[Congressional Record Volume 140, Number 106 (Thursday, August 4, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 4, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                       VA-HUD APPROPRIATIONS ACT

  The Senate continued with the consideration of the bill.
  The ACTING PRESIDENT pro tempore. The Senator from Alaska [Mr. 
Murkowski] is now recognized to offer an amendment, with a time 
limitation thereon of 90 minutes, to be equally divided and controlled.
  Senator Murkowski.


                           Amendment No. 2450

  Mr. MURKOWSKI. Mr. President, I send an amendment to the desk and ask 
for its immediate consideration.
  The ACTING PRESIDENT pro tempore. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Alaska [Mr. Murkowski] proposes an 
     amendment numbered 2450.

  The amendment is as follows:

       On page 13, line 4, after the colon, insert the following: 
     ``Provided further, That no funds provided under this head 
     may be used for the construction of acute care, inpatient 
     hospital capacity:''.

  Mr. MURKOWSKI. Mr. President, my amendment is a very simple one. It 
would prohibit fiscal year 1995 funding to construct three VA inpatient 
hospitals. The amendment would make $87 million allocated by the 
committee to low priority inpatient projects available instead for 
outpatient care and long-term care patients of a nursing home or 
domiciliary type.
  I offer the amendment for a simple reason, that is the need for 
veterans' outpatient care facilities exceeds dramatically the need for 
inpatient care facilities. So what we have here is a question of what 
are the veterans' most important needs?
  The Department of Veterans Affairs agrees with the assessment that, 
indeed, the emphasis and priority should be on outpatient care. The 
Department's system for setting construction priorities assigns the 
lowest weight to inpatient projects or hospitals and the highest weight 
to outpatient projects.
  It has been observed by some that it takes 1 to 2 miles to stop a 
freight train, 3 to 5 miles to stop a moving tanker at sea, but it is 
almost impossible to stop VA hospital construction once it is proposed. 
A VA hospital involves Members in individual States--in this case 
California, Tennessee, Hawaii--and obviously they can say they brought 
back a VA hospital to their State. That is a worthwhile and justifiable 
goal. But the question we must ask ourselves is, Is it needed? Is it 
the highest priority for the veterans?
  As we address our obligation to America's veterans, we can never 
properly repay them for the sacrifice they made. Our job is to take the 
funding available and prioritize how it is used as veterans' needs 
change. And needs are changing. The Appropriations Committee agrees 
that it is unwise to proceed with more inpatient hospitals. I quote 
from their report as follows:

       The committee does not believe that it is prudent to begin 
     design and construction of new medical center hospitals at 
     this time, pending enactment of health insurance reform 
     legislation. VA's future is unclear. Demographic information 
     statistics are likely to change under a reformed health 
     insurance system.

