[Congressional Record Volume 144, Number 141 (Friday, October 9, 1998)]
[Senate]
[Pages S12164-S12182]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

                                 ______
                                 
      By Mr. TORRICELLI (for himself, Mr. Leahy, Mr. DeWine, and Mr. 
        Jeffords):
  S. 2596. A bill to amend the Federal Agriculture Improvement and 
Reform Act of 1996 to improve the farmland protection program; to the 
Committee on Agriculture, Nutrition, and Forestry.


                    farmland protection legislation

 Mr. TORRICELLI. Mr. President, today I introduce legislation 
which will assist in the critical effort to preserve our nation's most 
vulnerable farmland. I want to first acknowledge Senator Leahy's 
decisive leadership on this issue, and recognize him as the author of 
the original legislation establishing the Farmland Protection Program 
in the 1996 Farm Bill. He has been a tireless advocate for this 
important issue, and I look forward to working closely with him in the 
future to protect more of our Nation's open spaces.
  We have heard a lot during the last decade about the dissolution and 
destruction of the American Family Farm. Indeed, the family farm is 
under serious threat of extinction. Today, there are 1,925,300 farms in 
the United States, the lowest number of farms in our Nation since 
before the Civil War. The U.S. is losing two acres of our best farmland 
to development every minute of every day. In my State, New Jersey, we 
have lost 6,000 farms, or 40 percent of our total, since 1959. This 
reduction has serious implications for the environment, the economy and 
our food supply.
  The threat comes partially from an anachronistic and unfair 
inheritance tax that threatens the generational continuity of the 
family farm and partially from the fact that much of America's farmland 
is near major cities. As our cities sprawl into neighboring rural 
areas, our farms are in danger of becoming subdivisions or shopping 
malls.
  Last year I strongly supported a significant reduction in the estate 
tax to

[[Page S12165]]

keep farms in the family, preserve open space and ensure fairness in 
our tax code. This was an important victory for farmers across the 
Nation. However, we also need programs like the Farmland Protection 
Program to reinforce this effort. This critical initiative is designed 
to protect soil by encouraging landowners to limit conversion of their 
farmland to non-agricultural uses. It has proven so successful that 
demand for these grants currently outstrips availability of funds by 
900 percent, and the last of its authorized funding was spent during 
fiscal year 1998.
  The legislation I am introducing today with Senators Leahy, DeWine 
and Jeffords will provide authorization for additional funding, and 
ensure the survival of this important program. Our bill will 
reauthorize the program at $55 million a year through 2002, and will 
broaden the original legislation to allow non-profit conservation 
groups to hold these easements. This provision is necessary because 
some State governments, such as Colorado's, are barred from holding 
easements by their constitution. This legislation will allow non-profit 
groups to hold these easements in lieu of the state government and this 
will broaden participation in the program.
  I hope my colleagues are able to support this legislation and allow 
us to continue building on the success of the past few years, during 
which we were able to protect nearly 82,000 acres on more than 230 
farms.
                                 ______
                                 
      By Mr. TORRICELLI. (for himself and Mr. Lautenberg):
  S. 2598. A bill to require proof of screening for lead poisoning and 
to ensure that children at highest risk are identified and treated; to 
the Committee on Finance.


     children's lead prevention and inclusive treatment act of 1998

 Mr. TORRICELLI. Mr. President, today with my colleague from 
New Jersey, Senator Lautenberg, I introduce the ``Children's Lead 
Prevention and Inclusive Treatment Act of 1998.'' For almost thirty 
years Congress has focused attention on lead-related issues. In 1971 we 
first passed the Lead-based Paint Poisoning Prevention Act, and much 
has been done since that time to identify children with elevated lead 
levels, to educate parents on the dangers of lead, and to devise means 
of removing or controlling lead in homes. Over the last 20 years, the 
removal of lead from gasoline, food canning, children's toys, and other 
sources has seen a reduction in national population blood lead levels 
by over 80 percent.
  Yet recent studies indicate that we are still not doing enough. While 
national lead levels have dropped over 80 percent, the numbers for 
Medicaid children, and poor children overall, are nothing short of 
disgraceful. Since 1992 the Health Care Financing Administration, at 
the behest of Congress, has required that Medicaid children be screened 
for elevated blood-lead levels at least twice before they reach the age 
of 2. But the Centers for Disease Control and Prevention estimates that 
nationally, 890,000 children between the ages of one and five have 
elevated blood lead levels and have never been tested.
  Even worse, Mr. President, in a Report to Congress earlier this year, 
the General Accounting Office reported that almost 79 percent of 
Medicaid children under two years of age have never been screened! This 
means that as many as 206,000 Medicaid children between the ages of 1 
and 2 have not been screened. Considering that in 1991 the U.S. Public 
Health Service called for a society-wide effort to eliminate childhood 
lead poisoning by the year 2011, it is quite apparent that we are not 
making much progress in reaching that goal.
  A subsequent GAO report further identified poor and minority children 
as being at greatest risk of lead poisoning. GAO reported that the 
prevalence of elevated blood lead levels in Hispanic children aged 1 
through 5 was more than twice that of white children, and for African-
American children it was more than five times that of white children. 
Additionally, children in families below 130 percent of the Federal 
poverty level had a higher prevalence of elevated blood lead levels 
than those children above the Federal poverty level. Yet all these 
children continue to be the very ones falling through the cracks!
  That is why, Mr. President, I am introducing this legislation. The 
Children's Lead PAINT Act promises to be a three-pronged attack on the 
lead-screening system. First, it will create a ``safety net'' through 
WIC and Early Start to ensure that high-risk children are screened. A 
parent enrolling their child in either of these programs must provide 
proof of screening, within 180 days of enrollment. If a child hasn't 
been screened, a parent can request WIC or Early Start to perform the 
test themselves. Additionally, if WIC or Early Start performs the test, 
Medicaid will be authorized to reimburse the program.
  Second, we will be putting teeth into the State's screening 
obligation, by setting a Minimum number of Screenings a State must 
perform, or having it face a penalty for failure. Beginning in Fiscal 
Year 2000, States will be required to screen at least 50 percent of 
Medicaid children under age 2. This will increase 10 percent each year 
until it hits 90 percent, where it must remain. If States fail to meet 
these targets, they stand to lose one percent of their Medicaid funds.
  Finally, Mr. President, we will require any Health Care Provider that 
signs a State Medicaid contract to agree in that contract to comply 
with the screening requirements, and to provide follow-up services to 
children who test positive. Although States have been required to 
perform these screenings, they are not a mandatory requirement of 
Medicaid health care contracts. Thus, there is no statutory obligation 
on the part of physicians to perform the tests. This will ensure that 
doctors perform the tests and that if a child does test positive that 
an environmental assessment will be done at their home and that follow-
up testing and evaluations will be conducted.
  I am especially pleased that I have been joined in this fight by two 
highly regarded national advocacy groups. The Alliance to End Childhood 
Lead Poisoning, a non-profit public interest organization exclusively 
dedicated to the elimination of childhood lead poisoning, has publicly 
endorsed the Lead PAINT Act. Similarly, the Coalition to End Childhood 
Lead Poisoning, a non-profit parents and victims organization dedicated 
to educating the public on the dangers of lead poisoning and as well as 
to eradicating this disease, has also publicly endorsed this 
legislation.
  Mr. President, although we have made great progress in lead poison 
prevention techniques, first, by banning lead-based paint in homes and 
more recently by strengthening our home testing system, the GAO report 
makes it very clear that we are failing to identify those children with 
lead already in their bodies. It is time we demand accountability. Our 
children deserve no less.
  I look forward to working with my colleagues on this legislation and 
this issue. I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2598

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Children's Lead Prevention 
     and Inclusive Treatment Act of 1998'' or the ``Children's 
     Lead PAInT Act''.

     SEC. 2. FINDINGS AND PURPOSES.

       (a) Findings.--Congress finds that--
       (1) lead poisoning remains a serious environmental risk, 
     especially to the health of young children;
       (2) childhood lead poisoning can cause reductions in IQ, 
     attention span, reading, and learning disabilities, and other 
     growth and behavior problems;
       (3) children under the age of 6 are at the greatest risk 
     because of the sensitivity of their developing brains and 
     nervous systems;
       (4) poor children and minority children are at 
     substantially higher risk of lead poisoning;
       (5) it is estimated that more than 500,000 children 
     enrolled in medicaid have harmful levels of lead in their 
     blood;
       (6) children enrolled in medicaid represent 60 percent of 
     the 890,000 children in the United States with elevated blood 
     lead levels;
       (7) although the Health Care Financing Administration has 
     required mandatory blood lead screenings for children 
     enrolled in medicaid who are not less than 1 nor more than 5 
     years of age, approximately two-thirds of children enrolled 
     in medicaid have not been screened or treated;

[[Page S12166]]

       (8) the Health Care Financing Administration mandatory 
     screening policy has not been effective, or sufficient, to 
     properly identify and screen children enrolled in medicaid 
     who are at risk;
       (9) uniform lead screening requirements do not exist for 
     children not enrolled in medicaid; and
       (10) adequate treatment services are not uniformly 
     available for children with elevated blood lead levels.
       (b) Purpose.--The purpose of this Act is to create a lead 
     screening safety net that will, through medicaid and other 
     entitlement programs, ensure that low-income children at the 
     highest risk of lead poisoning receive blood lead screenings 
     and appropriate followup care.

     SEC. 3. INCREASED LEAD POISONING SCREENINGS AND TREATMENTS 
                   UNDER THE MEDICAID PROGRAM.

       (a) Penalty for Insufficient Increases in Lead Poisoning 
     Screenings.--
       (1) Performance improvement.--Section 1903 of the Social 
     Security Act (42 U.S.C. 1396b) is amended by adding at the 
     end the following:
       ``(x) Performance Improvement.--
       ``(1) In general.--Notwithstanding section 1905(b), 
     beginning with fiscal year 2000 and for each fiscal year 
     thereafter, with respect to any State that fails to meet 
     minimum blood lead screening rates stated in paragraph (2), 
     the Federal medical assistance percentage determined under 
     section 1905(b) for the State for the fiscal year shall be 
     reduced by 1 percentage point, but only with respect to--
       ``(A) items and services furnished under a State plan under 
     this title during that fiscal year;
       ``(B) payments made on a capitation or other risk-basis 
     under a State plan under this title for coverage occurring 
     during that fiscal year; and
       ``(C) payments under a State plan under this title that are 
     attributable to DSH allotments for the State determined under 
     section 1923(f) for that fiscal year.
       ``(2) Minimum blood lead screening rates.--The minimum 
     acceptable percentages of 2-year-old medicaid-enrolled 
     children who have received at least 1 blood lead screening 
     test are--
       ``(A) 50 percent in fiscal year 2000;
       ``(B) 60 percent in fiscal year 2001;
       ``(C) 70 percent in fiscal year 2002;
       ``(D) 80 percent in fiscal year 2003; and
       ``(E) 90 percent in each fiscal year after fiscal year 
     2003.
       ``(3) Modification or waiver.--The Secretary may modify or 
     waive the application of paragraph (1) in the case of a State 
     that the Secretary determines has performed during a fiscal 
     year such a significant number of lead blood level 
     assessments that the State reasonably cannot be expected to 
     achieve the minimum blood lead screening rates established by 
     paragraph (2).''.
       (2) Reporting requirement.--Section 1902(a)(43)(D) of the 
     Social Security Act (42 U.S.C. 1396a(a)(43)(D)) is amended--
       (A) in clause (iii), by striking ``and'' at the end;
       (B) in clause (iv), by striking the semicolon and inserting 
     ``, and''; and
       (C) by adding at the end the following:
       ``(v) the number of children who are not more than 2 years 
     of age and enrolled in the medicaid program and the number 
     and results of lead blood level assessments performed by the 
     State, along with demographic and identifying information 
     that is consistent with the recommendations of the Centers 
     for Disease Control and Prevention with respect to lead 
     surveillance;''.
       (b) Mandatory Screening Requirements.--Section 1902(a) of 
     the Social Security Act (42 U.S.C. 1396a(a)) is amended--
       (1) in paragraph (65), by striking the period and inserting 
     ``; and''; and
       (2) by adding at the end the following:
       ``(66) provide that each contract entered into between the 
     State and an entity (including a health insuring organization 
     and a medicaid managed care organization) that is responsible 
     for the provision (directly or through arrangements with 
     providers of services) of medical assistance under the State 
     plan shall provide for--
       ``(A) compliance with mandatory screening requirements for 
     lead blood level assessments (as appropriate for age and risk 
     factors) that are commensurate with guidelines and mandates 
     issued by the Secretary through the Administrator of the 
     Health Care Financing Administration; and
       ``(B) coverage of appropriate qualified lead treatment 
     services, as prescribed by the Centers for Disease Control 
     and Prevention guidelines, for children with elevated levels 
     of lead in their blood.''.
       (c) Reimbursement for Treatment of Children with Elevated 
     Blood Lead Levels.--Section 1905 of the Social Security Act 
     (42 U.S.C. 1396d) is amended--
       (1) in subsection (a)--
       (A) in paragraph (26), by striking ``and'' at the end;
       (B) by redesignating paragraph (27) as paragraph (28); and
       (C) by inserting after paragraph (26) the following:
       ``(27) qualified lead treatment services (as defined in 
     subsection (v);''; and
       (2) by adding at the end the following:
       ``(v)(1) The term `qualified lead treatment services' means 
     all appropriate and medically necessary services that are 
     provided by a qualified provider, as determined by the State, 
     to treat a child described in paragraph (2), including--
       ``(A) environmental investigations to determine the source 
     of a child's lead exposure, including the costs of qualified 
     and trained professionals (including health professionals and 
     lead professionals certified by the State or the 
     Environmental Protection Agency) to conduct such 
     investigations and the costs of laboratory testing of 
     substances suspected of being significant pathways for lead 
     exposure (such as lead dust, paint chips, bare soil, and 
     water);
       ``(B) professional case management services to coordinate 
     access to such services; and
       ``(C) emergency measures to reduce or eliminate lead 
     hazards to a child, if required (as recommended by the 
     Centers for Disease Control and Prevention).
       ``(2) For purposes of paragraph (1), a child described in 
     this paragraph is a child who--
       ``(A) has attained 6 months of age but has not attained 73 
     months of age; and
       ``(B) has been identified as having a blood lead level that 
     equals or exceeds 20 micrograms per deciliter (or 
     persistently equals or exceeds 15 micrograms per 
     deciliter).''.
       (d) Effective Date.--
       (1) In general.--The amendments made by this section apply 
     on and after October 1, 1998.
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act which the Secretary of Health and Human Services 
     determines requires State legislation in order for the plan 
     to meet the additional requirements imposed by the amendments 
     made by this section, the State plan shall not be regarded as 
     failing to comply with the requirements of this section 
     solely on the basis of its failure to meet these additional 
     requirements before the first day of the first calendar 
     quarter beginning after the close of the first regular 
     session of the State legislature that begins after the date 
     of the enactment of this Act. For purposes of the previous 
     sentence, in the case of a State that has a 2-year 
     legislative session, each year of the session is considered 
     to be a separate regular session of the State legislature.

     SEC. 4. LEAD POISONING SCREENING FOR SPECIAL SUPPLEMENTAL 
                   NUTRITION PROGRAM FOR WOMEN, INFANTS, AND 
                   CHILDREN.

       Section 17(d) of the Child Nutrition Act of 1966 (42 U.S.C. 
     1786(d)) is amended by adding at the end the following:
       ``(4) Lead poisoning screening.--
       ``(A) In general.--Subject to subparagraph (B), for an 
     infant or child to be eligible to participate in the program 
     under this section, a member of the family of the infant or 
     child shall provide proof to the State agency, not later than 
     180 days after enrollment of the infant or child in the 
     program and periodically thereafter (as determined by the 
     State agency), that the infant or child has received a blood 
     lead test for lead poisoning using an assessment that is 
     appropriate for age and risk factors.
       ``(B) Waivers.--A State agency or local agency may waive 
     the requirement of subparagraph (A) with respect to an infant 
     or child if the State agency or local agency determines 
     that--
       ``(i) the area in which the infant or child resides does 
     not pose a risk of lead poisoning; or
       ``(ii) the requirement would be contrary to the religious 
     beliefs or moral convictions of the family of the infant or 
     child.
       ``(C) Screenings by state agencies.--
       ``(i) In general.--On the request of a member of a family 
     of an infant or child who has not been screened for lead 
     poisoning and who seeks to participate in the program, at no 
     charge to the family, a State agency shall perform a blood 
     lead test on the infant or child that is appropriate for age 
     and risk factors.
       ``(ii) Reimbursement.--On the request of a State agency 
     that screens for lead poisoning under clause (i) an infant or 
     child that is receiving medical assistance under a State plan 
     under title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.), the Secretary of Health and Human Services shall 
     reimburse the State agency, from funds that are made 
     available under that title, for the cost of the screening 
     (including the cost of purchasing portable blood lead 
     analyzer instruments approved for sale by the Food and Drug 
     Administration and providing screening with the use of such 
     instruments through laboratories certified under section 353 
     of the Public Health Service Act (42 U.S.C. 263a)).''.

