[Congressional Record Volume 142, Number 120 (Thursday, September 5, 1996)]
[Senate]
[Pages S9899-S9926]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




[[Page S9899]]



 DEPARTMENT OF VETERANS AFFAIRS AND HOUSING AND URBAN DEVELOPMENT, AND 
             INDEPENDENT AGENCIES APPROPRIATIONS ACT, 1997

  The Senate continued with the consideration of the bill.
  Mr. HELMS. Madam President, what is the pending business?
  The PRESIDING OFFICER. H.R. 3666.
  Mr. HELMS. There is no amendment to the bill pending?
  The PRESIDING OFFICER. That is correct.
  Mr. HELMS. Therefore, it is open to amendment?
  The PRESIDING OFFICER. The Senator is correct.


                           Amendment No. 5191

       (Purpose: To increase funding for drug elimination grants)

  Mr. HELMS. Madam President, I send an amendment to the desk and ask 
that it be stated.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from North Carolina [Mr. Helms], for himself, 
     Mr. Bond, Mr. Faircloth, Mr. McCain and Mr. Coverdell, 
     proposes an amendment numbered 5191.

  Mr. HELMS. Madam 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:

       ``Of the amount made available under this heading, 
     notwithstanding any other provision of law, $20,000,000 shall 
     be available for grants to entities managing or operating 
     public housing developments, Federally-assisted multifamily-
     housing developments, or other multifamily-housing 
     developments for low-income families supported by non-Federal 
     governmental entities or similar housing developments 
     supported by private sources, to reimburse local law 
     enforcement entities for additional police presence in and 
     around such housing developments; to provide or augment such 
     security services by other entities or employees of the 
     recipient agency; to assist in the investigation and/or 
     prosecution of drug related criminal activity in and around 
     such developments; and to provide assistance for the 
     development of capital improvements at such developments 
     directly relating to the security of such developments: 
     Provided, That such grants shall be made on a competitive 
     basis as specified in section 102 of the HUD Reform Act.''

  Mr. HELMS. Madam President, I believe the pending amendment has been 
approved on both sides.
  Mr. BOND. Madam President, if I may interrupt, with respect to my 
colleague from North Carolina, I think there was one additional change 
that had been suggested by the minority side. I have not seen whether 
that was incorporated.
  Mr. HELMS. I think it already has been.
  Mr. BOND. On behalf of my ranking member, I want to be sure that has 
been incorporated. They have worked very closely with us. We appreciate 
their cooperation, and we particularly appreciate your work on this. I 
apologize for interrupting. I wanted to make sure that change had been 
made in the amendment submitted to the desk.
  Mr. HELMS. It is certainly no problem. I suppose we are talking about 
on page 39, after line 10 * * * ``developments supported by'', 
inserting the words ``nonprofit private sources''. Is that it?
  Mr. BOND. Yes.
  Mr. HELMS. That is the amendment that was submitted.
  The PRESIDING OFFICER. Is there any further debate on the amendment?
  Mr. BOND. Madam President, I was going to make a few comments in 
support of the amendment, and I suggest that we await the arrival of 
the ranking member before actually moving to adoption of the amendment.
  Mr. HELMS. Yes, and I have a few remarks.
  Mr. BOND. The Senator from North Carolina has some comments, as I 
will, on this measure. We do want to wait for the ranking member before 
moving to acceptance of the amendment.
  I thank the Chair, and I thank my colleague.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. HELMS. Mr. President, the pending amendment will markedly 
increase efforts to eliminate the scourge of drugs and crime in public 
housing project by increasing funding by $20 million for local housing 
authorities to stimulate the fight against drugs.
  These programs help curb crime within public housing neighborhoods by 
providing funds to housing authorities that can be used to employ more 
law enforcement or security personnel, to establish voluntary tenant 
patrols and to sponsor programs designed to reduce illegal drug use in 
and around public housing developments.
  Most public housing residents are law-abiding citizens who deserve to 
live in a community free of crime, drugs, and fear. Unfortunately, this 
is not the reality for many public housing tenants who instead are 
faced with daily assaults by drug dealers and criminals who not only 
rob them of their freedom, but also rob them of their dignity.
  Many public housing projects are incubators for crime and drug 
dealing. Children sell and use drugs and, even worse, children shoot 
other children. This violence spreads throughout our cities and 
jeopardizes all citizens.
  The Foreign Relations Committee, of which I am chairman, held a 
hearing recently on international drug trafficking and its effect on 
local communities. Among the witnesses were two law-enforcement 
officers from my home State and a member of the ``blood'' gang, who 
described the effects of street-level drug dealing in detail. One thing 
that was clear after their testimony was that we have seen only the tip 
of the iceberg.

  While there is no one solution to the problem of illegal drug use, it 
is clear that any long-term solution must empower the residents to take 
back their streets and enable them to live safely in their homes.
  The epidemic of drug use among juveniles has been confirmed by recent 
statistics which show that since 1992, teenage drug use in general has 
increased by 105 percent, marijuana use by 141 percent, and cocaine use 
by 166 percent. Drug abuse and the crime it spawns are rampant in 
public housing projects. The war against drug use and drug-related 
crime in public housing communities must be fought and won in the 
neighborhoods themselves. Enhanced law enforcement is critical to 
prevailing in the war on drugs. Towards that end, the additional funds 
provided by this amendment will allow local housing authorities to hire 
more cops and security guards to protect their residents.
  Recently, there have been a number of stories that have documented 
the crime that occurs in these neighborhoods. Here are just a few 
examples:

       March 30, 1996--``Already this month, two young men have 
     been shot and killed in Durham's public housing communities, 
     one in front of a crowd of young children.'' (The News & 
     Observer)
       July 24, 1996--``There is evidence that increased 
     trafficking along the U.S. 64 corridor from Raleigh is 
occurring, and that public housing is a target for drug dealers.'' (The 
News & Observer)

  August 17, 1996--``When Durham police found 18-year-old Germaine 
DeMarco Ansley shot and bleeding to death in Few Gardens last month, 
they knew there must be a witness in the crowd gathered around his 
body, but no one at the public housing complex would talk.'' (The News 
& Observer)

  It's time to stand up with the folks who live in these communities 
and help them to rid themselves of the fear and crime in their 
neighborhoods.
  Experience has shown that the residents themselves--who are most 
directly affected by drugs and drug-related crime--can do a lot to turn 
the tide against drugs when given the opportunity.
  The success of the drug elimination grants is rooted in the fact that 
people who live in public housing are encouraged to save their own 
neighborhoods. And maybe, just maybe, we can prevent a few murders, 
stop a few drug deals, and give children the opportunity to grow up in 
a safe environment.
  Mr. President, this program is effective, and it is working well in 
my home State of North Carolina as well as across the Nation. Through 
the use of this grant the following areas have shown marked success: 
The Durham Housing Authority reported that in 1994, there were 33 drug-
related evictions in Durham public housing. The Charlotte Housing 
Authority reported that in 1994, the crime rate fell by 8.7 percent 
overall, and by 12.4 percent in the target neighborhoods when the drug 
elimination program was implemented. There were 104 drug arrests and 26 
drug-related convictions.

[[Page S9900]]

  The Greensboro Housing Authority reported that in 1993--the first 
year of administering a Police Neighborhood Resource Center at the 
Hampton Homes Development--violent crime dropped by more than 40 
percent. Similar statistics have been shown across the Nation 
indicating the effectiveness of combating the war on both drugs and 
crime.
  Mr. President, with these programs in place, local housing 
authorities and residents are doing their part to rid cities of drugs 
and their terrible consequences. I urge Senators to support this 
amendment, which will be offset by reductions taken from general 
administrative expenses, that will increase funding for this necessary 
and successful drug-fighting venture.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Ms. MIKULSKI. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. MIKULSKI. Madam President, I would like to comment on the 
amendment offered by the Senator from North Carolina. And as we do, I 
sincerely hope that the people of North Carolina are spared any damage 
from Hurricane Fran. We know your cousins in South Carolina are bracing 
for some pretty heavy weather. And as another coastal State, we know 
what these things mean. So I just, in a spirit of cordiality and 
collegiality, want the people to know in the Carolina's that we, in 
Maryland, are worried about them and are thinking about them.
  Mr. HELMS. The Senator is most thoughtful. Of course, on behalf of 
the people of North Carolina, I thank her. I will say that the 
southeastern part of North Carolina and northeastern part of South 
Carolina, the people in both areas, as the saying goes, are living on a 
diet of finger nails right now. I thank the Senator.
  Ms. MIKULSKI. We are very happy about the fact that this subcommittee 
that has so many wonderful agencies in it also funds emergency 
management. And right now, Senator Bond and I, in trying to decide how 
FEMA will meet its obligations, are also on those diets of finger 
nails, or any other one that might work, I might add.
  Madam President, I think the amendment offered by the Senator from 
North Carolina indeed has merit. The whole idea of getting drugs out of 
public housing has been something that we have supported for many 
years. When I chaired this subcommittee I had the good fortune of 
working with the Vice Presidential nominee, Mr. Jack Kemp, who was the 
Secretary of HUD, and now Mr. Cisneros, on a focused approach to get 
drugs out of public housing. It was always our belief that public 
housing should be a steppingstone to a better life and not to be an 
incubator for drug dealers.
  In the course of watching this effort develop, we were aware that 
there were certain gaps in the program. What were those gaps? That 
often the grand program to get drugs out of public housing was limited 
only to public housing, those horrendous, horrific high-rise public 
housing projects that often were tools of neighborhood destabilization 
rather than tools of empowerment.
  But also we saw something else, that where the Federal Government has 
subsidized housing in other areas, that they too have presented 
problems. In my own home State of Maryland, there was a project called 
Riverdale in a suburban area. And it was owned by the private sector. 
We thought, oh, gosh, this was going to be terrific. Get rid of all the 
issues in public housing. But what did we see? A scurrilous landlord 
who did not do maintenance, who did not work with the county in being 
able to screen the residents, did not use the section 8 subsidies to 
modernize, keep the building fit for duty.
  Guess what? It took on all of the trappings of the negative aspects 
of public housing, became poorly maintained, with neighborhood 
destabilization, and became an incubator of crime.
  There were no funds to help the local police department or whoever to 
really deal with this. I think that is wrong. And what I like about the 
Helms amendment is that it will include those entities that are 
Federally assisted, multifamily housing developments or other 
multifamily housing developments for low-income families, supported by 
non-Federal entities.

  That means that we will be able to make sure that whatever the 
Federal Government is involved with, we are going to make sure it is 
fit for duty, and fit for duty not only in terms of maintaining the 
physical structure, but, through the work of Senator Bond and myself, 
Senator D'Amato and Senator Sarbanes here, we now have something called 
``one strike, you're out,''--``one strike, you're out''--which means 
that if you have been arrested for a criminal act, you were not going 
to stay in public housing or section 8.
  We are not going to subsidize criminal behavior if we are on the 
watch. We are going to get them out so that the poor people who want to 
see Federal help as a tool to be able to empower themselves to a better 
life--we want to help them, but we do not want to subsidize people who 
are part of the problem. We want to help people become part of the 
solution. That is why we like the conceptual framework of the Helms 
amendment.
  I must say, I have pause about creating an earmark in CDBG. The 
reason I like CDBG, otherwise known as community development block 
grant money, is because community development block grant money was to 
be a block grant, maximum flexibility, minimum micromanagement by the 
Federal Government, so that local governments could best decide how to 
meet their needs. The rural needs of Maine are very different than the 
bustling metropolis of Baltimore City in the Baltimore-Washington 
corridor. Who could do what?
  So at this time I do not think we should fuss about budget over that. 
I am going to support the Helms amendment here on the floor of the U.S. 
Senate. I will be happy to adopt it just on a voice vote. I understand 
the leadership from the other side of the aisle is considering the 
vote.

  First of all, to Senator Helms, I congratulate him on his thought--
and his staff--behind this. I think it is about time we start really 
thinking about how, when the Federal Government spends its money, the 
taxpayers feel satisfied, and we should be creating opportunities, 
opportunities for the poor to help themselves. I believe now with our 
strong, no nonsense zero tolerance one-strike-you-are-out approach 
combined with the grant program and the initiative of the Helms 
amendment, that we can start making sure anything that the Federal 
Government is involved in in neighborhoods is not a tool of 
neighborhood stabilization, but a tool of empowerment.
  I look forward to supporting this amendment by whichever vehicle is 
best to move it. I yield the floor.
  Mr. BOND. Madam President, I thank my ranking member for her very 
strong and supportive words. I heartily concur with them. I extend my 
particular thanks to the Senator from North Carolina who gave us a 
reality check and really brought back to our attention the fact that 
crime, lawlessness, and insecurity, fear for personal safety, is a 
grave problem that affects everybody who lives in many of these 
assisted housing projects.
  By targeting these funds for assistance for law enforcement agencies, 
I think the Helms amendment is going to go a long way toward improving 
safety and security for families and for the individuals in assisted 
housing. This is different from some of the programs that we already 
have. Many of the drug elimination grants are grants for a broad scale 
of activities. They are generally limited to Federal housing 
activities.
  This amendment says that the CDBG funds can be used not only for 
federally assisted multifamily housing developments but for other 
multifamily housing developments for low-income families supported by 
non-Federal Government entities or similar housing developments 
supported by nonprofit private sources. So this gives us an opportunity 
to provide assistance not just to a federally assisted housing program 
but to a State, a city, or a private not-for-profit entity with a 
multifamily-housing development. These are the people who are most at 
risk. These are the people who have the most to lose if a foothold for 
crime, for drug activities, gets into one of these developments.

[[Page S9901]]

  My colleague from Maryland points out a very important fact that a 
lot of people seem to overlook. It was Congress that said one strike 
and you are out. I think that kind of get tough with the people who 
have shown they do not deserve to receive taxpayer-supported housing 
assistance is a very large step in the right direction.
  I have talked to an awful lot of residents in my State who have 
expressed fear or concern for their public safety, and if we can tell 
them that if one of their neighbors is convicted of a crime of drug use 
that they are out, they will feel better. With the funds available 
under the Helms amendment to include extra policing and extra drug/law 
enforcement efforts, we can take another significant step toward 
ensuring that these developments and the people who live in them--the 
families, the individuals, the elderly in many instances who right now 
are often held hostage in their own apartments, their own homes--these 
people will be safer.
  Incidentally, we spoke yesterday about the repeated efforts that we 
have made in this subcommittee, in the authorizing committees, to let 
the local housing authorities designate some housing as elderly only, 
or some as disabled only, or some as mixed, because there have been 
grave problems all across the country--in many of those units, 
certainly some in my State--where there is a mixture of disabled and 
elderly in the same housing. The elderly are very fearful, in some 
instances because of criminal behavior.

  Along with the one-strike-you-are-out policy and the additional 
resources available under the Helms amendment, I think we are going to 
take some significant steps toward assuring these people of safety in 
their own homes. That, along with food and shelter is certainly one of 
the most basic and compelling needs we ought to provide to those of our 
citizens who need our assistance.
  I commend the Senator from North Carolina for giving us a boost, 
getting us started on this right track. I thank my colleague from 
Maryland who, as always, made improvements on it. I expect shortly we 
will either move to formal passage or adopt this amendment. I yield the 
floor.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. HELMS. Needless to say, I am so grateful to both managers of this 
bill for their kind comments about the amendment.
  Just to be sure that the amendment is modified as agreed to with the 
distinguished Senator from Maryland, I send a modification to the desk 
and ask that the amendment be modified.
  The PRESIDING OFFICER. The Senator has that right. Without objection, 
the amendment is modified.
  The amendment (No. 5191) is modified, as follows:

       On page 39, after line 10, insert the following new 
     paragraph:
       ``Of the amount made available under this heading, 
     notwithstanding any other provision of law, $20,000,000 shall 
     be available for grants to entities managing or operating 
     public housing developments, Federally-assisted multifamily-
     housing developments, or other multifamily-housing 
     developments for low-income families supported by non-Federal 
     governmental entities or similar housing developments 
     supported by non-profits private sources, to reimburse local 
     law enforcement entities for additional police presence in 
     and around such housing developments; to provide or augment 
     such security services by other entities or employees of the 
     recipient agency; to assist in the investigation and/or 
     prosecution of drug related criminal activity in and around 
     such developments; and to provide assistance for the 
     development of capital improvements at such developments 
     directly relating to the security of such developments: 
     Provided, That such grants shall be made on a competitive 
     basis as specified in section 102 of the HUD Reform Act.''

  Ms. MIKULSKI. I ask the Senator from North Carolina, is that adequate 
nonprofit clarification?
  Mr. HELMS. Yes.
  Madam President, I ask unanimous consent that Senator Bond, Senator 
Coverdell, Senator Faircloth, and Senator McCain be identified as 
cosponsors of this amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HELMS. I yield the floor.
  The PRESIDING OFFICER (Mr. Kempthorne). The Senator from Georgia.
  Mr. COVERDELL. Mr. President, I rise in support of the amendment. I 
have enjoyed listening to the remarks of the Senators from Maryland, 
Missouri, and North Carolina about the importance of the amendment.
  I bring a little bit of a unique personal experience to this. The 
first public housing was erected in my home city of Atlanta, GA, in the 
early 1930's, and dedicated by President Roosevelt. Today, there is 
more public housing in my capital city than any other city in America, 
save one, per capita.
  To reinforce the importance of this amendment, let me say there have 
been numerous revelations of late with regard to drug activities in 
these projects. It is even suspected in our housing projects that drugs 
are being sold with impunity and have become the hub of a distribution 
system.
  I have said many times that one of the great changes in the current 
drug epidemic that we are experiencing is the age of the audience 
infected. It has moved from age 16, 17, and 18 to 8, 11, 12, and 13. 
Many of these youngsters in these housing projects are being recruited 
systematically into becoming instruments of drug transactions 
themselves. It is an absolute tragedy.
  One of the other ramifications, Mr. President, is that when these 
gangs begin to set up these instruments of distribution in housing 
projects and they come upon a disagreement, it is not unusual for the 
resolution to be a shootout. Very recently, in one of these drug-
related shoot outs, an 8-year-old girl, Kimberly Session, was shot, and 
two of her friends were wounded, as she was playing at McDaniel-Glenn 
public housing project. Absolutely innocent--just out playing in her 
neighborhood. They are not even safe in their home.
  Four-year-old Monica Rose Mae Carr was shot as a drug-related gang 
pumped 40 rounds into an apartment unit, striking her in the heart as 
she lay asleep.
  In Atlanta public housing two-thirds of those affected by the drug 
crisis in the housing projects are women and children, 97 percent 
African American. In an analysis of the effect of violent crime, half 
of Atlanta's low-rise public housing units, the violent crime rate is 
60 percent higher than the immediate neighborhood that surrounds it--
all related to drug distribution, drug transaction, and drug gangs.
  So in Atlanta, we are experiencing the cost and effect of rampant 
drug violations in crime and use in our housing projects. So I come to 
the floor briefly to echo support for the amendment offered by the 
Senator from North Carolina. It is well targeted, well-meaning, and it 
will have a very positive effect on a lot of our young people, not only 
in Atlanta, but throughout the country.
  I yield the floor.
  The PRESIDING OFFICER. Is there further debate?
  Ms. MIKULSKI. Mr. President, I know that the Democratic leader has no 
reservations about a vote occurring. The majority leader is testifying 
and would like a short quorum call. I suggest the absence of a quorum, 
and I believe we should notify Members that a vote will be forthcoming.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Ms. MOSELEY-BRAUN. Mr. President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                         Agent Orange Benefits

  Ms. MOSELEY-BRAUN. Mr. President, I salute the minority leader, Tom 
Daschle, for sponsoring the Agent Orange Benefits Act of 1996 which 
creates the benefits package for the children of Vietnam veterans who 
suffer from spina bifida, a congenital disease that requires lifelong 
medical care. Approximately 2,700 of our citizens would be eligible for 
the benefits conferred by this amendment.
  Mr. President, you would think that legislation which help the sick 
children of our soldiers--children who have developed debilitating 
medical problems as a result of their parents' service in the Armed 
Forces who sacrificed to preserve the freedom and independent way of 
life that we all enjoy--that such a thing would be free of controversy. 
However, some of my colleagues are holding up this amendment. And quite 
frankly I think those reasons can only be characterized as puzzling. 
While I respect those who oppose this legislation on procedural 
grounds, I point out

[[Page S9902]]

that what is being proposed in this amendment is not unprecedented. It 
is consistent with our overarching responsibility to legislate in the 
public interest that this amendment is put forward today.
  The opposition's argument that the scientific evidence does not 
clearly establish a link between dioxin and other herbicides and spina 
bifida is particularly troubling. While it may be true that earlier 
studies did not show a nexus between spina bifida and agent orange, the 
most recent National Academy of Sciences Institute of Medicine study, 
entitled, ``Veterans and Agent Orange; Update 1996,'' suggests more 
than a casual nexus between the horrible condition of spina bifida and 
the use of agent orange. Based on that study, which was commissioned by 
the Veterans' Administration in 1991, Veterans Administration Secretary 
Jesse Brown moved to provide presumptive compensation to the children 
of Vietnam veterans who are suffering from spina bifida.
  Arguments that the Government does not have irrefutable proof and 
scientific certainty of the link between dioxin and herbicide and spina 
bifida beg the issue. It is a scientific fact, as the most recent NAS 
study confirms, that there is more than a casual connection between 
agent orange and spina bifida. Given this fact, I believe it is 
prudent--not to mention compassionate--that we err on the side of the 
innocent children who have been stricken with this horrible disease.
  Furthermore, arguments regarding the proliferation and the cost of 
entitlement I think only serve to obfuscate or cloud the issue and fail 
to address the issue at hand, which is our responsibility to the 
children of those who bravely served our country during the Vietnam 
war.
  I would like to point out--you have heard me make this argument 
before--that the truth is in America no one goes without help. Everyone 
gets helped. Every child with spina bifida who has been a victim of 
this situation will get health care treatment one way or the other. The 
only question is who will pay for it. Whether or not it is a family 
that is required to pay for the cost associated with the lifelong 
health care associated with this horrible illness, or whether or not it 
is the insurance companies which, of course, means that all of us who 
have private insurance pay more--whether or not it will be the 
ratepayers who pay--the insurance company bills will be made higher 
because, as you know, for those who are insured it does not cover the 
universe of people in this country who will need health care.

