[Congressional Record Volume 142, Number 69 (Thursday, May 16, 1996)]
[Senate]
[Pages S5177-S5186]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  CONCURRENT RESOLUTION ON THE BUDGET

  The Senate continued the consideration of the concurrent resolution.
  Mr. DOMENICI. I suggest the absence of a quorum and ask it be charged 
to both sides.
  The PRESIDING OFFICER. The clerk will call the roll.
  Mr. DOMENICI. 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for the quorum call be rescinded.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. DOMENICI. Mr. President, we understand Senator Boxer from 
California is prepared with an amendment at this point.
  The PRESIDING OFFICER. The Senator from California is recognized.


                           Amendment No. 3982

(Purpose: To preserve, protect, and strengthen the Medicaid program by 
 controlling costs, providing state flexibility and restoring critical 
   standards and protections, including coverage for all populations 
   covered under current law. The amendment restores $18 billion in 
     excessive cuts, offset by corporate and business tax reforms)

  Mrs. BOXER. Thank you very much, Mr. President. I thank my chairman

[[Page S5178]]

and ranking member for allowing me to offer this amendment at this 
particular time. On my side, Senators Kennedy and Graham would like to 
speak to this amendment, and I send it to the desk.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from California [Mrs. Boxer], for herself, Mr. 
     Graham, Mr. Dorgan, and Mr. Kennedy, proposes an amendment 
     numbered 3982.

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

       On page 3, line 5, increase the amount by $1,900,000,000.
       On page 3, line 6, increase the amount by $2,500,000,000.
       On page 3, line 7, increase the amount by $3,200,000,000.
       On page 3, line 8, increase the amount by $2,700,000,000.
       On page 3, line 9, increase the amount by $2,600,000,000.
       On page 3, line 10, increase the amount by $5,400,000,000.
       On page 3, line 14, increase the amount by $1,900,000,000.
       On page 3, line 15, increase the amount by $2,500,000,000.
       On page 3, line 16, increase the amount by $3,200,000,000.
       On page 3, line 17, increase the amount by $2,700,000,000.
       On page 3, line 18, increase the amount by $2,600,000,000.
       On page 3, line 19, increase the amount by $5,400,000,000.
       On page 4, line 8, increase the amount by $1,900,000,000.
       On page 4, line 9, increase the amount by $2,500,000,000.
       On page 4, line 10, increase the amount by $3,200,000,000.
       On page 4, line 11, increase the amount by $2,700,000,000.
       On page 4, line 12, increase the amount by $2,600,000,000.
       On page 4, line 13, increase the amount by $5,400,000,000.
       On page 4, line 17, increase the amount by $1,900,000,000.
       On page 4, line 18, increase the amount by $2,500,000,000.
       On page 4, line 19, increase the amount by $3,200,000,000.
       On page 4, line 20, increase the amount by $2,700,000,000.
       On page 4, line 21, increase the amount by $2,600,000,000.
       On page 4, line 22, increase the amount by $5,400,000,000.
       On page 27, line 16, increase the amount by $1,900,000,000.
       On page 27, line 17, increase the amount by $1,900,000,000.
       On page 27, line 23, increase the amount by $2,500,000,000.
       On page 27, line 24, increase the amount by $2,500,000,000.
       On page 28, line 5, increase the amount by $3,200,000,000.
       On page 28, line 6, increase the amount by $3,200,000,000.
       On page 28, line 12, increase the amount by $2,700,000,000.
       On page 28, line 13, increase the amount by $2,700,000,000.
       On page 28, line 19, increase the amount by $2,600,000,000.
       On page 28, line 20, increase the amount by $2,600,000,000.
       On page 29, line 2, increase the amount by $5,400,000,000.
       On page 29, line 3, increase the amount by $5,400,000,000.
       On page 46, line 12, decrease the amount by 
     $18,300,000,000.
       At the appropriate place insert the following:

     SEC.   . SENSE OF THE SENATE.

       It is the sense of the Senate that the provisions contained 
     in this budget resolution assume Medicaid reforms shall--
       (1) maintain the guarantees in current law for Medicaid 
     coverage of seniors, children, pregnant women, and persons 
     with disabilities.
       (2) preserve current laws protecting spouses and adult 
     children from the risk of impoverishment to pay for long-term 
     nursing home care;
       (3) maintain the current Federal nursing home quality and 
     enforcement standards;
       (4) protect states from unanticipated program costs 
     resulting from economic fluctuations in the business cycle, 
     changing demographics, and natural disasters;
       (5) maintain the successful Federal-State partnership and 
     protect the Federal Treasury against practices that allow 
     States to decrease their fair share of Medicaid funding; and,
       (6) continue to provide coverage of Medicare premiums and 
     cost-sharing payments for low-income Medicare beneficiaries, 
     consistent with current law.

  Mrs. BOXER. Mr. President, I am honored and pleased to be able to 
offer the Boxer-Graham-Dorgan-Kennedy amendment regarding Medicaid. The 
purpose of this amendment is really quite simple and straightforward.
  First, my amendment restores the $18 billion in excess cuts made by 
the Republican budget, and it will be offset by closing corporate tax 
loopholes.
  Second, my amendment contains a sense of the Senate that any reforms 
made to Medicaid maintain six particular principles, and I will outline 
those principles briefly.
  But before I do, I think it is important to ask the question, Who 
does Medicaid really help in this everyday world? Who are the people 
out there who depend on Medicaid?
  First of all, 2 million senior citizens who are in nursing homes are 
on Medicaid and depend on Medicaid. Two out of every three residents in 
nursing homes depend on Medicaid.
  We also know there are 18 million children who depend on Medicaid--
children. It is their lifeline. Half of these children live in working 
families where their families work very hard. They are the working 
poor, and their children rely on Medicaid.
  The disabled--6 million of our citizens who are disabled rely on 
Medicaid and perhaps up to 1 million pregnant women rely on Medicaid. 
Of our children between the ages of 13 and 18, there are 2.5 million.
  So millions and millions of Americans rely on Medicaid, and, 
therefore, this amendment, I think--and I am so pleased that it has 
broad support on this side of the aisle--is really key to real people.
  So the first part of the amendment is that we restore $18 billion 
that has been cut, what we call excess cuts. Second, we have a sense of 
the Senate on six principles. They are as follows: First, maintain 
Medicaid coverage for low-income seniors, children up to 18 years of 
age, pregnant women, and the disabled; second, maintain current 
protection against the impoverishment of spouses and adult children 
whose family member is in a nursing home; third, maintain Federal 
nursing home standards; fourth, protect States from unanticipated 
increases in enrollment, which can occur as a result of economic 
fluctuations such as recessions, changing demographics or natural 
disasters; fifth, maintain the successful Federal-State partnership and 
protect our Federal Treasury against practices that may allow States to 
decrease their fair share of Medicaid funding; and sixth, continue to 
provide Medicare premiums and cost-sharing payments for low-income 
Medicare beneficiaries that are consistent with current law.
  I would like to make this point, Mr. President. All of these six 
principles that are outlined in this amendment are contained in the 
President's budget, as well as in the Chafee-Breaux budget proposal; 
however, they are not maintained or referenced in the Republican 
budget.
  So of the budgets that we will be looking at, namely, the President's 
budget, the Republican budget, and the Chafee-Breaux budget, we find 
the Republican budget does not address these six principles. Frankly, 
we feel it is very important that these principles be adhered to.
  Why do I say that? I think the backbone of all the other principles 
is the guarantee of coverage that exists in current Medicaid law for 
seniors, children, pregnant women, and persons with disabilities. We 
know this is a real problem because in the reconciliation bill we saw 
that there was a walking away from this commitment.
  We also believe that a person with certain disabilities in one State 
might not be considered disabled in another State under this budget. We 
want to make sure that does not happen. Some States could decide to 
define disability in such a way that it will not cover many serious 
disabilities.
  So we think it is very important that the people who are now covered 
remain covered. We do not have that assurance at all in this budget. As 
a matter of fact, the plans that the Republicans have talked about 
would allow the States to decide these questions. I think it is very 
important that it be a national standard here as to who is disabled and 
who should definitely have coverage.
  I want to talk about the guarantee to children. We have no certainty 
in this Republican budget that children from the ages of 13 to 18 would 
be covered. Let me tell you the problem. It would mean that a low-
income teenage girl, the only way she could get health coverage, if the 
State decided to cut her