     SEC. 5. LEAD POISONING SCREENING FOR EARLY HEAD START 
                   PROGRAMS.

       Section 645A of the Head Start Act (42 U.S.C 9840a) is 
     amended--
       (1) in subsection (c)(2), by inserting before the semicolon 
     the following: ``, if the families comply with subsection 
     (i)''; and
       (2) by adding at the end the following:
       ``(i) Lead Poisoning Screening.--
       ``(1) In general.--Subject to paragraph (2), for a child to 
     be eligible to participate in a program described in 
     subsection (a)(1), a member of the family of the child shall 
     provide proof to the entity carrying out the program, not 
     later than 180 days after enrollment of the child in the 
     program and periodically thereafter (as determined by the 
     entity), that the child has received a blood lead test for 
     lead poisoning using an assessment that is appropriate for 
     age and risk factors.

[[Page S12167]]

       ``(2) Waivers.--The entity may waive the requirement of 
     paragraph (1) with respect to a child if the entity 
     determines that--
       ``(A) the area in which the child resides does not pose a 
     risk of lead poisoning; or
       ``(B) the requirement would be contrary to the religious 
     beliefs or moral convictions of the family of the child.
       ``(3) Screenings by entities.--
       ``(A) In general.--On the request of a member of a family 
     of a child who has not been screened for lead poisoning and 
     who seeks to participate in the program, at no charge to the 
     family, the entity shall perform a blood lead test on the 
     child that is appropriate for age and risk factors.
       ``(B) Reimbursement.--On the request of an entity that 
     screens for lead poisoning under subparagraph (A) a child 
     that is receiving medical assistance under a State plan under 
     title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.), the Secretary shall reimburse the entity, from funds 
     that are made available under that title, for the cost of the 
     screening (including the cost of purchasing portable blood 
     lead analyzer instruments approved for sale by the Food and 
     Drug Administration and providing screening with the use of 
     such instruments through laboratories certified under section 
     353 of the Public Health Service Act (42 U.S.C. 
     263a)).''.
                                 ______
                                 
      By Ms. SNOWE:
  S. 2599. A bill to amend title 38, United States Code, to establish a 
presumption of service-connection for certain veterans with Hepatitis 
C, and for other purposes; to the Committee on Veterans' Affairs.


                    hepatitis c veterans legislation

 Ms. SNOWE. Mr. President, today I introduce legislation to 
address a serious health concern for veterans infected with the 
hepatitis C virus. This legislation would make hepatitis C a service-
connected condition so that veterans suffering from this virus can be 
treated by the VA.
  Specifically, the bill will establish a presumption of service 
connection for veterans with hepatitis C, meaning that we will assume 
that this condition was incurred or aggravated in military service, 
even if there is no record of evidence that the condition existed 
during the actual period of service, provided that certain conditions 
are met.
  Under this legislation, veterans who received a transfusion of blood 
during a period of service before December 31, 1992; veterans who were 
exposed to blood during a period of service; veterans who underwent 
hemodyalisis during a period of service; veterans diagnosed with 
unexplained liver disease during a period of service; veterans with an 
unexplained liver dysfunction value or test; or veterans working in a 
health care occupation during service, will be eligible for treatment 
for this condition at VA facilities.
  I am introducing this legislation today because of medical research 
that suggests many veterans were exposed to hepatitis C in service and 
are now suffering from liver and other diseases caused by exposure to 
the virus.
  I am troubled that many ``hepatitis C veterans'' are not being 
treated by the VA because they can't prove the virus was service 
connected, despite that fact that hepatitis C was little known and 
could not be tested for until recently.
  Mr. President, we are learning that those who served in Vietnam and 
other conflicts, tend to have higher than average rates of hepatitis C. 
In fact, VA data shows that 20 percent of its inpatient population is 
infected with the hepatitis C virus, and some studies have found that 
10 percent of otherwise healthy Vietnam veterans are hepatitis C 
positive.
  Although hepatitis C is a very serious infection, it was actually 
unknown until recently. Hepatitis C was not isolated until 1989, and 
the test for the virus has only been available since 1990. Hepatitis C 
is a hidden infection with few symptoms. However, most of those 
infected with the virus will develop serious liver disease 10 to 30 
years after contracting it. For many of those infected, hepatitis C 
leads to liver failure, transplants, liver cancer, and ultimately 
death.
  And yet, most people who have hepatitis C don't even know it and 
often do not get treatment until it's too late. Only five percent of 
the estimated four million Americans with hepatitis C know they have 
it, but with new treatments, some estimates indicate that 50 percent 
can have the virus eradicated.
  Vietnam Veterans in particular are just now starting to show up with 
liver disease caused by hepatitis C. And detection and treatment now 
may help head off serious liver disease for many of them. However, many 
veterans with hepatitis C will not be treated by the VA because they 
cannot establish a service connection for their condition in spite of 
the fact that we now know that many Vietnam-era and other veterans got 
this disease serving their country.
  Many of my colleagues may be interested to know how veterans likely 
were exposed to this virus. Many veterans received blood transfusions 
while in Vietnam. This is one of the most common ways hepatitis C is 
transmitted. Medical transmission of the virus through needles and 
other medical equipment is possible in combat. And Medical care 
providers in the services were likely at increased risk, and may have, 
in turn, posed a risk to the service members they treated.
  Researchers have discovered that hepatitis C was widespread in 
Southeast Asia during the Vietnam war, and that some blood sent from 
the U.S. was also infected with the virus. Researchers and veterans 
organizations, including the Vietnam Veterans of America, with whom I 
worked to prepare this legislation, believe that many veterans were 
infected after being injured in combat and getting a transfusion or 
from working as a medic around combat injuries.
  Yet, veterans cannot establish a service connection because 
frequently there were no symptoms when they were infected in Vietnam. 
In addition, while medical records may show a short bout of hepatitis, 
hepatitis C was not known then and there was no testing to detect the 
hepatitis C infection at discharge.
  The hepatitis C infected veterans are essentially in a catch 22: the 
VA is reluctant to depart from their routine service connection 
requirements and veterans cannot prove that they contracted hepatitis C 
in combat because the science to detect it did not exist during the 
period of service. Without congressional authority in the form of 
legislation providing for presumptive service connection, thousands of 
Vietnam vets infected with hepatitis C in service will not get VA 
health care testing or treatment. I believe the government will 
actually save money in the long run by testing and treating this 
infection early on. The alternative is much more costly treatment of 
end-stage liver disease and the associated complications, or other 
disorders.

  I would like to describe some of the research that has led me to the 
conclusion that hepatitis C may be service connected in many veterans. 
A number of studies have established a link between hepatitis C in 
veterans and high risk factors for hepatitis C that are unique to 
combat or are highly prevalent in combat situations.
  A study published in the American Journal of Epidemiology in 1980 
found that veterans have a higher incidence of hepatitis C compared to 
non-veterans. The study of veterans receiving liver transplants at the 
Nashville, Tennessee VA medical center, which was conducted by 
researchers at the Vanderbilt University Medical Center, found that 
there ``was a significantly greater incidence of hepatitis C . . . in 
veterans compared with non-VA patients.'' The study claims to confirm 
that ``veteran patients have a higher incidence of hepatitis C. . .''
  A study published in Cancer in 1989 found that veterans have 
increased risk of liver cancer as compared to non-veterans. The study 
found that there was a 50 percent increase in the rate of liver cancer 
among male veterans using VA medical systems from 1970 to 1982.
  A study published in Military Medicine in 1997 found that from 1991 
to 1994, the number of veterans diagnosed with hepatitis C increased 
significantly from 6,612 in 1991 to 18,854 in 1994, which is an 
increase of more than 285 percent. The study notes that ``total 
patients seen nationally . . . increased by only 4.87 percent during 
the same period.'' Therefore, this increase cannot be explained by 
increased in workload. Over the subsequent year, this increased to 
21,400 (in 1996), and has since continued to increase.
  Some will argue that further epidemiologic data is needed to resolve 
or prove the issue of service connection. I agree that we have our work 
cut out for us, and further study is required. However, while the 
research being done is providing more and more data on the relationship 
between military service

[[Page S12168]]

and hepatitis C, we should not force those who fought for our country 
to wait for the treatment they deserve.
  It should be noted that some progress has been made in recent years 
in the effort to address this health concern. This is not a new issue.
  The VA has done some screening and testing for hepatitis C in 
veterans. VA Under Secretary for Health, Ken Kizer, issued a directive 
that all VA medical centers should test veterans for hepatitis C if 
they fall into certain risk categories. However, I understand that 
medical centers are not complying with this directive uniformly. In 
addition, there is no mention of treatment in the Kizer directive. 
Therefore, if the virus is detected, the VA does not necessarily treat 
it.
  I would also note that the FY98 VA-HUD Appropriations report contains 
the following language: ``The Committee is concerned that the rates of 
serious liver disease, liver cancer and liver transplants related to 
hepatitis C infection are expected to rise rapidly among veterans 
populations over the next decade. Veterans health care facilities will 
bear a large part of the treatment cost. Those costs can be reduced 
with early screening and treatment of veterans infected with hepatitis 
C. Therefore, the Committee directs the Department to determine rates 
of hepatitis C infection among veterans receiving health services from 
the VA and to establish a protocol for screening new entrants to the VA 
health care system. The Committee also directs the Department to 
provide counseling and access to treatment for veterans who test 
positive for hepatitis C. The Department should pay special attention 
to rates of hepatitis C among veterans of Vietnam and more recent 
deployments.''
  Former Surgeon General C. Everett Koop, well respected both within 
and outside of the medical profession, has said, ``In some studies of 
veterans entering the Department of Veterans Affairs health facilities, 
half of the veterans have tested positive for HCV. Some of these 
veterans may have left the military with HCV infection, while others 
may have developed it after their military service. In any event, we 
need to detect and treat HCV infection if we are to head off very high 
rates of liver disease and liver transplant in VA facilities over the 
next decade. I believe this effort should include HCV testing as part 
of the discharge physical in the military, and entrance screening for 
veterans entering the VA health system.''
  The VA requires that a veteran demonstrate onset during service or 
within requisite presumptive periods with chronic residuals of a 
disease or injury that had its onset during active military service. 
How does a veteran prove service connection under these criteria for a 
condition that did not even have a name until 10 years ago.
  Veterans have already fought their share of battles--these men and 
women who sacrificed in war so that others could live in peace 
shouldn't have to fight again for the benefits and respect they have 
earned.
  In closing, let me say that we are just now beginning to learn the 
full extent of this emerging health threat to veterans and the general 
population. We still have a long way to go before we know how best to 
confront this deadly virus. A comprehensive policy to confront such a 
monumental challenge can not written overnight. It will require the 
long-term commitment of Congress and the Administration to a 
serious effort to address this health concern.

  I hope this legislation will be a constructive step in this effort, 
and I look forward to working with the Veterans' Affairs Committee, the 
VA-HUD appropriators, Vietnam Veterans of America, and others to meet 
this emerging challenge.
                                 ______
                                 
      By Mr. HATCH:
  S. 2600. A bill to amend section 402 of the Controlled Substances Act 
to reform the civil remedy provisions relating to recordkeeping 
violations; to the Committee on the Judiciary.


             controlled substance civil penalty reform act

  Mr. HATCH. Mr. President, I rise today to introduce the ``Controlled 
Substances Civil Penalty Reform Act of 1998,'' S. 2600, legislation I 
have been developing for some months working in conjunction with 
Senator Gregg and the Appropriations Committee, our House colleague, 
Bill McCollum, and other interested parties including the Drug 
Enforcement Administration, the National Association of Chain Drug 
Stores, and the National Wholesale Druggists Association.
  This is a ``good government'' bill, legislation which I intend to 
correct a situation which has proven to be of great concern to 
America's drug stores, the wholesale community which supplies them, and 
America's consumers.
  As a House hearing amply documented last month, there have been a 
number of cases in which the Drug Enforcement Administration has 
imposed large fines for small, record-keeping errors committed by those 
the agency regulates, primarily drug stores and their suppliers.
  The DEA has a critical mission to combat diversion of controlled 
substances. This is of great national significance, and the agency 
should zealously pursue to the limits of the law those who traffic in 
illicit drugs.
  That being said, there is a difference between going after drug 
dealers and examining the records kept by legitimate wholesalers and 
pharmacies. Overzealously throwing the book at above-board businesses, 
who are doing so much to help America's consumers, for relatively minor 
record-keeping violations is not warranted.
  In 1997, these fines, which may be assessed at up to $25,000 per 
violation, totaled a substantial $12 million. But given the nature of 
some of the minor deficiencies, which I am advised are sometimes for 
trivial matters such as incorrect zip codes, the question must be 
raised whether this particular enforcement activity is operating more 
life a hidden tax or user fees than a meaningful deterrent to drug 
diversion.
  In short, S. 2600 amends the Controlled Substances Act in three 
important ways. First, it adds a negligence standard to current law, so 
that the government must prove that the record-keeping violation was 
due to a negligent act, rather than an unintended mistake or omission, 
prior to any fines being imposed. Second, it lowers the ceiling on 
these fines from ``up to $25,000'' per violation, to ``up to $10,000'' 
per violation.
  The third provision adds a number of needed standards that the 
Attorney General must consider before any fine is imposed. These 
include: whether diversion actually occurred; whether actual harm to 
the public resulted from the diversion; whether the violations were 
intentional or negligent in nature; whether the violations were a first 
time offense; the time intervals between inspections where no, or any 
serious, violations were found; whether the violations were multiple 
occurrences of the same type of violation; whether and to what extent 
financial profits may have resulted from the diversion; and the 
financial capacity of registrants to pay the fines assessed.
  Finally, my proposal makes clear that in determining whether to 
assess a penalty, the Attorney General may take into account whether 
the violator has taken immediate and effective corrective action, 
including demonstrating the existence of compliance procedures, in 
order to reduce the potential for any future violations. The Attorney 
General may also follow informal procedures such as sending one or more 
warning letters to the violator, as she determines appropriate.
  Mr. President, I recognize that our time is short for the remainder 
of this session. However, given Senator Gregg's significant interest in 
this issue, and the abundant work that Representative McCollum and I 
have devoted to this issue this year, I am hopeful this needed reform 
is something we can accomplish before we adjourn.
                                 ______
                                 
      By Mr. KYL:
  S. 2601. A bill to provide block grant options for certain education 
funding; to the Committee on Labor and Human Resources.


             dollars follows the kid education block grant

  S. 2602. A bill to amend the Internal Revenue Code of 1986 to allow a 
credit against income tax for expenses of attending elementary and 
secondary schools and for contributions to charitable organizations 
which provide scholarships for children to attend such schools; to the 
Committee on Finance.

[[Page S12169]]

                 k through community participation act

 Mr. KLY. Mr. President, I rise to introduce two education 
legislative proposals that will increase parental and student choice, 
educational quality, and school safety.
  A colleague from the Arizona delegation, Representative Matt Salmon, 
is today introducing these proposals in the House of Representatives.
  The first proposal is the ``Dollars Follow the Student Education 
Block Grant Act.''
  This proposal would ensure that education dollars are spent in the 
classroom on behalf of specific students rather than in bureaucracies 
like the Department of Education in Washington, D.C.
  The second proposal is the ``K through 12 Community Participation 
Act'' which would offer tax credits to families and businesses of up to 
$500 annually for qualified K through 12 education expenses or 
activities.
  Over the last 30 years, Americans have steadily increased their 
monetary commitment to education.
  Unfortunately, we have not seen a corresponding improvement in the 
quality of the education our children receive.
  Given our financial commitment, and the great importance of 
education, these results are unacceptable.
  Mr. President, I believe the problem is not how much money is spent, 
but how it is spent, and by whom.
  Our national commitment to education is clear from the ever-
increasing sums we spend annually.
  The problem is the big-government, Washington D.C.-based policies 
that have squandered these resources on well-meaning but misguided 
programs that are failing our children and our country.
  By beginning the debate on these two legislative proposals at the end 
of the 105th Congress, I believe the Congress can build upon the great 
progress made in the direction of parental choice, educational quality, 
and safety--progress which has been led by Senator Paul Coverdell and 
Senator Slade Gorton, and Senator Tim Hutchinson.


     the dollars follow the student education block grant proposal

  As a nation we have long recognized the supreme importance of 
educating our children.
  It is the foundation for a productive and rewarding future for all 
individuals and, as Thomas Jefferson noted, ``is essential to the 
preservation of our democracy.''

