[Congressional Record Volume 144, Number 39 (Tuesday, March 31, 1998)]
[Senate]
[Pages S2797-S2826]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




CONGRESSIONAL BUDGET FOR THE UNITED STATES GOVERNMENT FOR FISCAL YEARS 
                    1999, 2000, 2001, 2002, AND 2003

  The Senate continued with the consideration of the concurrent 
resolution.


                           Amendment No. 2165

  The PRESIDING OFFICER. Under the previous agreement, there are 5 
minutes of debate equally divided on the amendment that is pending.
  Who yields time?
  Mrs. MURRAY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Thank you, Mr. President.
  Mr. President, the amendment that we will vote on shortly simply puts 
in place a deficit-neutral reserve fund for class-size improvement, 
especially in the early grades. And, it would use as an offset anything 
we designate over the coming year in available mandatory savings or 
revenues, except for tobacco revenues.
  I know that the chairman is going to say that this reserve fund has 
no money and it has not set up any specific policy on class size 
reduction. He is absolutely right. It is exactly what he has done in 
his budget with the tobacco reserve fund and with the tax cut fund. I 
have learned from him that if we want priorities within our budget, 
this is the way we go about it.
  Education is a priority. As I pointed out this morning, 2 percent of 
our budget goes to education. At a time when parents and families and 
communities and States are struggling with this issue. Parents say to 
us that they want their children's class sizes reduced. I have talked 
to parents, I have talked to students, teachers, principals. Down the 
road, they say, this is going to make an important difference in our 
children's education.
  I think the most important thing to remember is what every parent 
says to their child when they come home on the first day of school. 
They ask two questions: Who is your teacher? and how many students are 
in your classroom? because they know that the best qualified teacher, 
the best trained teacher will make a difference for their child, and 
they know that the number of students who are in that classroom will 
make a difference in their child's ability to learn and be productive 
and get the skills they need to grow up and get a job and be a positive 
member of our economy and society in the future.
  Budgets are not just about today. Yes, we have a balanced budget 
before

[[Page S2798]]

us today. But, more importantly, we have to ask ``will it be balanced 
in the future?'' The only way for our budget to be balanced in the 
future is for us to make sure that our students, who are in school 
today, have adequate resources available. To make sure they get the 
skills they need to contribute to the economy, so that we have a strong 
budget in the future.
  Mr. President, I ask unanimous consent to add Senator Dodd and 
Senator Kennedy as original cosponsors of this amendment, as well as 
Senator Daschle.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. MURRAY. Mr. President, we will vote on this shortly. I believe 
it is one of the most important issues that is before us, and I urge 
its adoption.
  Mr. President, I ask unanimous consent that material regarding class 
size reduction be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               Why is Class Size Reduction so Important?


                           what students say

  Christopher Shim, 17 years old, Mercer Island High School: ``In 
elementary school, I actually feel I was pretty lucky. I was able to 
get personal time with the teacher, even though we had 30-35 students 
in my elementary classrooms.''
  Chris continues: ``In high school, I have 40 people in my calculus 
class. This means anytime I have a question, there are 10 people in 
line.''
  Ahmad Javid (A.J.) Aaf, 15 years old, Tahoma High School, Maple 
Valley, Washington: ``Kids need more attention--personal attention for 
students is important.''
  Antonella Novi, 18 years old. Anacortes High School, Anacortes, 
Washington: ``In elementary school or high school, class size is really 
important. Because interpersonal relationships among students are 
important, and being able to talk to the teacher is important. 
Closeness leads to comfort--if you ask teachers about school, then you 
can ask teachers about things outside the classroom. It's easier to go 
to teachers you know.''
  Antonella continues: ``In high school civics class, there is only one 
teacher, teaching two classes of 40 students each. It's harder to get 
through the curriculum, and to get answers to your questions.
  ``When I was younger, I went to school in California. We were in one 
school building when I started, but by the time I left, the building 
was surrounded by portables.
  ``I always got my questions answered by the teachers. I spoke up; I 
asked questions. But there were lots of kids who were quiet, who didn't 
get the attention they needed from teacher.
  ``In smaller classes its easier to relate to your peers. You get to 
know each other better. In large classes, if you don't like talking in 
front of large groups, you're out of luck.''
  Devone Van Dyne (female), 16 years old, University High School, 
Spokane, Washington: ``Class size is really, important. For example, my 
high school chemistry class has almost 40 students. It's hard to get 
individual help; lectures alone don't work. If there were fewer 
students, we could get the kind of help we need.
  ``I have trouble keeping up--it's easier to fall behind in a large 
class. You don't feel the same investment. I have to make sure and find 
the time outside class to meet with the teacher.''
  Amber Casali, 16 years old, and Rebecca Dean 15 years old, Shorecrest 
High School, Seattle, Washington: ``In elementary school, the benefits 
of having smaller class size include getting more attention from 
teachers. You can do more activities, and fewer lectures. You can plan, 
and work more cohesively as a class. Especially for the early grades 1-
3, smaller class sizes are very important. It's so important to start 
early. Students can develop good working skills, and get more attention 
from the teacher early on, when it counts the most.''
                                                                    ____


Statement by Sandra Feldman, President, American Federation of Teachers 
                        On Reducing Class Sizes

       Modern schools and more well-trained teachers are the right 
     antidote for the overcrowding that plagues too many American 
     schools. Research shows that youngsters, especially in the 
     early grades, perform better in smaller classes that allow 
     for greater one-on-one instruction. Smaller classes also help 
     teachers maintain discipline. Parents and teachers understand 
     this well, and that's why Senator Murray is absolutely 
     correct in supporting the President's proposal to provide 
     subsidies for school construction and to emphasize teacher 
     recruitment.
       Several new studies clearly demonstrate the link between 
     reduced class sizes and improved academic achievement. A 
     sampling:
       STAR, the highly reputed Tennessee class-size study, 
     analyzed the achievement levels of K-3 students randomly 
     assigned to classes of 13 to 17. Those in small classes did 
     much better than students in regular classes in math and 
     reading, every year and in all grades. The small classes made 
     the biggest difference in the scores of children in inner-
     city schools.
       SAGE, a Wisconsin program begun in 1996-97, reduces class 
     size for K-3 children in certain high-poverty schools. At the 
     end of the first year, SAGE kids had made significantly 
     greater improvements in reading, language arts, and math than 
     children had in similar schools.
                                                                    ____


            The Association of Washington School Principals

       The Association of Washington School Principals (AWSP) is 
     strongly committed to supporting legislation which reduces 
     class size in our public school system. It is increasingly 
     evident that students entering our schools have diverse and 
     unique needs which can only be addressed by principals, 
     teachers, and support personnel who are not overwhelmed by 
     crowded classrooms. Rather, educators must be able to devote 
     attention to each student in smaller, more manageable 
     classes.
       Recent studies on reduced class size and their impact on 
     student performance, undertaken in Tennessee (STAR study) and 
     Wisconsin (SAGE study), speak to learner benefits in areas 
     such as reading, language arts, and math. In our own state of 
     Washington, reduction of class size and improved student 
     performance are priorities for both legislators and 
     educators.
       AWSP is convinced that class size reduction is essential if 
     our state's, and nation's, efforts towards school improvement 
     are to be successful. We appreciate and support Senator Patty 
     Murray's commitment to this end.
                                                                    ____


             Washington State School Directors' Association

       ``As we pursue our state's goal of improving learning for 
     all of our students,'' Larry Swift, executive director of the 
     Washington State School Directors' Association, said, ``it 
     becomes increasingly important that all of our resources be 
     used efficiently and effectively. The most valuable resource 
     in today's schools is the people who devote their time and 
     effort to make schools successful--the teachers. Reducing the 
     ratio of students to adults is particularly critical for 
     youngsters with a variety of learning challenges that must be 
     overcome if those students are to meet the new, higher 
     learning standards.
       ``We acknowledge and commend Senator Murray for leading the 
     way to assuring that our students have the learning 
     environment and the human resources necessary for the kind of 
     schools that will provide the opportunities and training they 
     need to become successful,'' Swift said.
       The Washington State School Directors' Association is a 
     statewide organization representing all of the 1,482 locally-
     elected school board members from the state's 296 school 
     districts. WSSDA serves as an advocate for the state's public 
     schools, provides training and technical assistance for 
     school board members and is very active in the legislative 
     process.

  The PRESIDING OFFICER. The Senator's time has expired. Who yields 
time?
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, it is with regret that I, once again, 
tell the Senate that this is an empty amendment--empty. It states a 
wish, a hope, and maybe a prayer, and it couches it in language that 
says we are setting up a reserve.
  Reserves normally have something in them. This reserve says maybe at 
some point in time we will have something to put in this reserve. Maybe 
we will raise taxes and put the raised taxes in this reserve. Maybe we 
will cut a mandatory program, take away from some entitlement program 
and put it in there. Otherwise, it is an empty amendment. To have an 
empty amendment on a budget resolution ought to violate some rule, and, 
as a matter of fact, it does. This is subject to a point of order.
  I think from time to time we wonder whether points of order really 
contribute substantively to an argument. This one does. For anybody who 
thinks this amendment proposes anything real for the classrooms of 
America--if one wanted to have the Federal Government involved in a 
program and if one knew what the program was--the truth of the matter 
is that this is empty and, therefore, is subject to a point of order.

[[Page S2799]]

  Mr. President, I yield back any time that I have remaining. The 
pending amendment is not germane to the provisions of the budget 
resolution pursuant to section 305(b)(2) of the Budget Act. I raise a 
point of order against the pending amendment.
  Mrs. MURRAY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, I move to waive all points of order 
against the pending 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 
waive the Budget Act with respect to the Murray amendment No. 2165. The 
yeas and nays have been ordered. The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. NICKLES. I announce that the Senator from Arkansas (Mr. 
Hutchinson), is necessarily absent.
  I further announce that if present and voting, the Senator from 
Arkansas (Mr. Hutchinson) would vote ``no.''
  Mr. FORD. I announce that the Senator from Maryland (Ms. Mikulski) is 
necessarily absent.
  The yeas and nays resulted--yeas 46, nays 52, as follows:

                      [Rollcall Vote No. 50 Leg.]

                                YEAS--46

     Akaka
     Baucus
     Biden
     Bingaman
     Boxer
     Breaux
     Bryan
     Bumpers
     Byrd
     Cleland
     Conrad
     D'Amato
     Daschle
     Dodd
     Dorgan
     Durbin
     Faircloth
     Feingold
     Feinstein
     Ford
     Glenn
     Graham
     Harkin
     Hollings
     Inouye
     Johnson
     Kennedy
     Kerrey
     Kerry
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Moseley-Braun
     Moynihan
     Murray
     Reed
     Reid
     Robb
     Rockefeller
     Sarbanes
     Torricelli
     Wellstone
     Wyden

                                NAYS--52

     Abraham
     Allard
     Ashcroft
     Bennett
     Bond
     Brownback
     Burns
     Campbell
     Chafee
     Coats
     Cochran
     Collins
     Coverdell
     Craig
     DeWine
     Domenici
     Enzi
     Frist
     Gorton
     Gramm
     Grams
     Grassley
     Gregg
     Hagel
     Hatch
     Helms
     Hutchison
     Inhofe
     Jeffords
     Kempthorne
     Kyl
     Lott
     Lugar
     Mack
     McCain
     McConnell
     Murkowski
     Nickles
     Roberts
     Roth
     Santorum
     Sessions
     Shelby
     Smith (NH)
     Smith (OR)
     Snowe
     Specter
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner

                             NOT VOTING--2

     Hutchinson
     Mikulski
       
  The PRESIDING OFFICER. On this vote, there are 46 yeas and 52 nays. 
Three-fifths of the Senators duly chosen and sworn not having voted in 
the affirmative, the motion is rejected. The point of order is 
therefore sustained, and the amendment falls.
  The Senator from New Mexico.
  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.
  Mr. DODD addressed the Chair.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. DODD. Mr. President, what is the pending business, I inquire of 
the distinguished manager through the Chair?
  The PRESIDING OFFICER. Under the previous order, debate is to 
continue until 4 p.m., evenly divided, at which point the Senate will 
vote with respect to the Senator's amendment.
  Mr. DODD. I appreciated that.
  The PRESIDING OFFICER. And the amendment of the Senator from New 
Hampshire.
  Mr. DODD. The Senator from New Hampshire, Senator Gregg, had an 
amendment. I see the manager is here.
  The PRESIDING OFFICER. That amendment will be voted on also at that 
time.
  Mr. DODD. The debate on that is over?
  Mr. DOMENICI. Well, Senator Gregg, we understand, desires no more 
time on his amendment, which is his second-degree amendment.
  The PRESIDING OFFICER. It is the understanding of the Presiding 
Officer that the debate is concurrent, but apparently the Senator from 
New Hampshire did not desire additional time.
  Mr. DODD. Parliamentary inquiry. Will the Senator allow me to make 
that amendment?
  Mr. DOMENICI. I ask unanimous consent, if Senator Gregg desires the 
time, that he be allotted time after the debate on the Dodd amendment. 
I am not sure the Senator will desire that. The regular order would now 
prescribe, if that unanimous consent is granted, the next amendment is 
Senator Dodd's amendment.
  The PRESIDING OFFICER. Is there objection?
  Mr. LAUTENBERG. It is my understanding, therefore, if the unanimous 
consent is agreed to, that Senator Dodd will have as much as an hour on 
his amendment based on the unanimous consent that was constructed.
  The PRESIDING OFFICER. The time between now and 4 p.m. will be 
equally divided.
  Mr. LAUTENBERG. Between the proponents and the opponents?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. LAUTENBERG. But if there is any opposition, then, of course, that 
time would be available. But let us assume for a moment that there 
might not be. Would Senator Dodd then have an hour at his disposal?
  The PRESIDING OFFICER. Under the unanimous consent request, if it is 
agreed to, he would be able to secure the time.
  Mr. LAUTENBERG. I thank the Senator.
  Mr. DOMENICI. And that is a very big assumption.
  The PRESIDING OFFICER. There is a unanimous consent request on the 
floor; is there objection?
  Without objection, the unanimous consent request is agreed to.


               Amendment Nos. 2186 through 2188, En Bloc

  Mr. WELLSTONE. If I could ask for 10 seconds to send three amendments 
to the desk.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The PRESIDING OFFICER. Is the Senator from Minnesota seeking consent 
they be called up and then set aside?
  Mr. WELLSTONE. I want to put them in proper sequence.
  The PRESIDING OFFICER. Without objection, the clerk will report those 
amendments.
  The legislative clerk read as follows:

       The Senator from Minnesota [Mr. Wellstone] proposes 
     amendments numbered 2186 through 2188, en bloc.

  Mr. WELLSTONE. I ask unanimous consent reading of the amendments be 
dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendments are as follows:


                           amendment no. 2186

(Purpose: to ensure that the provisions in this resolution assume that 
          Pell Grants for needy students should be increased)

       At the appropriate place insert the following:
       ``It is the sense of the Senate that the assumptions 
     underlying the functional levels in this concurrent budget 
     resolution on the budget assume that corporate tax loopholes 
     and corporate welfare should be reduced in order to produce 
     the funds necessary to increase the maximum Pell Grant award 
     to $4,000.''
                                                                    ____



                           amendment no. 2187

(Purpose: To express the sense of the Senate regarding a report of the 
   Secretary of Health and Human Services evaluating the outcomes of 
                            welfare reform)

       At the end of title III, insert the following:

     SEC.   . SENSE OF THE SENATE REGARDING AN EVALUATION OF THE 
                   OUTCOME OF WELFARE REFORM.

       It is the sense of the Senate that the budgetary levels in 
     this resolution assume that--
       (1) the Secretary of Health and Human Services will, as 
     part of the annual report to Congress under section 411 of 
     the Social Security Act (42 U.S.C. 611), include data 
     regarding the rate of employment, job retention, and earnings 
     characteristics of former recipients of assistance under the 
     State programs funded under part A of title IV of the Social 
     Security Act (42 U.S.C. 401 et seq.) for each such State 
     program; and
       (2) for purposes of the annual report for fiscal year 1997, 
     the information described in paragraph (1) will be 
     transmitted to Congress not later than September 1, 1998.
                                                                    ____



                           amendment no. 2188

(Purpose: To provide an additional $40,274,000 for fiscal year FY 1997 
                     for medical care for veterans)

       On Page 21, strike lines 7 through 10 and insert the 
     following:
       Fiscal Year 1999:
       (A) New Budget Authority, $42,840,274,000.
       (B) Outlays, $43,340,274,000.
       On Page 53, after line 22, add the following:

     SEC. 317. SENSE OF THE SENATE ON FUNDING FOR MEDICAL CARE FOR 
                   VETERANS.

       It is the sense of the Senate that the assumptions 
     underlying the functional levels

[[Page S2800]]

     in this concurrent resolution on the budget assume that any 
     additional amounts made available for the Department of 
     Veterans Affairs in fiscal year 1999 as a result of the 
     declarations of additional budget authority and outlays for 
     fiscal year 1999 for Veterans Benefits and Services (budget 
     function 700) by reason of the adoption by the Senate of this 
     amendment be available for medical care for veterans.


                           amendment no. 2173

  Mr. DODD. I call up my amendment for immediate consideration.
  The PRESIDING OFFICER. The clerk will now report the amendment of 
Senator Dodd.
  The legislative clerk read as follows:

       Amendment No. 2173 previously proposed by the Senator from 
     Connecticut [Mr. Dodd].

  Mr. DODD. I ask unanimous consent reading of the amendment be 
dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The text of the amendment is printed in the March 30, 1998, edition 
of the Record.)


                         Privilege of the Floor

  Mr. DODD. Mr. President, I ask unanimous consent a member of my 
staff, Dr. Caryn Blitz, be given floor privileges during consideration 
of the budget resolution.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DODD. I have some comments to make on my own amendment, but 
several of my colleagues have other matters to attend to, and I will 
yield, if I may, whatever time she may consume to the distinguished 
colleague from California and then to my colleague from Minnesota.
  I yield first to my colleague from California.
  Mrs. FEINSTEIN. I thank the Senator from Connecticut. I want the 
Senator to know what a pleasure it is for me to be able to support the 
Senator's amendment and also to say many, many thanks for his 
leadership on this issue. I am a member of his task force. He has been 
absolutely indefatigable in the pursuit of quality child care for the 
citizens of our country. I am very proud to support this amendment.
  Mr. President, if I might begin by asking a quick question through 
the Chair. I ask the Senator from Connecticut this question: Is he 
aware of how many children are on the waiting list for child care 
facilities in the largest State in the Union?
  Mr. DODD. I would say to our colleague from California I am aware of 
this figure. It is 200,000. The reason I know that number is because in 
1996 I asked the General Accounting Office to do an assessment to 
determine the extent to which the child care needs of working families 
were being met, including whether there were waiting lists for child 
care. California was one of the States that was surveyed. The report 
found that California presently has some 200,000 families who are 
waiting for a quality, affordable, accessible child care slot to open 
up so they may leave their child in a safe place.
  Mrs. FEINSTEIN. I thank the Senator.
  Mr. President, on behalf of Senator Boxer and I, I think this one 
statistic irrefutably points out the need for this amendment. I did not 
support the welfare reform bill. The reason I didn't support the 
welfare reform bill was exactly this. The way the bill is weighted, the 
targets that need to be met in the State of California increase with 
time. We estimated that we had to develop in California 600,000 
additional child care slots a year just to keep up with the need.
  What the Senator has just revealed to me indicates that within this 
first year we already see a waiting list of 200,000. I expect in the 
next 2 years this waiting list to increase threefold, up to 600,000 
families waiting for adequate child care.
  If we want Americans to leave welfare behind as a way of life, if we 
want to see Americans entrepreneurial and working, then we must see 
there is adequate child care available for the children of these 
families. A great bulk of the people involved here are single parents 
with children. They need to earn a living. They have no choice. They 
must find child care.
  This amendment creates in the reserve fund some moneys to be able to 
help the State create the slots. Let me say how difficult this is in 
California, an earthquake-prone State, tough building codes, tough 
individual county and city codes. Therefore, these facilities are 
expensive to build. This amendment provides an opportunity to try a 
number of different approaches, including employer-based child care, 
child care that is shared, chambers of commerce working with schools, 
working with college districts to provide teachers for these child care 
facilities. All of this can be done. You cannot do it without money. 
Therefore, I think this reserve fund is certainly small to begin with 
but certainly necessary.

  It is with great pride that I thank the Senator for his leadership 
and that both Senator Boxer and I are delighted to support this 
amendment.
  Mr. DODD. I thank both of our colleagues from California, Senator 
Feinstein and Senator Boxer.
  To our colleague from Minnesota, I yield such time as he may desire.


                         Privilege of the Floor

  Mr. WELLSTONE. First, I ask unanimous consent Joseph Goodwin, an 
intern, be allowed to be on the floor during the duration of this 
debate.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WELLSTONE. Mr. President, first of all, let me start out on a 
personal note. I really consider it an honor to work with Senators. I 
consider it an honor to be here. Every time I come to the floor of the 
Senate, I still get goose bumps, and I think it is something I never 
expected to have a chance to do.
  Senator Dodd is one of the Senators I most love working with because 
he has been, over the years, such a strong and such a committed voice 
for children. I thank him for that.
  I think this amendment is extremely important, because all it is 
really saying is let's hold out a reserve fund for children so when it 
comes to our commitments here in the Senate, we make the investment.
  I will be brief. I have had a chance to travel the country. I have 
been in a lot of low- and moderate-income communities. I have been in a 
lot of other communities. Let me just say that the initial travel I did 
from Appalachia to Letcher County, KY, to Delta, MS, to inner city 
Baltimore, to public housing in Chicago, to urban and rural Minnesota, 
everywhere I go people ask the same question: Where is the equal 
opportunity for our children? Everywhere I go this focus on how we can 
make sure the children come to school ready to learn is the priority. 
We just have to do a lot better for our children. We have to do a lot 
better for all of our children.
  My colleague from California talked about the welfare bill. She is 
absolutely right, there are long waiting lists for affordable child 
care, even longer now, because of the welfare-to-work provisions.
  Above and beyond that, I say that I meet people, they are heroes and 
heroines of Head Start and child care, they do their very best, and 
they can make a huge difference for children, but we have long waiting 
lists all across our country for affordable child care. When you talk 
to middle-income families--this is not just low-income--working 
families, they will tell you that the expense may be up to $10,000 or 
more per child, and it can be up to a quarter of their income.
  This is a huge issue. If there is anything that we could do in the 
U.S. Senate that would be good for families, that would be good for our 
country, it would be to make this investment.
  I have said this before and I will say it one more time and I will 
not say it in a shrill way. I say to both colleagues--and I see my 
colleague from Washington here on the floor, as well--every time there 
is a discussion of child care, every time we have a discussion about 
children, I think of Fannie Lou Hammer, the civil rights leader, 
Mississippi, daughter of a sharecropper, who said in one of her 
speeches, ``I'm sick and tired of being sick and tired.'' Sometimes I 
get tired of the symbolic politics. Everyone loves children. Everyone 
wants to have a photo opportunity next to a child. Everyone says they 
are for children and education. Every breed of political person says 
that. But there comes a point in time when if we are really for 
children we have to dig into our pockets and make the investment.

