[Congressional Record Volume 142, Number 38 (Tuesday, March 19, 1996)]
[Senate]
[Pages S2268-S2277]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  BALANCED BUDGET DOWNPAYMENT ACT, II

  The Senate continued with the consideration of the bill.
  Mr. KENNEDY. Mr. President, I understand the time is controlled. I 
yield myself 12 minutes from Senator Boxer.
  The PRESIDING OFFICER. The Senator from California has 5 minutes 
remaining. Senator Murray has 7\1/2\, and Senator Feinstein has 7\1/2\.
  Mr. KENNEDY. I yield myself 3 minutes, Mr. President.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 3508

  Mr. KENNEDY. Mr. President, very briefly, there are two major 
proposals before the Senate this afternoon. One proposal prohibits the 
District of Columbia from using locally raised funds to provide 
abortions for its residents. It allows the Congress of the United 
States to undermine the constitutional rights of poor women and thus, 
their ability to receive an abortion.
  We do not interfere with the disbursement of local funds in any of 
the States because it is inappropriate to dictate State and local 
policy in this area. It is equally inappropriate to impose the will of 
the Federal Government on the District of Columbia. This is the long 
arm of the Federal Government reaching in and dictating the health 
conditions for needy women in the District. Many of these women have 
determined that they must have an abortion but, because they are poor, 
they need assistance from the District of Columbia. District of 
Columbia elected officials should have the ability to allocate funds to 
women in these circumstances.
  Second, I reject the belief that the Senate should determine medical 
residency training criteria as it pertains to issues regarding women. 
This is the first real attempt to superimpose Congress' view on 
obstetric and gynecological medical training. Today, we are saying we 
will not require that medical training institutions provide abortion 
training for ob/gyn residents. Tomorrow, we may be making policy and 
setting standards in another area of medical training. Congress should 
leave the practice of medicine to the doctors. In this case, a highly 
respected board is attempting to insure that we have the best-trained 
physicians in the world. We have already acceded to a conscience clause 
that protects religious and moral beliefs of institutions and 
residents. Those individuals and institutions will not be required to 
participate in certain medical procedures that violate their conscience 
or their religious training. But to go beyond that by passing a law 
that substitutes congressional and political opinion for medical 
decisionmaking is wrong. Congress should not interfere with current 
ACGME policy. It is an inappropriate use of our authority. It is bad 
policy and it is bad medicine. We should reject this proposal.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. KENNEDY. Mr. President, I yield whatever time remains.
  Mrs. BOXER addressed the Chair.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. I yield myself 1 minute just to say to the Senator from 
Massachusetts how grateful I am that he expressed his views on the 
floor. This has been a very difficult morning because there was a 
modified amendment which, unfortunately, I could not get to analyze 
until this morning. And the Senator is right. We already have a 
conscience clause. Any institution who has a moral or religious 
objection to teaching abortion is covered under current law, and what 
this would say is that any institution, even if they did not have a 
moral or religious objection, would not have to teach residents how to 
perform safe, competent abortions so that our women are safe.
  On the matter of Washington, DC, I wish to tell the Senator that 
there are 3,049 counties, 19,100 cities, and every one of them has the 
right to spend their locally raised funds as they wish. To pick out one 
entity and reach the long arm of the Federal Government into it is 
really unfair and goes against the supposed spirit of this Republican 
Congress. So I thank my friend very much.

  The PRESIDING OFFICER. The Senator has used her 1 minute.
  Who yields time?
  Ms. SNOWE addressed the Chair.
  The PRESIDING OFFICER. The Senator from Maine.
  Ms. SNOWE. I thank the Chair.
  The PRESIDING OFFICER. The Senator from Maine has 30 minutes 
allocated to her under the previous order.


                    Amendment No. 3513, as Modified

  Ms. SNOWE. I will consume as much time as I require. I thank the 
Chair.
  I rise today to join the distinguished Senator from Indiana in 
offering an amendment that I think will address many concerns. In fact, 
I am pleased to have the opportunity to clarify some of the 
misinformation that has been expressed regarding this compromise 
amendment.
  No one can question whether or not it is appropriate to ensure 
quality care for women in America. No one can question that we need to 
maintain accreditation standards for medical institutions across this 
country. The fact remains that this amendment on which I worked in 
conjunction with the Senator from Indiana does not allow Federal funds 
to go to an unaccredited institution because they fail to provide for 
abortion training.
  Nothing could be further from the truth. This amendment accomplishes 
two things. One, it does protect those institutions and those 
individuals who do not want to get involved in the performance or 
training of abortion when it is contrary to their beliefs. Second, and 
just as important, it preserves the quality of health care that will be 
provided to women because it protects the universally accepted 
standards--there is only one set of standards--of the Accreditation 
Council for Graduate Medical Education that provides for quality 
standards for ob-gyn programs. So this amendment would not only make 
sure that women have access to quality health care with the strictest 
of standards when it comes to quality and safety but it also will 
ensure that they have access to physicians who specialize in women's 
health care.
  I do not think anybody would disagree with the fact--and I am pro-
choice on this matter, but I do not think anybody would disagree with 
the fact that an institution or an individual who does not want to 
perform an abortion should do so contrary to their beliefs. But at the 
same time we have to make sure we preserve the accreditation standards 
that are established by the Accreditation Council for Graduate Medical 
Education, that provides for the standards for more than 7,400 medical 
institutions in America.

[[Page S2269]]

  We want to make sure we do not undo 50 State licensure boards with 
respect to overturning or overriding this one set of accreditation 
standards. That is what we were dealing with, and hence this compromise 
here today, because whether we like it or not--and certainly I do not 
like it--in the House of Representatives they have already passed 
legislation that would allow Federal funds to go to an unaccredited 
institution. That is a fact, and that is unacceptable. That is why I 
worked with the Senator from Indiana to ensure that would not happen.
  Contrary to what has been said here today, 88 percent of medical 
institutions in this country do not provide abortion training even 
though it is implicitly required in the accreditation standards. So we 
are not broadening this issue to provide for an exodus from performing 
or participating in abortion training. Eighty-eight percent of the 
institutions currently do not provide it, even though there is a 
conscience clause.
  So this legislation is saying we do not want what is going to happen 
in the House of Representatives with the accreditation standards being 
dismissed and abandoned. That is an issue and that is a reality. That 
is why I worked with the Senator from Indiana to ensure that we 
preserve the one set of standards in America that the Federal 
Government relies on for the purposes of Federal funding, that medical 
students rely on for the purposes of Federal funding, that physicians 
rely on in terms of judging standards, that patients and consumers and 
States rely on in terms of determining their licensing procedures.
  So the choice was not to address the reality of what is taking place 
in the House or making sure, more importantly, that the Senate was on 
record in opposition to that kind of language and developing a 
compromise with the Senator from Indiana to ensure that we maintained 
the accreditation standards for all medical institutions to advance the 
quality health care for women and at the same time to allow training 
for abortion for those who want to participate in that training or for 
the institutions who want to provide it. Because that is the way it is 
done now. That is the status quo, and that is not changing.
  I know consensus and compromise is not the norm anymore. I think it 
is important on this issue because abortion is a very divisive issue. 
No one can challenge me on where I stand on this issue. But I think it 
is also important to make sure that we preserve quality health care for 
women in America. I do not want to see these accreditation standards 
undone, and that is what the legislation that was originally pending 
would have done. The House language went much further than that. This 
is a compromise to preserve those standards. This is a compromise to 
ensure that it does not jeopardize the 273 ob-gyn programs that 
otherwise would have been affected if this compromise was not before 
us. That is the risk, and that is why I worked with the Senator from 
Indiana to ensure that would not happen.
  It is inappropriate for this institution to be involved in the 
accreditation standards or curriculum, but that is not what we are 
dealing with here. It has already happened. I want to be able to go to 
conference to ensure that the House language is not adopted, and the 
best way to do that is to ensure we can pass language that everybody 
could agree on, that represents a consensus and does not jeopardize the 
kind of care that women in America deserve. That is what this 
compromise amendment is all about.
  I urge adoption of this compromise amendment. To do otherwise is to 
risk getting the House language in the final analysis. That, indeed, 
would set a very dangerous precedent.
  Mr. President, I yield 5 minutes to the Senator from Indiana.
  The PRESIDING OFFICER. The Senator from Indiana is recognized for 5 
minutes.
  Mr. COATS. Mr. President, I thank the Senator from Maine for her 
diligent work with us in clarifying language here and for her 
articulate statement of support and the reasons why she supports this 
particular amendment. I will not repeat those, but I think they clearly 
make the case.
  I would like to respond, also, to the Senator from California, who 
indicated that one of the reasons why she opposes the Coats amendment 
is that we will not have medical personnel adequately trained to 
perform abortions if necessary.
  I would like to state for the record that an ACGME member--the 
certifying body--ACGME member submitted testimony to the Senate Labor 
and Human Resources Committee that the D&C procedures that are taught 
to every ob-gyn and procedures used in cases of miscarriages and those 
of induced abortion require similar experience. Numerous ob-gyn's have 
indicated to us--and I have a pile of letters here from them, 
indicating so, and I will be happy to submit those for the Record--that 
an OB-GYN who is trained, as they must be trained, to perform D&C 
procedures in the case of spontaneous abortions, are more than 
adequately prepared, should the need arise, to perform an induced 
abortion. Again, I have an extensive set of letters from those who are 
trained in those procedures, indicating that is the case.