  The critical issue is whether the taxpayers are getting their money's 
worth for their education tax dollar in light of the disappointing 
conclusions of the recent congressional Education at the Crossroads 
report.
  As the report pointed out, the federal government pays only seven 
percent of the cost of education, but imposes 50 percent of the 
paperwork requirements that schools face.
  Our students are struggling to master just the basics in reading, 
math, and science. Around 40 percent of our fourth graders can't read, 
while the government pays to add subtitles to the ``Jerry Springer 
Show.''
  It is clear that after more than 30 years of topdown control, 
hundreds of duplicative federal programs and one-size-fits-all policies 
from Washington are not working.
  In fact, according to a recent study by the Heritage Foundation, 20 
cents of each education tax dollar are lost to administrative and 
federal compliance costs. I believe these resources would be better 
spent on textbooks or making schools safer than on salaries of, and 
regulations issued by, bureaucrats in Washington.
  It's clear that we need to get more from our education tax dollars by 
spending more of them in the classroom and less in Washington.
  This idea--an education block grant--has been successfully promoted 
by Senator Slade Gorton of Washington state. The Gorton block grant 
proposal passed the Senate and the House in 1997, but, at the Clinton 
administration's insistence, it was stripped from the Labor, Health and 
Human Services, and Education appropriations bill of 1997.
  As with the Gorton proposal, my bill would consolidate most federally 
funded K through 12 education programs, except for special education. 
This money is sent directly to states and local school districts free 
from federal mandates or regulations.
  Under both proposals, each state would choose one of three options: 
1. To have federal block grant funds sent directly to local school 
districts minus federal regulations; 2. To have federal block grant 
funds sent to the state education authority, again without federal 
regulations; 3. Or to continue to receive federal funds under the 
current system of categorizing monies rigidly into specific programs.
  But my amendment adds a new feature to the block grant idea for 
states that choose a block grant option. Several years ago, the 
Goldwater Institute, a Phoenix-based educational think tank, began to 
advocate market-based education finance reform in which a specific 
amount of money would follow each child to the school of his or her 
choice. I believe the time has come for this concept of ``dollars 
following kids'' to be debated and implemented on the national level.
  Under this proposal, each state electing to have a block grant could 
also decide to allow parents of children in private schools, public 
schools (including charter schools), and parents of ``home schooled'' 
kids, to receive their ``per capita'' amount directly, rather than 
indirectly through the school district and school. This money would 
literally ``follow the child'' from school to school, thus creating an 
incentive for the school to muster the best education product possible 
in order to keep the child enrolled.

  I believe the fundamental problem with today's method of federal 
education funding is that it provides little if any link between the 
quality of a school or school district's educational product and the 
education funding it receives. The absence of a link between school 
funding and education quality has led to a loss of accountability and 
to an education product that is, in many ways, severely deficient. 
Parents, students, and the nation suffer from this loss of 
accountability.
  As we all know, under current education-funding procedures, federal 
dollars allocated by the U.S. Department of Education are sent to state 
education agencies, and then to each school district, and finally, to 
each school. At each level, important education decisions are being 
made by bureaucrats--and more importantly, not being made by parents. 
Also, at each level of bureaucracy, additional percentages of the 
original education-funding dollar that left Washington is being lost. 
Currently, fully 20 percent of all federal education dollars never make 
it to the classroom and the student.
  I believe we need to explore a new education-funding framework that 
is child-centered rather than school, or school district, centered. The 
current system has proven to be inconsistent with the fundamental 
principles of parental choice, competition, and education quality.
  This proposal would implement the fundamental reform needed in our 
education financing system. I believe we should consider financing 
public education by linking funding to individual students and 
requiring that the schools and school districts compete for those 
students by providing a quality education. This approach puts the 
child, rather than the system itself, at the center. With child-
centered funding, students are more valuable to schools than the 
bureaucrats who make funding decisions.
  Simply put, under my plan, the federal money that supports primary 
and secondary education would go directly from the state to parents, 
and only then to the schools in which parents chose to educate their 
children.
  Practically speaking, what does this mean? First, the federal 
government funds about 6.3% of the total amount--$358 billion--invested 
in primary and secondary education each year. If every state chose the 
block grant, this proposal would result in a block grant of roughly $13 
billion sent to the states with greatly reduced regulatory mandates. 
(It is important to note that federal funding through the Individuals 
with Disabilities Act is exempted from this block grant.)
  This amount--$13 billion--divided among roughly 50 million students 
results in $255 dollars that will ``follow'' each student. When one 
considers that the average school enrollment is 530 students, this 
block grant proposal would mean that each school would receive an 
average of $135,000 in federal dollars and, more importantly, would

[[Page S12170]]

have the flexibility to sue it to address the specific educational 
needs of the students in that school.

  Suppose the parents of 50 students decided to remove their children 
because they were unsatisfied with the educational product of the 
school: that school would lose over $12,000 as a result. This would 
mean that each school would have the strong incentive to improve its 
curriculum, its staff, and its overall performance, since, if parents 
weren't satisfied, they could move their child to another school--and 
the dollars along with the child.
  To allay fears that federal funding will be cut if consolidated into 
a block grant, this proposal provides that, if federal funding falls 
below the levels agreed to in the 1997 budget agreement, it will revert 
back to funding under federally-designated categories.
  Also, my bill encourages states that choose block grants to adjust 
the per-student amounts by two factors: The relative cost of living, 
i.e., rural v. urban; and the income of the child's parents.
  Citizens in the states put their trust in members of Congress to 
represent them in the nation's capital. It is time Congress showed the 
same trust in them and gave them more discretion in how their education 
tax dollars are spent.
  It comes down to this: Will local schools be improved through more 
control from Washington, or will they be improved by giving more 
control to parents, teachers, and principals? The question needs only 
to be asked to be answered. The K through 12 Community Participation 
Act.
  Mr. President, the second education legislative proposal I am 
introducing today is the K through 12 Community Participation Act. This 
proposal addresses the problem of falling education standards by giving 
families and businesses a tax incentive to provide children with a 
higher quality education through choice and competition.
  The problem of declining education standards is illustrated by a 
report just released by the Education and Workforce Committee of the 
House of Representatives, Education at the Crossroads. This is the most 
comprehensive review of federal education programs ever undertaken by 
the United States Congress. It shows that the federal government's 
response to the decline in American schools has been to build bigger 
bureaucracies, not a better education system.
  According to the report: There are more than 760 federal education 
programs overseen by at least 39 federal agencies at a cost of $100 
billion a year to taxpayers. These programs are overlapping and 
duplicative. For example, there are 63 separate (but similar) math and 
science programs, 14 literacy programs, and 11 drug-education programs.
  Even after accounting for recent streamlining efforts, the U.S. 
Department of Education still requires over 48.6 million hours worth of 
paperwork per year--this is the equivalent of 25,000 employees working 
full time.
  As I mentioned earlier, states get at most seven percent of their 
total education funds from the federal government, but most states 
report that roughly half of their paperwork is imposed by federal 
education authorities.
  The federal government spends tax dollars on closed captioning of 
``educational'' programs such as ``Baywatch'' and Jerry Springer's 
squalid daytime talk show.
  With such a large number of programs funded by the federal 
government, it's no wonder local school authorities feel the heavy hand 
of Washington upon them.
  And what are the nation's taxpayers getting for their money? 
According to the report, around 40 percent of fourth grades cannot 
read, and 57 percent of urban students score below their grade level. 
Half of all students from urban school districts fail to graduate on 
time, if at all. U.S. 12th graders ranked third from the bottom out of 
21 nations in mathematics. According to U.S. manufacturers, 40 percent 
of all 17-year-olds do not have the math skills to hold down a 
production job at a manufacturing company.
  The conclusion of the Education at the Crossroads report is that the 
federally designed ``one-size-fits-all'' approach to education is 
simply not working.
  I believe we need a federal education policy that will: Give parents 
more control. Give local schools and school boards more control. Spend 
dollars in the classroom, not on a Washington bureaucracy. Reaffirm our 
commitment to basic academics.
  As was the case regarding my block grant proposal, my state of 
Arizona has led the way with legislation passed in 1997. This state law 
provides tax credit that can be used by parents and businesses to cover 
certain types of expenses attendant to primary and secondary education.
  Mr. President, today, Representative Salmon and I are introducing a 
form of the new Arizona education tax-credit law.
  The K through 12 Community Participation Education Act would be 
phased in over four years and would impel parents, businesses, and 
other members of the community to invest in our children's education. 
Specifically, it offers every family or business a tax credit of up to 
$500 annually for any K through 12 education expense or activity. This 
tax credit could be applied to home schooling, private schools 
(including charter schools), or parochial schools. Allowable expenses 
would include tuition, books, supplies, and tutors.
  Further, the tax credit could be given to a ``school-tuition 
organization'' for distribution. To qualify as a school-tuition 
organization, the organization would have to devote at least 90 percent 
of its income per year to offering available grants and scholarships 
for parents to use to send their children to the school of their 
choice.
  How might this work? A group of businesses in any community could 
join forces to send sums for which they received tax credits to 
charitable ``school-tuition organizations'' which would make 
scholarships and grants available to low income parents of children 
currently struggling to learn in unsafe, non-functional schools.
  Providing all parents--including low income parents--the freedom to 
choose will foster competition and increase parental involvement in 
education. Insuring this choice will make the federal education tax 
code more like Arizona's. It is a limited but important step the 
Congress and the President can--and I believe, must--take.
  Mr. President, it's clear that top-down, one-size fits all, big 
government education policy has failed our children and our country.
  This tax-credit legislation, as well as the block-grant legislation I 
described earlier, will refocus our efforts on doing what is in the 
best interests of the child as determined by parents, and will give 
parents and businesses the opportunity to take an important step to 
rescue American education so that we can have the educated citizenry 
that Jefferson said was essential to our health as a nation.
                                  ____

      By Mr. BAUCUS (for himself, Mr. Daschle, Mr. Inouye, Mr. 
        Bingaman, Mr. Johnson, and Mr. Conrad):
  S. 2603. A bill to promote access to health care services in rural 
areas; to the Committee on Finance.


              promoting health in rural areas act of 1998

  Mr. BAUCUS. Mr. President, all Americans deserve access to primary 
health care and emergency treatment. But in rural America the delivery 
of these services is often difficult, given the vast distances and 
extreme weather conditions that typically prevail. Just as small 
communities' transportation, education and housing needs are different 
than those of urban areas, so too are their mechanisms for delivering 
health care.
  That's why Senator Daschle and I are introducing the Promoting Health 
In Rural Areas Act of 1998. PHIRA would, among other things: 
reformulate the Adjusted Average Per Capita Cost for Medicare payments 
to managed care; direct Medicare payments to tribally-owned hospitals; 
rebase provisions for Sole Community Hospitals; revise the underserved 
criteria used by the Office of Personnel Management; and allow 
recently-closed hospitals to be designated on a Critical Access basis.
  As you know, 1997 reforms went a long way towards ensuring the 
viability of the Medicare program, including its use by rural 
Americans. For example, under Section 4201 of the 1997 BBA, Congress 
established a rural-friendly

[[Page S12171]]

hospital program. Modeled on a demonstration project conducted in my 
state of Montana, the new program allows a rural hospital to convert to 
a limited-service hospital status, called a ``Critical Access 
Hospital,'' or CAH. These hospitals are given flexibility and relief 
from Medicare regulations designed for full-size, full-service acute 
care hospitals. By giving these smaller hospitals greater latitude on 
staffing and other cumbersome federal regulations, it is easier for 
rural hospitals to organize their staffs and facilities based on 
patient needs.
  If the demonstration project on which this new program is based is 
any indication (and I certainly hope that it is), Congress can be proud 
of this new law. And rural folks across the country will benefit. They 
will receive access to quality care in a way that meets their unique 
needs, and they will be assisted in preserving a way of life that is 
increasingly threatened by the urban- and sub-urbanization of America.
  Yet despite many positive developments, it has become clear to the 
Minority Leader and I that much still needs to be done to facilitate 
the delivery of rural health services. In order to meet those needs, 
the Promoting Health in Rural Areas Act will do several things. First, 
it will change the Office of Personnel Management's underserved 
designation criteria by changing the way the Office of Personnel 
Management designates rural areas. Back in the 1960s, underserved areas 
were designated on a state-by-state basis. Now, the Department of 
Health and Human Services has the sophistication to designate areas by 
county, or even sub-county. The bill we are introducing today would 
require OPM to designate underserved areas on a county-by-county, not 
state-by-state, basis.
  Second, PHIRA would direct Medicare payments to tribally-owned 
hospitals. As you know, Mr. President, a demonstration project 
conducted in Alaska, Mississippi and Oklahoma allowed four tribal 
health care providers operating Indian Health Services hospitals to 
bill Medicare and Medicaid directly. The demo project increased 
efficiency and, by allowing providers to directly bill Medicare, 
provided badly-needed revenue. Our bill would expand the demonstration 
project nationwide and make it permanent.
  Mr. President, our bill would also allow recently-closed hospitals to 
be designated as Criticala Access Hospitals. Under the 1997 law 
establishing the Critical Access Hospital program, a closed or 
downsized hospital does not qualify. Our bill would allow a hospital 
that had closed within the last five years to qualify for conversion to 
CAH status.
  Our bill also addresses rural needs for Medicare Graduate Medical 
Education (GME). As you know, BBA mandated a cap on the number of 
residents a teaching hospital is allowed to train. Because this 
provision threatens to exacerbate an already serious shortage of 
physicians in rural America, our bill would allow programs training 
residents targeted for rural areas to be exempt from the cap.
  Mr. President, by reforming the way health care is delivered in rural 
areas, we are not only making government more efficient, we are making 
agencies more accountable. And we are preserving a way of life that 
American pioneers established long ago and that rural Americans 
continue today. It is in many ways a simpler lifestyle, uncomplicated 
by traffic, smog and a desire to get everything done yesterday. But it 
is also a difficult way of life, characterized by harsh weather, long 
distances, and the historic tendency of the Federal Government to view 
all areas--rural or urban--through a one-size-fits-all lens. I invite 
senators to join the Minority Leader and I today, to ensure that our 
rural residents are given proper access to the health care they need. I 
urge my colleagues to support this important legislation.
  Mr. DASCHLE. Mr. President, today, with Senator Baucus, I introduce a 
bill intended to improve health care for Americans living in rural 
communities. The Promoting Health in Rural Areas Act of 1998 would help 
rural communities attract and retain health care providers and health 
plans, improve the viability of sole community hospitals, and make 
optimal use of the advances in medical technology available today.
  Delivering health care in rural America presents unique challenges--
issues related to geography, lack of transportation, and reimbursement. 
With a relatively small population spread over a large area, and health 
care professionals in short supply, patients often must travel long 
distances to see a physician or get to a hospital. While these rural 
communities strive to improve access through telemedicine and 
recruitment efforts, they must also struggle to maintain what they 
have, to ensure that providers who leave their area are replaced, and 
to keep their hospitals' doors open.
  Rural communities have long had great difficulty recruiting and 
retaining health care providers to serve their needs. Despite great 
increases in the number of providers trained in this country over the 
past 30 years, rural communities have not shared equitably in the 
benefits of this expansion. Even though 20 percent of Americans live in 
non-metropolitan counties, only 11 percent of physicians practice in 
those counties, and that percentage has been falling for the last 25 
years. Currently, 30 towns in South Dakota are looking for family 
physicians.
  Telemedicine is a promising tool to provide medical expertise to 
rural communities. Through telemedicine technology, rural patients can 
have access to specialists they would otherwise never encounter. The 
benefits of telemedicine extend to rural health professionals as well, 
providing them with technical expertise and interaction with peers that 
can make practicing in a rural area more attractive. Yet the potential 
of telemedicine has been limited by reimbursement issues and a number 
of other obstacles.
  In addition to problems with provider recruitment and limitations 
facing telemedicine, seniors in rural areas do not have the array of 
health plan options available in more urban areas due in part to a 
disparity in reimbursement. Although the Balanced Budget Act began to 
address the issue of low payment levels in rural areas, and has been 
successful to some degree, budgetary constraints have prevented the 
expected increase in rural areas.
  The Promoting Health in Rural Areas Act of 1998 is intended to 
address some of the basic challenges facing rural health care. It will 
not address every health problem facing rural America. It is, however, 
intended to take important steps to improve access, increase choice, 
and improve the quality of care provided in more isolated parts of the 
country.
  The bill addresses obstacles in current law to the recruitment and 
training of providers in rural areas. One provision in the bill ensures 
that new rules enacted as part of the Balanced Budget Act, regarding 
reimbursement for medical residents, do not discriminate against areas 
that train residents in rural health clinics or other settings outside 
a hospital.
  The bill also helps medically underserved communities plan and be 
ready for the retirement of a physician. Current law effectively 
requires communities to actually lose a physician before they qualify 
for recruitment assistance to replace that doctor. Because recruitment 
is rarely less than a 6-month-long process, current policy places a 
community at risk of potentially having no physician available to them 
for long periods of time. This bill would provide communities with 12 
months of lead time to secure recruitment assistance when they know a 
retirement or resignation is pending.
  The bill would enhance the economic viability of Sole Community 
Hospitals, often the only source of inpatient services that are 
reasonably available in a geographic area, by updating the base cost 
reporting period.
  The bill would ensure that health plans for Medicare beneficiaries 
who want to develop in rural counties get the increased reimbursement 
promised in the Balanced Budget Act, while maintaining budget 
neutrality. This provision is important to ensure that beneficiaries in 
rural areas begin to have some of the health plan choices available to 
urban seniors.
  The bill also places significant focus on the promise of telemedicine 
for rural areas and attempts to overcome some of the barriers that have 
limited its potential. The bill would expand reimbursement for 
telemedicine to all rural areas, not just those designated as health 
professional shortage areas. The bill also would allow reimbursement 
for services currently covered by