  The committee report uses those words to discuss a proposed new 
hospital in Florida, a hospital requested by the administration but not 
funded by this bill in reality. I believe those words also apply to the 
hospital projects which are funded by this bill in Hawaii, Tennessee, 
and California.
  My amendment says wait. Wait and see how the VA is going to fit into 
the national health care system. We might have some idea in a 
relatively short period of time. No one knows what will be in the 
health care bill approved by Congress this year. Thus, no one knows the 
health care environment within which the VA will soon be competing for 
patients. I want to stress that because reform is a departure, an 
expansion, if you will, of the thought process associated with the VA: 
That you have veterans out here and you have a VA system here and the 
two are locked in together.
  After we adopt national health care, that is not necessarily going to 
be the case. Veterans are very likely going to have the alternative of 
selecting other medical care facilities, hospitals in their community. 
So the VA is going to have to compete and it is going to be very 
difficult for the VA to compete initially because they are not geared 
up to compete. They are a cost-plus Government facility and have been 
since they were initiated.
  So, with the VA having to compete with the private sector, very 
likely, one wonders the justification of building new hospitals at this 
time. Again, as I intend to reflect further, I am going to stress the 
need--are new hospitals indeed a priority? What is the greatest need? 
Is it hospitals? And the answer is clearly no, it is outpatient 
facilities.
  I believe there is universal agreement that the VA must expand its 
ability to provide outpatient care if it is going to meet its 
responsibility to American veterans. That change to an outpatient focus 
must come in either the current health care system, as I said, or under 
a reform system.
  My amendment would make the policy decision to focus VA construction 
on outpatient care rather than inpatient brick and mortar. As we look 
at the VA entering the potential field of competing under a national 
health care plan, let us look at what American medicine has done. They 
have made a transition to outpatient care and the VA also must make 
that transition.
  I know many Members of this body are fearful of offending the 
veterans organizations or the veterans themselves because there is 
always the implication that somehow we are reducing the VA health care 
system when we question any expenditure or any projects. Yet, what we 
have to do is attempt to meet the changing needs of our veterans and 
those changing needs are not the tremendous acute care system we have 
built up to respond to the need for reconstruction of veterans after 
injuries from war. We now need outpatient care in their communities. We 
need domiciliary and nursing home care as they age.
  It is interesting to note, the average age of the Second World War 
veteran: 72 years old; Korean veteran, 62 years old; Vietnam veteran, 
48 years old. These veterans need domiciliary care, they need 
outpatient care, and they do not need new hospitals.
  My amendment does not specify which outpatient projects would be 
funded. I simply seek a change in policy. I leave it to the VA and the 
appropriators to implement. As I said, as a practical matter this 
amendment as it stands now will affect three projects.
  Let us look at these three projects.
  There is a new hospital in Honolulu. I am very sensitive to that 
because the proposal is to name the hospital after the late Sparky 
Matsunaga, a former Member of this body who was a good friend of mine.
  But nevertheless, there is a legitimate question as to whether or not 
this is a needed hospital. And there is a new hospital at Travis Air 
Force Base in California and a replacement bed tower in Memphis, TN. I 
would like to talk about these projects one at a time.
  First of all, we have three proposed hospitals: Honolulu, Travis, and 
Memphis. Starting with Honolulu, we find we have vacancy rates, roughly 
43 percent at Tripler Army Hospital, where veterans are now treated, 
and in the private sector in Honolulu, on the Hawaiian Islands, a 33-
percent vacancy rate.
  The $171 million Honolulu project would add a new wing to the 
existing Tripler Army Hospital.
  Let us look at the treatment that Hawaiian veterans are receiving at 
Tripler under a sharing agreement with the Army.
  Hawaii takes great pride in its health care system which provides, I 
might add, universal coverage to Hawaiian citizens, including Hawaiian 
veterans. The Hawaiian experiment is something we have observed as we 
have looked at our national health care system.
  The VA project draft environmental impact statement confirms that the 
Honolulu area has 2,643 acute care hospital beds to meet an existing 
demand for 1,779. That leaves 864 beds currently available for 
inpatient care. Do we need more? Clearly, we do not.
  By the year 2010, demand for beds is projected to increase only to 
1,954, still almost 600 beds less than existing capacity.
  If this VA project is built in Hawaii, the Federal Government will be 
adding 105 acute care hospital beds in a community that is projected to 
use only 73 percent of the beds it already has. It would build new VA 
hospital beds in a State where veterans already have universal access 
to care. They can go anywhere and they probably will.
  The cost if this project is built will be paid not just from 
taxpayers' dollars. The real cost of the project will be paid by 
veterans nationwide who will very possibly be turned away by the VA 
because outpatient clinics remain unbuilt. These clinics will remain 
dreams if unneeded inpatient hospitals and other buildings consume VA's 
limited construction funding. I might add, in this bill, there are only 
two outpatient clinics newly requested by VA.
  Let us turn to Memphis. It is rather interesting. The VA justifies a 
second project, a $94 million bed tower in Memphis on the basis of 
perceived risk of earthquake exposure. Let us take a look at this 
relative to the vacancy rate. In Memphis, the vacancy rate is 43 
percent. In the community, the private sector, they have a vacancy rate 
of 30 percent.
  If we go over to Travis, which I will touch on later, we have in the 
area of San Francisco, Palo Alto, and Livermore basically three VA 
hospitals. We are proposing to build a fourth one. Look at the vacancy 
rates: 23 in San Francisco, 22 in Palo Alto, and 30 in Livermore, and 
30 percent in the private sector. We could probably accommodate the 
veterans' needs with two hospitals based on the current vacancy rate. 
So you have to look at the reality associated with need, not just the 
mandate to respond to the question of bringing a hospital home.
  Let us look at Memphis. This is rather interesting because the VA 
hospital in Memphis is perceived to have an earthquake risk. But we 
note that the VA's hospital in Martinez, CA, was identified as an 
earthquake risk and the VA closed that hospital, as they appropriately 
should have. The VA did not choose to close the hospital in Memphis.
  If this hospital really places the lives of veterans and staff at 
risk, I think the VA ought to close it now. The fact that it is still 
open speaks, I think, eloquently to the VA's assessment of the actual 
danger in an area where the last major earthquake was in 1812. We 
probably have in Alaska 10 earthquakes a day.
  I note when my staff asked if the VA had considered contracting for 
the use of existing vacant beds in private Memphis hospitals, they were 
told that those beds were unsuitable because they did not meet VA 
seismic standards, yet those private hospitals remain open with no 
plans for replacement.
  I also note that the independent budget prepared by the veterans' 
service organizations asked the VA to change its standards for seismic 
safety because these standards are more stringent than private sector 
standards. These standards compel the VA to spend limited resources to 
conform to a standard that the rest of the Nation's health care system 
does not even attempt to meet. I also note that the occupancy rate of 
the VA medical center in Memphis is only 57 percent and that the 
community, private sector hospitals have a vacancy rate of 30 percent.
  So, Mr. President, if this project is funded, the VA, again, will 
build excess hospital beds in a community that already has more beds 
than it uses.
  Again, this hurts the private sector, and under the national health 
care plan, the veterans are going to have the option to go wherever 
they wish anyway. So I suggest that it may reduce the requirement for 
VA hospital inpatient care.
  So, again, I note that this is an unneeded project, imposing a double 
cost to our Nation. Taxpayer dollars would be spent on unneeded 
hospital beds and, again, veterans will be turned away by the VA 
because the expenditure of limited dollars on unneeded hospital 
projects. Inpatient facilities will prevent the use of those dollars to 
build urgently needed outpatient projects.
  Let us go to Travis Air Force Base, CA, which is the third project, 
which will be a $163 million wing to an existing Air Force hospital. 
This project would replace the hospital in Martinez that was closed due 
to the earthquake danger.
  The proposal sounds fine up to that point. The hospital was closed 
several years ago, but it is interesting to note what happened to the 
veterans who were using that hospital. The veterans who had been 
treated in the closed hospital are now being treated on a contract 
basis in private hospitals, at the existing Travis Hospital, and other 
VA hospitals in the San Francisco Bay area. Some of these veterans are 
certainly put out or necessarily inconvenienced by this change.
  There are now three VA medical centers in the San Francisco Bay area: 
Palo Alto, San Francisco, and Livermore, probably within 60 miles of 
one another. These hospitals are treating the veterans who used to be 
treated at the now closed Martinez hospital. They are not overcrowded. 
The occupancy rates ranged from 70 to 78 percent in 1993.
  If the VA were designing a system of care from scratch, I do not 
think they would put four hospitals in an area knowing that the VA's 
greatest unmet need is outpatient clinics rather than hospitals. I 
acknowledge for veterans in central and northern California, a new 
hospital at Travis would be more convenient, but, again, our resources 
are limited. And I will say again, we have entered an era when our 
Nation has too many hospitals. The private hospital occupancy rate in 
the Travis area is only 70 percent. Hospitals are consistently closing 
in the private sector, and we should not be building new ones at 
taxpayers' expense.
  We all know we can never build enough hospital beds convenient to all 
our veterans, but if we continue to build hospitals instead of 
outpatient clinics, we will never make a medical care system, as 
opposed to a hospital system, accessible to America's veterans, and the 
VA health care system will die on the vine if it is left in the 
position of competing with the private sector without the convenience 
of the outpatient centers.
  I know that I will hear the argument that it is already too late for 
this amendment. I will hear the argument that ground has been broken at 
Travis and money has been spent on engineering work in Memphis, but 
construction at Travis is for auxiliary buildings and has just begun. 
If we do not stop now, Travis will be back next year for $156 million 
in addition to the $7 million in this year's bill. Memphis is still in 
the paper stage. If we do not stop now, Memphis will be back for 
another $20 million. If we do not stop now, VA inpatient construction 
will be like a 300-pound man's plan to lose weight--a good intention 
topped off by a hot fudge sundae for dessert.
  We cannot wait for tomorrow to change the VA's course. There will 
always be the special case calling for just one more inpatient 
hospital, just like there is always a reason to put a diet off until 
tomorrow. Now is the time to change the VA's course.
  Mr. President, one might say, well, the Senator does not have a 
hospital in this bill. He does not have a bone to pick, so to speak. 
Let the record note that this Senator last year attempted to strike 18 
beds from a new Department of Defense hospital in my State of Alaska at 
Elmendorf Air Force Base. We simply did not need it. People of Alaska 
understood that. The veterans in Alaska understood that. This Senator 
understood that. So I am trying to practice what I preach when I 
suggest that these hospitals are simply not needed.
  Mr. President, now is the time to change the VA's course. This 
appropriation is the camel's nose under the tent for these projects. If 
we do not change the course now, next year we will see the entire camel 
inside the tent, and that camel will consume VA construction funding 
for years to come.
  This bill appropriates $87 million for inpatient projects, but the 
future cost of these projects is an additional $316 million at least. 
Once the camel is in the tent, these projects will consume all of the 
money available for major construction for almost 2 years unless the VA 
construction budget is substantially increased, which I doubt. I 
believe that such an increase is unlikely.
  If my amendment is rejected, we will postpone for 2 years the day 
when the VA can again begin to address the pressing need for more 
outpatient clinics. Rejection of the amendment would mean that the 
Senate will be trading away, trading away, Mr. President, outpatient 
clinics and long-term care facilities that can be constructed quickly 
and which could meet pressing current needs. Instead, veterans will get 
inpatient hospitals that will not be open until the turn of the 
century. These hospitals will provide excess hospital beds to 
communities that are already burdened with more beds than they need.
  I would again remind my colleagues of the action taken by the 
Appropriations Committee in striking the Florida hospital which was 
authorized by the Veterans Committee but Appropriations said no; they 
felt it was not needed. So these may be subject to that at some point 
in time in the future.
  Mr. President, a few weeks ago the Washington Post reported that the 
George Washington University Hospital here in Washington, DC, was 
abandoning a project to rebuild its hospital and instead would build a 
large new outpatient clinic. This change in plans reflects reality and 
responds to the changes in the practice of medicine in our country 
today. A private hospital must respond to changing conditions or go out 
of business. Congress can use appropriations to shield the VA health 
care system from the realities of modern medicine for a while but only 
for a while. In the end, even the VA must conform to standards of 
practice for modern American medicine. And that means outpatient rather 
than inpatient care.
  The more time that passes before the VA makes this change, the less 
the VA will be able to meet the health care needs of America's veterans 
as they change. That outcome will defeat the purpose of the health care 
system that Congress has created to serve America's veterans. That is 
the reason, Mr. President, I urge my colleagues to join me in support 
of this amendment.
  You have seen the charts. You have seen the examples. You know what 
the need is. You know what the occupancy rate is. So let us really put 
America's veterans first, not just the bricks and mortar of unneeded 
hospitals.
  I know some Members will come to me after the vote and say, ``Well, 
Frank, we were with you in spirit. You are probably doing the right 
thing, but we cannot be seen as voting against veterans' needs or the 
veterans' organizations.'' I know that the staffs that are working and 
listening and watching this debate are probably thinking, what kind of 
an effect would a vote to halt these additional inpatient hospitals 
have. How would it look to the veterans and their organizations and how 
would it impact the support that the individual Members of this body 
enjoy from veterans?
  Well, I think it is better that those staffs ask the question: What 
are we doing today to meet veterans' changing needs, and can we best 
meet those needs by building more hospitals or more outpatient 
facilities? The answer is clearly outpatient facilities.
  Finally, Mr. President, my amendment is grounded on two principles: 
First, VA construction should focus on critical needs for delivering VA 
care in the century to come. We must focus on ambulatory care and long-
term care, not brick and mortar and more hospitals. Second, because 
resources are scarce, veterans will suffer if money is spent on lower 
priority projects.
  Mr. President, I urge adoption of my amendment, and I look forward to 
the debate about to ensue.
  Mr. ROCKEFELLER. Mr. President, first of all, I bring greetings of 
the morning to Senator Murkowski and John Moseman and Chris Yoder. I 
listened with great interest to what they said.
  I wish to say in the beginning that I am going to oppose Senator 
Murkowski's amendment, but I cannot think of a committee chairperson 
who has a greater honor to work with somebody so good as Senator 
Murkowski and the people who work with him for veterans in our country. 
I admire the Senator greatly, and I admire his staff greatly. I would 
care to say before I oppose his amendment, which I will now do, that at 
the proper time I am going to move to table his amendment.
  As chairman, Mr. President, of the Committee on Veterans' Affairs, I 
am in fact very pleased that the committee has supported the projects 
that are the subject of Senator Murkowski's amendment. I am not neutral 
on them. I am pleased. I am very glad about it. And that the 
Appropriations Committee requested funding for the projects that 
Senator Murkowski now opposes.
  This amendment would prohibit the use of funds for VA medical 
facility projects that were carefully evaluated, and I can go into that 
well, and that were determined to be needed by the Veterans 
Administration, by the Committee on Veterans' Affairs, and by the 
Appropriations Committee. These were not haphazard decisions. They were 
carefully thought through. With one exception, the projects were 
requested in the President's budget for fiscal year 1995.
  While the hospital at Tripler Medical Center in Honolulu was not in 
this year's budget, it received design funds in 1993 and had been 
scheduled to receive construction funding in 1997.
  The projects in Honolulu and Travis, CA, will provide access to acute 
care for large numbers of veterans in the areas to be served. Without 
them, veterans in these areas will not have access to VA inpatient 
services.
  These projects also afford opportunities for joint ventures with the 
Army and the Air Force. I would say, Mr. President, that increasingly 
we have hospitals where there is cooperation between the military and 
the VA. I visited one in Albuquerque. They are superb. Cooperation 
between the services and the veterans hospitals is a very good 
combination. It is the wave of the future. Both the Department of 
Defense and the Department of Veterans Affairs have determined that the 
facilities at Travis and Honolulu are needed.

