[Congressional Record Volume 140, Number 137 (Tuesday, September 27, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: September 27, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND 
  EDUCATION AND RELATED AGENCIES APPROPRIATIONS ACT, 1995--CONFERENCE 
                                 REPORT

  The Senate continued with the consideration of the conference report.


 amendments of the house to the amendments of the senate nos. 73 and 83

  Mr. HARKIN. Madam President, I ask unanimous consent that the Senate 
concur in the amendments of the House to the amendments of the Senate 
numbered 73 and 83.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendments are as follows:

       Resolved, That the House recede from its disagreement to 
     the amendment of the Senate numbered 73 to the aforesaid 
     bill, and concur therein with an amendment as follows:
       In lieu of the sum proposed by said amendment, insert: 
     ``$877,223,000''.
       Resolved, That the House recede from its disagreement to 
     the amendment of the Senate numbered 83 to the aforesaid 
     bill, and concur therein with an amendment as follows:
       In lieu of the matter inserted by said amendment, insert:
       Sec. 209. Of the funds appropriated or otherwise made 
     available for the Department of Health and Human Services, 
     General Departmental Management, for fiscal year 1995, the 
     Secretary of Health and Human Services shall transfer to the 
     Office of the Inspector General such sums as may be necessary 
     for any expenses with respect to the provision of security 
     protection for the Secretary of Health and Human Services.

  Mr. INOUYE. Mr. President, I would like to thank the House and Senate 
conferees for accommodating the request I submitted to the Labor, HHS, 
Education appropriations bill, H.R. 4606. I am especially appreciative 
of the additional $3 million that was appropriated to the Corporation 
for Public Broadcasting [CPB] for fiscal year 1997. In looking at the 
language accompanying the conference report, I noted that there was a 
reference in title IV to the CPB, regarding the compensation of a 
certain public television personality. I believe the information 
contained in the report language has been taken out of context and is 
misleading. I would like to clarify this issue for the Record.
  First, the report specifically states that ``the conferees have 
learned that a single individual is paid $438,000 annually for his once 
a week 30 minute appearance.'' It also says that ``these costs are paid 
directly by taxpayers and contributors to local stations.'' I would 
like to note that the individual referred to in the report is not an 
employee of public broadcasting. The individual is a television 
personality who is compensated for his expertise and performance on a 
popular television program.
  Second, CPB's share of the compensation paid to this individual is 
approximately $14,000. In other words, the vast majority of the 
compensation level mentioned in the report is not made up of taxpayer 
funds; only $14,000 of this amount can be traced to Federal taxpayer 
funds.
  Let me tell you how this difference originates. The total yearly cost 
of the television program in question is approximately $2.3 million. 
The Public Broadcasting Service [PBS] invests approximately $400,000 
for a year's schedule of the program. This is about 17 percent of the 
program's yearly cost.
  Thus, the total PBS contribution to the $438,000 compensation level 
would be 17 percent, or $75,000. But this $75,000 PBS contribution is 
not composed totally of Federal funds. PBS is not a direct recipient of 
Federal funds, but it does receive funding from the private, nonprofit. 
Government-funded Corporation for Public Broadcasting. PBS receives 
approximately 19 percent of its yearly budget from the taxpayer-
supported CPB to acquire and distribute national programming. 
Therefore, 19 percent of the $75,000 contribution of PBS money could be 
said to originate with Federal funds. This amount is $14,000. In other 
words, approximately $14,000 of the compensation paid to the television 
personality can be traced to Federal funds.
  Mr. President, this modest contribution produces a 600 percent return 
on its investment because the program as a whole brings in almost $1.5 
million from corporations, another $1.22 million from local businesses, 
and $288,417 in station pledges. Due to this increasing private 
support, the PBS investment in this program has been declining over the 
past 4 years.
  Mr. President, we are all concerned about rising costs and inflated 
salaries. However, to imply that taxpayers are footing the entire bill 
for the compensation level of this on-air talent is misleading. 
Opinions will differ with regard to the talent or likability of on-air 
personalities. I believe that decisions about compensation for on-air 
talent are best left to program producers.
  Finally, I would like to remind my colleagues that the Federal 
Government is just one source of funding for public broadcasting. CPB 
appropriations account for approximately 14 percent of the public 
broadcasting industry's income--including public television and public 
radio. The largest source of funding comes from the more than 5 million 
individuals and families who contribute each year. In addition, Federal 
support for public television costs each taxpayer approximately $1 each 
year. I believe this is a small price to pay for the number of high 
quality programs and services we receive each year.


                             cpb rescission

  Mr. HARKIN. Mr. President, the conference agreement on H.R. 4606 
rescinds $7 million of CPB's fiscal year 1995 appropriation provided in 
Public Law 102-394, the fiscal year 1993 Labor, Health and Human 
Services, and Education appropriations bill. The Senate bill did not 
include a CPB rescission. The House bill included a $21.1 million 
rescission.
  The $7 million rescission in the conference agreement resulted from 
severe financial constraints imposed by the discretionary budget caps. 
Unfortunately, our budget problems were compounded by the fact that the 
House refused to agree to appropriating an additional $61 million out 
of the Department of Defense budget for impact aid, thereby reducing 
funding for impact aid in H.R. 4606 by that amount.
  A CPB rescission in the fiscal year 1995 bill, while not based on any 
effort to influence public broadcasting programming decisions, could 
open the floodgates for such action. It is not my intention that the 
fiscal year 1995 rescission for CPB serve as a precedent for future 
appropriations.
  Mr. INOUYE. Mr. President, Senator Stevens, Senator Cochran, and I 
regretfully agreed to rescind fiscal year 1995 appropriations funding 
for the Corporation for Public Broadcasting [CPB]. This rescission is a 
serious threat to the editorial integrity and financial stability of 
the public broadcasting system. It jeopardizes the continuity and 
stability that is essential to the continued development of high 
quality public radio and television programming for our country. More 
importantly, the rescission threatens the concept of advance funding.
  We have grave concerns about the potential precedent that the 
rescission may have on the future of public broadcasting. When Congress 
created the CPB in 1967, it took great pains to ensure that CPB would 
act as a heatshield from political pressures. Its structure and 
statutorily restricted activities were designed to ensure that 
producers and stations would not be subject to political interference.
  Placing public broadcasting funding on a regular appropriations 
schedule provides the opportunity for Congress to immediately influence 
programming decisions by delaying or reducing funding until concessions 
were made. The principle of advance funding was established in 1975 to 
address this very issue. Advance funding was a carefully considered 
approach to providing much needed Federal support for the CPB while 
ensuring insulation from political interference and outside pressures.
  Mr. President, this rescission must not be repeated. We will not 
support future rescissions of CPB appropriations. Senators Inouye and 
Stevebs of the Communications Subcommittee and Senator Cochran are 
committed to providing multiple year authorizations and advance 
funding, both of which are vital to ensuring a healthy public 
broadcasting system in this country. The Communications Subcommittee, 
which is in the process of reauthorizing the CPB, will take steps to 
ensure that the principle of advance funding is emphasized as a 
critical component of Federal support for public broadcasting.
  We must not turn our backs on the commitment we made to the public 
broadcasting system nearly 20 years ago. It is imperative that we 
continue to provide the financial stability and means needed for the 
CPB to realize its full potential.
  Mr. SASSER. Mr. President, the Senate Budget Committee has examined 
the conference report on H.R. 4606, the fiscal year 1995 Labor, Health 
and Human Services, Education, and related agencies appropriations 
bill, and has found that the conference report is below its 602(b) 
general purpose allocation by $124,000 in budget authority and by 
$169,000 in outlays. This conference report exactly meets its 602(b) 
crime allocation in budget authority and is below by $1,288,000 in 
outlays.
  Mr. President, I have a table prepared by the Budget Committee which 
shows the official scoring of the fiscal year 1995 Labor, Health and 
Human Services, Education, and related agencies appropriations 
conference report and I ask unanimous consent that it be inserted in 
the Record at the appropriate point.
  There being no objection, the table was ordered to be printed in the 
Record, as follows:

  SENATE BUDGET COMMITTEE SCORING OF H.R. 4606--FISCAL YEAR 1995 LABOR, 
           HHS, AND EDUCATION APPROPRIATIONS--CONFERENCE BILL           
                          [Dollars in millions]                         
------------------------------------------------------------------------
                                                   Budget               
                                                 authority     Outlays  
------------------------------------------------------------------------
           VIOLENT CRIME TRUST FUND                                     
                                                                        
Crime Total...................................           38            7
Senate 602(b) crime allocation................           38           8 
                                               -------------------------
      Difference..............................            0           -1
                                                                        
                GENERAL PURPOSE                                         
                                                                        
Discretionary Totals:                                                   
    New spending in bill......................       68,245       28,123
    Outlays from prior years appropriations...  ...........       39,953
    Permanent/advance appropriations..........        1,771        1,769
    Supplementals.............................            0         -20 
                                               -------------------------
      Subtotal, discretionary spending........       70,016       69,826
Mandatory Totals..............................      196,154      195,904
    General purpose bill total................      266,132      265,723
    Senate 602(b) allocation..................      266,132     265,723 
                                               -------------------------
      Difference..............................         -(*)         -(*)
General Purpose totals above (+) or below (-):                          
    President's request.......................       -1,680         -502
    House-passed bill.........................          314            1
    Senate-reported bill......................            1           -0
    Senate-passed bill........................           -0            0
Overall Totals:                                                         
    General Purpose, Discretionary............       70,016       69,826
    General Purpose, Mandatory................      196,154      195,904
    Crime Trust Fund..........................           38           7 
                                               -------------------------
      Overall bill total......................      266,208      265,736
------------------------------------------------------------------------

  Mr. DOMENICI. Mr. President, I rise in support of the conference 
agreement accompanying H.R. 4606, the Labor, Health and Human Services, 
Education and related agencies appropriations bill for fiscal year 
1995.
  The conference agreement provides $213.4 billion in new budget 
authority and $176.5 billion in new outlays for programs of the 
Departments of Labor, Health and Human Services, and Education and 
related agencies.
  When adjustments are made for prior-year outlays and other completed 
actions, the bill as adjusted totals $266.2 billion in budget authority 
and $265.7 billion in outlays for fiscal year 1995.
  The subcommittee has done a good job under very difficult budgetary 
constraints. I am pleased that the bill is within the subcommittee's 
602(b) allocation.
  There are several items for which the Senator from New Mexico would 
like to express appreciation. One item is $12 million for Hispanic 
serving institutions. This will be the first time funding will be 
provided to institutions of higher education attempting to meet the 
needs of Hispanic students. Thirteen universities, serving over 20,000 
students in New Mexico, are designated as HSI's.
  I would like to thank the chairman and ranking member of the 
subcommittee for supporting funds for the newly authorized character 
education grants. The bill provides $750,000 to assist local 
partnerships working to develop character-counts education programs in 
their communities. This is the first installment of a $6 million grant 
program that is authorized in the pending elementary and secondary 
education reauthorization bill.
  I am extremely pleased that this bill provides $25.9 million for the 
Community Schools Youth Services and Supervision Grant Program.
  This program, adopted through an amendment I offered to the crime 
bill, has tremendous bipartisan support. It will go a long way to 
providing constructive after-school opportunities for our young people.
  I continue to be concerned about the practice of providing a $600 
million contingency fund for LIHEAP that must be designated as 
emergency spending to be released. These expenses, in most cases, can 
be anticipated and should be addressed through the regular 
appropriations process.


                  National Institute of Mental Health

  The conference report provides $543.55 million for non-AIDS research 
at the National Institutes of Mental Health [NIMH], which is now funded 
as one of the National Institutes of Health. This funding level is 
$17.3 million above the fiscal year 1994 level and $1.5 million above 
the House bill. The Senate directed the increase in funding above the 
House bill, to Decade of the Brain activities. I strongly urge NIH to 
fulfill this intent.


                      Centers for Disease Control

  Depsite the fact that overall funding for CDC remains close to the 
fiscal year 1994 level, I am pleased that the subcommittee provided 
$54.5 million for the infectious disease program, to, among other 
things, continue monitoring the hantivirus outbreak in the southwest. 
This represents a $6.7 million increase above the fiscal year 1994 
funding level.