  In short, a resident needs not to have performed an abortion on a 
live, unborn child, to have mastered the procedure to protect the 
health of the mother if necessary. Maternal health will not be improved 
by forcing ob-gyn's to perform abortions on live fetuses if an ob-gyn 
will not do an abortion in actual practice. But it is clear from the 
record that they will have sufficient training to do so if necessary.
  Second, I would like to just once again, for my colleagues' benefit, 
indicate the support of Dr. Bill Frist, the Senator from Tennessee, for 
this amendment, who has stated, ``The Coats amendment will protect 
medical residents, individual physicians, and medical training programs 
from abortion-related discrimination in the training and licensing of 
physicians.'' ``However,'' he goes on to say, ``in our efforts to 
safeguard freedom of conscience, there are limits to what Congress can 
impose on private medical accrediting bodies. I believe this amendment 
stays within the confines of the governmental role and addresses the 
matter of discrimination in a way that is acceptable to all parties. 
The Congress is responsible,'' he goes on to say, ``for the Federal 
funding that is tied to accreditation by the ACGME, and as public 
servants we must ensure that there is no hint of discrimination 
associated with the use of public funds, and that is exactly what this 
amendment does.''


                           Amendment No. 3508

  I would like to respond to the issue raised in the second amendment, 
the amendment offered by the Senator from California, relative to the 
use of funds for abortions in the District of Columbia. It is clear, as 
the Constitution so states, that article I, section 8, gives this 
Congress exclusive legislation over all cases whatsoever in the 
District of Columbia. It is stated in the Constitution clearly. It has 
been the basis on which we have operated, and it is a constitutional 
basis. In all matters relative to the District of Columbia, the 
responsibility for protection of those and implementation of those and 
establishment of those is established in the Constitution of the United 
States.
  Public law 931-98, the home rule law, is consistent with this 
constitutional mandate, because it charges Congress with the 
responsibility for the appropriation of all funds for our Nation's 
Capital. The Congress, then, bears the ultimate constitutional and full 
responsibility for the District's abortion policies.
  Second is the question of separating or mingling.
  I ask the Senator from Maine if I could have an additional 2 minutes 
from her time?
  Ms. SNOWE. Mr. President, how much time do I have left?
  The PRESIDING OFFICER. The Senator from Maine has 17 minutes 
remaining.
  Ms. SNOWE. Yes, I yield the Senator 2 additional minutes.
  Mr. COATS. Second, let me state this idea of separating Federal from 
District funds is nothing more than a bookkeeping exercise. 
Essentially, what would happen is that the so-called District funds 
would allow the local government to continue funding abortion on 
demand. I do not believe that is something this Congress endorses. I do 
not believe that is something that we should not deal with as

[[Page S2270]]

we have dealt before. The separation of Federal funds from District 
funds is a distinction without a difference, given the constitutional 
mandate and the practice of this Congress to appropriate all funds for 
expenditure in the District. We all know that the District has one of 
the more permissive, if not one of the most permissive abortion funding 
policies in the country. It is essentially unrestricted abortion on 
demand. I do not believe that is what this Congress wants to authorize 
for the District of Columbia, and we have, on numerous instances, 
addressed this issue.
  In the conference report that is before us on the omnibus funding 
bill, this was discussed at length. The language that is incorporated 
is language that has been agreed to by the conferees. It does allow the 
use of funds for abortions to protect the life of the mother or in 
cases of rape or incest. Members need to understand that. What we are 
not trying to do, what we are opposing, what I am opposing and others 
are opposing, is the use of those funds for unrestricted abortion, 
abortion on demand. That is the issue before us on the Boxer amendment, 
and I urge my colleagues to vote no on that and vote yes for the Coats 
amendment, which is a separate issue, and that is the discrimination 
issue relative to the use of Federal funds for hospitals that provide 
abortion.
  I yield.
  Mrs. BOXER addressed the Chair.
  The PRESIDING OFFICER (Mr. Campbell). The Senator from California 
[Mrs. Boxer] is recognized.
  Mrs. BOXER. Mr. President, Senator Feinstein offered me her time. I 
ask unanimous consent that I be allowed to use her time.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. BOXER. I ask the President how much time Senator Feinstein has.
  The PRESIDING OFFICER. Senator Feinstein has 7\1/2\ minutes.
  Mrs. BOXER. And I believe I have a minute and some?
  The PRESIDING OFFICER. The Senator from California has 1 minute 15 
seconds.
  Mrs. BOXER. Mr. President, will you let me know when I have 5 minutes 
remaining?
  The PRESIDING OFFICER. Yes, the Chair will.
  Mrs. BOXER. Thank you very much, Mr. President. I want to respond to 
Senator Coats' point on the D.C. issue when he says, ``Look, we still 
allow them to use their own local funds for rape and incest but not for 
abortion on demand, not for unrestricted abortion.'' I want to make 
this point because over and over again in this debate by the anti-
choice Senators, they use the terms abortion on demand and unrestricted 
abortion. They use the terms and ignore the holding of Roe versus Wade.
  Anyone who has read Roe versus Wade knows the anti-choice Senators 
are not using the terms correctly. According to Roe, in the first 3 
months of a woman's pregnancy, she has a right to choose. That is her 
legal right. The Supreme Court has decided it, and even in this more 
conservative Court, has reaffirmed it.
  Clearly, a poor woman in Washington, DC, cannot get access to 
Medicaid funding, and the only option she would have, except for 
charity, would be Washington, DC's own locally raised funds, Mr. 
President. We do not stop any one of the 3,000-plus counties in this 
country from using their local funds if they wish, if they desire to 
help a poor woman. We do not tell the 19,100 cities that they cannot 
use their locally raised funds.
  Washington, DC, does have property tax funds, and they have other 
funds that clearly are raised by them. If they feel it is a priority to 
help a woman in poverty in a desperate situation exercise her right to 
choose, I do not think the long arm of U.S. Senators ought to reach 
into that situation. That ought to be her own private personal decision 
and the decision of the locality to help her out.
  So I hope that there will be support for the Boxer amendment.


                           Amendment No. 3513

  As to the Coats amendment regarding Federal funding to medical 
schools, I want to reiterate what I think is a very important point.
  The Senator from Indiana says, ``There is not going to be any danger, 
no one is going to be put in danger by this. So what if every single 
teaching hospital and medical school says, `We will not teach our 
residents how to do surgical abortion.''' He says, ``Oh, they will have 
enough training in emergency areas, D&C's, and other ways.''
  I do not think the Senator from Indiana would get up here and say it 
is not necessary for residents to learn how to do a bypass if it was 
their heart. ``Oh, you can just learn it from reading a book, you can 
look at a computer simulation.'' No one would ever suggest that.
  I really have to say, with due respect, total respect for my 
colleague, that we are treating women in this circumstance quite 
differently than a person who had a heart condition, than a person who 
needed a kidney operation. We would never stand up here and say that 
doctors do not have to be trained in actually doing those procedures.
  Mr. COATS. Will the Senator yield on that point?
  Mrs. BOXER. I will yield on the Senator's time, because I am running 
out of time. I will yield on Senator Snowe's time.
  The PRESIDING OFFICER. The Senator asked to be notified when she had 
5 minutes remaining. She has 5 minutes.
  Mrs. BOXER. Why do I not yield to the Senator on Senator Snowe's 
time?
  Mr. COATS. If that is appropriate with the Senator from Maine.
  Mrs. BOXER. I retain my 5 minutes.
  Ms. SNOWE. I yield 2 minutes.
  Mr. COATS. Mr. President, I just want to inform the Senator from 
California and our colleagues that what I stated was that on the basis 
of letters that we have received from a number of trained physicians in 
obstetrics and gynecology that the similarities between the procedure 
which they are trained for, which is a D&C procedure, and the 
procedures for performing an abortion are essentially the same and, 
therefore, they have the expertise necessary, as learned in those 
training procedures, should the occasion occur and an emergency occur 
to perform that abortion.
  But to compare that with not having training for a bypass operation 
or kidney operation or anything else would not be an accurate 
comparison. There are enough similarities between the procedure they 
are trained for and the procedure the Senator from California is 
advocating they need to be trained for that is not a problem.
  I ask unanimous consent to have printed in the Record, Mr. President, 
letters that I have received which so state that training is adequate.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                                            National Federation of