  The project at Memphis, TN, involves the correction of serious 
seismic deficiencies and will, in fact, result in a reduction of the 
number of beds at the facility. It will not create new beds, but rather 
will make the Memphis facility safe.
  I was interested in the graph about the 1811-1812 earthquake 
involving Memphis and radiating out, even covering my own State of West 
Virginia. I really need to say for the record, Mr. President, that I 
think in the East there is no site, no place, no terminus which is more 
vulnerable, more dangerous, more thought to be imminently dangerous, 
than the terminus in the Memphis, TN, area. It is talked about 
frequently, and it is the eastern danger point, not perhaps on the 
level of Alaska or other places. But in the East it is a place which 
the professionals worry about.
  I frankly agree with Senator Murkowski that the Veterans' 
Administration must adapt to changing health care practices and 
demographics. I think he is totally right. The criteria used by VA to 
select projects for construction do in fact, in my judgment, reflect 
transit health care and the transit veterans population. While we must 
look toward the future, we cannot overlook the veterans in need of 
health care today.
  It was interesting to me that the Senator from Alaska referred to the 
need for inpatient facilities. That is the mantra of our Veterans' 
Committee meetings. We have a lot of inpatient facilities. But we need 
outpatient facilities. The care they offer can be much more efficient 
and convenient. Technology in medicine has made this possible.
  I point out to my friend from Alaska that in the President's --it is 
no longer the President's; it is the Mitchell bill in the health care 
reform effort. Outpatient facilities are emphasized in the so-called 
investment fund which the Veterans' Committee voted for. The Senator 
from Alaska did not vote for that, and I have to say that I think it 
was more or less a party line vote, and therefore, can reflect some 
nuances in that sense. But outpatient is in part what the investment 
fund is trying to provide for.
  That is a lot of money, over $3 billion, that we are asking for in 
health care reform so we can in fact make the veterans hospitals more 
competitive with nonveterans hospitals.
  We need to be able to offer better services particularly for women 
veterans. There are a lot of women soldiers. While there are relatively 
fewer women veterans, that number is growing. We need to be good at 
competing with non-VA hospitals in general and in women services, 
preventive care, and things of that sort.
  So I think that we are trying to reflect future needs and our needs 
for today. All indications are that these projects are needed today and 
that they will contribute to VA's ability to compete in a reformed 
health care environment tomorrow.
  The Appropriations Committee considered the issues now raised by 
Senator Murkowski during the appropriations process and, on that basis, 
chose not to fund an inpatient facility in Brevard County, FL.
  The Appropriations Committee concluded, however, that the projects 
that are the subject of this amendment are needed. I listened to 
Senator Murkowski's remarks carefully, and he has not shown that the 
proposed projects are unnecessary. He does not want them, but he has 
not shown that they are unnecessary. Nor has he offered alternatives to 
the care that the veterans in those areas do, in fact, need.
  The level of funding provided for construction of VA medical 
facilities is already minimal. It is a fight for every dollar every 
year. Budget authority for major projects has declined from $369 
million in fiscal year 1994 to $208 million--a $160 million decrease--
in fiscal year 1995.
  The projects to be funded will not create excess capacity or 
facilities that are inconsistent with VA's mission under health care 
reform.
  I strongly urge my colleagues to reject the proposed amendment and 
will have more to say at the proper time.
  Mrs. FEINSTEIN addressed the Chair.
  The PRESIDING OFFICER. Who yields time?
  Mr. ROCKEFELLER. Mr. President, I yield the distinguished Senator 
from California 10 minutes, or more if she needs it.
  The PRESIDING OFFICER. The Senator from California [Mrs. Feinstein], 
is recognized.
  Mrs. FEINSTEIN. I thank the Senator. I thank you, Mr. President.
  I rise today in strong opposition to the amendment offered by the 
Senator from Alaska.
  On the eve of our effort to put together a health care package, to 
make health care accessible to everyone, this amendment would simply 
make acute medical care less accessible to our Nation's veterans. For 
the men and women who have served this Nation in times of war, and have 
stood ready in times of peace, this amendment would simply leave them 
out in the cold. Mr. President, that is wrong.
  Let me discuss the facility in California, the funds for which would 
be eliminated as a result of this amendment. Included in the bill 
before us is $7.3 million for initial work on a replacement facility 
which would be located at the David Grant Medical Center at Travis Air 
Force Base in Fairfield, CA.
  Mr. President, north of the San Francisco Bay area, and the Livermore 
facility, this would be the only veterans hospital in the entire 
northern California catchment area of over 420,000 veterans and a 
geographical area that is bigger than most States.
  The military has, for years, had a strong presence in northern 
California, with Mare Island Naval Shipyard, McClellan Air Force Base, 
Beale Air Force Base, the Alameda Naval Air Station Complex, Oak Knoll 
Naval Hospital, the Presidio of San Francisco, Castle Air Force Base 
and others. These bases have been welcome neighbors to the communities 
of the bay area, and have been a true asset to the State of California 
and I fought hard for them to remain open, but many of them are being 
closed.
  As result of the military presence, though, northern California will 
remain home to more than 420,000 veterans.
  I would like to submit a list, or table 1A1, of the Martinez medical-
surgical population by county for the Record, if I may.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

         TABLE 1.A.1.--MARTINEZ MEDICAL/SURGICAL DPPB BY COUNTY         
                   [1990 revised population estimates]                  
------------------------------------------------------------------------
                           1990 Veteran     Percent of                  
         County             population       county in     Martinez 1990
                             estimate      Martinez DPPB   estimate DPPB
------------------------------------------------------------------------
Alameda.................         127,881           43.07          55,083
Alpine..................             169            8.70              15
Amador..................           5,158           60.19           3,104
Butte...................          23,773           58.69          13,951
Calaveras...............           5,778           43.75           2,528
Colusa..................           1,575           75.00           1,181
Contra Costa............          92,978           87.88          81,708
El Dorado...............          19,005           45.92           8,726
Glenn...................           2,654           70.00           1,858
Humboldt................          15,056            8.92           1,342
Lake....................           8,615           48.68           4,194
Lassen..................           4,015            6.17             248
Mendocino...............          10,532           11.86           1,249
Merced..................          15,659            5.31             832
Modoc...................           1,477            7.58             112
Napa....................          15,550           38.30           5,956
Nevada..................          12,392           24.32           3,014
Placer..................          22,981           50.14          11,522
Plumas..................           3,321            7.19             239
Sacramento..............         132,955           83.54         111,073
San Joaquin.............          48,947           30.14          14,755
Shasta..................          20,605           64.47          13,284
Siskiyou................           6,689           10.53             704
Solano..................          46,243           85.90          39,724
Sonoma..................          46,638            9.73           4,536
Stanislaus..............          35,556           20.26           7,202
Sutter..................           7,922           64.75           5,130
Tehama..................           6,928           66.67           4,619
Trinity.................           2,277           58.49           1,332
Tuolumne................           7,697           23.38           1,799
Yolo....................          13,580           76.80          10,429
Yuba....................           7,571           65.54           4,962
                         -----------------------------------------------
    Total...............         772,177           53.93         416,411
------------------------------------------------------------------------
Source: Population from revised 1990 census. Percent of veteran         
  population provided by Planning Systems Support Group, Gainesville,   
  FL.                                                                   


  Mrs. FEINSTEIN. Mr. President, this documents a large number of 
counties in which veterans are a substantial part of the population.
  Unfortunately, the Martinez VA Medical Center in Martinez which 
served much of this population, was closed in March 1991 due to seismic 
deficiencies. Because of the closure, the region's veterans were left 
without acute medical care. Medical services for area veterans 
previously offered by the Martinez VA Medical Center could not be 
adequately met by redirecting patients to other area hospitals. Waiting 
periods and appointments were too long and found to be unacceptable for 
effective health care, and the travel to San Francisco--the closest VA 
medical center--was too difficult and too long for many of the 
patients.
  In November 1992, after much deliberation, the VA announced plans to 
build a new 243-bed hospital adjacent to the David Grant Medical Center 
at Travis AFB to replace the sorely missed Martinez facility. This 
facility is a very unique joint venture between the Air Force and the 
VA.
  It is the goal of both departments to combine and colocate staffs and 
resources to provide cost-effective, quality care. Today, the Senator 
from Alaska is making the argument that this facility is unnecessary. I 
want to explain why it is necessary.
  The area that was served by the Martinez facility, and will be served 
by the Travis facility, and it is one of the largest--as I have pointed 
out, in terms of geography and population--in the entire Nation. Over a 
quarter of the population in this service area live in Sacramento 
County, which is over a 2-hour drive from the nearest VA acute-care 
facility.
  I do not know how many of my colleagues have ever visited northern 
California, but there is a lot of area north of San Francisco, and it 
requires a lot of driving time from one place to another. And having no 
hospital to serve this region, those distances are only increased.
  According to the VA, northern California is one of the most 
underserved areas in the entire VA system. It is the only ``catchment'' 
area in the country in which emergency services are not available 24 
hours per day, and on weekends and holidays.
  To compound this situation, there have been recent base closures of 
Oak Knoll Naval Hospital in Oakland, the Letterman Army Hospital at the 
Presidio, and the Letterman Army Institute of Research. So all of the 
facilities in the San Francisco Bay area, essentially, are slated for 
closure.
  Since Martinez closed, the VA has gone to great lengths to provide 
for the health care of the region's veterans, but hospital beds have 
been lacking, and the need for the new facility is long overdue.
  Mr. President, I, my colleagues in the House, Congressmen Hamburg and 
Fazio, as well as Senator Boxer, have appealed to the VA and argued 
that the region's veterans deserved better. Secretary Jesse Brown and 
the Veterans' Administration heard these appeals and included $7 
million in this year's budget.
  Construction efforts, up until late last year, had been at a 
standstill. But I was pleased to join Vice President Gore and my House 
colleagues in June at a groundbreaking ceremony for this hospital. The 
Travis hospital should be open by the end of 1998. But more important 
than the ceremony, and the work that will soon begin, was the 
opportunity I had to meet with some of the area's veterans that will 
benefit from this facility.
  The funds in this bill are a big step in returning quality acute 
medical care to the veterans of northern California, care that many of 
them need and, to a great extent, care that we are obligated to 
provide.
  Anyone that thinks that the Travis facility or any of the other 
hospitals are Government largess only need to speak and talk to some of 
these veterans to know the need for these hospitals.
  We should be sending a clear message to our Nation's veterans that 
they will not be forgotten, having served so bravely for our country. 
But this amendment sends just the opposite message.
  I urge my colleagues to oppose this amendment and support the motion 
to table.
  I thank the Chair and yield the floor.
  Mr. ROCKEFELLER. Mr. President, I yield 10 minutes to the Senator 
from Hawaii.
  The PRESIDING OFFICER (Mr. Mathews). The Senator from Hawaii [Mr. 
Akaka] is recognized.
  Mr. AKAKA. Mr. President, I rise to oppose the amendment offered by 
the junior Senator from Alaska, which would strike funding in this bill 
for all new inpatient construction projects, including the long-planned 
Spark M. Matsunaga VA Medical Center in Hawaii.
  Mr. President, the $33 million provided in this bill for the Hawaii 
hospital would simply allow VA to continue work on this long-awaited 
facility. Congress has already appropriated $37 million in design, 
planning, and construction funds for the facility in previous 
appropriations bills. The funding in this measure would keep the 
hospital on track to meet the anticipated 1998 completion deadline, and 
help avoid further delays in this long-overdue project.
  Mr. President, the issue here can be stated simply: Unlike virtually 
every other State, Hawaii does not have a veterans hospital. Although 
VA operates 171 medical centers throughout the Union, including a 
hospital in Puerto Rico, the Department has never established a medical 
center in the Aloha State. Consequently, Hawaii's 120,000 veterans, and 
thousands more veterans who live throughout the Pacific basin, lack 
fundamental access to an integrated health care system that is devoted 
solely to their special needs.
  Hawaii veterans, like so much unwanted baggage, are shuffled among 
several, often incompatible health care providers. This highly 
fragmented health care system--consisting of private contract 
providers, a VA outpatient clinic, and Tripler Army Medical Center--is 
not conducive to the provision of top-quality health care. To make 
matters worse, at Tripler, which currently provides most inpatient care 
to veterans, veterans are assigned the lowest priority of care--behind 
active duty personnel, their dependents, and military retirees. In 
addition, as a military facility that is designed for a younger, active 
duty population, Tripler does not offer the type or range of services, 
such as geriatric care, required by an older, sicker veterans 
population.
  VA itself has long recognized the inadequacy of the current 
arrangement in Hawaii. Twenty years ago, VA promised to establish 
inpatient beds in the E-wing of Tripler that would be devoted solely to 
the needs of veterans. An agreement was signed between VA and the 
Department of Defense in 1981 to this effect. However, because the 
military delayed making the E-wing space available to VA, this 
initiative was eventually abandoned.
  In 1987, this broken promise, plus reports of unsatisfactory, even 
abusive, treatment of veterans at the military hospital, impelled my 
predecessor, Spark Matsunaga, to convene the first of several 
congressional hearings in Hawaii. That hearing revealed major 
deficiencies in services provided veterans at Tripler, and led to the 
formation of a blue-ribbon VA task force to assess the adequacy of 
Hawaii veterans health care. The task force confirmed the hearing 
results, and strongly recommended that a 165-bed, freestanding VA 
medical center be established in Hawaii to address these shortcomings. 
This recommendation was initially supported by VA's chief medical 
director, the Department's top health care expert, and eventually 
endorsed by Administrator Turnage, Secretary Derwinski, and, most 
recently, Secretary Brown.