[[Page S5179]]

off, is to get pregnant. This is not a message that we want to send to 
our young people. We should cover children until they turn 18. I think 
we owe them that.
  I want to talk a minute about the other principle, the spouses and 
adult children who are at risk of impoverishment if one of their family 
members winds up in a nursing home. Remember, there are 2 million 
senior citizens in nursing homes, and two out of three of them are on 
Medicaid. We passed a very important law, when I was over in the House 
of Representatives, that said we will not drive the adult children of 
nursing home residents and we will not drive the spouse of a nursing 
home resident into the poor house simply because their family member is 
in a nursing home.
  I am very fearful that without saying something affirmative in this 
budget, we could repeal this very important spousal impoverishment 
provision. We should not be forcing spouses or adult children to be 
thrust into poverty.
  Why do I say that? The average cost for nursing home care, Mr. 
President, is about $36,000 a year. Clearly, how many of our people 
could really pay that?
  I think it is crucial that we protect spouses and the adult children 
of nursing home residents. I think if we do not pass this amendment, 
our amendment that we have worked on here, that could happen.

  Nursing home quality standards. Very clearly we ought to say that we 
believe there ought to be national standards. Why do I say this? 
Because we know what can happen. We saw what happened in the 1980's. 
There were nursing home scandals. We know that our senior citizens were 
being mistreated, abused. Some of the stories are hair-raising. I will 
not go into them because time does not permit it. But they were 
drugged, they were put into baths that were scalding.
  What happened? We decided we would have standards and enforcement. 
Now we have absolutely no assurance in this particular budget that is 
before us that this will happen. That is why we hope we can get 
bipartisan support for this particular amendment that I am offering. So 
it is key to save those nursing home national standards.
  One senior citizen in Nebraska is as important as a senior citizen in 
New York or Ohio or Wyoming or Montana. We want to treat our grandmas 
and grandpas and our great grandmas and great grandpas with respect. We 
should have national standards and not back away from them.
  We protect the States from unanticipated program costs in the sense 
of the Senate. We say that, in fact, when you have a natural disaster 
such as my State of California, or there is an unanticipated cost from 
a recession, that we will help the States meet their Medicaid burdens.
  Finally, an issue that I know Senator Graham is going to speak to 
because he was a Governor of the great State of Florida. We want to 
maintain the successful Federal-State partnership involving Medicaid. 
We also want to make sure there are no scams in the States, that, in 
fact, the States do not abuse the Medicaid program.
  So, Mr. President, that concludes my remarks. I know that Senators 
Kennedy and Graham would like to speak.
  I would like at this time to yield them some time, if that is 
agreeable.
  Mr. President, I yield to the Senator from Massachusetts and then to 
the Senator from Florida. We have had a little bit of intervening 
debate and I just want to remind everyone what we are talking about 
here are the people in our country who need us to stand with them: The 
seniors in the nursing homes, the children with disabilities, the 
pregnant women, the working poor, the people who are working very hard 
to stay afloat and need us not to abandon them. I think this amendment 
we are presenting to you will give them that reassurance that they will 
not be abandoned.
  It is my pleasure to yield 15 minutes to the Senator from 
Massachusetts.
  Mr. KENNEDY. Mr. President, my friend and colleague from Florida will 
address the Senate on an extremely important aspect of this whole issue 
of the cutback in Medicaid. I will try to be to the point but also 
speak about the importance of this particular amendment.
  First of all, I want to thank the Senator from California, Senator 
Boxer, for being the leader on this particular issue as she has been on 
so many of the issues involving working families, children, and their 
parents and the disabled. All of us are grateful to her for her 
leadership on this issue of restoring some $18 billion in the Medicaid 
Program over the next 6 years.
  Now, I think Members can ask whether this $18 billion we see under 
the Republican program, the reduction of $72 billion, I think it is 
important as we commence this debate to understand where that serious 
cut will come from in the Republican budget and the benefits that this 
program reaches in terms of children, the disabled and the elderly. The 
importance of this amendment of the Senator from California is that 
with the acceptance of some cuts in the Medicaid, those cuts basically 
will be out of what we call the disproportionate share payments, which 
go not to the individual reduction in benefits, but are basically funds 
that go to the State generally. It is extremely important to understand 
that every dollar in the Senate's program is a dollar that will make a 
difference in the quality of life of children and seniors.
  The second point which is an enormous part of the Senator's amendment 
which I know that the Senator from Florida will cover is the 
significance of the Republican budget cuts, which will mean $250 
billion in reduced payments of benefits over the period of the next 6 
years because of the changing of the formula in terms of what is 
required by the States.
  This is a very, very dramatic reduction and cut in who will be 
affected by this. The people that will be affected by this, as the 
Senator has pointed out, will be the children, the elderly people, 
nursing homes, and the disabled in our country.
  The further point I want to make this evening is that it is important 
that we had the earlier vote on the Medicare and now on the Medicaid 
because to a great extent we are talking about the same populations. We 
are seeing the reductions in the Medicare programs that will affect our 
seniors, and this is another significant reduction in services for our 
elderly people as well as the children.
  So if you look at the reductions in the Medicare Program, and you 
look at the reductions in the Medicaid Program, you are finding those 
cuts, together, are going to be an extremely heavy burden on the most 
vulnerable in our society--the children, the frail elderly, and the 
disabled in our community.
  Medicaid is the companion program to Medicare, and the Republican 
assault on Medicaid is just as misguided and unfair as their assault on 
Medicare. The Republican plan would cut Federal Medicaid payments by 
$72 billion over the next 6 years--but that is only the tip of the 
iceberg. Under the Republican plan, total Medicaid spending would be 
cut by a staggering $250 billion--and States will be allowed to spend 
Federal Medicaid dollars on roads, bridges, and political patronage 
rather than health care services.
  In large measure, the Republican cuts in Medicaid will strike another 
heavy blow at the same groups hurt by the Republican cuts in Medicare--
senior citizens and the disabled. Ten million elderly and disabled 
individuals are enrolled in Medicaid. Seventy percent of all spending 
under the program is for these two groups--much of it for long-term 
nursing home care.
  Another group will also be injured by the Republican plan--America's 
children. Seventy percent of those who rely on Medicaid are children 
and their parents--a total of 18 million children. One in every five 
children in America depends on Medicaid. One in every three children 
born in this country depend on Medicaid to cover their prenatal care 
and delivery.
  Every child deserves a healthy start in life. Under the Republican 
plan millions of children who have adequate medical care today will be 
forced to do without it tomorrow.
  Medicaid provides good coverage to children today. They are 
guaranteed prenatal care, immunizations, regular checkups, 
developmental screenings, and both chronic and intensive physician and 
hospital care.
  The great bulk of Medicaid-covered children are in families with 
working parents. Most of these parents work