                                  Catholic Physicians' Guilds,

                                    Elm Grove, WI, March 23, 1995.
     Re the amendment offered by Senator Coats to S. 555, Health 
         Professions Education Consolidation and Reauthorization 
         Act of 1995.
     Members,
     Senate Labor and Human Resources Committee, U.S. Senate, 
         Washington, DC.
       Dear Senator: I am writing on behalf of the National 
     Federation of Catholic Physicians' Guilds which is the 
     Catholic medical association in the United States, 
     representing physicians and physician's guilds from all over 
     the U.S. I respectfully urge you to support Senator Coats' 
     Amendment, specified in Sec. 407. Civil Rights for Health 
     Care Providers.
       Senator Coats' amendment is certainly accurate in finding 
     the ACGME's revised regulations on Residency Training for 
     Obstetrics and Gynecology a violation of the civil rights of 
     individuals and institutions that are morally or 
     conscientiously opposed to abortion. The revised regulations 
     would require, under penalty of loss of accreditation, 
     Catholic Ob-Gyn training programs, or any training program 
     for that matter, to provide for training in the performance 
     of induced abortion. As you probably know, Catholic moral 
     teaching holds abortion to be a grave moral evil. What might 
     not be as clear is the fact that not only may a Catholic not 
     participate in the procurement of an abortion, they may also 
     not cooperate in any way with the procurement of an abortion; 
     not only may they not offer training in abortions, they may 
     also not provide for the opportunity of training in 
     abortions. Such cooperation would give the cooperator a share 
     of the culpability. The ACGME's regulation would be coercion, 
     an attempt, under severe penalty for failure to comply, to 
     force the institution to participate in the performance of an 
     activity which it, in conscience, considered evil. This would 
     seem to be a clear violation of the civil rights of the 
     individuals and institutions involved.
       It is of significant note that the ACGME's regulation 
     revision in this matter comes at a

[[Page S2271]]

     time when fewer and fewer Ob-Gyn physicians will do 
     abortions. Ob-Gyn training programs that require abortion 
     training are also declining in number. Physicians do not want 
     to be involved in this procedure. Why they do not want to be 
     involved is understandable. The medical profession has always 
     held the moral belief that it's charge is the care of the 
     life of the human being. The Obstetrician has always been the 
     doctor who takes care of the mother and the baby until the 
     baby is born and the Pediatrician can take over the baby's 
     care. It is not in the professional ethos, in the soul of the 
     physician, to take life. It is his or her charge to protect 
     it! Abortion is a surgical procedure that intentionally takes 
     the life of the baby and exposes the mother to a normally 
     unnecessary operation. All of this violates the moral basis 
     of the physician's code. The physician cannot be cast as a 
     killer. He or she is a healer and an agent of the patient for 
     healing. If the regulation mandate from the ACGME is an 
     attempt to require physicians to perform a morally 
     reprehensible act to serve a political charge, then the ACGME 
     has stepped well beyond it's reason for existence.
       The stated premise behind the ACGME's revision of the 
     standards was to ``address the need for enhanced education in 
     the provision of primary and preventative health care for 
     women by obstetrician-gynecologists''. (ACGME Press Release, 
     16 Feb. 95) How does abortion training enhance the provision 
     of primary and preventative health care for women? Primary 
     health care involves the prevention of pathology. Pregnancy 
     is not a disease that must be treated by termination. Primary 
     health care provides medical care for the mother and the 
     child she is carrying. Primary care cares for the well-being 
     of mother and child. To talk of abortion as primary care is a 
     distortion of the meaning of care. We cannot define killing 
     as care. Does abortion training enhance preventative health 
     care for women? What does it prevent? Exposure to sexually 
     transmitted diseases? No. Pregnancy? It certainly doesn't 
     prevent pregnancy. The woman is already pregnant (which means 
     she is already carrying a very dependent human life whom the 
     Ob-Gyn is normally committed to care for, too, working to 
     ensure the baby's successful entrance into the world). What 
     does it prevent, then? Responsibility for my actions? 
     Maternal love? Enhanced education in the provision of primary 
     and preventative health care for women could cover a lot of 
     territory. The destruction of one of the most natural 
     functions of the human person; the characterization of 
     pregnancy as a pathological condition; the denial of 
     professional responsibility to two patients when the pregnant 
     woman comes to your clinic; the acceptance of a cooperative 
     role with the woman in the ending of her child's life . . . 
     these do not seem to fit into this educational objective.
       It must be noted that all Ob-Gyn physicians are trained to 
     do D&C's and to handle fetal demise. The training in the 
     specific procedure of induced abortion, especially 
     considering the great moral questions involved, probably has 
     no place as a requirement in Ob-Gyn training. If the ACGME 
     believes it is responsible for providing physicians to do 
     abortions, it needs to find a way to do it other than 
     mandating that training programs include this procedure in 
     their curricula.
       Thank you for reading through a somewhat lengthy letter. 
     The issue really is significant. It deals with a 
     controversial area; a procedure that is legal to perform, but 
     morally questionable and lamented by most Americans as an 
     indication that something has failed. Also at stake are the 
     civil rights of those who morally and religiously object to 
     induced abortion and who are now being told that they must, 
     under penalty, provide for training in abortion procedures. 
     There is, as Senator Coats points out, the effect of 
     ``running out of business'' training programs that could not 
     obey the ACGME mandate. And, there is the chilling advocacy 
     of the notion that the doctor should be killer.
       I ask you, on behalf of the many members of the NFCPG, and 
     other medical professional men and women of conscience who 
     cannot obey this regulation, to support Senator Coats' 
     amendment and keep true choice available to us.
       God bless you in your many varied and difficult duties.
           Sincerely,
                                           Kevin J. Murrell, M.D.,
     President.
                                                                    ____

                                                 The University of


                            Texas Medical Branch at Galveston,

                                    Galveston, TX, March 23, 1995.
     Vincent Ventimiglia,
     Office of Senator Dan Coats,
     U.S. Senate, Washington, DC.
       Dear Mr. Ventimiglia: I am a Professor of Obstetrics and 
     Gynecology at the University of Texas Medical Branch at 
     Galveston. It has come to my attention that Senator Coats, 
     during upcoming hearings to reauthorize the Health 
     Professions Education Act, will make efforts to protect the 
     rights of Obstetrics and Gynecology training programs who 
     choose not to teach techniques of abortion for contraception. 
     For this I am deeply grateful.
       The Commission which accredits training programs for 
     residents in Obstetrics and Gynecology has made significant 
     changes in requirements for accreditation. In the near 
     future, ``hands on'' experience with elective abortion will 
     be a required component of an approved residency training 
     program. Although an individual trainee may invoke moral 
     grounds to excuse himself from participating, no approved 
     program, or program director, may excuse themselves.
       Requirements for an accredited residency training are 
     ultimately approved by the AMA's Committee on Graduate 
     Medical Education (ACGME), and are listed in the Essentials 
     of an Approved Residency. Under the current Essentials of an 
     Approved Residency, an approved program is required to teach 
     its trainees about management of abortion related 
     complications, and provide some exposure to the technique of 
     abortion. Currently a program may fulfill this requirement by 
     providing instruction to residents in the care of women 
     with spontaneous incomplete abortions or missed abortions. 
     Requirements that become effective January 1 1996 
     specifically require training in the performance of 
     elective abortion as a contraception technique.
       Those involved in resident education at the University of 
     Texas Medical Branch made a decision in the mid 1970's not to 
     teach elective abortion as part of our curriculum. This 
     decision was based, originally, on concerns other than moral 
     issues. We encountered two significant problems with our 
     ``Pregnancy Interruption Clinic,'' or the PIC as it was known 
     at the time. First, the PIC was a money loser. Since there 
     was no reimbursement for elective abortions from either state 
     funds or Medicaid a great deal of the expense of the PIC was 
     underwritten by faculty professional income. Faculty income 
     was used without regard to the moral concerns of individual 
     faculty members who generated the income. A second problem 
     was more significant and involved faculty, resident, and 
     staff morale. Individuals morally opposed to performing 
     elective abortions were not required to participate. This led 
     to a perception, by trainees performing abortions, that they 
     were carrying a heavier clinical load than trainees not 
     performing abortions. As fewer and fewer residents chose to 
     become involved in the PIC, this perceived maldistribution of 
     work became a significant morale issue. Morale problems also 
     spilled over to nursing and clerical personnel with strong 
     feelings about the PIC. It is a gross understatement to say 
     that elective abortion is intensely polarizing. Because of 
     bad feelings engendered by a program that was a financial 
     drain, the PIC was closed.
       Regardless of our reasons, the failure to teach the 
     technique of elective abortion has never been a factor in the 
     approval of our program by an accrediting agency. When the 
     changes to the Essentials of an Approved Residency become 
     effective next January, I will never be forced to participate 
     in the performance of abortion; but I am distressed that, to 
     keep my current job, I would be forced to cooperate in an 
     educational mission that espouses these objectives. To me, a 
     ``non-combatant'' working to advance amoral objectives bears 
     significant culpability. How could a pro-life physician ever 
     become a Program Director if required to teach this 
     curriculum? How could any Catholic hospital support such a 
     training curriculum, even if its trainees went elsewhere to 
     obtain the skills? Shouldn't program directors have freedom 
     of choice to decide if a morally controversial area is 
     included in their program? Where does a pro life medical 
     student obtain training in an abortion free environment?
       Aside from my personal problems there are larger issues. 
     Due to a number of forces, there recently has been a de facto 
     segregation of the abortionist from the mainstream of 
     practitioners of Obstetrics and Gynecology. The abortionist 
     has become a specialist apart from the rest of us--they 
     are practitioners of a peculiar paraspecialty. Trainees 
     completing a residency program in Obstetrics and 
     Gynecology recognize that the professional community 
     considers the abortionist to be a physician on the fringe 
     of respectability. In addition to this marginalization by 
     the professional community, marketplace forces make a new 
     practitioner avoid abortions. Patients do not tend to seek 
     obstetric services from physicians heavily identified with 
     abortion. Young physicians who start doing abortions soon 
     have a medical practice which only does abortions. 
     Residents, hoping to practice the breadth of our 
     specialty, structure their new practices accordingly. 
     Changing the Essentials of an Approved Residency is a 
     deliberate attempt by those wishing to disseminate 
     abortion services to try to reintroduce abortion into the 
     ``everyday practice'' of our specialty. Their claim that 
     unique technical skills are involved in performing 
     elective abortions, that are different from technical 
     skills involved in treating spontaneous abortions, is 
     ridiculous and a clear attempt to mislead. The changes in 
     training requirements were not made to serve an 
     educational agenda--only a political agenda.
       This change in the Essentials is coercive. It will make my 
     participation in furthering an amoral educational objective a 
     condition of employment. I currently have the right not to 
     teach that which is morally repugnant. I hope my right can be 
     protected.
           Sincerely,
                                         Edward V. Hannigan, M.D.,
     Frances Eastland Connally Professor.
                                                                    ____



