[Congressional Record Volume 140, Number 35 (Thursday, March 24, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: March 24, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                THE ORGAN TRANSPLANT REAUTHORIZATION ACT

  Mr. CONRAD. Mr. President, I ask unanimous consent that the Labor and 
Human Resources Committee be discharged from further consideration of 
H.R. 2659, the Organ Transplant Reauthorization Act, and that the 
Senate proceed to its immediate consideration.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The bill will be stated by title.
  The legislative clerk read as follows:

       A bill (H.R. 2659) to amend the Public Health Service Act 
     to revise and extend programs relating to the transplantation 
     of organs and of bone marrow.


                           amendment no. 1594

            (Purpose: To provide for a substitute amendment)

  Mr. CONRAD. Mr. President, I send an amendment to the desk on behalf 
of Senator Kennedy and ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from North Dakota [Mr. Conrad], for Mr. 
     Kennedy, proposes an amendment numbered 1594.

  Mr. CONRAD. Mr. President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       Strike out all after the enacting clause and insert in lieu 
     thereof the following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Organ Transplant Program 
     Reauthorization Act of 1994''.

     SEC. 2. ORGAN PROCUREMENT ORGANIZATIONS.

       (a) In General.--Subsection (a) of section 371 of the 
     Public Health Service Act (42 U.S.C. 273(a)) is amended to 
     read as follows:
       ``(a)(1) The Secretary may make grants for the 
     consolidation and expansion of qualified organ procurement 
     organizations described in subsection (b).
       ``(2) The Secretary may make grants to, and enter into 
     cooperative agreements and contracts with, qualified organ 
     procurement organizations described in subsection (b) and 
     other public or nonprofit private entities for the purpose of 
     increasing organ donation through--
       ``(A) the planning and conducting of programs to provide 
     information and education to the public on the need for organ 
     donations;
       ``(B) the training of individuals in requesting such 
     donations; or
       ``(C) the provision of technical assistance to organ 
     procurement organizations and other entities in the health 
     care system.
       ``(3)(A) In making awards of grants, cooperative agreements 
     and contracts under subparagraphs (A) and (B) of paragraph 
     (2), the Secretary shall give priority to carrying out the 
     purpose described in such paragraph with respect to minority 
     or other populations for which there is a greater degree of 
     organ shortages relative to the general population.
       ``(B) In making awards of grants, cooperative agreements 
     and contracts under paragraph (2)(C), the Secretary shall 
     give priority to carrying out the purpose described in such 
     paragraph with respect to organ procurement organizations and 
     hospitals with lower rates of procurement relative to other 
     such organizations or hospitals.''.
       (b) Qualified Organ Procurement Organizations.--Section 
     371(b) of such Act (42 U.S.C. 273(b)) is amended--
       (1) in paragraph (1)--
       (A) in the matter preceding subparagraph (A), by striking 
     ``for which grants may be made under subsection (a)'' and 
     inserting ``described in this section'';
       (B) by realigning the margin of subparagraph (E) so as to 
     align with the margin of subparagraph (D); and
       (C) in subparagraph (G)--
       (i) in the matter preceding clause (i), by striking 
     ``directors or an advisory board'' and inserting ``directors 
     (or an advisory board, in the case of a hospital-based organ 
     procurement organization established prior to September 1, 
     1993)''; and
       (ii) in clause (i)--

       (I) by striking ``composed of'' in the matter preceding 
     subclause (I) and inserting ``composed of a reasonable 
     balance of''; and
       (II) by inserting before the comma in subclause (II) the 
     following: ``, including individuals who have received a 
     transplant of an organ (or transplant candidates), and 
     individuals who are part of the family of an individual who 
     has donated an organ'';

