[Congressional Record Volume 143, Number 91 (Wednesday, June 25, 1997)]
[Senate]
[Pages S6301-S6332]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
BALANCED BUDGET ACT OF 1997
Mr. DOMENICI. Parliamentary inquiry. Is it not time to return to
consideration of the bill?
The PRESIDING OFFICER. Under the previous agreement, the Senate
resumes consideration of S. 947. The Senator is correct.
The Senate continued with the consideration of the bill.
[[Page S6302]]
Amendment No. 467, as Modified
(Purpose: To preserve religious choice in long-term care)
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. Mr. President, in behalf of Senator Grassley, I submit
a modified amendment, No. 467. It has been cleared on both sides. I ask
for its immediate consideration.
The PRESIDING OFFICER. Without objection, it is so ordered. The clerk
will report.
The assistant legislative clerk read as follows:
The Senator from New Mexico [Mr. Domenici], for Mr.
Grassley, proposes an amendment numbered 467, as modified.
Mr. DOMENICI. Mr. President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment, as modified, is as follows:
On page 689, between lines 2 and 3, insert the following:
``(iii) Religious choice.--The State, in permitting an
individual to choose a managed care entity under clause (i)
shall permit the individual to have access to appropriate
religiously-affiliated long-term care facilities that are not
pervasively sectarian and that provide comparable non-
sectarian medical care. With respect to such access, the
State shall permit an individual to select a facility that is
not a part of the network of the managed care entity if such
network does not provide access to appropriate faith-based
facilities. Such facility that provides care under this
clause shall accept the terms and conditions offered by the
managed care entity to other providers in the network. No
facility may be compelled to admit an individual if the
medical director of that facility believes that the facility
cannot provide the specific nursing care and services an
enrollee requires.
Mr. DOMENICI. I yield any time we have on the amendment.
The PRESIDING OFFICER. All time is yielded back. If there be no
further debate, the question is on agreeing to the amendment.
The amendment (No. 467), as modified, was agreed to.
Mr. DOMENICI. 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. 473, Withdrawn
Mr. DOMENICI. Mr. President, in behalf of Senator Hutchison, I seek
the withdrawal of amendment No. 473. I ask it be withdrawn.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment (No. 473) was withdrawn.
Amendment No. 493
Mr. DOMENICI. Senator Kennedy has an amendment, No. 493, Kennedy-
Lautenberg. Senator Lautenberg introduced it for Senator Kennedy, to
exempt severely disabled aliens from the ban on receipt of supplemental
income. It is at the desk. I indicate from our side that there is no
objection. I understand from the Democratic side there is no objection.
Senator Kennedy, is that correct?
Mr. KENNEDY. That is correct. I thank the chairman of the committee
for his consideration. It is a serious issue and a heartrending issue
for many different individuals. The willingness to accept this
amendment is something we are very, very appreciative of. If I might
just say a few words about it.
Under the budget reconciliation bill, legal immigrants who are
already in this country can keep their SSI benefits. But for those who
come in the future, SSI is only for citizens. They have to become
citizens to qualify in the future, so your sponsor must take care of
you until then.
This amendment creates a small exception to that rule. It enables
immigrants who are too disabled to qualify for citizenship to retain
their SSI eligibility.
Some immigrants and refugees--though not many--become too disabled to
qualify for citizenship. Under this bill, their sponsors have to care
for them for life. If they don't have sponsors, they have nowhere to
turn.
One example is Vien Vu. His family fled Vietnam after years of
serving side-by-side with the United States Armed Forces. But Vien Vu
has Downs syndrome. He is 34 years old. The rest of his family has
become American citizens but Vien will never qualify for citizenship.
His family needs SSI to care for him for the rest of his life.
Mendel Tsadovich is a Latvian Holocaust survivor who is too mentally
retarded to qualify for naturalization. In 1992, he and his family
escaped as refugees from the anti-Semitism of the former Soviet Union.
He is now 61 and living in New York. He is the only surviving member of
his family, and depends on SSI for assistance. He has no sponsor.
Vien and Mendel are the lucky ones. They arrived before passage of
last year's welfare law. So the reconciliation bill will continue their
SSI coverage. But what about the Viens and Mendels who arrive in the
future?
With the passage of the Lautenberg amendment this morning, my
amendment costs almost nothing. CBO scores it as having little budget
impact. So, we can help all those like Vien and Mendel and still
balance the budget by 2002.
The number of immigrants this amendment affects is small, perhaps
only a few thousand people a year. But these immigrants often depend on
SSI benefits for their survival. If they do not have the ability to
become citizens, Congress should not deny them the SSI benefits they
need.
Mr. DOMENICI. Mr. President, I have a couple of seconds. I want to
say, some may ask why I accepted this. Actually, it's a very tiny group
of people. It covers those who are so seriously disabled that the
disability disqualifies them from completing their naturalization
process. Therefore, they cannot become citizens. They are noncitizens,
but legal. As a result, they are denied benefits described in the
Kennedy amendment for only that reason. So I agree to accept that.
THE PRESIDING OFFICER. If there be no further debate, the question is
on agreeing to the amendment.
The amendment (No. 493) was agreed to.
Mr. DOMENICI. Mr. President, I move to reconsider the vote.
Mr. KENNEDY. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Amendment No. 469
Mr. DOMENICI. I understand the next amendment in order is by Senator
Specter, No. 469. Is that correct?
The PRESIDING OFFICER. That is correct.
Mr. DOMENICI. I yield the floor.
The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
Mr. SPECTER. Mr. President, I am offering this amendment on behalf of
Senator Rockefeller, Senator Santorum, Senator Snowe, Senator Collins,
and Senator Campbell. It would ensure that $1.5 billion over 5 years of
Medicare premium subsidies is provided to the low-income elderly with
annual incomes up to $12,000 through expansion of the existing Medicaid
Program, instead of what is in the current bill, to add $1.5 billion
through a new State block grant program.
This amendment is preferable, by doing it on an existing program
instead of setting up a new bureaucracy. It is necessary because the
premium increases in the bill are permanent, but there is no guarantee
of permanent subsidies for the 3.2 million poor senior citizens covered
unless this amendment would be adopted.
I yield the remainder of my time to Senator Rockefeller.
Mr. ROCKEFELLER. Mr. President, I point out that this amendment would
help seniors making, on an annual basis, between $9,500 a year and
$11,900 a year. It would simply take the principles of the Medicaid
Program and carry them forward, and simply say those folks deserve to
get help in the Medicare payment because they are so desperately poor.
This is well established in Medicaid. We are now applying it to a new
area and saying, rather than 120 percent of poverty, we are saying 120
percent of poverty to 150 percent of poverty. It is very sensible. It
helps people.
This program is going to sunset in 5 years, but their costs are not
going to sunset in 5 years. We think it is an amendment which both
sides are willing to vote for.
The PRESIDING OFFICER. The time has expired. The Senator from New
Mexico.
Mr. DOMENICI. Mr. President, first I make a point of order that the
amendment is not germane.
[[Page S6303]]
Mr. SPECTER. Mr. President, I move to waive.
Mr. President, 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.
Mr. DOMENICI. Mr. President, yesterday we provided $1.5 billion in
new funds to assist Medicare beneficiaries between 120 and 150 percent
of the poverty line with their part B premiums. That was expected under
the agreement that we entered into with the White House. We provided
these funds as a State program, providing maximum flexibility to reach
these individuals in the greatest need. We do not need this additional
program, which would create a new entitlement, which we can't afford. I
urge my colleagues to oppose the amendment, or to support the point of
order.
I yield the floor.
Motion to Waive the Budget Act
The PRESIDING OFFICER. The question is on the motion of the Senator
from Pennsylvania to waive the Budget Act. The yeas and nays have been
ordered.
The clerk will call the roll.
The bill clerk called the roll.
The PRESIDING OFFICER (Mr. Gregg). Are there any other Senators in
the Chamber who desire to vote?
The yeas and nays resulted, yeas 52, nays 48, as follows:
[Rollcall Vote No. 121 Leg.]
YEAS--52
Akaka
Baucus
Biden
Bingaman
Bond
Boxer
Breaux
Bryan
Bumpers
Byrd
Cleland
Collins
Conrad
D'Amato
Daschle
Dodd
Dorgan
Durbin
Feingold
Feinstein
Ford
Glenn
Graham
Harkin
Hollings
Inouye
Jeffords
Johnson
Kennedy
Kerrey
Kerry
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Mikulski
Moseley-Braun
Moynihan
Murray
Reed
Reid
Robb
Rockefeller
Santorum
Sarbanes
Snowe
Specter
Torricelli
Wellstone
Wyden
NAYS--48
Abraham
Allard
Ashcroft
Bennett
Brownback
Burns
Campbell
Chafee
Coats
Cochran
Coverdell
Craig
DeWine
Domenici
Enzi
Faircloth
Frist
Gorton
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
Hutchinson
Hutchison
Inhofe
Kempthorne
Kyl
Lott
Lugar
Mack
McCain
McConnell
Murkowski
Nickles
Roberts
Roth
Sessions
Shelby
Smith (NH)
Smith (OR)
Stevens
Thomas
Thompson
Thurmond
Warner
The PRESIDING OFFICER. On this vote, the yeas are 52, the nays are
48. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected. The point of order is
sustained, and the amendment falls.
Mr. DOMENICI. Mr. President, I move to reconsider the vote by which
the motion was rejected.
Mr. LAUTENBERG. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. DOMENICI. Mr. President, how much time did that vote take?
The PRESIDING OFFICER. That vote took 17 minutes.
Mr. DOMENICI. I understand the leader will be--
The PRESIDING OFFICER. If the Senator will suspend, I ask that there
be order in the Chamber and that Members wishing to pursue discussions,
and especially staff wishing to pursue discussions, take those
discussions to the Cloakroom. We are not going to proceed until there
is order so the Senator from New Mexico can be heard.
The Senator from New Mexico.
Mr. DOMENICI. Mr. President, I repeat my question. How much time did
the last vote take?
The PRESIDING OFFICER. The last vote took approximately 17 minutes.
Mr. DOMENICI. We are operating on a unanimous-consent agreement that
says we will take 10 minutes for rollcall votes. I understand the
leader will be along shortly and indicate we that will go to the 10-
minute rule. But I am not going to hold Senators to that unless the
leader comes and confirms it. But 17 minutes, that is an extra hour for
people today; it seems like to me maybe longer.
We have a little business we can conduct at this point.
Amendment No. 495
Mr. DOMENICI. We are willing to accept a Conrad amendment dealing
with the nurse aide registry.
I ask the Senator, are you willing to accept that on your side?
Mr. LAUTENBERG. We are.
Mr. DOMENICI. We yield back any time on the amendment.
The PRESIDING OFFICER. Without objection, it is so ordered. The
amendment is agreed to.
The amendment (No. 495) was agreed to.
Mr. DOMENICI. I move to reconsider the vote.
Mr. LAUTENBERG. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Amendment No. 470
Mr. DOMENICI. Mr. President, I ask unanimous consent that Senator
Specter's next amendment, which is 470, that it be temporarily set
aside. And the Senator would like 30 seconds to explain why he is
agreeing to that.
Mr. SPECTER. Mr. President, this is an amendment related to
disproportionate share. Some States have been hit very hard because
some of the funds have been used for mental health facilities. There
has already been substantial improvement; illustratively, for
Pennsylvania, which had been on the books to sustain a loss of $1.7
billion, it is down to $750 million. And the managers are now
considering an amendment which would improve that situation materially.
So I agree with my distinguished colleague from New Mexico to set it
aside temporarily with the hope we may be able to work it out, and
ultimately have it withdrawn if a satisfactory resolution can be
arrived at.
The PRESIDING OFFICER. Without objection, it is set aside.
Mr. DOMENICI. Mr. President, I ask one further unanimous consent,
that Senator Mikulski's amendment No. 489 follow Senator Specter's
amendment, which he will proceed with now, which is amendment 471.
I yield the floor.
The PRESIDING OFFICER. Is there objection?
Mr. ROCKEFELLER addressed the Chair.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The Senator from West Virginia.
Point of Order
Mr. ROCKEFELLER. Mr. President, I ask for the regular order with
regard to the point of order under the Byrd rule which was raised on
the balanced billing.
The PRESIDING OFFICER. The Senator's point of order is the regular
order.
Mr. DOMENICI. Mr. President, might I ask, how is the Chair going to
rule? Parliamentary inquiry. Can't do that? I withdraw the question.
I move to waive the point of order and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There is a
sufficient second.
The yeas and nays were ordered.
The PRESIDING OFFICER. The question is on agreeing to the motion. The
clerk will call the roll.
Mr. BYRD. Mr. President, may we have some explanation what we are
about to vote on?
Mr. ROCKEFELLER addressed the Chair.
The PRESIDING OFFICER. The Senator from West Virginia is recognized
for 1 minute.
Mr. ROCKEFELLER. I urge my colleagues to vote no, against the motion
to waive the Budget Act, so that we protect patients in these sorts of
very special Medicare Choice programs who, unless we give them the
protection, unless we vote no, doctors are going to be able to charge
whatever they want. Everybody else under Medicare is under something
called balanced billing. Balanced billing means you can only charge 15
percent more than what Medicare pays for it. This was agreed to in 1989
when we did a massive Medicare reform.
We should not be able to take a sort of special fee for service part
of the new Medicare Choice and suddenly say that the doctor can charge
them anything they want. They have no protection from balanced billing
rules which protects all other people who are under Medicare. And it is
the law of the land. It is a very important principle, a very important
point. And since we have
[[Page S6304]]
done this in 1989, since we have put a cap on the balanced billing,
which the other side would have us let go, seniors have saved $2
billion since 1989.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. DOMENICI addressed the Chair.
The PRESIDING OFFICER. The Senator from New Mexico has 1 minute.
Mr. DOMENICI. Mr. President, I yield 40 seconds of that to Senator
Gramm. I will use 20.
The PRESIDING OFFICER. The Senator from Texas.
Mr. GRAMM. Mr. President, by giving a broad range of choices to our
seniors, we have given them the ability to opt into a private fee-for-
service health insurance policy.
Now, if we come along and start restricting the way that a private
health insurance policy can function, and tell them how they are to
bill for physician services, we take away the whole competitive nature
of what we are trying to create. I know some people do not like the
idea of expanding choices for seniors.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. GRAMM. But that is what we have done, and we need to preserve the
ability of these mechanisms to function. It is important we waive the
point of order.
Mr. DOMENICI. Mr. President, essentially this amendment will gut
MSA's and private fee-for-service programs that come into this bill
which permits seniors a wide array of options. They are gone
essentially, for the regulatory mechanisms that will be imposed on them
will make them a nullity.
Vote on Motion to Waive the Budget Act
The PRESIDING OFFICER. The question is on agreeing to the motion. 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] is
necessarily absent.
The yeas and nays resulted--yeas 62, nays, 37, as follows:
[Rollcall Vote No. 122 Leg.]
YEAS--62
Abraham
Allard
Ashcroft
Bennett
Biden
Bingaman
Bond
Breaux
Brownback
Burns
Campbell
Chafee
Coats
Cochran
Collins
Coverdell
Craig
D'Amato
DeWine
Domenici
Enzi
Faircloth
Feinstein
Frist
Gorton
Gramm
Grams
Grassley
Gregg
Hagel
Helms
Hutchinson
Hutchison
Inhofe
Jeffords
Kempthorne
Kerrey
Kyl
Landrieu
Lott
Lugar
Mack
McCain
McConnell
Moynihan
Murkowski
Nickles
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Torricelli
Warner
NAYS--37
Akaka
Baucus
Boxer
Bryan
Bumpers
Byrd
Cleland
Conrad
Daschle
Dodd
Dorgan
Durbin
Feingold
Ford
Glenn
Graham
Harkin
Hollings
Inouye
Johnson
Kennedy
Kerry
Kohl
Lautenberg
Leahy
Levin
Lieberman
Mikulski
Moseley-Braun
Murray
Reed
Reid
Robb
Rockefeller
Sarbanes
Wellstone
Wyden
NOT VOTING--1
Hatch
The PRESIDING OFFICER. On this question, the yeas are 62, the nays
are 37. Three-fifths of the Senators duly chosen and sworn having voted
in the affirmative, the motion is agreed to.
Mr. DOMENICI. I move to reconsider the vote.
Mr. NICKLES. I move to lay it on the table.
The motion to lay on the table was agreed to.
Mr. LOTT. Mr. President, the Democratic leader and I have talked
about the necessity to try to complete votes in the time prescribed. We
have been warning and urging Members to stay in the Chamber to do these
votes. It has taken about 50 minutes to do two votes. We did cut that
last vote off with one Member missing. This is the final warning. From
here on in after 10 minutes we are going to turn in the vote.
So please stay in the Chamber. Let's vote. We can save ourselves an
hour or more if we do that. Please do that. Please cooperate with us
and we can get our work done and get it done an hour or so earlier.
I yield the floor.
The PRESIDING OFFICER. Who seeks recognition?
Mr. DOMENICI. Mr. President, I believe under the rule, Senator
Specter is up.
Amendment No. 471
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. SPECTER. Mr. President, this amendment eliminates the cuts on
indirect grants in medical education. In 48 States there are 1,085
teaching hospitals which perform very, very valuable services. In
addition to teaching professionals, they give basic health services,
customarily in the inner cities. With a disproportionate share coming
into effect, their financing is very, very important.
Beyond that, they give highly specialized patient care so that if you
have some really extraordinary medical problem, where you go is to
these graduate medical educational institutions.
These cuts would be crippling. I suggest that as a matter of priority
they be eliminated from this bill.
Mr. DOMENICI. Mr. President, I yield 40 seconds of the 1 minute to
Senator Roth.
Mr. ROTH. Mr. President, I oppose this amendment. Simply put,
according to most experts, Medicare today overpays for indirect medical
education, which is a special Federal subsidy for training new doctors.
We have substantially but responsibly reduced those payments in our
bill, and, indeed, these payments will remain very generous. This
amendment is not needed and would prevent us from meeting our budget
instructions.
Mr. DOMENICI. Mr. President, this amendment will cost us $5.6 billion
in this bill alone. The explanation given by the distinguished chairman
seems to me to indicate we are going to be more than fair with
reference to the indirect payment.
Mr. SPECTER. I believe I have 7 seconds remaining.
Mr. President, this will not require a waiver of the Budget Act, and
although the sum is not insignificant, this is really important for
America.
I ask that Senator D'Amato be listed as a cosponsor.
Mr. DOMENICI. Some Senators might wonder why it is not subject to a
point of order when it cuts $5.6 billion. That is because it is a
motion to strike, and motions to strike are in order under the Budget
Act regardless of their impact.
I move to table the amendment, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays were ordered.
The PRESIDING OFFICER. The question is on agreeing to the motion to
lay on the table the amendment of the Senator from Pennsylvania.
The clerk will call the roll.
The legislative clerk called the roll.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 71, nays 29, as follows:
[Rollcall Vote No. 123 Leg.]
YEAS--71
Abraham
Allard
Ashcroft
Baucus
Bennett
Breaux
Brownback
Bryan
Burns
Campbell
Chafee
Coats
Cochran
Collins
Conrad
Coverdell
Craig
DeWine
Dodd
Domenici
Dorgan
Enzi
Feingold
Feinstein
Ford
Frist
Glenn
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
Hollings
Hutchinson
Hutchison
Inhofe
Kempthorne
Kerrey
Kohl
Kyl
Landrieu
Lautenberg
Leahy
Lieberman
Lott
Lugar
Mack
McCain
McConnell
Moseley-Braun
Murkowski
Nickles
Reed
Robb
Roberts
Rockefeller
Roth
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Stevens
Thomas
Thompson
Torricelli
Warner
NAYS--29
Akaka
Biden
Bingaman
Bond
Boxer
Bumpers
Byrd
Cleland
D'Amato
Daschle
Durbin
Faircloth
Harkin
Inouye
Jeffords
Johnson
Kennedy
Kerry
Levin
Mikulski
Moynihan
Murray
Reid
Santorum
Sarbanes
Specter
Thurmond
Wellstone
Wyden
The motion to lay on the table the amendment (No. 471) was agreed to.
[[Page S6305]]
Mr. DOMENICI. Mr. President, I move to reconsider the vote.
Mr. LAUTENBERG. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The regular order would now be the Mikulski
amendment.
Amendment No. 472, Withdrawn
Mr. DOMENICI. Mr. President, on behalf of Senator Burns, I withdraw
Senate amendment No. 472.
The PRESIDING OFFICER. Without objection, the amendment is withdrawn.
The amendment (No. 472) was withdrawn.
Amendment No. 494, Withdrawn
Mr. DOMENICI. On behalf of Senator Conrad, I withdraw amendment No.
494.
The PRESIDING OFFICER. Without objection, the amendment is withdrawn.
The amendment (No. 494) was withdrawn.
Amendment No. 489
The PRESIDING OFFICER. The Senator from Maryland is recognized.
Ms. MIKULSKI. Thank you very much. On behalf of Mr. Wellstone and
myself, we have an amendment at the desk that will strike the committee
action and restore something called the Boren amendment. The Boren
amendment was passed and signed by President Reagan in 1981 to ensure
adequate access to health care services for Medicaid beneficiaries.
The Boren amendment simply stated that payment rates for hospitals
and nursing homes must be reasonable and adequate to meet the cost of
operating the facilities. That is reimbursements by Medicaid. Now,
under the committee action, we would take that away. We would give
permission to States to further reduce payment rates to nursing homes
at this time. This would have a devastating affect on quality care, and
it would have a devastating affect on access to care for beneficiaries.
The simple fact is that Medicaid payment rates to nursing homes does
affect quality and our ability to meet the standards that are mandated
for health and safety. Nursing homes have stopped taking Medicaid
patients. Because of that, I urge adoption of the amendment.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. Mr. President, I yield 30 seconds of my minute to the
Senator from Texas.
Mr. GRAMM. Mr. President, we are always looking for bipartisanship.
The President is in favor of repealing the Boren amendment. The
National Governors' Association is in favor of repealing the Boren
amendment. The amendment of the Senator from Maryland will raise the
deficit and reduce our savings by $1.2 billion. How does anybody know
what is reasonable and adequate? The Boren amendment has produced
endless lawsuits. States want to negotiate with hospitals and get the
best rate they can. Repealing the Boren amendment takes it out of the
courts.
Mr. DOMENICI. Mr. President, as we negotiated a balanced budget with
the President and the Governors, the administration regularly said,
``We want to provide flexibility.'' What is flexibility? Get rid of the
Boren amendment. That is what they kept saying. Provide flexibility
instead of the rigidity brought on by lawsuits. The Boren amendment
should be dead. The President is not for it. Now someone wants to put
it back in, and it will cost $1.2 billion to put something back in that
didn't work.
I move to table the Mikulski amendment and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays are ordered, and the clerk will call the roll.
The bill clerk called the roll.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 66, nays 34, as follows:
[Rollcall Vote No. 124 Leg.]
YEAS--66
Abraham
Allard
Ashcroft
Baucus
Bennett
Bingaman
Bond
Breaux
Brownback
Bryan
Burns
Campbell
Chafee
Coats
Cochran
Collins
Conrad
Coverdell
Craig
DeWine
Domenici
Enzi
Faircloth
Feingold
Frist
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
Hollings
Hutchinson
Hutchison
Inhofe
Jeffords
Kempthorne
Kerrey
Kohl
Kyl
Lautenberg
Leahy
Lott
Lugar
Mack
McCain
McConnell
Moynihan
Murkowski
Nickles
Robb
Roberts
Roth
Santorum
Sessions
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
NAYS--34
Akaka
Biden
Boxer
Bumpers
Byrd
Cleland
D'Amato
Daschle
Dodd
Dorgan
Durbin
Feinstein
Ford
Glenn
Harkin
Inouye
Johnson
Kennedy
Kerry
Landrieu
Levin
Lieberman
Mikulski
Moseley-Braun
Murray
Reed
Reid
Rockefeller
Sarbanes
Shelby
Torricelli
Warner
Wellstone
Wyden
So the motion to lay on the table the amendment (No. 489) 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. LOTT. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. DOMENICI. Mr. President, how much time did we use on that vote?
The PRESIDING OFFICER. Twelve minutes.
Mr. DOMENICI. I thank the Chair.
Change of Vote
The PRESIDING OFFICER. The Senator from Wisconsin.
Mr. KOHL. Thank you, Mr. President.
On rollcall vote 124, I voted ``no.'' It was my intention to vote
``yes.'' Therefore, I ask unanimous consent that I be permitted to
change my vote. This will in no way change the outcome of the vote.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The foregoing tally has been changed to reflect the above order.)
Mr. DOMENICI. Regular order.
Amendment No. 488
The PRESIDING OFFICER. Regular order is the amendment of the Senator
from Minnesota, No. 488.
Mr. WELLSTONE. Mr. President, may we have order?
The PRESIDING OFFICER. The Senate will come to order.
We can move this along if Members in the room would withdraw their
conversations to the Cloakroom, and if the staff will reserve their
conversations.
The Senator from Minnesota is recognized.
Mr. WELLSTONE. Mr. President, if I could just say to you, I am not
going to start, if I could ask for order.
The PRESIDING OFFICER. If the Senator will suspend, we are not going
to proceed until the Senator from Minnesota can be fairly heard. The
staff will reserve their conversations. It will help to move this
along.
The Senator from Minnesota is recognized for 1 minute.
Mr. WELLSTONE. Mr. President, it is hard in this process because
people want to talk. But these amendments have consequences for
people's lives.
I would like to wait until we have order.
Mr. DOMENICI. Mr. President, we can't hear.
Mr. WELLSTONE. I have people talking all around me.
The PRESIDING OFFICER. The Senator from Minnesota is correct.
The Senator from Minnesota is recognized.
Mr. WELLSTONE. Thank you.
Mr. President, I offer this amendment with Senator Mikulski. We just
repealed the Boren provision, which was an effort to make sure that
there was reasonable and adequate rates of reimbursement. This was for
nursing homes, children's hospitals, group care for people with
disabilities.
What we do in this amendment is a compromise, colleagues. We just
simply require that States provide assurance to the Secretary that the
rates will be actuarially sufficient to ensure adequate care.