                          Homeless Initiatives

  Finally, I appreciate the subcommittee's support of my efforts to 
provide increased funding for the Health Care for the Homeless Program. 
The bill provides $65.4 million for this program, an increase of $2.4 
million above the fiscal year 1994 level and the President's request.
  Mr. President, there are many worthy programs funded in this 
legislation. The subcommittee did a good job in setting priorities and 
staying within its budget allocation. I urge my colleagues to support 
the conference agreement.
  Mr. NUNN. Mr. President, I vote against this conference report for a 
very specific reason: the appropriations conferees apparently in 
deference to the for-profit trade school sector, have tied the hands of 
the Secretary of Education, prohibiting him from implementing a key 
provision of the Higher Education Act for 1 year. A ``yes'' vote for 
this conference report undermines attempts to bring integrity and 
accountability to the Federal student financial aid programs.
  At issue is a new requirement which for-profit trade schools would 
have to comply with: a requirement that in order to participate in 
Federal student aid programs, at least 15 percent of a school's revenue 
come from somewhere other than the Federal Pell grant or guaranteed 
student loan programs. This requirement, commonly referred to as the 
``85-15 rule,'' was contained in the 1992 amendments to the Higher 
Education Act, and was to be implemented by the Department of Education 
on September 30, 1994. However, the conference report, in deference to 
objections raised by the trade school industry, prohibits the Secretary 
of Education from implementing this requirement. In doing so, I believe 
Congress is sending the wrong signal to the trade school sector and may 
also be costing the taxpayers millions of dollars for substandard job 
training.
  Mr. President, the integrity of the Federal student aid programs is 
at stake. These programs have been, and are being, wracked by blatant 
fraud and abuse. Investigations by Congress, the General Accounting 
Office, the media, the FBI, and the inspector general at the Department 
of Education have, time and time again, determined that much of the 
fraud and abuse--amounting to hundreds of millions of dollars per 
year--was perpetrated by owners of for-profit trade schools. A good 
portion of Congress' investigative work was done by the Senate 
Permanent Subcommittee on Investigations which, under my chairmanship, 
conducted an in-depth examination of waste, fraud, and abuse in title 
IV programs in 1990, and again in 1993.
  Every school which the subcommittee investigated for fraud and abuse 
had, it turned out, relied very heavily on Federal student aid programs 
as the main source of revenue. In fact, were it not for student aid 
programs, the schools we investigated would probably not have existed. 
Our investigation confirmed that some for-profit trade schools 
establish their tuition charges based not on what the cost of education 
is, but rather on the amount of student aid available to the students. 
When the Pell grant and loan limits were raised, we found that many of 
these schools raised their tuition.
  Clearly, not every trade school is a scam. If I believed that, I 
would be working to remove that sector from participation in all 
Federal aid programs entirely. I am not doing that. But I am deeply 
disappointed that the conferees have bowed to the interests of the 
trade school sector to delay the implementation of a new eligibility 
requirement that these schools would have had to comply with. I ask 
those Members who have opposed the 85-15 rule for fear that some trade 
schools would close: Do you know the default rate of those schools? Do 
you know about their teachers and curriculum? Do you know what 
percentage of the people who enroll in those schools graduate? How many 
of them get jobs as a result of the training? If you cannot answer 
these questions, I suggest you should not be asking the Federal 
taxpayer to be the sole supporter of those schools.
  This 85-125 rule is not that tough. Prior to its enactment, we 
allowed these for-profit businesses to reap profits--big profits--
without one dime of funding other than Federal student loans and 
grants. That is preposterous. Again, every trade school which the 
Permanent Subcommittee on Investigations has investigated for abusing 
the Federal loan and Pell grant programs relied almost exclusively on 
Federal student aid as their revenue source. One school in Florida took 
in $153 million in Federal loans in just 3 years, and the two 
schoolowners took out $7.8 million in salary in the same timeframe. 
That would not have happened if this provision would have been in 
place. We need to make sure that some other entity, whether it be 
private companies who hire graduates, the students themeselves, or some 
other financial aid program is willing to provide at least 15 percent 
of that corporation's tuition revenues. It is hoped that by doing so, 
some additional measure of quality would be assured. Why should the 
Federal taxpayer be paying for schools that, on the basis of merit, 
cannot attract any other form of financial support.

  When we allow for-profit schools to rely exclusively on Federal 
funds, we eliminate competition and a free market. We have created 
hundreds, if not thousands, of Government-sponsored enterprises which 
are operated for the benefit of private individuals and to the 
detriment of the students we aim to assist. We need to constantly 
remind ourselves that these are student aid programs, not school aid 
programs.
  I am disappointed because, after working diligently to expose the 
fraud and abuse in these programs, and after working with the Labor and 
Human Resources Committee to get strong integrity provisions included 
in the 1992 reauthorization of the Higher Education Act, this 
appropriations bill protects this industry from what I believe to be a 
very sound provision of law. Every Member of Congress receives the 
semiannual reports from the inspector general. Every report I've seen 
since the late 1980's spell out in graphic detail the extent of the 
fraud and abuse being perpetrated against us, yet the conferees want us 
to delay this provision for another year.
  Mr. President, I believe this delay is a big mistake. The taxpayers 
have demanded that defaults be reduced and fraud eliminated. The 
Congress has directed the Secretary of Education to better manage these 
programs. If Senators believe that there are truly good for-profit 
trade schools which will be adversely impacted by this requirement, 
then perhaps we should give the Secretary of Education specific and 
limited waiver authority, but we should not delay this provision 
entirely for another year, while the trade school lobby works to kill 
this provision altogether.


       CDC birth defects prevention funding for fiscal year 1995

  Mr. BOND. Mr. President, I would like to bring the attention of the 
Senate to an important aspect of this bill. It is my understanding that 
we are providing the Centers for Disease Control and Prevention with a 
$17 million, or nearly 15 percent, increase over the fiscal year 1994 
level for its activities in the chronic and environmental disease 
prevention area, including birth defects prevention.
  Mr. HARKIN. That is correct. The conference agreement significantly 
expands funding for the CDC's chronic and environmental disease 
prevention activities and the Senate report specifically urges CDC to 
provide expanded funds for State birth defects surveillance programs. I 
share the Senator's concern for the prevention and treatment of birth 
defects which are a leading cause of childhood disability and infant 
mortality in this country.
  Mr. BOND. As the chairman well knows, through his good work for 
children with disabilities, 150,000 babies are born each year with 
defects and many more have birth defects which are not identified until 
later in their childhood. Yet we have no system to track these births 
as we do for low birthweight or even for cancer through national cancer 
registries. With these expanded birth defects surveillance funds it is 
my hope that data can be collected to identify environmental factors 
associated with birth defects and to apply this knowledge to guide 
public health interventions. I would like to clarify that the committee 
has prioritized the birth defects surveillance program at CDC for a 
portion of the increased funds.
  Mr. HARKIN. Yes, it is our intention that a portion of the increase 
provided to the CDC for fiscal year 1995 be used specifically to expand 
assistance to States for birth defects monitoring systems.
  Mr. BOND. I thank the chairman. I know of no greater advocate for 
children with birth defects than the chairman of this subcommittee, and 
know he looks forward to the day, as I do, that we have in place a 
national system for the prevention of birth defects.


                               bonus caps

  Ms. MIKULSKI. Mr. President, I note that the conference report on 
this bill includes language that places a cap on the amount that 
agencies may spend on cash performance awards, known as bonuses. Under 
this provision, the amount spent by an agency on employee bonuses may 
not exceed 1 percent of the amount budgeted for the agency's personnel 
compensation and benefits.
  Mr. HARKIN. The Senator from Maryland is correct.
  Ms. MIKULSKI. As I understand it, this language is not intended to 
restrict bonuses to hard-working nonsupervisory employees who qualify 
for performance awards.
  Mr. HARKIN. That is correct.
  Ms. MIKULSKI. Full-time rank-and-file employees would still be 
eligible to receive bonuses. Is that correct?
  Mr. HARKIN. Yes, that is correct.
  Ms. MIKULSKI. Mr. President, because of increasing budget constraints 
and efforts to downsize and streamline the Federal Government, agency 
personnel are being asked to assume more and more responsibilities, 
with fewer resources and rewards. Unfortunately, it is often the lower 
grade workers that tend to suffer the most from this trend. I want to 
make it clear for the record that it is not the intent of the Congress 
to in any way discourage agencies from appropriately rewarding lower 
level employees who perform their work in an exemplary fashion.


                  office of american workplace funding

  Mr. KENNEDY. Mr. President, the conferees have agreed to an 
appropriation of $7 million for salaries and activities by the Office 
of the American Workplace. It is my understanding that while the 
conferees did not provide the specific increase in funding for the 
Workers Technology Skills Development Act that the Senate had sought, 
it would be consistent with the appropriation bill that we are passing 
today to fund this program. As you know, the purpose of that act, which 
we expect to enact shortly as part of the Elementary and Secondary 
Education Act, is to increase worker involvement in the introduction 
and deployment of technology in the workplace and promote the use of 
advanced workplace practices to improve workers' wages, skills, and 
participation in the changing workplace.
  Mr. HARKIN. Yes. I am a cosponsor of that legislation. I think it 
would be appropriate and meritorious for the Department of Labor to 
fund projects under that program. As you know, we had specifically 
indicated in our Senate report that we intended the $500,000 we had 
provided to fund pilot programs to be used to fund projects pursuant to 
that act. The Department of Labor has the ability under our 
Appropriations Act to fund such programs and to the extent that the 
Department is able to use appropriated moneys in the coming fiscal year 
to fund pilot programs, we intend that such funds be used to fund 
projects under the Workers Technology Skills Development Act.
  Mr. WOFFORD. Mr. President, as secretary of labor and industry, I saw 
first hand what worked for workers in Pennsylvania. I have been very 
pleased that working with both my colleagues, over a relatively short 
period of time, the Congress has been able to address the need, even in 
a modest manner, for ensuring full worker involvement in any efforts to 
modernize the workplace and make it more competitive. I am pleased that 
the Department of Labor will be able to fund such programs in the 
upcoming fiscal year.
  Mr. HARKIN. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. COHEN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           amendment no. 2593

   (Purpose: To provide for enhanced penalties for health care fraud)

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

       The Senator from Maine [Mr. Cohen] proposes an amendment 
     numbered 2593.

  Mr. COHEN. Madam President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. COHEN. Madam President, it became clear yesterday, with Senator 
Mitchell announcing that there will be no further consideration of 
health care reform this year, that we are missing an opportunity to do 
a number of things. Senator Specter, Senator Chafee, myself, and a 
delegation of Senators from both the Democratic and Republican side, 
have been working for some time in trying to come up with a bipartisan 
mainstream coalition bill. We felt we were on the edge of producing 
such a proposal that we believe would have provided a very sound basis 
for health care reform for certainly this year and well into the 
future.
  But that is no longer a reality. In addition to not addressing health 
care reform, there is another opportunity that we are losing due to our 
failure to consider health care reform measures, and that is the 
opportunity to crack down on health care fraud. There is strong  
agreement between Republicans and Democrats that we need to rid our 
health care system of fraud and abuse that is costing taxpayers, 
patients, and families dearly and driving up the cost of the entire 
health care system for all Americans.