  So here is really an efficient way of addressing these health care 
costs for which there has been a causal connection as demonstrated by 
the NAS study and, frankly, by common sense and observation.
  The fact that we have so many people with spina bifida, which is 
showing up among the children of Vietnam veterans who were exposed to 
agent orange, ought to compel us to give the benefit of the doubt to 
those children and to the servicemen and women who served our country 
and deserve better than to be called upon to be put in jeopardy if they 
are not going to be able to pay for their children's health care 
because of their service.
  Most important, the opposition places process over what I think is 
our duty, whether it is fairness, or whether it is our obligation or 
compassion, and does nothing to improve the well-being of innocent 
children who have been stricken by this disease.
  I believe that we have a responsibility to care for the health of 
those who served in our Nation's armed services, particularly those who 
answered the Nation's call to duty in defense of democracy in a 
military conflict.
  When our men and women joined the military we promised to give them 
the best training, the finest equipment, and to care for them and their 
families should they become casualties of war. Passage of this 
amendment is simply an acknowledgment of that commitment. While these 
brave men and women sacrificed for our community as a whole, it seems 
to me that it is our duty to keep our promise to them and to provide 
some means for the kind of support and medical expenses associated with 
this devastating disease.
  We have a contract with our veterans--a contract that is both 
irrevocable and inviolate. If we break this contract we send a 
disturbing message to our men and women in uniform that America is 
giving lip service to their sacrifice and to their service and that we 
cannot be counted on to honor the commitment should there be a 
situation occur such as the birth of a child with a debilitating 
disease; that is, to care for them or their dependents should they 
become disabled as a result of their service to our Nation, and it 
ought to be something for which there is unanimous support by our 
citizens and society. I can think of nothing that would more adversely 
affect and impact the morale of those now serving in our Armed Forces 
than to turn our back on them for the condition of their sick children.
  Mr. President, our responsibility and obligation to our veterans was 
best articulated by the most favorite of the favorite sons and 
daughters of my State of Illinois, Abraham Lincoln, who in his second 
inaugural address said: ``To care for him who shall have borne the 
battle, and for his widow and his orphan * * *'' Today, of course, we 
would acknowledge the contribution and participation of the men and 
women in our military in the defense of our country. That change 
notwithstanding, President Lincoln's words are as valid today as when 
they were first 131 years ago. In the spirit of our obligation ``To 
care for him who shall have borne the battle, and for his widow and his 
orphan,'' or his children I think is embodied in Senator Daschle's 
amendment. I hope that we will recognize those arguments, 
notwithstanding the overarching responsibility that we have in this 
situation to support this legislation. It is sensible for us to do so. 
It is the important thing for us to do, and certainly it is in keeping 
with our inviolate commitment to the veterans.

  So I rise in strong support of the amendment, and I hope that our 
colleagues will support it as well.
  Thank you, Mr. President.
  I yield the floor. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the role.
  Mr. BOND. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 5191

  Mr. BOND. Mr. President, what is the pending business?
  The PRESIDING OFFICER. The pending business is Amendment 5191 offered 
by the Senator from North Dakota.
  Mr. BOND. Mr. President, I think we are ready to go to a rollcall 
vote.
  Mr. BOND. But before I ask for the yeas and nays, I will advise my 
colleagues that while we have been at work here our colleague, Senator 
Abraham and his wife, Jane, are the proud parents of a healthy baby 
boy. We offer them our congratulations and our very best wishes.
  On the Helms amendment, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. If there is no further debate, the question 
now is on agreeing to amendment No. 5191, as modified. The yeas and 
nays have been ordered. The clerk will call the roll.
  Mr. NICKLES. I announce that the Senator from Oregon [Mr. Hatfield] 
and the Senator from Alaska [Mr. Murkowski] are necessarily absent.
  I further announce that, if present and voting, the Senator from 
Oregon [Mr. Hatfield] would vote ``yea.''
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
who desire to vote?
  The result was announced--yeas 98, nays 0, as follows:

                      [Rollcall Vote No. 271 Leg.]

                                YEAS--98

     Abraham
     Akaka
     Ashcroft
     Baucus
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Bradley
     Breaux
     Brown
     Bryan
     Bumpers
     Burns
     Byrd
     Campbell
     Chafee
     Coats
     Cochran
     Cohen
     Conrad
     Coverdell
     Craig
     D'Amato
     Daschle
     DeWine
     Dodd
     Domenici
     Dorgan
     Exon
     Faircloth
     Feingold

[[Page S9903]]


     Feinstein
     Ford
     Frahm
     Frist
     Glenn
     Gorton
     Graham
     Gramm
     Grams
     Grassley
     Gregg
     Harkin
     Hatch
     Heflin
     Helms
     Hollings
     Hutchison
     Inhofe
     Inouye
     Jeffords
     Johnston
     Kassebaum
     Kempthorne
     Kennedy
     Kerrey
     Kerry
     Kohl
     Kyl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lott
     Lugar
     Mack
     McCain
     McConnell
     Mikulski
     Moseley-Braun
     Moynihan
     Murray
     Nickles
     Nunn
     Pell
     Pressler
     Pryor
     Reid
     Robb
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Shelby
     Simon
     Simpson
     Smith
     Snowe
     Specter
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner
     Wellstone
     Wyden

                             NOT VOTING--2

     Hatfield
     Murkowski
       
  The amendment (No. 5191), as modified, was agreed to.
  Mr. HELMS. Mr. President, I move to reconsider the vote by which the 
amendment was agreed to.
  Mr. BOND. I move tolay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. BRADLEY addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Jersey is recognized.


                           Amendment No. 5192

 (Purpose: To require that health plans provide coverage for a minimum 
hospital stay for a mother and child following the birth of the child, 
                        and for other purposes)

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

       The Senator from New Jersey [Mr. Bradley], for himself, 
     Mrs. Kassebaum, Mr. Frist, and others, proposes an amendment 
     numbered 5192.

  Mr. BRADLEY. Mr. President, I ask unanimous consent that further 
reading of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. BRADLEY. Mr. President, this is an amendment that deals with the 
Newborns Act. It is an attempt to require at least 48 hours for a 
childbirth.
  Mr. FRIST addressed the Chair.
  The PRESIDING OFFICER. The Senator from Tennessee.


                Amendment No. 5193 To Amendment No. 5192

 (Purpose: To require that health plans provide coverage for a minimum 
hospital stay for a mother and child following the birth of the child, 
                        and for other purposes)

  Mr. FRIST. Mr. President, a number of my colleagues have expressed 
concern regarding a provision in the amendment just sent to the desk 
which appears to have a conflict in it. I wish to offer a second-degree 
amendment at this time to clarify the intent of the legislation. 
Specifically, language was added to the section on postdelivery care to 
clarify that it is the attending provider, in consultation with the 
mother, that determines the appropriate location for followup services 
in combination with an earlier discharge which is less than 48 hours. 
It is confusing as initially written because the amendment appears to 
give the mother the option of demanding home care regardless of the 
attending provider's assessment of their individual needs.
  This decision is most appropriately made in cooperation with the 
provider and the mother. Therefore my second-degree amendment strikes 
the language which appears to conflict with this intent.
  The PRESIDING OFFICER. Does the Senator intend to offer this 
amendment at this point?
  Mr. FRIST. Yes, I do.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Tennessee [Mr. Frist], for himself and Mr. 
     Bradley, proposes an amendment numbered 5193 to amendment No. 
     5192.

  Mr. FRIST. Mr. President, I ask unanimous consent that further 
reading of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. FRIST. Let me just briefly close by saying one other thing that 
this second-degree amendment does. The amendment guards against 
monetary incentives directed at discharging mothers and babies before 
the attending provider feels it is appropriate. Specifically, my 
second-degree amendment provides language sought by health plans to 
provide that nothing in this bill interferes with rate negotiators 
between a plan and a provider.

  Mr. BRADLEY addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. BRADLEY. Mr. President, I welcome the second-degree amendment by 
the distinguished Senator from Tennessee. I do think he clarifies my 
own intent in the original amendment. I believe that it is important. 
It adds to the purpose of the original amendment.
  Mr. President, the amendment I have offered and that has been second-
degreed by the distinguished Senator from Tennessee I think is a very 
important amendment. His is offered on behalf of himself and me. I 
offered mine on behalf of myself and him, as well as the distinguished 
chairman of the committee, Senator Kassebaum, the ranking member 
Senator Kennedy, Senator DeWine, Senator Murray.
  Mr. President, I ask unanimous consent that all 52 cosponsors of this 
amendment be listed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                               Cosponsors

       The following Senators have cosponsored the Newborns' and 
     Mothers' Health Protection Act as of September 5, 1996.
       Bill Bradley.
       Nancy Kassebaum.
       Bill Frist.
       Jay Rockefeller.
       Barbara Boxer.
       Barbara Mikulski.
       Paul Sarbanes.
       Patty Murray.
       Mike DeWine.
       Harry Reid.
       Claiborne Pell.
       Edward Kennedy.
       Paul Simon.
       Paul Wellstone.
       Carol Moseley-Braun.
       Richard Bryan.
       Wendell Ford.
       Frank Lautenberg.
       Daniel Inouye.
       Ben Nighthorse Campbell.
       Robert Kerrey.
       Mitch McConnell.
       Carl Levin.
       Jesse Helms.
       Charles Grassley.
       Pete Domenici.
       John Kerry.
       Olympia Snowe.
       Alan Simpson.
       Patrick Leahy.
       John Glenn.
       Charles Robb.
       Ted Stevens.
       Diane Feinstein.
       Joe Biden.
       Rod Grams.
       Alfonse D'Amato.
       Ernest Hollings.
       Kay Bailey-Hutchison.
       Herb Kohl.
       Bob Graham.
       John Warner.
       Pat Moynihan.
       Chris Dodd.
       John Breaux.
       Larry Pressler.
       Arlen Specter.
       Bill Cohen.
       James Inhofe.
       Max Baucus.
       Byron Dorgan.
       Ron Wyden.
  Mr. BRADLEY. Of these cosponsors, 19 are Republican. So this is a 
bipartisan amendment and a bipartisan bill. What the bill does is very 
simple. It says that insurers are required to allow 48 hours, up to 48 
hours, for a woman in the hospital after giving birth and requires 
insurers to allow up to 96 hours if that birth is a Caesarean section.
  If the mother and her doctor choose to leave the hospital in less 
than 24 hours, less than 48 hours, she is permitted to do so. There is 
nothing in this bill that says that she cannot leave earlier. Followup 
care will be provided if she leaves earlier.
  Mr. President, why is this amendment needed? Why are we offering this 
amendment? The answer is because all of us, I am sure, have received 
reports of women in our respective States being required to leave a 
hospital prior to 48 hours, in some cases prior to 24 hours. In 
California, for example, in 1994, for 1 in 6 babies that were born, the 
mother had to leave the hospital in less than 24 hours. That is for 
90,000 births.

[[Page S9904]]

  The problem here is that some illnesses do not develop until the 
second day. If the mother were in the hospital, they would be able to 
detect it and deal with it. A good example is jaundice, which does not 
really develop until the second day. Heart defects are another. What 
happens is that the mother is pushed out of the hospital. She goes home 
after 12, 14 hours, 16 hours, 26 hours. In the second day jaundice is 
detected, or worse, a heart defect, and the mother is rushed back to 
the hospital at a much greater cost.
  In New Hampshire, for example, there was the study that showed that 
women who leave the hospital in less than 48 hours have a 50-percent 
increased risk of readmission to the hospital, a 70-percent increase in 
risk to be readmitted at the emergency room. So in the long run, by 
saying that someone has to leave in 24 hours, you are really saying it 
is going to cost more, it is going to cost more because the readmission 
and the treating of the more serious illness could have been avoided 
had she been in the hospital when it was first detected.
  So, Mr. President, the need here is very clear. It is kind of common 
sense. I mean, my distinguished cosponsor on this bill, Senator Frist, 
refers to a safe haven of time, 48 hours. That is why it is needed. Who 
supports this amendment and this bill? It is supported by the American 
Medical Association. The American Academy of Pediatrics supports this. 
The College of Obstetricians and Gynecologists supports this.
  In fact, the Academy of Pediatrics, their recommended guideline is 48 
hours. Gynecologists and obstetricians, 48 hours is the guideline they 
set. That is how we arrived at this number. Why 48 hours? Because the 
doctors in question recommended that. The obstetricians and 
gynecologists stated that, if we keep the 24-hour limit, ``it could be 
the equivalent of a large uncontrolled, uninformed experiment on women 
and babies.''
  We all want to reduce health care costs. We can do so without 
jeopardizing the health of mothers and their newborns. Again, who makes 
the decision? That is really the question here. We believe that the 
person who makes the decision should be the doctor and the mother, that 
the decision should not be made by an accountant in a distant office 
seeking cost savings and forcing women out of hospitals within 12 to 14 
hours after they have given birth to their child.
  This is the basic question: Who makes the decision? We have stories 
all across the land of doctors who have been put under great financial 
pressure to discharge in 24 hours or less or they will be dropped from 
health plans.
  So, Mr. President, this is needed because there is a clear health 
problem with women who are discharged too early. The 48-hour and 96-
hour for Caesarean section limits were set pursuant to the guidelines 
of the American Academy of Pediatrics and the American College of 
Obstetricians and Gynecologists.
  A number of States have already acted on this. Twenty-eight States 
have passed laws requiring a 48-hour limit. Why, then, do we need a 
national law, people ask. You need a national law obviously for the 
other States that have not passed it, but even if all of them passed 
it, you would still have many in a State that would be unaffected by 
the State law.

  For example, we need a Federal law to get at the so-called ERISA 
plans, the self-insured plans, the plans of large companies like 
Boeing, IBM, 3M, Dupont, and others. They would not be affected by a 
State law because they are self-insuring ERISA, controlled by Federal 
law.
  There is also another problem, at least in my State of New Jersey. 
There is a State law that says you have 48 hours, but the law says the 
State has no authority to regulate insurance companies that are 
headquartered in a different State, Mr. President. So there are large 
numbers of people who are not covered then, of course, in States like 
Kansas, Missouri, New Jersey, Pennsylvania, New York. You might have a 
48-hour law in a particular State, but you might have a hospital in 
another State, and when you gave birth to the child in a hospital in 
another State, you would not be covered by the 48 hours and you would 
be pushed out of the hospital in 24 hours.
  That, not coincidentally, would have been the case in my own family 
when our daughter was born. The birth was delivered across the line in 
New York--24 hours, you are out.
  We need this national law in order to make sure women have 48 hours 
to stay in a hospital. There are some places, for example, in Kansas, 
40 percent of the companies--only 40 percent--would be subject to 
regulation under just a State law. In some States, 75 percent of the 
women are uncovered because State laws do not and cannot reach them as 
they are now written.
  Now, Mr. President, this is an issue that came to my attention 
because I had several letters from women who had been subjected to this 
rigid 24-hour-and-you're-out policy. Drive-through deliveries is what 
they are called. There was an article about it, after this came to my 
attention, in Good Housekeeping magazine, and someone, the author of 
the article, put a little box in the article that said if you care 
about this issue, write to Senator Bradley.
  Mr. President, I have received, since that article appeared about a 
year and a half ago, more mail than I have received on any one issue, 
with the exception of interest and dividend withholding, in my entire 
18 years. I received over 85,000 pieces of mail from women and families 
of women in this country who have been pushed out of the hospital in 
less than 24 hours. Now, I do not intend to read a long list of these 
letters--85,000 is a long time. We want to move this amendment as 
quickly as possible. Let me share two with you.
  The McCloskeys, who live outside Philadelphia, write:

       Our daughter Shannon was discharged from the hospital 
     approximately 27 hours after birth. After only 8 hours at 
     home, she went into seizures and we had to rush her back to 
     the emergency room. She was diagnosed with streptococcus. The 
     timing of our arrival at the hospital was critical, and we 
     feared for her life. The doctor told us that if we had 
     arrived at the hospital 15 minutes later, she would have been 
     dead.

  Linda Dunn of Knoxville, TN, writes:

       We almost lost my grandson, Brantley, because of an early 
     hospital release. Brantley was one month premature and was 
     born via a Caesarean section. In spite of this, he was 
     released with his mother only 36 hours after the birth. 
     Within 20 minutes of arriving home, Brantley choked, quit 
     breathing, and was rushed to Children's Hospital in 
     Knoxville, where he was placed in neonatal intensive care and 
     noted as having ``a serious, life-threatening episode.'' The 
     frightening part of the scenario was that if I had not been 
     trained in infant resuscitation at my prior job, the baby 
     would simply be dead.

  Mr. President, if the baby were in the hospital, the baby would not 
have been even risking death. In the first 48 hours when some baby 
started to turn sort of a greenish color and jaundiced, it would be 
recognized and dealt with immediately. You are a first-time mother and 
you have a child, you are forced out of the hospital, you do not know 
quite what to do and you arrive home with the baby. In the first 24 
hours you have a life-threatening health problem; you do not have 
anybody to turn to. Mr. President, that is why we need this bill.
  I might also say that there were people who say you will not get any 
support from the insurance industry or HMO's, that they are the bad 
guys here. Mr. President, that is not necessarily so. We have letters 
of endorsement for this bill from one of the largest HMO's in the 
country, Kaiser Permanente. We have an endorsement from the HIP plan of 
New York-New Jersey.
  Mr. President, this bill has 52 cosponsors, 33 who are Democrat, 19 
who are Republican. This passed out of the Labor and Human Resources 
Committee 14 to 2. In the House, the leader on this legislation is a 
Republican, Gerald Solomon, with George Miller as his No. 1 helper in 
this effort. They have over 150 cosponsors.
  It is time to do this amendment. It is time to do it now. I hope we 
will pass it on this bill and that we will send it to conference and 
hopefully the conference will hold this amendment, say to those 
hundreds of thousands of women out there who are going to give birth in 
the next 6 months that you are not going to be rushed out of the 
hospital. You will have a little time to take care of the health 
problem of your child if it should develop. You will have

[[Page S9905]]

a little time to gather yourself after an exhausting delivery. You will 
have a little time to get you and your baby off to a right start, a 
healthy start, because the U.S. Senate saw fit on this bill at this 
time to say that 48 hours is not too much to require an insurance 
company to give you after giving birth.
  The PRESIDING OFFICER (Mr. Thompson). The Senator from Delaware.
  Mr. BIDEN. I want to thank Senator Bradley. This issue was called to 
my attention by someone reading Good Housekeeping who asked me why 
everybody was writing to Bradley. I contacted Senator Bradley and 
wanted to know more about what he was talking about because I was 
hearing about this and found it hard to believe. You hear so many 
rumors today, so many people are upset about HMO's--much of it 
legitimate, some of it not legitimate--that you hear these horror 
stories.
  Quite frankly, when I first heard this back in my home State, I 
really did not believe that some HMO's and insurance companies were 
actually doing this. I did not think it was a joke, but I thought it 
was a clear misunderstanding on the part of the people who were saying 
this was happening--24 hours and you are out.
  This is, quite frankly, very scary. The potential danger is real. 
Think back, those of you women and men on this floor when you were 
young parents, to the first child you had and think back to when you 
brought that child home. I know this is a distant memory for some of 
us, myself included, but remember how it was. You brought that baby 
home, and when your wife turned and handed the baby to you, your first 
concern was maybe, ``Is it going to break?'' Or, ``I don't know what I 
am going to do here, I'm not sure.'' Then your wife, no matter how 
instinctively good a mother she is, used to go, in the first couple 
days the baby was home, and literally lean over the crib to make sure 
the baby was breathing. How many of you actually leaned over the crib 
and stuck your ear down to see if you could literally hear the baby 
breathing? The reason I point that out is the baby was healthy. Your 
children were, 99 percent of the time, healthy and nothing was wrong. 
But the point is, you didn't know. There are so many young mothers. The 
tragedy is that there are teenagers giving birth to children. The 
tragedy is that there are thousands of unwed mothers out there. What do 
they do when they go home--you may say that maybe they shouldn't be in 
that position, but they are--without anybody even having an opportunity 
to instruct them on how to deal with the baby, what to look for? These 
are very basic little things, just basic things.

  So I contacted the Delaware Medical Association and other doctors in 
Delaware. I wanted to know what their view on this was before I 
cosponsored Senator Bradley's bill. I was pleasantly surprised when the 
leading pediatricians and ob/gyn's showed up at a meeting I held and 
they unanimously supported the Bradley proposal. It was unanimous. 
Usually, you get some kind of heat when the Government is going to 
indicate that something must be done or when the Government is going to 
dictate something. In this case, it would dictate that an insurance 
company can't throw you out in 48 hours or 24 hours if the doctor says 
no. But here you had all these doctors, who are no fans of Government 
intervention, every one of them saying this is important. I will not 
take the time now to recount what they said because we want to move 
along. But, they gave me specific story after story, incident after 
incident, in just that one long breakfast meeting, of specific cases 
they had personally handled. This was 21 or 22 pediatricians and 
obstetricians. It amazed me. The intensity of their political views and 
the variation of their views was wide.
  So the only real mystery to me is, why in the devil is it taking us 
so long to pass this? That is the real mystery. The mystery to me is no 
longer if it is needed; the mystery is no longer that enough Members of 
Congress want it; the mystery to me is, who is stopping it? Why? Who is 
stopping this? Why isn't it done already?
  Now, you know the fact of the matter is that this is not the usual 
vehicle to pass this. I understand my friend from New Jersey concluded 
that he is getting all kinds of promises that we can bring this up and 
will have a chance to vote on it. I have not had a chance to speak to 
him about this point, but I assume the reason he is attaching it here 
is that his patience is running a little thin. He wants to make sure 
that before we go out of session we get a chance to act on something 
that clearly a majority of people want. So the biggest mystery to me is 
not why it is needed, not why it is important, not why do doctors 
support it, not why do mothers support it, but why hasn't it been done?
  Now, I know that speed was not what my colleague was known for on the 
court--I am only joking, Senator. I want to make it clear that he could 
go to his left and right and he could do everything on the court. He is 
a Hall of Famer. But the fact of the matter is, the reason it is not 
being done is not for the lack of my friend's pushing it. Although I 
imagine we are going to hear that this is not the vehicle--the HUD 
appropriations bill--to put this on, we are running out of runway and 
running out of time. A lot of women and a lot of children are at risk. 
Some would say, oh, what difference does it make to wait another month? 
In another month we are out of here, which means waiting until next 
year, and waiting until next year means the end of the next year. So 
the health and safety of hundreds of thousands of women and children 
are at risk here. It is a really basic proposition.
  Let me conclude by reiterating one point. A lot of my colleagues and 
individuals have asked me about this. And because they have not focused 
on it, I suspect, they did not understand one of the first points the 
Senator made when he took the floor, and that is, why don't they do it 
at the State level? Why not get this done at the State level? The 
Senator explained ERISA. The bottom line of this is that, in Delaware, 
only about 15 percent of the people with health insurance would be 
affected by a State law that my State is passing. My State is passing a 
law saying leave it to the doctor to decide. Notwithstanding that, 
those State legislators have come to me and said, we need a national 
law, because even with the State acting, and acting promptly, only 15 
percent--15 percent--of the people with health insurance would be 
positively affected by the State law. To put it another way, the other 
85 percent are out. They are out, without Federal legislation.