We don't have any vague standard. This is an actuarially sufficiency
standard. We are just saying to States, let's have some standard that
you can say you have had an independent analysis done and that you are
providing the resources so the children's hospitals and nursing homes
and group
[[Page S6306]]
homes can provide adequate care to very vulnerable seniors, children
and the disabled.
Please vote for this compromise. We can't wipe out all of these
standards.
Other than that, I do not feel strongly about it.
The PRESIDING OFFICER. Who rises in opposition?
The Senator from New Mexico.
Mr. DOMENICI. Would Senator Roth like some time on this?
I will give you half the time.
Mr. ROTH. All right. Mr. President, I rise in opposition to this
amendment. It raises again the same questions that were raised in
respect to the Boren amendment. The history of the Boren amendment is a
classic example of unintended consequences as its been used to increase
costs of the program rather than control costs. The Governors are in
opposition as well as the administration.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. ROTH. I yield the floor.
The PRESIDING OFFICER. The Senator from New Mexico has 30 seconds.
Mr. DOMENICI. Mr. President, the Senate has just overwhelmingly
agreed we do not need the Boren amendment back on the horizon, and I
view this as a new, similar burden on trying to get reasonably priced
care. Perhaps it will be known in the future not as the Boren amendment
but the Wellstone amendment. But believe you me, it will be just as
egregiously antiefficient as the previous one, for there will be many,
many court interpretations of the language that is now going to be
inserted as a test of whether or not the charges are fair.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. DOMENICI. I make a point of order that amendment violates section
310 of the Budget Act.
Mr. WELLSTONE. I move to waive that.
The PRESIDING OFFICER. Is there a sufficient second on the motion to
waive? There is a sufficient second.
The yeas and nays were ordered.
Vote on Motion to Waive the Budget Act
The PRESIDING OFFICER. The question is on agreeing to the motion to
waive. The yeas and nays have been ordered. The clerk will call the
roll.
The legislative clerk called the roll.
Mr. FORD. I announce that the Senator from Ohio [Mr. Glenn] is
necessarily absent.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
who desire to vote?
The yeas and nays resulted--yeas 39, nays 60, as follows:
[Rollcall Vote No. 125 Leg.]
YEAS--39
Akaka
Baucus
Biden
Bingaman
Boxer
Bumpers
Byrd
Chafee
Cleland
Conrad
Daschle
Dodd
Dorgan
Durbin
Feinstein
Ford
Frist
Graham
Harkin
Hollings
Inouye
Jeffords
Johnson
Kennedy
Kerry
Lautenberg
Leahy
Levin
Lieberman
Mikulski
Moseley-Braun
Murray
Reed
Reid
Rockefeller
Sarbanes
Torricelli
Wellstone
Wyden
NAYS--60
Abraham
Allard
Ashcroft
Bennett
Bond
Breaux
Brownback
Bryan
Burns
Campbell
Coats
Cochran
Collins
Coverdell
Craig
D'Amato
DeWine
Domenici
Enzi
Faircloth
Feingold
Gorton
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
Hutchinson
Hutchison
Inhofe
Kempthorne
Kerrey
Kohl
Kyl
Landrieu
Lott
Lugar
Mack
McCain
McConnell
Moynihan
Murkowski
Nickles
Robb
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Warner
NOT VOTING--1
Glenn
The PRESIDING OFFICER. On this vote the yeas are 38; the nays are 61.
Three-fifths of the Senators duly chosen and sworn not having voted in
the affirmative, the motion is not agreed to. The point of order is
sustained and the amendment falls.
Mr. DOMENICI. Mr. President, I move to reconsider the vote.
The PRESIDING OFFICER. Without objection, the motion to reconsider is
laid on the table.
The motion to lay on the table was agreed to.
Mr. FRIST addressed the Chair.
The PRESIDING OFFICER. The Senator from Tennessee.
Change of Vote
Mr. FRIST. Mr. President, on rollcall vote No. 125, it was my
intention to vote nay. I ask unanimous consent that I be permitted to
change my vote. This will in no way change the outcome of the vote.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The foregoing tally has been changed to reflect the above order.)
The PRESIDING OFFICER. The Senator from New Mexico.
Amendment No. 497 Withdrawn
Mr. DOMENICI. Mr. President, amendment No. 497, of Senator Kohl, I
move to withdraw that in his behalf.
The PRESIDING OFFICER. Without objection, it is so ordered.
Amendment No. 497 was withdrawn.
Amendment No. 498
Mr. DOMENICI. There are two amendments we are going to accept, and
then we will proceed to a Kennedy education amendment. The first is a
Harkin amendment, No. 498, on microdemonstration programs for welfare
recipients under small business. Senator Harkin, we have agreed to
accept that. There is no objection on either side.
Mr. HARKIN. I appreciate that very much. I thank the chairman.
Mr. DOMENICI. I ask consent Senator Bond, chairman of the Small
Business Committee, and Senator Domenici, be cosponsors.
The PRESIDING OFFICER. Without objection, it is so ordered.
The PRESIDING OFFICER. If there be no further debate, the question is
on agreeing to the amendment.
The amendment (No. 498) was agreed to.
Mr. DOMENICI. Mr. President, I move to reconsider the vote.
The PRESIDING OFFICER. Without objection, that motion is laid on the
table.
The motion to lay on the table was agreed to.
Amendment No. 491
Mr. DOMENICI. Senator Baucus has an amendment, No. 491, regarding
cost-sharing provisions. We are prepared to accept that amendment at
this time.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, the chairman of the committee has
adequately described the amendment. I very much appreciate that he will
accept the amendment.
THE PRESIDING OFFICER. If there be no further debate, the question is
on agreeing to the amendment.
The amendment (No. 491) was agreed to.
Mr. DOMENICI. Mr. President, I move to reconsider the vote.
The PRESIDING OFFICER. Without objection, the motion to reconsider is
laid on the table.
The motion to lay on the table was agreed to.
Amendment No. 490
Mr. DOMENICI. Now I believe amendment No. 490 by Senator Kennedy is
next.
The PRESIDING OFFICER. We shall not proceed to it until we have
order. The Senator from Massachusetts is recognized for 1 minute.
Mr. DOMENICI. Will the Senator yield for a moment?
Mr. KENNEDY. Yes.
Mr. DOMENICI. Let me say for Senators' benefit, it looks like there
are only three to four amendments left. So, if you can bear with us for
just a little longer, I know this has been an ordeal. The only
remaining thing after that would be the points of order, if any, that
they might have on the Democrat side.
Mr. LAUTENBERG. We have a few.
Mr. DOMENICI. I yield the floor.
The PRESIDING OFFICER. If we could get the attention of the Senate
again. If we could have conversations removed to the Cloakroom.
The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, I yield myself 40 seconds, 20 seconds to
my colleague, Senator Dodd. We offered this together.
This amendment is supported by the American Council on Education and
virtually all of the higher education agencies and organizations, as
well as the student organizations. Effectively, it will reduce tuitions
by $1.4 billion over the next 5 years, and it is fully paid for by the
reduction in terms of the guarantees to the guaranty agencies from 98
to 95 percent of the loans.
[[Page S6307]]
There are offsets there. The process that we have done in terms of the
offsets is virtually identical to what was done by the Republican
initiative in the reconciliation bill. I hope it will be successful. It
will reduce student tuitions by at least $70.
Mr. DODD. Mr. President, there are $26 billion outstanding in student
loans. This amendment has two parts. It does away with the
automatically required administrative cost allowance, which is
unnecessary. That can be dealt with in the higher education bill. And
it cuts in half the origination fees, 4 percent to 2. It is a very big
issue for families.
The PRESIDING OFFICER. Who rises in opposition?
Mr. JEFFORDS. Mr. President, I rise in opposition to the amendment
offered by the Senator from Massachusetts, [Mr. Kennedy]. Briefly, this
amendment would rewrite title VII of the reconciliation bill, which
includes the student loan provisions reported by the Committee on Labor
and Human Resources by a vote of 17 to 1.
I have two major reasons for opposing this amendment. First, it will
harm students by destabilizing the guaranteed loan program; and,
second, it addresses issues which belong in the debate of
reauthorization of the Higher Education Act--not the budget
reconciliation bill.
Let me be clear. Adoption of the Kennedy amendment will harm
students--not help them. No one in the Senate is more committed to
improving educational opportunities than I am. I have worked to
strengthen student loan programs for over 22 years. If I honestly
believed that this amendment was in the best interests of students, I
would support it. It is precisely because of my commitment to the well
being of students, however, that I so strongly oppose this amendment.
I want to take a few minutes to explain exactly why this amendment is
not in the best interests of students or their families and why it was
rejected when it was considered by the Labor Committee.
First of all, it is important to understand that the proposal which
was approved by the committee was carefully crafted to preserve two
viable student loan programs--the Federal Family Education Loan [FFEL]
Program, guaranteed loans, and the Federal Direct Loan Program. This
proposal respects the so-called truce between the two programs which
was reflected in the portion of the budget agreement calling for a fair
distribution of savings between the two programs.
The amendment of the Senator from Massachusetts breaks this truce. In
the name of helping students, this amendment would drain such a
substantial portion of funds from guaranty agencies that the
Congressional Budget Office estimate of the amendment assumes the
failure of many of these agencies.
The provisions approved by the committee already recapture $1 billion
in guaranty agency reserve funds over the next 5 years. The recall of
these funds is conducted in such a way that guaranty agencies with low
reserves--Arkansas, Connecticut, Georgia, Illinois, Massachusetts,
Minnesota, Nebraska, New Hampshire, Oklahoma, Texas, Vermont,
Washington, and Wisconsin--will not be forced to close their doors to
the students who depend upon them.
The Kennedy amendment would nearly double the savings expected from
guaranty agencies--calling for an additional $960 million reduction
over 5 years. Because the amendment eliminates any assurance that
guaranty agencies will receive an administrative cost allowance [ACA]
from section 458 funds, the reductions absorbed by guaranty agencies
could well be even higher.
The guaranteed student loan program serves 80 percent of the
institutions of higher education in this country and provides over 60
percent of total student loan volume. Yet, the Kennedy amendment makes
no provision whatsoever for mitigating the severe disruption to student
borrowers which will occur when agencies inevitably fail. If the goal
is to enhance the direct loan program by crippling the guaranteed
program, this amendment will be remarkably effective. However, if the
goal truly is to help students, we should be working together in the
appropriate forum--which is reauthorization, not reconciliation.
Moreover, I would note that the proposed reduction in the loan
origination fee charged to students would not take effect until July
1998. There is no compelling reason to consider this provision outside
of the current effort to reauthorize the Higher Education Act.
Before closing, I would like to take a few minutes to discuss the
proposal that was approved by the Labor Committee and provide the
history and context for this debate.
The budget agreement approved by the Senate reflects the strong
bipartisan support for education. The agreement provides for $35
billion in education related tax provisions, and assumes increased
Federal support for special education, Head Start, and funding for
literacy programs. The budget agreement supports providing an
additional $7.6 billion for Pell grants allowing the maximum grant to
grow from $2,700 to $3,000.
In addition, the subsidy for student loans is assumed to grow from
$3.9 billion in 1998 to $4.1 billion in 2002. This will support growth
in Federal student loan volume from $28.8 billion in 1998 to $35.8
billion in 2002. These provisions provide an unprecedented level of
support for educational opportunity for students at all levels of
education.
In order to accommodate this unprecedented level of support for
students, the Senate budget resolution requires $1.792 billion in
savings over 5 years from mandatory spending under the jurisdiction of
the Committee on Labor and Human Resources.
The savings required by the agreement and submitted by the committee
will not increase costs, reduce benefits, or limit access to loans for
students and their families. In accordance with the budget agreement,
this proposal attempts to maintain an equitable balance in the savings
that are taken from the Federal Family Education Loan Program [FFEL]
and the Federal Direct Lending Program [FDLP].
The budget submission approved by the committee achieves the required
savings by recalling $1.028 billion in excess guaranty agency reserves,
eliminating the $10 direct loan origination fee, and reducing the
Department of Education's entitlement for the administration of the
Federal direct lending program by $604 million. This language preserves
a very delicate balance--it achieves major savings and preserves the
viability of both loan programs, so that students will not be at risk
of losing access to loans. The key provisions of title VII as reported
by the Committee on Labor and Human Resources include:
A. Elimination of the Direct Lending Loan Origination Payment
This proposal repeals the provision authorizing the Federal payment
of $10 per loan to schools and/or alternate originators who make direct
loans. This repeal will provide five-year savings of $160 million.
B. Recall of Excess Guaranty Agency Reserves
The committee proposal requires the recall of $1.028 billion in
reserves and requires each guaranty agency to deposit its share of the
total excess reserves into a newly created restricted account in annual
payments over the next five years.
C. Reductions in Section 458 Expenditures
Section 458 of the Higher Education Act provides funds to the
Secretary of Education for the administrative expenses associated with
the direct lending program as well as the administrative cost allowance
paid to guaranty agencies for administration of FFEL programs. The
committee proposal reduces section 458 expenditures in conformity with
the budget agreement resulting in savings of $603 million over 5 years.
The Department will continue to receive over $3.3 billion in this
account over the next 5 years.
In order to ensure that these reductions are not redirected from
direct lending to the FFEL program and to ensure that an equitable
balance in savings is maintained between the two programs, the
committee included a provision that reaffirms the Department of
Education's obligation to continue to pay the administrative cost
allowance to the guaranty agencies. This authority is capped at $170
million in each of fiscal years 1998 and 1999 and at $150 million in
fiscal years 2000, 2001, and 2002.
In summary, these provisions reflect a commitment to preserving two
viable student loan programs. Second, they reflect the belief that
substantive
[[Page S6308]]
changes in student aid policy should not be included within
reconciliation but should be fully and carefully considered as part our
comprehensive effort to reauthorize the Higher Education Act.
Consistent with these principles, our proposal meets our budget
instruction, preserves two loan programs, and retains the framework of
the budget agreement. It deserves the support of the full Senate.
Finally, let me say that we are here today due to the budget
agreement reached between the President and the leadership of the House
and Senate. Whatever the disagreements may be about specific details,
there is broad support for this agreement and its objectives. That is
illustrated by the 17-to-1 vote for the Labor Committee's submission
and by the similar margins of support for the proposals reported by
other committees.
Certainly, the agreement is a series of compromises. Implicit in
compromise is the fact that neither party got everything it wanted. In
the student loan area, the core compromise was that a truce was to be
declared in the battle between the Federal Family Education Loan
Program--guaranteed loans--and the Federal Direct Loan Program. The
approximately $1.8 billion in savings was to be equitably divided
between the two programs.
The proposal reported by the committee honors that compromise: 57
percent of the savings are made in the guaranteed loan program and the
remaining 43 percent come from direct lending. The amendment of the
Senator from Massachusetts would destroy that balance.
When filling in the detail of a broad compromise, there is always the
urge to push further toward one's preference. What the Senator is
attempting to do is therefore understandable. But, we need to recognize
the amendment for what it is. I urge my colleagues to join me in
opposing it.
Mr. DOMENICI. I thank the Senator, the chairman of the committee on
Labor, Health and Human Resources. The chairman opposes this.
Mr. President, the Kennedy amendment is a substitute to the Labor
Committee's title. It violates the bipartisan agreement that we made
with the President and with Democrats and Republicans. It is not
germane to this bill before us. It violates the Byrd rule because it
increases spending in the year 2002 and thereafter without any offsets.
The Kennedy amendment reduces the student loan origination fees, and is
offset by significant reductions in revenues to the lenders and
guaranty agencies participating in student loan programs.
With that, I make a point of order that the Kennedy amendment is a
violation of the Budget Act and the Byrd amendment.
Mr. DODD. I move to waive.
Mr. President, 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.
Vote on Motion to Waive the Budget Act
The PRESIDING OFFICER. The question is on agreeing to the motion. The
yeas and nays have been ordered.
The clerk will call the roll.
The legislative clerk called the roll.
The PRESIDING OFFICER. Are there any Senators in the Chamber who
desire to change their vote?
The yeas and nays resulted, yeas 43, nays 57, as follows:
[Rollcall Vote No. 126 Leg.]
YEAS--43
Akaka
Baucus
Biden
Bingaman
Boxer
Breaux
Bryan
Bumpers
Byrd
Cleland
Conrad
Daschle
Dodd
Dorgan
Durbin
Feingold
Feinstein
Ford
Glenn
Graham
Harkin
Hollings
Inouye
Kennedy
Kerrey
Kerry
Kohl
Lautenberg
Leahy
Levin
Lieberman
Mikulski
Moseley-Braun
Moynihan
Murray
Reed
Reid
Robb
Rockefeller
Sarbanes
Torricelli
Wellstone
Wyden
NAYS--57
Abraham
Allard
Ashcroft
Bennett
Bond
Brownback
Burns
Campbell
Chafee
Coats
Cochran
Collins
Coverdell
Craig
D'Amato
DeWine
Domenici
Enzi
Faircloth
Frist
Gorton
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
Hutchinson
Hutchison
Inhofe
Jeffords
Johnson
Kempthorne
Kyl
Landrieu
Lott
Lugar
Mack
McCain
McConnell
Murkowski
Nickles
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Warner
The PRESIDING OFFICER. On this vote, the yeas are 43, the nays are
57. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected. The point of order is
sustained, and the amendment falls.
Mr. DOMENICI. Mr. President, I move to reconsider the vote by which
the motion was rejected.
Mr. LAUTENBERG. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
amendment no. 490
Mr. SPECTER. Mr. President, I want to address my vote on the Kennedy-
Dodd amendment regarding savings to be generated from direct and
guaranteed loan programs. Although, I have ardently supported efforts
to increase Pell grants and improve the ability of millions of American
families to afford a college education for their children, the Kennedy-
Dodd amendment would have disrupted the guaranteed student loan program
substantially. It would have upset the balanced approach in the budget
agreement to derive savings equitably from both direct and guaranteed
loan programs.
I am advised that the Kennedy-Dodd amendment would create undue
hardship on student borrowers by adversely impacting guaranteed
lenders, which would lose part of their loan origination fees.
I look forward to working with Chairman Jeffords, Senator Kennedy,
and Senator Dodd as the Senate considers these issues in the context of
the Higher Education Act reauthorization later in the 105th Congress.
Motion to Waive the Budget Act Withdrawn
Mr. DOMENICI. Mr. President, I ask that the motion of the Senator
from Texas to waive the Budget Act with respect to the point of order
lodged by Senator Conrad last night be withdrawn.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DOMENICI. Senator Conrad had lodged the point of order.
The PRESIDING OFFICER. The regular order is the amendment by Senator
McCain.
Mr. DOMENICI. We have to complete business on this. We have withdrawn
the waiver.
Mr. CONRAD addressed the Chair.
The PRESIDING OFFICER. The Senator from North Dakota.
Point of Order
Mr. CONRAD. Mr. President, I make a point of order that section 5822
of the bill violates section 313(b)(1)(D) of the Budget Act.
The PRESIDING OFFICER. The point of order is sustained.
Mr. DOMENICI. And the amendment falls?
The PRESIDING OFFICER. That is correct.
Amendment No. 474
Mr. DOMENICI. Mr. President, I believe the next order of business is
Senator McCain's amendment. That is amendment No. 474. That is McCain-
Lott-Domenici.
Amendment No. 474, As Modified
Mr. DOMENICI. I ask unanimous consent that I be permitted to modify
that amendment by adding just the following words: ``. . . including
emergency auto service by nonprofit organizations, that . . .'' I send
the modification to the desk, and I understand the minority has no
objection to the modification.
The PRESIDING OFFICER. Is there objection? Without objection, it is
so ordered. The amendment is so modified.
The amendment, as modified, is as follows:
On page 92, beginning with line 6, strike through line 24
on page 128 and insert the following:
SEC. 3001. SPECTRUM AUCTIONS.
(a) Extension and Expansion of Auction Authority.--
(1) In general.--Section 309(j) of the Communications Act
of 1934 (47 U.S.C. 309(j)) is amended--
(A) by striking paragraphs (1) and (2) and inserting in
lieu thereof the following:
``(1) General authority.--If mutually exclusive
applications are accepted for any initial license or
construction permit that will involve an exclusive use of the
electromagnetic spectrum, then, except as provided
[[Page S6309]]
in paragraph (2), the Commission shall grant the license or
permit to a qualified applicant through a system of
competitive bidding that meets the requirements of this
subsection. The Commission, subject to paragraphs (2) and (7)
of this subsection, also may use auctions as a means to
assign spectrum when it determines that such an auction is
consistent with the public interest, convenience, and
necessity, and the purposes of this Act.
``(2) Exceptions.--The competitive bidding authority
granted by this subsection shall not apply to a license or
construction permit the Commission issues--
``(A) for public safety services, including private
internal radio services used by State and local governments
and non-government entities, including Emergency Auto Service
by non-profit organizations, that
``(i) are used to protect the safety of life, health, or
property; and
``(ii) are not made commercially available to the public;
``(B) for public telecommunications services, as defined in
section 397(14) of this Act, when the license application is
for channels reserved for noncommercial use;
``(C) for spectrum and associated orbits used in the
provision of any communications within a global satellite
system;
``(D) for initial licenses or construction permits for new
digital television service given to existing terrestrial
broadcast licensees to replace their current television
licenses;
``(E) for terrestrial radio and television broadcasting
when the Commission determines that an alternative method of
resolving mutually exclusive applications serves the public
interest substantially better than competitive bidding; or
``(F) for spectrum allocated for unlicensed use pursuant to
part 15 of the Commission's regulations (47 C.F.R. part 15),
if the competitive bidding for licenses would interfere with
operation of end-user products permitted under such
regulations.'';
(B) by striking ``1998'' in paragraph (11) and inserting
``2007''; and
(C) by inserting after paragraph (13) the following:
``(14) Out-of-Band Effects.--The Commission and the
National Telecommunications and Information Administration
shall seek to create incentives to minimize the effects of
out-of-band emissions to promote more efficient use of the
electromagnetic spectrum. The Commission and the National
Telecommunications and Information Administration also shall
encourage licensees to minimize the effects of
interference.''
(2) Conforming amendment.--Subsection (i) of section 309 of
the Communications Act of 1934 is repealed.
(b) Auction of 45 Megahertz Located at 1,710-1,755
Megahertz.--
(1) In general.--The Commission shall assign by competitive
bidding 45 megahertz located at 1,710-1,755 megahertz no
later than December 31, 2001, for commercial use.
(2) Federal government users.--Any Federal government
station that, on the date of enactment of this Act, is
assigned to use electromagnetic spectrum located in the
1,710-1,755 megahertz band shall retain that use until
December 31, 2003, unless exempted from relocation.
(c) Commission to Make Additional Spectrum Available by
Auction.--
(1) In general.--The Federal Communications Commission
shall complete all actions necessary to permit the
assignment, by September 30, 2002, by competitive bidding
pursuant to section 309(j) of the Communications Act of 1934
(47 U.S.C. 309(j)), of licenses for the use of bands of
frequencies currently allocated by the Commission that--
(A) in the aggregate span not less than 55 megahertz;
(B) are located below 3 gigahertz; and
(C) as of the date of enactment of this Act, have not
been--
(i) designated by Commission regulation for assignment
pursuant to section 309(j);
(ii) identified by the Secretary of Commerce pursuant to
section 113 of the National Telecommunications and
Information Administration Organization Act (47 U.S.C. 923);
or
(iii) allocated for Federal Government use pursuant to
section 305 of the Communications Act of 1934 (47 U.S.C.
305).
(2) Criteria for Reassignment.--In making available bands
of frequencies for competitive bidding pursuant to paragrph
(1), the Commission shall--
(A) seek to promote the most efficient use of the
electromagnetic spectrum;
(B) consider the cost of incumbent licensees of relocating
existing uses to other bands of frequencies or other means of
communication;
(C) consider the needs of public safety radio services;
(D) comply with the requirements of international
agreements concerning spectrum allocations; and
(E) coordinate with the Secretary of Commerce when there is
any impact on Federal Government spectrum use.
(3) Notification to the Secretary of Commerce.--The
Commission shall attempt to accommodate incumbent licenses
displaced under this section by relocating them to other
frequencies available to the Commission. The Commission shall
notify the Secretary of Commerce whenever the Commission is
not able to provide for the effective relocation of an
incumbent licensee to a band of frequencies available to the
Commission for assignment. The notification shall include--
(A) specific information on the incumbent licensee;
(B) the bands the Commission considered for relocation of
the licensee; and
(C) the reasons the incumbent cannot be accommodated in
these bands.
(4) Report to the Secretary of Commerce.--
(A) Technical report.--The Commission in consultation with
the National Telecommunications and Information
Administration, shall submit a detailed technical report to
the Secretary of Commerce setting forth--
(i) the reasons the incumbent licensees described in
paragraph (5) could not be accommodated in existing non-
government spectrum; and
(ii) the Commission's recommendations for relocating those
incumbents.
(B) NTIA use of report.--The National Telecommunications
and Information Administration shall review this report when
assessing whether a commercial licensee can be accommodated
by being reassigned to a frequency allocated for government
use.
(d) Indentification and Reallocation of Frequencies.--
(1) In general.--Section 113 of the National
Telecommunications and Information Administration
Organization Act (47 U.S.C. 901 et seq.) is amended by adding
at the end thereof the following:
``(f) Additional Reallocation Report.--If the Secretary
receives a report from the Commission pursuant to section
3001(c)(6) of the Balanced Budget Act of 1997, the Secretary
shall submit to the President, the Congress, and the
Commission a report with the Secretary's recommendations.
``(g) Reimbursement of Federal Spectrum Users for
Relocation Costs.--
``(1) In general.--
``(A) Acceptance of compensation authorized.--In order to
expedite the efficient use of the electromagnetic spectrum,
and notwithstanding section 3302(b) of title 31, United
States Code, any Federal entity that operates a Federal
Government station that has been identified by NTIA for
relocation may accept payment, including in-kind compensation
and shall be reimbursed if required to relocate by the
service applicant, provider, licensee, or representative
entering the band as a result of a license assignment by the
Commission or otherwise authorized by Commission rules.