       (2) by striking paragraph (2);
       (3) by redesignating paragraph (3) as paragraph (2);
       (4) in paragraph (2) (as so redesignated)--
       (A) by redesignating subparagraphs (B) through (K) as 
     subparagraphs (C) through (L), respectively,
       (B) by inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) conduct and participate in systematic efforts, 
     including public education, to increase the number of 
     potential donors,'';
       (C) by inserting before the comma in subparagraph (F) (as 
     so redesignated) the following: ``, which system shall, at a 
     minimum, allocate each type of organ on the basis of--
       ``(i) a single list encompassing the entire service area;
       ``(ii) a list that encompasses at least an entire State; or
       ``(iii) a list that encompasses an approved alternative 
     local unit (as defined in paragraph (4)),

     of individuals who have been medically referred to a 
     transplant center in the service area of the organization in 
     order to receive a transplant of the type of organ with 
     respect to which the list is maintained;'';
       (D) by striking subparagraph (I) (as so redesignated) and 
     inserting the following new subparagraph:
       ``(I) be a member of and abide by the rules and 
     requirements of the Organ Procurement and Transplantation 
     Network established under section 372,''; and
       (E) by striking subparagraph (K) (as so redesignated) and 
     inserting the following new subparagraph:
       ``(K) evaluate annually, and report to the Organ 
     Procurement and Transplantation Network established under 
     section 372, on the effectiveness of the organization in 
     acquiring potentially available organs, particularly among 
     minority populations, and the variation of procurement across 
     hospitals within the organ procurement organization region, 
     and identify a plan to increase procurement, particularly 
     among minority populations and other populations for which 
     there is a greater degree of organ shortages relative to the 
     general population, and at hospitals with low rates of 
     procurement, and''; and
       (5) by adding at the end thereof the following new 
     paragraphs:
       ``(3)(A) The Office of Technology Assessment shall conduct 
     a study for the purpose of defining--
       ``(i) the appropriate standards by which to judge the 
     quality of performance of organ procurement organizations; 
     and
       ``(ii) the proper criteria for a determination of 
     inadequate service from an organ procurement organization.
       ``(B) Not later than 2 years after the date of enactment of 
     this paragraph, the Office of Technology Assessment shall 
     complete the study required under subparagraph (A) and 
     prepare and submit to the Committee on Labor and Human 
     Resources of the Senate, the Committee on Energy and Commerce 
     of the House of Representatives, and the Secretary, a report 
     describing the findings made as a result of the study.
       ``(C) For purposes of this paragraph the term `organ' means 
     a human kidney, liver, heart, lung, pancreas, and any other 
     human organ or tissue specified by the Secretary for purposes 
     of this paragraph.
       ``(4)(A) As used in paragraph (2)(F), the term `alternative 
     local unit' means--
       ``(i) a unit composed of two or more contiguous organ 
     procurement organizations; or
       ``(ii) a subdivision of an organ procurement organization 
     that operates as a distinct procurement and distribution unit 
     as a result of special geographic, rural, or minority 
     population concerns but that is not composed of any subunit 
     of a metropolitan statistical area.
       ``(B) The Organ Procurement and Transplantation Network 
     shall make recommendations to the Secretary concerning the 
     approval or denial of alternative local units. The Network 
     shall assess whether the alternative local units will better 
     promote organ donation and the equitable allocation of 
     organs.
       ``(C) The Secretary shall approve or deny any alternative 
     local unit principle or designation recommended by the 
     Network. If the Secretary does not provide otherwise prior to 
     the expiration of the 90-day period beginning on the date on 
     which the application is submitted, the recommendations of 
     the Network under subparagraph (B) with respect to the 
     application of the alternative local unit shall go into 
     effect.''.
       (c) Effective Date.--The amendments made by subsection 
     (b)(5) shall apply to organ procurement organizations 
     beginning January 1, 1995.

     SEC. 3. ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK.

