[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
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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.
____________________