  There is no more important national security issue than to invest in 
the

[[Page S2801]]

health and skills of intellect and character of our children, all of 
our children. That is what this Dodd amendment speaks to, that is what 
the position that Democrats are taking speaks to, and I really think 
that this is where the rubber meets the road. This is where ``the 
differences make a difference.''
  I am hopeful that colleagues on the other side, many of them good 
friends, many of whom I think do have this commitment, will support 
Senator Dodd in his amendment. It is just not enough to give speeches. 
It is just not enough to be talking about how we are for child care and 
children and education. We have to make the investment. That is what 
this amendment speaks to.
  I yield the floor.
  Mr. DODD. I thank my colleague from Minnesota for his eloquent 
remarks. Let me turn to my colleague from the State of Washington who 
has been a leader long before she arrived in the Senate on the child 
care issue as a member of the legislature in Washington.
  Mrs. MURRAY. Thank you, Mr. President.
  I thank my colleague from Connecticut, Senator Dodd, for offering 
this amendment I offered in the Budget Committee. I can tell you, as a 
working parent, one of the most critical issues that faces parents 
every single morning across this country is, will my child have a place 
to be? I have had the experience, and I guess that many parents across 
this country have had the experience, of dropping their child off at 
day care on a Friday and have them say to you, ``We will not be here on 
Monday. We decided to go out of the business.'' There is nothing worse 
that can happen to you in a day than to all of a sudden panic and try 
to find a place to put your child who may be 2, 3, 8, or 10, and you 
know they need a safe place, you know you need to be at work Monday 
morning, and there is nowhere for your child.
  Mr. President, across this country businesses are recognizing this 
critical issue because they know they need their employees to be 
productive. A productive employee is not sitting at work worrying about 
whether their child is safe or taken care of; a productive employee is 
one who knows their child is all right. This amendment simply puts in 
place a placeholder so that this Congress will address the issue that 
is discussed at almost every kitchen table of every family across this 
country.
  I thank my colleague from Connecticut for being a leader on this 
issue for so many years.
  Mr. DODD. I thank our colleague from Washington as well. As I 
mentioned, her experience goes back to her years of public service and 
her years as a parent.
  I was looking at the clock as she spoke. It is almost 3 o'clock. This 
would not apply to all parts of the country, but certainly on the east 
coast right now there are as many as 5 million children who have no 
safe place to go after leaving school. We know that for parents who 
have no choice but to be in the workplace, when school lets out, and 
before they get home from work at 5 o'clock or 6 o'clock, there is a 
great sense of anxiety about where their child is? They worry: Who is 
watching my child? What is my child doing?
  We know from police chiefs all over the country, that juvenile 
delinquency rises, not after 11 p.m. at night, but between 3 o'clock 
and 8 o'clock in the evening.
  My hope is to raise some legislative ideas which would allow us to at 
least deal with after-school care, with infant care, with the quality 
of child care. But, I am being told by the budget resolution I cannot 
do that; I cannot bring up my idea on after-school care on child care 
in this Congress because it is subject to a point of order. I don't 
think it is fair. I don't think it is right. I think it is harmful to 
children and working families.
  My colleague from Massachusetts cares about this issue very, very 
much. I know he has some comments he would like to share as well.
  Mr. KERRY. Mr. President, I thank my colleague from Connecticut for 
the time. I also thank him particularly for his longstanding leadership 
in the Congress on this issue. There has been no more persevering or 
more eloquent voice on the subject of children than Senator Dodd.
  This is really the most important work we can do in America today: 
pay attention to our children. All across this country, on a daily 
basis, we pick up a newspaper and read a headline about trouble that 
comes from children who are not structured in their lives in the course 
of a day, who don't have the care they ought to have at the earliest 
stages of their lives. Every bit of pediatric, psychological, 
psychiatric, early child development evidence that we have in this 
country indicates that the first years of a child's life are absolutely 
the most important in the development of that child. You could 
literally have a brain that is 25 or 30 percent larger, based on the 
appropriate nurturing, attention, problem-solving, love, and focus that 
children get in the earlier stages. Why? Because that is when the brain 
connections are being made. We know this scientifically beyond any 
doubt whatsoever.
  In Boston the other day, I was in the Castle Square Early Child 
Development Center. There are 67 kids there. They are getting a 
nurturing, caring, structured environment which, while their parents 
are out at work, is precisely what we required in the welfare bill. 
Precisely what most Americans want most other Americans to be sharing 
along with them is the burden of work in America. So while they are out 
doing it, where are their kids? For the 67 kids in the Castle Square 
Early Child Development Center, there are 500 on the waiting list--500 
kids who will never cross the threshold of that center by the time they 
reach 6 years of age and are supposed to go to school and be ready to 
learn. The truth is that in too many schools in America today, when 
kids are 6 years old and they go to school, there are among them 
children who cannot recognize numbers, who cannot recognize colors or 
shapes or forms or even perform the most simple kinds of problem-
solving.
  Now, I know our Republican friends speak a lot about values and about 
the nature of parenting and the importance of it. But the fact is that, 
in America today, one-third of our children are born out of wedlock. 
They start with a single parent. In too many cases, that single parent 
is out in the workplace trying to make ends meet, and the child has 
nobody at home. I was in a middle school the other day in Boston, with 
kids age 10 to 14, 35 kids in a class. I asked them, ``When you go home 
at 2 o'clock in the afternoon, how many of you go to a house, apartment 
house, or whatever, where there is no adult present until around 6 
o'clock in the evening?'' Fully 50 percent of the hands in that room 
went up, Mr. President. Whose fault is that, theirs or ours? It is 
ours.
  What the Senator from Connecticut is trying to say is, let us at 
least have the vision of trying to set aside a reserve fund that will 
permit us to be able to come down the road and say that we are going to 
help America do this. Out of 3 million children in the United States of 
America that are eligible for early Head Start, only 30,000 get it. Out 
of 1.6 million kids in America that are eligible for Head Start itself, 
only about 800,000 get it.
  Now, Mr. President, if we don't want to come back here and decide how 
many prisons we are going to build and how many drug abuse programs we 
need and how we are going to cope with the trauma in our streets or 
deal with countries that can outcompete us in the marketplace because 
our kids don't have the skills for the new world of globalization and 
technology, this is the business of America that we should be paying 
attention to. I think it's unconscionable that we can have a reserve 
fund for tax cuts but not a reserve fund for children. I can't think of 
anything more important in the business of the Senate than to at least 
say let's avoid the parliamentary chicanery of a point of order on 
behalf of our children. A point of order can deprive our kids of the 
opportunity to have child care, because I will tell you, Mr. President, 
there is a majority in the Senate prepared to vote for it--a majority. 
To steal from the majority of those Senators the right to be able to 
give those children that child care is to take it away from those 
children itself for the sake of parliamentary process and not for a 
future vision of this country.

[[Page S2802]]

  I thank my colleague profoundly for his willingness to bring this to 
the floor of the Senate.
  Mr. DODD. Mr. President, I thank my colleague from Massachusetts. And 
I'd like to recognize him for his significant contribution to the issue 
of child care, particularly to early child development. We've all 
learned a great deal over the past year about brain development and the 
critical period in children's growth from the ages of zero to 3. My 
colleague from Massachusetts has been instrumental in focusing 
attention on the needs of children during the earliest years. I am 
particularly grateful that he is here today to comment on this 
amendment.
  I ask unanimous consent that Senators Murray, Kerry of Massachusetts, 
Daschle, Kennedy, Lautenberg, Landrieu, Durbin, Wellstone, Kohl and 
Harkin be listed as cosponsors of this amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LAUTENBERG. Mr. President, I want to express my strong support 
for the Dodd amendment. This amendment would provide a reserve fund to 
improve the affordability, availability, and quality of child care. It 
also would support families' choices in caring for their children.
  As you know, Mr. President, child care remains a pressing national 
problem. More families need it. Not enough families can afford it. And 
there aren't enough qualified professionals to provide it.
  Families with children under 5 and with incomes under $14,400 a year 
today spend one-quarter of their incomes on child care. Yet only 1 of 
every 10 children eligible for child care assistance receives it. Most 
modest-income families are getting crushed by the costs of child care.
  Compounding matters, the quality of much child care remains seriously 
deficient. And a major reason is the high rate of turnover among child 
care providers. More than one-third of them leave their jobs each year, 
largely because of low wages.
  Mr. President, this amendment would help address these problems by 
providing a mechanism for additional federal support for child care. 
And it is critically important.
  Some have argued that working families don't need this help, because 
the states already are getting more federal child care funding than 
they can spend. But that is just wrong. According to the latest HHS 
data, states' child care outlays are 90 percent of total budget 
authority for 1997, and states have obligated 99.8 percent of those 
funds. Morover, so far in 1998, states are drawing down child care 
funds at a higher rate than last year--and at a higher rate than either 
CBO or OMB had projected.

  I also have heard the argument that we don't need to support spending 
on child care when we can expand the dependent care tax credit instead. 
But that's just not sufficient.
  As long as the dependent care tax credit remains non-refundable, 
expanding it will not help modest-income working families. In fact, a 
two-parent family with two children that pays $400 per month for child 
care would not begin to benefit from a non-refundable expansion until 
its annual income reaches almost $31,000.
  Let me emphasize that. If you have two kids, a $30,000 income, and 
you pay $400 a month for child care, you're not going to benefit at all 
from current proposals to expand the dependent care tax credit. Your 
income is just too low.
  Finally, I know that the Republican budget resolution is assuming 
some additional discretionary funds for child care. But I question 
whether these funds will materialize given the strict overall caps on 
discretionary spending. And, in any case, discretionary spending is a 
1-year, short-term approach to a long-term problem. Americans' child 
care needs are increasing, and families should have our commitment that 
we will lend a helping hand.
  Mr. President, I hope my colleagues will agree that it's time to 
address child care needs in a serious way. And I hope we can get 
bipartisan support for Senator Dodd's important amendment.
  Ms. MOSELEY-BRAUN. Mr. President, first, let me thank Senator Dodd 
for his important leadership on this issue. I am a cosponsor of his 
child care ACCESS bill and I am proud to join him in supporting this 
amendment.
  I have been on this floor already today talking about the importance 
of education and how closely educational attainment is tied to every 
indicia of well being. From an individual's physical health to the 
nation's economic health, education is the key.
  With this amendment, we turn to the issue of child care. I submit 
that adequate public and private funding for child care is a necessary 
foundation for educational attainment and economic well being at every 
level. Children who are not well cared for have trouble thriving and 
succeeding in school and in life. Parents who cannot find or afford 
decent child care cannot work or are less productive and reliable when 
they are working. We all suffer when good, safe child care is not 
available.
  Children who have the opportunity to learn and grow with adult care 
and attention will do better throughout their lives. Recent studies 
have confirmed that the first three years of a child's life are the 
most critical in a child's development. For a child, it is these first 
three years that have, as a Carnegie study stated, ``. . . a decisive, 
long-lasting impact on their well-being and ability to learn.''
  There are many child care alternatives for families ranging from 
small, home care settings to child care centers with low child to 
teacher ratios to a stay-at-home mother or father--but only if the 
families can afford them. The key to successful child care is that the 
parents have choices about how to best care for their children. For too 
many American families the high cost of child care puts options out of 
their reach.
  In Illinois, full-day child care can cost from $4,000 to $10,000 per 
year for just one child. This can be compared to the cost of a college 
tuition at the University of Illinois of just over $4,000. These high 
costs often force parents into unsafe choices. A recent national study 
found that 40 percent of the rooms used to provide care for infants in 
child care centers provided care that was so poor as to put the child's 
health, safety or development at risk. Only 8 percent were rated as 
providing quality care for infants and toddlers. These statistics do 
not even take into account those parents who cannot find care at all. 
In Chicago, for example, a 1995 report found the demand for child care 
for infants exceeded the supply.
  Without choices, parents are unable to work, have to forgo needed 
family income, or are unable to devote their full time and attention to 
their work. The lack of choices not only affects the family but has a 
direct and negative impact on the economy as a whole in public 
assistance and lost productivity costs.
  A 1991 study for the Illinois Department of Public Aid, for instance, 
found that for single parents in Illinois receiving welfare, child care 
problems kept 42 percent of them from working full time. Twenty percent 
of those women who worked but returned to welfare within a year were 
forced back onto welfare because of child care problems. For those who 
had to quit school, 42 percent left because of child care programs. 
While the statistics may not be so stark for middle-class families, the 
effects can be as great. The lack of decent, affordable care crosses 
economic lines.
  The fiscal year 1999 budget resolution has several provisions for 
improving child care, but these are tentative and modest compared to 
the need. This amendment will allow those in the Senate concerned with 
the lack of child care choices for at-home and working parents to 
effectively target public and private resources to address the child 
care crisis. We cannot slam the door on child care as we open the door 
to the 21st Century. It would be irresponsible. I urge my colleagues to 
vote for this amendment.
  Mrs. MURRAY. Mr. President, I rise in support of the amendment 
offered by Senator Dodd, and I commend the Senator from Connecticut for 
attempting to make the Senate address the need to improve affordable 
childcare in this nation.
  Mr. President, few issues are more important in determining the 
future of our children and our nation than access to safe and 
affordable child care. Ensuring the availability of affordable, quality 
child care programs must be a top national priority for us as 
lawmakers, as parents, and as citizens. Today, we have a rare 
opportunity to

[[Page S2803]]

offer hope to families struggling to find or keep their children safe 
and learning.
  By sponsoring this amendment, Senator Dodd has sent an important 
message to every American who is working hard to raise a child--we know 
it is sometimes difficult, and we know your government has a 
responsibility to assist you in your most important work. With this 
amendment, of which I am lead cosponsor, we make room in the budget to 
lay out a vision for the type of assistance the American public has 
told us will truly help.
  First, I must say that like many issues affecting children and 
families, child care is not a Republican or a Democratic issue. Senator 
Dodd and I have had the opportunity to work toward child care solutions 
with several Republican senators over the past couple of months. 
Although both parties and the administration have submitted differing 
child care proposals, I know we can all work together to create a new 
child care law that does what American families need. With the right 
mix of participation from families and communities, private industry, 
and government, we can create a child care system that is the envy of 
the world.
  But we don't have that system today. And, this is why the Senator 
from Connecticut's proposal is so critical to our nation's success. 
Because child care is not just a place you put a child until you get 
home from work. If we know one thing about child care today, that many 
of us have long intuitively known was the case, it is that child care 
is an enterprise defined by the quality of education and care that it 
provides.
  Let us examine some of what we know about child care in America 
today:
  Recent research about the way a child's brain develops shows us the 
importance of quality care to a child's healthy development. The first 
three years of a child's development are decisive in determining that 
child's future. Quality child care, with an age-appropriate 
developmental and educational focus, provides the early stimulation 
required to correctly develop a child's sensitive neural systems.
  It is time for policy-makers and the American public to reject the 
narrow view of early child care and education as separate entities. 
Early child development must now assume its place in our local and 
national funding priorities as an integral piece of the educational 
process. Child care lays the foundation required for a lifetime of 
learning.
  Children who experience quality care demonstrate higher language and 
math skills when entering school. Our first National Educational Goal 
is that by the year 2000 every child will enter school ready to learn. 
Without quality early child development programs for all children, we 
cannot meet this important goal. Early child development also gives 
children the increased self-perception and social skills that allow 
them to succeed in school and in life.
  We cannot continue to view child care as ``just another expense.'' 
Funding for quality care represents a wise investment in our nation's 
future. Studies consistently show that quality child development 
programs produce long-term positive social benefits. Quality care 
reduces the anti-social behavior and chronic delinquency which threaten 
the stability of our communities. Early child development must also be 
a priority if we truly want to halt the spread of crime. Law 
enforcement leaders across the nation agree that investments that 
create a safe and nurturing environment for children, especially in the 
critical hours between 3 and 10 p.m., will sharply reduce crime.
  Some early childhood services for low-income toddlers have been found 
to cut the number of chronic criminal offenders by 80 percent and 
delinquency by 90 percent. By providing children with the preparation 
to learn, quality child care prevents the lack of literacy and 
marketable skills that force many people to rely on public assistance.
  By reducing the later, more-expensive costs of public assistance and 
imprisonment, investment in child care can save billions of taxpayer 
dollars. The High Scope Preschool Study found that by providing 
increased tax revenues and reduced costs of crime and welfare, every 
dollar invested in high quality early childhood programs for low income 
children eventually saved $7 of taxpayer money.
  Despite the monumental consequences, the current American ``system'' 
of early child development meets neither the demand for supply, nor the 
quality required of it. In too many communities, parents are simply 
unable to find affordable, quality care. The situation is especially 
acute for low-income parents; the working poor currently face waiting 
lists in thirty-eight states. Although children from low-income 
families receive the most benefit from child care, they attend child 
development programs at only half the rate of children from high-income 
families.
  The 1996 welfare law dramatically increased the already urgent demand 
for affordable, quality child care. Welfare plans will direct over two 
million parents, mostly mothers, into the workforce. Without the 
support provided by child care which meets at least minimal standards 
of affordability and quality, few parents can afford to leave the home 
for the workplace.

  Too many existing child care programs fail to provide 
developmentally-appropriate care. Studies show that less than a tenth 
of child care centers provide appropriate care. A recent national study 
found that most centers provide care that is poor or mediocre. The 
widespread lack of appropriate training and experience, and the lack of 
safe facilities, holds long-term consequences for the health and 
development of American children.
  Efforts to improve K-12 education can never be fully successful when 
one-third of our children enter kindergarten unprepared to learn.
  We cannot not allow providers to maintain environments which harm our 
children. The federal government must do something to help states 
improve their standards--we cannot allow dangerous and inadequate child 
care environments to continue. A recent analysis of state regulations 
found that no states have child care safety regulations above the 
``mediocre'' level.
  We must also improve standards in the half million to million 
unlicensed home child care businesses operating in this country. Simply 
because a child is in an unlicensed facility does not decrease her need 
for developmentally-appropriate challenges. There are things we can do 
to increase the kind of care that stimulates a child's early growth.
  Parents are an integral part of a child's early developmental growth 
and must have the opportunity to become involved in early child care 
programs. Parents cite lack of time as the top reason for not becoming 
involved in their children's education. I am proud to have sponsored 
the Time for Schools Act of 1997 which expands uses for time under the 
Family Medical Leave Act to allow parents to be involved in their 
children's education, or to take care of child care emergencies, 
without losing their job.
  There is also so much more we can do to involve parents in the care 
and education of their children. Across this nation, people have worked 
to put tools in the hands of parents, so they can make the best choices 
possible when it comes to the care of their children. The family is the 
engine that drives our economy and society. Any child care legislation 
must include efforts to get parents and families the information they 
need, whether it's about choosing quality child care, choosing to stay 
home and care for a child, or choosing strategies to make caring for a 
child safer and more affordable.
  There are things that states across the nation can learn from my the 
experiences of my home state of Washington. Washington state has a 
child care system nationally recognized for its excellence. State 
licensing requirements far exceed federal standards and go further than 
almost all state regulations towards ensuring safe child care. The 
state has implemented an integrated system of child care assistance for 
all low-moderate income families, regardless of whether they are 
involved in work first programs. In addition, the state legislature has 
instituted a training requirement for child care professionals, and 
provided initial funds for a training system and a registry to track 
that training.
  But even in a state like Washington, the lack of investment from the 
federal level forces difficult choices at the state level--in our case, 
lower subsidies which are reducing options for low-income parents.

[[Page S2804]]

  So whatever solutions we seek here must give assistance flexibly to 
states, so individual states can make improvements in the areas where 
they need it most.
  Two other discussions in my state are very promising, and they 
deserve your attention.
  First, there is the work of the Human Services Policy Center at the 
University of Washington. The Policy Center has reached out to leaders 
in the private and public sectors, and to parents and the child care 
community, and come up with recommendations to improve child care 
financing. Their study, ``Financing Quality Child Care in Washington,'' 
provides a thorough review of the state of child care financing in one 
state, with implications for our national debate.
  Another very exciting discussion and project is underway in Spokane, 
Washington, of which you all should be aware. It is a family child care 
demonstration home and small business center, created by a wide array 
of partners:
  Founding partners, including The Health Improvement Partnership of 
Spokane, Holy Family Hospital, the Nevada-Lidgerwood Neighborhood, and 
Northwest Regional Facilitators (the local child care resource and 
referral agency); and newer partners, including the Child Care Facility 
Fund of Washington State, the Dayton Hudson Foundation, Spokane Falls 
Community College, Eastern Washington Association for the Education of 
Young Children, Eastern Washington Family Child Care Association, 
Family Care Resources, Kathy Modigliani National Accreditation, the 
National Association of Child Care Resource and Referral Agencies, the 
Washington State Office of Child Care Policy, the Small Business 
Development Center, and the Washington State Child Care Resource and 
Referral Network.
  The project is called the ``Family Child Care HOME (Hands On Model 
Environment)'' and provides child care in a high quality family child 
care setting for children from infant to age twelve. The projects also 
provides orientation and training for child care providers, and a 
business incubation center for new family child care businesses. The 
HOME project partners have also set up a revolving microcredit loan 
program, for child care providers to purchase equipment, expand their 
business, acquire professional training and remodel their facilities. 
On site at the child care home, there is a library, equipped with toys, 
books, start-up supplies, videos, and child centered leaning materials 
for all child care providers throughout the county. In addition, there 
is a consumer education center for parents, businesses, and communities 
to learn more about family child care.

  I have gone into some detail today, about the state of child care in 
this nation, and some examples from my own home state, because the Dodd 
amendment gives us a chance to do something good for American families.
  The Senator from Connecticut has introduced legislation to address 
this issue more comprehensively than the amendment before us today. I 
am proud to be a cosponsor of that bill as well. But if we do not pass 
this amendment, this Senate will never even have a chance to debate the 
merits of the bill that could actually improve child care for working 
parents.
  Working Americans, many of them lower income, are in the greatest 
need for assistance in our current child care system; the Dodd-Kennedy-
Harkin-Murray ACCESS bill would do a lot of important things to help 
them. It includes refundable tax credits to provide such assistance. 
The ACCESS bill does not mandate national standards; it gives states 
the funding and flexibility to make quality improvements where they see 
them as necessary. The bill expands Family and Medical Leave to more 
employees. Taken along with my ``Time for Schools Act'' allowing 
parents to take care of child care emergencies, this represents a true 
step forward.
  The ACCESS bill provides funding for important quality improvements, 
including resource and referral services --currently the best source 
parents have for child care information in many states. Parent 
education can be expanded with these funds--giving parents the kind of 
information and resources they are looking for.
  The bill makes several changes to promote the kind of private/public 
partnerships happening in my state. It sends out challenge grants and 
employer tax credits, but doesn't limit businesses' involvement to the 
children of their own employees. The quality of child care in the 
community as a whole will benefit from such provisions.
  But the point here today is that we will never even have a chance to 
pose such questions to the Senate if the Dodd amendment is rejected. 
That is because the budget resolution before us today does not allow us 
to debate childcare. It makes no provisions for addressing the 
childcare needs of American families. By reading this resolution, one 
could easily conclude the majority party in the Senate simply does not 
care about childcare.
  Not every partent can afford to hire a nanny to look after their 
children. When we begin to see child care, especially family child 
care, as a business opportunity, and supporting investments that lead 
to child care businesses becoming licensed and meeting other quality 
guidelines then we will begin to build capacity in our communities. We 
want people to enter this business, to do it well, and to succeed.
  As I mentioned, there is bipartisan agreement about the need to 
improve child care in this country. There must also be agreement about 
funding, or we will not have child care improvement this year. I can 
assure the American public that if Congress hears loudly enough about 
the interest and need for child care improvement, we will find the 
money for this. Within the context of a balanced budget, with or 
without a tobacco settlement or any other possible funding source--if 
this is a national priority, we can take this step.
  But the American people must weigh in, or it will not happen. 
Increasing the supply of quality child care must become a top national 
priority. Failure to do so threatens our children's future, and that of 
our nation. I urge my colleagues to support the Dodd amendment.
  Mr. DODD. Mr. President, let me take a few minutes and describe what 
we are trying to do. This amendment is a procedural one. I am not 
really debating the issue of how we should resolve the child care 
crisis--although there are certainly no shortage of opinions on how we 
ought to do that. All I am trying to do here with this amendment is to 
say, at some point later this year, if the funds are available, can I 
bring up a child care amendment without being subjected to a point of 
order? That is all I want to do. We can get to the merits of various 
child care proposals at some point later. But under this budget 
resolution, I am precluded from bringing up such proposals, unless I 
can override a point of order that requires a supermajority. I don't 
think that is right or fair.
  I don't disagree with those who might say we want to provide a tax 
cut as a result of having additional revenues, either because the 
economy is doing tremendously well or if we are able to come up with a 
tobacco settlement. But what I don't understand is, if it's OK to bring 
up those issues, why can't I bring up child care, which is a staggering 
problem? Five million children at this hour, as they finish school for 
the day, are home alone, unattended. Thirteen million children, every 
day need some kind of child care setting. And their parents need the 
ability to pay for that care. But, as you can see from this graph, due 
to inadequate funding, only 1 in 10 eligible children are receiving 
assistance from the Child Care and Development Block Grant. Many other 
families are left to cope with skyrocketing costs. As you can see from 
this second chart the cost of child care in various cities across 
America is truly astonishing. In Boston, child care for an infant is 
$11,860 a year. For a 3-year-old, it's $8,840. For 6-year-olds, it's 
$6,600. Costs of child care in other states--Florida, Minnesota, Texas, 
Colorado--range from $4,000 to $9,000.
  These figures are all the more astonishing when you realize that half 
of all the parents with young children earn less than $35,000. Can you 
imagine how difficult it must be for a family in the city of Boston 
that earns $35,000 a year to afford $11,000 in child care for an 
infant? Your family is making $35,000 a year and you may have to spend 
a third of your budget on child care. How do you make ends meet?

[[Page S2805]]

  I am not suggesting that the federal government should pick up the 
whole tab here. But I have some ideas about how we can leverage funds 
from states, from communities, and from businesses. But I can't even 
offer these ideas without overcoming a point of order.
  Whatever else you may agree or disagree with when it comes to child 
care, isn't it at least fundamentally fair on an issue this important 
that we be allowed in this body to debate our options? The budget 
resolution is about making decisions on how to spend the money of the 
American people. Now not all of my constituents may agree that child 
care is important, but a lot of people do. I am going to have to say to 
them: I am sorry, I can't even bring up your ideas about what we should 
do to make sure that your child has a safe place to be when you can't 
be with them. I am not allowed to raise your concerns under this budget 
resolution. We are allowed to have, on page 27 of this bill, title II, 
budgetary restraints and rulemaking, line 3, a tax cut reserve fund. 
That is allowed. So we are allowed to have a reserve fund for tax cuts, 
but we're not allowed to have a reserve fund for child care.
  All I want to do is to create a reserve fund to leave open the 
possibility of dealing with the issue of child care. Vote against me 
later if you want. Stand up and say you're sorry, but you don't like my 
ideas. I will accept it if you disagree with me. But, I can't imagine 
anybody here, regardless of ideology or party, would say I should not 
be allowed, in a budget resolution --to address a priority we all agree 
is pretty high on the list. I ask my colleagues here, 50 plus 1, to say 
we agree with you, we think that ought to be a priority and we are 
going to support you. As it stands right now, if it tries to raise 
concerns or offer solutions to this problem then I have to produce a 
supermajority to overcome a point of order--which everybody around here 
knows is virtually impossible to do.