[[Page S5180]]

full time--40 hours a week, 52 weeks a year--but all their hard work 
does not buy them health care for their children, because their 
employer does not provide it and they cannot afford it.
  Even with Medicaid, over 10 million children are uninsured, and each 
day the number rises. Soon, less than half of all children will be 
covered by employer-based health insurance. We tried to address this 
problem in the last Congress--but the Republicans said no. Today, they 
are trying to undermine the only place that families can turn without 
employer-provided coverage.
  Last year, the Republicans proposed to eliminate all guarantees of 
coverage for children. This year, it is ``only''--only--poor children 
13 to 18 who will lose their coverage. In addition, children of all 
ages--even babies--will lose their current guarantee that all medically 
necessary treatments will be covered.
  The 6 million disabled who depend on Medicaid are even less 
fortunate. The Republican plan repeals all Federal standards for 
coverage of the disabled.
  States are also free to set any limits on scope and duration of 
services that they choose. If a State budget is tight this year, why 
not limit the sick to shorter hospital stays. If they need a week to 
recover from serious illness or surgery--too bad. That's somebody 
else's problem--if the Republican plan is adopted.
  In a very real way, Medicaid is a lifeline for children and families 
who have nowhere else to turn. Without access to Medicaid, many healthy 
children will become sick and many sick children will die. It is wrong 
to put children at risk to pay for tax breaks and special favors for 
the wealthy and powerful. Greed is not a family value.
  Under the Republican plan, senior citizens and the disabled suffer a 
one-two punch. Deep Medicare cuts, and even deeper cuts in Medicaid. 
Many will lose their Medicaid coverage or see their benefits cut back. 
But they will also be victimized by one of the harshest parts of the 
Republican plan--the elimination of Federal enforcement of quality 
standards for nursing homes.
  Strong quality standards for nursing homes were enacted by Congress 
with solid bipartisan support in 1987, after a series of investigations 
revealed appalling conditions in such homes throughout the Nation and 
shocking abuse of senior citizens and the disabled.

  Elderly patients were often allowed to go uncleaned for days, lying 
in their own excrement. They were tied to wheelchairs and beds under 
conditions that would not be tolerated in any prison in America. 
Deliberate abuse and violence were used against helpless senior 
citizens by callous or sadistic attendants. Painful, untreated, and 
completely avoidable bedsores were widespread. Patients were scalded to 
death in hot baths and showers. Others were sedated to the point of 
unconsciousness, or isolated from all aspects of normal life by fly-by-
night nursing home operators bent on profiteering from the misery of 
their patients.
  These conditions, once revealed, shocked the conscience of the 
Nation. The Federal standards enacted by Congress ended much of this 
unconscionable abuse and achieved substantial improvement in the 
quality of care for nursing home residents.
  Last year, the Republican proposal eliminated these standards 
altogether. When the public outcry was too great, they weakened the 
standards instead. This year, they claim to leave them unchanged--but 
they are proposing to leave enforcement to the States, even though it 
was the States' failure to protect senior citizens that necessitated 
passing the 1987 law in the first place.
  Whatever the formal rules and regulations say, the Republican cuts in 
Medicaid are so deep that even conscientious nursing home operators who 
want to maintain high quality care will be hard-pressed to afford the 
staff and equipment necessary to provide it.
  It is difficult to believe that anyone, no matter how extreme their 
ideology, would take us back to the harsh conditions before 1987. But 
that is what the Republican plan will do.
  Further, the Republican plan victimizes not only the elderly but 
their families as well. Last year, the Republicans proposed to repeal 
the spousal impoverishment protections that protected the husband or 
wife of a nursing home resident against the double loss of a loved one 
and the chance to maintain even a modest standard of living. They 
proposed to repeal protections that have been in place since the 
Medicaid program was enacted against adult children being required to 
impoverish themselves to pay for the care of an aged parent.
  Again, the public outcry was so great that the Republicans were 
forced to modify their plan--but they left the fine print in place. 
Spousal impoverishment provisions were supposedly retained--but they 
were rendered meaningless by other parts of the Republican plan.
  Without a guarantee of coverage, a protection against spousal 
impoverishment is useless for those who can no longer qualify for 
assistance in the first place. The plan allowed nursing homes to add 
extra charges that Medicaid did not cover, and require families to make 
large up-front deposits before a patient is admitted. Adult children 
were protected--but only if their income was below the median. Families 
whose total income is less than the cost of a year in a nursing home 
would still be liable for the cost of care for their elderly family 
member.
  Republicans claim their new plan avoids this last set of abuses, but 
the American people should read the fine print.
  The Republican plan for Medicaid is an outrage. It says that our 
society does not care about the most vulnerable groups in our country--
people with disabilities, senior citizens, and children.
  These Republican proposals are too harsh and too extreme. They are 
not what the American people voted for in the last election. They 
should be rejected out of hand by the Congress, and the American people 
should reject their sponsors in the next election.
  I thank the Senator from California. I yield back whatever time 
remains.
  Mrs. BOXER. Mr. President, I thank my friend from Massachusetts. 
Before he leaves, I think we have a chance to win this amendment, I say 
to my friend, because, actually, the Democratic budget addresses these 
issues. This amendment gives us a chance, those of us who supported 
that budget, to vote in favor of it. The Chafee-Breaux budget actually 
that will be presented to us does, in fact, make these commitments. So 
if everyone who voted for Chafee-Breaux, who voted for the Democratic 
budget, votes aye on this amendment, I say to my friend that maybe we 
will have some better luck in the outcome.
  My friend talked about turning our backs on those who need us the 
most. I was present for a hearing that we held when we were doing the 
health care bill in which we had disabled children who were relying on 
Medicaid come into the Congress with their caregivers. Usually it was 
their mom or dad. Just looking at those kids with spina bifida, with 
kidney problems, with muscular dystrophy, or with multiple sclerosis, 
trying to live their life with some dignity, relying completely on 
these payments, it seems to me, I say to my colleagues at this late 
hour, even if it is late, this is a little sacrifice to make when we 
think of those children and the sacrifices that they make every day of 
their lives and the sacrifices that their families make every day of 
their lives. It is shameful that we would walk away from these 
children. It is shameful.
  Nobody needs to hear a lecture from one Senator to another. I do not 
mean at all to sound that way, because I do not think that anyone who 
votes against this amendment wants to hurt those children. But I do 
think, in the end, that is what will happen.
  I yield 15 minutes to my friend from Florida, Senator Graham.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. GRAHAM. I thank my colleague from California.
  Mr. President, this debate should commence with one fundamental 
truth: The Medicaid Program for the last 30 years has been a great 
American success. The Medicaid Program has been a great American 
success. Let me give you a few examples of that success.
  In the early 1980's, in many parts of this country--I can speak 
specifically for the American South--the rate of infant mortality was a 
disgrace, rates of infant mortality that were close to those that would 
be found in some of the less-developed nations of the world.

[[Page S5181]]

 In that period, leaders in the South decided that they wanted to have 
a different legacy for the future.

  So under the leadership of Governors such as Lamar Alexander of 
Tennessee, Bill Clinton of Arkansas, Governor Dick Riley of South 
Carolina, who was designated to be the chair of a task force in the 
South on the children of the South, Governor Riley made a series of 
recommendations which were adopted by most of the Southern States. But 
the keystone recommendation was that the South should take steps to 
reduce its infant mortality by substantial increases in its commitment 
to appropriate prenatal care, care for pregnant women, care for 
infants, and care for children in those critical early days of life.
  The effect of that program 10 years later has been a dramatic 
reduction in infant mortality in the South, and because of that, a 
significant reduction in infant mortality in the United States, 
approximately a 20-percent reduction in the number of children who were 
born without life or with a life that was less than it might have been.
  Mr. President, Medicaid was an absolutely critical component of that 
effort to reduce infant mortality in our Nation, and because of it, 
there are literally hundreds of thousands of boys and girls who are 
alive today, living lives that have great promise and opportunity.
  Medicare is an American success story. Medicaid has also allowed 
older Americans to live a life of dignity and respect when otherwise 
they would have been consigned to the same condition of their parents 
and grandparents. To get old in America and to be poor in America was 
to be without dignity and respect.
  You say, ``Why is this true of Medicaid? I thought it was Medicare 
that provided services for older Americans.'' The fact is the two 
programs work in a very compatible manner. Medicaid, for those elderly 
who are unable to pay their premiums for Medicare, pays those premiums. 
It allows the indigent elderly to continue to have access to Medicare 
physician services. For those indigent elderly who cannot pay their 
prescription medication, Medicaid pays for their prescriptions so that 
they can have access to the modern miracles that make life possible and 
make a quality of life possible.
  For many Americans, it is Medicaid which provides access to long-term 
care, whether that be in a community setting or in an institutional 
setting such as a nursing home. As the Senator from California has 
pointed out, most Americans who are in nursing homes today--over two 
out of three--receive their nursing home monthly payments through the 
Medicaid Program.