       Section 372(b) of the Public Health Service Act (42 U.S.C. 
     274(b)) is amended--
       (1) in paragraph (1)(B)--
       (A) in clause (i)--
       (i) by striking ``(including organizations that have 
     received grants under section 371)''; and
       (ii) by striking ``; and'' at the end thereof and inserting 
     ``(including both individuals who have received a transplant 
     of an organ (or transplant candidates), and individuals who 
     are part of the family of individuals who have donated an 
     organ, the number of whom shall make up not less than 40 
     percent of the total number of board members); and''; and
       (B) in clause (ii), by inserting ``including a patient 
     affairs committee'' after ``committees,''; and
       (2) in paragraph (2)--
       (A) in subparagraph (A), by striking clause (i) and 
     inserting the following new clause:
       ``(i) with respect to each type of transplant, a national 
     list of individuals who have been medically referred to 
     receive a transplant of the type of organs with respect to 
     which the list is maintained (which list shall include the 
     names of all individuals included on lists in effect under 
     section 371(b)(2)(F), and'';
       (B) in subparagraph (B), by inserting ``, including 
     requirements under section 371(b),'' after ``membership 
     criteria'';
       (C) by redesignating subparagraphs (E) through (L), as 
     subparagraphs (F) through (M), respectively;
       (D) by inserting after subparagraph (D), the following new 
     subparagraph:
       ``(E) assist organ procurement organizations in the 
     equitable distribution of organs among transplant 
     patients,'';
       (E) in subparagraph (K) (as so redesignated), by striking 
     ``and'' at the end thereof;
       (F) in subparagraph (L) (as so redesignated), by striking 
     the period and inserting ``, including making recommendations 
     to organ procurements organizations and the Secretary based 
     on the annual reports required under section 371(b)(2)(K),'';
       (G) in subparagraph (M) (as so redesignated), by striking 
     the period and inserting a comma; and
       (H) by adding at the end thereof the following new 
     subparagraphs:
       ``(N) submit to the Secretary for review and approval any 
     change in the amount of fees imposed by the Network for the 
     registration of individuals on the lists maintained under 
     subparagraph (A)(i), such change to be considered as approved 
     if the Secretary does not provide otherwise prior to the 
     expiration of the 90-day period beginning on the date on 
     which the change is submitted to the Secretary,
       ``(O) make available to the Secretary such information, 
     books, and records regarding the Network as the Secretary may 
     require,
       ``(P) submit to the Secretary, on an annual basis, a report 
     on the clinical and scientific status of the organ 
     transplantations, and
       ``(Q) meet such other criteria regarding compliance with 
     this part as the Secretary may establish.''.

     SEC. 4. STUDY BY GENERAL ACCOUNTING OFFICE.

       Section 377 of the Public Health Service Act (42 U.S.C. 
     274f) is amended to read as follows:

     ``SEC. 377. STUDY BY GENERAL ACCOUNTING OFFICE.

       ``(a) Study.--
       ``(1) In general.--The Comptroller General of the United 
     States shall conduct a study for the purpose of determining 
     and making recommendations concerning--
       ``(A) the composition of the boards of directors of organ 
     procurement organizations and of the Organ Procurement and 
     Transplantation Network on the date of enactment of this 
     section, and the effect of the Organ Transplant Program 
     Reauthorization Act of 1994 on the composition and 
     functioning of such boards;
       ``(B)(i) the number and percentage of cadaveric organ 
     transplants for foreign nationals and nonresident aliens 
     categorized by organ procurement organization and by 
     transplant center and information on any reciprocal 
     agreements between organ procurement organizations and 
     foreign countries or territories;
       ``(ii) the number and percent of the organizations referred 
     to in clause (i) above the organ procurement transplant 
     network guideline of 10 percent; and
       ``(III) any information on the current rate of organ 
     donation by individuals other than United States citizens or 
     legal residents;
       ``(C) organ donation rates and the impact of various organ 
     allocation systems on organ procurement rates; and
       ``(D) the equitable allocation of organs nationwide, 
     including an analysis of the relative probability of 
     receiving an organ for patients with similar characteristics 
     for each category of transplanted organ by organ procurement 
     organization and recommendations for developing a regional 
     allocation system in order to ensure that--
       ``(i) patients in one region have an equivalent probability 
     of receiving an organ as do patients with similar 
     characteristics in another region; and
       ``(ii) patients within a region have an equivalent 
     probability of receiving an organ as do other patients with 
     similar characteristics in that region.
       ``(2) Equitable allocation.--In carrying out paragraph (1) 
     with respect to subparagraph (D), the Comptroller General 
     shall--
       ``(A) recommend regions for allocating organs to encompass 
     as large a geographic area as is practical, taking into 
     account medical appropriateness, and the geographic proximity 
     of patients with comparable priority for receiving an organ;
       ``(B) take into account the impact on organ donation and 
     procurement rates; and
       ``(C) consult with experts in the area of organ allocation 
     and organ donations and consider their recommendations 
     regarding the establishment of regions in the country for the 
     purpose of allocating organs.
       ``(b) Report.--Not later than 2 years after the date of 
     enactment of the Organ Transplant Program Reauthorization Act 
     of 1994, the Comptroller General of the United States shall 
     complete the study required under subsection (a) and prepare 
     and submit to the Committee on Energy and Commerce of the 
     House of Representatives, and to the Committee on Labor and 
     Human Resources of the Senate, a report describing the 
     findings made as a result of the study.''.