  Mr. President, this is a very real issue, one that I think is 
important. I only have half an hour and to even debate this issue and 
to tell people why I feel so strongly about it. We have to move along.
  I will say from the outset that I have great respect for the chairman 
of the Budget committee. He has a thankless job, as does my colleague 
from New Jersey. It is difficult work. I sat on his committee for a 
number of years. I realize it is not easy to put a budget resolution 
together. But I believe I ought to have a chance--I believe I deserve a 
chance--to speak to the needs of children in this nation. There are 
millions of children, Mr. President--who don't have access to high 
quality care. Only 17 States have child care standards that meet even 
minimal standards of quality. In most States, if give manicures, if you 
work on someone's nails, you have to meet tough standards. But only 17 
States require any training at all for somebody who is going to hold a 
child's life in their hands. Where is the logic in that?
  What I would like to see is debate on how we can improve the quality 
of child care, through training, and by improving provider-child 
ratios. I want to debate tax cuts to assist businesses that want to 
provide child care to their employees. I know my colleague from 
Wisconsin, Senator Kohl, would like the chance to present this very 
good idea.
  There is something fundamentally wrong with a process that would 
preclude debate on those ideas.
  I see my colleague from Louisiana, Senator Landrieu, is here. Let me, 
if I can, yield a few minutes to her. I turn to my colleague from 
Louisiana, who has worked for many years on children's issues in her 
state and has brought great energy to these matters since her arrival 
in the U.S. Senate.
  Ms. LANDRIEU. I thank my colleague from Connecticut for his great and 
tireless leadership on this important issue.
  Mr. President, it has been well stated, the need for child care in 
the United States. But the point I want to make is that the child care 
that is just barely there now in our system is not really affordable to 
working families. As much as there is not enough of it, and not enough 
spots, we have a real crisis, as my colleague from Connecticut and 
others realize, because even if it were available under the current 
system, it is not really affordable to working families.
  We have the majority, 65 percent of moms--and I am in that 65 
percent; I am a working mom here in the Senate. I have a 6-year-old and 
an 8-month-old, so I can really speak to all those mothers and fathers 
who are working with children at home. Some of us work out of choice, 
but many of us work out of necessity. Many, many parents have to work; 
they don't have a choice to be at home. Because of some laws that we 
just recently passed--welfare-to-work and welfare reform, which I 
generally supported--we have now mandated it. It is not a choice that 
many poor women have now; we have actually mandated that they leave 
home and go to work. So we have made what was a problem 2 years ago 
even greater by forcing many women, who were home, out to work.
  It seems to me that in our efforts towards welfare reform--which, 
again, I support--some Members of this Congress might be somewhat 
hypocritical in mandating poor women to go to work, wanting to give tax 
breaks for middle class women to stay home, and then not providing 
child care to anybody that is affordable to anybody. Mr. President, 
that is really the situation we are in, which is a crying shame for the 
working families in our country.
  I know my colleague from Connecticut knows the average cost of out-
of-home care is $6,000. For even two parents who are working at a 
minimum wage 40 hours a week, their income is $21,000. By the time they 
pay whatever taxes and other requirements for that paycheck, they don't 
even take home enough money to pay for the child care.
  So what are some of the options? Some of the options have been 
outlined, mostly on this side of the aisle. Tax credits for 
businesses--we have to do a better job as an employer, ourselves, in 
the Senate, in the Federal Government, to make our systems and our 
centers more affordable to all of our employees, from our highest paid 
to our lowest paid. We can do that. We can also provide some direct 
subsidies, some tax credits, and then some block grants, in addition, 
to States to expand the slots that they have.
  But my final point on this is to say to this Senate and to our 
colleagues that we can talk about family values, talk about how much we 
love our children, talk about how important families are, but, really, 
our checkbooks reflect our priorities. In this budget, it doesn't 
reflect that our priorities are our families or our children. Only 
Government, through some action--not by doing it all--can pull this 
system in our country together for child care and reward, if we will, 
the families who are working and have made the best choices they can 
for their families.
  I hope we can adopt the amendment of Senator Dodd and many other 
amendments that speak to this issue, because there is a crisis in this 
country and one that we should not ignore and one that our checkbook--
not our words but our checkbook--should reflect.
  I thank the Senator from Connecticut.
  Mr. DODD. I thank my colleague.
  Let me reiterate the point of this amendment. What this amendment 
would do is establish a deficit-neutral reserve fund, similar to the 
tax reserve fund created by the Chairman on page 27 of the resolution, 
to improve the availability, affordability, and quality of child care. 
A reserve fund--for those who may not be aware--is simply a mechanism 
that allows legislation, in this case child care legislation, to be 
offered later in the year without the threat of a budget point of order 
being brought against it.
  Why is that necessary? The budget resolution before us today 
forecloses the possibility of other meaningful and comprehensive 
solutions to child care. It does contain some proposals for child care, 
but it doesn't allow us to offer our alternatives for meeting the 
concerns of families in this country.
  Senator Murray, our colleague from Washington, offered an amendment 
as a member of the Budget Committee in the markup which would have kept 
our options open. That amendment and this one would allow the Senate to 
consider mandatory funding--just consider it, not require it--for child 
care. This amendment was rejected by the committee along party lines. 
So, as the budget resolution now stands, future

[[Page S2806]]

legislative attempts to improve the quality of child care, or to help 
families afford the skyrocketing costs of care, or to create after-
school programs for the 5 million children home alone each day after 
school, to provide for care for children with special health needs, are 
all shut out. I would like the opportunity to offer those ideas. To do 
so, this amendment must be adopted. If not, then I am foreclosed from 
doing so, and that is the reason I am asking for support.
  Mr. DOMENICI. Will the Senator yield for a question?
  Mr. DODD. I am happy to yield to my colleague.
  Mr. DOMENICI. I do not need time in opposition for another 5 or 6 
minutes, if he wants to speak some more. He is eloquent on the subject. 
Even though his amendment is quite deficient, he is spectacular in 
terms of his presentation.
  Let me just ask a question.
  Mr. DODD. Certainly.
  Mr. DOMENICI. You said even if you wanted to present a child care 
proposal, you would be precluded from doing that unless there were 
something in this budget resolution that allowed it. I don't believe 
the Senator meant that. For, let me tell you, this budget resolution 
does nothing to the right of anyone to bring up a bill with a new 
entitlement, which is what you are contemplating, so long as it is paid 
for. You would have to provide tax increases or entitlement restraint. 
And you can offer all the child care add-on mandatories you would like; 
they may not pass, but they would not be subject to a point of order. 
The budget processes are complicated and in some cases arcane, but 
there is a simple one: You pay for entitlements with entitlement cuts 
or tax increases. So you could do that.
  I am not suggesting that is the best way, or the only way, but I 
believe you said you could not, and I just wanted to make sure that, at 
least from my standpoint, you either--if you meant what you said, you 
at least take into consideration what I have said--or perhaps you could 
suggest that I am in some way in error?
  Mr. DODD. To my good friend and colleague, who is so knowledgeable on 
these issues, let me state this as I understand it, and you respond, if 
you will.
  In order to do what you have suggested, of course, I would have to 
operate within the existing budget structure--which means I would have 
to take from one critical program--perhaps Head Start or education, to 
fund child care. I would have to make families compete against 
themselves. But if I want to take anticipated tobacco revenues or draw 
from the additional resources of a growing economy, as I understand it, 
I am precluded under this budget resolution from doing so.
  Out of that $300 billion or $500 billion in tobacco funds--whatever 
amount we ultimately decide here--I believe that $15 billion or $20 
over 5 years can be found to commit to child care. But under this 
budget resolution, I would be subject to a point of order; is that not 
correct?

  Mr. DOMENICI. The Senator is correct. But I didn't raise that point. 
I answered a statement you made that you would be precluded from 
offering it under this budget resolution. All I said is, anybody can 
offer a spending bill, an entitlement, mandatory spending bill. It will 
not be subject to a budget point of order if it is paid for, and the 
``paid for'' is either cutting other similar programs or tax increases 
that you use for it.
  You raise a different question. You raise the question now, which I 
did not think was in your reserve fund, because the reserve fund is set 
up for all of the tobacco settlement receipts. If you want to take 
something out of that, then, like others, you might want to amend that. 
If you try to amend that, we suggest that money should go to Medicare. 
So that will be the battle, and we will have that out. There will be a 
number of amendments which handle it that way.
  Let me just also suggest that you mentioned appropriated accounts. I 
don't want to get this to be a mumbo-jumbo ``budgetese'' discussion 
here, but your amendment is not one that has anything to do with 
discretionary programs. It creates an entitlement program. So the 
discretionary caps which we are all--excepting maybe three Senators or 
four--coming down here saying we want to keep--and I don't know where 
you stand on that, whether you want to break them or not--you break 
those by spending discretionary money. You don't break them by creating 
a new mandatory program, a new entitlement. Although nobody thought we 
would be creating new entitlement programs once we got the budget 
balanced; most people thought we would not do that anymore because we 
want to keep it balanced. But if you want to do it some more, you have 
to pay for them in the ways I have described.
  Mr. DODD. I thank my colleague. I agree that we should not be 
creating programs that we can't pay for. That is the purpose of 
creating a deficit neutral reserve account. Like all reserve funds, 
including that of my friend and colleague from New Mexico, this reserve 
fund makes the hypothetical statement that if we somehow find 
additional revenues we should use them for the purpose stated in the 
fund. Being deficit neutral means that we would be required to find an 
offset. We don't know where the funds might come from, obviously. 
Around here, anything can happen between cup and lip. But we are 
working on an assumption that there will be some revenues available 
this year, and we want the opportunity to debate whether those funds 
can be used for child care.
  With regard to potential tobacco funds, the majority has made the 
decision that they must exclusively be used for Medicare. What some of 
us are saying here is that we don't disagree that certainly part of it 
ought to be for that purpose. But we think in addition to Medicare 
there are some other legitimate purposes, and one of them is child 
care.
  The fact is that the tobacco industry has, for generations, targeted 
children--and we all know that to be the case. Certainly their 
advertising, Joe Camel for example, has been designed to appeal to 
kids. Why? Because the industry knows that 90 percent of the adults who 
smoke began as teenagers.
  We are suggesting if you have some additional resources generated by 
tobacco company payments, shouldn't some of those funds be targeted to 
children and families? That is all we are suggesting. I am certainly 
not asking for the money to go exclusively to child care. I am not 
asking for a provision which says that money from tobacco can only be 
used for children. I wouldn't say that, because I respect the fact that 
there are other activities that need and deserve these dollars--public 
health programs, smoking cessation and biomedical research, and 
certainly Medicare. But I think that child care also has merit and that 
I ought to be allowed to make a case on why it deserves some of these 
tobacco dollars.
  Again, we may differ, as we certainly do, about how a child care bill 
ought to be framed. My colleague, for instance, from Vermont and my 
colleagues from Kansas, Pat Roberts, Senator Snowe from Maine, Senator 
Collins from Maine, Senator Specter of Pennsylvania and others--all 
have had ideas on child care which are ones they would like to have 
considered. So when I stand here to try to set up a reserve account, it 
isn't just to protect my proposals, it is to protect ideas they may 
have as well. But in the absence of the adoption of this amendment, 
whether it is my colleagues from the Republican side who care about 
child care, or colleagues from this side, unless we have the reserve 
account, we are precluded from doing anything meaningful in this area.

  I see my time has expired, the time of those who are the proponents 
of this amendment. I will yield the floor.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, parliamentary inquiry. Are we scheduled 
now to vote on the Gregg amendment at 4 o'clock, except that each side 
has 1 minute to discuss the Gregg amendment?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. DOMENICI. That will be followed by the Dodd amendment, which is 
not amendable, and there will be 1 minute on each side after that vote 
has expired.
  The PRESIDING OFFICER. That is correct.
  Mr. DOMENICI. Clearly, Senator Dodd has perceived my position 
correctly. I will make a point of order

[[Page S2807]]

with reference to his amendment. It clearly is subject to a point of 
order, and then I presume he would like to vote on a waiver. That is 
probably what the vote is going to be when it comes to the amendment of 
Senator Dodd, because we have waived no points of order as we have gone 
through this process.
  Mr. President, I say to Senator Dodd, while I believe I am entitled 
to the rest of the time, of course, in the interest of half the time to 
each side, if the Senator from Connecticut needs some time, he can call 
on me and I will relinquish some of my time.
  I will discuss various reserve funds shortly, but I would like very 
much to talk about this amendment which, in essence, as to its 
substantive effect, is very, very similar to the Murray amendment which 
was denied germaneness by the Senate in the last vote, and it fell. 
With regard to what it attempts to do, it is a different subject matter 
but the same kind of process.
  There is a little-used process called a reserve fund. There is 
nothing wrong with trying to expand. We will get a proliferation of 
reserve fund attempts this year. It is interesting, and perhaps, Mr. 
President, you would be interested in why there will be a proliferation 
of reserve funds.
  First of all, most reserve funds create a new spending program, and 
almost all reserve funds--there have been very few--when it comes to a 
new program, they are entitlements that are created. Essentially, 
reserve funds say that if you want to fund a new transportation program 
or Amtrak, that if, in fact, you put into that reserve fund the 
resources to do it, then the chairman of the Budget Committee says the 
budget accommodates it, and it would, obviously, be neutral, by 
definition; it would not increase the deficit or the expenditure.
  The problem this year is most interesting. The era of the balanced 
budget is bringing forth a plethora of suggestions--get this--that we 
increase entitlement programs, not necessarily in dollars spent on each 
one, but brand new ones. Isn't that interesting? At the time we finally 
have our budget under control, when we have spent the best part of 18 
years, that I am aware of, saying, ``Let's get entitlements under 
control''--that is, the automatic spending items; they just spend 
pursuant to a formula or the letter of the law, and they spend until 
you change the law, whereas appropriations you do every year--every 
year.
  The plethora of these new ones is because we found a way, believe it 
or not, to say you can't spend any more money on this other kind of 
account, the annual appropriations bills, in which these programs 
belong. This child care program belongs in that category called an 
annual appropriation. But if you put it in there, you have to do two 
things, and that is why there will be reserve funds, because you have 
to cut some domestic program to make room for it, or you break the 
budget, which has a dollar number in for each year.
  So now that that is firmly fixed and we have it under control and 
Wall Street and Alan Greenspan and those who make interest rates in 
America are saying, ``The one thing you really did''--now let's follow 
through--``is you placed that cap, annual amount, that dollar number, 
that you can't exceed, you put it in each year,'' now they said, 
``Prove it; do it.'' What we do is say we don't want to provide any 
cuts, reductions, or eliminations, so we are coming around and creating 
new mandatory expenditures.

  Frankly, the problem with mandatory expenditures is, they go on 
almost forever, but, secondly, you frequently underestimate them. Yet, 
if they spend out above the estimate, they just spend out. An example 
is Medicaid. Medicaid was created on the floor of the Senate with an 
estimate of less than a billion dollars in cost. It became an 
entitlement. I don't remember, when we finally reformed it and made it 
a block grant, how many billions it was, but it was many tens of times 
bigger than the estimate. When we changed it, we usually changed it to 
spend more.
  You can see why we were so worried that if we wanted to get to an era 
of balanced budgets and surpluses--``Good for America,'' everybody in 
the world said; ``It is great for America that our unified budget is 
balanced; you have to try to keep those caps in place, and you have to 
try to not create any new entitlement programs.'' But if you cannot 
spend any more on this side of the ledger, then go over to this side 
and say we will create a new one over here, and we will try to pay for 
it one way or the other so it won't increase--it won't affect the 
budget surplus.
  The problem with this one is very, very simple. Just like Senator 
Murray's reserve, it said we would like to spend more money on child 
care and we would like to have our programs expanded rather 
substantially--I don't know how many billions; it just says child care 
program.
  Then it says here is a reserve fund, but the reserve fund is only 
half filled, because it says what we want to spend the money on but it 
does not say where we get the money to spend. It does not say increase 
taxes $15 billion to pay for it. It does not say decrease entitlement 
programs in some way to pay for it, because what no one wants to do is, 
no one wants to go home and tell their constituents that in order to 
have a new program, ``We had to raise your taxes.'' They just want to 
say, ``We are giving you a new program.''
  No one wants to go home and say, ``We got you a new program, and we 
had to cut these other programs,'' because, obviously, there will be 
people who like the programs that were cut, too.
  So here we are with, as I said, a number of these proposals going to 
be forthcoming, and they are going to sound, for all intents and 
purposes--and I really give Senator Dodd credit in this area. He has 
been a leader in bringing everybody's attention to child care needs and 
getting it started in one very serious way. We had a big compromise 
battle one time. He gave, we gave, and we actually got a bipartisan 
bill, the first one that was bipartisan. He deserves credit, no doubt 
about it.
  What we are doing now is saying we want more of those but we don't 
want to tell anyone what we have to do to pay for it. We just want to 
put it in this reserve fund, and that will happen some other time, but 
let everyone know the sponsors want an expanded child care program. I 
have no doubt that they do. It is just that the budget law says you 
can't do it this way.
  It is going to be subject to a point of order, and I am very hopeful 
it will fail on that. I am very hopeful that those in the country who 
look at this will conclude that it was not a proposal that had much of 
a chance to ever be carried out, because there was no money to do it. 
If you are going to spend $12 billion or $16 billion, keep a balanced 
budget--and you know how that is already planned; it is called the 
baseline--if you already know that, and then somebody comes along and 
says, ``We want $16 billion more,'' it is pretty obvious you have to 
raise taxes or you have to cut something. That is one argument for 
today. But I want to give you a couple others.

  First of all, according to the General Accounting Office, there are 
now 22 separate programs and tax expenditures which support and fund 
child care. The combined Federal programs provide child care services 
and subsidies to over 5.1 million children, or half the children under 
5 with working mothers. The Federal Government, as one part of 
government in America, pays for 40 percent of all child care 
expenditures that are governmental.
  In 1997, the Federal Government spent $13.8 billion on child care 
programs. And I will give you the range of them:
  Dependent care tax credit, child care programs ranging from Head 
Start to the program I just mentioned, and a couple of others. The 
military has the largest single program, $302 million, 166,000 kids.
  The Federal Government spending on child care has increased $6.1 
billion, for an 82-percent increase since 1990. Not too shabby. Under 
current law, by 2003 the Federal Government will spend almost $17 
billion for child care programs and subsidies. The budget resolution 
would increase this spending to $20 billion and an increase of almost 
20 percent. In particular, the budget resolution more than doubles the 
size of the child care and the child care development block grant, 
increasing the funds from $1 billion in 1998 to $2.2 billion by the 
year 2003.
  The budget resolution also assumes that tax relief of up to $9 
billion could be afforded as a portion of the funds and a portion of 
the funds could go to

[[Page S2808]]

tax relief to stay-at-home parents if the tax-writing committee so 
decides.
  All of these funds are within the $1.7 trillion budget. They are all 
within the $1.7 trillion. We do not increase taxes to pay for them; we 
do not worsen the deficit to pay for the new spending. The amendment 
before us is different from that, albeit, in the mind of the principal 
sponsor, totally justifiable. But the $1.7 trillion is not enough, and 
we must ask the taxpayers to give us, the Federal Government, more so 
that we can spend even more on child care than is assumed in this 
resolution.
  In short, while I am not necessarily arguing that under no 
circumstances should we ever put any more money in child care, I am 
suggesting that this year in this budget resolution we do provide some 
significant increases.
  Let me make one other statement and then call one precise item to the 
attention of the Senate. I know this sounds like a lot of money and, on 
the other hand, my friend Senator Dodd might say it is not enough 
money, but just prior to the budget markup I asked for a breakdown of 
all of the money being spent on what would commonly be called child 
care.
  Mr. President, Senator Dodd may still maintain that we need more and 
he may have evidence that we need more, but, obviously, there are a lot 
of things we need more in America, and we can't afford to pay for them 
all. The Senator from Connecticut voted many times not to pay for 
something because we didn't have enough money.
  I went through and looked at the total amount of money that we will 
spend under this 5-year budget, under the discretionary part of this 
budget--that is, the annual appropriations for child care of various 
types, special education for infants and toddlers, development block 
grant, head Start--we will spend $31 billion in just that one category 
over these 5 years.
  Then I looked and said, what about mandatory programs, those that you 
do not have to appropriate each year? I found a child care development 
fund, which is a perpetual fund, not one that you feel you must vote on 
each year, a child care feeding program, social service block grant, 
and I found that $23 billion is spent over the next 5 years for that.
  Then I looked on the tax side to see how we were doing, and I found 
that dependent-care tax credit, $15 billion for 5 years; employer-
provided child care exclusion, $22.3 billion; dependent-care assistance 
program, $800 million. Now if you add them all up, it is $76.8 billion 
that goes out of the Federal Treasury in this area helping little 
children with developmental funds, feeding programs and child care. 
This number is without the add-ons. This is if we started off the 
budget process and said we are going to make no reductions and no 
increases; that is it.
  I want to raise one other program with you, I say to Senator Dodd. 
Maybe you are unaware of it. Maybe you and others, if you are made 
aware of it, might say we should do something about this. But I think 
you recall--you probably were part of it--when we did the welfare 
reform, we put $1.7 billion in there for child care.
  Remember the package. We said, let us help with child care, let us 
help with training; and all that went into welfare. I understand that 
55 percent--just a moment. CBO estimates, and this is a current 
estimate, that States will use only 80 percent of the available funding 
in 1999. States have obligated all funds, but if they do not obligate, 
they lose any rights to the funds. So they are not going to be able to 
draw down all the money. Frankly, I think we ought to try to do 
something about that. That has already been provided for. I do not know 
what we can do about it.
  Mr. DODD. If my colleague will yield on that last point.
  Mr. DOMENICI. I will be glad to.
  Mr. DODD. We anticipated that this might be one of the arguments that 
would be raised, and asked the Department of Health and Human Services 
to tell us exactly what the status of child care spending by the States 
is. I think this graph here states it well. My colleague from New 
Mexico just pointed out that 98.8 percent of child care funds have been 
obligated, but in addition, by January of this year 90.6 percent of 
funds had actually been spent. So the notion somehow that states are 
not spending the available child care money is not valid. I appreciate 
the Senator raising this point, but according to our latest data, the 
States have already spent pretty much 90 percent of available child 
care dollars. And they have obligated, of course, virtually 100 percent 
of it, which demonstrates, I think, a clear need out there.
  Mr. DOMENICI. I say to the Senator, let me tell you, we are both 
right. It is just that those numbers of what HHS is telling you about 
are the moneys that the Treasury of the United States has turned over 
to be spent. But now we have to have the States literally draw them 
down. The Congressional Budget Office is saying that they estimate that 
the States will draw down and use only 80 percent, and there is a 
chance they will lose some money, according to what my staff says. So 
maybe we can work on something there saying that they are extending 
something so they will not lose it. That might be one thing we could 
work on.
  Now, Mr. President, let me ask my friend, Senator Dodd, if he needs 
another 5 minutes or so.
  Mr. DODD. If I could. I appreciate, Mr. President, the chance to, if 
I could, take just a couple minutes to rebut.
  Mr. DOMENICI. I will split the time with you.
  Mr. DODD. I have my colleague from Illinois and the ranking member 
from New Jersey who would like to be heard. So I will take a couple 
minutes, if I can, and just respond.
  Let me, first of all, thank my colleague from New Mexico for his 
generosity.
  Mr. DOMENICI. Could I ask a question?
  Mr. DODD. Yes.
  Mr. DOMENICI. It is the regular order, however, unless changed by UC 
that we will start voting by 4 o'clock?

  The PRESIDING OFFICER. The Senator is correct.
  Mr. DOMENICI. I will give you half the time and keep half for myself 
and Senator Enzi.
  Mr. DODD. Very quickly, first let me thank my colleague from New 
Mexico for his generosity in providing time here, on his time, to 
respond to his arguments.
  They still come back to the central point. We can debate all day the 
question of whether or not you think we are doing enough or not enough 
for child care.
  I tell you again that there are waiting lists in California of 
200,000, Texas of 25,000, Florida 30,000--and in my State they don't 
even keep the waiting lists any longer. I say again that there are 
parents out there, as we sit here today, worried about where their 
children are. And the costs of child care, when it can be found, are 
staggering.
  Putting aside those issues--all I want to be able to do is at some 
point this year, before we adjourn, is to be able to offer child care 
legislation. I want to create a reserve account for children just like 
Senator Domenici has created for tax cuts.
  And I would like the chance to use some of the tobacco dollars, Mr. 
President. There may be as much as $600 billion in tobacco funds. But 
my good friend from New Mexico has said you cannot touch that money. 
That money is only going to be for Medicare.
  I do not disagree that Medicare is a priority. But if the tobacco 
companies for decades have targeted young people in my State of 
Connecticut and all across this country and 1,000 of the 3,000 children 
who every day start smoking will die prematurely, I think we ought to 
be able to take some of those moneys from tobacco and apply them to 
kids' needs in this country. I think most Medicare recipients would 
tell you they think their children and their grandchildren are 
important. You go ahead and ask any grandparent in this country whether 
or not they think every dollar we get from tobacco ought to go to 
Medicare. I think many of them will say that we should give something 
to our children--that they are also a priority. But unless I get this 
amendment adopted here, I am not going to be able to ask that question.
  I would like to have a debate about whether or not you think we do 
too much or too little in child care. But we are never going to get to 
that debate unless this amendment is adopted.
  This is not the time to debate child care, although I know I can make 
a case for the tremendous need that exists. The question my colleagues 
have

[[Page S2809]]

to ask themselves is, should this body have the right to debate the 
issue of child care? Should we be allowed to go after some revenues 
that are coming in from the tobacco resources? Yes or no?
  If we adopt my amendment, you give me a chance to try. It does not 
guarantee me that I am going to get what I want. You may defeat me, but 
at least I get a chance to try.
  With that, let me yield a minute or two to my friend from Illinois.
  Mr. DURBIN addressed the Chair.
  The PRESIDING OFFICER. The Senator from Connecticut has 1 minute 
under his control. The Senator from Illinois is recognized.
  Mr. DURBIN. I thank the Senator from Connecticut.
  Let me say, I hope those who are listening to this debate understand 
the issue that is at stake here. It is the care of our children. When 
Senator Domenici speaks about 4.5 percent of the Federal budget going 
to the care of our children, that is not an overwhelming percentage. 
But I will tell you what is overwhelming, speak to the working families 
who show up every day at day care centers struggling to pay for 
quality, safe child care. Senator Dodd understands what their concerns 
are.
  I hope this Senate will support his effort to finally let this 
Federal Government go on record as saying, yes, let us reward work but 
let us also care for the children. We pay a fortune when we fail with 
children. And we pay it every day. Let us invest some money to help 
families take care of their kids and in a safe, quality setting.

