with respect to enrollment under this part in the same manner as they and maximum rating increments for age ad- ‘‘(C) NOT ELIGIBLE FOR COVERAGE UNDER apply to enrollment under part B. justment factors that reflect the relative ac- GROUP HEALTH PLANS OR FEDERAL HEALTH IN- ‘‘(c) DATE COVERAGE BEGINS.— tuarial costs of benefit packages among en- SURANCE PROGRAMS.—The individual is not ‘‘(1) IN GENERAL.—The period during which rollees. For individuals who have attained eligible for benefits or coverage under a Fed- an individual is entitled to benefits under age 18 but not age 65, the highest age adjust- eral health insurance program (as defined in this part shall begin as follows, but in no ment factor may not exceed 3 times the low- subsection (a)(2)(B)) or under a group health case earlier than July 1, 2002: est age adjustment factor.’’. plan (other than such eligibility merely ‘‘(A) In the case of an individual who en- SEC. 3. TAX DEDUCTION FOR SELF-EMPLOYED. through a Federal or State COBRA continu- rolls (including pre-enrolls) before the month (a) IN GENERAL.—Paragraph (1) of section ation provision) as of the last day of the in which the individual satisfies eligibility 162(l) of the Internal Revenue Code of 1986 is month involved. for enrollment under section 1859, the first amended to read as follows: ‘‘(2) LIMITATION ON ELIGIBILITY IF TERMI- day of such month of eligibility. ‘‘(l) ALLOWANCE OF DEDUCTION.—In the case NATED ENROLLMENT.—If an individual de- ‘‘(B) In the case of an individual who en- of an individual who is an employee within scribed in paragraph (1) enrolls under this rolls during or after the month in which the the meaning of section 401(c)(1), there shall part and coverage of the individual is termi- individual first satisfies eligibility for en- be allowed as a deduction under this section nated under section 1859A(d) (other than be- rollment under such section, the first day of an amount equal to 100 percent of the cause of age), the individual is not again eli- the following month. amount paid during the taxable year for in- gible to enroll under this subsection unless ‘‘(2) AUTHORITY TO PROVIDE FOR PARTIAL surance which constitutes medical care for the following requirements are met: MONTHS OF COVERAGE.—Under regulations, the taxpayer, the taxpayer’s spouse, and tax- ‘‘(A) NEW COVERAGE UNDER GROUP HEALTH the Secretary may, in the Secretary’s discre- payer’s dependents.’’. PLAN OR FEDERAL HEALTH INSURANCE PRO- tion, provide for coverage periods that in- (b) EFFECTIVE DATE.—The amendment GRAM.—After the date of termination of cov- clude portions of a month in order to avoid made by this section shall apply to taxable erage under such section, the individual ob- lapses of coverage. years beginning after December 31, 2004. tains coverage under a group health plan or ‘‘(3) LIMITATION ON PAYMENTS.—No pay- SEC. 4. ACCESS TO MEDICARE BENEFITS FOR IN- under a Federal health insurance program. ments may be made under this title with re- DIVIDUALS 62-TO-65 YEARS OF AGE. ‘‘(B) SUBSEQUENT LOSS OF NEW COVERAGE.— spect to the expenses of an individual en- (a) IN GENERAL.—Title XVIII of the Social The individual subsequently loses eligibility rolled under this part unless such expenses Security Act is amended— for the coverage described in subparagraph were incurred by such individual during a pe- (1) by redesignating section 1859 and part D (A) and exhausts any eligibility the indi- riod which, with respect to the individual, is as section 1858 and part E, respectively; and vidual may subsequently have for coverage a coverage period under this section. (2) by inserting after such section the fol- under a Federal or State COBRA continu- ‘‘(d) TERMINATION OF COVERAGE.— lowing new part: ation provision. ‘‘(1) IN GENERAL.—An individual’s coverage ‘‘PART D—PURCHASE OF MEDICARE BENEFITS ‘‘(3) CHANGE IN HEALTH PLAN ELIGIBILITY period under this part shall continue until BY CERTAIN INDIVIDUALS AGE 62-TO-65 DOES NOT AFFECT COVERAGE.—In the case of the individual’s enrollment has been termi- YEARS OF AGE an individual who is eligible for and enrolls nated at the earliest of the following: ‘‘SEC. 1859. PROGRAM BENEFITS; ELIGIBILITY. under this part under this subsection, the in- ‘‘(A) GENERAL PROVISIONS.— ‘‘(a) ENTITLEMENT TO MEDICARE BENEFITS dividual’s continued entitlement to benefits ‘‘(i) NOTICE.—The individual files notice (in FOR ENROLLED INDIVIDUALS.— under this part shall not be affected by the a form and manner prescribed by the Sec- ‘‘(1) IN GENERAL.—An individual enrolled individual’s subsequent eligibility for bene- retary) that the individual no longer wishes under this part is entitled to the same benefits or coverage described in paragraph to participate in the insurance program fits under this title as an individual entitled (1)(C), or entitlement to such benefits or cov- under this part. to benefits under part A and enrolled under erage. ‘‘(ii) NONPAYMENT OF PREMIUMS.—The indi- part B. ‘‘SEC. 1859A. ENROLLMENT PROCESS; COVERAGE. vidual fails to make payment of premiums ‘‘(2) DEFINITIONS.—For purposes of this ‘‘(a) IN GENERAL.—An individual may en- required for enrollment under this part. part: roll in the program established under this ‘‘(iii) MEDICARE ELIGIBILITY.—The indi- ‘‘(A) FEDERAL OR STATE COBRA CONTINU- part only in such manner and form as may vidual becomes entitled to benefits under ATION PROVISION.—The term ‘Federal or be prescribed by regulations, and only during part A or enrolled under part B (other than State COBRA continuation provision’ has an enrollment period prescribed by the Sec- by reason of this part). the meaning given the term ‘COBRA con- retary consistent with the provisions of this ‘‘(B) TERMINATION BASED ON AGE.—The indi- tinuation provision’ in section 2791(d)(4) of section. Such regulations shall provide a vidual attains 65 years of age. the Public Health Service Act and includes a process under which— ‘‘(2) EFFECTIVE DATE OF TERMINATION.— comparable State program, as determined by ‘‘(1) individuals eligible to enroll as of a ‘‘(A) NOTICE.—The termination of a cov- the Secretary. month are permitted to pre-enroll during a erage period under paragraph (1)(A)(i) shall ‘‘(B) FEDERAL HEALTH INSURANCE PROGRAM prior month within an enrollment period de- take effect at the close of the month fol- DEFINED.—The term ‘Federal health insur- scribed in subsection (b); and lowing for which the notice is filed. ance program’ means any of the following: ‘‘(2) each individual seeking to enroll ‘‘(B) NONPAYMENT OF PREMIUM.—The termi- ‘‘(i) MEDICARE.—Part A or part B of this under section 1859(b) is notified, before en- nation of a coverage period under paragraph title (other than by reason of this part). rolling, of the deferred monthly premium (1)(A)(ii) shall take effect on a date deter- ‘‘(ii) MEDICAID.—A State plan under title amount the individual will be liable for mined under regulations, which may be de- XIX. under section 1859C(b) upon attaining 65 termined so as to provide a grace period in

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00066 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.032 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15657 which overdue premiums may be paid and under section 1859(b). In making such esti- rate determined for the individual under sec- coverage continued. The grace period deter- mate for coverage beginning in a year before tion 1859B(c). mined under the preceding sentence shall not 2006, the Secretary may base such estimate ‘‘(B) SPECIAL RULES FOR THOSE WHO exceed 60 days; except that it may be ex- on the average, per capita amount that DISENROLL EARLY.— tended for an additional 30 days in any case would be payable if the program had been in ‘‘(i) IN GENERAL.—If such an individual’s where the Secretary determines that there operation over a previous period of at least 4 enrollment under such section is terminated was good cause for failure to pay the overdue years. under clause (i) or (ii) of section premiums within such 60-day period. ‘‘(2) DIFFERENCE BETWEEN ESTIMATED EX- 1859A(d)(1)(A), subject to clause (ii), the ‘‘(C) AGE OR MEDICARE ELIGIBILITY.—The PENDITURES AND ESTIMATED PREMIUMS.— amount of the deferred premium otherwise termination of a coverage period under para- Based on the characteristics of individuals in established under this paragraph shall be graph (1)(A)(iii) or (1)(B) shall take effect as such group, the Secretary shall estimate pro-rated to reflect the number of months of of the first day of the month in which the in- during the period of coverage of the group coverage under this part under such enroll- dividual attains 65 years of age or becomes under this part under section 1859(b) the ment compared to the maximum number of entitled to benefits under part A or enrolled amount by which— months of coverage that the individual for benefits under part B (other than by rea- ‘‘(A) the amount estimated under para- would have had if the enrollment were not so son of this part). graph (1); exceeds terminated. ‘‘SEC. 1859B. PREMIUMS. ‘‘(B) the average, annual per capita ‘‘(ii) ROUNDING TO 12-MONTH MINIMUM COV- ERAGE PERIODS.—In applying clause (i), the ‘‘(a) AMOUNT OF MONTHLY PREMIUMS.— amount of premiums that will be payable for number of months of coverage (if not a mul- ‘‘(1) BASE MONTHLY PREMIUMS.—The Sec- months during the year under section tiple of 12) shall be rounded to the next high- retary shall, during September of each year 1859C(a) for individuals in such group (in- est multiple of 12 months, except that in no (beginning with 2001), determine the fol- cluding premiums that would be payable if case shall this clause result in a number of lowing premium rates which shall apply with there were no terminations in enrollment months of coverage exceeding the maximum respect to coverage provided under this title under clause (i) or (ii) of section number of months of coverage that the indi- for any month in the succeeding year: 1859A(d)(1)(A)). vidual would have had if the enrollment were ‘‘(A) BASE MONTHLY PREMIUM FOR INDIVID- ‘‘(3) ACTUARIAL COMPUTATION OF DEFERRED not so terminated. UALS 62 YEARS OF AGE OR OLDER.—A base MONTHLY PREMIUM RATES.—The Secretary ‘‘(2) PERIOD OF PAYMENT.—The period de- monthly premium for individuals 62 years of shall determine deferred monthly premium scribed in this paragraph for an individual is age or older is equal to 1⁄12 of the base annual rates for individuals in such group in a man- the period beginning with the first month in premium rate computed under subsection (b) ner so that— which the individual has attained 65 years of for each premium area. ‘‘(A) the estimated actuarial value of such age and ending with the month before the ‘‘(B) DEFERRED MONTHLY PREMIUMS FOR IN- premiums payable under section 1859C(b), is month in which the individual attains 85 DIVIDUALS 62 YEARS OF AGE OR OLDER.—The equal to years of age. Secretary shall, during September of each ‘‘(B) the estimated actuarial present value ‘‘(3) COLLECTION.—In the case of an indi- year (beginning with 2001), determine under of the differences described in paragraph (2). vidual who is liable for a premium under this subsection (c) the amount of deferred month- Such rate shall be computed for each indi- subsection, the amount of the premium shall ly premiums that shall apply with respect to vidual in the group in a manner so that the be collected in the same manner as the pre- individuals who first obtain coverage under rate is based on the number of months be- mium for enrollment under such part is col- this part under section 1859(b) in the suc- tween the first month of coverage based on lected under section 1840, except that any ceeding year. enrollment under section 1859(b) and the reference in such section to the Federal Sup- ‘‘(3) ESTABLISHMENT OF PREMIUM AREAS.— month in which the individual attains 65 plementary Medical Insurance Trust Fund is For purposes of this part, the term ‘premium years of age. deemed to be a reference to the Medicare area’ means such an area as the Secretary ‘‘(4) DETERMINANTS OF ACTUARIAL PRESENT Early Access Trust Fund established under shall specify to carry out this part. The Sec- VALUES.—The actuarial present values de- section 1859D. retary from time to time may change the scribed in paragraph (3) shall reflect— ‘‘(c) APPLICATION OF CERTAIN PROVISIONS.— boundaries of such premium areas. The Sec- ‘‘(A) the estimated probabilities of survival at ages 62 through 84 for individuals enrolled The provisions of section 1840 (other than retary shall seek to minimize the number of subsection (h)) shall apply to premiums col- such areas specified under this paragraph. during the year; and ‘‘(B) the estimated effective average inter- lected under this section in the same manner ‘‘(b) BASE ANNUAL PREMIUM FOR INDIVID- as they apply to premiums collected under est rates that would be earned on invest- UALS 62 YEARS OF AGE OR OLDER.— part B, except that any reference in such sec- ments held in the trust funds under this title ‘‘(1) NATIONAL, PER CAPITA AVERAGE.—The tion to the Federal Supplementary Medical during the period in question. Secretary shall estimate the average, annual Insurance Trust Fund is deemed a reference per capita amount that would be payable ‘‘SEC. 1859C. PAYMENT OF PREMIUMS. to the Trust Fund established under section under this title with respect to individuals ‘‘(a) PAYMENT OF BASE MONTHLY PRE- 1859D. residing in the United States who meet the MIUM.— ‘‘SEC. 1859D. MEDICARE EARLY ACCESS TRUST requirement of section 1859(b)(1)(A) as if all ‘‘(1) IN GENERAL.—The Secretary shall pro- FUND. such individuals were eligible for (and en- vide for payment and collection of the base ‘‘(a) ESTABLISHMENT OF TRUST FUND.— rolled) under this title during the entire year monthly premium, determined under section ‘‘(1) IN GENERAL.—There is hereby created (and assuming that section 1862(b)(2)(A)(i) 1859B(a)(1) for the age (and age cohort, if ap- on the books of the Treasury of the United did not apply). plicable) of the individual involved and the States a trust fund to be known as the ‘Medi- ‘‘(2) GEOGRAPHIC ADJUSTMENT.—The Sec- premium area in which the individual prin- care Early Access Trust Fund’ (in this secretary shall reduce, as determined appro- cipally resides, in the same manner as for tion referred to as the ‘Trust Fund’). The priate, the amount determined under para- payment of monthly premiums under section Trust Fund shall consist of such gifts and be- graph (1) for a premium area (specified under 1840, except that, for purposes of applying quests as may be made as provided in section subsection (a)(3)) that has costs below the this section, any reference in such section to 201(i)(1) and such amounts as may be depos- national average, in order to assure partici- the Federal Supplementary Medical Insur- ited in, or appropriated to, such fund as pro- pation in all areas throughout the United ance Trust Fund is deemed a reference to the vided in this title. States. Trust Fund established under section 1859D. ‘‘(2) PREMIUMS.—Premiums collected under ‘‘(3) BASE ANNUAL PREMIUM.—The base an- ‘‘(2) PERIOD OF PAYMENT.—In the case of an section 1859B shall be transferred to the nual premium under this subsection for individual who participates in the program Trust Fund. months in a year for individuals 62 years of established by this title, the base monthly ‘‘(b) INCORPORATION OF PROVISIONS.— age or older residing in a premium area is premium shall be payable for the period ‘‘(1) IN GENERAL.—Subject to paragraph (2), equal to the average, annual per capita commencing with the first month of the in- subsections (b) through (i) of section 1841 amount estimated under paragraph (1) for dividual’s coverage period and ending with shall apply with respect to the Trust Fund the year, adjusted for such area under para- the month in which the individual’s coverage and this title in the same manner as they graph (2). under this title terminates. apply with respect to the Federal Supple- ‘‘(c) DEFERRED PREMIUM RATE FOR INDIVID- ‘‘(b) PAYMENT OF DEFERRED PREMIUM FOR mentary Medical Insurance Trust Fund and UALS 62 YEARS OF AGE OR OLDER.—The de- INDIVIDUALS COVERED AFTER ATTAINING AGE part B, respectively. ferred premium rate for individuals with a 62.— ‘‘(2) MISCELLANEOUS REFERENCES.—In ap- group of individuals who obtain coverage ‘‘(1) RATE OF PAYMENT.— plying provisions of section 1841 under para- under section 1859(b) in a year shall be com- ‘‘(A) IN GENERAL.—In the case of an indi- graph (1)— puted by the Secretary as follows: vidual who is covered under this part for a ‘‘(A) any reference in such section to ‘this ‘‘(1) ESTIMATION OF NATIONAL, PER CAPITA month pursuant to an enrollment under sec- part’ is construed to refer to this part D; ANNUAL AVERAGE EXPENDITURES FOR ENROLL- tion 1859(b), subject to subparagraph (B), the ‘‘(B) any reference in section 1841(h) to sec- MENT GROUP.—The Secretary shall estimate individual is liable for payment of a deferred tion 1840(d) and in section 1841(i) to sections the average, per capita annual amount that premium in each month during the period 1840(b)(1) and 1842(g) are deemed references will be paid under this part for individuals in described in paragraph (2) in an amount to comparable authority exercised under this such group during the period of enrollment equal to the full deferred monthly premium part; and

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00067 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.032 S23PT1 S15658 CONGRESSIONAL RECORD — SENATE November 23, 2003 ‘‘(C) payments may be made under section (E) in section 1853(a)(1)(A) (42 U.S.C. 1395w– clause (ii), the aggregate of the periods of 1841(g) to the trust funds under sections 1817 23(a)(1)(A)), by striking ‘‘1859(e)(4)’’ and in- creditable coverage (as determined under and 1841 as reimbursement to such funds for serting ‘‘1858(e)(4)’’; and section 2701(c) of the Public Health Service payments they made for benefits provided (F) in section 1853(a)(3)(D) (42 U.S.C. 1395w– Act) is 12 months or longer. under this part. 23(a)(3)(D)), by striking ‘‘1859(e)(4)’’ and in- ‘‘(D) EXHAUSTION OF AVAILABLE COBRA CON- ‘‘SEC. 1859E. OVERSIGHT AND ACCOUNTABILITY. serting ‘‘1858(e)(4)’’. TINUATION BENEFITS.— ‘‘(a) THROUGH ANNUAL REPORTS OF TRUST- (5) Section 1853(c) of such Act (42 U.S.C. ‘‘(i) IN GENERAL.—In the case of an indi- EES.—The Board of Trustees of the Medicare 1395w–23(c)) is amended— vidual described in clause (ii) for a month de- Early Access Trust Fund under section (A) in paragraph (1), by striking ‘‘and (7)’’ scribed in clause (iii)— 1859D(b)(1) shall report on an annual basis to and inserting ‘‘, (7), and (8)’’, and ‘‘(I) the individual (or spouse) elected cov- Congress concerning the status of the Trust (B) by adding at the end the following: erage described in clause (ii); and Fund and the need for adjustments in the ‘‘(8) ADJUSTMENT FOR EARLY ACCESS.—In ‘‘(II) the individual (or spouse) has contin- program under this part to maintain finan- applying this subsection with respect to indi- ued such coverage for all months described cial solvency of the program under this part. viduals entitled to benefits under part D, the in clause (iii) in which the individual (or ‘‘(b) PERIODIC GAO REPORTS.—The Comp- Secretary shall provide for an appropriate spouse) is eligible for such coverage. troller General of the United States shall pe- adjustment in the Medicare+Choice capita- ‘‘(ii) INDIVIDUALS TO WHOM COBRA CONTINU- riodically submit to Congress reports on the tion rate as may be appropriate to reflect ATION COVERAGE MADE AVAILABLE.—An indi- adequacy of the financing of coverage pro- differences between the population served vidual described in this clause is an indi- vided under this part. The Comptroller Gen- under such part and the population under vidual— eral shall include in such report such rec- parts A and B.’’. ‘‘(I) who was offered coverage under a Fed- ommendations for adjustments in such fi- (c) OTHER CONFORMING AMENDMENTS.— eral or State COBRA continuation provision nancing and coverage as the Comptroller (1) Section 138(b)(4) of the Internal Rev- at the time of loss of coverage eligibility de- General deems appropriate in order to main- enue Code of 1986 is amended by striking scribed in subparagraph (C)(ii); or tain financial solvency of the program under ‘‘1859(b)(3)’’ and inserting ‘‘1858(b)(3)’’. ‘‘(II) whose spouse was offered such cov- this part. (2)(A) Section 602(2)(D)(ii) of the Employee erage in a manner that permitted coverage ‘‘SEC. 1859F. ADMINISTRATION AND MISCELLA- Retirement Income Security Act of 1974 (29 of the individual at such time. NEOUS. U.S.C. 1162(2)) is amended by inserting ‘‘(not ‘‘(iii) MONTHS OF POSSIBLE COBRA CONTINU- ‘‘(a) TREATMENT FOR PURPOSES OF THIS including an individual who is so entitled ATION COVERAGE.—A month described in this TITLE.—Except as otherwise provided in this pursuant to enrollment under section clause is a month for which an individual depart— 1859A)’’ after ‘‘Social Security Act’’. scribed in clause (ii) could have had coverage ‘‘(1) an individual enrolled under this part (B) Section 2202(2)(D)(ii) of the Public described in such clause as of the last day of shall be treated for purposes of this title as Health Service Act (42 U.S.C. 300bb– the month if the individual (or the spouse of though the individual was entitled to bene- 2(2)(D)(ii)) is amended by inserting ‘‘(not in- the individual, as the case may be) had elect- fits under part A and enrolled under part B; cluding an individual who is so entitled pur- ed such coverage on a timely basis. and suant to enrollment under section 1859A)’’ ‘‘(E) NOT ELIGIBLE FOR COVERAGE UNDER ‘‘(2) benefits described in section 1859 shall after ‘‘Social Security Act’’. FEDERAL HEALTH INSURANCE PROGRAM OR be payable under this title to such an indi- (C) Section 4980B(f)(2)(B)(i)(V) of the Inter- GROUP HEALTH PLANS.—The individual is not vidual in the same manner as if such indi- nal Revenue Code of 1986 is amended by ineligible for benefits or coverage under a Fed- vidual was so entitled and enrolled. serting ‘‘(not including an individual who is eral health insurance program or under a ‘‘(b) NOT TREATED AS MEDICARE PROGRAM so entitled pursuant to enrollment under group health plan (whether on the basis of FOR PURPOSES OF MEDICAID PROGRAM.—For section 1859A)’’ after ‘‘Social Security Act’’. the individual’s employment or employment purposes of applying title XIX (including the SEC. 5. ACCESS TO MEDICARE BENEFITS FOR of the individual’s spouse) as of the last day provision of medicare cost-sharing assist- of the month involved. ance under such title), an individual who is DISPLACED WORKERS 55-TO-62 YEARS OF AGE. ‘‘(2) SPOUSE OF DISPLACED WORKER.—Sub- enrolled under this part shall not be treated (a) ELIGIBILITY.—Section 1859 of the Social ject to paragraph (3), an individual who as being entitled to benefits under this title. Security Act, as inserted by section 4(a)(2), meets the following requirements with re- ‘‘(c) NOT TREATED AS MEDICARE PROGRAM is amended by adding at the end the fol- spect to a month is eligible to enroll under FOR PURPOSES OF COBRA CONTINUATION PRO- lowing new subsection: this part with respect to such month: VISIONS.—In applying a COBRA continuation ‘‘(c) DISPLACED WORKERS AND SPOUSES.— provision (as defined in section 2791(d)(4) of ‘‘(A) AGE.—As of the last day of the month, ‘‘(1) DISPLACED WORKERS.—Subject to para- the Public Health Service Act), any ref- the individual has not attained 62 years of graph (3), an individual who meets the fol- erence to an entitlement to benefits under age. lowing requirements with respect to a month this title shall not be construed to include ‘‘(B) MARRIED TO DISPLACED WORKER.—The is eligible to enroll under this part with re- entitlement to benefits under this title pur- individual is the spouse of an individual at suant to the operation of this part.’’. spect to such month: the time the individual enrolls under this (b) CONFORMING AMENDMENTS TO SOCIAL SE- ‘‘(A) AGE.—As of the last day of the month, part under paragraph (1) and loses coverage CURITY ACT PROVISIONS.— the individual has attained 55 years of age, described in paragraph (1)(C)(ii) because the (1) Section 201(i)(1) of the Social Security but has not attained 62 years of age. individual’s spouse lost such coverage. Act (42 U.S.C. 401(i)(1)) is amended by strik- ‘‘(B) MEDICARE ELIGIBILITY (BUT FOR AGE).— ‘‘(C) MEDICARE ELIGIBILITY (BUT FOR AGE); ing ‘‘or the Federal Supplementary Medical The individual would be eligible for benefits EXHAUSTION OF ANY COBRA CONTINUATION COV- Insurance Trust Fund’’ and inserting ‘‘the under part A or B for the month if the indi- ERAGE; AND NOT ELIGIBLE FOR COVERAGE Federal Supplementary Medical Insurance vidual were 65 years of age. UNDER FEDERAL HEALTH INSURANCE PROGRAM Trust Fund, and the Medicare Early Access ‘‘(C) LOSS OF EMPLOYMENT-BASED COV- OR GROUP HEALTH PLAN.—The individual Trust Fund’’. ERAGE.— meets the requirements of subparagraphs (2) Section 201(g)(1)(A) of such Act (42 ‘‘(i) ELIGIBLE FOR UNEMPLOYMENT COM- (B), (D), and (E) of paragraph (1). U.S.C. 401(g)(1)(A)) is amended by striking PENSATION.—The individual meets the re- ‘‘(3) CHANGE IN HEALTH PLAN ELIGIBILITY AF- ‘‘and the Federal Supplementary Medical In- quirements relating to period of covered em- FECTS CONTINUED ELIGIBILITY.—For provision surance Trust Fund established by title ployment and conditions of separation from that terminates enrollment under this sec- XVIII’’ and inserting ‘‘, the Federal Supple- employment to be eligible for unemployment tion in the case of an individual who be- mentary Medical Insurance Trust Fund, and compensation (as defined in section 85(b) of comes eligible for coverage under a group the Medicare Early Access Trust Fund estab- the Internal Revenue Code of 1986), based on health plan or under a Federal health insur- lished by title XVIII’’. a separation from employment occurring on ance program, see section 1859A(d)(1)(C). (3) Section 1820(i) of such Act (42 U.S.C. or after January 1, 2001. The previous sen- ‘‘(4) REENROLLMENT PERMITTED.—Nothing 1395i–4(i)) is amended by striking ‘‘part D’’ tence shall not be construed as requiring the in this subsection shall be construed as pre- and inserting ‘‘part E’’. individual to be receiving such unemploy- venting an individual who, after enrolling (4) Part C of title XVIII of such Act is ment compensation. under this subsection, terminates such en- amended— ‘‘(ii) LOSS OF EMPLOYMENT-BASED COV- rollment from subsequently reenrolling (A) in section 1851(a)(2)(B) (42 U.S.C. 1395w– ERAGE.—Immediately before the time of such under this subsection if the individual is eli- 21(a)(2)(B)), by striking ‘‘1859(b)(3)’’ and in- separation of employment, the individual gible to enroll under this subsection at that serting ‘‘1858(b)(3)’’; was covered under a group health plan on the time.’’. (B) in section 1851(a)(2)(C) (42 U.S.C. 1395w– basis of such employment, and, because of (b) ENROLLMENT.—Section 1859A of such 21(a)(2)(C)), by striking ‘‘1859(b)(2)’’ and in- such loss, is no longer eligible for coverage Act, as so inserted, is amended— serting ‘‘1858(b)(2)’’; under such plan (including such eligibility (1) in subsection (a), by striking ‘‘and’’ at (C) in section 1852(a)(1) (42 U.S.C. 1395w– based on the application of a Federal or the end of paragraph (1), by striking the pe- 22(a)(1)), by striking ‘‘1859(b)(3)’’ and insert- State COBRA continuation provision) as of riod at the end of paragraph (2) and inserting ing ‘‘1858(b)(3)’’; the last day of the month involved. ‘‘; and’’, and by adding at the end the fol- (D) in section 1852(a)(3)(B)(ii) (42 U.S.C. ‘‘(iii) PREVIOUS CREDITABLE COVERAGE FOR lowing new paragraph: 1395w–22(a)(3)(B)(ii)), by striking AT LEAST 1 YEAR.—As of the date on which ‘‘(3) individuals whose coverage under this ‘‘1859(b)(2)(B)’’ and inserting ‘‘1858(b)(2)(B)’’; the individual loses coverage described in part would terminate because of subsection

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00068 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.032 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15659

(d)(1)(B)(ii) are provided notice and an oppor- ‘‘(1) NATIONAL, PER CAPITA AVERAGE FOR ‘‘(c) The Office shall prescribe regulations tunity to continue enrollment in accordance AGE GROUPS.— to apply the provisions of this chapter to the with section 1859E(c)(1).’’; ‘‘(A) ESTIMATE OF AMOUNT.—The Secretary greatest extent practicable to eligible indi- (2) in subsection (b), by inserting after Not- shall estimate the average, annual per capita viduals covered under this section. withstanding any other provision of law, (1) amount that would be payable under this ‘‘(c) In no event shall the enactment of this the following: title with respect to individuals residing in section result in— ‘‘(2) DISPLACED WORKERS AND SPOUSES.—In the United States who meet the requirement ‘‘(1) any increase in the level of individual the case of individuals eligible to enroll of section 1859(c)(1)(A) within each of the age or Government contributions required under under this part under section 1859(c), the fol- cohorts established under subparagraph (B) this chapter, including copayments or lowing rules apply: as if all such individuals within such cohort deductibles; ‘‘(A) INITIAL ENROLLMENT PERIOD.—If the were eligible for (and enrolled) under this ‘‘(2) any decrease in the types of benefits individual is first eligible to enroll under title during the entire year (and assuming offered under this chapter; or such section for July 2005, the enrollment pe- that section 1862(b)(2)(A)(i) did not apply). ‘‘(3) any other change that would adversely riod shall begin on May 1, 2002, and shall end ‘‘(B) AGE COHORTS.—For purposes of sub- affect the coverage afforded under this chap- on August 31, 2002. Any such enrollment be- paragraph (A), the Secretary shall establish ter to employees and annuitants and mem- fore July 1, 2002, is conditioned upon compli- separate age cohorts in 5-year age incre- bers of family under this chapter. ance with the conditions of eligibility for ments for individuals who have not attained ‘‘(d) The Office shall develop methods to July 2002. 60 years of age and a separate cohort for in- facilitate enrollment under this section, in- ‘‘(B) SUBSEQUENT PERIODS.—If the indi- dividuals who have attained 60 years of age. cluding the use of the Internet. vidual is eligible to enroll under such section ‘‘(2) GEOGRAPHIC ADJUSTMENT.—The Sec- ‘‘(e) The Office may enter into contracts for a month after July 2002, the enrollment retary shall adjust the amount determined for the performance of appropriate adminis- period based on such eligibility shall begin under paragraph (1)(A) for each premium trative functions under this chapter. on the first day of the second month before area (specified under subsection (a)(3)) in the ‘‘(f) Each contract entered into under sec- the month in which the individual first is el- same manner and to the same extent as the tion 8902 shall require a carrier to offer to eligible to so enroll (or reenroll) and shall end Secretary provides for adjustments under igible individuals under this chapter, 4 months later.’’; subsection (b)(2). throughout each term for which the contract (3) in subsection (d)(1), by amending sub- ‘‘(3) BASE ANNUAL PREMIUM.—The base an- remains effective, the same benefits (subject paragraph (B) to read as follows: nual premium under this subsection for to the same maximums, limitations, exclu- ‘‘(B) TERMINATION BASED ON AGE.— months in a year for individuals in an age sions, and other similar terms or conditions) ‘‘(i) AT AGE 65.—Subject to clause (ii), the cohort under paragraph (1)(B) in a premium as would be offered under such contract or individual attains 65 years of age. area is equal to 165 percent of the average, applicable health benefits plan to employees, ‘‘(ii) AT AGE 62 FOR DISPLACED WORKERS AND annual per capita amount estimated under annuitants, and members of family. SPOUSES.—In the case of an individual en- paragraph (1) for the age cohort and year, ad- ‘‘(g)(1) The Office may waive the require- rolled under this part pursuant to section justed for such area under paragraph (2). ments of this section, if the Office deter- 1859(c), subject to subsection (a)(1), the indi- ‘‘(4) PRO-RATION OF PREMIUMS TO REFLECT mines, based on a petition submitted by a vidual attains 62 years of age.’’; COVERAGE DURING A PART OF A MONTH.—If the carrier that— (4) in subsection (d)(1), by adding at the Secretary provides for coverage of portions ‘‘(A) the carrier is unable to offer the ap- end the following new subparagraph: of a month under section 1859A(c)(2), the Sec- plicable health benefits plan because of a ‘‘(C) OBTAINING ACCESS TO EMPLOYMENT- retary shall pro-rate the premiums attrib- limitation in the capacity of the plan to de- BASED COVERAGE OR FEDERAL HEALTH INSUR- utable to such coverage under this section to liver services or assure financial solvency; ANCE PROGRAM FOR INDIVIDUALS UNDER 62 reflect the portion of the month so cov- ‘‘(B) the applicable health benefits plan is YEARS OF AGE.—In the case of an individual ered.’’. not sponsored by a carrier licensed under ap- who has not attained 62 years of age, the in- (d) ADMINISTRATIVE PROVISIONS.—Section plicable State law; or dividual is covered (or eligible for coverage) 1859F of such Act, as so inserted, is amended ‘‘(C) bona fide enrollment restrictions as a participant or beneficiary under a group by adding at the end the following: make the application of this chapter inap- health plan or under a Federal health insur- ‘‘(d) ADDITIONAL ADMINISTRATIVE PROVI- propriate, including restrictions common to ance program.’’; SIONS.— plans which are limited to individuals hav- (5) in subsection (d)(2), by amending sub- ‘‘(1) PROCESS FOR CONTINUED ENROLLMENT ing a past or current employment relation- paragraph (C) to read as follows: OF DISPLACED WORKERS WHO ATTAIN 62 YEARS ship with a particular agency or other au- ‘‘(C) AGE OR MEDICARE ELIGIBILITY.— OF AGE.—The Secretary shall provide a proc- thority of the Government. ‘‘(i) IN GENERAL.—The termination of a ess for the continuation of enrollment of in- ‘‘(2) The Office may require a petition coverage period under paragraph (1)(A)(iii) or dividuals whose enrollment under section under this subsection to include— (1)(B)(i) shall take effect as of the first day 1859(c) would be terminated upon attaining ‘‘(A) a description of the efforts the carrier of the month in which the individual attains 62 years of age. Under such process such indi- proposes to take in order to offer the appli- 65 years of age or becomes entitled to bene- viduals shall be provided appropriate and cable health benefits plan under this chap- fits under part A or enrolled for benefits timely notice before the date of such termi- ter; and under part B. nation and of the requirement to enroll ‘‘(B) the proposed date for offering such a ‘‘(ii) DISPLACED WORKERS.—The termi- under this part pursuant to section 1859(b) in health benefits plan. nation of a coverage period under paragraph order to continue entitlement to benefits ‘‘(3) A waiver under this section may be for (1)(B)(ii) shall take effect as of the first day under this title after attaining 62 years of any period determined by the Office. The Of- of the month in which the individual attains age. fice may grant subsequent waivers under 62 years of age, unless the individual has en- ‘‘(2) ARRANGEMENTS WITH STATES FOR DE- this section. rolled under this part pursuant to section TERMINATIONS RELATING TO UNEMPLOYMENT ‘‘(h) The Office shall provide for the imple- 1859(b) and section 1859E(c)(1).’’; and COMPENSATION ELIGIBILITY.—The Secretary mentation of procedures to provide for an (6) in subsection (d)(2), by adding at the may provide for appropriate arrangements annual open enrollment period during which end the following new subparagraph: with States for the determination of whether eligible individuals may enroll with a plan or ‘‘(D) ACCESS TO COVERAGE.—The termi- individuals in the State meet or would meet contract for coverage under this section. nation of a coverage period under paragraph the requirements of section 1859(c)(1)(C)(i).’’. ‘‘(i) Except as the Office may by regulation (1)(C) shall take effect on the date on which (e) CONFORMING AMENDMENT TO HEADING TO prescribe, any reference to this chapter (or the individual is eligible to begin a period of PART.—The heading of part D of title XVIII any requirement of this chapter), made in creditable coverage (as defined in section of the Social Security Act, as so inserted, is any provision of law, shall not be considered 2701(c) of the Public Health Service Act) amended by striking ‘‘62’’ and inserting ‘‘55’’. to include this section (or any requirement under a group health plan or under a Federal SEC. 6. PROVISIONS TO MAKE FEHBP COVERAGE of this section). health insurance program.’’. AVAILABLE FOR THE SELF-EM- ‘‘(j) This section shall take effect on the (c) PREMIUMS.—Section 1859B of such Act, PLOYED. date of enactment of this section and shall as so inserted, is amended— Chapter 89 of title 5, United States Code, is apply to contracts that take effect with re- (1) in subsection (a)(1), by adding at the amended by adding at the end the following: spect to calendar year 2002 and each calendar end the following: ‘‘§ 8915. Expanded access to coverage for the year thereafter.’’. ‘‘(B) BASE MONTHLY PREMIUM FOR INDIVID- self-employed SEC. 7. MEDIKIDS HEALTH INSURANCE. UALS UNDER 62 YEARS OF AGE .—A base month- ‘‘(a) The Office of Personnel Management (a) BENEFITS FOR ALL CHILDREN BORN ly premium for individuals under 62 years of (referred to in this section as the ‘Office’) AFTER 2002.— 1 age, equal to ⁄12 of the base annual premium shall administer a health insurance program (1) IN GENERAL.—The Social Security Act is rate computed under subsection (d)(3) for for eligible individuals who are non-Federal amended by adding at the end the following: each premium area and age cohort.’’; and employees in accordance with this section. (2) by adding at the end the following new ‘‘(b) The term ‘eligible individual’ means a ‘‘TITLE XXII—MEDIKIDS PROGRAM subsection: self-employed individual as defined in sec- ‘‘SEC. 2201. ELIGIBILITY. ‘‘(d) BASE MONTHLY PREMIUM FOR INDIVID- tion 401(c)(1) of the Internal Revenue Code of ‘‘(a) ELIGIBILITY OF INDIVIDUALS BORN UALS UNDER 62 YEARS OF AGE.— 1986. AFTER DECEMBER 31, 2002; ALL CHILDREN

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00069 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.033 S23PT1 S15660 CONGRESSIONAL RECORD — SENATE November 23, 2003