[[Page S12172]]

Medicare in face-to-face interactions with health professionals. It 
also would make telemedicine more convenient, by allowing any health 
care practitioner to present a patient to a specialist on the other 
side of the video connection.
  Mr. President, providing health care in rural communities raises 
unique challenges that require targeted responses. Rural America 
deserves appropriate access to health care--access to providers, access 
to hospitals, access to quality care, and greater choice. The bill we 
introduce today takes important steps to achieve these ends.
                                 ______
                                 
      By Mr. TORRICELLI:
  S. 2604. A bill to provide demonstration grants to local educational 
agencies to enable the agencies to extend time for learning and the 
length of the school year; to the Committee on Labor and Human 
Resources.


                      extended school legislation

 Mr. TORRICELLI. Mr. President, today I introduce legislation 
authorizing funding for extended school day and extended school year 
programs across the country. The continuing gap between American 
students and those in other countries, combined with the growing needs 
of working parents and the growing popularity of extending both the 
school day and the school year, have made this educational option a 
valuable one for many school districts.
  Students in the United States currently attend school an average of 
only 180 days per year, compared to 220 days in Japan, and 222 days in 
both Korea and Taiwan. American students also receive fewer hours of 
formal instruction per year compared to their counterparts in Taiwan, 
France, and Germany. We cannot expect our students to remain 
competitive with those in other industrialized countries if they must 
learn the same amount of information in less time.
  Our school calendar is based on a no longer relevant agricultural 
cycle that existed when most American families lived in rural areas and 
depended on their farms for survival. The long summer vacation allowed 
children to help their parents work in the fields. Today, summer is a 
time for vacations, summer camps, and part-time jobs. Young people can 
certainly learn a great deal at summer camp, and a job gives them 
maturity and confidence. However, more time in school would provide the 
same opportunities while helping students remain competitive with those 
in other countries. As we debate the need to bring in skilled workers 
from other countries, the need to improve our system of education has 
become increasingly important.
  In 1994, the Commission on Time and Learning recommended keeping 
schools open longer in order to meet the needs of both children and 
communities, and the growing popularity of extended-day programs is 
significant. Between 1987 and 1993, the availability of extended-day 
programs in public elementary schools has almost doubled. While school 
systems have begun to respond to the demand for lengthening the school 
day, the need for more widespread implementation still exists. 
Extended-day programs are much more common in private schools than 
public schools, and only 18 percent of rural schools have reported an 
extended-day program.
  This bill would authorize $50 million over the next five years for 
the Department of Education to administer a demonstration grant 
program. Local education agencies would then be able to conduct a 
variety of longer school day and school year programs, such as 
extending the school year to 210 days, studying the feasibility of 
extending the school day, and implementing strategies to maximize the 
quality of extended core learning time.
  The constant changes in technology, and greater international 
competition, have increased the pressure on American students to meet 
these challenges. Providing the funding for programs to lengthen the 
school day and school year would leave American students better 
prepared to meet the challenges facing them in the next 
century.
                                 ______
                                 
      By Mr. TORRICELLI (for himself and Mr. Lautenberg):
  S. 2605. A bill to amend the Public Health Service Act to provide for 
the establishment of a national program of traumatic brain injury and 
spinal cord injury registries; to the Committee on Labor and Human 
Resources.


          Traumatic Brain and Spinal Cord Injury Registry Act

 Mr. TORRICELLI. Mr. President, I introduce legislation that 
represents an important step forward in our national strategy for 
addressing traumatic brain injury (TBI) and spinal cord injury (SCI). 
Tragically, these injuries have enormous personal and economic costs on 
victims, their families, and our nation as a whole.
  Today, an estimated 4.5 million Americans live with a disability as a 
result of a TBI. Each year, more than two million people suffer a TBI, 
10,000 of whom live in my State of New Jersey. More than 200,000 
Americans live with a SCI, with 10,000 new injuries reported each year. 
Collectively, TBI and SCI costs the U.S. more than $35 billion per 
year.
  These statistics, however, reveal only a fraction of the problem. In 
the U.S., we have no standardized system of collecting information on 
these injuries. Instead, we rely on the work of a few limited State 
programs and private organizations who often lack the resources to 
collect complete, timely, and accurate data.
  Mr. President, the legislation I introduce today, the TBI/SCI 
Registry Act, will allow the Centers for Disease Control and Prevention 
(CDC) to make grants available to states to establish their own TBI/SCI 
registries. The CDC and state departments of health will then work as 
partners in establishing and maintaining comprehensive tracking systems 
that ensures patient privacy.
  The important information that state registries will be responsible 
for collecting will include: circumstances of injury and demographics 
of patients; length of stay in hospital and treatments used; severity 
of the injury; outcomes of treatments and services.
  The benefits will be far-reaching because the collection of accurate 
data will help identify high-risk populations for future prevention 
programs and will help link patients to effective treatments and social 
services. Perhaps most important, the information from these registries 
will help advocates and legislators justify TBI/SCI as a greater 
funding priority.
  The National Institutes of Health (NIH) currently spends 
approximately $60 million for SCI and $52 million for TBI. This 
research has contributed to tremendous progress, but we must improve 
our ability to identify innovative research projects and increase our 
financial commitment to those efforts.
  Mr. President, this legislation will ultimately help achieve this 
goal by creating a foundation for a unified scientific and public 
health approach for preventing, treating, and someday finding a cure 
for TBI/SCI. I am proud that my bill has already received the 
endorsement of the Christopher Reeve Foundation, the American Paralysis 
Association, the Brain Injury Association, and the Eastern Paralyzed 
Veterans Association.
  Mr. President, I ask that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2605

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Traumatic Brain Injury and 
     Spinal Cord Injury Registry Act''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) traumatic brain and spinal cord injury are severe and 
     disabling, have enormous personal and societal costs;
       (2) 51,000 people die each year from traumatic brain injury 
     and 4,500,000 people live with lifelong and severe disability 
     as a result of a traumatic brain injury;
       (3) approximately 10,000 people sustain spinal cord 
     injuries each year, and 200,000 live with life-long and 
     severe disability; and
       (4) a nationwide system of registries will help better 
     define--
       (A) who sustains such injuries and the impact of such 
     injuries;
       (B) the range of impairments and disability associated with 
     such injuries; and
       (C) better mechanisms to refer persons with traumatic brain 
     injuries or spinal cord injuries to available services.

     SEC. 3. TRAUMATIC BRAIN INJURY AND SPINAL CORD INJURY 
                   REGISTRIES PROGRAM.

       Title III of the Public Health Service Act (42 U.S.C. 241 
     et seq.) is amended by adding at the end the following:

[[Page S12173]]

 ``Part O--National Program for Traumatic Brain Injury and Spinal Cord 
                           Injury Registries

     ``SEC. 399N. NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY AND 
                   SPINAL CORD INJURY REGISTRIES.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     may make grants to States or their designees to operate the 
     State's traumatic brain injury and spinal cord injury 
     registry, and to academic institutions to conduct applied 
     research that will support the development of such 
     registries, to collect data concerning--
       ``(1) demographic information about each traumatic brain 
     injury or spinal cord injury;
       ``(2) information about the circumstances surrounding the 
     injury event associated with each traumatic brain injury and 
     spinal cord injury;
       ``(3) administrative information about the source of the 
     collected information, dates of hospitalization and 
     treatment, and the date of injury;
       ``(4) information characterizing the clinical aspects of 
     the traumatic brain injury or spinal cord injury, including 
     the severity of the injury, the types of treatments received, 
     and the types of services utilized;
       ``(5) information on the outcomes associated with traumatic 
     brain injuries and spinal cord injuries, such as impairments, 
     functional limitations, and disability;
       ``(6) information on the outcomes associated with traumatic 
     brain injuries and spinal cord injuries which do not result 
     in hospitalization; and
       ``(7) other elements determined appropriate by the 
     Secretary.
       ``(b) Eligibility for Grants.--
       ``(1) In general.--No grant shall be made by the Secretary 
     under subsection (a) unless an application has been submitted 
     to, and approved by, the Secretary. Such application shall be 
     in such form, submitted in such a manner, and be accompanied 
     by such information, as the Secretary may specify. No such 
     application may be approved unless it contains assurances 
     that the applicant will use the funds provided only for the 
     purposes specified in the approved application and in 
     accordance with the requirements of subsection (a), that the 
     application will establish such fiscal control and fund 
     accounting procedures as may be necessary to assure proper 
     disbursement and accounting of Federal funds paid to the 
     applicant under subsection (a) of this section, and that the 
     applicant will comply with review requirements under sections 
     491 and 492.
       ``(2) Establishment of Registries.--Each applicant, prior 
     to receiving Federal funds under subsection (a), shall 
     provide for the establishment of a registry that will--
       ``(A) comply with appropriate standards of completeness, 
     timeliness, and quality of data collection;
       ``(B) provide for periodic reports of traumatic brain 
     injury and spinal cord injury registry data; and
       ``(C) provide for the authorization under State law of the 
     statewide traumatic brain injury and spinal cord injury 
     registry, including promulgation of regulations providing--
       ``(i) a means to assure timely and complete reporting of 
     brain injuries and spinal cord injuries (as described in 
     subsection (a)) to the statewide traumatic brain injury and 
     spinal cord injury registry by hospitals or other facilities 
     providing diagnostic or acute care or rehabilitative social 
     services to patients with respect to traumatic brain injury 
     and spinal cord injury;
       ``(ii) a means to assure the complete reporting of brain 
     injuries and spinal cord injuries (as defined in subsection 
     (a)) to the statewide traumatic brain injury and spinal cord 
     injury registry by physicians, surgeons, and all other health 
     care practitioners diagnosing or providing treatment for 
     traumatic brain injury and spinal cord injury patients, 
     except for cases directly referred to or previously admitted 
     to a hospital or other facility providing diagnostic or acute 
     care or rehabilitative services to patients in that State and 
     reported by those facilities;
       ``(iii) a means for the statewide traumatic brain injury 
     and spinal cord injury registry to access all records of 
     physicians and surgeons, hospitals, outpatient clinics, 
     nursing homes, and all other facilities, individuals, or 
     agencies providing such services to patients which would 
     identify cases of traumatic brain injury or spinal cord 
     injury or would establish characteristics of the injury, 
     treatment of the injury, or medical status of any identified 
     patient; and
       ``(iv) for the reporting of traumatic brain injury and 
     spinal cord injury case data to the statewide traumatic brain 
     injury and spinal cord injury registry in such a format, with 
     such data elements, and in accordance with such standards of 
     quality timeliness and completeness, as may be established by 
     the Secretary.
       ``(3) Applied research.--Applicants for applied research 
     shall conduct applied research as determined by the 
     Secretary, acting through the Director of the Centers for 
     Disease Control and Prevention, to be necessary to support 
     the development of registry activities as defined in this 
     section.
       ``(4) Assurances for confidentiality of registry data.--
     Each applicant shall provide to the satisfaction of the 
     Secretary for--
       ``(A) a means by which confidential case data may in 
     accordance with State law be disclosed to traumatic brain 
     injury and spinal cord injury researchers for the purposes of 
     the prevention, control and research of brain injuries and 
     spinal cord injuries;
       ``(B) the authorization or the conduct, by the statewide 
     traumatic brain injury and spinal cord injury registry or 
     other persons and organizations, of studies utilizing 
     statewide traumatic brain injury and spinal cord injury 
     registry data, including studies of the sources and causes of 
     traumatic brain injury and spinal cord injury, evaluations of 
     the cost, quality, efficacy, and appropriateness of 
     diagnostic, rehabilitative, and preventative services and 
     programs relating to traumatic brain injury and spinal cord 
     injury, and any other clinical, epidemiological, or other 
     traumatic brain injury and spinal cord injury research;
       ``(C) the protection of individuals complying with the law, 
     including provisions specifying that no person shall be held 
     liable in any civil action with respect to a traumatic brain 
     injury and spinal cord injury case report provided to the 
     statewide traumatic brain injury and spinal cord injury 
     registry, or with respect to access to traumatic brain injury 
     and spinal cord injury case information provided to the 
     statewide traumatic brain injury and spinal cord injury 
     registry; and
       ``(D) the protection of individual privacy and 
     confidentiality consistent with Federal and State laws.

     ``SEC. 399O. TECHNICAL ASSISTANCE IN OPERATIONS OF STATEWIDE 
                   REGISTRIES.

       ``The Secretary, acting through the Director of the Centers 
     for Disease Control and Prevention, may, directly or through 
     grants and contracts, or both, provide technical assistance 
     to the States in the establishment and operation of statewide 
     registries, including assistance in the development of model 
     legislation for statewide traumatic brain injury and spinal 
     cord injury registries and assistance in establishing a 
     computerized reporting and data processing system. In 
     providing such assistance, the Secretary shall encourage 
     States to utilize standardized procedures where appropriate.

     ``SEC. 399P. AUTHORIZATION OF APPROPRIATIONS.

       ``For the purpose of carrying out this part, there are 
     authorized to be appropriated $10,000,000 for fiscal year 
     1999, and such sums as may be necessary for each of the 
     fiscal years 2000 through 2004.

     ``SEC. 399Q. DEFINITIONS.