                                Congress of the United States,

                                   Washington, DC, August 2, 1995.
       Dear Colleague: There is one thing that can be said with 
     certainty about the abortion training mandate of the 
     Accreditation Council for Graduate Medical Education: it has 
     nothing to do with ensuring that medical residents receiving 
     training will be better equipped to provide appropriate 
     health care

[[Page S2272]]

     to women and children. OB/Gyn residents already learn the 
     techniques to handle pregnancy, miscarriages and 
     complications from abortions and, in learning these, learn 
     the medical techniques to handle those extremely rare 
     situations in which an abortion is actually performed in 
     response to a women's health emergency.
       So, if the ACGME directive is not really about providing 
     medically necessary training for medical residents, what is 
     it about? Simply, to accomplish what 20 years of legalized 
     abortion have failed to do: to make abortion a part of 
     mainstream of medical care and force doctors and hospitals to 
     do abortion as if a refusal on their part would constitute 
     substandard medical practice. Can there be any doubt 
     whatsoever that after they define abortion as a part of 
     standard medical care for residents, they will move on to 
     declare it standard care for every hospital? Can there be any 
     doubt the directive that we would overturn is only the first 
     step in a battle against every medical facility which would 
     dare claim that abortion is not ``health care,'' that it is 
     no part of standard medical practice?
       The way in which ACGME and their friends in the pro-
     abortion community are going about this is deeply disturbing. 
     They are not merely forcing doctors and hospitals to adhere 
     to a particular ideology, they are requiring them in the name 
     of practicing good medicine--to actually kill defenseless, 
     unborn human lives. It is not enough for them that medical 
     residents are already learning the techniques that could be 
     used in abortion, but learning these without using them to 
     destroy live human beings. Abortion advocates are not 
     satisfied unless these techniques are used to kill unless 
     residents resistance in this killing is actually numbered.
       This attempt to overturn the healing ethic that is the very 
     lifeblood of medical residency programs and medicine itself 
     must be rejected. I ask that all Members support the 
     provision in the bill to overturn the ACGME's directive and 
     to oppose any motion to strike it.
           Sincerely,
     Tom Delay,
       Majority Whip.
     Tom A. Coburn, M.D.,
       Member of Congress.
                                                                    ____

                                                 St. John Hospital


                                           and Medical Center,

                                      Detroit, MI, March 27, 1995.
     Dan Coats,
     Russell Senate Office Building,
     Washington, DC.
       This is a letter of support for any legislation that would 
     prevent a residency program from being forced to implement a 
     special kind of training that would be against the ethical 
     and moral teachings of the institution in which the residency 
     program resides. Specifically, we decry the decision made by 
     the ACGME to mandate induced abortion training in all 
     residency programs. There are major flaws in the reasoning of 
     the ACGME: 1) an assumption that somehow abortions are not 
     being carried out because of lack of providers: there is 
     certainly no evidence of this locally or nationwide; 2) 
     failure of the ACGME to recognize the fact that training to 
     perform an induced abortion is exactly the same training as 
     to perform a uterine evacuation procedure in the context of a 
     missed abortion; 3) assuming that OB/GYN residency graduates 
     are not performing induced abortion because they don't know 
     how to; clearly every graduating OB/GYN resident from any 
     program in the United States has the capabilities of being 
     able to perform induced abortions but chooses not to on the 
     basis of conscience and possibly also for a concern for 
     personal rather than because they don't know how to do it; 4) 
     by coming out so strongly for induced abortion, the ACGME 
     creates further polarization in the United States over a very 
     inflammatory issue when further polarization is counter-
     productive, 5) failing to recognize the philosophical 
     integrity of an institution by arbitrarily forcing health 
     care providers or individuals to do something against their 
     institutional ethics.
       In conclusion, the directors of the St. John Hospital and 
     Medical Center's OB/GYN residency program strongly support 
     legislation preventing coercion of a residency program toward 
     implementing an unnecessary training that is against any 
     institution's ethical and moral philosophy and thereby only 
     contributes to the further polarization of the abortion issue 
     in the United States.

                                  Michael Prysak, Ph.D., M.D.,

                                                  Program Director
     and Vice Chief of Obstetrics.
                                                                    ____

                                           Providence Hospital and


                                              Medical Centers,

                                   Southfield, MI, March 29, 1995.
     Hon. Dan Coats,
      U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Coats: I urge the Senate Labor and Human 
     Resources Committee to adopt the amendment you offered to S. 
     555, Health Professional Education Consolidation and 
     Reauthorization. This amendment would neither limit abortion 
     services currently available in this country, nor would it 
     prevent physicians from seeking the training they might 
     choose in order to perform abortions. This amendment would 
     not interfere with a woman's legal right to choose an 
     abortion. This amendment is about the right of institutions 
     to refuse participation or cooperation in procedures which 
     directly violate their ethical codes.
       The reason that our organization, Providence Hospital and 
     Medical Centers, supports this is because:
       As a Catholic institution, we hold that direct abortion is 
     a grave evil. It is therefore not an optional procedure for 
     us, since we are bounded by Catholic ethical standards of 
     health care. Since Catholic teaching classifies the direct 
     killing of innocent human life to be among the gravest forms 
     of evil, cooperating with the new ACGME OB/GYN residency 
     guidelines by sending our OB/GYN medical residents to other 
     facilities for training in induced abortions may not be a 
     moral option for us.
       There are over 45 OB/GYN residency programs in Catholic 
     hospitals, about a third of all OB/GYN residency programs in 
     the United States. We cannot afford losing these programs. 
     Trying to coerce health care facilities who are morally 
     opposed to direct abortions into cooperating with the new 
     ACGME guidelines will not resolve the issue of the dwindling 
     number of physicians being willing to perform abortions in 
     the United States. It will only exacerbate the situation.
       How would mandating abortion training enhance the provision 
     of primary and preventative health care for women? Primary 
     health care involves the prevention of a pathology. Pregnancy 
     is not a disease to be treated by termination. Furthermore, 
     all OB/GYN medical residents are currently trained to do 
     D&C's, to handle fetal demise, and are trained in techniques 
     such as early induction of labor when the pregnancy 
     constitutes a serious life-threatening condition for the 
     mother.
       Thank you for considering adoption of this amendment.
           Sincerely,
                                         Sister Jane Burger, D.C.,
     Vice President--Mission/Ethics Services.
                                                                    ____



                           Christian Medical & Dental Society,

                                Richardson, TX, February 15, 1995.