UNDER 23 YEARS OF AGE IN SIXTH YEAR.—An clude portions of a month in order to avoid ‘‘(4) COST-SHARING.— individual who meets the following require- lapses of coverage. ‘‘(A) IN GENERAL.—Subject to subparagraph ments with respect to a month is eligible to ‘‘(3) LIMITATION ON PAYMENTS.—No pay- (B), such benefits also shall include the cost- enroll under this title with respect to such ments may be made under this title with re- sharing (in the form of deductibles, coinsur- month: spect to the expenses of an individual en- ance, and copayments) applicable under title ‘‘(1) AGE.— rolled under this title unless such expenses XVIII with respect to comparable items and ‘‘(A) FIRST YEAR.—During the first year in were incurred by such individual during a pe- services, except that no cost-sharing shall be which this title is effective, the individual riod which, with respect to the individual, is imposed with respect to early and periodic has not attained 6 years of age. a coverage period under this section. screening and diagnostic services included ‘‘(B) SECOND YEAR.—During the second year ‘‘(d) EXPIRATION OF ELIGIBILITY.—An indi- under paragraph (2). in which this title is effective, the individual vidual’s coverage period under this part shall ‘‘(B) NO COST-SHARING FOR LOWEST INCOME has not attained 11 years of age. continue until the individual’s enrollment CHILDREN.—Such benefits shall not include ‘‘(C) THIRD YEAR.—During the third year in has been terminated because the individual any cost-sharing for children in families the which this title is effective, the individual no longer meets the requirements of sub- income of which (as determined for purposes has not attained 16 years of age. section (a) (whether because of age or change of section 1905(p)) does not exceed 150 percent ‘‘(D) FOURTH YEAR.—During the fourth in immigration status). of the official income poverty line (referred year in which this title is effective, the indi- ‘‘(e) ENTITLEMENT TO MEDIKIDS BENEFITS to in such section) applicable to a family of vidual has not attained 21 years of age. FOR ENROLLED INDIVIDUALS.—An individual the size involved. ‘‘(E) FIFTH AND SUBSEQUENT YEARS.—Dur- enrolled under this section is entitled to the ‘‘(C) REFUNDABLE CREDIT FOR COST-SHARING ing the fifth year in which this title is effec- benefits described in section 2202. FOR OTHER LOW-INCOME CHILDREN.—For a re- tive and each subsequent year, the individual ‘‘(f) LOW-INCOME INFORMATION.—At the fundable credit for cost-sharing in the case has not attained 23 years of age. time of enrollment of a child under this title, of children in certain families, see section 35 the Secretary shall make an inquiry as to ‘‘(2) CITIZENSHIP.—The individual is a cit- of the Internal Revenue Code of 1986. whether or not the family income of the fam- izen or national of the United States or is ‘‘(c) PAYMENT SCHEDULE.—The Secretary, ily that includes the child is less than 150 permanently residing in the United States with the assistance of the Medicare Payment percent of the poverty line for a family of under color of law. Advisory Commission, shall develop and im- the size involved. If the family income is ‘‘(b) ENROLLMENT PROCESS.—An individual plement a payment schedule for benefits cov- below such level, the Secretary shall encode may enroll in the program established under ered under this title. To the extent feasible, in the identification card issued in connec- this title only in such manner and form as such payment schedule shall be consistent tion with eligibility under this title a code may be prescribed by regulations, and only with comparable payment schedules and re- indicating such fact. The Secretary also during an enrollment period prescribed by imbursement methodologies applied under shall provide for a toll-free telephone line at the Secretary consistent with the provisions parts A and B of title XVIII. which providers can verify whether or not of this section. Such regulations shall pro- ‘‘(d) INPUT.—The Secretary shall specify such a child is in a family the income of such benefits and payment schedules only vide a process under which— which is below such level. ‘‘(1) individuals who are born in the United after obtaining input from appropriate child ‘‘(g) CONSTRUCTION.—Nothing in this title health providers and experts. States after December 31, 2002, are deemed to shall be construed as requiring (or pre- ‘‘(e) ENROLLMENT IN HEALTH PLANS.—The be enrolled at the time of birth and a parent venting) an individual who is enrolled under Secretary shall provide for the offering of or guardian of such an individual is per- this section from seeking medical assistance benefits under this title through enrollment mitted to pre-enroll in the month prior to under a State medicaid plan under title XIX in a health benefit plan that meets the same the expected month of birth; or child health assistance under a State (or similar) requirements as the require- ‘‘(2) individuals who are born outside the child health plan under title XXI. ments that apply to Medicare+Choice plans United States after such date and who be- ‘‘SEC. 2202. BENEFITS. under part C of title XVIII. In the case of income eligible to enroll by virtue of immigra- ‘‘(a) SECRETARIAL SPECIFICATION OF BEN- dividuals enrolled under this title in such a tion into (or an adjustment of immigration EFIT PACKAGE.— plan, the Medicare+Choice capitation rate status in) the United States are deemed en- ‘‘(1) IN GENERAL.—The Secretary shall described in section 1853(c) shall be adjusted rolled at the time of entry or adjustment of specify the benefits to be made available in an appropriate manner to reflect dif- status; under this title consistent with the provi- ferences between the population served ‘‘(3) eligible individuals may otherwise be sions of this section and in a manner de- under this title and the population under enrolled at such other times and manner as signed to meet the health needs of enrollees. title XVIII. the Secretary shall specify, including the use ‘‘(2) UPDATING.—The Secretary shall up- ‘‘SEC. 2203. PREMIUMS. of outstationed eligibility sites as described date the specification of benefits over time ‘‘(a) AMOUNT OF MONTHLY PREMIUMS.— in section 1902(a)(55)(A) and the use of pre- to ensure the inclusion of age-appropriate ‘‘(1) IN GENERAL.—The Secretary shall, dur- sumptive eligibility provisions like those de- benefits to reflect the enrollee population. ing September of each year (beginning with scribed in section 1920A; and ‘‘(3) ANNUAL UPDATING.—The Secretary 2002), establish a monthly MediKids pre- ‘‘(4) at the time of automatic enrollment of shall establish procedures for the annual re- mium. Subject to paragraph (2), the monthly a child, the Secretary provides for issuance view and updating of such benefits to ac- MediKids premium for a year is equal to 1⁄12 to a parent or custodian of the individual a count for changes in medical practice, new of the annual premium rate computed under card evidencing coverage under this title and information from medical research, and subsection (b). for a description of such coverage. other relevant developments in health ‘‘(2) ELIMINATION OF MONTHLY PREMIUM FOR The provisions of section 1837(h) apply with science. DEMONSTRATION OF EQUIVALENT COVERAGE (IN- respect to enrollment under this title in the ‘‘(4) INPUT.—The Secretary shall seek the CLUDING COVERAGE UNDER LOW-INCOME PRO- same manner as they apply to enrollment input of the pediatric community in speci- GRAMS).—The amount of the monthly pre- under part B of title XVIII. fying and updating such benefits. mium imposed under this section for an indi- ‘‘(c) DATE COVERAGE BEGINS.— ‘‘(5) LIMITATION ON UPDATING.—In no case vidual for a month shall be zero in the case ‘‘(1) IN GENERAL.—The period during which shall updating of benefits under this sub- of an individual who demonstrates to the an individual is entitled to benefits under section result in a failure to provide benefits satisfaction of the Secretary that the indi- this title shall begin as follows, but in no required under subsection (b). vidual has basic health insurance coverage case earlier than January 1, 2003: ‘‘(b) INCLUSION OF CERTAIN BENEFITS.— for that month. For purposes of the previous ‘‘(A) In the case of an individual who is en- ‘‘(1) MEDICARE CORE BENEFITS.—Such bene- sentence enrollment in a medicaid plan rolled under paragraph (1) or (2) of sub- fits shall include (to the extent consistent under title XIX, a State child health insur- section (b), the date of birth or date of ob- with other provisions of this section) at least ance plan under title XXI, or under the medi- taining appropriate citizenship or immigra- the same benefits (including coverage, ac- care program under title XVIII is deemed to tion status, as the case may be. cess, availability, duration, and beneficiary constitute basic health insurance coverage ‘‘(B) In the case of an another individual rights) that are available under parts A and described in such sentence. who enrolls (including pre-enrolls) before the B of title XVIII. ‘‘(b) ANNUAL PREMIUM.— month in which the individual satisfies eligi- ‘‘(2) ALL REQUIRED MEDICAID BENEFITS.— ‘‘(1) NATIONAL, PER CAPITA AVERAGE.—The bility for enrollment under subsection (a), Such benefits shall also include all items and Secretary shall estimate the average, annual the first day of such month of eligibility. services for which medical assistance is re- per capita amount that would be payable ‘‘(C) In the case of an another individual quired to be provided under section under this title with respect to individuals who enrolls during or after the month in 1902(a)(10)(A) to individuals described in such residing in the United States who meet the which the individual first satisfies eligibility section, including early and periodic screen- requirement of section 2201(a)(1) as if all for enrollment under such subsection, the ing, diagnostic services, and treatment serv- such individuals were eligible for (and en- first day of the following month. ices. rolled) under this title during the entire year ‘‘(2) AUTHORITY TO PROVIDE FOR PARTIAL ‘‘(3) INCLUSION OF PRESCRIPTION DRUGS.— (and assuming that section 1862(b)(2)(A)(i) MONTHS OF COVERAGE.—Under regulations, Such benefits also shall include (as specified did not apply). the Secretary may, in the Secretary’s discre- by the Secretary) prescription drugs and ‘‘(2) ANNUAL PREMIUM.—Subject to sub- tion, provide for coverage periods that in- biologicals. section (d), the annual premium under this

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00070 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.033 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15661 subsection for months in a year is equal to 25 eral shall include in such report such rec- (b)(1), except as otherwise provided in this percent of the average, annual per capita ommendations for adjustments in such fi- section, enrolled individuals shall receive amount estimated under paragraph (1) for nancing and coverage as the Comptroller services described in section 1905(t)(1) and the year. General deems appropriate in order to main- may receive additional items and services as ‘‘(c) PAYMENT OF MONTHLY PREMIUM.— tain financial solvency of the program under described in subparagraph (B). ‘‘(1) PERIOD OF PAYMENT.—In the case of an this title. ‘‘(B) ADDITIONAL BENEFITS.—The Secretary individual who participates in the program ‘‘SEC. 2206. INCLUSION OF CARE COORDINATION may specify additional benefits for which established by this title, subject to sub- SERVICES. payment would not otherwise be made under section (d), the monthly premium shall be ‘‘(a) IN GENERAL.— this title that may be available to individ- payable for the period commencing with the ‘‘(1) PROGRAM AUTHORITY.—The Secretary, uals enrolled in the program under this sec- first month of the individual’s coverage pe- beginning in 2003, may implement a care co- tion (subject to an assessment by the care riod and ending with the month in which the ordination services program in accordance coordinator of an individual’s circumstance individual’s coverage under this title termi- with the provisions of this section under and need for such benefits) in order to en- nates. which, in appropriate circumstances, eligible courage enrollment in, or to improve the ef- ‘‘(2) COLLECTION THROUGH TAX RETURN.— individuals may elect to have health care fectiveness of, such program. For provisions providing for the payment of services covered under this title managed ‘‘(2) CARE COORDINATION REQUIREMENT.— monthly premiums under this subsection, and coordinated by a designated care coordi- Notwithstanding any other provision of this see section 59B of the Internal Revenue Code nator. title, the Secretary may provide that an in- of 1986. ‘‘(2) ADMINISTRATION BY CONTRACT.—The dividual enrolled in the program under this ‘‘(3) PROTECTIONS AGAINST FRAUD AND Secretary may administer the program section may be entitled to payment under ABUSE.—The Secretary shall develop, in co- under this section through a contract with this title for any specified health care items ordination with States and other health in- an appropriate program administrator. or services only if the items or services have surance issuers, administrative systems to ‘‘(3) COVERAGE.—Care coordination services been furnished by the care coordinator, or ensure that claims which are submitted to furnished in accordance with this section coordinated through the care coordination more than one payor are coordinated and du- shall be treated under this title as if they services program. Under such provision, the plicate payments are not made. were included in the definition of medical Secretary shall prescribe exceptions for ‘‘(d) REDUCTION IN PREMIUM FOR CERTAIN and other health services under section emergency medical services as described in LOW-INCOME FAMILIES.—For provisions re- 1861(s) and benefits shall be available under section 1852(d)(3), and other exceptions deter- ducing the premium under this section for this title with respect to such services with- mined by the Secretary for the delivery of certain low-income families, see section out the application of any deductible or coin- timely and needed care. 59B(c) of the Internal Revenue Code of 1986. surance. ‘‘(e) CARE COORDINATORS.— ‘‘(b) ELIGIBILITY CRITERIA; IDENTIFICATION ‘‘(1) CONDITIONS OF PARTICIPATION.—In ‘‘SEC. 2204. MEDIKIDS TRUST FUND. AND NOTIFICATION OF ELIGIBLE INDIVIDUALS.— order to be qualified to furnish care coordi- ‘‘(a) ESTABLISHMENT OF TRUST FUND.— ‘‘(1) INDIVIDUAL ELIGIBILITY CRITERIA.—The nation services under this section, an indi- ‘‘(1) IN GENERAL.—There is hereby created Secretary shall specify criteria to be used in vidual or entity shall— on the books of the Treasury of the United making a determination as to whether an in- ‘‘(A) be a health care professional or entity States a trust fund to be known as the dividual may appropriately be enrolled in (which may include physicians, physician ‘MediKids Trust Fund’ (in this section re- the care coordination services program group practices, or other health care profes- ferred to as the ‘Trust Fund’). The Trust under this section, which shall include at sionals or entities the Secretary may find Fund shall consist of such gifts and bequests least a finding by the Secretary that for co- appropriate) meeting such conditions as the as may be made as provided in section horts of individuals with characteristics Secretary may specify; 201(i)(1) and such amounts as may be depos- identified by the Secretary, professional ‘‘(B) have entered into a care coordination ited in, or appropriated to, such fund as pro- management and coordination of care can agreement; and vided in this title. reasonably be expected to improve processes ‘‘(C) meet such criteria as the Secretary ‘‘(2) PREMIUMS.—Premiums collected under or outcomes of health care and to reduce ag- may establish (which may include experience section 2203 shall be transferred to the Trust gregate costs to the programs under this in the provision of care coordination or pri- Fund. title. mary care physician’s services). ‘‘(b) INCORPORATION OF PROVISIONS.— ‘‘(2) PROCEDURES TO FACILITATE ENROLL- ‘‘(2) AGREEMENT TERM; PAYMENT.— ‘‘(1) IN GENERAL.—Subject to paragraph (2), MENT.—The Secretary shall develop and im- ‘‘(A) DURATION AND RENEWAL.—A care co- subsections (b) through (i) of section 1841 plement procedures designed to facilitate en- ordination agreement under this subsection shall apply with respect to the Trust Fund rollment of eligible individuals in the pro- shall be for one year and may be renewed if and this title in the same manner as they gram under this section. the Secretary is satisfied that the care coor- apply with respect to the Federal Supple- ‘‘(c) ENROLLMENT OF INDIVIDUALS.— dinator continues to meet the conditions of mentary Medical Insurance Trust Fund and ‘‘(1) SECRETARY’S DETERMINATION OF ELIGI- participation specified in paragraph (1). part B, respectively. BILITY.—The Secretary shall determine the ‘‘(B) PAYMENT FOR SERVICES.—The Sec- ‘‘(2) MISCELLANEOUS REFERENCES.—In ap- eligibility for services under this section of retary may negotiate or otherwise establish plying provisions of section 1841 under para- individuals who are enrolled in the program payment terms and rates for services de- graph (1)— under this section and who make application scribed in subsection (d)(1). ‘‘(A) any reference in such section to ‘this for such services in such form and manner as ‘‘(C) LIABILITY.—Case coordinators shall be part’ is construed to refer to title XXII; the Secretary may prescribe. subject to liability for actual health dam- ‘‘(B) any reference in section 1841(h) to sec- ‘‘(2) ENROLLMENT PERIOD.— ages which may be suffered by recipients as tion 1840(d) and in section 1841(i) to sections ‘‘(A) EFFECTIVE DATE AND DURATION.—En- a result of the care coordinator’s decisions, 1840(b)(1) and 1842(g) are deemed references rollment of an individual in the program failure or delay in making decisions, or other to comparable authority exercised under this under this section shall be effective as of the actions as a care coordinator. title; first day of the month following the month ‘‘(D) TERMS.—In addition to such other ‘‘(C) payments may be made under section in which the Secretary approves the individ- terms as the Secretary may require, an 1841(g) to the Trust Funds under sections ual’s application under paragraph (1), shall agreement under this section shall include 1817 and 1841 as reimbursement to such funds remain in effect for one month (or such the terms specified in subparagraphs (A) for payments they made for benefits pro- longer period as the Secretary may specify), through (C) of section 1905(t)(3). vided under this title; and and shall be automatically renewed for addi- ‘‘SEC. 2207. ADMINISTRATION AND MISCELLA- ‘‘(D) the Board of Trustees of the MediKids tional periods, unless terminated in accord- NEOUS. Trust Fund shall be the same as the Board of ance with such procedures as the Secretary ‘‘(a) IN GENERAL.—Except as otherwise pro- Trustees of the Federal Supplementary Med- shall establish by regulation. Such proce- vided in this title— ical Insurance Trust Fund. dures shall permit an individual to disenroll ‘‘(1) the Secretary shall enter into appro- ‘‘SEC. 2205. OVERSIGHT AND ACCOUNTABILITY. for cause at any time and without cause at priate contracts with providers of services, ‘‘(a) THROUGH ANNUAL REPORTS OF TRUST- re-enrollment intervals. other health care providers, carriers, and fis- EES.—The Board of Trustees of the MediKids ‘‘(B) LIMITATION ON REENROLLMENT.—The cal intermediaries, taking into account the Trust Fund under section 2204(b)(1) shall re- Secretary may establish limits on an indi- types of contracts used under title XVIII port on an annual basis to Congress con- vidual’s eligibility to reenroll in the pro- with respect to such entities, to administer cerning the status of the Trust Fund and the gram under this section if the individual has the program under this title; need for adjustments in the program under disenrolled from the program more than ‘‘(2) individuals enrolled under this title this title to maintain financial solvency of once during a specified time period. shall be treated for purposes of title XVIII as the program under this title. ‘‘(d) PROGRAM.—The care coordination though the individual were entitled to bene- ‘‘(b) PERIODIC GAO REPORTS.—The Comp- services program under this section shall in- fits under part A and enrolled under part B troller General of the United States shall pe- clude the following elements: of such title; riodically submit to Congress reports on the ‘‘(1) BASIC CARE COORDINATION SERVICES.— ‘‘(3) benefits described in section 2202 that adequacy of the financing of coverage pro- ‘‘(A) IN GENERAL.—Subject to the cost-ef- are payable under this title to such individ- vided under this title. The Comptroller Gen- fectiveness criteria specified in subsection uals shall be paid in a manner specified by

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00071 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.033 S23PT1 S15662 CONGRESSIONAL RECORD — SENATE November 23, 2003 the Secretary (taking into account, and Social Security Act that results from chil- ‘‘(iii) $26,475 in the case of a taxpayer hav- based to the greatest extent practicable dren from enrolling under title XXII of such ing 3 MediKids, and upon, the manner in which they are provided Act shall be used in a manner that improves ‘‘(iv) $31,005 in the case of a taxpayer hav- under title XVIII); services to beneficiaries under title XIX of ing 4 or more MediKids. ‘‘(4) provider participation agreements such Act, such as through increases in pro- ‘‘(C) PHASEOUT OF EXEMPTION.—In the case under title XVIII shall apply to enrollees and vider payment rates, expansion of eligibility, of a taxpayer having an adjusted gross in- benefits under this title in the same manner improved nurse and nurse aide staffing and come which exceeds the exemption amount as they apply to enrollees and benefits under improved inspections of nursing facilities, but does not exceed twice the exemption title XVIII; and and coverage of additional services. amount, the premium shall be the amount ‘‘(5) individuals entitled to benefits under (B) MEDIKIDS AS PRIMARY PAYOR.—In apply- which bears the same ratio to the premium this title may elect to receive such benefits ing title XIX of the Social Security Act, the which would (but for this subparagraph) under health plans in a manner, specified by MediKids program under title XXII of such apply to the taxpayer as such excess bears to the Secretary, similar to the manner pro- Act shall be treated as a primary payor in the exemption amount. vided under part C of title XVIII. cases in which the election described in sec- ‘‘(D) INFLATION ADJUSTMENT OF EXEMPTION ‘‘(b) COORDINATION WITH MEDICAID AND tion 2207(b)(2) of such Act, as added by sub- AMOUNTS.—In the case of any taxable year SCHIP.—Notwithstanding any other provi- section (a), has been made. beginning in a calendar year after 2001, each sion of law, individuals entitled to benefits (4) EXPANSION OF MEDPAC MEMBERSHIP TO dollar amount contained in subparagraph (C) for items and services under this title who 19.— shall be increased by an amount equal to the also qualify for benefits under title XIX or (A) IN GENERAL.—Section 1805(c) of the So- product of— XXI or any other Federally funded program cial Security Act (42 U.S.C. 1395b–6(c)) is ‘‘(i) such dollar amount, and may continue to qualify and obtain benefits amended— ‘‘(ii) the cost-of-living adjustment deter- under such other title or program, and in (i) in paragraph (1), by striking ‘‘17’’ and mined under section 1(f)(3) for the calendar such case such an individual shall elect ei- inserting ‘‘19’’; and year in which the taxable year begins, deter- ther— (ii) in paragraph (2)(B), by inserting ‘‘ex- mined by substituting ‘calendar year 2000’ ‘‘(1) such other title or program to be pri- perts in children’s health,’’ after ‘‘other for ‘calendar year 1992’ in subparagraph (B) mary payor to benefits under this title, in health professionals,’’. thereof. which case no benefits shall be payable under (B) INITIAL TERMS OF ADDITIONAL MEM- If any increase determined under the pre- this title and the monthly premium under BERS.— ceding sentence is not a multiple of $50, such section 2203 shall be zero; or (i) IN GENERAL.—For purposes of staggering increase shall be rounded to the nearest mul- ‘‘(2) benefits under this title shall be primary payor to benefits provided under such the initial terms of members of the Medicare tiple of $50. program or title, in which case the Secretary Payment Advisory Commission under sec- ‘‘(2) PREMIUM LIMITED TO 5 PERCENT OF AD- shall enter into agreements with States as tion 1805(c)(3) of the Social Security Act (42 JUSTED GROSS INCOME.—In no event shall any may be appropriate to provide that, in the U.S.C. 1395b–6(c)(3)), the initial terms of the taxpayer be required to pay a premium under case of such individuals, the benefits under 2 additional members of the Commission pro- this section in excess of an amount equal to titles XIX and XXI or such other program vided for by the amendment under sub- 5 percent of the taxpayer’s adjusted gross in- (including reduction of cost-sharing) are pro- section (a)(1) are as follows: come. ‘‘(e) COORDINATION WITH OTHER PROVI- vided on a ‘wrap-around’ basis to the benefits (I) One member shall be appointed for 1 SIONS.— under this title.’’. year. ‘‘(1) NOT TREATED AS MEDICAL EXPENSE.— (2) CONFORMING AMENDMENTS TO SOCIAL SE- (II) One member shall be appointed for 2 For purposes of this chapter, any premium CURITY ACT PROVISIONS.— years. (A) Section 201(i)(1) of the Social Security (ii) COMMENCEMENT OF TERMS.—Such terms paid under this section shall not be treated Act (42 U.S.C. 401(i)(1)) is amended by strik- shall begin on January 1, 2002. as expense for medical care. ing ‘‘or the Federal Supplementary Medical (b) MEDIKIDS PREMIUM.— ‘‘(2) NOT TREATED AS TAX FOR CERTAIN PUR- Insurance Trust Fund’’ and inserting ‘‘the (1) IN GENERAL.—Subchapter A of chapter 1 POSES.—The premium paid under this section Federal Supplementary Medical Insurance of the Internal Revenue Code of 1986 (relat- shall not be treated as a tax imposed by this Trust Fund, and the MediKids Trust Fund’’. ing to determination of tax liability) is chapter for purposes of determining— (B) Section 201(g)(1)(A) of such Act (42 amended by adding at the end the following ‘‘(A) the amount of any credit allowable U.S.C. 401(g)(1)(A)) is amended by striking ‘‘new part: under this chapter, or and the Federal Supplementary Medical In- ‘‘PART VIII—MEDIKIDS PREMIUM ‘‘(B) the amount of the minimum tax im- surance Trust Fund established by title ‘‘Sec. 59B. MediKids premium. posed by section 55. XVIII’’ and inserting ‘‘, the Federal Supple- ‘‘(3) TREATMENT UNDER SUBTITLE F.—For ‘‘SEC. 59B. MEDIKIDS PREMIUM. purposes of subtitle F, the premium paid mentary Medical Insurance Trust Fund, and ‘‘(a) IMPOSITION OF TAX.—In the case of an under this section shall be treated as if it the MediKids Trust Fund established by title individual to whom this section applies, were a tax imposed by section 1.’’. XVIII’’. there is hereby imposed (in addition to any (2) TECHNICAL AMENDMENTS.— (C) Section 1853(c) of such Act (42 U.S.C. other tax imposed by this subtitle) a 1395w–23(c)) is amended— (A) Subsection (a) of section 6012 of such MediKids premium for the taxable year. Code is amended by inserting after para- (i) in paragraph (1), by striking ‘‘or (7)’’ ‘‘(b) INDIVIDUALS SUBJECT TO PREMIUM.— graph (9) the following new paragraph: and inserting ‘‘, (7), or (8)’’, and ‘‘(1) IN GENERAL.—This section shall apply ‘‘(10) Every individual liable for a premium (ii) by adding at the end the following: to an individual if the taxpayer has a under section 59B.’’. ‘‘(8) ADJUSTMENT FOR MEDIKIDS.—In apply- MediKid at any time during the taxable (B) The table of parts for subchapter A of ing this subsection with respect to individ- year. chapter 1 of such Code is amended by adding uals entitled to benefits under title XXII, the ‘‘(2) MEDIKID.—For purposes of this section, at the end the following new item: Secretary shall provide for an appropriate the term ‘MediKid’ means, with respect to a adjustment in the Medicare+Choice capita- taxpayer, any individual with respect to ‘‘Part VIII. MediKids premium.’’. tion rate as may be appropriate to reflect whom the taxpayer is required to pay a pre- (3) EFFECTIVE DATE.—The amendments differences between the population served mium under section 2203(c) of the Social Se- made by this subsection shall apply to under such title and the population under curity Act for any month of the taxable months beginning after December 2002, in parts A and B.’’. year. taxable years ending after such date. (3) MAINTENANCE OF MEDICAID ELIGIBILITY ‘‘(c) AMOUNT OF PREMIUM.—For purposes of (c) REFUNDABLE CREDIT FOR COST-SHARING AND BENEFITS FOR CHILDREN.— this section, the MediKids premium for a EXPENSES UNDER MEDIKIDS PROGRAM.— (A) IN GENERAL.—In order for a State to taxable year is the sum of the monthly pre- (1) IN GENERAL.—Subpart C of part IV of continue to be eligible for payments under miums under section 2203 of the Social Secu- subchapter A of chapter 1 of the Internal section 1903(a) of the Social Security Act (42 rity Act for months in the taxable year. Revenue Code of 1986 (relating to refundable U.S.C. 1396b(a))— ‘‘(d) EXCEPTIONS BASED ON ADJUSTED GROSS credits) is amended by redesignating section (i) the State may not reduce standards of INCOME.— 35 as section 36 and by inserting after section eligibility, or benefits, provided under its ‘‘(1) EXEMPTION FOR VERY LOW-INCOME TAX- 34 the following new section: State medicaid plan under title XIX of the PAYERS.— ‘‘SEC. 35. COST-SHARING EXPENSES UNDER Social Security Act or under its State child ‘‘(A) IN GENERAL.—No premium shall be im- MEDIKIDS PROGRAM. health plan under title XXI of such Act for posed by this section on any taxpayer having ‘‘(a) ALLOWANCE OF CREDIT.—In the case of individuals under 23 years of age below such an adjusted gross income not in excess of the an individual who has a MediKid (as defined standards of eligibility, and benefits, in ef- exemption amount. in section 59B) at any time during the tax- fect on the date of the enactment of this Act; ‘‘(B) EXEMPTION AMOUNT.—For purposes of able year, there shall be allowed as a credit and this paragraph, the exemption amount is— against the tax imposed by this subtitle an (ii) the State shall demonstrate to the sat- ‘‘(i) $17,415 in the case of a taxpayer having amount equal to 50 percent of the amount isfaction of the Secretary of Health and 1 MediKid, paid by the taxpayer during the taxable year Human Services that any savings in State ‘‘(ii) $21,945 in the case of a taxpayer hav- as cost-sharing under section 2202(b)(4) of the expenditures under title XIX or XXI of the ing 2 MediKids, Social Security Act.

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00072 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.033 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15663 ‘‘(b) LIMITATION BASED ON ADJUSTED GROSS could sign up or not. They could then first of those two points. Medicare has INCOME.—The amount of the credit which pay a monthly premium. They would historically controlled costs far better would (but for this subsection) be allowed get a card. They could take that card, than either private health care plans under this section for the taxable year shall go to the pharmacy and get their pre- have, or even better than the Federal be reduced (but not below zero) by an amount which bears the same ratio to such scription drugs. They might have to Employees Health Benefits Program, amount of credit as the excess of the tax- pay a copay. They might have to pay FEHBP. We all take great pride in the payer’s adjusted gross income for such tax- some deductible. But it was basically FEHBP program and talk about how able year over the exemption amount (as de- the adding of a prescription drug ben- this is a great benefit and we should fined in section 59B(d)) bears to such exemp- efit to Medicare. That is what I extend it to others. tion amount.’’. thought both candidates were talking Between 1969 and now, Medicare’s (2) TECHNICAL AMENDMENTS.— about. costs have increased at an annual rate (A) Paragraph (2) of section 1324(b) of title That is not what we have in these of 8.9 percent a year, which stands in 31, United States Code, is amended by insert- 1,100 pages. Had we decided to enact contrast to the 11 percent growth rate ing before the period ‘‘or from section 35 of that, it could have been done in a much such Code’’. in the private health insurance arena (B) The table of sections for subpart C of smaller document. and 10.6 percent growth rate in FEHBP. part IV of subchapter A of chapter 1 of such I regretfully have to oppose the con- So the ideology of this drive to mod- Code is amended by striking the last item ference report for H.R. 1 as it comes be- ernize Medicare or move people out of and inserting the following new items: fore us tonight and tomorrow. traditional Medicare into the private I will cite six reasons I have come to system does not match the evidence. In ‘‘Sec. 35. Cost-sharing expenses under that conclusion. The first reason is MediKids program. fact, the recent record is even more that the bill, in my view, over time, ‘‘Sec. 36. Overpayments of tax.’’. dramatic. Between 1996 and 2003, Medi- will undermine traditional Medicare. care’s per capita growth was 4.2 per- (3) EFFECTIVE DATE.—The amendments The second reason is that the bill recent compared to 5.9 percent for pri- made by this subsection shall apply to tax- quires the Government to overpay private health plans and 5.3 percent for able years beginning after December 31, 2002. vate health plans by tens of billions of (d) REPORT ON LONG-TERM REVENUES.— FEHBP. dollars. Medicare wins the contest going Within 1 year after the date of enactment of The third reason is that the bill actu- this Act, the Secretary of the Treasury shall away. But maybe some are willing to ally will harm many senior citizens propose a gradual schedule of progressive tax pay higher costs, so this chart should changes to fund the program under title who are intended to benefit. Fourth, the bill will increase drug make that point. The red line shows XXII of the Social Security Act, as the num- the increase in costs from 1970 to the ber of enrollees grows in the out-years. costs rather than reducing them. Fifth, the bill will dramatically in- end of the century in private insur- f crease the complexity and volatility of ance. The blue line shows the increase ORDER FOR ADJOURNMENT the Medicare system for many of our in the cost of Medicare. They have both seniors. gone up, but Medicare has gone up less Mr. GRASSLEY. Mr. President, we Finally, the sixth point is that the rapidly. We might still be willing to want to make sure there is time this bill will increase the financial burden pay more—pay the amount required to evening for Senators BINGAMAN and on States and make it more difficult put people on this red line if, in fact, LEVIN to give their remarks. If there is for each of our States to maintain the we had greater patient satisfaction by no further business to come before the benefits they provide through their doing so. Senate, I ask unanimous consent that Medicaid programs to low-income pa- There is a recent study by the Com- the Senate stand in adjournment under tients. monwealth Fund, published in Health the previous order, following the re- Let me start with the problem that I Affairs, and it is reflected on this marks of Senator BINGAMAN and Sen- see of this bill undermining traditional chart. It is hard to read because the ator LEVIN. Medicare. Today, 88 percent of all of colors are too similar. What is re- The PRESIDING OFFICER. Without those 41 million people who are served flected is that of those with private objection, it is so ordered. by Medicare are enrolled in traditional health insurance, there were 51 percent The Senator from New Mexico. Medicare. The major thrust of this bill of those who were satisfied, and 62 per- Mr. BINGAMAN. Mr. President, I is not to add a prescription drug ben- cent of those in traditional Medicare thank the chairman of the committee. efit but instead to do what is were satisfied with their coverage. I appreciate the chance to speak brief- euphemistically referred to as ‘‘mod- That is the case, despite the fact that ly on this bill. It is a very important ernize’’ Medicare. Medicare benefits are less generous and piece of legislation. I congratulate the Now, there are definitely some things its beneficiaries are more elderly and Senator from Iowa on the hard work he we should do to modernize Medicare. I disabled and have higher health needs has put into this legislation. I do not would agree with that. But as that than individuals in the private health share his conclusion about it at this term is used in this discussion, most of care system. stage, but I certainly admire the work the time it is a code word, meaning So the bill seeks to move people out he has put in and admire the good job that we should move people—seniors of traditional Medicare into private he does as chairman of the committee and disabled individuals—out of tradi- health plans. It does so by dramati- on which I serve. tional Medicare into the private health cally overpaying the private health When the 2000 Presidential campaign care system. That is what is meant by plans. was underway, I saw one of the debates a lot of our colleagues when they talk Let me move to my second point. between then-Governor Bush and then- about modernizing Medicare. Since managed care is not more effi- Vice President Gore. Both of them in There are two good reasons for mov- cient than traditional Medicare, the that debate endorsed the enactment of ing people out of traditional Medicare conference report concludes that the a prescription drug benefit for seniors into the private health care system, as way to get people into these private for Medicare beneficiaries. I remember I see it. I could certainly favor doing health plans is to spend billions of dol- thinking when I saw that, this is one that if we could accomplish these pur- lars in overpayment to those plans. good thing that will come out of this poses. The first, obviously, would be to The legislation begins by setting its campaign in the next few years, no make the program more efficient and benchmark for payments to private matter who wins. But what I had in save money—save some taxpayer dol- plans at 109 percent of what Medicare mind as a prescription drug benefit was lars by moving these people out of the fee for service would have to spend for a very different animal than what we Government plan into a private plan. those beneficiaries. It does so in other have in these 1,100 pages that have The second, of course, would be if we ways as well, including giving health been referred to repeatedly. could improve services, increase the plans money that Medicare otherwise What I had in mind was a benefit satisfaction of Medicare beneficiaries would pay to a disproportionate share where Medicare beneficiaries would be by moving them into the private plan. of hospitals, to graduate medical edu- able to sign up for a prescription drug Let me just show this chart. Medi- cation, and the cost of veterans retiree benefit. It would be voluntary. They care cost growth: This relates to the health care.

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00073 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.033 S23PT1 S15664 CONGRESSIONAL RECORD — SENATE November 23, 2003 It makes no sense to me to subsidize come beneficiaries who will benefit love to understand that. How we can and pay health plan payments that from this; there are 6.4 million low-in- enact this enormous piece of legisla- Medicare intends, or could have, for come beneficiaries currently enrolled tion and see it reduce paperwork is a safety net hospitals or teaching hos- in Medicaid who will be worse off. It is mystery to me. pitals or veterans retirees. These HMOs hard for me to see how that adds up to This is a chart that was put together do not provide unpaid services to the a major benefit for a lot of those people by the Medicare Rights Center. It tries poor. They do not educate our Nation’s who are expecting a benefit under this to set out some depiction of how this is medical students. They do not provide legislation. all going to work. I can’t begin to ex- health care to our veterans. Yet the Let me talk a minute about drug plain it to you at this point, but I can conference report provides payment for costs. What will this bill do for drug tell you that you can study it for a such services. costs? When I talk with seniors in my great length of time and still not un- It makes no sense, but it is intended State, the No. 1 problem they cite to derstand how it is going to work. to camouflage the fact that private me when it comes to prescription drugs Most people receiving benefits health plans cannot compete with tra- is the enormous growth in the cost of through Medicare choose traditional ditional Medicare if they merely re- those drugs. Medicare. They like the stability of ceive the amount traditional Medicare I have concluded, reluctantly, that traditional Medicare. spends to provide these services to not only will this legislation not bring The Washington Post today had a beneficiaries. So that is not enough. down drug costs but it will actually story about the problems beneficiaries The other thing that is done is that cause them to go up. Surveys indicate who have enrolled in Medicare+Choice we, in this bill, provide a $10 billion to that Medicare beneficiaries cite this as have encountered: the changing bene- $12 billion stabilization fund. That sta- their No. 1 problem. The Congressional fits that health plans offer on an an- bilization fund essentially is money Budget Office has concluded the con- nual basis; the changes in premiums that the Secretary of Health and ference report will actually raise the and copayments; the problem of health Human Services has available to add to price of drugs by 3.5 percent overall. plans coming in and out of the market- what private plans are receiving and The legislation that is before us, this place. We have had that problem in my further advantage them over the tradi- 1,100 pages, delivers to hundreds of pri- State of New Mexico. Health plans tional Medicare system if he or she de- vate drug companies and HMOs an income in, advertise, sign up a lot of peo- termines that that is necessary in surance-administered drug benefit that ple, and 6 months or a year later they order to keep them providing services vastly dilutes the purchasing power of announce they are not making money and they pull out. They send a letter to to this portion of our population. Medicare. Rather than Medicare pur- Of course, the other issue that I chasing the drugs in bulk to achieve everybody and say: Sorry, we decided think is extremely important is that significant savings, the medication not to provide your benefits. Those these private health plans, under the splits Medicare’s purchasing power into people come to my office and say: What legislation, are fully free to engage in hundreds of purchasing pools and are we going to do? This is a volatility in the system practices that allow them to enroll eliminates the significant leverage that most people on Medicare do not healthy Medicare beneficiaries and that Medicare could have in controlled appreciate. I see that increasing dra- costs. shift the sicker and the more costly or matically under this legislation. How This bill expressly prohibits Medi- elderly beneficiaries into the Medicare in the world we can see less paperwork, care from negotiating for prices. Peo- system. They do this by adjusting their how in the world we can see less comple need to focus on that. Here we are benefits. They do this by designing plexity and less volatility as a result of setting up a program where Medicare is their benefit packages and marketing this bill escapes me. them to the healthy segments of the going to pay for prescription drugs, and A final point I want to make is the society. we are prohibiting Medicare from nego- impact on States, expanding on this Some might ask how do they do this. tiating as to the price it is going to concept of ‘‘do no harm.’’ This legisla- I will give you an example. Some pri- pay. tion has potentially major negative vate plans impose a higher cost share Consumers Union came out with a re- consequences for our States. In the for services such as chemotherapy or port last week saying the proposal’s first 3 years of the bill, the Congres- renal dialysis than traditional Medi- modest benefits, coupled with an ex- sional Budget Office estimates that the care in order to encourage those who pected high growth of prescription drug costs, or the unfunded liability of the have contracted cancer or renal failure prices, could result in major dis- bill to the States in their Medicaid pro- to enroll, to leave the private plan and appointments for many of these Medi- grams, will be $1.2 billion. to go back into traditional Medicare. care beneficiaries. Medicare bene- We are, in effect, adding $1.2 billion Proponents of the bill say what they ficiaries at most prescription drug ex- in costs to the Medicaid Program at a are trying to do by getting these pri- penditure levels will actually face time when States have been begging vate plans involved is to foster com- higher out-of-pocket costs when they for relief from the Federal Government petition. Obviously, we all favor com- have coverage in 2007—that is one year due to the growing Medicaid costs that petition, but I do not see that it is par- after the bill is implemented—than States have experienced because of the ticularly competitive for us to provide they do in 2003 when they have no cov- slow economy and the growing bene- this kind of very major subsidy. erage. ficiary roles. When you add together the 109 per- That is an incredible finding, in my States have had to make rather dra- cent payment to the private plans and view. For example, it only provides matic cuts in their Medicaid programs the risk selection in which they are people with a benefit of around $1,000 because of these changes, and this $1.2 permitted to engage, private plans will for the first $5,000 in prescription drug billion in additional costs to them will be paid an estimated 25 percent more spending. When you couple that with result in additional cuts in Medicaid. than the cost of traditional Medicare weak cost containment provisions, the There is a misconception, I believe, for each enrollee, for each beneficiary. Consumer Union finds that the average about this legislation, and that is, peo- This amounts to $1,920 more per en- out-of-pocket spending for bene- ple think that because Medicare is tak- rollee in the year 2006. ficiaries rises to $2,900 in 2000 compared ing over the payment for dual-eligi- A third problem is the bill actually to $2,300 in 2003 for beneficiaries with bles—that is low-income individuals does harm. I mentioned what many of absolutely no prescription drug cov- who are eligible for Medicaid but also my colleagues have already mentioned, erage. old enough to be eligible for Medicare— and that is the 2.7 million retirees who Let me also move to this final chart since Medicare is going to take over are expected to lose their prescription to talk about the problem of com- that expense, people think this is going drug coverage once we enact this legis- plexity and volatility. I heard some of to save the States money. lation. the majority leader’s comments earlier First of all, until the year 2008 under Also, the Congressional Budget Office this evening. He indicated that one of this legislation, States do not receive analysis says as to low-income bene- the great advantages of this bill is that any benefit from the Federal assump- ficiaries, there are 3.4 million low-in- it would reduce paperwork. I would tion of drug costs for dual-eligibles or

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00074 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.120 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15665 low-income beneficiaries who currently one of those States. I authored legisla- ico for his analysis of this bill. I lis- get their prescription drugs from Med- tion to increase that 1 percent to 3 per- tened to the last part of it and I icaid. That is 5 years from now before cent, not to get it up to the national thought it was exactly on point. I par- they receive any benefit. States ex- average, which would have been 8 per- ticularly would like to emphasize his pecting to get savings from this bill, in cent, but to get it up to 3 percent. That last point, which is that this is not the the words of the National Conference of would have allowed the dispropor- end of the Congress, this is just the end State Legislatures, will be ‘‘deeply dis- tionate share hospitals in my State, in- of a session, or nearing the end of a ses- appointed.’’ stead of receiving $9 million a year, to sion. In addition, this report contains receive a total of $45 million a year. With 4 days’ notice of a bill of this what is called the clawback or the re- Unfortunately, the conference report complexity—now, I think the bill itself verse block grant. This is a new con- cut the amount my State would receive is about 700 pages and there are hun- cept to me, but it is a fascinating one. from $45 million down to $10 million. dreds of pages of commentary that go Instead of the Federal Government giv- Current law is $9 million. Under this with it, but the idea that we should ing a block grant to the States, the bill, we would go to $10 million instead take up a bill of this complexity, when Federal Government legislates a re- of going from $9 million to $45 million. seniors are just having the first oppor- quirement on the States to give the In sharp contrast, Louisiana’s share tunity after 4 days to try to fathom Federal Government a block grant. of the Medicaid DSH funding goes from what is in it, is a terrible mistake. It is through this clawback or reverse $500 million to $600 million next year. The Senator from New Mexico was block grant the Federal Government This is an unacceptable disparity, in exactly right in urging that we not demands that States pay the Federal my view. Louisiana’s $100 million in- rush to consider this bill tomorrow and Government for any savings the Fed- crease is more than the $43 million in- to adopt this bill. It took a great deal eral Government estimates the States crease that is provided to all of the 20 of effort to create Medicare. It was not might gain from the new Medicare Pro- low-DSH States combined. This pre- until 20 years after Harry Truman first gram. cludes States such as mine from pro- proposed the idea of a guaranteed When we take the period between tecting their safety net hospitals and health benefit for seniors that Presi- 2004 and 2013, the amount the States dealing with the fact that the unin- dent Lyndon Johnson signed the Medi- will have to pay back to the Federal sured rate in our States has increased care Program into law. It was fitting Government is $88.5 billion. Now, that by 4 million people over the last 2 that Harry Truman was the program’s is a big number, $88.5 billion. The con- years. first beneficiary. He paid his $3 pre- ference report requires States to write In conclusion, it is my view that Con- mium and he enrolled in Medicare in checks to the Federal Government in gress does its worst work under the cir- 1965. the amount of $5.7 billion in 2006. This cumstances we are being presented We are confronting in this bill a goes up to $14.9 billion in 2013. Over with tonight and tomorrow. It is late turning away from Medicare’s noble that 7-year period, that is a 261 percent in the session. There is no time for ade- purpose. That purpose was to create an increase in the amount the States have quate review of the 1,100 pages that insurance pool for all seniors, where to pay the Federal Government. have been put on each of our desks. We the risks and financial burdens are One may ask how they go up that shared—not for the profit of insurance much. It goes up that much because are being pushed up against a totally companies or pharmaceutical compa- the Federal Government has built into artificial deadline. This is not the end nies but for the common good. The leg- this a 15 percent compounded inflation of the Congress. It is barely the middle islation before us is a fundamental and rate, and that is being imposed on the of the Congress. There is no reason this ill-advised restructuring of Medicare States. The States have nothing to say bill has to be passed before we leave for under the guise of adding a prescrip- about it. If the States want to partici- Thanksgiving. We could either come tion drug benefit to the program. pate in Medicaid, they will pay that back after Thanksgiving or we could take it up in January. Many Members of Congress have amount back to the Federal Govern- worked for years to bring a Medicare ment. I have a letter from the Democratic prescription drug benefit to fruition. State general revenues, tax revenues, Governors Association which says: We While the Senate-passed version of this will not go up 15 percent annually dur- urge you to reject any efforts to vote ing those 7 years. So States are right- on this legislation before you know its bill had enough flaws to cause me, fully upset by this clawback. They full content and cost impact on your along with a number of colleagues, to rightfully point out that they are being State and the people we both serve. vote against it, at least I was hopeful required to now pay an inflation rate This is to all Members of the Senate that some of these flaws would be cor- for something they do not control. The from the Democratic Governors Asso- rected in the conference committee. clawback, or the reverse block grant, is ciation. They go on to say: Any rush to Unfortunately, the prescription drug increasing by 261 percent over 7 years. judgment without the necessary infor- plan before us not only worsens the What this is going to do is to put in- mation may have both short- and long- prescription drug program as adopted creased pressure on State budgets term consequences that could prove to by the Senate, it has become a mill- which will result in cuts in Medicaid, be irrevocably severe. stone dragging Medicare down with it. cuts in education, cuts in transpor- We do not know the consequences of The promise of a prescription drug tation. This should not be an accept- this legislation that we are being urged plan is being used to begin the unravel- able outcome for those of us in the to pass tomorrow. We owe it to senior ing of Medicare. First, there are the Senate. The bill we sent to the con- citizens in this country to understand dangers for seniors created by the pre- ference from the Senate loaded a $10 what we are doing. We owe it to the scription drug provisions themselves. billion burden on the States. Now that taxpayers of the country to buy health The Congressional Budget Office esti- it has come back to us, it has an $88 care services for seniors without over- mates that up to 25 percent of retirees, billion burden that we are loading on paying for those health care services. with existing prescription drug cov- the States as part of this legislation. We owe it to the public to do all we can erage through a former employer, I would add one other point about to reduce health care costs. Unfortu- would lose that coverage under this this burden. There is a group of 20 nately, we are doing none of these bill’s plan. That is about 2.7 million States that have a cap that is imposed things if we take up this bill and pass senior citizens who currently have upon them through Medicaid’s dis- it tomorrow. good private insurance and are paying proportionate share hospital program. I hope Senators will join me in vot- less now than they would have to under That cap says they can receive no more ing not to send this bill to the Presi- a Medicare prescription drug plan. than 1 percent of the total Medicaid dent in its present form. That is 2.7 million retirees who will spending in their State. That compares I yield the floor. lose benefits, above and beyond the to 8 percent, which is the national av- The PRESIDING OFFICER. The Sen- number of retirees who are projected to erage. ator from Michigan. lose their benefits under the current The 20 States I am talking about are Mr. LEVIN. Mr. President, first, I trend of employers reducing prescrip- called low-DSH States. New Mexico is commend the Senator from New Mex- tion drug coverage for their retirees.