  The results of the 1987 hearing, as well as the findings of the VA 
task force, have been confirmed by subsequent congressional hearings 
and departmental reviews. The one inescapable fact that arises from 
these investigations is that Hawaii veterans do not have equitable 
access to VA services. This is why VA has supported establishing the 
Matsunaga VA Medical Center, and why Congress has, through periodic 
appropriations, and by the simple expedient of naming the facility 
after my predecessor, encouraged development of this project.
  Ever since it was first proposed in 1987, the Hawaii project has been 
threatened and delayed by frequent internal reassessments, and by at 
least six major design and scoping changes. These changes have 
incrementally delayed the operational date of the hospital by least 5 
years, from 1993 to 1998. Consequently, even if VA manages to adhere to 
the latest construction schedule, Hawaii veterans will have waited 12 
years since this particular project was first authorized. Incredibly, 
if one counts the original Tripler E-wing initiative that was proposed 
in the 1970's, veterans will have waited a quarter of a century for the 
Government to fulfill its pledge to bring a veterans inpatient facility 
to Hawaii.
  Thus, Mr. President, to cancel the project now, as this amendment 
would do, after all Hawaii veterans have been forced to endure, after 
all the studies and reviews and hearings that have been conducted on 
this subject, after all the promises that have been made and broken, 
would be unspeakably cruel, pointless, and wasteful.
  Mr. President, the Senator from Alaska has referred to the need to 
move toward outpatient modalities and away from inpatient care. In his 
``Dear Colleague,'' he states:

       Health care reform would make VA's transition to ambulatory 
     care even more important because a VA still imprisoned by its 
     hospital buildings will be unable to compete successfully for 
     patients.

  Mr. President, I have no quarrel with this statement. I agree with my 
friend from Alaska that ambulatory care is the wave of the future. 
However, all of the viable health care reform plans before us call for 
significant additional resources to establish outpatient clinics. The 
Clinton health plan, for example, as well as the blueprint offered by 
the majority leader, proposes a special $3.5 billion investment fund, 
above and beyond funding for current construction projects, to help VA 
to adapt to a competitive environment. Everything that I have read 
indicates that by far the largest component of this investment fund 
will be earmarked for new outpatient facilities. Therefore, it seems we 
already have plans to deal with the ambulatory care issue; there is no 
need to divert funds from the fiscal year 1995 major medical 
construction account for this purpose.

  Moreover, with specific regard to Hawaii, it should be kept in mind 
that outpatient clinics traditionally function as satellites of medical 
centers. That is, the services they offer are designed to complement 
and supplement the inpatient services offered through medical centers. 
In Hawaii, there is no shortage of VA outpatient care; what is lacking 
is the full range of hospital-based services that support outpatient 
clinics. Thus, ironically, the Senator from Alaska's call for more 
ambulatory services actually supports the need to establish a VA 
medical center in Hawaii.
  My colleague from Alaska has also referred to a 1992 GAO study that 
recommended against building additional VA inpatient beds in Hawaii. 
The GAO report supported this conclusion with two assumptions. The 
first was that new VA inpatient beds were not necessary because 
Hawaii's near-universal health care coverage would reduce demand for VA 
services.
  Mr. President, this is a false assumption, because Hawaii's health 
insurance system would not improve access to care for veterans who 
typically use VA programs and facilities. These include veterans who 
need rehabilitation, long-term care, and many forms of specialized care 
that VA routinely provides, such as care for the elderly and those who 
require mental health care or spinal cord injury treatment. I should 
also point out that while Hawaii veterans are eligible for state health 
care benefits like any other resident of the State, the State will not 
reimburse VA any costs associated with VA expenditures on behalf of a 
veteran. If the State were to undertake additional, unplanned 
responsibility for veterans care, the viability of the entire State 
insurance system could be undermined. In any case, it would be patently 
unfair to ask Hawaii residents to foot the bill for health care 
services that are the statutory responsibility of the Federal 
Government, and for which they already help fund through Federal taxes.
  Mr. President, the GAO report's second assumption was that so-called 
underused inpatient bed capacity at Tripler Army Medical Center could 
be used to treat veterans. My question is, who would operate these 
beds, VA or Tripler? If Tripler, then implementing the GAO's 
recommendations would effectively result in supporting the status quo, 
under which veterans are forced to seek treatment through a highly 
fragmented care offered through multiple, autonomous providers. Aside 
from ignoring years of exhaustive congressional and VA investigations, 
this option dismisses the testimony of veterans themselves about the 
inadequacy and low priority of care they receive at Tripler. On the 
other hand, if VA itself is expected to operate and staff these excess 
beds itself, we would face the impossible problem of administering a 
hundred beds located in many different parts of the military hospital 
complex. Establishing an identifiable VA presence would be very 
difficult under such circumstances.