  I see Congressman Solomon on the floor. I thank him for his 
leadership. I thank Senator Bradley on this side for calling my 
attention to this and making me realize that this was not some 
exaggerated criticism of HMO's--which I honestly thought was the case 
when I first heard it in my State, that this was one of these horror 
stories that had been blown out of proportion. It is real, it is 
genuine, and the bottom line is that this will make a difference in the 
lives of mothers and their children. We should not wait any longer.
  I thank the Chair.
  Mr. FRIST addressed the Chair.
  The PRESIDING OFFICER. The Senator from Tennessee is recognized.
  Mr. FRIST. Mr. President, the bill before us, the Newborns' and 
Mothers' Health Protection Act of 1996, does one very simple thing. I 
refer to it as a ``safe haven.'' It guarantees a safe haven for care of 
mothers and their newborn infants during the immediate postdelivery 
period. That period of time is 48 hours after delivery, that 
postdelivery period. I have been very aware of the potential for having 
Government get too involved, but it does this without excessive 
interference by the Government in the health care system.
  As background, maternity care today--many people don't know this--is 
the most frequent reason for hospitalization today. Hospital stays of 
24 hours or less have indeed become the norm in many parts of the 
country for those routine, uncomplicated vaginal deliveries. Sometimes 
hospitalizations are as short as 12 hours and even 6 hours. However, 
adopting this approach of a 6-hour discharge, or even a 12-hour 
discharge, to the general population, and not being able to predict 
every time which child will have a ventricular arterial contraction or 
a defect, it has not proven to be uniformly successful.
  This bill ensures appropriate coverage. Let me make it clear. It does 
not mean 48 hours for everybody in the hospital. People can still be 
discharged

[[Page S9906]]

at 12 hours or 24 hours. What this bill says is that the insurance 
company does not decide when you are discharged, but it is you, the 
mother, in consultation with the physician. The physician and mother 
decide, the two of them, not an insurance company.
  Why has all of this become an issue today in 1996 when it was not an 
issue 8 or 10 years ago? Over the last several years, we have seen how 
these progressively shortened hospital stays have, in some cases, hurt 
new mothers and their infants. These cases that will be referred to 
have been brought to the attention of physicians, have been brought to 
the attention of the American people, and have been brought to the 
attention of the U.S. Congress. Problems for both the mothers as well 
as the infants--either one of them--can simply occur with too early a 
discharge.

  Today with the evolution of care in our rapidly changing health care 
system there are certain dynamics which can and do raise their heads 
that encourage too early discharge overruling the mother and overruling 
what the physician regards as being in the best interests of that child 
or that mother. The decision for discharge should remain with the 
health care provider in consultation with the mother.
  Changes in maternity stay have occurred over the last 2 decades. We 
only need to look back at older brothers and sisters and see how long 
they were in the hospital, or how long we were kept in the hospital and 
compare it to today. Mothers used to stay in the hospital routinely for 
5 days or more. At the same time--remember this is not that long ago--
infants were frequently isolated from mothers and brought to them only 
at nursing time. And mothers were heavily sedated during birth. And 
fathers very, very rarely were present at the delivery of their infants 
and children.
  Over time--again it has been over the last 30 years--this type of 
delivery environment was recognized as being abnormal and unacceptable 
to many people--to parents who asked for more, and who won more 
appropriate care for this most natural of all events; that is birth. 
But increasing emphasis was placed on returning home as soon as 
possible. Many people wanted to get back home.
  This legislation does not discourage innovation, creativity, new 
environments in which this delivery can be carried out; this birthing 
can be carried out. Alternatives to hospital delivery have become 
available. We now have birthing centers under the supervision of other 
types of health care providers, not just physicians, but midwives. All 
of this experience which has occurred in the last 20 years has taught 
us much about what is necessary, what is not necessary, what is safe, 
and what is not safe for the delivery during a normal pregnancy. 
Midwives carefully screen their mothers for such deliveries, prepare 
the parents for this experience, and visit their patients shortly after 
discharge.
  And in this framework of carefully-crafted policy mothers and their 
newborns are frequently ready--yes, ready--to return home as early as 6 
hours after delivery. But then on the flip side insurers--again not all 
insurers--but insurers seeing these results have been attracted by the 
successful outcomes and by the opportunity to decrease costs and free 
up funds which can be utilized elsewhere in the system--all of that can 
be a laudable goal. But an overvigorous institution of a policy of 
early discharge without enough attention paid to potential consequences 
when this approach is inappropriately applied has resulted in the 
situation in which we find ourselves today.
  Health care providers--that is physicians and midwives--frequently 
feel undue pressure to discharge a mother and her infant before they 
believe it is in the best interest of their patients. We just simply 
cannot let that happen. I concluded that in this limited situation in 
which there has been excess interference in the exercise of a 
physician's best interest of the patient, a physician's responsibility 
for his or her patient, Federal legislation is justified.
  Very quickly, what does this bill do? Number one, as I said, it 
provides a safe haven of time during which those making the decision 
about discharge are those most directly involved--the mother--and the 
health care provider. Many times I will hear from my medical colleagues 
who will tell me that sometime in that 48- or 96-hour period a health 
care provider will receive a phone call, and say, ``We need to 
encourage your patient to leave earlier.'' Then you may think it is in 
the best interest of that patient. That is simply unsatisfactory today.
  No. 2, this bill guarantees that in those cases where the provider in 
consultation with the mother decides that a mother and her newborn can 
safely leave the hospital before 48 hours, that the insurer, if they 
say they are in the business of covering maternity benefits during that 
48-hour period, will provide coverage for these timely postdelivery 
care situations.

  That is very important because some people come, and say, ``You are 
forcing people to stay in the hospital for 48 hours.'' We are not. The 
provider and the mother decide about discharge. If it is before 48 
hours, timely care must be given by that insurance company.
  No. 3, this bill guarantees that there will no longer be undue 
pressure in the form of a monetary incentive to either the mother or 
the health care provider to discharge in less than 48 hours.
  This bill does not do several things. Again, to understand the bill 
fully, we need to look at those things.
  First, this bill does not require a mother and her newborn to stay 
any fixed time in the hospital.
  Second, this bill does not require that a mother go to a hospital to 
deliver her infant. It allows other types of environments. It allows 
innovation within our changing health care system.
  Third, it does not preempt laws or regulations passed by any State 
that provide already as much or more protection for the mother and her 
infant than is provided in this bill.
  Many mothers are ready for early discharge, and many health care 
systems have the appropriate safeguards in place for this to occur, but 
not all, and that is why we need this legislation. With time more will 
provide appropriate prenatal preparation and follow up. However, now 
and in the future, it should always be the health care provider in 
consultation with the mother who will decide when the mother is ready 
to go home with her newborn child and to what environment.
  The amendment before the Senate guarantees this period of time which 
I call a safe haven for this decisionmaking process to be carried out. 
It is the best and the only way to support the successful transition 
for mother with child to mother caring for child.
  What will be appropriate for health care in the 21st century? There 
is no way for us to predict now and, thus, in this bill we have the 
flexibility to allow innovative solutions to the problems that may face 
us in the future. It is not a rigid bill.
  Professional organizations such as the American College of Obstetrics 
and Gynecology and the American Academy of Pediatrics have endorsed the 
bill. Some managed care plans have endorsed the bill as well. The 
National Association for Home Care has endorsed the bill. The American 
Medical Association supports the bill and their comment is basically 
that this bill does not dictate medical practice nor lock medical care 
into statute. It restores the clinical autonomy of doctors and their 
patients to make the best decision about health care for women and 
their newborns. It provides flexibility for early discharge when both 
the mother and physician agree on an abbreviated stay.
  It is also endorsed by the American Nurses Association, the 
Association of Women's Health, Obstetrics and Gynecologic Nurses, the 
March of Dimes Birth Defect Foundation, the Consortium for Citizens 
with Disabilities, the American Association for University Affiliated 
Programs, and a number of other organizations.
  Mr. President, I opened by saying that I am not a fan of big 
Government intruding into our health care. But in very specific 
situations--situations where the care of patients is being restricted 
in many ways I think to the detriment of society--there is a point for 
Government to stand up. At the same time we must guard against a one-
size-fits-all health care system, or to use the Federal Government to 
micromanage those difficult cost-benefit tradeoffs that every health 
care plan must make.

[[Page S9907]]

  However, I do believe that there are times when it is appropriate for 
Government to provide guidance by setting national rules. This is one 
of those times. The challenge is to do so in a way that protects the 
individual but still allows the necessary flexibility for the system to 
respond appropriately and in a timely manner to a rapidly changing 
health care environment.
  This bill does exactly that. Therefore, I urge all of my Senate 
colleagues to join me in supporting this important and timely piece of 
legislation.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, I only want to ask a question. I am not 
going to speak.
  Parliamentary inquiry, Mr. President. After this amendment is 
disposed of, is there some pending business by order or what will be 
the pending business?
  The PRESIDING OFFICER. After the Bradley and Frist amendment is 
disposed of, the bill will be open for further amendment.
  Mr. DOMENICI. Is there a time agreement on the amendment that is 
pending?
  The PRESIDING OFFICER. There is not.
  Mr. DOMENICI. And do I understand then a Senator taking the floor and 
getting recognized with an amendment would be the pending business 
after the disposition of this amendment? Is that correct?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. DOMENICI. I would like to state to the Senate that when this 
matter is disposed of, I do intend with the aid and assistance of my 
able friend, Senator Wellstone, to call up the compromise Domenici-
Wellstone mental health coverage issue as an amendment if possible yet 
today before we finish.
  I yield the floor.
  Mr. WELLSTONE addressed the Chair.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. I ask unanimous consent that after this amendment is 
disposed of, the Domenici-Wellstone amendment be next in line.
  The PRESIDING OFFICER. Is there objection?
  Mr. DOMENICI. I reserve the right to object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. WELLSTONE. Does the Senator know I asked unanimous consent that 
our amendment be brought up?
  Mr. DOMENICI. Yes. I had to reserve the right to object in behalf of 
the leadership because the manager deserves an opportunity to pass 
judgment on whether that should be granted.
  Mr. WELLSTONE. I see.
  Mr. President, I will just take a moment. I certainly thank Senator 
Bradley and Senator Frist and other Senators for their leadership, and 
I am very proud to be a cosponsor of this amendment. I just want to 
make four points. The first one is the point the Senator from Delaware, 
[Mr. Biden] made.
  I come from a State where very simple legislation has now been passed 
with overwhelming support. The problem is, as with so many of the self-
insured plans, that people because of ERISA are just not covered at 
all. In Minnesota I think it is about only 40 percent of the people, 
actually a quite smaller percentage in Delaware. So we really have to 
do this at the Federal level to provide this protection for women, 
their husbands and their children.

  My second point, an alarming one, is that too many health plans are 
refusing to provide the postpartum coverage both women and their 
physicians feel is necessary. Senator Domenici and I are going to talk 
about mental health. That is another example where too often in the 
plans you find discrimination or you sort of find a point where some of 
the limits set are arbitrary. That is exactly what is going on here. 
This is really an effort to deal with what some people call the drive-
through deliveries.
  I think this amendment is long overdue. It is not that often we can 
pass an amendment or a piece of legislation which so clearly connects 
to people's lives--women's lives, children's lives, husbands' lives, 
families' lives.
  This is an extremely important amendment.
  Again, point one is that we do need to do this at the Federal level 
to provide this coverage to people in the United States.
  My second point is that we do have these drive-through deliveries.
  Three, as referred to by my colleague from Tennessee, nobody is 
mandating that a mother stay in the hospital 48 hours. My daughter, 
Marcia, had a boy several months ago and in a day was more than ready 
to go home. But what I am worried about is the bottom line becomes the 
only line, and what you have is people discharged out of the hospital 
when they should not be and when they are in need of more assistance or 
when their babies are in need of more assistance. So I think it is 
extremely important on those grounds.
  And the final point, which is different, is that I think this 
amendment and the fine work that was done in the House of 
Representatives speaks to a broader question. We are not going to get 
to it today, but I really do think that what is going on in the country 
is a major concentration of power in health care. The fact that there 
have not been a lot of changes taking place in the 104th Congress does 
not mean that there are not major changes taking place all around the 
country.
  These are rough figures; I am just speaking from memory here, but 
something like the nine largest insurance plans control over 60 percent 
of the managed care plans in our country today. I am not trying to make 
any conspiracy argument, but what I am trying to say is when you move 
toward this kind of concentration of power and you find situations when 
women and their babies are leaving the hospitals, really forced to 
leave the hospitals because they do not have the necessary coverage 
where they should be there that extra day, that points to a larger set 
of problems, and I think we need to legislatively figure out how to 
build more accountability into the system, how to make sure some of the 
care givers are involved in setting some of these standards, how to 
make sure that there is more consumer protection, how to make sure that 
while we move forward with cost cutting or cost containment, all of 
which we need to do, the bottom line is not the only line because when 
it comes to the health of a mother and her newborn or when it comes to 
the concerns of families, there is nothing more precious than good 
health.
  That is what this amendment speaks to in a very dramatic and very 
direct way, and I am very pleased to be an original cosponsor.
  I yield the floor.
  Mr. DeWINE addressed the Chair.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. DeWINE. Mr. President, I rise in strong support of this 
amendment. I believe it is a major step toward insuring health for 
newborn babies and for their mothers. For the last few decades, we have 
made great progress in medical care, pregnancy and childbirth. I have 
had the occasion, as my wife has, to see this firsthand. My wife, Fran, 
had our eight children over a pretty widely spaced period of time. We 
have had children in the 1960's and 1970's, the 1980's, and the 1990's. 
So we have seen a lot of changes.
  The progress during this period of time has certainly been 
measurable. In 1968, for example, when our first child, Patrick, was 
born, there was relatively little in the way of prenatal education for 
the mother. Since then, with each new child, we have seen some truly 
remarkable improvements: Prenatal child birthing courses now for both 
parents, ultrasound, fetal monitoring during labor to detect problems, 
birthing rooms which have done a lot to make the whole process much 
easier and certainly much more humane. Fran and I have watched all of 
these innovations as they were introduced, refined and perfected, and 
we can both testify that as a result of these improvements today's 
mothers are better prepared to deal with their pregnancies in a healthy 
way and better prepared to give birth.
  All that being said, we still have a long way to go if we want to 
make sure new mothers and their babies get the care they need. This 
amendment addresses one of the key areas in which we need to make 
substantial improvements. We can no longer ignore the fact that today's 
new mothers and

[[Page S9908]]

their babies are often being moved out of hospitals far faster than a 
real concern for their health would allow. This is being done without 
any real consideration for what else needs to be done to compensate for 
that quick movement out of the hospital, what kind of additional care 
the mother and child need if the hospital stays are shorter and 
shorter, and shorter. Often, as we have already heard in the Chamber 
today, the mother and the baby are moved out of hospitals just 24 hours 
after the child is born, in some cases even less than that.
  If you talk to doctors, as I have, they will tell you that they are 
under a tremendous amount of pressure to keep the new mothers moving 
out the hospital door. The pressure is coming on the doctors, coming on 
the mothers. It is coming on the hospitals. I think it is wrong. I 
think it is unconscionable. This is a decision, as Dr. Frist said just 
a moment ago, that should be made between the mother and the 
doctor. That is who should be involved in this decision. It is a 
decision that should be based on the best interests of the mother and 
the child. It should not, frankly, be a business decision.

  When our son Patrick was born in 1968, my wife, Fran, stayed in the 
hospital with him for almost 5 days. That was standard operating 
procedure in Hamilton, OH, in 1968. When our last child, Anna, was born 
in 1992, Fran stayed in the hospital for 36 hours, about a day and a 
half.
  This trend is not bad in and of itself. In some cases, a mother might 
want to leave the hospital sooner rather than later. For example, back 
in January 1987, my wife Fran had just given birth to our son Mark, 
when a blizzard threatened to hit. In fact, she gave birth between two 
blizzards--one had come, then we went to the hospital, then we were 
worrying about the second one coming. So for her the choice was clear: 
either leave the hospital after a day and a half, or risk being stuck 
there for up to a week. Fran chose to take Mark home. That is what she 
did. The blizzard came just a few hours after we got home.
  But it is not, therefore, a question of mandating hospital stays. 
Government should not be in the business of doing this. All we are 
trying to do with this amendment is to make sure it is the mothers and 
their doctors who are making this important choice, a choice that 
affects the health of the mother and the child.
  It is also important that we not look at the number of hours mothers 
spend in the hospital as if it were an isolated issue or an isolated 
problem. I think we need to pay greater attention to the overall issue 
of postnatal care. The way my wife Fran likes to put it, it is time to 
make the same kind of investment in improving postnatal care as we have 
invested in prenatal care in recent years.
  Let me tell another story which I think illustrates this. Last year, 
our daughter Jill gave birth to our second grandchild. At 10:55 p.m. on 
a Wednesday, the birth took place. At 2 a.m., Thursday morning, just 
about 3 hours later, Jill was being taught how to bathe the baby and 
other necessary information. At 7:30 that morning, they started 
marching Jill through three or four separate videos on child care. And 
by noon on Friday, she and the baby were out the hospital door. Jill, 
at least, was exhausted.
  We all realize the doctors and nurses who take care of our young 
mothers and their babies are the best in the world. They are true 
professionals with the best combination of competence and compassion. 
But they have an incredibly long checklist--that is literally what it 
is today--a long checklist of things that they have to teach the new 
mother. Frankly, they do not have enough time to teach it in. Sometimes 
we forget the new mother needs some time to rest, too, especially after 
an exhausting labor, during which she may well have missed a night's 
sleep. Longer hospital stays very well may be an answer to these 
problems.
  But, in addition to that, we have to look at the overall issue, the 
overall issue of postnatal care. Frankly, there ought to be more 
followup care for the mothers and their babies. As we heard in 
testimony in our committee, and as my daughter-in-law Karen just 
experienced when she had her baby, the enlightened insurance companies, 
the enlightened HMO's, are now building into the policy, building into 
the plan, this type of postnatal care, because the fact is that most 
doctors do not require a followup visit for a week or two. Frankly, as 
parents, sometimes it is hard to take a new baby out before then. We, 
therefore, need to consider the importance of followup in-home visits. 
This kind of followup care can make a huge difference, a huge 
difference in the welfare of the child.

  We had an experience, I think, that would shed a little light on this 
as well. Our youngest child, Anna, was born 5 weeks early, but she 
appeared to be healthy and had no medical problems. My wife, Fran, and 
our daughter Anna, were sent home after 36 hours. But after a few days, 
Anna began to look slightly yellowish. Fran and I really were not 
worried. We knew it was common for breast-fed babies to become slightly 
jaundiced. Fran was watching her, and about the fifth day she took her 
to the doctor. It turned out Anna's bilirubin level was dangerously 
high. Even as experienced and educated parents--seven other children--
we had not noticed the change and had not noticed how fast the change 
was occurring. If Fran had not taken her in when she did, there could 
have been medical complications. This whole incident was particularly 
scary for us. We felt we knew the danger signals, but we obviously 
missed them.
  This is a case of a mother and father who had seven children, who had 
been through this before. If it was tough for us, can you imagine how 
difficult it must be for a young mother, with no experience at all, to 
detect some of these medical problems? Therefore, we need to do more in 
this area. In fact, when we were considering this legislation in the 
Labor and Human Resources Committee, some of my colleagues and I added 
the provision requiring a study of post partum care. I think this study 
is very important and is, in fact, included in the pending amendment.
  Let me conclude by saying that today we are making, I think, a very 
good beginning. It is a very good beginning to deal with a problem that 
I have seen firsthand, a problem I have discussed with doctors and a 
problem that I have discussed with other constituents.
  So, I commend my colleague from New Jersey, my colleague from 
Tennessee, and the other cosponsors of this amendment for the work they 
have done, the work they have done to refine the amendment and the work 
they have done to bring it to the floor of the Senate today.
  I yield the floor.
  Mrs. BOXER addressed the Chair.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. Mr. President, I rise in strong support of the Bradley 
amendment. I want to say to my colleague before he leaves the floor, I 
am going to miss him from this Senate. This is a perfect example. This 
is a Senator who understands what makes a difference in the lives of 
real people and goes after these issues with great skill.
  I am so delighted to rise as, I think, the first Senator here who has 
ever actually given birth to testify that this is a very important 
amendment. I believe it will save lives. I believe it will spare 
families a great deal of heartache.
  I will explain that. First of all, it is just incomprehensible to me 
that there would be a one-size-fits-all prescription being put out by 
so many of the HMO's today, when, in fact, each particular case is 
different from the one before. Not all women have an easy time giving 
birth. Not all babies have an easy time being born. There are so many 
complications, there are so many differences, so many problems. Senator 
DeWine spoke, I think, from the heart, about having the seventh child 
and still almost missing a serious problem. I am going to address that 
in my remarks, I say to my friend.
  I think it is important to note that this amendment really gives the 
flexibility where it belongs, to the patient and to the doctor. I 
strongly believe that, in any medical procedure, any medical issue, 
that is where the decision belongs, in the hands of the patient and the 
hands of the doctor. Childbirth is one of the most incredible 
experiences a woman can have. It is probably the most exciting--more 
exciting than winning elections. And, I have to say, it is also very 
difficult. It is usually very painful. Even in the

[[Page S9909]]

best of circumstances, where everything just goes according to the 
book, if there is such a book, it is hard on the woman and it is hard 
on the baby--even a perfect birth.

  In the old days when my mother gave birth to me--and that's the old 
days--she stayed in the hospital for a week or longer. When I had my 
children, I stayed in the hospital for several days. It was very 
important, because I gave birth to premature babies, and they were 
there in little incubators. In those days, they did not even let you 
hold the babies, but I so wanted to be close to them, and I was able to 
stay in the hospital several days while I got stronger, and I watched 
them happily grow stronger.
  When my daughter gave birth just a year ago, or so, the hospital 
figured she would stay in for 24 hours. She asked her doctor if she 
could stay in for 2 days. She felt she needed that extra day. 
Fortunately, he intervened on her behalf and she got to stay in for 48 
hours and was very grateful for that.
  I do not think that should be a gift from an insurance company. I 
think that ought to be something that is absolutely a right of a 
patient. When we have gone from women staying in the hospital for a 
week or 10 days down to where they are being thrown out after a day, 
believe me, women are not any stronger today physically than they were 
then. It is the same thing. So it just doesn't add up.
  Particularly new mothers need that option, it seems to me. They need 
to know how to nurse their children. That may sound strange, but I want 
to say for the benefit of my colleagues that nursing a baby takes a 
little bit getting used to. You have to learn how to do it. That added 
day in the hospital is very important to become comfortable with your 
baby, to understand the signs to look for if there is trouble. And that 
brings me to the issue that Senator DeWine spoke about, the jaundice.
  The fact is that many babies do become jaundiced, and it is easy to 
treat it with light, if you know what to look for. But many of these 
mothers, because it takes a while for the jaundice to develop, are out 
of that hospital within 24 hours and are not prepared, and terrible 
consequences can flow from that.
  In the case of my own grandchild, they noticed something right before 
they left. They told her to watch for jaundice, and it happened. They 
had to come over and bring the little light boxes into the home.
  So I just want to say to my colleague, that added chance, that extra 
24 hours can make a great difference. I am very glad he put in the 
Record that Kaiser Permanente supports this. They are a huge HMO in 
California. I could not be more proud of them for that.
  Again, I thank my colleague for bringing an issue to the floor of the 
Senate that is extremely important to the families of America. I am so 
proud that I had a moment or five or six to speak to your amendment.
  I yield the floor.
  Mr. WYDEN addressed the Chair.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. I thank the Chair.
  Mr. President, I, too, rise to speak in support of the Bradley-Frist 
amendment. I am going to be very brief this afternoon, but I did want 
to take a minute or two and discuss a General Accounting Office report 
that I will have coming out next week. The General Accounting Office 
has summarized a number of findings in a report for me, which report 
will be available next week, and I would like to discuss those findings 
very briefly.