  I yield back my time.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. I have the remaining time?
  The PRESIDING OFFICER. The Senator has 5 minutes remaining. The 
Senator from Connecticut has 12 seconds.
  Mr. DOMENICI. Twelve seconds. Do you want to use your 12 seconds?
  Mr. DODD. If you would give me 1 minute.
  Mr. DOMENICI. I yield 1 minute of mine.
  Mr. LAUTENBERG. That is very kind. I thank the Senator from New 
Mexico for his generous giving up of some time here.
  In 1 minute, very succinctly, Mr. President, it is this: I heard our 
friend from New Mexico talk about the proliferation of reserve funds. I 
want to remind the Senator that he and I were part and parcel of an 
agreement to establish a major reserve fund last year in the budget 
agreement. It was designed for transportation.
  We encouraged that process to make sure that there would be money to 
take care of the transportation needs. We had a commitment by the 
chairman of the Finance Committee that that was an appropriate use of 
process, to set up a reserve fund. Well, we have a reserve fund now to 
make sure our kids, when they grow up, are healthy and learned and 
ready to take on their responsibilities. I do not mind a little reserve 
fund. I hope that the Senator's vote carries.
  Mr. DOMENICI. Mr. President, I am kind of confused on my side for the 
moment. I see two Senators. I yield time to Senator Enzi. I ask the 
Senator, do you want to speak on the Dodd amendment or do you want to 
speak on another amendment?
  Mr. ENZI. I would like to speak on the Gregg amendment.
  Mr. DOMENICI. I ask Senator Hatch, do you want to speak 1 minute on 
the Gregg amendment?
  Mr. HATCH. One minute on the Gregg amendment.
  Mr. DOMENICI. I will give you each 1 minute on mine. I will try to go 
quicker than that.
  The argument has now reached the point where everybody can understand 
it. Although the amendment which the Senator offered does not address 
the reserve funds set up with the tobacco settlement money, he has 
clearly stated his case. He would like to be able to spend some of the 
tobacco settlement on his ideas on child care.
  Even if his amendment passed, he could not do that. But let me just 
tell you what this means. This means that the Senator from Connecticut 
wants to spend tobacco settlement money on child care where the Budget 
Committee wants to spend it on Medicare. Medicare spends $25 billion a 
year and thus it is in default and will be bankrupt in 10 years because 
of cigarette smoking which causes illness and cancer in the seniors 
covered.
  The Budget Committee said the best place to use the money is to put 
it in the Medicare fund so we do not let the program go bankrupt. I 
continue to say that is the best place and the highest priority.
  Today is another good example. No matter what the Government of 
America is doing, we must do more. Whatever we are doing in child care, 
we must do more. Whatever we are doing in some other area, it is not 
enough. Now we have heard that for a long time, but I believe we are 
passed that stage. I think we are in an era of balanced budgets and 
surpluses. You will not stay there very long if you return to the day 
that whatever the Government is spending, it is not spending enough, 
let us have a new program.
  Mr. ENZI addressed the Chair.
  The PRESIDING OFFICER. The Senator from Wyoming is recognized for 1 
minute.
  Mr. ENZI. Thank you, Mr. President.


                           Amendment No. 2168

  Mr. ENZI. Mr. President, I reluctantly rise in opposition to the 
amendment offered by my friend and colleague from New Hampshire, Mr. 
Gregg. I think it is too early in the process to talk about whether we 
are going to limit liability or not. I have never accepted any money 
from the tobacco companies.
  I am not trying to help the tobacco companies. What I want is for the 
smokers of America to realize that there is not enough money in all of 
the assets of all of the tobacco companies to take care of the problems 
that have already been caused. What the smokers need to be worrying 
about is how they are going to divide up those assets to take care of 
the health problems which have already been caused to be sure that they 
are getting a piece of the money that they have already paid in and 
will be paying in through higher taxes.
  We need to wait on the debate to make sure that we are debating the 
issues on liability and leaving the options open to protect those 
people who have already been harmed by smoking and those people that 
will be harmed by smoking.
  As I said, Mr. President, I reluctantly rise in opposition to the 
amendment offered by my friend and colleague from New Hampshire, Mr. 
Gregg. I have worked with the Senator from New Hampshire on the tobacco 
issue in the Labor Committee and I can appreciate his position on this 
aspect of the settlement. However, I oppose this amendment because I 
believe it is premature for this body to decide the issue of immunity, 
even in a sense of the Senate resolution, before we have the 
opportunity to debate tobacco legislation on the Senate floor.
  First, I would like to explain that my reasons for opposing this 
amendment are not based on any desire to protect the tobacco companies 
from legitimate legal actions. I have explained before that I did not 
accept any money from the tobacco companies during my campaign because 
I have seen the destructive effects of cigarette smoking my entire life 
and I have never seen that smoking ever helped anyone. In short, I 
oppose this amendment because it is too early in the debate to limit 
our options on the issue of liability.
  Mr. President, let me make it very clear that we will not help one 
person suffering from smoking-related illnesses by adopting this sense-
of-the-Senate resolution. Rather, we will send a green light to 
plaintiffs' lawyers that Congress will not stand in the way as they 
fill their retirement coffers at the expense of the smokers and the 
American public.
  By prohibiting any type of current or future immunity for the tobacco 
manufacturers, we actually do a disservice to the very people we are 
trying to help. If Congress is really concerned about providing long-
term reimbursement for people suffering from smoking-related illnesses, 
we should look at ensuring that the money will actually go to smokers--
not into the pockets of trial lawyers.
  Mr. President, I have proposed for some time that we should take a 
look at a smokers' compensation fund, whereby individual smokers could 
be reimbursed for their smoking-related medical expenses from an 
account funded by payments by the tobacco companies. Such a system as 
this

[[Page S2810]]

would ensure that real stakeholders in the tobacco debate--smokers 
themselves, would receive the proceeds from any tobacco settlement. It 
would also be a good way to help the long term solvency of both the 
Medicare and Medicaid programs by alleviating some of the burden of 
reimbursing providers for smoking-related medical expenses.
  I understand that any such comprehensive reimbursement scheme is not 
going to be accomplished this year. That is why I support the efforts 
of the chairman of the Budget Committee in his efforts to ensure that 
any money received from a tobacco settlement is going to be dedicated 
to the Medicare trust fund. I applaud his efforts in ensuring that any 
possible proceeds actually be used to help pay for the smoking-related 
expenses of Medicare beneficiaries instead of being used for any number 
of unrelated programs.
  I urge my colleagues to join me in opposing this amendment. We should 
send a message to the American people that any money from the tobacco 
settlement should be used for smokers--not inflated legal judgments.
  I thank the Senator from New Mexico for the time to speak on this. I 
fully support putting that money, if we ever get it, into the Medicare 
Program. Thank you, Mr. President.
  The PRESIDING OFFICER. The Senator from Utah is recognized for 1 
minute.
  Mr. HATCH. I rise in opposition to the Gregg amendment. The Gregg 
amendment is an attempt to put the Senate on record against any 
liability provisions in connection with the tobacco bill now being 
formulated in the Commerce Committee.
  True, the amendment refers to ``immunity.'' Now, I do not want to 
give the tobacco industry and nobody else wants to give them immunity. 
No one does. However, the term ``immunity'' is broader than the limited 
liability provisions many of us believe are key to the comprehensive 
antitobacco global settlement bill.
  I fear many will seize upon what will be a near unanimous vote today 
to say the Senate opposes any liability provisions. That is not the 
case. And 284 days ago, 40 courageous State Attorneys General, both 
Democrats and Republicans, announced an agreement which should continue 
to be the basis of any legislation to curb youth smoking. It is 
predicated on large tobacco industry payments for a whole host of 
antitobacco programs, including cessation, prevention, and biomedical 
research.
  I, for one, continue to believe that the best way to ensure we will 
have the huge sums necessary to wean a generation of teens off tobacco 
is to guarantee there are industry payments. I do not believe that it 
will be possible to attain that without endorsing the framework of the 
AG settlement which does include some liability provisions.
  I yield the floor.
  The PRESIDING OFFICER. All time has expired.
  Mr. DOMENICI. I ask for the yeas and nays on the second-degree 
amendment of Senator Gregg.
  The PRESIDING OFFICER. Is there a sufficient second? There is a 
sufficient second.
  The yeas and nays were ordered.
  Mr. DOMENICI. I ask unanimous consent for it to be in order for me to 
make a point of order on the Dodd amendment so he can make the motion 
to waive, so that will have been accomplished, and we will, therefore, 
have that be the second vote.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DOMENICI. Regarding the Dodd amendment, it is not germane to the 
provisions of the budget resolution pursuant to section 305(b)(2) of 
the Budget Act, and I raise a point of order against the Dodd 
amendment.
  Mr. DODD. Mr. President, I move to waive the point of order and I ask 
for the yeas and nays on my motion.
  The PRESIDING OFFICER. Is there a sufficient second? There is a 
sufficient second.
  The yeas and nays were ordered.


                           amendment no. 2168

  Mr. LAUTENBERG. Mr. President, I rise in strong support of the 
amendment offered by the distinguished Senator from New Hampshire, Mr. 
Gregg, which expresses the sense of the Senate that Congress should not 
grant immunity to the tobacco companies as part of comprehensive 
tobacco legislation.
  Mr. President, I want to commend the Senator from New Hampshire for 
offering this sense of the Senate. It's a clear statement on a critical 
issue.
  Mr. President, there is no valid reason to give the tobacco industry 
special protections from liability. The tobacco industry, for decades, 
has lied to the American people. It's intentionally boosted the 
addictive power of its products to hook consumers. And, worst of all, 
it's conspired to illegally market its products to children.
  The end result of all this fraud and deception is that millions of 
Americans have died prematurely. Families have lost mothers. Fathers. 
Grandparents. Brothers. Sisters. And all too often, these families 
watched helplessly as their loved ones smoked themselves to death, 
unable to break this deadly addiction.
  Now. Mr. President, the tobacco industry is asking for a special 
favor. They want to be shielded from liability for the harms they've 
caused. A shield that hasn't been granted to any other industry.
  Mr. President, why would Congress give special immunity to the 
tobacco industry, of all industries?
  Well, the main argument you hear is that Congress must let the 
industry off the hook because otherwise they'll keep marketing tobacco 
to our kids. It's as if the industry has a gun to our heads. Or, more 
precisely, the heads of our children.
  Well, Mr. President, that's an outrageous threat. And I don't think 
we should give in to it. After all, the U.S. Government doesn't 
negotiate with terrorists. And the same should be true for those who 
threaten to market deadly drugs to our children.
  I also would point out, Mr. President, that if we did give the 
industry the broad liability restrictions that it wants, we still 
wouldn't get much in return. And it's important to understand why not.
  The tobacco industry has said that it would be willing to give up 
advertising to kids if we give it immunity. But the tobacco 
manufacturers can't make an agreement on behalf of all those who might 
want to advertise. So, instead of RJR buying ads, its distributors 
could. Or retailers. Or anyone else. These others would not be bound by 
any agreements entered into by manufacturers.
  It's also important to remember that many constitutional experts 
believe that these agreements could be ruled unenforceable. So we could 
discover later that we have compromised the legal rights of tobacco 
victims, and gained absolutely nothing in the process.
  Mr. President, instead of giving special breaks to the tobacco 
industry, Congress should be developing legislation that keeps our kids 
away from tobacco. That helps adults kick the habit. And that saves 
lives.
  We need legislation that will increase the price of cigarettes to at 
least $1.50 per pack--as the Budget Committee agreed, in a bipartisan 
vote.
  We need legislation to give FDA the authority to regulate tobacco as 
a drug. Legislation to fund anti-teen smoking programs, smoking 
cessation programs, counter advertising, and other anti-tobacco 
initiatives.
  Mr. President, there's no reason to give the tobacco industry veto 
rights over that kind of legislation. None.
  Mr. President, this is the Senate of the United States of America. 
And our job is to do what is right for the American people. It is to do 
what we can to save lives. And if the tobacco industry doesn't like 
it--frankly, that's too bad.
  So, Mr. President, I hope my colleagues will support the amendment 
offered by the distinguished Senator from New Hampshire. Let's not give 
the tobacco industry a special handout. This is an industry that has 
lied to the American people. It's an industry that's directly 
responsible for the deaths of millions of Americans. And they should be 
held accountable. There just is no excuse for letting them off the 
hook.
  The PRESIDING OFFICER (Mr. Gorton). The question is on agreeing to 
the Gregg second-degree amendment No. 2168. 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 Arkansas (Mr. 
Hutchinson) is necessarily absent.
  Mr. FORD. I announce that the Senator from Maryland (Ms. Mikulski) is 
necessarily absent.

[[Page S2811]]

  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 79, nays 19, as follows:

                      [Rollcall Vote No. 51 Leg.]

                                YEAS--79

     Abraham
     Akaka
     Allard
     Ashcroft
     Baucus
     Biden
     Bingaman
     Bond
     Boxer
     Breaux
     Brownback
     Bryan
     Bumpers
     Byrd
     Chafee
     Cleland
     Collins
     Conrad
     Coverdell
     Craig
     D'Amato
     Daschle
     DeWine
     Dodd
     Domenici
     Dorgan
     Durbin
     Feingold
     Feinstein
     Frist
     Glenn
     Graham
     Gramm
     Grams
     Grassley
     Gregg
     Harkin
     Hutchison
     Inouye
     Johnson
     Kempthorne
     Kennedy
     Kerrey
     Kerry
     Kohl
     Kyl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lugar
     Mack
     McCain
     Moseley-Braun
     Moynihan
     Murkowski
     Murray
     Nickles
     Reed
     Reid
     Robb
     Roberts
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Shelby
     Smith (NH)
     Smith (OR)
     Snowe
     Specter
     Thomas
     Thompson
     Thurmond
     Torricelli
     Warner
     Wellstone
     Wyden

                                NAYS--19

     Bennett
     Burns
     Campbell
     Coats
     Cochran
     Enzi
     Faircloth
     Ford
     Gorton
     Hagel
     Hatch
     Helms
     Hollings
     Inhofe
     Jeffords
     Lott
     McConnell
     Sessions
     Stevens

                             NOT VOTING--2

     Hutchinson
     Mikulski
       
  The amendment (No. 2168) was agreed to.
  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.


                     Amendment No. 2167, as Amended

  The PRESIDING OFFICER. The question is on the first-degree amendment, 
as amended.
  Mr. DOMENICI. I ask unanimous consent that the yeas and nays be 
vitiated.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The question is on agreeing to the amendment.
  The amendment (No. 2167), as amended, was agreed to.


                 Vote on Motion to Waive the Budget Act

  The PRESIDING OFFICER. The question is on agreeing to the motion to 
waive the Budget Act as to the amendment of the Senator from 
Connecticut, Mr. Dodd. 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 Arkansas (Mr. 
Hutchinson) is necessarily absent.
  Mr. FORD. I announce that the Senator from Maryland (Ms. Mikulski) is 
necessarily absent.
  The yeas and nays resulted--yeas 50, nays 48, as follows:
  The result was announced--yeas 50, nays 48, as follows:

                      [Rollcall Vote No. 52 Leg.]

                                YEAS--50

     Akaka
     Baucus
     Biden
     Bingaman
     Boxer
     Breaux
     Bryan
     Bumpers
     Byrd
     Campbell
     Cleland
     Cochran
     Conrad
     D'Amato
     Daschle
     Dodd
     Dorgan
     Durbin
     Faircloth
     Feingold
     Feinstein
     Ford
     Glenn
     Graham
     Harkin
     Hollings
     Inouye
     Jeffords
     Johnson
     Kennedy
     Kerrey
     Kerry
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Moseley-Braun
     Moynihan
     Murray
     Reed
     Reid
     Robb
     Rockefeller
     Sarbanes
     Specter
     Torricelli
     Wellstone
     Wyden

                                NAYS--48

     Abraham
     Allard
     Ashcroft
     Bennett
     Bond
     Brownback
     Burns
     Chafee
     Coats
     Collins
     Coverdell
     Craig
     DeWine
     Domenici
     Enzi
     Frist
     Gorton
     Gramm
     Grams
     Grassley
     Gregg
     Hagel
     Hatch
     Helms
     Hutchison
     Inhofe
     Kempthorne
     Kyl
     Lott
     Lugar
     Mack
     McCain
     McConnell
     Murkowski
     Nickles
     Roberts
     Roth
     Santorum
     Sessions
     Shelby
     Smith (NH)
     Smith (OR)
     Snowe
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner

                             NOT VOTING--2

     Hutchinson
     Mikulski
       
  The PRESIDING OFFICER. On this vote the yeas are 50, the nays 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. THURMOND addressed the Chair.
  The PRESIDING OFFICER. The Senator from South Carolina.
  Mr. THURMOND. Mr. President, I will offer two amendments. Both of 
them clarify outlay levels for fiscal year 1999 and thereafter. One 
amendment is with respect to national defense, and the other is with 
respect to outlay levels for major functional categories in the budget.


                 Amendments Nos. 2191 and 2192, En Bloc

  Mr. THURMOND. Mr. President, I send two amendments to the desk and 
ask for their immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from South Carolina [Mr. Thurmond] proposes 
     amendments numbered 2191 and 2192, en bloc.

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


                           amendment no. 2191

  (Purpose: To clarify outlay levels for major functional categories)

       On page 26, after line 25, insert the following:

     SEC. 104. OUTLAY LEVELS FOR MAJOR FUNCTIONAL CATEGORIES.

       (a) Determinations for Fiscal Year 1999.--Notwithstanding 
     the provisions of section 103, outlay levels for the major 
     functional categories for fiscal year 1999 shall be 
     determined in the following manner:
       (1) Prior year outlays shall be determined using historical 
     rates as employed by the Office of Management and Budget.
       (2) Current and future year outlays shall be determined 
     using rates calculated by the Congressional Budget Office.
       (b) Determinations for Fiscal Years 2000 and Thereafter.--
     Notwithstanding the provisions of section 103, outlay levels 
     for the major functional categories for fiscal years 2000 and 
     thereafter shall be determined in the following manner:
       (1) The Office of Management and Budget and the 
     Congressional Budget Office shall annually attempt to 
     reconcile their technical assumptions with respect to 
     preparing estimates for all accounts in those categories, and 
     shall report the outcome of these attempts to the Committees 
     on the Budget not later than December 15 of each year.
       (2) If the Office of Management and Budget and the 
     Congressional Budget Office are able to reconcile their 
     technical assumptions by the date of that report, the 
     technical assumptions used to determine outlay levels shall 
     be those agreed to by those agencies.
       (3) If the Office of Management and Budget and the 
     Congressional Budget Office are unable in any year to 
     reconcile their technical assumptions, the outlay levels for 
     that fiscal year shall be determined by the Committee on the 
     Budget of each House, prior to the receipt by the committee 
     of the estimate of the Congressional Budget Office.
                                                                    ____



                           amendment no. 2192

        (Purpose: To clarify outlay levels for national defense)

       On page 26, after line 25, insert the following:

     SEC. 104. OUTLAY LEVELS FOR NATIONAL DEFENSE.

       (a) Determinations for Fiscal Year 1999.--Notwithstanding 
     the provisions of section 103, outlay levels for major 
     functional category 050 (national defense) for fiscal year 
     1999 shall be determined in the following manner:
       (1) Prior year outlays shall be determined using historical 
     rates as employed by the Office of Management and Budget.
       (2) Current and future year outlays shall be determined 
     using rates calculated by the Congressional Budget Office.
       (b) Determinations for Fiscal Years 2000 and Thereafter.--
     Notwithstanding the provisions of section 103, outlay levels 
     for major functional category 050 (national defense) for 
     fiscal years 2000 and thereafter shall be determined in the 
     following manner:
       (1) The Office of Management and Budget and the 
     Congressional Budget Office shall annually attempt to 
     reconcile their technical assumptions with respect to 
     preparing estimates for all accounts in those categories, and 
     shall report the outcome of these attempts in the report 
     required by section 226 of title 10, United States Code.
       (2) If the Office of Management and Budget and the 
     Congressional Budget Office are able to reconcile their 
     technical assumptions by the date of that report, the 
     technical assumptions used to determine outlay levels shall 
     be those agreed to by those agencies.
       (3) If the Office of Management and Budget and the 
     Congressional Budget Office are unable in any year to 
     reconcile their technical assumptions, the outlay levels for 
     that fiscal year shall be determined by the Committee

[[Page S2812]]

     on the Budget of each House, prior to its receipt of the 
     estimate of the Congressional Budget Office.

  Mr. THURMOND. Mr. President, I ask unanimous consent that these two 
amendments be temporarily laid aside.
  The PRESIDING OFFICER. Without objection, the amendments are laid 
aside.
  Mr. DOMENICI. I don't think we have anything further by unanimous 
consent. By virtue of the list we have, the next amendment is Senator 
Kyl's. That will be followed by a Democratic amendment yet to be 
chosen.
  Mr. LAUTENBERG. Mr. President, I ask the manager if we can take a 
couple of minutes to lay down some amendments here--I think people have 
had a chance to look at them and know what they are--so that we are in 
the order to be considered.
  Mr. DOMENICI. Is the Senator talking about the two amendments we had 
agreed we were going to dispose of by Senator Burns and Senator Kerry?
  Mr. LAUTENBERG. We have the two that were cleared by Senator Burns 
and Senator Kerry. We can do those. I was talking about in advance of 
Senator Kyl's amendment.
  Mr. DOMENICI. Does the Senator have more amendments?
  Mr. LAUTENBERG. We have two we would like to lay down on behalf of 
some of our Members here.
  Mr. DOMENICI. Let's do that.
  The PRESIDING OFFICER. The Senator from New Jersey is recognized for 
that purpose.
  Mr. LAUTENBERG. Mr. President, I ask unanimous consent that the 
following amendments be called up and set aside for disposition in a 
sequence that would be agreed to by the managers. There are four first-
degree amendments and one second-degree amendment. We have an amendment 
on behalf of Senator Hollings which concerns Social Security, a 
Lautenberg amendment, a Conrad second-degree amendment, a Lautenberg 
amendment on the environment, and a Boxer amendment on education. I ask 
unanimous consent that these be accepted at the desk.
  Mr. DOMENICI. Mr. President, parliamentary inquiry. I am not 
objecting on the basis that the second-degree amendment alluded to is 
not automatically called up as a second-degree amendment to the 
amendment suggested, because I believe we will have an opportunity, 
even if we have to have the majority leader here, to offer the second-
degree amendment before it is offered on that side. Is that correct?
  The PRESIDING OFFICER. The second-degree amendment will not be a part 
of the unanimous consent agreement if the Senator from New Mexico 
objects to it. If the Senator accepts the unanimous consent agreement 
as propounded----
  Mr. DOMENICI. I didn't think it was a unanimous-consent request. I 
object. I have no objection to the amendments.
  The PRESIDING OFFICER. The four first-degree amendments----
  Mr. DOMENICI. They are just going to be pending like the other 
amendments, as I understand it.
  Mr. LAUTENBERG. Mr. President, in the interest of moving the program 
along, we will eliminate the Conrad second-degree amendment at this 
time.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.


               Amendments Nos. 2193 through 2195, en bloc

  Mr. LAUTENBERG. Mr. President, I send three amendments to the desk 
and ask for their immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from New Jersey [Mr. Lautenberg] proposes 
     amendments numbered 2193 through 2195, en bloc.

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


                           AMENDMENT NO. 2193

(Purpose: To provide a supermajority point of order against any change 
              in the off-budget status of Social Security)

       At the end of title II, add the following:

     SEC.  . PROTECTING THE OFF-BUDGET STATUS OF SOCIAL SECURITY.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, resolution, or amendment or motion 
     thereto or conference report thereon, including legislation 
     reported by the Committee on the Budget of either House 
     pursuant to section 306 of the Congressional Budget Act of 
     1974, that changes section 301(i), 302(f), 310(g), or 311 of 
     the Congressional budget Act of 1974, or section 13301 of the 
     Budget Enforcement Act of 1990, section 202 of H. Con. Res. 
     67 (104 Congress), or this section, or would otherwise change 
     budget procedures regarding Social Security.
       (b) Waiver.--This section may be waived or suspended in the 
     Senate only by the affirmative vote of three-fifths of the 
     Members, duly chosen and sworn.
       (c) Appeals.--Appeals in the Senate from the decisions of 
     the Chair relating to any provision of this section shall be 
     limited to 1 hour, to be equally divided between, and 
     controlled by, the appellant and the manager of the bill or 
     joint resolution, as the case may be. An affirmative vote of 
     three-fifths of the Members of the Senate, duly chosen and 
     sworn, shall be required in the Senate to sustain an appeal 
     of the ruling of the Chair on a point of order raised under 
     this section.
                                                                    ____



                           AMENDMENT NO. 2194

(Purpose: To ensure that the tobacco reserve fund in the resolution may 
                 be used to protect the public health)

       At the end of title III, insert the following:

     SEC.  . SENSE OF THE SENATE ON PRICE INCREASE ON TOBACCO 
                   PRODUCTS OF $1.50 PER PACK.

       (a) Findings.--The Senate finds that--
       (1) smoking rates among children and teenagers have reached 
     epidemic proportions;
       (2) of the 3,000 children and teenagers who begin smoking 
     every day, 1000 will eventually die of smoking-related 
     disease; and
       (3) public health experts and economists agree that the 
     most effective and efficient way to achieve major reduction 
     in youth smoking rates is to raise the price of tobacco 
     products by at least $1.50 per pack.
       (b) Sense of the Senate.--It is the sense of the Senate 
     that the levels in this resolution assume that comprehensive 
     tobacco legislation should increase the price of each pack of 
     cigarettes sold by at least $1.50 through a per-pack fee or 
     other mechanism that will guarantee a price increase of $1.50 
     per pack within three years not including existing scheduled 
     Federal, State, and local tax increases, with equivalent 
     price increases on other tobacco products, and should index 
     these price increases by an appropriate measure of inflation.
                                                                    ____



                           AMENDMENT NO. 2195

(Purpose: To establish a deficit-neutral reserve fund for environmental 
                         and natural resources)

       At the appropriate place, insert the following:

     SEC.  . DEFICIT-NEUTRAL RESERVE FUND FOR ENVIRONMENTAL AND 
                   NATURAL RESOURCES.