  Mr. President, let me conclude this point by saying that the House 
and Senate Veterans' Affairs Committees received strong and convincing 
testimony opposing the GAO's conclusions, from both the Department of 
Veterans Affairs and veterans service organizations.
  On another issue, the Senator from Alaska has alluded to the fact 
that funding for the hospital was not requested in the administration's 
fiscal year 1995 budget. This is strictly true; however, VA requested 
funds for the Hawaii hospital, and included the facility in its 5-year 
plan, but was overridden by OMB in the final budget submission. This 
does not vitiate the fact that the agency charged by statute to promote 
the welfare of veterans supports the hospital. We have been told on 
many occasions by Secretary Brown and his predecessors that the 
hospital is an important and medically necessary project.
  In any event, Congress has its own obligation to decide how best to 
spend scarce resources with respect to veterans, as well as to correct 
past inequities. By naming the hospital after Senator Matsunaga, and by 
previously appropriating funding for the medical center, Congress has 
already gone on record as supporting the need for a veterans hospital 
in the 50th State.
  So, in conclusion, Mr. President, I urge my colleagues to oppose this 
amendment. At least with respect to the Hawaii project, this amendment 
is terribly misguided. The need for the hospital has been well 
documented by VA and Congress. The project has been endorsed on a 
bipartisan basis by Secretary Brown and his predecessors. Congress has 
previously appropriated funding for the hospital, and, 4 years ago, 
unanimously voted to name the unbuilt hospital after our late 
colleague, Senator Matsunaga. Let us not insult his memory, or the good 
judgment and compassion of this body, by denying health care equity for 
Hawaii veterans, as this amendment would do.
  Thank you, Mr. President. I would like to express my appreciation to 
Senator Mikulski, the manager of this bill; Senator Rockefeller, the 
chairman of the Veterans' Affairs Committee; and, my senior colleague, 
Senator Inouye, for their unyielding support and leadership on this 
issue.
  I yield my time.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. ROCKEFELLER Mr. President, I might inquire from my colleague. I 
have two relatively short sets of comments that I wish to make, and 
that would be pretty much it for me.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. MURKOWSKI. I wonder if the Chair would advise us of the remaining 
time on each side.
  The PRESIDING OFFICER. The Senator from Alaska retains 18 minutes 50 
seconds; the Senator from West Virginia has 17 minutes and 55 seconds.
  Mr. MURKOWSKI. Mr. President, let me respond to my good friend from 
West Virginia. I anticipate at least one other Senator speaking on 
behalf of my amendment, and I would imagine we will probably use close 
to 12 minutes or so of our remaining 18 minutes. But I would reserve 
the remainder of my time to accommodate our side.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. ROCKEFELLER. Mr. President, let me talk a little bit about 
Barbara Mikulski, the Senator from Maryland.
  I need to say, first of all, that I was enormously pleased with the 
fiscal year 1995 appropriations for the Department of Veterans Affairs.
  Yesterday, we were talking on another subject that had to do with 
ethanol and methanol, and I made reference to the fact that the Senator 
from Maryland has a very, very complex sort of interstitching of 
agencies' requirements that she has to balance and try to do the best 
by the people of the United States and the people that she represents 
in Maryland so well.
  In fact, over the years, the chair of the VA-HUD subcommittee, who is 
Senator Mikulski from Maryland, has shown absolutely unfailing support 
for veterans, and I cannot help but be grateful for that.
  This year is no exception. Her strong commitment to veterans is 
clearly exhibited in print in the appropriations bill which comes from 
her sense of priorities of where money ought to go.
  She deserves tremendous credit for what went into this bill. It has 
been a particularly difficult year fiscally for her. The Senator's 
subcommittee allocation was, in fact, $316 million below that of her 
House counterpart. So she had less to work with than her House 
counterpart. It was $729 million below the President's request. So she 
was already scrambling as she began this process.
  That she paid such close attention to the priorities in the Veterans' 
Affairs Committee was very, very important and, in particular, I want 
to acknowledge the increased funding in the bill for VA medical 
research. Senator Mikulski clearly recognized the importance of 
veterans medical research.
  With respect to VA medical care, I note that her bill provides 
increased funding for medical care for women veterans, which is a 
subject she is very strong on; expanding programs for homeless 
veterans, something she cares about, as we all do in the committee. 
Defer the waiting time for the blind. That would not spring out to the 
casual observer, but it did for her, and it causes untold good for 
veterans needing that kind of service. Establishing up to five centers 
of excellence in the area of mental illness at existing VA facilities. 
And something very small, but very big, putting up more money to 
install phones at the bedsides of our veterans.
  It is really quite amazing when you go to a veterans hospital. If you 
go to any nonveterans hospital, beside every bed is a telephone. If you 
go to a veterans hospital, beside every bed there is no telephone. You 
think of veterans in a long-term care capacity in the hospitals. Their 
years are declining. They feel cut off from their families. They cannot 
communicate. They are isolated. So their self-esteem and morale goes 
down. When you put in a telephone, you cannot correct that entirely, 
but you can do magic, and I have seen it. I have seen it myself, 
because of the money that the Senator from Maryland has made available.
  So, in fact, our program and our goal is to put a telephone by every 
single bed in every single VA facility in the United States of America.
  If I wanted to, and I will not do this because I do not have the time 
to do this, but there was a memo that my chief of staff, Jim Gottlieb--
who I can spend many hours praising, too, as well as Valerie Kessner--
Jim Gottlieb and his staff wrote me a memo, and in fact it is very 
interesting because it is a memo to me. It is not to be shared with my 
colleagues.
  But it was written really sort of in awe at what Senator Mikulski was 
able to do. It just goes one item after another saying, ``In your 
letter to her, you requested this, and this is what she did.'' Time 
after time after time after time, she came through. There is no way 
that veterans can understand what a champion they have in the Senator 
from Maryland.
  So I applaud Senator Mikulski. I applaud her committee for their 
extraordinarily good work under very difficult financial circumstances. 
I look forward to working with Senator Mikulski on veterans issues in 
the future. Veterans just need to know, whether they reside in Maryland 
or wherever they may reside in this country or across the world, that 
they really have a champion in Barbara Mikulski.
  Ms. MIKULSKI. Will the Senator yield?
  Mr. ROCKEFELLER. Yes.
  Ms. MIKULSKI. I know it is not for a question, but I would like to 
thank the Senator for his enormously kind and generous words and to his 
staff that has worked so cooperatively. And real kudos to the 
authorizing committee, both to you and to Senator Murkowski.
  Because what we tried to do was follow the authorizing committee and 
then, in anticipation of what you and Senator Murkowski pass, then for 
us to fund it. But because the policies were rational and 
compassionate, because the funding limits again were not a wish list 
but an achievable and affordable list, we were able to make these 
significant gains, and we looked forward to it.
  I feel the debate today, again, was in the spirit of the way the 
committee operates. These are very serious policy decisions that will 
be debated both this year and next year.
  I thank the Senator for his kind words and the effective leadership 
and stewardship that he provides, as well as the ranking Republican 
member on the bill.
  Mr. ROCKEFELLER. I thank the Senator very much in many, many ways.
  Does the Senator wish to speak?
  I yield the floor.
  Mr. MURKOWSKI addressed the Chair.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. MURKOWSKI. Mr. President, I certainly want to commend my 
colleagues, the Senator from West Virginia and his staff, and the 
comments made by the Senator from Maryland, who I have the most 
affection for and who has been so kind and accommodating to the Senator 
from Alaska.
  I would like to again point out to my colleagues that what we are 
attempting to do here is to change the priority from building three 
hospitals that are not needed to what is needed; and that is outpatient 
facilities. This Senator is trying to focus in with the appropriate 
committees to direct the construction of what is needed by America's 
veterans. So I hope we understand each other. I hope we recognize that, 
as I attempt to point out the realities, Mr. President, that are 
reflected in these charts that address average utilization.
  In San Francisco, in the VA hospital, 23 percent underutilized; Palo 
Alto, 22 percent. These are vacancies. These are the vacancy rates--30 
percent, Livermore; and in the private sector around Sacramento and in 
the general area, 30 percent. Those are facts.
  Now one could quickly see we could close two hospitals and 
accommodate the veterans, not perhaps as well, but we certainly would 
have the beds. Now I am not suggesting we do this.
  The same thing is true in Hawaii, 43 percent vacancy rate; the 
community has a 33 percent vacancy rate.
  And in Memphis, TN, we have not heard from anyone from Tennessee. But 
these are factual realities--43 percent vacancies, 30 percent in the 
community.
  Now there is not a city in this Nation, Mr. President, that does not 
need more outpatient clinics. Why are we not giving them to them? 
Because we are hellbent on bringing back hospitals for inpatient care 
that is not the priority of the veterans.
  How many outpatient clinics could we get for the $400 million total 
cost of these three hospitals? How many could we get?
  Well, Mr. President, when we closed the Martinez, CA, hospital, they 
put up a new outpatient clinic, put it out in about 18 months. Do you 
know what the cost was? Twelve million dollars.
  For the money for these hospitals in this bill we could pay for 34 
clinics like Martinez--clinics that would be available in a few years, 
not at the turn of the century. That is what the Senator from Alaska is 
appealing for our colleagues to consider as they reflect on this 
upcoming vote.
  My good friend from West Virginia mentioned the earthquake exposure 
associated with the proposed hospital in Memphis. I point out to you a 
rather curious thing, and that is in this area where the intensity of 
the last New Madrid earthquake was. Seven or greater, there are 
approximately six other VA hospitals. They are not proposing that they 
should close those hospitals because of the earthquake exposure; they 
use earthquake risk just to justify the new hospital in Memphis itself.
  Now in the intensity level 6 area of that quake, which obviously has 
less intensity associated the further out you go VA has eight more 
hospitals.
  But the point is, the VA and others are looking to justify a new 
hospital, so they are saying it is of great exposure for a earthquake. 
I will not dispute that in general terms. But the reality is there are 
other hospitals in the same area that are exposed to the same intensity 
and we are not rebuilding those, and some of them are of similar 
construction.
  So it is not appropriate to argue that they were built necessarily 
with all the latest earthquake engineering that would ordinarily go 
into them. So we have an inconsistency.
  Mr. President, as we look at Travis, the necessity of a fourth VA 
medical center in the San Francisco Bay Area, I recognize it would be 
convenient to have another hospital in the area. But it is more 
convenient to have outpatient clinics.
  Now, the good Senator from California spoke about reduction in the 
military facilities in California. Everybody knows that. Bases are 
closing.
  Do you know what is also closing with those bases? Department of 
Defense hospitals. Every major base in California has a hospital. What 
is going to happen to those hospitals?
  Well, I assume they will be declared surplus. The better ones, 
perhaps, will be turned over to the communities. So we are going to 
have more beds.
  So, on one hand, in California we are about to build a new hospital, 
while we have the Department of Defense closing bases, we have excess 
hospitals, we have excess hospital capacity. It simply does not make 
sense.
  The private sector would look at it and make very simple decision: 
Let us wait and see what comes up in the Department of Defense 
disposal, how many of those medical facilities can we use as opposed to 
building a new hospital.
  And to suggest that those veterans are not being served now does not 
reflect reality. There is no shortage of beds in the Travis area. The 
hospital vacancy rate in the Vallejo-Napa area is 29 percent and 30 
percent in Sacramento. And remember, only 9 percent of America's 
veterans look only to the VA for their health care and the VA provides 
only 30 percent of Federal dollars spent on veterans health care.
  So one could make a good argument, Mr. President, that we should wait 
until this thing settles down; that we should wait until we can make a 
determination just how, under the national health care plan, the VA is 
going to fit in. Because it is going to have to compete and veterans 
are going to have a choice.
  I know what we are up against here. We are up against a tough lobby. 
We are up against a sensitive issue that says VA is sacred. We do not 
touch VA hospitals. We do not touch matters affecting individual 
Members. But I would urge the Members that have spoken--my friends from 
Hawaii, who I have the greatest respect for, the senior and junior 
Senators; the Senator from California--as we reflect on the need. The 
needs are there, but the needs are not hospitals. The needs are 
outpatient. For heaven's sakes, let us meet those needs.
  Further, Mr. President, as we look at Hawaii--and the staff has 
provided me with a GAO report from a House hearing on May 6, 1993.
  It reads as follows:

       The administrator of Hawaii's Health Care Planning Agency 
     states that there is no shortage of acute care beds in 
     Hawaii. Excess capacity is so prevalent that local officials 
     estimate it could take as long as 15 years before a 
     certificate of need is approved by the Health Planning Agency 
     for construction of additional acute care capacity.

  I ask unanimous consent that an excerpt from this GAO report 
delivered 11 o'clock, Thursday, May 6, 1993, under the title ``Veterans 
Care'' be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       In Hawaii, about 25 percent of the veteran population lives 
     on the outer islands. Because there is no VA hospital in 
     Hawaii, veterans are authorized to use either the Tripler 
     Army Medical Center, which was renovated in the late 1980's 
     with adequate capacity to meet VA's current and anticipated 
     needs, or community hospitals on Oahu and the outer islands. 
     The administrator of Hawaii's health planning agency told 
     that there is no shortage of acute care beds in Hawaii. 
     Excess capacity is so prevalent that local officials estimate 
     that it could be as long as 15 years before a certificate of 
     need is approved by the health planning agency for 
     construction of additional acute care capacity.