  First, it seems to me that, if you pass this important legislation, 
our country increases the odds that the next generation gets off to a 
healthy start. That is what this legislation is all about: getting off 
to a healthy start.
  As I mentioned, I asked the General Accounting Office a number of 
months ago to help the Congress identify the risks attributable to 
foreshortened hospital stays for mothers and their newborns, as well as 
to analyze health care plans on how well they provide postpartum care.
  The General Accounting Office has given me a letter, Mr. President, 
that I will make a part of the Record this afternoon, but I would like 
to summarize very briefly just four of the findings in the General 
Accounting Office report that they will have next week.
  The first is the General Accounting Office has pinpointed studies 
analyzing readmission statistics that indicate that babies staying less 
than 48 hours do, in fact, have a higher rate of rehospitalization for 
health problems.
  The General Accounting Office concludes that not every early 
discharge is a danger to each and every child, but certainly there are 
studies that do indicate that readmission statistics demonstrate that 
babies staying less than 48 hours do, in fact, have a higher rate of 
rehospitalization.
  Second, the General Accounting Office has found that a number of the 
discharge plans are simply that they are just a drive-by delivery with 
no at-home follow up to ensure that the mother and the child are doing 
well.
  Third, the General Accounting Office has found that while a number of 
the States do have laws on the books that deal with this practice, not 
all of the insured individuals, and certainly some of the most 
vulnerable of America's families, are protected by these laws. So I 
think it is fair to conclude that there is a very significant variation 
with respect to consumer protection in terms of State laws, and I think 
that, too, makes a compelling argument for the Bradley-Frist 
legislation.
  Fourth--and I close with this point, because I think it is the most 
significant one and, in and of itself, makes the case for the Bradley-
Frist bipartisan legislation--the General Accounting Office has found 
that a significant number of plans offer doctors alternative financial 
incentives for early discharge and significant penalties for keeping 
young mothers and babies in the hospital longer than the plans would 
like. So what we have--and I point out that this will be the first 
Government study looking at this problem--is already significant 
evidence that two sets of disincentives to good health for young 
families exists on the basis of the GAO report: first, the question of 
plans offering financial incentives for early discharge and, second, 
the matter of heavy penalties that the GAO has found in a number of 
instances for keeping young mothers and babies in the hospital longer 
than the plans would like.
  What it comes down to--and I sure hope we get a unanimous vote in a 
few minutes with respect to this legislation--is that this Congress has 
a chance to put some votes behind all of the family-friendly rhetoric.
  I am very hopeful that the Bradley-Frist legislation will pass on a 
bipartisan basis. I think that the Senator from New Jersey has 
contributed so much, but what an important bill on which to finish a 
stellar career.

  Mr. President, I ask unanimous consent to have printed in the Record 
the letter from the General Accounting Office to which I referred.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                       GAO, Health, Education, and


                                      Human Services Division,

                                Washington, DC, September 4, 1996.
     Hon. Ron Wyden,
     U.S. Senate.
       Dear Senator Wyden: To contain costs, some health care 
     plans have adopted guidelines to shorten hospital stays 
     associated with maternity care--the most common condition 
     requiring hospitalization. Some plans have limited hospital 
     coverage for mothers and their newborns to a maximum of 24 
     hours after delivery. As a result, between 1980 and 1994, the 
     percent of 1-day postpartum hospital stays rose from about 9 
     percent to about 40 percent of all births. Many in the 
     medical community have voiced concerns that these shortened 
     stays expose newborns to undue risks.
       To better understand the issues involved, you asked us to 
     (1) identify the risks that are attributable to short 
     hospital stays for maternity care, (2) examine health plan 
     actions to ensure quality postpartum care for short-stay 
     mothers and newborns, and (3) determine state responses to 
     concerns about patient protection. To do this study, we 
     analyzed pertinent trend data and interviewed medical experts 
     and representatives from hospital maternity programs, managed 
     care organizations, home health agencies, medical specialty 
     societies, and health care trade associations. In briefing 
     your staff on our work, we noted that our report would be 
     available by the end of next week. In the interim, you asked 
     us to summarize the results of our work. Our key findings 
     include the following:
       Guidelines issued by the American Academy of Pediatrics 
     suggest--notwithstanding the presence of complications--
     either minimum 2-day stays for vaginal deliveries and 4-day 
     stays for caesarean sections or shorter stays if: (1) Medical 
     stability criteria are

[[Page S9910]]

     met, (2) the decision on length of stay is agreed to by 
     physician and patient, and (3) provisions are made for 
     timely, comprehensive followup care delivered by a maternity 
     care professional.
       Neither researchers nor medical experts agree about the 
     direct effect of short stays on maternal and newborn health. 
     Using hospital readmission rates as an indicator of adverse 
     outcome, one recent study shows no association between the 
     number of days a newborn spends in the hospital and the rate 
     of readmission, while other studies show increased risk 
     for newborns discharged within 48 hours of birth.
       Some plans allow physicians flexibility to apply early 
     discharge policies selectively. In addition, they have 
     programs of maternity care services that include intensive 
     prenatal assessment and education and comprehensive followup 
     care provided within 72 hours of discharge by a trained 
     professional at home or in a clinic. We found, however, that 
     some plans with shortened postpartum stays do not provide 
     adequate prenatal education or appropriate followup services. 
     For example, some plans' followup care consists of a phone 
     call rather than an actual home or office visit.
       Early discharge policies have prompted more than half the 
     states to enact laws that regulate the length of maternity 
     stays but vary widely in degree of consumer protection and do 
     not apply to all insured individuals. For example, states 
     vary on whether the law specifies stay minimums, identifies 
     discharge decision makers, or mandates number of home visits 
     covered, among other things. The laws are also limited in 
     jurisdictional scope in that they: (1) Do not apply to plans 
     that are exempt from state regulation under the Employee's 
     Retirement Income Security Act of 1974 (ERISA) or (2) may not 
     apply to individuals living in one state but working and 
     receiving insurance in another.
       Federal legislation has been introduced to make maternity 
     care more consistent nationally and available to all 
     privately insured women. The Senate is considering S. 969, 
     Newborns' and Mothers' Health Protection Act, which would 
     mandate a minimum 48-hour hospital stay for normal vaginal 
     deliveries and 96-hour stays for caesarean section deliveries 
     unless the attending provider, in consultation with the 
     mother, makes the decision to discharge early and coverage is 
     provided for prescribed timely followup care. Timely care is 
     defined as care provided in a manner that meets the health 
     care needs of the mother and newborn, provides for 
     appropriate monitoring of their conditions, and occurs within 
     24-72 hours immediately following discharge. These provisions 
     are consistent with the findings contained in our forthcoming 
     report.
       We hope that this information meets your needs in 
     considering proposed federal legislation on hospital length 
     of stays for maternity care. Please call me on (202) 512-7119 
     if you or your staff have any questions regarding the issues 
     discussed above.
           Sincerely yours,

                                              Sarah F. Jaggar,

                                        Health Service Quality and
                                             Public Health Issues.

  Mr. WYDEN. Mr. President, I yield the floor and will make for the 
Senators a copy of the General Accounting Office's findings a matter of 
the Record. I yield the floor.
  Mr. HELMS addressed the Chair.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. HELMS. Mr. President, I thank the Chair for recognizing me.
  I am so glad Senator Bradley came to me sometime back in October 
about this legislation and asked if I could become a cosponsor, which I 
readily did. I have not been a mother myself, but I have been around 
mothers. I am the husband of one, the father of two, and potentially 
the grandfather of five.
  In any case, this Newborns' and Mothers' Health Protection Act, as it 
is formally titled, will be beneficial to countless mothers and their 
newborn children, because it will restore health care decisions to 
those best suited to make them--the mothers and their doctors--
while making certain that new mothers and their babies are allowed to 
remain in the hospital at least 48 hours following natural births and 
96 hours after Caesareans.

  As Senators have already pointed out several times, in some instances 
new mothers and their babies are forced to leave the hospital as early 
as 8 hours after delivery because insurance companies often refuse to 
pay the bills otherwise.
  It simply is unconscionable to require a new mother and her doctor to 
make this decision based on arbitrary insurance deadlines. That is what 
the distinguished Senator from New Jersey had in mind. I compliment him 
on this amendment and I am honored to be a cosponsor.
  I am not alone in my contention that mothers and their physicians are 
better able to determine what is needed to promote a mother's and 
child's health rather than some arbitrary insurance deadline.
  As a matter of fact, a Dartmouth-Hitchcock Medical Center study 
concluded that babies released earlier than 48 hours after birth had a 
50-percent greater chance of needing readmission to the hospital and a 
70-percent increased risk of emergency room visits.
  Mr. President, the too-early discharges so often lead to jaundice 
which afflicts approximately one-third of newborns, dehydration 
resulting from breast-feeding difficulties and infections. Although 
these conditions are of course treatable, each must be diagnosed 
quickly, within 3 to 5 days, lest they result in brain damage or worse.
  Mr. President, in recent years hospitals around the Nation have 
reported an increasing number of babies being readmitted to hospitals 
with complications of dehydration and jaundice.
  A Virginia infant suffered dehydration-induced brain damage, and 
severe dehydration of a Cincinnati baby led to the amputation of his 
leg. The truth is that these tragedies could have been prevented with 
longer hospital stays.
  Back in the 1970's, postbirth hospital stays were about 4 or 5 days 
for routine normal births, and 1 to 2 weeks for Caesareans. According 
to the Centers for Disease Control, the median length of 
hospitalization between 1970 and 1992 for mothers having normal births 
declined by 46 percent, from 3.9 to 2.1 days, and by 49 percent for 
mothers having Caesareans, from 7.8 to 4 days.
  There is broad agreement, I think, about the importance of reducing 
health care costs and I agree with that. While I am convinced that this 
goal can best be accomplished through less, not more, Federal 
regulations, I also insist that the well-being of mothers and babies 
must not be compromised in the process. This amendment addresses a 
unique, isolated problem which can be addressed by a carefully crafted 
Federal rule. And that is exactly what Senator Bradley has done. And I 
compliment him for offering this amendment.
  In short, Mr. President, the Newborns' and Mothers' Health Protection 
Act of 1996, will ensure that arbitrary insurance guidelines do not 
override the objective of healthy births.
  I thank the Chair and yield the floor.
  The PRESIDING OFFICER (Mr. Brown). Who seeks recognition?
  Mr. BRADLEY addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Jersey is recognized.
  Mr. BRADLEY. Mr. President, I suggest the absence of a quorum.
  Mr. CHAFEE. I wonder if the Senator would withhold that.
  Mr. BRADLEY. I withhold.
  Mr. CHAFEE addressed the Chair.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. CHAFEE. Mr. President, when I heard about this amendment of the 
Senator from New Jersey originally, my first thought was, why is the 
Federal Government getting involved in deciding how long hospital stays 
are? It seemed to me that was a matter that quite properly should be 
handled by States. And indeed in my State we have handled it. We have a 
bill, the best as I understand it, that is very similar to the 
suggestion of the bill proposed by the Senator from New Jersey.
  Indeed, I made notes of the Senator's remarks. He indicated that some 
28 States have taken action. That does not mean they have gone the 
complete route--and the Senator can obviously explain that further--but 
I take it some 28 States have dealt with this matter of how long a 
hospital stay should be or could be.
  So I will confess that my original reaction was unfavorable to the 
Senator's proposal. However, two things happened. For one thing, my 
daughter called me. She has four children and she has some views on 
this subject. And also the ERISA point that the Senator raised. And I 
would like to explore that if I might.
  Finally, the so-called Frist amendment. I am not sure exactly what 
the Frist amendment does. But my first question would be, of the 
Senator from New Jersey, as I understand it--first, I want to say, I 
listened to his arguments. One of his arguments is that you need a 
national law because you might have the State wherein the individual 
resides on a town right on the border of another State where the 
hospital is that serves that town, and the other State does not have 
the legislation.

[[Page S9911]]

  However, I thought the most telling argument he made was the so-
called ERISA argument. That is, as I understand it, that because ERISA 
applies to those corporations that have interstate health care plans, 
that the ERISA law prevents the State government--and we dealt with 
this, of course, when we were dealing with the health care business in 
1994--the ERISA prevents the State law from getting involved with the 
plans that are covered by the ERISA statute.
  I had not thought of that. And so first, if the Senator would be good 
enough to explain a little bit on that. Is that point correct?
  Mr. BRADLEY. Mr. President, I say to the distinguished Senator from 
Rhode Island, yes, the Senator is correct. For example, we have had on 
the floor today the Senator from Delaware speaking. One of the largest 
employers in his State is DuPont. And we had the Senator from Minnesota 
speaking. One of the larger employers in his State is 3M. Each has what 
is known as a self-ensured ERISA plan. And under a State law, in 
Minnesota or Delaware, as each of the Senators has testified today on 
the floor, it could not reach those plans in requiring them to allow 48 
hours for delivery. Only this Federal law would achieve that objective.
  Mr. CHAFEE. So your point is, to follow it up, it only would be a 
Federal law that would deal with that situation. The State law could 
not affect it.
  The second point that would be helpful--maybe I should address this 
to the Senator from Tennessee. I am not sure exactly what the Frist 
amendment is. What does it do?
  Mr. BRADLEY. I think I can answer. Essentially, the differences 
between the first- and second-degree amendments are minimal. The only 
difference relates to a deletion of the sentence that essentially is 
inconsequential but was confusing, and the second-degree amendment adds 
a sentence that gives some flexibility to health plans.

  Mr. CHAFEE. Now, is this the so-called Kaiser Permanente language? Is 
that in the first amendment?
  Mr. BRADLEY. I say to the Senator that in the first amendment is 
language that does allow some flexibility, and I think it would be in 
the first amendment. I think Kaiser Permanente endorsed both the first- 
and the second-degree amendments.
  Mr. CHAFEE. Now, the final question, the number of States that have 
dealt with this you say is 28 in total or in part?
  Mr. BRADLEY. The answer to the question is yes, 28 States have passed 
laws that require insurers to provide 48 hours for a delivery, coverage 
for 48 hours for delivery.
  As the Senator has pointed out, there are a few gaps there. One is 
the ERISA problem; the other is the problem of the hospital that is 
across a State line in a State that is uncovered. Then there is the New 
Jersey problem. I guess some other State law might have that problem, 
but in New Jersey the State passed a law that said that the State 
requirement of 48 hours would apply to only those insurance companies 
that were headquartered in New Jersey. So you could be headquartered in 
another State and you would not be covered. This could get at that 
issue as well.
  Mr. CHAFEE. I thank the Senator for that description.
  As I say, I am troubled by the U.S. Congress getting involved in an 
issue like this. I found the explanation, particularly the ERISA 
argument, to be a very telling argument.
  The PRESIDING OFFICER. The Senator from Tennessee is recognized.
  Mr. FRIST. Mr. President, just to sort of further clarify, the Kaiser 
Permanente language was basically a clarification of the way it was 
written. It was written in the bill that if you are discharged in fewer 
hours than 48 hours--this bill says you have a safe haven for 48 hours 
and followup care has to be somewhere--you have to have care for 48 
hours. You cannot be dumped out of the hospital after 6 hours, and that 
is the end of it.
  What Kaiser said is you need to make it clear that it is the health 
care provider who determines, in consultation with the mother, as to 
where that followup care is delivered. In other words, it is not just 
up to the mother as to where the followup care during the 48 hours was 
delivered. That was written into the bill.
  My amendment was to clarify that further.
  Mr. CHAFEE. Mr. President, I think that is an important point. I will 
give my qualifications in the area. I had six children. I suppose that 
would give me some knowledge about this subject.
  As I understand it, if a mother should choose to leave in 24 hours--
obviously, that is a big savings to the insurance company; say it cost 
$1,000 a day in a hospital, and I do not think that is outrageous and 
that suggestion is pretty much on the mark, or something like that--it 
may well be that the mother would vastly prefer being home but have 
some help at home, and maybe that help would extend for 5 days. How do 
you handle that?
  Mr. FRIST. The health care plan can put whatever they want in. It has 
to be a minimum of 48 hours coverage. That coverage can be in any 
facility that the mother and the physician decide--not the health 
insurance plan--that they decide, during that 48-hour period. After 
that 48 hours after vaginal delivery or 72 hours after a C-section, it 
can be dictated by the insurance company.

  Mr. CHAFEE. So in other words, the mother could say, ``I want to go 
home in 24 hours,'' but she would get the care, somebody at home would 
care, if she wanted, for the next 24 hours?
  Mr. FRIST. That is right. It could be at home, a followup clinic, a 
birthing clinic. That is why it was important in this bill to give the 
flexibility. We do not know how babies will be delivered 4 years from 
now.
  Initially, it was fairly rigid, 48 hours in the hospital. Now the 
bill is flexible enough to say for 48 hours you are covered, and it can 
be in the setting that you and your doctor decide, not some insurance 
company or not somebody sitting 500 miles away behind a telephone.
  Mr. CHAFEE. Thank you.
  Mr. BROWN. Mr. President, the Bradley amendment denies consumers the 
right to select the type of insurance coverage they wish to purchase. 
While I would hope all policies would include the type of maternity 
coverage he suggests, for the Federal Government to mandate it is a 
mistake. It establishes a precedent that consumers are no longer free 
to choose. I thus oppose the amendment.
  Ms. MOSELEY-BRAUN. Mr. President, I want to take this opportunity to 
express my support for the Bradley amendment.
  A few weeks ago Congress made an important step in the right 
direction of adding necessary reform to our health care system. By 
limiting exclusions for pre-existing conditions and by making health 
insurance coverage portable, we answered the concerns of millions of 
Americans that they will lose their access to health care. While I 
believe universal health coverage should be the ultimate goal, the 
Health Insurance Reform Act represented a practical, incremental, and 
caring attempt to deal with the real health care problems facing so 
many Americans, based on their everyday realities.
  Similarly, the Bradley amendment makes an important step in the right 
direction. It is hard to conceptualize that the growing trend among 
health insurers is to force new mothers and their infants to leave the 
hospital 24 hours after an uncomplicated vaginal delivery and 72 hours 
after a cesarean section. In many cases, 24 hours is not sufficient 
time to recover physically from the birth, not to mention have time to 
learn essential child care information. You would think that this alone 
would be sufficient to warrant allowing new mothers to stay longer in 
the hospital. Having a mother who is strong and prepared to care for 
her new child will avoid unnecessary return visits to the hospitals due 
to insufficient care.
  It is also important to note that many of the health problems 
newborns face such as dehydration and jaundice do not appear until 
after the first 24 hours of life. If undiagnosed, these easily 
treatable conditions can lead to brain damage, strokes, and in the 
worst case scenarios, death. There is no justification against 
monitoring babies that we know may be at risk for clearly preventable 
health conditions.

  I do not believe that this bill is the panacea for health problems 
facing mothers and newborns in this Nation. The proportion of babies 
born at low birth-weight in the United States has been rising since 
1984, and is now at its highest level since 1976. Nearly 300,000

[[Page S9912]]

babies, 7.2 percent of all those born in 1993, were born at low birth-
weight. These infants were more vulnerable to infant death and serious 
health problems, such as developmental delays, cerebral palsy, and 
seizure disorders, as a result of their shaky start in life.
  We need to focus more attention on making our children healthy on the 
front-end so that we never have to have a discussion about how long a 
new mother and baby should stay in a hospital. In 1993, almost 200,000 
children were born to women who received either no prenatal care or 
prenatal care after the first trimester of their pregnancy. Good 
prenatal care can reduce rates of low-weight births and infant 
mortality, thus preventing disabilities and savings billions of dollars 
which are spent each year on caring for very sick newborns.
  While the Bradley amendment is far from the total answer to the 
health problems of new mothers and their children, we should not 
underestimate the importance of what we will be achieving if this 
policy becomes law. Protecting the ability for mothers and infants to 
remain in the hospital up to 48 hours for vaginal deliveries and 96 
hours for cesarean births has been endorsed by all four major medical 
groups which involved in maternal health and caring for newborns: the 
American Medical Association, the American Academy of Pediatrics, the 
American College of Obstetricians and Gynecologists, and the American 
Nurses' Association.
  I want to conclude by congratulating Senators Bradley, Kassebaum, and 
Frist for their leadership and for all the hard work they have put in 
to building momentum for this important amendment. I strongly urge the 
Senate to adopt the Bradley amendment. I urge all of my colleagues to 
think about how much this bill means to Americans all across this 
country, and how critically necessary it is to make this improvement in 
our health care system. This amendment is another good step in the 
right direction.
  Mr. KENNEDY. Mr. President, I commend my colleagues, Senator Bradley 
and Senator Kassebaum, for their leadership in bringing this important 
legislation before the Senate for consideration. Current trends in 
health care financing have created a clear need for this legislation. 
Doctors are under increasing pressure from insurance companies to 
discharge mothers and newborns earlier and earlier.
  Until a few years ago, the birth of a child was typically followed by 
a 4-day hospital stay for the mother and her newborn, so that mothers 
had time to recover from labor and delivery, and learn about the care 
of their infants. Health care providers had adequate time to watch the 
initial development of the newborns carefully, to assure that the 
babies were healthy. This initial period of expert observation is 
critical, since it means early diagnosis and immediate response and 
treatment when complications develop.
  Now, however, the length of stay following a normal delivery is 
commonly only a day or two, and in many cases, even less.
  To some extent, this change results from better medical management of 
childbirth, and greater responsiveness to women's desire for a less 
hospital-centered and more family centered experience of childbirth. 
But the dominant motivation behind these shortened stays, however, is 
the financial incentive to reduce the cost of childbirth, which is the 
most common cause of hospitalization in the United States. Profit, not 
sound medical judgement is driving the increasingly serious problem of 
drive-through deliveries.
  The guidelines of the major medical societies provide for at least 2 
days of hospitalization after a normal delivery, to give mothers 
adequate time to recover and learn to care for their infant in a 
restful atmosphere where professional help is immediately available.
  Serious harm can result if a mother and her newborn are released too 
soon. Conditions such as jaundice and dehydration typically do not 
appear until after the first 24 hours of life. Recent research in 
Massachusetts shows that babies discharged less than 1 day after birth 
have a 25 times higher rate of not being screened for treatable 
congenital disorders, compared with babies who stay longer.
  Many serious condition are not easy to detect. Long-term 
disabilities--even death--may result. Congress should not acquiesce in 
irresponsible insurance industry practices that put profits ahead of 
families and the bottom-line ahead of babies. This legislation will 
guarantee that mothers and their doctors--not insurance companies--
decide when to leave the hospital after childbirth.
  This legislation was written in accord with the recommendations of 
the two leading medical societies with expertise in this area--the 
American College of Obstetricians and Gynecologists, and the American 
Academy of Pediatrics. They endorse this amendment. There is clear 
agreement among these experts that hospital stays should range from 48 
hours for normal deliveries to 96 hours for cesarean sections.
  By adopting this legislation, the Senate will not be requiring 
mothers and newborns to stay in the hospital unnecessarily. In many 
cases, mothers, in consultation with their doctors, will elect to go 
home early. But this amendment will guarantee that patient choice and 
medical judgment guide this decision--not insurance company orders.
  I urge the Senate to support this important legislation. It has 
broad, bipartisan support. It is endorsed by the American Academy of 
Pediatrics, the American College of Obstetrics and Gynecologists, the 
American Medical Association, the American Nurses Association, the 
Association of Women's Health, Obstetric, and Neonatal Nurses, and the 
March of Dimes Birth Defects Foundation. It is appropriate--indeed 
overdue--for the Federal Government to set these minimum standards for 
health and safety. Newborns should not be placed at risk for the sake 
of insurance industry profits.
  Ms. MIKULSKI. Mr. President, I rise today in support of the newborns' 
and mothers' health protection amendment. I am proud to be a cosponsor 
of this legislation. This amendment is about family friendly health 
care. It puts the care of mothers and babies before the financial 
interests of insurance companies. It puts into practice what we have 
always preached--to honor the mother and to defend motherhood.
  This amendment requires that insurance companies provide coverage for 
care for a minimum of 48 hours after a vaginal delivery and 96 hours 
after a caesarean section. It allows mothers and infants to be 
discharged earlier if there is appropriate follow-up care. This is 
consistent with the practice guidelines issued jointly by the American 
College of Obstetricians and Gynecologists [ACOG] and the American 
Academy of Pediatrics [AAP].
  What I like about this amendment is that what we explicitly state as 
our values, we implicitly practice in public policy and public law. 
What we do with this legislation is ensure that mothers and their 
babies receive the care that they need, that is deemed appropriate by 
their physicians. On both sides of the political aisle, we talk about 
putting families first. This amendment does that. It puts value on 
motherhood.
  This whole movement around providing care for 48 hours or 96 hours or 
whatever is medically appropriate came from mothers themselves. Then it 
was the movement of the extraordinary medical facilities that were 
willing to step forward and even defy the insurance companies. St. 
Agnes Hospital in my hometown of Baltimore insisted that they would 
provide this care if they had to do it out of a charitable endowment or 
if we all had to pitch in and do bake sales. St. Agnes took a stand--
they were going to assure that mothers and their babies got what they 
needed when they needed it. That resulted in the Maryland general 
assembly acting--and now I am proud to say that Maryland has a law that 
really mirrors in many ways what we are doing in the Federal 
legislation.
  So, I salute Senator Bradley for offering this amendment, but I also 
salute the mothers who organized, and the doctors and medical 
facilities who defied the insurance companies. I want to see managed 
care, but I don't want to see doctors managed. There is a fundamental 
distinction. We have to start getting our priorities straight and 
decide where we are going to be making our decisions. And in the case 
of newborns and their mothers--I believe decisions need to be made in 
the delivery room and not the boardroom.
  I urge support for this amendment.
  Ms. SNOWE. Mr. President, as a cosponsor of the Newborns and Mothers