       (a) In General.--In the Senate, revenue and spending 
     aggregates and other appropriate budgetary levels and limits 
     may be adjusted and allocations may be revised for 
     legislation to improve the quality of our nation's air, 
     water, land, and natural resources, provided that, to the 
     extent that this concurrent resolution on the budget does not 
     include the costs of that legislation, the enactment of that 
     legislation will not increase (by virtue of either 
     contemporaneous or previously-passed reinstatement or 
     modification of expired excise or environmental taxes) the 
     deficit in this resolution for--
       (1) fiscal year 1999;
       (2) the period of fiscal years 1999 through 2003; or
       (3) the period of fiscal years 2004 through 2009.
       (b) Revised Allocations.--
       (1) Adjustments for legislation.--Upon the consideration of 
     legislation pursuant to subsection (a), the Chairman of the 
     Committee on the Budget of the Senate may file with the 
     Senate appropriately-revised allocations under section 302(a) 
     of the Congressional Budget Act of 1974 and revised 
     functional levels and aggregates to carry out this section. 
     These revised allocations, functional levels, and aggregates 
     shall be considered for the purposes of the Congressional 
     Budget Act of 1974 as allocations, functional levels, and 
     aggregates contained in this resolution.
       (2) Adjustments for amendments.--If the Chairman of the 
     Committee on the Budget of the Senate submits an adjustment 
     under this section for legislation in furtherance of the 
     purpose described in subsection (a), upon the offering of an 
     amendment to that legislation that would necessitate such 
     submission, the Chairman shall submit to the Senate 
     appropriately-revised allocations under section 302(a) of the 
     Congressional Budget Act of 1974 and revised functional 
     levels and aggregates to carry out this section. These 
     revised allocations, functional levels, and aggregates shall 
     be considered for the purposes of the Congressional Budget 
     Act of 1974 as allocations, functional levels, and aggregates 
     contained in this resolution.
       (c) Reporting Revised Allocations.--The appropriate 
     committees shall report appropriately-revised allocations 
     pursuant to section 302(b) of the Congressional Budget Act of 
     1974 to carry out this section.

  Mr. LAUTENBERG. Mr. President, I ask unanimous consent that these 
three amendments be temporarily laid aside.
  The PRESIDING OFFICER. Without objection, the amendments are laid 
aside.


                    Amendment No. 2176, As Modified

  Mr. LAUTENBERG. Mr. President, I send a modification of the Boxer 
amendment to the desk.

[[Page S2813]]

  The PRESIDING OFFICER. The amendment will be so modified.
  The amendment (No. 2176), as modified, is as follows:

       On page 16, line 9, increase the amount by $50,000,000.
       On page 16, line 10, increase the amount by $6,000,000.
       On page 16, line 13, increase the amount by $50,000,000.
       On page 16, line 14, increase the amount by $40,000,000.
       On page 16, line 17, increase the amount by $50,000,000.
       On page 16, line 18, increase the amount by $49,000,000.
       On page 16, line 21, increase the amount by $50,000,000.
       On page 16, line 22, increase the amount by $50,000,000.
       On page 16, line 25, increase the amount by $50,000,000.
       On page 17, line 1, increase the amount by $50,000,000.
       On page 25, line 8, strike ``-$300,000,000'' and insert 
     ``-$350,000,000.''
       On page 25, line 9, strike ``-$1,900,000,000'' and insert 
     ``-$1,906,000,000.''
       On page 25, line 12, strike ``-$1,200,000,000'' and insert 
     ``-$1,250,000,000.''
       On page 25, line 13, strike ``-$4,600,000,000'' and insert 
     ``-$4,640,000,000.''
       On page 25, line 16, strike ``-$2,700,000,000'' and insert 
     ``-$2,750,000,000.''
       On page 25, line 17, strike ``-$3,000,000,000'' and insert 
     ``-$3,049,000,000.''
       On page 25, line 20, strike ``-$3,800,000,000'' and insert 
     ``-$3,850,000,000.''
       On page 25, line 21, strike ``-$7,000,000,000'' and insert 
     ``-$7,050,000,000.''
       On page 25, line 24, strike ``-$5,400,000,000'' and insert 
     ``-$5,450,000,000.''
       On page 25, line 25, strike ``-$5,000,000,000'' and insert 
     ``-$5,050,000,000.''


               amendments nos. 2186 and 2188, as modified

  Mr. LAUTENBERG. Mr. President, Senator Wellstone has three amendments 
that are at the desk and have been laid aside. I understand that 
amendments 2186 and 2188 need to be modified. I now ask that those two 
amendments be modified with the changes that are now at the desk. They 
have been reviewed by the majority.
  The PRESIDING OFFICER. The Senator has the right to modify the 
amendments.
  The amendments (Nos. 2186 and 2188), as modified, are as follows:

                           AMENDMENT NO. 2186

       At the end of title II, add the following:

     SEC. 204. DEDICATION OF CORPORATE WELFARE SAVINGS TO PELL 
                   GRANTS.

       (a) Spending Reserve.--In accordance with section 312(a) of 
     the Congressional Budget Act of 1974 and for the purposes of 
     title III of that Act, the Chairman of the Committee on the 
     Budget may reserve the estimated increased revenues resulting 
     from changes in legislation specified in subsection (b) for 
     the purpose of offsetting additional outlays not to exceed 
     $12,450,000,000 for fiscal years 1999 through 2003 for 
     increasing the maximum Pell grant award from $3,000 to 
     $4,000.
       (b) Offsets.--
       (1) In general.--For purposes of subsection (a), increased 
     revenues from the elimination of corporate welfare tax 
     provisions not to exceed $12,450,000,000 for fiscal years 
     1999 through 2003 are reserved in function 920, Allowances.
       (2) Specific Taxes.--The tax provisions referred to in 
     paragraph (1) include--
       (A) expensing for oil and gas exploration;
       (B) elimination of the oil and gas allowance for producers; 
     and
       (C) elimination or reduction of the foreign-earned income 
     exclusion.
                                                                    ____



                           AMENDMENT NO. 2188

       On page 53, after line 22, add the following:

     SEC. 317. SENSE OF THE SENATE ON FUNDING FOR MEDICAL CARE FOR 
                   VETERANS.

       It is the sense of the Senate that the functional totals 
     underlying this resolution assume that $40,274,000 in 
     additional amounts above the President's budget levels will 
     be made available for veterans health care for fiscal year 
     1999.

  Mr. LAUTENBERG. I thank the chairman for permitting me to send those 
amendments to the desk. We are ready to proceed.
  Mr. DOMENICI. Mr. President, I yield the floor to Senator Kyl.


                           Amendment No. 2169

  Mr. KYL. Mr. President, we are now back on amendment No. 2169. That 
amendment is a sense of the Congress, and it is very simple. I will 
read the operative clause:

       It is the sense of Congress that seniors have the right to 
     see the physician or health care provider of their choice and 
     not be limited in such right by the imposition of such 
     unreasonable conditions on providers who are willing to treat 
     seniors on a private basis, and that the assumptions 
     underlying the functional totals in this resolution assume 
     that legislation will be enacted to assure this right.

  It is that simple, Mr. President. Senior citizens should not be 
discriminated against because when they turn 65 they are eligible to 
receive Medicare. Unfortunately, the administration has taken the 
position that eligibility to receive Medicare is exclusive; that is to 
say, that it's either Medicare or no care, that a senior citizen has no 
right to be treated outside of Medicare for Medicare-covered services. 
How could we be in that situation in the United States of America, 
where the Government provides a good program for senior citizens which, 
in most cases, is going to be precisely what they want to take 
advantage of, but it says to them that, if there is some reason why you 
might want to privately contract and pay the bill yourself, you can't 
do that.
  Here is the history of it, Mr. President. For over 20 years during 
the time Medicare has been in force, senior citizens have had the right 
either to go to the physician of their choice and have him submit a 
bill to Medicare or, if they choose, to be treated outside of Medicare 
and not submit the bill. There are some people who have not wanted 
their records to be part of the official Government archive.
  They may have psychiatric problems, for example, and they didn't want 
to have their treatment be a part of Medicare and they were willing to 
pay the bill themselves. That is just one example.
  But recently HCFA, the Health Care Financing Administration, began 
taking the view that that was illegal and began sending letters to 
physicians threatening them with prosecution if they treated patients 
outside of Medicare. So, as part of the Balanced Budget Act, I offered 
an amendment which prevailed on an overwhelming vote here last year 
that citizens did, in fact, have the right to privately contract--a 
very straightforward proposition.
  During the last-minute negotiations of the Balanced Budget Act, 
however, the administration representatives convinced whoever was 
negotiating on our side that the President would veto the entire 
Balanced Budget Act if the Kyl amendment stayed in, and it was changed, 
pursuant to the administration's request, to provide that while the 
right of the senior citizen existed, it could only be exercised by a 
physician who, in advance, dumped all of his Medicare patients for a 
period of 2 years. That is obviously an unreasonable requirement. Very 
few, if any, physicians are going to do that. So, as a practical 
matter, the right of senior citizens to go to a physician of their 
choice under Medicare was eliminated.
  We have not yet offered legislation for a vote here which would 
reverse that. But this is the first opportunity we have had, so we 
present to the Senate a sense of the Senate, as part of the budget 
resolution, which says that senior citizens should have this right. 
Then, when the opportune time comes, we will be offering the 
legislation which has already been introduced and has 49 cosponsors in 
the Senate, and 190 cosponsors in the House of Representatives, a bill 
sponsored by the Ways and Means Committee Chairman Bill Archer called 
the Medicare Beneficiaries Freedom to Contract Act. That legislation, 
which, as I say, has 49 cosponsors here and 190 in the House already, 
will be offered, so we will have the opportunity to actually change the 
law. But pending that, this presents the principle that seniors ought 
to have this freedom to contract.
  Our resolution, by the way, is sponsored by Senator Hollings, Senator 
Lott, Senator Frist, Senator Gramm, Senator Domenici, Senator Stevens, 
Senator Gorton--the Presiding Officer--and, as I say, 49 Members total.
  Let me give an example of a specific situation which came to my 
attention. One of my constituents from Prescott, AZ--a relatively small 
town--has a severe case of diabetes. She went to a physician who said, 
``I am sorry, I am not taking any Medicare patients, so I cannot take 
care of you.'' He was the only specialist, really, in the small 
community who could care for her.
  Why is it, by the way, that some physicians are in that position? We 
know that Medicare reimburses at such a low rate--the average is 70 
cents on the dollar of cost--that many physicians simply cannot take 
all Medicare patients. So they have to draw the line and not take any 
beyond a certain point.
  In any event, she said, ``That's fine, bill me directly, and I will 
be happy to pay.'' He said, ``Medicare will prosecute me for fraud if I 
do that.'' And that is

[[Page S2814]]

what we are trying to fix here. There are a lot of situations where 
people may wish to go to the doctor of their choice and be treated 
outside of Medicare.

  I know of a situation in which I helped a constituent obtain a 
compassionate release from FDA so that constituent could take an 
experimental drug to treat her for cancer. The reason is that her 
husband was willing to go to any lengths, to do anything, to preserve 
her life. She ended up dying, but I think her case is illustrative of 
what every one of us would do in her husband's position. If we had the 
money, if we had the ability, we would go to any length to do anything 
to save our loved one's life. That is what is being denied American 
citizens today.
  Believe it or not, the socialized medicine system in Great Britain 
allows patients this choice. They can either be treated under their 
socialized medicine system or they can go to a private physician and 
pay the bill themselves. But here in the United States of America, once 
you turn 65, you lose that right. This amendment simply expresses the 
sense of Congress that that should not be the case. The seniors here 
should have the freedom of choice. That right should not be limited by 
any unreasonable conditions placed upon providers.
  Mr. President, I thank the Chair for the opportunity to present these 
views. I would love to hear from anyone who would like to speak in 
opposition to this principle that senior citizens should have the right 
to privately contract. I invite anyone who is in opposition to present 
those views here, because I would love to debate that, as I said. 
Constituents all over this country are writing in and calling me 
saying, this is outrageous; please reestablish this right.
  So I am going to cease my presentation now since we are limited in 
the amount of time we have. I reserve whatever time we have to respond 
to anyone who is willing to come defend the proposition that senior 
citizens should not have the right to privately contract in the United 
States of America.
  Mr. President, observing no other Members on the floor, I suggest the 
absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. SMITH of Oregon. Mr. President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Kyl). Without objection, it is so ordered.
  Mr. SMITH of Oregon. Also, that the Kyl amendment may be temporarily 
laid aside so I may speak to an amendment I introduced early this 
morning.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 2180

  Mr. SMITH of Oregon. Mr. President, I sent an amendment to the desk 
earlier today to modify my original amendment numbered 2180. This 
amendment simply provides an exception for federally funded research 
projects being conducted on marijuana. This is to ensure that the 
National Institute of Drug Abuse at NIH and other agencies may continue 
their important research on the long-term effects of drug use, and 
possible alternatives to the persistent use of marijuana.
  This amendment addresses an issue which has become a great concern to 
me and to many in my State--legalization of marijuana for medical use. 
While this is simply a sense of the Senate to prohibit the use of 
Federal funds for medical use of marijuana, I intend to work with my 
colleagues on legislation on this issue following the budget 
resolution. While this is not a new issue for the State of Arizona, or 
for the State of California, which have already passed laws and put 
them in place following the passage of Proposition 215, there are other 
States, including Oregon, Maine, Alaska, Nevada, Florida, and the 
District of Columbia, which are facing similar ballot measure 
proposals.

  In my State of Oregon alone, five ballot measures have been proposed 
which would legalize the use of marijuana in varying degrees, from an 
outright legalization of the drug to legalization for medical purposes. 
California and Arizona have already passed legislation legalizing 
medical use of marijuana and are already experiencing the adverse 
effects on their communities. In California, for instance, the law has 
become almost impossible to enforce, as the law enforcement community 
has had difficult times suppressing illegal marijuana use and its sale. 
With the opening of ``pot cafes'' in that State, it is impossible to 
prove whether patrons are there for medicinal or recreational use.
  At a time when illegal drug abuse is on the rise, legalizing the use 
of marijuana in any form, medical or recreational, sends a mixed signal 
at best to our children, particularly when there are prescription drugs 
in the marketplace such as Marinol.
  While the effectiveness of these prescription drugs is varied, I 
believe it is our responsibility to encourage a healthy alternative to 
marijuana that is effective, safe, and can be regulated like any other 
prescription drug in the marketplace. I would be interested in working 
with any of my colleagues on both sides of the aisle who have an 
interest in this issue, particularly those who want to keep drugs, such 
as marijuana, out of the reach of our children.
  In a study released by the National Institute of Drug Abuse at NIH, 
marijuana is noted as the most commonly used drug in America. In fact, 
18 million Americans used it last year alone. In fact, smoking 
marijuana over a long term has the same damaging effects on the brain 
as long-term use of cocaine and heroin and produces the same lung 
damage and potential cancer risk as smoking cigarettes, even though 
marijuana smokers smoke less.
  Perhaps even more disturbing is that the National Institute of Drug 
Abuse also reported that 23 percent of all eighth graders in the United 
States used marijuana in 1996 and that marijuana use overall has 
steadily increased since 1993.
  Mr. President, while this is a sense of the Senate and it is only a 
start, I believe this is our opportunity to voice our opposition to 
these efforts to legalize the use of marijuana in our States. Through 
these laws, we are proceeding down a dangerous path by sending a mixed 
signal to our children that marijuana use is an acceptable alternative. 
It is not. It is dangerous. It is deadly.
  I thank the Chair and encourage my colleagues to adopt this 
amendment.
  Mr. ROCKEFELLER addressed the Chair.
  The PRESIDING OFFICER. The Senator from West Virginia.


                           Amendment No. 2169

  Mr. ROCKEFELLER. Mr. President, are we now back on the Kyl amendment?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. ROCKEFELLER. Mr. President, I hope that Senator Richard Bryan 
from Nevada is on the way to the floor as I speak. I speak in 
opposition to this amendment.
  I need to point out that Medicare beneficiaries did not ask for this 
so-called ``new right.'' This is a proposal which is written to, 
frankly, charge seniors more money. That comment can be thrown around 
and thrown around very glibly when one is trying to make a populist 
point. On the other hand, therefore, it is true--and it has to be said 
in that manner--92 percent of beneficiaries are satisfied or, in fact, 
very satisfied with the availability of care under the Medicare Program 
now.
  It is this Senator's belief that fraud and abuse in the Medicare 
Program will increase very substantially if private contracting is 
allowed to occur. The Congressional Budget Office has this to say about 
the Kyl-Archer bill:

       HCFA's efforts to screen inappropriate or fraudulent claims 
     could be significantly compromised because it would be 
     difficult to evaluate episodes of care with gaps where 
     services were directly contracted--

  A very complicated way of saying a rather easy thing. It would not be 
very easy to track this:

       Without adequate regulatory oversight, unethical providers 
     could bill Medicare while also collecting from directly-
     contracted patients.

  In other words, they could collect twice from Medicare and the 
patient.

  The bill would almost certainly raise national health spending.

  The Government Accounting Office.
  Private contracting, further, Mr. President, is not about the freedom 
of choice, as some of our friends from across the aisle would have us 
believe. The effort to privately contract is really, as I indicated 
much earlier, about

[[Page S2815]]

money. Seniors have freedom of choice now.
  You can make a very, very good case that the strength of Medicare is 
based upon an original concept that no longer exists, and that is one 
gigantic pool. Because everybody is in that pool, almost like the 
original Blue Cross, Medicare wins money on some, loses on others, but 
in the end everything tends to wash out evenly.
  Seniors now are given many options. I participated in one of the 
options myself, the PSO amendment, which I did with Senator Bill Frist, 
and it was successful. But all this does not indicate, therefore, that 
seniors do not have the freedom of choice now. They do. They can go in 
many directions, and that is increasing all the time. They can see any 
doctor they want now, and they have adequate protections that the 
Medicare Program has and is providing them.
  The proposal to privately contract is opposed by the American 
Association of Retired Persons, the American College of Physicians, the 
National Council of Senior Citizens, Families USA, et cetera, and that 
is not really the point, is it? Because one can always find groups that 
are for or against something.
  While private contracting may be a good deal for doctors, it really 
is not necessarily a very good deal for beneficiaries, and that becomes 
important in the Medicare communities. Seniors would pay 100 percent of 
the bill when they privately contract. That is the way it would work--a 
large price tag for services that Medicare would otherwise cover.
  Private contracting would cripple Medicare's ability to hold down 
health care costs and would put elderly and disabled citizens at 
serious financial and medical risk. Under the Kyl-Archer bill, doctors 
can charge whatever they want for a Medicare-covered service. One would 
ask, why would one want to do that? The Kyl-Archer bill would allow 
doctors to give priority, frankly, to wealthy patients who are willing 
and able to pay out of pocket.
  My wife and I recently had an event--not serious--with our 18-year-
old son. We took our son to six different physicians, most of them 
specialists. So when I say this, I say this in the context of an 
enormous regard for physicians and for the field and for the fact that 
our 18-year-old son wants to become a physician himself. Nevertheless, 
it is an incentive for doctors to go to those who are able to pay and 
get them to pay out of their pocket and pay more.
  In a February 23, 1998, letter from the GAO--which I believe is 
fairly broadly respected around here--to Senator Moynihan, the GAO's 
findings do not support Senator Kyl's sense-of-the-Senate amendment. 
Senator Kyl's amendment, for example, reads, according to the GAO, 
``most seniors are denied this right (to obtain health care from 
physicians or providers of their choice) by current restrictions on 
their health care choices.''
  Again, a denial of choice argument.
  The GAO letter to Senator Moynihan reads:
       Nearly all physicians treat Medicare patients and accept 
     new patients covered by Medicare. Recent data from the AMA 
     indicate that 96.2 percent of all non-Federal physicians 
     treated Medicare beneficiaries in 1996. Moreover, the 
     percentage of physicians treating Medicare patients has 
     increased--from 95.2 percent in 1995 and 94.2 percent in 
     1994--over the last 2 years.

  A 1-percent increase. It simply shows the direction of more 
physicians treating Medicare patients.
  Again, the GAO says:

       According to the recent reports from PPRC, ``access for 
     most [fee-for-service] beneficiaries remains excellent and . 
     . . measures of access are essentially unchanged from 
     previous years.''

  In closing, Mr. President, I wish to make this statement. Much has 
been made of the United Seniors Association, which is a conservative 
fundraising arm of the Republican Party, in fact, and is the No. 1 
supporter of the Kyl private contracting amendment. But then again, 
those things happen, too. I will say when Chairman Roth of the Senate 
Finance Committee heard their testimony, he said, ``I just want to make 
it clear that those kinds of statements are not satisfactory to this 
chairman.'' And he was not at that point a particularly happy chairman.
  At the beginning of the Kyl amendment, frankly, there were some of us 
who were very, very concerned because there were 47 cosponsors, 
including one Democrat. There has been a lot of emphasis, I think, in 
the last number of weeks to try to get this to be a better-understood 
proposition. In fact, I think now people are beginning to understand 
that this is not necessary, and there is a way for physicians to be 
able to charge Medicare beneficiaries more, and, in a sense, if a 
Medicare beneficiary is in a very sick condition or bad condition, how 
are they able to negotiate in the first place? I think the Senate would 
do best to simply send this sense of the Senate underground.
  I thank the Presiding Officer for his courtesy.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER (Mr. Smith of Oregon). The Senator from 
Massachusetts.
  Mr. KENNEDY. Can I yield myself 8 minutes off the amendment?
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KENNEDY. I yield myself 8 minutes off the amendment.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, I thank my friend and colleague, the 
Senator from West Virginia, for his analysis of this issue. He is one 
of the real experts on Medicare and Medicaid and is very much involved 
in the subcommittee of the Finance Committee dealing with all of these 
issues. He brings a very sound perspective to this issue. His comments 
identified the weaknesses of the Kyl proposal and also what are the 
dangers for so many of our senior citizens. I hope that our colleagues 
pay close attention to his words.
  I join in urging the Senate to oppose the Kyl amendment and defeat 
this attempt to undermine Medicare by eliminating the protections in 
current law that prevent doctors from overcharging senior citizens. 
This is not a ``freedom of choice'' amendment for patients; it is a 
``freedom to price gouge'' amendment for physicians, and it deserves to 
be rejected by the Senate.

  Medicare patients already have freedom of choice. In fact, because 
Medicare is one of the only insurance programs that still offers a true 
fee-for-service option, senior citizens generally have more choices in 
health care than other citizens, including those of us in the Senate.
  According to a February 23 report from the General Accounting Office, 
the information available to us indicates that Medicare beneficiaries 
have ready access to physicians. The report emphasizes the high 
participation rate in Medicare by physicians. Ninety-six percent of all 
the doctors accept and treat Medicare patients.
  The report also emphasizes that few Medicare patients have problems 
in obtaining health care. Only 4 percent report difficulty in finding a 
physician. This does not appear to be due to the reimbursement levels. 
The GAO found reimbursement levels for physicians under Medicare are 
adequate and do not jeopardize access to health care for senior 
citizens.
  The Kyl amendment is no answer to the problems of Medicare. It will 
only make those problems worse. The freedom it proposes is the freedom 
to exploit senior citizens and the freedom to dismantle the fundamental 
guarantee of affordable health care for the elderly that has served 
American senior citizens well for so many years.
  Senior citizens deserve affordable health care provided by Medicare, 
and that they have earned through a lifetime of hard work and service 
to this country. The Kyl amendment takes the choice out of the hands of 
the vast majority of senior citizens and puts it in the hands of the 
doctors. That is the key flaw in the Kyl amendment.
  Who is going to be making the decision? Is it going to be the 
patient, or is it going to be the provider? The patient already has 
that kind of freedom today. If they want to indicate that they do not 
want their doctor to bill the Medicare system, then they can go ahead 
and pay if they want to. They have that opportunity to do so.
  That is not what the Kyl amendment is about. The Kyl amendment puts 
the power in the hands of the doctors. If such legislation were to 
pass, doctors would be free to charge unlimited fees and patients would 
be free to pay them. Some freedom. Some choice.
  Medicare works well for patients and physicians alike. Senior 
citizens are

[[Page S2816]]

free to chose their doctor and are free to self-pay if they desire. 
Physicians must abide by limits on what they can charge for services 
covered by Medicare, which means that senior citizens know they cannot 
be overcharged.
  In addition, because Medicare covers the basic services, but not all 
services, the elderly are free to pay out of pocket for services not 
covered by Medicare. If they are able to afford it and they want to pay 
privately for Medicare-covered service, they can do that too by asking 
the doctor not to submit a claim. If the patient wants to pay the 
doctor, and pay the doctor more, and pay the doctor an exorbitant 
amount, the patient is free to do so now at the present time and not 
have them submit the claim to Medicare.
  This was the case before the Balanced Budget Act was enacted last 
year, and it is the case today. The current system works and works 
well. This aspect of Medicare is not broken, and it does not need to be 
fixed. The only fix the Kyl amendment provides is the authority for 
doctors to fix the higher prices than Medicare allows.
  Current law favors the patient by guaranteeing that it is the patient 
who initiates actions to pay outside of Medicare. Medicare's balanced 
billing limits continue to apply. The patients have the choice. They 
are the ones who can initiate or end the private transaction. The power 
is in the hands of the patient. That is where it should be. The Kyl 
amendment gives that choice to the physician. That is the serious 
mistake that would jeopardize Medicare coverage for large numbers of 
senior citizens.
  The reality is that in a number of instances the patient will ask the 
doctor not to submit the claim or the bill under Medicare. These are 
primarily in the cases of mental health and substance abuse where the 
individual, for any number of reasons, fears what might happen to them 
in the job market or because it might make it more difficult or complex 
in terms of other different personal reasons and chooses to pay 
themselves and tells the doctor, ``Look, don't bill Medicare. I'll pay 
you. I'll pay you.'' That happens today. It is not widely advertised, 
not widely proclaimed, but it happens today. That goes on, and the 
Medicare system respects that.
  But that isn't what this is about. This is about where the doctor 
says to the patient who is in that doctor's office and needs help and 
assistance, ``Look, you're not going to effectively get it''--it might 
be a little smoother than this, but the message is going to be clear--
``unless you're going to pay me whatever I say.'' Now, that is the 
beginning of the end. That is something that we have guarded against 
over a long period of time, and we should not open up those gates 
today.
  Congress should not imperil the financial security of 38 million 
senior citizens. Congress should not take the money out of the pockets 
of the elderly and put it in the bank accounts of wealthy physicians. 
That is what this issue is really about. Simply put, who is going to be 
the one who is going to make the decision? Is it going to be the 
patient, which I think all of us feel is the way that it should go, and 
it is that way at the present time, or is it going to be the physician 
who is going to be making that judgment, looking into the eyes of a 
sick patient, virtually at the will of the physician, when they have 
that illness and sickness and are told, ``Look, if you want my 
treatment, if you want to be treated by me, it's going to cost you a 
bundle.'' That we have guarded against over a long period of time. It 
is a key element in terms of the whole guarantee of quality, good care 
for our senior citizens, and we should not alter and change that 
particular protection now.