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00075 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.122 S23PT1 S15666 CONGRESSIONAL RECORD — SENATE November 23, 2003 The tax subsidies for employers in- One of the most disturbing aspects of The six so-called premium support cluded in this conference report are not this legislation is the fact that private demonstration projects created by this enough to entice employers to keep insurance companies can use the pur- bill are the opening act for the privat- their drug coverage for those 2.7 mil- chasing power of their large number of ization of Medicare. Proponents argue lion retirees. beneficiaries to negotiate lower pre- that Medicare’s costs won’t come down Another fundamental flaw with the scription drug prices, but Medicare is without a private sector competitor. prescription drug benefit in this legis- prohibited from doing so. This is one of But this bill, while purporting to pro- lation is the lack of a guaranteed Medi- the most unacceptable ways this bill mote competition between Medicare care prescription drug plan. In the Sen- protects private insurance companies and private insurers, tilts the playing ate bill, in the absence of two com- and prescription drug companies from field against Medicare. First, there is a peting private plans offering a senior a fair competition from Medicare, all at $12 billion so-called stabilization fund, prescription drug benefit, Medicare was the expense of seniors and American which is in reality a slush fund. It is a the fallback. This approach was gutted taxpayers. slush fund for insurance companies to in conference. Here is what the con- Ask veterans how much prescription subsidize their policies. The $12 billion ference report provides. If one insur- drugs cost at VA hospitals compared to in slush money is not available to tra- ance company in a region offers a pre- their local pharmacy. Many of the ditional Medicare, only to the private scription drug benefit, regardless of drugs the VA offers are as little as half insurance companies. how unattractive it is to seniors in the price. The reason is the VA buys Second, the claims of the insurance terms of its premiums and copayments, drugs in large quantities from drug industry that they will and must ac- both of which are left up to the insur- manufacturers and has leverage in ne- cept every senior who applies are dis- ance company, and if an HMO offers gotiating the prices. Instead of buying ingenuous. Here is why. Private insur- coverage in that region as a substitute the 30-day supply of pills for someone ers will have the flexibility to alter and to Medicare, no matter how unattrac- on Medicare, why not allow Medicare change their plans, to be able to cher- tive that HMO is to seniors, and assum- to buy thousands of 30-day supplies at ry-pick the healthy senior. For exam- ing that HMO also offers a prescription once for a fraction of the cost? That ple, if an insurance company designed a drug benefit, the senior will not be of- makes a lot of sense, but it is prohib- program with a very low monthly pre- fered the fallback Medicare prescrip- ited under this bill. mium but with high copayments and tion drug benefit. The conferees left out some other Let me put that another way. We high deductibles, this would be an in- real solutions to address the high cost begin with the fact that private insur- centive for a healthy senior to enroll, of prescription drugs. Both the House- ance companies offering a prescription someone who could risk having to pay and Senate-passed versions included a drug policy under this bill could charge high copayments and deductibles be- whatever premiums and copayments provision to allow seniors to buy drugs cause he or she has relatively infre- they want. If only one private prescrip- in other countries at lower prices, so- quent medical treatment. Less healthy tion drug plan exists in a region, re- called reimportation provision. How- seniors, whose frequent medical treat- gardless of how unappealing it is, and ever, these provisions have been ments make it difficult or impossible one HMO offering a prescription drug stripped from the final bill. Even for them to pay high copayments and plan also exists in that region, a senior though the House and Senate have high deductibles, would be left for the has the choice of purchasing the bad voted to allow reimportation with Medicare program to cover. This is pri- prescription drug plan or leaving Medi- strong bipartisan votes, the conferees vatization plus. It simply cannibalizes care to join an HMO that he or she does ignored these votes. More important, Medicare. Subsidizing insurance com- not want to join, in order to get that they ignored the problem of high pre- panies and allowing them to cherry- prescription drug benefit. Forcing sen- scription drug costs. Americans pay pick the beneficiary population means iors to make the choice between stay- more for prescription drugs than any that insurance companies will be prof- ing in traditional Medicare or leaving people in the world. U.S. taxpayers’ iting mightily, while leaving the U.S. Medicare and joining an HMO they oth- dollars help to subsidize the research taxpayer to pick up the tab of insuring erwise would not join in order to get a and development of many prescription the less profitable population. prescription drug benefit is a thinly drugs. Yet drug companies then sell How did we arrive at this ill-con- disguised attempt to unravel and pri- them abroad for less. Because this bill ceived legislation? Democrats were all vatize Medicare. That is a choice no does not address the high cost of pre- but shut out of the conference com- senior citizen in America should have scription drugs, needed medicine will mittee which wrote this bill. Only two to make. still be inaccessible for millions of our Democrats were allowed to participate Also troubling is the fact that the citizens. in the conference negotiations. This private company which offers the pre- Unfortunately, the prescription drug massive shift in Medicare’s approach scription drug benefit, and the com- benefit in this bill is what Newt Ging- and purpose was delivered publicly to pany which offers the managed care al- rich envisioned for the future of the en- us about 4 days ago. In this bill’s 700 ternative to Medicare, can be one and tire Medicare Program. The former pages are provisions to dismantle the same under the provisions of this House Speaker said that he wanted Medicare as we know it, replacing it bill. In addition, the prescription drug Medicare to wither on a vine. To slowly with a network of private insurers and benefit in the legislation before us has chip away at the foundation of Medi- drug companies whose goal is making a a large gap in the prescription drug care until it crumbles with a private profit. coverage. Once a senior’s total drug network of managed care and drug There is a fundamental difference be- spending reaches about $2,500 for the companies eventually replacing Medi- tween private industry and govern- year, he or she will have to pay 100 per- care is what he envisioned. ment: Private companies fail if they do cent of the cost of their prescriptions Apparently AARP, which once stood not make money, while government until their total drug spending reaches for preserving social insurance for fails if we do not help citizens—espe- $3,600. This has come to be called the America’s seniors, agrees with Mr. cially those that cannot help them- donut hole. This coverage gap will Gingrich. The AARP executive director selves. leave many seniors to pay the full cost and CEO wrote the forward to the I have heard from many of my con- of prescriptions at a time when they former Speaker’s book entitled ‘‘Sav- stituents in the State of Michigan who most need assistance. I know of no ing Lives and Saving Money,’’ and need help in getting affordable pre- other insurance program that is so un- later commented that ‘‘Newt’s ideas scription drugs. Let me read you a few fairly structured in that way. are influencing how we at AARP are excerpts from letters that I have re- Adding insult to injury, while there thinking about our national role and in ceived on this issue. One constituent is a gaping hole in coverage, there is no our advocating for system change.’’ writes: gap in the requirement to pay pre- With this bill, the chief cooks of the I am writing for your support for the Medi- miums. That obligation continues, Republican Party are following Newt care Program. Please provide a Medicare even during the period that benefits Gingrich’s ‘‘wither on a vine’’ recipe drug benefit that is comprehensive, afford- are halted. for the future of Medicare. able and secure. Do not undermine Medicare

VerDate jul 14 2003 02:49 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00076 Fmt 0637 Sfmt 0634 E:\CR\FM\G23NO6.125 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — SENATE S15667 as a defined benefit program through the House-passed or Senate-passed prescription drug program by letting privatizing it. bills. Hastily acting on this legislation the private provider use its purchasing Another constituent writes: is fundamentally unfair to millions of power to drive down its drug prices, We do not want a drug bill that eliminates seniors who want and deserve to be but not letting Medicare do the same; or reduces our current prescription plan that treated fairly. I predict that when sen- and in the dismantling of Medicare, by we now have . . . When I retired . . . this iors become familiar with this bill’s de- pushing people out of Medicare into plan was part of my benefit package and we tails, there will be a crescendo of oppo- private HMOs in order to obtain a pre- fell that it is their obligation to continue it, sition. scription drug benefit. and the cost of our drugs should not be The siren song you hear now prin- passed on to the tax payers. The bill before us will begin undoing cipally from our Republicans col- I get hundreds of messages a week 37 years of progress in Medicare. It is leagues is that competition is nec- an ill-advised assault on the one pro- like that from constituents with con- essary to drive the cost of health care cerns over the privatizing of Medicare gram that guarantees medical care to down. The reality of this bill is not our most vulnerable population, our and the possible loss of existing pre- competition but government subsidies scription drug benefits. It is estimated senior citizens. An historic opportunity for insurance companies while allowing is being squandered if we adopt this that this bill, if it becomes law, would them to carve out the most profitable cause 138,000 seniors in Michigan cur- bill. Our Nation’s seniors deserve bet- segment in the business—caring for the ter. I yield the floor. rently receiving prescription drug ben- healthiest—leaving the seniors with efits to lose some or all of those bene- greatest need as the responsibility of f fits. And 90,000 seniors in my State who the Federal government. Privatizing are Medicaid beneficiaries with a cur- ADJOURNMENT UNTIL 9 A.M. the most profitable part with a subsidy TOMORROW rent prescription drug coverage will be is not competition; it is a huge gift to worse off if this bill becomes law than private companies at the expense of the The PRESIDING OFFICER. Under they are under current law. U.S. Treasury. the previous order, the Senate stands A fundamental restructuring of Medi- Supporters of this legislation say adjourned until 9 a.m. tomorrow morn- care of this magnitude demands careful they are harnessing the power of the ing. and thoughtful deliberation. The con- marketplace to drive down prices. The There being no objection, the Senate, ference report contains a large amount reality is just the opposite. They are at 10:45 p.m., adjourned until Monday, of new material not included in either hobbling the Medicare program in the November 24, 2003, a 9 a.m.

VerDate jul 14 2003 04:05 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00077 Fmt 0637 Sfmt 0634 E:\CR\FM\A23NO6.042 S23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2423 EXTENSIONS OF REMARKS

H.R. 2417, THE FISCAL YEAR 2004 Winston Cup Championship after placing tant is the protection of the diverse range of INTELLIGENCE AUTHORIZATION fourth at the Pop Secret 400 at North Carolina fish stocks that inhabit our world’s oceans, CONFERENCE REPORT Speedway on November 9, 2003. many of which are very close to disappearing Matt began working on his father’s racecar forever. Given the recent release of two stud- SPEECH OF when he was thirteen years old, and then he ies essentially stating that what I have been HON. BETTY McCOLLUM got the chance to start racing at the young talking about is likely to happen, I am more age of sixteen. As a sign of his early talent for convinced than ever that we need to take ag- OF MINNESOTA the sport, Matt was racing competitively by the gressive action immediately. Many of our IN THE HOUSE OF REPRESENTATIVES age of nineteen. He moved up quickly to the oceans’ fish stocks are now reportedly 90 per- Thursday, November 20, 2003 ultra-competitive Wisconsin Late Model ranks, cent depleted, meaning only 10 percent of the Ms. MCCOLLUM. Mr. Speaker, it is with and he became the youngest winner ever in stocks that once existed remain. And many of great dismay that I rise to oppose H.R. 2417, ARTGO Challenge Series history. these stocks are in grave danger of extinction the Fiscal Year 2004 Intelligence Authorization After driving the American Speed Associa- if we proceed down the same path we are on Report. tion’s ACDelco Challenge Series, Matt re- now—that is, continue to study these stocks The Republican Leadership inserted a conceived a call from Robbie Reiser to drive his and do little to mitigate the damage that has troversial provision in the FY04 Intelligence Busch Series car. In the NASCAR Busch already been done. Authorization Report that will expand the al- Grand National Series, Matt excelled in his One of these two studies recently published ready far-reaching USA Patriot Act, threat- first full year by finishing second in the points was conducted by Dalhousie University, in ening to further erode our cherished civil lib- battle. As a tribute to his success, he was Halifax, Canada, stating that the global ocean erties. This provision gives the FBI power to called to substitute for Bill Elliott in the elite has lost over 90 percent of its large predatory demand financial and other records, without a NASCAR Winston Cup Series at Dover Downs fishes, such as tuna, swordfish and marlin. I judge’s approval, from post offices, real estate in September of 1998. This was his first start have long known that the use of pelagic agents, car dealers, travel agents, pawn- against the biggest names and greatest stock longline gear is one of the most, if not the brokers and many other businesses. This pro- car drivers around, and Matt finished an im- most destructive, indiscriminate way to fish. A vision was included with little or no public de- pressive sixth place. The motorsports world direct result of the use of this geartype, start- bate, including no consideration by the House certainly took notice of Matt in 2000, when he ing in the early 1960s, has provided for the al- Judiciary Committee, which is the committee took the Winston Cup scene by storm winning most complete disappearance of white marlin. of jurisdiction. It came as a surprise to most the Raybestos Rookie of the Year Award. Though not the target species of longline gear, Members of this body. This year, in his fourth season in NASCAR’s marlin are a bycatch species, meaning that It is of great concern that the Republican top stock car series, Matt’s commitment and this geartype catches whatever eats the bait, Leadership, along with the Administration and consistency paid off because with one win, and as the lines are left in the water overnight, Attorney General Ashcroft, would seek to in- eleven top-five finishes, and twenty-five top any fish that bites onto a hook is more likely clude such a non-germane, controversial pro- ten finishes, he was able to take the Winston than not dead by the time the lines are pulled vision into what should otherwise be a non- Cup title. Matt’s achievements certainly have in, killing not only the target species, which is partisan bill. Furthermore, the Republican brought out the community pride and home- primarily swordfish, but also marlin or turtles Leadership, in the Senate defeated an attempt town spirit in Cambridge and across Wis- or sharks or even small whales that happen to to ‘‘sunset’’ this provision when they consid- consin. He is a hero to countless young aspir- take the bait. ered it. It is clear the Republican Leadership ing drivers, and he has shown why with his The U.S. Commission on Ocean Policy, cre- and the Administration would rather expand on dedication through this long and challenging ated from my Oceans Act of 2000, has it’s the USA Patriot Act through deception and se- season. This December, he and his team will own report forthcoming on the status of our crecy than debate such provisions in an open deservingly sit at head of the head table at the oceans, it will be interesting to see what con- forum. The freedoms and civil liberties of the Waldorf-Astoria. clusions they put forward. Mr. Speaker, I am proud to rise today to American people are too important to allow The National Marine Fisheries Service, the honor Cambridge Native Matt Kenseth for his such an irresponsible, abusive power play by agency tasked with the protection of these accomplished racing career and his recent the Majority. species has failed to do so. The United States NASCAR Winston Cup Championship title. The importance of our intelligence commu- is a world leader on so many important and nity has grown significantly in the wake of the f complex issues; it is hard to understand why September 11th terrorist attacks and the sub- INTRODUCTION—OFFICE OF OCEAN the issue of fisheries management, and en- sequent, continuing campaign against ter- AND COASTAL POLICY CREATION forcement of the regulations currently in place rorism. The FY04 Intelligence Authorization ACT OF 2003 both domestically and internationally, seems Report includes a number of positive, bene- impossible to accomplish. ficial provisions designed to improve our coun- We need to take immediate aggressive HON. JIM SAXTON steps to prevent the disappearance of these terintelligence capabilities, strengthen our abil- OF NEW JERSEY fish species, before it’s too late. These studies ity to share information between the federal IN THE HOUSE OF REPRESENTATIVES government, local and state officials, and pro- should be a wake-up call that the process vide for our intelligence officers and their fami- Friday, November 21, 2003 through which our world’s fisheries is man- lies. It is unfortunate that such a controversial Mr. SAXTON. Mr. Speaker, I am pleased to aged is broken and needs to be fixed. provision had to be included. be here today to introduce an important piece This is an issue that resonates with anyone f of conservation legislation, the Office of Ocean who has ever been to the beach in states like and Coastal Policy Creation Act of 2003. This New Jersey, or watched a television program MATT KENSETH bill establishes in the Executive Office of the involving the deep blue sea. And given that 50 President, an Office of Ocean and Coastal percent of the population of the United States HON. TAMMY BALDWIN Policy. I believe this Office will serve as a val- lives within 100 miles of a coast, there are OF WISCONSIN uable complement to the environmental offices many who are personally affected by this IN THE HOUSE OF REPRESENTATIVES and agencies that currently exist, and will pro- issue. We have a unique opportunity to do vide a unique perspective on the direction we something amazing and I think we owe it Friday, November 21, 2003 ought to be moving in with regard to com- these wonderful resources that are our oceans Ms. BALDWIN. Mr. Speaker, I rise today to prehensive ocean policy. to do all we can to bring them back to a recognize Matt Kenseth, a native of Cam- An issue to which I have devoted a great healthy and sustainable level, for future gen- bridge, Wisconsin, for clinching the NASCAR deal of time and one that I feel is very impor- erations. I look forward to working with this

∑ This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor.

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00001 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.116 E23PT1 E2424 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 unique Office on Ocean Policy to preserve agrees. ‘‘The world is run by average peo- That attitude has rankled some in the St. these magnificent resources. ple,’’ he says. ‘‘We reward people who can Louis business community, says Brown, the run fast, jump high and throw balls through newspaper columnist. f holes. The least we can do is help those who ‘‘Earl doesn’t go begging in the business HONORING THE ST. LOUIS GATE- might not be academic stars but who are community, and that rubs some people the WAY CLASSIC SPORTS FOUNDA- willing to work hard.’’ wrong way. He says [racial] integration is a ‘‘It’s the trickle-up theory,’’ says Sylvester wonderful thing, but we have to take care of TION Brown Jr., a columnist for the St. Louis our own. That’s his integrity. Every year, he PostDispatch. Brown defends Wilson against beats his head against the wall trying to fill HON. WM. LACY CLAY charges from another St. Louis writer that the [Edward Jones] dome, every year he doesn’t do it, and every year he smiles and OF MISSOURI he’s ‘‘creating dumbness’’ by so generously supporting less-than-stellar scholars. says we’ll do it next year.’’ IN THE HOUSE OF REPRESENTATIVES ‘‘I’d much rather see Earl spend $10,000 on St. Louis’ only historically black institu- Friday, November 21, 2003 one scholarship than give $1,000 scholarships tion, Harris-Stowe State College, doesn’t to 10 students,’’ says Brown. ‘‘What he’s say- have a football program, so the Gateway Mr. CLAY. Mr. Speaker, I rise today to pay ing by doing it this way is that we have Classic turns to regional schools for the an- tribute to the St. Louis Gateway Classic Sports enough faith in you to support you for four nual competition. In recent years, Arkansas- Foundation for its commitment to providing years. You have no financial worries. All you Pine Bluff, about seven hours away by car, academically average youth in St. Louis with have to do is focus on being great.’’ has become a permanent contestant, its op- the opportunity to attain a valuable college The foundation distributes application ponents rotating among Kentucky State education. Since 1998, the St. Louis Gateway forms to high school guidance counselors, University and others. The Classic weekend Classic Sports Foundation has striven to even and uses radio and print advertising to get features band competitions, street parties the word out. Winners are chosen by a com- and lunches with African-American sports the educational playing field by giving gener- mittee of educators and others who review figures. ously to hard-working students. the applications and interview applicants. ‘‘I ‘‘It’s all generated by Earl,’’ says Julius The Foundation is sending a clear, unmis- stay completely out of the selection proc- Dix, 74, a retired St. Louis school adminis- takable message to urban youth that someone ess,’’ says Wilson. Sixteen recipients are cur- trator who sits on the selection committee. does care about them by believing in them rently attending college through the pro- ‘‘He’s a born salesman. He could sell you and financially supporting their goals of attain- gram. anything.’’ Davis, the UAPB chancellor, says the an- ing a valuable college degree. Since the foundation began giving scholarships 5 years ago, the champion recipient is nual event is ‘‘really great for our univer- Mr. Speaker, it is with great privilege that I Dedree Smart, 23, who went to Howard Uni- sity. We bring in hundreds for the game. It’s recognize the St. Louis Gateway Classic versity in Washington. ‘‘I have been so great visibility for us and our students. It’s Sports Foundation today before Congress. blessed,’’ she says. ‘‘There’s no way I could like a second homecoming.’’ The Foundation was recently honored in an have afforded Howard. I didn’t have to worry Several Gateway scholarship students have article published in the Baltimore Sun. I would about anything financially, so I could con- enrolled at Pine Bluff, including two with like to share this article with my colleagues centrate on my grades. I went from a low B the title Miss Gateway Classic. These are average in high school to graduating magna young women who prevail in a pageant after which further details its dedication to providing their junior year in high school and preside a vital contribution to our youth by helping to cum laude.’’ Smart earned her degree last year and is as Miss Gateway Classic as seniors, making produce an educated society. back in Missouri, working as special events appearances around St. Louis at foundation- [From the Baltimore Sun, Nov. 9, 2003] coordinator for the State’s public university sponsored events. BLACK SCHOLARSHIP PROGRAM HELPS ‘‘PEO- system. ‘‘I am so elated, so grateful and so The pageant is partly a beauty contest PLE IN THE MIDDLE’’; MO. FOUNDATION RE- proud of my baby,’’ says her mother, Delores [with evening gowns but not bathing suits] WARDS THE ACADEMICALLY AVERAGE Smart. and partly a contest of brains and poise, says Janell Wallace, the 2002 winner, who is at- (By Mike Bowler) Wilson says the foundation carefully monitors the scholarship program. ‘‘The ones tending Pine Bluff on a $40,000 Gateway Clas- Don’t even dare dream about college, a who finish college almost always get better sic scholarship. guidance counselor warned Leonard Wood- grades’’ than they did in high school, he ‘‘I had to write an essay and answer ques- son. With your mediocre academic record, says. tions on current events. I had to learn eti- you’ll be lucky to survive high school. ‘‘These are the late bloomers,’’ says Irving quette and how to walk and speak publicly The counselor was wrong. It took Woodson Clay, 78, a former city alderman who sits on and keep calm. That’s helped a lot here,’’ she an extra semester, but next month he’ll the foundation’s board. ‘‘I and Earl, we grew says. graduate from Lincoln University in Jeffer- up in tenements about 10 blocks from here. For Wallace, 18, who had never been away son City, Mo., with a B average—and no col- We all know what it’s like to struggle. We from St. Louis for more than two weeks, college debt. All his costs were covered by a St. know late bloomers.’’ lege has been ‘‘awesome and at times scary,’’ Louis foundation that rewards academically But the scholarship program has had its she says. ‘‘Everything seems a lot bigger. average students in financial need. failures and setbacks. About 40 percent of re- Even the bugs are bigger. I never killed bugs; ‘‘It took me two hours to do what my fel- cipients have washed out, and since Smart’s that’s what you have a daddy for.’’ low students could do in an hour, but I graduation, the foundation has dropped How- But classes at UAPB are smaller, she says, learned to survive in the world,’’ says Wood- ard and Virginia’s Hampton University be- than they were at Hazelwood Central High. son, 22. Unable to keep up taking notes, he cause of their high, private-college tuition. In the first couple of months of school she recorded lectures and played them back in Then, too, some scholarship recipients has become active in student government. his dorm room. ‘‘haven’t so much as said thank you,’’ Wilson She plays softball, and she has joined the Woodson is one of about 50 graduates of St. says. ‘‘That’s a real disappointment.’’ He ex- modeling squad, a group that puts on fashion Louis-area high schools who have received pects them to send him an invitation when shows. ‘‘There were a couple of times I wanted to full scholarships to historically black col- they graduate, and he wants all recipients— give up and go home,’’ she says. ‘‘But I’m be- leges and universities since 1998. The founda- and their parents—to sell tickets to the an- ginning to feel complete now. I never felt tion raises the money, in part, by sponsoring nual classic. an annual football ‘‘classic’’ between black In addition to the football game, which that way in high school.’’ college teams, devoting the proceeds to Wilson estimates has generated $3.5 million f scholarships and other charities. in 10 years, the foundation raises money ‘‘Average kids don’t get a chance because through charity golf and high school basket- THANKS DIANA ‘‘TOODLES’’ HAUF everybody gives to the cream of the crop,’’ ball events. Last year, it opened a $2.8 mil- says Earl Wilson Jr., a retired IBM executive lion sports complex near downtown St. Louis HON. JOHN T. DOOLITTLE who established the foundation a decade ago. that includes a computer laboratory for OF CALIFORNIA ‘‘It’s our way of giving back to the commu- after-school tutoring and a ‘‘Walk of Fame’’ IN THE HOUSE OF REPRESENTATIVES nity.’’ featuring prominent local African-Ameri- Wilson, 71, began his IBM career as one of cans. Friday, November 21, 2003 the company’s first black salesmen. He says About 20 percent of foundation revenue Mr. DOOLITTLE. Mr. Speaker, today my he understands students in the middle. ‘‘My- comes from corporate sponsors such as An- colleagues Mr. POMBO, Mr. OSE, and Mr. MAT- self and many of my colleagues were average heuser-Busch Inc., whose brand name SUI and I wish to express warm thanks, con- students or worse,’’ he says. ‘‘People at the Budweiser is attached to the football game. extremes get help. People in the middle ‘‘We raise 80 percent ourselves,’’ Wilson gratulations, and best wishes to Diana don’t.’’ says. ‘‘That’s extremely high for a founda- ‘‘Toodles’’ Hauf upon her retirement as Execu- Lawrence A. Davis Jr., chancellor of the tion like this. We are all about self-help. We tive Services Director and Concierge for University of Arkansas at Pine Bluff, whose don’t want anyone interfering with our inde- United Airlines, at the Sacramento Inter- Golden Lions play in the annual fall classic, pendence.’’ national Airport. With an always helpful and

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00002 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.118 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2425 pleasant demeanor, Toodles went above and many years to ensure the continuation of this to regional manufacturing manager, and then beyond, ensuring the utmost in customer serv- military presence on the eastside of New Mex- to acting general manufacturing manager for ice for those passengers so fortunate to be ico. In addition, he has always been extremely Chevrolet. In February of 1984, he became assisted by her. aware of how critical a congenial and produc- the manufacturing manager at the former Toodles began her 34-year career with tive relationship is between the air base per- Chevrolet-Pontiac-GM of Canada Group. From United Airlines in Buffalo, New York, on April sonnel and the local residents. Doc’s business 1985 to 1991, he was vice president in charge 28, 1969, where she began as the Station acumen, keen insight, delightful personality of manufacturing operations for GM’s Saturn Manager Secretary. In a few short years, and affable manner always served the com- Corp. subsidiary. In 1991, Guy was elected Toodles was given the opportunity to relocate munity well in this effort. vice president of GM and appointed group di- to Sacramento, California to assist in the Doc knew early on that Cannon was a key rector of operations for the truck group. In opening of the Red Carpet Club where she player in the economic health of Clovis. His 1996 he was named vice president and gen- continued to serve until it closed ten years exceptional efforts as a member of the Com- eral manager of the GM truck group until 2001 later. In 1984, Toodles was named Executive mittee of Fifty have clearly demonstrated when he became vice president and general Services Director for Premium Travelers. Doc’s sincere interest and concern for the bet- manager of vehicle manufacturing. Effective Noted for her outstanding organization and terment of his fellow residents. Even though May 1, 2003 Guy was appointed GM vice leadership, Toodles has provided exemplary managing his own successful business re- president of manufacturing, his new role will service to numerous Federal and State Rep- quired much of his time, he always made him- allow him to continue to work with the manu- resentatives, State and Local Officials and self available to be involved in activities that facturing leadership team to provide support Dignitaries. In addition to these responsibil- were critical in retaining the presence of Can- during the 2004 model-year product launches ities, Toodles directed the advance travel non Air Force Base, whether those be local, and the 2003 Labor negotiations. Guy is cur- preparations for Former Governor Deukmejian, state or national. rently the Chairman of the board for the Oak- Former Governor Wilson, and Former Gov- Doc Stewart is an outstanding member of land County (Michigan) Traffic Improvement ernor Davis. Toodles continued to facilitate su- his community and our state. Not only has he Assoc., and a member of the Bishop Inter- perior customer service as the Executive Serv- been dedicated to the efforts of the Committee national Airport Authority board of directors, ices Director and as a Concierge until her re- of Fifty, his additional involvement in commu- Executive Board member for the Detroit Area tirement. nity service has been invaluable. I invite my Council of Boy Scouts and GM’s key execu- Throughout her outstanding career with colleagues to join me in extending best wishes tive for the University of Wisconsin. United Airlines, Toodles has received numer- for a job well done and continued success in Guy Briggs has spent his entire career en- ous accolades for exceptional service. Most all Doc’s future endeavors. suring that GM remains the best in the world. notable, in 1988, she received the Airport f His loyalty to GM is evident by the number of Services Award, the Most Valuable Players moves he and his family have made. Aside Exemplary Service Award, and the Regional HONORING GUY D. BRIGGS from being an automotive enthusiast, Guy is a Award. In 1997, her hard work and dedication humble family man. He is a devoted husband were again recognized with the Division HON. DALE E. KILDEE to his lovely wife Karen and a devoted father Award. Furthermore, in addition to the above OF MICHIGAN to his five children. During his tenure Guy has mentioned acknowledgements, Toodles re- IN THE HOUSE OF REPRESENTATIVES earned the respect of his Company and its ceived two gold medal medallions for safety Friday, November 21, 2003 employees. He has a strong love for the Auto- and customer service. motive Industry and Flint, Michigan. Although Toodles’ tenure with United Air- Mr. KILDEE. Mr. Speaker, I rise before you Mr. Speaker, as a member of Congress, I lines has come to a close, her professional today to honor one of General Motors Cor- ask my colleagues in the 108th Congress to endeavors will continue to thrive as she em- poration’s (GM) finest, Mr. Guy D. Briggs, who please join me in congratulating my con- barks on a new career with Lyon Realtors in is retiring as GM’s Vice President of Manufac- stituent and my dear friend, Guy Briggs, on his Roseville, California. We are certain that the turing after 43 years of distinguished service retirement, and wishing him and his family the talents and skills that allowed her to excel on December 31, 2003. To recognize his ac- best in future endeavors. complishments, Guy will be honored during a while at United Airlines will serve her just as f well in her new career. plant wide celebration to be held in his honor Toodles vivacious and dynamic personality at the Truck and Bus Plant located in Flint, IN RECOGNITION OF L. JOEL will truly be missed. We thank Diana Michigan on December 1, 2003. MARTINEZ ‘‘Toodles’’ Hauf for her outstanding service Guy D. Briggs received a bachelor’s degree and wish her well in the future. in economics and an M.B.A. from the Univer- HON. CHRIS BELL sity of Michigan in 1960 and 1961, respec- f OF TEXAS tively. Upon graduating he hired in at General IN THE HOUSE OF REPRESENTATIVES HONORING DOC STEWART Motors Corporation (GM) as a college graduate in training, and was assigned to the Friday, November 21, 2003 HON. TOM UDALL Chevrolet Manufacturing Plant located in Flint, Mr. BELL. Mr. Speaker, I rise to honor the OF NEW MEXICO Michigan. While working at the Chevrolet life of L. Joel Martinez, a nationally known IN THE HOUSE OF REPRESENTATIVES Plant, Guy held several supervisory positions. AIDS activist who died Wednesday, November In 1969 he was selected for the Chevrolet Ex- 12, 2003. Mr. Martinez was the founding direc- Friday, November 21, 2003 ecutive Development Training program. Once tor of the Center for AIDS, a Houston-based Mr. UDALL of New Mexico. Mr. Speaker, I he completed the program he returned to his clearinghouse for treatment and research in- am honored to have the opportunity to ex- plant as the superintendent of manufacturing. formation. The center was founded in 1995 to press my heartfelt appreciation and congratu- In 1973 GM assigned Guy to the former Chev- address the lack of treatment and research in- lations to Doc Stewart, one of the treasures of rolet Parts Plant, located in Saginaw, Michigan formation available to the public. Eastern New Mexico. Considering all that Doc to assume the role of general superintendent Joel Martinez had a profound effect on the has done for Clovis and the surrounding com- of production, and a year later he transferred way pharmaceutical companies developed munities, how very appropriate it is that No- to the Saginaw Manufacturing Plant holding their drugs and the way they looked at issues vember 21, 2003, has been designated ‘‘Doc the same position. In September of 1975, Guy relating to people with HIV and AIDS. He met Stewart Day.’’ I salute Doc with great honor was appointed to the position of super- with companies to help change the guidelines and respect. intendent of production at the Saginaw Grey for clinical trials and encouraged them to do It would be very difficult to mention all that Iron Casting Plant, a position he maintained research and testing in Houston. He urged Doc Stewart has done to further the success until 1976 when he was promoted to manager companies to test drugs not just on gay, white of Clovis and the smaller communities that de- of the Chevrolet’s Pressed Metal Plant located males, but also on minorities, women and chil- pend on the services this eastside hub pro- in Parma, Ohio. After his stint away from dren. vides. In addition to the vital importance of home, Guy returned to Flint, Michigan in 1978 He was an excellent and articulate spokes- such as the excellent public schools, the busi- to become manager of the Chevrolet Engine person for people with HIV and AIDS and a ness community and the agriculture industry, Plant and to complete the Dartmouth College true leader in treatment advocacy issues. Mr. of great significance is Cannon Air Force Executive Development Program, which sub- Martinez was a community representative for Base. Doc has worked tirelessly for many, sequently led to his promotion in May of 1983 amFAR and the AIDS Clinical Trials Group.