``(B) Duty to compensate ousted federal entity.--Any such
service applicant, provider, licensee, or representative
shall compensate the Federal entity in advance for relocating
through monetary or in-kind payment for the cost of
relocating the Federal entity's operations from one or more
electromagnetic Spectrum frequencies to any other frequency
or frequencies, or to any other telecommunications
transmission media.
``(C) Compensable costs.--Compensation shall include, but
not be limited to, the costs of any modification,
replacement, or reissuance of equipment, facilities,
operating manuals, regulations, or other relocation expenses
incurred by that entity.
``(D) Disposition of payments.--Payments, other than in-
kind compensation, pursuant to this section shall be
deposited by electronic funds transfer in a separate agency
account or accounts which shall be used to pay directly the
costs of relocation, to repay or make advances to
appropriations or funds which do or will initially bear all
or part of such costs, or to refund excess sums when
necessary, and shall remain available until expended.
``(E) Application to certain other relocations.--The
provisions of this paragraph also apply to any Federal entity
that operates a Federal Government station assigned to use
electromagnetic spectrum identified for reallocation under
subsection (a), if before the date of enactment of the
Balanced Budget Act of 1997 the Commission has not identified
that spectrum for service or assigned licenses or otherwise
authorized service for that spectrum.
``(2) Petitions for relocation.--Any person seeking to
relocate a Federal Government station that has been assigned
a frequency within a band allocated for mixed Federal and
non-Federal use under this Act shall submit a petition for
relocation to NTIA. The NTIA shall limit or terminate the
Federal Government station's operating license within 6
months after receiving the petition if the following
requirements are met:
``(A) The proposed relocation is consistent with
obligations undertaken by the United States in international
agreements and with United States national security and
public safety interests.
``(B) The person seeking relocation of the Federal
Government station has guaranteed to defray entirely, through
payment in advance, advance in-kind payment of costs, or a
combination of payment in advance and advance in-kind
payment, all relocation costs incurred by the Federal entity,
including, but not limited to, all engineering, equipment,
site acquisition and construction, and regulatory fee costs.
``(C) The person seeking relocation completes all
activities necessary for implementing the relocation,
including construction of replacement facilities (if
necessary and appropriate) and identifying and obtaining on
the Federal entity's behalf new frequencies for use by the
relocated Federal Government station (if the station is not
relocating to spectrum reserved exclusively for Federal use).
``(D) Any necessary replacement facilities, equipment
modifications, or other changes
[[Page S6310]]
have been implemented and tested by the Federal entity to
ensure that the Federal Government station is able to
accomplish successfully its purposes including maintaining
communication system performance.
``(E) The Secretary has determined that the proposed use of
any spectrum frequency band to which a Federal entity
relocates its operations is suitable for the technical
characteristics of the band and consistent with other uses of
the band. In exercising authority under this subparagraph,
the Secretary shall consult with the Secretary of Defense,
the Secretary of State, and other appropriate Federal
officials.
``(3) Right to reclaim.--If within one year after the
relocation of a Federal Government station, the Federal
entity affected demonstrates to the Secretary and the
Commission that the new facilities or spectrum are not
comparable to the facilities or spectrum from which the
Federal Government station was relocated, the person who
sought the relocation shall take reasonable steps to remedy
any defects or pay the Federal entity for the costs of
returning the Federal Government station to the
electromagnetic spectrum from which the station was
relocated.
``(h) Federal Action To Expedite Spectrum Transfer.--Any
Federal Government station which operates on electromagnetic
spectrum that has been identified for reallocation under this
Act for mixed Federal and non-Federal use in any reallocation
report under subsection (a), to the maximum extent
practicable through the use of subsection (g) and any other
applicable law, shall take prompt action to make
electromagnetic spectrum available for use in a manner that
maximizes efficient use of the electromagnetic spectrum.
``(i) Federal Spectrum Assignment Responsibility.--This
section does not modify NTIA's authority under section
103(b)(2)(A) of this Act.
``(j) Definitions.--As used in this section--
``(1) The term `Federal entity' means any department,
agency, or instrumentality of the Federal Government that
utilizes a Government station license obtained under section
305 of the 1934 Act (47 U.S.C. 305);
``(2) the term `digital television services' means
television services provided using digital technology to
enhance audio quality and video resolution, as further
defined in the Memorandum Opinion, Report, and Order of the
Commission entitled `Advanced Television Systems and Their
Impact Upon the Existing Television Service,' MM Docket No.
87-268 and any subsequent FCC proceedings dealing with
digital television; and
``(3) the term `analog television licenses' means licenses
issued pursuant to 47 CFR 73.682 et seq.''.
(2) Section 114(a) of that Act (47 U.S.C. 924(a)) is
amended by striking ``(a) or (d)(1)'' and inserting ``(a),
(d)(1), or (f)''.
(e) Identification and Reallocation of Auctionable
Frequencies.--
(1) Second report required.--Section 113(a) of the National
Telecommunications and Information Administration
Organization Act (47 U.S.C. 923(a)) is amended by inserting
``and within 6 months after the date of enactment of the
Balanced Budget Act of 1997'' after ``Act of 1993''.
(2) In general.--Section 113(b) of the National
Telecommunications and Information Administration
Organization Act (47 U.S.C. 923(b)) is amended--
(A) by striking the caption of paragraph (1) and inserting
``Initial reallocation report.--'';
(B) by inserting ``in the initial report required by
subsection (a)'' after ``recommend for reallocation'' in
paragraph (1);
(C) by inserting ``or (3)'' after ``paragraph (1)'' each
place it appears in paragraph (2); and
(D) by adding at the end thereof the following:
``(3) Second reallocation report.--The Secretary shall make
available for reallocation a total of 20 megahertz in the
second report required by subsection (a), for use other
than by Federal Government stations under section 305 of
the 1934 Act (47 U.S.C. 305), that is located below 3
gigahertz and that meets the criteria specified in
paragraphs (1) through (5) of subsection (a).''.
(3) Allocation and assignment.--Section 115 of that Act (47
U.S.C. 925) is amended--
(A) by striking ``the report required by section 113(a)'';
in subsection (b) and inserting ``the initial reallocation
report required by section 113(a)''; and
(B) by adding at the end thereof the following:
``(c) Allocation and Assignment of Frequencies Identified
in the Second Allocation Report.--
``(1) Plan.--Within 12 months after it receives a report
from the Secretary under section 113(f) of this Act, the
Commission shall--
``(A) submit a plan, prepared in coordination with the
Secretary of Commerce, to the President and to the Senate
Committee on Commerce, Science, and Transportation and the
House of Representatives Committee on Commerce, for the
allocation and assignment under the 1934 Act of frequencies
identified in the report; and
``(B) implement the plan.
``(2) Contents.--The plan prepared by the Commission under
paragraph (1) shall consist of a schedule of reallocation and
assignment of those frequencies in accordance with section
309(j) of the 1934 Act in time for the assignment of those
licenses or permits by September 30, 2002.''.
SEC. 3002. DIGITAL TELEVISION SERVICES.
Section 309(j) of the Communications Act of 1934 (47 U.S.C.
309(j)) is amended by adding at the end thereof the
following:
``(15) Auction of recaptured broadcast television spectrum
and potential digital television license fees.--
``(A) Limitations on terms of terrestrial television
broadcast licenses.--
``(i) A television license that authorizes analog
television services may not be renewed to authorize such
services for a period that extends beyond December 31, 2006.
The Commission shall extend or waive this date for any
station in any television market unless 95 percent of the
television households have access to digital local television
signals, either by direct off-air reception or by other
means.
``(ii) A commercial digital television license that is
issued shall expire on September 30, 2003. A commercial
digital television license shall be re-issued only subject to
fulfillment of the licensee's obligations under subparagraph
(C).
``(iii) No later than December 31, 2001, and every 2 years
thereafter, the Commission shall report to Congress on the
status of digital television conversion in each television
market. In preparing this report, the Commission shall
consult with other departments and agencies of the Federal
government. The report shall contain the following
information:
``(I) Actual consumer purchases of analog and digital
television receivers, including the price, availability, and
use of conversion equipment to allow analog sets to receive a
digital signal.
``(II) The percentage of television households in each
market that has access to digital local television signals as
defined in paragraph (a)(1), whether such access is attained
by direct off-air reception or by some other means.
``(III) The cost to consumers of purchasing digital
television receivers (or conversion equipment to prevent
obsolescence of existing analog equipment) and other related
changes in the marketplace, such as increases in the cost of
cable converter boxes.
``(B) Spectrum reversion and resale.--
``(i) The Commission shall--
``(I) ensure that, as analog television licenses expire
pursuant to subparagraph (A)(i), each broadcaster shall
return electromagnetic spectrum according to the Commission's
direction; and
``(II) reclaim and organize the electromagnetic spectrum in
a manner to maximize the deployment of new and existing
services.
``(ii) Licensees for new services occupying electromagnetic
spectrum previously used for the broadcast of analog
television shall be selected by competitive bidding. The
Commission shall start the competitive bidding process by
July 1, 2001, with payment pursuant to the competitive
bidding rules established by the Commission. The Commission
shall report the total revenues from the competitive bidding
by January 1, 2002.
``(D) Definitions.--As used in this paragraph--
``(i) the term `digital television services' means
television services provided using digital technology to
enhance audio quality and video resolution, as further
defined in the Memorandum Opinion, Report, and Order of the
Commission entitled `Advanced Television Systems and Their
Impact Upon the Existing Television Service,' MM Docket No.
87-268 and any subsequent Commission proceedings dealing with
digital television; and
``(ii) the term `analog television licenses' means licenses
issued pursuant to 47 CFR 73.682 et seq. .''.
SEC. 3003. ALLOCATION AND ASSIGNMENT OF NEW PUBLIC SAFETY AND
COMMERCIAL LICENSES.
(a) In General.--The Federal Communications Commission, not
later than January 1, 1998, shall allocate from
electromagnetic spectrum between 746 megahertz and 806
megahertz--
(1) 24 megahertz of that spectrum for public safety
services according to terms and conditions established by the
Commission, in consultation with the Secretary of Commerce
and the Attorney General; and
(2) 36 megahertz of that spectrum for commercial purposes
to be assigned by competitive bidding.
(b) Assignment.--The Commission shall--
(1) commence assignment of the licenses for public safety
created pursuant to subsection (a) no later than September
30, 1998; and
(2) commence competitive bidding for the commercial
licenses created pursuant to subsection (a) no later than
March 31, 1998.
(c) Licensing of Unused Frequencies for Public Safety Radio
Services.--
(1) Use of unused channels for public safety.--It shall be
the policy of the Federal Communications Commission,
notwithstanding any other provision of this Act or any other
law, to waive whatever licensee eligibility and other
requirements (including bidding requirements) are applicable
in order to permit the use of unassigned frequencies for
public safety purposes by a State or local government agency
upon a showing that--
(A) no other existing satisfactory public safety channel is
immediately available to satisfy the requested use;
(B) the proposed use is technically feasible without
causing harmful interference to existing stations in the
frequency band entitled to protection from such interference
under the rules of the Commission; and
(C) use of the channel for public safety purposes is
consistent with other existing public safety channel
allocations in the geographic area of proposed use.
[[Page S6311]]
(2) Applicability.--Paragraph (1) shall apply to any
application--
(A) is pending before the Commission on the date of
enactment of this Act;
(B) was not finally determined under section 402 or 405 of
the Communications Act of 1934 (47 U.S.C. 402 or 405) on May
15, 1997; or
(C) is filed after May 15, 1997.
(D) Protection of Broadcast TV Licensees During Digital
Transition.--Public safety and commercial licenses granted
pursuant to this subsection--
(1) shall enjoy flexibility in use, subject to--
(A) interference limits set by the Commission at the
boundaries of the electromagnetic spectrum block and service
area; and
(B) any additional technical restrictions imposed by the
Commission to protect full-service analog and digital
television licenses during a transition to digital
television;
(2) may aggregate multiple licenses to create larger
spectrum blocks and service areas;
(3) may disaggregate or partition licenses to create
smaller spectrum blocks or service areas; and
(4) may transfer a license to any other person qualified to
be a licensee.
(e) Protection of Public Safety Licensees During Digital
Transition.--The Commission shall establish rules insuring
that public safety licensees using spectrum reallocated
pursuant to subsection (a)(1) shall not be subject to harmful
interference from television broadcast licensees.
(f) Digital Television Allotment.--In assigning temporary
transitional digital licenses, the Commission shall--
(1) minimize the number of allotments between 746 and 806
megahertz and maximize the amount of spectrum available for
public safety and new services;
(2) minimize the number of allotments between 698 and 746
megahertz in order to facilitate the recovery of spectrum at
the end of the transition;
(3) consider minimizing the number of allotments between 54
and 72 megahertz to facilitate the recovery of spectrum at
the end of the transition; and
(4) develop an allotment plan designed to recover 78
megahertz of spectrum to be assigned by competitive bidding,
in addition to the 60 megahertz identified in paragraph (a)
of this subsection.
(g) Incumbent Broadcast Licensees.--Any person who holds an
analog television license or a digital television license
between 746 and 806 megahertz--
(1) may not operate at that frequency after the date on
which the digital television services transition period
terminates, as determined by the Commission; and
(2) shall surrender immediately the license or permit to
construct pursuant to Commission rules.
(h) Definitions.--For purposes of this section--
(1) Commission.--The term ``Commission'' means the Federal
Communications Commission.
(2) Digital television (DTV) service.--The term ``digital
television (DTV) service'' means terrestrial broadcast
services provided using digital technology to enhance audio
quality and video resolution, as further defined in the
Memorandum Opinion, Report, and Order of the Commission
entitled ``Advanced Television Systems and Their Impact Upon
the Existing Television Service,'' MM Docket No. 87-268, or
subsequent findings of the Commission.
(3) Digital television license.--The term ``digital
television license'' means a full-service license issued
pursuant to rules adopted for digital television service.
(4) Analog television license.--The term ``analog
television license'' means a full-service license issued
pursuant to 47 CFR 73.682 et seq.
(5) Public safety services.--The term ``public safety
services'' means services whose sole or principal purpose is
to protect the safety of life, health, or property.
(6) Service area.--The term ``service area'' means the
geographic area over which a licensee may provide service and
is protected from interference.
(7) Spectrum block.--The term ``spectrum block'' means the
range of frequencies over which the apparatus licensed by the
Commission is authorized to transmit signals.
SEC. 3004. FLEXIBLE USE OF ELECTROMAGNETIC SPECTRUM.
Section 303 of the Communications Act of 1934 (47 U.S.C.
303) is amended by adding at the end thereof the following:
``(y) Shall allocate electromagnetic spectrum so as to
provide flexibility of use, except--
``(1) as required by international agreements relating to
global satellite systems or other telecommunication services
to which the United States is a party;
``(2) as required by public safety allocations;
``(3) to the extent that the Commission finds, after notice
and an opportunity for public comment, that such an
allocation would not be in the public interest;
``(4) to the extent that flexible use would retard
investment in communications services and systems, or
technology development thereby lessening the value of the
electromagnetic spectrum; or
``(5) to the extent that flexible use would result in
harmful interference among users.''.
Mr. DOMENICI. I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. DOMENICI. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DOMENICI. Mr. President, this amendment is acceptable to the
other side. It is the best we can do to try to achieve spectrum
consistency with the Budget Act, and even with this amendment, we are
somewhat short.
Senator McCain does not insist on speaking. If he does, we yield to
him right now.
The PRESIDING OFFICER. The question is on agreeing to the amendment.
Mr. BYRD. Mr. President, what does the amendment do?
Mr. DOMENICI. Mr. President, this substitute amendment for title III
offered by Senator McCain, Senator Lott, and myself, will help the
committee get $4 billion closer toward its instruction on spectrum
fees, and it does this without any fees. It has been approved by the
Commerce Committee on both sides, Democrat and Republican, and there is
no objection from the minority side with reference to this amendment.
The PRESIDING OFFICER. The question is on agreeing to amendment No.
474, as modified.
The amendment (No. 474), as modified, was agreed to.
Mr. LAUTENBERG. Mr. President, I move to reconsider the vote by which
the amendment was agreed to.
Mr. DOMENICI. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. DOMENICI. Can I ask the minority, there is a D'Amato amendment we
are asking if you can clear. We are getting close to the end here.
Mr. LAUTENBERG. We will accept that.
Amendment No. 502
Mr. DOMENICI. I ask the D'Amato amendment No. 502, Medicare
antiduplication provisions, be called up. We have agreed with the
minority and they with us that this is acceptable.
The PRESIDING OFFICER. Without objection, the amendment is agreed to.
The amendment (No. 502) was agreed to.
Mr. LAUTENBERG. Mr. President, I move to reconsider the vote by which
the amendment was agreed to.
Mr. DOMENICI. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. DOMENICI. Mr. President, according to our records, we have four
amendments, but they are all waiting to see what the managers'
amendment includes in it. If it includes the proper subject matter,
then there will not be a presentation of those four amendments. So I
think the managers are working on that, and maybe we need a little bit
of time while they finish it, and the four Senators can look at it to
see if it takes care of their concerns.
The PRESIDING OFFICER. The regular order is the Kennedy amendment No.
492.
Mr. DOMENICI. Yes, that is correct.
Senator Kennedy desires to withhold his amendment to see what the
managers' amendment does; is that correct?
Mr. LAUTENBERG. Yes.
Mr. DOMENICI. Senator Kerry's amendment No. 496. I gather that you
want to wait.
Mr. LAUTENBERG. Senator Kerry wants to wait and see what the
managers' amendment does.
Mr. DOMENICI. And Senator Rockefeller's amendment No. 503, we believe
the same holds, and Senator Kennedy's amendment regarding part B.
Might I discuss a few matters with the ranking minority member? I
believe when we finish this, we will be finished with amendments. The
only thing I can imagine left would be points of order to be lodged by
anyone. We have none on our side.
Mr. LAUTENBERG. Mr. President, we have five in total that we will be
happy to show the majority. I think Senator Murray has a point of
order, and then we have the four remaining.
Mr. DOMENICI. I wonder if the time would be best spent if you let us
see those. Maybe we can dispose of those and maybe agree we not have
any votes, depending on what they are.
[[Page S6312]]
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. DOMENICI. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Coats). Without objection, it is so
ordered.
Amendment No. 506
Mr. DOMENICI. I understand that the chairman of the Finance Committee
is ready with the managers' amendment, and I yield the floor. The
amendment is numbered 506.
The PRESIDING OFFICER. The Senator from Delaware.
Modification to Amendment No. 506
Mr. ROTH. Mr. President, I ask unanimous consent that amendment No.
506, the managers' amendment, be called up, and I send a modification
to the desk.
The PRESIDING OFFICER. Without objection, it is so ordered.
Under a previous order, the Senator has a right to modify his
amendment, and the amendment is so modified.
The modification follows:
At the end of the amendment, add the following:
On page 774, strike lines 13 through 15, and insert the
following:
``(A) for fiscal year 1999, 92 percent;
``(B) for fiscal year 2000, 85 percent; and
``(C) for fiscal years 2001 and 2002, 80 percent.
On page 775, strike lines 21 through 25 and insert the
following:
``(C) States with state 1995 dsh spending amounts above 3
percent.--In the case of any State with a State 1995 DSH
spending amount that is more than 3 percent of the Federal
medical
On page 779, line 10, strike ``2000'' and insert ``2001''.
On page 779, line 11, strike ``2001'' and insert ``2002''.
On page 779, line 10, strike ``2002'' and insert ``2003 and
thereafter''.
Mr. ROTH. Mr. President, the managers' amendment with the
modification has been approved on both sides of the aisle. I urge its
adoption.
Mr. BYRD. Mr. President, could someone explain what is in the
managers' amendment?
Mr. ROTH. Yes, I am happy to explain to my distinguished friend from
West Virginia. It includes two Medicare hospital-related provisions.
The first is a modification to the Medicare PPS, exempt hospital
payments, and the second is a hospital wage index classification.
The second makes three additions to the Medicaid provisions. These
include a Grassley amendment that was adopted in committee on the
effect of managed care on individuals with special needs, a
clarification on the definition of provider taxes, and continuation of
certain 1115 waivers. There are four provisions on welfare,
clarification of the language on SSI, and Medicaid benefits of certain
Indians. It makes a conforming amendment on work activities, and it
confirms the maintenance-of-effort requirement to the existing welfare
block grant. It also requires that half of the payments for job
placement be provided after an individual has been placed in the work
force for at least 6 months.
Finally, the modification to the managers' amendment also modifies
the formula for achieving savings in the Disproportionate Share
Hospital Program. The amendment provides a smoother transition for the
States and delays the restrictions on payment to mental health
facilities.
As I said, Mr. President, all these amendments have been cleared by
both sides of the aisle. I urge their adoption.
Mr. MOYNIHAN. Mr. President, may I simply affirm the statement of the
distinguished chairman. These are agreed to on both sides of the aisle.
The PRESIDING OFFICER. Is there further debate on the amendment as
modified?
Mr. BYRD. Mr. President, I am not on the Budget Committee, I am not
on the Finance Committee, but I do have a right to have a little
knowledge of what we are voting on. By my not being a member of those
committees--it might very well be stated as to what we are voting on--I
may yet not understand it, but there are Senators in this body who can
understand. It seems to me we are going a little fast.
Is this amendment divisible?
The PRESIDING OFFICER. In the opinion of the Chair, the amendment
would be divisible.
Mr. BYRD. How many divisions would there be?
The PRESIDING OFFICER. There would be numerous divisions because the
amendment hits the bill in a number of diverse places. We are
attempting to assert the exact number.
The Senator from West Virginia is recognized.
Mr. BYRD. I yield to the distinguished Senator.
Mr. DOMENICI. Might I say to the distinguished Senator from West
Virginia, I think you have been in this position and the position of
this chairman many, many times. I do not know whether we ever have a
chance to be in exactly this position when we have a reconciliation
bill like this.
I might say, I think this amendment fits together a lot of concerns
and fulfills a lot of concerns about the bill by many, many Senators. I
hope the Senator would not ask for its division, but rather ask us to
spend more time discussing it, which I believe, even though the consent
agreement says a minute on a side, I think you might be clearly within
your rights to say: This is a managers' amendment. Could we have some
additional time? Certainly I would not object.
I objected one time in my life to giving the distinguished Senator
from West Virginia additional time when time had run out, and I vividly
remembered that for at least 5 years. It seemed like every time you
looked at me it was reminding me that I had jumped up and objected to
your getting time, additional time. I have never done that again, so I
would not do it now.
I just wonder if that makes any sense to my friend from West
Virginia.
Mr. BYRD. Mr. President, let me attempt to respond to the
distinguished Senator.
I have a sense of what my responsibility is. I do not know what is in
the managers' amendment. I have understood, in listening here, that
there are various Senators who have amendments which are qualified and
which are listed that they will call up unless the managers' amendment
is satisfactory to them in respect to their several amendments.
Now, if each amendment is called up, we at least get 2 minutes for an
explanation. We get no explanation here of what is in this managers'
amendment. It is not my desire to hold up action on this measure. It is
somewhat embarrassing to me to have to stand and admit that I don't
know what is in this amendment. I have voted on amendments today that I
had very, very slender knowledge as to what I was voting on.
I am not blaming anyone for this. I am not saying this to be critical
of anyone. But I am concerned that here we are, before the American
people, and it should be obvious to anyone who is viewing these actions
that we are taking that many of us do not know what we are doing, what
we are voting on, and these are very complex amendments. This is a very
complex bill.
We are at a great disadvantage because we have only 20 hours on a
reconciliation measure. I tried last year to get 50 hours on a
reconciliation bill, and I believe I got a majority of votes, but I
believe I lost because it ran afoul of the Byrd rule. Therefore, it
required 60 votes. Thank heavens for the Byrd rule.
But, Mr. President, I do have a duty to my own conscience, if to no
one else, and I am pretty sure I have a great duty to my constituents,
to try to find out what's in the amendment we are about to vote on. In
doing so, I am holding up the measure, I am delaying action on this
measure. I am very well aware of it.
I know the burdens that are upon the leadership, the joint
leadership. I know the burdens that are on the managers of this bill.
I, at least, have some idea. They have done well. They have had heavy
burdens. They have spent hours, they have spent hours when I was at
home with my wife, Lady Byrd, and my little dog, Billy Byrd. But they
have spent hours. I saw them working here last night. I cannot
understand a great deal in watching that tube as to what is at issue
here.
So I am considering asking for a division here. I think we have to
shock this Senate one way or another into a realization that we have to
change the rules with regard to reconciliation so that Members will
have more time
[[Page S6313]]
than we have. Here we are, we have run out of time, yet Senators have
amendments that they want votes on. It is by unanimous consent that we
have 2 minutes of explanation between each amendment. That is no way to
operate.
I cannot help it, Mr. Domenici cannot help it, Mr. Lautenberg cannot
help it, the two leaders can't help it. That's the rule, 20 hours.
There are Senators who insist on having votes on their amendments,
and I think they have a right to have votes on their amendment. We are
constrained by a rule here that just does not make sense. It may have
made sense at one time. It does not anymore. We are living at a
different time when we are under severe budget constraints and when the
administration and the leadership enter into some kind of agreement of
which I am not a part and about which I know little, other than what I
read in the newspaper.
So I have taken the floor here today to call attention to this very
sad situation in which we are expected to vote on something without
knowing what we are voting on. As I say, we are caught on the horns of
the dilemma, and I do not feel right within myself about raising these
points of concern.
Now, the distinguished manager of the measure has suggested that we
have an explanation of the amendments. That is all I am seeking in this
instance. But I think we ought to get our collective heads together and
try to work out some change in the rules whereby we will not be caught
in this kind of situation.
The American people would be ashamed of us. I think they would be
very disappointed, and disappointed in me, too. They sent me up here to
represent the people of West Virginia, and I don't know what I am
voting on here. Who can blame me? My staff can't find out overnight.
This morning when I came in, some of my staff stayed late into the
evening hours. When I came in this morning, they didn't have the
amendments available. They hadn't been printed. We just can't operate
wisely and with any kind of solid judgment in that fashion.
So I won't take more of the Senate's time now. But I do raise the
specter of asking for a division, and a request for a division under
the rules means that we vote on every divisible provision in that
measure. And if I understood the Chair in response to my parliamentary
inquiry, there must be scores of provisions which would be subject to
division.