          Christian Doctors Protest Abortion Training Mandate

       Dallas, TX.--The Christian Medical & Dental Society (CMDS) 
     announced today that it is protesting a medical council's 
     decision to mandate abortion training as politically induced, 
     personally coercive and professionally unnecessary. The 
     Council for Graduate Medical Education, which oversees 
     physician training, announced yesterday that obstetrical 
     residents must be taught how to do abortions.
       Dr. David Stevens, executive director of the Dallas-based 
     CMDS, said, ``The Council is clearly out of touch with its 
     constituency, the vast majority of whom oppose abortion on 
     demand.'' He cited the results of an independent nationwide 
     poll of obstetricians, conducted in 1994 by the PPS Medical 
     Marketing Group in Fairfield, New Jersey, that revealed that 
     over 59 percent of obstetricians disagreed with the statement 
     that ``every OB/GYN residency training program should be 
     mandated to include elective abortion training.''
       Stevens says the Council's decision ``is apparently induced 
     by political pressure from pro-abortion groups who want to 
     force their belief system on a medical community that has 
     largely rejected abortion.'' Stevens said that ``pro-abortion 
     leaders are worried that few doctors are willing to perform 
     abortions, based on personal convictions as well as the sheer 
     repugnancy of the act itself.''
       Stevens said that despite the Council's technical 
     allowances for moral or religious objections, the practical 
     effect of the Council's ruling will be to pressure every 
     resident and teaching hospital into performing abortions.
       ``Throwing in a little verbiage about `moral or religious 
     objections' does little to remove the intense pressure these 
     residents will now face to perform abortions,'' Stevens 
     explained. ``The threat of failing to meet GME requirements 
     will now be like a sword of Damocles hanging over their heads 
     as well as over the heads of program administrators,'' 
     Stevens noted.
       ``In everyday practice, when one resident attempts to opt 
     out of the procedure, he or she can face intense pressure 
     from colleagues who would be forced to take up the slack by 
     performing more abortions,'' Stevens asserted. ``The mandate 
     will also effectively discourage those opposed to abortion on 
     demand from entering the OB/GYN field.''
       CMDS chief operating officer Dr. Gene Rudd, an OB/GYN 
     physician, explained that abortion training is unnecessary. 
     ``The skills required to perform first trimester abortions 
     are acquired through learning dilation and curettage (D&C) 
     and other procedures involving spontaneous abortions,'' Rudd 
     noted. ``Only the more controversial second and third 
     trimester abortions require additional training.
       ``Does the Council's new policy mean,'' Rudd posited, 
     ``that all OB/GYN's who have not been trained to do abortions 
     are inadequately prepared for professional practice? Of 
     course not! There is absolutely no practical reason to force 
     residents to learn to perform abortions if those residents do 
     not intend to perform abortions in practice. Abortion 
     training need not be considered an integral part of OB/GYN 
     training, as evidenced by the fact that roughly a third of 
     all residency programs in the U.S. do not even offer it.''
       To receive a free booklet on bioethical issues or for more 
     information on the Christian Medical & Dental Society, 
     contact CMDS at P.O. Box 830689, Richardson, TX 75083 or 
     phone (214) 479-9173.


[[Page S2273]]


  Mr. COATS. Mr. President, I will also just state, with what little 
time I have remaining, that the Coats amendment has the support of the 
AMA, the American Medical Association, the American College of 
Obstetricians and Gynecologists and the Accrediting Council for 
Graduate Medical Education. So the very organizations that are most 
directly involved in this have looked at the Coats amendment, and they 
have said it is a reasonable amendment and they not only do not oppose 
it, they support it.
  So the very organizations that are held up as being the objectors to 
this are supporters of the Coats amendment, and I hope my colleagues 
will use that as a basis for their determination.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. Mr. President, on my own time, and I ask that I have 3 
minutes remaining so that I can close on those 3 minutes.
  Mr. President, let me say to my friend from Indiana, I just talked to 
the representative of the American College of Obstetricians and 
Gynecologists. They much prefer the existing policy. The reason they 
are on this particular amendment is because they feel this is far 
superior than the House language, but they prefer the current policy.
  I will further say, just trying to exercise a little common sense--
and, Mr. President, I feel many times we think these things are over 
our head--if your daughter found herself in a circumstance where she 
was raped, let us say, and, let us say she found out within a month 
that she was pregnant and she made the decision to end this pregnancy, 
she did not want to bear this rapist's child, and someone asked you, 
``Senator, I've got two doctors available to do this. One of them 
performed a D&C a few times and never did a surgical abortion and one 
has the experience,'' I do not think it takes a degree in science to 
know that if you want her to be safe, you want her to go to someone who 
had the actual experience of performing a surgical abortion.
  So I simply do not buy into this argument that because someone 
performed a D&C and it is similar--it is not the same thing, by any 
stretch of the imagination.
  The PRESIDING OFFICER. The Senator has 3 minutes.
  Mrs. BOXER. I ask for another 30 seconds. What this amendment would 
do is basically say you do not have to teach your ob-gyn residents how 
to perform surgical abortion and you would still get Federal funds. 
That is why it is opposed by Planned Parenthood, National Women's Law 
Center, American Association of University Women, National Abortion 
Federation, Women's Legal Defense Fund and NARAL. I think it is very 
clear where this comes down. This takes a situation and makes it 
dangerous for women.
  Is it better than the House language? Sure it is, but why should we 
go forward with something that is worse than the current policy and I 
think open up a grave risk to the women of this country?
  I retain the remainder of my time.
  Mrs. FEINSTEIN. Mr. President, I oppose the Coats-Snowe amendment to 
the continuing resolution, S. 1594.
  This amendment does two things: It puts into law a prohibition on 
Federal and State governments from discriminating against institutions 
that refuse to provide training for abortion procedures; and, it 
undermines the long-respected accreditation system by allowing programs 
to opt out of meeting the required medical training standards set by 
the ACGME and still receive Federal funds as if these programs met 
those standards.
  The Coats-Snowe amendment is unnecessary, it undermines the integrity 
of Federal and State medical educational and licensing standards, and 
it represents another step in the erosion of freedom of choice in this 
country.


                              UNNECESSARY

  First of all, this amendment is unnecessary because its 
antidiscrimination section is redundant. Although earlier standards set 
by the Accreditation Council for Graduate Medical Education, the 
accrediting body for medical residency programs, did require abortion 
training in ob-gyn residency programs, ACGME revised those requirements 
in February 1995 to explicitly exempt ob-gyn residents or institutions 
with religious or moral objections to performing abortions.
  The policy states: ``No program or resident with a religious or moral 
objection will be required to provide training in, or to perform, 
induced abortions.''
  The revised standard does not require programs to make alternative 
arrangements for abortion training. The only obligations on programs 
that do not provide the training are to inform applicants to the 
residency program that they do not provide abortion training and to not 
impede their residents from obtaining the training elsewhere for those 
who wish to do so.
  These requirements strike a balance between the program's desire not 
to be involved in abortion training and fairness to residents who 
desire to obtain such training.
  So I fail to see any need for this amendment other than to inject 
Congress further into the abortion decision and into questions of 
medical curriculum.


                    UNDERMINES ACCREDITATION SYSTEM

  This amendment, even with the compromise language, still undermines 
the system for evaluating the quality of medical training programs in 
this country. Under current law, medical training programs may only 
receive Federal funds if they are an accredited institution.
  This amendment creates a loophole by allowing entities to not meet 
educational and training standards for ob-gyns set by ACGME, the 
independent accrediting body of medical experts.
  Does anyone in this body think Congress is better equipped to 
determine the educational requirements for a medical specialty such as 
obstetrics and gynecology than the medical professionals who actually 
practice medicine?
  The ACGME, a private-sector, professional entity, is the only 
graduate medical education accreditation organization in the United 
States, responsible for evaluating over 7,000 medical residency 
programs throughout the United States.
  ACGME is sponsored by five of the leading medical organizations in 
the Nation: the American Medical Association, the American Hospital 
Association, the American Board of Medical Specialties, the Association 
of American Medical Colleges, and the Council of Medical Specialty 
Societies.
  Accreditation by medical experts provides the only method the Federal 
Government has to assure that residency programs meet appropriate 
medical training standards. Congress should not undermine that system 
by supplanting political judgment in place of medical expertise.


            FEDERAL INTRUSION INTO STATE LICENSING STANDARDS

  Accreditation is relied upon not just by the Federal Government, but 
also by State governments, private funding sources, students and 
patients to ensure quality in medical training.
  Even if the Federal Government is willing to abandon educational 
standards in medical training, which it should not be, it should 
certainly not prevent the States from maintaining standards.
  All 50 States currently require an individual to participate in an 
ACGME accredited residency program to obtain a right to practice 
medicine. The Coats-Snowe amendment would prevents States from 
requiring that ob-gyn residency programs meet ACGME standards in 
abortion training for those they are licensing to practice medicine in 
their States. The alternative for States that wish to maintain ACGME 
training standards is the loss of Federal funds.
  This is an unconscionable intrusion by the Federal Government into 
State licensing procedures.
  The ACGME standards, which were unanimously approved by the 
sponsoring medical organizations, reflect the input of physicians, 
medical specialists, hospital administrators, clinicians, researchers, 
and educators who bring decades of medical judgment to their decisions.
  The Federal Government has long recognized the specialized expertise 
that formulates the ACGME accreditation standards and we should not 
reject that expertise now simply because the issue is abortion.