       ``In this part:
       ``(1) Spinal cord injury.--The term `spinal cord injury' 
     means an acquired injury to the spinal cord. Such term does 
     not include spinal cord dysfunction caused by congenital or 
     degenerative disorders, vascular disease, or tumors, or 
     spinal column fractures without a spinal cord injury.
       ``(2) Traumatic brain injury.--The term `traumatic brain 
     injury' means an acquired injury to the brain, including 
     brain injuries caused by anoxia due to near-drowning. Such 
     term does not include brain dysfunction caused by congenital 
     or degenerative disorders, cerebral vascular disease, tumors, 
     or birth trauma. The Secretary may revise the definition of 
     such term as the Secretary determines appropriate.''.
                                 ______
                                 
      By Mr. KYL (by request):
  S. 2608. A bill to approve a mutual settlement of the Water Rights of 
the Gila River Indian Community and the United States, on behalf of the 
Community and the Allottees, and Phelps Dodge Corporation, and for 
other purposes; to the Committee on Indian Affairs.


the gila river indian community--phelps dodge corporation water rights 
                         settlement act of 1998

  Mr. KYL: Mr. President, today I introduce, by request, a bill to 
authorize an Indian water rights settlement agreement that was entered 
into on May 4, 1998 by the Gila River Indian Community of Arizona and 
the Phelps Dodge Corporation.
  As other Western members well know, any Indian water rights 
settlement is a difficult, lengthy, and often frustrating process. 
Reaching a settlement requires years of hard work and cooperation by 
all parties involved. But the work is worthwhile. By reaching 
settlement, parties avoid decades of costly litigation and the 
uncertainty regarding water rights that inevitable comes when the 
determination of rights and liabilities is delayed. I have been, both 
in my prior career, and in this one, an ardent supporter of the 
settlement process and I hope that by introducing this legislation, I 
can give the negotiating parties at home in Arizona some encouragement. 
There is light at the end of the tunnel.
  This particular settlement agreement is part of a much larger, 
comprehensive settlement process that will eventually settle all claims 
of the Gila River Community. I have been involved in several aspects of 
the Gila negotiations and I am comforted that the negotiations are 
progressing far enough that the parties are beginning to put their 
agreements down on paper and actually sign their names to those 
documents. In reference to his particular

[[Page S12174]]

agreement, I want to note that my introduction of legislation does not 
endorse the May 4, 1994 agreement. Rather, my intention is to endorse 
and encourage the process. The settlement agreement is complex and 
lengthy and contains some elements that all parties in the larger Gila 
negotiation proceeds, including the federal government, may not agree 
with. My purpose in introducing a bill this year is to put a document 
on the table that will provide an opportunity for all interested 
parties to comment. In addition, a bill introduced this year will help 
move the process forward next year.
  I encourage the parties to continue their discussions. Indian water 
settlements are among the most important bills that Congress passes--we 
in the federal government have a trust responsibility to provide water 
for tribes and in passing legislation that has been carefully crafted 
to consider the interests of all parties, we are able to take steps 
toward fulfilling that trust responsibility.
                                 ______
                                 
      By Mr. BENNETT (for himself and Mr. Mack):
   S. 2609. A bill to ensure confidentiality with respect to medical 
records and health care-related information, and for other purposes to 
the Committee on Labor and Human Resources.


             The Medical Information Protection Act of 1998

  Mr. BENNETT. Mr. President, today I introduce the Medical Information 
Protection Act of 1998. I know it is late in the 105th Congress and 
that there will not be time to give this legislation full 
consideration. However, I feel strongly about this issue and did not 
want this session to end without the introduction of this legislation. 
I feel that great progress has been made and that the legislation that 
I am introducing addresses many of the concerns that have been 
expressed. I will include letters and statements of support for the 
Record from the following groups: American Medical Informatics 
Association; Joint Healthcare Information Technology Alliance; 
Intermountain Health Care; Premier Institute; Association of American 
Medical Colleges; American Health Information Management Association; 
Healthcare Leadership Council; Federation of American Health Systems; 
American Hospital Association and Pharmaceutical Research and 
Manufacturers of America. It is my intention to reintroduce this 
legislation early in the 106th Congress and seek for its passage.
  Most individuals wrongly assume that their personal health 
information is protected under federal law. It is not. Federal law 
protects the confidentiality of our video rental records, and federal 
law ensures us access to information about us such as our credit 
history. However, there is no current federal law which will protect 
the confidentiality of our medical information and ensure us access to 
our own medical information. This is a circumstance that must change. 
This is a circumstance that the Medical Information Protection Act will 
correct.
  At this time, the only protection of an individual's personal medical 
information is under state law. These state laws, where they exist, are 
incomplete, inconsistent and inadequate. At last check, there were over 
34 states with each state having its own unique set of laws to protect 
medical records. In many states there is no penalty for releasing and 
disseminating the most private information about our health and the 
health care that we have received. Many of our local health care 
systems continue to expand across state lines and are forced to deal 
with multiple and conflicting state laws. In addition, advances in 
technology allow information to be moved instantaneously across the 
country or around the world. The majority of providers, insurers, 
health care professionals, researchers and patients agree that there is 
an increasingly urgent need for uniformity in our laws that govern 
access to and disclosure of personal health information.
  Mr. President, I remind my colleagues that if we do not act by August 
of 1999, the Health Insurance Portability and Accountability Act of 
1996 (HIPAA) requires the Secretary of Health and Human Services (HHS) 
to put into place regulations governing health information in an 
electronic format. Thus, we could have a circumstance where paper based 
records and electronic based records are treated differently. I urge my 
colleagues to work with me to pass legislation that would give HHS 
clear direction and provide each American with greater protection of 
their health information.
  Mr. President, I ask unanimous consent that the letters of support be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                       Pharmaceutical Research and


                                     Manufacturers of America,

                                  Washington, DC, October 7, 1998.
     Hon. Robert F. Bennett,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bennett: The Pharmaceutical Research and 
     Manufacturers of America (PhRMA) applauds your introduction 
     of the Medical Information Protection Act of 1998 and your 
     leadership on this issue. This legislation would help 
     patients in important ways. First, it would protect the 
     confidentiality of their medical information. Second, it 
     would help patients with unmet medical needs and their 
     families by facilitating valuable biomedical research leading 
     to the discovery and development of innovative medicines. 
     Third, it would protect and promote health care quality by 
     encouraging the appropriate use of medical information for 
     epidemiological research, pharmaco-economics and outcomes 
     analysis.
       Your bill provides a sound regulatory framework to help 
     foster biomedical research and the delivery of high-quality 
     care in an increasingly integrated health care system, while 
     at the same time preserving the confidentiality of sensitive 
     medical information identifying patients.
       PhRMA welcomes the Medical Information Protection Act of 
     1998 as a good prescription to help patients, commends you 
     leadership on this issue, and looks forward to working 
     together.
           Sincerely,
                                                   Alan F. Holmer,
     President.
                                  ____



                                American Hospital Association,

                                  Washington, DC, October 2, 1998.

  AHA Applauds Introduction of Bill That Protects Privacy of Patient 
                          Medical Information

       The American Hospital Association (AHA) applauds the 
     introduction of a new bill which for the first time would 
     establish a federal confidentiality law that protects 
     patients' private health care information.
       As guardians of patient medical information, hospitals and 
     health systems have long sought strong federal legislation 
     that would establish a uniform national standard to protect 
     patient privacy. The bill, the Medical Information Protection 
     Act of 1998, appropriately balances the need to protect the 
     privacy of confidential patient information with the need for 
     that information to flow freely among health care providers.
       ``Comprehensive confidentiality legislation is critical to 
     thousands of patients who come through the doors of our 
     nation's hospitals each day,'' said AHA President Dick 
     Davidson. ``It puts in place the safeguards needed to protect 
     the most sensitive and personal information. We commend 
     Senator Bennett for introducing the bill and for his 
     leadership and guidance on an issue that is relevant to 
     everyone.''
       The Medical Information Protection Act bill:
       Allows patients in all states access to their records, a 
     right not currently given in some areas.
       Establishes full federal preemption of all state 
     confidentiality laws--with the exception of some key public 
     health laws--and sets a uniform standard over weaker or 
     stronger state laws so that patient information is equally 
     protected even as providers are linked across delivery sites 
     and state boundaries.
       Recognizes the need for confidential medical information to 
     move appropriately and timely within groups and systems of 
     providers without impeding the quality of care.
       Broadly applies not only to providers, payers, and 
     employers, but also to law enforcement agencies. The Bennett 
     bill moves in the right direction on this issue by setting a 
     national standard for how law enforcers can gain access to 
     confidential patient records.
       Contains language that, for the first time, would put in 
     place federal sanctions against those who inappropriately 
     disclose medical information.
       ``This is an issue that affects each of us personally,'' 
     Davidson said. ``America's hospitals and health systems look 
     forward to working with Senator Bennett and Congress to help 
     enact legislation to protect the privacy of each and every 
     individual they serve.''
       The AHA is a not-for-profit organization of health care 
     provider organizations that are committed to the health 
     improvement of their communities. The AHA is the national 
     advocate for its members, which includes 5,000 hospitals, 
     health care systems, networks and other providers of care. 
     Founded in 1898, AHA provides education for health care 
     leaders and is a source of information on health care issues 
     and trends. For more information, visit the AHA Web site at 
     www.aha.org.

[[Page S12175]]

     
                                  ____
                                                  American Medical


                                      Informatics Association,

                                    Bethesda, MD, October 5, 1998.
     Hon. Robert F. Bennett,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bennett: The American Medical Informatics 
     Association (AMIA) is a national organization dedicated to 
     the development and application of medical informatics in 
     support of patient care, teaching, research, and health care 
     administration. On behalf of AMIA's more than 3,800 
     physicians, researchers, librarians, information systems 
     managers, and other professionals with expertise in 
     information technologies, I write to commend you on the 
     introduction of the ``Medical Information Protection Act of 
     1998.''
       AMIA recognizes that the enormous potential of computer and 
     communications technology to improve health care delivery, 
     quality and access cannot be realized unless individuals, and 
     the society-at-large, are reasonably certain that safeguards 
     are in place to protect the confidentiality of personal 
     health information in medical records. Simply, every person 
     must feel that his or her health data is protected against 
     unnecessary disclosure. At the same time, there can be no 
     doubt that the delivery of highest quality health care and 
     advances in medical research cannot proceed without the 
     timely and efficient transfer of health data across the 
     health information infrastructure. Thus, in developing 
     national standards for health information, Congress--as 
     charged by the Health Insurance Portability and 
     Accountability Act of 1996--must thoughtfully and carefully 
     balance the rights of individuals, the capacity of the health 
     care system to provide needed health care, and the interests 
     of our nation as a whole. We believe that the ``Medical 
     Information Protection Act'' does an admirable job of 
     accomplishing those complex goals.
       Our association is especially concerned that health 
     information standards allow appropriate access to health data 
     for research, while adequately protecting patient 
     confidentiality. Dr. Don Detmer, Co-Chair of AMIA's Public 
     Policy Committee, was pleased to consult with your staff on a 
     number of occasions to address that issue, and to devise 
     enforcement mechanisms to effectively sanction the misuse of 
     protected health information.
       The American Medical Informatics Association thanks you for 
     introducing the ``Medical Information Protection Act of 
     1998.'' We look forward to passage of the bill, an essential 
     first step in the development of a national health 
     information strategy to advance the health of our nation.
           Sincerely,
     Paul D. Clayton, Ph.D.,
       President.
                                  ____

                                      Joint Healthcare Information


                                          Technology Alliance,

                                                  October 5, 1998.
     Hon. Robert F. Bennett,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bennett: Representing a broad array of 
     medical, information, and technology professionals involved 
     in the development, use, management, and security of 
     healthcare information systems, the organizations of the 
     Joint Healthcare Information Technology Alliance (JHITA) 
     strongly support enactment of federal legislation to protect 
     the confidentiality of medical records. We write today to 
     commend you on the introduction of the ``Medical Information 
     Protection Act of 1998.''
       The more than 50,000 members of our constituent 
     organizatons--physicians, researchers and other health 
     professionals, medical records professionals and information 
     systems managers and executives, healthcare information 
     technology developers and vendors--believe that computer and 
     communications technologies hold enormous potential to 
     improve healthcare delivery, quality and access, while also 
     reducing costs. Yet, these benefits cannot be realized unless 
     individuals, and society, are confident that safeguards are 
     in place to protect the confidentiality of personal health 
     information. Simply, every person must feel that his or her 
     health data is protected against unnecessary disclosure. At 
     the same time, there can be no doubt of the need for timely 
     and efficient transfer of health data across the health 
     information infrastructure. Thus, national standard for the 
     collection, use and dissemination of healthcare information 
     must thoughtfully and carefully balance the rights of 
     individuals, the capacity of the healthcare system to provide 
     needed services and the interests of our nation as a whole. 
     The JHITA believes that the ``Medical Information Protection 
     Act'' does an admirable job of accomplishing those complex 
     goals.
       In order for national fair information standards to offer 
     consistent and genuine guidance and protection to healthcare 
     professionals and consumers, and effect significant Federal 
     penalties and sanctions for the misuse of health data, the 
     JHITA believes that federal law must preempt the current 
     patchwork of federal, state and local laws and regulations 
     governing health information. We applaud your commitment in 
     the ``Medical Information Protection Act'' to a uniform and 
     high level of confidentiality for all health information, 
     regardless of the individual's diagnosis or state of 
     residence.''
       The Joint Healthcare Information Technology Alliance thanks 
     you for introducing the ``Medical Information Protection Act. 
     We look forward to working with you to win passage of the 
     bill, an essential first step in the development of a 
     national health information strategy that will advance the 
     health of our nation and protect the rights of all.
           Sincerely,
     Linda Kloss,
       Executive Vice President & CEO, AHIMA.
     Carla Smith,
       Executive Director, CHIM.
     John Page,
       Executive Director, HIMSS.
     Dennis Reynolds,
       Executive Director, AMIA.
     Richard Correll,
       President, CHIME.
                                  ____

                                       american Health Information


                                       Management Association,

                                  Washington, DC, October 6, 1998.
     Senator Robert F. Bennett,
     Dirksen Building,
     Washington, DC.
       Dear Senator Bennett: On behalf of the more than 37,000 
     members of the American Health Information Management 
     Association (AHIMA), thank you for once again being in the 
     forefront of the effort to pass legislation to protect the 
     confidentiality of individually identifiable health 
     information. AHIMA is pleased to offer its strong support for 
     the Medical Information Protection Act of 1998.
       During the past several years, we have worked with you and 
     your Legislative Director Paul A. ``Chip'' Yost and developed 
     several legislative proposals that have resulted in the 
     current bill. The hard work put into the drafting of this 
     landmark legislation has paid-off. The bill strikes a hard-
     to-achieve balance between protecting the confidentiality of 
     a patient's health information while not impeding the 
     provision of patient care or the operations of the nation's 
     health care delivery system. One of the most important facets 
     of the Medical Information Protection Act is that it contains 
     strong criminal and civil sanctions to provide remedies 
     against wrongful disclosure of health information. In 
     addition, the legislation will eliminate the current 
     patchwork-quilt of various state statutes and regulations, 
     thus providing all Americans the confidentiality protections 
     that they truly deserve.
       Senator, AHIMA is pleased to continue working with you and 
     your office on this important issue. Your dedication has kept 
     us encouraged that Congress will pass legislation to 
     establish a uniform national policy for the use and 
     disclosure of individually identifiable health information. 
     As you know from our past association, AHIMA has been a 
     leader in the effort to pass comprehensive confidentiality 
     legislation. Throughout the legislative process, we have 
     achieved a reputation for working on a bipartisan basis with 
     various elected officials and health policy makers. In this 
     context, we continue to support your efforts and offer our 
     assistance and expertise to help move this important issue 
     forward.
       Again, thank you for your dedication to this important 
     issue. If AHIMA can provide any assistance, please do not 
     hesitate to contact me in the AHIMA Washington, DC Office at 
     (202) 218-3535.
           Sincerely,

                                      Kathleen A. Frawley, JD,

                                       Vice President, Legislative
     and Public Policy Services.
                                  ____



                                Healthcare Leadership Council,

                                  Washington, DC, October 7, 1998.

  Healthcare Leadership Council Commends Senator Bennett for Medical 
                        Information Act of 1998

       WASHINGTON, DC.--The Healthcare Leadership Council (HLC) 
     today commended Sen. Robert Bennett (R-UT) for introducing 
     the ``Medical Information Protection Act of 1998.''
       ``This bill protects the confidentiality of patient health 
     information and establishes new federal penalties for its 
     misuse,'' said HLC President Pamela G. Bailey. ``At the same 
     time, the Bennett bill allows for the appropriate use of 
     patient health information to promote a better health care 
     delivery system and protect vital health care research.''
       Information is the cornerstone of a high quality, 
     innovative health care system,'' Bailey said. ``In fact, it 
     can be an issue of life or death. Without access to patient 
     information, physicians, health plans, hospitals and 
     researchers would be unable to provide the high standard of 
     care that Americans deserve.''
       As the leading innovators in the health care industry, HLC 
     members support federal rules to ensure patient 
     confidentiality rather than the increasingly confusing 
     patchwork of state laws. ``The Bennett bill would replace 
     this patchwork of state laws with a strong federal law that 
     protects patients and provides a workable, uniform framework 
     that facilitates the delivery of the highest quality health 
     care.''
       ``In the debate over patient confidentiality, we sometimes 
     lose sight of what most patients want most--to get healthy. 
     Fundamental to the fantastic advances made in treatment of so 
     many diseases is our ability to use patient information 
     throughout our increasingly complex health care system,'' 
     said Bailey.
       The HLC is committed to working toward final enactment of 
     comprehensive, uniform

[[Page S12176]]

     confidentiality legislation by the August 1999 deadline 
     imposed under the Health Insurance Portability and 
     Accountability Act.
       The HLC is a coalition of the chief executive of America's 
     leading health care institutions.
                                  ____

                                                     Federation of


                                      American Health Systems,

                                  Washington, DC, October 7, 1998.