  Medicaid is an American success story for older Americans. Medicaid 
is an American success story because it has served as the fundamental 
safety net under millions of poor children who without Medicaid would 
be without any financing for their health care.
  In 1980, of all Americans who were employed, approximately 65 to 70 
percent were employed in a workplace which provided health care 
coverage for themselves and for their families. That was part of what 
we thought was the American dream, that if you worked hard and you 
supported your family, you would have access to and the capacity to 
afford to acquire health care. We in Congress promoted that by 
providing very favorable tax treatment for employer-provided health 
care benefits. But since 1980, there has been a precipitous decline in 
the percentage of Americans who are covered at this point of employment 
with health care. Today that number is below 60 percent, and the 
estimate is that in the foreseeable future it will drop below 50 
percent. Less than half of the Americans who are working will be 
securing their health care through their place of employment.
  The result of this has been literally millions of low-income, not 
only the employees themselves but even more the dependents of those 
employees, their spouses and their children, without health care 
coverage.
  What has happened is that as these people fell into medical 
indigency, it was Medicaid which came to their rescue, and it has 
provided them with access to health care coverage. If it had not been 
for Medicaid, we would not be a nation today with some almost 40 
million Americans without access to health care financing; we would be 
a nation with 45 to 50 million Americans without access because persons 
who had lost their coverage are able, and particularly their dependents 
are able, to get it through the Medicaid Program.
  So the Medicaid Program has been an American success story. Because 
of that we should not be talking, as is suggested in the Republican 
proposal of 1996, as it was in the Republican proposal of 1995, about 
an amputation of Medicaid. Rather, we should be talking about 
thoughtful reforms that will preserve the fundamental values of the 
system while making it stronger and better and more adapted to some of 
the current changes in health care delivery.
  What are some of the fundamental issues in that reform of Medicaid? 
One is, should we maintain the basic national partnership between the 
Federal Government and the State governments in the financing and 
delivery of Medicaid services?
  There are those who would suggest that that partnership is an 
anachronism, that it has had its day, but now we should amputate it, 
cut it off. Let us look for some new mutation to take its place, and 
that new mutation is going to be some form of block grants where the 
Federal Government's role is essentially consigned to that of being a 
check writer that on the October 1 will write 50 checks, send them off 
to the State capitals of America and with very little involvement wash 
its hands of the Medicaid Program.
  The irony of this proposal, Mr. President, is that the very people 
who make it with such ardor frequently on other issues look, as one of 
their political North Stars, to former President Ronald Reagan and 
suggest that he is in many ways the father of modern conservative 
political thought.
  Would Ronald Reagan have supported a program of block grants to the 
States for Medicaid? As my colleague from California, who no doubt had 
an opportunity to observe former Governor and then President Reagan 
over a number of years, will certainly know, the answer is no, because 
what President Reagan proposed was that rather than Balkanize Medicaid, 
Medicaid should be federalized.

  He had a couple of compelling reasons why he thought that should be 
the case. The first was that as a Californian he recognized the fact 
that if you had differentials in standards, there was a tendency for a 
mobile population of poor people to seek out those communities that had 
the most generous standards. In the 1960's and 1970's California had 
among the most generous standards in the country and therefore served 
as a magnet for persons to come in the State in order to access those 
standards. So one rationale of President Reagan was that we needed to 
have greater uniformity in order to avoid this inducement to move.
  A second rationale which I think is extremely relevant today is that 
President Reagan recognized that Medicaid, which had started as being 
primarily a program for poor children and their families, was 
increasingly becoming a program for the frail elderly. In my State 
today about 60 to 70 percent of the Medicaid funding is spent on people 
over 65, a very high percentage spent on people over 85. So President 
Reagan felt that we needed to relook at both Medicare, the health care 
financing program for the elderly, and Medicaid, the program for the 
indigent, and attempt to rationalize, harmonize, knit those two 
programs more effectively together, and that that knitting together 
would occur with more likelihood if Medicaid was a Federal program than 
if it were distributed to the States.
  Mr. President, I think those two reasons of President Reagan were 
compelling in the 1980's and, if anything, they are even more 
compelling today. So it is somewhat of a shock now to see that the 
descendents of the philosophy of Ronald Reagan want to go exactly in 
the opposite direction from his advice, and that is to remove the 
Federal Government as a continuing partner in this national program of 
Medicaid.
  Mr. FRIST. Mr. President, will the Senator from Florida yield for a 
question for a second?
  Mr. GRAHAM. The Senator from Florida is close to being through, and 
at the conclusion of my remarks, I will be pleased to yield.
  The second point is that the Medicaid Program requires a base of 
financing in

[[Page S5182]]

order to meet its current needs and to be able to assume the new 
responsibilities which clearly lie just over the horizon. As the 
Senator from Massachusetts pointed out, the proposal of the Republicans 
will reduce the total funds available for Medicaid over the next 7 
years not just by the some $70 to $80 billion that will be eliminated 
at the Federal level but by a figure of close to $250 billion because 
the amount that will be asked of the States in their contribution to 
participate in the Medicaid Program will be so reduced.

  Mr. President, I do not believe any serious analysis of the 
challenges facing Medicaid could come to the conclusion that we can 
meet the health care needs of Americans with a $250 billion reduction 
in funds available in the fundamental safety net program of our 
national health care system, Medicaid. In fact, there are a number of 
factors that are going to put Medicaid under greater pressure. One of 
those factors is the fact that we have a growing number of children and 
adolescents in our population.
  To give just one statistic, last year America graduated approximately 
2.5 million students from its high schools. Within less than 9 years, 
we will be graduating over 3 million children from our high schools, as 
an indication of this surge of youth that is coming through our 
society, who in addition to having education needs will also have 
health care needs which Medicaid would be the principal instrument for 
meeting.
  I ask the Senator from California if she could yield an additional 5 
minutes.
  Mrs. BOXER. I will do that.
  The PRESIDING OFFICER. The Senator from Florida is recognized for 5 
minutes.
  Mr. GRAHAM. Also, there will continue, unfortunately, to be a decline 
in the number of children covered by the health insurance of their 
parents at a point of employment. The population will continue to age. 
More people will be in the advanced ages, which is the greatest source 
of additional cost to the Medicaid Program. We are making some policy 
decisions such as those embedded in our recent vote on the immigration 
bill that are going to result in greater demands on the Medicaid 
system.
  So there is no basis for the proposition that we can meet all of 
these challenges to the Nation's health care system and sustain a $250 
billion cut in the Medicaid Program, most of it being a cut at the 
State level, not at the Federal level.
  Finally, in the Medicaid system, one area of reform that cries out is 
to treat all States fairly. Today we have extreme disparities in terms 
of the funding that is provided for the poor child, the poor frail 
elderly, and the disabled from one State to the next. Those disparities 
are a function of history, the fact that we have built up a practice of 
inducing States to come into expanded Medicaid services by the Federal 
Government, matching or more than matching those State commitments. 
Those States that had a sufficient level of affluence to afford a more 
luxurious system have developed that, and, therefore, that has led to 
substantially higher amounts of Federal support for their Medicaid 
programs than for the less affluent States.