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00003 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.123 E23PT1 E2426 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 He also was a voting member of a U.S. Food While Governor Turnbull is to be com- Fellow of the Royal Society of Health in Lon- and Drug Administration advisory committee mended for his response to that crisis and the don, England. As a member of the program that influenced the way the agency reviews succeeding ones he has faced, because of the committee of the Atlantic Economic Con- drugs during the approval process. special and unique burdens we face, history ference, an international group, he has pre- Most recently, he was involved in the AIDS informs that the necessary political resolve to sented papers in Paris, Rome, Puerto Rico, Treatment Activists Coalition, a national coali- put measures in place to address these prob- Scotland, and Munich on various hospital eco- tion of activists working to end HIV and AIDS lems, some of which will call for public sac- nomic topics. He has been a presenter at nu- by advancing research. rifice, is best found and sustained outside of merous seminars with John Goodman and As- Mr. Martinez was born in Harlingen, Texas the political process. sociates regarding Hospital Based Heart Cen- in 1953 to Luis and Teresa Martinez. He was It is for this reason that I am introducing the ters. salutatorian of the class of 1970 at Brownsville Virgin Islands CFO Act today. The CFO will be Nobly, Ed has committed a life of service to High School. A Rice University graduate, he empowered to oversee and approve all spend- Northwest Indiana through his work in the earned a law degree from the Columbia Uni- ing of the government of the Virgin Islands health care community. He has received the versity School of Law in New York in 1977. and be authorized by law to disapprove items Meritorious Service Award from the Munster He was an associate at Vinson & Elkins for of spending which would send the government Board of Trustees and a Special Award for six years before going into private practice in into financial deficit. The CFO position would Outstanding Leadership from the Munster 1983. He re-evaluated his life after he was di- sunset after five years and while he or she Medical Research Foundation. He is also a agnosed with HIV in 1987. In the early 1990s, would be appointed by the Governor of the founding member of the Board of Directors of the focus of public information on HIV and Virgin Islands from a list of names selected by Community Foundation, Inc. and the President AIDS was on prevention and not on treatment a search commission, and confirmed by the of the Board of Directors of Hospice of the and research. Mr. Martinez set about to im- Legislature, he or she will not be an ‘‘at-will’’ Calumet Area. He has also shared his time prove public information by making numerous employee of the government and could only with Board of the Northwest Indiana Sym- presentations on HIV and AIDS and by writing be removed for cause. phony, as well as serving as Co-Chairman of many articles in English and Spanish on re- Mr. Speaker, this is not an easy bill for me the Community Veterans Memorial Park in search and treatment of the disease. His sig- to introduce, but it is a necessary one at this Munster. nificant influence on HIV and AIDS research time. It is an action that I feel is in the best in- Mr. Speaker, Ed Robinson will be greatly and treatment helped so many people affected terest of all of my constituents and the respon- missed at The Community Hospital by all of by the disease. sible course of action for me to take. I ask for those who have served with this caring and I know my colleagues join me in honoring my colleagues support. compassionate man. At this time I ask that Joel Martinez for his exceptional life and pas- f you and my other distinguished colleagues sionate activism. I extend my heartfelt condo- join me in honoring and congratulating Mr. lences to his family and friends especially to CONGRATULATING EDWARD Robinson for an outstanding career, not only Vann Vaughan, his life partner of twenty-two ROBINSON in health care, but also in service to his com- years, his mother Teresa, his sisters Rebecca munity. Ed’s leadership and passion for his and Zoe, and his brother Harry. Joel Martinez HON. PETER J. VISCLOSKY career are to be commended, and his profes- was a great American who fought tirelessly for OF INDIANA sional absence from the Northwest Indiana those in need. His important work must con- IN THE HOUSE OF REPRESENTATIVES community will surely be missed. tinue until a cure for HIV and AIDS is found. Friday, November 21, 2003 f f Mr. VISCLOSKY. Mr. Speaker, it is with TRIBUTE TO WILLIAM (BILL) CHIEF FINANCIAL OFFICER FOR great sincerity and enthusiasm that I rise to LYONS, JR. THE GOVERNMENT OF THE VIR- congratulate Mr. Edward Robinson on his re- GIN ISLANDS tirement from The Community Hospital in HON. DENNIS A. CARDOZA HON. DONNA M. CHRISTENSEN Munster Indiana, where he served as the Hos- OF CALIFORNIA pital Administrator for 37 years. Mr. Robinson IN THE HOUSE OF REPRESENTATIVES OF THE VIRGIN ISLANDS has been a substantial fixture of the health IN THE HOUSE OF REPRESENTATIVES care community in Northwest Indiana and he Friday, November 21, 2003 Friday, November 21, 2003 will be greatly missed. Mr. CARDOZA. Mr. Speaker, I rise today to Mrs. CHRISTENSEN. Mr. Speaker, I rise Ed Robinson attended the University of pay tribute to Secretary William (Bill) Edward today to introduce legislation to create the po- Pittsburgh after receiving a highly competitive James Lyons, the V for his service to our Na- sition of Chief Financial Officer for the Govern- four-year scholarship from the American Le- tion and to his community. Bill was born in ment of the Virgin Islands. It is my hope and gion. After the completion of his under- Modesto, California to William, the IV, and intention that by temporarily placing the reins graduate college degree he was designated Mary Lyons on July 4, 1950. He attended of fiscal management of the Virgin Islands as a Distinguished Military Graduate by the school at Modesto High School in Modesto, government outside of the political arena we United States Air Force in 1950, when he re- California. Bill then attended college at Cali- will be able to end years of crisis management ceived his commission. fornia State University, Chico where he re- and place the islands on sound financial foot- With his commission, Ed served as a Cap- ceived his bachelor’s degree and secondary ing for the long term. tain in the United States Air Force for three teaching credential. Mr. Speaker, my beloved community, has years and was stationed in Korea with the Throughout his career Bill has become a been plagued over the years and several ad- Fifth Air Force and was also a staff officer for well-respected leader in the field of agriculture ministrations, by one economic or fiscal crisis the personnel at the headquarters of the and is consistently sought out for his exper- after another. If allowed to continue or recur, Eighth Air Force, Strategic Air Command. tise. Appointed by Governor Gray Davis and they have the potential of forcing us into total Knowledge has always been something val- confirmed by the California State Senate, Bill fiscal collapse. ued by Ed. He holds a Master’s Degree in Lyons, Jr. served as the Secretary of the Cali- The factors which have caused these crises Hospital Administration from the Graduate fornia Department of Food and Agriculture, are numerous and include among other things: School of Public Health of the University of from January 1999 to November 2003. As a the decline in our tourism sector due to the Pittsburgh, as well as a Master of Business rancher and businessman, Bill brought nearly demographic shift from cities of the Eastern Administration and a Bachelor of Arts Degree three decades of leadership and business ex- Seaboard to areas in the West and Midwest; from the same institution. Mr. Robinson was pertise to the department. As Secretary, Bill being hit by as many as 6 catastrophic hurri- awarded on Honorary Doctor of Laws Degree was responsible for a Department of 2,300 canes since 1989; and the fact that the terri- from Calumet College in May 1997. employees, and a budget of $250 million. Sec- tory’s geography mandates a large govern- Ed’s career as a health care professional retary Lyons’ key responsibilities included pol- ment workforce and necessitates the replica- has been multifaceted and world-renowned. icy development and implementation of pro- tion of many basic services. He has been published in numerous profes- grams that support California’s $27 billion agri- When the current administration of Governor sional journals and received first prize in the cultural industry. He was responsible and suc- Charles W. Turnbull took office in January of ‘‘Hospital Topics’’ editorial National-wide com- cessful in implementing the marketing cam- 1999, the territory was in a fiscal state of enor- petition for his thesis on ‘‘Nursing Staffing Pat- paign of the ‘‘Buy California’’ program in the mous and alarming proportions. tern in an Intensive Care Unit.’’ Ed is also a state. While Secretary, Bill served as president

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00004 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.126 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2427 of the Western Association of State Depart- FLAWED ELECTIONS IN THE ties detained some 200 opposition campaign ments of Agriculture, chair of the Specialty CAUCASUS workers and supporters. On election day, they Crop Task Force for the National Association did whatever was necessary to win in a land- of State Departments of Agriculture, and chair- HON. CHRISTOPHER H. SMITH slide. The final judgement of the OSCE elec- man of the Agricultural Worktable for the U.S.- OF NEW JERSEY tion observation mission was that ‘‘the overall Mexico Border Governors’ Conference. IN THE HOUSE OF REPRESENTATIVES process failed to provide equal conditions for In California’s great Central Valley, the Friday, November 21, 2003 the candidates. Voting, counting and tabula- Lyons family has been engaged in production tion showed serious irregularities, including Mr. SMITH of New Jersey. Mr. Speaker, as agriculture for more than 75 years. Secretary widespread ballot box stuffing.’’ The Armenian we approach the end of session, I would like Lyons managed the 6,000-acre ranch located Assembly of America on March 18 noted that to take note as Helsinki Commission Chair- in the Modesto area from 1976 to 1999. The ‘‘the people of Armenia deserved nothing less man of a very disturbing trend in the ranch produces a number of crop and live- than the declared aim of their government for Caucasus republics of Armenia, Azerbaijan stock commodities. free, fair and transparent presidential elec- and Georgia. At this very moment, thousands tions. As reported in depth by the OSCE, this Bill currently serves as a member of the of Georgians are engaging in a campaign of achievable standard was not met.’’ California Water Commission and on the civil disobedience in the wake of the Novem- There was some improvement in the May Board of the California Department of Food ber 2 parliamentary elections. Georgian and parliamentary contest, concluded the OSCE, and Agriculture. From 1993 to 1999, Bill international monitors registered large-scale especially in the campaign and media cov- served as chairman of the USDA’s Farm Serv- falsification and ballot stuffing, not to mention erage. Nevertheless, the election ‘‘fell short of ice Agency state committee. Bill was also ap- the exclusion of many thousands of eligible international standards . . . in a number of pointed by the Stanislaus County Board of Su- voters. When the Central Election Commission key respects, in particular the counting and pervisors to serve from 1996 to 1998 as gave the largest tallies to President tabulation of votes.’’ founding director of the East Stanislaus and Shevardnadze’s party and the nominally-oppo- In sum, Mr. Speaker, a discouraging and Toulmne County USDA Agriculture Stabiliza- sition but Shevardnadze-allied Revival Party, disturbing record for all three countries, tion and Conservation Service Committee, and opposition leaders organized large demonstra- marked by a consistent pattern of election rig- the Stanisulaus/San Joaquin Counties’ Cattle- tions in Tbilisi’s main street. There, in the rain ging by entrenched elites who have learned men’s Association. and cold, protesters spent days demanding that they can ‘‘get away with it.’’ The inter- Bill is a widely respected member of his the President’s resignation and new elections. national community is prepared to register dis- community and has greatly contributed to his Their efforts, born of rage and despair, have approval, by proclaiming these elections—in state and nation. The USDA has honored Sec- been peaceful and the authorities have so far diplomatic language, to be sure—short of retary Lyons on three occasions: in 1998 with acted with restraint. But Georgia faces a gen- OSCE norms. But there have never been any a certificate of appreciation; in 1997 with an uine crisis, make no mistake. After ten years other consequences for subverting the demo- award for excellence; and in 1996 with a na- of growing frustration at official incompetence cratic process. Nor have opposition parties tional environmental award. In 1995, the Cali- and corruption, the country’s impoverished anywhere been able to annul or change the fornia Farm Bureau Federation recognized him public has begun to resist business as usual. official results of a falsified electoral process, with a service award. The United States Jay- Eduard Shevardnadze, still lionized in the or even compel governments to negotiate with cees named him the Outstanding Young Man West for helping to end the Cold War as So- them. of American in 1984 and both the City of Mo- viet Foreign Minister, has long been deeply Perhaps Georgia, where the state is rel- desto and Stanislaus County has awarded him unpopular at home. Demands by successive atively weak and discontent widespread, will with various service commendations. In addi- U.S. administrations and international financial prove the exception—although it is alarming tion, California State University at Chico institutions to curb pervasive corruption have that President Shevardnadze has sent his awarded Bill in 2000 with a Distinguished gone unheeded. And the November 2 election sometime rival Aslan Abashidze, who runs the Alumni Award. was a harbinger of the presidential race in region of Ajaria like a Central Asian potentate, Secretary Lyon’s illustrious career also in- 2005, when Shevardnadze will not be eligible north to gain Moscow’s support. The prospect cludes various elected office positions in to run. All participants and analysts agree that of Russia propping up a shaky, illegitimate Stanislaus County such as: Member of the the outcome of this year’s parliamentary con- Georgian Government should send shivers Central Catholic High School Board of Direc- test will influence the coming succession. down the spine of any American. But until and tors, Chairman, Doctors Medical Center, and How the Georgian drama will play itself out unless an opposition movement registers Director, Modesto Irrigation District. Bill also is hard to predict. But it is clear that Georgia some tangible success, the men in charge of worked as a Religion teacher at Saint is not alone in suffering through a crisis of the destinies of Armenia, Azerbaijan and Stanislaus elementary school, in Modesto trust and legitimacy. On October 17, Azer- Georgia have no reason to change course. California. baijan held presidential elections that, accord- What they are doing works and it benefits ing to OSCE observers, did not meet inter- them, even if it harms their countries’ chances Throughout his lifetime, Secretary Lyons national norms. Serious clashes between op- of developing democracy. has demonstrated a deep commitment to com- position backers and the authorities erupted in Even worse, there is little reason to expect munity service. Throughout the years, he has which at least one person was killed and hun- changes for the better. For years, optimists worked with countless community organiza- dreds were injured. Law enforcement agencies maintained that however discouraging things tions such as the Salvation Army, United Way, arrested hundreds of opposition activists; were, time and constant pressure from Wash- American Cancer Society, the Modesto Cham- though most have since been released, ac- ington and the international community would ber of Commerce, and Camp Sylvester, a cording to human rights groups, many were bring gradual change. As we approach 2004, local youth camp. Additionally, he has beaten in detention. The Azerbaijani election, the 13th year of independence for the former coached sports teams for nearly two decades. moreover, marked the transfer of power from Soviet republics, that prognosis seems in- It is my pleasure to join the Stanislaus com- President Heydar Aliev to his son, establishing creasingly pollyanish. The consolidation of rul- munity in recognizing Secretary Bill Lyons, Jr. the first family dynasty in the former Soviet ing groups, determined to remain in power, in for his commitment to his community, state Union. But Ilham Aliev has begun his term control of the state’s law enforcement and ju- and nation. I have personally known the Lyons under a shadow, tainted by an election seen dicial agencies, and disposing of significant family for over two decades. Bill Lyons, Jr. as unfair inside and outside the country and wealth, makes gradual evolution towards a and the entire Lyons family have a passion for marred by the accompanying violence. genuinely democratic mentality and practices California agriculture and for the values of Earlier this year, Armenia held presidential ever less plausible. Instead, we see evolution hard work and community service in the San elections in February and parliamentary elec- towards what some analysts call ‘‘semi-author- Joaquin Valley. Bill is a trusted and dear tions in May that also fell short of OSCE itarian’’ states and others, with reference to friend. I look forward to our continued friend- standards. In February, thousands of pro- the Middle East, term ‘‘liberal autocracies.’’ ship and to his wise counsel, and know that testers marched in the snowy streets of Mr. Speaker, this admittedly depressing Bill’s future path will continue to benefit Cali- Yerevan; perhaps their numbers kept Presi- analysis leads to several worrisome conclu- fornia agriculture and all of us in the San Joa- dent Robert Kocharian from claiming a first sions. First, political opposition and publics in quin Valley. It is a pleasure to represent Bill round victory and forced him into a runoff—a the Caucasus have concluded that electoral and the entire Lyons family in the 18th Con- first for a sitting president in the Caucasus. processes are hopelessly corrupted and offer gressional District of California. Between the two rounds, however, the authori- no prospect of fairly competing for power or

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00005 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.130 E23PT1 E2428 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 even trying to influence policymaking. Accord- His list of awards and achievements is re- will miss her presence on Capitol Hill. Barbara ingly, they are increasingly inclined to mobilize markable. He was a Kiwanian of the Year and Reynolds’s retirement is well earned. She against their leaders and governments. Even had 50 years of perfect attendance at the plans to pursue her hobby of boating on the though victories have thus far eluded them, Kiwanis Club of Bossier. He was inducted into Chesapeake with her husband, Bob, as well this turn to the ‘‘street’’ bespeaks a perennial the Louisiana High School Athletic Hall of as continue to be a loving mother and grand- politics of resentment instead of compromise Fame and the Northwestern Educators’ Hall of mother to her two grown children and to her and consensus-building. Second, the gulf be- Fame. He was a recipient of the Air Force grandchildren. We all wish her many blessings tween rulers and ruled has obvious implica- R.O.T.C. Outstanding Service Award. and much happiness in the years to come. tions for stability and democracy. Ruling elites Despite all of these achievements, Mr. Thank you Barbara, for your service to my will try to tamp down actual protest and curb Lampkin will best be remembered as a hus- office, the people of Florida, and the many society’s organizing capability, infringing on band, a father, a mentor, a neighbor, and a others with whom you have worked on Capitol their basic liberties; this, in turn, will upset the friend. Hill. delicate balance between state and society. Frank Lampkin was an inspiring member of f Change, when it comes, may be violent. his community and I am pleased to have had CONFERENCE REPORT ON H.R. 2417, Steadily losing hope, many Armenians, a chance today to share some of the high- Azerbaijanis and Georgians will likely opt out INTELLIGENCE AUTHORIZATION lights of his life with those who never had the ACT FOR FISCAL YEAR 2004 of politics altogether. Many others will emi- chance to meet him. grate if they can. This trend has been marked f SPEECH OF for years in all three countries; Armenians often try to come to the United States; while COMMENDING BARBARA REY- HON. RON PAUL Azerbaijanis and Georgians find it easier to NOLDS FOR HER YEARS OF OF TEXAS move to Russia. But the departure of these SERVICE ON CAPITOL HILL IN THE HOUSE OF REPRESENTATIVES highly motivated individuals and their families, Thursday, November 20, 2003 who often find ways to prosper in their adopt- HON. DAVE WELDON Mr. PAUL. Mr. Speaker, I rise with great ed homes, weakens their homelands. OF FLORIDA concerns over the Intelligence Authorization Washington has observed these tendencies IN THE HOUSE OF REPRESENTATIVES Conference Report. I do not agree that Mem- with concern but little action. Democracy-build- Friday, November 21, 2003 bers of Congress should vote in favor of an ing programs may help develop civil society authorization that most know almost nothing but have little impact on leaders who pursue Mr. WELDON of Florida. Mr. Speaker, I about—including the most basic issue of the their own interests and are quite prepared to come to the floor today to pay tribute to a level of funding. dismiss the State Department’s criticism of yet long-time member of my staff who is retiring What most concerns me about this con- another rigged election—even if, as happened this December. Barbara Reynolds has worked ference report, though, is something that yesterday, the Department, in unprecedentedly for me as my scheduler and executive assist- should outrage every single American citizen. strong language, said the Georgian election ant since I was elected in 1994. Barbara’s ca- I am referring to the stealth addition of lan- ‘‘results do not accurately reflect the will of the reer on Capitol Hill preceded mine by 13 guage drastically expanding FBI powers to se- Georgian people, but instead reflect massive years. This experience, along with her talent cretly and without court order snoop into the vote fraud in Ajara and other Georgian re- and willingness to accommodate the busy business and financial transactions of Amer- gions.’’ And while we are preoccupied with schedule of a Congressman, was invaluable. ican citizens. These expanded internal police Iraq and the war on terrorism, Moscow has Before coming to work on the Hill, Barbara powers will enable the FBI to demand trans- been steadily rebuilding its assets in these had been a stay-at-home mom, taking care of action records from businesses, including auto countries, buying up infrastructure in equity- her two children. She had never really given dealers, travel agents, pawnbrokers and more, for-debt deals and offering all possible support much thought to getting involved in the polit- without the approval or knowledge of a judge to those in power. ical world, but, in 1979, at the suggestion of or grand jury. This was written into the bill at Under these circumstances, Mr. Speaker, her father-in-law, she handed a resume to a the 11th hour over the objections of members our chances of influencing political evolution in friend at the Republican Policy Committee of the Senate Judiciary Committee, which Armenia, Azerbaijan and Georgia may not be and, in about a week, landed a job with then- would normally have jurisdiction over the FBI. very great. But they will diminish to zero un- Representative Carlos Moorehead from Cali- The Judiciary Committee was frozen out of the less we recognize the problem, and soon. fornia. This, however, was not her only job at process. It appears we are witnessing a f the time. Barbara often spent her weekends stealth enactment of the enormously unpopu- HONORING MR. FRANK M. as a professional model—many say she lar ‘‘Patriot II’’ legislation that was first leaked LAMPKIN, JR. looked just like Jackie Kennedy Onassis. Her several months ago. Perhaps the national out- modeling took her all over the world as well as cry when a draft of the Patriot II act was provided her with many commercial adver- leaked has led its supporters to enact it one HON. JIM McCRERY tising opportunities. As a result of this, some piece at a time in secret. Whatever the case, OF LOUISIANA current House maintenance workers who were this is outrageous and unacceptable. I urge IN THE HOUSE OF REPRESENTATIVES around at the time still refer to Barbara as each of my colleagues to join me in rejecting Friday, November 21, 2003 ‘‘Jackie’’ when they see her in the halls. this bill and its incredibly dangerous expansion Mr. MCCRERY. Mr. Speaker, October 24th In 1985 Barbara began working for then- of Federal police powers. of this year, Louisiana and the United States Representative and eventual presidential can- I also have concerns about the rest of the lost a fine American and a good friend. Frank didate Jack Kemp. In addition to working in his bill. One of the few things we do know about Lampkin, Jr. of Bossier City passed away at personal office she also worked on his cam- this final version is that we are authorizing the age of 79. Though he has passed away, paign in New Hampshire. even more than the president has requested he leaves behind a rich legacy and a commu- After working with Jack Kemp, Barbara for the intelligence community. The intel- nity made better by his good work. moved on to work for my Florida colleague, ligence budget seems to grow every year, but Mr. Lampkin was a giver in every sense of Representative CLIFF STEARNS in 1988. Bar- we must ask what we are getting for our the word. He gave to his country as a Ser- bara spent six years working for Representa- money. It is notoriously difficult to assess the geant in the Marines. He gave his time and tive STEARNS where she established her Flor- successes of our intelligence apparatus, and energy, inspiring the children of Northwest ida roots. perhaps it is unfair that we only hear about its Louisiana as a teacher, a coach, and a prin- In 1995 Barbara came to work for me and failures and shortcomings. However, we can- cipal for more than three decades. He raised has worked in my Washington office since my not help but be concerned over several such a family. And he continued to find ways to first day in office. I am incredibly grateful for failures in recent years. Despite the tens of bil- give back even more to his community. her loyalty to my staff and me. It will be nearly lions we spend on these myriad intelligence Over the years Mr. Lampkin was an integral impossible to replace her uplifting spirit. Her agencies, it is impossible to ignore the failure member of campaigns like the Clean City presence in my office added a touch of class of our federal intelligence community to detect Committee, the Salvation Army Food Drive and style, which are sometimes hard to find in and prevent the September 11 attacks. Addi- and Bell Ringing, Shots for Tots, and awards the world of politics. tionally, it is becoming increasingly obvious programs to inspire learning in elementary I, along with her coworkers and others out- that our intelligence community failed com- school children. side my office whose lives she has touched, pletely to accurately assess the nature of the

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00006 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.133 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2429 Iraqi threat. These are by any measure grave rado Irrigation District’s service area are Organization subject to FERC oversight in the failures, costing us incalculably in human lives hooked up to recycled water lines that run in U.S. Having been so recently reminded that and treasure. Yet from what little we can know the front and back of the properties which con- transmission system failures and system reli- about this bill, the solution is to fund more of serves precious drinking water. However, if ability do not respect state or international the same. I would hope that we might begin current trends continue, which all indications boundaries, it is essential that this legislation coming up with new approaches to our intel- say they will, other alternative sources of protect consumers in one state from actions or ligence needs, perhaps returning to an em- water will be required in order to keep up with events in another. Under the plain language of phasis on the proven value of human intel- demand. To avoid a crisis, the District is in the new FPA section 215 (i)(3), no state may take ligence and expanded linguistic capabilities for process of developing a comprehensive plan any action with respect to the safety, ade- our intelligence personnel. to protect against multiple-year drought quacy and reliability of electric service within I am also concerned that our scarce re- events. The Alder project would be a key com- that State if that action is determined by the sources are again being squandered pursuing ponent in the Districts overall drought protec- Electric Reliability Organization or by the Fed- a failed drug war in Colombia, as this bill con- tion strategy that would also include water eral Energy Regulatory Commission to be in- tinues to fund our disastrous Colombia policy. banking and intergovernmental agreements. consistent with any reliability standard. A re- Billions of dollars have been spent in Colom- Mr. Speaker, I would ask that this legislation gional entity that satisfies the requirements of bia to fight this drug war, yet more drugs than be given prompt consideration so that the ben- new section 215 (e)(4) may propose to the ever are being produced abroad and shipped efits of this important project can be realized Electric Reliability Organization reliability into the United States—including a bumper in a timely manner. standards that reflect regional differences, and crop of opium sent by our new allies in Af- f ghanistan. Evidence in South America sug- the Electric Reliability Organization may ap- INTRODUCTION OF THE ‘‘NA- gests that any decrease in Colombian produc- prove such proposed standards when justified. TIONAL FILM PRESERVATION tion of drugs for the US market has only re- f sulted in increased production in neighboring ACT OF 2003’’ countries. As I have stated repeatedly, the so- HON. JOHN CONYERS, JR. TRIBUTE TO PASTOR EPHRAIM lution to the drug problem lies not in attacking AND MRS. CARRIE SUE WILLIAMS the producers abroad or in creating a milita- OF MICHIGAN rized police state to go after the consumers at IN THE HOUSE OF REPRESENTATIVES home, but rather in taking a close look at our Friday, November 21, 2003 HON. ROBERT T. MATSUI seemingly insatiable desire for these sub- Mr. CONYERS. Mr. Speaker, I am pleased OF CALIFORNIA stances. Until that issue is addressed we will to announce the introduction of the National continue wasting billions of dollars in a losing Film Preservation Act of 2003, which reauthor- IN THE HOUSE OF REPRESENTATIVES battle. izes the National Film Preservation Act of In conclusion, I strongly urge my colleagues Friday, November 21, 2003 1996. to join me in rejecting this dangerous and ex- We all know that motion pictures are Mr. MATSUI. Mr. Speaker, I rise in tribute to pensive bill. amongst this nation’s cultural treasures, going Pastor Ephraim and Mrs. Carrie Sue Williams f beyond entertainment to represent American as they celebrate a personal milestone. On THE ALDER CREEK DROUGHT ideals and values to people across the world. November 22, 2003, Pastor Williams and his PROTECTION PROJECT Unfortunately, the films on which many motion beloved wife will celebrate their 50th wedding pictures are created are easily susceptible to anniversary. As their friends and family gather HON. JOHN T. DOOLITTLE physical deterioration; in fact, over fifty percent to commemorate this momentous occasion, I OF CALIFORNIA of movies made before 1950 have deterio- ask all my colleagues to join me in wishing IN THE HOUSE OF REPRESENTATIVES rated and over ninety percent of movies from one of Sacramento’s most revered couples a Friday, November 21, 2003 before 1929 have disintegrated. happy anniversary and continued happiness in Mr. DOOLITTLE. Mr. Speaker, I rise today The 1996 Act was designed to ensure that the future. we could protect the treasures we still have. It to introduce The Alder Creek Water Storage For the past 32 years, Mr. and Mrs. Wil- created the National Film Preservation Board and Conservation Project Act. This legislation liams have served with great class, dignity, will authorize The U.S. Bureau of Reclama- and the National Film Preservation Founda- tion. The NFPB generates public awareness of and distinction as the Pastor and First Lady of tion, in cooperation with the El Dorado County the St. Paul Baptist Church in Sacramento Irrigation District, to conduct a study to deter- a national film registry and reviews initiatives to ensure the preservation valued films. The California. As Pastor, Mr. Williams has played mine the feasibility of constructing a water an instrumental role in directing and coordi- storage project on Alder Creek in El Dorado NFPF issues grants to libraries and other institutions that can save films from degradation. nating all aspects of the St. Paul Missionary County, California. Baptist Church. Pastor Williams made vital de- The Alder Creek Water Storage and Con- The program has received accolades from organizations such as the Directors Guild of cisions related to staffing, church organization servation Project would include the construc- structure, finances, and the modification of fa- tion of a dam and 31,700 acre foot reservoir America and the Academy of Motion Picture Arts and Sciences. Noted filmmakers Martin cilities. Pastor Williams was the driving force that would yield approximately 11,500 acre behind the construction of a seventy-nine feet of additional water supply per year. A Scorsese and Ken Burns also have praised the NFPB and the NFPF. square foot edifice, which includes an adminis- major advantage of this location is the ability tration wing, sanctuary, fellowship hall and to deliver this water by gravity into El Dorado Unfortunately, the program officially expired October 11, 2003, and was not reauthorized. classroom wing. Pastor Williams spearheaded Irrigation District’s existing water delivery sys- a 7-year effort that liquidated a $4 million debt tem and to the American River to increase in- The legislation being introduced today would remedy that oversight by reauthorizing both for the church so that it could cover the $7.7 stream flows for the propagation of fallrun Chi- million that was required for the construction nook salmon and Steelhead trout. the NFPB and the NFPF. I hope my col- Like many communities in the arid West, El leagues will join me in supporting this valuable project. Pastor Williams is currently leading Dorado County faces water supply shortages effort as we move it through the House. the church in the building of a multi million-dol- that threaten people, cities, farms and the en- f lar Family Life Center that will include a gym- nasium, classrooms, computer lab, dance vironment. The El Dorado Irrigation District, CONFERENCE REPORT H.R. 6 which serves over 100,000 of my constituents, rooms, nursery, office space, library, weight is charged with the difficult task of providing a SPEECH OF room and conference room. Pastor Williams’ safe and reliable water supply throughout the HON. W.J. (BILLY) TAUZIN commitment to improve the church is great region for all of these competing interests. Se- proof of his willingness to work hard to im- OF LOUISIANA vere drought periods, like we are experiencing prove the lives of other people. IN THE HOUSE OF REPRESENTATIVES now, and explosive growth rates that are oc- Mrs. Carrie Sue Williams is a former busi- curring in portions of El Dorado County, have Tuesday, November 18, 2003 ness owner and she has brought her trade- made this task even more arduous. EID de- Mr. TAUZIN. Mr. Speaker, the Energy Policy mark grace and dignity to her role as the First serves great credit for developing alternative Act of 2003, among other things, would au- Lady of St. Paul Baptist Church. As the First sources of water, such as recycled water, to thorize the promulgation of mandatory and en- Lady, Mrs. Williams regularly visits the sick ease the burden of inadequate supplies. In forceable standards for the North American and the confined. She also counsels women fact, all new developments within The El Do- transmission system by an Electric Reliability and couples. Mrs. Williams helped to design

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00007 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.136 E23PT1 E2430 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 the St. Paul Children and Youth Reading Min- iat featured prominently. When asked about that the provision of improved medical care istry, a program that is designed to motivate what inspired him with the coin’s design, Dan- and disease-related pre-ESRD educational and reward children for their reading efforts. iel simply said, ‘‘I toyed around with putting and counseling services to advanced chronic Pastor Williams is undoubtedly one of the the Alamo in, but Texas is so much more than kidney disease patients prior to their pro- strongest civic leaders in the Capital Region. just the Alamo.’’ gressing to end-stage renal status has multiple Pastor Williams’ leadership capacities have in- Indeed, Texas is much more than the positive effects. The provision of these pre- cluded: President of United Pastors of Sac- Alamo. Its rich history and people can hardly ESRD services slows down the progression ramento, Vice President of the National Bap- be summed up in a coin, but Mr. Miller has toward ESRD status, decreases the occur- tist Convention, U.S.A., Inc, President of the gamely risen to the task. Although a native rence and intensity of related diseases and California State Baptist Convention and Presi- Minnesotan, having come to Texas only 15 decreases overall mortality rates. By allowing dent of the Northern District Baptist Associa- years ago, Daniel’s design tells me that the uninsured patients with advanced kidney dis- tion. Pastor Williams is the current President blood of a true Texan runs through his veins. ease to access care prior to qualifying for of the Oak Park and St. Paul Community Out- Daniel’s inspired work will soon be familiar Medicare due to an End Stage Renal Disease reach Program. to millions of people across this great nation. diagnosis, this bill wisely and appropriately ad- Pastor and First Lady Williams are the Whether they collect or spend the Texas quar- dresses a critical unmet health need. proud parents of Gwen and Ephraim Jr., alter, I believe that a little bit of the Texas spirit Under the Medicare Chronic Kidney Disease though he has since passed on. They also will rub off on everyone who encounters Dan- Management Act, uninsured, pre-ESRD chron- enjoy the love and companionship of their four iel’s work of art. ic kidney disease patients would be eligible for grandchildren and three great grandchildren. Mr. Speaker, I am proud of Daniel and his full Medicare coverage and pre-ESRD coun- Mr. Speaker, I am honored to congratulate work to recognize Texas’s great history. I seling and educational services. To be eligible, Pastor Williams and First Lady Williams on know my colleagues will join me in congratu- a physician would need to certify that a chron- their 50th wedding anniversary. As the family lating Daniel Miller as we celebrate his design ic kidney disease patient has reached a level and friends of the Williams family gather to for the Texas State quarter. We salute him of kidney functioning deterioration predictive of celebrate this terrific milestone, I would like to today. a need for dialysis or a transplant in the next especially thank Pastor Williams and First f 11⁄2 years under a widely accepted clinical Lady Williams for all their great service to their INTRODUCTION OF THE MEDICARE standard. Individuals eligible under the bill community. I ask all my colleagues to join with CHRONIC KIDNEY DISEASE MAN- would pay Medicare Part B premiums. Pre- me in wishing Pastor Ephraim Williams and AGEMENT ACT OF 2003 ESRD educational and counseling services First Lady Carrie Sue Williams continued suc- provided by this legislation address treatment cess in all their future endeavors. HON. FORTNEY PETE STARK options, disease management, and nutrition. f OF CALIFORNIA These new services would also be available to IN THE HOUSE OF REPRESENTATIVES current Medicare enrollees who become diag- PERSONAL EXPLANATION nosed with chronic kidney disease. Friday, November 21, 2003 This bill also requests that the Secretary of HON. XAVIER BECERRA Mr. STARK. Mr. Speaker, I rise today to in- Health and Human Services establish at least OF CALIFORNIA troduce the Medicare Chronic Kidney Disease 2 demonstration projects in cooperation with IN THE HOUSE OF REPRESENTATIVES Management Act of 2003. My bill would ex- recognized kidney patient organizations, to de- pand Medicare eligibility for uninsured patients vise ways, or demonstrate means through Friday, November 21, 2003 with advanced chronic kidney disease before which peer education procedures can slow Mr. BECERRA. Mr. Speaker, on Monday, their condition progresses to end-stage renal progress to ESRD and improve outcomes for November 17, 2003, I was unable to cast my disease (ESRD) status. The bill would provide patients with this disease. floor vote on rollcall numbers 620, 621, 622, access to healthcare and most importantly dis- Today, more than 300,000 individuals are and 623. The votes I missed include rollcall ease management and pre-ESRD educational covered under the Medicare ESRD program. vote 620 on the Motion to Suspend the Rules and counseling services. It would improve the By 2010, it is expected that this number will and Pass S.J. Res. 22, Recognizing the Agri- health and quality of life for those suffering more than double. This bill, which is supported cultural Research Service; rollcall vote 621 on from kidney disease and could provide real by the National Kidney Association and the the Motion to Suspend the Rules and Pass savings for the Medicare program by helping American Association of Kidney Patients, will S.J. Res. 18, Commending the Inspectors chronic kidney disease patients delay costly help minimize the damaging impact of this General; roll call vote 622 on the Motion to dialysis treatments and kidney transplants as- chronic illness and slow the growth of individ- Suspend the Rules and Agree to H. Con. Res. sociated with the end stage status of the dis- uals suffering from ESRD. By delaying the 299, Honoring Sargent Shriver; and rollcall ease. need for either dialysis or transplantation, one vote 623, on the Hour of Meeting. ESRD patients are the only group of pa- can also anticipate substantial cost savings to Had I been present for the votes, I would tients eligible for Medicare enrollment solely the government. I urge my colleagues to join have voted ‘‘aye’’ on roll call votes 620, 621, due to their medical diagnosis. ESRD is char- me in supporting the Medicare Chronic Kidney 622, and 623. acterized by a permanent loss of kidney func- Disease Management Act so we can make f tion, which results in the need for dialysis these vital improvements to the Medicare pro- treatments or kidney transplantation in order to gram for those who suffer from chronic kidney HONORING MR. DANIEL MILLER sustain life. Under current law, a physician disease. OF ARLINGTON, TEXAS, TO REC- must certify that an individual’s kidney func- f OGNIZE HIS DESIGN OF THE tions have deteriorated to end-stage status for TEXAS STATE QUARTER a patient to be eligible for the Medicare ESRD TRIBUTE TO JENNIFER DOWNEY program. Subsequently, there may be an addi- OF CLINTON TOWNSHIP, MICHIGAN HON. MARTIN FROST tional waiting period of up to 3 months de- OF TEXAS pending on the type of dialysis procedure cho- HON. SANDER M. LEVIN IN THE HOUSE OF REPRESENTATIVES sen by the patient before the individual be- OF MICHIGAN Friday, November 21, 2003 comes eligible for benefits. Thus, benefits are IN THE HOUSE OF REPRESENTATIVES only received after the cessation of adequate Friday, November 21, 2003 Mr. FROST. Mr. Speaker, I rise today to kidney functioning. honor Daniel Miller of Arlington, Texas. Daniel The cost to the Federal Government for pro- Mr. LEVIN. Mr. Speaker, it is with genuine is the artist who designed the Texas State viding care to an ESRD patient is very high. pleasure that I rise to recognize one of my quarter, which will debut in 2004 and will be The average per capita expense for all ESRD constituents, Jennifer Downey of Clinton the 28th in the series of state commemorative patients was $33,282 in 2000, approximately 8 Township, Michigan, for her recent promotion quarters from the U.S. Mint. His design was times the annual cost of care for the average to Chief Petty Officer in the U.S. Naval Sea picked from over 3000 entries. Medicare beneficiary. The annual cost for in- Cadet Corps. Daniel has gracefully and accurately cap- center hemodialysis, the most frequent form of The U.S. Naval Sea Cadet Corps was es- tured the spirit of our great State. The Texas dialysis used, approaches $55,000. tablished in 1958 to develop an appreciation State quarter will feature a Lone Star springing There has been a substantial amount of re- for the United States’ naval history, customs, from the outline of a map of Texas, with a lar- search within the past several years indicating traditions, and its significant role in national

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00008 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.140 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2431 defense. The goal of the Cadet Corps is to en- basis of reasonable beliefs and assumptions, Barry University community this December. courage young people to develop an interest not proven facts. Most notably, there is ref- Sister Jeanne is the president of Barry Univer- in basic seamanship and teach cadets patriot- erence to Syria’s ‘‘hostile actions’’ in regard to sity, which is located in Miami Shores, Florida. ism, courage, confidence and self reliance. the United States and our troops in Iraq. Al- Since becoming president in 1981, Sister Cadet CPO Downey has been a member of though our suspicions are well founded, there Jeanne has worked endlessly to increase the the Naval Sea Cadet Corps Program’s Tomcat is as yet no proven connection between the reputation and endowment of Barry University, Squadron for over 5 years. She has com- government of Syria and terrorism in Iraq. raise hundreds of millions of dollars for her pleted a large number of advanced training I have concerns the President may not draw student’s aid, and create a student body and courses over her tenure in the program, in- this distinction and take these words as alumni that stretches 70 countries, ranking cluding seamanship training aboard the grounds for pursuing preemptive military ac- number one in diversity among southern re- USNSCS Grayfox, Coast Guard training, Mas- tion. gional universities. ter at Arms School, and Petty Officer Leader- Frankly, Mr. Speaker, I don’t trust this Presi- Sister Jeanne O’Laughlin was born and ship Academy. In addition, she has completed dent. His actions toward Iraq have clearly raised in Detroit, Michigan where she first sixty-four hours of community service and won demonstrated his willingness to lie to the learned what it meant to love and educate. As numerous citations and ribbons. American people. But, they also underscore a little girl, she realized that in order to stop Cadet CPO Downey’s promotion to Chief his willingness to use force indiscriminately hatred, crime, and injustice, education must be Petty Officer was brought to my attention in a without the burden of proof. the first priority on any agenda. Sister recalls letter from her Commanding Officer, LTJG I cannot support a resolution that might be the story when she was a 13-year old girl Lisa Stoyanovich, who writes me to say that used as a vehicle for the President to act riding a streetcar in Detroit, she noticed a CPO Downey ‘‘is a very personable young counter to the interest of the American people. black woman enter the car with four small chil- woman who takes pride in herself and her I vote ‘‘no’’ on this resolution. dren. As the streetcar lurched forward, one of unit. CPO Downey’s performance of her duties f the children fell into her lap. Without hesi- is always top-notch, her leadership abilities tating, young Jeanne gladly held the young are exceptional, and her ability to motivate HONORING THE BASIC HIGH child for the remainder of the ride. Later, as a other cadets is finely tuned. Through her years SCHOOL MJROTC UNIT man departed the streetcar, he walked by and of Navy League Cadet and Naval Sea Cadet spit on young Jeanne. training, she has earned the respect of her HON. JON C. PORTER Startled by what occurred, Jeanne asked peers, and the officers in the unit.’’ OF NEVADA her father later that evening why the man spit The letter from Lieutenant Stoyanovich goes IN THE HOUSE OF REPRESENTATIVES on her. Jeanne’s father replied, ‘‘prejudice’’. on to say that ‘‘Chief Petty Officer Downey Innocently, Jeanne asked, ‘‘how do you stop has developed into a mature, solid leader and Friday, November 21, 2003 that?’’ ‘‘Education’’ was her father’s answer. is a fine example of what the Sea Cadet Mr. PORTER. Mr. Speaker, I rise today to This simple response began a vision. A vision Corps hopes to develop in young people.’’ honor the Basic High School Marine Corps we honor today. I ask all my colleagues to join me in con- JROTC unit. I am proud to represent this out- The Adrian Dominican Sisters founded gratulating Chief Petty Officer Jennifer Dow- standing group of young men and women and Barry University in 1940, as a university dedi- ney for her achievements as a member of the urge the entire House to join me in com- cated to educating women. Since then, the U.S. Naval Sea Cadet Corps. mending them today. University has continued to be administered f The MJROTC unit at Basic High, in Hender- by women, including the last 22Ðyears with son, Nevada is one of the top JROTC units in Sister Jeanne at the helm. My first year in the OPPOSING THE SYRIA the country, having been recognized as a people’s House, was also Sister’s first year as ACCOUNTABILITY ACT Naval Honor School for the 2002Ð2003 school Barry president. The year was 1981, and for year. In addition, the Basic High MJROTC unit Sister Jeanne it was the beginning of an edu- HON. FORTNEY PETE STARK is the National Champion of the unarmed cational revolution. In 22 tremendous years, OF CALIFORNIA competition at the United States Air Force Barry has changed from a predominantly IN THE HOUSE OF REPRESENTATIVES Academy National Invitational Drill Meet women’s university of 2,000, into a diverse Friday, November 21, 2003 Championship, and has won seven times in campus of 8,500. She has raised nearly $170 Mr. STARK. Mr. Speaker, I rise in opposi- the last 9 years. The Basic High armed com- million for the university since she took office tion to this bill despite being one of its cospon- petition unit has won the National Champion- and has seen the university contribute nearly sors and having voted for it when it came be- ship every time it has competed. $200 million to South Florida’s economy last fore the House on October 15th. Basic High MJROTC is not only a champion year. I strongly believe Syria’s actions ought to be on the drill field; it is also a champion in pro- Under the supervision of Sister Jeanne, called into question. To say this regime is a ducing young men and women of character. Barry has been able to sustain in excess of bad actor is putting it mildly. Their actions are Basic High MJROTC has been an active part 1,000 employees, up from 340 when Sister rightly condemned, especially when it comes of honoring Veterans Day in Henderson, with Jeanne started in 1981. Barry’s budget has to their tacit support for terrorism and ongoing the whole battalion presenting the colors for also increased dramatically rising from $8.3 occupation of Lebanon. The United States the City of Henderson ceremony. The unit also million to a staggering $100 million. Barry’s ought to use the tools at our disposal—both led the local celebrations of the 228th anniver- endowment has also risen more than 2,000 political and economic—to demand an end to sary of the founding of the U.S. Marine Corps. percent to $22 million during the past 22 their egregious policies. I want to thank the members of the unit, and years. The university now offers seven doc- There is, however, a reason why I am vot- instructors Lieutenant Colonel Montgomery, toral degrees, including the only Doctor of ing against this resolution. It is based on my Master Gunnery Sergeant Ignatz, and First Podiatric Medicine in the Southeast, and only long held reservations about the President’s Sergeant Rael for standing always faithful, seven universities in the country to offer such intentions on foreign policy. Given his bellig- ‘‘Semper Fidelis,’’ to the best traditions of Ne- a degree. During her term as president, Sister erent declarations yesterday, I have genuine vada, America, and the U.S. Marine Corps. Jeanne has inspired those around her to give concerns that he may seek authority in this f more and more of themselves to better the resolution to pursue aggressive military action lives of the students of Barry University. A tire- against Syria. HONORING SISTER JEANNE less educator, Sister Jeanne has not only con- After all, Mr. Speaker, this President did not O’LAUGHLIN tributed greatly to Barry University, but also to need much to march to war against Iraq. At many other institutions around Florida and the best, the evidence was soft, the intelligence HON. E. CLAY SHAW, JR. nation. was trumped up and now not a grain of proof OF FLORIDA Sister Jeanne has served as chair of the can be found showing Iraq had any weapons IN THE HOUSE OF REPRESENTATIVES Council of Independent Colleges from 1994Ð of mass destruction. But, ultimately, President 1996, the chair of the Association of Catholic Friday, November 21, 2003 Bush used past declarations of Congress Colleges and Universities also from 1994Ð meant merely to reprimand Iraq for its policies Mr. SHAW. Mr. Speaker, I rise today in rec- 1996, and as an Executive Council member of to justify full-blown war against that regime. ognition of the amazing life and contributions the Southern Association of Colleges and This resolution today contains provisions of Sister Jeanne O’Laughlin, OP, Ph.D., as Schools’ Commission on Colleges from 1991Ð that rightly admonish Syria, but do so on the she prepares to retire from service to the 1996. Just in Florida alone, Sister Jeanne has