  Mr. MURKOWSKI. Under ``Appendix 1, VA Health Care in Hawaii: 
Construction of Additional Acute Care Beds Not Needed,'' the GAO 
report, VA's planned medical center in Hawaii, page 17:

       The renovated Tripler facility was constructed with 
     adequate bed capacity to meet present and future acute care 
     needs of Hawaii's veterans. * * *  Tripler has enough acute 
     care beds in currently closed [Mr. President, currently 
     closed] medical, surgical, and psychiatric wards to meet VA's 
     projected workload, even under VA's inflated bed needs 
     projections. * * * 
       As a result, construction of additional acute care beds 
     would create additional excess capacity in an already 
     underutilized hospital.

  Is that justification for a new hospital? I want to see an 
appropriate memorial to the late Sparky Matsunaga as well as every 
other Member. But what is the need in Hawaii?
  In addition, Tripler has 68--right now--68 unused beds suitable for 
the care of veterans located in renovated wards that are fully equipped 
but closed off because of low demand and staff shortages. I quote from 
the GAO: ``Demand for VA-sponsored care at Tripler has consistently 
been well below the 69-bed constructed capacity, averaging about 40 
patients per day.''
  We should not be building hospitals for long-term care. We should be 
building nursing homes, domiciliaries, but not hospitals. The cost per 
bed and the return to the veterans simply is not there.
  Again, I reflect on the age of the veterans: Second World War, 72; 
Korean war, 62; Vietnam war, in the mid-40's.
  The needs of the veterans are changing. We must change with those 
needs and provide what is necessary and that is outpatient care.
  Now is not the time to build hospitals. Now is not the time as we 
transition into the national health care system where the VA is going 
to have to be competitive, to move on a $400 million commitment. We 
should look at the needs of the veterans as they relate to outpatient 
care. And we should be looking to the closed Department of Defense 
hospitals which are coming up to evaluate how they can be fitted in to 
meet veterans' care needs as well.
  Mr. President, I reserve the remainder of my time to accommodate 
Senator Strom Thurmond who I understand is on his way to the floor at 
this time.
  Mr. President, how much time remains?
  The PRESIDING OFFICER. The Senator from Alaska controls 7 minutes.
  Mr. MURKOWSKI. Mr. President, in order to accommodate my friend, I 
suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ROCKEFELLER. Mr. President, I will just conclude my wrap-up, 
which will not take long, and then the Senator from South Carolina can 
speak and then we can proceed to a tabling motion and a vote.
  The Senator from Alaska has made some thoughtful and interesting 
points. It is true there is excess inpatient capacity in the VA system 
today. But while there is excess inpatient capacity on a systemwide 
basis, it does not mean that it exists in each and every area. Reducing 
care in underserved areas is not going to be helpful in solving any 
kind of problem. Now, and in a reformed health care environment, VA 
will have to provide access to acute care. In the health care reform 
movement there is $3 billion put aside--more than that--which will be 
used to increase the availability of outpatient care. I encourage the 
Senator from Alaska and others to support the veterans' part of health 
care reform so that $3 billion can be used to increase outpatient care. 
That is the whole point. That is the whole point.
  We cannot, however, in underserved areas, just stop providing 
inpatient care where that is needed. I agree in principle that VA needs 
to direct resources to outpatient and long-term care. That is 
absolutely true. I think the answer to insufficient funds for 
outpatient and long-term care is to increase the funds available for 
that as in health care reform, not to eliminate funding for needed 
inpatient facilities.
  Just a word on the three projects and I am finished. With respect to 
the Travis, CA, project, the projected need by the year 2005, in terms 
of beds in the area served by the proposed Travis project--is for 243 
beds. The project will add 203 beds to the David Grant Medical Center 
Hospital and will transfer use of 40 existing beds from the Air Force 
to the VA. It replaces a 359-bed facility at Martinez. In this sense, 
VA is limiting the creation of new beds.
  The Air Force maintains a high vacancy rate at the David Grant 
Medical Center, and they do that for a very special reason which has to 
do with potential conflict. They have excess capacity there and it is 
needed because in the event of conflict and casualties, they need to 
have that excess. We build that kind of formula into our thinking for 
potential conflict.
  VA's costs for fee-based care increased from $1.8 billion in 1991 to 
$9.3 billion in 1993, after the Martinez Hospital was closed. The 
Senator from California [Mrs. Feinstein] made reference to this.
  Veterans testified at a House Veterans' Affairs Subcommittee field 
hearing about having to wait 6 months for appointments; having to wait 
6 hours to see a doctor; having to travel all day, and stay overnight 
to get treatment. Clearly, there is not sufficient access to inpatient 
care for the 400,000 veterans in that area. Hence the need for Travis.
  With respect to Honolulu, as both Senators from Hawaii indicated, 
there is no VA hospital in Honolulu and no veterans home. The acute 
care provided to veterans through agreement with the Tripler Army 
Medical Center and contracts with private hospitals is dependent on the 
willingness of those hospitals to continue caring for veterans. VSO's, 
Veterans Service Organizations, have complained that the care given to 
veterans by these facilities is inadequate and that these hospitals do 
not have the expertise in geriatric care that VA hospitals can provide. 
I cannot speak to that from personal experience, but that is what they 
say.
  People say Hawaii has universal health care, and it is approaching 
it.
  Universal health care in Hawaii or elsewhere will not preclude the 
need for VA health care services. I strongly defend the Hawaii project.
  Finally, Mr. President, with respect to the Memphis project, the 
project will replace the existing bed tower with a seismically safe one 
containing fewer beds than are in the existing tower, thereby reducing 
the inpatient capacity of the hospital by almost 300 beds, moving in 
the right direction.
  As chairman of the Veterans' Committee, I do not want to be the 
person to say that the facility located in the New Madrid fault zone is 
safe enough. I do not care when the last earthquake was, it is a 
projected hot spot. I do not want to say it is safe enough when the 
Department of Veterans Affairs has a structural safety committee 
comprised of experts to make those decisions and to make 
recommendations, as they have, and we have followed them.
  If we can increase safety and reduce inpatient capacity at the same 
time, I think that is a worthwhile project.
  So I think we have covered our bases on this, Mr. President. I hope 
our colleagues will support my motion to table, but I will not make 
that motion to table until the Senator from South Carolina, who wishes 
to speak, has done so.
  Mr. MURKOWSKI. Mr. President, I believe this side has 7 minutes left. 
I yield 3 minutes to the Senator from South Carolina.
  The PRESIDING OFFICER. The Senator from Alaska controls 6 minutes 40 
seconds, and he is yielding 3 minutes to the Senator from South 
Carolina?
  Mr. MURKOWSKI. Four minutes. I need a couple minutes to wrap up.
  Mr. THURMOND. Mr. President, I rise in support of the amendment of my 
colleague from Alaska regarding a moratorium on the construction of 
acute care, inpatient hospital capacity. I know the distinguished 
ranking member of the Senate Committee on Veterans' Affairs has given 
thoughtful consideration to this issue, and I applaud him for his 
leadership in this area.
  As we consider the future medical facility needs of veterans, I am 
concerned that facilities may be constructed that may not be fully 
utilized. The Department of Veterans Affairs must give greater 
consideration to out-patient treatment centers, clinics which provide 
greater accessibility, and nursing home care facilities.
  The Veterans' Affairs Committee has received reports from the General 
Accounting Office and the VA inspector general on areas where 
improvement can be made in the execution of the major construction 
program. Last year, the committee expressed its dissatisfaction with 
the VA construction planning and management process. The committee 
directed the Secretary to request an independent review of the 
construction program and to report the findings of this review to the 
committee prior to the submission of the fiscal year 1995 budget. To 
the best of my knowledge, Mr. President, this report has not been 
received by the committee. I believe the prudent course of action for 
the Congress and the Department is to not begin new construction for 
acute care facilities until improvements can be implemented. I further 
urge the Department to comply with the committee directive before 
undertaking new in-patient projects.
  The Annual Report of the Secretary of Veterans Affairs for fiscal 
year 1993 has this statement on its cover--``Putting Veterans First.'' 
While I support the Secretary in this view, I fear that too often when 
it comes to major construction, the Department of Veterans Affairs 
takes the approach of putting buildings first. That report indicates an 
overall inpatient bed vacancy rate of 23 percent. I would note that 
Memphis has a vacancy rate of 43 percent.
  In the Independent Budget for the Department of Veterans Affairs, a 
proposal prepared by a consortium of veterans groups, there is a 
recommendation for increasing the major construction appropriation. 
However, that document states that the majority of the Independent 
Budget recommended appropriation is for leases for outpatient clinics 
and nursing homes. It states ``In these uncertain times, the 
Independent Budget co-authors believe that leasing is preferable to new 
construction. [This] offers an affordable * * * solution to the 
immediate need for VA capacity in the outpatient and nursing homes 
venues.'' Thus, Mr. President this demonstrates the veterans groups 
understand the uncertainties of the role of the Veterans Affairs 
medical system under health care reform and the wisdom in not beginning 
new construction of inpatient facilities. They also recognize the need 
to move resources to out-patient and long-term care. The amendment 
would address both of these concerns.
  Let me emphasize that I have supported the Veterans Affairs medical 
care system, and will continue to do so. I have encouraged the 
Department of Veterans Affairs to take measures that will result in the 
most prudent use of our scarce Federal resources. I encourage my 
colleagues to join me in supporting the amendment.
  Mr. MURKOWSKI addressed the Chair.
  The PRESIDING OFFICER. The Senator from Alaska has 2 minutes 20 
seconds remaining.
  Mr. MURKOWSKI. Mr. President, I want to thank my good friend from 
South Carolina, who truly is a veteran and has supported veterans' 
benefits. He is a World War II veteran, having gone into Europe in a 
glider, and probably has had more reflection on the Second World War 
than any Member of this body.
  In the brief time I have, I think the Senator from West Virginia had 
made a point to the Senator from Alaska relative to the situation in 
California where you have to stand in line for 6 hours. If we had 
outpatient facilities, veterans would not have to stand in line for 6 
hours, and that is the point that the Senator from Alaska is attempting 
to make.
  The cost of the Memphis project alone, $94 million, would fund high-
priority, VA-requested outpatient clinics in Fort Myers and 
Gainesville, FL; Hampton, VA; and San Juan, PR. These are the needs. 
The VA suggests those are the needs. The outpatient clinics are 
projected to provide over 330,000 outpatient visits a year. That is 
almost 1,000 veterans served each day for the same cost as replacing a 
building that is treating only 368 veterans.
  So my amendment would prohibit spending money specifically on new 
inpatient-care hospital capacity. It would have the effect of 
transferring to outpatient and long-term care construction the $87 
million that would otherwise be spent on inpatient hospitals in 
Honolulu, Travis, and Memphis.
  These hospitals are going to require an additional $316 million in 
the future to complete. Are we going to change our minds now or later? 
The amendment is necessary because the VA has an enormous, unmet need 
for additional outpatient capacity. The outpatient facilities are a 
higher priority than the inpatient hospitals, and the amendment is good 
policy because the hospitals in question are currently not needed and 
the capacity of the existing hospitals is not being met.
  Mr. President, as we attempt the realities of rolling uphill on 
veterans' issues, let us start where the real need is by supporting the 
amendment of the Senator from Alaska in getting on with the business of 
providing outpatient facilities for America's veterans. I thank my 
colleague. I yield the floor.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. ROCKEFELLER. Mr. President, I move to table the amendment of the 
Senator from Alaska, and I ask for the yeas and nays.
  The PRESIDING OFFICER. The Senator has 3\1/2\ minutes remaining.
  Mr. SIMPSON. Mr. President, I would applaud my colleagues on both 
sides of the aisle for their hard work and dedication to veterans' 
programs and benefits. They have also worked diligently and carefully 
to preserve adequate funding for the Housing and Urban Development 
Agency, and the other agencies covered in this bill.
  I would simply like to focus some of my comments on the VA portion of 
this bill, and to point out that this bill provides for a total of 
$37.4 billion for the Department of Veterans Affairs, including $19.3 
billion in mandatory programs.
  That is an increase of approximately $1 billion over the current 
budget, and $314 million over the budget request.
  This amount will cover increases for veterans' compensation and 
pension programs, for medical care, and for VA major and minor 
construction projects.
  It is the VA construction portion of the bill that I would like to 
address. There is $362 million in this bill for VA construction 
projects. Many of these projects are surely worthy and necessary. But, 
I question whether we should appropriate such large sums of funding for 
a VA health care system when we stand on the verge of our full debate 
about national health care reform.
  Whether the VA system evolves into a group of health plans or whether 
it contracts with other providers remains to be seen. Regardless of 
what shape the VA takes, the VA will have to compete with other health 
plans to deliver services. I have called on the VA Department to 
describe for the Congress just exactly what is needed in order to make 
the transition from a provider of services to a payer for services. I 
foresee the VA acting as a managed care delivery system under national 
health care reform. In order to do that, the VA should start focusing 
less on physical structures--such as the construction projects 
contained in this bill--and start moving toward an emphasis on paying 
for care and services for veterans. I believe that this would increase 
and improve access and quality of care to veterans. Surely, that is 
what all of us would like to see.