  Earlier this year, I released the results of a year-long 
investigation into health care fraud and abuse conducted by my staff on 
the Senate Special Committee on Aging. We found that health care fraud 
and abuse is rampant throughout Federal, State, and private health care 
programs, and that losses to health care fraud and abuse over the last 
5 years are almost four times the total costs to date of the entire 
savings and loan crisis.
  Defrauding the Federal and private health care programs, Mr. 
President, is shockingly simple, and Medicare and Medicaid and private 
insurers are leaving their doors wide open to fraud, inviting scam 
artists to rip off the system. According to the GAO, as much as 10 
percent of the entire health care budget is lost to fraud and abuse 
each year. That amounts to up to $100 billion a year--as much as $275 
million every single day--and more than $11.5 million every hour--in 
health care dollars lost to health care fraud and abuse.
  Mr. President, that is a staggering sum of money that we are losing 
every single day and every single hour. One of my great regrets about 
not taking up health care legislation this year is that we are going to 
be back here next year in the same position, but having lost $100 
billion more by failing to toughen our defenses against health care 
fraud. I first introduced this legislation last year. Despite strong 
agreement on the need to combat health care fraud, no action was taken. 
Then last year I introduced parts of this legislation as an amendment 
to the crime bill. It was accepted by a unanimous vote, only to be 
rejected by the House of Representatives. The House stripped it out of 
the crime bill in order to attach it to the health care reform bill. 
And now we have no health care reform, but we still have health care 
fraud. That, Mr. President, should not be tolerated a single day 
longer. That is the reason why I am standing here today to offer this 
legislation on this pending bill.
  Mr. President, the vulnerabilities to fraud exist throughout the 
entire health care system, and defrauding the system has become a 
routine way of doing business for many unscrupulous providers.
  Major patterns of abuse that plague the system are overbilling, 
billing for services not rendered, unbundling, whereby one item--for 
example, a wheelchair--is billed as many separate component parts, 
upcoding services to receive higher reimbursements, or providing 
inferior products to patients. Some of the other widespread scams are 
paying kickbacks and inducements for referrals of patients, falsifying 
claims and medical records to fraudulently certify an individual for 
Government benefits, billing for so-called ghost patients, and even 
paying drug addicts or other patients to have their blood drawn or have 
unnecessary medical tests performed so the fraudulent doctor or clinic 
can be reimbursed by Medicare or private insurance.
  Our health care system is rife with abuse, and Medicare and Medicaid 
and private insurers are leaving their doors wide open to the fraud. 
Here are several examples:
  Physician-owners of a clinic in New York stole over $1.3 million from 
the State Medicaid Program by fraudulently billing for over 50,000 
phantom psychotherapy sessions never given to Medicaid recipients.
  A speech therapist submitted false claims to Medicare for services 
rendered to patients who were already dead.
  A home health care company stole more than $4.6 million from Medicaid 
by billing for home care provided by unqualified home care aides. In 
addition to cheating Medicaid, this company placed elderly and disabled 
individuals at risk from untrained and unsupervised aides. Nursing home 
operators charged personal items such as swimming pools, jewelry, and 
even the family nanny, to Medicaid cost reports.
  Large quantities of sample and expired drugs were dispensed to 
nursing home patients and pharmacy customers without their knowledge. 
When complaints were received from the nursing home staff and patient 
relatives regarding the ineffectiveness of the medications, one of the 
scam artists stated ``those people are old, they will never know the 
difference, and they will be dead soon anyway.''
  One scheme involved the distribution of $6 million worth of reused 
pacemakers and mislabeled pacemakers intended for animal use only. 
Think about that. We have people out there using pacemakers whose 
batteries have gone dead, that are totally useless. Some are intended 
for animals only and are being implanted in human bodies. The scheme 
involved kickbacks to cardiologists and surgeons to induce them to use 
pacemakers that already expired.
  Then we have a clinical psychologist who was indicted for having 
sexual intercourse with some of his patients and then seeking 
reimbursement from a Federal health plan for these encounters as so-
called therapy sessions.
  These cases are just the tip of an enormous iceberg of fraud and 
abuse that is costing taxpayers and patients dearly, and freezing out 
millions of Americans from affordable health care coverage.
  To give you an illustration as to how health care fraud can strike 
very close to home, I will offer another example of a Medicare 
beneficiary living in a boarding home in Saco, ME. She fell and 
sustained a very small cut on her forearm. It was less than an inch 
long. It required no medical treatment by a physician. The cut healed 
within 2 weeks, without requiring any doctor's services. At most, she 
used 14 of the so-called waterproof, 6- by 8-inch dressings, at a total 
cost, actually, of less than $40. An unscrupulous medical supplier, 
however, billed Medicare $850 for 50 of these dressings, which were 
never medically necessary. In addition, that same supply company billed 
Medicare $2,660 more for these dressings, plus  gels, which were never 
needed by the patient. So, in essence, you and me and everybody here in 
this country ended up paying almost $3,800 for the treatment of a cut 
of less than one-inch long that never required a doctor's attention or 
services.

  The amendment I am offering today, Mr. President, will toughen our 
defenses against such health care fraud and abuse. There is broad 
agreement on both sides of the aisle on the changes proposed by this 
amendment in order to stop the fraudulent providers from bleeding 
billions of dollars from our health care system.
  The provisions of this amendment, to give an example, were included 
in the legislation I first introduced last year, and they are included 
in the so-called mainstream coalition health care reform bill. They are 
also included in Senator Dole's health care reform bill, Senator 
Mitchell's reform plan, and, indeed, even the Clinton administration's 
health care reform package.
  Everybody agrees with the provisions in this amendment-- President 
Clinton, Mrs. Clinton, Senator Dole, Senator Mitchell, the mainstream 
coalition. Everybody agrees that we need this legislation.
  Ridding the health care system of this kind of fraud and abuse, as I 
pointed out, is not a partisan issue. Rather, the proposals I am 
offering in this amendment today are based on recommendations of a 
Health Care Fraud Task Force convened by the Bush administration. They 
have been endorsed by the current administration, numerous law 
enforcement agencies, and many health care provider groups.
  The amendment will do the following:
  It will give prosecutors stronger tools and tougher statutes to 
combat criminal health care and fraud.
  It should allow health care plans and the Government to kick the so-
called bad apples out of the system entirely.
  It will create much tougher civil penalties and remedies for fraud 
and abuse.
  It will coordinate enforcement programs and beef up the investigative 
resources which are inadequate.
  The amendment does this by financing additional health care fraud 
enforcement resources with proceeds derived from forfeiture, fines, and 
other health care fraud enforcement efforts.
  While toughening the system against fraud and abuse, this amendment 
also gives guidance to health care providers and industries on how to 
comply with fraud rules, so they will know what is or is not prohibited 
activity.
  I firmly believe the vast majority of health care providers are 
honest professionals whose highest priority is quality care for their 
patients. This amendment is in no way designed to impugn the integrity 
of these dedicated individuals.
  Unfortunately, however, health care fraud has become a very lucrative 
business and some dishonest providers will do all they can to 
manipulate the system. Just as Willie Sutton said he robbed banks 
because ``that's where the money is,'' many scam artists seek out 
health care fraud because they know that the health care budget 
provides one of the biggest pots of money available for the taking --
and one that has very little chance of them being caught.
  While the Federal and State law enforcement officials are making some 
progress cracking down on health care fraud, the current enforcement 
scheme has resulted in a system whereby the  mouse has outsmarted the 
mousetrap. Those defrauding the system are ingenious and motivated, 
while the Government and private sector responses cannot hope to keep 
pace with the sophistication and cunning of those individuals they 
pursue. We must take steps to stop this abuse now.

  Our current system of fighting health care fraud is like trying to 
put out a forest fire with a garden hose. By providing tougher tools, 
better coordination, and more resources, this amendment will help equip 
the law enforcement and health care officials to fight fraud and abuse 
effectively.
  I fully expect that this amendment will be opposed by those who argue 
that we should wait another year, wait until next year, to come back 
and start the debate all over again on health care reform. That means 
maybe sometime in March the debate will begin, maybe sometime next 
August or September we will conclude that debate and maybe, finally, we 
will have some kind of health care fraud legislation.
  As I indicated before, Mr. President, that means we are out another 
$100 billion. That means we are out another $275 million a day. That 
means we are out another $11.5 million an hour. We sit here and say, 
well, wait until next year.
  Mr. President, I do not think we can afford to wait until next year. 
Over 300 days have elapsed since the Senate passed its crime bill 
containing some of these health care fraud provisions, and with the 
estimates that I have just reeled off, that we are losing these $275 
million every day, these 300 days could represent over $85 billion lost 
to health care fraud and abuse just since the Senate passed its crime 
bill last year.
  So here we are, Mr. President, just days before we are due to adjourn 
and there is no health care reform bill in sight. While it was my hope 
we could have passed a health care reform bill this year, that is not 
going to be the case.
  The only ones who are benefiting from this delay on this important 
issue are the ones who are bilking billions from our system. The very 
big losers are going to be the American people, taxpayers, patients, 
and families who cannot afford health care coverage now because the 
premiums and the health care costs are padded to cover these exorbitant 
costs that are being lost to the scam artists.
  Mr. President, I ask that the section-by-section description of my 
amendment be placed in the Record.
  I urge my colleagues to accept this amendment.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                      Section-by-Section Analysis