     SEC. 5. GENERAL PROVISIONS.

       (a) Limitation.--Section 374(b) of the Public Health 
     Service Act (42 U.S.C. 274b(b)) is amended--
       (1) by striking paragraph (2);
       (2) by redesignating paragraph (3) as paragraph (2); and
       (3) in paragraph (2) (as so redesignated), by striking 
     ``371(a)(3)'' and inserting ``371(a)(2)''.
       (b) Repeal.--Section 376 of the Public Health Service Act 
     (42 U.S.C. 274d) is repealed.
       (c) Transfer.--Section 378 of the Public Health Service Act 
     (42 U.S.C. 274g) is amended--
       (1) by transferring such section to part H of title III; 
     and
       (2) by inserting such section after section 377.
       (d) Authorization of Appropriations.--Section 378 of the 
     Public Health Service Act (42 U.S.C. 274g) is amended by 
     striking ``1991'' and all that follows through the period and 
     inserting ``1994, and such sums as may be necessary for each 
     of the fiscal years 1995 and 1996.''.

     SEC. 6. EFFECTIVE DATES.

       (a) In General.--Except as provided in subsection (b), the 
     amendments made by this Act shall become effective on the 
     date of enactment of this Act.
       (b) Exception.--The amendments made by section 2(b)(4)(C) 
     shall become effective 9 months after the date of enactment 
     of this Act. Prior to such date, section 371(b)(3)(E) of the 
     Public Health Service Act, as in effect on the day before the 
     date of the enactment of this Act, shall remain in effect.