I am not going to put the Senate through that today, but I warn the
Senate that we had better do something about this because, otherwise,
some Senator is going to feel conscience-stricken enough one day to
stand up and use the rules, and there are some Senators who know
something about the rules. So I raise that question here just to put
Senators on notice that one Senator--one Senator--can cause all
Senators to sit back and realize what we are doing and the way we are
doing it is not good, not good for the Senate, not good for the
American people.
Mr. DOMENICI. Will the Senator yield?
Mr. BYRD. Yes, I will be happy to yield.
Mr. DOMENICI. Mr. President, I could not agree with the Senator more.
But I think we have followed the rules--the general rules of the Budget
Act, plus the Byrd rule interpretations--as best we can. I think
everyone should know that one of the problems on any reconciliation
bill is that when the time has run, people can still offer amendments.
That is written right into the statute. It says that when the time has
run, you can send amendments to the desk, and I assume one could stay
forever--I don't mean literally--and they shall be voted on then and
there. I believe it says there is no time on the amendment. We have
gone from allowing 1 minute to 2 minutes to 3 minutes per amendment. We
decided we would allow Senators to offer their amendments last night,
thinking they would stay and offer them. We got caught in a trap
because Senators started walking up to me and Senator Lautenberg and
giving us their amendments and asking us, as managers, to introduce
them for them. I guess I could have said no, and the literal
interpretation would have been that if you are not going to be around
here, you are not going to offer them.
That was the genesis of what happened this morning. We put them all
in order and tried to encapsulate them so you could understand them,
and there were 64 of them, plus a couple of points of order. So we have
done the best we could. As a matter of fact, I am very grateful. I
would guess that more than 30 amendments were withdrawn--maybe 35.
Others were clearly very simple amendments, and maybe in adopting them
we should have used a little more words of explanation than we did. If
that is the case, as to any Senator or anybody listening, we will just
try to do better. But that situation is the law.
Now, the law is, as you say it also. You can still divide those
amendments and have that minute on every one, I assume. You know the
rules better than I. I have learned them a little bit now. But I
believe, from this point on, we only have a few left. We would be very
glad on this one--I asked the chairman, and he would be glad to explain
it now as much as you would like and answer any questions. I understand
we would only have a few more, and three or four points of order, and,
finally, this ordeal will be behind us. Again, you have reminded us of
our responsibility. I thank the Senator for that.
Mr. BYRD. Mr. President, I don't need to remind the distinguished
Senator from New Mexico of his responsibility or any other Senator of
his or her responsibility. As I said earlier, I am not complaining
about anyone. I sympathize and empathize with the managers of the
measure. They have done the best they could. You can't do any better.
We have all been caught in this situation. It is not to our liking. But
the distinguished manager, the chairman of the Finance Committee,
sought to explain to me a minute ago, in 2 minutes, what was in this
managers' packet. I didn't know anything, and when he completed, I
didn't know any more than when he started. As a matter of fact, I was
probably more confused. I think we would have had a little better
explanation if we had a division and had each amendment explained.
Mr. LAUTENBERG. If the Senator will yield, I would like to make a
comment. When Senator Byrd makes a statement, talks about a rule, talks
about the process, I think it is kind of like the investment banker's
advertising slogan that ``when they talk, everybody listens.'' When
Senator Byrd speaks here, everybody listens, and much of the country at
the same time, because of the experience and knowledge that he brings
to this body and the concern that he has for being forthright with our
constituents.
I would just like to say this to the Senator. There was a degree of
diligence--excessive haste, I agree. I will say one thing. I think that
we appropriately learned a lesson about the process of stacking votes.
I even suggested to the distinguished Senator from West Virginia that
perhaps another Byrd rule could be put into place. I don't have the
courage to offer it in my own name. But another Byrd rule might say
that no more than 5 amendments, or 4 or 5 votes, or something like
that, could be stacked at any time so that we would not get ourselves
into this mad dash not to deceive and not to obscure, but rather to
accommodate this very complicated process.
As the Senator from West Virginia knows, the Senator from New Mexico
and I spent roughly 2 months, almost every day, reviewing and
negotiating the points in the budget agreement. We tried--I speak for
myself, and I am sure the same situation occurred on the Republican
side of the aisle--to keep our members on the committee informed
because, as the distinguished former chairman of the Appropriations
Committee knows, it is very hard to conduct an honest negotiation and
debate when there are 20 people in the room. So what we tried to do is
consolidate a consensus view and do it that way. So we met with the
committee members and then we met with the members of the Democratic
Caucus, because there were questions that arose.
So I have to say this to the distinguished Senator. In my 15 years
here, I honestly don't think that there has been a tighter review of
matters related to the budget resolution than I have seen, because I
have been on the Budget Committee almost all of the time that I have
been here. We kept learning
[[Page S6314]]
each year. I found the chairman of the Budget Committee, the Senator
from New Mexico, good to work with. We had lots of different views, but
the one thing that we didn't differ on is that the other person had a
right to respect, a right to offer their opinion, and we did it that
way. It got tedious at times, especially when one could not listen to
one's self. On the other hand, we did gain, seriously, a lot of
knowledge during that period.
I would say this. As I look around the room, we have experts in
specific areas. If you want to talk about health, you know you would be
talking quickly to the Senator from Massachusetts, and others on
different matters of concern. And these matters were reviewed, not
perhaps as thoroughly as we would have liked because we were committed
to a time constraint overall. But, last night, I was here with the
distinguished chairman of the Finance Committee until past 10 o'clock--
about 10:30--and we were hung up on a single amendment, reviewing it
and trying to get into a position that we felt would satisfy our
respective constituencies in the Senate, and back home, and across the
country, as well. So the effort was put in.
I think there is a mistake in the process, or a fault in the process,
that needs to be corrected. I thank the Senator for raising the issue
because, in these last hours, I have heard complaints from other
Members of the Senate, as well, about this being too quick, too rushed.
But we had a commitment. This is an unusual budget, a budget committed
to a goal of zero deficit in 5 years. A lot was packed into it. The
negotiations included members of the administration. It has been a very
complicated, very tedious process, but no one, in my view shirked their
responsibility.
I hope that, from this point forward, we will remember another Byrd
lesson. I remember many of them. Despite my white hair, I feel like I
am going to ``professor'' Byrd's class when I do attend appropriations
meetings or other meetings. I would say this, ``professor": I don't
know what kind of a report card I have gotten, but I hope that it is
better than a failing one and that you will say, OK, go forward and
learn from this and next time I want to see a better performance. Thank
you very much.
Mr. BYRD. Mr. President, I don't propose to have the answer to this
problem. But it just seems to me that we are always caught up against a
holiday, where we have a break the next week. And here we have this
bill, and we will have the tax portion of the reconciliation process
that will follow after that. And we are asked to cut a little of the
time off here, cut a little off there. It would seem to me that if we
could get started on these measures earlier, we would not be faced with
a situation in which the managers have to stay here far into the
evening hours, while other Senators go home. It seems to me that if we
had been able to get to this measure earlier, we could have had more
time. But here we are, and it seems to work out this way upon every
occasion, where we are backed up to a wall of some kind, where there is
the attempt to cut 20 hours down to 15, 12, or 10, or an attempt to cut
50 down to 40 on the budget resolution. We always get the question,
``Would you be willing to cut some time off of the 40 hours, cut it
down to 30?'' ``Would you be willing to go home and come back Monday
and say that 15 of the hours, or 10 hours, or 20 hours have been
consumed?'' So I suppose these situations could be avoided.
Let me get down to the point. Would someone explain what is in this
amendment? As I explained, four or five Senators had amendments that
they wanted to call up, but they were waiting to see what was in the
managers' amendment. Those amendments must have been pretty important;
otherwise, if they weren't in the managers' amendment, there would be a
vote on each, some kind of vote, a vote by voice, a vote by division,
or a vote by rollcall. There would be a vote and an explanation.
Perhaps if we knew what was in those four or five major amendments,
that would help.
Mr. REID. Will my friend yield?
Mr. BYRD. Yes.
Mr. REID. I say this to my friend from West Virginia and to the two
managers of the bill. Speaking from my perspective only, I think that
the explanations that have been given in 1 minute have been quite good.
I am glad that the Senator from West Virginia asked for that, because I
felt pretty comfortable voting on each amendment. I say this to my
friend from West Virginia. If we look down the road to making this
process better, we are not going to improve it by adding hours; we are
going to improve it by making sure that amendments are offered before
we finish the debate. If we have 50 hours, people are still going to
offer all of these amendments at the end, if you have a loophole like
this. I look forward to improving the system, but that we do it in
whatever hours we have, and amendments should be offered during that
time.
Mr. BUMPERS. Mr. President, will the Senator yield?
Mr. BYRD. Yes.
Mr. BUMPERS. Mr. President, we are all speaking here at the
indulgence of the managers of the bill because there is no time left on
this bill. I will not delay it for long.
First, I want to say that I have never been as happy with my decision
not to seek reelection as I have been today. I have been voting on
amendments that involve billions of dollars today with only a
superficial or cursory knowledge of what I was voting on. I would not
like to go home--and I don't speak for the rest of you but I expect I
am speaking for the rest of you, too--I would hate to have to go home
and explain to people what was involved in all of these amendments,
particularly this one which I do not have a clue about.
But we must not lose sight of the point that the distinguished
Senator from West Virginia made in the opening part of his statement a
moment ago. That is, it is the rule that is the tyrant here with 20
hours to debate this part of the reconciliation bill and 20 hours to
debate the tax portion of it, which is monumental and most probably
will be the most significant important legislation we will deal with
all year--20 hours. We will wind up at the end of that 20 hours
precisely the way we have with this one. There will be a long list of
amendments down there. Maybe we will have another unanimous-consent
agreement where you are allowed 60 seconds to explain a bill that
involves $10 billion.
We are not doing the people of this Nation a service as long as we
allow this kind of a rule to put us in this kind of a straitjacket
where we have to get up and openly confess that this system is not
working as it ought to.
So, I applaud the Senator from West Virginia for his comments. He is
right on target. Fifty hours ought to be a minimum for the
consideration of a reconciliation bill.
I thank the Senator for making everybody aware of our shortcomings on
this day.
Mr. BYRD. I thank the Senator.
Mr. President, I do not want to hold the floor longer. I apologize to
the managers of the measure for imposing on them.
Is there some way that the distinguished Senator from New Mexico or
the distinguished Senator from New Jersey can enlighten Senators as to
what is in this managers' amendment--particularly, if I may say, with
reference to the four or five amendments that have qualified and were
being held back to see if the managers' amendment took care of those
amendments?
As I understood it, Mr. Kennedy had one amendment.
Mr. DOMENICI. On those four amendments we will try, if the chairman
of the Finance Committee will explain, we will try to ask the Senators
the relationship. It is not obvious on two of them that they are
related at all, from what I could see. I think they were just trying to
see how these major health matters are going to get clarified here,
which is not in this amendment. I don't believe they are even in this
amendment. So we will find that out, and before we vote, we will try to
have an explanation.
Mr. BYRD. All right.
Mr. DOMENICI. Would the chairman like to explain in the best way
possible what is in the amendment?
Is that what we would like to do next?
Mr. BYRD. That is what I would like.
May I say to the distinguished leader that he is frustrated with this
process also. He said to me earlier today that we have to find some
better way.
I do not want to be a part of a problem. I am hoping we can at least
get some response from those who understand what is in the amendment so
[[Page S6315]]
that the rest of us will at least go home feeling we did our best in
understanding it and that we at least made it clear that something is
wrong with the way the process is working.
Mr. DOMENICI addressed the Chair.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. Mr. President, I want to yield all of the time to the
chairman of the Finance Committee. But I do want to make one statement.
My friend from Arkansas said, I guess, that today made him happy that
he would soon stop being a Senator.
Let me make sure, if there are only six people listening on
television, that this Senator would like to say that it makes me very
proud what we are doing here. I am very proud of this bill. I am very
proud of the balanced budget. I am very proud of how we got here and
what we are doing here.
Frankly, if things keep going as well as this, I may break all
longevity and stay here for a lot longer.
I yield the floor.
The PRESIDING OFFICER. The Senator from Delaware.
Mr. ROTH. Mr. President, if I may say so, I am encouraged very
greatly by the news that the Senator from New Mexico will stay as long
as possible, as does our distinguished friend and leader from West
Virginia.
I say to my good friend from West Virginia, as he well knows, in
every major piece of legislation there are a lot of technicalities and
complexities involved in the legislation. In the efforts to draft them
and put them in final shape, it becomes necessary to have a number of
technical modifications at the end.
I would also say that in developing this legislation, it has been my
intention to work with everyone, both in committee and on the floor. We
have tried to include everybody--Republican, Democrats, senior Members,
and junior Members.
So I think the process has been all-inclusive. Basically, what we
have here in the so-called managers' amendment is sort of a cleanup of
a number of matters that had to be modified to make them technically
correct to take care in some cases of some of the concerns of
individual Members. Each of these have been reviewed very carefully by
the technicians who understand it.
I think part of the problem is that these are very complex matters
that aren't easy to explain or even to understand. But let me point
out, for example, that in the managers' amendment, the first section
that deals with what is known as ``PPS-exempt'' hospital changes, it
deals with technical changes as to how they are reimbursed.
For example, the first says strike the update formula and substitute
with a zero; update for fiscal years 1998, 2001, and market basket,
minus 3 percent in 2002.
In trying to reach the $115 billion savings that we are supposed to
make in Medicare, we reduce payments to the providers. Normally the
reimbursement each year reflects the cost-of-living or inflation. But
in this particular case, in order to make savings and because the
hospitals are doing reasonably well, we are reducing the reimbursement.
It is that kind of technical change that much of this deals with.
In another situation, we are--again in efforts to save money--
reducing what is known as disproportion payment and we have based the
recommendations on what an independent commission has recommended, and
I might say that is what the administration has recommended as well.
These, again, are all basically very technical.
But going back to the reduction of the disproportion, because both
Democrat and Republican Members were concerned about reducing as much
as was recommended by this independent board, we have slowed that
phase-in a little bit to make it easier for those organizations to
adjust.
So essentially I would say it is this kind of technical change that
we are trying to deal with here rather than major policy.
I assure you that we have dealt with both managers--the Republican
manager, the Democrat, and, of course, I might say that we have been
working very closely with my good friend and colleague, Pat Moynihan.
Mr. MOYNIHAN. You most assuredly have, sir.
Mr. ROTH. So I don't have any disagreement with our distinguished
friend and leader as to the whole process, but we have in good faith
tried to deal with the process and meet the time schedules that
everybody has wanted us to achieve.
I could go on and read all of these, if you like, sir. But I will say
they are highly technical.
The first one, I might point out, included two Medicare hospital-
related provisions. As I said, the first is a modification as to how we
reimburse what are called Medicare PPS-exempt hospitals. A PPS hospital
is paid on a prospective payment basis. That was a means that was
adopted many years ago to try to gain better control of expenditures
than you have when you have cost reimbursements. The hospital knows
that for a certain kind of function, they will be able to receive so
much money--say, $1,000. And they know they have to live within that.
So they have an incentive to try to keep those costs down. But now we
are cutting because we have to make greater savings. The hospitals,
according to our independent panel, are doing relatively well, and we
are trying to cut it more.
The second is a hospital wage index classification and reimbursement.
We deal or address the wage index, and a highly technical modification
takes place there.
So, as I say, they are this kind of technical change basically in an
effort to make legislative language accurate and achieve the goals that
were intended by the policy.
Mr. BYRD. Mr. President, the distinguished Senator is certainly doing
everything that he can in the best of faith to try to explain some
things about this amendment. I am sure this could go on quite a long
time. It is not that kind of detail that this Senator is seeking.
Let me say again that I am not accusing anyone of acting in bad
faith. Everybody is acting in good faith.
May I ask the distinguished manager of the bill: What were the four
amendments that I understood Senators were holding back on to see what
was in the managers' amendment? If we could have some indication of
what they were about, that would be satisfactory with me.
Mr. DOMENICI. Sure.
Let me say, Mr. President, to the Senator from West Virginia that
there was a Hutchison amendment. It had to do disproportionate share of
payments to hospitals, and there is a modification of that which had
adversely affected Texas that is apparently somewhat ameliorated there.
Senator Specter had the exact issue, and he had a disproportionate
share of payments amendment. He is part of this overall agreement that
is in this managers' amendment.
Then there was a Bob Kerrey abortion amendment that had nothing to do
with this amendment. But I asked him to wait for the managers'
amendment before he did something on it.
I assume that Senator Murray is going to make the point of order on
that issue. But I am not certain of that.
Mr. KERREY. That is close enough. There was actually a modification
that requires me to wait before I offer my amendment. Otherwise I will
have to offer it twice.
Mr. DOMENICI. OK. Unless he waits for that, he will have to offer it
again.
Then there was a Senator Kennedy uninsured children's amendment that
also seems unrelated. But he indicated that he would like to wait and
see what happened to this amendment.
That was the four that I mentioned.
I think that is the full stint of those amendments and the stories
behind them.
I yield the floor.
Mr. BYRD. Mr. President, I thank all Senators, particularly the
managers of the bill, the Senator from Delaware, and also the
distinguished Senator from New York [Mr. Moynihan]. I thank them all. I
thank all of them.
I don't have any other questions to raise. I will not ask for a
division. Senators have certainly done the best they could to go as far
as they could in answer to this Senator's frustration. That is what we
are talking about. We are all frustrated. It is the rule, and we ought
to try to find some way to change it. I don't have any quarrel with any
Senator in particular.
I thank all Senators.
[[Page S6316]]
The PRESIDING OFFICER. The pending question is the amendment, as
modified, No. 506.
Is there further debate? If not, the question is on agreeing to the
amendment.
The amendment (No. 506), as modified, was agreed to.
Mr. LAUTENBERG. Mr. President, I move to reconsider the vote by which
the amendment, as modified, was agreed to.
Mr. DOMENICI. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. Now, Mr. President, do we have the child health
amendment ready?
Mr. JEFFORDS. Mr. President, I believe we are all set with a colloquy
that has clarified the language.
Mr. DOMENICI. I would like to proceed with that. We are very, very
close to having no amendments left except a Murray point of order and a
Kennedy point of order.
Mr. KENNEDY. Mr. President, if is agreeable with the floor manager, I
would call up our Medicare home health benefit transfer from part A to
part B and proceed with that.
Mr. DOMENICI. I say to the Senator, I was trying, if I could, to get
one amendment before you, but if it is not ready, we will go right to
you.
Mr. KENNEDY. That is all right. We are here so we will accommodate
whatever.
Mr. DOMENICI. Mr. President, the amendment, which is a product of
many Senators on both sides, with reference to child health is not
ready. Therefore, we would like to move to the point of order either by
Senator Murray or Senator Kennedy.
Is Senator Murray ready?
Mrs. MURRAY addressed the Chair.
The PRESIDING OFFICER. The Senator from Washington is recognized.
Point of Order
Mrs. MURRAY. Mr. President, I make a point of order that section
1949(a)(2) of this act violates section 313(b)(1)(A) of the
Congressional Budget Act.
Mr. President, as an appropriator, I object to the language included
in this legislation by the Finance Committee that would make permanent
a prohibition against Medicaid managed care funds being used for
abortion services except in the cases of rape, incest, or where the
woman's life is in danger. This is, for all intents and purposes, a
permanent extension of the so-called Hyde amendment that has been
included in every Labor-HHS and education appropriations bill since
1987. A reconciliation bill is not the proper vehicle for major
abortion policy decisions. This is not how Congress has traditionally
dealt with such decisions, and this is not how we should begin to deal
with such decisions.
I know that some of my colleagues disagree----
Mr. LAUTENBERG. If the Senator will yield, Mr. President, this place
is not in order. It is terribly unfair to the Senator. Her voice is
soft, and we ought to make sure that we can hear it. She has an
important message for all of us, and I resent the fact that people are
talking and laughing and doing what they are doing.
Please, Mr. President, let us get order.
The PRESIDING OFFICER. Before the Senator from Washington proceeds,
let me ask all Senators, if they would, to please take their
conversations to the Cloakroom and give the Senator from Washington the
courtesy of everyone hearing her remarks.
Mr. DOMENICI. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The absence of a quorum is suggested. The
clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. DOMENICI. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DOMENICI. I might explain to the Senators the reason for the
delay and the quorum call is that we are discussing with Senator
Murray, with reference to a point of order, we are discussing exactly
what it means and what it doesn't mean, and she has requested that we
set it aside pending further discussion. So I so propose a unanimous-
consent request to the Senate.
The PRESIDING OFFICER. Is there objection? Without objection, it is
so ordered.
The point of order will be set aside.
Amendment No. 504
Mr. DOMENICI. I understand Senator Kennedy has two remaining
amendments. One has to do with home health care and the trust fund. I
believe he is going to take that up now.
The PRESIDING OFFICER. The Senator from Massachusetts is recognized.
Mr. KENNEDY. Mr. President, if we could have the attention of the
Senate.
The PRESIDING OFFICER. The Senate will be in order.
Mr. KENNEDY. Mr. President, this amendment would speed up the agreed-
upon transfer of a portion of the Medicare home health benefit from
part A to part B. This acceleration would extend the solvency of the
Medicare trust fund by 2 years. It would not affect the deficit or
seniors' premiums. We have maintained in our amendment that the
premiums that have been agreed to would be maintained, or it would not
affect the total amount of the benefit ultimately transferred.
It is strictly a bookkeeping transaction, but it will help save
Medicare. It extends the solvency of the Medicare Program by 2 years.
It was in the President's budget. It is a desired outcome for those who
are interested in the financial security of the Medicare trust fund. We
debated the stability and the security of the Medicare trust fund at
length yesterday. This is a way of extending it by 2 years.
The PRESIDING OFFICER. Is there further debate on the amendment?
Mr. DOMENICI. I yield time in opposition to Senator Roth, chairman of
the Finance Committee.
The PRESIDING OFFICER. The Senator from Delaware.
Mr. ROTH. Mr. President, I object to the amendment. We are
transferring, over 7 years, home health care to part B, but we want to
do it in seven segments because it is agreed that the beneficiaries
should continue to pay 25 percent of the cost of the part B services.
We do not want to put it all over the first year because we do not want
to raise the premiums that rapidly.
So in order to be consistent, what we provide in the legislation is
that the home health care will be transferred over 7 years. Each year
an additional seventh will be included in the cost of the premium, so
that will make the phasein much lower.
The PRESIDING OFFICER. Is there further debate?
The Senator from New Mexico.
Mr. KENNEDY. Mr. President, do I have any further time?
The PRESIDING OFFICER. Both sides have used their allotted time.
Mr. DOMENICI. Mr. President, I make a point of order that the Kennedy
amendment violates the Budget Act in that the amendment is subject to
the Byrd rule.
Mr. KENNEDY. Mr. President, I move to waive the point of order as
made.
The PRESIDING OFFICER. The question is on agreeing to the motion to
waive the point of order. All those in favor say yea.
Mr. KENNEDY. I ask for the yeas and nays, Mr. President.
The PRESIDING OFFICER. The yeas and nays have been requested. Is
there a sufficient second? There is a sufficient second.
The yeas and nays were ordered.
Vote on Motion to Waive the Budget Act
The PRESIDING OFFICER. The question is on agreeing to the motion to
waive the Budget Act. The yeas and nays have been ordered. The clerk
will call the roll.
The bill clerk called the roll.
The yeas and nays resulted--yeas 38, nays 62, as follows:
[Rollcall Vote No. 127 Leg.]
YEAS--38
Akaka
Bingaman
Boxer
Breaux
Bryan
Bumpers
Byrd
Cleland
Conrad
Daschle
Dodd
Dorgan
Durbin
Feingold
Feinstein
Ford
Glenn
Graham
Harkin
Inouye
Johnson
Kennedy
Kerry
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Mikulski
Murray
Reed
Reid
Robb
Rockefeller
Sarbanes
Torricelli
Wellstone
Wyden
[[Page S6317]]
NAYS--62
Abraham
Allard
Ashcroft
Baucus
Bennett
Biden
Bond
Brownback
Burns
Campbell
Chafee
Coats
Cochran
Collins
Coverdell
Craig
D'Amato
DeWine
Domenici
Enzi
Faircloth
Frist
Gorton
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
Hollings
Hutchinson
Hutchison
Inhofe
Jeffords
Kempthorne
Kerrey
Kohl
Kyl
Lott
Lugar
Mack
McCain
McConnell
Moseley-Braun
Moynihan
Murkowski
Nickles
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Warner
The PRESIDING OFFICER. On this vote, the yeas are 38, the nays are
62. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected.
The point of order is sustained and the amendment falls.
Mr. LAUTENBERG. Mr. President, I move to reconsider the vote.
Mr. LOTT. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
amendment no. 504
Mr. SPECTER. Mr. President, I have sought recognition to explain my
views concerning the Kennedy amendment 504, which would have
immediately transferred to Medicare part B the home health benefits
currently paid for under the Medicare part A trust fund.
Payment for home health care is made from the part A trust fund for
home health services such as part-time or intermittent nursing care
provided by or under the supervision of a registered nurse or home
health aide.
To protect the solvency of the part A trust fund, the bill shifts
some of the home health costs on a 7-year phased-in basis from part A
to part B.
The budget reconciliation bill reflects a careful compromise on
protecting the solvency of the part A trust fund for all seniors
without unduly burdening the taxpayers. Under the Kennedy amendment
some of the bill's fiscal protections would have been dropped, and
taxpayers would have effectively funded 100 percent of the home health
services in fiscal year 1998, which would be unprecedented under
Medicare. In my judgment that goes too far and adversely affects the
present preferable balance.
The PRESIDING OFFICER. The majority leader.
Mr. LOTT. Mr. President, throughout the day I have been working with
Senator Chafee and others with regard to amendments.
Mr. LAUTENBERG. May we have order, Mr. President?
The PRESIDING OFFICER. The Senate is not in order. The Senate will
please come to order.
The majority leader.
Unanimous Consent Agreement
Mr. LOTT. Mr. President, I have been working with Senator Chafee and
others, including Senator Jeffords, on a number of amendments that were
offered last night as first- or second-degree amendments. I think we
have worked out a process, now, that we are all comfortable with. Let
me enter this unanimous-consent request and then we will have a brief
colloquy also.