[[Page S9913]]

Health Protection Act, I am extremely pleased to rise in support of 
this amendment to the VA/HUD appropriations bill. My colleague from New 
Jersey, Senator Bradley, has worked steadfastly and diligently for well 
over a year to bring this important bill to the floor, and I commend 
him for his tireless efforts. I share his concern over the growing 
practice of what has come to be known as drive-thru deliveries, and I 
believe that this practice of discharging new mothers and their infants 
too soon after delivery is simply unacceptable.
  This amendment requires health plans to provide coverage for a 
minimum hospital stay for a mother and her newborn infant following 
delivery, in accordance with established medical guidelines. These 
guidelines, developed in 1983 by the American College of Gynecologists 
and Obstetricians and the American Academy of Pediatrics, recommend 
that mothers remain in the hospital for 48 to 96 hours after giving 
birth, depending on the type of delivery. Shorter hospital stays are 
permitted if the physician, in consultation of the mother, determines 
that is the best course of action. For those mothers and newborns who 
leave the hospital after staying less than 48 or 96 hours, followup 
care within 72 hours of discharge must be provided in order to monitor 
both the mother and the infant during this vulnerable time.
  Since 1970, the average hospital stay for newborns has been cut 
almost exactly in half. Today, many insurers provide for only a 24-hour 
stay for deliveries, while some medical plans call for discharging 
women within 8 to 12 hours of a birth. Usually, women are not informed 
of these policies until they are already in the hospital. Many doctors 
who decide, based on their best medical judgment, that their patients 
should stay beyond the short time-frame are overruled by insurance 
companies. Others are unduly pressured to release these women and their 
babies prematurely.
  There are certain myths surrounding the impact of this bill, so I 
would like to clarify what this bill does not do. It does not 
mandate how long a mother and baby must stay in the hospital. It simply 
states that these patients may stay in the hospital up to the minimum 
period recommended by established medical guidelines. Insurers are 
permitted, and even encouraged, to develop alternatives to inpatient 
care, and to allow doctors, in consultation with their patients, to 
select the type of care which is most appropriate for a mother and her 
baby.

  I believe that this bill is one of the most important pieces of 
legislation this Congress has and will consider in the 104th Congress. 
To date, stories abound about women whose infants have suffered 
physical harm and even death as the result of early discharge policies. 
No woman or family should have to endure such tragedy.
  Often, doctors are not able to detect certain health problems in 
infants within the first 12 or 24 hours after birth. For example, 
doctors may be unable to detect jaundice--a disorder which may lead to 
permanent brain damage--within the first day after birth. Other infants 
have been released before their doctors had time to test them for PKU--
an easily treated metabolic disorder that causes mental retardation if 
not detected early enough.
  In addition, early discharge deprives mothers of important 
opportunities to learn how best to care for their infants, including 
proper breast feeding techniques. Problems with breast feeding can 
cause infants to suffer severe medical complications--even death--from 
dehydration. Hospitals report that increasing numbers of women and 
their children are returning for care after discovering problems such 
as life-threatening infections that could have been caught if the 
mother and child had been able to stay in the hospital just a little 
bit longer. While the financial costs of hospital readmissions 
resulting from early discharge can be astronomic, the human costs can 
be truly tragic.
  Twenty-eight States have passed maternity stay laws similar to this 
bill, including my home State of Maine. However, State legislation 
alone does not sufficiently protect the women of America and their 
newborns. For example, many women are not protected by State 
legislation because they work for employers with self-insured plans 
shielded by Federal ERISA preemption. In addition, women who live in 
one State and work in another may find themselves vulnerable without 
Federal legislation.
  Don't we owe it to the women of America and to our very youngest 
citizens--those who are only a few days old--to ensure that they enjoy 
the full protections and benefits of one of the best health care 
systems in the world?
  There is nothing more precious than the birth of a child. There is 
nothing more tragic than the death of an infant that could have been 
prevented. That is why we must leave it to doctors, not insurers, to 
decide how long women stay in the hospital following delivery in 
accordance with established medical guidelines. I urge my colleagues to 
join me in supporting this important amendment.
  Mr. FAIRCLOTH. Mr. President, I would like to comment briefly on the 
amendment offered by Senator Bradley, the Newborns' and Mothers' Health 
Protection Act.
  Supporters of this legislation contend that it is becoming a widely 
used cost-containment practice of health insurers to force the 
premature discharge of mothers and their newborns from the hospital 
following childbirth. In other words, insurance companies supposedly 
are improperly influencing doctors' medical decisions regarding the 
appropriate lengths of stay for mothers and newborns following 
childbirth. The remedy proposed in this amendment would require 
insurance companies to cover at least 48 hours of inpatient care 
following an uncomplicated vaginal delivery and 96 hours following a 
cesarean delivery.
  Mr. President, I certainly share the concerns which have been 
expressed in this debate regarding the health and safety of mothers and 
their newborn children. I am troubled, however, over the construction 
of this legislation. Not only would this amendment become the first 
Federal law to mandate health insurance benefits, it also comes 
dangerously close to being a statutory prescription for the practice of 
medicine.
  I believe that no one is more qualified than a woman's doctor to 
judge how long that woman and her newborn child should stay in the 
hospital following childbirth. Just as I believe that an insurance 
company has no business second guessing this decision, I firmly believe 
that the Government also has no prerogative to interfere.
  While I realize that this legislation does not require a woman and 
newborn to spend 48 hours in the hospital after childbirth; the 
construction of this amendment, and the specification of 48 and 96 
hours of coverage, strongly implies that these figures are some sort of 
legally significant standard for the length of stay.
  The sponsors of this legislation argue that legislation is necessary 
to ensure that mothers and newborns are assured an appropriate hospital 
stay following childbirth. Obviously, the appropriate length of stay 
will depend on each mother and child individually, and the attending 
doctor is the most qualified authority to make this decision. I am 
concerned that, according to this amendment's construction, the 
decision of the doctor is made an exception to the legislation's 48 and 
96 hour standards, rather than the rule.
  If it is necessary to pass legislation to assure the health and 
safety of mothers and newborns, then we should do it by protecting the 
authority of doctors to make medical decisions regarding their 
patients, free from interference from both insurance companies and the 
Government. We should not replace insurance company interference with 
Government interference.
  Mr. BRYAN. Mr. President, I am pleased to be a cosponsor of the 
Newborns' and Mothers' Health Protection Act of 1996 introduced by 
Senators Bill Bradley, Nancy Kassebaum, and Bill Frist.
  This bipartisan legislation--with the support of 52 Senate 
cosponsors--will help ensure that newborns and their mothers will have 
the best possible beginning.
  Unfortunately, a pattern has begun to develop throughout this country 
of pushing mothers and their newborns out of the hospital too quickly. 
Too often, some health insurance plans covering the costs of childbirth 
offer very limited benefits for post partum hospital stays.
  Sometimes the coverage is limited to as little as 24 hours, which in 
many

[[Page S9914]]

cases is not long enough to ensure that a mother and her infant remain 
healthy after their hospital discharge. Sometimes doctors have found 
that insurers refuse to agree to longer hospital stays, even when the 
doctor argues the mother and newborn need to remain in the hospital 
longer.
  It is the first couple of days following the birth of a child that 
are the most critical to ensure the long-term health of both the infant 
and mother. Many mothers have difficulty in learning how to properly 
breast feed, putting their infants at risk of inadequate nutrition in 
their first days of life. Likewise some mothers are just not physically 
capable of providing for a newborn's care needs within 24 hours of 
giving birth.
  Medically, many health problems experienced by newborns do not show 
up until after the first 24 hours of life. These include jaundice and 
dehydration, and other conditions that only health professionals can 
detect. Early hospital discharges can mean these conditions go 
undetected until it is too late.
  The length of a hospital stay is a question that should not be driven 
by the limitations of an insurance policy, but should be the joint 
medical decision of the mother and her physician.
  Under this bill, if both the mother and her doctor agree that a 
shorter post partum stay is acceptable, the stay can be shortened. 
However, in these situations--and this is the key distinction--the 
decision will still be a medical one, rather than a financial one.

  This bill will require all health care insurance plans, which offer 
maternity benefits, to cover post-partum stays of at least 48 hours 
after a vaginal birth, and at least 96 hours after a caesarean section. 
The bill's hospital stay requirements are consistent with post 
childbirth guidelines of the American College of Obstetricians and 
Gynecologists, and the American Academy of Pediatrics.
  This bill will end these drive-through baby deliveries, which push 
mothers and their newborns out of the hospital before they are 
medically ready to go home. Such drive-through deliveries put the 
health of both mothers and their babies at risk. A mother and her 
newborn's homecoming should be a time of celebration, not a time of 
trepidation because neither was ready to leave the hospital.
  In August, the Centers for Disease Control and Prevention released 
its study of New Jersey's maternity stay law. Following enactment of 
The State's law, the CDC found that new mothers who had problem free 
deliveries were the mothers who had stayed in the hospital 
approximately 10 to 12 hours longer than mothers had prior to the law. 
The CDC research appears to indicate that just a few hours longer in 
the hospital can result in major improvements in the health of both the 
mother and the newborn baby. The importance of those few more hours 
cannot be underestimated.
  Many managed care plans place the care of the mother and newborn 
infant at the forefront.
  But many other managed care plans appear to have put the bottomline 
of profitability ahead of the real medical needs of newborns and their 
mothers. Those managed care plans should view this bill as a heads up. 
Cutting medical costs will not be allowed to undermine the quality of 
health care.
  We all acknowledge the need for controlling health care costs, and 
support efforts to curtail unnecessary spending. But there also must be 
a reality check when cost cutting goes so far, that the quality of 
health care is endangered.
  We want every newborn child to have the best chance for long-term 
health. I urge my colleagues to join in supporting this legislation to 
give mothers and newborns the assurance that their health needs will 
always be paramount.
  Mrs. FEINSTEIN. Mr. President, I am pleased to support Senator 
Bradley's amendment to require health insurance plans to cover hospital 
maternity stays for 48 hours for routine deliveries and 96 hours for 
cesarean deliveries.
  The issue here in whether the decision on how long a mother and her 
newborn stay in the hospital is based on the mother's health or the 
insurance company's bottom line.
  I believe it is a medical decision that should be made by a doctor 
and a patient.
  Before 1970 the median length of stay in this country for routine 
deliveries was 4 to 5 days. By 1992, the median stay dropped to 2.1 
days.
  In 1991--the latest year for which figures are available--nearly 40 
percent of newborns in California were discharged in fewer than 24 
hours.
  And the problem seems to be even worse today.
  Some insurers limit coverage of postpartum hospital care to 1 day or 
12 hours.
  One large California HMO has reduced coverage to 8 hours.
  These are not generally doctors determining that it is in their 
patients' best interest to be discharged sooner. The reduction in 
hospital care is the result of insurance companies making that decision 
based on how much they want to pay--and the real cost is being borne by 
patients--mother and child--in greater health risks.
  There are many medical reasons why a longer hospital stay may be 
necessary. Some medical conditions do not manifest in 10 or 24 hours 
after delivery, such as jaundice, heart murmurs, circulatory 
disfunctions and fevers.
  Early discharges can also exacerbate medical problems:
  Studies presented to the Senate Labor Committee have shown that early 
release of infants can result in the baby having jaundice, feeding 
problems, respiratory difficulties, metabolic disorders and infections.
  In fact, a New Hampshire study of hospital readmission rates found 
that babies discharged at less than 2 days of age have a 70 percent 
increased risk of facing an emergency room visit.
  Early discharge not only increases health risks, in many cases, it is 
so much more costly.
  A Pasadena women and her 6-week premature infant were discharged 
after only 23 hours of delivery. The baby was readmitted to the 
hospital for jaundice and dehydration 2 days later, costing an extra 
$20,000--$1,000 that had to be paid by the family.
  Let me give some examples of the human impact of this problem:
  A Los Angeles woman was released 15 hours after giving birth because 
of limited insurance coverage. Two days later, her baby was 
hospitalized for malnutrition--the infant had difficulty with lactation 
and breast feeding.
  A San Francisco woman had to leave the hospital 23 hours after 
delivery against her doctor's advice, even though her baby was 5 weeks 
premature. The baby was in the emergency room less than 2 days later, 
and was readmitted to the hospital for dehydration and jaundice.
  Another California mother was discharged less than 14 hours after 
deliver. The next morning she was shaking, feverish, and nauseous. She 
was diagnosed as having a staph infection and was readmitted to the 
hospital for 4 days.
  Sometimes these stories have tragic endings.
  Leigh Fallon, of Petaluma, CA entered the hospital on July 25, 1994. 
After 2 days of labor with extraordinary complications, she had an 
emergency caesarean section.
  The mother had a high fever and great physical distress. Her baby boy 
developed jaundice, was being treated with antibiotics, and was 
diagnosed with a heart murmer.
  Still, under pressure from their insurance company, Leah and the baby 
were discharged 72 hours after birth. The baby was rushed to the 
hospital a few days later and did not survive emergency heart surgery.
  Perhaps nothing could have saved Leah's baby. But clearly, the 
decision to discharge such a fragile patient was made in the interest 
of saving money instead of saving a life.
  Medical decisions should be made by medical professionsals--not 
insurance companies. That is what they are trained to do.
  Twenty-nine States have enacted legislation or regulations to curb 
what's called drive-through deliveries. In California, the legislature 
failed to come to agreement on legislation at the close of the current 
session. California voters, instead, will face two ballot measures 
which include regulations on the subject this November.
  This is a national problem, and Congress must set a uniform standard 
in the interest of public health.
  I urge my colleagues to join me in voting for the newborns and 
mothers bill.

[[Page S9915]]

  Mr. BRADLEY. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mrs. KASSEBAUM. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. KASSEBAUM. Mr. President, as an original cosponsor of the 
legislation before us, I would like to say how pleased I am that we are 
ready now to vote on what I think is a very important and useful piece 
of legislation. I have been proud to work with Senator Bradley and 
Senator Frist, and I appreciate the efforts of those who have offered 
some very constructive improvements in the language that have helped to 
clarify some concerns that existed.
  I have visited maternity floors at a number of hospitals. I must tell 
you, I think this amendment will provide an increased sense of 
security, particularly to first-time mothers, who will now feel that 
they can remain in the hospital a bit longer if necessary. Some will 
ask, ``Why not even longer?'' Well, how do we know the correct length 
of stay in each situation? This should be decided on an individual 
basis. But we do know that even an additional 24 hours is going to make 
a difference. For some, it will make a big difference--where there is 
no family available to offer support when they come home and, 
particularly, as I mentioned, with first-time mothers, where there is 
uncertainty about what lies ahead. I say thank you to all who have 
spent a great deal of time and effort on this amendment. It is a very 
constructive and beneficial piece of legislation.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. HELMS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                             Change of Vote

  Mr. HELMS. Mr. President, it was called to my attention that last 
evening there must have been some confusion. I take responsibility for 
it. I don't know what happened. I was incorrectly identified as voting 
against the motion involved in vote No. 267.
  I ask unanimous consent that it be in order for me to have my vote 
recorded as voting in the affirmative in that instance instead of in 
the negative.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The PRESIDING OFFICER. I thank the Chair.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. FRIST. 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. FRIST. Mr. President, I ask unanimous consent that the vote on 
the Frist amendment No. 5193 occur at 5:35 p.m. today, and immediately 
following that vote, the Senate proceed to vote on or in relation to 
the Bradley first-degree amendment, as amended, if amended; further, 
that immediately following that vote, Senator Domenici be recognized to 
offer an amendment regarding mental health, which was previously listed 
as a Wellstone amendment, and that the preceding occur without any 
intervening action.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. FRIST. Mr. President, I ask for the yeas and nays on my 
amendment.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  Mr. BRADLEY addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Jersey is recognized.
  Mr. BRADLEY. Mr. President, I strongly support the amendment of the 
distinguished Senator; the amendment to my amendment. I hope we adopt 
it unanimously by a large, overwhelming vote, and hopefully we will be 
able to move forward. It is an amendment that would confirm that 
insurers have to allow 48 hours for delivery of a child by a mother in 
the hospital, 96 hours for cesarean section. The Senator's changes are 
merited and important. It is a pleasure to work with him. I look 
forward to the 5:35 hour so that we can vote. Maybe we can move sooner.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BRADLEY. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The hour of 5:35 having arrived, the question is on agreeing to the 
amendment of the Senator from Tennessee. On this question, the yeas and 
nays have been ordered, and the clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. NICKLES. I announce that the Senator from Oregon [Mr. Hatfield] 
and the Senator from Alaska [Mr. Murkowski] are necessarily absent.
  I further announce that, if present and voting, the Senator from 
Oregon [Mr. Hatfield] would vote ``yea.''
  The result was announced--yeas 98, nays 0, as follows:

                      [Rollcall Vote No. 272 Leg.]

                                YEAS--98

     Abraham
     Akaka
     Ashcroft
     Baucus
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Bradley
     Breaux
     Brown
     Bryan
     Bumpers
     Burns
     Byrd
     Campbell
     Chafee
     Coats
     Cochran
     Cohen
     Conrad
     Coverdell
     Craig
     D'Amato
     Daschle
     DeWine
     Dodd
     Domenici
     Dorgan
     Exon
     Faircloth
     Feingold
     Feinstein
     Ford
     Frahm
     Frist
     Glenn
     Gorton
     Graham
     Gramm
     Grams
     Grassley
     Gregg
     Harkin
     Hatch
     Heflin
     Helms
     Hollings
     Hutchison
     Inhofe
     Inouye
     Jeffords
     Johnston
     Kassebaum
     Kempthorne
     Kennedy
     Kerrey
     Kerry
     Kohl
     Kyl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lott
     Lugar
     Mack
     McCain
     McConnell
     Mikulski
     Moseley-Braun
     Moynihan
     Murray
     Nickles
     Nunn
     Pell
     Pressler
     Pryor
     Reid
     Robb
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Shelby
     Simon
     Simpson
     Smith
     Snowe
     Specter
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner
     Wellstone
     Wyden

                             NOT VOTING--2

     Hatfield
     Murkowski
       
  The amendment (No. 5193) was agreed to.


                     Amendment No. 5192, As Amended

  The PRESIDING OFFICER. The vote now occurs on the Bradley amendment 
as amended. The question is on agreeing to the amendment.
  The amendment (No. 5192), as amended, was agreed to.
  Mr. BRADLEY. Mr. President, I move to reconsider the vote.
  Mr. FORD. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.


                           Amendment No. 5194

  (Purpose: To provide health plan protections for individuals with a 
                            mental illness)

  The PRESIDING OFFICER. Under the previous order, the Senator from New 
Mexico is recognized to offer an amendment.
  The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, I just wanted to tell the Senators this 
is going to be the Domenici, Wellstone, et al., amendment that we have 
voted out here before on mental illness. I do not believe we are going 
to take more than 40 minutes on the entire amendment. We will ask for 
the yeas and nays. I would just like to make sure everybody understood 
that.
  Shortly, I am going to send to the desk an amendment on behalf of 
myself, Senator Wellstone, and a number of Senators who have asked to 
be cosponsors, including Senator Simpson, Conrad, Kennedy, Inouye, 
Reid, Dodd, Grassley, Kassebaum, Burns, Harkin, and Moynihan, and I 
send the amendment with the cosponsors to the desk and ask for its 
immediate consideration. I ask Senator Chafee be added, and Senators 
Hatfield and Dorgan also.
  The PRESIDING OFFICER (Mr. Bennett). The clerk will report.

[[Page S9916]]

  The assistant legislative clerk read as follows:

       The Senator from New Mexico [Mr. Domenici], for himself, 
     Mr. Wellstone, Mr. Simpson, Mr. Conrad, Mr. Kennedy, Mr. 
     Inouye, Mr. Reid, Mr. Dodd, Mr. Grassley, Mrs. Kassebaum, Mr. 
     Burns, Mr. Harkin, Mr. Moynihan, Mr. Chafee, Mr. Hatfield and 
     Mr. Dorgan, proposes an amendment numbered 5194.

  Mr. DOMENICI. 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:

       At the appropriate place, insert the following new title:
                    TITLE ____--MENTAL HEALTH PARITY

     SEC. ____01. SHORT TITLE.

       This title may be cited as the ``Mental Health Parity Act 
     of 1996''.

     SEC. ____02. PLAN PROTECTIONS FOR INDIVIDUALS WITH A MENTAL 
                   ILLNESS.