  Mr. KENNEDY. Mr. President, I urge the Senate to support H.R. 2659, 
the Organ Transplant Reauthorization Act. This legislation addresses 
the need for reform in the organ procurement and allocation system. I 
particularly commend Senator Kassebaum and Senator Wofford for their 
efforts, and the work of the other members of the Labor Committee on 
this important legislation.
  Twelve years ago the attention of the Nation focused on Jamie Fiske 
of Massachusetts as her father appealed to people in all parts of the 
country for help in finding a liver to save his daughter's life. Jamie 
is doing well today, but unfortunately over 30,000 people like her are 
waiting for life saving organ transplants. Currently, the median 
waiting times vary from a few months to a few years in different parts 
of the country.
  Organ demand has increased by 50 percent since 1988 but organ 
donation rates have barely changed. We need to close the widening gap 
between the number of available organs and the number of patients in 
need of transplants. In addition, a patient waiting for an organ in one 
area should not have a substantially longer or shorter waiting time 
than a patient in similar condition in a nearby area.
  The reauthorization of the organ transplant program seeks to increase 
donation and to promote more equitable organ allocation. The bill 
reauthorizes funding at $8 million in fiscal year 1994, and such sums 
as may be necessary in 1995, and 1996.
  The bill enables the Secretary to make grants or enter into 
cooperative agreements with OPO's and other public or non-profit 
organizations to increase organ donations. These entities may engage in 
public education, train individuals to request donations, or provide 
technical assistance to OPO's and hospitals. Since individuals who are 
members of minority groups have more difficulty than others in finding 
an organ match, priority will be given to grant requests designed to 
alleviate organ shortages for those populations where shortages are 
more severe.
  OPO's will also be required to participate in systematic efforts, 
including public education, to increase donation rates, and to annually 
evaluate their effectiveness in acquiring organs. The Office of 
Technology Assessment will evaluate performance standards for OPO's.
  This bill helps to move toward a more equitable system for allocating 
organs by requiring that a single list of transplant candidates be 
maintained in an OPO service area, in an area encompassing at least an 
entire State, or in an approved alternative local unit. The committee 
has also asked the General Accounting Office to study a number of 
issues, including evaluating other ways to change the organ allocation 
process to assure transplant candidates similar access to the organs 
they need, regardless of where they live.
  The bills calls for greater participation by transplant recipients 
and donor families on the boards of organ procurement organizations, 
which are know as OPO's. The legislation also makes permanent the 
Patient Affairs Committee of the Organ Procurement and Transplant 
Network to address the needs of recipients and donors. To protect 
patients from substantial price increases in organ transplant program 
registration fees, the Network will be required to submit any fee 
changes to the Secretary of Health and Human Services for review and 
approval.
  The original intent of the National Organ Transplant Act was to 
assure patients that no matter who they were or where they lived, they 
would have a fair chance of receiving a necessary organ transplant. The 
Committee believes that the organ transplant system can be improved by 
focusing on public education, addressing problems in the current 
system, and increasing the role transplant recipients, donor families, 
and community leaders play in the process.
  Ultimately however, we need more public recognition about the need 
for the life-saving gift of organ donation and the importance of family 
consent in the process. A signed organ donor card does not ensure 
donation. The Organ Transplant Program is worthy of our support and 
invaluable to those Americans in need of an organ transplant. We can 
and should do better. In a very real sense, this bill saves lives, and 
I urge my colleagues to join in expediting its consideration.
  Mrs. KASSEBAUM. Mr. President, I speak today in support of the Organ 
Transplant Program Reauthorization Act of 1993, S. 1597. This 
legislation authorizes initiatives both to increase organ donations and 
provide equitable allocation of organs to individuals in need. I will 
vote in support of this legislation, and I urge my colleagues to do the 
same.
  The Organ Transplant Program Reauthorization Act of 1993 includes 
many important measures which would help improve organ donation. 
Clearly, improved donation would decrease the need for a complex 
allocation system. Specific measures in this legislation would result 
in increased technical support for hospitals with low organ donation 
rates. In addition, States and not-for-profit organizations would be 
able to experiment with innovative ways to increase donations through 
improvements in public organ donor awareness.
  However, because the national pool of donated organs remains small, 
this legislation would also change the existing organ allocation system 
to ensure a more equitable distribution system. In particular, S. 1597 
would require that each organ procurement organization [OPO] maintain a 
single waiting list for each organ. Alternatively, each State or 
approved alternative local unit would also be able to maintain a 
waiting list for each organ. This measure would ensure that the sickest 
person in an OPO, rather than a healthier patient in the hospital where 
the organ is collected, receives an available organ. Additionally, I 
also support measures in the legislation authorizing the General 
Accounting Office to study a new regionalized distribution system for 