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00009 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.145 E23PT1 E2432 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 served as president of the Florida Association dependent children of veterans with perma- mittee, I strongly support strengthening bene- of Colleges and Universities and chairman of nent total disabilities, or who have died as a fits for our Nation’s veterans, who have fought the Independent Colleges and Universities. As result of combat. so bravely to protect our country. I support the a testament to her dedication to education, Among the housing benefits in the bill is a passage of H.R. 2297 and look forward to four Florida universities: Holy Cross College, provision allowing remarried surviving spouses continuing work in the House Veterans’ Affairs University of Miami, Rollins College, and Lynn of veterans to be buried next to the veteran in Committee to support our Nation’s heroes. University, have conferred honorary degrees a national cemetery, based on the original f on Sister Jeanne, making her one of the most marriage. A prohibition on remarried spouses respected and loved educators in Florida’s his- burial eligibility is unfair to many of the dedi- LET’S GO LANCERS tory. cated spouses who have faithfully supported Sister Jeanne has also been an advocate of their veterans for years. I was a cosponsor of HON. EDWARD J. MARKEY revitalizing South Florida’s economy. South the original bill for this measure and support OF MASSACHUSETTS Florida’s power elite noticed her qualities and its passage. IN THE HOUSE OF REPRESENTATIVES dedication and named Sister the first female The section of the bill relating to benefits for Friday, November 21, 2003 member of two exclusive groups: The Orange former Prisoners of War contains a provision Mr. MARKEY. Mr. Speaker, while the Bos- Bowl Committee and the Non-Group. The Or- that will add cirrhosis of the liver to the list of ton Red Sox failed to finally capture a World ange Bowl Committee is a group of dedicated, presumed service-connected disabilities for Series victory that has eluded them since South Florida volunteers, who are committed former POWs. It also eliminates the unfair re- 1918, another group of Hardball Heroes from to bringing tourism to South Florida through quirement that a POW must be held for at Red Sox Nation did achieve their ultimate the annual college football game. Now, one of least 30 days to qualify for presumption of goal. The Malden Catholic Lancers defied all the four most prestigious college football bowl service-connection for certain disabilities, such expectations, overcame every obstacle, and games in America, the Orange Bowl festivities as psychoses and states of anxiety. We owe defeated every opponent to finish the year as bring in an excess of 150,000 visitors every it to our former POWs to repay them for what Massachusetts Division One State Cham- year, which contribute to a thriving South Flor- they have been through as much as we pos- pions. ida economy. sibly can, and this provision is a step in that While Red Sox fans will have to wait until Despite all her dedication and hard work, direction. next year yet again, the Lancers fans can re- even Sister Jeanne is susceptible to illness Yet another beneficial provision in this bill is joice and celebrate the success of this young and in 1996, Sister was diagnosed with lung the extension for six years of the Advisory Committee on Minority Veterans. As a rep- team of schoolyard superstars. cancer. However, even this disease could not Mr. Speaker, today I join with faculty, stu- stop her determination. Following disclosing resentative in a state with over 9,000 Native American veterans, and with over 17,200 His- dents, my fellow alumni, and all members of publicly her illness, Sister helped raise aware- the Malden Catholic community who are say- ness and funds for the American Cancer Soci- panic veterans in my district alone, I fully support this provision and believe it is a nec- ing congratulations! ety. It was Coach Stephen Freker’s guidance essary step to the continued service to all mi- Mr. Speaker, as a fellow lung cancer sur- and leadership that fueled these young men nority veterans. vivor, I know how difficult life seems after as they drove to the championship. The Na- being diagnosed with such a terrible illness. Another provision in the bill provides federal contracting officials the discretionary authority tional High School Baseball Coach’s Associa- For Sister Jeanne to continue her work like tion affirmed what we knew all along by nam- this is an inspiration to every cancer patient to award sole source contracts to small businesses owned by service-disabled veterans. I ing Coach Freker New England’s Coach of the and survivor in America. I am also grateful to Year. Sister for her thoughts and prayers during my am pleased that the Senate took out the ‘‘notwithstanding any other provision of law’’ These Lancers worked hard, practiced long, illness earlier this year. and gave their hearts and souls for the blue Sister Jeanne is a dear friend, and someone phrase that was in the original version of H.R. 1460, from which the language for this provi- and gold all year long. While they are great in- I am truly proud to know and love. Sister dividual players, their true greatness lies in Jeanne’s vision continues. Her love for Barry sion of H.R. 2297 was taken. The language included in the original version of H.R. 1460 their ability to play as team. and South Florida is evident evermore. Under Mr. Speaker, this was our year. was very harmful to the 8(a) small business Sister Jeanne’s supervision, Barry University Let’s Go Lancers! is attempting the largest construction project in contract program, a program that benefits mi- f Miami Shores history. Nearly $18 million will nority-owned small businesses all across this bring a new student center and residence hall country. As a member of both the House Vet- IN RECOGNITION OF THE GLEN- to accommodate the growing student popu- erans’ Affairs Committee and House Small DALE GENERAL RICHARD lation, which Sister Jeanne has pushed to Business Committee I worked to forge a suit- GRIDLEY CHAPTER OF THE grow and expand ever since she took office. able compromise that would ensure increased DAUGHTERS OF THE AMERICAN Mr. Speaker, as Chairman of Florida’s Con- contracting opportunities for veteran-owned REVOLUTION gressional Delegation, I salute Sister Jeanne small businesses, while not harming the 8(a) O’Laughlin for her 22 years as President of program that has helped provide economic op- HON. ADAM B. SCHIFF Barry University. May God bless Sister Jeanne portunity for minority entrepreneurs. With the OF CALIFORNIA O’Laughlin. help of the Chairmen and Ranking Members IN THE HOUSE OF REPRESENTATIVES f of both committees, we were able to unanimously pass an amended version of H.R. Friday, November 21, 2003 H.R. 2297, VETERANS BENEFITS 1460. Mr. SCHIFF. Mr. Speaker, I rise today to ACT OF 2003 Unfortunately the unanimously passed congratulate the General Gridley Chapter of version of H.R. 1460 is not what is included in the Daughters of the American Revolution on SPEECH OF H.R. 2297 today, but neither is the originally their 90th anniversary celebration. HON. TOM UDALL damaging language of H.R. 1460 included in Mrs. Mary Howard Gridley Braly founded OF NEW MEXICO this bill. I do have remaining concerns about the chapter on December 19, 1913. Mrs. Braly IN THE HOUSE OF REPRESENTATIVES the effect of the included contracting provision served as an organizing regent, and was later on the 8(a) and other small business pro- named Regent-For-Life by Chapter members. Thursday, November 20, 2003 grams, but considering the numerous impor- Mrs. Braly and her daughter first became Mr. UDALL of New Mexico. Mr. Speaker, tant provisions for our nation’s veterans con- members of the National Society of D.A.R. in H.R. 2297, the Veterans Benefits Act of 2003, tained in this bill, I will vote in favor. 1983 in Highland Park, Illinois. Then recording contains myriad benefits for our nation’s vet- In closing, Mr. Speaker, let me say that I Secretary General Miss Eugenia Washington, erans, many of which are long overdue. The strongly support increased opportunities for one of the D.A.R. founders, signed their appli- bill builds on education benefits by expanding veteran entrepreneurs. In fact, with the sup- cations. the Montgomery GI Bill program, a successful port of Congresswoman SUE KELLY, I recently The chapter is named for General Richard program that will now include educational as- introduced H.R. 3483, the Seeds for Soldiers Gridley, ancestor of Mary’s first husband sistance for on the job training in certain self- Act, to establish a loan program and a voca- James Conger Gridley. General Gridley was employment programs. It also increases tional rehabilitation program for veterans. As a born in Boston in 1711. In 1745 he was com- monthly educational benefits for spouses and member of the House Veterans’ Affairs Com- missioned Lieutenant Colonel of the Artillery in

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00010 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.150 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2433 the expedition against the French fortress of While Mr. Hodges most certainly leaves be- tion—this hydro facility can continue to oper- Louisbourg of Cape Breton Island. At the out- hind an amazing personal and military history, ate unencumbered. break of the Revolutionary War in April 1775, I must say that in my opinion, the most signifi- Mr. Speaker, H.R. 1651 is a non-controver- he was commissioned chief engineer and cant legacy this hero left behind is a pure and sial piece of legislation that will benefit the Colonel of Artillery and was wounded in the stalwart love of Jesus Christ. Last year Mr. lives of Boy Scouts for years to come. As battle of Bunker Hill. He married Hannah Hodges was quoted as saying, ‘‘What I figure such, I encourage my colleagues to support its Deming and had nine children. He served with on is anything you can do for the Lord is all passage. General George Washington throughout the right.’’ f Despite all his honors and all the attention Revolutionary War. In 1798 General Gridley CONFERENCE REPORT ON H.R. 2754, he had showered on him through the years, died in Staughton, Massachusetts at the age ENERGY AND WATER DEVELOP- Mr. Hodges always kept his heart in check. He of 87. MENT APPROPRIATIONS ACT 2004 Today the chapter is extremely involved in knew that in the end, he would take nothing the community. It is active in veterans’ serv- with him when he left this world. SPEECH OF ices, ROTC programs, and scholarship pro- More important than all the military medals grams with our local high schools. The chapter and awards was the love of Jesus. HON. MAURICE D. HINCHEY also presented the City of Glendale with the I believe wholeheartedly that the secret of OF NEW YORK Department of Defense’s 50th Anniversary of Mr. Hodges long life was love of family and IN THE HOUSE OF REPRESENTATIVES the Korean War flag. This flag currently flies love of the Lord. Tuesday, November 18, 2003 over the Glendale War Memorial at City Hall. That is why I’m confident that when Mr. Mr. HINCHEY. Mr. Speaker, I want to com- I ask all Members of Congress to join me Hodges closed his eyes to this world, he mend the Chairman of the Energy and Water today in congratulating the General Gridley opened them in Heaven. And that, Mr. Speak- Subcommittee, Mr. Hobson and the ranking Chapter of the Daughters of the American er, is a reward well earned by Mr. Hodges’ life member, Mr. Visclosky for their good work on Revolution on 90 exemplary years of service lived by faith. From battlefield to his front this bill. This conference report deserves the to the City of Glendale and surrounding com- porch, Mr. Hodges did it all for the glory of the overwhelming support it is about to receive. munities. Lord. I do want to bring attention to one provision f I stand today in remembrance of this military in this bill that has not received the scrutiny it hero and godly man. May God bless his soul, A HERO LEAVES BEHIND A LAST- deserves. Section 115 is an affront to our na- and the family he left behind. tion’s environmental laws. It was not included ING LEGACY—GOD’S LOVE: RE- in either the House or Senate bills and was MARKS ON BEHALF OF ROBERT f added in conference. The provision waives all HODGES SIERRA NATIONAL FOREST LAND environmental laws and directs the construc- EXCHANGE ACT OF 2003 HON. WALTER B. JONES tion of a road from the village of King Cove, SPEECH OF Alaska through the sensitive Izembek National OF NORTH CAROLINA Wildlife Refuge and right to the boundary of IN THE HOUSE OF REPRESENTATIVES HON. GEORGE RADANOVICH the fragile and internationally significant Friday, November 21, 2003 OF CALIFORNIA Izembek Wilderness Area. Mr. JONES of North Carolina. Mr. Speaker, IN THE HOUSE OF REPRESENTATIVES Specifically, Section 115 directs the Corps last Monday was a sad day for Eastern North Tuesday, November 18, 2003 of Engineers to build a road proposed in one Carolinians and America as a whole. On No- Alternative from a draft Environmental Impact Mr. RADANOVICH. Mr. Speaker, I am vember 10, 2003, North Carolina lost her old- Statement prepared to evaluate several pleased the House is considering H.R. 1651Ð est living Veteran, Robert Hodges. When Mr. modes of transportation between the villages The Sierra National Forest Land Exchange Act Hodges passed away, he was 115. of King Cove and Cold Bay, Alaska. The Envi- I had the privilege of meeting Mr. Hodges at of 2003 on suspension today. I thank my col- ronmental Protection Agency has raised sig- an event in his hometown just a few years leagues, Mr. NUNES and Mr. DOOLEY, in addi- nificant concerns with the alternative man- ago. Even in the brief interaction I shared with tion to Resources Committee Chairman dated by Section 115. The Corps of Engineers this living legend, I was struck by his sharp POMBO, for their support and assistance on is still reviewing public comment on the draft mind and vitality. I can still remember Mr. this measure. EIS. Hodges singing ‘‘Over There’’ so beautifully H.R. 1651 completes a land exchange be- The King Cove Access Project first surfaced . . . he was so lucid, his voice so clear, you tween the Forest Service and a constituent of as legislation in 1998. Proponents attempted would never have believed he was celebrating mine, Mr. Bob Glassman. Under the ex- to add the provision to an appropriations bill his 114th birthday. change, the Forest Service will obtain an 80 that year but were not successful. A com- Born June 18, 1888, Mr. Hodges was not acre parcel within the Sierra National Forest promise was reached later that year with the only North Carolina’s oldest living veteran, he from my constituent, who will in turn receive a King Cove Health and Safety Act which was was one of America’s longest living war he- 160 acre parcel located on Shaver Lake and included as Section 353 of Public Law 105Ð roes as well. also within the Sierra National Forest. 277, the Department of Transportation and Mr. Hodges had a phenomenal story. He Upon completion of the land exchange with Related Agencies Appropriations Act. The was born in North Carolina’s first official town, the Forest Service, my bill states that my con- measure appropriated $40 million to address Bath. The grandson of slaves, Mr. Hodges stituent will convey the newly acquired 160 the access needs of the communities of King shared a three-room house with his parents parcel on Shaver Lake to the Sequoia Council Cove and Cold Bay; however, the Act did not and 9 siblings. of the Boy Scouts. The Boy Scouts have oper- approve a road through the Izembek refuge or He worked the fields in rural Eastern North ated a recreational camp on a portion of this the Izembek Wilderness. In fact, the legislation Carolina until 1918. At the age of 20, Mr. land for over five decades. Thousands of specifically required that expenditure of the Hodges enlisted in the Army and went on to Scouts use the camp each year to experience funds allocated in the bill ‘‘must be in accord- serve in France during World War I. outdoor activities and gain leadership skills. ance with all other applicable laws.’’ After World War I, Hodges returned to North Owning the property will allow the Sequoia Five years after a satisfactory compromise Carolina and married Malinda. The couple en- Council of the Boy Scouts to make improve- was agreed upon, this rider inappropriately joyed 70 years together until her death at the ments to the facilities located on the land. This short-circuits the public process. An adminis- age of 92. bill, therefore, allows the Scouts to provide trative decision on a project to enhance ma- Mr. Hodges and his wife raised 7 children continued opportunities for young men to learn rine-road access for the community of King on their farm in Pamlico County, where Mr. the importance of and actively participate in Cove is proceeding in a timely manner and Hodges worked until his poor eyesight forced serving their community. does not require intervention by Congress. him into retirement. The Hodges family still Given that there is a hydroelectric facility at However, the King Cove Access Project man- calls the Pamlico area home, with his sur- Shaver Lake, I have worked with the operator dates one alternative in the EIS, thereby effec- viving children living in Stonewall and New of that facility, Southern California Edison, to tively ignoring the advice of the U.S. Fish & Bern. ensure it can maintain and operate its hydro Wildlife Service, other federal agencies and He was honored in 2002 with North Caro- project once the land exchange is completed. the American public. lina’s Order of the Longleaf Pine, the state’s As a strong supporter of hydroelectric power, Section 115 is an affront not only to public highest civilian order. I am pleased to say that under my legisla- process, but also to our nation’s environmental

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00011 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.155 E23PT1 E2434 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 laws. Unlike the King Cove Health & Safety in lower prices, a greater choice of lens pro- OXYCONTIN CONTINUES TO Act, which is subject to national environmental viders, and more convenient ways to fill con- DESTROY LIVES laws, the King Cove Access Project is ‘‘not- tact lens prescriptions. withstanding any other provision of law.’’ It is H.R. 3140 is bipartisan legislation supported HON. FRANK R. WOLF inappropriate to exempt the Izembek refuge by both optometrists and retailers. I have been OF VIRGINIA from federal environmental laws in this man- working on this issue for a number of years, IN THE HOUSE OF REPRESENTATIVES ner. and am pleased to ‘‘see’’ it pass the House in The Izembek National Wildlife Refuge, on a bipartisan manner. I encourage the Senate Friday, November 21, 2003 the Alaska Peninsula, is internationally recog- to take up this bill and help contact lens wear- Mr. WOLF. Mr. Speaker, over the past year nized as one of the most important wetland re- ers receive this right. I have been writing to Health and Human serves in the Northern Hemisphere. Home to Services Secretary Tommy Thompson and threatened and endangered species, as well f Food and Drug Commissioner Mark McClellan as millions of migratory birds, the Izembek Na- urging their action to curb the continuing tional Wildlife Refuge and Izembek Wilderness HONORING MR. SARGENT SHRIVER abuse of the powerful prescription painkiller, are keys in the fight to conserve the natural di- OxyContin. In many of those letters I have en- versity of wildlife populations and habitats. A SPEECH OF closed newspaper articles about another life road through the refuge will inevitable damage HON. PATRICK J. KENNEDY destroyed by this drug. the refuge’s critically important habitat. Their inaction is perplexing. The death toll OF RHODE ISLAND The King Cove Access Project ignores envi- continues to rise and thousands of lives con- ronmental laws, threatens important wildlife IN THE HOUSE OF REPRESENTATIVES tinue to be ruined because of the abuse of this habitat and sets a dangerous anti-wilderness Monday, November 17, 2003 drug. When will they do something to stop this precedent. The 17-mile road proposal is not Mr. KENNEDY of Rhode Island. Mr. Speak- tragedy? compatible with the purposes of the refuge, as I want to submit the letters I have been er, I am proud to join my colleagues in support established by ANILCA, or with the Wilderness sending to Secretary Thompson and Commis- of H. Con. Res. 299, a resolution honoring Mr. Act. The King Cove Access Project rider is ter- sioner McClellan over the past six months. Sargent Shriver for his dedication and service rible policy and terrible process. to the United States of America, for his service HOUSE OF REPRESENTATIVES, f COMMITTEE ON APPROPRIATIONS, in the United States Navy, and for his lifetime Washington, DC, March 28, 2003. FAIRNESS TO CONTACT LENS of work as an ambassador for the poor and Hon. TOMMY THOMPSON, CONSUMERS ACT powerless citizens of the United States of Secretary, Department of Health and Human America. Growing up with a role model like my Services, Independence Ave, SW., Wash- SPEECH OF uncle, Sargent Shriver, doesn’t allow much ington, DC. HON. F. JAMES SENSENBRENNER, JR. room for failure. He has served our nation in DEAR SECRETARY THOMPSON: In December countless ways and on multiple fronts. When 2001, the Commerce-Justice-State and the OF WISCONSIN he retired from the Navy as a Lieutenant Com- Judiciary appropriations subcommittee held IN THE HOUSE OF REPRESENTATIVES a hearing on the illegal diversion of the pre- mander, he could have ended his public serv- Wednesday, November 19, 2003 scription drug OxyContin, a pain-killing ice career then, and been proud of his accom- Schedule II narcotic manufactured by Pur- Mr. SENSENBRENNER. Mr. Speaker, I rise plishments. But he chose to continue to serve due Pharma L.P. One of the witnesses, the today in support of H.R. 3140, ‘‘The Fairness our nation when President Kennedy appointed father of recovering OxyContin addict, told a to Contact Lens Consumers Act of 2003,’’ him the first Director of the Peace Corps. Sar- gripping story of the devastating impact the which provides contact lens wearers with im- gent Shriver exceeded expectations for the ini- drug has had on his family and his son, who was in his early 20s. He proudly told the portant new rights. This bill ensures that un- tiative by developing volunteer programs in more than 50 countries around the world. committee how his son had just finished scrupulous eye doctors will no longer be able rehab and had kicked his addiction. Sadly, a hold consumers’ contact lens prescriptions Sargent Shriver and his wife, Eunice Ken- few months after appearing before the sub- hostage, forcing them to purchase lenses nedy Shriver, went on to establish the Special committee, the son died as a result of abus- solely from their doctor’s office. In addition, Olympics during the 1960’s, when those with ing the drug. this legislation will make shopping for lenses mental retardation were often institutionalized When used properly, OxyContin is consid- simpler and cheaper. because of a lack of understanding of their ered a wonder drug, especially for the termi- Currently, eye doctors are only required to needs and abilities. The Shrivers recognized nally ill cancer patients. I know what it is give patients their prescriptions for eye- the importance of challenging these individuals like to see people suffer from cancer. Both my mother and father died of cancer. I can glasses. Eyeglass wearers have had this right with physical activities, when others simply remember my mother constantly asking the since 1978, when the Federal Trade Commis- cast them aside. The Special Olympics nurses for more morphine but being told she sion issued a regulation granting eyeglass brought courage to their lives and taught them couldn’t have any more. My mother was in a wearers the right to automatically receive a the value of teamwork, and proved that people great deal of pain. OxyContin, if it had been copy of their prescription following an exam. with mental retardation were strong and caring available when she was dying, probably Contact lenses were understandably not in- individuals who could be successful and inde- would have made her a lot more comfortable cluded in this regulation because, at the time, pendent. The Special Olympics has grown ex- at the end. ponentially under the Shrivers direction. When When used illegally, however, OxyContin most contacts were hard lenses, which were destroys families and communities. It also custom-made to fit each patient. Today, most given the position of president of the Board of can lead to death. This powerful painkiller contact lenses are mass produced, soft lenses Directors of the Special Olympics, Sargent has increasingly become a drug of choice for that do not require manipulation by eye doc- Shriver, again, reached out to other nations to people who choose to abuse it by chewing it tors. As a result of this improvement, today’s bring together people of all nationalities to or grinding it up. By disabling the time re- contact lens wearers should have the same compete in the games. In 1985, athletes from lease mechanism in OxyContin, abusers get a right as eyeglass wearers to obtain their pre- 14 countries were represented at the Special heroin-like high. scription, at no additional charge. That is why Olympics Winter Games in Utah, and today, Initially, cases of abuse and illegal diver- more than 1 million athletes participate in the sion occurred primarily in poor, rural com- I am proud to be an original cosponsor of the munities in Virginia, Kentucky, West Vir- Fairness to Contact Lens Consumers Act. Special Olympics in over 150 countries. ginia and Ohio. Abuse is no longer limited to Approximately 36 million Americans wear I hesitate to end my remarks with this short Appalachia. The drug has found its way to contact lenses. Each year, these Americans list of what Sargent Shriver has accomplished urban areas and there are now reports of spend an estimated $3.5 billion on contact in his life. Unfortunately, I am not sure if there widespread abuse as far away as Arizona. lenses. Providing consumers with an auto- is anyway to accurately reflect the number of Florida, I am told, has been hit extremely matic right to their prescriptions will allow them lives he has touched as our nation’s ambas- hard. to shop around for contact lenses based on sador, through Head Start and the Special Several pharmacies in my congressional District have been robbed at gun point in re- price, service, and convenience. It is esti- Olympics, to name a few. But I am sure that cent months for OxyContin. No money was mated that H.R. 3140 could save consumers even at the age of 88, he will continue to add taken; the robbers only demanded the drug. approximately $350 million annually, thanks in accomplishments to this list of public service, Earlier this month, a prominent defense law- large part to increased competition. Competi- and he will continue to touch the lives of peo- yer in northern Virginia who twice served as tion among contact lens companies will result ple around the world. a local prosecutor in Prince William County

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pleased guilty to Federal drug charges HOUSE OF REPRESENTATIVES, I am waiting to hear what FDA is going to linked to a large-scale investigation into the Washington, DC, May 16, 2003. do. illegal distribution of OxyContin and other Hon. TOMMY G. THOMPSON Sincerely, painkillers. Secretary, Department of Health and Human FRANK R. WOLF, Communities where the illegal drug has Services, Independence Ave., SW., Wash- Member of Congress. taken hold are being completely destroyed. I ington, DC. am told there is one county in southwest DEAR MR. THOMPSON: Here’s another news HOUSE OF REPRESENTATIVES, Virginia where no one isn’t either using the article from my District and another death. Washington, DC, June 5, 2003. drug, knows someone using the drug or been I am waiting to hear what you are going to Dr. MARK MCCLELLAN, the victim of a crime by someone needing do. Commissioner, Food and Drug Administration, the drug. Sincerely, Fishers Ln., Rockville, MD. When a professional baseball player re- FRANK R. WOLF, cently died after taking the dietary supple- Member of Congress. DEAR DR. MCCLELLAN: The enclosed article ment ephedra, your agency immediately is from today’s Washington Post. When are issued fact sheets regarding potential serious HOUSE OF REPRESENTATIVES, you going to take some action? Please do risks of dietary supplements containing Washington, DC, April 29, 2003. something. ephedra. You were even quoted as cautioning Dr. MARK MCCLELLAN, Sincerely, all Americans about using dietary supple- Commissioner, Food and Drug Administration, FRANK R. WOLF, ments that contain ephedra. Fishers Ln., Rockville, MD. Member of Congress. According to fact sheets produced by the DEAR DR. MCCLELLAN: I want to share with you two news articles I recently came across FDA, two deaths, four heart attacks nine HOUSE OF REPRESENTATIVES, concerning the marketing of OxyContin. The strokes and five psychiatric cases involving Washington, DC, June 25, 2003. ephedra have been reported. More than 240 articles stem from the investigation under- taken in 2001 by the Florida Attorney Gen- Hon. TOMMY G. THOMPSON, people have died from the abuse of Secretary, Department of Health and Human OxyContin and countless numbers of families eral. Several sensitive company documents were initially sealed but two Florida papers Services, Independence Ave., SW., Wash- and communities have been torn apart by ington, DC. this drug. have successfully sued to make the informa- Your agency has done a good job educating tion public. I have highlighted some ex- DEAR MR. THOMPSON: See the enclosed arti- the public about the dangers of ephedra and tremely troubling sections in the articles. cle from today’s Post. Please take action. other dietary supplements. I urge you to ini- You have to do something before things Sincerely, tiate a similar public information campaign get worse. about the dangers of abusing OxyContin. FRANK R. WOLF, Member of Congress. When a professional baseball player died I have previously written to your depart- after taking the dietary supplement ephedra, ment asking for a review of the marketing of your agency took immediate action to warn OxyContin and its classification for treat- HOUSE OF REPRESENTATIVES, Washington, DC., April 30, 2003. the public about the dangers of taking such ment of moderate to severe pain. The Food supplements. Sadly, the same cannot be said and Drug Administration did change the Dr. MARK MCCLELLAN, Commissioner, Food and Drug Administration, when it comes to your agency’s efforts on warning label on OxyContin but more needs OxyContin. to be done. The drug should not be marketed Fishers Ln., Rockville, MD. DEAR DR. MCCLELLAN: I wanted to be sure Sincerely, to treat moderate pain. I urge you to no you saw this letter by Pennsylvania State FRANK R. WOLF, longer allow OxyContin to be prescribed for Senator LISA BOSCOLA. This is tragic. Member of Congress. moderate pain. The FDA needs to address this issue. Too many people have died, too many fam- Sincerely, ilies have suffered and too many commu- HOUSE OF REPRESENTATIVES, FRANK R. WOLF, nities have been devastated by the improper Washington, DC, June 25, 2003. Member of Congress. use of this drug. Dr. MARK MCCLELLAN, Sincerely, Commissioner, Food and Drug Administration, HOUSE OF REPRESENTATIVES, Fishers Ln., Rockville, MD. FRANK R. WOLF, Washington, DC., May 13, 2003. Chairman, Subcommittee on Commerce- Hon. TOMMY G. THOMPSON, DEAR DR. MCCLELLAN: The enclosed article Justice-State and the Judiciary. Secretary, Department of Health and Human from today’s Post speaks for itself. Services, Independence Ave., SW., Wash- Please take some action. What are you HOUSE OF REPRESENTATIVES, ington, DC. Washington, DC, April 7, 2003. waiting for. DEAR MR. THOMPSON: The attached article Sincerely, Dr. MARK MCCLELLAN, ran in a newspaper in my District on Mon- Commissioner, Food and Drug Administration, FRANK R. WOLF, day. Please step in and do something to pre- Member of Congress. Fishers Ln., Rockville, MD. vent OxyContin from being allowed to be DEAR DR. MCCLELLAN: I want to share two prescribed for moderate pain. The drug is de- newspaper articles about OxyContin that I stroying communities, families and careers. HOUSE OF REPRESENTATIVES, came across since our meeting Thursday. Sincerely, Washington, DC, July 10, 2003. One is from a paper in my District; the other FRANK R. WOLF, Dr. MARK MCCLELLAN, is from a paper in Florida. Both are very Member of Congress. Commissioner, Food and Drug Administration, troubling. Fishers Ln., Rockville, MD. I trust you will give this issue the atten- HOUSE OF REPRESENTATIVES, DEAR DR. MCCLELLAN: The enclosed brief tion it deserves. Washington, DC., May 13, 2003. was in today’s Post. You have to do some- Sincerely, Dr. MARK MCCLELLAN, thing. What more evidence do you need that FRANK R. WOLF, Commissioner, Food and Drug Administration, there is a problem? Member of Congress. Fishers Ln., Rockville, MD. Sincerely, DEAR DR. MCCLELLAN: The attached article FRANK R. WOLF, HOUSE OF REPRESENTATIVES, ran in a newspaper in my District on Mon- Member of Congress. Washington, DC, April 11, 2003. day. Hon. TOMMY G. THOMPSON, The FDA needs to step in and do something Secretary, Department of Health and Human OxyContin should not be allowed to be pre- HOUSE OF REPRESENTATIVES, Services, Independence Ave., SW., Wash- scribed for moderate pain. Too many fami- Washington, DC, July 10, 2003. ington, DC. lies, communities and careers are being de- Hon. TOMMY G. THOMPSON, DEAR SECRETARY THOMPSON: stroyed. Secretary, Department of Health and Human As a follow up to my March 28 letter on Please take some action. Services, Independence Ave. SW., Wash- OxyContin, I want to share with two recent Sincerely, ington, DC. newspaper articles that I recently came FRANK R. WOLF, DEAR MR. THOMPSON: I wanted you to see across. One is from a paper in my District; Member of Congress. this brief in today’s Post. As you can see the the other is from a paper in Florida. Both OxyContin problem has no boundaries. are extremely troubling. HOUSE OF REPRESENTATIVES, Thank you for your response to my earlier OxyContin, when used properly, is a won- Washington, DC., May 21, 2003. letters. I hope we can come up with some so- der drug. When abused, it is destroying fami- Dr. MARK MCCLELLAN, lutions. lies and communities. Commissioner, Food and Drug Administration, Please look at this issue. Fishers Ln., Rockville, MD. Best wishes. Sincerely, DEAR DR. MCCLELLAN: Enclosed is another Sincerely, FRANK R. WOLF, news story from my District and another FRANK R. WOLF. Member of Congress. death. Member of Congress.

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00013 Fmt 0626 Sfmt 0634 E:\CR\FM\A21NO8.165 E23PT1 E2436 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 HOUSE OF REPRESENTATIVES, The family was instrumental in the formation quired to save her life. As Vicki rightly points Washington, DC, October 28, 2003. of the Trenton Special School District and out, the ban on so-called ‘‘partial birth abor- Hon. TOMMY G. THOMPSON, years later helped replace the aging school tion’’ prevents women—along with their fami- Secretary, Department of Health and Human Services, Independence Ave. SW., Wash- building with a new high school. Believing that lies and doctors—from making private deci- ington, DC. Gibson County could support a satellite com- sions about saving their own lives and pro- DEAR MR. THOMPSON: The enclosed article munity college, Robert and Gail also helped tecting their right to future pregnancies. describes another tragic account of raise money to fund Dyersburg State Commu- A short while ago, the House debated the OxyContin abuse. nity College in Trenton. so-called ‘‘Partial Birth Abortion’’ ban. Several How many more stories do we have to read Gail has dedicated much of her life to the members who supported the ban tried to deny about this problem before you take more ac- education of her children and others in our tion? Vick’s story. Sincerely, community. She has always been very in- Those Members didn’t know what they were FRANK R. WOLF. volved in school parent organizations and talking about. Here is the truth as printed in Member of Congress. takes an active role in making our schools bet- the San Jose Mercury News. ter, including beautiful murals in school hall- [From the San Jose Mercury News] HOUSE OF REPRESENTATIVES, ways. Washington, DC, October 28, 2003. Gail has not limited her helpful involvement HEARTBREAK AND A CHOICE: I HAD AN Dr. MARK MCCLELLAN, to working with children, however. A cancer ABORTION AT EIGHT MONTHS Commissioner, Food and Drug Administration, survivor, she has been an active participant in (By Vicki Wilson) Fishers Ln., Rockville, MD. DEAR DR. MCCLELLAN: The enclosed article Relay for Life efforts of the American Cancer The right to end a pregnancy is frighten- describes another tragic account of Society and has helped counsel others who ingly precarious, something I didn’t under- OxyContin abuse. are also battling cancer, using her own experi- stand until I had an abortion at eight How many more stories do we have to read ences to help comfort those around her. months. The new abortion ban covers what is about this problem before action is taken? Mr. Speaker, please join Robert and Gail’s not actually a recognized medical procedure; Sincerely, ‘‘partial birth’’ was coined by the anti-choice friends and family as we recognize their dedi- lobby to rile public sensibilities and distort FRANK R. WOLF. cation and service to our community. Member of Congress. the truth. f At 36 weeks of pregnancy, an ultra-sound f showed what all my previous parental test- HONORING THE CIVIC LEADERSHIP IN HONOR OF MAYOR DAVID ing failed to detect—an encephalocoele. Two- OF ROBERT SIDNEY AND GAIL PENDERGRASS OF SAND CITY, thirds of my daughter’s brain had formed PHELAN CALIFORNIA outside her skull. What felt to be strong, big, healthy baby movements were in fact sei- HON. SAM FARR zures. HON. JOHN S. TANNER My doctor sent me to several specialists in OF CALIFORNIA OF TENNESSEE a desperate attempt to find a way to save IN THE HOUSE OF REPRESENTATIVES IN THE HOUSE OF REPRESENTATIVES her. Everyone agreed she would not survive Friday, November 21, 2003 Friday, November 21, 2003 outside my body. As the pregnancy pro- gressed before I went into labor, she would Mr. TANNER. Mr. Speaker, today I rise in Mr. FARR. Mr. Speaker, it is with great probably die from the increased compression honor of Robert Sidney and Gail Phelan, fine honor and pleasure that I am able to rise of her brain. public servants who have dedicated them- today to recognize Mayor David Pendergrass, Our doctors explained our options. Let selves throughout their lives as loyal citizens a dedicated public servant of Sand City, Cali- ‘‘nature take its course.’’ But how could I let to our community. fornia. Mayor Pendergrass has served Sand my daughter suffer the ongoing seizures? The couple married in 1958, months after City for 25 years, where throughout his tenure Second: Abortion. My God! I thought. Here I Gail had been crowned Miss Trenton. They as a Mayor-Councilmember, Mayor am at the end of a planned and very much are members of the 1st United Methodist Pendergrass has distinguished himself as a wanted pregnancy: Her name is Abigail. How can one even utter the word ‘‘abortion’’ now? Church of Trenton and the proud parents of strong leader. Despite being a nurse, I’d never heard of any Robert Sidney Phelan, Jr., Paul Edmund Under Mayor Pendergrass’ leadership, the abortion in the eighth month. I asked about Phelan, and Mary LeAnn Phelan. Robert and City of Sand City has been enhanced in many a Caesarean section. Doctors perform C-sec- Gail also have three grandchildren and two different ways. He has overseen the establish- tions only to save babies lives. Mine couldn’t step-grandchildren. ment of an active redevelopment program and be saved so they didn’t want to risk the pos- Robert operated the family business, a Ford agency, the organization of a modern city gov- sibility of hurting my future fertility. It was automobile dealership, for 50 years, before ernment with a City Administrator-Council ad- a risk I wasn’t willing to take either. selling it. He has since started a smaller inde- ministrative structure, and maintained an on- We agonized over our options, which pendent dealership. In 1963, Robert became going forum to receive and respond to citi- doesn’t convey the heartbreak and rage we felt. It was hard even to think of these the acting Postmaster while continuing to run zens’ concerns. Furthermore, Mayor ‘‘choices.’’ I wanted my daughter to be born his auto dealership. He also served in the Pendergrass has been able to keep Sand with a brain—period. We decided to make Tennessee National Guard, from which he re- City’s focus on its primary goals with diplo- our choice based on what was best for Abi- tired as a First Lieutenant. With the help of macy, patience, and consideration. gail. U.S. Senator Jim Sasser, Robert was instru- Mayor Pendergrass’ committed public serv- As health-care professionals, my husband mental in establishing a new National Guard ice has improved the quality of life at Sand and I understood the medical risks of each Armory in 1991. City, California. He has made great contribu- alternative. We understood that it wasn’t ‘‘is He has served as Exalted Ruler of the Tren- tions, and his lifelong dedication to public she going to die’’—a higher power had de- ton Elks Lodge and President of the Trenton service is commendable. His achievements cided that—but ‘‘how?’’ To this day, I thank God that this decision, at least, was ours. Chamber of Commerce. Robert also served are truly honorable, and I along with the City on the Trenton Rotary Club, the Gibson Coun- I continue to battle the anti-choice hard- of Sand City, honor this great man. liner machine from banning the very proce- ty Election Commission, the Trenton Housing f dure that saved my health and ended Abi- Authority Board and the Trenton Industrial gail’s suffering. When will politicians under- Board. He served on the board of Citizen WRITING BY VICKI WILSON stand: The decision about terminating a State Bank, spending some of that tenure as pregnancy should be between women, their Chairman. Robert worked diligently to form HON. ZOE LOFGREN family and their doctors—not politicians. While I was struggling with the most Citizen City and County Bank, where he now OF CALIFORNIA wrenching choice I have ever made, it never serves as Chairman of the Board. IN THE HOUSE OF REPRESENTATIVES The Phelans have always been devoted to occurred to me to confer with a lawyer or a judge or a politician. the Democratic Party on local, state and na- Friday, November 21, 2003 Those opposed to abortion for any reason tional levels, including involvement with gen- Ms. LOFGREN. Mr. Speaker, I am honored declare that women are selfishly choosing to erations of Tennessee governors, Members of to share with my colleagues this editorial writ- end their pregnancies late. They deny med- Congress and Vice President Al Gore. Their ten by my courageous friend Vicki Wilson. In ical necessity; they’d rather see Abigail suf- son Paul served for 10 years as a State Rep- it she describes her very personal story about fer and me lose my fertility than allow us to resentative. her pregnancy and a procedure that was re- choose the most decent path for our family.