       (a) Permissible Coverage Limits Under a Group Health 
     Plan.--
       (1) Aggregate lifetime limits.--
       (A) In general.--With respect to a group health plan 
     offered by a health insurance issuer, that applies an 
     aggregate lifetime limit to plan payments for medical or 
     surgical services covered under the plan, if such plan also 
     provides a mental health benefit such plan shall--
       (i) include plan payments made for mental health services 
     under the plan in such aggregate lifetime limit; or
       (ii) establish a separate aggregate lifetime limit 
     applicable to plan payments for mental health services under 
     which the dollar amount of such limit (with respect to mental 
     health services) is equal to or greater than the dollar 
     amount of the aggregate lifetime limit on plan payments for 
     medical or surgical services.
       (B) No lifetime limit.--With respect to a group health plan 
     offered by a health insurance issuer, that does not apply an 
     aggregate lifetime limit to plan payments for medical or 
     surgical services covered under the plan, such plan may not 
     apply an aggregate lifetime limit to plan payments for mental 
     health services covered under the plan.
       (2) Annual limits.--
       (A) In general.--With respect to a group health plan 
     offered by a health insurance issuer, that applies an annual 
     limit to plan payments for medical or surgical services 
     covered under the plan, if such plan also provides a mental 
     health benefit such plan shall--
       (i) include plan payments made for mental health services 
     under the plan in such annual limit; or
       (ii) establish a separate annual limit applicable to plan 
     payments for mental health services under which the dollar 
     amount of such limit (with respect to mental health services) 
     is equal to or greater than the dollar amount of the annual 
     limit on plan payments for medical or surgical services.
       (B) No annual limit.--With respect to a group health plan 
     offered by a health insurance issuer, that does not apply an 
     annual limit to plan payments for medical or surgical 
     services covered under the plan, such plan may not apply an 
     annual limit to plan payments for mental health services 
     covered under the plan.
       (b) Rule of Construction.--
       (1) In general.--Nothing in this section shall be construed 
     as prohibiting a group health plan offered by a health 
     insurance issuer, from--
       (A) utilizing other forms of cost containment not 
     prohibited under subsection (a); or
       (B) applying requirements that make distinctions between 
     acute care and chronic care.
       (2) Nonapplicability.--This section shall not apply to--
       (A) substance abuse or chemical dependency benefits; or
       (B) health benefits or health plans paid for under title 
     XVIII or XIX of the Social Security Act.
       (3) State law.--Nothing in this section shall be construed 
     to preempt any State law that provides for greater parity 
     with respect to mental health benefits than that required 
     under this section.
       (c) Small Employer Exemption.--
       (1) In general.--This section shall not apply to plans 
     maintained by employers that employ less than 26 employees.
       (2) Application of certain rules in determination of 
     employer size.--For purposes of this subsection--
       (A) Application of aggregation rule for employers.--All 
     persons treated as a single employer under subsection (b), 
     (c), (m), or (o) of section 414 of the Internal Revenue Code 
     of 1986 shall be treated as 1 employer.
       (B) Employers not in existence in preceding year.--In the 
     case of an employer which was not in existence throughout the 
     preceding calendar year, the determination of whether such 
     employer is a small employer shall be based on the average 
     number of employees that it is reasonably expected such 
     employer will employ on business days in the current calendar 
     year.
       (C) Predecessors.--Any reference in this subsection to an 
     employer shall include a reference to any predecessor of such 
     employer.

     SEC. ____03. DEFINITIONS.

       For purposes of this title:
       (1) Group health plan.--
       (A) In general.--The term ``group health plan'' means an 
     employee welfare benefit plan (as defined in section 3(1) of 
     the Employee Retirement Income Security Act of 1974) to the 
     extent that the plan provides medical care (as defined in 
     paragraph (2)) and including items and services paid for as 
     medical care) to employees or their dependents (as defined 
     under the terms of the plan) directly or through insurance, 
     reimbursement, or otherwise.
       (B) Medical care.--The term ``medical care'' means amounts 
     paid for--
       (i) the diagnosis, cure, mitigation, treatment, or 
     prevention of disease, or amounts paid for the purpose of 
     affecting any structure or function of the body,
       (ii) amounts paid for transportation primarily for and 
     essential to medical care referred to in clause (i), and
       (iii) amounts paid for insurance covering medical care 
     referred to in clauses (i) and (ii).
       (2) Health insurance coverage.--The term ``health insurance 
     coverage'' means benefits consisting of medical care 
     (provided directly, through insurance or reimbursement, or 
     otherwise and including items and services paid for as 
     medical care) under any hospital or medical service policy or 
     certificate, hospital or medical service plan contract, or 
     health maintenance organization contract offered by a health 
     insurance issuer.
       (3) Health insurance issuer.--The term ``health insurance 
     issuer'' means an insurance company, insurance service, or 
     insurance organization (including a health maintenance 
     organization, as defined in paragraph (4)) which is licensed 
     to engage in the business of insurance in a State and which 
     is subject to State law which regulates insurance (within the 
     meaning of section 514(b)(2) of the Employee Retirement 
     Income Security Act of 1974), and includes a plan sponsor 
     described in section 3(16)(B) of the Employee Retirement 
     Income Security Act of 1974 in the case of a group health 
     plan which is an employee welfare benefit plan (as defined in 
     section 3(1) of such Act). Such term does not include a group 
     health plan.
       (4) Health maintenance organization.--The term ``health 
     maintenance organization'' means--
       (A) a federally qualified health maintenance organization 
     (as defined in section 1301(a) of the Public Health Service 
     Act),
       (B) an organization recognized under State law as a health 
     maintenance organization, or
       (C) a similar organization regulated under State law for 
     solvency in the same manner and to the same extent as such a 
     health maintenance organization.
       (5) State.--The term ``State'' means each of the several 
     States, the District of Columbia, Puerto Rico, the Virgin 
     Islands, Guam, American Samoa, and the Northern Mariana 
     Islands.

     SEC. 04. SUNSET.

       Sections 1 through 3 shall cease to be effective on 
     September 30, 2001.
       Sec. 05. Federal Employee Health Benefit Program. For the 
     Federal Employee Health Benefit Program, sections 1 through 3 
     will take effect on October 1, 1997.

  Mr. DOMENICI. Mr. President, first, I thank Senator Wellstone early 
on in the debate on this bill that is pending. He had the good sense to 
put the amendment in, and, thus, it became relevant under the 
unanimous-consent decree.
  I thank him for his generosity in permitting me to call up his 
amendment, which is commonly known as the Domenici-Wellstone amendment. 
I am not going to take a lot of time. The U.S. Senate has heard me 
argue this issue a number of times.
  I do believe in the 5 weeks that we have been gone--many of us at 
home--I think a lot of U.S. Senators and a lot of House Members have 
been approached in their respective States and districts with reference 
to the need to adopt this amendment and to make it part of the 
substantive law of this land.
  I am counting on that, because I believe the U.S. Senate will adopt 
it by a rather overwhelming margin. But I do want to say to those who 
wonder whether or not we are just offering an amendment again that has 
passed and then did not see the full rising Sun and the beauty of 
daylight as a piece of legislation because the House had denied it in 
conference, that we clearly intend for the U.S. House to take a very 
serious look at this, even though it is in a conference and they have 
already passed the HUD and independent agencies bill.
  I believe before this bill is finally conferenced that there will be 
many House Members on both sides of the aisle who will indicate their 
support. How we will go about doing that within the technical rules of 
the U.S. House, I am not prepared yet to discuss, but a number of House 
Members, both Republican and Democrat, want to help us get this 
amendment before the President as part of this appropriations bill.
  Having said that, let me make sure that Senators and that those out 
in the

[[Page S9917]]

audience, called America, whether it is families of severely mentally 
ill young people, or whether it is small businesses, or whether it is 
big businesses in the United States, this amendment is not the bill 
that passed that brought concern as to the cost to business. This is a 
very simple proposition.
  This bill, let me make it clear, does not mandate mental health 
services or determine charges. It does not require parity for 
copayments and deductibles. It does not require parity for inpatient 
hospital stays or outpatient limits.
  This amendment, as presented, does not cover substance abuse, and it 
does not cover chemical dependency. It excludes Medicare and Medicaid, 
to be handled separately in legislation with reference to those 
statutory benefits. It allows for managed care and mental health carve-
outs, does not apply to individual health coverage, and exempts small 
businesses with 25 or fewer employees.
  So I guess with that clearly understood, one might ask, what does it 
do? Essentially, this is a compromise to begin down the path of parity 
and nondiscrimination for the mentally ill people in this country who 
have health insurance. It does just two very fundamental things.
  The aggregate lifetime coverage on an insurance policy and the annual 
payment limits, Mr. President, must be the same for mental health 
coverage as for the physical health coverage.
  In simple terms, if heretofore you bought an insurance policy and it 
covered mental health, with whatever conditions are attached--normally 
down here well into the policy it would say the aggregate lifetime 
coverage is $50,000, and up here in the bolder print it might say the 
coverage for everybody in this policy, not otherwise provided for, is 
$1 million. So if you get sick from cancer or a heart condition or 
tuberculosis or, God forbid, any of the serious illnesses, the lifetime 
coverage is $1 million under that policy.

  But if you get schizophrenia when you are 16 or 18, which is within 
the age, between 17 and 32 or so, you might get that dread mental 
disease, this policy that I was just alluding to that is out there now 
would say mental health is covered, mental illness, but it would say 
for that one, you only get $50,000 worth of aggregate lifetime 
coverage.
  This Domenici-Wellstone amendment says that will not be legal 
anymore, for it says if you choose to write that policy or if you 
choose to buy coverage as a big company and you buy a $1 million 
aggregate coverage for your employees for their illnesses, then if you 
want to cover them for mental illness, you have to cover them lifetime 
for $1 million also.
  And if the annual payment limit, for those are common also --you may 
have a $1 million aggregate for your lifetime, but it may only cover 
$50,000 a year as the annual, or $100,000--it says that figure, too, 
for the annual limits has to be the same for the coverage provided for 
mentally ill people as for others with physical ailments covered in an 
insurance policy.
  Frankly, Mr. President, I say to my fellow Senators, from where we 
started, I will confess to everyone, this compromise truly--truly--
dramatically reduced our expectations and our hopes. But we understand. 
We have dramatically reduced the scope.
  We understand that the first bill that cleared the Senate with 68 
votes required the same exact coverage for the mentally ill as you 
provide for anyone else, for other illnesses. And we understand there 
was a concern about that in terms of how much it might cost. There was 
some concern expressed about what kind of treatment is treatment of the 
mentally ill. Is it just an ordinary visit to a psychiatrist because 
you have marital difficulties or because you have a very temporary kind 
of depression?
  So what we decided to do was to scale back our desire and our hope 
for parity for this very important part of the American population and 
say let us get started by eliminating the hoax that exists in many 
cases where mentally ill people think they have coverage, but when you 
look at the fine print, the aggregate lifetime coverage is so small as 
compared to the coverage for other illnesses that, in many cases, it is 
a shock to those who have a family member who comes down with manic 
depression or severe depression or schizophrenia or one of the bipolar 
illnesses.
  So we, to make it clear again, do not mandate the copayments. If you 
want to differentiate by having different copayments for mentally ill 
people and the coverage you provide, that is your privilege, that will 
be negotiated. That will be there in big companies as they work out how 
they are going to cover people. We do not mandate that parity to go 
down that far. We say just parity at the top, parity for the aggregate 
and parity for the aggregate annual.
  We are starting down a path of at least beginning to understand that 
there are indeed millions of Americans who have members of their family 
with these dread diseases. Believe you me, the stereotype of old as to 
how these happen, where they come from, are all out the window. They 
did not come because a mother mistreated a child. They did not get 
schizophrenia because somebody neglected them for 10 years. These are 
very, very serious illnesses of the brain. Someday we will tie those 
down into very, very understandable physical treatments with medicines 
and other things which are already making dramatic, dramatic progress 
for this part of our population.
  So we have a chance to just send a little ray of hope to the millions 
of American people, hundreds of thousands of families who have this 
kind of situation that heretofore your companies, if they are insuring 
you and your family through your employment, if they cover you for 
mental illness, then it will not be trivial coverage, it will not be a 
scaled-down coverage so insignificant that it hardly, hardly deserves 
being called coverage, because if you get schizophrenia or one of your 
children do or they get manic depression or they become seriously 
depressed where it becomes chronic for any period of time, anybody in 
this room knows those $50,000 lifetime limits do not cover it at all no 
more than they would cover for somebody who is desperately ill with 
cancer and needs 10 operations and chemotherapy and 6 months in the 
hospital. That $50,000 would be gone in 5 months or 3 months.
  So we get a little bit of what we call parity. And we move just a 
little bit further away from the rampant discrimination that besets 
coverage for the mentally ill men, women, teenagers, young people 
across this land.
  I repeat, when you vote for this tonight, many of you will have 
heard--many of the men and women in the Senate on their trips home and 
certainly many House Members in their districts will have heard from 
the Alliance for the Mentally Ill, thousands and thousands of their 
members. I have already run into two Senators who met their membership 
at home. And some were joking, I say to Senator Wellstone, because they 
seem to say your name right but they seem to say my name wrong. So they 
say you have to support that ``Dominichi''-Wellstone bill. But that is 
all right just so long as we all understand what it is.
  So Mr. President, at this point I am going to yield to Senator 
Wellstone. But I am wondering if we could get a time agreement to 
satisfy--we have a second-degree amendment being offered here. Before I 
agree to a time agreement, I want to see it. So I yield the floor.
  Mr. WELLSTONE addressed the Chair.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. Mr. President, I will be relatively brief because I 
know there are several other Senators who want to speak tonight. 
Senator Kennedy has spent many of his years as a Senator fighting on 
behalf of parity and fairness for people struggling with mental 
illness, and others.
  Mr. President, on April 18 of this year, 68 Senators voted for our 
amendment. This was really an amendment that said we ought to end the 
discrimination. There ought to be full parity for the treatment of 
mental illness in our country. I think what the Senate was saying--68 
Senators, which is really a significant vote--was that for too long the 
stigma of mental illness has kept many in need from seeking help and 
for too long it has prevented policymakers from providing the help. We 
heard from a number of Senators who spoke in very personal terms about 
their own families and their own experiences--Senator Conrad, Senator 
Simpson, and Senator Domenici.
  Mr. President, their testimony was eloquent and powerful. But in 
addition

[[Page S9918]]

I want to point out tonight that there are also very sound policy 
reasons for supporting this amendment. I will not describe our 
amendment. Senator Domenici has already done so. But I do want 
colleagues to know that it is just an incremental step forward, but a 
significant one.
  What we are saying is that when it comes to lifetime caps and annual 
caps, at least have parity there so that we do not have a situation 
where there is a million-dollar cap for someone who is struggling with 
cancer or heart disease and then you find out that if someone is 
struggling with mental illness all together it is a $40,000 cap or an 
annual cap of only $10,000.
  This amendment would really help many families in our country who 
right now, given the present arrangement, which is an arrangement of 
discrimination and stigma, just face economic catastrophe. People just 
go bankrupt. People go under all too often.
  So, Mr. President, this amendment is incremental. It is not full 
parity, but it would be an enormous step forward. As I said, it is not 
just the personal stories. Certainly I could talk about this tonight in 
very personal terms. We have done that already. But there are sound 
policy reasons. The MIT Sloan School of Management reported in 1995 
that clinical depression costs American business $28.8 billion in lost 
productivity and worker absenteeism.
  In addition, there are too many people in prison who should not be. 
There are too many children who could be doing well in school who do 
not do well. There are too many families under tremendous strain that 
do not need to be under so much strain. I mean, in many ways we talk so 
much about the importance of supporting families.
  If we could pass this amendment tonight with a huge vote, and then 
work hard and get the support in the House--and I think we will. 
Senator Domenici is right, so many families and so many people who have 
struggled with this have been active. One of the things that has 
changed through organizations like the National Alliance of the 
Mentally Ill and others is that people no longer will accept the idea 
that because they have to struggle with mental illness they are somehow 
women or men of less worth or less substance or less dignity. People 
are speaking up for themselves.
  I think if we get a really strong vote tonight--and I think we will--
I think you will see many of those families working hard with Members 
of the House and we will pass this. And we should, Mr. President. It 
would make an enormous difference.
  I said to my colleague, Senator Domenici, and I have said to other 
friends as well, that the only thing that troubled me that evening--I 
will never forget; I was very proud to be a part of this--was that at 
the very end the expectations of all of the people that had just risen, 
the hopes would just be dashed and people would end up just being 
devastated and discouraged and feel like it all was for naught.
  We did not make it on the insurance reform bill, but this is not just 
a symbolic exercise tonight. We are hoping to get a huge vote from 
Republicans and Democrats alike. I think we have the support for this. 
Then we are hoping that in conference committee this stays in and this 
becomes the law of the land. It is not full parity, it is just 
incremental, but what a difference it would make. What a difference it 
would make for families that are struggling with mental illness. Mr. 
President, what a difference it would make.
  I do not guess this is the most important reason, but what a 
difference it would make for all of the families that now are speaking 
for themselves and talking to Senators and talking to Representatives.
  I see Senator Conrad, and I talked about what the Senator said on the 
floor on April 18. I said I would never forget those words. I see he is 
here to speak. I do not want to cut into the time of others.
  However, I think it is only old data and old ideas that have kept us 
from covering mental health the same way we cover other real illnesses, 
whether they are acute or chronic. Congress should pass this. The 
Senate should pass this amendment. We should pass it by a huge margin. 
It is a necessary and affordable step toward ending the stigma and 
discrimination against Americans suffering from mental illness.
  Let me repeat one more time: This vote tonight, the larger the margin 
the better, will be a necessary and affordable step that we as Senators 
have taken toward ending the stigma of discrimination against Americans 
suffering from mental illness. Colleagues, Democrats and Republicans 
alike, to take that step is no small accomplishment.
  I yield the floor.
  Mr. KENNEDY. Mr. President, I ask unanimous consent that Sarah 
Vogelsberg, a fellow in my office, be given the privilege of the floor 
during the consideration of this amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KENNEDY. Mr. President, few forms of discrimination are crueler, 
more counterproductive, and more widespread than those inflicted on the 
mentally ill and their families. Lack of adequate insurance coverage 
for the severely mentally ill is a major factor leading to 
homelessness--and hopelessness. Illness is a tragedy for any family. 
Mental illness is a triple tragedy because the inevitable strain of 
coping with the illness is compounded by the unfair stigma associated 
with the illness and the lack of adequate insurance coverage to make 
treatment affordable.
  Five million Americans suffer from serious mental illnesses every 
year. Few Americans do not have a family member, a friend, or a 
coworker, who has been touched by these tragic illnesses.
  The financial burden of serious illness can be crushing, whether the 
illness is mental or physical, whether schizophrenia, heart disease, or 
cancer. For the majority of Americans, health insurance provides 
protection against the cost of treating heart disease, cancer, or other 
physical diseases, but this protection is shamefully less available for 
mental illnesses. There is no discrimination in insurance coverage 
against victims of heart disease or cancer, but there is vast 
discrimination against those afflicted with mental illness, and it is 
time for Congress to end it.
  Every year, one in five Americans is afflicted by severe mental 
illness. Even mental illnesses that are less severe in the sense they 
are not chronic or do not have a clear biological basis can be 
devastating to individuals and families. Transient depression can lead 
to suicide. Mental health problems can result in divorce, child abuse, 
job loss, failure in school, delinquency, and substance abuse. The 
health costs of treating severe mental illness is $27 billion a year. 
The total cost of treating all mental illness is $70 billion a year.
  Even these figures are far from reflecting the true cost of mental 
illness because such illnesses are often inappropriately treated in the 
health care system at a high cost with poor outcomes. It is estimated 
that adequate treatment for mental illness would save 10 percent of 
overall medical costs.

  And these are only the direct costs. The indirect costs of severe 
mental illness--lost productivity, disability, and premature death--
exceed $40 billion a year, and the indirect costs of all mental 
illnesses are far higher than that.
  Mental illness is treatable and often curable. And treatments are 
becoming more effective every year. In fact, treatment for even very 
severe mental disorders is more effective than angioplasty, one of the 
most common treatments for heart disease.
  Yet, insurance discrimination against mental illness is rampant, 
despite the fact that mental illness can be as devastating as any 
physical illness, despite the fact that good mental health care can 
actually save money, despite the heavy burden that mental illness 
places on millions of Americans and their families. Only about 11 
percent of all employer-sponsored health plans cover treatment of 
mental illness as generously as treatment of other illnesses. Two-
thirds of such plans place dollar limits on outpatient treatment. 
Eighty percent have more restrictive hospital coverage for mental 
illness.
  Senator Domenici and Senator Wellstone offered a landmark amendment 
to end this injustice when the Kassebaum-Kennedy health insurance bill 
was considered by the Senate. Their full parity role made sense.
  Five States have already adopted comparable laws. None has 
experienced

[[Page S9919]]

significant cost increases as a result. If it works for Maryland, 
Minnesota, Maine, Rhode Island, and New Hampshire, it can work for the 
rest of the country.
  Here is what the Governor of New Hampshire said:

       In the 2 years since I signed this bill, this has proven to 
     be an affordable and effective piece of legislation. . . I 
     urge you to pass similar health reform legislation on the 
     national level.

  The Governor of Minnesota said:

       Since the enactment of [our] law, there has not been a 
     significant cost increase . . . I encourage you to support 
     the Domenici-Wellstone amendment.

  The Governor of Maine said:

       Our experience with serious mental illness has indicated 
     that providing responsive and supportive coverage upfront . . 
     . is not only the proper public policy, but also has positive 
     economic impact with very little upfront costs for our State.