  We also have the situation in which certain States severely abused a 
program that had a good purpose: to recognize the special cost of 
hospitals that served large numbers of indigent Americans. Those 
hospitals were to be recognized by getting a disproportionate share of 
Medicaid funds in order to pick up some of that cost that was otherwise 
uncompensated. Unfortunately, that program was severely abused by a 
handful of States and resulted in extreme distortions in where Federal 
Medicaid money went, State to State.
  The proposal we have before us would largely freeze those past 
inequities into place and would make us live with them for the 
foreseeable future. The amendment offered by the Senator from 
California represents a clarion voice for reform and fair treatment in 
that all Americans should be assured that they will be treated equally 
by their National Government in terms of their access to quality health 
care.
  Those are some of the fundamental issues we are dealing with. Are we 
going to maintain the Federal-State partnership which has served us so 
well in reducing infant mortality, providing dignity for older 
Americans, providing a safety net under an increasingly frayed system 
of employer-based health insurance? Are we going to maintain an 
adequate funding basis at both the Federal and the State level to meet 
increasing demands on our Medicaid Program? And are we going to treat 
all Americans, wherever they live, fairly?
  The amendment that is offered by the Senator from California meets 
those tests of fundamental fairness and vision for the future of 
America. The underlying proposal fails on all of those tests.
  I urge the adoption of the amendment of the Senator from California.
  Mrs. Boxer addressed the Chair.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. Mr. President, I thank my friend from Florida, the former 
Governor and distinguished U.S. Senator. He is on this floor with, I 
think, very important advice for Senators. It is fiscally responsible. 
He understands that when you help people who are trying to help 
themselves, when you help people who deserve help, people who have such 
problems, disabilities, infirmities, that in fact you are doing the 
right thing. I thank him very much for his leadership on this.

  I say to my friend from Tennessee, that concludes our discussion of 
this amendment. I will be very happy to yield the floor at this time 
for him if he wishes to rebut. But I again urge my colleagues to look 
carefully at the Democratic budget, at the Breaux-Chafee budget--or 
Chafee-Breaux budget, as it is called--and the Republican budget. You 
will see that two out of three of these budgets believe in this 
amendment, believe strongly in this amendment. I hope those who support 
both the Democratic proposal and the Chafee-Breaux budget proposal will 
support this amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Tennessee.
  Mr. FRIST. Does the distinguished Senator from California yield back 
the remainder of her time?
  Mrs. BOXER. If my friend is going to speak and wishes to debate this, 
I have no need to take any amount of time other than to rebut, perhaps, 
some of his comments if I feel I need to do so. It is not my intention 
to prolong this debate.
  Mr. FRIST. Mr. President, I rise to oppose the amendment of the 
Senator from California for a number of reasons. Fundamentally, this 
particular amendment results in more taxation and more spending. The 
case I would like to lay out is that that increased taxation and 
increased spending is unnecessary. It is unnecessary.
  Let me say at the outset, we have heard a lot from people who care 
very much about this Medicaid Program. The Medicaid Program is 
something that I, too, care very much about. I have worked with Members 
on both sides of the aisle to guarantee that we preserve what is a very 
good program that has served millions of people, both today and over 
time.
  My role as a public servant, as a U.S. Senator, is one hat that I 
wear, but in addition to that perspective, I wear the hat of a 
physician who has taken care of the very people that we have heard 
talked about tonight. It hurts me when people use words like ``walk 
away from children.'' I have dedicated my entire adult life to helping 
children, one on one, as a physician, and to have words like that used 
on either side of the aisle hurts a great deal.
  About 35 percent of the patients I have treated over the last 18 
years of my life are Medicaid recipients. Night after night I have sat 
at the bedside of children, of mothers, of fathers, of people who have 
benefited from a program that served as a very important safety net for 
people who otherwise might not have access to care. It is to those 
people I say, to hear this accusation, it is not medagoguery, but it is 
close, when we have these accusations of walking away. Again, I am not 
sure it is intended that way, but the fact we are talking about the 
case of individuals, of children, with accusations elevated to that 
political--rhetorical, I think--level hurts.

  When we heard here words about cut, and the distinguished Senator 
from Massachusetts used cut again and again and again, and that is 
associated

[[Page S5183]]

with the comments made about walking away from children and the 
amputation of programs--the growth rate in our proposal is 6.5 percent 
next year, the year after that, and the year after that--6.5 percent 
annual growth rate. That means an increase, not a cut, year after year 
over the next 6 years.
  I think, finally, the public at large understands this is not a cut. 
It was President Clinton who, 3 years ago, in 1993, in an AARP meeting 
out on the west coast, said what we need to do for this program, 
Medicaid, is slow the growth from about 10 to 11 percent down to two 
times inflation. That is what we have done. A program that gives 
flexibility to States, that covers the people who need to be covered--
and I will come to that shortly--we have slowed the growth to exactly 
what the President said 3 years ago, down to more than two times the 
rate of inflation. Anybody who has taken time to read what we proposed, 
it is 6.5 percent growth, year after year.
  The President's plan is 7.1 percent. I guess we can debate whether it 
should be 7.1 or 6.5, but to say we are walking away from children and 
we are cutting or amputating programs, it is not true and the American 
people are going to see through that.
  I do want to restate the ideas behind the Medicaid reforms and the 
question I was going to ask earlier of my colleague from Florida, 
because he kept saying this is a block grant to the States. It is not a 
block grant. It is not even close to a block grant.
  No. 2, he talked about the dissolution, what is no longer a joint 
Federal-State partnership. It is just not true. It is not true. If you 
read what our assumptions are in the concurrent budget resolution, it 
is real simple. It basically says the committee's recommendation 
assumes implementation of a bipartisan--bipartisan--Medicaid reform 
plan approved by 48 Governors in early February. It was the unanimous 
consent of 48 Governors, who put together the plan, which is the basis, 
the foundation for the assumptions which resulted in our proposal.

  It is important to say that, because the second half of the amendment 
proposed by the Senator from California lists six principles. Let me 
say at the outset that I agree with most all of those principles. I 
think that is important. I do not agree we have to increase spending by 
$18 billion to accomplish that, and I will come back to it.
  But let me say what our plan--the assumptions in the 48 Governors' 
unanimous consent bipartisan plan which is the foundation, the verbatim 
foundation for our proposal--does. It is not a cut, it is an increase. 
I have said that. It is not a block grant, it is a Federal-State 
partnership.
  It is not walking away from children. We cover the same populations, 
and I will come back to that. We guarantee coverage in this plan of 
low-income children who I have taken care of; and of pregnant women who 
I have taken care of in the past; and of the senior citizens who I have 
taken care of; and the individuals with disabilities for whom I am an 
advocate. We guarantee coverage. Period.
  No. 2, we maintain the Medicaid Program as a matching program. 
Matching, that means Federal and that means State; a partnership; hand 
in hand; money comes from both. It is not a block grant to the States.
  No. 3, we continue the Federal minimum standards for nursing homes, 
which were brought out in the principles of my colleague from 
California.
  No. 4, we continue Federal rules that prevent wives or husbands from 
being required to impoverish themselves just to keep and obtain 
Medicaid benefits for their spouses, requiring nursing home care. We 
continue those Federal rules. Period.
  No. 5, we provide coverage of Medicare premiums and cost sharing 
payments for low-income seniors consistent with the unanimous 48 
Governors'--at the National Governors Association--Medicaid policy. 
That is what we do. Let us strip away the rhetoric.
  The fundamental problem with Medicaid, because we do have a problem 
with the program that does serve over 30 million people--we do have a 
problem. Let us step away and look at the numbers, because we have the 
budget. We have the assumptions I just talked about, but let us go back 
to the numbers for one second.
  The problem: Federal spending on Medicaid has doubled over the last 5 
years; $90 billion in 1995. It is 20 percent of the State budget. That 
means if you are a Governor today, anywhere from 18 to as high as 23 
percent of all the money in your budget is going to Medicaid. You can 
say, ``Should it be 20 percent? Should it be 15 percent? Should it be 
25 percent?'' None of us can really answer that question. But what we 
do know, if you have 20 percent of your budget and the other 80 percent 
is being spent on crime and the environment and education and roads and 
police, that if you let that 20 percent grow to 25 percent or 30 
percent or 35 percent, what suffers? Education, environment, crime, 
police, roads.