       The Cohen legislation establishes a stronger, better 
     coordinated federal effort to combat fraud and abuse in our 
     health care system. It expands criminal and civil penalties 
     for health care fraud to provide a stronger deterrent to the 
     billing of fraudulent claims and to eliminate waste in our 
     health care system resulting from such practices. It also 
     seeks to deter fraudulent utilization of health care 
     services.
       Section 101.a. All-Payer Fraud and Abuse Control Program: 
     The Secretary of Health and Human Services and the Attorney 
     General are required to jointly establish and coordinate an 
     all-payer national health care fraud control program to 
     restrict fraud and abuse in private and public health 
     programs. The Secretary and Attorney General would be 
     authorized to conduct investigations, audits, evaluations and 
     inspections relating to the delivery and payment for health 
     care; would be required to arrange for the sharing of data 
     with representatives of health plans; and would have to 
     establish standards by regulation to carry out the program.
       b. Health Care Fraud and Abuse Control Account: To 
     supplement regularly appropriated funds, a special account 
     would be established to fund the all-payer program, managed 
     by the Secretary and Attorney General. All criminal fines, 
     penalties, and civil monetary penalties imposed for 
     violations of fraud and abuse provisions of this legislation 
     would be deposited into the account and used for carrying out 
     the proposed requirements.
       Section 102. Application of Federal Health Anti-Fraud and 
     Abuse Sanctions to All Fraud and Abuse Against Any Health 
     Plan: The provisions under the Medicare and Medicaid program, 
     which provide for criminal penalties for specified fraud and 
     abuse violations, would apply and be extended to similar 
     violations for all payers in the health care system. The 
     violations would include willful submission of false 
     information or claims, acceptance of kickbacks, bribes or 
     rebates in return for referral for services and other 
     violations currently included under Medicare. Penalties would 
     include fines and possible imprisonment. The Secretary could 
     also consider community service opportunities.
       Section 103. Health Care Fraud and Abuse Guidance: Provides 
     mechanisms for further guidance to health care providers on 
     the scope and applicability of the anti-fraud statutes in 
     order to better comply with these statutes. The further 
     guidance would be provided by the modifications of existing 
     safe harbors and the promulgation of new safe harbors; 
     interpretive rulings providing the HHS' Inspector General's 
     interpretation of anti-fraud statutes; and special fraud 
     alerts setting activities that the Inspector General 
     considers suspect under the anti-fraud statutes.
       Section 104. Reporting of Fraudulent Actions Under 
     Medicare: The Secretary is required to establish a program 
     through which Medicare beneficiaries may report instances of 
     suspected fraudulent actions on a confidential basis.
       Section 201. Mandatory Exclusion from Participation in 
     Medicare and State Health Care Programs: The Secretary 
     currently is required to exclude individuals and entities 
     from Medicare and Medicaid based on convictions for program-
     related crimes relating to patient abuse or neglect. This 
     section would extend the Secretary's authority to felony 
     convictions relating to fraud and felony convictions relating 
     to controlled substances. Currently the Secretary is 
     permitted, but not required, to exclude those convicted of 
     such an offense. Adoption of this proposal would better 
     recognize the seriousness of such offenses and ensure that 
     beneficiaries are well protected from dealing with such 
     individuals.
       Section 202. Establishment of Minimum Period of Exclusion 
     for Certain Individuals and Entities Subject to Permissive 
     Exclusion from Medicare and State Health Care Programs: 
     Mandatory exclusions contain a minimum period of exclusion 
     for five years. This section establishes a minimum period of 
     exclusion expressly determined by statute for certain 
     permissive exclusions, such as three years for specific 
     convictions.
       Section 203. Permissive Exclusion of Individuals with 
     Ownership or Control Interest in Sanctioned Entities: Some of 
     the current permissive exclusions are ``derivative'' 
     exclusions--that is, they are based on an action previously 
     taken by a court, licensure board, or other agency. Current 
     law allows permissive exclusion authority for entities when a 
     convicted individual has ownership, control or agency 
     relationship with such entity. The bill would extend the 
     current permissive exclusion authority for entities 
     controlled by a sanctioned individual to individuals who held 
     a controlling interest in sanctioned entities at the time of 
     the violation.
       Sections 204-205. a. Actions Subject to Criminal Penalties: 
     The current employer-employee exception to the anti-kickback 
     statute would be clarified to prohibit payment to employees 
     based on value and volume of referrals to the employer.
       b. New Exception for Capitated Payments: In order to allow 
     basic managed care arrangements to provide incentives for 
     preventive care and to provide coinsurance and deductible 
     differentials (disclosed in writing) designed to encourage 
     enrollees to utilize a preferred provider network, the bill 
     provides certain exceptions to both the criminal anti-
     kickback provision and civil monetary penalties provision.
       A new exception has been created from the criminal anti-
     kickback statute for capitated payments.
       Section 206. Intermediate Sanctions for Medicare Health 
     Maintenance Organizations: The Secretary would be able to 
     impose civil monetary penalties on Medicare-qualified HMOs 
     for violations of Medicare contracting requirements.
       Section 301. Establishment of the Health Care Fraud and 
     Abuse Data Collection Program: The Secretary would create a 
     comprehensive national data collection program for the 
     reporting of information about final adverse actions against 
     health care providers, suppliers, or licensed practitioners 
     including criminal convictions, exclusions from participation 
     in Federal and State programs, civil monetary penalties and 
     license revocations and suspensions.
       Section 401. Civil Monetary Penalties: The provisions under 
     Medicare and Medicaid which provide for civil monetary 
     penalties for specified violations would apply to similar 
     violations for all payers in the health care system. The 
     violations would include billing for services not provided, 
     submitting fraudulent claims for payment, hospitals giving 
     financial incentives to physicians to reduce or limit care 
     provided to hospital inpatients, and other violations 
     currently included under the Medicare program.
       The provisions would also clarify that repeatedly claiming 
     a higher code, or repeatedly billing for medically 
     unnecessary services, for purposes of reimbursement is 
     prohibited and subject to civil monetary penalties.
       An intermediate civil monetary penalty would also be 
     established for criminal anti-kickback violations.
       The provision also clarifies that the routine waiver of 
     Medicare Part B copayments and deductibles would be 
     prohibited and subject to civil monetary penalties, although 
     exceptions are provided.
       In addition, retention by an excluded individual of an 
     ownership or control interest of an entity who is 
     participating in Medicare or Medicaid would be prohibited and 
     subject to civil monetary penalties.
       Finally, the amount of civil monetary penalty that can be 
     assessed is increased from $2,000 to $10,000.
       Section 501. Health Care Fraud: Establishes a new health 
     care fraud statute in Title 18. Provides a penalty of up to 
     10 years in prison, or fines, or both for knowingly executing 
     a scheme to defraud a health plan in connection with the 
     delivery of health care benefits, as well as for obtaining 
     money or property under false pretenses from a health plan. 
     This section is patterned after existing mail and wire fraud 
     statutes.
       Section 502. Forfeitures for Federal Health Care 
     Offenses: Requires the court, in imposing sentence on a 
     person convicted of a Federal health care offense, to 
     order the forfeiture to the United States of property used 
     in commission of an offense if it results in a loss or 
     gain of $50,000 or more and constitutes or is derived from 
     proceeds traceable to the commission of the offense.
       Section 503. Injunctive Relief Relating to Federal Health 
     Care Offenses: This provision expands the scope of the 
     current injunctive relief section by adding the commission of 
     a health care offense. This provision allows the Attorney 
     General to commence a civil action to enjoin such violation.
       Section 601-604: Payments for State Health Care Fraud 
     Control Units: Provides language to establish state health 
     care provider fraud control units modeled on the current 
     state Medicaid Fraud Control Units. The jurisdiction of these 
     units would be expanded to include investigation and 
     prosecution of provider fraud in other federally-funded or 
     mandated programs. The proposal also allows the states to 
     choose whether to conduct investigations and prosecutions for 
     patient abuse related crimes occurring in board and care 
     facilities and other alternative residential settings.
       The HHS' Inspector General would continue oversight and the 
     state units would detail its activities in its yearly grant 
     applications. This section also contains a recitation of the 
     units' original authorization language as currently contained 
     in the Social Security Act, and also allows the units to 
     participate in the all-payer fraud abuse control program.

  Mr. BIDEN. Mr. President, I rise for three purposes.
  First, I compliment the Senator from Maine. He has worked long and 
hard on dealing with what is a multibillion-dollar problem. A report 
which my committee issued several years ago established that there were 
a minimum of $70 billion in health care fraud per year. That estimate 
is probably a little low.
  I compliment Senator Cohen for sticking to this issue and being as 
involved in trying to do something about this fraud that takes place 
with as much diligence and insight as he has. That is the first reason 
I rise.
  The second reason is that a number of my colleagues have said, ``Joe, 
why was this dropped from the crime bill?'' The truth of the matter 
is--and the Senator from Maine did not suggest anything other than 
this--that the vast bulk of what the Senator has introduced was not in 
the crime bill. It was not a part of the crime bill, and it was not 
dropped from the crime bill.
  There were several very important amendments, which I supported, 
cosponsored, if I am not mistaken, with the Senator from Maine, and 
fought to keep in the crime bill. One was a new health care fraud 
offense, that is in title 18, Criminal Code of the United States, to 
set up a new offense called health care fraud. Second, we had in the 
crime bill a forfeiture provision for health care fraud cases. That is 
where the Government recovered against a defendant where they found a 
defendant guilty of being engaged in health care fraud, they could go 
out like they can in drug cases and through the forfeiture process 
acquire the fruits of that fraud.
  Third, it had a new so-called RICO provision, predicate, that we 
placed in the crime bill.
  Fourth, a few other titles including a total of 18 provisions 
relating to the Criminal Code.
  But this amendment--I am not commenting on the merits of the 
amendment--goes well beyond what was in the crime bill. Many of the 
items are things that I personally support and I think we could 
probably, the bulk of us, reach agreement on. But these provisions I 
think have to be considered in the context where everybody interested 
can be involved.
  This amendment, for example, includes a provision which creates a 
special fund for the proceeds of health care fraud to be used by other 
agencies without further appropriations. I am not sure that is a bad 
idea. I think that is probably a pretty good idea. In my experience 
that usually causes apoplexy around here when we set up separate funds 
which bypass appropriators. It creates a new interagency enforcement 
structure.
  Conceptually I think that is a good idea because we have so much 
overlapping that goes on. Quite frankly the Justice Department does not 
know nearly enough about this area, whereas HHS and the others do know 
a great deal, and to call on the multiple talents of the interagency 
structure I think would make sense.
  It also refuses many of the medically related fraud provisions which 
the Finance Committee needs to consider. It does some other things as 
well.
  Again, the second purpose of my rising today is to suggest that, to 
answer the question at least half a dozen of my colleagues have asked 
me on both sides of the aisle: ``Hey, Joe, why did you drop this in the 
crime bill?''
  Mr. COHEN. Will the Senator yield?
  Mr. BIDEN. Certainly. I yield to the Senator.
  Mr. COHEN. I believe all the provisions in this amendment that are 
made to title 18 were added to the crime bill on the floor.
  Mr. BIDEN. That is correct. But I understand the Senator goes beyond 
the title 18 provision.
  MR. COHEN. That is true. But those provisions were dropped in 
conference because I understand the House objected. They wanted to wait 
to consider the provisions as part of health care reform.
  Mr. BIDEN. That is correct. Both the Republicans and the Democrats in 
the House side wanted it dropped. And, quite frankly, a number of 
people on this side, and leadership on both sides, wanted it dropped 
because at the time they all wanted it included in a large health care 
bill.
  As the Senator from Maine knows, I share his view. I was, skeptical 
that would occur and, thought we should not waste any time anyway 
whether or not they would be included later.
  The only point I wish to make is, it is not a criticism but an 
explanation, I hope a clarification. What the Senator is offering goes 
well beyond the title 18 provisions which were dropped.
  The third point I wish to make is, regardless of what the outcome of 
this vote will be--and if the Senator is going to keep it on this bill 
and vote on it or another bill, I do not know what his preference is--
but regardless of what happens, if it fails or succeeds, I can assure 
him that it is my intention--and this is not in any way to dissuade 
people from supporting the Senator but to make the point that I think 
that we must, and the Senator from Maine has introduced a bill as well 
as I have in the Judiciary Committee--if this does not move forward we 
must create enough of an awareness and a consensus on acting on dealing 
with health care fraud in the beginning of the next term. So it is my 
intention to hold hearings in the Judiciary Committee. Again I do not 
say this as a way to delay action to tell the Senator I am going to do 
this anyway. I would only do it with his help, input, and cooperation 
as a member of the Judiciary Committee.
  So I just want to make the three points. One, I compliment him for 
being so vigilant and persistent on this multibillion-dollar issue; 
second, much of what the Senator suggests in his amendment is 
noteworthy but was not of part of the crime bill; third, regardless of 
the outcome of this vote whenever it takes place on this amendment, I, 
as Chair, assuming that will be the case next year, will continue to 
pursue this with him.
  Mr. COHEN. If the Senator will yield----
  Mr. BIDEN. I am happy to yield the floor.
  Mr. COHEN. Mr. President, to make it very clear, this legislation 
that I am proposing basically is endorsed by everyone. President 
Clinton has the same provisions in his legislation with health care 
reform. Senator Mitchell has the same provisions. Senator Dole has the 
same provisions. The mainstream coalition has the same provisions. 
There is no disagreement in terms of the necessity of this legislation.
  The Senator is correct. I attached the criminal provisions to the 
crime bill. Those were dropped. This amendment goes beyond that.
  But even this large amendment is supported by virtually everyone. I 
know of no dissent. I am simply suggesting time is running out. We lost 
$100 billion this year to health care fraud and we cannot afford to 
delay further..
  What I am saying is we do not have a health care bill. We are still 
losing money, $11.5 million an hour every day. We have an opportunity 
to correct that with no dissension that I am aware of in this body.
  Mr. BIDEN. If the Senator will yield for just a moment, Mr. 
President, I do not take issue with that at all. I do not disagree with 
anything the Senator just said. I just was clarifying because so many 
people asked me whether all of this had been considered.
  I yield the floor.
  Mr. SPECTER. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the role.
  Mr. HARKIN. 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. HARKIN. Mr. President, if I might, I have tried to listen to the 
explanation of the Senator from Maine of his amendment. Evidently, it 
has to do with waste, fraud, and abuse. I will take the time 
momentarily to go through the provisions in our bill that we have 
already done on waste, fraud, and abuse.
  I would say to the Senator from Maine that this amendment, as I 
understand it, is 58 pages long. It is a major piece of legislation. I 
say to the Senator from Maine that this is part of health care reform. 
I hope the Senator will not want to open that can of worms. I thought 
we had all kinds of admonitions from the Republican side and the 
Republican leader that we should not bring up health care reform, that 
other things may happen. If this happens here, I can tell you there are 
a bunch of health care reform amendments on this side. If the Senator 
wants to, we will start the health care reform debate and we will be 
here for the next week and a half on it.
  Mr. COHEN. That is fine with me. I am trying to get a forum where we 
get this legislation passed. We have delayed year after year. Nothing 
has been done with this issue in a substantive fashion. There is no 
disagreement. If you want to take the time to go through the 58 pages, 
that is fine with me. This proposal is contained in President Clinton's 
proposal and in Senator Dole's proposal. There is no disagreement on 
this. Yet, it is not simply a health care reform proposal, it is 
anticrime as well. This is criminal activity that is taking place on an 
hourly basis and we are being robbed; being robbed blind. We simply 
say, ``Well, we will get to it sometime next year, maybe.''
  Mr. HARKIN. I will simply respond that we have addressed a lot of 
these issues in our bill. As I said, this is a major piece of 
legislation that should not find its way on an appropriations bill.
  I understand the Senator's frustration. I happen to be frustrated 
too. We have been debating health care reform for years around here. We 
are spending $1 trillion a year. What the Senator is talking about is 
peanuts compared to what he says about being robbed from the public out 
there day after day with all kinds of fraud, all kinds of prices with 
all kinds of discrimination, preexisting condition clauses, lack of 
portability. All of those things are happening out there day after day. 
We are not addressing those.
  I sympathize with the Senator from Maine. A lot of things out there 
we ought to be addressing this year on health care reform. But we did 
not get it done.
  Again, we have been through that debate before. I had my say on that 
yesterday. I do not mean to say it again. This is the appropriations 
bill to fund the Department of Education and the Department of Health 
and Human Services and the Department of Labor; the National Institutes 
of Health, biomedical research.
  There are some things we can do on waste, fraud, and abuse. We have 
done it every year. Senator Specter and I every year have had hearings 
on this. We figured out what we could do within the confines of the 
appropriations process to go after waste, fraud, and abuse. We have 
done a lot in the last 3 or 4 years that we have worked together on it.
  For example, the administration proposed some cuts in the Medicare 
payments safeguard activities. We held hearings that showed that for 
every $1 we spent on payment safeguards, we saved $14 in catching the 
very waste, fraud, and abuse items that the Senator from Maine is 
talking about. So we put money back in there for that. We also added $3 
million for Medicaid fraud demonstration projects. This bill also 
suspends workers compensation benefits to individuals who have been in 
prison for a felony offense. We hear a lot of talk about that. We took 
care of it in here. This bill provides for increased monitoring of SSI 
beneficiaries disabled by drug addiction and alcoholism, to prevent 
fraud and abuse. We heard a lot of stories about that where people were 
supposed to go to alcoholism programs and drug treatment programs. They 
did not do it, and in some cases used Federal funds to support 
substance abuse. So we tightened down on it in this bill.
  So I think Senator Specter and I and the members of this subcommittee 
have worked very hard and very diligently to go after waste, fraud, and 
abuse and save the taxpayers tens of millions of dollars in each of the 
last several years.
  Every year we confront this. We have hearings to find out what else 
we can do to cut down on it.
  Again, I am sure there are other things in the whole health care 
field that can be done and should be done to cut down on further waste, 
fraud, and abuse.
  That is not in the purview of this appropriations committee, not at 
all. It would be an apt subject for a health reform bill. I daresay in 
the last couple of weeks I proposed a piece of legislation on health 
care reform and it had these provisions in it, too. But this is not the 
place for it.
  Again, we are going to have health care reform next year. I suggest 
that is the place for the Senator from Maine to work to try to get his 
provisions in that bill, not on this appropriations bill.
  Mr. SPECTER addressed the Chair.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. SPECTER. Mr. President, at the outset I compliment my 
distinguished colleague from Maine for the work which he has done 
culminating in the legislation which he is proposing here today. He has 
argued the need for all of these items, and I agree with him totally. I 
serve with him on the Aging Committee where he has held these hearings 
which have produced this evidence leading to this legislation. He is 
the ranking member of that committee and has done extraordinary work 
there.
  This is a very, very important piece of legislation. I have been 
working with him, along with Senator Chafee and others, on the so-
called Chafee task force'' which has produced legislation, where these 
provisions are a part. It is true that he brought several of the 
provisions them forward on the crime bill, and they were passed 
successfully. The difficulty which is presented here, on this bill, 
which I have talked to Senator Cohen about privately, is that it will 
delay the passage of this appropriations bill on Labor, Health, and 
Human Services, and Education.
  The distinguished Senator from Maine quite accurately says he wants 
to see this bill passed this year. I agree with him. But I think the 
reality is it will not be passed this year because it will go back to 
the House and the House will object to it as the House did when these 
provisions were on the crime bill.
  And the reason they will object is that it is within the jurisdiction 
of the Ways and Means Committee and it is legislation on an 
appropriations bill, although in a broad sense it is certainly relevant 
or germane or within the context of this general category of 
legislation.
  What happens, as those of us who are working on the floor today know, 
is that we are in the very last few days of this session and there are 
a number of amendments which a number of other Senators wanted to offer 
which did not relate to health care, as do the provisions of Senator 
Cohen's amendment. So to that extent, it is a more logical spot here 
than on some of the other amendments to which other Senators want to 
add.
  Those other Senators have been persuaded not to bring their 
amendments to this bill, but instead there will be a vehicle which the 
majority leader has set aside, the appropriations bill for the District 
of Columbia, where there is already an amendment pending to an 
amendment in disagreement which may have to go back to the House of 
Representatives. And it is the thought of the ranking Republican on the 
full committee, Senator Hatfield, who has discussed this matter also 
with Senator Cohen, that Senator Cohen's amendment be offered to an 
amendment in disagreement on the District of Columbia appropriations 
bill.
  The concern that I had and have just expressed to the Senator from 
Maine is there are other Senators who want to add health care 
amendments to this pending bill. Frankly, I would like to add Senate 
bill 18, my health care reform bill, because I certainly am not happy 
to see the session end without reform legislation. But I think it is 
plain that at this stage, we are not going to be able to deal with 
health care generally.
  So that is where we are. If the distinguished Senator from Maine 
presses the issue, I think he will succeed; I think he will succeed. 
The HUD appropriations bill had, I think 43 votes in support of 
amendments which were not nearly as attractive as what the 
distinguished Senator from Maine is offering. He has offered it before, 
and I have supported it, and it is a very difficult amendment to 
disagree with on the substance and on the merits.
  But the consequence will be, I think, that we will have a continuing 
resolution on Labor, Health, and Human Services, and Education, and the 
consequence of that is that there may be less appropriated for those 
important items because a continuing resolution often takes the lesser 
of the 1994 bill, which is in existence now and the conference report, 
correct? We always turn to learned staff to be absolutely sure on these 
technical matters. That is what likely will happen, and that will 
result in the reduction of appropriations for Health, Education, Human 
Services, and Labor, which I know the distinguished Senator from Maine 
would not want to see happen.
  So that is the procedural posture we are in. Senator Cohen has every 
right to proceed with his amendment here. There is no doubt about that. 
It is a very, very important amendment, and it should have been 
accepted long ago. And he is right when he talks about $100 billion in 
waste, fraud, and abuse, and it ought to be enacted. And, as the 
distinguished Senator from Iowa, Senator Harkin, has pointed out, we 
have dealt with it within the confines of this appropriations bill to 
the extent we could. But the fact, too, is that we have not done as 
much as a new substantive bill on this subject would do.
  So it is my hope that the distinguished Senator from Maine will not 
press the issue. I think if it is pressed, and again I repeat, he has 
every right to press it, we are going to have Senators coming to the 
floor with other health care amendments and Senators on other issues, 
and then the ranking member, Senator Hatfield, is talking about taking 
the bill down in the hope that these amendments will be offered 
somewhere else.