I ask unanimous consent the following amendments be withdrawn: Chafee
amendment No. 448, Chafee amendment No. 500, Chafee amendment No. 501,
Lott amendments Nos. 505, 507, 508, 509, Rockefeller amendment No. 510
and the Roth amendment No. 513;
I further ask unanimous consent that the Senate turn to the Roth
amendment No. 511, and that all between lines 23 on page 22 and line 3
on page 23 be stricken;
I further ask the Senate then call up the Chafee amendment No. 512 to
the Roth amendment No. 511, as modified, that the Chafee amendment be
agreed to, and the Roth amendment, as amended, then be agreed to;
I further ask unanimous consent that when the committee amendment to
S. 949, the Taxpayer Relief Act, is before the Senate, Senator Roth be
recognized to offer an amendment which is the text of the Roth
amendment No. 511, as modified and amended, and the text of the Kennedy
amendment, No. 492, if adopted by the Senate, to S. 947, to the
language regarding the children's health initiative, and the amendment
be agreed to;
Finally, I ask unanimous consent that it not be in order during the
pendency of S. 949 to offer further amendments or motions regarding
title XXI of the Social Security Act, except amendments regarding
revenues and outlays.
The PRESIDING OFFICER. Is there objection?
Mr. CHAFEE. Reserving the right to object.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. JEFFORDS. Reserving the right to object.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. JEFFORDS. The Senator from Delaware----
The PRESIDING OFFICER. The Senator from Vermont will suspend. The
Senate is not in order. Senators please take their conversations off
the Senate floor. The Senator from Vermont.
Mr. JEFFORDS. If the chairman of the Finance Committee would give me
his attention, as I read the unanimous consent request, States would
not be able to use the new funds under the children's health insurance
initiative to provide health care coverage under either the block grant
or to provide Medicaid for children over 200 percent of poverty.
This creates a real problem for a number of States. Vermont is
currently covering all children aged 18 that have family incomes of 225
percent of poverty through its Medicaid Program. I would like to be
assured that we will work to address this concern in the conference so
that States have the ability to use the new funds to provide health
care coverage for children over 200 percent of poverty. There are
children above this level that need the help badly.
Mr. ROTH. Mr. President, I say to the Senator from Vermont, he has my
assurance that we will discuss this concern in the conference
committee. It is not my intent to penalize those States that have done
a good job in covering their low-income children or to exclude needy
children from coverage.
Mr. CHAFEE. I would like to address this, Mr. President, if I might,
to the distinguished chairman of the Finance Committee. It is also my
understanding that a State would be able to use any new funds to
provide health coverage for children under 200 percent of poverty and
use existing State dollars, normally used for this purpose, in order to
provide health care coverage for children over 200 percent of poverty.
Mr. ROTH. Mr. President, section 2102 allows for the use of existing
State funds to provide additional health care coverage for children
over 200 percent of poverty.
Mr. CHAFEE. I thank the chairman for that. I also extend my thanks to
the distinguished majority leader for helping us reach this unanimous-
consent agreement. I believe the resolution of this problem has been a
very good one. I thank, as I say, the majority leader and the chairman
of our Finance Committee and other Senators who have worked on this,
particularly on our side, Senator Jeffords.
Mr. GREGG. Reserving the right to object.
The PRESIDING OFFICER. The Senator from New Hampshire reserves the
right to object.
Mr. GREGG. Is the practical effect of this amendment that there will
only be two options available now to States: One would be to put the
child in Medicaid, and the other would be to use a Blue Cross/Blue
Shield standard option plan with hearing and eyeglasses?
Mr. ROTH. No; the choice is not limited to that. Under the option,
the States must provide benefits that are the equivalent of a Blue
Cross standard plan. But I emphasize the word ``equivalent,'' because
it means considerable flexibility. I should point out, it also includes
vision and hearing services.
Mr. CHAFEE. That is right. The State can use its own funds. If it has
been using its funds for other types of services, they can continue
using their State funds for those other types of services.
Mr. GREGG. Further reserving the right to object.
The PRESIDING OFFICER. The Senator from New Hampshire further
reserves the right to object.
Mr. GREGG. The practical effect of this then is that the programmatic
activities are specifically mandated as being either a Medicaid Program
or a
[[Page S6318]]
Blue Cross/Blue Shield equivalent program, is that not correct?
Mr. ROTH. That is correct.
Mr. GREGG. I have very serious reservations about this. I presume the
leaders worked hard on reaching this agreement, and I presume that
there is going to be further consideration of this issue.
Mr. LOTT. As a matter of fact, Mr. President, if I can respond to the
Senator's reservation, I noted when I read through this that there were
a series of amendments that had been offered in a variety of ways
affecting this particular area: Three by Senator Chafee, four by
myself, one by Senator Roth, one by Senator Rockefeller. So this is
quite a laboriously worked-out process.
The Senator from Vermont, as a matter of fact, is not particularly
happy with some provisions still remaining, and he had an amendment
that would have tried to change that. A number of others--Senator
Nickles of Oklahoma--I believe, had something. But this unanimous-
consent agreement was worked out in a way that a number of Senators
decided not to go forward with their objections.
I personally don't agree with this, but it is the best way that we
could work through about six or eight amendments that were pending in a
reasonable and fair way, and it certainly will have another day in
court.
Mr. GREGG. Well, on that representation, I won't object, but I have
serious reservations, I must say.
Mr. ROCKEFELLER addressed the Chair.
The PRESIDING OFFICER. The Senator from West Virginia.
Mr. ROCKEFELLER. Mr. President, I say to my colleagues, I think the
majority leader is exactly right, and I congratulate him, as well as
Senator Roth and his excellent staff, as well as Senators Chafee,
Jeffords and many others who worked on it.
As the majority leader has indicated, it has been a very laborious,
long process in which things sort of just gradually, tectonically moved
together, but very, very slowly.
The point is that we can say now children are going to have good
benefits, and that doesn't mean that they have to pick a particular
plan. There is not a mandate in this that they have to pick this plan
or that plan, but they will be able to get the kinds of benefits that
we have as Senators, as Federal workers.
I think, frankly, we have an obligation to make sure our children
have plans. Preventive care, hospital care, doctor care, prescription,
vision and hearing is in this. That is very important for early years,
preventive care.
So I think, frankly, it has been extremely complicated, it has taken
a long time, but I think it is a good compromise, a good agreement, and
I congratulate those who brought it together.
Mr. LOTT. Mr. President, also, before I renew my unanimous-consent
request, Senator Breaux was also involved in this exercise and was
helpful. I express my appreciation to him.
I renew my unanimous-consent request.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. LOTT. I yield the floor, Mr. President.
Mr. CHAFEE addressed the Chair.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. CHAFEE. Mr. President, I thank the distinguished Senator from
West Virginia, Senator Rockefeller, for his help in this. As he
mentioned, this has been a very long, long difficult process. He has
been very helpful.
Mr. KENNEDY addressed the Chair.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, if it is agreeable with the floor
managers, I am prepared to move ahead with my amendment dealing with
children's benefits.
Mr. DOMENICI. I believe that is the last amendment, except the three
points of order that are going to be submitted by the Democratic floor
leader en bloc.
Mr. KERREY. I still have my amendment.
Mr. DOMENICI. Sorry, I forgot. I thought that was going with Senator
Murray when she withdraws her point of order. It is different?
Mr. KERREY. Yes.
Mr. DOMENICI. Can we recognize Senator Murray for a moment? She
intends to speak to the Senate with reference to her previous point of
order.
Point of Order, Withdrawn
Mrs. MURRAY. Mr. President, I withdraw my previous point of order,
but I want this body to know that I object to the language in this bill
that essentially makes Hyde permanent and affects those States whose
managed care plans now cover medically necessary abortions.
Unfortunately, the way the language was cleverly drafted, my point of
order would have unintended consequences.
I go back to what my colleague from West Virginia said to all of us a
few minutes ago. I think as we move toward final passage, I hope we all
understand the severe consequences of the many different arenas in this
bill.
I withdraw my point of order.
The PRESIDING OFFICER. The Senator has a right to withdraw her point
of order. The point of order is withdrawn.
The Senator from Massachusetts.
Amendment No. 492
Mr. KENNEDY. Mr. President, I call up our amendment dealing with the
special health needs of children. I call up the amendment on behalf of
myself and Senator Harkin.
First of all, I commend the Senators for getting us where we are in
terms of the new health benefits package for children, but there are
some very critical needs for children, children with disabilities,
children who are developmentally delayed and children with special
needs.
Those needs are not attended to, and that is why this amendment is
supported by the Consortium of Citizens with Disabilities, the American
Academy of Pediatrics, the American Association of Retarded Citizens
and the National Alliance for the Mentally Ill.
This will ensure that, in those particular areas, the children will
receive what is medically necessary. The Federal employees program is
targeted to adults and not toward children. This recognizes that there
are special needs for children in these areas, and it permits what is
medically necessary. It is a limited program, but it is vital in terms
of the special needs of those children. I hope that it will be agreed
to.
Mr. DOMENICI addressed the Chair.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. I yield 40 seconds of our time to Senator Roth, and I
will use 20 seconds.
Mr. ROTH. Mr. President, I oppose the Kennedy amendment. As we have
just been discussing, we have carefully crafted and negotiated the
issue of the benefits package for the new children's health initiative.
This amendment would break that agreement by requiring additional
benefits. It does the very opposite of what we want to do. We want to
provide flexibility to the States, and this would be a major step in
the wrong direction.
Mr. DOMENICI addressed the Chair.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. DOMENICI. Mr. President, this would change a bipartisan
compromise in the committee and make a long list of benefits mandatory.
Thus, it would fly in the face of reform and make it more difficult for
the States to deliver quality care for less money. In essence, it is
apt to produce less quality care under the rubric of supplying all of
the specifics, even if you could get better care with less specifics.
I move to table the Kennedy amendment and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays were ordered.
The PRESIDING OFFICER. The question is on agreeing to the motion to
lay on the table amendment No. 492. The yeas and nays have been
ordered. The clerk will call the roll.
The assistant legislative clerk called the roll.
The result was announced--yeas 57, nays 43, as follows:
[Rollcall Vote No. 128 Leg.]
YEAS--57
Abraham
Allard
Ashcroft
Baucus
Bennett
Bond
Breaux
Brownback
Burns
Campbell
Coats
Cochran
Collins
Coverdell
Craig
D'Amato
DeWine
Domenici
Enzi
Faircloth
Frist
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
[[Page S6319]]
Hutchinson
Hutchison
Inhofe
Kempthorne
Kerrey
Kyl
Lott
Lugar
Mack
McCain
McConnell
Moynihan
Murkowski
Nickles
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Stevens
Thomas
Thompson
Thurmond
Warner
NAYS--43
Akaka
Biden
Bingaman
Boxer
Bryan
Bumpers
Byrd
Chafee
Cleland
Conrad
Daschle
Dodd
Dorgan
Durbin
Feingold
Feinstein
Ford
Glenn
Harkin
Hollings
Inouye
Jeffords
Johnson
Kennedy
Kerry
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Mikulski
Moseley-Braun
Murray
Reed
Reid
Robb
Rockefeller
Sarbanes
Specter
Torricelli
Wellstone
Wyden
The motion to lay on the table the amendment (No. 492) was agreed to.
Mr. DOMENICI. 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. 427
Mr. DOMENICI. Mr. President, there is an amendment pending at the
desk, an amendment for Senator DeWine that is No. 427.
I am going to send, at his request and with the approval of the
minority, a modification. This amendment, as modified, will amend the
Social Security Act to continue full-time equivalent resident
reimbursement for 1 additional year under Medicare for direct graduate
medical education for residents enrolled in combined approved primary
care medical residency training programs.
Amendment No. 427, As Modified
Mr. DOMENICI. I send the modification to the desk, and ask unanimous
consent that we call up the amendment as modified.
The PRESIDING OFFICER. Is there objection to modifying the amendment?
Without objection, it is so ordered. The amendment is modified.
The amendment (No. 427), as modified, is as follows:
At the appropriate place in chapter 3 of subtitle F of
division 1 of title V, insert the following:
SEC. . MEDICARE SPECIAL REIMBURSEMENT RULE FOR PRIMARY CARE
COMBINED RESIDENCY PROGRAMS.
(a) In General.--Section 1886(h)(5)(G) of the Social
Security Act (42 U.S.C. 1395ww(h)(5)(G)) is amended--
(1) in clause (i), by striking ``and (iii)'' and inserting
``, (iii), and (iv)''; and
(2) by adding at the end the following:
``(iv) Special rule for primary care combined residency
programs.--(I) In the case of a resident enrolled in a
combined medical residency training program in which all of
the individual programs (that are combined) are for training
a primary care resident (as defined in subparagraph (H)), the
period of board eligibility shall be the minimum number of
years of formal training required to satisfy the requirements
for initial board eligibility in the longest of the
individual programs plus one additional year.
``(II) A resident enrolled in a combined medical residency
training program that includes an obstetrics and gynecology
program qualifies for the period of board eligibility under
subclause (I) if the other programs such resident combines
with such obstetrics and gynecology program are for training
a primary care resident.''.
(b) Effective Date.--The amendments made by subsection (a)
apply to combined medical residency training programs in
effect on or after January 1, 1998.
Mr. DOMENICI. I believe that amendment is acceptable.
I yield back any time I might have.
The PRESIDING OFFICER. Is there further debate on the amendment? If
not, the question is on agreeing to the amendment.
The amendment (No. 427), as modified, was agreed to.
Mr. DOMENICI. I move to reconsider the vote.
Mr. LAUTENBERG. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Amendments Nos. 447, 464, 470, 477, and No. 503, As Modified, Withdrawn
Mr. DOMENICI. I ask unanimous consent to withdraw five amendments
that remain: 447, Senator Hutchison; 464, Senator Brownback; 470,
Senator Specter; 477, Senator Durbin; and 503, Senator Rockefeller.
The PRESIDING OFFICER. Is there objection?
Without objection, the amendments are withdrawn.
The amendments (Nos. 447, 464, 470, 477, and No. 503), as modified,
were withdrawn.
Mr. DOMENICI. Mr. President, there is one additional amendment by
Senator Kerrey.
The PRESIDING OFFICER. The Senate will come to order.
Mr. DOMENICI. One additional amendment by Senator Kerrey, which will
require a vote. Then there will be three points of order en bloc by the
minority. We will not seek to overrule them. We will accept them. The
provisions will then cause those portions of the bill to fail, to drop.
Following that, we will have final passage.
Mr. KERREY addressed the Chair.
The PRESIDING OFFICER. The Senator from Nebraska.
Amendment No. 496, As Modified
Mr. KERREY. Mr. President, I ask unanimous consent to modify my
originally filed amendment since the managers' amendment changes the
language that my amendment seeks to strike.
The PRESIDING OFFICER. Is there objection to the modification?
Without objection, the amendment is modified.
The amendment (No. 496), as modified, is as follows:
At the appropriate place in section 2106, as added by
section 5801, strike all matter related to ``use limited to
State Program Expenditures'' and insert the following:
``(d) Use Limited to State Program Expenditures.--Funds
provided to an eligible State under this title shall only be
used to carry out the purposes of this title.''
Mr. KERREY. Mr. President, there is language in the bill that imposes
what has been imposed typically in the appropriations process,
permanently imposing a restriction on the use of Federal money for
payment for abortions. I know it is very controversial, a lot of fun to
debate. But by putting it in permanent law, we are doing something
entirely different than has been done before.
Second, I would say to my colleagues, this affects only low-income
teenagers. That is basically what we are doing, saying to low-income
teenagers that we are not going to allow taxpayer money to be used for
abortions.
Third, I would say, for those who say, ``Well, that's right, we don't
want to use taxpayer money for abortions,'' we do not have a similar
restriction on our salaries, we do not have a similar restriction on
any other Federal employee's salary. If we have income coming to us,
that is taxpayer income.
If you want to be consistent here, you want to say you are going to
treat low-income teenagers the same as our teenagers are treated, then
you would have to put restrictions on how we can spend our salaries as
well.
I hope that this amendment will pass and we will strike this
language. If you want to bring the Hyde amendment up, I think it is
much more appropriate to do so not on appropriations bills.
Mr. DOMENICI. I yield time in opposition to Senator Nickles.
Mr. NICKLES. Mr. President, I rise in opposition to the amendment of
Senator Kerrey. We put in language in this bill to make sure in this
new program--we created a new program for health care for kids, for
teenagers. What we are doing in this amendment is saying this health
care program should not include abortion or money for elective
abortion.
We basically said no public funds would be used for abortion --only
if the abortion is necessary to save the life of the mother or in cases
of rape or incest. That is consistent with the Medicaid Program. That
is consistent with Federal health care policies that we have for
Federal employees right now, and we certainly should not create a new
program that says, ``Oh, you can have abortion on demand, paid for by
taxpayers.'' We will spend billions of dollars. We should not be saying
those billions are eligible for teenagers for elective abortion.
I urge my colleagues to vote no on the Kerrey amendment.
Mr. KERREY. I ask for the yeas and nays.
The PRESIDING OFFICER (Mr. Abraham). Is there a sufficient second?
There is a sufficient second.
The yeas and nays have been ordered.
The PRESIDING OFFICER. The question is on agreeing to the amendment
No. 496, as modified.
The clerk will call the roll.
The legislative clerk called the roll.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
[[Page S6320]]
The result was announced--yeas 39, nays 61, as follows:
[Rollcall Vote No. 129 Leg.]
YEAS--39
Akaka
Baucus
Bingaman
Boxer
Bryan
Bumpers
Campbell
Chafee
Daschle
Dodd
Durbin
Feingold
Feinstein
Glenn
Harkin
Hollings
Inouye
Jeffords
Kennedy
Kerrey
Kerry
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Mikulski
Moseley-Braun
Moynihan
Murray
Reed
Robb
Rockefeller
Sarbanes
Specter
Stevens
Torricelli
Wellstone
Wyden
NAYS--61
Abraham
Allard
Ashcroft
Bennett
Biden
Bond
Breaux
Brownback
Burns
Byrd
Cleland
Coats
Cochran
Collins
Conrad
Coverdell
Craig
D'Amato
DeWine
Domenici
Dorgan
Enzi
Faircloth
Ford
Frist
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Hatch
Helms
Hutchinson
Hutchison
Inhofe
Johnson
Kempthorne
Kohl
Kyl
Lott
Lugar
Mack
McCain
McConnell
Murkowski
Nickles
Reid
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Thomas
Thompson
Thurmond
Warner
The amendment (No. 496) as modified, was rejected.
Mr. DOMENICI. Mr. President, I move to reconsider the vote.
Mr. KERREY. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. DOMENICI. Mr. President, may we have order?
The PRESIDING OFFICER. The Senate will please come to order.
The Senator from New Mexico.
Mr. DOMENICI. Mr. President, I am just waiting for the minority
manager to make a point of order, and we will be ready to go to final
passage.
Point of Order
Mr. DASCHLE. Mr. President, pursuant to section 313 of the
Congressional Budget Act, I make a point of order that the following
sections of the pending bill are extraneous to the reconciliation
instructions of the respective committee of jurisdiction: section 5713,
section 5833, and section 5987.
The PRESIDING OFFICER. The Chair sustains the points of order.
Mr. ROBB. Mr. President, I rise today to discuss S. 947, the Balanced
Budget Act of 1997. I'm pleased that we've come together in a
bipartisan way--both sides of the aisle, both sides of the Capitol, and
both ends of Pennsylvania Avenue--to craft a plan that brings us a step
closer to fiscal sanity.
The good news, Mr. President, is that the bill before us realizes
roughly $137 billion in savings over the next 5 years. And that's good
news for our country and for our children and our grandchildren.
S. 947 provides additional years of solvency to the Medicare hospital
trust fund, reforms payment methodologies for skilled nursing
facilities, home health, and outpatient entities, and includes greater
choice--and expanded preventive benefits--for millions of Medicare
beneficiaries. As a cosponsor of the original Chafee-Rockefeller child
health bill, I'm delighted that this bill contains $16 billion to
expand access to health care for America's children, most of whom live
in the home of an American worker.
Someday, our children will be grateful for the $16 billion we
invested in their health care, Mr. President. And they will be grateful
that we succeeded today in saving $137 billion in future debt--debt we
will not ask them to pay.
But our children will not be grateful if we don't take this
opportunity in this budget to tackle long-term entitlement reform in a
systemic way.
We all know the statistics. While entitlements and interest on the
national debt represented just 30 percent of our budget in l963, they
will absorb 70 percent by the year 2002. And even more alarmingly, if
we don't make changes in the way we do business around here,
entitlements and interest on the debt will absorb the entire Federal
revenue base by the year 2012. How then can we responsibly invest in
our children? How can we sustain the transportation infrastructure
needed to support a thriving economy in the next century? How do we pay
our soldiers, repair our subs and carriers, and invest in the
technology we need to remain the last great superpower on Earth?
Mr. President, despite the fact that the vast majority of economists
have told us that we need to adjust the consumer price index to
accurately reflect inflation, we have no legislative CPI adjustment in
this package. Opponents say that since we don't need a legislative CPI
adjustment to balance the budget in 5 years, it's not in this plan. But
what about when the baby boom generation retires, Mr. President, when
just three workers--and then two--will support each Social Security
beneficiary?
The Finance Committee had the courage to include a provision in this
bill to gradually increase the eligibility age for Medicare from 65
today to 67 by the year 2027. This provision has been under assault--
and will continue to be--from many sides. Some who oppose it argue that
this is not the time. And while I'm committed to identifying methods to
provide access for those who may encounter a lapse in coverage--and
this bill creates a bi-partisan commission that will look at the
feasibility of a Medicare buy-in program--when will the time be right?
We had a good vote in support of this eligibility increase in the
Senate and we have to fight to retain it in conference.
Finally, the home health copay and the affluence testing for wealthy
seniors which were included in the committee mark and which were
supported by the majority of the Senate during two rollcall votes held
yesterday will likely not survive conference as well, Mr. President.
These provisions are in danger even though we all know we have to find
responsible ways to reduce the Federal cost of Medicare. While
affluence testing of part B premiums is a political lightning rod, it
is good public policy. It is simply indefensible to require lower
income families, many who cannot afford health insurance for their own
children today, to continue to help subsidize 75 percent of the
Medicare premiums of wealthy seniors.
We have much to do, Mr. President, to fulfill our obligation to leave
our children a strong economic future and a quality of life equal to
the one we inherited from our own parents. The first step is to balance
our budget--and I hope the bill before us accomplishes that goal. The
next step--and it is an essential one--is to tackle long term, systemic
entitlement reform that will protect both the solvency of Medicare and
Social Security and the economic security of the generations that
follow us.
I hope the conferees will not make those goals even harder to achieve
in the future.
With that plea Mr. President, I yield the floor.
THE BUDGET RECONCILIATION BILL MUST PROTECT LEGAL IMMIGRANTS
Mr. KENNEDY. Mr. President, I continue to be concerned about actions
by Congress that hurt legal immigrants.
Last year, Congress passed a so-called welfare reform bill. This
harsh bill cut off legal immigrants from most Federal assistance
programs for the first time in history. It permanently banned legal
immigrants from SSI and food stamps. It banned them for 5 years from
AFDC, Medicaid, and other programs. And, it gave the States the option
of permanently banning them from these programs.
We quickly saw the effect of these extreme provisions. Panic spread
through the immigrant community. The Social Security Administration
sentnotices to legal elderly and disabled immigrants that they would
soon lose their SSI benefits. Numerous reports in the press told of
legal immigrants who would be turned out of nursing homes, or cut off
from disability payments. Some legal immigrants took their own lives,
rather than burden their families. Thankfully, many Members of Congress
realized that these provisions went too far.
This budget reconciliation bill corrects many of those mistakes.
Members of the Finance Committee and Budget Committee showed impressive
leadership in developing this bill. They recognized that the immigrants
affected by last year's harsh cuts are individuals and families who
came here legally. By and large, they are family members--mothers,
fathers, and sons, daughters--of American citizens. They play by the
rules, pay their taxes, and serve in the Armed Forces. They can be
drafted. They can volunteer. We have hundreds of them in Bosnia today.
[[Page S6321]]
They are future citizens trying to make new lives for themselves and
their families in this country. I commend the committees for working so
hard to come up with a bipartisan proposal.
This bill allows legal immigrants who are already receiving SSI to
continue their SSI payments. It preserves SSI coverage for immigrants
already in the United States who become disabled in the future, and for
future immigrants who are too severely disabled to go through the
process of naturalization to become citizens. It extends the exemption
for refugees from 5 to 7 years. It exempts children from the 5-year ban
on Medicaid eligibility.
There is still much more to be done to correct the problems created
for immigrants by last year's welfare reform law. But, overall, this
bill makes worthwhile progress toward restoring a safety net for
immigrants who fall on hard times. I hope that Senators will do all
they can to see that the immigrant provisions in this bill are retained
in the Senate-House conference and final bill.
Medicare Reform
Mr. GRAMS. Mr. President, I rise today in support of some very
important Medicare reforms made within the reconciliation package
before us. Specifically, I am pleased the committee included reforms to
the formula used to determine the reimbursement rate for health plans
under the Medicare Program to make it fairer and more equitable for
States like Minnesota and other parts of rural America, changes to
ensure better access to emergency medical services, and an expansion of
Medical Savings Accounts.
Reform of the Adjusted Average Per Capita Cost formula has been
needed for years because the formula has discriminated against seniors
who choose to live and retire in rural communities. It has penalized
States like Minnesota which are efficient in delivering health care
services, and in doing so, discouraged quality health care. Since being
elected to the Senate in 1994, I have made restoring fairness and
equity to Medicare recipients in Minnesota and other parts of rural
America a top priority.
Mr. President, we are all aware of the fact that the current Medicare
reimbursement formula discriminates against Minnesota by giving our
State the second-lowest payment rates in the Nation. Not one county in
the entire State of Minnesota, or in 15 other States, receives the
national average of $467 in AAPCC payment per month.