  So at some point, the Governors have to sit back and say, ``We have 
to do something about a program that is one-fifth of our budget that is 
skyrocketing year after year at the Federal level,'' and by definition 
at the State level, is doubling at least every 5 years. If you do not, 
schools are going to get even worse, our environmental protection is 
going to get worse, there are going to be fewer police on the streets.
  So we have a problem. We all know it is a problem. We are all trying 
to work together, in a bipartisan way--at least the Governors are, 48 
of them--in addressing that problem.
  This is why you do not have to raise taxes $18 billion in this 
amendment that has been put on the table. You do not have to. Excessive 
regulation results in waste.
  What has happened over the last 30 years in this program is that with 
our good intentions in this body, Washington, DC, inside the beltway, 
we want to help people. How do we do that? We do that by coming to this 
floor and passing a layer of regulations, and the next year, another 
layer of regulations put on that, and then another layer of 
regulations, to where you get to 1996 and you have a program with 
50,000 regulations telling you how to spend a health care dollar, which 
is the taxpayers' dollar, in taking care of that child who I had to do 
a transplant on or do a heart operation on back at Vanderbilt Medical 
Center where I was 3 years ago before I came here.
  That taxpayer dollar gets eaten up, literally eaten up by the time it 
gets down to the doctor-patient relationship, and that is the problem 
we have. It is excessive regulation and waste.
  Somebody else has realized that. It is not just us. Governor Bill 
Clinton, before the House Government Operations Committee, December 8, 
1990, I think said it much better than I can. He has been at this a lot 
longer than I have. He knows how to say things, I think, pretty well. 
He used the right words:

       Medicaid used to be a program with a lot of options and few 
     mandates.

  We are the ones who do the mandates.

       Now it's just the opposite.

  Let us face the facts. He had it right back in 1990, and in this 
proposal we have today, we have it right. It is not perfect, but it is 
a lot better than what we have today.
  Why do we have to spend another $18 billion, increase spending $18 
billion, increase taxes $18 billion, which is what this amendment 
implies we have to do? Our contention, and the contention of the 
Governors, is that if you strip away the regulations, if you strip away 
the requirements of dictating that doctor-patient relationship, what 
goes on, eligibility, out of Washington, DC, if you strip away those 
50,000 regulations and you give much of that responsibility back to 
States and give them the flexibility to run their programs, you can 
save money.
  You do not have to cut, you can still allow Medicaid to grow over 6 
percent, over twice inflation, which is what we do, but you do not have 
to let it grow at 15 to 17 percent a year.
  Let me turn to this one chart just to show you. Tennessee--and we 
have had discussions on both sides of the aisle of what are called 
1115(a) waivers. It is hard to get these 1115(a) waivers. I can tell 
you, before I came to this Senate, I went through that process with 
Tennessee and it ain't easy.
  The 1115(a) waiver says, in essence, we will let you, as a State, run 
a program how you see best; we will give you the flexibility, instead 
of mandating how you run it out of Washington, DC, and let us see what 
you do.

[[Page S5184]]

  Tennessee applied for a waiver, received that waiver and let me just 
show you--it is not a perfect program, and I am not going to be here 
defending everything about the program--but let me show you just the 
dollars and cents of what can be done if you give those Governors the 
responsibility, let them design an appropriate program over time.
  This is the Medicaid expenditure growth in the State of Tennessee. 
This starts in fiscal year 1986, 1987, continues to 1992, 1993, and 
1994. The yellow bars are the percentage change in increased 
expenditures in a State, the overall program, joint State and Federal 
match.
  You can see in fiscal year 1986, the Medicaid Program in Tennessee 
was growing at 21 percent, and it has happened in all of our States at 
varying levels. In 1987, it grew at 16 percent; in 1988, it grew at 21 
percent; in 1989, a pretty good year, it grew at 14 percent; it grew at 
20 percent; 20 percent; 1993, 13 percent; 1992, 34 percent.
  Think, if you are a Governor and have a program growing on average 
about 20 percent, which is this red line, each and every year and you 
have your budget, 20 percent a year, that part of your budget is 
growing, all of a sudden, you have to start saying, I can't spend as 
much on education, I can't spend as much on fighting crime, on putting 
police on the streets, because we're growing at 20 percent per year.
  In Tennessee, for the same amount of money being spent, both at the 
State and Federal level, by having these 50,000 regulations stripped 
away, growth in 1994 was right at 1 percent --1 percent. That overall 
budget about $2.5 billion did not grow over the course of 1 year. That 
shows what can be done. It can be done if you give States that 
flexibility.
  That is why I oppose this amendment. You do not have to charge it; 
$18 billion more in increased taxes and increased spending.
  Let me go back to one other chart just to demonstrate what that 
actually means. Again, we are talking dollars right now. I am coming 
back to the eligibility.
  This is TennCare in yellow. This is Medicaid in red, which is what 
would have been projected if we had to still live under the Federal 
regulations in the State of Tennessee, which other States have to live 
under. This is in 1994 when the program started. If you look over time 
with TennCare, you can see that cost and expenditures are controlled, 
increasing, ironically, at a rate of about 6.5 percent a year in the 
State of Tennessee.
  Look what it would have increased to if we had to live under those 
excessive, burdensome regulations. President Clinton said it best back 
in 1990.
  Someone might say, Well, I bet you did it in Tennessee by not 
covering as many people. You are not doing as good a job. In some way 
you are cutting back on benefits and cutting back on services. The 
beauty is we do not have to let taxes grow, and at 20 percent of 
expenditures. In 1993, 89 percent of the population was covered. This 
is not very good. This is, of the entire population, 89 percent of all 
Tennesseans were covered.
  By giving States the right to look at their own programs, strip away 
their regulations, for the same amount of money, for the same amount of 
money for controlled growth, we were able to cover 94 percent of the 
population. It is ironic; 89 percent was probably in the lower 10 or 15 
of all States of people covered.
  In 1994, Tennessee was the No. 1 State in the country in terms of 
numbers of people covered. Why? Because we were able to cover more 
people for the same amount of money by stripping away these excessive 
Government regulations. What? This proposal? We heard a lot of things. 
A lot of it has been rhetoric.
  What is actually in our proposal? I have said, we are going to 
increase Medicaid spending more than two times inflation, at a rate of 
an average annual growth of 6.5 percent. Is that a cut? That is not a 
cut. We are going to spend, in fact, $54 billion more than in last 
year's budget resolution.
  So we have moved from the resolution last year. The President's plan, 
as I said, is 7.1 percent growth. The big thing, I think, is that all 
of our assumptions, all of our savings, are based on the Governors' 
Medicaid proposal. I think this was missed in all of the earlier 
comments when we talked about block grants, we talked about no nursing 
home standards, we talked about lack of eligibility.