  So we are just a hair's breadth away from getting this bill passed, 
and I leave it to my distinguished colleague from Maine.
  The PRESIDING OFFICER. The Senator from Maine.
  Mr. COHEN. Mr. President, during my service here in the Senate, I 
tried not to be an obstructionist, as some of us are frequently 
labeled. I have tried always to make some constructive proposals, and 
that is simply what I am trying to do in this particular case.
  If I were allowed by Senate rules to do so, I would hold up a little 
6-by-8-inch waterproof dressing to show the American people that this 
item which is being used to treat a scratch or a cut less than an inch 
long is costing them $3,800. I would bring over a leg prosthesis that I 
used during a press conference to try to draw the public's attention to 
what is taking place. It was remarkable. It was a leg prosthesis, but 
it looked like it came off a mannequin in Macy's department store 
window. It was a shell, plastic; it was from the knee down, for someone 
who has lost the lower part of their leg. What was interesting about 
this particular device, this prosthesis, I should say, is that it had a 
right calf and a left foot. Pretty extraordinary for someone who might 
have to wear that because he or she has lost a leg.
  The leg prosthesis was shoddily made and totally useless. But guess 
what the supplier billed you and me for? Take a wild guess. This thin 
piece of plastic, this piece of trash, was billed to the Federal 
Government to the tune of $8,800.
  The Health Care Financing Administration approved payment of $1,400. 
When I held it up and looked at it, I thought it was not worth even 14 
cents if it couldn't be used. But we were billed $8,800 and the Federal 
Government approved $1,400 as a reasonable price for something that was 
completely worthless.
  Then, we have the issue of blood sugar monitoring kits for those who 
suffer from diabetes. In the Washington Post, there is an ad saying you 
can buy this at such-and-such store, and with a manufacturer's rebate, 
you can purchase the kit for roughly $10 to $12.
  You know what the suppliers are billing you and me and all the 
taxpayers in this country? Roughly $250 per kit. And how are they able 
to do this? They take each item in the kit, the lance and the other 
items in the kit, and they bill us separately. It is called unbundling. 
So each item gets billed separately, and the total comes up to roughly 
$250 for an item that would cost $10 to $12 off the shelf.

  There is an explosion of this type of fraud taking place. That is why 
I felt compelled to offer this amendment. I introduced the bill last 
year and no action was taken on it. I offered--and I believe the 
Senator from Delaware is correct in clarifying this--I offered the 
criminal provisions of this amendment to the crime bill, when it was on 
the Senate floor and accepted unanimously, but then stripped out by the 
House for the same reasons that Senator Biden expressed. The House Ways 
and Means Committee said this is a finance matter, a tax matter; it is 
our jurisdiction. I would like them to explain to the American people 
why there has been no action taken.
  I have been told, well, just wait until the health care bill comes 
along. We have no health care bill. Now we are told wait until next 
year. A familiar expression up in New England, when we are still 
waiting for the Boston Red Sox, to win that pennant again, is: Wait 
until next year; we will be back next year.
  I am not sure how much longer we can afford to wait. I am not sure 
how much longer the American people are going to tolerate us not taking 
action. We lost $100 billion last year and the year after, and now we 
will lose another $100 billion this year. I do not know how long it is 
going to take to get a health care bill next year. We come back toward 
the end of January. We go out for the Lincoln Day recess. We are out 
most of February. We get serious about March or April. And then, the 
debate starts all over again. We will have either the mainstream 
coalition proposals as a basis to start off with, or maybe the Dole 
proposal. Or we will have another, probably, a sequel to Senator 
Mitchell's proposal, perhaps in another form. And we are off in 
debating, and all the interest groups start lobbying us. We start 
taking more and more time to work our way through the complexities of 
the health care system. In the meantime, I dare say we are probably 
into late next year, and still no health care bill, no antifraud 
provisions.
  So this is not intended as a major proposal to amend our health care 
system. What this is designed to do is to give our prosecutors a health 
care fraud statute. Right now, they have to prosecute these individuals 
by going through mail fraud and wire fraud. It is very complicated and 
time consuming. They want a statute they can go right to and say: We 
are going to prosecute you if you try to defraud the Federal taxpayers 
and the private health insurance. We are going to prosecute you, and we 
have the law here to do it.
  They do not have that now. We can talk about procedure, or other 
people having amendments that they can come forward with to offer 
tonight and kill the bill. But someone is killing our system. And if 
there is anger out in America today directed toward us, this is another 
classic example of it. We say, well, our procedure does not allow for 
it. The House wants it to go through Ways and Means. They have to have 
hearings. It does not matter that the President wants it, or the 
majority leader wants or the minority leader wants it. It does not 
matter. We have to have the jurisdiction all sorted out. That may take 
some time.
  So, Mr. President, I must say that we have waited too long. This is 
something that I think the American people should be justifiably 
outraged about, saying: Do something. If we cannot pass a reform bill 
because of complexity, this is pretty straightforward; this is pretty 
simple. This gives a tool to the prosecutors of our Federal Government 
to go after those who would defraud us, day in and day out--$11.5 
million an hour, $275 million a day, $100 billion a year--and we are 
sitting around saying, well, this isn't in the committee's 
jurisdiction; overlap; delay. You have to wait until next year.
  I do not think the American people are going to accept that, not on 
our part. I do not think they should accept it. If we are going to be 
met with their anger at the polls in November, I think it is justified. 
They will look at this and see we had an opportunity and we passed up 
that opportunity with the invocation of: Let us just wait for next 
year; we will get it a year from now.
  Mr. HARKIN. Will the Senator yield for a question?
  Mr. COHEN. Yes.
  Mr. HARKIN. First of all, I cannot find anything I disagree with the 
Senator on. As a matter of fact, we have had hearings on this, almost 
everything he mentioned, except the prosthesis. For example, we looked 
excessive payments for such items as blood glucose monitors, bandages, 
and TENS units. We have all kinds. And every year, we have hearings to 
expose wasteful spending and how we can combat it.
  And so with the mechanisms in our bill, we try to put more emphasis 
on activities such as the payment safeguards program. This is where 
Medicare hires investigators, accountants, and auditors to go after 
fraud, waste, and abuse. They are woefully understaffed. And as I 
mentioned in my comments, we have proven from GAO and from the 
inspector generals that for every dollar we put into these activities, 
we have actually saved, in real, hard cash dollars in that given year, 
$14 for every dollar we put in. In every administration, this was no 
different from the one before. Both administrations were asked to put 
in the payment safeguard program.
  We are in the odd position of trying to put money into the program. 
Talk about spending around here. This is one program we put money into 
that actually pays the taxpayers back. I assume at some point there, 
the cost-benefit ratio is not that great. But we have not even 
approached that yet.
  I have not read the Senator's amendment. My staff tells me that much 
of what is in the Senator's amendment was in amendments offered by 
myself and others in different, various health reform bills that come 
through the Labor Committee. Much of this was in the Labor Committee's 
bill. And some was in the Dole bill. So there is broad general 
agreement, I think, for what the Senator is trying to do.