  Accordingly, I will support Senator Murkowski's to increase funding 
available for outpatient and long-term VA health care by $87 million. 
These resources will be paid for by reducing funding for low priority 
inpatient hospitals by an equal amount. This amendment is necessary to 
demonstrate to the VA that it must begin the transition now to 
providing access and outpatient care to all veterans deserving of it. 
We must stop focusing on new buildings and increased construction 
projects and start focusing on caring for veterans, whether that care 
be in a VA hospital or in another quality hospital in a community. The 
Murkowski amendment will ensure that the veterans' care and needs come 
first. That is why I support it.
  In closing, let me simply reiterate--I feel this is a fine piece of 
legislation that will give full adequate care to deserving veterans as 
well as to provide for other agencies. I do hope that it can be 
modified to better deal with the concerns I have outlined in support of 
the Murkowski amendment.
  Mr. SASSER. Mr. President, I rise today in opposition to the 
amendment offered by the junior Senator from Alaska. This amendment 
would eliminate the already very modest funding for Veterans' 
Administration inpatient construction.
  The Senator from Alaska argues that the projects targeted by his 
amendment would unnecessarily increase the VA's inpatient capacity. But 
the majority of the funding his amendment would eliminate is for 
vitally needed seismic corrections at the VA medical center in Memphis, 
TN. This project does not increase inpatient bed capacity, but rather 
would bring the Memphis center into compliance with current seismic 
standards. In fact, this project will decrease the center's inpatient 
capacity from 763 beds to 453 beds. The 453 bed capacity meets the 
minimum requirement established by the Veterans' Administration using a 
methodology developed jointly by the VA and GAO.
  The VA can not fulfill this Nation's obligation to veterans in 
Tennessee and surrounding States without this project. There are no 
other VA medical centers in the area which can take on the mission of 
the Memphis center. The medical center provides all levels of medical, 
surgical and psychiatric care, as well as serving as a referral center 
for eight States for both chronic and acute spinal cord injury 
patients. The center also provides extended care in intermediate and 
nursing home settings to a population based of over 200,000 veterans. 
However, the medical center must be brought into compliance with 
seismic standards in order to safely continue its mission into the next 
century.
  I strongly urge my colleagues to vote to table the Murkowski 
amendment.
  Mrs. BOXER. Mr. President, I urge my colleagues to vote against the 
Murkowski amendment, which would prohibit funding for the construction 
of new inpatient Veterans' Administration hospitals. Among the projects 
this amendment would terminate is the 243-bed Travis VA Medical Center.
  This vitally needed facility will benefit more than 400,000 veterans 
in Northern California who have been without an acute care medical 
facility since the Martinez Hospital was closed in 1991. The Travis 
Medical Center is not really a new hospital, but a replacement for the 
Martinez facility.
  This May, Vice President Gore broke ground on the Travis facility. 
The hospital is a joint venture between the Air Force and the VA and 
will cost far less than building separate VA and Air Force hospitals. 
For that reason, it was hailed by Vice President Gore as an example of 
reinventing government in action.
  I want to make very clear to all Senators that the Travis VA Medical 
Center is not a frivolous, unneeded, Congressional add-on project. It 
was included in the President's budget and is a high priority of the 
VA. This hospital is the culmination of a four-year community effort to 
bring a VA facility to northern California to serve the more than 
400,000 veterans residing there.
  Building this facility will also jump-start California's ailing 
construction industry. Construction of the hospital will generate over 
1,000 badly needed jobs. This region of the State has been battered by 
economic hard times and base closures. The closure of nearby Mare 
Island Naval Shipyard is expected to result in 10,000 additional 
layoffs. The unemployment rate for the building construction and trades 
union membership in Solano County is over 30 percent.
  The corollary benefits to California's economy are important, but 
ultimately, I believe that this project should be supported to fulfill 
the promise our government made to the veterans of northern California. 
Over 400,000 veterans currently lack access to an acute care facility. 
That is not fair and it is not right.
  I urge my colleagues to oppose this amendment.
  Mr. ROCKEFELLER. I yield back the remainder of my time. I move to 
table the amendment, and I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. The question is on agreeing to the motion to 
table the amendment.
  The yeas and nays have been ordered. The clerk will call the role.
  The legislative clerk called the roll.
  Mr. FORD. I announce that the Senator from Alabama [Mr. Heflin] is 
necessarily absent.
  Mr. SIMPSON. I annouce that the Senator from Mississippi [Mr. Lott] 
is necessarily absent.
  The PRESIDING OFFICER (Mr. Breaux). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 62, nays 36, as follows:

                      [Rollcall Vote No. 256 Leg.]

                                YEAS--62

     Akaka
     Baucus
     Biden
     Bingaman
     Bond
     Boren
     Boxer
     Bradley
     Breaux
     Bryan
     Bumpers
     Byrd
     Campbell
     Conrad
     D'Amato
     Daschle
     DeConcini
     Dodd
     Domenici
     Dorgan
     Exon
     Feingold
     Feinstein
     Ford
     Glenn
     Graham
     Gramm
     Harkin
     Hatfield
     Hollings
     Inouye
     Jeffords
     Johnston
     Kennedy
     Kerrey
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Mack
     Mathews
     Metzenbaum
     Mikulski
     Mitchell
     Moseley-Braun
     Moynihan
     Murray
     Nunn
     Pell
     Pryor
     Reid
     Riegle
     Robb
     Rockefeller
     Sarbanes
     Sasser
     Shelby
     Simon
     Wellstone
     Wofford

                                NAYS--36

     Bennett
     Brown
     Burns
     Chafee
     Coats
     Cochran
     Cohen
     Coverdell
     Craig
     Danforth
     Dole
     Durenberger
     Faircloth
     Gorton
     Grassley
     Gregg
     Hatch
     Helms
     Hutchison
     Kassebaum
     Kempthorne
     Lugar
     McCain
     McConnell
     Murkowski
     Nickles
     Packwood
     Pressler
     Roth
     Simpson
     Smith
     Specter
     Stevens
     Thurmond
     Wallop
     Warner

                             NOT VOTING--2

     Heflin
     Lott
       
  So the motion to lay on the table the amendment (No. 2450) was agreed 
to.
  Mr. ROCKEFELLER. Mr. President, I move to reconsider the vote.
  Mr. FORD. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. REID. I ask unanimous consent that the pending amendments be set 
aside.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 2451

(Purpose: To provide that none of the funds made available in this Act 
   to the Department of Housing and Urban Development may be used to 
   provide any individual assistance or benefit to any individual or 
 entity in the United States unless the Federal entity or official to 
    which the funds are made available takes reasonable actions to 
 determine whether the individual is in a lawful immigration status in 
                           the United States)

  Mr. REID. Mr. President, I send an amendment to the desk and ask for 
its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from Nevada [Mr. Reid], for himself, Mr. Bryan, 
     and Mrs. Feinstein, proposes an amendment numbered 2451.