    FAHS Praises Introduction of Medical Information Protection Act


    applauds utah gop senator bennett for his leadership and health 
                       community outreach efforts

       The Federation today praised Sen. Robert Bennett (R-UT) for 
     introducing the Medical Information Protection Act of 1998 
     and applauded his leadership in drawing upon the input of a 
     broad range of health care organizations in crafting the 
     legislation.
       ``Although it's a bit like walking a tight-rope, Sen. 
     Bennett's commitment to working with varying interests on 
     this important issue should be commended,'' said Laura 
     Thevenot, Federation Executive Vice President and COO. ``He 
     has approached the task before Congress of passing 
     legislation relating to medical records confidentiality by 
     August of 1999 with openness and a real determination to 
     reach a consensus that protects patients and still allows 
     hospitals and health systems to do their jobs. This 
     legislation establishes a good framework for an issue that 
     will be debated at length when the 106th Congress convenes 
     next January.''
       Thevenot highlighted a couple of key provisions in the 
     legislation: uniform national confidentiality standards, 
     which would avoid a cumbersome patchwork of state law and 
     regulation, and enhanced security safeguards to ensure 
     appropriate access to patient data.
       ``As the debate moves forward, one of the Federation's 
     primary concerns is that Congress not tie the hands of 
     hospitals and health systems by putting obstacles in the way 
     of their commitment to provide the necessary treatment and 
     care patients need,'' Thevenot added. ``Our commitment has 
     always been and will remain to serve the patient. Proper uses 
     of information for treatment, payment, quality improvement, 
     and where appropriate, research, are a critical component of 
     that commitment.''
                                  ____



                                    Intermountain Health Care,

                              Salt Lake City, UT, October 2, 1998.
     Hon. Robert F. Bennett,
     Dirksen Senate Office Building,
     Washington, DC.
       Dear Senator Bennett: Intermountain Health Care (``IHC'') 
     applauds the introduction of the ``Medical Information 
     Protection Act of 1998.'' IHC is deeply appreciative of your 
     leadership in developing legislation to establish uniform 
     federal confidentiality standards. IHC also wishes to express 
     its deep appreciation of the hard work and dedication of Chip 
     Yost and Mike Nielsen of your staff.
       The bill you have crafted reflects a keen understanding of 
     the need to strike an appropriate balance between 
     safeguarding patient identifiable health information and 
     facilitating the coordination and delivery of high quality, 
     network-based health care, such as that provided at IHC. 
     Indeed, striking the right balance is critical to the 
     delivery of the best possible patient care.
       As you well know, IHC has developed state-of-the-art 
     electronic medical records and common databases which we used 
     extensively not just for treatment and payment but for such 
     fundamental quality enhancing activities as outcomes review, 
     disease management, health promotion and quality assurance. 
     You bill rightly recognizes that all of these efforts are 
     essential to optimizing patient health.
       In addition, we are particularly pleased that you have 
     called for federal preemption of state law. Health systems 
     like IHC, which operate across state lines, would have 
     enormous difficulty complying with different federal and 
     state standards.
       As you know, IHC is a large integrated health care delivery 
     system based in Salt Lake City and operating in the states of 
     Utah, Idaho, and Wyoming. The IHC system includes 23 
     hospitals, 33 clinics, 16 home health agencies, and 400 
     employed physicians. Additionally, our system operates a 
     large Health Plans Division with enrollment of 350,000 
     directly insured plus 430,000 who use our networks through 
     other insurers. IHC's 20,000 employees are keenly aware of 
     their responsibility to safeguard personal health information 
     and IHC has invested considerable resources in order to 
     develop effective protections and procedures.
       IHC pledges to work with you toward enactment of this 
     important legislation well in advance of the August 1999 
     deadline established by the Health Insurance Portability and 
     Accountability Act of 1996. Please do not hesitate to contact 
     me or IHC's Washington Counsel Michael A. Romansky (202/756-
     8069) and Karen S. Sealander (202/756-8024) of McDermott, 
     Will & Emery with questions or for further information.
           Sincerely,

                                        John T. Nielsen, Esq.,

                                                Senior Counsel and
     Director of Government Relations.
                                  ____



                                            Premier Institute,

                                  Washington, DC, October 5, 1998.

The Premier Institute Applauds Introduction of the Medical Information 
                         Protection Act of 1998

       Washington, DC.--Jim Scott, president of the Premier 
     Institute, commended Senator Robert F. Bennett (R-UT) for his 
     leadership in introducing the ``Medical Information 
     Protection Act of 1998.'' ``This legislation protects 
     patients from being subjected to unauthorized or 
     inappropriate use of their medical records and, at the same 
     time, ensures that hospitals and health plans have access to 
     information necessary to do their jobs in serving patients,'' 
     said Scott. ``Senator Bennett creates workable standards that 
     protect patient's confidentiality and assures that medical 
     information is available for the treatment, quality 
     assurance, and research needs that are so important to our 
     health care system and the patients it serves.''
       The Bennett bill recognizes the many legitimate uses for 
     medical information and provides the right regulatory 
     framework for safeguarding the use and disclosure of 
     protected health information by the health care industry. The 
     bill permits its use for patient treatment, quality enhancing 
     activities, payment for health care activities, and research 
     for the development of life saving pharmaceuticals and new 
     medical procedures. By providing for a singular authorization 
     process when a patient accesses the health care system, the 
     bill avoids costly administrative burdens for health care 
     providers and barriers to the efficient use of information 
     within integrated care networks, hospital systems, physician-
     hospital organizations, or managed care organizations.
       The bill also adopts uniform national confidentiality 
     standards. Given the increasingly complex and interstate 
     nature of the way health information flows in today's 
     delivery system, strong preemption of state confidentiality 
     laws protects consumers and minimizes the costs associated 
     with the increasing patchwork of conflicting state laws.
       Finally, the bill clearly recognizes the value of medical 
     research and does not establish unnecessary barriers to 
     research. It allows for the use of protected health 
     information in research activities while holding medical 
     researchers to confidentiality requirements that protect the 
     identity of the individuals in a medical study. Under this 
     bill, researchers will continue to have access to databases 
     of patient information that are crucial in discovering trends 
     and anomalies that lead to cures for diseases over time.
       ``Today marks the introduction of an important piece of 
     legislation for the future of our health care system,'' said 
     Scott. ``We look forward to working with Senator Bennett to 
     enact the right patient confidentiality standards into law.''
       Premier is a strategic alliance of leading hospitals and 
     healthcare systems across the country, representing nearly 
     215 owners and the 800 hospitals and healthcare facilities 
     they operate, and approximately 900 other affiliated 
     hospitals. Premier provides hospitals and healthcare systems 
     across the nation with products and services designed to help 
     them reduce costs, develop integrated delivery systems, 
     manage technology, and share knowledge. The organization 
     maintains offices in Charlotte, NC; San Diego, CA; Chicago, 
     IL; and Washington, DC.
                                  ____

                                           Association of American


                                             Medical Colleges,

                                  Washington, DC, October 2, 1998.
     Hon. Robert Bennett,
     U.S. Senate, Dirksen Senate Offices Building, Washington, DC.
       Dear Senator Bennett: I write to convey the Association of 
     American Medical Colleges' (AAMC) support for your bill 
     entitled the ``Medical Information Protection Act.'' The AAMC 
     represents the nation's 125 accredited medical schools, 
     approximately 400 major teaching hospitals, and 86 academic 
     and professional societies representing over 90,000 faculty 
     members.
       We believe the Medical Information Protection Act is a 
     thoughtful effort to address the very important and complex 
     issues surrounding the protection of patient health 
     information. This legislation is a significant step in the 
     right direction as Congress attempts to achieve the delicate 
     balance between the competing goods of individual privacy and 
     the considerable public benefit that results from controlled 
     access to health information that is crucial to our country's 
     continuing ability to deliver high-quality health care and 
     cutting-edge research.
       Over the past year, the AAMC has advocated for medical 
     information privacy legislation that employees appropriate 
     confidentiality safeguards while ensuring access to patient 
     records and other archival materials required to pursue 
     biomedical, behavioral, and health services research. The 
     AAMC is pleased that the Medical Information Protection Act 
     incorporates many of the major principles articulated by the 
     Association.
       In particular, the AAMC supports the legislation's clear 
     and workable definitions for ``protected health information'' 
     and ``nonidentifiable health information,'' the creation of 
     appropriate safeguards and stiff penalties to protect patient 
     confidentiality, and the proposed preemption of state privacy 
     laws. While recognizing that preemption is a politically 
     highly-charged issue, the Association believes that, in an 
     era of rapidly emerging information technology and major 
     consolidation of the health care industry, protecting the 
     ability of medical information to flow unimpeded across state 
     lines is essential to the functioning of a high-quality, 
     medically-effective and efficient care delivery system.

[[Page S12177]]

       In addition, the AAMC applauds the bill's affirmation of 
     support for the role of institutional review boards in the 
     disclosure of protected health information for research 
     purposes. We believe that the security of medical information 
     created, maintained and used in the course of medical 
     research would be significantly strengthened by the 
     provisions of this bill.
       We thank you for your leadership on this issue and look 
     forward to continuing to work with you as this bill is 
     considered by the Senate.
           Sincerely,
                                             Jordan J. Cohen, M.D.
                                                        President.
                                 ______
                                 
      By Mr. LIEBERMAN (for himself, Mr. Dodd, Mr. Kerry, Mr. 
        Lautenberg, and Mr. Torricelli):
  S. 2610. A bill to amend the Clean Air to repeal the grandfather 
status for electric utility units; to the Committee on Environment and 
Public Works.


                  the clean electric power act of 1998

  Mr. LIEBERMAN. Mr. President, I am pleased to introduce today the 
Clean Electric Power Act of 1998, and to be joined by my colleagues 
Senators Dodd, Kerry, Lautenberg, and Torricelli.
  This legislation would address a gap in the Clean Air Act that 
exempts older power plants from strict environmental standards, 
allowing them to emit more pollutants than newer facilities and 
contributing to serious environmental problems. This disparity is of 
particular concern right now as we enter the new world of restructuring 
of the electric utility industry--a world that was never envisioned at 
the time of any of the Clean Air Act Amendments, including the 1990 
Amendments. Because most of the older plants don't have to expend the 
same amount of money on environmental controls that newer plants do, it 
is simple economics that these older plants will benefit under 
deregulation by increasing their generation of power and, therefore, 
their emissions of dangerous pollutants into the air. This situation is 
unfair to utilities that generate electricity while meeting stricter 
environmental standards, and it is unfair to the public whose health 
will be endangered.
  Electricity deregulation carries the promise of enormous benefits for 
the consumer in terms of reduced electric bills which I strongly 
support. But unless we do it right, electricity deregulation also can 
result in significant adverse environmental and public health effects. 
Some of the early results from the initial efforts at deregulation of 
wholesale power sales, as well as studies containing projections about 
what might occur, are very disturbing:
  In February, EPA projected increases of 553,000 tons of nitrogen 
oxides and 62 million tons of carbon by the year 2010 resulting from 
restructuring, without provisions in restructuring legislation to 
address pollution increases.
  THe Northeast States for Coordinated Air Use Management in January 
1998 found that several large Midwestern power companies substantially 
increased their wholesale electricity sales between 1995 and 1996. This 
meant substantially increased generation at several of the companies' 
highest polluting coal-fired power plants, large increases in the flow 
of power from the Midwest towards the east, and substantial increases 
in emissions from power plants.
  A 1995 Harvard University Study concluded that electricity 
restructuring could adversely affect environmental quality for a number 
of reasons, including increasing utilization of older, higher emitting 
coal facilities.
  A 1996 Resources for the Future Study examined the regional air 
pollution effects that could result from a more competitive market. The 
study concluded that in the year 2000, the Nation's NOX 
emissions would increase by about 350,000 tons and the carbon dioxide 
emissions would increase by about 114 million tons.
  Let me give a little background about how we got to where we are.
  A series of requirements in the 1970 and 1977 Clean Air Act and 
amendments thereto required that utility plants meet new source 
performance standards for pollutants, including nitrogen oxides and 
sulfur dioxide. The act defines these standards as emissions limits 
reflecting the degree of emission limitation achievable through the 
application of the best system of emission reduction, taking into 
account cost, as determined by the Administrator. However, these 
standards were only imposed on new generating plants, and did not cover 
existing plants, plants under construction, or in the permitting 
process or being planned for, unless they undertook major construction.
  At the time, the view was that it would be more cost-effective to 
impose stricter standards on new facilities than existing ones, and 
that many of the existing facilities would be retiring soon. But for a 
number of economic reasons, the anticipated retirement of plants did 
not occur. More than half of the power plants operating today were 
built before the new source standards went into effect.
  My legislation would require that power plants that generate 
electricity that flows through transmission or connected facilities 
that cross State lines comply with the stricter environmental 
standards. It would also require EPA to set up a market-based allowance 
trading program to allow utilities to comply in the most cost-effective 
manner.

  Electric power generating plants are among the largest sources of air 
pollution in the United States. According to EPA reports, power plants 
account for 67 percent of all sulfur dioxide emissions, 28 percent of 
all nitrogen oxide emissions, 36 percent of all carbon dioxide 
emissions and over 33 percent of mercury emissions. These pollutants 
contribute significantly to some of the most urgent public health and 
environmental problems in the United States, including smog, fine 
particles acid rain, excessive nutrient loads to important water bodies 
such as Long Island Sound, toxic impacts on health and ecosystems from 
mercury emissions, climate change, and nitrogen saturation of sensitive 
forest ecosystems.
  This is not to say that older plants do not have any pollution 
controls. Some controls are required on these plants under older 
standards, State Implementation Plans, and the requirements under the 
acid rain provisions of the Clean Air Act Amendments of 1990. But in 
many cases, the controls fall far short of levels that would be 
achieved under the new source performance standards. Some studies show 
that the older plants emit pollutants at rates that are often four to 
ten times higher than the cleanest operating plants, but there is 
significantly less disparity in areas where states have imposed tighter 
controls under the State Implementation Plans, state laws or regional 
programs such as California and parts of the Northeast. In addition, 
EPA's new regulation requiring 22 states to reduce 
NOx emissions will result in significant reductions at many 
power plants. The bill makes clear that nothing affects the obligations 
of sources to comply with that new regulation in the timeframe set 
forth by EPA or to comply with any other provision of the Clean Air 
Act.
  But we still have a situation where there is currently an 
unacceptably high level of power plant emissions and, in many cases, a 
disparity in emission requirements between different generators. On top 
of this, we have a new era of electricity deregulation and 
restructuring which we are entering at a rapid pace; in the foreseeable 
future, retail consumers all over the country may be able to choose 
their supplier of electricity. As I've noted, this era of deregulation 
was never envisioned at the time of either the 1977 Clean Air Act 
Amendments or the more recent 1990 Amendments. Increasing competitive 
markets provide opportunities for relatively low cost generators to 
increase generation; where cost differentials are due in part to 
differences in emission standards this will mean increases in 
generation at the highest emitting plants.
  Mr. President, the good news is that cost-effective technologies are 
available to meet these stricter standards. For example, the Northeast 
States for Coordinated Air Use Management and the Mid-Atlantic Regional 
Air Management Association have recently completed a report on the 
availability of controls for NOx and the cost-effectiveness 
of those controls. The report shows that a number of advanced emissions 
control technologies are available that can reduce NOx 
emissions from utilities by 85 percent or more, and that these controls 
are not only feasible but are highly cost-effective. The report looked 
at real world experience with the application of available technology 
at 19 coal fired facilities

[[Page S12178]]

and found that NOx emissions nearly 50 percent stricter than 
EPA's new standard for NOx can be achieved at the vast 
majority of coal utilities. Of course, under the bill grandfathered 
utilities would have the option of purchasing allowances as an 
alternative method of meeting the performance standards.
  Mr. President, as we enter the era of deregulation we have a unique 
opportunity to provide great benefits for the consumers and reduce air 
pollution, which I strongly support. But we need to ensure that proper 
pollution safeguards are in place to rectify the current disparity in 
standards and to ensure that air pollution does not increase in a 
competitive market.
  Mr. President, I ask unanimous consent that the full text of my 
legislation be included in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2610

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. STANDARDS OF PERFORMANCE FOR ELECTRIC UTILITY 
                   UNITS.