Because of these low reimbursement rates, managed care organizations
have been discouraged from offering our senior citizens many of the
alternative health plans available in other parts of the country, plans
which offer additional benefits such as eyeglasses and prescription
drugs. Clearly, this is a problem which should have been addressed long
ago.
In February, several of my colleagues and I introduced S. 359, the
Medicare Payment Equity Act, which would have established a floor of 80
percent of the national adjusted capitation rate for the year and made
the AAPCC formula more equitable by blending the national and county
specific percentage. More recently, I cosponsored S. 862, authored by
Senator Grassley, which followed the same lines of reform and even more
closely resembles what was ultimately passed by the Finance Committee.
Under the leadership of Finance Chairman Roth and through the tireless
efforts of Senators Thomas, Burns, Grassley, and Roberts, we have
succeeded in beginning to fix the Medicare formula to make it fairer
for Minnesota's seniors and right some of the wrongs against us.
The AAPCC reforms contained in the reconciliation bill are a very
important step in restoring fairness and providing greater choices for
Medicare recipients who live in Minnesota, particularly in rural
communities. This truly represents a great victory for Minnesota's
senior citizens as we close the longstanding gap of inequity in the
Medicare Program.
Mr. President, this legislation also addresses another important
issue in which I have been deeply involved. In January, Senator Graham
of Florida and I introduced S. 238, the Emergency Medical Services
Efficiency Act, to establish a reasonable standard for determining
Medicare reimbursement for EMS services. Our bill would ensure that EMS
providers would be reimbursed based upon a prudent layperson standard,
rather than the ultimate diagnosis of a physician. This revised
definition will ensure that EMS providers are prepared to meet the
challenges facing them as they work to improve their services.
All of us depend daily on the readiness, efficiency, and immediate
response of our emergency medical system. And while many of us take it
for granted, we all want it to work well when we need it. Many of the
men and women who risk their lives delivering emergency care have told
me the system can be improved, yet their desire to improve the services
they provide has rarely been recognized by Congress. This provision in
the reconciliation bill is the first step in helping EMS providers help
themselves become more efficient. I would like to thank Senator Graham
for his efforts in the Finance Committee to see that this important
issue was included in the package.
Finally, I would like to thank Chairman Roth for his efforts to
include an expansion of Medical Savings Accounts. In developing a
Medicare Choice Program modeled on the Federal Employee Health Benefits
plan, this will offer, for the first time, a real choice to America's
seniors.
Again, I commend and thank Chairman Roth and his Finance Committee
colleagues for including these important changes in the reconciliation
spending package.
BIPARTISAN BUDGET AGREEMENT ITEMS TO BE ACHIEVED IN APPROPRIATIONS
PROCESS
Mr. DOMENICI. Mr. President, I rise to address some concerns
expressed by the administration with regard to two items they believe
should be in this reconciliation bill. I would like to clarify what we
assumed in the 1998 budget resolution for those items.
The bipartisan budget agreement did include assumptions on additional
funding for unemployment insurance benefits integrity and on extension
of fees for SSI State supplemental benefit administration. In both
instances, the budget resolution assumed that these proposals would be
implemented by the Appropriations Committee, and therefore the
authorizing committees were not instructed to achieve these savings in
reconciliation. The budget resolution is the basis for scoring
congressional action and cannot be changed in an ad hoc manner, that
is, without passing another concurrent resolution to change it.
I would ask the chairman of the Appropriations Committee if it is not
also his understanding that these proposals are to be considered by his
committee?
Mr. STEVENS. As chairman of the Appropriations Committee, I am
committed to working with the chairman, and the administration
regarding the levels of funding assumed in the bipartisan budget
agreement that are within purview of the Appropriations Committee. It
is my understanding that the Subcommittee on Labor, Health and Human
Services, and Education has been working with the Office of Management
and Budget with regard to the proposals you have mentioned.
Mr. DOMENICI. I thank the Senator for helping clarify this matter.
COVERAGE OF CERTAIN SERVICES IN RELIGIOUS NONMEDICAL HEALTH CARE
INSTITUTIONS UNDER THE MEDICARE AND MEDICAID PROGRAMS
Mr. KENNEDY. Mr. President, I strongly support the provisions in this
bill to ensure the continuation of Medicare and Medicaid reimbursement
for secular nursing services in religious nonmedical health care
institutions. These provisions ensure that strong religious beliefs are
not a barrier to Medicare and Medicaid benefits.
When Medicaid and Medicare were enacted over 30 years ago, Congress
included a special provision granting a religious accommodation for
members of the church, so that they could receive benefits for care in
their facilities comparable to the benefits available to others for
similar cases.
For 30 years, the Christian Science Church relied on Medicare and
Medicaid benefits and built a health care system that assists thousands
of men and women. At a time when the Health Care Finance Administration
has expressed increasing concerns about fraud and abuse in Medicare and
Medicaid, there are no complaints about the Christian Science Church.
Members of the church only ask to practice their religion without
unnecessary interference.
[[Page S6322]]
Last summer, however, a Minnesota district court determined that the
provisions in the Medicare and Medicaid statutes onto the Christian
Science Church are unconstitutional. As Judge Kyle stated in his
opinion, ``legislative accommodation of religious beliefs is a valuable
and worthy enterprise, but here * * * the accommodation has gone too
far and too strongly favors the convictions of one particular sect.''
However, the court also recognized the fundamental injustice that
Christian Scientists were required to pay the taxes for Medicare and
Medicaid, but could not receive the benefits of these programs. The
court also recognized the purpose underlying the original statutes. The
court clearly identified the statutory language referring to the church
as the problem, not the goal of providing comparable benefits to those
who disavow traditional medical treatment because of their religious
beliefs.
The provision in the reconciliation bill meets this goal without
undermining the Constitution. All references to the Christian Science
Church are eliminated. The provision will grant reimbursement for
secular nonmedical nursing services to any person who, because of
religious beliefs, does not believe in medical care and relies on faith
healing in a religious nonmedical health care institution. As with
other aspects of this health care system, the Health Care Finance
Administration will closely monitor the provision for fraud, abuse, and
public health concerns.
The chairmen of the House and Senate Judiciary Committees, the
chairman of the House Ways and Means Committee, the chairman of the
Senate Finance Committee, and I have worked closely to ensure the
constitutionality of this provision.
This provision meets the worthwhile goals of the original Medicare
and Medicaid laws, while meeting constitutional concerns. It deserves
to be enacted into law so that the needed benefits will continue to be
available.
food stamps for cross-border native americans
Mr. JEFFORDS. Mr. President, I know it is too late for Chairman Roth
to include this change in the manager's amendment, but I did want to
raise it before we finish here today.
As the chairman knows, thanks to a provision in both the Finance and
Ways and Means packages, native Americans who are entitled to cross the
U.S. border under the Jay Treaty are not affected by last year's
welfare law restrictions on providing SSI to aliens. Unfortunately, due
to jurisdictional considerations, neither the Finance nor the Ways and
Means Committees included food stamps in this provision. Preliminary
estimates indicate that such an inclusion would not incur significant
cost.
I understand Senator Lugar is supportive of the inclusion of food
stamps and I hope the chairman and ranking member will work with me and
other Members during conference with the House to include a food stamp
modification.
Mr. SMITH of New Hampshire. Mr. President, I rise today to commend my
colleagues on the Armed Services Committee and the Finance Committee
for having the courage to follow through on a promise the Government
made long ago to career military personnel. I know the future of health
care for elderly military retirees is an issue that deeply concerns
many of us, and I am pleased that we have found a financially
responsible solution to the growing problem of health care access for
this group of retired personnel.
With the Defense Department expected to complete full implementation
of the Tricare medical plan within the year, many retirees, who made it
their lives' work to defend our freedom, face the certain loss of
medical benefits when they turn 65 unless Congress acts now. As a
member of the Armed Services Committee, I am deeply disturbed by this
prospect. That is why I have consistently supported responsible
initiatives to guarantee the future of DOD health care for Medicare-
eligible military retirees.
In New Hampshire, I have witnessed firsthand the impact of defense
downsizing on health care resources for this vulnerable population.
When Pease Air Force Base closed in 1991, thousands of aging retirees
were left to compete with active duty personnel and military retirees
from neighboring States for fewer spaces in the New England DOD health
care system. Once Tricare takes hold, this group will lose any
remaining access to the military system they now enjoy because the
Defense Department can no longer afford to offer these retirees the
medical benefits they were promised. This is unacceptable.
After 4 years of meetings, hearings, and failed legislative
initiatives, the Senate has finally reached a workable solution to the
health care crisis now facing Medicare-eligible military retirees.
Medicare subvention, as the plan is known, will allow the Defense
Department to seek reimbursement from Medicare for the cost of treating
eligible retired military personnel. By authorizing the DOD to carry
out a 3-year Medicare subvention test program, the Senate has taken a
decisive step toward restoring military retirees' faith in the country
they honorably served. I am pleased to have supported Medicare
subvention since the proposal's inception, and I look forward to
working with my colleagues in the coming years to ensure that our
Government does not shirk the responsibility of providing elderly
military retirees with the quality, affordable health care they
deserve.
I thank the chair and I yield the floor.
MEDICARE SUBVENTION
Mr. INHOFE. Mr. President, throughout each year we address a number
of Medicare issues. This year, we have a Medicare issue within the
reconciliation bill which is related to military health care,
specifically, Medicare subvention. Without Medicare subvention,
military treatment facilities cannot receive reimbursement from
Medicare for care the facilities provide to military retirees who are
also eligible for Medicare. With Medicare subvention, we can continue
to improve the quality of life for military personnel, their families,
and retired service members and their families by providing them with
alternative access to treatment.
Because health care is such an important aspect of quality of life in
the military, it is imperative that we continue to provide our military
personnel and retirees with the access which they were promised.
Currently, because the access of military retirees age 65 and over is
on a space-available basis and due to overcrowding of military
treatment facilities, finding adequate medical care has proven
increasingly difficult if not impossible. Clearly, this is not a trend
we want to continue if we hope to retain and recruit the quality and
quantity of men and women needed to fight and win wars in the future.
Medicare subvention would fulfill the commitment made to our former
service members by allowing Medicare to reimburse the Department of
Defense [DOD] for care provided to members who are Medicare-eligible
beneficiaries. I believe that Medicare subvention would be fiscally
beneficial to Medicare and would make available an important revenue
source that will enable and encourage DOD to provide care to over-65
retirees. Further, Medicare will save money because DOD can provide
care less expensively than civilian providers. This is clearly a win-
win situation for both the DOD and Medicare.
Clearly, ending access to military medical facilities when
beneficiaries reach an age when they will most need it is fundamentally
unfair. Our veterans have earned our support, and they deserve the best
access to medical care that we can make available. I believe that
Medicare subvention is a necessary step in the right direction, and I
fully support the Medicare subvention provisions found in the
reconciliation bill.
Food Stamp Nutrition Education
Mr. SANTORUM. Mr. President, I support the amendment offered by the
Senator from Texas, and I commend her for her diligent work in fighting
fraud in the Food Stamp Program. I would also like to thank her for
working with me to address a concern of mine with regard to food stamp
nutrition education.
For 2 years, the Reading Terminal Farmers' Market trust participated
in a partnership with the USDA to develop a community-based nutrition
education program in Philadelphia. Using a Federal share to match
private grants from the Knight, Pew and Kellogg Foundations, the trust
established
[[Page S6323]]
the Philadelphia nutrition education network to integrate nutrition
education into ongoing food distribution and health programs. The
Philadelphia School District, Allegheny University of Health Sciences,
WIC, the Archdiocese of Philadelphia and others were engaged as
partners in the network, which reached over 17,000 children and adults
in 1996.
By all accounts, this program was a success; and last summer, when
the one-time cooperative agreement with USDA expired, the trust sought
to continue their important work under the existing food stamp
nutrition education program. In June 1996, the trust submitted a food
stamp nutrition education plan requesting matching funds for a
nutrition education plan in four low-income communities and at the
Reading Terminal Market. Unfortunately, USDA regulations only permit a
Federal match for local or State government funding. Since the Reading
Terminal Farmers' Market Trust relies upon private contributions to
fund their programs, USDA determined that they were not eligible to
participate in the food stamp nutrition education program.
Since last summer, my office has been working with Reading Terminal
Farmers' Market Trust to find a way for this program to continue. It is
my understanding that nutrition education programs in Vermont and New
York City have encountered similar problems with USDA matching funds. I
have worked with Chairman Lugar of the Agriculture Committee and
Senator Leahy to craft an amendment that will address these problems,
and I am grateful to the Senator from Texas for including this language
as section 2 of her amendment.
The language in this amendment will enable nonprofits and State
agencies to receive grants in order to operate nutrition education
programs that are coordinated among a broad range of food distribution
and social service providers. In order to reach the maximum amount of
eligible individuals and to leverage private funds for this endeavour,
private donations will be made eligible to match the Federal grant.
The amendment provides $600,000 for grants for each of fiscal years
1998 through 2001, and no individual grant may exceed $200,000.
This provision has the support of Agriculture Committee Chairman
Lugar and Senator Leahy.
FINAL REGULATIONS ON SOCIAL SECURITY INSURANCE DETERMINATIONS FOR
CHILDREN
Mr. JEFFORDS. Mr. President, during the consideration of this
important bill, I would like to bring to your attention developments
regarding the administration's recently released SSI regulations for
children. Through sections 211 and 212 of Public Law 104-193, the
Personal Responsibility and Work Opportunity Act of 1996, Congress
established a new eligibility test requiring that children show the
presence of ``marked and severe functional limitations'' to become
eligible for Supplemental Security Income [SSI] disability benefits.
Additionally, under these new rules up to 300,000 children who are
currently eligible for SSI will undergo a redetermination assessment
over the next several months.
On February 11, 1997, in an attempt to implement these provisions,
the Social Security Administration issued interim final regulations
that require a level of disability that meets or equals the listings of
impairments criteria. As stated in a letter written by nine of my
colleagues and me to the President in April, I believe this regulation
establishes an overly severe standard that misinterprets the intent of
Congress to reform the SSI program for children with disabilities.
SSA's test would remove up to 135,000 SSI disabled children this year
alone. Thus, thousands of severely disabled children would face a loss
of needed SSI benefits--contrary to the will of Congress.
I believe the Social Security Administration should establish a
comprehensive functional test at a stricter severity level than the
former individualized functional assessment test, but one that does not
harm children with serious disabilities. A test protecting children
with severely disabling conditions--including those with one marked and
one moderate condition--would accurately reflect the intent of
Congress. The administration has estimated this test would terminate
45,000 children this year, and close to 250,000 over 6 years.
Mr. President, I have already heard from constituents in my State of
Vermont whose children will soon lose their SSI benefits. These
families have nowhere else to turn. Such predicaments present troubling
moral and budgetary questions--how to provide for those families who
are shut off from desperately needed SSI benefits, and whether these
regulations will simply shift the costs of providing for children with
disabilities from SSI to other Federal entitlement programs, or to the
States as communities react to these troubling cases. Such cost
shifting would eliminate any significant savings gained. Additionally,
the loss of SSI benefits will force families to move their children to
costly out-of-home placement, as parents would no longer have the
financial support to stay at home and care for the disabled child.
This is a matter that I will be pursuing with the Administration with
the intent of reconciling the Administration's interpretation with the
regulations passed by Congress during the welfare debate last fall.
Welfare-to-Work Grant Program
Mr. HARKIN. The pending legislation provides $3 billion to establish
a Welfare-To-Work Program and specifies the activities for which the
funding may be used. The list of allowable activities does not allow
assistance for education or training activities with the exception of
on-the-job-training.
Mr. ROTH. That is correct.
Mr. HARKIN. Over the past several years I have met with a number of
welfare recipients, caseworkers and others to discuss the issue of
welfare reform in the State of Iowa. The discussions have also included
a number of individuals who have successfully made the transition from
welfare to self-sufficient employment. In many cases, the key to this
successful transition was participation in post-secondary classroom
training. I understand that the pending legislation prohibits use of
the Welfare-To-Work Programs funds for this purpose but want to clarify
that States may continue to use Federal funds received under the
temporary Assistance for Needy Families Program or their own resources
for post-secondary classroom training.
Mr. ROTH. The Senator is correct. TANF does have some restrictions on
vocational education activities, however States may use these funds or
their own State funds for the education and training activities
described by the Senator.
Mr. HARKIN. I thank the Senator for making that clear. I have another
question.
The Welfare-To-Work Program provides formula grants to States and
requires States to develop a formula for distribution of the funds
within the State in consultation with sub-State areas. However, it is
not clear what types of entities are eligible to provide the welfare-
to-work services and that States have flexibility on this score.
In 1989, Iowa established 11 Family Development and Self-Sufficiency
Programs to work with welfare recipients with a history of long-term
dependency on the program and those who were at risk of long term
dependency. These projects, 10 at nonprofit organizations, have been
evaluated and have demonstrated success in moving welfare recipients
off of welfare and into self-sufficient employment. In addition, a
number of community action agencies and community development
corporations have also been working with welfare recipients on exactly
the kind of activities envisioned by the pending legislation.
I just want to make sure that a State may provide funding from the
Welfare-To-Work Program to entities such as community action agencies,
community development corporations and other nonprofit organizations.
Mr. ROTH. That is correct. States may provide funding to these types
of organizations.
Mr. HARKIN. I thank the Senator.
Mr. GRAMS. Mr. President, when Congress and the President reached
agreement on the broad outlines of plan to balance the Federal budget,
I had hoped that I could stand before the Senate during debate on the
reconciliation legislation and proudly announce my full support. It is
with deep regret, Mr. President, that I cannot. After careful
examination of S. 947, the Balanced Budget Act of 1997, I have come
[[Page S6324]]
to the conclusion that this legislation is good for Washington but bad
for the taxpayers, and because it is not in the best interests of the
working Americans we represent, I must reluctantly oppose it. Here are
the major grounds on which I base my decision.
As I have said in previous statements before this Chamber, I have
made the pursuit of a balanced budget my top priority in Congress, and
have always said that I would support a budget plan that meets three
specific criteria: First, it must shrink the size and scope of
Government and return money--and the power those dollars represent--to
the taxpayers; second, it must balance the budget by the year 2002 with
steadily declining deficits each year without the use of rosy economic
scenarios; and third, it must provide meaningful, broad-based tax
relief to working families.
Tax relief, of course, will be dealt with in the other half of the
reconciliation package. While there are many good provisions included
in the bill, this so-call spending reduction legislation still fails to
meet those pro-taxpayer standards.
First and foremost, like the budget agreement on which this
reconciliation legislation is based, this bill does not shrink
Government and return power to the taxpayers. In fact, it does the
opposite; it increases mandatory spending. In the next 5 years, total
mandatory spending would increase from $825 billion in 1997 to $1.1
trillion in 2002, a growth of 32 percent. Over the next five years,
Medicare will increase at a rate of 6.1 percent and Medicaid will
increase nearly 7 percent each year from the inflated baseline. Instead
of eliminating wasteful spending to reduce the Federal deficit, this
budget plan actually creates numerous new programs, including $34
billion in new entitlement programs funded by the taxpayers' hard-
earned dollars.
In doing so, the plan has erased all of the savings achieved in last
year's landmark welfare reform legislation. The reconciliation
legislation includes about $24 billion in spending for new children's
health care initiatives, while adding back $14.2 billion in welfare
benefits for legal aliens and food stamp recipients.
Under this legislation, the Federal Government will spend $1.2
trillion on welfare alone over the next 5 years. That is $15 billion
higher than the CBO projected. Of every dollar collected by the IRS, 14
cents goes to welfare programs, with less than 1 cent dedicated to tax
relief for working families.
The fundamental flaw of the bill and the major source of my
opposition to it is the new entitlement programs it creates. Such
spending is a serious mistake at a time when we should control the
explosive growth of mandatory spending and reduce the size of the
Federal Government. History tells us that earlier entitlement programs
started small, with perhaps the best of intentions, but have since
exploded and now consume about 70 percent of all Federal revenues. To
my disappointment, Washington has still not learned its lesson.
Second, Mr. President, despite some positive changes, including
structure changes in Medicare, the entitlement programs remain intact.
This not only breaks our promise to the American people on fundamental
entitlement restructuring, but also ensures that big Government lives
on by allowing Washington to avoid the hard choices it must make to
address our long-term fiscal imbalances.
Without fundamental changes, the imbalance between the Government's
entitlement promises and the funds it will have available to pay for
them will eventually shatter our economy. In its recent report, ``Long-
Term Budgetary Pressures and Policy Options,'' the Congressional Budget
Office warns us that if these long-term budgetary pressures are not
relieved, Federal budget deficits would mount and could seriously erode
future economic growth. The Federal deficit would increase from 1.4
percent of GDP, or $107 billion today to 30 percent of GDP in 2035,
nearly $11 trillion. The debt held by the public would increase from 50
percent of GDP, or $3.9 trillion in 1996 to 250 percent of GDP, $91
trillion in 2035. Such rapid growth of the Federal debt and deficit
will bankrupt this great Nation.
This gloomy picture has been confirmed by the recently released
report of the Social Security and Medicare boards of trustees. Without
clear changes in public policy to address the financial imbalance, the
hospital insurance fund, one of the Medicare trust funds, will be
bankrupt in just 4 years. The Medicare trust fund will run a deficit of
$13 billion this year. By 2001, it will run a deficit of $49 billion
and go broke. The disability insurance trust fund will be bankrupt in
2015, and Social Security trust funds will be bankrupt in 2029. And we
do not have any clear and agreed public policy to address this
imbalance.
Although the proponents of the legislation claim that it will avert
the crisis of Medicare bankruptcy until 2007, the fix is temporary and
is no more than tinkering with the system. Accounting gimmicks are also
applied to extend the life of Medicare. It shifts home health care from
part A to part B and use the general account to cover the deficits of
the trust fund. This means a surge of new spending in Medicare in the
future that taxpayers will be obligated to fund.
Third, unlike the Balanced Budget Act produced by the Republican
Congress in 1996, this Balanced Budget Act does not result in steadily
declining deficits, because the savings are achieved not through honest
accounting but through rosy economic scenarios. Although this
legislation claims over $117 billion savings in Medicare and $8 billion
in Medicaid, all of the spending cuts result from a baseline projection
of Government spending in which programs are assumed to grow according
to such factors as the rate of inflation, population growth, and
formulas written into the law.
Any honest budget plan must reach balance through steadily declining
deficits every year; in other words, the deficit must be lower each
year than the preceding one. This 5-year budget agreement actually
increases the deficit for the first 2 years, then projects enough of a
reduction in the final 2 years to reach balance. The deficit under this
budget will go up by $23 billion next year, from $67 billion this year
to $90 billion, and remain as high as $90 billion in 1999. Over 70
percent of the deficit reduction will not occur until after President
Clinton leaves the White House. A significant percentage of the plan's
deficit reduction results from optimistic economic assumptions, not
sound policy changes.
A budget plan must also be based on real numbers and not the inflated
budget estimates that have been used in the past to justify more
spending and higher taxes. This budget agreement fails on that score as
well by continuing to use the inflated budget estimates of the past to
mask the spending increases it contains. I cannot support a budget that
uses such gimmicks simply to make the numbers add up on paper.
In its analysis of the budget, the Heritage Foundation concluded that
``a credible plan to balance the Federal budget must result in a
smaller Government that costs less and leaves much more money in the
pockets of working Americans. The current reconciliation bill not only
fails these important tests, but in many cases would implement policies
that are worse than taking no action at all.''
Our current sound economic growth has reduced the budget deficit to a
17-year low without any fiscal constrains and reforms. We should use
this historic opportunity to balance the budget in less than 5 years,
start to pay back our $5.4 trillion national debt, and address our
long-term fiscal imbalances. Unfortunately, we have once again missed
this opportunity.
Mr. President, under the legislation before us, Washington will spend
more of the taxpayers' hard-earned dollars creating new entitlement
programs, while expanding old programs just to please the big-spending
politicians and the special interest groups they feed. That is not the
budget the taxpayers of Minnesota are expecting. That is not the budget
Congress owes America's working families. But that is the budget
Washington claims is the right answer. I regret that I do not agree,
and cannot therefore support the spending portion of the budget
reconciliation legislation.
amendment no. 445
Mr. SPECTER. Mr. President, I would like to take this opportunity to
explain my vote in opposition to the motion to waive the Budget Act for
[[Page S6325]]
consideration of the substitute amendment offered by Senator Reed.
To its credit, the Reed substitute did not contain the Medicare home
health care/copayment language or the 65-67 Medicare age eligibility
language in the reported bill. I voted against both of those provisions
on independent votes yesterday and continue to be concerned about their
inclusion in S. 947.
Notwithstanding those elements of the Reed amendment, I could not
support it because it failed to include an important provision or
medical savings accounts for Medicare beneficiaries.
exemption from auctions for public safety radio services and allocation
of spectrum for public safety and public service entities
Mr. BRYAN. Mr. President, I rise in support of the proposal to ensure
that sufficient radio spectrum is made available for public safety and
maintenance of the Nation's critical infrastructure, such as pipeline,
railroad, and electric, gas and water utility services. With the
success of spectrum auctions for commercial radio services, the FCC has
been reluctant to allocate sufficient spectrum for these vital
services. This legislation will expand the FCC's authority to auction
spectrum, but not at the expense of entities that we have entrusted to
protect the safety of life, health and property and to provide
essential public services.
In adopting rules for the use of this new spectrum, I hope the FCC
will promote the development of shared public safety/public service
radio systems. In Nevada, it was recognized several years ago that it
would be prohibitively expensive for any one public safety agency or
public service utility to build and maintain a state-of-the-art 2-way
radio system to cover this vast territory and provide the service
features these various agencies need. Several key public service and
public safety organizations took the initiative to pool their resources
to build a system that would share backbone infrastructure, such as
mountaintop repeater sites and radio frequencies. Through software
partitioning, each user has its own discreet and secure virtual private
network on this shared infrastructure. The parties first had to secure
waivers of the FCC's rules so that nongovernment entities could share
public safety frequencies on a not-for-profit basis. Initial system
users include the Nevada Department of Transportation, University of
Nevada law enforcement personnel, City of North Las Vegas, Sierra
Pacific Power Company, and the Nevada Power Company. Other utilities
and state and local government agencies are also looking to partner in
the system, which currently covers more than half of the State's
geography.