                           EROSION OF CHOICE

  This amendment is yet another effort to chip away at a woman's right 
to

[[Page S2274]]

choose--a constitutionally protected right that the Supreme Court has 
clearly affirmed. This is one more in a series of steps Congress has 
taken to destroy that right:
  The 104th Congress, in particular, has enacted an unprecedented 
number of laws threatening access to safe and legal abortion for many 
women:
  Ending access to abortion for U.S. servicewomen overseas by barring 
abortions on military bases even if the woman used her own money. This 
is particularly harsh on servicewomen overseas where private facilities 
may be inadequate or abortion is illegal.
  Prohibiting Federal employees from choosing health insurance plans 
with abortion coverage.
  Maintaining the prohibition on Medicaid coverage for abortion for 
low-income women--except in cases of rape, incest, or life 
endangerment.
  Denying access to abortion for women in Federal prisons.
  Prohibiting the District of Columbia from using its own locally 
raised money to pay for Medicaid funded abortions.
  Banning Federal funds for human embryo research.
  Most significantly, Congress for the first time directly challenged 
Roe versus Wade by passing legislation that criminalizes a particular 
and rarely used abortion procedure and jails doctors who perform them.
  All of these represent a steady march by the Federal Government into 
the abortion decision, and the weakening of a woman's constitutional 
right of personal privacy. The Coats amendment is yet another erosion 
of that right.
  But it is an extremely important one. This is a direct attack on 
maintaining access to quality reproductive health care for women.


                          SHORTAGE OF DOCTORS

  There is already a severe and escalating shortage in the number of 
physicians who are trained and willing to provide abortion services.
  The total number of abortion providers in the country decreased by 
nearly 20 percent since 1982--from 2,908 to 2,380--in spite of a 10-
percent increase in the population.
  Eighty-four percent of the counties in the United States have no 
physicians who can perform abortions. States such as North and South 
Dakota have only one provider each.
  Only 25 percent of obstetrician-gynecologists in the southern United 
States are trained to perform abortions. Only 16 percent of doctors in 
the Midwest are trained.
  With the violence and harassment aimed at abortion providers 
increasing steadily in recent years, fewer doctors are willing to risk 
their lives or the safety of their families, to provide abortion 
services.
  This amendment is a thinly veiled attack on freedom of choice. By 
making abortion unavailable, opponents of abortion will do what they 
cannot do legislatively--eliminate abortion as a safe and legal option 
for women in this country--one State, one doctor, one piece of 
legislation at a time. I strongly urge my colleagues to oppose this 
amendment.
  Ms. SNOWE addressed the Chair.
  The PRESIDING OFFICER. The Senator from Maine.
  Ms. SNOWE. Mr. President, I think it is always important that, when 
we are discussing legislation, we get a chance to read the legislation, 
in this case, the amendment that is before this body. The fact remains 
that this compromise amendment allows that anybody who wants to 
participate in training of abortions is allowed to do so. Nothing 
changes from the current circumstances. Any agency or institution that 
wants to provide the training of abortions to medical residents can do 
so. That is how the legislation reads. That is fact.
  I regret the fact that there has been so much misinformation 
circulated about what this amendment does and does not do. This 
amendment avoids getting the U.S. Congress involved in setting 
accreditation standards, because that is exactly what is happening with 
the legislation that passed in the House of Representatives. The 
Senator from Indiana and I worked with the American College of 
Obstetrics and Gynecologists on this very language. Sure we prefer not 
to be here today discussing this issue, but that is not reality.
  I am looking down the road. What I do not want to have happen is to 
have the U.S. Congress overturning the one set of accreditation 
standards that is predicated on quality care. If we do nothing, we run 
the very serious risk of having the U.S. Congress, because of the House 
language, overturn that one set of standards that everybody in America 
uses to determine the standards and the quality of care.
  If you think that is a risk worth taking, then vote against this 
amendment. I do not happen to think so. This accreditation standard 
that we are talking about in this legislation is the accreditation 
standard that has been developed by the Accrediting Council for 
Graduate Medical Education. You might say, Who sits on this 
accreditation council? This is the one council that everybody looks to 
for setting the standards for medical institutions and residents in 
this country.
  The organizations that sit on the council are: the American Medical 
Association, the American Hospital Association, the Association of 
American Medical Colleges, the American Board of Medical Specialties, 
the Council of Medical Specialties Societies. Then you have the 
residency review committee that reviews the ob-gyn programs that set 
the standards for the accreditation council, the American Board of 
Obstetricians and Gynecologists, the American College of Obstetricians 
and Gynecologists, and the Council on Medical Education of the American 
Medical Association.
  These standards have been set with the conscience clause for medical 
residents since 1982. There has always been a conscience clause. That 
is what this legislation does. It allows for that. The accreditation 
council had to go a step further and establish a conscience clause for 
institutions because of a recent court case. That is a fact.
  Not one institution in America--even when it was implicitly required 
in the accreditation council standards before their proposed change 
this year, they did not deny accreditation to one institution in 
America because they solely refused to provide abortion training. It 
was for a host of other issues.
  So even when it was required, 88 percent of the institutions did not 
provide for abortion training. So this amendment basically preserves 
the status quo under the Accrediting Council for Graduate Medical 
Education, the one set of standards that everybody uses from the 
Federal Government on down.
  If we fail to support this amendment, I hesitate to think what 
message it is going to send to the conference committee on this issue. 
It is important that the Senate send a very strong message that we 
reject the intervention of Congress in establishing a different set of 
standards. That is what this is all about.
  Mr. President, how much time do I have remaining?
  The PRESIDING OFFICER. The Senator has 7 minutes 20 seconds.
  Ms. SNOWE. I would like to quote part of a letter that was sent by 
Dr. James Todd, executive vice president of the American Medical 
Association, which he sent in March 1995 to Senator Kassebaum. I quote:

       The Accrediting Council for Graduate Medical Education 
     standards were developed by professional medical educators in 
     the field of obstetrics and gynecology. The standards were 
     developed with great sensitivity to the differing moral and 
     ethical views about abortion and after substantial 
     consultation with medical societies, program directors, and 
     obstetrics and gynecology and other individuals and 
     organizations.

  So that is the standard that is embodied in this compromise 
legislation. If individuals who are participating in medical training 
programs want to get training for abortion, they will be allowed to do 
so. If an institution wants to provide it, they will be allowed to do 
so, just like it is under current circumstances.
  We, also, preserve the accreditation standards of the one group in 
America that sets those standards, rather than running the risk of what 
has been established in the House of Representatives that says that 
Federal funds can go to any institution in America that is unaccredited 
if those standards mention abortion. That is what the legislation says 
in the House of Representatives. That is what we are dealing with here. 
They would allow Federal funds to go to any institution that is 
unaccredited if those institutions use the accreditation standards, of 
which there is only one set in America, if they refer to abortion in 
whatever way.

[[Page S2275]]

  That is what I do not want to have happen in this body. That is why I 
supported and worked on this compromise legislation. The fact is the 
House goes further. Every State has a licensing board. Every State 
looks to the Accrediting Council for Graduate Medical Education 
standards in order to determine the licensing. So, if we are saying it 
does not matter anymore, then they are going to have to go back, and 
every State will have their own set of standards for medical 
institutions, of which there are 7,400 in America.
  So is that what we want to create? I do not think so. I think there 
is a time when you have to accept what is before you and work together 
in reaching a consensus, which is what the Senator from Indiana and I 
have done. I think that is what the American people want. We are never 
going to get unanimity on the issue of abortion. Far from it.
  But I do think it is important that we work together in the best way 
that we can to ensure that we have legislation that will benefit, in 
this case, the women of America, because this is who will be most 
directly affected by this legislation, and to ensure that our medical 
institutions are dealing with one set of accreditation standards rather 
than 50 different sets because that is, in essence, what will happen if 
we reject this amendment. That is the risk that we are running. That is 
why I would urge adoption of the Coats-Snowe amendment.
  Mr. President, I yield the floor.
  Mrs. BOXER addressed the Chair.
  Mr. McCAIN addressed the Chair.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. I will yield to the Senator from Arizona for a question.
  Mr. McCAIN. I was going to call up an amendment of mine. I will be 
glad to wait until the Senator from California finishes.
  Mrs. BOXER. I thank the Senator.
  Mr. President, I am assuming we are debating the abortion amendment 
that is----
  The PRESIDING OFFICER. That is correct.
  Mrs. BOXER. Mr. President, I think the Senator from Maine makes a 
good point when she says we have to work together. That is what we did 
to get to where we are with the current policy. Current policy says 
that, if you are an ob-gyn resident with a religious or moral objection 
to learning to perform surgical abortion, or if you are an institution 
with a religious or moral objection to teaching abortion procedure, you 
do not have to learn it and you do not have to teach it.
  I support that. I am pro-choice. I believe very much in Roe versus 
Wade and a woman having the right to choose to make this decision 
without Government interference. But I believe that if someone has a 
deep religious or moral objection, and they are a medical school or an 
ob-gyn resident, they should have the right to say, I really do not 
want to learn this. However, if there is no religious or moral 
objection, I believe that it is very important that these ob-gyn 
residents learn how to perform surgical abortion until there is another 
safe alternative. And what the Coats amendment does, regardless of the 
kind of spin we hear, is basically says to us that an institution that 
has no religious objection can just decide, because they bow to public 
pressure, we are not going to teach our residents how to perform 
surgical abortion, and we will get Federal funds anyway.