       (a) Findings.--Congress finds that--
       (1) older electric utility units are exempt from strict 
     emission control requirements applicable to newer facilities, 
     allowing some older units to emit greater quantities of 
     dangerous pollutants;
       (2) this disparity in regulatory treatment is of particular 
     concern in the new era of electric utility restructuring, 
     which was never envisioned at the time of enactment of the 
     Clean Air Act (42 U.S.C. 7401 et seq.) or amendments to that 
     Act;
       (3) in an era of electric utility restructuring, utilities 
     that spend less money on environmental controls will be able 
     to increase their generation of power and emissions of 
     dangerous pollutants;
       (4) this situation results in an unfair competitive 
     disadvantage for utilities that generate electricity while 
     meeting strict environmental standards; and
       (5) electricity restructuring can result in enormous 
     benefits for consumers and the environment if done right.
       (b) Standards.--Section 111 of the Clean Air Act (42 U.S.C. 
     7411) is amended by adding at the end the following:
       ``(k) Standards of Performance for Electric Generating 
     Units.--
       ``(1) Definition of grandfathered unit.--In this 
     subsection, the term `grandfathered unit' means a fossil 
     fuel-fired electric utility unit that, before the date of 
     enactment of this subsection, was not subject to the 
     standards of performance set forth in subpart D of part 60 of 
     title 40, Code of Federal Regulations, or to any subsequently 
     adopted standard of performance under this section applicable 
     to fossil fuel-fired electric utility units.
       ``(2) Applicability.--Notwithstanding any other provision 
     of law, in the case of a fossil fuel-fired electric utility 
     unit, a standard of performance under this section that 
     applies to new or modified electric utility units shall also 
     apply to a grandfathered unit that--
       ``(A) has the capacity to generate more than 25 megawatts 
     of electrical output per hour; and
       ``(B) generates electricity that flows through transmission 
     or connected facilities that cross State lines (including 
     electricity in a transaction that for regulatory purposes is 
     treated as an intrastate rather than an interstate 
     transaction).
       ``(3) Deadlines for compliance.--Each grandfathered unit 
     shall comply with--
       ``(A) a standard of performance established under this 
     section before the date of enactment of this subsection, not 
     later than 5 years after the date of enactment of this 
     subsection; and
       ``(B) a standard of performance established under this 
     section on or after the date of enactment of this subsection, 
     not later than 3 years after the date of establishment of the 
     standard.
       ``(4) Alternative compliance.--
       ``(A) In general.--To provide an alternative means of 
     complying with standards of performance made applicable by 
     this subsection, the Administrator shall--
       ``(i) establish national annual limitations for calendar 
     year 2003 and each calendar year thereafter for each 
     pollutant subject to the standards at a level that is equal 
     to the aggregate emissions of each pollutant that would 
     result from application of the standards to all electric 
     utility units subject to this section;
       ``(ii) allocate transferable allowances for pollutants 
     subject to the standards to electric utility units subject to 
     this section in an annual quantity not to exceed the 
     limitations established under clause (i) based on each unit's 
     share of the total electric generation from such units in 
     each calendar year; and
       ``(iii) require grandfathered units to meet the standards 
     by emitting in any calender year no more of each pollutant 
     regulated under this section than the quantity of allowances 
     that the unit holds for the pollutant for the calendar year.
       ``(B) Calculation of limitations.--In calculating the 
     limitations under subparagraph (A)(i), the Administrator 
     shall apply the standard for the applicable fuel type in 
     effect in calendar year 2000.
       ``(5) No effect on obligation to comply with other 
     provisions.--Nothing in this subsection affects the 
     obligation of an owner or operator of a source to comply 
     with--
       ``(A) any standard of performance under this section that 
     applies to the source under any provision of this section 
     other than this subsection; or
       ``(B) any other provision of this Act (including provisions 
     relating to National Ambient Air Quality Standards and State 
     Implementation Plans).''.
                                 ______
                                 
      By Mr. ROTH (for himself, Mr. Lieberman, and Mr. Mack):
  S. 2611. A bill to amend title XVIII of the Social Security Act to 
enable medicare beneficiaries to remain enrolled in their chosen 
medicare health plan; to the Committee on the Judiciary.


                          Medicare Legislation

  Mr. ROTH. Mr. President, yesterday the President announced his plans 
for helping Medicare beneficiaries who are enrolled in health plans 
which are not renewing their Medicare contracts for next year. I am 
glad that President Clinton recognizes the problems Medicare 
beneficiaries are facing and I think it is important that we all work 
together to address this issue. But I am concerned that the President 
offered a `tomorrow' solution for today's problem.
  The problems facing Medicare HMO beneficiaries need attention now and 
cannot wait until next year. The President's proposal is inadequate and 
we must take immediate action to help Medicare beneficiaries to stay in 
their chosen health plans.
  Across the country, including in my home state of Delaware, thousands 
of Medicare beneficiaries are losing their HMO coverage and being 
forced back into the original Medicare program with expensive Medigap 
policies. We need to help these beneficiaries today.
  I am urging my colleagues in the House and Senate to act now to allow 
Medicare managed care plans that have withdrawn from the program to get 
back into Medicare. The legislation I am introducing today, along with 
my colleagues Senator Liebermann and Senator Mack, would instruct the 
Health Care Financing Administration to allow these plans to 
restructure their costs where justified. This would give many of the 
health insurance providers the flexibility they need to go back in to 
these markets. But most critically important, it would give 
beneficiaries the opportunity to remain in their current plans without 
the disruption and increased costs that they will otherwise face.
  I am presenting this legislation today after several attempts over 
the last month to work with the Administration to allow Medicare+Choice 
plans to update their cost and beneficiary filings for 1999. I had 
hoped to resolve this problem administratively--before these plans made 
their final decisions to pull out of 371 counties leaving 220 thousand 
beneficiaries to find another Medicare option. I sent a letter to HCFA 
head Nancy-Ann Min Deparle urging HCFA to take immediate action to 
prevent these manage care plans from leaving the Medicare+Choice 
program.
  I find it highly regrettable that the Health Care Financing 
Administration decided not to allow Medicare+Choice plans to update 
their cost and benefit filings for 1999. This decision could undermine 
the Medicare+Choice program enacted into law just last year and which I 
believe holds so much promise for improving Medicare for seniors.
  HCFA's shortsighted decision will result in large out-of-pocket cost 
increases, fewer benefits, and fewer choices for hundreds of thousands 
of Medicare beneficiaries. The beneficiaries who will bear the hardest 
brunt of the Administration's decision are the 455,000 enrolled in non-
renewing Medicare+Choice plans in counties where no additional plans 
exist. These beneficiaries will now be left with only a significantly 
more expensive Medicare option; that is, the original Medicare program 
combined with a Medigap insurance policy. This is particularly 
unfortunate given that premiums for Medigap insurance policies have 
been sharply increasing each year. In fact, the American Association 
for Retired Persons announced just this week that its Medigap insurance 
premiums will increase by an average of 9 percent nationwide next year.

[[Page S12179]]

  And even in areas where beneficiaries will be left with one or more 
health plan options, the plan withdrawal will result in reduced 
competition which translates to higher out-of-pocket costs for Medicare 
beneficiaries.
  I am very concerned by the agency's failure to evaluate potential 
increased beneficiary cost-sharing when making the critical decision 
not to allow plans to update their cost and benefit filings. I believe 
this action demonstrates HCFA's continued resistance to facilitate 
private plan choices for Medicare beneficiaries, regardless of the 
consequence to beneficiaries.
  I hope that the Congress and President Clinton will fight the 
temptation to play politics with Medicare and instead do the right 
thing for beneficiaries by taking action before Congress adjourns for 
the year to help beneficiaries to remain in their current Medicare 
health plans if they so choose. Next year, we can work together toward 
a more comprehensive solution to this issue.
                                 ______
                                 
      By Mr. FORD:
  S. 2612. A bill to provide that Tennessee may not impose sales taxes 
on any goods or services purchased by a resident of Kentucky at Fort 
Campbell, nor obtain reimbursement for any unemployment compensation 
claim made by a resident of Tennessee relating to work performed at 
Fort Campbell; to the Committee on Governmental Affairs.


                 fort campbell tax fairness act of 1998

  Mr. FORD. Mr. President, today I introduce the Fort Campbell Tax 
Fairness Act. This legislation is designed to restore some sense of 
balance and maintain some level of fairness in the taxation of 
individuals who work at the Fort Campbell military installation in 
Kentucky and Tennessee.
  My colleagues may recall that earlier this month, an unprecedented 
provision was included in the Defense Authorization bill which granted 
special tax status for a single site--Fort Campbell--to Tennessee 
residents who work on the Kentucky side of the border. Even worse, the 
provision in the Defense bill preempted State tax law. It preempted the 
ability of my State to administer its own tax laws in a fair manner, 
and in a way in which the State determined was fairest and best.
  The provision adopted in the Defense bill exempts Tennessee residents 
who work in Kentucky at Fort Campbell from paying Kentucky state income 
taxes. This special exemption was snuck into the House version of the 
bill, and then maintained in the conference committee. It is extremely 
unfair.
  Mr. President, the Congress has no business dictating to States how 
they should administer their own tax laws. This is a matter for the 
States to determine by themselves. The basic principle of taxation is 
that income is taxed at the location where it is produced. There are 
exceptions to this rule, but generally they are worked out among and 
between States themselves. The only other exceptions of which I am 
aware relate to federal employees with a unique interstate aspect to 
their jobs, like members of the military or Members of Congress, or 
other employees with a special interstate job situation, like Amtrak 
employees or those involved in constructing interstate highways.
  I have never heard of a special State tax exemption for private 
sector employees at a single site. That is, I had never heard of it 
until I saw this year's Defense Authorization bill.
  But Mr. President, the provision in the Defense Authorization bill is 
a one way street. It preempts Kentucky state law for Tennessee 
residents who would otherwise be taxed within Kentucky's borders. But 
there is no comparable preemption of Tennessee state law for Kentucky 
residents who are taxed at Fort Campbell within Tennessee's borders.
  As a matter of basic fairness, if Tennessee residents are to be 
granted a special tax exemption while on the Kentucky side of Fort 
Campbell, Kentucky residents should be given equal consideration while 
on the Tennessee side of Fort Campbell. In addition, it is currently 
the case that unemployment compensation for any Tennessee residents who 
work on the Kentucky side of Fort Campbell are paid out of Kentucky tax 
dollars. This should no longer be the case now that Tennessee workers 
are being given a special tax status and are exempt from Kentucky laws.
  My legislation attempts to correct these new inequities created by 
the passage of this year's Defense Authorization bill. First, it would 
direct that Tennessee sales taxes imposed on the Tennessee side of Fort 
Campbell apply only to Tennessee residents. The distinguished Senator 
from Tennessee, in debate on the Defense Authorization bill, asserted 
that no such taxes are currently collected at Fort Campbell. Therefore, 
he should have no objection to this provision whatsoever. However, I 
have been informed that Tennessee sales taxes are in fact collected 
from private business operations within the Fort Campbell boundaries. 
So this provision is badly needed as a matter of fairness.
  Second, the legislation clearly states that the Commonwealth of 
Kentucky has absolutely no obligation to continue paying the 
unemployment benefits of Tennessee residents out of Kentucky tax 
dollars. Since Tennessee residents have been given this special tax 
status and preemption of State laws, Kentucky should no longer have any 
liabilities should these workers become unemployed. Those claims should 
be the responsibility of the State of Tennessee.
  Mr. President, I have always attempted to fiercely defend the 
interests of my State during my 24 years in the Senate. The special tax 
preemption provision tucked into the Defense Authorization bill was one 
of the most unfair provisions imaginable, singling out my State for 
unfair treatment. I realize the time is short in the current session, 
and the odds of enacting this legislation are not great in the days 
ahead. However, I am introducing this bill to go on the Record in 
advocating fairness for my State. It is my hope that when the Congress 
reconvenes vigorously pursue efforts to pass this legislation and 
correct an unfairness which has been imposed upon my State.
                                 ______
                                 
      By Mr. COATS:
  S. 2614. A bill to amend chapter 96 of title 18, United States Code, 
to enhance the protection of first amendment rights; to the Committee 
on the Judiciary.


                the first amendment freedoms act of 1998

  Mr. COATS. Mr. President, in 1970, Congress passed provisions known 
as the Racketeer Influenced and Corrupt Organization Act, or RICO, as 
part of the larger Organized Crime Control Act of 1970. The bill was 
designed to help law enforcement officials better address the plague of 
organized crime, and has been a valuable tool in this effort.
  During drafting of this legislation, concerns were raised by several 
members of this body, including my colleague from Massachusetts, 
Senator Kennedy, that the bill was written so broadly that it might be 
used against organized civil disobedience, including anti-war 
demonstrators. This was at the height of the Vietnam War, and anti-war 
demonstrations were taking place across the country. Senator Kennedy, 
along with Senator Hart of Michigan, submitted their views as part of 
the Senate Judiciary Committee Report on the Organized Crime Control 
Act of 1969.
  I think their words deserve our attention today. They recognized 
that, and I quote: ``To combat organized crime, as distinguished from 
other forms of criminal activity, requires procedures specifically 
designed for that purpose.'' They continued, ``The reach of this bill 
goes beyond organized criminal activity. Most of its features propose 
substantial changes in the general body of criminal procedures. 
Finally, their statement notes that, ``Amended to restrict its scope 
solely to organized criminal activity and to assure the protection of 
individual rights, the bill could contribute important and useful means 
of eradicating organized crime.'' Mr. President, I ask that a copy of 
this statement from the Judiciary Committee Report be included in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

              Individual Views of Messrs. Hart and Kennedy

       To combat organized crime, as distinguished from other 
     forms of criminal activity, requires procedures specifically 
     designed for that purpose.

[[Page S12180]]