  Mr. President, I yield the floor.
  Mr. KYL addressed the Chair.
  The PRESIDING OFFICER. The Senator from Arizona is recognized.
  Mr. KYL. Mr. President, I would like to respond to the remarks of the 
Senator from Massachusetts, and perhaps those of the Senator from West 
Virginia as well.
  First of all, let me clarify something. The Senator from 
Massachusetts says that this is the ``freedom to price gouge'' and the 
``freedom to exploit.'' In so saying, the Senator misrepresents 
significantly the amendment, or the bill that Representative Archer and 
I have introduced, which has a variety of provisions specifically 
designed to prevent fraud and abuse.
  The only thing that we have before us here today is the sense-of-the-
Congress resolution. I draw the Senator's attention to some of the 
provisions on page 2 which specifically set forth the requirements that 
would protect against fraud and abuse. In other words, what we are 
saying is that this freedom to choose must--and I am quoting now from 
the amendment that we are debating--must include provisions that ``are 
subject to stringent fraud and abuse law, including the Medicare 
antifraud provisions in the Health Insurance Portability and 
Accountability Act of 1996.''
  Now, if those are not good enough, then perhaps we ought to be 
changing the existing law. But we are going to actually have more 
stringent fraud and abuse provisions than the existing law has. So I 
really in a sense resent the suggestion that there is nothing in here 
that prevents fraud and abuse. This legislation has more antifraud and 
abuse provisions than existing law.
  Second point. The Senator from Massachusetts says that only 4 
percent, according to a study, only 4 percent of seniors have 
difficulty getting their health care under Medicare. Well, by my 
calculation that is ``only'' 1,360,000 seniors. That is a lot of 
seniors.
  The truth of the matter is most seniors will take advantage of 
Medicare. It is a good deal. We hope that will continue to be the case. 
But for those few who choose to contract privately, why deny them that 
right? The GAO study cited by the Senator from Massachusetts says, ``If 
direct contracting continued to be rarely used''--and I say ``continued 
to be'' because the right does exist today--``there would be no changes 
in the benefit payments, no additional difficulties in combating fraud 
and abuse, and no major new administrative burdens placed on HCFA.''
  So if it is not a problem, then why oppose this amendment? GAO says 
it would not be a problem. And, in fact, the Senator proves too much by 
the last point that he made. He said, actually it is the case today 
that if a patient wants to ask the doctor not to submit a claim, the 
doctor does not have to do that and therefore we already have this so 
we do not need the Kyl amendment--to which there are two responses. 
First of all, if current law already provides this, then why does the 
Senator object to the mere statement of the principle that the choice 
should exist? If the Senator is happy with existing law, he can't very 
well oppose the principle that simply restates existing law.
  I again quote from what we are debating. It is frequently helpful to 
do that. All the sense-of-the-Senate provides is, and I quote, ``It is 
the sense of Congress that seniors have the right to see the physician 
or health care provider of their choice, and not be limited in such 
right by the imposition of unreasonable conditions on providers who are 
willing to treat seniors on a private basis. . .''
  Does the Senator oppose that principle? The Senator suggests that 
that is already existing law. If so, then what is the problem? The 
truth, however, Mr. President, is that it is not existing law. As a 
matter of fact, the Senator from Massachusetts cannot cite either a 
statute or a regulation which says that this is existing law, because 
it is not. HCFA will quietly tell you that they would not mind if a 
patient did that, but they do not want to advertise it and there is no 
legal authority for it.
  The truth of the matter is that, as the GAO pointed out, it has 
always been the case up until January 1, 1998, that patients had this 
right to privately contract. You have all of the great concerns about 
fraud and abuse that have been articulated by the Senator from West 
Virginia and the Senator from Massachusetts, but I have never heard of 
one single case--and I would be delighted if the Senator could cite 
one--where in the past 20 years, since this right did exist until 
January 1 of this year, there was fraud and abuse as a result of this. 
I know of none.
  So, Mr. President, I will make one final point. The Senator from West 
Virginia is not on the floor, but he made the point that this isn't 
good for Medicare beneficiaries. I suggest, that goes to the heart of 
this debate. Who decides what is good for the beneficiaries? 
Washington, DC, bureaucrats or the

[[Page S2817]]

beneficiaries? Let the beneficiaries decide.
  As the GAO points out, if most beneficiaries do not take advantage of 
this freedom to contract--and I doubt that they will--then there is no 
problem. But let them make the decision. We should not be making the 
decision that they do not have the right even if they desire to 
exercise it.
  I think it is pretty hard to argue with the proposition that patients 
should have this freedom of choice. And I have not heard anything yet 
that persuades me that this is not a good amendment.
  I again urge my colleagues to support it. I thank the Chair.
  Mr. BRYAN addressed the Chair.
  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. BRYAN. I thank the Chair.
  Mr. President, I rise in respectful opposition to the amendment of my 
friend, the junior Senator from Arizona. Although this amendment is 
dressed in the robes of patient choice, in my view it dramatically 
changes the nature of the Medicare system and now, for the first time 
in more than three decades of Medicare experience, would give to the 
physician the ability to determine how much a Medicare patient pays for 
Medicare-covered services. I believe it is a prescription for disaster 
for the Medicare system and for the patient himself or herself.
  Let me put this in some context, if I may. For 30 years-plus Medicare 
patients have come to their physician and have known with reasonable 
certainty what kind of financial expectation they are required to pay 
in order to receive Medicare-covered benefits. This amendment would 
change that and allow the physician to make that determination.

  No. 2, we are plagued in the Medicare system today with fraud that 
some estimate may exceed $20 billion a year. I believe that this change 
would make it more complicated in addressing the problems of fraud that 
the system confronts.
  And, finally, for the Medicare patient himself or herself, I think it 
injects a notion of uncertainty and confusion when that Medicare 
patient goes to the physician.
  Let me put this in some context, as I understand it, so we can talk 
about what is not involved here. Since the inception of Medicare, and 
continuing beyond the 1998 balanced budget agreement for noncovered 
Medicare services--that would be, for example, plastic surgery--a 
Medicare patient has always had the right to enter into a private 
contractual arrangement with the physician of his or her choice. That 
is the history. That was unchanged by the balanced budget agreement of 
1997, and it continues to be the law today.
  With respect to a Medicare-covered service, such as a diagnostic test 
in which Medicare pays for only one or two of those diagnostic tests, 
if a Medicare patient is uncertain as to the kind of advice he or she 
is getting as a consequence of that test, it has always been the case 
that if a second or third or fourth opinion is sought by the Medicare 
patient, that Medicare patient has the right to enter into a private 
contractual arrangement with the physician of his or her choice. That 
has been true historically. That was true prior to the balanced budget 
agreement and remains the case as well.
  Thirdly, this applies to part B Medicare, so we are not talking about 
the trust fund. For an individual who is philosophically opposed or for 
whatever reason chooses not to be a part of Medicare part B, that is 
his or her absolute choice. No one is required to participate or to pay 
that premium. And that is true with the physician as well.
  What I apprehend will occur here is a rather dramatic change in the 
Medicare system. A Medicare patient goes to a physician, and the 
Medicare physician says, ``Look, there are three or four procedures 
which I believe you need. With respect to three of those procedures, 
I'm satisfied that the Medicare reimbursement schedule is adequate. As 
to the fourth, I will need additional compensation in order to provide 
that service.''
  The net effect of all of that, I respectfully submit, is that no 
Medicare patient, going to his or her doctor's office, will know with 
certainty what the financial expectation will be of that Medicare 
patient. That changes the system rather dramatically.
  For more than three decades, to the best of my ability, there has 
been no private contracting between Medicare patient and physician with 
respect to covered service. My distinguished colleague may be right 
that there may not be carved in stone any legal prescription, but that 
indeed has been the practice. And 96 percent of physicians in America 
cover and treat Medicare patients. So I think we ought to give a 
considerable reflection to what is at issue here.
  My distinguished friend and colleague offered in the balanced budget 
amendment an amendment which was ultimately fashioned into law. That 
provided, for the first time, an opportunity for a physician who wants 
to enter into a private contractual arrangement with a Medicare patient 
to do so.
  If the Medicare physician chooses to do so, then that Medicare 
physician may not have other Medicare patients for a period of 2 years. 
That was, in effect, an opening, if you will. That provided an expanded 
opportunity which did not heretofore exist.
  There are some groups who I think have been irresponsible in 
characterizing that as a limitation. That is not the case, as I 
understand it.
  I simply say to my colleagues, the Medicare system is not perfect. 
There are certainly some things which we need to do, and, indeed, the 
Medicare Commission has been formed for that purpose. Hopefully, it 
will come with some bipartisan recommendations. But I do not believe we 
will want to change dramatically the nature of that system which does 
have certainty; namely, a fee schedule for reimbursement to a physician 
for Medicare-covered services. That has been the hallmark of the 
Medicare system. That will change rather dramatically if the proposal 
which my friend from Arizona offers is accepted, and would allow not 
the patient, but the physician, to make that judgment.
  Most of us, when we go to our physician, even those of us who might 
be described as being in the ``pre-Medicare age''--that is, we are not 
quite eligible for Medicare services--approach the annual visit to our 
physician with some trepidation. A physician has the ability to say, 
``Look, that condition that you have is terminal.'' So there is some 
apprehension, some ill at ease, no matter how many times you have been 
to a doctor. When you are in that context, it is not a level playing 
field, and the doctor saying to you, ``Look, I no longer accept this 
rate of reimbursement from Medicare which I previously accepted,'' 
places, in my view, the patient at a decided disadvantage in dealing 
with that physician and is more likely than not to say, ``Well, all 
right, I will agree to pay.''
  As I indicated previously, if there are two or three Medicare 
services that the patient requires, the confusion of, ``I will accept 
Medicare reimbursement for two of the services but not a third,'' I 
think leaves the patient in a very confused situation.
  I urge my colleagues to reject this amendment. Let's all work 
together as a result of the Medicare Commission and see what kind of 
changes we need to make to improve the system.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. DURBIN. I rise in opposition to the amendment.
  I don't know what the time allocation is. I believe Senator 
Lautenberg is in charge of our side.
  Mr. LAUTENBERG. Mr. President, I am happy to yield 8 minutes to the 
Senator from Illinois.
  Mr. DURBIN. I thank my colleague and friend.
  The great philosopher Kris Kristofferson once said, ``Freedom is just 
another word for nothing left to lose.'' I believe those were actually 
sung or spoken by the late, great Janice Joplin.
  This amendment characterized as the Freedom of Health Care Choice for 
Medicare Seniors, on its face, appears to be a positive addition to the 
Medicare system. You would think if you proposed, as the Senator from 
Arizona does, that we will give more freedom to Medicare seniors--more 
freedom--that you would just guess that the major senior organizations 
from around the country would be unified in support of this amendment. 
In fact, they are unified in opposition to this amendment.

[[Page S2818]]

 So there might be more to this amendment than freedom. There is 
something to lose in this amendment.

  Let me get down to the bottom line of what all this debate is about. 
This debate is about whether a Medicare senior going into a doctor's 
office is going to have to pay according to an established Medicare 
schedule or whether that doctor can charge more. So it is whether the 
doctor--some doctors have the freedom to charge some seniors more for 
services. You might argue that that is necessary if there is a shortage 
of doctors providing benefits to Medicare seniors. But, lo and behold, 
96 percent of doctors are already providing benefits to Medicare 
seniors. So virtually all of the doctors, 96 percent of them 
nationwide, have signed on. They are prepared to treat Medicare seniors 
and to be paid according to the fee schedule.
  What is at stake here is not about doctors in service but, rather, 
whether or not some doctors can charge more. What will this mean to us 
when we reach the Medicare eligibility age, which is creeping up on 
many of us, or our parents, or grandparents? It may mean before you 
have a chance--if the amendment of the Senator from Arizona prevails, 
before you have a chance to talk to your doctor about your problem, if 
you are a Medicare senior with this new ``freedom,'' first you will 
have to talk to the accountant in the office, who is going to want to 
know a little bit about your salary, your net worth, and how much they 
can charge you for the benefits they will provide. For some, that may 
be freedom. From where I am standing, that is not freedom. In fact, it 
restricts the rights which seniors already have.
  I think we ought to take a look at this amendment for what it really 
does. Private contracting sounds good on its face, unless you 
understand what you lose in the process of private contracting. In this 
situation, it means for seniors that instead of knowing what they pay 
when they go to the doctor's office, it really is going to be an 
uncertainty; they won't know. They will walk into the office uncertain 
whether that doctor will charge considerably more than they might have 
expected. That is the reason every seniors group--the AARP, the 
National Council of Senior Citizens, Families USA, and others--have 
come out in opposition to this amendment.
  I might also add that there have been groups, one group in 
particular, which is called the United Seniors Association, which is 
sending mailings to seniors and would-be seniors. Lo and behold, I 
ended up on their mailing list. They were writing on behalf of this 
amendment's concept. I don't believe they were authorized by the 
Senator from Arizona. I am sure they were not. But they are, 
unfortunately, spreading some rather alarming news to seniors across 
America.
  Listen to what it says on the front of the envelope sent to my home 
in Springfield, Il:

       Mr. and Mrs. Richard Durbin: As of January 1998, our 
     government for the first time ever will stop everyone over 
     age 64 from getting lifesaving medical treatment.

  If you receive this and you are a senior, or close to it, boy, you 
will open it up in a hurry. What you find in here is a total 
misrepresentation of the Medicare system as it currently exists. The 
Medicare system in America is a very successful medical system. It is 
true that we will need to deal with the fact that the cost of health 
care continues to go up and our resources to pay for it are not 
matching that, but the bottom line is from the viewpoint of parties. 
They are happy with the system. They are content with the care they are 
receiving. They don't want Members of Congress, House or the Senate, 
meddling with the basic Medicare system. This amendment, this so-called 
private contracting freedom amendment, meddles with the system in a way 
that most seniors are not going to be happy with.

  Some doctors will, because they can charge more. But for a lot of 
seniors, we will find them really disadvantaged. For 38 million 
Americans who rely on the system, I think it would be a serious mistake 
for us to adopt this amendment. As a matter of fact, Senator Chafee and 
I will be offering an amendment at a later time in this debate which I 
think more correctly addresses the feelings that I hope more Members of 
the Senate share about the future of the Medicare system. In that 
amendment, we say as a sense of Congress that the assumptions 
underlying the functional totals in this budget resolution assume that 
seniors have the right to affordable, high-quality health care, and 
they have the right to choose their doctors, and no change should be 
made to the Medicare Program that could impose unreasonable and 
unpredictable out-of-pocket costs for seniors or erode their benefits.
  If the Senator from Arizona prevails with his amendment, we cannot 
make that claim, because the benefits provided to seniors will be 
unpredictable in cost. Each doctor can decide how much more they want 
to charge.
  We also say in our resolution that we don't want to compromise the 
efforts of the Secretary of Health and Human Services to screen 
inappropriate or fraudulent claims for reimbursement and, finally, to 
allow unscrupulous providers under the program to bill twice for the 
same services. Senator Chafee and I will offer this later during the 
course of the debate. I hope my colleagues, Democrat and Republicans, 
will join us in supporting it.
  In closing, let me say I know the Senator from Arizona is firm in his 
belief that this would be a solid addition to the Medicare system. I 
happen to think the system as it currently exists, with predictable 
costs and predictable services for seniors, is exactly what they want 
to protect.
  I yield back the remainder of my time.
  Mr. BUMPERS. I wonder if the Senator from New Jersey would yield 8 
minutes.
  Mr. LAUTENBERG. I am pleased to yield 8 minutes to the Senator from 
Arkansas.
  Mr. DOMENICI. Might I inquire how much time remains on the amendment 
and how much in opposition?
  The PRESIDING OFFICER. The Senator from Arizona has 39 minutes, and 
the Senator from New Jersey has 28 minutes.
  Mr. DOMENICI. If we use that, each side has used an hour.
  The PRESIDING OFFICER. That is correct.
  Mr. DOMENICI. Thank you.
  Senator Bumpers.
  Mr. BUMPERS. Mr. President, I have the utmost respect for the sponsor 
of this bill, but I have utterly nothing but contempt for the 
amendment.
  Medicare has done more to provide a good night's sleep to the elderly 
of this country than any other single program, with the possible 
exception of Social Security. We made a solemn contract with the 
elderly of this country to provide them with medical care. When I was 
first elected Governor of my State, I found that 50 percent of the 
people didn't even know what to do in case they got sick. But when you 
polled the people over 65, they knew what to do and they knew where to 
go and they knew their bill was going to be paid.

  The underlying assumption of the Kyl amendment is that somehow or 
other people are having a difficult time getting a doctor to take them. 
Now, the General Accounting Office has answered a number of questions 
propounded to them by the distinguished senior Senator from New York, 
Mr. Moynihan, and in answer to one of the questions: How much 
difficulty are they having? here is the answer. According to the GAO, 
96 percent of the Medicare-eligible people in this country stated that 
they had some difficulty getting medical care. But listen to this. The 
Kyl amendment goes to this figure: Only two-tenths of 1 percent said 
they had difficulty getting satisfactory assistance because of 
Medicare. Here we are tinkering with a system that has been so 
successful and so rewarding to our elderly, because two-tenths of 1 
percent of the people in this country said they had difficulty getting 
the kind of care they wanted under Medicare.
  No. 1, doctors right now, under the Balanced Budget Act of 1997, are 
eligible to charge 15 percent more than the Medicare allowance. For 
example, you have a procedure--say, laser surgery for your eyes. Assume 
that the Medicare limit on laser surgery for your eye, or eyes, is 
$1,000, but the doctor can charge 15 percent more than that, or $1,150. 
Medicare may only pay 80 percent of the allowable charge, or $800, but 
the doctor can charge 15 percent more than the Medicare allowance.

[[Page S2819]]

  The balanced budget amendment also provided that if a doctor wants to 
privately contract, he or she may privately contract, but they have to 
drop out of the program for 2 years.
  Now, we feel strongly--many of us--that this is an elitist amendment. 
Obviously, there are a lot of people in this country--perhaps 2 percent 
to 5 percent--who will pay a doctor of their choice whatever he 
charges. They want him; they are used to him. Say I worked from the 
time I was 30 years old until I was 65 and went to the same doctor, and 
when I became 65 I said, ``Doctor, I am switching from my Blue Cross 
policy over to Medicare.'' The doctor says, ``I'm sorry, I'm not going 
to be able to take care of you anymore because Medicare is simply not 
meeting my expenses.'' You think about that. The patient may be a 
person of very modest means but who, above all, wants to go to the 
doctor he or she has been going to for years, and the doctor says, 
``Well, now, if you are willing to pay, that is a different matter, I 
will let you keep coming to see me.''
  Let me tell you another thing the doctor can do. Assume you are in a 
fairly big-sized clinic, and the doctor says, ``We will take you for 
your heart conditions under Medicare, but we can't take your liver,'' 
or, ``we can't take your kidneys.'' Think of all the different kinds of 
contracts people would enter into. If this amendment ever became law--
God forbid--you would start hearing some of the most fraudulent 
contracts and some of the most exorbitant charges for medical services 
that would choke a mule.
  Mr. President, if there is a problem with Medicare, if we are not 
paying enough to entice a majority of the doctors in this country to 
provide services under Medicare, let's raise the rates. But for Pete's 
sake, let's not allow people to enter into these private contracts. I 
have the utmost respect for the medical profession. But I am telling 
you, you are giving them unbelievable leverage over millions of 
Medicare patients if you allow them to say, ``I can't take you because 
Medicare is not enough.'' If only two-tenths of 1 percent of the people 
in this country are having difficulty getting medical care because of 
Medicare rates, I suggest to you that that is not a sufficient number 
to warrant tinkering with one of the finest programs this country has 
ever produced.
  I yield the floor and yield the remainder of my time.
  Mr. WELLSTONE addressed the Chair.
  Mr. LAUTENBERG. Mr. President, I yield up to 6 minutes to my friend 
from Minnesota. If more is needed, let me know.
  The PRESIDING OFFICER. The Senator from Minnesota is recognized for 
up to 6 minutes.
  Mr. WELLSTONE. Mr. President, let me just say one more time to my 
colleague from Arkansas, I wish he wasn't leaving the Senate. I can't 
add too much to what he said.
  Let me just say to my colleague from Arizona, whom I really respect, 
that I don't agree with him on a lot of issues, but I respect him. I 
mean that very sincerely. I think this amendment is mistaken, and I 
rise in strong opposition to it.
  I have just a few quotes. Families USA Foundation states that this 
provision, the Kyl amendment, ``may put increasing pressure on older 
Americans to choose between getting the health services they need or 
putting food on their table.'' I think Families USA has really had a 
great deal of credibility. I know what they mean. I think the fear is 
now, what would happen with the Kyl amendment is that doctors could 
charge an elderly person, a senior citizen, just about any fee for any 
visit or service. The problem is that if doctors are now going to be 
making this judgment and they can charge more than Medicare payments 
and stay in the Medicare system, the danger is that many will do so.
  I had two parents with Parkinson's, and neither one of them made much 
money. The Medicare Program was the difference for them between being 
able to live a life toward the end of their years with dignity, albeit 
a struggle, and going under. Who is to tell what a doctor decides in 
any given community? A lot of elderly people are going to be put under 
enormous pressure. Indeed, it could be a choice between whether or not 
people get the services they need or whether they put food on the 
table.
  Also, remember that senior citizens are paying more and more out of 
pocket. Since we had the debate on universal health care coverage, 
national health insurance, a few short years ago--a debate we should 
get back to--the fact is that seniors are paying even more out of 
pocket for health care costs. For many of them, it is the prescription 
drug costs.
  I don't know about other States, but my guess would be that in 
Minnesota the median income for senior citizens may be $15,000 or 
$16,000 a year. I suppose if you are a senior citizen with an income of 
$150,000 a year--there are very few, contrary to the stereotype--then 
you know a doctor could say, ``I want you to pay what I am going to 
charge and we will have this private contract.'' Those people would be 
all right, but for the vast majority of elderly people in our country--
and we are not talking about a high-income profile--the Kyl amendment 
is a very real threat to a system that has worked well for people.