  Now, just to stand up here and say, ``I have a compromise'' is not 
enough.
  I ask unanimous consent that I be allowed to take Senator Murray's 
time. She has offered it to me.
  The PRESIDING OFFICER. Is there objection?
  Ms. SNOWE. Reserving the right to object. How much time is that?
  The PRESIDING OFFICER. Senator Murray has 7\1/2\ minutes reserved.
  Ms. SNOWE. How much time do I have remaining?
  The PRESIDING OFFICER. Three minutes 30 seconds.
  Mr. BUMPERS. Mr. President, was there some kind of an agreement about 
time?
  Mrs. BOXER. Mr. President, if I may answer the question, I asked if I 
could take Senator Murray's time as it relates to the abortion issue. 
She has 7 minutes. I do not think I am going to use it all, but I need 
to make a couple of points.
  Mr. BUMPERS. Mr. President, I have no objection. I was under the 
impression that we were going to recess at 12:30. I thought I would 
speak on the Murkowski Greens Creek amendment prior to the recess.
  The PRESIDING OFFICER. The Senator is correct that we were to adjourn 
at 12:30.
  Mr. BUMPERS. I do not understand the time. How much time is left on 
the Coats amendment?
  The PRESIDING OFFICER. The Senator from Maine has 3 minutes 30 
seconds. Senator Boxer used her time, and Senator Murray had reserved 
7\1/2\ minutes.
  Mrs. BOXER. Mr. President, I ask unanimous consent that the Senator 
from Arkansas have 15 minutes to speak immediately following the hour 
of 12:40, and that we extend the time.
  The PRESIDING OFFICER. That will require postponing the recess.
  Mrs. BOXER. That is correct, until 12:55, so the Senator can have his 
15 minutes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mrs. BOXER. I say to my friend that we may not use all this time. I 
think it is important that when we stand on the floor of the Senate and 
talk about a compromise, we understand what we are compromising. A 
compromise was made on this issue previously. Institutions and ob-gyn 
residents already have a very generous and appropriate clause for a 
religious or moral objection. So not only individual doctors and 
residents in medical school, but also we, the institutions themselves, 
may exercise a conscious clause exemption.
  So now to take that compromise and say we need to compromise because 
the House has some terrible language--Mr. President, I came here to 
fight for the issues that I think are right. I came here to fight for a 
woman's right to choose. I believe that there are some things you can 
compromise, and I was very pleased to support a religious conscience 
clause.
  But if you take it further, theoretically, under the Coats amendment, 
every single medical school in this country could say that they were no 
longer going to teach residents how to perform surgical abortions, and 
they would still get their Federal funds.
  Now, you can stand up here and read off everybody who belongs to the 
American College of Obstetricians and Gynecologists. The fact is that 
they prefer current policy. Yes, they are willing to go with the Coats 
amendment as a lesser of two evils, but why are we not fighting this, 
straightforwardly fighting this, and saying this is nonsense--saying it 
is nonsense that institutions who have no religious problem would still 
be able to not teach surgical abortion and get Federal funds?
  On the issue of Washington, DC, they would be the only one of 19,000 
cities to be told by the Federal Government what they can or cannot do 
with their local funds.
  Mr. President, I see that the Senator from New Jersey has just come 
on the floor. We have precious few moments remaining. I would be very 
pleased if he is ready to yield to him the time I have remaining, if I 
might inquire how much that would be.
  The PRESIDING OFFICER. There are 4 minutes 52 seconds of Senator 
Murray's time remaining.
  Mrs. BOXER. I ask the Senator from New Jersey if he would like my 
remaining time?
  Mr. LAUTENBERG. I would appreciate having some time from the 
distinguished Senator from California.
  Mrs. BOXER. I yield the Senator from New Jersey the remainder of my 
time.
  Mr. McCAIN. Will the Senator allow me 30 seconds to make a request to 
modify my pending amendment?
  Mr. LAUTENBERG. I am happy to do it, and I ask unanimous consent that 
it does not come off the remaining time.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                    Amendment No. 3521, As Modified

  Mr. McCAIN. Mr. President, I ask unanimous consent to modify my 
amendment No. 3521.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 3521), as modified, is as follows:

       On page 756, between lines 10 and 11, insert the following:

[[Page S2276]]

     SEC. 1103. ALLOCATION OF FUNDS.

       Notwithstanding any other provision of this title, funds 
     made available under this title for emergency or disaster 
     assistance programs of the Department of Agriculture, 
     Department of Housing and Urban Development, Economic 
     Development Administration, National Park Service, Small 
     Business Administration, and United States Fish and Wildlife 
     Service shall be allocated in accordance with the established 
     prioritization process of the respective Department, 
     Administration, or Service.


                    Amendment No. 3513, as Modified

  Mr. LAUTENBERG. Mr. President, the one thing that mystifies me about 
some of the actions that we take here is, why is it that a few want to 
control the thoughts for so many? It is an assault on one's human 
rights, one's civil rights. It is inappropriate to be introducing this 
kind of legislation that has to deal with things other than the funding 
issue, and to intrude on people's private lives.
  To suggest that the way to deal appropriately with the sparseness of 
funds is to take away people's right to learn as part of a medical 
education, and that they might lose their Federal funding--not might, 
but will--it is outrageous. God was good to me yesterday. My oldest 
daughter delivered a beautiful baby boy, and I was in that hospital on 
the maternity ward, and I was looking around, and I thought, thank 
goodness, they have the facilities that they have to be able to bring 
new life into being. I thought about those poor women who, at the same 
time, who may be distressed by the fact that there was a conception. It 
was bizarre, but in the news today was a woman who was 10 years 
comatose, was raped by someone in the institution she was in, and she 
delivered a child. Is that not ridiculous that we would object to 
having someone learn the abortion technique, so that in the case of a 
request or a need, that it is unavailable?
  I think this is mischievous, I think it is unfair, and I think that 
the American people ought to rise up and say: Listen, enough of that 
stuff. You do what you want to. If you do not believe that a woman 
ought to have choice in an unwanted pregnancy, then do not do it. But 
why should someone else lose their right to make that choice if they 
are in such a situation? It is outrageous. We have these sneak attacks 
constantly--do it one way, do it another way. You violate the 
principles that we operate under. Privacy--that is what the Supreme 
Court said. Why is it OK for some people to decide what is appropriate, 
private or not? The courts have made a decision.
  So, I hope, Mr. President, that both bodies will reject this. I hope 
the Senate will decline to support this. The notion that the city of 
Washington should not be able to use its own funds as it sees fit, I 
think, is a disgrace. So I hope that we will reject this invasion of 
privacy, of decency, if you will. This issue is not about abortion, it 
is about Federal intrusion into a private decision.
  With that, I yield the floor back to my colleague, if any time 
remains.
  The PRESIDING OFFICER. The Senator from California has 28 seconds 
left.

  Mrs. BOXER. Mr. President, the ACLU opposes this amendment, as does 
the Center for Reproductive Rights, Planned Parenthood, and on and on. 
I just hope my colleagues will stand up and say that we already 
compromised and gave a good conscience clause. That was a compromise. 
Let us not open this up wide and have women's lives put at risk. Say 
``no'' to this Coats amendment and ``yes'' to the Boxer amendment. Let 
us protect the lives of women.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Ms. SNOWE addressed the Chair.
  The PRESIDING OFFICER. The Senator from Maine.
  Ms. SNOWE. Mr. President, to sum up on where we stand with respect to 
the Coats-Snowe amendment, first of all, I remind this body what we are 
dealing with here. This amendment modifies an underlying amendment, and 
that underlying amendment would allow Federal funds to go to an 
unaccredited institution. That is what I wanted to prevent. That is the 
issue. That is what we are modifying through this compromise amendment, 
so that does not happen. Who supports this amendment? I think that is 
important since we are naming groups.