VerDate jul 14 2003 02:48 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00014 Fmt 0626 Sfmt 0634 E:\CR\FM\A21NO8.169 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2437 They state that Americans are opposed to Second, I am opposed to the blanket ex- IN MEMORY OF KESH their politically motivated ‘‘partial birth’’ emptions from our nation’s environmental pro- abortions. They don’t acknowledge that tection laws for the Pentagon in this bill. There Americans believe the choice should remain HON. JIM McDERMOTT with my family. is no convincing evidence that environmental OF WASHINGTON Almost nine years have passed since we laws like the Clean Air Act and the Endan- IN THE HOUSE OF REPRESENTATIVES lost Abigail, and not a day passes that I gered Species Act hinder our military’s capac- don’t think of her. In my heart I know I did ity to defend our nation. Friday, November 21, 2003 the right thing for me and my family. But you don’t have to take my word for it. Mr. MCDERMOTT. Mr. Speaker, his full f Former EPA Administrator, Christine Whitman, name was Nayaran Dilip Keshavan Ayyangar, but everyone simply knew him as Kesh. Kesh EXPLANATION OF VOTE ON CON- testified to the Congress that she does not was a journalist, a Hill staffer, a community FERENCE REPORT ON FY 2004 ‘‘believe that there is a training mission any- activist and a friend to anyone who cared pas- DEFENSE AUTHORIZATION BILL where in the country that is being held up or not taking place because of environmental sionately about the political, economic and cul- HON. RUSH D. HOLT protection.’’ Furthermore, the U.S. General Ac- tural relationship between his adopted country, counting Office (GAO) has reported to the the United States, and his native country, OF NEW JERSEY India. IN THE HOUSE OF REPRESENTATIVES Congress that the Pentagon has failed to produce any evidence that environmental laws Last Thursday, November 13th, Kesh was Friday, November 21, 2003 have significantly affected our military readi- doing what he had done for the past 2 dec- Mr. HOLT. Mr. Speaker, the final version of ness. ades. He was advocating that India’s interests were in confluence with the United States’. He this legislation continues our shared bipartisan I do not think the Pentagon or any other had just finished taping an appearance on Lou commitment to boost the income for all of our federal agency should be above the law. Dobbs’s Moneyline on CNN. Ten minutes after military personnel with a 4.15-percent average Moreover, current law already allows case-by- leaving the studio, Kesh was dead of a mas- increase in base pay. This is an important tes- case environmental exemptions for the Pen- sive heart attack at the young age of 53. tament to the brave men and women who risk tagon, when they are determined to be in the Mr. Speaker, as a former Chairman of the their lives to defend America’s freedom. national interest. In addition, this conference report extends Congressional Caucus on India and Indian several special pay provisions and bonuses Finally, this conference report also contains Americans, I know first hand the gravity of the for active duty personnel through December provisions that will be very harmful to hun- loss both countries have suffered. Not only 31, 2004. It reduces the average amount of dreds of thousands of dedicated civilian men was Kesh’s knowledge of U.S. India relations housing expenses paid by service members and women who make our Defense Depart- comprehensive, the breadth and depth of his from 7.5 percent to 3.5 percent in FY 2004 ment work. contacts, here in Washington and back in and eliminates the out-of-pocket expense Last year saw the largest government reor- Delhi, was truly amazing. completely by FY 2005. It increases the family ganization in more than 3 decades with the A review of Kesh’s career will give our col- separation allowance for service members creation of the U.S. Department of Homeland leagues an idea of why Kesh was such a crit- with dependents, worldwide, from $100 per Security, affecting 170,000 federal employees. ical player in the U.S India dialogue. For the month to $250 per month for the period begin- Following extensive congressional debate, past 2 years Kesh served as President of the ning October 1, 2003 and ending December Secretary Ridge was granted authority to es- New York City Chapter of the Indian American 31, 2004. Finally, it increases the rate of spe- tablish a more flexible that attempted to pro- Forum for Political Education. Prior to that he cial pay for those subject to hostile fire and tect basic worker rights. was the Executive Director of the India Cau- imminent danger, worldwide from $150 per But this legislation will give Defense Sec- cus here in this body. And for more than 15 month to $225 per month for the period begin- retary Rumsfeld broad authority to rollback years before coming to Capitol Hill, Kesh was ning October 1, 2003 to December 31, 2004. worker protections for hundreds of thousands a distinguished journalist, serving as Editor in While I am not satisfied with the provisions of Pentagon employees. There will be nothing Chief of the India Post, as the Washington Bu- in this conference report regarding concurrent to prevent agency managers from abusing reau Chief of the Indian American, as a re- receipt for military retirees, it does provide their power for political advancement or en- porter for the Washington Times and as the some, overdue redress for this out-of-date pol- gaging in discriminatory practices. Allowing Chief Diplomatic Correspondent for the New icy. managers the ability to waive such protections York City Tribune. Kesh was educated here in But on balance, I am opposing this final under the guise of national security and the the U.S. at the School of Journalism at Syra- conference report because I fundamentally need for greater flexibility is wrong. It will not cuse University and also in India at Osmanis disagree with key aspects of its policy pre- make us safer. University in Hyderabad, where he obtained a sumptions and prescriptions. On balance, it journalism degree, and at Andhra University, Thanks to this legislation, Secretary Rums- will make America less safe in an increasingly where he was awarded a degree in pharmacy. feld will be able to do away with the current unstable world. Mr. Speaker, I am certain all members of personnel system in the Pentagon. I am un- First and most importantly, the growing reli- this body join me in expressing our condo- willing to give the Bush Administration a blank ance upon nuclear weapons that this legisla- lences to his father, a former head of the In- check to undo, in whole or in part, many of the tion encourages makes our nation and the dian Geological Survey, his sister, and his civil service laws and protections that have world less safe, not more so. Accordingly, I many friends, both here in the United States been in place for nearly a century to safe- strongly disagree with the funding in this bill to and back in India. We have all lost a devoted guard against the return of an unfair patron- continue work on high yield, burrowing nuclear public advocate. Kesh’s loss will be felt for age system. ‘‘bunker-busters’’ that target underground mili- many years. I want to be very clear. I support a strong tary facilities or arsenals. I am equally op- f posed to the language in this bill that lifts the national defense. I support modernizing our ban on research leading to low yield ‘‘mini-nu- military. I support giving our troops the re- HONORING SARGENT SHRIVER clear weapons’’ of 5 kilotons or less. sources and training they need to keep our Last April, I sent a letter to President Bush nation secure. But I cannot support this con- HON. SAM FARR that was co-signed by 34 of my colleagues to ference report which contains provisions that OF CALIFORNIA convey our grave concern that he is weak- will take our military backwards, rather than IN THE HOUSE OF REPRESENTATIVES ening long-standing U.S. policy governing the forwards. I cannot support legislation that will use of nuclear as opposed to conventional re-ignite a global nuclear arms race, even as Friday, November 21, 2003 weapons. I regret that we have never received our troops in Iraq and elsewhere risk their Mr. FARR. Mr. Speaker, I rise today to a substantive reply from the President. That lives every day to stop the spread of nuclear honor the dedication, spirit, and accomplish- congressional action coupled with the exam- weapons. I cannot support legislation that ments of my good friend Sargent Shriver who ples I’ve cited and other provisions in this con- takes away the rights of hundreds of thou- celebrated his 88th birthday last week. I met ference report further undermine the U.S. non- sands of hard-working Pentagon employees Sarge while I was in Peace Corps Training in proliferation efforts of Republican and Demo- Finally, I cannot support legislation that dis- Questa, New Mexico in 1963. He was a hero cratic Presidents alike and heighten growing ingenuously claims that stripping away impor- figure: handsome, smart, engaging, and the international fear that Bush Administration’s tant environmental protections here at home President’s brother-in-law. We were all so policies are fueling a new nuclear arms race. will somehow bolster our national security. proud of being chosen to be in one of the

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00015 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.172 E23PT1 E2438 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 early waves of the Peace Corps. President He started his service on January 1, 1969, more fully engages and supports local elected John F. Kennedy asked our nation’s citizens the first day of operation for the ambulance leaders and the communities they represent. to ‘‘ask not what this country could do for you, service, which was one of the first countywide We need to engage the public and local deci- but what you can do for your country.’’ Sar- ambulance services in Tennessee to also offer sion-makers to address the nation’s many gent Shriver was a living demonstration of the an emergency medical technician training pro- transportation challenges. way to serve and the spirit it took to launch gram. Sinclair volunteered for rotating shifts so The proposals in this legislation include two the new and bold idea of the Peace Corps. his workers could get the training they needed initiatives that follow the basic thrust of the Peace Corps began under Sargent Shriver’s to become paramedics. The service was origi- Committee’s TEAÐ21 renewal package. directorship on March 1, 1961. Today, over nally based in the Paris Fire Department, and First, this legislation invests more in our 170,000 Americans, including six members of hearses purchased from the Ridgeway Morti- local decision-makers, those who now lead Congress, have served in 136 countries. Many cians were used as ambulances. our nation’s very important metropolitan volunteers who served under Sargent Shriver Mr. Sinclair remained diligent, however, and economies and those in non-urbanized areas. have become Ambassadors, Presidents of helped the ambulance service grow, becoming Secondly, it further strengthens the partner- Universities, and Chairmen of major corpora- director in 1970 and remaining there until ship set forth in the 1991 ISTEA law that tions. 1985, when the service was assigned to the began devolving resources and decision-mak- Sargent Shriver began his public service in Henry County Medical Center. Mr. Sinclair is ing to the nation’s larger metropolitan areas. the United States Navy where he earned the now a member the HCMC Board of Trustees Finally, this legislation continues to place more rank of Lieutenant Commander. Following his and has also been a longtime member of the responsibility where it belongs, with local com- naval career, Sargent Shriver dedicated him- Henry County Commission. munity leaders and metropolitan planning or- self to the societal problems facing the youth Mr. Sinclair continued to give his time and ganizations. These are the entities most chal- of the country—organizing the National Con- devotion to the Henry County Ambulance lenged by pressing transportation needs, be it ference on Prevention and Control of Juvenile Service and overcame many obstacles, such traffic congestion, air quality degradation or Delinquency in Washington and serving as the as funding and vehicle replacement issues. He the rising demands of global competition. President of the Chicago Board of Education. helped make the ambulance service what it is These selected reforms and adjustments will He continued to foster quality social program- today. yield results for all areas of our states. In ming through the creation of VISTA, Head Time and time again, Mr. Sinclair has given those provisions targeted to metropolitan Start, Community Action, Foster Grand- his time and dedication to his community, and areas, all taxpayers and areas will benefit as parents, Job Corps, Legal Services, Indian this will continue to be appreciated. Mr. these additional commitments will improve the and Migrant Opportunities and Neighborhood Speaker, please join me in honoring the ac- performance of our existing assets and help Health Services. In addition, Sargent Shriver complishments and dedication of a fine leader, us use available transportation dollars more has served on the Board of many humani- Mr. Bob Sinclair. efficiently. tarian organizations, including as President of f Mr. Speaker, let me talk for a minute about the Special Olympics the key features of this legislation and what it Sargent Shriver’s dedication to living his PERSONAL EXPLANATION does and does not do. ideals, and making them a reality has inspired First, it does not affect the allocation of re- subsequent generations to do the same. His HON. LUIS V. GUTIERREZ sources from any of TEAÐ21’s formula high- invaluable contributions to the formation and OF ILLINOIS way programs to the states, which is to say longevity of the Peace Corps has brought IN THE HOUSE OF REPRESENTATIVES that it is policy neutral on the donor/donee hope to people around the world and has edu- issue. For the record, I am one member who cated generations of Returned Peace Corps Friday, November 21, 2003 has an interest in seeing more equity among Volunteers, such as myself, in the necessity Mr. GUTIERREZ. Mr. Speaker, I was un- the states, and this legislation does not disrupt and value of public service. The Peace Corps avoidably absent from this chamber on Sep- any of these important efforts. continues to be a means for understanding the tember 3, 2003. I would like the record to Second, the law this legislation amends is cultures, and languages of the world while rec- show that, had I been present, I would have the Transportation Equity Act for the 21st Cen- ognizing the differences between different voted ‘‘yea’’ on rollcall votes 460, 461 and tury. As we make progress on equity among countries. 462. On September 4, 2003, I missed rollcall the states, we should also make some greater The vision of peace that Director Shriver vote 467 and would like the record to show strides in providing some modest assurances has committed so much time and energy to that, had I been present, I would have voted of equity to local areas and local taxpayers has only become more important during this ‘‘nay.’’ within our states. Here in this chamber and in time of war. Director Shriver once wisely said, f the Transportation Committee we talk often ‘‘I say what our nation needs now is a call to about ‘‘fair share’’ among the states, and yet peace and service—peace and service on a INTRODUCTION OF THE ‘‘METRO- there is nothing in current law that addresses scale we have scarcely begun to imagine.’’ POLITAN CONGESTION RELIEF how equity is assured at the sub-state level. Mr. Speaker, today I honor Sargent Shriver ACT’’ Let me illustrate this point further from the and wish him the very best in the coming perspective of my district and the Dallas-Fort year. HON. EDDIE BERNICE JOHNSON Worth region. As each new fiscal year arrived f OF TEXAS under TEAÐ21, local decision-makers in my RECOGNIZING THE CONTRIBU- IN THE HOUSE OF REPRESENTATIVES region were certain that they would determine the fate of about 21⁄2 cents of every highway TIONS OF BOB SINCLAIR TO SAV- Friday, November 21, 2003 ING LIVES IN TENNESSEE formula dollar coming to the State of Texas. Ms. EDDIE BERNICE JOHNSON of Texas. This is an inadequate commitment to a region Mr. Speaker, I am pleased to introduce legis- that accounts for nearly one out of every five HON. JOHN S. TANNER lation that strengthens our commitments to the Texans and, in recent years, more than one OF TENNESSEE public and their local decision-makers in both out of every three new jobs in the State. By IN THE HOUSE OF REPRESENTATIVES urbanized and rural areas of this nation. the donor/donee yardstick, this amounts to my Friday, November 21, 2003 The ‘‘Metropolitan Congestion Relief Act’’ local decision-makers having the certainty and Mr. TANNER. Mr. Speaker, I rise today to proposes a number of simple adjustments to direct control over about 10Ð12 cents on every recognize the accomplishments of a tireless the TEAÐ21 law, which as you know is now federal highway dollar that is generated from public servant, Mr. Bob Sinclair. The service under discussion in the House Transportation local taxpayers and returned to the state. This he has provided over the years through the Infrastructure Committee. Two days ago, the is simply inequitable and can no longer be jus- Henry County Ambulance Service has leaders of the Committee introduced legisla- tified. touched—and saved—many lives in our com- tion setting forth a six-year reauthorization My legislation proposes to deliver more cer- munity. plan for TEAÐ21, legislation that I am proud to tainty to all areas of the state, both large and Mr. Sinclair is a decorated veteran of World cosponsor. small, helping make some modest gains in en- War II and a former employee of the Ten- My legislation compliments the Committee suring more funding equity for the public in nessee Valley Authority, but it is his dedicated legislation and proposes key adjustments to their local areas. work for the Henry County Ambulance Service current congestion-related programs. This leg- The legislation directs that Surface Trans- that makes him stand out among the rest. islation would ensure that our national policy portation Funds provided to each of the states,

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00016 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.176 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2439 either through the STP or indirectly through ship. This legislation makes some modest ad- some strides to update our institutional ar- the unprogrammed share of the Minimum justments and empowers these critical officials rangements, and this legislation builds on Guarantee program, be directed to local in the transportation partnership. those improvements. areas, following existing law using the fair Finally, this legislation specifically addresses Mr. Speaker, this legislation is nonpartisan. share distribution to urbanized and non-urban- the needs of local areas with the most air It represents an effort to establish a fair and ized areas. All areas within the states will quality and congestion problems. It does so by equitable distribution of our Federal transpor- have more funding certainty as a result. directing States to allocate Congestion Mitiga- tation dollars. Third, the Metropolitan Congestion Relief tion and Air Quality Improvement program f Act enhances our federal surface transpor- (CMAQ funds to local areas that are in non- HONORING C. K. WILLIAMS tation policies by enlisting local decision-mak- attainment or maintenance of applicable na- ers and their substantial transportation assets tional ambient air quality standards. Specifi- under their control more fully into the TEAÐ21 cally, it requires States to pass these funds to HON. RUSH D. HOLT partnership. local areas on a fair share basis where metro- OF NEW JERSEY In addition to directing more STP and Min- politan planning organizations are in place. IN THE HOUSE OF REPRESENTATIVES imum Guarantee resources to metropolitan Simply put, States earn CMAQ funds based Friday, November 21, 2003 planning organizations and other local areas on local air problems and the legislation Mr. HOLT. Mr. Speaker, this week C. K. under ongoing state-directed programs, the makes sure that funds are passed through to Williams was honored with the National Book legislation specifically directs states to work these areas. Recently, this chamber debated Award in Poetry for his book ‘‘The Singing: more directly with local decision-makers, par- the extension of the compliance deadlines in Poems’’. ticularly in the larger urban areas, in deciding some Texas cities and other places, all the The National Book Award, established in on investments in the National Highway Sys- while my own State of Texas had piled up 1950, has become one of the most significant tem. This is a critical asset for all of us and more than $270 million in unspent CMAQ literary prizes in the country and comes with a one where local governments either own a funds that could have helped improve air qual- $10,000 cash award. A creative writing pro- share of these facilities or where locally-owned ity in my area and others in the State. This fessor at Princeton University since 1995, C. facilities are substantially affected by NHS fa- provision will make sure that the local areas K. Williams has authored 14 books of poetry cility investments. that carry these-requirements under Federal over his long and distinguished career and in Let me provide some additional background law are certain to receive their fair share of 2000 he received the Pulitzer Prize in poetry on this and related points. One of the weak- the resources that are provided. for his work ‘‘Repair’’. nesses of the current Federal policy is that it There are also two new initiatives in the leg- Charles Kenneth Williams was born in New- relies too heavily on overburdened State islation that address congestion. One is a new ark, New Jersey in 1936. He started writing transportation agencies. Overall, States own $2 billion annual formula program aimed at the poetry at the age of 19 and has said that ‘‘Po- the smallest share of the Nation’s transpor- Nation’s most congested metropolitan mar- etry didn’t find me, in the cradle or anywhere tation facilities relative to local governments kets, as analyzed by the Texas Transportation else near it: I found it. I realized at some and yet are given direct control over an over- Institute. This program will target resources to point—very late, it’s always seemed—that I whelming share of Federal transportation dol- areas of the Nation with clear congestion needed it, that it served a function for me—or lars. On average, for each highway dollar that needs. The other program will provide modest someday would—however unclear that func- a State receives, only six percent is guaran- resources of $500 million annually to local tion may have been at first.’’ teed to reach local decision-makers, those in governments to support incident management Mr. Speaker we all are very lucky that C. K. metropolitan areas of 200,000 or more where programs. Williams found poetry and its clear to me that he has served a function to those of us who more than one out of every two Americans Let me speak to the need for these targeted have had the pleasure to read his wonderful live. programs. Every taxpayer and every commu- Let me explain further. Presently, local gov- nity in our States benefits if we make some poetry. At times his poetry delves in to the dark areas of despair and our eventual mor- ernments—cities, towns and counties—directly selected investments that improve the per- tality. As such his poetry is thought provoking, or indirectly through regional agencies own formance of our Nation’s most productive eco- deeply moving, and at times extremely per- and/or operate more than three-quarters of the nomic centers. All of our economic data shows sonal. Nation’s roads and streets, about one-half of that our metropolitan areas are truly the eco- Again, I congratulate Mr. Williams on his the Nation’s bridges, more than ninety percent nomic engines of our State economies and award, and I deeply thank him for the con- of all transit systems and about the same help drive overall U.S. economic growth. They tributions he has made through his poetry to share of the Nation’s airports, most of the train now account for the overwhelming and dis- enrich our society. C. K. Williams continues in stations, port facilities, traffic signals, public proportionate share of the Nation’s new jobs, the long great tradition of other New Jersey parking structures, sidewalks and trails, and personal income and total economic output. poets such as Walt Whitman, William Carlos so on. Let us not forget that 63 percent of This legislation speaks directly to the pressing Williams, Alan Ginsburg, and Robert Pinsky, urban area highways in the Federal Aid Sys- needs of these city and county metropolitan and he is certainly one of the best poets that tem, which includes those facilities generally areas by investing immediately in congestion New Jersey has to offer today. And as the Na- eligible under Federal TEAÐ21 programs, are relief strategies and programs that will pay tional Book Selection Committee, The Pulitzer owned by local governments. Yet, existing pol- substantial dividends to the economic bottom Committee, and other juries make clear, C. K. icy directs virtually all of the resources to State lines of our State and the Federal Govern- Williams is one of the best. I am so pleased highway and transportation departments. ment. These initiatives, coupled with other pro- to have a poet of such talent and mettle both In aviation, Congress rightly directs revisions in this legislation, will help us extract writing and teaching in my district. sources to the agencies, be it the State, re- more economic output from these areas. Mr. Speaker I would like to include in the gion or local government who own and oper- This investment in our regional economic RECORD a copy of the title poem of C. K. ate airports. In transit, Congress rightly directs engines will also position our Nation more fa- Williams’s award winning book, which is enti- resources to the level of government who de- vorably in the global competition of world tled The Singing. livers these services. In flood control, the trade. For instance, consider my own district, THE SINGING State, region, or local agency responsible for the Dallas Metro area, not including the ad- I was walking home down a hill near our the improvements receives the funding. And joining Fort Worth Metro area. The Dallas house on a balmy afternoon under the so on. Metro area produced more goods and serv- blossoms As this Congress seeks to address the bur- ices—about $170 billion in 2001—than 29 Of the pear trees that go flamboyantly mad dens of congestion the need for smarter and States. This output exceeded that of many here every spring with their bur- more balanced transportation investments to countries, such as Denmark or Hong Kong. geoning forth give taxpayers more for their dollars, we must This legislation is about recognizing the impor- When a young man turned in from a corner recognize that we have reached the point tance of the role local decision-makers play in singing no it was more of a cadenced shouting where it is impossible to achieve these out- steering these vital economic units and the Most of which I couldn’t catch I thought becomes without more fully involving our local value of tapping the vast range of our Nation’s cause the young man was black speak- transportation partners. This means bringing broadest asset base. In the end, our Federal ing black local elected officials—mayors, city council policy needs to go beyond the Federal/State It didn’t matter I could tell he was making members, county executives and commis- partnership of the 1950s that was built around his song up which pleased me he was sions, and others—more fully into this partner- the Interstate era. The 1991 ISTEA made nice-looking

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00017 Fmt 0626 Sfmt 0634 E:\CR\FM\A21NO8.180 E23PT1 E2440 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 Husky dressed in some style of big pants ob- isiana has alerted me to the difficulties that ‘‘yea’’ on rollcall votes Nos. 354, 355, 358 and viously full of himself hence his lyrical small businesses can face in bankruptcy pro- 359 and ‘‘nay’’ on rollcall vote No. 356. I was flowing over ceedings. In the wake of this chemical com- also absent from this Chamber on July 17, We went along in the same direction then he pany’s bankruptcy, a number of small busi- 2003, and would like the RECORD to show noticed me there almost beside him nesses in Louisiana found themselves defend- that, had I been present, I would have voted and ‘‘Big’’ He shouted-sang ‘‘Big’’ and I thought how ants in preferential payment lawsuits brought ‘‘yea’’ on rollcall vote No. 387. Furthermore, droll to have my height incorporated in by the bankruptcy trustee. Many of these com- on July 18, 2003, I was unavoidably absent his song panies were shocked that they would be ac- from this Chamber and I would like the So I smiled but the face of the young man cused of receiving preferential payments when RECORD to show that, had I been present, I showed nothing he looked in fact point- they had had a long history of consistent busi- would have voted ‘‘yea’’ on rollcall vote No. edly away ness dealings with the chemical company. Not 396 and ‘‘nay’’ on rollcall vote No. 397. And his song changed ‘‘I’m not a nice per- only were these businesses surprised by the On July 21, 2003, I was absent from this son’’ he chanted ‘‘I’m not I’m not a lawsuits, but they were dismayed that they Chamber and I would like the RECORD to show nice person’’ were forced to defend these lawsuits in Dela- that, had I been present, I would have voted No menace was meant I gathered no par- ware. The burden of hiring an attorney in Lou- ‘‘yea’’ on rollcall votes Nos. 398, 399 and 400. ticular threat but he did want to be isiana and Delaware was significant and a I was unavoidably absent from this Chamber certain I knew That if my smile implied I conceived of any- number of these small businesses were forced on July 24, 2003 and would like the RECORD thing like concord between us I should to settle these meritless lawsuits to avoid the to show that, had I been present, I would have forget it costs associated with a legal defense. voted ‘‘yea’’ on rollcall vote No. 441. I missed That’s all nothing else happened his song be- I believe that we are placing these small rollcall vote No. 452 on July 25, 2003, and came indecipherable to me again he ar- businesses in an unacceptable position. Ask- would like the RECORD to show that, had I rived ing small businesses to pay several thousand been present, I would have voted ‘‘nay.’’ Where he was going to a house where a girl dollars in legal fees or settlement fees is a sig- f in braids waited for him on the porch nificant burden for many of these businesses. that was all It appears that in a number of cases, bank- IN RECOGNITION OF BANQUET No one saw no one heard all the unasked and ruptcy trustees realize the leverage they have HONORING THE HEROES OF THE unanswered questions were left where on these small businesses and exploit this le- MONTGOMERY, ALABAMA BUS they were verage. It costs little for the trustees to file suit BOYCOTT It occurred to me to sing back ‘‘I’m not a against these small businesses and then the nice person either’’ but I couldn’t come up with a tune trustees have the luxury of adjudicating the HON. MIKE ROGERS lawsuits in the State they are working in. Au- OF ALABAMA Besides I wouldn’t have meant it nor he have believed it both of us knew just where thorizing penalties for frivolous lawsuits and IN THE HOUSE OF REPRESENTATIVES we were changing the venue for preferential payments Friday, November 21, 2003 In the duet we composed the equation we cases that fall below a meager $5,000 thresh- made the conventions to which we were old has done little to improve the situation for Mr. ROGERS of Alabama. Mr. Speaker, I condemned small businesses. I believe that we must force rise today to join the Montgomery, Alabama Sometimes it feels even when no one is there bankruptcy trustees to take a harder look at Transportation Coalition in recognizing the he- that someone something is watching the merits of these preferential payments roes of the 1955 Montgomery Bus Boycott. and listening cases and we need to allow small businesses On December 4, 2003, the Coalition will Someone to rectify redo remake this time the courtesy of defending these lawsuits in the hold its annual awards dinner, and the theme again though no one saw nor heard no State in which they reside. for this year’s banquet is ‘‘Reclaiming the one was there For this reason, I have introduced the Dream.’’ They have chosen this occasion to f ‘‘Small Business Bankruptcy Venue Relief honor the heroes of the Montgomery Bus Boy- INTRODUCTION OF BIPARTISAN Act.’’ This legislation will allow small busi- cott. These heroes are former Pastor Robert RESOLUTION ON JUA´ REZ nesses of under 25 full-time employees to de- Graetz, Mrs. Inez Jessie Baskin, Mrs. Johnnie fend preferential payments claims in the State Carr, Mrs. Daisy Childrey, Mrs. Thelma Glass, HON. HILDA L. SOLIS where they reside. In addition to lowering legal Mrs. Hazel Gregory, Mrs. Vera Harris, Mr. OF CALIFORNIA costs for these small businesses, this legisla- Bobby Jackson, Mrs. Zecozy Williams, and IN THE HOUSE OF REPRESENTATIVES tion will force bankruptcy trustees to give posthumously, Mrs. Aurelia Browder, Mrs. Vir- ginia Durr and Mr. Eddie Posey. Friday, November 21, 2003 greater consideration to the merits of preferential payment claims against small busi- Today, it may be difficult for some to recog- Ms. SOLIS. Mr. Speaker, I rise today to in- nesses. nize the importance of what these individuals troduce this bipartisan resolution with my col- Mr. Speaker, I hope that members will con- did because, thankfully, times have changed. leagues Ms. SLAUGHTER, Mr. REYES, Mr. sider the plight of small businesses and co- But, the change has come about because of RAMSTAD, Mr. RODRIGUEZ, and Ms. CAPITO. sponsor the ‘‘Small Business Bankruptcy their actions. They truly are heroes, and I sa- We are deeply concerned about the murders Venue Relief Act.’’ lute each of them. and violence against women that has occurred f f in the state of Chihuahua, Mexico. Since 1993 over 300 women have disappeared from this PERSONAL EXPLANATION INTRODUCING THE AUDITOR INDE- area. Oftentimes their mutilated bodies are PENDENCE AND TAX SHELTERS found in the abandoned or desert areas. This HON. LUIS V. GUTIERREZ ACT resolution expresses our sincerest condo- OF ILLINOIS lences and deepest sympathy to the families IN THE HOUSE OF REPRESENTATIVES HON. RAHM EMANUEL of the victims, and encourages increased U.S. OF ILLINOIS involvement in bringing an end to these hei- Friday, November 21, 2003 IN THE HOUSE OF REPRESENTATIVES nous crimes that for the most part have gone Mr. GUTIERREZ. Mr. Speaker, I was un- unsolved. avoidably absent from this Chamber on July 8, Friday, November 21, 2003 f 2003. I would like the RECORD to show that, Mr. EMANUEL. Mr. Speaker, today, I am SMALL BUSINESS BANKRUPTCY had I been present, I would have voted ‘‘nay’’ proud to introduce bipartisan legislation to stop VENUE RELIEF ACT on rollcall vote No. 334 and ‘‘yea’’ on rollcall the unethical, and in certain cases, criminal Nos. votes 335 and 336. On July 10, 2003, I conduct by some of our Nation’s most re- HON. RICHARD H. BAKER was absent from this Chamber for a journal spected accounting firms that market abusive vote No. and I would like the RECORD to show tax shelters under the guise of ‘‘non-audit OF LOUISIANA that, had I been present, I would have voted services’’ to the public companies whose IN THE HOUSE OF REPRESENTATIVES ‘‘yea’’ on rollcall vote No. 346. books they audit—in effect auditing their own Friday, November 21, 2003 On July 14, 2003, I was absent from this work. The Auditor Independence and Tax Mr. BAKER. Mr. Speaker, the recent bank- Chamber and I would like the RECORD to show Shelters Act, cosponsored by Representatives ruptcy of a large chemical company in Lou- that, had I been present, I would have voted MARK FOLEY, BART STUPAK, DAVE CAMP, and

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TOM LANTOS, will eliminate this irreconcilable Lafarge West operates the Specification Ag- the railroad site. In 1858, when the railroad conflict of interest that fuels the engine of an gregates Quarry on Colfax Avenue in Golden, reached the place, the mill company laid out ever-expanding tax shelter industry. Colorado. I am proud to serve Golden as their off the town, with the mill in the center. It was Ongoing Senate hearings and the General Congressman, especially after watching this called Hurtsville for the principal founder. Accounting Office investigations reveal that tax tremendous effort put forth by all parties in- On November 5, 1878, a petition was filed revenue lost from known shelters totaled $33 volved to create a win-win situation for with the Russell County Judge of Probate billion over the past decade, and that losses Lafarge, the city of Golden, concerned envi- Simeon O’Neal by more than 20 of the male from undetected shelters could total another ronmental groups and, of course, the citizens inhabitants of the town laying out the bound- $52 billion. Last year, for example, an abusive of Jefferson County. aries of the town and the name to be given if tax shelter known as ‘‘Slapshot’’ was expected In fact, I recently received a letter from the incorporated and requesting that an election to produce tax breaks exceeding $120 million mayor of Golden, Charles Baroch where he be held for incorporation. Judge O’Neal then for Enron. It was based on a $1 billion loan said, ‘‘Lafarge has for many years been a set the election for December 3, 1878, and on and concealed by a highly intricate combina- good neighbor, being very concerned about that day, no votes were cast against incorpo- tion of loans and stock transactions occurring the impact of the mine and crushing plant on ration. Therefore, on December 4, 1878, within minutes of each other that were de- the neighborhood. Lafarge listens to citizens Judge O’Neal made entry in the record that in- signed to prevent tax regulators and authori- concerns and takes action to correct the prob- habitants of the town of Hurtsville were incor- ties from discovering what really happened. lem. Most everyone in Golden is proud to porated under the name of ‘‘Hurtsville’’ with As William McDonough, Chairman of the have this business a part of Golden.’’ such boundaries to extend one half mile in Public Company Accounting Oversight Board The partnership began when Lafarge real- every direction from the present public croping recently said, major accounting firms have suf- ized it’s basic need to increase the reserves of at the depot of the Mobile and Girard Railroad. fered a ‘‘complete ethical collapse.’’ Chairman the quarry to serve the growing Denver mar- On March 24, 1883, a petition was filed by McDonough added during recent testimony ket. A market, I hope, that will be even strong- more than 10 of the male inhabitants of before Congress that the willingness to sell er soon with the passage of a new transpor- Hurtsville that the name of the town be faulty tax shelters and hide them from the IRS tation re-authorization bill. changed to Hurtsboro (to avoid confusion with is ‘‘immensely and immorally repugnant.’’ So, in the spirit of cooperation, Lafarge the town of Huntsville, Alabama). An election Moreover, David Clay Johnston of the New began a 2-year process of meeting with local was held on April 11, 1883, and based on the York Times and author of Perfectly Legal, re- citizens, businesses, community leaders and results, Russell County Judge of Probate ports that tax avoidance among corporations environmental groups to learn what concerns Simeon O’Neal entered into the record that and upper-income individuals is far outrunning may be out there regarding a quarry expan- the town’s name be changed to ‘‘Hurtsboro.’’ the audit capacity of the IRS. He estimates sion. In the end, after many presentations, I congratulate Hurtsboro, Alabama, on its that a $113 billion gap exists between what many meetings and many late nights, they did 125th anniversary of incorporation and join its corporations should be paying and what they find that win-win solution. Scott Gudahl put it residents in recognizing their proud history. actually pay. Clearly, the burden of this gap in simply when he said, ‘‘We kept addressing ex- tax receipts is being shouldered by middle- pectations and concerns until there were none f class families. left—and that’s what you basically have in the In response to this costly and unethical final proposal.’’ COMMENDING PENNINGTON practice, our legislation prohibits auditors from That final proposal was an innovative land ELEMENTARY IN WHEAT RIDGE providing those tax shelter services for which swap. The quarry will be able to expand by 60 a significant purpose is the avoidance or eva- acres and Jefferson County will receive more HON. BOB BEAUPREZ sion of federal income tax to the publicly trad- than 500 acres of added scenic open space. OF COLORADO ed corporations they audit. The bill also pro- Even the quarry itself, once reclaimed, will be IN THE HOUSE OF REPRESENTATIVES hibits auditors from offering tax shelter serv- donated as additional open space for the en- ices to the corporation’s officers and directors. joyment of Jefferson County citizens. Friday, November 21, 2003 Additionally, guiding principles under this bill Mr. Speaker, you know as well as I that all Mr. BEAUPREZ. Mr. Speaker, I rise today will clarify how audit committees decide too often, good honest businesses are painted to add to the RECORD a story of true leader- whether the corporation’s auditor may provide with unfair labels by those who do not under- ship and determination occurring in the very certain non-audit services to the corporation. If stand the process of making the roads and place that it should, our school system. the audit committee finds that a proposed highways that keep our economy moving. I I recently had the honor of visiting Pen- service would reasonably result in an impair- applaud the people at Lafarge for putting forth nington Elementary, a small school located ment of the auditor’s independence by vio- the extra effort not only to create a better back home in my great Colorado district. Not lating one of these principles, the audit com- company, but also create a better community. only was I impressed by the moral this house mittee would be unable to approve the pro- I am proud of their efforts and I am proud to of education puts forth to its visitors, I was posed service. represent their employees in this Congress. amazed at the progress I learned of that these Under our legislation, auditors would still be f young minds are making and the dedication of able to market tax reduction strategies to other IN RECOGNITION OF THE 125TH AN- their instructors and administrators. companies and individuals, but not to the com- NIVERSARY OF THE CITY OF Four years ago Pennington Elementary was panies that they are responsible for auditing. HURTSBORO, ALABAMA considered to be the school to which no one This is a common sense approach to pro- wanted to send their children. The children in tecting our investors and American middle- the community were known to be impolite and class families from the increasing cost and the HON. MIKE ROGERS OF ALABAMA irresponsible. Now if you ask neighbors of this expanding prevalence of tax shelters, which IN THE HOUSE OF REPRESENTATIVES accomplished school about the little ones’ de- should be exposed for what they really are— meanor in and out of the school setting, they unfair and unpatriotic corporate behavior, and Friday, November 21, 2003 will tell you the children are intelligent, delight- which should be stopped once and for all. Mr. ROGERS of Alabama. Mr. Speaker, I ful and always polite and courteous to those f rise today to pay tribute to the City of around them. Hurtsboro, Alabama, on its 125th anniversary COMMENDING LAFARGE This school of only 248 students has risen CONSTRUCTION MATERIALS of its incorporation on December 4, 2003. to the top of the pile and now begins their day Hurtsboro, Alabama, located in Russell with a ‘‘Pennington Pledge’’ as a daily re- SPEECH OF County, Alabama, was originally station Num- minder of what they stand for; a good motto HON. BOB BEAUPREZ ber 4 on the Mobile and Girard Railroad. In for any upcoming citizen. It reads: 1857, Joel Hurt, Sr. came to the site of We the students of Pennington agree to OF COLORADO Hurtsboro and with a partner, William Mar- IN THE HOUSE OF REPRESENTATIVES have a drug free school, a safe and orderly shall, bought land and established a sawmill learning environment, to be big brothers and Friday, November 21, 2003 by a creek now called Hurtsboro Creek. Mr. big sisters to any little student. As a respon- Mr. BEAUPREZ. Mr. Speaker, I would like Hurt had moved from Eatonton, Georgia, to sible citizen I will follow the rules of Pen- to take this opportunity to commend Lafarge Olivet, Alabama, a thriving farm community nington. Construction Materials on their exceptional about 3 miles from Hurtsboro. However, when Because the school has changed the out- contribution as a corporate member of the Olivet was bypassed in the survey to the Mo- look of the staff, community and parents, suc- Golden community. bile and Girard Railroad, Mr. Hurt moved to cess is a regularly heard word within the walls

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00019 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.189 E23PT1 E2442 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 of Pennington Elementary. The school’s stand- ground of discrimination and persecution in pired to, and to promote the peace in which ardized state test scores have risen from 28 Europe. Jews were barred from higher edu- he believed despite the forces of darkness ex- emplified by those who murdered him; percent proficient or better in 1998Ð1999 to cation in Russia and Romania, and there were Because Revital Barashi will no longer 56.7 percent during the 2002Ð2003 school similar restrictions in many other countries. share her pleasant manner with her col- year and continue to rise. Their fourth grade Also, there was an increasing demand from leagues in the corridors of the Faculty of reading scores alone have gone from 35 per- high school graduates in pre-state Israel for Law; cent proficient or greater to 82 percent during higher education. Because Dina Carter will never continue the same span of time, gaining them the rec- The idea of a university in the Holy Land with her dedicated work in the Library and ognition for the largest, improvement in read- was proposed by Chaim Weizmann, Israel’s Janis Ruth Coulter will never continue to devote herself to the University in America. ing scores for the state of Colorado. first president. Among those backing the idea Because we will never again see the won- I would also like to make mention that Pen- and assisting in raising financial support for derful smile that lit up the face of Levina nington has achieved these great strides by the future university was Albert Einstein. The Shapira, adopting a ‘‘no excuses attitude.’’ The stu- university’s foundation stones were dedicated Because the intelligence and the wisdom dents and faculty of Pennington believe that on Mount Scopus overlooking Jerusalem in which Daphna Spruch personified has gone and will never return. there is no reason that their school should not 1918. Even before the university officially And even those amongst us who were not be a school of excellence, and that very atti- opened its doors in 1925, there was an inau- here last year, or who arrived after the tude is what has placed them as such in my gural lecture given by Einstein in 1923. dreadful explosion, cannot return to being eyes. From its core of three institutes in the exact how they were before. Because we all under- Pennington illustrates pride in education and sciences and Jewish studies, the university stand that this University, which is so dear excitement for the learning process. Mr. expanded rapidly to eventually include all to us all, is hated by the forces of darkness, Speaker, I am proud to have such a school of areas of higher education—the social and that it was not by chance that the Uni- excellence back home in my district. Pen- sciences, law, medicine, dental medicine, agri- versity was chosen as a target because we are Israeli or Jewish, but dafka because we nington has truly shown that they are an ex- culture, social work and education. The War of are dedicated to openness and tolerance, be- cellent educational institution that strives daily Independence, with its division of Jerusalem, cause we are part of the free and enlightened to deliver on their goals and dedication to their caused the loss of the Mt. Scopus campus to world and the wicked spared no effort to children and the futures that await them. I am the university in 1948 and its subsequent dis- strike at the University, dafka because our truly proud of the students, staff and commu- persal to various sites in West Jerusalem. Campuses are oases of wisdom, of dialogue nity surrounding and supporting Pennington After the Six-Day War of 1967 and the re- between people of different faiths and back- unification of Jerusalem, the university re- grounds, of different beliefs and religions. Elementary. And then, you realize that this Campus is f turned to Mt. Scopus, which again became the part of the war zone in the war for the remain campus. Today the university operates birth of the Jewish people in its land, part of COMMEMORATING FIRST ANNI- from four campuses—three in Jerusalem and the war zone in the war of the free world VERSARY OF TERROR ATTACK one in Rehovot and has a total enrollment of against the forces of hate, intolerance and ON MOUNT SCOPUS some 23,000 students and an academic staff tyranny. of about 1,200. The year that has passed has not been an The Hebrew University of Jerusalem is an easy one. Those who lost their dear ones HON. ERIC CANTOR have found it difficult to accept their loss; OF VIRGINIA institution of international renown and is a the wounded have fought to rebuild their IN THE HOUSE OF REPRESENTATIVES beacon of open inquiry and academic freedom lives again, but the emotional and physical Friday, November 21, 2003 in the Middle East. The key point is that the scars will forever be with them. university is open to all, regardless of nation- The Hebrew University family gritted their Mr. CANTOR. Mr. Speaker, I had the great ality, ethnic origin, religion or race. Its teeth, and returned to the sacred work of re- opportunity to return to Israel during this past Rothberg International School hosts students search and teaching. We were faced with almost impossible decisions. The threats August. Every visit to Israel brings forth so from dozens of countries, and its Jewish Na- many emotions, some happy, some sad, but against this University, its principles and all tional and University Library is an unparalleled that it represents haven’t disappeared. always inspirational. My visit was approxi- research source used by scholars from around We have had to make painful compromises mately a year after one of the most senseless the world. between security considerations and main- and brutal attacks that has taken place since The following is a copy of a speech deliv- taining a free and dynamic Campus. The eco- the beginning of the so-called second Intifada. ered by Menachem Magidor, President of the nomic situation and the budgetary burdens On July 31, 2002, a terrorist placed a bomb in Hebrew University, on the occasion of the first have not made it any easier, but the year that has passed has proved to us all, as has the cafeteria at Hebrew University. Nine young anniversary of the attack on the school. people were killed and many more wounded. happened so many times during the 78 years PRESIDENT MAGIDOR’S SPEECH AT THE CERE- of the existence of the Hebrew University, Of the nine, five were Americans. I mourn the MONY COMMEMORATING THE FIRST ANNIVER- that this living and growing tree, called the loss of all innocent lives, but this particular at- SARY OF THE TERROR ATTACK ON MOUNT Hebrew University, is difficult to uproot. tack stands out for two main reasons. SCOPUS Because the University’s existence draws First, of course, the attack underscores the Just one year ago.at exactly this moment, its life’s breath from the never-ending strug- close relationship of Hebrew University to the this was the scene of a ghastly event, a scene gle for truth; because it aspires to help the United States. This goes beyond the tragic of broken glass, overturned tables, blood and advancement of humanity; because it is root- deaths of the five Americans. The fact that so the cries of the injured and dying. ed deep in the essence of our traditions while ‘‘Desolation, devastation and destruction!’’ its branches stretch forth to the winds of tol- many Americans were there and that so many One year has passed—the murdered have erance, openness and respect for one another; are still going there to study underscores the been laid to rest, and among the injured, because despite the forces of darkness that close relationship between this university and there are those who have recovered fully, tried to destroy it, it has not lost its aspira- the people of the United States. Thousands of and there are those who will never return to tions for peace. Americans have studied at Hebrew University, their former selves. The blood has been May the memory of the nine be blessed. particularly in their exceptional ‘‘year-abroad’’ washed away, the blackened walls have been f repainted, students rush to classes, and program and in their graduate schools. Many CONFERENCE REPORT ON ENERGY are there still and many more will follow. Many young people gather at the new tables in the cafeteria, engaged in lively and friendly con- POLICY ACT OF 2003 scientists from Hebrew University are also re- versations. cipients of research grants from the American Has life simply returned to the way it was SPEECH OF government and American institutions. Their before? Of course not, because of those who HON. W.J. (BILLY) TAUZIN work has been and continues to be of the are no longer with us. OF LOUISIANA highest quality. Second, targeting Hebrew Uni- Because Marla Bennett and Benjamin IN THE HOUSE OF REPRESENTATIVES versity for such an attack was truly heinous. Blutstein will never continue on their mar- Throughout its long and distinguished history, velous journey of discovery of their roots Thursday, November 20, 2003 Hebrew University has reached out to stu- and traditions; Because David Gritz will never continue Mr. TAUZIN. Mr. Speaker, I rise to explain dents and scholars of all religions and races. with his unique combination of philosophy, for the record the role of the FERC in regu- The Hebrew University of Jerusalem, the Jewish Studies and music; lating public utility holding companies following ‘‘flagship’’ of Israeli universities, was first con- Because David Diego Ladowski will never repeal of the Public Utility Holding Company ceived in the 19th century against the back- serve society and the country as he had as- Act. The repeal contains several savings