  Catholic Charities USA, representing nearly 13 million people, states 
that the Kyl legislation would ``dangerously undermine the Medicare 
Program.'' They are right.
  It would leave ``average and low-income Medicare patients at grave 
risk of substandard care and second-class medicine.'' That was in a 
letter to all Senators from Fred Kammer, March 31--today, my son's 
birthday.
  The National Council of Senior Citizens, asserting that the Kyl 
legislation ``is fraudulent and should be defeated,'' says that the 
bill would ``essentially end Medicare as a national health insurance 
program for almost 40 million Americans.''
  ``This proposal would essentially license doctors to gouge millions 
of seniors for Medicare services.'' That is from a letter to Senator 
Daschle from Steve Protulis dated today.
  If the Kyl amendment succeeds, ``seniors will be left with big 
medical bills and the doctors will have new weapons to exploit health 
needs for profit.'' That comes from a memo by the National Council of 
Senior Citizens.
  I ask unanimous consent that quotes from these organizations, along 
with a series of other letters from organizations representing senior 
citizens, be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                      Private Contracting--Letters

       1. Families USA Foundation states that the Kyl provision 
     ``may put increasing pressure on older Americans to choose 
     between getting the health services they need or putting food 
     on their table.'' [Press Release, Families USA, 10/8/98]
       2. Catholic Charities USA, representing nearly 13 million 
     people, states that the Kyl legislation would ``dangerously 
     undermine the Medicare program.'' [Letter to all Senators 
     from Fred Kammer, 3/31/98]
       It will leave ``average- and low-income Medicare patients 
     at grave risk of substandard care and second class 
     medicine.'' [Letter to All senators from Fred Kammer, 3/31/
     98]
       3. The National Council of Senior Citizens, asserting that 
     the Kyl legislation ``is fraudulent and should be defeated,'' 
     says that the bill would ``essentially end Medicare as a 
     national health insurance program for almost 40 million 
     Americans.'' [Letter to San. Daschle from Steve Protulis 3/
     13/98]
       ``This proposal would essentially license doctors to gouge 
     millions of seniors for Medicare services.'' [Letter to Sen. 
     Daschle from Steve Protulis 3/31/98]
       If the Kyl Amendment succeeds, ``seniors will be left with 
     big medical bills and the doctors will have new weapons to 
     exploit health needs for profit.'' [Memo from National 
     Council of Senior Citizens, 10/27/98]
       4. The Service Employees International Union, on behalf of 
     1.2 million workers and retirees, strongly opposes S. 1194 
     saying that ``this legislation is an underhanded effort to 
     destabilize the entire Medicare system and make it 
     unaffordable for poor and working class citizens.'' [Written 
     statement submitted to Senate Committee on Finance for 
     hearing record, 2/26/98]
       This legislation would give ``doctors more leeway to rush 
     people into contracts they don't understand, to charge higher 
     rates, and to select to serve people who will make them the 
     most money.'' [Written statement submitted to Senate 
     Committee on Finance for hearing record, 2/26/98]
       5. Beatrice S. Braun, M.D., currently a member of AARP 
     Board of Directors testified that ``AARP firmly believes that 
     if S. 1194 were adopted, beneficiaries and the Medicare 
     program would be more vulnerable to fraud and abuse.'' 
     [Written testimony: Senate Committee on Finance hearing, 2/
     26/98]
       6. Dr. William A. Reynolds, President of the American 
     College of physicians, testified

[[Page S2820]]

     that the Kyl legislation would: ``(1) create access problems 
     where none existed; (2) increase administrative complexity 
     for physicians, who will be struggling with billing errors 
     and ad hoc incoming testing of their patients; and (3) 
     produce conflict in the physician-patient relationship.'' 
     [Written testimony: Senate Committee on Finance hearing, 2/
     28/98]
       The ACP strongly believes that ``the Kyl bill threatens 
     Medicare's viability as a health plan.'' [Letter to Sen. 
     Moynihan from Dr. Reynolds, 10/5/97]
       7. The National Association of Retired Federal Employees, 
     urging opposition to the Kyl legislation, wrote that Medicare 
     patients would negotiate from a position of weakness if 
     doctors were allowed to pick and choose when to be in or out 
     of Medicare. [Letter to Sen. Daschle from NAREE, 3/31/98]
       8. OWL, the Older Women's League, believes that the Kyl 
     legislation would take away ``guarantees of access and 
     quality that Medicare has always provided to America's older 
     women. [Press Release, OWL, 10/8/98]
       9. The National Council on the Aging fears that ``access to 
     specialists would suffer, as they could refuse to see the 
     vast majority of Medicare beneficiaries so that a small 
     handful of the wealthiest seniors could pay their highest 
     rate.'' [Press Release, The National Council on the Aging, 
     10/97]
       10. The Leadership Council of Aging Organizations believes 
     that the passage of S. 1194 ``would be anti-consumer and 
     would hurt Medicare beneficiaries and the program generally. 
     ``[Letter to ALL Representatives from the Leadership Council 
     of Aging Organizations, 10/30/97]
       11. Retired Public Employees Association believes that 
     under the Kyl legislation, ``the possibility exists that less 
     affluent Medicare beneficiaries will be forced to choose 
     between a private contract which they can ill afford and 
     or an interruption in their continuity of care. [Stanley 
     Winter, Written Statement submitted to Senate Committee on 
     Finance for hearing record, 2/26/98]
       12. Jane Bryant Quinn, with the Washington Post, wrote that 
     this ``anti-senior law'' would be ``freedom for Doctors to 
     charge you more.'' [Jane B. Quinn. Washington Post. 3/8/98]
       13. The New York State Council of Senior Citizens, 
     representing over 200,000 elders, wrote that this 
     ``pernicious bill masquerades under a pretense of increasing 
     `free-choice' to Medicare beneficiaries.'' [Letter to Sen. 
     Moynihan from Eleanor Litwak, 1/26/98]
       They fear that were the bill to be enacted, ``Medicare 
     would become impoverished and would rapidly become a program 
     for the poorest and the sickest instead of the great 
     universal entitlement it is now.'' [Letter to Sen. Moynihan 
     from Eleanor Litwak, 1/26/98]
                                                                    ____


Written Statement Submitted to the Senate Finance Committee by Patricia 
      A. Ford, Executive Vice President of the Service Employees 
  International Union, in Opposition to Medicare Private Contracting 
                    Legislation (S. 1194; H.R. 2497)

       The Service Employees International Union strongly opposes 
     S. 1194, the Medicare private contracting legislation. We are 
     deeply concerned about the consequences that this legislation 
     would have for access to affordable, quality care for 
     Medicare beneficiaries. In our view, this legislation is an 
     underhanded effort to destabilize the entire Medicare system 
     and make it unaffordable for poor and working class senior 
     citizens.
       Our union represents over 1.2 million workers and retirees. 
     More than 600,000 of these are front line health care 
     workers, including nurses, hospital workers, nursing home 
     workers and home health workers, who provide Medicare funded 
     services to senior citizens every day. We also represent our 
     retired members--former public sector, building service and 
     health care workers. These retired janitors, secretaries, and 
     clerks live on fixed incomes and rely on Medicare to cover 
     the bulk of their health care needs.
       Some have touted that this amendment is about offering 
     patients more choice, but this is very misleading. Medicare 
     beneficiaries have always been free to privately purchase 
     services that Medicare does not cover. Last year's Balanced 
     Budget Act broadened choice even further by allowing 
     beneficiaries to privately contract for services that are 
     already covered under Medicare. Medicare Beneficiaries 
     already have choice.
       The Medicare private contracting legislation is really 
     about offering physicians, not consumers, more choice. This 
     legislation would remove the two-year exclusion provision and 
     other consumer protections that govern these private 
     contracts, giving doctors more leeway to rush people into 
     contracts they do not understand, to charge higher rates, and 
     to select to serve people who will make them the most money.
       Currently, even with Medicare coverage, more than one out 
     of every five retiree dollars goes to covering health care 
     costs. And when the median income for those over 65 is a 
     little over $11,000 that leaves precious little for food and 
     much less for clothing and shelter. This means that the vast 
     majority of senior citizens in this country will not have the 
     means to enter into private contracts.
       One of our major concerns--that lies at the heart of this 
     bill--is that it would destabilize the entire Medicare system 
     and make it unaffordable for many beneficiaries. This 
     legislation would have the effect of transforming Medicare 
     from a social insurance program that everyone pays into and 
     everyone benefits from to a privatized program with 
     incentives for doctors to serve only the most profitable 
     patients.
       The 1.2 million members of our Union, along with all 
     working families in this country, count on care being 
     available when they need it--that is why health insurance was 
     developed in the first place. By allowing physicians to 
     charge for services at will this basic premise is lost. The 
     Medicare private contracting legislation would destroy the 
     stability of paying into a system that insures available, 
     affordable coverage for those who need it. Getting medical 
     treatment--although vital--is a service and as such should 
     not fluctuate in price depending on the income of the person 
     who seeks it.
       We object to the premise of this legislation and question 
     why the Federal Government would want to replace a system in 
     which 95% of all physicians provide care to 100% of qualified 
     enrollees with a two-tiered system in which access to quality 
     care is determined by income rather than illness. The 
     potential effect of this legislation on overall health 
     spending is also very alarming. The non-partisan 
     Congressional Budget Office (CBO) predicts that if this 
     legislation is approved it would ``almost certainly'' send 
     national health care spending spiraling upwards.
       Again, on behalf of our more than 1.2 million members and 
     our thousands of low-income retired members, I urge you 
     strongly to oppose Medicare private contracting legislation, 
     S. 1194. Thank you.
                                                                    ____

                                               National Council of


                                              Senior Citizens,

                                Silver Spring, MD, March 31, 1998.
     Senator Tom Daschle,
     Hart Senate Office Building,
     Washington, DC.
       Dear Senator Daschle: The National Council of Senior 
     Citizens urges you and your Senate colleagues to vote against 
     Senator Kyl's amendment to S. Con. Res. 86. In our view, 
     Senator Kyl's proposal would essentially end Medicare as a 
     national health insurance program for almost 40 million 
     Americans. It would virtually destroy the price protections 
     that beneficiaries now enjoy.
       This proposal would essentially license doctors to gouge 
     millions of seniors for Medicare services. It would add not a 
     scintilla of ``freedom of choice'' for Medicare beneficiaries 
     in finding a doctor to treat their medical needs. Ninety-five 
     percent of all doctors already treat Medicare patients.
       The recent hearing held by the Senate Finance Committee 
     demonstrated that current Medicare rules allow Medicare 
     patients to pay their doctors for specific services without 
     requiring the doctor to withdraw from Medicare for two years.
       In short, Senator Kyl's sense of the Congress resolution 
     would add no benefit or freedom to the lives of seniors. It 
     is fraudulent and should be defeated.
           Sincerely,
                                                   Steve Protulis,
     Executive Director.
                                                                    ____

                                           National Association of


                                    Retired Federal Employees,

                                   Alexandria, VA, March 31, 1998.
     To: Hon. Tom Daschle.
     From: Charles R. Jackson, NARFE President.
       Misinformation and deliberate distortion of facts about 
     Medicare's Private Contracting rules should not be the basis 
     for attaching even a non-binding version of Senator Kyl's 
     bill, S. 1194, to the Senate budget resolution, S. Con. Res. 
     86. Federal retirees, particularly the 8,296 annuitants in 
     your state ask that you vote against this amendment.
       Medicare patients would negotiate from a position of 
     weakness if doctors were allowed to pick and choose when to 
     be in or out of Medicare. Absent private contracting 
     protections, physicians--not beneficiaries--would decide what 
     to charge for their services. That is the only freedom being 
     enhanced by the Kyl and Archer bills, S. 1194 and H.R. 2497.
       Congress and President Bush approved legislation in 1989 to 
     limit doctor fees to 115 percent of the Medicare fee 
     schedule. Fee limitations were enacted to ensure that 
     beneficiaries have access to health care at predictable 
     costs. More than 90 percent of America's physicians 
     participate in Medicare despite fee limitations which private 
     contract protections help to enforce. Fee limitations have 
     not resulted in services being denied to Medicare patients, 
     but we fear repealing private contract protections will 
     render fee limitations meaningless.
       The nonpartisan Congressional Budget Office (CBO) has 
     warned Congress that this legislation could significantly 
     compromise Medicare's ability to screen inappropriate claims. 
     As a result, CBO says that it would be easier for an 
     unethical physician to bill both Medicare and the private 
     contract patient for the same service.
       Fraud, waste and abuse is already a $23 billion a year 
     problem in Medicare. NARFE believes unrestricted private 
     contracting will only increase fraud at a time when public 
     policy makers are trying to preserve Medicare for current and 
     future generations.
                                                                    ____


                         Medicare Rights Center


   F.A.L.S.E. ALARM Fooling Americans into Losing Senior Entitlements

       Seniors around the country are being fooled into believing 
     that Medicare won't take care of them. Americans Lobbying 
     Against Rationing Of Medicaid Care (A.L.A.R.M.). Alarm of 
     United Seniors Association, is falsely scaring seniors and 
     tricking them into giving up one of Medicare's

[[Page S2821]]

     greatest protections: the limit on the amount doctors can 
     charge Medicare patients.
       ``A.L.A.R.M. is not telling seniors the truth when they 
     state that Medicare won't pay for their health care and they 
     will be left with nowhere to go to get it.'' says Diane 
     Archer, Executive Director of the Medicare Rights Center, a 
     national not for profit consumer service organization.
       Currently, traditional Medicare pays for all reasonable and 
     necessary services and limits seniors' out-of-pocket costs. 
     Seniors can see almost any doctor they want anywhere in the 
     country: 96% of doctors treat Medicare patients and agree to 
     charge these patients at a fixed rate set by the government.
       ``The real alarm is that unless Medicare retains its 
     billing protection, seniors will have to pay out of their own 
     pockets whatever fees their doctors come up with. If they 
     cannot afford the fee, they will be forced to go without 
     health care.'' says Ms. Archer.
       The current limits on doctors' charges allow people on 
     Medicare freedom to get the health care they need. permitting 
     doctors once again to set their own fees only makes health 
     care unaffordable for many seniors.
       In short, says Ms. Archer, ``A.L.A.R.M. wants to shift 
     responsibility for the cost of health care from the 
     government to seniors who cannot afford to pay for it.''
       A copy of A.L.A.R.M.'s letter is attached along with a MRC 
     fact sheet about what Medicare really provides seniors.
                                                                    ____


     New Kyl Legislation Would Disproportionately Harm Older Women


    Older Women Are Poorer, Have More, and More Complex, Illnesses; 
    Increased Costs Would Price Them Out Of Health Care Marketplace

       OWL, an organization representing the more than 57 million 
     American women over the age of 40, today (October 8) issued 
     the following statement opposing S 1194/HR 2497, bills that 
     would enable physicians, without any consumer protections, to 
     contract privately for services with Medicare beneficiaries:
       ``Kyl II,'' which would give doctors license to charge 
     whatever the market would bear for services that already have 
     Medicare-imposed cost ceilings, would be particularly 
     damaging to women who suffer from more, and often more 
     complex conditions than men. Requiring more general physician 
     care and more specialist care, these already vulnerable 
     patients, who even now have trouble affording the out-of-
     pocket health care expenses they must pay, could be faced 
     with a choice of private treatment or a Medicaid-funded 
     nursing home stay.
       ``Kyl II'' would make bad public policy worse. The so-
     called Medicare ``reforms'' that were include din the 
     Balanced Budget Act have aptly been identified as the start 
     down a slippery slope that will eventually lead to the total 
     dismemberment of Medicare. OWL believes that ``Kyl II'' would 
     be a large rock rapidly careening down that slope, taking 
     with it the guarantees of access and quality that Medicare 
     has always provided to America's older women.
       21.8 million (out of 38.1 million) of all Medicare 
     beneficiaries are women, and 83% have an annual income of 
     less than $25,000 per year. in fact, older women live on a 
     median income of $9,355 a year (compared to a man's $14,983), 
     and depend upon Medicare and their monthly Social Security 
     check for maintaining their independence at home rather than 
     entering a nursing home. This proposed legislation not only 
     threatens to destroy the foundation of a critical social 
     insurance program, but could seriously threaten the lives of 
     America's older women.
                                                                    ____


 Statement by Judy Waxman, Director, Government Affairs, Families, USA

       The Medicare Beneficiary Freedom to Contract Act of 1997 
     could result in beneficiaries being held hostage to high-
     priced doctors. Doctors could seek any fee they want for any 
     service, and Medicare beneficiaries would feel compelled to 
     pay such unlimited fees to retain their doctors.
       Out-of-pocket health care costs have continued to rise for 
     America's seniors since Medicare's inception. This provision 
     may put increasing pressure on older Americans to choose 
     between getting the health services they need or putting food 
     on their table. This choice is simply unacceptable.
       Families USA is the national health consumer group.
                                                                    ____


                   The National Council on the Aging


           LCAO Opposes Medicare Private Contracting Proposal

       My name is Howard Bedlin and I am the Vice President for 
     Public Policy and Advocacy for the National Council on the 
     Aging, which currently chairs the Leadership Council on Aging 
     Organizations (LCAO). The LCAO represents 43 national 
     organizations serving over 40 million older persons.
       The Leadership Council of Aging Organizations opposes 
     efforts to overturn current provisions that protect Medicare 
     beneficiaries from physician overbilling. Doctors are already 
     permitted to charge 15% more than what Medicare considers to 
     be a reasonable price, and now they want to charge even more. 
     We oppose opening up Medicare provisions enacted under the 
     Balanced Budget Act just two months ago on an issue that has 
     far reaching implications, yet has never been the subject of 
     a congressional hearing or even debated on the House or 
     Senate floor. LCAO members will be sending a letter to 
     members of Congress next week to express our opposition to 
     this ill-conceived, anti-consumer proposal.
       The National Council on the Aging believes that the 
     proposals introduced by Senator Kyl and Chairman Archer are 
     not designed to solve any problem experienced by Medicare 
     beneficiaries. Well over 90 percent of physician's bills 
     accept Medicare rates and there is no evidence to indicate 
     that access problems exist because of Medicare payments to 
     doctors. The proposals would, however, increase physicians' 
     income and fundamentally change the nature of the doctor-
     patient relationship.
       Without notice, or in the middle of a course of treatment, 
     doctors could tell Medicare patients that treatment will be 
     denied unless payment is made for the full amount of whatever 
     the doctor wants to charge. No other insurance policy, in 
     either the public or private sectors, permits this. Access to 
     specialists would suffer, as they could refuse to see the 
     vast majority of Medicare beneficiaries so that a small 
     handful of the wealthiest seniors could pay their higher 
     rates. Instances of fraud and abuse would increase, as 
     unscrupulous doctors would have an easy time getting away 
     with double billing both Medicare and the patient.
       Beneficiaries could be subject to bait-and-switch tactics, 
     in which doctors begin a course of treatment under Medicare 
     and then turn around and demand full payment of higher 
     charges out-of-pocket for treatment to continue. What if a 
     particular doctor doesn't like what Medicare is paying him 
     for one particular service? What if the doctor notices that 
     the patient has driven up in a nice new car? The kind of 
     uncertainty this proposal would create would be extremely 
     harmful to Medicare beneficiaries.
       We strongly urge members of Congress to reject this 
     proposal, to act in the interest of 33 million Medicare 
     beneficiaries, and to refuse to line the pockets of a few 
     greedy doctors.

  Mr. WELLSTONE. Mr. President, I say to my colleague from Arizona and 
to other colleagues, this amendment is profoundly mistaken. This 
amendment, if passed, I believe, really puts way too many senior 
citizens at risk.
  The Medicare Program is a universal coverage program. The Medicare 
Program is, for many seniors, the difference between survival and even 
life with dignity versus going under. To all of a sudden now say to 
doctors and other providers in this country that you can charge what 
you want and still stay in the Medicare system now, I am not in favor 
of that. But if they do it for 2 years, they are out of Medicare. To 
tell the doctors and providers they can charge what they want and stay 
in Medicare, that doctors can decide, for any senior citizen and their 
families, whether or not they have the money to pay for additional 
costs the doctors want to impose on them does a grave injustice to the 
Medicare system.
  I don't hear a lot of senior citizens--I say to my colleagues--in 
Minnesota saying they want to see the Medicare system ``fixed'' in this 
direction. I hear people talking about, ``Can there be coverage for 
prescription drug costs?'' I hear people talking about the problems 
they have when they are faced with catastrophic expenses, not wanting 
to spend the end of their lives in a nursing home and maybe going under 
because of that. I hear senior citizens talking about the need to have 
more funding for home-based health care so they can live at home in as 
near normal circumstances as possible with dignity. I don't hear senior 
citizens in Minnesota saying they want the Kyl amendment passed, which 
will enable providers, in too many cases, to gouge them, to charge what 
they want to charge to seniors, to put a whole lot of senior citizens 
at risk. This amendment is mistaken. This amendment undermines the 
Medicare system, and this amendment should be resoundingly defeated.
  Mr. President, I yield the floor.
  Mr. KYL addressed the Chair.
  The PRESIDING OFFICER. The Senator from Arizona is recognized.
  Mr. KYL. Mr. President, might I inquire about the time remaining?
  The PRESIDING OFFICER. The Senator from Arizona controls 39 minutes 
30 seconds. The Senator from New Jersey controls 14 minutes 15 seconds.
  Mr. KYL. I thank the Chair.
  I think it is probably time for me to respond to some of the things 
that have been said. I appreciate the spirit in which the comments were 
made by the Senator from Minnesota, and earlier by the Senator from 
Arkansas, and certainly also by the Senator from Nevada. We have 
reasonable differences of opinion about certain matters here. I 
appreciate the spirit in which their comments have been made.
  But my, oh, my, Mr. President, it is amazing to me that we would have 
49

[[Page S2822]]

or 50 cosponsors of this legislation in the Senate and almost 200 in 
the House if it were going to do all of the horrible things that have 
been suggested by my colleagues. I don't think I could go home. I 
daresay that I probably represent more senior citizens--or at least as 
many as my distinguished colleague from Minnesota. In fact, half of the 
State of Minnesota comes to my State in the wintertime, and we really 
enjoy visiting with his constituents. Obviously, they probably receive 
some medical care in our State, too. Obviously, we are not going to be 
doing something by which my mother and father and all of their friends 
and all of my other senior constituents are going to feel threatened.

  What could it be that is so horrible about this?
  The Senators from Arkansas and Nevada made, I think, a very telling 
point. They said that Medicare has certainty. The Senator from Nevada 
said that it may not be perfect but at least it has certainty. Mr. 
President, that is true. The Congress began here with a program, an 
entitlement for senior citizens, to provide certain medical care--not 
all care, but certain care for senior citizens. Gradually, over time, 
that has transformed from an entitlement into an exclusive program. It 
is Medicare or no care, as of January 1 of this year.
  Up to that point, you had options. You could go outside the Medicare 
system, if you wanted to, for covered services. As the Senator from 
Nevada pointed out, it wasn't done very much, but you had the right. 
That is the point. All of these dire warnings about price gouging and 
people having to choose between food and medical care, that has been 
the situation for the last 20 some years. Patients have always had this 
right to privately contract. It was taken away from them, as a 
practical matter, on January 1 of this year. That is why I am standing 
here. I would not be here otherwise.
  What happened was that because the Health Care Financing 
Administration was writing letters to doctors threatening them that 
they had to submit a bill to Medicare for anyone who was ``Medicare 
eligible''--obviously, that is everybody over 65--the doctors were 
worried. They said, ``We never had to do this before,'' and, as a 
colleague pointed out, ``If the patient doesn't want to have this done, 
we don't have to do it. They could be treated outside of Medicare. So 
would you please confirm that, make it absolutely certain in the law?'' 
So I introduced the amendment. It passed overwhelmingly, like 65-35 or 
so.
  All of us want to give patients the freedom of choice: Even if the 
right isn't going to be exercised very much, let the patient decide. 
But what happened was that after that became part of the Balanced 
Budget Act of last year, as it was being negotiated in its details at 
the very end of the year, in the middle of the night, the 
administration officials convinced some House and Senate negotiators 
that they had to attach a condition onto our amendment; namely, in 
order for a patient to have this right, they had to find a doctor who 
would dump all of that doctor's Medicare patients for 2 years in 
advance, or you could not contract privately. As a practical matter, 
that eliminated the choice, because very few doctors are going to dump 
all of their existing Medicare load to just treat a few private 
contract patients.
  So, as a result, we are now dealing with a new phenomenon. What 
started as a great program, an entitlement, which people could take 
advantage of, has now become the exclusive, only way for senior 
citizens to receive care in our country. As I pointed out earlier, even 
in England where they have socialized medicine, they have a system 
whereby, if you don't want to go to the socialized medicine program, 
you can go to a doctor of your choice. Many people do, and has it 
ruined the English system of health care? No. If this is going to be 
such a horrible thing and ruin Medicare, why hasn't it ruined the 
English system, where this right of private choice always has existed? 
Why didn't it ruin the Medicare system before January 1, when this 
right existed? It may not be perfect, but at least there is certainty. 
We are saying the certainty has now gotten to the point where it is a 
constraint, the denial of a right and the denial of a freedom. In that 
regard, certainty is less desirable than choice.

  Now, my colleague from Minnesota made an interesting point in 
concluding. He said doctors could overcharge here and you could 
actually create two classes of medicine. Mr. President, I think this 
says a lot, because what it says in the long run is that we are going 
to have one level of care for senior citizens. We can't predict exactly 
what that level of care is going to be, but whatever it is, if a senior 
feels dissatisfied with that level of care, he or she is stuck with it; 
there is no way out. Even in Great Britain, you have a way out. If you 
are not satisfied with it, if you don't think it suits your particular 
needs, you at least have the right to go to the doctor of your choice 
outside the system. But not in the United States of America.
  We are going to say, ``No, no, there has to be only one type of care 
and it has to be the same for everybody once you hit 65.'' What we are 
saying is that there may be a few people--and I grant it will not be a 
large number--but there may be a few people who are not satisfied with 
that, who, for whatever reason, decide they want to have care outside 
of the Medicare system and they are willing to pay for it. Why deny 
them that right? This is America.
  One of my colleagues made the point, I think it was the colleague 
from Arkansas, that this is elitist because some people will pay for 
their own care. Perhaps you have a patient who has been treated by the 
same doctor for many years and he just wants to go back to that same 
doctor even though he would have to privately contract. That could well 
happen, but I don't call that elitist. I cited the example of a friend 
of mine, who is not a senior citizen, by the way, but his wife was 
very, very ill with cancer. He would have spent every nickel that he 
had, he would have spent his life savings, he would have done anything 
to save her life. In the end he couldn't, but he went to great lengths 
to try to save her life.
  As I said, I was successful in getting a compassionate release from 
FDA so she could be treated with some experimental drugs. When it is 
your life, or your wife, your spouse, you will do anything when their 
health care, their life, is involved. Are we going to say to them, in 
the United States of America, ``No, you are stuck with Medicare whether 
you like it or not,'' even though you might be able to go to a great 
specialist somewhere at some great university who is not taking very 
many Medicare patients and he doesn't want to take any more Medicare 
patients but he is willing to treat you? We are saying, ``No, we are 
not going to let that great surgeon, that university research expert, 
treat you outside of Medicare because we only have one level of care in 
this country and we don't want anybody to have any better care than 
anybody else.''
  I don't call that elitist. I call that the denial of the basic 
American right of freedom. That is why I think we need to get this back 
to what we are really talking about.
  Let me read again the words, because I find it hard to believe that 
my colleagues would really vote against these words. This is the 
amendment we are debating here:

       It is the sense of Congress that seniors have the right to 
     see the physician or health care provider of their choice.

