[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.
____________________