each organ.
  I complement the senator from Massachusetts and the other committee 
members for their efforts in reaching a difficult consensus on this 
act. However, there is one issue I hope to address further when we go 
to conference with the House. Specifically, I believe that every 
hospital should be required to work with its designated organ 
procurement organization, subject only to limited exceptions. The House 
version of this bill contains provisions addressing this important 
issue, while this bill does not.
  The Health Care Financing Administration [HCFA] determines which 
geographic service area an OPO should serve. Unfortunately, under its 
interpretation of the law, HCFA allows OPO's to enter into agreements 
with hospitals outside of the OPO designated service area. HCFA 
maintains this current policy because it believes such an arrangement 
results in competition between OPOs to improve their service quality. 
On the other hand, serious problems can be created. For example, 
Midwest Organ Bank, the OPO which serves Kansas, estimates that it is 
losing up to 20 percent of its geographic service area organs.
  The original legislative intent was that an OPO would distribute 
organs only to the hospitals in its designated service area. In 
addition, such hospitals would procure organs only for their respective 
service area OPO. This system was designed to assure that each 
geographic service area in the country would procure enough organs to 
meet the needs of its citizens. In addition, the service areas were 
carefully designed to assure that each OPO could procure and allocate a 
sufficient quantity of organs to maintain its quality standards.
  Mr. President, despite my concern about the OPO service area issue, I 
commend Senator Kennedy and my Labor Committee colleagues for their 
work on this legislation. Reauthorization of the organ transplant 
program will benefit many.
  Mr. GREGG. Mr. President, I am pleased at the favorable consideration 
that the Senate has given to provisions of the Comprehensive Child 
Immunization Act as reported by the Senate Committee on Labor and Human 
Resources and approved again today by the Senate as part of S. 1597, 
the provisions of which have been substituted for the provisions of 
H.R. 2659. However, I want to raise an issue of serious concern to the 
State of New Hampshire regarding the availability of Federal funds to 
support the distribution of childhood vaccines by States through their 
public health departments.
  In the President's fiscal year 1995 budget request, funds for state 
public health vaccine programs were greatly reduced. This is in direct 
conflict with the intent of the Congress last year at the time the 
Vaccine for children Program was passed as part of the Omnibus Budget 
Reconciliation of 1993. Congress recognized at that time the importance 
of maintaining a strong commitment to the public health delivery 
system, particularly in those States which have few federally qualified 
health centers. Given the restrictions on the children who are eligible 
to recieve federally purchased vaccines under the Vaccine for Children 
Program, particularly the underinsured who are eligible only at FQHCs 
or RHCs, a heavy burden will continue to fall on the public health 
system in many States such as New Hampshire.
  I know that a number of my colleagues share my concern about the 
underfunding of the State cooperative agreements with the Centers for 
Disease Control for the distribution of federally purchased vaccines 
through public health departments, and I have raised this issue with 
Secretary Shalala directly. I hope that as the budget and 
appropriations process moves forward, we can work together to address 
this very serious problem.
  Mr. KENNEDY. Mr. President, I thank my colleague from New Hampshire 
for raising this important issue today. It is a concern that I share. I 
am committed to improving immunization rates for the Nation's children, 
and the legislation we have passed today is a major step in this 
direction.
  A key feature of this legislation is building and expanding on 
current public health efforts to immunize all children who are at risk 
of not receiving life-saving vaccinations at the proper time.
  I am concerned that the administration's proposed reduction of 
support for State vaccine programs will undermine the recent gains we 
have made in serving vulnerable children. Senator Bumpers and I have 
sent a letter to Secretary Shalala to emphasize the importance of 
maintaining adequate financial support for State public health vaccine 
programs.
  In this time of limited resources, immunizations are a wise and cost-
effective investment. I look forward to working with my colleagues and 
with the Administration to maintain adequate funding for State vaccine 
programs, in order to ensure continuing progress toward our common goal 
of immunizing all children.
  Mrs. KASSEBAUM. Mr. President, I, too, wish to thank my colleague 
from New Hampshire for raising the serious problems posed for many 
states by the reduction in Federal support for State public health 
vaccine distribution programs proposed in the administration's fiscal 
year 1995 budget. In my State of Kansas, for example, the public health 
department has taken a leadership role in the effort to ensure that all 
children are fully immunized against potentially devastating childhood 
diseases, not only by conducting ambitious outreach programs but also 
by providing affordable immunization services through local public 
health clinics.
  As we move forward with the budget and appropriations process, I am 
strongly committed to working with the administration and with my 
colleagues in Congress to maintain a firm Federal commitment to State 
public health vaccine distribution programs. In Kansas, as in many 
other States, these programs are and will likely remain an essential 