  The Accreditation Council for Graduate Medical Education, which is 
the entity that establishes the one set of standards in America for the 
medical institutions; the American College of Obstetricians and 
Gynecologists--it is very important because we are talking about ob-gyn 
programs, and the medical association is made up of the profession of 
physicians. That is who supports this amendment. They say it is 
acceptable. They saw what I saw. What were the choices? What we will be 
facing here potentially is a major risk and threat to women's health.
  The House language, which gives Federal funds to unaccredited 
institutions, basically guts the accreditation standards for ob-gyn 
programs if those standards mention ``abortion.'' Then we have the 
original--the underlying--amendment which we are now seeking to modify 
through this compromise amendment which would have also let funding go 
to unaccredited medical institutions.
  Finally, you have the Coats-Snowe amendment--the compromise 
amendment--which says we will prevent Congress from engaging in the 
accreditation standards of medical institutions, will preserve those 
very important standards for health care in America, and at the same 
time we will also protect the accreditation standard when it comes to 
abortion. And that is what it has always been. Nothing has changed. It 
has always been that, if an individual, who is in a medical training 
program, does not want to get training for abortion, he or she does not 
have to. The same is true for institutions. They will be able to exempt 
the institution from providing that training if it is contrary to their 
belief. That is what it has always been. The accreditation council has 
never denied an institution accreditation based on the fact that they 
refused to provide abortion training. It was always for a host of other 
standard equality reasons.
  I want to make sure that we preserve those reasons by preventing 
Congress from engaging in establishing, or overturning, accreditation 
standards which is our only guidepost for quality care for women in 
America.
  That is the reality. I hope the Senate understands that because to do 
otherwise, if this amendment is rejected, is that we will face the 
language in the House which would basically gut and do away with 
accreditation for all medical institutions in America. That is not a 
choice nor a decision that we should have to make.
  Thank you. I yield.
  The PRESIDING OFFICER. Under the previous order, the Senator from 
Arkansas has 15 minutes.


                           Amendment No. 3525

  Mr. BUMPERS. Thank you, Mr. President.
  Mr. President, I rise in support of the amendment by the junior 
Senator from Alaska [Mr. Murkowski], which authorizes the Greens Creek 
Land Exchange. This amendment gives the Kennecott mining company 7,500 
acres in the Admiralty Island Monument area of Alaska, in addition to 
the 340 acres they already own. They received the 340 acres they 
already own from the U.S. Government in the traditional way. They paid 
$2.50 an acre for it. For a while Kennecott had to shut down their 
silver, copper, and gold mine at the site because they were losing 
money. Now metal prices are higher and Kennecott has reopened the mine. 
I am glad they reopened the mine because it is good business for them.
  But more than anything else, Kennecott has agreed to pay a 3-percent 
net smelter return royalty on everything they mine from the additional 
7,500 acres they are receiving as long as metal prices are at least 
$120 a ton. If prices go below $120 a ton, their royalty will decline. 
I want to pay a little tribute to Kennecott. That is what I call good 
corporate citizenship.
  They got the 340 acres for a song because of the 1872 mining law 
which continues to this day to be the biggest scam in America. And the 
U.S. Senate has consistently ratified that scam at the same time this 
body is willing to cut Head Start, student loans so kids can go to 
college, school lunches, Medicaid, 40 percent of which is used to keep 
elderly people in nursing homes, and another 40 percent for children. 
They are willing to cut all of that but not to address this scam.
  As I say, I am happy to support the amendment of the Senator from 
Alaska. It is a good deal for them. It is a

[[Page S2277]]

good deal for the taxpayers of America. That is what we ought to be 
doing around here. But that is not what we are doing.
  Mr. President, when I took this issue on 7 years ago, 7 long years 
ago, the price of gold in this country was $300 an ounce. Every time I 
have attempted to stop the giveaway of Federal lands for $2.50 an acre, 
I got my brains beat out. Fortunately, I have been successful in 
gaining passage of a moratorium on the processing of new mining patent 
applications.
  The small progress I have made has been glacial. The mining companies 
want the taxpayers of this country to deed them Federal lands that 
belong to all of us for $2.50 an acre, $5 max, mine the gold, silver, 
copper, platinum, and other minerals off of this land and then, 
oftentimes, leave an unmitigated environmental disaster for the 
taxpayers to clean up--and not pay one thin dime.
  When I first took this issue on, gold was $300 an ounce. And the 
mining industry said, ``Well, if you put a 3- or 4- percent royalty on 
us, we will go broke. We will have to shut down, and all of these poor 
miners will be out of a job.'' Today gold is $400 an ounce. And what do 
you think their argument is? ``We will lose money. We will have to shut 
down and put all of those poor miners out of work.'' And like Pavlov's 
dog, Senators in the U.S. Senate grab it like a raw piece of meat and 
think that is the most wonderful thing they ever heard--``Keep all of 
these people working, if we will just not put a royalty on it.''
  We charge people 12.5 percent for every ounce of coal they take off 
Federal lands--12.5 percent. We make people who mine underground coal--
a very expensive undertaking--pay 8 percent for every ounce of coal 
they mine. We make the natural gas companies and the oil companies pay 
12.5 percent for every dollar's worth of oil and gas they take off 
Federal lands. And here is what we get for gold--zip. Here is what we 
get for silver--zip. And here is what we get for platinum--zip.
  Do you know what platinum is selling for as of this moment? It is 
$413 an ounce. We have given billions and billions of dollars worth of 
platinum and palladium away in Montana in the process of doing it, and 
we will not get one thin dime out of it.
  Just look at this chart: ``Miners Get the Gold and the Taxpayers Get 
the Shaft.'' Here is Barrick Gold Co., the stock of which has climbed 
in accordance with the price of gold. About a year and a half ago 
Secretary Babbitt was required by law to give Barrick Resources 11 
billion dollars' worth of gold. Do you know what the Secretary and the 
taxpayers of the United States got for that $11 billion? Yes, $9,000. 
Ask Senators who own land with gold or silver or platinum or palladium: 
How many of you are willing to give the gold companies that kind of a 
deal? You know the answer to that question.
  Then just recently the Secretary was required by law to give a Danish 
company--Faxe Kalk--1 billion dollars' worth of travertine. Travertine 
converts into a powder which has very special uses. What do you think 
the taxpayers of the United States got for that $1 billion? Why, they 
got a whopping $700--enough to take your family out to dinner about 
five times.
  Do you think I am making this up? If you think I am making it up, 
invite all Senators who think this is just such a wonderful thing to 
come to the floor and refute it.
  In the past year, we gave Asarco, a copper and silver company, lands 
that have underneath them--who cares about the value of the surface? We 
just gave Asarco 3 billion dollars' worth of copper and silver. What 
did the taxpayers get for their $3 billion? Yes, $1,745. We are going 
to be required--we have not done it yet, but under the law, because of 
the 1872 law that Ulysses Grant signed when he was President, we are 
going to be required to give the Stillwater Mining Co. 44 billion 
dollars' worth of platinum and palladium. Mr. President, this is their 
figure, not mine. You want to go and find out where I got that figure? 
Look at their prospectus. And the taxpayers of this country in exchange 
for their $44 billion are going to get the whopping sum of $10,000.
  We are trying to balance the budget. It makes a mockery of it. It 
makes an absolute mockery of it. You talk about corporate welfare. That 
is the reason I applaud the Kennecott Co. At least in the land 
exchange, the grant we are going to give Kennecott in the Murkowski 
bill, they had the decency to say, ``We will give you a 3-percent net 
smelter return for all the copper we mine.'' That is still less than 
private property owners charge, but it is at least reasonable. If the 
taxpayers of this country were getting a severance tax or a net smelter 
return royalty over the next 7-year period when we are trying to 
balance the budget, it is a big piece of money.
  When we look at some of the things we are doing to the environment, 
even after the add-back in the amendment we are going to vote on here 
in about 2 hours, even after we add that back into the environmental 
fund, EPA is still going to be cut significantly. Mr. President. When I 
came to the Senate, 65 percent of the streams and lakes of this country 
were not swimmable and not fishable. Today, in 1996, that figure has 
been reversed; 65 percent of the streams and lakes are fishable, are 
swimmable. And I do not care where you go. If you go to Main Street 
America--you pick the town--and you ask people: Do you think we are 
doing enough for the environment? Seventy percent of the people say, 
no. Do you want to reverse that figure to 35 percent of the streams and 
lakes not being fishable and swimmable from the point that 65 percent 
of them are? No. Nobody wants to turn the clock back on the 
environment.
  The air we breathe, the water we drink goes to the very heart of our 
existence, and we are cutting the Environmental Protection Agency's 
budget. Too much regulation, they say. That may be true. Cut the 
regulations back, but do not cut back the quality of water and air.
  Here is an opportunity to find an awful lot of money that we have 
been giving away since 1872, originally to encourage people to move 
west. You think about the rationale for the 1872 law--to encourage 
people to move west--124 years ago. What is the rationale now? 
Corporate greed. Political campaign contributions. That is it, pure and 
simple. People will not vote to impose a royalty on mining companies 
because they give away a lot of money around here. Until we straighten 
that out, this is not going to be straightened out.
  Mr. President, I have made the same speech on this floor many times. 
The figures keep changing. The companies that are benefiting from it 
keep changing. I do not know how much longer I am going to be in the 
Senate, but I promise you one thing: The last day I serve here I will 
be standing right here, unless this is rectified, making the same 
speech.
  I yield the floor.

                          ____________________