  Those who vote no are saying, no, they should not have that right. It 
is that simple.
  Finally, perhaps I could refer to some of the antifraud provisions. I 
had not wanted to take the time to do this, but there has been a 
suggestion that patients are in jeopardy, that seniors would be in 
jeopardy because doctors could charge all kinds of extra money. I 
really don't have the time to read all of this; it is page after page 
after page. Let me just cite some examples here of some of the things 
that are included that a physician would have to do in order to enter 
into this kind of contract, in order to assure that there is no fraud 
or abuse. And HCFA, Health Care Finance Administration, would have 
total control over this. The requirements are as follows.
  First of all, a contract would have to be in writing and signed. No 
claims could be--the contract provides that no party to the contract 
and no entity on behalf of any party to the contract shall submit any 
claim or request for payment to Medicare.
  The contract must identify the Medicare-covered professional services 
and

[[Page S2823]]

the period, if any, to be covered, but does not cover any services 
furnished before the contract is entered into for the treatment of an 
emergency medical condition. So this couldn't be used when the patient 
is in extremis unless the contract was entered into before the onset of 
the emergency medical condition. There must be clear disclosure of 
terms. The contract must clearly indicate that by signing the contract 
the Medicare beneficiary understands and agrees not to submit a claim 
to Medicare, agrees to be responsible, whether through insurance or 
otherwise, to pay for the services, acknowledges that no limits under 
this title may be charged, acknowledges that Medicare supplemental 
policies do not make payments for such services, acknowledges that the 
beneficiary has the right to have such services provided by other 
physicians or health care practitioners for whom payment would be made 
by Medicare; that the contract must also clearly indicate whether the 
physician or practitioner is excluded from participation; the parties 
can modify the contract if they consent, the health care practitioner 
must submit a variety of--a whole variety here of things to HCFA, 
including information to HCFA which makes it clear as to what the 
charges are, what the services are for which the payment is being made 
by the patient, and other information that Medicare--HCFA deems 
necessary to prevent fraud and abuse. It goes on and on and on. I don't 
need to quote it all.
  The point is the sense-of-the-Senate resolution that we have before 
us here also makes reference to and summarizes those provisions. I 
noted just one of the provisions. I will cite it again, that the 
legislation we are talking about here must include provisions that are 
subject to stringent fraud and abuse law, including the Medicare anti-
fraud provisions in the Health Insurance Portability and Accountability 
Act of 1996.
  The point is, if the existing law antifraud provisions are good 
enough for the existing law, then it is kind of hard to criticize them 
as applicable to this.
  So I think it is a red herring to say doctors could somehow gouge 
patients under this. They are going to be subject to very stringent 
antifraud provisions, at least as stringent, and frankly more 
stringent, than those under existing law. So I really don't think that 
is a fair criticism of what we are trying to do here.
  This is merely a sense of the Senate that people in this country, 
just because they turn 65, should not be precluded from making the 
choice--that they are willing to pay for--to be treated outside of the 
Medicare Program. Most will not want to do so. But who are we to say in 
those cases in which a person does want to do so that they can't do it, 
whatever it means to their life or the life of their loved ones? I 
think that is what is elitist. I hope my colleagues will join me in 
supporting this amendment.
  Mr. WELLSTONE addressed Chair.
  The PRESIDING OFFICER. Who yields time?
  Mr. WELLSTONE. Mr. President, I ask for 4 minutes to respond.
  Mr. LAUTENBERG. Mr. President, I yield the Senator from Minnesota 4 
minutes.
  The PRESIDING OFFICER. The Senator from Minnesota is recognized for 
up to 4 minutes.
  Mr. WELLSTONE. Mr. President, again, colleagues should understand 
exactly what this sense of the Senate is about. What this amendment is 
about is what the Kyl legislation is about, which is really quite a 
change from current policy. Right now what we have said is that if a 
doctor or provider wants to charge more than the reimbursement he or 
she will get from Medicare, fine. Go ahead and do it. But if you do 
that with your own private contracting, then for 2 years you are not in 
the Medicare system. The reason for that is to protect people, elderly 
people, who rely on this program.
  Mr. President, again I present to colleagues a very important letter 
on private contracting, a GAO letter to Senator Moynihan of February 
23, 1998:

       Nearly all physicians treat Medicare patients and accept 
     new patients covered by Medicare. The recent data from the 
     AMA indicate that 96.2 percent of all non-Federal physicians 
     treated Medicare beneficiaries in 1996. Moreover, the 
     percentage of physicians treating Medicare patients has 
     increased to 95.2 percent in 1995 from 94.2 percent in 1994; 
     over the last 2 years.

  Mr. President, here is the point. The point is that the Medicare 
Program is a program that seniors rely on. A lot of Senators may not 
understand where the Kyl amendment takes us. Where the Kyl amendment 
takes us is the following direction.
  By the way, people who are covered by Medicare are covered. They are 
able to get the care they need. My colleague was talking about the 
horrible example of someone who had a loved one who was struggling with 
cancer. It's the vast majority of people in the country who do not have 
insurance or are underinsured who need the most help. We really ought 
to be expanding Medicare for people in our country. We ought not to be 
about the business of dismantling Medicare.
  I will use the same example as my colleague from Arizona used, but I 
will reach a whole different set of conclusions. I will simply say to 
you: Imagine a situation where you have an elderly couple, age 70. The 
wife is now battling cancer. It turns out that in the community where 
they live, under the Kyl amendment, given where the Kyl amendment is 
taking us, the vast majority of doctors in the community have decided, 
``Listen, we are going to charge more than Medicare reimbursement will 
give us. We are going to charge more.'' It just so happens that this 
couple can't afford it. They maybe have a total income of $20,000 or 
$25,000 a year.
  Now it is two classes of medicine. If you are wealthy, you are going 
to be able to afford it. But what about the vast, vast majority of 
senior citizens who can't afford now what doctors are charging them? 
That is really what we are going into. We are not talking about freedom 
of choice for elderly people. We are taking a lot of choice away. We 
are talking about a situation where conceivably in a given community 
doctors could get together, or the majority of doctors could get 
together, charge more, still be in the Medicare system, and decide for 
each and every elderly person and their loved one what they pay--what 
they pay.
  A whole lot of people who now can go and get the care they need, 
given the Medicare system, may no longer be able to afford it. The 
whole purpose of Medicare was that we said when you get to be older, 
you are going to incur more health care costs and we want to make sure 
that there is coverage for you, that we should at least do that for 
elderly people. Why in the world would we want to turn the clock back? 
Why in the world would we want to turn our backs on elderly people? Why 
in the world would we now want to create a situation where, if you are 
wealthy--and by the way most senior citizens are not--you have it made. 
Yes, you can contract with this doctor and these doctors. This doctor 
or these doctors can charge you anything they want to. But for the vast 
majority of people, Medicare beneficiaries, this will not work well. 
This will not work well.

  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. LAUTENBERG. The Senator can have a couple more minutes as he 
needs.
  Mr. WELLSTONE. I thank my colleague.
  Let me just give an analogy. Take the Kaiser plan. It is well known, 
a managed care plan. You join the Kaiser plan and you are going to pay 
a given fee, the enrollees pay a given fee. Can you imagine what it 
would be like if all of a sudden doctors in the Kaiser plan could 
decide on their own, based upon what particular citizens they were 
seeing, that they would charge more for service? You join the plan just 
like people join Medicare. You join the Kaiser plan. Where Senator Kyl 
is taking us, it would be as if doctors in the Kaiser plan could now 
say to the enrollees, ``By the way, we have decided we are going to 
charge you more for coverage of this service.'' I mean, people would be 
furious. People would feel betrayed. People would say, ``Wait a minute, 
that is not the contract with us.''
  Medicare is a sacred contract with senior citizens. We ought not 
create this gigantic loophole for too many providers who I fear rip off 
elderly people to charge fees for services that senior citizens cannot 
afford. We ought not tear up a very sacred contract.
  I hope we will have a strong vote against this amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona.

[[Page S2824]]

  Mr. KYL. Mr. President, if I could make just a couple of comments in 
response to the Senator from Minnesota. If an insurance company or plan 
like Kaiser company has a contract to provide care, they would be 
obligated to provide the care they contracted to provide. They can't 
all of a sudden just opt out and say we have decided we don't want to 
do that anymore or we are going to charge more money for it. I really 
don't understand the point of the Senator from Minnesota in that 
regard.
  Second, he argued that under this amendment it could well come to 
pass, probably would come to pass, that so many physicians would charge 
so much more that pretty soon people wouldn't be able to afford their 
medical care. Yet it has also been argued here that very few people 
would want to take advantage of this; that 92 percent of the people in 
Medicare are happy with the care that they are getting. I don't think 
you can have it both ways. I don't think you can argue on the one hand 
that there would be dire consequences because everybody will want to do 
this and on the other hand everything is just fine and nobody is going 
to want to do it.
  The truth of the matter is that probably not very many people will 
want to do this and therefore it will not have dire consequences on the 
system. But for those people who do want to do it, it becomes a very 
important matter to them. They may want to spend whatever they have--
whether they have very much or not--in order to get that physician of 
their choice.
  Let me present an analogy to you, Mr. President, about what the 
Senators who are arguing in opposition to this are really arguing.
  They said we provided this great health care system for the citizens 
of the United States, and so it has to be the only system. To be 
consistent, they should also say we provided a great retirement system 
for people in this country; it is called Social Security. So in order 
to prevent anybody from getting anymore money than anyone else in 
retirement, we are going to provide that under Social Security; that is 
what you got; you can't go outside; you can't have pension benefits, 
insurance benefits, stock paying you dividends or money from your kids 
or whatever. It is the Government plan or no plan, just like they are 
saying, here it is, Medicare or no care. Same thing, Mr. President. You 
can see how absurd the proposition is when presented in that way.
  For retirement savings, we acknowledge the fact that people ought to 
have a choice. They can have the Government plan but they can also 
exercise their own freedom of choice to provide for themselves as they 
see necessary. But what our colleagues on the other side are saying is, 
when it comes to health care, which I argue is even more important to 
people than money, ``No, you don't have that choice, because the 
Government has decided not only is it going to provide you an 
entitlement of health care, but it has now decided that is the only 
thing you can get once you turn 65; that you cannot go outside of that 
system.''
  That, Mr. President, is what is so wrong with the law that took 
effect as of January 1 of this year and what we are trying to correct. 
That is why we need to go on record expressing the sense of the Senate, 
and I will read it again:

       [Expressing] the sense of the Senate that seniors have the 
     right to see the physician or health care provider of their 
     choice. . .

  I hope my colleagues will support us in that expression.
  Mr. LAUTENBERG. Mr. President, I rise in opposition to the sense-of-
the-Senate amendment offered by Senator Kyl, which calls for the 
expansion of private contracting between physicians and Medicare 
beneficiaries. This proposal could leave beneficiaries vulnerable to 
higher out-of-pocket costs for Medicare services. And it could leave 
the Medicare Program more vulnerable to fraud and abuse.
  Mr. President, the Balanced Budget Act of 1997 allows physicians to 
enter into ``private contracts'' with Medicare enrollees and set their 
own fees for services covered by Medicare. The intent of this provision 
was to allow the 9 percent of physicians who don't participate in the 
Medicare Program, to continue to treat their Medicare-eligible patients 
through private contracts.
  To protect Medicare from fraud and to ensure that private contracting 
arrangements are limited to physicians who otherwise would not be 
available to Medicare beneficiaries, the law is limited to those 
physicians who agree, in an affidavit, to forgo all reimbursement from 
Medicare for at least 2 years. The law also requires a physician to 
disclose to the patient that no Medicare payment will be made for 
privately contracted services, no balance billing limits will apply, no 
Medigap coverage will be available, and the services to be performed 
would be paid for by Medicare if provided by another physician.
  The proposal advocated by Senator Kyl could jeopardize these 
important protections by allowing all physicians to charge Medicare 
beneficiaries more than the levels set by the Congress on a service-by-
service or patient-by-patient basis. And that could lead many seniors 
vulnerable to pressure from providers to pay higher rates. For example, 
a physician could tell someone with a serious illness that they would 
have to pay extra to get the services they need. And for a desperately 
ill person, that may leave them feeling that they have no real choice.
  So, Mr. President, we need to evaluate the impact of the law we just 
passed before we make changes that could raise costs for beneficiaries 
or add to the already critical problems of fraud and abuse. The 
American College of Physicians has recommended that we not legislate 
further on the issue of private contracting at this time. They have 
advised that any further expansion of private contracting could have 
many unknown effects that should be studied in the broader context of 
Medicare reform by the bipartisan commission on Medicare. I believe 
that's good advice, Mr. President, and I would urge my colleagues to 
oppose this amendment.
  Mr. REID. Mr. President, I rise in opposition to the Kyl amendment. I 
do so because I am not convinced that a private contracting provision 
is necessary in the first place. This amendment is presented in the 
name of freedom of choice when in fact it has a potentially devastating 
effect on the Medicare program and the health care costs paid by 
America's senior citizens. Seniors today have a choice in their health 
care options. They have the ability to privately contract for care not 
covered by Medicare as they always have. They also have payment 
protection in terms of how much they can be charged for Medicare 
covered services. Under the Kyl amendment these protections are removed 
and seniors who engage in private contracting would be responsible for 
100% of the cost of their care. Even if this care is for Medicare 
covered services. Medicare would not pay for these services under 
private contract nor would supplemental policies pay as well. Seniors 
would be 100% responsible for these costs.
  Today, 92% of Medicare beneficiaries are satisfied with Medicare. 
Under this amendment, the potential for significant out of pocket costs 
for seniors becomes a reality. When seniors already pay 21% of their 
health care costs out of pocket, any amendment to raise these costs 
should be closely scrutinized. The potential for fraudulent activity is 
also significantly increased under this amendment. While I have faith 
in our physician community and don't believe they are waiting in the 
wings to defraud our Medicare system, the potential for the Health Care 
Financing Administration (HCFA) to monitor claims that might be 
submitted while a private contracting relationship has been established 
is questionable. We have a responsibility to minimize any scenario that 
might lead to fraudulent activity and under this amendment, those 
guarantees to do not exist. The Congressional Budget Office reports 
that the HCFAs efforts to screen inappropriate or fraudulent claims 
could be significantly compromised. There is no system is a place that 
would allow HCFA to determine which patients are paying for their care 
out of pocket from those whose physician is submitting claims to 
Medicare for these same services. It is for this reason that the 
private contracting clause in the balanced budget Act of 1997 has a 2-
year exemption clause which would require physician's who participate 
in private contracting to see no other Medicare patients during this 
period. This would enable HCFA to ensure that no double payments are 
being made. This is the only

[[Page S2825]]

way HCFA at this time could preclude possible fraudulent activity.
  Prior to the Balanced Budget Act of 1997 few of us in Congress had 
ever heard about private contracting in Medicare. This is because our 
senior constituents were not concerned about this issue and our 
physician constituents had never surfaced the issue either. My sense is 
that the truth of the matter is that they would not be concerned about 
this issue now as well had it not surfaced during the balanced budget 
debate. The cost protections afforded by Medicare are valuable to 
seniors and the peace of mind that is achieved knowing out of pocket 
costs will be limited means a great deal to those on fixed incomes. In 
that 96 percent of physicians participate in Medicare, there were no 
signs of their dissatisfaction or a call for change. Perhaps rather 
than voting on this amendment which is framed in the name of freedom of 
choice, the better approach would be to remove the private contracting 
choice provision in the Balanced Budget Act of 1997 and return to the 
way things were. I do not believe that this debate is about freedom of 
choice for seniors nor do I believe that physicians are standing in 
line to defraud our Medicare system. What I do believe is that we are 
debating an issue that before we learned what it meant seven months 
ago, few of us, constituents included, were even aware of. I submit 
that change for change sake is a mistake. We have a strong Medicare 
Program with protections in place to protect beneficiaries from high 
out of pocket costs and one that is committed to removing the potential 
for fraudulent activity from the system. We must be very cautious 
before we take steps to destroy the success of this program and the 
many protections this program provides to the 38 million beneficiaries 
who count on it for their day to day health care. In my view, the Kyl 
amendment does not pass the test to ensure payment protection for 
beneficiaries nor does it ensure the potential for fraudulent activity 
is removed. As such, I must oppose this amendment.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. How much time remains on the Kyl amendment and the 
opposition to it?
  The PRESIDING OFFICER. The Senator from Arizona controls 22 minutes 
40 seconds; the Senator from New Jersey controls 8 minutes 30 seconds.
  Mr. DOMENICI. I wonder if the distinguished Senator from New Jersey 
can agree we will both yield back the remainder of the time. I wonder 
if you intend to second degree the amendment. If you do not, then based 
on a UC that says that, we won't offer a second-degree amendment. If 
not, we intend to----
  Mr. LAUTENBERG. Mr. President, we have no indication from anybody 
here that they want to offer a second-degree amendment. So that would 
take care of that.
  Is the Senator proposing that we yield back all remaining time from 
the Senator from Arizona as well as our side; all yielding back?
  Mr. DOMENICI. Yes, I am. Obviously, when this amendment comes up, if 
you desire to yield off the resolution, we can still do that. I just 
want to get on to another amendment, if we can.
  Mr. LAUTENBERG. When is the Senator proposing to set the vote on this 
amendment?
  Mr. DOMENICI. Mr. President, I say to the Senator from New Jersey, I 
received a note from the majority leader that votes will start tomorrow 
at 12 noon on a number of stacked amendments.
  Mr. LAUTENBERG. So all the people who want to rush down here and 
offer amendments will still have time to do so tonight?
  Mr. DOMENICI. We know of three that will take quite a bit of time, 
and they are willing to do that.
  Mr. LAUTENBERG. That would be wonderful. We are not thinking of 
closing up shop until we have heard all the amendments.
  Mr. DOMENICI. All amendments that can possibly be taken up on the 
floor.
  Mr. LAUTENBERG. Oh, that would be excellent. I can't wait to hear 
them.
  Mr. President, 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, I say this in all sincerity, because the 
votes were very long. One was in excess of a half hour, and quorum 
calls before the votes don't count and the vote time doesn't count. We 
have not even used 5\1/2\ hours today from starting at 9:30 this 
morning. We still have 29 hours remaining at this point, and we have 
essentially 2 days, Wednesday and Thursday, to get it done. That is 
going to be very difficult.
  I am going to stay here, and we are not going to close the Senate. We 
would like Senators to come down and offer amendments.
  I propose the following so there will be a sequence: First of all, 
there will be no votes until 12 noon tomorrow, and then there should be 
three votes. While this is not a unanimous consent request--it will be 
proposed later--let me say those votes will be on or in relation to the 
Kyl amendment, on or in relation to the Conrad amendment, and on or in 
relation to the Coverdell-McCain amendment. We are expecting to debate 
at least, if not more, Senator Conrad's amendment and the Coverdell, 
McCain, et al. amendment. We are trying to get Senator Conrad, and I 
hope Senator Coverdell is on notice we will be ready soon after that. 
With that, I yield to my friend from New Jersey.

  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. LAUTENBERG. Mr. President, I appreciate the message that the 
chairman of the Budget Committee is sending out here, and that is the 
time is going to be consumed. We always know what happens when it gets 
to the bewitching hour, which is the end of the week, and people want 
to go home or take care of other business.
  I say to my colleagues on my side, as well as the other side, do not 
be surprised, if you want to delay doing it now, that you are not going 
to be able to get enough time, in many cases, to really explore the 
amendment that you want to present. We could wind up in a vote-a-thon. 
That is going to be allowed. It means 1 minute debate and a vote. I 
don't think that is a good way to do legislation.
  I say we are going to be here. Senator Domenici and I have agreed we 
will stay as long as we can, to use the expression, to do some 
business, to have people come down and offer their amendments. We 
invite them, whether it is 10 o'clock or 12 o'clock. We don't want an 
hour to elapse in between them, frankly, but we are here and we will 
stay as long as our colleagues want to bring amendments. We hope they 
will. If I still have the floor, I have a couple of amendments to send 
to the desk.
  Mr. DOMENICI. Will the Senator let me make an assignment? Mr. 
President, Senator Gorton is going to take over my responsibilities as 
manager, and whatever privileges I have under the Budget Act belong to 
Senator Gorton from this point until I return.
  The PRESIDING OFFICER. Do the Senators yield back the time on the 
pending amendment?
  Mr. DOMENICI. I yield back any time Senator Kyl had on his amendment.
  Mr. LAUTENBERG. And we yield back on our side as well.
  The PRESIDING OFFICER. All time is yielded back.
  Mr. DOMENICI. It is understood there will be no second-degree 
amendments, and the Kyl amendment will be voted on tomorrow in 
sequence. I ask unanimous consent that that be the case.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DOMENICI. I yield the floor.


                     Amendments Nos. 2204 and 2205

  Mr. LAUTENBERG. Mr. President, I have two amendments that I send to 
the desk. One is for Senator Kohl from Wisconsin and the other is for 
Senator Durbin and Senator Chafee. I send these to the desk and ask 
they be held pending further action.
  The PRESIDING OFFICER. If there is no objection, the pending 
amendment will be set aside and the clerk will report.
  The legislative clerk read as follows:


[[Page S2826]]


       The Senator from New Jersey [Mr. Lautenberg] proposes 
     amendments numbered 2204 and 2205.

  The amendments are as follows:


                           amendment no. 2204

      (Purpose: To express the sense of the Senate regarding the 
establishment of a national background check system for long-term care 
                                workers)

       At the end of title III add the following:

     SEC. ____. SENSE OF THE SENATE REGARDING THE ESTABLISHMENT OF 
                   A NATIONAL BACKGROUND CHECK SYSTEM FOR LONG-
                   TERM CARE WORKERS.

       (a) Findings.--The Senate makes the following findings:
       (1) Over 43 percent of Americans over the age of 65 are 
     likely to spend time in a nursing home.
       (2) Home health care is the fastest growing portion of the 
     medicare program under title XVIII of the Social Security Act 
     (42 U.S.C. 1395 et seq.), with an average annual growth rate 
     of 32 percent since 1989.
       (3) A 1997 report from State Long-Term Care Ombudsmen 
     assisted under the Older Americans Act of 1965 indicated that 
     in 29 States surveyed, 7,043 cases of abuse, gross neglect, 
     or exploitation occurred in nursing homes and board and care 
     facilities.
       (4) A random sample survey of nursing home staff found that 
     10 percent of the staff admitted committing at least 1 act of 
     physical abuse in the preceding year.
       (5) Although the majority of long-term care facilities do 
     an excellent job in caring for elderly and disabled patients, 
     incidents of abuse and neglect do occur at an unacceptable 
     rate and are not limited to nursing homes alone.
       (6) Most long-term care facilities do not conduct both 
     Federal and State criminal background checks on prospective 
     employees.
       (7) Most State nurse aide abuse registries are limited to 
     nursing home aides, thereby failing to cover home health and 
     hospice aides.
       (8) Current State nurse aide abuse registries are 
     inadequate to screen out abusive long-term care workers 
     because no national system is in place to track abusers from 
     State to State and facility to facility.
       (9) Currently, 29 States have enacted varying forms of 
     criminal background check requirements for prospective long-
     term care employees. However current Federal and State 
     safeguards are inadequate because there is little or no 
     information sharing between States about known abusers.
       (10) Many facilities would choose to conduct background 
     checks on prospective employees if an efficient, accurate, 
     and cost-effective national system existed.
       (11) The impending retirement of the baby boom generation 
     will greatly increase the demand and need for quality long-
     term care.
       (12) It is incumbent on Congress and the President to 
     ensure that patients receiving care under the medicare and 
     medicaid programs (42 U.S.C. 1395 et seq.; 1396 et seq.) are 
     protected from abuse, neglect, and mistreatment.
       (b) Sense of the Senate.--It is the sense of the Senate 
     that the assumptions underlying the functional totals in this 
     concurrent resolution on the budget assume that--
       (1) funds should be directed toward the establishment of a 
     national background check system for long-term care workers 
     who participate in the medicare and medicaid programs (42 
     U.S.C. 1395 et seq.; 1396 et seq.);
       (2) such a system would include both a national registry of 
     abusive long-term care workers and a requirement for a 
     Federal criminal background check before such workers are 
     employed to provide long-term care; and
       (3) such a system would be created with ample input and 
     comment from representatives of the Department of Health and 
     Human Services, State government, law enforcement, the 
     nursing home and home health industries, patient and consumer 
     advocates, and advocates for long-term care workers.
                                                                    ____



                           amendment no. 2205

   (Purpose: To express the sense of Congress regarding the right to 
           affordable, high-quality health care for seniors)

       At the end of title III, insert the following:

     SEC. ____. FINDINGS AND SENSE OF CONGRESS REGARDING 
                   AFFORDABLE, HIGH-QUALITY HEALTH CARE FOR 
                   SENIORS.

       (a) Findings.--Congress finds the following:
       (1) Seniors deserve affordable, high quality health care.
       (2) The medicare program under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.) has made health care 
     affordable for millions of seniors.
       (3) Beneficiaries under the medicare program deserve to 
     know that such program will cover the benefits that they are 
     currently entitled to.
       (4) Beneficiaries under the medicare program can pay out-
     of-pocket for health care services whenever they--
       (A) do not want a claim for reimbursement for such services 
     submitted to such program; or
       (B) want or need to obtain health care services that such 
     program does not cover.
       (5) Beneficiaries under the medicare program can use 
     doctors who do not receive any reimbursement under such 
     program.
       (6) Close to 75 percent of seniors have annual incomes 
     below $25,000, including 4 percent who have annual incomes 
     below $5,000, making any additional out-of-pocket costs for 
     health care services extremely burdensome.
       (7) Very few beneficiaries under the medicare program 
     report having difficulty obtaining access to a physician who 
     accepts reimbursement under such program.
       (8) Allowing private contracting on a claim-by-claim basis 
     under the medicare program would impose significant out-of-
     pocket costs on beneficiaries under such program.
       (b) Sense of Congress.--It is the sense of Congress that 
     the assumptions underlying the functional totals in this 
     resolution assume that seniors have the right to affordable, 
     high-quality health care and that they have the right to 
     choose their doctors, and that no change should be made to 
     the medicare program that could--
       (1) impose unreasonable and unpredictable out-of-pocket 
     costs for seniors or erode the benefits that the 38,000,000 
     beneficiaries under the medicare program are entitled to;
       (2) compromise the efforts of the Secretary of Health and 
     Human Services to screen inappropriate or fraudulent claims 
     for reimbursement under such program; and
       (3) allow unscrupulous providers under such program to bill 
     twice for the same services.

  Mr. LAUTENBERG. 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. GORTON. 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. GORTON. Mr. President, I ask unanimous consent that a vote occur 
on or in relation to the Kyl amendment at 12 noon, Wednesday, April 1, 
and no amendments be in order to the Kyl amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GORTON. I announce on behalf of the majority leader there will be 
no further votes this evening.

                          ____________________