  But, again, I just have one question. Take the blood glucose 
monitors. We know what the prices were on that, and they were way out 
of line. How does the Senator's bill get at that? How would you prevent 
that from happening? What is the mechanism in your bill that would 
prevent durable medical equipment, such as blood glucose monitors, or 
TENS units, from being overpriced in the beginning, in the future?
  Mr. COHEN. It does several things. No. 1, it gives the Justice 
Department a single statute to go to to prosecute those individuals 
who, in fact, are engaging in fraudulent behavior.
  The amendment will also address the problem by getting more people 
conducting oversight and policing the system. As I understand it, we 
have a caseload problem in going after those who are fraudulently 
overbilling our system. In the two major Federal law enforcement 
agencies, only 450 Federal positions investigate health care fraud. 
This works out to about one investigator for about 8 million claims. 
One investigator has to oversee 8 million claims that are coming 
through the pipeline. With enforcement and oversight capacity as low as 
this, catching fraud is almost impossible.
  We simply do not have enough people. But what we ought to be doing is 
creating a system sending forth a signal saying, if you engage in 
fraud, we have a single statute the Justice Department is going to turn 
to, we are going to penalize you, collect it, and we are also going to 
expand the oversight ability on the part of the Federal Government.
  Mr. HARKIN. If the Senator will yield further, I understand. The 
problem is, as I understand it--and we looked into this in great 
detail--take the blood glucose monitor, for example, which was 
drastically overpriced. I sent a staff person down to a drug store and 
bought one for $39. Yet HCFA was allowing payment as high as $500 for 
one. Just ridiculous. But it turned out that the overpricing was not 
fraudulent because it is allowed under the fee schedules set up under 
Medicare.
  So I suggest to the Senator, you might want to turn this over to the 
Justice Department. They go in there and, lo and behold, they find out 
that is part of the law.
  What we have to do is get in there and change the kind of fee 
schedules that we have in there by which these people cannot overprice 
us for these things. That is the problem. Once we get our fingers on 
it, then we can do something about it. But it is those initial 
overpricings we have a problem getting at.
  I suggest to the Senator what we really need in Medicare is to get 
away from that old fee schedule we used to have and perhaps we ought to 
have more competitive bidding. I suggest that to the Senator. That 
might take care of a lot of this.
  There is fraud. There are other frauds happening. Fraud is where 
perhaps a doctor would submit a bill for services that he did not 
render, or a hospital would submit a bill for items that they never 
provided. That is fraud. A company that makes a product and says, 
``Hey, this is worth $500.'' Well, that is what the fee schedule 
allows, and so they bid it in. That is why they are not being 
prosecuted for fraud. We need to change that underlying provision to 
provide for more competitive bidding.

  Having said that, the Senator is right on target in terms of giving 
the Justice Department more authority to go after the fraudulent 
activities that are happening out there day after day.
  But some of these other things that he brings up, I think we have to 
go under the underlying law itself and change the way that Medicare is 
able to buy these things. I just ask the Senator if he had any further 
thoughts on that?
  Mr. COHEN. This problem is the combination of two parts. It is 
correct that we pay far too much legally for some items that can be 
purchased for much less off the shelf, but we also should never 
tolerate the kind of billing that is taking place now where the 
supplier unbundles the glucose monitoring kit, thereby increasing the 
price from $12 to $250, or even $500.
  If that is not fraudulent activity, I do not know what is. That is a 
fraud upon the Government, and they are getting away with it. We do not 
have enough people: How can one investigator possibly investigate 8 
million claims?
  I am trying to create a system whereby we fund greater oversight, 
greater investigative ability on the part of the Federal Government 
than we are currently doing. There is no doubt in my mind there have to 
be changes as far as the fee schedule is concerned. But we also have 
providers who are upcoding. They simply upcode what they are supplying, 
even though it is a fraudulent upcoding, in order to get a higher price 
for something they are not furnishing.
  So there is a lot to be done. What I am suggesting is we have a 
statute, very clear, very specific, have civil monetary penalties that 
act as a deterrent, and an enforcement mechanism by the Justice 
Department that will try and discourage this. It will not catch 
everybody, but it will discourage a lot of people from engaging in the 
kind of conduct they have been engaging.
  I hear the health care industry, frankly, does not like this 
particular provision. They are worried about it. I had to explain to 
them we are talking about intentional fraudulent behavior, not innocent 
mistakes. But when a doctor or a hospital unit starts billing for 
thousands of psychotherapy sessions that never occurred, something is 
wrong. That is fraud. When you have ghost patients or patients who have 
died and you are still getting reimbursed for services rendered to 
them, when you are selling pacemakers that are dead and having them 
implanted in the human body, there is something wrong with that, or 
intended for animal use only. That is what we are really trying to get 
at with this particular statute.
  Frankly, again, the Justice Department does not oppose it. They 
support this. The President supports this. Everybody supports it. But 
we cannot take any action: It is the end of the session, the House will 
object, jurisdictional toes will be stepped upon. In the meantime, we 
are out $100 billion.
  Mr. President, I think it is a pretty straightforward amendment. It 
enjoys broad bipartisan support. I think it is long overdue. It was not 
right for the crime bill. It was not right for the health care bill, 
because we do not have one. So we are just told to wait for the pennant 
until next year.
  Mr. President, I yield the floor.
  Mr. HARKIN. I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Akaka). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. COHEN. 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. COHEN. Mr. President, I have had discussions with my friend, the 
Senator from Oregon, Senator Hatfield, with Senator Dole, and with 
other members of the Appropriations Committee. I am persuaded that, No. 
1, the amendment, if pressed to a vote, will pass; that, No. 2, we will 
send this bill back to conference where it will be dropped because of 
objections from the House, and we will then have the entire conference 
report brought back with a day or two of delay. As I indicated before, 
that is not my intent.
  My intent is not to obstruct or to delay but to try and pass 
legislation that everybody seems to be in favor of. As a matter of 
fact, just this afternoon I spoke with Director Freeh of the FBI, and 
he also assured me he would work diligently as possible to get this 
legislation passed because it is in the interest of our justice system 
to curb the fraud and waste and abuse taking place right now.
  One of the suggestions made is that, well, we still have the D.C. 
appropriations coming up. Frankly, I do not think, from my perspective, 
that that is the appropriate vehicle to start debating health care 
fraud, on the D.C. appropriations. But it appears that may be the only 
option available to me.
  I have discussed this matter with the Senator from Oregon, the 
ranking member on appropriations. He has indicated to me that he would 
be willing to urge my colleagues to make sure that I have an 
opportunity to offer this amendment once again on the D.C. 
appropriations bill, which I have agreed to do.
  I do that in the interest of accommodating not only him, since I have 
the highest respect for the Senator from Oregon, and I know of his 
interest in seeing to it that as many, if not all, of the 
appropriations bills are passed and that we not be required to go to a 
continuing resolution if at all possible.
  So I do not intend to press this to a vote this evening and I will, 
in a moment, withdraw the amendment. But I must say I want to address 
this to my colleagues. We keep talking about the anger that is out in 
the countryside. We keep looking at the poll numbers of how low we are 
in the public's opinion. We look with astonishment at some of the 
Members who have very richly deserved reputations in this Chamber and 
elsewhere but are being defeated. We ask the question why? I think this 
is an example of why, because we have something that virtually everyone 
agrees upon and yet it cannot be passed.
  So the taxpayer looks at the accumulation of the national debt and it 
is now some $4 trillion, and climbing. Annual deficits of $200 billion, 
tax increases going up. They see their tax dollars being wasted day 
after day after day and they watch us on C-SPAN or elsewhere and say 
``What are they doing? Why is somebody not trying to put a finger in 
the dike?'' This may not be a panacea but it is virtually something 
everybody wants--from the White House, to the House, to the Senate. 
Yet, because of procedural reasons or because time is running out and 
we are at the end of the session, 1 week to go, we cannot pass 
something as straightforward as a bill designed to combat fraud.
  I think that is just one of the reasons why there is such great 
public disenchantment, that we do not seem to be making any progress in 
this regard and in many others.
  So I will, for the moment, withdraw the amendment, Mr. President, and 
indicate to my colleagues that as soon as the D.C. appropriations bill 
is brought to the floor, at an appropriate time, I will, once again, 
seek recognition to introduce this amendment and hope that it enjoys 
the bipartisan support of my colleagues who have indicated that they 
cannot find anything to disagree with about the amendment except it 
does not belong on this bill. It does not belong on the crime bill and 
we have no health care bill to put it on. It does not belong on health 
and human services appropriations. ``Try D.C. appropriations, or try 
whatever else is left.'' So they say try again next year, which in all 
probability is going to be the case.