  Mr. REID. 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:

       At the appropriate place, insert the following new section:
       Sec.   . None of the funds made available in this Act to 
     the Department of Housing and Urban Development may be used 
     to provide any individual assistance or benefit to any 
     individual or entity in the United States unless the Federal 
     entity or official to which the funds are made available 
     takes reasonable actions to determine whether the individual 
     is in a lawful immigration status in the United States: 
     Provided, That in no case may a Federal entity, official, or 
     agent of any Federal entity or official discriminate against 
     any individual with respect to filing, inquiry, or 
     adjudication of an application for funding made available in 
     this Act on the basis of race, color, creed, handicap, 
     religion, sex, national origin, citizenship status or form of 
     lawful immigration status: Provided further, That for 
     purposes of this section, the term ``individual assistance or 
     benefit'' does not include search and rescue, emergency 
     medical care, emergency mass care, emergency shelter, 
     clearance of roads and construction of temporary bridges 
     necessary to the performance of emergency tasks and essential 
     community services, warning of further risks or hazards, 
     dissemination of public information and assistance regarding 
     health and safety measures, the provision on an emergency 
     basis of food, water, medicine, and other essential needs, 
     including movement of supplies or persons, or reduction of 
     immediate threats to life, property, and public health and 
     safety: Provided further, That, notwithstanding any other 
     provision of this section, a homeless individual may, for a 
     period not to exceed 45 days, receive assistance from funds 
     made available under this Act to assist homeless individuals 
     pursuant to the Stewart B. McKinney Homeless Assistance Act, 
     regardless of the immigration status of such individual.

  Mr. REID. Mr. President, in this morning's Washington Post, there 
were two stories probative of this matter before us. One story deals 
with the fact that the world may have, by the year 2030, 3 billion 
people more than now exist.
  In addition, Saturday's New York Post newspaper indicated that 
Immigration and Naturalization's hands are tied as alien thugs laugh at 
deportation laws. It goes on to state that that is what is actually 
happening. They do not bother to show up. Immigration does not have 
agents to go get them. They just disappear into the woodwork. One of 
the INS agents says: ``Morale at the Immigration and Naturalization 
Service is at an all-time low and other agents are defecting in droves 
to other Federal agencies.''
  I have here a letter from Michael Antonovich, who is supervisor of 
the Board of County Supervisors in Los Angeles, which says in one 
paragraph, referring to the vote that took place earlier this year 
dealing with immigration: ``The decisive vote for this reform 
demonstrates the need for a HUD policy revision which would permanently 
bar illegal aliens from residing in our scarce and critically needed 
public housing.''
  Mr. President, we have reached a crisis as a result of our failed 
immigration laws. Twenty-five percent of the Federal prison inmates are 
foreign born. Taxpayers are being stuck with literally billions of 
dollars in costs for people who are not legally within the country for 
their health care, education, public housing, and other social 
benefits. For example, In L.A. County, 70 percent of the babies that 
are born there are born to illegal immigrant mothers.
  Mr. President, we in the United States cannot take in the rest of the 
world. Billions of people would like to come here. We have to do the 
best we can with the people that are here. Even in spite of the fact 
that we are doing the best we can, we still have the highest rate of 
growth of any modern industrialized nation in the world. Our 
infrastructure is deteriorating. Sewer and water systems are at 
capacity. Highways, roads, and bridges are in need of repair. Our 
system of public recreation is at a breaking point. Our public parks--
parts of them--are being closed because they are in a state of 
disrepair. We do not have money to repair our national parks. People 
have to get tickets or numbers so that they can go through our 
wilderness areas because they are so overcrowded.
  Mr. President, this amendment, which I will speak very briefly about, 
is as a result of the fact that the chairman of the Appropriations 
Subcommittee, the manager of this bill, the Senator from Maryland, has 
agreed to accept this amendment, for which I am grateful.
  I want to state that this amendment does just a few things. It 
requires Federal authorities to take reasonable action to determine 
whether recipients of housing benefits are of lawful immigration 
status. Currently, there are no regulations requiring the agency to 
make any verification determinations before benefits and assistance are 
distributed. A significant number of unlawful immigrants end up in our 
public housing, taking housing that people who play by the rules are 
not able to get because the funds run out.
  With our homeless shelters, even though my amendment takes care of 
emergencies--that is for 45 days--there are really no questions asked. 
There are no regulations requiring that Housing and Urban Development 
make any verification and determinations before benefits and assistance 
are distributed.
  This should be of interest to Congress, because 14 years ago, in 
1980, a law was passed requiring the implementation of regulations. In 
1986, 8 years ago, a law was passed requiring the implementation of a 
regulation. We still do not have one, even though I received a 
telephone call today from the Secretary of Housing and Urban 
Development saying they were going to issue one today. I do not have it 
yet. I understand that one is out, and I am happy about that.
  This, Mr. President, is something that should have been done years 
ago. This amendment simply requires that a reasonable standard be 
instituted when distributing housing benefits; that is, that reasonable 
actions be taken to determine that an applicant is of lawful 
immigration status. That is not asking too much. It puts into law a 
protection against discrimination and the distribution of these funds 
by including a clear nondiscrimination clause. We have done it before. 
We did it in the emergency supplemental earthquake bill. We did it in 
the agriculture appropriations bill. There is no reason we should not 
do it today.
  This amendment would require HUD to implement a modest policy of 
enforcement with respect to the distribution of housing benefits. 
Again, under current law, no such regulations exist covering the 
distribution of funds to illegal immigrants.
  I say to my friend from Maryland--and she is a veteran legislator, as 
am I--I understand the difficulty the chairman will have holding this 
amendment in conference. I understand that. But I want my friends in 
the other body, and those in this body, to understand that I will be 
back. If we do not get this in conference--and I know that my friend, 
the esteemed Senator from Maryland, can only do so much--there is going 
to be a housing authorization bill coming through this body later this 
year.
  I will be back because this is only fair. This is a modest approach. 
This is not immigrant bashing. This is making those people who play by 
the rules get what they are entitled to.
  I yield the floor.
  The PRESIDING OFFICER. Is there additional debate on the amendment of 
the Senator from Nevada?
  Mr. SIMPSON. Mr. President, I support this amendment. I am not a 
cosponsor. I would like to do so and ask unanimous consent that that be 
the case.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SIMPSON. Mr. President, I think that Senator Reid is on the right 
track. This amendment will require HUD to make a reasonable effort to 
determine the lawful status of persons applying for housing assistance. 
This is a consistent tack of his approach, and I think he has finally 
jarred the bureaucracy at HUD that has existed through several 
administrations.
  In 1986 Congress told HUD not to give housing benefits to illegal 
aliens. HUD did not respond during the Reagan administration, nor did 
it respond during the Bush administration. Now apparently, I ask my 
friend, have they now responded with the regulations that they were 
supposed to do 8 years ago?
  Mr. REID. Mr. President, I respond, through the Chair, to my friend 
from Wyoming that yesterday I was told there would be a regulation 
issued in the next few weeks. Toward the end of the day, I was told it 
was only a matter of days until OMB was going to authorize the issuance 
of regulations.
  This morning I got a call from Secretary Cisneros. And, I would like 
to add that I believe his leadership has been instrumental to moving 
forward with a regulation. He was on a plane flying someplace, but he 
said that the regulation was issued last night. My staff has informed 
me the regulation is on its way to our office, but I have yet to see 
it.
  I do not know if it has been issued. If it has been finalized, I hope 
it is fair and reasonable. After 14 years I hope they had plenty of 
time to work on it.
  I would say on the record I appreciate very much the assistance of my 
friend from Wyoming for his support for this amendment. In particular, 
I appreciate the support of his staff. His staff has been involved in 
immigration matters for many years and his staff was like having an 
encyclopedia for my staff. They were willing to assist when issues were 
raised and, through the Chair, I say to my friend from Wyoming that I 
express appreciation for the assistance his staff gave my staff in 
arriving at the point where this amendment is now being accepted.
  Mr. SIMPSON. Mr. President, I do appreciate those remarks and I know 
better than anyone the remarkable work this staff does for me and gives 
me the ability to function in this area fraught with emotion, fear, 
guilt, and racism.
  I applaud the Senator from Nevada. He put this amendment on the 
earthquake relief bill and the agricultural supplemental appropriation. 
It is also appropriate here.
  I do hope it will be held in conference. I do know our chairman, 
Senator Mikulski, will make that effort, as she does with all the work 
we do here in the Senate.
  The PRESIDING OFFICER. Is there further debate?
  Ms. MIKULSKI. Mr. President, I rise in support of the Reid amendment, 
as manager of the bill.
  It requires HUD to take reasonable steps to make sure that recipients 
of HUD funds are legal residents of the United States.
  The language is comparable to that which we included in the 
Northridge earthquake supplemental and in several other appropriations 
bills.
  I believe it is a good amendment and consistent with sound housing 
policy and good immigration policy.
  We have a significant waiting list for housing and housing subsidies, 
particularly where we want to reward work, and they should go to those 
people who are American citizens, and in terms of immigration policy we 
need to reward those who are willing to stay around the world and not 
come in under illegal auspices.
  Therefore, I intend to support the amendment. It has been cleared on 
both sides of the aisle. I, therefore, urge its adoption.
  The PRESIDING OFFICER. Is there further debate?
  If not, the question is on agreeing to the amendment of the Senator 
from Nevada.
  The amendment (No. 2451) was agreed to.
  Mr. SIMPSON. Mr. President, I move to reconsider the vote.
  Ms. MIKULSKI. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. Under the previous order, the Senator from 
Maine [Mr. Cohen] is recognized.
  Mr. McCAIN. Mr. President, I ask unanimous consent to speak for a few 
minutes or so and then yield the floor.
  The PRESIDING OFFICER. Without objection, it is so order.
  The Chair recognizes the Senator from Arizona.

                          ____________________