  Let me just tell you what the Governors' Medicaid proposal says.
  Restructuring Medicaid. These are our assumptions.
  Eligibility. It is guaranteed for pregnant women up to 133 percent of 
poverty. It is guaranteed for children to age 6 to 133 percent of 
poverty; age 6 through 12 to 100 percent of poverty. It is guaranteed 
for the elderly who meet SSI income and resource standards. It is 
guaranteed for individuals with disabilities.
  Benefits. The following benefits are spelled out by the National 
Governors' Association recommendation, which was accepted. We based all 
our assumptions on adopting this plan. The benefits remain guaranteed 
for in-patient and outpatient hospital services, physician services, 
prenatal care, nursing facility services, home health care, family 
planning services and supplies, laboratory and x-ray services, 
pediatric and family nurse practitioner services, nurse midwife 
services, and early and periodic screening and diagnosis treatment 
services.
  Nursing home reforms. Again, let me say that in terms of the 
principles outlined in the amendment under discussion, I agree with 
many of those principles.
  Nursing home reforms. What is in the Governors' plan which is our 
plan? States will abide by the OBRA '87 standards for nursing homes. 
States will have the flexibility to determine enforcement strategies 
for nursing home standards and will include them in their State plans.
  Financing. We heard this statement that this was a block grant to the 
States. Each State will have a maximum Federal allocation that provides 
the State with the Federal capacity to cover Medicaid enrollees. The 
match will continue.
  We also have in that plan an insurance umbrella. The insurance 
umbrella is designed to ensure that States will get access to 
additional funds for certain populations if, because of unanticipated 
consequences, the growth factor fails to accurately estimate the growth 
in the populations. Funds are guaranteed on a per beneficiary basis for 
those described below who are not included in the estimates of their 
base and their group.
  In closing, Mr. President, I oppose this amendment. I have made the 
point that we do not need to spend and tax $18 billion or more to 
accomplish the goals that are laid out. I have shown, in fact, how one 
State required zero percent growth, not 10, 15, 20 percent growth, and 
was able to treat, was able to cover more individuals. We do not need 
to tax more and we do not need to spend more.

  We heard of the amputation of programs. We heard of walking away from 
children. I do hope we can stay away from that rhetoric because I, as a 
physician--I am a Senator for awhile, but basically I am a physician. I 
have taken an oath, and I have lived my life in the service of 
individuals, again, with about a third of that population being 
Medicaid recipients.
  I want it there. I understand the value of it to be there. I 
understand the importance of this program and feel that I, in a 
bipartisan way, with 48 Governors who put their proposal on the table, 
can achieve the goals that we all want, and that is to provide a safety 
net for this population, for all three populations who need Medicaid 
over time.
  Mr. President, I yield the floor.
  Mrs. BOXER addressed the Chair.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. I do not intend to take a great deal of time at all, but 
I just want to make certain points in response to my friend from 
Tennessee.
  He said it hurt him to hear Senators on this side--and I guess he was 
quoting me--say their budget, the Republican budget, is walking away 
from children and poor seniors. When I made that remark, I said 
specifically, I know no one intends that to be the case. I just happen 
to believe it is the case. I do not think anyone intends to hurt a 
child. To hurt a child with spina bifida, to hurt a child in a 
wheelchair, to hurt a senior citizen who depends on others in nursing 
homes--no one would ever want to hurt those people.

[[Page S5185]]

  I just happen to believe that is the outcome. I am not alone in this. 
I am not alone in this. I am going to talk a little bit about who on 
the Republican side of the aisle would like to add even more back than 
Senators Graham, Kennedy, Dorgan, and I are adding back.
  So when I say I think this Republican budget, in terms of its 
Medicare cuts--I call them excessive cuts--walks away from kids, I do 
not mean it to hurt any Senators. I am saying it because I think in 
pragmatic terms it is going to hurt kids and people who are quite 
vulnerable.
  I heard the Senator say that he is proud of the Governors and that 
they decided they would cover children and they would cover the seniors 
who are disabled and they would cover pregnant women. I am very glad 
that they want to. But I would have to take it another step. If the 
Senator believes it so important to cover pregnant women, if the 
Senator believes it is so important to cover the disabled and the 
seniors in nursing homes, then why do we not do it as Americans, as a 
national Government, and not leave it up to 50 States? Because, let me 
say this, States can say one thing today. They could be hit with a 
natural disaster tomorrow, and simply not have the wherewithal to do 
the job.
  You know, when States want to get block grant funding, they may say 
one thing, and a few years later, change their mind. Why does the 
Senator think we have Federal nursing home standards? It is simply 
because the States set the standard, and there was scandal after 
scandal after scandal. And there were hearings.
  I do not know what condition the Senator's State was in, but I can 
tell you in my home State, there were scandals. Seniors were scalded in 
bath tubs and were drugged. I know the Senator from Oregon, who has 
been a champion for senior citizens, knows about those stories. We saw 
spouses becoming impoverished. We saw adult children of those nursing 
home residents becoming impoverished. We worked hard over in the House, 
he and I, with Henry Waxman--and I remember it well--and Barbara 
Mikulski over here on this side. We said never again will that happen.

  Now the Senator from Tennessee says, is it not great that Governors 
care. I believe that Governors care. But so do I. I happen to be a U.S. 
Senator. He happens to be a U.S. Senator. We have a chance in the U.S. 
Senate to say it is important to have Federal nursing home standards 
and enforcement.
  I also would like to say this. My friend says this is a very 
expensive proposal, $18 billion. Does he know that Breaux-Chafee, a 
bipartisan proposal in this U.S. Senate, adds $31 billion more to the 
Republican budget? Does he think those people are spendthrifts? Does he 
think Senator Bennett, Senator Bond, Senator Brown, Senator Chafee, 
Senator Cohen, Senator Gorton, Senator Jeffords, Senator Specter, 
Senator Simpson, Senator Snowe, his colleagues on the Republican side 
of the aisle are spendthrifts and do not care about fiscal 
responsibility? I am sure that he agrees with me that they do care. Yet 
they are going to be $31 billion over the Republican budget.
  In conclusion, I say this: This is not about rhetoric. This is about 
adding back $18 billion, when Breaux-Chafee with all these Republican 
Senators want to spend $31 billion more in that same time period.
  My friend talks about bipartisanship. My goodness, our amendment is 
less than their budget in terms of Medicaid. Clearly, there are three 
proposals out here dealing with Medicaid: The Republican proposal, the 
Democratic proposal, and Breaux-Chafee. The one, in my opinion, that 
hurts children, and I do not mean to hurt the Senator when I say this, 
I just think it is a result of his priority, that hurts seniors, that 
hurts the disabled, happens to be the Republican budget. That is why I 
hope we can join hands together, all of us, and support this amendment.
  I know the hour is late and I thank my colleague from Florida, my 
colleague from Massachusetts, my colleague from Oregon for his 
patience.
  I yield the floor.
  Mr. FRIST. Mr. President, I oppose the amendment. I disagree on the 
closing that this proposal hurts children. It is a statement, but there 
is no data, evidence, or suggestion given that it hurts children. I 
said eligibility covered children to age 6 through 12 to 100 percent of 
poverty. This is a National Governors' assumption, proposals.
  I guess we could say it hurts children, but there is no evidence and 
no data that it hurts children. I see nothing, having taken care of 
children with my hands in a Medicaid Program, I see nothing, nothing, 
in this proposal that hurts children. Walk away from kids, hurting 
children--I guess we will just disagree on that.
  The Senator from California did strike--I think, again, this is a 
difference we will not agree upon, but when she has argued that it 
takes a national program, a National Government, to be able to protect 
children----
  Mrs. BOXER. Will the Senator yield?
  I said national standards, not a national program. I said national 
standards.
  Mr. FRIST. If the statement was national standards, let me just say 
that the standards in the Governors' proposal are basically standards 
that will be carried out by every State. That is part of the 
assumption. If it is just national standards, we are OK.
  My feeling was at a national level it took us to best decide how to 
take care of people in Tennessee or in Washington State or in Alabama 
or Mississippi. That is a fundamental difference, I believe. I think 
the more we can do at the State level and at the local level, the 
better. That is where accountability will rest.
  I argue strongly that this body, Washington Government, Washington, 
DC, is not the body that can best cover children or protect children or 
prevent people from hurting children. I argue it is the people closest 
to home, that it is the Governors, it is the local governments that can 
best watch after our children. That is a fundamental difference.
  Third, on the Chafee-Breaux, Breaux-Chafee proposal, we have not had 
that presented yet. I do not know what the dollar figures will be. 
There are some assumptions that it might be that reform is delayed a 
year. I have heard that mentioned in these particular proposals. I 
cannot comment. I do not know the fact that they spend more makes it a 
better program. I argue that increasing at 6 percent a year based on 
what we have seen in at least one State, in Tennessee, we can 
accomplish all of our goals without this radical increase in taxation, 
more taxation and more spending.
  Last, we will come back to the word ``bipartisan.'' I have already 
mentioned from where we were in the budget resolution last year, we 
have shifted $54 billion already. I will say what we have endorsed is a 
bipartisan plan that Governors together came and endorsed. That is 100 
percent of the assumptions we put in our budget. That is bipartisan. We 
have endorsed that. That is the basis of our assumptions.
  With that, I hope when we do vote on this amendment, again, agreeing 
with many of those principles laid out, but arguing that many, if not 
most of those proposals are spelled out in this very document which we 
have endorsed, that we do not need that increased spending. It is 
unnecessary.
  Mr. President, could I ask my colleague from California if she is 
willing to yield back her time?
  Mrs. BOXER. I am happy to yield back all my time on this. I assume, I 
say to my friend, that we will be voting on this amendment on Tuesday. 
Is that correct?
  Mr. FRIST. I understand it will be stacked on Tuesday.
  Mrs. BOXER. I also ask unanimous consent that each side be allowed 1 
minute before the vote to explain the amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. BOXER. Mr. President, I ask unanimous consent that the amendment 
be laid aside so the Senator from Oregon can offer an amendment.
  Mr. FRIST. I yield back all my time.