  The Domenici-Wellstone amendment, as has been pointed out, was 
approved by the Senate by an overwhelming 68-30 bipartisan vote. 
President Bill Clinton urged that it be enacted into law. 
Unfortunately, it was dropped in the House-Senate conference because of 
the opposition of our House Republican conferees.
  Now on this bill we have another chance to do the right thing. The 
pending amendment is a compromise--a worthwhile downpayment on this 
basic issue. Under the amendment, the annual dollar limit and lifetime 
dollar limit for mental health services covered by insurance could not 
be less than the limits set for other health services.
  The amendment does not address many other special limits often 
imposed on mental health services, such as higher copayments, limits on 
outpatient visits, or limits on hospital days. Like the original 
amendment, it does not limit in any way legitimate cost containment 
steps to assure that care is necessary and effective.
  The cost of this amendment is minimal. At most, it may lead to a rise 
of four-tenths of 1 percent in health insurance premiums, according to 
the Congressional Budget Office. Other analyses estimate the costs may 
even be lower. And none of these cost estimates take into account the 
savings that better mental health care will provide.
  Opponents contend this proposal is an unjustified interference with 
the rights of employers. We heard the same objections to the minimum 
wage, to laws outlawing racial discrimination in employment, to the 
Americans With Disabilities Act, and to child labor laws. The opponents 
were wrong then, and they are wrong now.
  Americans with mental illnesses and their families deserve a simple 
justice from employers, from the health insurance industry, and from 
their Government. This is the Congress that can begin to show the 
common sense, the compassion, and the basic fairness that the mentally 
ill and their families deserve. I urge the Senate to adopt this 
amendment.
  I join in paying tribute to my two colleagues and friends, Senator 
Domenici and Senator Wellstone for their efforts. They have fought long 
and hard to make this amendment a reality. Every family that will ever 
have a loved one who will need mental health care is in their debt. I 
also want to mention Tipper Gore, the Vice-President's wife, who has 
done so much to increase understanding of the need to improve mental 
health coverage and has worked so hard for mental health parity. 
Finally, President Clinton's untiring efforts in this cause deserve 
special commendation.
  I urge the Senate to adopt this amendment--and I urge the Senate 
conferees to hold firm this time, so that the House extremists will 
fail, and that this long overdue measure will go to the President for 
signature.
  This amendment has a special meaning for me and my family. In 1963, 
the first Presidential message on mental illness in history was sent to 
the Congress by President Kennedy. This message resulted in the passage 
of the first program to establish community mental health centers and 
provide community-based services for the mentally ill. And I am proud 
that, as chairman of the Committee on Labor and Human Resources, I had 
the opportunity to send to the full Senate President Clinton's Health 
Security Program, providing for full parity and comprehensive coverage 
of mental health services for every American. I believe the day will 
yet come when we will enact a program that assures the basic human 
right to health care for every American, whatever their wealth--and 
whatever their illness.
  Mr. President, this Senate owes a great sense of appreciation to our 
two colleagues for fighting for this modest but enormously significant 
and most important program. I hope it will be carried by an 
overwhelming margin.
  Mr. CONRAD addressed the Chair.
  The PRESIDING OFFICER. The Senator from North Dakota is recognized.
  Mr. CONRAD. Mr. President, I want to join my colleague, Senator 
Kennedy, in commending Senator Domenici and Senator Wellstone for 
offering this amendment.
  The Senate has concerned itself with this issue several times in the 
past. Previously, when Senator Domenici and Senator Wellstone offered 
this amendment--a much broader amendment than this one--we got 68 votes 
on the floor of the U.S. Senate. In the reconciliation bill, I had this 
passed in the Finance Committee, and it passed on the floor of the 
Senate on reconciliation. So the Senate has considered a much broader 
version of mental health parity than we are considering tonight. This 
only relates to parity on lifetime and annual caps for mental illness. 
It is a small part of the parity provision that previously passed with 
an overwhelming vote on the floor of the U.S. Senate.
  Now, Mr. President, this is a beginning. It is an important 
beginning, and we ought to make the start. It is the right thing to do. 
We ought to treat a mental illness in the same way that we treat a 
physical illness.
  Mr. President, the last time I spoke on this matter before my 
colleagues, I talked about an experience I had when I was the assistant 
tax commissioner in the State of North Dakota. We had a receptionist 
who was struck by a mental illness. I recounted her case. I don't want 
to take the time of my colleagues tonight to repeat the specifics of 
that matter, but I will simply say that she was a young, vibrant woman, 
who one day was healthy--perfectly healthy, radiantly healthy--and the 
next day she thought the pictures on the walls were talking to her. Her 
life was badly damaged. In fact, she ultimately tried to take her own 
life.

  Mr. President, it was in dealing with that case that I learned that, 
in this country, insurance policies frequently discriminate against 
those with mental illness. And it is a very serious matter, this matter 
of discrimination, because if you are so unfortunate as to have a loved 
one or a family member or, God forbid, you yourself are stricken, you 
will quickly find out that the coverage in most policies is 
dramatically different for a mental illness than a physical illness.
  For example, annual caps, typically, for mental illness are $10,000 a 
year. For physical illness they are $100,000 or $250,000 a year, which 
is a dramatic difference. Believe me, if you are part of a family that 
has this awful thing happen to you, and you are up against those kinds 
of limits, you will find out very quickly that this can drain your 
family's finances. This can be devastating, not only in terms of the 
personal tragedy, but in terms of the financial tragedy that follows, 
as well.
  Mr. President, this is a modest proposal. According to CBO, on 
average, this would increase health insurance premiums by .16 percent, 
not 16 percent, not 1.6 percent, but .16 percent.
  Mr. President, this is the right thing to do. We ought to take this 
step. I hope my colleagues will join in on a bipartisan basis in 
passing the Domenici-Wellstone amendment. I thank the Chair and yield 
the floor.
  Mr. SIMPSON. Mr. President, I am very proud to be a cosponsor of the 
Domenici-Wellstone amendment, which provides for just a small measure 
of mental health ``parity.'' I am also a cosponsor of the freestanding 
bill, S. 2031, the Mental Health Parity Act of 1996, which was 
introduced on August 2. I am--and will remain--deeply committed to this 
cause. I sincerely believe that the manner in which we address this 
singular issue will speak volumes about the true nature of the 104th 
Congress.
  I want to emphasize as clearly as I can that this amendment does not 
ask

[[Page S9920]]

for anything grand or far reaching. It would merely require health 
plans to provide parity with respect to lifetime caps and annual 
payment limits. In other words, if an existing health plan has a 
lifetime cap or an annual limit on what it will spend for medical or 
surgical services, that plan must either include services for mental 
illness in that total or have a separate ceiling for mental illnesses 
that is no more restrictive than the ceiling for medical and surgical 
services.
  This very limited proposal would apply only in these two areas--for 
lifetime caps and for annual payment limits. It would not require 
``parity'' for copayments or deductibles or any other aspects of health 
coverage.
  Considering that the Senate has previously voted--on April 18, by a 
margin of 68 to 30--for an amendment that would have required a much 
more sweeping version of mental health ``parity,'' it surely seems to 
me that the pending amendment--which is so very limited in scope--
should pass by an even larger vote. I would look forward to that.
  But those of us who have been involved in this cause have learned not 
to take a thing for granted. Even if we are to win this vote, we know 
that we will confront myriad further roadblocks as this measure works 
its way though the legislative process in the remaining weeks of this 
session.
  I still have a bit of a hollow feeling about our failure to include 
this reasonable compromise in the health insurance reform bill. In a 
bill that was so packed full of ``mandates''--which is exactly what the 
health insurance bill consisted of--somehow this mental health 
provision was singled out as some terrible mandate that would ``cost 
too much.''
  As much as I don't want to believe this, my gut instincts tell me 
that this outcome most surely had something to do with discrimination 
against the mentally ill. This Congress should not make this mistake a 
second time. I urge my colleagues to support the pending amendment.
  Mr. BROWN addressed the Chair.
  The PRESIDING OFFICER. The Senator from Colorado is recognized.
  Mr. BROWN. Mr. President, I rise with a heavy heart to address this 
subject. I say heavy heart because no one could fail to be moved by the 
very eloquent statements that the distinguished Senator from New Mexico 
has made on this floor concerning this problem, both now and in the 
past. He has brought to light the problem that, I think, affects many 
Americans and has focused our attention on a very difficult aspect of 
the current health care policy.
  On the major tenet that suggests that there are differences in 
coverage in this area, I must say, the Senator is exactly right. That 
certainly conforms with my understanding. There are differences in 
coverage with regard to mental health. He has eloquently put the case 
that many of the citizens who suffer from these infirmities suffer 
tremendous consequences because of the lack of insurance coverage in 
that area. I think he has done an excellent job in articulating the 
difficulties visited upon their families, not only because of the 
illness, but because of the nuances in the insurance policies.
  Why would one rise to voice concerns? It is simply this, Mr. 
President. As this body requires coverage, or in this case sets 
limitations, fixes limitations, what we also do is not only help people 
out who are on the receiving end, but we establish the precedent that 
it is for the Government to decide what kind of coverage you purchase, 
not the person who is paying for it.
  Mr. President, let us be very specific. If this amendment passes, 
consumers will be denied the right to pick the terms of coverage, or 
negotiate the terms of coverage they wish with an insurance company. We 
will have had the Government make that decision and not the consumers. 
Now, I put it to Senators that it is important for consumers to have 
choices. I must say that I think it is commendable that the Senators' 
underlying amendment does not mandate the mental health coverage. It 
still leaves that open. I do hear--and I think he and others have 
acknowledged it--that it may have a tendency to have people drop mental 
health coverage from their policies, if this passes in its present 
form.
  What we do if we pass this is say that consumers are no longer 
allowed to make a choice as to the limitations on the mental health 
coverage that they purchase. What we are saying is, you are going to 
have to buy a policy that will conform with these guidelines, even 
though you don't want to. Now, Mr. President, I believe that consumers 
ought to retain that choice. I believe it is fair to require people to 
offer coverage, with the commensurate costs that it may involve, but I 
don't think it is appropriate for us to take that decision away from 
consumers. Thus, Mr. President, I do rise with an amendment that I 
think clarifies the issue.


                Amendment No. 5195 To Amendment No. 5194

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

       The Senator from Colorado [Mr. Brown] proposes an amendment 
     numbered 5195 to amendment No. 5194.
       At the appropriate place in the amendment, insert the 
     following:
       Notwithstanding the provisions of this title, consumers 
     shall retain the freedoms to choose a group health plan with 
     coverage limitations of their choice, even if such coverage 
     limitations for mental health services are inconsistent with 
     section 2 of this title.

  Mr. BROWN. Mr. President, the amendment is very simple and it is very 
direct. It simply retains the matter of choice in the consumer. If you 
think the consumer ought to be able to purchase the protection that 
they wish, you will want to vote for this amendment because it makes it 
clear that consumers can end up making that choice themselves. If you 
wish to deny the consumer the right to purchase the coverage that they 
prefer, you will want to vote against the amendment.
  Mr. President, I think underlying this is a very important principle. 
Should we force people to buy coverage they do not want to buy? There 
are good arguments on both sides, incidentally. I will certainly 
concede that. I will concede that the case the distinguished Senator 
from New Mexico brings for his amendment is one of the most heart-
rending and eloquent presentations I have ever listened to.
  So, Mr. President, I also believe it is important in this land of 
freedom to retain freedom of choice for consumers. Thus, I offer my 
amendment here on the floor.
  Mr. DOMENICI. Mr. President, I do not know if there are any other 
Senators who want to speak in behalf of the Domenici-Wellstone, et al., 
amendment. I understand the Chair would like to speak. I will 
personally relieve him shortly so he can speak. But let me make a 
comment about the Brown amendment, after which I will move to table it 
once Senators who want to speak have had an opportunity to do so.
  Let me just make a case here. Fellow Senators, we just passed a 
Kassebaum-Kennedy health reform bill. What did we say in it with 
reference to preexisting conditions? We said insurance companies can no 
longer deny coverage because of preexisting conditions. We could have 
had a distinguished Senator like the Senator from Colorado--and he is 
distinguished--come to the floor and say, ``But we ought to have the 
consumers retain the right to choose.'' So we could offer an amendment 
here that would have said it. But we need to protect the consumers' 
choice.
  So we are saying you have to do this; you have to cover the 
preexisting conditions, but the consumer ought to have the choice, and 
he ought to be able to opt out. You see what that did. Nobody dared do 
it--not even my distinguished friend from Colorado--because that 
produced what we all call cherry picking. It permits people to offer 
coverage at the lowest possible rate denying coverage to many, many 
people and leaving those to somebody else.
  I cited here on the floor where cherry picking came from. I thought 
it came from the basketball player where, when the fellow didn't want 
to get into the game of getting rebounds, he stood out on the side over 
there and let the other people do all the work. And he would run down, 
and they throw him the ball, and he would get to cherry pick the 
basket.
  What the Senator is doing here in this amendment, which sounds great, 
is he is taking a provision that we are offering that says simply the 
following:

[[Page S9921]]

 If an insurance company chooses to cover mental health--let me repeat; 
if they choose to cover mental health. Implicitly they do not have to 
cover mental health. I would assume they will offer policies without 
coverage for mental health. I assume that exists today. It will exist 
tomorrow. It will exist a year from now if this becomes law. Companies 
will offer policies with no mental health coverage, and that is 
available for those consumers who want to choose that. But it will also 
offer mental health coverage. All we are saying is, if you choose to 
offer that coverage, then you must offer two things--only two things: 
The annual amount to be paid for the illness and treatment must be the 
same for physical as for severe or mental illness. You can't have two 
different annual payments. As to the lifetime aggregate coverage, you 
cannot have two different ones, if you cover mental health.

  So, in a sense, I say to my fellow Senators, this choice is already 
provided for because insurance companies are going to provide ample 
choice. They are going to say we are not covering mental health. Would 
you like to buy that kind of policy? We are only saying if they choose 
to cover mental health that these two characteristics, qualities, must 
be present.
  If the Senator chooses to say, for those companies that choose to 
write insurance policies that have mental health and, therefore, have 
this kind of coverage, people ought to be able to say, ``I opt out of a 
portion of it.'' Then I submit we are right back where we started where 
we do not have coverage for the mentally ill because people who do not 
have any problems will opt out of it, and there will not be coverage 
under even those cases where policies have it expressly because the 
decision has been made--because the decision has been made--to include 
it.
  So from my standpoint, I will very soon move to table this. I say to 
everyone that I think, if it were adopted and implemented literally, I 
believe we will have done away with the kind of coverage we seek to 
provide within the confines of a policy that the offset chooses--
coverage for mental illness.
  I yield the floor.
  Mr. WELLSTONE addressed the Chair.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. Very briefly, I say openly that I could go through in 
a kind of logical way all of the specifics of it. But I believe the 
amendment of my good friend from Colorado guts this amendment in the 
second degree. I think what he most objects to is the idea of any kind 
of standard. We just voted on a standard. That is what we just did. 
That is the vote we just took. It was 98 votes where we said, ``Look, 
when it comes to the whole issue of the mother-child, we want to make 
sure there is at least a 48-hour period of time.'' That is what we just 
did. We are now saying in a very incremental way that when it comes to 
the mental health area we ought to deal with this discrimination and we 
ought to make sure that, at least with the lifetime or annual caps, you 
have some parity. If you begin to say, ``I am all for the plans, but I 
do not want to have a situation where in fact there has to be in mental 
health coverage an equality with caps,'' then you move away from the 
whole strength of this.
  So this is the opposite of the perfecting amendment. This amendment 
guts this legislation. I hope that it will be defeated resoundingly.
  Mr. BROWN addressed the Chair.
  The PRESIDING OFFICER (Mr. Domenici). The Senator from Colorado.
  Mr. BROWN. Mr. President, if I could, I would like to address the 
comments of the two previous speakers.
  With all respect to my good friend from Minnesota, let me suggest 
that the vote we just had, at least in my view, is not quite the same 
as he implied. The record vote we just had was on the Frist amendment 
that perfected the Bradley amendment. I voted for that because it did 
improve the Bradley amendment. I certainly would confess to the Senator 
with regard to the underlying Bradley amendment that there are 
significant similarities, and I think he makes a valid point there. One 
difference, I might point out, is the cost differential for that very 
modest step, first, I might say, which is something that I hope would 
be in all policies, which is dramatically different than what I believe 
the cost impact with regard to the mental health coverage is.

  Second, Mr. President, with regard to the statement of the 
distinguished Senator from New Mexico with regard to his point in 
regard to choice being still present, if his amendment passes, I think 
that is a valid point if either choice is retained. Unfortunately, the 
choice, though, as to whether or not you have any mental coverage, if 
you do not want to go with the higher limit, you have to drop all 
coverage, this amendment would make it clear that you retain the choice 
as to the level of coverage. I think that is the crux of it.
  Why is that significant? It may be possible to afford 10,000 dollars' 
worth of coverage, or 100,000 dollars' worth of coverage, or 1 million 
dollars' worth of coverage. But it may not be possible to pay for $10 
million of coverage. Does that mean, if you can't go with the higher 
level, that you are not allowed to have any choice at all? Unless the 
Brown amendment passes, the second-degree amendment, that is exactly 
what it means. If the Brown amendment passes, it means that you are 
allowed to have choices as to the coverage levels you may wish for 
mental health.
  It seems to me that is fundamentally a question of choice and an 
important part of it. And it is vital for our consumers to retain that 
option.
  I yield the floor.
  Mr. BENNETT addressed the Chair.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. BENNETT. I have listened to this debate with great interest. I 
find myself philosophically agreeing with the Senator from Colorado 
about the issue of choice, but I intend to oppose his amendment because 
it ignores the reality of our current health care structure and raises 
an issue that I have raised before and will raise again and again and 
again as we deal with the health care circumstance.
  He uses in his amendment the word ``consumers.'' The fact is that 
consumers do not buy health insurance. Individual consumers do not buy 
health insurance except in very rare cases. Companies buy health 
insurance. Employers buy health insurance.
  In my view, that is one of the main things that is wrong with our 
health care system, that individual consumers are not allowed choice. 
We are forced to take whatever our employers decide to choose on our 
behalf.
  I have said on this floor before I had a better health care plan 
before I came to the Senate than I have now. Why? Because the employer 
for whom I worked did a better job from my point of view than the U.S. 
Government does in choosing plans. If I were an individual consumer 
buying health care the way I buy an automobile, I would have chosen to 
bring that health care plan with me when I came from one employer to 
the other employer. But because of the way our health care system is 
structured, we are not allowed to do that. We, as individual consumers, 
are not allowed to make those kinds of choices. So let us understand 
that when the Senator from Colorado talks about consumers making 
choices, he is using the language of the marketplace that simply does 
not apply in health care.
  We had a long battle on this floor for many weeks over the idea of 
allowing individuals to set up savings accounts from which they could 
purchase health services. We finally had a compromise saying that we 
would only allow 750,000 people to do that. If we cannot find a more 
dramatic statement than that fact that underlies that consumers, that 
is, individuals, are not allowed to make these kinds of decisions, then 
I do not know where we would find a more dramatic statement.
  I would like in coming Congresses to restructure the system around 
medical savings accounts and around consumer choice. I think that is 
the ultimate solution, and if we get to that point, then I think we can 
consider the amendment of the Senator from Colorado. But when we are 
stuck with the circumstance we are stuck with now where decisions are 
made by somebody other than individuals, I think the amendment of the 
Senator from New Mexico is an appropriate one, and I intend to oppose 
the second-degree amendment and support the amendment of the Senator 
from New Mexico.

[[Page S9922]]

  Mr. BROWN. Will the Senator yield for a question?
  Mr. BENNETT. I would be happy to yield for a question.
  Mr. BROWN. It is my understanding the Senator has favored letting 
employers give employees choices. Would I be fair and accurate in 
saying that, if the Domenici amendment passes, it would preclude 
employers offering, making available to their employees a choice as to 
the various levels of mental health coverage if they differ?
  Mr. BENNETT. It is my understanding, in response to the Senator's 
question, that an employer would not be precluded from offering 
whatever he wanted. From my own experience as an employer, let me 
describe to the Senator what we offered to our employees. Under the 
cafeteria plan proposal, we say to our employees that we have x number 
of benefit dollars. You tell us how you want us to spend them on your 
behalf. And under a cafeteria plan approach--a 125(c) plan, I think it 
is described in the Tax Code--an employer could say, here is a mental 
health care plan of x amount of coverage. Here is a mental health care 
plan of y amount of coverage. Here is a mental health care plan of z 
amount of coverage. And here is a physical health care plan of x amount 
of coverage, and you get to pick.
  The employee under those circumstances could say, ``I want $10,000 of 
coverage in mental health care under this plan, and as a second option, 
I want a plan that has $1 million worth of physical coverage.''
  Yes, I get, in effect, the same thing the Senator is talking about, 
but I have to buy two plans to do it and there is nothing in the 
current law or nothing in the Domenici-Wellstone amendment that would 
prevent an employer from offering that kind of circumstance.
  Mr. BROWN. To follow up, if I may, my understanding of the reading of 
the Domenici amendment is that he does exempt from these limitations 
restrictions to small employers. That, I think, is a commendable aspect 
of his amendment. But I do not see an amendment that provides the 
exemption that the Senator just talked about. As a matter of fact, the 
way I read the amendment--and perhaps the Senator will want to clarify 
it or set me straight on it--the way I read it, it says precisely that 
you cannot do what the Senator describes, that you cannot have a plan 
that has $1 million for physical coverage and $100,000 for mental 
health coverage.
  Mr. BENNETT. You cannot have a single plan that has that 
discrimination, but if under a 125(c) cafeteria plan you say we are 
going to offer separate plans and you buy both, you could get that 
effect if the employee made that kind of choice.
  Mr. BROWN. I appreciate the Senator making that point. I think it is 
a very important point, that you do retain that option at least in the 
cafeteria plan.
  Mr. BENNETT. That is right. An employer who does not have a cafeteria 
plan would not face that option. But if by passage of this we encourage 
employers to move to a 125(c) plan, a cafeteria plan, I think that is 
all to the good. My underlying point is that the consumer does not make 
these choices, which I think is wrong and needs to be changed at some 
point when we restructure our health care system.
  Mr. BROWN. If the Senator would permit me another.
  Mr. BENNETT. Surely.
  Mr. BROWN. It is this Senator's view that the option that the Senator 
just described for the employer about the cafeteria plan, which I think 
is an important option, is the option that ought to be preserved for 
other consumers who do not fit in the small employer option.
  Mr. BENNETT. I agree with the Senator, but I do not think this 
legislation is the place in which to do it.
  Mr. GRAMM addressed the Chair.
  The PRESIDING OFFICER (Mr. Bennett). The Senator from Texas.
  Mr. GRAMM. Mr. President, what we have before us is a very bad 
amendment with very good intentions. What this amendment in essence is 
saying is that we in the Senate know better than employers and workers 
what kind of health insurance coverage they need.
  This amendment overrides the decision making of those workers who are 
affected by this amendment, and a very large portion of the population 
of the country will be affected.
  We are going to say to them that we know better. You may think that 
you want different limits for traditional physical health insurance 
than mental health coverage, but we know better than you and are going 
to make you buy the coverage with increased mental health limits. The 
incredible paradox is that the only way you can escape this is to drop 
mental health coverage altogether.
  This is an unfunded mandate. If we had a proposal before us tonight 
to raise taxes to provide this benefit, I doubt it would get 30 votes. 
But what we have is a proposal tonight where ``Big Brother'' Congress, 
know-it-all Congress, perfect-insight Congress, is going to say that 
even if you are a young worker and are having trouble buying health 
insurance and remaining competitive in the job market, we are going to 
force you to balloon your mental health coverage, as commendable as 
that might be.
  How wonderful it would be if everybody in America could afford this 
coverage. But what we are saying is, if you have any mental coverage in 
your plan, we are going to make you pay for a coverage limit up to the 
amount you have for traditional physical ailments. In the process we 
are going to drive up the cost of health insurance. We are going to 
reduce the choices that people have. The Senator from Colorado is 
saying if you want to mandate that insurance companies offer the 
coverage, then do it, but do not make people buy it if they do not want 
it.
  I would like to remind my colleagues--none of whom are having 
difficulty buying health insurance--that even though this may sound 
great from our point of view, the problem with private health insurance 
is young working couples are having trouble paying for the health 
insurance they have. And, to the extent that this bill drives up the 
cost of hiring people, it will cost people their jobs, it will force 
companies who cannot afford to provide this benefit to eliminate all 
mental health coverage, and it will force working families to do 
without, because every penny that goes towards health insurance comes 
right out of the pocket of the worker. Every economic study done, 
including studies by the administration, count fringe benefits as part 
of the wage package. What we are doing to young couples who are trying 
to make ends meet, who want health insurance in case Johnny falls down 
the steps, is saying that you are going to have to pay for this 
extensive mental health coverage whether you want it or not. This 
amendment says that Congress supposedly knows what is better for you 
than you yourself do--it assumes that Congress is capable of making 
better decisions.