VerDate jul 14 2003 02:48 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00020 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.192 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2443

clauses. In essence, the savings clauses state working with Congressman FRELINGHUYSEN on country, and to salute him on the occasion of that none of them give the FERC any new au- the Appropriations Committee to preserve his retirement from the ranks of federal law thority. They confirm that once PUHCA repeal New Jersey’s open space. enforcement. takes effect, the FERC will continue to apply f Special Agent Rod Miller was born and existing utility rate regulation to public utilities raised in Linton, Indiana, which is in the heart within formerly registered holding companies HALF A LOAF FOR AMERICA’S of Indiana’s 8th Congressional District. The under PUHCA of 1935. DISABLED VETERANS IN ELIMI- son of an Army veteran who was awarded the Particularly, Section 1275(a) states if a state NATING DISABILITY TAX Purple Heart during World War II and who commission disagrees with the allocation of himself worked as a Navy employee for some costs of non-power goods or services provided HON. RUSH D. HOLT 30 years thereafter, Rod spent time as a life- by an affiliate organized specifically for that OF NEW JERSEY guard and paperboy in Linton before grad- purpose, typically a service company, either IN THE HOUSE OF REPRESENTATIVES uating from Linton High School in 1966. He the state commission or the holding company enrolled at Indiana State University in Terre Friday, November 21, 2003 system may ask the FERC to resolve the allo- Haute, and completed two years of study be- cation issue. The FERC will then make a de- Mr. HOLT. Mr. Speaker, earlier this session fore enlisting in the U.S. Air Force in 1969. termination of the proper allocation of such I signed the discharge petition to force a vote After a four-year stint in the Air Force, includ- costs under the standards contained in the on legislation that I co-sponsored (H.R. 303) ing over a year spent in Vietnam, Rod re- section, but only at the request of a State which would have repealed altogether an anti- turned to Terre Haute and completed his un- commission or a holding company system. quated law from the 1890s that prevents dis- dergraduate studies, earning a Bachelor of The FERC has no authority to review or ap- abled veterans from receiving concurrently Science degree in Criminology in 1974. Short- prove such cost allocations absent such a re- both military retirement and veterans’ disability ly thereafter, he began coursework at the quest. Section 1275(b) merely states that both benefits. In response to that parliamentary same school to obtain a Master of Science de- the FERC and the State commissions retain procedure, the Republican Leadership finally gree, also in Criminology. whatever rights they now have to review cost relented and included a plan in the FY 2004 In May 1975, Rod commenced what would allocations from service companies among Defense Authorization Conference Report that become a long and illustrious career as a public utilities for rate-making purposes. will be phased in over ten years and would Special Agent with the Naval Investigative f provide greater benefits for approximately Service (NIS)—the predecessor of today’s 245,000 disabled veterans—only half of those Naval Criminal Investigative Service—at NIS H.R. 1964 THE HIGHLANDS who see their retirement benefits reduced or Resident Agency Great Lakes. There he CONSERVATION ACT eliminated under current law. learned the basics of criminal investigation, This is a good step forward and I surely and proved himself to be a talented and driven HON. STEVEN R. ROTHMAN would have voted in favor of this plan had it law enforcement professional. OF NEW JERSEY been brought to the House floor as a free- In 1978, Rod opened a new NIS office in IN THE HOUSE OF REPRESENTATIVES standing bill. Unfortunately, the Republican Crane, Indiana, where the Navy conducts Leadership folded it into the $400 billion De- some of its most important research, develop- Friday, November 21, 2003 fense Authorization Conference Report, which ment, and engineering of surface ship combat Mr. ROTHMAN. Mr. Speaker, I rise today in I voted against for several other reasons. Now systems. He also took this opportunity to con- strong support of H.R. 1964, the Highlands that this legislation has been enacted, it is include his studies at Indiana State University, Conservation Act, introduced by my colleague, cumbent upon this Congress to do more than finishing his thesis and earning his Master’s Mr. RODNEY FRELINGHUYSEN. provide half a loaf. We need to pass additional degree in 1979. I am very pleased to be an original cospon- legislation in the next session of Congress to Following his NIS service in his home state sor of the Highlands Conservation Act, which cover the remainder of our nation’s disabled of Indiana, Rod was assigned to the NIS Resi- is an important step forward in our ongoing ef- veterans who are unfairly left in the predica- dent Agency in Guam from 1980 to 1982. He fort to save New Jersey’s precious open ment of having to pay this de facto ‘‘disability demonstrated continued leadership and inves- space and enhance the quality of life for resi- tax’’. tigative acumen in Guam, where he received dents. New Jersey is the most densely popu- On January 21, 2001, President Bush said, a meritorious award from the Drug Enforce- lated State in the Nation, which is why it is so ‘‘America’s veterans ask only that government ment Administration for his role in a significant important that we think ahead and recognize honor its commitments as they honored theirs. international drug smuggling investigation, and the importance of preserving our remaining . . . In all matters of concern to veterans— was made an honorary Police Officer with the acres of open space. By protecting the 2 mil- from health care to program funding —- you Guam Department of Public Safety for the lion acres of the Highlands, which extend have my pledge that those commitments will support he provided to that department. He through our neighboring states as well, we are be kept. My Administration will do all it can to was rewarded with a supervisory role at the creating an environmental legacy for future assist our veterans and to correct oversights NIS Resident Agency in Portsmouth, Virginia, generations, safeguarding our area’s drinking of the past.’’ where he was appointed to the position of As- water, and ensuring that our children and our I couldn’t agree more. I will actively support sistant Special Agent in Charge in 1982. children’s children have places to explore and additional legislation in the next session of this For the next 21 years, Rod served with dis- opportunities to enjoy the great outdoors. Congress to ensure that none of the 4,263 tinction in supervisory roles at a host of critical The Highlands Conservation Act is a testa- veterans in New Jersey who currently receive Navy locations—from 1984 to 1985, as the ment to the foresight of the bill’s author, Con- military retirement benefits will have their dis- Special Assistant to the NIS Regional Director gressman RODNEY FRELINGHUYSEN, who rec- ability payments reduced commensurately be- in Norfolk; from 1985 to 1986, as the Assistant ognizes the importance of saving New Jer- cause they remain subject to the so-called Special Agent in Charge of the fraud unit at sey’s open space. I have seen Congressman concurrent receipt prohibition. NIS Resident Agency Norfolk; and from 1987 FRELINGHUYSEN’s commitment to the preserva- f to 1988, as the first Special Agent in Charge tion of undeveloped acres firsthand as a col- of the new NIS Mid-Atlantic Regional Fraud league of his on the House Appropriations ON THE OCCASION OF THE RE- Unit. Committee. He worked in a bipartisan fashion TIREMENT OF NAVAL CRIMINAL In 1988, Rod was appointed to be the first to garner support for his measure. Congress- INVESTIGATIVE SERVICE SPE- Special Agent in Charge of Operation Ill Wind, man FRELINGHUYSEN’s leadership to protect CIAL AGENT ROD MILLER one of the most significant defense procure- the Highlands will truly help New Jersey live ment fraud investigations in our nation’s his- up to its namesake as the Garden State. HON. JOHN N. HOSTETTLER tory. This joint investigation ultimately resulted Getting Congress to authorize $100 million OF INDIANA in the conviction of 46 individuals and six de- for the preservation of the Highlands would be IN THE HOUSE OF REPRESENTATIVES fense corporations, and yielded fines and pen- a victory for our quality of life and the environ- alties in the amount of some $190 million. ment, but also a victory for New Jersey’s tax- Friday, November 21, 2003 Rod’s professional success continued in the payers who will be spared from having to pay Mr. HOSTETTLER. Mr. Speaker, I rise to wake of his involvement in Operation III Wind. for the full cost of these preservation efforts. I express my appreciation to Special Agent In 1989, he was appointed the Special Agent am pleased that I was able to help get this bill Rodney Miller of the Naval Criminal Investiga- in Charge of the new NIS Regional Fraud Unit onto the floor today and I look forward to tive Service for his 32 years of service to his based in Los Angeles, California. And, when

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00021 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.196 E23PT1 E2444 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 the decision was made to open a new NIS manufacturers from around the country and facturing and research communities, to pass Field Office in Los Angeles in 1992, Rod was specifically spoken to manufacturers both this important legislation. the natural choice to be the first Special Agent large and small about their problems. They all f in Charge there, as well. agree that innovation is one of the keys to en- In 1993, in the aftermath of the Tailhook insuring our manufacturers remain competitive IN RECOGNITION OF OUTSTANDING vestigation, the then-acting Secretary of the and it is crucial to the development of new in- CONTRIBUTIONS OF AUBURN, Navy disestablished the Naval Investigative dustries. Funding research and development ALABAMA CITY MANAGER DOUG Service and established the Naval Criminal In- underpins innovation. WATSON TO THE AUBURN COM- vestigative Service (NCIS) in its stead. This Based on these discussions and a hearing MUNITY change, and the reforms associated with it, I held earlier this year, I am proud to introduce had profound and dramatic effects across the the Manufacturing Technology and Competi- HON. MIKE ROGERS organization. tiveness Act of 2003. This bill will help our na- OF ALABAMA Among other developments, in 1997 NCIS tion’s manufacturers maintain and improve IN THE HOUSE OF REPRESENTATIVES their technological edge. This legislation will created a new Office of Special Projects, or Friday, November 21, 2003 OSP, representing the vanguard of the agen- stimulate innovation through collaborative re- cy’s counterespionage efforts. The following search and development, and broaden and Mr. ROGERS of Alabama. Mr. Speaker, I year, Rod was named the Special Agent in strengthen the Manufacturing Extension Part- rise today to join the residents of Auburn, Ala- Charge of OSP, and set about to make his im- nership (MEP) program, which provides small- bama, in recognizing the contributions of Doug pact felt. He applied his vision and leadership and medium-sized manufacturers with the Watson to the City of Auburn, Alabama. to the OSP mission, ultimately evolving the tools to compete better. More importantly, it Doug Watson has been City Manager for unit far beyond original expectations. In addi- will bring together a variety of partners in the Auburn for 21 years. During this time, he has tion to enjoying success in several significant public and private sectors, building relation- gained the respect of the entire community for espionage cases, Rod’s unit applied its spe- ships that encourage and foster technological his loyal and dedicated service. To dem- cialized training to a broad range of other in- development and the ability to bring these de- onstrate their appreciation, the City of Auburn, vestigative and operational activities, including velopments to the marketplace. Auburn University and the Auburn Chamber of counterterrorism operations, counternarcotics Our global competitors are eagerly sup- Commerce are hosting a community-wide re- initiatives, and ‘‘cold case’’ homicide efforts. porting investments in manufacturing research ception on December 10, 2003. The reception The successes achieved in these endeavors and development because they know it is the will immediately follow the dedication cere- have earned OSP accolades from across the key to sustained economic development. If we mony of the Douglas J. Watson Municipal law enforcement and counterintelligence com- are to continue to be the world’s technological Complex, consisting of the Development Serv- munities. leader, we need to rise to this new global ices building, the Public Safety Administration Mr. Speaker, Rod Miller has served our na- challenge and make the investments envi- building, and the Municipal Court. The naming tion with distinction for 32 years—first in the sioned by this legislation. of this complex after Doug Watson is an indi- More specifically, the bill: uniform of an Air Force airman, and then in cation of the high esteem in which he is held. Ensures that all federal manufacturing the ranks of federal law enforcement with I salute Doug Watson for his service to the programs and related funding are coordi- Auburn community and wish him well as he NCIS. His is a record to be admired. I hope nated and focused on solving these impor- that the occasion of Rod’s retirement from tant problems. The bill requires a strategic takes on the new position of tenured professor NCIS this November will give all of us pause plan and improved budget process to ensure at the University of Texas at Dallas. to consider the many contributions and sac- these programs work together efficiently; f Designates the current Under Secretary for rifices of our nation’s law enforcement profes- CONFERENCE REPORT ON H.R. 6, sionals. On behalf of all Americans, I wish him Technology within the Department of Com- merce, as the Under Secretary for Manufac- ENERGY POLICY ACT OF 2003 ‘‘fair winds and following seas’’ as he pursues turing and Technology, to be the federal gov- the next stage in his life—returning to Linton ernment’s point person on manufacturing SPEECH OF with his wife of 34 years, to join his three chil- R&D policy, and outlines new duties focused dren and three grandchildren there—after a on fostering innovation within the manufac- HON. W.J. (BILLY) TAUZIN long, successful, and distinguished career in turing sector for this position; OF LOUISIANA Establishes a new collaborative research service to the United States of America. IN THE HOUSE OF REPRESENTATIVES and development program for manufacturing f technology to build partnerships among Tuesday, November 18, 2003 THE MANUFACTURING TECH- higher education institutions, businesses, Mr. TAUZIN. Mr. Speaker, offshore oil and NOLOGY COMPETITIVENESS ACT states and other partners. This program will provide $184 million over four years; gas production in the Gulf of Mexico provided OF 2003 Helps to develop future leaders in manu- nearly $6.6 billion in royalty, bonus and rent facturing technology through a fellowship revenues to the federal government in 2001. HON. VERNON J. EHLERS program in applied manufacturing research. The coastal states which supported this pro- Fellows will get to work with world-class OF MICHIGAN duction received approximately $130 million leaders in technology and engineering at the IN THE HOUSE OF REPRESENTATIVES combined—a royalty sharing rate of less than National Institute of Standards and Tech- two percent. Yet onshore oil and gas produc- Friday, November 21, 2003 nology (KIST). The fellowship program will tion revenues on federal lands is shared 50/50 provide $7.5 million over four years; Mr. EHLERS. Mr. Speaker, I rise today to Reauthorizes and reforms the Manufac- between the federal government and the state introduce ‘‘The Manufacturing Technology turing Extension Partnership (MEP) pro- in which the production occurs. In the case of Competitiveness Act of 2003.’’ gram by increasing competition among the Alaska, the state gets 90 percent of these on- While Congress, the Administration and the centers. MEP is funded at $120 million for shore revenues produced on federal lands. American people have discussed the many the first year, increasing to $137 million by The disparity between the onshore and off- challenges facing our nation’s manufacturers, year four; and, shore royalty sharing programs and their con- Creates a new competitive, peer-reviewed such as international trade, China policy, tax grant program within the Manufacturing Ex- tribution to our domestic energy security is policy and health care costs, I believe that a tension Partnership (MEP) program to de- striking. Federal lands within the United States fundamental issue has been generally left out velop new tools to help small businesses in- generated an estimated $2 billion in royalties of the debate—innovation. For decades inno- novate and compete. Funding for this pro- from the production of oil, gas and coal in vation has underpinned American’s dominance gram will come from the total MEP funding. 2001 with about $1 billion of these revenues in the world economy. If our manufacturing Mr. Speaker, while I am pleased that we are going to the states for ‘‘hosting’’ these energy sector is to remain competitive in the global on the road to economic recovery, we must production activities. In contrast, offshore pro- marketplace, we must foster innovation within still address underlying concerns about the fu- duction in Louisiana’s waters of oil and gas this sector. ture of U.S. manufacturing. This bill will help contributed over $5 billion in royalties to the As Chairman of the House Science Sub- address some of those concerns and put our U.S. Treasury in 2001 yet Louisiana received committee on Environment, Technology and Nation’s manufacturers in a better position to royalties of less than $30 million, a 0.6% re- Standards, I oversee many of the federal gov- compete today and in the future. turn. The Gulf of Mexico produces more en- ernment’s manufacturing-focused research I look forward to working with my colleagues ergy and associated revenues to the U.S. and development programs. I have met with in the House and Senate, and with the manu- Treasury than any other area of the federal

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00022 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.200 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2445 domain. Nearly $130 billion has been provided Section 32(d) requires states to submit vide oversight to the SERF program. Since the to the federal government as a result of oil plans to the Secretary for approval. The Gov- majority of the coastal energy states and near- and gas production in the Gulf of Mexico. ernor of each eligible state must include the ly all the federal offshore production is located States receive 100 percent of the royalties plans prepared by the political subdivisions in in the Gulf of Mexico, the conferees expect they charge and collect in state waters. Louisi- the state plan. It is not the intention of this the current Gulf of Mexico OCS Region office ana’s waters extend to only three nautical section to allow the Governor of a state to dis- to play a significant role in the administration miles, compared to 9 miles for Texas and approve the plans of a political subdivision. In of this program. Florida. Therefore, if Louisiana had waters preparation of the plans, the conferees strong- Section 32(i) directs that two percent of the equal to these states, the significant revenues ly urge the Secretary to ensure that states and SERF fund be provided to the CREST pro- produced in these waters would have been political subdivisions carefully evaluate and co- gram which has an existing relationship with wholly received by the state, not the US ordinate with other regions. Further, states the National Oceanographic and Atmospheric Treasury. and political subdivisions should seek to use Administration. This payment shall be without Section 1412 of the Energy Policy Act of existing federal and state programs that ad- limit and consist of two percent of all revenues 2003, the Secure Energy Reinvestment Fund vance the goals of the state plans. States and available in the fund annually. It is the intent (SERF), recognizes the significant contribution political subdivisions should leverage SERF of the conferees that the funds provided under coastal states provide by supporting offshore resources to other federal programs to the this section be used in a manner that is large- development to decrease our nation’s depend- maximum extent practicable. ly consistent with the goals of the existing ence on foreign oil and gas. The SERF pro- Subsection 32(d)(2)(A)(v) is designed to en- CREST MOU and the current relationship with gram shares a small portion of Outer Conti- sure that any state with significant offshore oil NOAA. In addition, the consortium may per- nental Shelf (OCS) revenues with states that and gas operations will address impacts that form any activity authorized in section 1412(c) host offshore oil and gas production. As in- are ‘‘significant’’ or ‘‘progressive’’. This sub- of this act. It is the intent of the conferees that cluded in the conference report, section 32(a) section requires that any state producing more Nicholls State University act as the fiscal of the Outer Continental Shelf Lands Act de- than 25 percent of qualified OCS revenues agent for this section. The conferees expect fines the terms used in the section, including spend not less than 30 percent of funding re- CREST to retain its primary facilities at their ‘coastal energy state’. It is the intention of the ceived annually from the SERF program (to- existing location at CCEER. conferees that the Secretary of Interior (Sec- gether with appropriate political subdivisions) Section 32(j) requires that any expenditure retary) reevaluate the eligibility of each coastal to address ‘‘significant’’ or ‘‘progressive’’ im- by a state or political subdivision using funds energy state’s participation in the SERF pro- pacts identified in the most recent EIS. For the provided under section 32 must be in compli- gram annually. first ten Fiscal Years of this program, the term ance with authorized uses specified in sub- Section 32(b) provides $35 million annually, ‘‘significant’’ means only infrastructure sup- section 32(e). Section 32(j) also provides that as well as OCS royalties and bonuses above porting ‘‘focal points of impact’’ (LAl) as identi- these funds may be used for any payment that the CBO baseline (in some cases, royalties fied in a relevant EIS. The term ‘‘progressive’’ is eligible under section 35 of the Mineral and bonuses will have to reach levels hun- means only coastal wetlands restoration. It is Leasing Act. So as to create parity with other dreds of millions or over a billion dollars above the conferees intent that greater than 15 per- federal revenue sharing programs, it is the in- the baseline before additional revenues will be cent of the funding received by the state and tent of the conferees that any funds provided shared with coastal energy states). This sub- appropriate political subdivisions be used under section 32 may be used for any pur- section authorizes up to $500 million for each equally for each of these items. Further, it is pose that is in an approved plan. The con- Fiscal Year through 2013, and after 2013, 25 the conferees intent that these monies shall ferees expect the Secretary to work with other percent of qualified OCS revenues are to be be in addition to those provided to a political federal agencies, if appropriate, to ensure that shared with coastal energy states. Section subdivision under subsection 32(c)(2)(B)(iii) states and coastal political subdivisions be 32(b) also includes a provision to protect de- (25 percent discretionary portion). permitted to use SERF monies in accordance posits into the Land and Water Conservation Section 32(e) specifies that the funds should with this section. Fund and Historic Preservation Fund. be used in a manner that is consistent with Section 32(k) requires states and political Section 32(c) establishes a distribution for- federal environmental laws and all relevant subdivisions to submit an annual joint report to mula comparable to those used in other fed- state laws. Additionally, this section provides the Secretary describing the expenditure of eral royalty sharing programs. It also recog- the eligible use of funds by states and political funds for the preceding fiscal year. nizes the historical contribution that some subdivisions. The SERF program is designed Section 32(l) requires that the otherwise es- states provided by hosting offshore oil and gas to ensure that mitigation and natural resource tablished signs at projects or programs receiv- production for decades, despite unfulfilled protection are top priorities of the eligible ing funds under this section identify the source promises of royalty sharing by the federal gov- states. The Secretary should work with states of revenue as being from the ‘‘Secure Energy ernment. The conferees have confirmed the and political subdivisions to establish reason- Reinvestment Fund (SERF) program’’ or other document referred to in subsection able administrative costs and keep these costs common name established by the Secretary. 32(c)(2)(A)(iii). This section also provides 35 to a minimum. It is not the intent of this pro- The signage should also identify the source of percent of a state’s share directly to the polit- gram to fund any otherwise required function funding as being from revenues generated ical subdivisions that are within the state’s of local or state government unless that func- from offshore oil and gas production. coastal zone. When determining criteria for the tion was designed to mitigate OCS activities or Section 1412(b) amends section 31 of the ‘‘relative level of OCS oil and gas activities’’ in improve the coastal environment. Should any OCSLA to reauthorize the program. a state, the Secretary shall seek to direct the state propose a program or expenditure that Section 1412(c) authorizes the CREST con- majority of this portion to the most impacted, would be authorized under subsection sortium through the Secretaries of Interior and or two most impacted, political subdivisions. In 32(e)(5), the Secretary shall not approve this Commerce. It is the intent of the conferees the case of Louisiana, the conferees have de- use of funds unless there is a clear and direct that the consortium will focus their work on termined activities in Port Fourchon/LA1 link to OCS activities. coastal wetlands loss in the lower Mississippi should be recognized as OCS oil and gas ac- Section 32(f) requires the Secretary to with- River delta and adjacent estuaries. Further, as tivities and the conferees direct the Secretary hold funding to any state or political subdivi- a condition of funding, the conferees expect to provide funds from the relevant portion of sion that spent funds provided under this sec- the Secretaries to require the consortium to the formula in subsection 32(c)(2)(B)(iii) to ad- tion in a manner inconsistent with the ap- establish an online library of existing informa- dress these impacts before any other activities proved plan of such state or political subdivi- tion and findings on coastal wetlands restora- in the state. sion. tion, the interaction between the Mississippi Section 32(c) specifies that only coastal en- Section 32(g) allows the Secretary to re- River and Gulf of Mexico, and other similar in- ergy states that have an approved plan as de- quire arbitration to resolve disputes among formation. The agencies should use CREST scribed under section 32(d) are eligible to re- any combination of coastal political subdivi- as a tool to coordinate the various coastal ac- ceive funds. Section 32(c) also gives the Sec- sions, states and the Secretary. tivities, research and development, and pro- retary authority to hold a state’s funds in es- Section 32(h) provides for an administrative grams of the various federal agencies that crow (within the fund) if necessary and estab- cost to be retained by the Minerals Manage- have existing authority over coastal activities lishes a reallocation provision if states fail to ment Service to implement this program. It is or programs that affect coastal use. It is not have an approved plan. Finally, the section the intent of the conferees the Secretary will the intent of the conferees that, as a condition ensures coastal energy states will receive a designate only the Minerals Management of funding, the Secretary or Secretaries re- minimum share of revenues. Service as the agency to administer and pro- quire the consortium to conduct operations

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00023 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.204 E23PT1 E2446 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 outside the region in which it currently oper- Additionally, I am pleased that the con- and public awareness they need to best serve ates. ference report seeks to decrease our over-reli- the American people. f ance on foreign sources of oil by repealing the As our nation’s primary line of defense current sunsets for the qualified electric vehi- against poison-related injuries and deaths, CONFERENCE REPORT ON H.R. 6, cle credit and clean fuel vehicles deductions. these centers provide physicians and the gen- ENERGY POLICY ACT OF 2003 Further, I appreciate the inclusion of a credit eral public with direct access to life-saving infor the purchase of hydrogen fuel cell motor formation. Health care professionals rely on SPEECH OF vehicles. I included a similar provision in my these centers for immediate, around-the-clock HON. MAX SANDLIN energy tax legislation, H.R. 1436, the Energy assessments and treatment recommendations OF TEXAS Independence and Security Act, and believe for many types of poisonings, overdoses and IN THE HOUSE OF REPRESENTATIVES strongly that fuel cell technology holds enor- drug interactions affecting people of all ages. Parents who find their child has consumed a Tuesday, November 18, 2003 mous potential for the future. The federal government has an important role to play in the toxic substance can receive immediate profes- Mr. SANDLIN. Mr. Speaker, I rise to ex- development and use of this clean, renewable sional help with one phone call, any time, day press my support for the long-overdue energy energy source. or night. conference report, while at the same time Any balanced energy plan must acknowl- Over 90 percent of all accidental poisonings sharing my disappointment with the process edge that Americans need to increase our take place in the home. More than 50 percent by which the House leadership has brought conservation efforts in an attempt to move of these accidents involve children under the this legislation to the floor. closer to energy independence. To that end, I age of six, with more than one million young As we all know, one of the greatest prob- appreciate the inclusion of incentives to home- children exposed to toxins annually. When a lems facing the United States today is our lack owners to make energy efficient home im- child’s life is potentially in danger, parents of national energy independence. The United provements that decrease their consumption need to know immediately where to go for States’ dependence upon foreign sources of of energy. help. Too often parents are unaware of the oil is simply unacceptable for a country rich in As well, the energy conference report’s in- services provided by poison control centers natural resources and equipped with the capa- creased funding authorization for the Low In- and turn to costly and time-consuming options bility to develop these resources as a means come Home Energy Assistance Program such as rushing to emergency rooms at dis- of increasing our national security. At the [LIHEAP] will directly benefit low-income Tex- tant hospitals. In response to this situation, height of the energy crisis during the 1970s, ans in my district who rely on LIHEAP aid to this bill provides for both a nationwide toll free the United States imported 46 percent of our pay their utility bills. Last yeas, Texans re- number connected to local poison control cen- oil supply. Today, it is estimated that we im- ceived $50.1 million through this federal grant ters, and a new media campaign to call the public’s attention to services available through port approximately 55 percent of all energy program, and this legislation should increase this number. used in this country. As America’s energy con- the amount of federal aid that Texas receives sumption increases, our need to produce more My home state of Illinois is served by the in the future. nation’s oldest poison control, information and energy rises as well. Unfortunately, supply is Further, I believe that the electricity provi- treatment center, the Illinois Poison Center. not meeting demand, and our increased reli- sions contained within the conference report The IPC has expertly served the needs of ance on foreign sources of energy has poten- will encourage the improvement of our coun- tially disastrous consequences for our econ- metropolitan Chicago since 1953, and handles try’s transmission infrastructure by reducing approximately 100,000 cases throughout the omy and national security. The energy con- the depreciable lives for transmission assets ference report contains significant incentives state of Illinois each year. In 1985, my state from twenty to fifteen years. Accelerating the was served by five regional poison control for the exploration and production of oil and depreciation period will provide additional re- gas and represents an important step toward centers, but only IPC remains after deep sources for electric utilities to modernize their budget cuts over the years. We must ensure increasing our national energy independence. transmission systems, which should increase At the same time, energy independence that our nation’s remaining centers receive the the reliability, safety, arid security of the na- support they need to continue serving the pub- cannot be attained through production alone. tional grid system. Though Congress should strongly encourage lic. I am, however, extremely disappointed with Our nation’s Poison Control and Information the production of energy sources such as oil, the process by which the Republican leader- Centers also play a vital role in managing pub- gas, and nuclear power, Congress should also ship has brought this measure to the floor. It lic health crises, environmental disasters, and incentivize businesses and consumers to is well known by now that the Republican the threat of weapons of mass destruction. In produce energy with wind and solar power leadership and energy conferees in both July of 2000, the Illinois Poison Center was and conserve energy through innovative tech- Houses drafted the conference report without the first to respond to a nitric acid leak at a nologies. Democratic participation. Democratic legisla- Chicago factory. In December of that same When used effectively, the Internal Revenue tors who, in some cases, have been involved year, the IPC was again the first to respond, Code [‘‘the Code’’] can help to stimulate both in drafting complex energy legislation for sev- this time to an anthrax threat at the British- the production and conservation of energy. eral decades were prohibited from taking part American Chamber of Commerce in Chicago. Provisions in the Code such as section 29 and in this process. Mr. Speaker, the Republicans’ And, in August of 2001, the IPC responded to section 45 have stimulated the production of behavior throughout this process has been a toxic chemical spill on the Dan Ryan Ex- nonconventional fuels and wind energy, re- outrageous and inexcusable, and their actions pressway. spectively, and the tax title of the energy con- demonstrate a contempt both for the demo- The Illinois Poison Center has developed ference report will extend these credits and cratic process and the constituents of the leg- protocols for response and notification of prop- encourage continued production from these islators who have been denied a voice over er governmental agencies when these events sources for years to come. the past several months. occur, and it is also a participant in regional Further, the report’s funding authorizations f disaster drills throughout the metropolitan Chi- and tax incentives for investment in clean coal cago area. Poison control and information technology will benefit both consumers and SUPPORTING POISON PREVENTION centers like the IPC are a critical part of our the environment in the state of Texas. Texas AND CONTROL CENTERS nation’s emergency response and disaster consumes more coal for electricity generation preparedness systems. than any other state in the country, with a sig- HON. RAHM EMANUEL Poison centers represent a cost effective in- nificant amount of that coal mined in Texas. OF ILLINOIS vestment that benefits the public health. In Unfortunately, while generation facilities must IN THE HOUSE OF REPRESENTATIVES 1998, the U.S. Department of Health and burn coal to provide the electricity that so Human Services estimated that every dollar Friday, November 21, 2003 many people take for granted, burning coal in- spent on a poison center saves seven dollars evitably releases some pollutants into our at- Mr. EMANUEL. Mr. Speaker, I rise today in in unnecessary medical costs. mosphere. Together with private industry, the strong support of S. 686, which strengthens Mr. Speaker, I commend our colleagues on Department of Energy’s clean coal technology poison prevention in America and guarantees both sides of the aisle for their hard work on program is working to develop cleaner-burning funding for our nation’s 74 poison control, in- this legislation. This bill is good for the health, technologies that will decrease emissions of formation and treatment centers. Each year safety and security of the American people. I nitrogen dioxide, sulfur dioxide, and other air- these centers save countless lives, and it is strongly encourage my colleagues to vote for borne pollutants. critical that we ensure the financial stability S. 686.

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00024 Fmt 0626 Sfmt 0634 E:\CR\FM\A21NO8.207 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2447 CONFERENCE REPORT ON H.R. 6, hydrogen fuels, associated hydrogen vehicles TRIBUTE TO SPC JEREMY ENERGY POLICY ACT OF 2003 RE- and necessary support infrastructure at a DIGIOVANNI GARDING TITLE VIII—HYDROGEN basic structural level. Section 803(a)(7), in particular, indicates that the development of HON. CHARLES W. ‘‘CHIP’’ PICKERING SPEECH OF necessary codes and standards needed to im- OF MISSISSIPPI HON. W.J. (BILLY) TAUZIN plement the program take place ‘‘after con- IN THE HOUSE OF REPRESENTATIVES OF LOUISIANA sultation with the private sector.’’ This statu- Friday, November 21, 2003 IN THE HOUSE OF REPRESENTATIVES tory directive applies to the production, dis- Mr. PICKERING. Mr. Speaker, I rise this Tuesday, November 18, 2003 tribution, storage and use of hydrogen, hydrogen-carrier fuels, and related products. Statu- evening to pay tribute to Specialist Jeremy Mr. TAUZIN. Mr. Speaker, as Co-Chairman tory authority conveyed to the Secretary of En- DiGiovanni who was killed in action Saturday, of Conference Committee on H.R. 6, the En- ergy for the promulgation of ‘‘necessary codes November 15, in Iraq. Along with seventeen ergy Policy Act of 2003, as well as Chairman and standards’’ is to be interpreted by the De- other American soldiers, including another of House Energy and Commerce Committee partment of Energy in conformance with the Mississippian, PFC Damien Heidelberg, Jer- which has jurisdiction over national energy ordinary and regular practice concerning these emy was killed in the collision of two Black policy as well as the production, storage, sup- legislative terms. Hawk helicopters. ply, marketing, pricing and regulation of en- Jeremy was a member of the A Company, ergy resources, including unconventional en- The concept of public/private partnership in 4th Battalion, 101st Airborne based in Fort ergy resources, I am taking this opportunity to implementation of the program established Campbell, Kentucky, and he served as crew elaborate on and clarify both the legislative through Title VIII is additionally reflected in chief on one of the Black Hawks. Jeremy provisions and Statement of Managers that is section 803(d) requiring the conduct of activi- hailed from Pike County, Mississippi, and he contained in the conference report on H.R. 6 ties to deploy hydrogen energy and energy in- served his country proudly and with honor. regarding Title VIII, Hydrogen. frastructure, fuel cells and advanced vehicle Specialist DiGiovanni made the ultimate On April 1, 2003 and April 2, 2003, the En- technologies. It should be noted that this de- sacrifice defending our Nation and helped free ergy and Commerce Committee met in mark ployment activity is separate and apart from millions of men, women, and children from the up session to consider a committee print, the section 803(c) which requires the Secretary of tyrannical grasp of an evil and brutal dictator. Energy Policy Act of 2003. On April 2, 2003, energy to fund a limited number of demonstra- We Mississippians are so proud of the men the Energy and Commerce Committee voted tion projects. This separation of demonstration and women we have serving in Iraq and ap- to approve the committee print and report this and deployment activities is intentional and re- preciate their dedication to defending freedom legislation to the full House of Representa- flects the fact that such required elements of and democracy. tives. This committee print contained, among the hydrogen program are distinct entities. I ask my fellow Members of the U.S. House other provisions, Title V, Vehicle and Fuels, of Representatives to remember Jeremy and Subtitle B, FreedomCar and Hydrogen Fuel f his family during this difficult time. To his fam- Program. ily, our prayers are with you, and we are IN REMEMBRANCE OF GUSTAVO H.R. 6, the Energy Policy Act of 2003, was grateful for Jeremy’s courage and service to MONTEJANO subsequently introduced in the House of Rep- the United States of America. resentatives on April 7, 2003. H.R. 6 con- f tained the legislative work product of the Com- HON. GENE GREEN mittee on Energy and Commerce as well as PROTECTING THE VULNERABLE, OF TEXAS other committees. Hydrogen provisions in H.R. ENSURING FOOD SAFETY 6 concerning the ‘‘FreedomCar’’ and hydrogen IN THE HOUSE OF REPRESENTATIVES fuel and infrastructure program were consoli- Friday, November 21, 2003 HON. JANICE D. SCHAKOWSKY dated in Division F—Hydrogen. The con- OF ILLINOIS ference report on H.R. 6 contains Title VIII, Mr. GREEN of Texas. Mr. Speaker, I rise IN THE HOUSE OF REPRESENTATIVES today to extend my deepest sympathies to the Hydrogen, which is based on Division F of Friday, November 21, 2003 H.R. 6, incorporating several elements of S. family and friends of my constituent Gustavo MS. SCHAKOWSKY. Mr. Speaker, I rise 14. Montejano (Mon-tay-HAH-no) and his two The program established under Title VIII of daughters, Katia and Esmerelda. today to address a danger that threatens the committee print provides for the production Gustavo Montejano is a true hero. When his every one of us—food-borne illnesses. Each of hydrogen from diverse energy sources, in- family’s home caught fire early on Monday year, 76 million people suffer from food-borne cluding conventional and renewable energy morning, Gustavo rushed his wife and 2-year- illness. Of those individuals, approximately sources. It also provides for the use of hydro- old son out of the house. He then went back 325,000 will be hospitalized and more than gen in electric power generation and the safe to rescue his two daughters, who were still 5,000 will die. Our children, the elderly, and delivery of hydrogen and hydrogen-carrier asleep inside. Unfortunately, the second story those with weakened immunity systems face fuels. The program additionally encompasses collapsed, and the smoke and flames overtook an even greater danger. Of the deaths caused advanced vehicle technologies, including auto- him before he could get his girls to safety. As by food-borne illness nearly every year, chil- mobile materials, energy storage, propulsion the headline from the Houston Chronicle dren comprise nearly 40 percent of the vic- and hybrid systems. reads, ‘‘He died hugging his two girls.’’ tims. I know parents who have lost their chil- Although Title VIII contains necessary ap- While we are all deeply saddened for the dren to this threat. Today, I am introducing legislation, the Na- propriations to the Secretary of Energy to fund Montejano family’s loss, I know that those girls tional Food Safety Database Act, that will give the activities authorized by the Title, central to were comforted by their father’s presence, and officials charged with caring for our children the operation of this federal program is the that they died together knowing that he loved and our other vulnerable loved ones the infor- public/private partnership required under Sec- them so much that he was willing to sacrifice mation they need to make safe food pur- tion 803(a). This partnership is reflected within his own life trying to save them. the section 803(b)(1)(A) programmatic goal, chasing choices. My bill will create a national Gustavo’s family remembers him as a kind specifically the directive to ‘‘enable a commit- database containing information that docu- and generous man, who took in his sister and ment by automakers no later than year 2015 ments whether a company has a history of her eight children when they needed a home. to offer for sale’’ hydrogen fuel vehicles. Sec- providing safe food—food that has been pro- tion 803(b)(2) contains a corresponding pro- Despite the fact that he had been laid off duced and packaged under sanitary conditions grammatic goal of obtaining a private sector from his job, he helped support his sister’s and is properly branded. It will also document commitment, not later than 2015, for nec- family as well as his own, helping to pay bills any outbreaks of food-borne illness that have essary hydrogen infrastructure. Under sections and care for the children. originated from the provider and any enforce- 803(b)(1)(A) and 803(b)(2), both the vehicle I know his wife, Maribel, and 2-year-old son ment actions that have been taken against the and infrastructure commitments are followed, are devastated by this loss, but they should be provider. Officials at hospitals, nursing homes, by five years, with availability, in the mass proud of the great man Gustavo was, and that schools, and child care facilities can access consumer market, of vehicles and safe and he died a hero’s death. this database from a secure website and use convenient refueling capacity. His loss will be felt by all of Galena Park, that information to ensure that they are serv- Title VIII, therefore, incorporates the public/ and I ask that you remember the Montejano ing those in their care the safest food pos- private partnership regarding the production of family in your thoughts and prayers. sible. The final authority over the information

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00025 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.211 E23PT1 E2448 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 included in this database will be granted to the The legislation passed with overwhelming However, last week they won their first-ever Secretary of Health and Human Services who support because it included tough account- playoff game beating PSJA 45Ð8 and ad- will work in consultation with the Secretary of ability requirements aimed at closing the vanced to the second round of the Texas high Agriculture. A task force consisting of antici- achievement gap between students of different school playoffs where they now face Gregory pated users, representatives of food manufac- economic backgrounds; stronger professional Portland. I wish them the best as they con- turers, processors, packers, transporters, and development standards and training for teach- tinue their amazing playoff run and season. representatives of consumer groups will also ers; additional resources do turn around low The Porter Cowboy story is one that has ev- advise the Secretary as to what information performing schools; allowances for an unprec- eryone in the community and in the Rio needs to be included to ensure our loved edented level of flexibility for local school dis- Grande Valley extremely excited and ener- ones’ safety. The Secretary will also have the tricts; and rewards and sanctions for States gized. Guided by Coach Jim Helms and his authority to make grants to states to help them based on the academic performance of stu- exceptional staff, this talented group of players access and use the database. dents. exceeded virtually all expectations that many The information that will be provided by the Despite the bill’s good intentions and tre- had for them coming into the season. Of database is critical to public health. We need mendous support in Congress, the legislation course, the players and coaches had some- to prevent outbreaks of food-borne illness in has become largely a hollow promise to our thing else in mind when they were preparing our schools. Earlier this year a school in Illi- children because of inadequate funding. The nois received ammonia-tainted food and did in the off-season and now they are in the mid- Administration’s budget request this year pro- dle of a dream season; a season that the fac- not receive adequate notification that the prod- vided only $22.7 billion for these important uct had been contaminated. Luckily, no one ulty, students and families, along with the education efforts—$9.7 billion less than what players, will never forget. died, but a number of teachers and students Congress agreed was necessary. As these Porter players make history on the suffered. Currently the ability of hospitals, The commitment of significant federal fund- football field they are now only opening the nursing homes, schools, and child care pro- ing to assist local schools in meeting the new doors to the future in which they will be part viders to provide quality care is compromised testing, achievement and training requirements of a generation that will make positive by their inability to get adequate and timely was a solemn promise made to all the children changes to the lives of many living in the com- food safety information. Safety histories of the of our nation. NCLB imposes strict standards munity. The same determination and commit- companies are not shared with the officials on our school districts with considerable pen- ment they possess on the football field every who purchase the food. Due to a complex web alties if they do not comply. But how can our of food manufacturers, distributors and bro- Friday night will prepare them to respond ac- schools be expected to meet these new stand- kers, if the USDA or FDA announces that a cordingly when faced with life’s challenges ards without adequate federal funding to meet manufacturer has produced tainted food, offi- and obstacles. these challenging mandates? cials often have no way to determine if af- For this reason, I have cosponsored legisla- The Porter Nation as they have come to be fected foods are in their kitchens and being tion, the Keeping Our Promises to America’s known were led by their star quarterback and served to our loved ones. Children Act of 2003, to suspend application he was surrounded by a cast of gifted athletes A person fed tainted food can experience di- of NCLB until the funding that was promised that contributed to the success of the stellar arrhea, nausea, vomiting, and abdominal pain. to our schools is actually delivered to our season. The arsenal in the passing game, Those in hospitals, nursing homes, schools, schools. The alternative merely sets up our complemented with a tremendous defense and child care centers are by far the most vul- schools for failure. and an excellent kicking game enabled them nerable among us. Their immune systems are Implementation of this important law has to truly dominate their opponents. not as strong; their bodies are just not as stur- also been unduly harsh. Award-winning I am so proud of these guys and wish them dy. They can become very ill and can even the best as they continue to achieve their die from food-borne illness, as far too many science teachers who have excelled at teach- goals both on the field and in the classroom. already have. ing for decades are deemed unqualified be- Food manufacturers also stand to gain from cause their bachelor’s degree was in a dif- Mr. Speaker, I respectfully ask that the ros- this bill. Companies that have a history of pro- ferent subject. As someone who supported ter with the names of each player, coach, and viding safe food will have that fact known. passage of NCLB, I am alarmed by its poor trainer be inserted in the CONGRESSIONAL Should an accident occur and there is an out- funding and implementation. RECORD of the United States House of Rep- break, it will be much easier for companies to Passing the NCLB was only one step in the resentatives. lawmaking process. To enact real education know where the tainted food has gone. The 2003 PORTER COWBOYS FOOTBALL VARSITY company will be able to stop the outbreak reform and to implement the new education ROSTER standards within NCLB, we must appropriate faster and reduce their liability. Chris Walker, Evy Chavez, Emmanuel I urge my colleagues to cosponsor this leg- the full funding required, and not blind ourselves in its application. We must not short- Gutierrez, Rick Monsivais, Jason Bernard, islation that will increase the safety of the Chris Vasquez, Billy Garza, Ivan Villarreal, most vulnerable in our society. Our loved ones change our children’s education. Michael Verduzco, Mike Salazar, Manuel deserve to know that someone is looking out I ask my colleagues today to reaffirm the Hernandez, Steve Garcia, Jimmy Gutierrez, for their safety while they can’t do it them- Congress’s commitment to the No Child Left Benny Salazar, Moises Salinas, Ivan Iglesias, selves. Without this bill, we can’t make that Behind Act and support full funding authorized and Louie Pineda. guarantee. by the legislation. Rogelio Camarillo, Ben Gomez, Jesus f Chapa, Carlos Lozano, Angel Ramirez, Jesus f Ferrer, Luis Cruz, Jose lzaguirre, Thomas J. EDUCATION FUNDING CONGRATULATING BROWNSVILLE Rios, Joe Espinoza, Juan Leal, Javier Ruiz, PORTER COWBOYS FOOTBALL Josh Burguete, Eli Perez, Ernesto Olivarez, TEAM Isaac Almaguer, and Omar Avila. HON. ADAM B. SCHIFF David Pallares, Emmanuel Lopez, Eliseo OF CALIFORNIA Balderas, Christian Lara, Stephen Cisneros, IN THE HOUSE OF REPRESENTATIVES HON. SOLOMON P. ORTIZ Eber Flores, David Diaz, Julian Mendez, OF TEXAS Friday, November 21, 2003 Oscar De Los Santos, Juan Pen˜ a, Julius Wil- IN THE HOUSE OF REPRESENTATIVES liams, Frankie Ramirez, Danny Palacios, Mr. SCHIFF. Mr. Speaker, I rise today to ex- Friday, November 21, 2003 Juan Perez, Jose Guerra, Will Jaramillo, and press concern over the failure to fund and Gilbert Flores. adequately implement the No Child Left Be- Mr. ORTIZ. Mr. Speaker, I rise today to con- Athletic Director: Joe A. Rodriguez. hind Act (NCLB). gratulate the Porter Cowboys on their incred- Athletic Coordinator: Jim Helms. This bipartisan legislation attempted a com- ible season, as they just completed their first- Football Assistants: Art Cantu, Ruben Cor- prehensive approach to reforming our schools ever winning record and were one win away tez, Bill Deen, Luis Garza, Benny Gonzalez, by refocusing our national education policy on from a perfect regular season record. James Kizer, Abel Moreno, Danny Pardo, helping states and local school districts raise In the almost 30 years of the school’s his- Armando Rangel, Tom Rios, Jeffrey academic achievement for all children, while tory, the Cowboys football team has endured Rodriguez, and Jose Luis Zarate. providing more funding and flexibility to states many tough seasons and constant criticism to Trainers: John Prosek and Jerry San and local districts. their program. Pedro.