  So I think the losers are the American taxpayers. They are the 
losers, and we are all the losers. The disenchantment and cynicism will 
continue to grow.
  I withdraw my amendment.
  The PRESIDING OFFICER. The Senator has that right. The amendment is 
withdrawn.
  The amendment (No. 2593) was withdrawn.
  Mr. HATFIELD. Mr. President, I want to make an observation on this 
action taken by the Senator from Maine, [Mr. Cohen]. What he reported 
here to the floor relating to my request to him to withhold this 
amendment at this time is absolutely accurate.
  I could not help but think as he described his amendment, which he 
has so valiantly and eloquently and frequently presented here on the 
floor, in which the Senate has agreed to in the past, of an experience 
I had as a younger Member of this body. The senior Senator from 
Mississippi, John Stennis, was managing a bill and I found myself 
offering an amendment which he had described as not belonging to that 
particular bill. I recited, much like the Senator from Maine, that it 
had been tried on another bill and did not belong there and I felt like 
it was truly an orphan amendment. He responded and said, well, I will 
tell you what it is like. It is like a half-drowned rooster running 
around in a chicken yard looking for shelter. Well, that was typical of 
Senator Stennis's graphic description of things we get involved with 
here in parliamentary procedure.
  I want to assure the Senator again that even though there could be a 
question of germaneness raised on the D.C. bill, as against this 
particular bill, there is still a point of order of legislating on an 
appropriation bill that coequally would be raised on the D.C. bill as 
well as this bill. We would like to accommodate the Senator, of course, 
in any way, not foreclosing his right by withdrawing the amendment here 
to offer it on another vehicle.
  Senator Coats of Indiana, who has what has commonly been referred to 
as his trash amendment, which he has offered on different vehicles, has 
also agreed to withhold his amendment. Senator Hank Brown of Colorado 
has also agreed to withhold his amendment on this bill so that we can 
finalize action on the bill, knowing that we do have another bill with 
amendments of disagreement. This will let us concentrate any extraneous 
amendments on that bill and let us expedite this procedure, because, 
Mr. President, when it comes Friday night at midnight, I need not 
remind the Senate that we are facing the deadline of the fiscal year.
  We have a half a dozen conference reports still pending. We are going 
to have a tremendous backlog and logjam at that moment. Let us move 
these bills through now and reserve these amendments to attach or at 
least to raise and debate on the D.C. appropriations bill.
  I understand from our leadership that in discussion with the 
Democratic leadership we are not going to be put in the bind of waiting 
to bring up the D.C. conference report at midnight or quarter to 
midnight on Friday, but that the D.C. conference report will follow the 
conference report on agriculture which follows this conference report. 
So we have four more reports after that.
  But, nevertheless, all I am saying is we have another vehicle with 
amendments in disagreement which will be open to amendments. While I 
commend Senator Harkin of Iowa and Senator Specter of Pennsylvania for 
trying to expedite this bill, bear in mind, any amendment on this bill 
goes back to conference or goes back to the House. This bill includes 
funding for Low-Income Home Energy Assistance and has some of the most 
important health and welfare and educational programs. We cannot afford 
in any way to delay beyond Friday night at midnight.
  So I plead with my colleagues on both sides. Since we have 
demonstrated good faith on this side of the aisle in withholding these 
amendments at this time on this bill to expedite the Labor-HHS and 
Education bill, I hope that the leadership can move this bill rapidly 
and complete it so we can take up the agriculture appropriations 
conference report and then the D.C. conference report before we take up 
interior, Treasury, and a number of the other conference reports down 
the line.
  Mr. COHEN. Will the Senator yield for a moment?
  Mr. HATFIELD. Yes.
  Mr. COHEN. I want to respond about what the Senator said about his 
experience with Chairman Stennis and being told it is not the 
appropriate place. I see several of my colleagues here on the floor--
Senator Cochran from Mississippi, who came to the House with me at the 
same time. I gave my maiden speech in the House of Representatives back 
in 1973. It was a speech pertaining to an amendment I offered to the 
energy bill. I offered an amendment to the energy bill to provide tax 
credits for people who conserve energy. The senior Members of the House 
of Representatives at that time got up and objected to the amendment 
saying that it was not germane under the House rules, that on the one 
hand by providing incentives for people to drill for oil was relevant 
and germane but providing tax incentives for people to save energy was 
completely nongermane. It was ruled out of order. It took 4 years 
before we finally passed that measure to provide tax credits for people 
to conserve energy. I feel the same sense here. It has been 2 years 
now, and maybe another year before we finally pass this bill dealing 
with health care fraud.
  So it is a measure of my own frustration. I have been at this nearly 
22 years now finding the same kinds of arguments being raised saying, 
well, wait until the next bill, not germane to this bill, we will get 
it next year with a little more patience.
  I yield the floor.
  Mr. HATFIELD. Mr. President, knowing Senator Cohen as I do I know he 
will persevere. I only say that I know his frustration. It took me 25 
years to get an underground test ban enacted. But perseverance won out. 
I wish him well. I hope it is  not 25 years for him.

  Mr. METZENBAUM addressed the Chair.
  The PRESIDING OFFICER. The Senator from Ohio is recognized, Mr. 
Metzenbaum.
  Mr. METZENBAUM. Mr. President, I would like to address myself to this 
question of going forward with amendments on this bill and using some 
other bill as an appropriate vehicle. The Senator from Ohio has been 
waiting and has attempted on previous occasions to bring to the floor 
of the U.S. Senate the bill having to do with baseball and the 
antitrust exemption that exists with respect to baseball and the fact 
that if the amendment were to be adopted--the amendment that has been 
submitted by myself and Senator Hatch--I do not know that the baseball 
season could be completed this year but certainly the players would 
indicate their being willing to go back to work for spring training.
  The argument is made, well, use some other bill as an appropriate 
vehicle to which you might attach an amendment. It so happens that the 
amendment that we are talking about offering on this bill in our 
opinion is germane to an amendment of the House and therefore not 
subject to a point of order. If we were to attach it to some other 
bill, it is not at all unlikely that a point of order could and would 
be raised.
  The Senator from Ohio attempted to bring a bill having to do with 
baseball to the floor a week or 10 days ago and asked unanimous consent 
to move forward, and an objection was made. It was perfectly 
appropriate to make the objection. I had no problem with that. But if 
there is to be a baseball season in 1995, then, as I see it, either the 
players or the owners are going to have to come to some agreement or we 
are going to have to pass legislation in the Congress that deals with 
the fact that there is now an antitrust exemption for the baseball 
owners.
  That exemption, in my opinion, should never be in the law. It is one 
of only two businesses in this country that are exempt from the law--
the insurance industry being the other one. And we have now drafted 
this in such a manner that it is not a total repeal of the exemption 
but rather an effort on our part to just deal with the exemption as it 
applies to the contract we are talking about and the very limited 
question of the right of the players to go into court when the owners 
attempt to impose unilaterally a cap on their salaries or any other 
kind of imposition of terms of a contract unilaterally.
  So the Senator from Ohio is not happy about the fact that there are 
many who would like to bring this bill to a conclusion. I do not care 
to be an obstructionist. I do not see that we need to have a lengthy 
debate on this, although some of my colleagues have indicated that they 
would like to debate the issue. But I would be willing to agree to some 
limited time either tonight or tomorrow morning, although I think 
tonight would be unfair because it would not be giving fair notice to 
some of those who may have an interest in it. But I would be willing to 
agree to a 2-hour limit tomorrow morning on the issue. I think we can 
lay down our amendment tonight. The issue of germaneness can then be 
raised. I would not want anyone to be taken unaware or not be prepared 
for it. But I am trying to lay out the picture as I see it.
  I do not know of any alternative the Senator from Ohio has in order 
to bring this matter before the U.S. Senate for a vote. I think the 
American people want to see baseball played in this country. I believe 
that if we pass this amendment, the House has already indicated through 
Chairman Brooks that if the Senate sends something over, he will act 
immediately to bring it to the floor of the House so that it may become 
law before we conclude this session.
  So I say to my colleagues, I do not have any better friends in this 
body than the manager of the bill, that I regret the fact that I am not 
being cooperative, and that I am prepared to offer an amendment on this 
subject. But I do not know that I have any other alternative. 
Therefore, I suggest the absence of a quorum.
  Mr. BUMPERS. Will the Senator withhold?
  Mr. METZENBAUM. Yes.
  Mr. BUMPERS addressed the Chair.
  The PRESIDING OFFICER. The Senator from Arkansas is recognized.
  Mr. BUMPERS. Mr. President, let me plead with the Senator from Ohio 
to offer his amendment on another vehicle just so we can get this HHS 
bill and the Agriculture appropriations bill out. As the Senator from 
Oregon pointed out, Friday is the deadline. September 30 we have to 
have all of these appropriations bills finished or have a continuing 
resolution. The issue is perfectly legitimate. The antitrust provision 
the baseball owners enjoy is a legitimate issue for debate.
  I must say I think the Senator tried to get this out of the committee 
two or three times without success, and I must also say that in the 
right atmosphere I would very seriously consider the Senator's 
amendment. In the atmosphere of this evening when we are trying to pass 
very important appropriations bills totaling probably in the vicinity--
I cannot speak for the HHS bill. Our bill is about $70 billion. HHS is 
probably $300 billion. We are trying to get these out so we can keep 
the Government running and do what we have been sent here to do.