Shared public safety/public safety radio networks such as the one we
have pioneered in Nevada have many advantages: First, joint use of a
system is a spectrally efficient; second, during disasters and
emergencies, there is a great need for interoperability between
emergency response agencies and public service utilities that is easily
accommodated on the shared system; third, equipment can be loaned from
one entity to another on an as-needed basis during specific emergencies
or special situations; fourth, other agencies and utilities can be
added to the system without system duplication of facilities; fifth,
smaller, rural agencies can access state-of-the-art technology that
would otherwise be beyond their reach; and sixth, taxpayer and utility
ratepayer costs can be significantly reduced.
Does the Senator from Arizona agree that these shared public safety/
public service radio networks should be promoted?
Mr. McCAIN. Yes, I agree. I would also like to offer my support for
the allocation of new spectrum for use by public safety and public
service organizations, and would urge the FCC to adopt rules that would
facilitate, if not promote, the development of shared radio systems by
such entities. I also know that Senators Stevens, Lott, and Burns have
been very concerned and involved in this issue. I look forward to
working with them and Senator Bryan to ensure that the Commission takes
such action as necessary to deal with this subject and I am also
hopeful that we can, if needed, clarify any problem with this language
in conference.
What is Right for Medicare
Mr. DORGAN. Mr. President, the votes on this reconciliation bill
included two votes on spending cuts in the Medicare Program. The two
controversial amendments dealt with increasing the eligibility age for
Medicare from age 65 to 67 and income-testing of Medicare for upper
income beneficiaries.
I support the change that will result in substantial savings through
reduction of Medicare reimbursements to providers. I also agree with
other changes that will improve and streamline the program.
However, I voted against the proposal included in the Committee's
bill which would increase the eligibility age from 65 to 67 and the
proposal to impose a means-test for higher-income beneficiaries.
I am willing to consider supporting both of these proposals under the
right conditions, which I will describe below but I think it is
inappropriate to be making Medicare cuts on the spending side of
reconciliation in order to make room for larger tax cuts on the revenue
side of reconciliation.
Whatever changes are made in Medicare should be made exclusively and
specifically for the purpose of extending the solvency of Medicare--not
for the purpose of providing additional room for tax cuts, the bulk of
which are proposed to go to upper income earners in the United States.
We must look at the right ways to keep Medicare solvent without
breaking faith with the country's senior citizens.
Asking senior citizens who make more than $50,000 to pay higher
prices for their Medicare policies so that investors who make $500,000
can be given tax cuts seems inappropriate to me. There's no denying a
direct connection when the Medicare proposals are made in the context
of a reconciliation bill that includes spending and taxing. The act of
achieving Medicare savings then becomes intertwined with the desire for
tax cuts on the revenue side.
The reconciliation bill specifically calls for a commission to make
recommendations on long term changes necessary to ensure the solvency
of the Medicare Program. I support that and I hope that such a
commission will be established quickly and will ultimately result in
solid recommendations which the Congress can then act on quickly.
When we are able to look at recommendations which are developed
specifically for the purpose of extending Medicare solvency, then I am
willing to consider changes to Medicare, including means-testing and/or
increasing the eligibility age under the following conditions.
First, with respect to increasing the eligibility age, if and when we
do that, we must be prepared to respond to the question of what happens
to those senior citizens whose incomes are inadequate to pay the higher
cost of private health care insurance between age 65 and 67 when they
would no longer be covered. Changing the eligibility age from 65 to 67
without providing some mechanism to provide for the availability of
affordable insurance coverage for the citizens in that age group would
simply mean we have millions more uninsured Americans. Low income
senior citizens between the ages of 65 and 67 will never be able to
afford the kind of premiums that will be assessed by the health care
industry to insure people of that age. So, the eligibility age increase
cannot simply be considered on its own as it was in the reconciliation
bill. Nor can it be argued that the increase in the eligibility age
parallels the increase in the social security retirement age. The
ramifications are very different for increasing the medicare
eligibility age.
Second, with respect to means-testing or income-testing, as it is
called, I am willing to support means-testing for Medicare, but again,
only on the condition that the means-testing itself is done for the
purpose of extending the solvency of Medicare and not part of a
reconciliation bill that is designed to cut spending in a way that will
accommodate additional tax cuts.
The temptation is too great for those in Congress who never supported
the Medicare bill in the first place. It is a concern of mine that the
proposed changes to Medicare in this bill are there not for the purpose
of increasing the solvency of Medicare, but rather are there to
accommodate tax cuts for upper income Americans. This, in my judgement,
undercuts the Medicare Program.
[[Page S6326]]
AMENDMENT NO. 428
Mr. McCAIN. Mr. President, I am proud to have cosponsored amendment
No. 428, which will significantly reduce fraud, abuse, and waste in the
Medicare system. This is an issue which I have been working on for many
years and I am pleased to have been joined in this battle to combat
fraud and abuse in our health care system by my colleague from Iowa,
Senator Tom Harkin.
This important amendment introduced by Senator Harkin incorporates
portions of my legislation, the Medicare Whistleblower Act S. 235,
which would assist Medicare beneficiaries with identifying provider
fraud in the Medicare system.
Over and over again, I have heard from seniors about their personal
experiences with fraudulent and negligent billings throughout the
Medicare Program. Many of these seniors say that their Medicare bills
frequently include charges for medical services which they never
received, double billings for a specific treatment, or charges which
are disproportionate and severely marked up. Usually, most of these
seniors have no idea what Medicare is being billed on their behalf, and
they have no way to obtain a detailed explanation from the Medicare
providers.
These personal stories from senior citizens are confirmed by analyses
and detailed studies. According to the General Accounting office, fraud
and abuse in our Nation's health care system costs taxpayers as much as
$100 billion each year. Medicare fraud alone costs about $17 billion
per year which is about 10 percent of the program's costs.
This is quite disconcerting, especially in light of the financial
problems facing our Medicare system.
A fundamental problem with the Medicare system is that most
beneficiaries are not concerned with the costs of the program because
the Government is responsible for them. One of my constituents shared
with me an experience he had when his provider double-billed Medicare
for his treatment and the provider told him not to be concerned about
it because ``Medicare is paying the bill.'' This is an outrage and we
cannot allow this flagrant abuse of taxpayer dollars to continue.
Remember, when Medicare overpays, we all over-pay, and costs to
beneficiaries and the taxpayers spiral while the financial
sustainability of the program is violated.
The amendment addresses this fundamental problem in the Medicare
program by strengthening the procedures for detecting and identifying
fraud and waste in the Medicare system. Beneficiaries would be given
the right to request and receive a written itemized copy of their
medical bill from their Medicare health care provider. This itemized
bill should be provided to the beneficiary within 30 days of the
provider's receipt of their request. If anyone knowingly fails to
provides a beneficiary with an itemized bill they will be subject to a
civil fine. Once the beneficiary receives the itemized bill they would
have 90 days to report any inappropriate billings to Medicare. The
Medicare intermediaries and carriers would then have to review the
bills and determine whether an inappropriate payment has been made and
what amount should be reimbursed to the Medicare system.
I recognize that provider fraud is not the sole source of waste and
abuse in the Medicare system, and I wholeheartedly support other
initiatives which address beneficiary fraud. However, studies indicate
that provider fraud is most prevalent and the greatest concern for the
system, making initiatives such as this one which specifically target
provider fraud very important.
It is imperative that we put an end to the rampant abuse and fraud in
the Medicare system. I wholeheartedly believe that this provision would
contribute significantly to this effort.
Mr. LIEBERMAN. Mr. President, the reconciliation bill contains
provisions that impact most of the programs and services provided by
the Federal Government. Few people in the United States are not touched
in some way by the changes we have voted for during this debate. I
would like to touch upon just a few of the provisions.
The bill includes significant progress toward protecting the Medicare
Program. Without the changes included in this legislation, the Medicare
trust fund would go bankrupt in 2001. The changes include the first
major structural changes to Medicare in its 30-year history. The Senate
bill modernizes Medicare by offering seniors the option of choosing
from among a range of quality private health plans in addition to
existing fee-for-service Medicare. It includes important new health
insurance coverage for the Nation's children. It returns a degree of
protection for people who live and work in our country, but because of
foreign birth are not citizens of the United States.
The bill makes substantial advances in ensuring that Medicare and
Medicaid beneficiaries can get comparative information to help them
choose the best available health care plan for their needs. An
amendment I sponsored with Senators Chafee, Jeffords, Kerrey, Breaux,
Wyden, and Kennedy requires that includes comparative information on
benefits, cost sharing, premiums, service area, quality and performance
including disenrollment, satisfaction, health process and outcomes,
grievance procedures, supplemental benefits, and physician
reimbursement method be provided to Medicaid recipients in managed
care. In many cases, Medicaid managed care plans have significant
differences in the treatment of asthma, immunization, heart disease,
diabetes, and other problems endemic to the Medicaid population. This
amendment should assist Medicaid beneficiaries in choosing high-quality
plans, and through competition among plans, increase the quality of
all.
The bill also included an important demonstration program for
Medicare based on the Government's own employee health care plan. That
demonstration program includes provisions to improve the quality of
health care for Americans based on a bill I sponsored, S. 795, the
Federal Health Care Quality, Consumer Information and Protection Act.
The dramatic drive of millions of people into managed care was all
geared toward stopping unacceptable cost increases in healthcare. Now
cost increases have slowed and it is time to focus on quality. Congress
has made some initial, spasmodic efforts, such as last year's drive-
through delivery legislation. The health care quality provisions in
this demonstration program represents an effort to take a more
comprehensive and durable approach to improving health care quality.
The Government has a powerful tool we think has gone unused--its
purchasing power. The Federal Government is the single biggest
purchaser of health care in the country. If we use that purchasing
power wisely, the quality of health care in the country will be pulled
upward dramatically. If we don't, the Federal Government will drag down
the efforts the private sector is making to improve their employee's
quality of health care.
If the bill passes, the Government will only purchase Medicare
coverage in this demonstration program that satisfies two requirements:
First, plans will have to provide information that allows people to
make straightforward plan-to-plan comparisons of health care quality.
With that information, Medicare beneficiaries could look up the plans
in their area to see which had the best record of care for the elderly.
Empowering consumers with comparative quality information would force
health care plans to compete continuously and aggressively on quality
resulting in ongoing health care improvements.
Second, all health care plans in the demonstration would have to meet
certain minimum criteria or they couldn't be purchased by the Federal
Government. Setting uniform federal criteria provides a powerful tool
to address quality issues that emerge from the rapidly evolving health
care industry. Existing accrediting agencies like the National
Committee on Quality Assurance for Quality Assurance [NCQA] or the
Joint Commission on Accreditation of Healthcare Organizations [JCAHO]
could be licensed to certify that the health care plans are in
compliance with the minimum criteria which should minimize bureaucratic
duplication.
Finally, to hold this proposed system together and prevent the
standards from becoming outdated, an Office of Competition is created
within the U.S. Department of Health and Human
[[Page S6327]]
Services. The Director of the Office of Competition will set and update
the basic requirements for comparative data and minimum criteria. They
will also work out a formula to pay for value. High quality plans will
get paid slightly more than low quality plans.
The Director will draw on the expertise already developed by large
private purchasers and coordinate with them in improving the purchasing
requirements over time.
The stakes are high. This year over $1 trillion, almost one-seventh
of the economy, will go toward health care services. Purchasers, both
private and public, need to demand quality from the health care
marketplace. Today you can identify a good stereo, a good car, or a
good shampoo. But, you can't get the most basic information about the
quality of your healthcare. That lack of information on health care
quality is no longer acceptable, it can be fixed, and the Government
should join the best corporate purchasers in the repair effort.
I am deeply concerned about one aspect of the Medicare package that
is included in this budget reconciliation bill. The Senate Finance
Committee has enacted a series of reforms that would dramatically
change the methodology by which payments are made to Medicare managed
care plans as well as the new plans envisioned in the bill. This new
payment structure would result in a redistribution of Medicare
resources that is very beneficial to areas that have low health care
costs and very damaging to areas where the delivery of health care
services is much more costly.
In my home State of Connecticut, seniors in four of our eight
counties would suffer from Medicare managed care payments that, under
this bill, would decline by more than 20 percent relative to current
law. Don't misunderstand--I support actions to keep the Medicare trust
fund solvent. But these reformulations don't just produce savings--they
fundamentally shift expenditures from high cost to low cost areas. In
one Connecticut county, this legislation would extract 57 times more
savings from seniors enrolled in managed care than would the House Ways
and Means Committee bill, which achieves similar savings. These are
sobering figures--and they do not even take into account the impact of
the bill's risk adjustment mechanism, which would automatically reduce
Medicare payments by an additional 5 percent for all new managed care
enrollees in their first year of enrollment.
This legislation over-reaches in seeking to achieve a greater measure
of geographic equity in the Medicare payment system. Instead of making
the modest adjustments that are needed to improve the fairness of the
current system, this bill calls for sweeping reforms that would disrupt
the coverage of many seniors in order to help others.
Tragically, many of those who would be hurt the most are low-income
seniors who already have selected Medicare managed care plans because
they need the additional benefits--such as prescription drug coverage,
and dental and vision care--and the low out-of-pocket costs that many
of these plans offer. These low-income seniors cannot afford to expose
themselves to the high deductibles and copayments of the Medicare fee-
for-service system, nor can they afford to purchase an expensive
supplemental Medigap policy.
As I consider this issue, I think about the many areas in Connecticut
that have suffered from economic downturns in recent years and, even
today, are not enjoying the strong economic growth that is evident
throughout much of the country. Seniors in these areas are particularly
vulnerable. Considering that a disproportionate number of Medicare
managed care enrollees are low-income seniors, I believe we should
proceed carefully as we contemplate reforms that affect their coverage.
For many of these seniors, a reduction in their Medicare benefits would
cause severe financial hardship.
I want to emphasize that I have no desire to be involved in any
contest that pits the Medicare beneficiaries of Connecticut against
those of Iowa, Nebraska or any other State. I completely support the
expansion of new health care choices to all seniors, regardless of
where they live. I am convinced, however, that this can be accomplished
without awarding 60-percent payment increases for certain low-cost
areas--many of which tend to be sparsely populated--at the expense of
other areas where large numbers of seniors are already enrolled in
private health plan options. The number of seniors who would be
penalized by this shortsighted approach far exceeds the number who
would benefit.
I strongly believe that a more cautious, thoughtful approach is
warranted. For example, a 70/30 blend between local and national
payment rates would go a long ways toward eliminating the disparities
that currently exist--without causing massive cuts in certain areas. In
addition, a minimum annual update for all plans, combined with some
kind of link between growth in fee-for-service spending and managed
care spending, would help to assure that the resources available to
Medicare managed care plans do not fall hopelessly behind the growth in
medical inflation. It is totally unrealistic to think that we can allow
payments to decrease in certain areas--while actual costs are
increasing by 5 or 6 percent annually--without having any adverse
affect on seniors.
As we move forward with Medicare reform, we need to acknowledge that
it is, in fact, more costly to serve Medicare beneficiaries in some
areas of the country than others. There are legitimate reasons why it
costs more to deliver health care services in densely populated urban
areas. The wages of medical personnel and the capital costs of medical
facilities differ considerably from region to region and from State to
State. Even within individual States, medical costs vary from county to
county. To discount this economic reality, as this legislation does, is
sheer folly.
Perhaps the most troublesome component of this Medicare payment
proposal is the new enrollee risk adjustment mechanism. This provision
arbitrarily and automatically reduces Medicare payments by 5 percent
for all new managed care enrollees--regardless of their age or health
status--in their first year of enrollment. I have serious concerns
about the implications of this proposal. How are we supposed to promote
competition within the Medicare Program if we begin by saying that
everyone who leaves the fee-for-service system will be subject to a 5
percent penalty? This new enrollee tax will limit beneficiary choice by
discouraging health plans from entering markets in which seniors do not
have private health plan options at this time. Everyone in this chamber
should be deeply alarmed by this misguided provision.
Having given this Medicare payment proposal an honest and thoughtful
evaluation, I am convinced that we should work toward a more sensible
and well-reasoned approach when this legislation is considered in the
Senate-House conference committee. I want to state very clearly that I
do not have a problem with the amount of Medicare savings this
legislation would achieve; I just believe we have an obligation to
achieve these savings in ways that do not disrupt the coverage of
seniors. I urge my colleagues to join me in calling for a new approach.
AMENDMENT NO. 460
Mr. McCAIN. Mr. President, I am proud to have offered an amendment to
the budget reconciliation package which provides incentives for States
with expanding access to health care coverage under the Medicaid system
to devise innovative and cost effective programs. This amendment is
important to any State interested in best serving the health care needs
of its people.
My amendment authorizes the continuation of a State's Medicaid
managed care program operating under a section 1115 waiver. States
would have the option of requesting an automatic extension of their
waiver program for 3 years or permanently continuing their waiver
managed care program if it has successfully operated for at least 5
years and has demonstrated an ability to successfully contain costs and
provide access to health care.
In addition, this amendment allows these same States to utilize their
own resources to revise their programs and expand coverage, while
reducing both State and Federal costs.
The amendment will assist States in expanding health care coverage to
their most vulnerable populations. This is something Congress has spent
a great deal of time talking about during this session of Congress in
terms of
[[Page S6328]]
children. But children are not the only ones for whom health coverage
is a priority. There are still millions of people in this country who
live below the poverty line who do not have coverage. Unfortunately, we
often forget about these individuals.
Several States have led the way in innovation for expanding coverage
through cost containment: Tennessee, Oregon, Rhode Island, Hawaii, and
Arizona. My home State, Arizona, was the first to recognize that
improved quality, better access and reduced costs could be achieved
through the appropriate use of managed care as an integrated approach
to health care for low income people.
These States have summoned the political will and marshaled their
State resources to improve their health care programs while reducing
both State and Federal costs. Many new States are now following the
examples set by the pioneers and have filed statewide section 1115
waiver requests to move their programs into managed care.
In Arizona, 72 percent of the voters decided last fall that health
care should be available to everyone under the poverty line. Arizona
already covers children up to 133 percent over the poverty line. This
means Arizona decided to cover the 50,000 men and women without
children who live under the poverty line. This is their only hope of
health care coverage.
Unfortunately, the administration has recently erected additional
barriers to Arizona's initiative. In spite of the substantial savings
documented by Health Care Financing Administration [HCFA] evaluators
since the program began in 1982, more than enough to offset the cost of
expanding coverage, the administration would not allow Arizona to
reinvest these savings it achieved over a traditional fee-for-service
program in expanded coverage. Nor will HCFA allow the State credit for
their program's expected savings over the next 5 years.
States like Arizona which have successfully been operating under an
1115 Medicaid waiver should not be penalized for a change in Federal
guidelines which occurred after the program began. No one is
questioning whether these States have saved the Federal Government
millions. Arizona, Tennessee, Hawaii, Rhode Island, and any other State
with such a proven track record, should be allowed to use the managed
care savings it achieved over a traditional fee-for-service program to
expand coverage for their most vulnerable populations.
This important amendment assists States in providing access to health
care for the most vulnerable populations.
medical research
Mr. HARKIN. Mr. President, I would like to submit for the Record some
of the many letters I have received in support of Senator D'Amato's and
my amendment to S. 947, the Balanced Budget Act of 1997, to create a
medical research fund. These letters show the widespread grassroots
support for this amendment which would expand support for medical
research above and beyond what is currently being done at the National
Institutes of Health [NIH].
The people behind these letters understand what many recent studies
have demonstrated--that investments in medical research can both save
lives and lower Medicare costs through the development of more cost-
effective treatments and by delaying the onset of illness. They
understand that while health care spending devours nearly $1 trillion
annually, the United States devotes less than 2 percent of its total
health care budget to health research. These letters are from people
that understand the importance of increased funding for biomedical
research. I ask unanimous consent that these letters in support of the
medical research amendment be submitted for the Record.
There being no objection, the letters were ordered to be printed in
the Record, as follows:
Thank you.
American Association for
Cancer Research, Inc.,
Philadelphia, PA, June 25, 1997.
Hon. Tom Harkin,
Hon. Al D'Amato,
Hon. Arlen Specter,
Hon. Connie Mack,
Hon. Tom Daschle,
Hon. Barbara Boxer,
Hon. Jay Rockefeller.
Dear Senators: Bluntly, while debate rages over the budget,
1 mother, father, brother, sister or friend dies every 57
seconds in this country from cancer.
On behalf of the 14,000 cancer researchers searching for
treatments, cures and prevention weapons in this country and
the 1.3 million people who get cancer every year, we urge you
on in your quest to find more funding for research and
education!
The medical research amendment you are proposing is
essential to continue to find resources to support the
growing underfunded research programs at the NIH.
It is essential amendments like this pass to support all of
our efforts to build a healthy America.
Sincerely,
Donald S. Coffey, Ph.D.,
President.
____
Parkinson's Action Network,
Santa Rosa, CA June 25, 1997.
Hon. Tom Harkin,
Hon. Arlen Specter,
Hon. Connie Mack,
Hon. Alfonse D'Amato,
Hon. John D. Rockefeller,
Hon. Barbara Boxer,
Hon. Tom Daschle.
Dear Senators: Thank you for your efforts to increase funds
provided to the National Institutes of Health through the
creation of a Health Research Fund.
A million Americans suffer from Parkinson's disease, a
neurological disorder that causes increasing tremor,
stiffness and slowness of movement, eventually leaving us
unable to move or speak. I have lived with Parkinson's for
ten years, watching Parkinson's increasingly disable me, and
seeing others like former Congressman Mo Udall lose the
battle to the point of total immobility. The human suffering
that results from Parkinson's is immense and incalculable,
but this condition also produces a fiscal nightmare:
Parkinson's is estimated to cost at least $25 billion a year
in medical care, disability benefits, assisted living and
lost productivity. The cost is so high because we typically
live in a disabled state for a long time, and the battle
against less of function is ongoing and expensive.
Meanwhile, there is immense scientific promise, with
Parkinson's described by scientists as ``one of the brightest
spots in brain research.'' Nonetheless, the research is in
slow motion, stymied by inadequate funding: the federal
research budget for Parkinson's totals only about $30 million
or $30 per American afflicted. The current federal policy on
Parkinson's wastes billions in public and private dollars
coping with the effects of the disease, when millions of
dollars could be put toward finding a cure.
The Congress is moving toward a dramatic reversal in this
policy, by support for the Udall Parkinson's Research bill,
which would authorize $100 million to adequately invest in
this research. The bill is co-sponsored by 57 Senators and
202 Congressmembers, and we expect to see it enacted very
soon. This momentum could be derailed by the present
allocation for health programs in the 1998 budget agreement.
If not corrected this year in appropriations for the National
Institutes of Health, the present funding disparity almost
surely will continue, leaving the human and fiscal nightmare
to go on unabated.
Your amendment can fix this funding problem, return fiscal
sanity to this policy, and give hope to our struggling and
desperate community today.
Thank you from the bottom of our hearts for your efforts.
Sincerely,
Joan I. Samuelson,
President, Parkinson's Action Network.
____
Cystic Fibrosis Foundation,
Bethesda, MD, June 25, 1997.
Hon. Thomas Harkin,
Hon. Alfonse D'Amato,
Hon. Arlen Specter,
Hon. Connie Mack,
Hon. Thomas Daschle,
Hon. Barbara Boxer,
Hon. John Rockefeller.
Dear Senators, Today, there are more than 30,000 children
and young adults in the United States suffering as a result
of cystic fibrosis. There is a way to stop this--Medical
Research.
Your amendment is vital to the support of finding
treatments and ultimately the cure for this devastating
disease.
Just at a time when there are so many possible
breakthroughs, grants cannot be funded, contracts are not
given, clinical trials go unfunded, and education programs do
not begin.
As a nation, as parents, we simply cannot let nearly 80
percent of our research opportunities slip away or be
delayed.
The one approved program that we do not fund may hold the
cure.
Sincerely yours,
Robert J. Beall, Ph.D.,
President and CEO.
____
Research Society on Alcoholism,
Austin, TX, June 24, 1997.
Hon. Tom Harkin, Hon. Alfonse D'Amato, Hon. Arlen Specter,
Hon. Connie Mack, Hon. Tom Daschle, Hon. Barbara Boxer,
Hon. John Rockefeller,
U.S. Senate,
Washington, DC.
Dear Senators: On behalf of the 1,100 members of the
Research Society on Alcoholism, I am writing to unequivocally
support the Medical Research Amendment. The
[[Page S6329]]
Research Society on Alcoholism is a professional research
society whose members conduct basic, clinical, and
psychosocial research on alcoholism and alcohol abuse.
Alcoholism is a tragedy that touches all Americans. One in
ten Americans will suffer from alcoholism or alcohol abuse.
It's cost to the nation is nearly $100 billion annually.
Research holds the promise of developing effective methods
for the prevention and treatment of this far reaching
disease.
The Medical Research Amendment is an answer to the problem
of desperately needed research funds. An investment of this
type will create the ability for the National Institutes of
Health to fund grant applications that will lead to
advancements in all areas of health research. At this time of
unprecedented opportunities in alcohol research, this
amendment provides much needed assistance.
Thank you for your support of the research community.
Please do not hesitate to contact me if I can be of
assistance in any way.
Sincerely,
Ivan Diamond, Ph.D.,
President.
____
College on Problems of
Drug Dependence, Inc.,
Richmond, VA, June 24, 1997.
Hon. Tom Harkin,
Hon. Alfonse D'Amato,
Hon. Arlen Specter,
Hon. Connie Mack,
Hon. Tom Daschle,
Hon. Barbara Boxer,
Hon. John Rockefeller,
U.S. Senate, Washington, DC.
Dear Senators: The College on Problems of Drug Dependence
(CPDD) is the leading scientific society in the field of drug
abuse. On behalf of our nationwide membership I am writing to
lend our support to the Medical Research Amendment. Our
commitment to research advances and their positive
implication for the future is strengthened by this amendment
and its commitment to the research community.
An estimated 30 million Americans suffer from drug and
alcohol addiction. Alarmingly, of the 59 million women of
child bearing age, nearly 5 million are using illicit drugs
such as marijuana, cocaine, and heroin. Economically, drug
and alcohol abuse cost this country more than $1600 billion
annually. Research is the answer to understanding this
complex and devastating problem.