                           Amendment No. 3984

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

       The Senator from Oregon [Mr. Wyden], for himself and Mr. 
     Kerry, proposes an amendment numbered 3984.

  Mr. WYDEN. Mr. President, I ask unanimous consent reading of the 
amendment be dispensed with.

[[Page S5186]]

  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       At the appropriate place, insert the following new section:

     SEC.   . SENSE OF THE SENATE REGARDING REVENUE ASSUMPTIONS.

       (a) Findings.--The Congress finds the following:
       (1) Corporations and individuals have clear responsibility 
     to adhere to environmental laws. When they do not, and 
     environmental damage results, the federal and state 
     governments may impose fines and penalties, and assess 
     polluters for the cost of remediation.
       (2) Assessment of these costs is important in the 
     enforcement process. They appropriately penalize wrongdoing. 
     They discourage future environmental damage. They ensure that 
     taxpayers do not bear the financial brunt of cleaning up 
     after damages done by polluters.
       (3) In the case of the Exxon Valdez oil spill disaster in 
     Prince William Sound, Alaska, for example, the corporate 
     settlement with the federal government totaled $900 million.
       (4) The tax code, however, currently allows polluters to 
     fully deduct all expenses, including penalties and fines 
     associated with these settlements. In the case of the Exxon 
     Valdez disaster, deductibility on that settlement at the 
     current corporate tax rate will result in $300 million in 
     losses to federal tax collections . . . losses which will 
     have to be made up through increased collections from 
     taxation of average American families.
       (5) Additionally, these losses also will make it more 
     difficult to move aggressively and successfully toward a 
     balanced federal budget.
       (b) Sense of the Senate.--It is the sense of the Senate 
     that--assumptions in this resolution assume that revenues 
     will be increased by a minimum of $100 million per year 
     through legislation that will not allow deductions for fines, 
     penalties and damages arising from a failure to comply with 
     federal or state environmental or health protection laws.

  Mr. WYDEN. Mr. President, this amendment which I offer tonight with 
Senator Kerry of Massachusetts would put the U.S. Senate on record as 
saying that it is time to end tax writeoffs under our Tax Code for 
polluters.
  We know our country wants the Senate to get serious about balancing 
the budget. I know this has been a slow moving exercise in the past. 
They want a serious sprint to balancing the budget. I believe it is 
possible to make real progress in balancing the budget. I said in my 
campaign that I believe you can balance the budget, just the way Oregon 
families have to balance their budget.
  Under the proposal that I offer tonight, if it had been law over the 
last 6 years, about $500 million would have gone to reducing the 
deficit simply by ending tax writeoffs for those who pollute in our 
country.
  What happens today, even though we want a polluter-pay philosophy 
with respect to environmental protection, what we do is under the tax 
law provide a Macy's basement discount for those who actually have to 
pay penalties.
  So what I am proposing tonight with Senator Kerry of Massachusetts, 
is basic tax fairness. Under our amendment, no longer would average 
working families pay more on their taxes just because the polluter has 
received a writeoff on their tax return. What we propose is to put the 
Senate on record that all revenues collected, when you have the kind of 
current tax treatment for these penalties, would go back to the 
Treasury. It would not go into the pockets of the polluter.
  Let me talk, for a moment, about the way it works today under our tax 
laws. If you have a polluter who violates the Safe Drinking Water Act, 
a statute that assures that the water our kids drink is safe, they then 
have to pay a penalty. But under the Federal tax laws, they get a tax 
break for that penalty that they would be paying.
  The Clean Air Act assures that the air our families breathe is pure. 
But if a polluter violates it and pays a penalty, they get another tax 
break when they violate that important environmental law.
  The Resource Conservation and Recovery Act protects our communities 
against hazardous waste. When a polluter violates that statute, they 
have to pay a penalty under the law, but they get a tax break under the 
Tax Code when they do so.
  The CERCLA Act is the one designed to clean up our Nation's Superfund 
sites, some of the most hazardous and dangerous waste in our country. 
When a polluter violates those laws, they pay penalties, and, again, 
get tax writeoffs.
  The Oil Pollution Act is a particularly important example of why this 
change Senator Kerry and I propose tonight is needed. The Oil Pollution 
Act seeks to guard against devastating oil spills like the Exxon 
Valdez. In the case of the Exxon Valdez disaster in Prince William 
Sound, the polluter agreed to a settlement of approximately $900 
million. The defendant in that case took an immediate $150 million tax 
deduction. Over the course of that 10-year payout on that particular 
settlement, you have a polluter that is going to be able to write off 
nearly $300 million of the total cost.
  Now, some are going to argue that it makes sense to provide a tax 
deduction as an incentive for polluters to somehow settle these damage 
suits. I argue that the knowledge that these polluters are going to pay 
the full freight of their damage is a lot more than incentive for them 
to comply with the environmental laws and get serious about cleanup. I 
do not think it provides any real incentive if you allow people to 
write off on their taxes when they violate the environmental laws and 
have to pay penalties. I think it erodes the fairness of the Tax Code 
when you provide almost unlimited deductibility arrangements for the 
polluters, where they get a discount of everything they pay up to 34 
percent.

  Now, the fact is, Mr. President, that all of the major environmental 
organizations are in support of this particular amendment. They have 
said this is one of their priorities with respect to the environment 
and this budget resolution.
  Every Member of this body who cares about tax fairness ought to 
support this amendment. I do not see how a Member can go and stand up 
at a community meeting, a town hall meeting in their own home State, 
and justify, at a time when we are seeing pressure for deficit 
reduction and many valuable programs cut, allowing a tax writeoff of up 
to 34 percent when you have somebody violating environmental laws and 
paying a penalty as a result.
  So, Mr. President, if the manager for the majority is prepared to 
yield back time on the amendment, I am prepared to yield back time, as 
well. Let me see what the desire of the majority is.
  Mr. FRIST. Mr. President, I will yield back my time, as well.
  Mr. WYDEN. I yield back my time, Mr. President.
  The PRESIDING OFFICER. All time is yielded back.

                          ____________________