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00026 Fmt 0626 Sfmt 0634 E:\CR\FM\A21NO8.215 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2449 HONORING WILLIAM THOMAS IN HONOR OF GARY SCHLANSKER, ducers who have to deal with participating in (BILL) POWERS CEO OF THE GREENVILLE YMCA a costly, time-consuming and flawed program. Employers have to comply with a lengthy labor HON. JIM DeMINT certification process that is slow, bureaucratic HON. MARY BONO OF SOUTH CAROLINA and frustrating. In addition, they are forced to OF CALIFORNIA IN THE HOUSE OF REPRESENTATIVES pay an artificially inflated wage rate. My bill will streamline the labor certification process IN THE HOUSE OF REPRESENTATIVES Friday, November 21, 2003 while also creating a wage standard that is Friday, November 21, 2003 Mr. DEMINT. Mr. Speaker, today I take privi- more fair and realistic. lege in honoring Gary Schlansker’s 11 years Likewise, as a long-time Member of the Mrs. BONO. Mr. Speaker, I rise to honor as the President of the Greenville YMCA. House Judiciary Committee, I understand the one of the most distinguished and remarkable Gary has recently accepted the position as the immigration problems that currently face our individuals in the Coachella Valley, a region of President of the Greater St. Louis YMCA, the country. Illegal immigration penalizes those southern California which I have the privilege 8th largest YMCA system in the country. Gary legal immigrants and citizens who play by the of representing. started his relationship with the YMCA back in rules. It is estimated that there are between 8 Mr. William Thomas (Bill) Powers has estab- 1956 when he was first enrolled in a YMCA and 11 million illegal aliens currently living in lished an impressive record of achievement program in St. Louis. Gary has indicated that the United States. This population grows by and service, both in his professional career the St. Louis position is the only job that would over 350,000 each year. Clearly, this situation and charitable activities. Since moving to the take him out of Greenville, as Gary grew up in has reached crisis proportions and cannot be Palm Springs region in 1986, after a long and St. Louis and has family in the Show Me allowed to continue. successful career in banking in Los Angeles, State. Some believe that the only way to reform Bill Powers dedicated himself to enhancing The Greenville YMCA has been a model of the guest worker program is by including am- our community’s economy and improving the stability and success for the YMCA system. nesty provisions and allowing illegal aliens to lives of its residents. Since the founding of the Greenville YMCA in adjust to Legal Permanent Resident (LPR) Now, our community joins to honor this 1876, only six people have served as Presi- status. However, this would create the wrong most deserving individual with the Desert Sa- dent of the Greenville YMCA. incentive by encouraging foreign nationals to maritans for the Elderly naming Bill Powers During Gary’s 11 years at the Greenville come into the country illegally in the hopes Good Samaritan of the Year 2003. YMCA, the annual operating budget increased that they, too, will be rewarded for their illegal from $4 million annually to in excess of $10 actions. Amnesty is not the answer to our Na- A native Californian, Bill is renowned in our million annually. The Greenville YMCA grew tion’s illegal immigration problem. community for his many good works and from five branches serving 35,000 community My bill would not grant blanket amnesty. In- strong stewardship of numerous worthwhile members annually to seven branches with stead, it would allow the large population of il- causes. At the same time, Bill has used his three additional outreach centers serving a legal farm workers one chance to come out of keen judgment and extensive professional ex- total of 55,000 people annually. The annual hiding and participate legally in the guest perience to establish one of the leading finan- scholarships campaign increased by over 200 worker program. Potential workers would be cial institutions in California’s Inland Empire, percent and collaborations with the greater required to return to their home countries and Pacific Western Bank. community now number in excess of 85 annu- apply for the program legally from there. In Bill’s own words he ‘‘believes in the com- ally. Program highlights for the Greenville In addition, this legislation would address a munity and the people who live here. The best YMCA include Camp Greenville, Youth in troublesome wage issue. Employers are re- way I know how to give back to the commu- Government, and outreach services through quired to pay an inflated wage called the Ad- nity is through excellent service; I extend that schools and churches. The Youth in Govern- verse Effect Wage Rate or AEWR. The AEWR philosophy in both my professional and per- ment program of South Carolina is sponsored was designed to protect similarly situated do- sonal life’’ and our community is better for his exclusively through the Greenville YMCA, and mestic workers from being adversely affected commitment to this code. is one of the most successful Youth in Gov- by guest workers coming into the country on Bill and his wife, Anita, have raised a won- ernment state programs in the country. a seasonal basis and being paid lower wages. derful family. Their children, David and Gary’s stewardship of the Greenville YMCA However, the shortage of domestic workers in Christie, and their grandchildren, Jessica, is accurately reflected by the tremendous the farm workforce forces employers to hire Teddy, Tommy, and Hunter are a great source growth and success of the Greenville YMCA. foreign workers, and thus, is also forcing them of pride to both Bill and Anita. Not only is the growth of the Greenville YMCA to pay an inflated wage. My bill abolishes this Bill has distinguished himself in our area impressive, but very importantly the kind and unfair wage and creates a prevailing wage through his ability to combine his love of fam- caring manner that Gary has conducted him- standard, under which, all workers are paid ily with his desire to work tirelessly in both self on a daily basis will be greatly missed by the same wage as workers doing similar work business and community causes. The list of those who he has served in the Greenville in that region. The facts are simple. Agriculture needs a charitable and civic causes that Bill has par- area. I sincerely wish Gary all the best for a nice reliable guest worker program. Workers need ticipated in over the years is literally to vast to start to his new job leading the St. Louis access to stable, legal, temporary employ- list in total, however, it is worth noting that he YMCA, as they are getting a wonderful work- ment. It is in our national security interest to has served as both President and Tournament horse of a leader to guide their YMCA. Thank create a sensible way for workers to come in Chairman of the Bob Hope Chrysler Classic, a you Gary for your 11 great years in Greenville, on a temporary basis, work, and go back to professional golf tournament that has provided and we will miss you. their home countries. My bill addresses the immense financial support to those in need in problems in the current guest worker program, this region. In addition, Bill has served as f and I look forward to working with all of the President or board member for the United TEMPORARY AGRICULTURAL Members in this body to reform this program Way of the Desert, the American Cancer Soci- LABOR REFORM ACT OF 2003 and make it a more viable process for every- ety, the John F. Kennedy Memorial Founda- one involved. tion, the Coachella Valley Economic Partner- ship, Desert Samaritans for the Elderly Board HON. BOB GOODLATTE f OF VIRGINIA of Governors, the John F. Kennedy Memorial ARSENIC-TREATED WOOD IN THE HOUSE OF REPRESENTATIVES Hospital, College of the Desert Foundation, PROHIBITION ACT Yucca Valley Economic Partnership, founding Friday, November 21, 2003 director of the Desert Town Hall Speakers Mr. GOODLATTE. Mr. Speaker, I rise today Forum, and as a member of the McCallum HON. JANICE D. SCHAKOWSKY to introduce the Temporary Agricultural Labor OF ILLINOIS Theatre’s Board of Trustees, to name a few. Reform Act of 2003, a bi-partisan bill to reform IN THE HOUSE OF REPRESENTATIVES Mr. Speaker, I consider it a privilege to call the HÐ2A guest worker program. As Chairman Bill Powers my friend, and ask that this brief of the House Agriculture Committee, I have Friday, November 21, 2003 tribute to this accomplished individual be traveled across the Nation and seen first-hand Ms. SCHAKOWSKY. Mr. Speaker, I rise placed permanently in the RECORD. I yield that the HÐ2A temporary visa process is not today to address the dangers posed to the back the balance of my time. working. I have talked face to face with pro- public health by arsenic-treated wood. Most of

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00027 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.220 E23PT1 E2450 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 the lumber sold for outdoor use in our schools’ spend more time playing outdoors. This risk Likewise, does overwhelming economic playgrounds and in our own private backyard passes the EPA’s historic threshold of concern power ensure loyalty or buy friendship even decks is pressure-treated and injected with about the effects of toxic chemicals. from the countries most indebted to the U.S.? toxins to preserve the wood and prevent in- In light of these facts, I believe that we must In other words, can military and economic sect infestation. The most common wood pre- take immediate action. I believe that a vol- might ever become a substitute for sensible servative and pesticide used is chromated untary phase-out of this potentially harmful and sensitive foreign policy? copper arsenate (CCA), which is 22 percent product is not adequate. Initiating a ban on And given the dilemma of Iraq, could it in- pure arsenic. The inorganic arsenic used in CCA-treated wood would greatly increase pub- deed be that the most important ‘‘multibillion’’ CCA-treated wood is a known carcinogen and lic awareness of the dangers that existing ar- problem America faces is not deficits meas- has been linked to skin, bladder, liver and lung senic-treated wood presents. By failing to ban ured in dollars, fiscal or trade, but the antag- cancers. The arsenic in CCA-treated wood CCA-treated wood, we are ignoring the re- onism of billions of people around the world has been shown to leach out, ending up in the sponsibility to protect and promote the best in- who object to our current foreign policy? soil in our back yards and playgrounds, rub- terests of consumers. I strongly believe that a Here, let me say that I strongly believe in bing off onto our clothing, and wiping off onto legislative mandate permanently banning its the need for clarification of thought as it ap- our hands. use and providing for its safe removal is crit- plies to policy, and anyone who wishes to re- Today, I am re-introducing a bill to begin to ical to ensuring the safety of children and their view the reasoning I have applied to the Iraq remove this threat, the Arsenic-Treated Wood families. issue, ranging from a floor explanation of a Prohibition Act. This bill will prohibit the use of The effect of arsenic in our environment is ‘‘no’’ vote on the Congressional resolution au- CCA treated lumber once and for all. This leg- undeniable: it kills. Arsenic-treated wood is a thorizing war last year to calls for international- islation will protect children and families by danger to the future health of America’s fami- izing the civil governance in Iraq last month, to mandating the phase out of arsenic in pres- lies. I encourage my colleagues to join me in a vote in favor of generosity in reconstruction sure treated lumber and will ensure that ar- this very important effort to remove this threat. efforts last week, can find the explanatory senic treated lumber is disposed of safely. f statements on my Congressional web site: Specifically, my bill will: phase-out the use of TRIBUTE TO PFC DAMIEN L. www.house.gov/leach. arsenic-treated wood in residential settings; re- HEIDELBERG What I would like to do today is summarize quire the disposal of arsenic-treated wood in the dilemma we face and make the following lined landfills to prevent contamination of points about where we might go from here: groundwater; require the Environmental Pro- HON. CHARLES W. ‘‘CHIP’’ PICKERING (1) There are no certitudes. Anyone who tection Agency (EPA) to finally complete its OF MISSISSIPPI was not conflicted on the original decision to risk assessment regarding arsenic-treated IN THE HOUSE OF REPRESENTATIVES approve intervention or who does not see a wood; provide monetary assistance to schools Friday, November 21, 2003 downside to all courses of action today is not and local communities to remove arsenic- Mr. PICKERING. Mr. Speaker, I rise this approaching the problem with an open mind. treated wood from their playgrounds; and di- evening to pay tribute to Private First Class America and the world are in a strategic pick- rect the Consumer Product Safety Commis- Damien Heidelberg who was killed in action le. In an era of anger, of divisions in the world sion (CPSC) to complete its mitigation studies Saturday, November 15, in Iraq. Along with based on economics, on color of skin, on eth- to determine the effect of sealants in pre- seventeen other American soldiers, including nicity, on religious belief, on happenstance of venting exposure to residues of CCA on treat- another Mississippian, Specialist Jeremy family and place of birth; in a world made ed wood. This bill would save lives and protect DiGiovanni, Damien was killed in the collision smaller by technological revolutions in commu- our environment. of two Black Hawk helicopters. nications and transportation, those who have Recent actions by the CPSC and prelimi- Damien was a member of the First Bat- causes—good or bad—have possibilities of nary findings released by the EPA make it talion, 187th Infantry Regiment, 101st Airborne being heard and felt around the globe that even more important that we in Congress based in Fort Campbell, Kentucky. The little never existed before. Great leaders like Gan- pass this legislation. Despite their own findings town of Shubuta, Mississippi was home to dhi and Martin Luther King appealed to the found that of every 1 million children exposed Damien. He was the ninth Mississippian to die higher angels of our nature and achieved rev- to the treated wood three times every week for in Iraq since the war began, and he served his olutionary change with non-violence. Menda- five years, two to 100 of them might develop country proudly and with honor. cious leaders like Hitler, Saddam Hussein and lung or bladder cancer later in life, the CPSC PFC Heidelberg made the ultimate sacrifice Osama bin Laden have sought to impose their recently decided to deny a petition to ban the defending our Nation and helped free millions wills on others through appeals to hate and re- use of arsenic-treated wood in playground of men, women, and children from the tyran- liance on increasingly wanton instruments of equipment and to recall existing playground nical grasp of an evil and brutal dictator. We oppression. structures using CCA-treated wood (HPÐ01Ð Mississippians are so proud of the men and As the world’s only superpower, the U.S. 3). In their statements denying the petition, the women we have serving in Iraq and appre- has no choice but to display firmness of pur- CPSC Commissioners cited that a voluntary ciate their dedication to defending freedom pose and resolve in deterring inhumane agreement between the EPA and CCA-treated and democracy. breaches of order. Yet, firmness and resolve wood manufacturer’s to voluntarily phase-out I ask my fellow Members of the U.S. House must be matched by compassionate under- the production of the product. The Commis- of Representatives to remember Damien and standing of the reasons people of the world sioners reasoned that rulemaking on the sub- his family during this difficult time. To his fam- lash out. We have the world’s greatest armed ject would be both unnecessary and redun- ily, our prayers are with you, and we are forces. But these forces cannot successfully dant. They further cited that the CPSC did not grateful for Damien’s courage and service to be deployed to counter international mis- have the authority to initiate a recall before the the United States of America. conduct if we don’t also seek to undercut the risk assumptions made in the Commission’s f causes of such conduct. staff study could be verified. THE LIMITS AND LIABILITY OF Reviewing the causes of World War I, histo- On November 13, a draft probabilistic expo- POWER: LESSONS OF IRAQ rians quickly concluded that there was not sure assessment released by the EPA con- enough flexibility in the European alliance sys- firmed the CPSC’s earlier findings. The study tem and that this allowed a rather minor event, concluded that the cancer risk for children who HON. JAMES A. LEACH the assassination of an Austrian archduke, to OF IOWA repeatedly come in contact with commonly precipitate a cataclysmic war. With this exam- IN THE HOUSE OF REPRESENTATIVES found playground equipment and decks made ple in mind, political leaders in the 1930s of arsenic-treated wood is considerably great- Friday, November 21, 2003 erred on the side of irresolution, which led er than EPA officials indicated last year. The Mr. LEACH. Mr. Speaker, the issue of our them to Munich and the partition of Czecho- agency’s preliminary findings show that 90 engagement in Iraq demands that we as a so- slovakia. Too much inflexibility caused one percent of children repeatedly exposed to ar- ciety probe the question of the limits of a su- war; too little spine a greater one. senic-treated wood face a greater than one-in- perpower’s power and the possible anomaly The problem today is not whether we should 1 million risk of cancer. The risk associated that there are severe liabilities to power, par- meet problems with firmness or compassion. with exposure to arsenic-treated wood ap- ticularly for a superpower. We need both. The problem is determining pears to be up to 100 times greater in the Does, for instance, overwhelming military when and how to respond with firmness, when warmer climates of southern States than in the might protect us from terrorism or, if used un- and how to express compassion. As in all general population since children tend to wisely, increase our vulnerability to terrorism? human conduct, the challenge is wisdom.

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00028 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.223 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2451 (2) We must listen as well as assert. Four Hussein’s WMD capacities, but put too much cluding what the defense secretary called the decades ago the British author Lawrence faith in a narrow cadre of ideologues who sug- ‘‘new Europe,’’ as well as in South and East Durrell wrote a series of novels called the Al- gested the U.S. would be welcomed as a lib- Asia, respect for American policy is in steep exandria Quartet, in which he describes a set erating rather than conquering or, worse yet, decline. of events in Alexandria, Egypt, preceding colonizing force in Iraq. Estimates of the costs In the Vietnam War we gave a great deal of World War II. An experiment in the relativity of of war, of the ramifications of involvement, of attention to the notion of ‘‘winning the hearts human perception, each of the four books the expected reaction of the population and of and minds’’ of the people. We didn’t succeed views the same events through the eyes of a the likelihood of foreign support were dead in convincing the Vietnamese or world opinion different participant. While the events de- wrong. of our good intentions despite the horrendous scribed are the same in each book, the stories (7) It is the responsibility of public officials to tactics of the Vietcong and the Communist as told by each of the participants are surpris- ensure that no American soldier is deployed North. Today, Americans must understand that ingly different. The reader comes to the real- as a defenseless magnet for terrorist attack— in the battle for the minds of men, particularly ization that a broad understanding about or in such a way as to incite foreign radicals in the Moslem world, we are doing less well events that transpire can only be developed to commit terrorist acts in America itself. than even in the most difficult days of the Viet- by synthesizing the singularly different percep- American soldiers have been trained to nam War. In this context, we would be well- tions of various protagonists. withstand the heat of battle in defense of advised to remember America’s original revo- To understand the Middle East today, we America and American values. For two and a lutionary commitment to a decent respect for need to listen to everyone’s story. quarter centuries no country has been more the opinions of mankind. (3) To shape or deter an opponents’ ac- effectively or more courageously served by a (10) While, for the time being, security in tions, we need to understand how they think. citizen soldiery than the United States. In Iraq, Iraq must remain the responsibility of U.S. American policy makers, at their best, reason our armed forces could not have performed military commanders in the field, we would be in a pragmatic, future-oriented manner. In more professionally or valiantly than in the ini- wise to put an international face on civil gov- much of the rest of the world, on the other tial engagement. But the difference between ernance in the country and ask Secretary hand, people reason by historical analogy. service in combat and service in occupation of General Kofi Annan to immediately appoint a Events dating centuries back, especially a foreign land, especially an Islamic society, is top civilian administrator to whom Ambassador umbrages, dominate thinking about today. profound. In Iraq, which is fast becoming for Bremer and his staff would report. People in the Middle East, like the Balkans, us much like Algeria was for the French in the Transfer of interim civil authority to the UN are oriented to the past and are driven by 1950s, our men and women in uniform are in- would provide greater legitimacy to the forma- ideas of honor of a different shape and em- creasingly facing hit-and-run terrorist assaults, tion of a new Iraqi government and encourage phasis than those we derive from American which are much more difficult to defend other countries to help with economic recon- culture. against than traditional military confrontations. struction and security requirements. We (4) No country can go it alone for long and The challenge of policy makers is to recog- should also work to transfer, as soon as prac- expect to be respected as an international nize that there is a distinction between three ticable, responsibility for internal security to leader. Doctrines of American endeavors: warfare, reconstruction and occu- troops of other nations or the Iraqis them- exceptionalism—the precept that we should pation. Our armed forces are trained to prevail selves. Transferring the police function to oth- not be bound by legal or procedural norms in the first; they can be helpful in the second; ers is a way to build up Iraqi’s own postwar in- that bind others—which are now fashionable but in the Islamic world no outside power is ternal security infrastructure and make evident in certain Washington ideological circles have ever going to be well received as an occu- that the U.S. does not desire long term con- led to intervention in Iraq without full UN sanc- pying force. Hence, strategies that emphasize trol. tion. Ironically, prior to 9/11 these same no- the first two endeavors and don’t lead to long- (11) We should also move forthwith to trans- tions led to rejection of a Comprehensive Test term reliance on the third should be the goal fer more political control to the Iraqi Governing Ban Treaty and of upgraded verification provi- of U.S. policy makers. Council and press for immediate elections and sions for the 1972 Biological Weapons Con- (8) Responses to terrorism often lead to es- constitution writing. Some argue that stability vention—agreements that would have stood in calating action/reaction cycles. When our is more likely to be achieved with a long U.S. the way of WMD production in Iraq and pro- forces become subject to terrorist assaults and occupation. I believe the reverse is true. The vided a legal basis for possible armed inter- the perpetrators disappear into their neighbor- longer we are in Iraq, the greater the instability vention if violations occurred. The world is cry- hoods, we, like Israel, will inevitably be tempt- there and the greater the likelihood that tering out for leadership in restraining weapons ed to retaliate in ways that may intensify rath- rorism will spread to other countries, including development. We are not providing it because er than restrain future violence. the United States. Washington policy makers prefer that restraint Calls will be made not only to use air power (12) America cannot cut and run politically, on others not apply to ourselves. in urban areas but to double or triple troop de- economically or militarily, but we would be (5) When Washington policy makers speak ployments, perhaps without adequate assess- wise to announce a timetable for troop with- on foreign policy they must understand that ment of what such troops will be assigned to drawal, by the end of next year at the latest. their audience is more than one party’s polit- do. In conventional warfare, the case for over- Some experts in and out of government be- ical base. While Saddam Hussein is widely whelming superiority (sometimes referred to lieve that American troops should stay in and perceived to be the worst sort of tyrant, many as the Powell Doctrine) is compelling. In a ter- control Iraq at least as long as we did in people around the world view us as bullies for rorist setting, as in modernist design, less can Japan and Germany after World War II. Such attacking a sovereign country without prior often be more. There may be cases where de- a time table (a minimum of 5 years) is out of armed provocation. That is why it is so critical ploying a large force to combat terrorism is sync with the times and the mood in the Is- that a case for intervention should be based appropriate. There may also be cases—and I lamic world. on concern for the well-being of others as well believe Iraq is one—where additional soldiers The world is more impatient today and Mus- as the U.S. national interest. simply become additional targets, and a dif- lims in particular are more history sensitive For foreign policy to be effective, it must be ferent mix of strategies is both preferable and than ever before. While we assume the Iraqi clearly articulated and convincing in those more effective. populace should accept the American pres- parts of the world most affected by it. (9) To defend against terrorism, especially ence because of our good will, the Muslim (6) We must rededicate ourselves to build- when it is fueled by an explosive mixture of re- world sees our forces as a compounding of ing up an intelligence capacity that better un- ligious and nationalist sentiments, requires grievances dating back to the crusades and, derstands the Middle East and the Islamic frank acknowledgment of the nature and depth more recently, to American support of Israel. world and is less susceptible to being politi- of the problem. The imagery AlJazeera projects of Baghdad is cized. Our inability to understand Islamic cul- For months, the administration has sug- that of another West Bank. In this context, ture resulted in the greatest intelligence failure gested the problem in Iraq is limited to 5,000 American commitments to ‘‘slog on’’ intermi- of our era. It is, however, not the sole intel- dissidents. This is a 5-digit miscalculation. At nably play into the hands of extremists. All ex- ligence failure. In one of the greatest least half the Muslim world—over 500,000,000 tremists have to do is continue blowing up a judgmental errors of our time we appear to people—are outraged by the U. S. govern- vehicle or two every day, thereby eliciting a have attempted to combat the ideological pos- ment’s attitudes and action. Long simmering military reaction that we might view as reason- turing of others by slanting our own intel- resentment of American policies in Muslim able but that the Islamic world is likely to see ligence. Based on what is known today, policy countries like Indonesia has in recent months as heavy-handed, angering the populace and makers not only erred in assessing Saddam metastasized into hatred. And in Europe, in- emboldening further dissent.

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00029 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.227 E23PT1 E2452 CONGRESSIONAL RECORD — Extensions of Remarks November 23, 2003 The longer we stay, the greater the oppor- There are many reasons why Europeans and nothing undercuts confidence more than tunity for al Qaeda and radical Baath party are so smugly opposed to our policy in Iraq. anarchist acts. Policies designed to deter ter- supporters to claim that the war is continuing One is historical experience with colonialism. rorism can be counter-productive. International and that they are prevailing. To prevent this The French were chased out of Algeria, the disapproval of our actions may jeopardize our and to keep control of events we would be Russians, and earlier the British, out of Af- economy and diminish the credibility of our po- wise to announce a withdrawal timetable that ghanistan. U.S. intervention in Iraq is seen in litical leadership in the world. Increased ter- we, not they, control. Setting such a timetable Europe as not too dissimilar to the British and rorism could well have the dual effect of pre- has the effect of asserting that the war itself French effort to re-establish control over the cipitating new U.S. military engagements and, is over and we prevailed, and that Iraqis can- Suez Canal in 1956. It is noteworthy that the ironically, strengthening isolationist senti- not dither in establishing a legitimate, elected Islamic world deeply appreciated President Ei- ment—which, in turn could degenerate into a government. senhower’s refusal to back the British and disastrous spiral of protectionism. A drawn out occupation plays into the hand French intervention in Egypt. Europeans now (18) The measure of success in reconstruc- of radicals. It gives them a rallying cry to keep think that the shoe is on the other foot. We tion is not the sum of accomplishments. In the up resistance in Iraq and expand terrorist as- appear insensitive to history. Vietnam War the Pentagon gave progress re- saults around the world. It gives them the (15) Credit will remain the dominant eco- ports that came to be symbolized by its body chance to suggest that America is bent on nomic issue until Iraq’s foreign debt is reduced counts. One of the most liberal critics of that continuing the crusades and, when we eventu- or canceled. Neither significant private nor war, I.F. Stone, once commented that he ac- ally withdraw, the prospect of claiming that large scale public credit will be made available cepted the validity of the body counts but they won the war. On the other hand, if we set to Iraqis until the burden of old debt is lifted. thought that they did not reveal the big picture. a firm schedule for drawing down our troops, Accordingly, we should press vigorously for It would be as if, Stone suggested, he were to we define the war as being over in its 3rd Saddam-era debt—which went largely to build be walking down the street and bump into a week, not in its 6th year. An announced time palaces for Saddam’s family and to buy weap- man running out of a bank waving a gun and table can later be modified to allow, for in- ons of aggression—to be written off. We carrying a satchel full of money, and were to stance, a small force to remain briefly in north- should also press to establish community-cen- ask the man, ‘‘What are you doing?’’ If the ern Iraq to maintain sovereign cohesion. Time- tered banks and credit unions where micro man responded, ‘‘I’m waiting for a car,’’ the tables can also be abbreviated. But the point credit can be offered. Oil wealth has its advan- man would be telling the truth but not reveal- is that they underscore our reluctance to be- tages only if revenues are used for the benefit ing the big picture. come an imperial power and, perhaps more of society rather than political insiders. In- Good things are being accomplished in Iraq, importantly, our determination to control our creasing petroleum production is not enough. particularly in the North where an American own destiny. Oil is not a labor intensive industry. Jobs mat- general has won a measure of popularity (13) It is critical to the security of our troops, ter, and Iraq needs bankers and small busi- through progressive stabilization initiatives. Yet as well as Iraqi security, that we create an ness entrepreneurs far more than oil barons. terrorism cannot credibly be contained in the Iraqi police force as soon as possible. Re- We have no choice except to help rebuild arms-infested Iraqi environment. American ci- sponsibility for domestic security is an internal Iraq’s oil infrastructure, but we must make vilians as well as armed services personnel not external matter. We can’t be their police- clear that we have no intention of controlling who have been posted to Iraq deserve to be men and if we persist in trying, we will make Iraq’s oil reserves. The natural resources of commended for their commitment and sac- it harder for stability to be established and Iraq must be treated as the patrimony of the rifices, but prudence suggests that brevity of maintained. Iraqi people. service is preferable to a long standing pres- Students of international politics have for the (16) Economic assistance to Iraq should be ence. Otherwise, in a world where terrorism is past generation questioned the capacity and front-loaded and generous. War has been a a growth industry even extraordinary sacrifice moral authority of any country to be policeman constant of history, but the concept of recon- and significant accomplishments could be for for the world. But little academic attention was struction is relatively new. The 20th century naught. devoted to the challenge of being policeman gave us two vastly different models. At the (19) We must respect Iraqi culture and work within a country after the conclusion of a con- end of World War 1, the victors imposed re- to ensure that the art and artifacts of this cra- flict. We have little experience with such a re- tributive terms on Germany, which so angered dle of civilization are preserved for the Iraqi sponsibility. In Japan, MacArthur relied on in- German society that it turned to fascism. people. There are few umbrages more long digenous Japanese police; in Germany, we World War II was the result. lasting than cultural theft. Cultural looting must quickly reconstituted a German constabulary The allies took a different approach at the be stopped and the market for stolen antiq- at most local levels. end of World War II. Generosity was the uities squelched. For our part we should en- Common sense would indicate that trying to watchword. The Marshall Plan was adopted to sure that Iraqi cultural sites are protected and police a country the size of France with sol- rebuild Europe and Gen. MacArthur directed that our laws are upgraded. Any stolen antiq- diers unfamiliar with the language and culture the reform and modernization of Japan. Model uities brought to America must be returned. of the society, untrained in the art of policing, democracies emerged. The world was made (20) The war in Iraq should not cause us to and unwelcome and resented in critical cities more secure. The economic plan for Iraq forget Afghanistan. While the center of our and towns must be a nearly impossible task. should be two-pronged: debt forgiveness cou- military attention may at the moment be Bagh- Hence the need to expedite the training of an pled with institution building. A better world is dad, we must remember that no Iraqi was in- indigenous Iraqi police force. more likely to emerge if the American agenda volved in hijacking the planes that struck the (14) We should announce that we have no places its emphasis on construction rather World Trade Center and Pentagon on 9/11. intention of establishing permanent military than destruction. Few countries are more distant physically or bases in Iraq. Some Washington policy mak- Here a note about the other reconstruction culturally from the United States than Afghani- ers want such bases but they would be a polit- model in American history is relevant. With his stan, yet it is there where the plotting for that ical burden for any new government in Bagh- call for malice toward none, Lincoln’s second terrorist act began. The Taliban have been re- dad and a constant struggle for the U.S. to de- inaugural address set the most conciliatory moved and a new, more tolerant government fend. Defense of American bases in Iraq from tone in the history of war. His successor once has been established, but the world commu- terrorism in the 21st century is likely to be far removed, U.S. Grant, proved to be a more nity has not fulfilled its commitments to raise more difficult than the challenge we foresaw of proficient soldier than President and coun- that country out of poverty and warlordism. maintaining U.S. sovereignty over the Panama tenanced carpet bagging conflicts of interest. The U.S. cannot continue to be complacent Canal in the 20th century. The reason the De- Our government today would be well advised about economic and social development in partment of Defense concluded in the Carter to recognize that neither history nor the Amer- that country, where foreigners have never administration that it was wise to transfer con- ican public approves of war or post-war profit- been welcome. Failure of the Karzai govern- trol over the Panama Canal to Panamanians eering. Great care has to be taken to ensure ment and a return of the Taliban would be a was the estimation that the Canal could be de- transparency and integrity in government con- major setback in the battle with terrorism. fended against traditional aggression but not tracts and common sense would indicate that (21) Lastly, and most importantly, U.S. pol- sabotage or acts of terrorism. It seemed wiser the more Iraqis are involved in rebuilding their icy makers should never lose sight of the fact to respect nationalist sentiment and provide own society, the more lasting such efforts are that events in Israel and Iraq are intertwined for a gradual transfer of the canal to local con- likely to be. and that no challenge is more important for re- trol than to insist on quasi-colonial assertions (17) Terrorism affects world economics as gional and global security than resolution of of power. well as politics. Markets depend on confidence the Israeli-Palestinian dilemma.

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00030 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.231 E23PT1 November 23, 2003 CONGRESSIONAL RECORD — Extensions of Remarks E2453 Extraordinarily, administration after adminis- more damaging to countries not directly in- must not. The key at this point is to recognize tration in Washington seems to pay only inter- volved in the conflict. The need for U.S. lead- the limits as well as magnitude of our power mittent attention to this issue. There should be ership in pressing for peace has never been and emphasize the most uplifting aspects of no higher priority in our foreign policy than a more urgent. It would be a tragedy if, focussed our heritage: democracy, opportunity, freedom resolution of the Arab-Israeli conflict. Attention on making war in one part of the Middle East, of thought and worship. Differences we must in Washington should be riveted at all times we neglected to promote peace in another. on this singular issue. The current status quo In conclusion, the world is noting what we respect; intolerance we must reject. But Amer- is good neither for Israel nor for the Palestin- are saying and what we are doing. Many are ica does better as a mediator and multi-party ians. Now, for the first time lack of progress in not convinced by our words; many are ap- peace maker than as a unilateral interven- establishing a mutually acceptable modus palled by our actions. Yet nothing would be tionist. This is the great lesson of the past vivendi between the parties may be even worse for the world than for us to fail. We year.

VerDate jul 14 2003 02:16 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00031 Fmt 0626 Sfmt 9920 E:\CR\FM\A21NO8.234 E23PT1 Sunday, November 23, 2003 Daily Digest Senate port at 9 a.m., on Monday, November 24, 2003 Chamber Action with a vote on the motion to close further debate at Routine Proceedings, pages S15591–S15667 12:30 p.m. Page S15644 Measures Introduced: Two bills were introduced, 2004 Budget Resolution Revisions: Senator Nick- as follows: S. 1934–1935. Pages S15646–47 les submitted changes to H. Con. Res. 95, Fiscal Medicare Prescription Drug, Improvement, and Year 2004 Budget Resolution, pursuant to section Modernization Act Agreement: Senate continued 401, the Medicare Reserve Fund Adjustment. consideration of the conference report to accompany Page S15610 H.R. 1, to amend title XVIII of the Social Security Statements on Introduced Bills/Resolutions: Act to provide for a voluntary prescription drug cov- Pages S15647–63 erage program under the medicare program, to modernize, strengthen, and improve the medicare pro- Additional Statements: Page S15646 gram, to amend the Internal Revenue Code of 1986 Adjournment: Senate met at 1 p.m. and adjourned to allow a deduction to individuals for amounts con- at 10:45 p.m. until 9 a.m. on Monday, November tributed to health savings accounts, to amend the 24, 2003. (For Senate’s Program, see the remarks of Federal Food, Drug, and Cosmetic Act with respect the Majority Leader in today’s Record on page to abbreviated applications for the approval of new S15644). drugs and the importation of prescription drugs. Pages S15592–S15644 A unanimous-consent agreement was reached pro- Committee Meetings viding for further consideration of the conference re- No committee meetings were held. h House of Representatives The House was not in session. Committee Meetings No committee meetings were held.

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VerDate jul 14 2003 04:46 Nov 24, 2003 Jkt 029060 PO 00000 Frm 00001 Fmt 0627 Sfmt 0627 E:\CR\FM\D23NO3.REC D23NO3 D1332 CONGRESSIONAL RECORD — DAILY DIGEST November 23, 2003

Next Meeting of the SENATE Next Meeting of the HOUSE OF REPRESENTATIVES 9 a.m., Monday, November 24 12 noon, Tuesday, November 25

Senate Chamber House Chamber Program for Monday: Senate will continue consideration of Program for Tuesday: Pro forma session. the conference report to accompany H.R. 1, to amend title XVIII of the Social Security Act to provide for a voluntary prescription drug coverage program under the medicare program, to modernize, strengthen, and improve the medicare program, to amend the Internal Revenue Code of 1986 to allow a deduction to individuals for amounts contributed to health savings accounts, to amend the Federal Food, Drug, and Cosmetic Act with respect to abbreviated applications for the approval of new drugs and the importation of prescription drugs with a vote on the motion to close further debate on the Conference Report to occur at 12:30 p.m.

Extensions of Remarks, as inserted in this issue

HOUSE Emanuel, Rahm, Ill., E2440, E2446 McCrery, Jim, La., E2428 Sensenbrenner, F. James, Jr., Wisc., Farr, Sam, Calif., E2436, E2437 McDermott, Jim, Wash., E2437 E2434 Baker, Richard H., La., E2440 Frost, Martin, Tex., E2430 Markey, Edward J., Mass., E2432 Shaw, E. Clay, Jr., Fla., E2431 Baldwin, Tammy, Wisc., E2423 Goodlatte, Bob, Va., E2449 Matsui, Robert T., Calif., E2429 Smith, Christopher H., N.J., E2427 Beauprez, Bob, Colo., E2441, E2441 Green, Gene, Tex., E2447 Ortiz, Solomon P., Tex., E2448 Solis, Hilda L., Calif., E2440 Becerra, Xavier, Calif., E2430 Gutierrez, Luis V., Ill., E2438, E2440 Paul, Ron, Tex., E2428 Stark, Fortney Pete, Calif., E2430, Bell, Chris, Tex., E2425 Hinchey, Maurice D., N.Y., E2433 Pickering, Charles W. ‘‘Chip’’, Miss., Bono, Mary, Calif., E2449 Holt, Rush D., N.J., E2437, E2439, E2443 E2447, E2450 E2431 Cantor, Eric, Va., E2442 Hostettler, John N., Ind., E2443 Porter, Jon C., Nev., E2431 Tanner, John S., Tenn., E2436, E2438 Cardoza, Dennis A., Calif., E2426 Johnson, Eddie Bernice, Tex., E2438 Radanovich, George, Calif., E2433 Tauzin, W.J. (Billy), La., E2429, E2442, Christensen, Donna M., The Virgin Jones, Walter B., N.C., E2433 Rogers, Mike, Ala., E2440, E2441, E2444 E2444, E2447 Islands, E2426 Kennedy, Patrick J., R.I., E2434 Rothman, Steven R., N.J., E2443 Udall, Tom, N.M., E2425, E2432 Clay, Wm. Lacy, Mo., E2424 Kildee, Dale E., Mich., E2425 Sandlin, Max, Tex., E2446 Visclosky, Peter J., Ind., E2426 Conyers, John, Jr., Mich., E2429 Leach, James A., Iowa, E2450 Saxton, Jim, N.J., E2423 Weldon, Dave, Fla., E2428 DeMint, Jim, S.C., E2449 Levin, Sander M., Mich., E2430 Schakowsky, Janice D., Ill., E2447, Wolf, Frank R., Va., E2434 Doolittle, John T., Calif., E2424, E2429 Lofgren, Zoe, Calif., E2436 E2449 Ehlers, Vernon J., Mich., E2444 McCollum, Betty, Minn., E2423 Schiff, Adam B., Calif., E2432, E2448

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