       S. 30, the Organized Crime Control Act of 1969, is billed 
     as a means of providing the procedures necessary to eradicate 
     the disease of organized crime and its serious threat to our 
     national security.
       But the reach of this bill goes beyond organized criminal 
     activity. Most of its features propose substantial changes in 
     the general body of criminal procedures.
       New rules of evidence and procedure applicable to all 
     criminal jurisprudence are established.
       Amended to restrict its scope solely to organized criminal 
     activity and to assure the protection of individual rights, 
     the bill could contribute important and useful means of 
     eradicating organized crime.
       Mr. Coats, in direct response to the legitimate concerns 
     raised by Senator Kennedy, Senator Hart, the ACLU, and 
     others, the language of the Organized Crime Control Act was 
     modified to narrow the definition of racketeering activity. 
     These modifications were seen as adequate, and debate moved 
     on to other issues. It is clear from the record of 
     congressional debate that nobody--not the bill's author, 
     Senator McClellan, not the Judiciary Committee, not the House 
     of Representatives, not my colleague from Massachusetts--
     nobody was interested in prosecuting civil disobedience as 
     organized crime.
       Mr. President, our country has a long and distinguished 
     history of political free speech under the First Amendment. 
     At times, political and social protesters have seen civil 
     disobedience as the best manner to bring the message home. 
     From abolitionists of the 18th and 19th centuries to the 
     civil rights demonstrations of Dr. Martin Luther King, non-
     violent civil disobedience has played a major role in shaping 
     this nation. While civil disobedience is inherently 
     ``disobedient'' to the law, and while such violations of the 
     law have consequences, there is a vast difference between 
     organized crime and organized political protest.
       Today, this difference is becoming much less noticeable As 
     many of us know, on April 20, 1998, a U.S. District Court 
     jury ruled that anti-abortion leaders had violated federal 
     anti-racketeering statutes by engineering a nationwide 
     conspiracy that involved 21 acts of extortion, mostly the 
     formation of barricades that prevented the use of clinics 
     performing abortions. The defendants were ordered to pay 
     nearly $86,000 in damages. That penalty was automatically 
     tripled under RICO. We are not talking about abortion 
     protesters being charged with political violence--murder, 
     bombing of abortion clinics, or physical violence against 
     patients or employees of the clinics involved. Rather, we are 
     talking about these protesters being charged as racketeers 
     for non-violent forms of civil disobedience.
       This is not an isolated decision, but rather followed on 
     the heels of a 1994 Supreme Court opinion regarding the scope 
     of RICO. In the case of NOW v. Scheidler, the Supreme Court 
     ruled that the National Orgnaization for Women could bring 
     suit under RICO against a coalition of anti-abortion groups, 
     alleging the defendants were members of a nationwide 
     conspiracy to shut down abortion clinics through a pattern of 
     racketeering activity. Both the U.S. District Court and Court 
     of Appeals had dismissed the suit on grounds that RICO 
     implied an ``economic motive'' for the racketeering activity. 
     The Supreme Court reversed the lower court decisions in 
     finding that the letter of the law in RICO did not require 
     proof that either racketeering enterprise or predicate acts 
     of racketeering be motivated by economic purpose. The Supreme 
     Court then remanded the case to the District Court.
       The Supreme Court ruling and the subsequent U.S. District 
     Court decision have radically expanded the scope of federal 
     anti-racketeering statues in direct contradiction to the 
     clear intent of Congress in the creation of RICO. The result 
     of the rulings is that civil disobedience is now open to 
     prosecution as organized crime. This is already having a 
     chilling effect on free speech in this country.
       Mr. President, before going further on this matter, let me 
     make several things very clear. First, this is not an 
     abortion issue. The Senate must continue to wrestle with the 
     morality of the legality of abortion in this country, and my 
     colleagues are well aware of my deep convictions on this 
     matter, but that is not what I am here to discuss. The 
     application of federal anti-racketeering statues to political 
     protest and civil disobedience is not an abortion issue--it 
     is a First Amendment issue. While the catalyst for the 
     expansion of RICO was its application to pro-life 
     demonstrators, the case could just as easily could have 
     involved civil rights advocates, animal rights activities, 
     anti-war demonstrators, or AIDS activists. The issue is not 
     abortion, it is political speech.
       Let me also make clear that the issue is not whether civil 
     disobedience should be punished: it is, and it should be. 
     This country has a proud history of both the rule of law and 
     the practice of civil disobedience. In a nation under the 
     rule of law, civil disobedience has legal consequences. I am 
     not here to debate whether abortion protesters, AIDS 
     activists, or animal rights demonstrators should abide by the 
     law, or, when they break the law, they should be accountable. 
     There are federal and state laws on the books dealing with 
     trespassing, vandalism, and many other crimes commonly 
     associated with civil disobedience. However, the punishment 
     ought to fit the crime. What we have, in the expansion of 
     RICO, is the application of the heavy rod intended for 
     organized crime, being turned against organized political 
     protest.
       Finally, let me emphasize that I am not here to debate 
     political violence. Murder, arson, death threats, physical 
     harm--these are not acts of civil disobedience, but of 
     terrorism, and RICO specifically applies to a pattern of such 
     activities. I am not concerned with protecting these actions, 
     whether engaged in by anti-abortion demonstrators or 
     environmental activists.
       What does concern me deeply, is the prosecution of non-
     violent civil disobedience as racketeering activity. Under 
     RICO, whoever participates in a commercial ``enterprise'' or 
     an ``enterprise'' which has an impact on commerce, through a 
     pattern of specific criminal ``racketeering'' activity, can 
     be penalized. Typical ``racketeering'' activity includes 
     murder, kidnapping, robbery, arson, bribery, loan-sharking, 
     mail fraud, wire fraud, obstruction of justice, witness 
     retaliation, or extortion. Also included as racketeering 
     activity is violation of the Hobbs Act, which modified the 
     Anti-Racketeering Act of 1934. The Hobbs Act includes a 
     provision which prohibits affecting commerce by ``extortion'' 
     using ``wrongful or threatened force, violence, or fear.''
       It is this final provision which has been expanded by the 
     Courts to apply to those engaged in civil disobedience. While 
     under common law understanding, ``extortion'' requires the 
     actual trespatory taking of property, the term is now being 
     interpreted as ``coercion,'' which involves compulsion of 
     action. Political and social protest by its very nature 
     attempts to compel a change of actions, whether it be the 
     actions of a logging company cutting old growth forests, a 
     restaurant that will not serve minorities, a business that 
     will not promote women, or a health clinic performing 
     abortions. Such organized efforts to compel action, inherent 
     in civil disobedience, are now captured in the net of RICO.
       As I stated earlier, Congress did not envision, and could 
     not conceive, of this application of the law, especially in 
     the wake of the modifications undertaken at the time. In its 
     original draft, RICO specified, and I quote, ``any act 
     dangerous to life, limb, or property,'' as predicate 
     offenses. In direct response to concerns raised by several 
     members of Congress, including the Senator from 
     Massachusetts, that this wording could put civil 
     disobedience into jeopardy, the language was redrafted to 
     clearly define RICO's predicate offenses, specifying 
     particular state and federal offenses. No offense remotely 
     related to rioting, trespass, vandalism, or any other 
     aspect of a demonstration that might stray beyond 
     constitutional limits was included as racketeering 
     activity. While state and federal law continues to apply 
     to many of these violations, these were intentionally 
     excluded from the scope of anti-racketeering laws and the 
     increased punishments these entailed.
       Mr. President, in response to recent Court rulings which 
     have grossly expanded the scope of federal anti-racketeering 
     laws to cover non-violent political protest, I am introducing 
     the First Amendment Freedoms Act today. This legislation 
     restores RICO to its originally intended application of 
     organized criminal activity, and codifies Supreme court 
     opinion regarding the protection of First Amendment rights.
       Specifically, the bill does two things. First, it narrows 
     the judicially expanded definition of ``extortion'' under 
     RICO, which has allowed for the erroneous prosecution of 
     civil disobedience under this statute. Second, it assures 
     that, in any civil action brought under RICO or any other 
     legal theory, the litigation is conducted consistent with the 
     First Amendment guidelines of the Supreme Court.

[[Page S12181]]

       Our nation has a long and distinguished history of non-
     violent civil disobedience as a legitimate form of political 
     and social protest. Such activity has legal consequences. 
     However, such activity is not the equivalent of organized 
     crime. The prosecution of political and social protest under 
     federal anti-racketeering statutes is entirely contrary to 
     anything Congress foresaw in enacting RICO. Congress should 
     act expeditiously to correct this obvious misapplication of 
     the law.
       Martin Luther king, Jr., in his acceptance of the Nobel 
     Peace Prize in 1964, said that: ``Nonviolence is the answer 
     to the crucial political and moral questions of our time; the 
     need for man to overcome oppression and violence without 
     resorting to oppression and violence.'' Those who engage in 
     non-violent civil disobedience should not, and it was never 
     the intent of Congress that they would be, prosecuted as 
     criminal racketeers. If the current interpretation of the law 
     had been in effect in the 1950's and 60's, the civil rights 
     movement could easily have been quashed. I trust that 
     Congress will take steps to address this matter in a timely 
     manner.
  Mr. President, I send my bill to the desk, and I yield the floor.
                                 ______
                                 
      By Mr. MURKOWSKI:
  S. 2615. A bill to study options to improve and enhance the 
protection, management, and interpretation of the significant natural 
and other resources of certain units of the National Park System in 
northwest Alaska, to implement a pilot program to better accomplish the 
purposes for which those units were established by providing greater 
involvement by Alaska Native communities, and for other purposes; to 
the Committee on Energy and Natural Resources.


                  Alaska National Interest Legislation

 Mr. MURKOWSKI. Mr. President, the legislation that I have 
introduced today will require the Secretary of the Interior to report 
on what he has done, or not done, to implement the requirements of 
sections 1307 and 1308 of the Alaska National Interest Lands 
Conservation Act. Those provisions sought to mitigate the effect of the 
designation of over 100 million acres of land in Alaska for permanent 
preservation on the Alaska Natives who have lived in the areas for 
centuries. Those provisions required the Secretary to allow those who 
were already providing visitor services to continue to provide such 
services and also provided a preference in hiring at those conservation 
units for local residents.

  Those provisions were intended to accomplish several objectives. 
First and foremost, they were designed to ensure that local residents 
who would assume the costs attendant to the establishment of these 
conservation units as a result of future limitations on economic 
opportunities received some of the benefits from whatever jobs were 
created. The provisions also ensured that the rich history and 
knowledge of the area that the local native population possessed was 
made available to visitors. For a change, Washington could learn from 
those in the surrounding communities. There would also be an incidental 
benefit from hiring local residents to the budget of the National Park 
Service since they would not have to pay employees to relocate to 
Alaska.
  Mr. President, while speaking to the issue of benefits, I have been 
told by several of the residents of Kotzebue that they have assisted in 
the rescue of Park Service personnel on a number of occasions. It makes 
little sense to me to bring someone to the Northwest parks from the 
lower forty-eight who is unfamiliar with the rugged terrain and 
treacherous weather. It makes better sense to hire an individual who 
stands little chance of getting lost or stranded.
  This is not a new concept. In various other units of the National 
Park System we have made provisions to take advantage of local 
communities, especially where the resource has particular historic or 
religious significance. At Zuni-Cibola Historical Park, for example, 
section 4 of Public Law 100-567 specifically authorizes the Secretary 
to enter into cooperative agreements with the Zuni Tribe and individual 
tribal members to provide training for the interpretation, management, 
protection, and preservation of archaeological and historical 
properties and in the provision of public services on the Zuni Indian 
Reservation to accomplish the purposes for which that unit of the Park 
System was established.
  At the National Park of American Samoa, the Secretary has been 
directed to establish a program to train native American Samoan 
personnel to function as professional park service employees and to 
provide services to visitors and operate and maintain park facilities. 
The law establishing the park also provided a preference for the hiring 
of local Samoans both as employees and under any contract. The general 
management plan for the park is to be developed in cooperation with the 
Governor of American Samoa. It is also conceivable, under the 
legislation, that after fifty years, sole authority to administer the 
park could be turned over to the Governor of American Samoa from the 
Secretary.
  There are other examples, but I think the time is long overdue for 
this philosophy to be realized at conservation units in Alaska. The 
Department of the Interior, in my view, has been dragging its feet and 
has failed to take advantage of the rich human resources present in the 
Alaska Native communities that lie in proximity to National Parks and 
Refuges. These units are remarkable and this Nation is not well served 
when the Secretary fails to take advantage of the local population.

  In particular, the four northwest Alaska units of the National Park 
System would be a good place for the Secretary to begin complying with 
section 1307 and 1308 of ANILCA and start contracting with the local 
people for the management of these park units.
  Bering Land Bridge National Preserve is a remnant of the land bridge 
that connected Asia with North America more than 13,000 years ago. The 
land bridge itself is now overlain by the Chukchi Sea and the Bering 
Sea. During the glacial epoch, this area was part of a migration route 
for people, animals, and plants whenever ocean levels fell enough to 
expose the land bridge. Scientists find it one of the most likely 
regions where prehistoric Asian hunters entered the New World.
  Today Eskimos from neighboring villages pursue subsistence lifestyles 
and manage their reindeer herds in and around the preserve. Some 112 
migratory bird species may be seen in the Preserve, along with 
occasional seals, walrus, and whales. Grizzly bears, fox, wolf, and 
moose also inhabit the Preserve. Other interesting features are rimless 
volcanoes called Maar craters, Serpentine Hot Springs, and seabird 
colonies at Sullivan Bluffs.
  Cape Krusenstern National Monument is comprised of 659,807 acres of 
land and water--a coastal plain dotted with sizable lagoons and backed 
by gently rolling, limestone hills. The Cape Krusenstern area has been 
designated an Archeological District in the National Register of 
Historic Places, and a National Historic Landmark. The core of the 
archeologic district is made up of approximately 114 marine beach 
ridges. These beach ridges, formed of gravel deposited by major storms 
and regular wind and wave action, record in horizontal succession the 
major cultural periods of the last 4,500 years. The prehistoric 
inhabitants of northwest Alaska occupied the cape seasonally to hunt 
marine mammals, especially seals. As new beach ridges were formed, 
camps were made on the ridges closest to the water. Thus, over 
centuries, a chronological horizontal stratigraphy was laid down in 
which the oldest cultural remains were found on the beach ridges 
farthest from the ocean. The discoveries made at Cape Krusenstern 
National Monument provided a definite, datable outline of cultural 
succession and development in northwest Alaska.
  The park contains approximately 1,726,500 acres of federal lands and 
encompasses a nearly enclosed mountain basin in the middle section of 
the Kobuk River in the Northwest Alaska Areas. Trees approach their 
northern limit in the Kobuk Valley, where forest and tundra meet. 
Today's dry, cold climate of the Kobuk Valley still approximates that 
of late Pleistocene times, supporting a remnant flora once covering the 
vast Arctic steppe tundra bridging Alaska and Asia. Sand created by the 
grinding of glaciers has been carried to the Kobuk Valley by winds and 
water. The great Kobuk Sand Dunes--25 square miles of shifting dunes--
is the largest active dune field in the arctic latitudes.

[[Page S12182]]

  Native people have lived in the Kobuk Valley for at least 12,500 
years. This human use is best recorded at the extensive archeological 
sites at Onion Portage. The Kobuk Valley remains an important area for 
traditional subsistence harvest of caribou, moose, bears, fish, 
waterfowl, and many edible and medicinal plants. The slow-moving, 
gentle Kobuk River is tremendous for fishing and canoeing or kayaking.
  Noatak National Preserve lies in northwestern Alaska, in the western 
Brooks Range, and encompasses more than 250 miles of the Noatak River. 
The preserve protects the largest untouched mountain-ringed river basin 
in the United States. The river basin provides an outstanding resource 
for scientific research, environmental education, and subsistence and 
recreational opportunities.
  Above the Arctic Circle, the Noatak River flows from glacial melt 
atop Mount Igikpak in the Brooks Range out to Kotzebue Sound. Along its 
425-mile course, the river has carved out the Grand Canyon of the 
Noatak. The preserve is in a transition zone between the northern 
coniferous forests and tundra biomes. The river basin contains most 
types of arctic habitat, as well as one of the finest arrays of flora 
and fauna. Among the Preserve's large mammals are brown bears, moose, 
caribou, wolves, lynx, and Dall sheep. Birdlife also is plentiful in 
the area because of the migrations from Asia and the tip of South 
America. The Noatak River supports arctic char, whitefish, grayling, 
and salmon and is an important resource for fishing, canoeing, and 
kayaking.
  Mr. President, these are the human and natural resources of Northwest 
Alaska. This legislation will direct the Secretary to finally bring the 
two together for the benefit of both Alaska Natives and the 
nation.
                                 ______
                                 
      By Mr. ROTH (for himself and Mr. Moynihan):
  S. 2616. A bill to amend title XVIII of the Social Security Act to 
make revisions in the per beneficiary and per visit payment limits on 
payment for health services under the Medicare program; to the 
Committee on Finance.


                      health services legislation

  Mr. MOYNIHAN. Mr. President, I am pleased to join my distinguished 
Chairman, Senator Roth, and other colleagues in introducing a bill to 
improve the home health interim payment system.
  Prior to the Balanced Budget Act of 1997 (BBA), home health agencies 
were reimbursed on a cost basis for all their costs, as long as they 
maintained average costs below certain limits. That payment system 
provided incentives for home health agencies to increase the volume of 
services delivered to patients, and it attracted many new agencies to 
the program. From 1989 to 1996, Medicare home health payments grew at 
an average annual rate of 33 percent, while the number of home health 
agencies increased from about 5,700 in 1989 to more than 10,000 in 
1997.
  In order to constrain the growth in costs and usage of home care, the 
BBA included provisions that would establish a Prospective Payment 
System (PPS) for home health care, a method of paying health care 
providers whereby rates are established in advance. An interim payment 
system (IPS) was also established while the Health Care Financing 
Administration works to develop the PPS for home health care agencies.
  The home health care industry is dissatisfied with the IPS. The 
resulting concern expressed by many Members of Congress prompted us to 
ask the General Accounting Office (GAO) to examine the question of 
beneficiary access to home care. While the GAO found that neither 
agency closures nor the interim payment system significantly affected 
beneficiary access to care, I remain concerned that the potential 
closure of many more home health agencies might ultimately affect the 
care that beneficiaries receive, particularly beneficiaries with 
chronic illness.
  The bill we are introducing today adjusts the interim payment system 
to achieve equity and fairness in payments to home health agencies. It 
would reduce extreme variations in payment limits applicable to old 
agencies within states and across states and would reduce artificial 
payment level differences between ``old'' and ``new'' agencies. The 
bill would provide all agencies a longer transition period in which to 
adjust to changed payment limits.
  Clearly, since the bill may not address all the concerns raised by 
Medicare beneficiaries and by home health agencies, we should revisit 
this issue next year. A thorough review is needed to determine whether 
the funding mechanism for home health is sufficient, fair and 
appropriate, and whether the benefit is meeting the needs of Medicare 
beneficiaries.
  America's home health agencies provide invaluable services that have 
given many Medicare beneficiaries the ability to stay home while 
receiving medical care. An adjustment to the interim payment system and 
delay in further payment reductions will enable home health agencies to 
survive the transition into the prospective payment system while 
continuing to provide essential care for beneficiaries.

                          ____________________