  I totally and absolutely reject this. We adopted an amendment similar 
to this, but we adopted it when the majority leader, Senator Dole, made 
it clear that we were never going to see it emerge from conference--yet 
we ended up in conference with serious negotiations about really doing 
this.
  I, frankly, think it is outrageous that, on an appropriations bill, 
we are getting ready to mandate that working people and businesses 
provide a benefit, whether they want it or not; that they pay for it, 
whether they want it or not; and we are doing exactly what the American 
people are continually outraged about: injecting our value judgments 
over theirs. We are saying that we know better than you know--that you 
really need this expanded mental health coverage, even if you do not 
want it and even if you can not afford it.
  The point is, mental health care may be a wonderful thing. If we 
could snap our fingers and have everybody in America covered, it would 
be great. The truth, however, is that we cannot. This is expensive 
coverage. It is not an accident that private health insurance policies 
normally have differentials. In fact, in many cases, people do not have 
mental health coverage.
  We have not had a tremendous amount of experience with mental health 
coverage under a third party payment system, where the insurance 
company is paying for it. I know we can get into a lengthy debate about 
experience of various States. I have seen estimates as high as 15-
percent increase, if you force people to pay for mental care for 
alcohol and drug rehabilitation. I do not know how to pull

[[Page S9923]]

that apart. But the point is, whatever the costs, how dare we, in the 
freest society in the history of the world, attempt to play God by 
telling people what kind of health insurance they must have.
  I think the amendment that has been offered by the Senator from New 
Mexico is perfectly reasonable--more than reasonable. It simply says to 
insurance companies: You do not really live in a free society, you can 
not decide what product you want to sell, instead we are going to 
mandate that you sell this policy. Indeed, we are going to use the 
police power of the State to make you sell this policy. But, at least 
the Senator from Colorado says: We are not going to force young working 
couples, whose jobs might be threatened, whose ability to afford 
physical health insurance might be threatened--we are not going to make 
them buy it.
  It seems to me that is the issue. In terms of somehow relating this 
to medical savings accounts, that is the most contorted logic I have 
ever heard in my life. The point of medical savings accounts is that, 
under the current tax law, if you buy low-deductible insurance it is 
tax free. But if you buy high-deductible insurance and you put the 
difference in a savings account, then you have to pay taxes on that 
difference. In essence, we are making people, through the Tax Code, buy 
low-deductible insurance. We are putting people in a position where, 
when they are buying health care, it is like going to the grocery store 
and having a grocery insurance policy, where 95 percent of what you put 
in your grocery basket is going to be paid for by grocery insurance. 
Needless to say, if you had such a policy, you would eat differently, 
and so would your dog--this is part of the problem.
  What medical savings accounts do is expand choices. What the Domenici 
amendment does is limits choices. What gives us the right to say that 
people should be forced to buy health insurance that provides coverage 
which they otherwise would not choose to buy? Who are we to say that we 
have made this value judgment, that mental health care and physical 
health care are equal? Furthermore, who are we to say that if you have 
a policy which has a certain limit on physical care, and if you have 
any element of mental care in that policy, you are going to be forced 
to have the same limits on mental health care as well?
  Let me tell you what this amendment would do. This amendment would 
drive up the cost of health insurance, it would drive up payroll costs, 
it would increase the cost of employing workers, and, therefore, people 
would lose their jobs.
  Some courageous Members were willing to stand up and be counted upon 
on the issue of the minimum wage. How is this issue any different? How 
is this at all different? The plain truth is, this is not different. 
What this amendment would do is impose an unfunded mandate on workers 
and businesses. This will drive up unemployment. It will limit freedom. 
It will drive up the cost of health care. It will reduce the number of 
people who are covered by health insurance. And, finally, in the most 
perverted provision of this amendment, it will induce people to drop 
mental health coverage rather than face these expanded limits.
  So, I know we have danced around this issue before. I know that, in a 
form people thought would go to conference and die there, we have voted 
on this before. I was proud to vote against it then and I am going to 
be proud to vote against it now. I think the Brown amendment is an 
amendment that makes the underlying amendment dramatically better. 
Because what the Brown amendment says, in its simplest form, is people 
have to offer this coverage for sale, but you do not have to buy it.
  If you believe in freedom, if you believe in the right of people to 
choose you will vote for the Brown amendment. I would remind my 
colleagues who talked about lack of choice--there is a choice. If you 
do not like the health insurance your employer is providing, you do 
have an option. We do not have indentured labor in this country. We do 
not allow the enforcement of indentured labor contracts. People have a 
right to change jobs, and in fact people change jobs every day because 
of health insurance, because they want it and they want to expand their 
freedom.
  This is an amendment that limits freedom. This is an amendment that 
is an unfunded mandate of the worst sort. This is an amendment which 
has the Congress choosing for consumers, choosing for their employers, 
and I think it is absolutely wrong. I strongly oppose the underlying 
amendment and I strongly support the Brown amendment, which simply 
tries to preserve consumer choice.
  I would think that the authors of the underlying amendment would 
accept the Brown amendment because all the Brown amendment says is 
that, while the insurance coverage has to be offered, if the consumer 
does not want it, cannot afford it, feels it threatens his or her job, 
or if it threatens the viability of the company, you do not have to buy 
it. You either believe in freedom or you do not.
  If you believe in freedom, you are not for the Domenici amendment. If 
you believe in freedom, you are for the Brown amendment. Those are 
strong words but they are words that exactly fit the case before us.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, I have heard the distinguished Senator 
categorize the words of my good friend, the occupant of the chair, as 
``preposterous,'' or what was it you chose to say, Senator? I think 
that is probably a good paraphrase.
  Let me suggest the entire debate by the Senator from Texas has been 
preposterous. First, it is wrong on the facts; and, second, it is wrong 
on the logic; and, third, it is a gross exaggeration if ever I have 
heard one. So, let me tell you the facts. And the Senator might do well 
to listen, because they are the facts.

  Mr. GRAMM. I will listen.
  Mr. DOMENICI. And I appreciate it, if you will.
  First of all, the only way we have been able to judge the cost of 
these various insurance changes is to get the Congressional Budget 
Office to tell us. Let me tell you what they said about this amendment. 
Sixteen one-hundredths of 1 percent possible increase. Sixteen 
hundredths of 1 percent possible increase. Caveat, they said--caveat, 
we are not taking into consideration that it will probably be 
substantially less, if we know the effect of managed care and HMO's.
  Would anybody gather from the argument of the distinguished Senator 
from Texas that we are talking about that? Let me convert it to an 
insurance policy's average costs: $6 to $8 a year. That is the choice 
between freedom and servitude, $6 a year, or $8.
  That is freedom from being in jail or being forced to be indentured--
$6 or $8 a year.
  Let me talk about eliminating choice. I just asked what the 
conference report on the Kassebaum-Kennedy bill passed by, how many 
votes. I looked and found my good friend, the Senator from Texas, voted 
for that. Though I might suggest to him--and I am his good friend--when 
he makes an argument I do not agree with, I make it as forcible as he, 
perhaps not as intellectually as he.
  Having said that, I noted he voted for that bill. Mr. President, if 
ever you wanted to make an argument about eliminating freedom of 
choice, that was the bill to do it on, because you no longer have any 
choice to say, ``I don't want to buy insurance that covers the 
preexisting condition of my neighbor.'' Right? You say, ``I want 
another insurance policy, because I want the right to choose between 
coverage of preexisting conditions or not.''
  Let me suggest, if there are degrees of freedom, you just waive 
freedom there in an astronomical way, and if you are losing some 
freedom here, you are losing it in a little, tiny, almost immeasurable 
quantity.
  So let me repeat to the U.S. Senate what this issue is about. This 
issue is about whether or not you want to take a little tiny step 
toward providing some kind of parity of treatment under insurance 
policies in this land to those who suffer mental illness.
  Let me tell you what it does not do. It does not require the kind of 
coverage, the amount of copayment, the deductibles. Those are all left 
up to the insurance companies. All it says, I say to my friend from 
Kentucky, is if you write an insurance policy that covers

[[Page S9924]]

mental illness, then write it for the aggregate coverage level that is 
identical to the coverage level for physical illnesses. Is that a 
monumental thing? Most policies aggregate between $500,000 and $1 
million. That is what you are saying: If you write one with mental 
illness, do not put one in at $50,000 and cancel at $1 million. Just 
put 1 million dollars' worth of coverage.
  I repeat, this is not a huge imposition of new costs on anyone. My 
friend from Texas says there is no experience with the coverage of 
mental illness. That is absolutely wrong. There is plenty of experience 
with the coverage of mental illness. There are all kind of insurance 
policies out there with coverage of mental illness without 
discrimination on the aggregate amount. Many companies already know 
what it will cost, and they know what it will save.
  All we are suggesting is that there are a few million American 
families out there who think they have insurance coverage, and they 
find that their 17-year-old daughter away at college got depression in 
her freshman year--could not make a choice, all of a sudden could not 
sleep, all of a sudden gets deathly sick, and all of a sudden the 
doctors say she has severe depression.
  All of a sudden they say, ``Well, we have insurance.'' They wake up 
and ask somebody. Surely, if the father of the house had a heart 
attack, he can stay in a hospital 6 weeks. He can get 300,000 dollars' 
worth of surgery. But for that daughter, if you look at the policy, and 
it probably said $50,000. And they thought they had insurance. If you 
have severe depression and get hospitalized and then have to have the 
treatment that follows it, $50,000 is not even going to begin to care 
for them, just like $50,000 will not touch bypass surgery and all of 
the rehabilitation that comes with it, or severe cancer with six 
operations and chemotherapy.
  That is all we are saying. If you are going to write an insurance 
policy, insurance industry of America, businesses in America, if you 
are going to cover your employees and you are going to cover physical 
ailments and mental illness, just make sure that the aggregate amount 
is the same.
  That is not making any huge, momentous decision for the populace of 
the United States. It is a very simple, forthright, practical approach 
to insurance coverage.
  As a matter of fact, the only reason they are writing it out of the 
policies now and writing it lower is because it is cheaper. When people 
start finding out and asking about it and wanting it, then they will 
cover them, but in many instances, it is already too late. But if you 
make it that they must have these aggregates in all of the policies, I 
repeat, the denial of freedom is so insignificant and the cost is so 
insignificant that it is a trivialization, it trivializes the use of 
the words ``denying freedom of choice.'' It is truly turning monumental 
words that we cherish and worry about, like ``freedom,'' and attaching 
those to something as insignificant as what we have just described here 
on the floor.

  Mr. President, I move to table the Brown-Gramm amendment and ask for 
the yeas and nays.
  Mr. GRAMM. I ask the Senator to withhold so that I might respond.
  Mr. DOMENICI. How much time would you like?
  Mr. GRAMM. I want time to respond, or I can suggest the absence of a 
quorum.
  The PRESIDING OFFICER. Does the Senator from New Mexico withhold?
  Mr. DOMENICI. I will let the Senator respond.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. GRAMM. Mr. President, every Member of the Senate voted for the 
Kassebaum-Kennedy bill. I stood on the floor and made it very clear 
that by moving toward community rating, we were driving up health 
insurance costs.
  What I wanted was medical savings accounts as a method to promote 
competition and empower the consumer to make rational choices. Like 
most bills, it represented a tradeoff: an expansion of freedom in one 
area, a reduction of it in another. I see no expansion of freedom here.
  No. 2. If this provision really costs one-sixth of 1 percent, why 
isn't it a matter of course in insurance policies? If this provision is 
so cheap and so good, why is it not provided?
  I will offer another amendment saying that if, under this provision, 
the cost of insurance rises more than 1 percent that this provision 
will be void, and we will see if that will be supported.
  Everyone who has ever argued that we should diminish freedom to 
promote a political objective has said that the political objective is 
big and the diminution of freedom is small. The point remains and is 
irrefutable that under this amendment, we are going to make you buy 
coverage that you may not want. We are going to make employers provide 
coverage that they may not be able to pay for unless they drop mental 
health coverage altogether. I believe that this is clearly a step in 
the wrong direction.
  Obviously, any of us can stand up and talk about things that any 
family would like to have. Wouldn't any family in America like to have 
comprehensive mental health care when a 17-year-old child in college 
comes down with severe depression? Obviously, they would. But there are 
also a lot of families who would like to have a 17-year-old in college.
  There are a lot of people who would like to have better jobs than 
they have. The point is, life is about choices. Life is about choices 
that we have to make in a free society.
  Senator Brown says that we can require insurance companies to offer 
the policy. But the Domenici amendment says you also have to buy the 
policy.
  You have to buy this coverage whether or not you want it, whether or 
not you can afford it, and whether or not it threatens your job or your 
company. Why? Because we, the Congress, in our infinite wisdom, have 
decided that this is something you need to have.
  It seems to me, if there was just one clear message in the last 
election, it was stop making decisions for us in Washington, let us 
make decisions for ourselves.
  If this policy really cost one-sixth of 1 percent, then let people 
choose to buy it, let companies decide to offer it. I do not believe it 
will cost one-sixth of 1 percent. I believe we are talking about a very 
expensive rider to insurance policies.
  I think that this rider is going to drive up the cost of health 
insurance and, in effect, deny people who are having trouble buying 
insurance the ability to cover themselves or their child should he or 
she fall down, break an arm, or, God forbid, be in an accident. We are 
going to jeopardize their ability to have any health insurance at all. 
Further, we are going to jeopardize their ability to have a job, and 
are going to induce many companies to drop health coverage altogether. 
Soon people will find out that if they have a child that has a mental 
problem, they will not even have $50,000 of coverage, let alone 
coverage equal to the rest of their policy.
  The point is this, if this is so cheap, if this is so irrelevant from 
the point of view of cost, why not let people choose it on their own? 
Or better yet, why not have the insurance company be required to 
provide it and then let people decide if they want it based on their 
analysis of cost and benefits? Or are they so foolish, are the American 
people so naive, so unaware of their own needs and their own wants that 
they must have us tell them what they need? I do not think so.
  It seems to me that the Brown amendment has the saving grace of 
letting people choose. You force the insurance companies to offer this 
coverage whether they want to offer it or not, but at least you let 
people decide if they want it. I cannot understand, for the life of me, 
why people are opposed to this. If really this coverage costs one-sixth 
of 1 percent, we would all want it; we would all choose it. The only 
reason you would not let people choose it on their own is if you do not 
believe that one-sixth of one percent number, or you believe that 
people would not choose it. The point is, freedom is the right to make 
wrong decisions as well as to make right decisions. I simply go back to 
a fundamental point which, in my opinion, despite all the wonderful 
speeches you can give about this--Bismarck once said, ``Never does a 
socialist stand on stronger ground than when he argues for the best 
principles of health.''
  Who can stand and argue against somebody having coverage for a 
physical or mental ailment? No one can. We

[[Page S9925]]

all want it. We wish we could magically make it happen. But we should 
not make it magically happen by mandating that people have it, by 
forcing people to pay for it whether they want to or not, without 
knowing what it costs, without knowing the ramifications of this, all 
on an appropriations bill at 7:30 p.m. at night in the month that we 
are going to adjourn the Senate.
  I think that this amendment violates everything that many of us claim 
that we stand for. I do not doubt the good intentions, nor have I ever 
doubted the good intentions, of the Senator who is offering this 
amendment. But this is bad public policy. It flies in the face of 
everything the 1994 election said because it denies people the right to 
choose.
  If we want to preserve this right to choose, not for the insurance 
companies, but for the consumer, then it is critical that the Brown 
amendment be adopted.
  I yield the floor.
  Mr. BROWN addressed the Chair.
  The PRESIDING OFFICER. The Senator from Colorado.
  Mr. BROWN. Mr. President, I shall not prolong the debate. We have had 
excellent comments by both sides. I appreciate the very thoughtful 
comments that Senator Domenici has made and Senator Gramm has made 
because I think they enlighten debate.

  I hope Members, when they vote on this, will do one thing: look at 
the amendment and read it. And let me just read the words because I 
think they are important to focus on. Here are the words of this 
amendment:

       Consumers shall retain the freedom to choose a group health 
     care plan with coverage limitations of their choice even if 
     such coverage limitations for mental health services are 
     inconsistent with section 2 of this title.

  Mr. President, that is all this amendment does. It retains, in the 
consumer, the right to choose.
  I yield the floor, Mr. President.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. I believe we have had debate on this. I just want to, 
one more time, suggest that what is missing from the Senator from 
Texas' discussion is--I would put it this way--there was total 
misunderstanding as I listened to him talk about severe mental illness 
and the marketplace and the neighborhoods of America. Because that 
illness has been so stigmatized for so long, it has even stigmatized 
the insurance policies of this land.
  We started out 30 or 40 years ago recognizing that we came out of the 
Dark Ages with reference to severe mental illness and crazies and 
loonies, and we started understanding that people really were sick. 
Yet, we dragged everybody kicking and screaming to understand that a 
mother or a father with a child with schizophrenia had nothing 
whatsoever to do by way of treatment or care with that child getting 
sick.
  Pretty soon we got to recognize that even that famous old Dr. Freud 
was wacko because you could not talk people out of mental illness. You 
can have them on the sofa and chair and talk until you are blue in the 
face, and if you are a schizophrenic, you are sick. What happened is, 
society just resisted that. And I guess part of it is that every now 
and then somebody who is mentally sick kills someone and there we are 
again talking about ``those people.''
  But let me tell you, there are millions of Americans who have members 
of their family with one of these dread illnesses. All we are 
suggesting in this measure, and I repeat, if an insurance company 
writes insurance that covers mental illness--now if you want choice, 
understand, they do not have to cover mental illness--but if they 
choose to, we just say, let us get rid of the stigma and cover them in 
total dollar coverage to the same extent you cover the other illnesses.
  If they want to triple the copayment, I say to Senator Kennedy, 
because they want to keep people away from psychiatrists, there is 
nothing in this measure that says they cannot do that. We are just 
saying, when you insure somebody that is mentally ill, and they get 
real sick, make sure they are the same limitations on total coverage 
that people who get cancer or diabetes or tuberculosis or triple bypass 
have. And that is all it says.
  That is the reason it is not going to cost very much. The amendment 
that passed early on, where we mandated coverage and we mandated parity 
of actual literal coverage, was very, very different. And my friend 
from Texas might have made a very serious argument there, but in this 
case that is not the situation.
  So I believe, to say if you are writing mental health coverage it has 
to have these limits and turn around and say, on the other hand, even 
if you have done that, insurance company, we have the right to say, 
well, lower the level and give us another kind of coverage with less of 
that because we want freedom of choice--the choice is clear.
  You can buy an insurance policy without mental health coverage or you 
can buy in the manner discussed so eloquently on the floor by the 
Senator from Utah, if that applies. So having said that, I move to 
table and ask for the yeas and nays.
  Mr. GRAMM. Mr. President, I ask the Senator on one point to allow me 
to respond.
  Mr. DOMENICI. I would be pleased to.
  Mr. GRAMM. I do understand. I grew up in a household with someone who 
had mental illness. I grew up in a household where nobody had health 
insurance. We did not have health insurance for physical or mental 
ailments. But the point is, if you are going to mandate coverage, then 
you will end up with more people who have no health insurance, and you 
are going to have more people without jobs.
  The point is that under this amendment you lose your right to choose. 
To keep a policy that has limited mental health coverage, you either 
have to take no mental health coverage or take coverage equal to that 
set for physical illness coverage. The Brown amendment gives you 
choice. It seems to me that is what we want.
  My problem here is not that I do not understand. My problem is that I 
do understand. My problem is that I do understand what this does 
economically. I do understand that this takes away from people the 
right to choose. That is why I am opposed to it. There certainly is no 
politics in opposing this amendment. We should all be for giving 
everybody everything. Unfortunately, we live in a world where people 
have to choose. When we choose for them, they not only have less 
freedom, they do not get to choose to spend their money as they would 
choose to spend it.
  I believe families know better than we do. Even though our intentions 
may be wonderful and even though we may wish everybody had mental 
health coverage, families have to make hard choices when they have to 
pay. Businesses have to make hard choices. All I am saying is let them 
choose. If you want to make insurance companies provide the coverage, 
do not make people buy it. Have it available. Let them look at the 
cost. If it costs one-sixth of 1 percent, they will buy it if they want 
it. I would certainly buy it at that cost.
  My fear is we are going to find out later this is a very costly add-
on, and we are going to price people out of the health insurance they 
have now, and they are going to end up with both physical and mental 
ailments, and they will not be covered for either.
  Mr. WELLSTONE. I know my colleagues are anxious to move forward. 
Although there is so much I want to say for the record, I yield.
  Mr. DOMENICI. I move to table the amendment, and I ask for the yeas 
and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays have been ordered. The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. NICKLES. I announce that the Senator from Utah [Mr. Hatch], the 
Senator from Oregon [Mr. Hatfield], and the Senator from Alaska [Mr. 
Murkowski], are necessarily absent.
  I further announce that, if present and voting, the Senator from 
Oregon [Mr. Hatfield], would vote ``yea''.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 75, nays 22, as follows:

[[Page S9926]]

                      [Rollcall Vote No. 273 Leg.]

                      [Rollcall Vote No. 273 Leg.]

                                YEAS--75

     Akaka
     Baucus
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Bradley
     Breaux
     Bryan
     Bumpers
     Burns
     Byrd
     Chafee
     Cochran
     Cohen
     Conrad
     Coverdell
     D'Amato
     Daschle
     DeWine
     Dodd
     Domenici
     Dorgan
     Exon
     Feingold
     Feinstein
     Ford
     Frist
     Glenn
     Graham
     Grassley
     Harkin
     Heflin
     Hollings
     Hutchison
     Inouye
     Jeffords
     Kassebaum
     Kennedy
     Kerrey
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lugar
     McConnell
     Mikulski
     Moseley-Braun
     Moynihan
     Murray
     Nunn
     Pell
     Pressler
     Pryor
     Reid
     Robb
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Shelby
     Simon
     Simpson
     Snowe
     Specter
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner
     Wellstone
     Wyden

                                NAYS--22

     Abraham
     Ashcroft
     Brown
     Campbell
     Coats
     Craig
     Faircloth
     Frahm
     Gorton
     Gramm
     Grams
     Gregg
     Helms
     Inhofe
     Johnston
     Kempthorne
     Kyl
     Lott
     Mack
     McCain
     Nickles
     Smith

                             NOT VOTING--3

     Hatch
     Hatfield
     Murkowski
  The motion to lay on the table the amendment (No. 5195) was agreed 
to.
  Mr. DOMENICI. Mr. President, I move to reconsider the vote by which 
the motion to lay on the table was agreed to.
  Mr. FORD. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. LOTT. Mr. President, for the information of all Members, we are 
working now on getting a UC typed up that would lay out how the time 
will be used for the next hour. We are in the process now of typing up 
an agreement that would lay out the debate, and the votes over the next 
hour and a half. I think that would allow us to make good progress and 
be able to get to the conclusion of the VA-HUD bill, and either go to 
final passage after that, or, depending on a couple of other things, we 
are working on final passage and could have stacked votes Tuesday 
morning. But we will have that worked out momentarily.
  The next thing we will do is to go to the next pending amendment for 
a vote. Senator Gramm I believe has a second-degree amendment.

                          ____________________