The Medical Research Amendment is the answer to a long
standing problem facing the United States, the undervalued
commodity of research. Research can provide us with the
elusive answers to questions of addiction, drug abuse, and
treatment. This amendment is an investment in the future of
America and not just the National Institutes of Health.
Thank you for your support of research and its advances.
Please do not hesitate to contact me if I can be of
assistance in the future.
Sincerely,
Robert L. Balster, Ph.D.,
Public Policy Officer.
____
College of Physicians &
Surgeons of Columbia University,
New York, NY, June 25, 1997.
Hon. Alfonse D'Amato,
U.S. Senate, Hart Senate Office Building, Washington, DC.
Hon. Tom Harkin,
U.S. Senate, Hart Senate Office Building, Washington, DC.
Dear Senators Al and Tom: On behalf of Columbia University
College of Physicians and Surgeons, I wish to express our
support for the amendment offered by Senators D'Amato,
Harkin, Specter, and Mack to provide additional funds over
appropriated amounts for the National Institutes of Health
that is being offered to the Budget Reconciliation Bill.
Current amounts for NIH are truly insufficient to fulfill
the objectives of NIH and the promise of biomedical research.
We have the opportunity to find the genetic basis of disease
and cures for illnesses such as Parkinson's, cancer,
diabetes, and others that afflict millions of Americans. The
contributions potentially offered by this amendment will save
millions of lives and billions of dollars.
Support for biomedical research is one of the most
important investments Congress can make in the health and
welfare of our citizens. All of us in academic medicine thank
you for your leadership and vision.
Sincerely,
Herbert Pardes, M.D.,
Vice President for Health Sciences,
and Dean of the Faculty of Medicine.
____
The National Coalition
for Cancer Research,
Washington, DC, June 25, 1997.
Hon. Tom Harkin,
Hon. Alfonse D'Amato,
Hon. Arlen Specter,
Hon. Connie Mack,
Hon. John D. Rockefeller,
Hon. Barbara Boxer,
Hon. Tom Daschle,
U.S. Senate,
Washington, DC.
Dear Senators: The 55,000 cancer researchers, nurses,
physicians, and health care workers, tens of thousands of
cancer survivors and their families; 40,000 children with
cancer and their families, 82 cancer hospitals and cancer
centers across the country, and more than 2 million
volunteers who make up the National Coalition for Cancer
Research commend your medical research amendment to the
fiscal year 1998 Senate Reconciliation Bill.
It is the Coalition's central conviction that the solution
to the complex problems surrounding cancer--the reduction in
morbidity, mortality, and the high costs of medical care--
will come in a stepwise manner from the generation of new
knowledge through research. Additional federal support for
cancer research as provided by your Health Research Fund will
abet the human and financial costs of cancer.
We must remember that despite the declining death rates of
the past few years, in the United States, men have a 1 in 2
lifetime risk of developing cancer, and women have a 1 in 3
risk. Cancer is still the second leading cause of death and
is expected to be the leading cause of death by the turn of
the century. The direct costs of health care services to
cancer patients is currently estimated at more than $104
billion annually and is increasing each year. The generation
of new knowledge through research into the molecular events
involved in the cause and progression of cancer should lead
to increasingly effective means of protection and treatment,
the only means to stop the spread of disease, and curtail
these costs.
The Coalition recognizes that the Congress is pressed with
securing savings in the Medicare and Medicaid programs, and
applauds your attention to the need to invest in biomedical
research to stop the spread of diseases which cause long term
care costs. The Coalition commends your amendment which
secures additional resources for biomedical research because,
without doubt, research is the gateway to progress against
cancer.
Thank you for seizing this opportunity now to do something
of utmost importance for our country.
Sincerely,
Albert H. Owens, Jr.,
President.
____
National Down Syndrome Society,
New York, NY, June 25, 1997.
Hon. Tom Harkin,
Hon. Alfonse D'Amato,
Hon. Arlen Specter,
Hon. Connie Mack,
Hon. Thomas Daschle,
Hon. Barbara Boxer,
Hon. John Rockefeller.
Dear Senators: One in every 800 children is born with Down
Syndrome and there are over 350,000 people with this
condition in the U.S. today. It is the most commonly
occurring chromosomal abnormality, resulting when an
individual possesses three, rather than usual two, copies of
the 21st chromosome.
Medical research supported by the National Institutes of
Health is our only hope in developing better therapeutics to
treat those individuals who have Down syndrome and to help us
better understand the causes of this disease so we can one
day prevent it from occurring. The National Down Syndrome
Society has just entered a historic public-private research
initiative with the National Institutes of Child Health and
Human Development to examine behavior and cognitive
development of individuals with Down syndrome. This project
is an important first step in increasing our understanding of
this disease.
Thank you for your efforts and commitment to ensuring the
longterm viability of our medical research infrastructure. We
support your efforts to establish a National Fund for Health
Research to ensure the NIH has the resources necessary to
continue to advance medical science in the United States.
Sincerely,
Myra E. Madnick,
Executive Director.
____
Alliance for Aging Research,
Washington, DC, June 25, 1997.
Hon. Tom Harkin,
Hart Senate Office Building,
Washington, DC.
Dear Senator Harkin: The Alliance for Aging Research, an
independent not-for-profit organization working to improve
the health and independence of older Americans, applauds and
strongly supports an amendment to establish a National Fund
for Health Research. We understand this fund would be
established in the Treasury to expand support for medical
research through the National Institutes of Health.
As you know, the Alliance has consistently made the case
that the most effective means to achieve savings in Medicare
and Medicaid is by improving the health status of older
Americans. The most effective long-term strategy is to
advance biomedical research and to apply what we learn to
improved geriatric health management and prevention of
chronic disease. Studies released this year from Duke
University show a steady decline in chronic disability since
the 1980s among this nation's older population, saving
Medicare billions of dollars.
In a special report presented by the Alliance to the White
House Conference on Aging, we stated that by postponing
physical dependency for older Americans by just one month
would save the nation $5 billion a year in health care and
nursing home costs. Postponing the onset of Alzheimer's
Disease by just five years would, in time, save $50 billion a
year in health care costs. And a
[[Page S6330]]
five-year delay in the onset of cardiovascular disease could
save an estimated $69 billion a year.
Your amendment would be a first step toward fulfilling the
commitment made by the Senate through the Mack Sense of the
Senate calling for a doubling of the NIH in the next five
years. We understand this would in no way take the place of
the Congressional appropriations to the NIH.
Unless we discover better ways to treat, prevent or
postpone diseases of aging, the costs to the nation will grow
exponentially in the decades ahead. Again, I commend you and
your colleagues invaluable support for a strong national
investment in medical research.
Best regards,
Daniel Perry,
Executive Director.
____
Autism Society of America,
Bethesda, MD, June 25, 1997.
Hon. Tom Harkin,
Hon. Alfonse D'Amato,
Hon. Arlen Specter,
Hon. Connie Mack,
Hon. Thomas Daschle,
Hon. Barbara Boxer,
Hon. John Rockefeller.
Dear Senators: I am writing on behalf of the Autism Society
of America to support your amendment to establish a National
Fund for Health Research with additional savings that may
result from changes made by the Balanced Budget Act which
exceed the savings called for in the Budget Resolution. As
the amount of discretionary funds available for medical
research funding continues to shrink, we must find other ways
to ensure that our research infrastructure is maintained.
Autism is a developmental disability that typically appears
during the first three years of life. It is believed to be a
genetically-based neurological disorder that affects more
than 400,000 individuals in the United States, making it the
third most prevalent developmental disability. Autism is four
times more prevalent in boys than girls, and knows no racial,
ethnic nor social boundaries. Family income, lifestyle, and
educational levels do not affect the chance of autism's
occurrence. The estimated health care cost associated with
autism is greater than $13 billion a year.
At the present time, there is no prevention, treatment, or
cure for autism. Our only hope in better understanding autism
is through research. NIH is embarking on many exciting
research endeavors focused on autism. In fact, NIH Director
Harold Varmus has said numerous times that the time is right
for autism research--we now have the tools to help us begin
to unlock the mysteries of this disorder.
We appreciate your commitment to identify an additional
source of funding for medical research and for giving
individuals with autism the hope that through research we
will find a treatment and cure.
Sincerely,
Sandra H. Kownacki,
President.
____
Depressive and Manic-
Depressive Association,
Chicago, IL, June 25, 1997.
Hon. Tom Harkin,
Hon. Alfonse D'Amato,
Hon. Arlen Specter,
Hon. Connie Mack,
Hon. Thomas Daschle,
Hon. Barbara Boxer,
Hon. John Rockefeller.
Dear Senators: Medical Research is critical to individuals
suffering for depressive illnesses. On behalf of the more
than 65,000 members of the National Depressive and Manic-
Depressive Association I am writing to support your amendment
to establish a National fund for Health Research.
Depressive illnesses are treatable diseases. Without the
research advances we have seen over the last 20 years, many
individuals suffering from depressive illnesses would not
have the opportunities they have today to participate as
contributing members of our society. New therapeutics which
have been developed through research are giving them this
chance.
In any given year, 17.4 million American adults have some
form of depressive illness such as major depression, bipolar
disorder, or chronic, moderate depression. These conditions
account for more than $148 billion in direct health care
costs, and indirect costs. Such as lost work days for
patients and care givers. Investments in biomedical and
behavioral research on mental disorders are imperative for
preventing and treating these debilitating illnesses and
controlling the costs associated with them.
Thank you for your efforts to expand our national
commitment to medical research!
Sincerely,
Lydia Lewis,
Executive Director.
Mr. BIDEN. Mr. President, this budget bill--which would put us on a
path to eliminating the budget deficit in the year 2002--contains
numerous reforms of the Medicare program. In addition, the bill would
restore short-term solvency to Part A of Medicare--the part that pays
hospital bills and will otherwise be bankrupt in four years. I have no
objection to most of the Medicare reform provisions, and I will vote
for this bill overall.
However, I want to talk briefly about two provisions that I oppose
and explain why I voted to take them out of this bill.
First, Mr. President, this bill would raise the age at which a person
becomes eligible for Medicare from the current age 65 to age 67. I
voted to keep the eligibility age at 65. While this increase would be
gradual and would be phased in over the next 30 years--so it would not
affect any current seniors--I think it moves us in the wrong direction.
What we should be doing is making sure that more, not fewer, people
have health insurance.
Changing the current law so that today's workers will have to wait
until they are 66 or 67 before they become eligible for Medicare
threatens to add millions of people to the rolls of the uninsured. It
is my understanding that 70 percent of Americans who retire between the
ages of 60 and 65 will have no health insurance through their
employers. If they have health insurance at all, they are paying
exorbitant rates to buy it on their own.
Increasing the eligibility age for Medicare by 2 years would leave
most of these people unprotected for 2 more years. This result is
totally counter to why we created Medicare in the first place: To make
sure that older Americans have access to health care services when they
are likely to need it the most. Raising the eligibility age for
Medicare without addressing the issue of those who will lose--or those
who will continue not to have--health insurance is a glaring gap in
this proposal.
Now, it has been argued by supporters of this change that because the
Social Security retirement age will gradually increase to age 67, the
eligibility age for Medicare should increase at the same time. But, Mr.
President, there is no rational basis for linking Social Security and
Medicare. They are two separate and distinct programs. If it is good
policy to raise the Medicare eligibility age to 67--which I do not
think it is at this time--then those arguments need to be presented. It
is not good enough simply to say, ``Well, that's what we're doing with
Social Security.'' And, I should note, that even when the Social
Security retirement age increases, people will still have the option of
early retirement at age 62. That is not the case with Medicare. It is
all or nothing. And, we should not tell people between 65 and 67 that
they get nothing.
The second provision that I opposed would have--for the first time--
imposed means testing on higher income seniors. Under the plan, the
monthly premiums for Medicare part B, which pays for doctor services,
would have been based on how much income a person has. Now, I have long
said that I believe it is not unfair or inappropriate to have wealthy
seniors pay more for their Medicare coverage. So I support means
testing in principle. But I am not sure that the means testing scheme
in this bill is either fair or appropriate--and I think we ought to be
sure of both before we make such a significant change in this program.
This legislation was just drafted last week. Until noon yesterday--
Tuesday--this bill would have charged wealthier seniors higher
deductibles under part B. But, then at midday, just a couple of hours
before we voted on this issue, the bill was changed so that retirees
with greater income would pay higher premiums, not higher deductibles.
The fact that this last minute change was made just exemplifies the
problem of trying to address this issue with haste.
The premium increases in this budget bill are very substantial, and
they would hit individuals with incomes over $50,000 and couples with
incomes over $75,000. But we really do not know yet what the effect of
these increases would be on these families, or on the Medicare system
itself. This is why we need to proceed with greater caution.
What we do in this budget bill--and what we must do--is what we have
done many times in the last 30 years: Make the changes necessary to
ensure the solvency of the Medicare Hospital Trust Fund over the next
10 years. To address the long-term concerns once the baby boom
generation reaches retirement age, I have previously called for the
establishment of a bipartisan commission to study the situation and
make recommendations. This bill establishes just such a commission, and
instructs it to report back to Congress in a year.
[[Page S6331]]
My point is that neither the increase in the Medicare eligibility age
nor means testing are necessary to solve the short-term financial
problems of the Medicare system. Instead, these are issues that the new
commission should look at. In making significant changes to the
Medicare program--among the most successful Federal programs ever--we
need to do so with great thoughtfulness and deliberation.
These changes have no immediate impact on the Medicare trust fund or
on our general goal of balancing the overall Federal budget by 2002. In
short, there is no reason why we cannot wait until we have the benefit
of the recommendations of the bipartisan commission--within the next
year--before we take action of this nature. That is why I supported
taking these changes out of the budget bill, and why I supported
Senator Reed's alternative Medicare proposal to make only those changes
needed to make sure that Medicare remains financially solvent.
MEDICARE PROVISIONS
Mr. McCAIN. Mr. President, the Senate took several difficult votes in
the last two days related to Medicare reform. After carefully
considering each of the amendments offered in the Senate, I cast my
vote in favor of preserving and protecting the long-term solvency of
the Medicare system.
I voted for an amendment to eliminate the bill's provisions which
would require means testing of Medicare premiums. I also voted for an
amendment which would have simply delayed the implementation of premium
means testing until the year 2000. I believe it is foolish to hastily
make such a drastic change as this without the benefit of an indepth
study of the entire Medicare Program. Unfortunately, both of these
amendments failed.
I am concerned about the bill's provisions which would delay the
eligibility age for Medicare to 67 from the current age of 65. However,
the bill would not implement this change until the year 2003, which
will not affect current beneficiaries and, I believe, will allow us to
assess this change within the context of a larger study of the program.
The bill does establish a bipartisan commission to study the entire
Medicare Program and make recommendations for the changes necessary to
keep the program solvent beyond the year 2001, which is when the
trustees have reported the program will be bankrupt. I believe we
should wait for the commission's recommendations before enacting any
fundamental changes to the program. However, I felt it was important to
show a willingness to consider taking a first step toward long-term
structural changes in order to give impetus to the commission's work.
The budget reconciliation bill before the Senate contains many key
provisions to expand benefits under Medicare and incorporate choice and
competition into the current program. For example, the bill authorizes
Medicare coverage of mammography screening, colorectal screening, bone
mass measurement, and diabetes management. It also creates a Medicare
Choice Program and a demonstration program for medical savings accounts
for seniors. It contains provisions designed to eliminate waste and
fraud in the Medicare system which could result in significant savings.
These are improvements to Medicare for which I have fought for many
years.
I believe firmly that our priority must remain protecting the
Medicare system from bankruptcy by the year 2001, and I will continue
to work toward that goal.
Amendment No. 482
Mr. LEVIN. Mr. President, the Levin-Jeffords amendment increases from
12 to 24 months the limit on the amount of vocational education
training that a State can count toward meeting its work requirement
under the new Temporary Assistance for Needy Families Program. Under
the old welfare law, recipients could attend postsecondary vocational
education training for up to 24 months. I strongly support the new
law's emphasis on moving welfare recipients more quickly into jobs, but
I am troubled by the law's restriction on vocational education
training, limiting it to 12 months. Two-year community college study,
for instance, would not meet the requirement.
Mr. President, the limitation on postsecondary education training
raises a number of concerns, not the least of which is whether persons
may be forced into low-paying, short-term employment that will lead
them back onto public assistance because they are unable to support
their families.
Study after study indicates that short-term training programs raise
the income of workers only marginally, while completion of at least a
2-year associate degree has greater potential of breaking the cycle of
poverty for welfare recipients. According to the U.S. Census Bureau,
the median earnings of adults with an associate degree are 30 percent
higher than adults with only a high school diploma or its recognized
equivalent.
Mr. President, let me just give some examples. The following are jobs
that a person could prepare for in a two-year community college program
and the salary range generally applicable to the positions:
NATIONWIDE
Accounting, $14,000-$28,000.
Computer technician, $14,000-$31,000.
Law enforcement, $13,500-$25,000.
Dental hygiene, $18,000-$60,000.
Respiratory therapy tech, $21,000-$32,000.
MICHIGAN
Computer programing, $24,800-$42,900.
Radiology technician, $22.235-$32.425.
Legal assistant, $28,630-$30,000.
Child care development (supervisor), $23,590-$29,724.
Registered nurse, $24,400-$38,135.
Mr. President, the National Governors Association recognizes the
merits of this amendment and has called for its passage. I urge my
colleagues to support it because it will help us reach the new law's
intended goal of getting families permanently off of welfare and onto
self-sufficiency.
In closing, I ask unanimous consent to have printed in the Record two
articles that are relevant to this issue which appeared in the February
17, 1997, USA Today and the June 1, 1996, New York Times.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From USA Today, Feb. 17, 1997]
College Off Limits in Welfare Plan
(By John Ritter)
States rushing to get welfare recipients off the rolls and
into jobs are telling some college students on public
assistance to drop out and find work.
Under the old welfare system, recipients of cash grants
could go to school full-time. The new law, with its emphasis
on moving welfare recipients quickly into jobs, restricts
educational options.
Short-term job training and a year of vocational education
are approved ``work activities'' under the new federal law,
passed last year, but regular college and community college
study are not.
So even as President Clinton preaches education as the
route to prosperity, welfare reform is forcing recipients--
predominantly single mothers--to forsake school for low-
paying jobs.
States must put bigger proportions of their welfare
caseloads to work--25% this year, 50% by 2002--or lose funds.
``The emphasis has shifted from how can we retrain people
or pick up where their education left off to how can we move
them into work,'' says Elaine Ryan of the American Public
Welfare Association.
By one estimate, as many as 700,000 single parents on
welfare are enrolled in higher education and training.
In California, 125,000 welfare recipients attend community
colleges. The City University of New York system has 20,500
welfare students.
Schools already are lobbying state legislatures to find
ways to keep these students and their tuition reimbursements.
But prospects are not bright.
____
[From the New York Times, June 1, 1996]
Workfare Rules Cause Enrollment to Fall, CUNY Says
(By Karen W. Orenson)
New rules introduced by New York City Mayor Rudolph
Giuliani's administration that require all welfare recipients
to work have led thousands of students to drop out of college
or not enroll, according to officials at the City University
of New York. The decline in enrollment is significant, CUNY
officials say, because studies show that college gives people
on welfare a good chance to get better jobs at higher pay.
Mr. DOMENICI addressed the Chair.
The PRESIDING OFFICER. The Senator from New Mexico is recognized.
Mr. DOMENICI. Mr. President, let me take 1 minute, and then we are
going to final passage. I want to thank everybody for their
cooperation. Under a very difficult process and procedure, I think we
did very well. On a number of issues, there was great bipartisan
support. I thank those on the other side of the aisle who have
supported this overall package, and I hope the vote is overwhelming.
Tonight we complete
[[Page S6332]]
the first step of three legs. The three legs are to get the deficit
down by reducing spending; second is for us to get a good tax bill for
all Americans; third is to do the appropriations bills in a manner that
is consistent with the agreement and which doesn't violate the Budget
Act.
I believe this is a historic beginning, and I am very pleased to be
part of it. I thank everyone here for their role. I thank all eight
committees that assumed their burden and produced their reconciliation
package. Mostly, I thank Senator Roth, the chairman of the Finance
Committee, and Senator Moynihan, his Democratic manager, and all those
on the Finance Committee who worked to produce a bipartisan bill.
The lesson learned is that we can get things done that are difficult
but good for the American people in a bipartisan way if we just work at
it. I believe the best example we have of that is the Finance Committee
this year. All the other committees had lesser responsibilities, but
they provided their savings without rancor and with almost unanimity
and, if not, a unanimity of spirit. I believe there is no process that
would have let us in the U.S. Senate get this much work done. If this
bill were freestanding and the tax bill were freestanding without the
protections of the Budget Act, I just ask you to dream about what might
happen. First, I think each bill could take 4 or 5 weeks, I think the
amendments could run into the hundreds, and the bill could look like
something completely different by the time we finished than what we
started with. So we take some bad with the good in this difficult
process called the reconciliation bill.
I thank the ranking member of the Budget Committee not only for the
work here on the floor, but actually as we moved through the last 3\1/
2\ months, Senator Lautenberg has been very good to work with, and we
produced a good package, which will show up here in a bipartisan vote
tonight. I thank the Senator. We produced a good bill.
Mr. LAUTENBERG addressed the Chair.
The PRESIDING OFFICER. The Senator from New Jersey is recognized.
Mr. LAUTENBERG. Mr. President, I will be brief. I sense that
everybody would like to hear a long speech, but I am going to
disappoint them. I just want to say, Mr. President, that I, too,
enjoyed my work with the distinguished chairman of the Budget
Committee. We managed to resolve all of our problems without too much
dispute, without any confrontation. There wasn't a moment that we
walked out on anything. This reconciliation bill is consistent with
that. We did, as it was appropriately noted, rush through some things.
But that does not at all, in my view, suggest that we rushed through
and didn't have the appropriate knowledge or review of the items that
we were processing.
I thought it was a job very well done. I must say, if we didn't have
some time constraint on this, Heaven knows how long we would all be
here. We would see summer come and go and we would still be debating.
Again, I enjoyed the process and my first time at bat with the Budget
Committee in the position that I have. I thoroughly enjoyed it. I hope
that Senator Domenici will, as my ranking member in the not-too-distant
future, also enjoy it. I promise to be cooperative.
I want to thank the staff of the Policy Committee, but particularly
my senior staff here--Bruce King, Sander Lurie, Nell Mays, Marty
Morris, Amy Abraham, John Cahill, Jodi Grant, Matt Greenwald, Phil
Karsting, Sue Nelson, Jon Rosenwasser, Jim Klumpner, and Mitch Warren--
who did a terrific job, as I know Bill Hoagland and his team did. I
won't go through the names, but I will say that I have gotten to know
them and respect them and admire the work they have done. I thank
everybody for their cooperation, particularly my colleagues on this
side.
Mr. DOMENICI. Mr. President, Senator Gramm would like 30 seconds.
The PRESIDING OFFICER. The Senator from Texas is recognized.
Mr. GRAMM. Mr. President, I have heard a lot of people speak in my 13
years in the Senate, but I don't think I have ever seen anybody do a
better job of taking complicated issues and explaining them in a very
short time as Senator Domenici has done in the last 2 days. I think we
have made history on this bill, and I think the Senator from New Mexico
has been a very important part of that.
Mr. DOMENICI. I ask for the yeas and nays on final passage.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays were ordered.
The PRESIDING OFFICER. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed for a third reading and was read
the third time.
The PRESIDING OFFICER. The bill having been read the third time, the
question is, Shall the bill pass?
The yeas and nays have been ordered and the clerk will call the roll.
The legislative clerk called the roll.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 73, nays 27, as follows:
[Rollcall Vote No. 130 Leg.]
YEAS--73
Abraham
Allard
Ashcroft
Baucus
Bennett
Biden
Bond
Breaux
Brownback
Bryan
Burns
Campbell
Chafee
Cleland
Coats
Cochran
Collins
Conrad
Coverdell
Craig
D'Amato
DeWine
Domenici
Enzi
Feingold
Feinstein
Ford
Frist
Glenn
Gorton
Graham
Gramm
Grassley
Gregg
Hagel
Hatch
Hutchinson
Hutchison
Inhofe
Jeffords
Kempthorne
Kerrey
Kohl
Kyl
Landrieu
Leahy
Lieberman
Lott
Lugar
Mack
McCain
McConnell
Moseley-Braun
Moynihan
Murkowski
Nickles
Robb
Roberts
Rockefeller
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Warner
Wyden
NAYS--27
Akaka
Bingaman
Boxer
Bumpers
Byrd
Daschle
Dodd
Dorgan
Durbin
Faircloth
Grams
Harkin
Helms
Hollings
Inouye
Johnson
Kennedy
Kerry
Lautenberg
Levin
Mikulski
Murray
Reed
Reid
Sarbanes
Torricelli
Wellstone
The bill (S. 947), as amended, was passed.
(The text of the bill will be printed in a future edition of the
Record.)
Mr. ROTH. Mr. President, I move to reconsider the vote by which the
bill was passed.
Mr. MOYNIHAN. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. ROTH. Mr. President, in my opening statement, I thanked my good
friend and colleague, Senator Moynihan, my colleague on the Finance
Committee, and our staff for their excellent work. I would be remiss,
however, if I failed to conclude without again expressing my
appreciation for these diligent professionals--men and women who work
into the wee, wee hours, late nights, early mornings, and weekends to
help us craft a bill that could find the kind of success that this has
found on the Senate floor.
I would like to particularly thank the following majority and
minority staff of the Finance Committee who worked so hard on this
bill, including Lindy Paull, Frank Polk, Julie James, Dennis Smith,
Gioia Bonmartini, Alexander Vachon, Dee Dee Spitznagel, Joan Woodward,
Brig Gulya, Mark Patterson, David Podoff, Faye Drummond, Kristen Testa,
Doug Steiger, Rick Werner, and Rakesh Singh.
Again, I am grateful for the outstanding work that they did. And I
believe that it merits the thanks and gratitude of all of us.
____________________