  If I had to vote on the Senator's amendment at this point, frankly, 
during this session of Congress, I would be constrained to vote no 
because I have not really studied the issue. I have the same, what I 
shall say, not necessarily revulsion, but aversion to antitrust 
exemptions. I know the Senator feels the antitrust laws in this country 
have not been very well enforced in the past.
  But I plead with the Senator, No. 1, to postpone the offering of this 
amendment until the next session of Congress. The only problem with 
that is the Senator is not going to be here the next session of 
Congress.
  Mr. METZENBAUM. It makes it a little difficult.
  Mr. BUMPERS. I do not expect him to agree with that request but at 
least offer it on the D.C. appropriations bill tomorrow. The Senator 
has suggested 2 hours. He can make that request tomorrow--or 3 hours--
whatever the Senator wants. But the Senator can accommodate some of his 
friends in the Senate by allowing us to go forward with these two 
appropriations bills tonight and bring that amendment up tomorrow. The 
Senator is not losing anything.
  Mr. METZENBAUM. Yes. I am.
  Mr. BUMPERS. I think the Senator and the Senate would be well served.
  Mr. HARKIN. Mr. President, I want to thank the Senator from Arkansas 
for his comments on this, and to say to my friend from Ohio, Senator 
Metzenbaum, that this Senator has no closer personal friend in the 
Senate and there is no Senator with whom I have greater admiration than 
Senator Metzenbaum. He knows that. He knows I wish he were going to be 
here next session, too. I probably would, like the Senator from 
Arkansas, vote with him on the antitrust exemption, although I do not 
know the issue that well, to tell you the truth. But I am usually on 
the same side of Senator Metzenbaum on these kinds of issues.
  But I must again reiterate what the Senator from Oregon said, who is 
of course our ranking minority member on the full Appropriations 
Committee. Members on the minority side, on the Republican side, 
withheld their amendments on this bill. I think there were at least 
three amendments that could have been offered on this bill, and it 
caused a lot of problems. That would have caused a lot of problems. 
This bill would have bounced to the House, they would not have accepted 
it, it probably would have bounced back here, and it would have bounced 
back to the House. The deadline is Friday.
  I point out to my friend from Ohio that if we go to a Continuing 
Resolution on this bill, it is the very people for whom he has fought 
and voted for all of these years who are going to be hurt. We have 
increases, to name just a few, in immunization, Head Start, breast 
cancer, AIDS prevention under the Ryan White Act--$2.2 billion over 
what we had last year.
  The Senator may say that will not happen. Well, it has happened 
before. I do not know how contentious his amendment is on baseball. I 
do not know. But I daresay if the Senator does this, I do not know that 
I, in good faith, could then go to my friends on the Republican side 
and say please withhold your amendments. It would be open season. And 
this whole bill could become bogged down in extraneous matters that 
have nothing to do with funding for education, health, job training, 
and medical research.
  So while I know the Senator feels strongly about his amendment and 
about the antitrust exemption for baseball, I join the Senator from 
Arkansas asking my friend from Ohio to think about what has transpired 
here earlier. I know how he may feel about this. Sometimes we all get 
caught in these things, but the Republicans have acted in good faith on 
this bill and they have withheld their amendments in good faith to 
offer them on the D.C. appropriations bill. I must say that in good 
faith I have to then strenuously object or ask the Senator from Ohio to 
please withhold his amendment on this bill. I hate to be in that 
position because I have such great respect for him.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. HARKIN. I yield the floor.
  Mr. METZENBAUM. Mr. President, I find myself in a very difficult 
position because it is a fact that two Members of the Senate for whom I 
have tremendous respect are friends of mine.
  Certainly Tom Harkin and I have been very close over the period of 
years.
  But let me tell you the dilemma in which I find myself. By 
happenstance this amendment is germane because the House had an 
amendment providing $12 million for the national youth sports program, 
and so I am informed by the Parliamentarian under those circumstances 
the amendment would not be ruled out of order, but the question of 
germaneness would be before the body.
  I do not have such a vehicle, at least I do not know of it at this 
moment on the D.C. appropriations bill or on any other bills that are 
coming up. It just is a peculiarity that this one particular House 
amendment included this provision and, therefore, instead of offering 
an amendment which would be legislation on an appropriations bill which 
would be subject to a point of order, this amendment would not be 
subject to a point of order, and the only question would be the 
question of germaneness which is a totally different issue.
  So I would say that I want to be cooperative. I do not want to put 
the bill in jeopardy. Let us face it. I am not talking about any 
filibuster, I am not talking about even engaging in lengthy debate. I 
am talking about a very limited time in which to consider this 
amendment, or particularly the amendment as it pertains to germaneness.
  The Senator from Nebraska, who is on the floor at the moment and 
speaking with the Senator from Iowa, was the one who objected to my 
moving forward the other evening when I asked unanimous consent to 
bring the bill up separately, independently, and just move forward with 
it. So I had an objection there and I respect his right and I hold no 
personal grudge against him for doing that. He was fully within his 
rights. But in this instance we have examined the legislation in order 
to find an amendment to which we could attach our amendment so that it 
would not be out of order, and I find myself in the dilemma that if I 
do not put it on this point or off it at this point and give my 
colleagues who wish to be heard on the subject an opportunity to be 
heard, then we are running out of time and I have no other vehicle to 
which I can attach the amendment.
  So I would just say that unless someone can come up with a better 
solution, the Senator from Ohio would intend to proceed forward, 
notwithstanding the fact that I know both of my colleagues from Iowa 
and Arkansas would prefer that I not do so.
  Mr. HARKIN. If the Senator will yield I will just point out that this 
amendment would still be subject, if I am not mistaken, to a rule 16 
point of order that it is legislation on appropriations.
  Mr. METZENBAUM. I do not believe so.
  Mr. HARKIN. Mr. President, a parliamentary inquiry.
  The PRESIDING OFFICER. The Senator will state it.
  Mr. HARKIN. Mr. President, would an amendment dealing with doing away 
with the antitrust exemption that is now in law, be considered 
legislation on appropriations?
  The PRESIDING OFFICER. The Chair has not been able to review the 
amendment. There is a possibility that the question might be raised.
  Mr. HARKIN. I appreciate the Chair's position. I know the Chair has 
not seen it. That probably was an unfair parliamentary inquiry. But I 
believe that it is; then again, we just have a vote on whether or not 
it is a point of order and that is just as simple.
  Mr. METZENBAUM. May I respond?
  Mr. HARKIN. Yes.
  Mr. METZENBAUM. Mr. President, it would not. I am advised by the 
Parliamentarian that it would not be subject to a point of order 
because it relates to an amendment adopted by the House. But it would 
be subject to raising the question of germaneness, which could then be 
decided by the body; is the amendment germane or is it not? That is a 
totally different issue for the Senator from Ohio than the question of 
appealing the decision of the Chair would be the case if I offer 
legislation on an appropriations bill unless there is something in the 
amendment from the House that permits me to do so. By happenstance 
there is in these circumstances.
  Mr. HARKIN. If the Senator will yield, we have two things here: We 
are concerned about germaneness and legislation on an appropriations 
bill. The national youth sports program was simply an appropriation. It 
is my feeling that while the Senator's amendment meets the test of 
germaneness, I do not know if it meets the test of not being 
legislation on an appropriations bill. We still could have a point of 
order. Whether the vote were subsequently on germaneness or appealing 
the ruling of the chair, it is still 51 votes, majority vote, anyway 
you look at it.
  Mr. METZENBAUM. I believe, Mr. President, that the Chair would rule 
that it is not subject to a point of order. I think that the Chair 
would rule that the question of germaneness would be before the body.
  Now, I would suggest the absence of a quorum----
  Mr. EXON addressed the Chair.
  The PRESIDING OFFICER. The Senator from Nebraska [Mr. Exon] is 
recognized.
  Mr. EXON. Mr. President, I rise once again to become involved in this 
debate on the efforts by my friend and colleague from Ohio to change 
the antitrust exemption of baseball.
  This matter came up some time last week when the Senator from Ohio 
asked unanimous consent, and I objected to that unanimous consent 
request. I said at that time I knew of the keen interest by the Senator 
from Ohio in this issue. I said at that time that I had not made up my 
mind. I have not studied the issue enough to know whether or not I 
believe there should be a temporary, partial, or a total exemption from 
change in the present exemption that organized baseball has.
  I think there are some pros and cons on this issue. I would simply 
point out to my friend from Ohio, as has been pointed out by the 
Senator from Arkansas and the Senator from Iowa, that regardless of the 
matter of germaneness, the measure that he suggested we bring up is 
essentially not different from what the Senator from Ohio and others 
attempted to do with a measure that was turned down earlier this year, 
as I understand it, by the Judiciary Committee.
  I see the chairman of the Judiciary Committee on the floor of the 
Senate. He may like to address that, but I believe I am correct in that 
the Judiciary Committee turned down the form of a change that the 
Senator from Ohio had sought.
  I rise again in opposition. I would hope that the Senator from Ohio, 
regardless of what he has a right to do to try to bring this up on this 
bill--I think it is a wrong bill at the wrong time when we are trying 
to wind down some very important appropriations measures. I would 
simply advise the Senator from Ohio that at least this one Senator 
would raise objection to any time agreements on such an amendment. 
Extended debate could follow.
  I simply say to my friend from Ohio once again that I think this the 
wrong time and the wrong place for the U.S. Senate in conjunction with 
a few people in the House of Representatives who are trying to 
immediately involve themselves in a side in a very intense labor 
dispute between the owners of the baseball franchises and the very 
talented players that make baseball go and make baseball grow.
  Again, Mr. President, I think there probably is no one in this body 
who is a better baseball fan, there is no one in this body I think who 
is more disturbed, distraught, upset, at the interruption in the middle 
of a very exciting season. I say a plague on both the houses, of the 
ownerships and of the players. Obviously the Senator from Ohio has made 
no secret of the fact that the players association feel that if some 
kind of an amendment as he has offered would become law, that then they 
would begin to agree to start playing baseball again if the owners 
would let them. I simply say that I am so discouraged. I believe that 
organized baseball is bringing down on that great American pastime, a 
cleavage that is going to be long felt by the baseball fans of the 
United States of America.
  I think it is wrong, it is improper and it is not wise, for the 
Congress of the United States to begin choosing up sides at this 
particular moment.
  Therefore, I say that I think I would certainly oppose the amendment 
offered by the Senator from Ohio, as it was opposed by his colleagues 
on the Judiciary Committee. I think this is the wrong place, the wrong 
time, and the Congress of the United States would be doing a very wrong 
action to try to involve the Congress of the United States in this 
labor-management matter.
  I simply say that I really believe it is a time for the baseball 
players and the baseball owners to slug it out, if that is what it 
takes, and to delay the start of the baseball season this year, the 
elimination of the World Series, the playoffs and maybe it goes into 
next year and from there on out. But I happen to think that the selfish 
owners and the selfish players who kiss off the organized fans of the 
United States of America who are very dedicated to baseball; I am going 
to object; I will continue to object to any kind of a shortcut action 
as suggested by my friend from Ohio.
  I know he is very sincere. I do not quarrel with his motives. But I 
believe it is the wrong time, and I will do everything that I can to 
oppose this. I would urge my friend from Ohio not to offer the 
amendment, as has been requested by the Senator from Arkansas and the 
Senator from Iowa. And I would simply say that if the Senator persists 
at least this Senator will object to any time agreements on any kind of 
an amendment as suggested by the Senator from Ohio.
  The PRESIDING OFFICER. The Senator from Arkansas [Mr. Bumpers].


                       unanimous-consent request

  Mr. BUMPERS. Mr. President, I ask unanimous consent that the pending 
conference report and any amendments thereto be temporarily laid aside 
in order for Senator Cochran and me to offer the agriculture 
appropriations bill on which there is no controversy, which will 
probably be disposed of in 10 minutes. And immediately upon the 
disposition of that conference report, the Senate return immediately to 
the pending matter on HHS.
  The PRESIDING OFFICER. Is there objection?
  Mr. HATCH. Mr. President, reserving the right to object, would the 
Senator modify his request to give me a minute and a half so I could 
just speak to Senator Metzenbaum's amendment?
  Mr. BUMPERS. I am happy to.
  Mr. DOMENICI. Mr. President, reserving the right to object, and I do 
not know whether I will at this point, but let me just ask a couple 
questions.
  I ask Chairman Bumpers whether there are amendments in disagreement 
on his bill.
  Mr. BUMPERS. There are not.
  Mr. DOMENICI. No amendments in disagreement?
  Mr. BUMPERS. No amendments in agreement. There is nothing on the 
conference report. We can dispose of it in 5 minutes.
  Mr. DOMENICI. I have no objection.
  Mr. COCHRAN. Mr. President, reserving the right to object, I have 
just been advised by staff that there is a Senator on this side of the 
aisle who has to object to that request. I certainly do not want to 
object to that request. But I hope the Senator will withhold for a 
minute and let the Senator from Utah proceed with his comments, and 
then make a renewal of the request to proceed without objection.
  There is no objection.
  Mr. President, I withdraw my reservation.
  The PRESIDING OFFICER. The Senator from New Mexico [Mr. Domenici] is 
recognized.
  Mr. DOMENICI. Mr. President, I do not say this in any manner other 
than to clarify something. I understand there are amendments in 
disagreement.
  Mr. BUMPERS. That is all. That is what I want the floor to say. I 
misspoke myself. There are.
  Mr. DOMENICI. I wonder, I do not choose to unduly delay the bill, but 
I would like just about 10 minutes to go talk to the leadership about a 
matter that has not yet been arranged to be called up. I would like to 
see if we can arrange it.
  If not, I might have to use the appropriations bill to put it on. I 
object at this point, but it will not be longer than 10 minutes.
  Mr. BUMPERS. Mr. President, I withdraw my unanimous-consent request.
  The PRESIDING OFFICER. The Senator has a right to withdraw his 
unanimous-consent request.
  The Senator from Utah [Mr. Hatch] is recognized.
  Mr. HATCH. Mr. President, I appreciate your recognizing me. I will 
just take a minute because I am one of the Senators who voted to keep 
the antitrust exemption alive in the Judiciary Committee. I have had a 
very difficult time voting to take the exemption away through the 
years, and I have always voted to keep it alive. If my recollection is 
correct, I cast a deciding vote on that matter.
  It was more than a deciding vote, because some other people voted 
with me, but literally had I gone the other way, it would have changed 
the dynamics.
  The reason the distinguished Senator from Ohio is bringing this up 
and, frankly, with my support, is not to cloud this issue but merely to 
solve a problem in labor law that really exists and in antitrust law 
that exists, something that would be more fair to both sides.
  Under our labor laws, when you have a strike and there is an impasse, 
the management has the power to impose unilaterally terms and 
conditions of employment upon the players in this case. Ordinarily, 
that is a right that they should have in labor law. The problem is they 
are going to impose their contractual provisions, or their sought-after 
contractual provisions, on the players while hiding behind an antitrust 
exemption that is greatly to the disadvantage of the players.
  I have said to the baseball owners that I think they would be better 
off if the exemption were lifted because then it comes down to a court 
litigation and they can resolve these matters without these types of 
strikes.
  I cannot blame either side. They both have arguments that are worthy 
of consideration. But all the distinguished Senator from Ohio and I am 
trying to do is to say to the owners of those teams, ``You can 
unilaterally impose, if you want to, any terms and conditions you want 
to under the law. But if you do, then you lose the antitrust exemption 
until this matter is resolved.'' It is a temporary loss, but it would 
give the players the right to have some rights as well in this matter.
  To me, that is a fair way of doing it. To me, it is an intelligent 
way of handling it. Neither side would have a major advantage. If they 
want to continue to strike, they can; if the owners want to 
unilaterally impose terms and conditions, they can, but then they are 
going to be subject to an antitrust suit by the players if they do. So 
there will be a disincentive to do that.
  I do think it would end the strike. I do think it would push both 
sides together. I do think they would resolve this. I really believe 
unless you do it, they are not going to resolve it, and we may face the 
same problems next year.
  So I want to commend the distinguished Senator from Ohio for at least 
trying to get this thing resolved in a fair and equitable manner. 
Normally, he and I do not agree on labor law, but in this particular 
case, I think it is in both sides' interest to do it this way, although 
I have to say, those representing the owners of the baseball teams do 
not like it because it takes away a super advantage that they have--two 
advantages, because they have an advantage to unilaterally impose their 
conditions and they have an advantage of not having to suffer from 
litigation under the antitrust laws.
  So some feel all the cards are in the hands of the owners, while 
really all they have is their ability to play ball. If the owners will 
not let them play, then that ability is gone as well.
  These players have forsaken a billion dollars in salaries and in 
contract terms because they feel so strongly about this and they do not 
want salary caps unless there are some other things that are done.
  I do not know what the final negotiations will result in, but what 
the amendment by the distinguished Senator from Ohio does is it gives 
both sides a chance to sit down without all of the fuss and fury and 
bother and really get this matter resolved. From that standpoint, I 
think it is a worthwhile thing to do, and I support the Senator from 
Ohio. I do think it is probably going to be very difficult for him to 
get it done in this context, but I support him and I hope we can get 
this matter resolved in the interest of everybody, but above all, 
especially the fans.
  I took a little longer than a minute and a half. I apologize to my 
colleagues. I did want to make that statement for the Record.
  I yield the floor.
  Mr. HARKIN. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. HARKIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________