avenue to achieving the early childhood immunization goals that we 
share and that inform the Childhood Immunization Act provisions we have 
approved again today as part of S. 1597.
  Mr. HARKIN. Mr. President, I have heard from many Iowans concerning 
the impact of the fiscal year 1995 budget request for vaccine 
purchases, and I share the concern of my colleagues. While overall, 
there has been no reduction in funding for vaccine purchases, the 
problem has arisen because the discretionary vaccine purchase program 
has been cut by $110 million; thus limiting the amount of vaccines 
available to State and local health departments. This situation is 
exacerbated by the fact that under the Vaccines for Children 
entitlement program, only federally qualified health centers are 
eligible to receive assistance for vaccines for those children whose 
health insurance does not include coverage for immunizations. In Iowa, 
as in other States, the primary responsibility for delivery of vaccines 
comes not from federally qualified health centers, but from state and 
local health departments. Consequently, the provisions relating to the 
Vaccines for Children entitlement have the effect of limiting Iowa's 
participation. This will result in fewer kids being immunized.
  Because of the fact that the Appropriations Committee will be below a 
freeze for the next 5 years, I cannot be overly optimistic that we will 
be able to restore the discretionary dollars for vaccine purchases 
under the 317 program. One solution would be to have State and Local 
health departments designated as federally qualified health centers for 
the purposes of vaccine delivery only. I have discussed this with 
Secretary Shalala of the Department of Health and Human Services, and I 
intend to continue to pursue in this matter. I can assure my colleagues 
that as chairman of the Appropriations Subcommittee that has 
jurisdiction over the vaccine program, I will do everything that I can, 
within budgetary constraints, to resolve this problem. I look forward 
to working with you.
  Mr. BUMPERS. Mr. President, as you know, I share my colleagues' 
strong commitment to substantially improving the immunization rates for 
the Nation's children and have sought to provide leadership in this 
effort. Today's approval of the provisions of S. 732, the Comprehensive 
Childhood Immunization Act, as part of the Senate substitute to H.R. 
2659, is a vital part of this effort. In addition to providing States 
with support to enhance their education and outreach programs and 
public health vaccine delivery infrastructure, this legislation 
includes a bonus program to reward those States that meet or exceed 
their immunization goals, as I originally proposed and as was adopted 
by the Senate during the consideration of the reconciliation bill last 
fall.
  I also share the deep concern expressed by my colleagues here today, 
however, over the effect on these public sector efforts that the 
reduction the administration is proposing in its fiscal year 1995 
budget in funds to the States for State vaccine distribution programs 
will have. The state vaccine purchase program has long been the 
cornerstone of state immunization programs, delivering childhood 
vaccine at no cost to children at local public health departments and 
clinics. I am committed to maintaining a strong public sector vaccine 
delivery system, and I will work with my colleagues as the budget and 
appropriations process proceeds to keep this commitment and restore the 
needed funding to the 317(j) program for fiscal year 1995.
  Mr. GRASSLEY. Mr. President, I join my colleagues today in voicing 
concern over the reduction of Federal funds for State public health 
vaccine distribution programs as proposed in the President's fiscal 
year 1995 budget request. I thank my colleague from New Hampshire for 
his leadership in this area.
  The Vaccine for Children Program produces significant changes in the 
Federal vaccine purchase and delivery system. These changes were 
intended to enhance immunization activities by establishing a new 
Federal program for the distribution of vaccines to vulnerable 
children. However, certain restrictions in the program will make it 
difficult for many Iowa children to participate in the program. These 
families will have to turn to the State public health system for their 
immunizations. Therefore, it is crucial that Federal funding for the 
State public health system remains intact and adequate. Without 
continued Federal support, the public health clinics will not be able 
to serve these children. I am committed to improving the immunization 
rates of our children and I look forward to working with my colleagues 
to reach this important goal.
  The PRESIDING OFFICER. The question is on agreeing to the amendment.
  The amendment (No. 1594) was agreed to.
  The PRESIDING OFFICER. Are there further amendments?


                           amendment no. 1595

(Purpose: To provide for the immunization of all children in the United 
              States against vaccine-preventable diseases)

  Mr. CONRAD. Mr. President, I send an amendment to the desk on behalf 
of Senator Kennedy and Senator Kassebaum and ask for its immediate 
consideration.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from North Dakota [Mr. Conrad], for Mr. 
     Kennedy, for himself, and Mrs. Kassebaum, proposes an 
     amendment numbered 1595.

  Mr. CONRAD. Mr. President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  The PRESIDING OFFICER. The question is on agreeing to the amendment.
  The amendment (No. 1595) was agreed to.
  The PRESIDING OFFICER. Without objection, the bill is deemed read a 
third time, and passed.
  So the bill (H.R. 2659) was deemed read the third time, and passed.
  Mr. CONRAD. Mr. President, I move to reconsider the vote.
  Mr. DOMENICI. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.

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